Severe Preeclampsia Patients Research Articles

Dysregulated miR-222-3p in plasma exosomes of preeclampsia patients and its In vitro effect on HTR8/SVneo extravillous trophoblast cells by targeting STMN1.

To investigate the diagnostic efficiency of miR-222-3p in plasma exosomes (Exos) and plasma for preeclampsia (PE) and the effect of miR-222-3p targeting STMN1 in PE. MiR-222-3p levels in total plasma and plasma Exos were detected in PE patients and healthy controls. A bioinformatics database and dual-luciferase reporter assay were employed to verify the targeting relationship between miR-222-3p and STMN1. Trophoblast HTR-8/Svneo cells were transfected with miR-222-3p inhibitors with/without STMN1 shRNA, followed by MTT, wound healing and Transwell invasion assays. The mRNA and protein expressions were measured by qRT‒PCR and Western blotting, respectively. MiR-222-3p levels in total plasma and plasma Exos were higher in PE patients than in healthy controls, particularly in severe PE patients. In addition, miR-222-3p levels in total plasma and plasma Exos from PE patients were positively correlated with diastolic and systolic blood pressure. The area under the curve (AUC) of miR-222-3p in total plasma for PE diagnostic efficiency was 0.798, with a sensitivity of 76.67% and specificity of 71.93%, while the AUC of miR-222-3p in plasma Exos was 0.708 (sensitivity: 61.67%; specificity: 78.95%). In vitro, miR-222-3p targeted STMN1 in HTR-8/Svneo cells. Low miR-222-3p expression reversed the inhibitory effect of STMN1 shRNA on the proliferation, invasion and migration of HTR/SVneo cells. PE patients had increased miR-222-3p expression in total plasma and plasma Exos, which both have high diagnostic efficiency for PE. MiR-222-3p can target STMN1 to promote the proliferation, invasion and migration of HTR-8/Svneo cells and is a potential therapeutic target of PE.

The involvement of long noncoding RNA APOA1-AS in the pathogenesis of preeclampsia.

Long noncoding RNAs (lncRNAs) are involved in preeclampsia (PE), and apolipoprotein A-1 antisense RNA (APOA1-AS) and has been found to be associated with a number of diseases. Our study aims to understand the involvement of APOA1-AS in PE. Clinically, APOA1-AS expression in early-onset severe PE (EOSPE) patients and healthy controls was detected by real-time quantitative polymerase chain reaction. In vitro experiments were divided into control [coculturing trophoblasts with human uterine microvascular endothelial cells (UtMVECs)], TNF-α [coculturing trophoblasts with UtMVECs treated with tumor necrosis factor-α (TNF-α)], and TNF-α + control siRNA/APOA1-AS siRNA groups (UtMVECs transfected with control siRNA/APOA1-AS siRNA were cocultured with trophoblasts in the presence of TNF-α). The animals were divided into normal group, PE group (PE model was established by administrating nitro-L-arginine methyl ester (L-NAME) in rats), PE + control siRNA group (PE rats were treated with control siRNA), and PE + APOA1-AS siRNA group (PE rats were treated with APOA1-AS siRNA). Increased APOA1-AS was found in the placental tissues of EOSPE patients. APOA1-AS siRNA abolished the decreased integration of trophoblasts into UtMVEC networks induced by TNF-α. Furthermore, APOA1-AS siRNA improved pregnancy outcomes in PE rats with increased expression of vascular endothelial growth factor, placental growth factor, and fms-like tyrosine kinase receptor (Flt-1) but decreased expression of E-cadherin, intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). Downregulation of APOA1-AS protected against TNF-α-induced inhibition of trophoblast integration into endothelial networks, thus exerting protective effects against PE rats.

Non-invasive hemodynamic trends before and after delivery in severe preterm preeclampsia patients

Cardiac output (CO) increases in normal pregnancy and decreases in the postpartum period. However, there is limited data on hemodynamic trends in patients with severe preterm preeclampsia. Our objective was to evaluate hemodynamics using non-invasive bioreactance (Starling, Baxter Medical) during the antepartum and postpartum periods for patients with severe preterm preeclampsia.

