Severe Preeclamptic Patients Research Articles

Comparison of Hemodynamic Changes and Their Management Following Subarachnoid Block Between Normotensive and Preeclamptic Women Undergoing Cesarean Section

Introduction. Spinal anesthesia (SA) is widely used for cesarean sections, yet its safety in preeclamptic patients remains uncertain. This study explores the use of subarachnoid block (SAB) in preeclamptic parturients during cesarean sections. Patients and Methods. This study was a single-center hospital-based controlled clinical trial. 30 normotensive and 30 preeclamptic women undergoing cesarean section were included in the study. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and SpO2 were evaluated at one, three, five, seven, nine, 11, 13, 15, 20, 25, 30, 40, 45, 50, 55 and 60 minutes intervals after giving the block. The independent samples t-test was used for statistical analysis. Results. In the normotensive (group N) vs. preeclamptic (group PE) comparison, significant differences in weight, SBP, DBP, and MAP were noted, with higher values in group PE (p<0.05). Heart rates and oxygen saturation were comparable. Mephentermine consumption was notably higher in normotensive women compared to preeclamptic women (p<0.001). Conclusion. Severe preeclamptic women exhibit significantly higher SBP, DBP, and MAP compared to normotensive women undergoing cesarean section following subarachnoid block. However, SAB does not impact heart rate and oxygen saturation. Importantly, hypotension following spinal anesthesia is less common in severe preeclamptic patients, indicating its potential safety in this group.

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

MiR-4443/MMP2 suppresses the migration and invasion of trophoblasts through the HB-EGF/EGFR pathway in preeclampsia

ABSTRACT Preeclampsia (PE) is a pregnancy-associated disease that may cause maternal and fetal morbidity and mortality. The dysregulation of microRNAs (miRNAs) and their potential functions has been an important direction for elucidating the mechanism of preeclampsia in recent years. The present study investigated whether miR-4443 was significantly increased in the placentas of severe preeclamptic patients, and the upregulation of miR-4443 inhibited the migration and invasion of HTR-8/SVneo cells according to transwell assays. Matrix metallopeptidase 2 (MMP2), which is involved in the degradation of extracellular matrix (ECM) components and harbors a miR-4443-binding site within its 3’-UTR as confirmed by a luciferase reporter assay, was identified to be directly inhibited by miR-4443. Moreover, siRNA targeting MMP2 imitated the effects of overexpressed miR-4443 on HTR-8/SVneo cell invasion and migration, whereas rescue experiments showed that MMP2 reversed this inhibitory function of miR-4443. Heparin-binding EGF-like growth factor (HB-EGF), as the downstream gene of MMP2, plays an important role in trophoblast invasion, and we confirmed that the expression of HB-EGF/EGFR pathway-related biomolecules was consistent with MMP2 influenced by upregulating and downregulating miR-4443 and that activated EGFR further transmitted intracellular downstream signaling via the MAPK pathway according to western blot assay. In conclusion, we demonstrated that miR-4443 suppresses the migration and invasion of trophoblasts, and its inhibitory effects are at least partially mediated by the suppression of MMP2. This inhibition might further affect the progression of preeclampsia through the HB-EGF/EGFR pathway, thus providing a new clue on the role of miR-4443 in the pathogenesis of preeclampsia.

Ultrasonographic Changes in Transorbital Measurement of Optic Nerve Sheath Diameter in Magnesium Sulfate-Treated Severely Preeclamptic Patients: A Prospective Observational Study.

