Severe Preeclampsia Research Articles

Ethnocultural status and risk of preeclampsia in a Canadian setting.

Disparities in hypertensive disorders of pregnancy are prevalent in the U.S., but are understudied in other settings. Our objective was to determine if ethnocultural disparity in the risk of preeclampsia was present in Canada. We carried out a retrospective cohort study of 862,759 pregnancies between 2008 and 2020 in Quebec, Canada. The exposure was the ethnocultural status of women, defined by linguistic origin (Anglophone or Francophone). The outcome was preeclampsia, including severity (severe, superimposed, mild), presence of fetal growth restriction, and gestational onset time (early or late onset of hypertension). We estimated risk ratios (RR) and 95 % confidence intervals (CI) for the association between ethnocultural status and risk of preeclampsia adjusted for maternal characteristics. In adjusted models, Anglophones had a slightly elevated risk of preeclampsia compared with Francophones (40.5 vs. 37.2 per 1000 pregnancies; RR 1.03, 95% CI 1.00-1.07). Associations were stronger for selected subtypes of preeclampsia, with Anglophones at greater risk of mild preeclampsia (RR 1.09, 95% CI 1.04-1.13), preeclampsia without fetal growth restriction (RR 1.04, 95% CI 1.00-1.08), and late onset preeclampsia (RR 1.04, 95% CI 1.01-1.08). An association with severe preeclampsia was less apparent, although Anglophones lacking a high school diploma (RR 1.46, 95% CI 1.12-1.90) or who were younger than 25years (RR 1.19, 95% CI 1.01-1.40) had a greater risk of severe preeclampsia compared with Francophones. Anglophones, especially Anglophones in vulnerable subgroups, have a slightly elevated risk of preeclampsia compared with Francophones. CI, confidence interval; HELLP, hemolysis, elevated liver enzymes, and low platelets; ICD-10-CA, International Classification of Diseases, 10th revision; mmHg, millimeter of mercury; No., number; RR, risk ratio; U.S., United States.

Contraindications to Magnesium Sulfate and Alternative Seizure Prophylaxis for Severe Preeclampsia with Levetiracetam.

Contraindications to Magnesium Sulfate and Alternative Seizure Prophylaxis for Severe Preeclampsia with Levetiracetam.

Impact of pre-pregnancy body mass index on preeclampsia

BackgroundIt remains unclear how pre-pregnancy body mass index (BMI) affects preeclampsia in the Chinese population, primarily due to insufficient large-scale research on this topic.ObjectiveThe study aimed to determine the relationship between pre-pregnancy BMI and (severe) preeclampsia in the Chinese population, providing a detailed description of the findings.MethodsThe retrospective study included a total of 75,773 pregnant women registered between 2016 and 2020. These participants were categorized into four groups based on their pre-pregnancy BMI: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5–<24 kg/m2), overweight (BMI 24–<28 kg/m2), and obese (BMI ≥ 28 kg/m2). The relationship between risks of preeclampsia or severe preeclampsia and pre-pregnancy BMI were further explored, with an evaluation of potential modification by maternal age.ResultsA lower risk of developing preeclampsia was observed in the underweight population, with an OR of 0.604 (95%CI, 0.507–0.719). In contrast, women who were overweight or obese during the pre-pregnancy period demonstrated a significantly higher risk of preeclampsia, with ORs of 2.211 (95%CI, 1.967–2.486) and 3.662 (95%CI, 3.026–4.431), respectively. After adjusting for confounding factors, the elevated risk of preeclampsia persisted, showing ORs of 2.152(95%CI, 1.911–2.425) for the overweight population and 3.493 (95%CI, 2.874–4.245) for those who were obese, while the risk for underweight women remained lower, with an OR of 0.609(95%CI, 0.511–0.727). For severe preeclampsia, the risk was also higher in the overweight and obese participants after adjusting for confounders, demonstrating ORs of 1.652(95%CI, 1.364–2.001) and 2.762(95%CI, 2.014–3.788), respectively. The underweight population exhibited a lower risk of severe preeclampsia, with an OR of 0.720(95%CI, 0.565–0.919). In addition, these risks were not significantly associated with maternal age.ConclusionRegardless of adjustment for confounders, underweight women demonstrated a lower risk of preeclampsia, whereas the overweight/obese population exhibited a higher occurrence of both preeclampsia and severe preeclampsia. These associations were not influenced by maternal age.

