Severe Preeclampsia Patients Research Articles

A Comparative Study of Coagulation Profile in Normal Pregnancy, Mild Preeclampsia, and Severe Preeclampsia Patients

A Comparative Study of Coagulation Profile in Normal Pregnancy, Mild Preeclampsia, and Severe Preeclampsia Patients

Cost and regression analysis of preeclampsia from the perspective of the reimbursement agency

ObjectiveThe aim of this study is to determine the financial burden of preeclampsia (PE) from a single institution's perspective and then determine the cost of the illness from the reimbursement institution perspective and finally draw a regression model that predicts the annual cost of a patient. Materials and methodsThe research is a descriptive and cross-sectional type of research and a retrospective cost analysis. Patients diagnosed with PE in 2021 were included in the study. For the regression analysis of the study, a dataset with 29 parameters belonging to 65 patients was created. Regression models were built on top of it. ResultsIn our study, per-patient expenses of PE patients from the perspective of the reimbursement institution were calculated and presented as average costs; severe PE patient with cesarean section 7598.5 Ł ($769.8), severe PE patient with normal vaginal delivery 8487.48 Ł (1050.43 $), mild PE patient with cesarean section 5331.67 Ł ($659.86) and mild PE patient with normal vaginal delivery was calculated as 6220.65 Ł (769.88 $). In the study, different regression formulas were created for the two groups of PE. The created regression model had an R2 score of 91.85%. ConclusionThe actors involved in the management of the disease should determine the cost-effectiveness of the disease by using the financial data of the patients and choose the right approach. Health costs in Turkey differ from the parameters in the European Union economy. Therefore, there are lower health costs. The financial findings of the disease are a guide for health policy makers, health managers and researchers.

Alteration of Coagulation Profile in Preeclampsia And Eclampsia Patients At Tertiary Level Hospital

Background: Preeclampsia and eclampsia is associated with a risk of abnormal hemostasis that occurs most commonly secondary to thrombocytopenia. Automated analyze technique measures whole blood coagulation and has been used to manage coagulation defects in obstetric patients. Objective: To find out the alteration of coagulation profile beyond physiological level in preeclampsia and eclampsia patients for early detection and planning of management. Method: It was a observation type of cross sectional study carried out Department of Obs& Gynae, Dhaka Medical College Hospital, Dhaka. Severe pre-eclamptic and eclamptic patients admitted in the department of Obstetrics &Gynaecology, Dhaka Medical College Hospital during the period of July 2018 to December 2018. Data were collected as predesigned data collection sheet and for coagulation profile. Collection of venous sample about 5ml of blood were done without a pressure cuff allowing the blood to enter the syringe by continuous free flow and sending to the laboratory for coagulation assay by automated analyzer Sysmex CA500. Results: In this study mean age was 26.94 years, majority 56% age group was 26-30 years of age. The mean gestational age was 32.36 weeks. All the coagulation parameters were altered in 6% of the patients, 4 parameters were altered in 10% of the patients, 3 parameters were altered in 16% of the patients 2 and 1 parameters were altered in 24% and 44% patients respectively. Regarding coagulation profile, thrombocytopenia was present in 22% patients, prothombin time was prolonged in 10% of the patients, APTT was prolonged in 20% of the patients, and fibrinogen level was reduced in 40% of the patients and FDP was elevated 32% of the patients. Out of 50 severe preeclamptic and eclamptic patients, 6% of the patients developed DIC in whom all the coagulation parameters were altered. Conclusion: In this study, in patients of severe pre-eclampsia and eclampsia 22% patients had thrombocytopenia. 6% of the patients had alteration of all the coagulation parameters. Coagulation indices were altered not only in the patients with reduced platelet count but also in the patients with normal platelet count. Among the patients, 6% of the patients developed DIC, PPH developed in 12% of the patients and maternal death occurred in 4% of the patients. J Dhaka Med Coll. 2021; 30(2) : 214-219