Severe preeclampsia can lead to various complications including increased intracranial pressure (ICP) which can be catastrophic but difficult to detect because of variable nonspecific symptoms. Ultrasonography has been used as noninvasive measure to monitor optic nerve sheath diameter (ONSD) as a marker of raised ICP. Effect of MgSO4 on ICP can modify the management approach, need for additional monitoring, targeting hemodynamic goals, timing of delivery, and choice of anesthesia. We evaluated the effect of MgSO4 on raised ICP in severely preeclamptic patients using ultrasound-guided ONSD as a surrogate marker of ICP. This prospective observational study was conducted after ethical committee approval and written informed consent from patients. Ultrasound-guided ONSD was measured and compared in 47 severe preeclamptic patients before and at 1 h, 4 h, 12 h, and 24 h after starting MgSO4 therapy. The analysis of data was done by one-way analysis of variance using Statistical Package for the Social Science. Mean ONSD was 5.56 ± 0.30 mm in our study group. ONSD above 5.8 mm was seen in 17 (36.17%) patients and was considered as marker of raised ICP. There was a significant decrease in ONSD after 4 h of administration of MgSO4. No significant correlation was observed between mean arterial pressure, serum magnesium level, and ONSD. Ultrasound-guided ONSD measurement can be used as a quick, noninvasive bedside tool in severe preeclamptic patient on MgSO4 treatment as marker of ICP which help us in determining clinical severity, therapeutic response, and to decide further course of management.

MNSFβ regulates placental development by conjugating IGF2BP2 to enhance trophoblast cell invasiveness.

ObjectivesSuccess in pregnancy in mammals predominantly depends on a well‐developed placenta. The differentiation of invasive trophoblasts is a fundamental process of placentation, the abnormalities of which are tightly associated with pregnancy disorders including preeclampsia (PE). Monoclonal nonspecific suppressor factor beta (MNSFβ) is an immunosuppressive factor. Its conventional knockout in mice induced embryonic lethality, whereas the underlying mechanism of MNSFβ in regulating placentation and pregnancy maintenance remains to be elucidated.MethodsTrophoblast‐specific knockout of MNSFβ was generated using Cyp19‐Cre mice. In situ hybridization (ISH), haematoxylin and eosin (HE), immunohistochemistry (IHC) and immunofluorescence (IF) were performed to examine the distribution of MNSFβ and insulin‐like growth factor 2 mRNA‐binding protein 2 (IGF2BP2) at the foeto‐maternal interface. The interaction and expression of MNSFβ, IGF2BP2 and invasion‐related molecules were detected by immunoprecipitation (IP), immunoblotting and quantitative real‐time polymerase chain reaction (qRT‐PCR). The cell invasion ability was measured by the Transwell insert assay.ResultsWe found that deficiency of MNSFβ in trophoblasts led to embryonic growth retardation by mid‐gestation and subsequent foetal loss, primarily shown as apparently limited trophoblast invasion. In vitro experiments in human trophoblasts demonstrated that the conjugation of MNSFβ with IGF2BP2 and thus the stabilization of IGF2BP2 essentially mediated the invasion‐promoting effect of MNSFβ. In the placentas from MNSFβ‐deficient mice and severe preeclamptic (PE) patients, downregulation of MNSFβ was evidently associated with the repressed IGF2BP2 expression.ConclusionsThe findings reveal the crucial role of MNSFβ in governing the trophoblast invasion and therefore foetal development, and add novel hints to reveal the placental pathology of PE.

EARLY MANAGEMENT OF SEVERE PRE-ECLAMPTIC AND ECLAMPTIC REFFERAL PATIENT AT KOTABARU REGENCY

ABSTRACTBackground: The maternal mortality rate is 305 per 100,000 live births in Indonesia. The most common cause of maternal death is preeclampsia / eclampsia. The maternal mortality rate is 247 per 100,000 live births in 2017 in Kotabaru Regency. Most preeclamptic referral patients are in critical condition when they arrive at the hospital. Method: This type of research is an observational descriptive study. The population is all patients with severe preeclampsia and eclampsia in the delivery room of RS Pangeran Jaya Sumitra Kabupaten Kotabaru from January - December 2018. The sample is total sampling.Results: PEB referral patients was 57 cases. Most of those are in the group age of 20 - 35 years which are 35 people (61.4%), not nullipara is 31 people (54,4%), 34-40 weeks of gestation is 43 people (75,4%), as many as 44 people (77,2%) with previous severe preeclampsia/ hypertension, 41 people (71,9%) brought referral letters, referred by Puskesmas are 47 people (82.5%), most of the locations of referral is from Pulau Laut as many as 35 referrals (61,4%). The initial management of PEB and eclampsia: IV Pathway in 11 patients (19.3%) of severe preeclamptic and eclamptic patients, 50 patients (87.7%) were not given MgSO4, 51 people (89.5% ) did not get anti-hypertension, 52 patients (91.2%) were not installed catheters. Conclusion: Early management of severe preeclamptic and eclamptic patients is not optimal and does not fulfil the standard yet. Proper and appropriate early management can reduce morbidity and maternal mortality from complications of severe preeclampsia and eclampsia that can be prevented by providing right initial management.