Downregulated PSME3 Contributes to Severe Preeclampsia by Promoting Trophoblast Cell Apoptosis.

Severe preeclampsia (sPE) is a serious condition posing risks to both maternal and fetal health. Based on mass spectrometry analysis, we identified a key protein, PSME3 (proteasome activator subunit 3), an 11S proteasome activator, whose protein level was significantly downregulated in sPE placentas and whose function in sPE remains unknown. PSME3 protein levels in human placental tissue were detected using Western blot, and PSME3 concentration in serum was detected by ELISA assay. The human preeclampsia-like phenotypes of Psme3-/- pregnant mice were examined. Trophoblast cell apoptosis was detected by flow cytometry. Pregnant mice were treated with 9.5% O2 to construct a preeclampsia mouse model for detecting placental Psme3 expression. The regulation of PSME3 expression by hypoxia was detected in trophoblast cell lines treated with 21% O2 or 1% O2. PSME3 protein levels were significantly downregulated in sPE placentas and serum. Pregnant mice with Psme3-/- embryos and placentas spontaneously presented human preeclampsia-like symptoms, including hypertension and proteinuria, increased serum soluble fms-like tyrosine kinase 1 concentration, fetal growth restriction, and increased cellular apoptosis. Mechanically, PSME3 knockdown promoted the apoptosis of trophoblast cells by repressing the degradation of UBE2V2 (ubiquitin conjugating enzyme E2 V2). Moreover, the placentas of hypoxia-induced preeclampsia mice presented significantly reduced Psme3 protein levels and elevated Ube2v2 protein levels. Hypoxia-inducible factor-1α functioned as a transcriptional repressor of PSME3. In sPE placentas, hypoxia of the placenta may lead to the transcriptional inhibition of PSME3. PSME3 deficiency promotes the accumulation of UBE2V2, thereby inducing trophoblast cell apoptosis. Our study provides a new perspective for elucidating the pathogenesis of sPE.

DSOG Guideline Bulletin: Preeclampsia and hypertension

Abstract Approximately 10% of pregnancies are complicated by hypertensive disorders of pregnancy (HDPs) in Denmark. The ‘Preeclampsia and hypertension’ guideline includes the classification, diagnosis, surveillance, and management of HDPs. This revision focuses on the diagnostic criteria for preeclampsia, preeclampsia-specific biomarkers for short-term prediction of disease, blood pressure thresholds and targets, and postpartum management. We reviewed the available literature in PubMed published since the last guideline revision in 2018, as well as the guidelines of other obstetric societies. HDPs are classified based on the timing of onset, i.e. before or after 20 weeks’ gestation, and whether proteinuria or other signs of organ dysfunction are present. We recommend against using the terms mild-moderate or severe preeclampsia in clinical practice. If possible, new-onset hypertension should be confirmed by home blood pressure monitoring. Women with HDPs should be monitored regularly, depending on diagnosis and clinical presentation. If blood pressure is ≥140 mmHg systolic and/or ≥90 mmHg diastolic, antihypertensive treatment with oral labetalol, nifedipine or methyldopa should be offered and titrated until reaching a target blood pressure of <135/85 mmHg. Magnesium sulphate treatment is recommended in eclampsia or signs of impending eclampsia. Delivery should be offered to women with preeclampsia no later than 37-38 weeks’ gestation; delivery is indicated sooner, regardless of gestational age, in preeclampsia with signs of serious, progressive disease which may include uncontrollable blood pressure, eclampsia, pulmonary oedema, progressive deterioration of biochemical parameters, or severe foetal compromise. Before operative delivery, blood pressure should be stable below 150/100 mmHg. Women with chronic or gestational hypertension should be offered planned delivery at 38-40 weeks’ gestation. Antihypertensive treatment should be continued at least one week after delivery. Lifelong yearly blood pressure monitoring is recommended to all women with HDPs.