Maternal and Fetal Outcomes in Severe Preeclampsia with Acute Lung Edema in Dr. Soetomo General Hospital in 2018-2019

Background: Pulmonary edema in severe preeclampsia is a serious problem because it requires intensive care and has poor maternal and infant outcomes, especially in developing countries. Objective: To understand risk factors, maternal and fetal outcomes in severe preeclampsia patients with acute pulmonary edema. Methods: This study is a descriptive analytic study, using case report data of patients with preeclampsia with acute pulmonary edema at dr. Soetomo General Hospital Surabaya during 2018 to 2019. Result: During 2018 ? 2019 the prevalence of severe preeclampsia cases was 29% of the total deliveries, while acute pulmonary edema occurred in 17.2% of severe preeclampsia cases. More than 50% of cases were found in patients younger than 35 years, with a mean maternal age of 31.7 years. The highest gestational age was more than 34 weeks (45% of cases) and was dominated by multiparas (70.3%). 81% cases of pulmonary edema occur in antepartum, and 48% of them require intensive care with a ventilator. Most cases (61.5%) were delivered by cesarean section. The mean birth weight of infants born was 2265 ? 815 grams with a first minute APGAR score ? was recorded in 72.3% of cases. On the outcome of severe preeclampsia with pulmonary edema, maternal mortality was 8.1% and infant mortality was 5%. Conclusion: The prevalence of acute pulmonary edema in patients with severe preeclampsia is 17.2%, occurs mostly in antepartum phase with gestational age more than 34 weeks and most cases requires intensive care with a ventilator.

Dysregulation of complement system in HELLP syndrome

ABSTRACT Objective To investigate the expression of complement system’s activation factors in patients with HELLP syndrome. Methods A case–control study was performed. Sixteen HELLP syndrome patients, 32 severe preeclampsia patients, and 48 normal pregnancy women were involved in this studyELISA was used to test C1q, C4d, MBL, Bb, C3a, C5a, sC5b-9, s-Endoglin, and sflt-1 in the plasma. Results The levels of C5a (P < 0.01) and sC5b-9 (P = 0.014) in HELLP syndrome were higher than those in severe preeclampsia patients. Conclusions The abnormal activation of the complement system is more significant in the pathogenesis of HELLP syndrome than in severe preeclampsia.

Study of coagulation profile and platelet count in pregnancy induced hypertension, preeclamptic and eclamptic patients

Introduction: Hypertensive disorders in pregnancy is one of the major causes of maternal & perinatal morbidity and mortality. Pregnancy induced hypertention (PIH) is defined as hypertension that develops as the direct result of the gravid state. Profound changes in coagulation and fibrinolytic system occur during normal pregnancy causing hypercoagulable state. Preeclampsia and eclampsia is a highly thrombotic and pro-coagulant state with platelet activation and thrombin and fibrin formation. Methodology: A prospective study carried out in department of pathology B. J. medical college during March 2021 to August 2021. Coagulation profile (PT, aPTT, and D-dimer) and platelet count was done in cases and values were correlated with the severity of PIH. Results: Total of 100 cases were included in the study. 26 were mild gestational hypertension, 13 cases were severe gestational hypertension, 36 cases were mild pre-eclampsia and 14 cases were in severe pre-eclampsia group and 11 patients in eclampsia group. Prolonged PT, aPTT, D-Dimer and thrombocytopenia was seen in 9 cases, 29 cases, 32 cases and 17 cases respectively. In our study we observed increased aPTT, D-dimer and thrombocytopenia in severe pre-eclampsia and eclampsia patients. Conclusion: Estimation of the coagulation parameters and platelet count play an important role in the evaluation of risk factors, early detection, and effective antenatal services. Which can help to reduce the maternal and fetal morbidity and mortality associated with pregnancy induced hypertension.