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 & Hospital, Kolkata. Study Population: Mothers and babies of severe preeclamptic patient with 34 or more gestational weeks admitted in Eden Hospital, Medical College & 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

Acute Kidney Injury in Severe Preeclamptic Patients Admitted to Intensive Care Unit: Epidemiology and Role of Serum Neutrophil Gelatinase-associated Lipocalcin.

BackgroundPatients with preeclampsia admitted to the intensive care unit (ICU) may have risk factors for acute kidney injury (AKI). Although the use of neutrophil gelatinase-associated lipocalcin (NGAL) to predict AKI is previously validated, we could locate only scanty data regarding the epidemiology of AKI and role of NGAL in preeclamptic patients admitted to ICU.MethodsPatients with preeclampsia admitted to our ICU were included. The incidence and severity of AKI during the entire ICU stay were assessed using kidney disease improving global outcomes criteria, while the a priori risk factors and serum NGAL were also evaluated.ResultsA total of 52 preeclamptic patients admitted to ICU were included, among whom the majority had eclampsia (75%). AKI developed in 25 (48.1%) patients with stages 1, 2, and 3 in 56, 36, and 8%, respectively. The incidence of sepsis (16 vs 0%), shock (40 vs 7.4%), and anemia (84 vs 59.3%) was significantly greater in patients with AKI (p < 0.05). ICU mortality (28 vs 3.7%), duration of ICU, and hospital stay were significantly higher in patients who developed AKI (p < 0.05). There was no association of serum NGAL [274 (240–335) ng/mL] with AKI or the mortality (p = 0.725, 0.861); there was, however, a significant discriminatory value for eclampsia [p = 0.019; area under curve = 0.736 (95% confidence interval: 0.569–0.904)].ConclusionsAlthough AKI is common among patients with preeclampsia admitted to ICU, serum NGAL does not predict its occurrence.How to cite this articleTyagi A, Yadav P, Salhotra R, Das S, Singh PK, Garg D. Acute Kidney Injury in Severe Preeclamptic Patients Admitted to Intensive Care Unit: Epidemiology and Role of Serum Neutrophil Gelatinase-associated Lipocalcin. Indian J Crit Care Med 2021;25(9):1013–1019.

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.

Maternal near-miss patients and maternal mortality cases in a Turkish tertiary referral hospital.

This study aimed to estimate the incidence of maternal near-miss (MNM) morbidity in a tertiary hospital setting in Turkey. In this retrospective study, we concluded 125 MNM patients who delivered between January 2017 and December 2017 and fulfilled the WHO management-based criteria and severe pre-eclamptic and HELLP patients which is the top three highest mortality rates due to pregnancy. Two maternal death cases were also included. The indicators to monitor the quality of obstetric care using MNM patients and maternal deaths were calculated. Demographic characteristics of the patients, the primary diagnoses causing MNM and maternal deaths, clinical and surgical interventions in MNM patients, shock index (SI) value of the patients with obstetric hemorrhage and maternal death cases were evaluated. The MNM ratio was 5.06 patients per 1000 live births. Maternal mortality (MM) ratio was 8.1 maternal deaths per 100 000 live births. SMOR was 5.14 per 1000 live births. The MI was 1.57%, and the MNM/maternal death ratio was 62.4:1. The SI of MNM patients with obstetric hemorrhage was 1.36 ± 0.43, and the SI of the patient who died due to PPH was 1.74. The MNM rates and MM rates in our hospital were higher than high-income countries but were lower than in low- and middle-income countries. Hypertensive disorders and obstetric hemorrhage were the leading conditions related to MNM and MM. However, the MIs for these causes were low, reflecting the good quality of maternal care and well-resourced units. Adopting the MNM concept into the health system and use as an indicator for evaluating maternal health facilities is crucial to prevent MM.