Variations in emergency care for severe pre-eclampsia in Uganda: a national evaluation study

Variations in emergency care for severe pre-eclampsia in Uganda: a national evaluation study

Relationship between Age and Parity with Late Onset Severe Preeclampsia at PKU Muhammadiyah Surabaya Hospital

Maternal and fetal mortality is 31.15% due to undetected preeclampsia leading to eclampsia. Pre-occurrence of eclampsia is often characterized by severe preeclampsia symptoms such as increased blood pressure, and proteinuria, furthermore, preeclampsia is also divided into 2 types, based on the time of symptom onset, in early-onset type preeclampsia appears at <34 weeks of gestation while for late-onset appears at >34 weeks of gestation. Extreme age and multigravida parity are risk factors for severe preeclampsia. This study aims to determine the relationship between age and parity with late-onset severe preeclampsia. This study used a cross-sectional study design, sampling method used nonprobability sampling techniques with observational analysis on pregnant women diagnosed with preeclampsia at PKU Muhammadiyah Surabaya Hospital for January 2022 - November 2023. The data collection instrument used medical record data, which was analyzed using Chi-Square. In the analysis obtained for the relationship between age and preeclampsia, the large p-value is 0.16 <0.05. The relationship of parity with preeclampsia is 0.004 < 0.05, thus proving a relationship between age and parity with late-onset severe preeclampsia at PKU Muhammadiyah Surabaya Hospital. In conclusion, there is a relationship between age and parity with late-onset severe preeclampsia at PKU Muhammadiyah Surabaya Hospital.

Emergency Pregnancy with Severe Preeclampsia and Total Atrioventricular Block In A 28-Year-Old Woman

The co-occurrence of preeclampsia with bradycardia due to total atrioventricular block (TAVB) during pregnancy is a rare yet severe phenomenon. There is limited literature available on this specific combination. This case report aims to contribute valuable insights by documenting the clinical presentation and management of a 28-year-old woman who is diagnosed with severe preeclampsia and total atrioventricular block during pregnancy. A 28-year-old pregnant woman was referred to the emergency room with dyspnea and vaginal discharge. She had a history of cardiac issues, including atrial septal defect and total atrioventricular block. Her blood pressure was 206/129 mmHg, and a pulse rate of 67 beats per minute. Then, she was diagnosed with severe preeclampsia, hypertensive emergency, and impending eclampsia with a suspect congenital disease contributing to her atrioventricular block. The patient underwent urgent cesarean section intrauterine stabilization and received postoperative care. Postoperatively, the patient reported no further dyspnea or bradycardia. The history of salbutamol usage and the activation of plasminogen activator inhibitor-1 (PAI-1) in patients with atrial septal defects (ASD) is suspected as a potential etiological factor in the pathophysiology of preeclampsia during pregnancy. TAVB can be induced by congenital ASD. In conclusion, the use of salbutamol and activation of PAI-1 in patients with TAVB induced by ASD are suspected as potential causes of preeclampsia during pregnancy.

Association Between Serum Uric Acid Levels and Severe Pre-Eclampsia

Association Between Serum Uric Acid Levels and Severe Pre-Eclampsia

Acute Lung Oedema in Severe Pre-eclampsia: Advanced Management and Anesthetic Interventions

Acute Lung Oedema in Severe Pre-eclampsia: Advanced Management and Anesthetic Interventions

Microalbuminuria, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1) as predictors of preeclampsia and gestational diabetes mellitus