STUDY OF THE EFFECT OF GENERALAND REGIONALANESTHESIA ON FOETOMATERNAL OUTCOME IN WOMEN UNDERGOING CAESAREAN SECTION FOR SEVERE PREECLAMPSIA

INTRODUCTION Motherhood is the ultimate joy in a woman's life. Every woman craves for her own child. However, more than half a million 1 women die each year from pregnancy related causes across the globe. The United Nations Millennium Development Goals has placed maternal health as a basic human right, one that is integral to the core of the ght against poverty and inequality. The high incidence of preeclampsia and its complications makes its prevention and effective management important. AIMS AND OBJECTIVES To study the effect of anaesthetic technique in the foetomaternal outcome in severe preeclamptic patients undergoing caesarean section and determining any difference in the maternal and perinatal morbidity/mortality amongst those receiving either general or regional anaesthesia. MATERIALS AND METHODS Study Area: Eden Hospital, Critical Care Unit (CCU), Special Neonatal Care Unit (SNCU), and Neonatal Intensive Care Unit (NICU) of Medical College &amp; Hospital, Kolkata. Study Population: Mothers and babies of severe preeclamptic patient with 34 or more gestational weeks admitted in Eden Hospital, Medical College &amp; Hospital, Kolkata undergoing caesarean section formed our study cohort. Study Period: 18 months (from February 2012 till June 2013). RESULTS AND OBSERVATIONS The patients of severe preeclampsia were in the age group 18 to 30 years (93 %). Only 1.2 % were aged more than 40years. 5.8 % of patients were between the ages of 30 to 40 years. The age patterns were similar in both the groups receiving either spinal or general anaesthesia. SUMMARY AND CONCLUSION Severe preeclampsia mothers receiving general anaesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was signicantly higher with general anaesthesia. Spinal anaesthesia is safer alternative to general anaesthesia in severe preeclampsia with less post operative morbidity and mortality

Peripartum Cardiomyopathy in Pregnancy with Severe Preeclampsia : A Cross-Sectional Study in A Tertiary Hospital

Cardiac disease is the third cause of maternal death in East Java and has changed the trends of maternal mortality rate in Indonesia. Preeclampsia occurs about 2-8% of all pregnancies in the world and is still a major concern in the Obstetrics area because it causes the high of maternal and fetal morbidity and mortality1. The etiology of Peripartum Cardiomyopathy is still unclear, presumably preeclampsia is the highest risk factor in PPCM. This study was undertaken to evaluate the prevalence of PPCM in Severe Preeclampsia in dr. Soetomo General Hospital Surabaya. The method was descriptive retrospective with cross sectional studies using the medical record of dr. Soetomo General Hospital Surabaya in 2018-2019 There were 2258 deliveries with 740 cases of severe preeclampsia (32,7%). In those, 52 (7%) were confirmed as PPCM. A total of 688 severe preeclampsia patients were obtained multiparity in 486 (70,6%), From the gestasional age, the most occurred were 28-36 weeks gestational about 473 (68,7%) (p=0.004), The most patient was found 375 (54,6%) with obesity. The patients with severe preeclampsia and PPCM mostly occur in productive age (16-34 years) with a median 28 y.o. In PPCM with severe preeclampsia, about 37 (71,1%) was multiparous, more likely happened in 28-36 weeks gestation about 27(51,9%) (p=0.004), and 28 (53,8%) had obesity state. The highest severity of PPCM with ejection fraction 35-44 was found about 33 (63,4%). The prevalence of PPCM in Severe Preeclampsia was 7:100 live birth. Therefore, the pregnant woman with preeclampsia can be significant risk factor for PPCM.