Mechanisms of vascular dysfunction in the interleukin-10–deficient murine model of preeclampsia indicate nitric oxide dysregulation

Preeclampsia is a pregnancy-specific hypertensive disorder characterized by proteinuria, and vascular injury in the second half of pregnancy. We hypothesized that endothelium-dependent vascular dysfunction is present in a murine model of preeclampsia based on administration of human preeclamptic sera to interleukin-10-/- mice and studied mechanisms that underlie vascular injury. Pregnant wild type and IL-10-/- mice were injected with either normotensive or severe preeclamptic patient sera (sPE) during gestation. A preeclampsia-like phenotype was confirmed by blood pressure measurements; assessment of albuminuria; measurement of angiogenic factors; demonstration of foot process effacement and endotheliosis in kidney sections; and by accumulation of glycogen in placentas from IL-10-/- mice injected with sPE sera (IL-10-/-sPE). Vasomotor function of isolated aortas was assessed. The IL-10-/-sPE murine model demonstrated significantly augmented aortic contractions to phenylephrine and both impaired endothelium-dependent and, to a lesser extent, endothelium-independent relaxation compared to wild type normotensive mice. Treatment of isolated aortas with indomethacin, a cyclooxygenase inhibitor, improved, but failed to normalize contraction to phenylephrine to that of wild type normotensive mice, suggesting the additional contribution from nitric oxide downregulation and effects of indomethacin-resistant vasoconstricting factors. In contrast, indomethacin normalized relaxation of aortas derived from IL-10-/-sPE mice. Thus, our results identify the role of IL-10 deficiency in dysregulation of the cyclooxygenase pathway and vascular dysfunction in the IL-10-/-sPE murine model of preeclampsia and point towards a possible contribution of nitric oxide dysregulation. These compounds and related mechanisms may serve both as diagnostic markers and therapeutic targets for preventive and treatment strategies in preeclampsia.

Comparative analysis of serum calcium and magnesium as a better predictor in cases of mild and severe pre-eclampsia.

Objectives: The hypertensive disorders of pregnancy (HDP), especially severe preeclampsia are most common cause of neonatal and maternal mortality and morbidity. Alteration in metabolism of calcium and magnesium during pregnancy is considered to be one of etiological factor for pre-elampsia. Study Design: Case-control study. Settings: Departments of Pathology and Gynecology and Obstetrics, Bahawal Victoria Hospital. Period: September 2018 to June 2019. Material &amp; Methods: To compare whether serum levels of calcium or magnesium showed significant change in mild and severe preeclamptic patients as compared to control group. Research population consisted of pregnant females that were divided into three groups. The mild and severe preeclamptic groups comprised of 55 and 26 participants respectively and 45 were included in control group. The serum calcium and magnesium levels were measured in these groups. Results: Maximum numbers of preeclamptic cases were presented at 28-32 week of gestation while severe pre-eclamptic group showed most cases in 33-36 weeks. In both groups, most of cases occurred in multiparous women as compared to nulliparous women. The normotensive group showed serum calcium and magnesium levels of 9.08±0.63 and2.12±0.22mg/dl while mild preeclamptic (mPE) had mean value of 7.91±0.64 and 1.58±0.42mg/dl and measurement were 7.67±0.48 and 1.26±0.44 in cases of severe pre eclampsia (sPE). Serum magnesium levels were significantly lower in sPE as compared to mPE (&lt;0.0001) while difference was not statistically significant for serum calcium level (0.14). Conclusion: Both decrease level of serum calcium and magnesium might be risk factor in development of preeclampsia with more emphasis on role of low magnesium as a prognostic marker in severe preeclamptic cases.