GAMBARAN TATALAKSANA PASIEN PREEKLAMPSIA YANG TERKONFIRMASI COVID-19 DAN NON-COVID-19 DI RSUD ULIN BANJARMASIN

Preeclampsia is hypertension in pregnancy which is characterized with blood pressure of 140/90 mmHg after 20 weeks of gestation, accompanied by proteinuria.3. There are three types of drugs that are often used in preeclampsia treatment, they are nifedipine, methyldopa, and MgSO4. This study was aimed to find out the description of confirmed covid-19 and non covid-19 preeclampsia patients treatment at Ulin Hospital, Banjarmasin in the COVID-19 period seen from administration of MgSO4, antihypertensive, method and time of termination. This study applied descriptive method with data collection through medical records. The sampling technique used purposive sampling which was selected based on the criteria. In this study, a sample of 176 preeclampsia patients with confirmed COVID-19 and non-COVID-19 were obtained. However, from the 176 samples, which met the criteria, only 55 preeclampsia patients had confirmed COVID-19 and 80 non-COVID-19 preeclampsia patients. The results showed that all severe preeclampsia patients with confirmed COVID-19 were given MgSO4 with a percentage of 100%.. Antihypertensives were often given was a combination of methyldopa + nifedipine. The most common method of delivery was by cesarean section.

Comparison of Serum Vitamin D Levels in Patients with Severe Preeclampsia and Normal Pregnancy at Dr. Zainoel Abidin Regional General Hospital Banda Aceh

AIM: This study aims to assess differences in the mean maternal Vitamin D levels between severe preeclampsia (SPE) and normal pregnant women at the Dr. Zainoel Abidin Hospital Banda Aceh, Indonesia. METHODS: This research was a case–control study conducted at the Dr. Zainoel Abidin Regional General Hospital Banda Aceh. Pregnant women with confirmed SPE and normal pregnancies were involved in the study. The level of 25(OH)D3 was assessed by taking serum samples and examined by the enzyme immunoassay method. The Mann–Whitney U test analysis was conducted for bivariate analysis with a 95% confidence level. RESULTS: A total of 82 participants were involved in this study, with 41 subjects in the case group and 41 patients in the control group. A total of 30 SPE patients (70.3%) showed moderate Vitamin D deficiency. The mean levels of 25(OH)D3 in the SPE and normal pregnancy groups, respectively, were 14.43 ng/mL and 27.94 ng/mL (p < 0.001). Based on the 20 ng/mL cutoff point, the difference in 25(OH)D3 levels between the two groups showed an odd ratio (OR) of 15.05. CONCLUSION: Serum Vitamin D levels in SPE patients were two times lower than in the normal group. Evaluation of serum Vitamin D levels needs to be carried out periodically during pregnancy as a screening and diagnostic effort to prevent the potential development of SPE.

The Efficacy of the Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients

Background: The most common causes of prenatal morbidity and death in Bangladesh are eclampsia and severe preeclampsia or toxemia (PET). Obstetricians and anesthesiologists have complex challenges while dealing with this condition. Despite the improved result of spinal anesthesia over general anesthesia, general anesthesia is still routinely used for emergency LUCS in underdeveloped nations. More and more people in industrialized nations, such as the United Kingdom and the United States, recognize spinal anesthesia for its safety. Objective: In this study our main aim is to evaluate the efficacy of the Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients. Method: This cross-sectional study was carried out at tertiary medical hospital from January 2020 to January 2021. Total 200 cases of severe PET (n=110) and eclampsia (n=100) patients were selected by subarachnoid block for emergency LUCS. Each patient was given magsulph as prophylactic or maintenance dose and judiciously preloaded by crystalloid fluid. Results: Most of the patients belong to 31-40 years age group, 55% and 95.8% cases were multigravida. In severe PET group, intraoperative hypotension was observed in 32% cases and postoperative period hypotension was observed in 8% cases. Whereas preeclampsia group, intraoperative hypotension was observed in 31% cases and postoperative period hypotension was observed in 9% cases. In addition, maternal morbidity where acute renal failure seen in 5%, syndrome 7%, DIC 7%, abruptio placentae 12%, pulmonary edema 4%, septicemia 13%, PPH 10% and postpartum eclampsia 15%.In severe PET group, 21% cases transferred to eclampsia ward, followed by 9% shifted to ICU, 1% case was expired. Whereas, in preeclampsia group 20% cases transferred to eclampsia ward, followed by 8% shifted to ICU, 2% case was expired. In eclamptic group 7% cases were transferred to NCU, whereas 8% had PET. Neonatal mortality was observed in 3% cases. p value was found 0.000 which is very highly significant. Conclusion: With close monitoring of perioperative events, spinal anesthesia may be used as a safe alternative technique to GA or epidural in severe preeclampsia and eclampsia, even in cases of altered consciousness or restlessness in the presence of an expert and skilled anesthesiologist, reducing perioperative maternal and neonatal morbidity and mortality.