Factors Affecting Delivery Methods in Severe Preeclampsia Patients at Dr. RSUP. Mohammad Hoesin Palembang January 2018 – December 2019

Background: Hypertension in pregnancy (HIP) is the second highest cause of maternal death in Indonesia. Termination of pregnancy in patients with HIP or preeclampsia is the most common treatment to save both the mother and the fetus. There are two methods of delivery that can be done, namely vaginal or abdominal termination (sectio caesaria). Due to the high incidence of severe preeclampsia in Indonesia and the various determinants in choosing a delivery method for severe preeclampsia, the aim of this study is to analyze what factors influenced it in Dr. Mohammad Hoesin Palembang Hospital.&#x0D; Method: This type of study is an analytic observational study with a cross-sectional study design. A total of 210 samples were taken using the simple random sampling technique from the medical records of severe preeclampsia patients who gave birth at Dr. Mohammad Hoesin Palembang Hospital during January 2018 – December 2019 and was analyzed by univariate, bivariate and multivariate analysis with SPSS ver.26.&#x0D; Result: A total of 81 (38.6%) PEB patients underwent vaginal delivery and 129 (61.4%) underwent a caesarean section delivery. From the observations, 67 people (57.3%) were aged 20-34 years, 40 people (78.4%) with a gestational age of 34-36 weeks, 92 people (57.9%) multiparity, 104 people (62, 3%) without a history of hypertension, 86 people (53.4%) without a history of SC, 98 people (84,5%) with a bishop score ≤5, 116 people (59,5%) without PJT, 122 people (61%) without macrosomic fetuses, 108 people (63.5%) without PROM, and 84 people (75%) with complications underwent cesarean delivery. The factors of gestational age (p value = 0.001), history of sectio caesaria (p value = 0.000), bishop score (p value = 0.000), and complications or comorbidities (p value = 0.000) had a significant relationship to the method of delivery for patients with PEB with factors bishop score is the most influencing factor (OR = 10,299).&#x0D; Conclusion: Therefore, gestational age, history of CS, bishop score, and complications or comorbidities are factors that influence the delivery method of PEB patients.

Evaluation of administration and use of antihypertensive drugs in severe preeclampsia patients at X General Hospital in Jakarta

The high number of maternal mortality rate (MMR) is still a problem in Indonesia. Three ethyologies of maternal death are infection (12%), hypertension in pregnancy (25%) and bleeding (30%). Pre-eclampsia as a form of hypertension during pregnancy requires antihypertensive drug therapy. Rationality assessment for any kinds of pharmacotherapy is based on the right indication, the right medicine, the right patient, and the right dose. The main indication for antihypertensive medication in pregnancy is applied to the mother’s in preventing cerebrovascular disease. The aim of this study was to evaluate the characteristics, patterns and accuracy of the administration and use of antihypertensive drugs in patients with severe preeclampsia at X General Hospital in Jakarta in 2018. It was a non-experimental study with a descriptive and retrospective design using medical records. Administration and use of antihypertensive drugs in patients with severe preeclampsia at the X General Hospital in Jakarta showed 91.9% right indication, 86.72% right drug, 96.9% right patient and only 5.26% right dose with 4.0% accuracy of rational administration and use of drugs. In conclusion, the right dose in the management of patients with severe preeclampsia in X General Hospital in Jakarta is still low. Further training and close monitoring and evaluation on the rational use of antihypertension in severe preeclampsia is needed.

THE RELATIONSHIP BETWEEN THE ONSET OF SEVERE PREECLAMPSIA AND PERINATAL COMPLICATIONS AT RUMKITAL Dr. RAMELAN IN SURABAYA

Abstract Background: Preeclampsia is one of the biggest causes of maternal-fetal morbidity and mortality. Based on the prognosis, the classification of Preeclampsia is early onset (&lt;34 weeks) and late onset (&gt; 34 weeks). Purpose: to investigate the relationship between the onset of severe Preeclampsia and perinatal complications. Method: This research is a quantitative study with a retrospective observational analytic study type and collected medical record data. The study population was severe Preeclampsia patients who gave birth at RUMKITAL Dr. Ramelan Surabaya for the period January 2018 - June 2020 and has no previous history of chronic hypertension. The research sample was 79 subjects with 44 subjects early onset, and 35 subjects late onset. Perinatal complications examined are preterm delivery, asphyxia, LBW, IUGR, stillbirth. The chi-square test or Fisher’s Exact Test was used to analyze relationships. Result: From the results of the study, the comparison of the percentage from early onset and late onset that experienced complications was 93.2% vs 48.6%, p-value = 0.000, OR = 14.5, CI = 3,764–55,635. At preterm delivery, it was found that 75% vs 28.6%, p-value = 0.000, OR = 7.5, CI = 2,754-20,422. . In asphyxia, it was found 41.7% vs 31.4%, p-value = 0.46. At LBW, it was found 72.7% vs 17.1%, p-value = 0,000, OR = 12.9, CI = 4,285-38,771. In IUGR, it was found that 15.9% vs 2.9%, p-value = 0.000. In stillbirth, it was found 18.2% vs 0% and p-value = 0.008. Conclusion: the onset of severe Preeclampsia is related with perinatal complications. Complications associated with the onset severe Preeclampsia are preterm, LBW, stillbirth. Meanwhile, complications that are not related with the onset severe Preeclampsia are asphyxia and IUGR