Hemodynamic Effects of Intrathecal Magnesium Sulphate as an Adjuvant for Spinal Anesthesia in Pre-Eclamptic Patients

Abstract Background pre-eclampsia is defined as a disorder that occurs in pregnancy after twenty weeks of gestation which manifests as hypertension and proteinuria with at least one maternal organ dysfunction involvement with an incidence of 5-10% of all pregnancies. Aim of the Work our study will examine the hemodynamic effects of adding two different doses of magnesium sulphate to bupivacaine in patients with severe preeclampsia undergoing caesarean section using spinal anesthesia. Patients and Methods: type of Study Prospective comparative study; it was done after approval of the Research Ethics Committee of Anesthesia, Intensive Care and Pain Management Department, Ain Shams University. Study Setting Ain Shams University Hospitals, Cairo, Egypt. Study Period 3 months. Study Population Pregnant females with severe preeclampsia undergoing caesarian section. Results results of this study indicated that the addition of magnesium sulfate at a dose of 100mg compared to the dose of 50 mg to bupivacaine showed that increasing the dose of magnesium sulfate had no significant hemodynamic effect (systolic blood pressure, diastolic blood pressure and heart rate) on severe preeclamptic patients undergoing caesarean section. But the addition of 100 mg magnesium sulfate lead to a significant delay in the onset of both sensory and motor blockade, and prolonged the duration of sensory and motor blockade compared to the addition of 50mg magnesium sulphate. Also there is no significant difference between the addition of 50 &amp;100mg on shivering, nausea and vomiting, sedation, postoperative pain score (at 2,4 and 8 hours) and APGAR score (at 1 and 5 min). Conclusion the addition of magnesium sulfate at a dose of 100mg compared to the dose of 50 mg to bupivacaine in our study, showed that increasing the dose of magnesium sulfate had no significant hemodynamic effect (systolic blood pressure, diastolic blood pressure and heart rate) on severe preeclamptic patients undergoing caesarean section.

Diagnostic accuracy of sFlt1/PlGF ratio as a marker for preeclampsia

BackgroundPreeclampsia (PE) is a serious complication of pregnancy and one of the main causes of maternal and neonatal mortality and morbidity in the world. Finding a biomarker with high sensitivity and specificity could lead to prediction and early diagnosis of the disease and reduces its complications. In this study, we evaluated diagnostic accuracy of Soluble fms-like tyrosine kinase-1 (sFlt-1) to Placental growth factor (PlGF) ratio for diagnosis of PE.MethodsThe cases included 23 mild, 15 severe preeclamptic patients, and 20 normal term pregnant women as control referred to GYN ward of the Persian Gulf Hospital in Bandar Abbas from 2014 to 2016. Levels of sFlt-1 and PlGF were measured. Receiver Operating Characteristic (ROC) curve analysis was applied to calculate diagnostic accuracy of sFlt-1/PlGF ratio.ResultsThe mean Level of sFlt-1/PlGF in PE patients (91.33 ng/ml) was significantly higher than control women (17.62) (P<0.001). ROC curve analysis showed sFlt-1/PlGF ratio diagnostic accuracy in preeclamptic patients with Area Under Curve (AUC) of 0.90, the best cut-off value of 24.96, sensitivity and specificity of 84.2 and 85.0%, respectively.ConclusionsOur data showed sFlt-1/PlGF ratio has higher accuracy for differentiating PE patients from non-PEs in comparison with its power for differentiating severe or early onset forms of the disease.

Dysregulated expression of ACTN4 contributes to endothelial cell injury via the activation of the p38-MAPK/p53 apoptosis pathway in preeclampsia.