Combination of Maternal Serum ESM-1 and PLGF with Uterine Artery Doppler PI for Predicting Preeclampsia.

This study aimed to determine whether the combination of pregnancy-associated endothelial cell-specific molecule 1 (ESM-1), the placental growth factor (PLGF) in the first- and second-trimester maternal serum, and the uterine artery Doppler pulsatility index (PI) in the second trimester can predict preeclampsia (PE). The serum levels of ESM-1 and PLGF in 33 severe preeclampsia (SPE) patients, 18 mild preeclampsia patients (MPE), and 60 age-matched normal controls (CON) were measured. The Doppler ultrasonography was performed, and the artery pulsatility index (PI) was calculated for the same subjects. The 2nd PLGF level was significantly lower and the 2nd PI was higher than those in the MPE group. Combining the 2nd PLGF with the 2nd PI yielded an AUC of 0.819 (83.33% sensitivity and 70.00% specificity). In the SPE group, the 1st ESM-1 level and the 2nd PLGF level were significantly lower, and the 2nd ESM-1 level and the 2nd PI were significantly higher in the SPE group. The combination of the 1st ESM-1, the 2nd PLGF, and the 2nd PI yielded an AUC of 0.912 (72.73% sensitivity and 95.00% specificity). The 1st ESM-1 and the 2nd PLGF levels and the 2nd PI were associated with PE. The combination of serum biomarkers and the PI improved the screening efficiency of the PE prediction, especially for SPE.

INDUCTION TO DELIVERY INTERVAL AND ITS EFFECT ON FETOMATERNAL OUTCOMES IN ECLAMPSIA AND SEVERE PRE-ECLAMPSIA

Objectives: To identify the fetomaternal complications in patients with Eclampsia and severe preeclampsia patients in association with induction to the delivery interval. Methods: This descriptive observational study was conducted From June to December 2019 in the department of obstetrics and Gynaecology at the Lady Reading Hospital, Peshawar, Pakistan. Antenatal patients with Eclampsia and pre-Eclampsia were included. IBM SPSS, Version 23.0 was used for data analysis, and tests were applied to find an association between induction to delivery interval and fetomaternal complications, chi-square test was applied and P -value < 0.05 was considered significant. Results: The final cohort comprised 60 women with a mean age of 28.72±6.02. Most Maternal complications were 25% (n= 15) seen in more than 18hr duration from induction to delivery, deranged renal function was the most common maternal complicated ion 13% ( n= 8), Pearson chi-square value of 0.01 shows a highly significant association between an increase in induction to delivery duration and maternal complications while stillbirth was most frequent fetal complication 13.3% ( n= 8A ). A P-value of 0.6 shows a non-significant association between induction to delivery duration and fetal complications Conclusion: Our study concludes that with an increase in induction to delivery time, maternal and fetal complication increases. Keywords Eclampsia, Pre-eclampsia induction to delivery interval

Extracellular Vesicles From Women With Severe Preeclampsia Impair Vascular Endothelial Function