Background: The health of young women of reproductive age is a key factor that directly influences the health of future generations. Therefore, early detection of chronic diseases, including chronic kidney disease, in this category of patients is one of the primary objectives of healthcare services. From an obstetric perspective, preventing chronic kidney disease can be linked to the early detection and prediction of preeclampsia and gestational diabetes mellitus. In the literature, there are studies that investigate microalbuminuria, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1) as predictors of these obstetric complications. Aim: The aim of this study was to evaluate microalbuminuria, KIM-1, and NGAL as markers for the development of gestational diabetes mellitus and preeclampsia. Materials and methods: This prospective study was conducted at the Department of Obstetrics and Gynecology, Academician I.P. Pavlov First Saint Petersburg State Medical University (Saint Petersburg, Russia) and involved 280 pregnant women during the first trimester at 6-13 weeks of gestation. The concentrations of microalbuminuria, KIM-1, and NGAL were measured. The second stage involved assessing the course of pregnancy and the development of obstetric complications in the participants. ROC analysis was performed to assess biological markers as predictors of preeclampsia, and predictive value was evaluated by the area under the ROC curve. Results: The urinary KIM-1 levels in all patients were within the reference values. Microalbuminuria in the range from 30 to 300 mg/L was detected in 20 patients (7.14%). Gestational diabetes mellitus was more common in patients with microalbuminuria above 30 mg/L (p = 0.0358). Elevated serum NGAL levels above the reference values (106 ng/L) were observed in 96 patients (34.2%). Urinary NGAL levels exceeded 9.8 ng/L in 203 patients (72.5%). Moderate or severe preeclampsia developed in 63 (22.5%) pregnant women. ROC analysis of NGAL’s predictive ability showed high sensitivity and specificity for preeclampsia prediction (sensitivity 95.24%, specificity 93.09%, area under the ROC curve 0.93). Conclusions: The data obtained suggest that the assessment of albuminuria, serum NGAL, and urinary NGAL levels in the blood serum and urine of pregnant women during the first trimester of gestation may serve as early prognostic biomarkers for gestational diabetes mellitus and preeclampsia.

Evaluation of the utility of the sFlt-1/PlGF ratio in pregnancy complicated by pre-eclampsia - single-center study. Preliminary analysis.

To evaluate relationship between sFlt-1/PlGF ratio, clinical characteristics and outcomes of pre-eclampsia. Retrospective analysis of 29 pregnant women with pre-eclampsia who had measured sFlt-1/PlGF ratio was conducted using electronic medical records from Obstetrics and Perinatology ward of University Hospital in Cracow. Women median age: 33.5 years, number of pregnancies: one 52%, two 15%, three 18%,more than three 15%, number of deliveries: one 59.3%, two 37%, three 3.7%, median body mass index during hospitalization: 29.4 kg/m². Chronic diseases apart from hypertension: 67% of women (diabetes 37%, hypothyroidism 26%, obesity 11%). Median newborns birth weight: 1640 g, median Apgar score at 5 minutes: 8, median umbilical cord blood pH: 7.32. Fetal growth restriction: 28.6% of cases. All deliveries were by c-section. Median gestational age at delivery: 32 weeks. sFlt-1/PlGF ratio was inversely correlated with gestational age at delivery (r = -0.42, p = 0.02). The median sFlt-1/PlGF ratio was higher in women with severe pre-eclampsia (n = 15) than in those with mild pre-eclampsia (n = 14) (211 vs. 57, p < 0.001). sFlt-1/PlGF ratio of > 85 had a sensitivity of 80% and a specificity of 71% for predicting severe pre-eclampsia. sFlt-1/PlGF ratio is useful in assessing the severity and prognosis of pre-eclampsia. sFlt-1/PlGF ratio should not be used as a sole criterion for making clinical decisions, but as an adjunct to other clinical and laboratory parameters.

The Relationship between Soluble Endoglin Levels, Endothelial Nitric Oxide Synthase Levels, and Thrombocyte Count and the Onset of Preeclampsia

Background Early-onset preeclampsia, or EOP, depicts clear placental abnormalities (placental factor), whereas late-onset preeclampsia, or LOP, does not. However, previous studies found varying results on the role of proangiogenic and antiangiogenic factors, including soluble endoglin (sEng), endothelial nitric oxide synthase (eNOS), and thrombocytes in both types of preeclampsia. Objective This study aimed to determine the relationship between sEng levels, eNOS levels, and thrombocyte count with the onset of preeclampsia. Methods A cross-sectional study was conducted on subjects diagnosed with severe preeclampsia receiving treatment at Dr. M. Djamil Hospital Padang from December, 2023, until March, 2024. After meeting the inclusion and exclusion criteria, maternal plasma concentrations of sEng and eNOS were determined by ELISA, while thrombocytes were measured by a complete blood count. Results A total of 40 women with EOP and 40 with LOP participated in this study. This study found no difference between the two groups in eNOS (p = 0.303) and sEng (p = 0.468). However, thrombocyte count differed between early and late-onset PE (p = 0.001). Spearman correlation analysis found a significant correlation between eNOS and sEng (p = 0.033), eNOS and thrombocyte count (p = 0.026), and thrombocyte count and sEng (p = 0.032). Conclusion This study found no difference in proangiogenic and antiangiogenic factors between EOP and LOP, which suggests that a subset of patients with LOP also has an imbalance in the concentrations of proangiogenic and antiangiogenic factors in maternal plasma. However, lower thrombocyte counts in EOP reflect a more severe disease course. This study also found a correlation between eNOS and sEng, eNOS and thrombocyte count, and thrombocyte count and sEng in preeclampsia.