Preeclampsia (PE) is a hypertensive disease associated with increased endothelial cell dysfunction caused by systemic oxidative stress. Alpha-actinin-4 (ACTN4) is a member of the α-actinin family of actin crosslinking proteins that are upregulated in several types of cancer. However, its role in PE remains unclear. In this study, we found that ACTN4 was localized in placenta vascular endothelial cells (ECs), and its expression was downregulated in primary human umbilical vein endothelial cells (HUVECs) from severe preeclamptic patients compared to that in HUVECs from normotensive pregnant women. ACTN4 expression was also decreased in normotensive HUVECs treated with H2O2. Downregulation of ACTN4 by siRNA or H2O2 treatment promoted normotensive HUVEC apoptosis and increased p38-MAPK phosphorylation along with elevated levels of p53 phosphorylation, caspase cascade proteins, and bax and repressed expression of bcl-2. Conversely, upregulation of ACTN4 in PE HUVECs significantly inhibited apoptosis and decreased p38-MAPK phosphorylation compared to that of the PE HUVEC controls. In addition, overexpression of ACTN4 in normotensive HUVECs attenuated H2O2 treatment-induced apoptosis with decreased p53 phosphorylation, caspase cascade, and bax expression levels and increased expression of bcl-2 compared to that of only H2O2 treatment. Moreover, the suppression of ACTN4 induced apoptosis, which could be blocked by the p38-MAPK inhibitor SB202190. Collectively, these results demonstrate that dysregulated ACTN4 expression may be associated with PE due to its effects on endothelial cell apoptosis via the p38-MAPK/p53 apoptosis pathway.

Comparison of Hemodynamic Changes Due to Endotracheal Intubation With Labetalol and Remifentanil in Severe Preeclamptic Patients Undergoing Cesarean Delivery With General Anesthesia

Objectives: Stress replication to laryngoscopy and intubation are exaggerated in the patient with severe preeclampsia and this stress can lead to an increased risk of maternal mortality and morbidity. The aim of this study was to compare the efficacies of remifentanil and labetalol in attenuating these responses in women with violent preeclampsia undergoing cesarean section (C-section) with general anesthesia. Methods: In this double-blind study, 70 women with violent preeclampsia undergoing cesarean delivery were randomly assigned to two groups to receive either remifentanil 1 µg/kg or labetalol 0.25 mg/kg before the induction of anesthesia. Then, blood pressure (BP) and heart rate (HR) were measured before and 1, 3, and 5 minutes after the intubation. The first and 5th-minute Apgar scores were evaluated as well. Results: All hemodynamic variables decreased in both groups after the administration of remifentanil or labetalol. Labetalol significantly attenuated the rise in BP and HR during laryngoscopy and intubation compared to remifentanil (P&lt;0.001). Eventually, no significant difference was found between the Apgar scores of the two groups (P=0.97 and P=0.19, respectively). Conclusion: Overall, the administration of labetalol before the inspiration of anesthesia can control stress replication to laryngoscopy and shows better intubation and more stability than remifentanil in patients with severe preeclampsia undergoing C-section.

Magnesium Sulfate Poisoning Revealed by Hypothermia and Visual Disturbances: About a Case

Eclampsia requires appropriate treatment of pregnancy-induced hypertension and early management before the onset of signs of seriousness. Patients in post-caesarean section are transferred to intensive care. Magnesium sulfate is the drug of choice because it reduces the incidence of eclampsia attacks in severe pre-eclamptic patients and the risk of recurrent seizures in eclamptic patients. Like any medicine, it has side effects, some of which may go unnoticed. This is a 30-year-old primip female patient at the maternity hospital for severe pre-eclampsia. Blood pressure was 180/130 mmHg. The patient had severe vertigo and edema. She was put under magnesium sulfate (MgSO4) at a rate of 4g in 20 minutes then 1g / h in pre and post-caesarean section. At the twelfth hour after admission to intensive care, she presented visual blur and persistent hypothermia. The course of action consisted in stopping magnesium sulfate and administering 2g of calcium gluconate. The evolution was favorable with a return to normal temperature and a good quality vision. The electrocardiogram was normal. She was transferred to the maternity ward at day 6.