(Anesth Analg. 2022;134:713–723) Preeclampsia causes worldwide maternal and neonatal morbidity and mortality. Previous studies confirm the placenta is heavily related to preeclampsia and vascular dysfunction likely caused by pro-angiogenic and anti-angiogenic factors due to changes in uteroplacental blood flow and oxygenation from abnormal trophoblastic invasion of the uterine spiral arterioles. A previous study involving a mouse model supports the idea of extracellular vesicles (EVs), particles which interact with microRNA and impact endocrine or paracrine organs, from the placenta being a main culprit for triggering preeclampsia. All pregnancies show levels of placenta-derived EVs (pEVs), but those with preeclampsia show an increased level, impacting the growth and weight gain of the child, levels of endothelial nitric oxide synthase (eNOS) to endothelial cells leading to irregular embryo development, implantation, trophoblast invasion, placental vascular development, function, and increased level of endothelial dysfunction. This study primarily measures the effect of EVs from both severe preeclampsia and normotensive patients on human aortic endothelial cells to test the hypothesis that preeclamptic EV cargo impairs endothelial function and regulation of NO signaling.

The Efficacy of the Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients

Background: In Bangladesh, severe preeclamptic toxemia and eclampsia are life-threatening conditions in pregnancy that are the leading cause of perinatal maternal and neonatal mortality and morbidity. Objective: in this study our main aim is to evaluate the efficacy of the Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients. Method: This cross sectional study was carried out at tertiary medical hospital from January 2021 to January 2022. Total 200 cases of severe PET (n=110) and eclampsia (n=100) patients were selected by subarachnoid block for emergency LUCS. Each patient was given magsulph as prophylactic or maintenance dose and judiciously preloaded by crystalloid fluid. Results: Most of the patients belong to 31-40 years age group, 52% and 95.8% cases were multigravida. In severe PET group, intraoperative hypotension was observed in 32% cases and postoperative period hypotension was observed in 8% cases. Whereas preeclampsia group, intraoperative hypotension was observed in 31% cases and postoperative period hypotension was observed in 9% cases. In addition,maternal morbidity where acute renal failure seen in 5%, syndrome 7%, DIC 7%, abruptio placentae 12%, pulmonary edema 4%, septicemia 13%, PPH 10% and postpartum eclampsia 15%.In severe PET group, 21% cases transferred to eclampsia ward, followed by 9% shifted to ICU, 1% case was expired. Whereas, in preeclampsia group 20% cases transferred to eclampsia ward, followed by 8% shifted to ICU, 2% case was expired. In eclamptic group 7% cases were transferred to NCU, whereas 8% had PET. Neonatal mortality was observed in 3% cases. p value was found 0.000 which is very highly significant. Conclusion: With close monitoring of perioperative events, spinal anesthesia may be used as a safe alternative technique to GA or epidural in severe preeclampsia and eclampsia, even in cases of altered consciousness or restlessness in the presence of an expert and skilled anesthesiologist, reducing perioperative maternal and neonatal morbidity and mortality

Serum MOTS-c levels remain unchanged in patients with preeclampsia.

Mitochondrial open-reading-frame of the twelve S rRNA-c (MOTS-c) is a mitochondrial derived peptide which has beneficial effects on muscle metabolism, insulin sensitivity, weight regulation, and bone mineral density. This study aims to investigate whether serum levels of MOTS-c are altered in patients with preeclampsia. This is cross sectional a case-control study of 30 patients with uncomplicated pregnancy, 30 patients with mild preeclampsia and 30 patients with severe preeclampsia that were admitted to the study center between June 2020 and January 2021. When compared to the healthy controls and patients with mild preeclampsia, maternal smoking was significantly more frequent, systolic and diastolic blood pressures were significantly higher and platelet count was significantly lower in patients with severe preeclampsia (p = 0.045, p = 0.0001, p = 0.0001 and p = 0.024 respectively). Serum MOTS-c concentrations were statistically similar in healthy controls, mild and severe preeclampsia patients (159.1 ± 28.7 ng/mL vs 129.6 ± 54.7 ng/mL vs 146.4 ± 48.3, p = 0.166). When compared to the healthy controls, systolic and diastolic blood pressures were significantly higher and platelet count was significantly lower in patients with late onset preeclampsia (p = 0.0001, p = 0.0001 and p = 0.022 respectively). Healthy controls and patients with early and late onset preeclampsia were statistically similar with respect to MOTS-c levels (159.1 ± 28.7 ng/mL vs 126.7 ± 56.9 vs 153.7 ± 39.8, p = 0.102). This study failed to detect any significant relationship between MOTS-c and preeclampsia. Large scale research is needed to clarify if MOTS-c is a novel biomarker for preeclampsia and therapeutic target for preeclampsia patients.