Comparison of serum nitric oxide levels with case severity in pre-eclampsia – A case control study

Introduction and Aim: In preeclampsia(PE) due to abnormal trophoblastic invasion of the maternal spiral arteries leads to decreased uteroplacental circulation. Nitric oxide (NO) is involved in regulation offeto-placental vascular permeability and resistance. It also affects maturation, development of the placenta and foetal survival. Maternal serum NO levels are controversial in PEandonly few studies have focused on birth outcomes. Hence, the current study was undertaken to estimate and compare the maternal serum NOlevels in normal pregnant and PE womenandalso see the correlation betweenmaternal serum NO level with severity of PEand to study its association with birth outcome.&#x0D; Materials and Methods:The study was conductedat a tertiary care hospital in North Karnataka, India.Forty singleton primigravida PE patients diagnosed and classified as mild/severePE, as per ACOG guidelines and 40 healthy pregnant were selected for the study. NO was estimated by ELISA method.&#x0D; Results: NO was high in PE cases than controls but it was not statistically significant. But NO was significantly (p=0.03) higher in mild PE than severe PE patients. The NO level negatively correlated significantly (p=0.031) with case severity. Maternal serum NO did not show any significant correlation with birth weight and APGAR score of the new born baby.&#x0D; Conclusion:In mild PE rise in maternal serum NO, may be to due compensatory mechanism to normalise persistently elevated blood pressure and decreased level of serum NO in severe PE may be due to down-regulation of the nitric oxide synthase.

Placenta-derived IL-32\u03b2 activates neutrophils to promote preeclampsia development

Immune activation at the maternal-fetal interface is a main pathogenic factor of preeclampsia (PE). Neutrophils (PMNs) are activated in PE patients, but the mechanism and consequences of PMN activation need to be further explored. Here, we demonstrated that interleukin-32 (IL-32) expression was significantly upregulated in syncytiotrophoblasts (STBs) and that IL-32β was the major isoform with increased expression in the placenta of severe PE (sPE) patients. Furthermore, the level of IL-32 expression in the placenta was correlated with its level in the serum of sPE patients, indicating that IL-32 in the serum is derived mainly from the placenta. Then, in vitro experiments showed that IL-32β could highly activate PMNs and that these IL-32β-activated PMNs were better able to adhere to endothelial cells (HUVECs) and enhance the expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular cell adhesion molecule-1 (ICAM-1) in HUVECs, which could be reversed by preincubation with the NADPH oxidase inhibitor VAS 2870. In addition, we showed that IL-32β mainly activated PMNs by binding to proteinase 3. Finally, IL-32β administration induced a PE-like phenotype in a pregnant mouse model. This study provides evidence of the involvement of IL-32β in the pathogenesis of PE.

Analysis of differential expression of hypoxia-inducible microRNA-210 gene targets in mild and severe preeclamptic patients.