50% and 95% effective doses of ropivacaine for subarachnoid block in severe preeclamptic patients undergoing cesarean section

Objective To examine the ED50 and 95% effective dose(ED95) of ropivacaine for subarachnoid block in severe preeclamptic patients undergoing cesarean section. Methods This study enrolled 250 severe preeclamptic patients undergoing cesarean section. They were randomly divided into 5 groups respectively received 0, 7.5, 10.0, 12.5, 15.0 mg and 17.5 mg ropivacaine(n=50). The use of ropivacaine and phenylephrine, and patients' satisfaction, intraoperative complications, and the neonates' Apgar scores were documented. Results ED50 and ED95 of ropivacaine for successful subarachnoid block were 9.3 mg(95%CI: 8.6-9.9 mg) and 14.9 mg(95%CI: 13.7-16.9 mg) respectively. The sensory block was significantly different among groups 10 min after intrathecal injection(P 0.05). Conclusions Our study showed that the ED50 and ED95 of ropivacaine for subarachnoid block in severe preeclamptic patients undergoing elective cesarean delivery were 9.3 mg and 14.9 mg, respectively. Key words: Ropivacaine; Cesarean section; Severe preeclampsia; Subarachnoid block

MiR-181a-5p suppresses invasion and migration of HTR-8/SVneo cells by directly targeting IGF2BP2

Pre-eclampsia is a pregnancy-related disease that may cause maternal, neonatal and fetal morbidity and mortality and exists in 3–5% of pregnancies worldwide. The discovery of dysregulated microRNAs and their roles in placental development has provided a new avenue for elucidating the mechanism involved in this pregnancy-specific disorder. Here, the roles of human miR-181a-5p, a microRNA that is increased in both the plasma and placenta of severe pre-eclamptic patients, in invasion and migration of trophoblasts were investigated. Ectopic-expression of miR-181a-5p impaired the invasion and migration of HTR-8/SVneo cells, whereas miR-181a-5p inhibition had the opposite effects. IGF2BP2, which harbors a highly conserved miR-181a-5p-binding site within its 3ʹ-UTR, was identified to be directly inhibited by miR-181a-5p. Moreover, siRNAs targeting IGF2BP2 imitated the effects of overexpressed miR-181a-5p on HTR-8/SVneo cell invasion and migration, whereas restoring IGF2BP2 expression by overexpressing a plasmid encoding IGF2BP2 partially reversed the studied inhibitory functions of miR-181a-5p. Thus, we demonstrated here that miR-181a-5p suppresses the invasion and migration of cytotrophoblasts, and its inhibitory effects were at least partially mediated by the suppression of IGF2BP2 expression, thus shedding new light on the roles of miR-181a-5p in the pathogenesis of severe pre-eclampsia.

Serum E-selectin in Preeclampsia: A Case – Control Study

Preeclampsia (PE) is an important disease in pregnancy, and is one of the causes of maternal morbidity, mortality and adverse neonatal outcomes. One of the basic pathophysiologies of preeclampsia is endothelial cell dysfunction as suggested by an elevated concentration of endothelin-selectin. The aim of this study was to compare the sera levels of endothelin-selectin (E-selectin) in normal and pre-eclamptic term pregnancy. This case-control study was followed on 80 patients admitted to the Departments of Obstetrics and Gynecology of the Ghaem and Emam Reza hospitals in Mashhad University of Medical Sciences. The Control group consisted of 40 normal term pregnant women (≥ 37 weeks) and the Case group was 40 term preeclamptic pregnant women. Participants were enrolled after approval by the ethics committee and received the informed consent. E-selectin concentration evaluated in two groups. The level of E-selectin was significantly in two groups. It was higher in sera of pre-eclamptic patients than the normal pregnancy (p=0.0001). Especially, it was significantly higher in severe pre-eclamptic patients (p<0.05). In conclusion, the found results showed that E-selectin was increased in term of PE that and may be useful for predicting the severity of pre-eclampsia.