Maternal Plasma Elabela, a Biomarker for the Severity and Kidney Function of Human Preeclampsia

Background: It reported that serum Elabela level was decreased in preeclampsia patients. However, there is no researcher done the study on the correlations between plasma Elabela and kidney function, blood pressure, blood glucose and lipid in preeclampsia patients. Our objective is determined whether plasma Elabela could be a marker for the severity and kidney function of preeclampsia. Methods: 72 pregnant women were enrolled in this study and divided into healthy group (n = 37), mild preeclampsia group (n = 20) and severe preeclampsia group (n = 15). The level of plasma Elabela was detected using ELISA. Results: Plasma Elabela was reduced in preeclampsia patients compared to healthy group, and severe preeclampsia patients had the lower level of Elabela and poorer kidney function. The level of plasma Elabela was negatively correlated with those of uric acid (UA), creatinine (Cre), cystatin C (CysC), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Conclusions: Lower concentration of plasma Elabela correlated with worse kidney function, and higher blood pressures in preeclampsia patients.

Severe Preeclamptic Patients in The Resuscitation Room of Dr. Soetomo General Academic Hospital Surabaya: A Retrospective Study

Introduction: Preeclampsia is the leading cause of maternal and fetal death. This is an urgency in maternal health, especially in developing countries such as Indonesia. Patients with severe preeclampsia who had critical conditions tend to be admitted to the resuscitation room for assistance from more skilled personnel and more sophisticated technology. Objective: This study aims to determine the complications, treatments, and outcomes of severe preeclampsia patients managed in the resuscitation room at Dr. Soetomo General Academic Hospital from January 1st, 2018 – December 31th 2019. Methods and Materials: The method used in this study was retrospective descriptive using medical records and analyzed using Microsoft Excel. Eighty-one samples met the inclusion criteria. Results: The majority of patients were aged 20-35 years (65.43%) and had completed senior high school (88.89%). Most patients were having stage 2 obesity (44.44%) and multigravida (41.97%). A history of preeclampsia and hypertension was not found in the majority of patients. Most patients are diagnosed with late-onset preeclampsia (69.14%). The majority of patients were referred from secondary health facilities (96.30%). The most common complication was pulmonary edema(53.09%). The majority of patients had 2 complications (43.17%) with the most common combinations being eclampsia and HELPP syndrome (13.58%). Intubation is given to the majority of patients (70.37%) and most often in patients with eclampsia (56.14%). Termination of pregnancy by cesarean section is carried out in the majority of patients (72.84%). There were no cases of maternal death in this study. Most of the fetal born had prematurity (70.11%), low birth weight (60%), and asphyxia as assessed by the first minute APGAR score (72.97%) and fifth minute APGAR score (54.05%). Conclusion: The majority of preeclampsia patients with complications in the resuscitation room at Dr. Soetomo General Academic Hospital Surabaya from January 1st 2018-December 31rd 2019 had good maternal outcomes but not the fetal outcome.

Two-Dimensional Ultrasound and Triplane Tissue Doppler Ultrasound of Patients with Severe Preeclampsia.