Preeclampsia (PE) is a multi-system disorder that is specific to human pregnancy. Inadequate oxygenation of uterus and placenta is considered as one of the leading causes for the disease. MicroRNA-210(miR-210) is one of the prime molecules that has emerged in response to hypoxia. The objective of this study was to determine miR-210 expression patterns in plasma from severe PE and mild PE patients, and how that affects the expression of miR-210 target genes. The expression levels of miR-210 were validated using reverse transcription-quantitative PCR in plasma of severe PE (15) and mild PE (15) patients in comparison to controls subjects (15) with normal pregnancy. Then, the association between miR-210 and its downstream genes was validated by using human miR-210 targets RT2 profiler PCR Array. Both the categories (mild and severe) showed significantly high miR-210 expression levels. Also out of the 84 hypoxia miR-210 associated genes screened using mRNA, 18 genes were found to be differentially expressed in severe PE whereas 16 genes in mild PE cases with varying magnitude. All the genes in both the PE groups were found downregulated in comparison to controls. These downregulated genes expressed in both the cases were shown to be participating in immunosuppression, apoptosis, cell growth, signaling, angiogenesis, DNA repair. This study provides novel data on the genes that work downstream of miR-210 and how dysregulated expression of miR-210 can affect their expression and in turn functioning which can be associated with PE risk and severity. This study is the very first to determine the effect of miR-210 expression levels on associated genes in plasma samples.

Can complete blood count parameters that change according to trimester in pregnancy be used to predict severe preeclampsia?

We aimed to evaluate the effectiveness of changes over time in complete blood count (CBC) parameters to estimate the diagnosis of preeclampsia. Data on 161 severe preeclampsia patients and 161 healthy pregnant patients who met the study criteria of pregnant women whose CBC had been measured at 10–12, 22–24 and 28–30 weeks of pregnancy were compared. In the preeclampsia group, an increase in the mean platelet volume (MPV) value and a decrease in the number of platelets were statistically significant in the transition from the second to the third trimester. MPV and lymphocyte counts were more significant in the third trimester and neutrophil lymphocyte ratio (NLR) were more significant in the second trimester. We found that evaluation of the changes in lymphocyte, MPV and NLR values in three different trimesters of pregnancy rather than a single trimester was more meaningful to predict severe preeclampsia. Impact Statement What is already known on this subject? Studies have shown that MPV and NLR can predict preeclampsia. However, a clear cut off value could not be determined. The reasons for this may be that the gestational week during which the measurement is made is not standard and the patient groups are not homogeneous. What the results of this study add? In this study, CBC parameters at different stages of the preeclampsia process were compared in the severe preeclampsia group. According to our results, lymphocytes, NLR and MPV can be used to predict severe preeclampsia. In addition, NLR measurements in the second trimester and MPV and lymphocyte measurements in the third trimester were found to be more significant in predicting severe preeclampsia. What the implications are of these findings for clinical practice and/or further research? In order to predict severe preeclampsia, instead of a single measurement of CBC parameters, new calculations should be made that add change over time.

Reduced angiovasculogenic and increased inflammatory profiles of cord blood cells in severe but not mild preeclampsia

Preeclampsia (PE) is a prevalent pregnancy disorder that leads to high maternal and fetal morbidity and mortality. While defective vascular development and angiogenesis in placenta are known as crucial pathological findings, its pathophysiological mechanism remains elusive. To better understand the effects of PE on angio-vasculogenesis and inflammatory networks in the fetus and to identify their biological signatures, we investigated the quantitative and functional characteristics of cord blood-derived mononuclear cells (CB-MNCs) and CD31-positive MNCs. Flow cytometry analysis demonstrated that the CB-MNCs from the severe PE group had significantly decreased number of cells expressing CD3, CD11b, CD14, CD19, KDR, and CD31 compared with the normal group. Quantitative real time PCR (qRT-PCR) shows down-regulation of the major angiogenic factor VEGFA in MNCs and CD31+ MNCs in severe PE. The major inflammatory cytokines IL1 was highly upregulated in CD31+ CB-MNCs in the severe PE patients. Mild PE patients, however, did not display any significant difference in expression of all measured angiogenic genes and most inflammatory genes. These findings show distinct angiogenic and inflammatory signatures from severe PE, and they may play a significant role in the pathogenesis of vascular defects in placenta of severe PE.