Evaluation of placental growth factor, Vitamin D, and systemic inflammatory index as predictive biomarkers for preeclampsia severity: a retrospective cohort study

AimOur study aimed to evaluate the predictive value of Placental growth factor (PlGF), Vitamin D, and systemic inflammatory index for assessing preeclampsia risk and severity.Materials and methodsThis retrospective cohort study included 457 pregnant individuals who delivered at our hospital between March 2023 and October 2024. Participants were divided into three groups: control (n = 217), mild preeclampsia (n = 101), and severe preeclampsia (n = 67). A separate validation cohort (n = 72) was used to test model performance. Data on demographic, clinical, and laboratory characteristics, including PlGF, Vitamin D, neutrophil, lymphocyte, and monocyte counts, were collected between 16 and 20 weeks of gestation. Logistic regression analysis was performed to identify independent risk factors, and receiver operating characteristic (ROC) curve analysis was used to assess the predictive power of PlGF, Vitamin D, lymphocyte count, and Pan-immune-inflammation value (PIV). The regression models adjusted for potential confounders, including maternal age, body mass index (BMI), and parity.ResultsIn the training cohort, significant differences were observed among control, mild, and severe preeclampsia groups, with severe cases showing elevated PIV (515.8 ± 126.7) and reduced levels of PlGF (12.5 ± 5.8 pg/mL) and Vitamin D (8.4 ± 1.9 ng/mL) compared to controls (P < 0.001). Logistic regression identified lower levels of PlGF (P < 0.001) and Vitamin D (P < 0.001) as significant independent risk factors for severe preeclampsia. PIV was also a strong predictor, showing a high hazard ratio (P < 0.001). In the training and validation cohorts, ROC analysis showed AUC values of 0.774 and 0.751 for PlGF, 0.805 and 0.796 for Vitamin D, 0.688 and 0.675 for Lymphocyte, and 0.724 and 0.752 for PIV, respectively, indicating strong predictive value for PlGF, Vitamin D, and PIV in assessing preeclampsia risk.ConclusionLower levels of PlGF and Vitamin D, along with higher PIV, were independently associated with an increased risk of severe preeclampsia. These findings suggest that PlGF, Vitamin D, and PIV are valuable biomarkers for early identification of high-risk preeclampsia patients, potentially aiding in timely intervention and improved outcomes.

Differences in Plasma Endothelin-1 Levels Before and After MgSO4 Administration in Pregnant Women with Preeclampsia

Introduction: Preeclampsia (PE) is a major cause of maternal morbidity and mortality, particularly in low-resource settings. Although Magnesium Sulfate (MgSO4) is the standard treatment for preventing eclampsia, its precise effects on vascular function, especially regarding Endothelin-1 (ET-1) levels, remain unclear. ET-1, a potent vasoconstrictor, is elevated in hypertensive disorders of pregnancy, contributing to endothelial dysfunction in PE. This study aims to investigate the impact of MgSO4 therapy on plasma ET-1 levels in pregnant women diagnosed with severe PE. Method: This observational follow-up study was conducted at RSUP Prof. Dr. I. G. N. G. Ngoerah, Denpasar, starting in October 2022. Participants included pregnant women with severe PE, aged 20–40 weeks of gestation, receiving MgSO4 therapy. Patients with chronic conditions such as diabetes or pre-existing hypertension were excluded. Blood samples were collected before and after MgSO4 administration, and plasma ET-1 levels were measured using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was conducted using the Wilcoxon test, with a significance level set at p &lt; 0.05. Results: A total of 31 participants, with a mean age of 32.09 ± 6.48 years, were included. Most patients were nulliparous (32.3%) and had a single marriage history (71.0%). Baseline characteristics showed high systolic and diastolic blood pressures (mean 165 and 110 mmHg, respectively), elevated MAP (131 mmHg), and significant proteinuria (+3 in 38.7% of cases). Laboratory results indicated abnormal levels of AST, ALT, LDH, and creatinine, with an average platelet count of 241.35 ± 69.77 x 103/L. Following MgSO4 therapy, ET-1 levels significantly decreased from a median of 12.45 ng/mL to 5.55 ng/mL (p = 0.004), suggesting an improvement in endothelial function. Conclusion: The study findings suggest that MgSO4 not only prevents seizures but also plays a role in reducing vasoconstriction in PE patients through the modulation of ET-1 levels. This supports the potential use of ET-1 as a marker to evaluate the therapeutic efficacy of MgSO4 in PE management, highlighting MgSO4’s broader vascular benefits in treating PE.