This study was to investigate the cardiac function characteristics under two-dimensional ultrasound and triplane tissue Doppler imaging (TDI) of patients with severe preeclampsia (SPE). 28 SPE patients with singleton pregnancy from January 2018 to December 2020 were included in the SPE group. 25 healthy nonpregnant women of reproductive age were taken as the control group (Ctrl group), and 26 normal pregnant women with singleton pregnancy were selected as the normal group (Norm group); all the research objects underwent ultrasonography. The morphological and functional indexes of left and right ventricles were compared among the cases in different groups. The results showed that the left ventricular end-diastolic period diameter (LVEDd), left ventricular relative wall thickness (LV-RWT), left ventricular mass index (LVMi), left anterior descending (LAd), left ventricular E/e and e/a values, right ventricular diameter (RV-D), right ventricular anterior wall thickness (RVAW), a value, right atrial septum (RA-S), pulmonary artery systolic pressure (PASP), left ventricular end-systolic period diameter (LVEds), interventricular septal thickness (IVSd), posterior wall thickness (PWd), end-diastolic period volume (EVD), end-systolic period volume (ESV), relative wall thickness (RWT), sphericity index (SpI), left atrium volume index (LAVi), and E/e value of patients in the SPE group were higher than those in the Ctrl group and the Norm group (P < 0.05). The mitral annular plane systolic excursion (MAPSE), s value, tricuspid annual plane systolic excursion (TAPSE), ratio of early diastolic blood flow velocity to late diastolic blood flow velocity (E/A), ratio of peak early diastolic velocity to peak late diastolic velocity (e/a), peak early diastolic velocity (e), and ejection fraction (EF) of the SPE group were lower than those of the Ctrl group and the Norm group (P < 0.05). The ratio of mitral valve early diastolic blood flow velocity to peak early diastolic velocity (E/e) of the Norm group was higher than that of the Ctrl group (P < 0.05). In two-dimensional ultrasound of the SPE group, the maximum difference in time from the start to the peak of systole (Ts) of the right ventricle between the basal and middle segments of the lateral wall and that of interventricular septum (RV-Ts-max) was 31.56 ± 0.39%. The maximum difference in time to peak of early diastole (Te) under the same condition (RV-Te-max) was 47.16 ± 0.19%. Left ventricular LV-Ts-max and LV-Te-max were 9.83 ± 0.80% and 8.37 ± 0.68%, respectively, in triplane TDI, which were considerably higher than those in the Ctrl and Norm groups (P < 0.05). It suggested that two-dimensional ultrasound and triplane TDI could reflect the ventricular morphology as well as diastolic and systolic function injury in patients, which offered a reference basis for the diagnosis of SPE.

MiR-27b-3p is Highly Expressed in Serum of Patients with Preeclampsia and has Clinical Significance.

Preeclampsia (PE) is defined as a salient complication of late pregnancy. microRNAs (miRNAs) have emerged as critical biological regulators in PE. This study determined miR-27b-3p expression in serum of PE patients and investigated its clinical significance in PE. This study enrolled a total of 130 pregnant women, including 90 PE patients (51 mild PE and 39 severe PE) and 40 healthy controls. miR-27b-3p expression in the serum of PE patients and healthy controls was detected using RT-qPCR. The correlation among miR-27b-3p expression and 24-h urine protein, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine, and fetal birth weight was analyzed using Pearson's correlation coefficient. The targeting relationship between miR-27b-3p and PPARG was verified. PPARG protein level in PE patients was detected using ELISA kits. The predictive efficiency of miR-27b-3p and PPARG in PE was analyzed using the receiver operating characteristic (ROC) curve. Compared to normal pregnant women, PE pregnant women, especially severe PE patients, had higher miR-27b-3p expression. miR-27b-3p was positively correlated with 24-h urine protein, SBP, DBP, and serum creatinine but negatively correlated with fetal birth weight. PPARG was poorly expressed in PE patients and negatively correlated with miR-27b-3p. ROC curve showed that both miR-27b-3p and PPARG had good predictive efficacy on PE. miR-27b-3p expression in serum of pregnant women with PE was positively correlated with the severity of PE symptoms, suggesting the involvement of miR-27b-3p in PE occurrence.