Dysregulated GLUT1 is Involved in the Pathogenesis of Preeclampsia by Impairing Decidualization

Background: Preeclampsia (PE), a hypertensive complication in pregnancy, is a major contributor to maternal and fetal morbidity and mortality. Thus far, the molecular mechanism underlying PE has not been investigated thoroughly. Glucose transporter 1 (GLUT1) is a central rate-limiting pump for glucose uptake and subsequent utilization. Our previous RNA-seq results demonstrated it was significantly downregulated in the decidua of severe preeclampsia (sPE) patients. Therefore, we aimed to explore the role of GLUT1 in the occurrence of PE. Methods: GLUT1 levels were evaluated by quantitative PCR, Western blotting and immunohistochemical staining in severe preeclamptic decidua. The regulatory role of GLUT1 in decidualization was further studied in human endometrial stromal cells (hESCs). We also explored the regulatory role of miRNA in GLUT1 expression. Findings: We observed a significant downregulation of GLUT1 mRNA and protein levels in the decidual tissues of women with sPE. Additionally, the expression of GLUT1 was substantially induced during in vitro decidualization. Moreover, GLUT1 knockdown in human endometrial stromal cells resulted in significant reduction in the mRNA levels of decidualization markers (IGFBP1 and PRL) and aerobic glycolysis-related genes (LDHA and MCT4), and decreased glucose uptake and lactate production. Furthermore, the expression of apoptotic signaling genes P53, P21 and BAX increased whereas the expression of BCL2 decreased after GLUT1 knockdown. Target prediction results and luciferase analysis showed that GLUT1 is one of the targets of miR-140-5p, which is partly responsible for the impaired GLUT1 level. Interpretation: Collectively, these results demonstrate that GLUT1 exerts pivotal role in human decidualization by participating in glycolysis, and its deficiency may trigger aberrant glycolysis and thus leads to destructive decidualization, which may be a pathogenetic mechanism of PE. These data suggest GLUT1 might be a promising target for PE therapy. Funding: This study was supported by grants from the National Key R&D Program of China (2019YFA0802600 and 2017YFC1001403), and National Natural Science Foundation of China (NSFC: 31871512 and 31671199) to C. Zhang. Support was also obtained by the Shanghai Commission of Science and Technology (17DZ2271100). Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: This study was approved by the Ethics Committee of Ji’nan Maternity and Child Care Hospital and informed written consent forms were obtained from all pregnant women.

Severe preeclampsia leads to higher prevalence of mortality and morbidity affecting maternal outcomes in single tertiary hospital

Objective: The purpose of this study was to determine the maternal outcomes of severe preeclampsia at RSUD Dr. Soetomo Surabaya in January 2013-December 2014.Materials and Methods: This research was a descriptive study with cross-sectional design to observe maternal characteristics and maternal outcomesof severe preeclampsia. Data were retrieved from medical records of severe preeclampsia patients admitted to Obstetric Ward of Dr Soetomo Hospital, from January 2013 to December 2014. This study used total sampling for collecting its data. These data were proccessed descriptively and presented in graphic, tables, and short description.Results: From January 2013 to December 2014 there were 386 (44.2%) cases of severe preeclampsia that were included in this study from a total of 874 cases available. The maternal outcomes of severe preeclampsia consisted of 42 cases (10.9%) of HELLP syndrome, 36 cases (9.3%) of pulmonary edema, 225 cases (58.3%) of sectio caesarea, 7 cases(1.8%) of antepartum bleeding with 5 cases (1.3%) of placenta previa and 2 cases (0.5%) of solutio placenta, 2 cases (0.5%) of postpartum bleeding, 8 cases (2.1%) of eclampsia, 31 cases (8%) of impending eclampsia, 5 cases (1.3%) of acute kidney injury, and 2 cases (0.5%) of maternal death.Conclusion: In conclusion, this study shows that severe pre-eclampsia patients have high prevalence of mortality and morbidities that affects maternal outcomes. It also reccommends that all patients with severe preeclampsia need to receive intensive maternal and fetal care. It is necessary to do careful complication examination, prevention of seizures using magnesium sulfate, and continous fetal and maternal monitoring.

