Treatment Of Severe Pre-eclampsia Research Articles

Enoxaparin sodium combined with magnesium sulfate in the treatment of severe preeclampsia

Objective: To observe the treatment of severe preeclampsia in newborns with enoxaparin sodium combined with magnesium sulfate.
 Methods: A retrospective analysis was conducted on the clinical data of 80 patients with severe preeclampsia admitted to Hefei Second People’s Hospital, China from January 2019 to December 2020. Treatment records showed that 40 cases received magnesium sulfate treatment (single group), and 40 cases received enoxaparin sodium combined with magnesium sulfate treatment (combination group). Levels of D-dimer, soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PLGF), Apgar scores of newborns delivered before and after treatment were compared. Gestation weeks and incidence of adverse reactions were analyzed.
 Results: After treatment, levels of D-dimer, sfit-1 and adverse reactions in the combination group were significantly lower than those in the single group (P<0.05), and the level of PLGF, newborn Apgar score and length of gestation were significantly higher than those in the single group (P<0.05).
 Conclusion: Compared to magnesium sulfate alone, the combination of enoxaparin sodium and magnesium sulfate in the treatment of pregnant women with severe preeclampsia can more effectively regulate the cytokine level of patients, improve pregnancy outcome, and improve neonatal Apgar score. The incidence of adverse reactions is low, making it a safe and efficient treatment modality.
 doi: https://doi.org/10.12669/pjms.40.5.9001
 How to cite this: Lu D, Yu J, Sang L. Enoxaparin sodium combined with magnesium sulfate in the treatment of severe preeclampsia. Pak J Med Sci. 2024;40(5):870-874. doi: https://doi.org/10.12669/pjms.40.5.9001
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

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

Subcapsular hepatic hematoma as a complication of severe preeclampsia: a case report

BackgroundSubcapsular hepatic hematoma is a rare and life-threatening complication of pregnancy. It is most commonly associated with severe preeclampsia and hemolytic anemia, elevated liver enzymes, and low platelets syndrome. Patients with subcapsular hepatic hematoma typically present with epigastric, right upper quadrant or shoulder pain, nausea and vomiting, and/or shortness of breath. Here we describe a patient with a classic pain presentation, a large unruptured hematoma, and an unusual postpartum course.CaseA 40-year-old gravida 1 para 0 Caucasian woman presented at 39 + 6 weeks gestational age with a 3-day history of new onset pain in an otherwise uncomplicated pregnancy. She described the pain along her right torso as severe, shooting, and sharp, but at times pleuritic in nature. She was found to have new onset preeclampsia and hemolytic anemia, elevated liver enzymes, and low platelets syndrome. Induction of labor was initiated and eventually she delivered by cesarean section. Her pain persisted in the postpartum period and abdominal computed tomography scan revealed a 16 cm subcapsular hepatic hematoma. Despite the hematoma being thin walled, conservative management was recommended by the general surgeon. She then re-presented on postpartum day 15 with tachypnea, dyspnea, and pleuritic chest pain. Secondary to the subcapsular hepatic hematoma, she then developed an infected and loculated, large pleural effusion. This required video-assisted thoracoscopic surgery before her eventual discharge home on postpartum day 21.ConclusionsThere should be high clinical suspicion of subcapsular hepatic hematoma in patients with persistent pain in the right upper quadrant of the abdomen. Urgent imaging to investigate for subcapsular hepatic hematoma is then indicated. Cesarean delivery without labor and treatment for severe preeclampsia should be undertaken if subcapsular hepatic hematoma is found. Conservative management and serial imaging are reasonable for the follow-up of a large, unruptured hematoma. Hepatic artery embolization should also be considered. Subcapsular hepatic hematoma may be complicated by infected pleural effusions and require video-assisted thoracoscopic surgery.