Maternal and perinatal outcomes of pre-referral magnesium sulfate treatment in severe preeclampsia patients

HIGHLIGHTS 1. Consumption of magnesium sulfate is recommended for prevention against eclampsia. 2. Magnesium sulfate administration to preeclamptic mothers is effective in reducing the risk of eclampsia.3. Pre-referral magnesium sulfate administration and maternal and perinatal outcomes in severe preeclampsia patients was analyzed.4. Magnesium sulfate did reduce eclampsia risk, but not ICU and NICU care rates, maternal mortality, perinatal asphyxia, and perinatal mortality. ABSTRACT Objectives: This study analyzed the association between pre- referral magnesium sulfate administration and maternal and perinatal outcomes in severe preeclampsia patients. Materials and Methods: This was a retrospective observational analytic study using cross-sectional design. Samples were 132 pregnant women with preeclampsia referred to dr. Saiful Anwar, Hospital Malang, Indonesia in 2019. Data were taken from the patients’ medical records. Maternal outcomes measured in this study were the incidence of eclampsia, ICU care, and maternal mortality, while the perinatal outcomes included the incidence of asphyxia, NICU care, and perinatal mortality. Results: Patients’ history of magnesium sulphate administration significantly associated with the incidence of eclampsia with p-value 0.035 and odds ratio (OR) 2.413, thus consumption of magnesium sulphate could reduce the risk of seizures. However, it did not associate with either maternal ICU care outcomes (p-value 0.087, OR 2.028), or maternal mortality (p-value 0.573). No relationship was found neither between history of magnesium sulphate administration in pregnant women with severe preeclampsia and perinatal outcomes nor with the incidence of asphyxia (p-value 0. 577, OR 0.795), with NICU treatment (p-value 0.205, OR 0.579), and with perinatal mortality (p-value 0.153, OR 3.259). Conclusion: Magnesium sulfate reduced the risk of eclampsia, yet it did not affect either the rate of ICU care, maternal mortality, incidence rate of perinatal asphyxia, the rate of NICU care, or perinatal mortality.

Impact of different referral timing on the pregnancy outcomes of severe pre-eclampsia in the referral system

Impact of different referral timing on the pregnancy outcomes of severe pre-eclampsia in the referral system

Optic nerve sheath diameter in severe preeclampsia with neurologic features versus controls

BackgroundOptic nerve sheath diameters (ONSD) have been validated as an accurate screening tool to detect elevated intracranial pressure in hypertensive encephalopathy. The neurologic manifestations of preeclampsia and/or eclampsia mimic those of hypertensive encephalopathy. This study was performed to assess the incidence of elevated optic nerve sheath diameters of patients with severe preeclampsia and neurologic criteria compared to non-preeclamptic patients. The secondary objective was to determine baseline optic nerve sheath diameters in patients with severe preeclampsia without neurologic criteria and preeclampsia without severe features.MethodsSingle site cohort study including 62 pregnant women 18 years or older and 20 weeks or further gestation. Patients with preeclampsia without severe features, preeclampsia with severe features by non-neurologic criteria, preeclampsia with severe features with neurologic criteria, and patients without preeclampsia were enrolled via convenience sampling. One blinded reviewer measured sheath diameters; baseline demographics and pregnancy data were collected by chart review. Statistical analysis was completed with STATA/IC 16. Categorical variables were compared by the χ2 test. Continuous variables were presented as mean ± standard deviation, and discrete variables were presented as medians and compared by Kruskal–Wallis testing. Normality was confirmed by Shapiro–Wilk testing. Linear and logistic regression were used to test the association between the preeclampsia groups and optic nerve sheath diameters. Models were presented as unadjusted and adjusted for BMI, gestation, hypertension, diabetes, parity, and gravidity.ResultsThe incidence of optic nerve sheath diameters > 5.8 mm was 43.8% in the severe preeclampsia with neurologic features cohort, and 42.1% in the control cohort, with a relative risk of 1.04. Patients with severe preeclampsia without neurologic features had sheath diameters of 5.75 mm ± 1.09 mm; non-severe preeclampsia patients had sheath diameters of 5.54 mm ± 1.26 mm.ConclusionsWe did not find a significant elevated optic nerve sheath diameter relative risk between severe preeclampsia patients with neurologic features and non-preeclampsia control patients. This is the first study to assess a North American population utilizing ACOG criteria for severe and non-severe preeclampsia, with severe cohorts additionally stratified by neurologic criteria.