Determining the Association between Preeclampsia and the Thyroid Hormone Status in Pregnant Women

Background: Preeclampsia is a significant multisystem disorder in pregnancy care that hormonal, environmental, and genetic factors can cause. Aim: This study aimed to investigate the relationship between preeclampsia and thyroid hormone levels in pregnant women. Method: This case-control study was conducted in 2022 with 200 pregnant women in southeast Iran, utilizing a convenience sampling method. The participants included 100 women in the preeclampsia group and 100 in the normal pregnancy group. Data related to preeclampsia were obtained from the Integrated Health System (SIB) at the health center in Jiroft city, while information about the thyroid hormones was extracted from the Ministry of Health's SIB system. The data were analyzed using SPSS-26 software, employing both descriptive and inferential statistical tests Results: Systolic pressure was significantly higher in the preeclampsia group (149.14 mm Hg) than in the control group (105.33 mm Hg), and diastolic pressure also showed a significant difference (94.57 mm Hg in preeclampsia vs. 64.33 mm Hg in normal pregnancies). Thyroid-stimulating hormone (TSH) levels were significantly higher in the preeclampsia group (3.7) compared to the normal pregnancy group (2.5), indicating a notable difference (P&lt;0.005). Thyroid thyroxine (TT4) levels were significantly lower in the preeclampsia group (10.78) compared to the control group (12.5) (P&lt;0.005). Conclusion: Thyroid function significantly impacts the risk and severity of preeclampsia, with elevated TSH and reduced TT4 levels indicating potential complications. Monitoring these hormone levels is crucial for managing affected pregnancies. It is recommended that health policymakers include thyroid function screening in prenatal care protocols.

Sphingosine-1-Phosphate, a Marker of Endothelial Injury and Disease Severity in Preeclampsia.

Preeclampsia is a hypertensive pregnancy disorder marked by endothelial damage. Healthy endothelium is covered by a protective glycocalyx layer, which, when degraded, releases detectable products into the blood. Sphingosine-1-phosphate (S1P) is a cardiovascular biomarker involved in glycocalyx preservation, linked to placentation and preeclampsia development. The study aimed to test the hypothesis that plasma S1P is altered alongside glycocalyx degradation products in severe preeclampsia compared with controls. We included 121 females: 41 with severe preeclampsia requiring treatment in the intensive care unit, 40 with preeclampsia but no need of intensive care unit treatment, and 40 with normotensive pregnancies. Plasma levels of S1P and glycocalyx degradation products-hyaluronic acid, SDC-1 (syndecan-1), and HSPG2 (heparan sulfate proteoglycan-2)-were analyzed from blood samples taken within 27 hours postpartum. Postpartum plasma S1P was significantly lower in the intensive care unit cohort compared with both preeclampsia controls and normotensive controls (P<0.001). Hyaluronic acid and SDC-1 levels were elevated in the intensive care unit group versus normotensive controls (P=0.009 and P=0.023), while HSPG2 was lower (P<0.001). Plasma S1P correlated with hyaluronic acid and blood pressure. Intensive care patients with severe preeclampsia have lower plasma S1P levels and higher concentrations of glycocalyx degradation products, indicating more pronounced endothelial damage. These findings suggest that S1P is associated with preeclampsia severity and may serve as a biomarker to assess vascular damage in this patient population. Further studies are needed to explore the potential role of S1P in long-term cardiovascular risk assessment for patients with preeclampsia.