Immediate versus delayed induction of labour in hypertensive disorders of pregnancy: a systematic review and meta-analysis

BackgroundMothers with hypertensive disorder of pregnancy can be managed with either immediate or delayed induction of labour with expectant monitoring of both mother and baby. There are risks and benefits associated with both the type of interventions. Hence, this review was conducted to compare outcomes of immediate and delayed induction of labour among women with hypertensive disorder of pregnancy based on disease severity and gestational age.MethodsWe conducted systematic searches in various databases including Medline, Cochrane Controlled Register of Trials (CENTRAL), Scopus, and Embase from inception until October 2019.Cochrane risk of bias tool was used to assess the quality of published trials. A meta-analysis was performed with random-effects model and reported pooled Risk ratios (RR) with 95% confidence intervals (CIs).ResultsFourteen randomized controlled trials with 4244 participants were included. Majority of the studies had low or unclear bias risks. Amongst late onset mild pre-eclampsia patients, the risk of renal failure was significantly lower with immediate induction of labour (pooled RR: 0.36; 95%CI: 0.14 to 0.92). In severe pre-eclampsia patients, immediate induction of labour significantly reduced the risk of having small-for-gestational age babies compared to delayed induction of labour (pooled RR: 0.49; 95%CI: 0.29–0.84).Delayed induction was found to significantly reduce the risk of neonatal respiratory distress syndrome risk among late onset mild pre-eclampsia patients (pooled RR: 2.15; 95%CI: 1.14 to 4.06) None of the other outcomes demonstrated statistically significant difference between the two interventions.ConclusionDelayed induction of labour with expectant monitoring may not be inferior to immediate induction of labour in terms of neonatal and maternal outcomes. Expectant approach of management for late onset mild pre-eclampsia patients may be associated with decreased risk of neonatal respiratory distress syndrome, while immediate induction of labour among severe pre-eclampsia patients is associated with reduced risk of small-for-gestational age babies and among mild pre-eclampsia patients, it is associated with reduced risk of severe renal impairment.

A prognostic model to calculate the probability of severe preeclampsia in healthy young reproductive age woman

Aim.To develop the prognostic model to calculate the probability of severe preeclampsia in healthy young reproductive age woman.&#x0D; Materials and methods.This study included two groups of healthy women aged 1835 years with spontaneous singleton pregnancy: 100 patients with severe preeclampsia (patient group), and 100 women with non-complicated pregnancy (control group). All women had not a risk factors of preeclampsia such as history of hypertension, autoimmune, metabolic, renal, or cardiac diseases, and family or individual history preeclampsia or thromboembolism before this pregnancy. Their body mass index in the 1-st trimester of gestation was 35 kg/sq. m. Gene polymorphisms were detected using the polymerase chain reaction-real time technique. The data were analyzed with methods of binary and multifactorial mathematical statistics. Our analysis of the predictive models was performed by using logistic regression. To determine the diagnostic value of the predictive models used the ROC-curve is followed by determining the area under it (AUC).&#x0D; Results.Some prognostic models to calculate the probability of severe preeclampsia were build using an anamnestic, clinical and genotypic characteristics and multifactorial analysis. Combination of genotypesAGTR2-1675АA/eNOS3-786СC; tobacco smoking; bacteriuria; acute respiratory infections and/or acute vulvovaginitis during 23 trimester of gestation were determinate as most informative predictors of severe preeclampsia. Logistic model included three predictors: bacteriuria; acute respiratory infections and/or acute vulvovaginitis during 23 trimester of gestation had higher prognostic value. ROC analysis identified a high specificity (89.58%) and sensitivity (76.47%) of the model, and the integral index of the effectiveness of predictive markers (AUC=0.885), according to the expert scale of values which is indicative of a very high quality model.&#x0D; Conclusion.It is recommended to use this elaborated predictive model for the purpose of individual risk assessment of severe preeclampsia in healthy young reproductive age woman.