G-Protein Coupled Receptor Dysregulation May Play Roles in Severe Preeclampsia—A Weighted Gene Correlation Network Analysis of Placental Gene Expression Profile

Preeclampsia is one of the major hypertensive diseases of pregnancy. Genetic factors contribute to abnormal placentation. The inadequate transformation of cytotrophoblasts causes failure of maternal spiral arteries’ remodeling and results in narrow, atherotic-prone vessels, leading to relative placental ischemia. This study aims to explore the possibility of identifying dysregulated gene networks that may offer a potential target in the possible prevention of preeclampsia. We performed a weighted gene correlated network analysis (WGCNA) on a subset of gene expression profiles of placental tissues from severe preeclamptic pregnancies. We identified a gene module (number of genes = 402, GS = 0.35, p = 0.02) enriched for several G-protein-coupled receptor (GPCR)-related genes with significant protein–protein molecular interaction (number of genes = 38, FDR = 0.0007) that may play key roles in preeclampsia. Some genes are noted to play key roles in preeclampsia, including LPAR4/5, CRLR, NPY, TACR1/2, and SFRP4/5, whose functions generally relate to angiogenesis and vasodilation or vasoconstriction. Other upregulated genes, including olfactory and orexigenic genes, serve limited functions in the disease pathogenesis. Altogether, this study shows the utility of WGCNA in exploring possible new gene targets, and additionally reinforces the feasibility of targeting GPCRs that may offer intervention against development and disease progression among severe preeclampsia patients.

MMP-9 and miR-181a-5p in serum and placenta are associated with adverse outcomes of patients with severe preeclampsia and their infants.

This study explored the correlation of MMP-9 with miR-181a-5p in severe preeclampsia (SPE). Placental tissues and serum were collected from 30 pregnant SPE patients (aged 29.42 ± 3.75) and 30 normal pregnant women (aged 27.72 ± 2.21), followed by detecting MMP-9 and miR-181a-5p fold changes using RT-qPCR, and grouped as follows: high expression groups (≥median value): H-MMP-9 and H-miR-181a-5p vs. low expression groups (<median value): L-MMP-9 and L-miR-181a-5p. MMP-9 was weakly expressed (F = 709.99, p < 0.001; F = 670.45, p < 0.001) (serum: 0.41 ± 0.06 (fold changes); placenta: 0.42 ± 0.09 (fold changes)), whereas miR-181a-5p was highly expressed (F = 284.93, p < 0.001; F = 353.78, p < 0.001) (serum: 2.26 ± 0.39; placenta: 2.02 ± 0.29) in SPE patients. MMP-9 was negatively correlated with miR-181a-5p (serum: r = -0.5767, p = 0.0009; placenta: r = -0.5667, p = 0.0011) in SPE patients. MMP-9 showed positive-correlation with gestational week at delivery (r = 0.7625; p < 0.0001) and infant weight (r = 0.4947; p < 0.0001) of SPE patients. miR-181-5p showed negative-correlation (gestational week at delivery: r = -0.5614, p = 0.0012; infant weight: r = -0.4081, p = 0.0252). H-MMP-9 group had lower adverse outcome than L-MMP-9 group (p = 0.0006), and H-miR-181a-5p group had higher adverse outcome than L-miR-181a-5p group (p = 0.0036). In brief, MMP-9 was negatively correlated with miR-181a-5p in serum and placenta of SPE patients. MMP-9 and miR-181a-5p affected gestational week at delivery and infant weight, providing novel targets for SPE treatment.