Cesarean Section in a Patient with Severe Preeclampsia with Pulmonary Edema: A Case Report

Cesarean Section in a Patient with Severe Preeclampsia with Pulmonary Edema: A Case Report

Fetal growth restriction: features of anamnesis, outcomes of pregnancy and childbirth

Background. Fetal growth restriction (FGR) is a serious medical and social problem, which is associated with high perinatal morbidity and mortality, as well as long-term consequences for offspring. To date, there are no absolute instrumental tests for accurately predicting the condition of the fetus, which justifies the relevance of this study.Objective. To study the features of the anamnesis, the course of pregnancy, and the outcome of childbirth in women with fetal growth restriction.Materials and methods. A retrospective cohort study was conducted using a continuous sample of 200 women who were delivered at the Clinic of the South Ural State Medical University (Chelyabinsk) in 2022. All the women were divided into two groups: group 1 - 30 women with FGR, group 2 - 170 women without FGR. The outcomes of pregnancy and childbirth were studied (the results were obtained by means of a questionnaire, analysis of medical documentation: the book of a pregnant woman, the history of childbirth).Results. There was a low effectiveness of the prognosis of FGR both according to the results of the analysis of anamnestic risk factors and according to laboratory and instrumental screening programs at 11-13,6 weeks of gestation. A low percentage of coverage with drug prevention was registered in the high-risk group of FGR (55%). We found that FGR is associated with other placental disorders, which more often began in the second trimester with changes in uterine and fetal blood flow and progressed as the gestation period increased. Fetal growth restriction is associated with severe preeclampsia, high incidence of premature birth, cesarean section, hypotrophy and severe asphyxia of newborns.Conclusion. The absence of significant anamnestic risk factors, the low effectiveness of predicting fetal growth retardation based on the results of programmatic screening at 11-13,6 weeks require the development of new modern methods for predicting pathology. Research should focus on the development of new fetal diagnostic tools that can improve the accuracy of predicting critical fetal conditions, as well as on the introduction of innovative therapeutic measures aimed at improving placental hemodynamics, which will further optimize the timing of delivery.

The Dose-Dependent Effect of Obesity on Adverse Maternal and Neonatal Outcomes in a Hispanic Population.

To evaluate the frequency of adverse maternal and neonatal outcomes associated with maternal obesity in a Hispanic population. We hypothesized that obesity confers a dose-dependent risk associated with these outcomes. This was a retrospective cohort study of singleton pregnancies delivered between 24 and 42 weeks gestation at an urban county hospital between 2013 and 2021. Body mass index (BMI) at first prenatal visit was used as a proxy for pre-pregnancy weight. Patients were excluded if their first trimester BMI was not available. Trends in adverse outcomes across increasing obesity classes were assessed. During the study period, 58,497 patients delivered a singleton infant, of which 12,365 (21.1%), 5429 (9.3%), and 3482 (6.0%) were in class I, II, and III obesity, respectively. Compared with non-obese patients, more obese patients were more likely to be younger and nulliparous with a higher incidence of hypertension and pregestational diabetes. Higher BMI was associated with a significant dose-dependent increase in cesarean delivery (27% for non-obese, 34% for class I, 39% for class II, and 46% for class III obesity); severe preeclampsia (8% in non-obese and 19% for class III obesity); and gestational diabetes (5% in non-obese and 15% in class III obesity). There were significant trends in increasing morbidity for infants born to patients with correspondingly higher obesity classes. Some of these adverse outcomes included respiratory distress syndrome, neonatal intensive care unit admission, fetal anomalies, and sepsis (all p < 0.001). Increasing body mass index is associated with a significant dose-dependent increase in multiple adverse perinatal outcomes in a Hispanic population. Associated adverse maternal outcomes include severe preeclampsia, gestational diabetes, and cesarean delivery. Infants born to patients with correspondingly higher BMI class have significantly increased associated morbidity. Often, only higher BMI classes are significantly associated with these adverse outcomes.