A One-Year Cross Sectional Analysis of Emergency Medical Services Utilization and Its Association with Hypertension in Pregnancy

Objective: To evaluate the prehospital obstetric population that utilizes emergency medical services (EMS) and their association with hypertensive disorders of pregnancy. Methods: We conducted a retrospective evaluation of one year of all medical calls from a large, municipal, midwestern fire department. Inclusion criteria included all pregnant patients transported to a hospital by EMS. Descriptive statistics were calculated to evaluate prehospital event information (e.g., zip code, time, and duration of call), patient characteristics, and clinical management data regarding blood pressure. Census data were used to compare neighborhood information with poverty rates. Results: Of the 1,575 identified patients, 64.4% (1015/1575) presented with obstetric complaints, 57.4% (700/1220) were in their third trimester and 72.7% (686/944) were multiparous. The median call duration was 17 (interquartile range 12–22) minutes. In the areas where EMS usage was highest, one quarter of individuals lived below the poverty level. Of the studied population, 32.0% (504/1575) were found to be hypertensive; 14.9% (75/504) of hypertensive patients were found to have severe hypertension. Only one patient (1/1575, 0.06%) presented with a chief complaint of hypertension; the rest were discovered by EMS. The highest rates of hypertension were noted in wealthier areas of the city. Patients with severe hypertension were more likely to present with seizures, consistent with eclampsia. Conclusion: Hypertension is common in the obstetric population using EMS. Prehospital management of hypertensive disorders of pregnancy may focus on identification and treatment of severe pre-eclampsia or eclampsia. Areas with longer call times may consider treatment of severe hypertension. Prehospital treatment of hypertensive disorders of pregnancy could be optimized.

Options of severe preeclampsia treatment

Background. Preeclampsia (PE) occurs in 2-8 % of all pregnancies. Every day 210 women die from PE, and neonatal losses are even greater (1380 children per day). Fatal complications of severe PE include cerebral hemorrhage, cerebral edema, pulmonary edema, placental abruption, adrenal hemorrhage, dissecting aortic aneurysm, HELLP syndrome, disseminated intravascular coagulation syndrome. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE.&#x0D; Objective. To describe the options of severe PE treatment.&#x0D; Materials and methods. Analysis of literature data on this issue.&#x0D; Results and discussion. The pathogenesis of PE is based on total damage to the vascular endothelium, which leads to an increase in its permeability, including for albumin molecules. Plasma protein loss is accompanied by a drop in oncotic blood pressure and fluid leakage into the interstitial space. Thus, in patients with PE there is an associated disturbance of fluid and electrolyte balance: along with intravascular dehydration there is extravascular hyperhydration. Infusion therapy (IT) allows to overcome this imbalance and to increase the colloid-osmotic pressure. According to modern views, a restricted IT regimen improves the effects of PE treatment. There are two ways to correct this disorder: an increase in oncotic blood pressure due to infusion of albumin (indicated in case of blood albumin levels &lt;25 g/L) and the administration of osmotically active drugs, such as Reosorbilact (“Yuria-Pharm”). The latter option prevents the loss of fluid from the vascular bed and promotes its return to the vessels from the intercellular space. The total fluid volume should be limited to physiological needs, taking into account pathological losses (not more than 1 ml/kg/h). The maximum IT volume should not exceed 800 ml per day. The drugs of choice for IT before delivery are balanced isotonic saline solutions and solutions containing 6 % sorbitol. Fresh-frozen plasma is not recommended for the correction of colloid-oncotic pressure. Influence on the redistribution of fluid in the interstitial space without the introduction of significant volumes of infusion solutions is the main principle of low-volume IT. Recommendations for the administration of Reosorbilact comply with this principle. The low osmolarity of Reosorbilact and its ability to improve the osmotic properties of blood justify the use of this drug in women with PE.&#x0D; Conclusions. 1. PE occurs in 2-8 % of all pregnancies. 2. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE. 3. Restricted IT mode improves the consequences of PE treatment. 4. Osmotically active drugs (Reosorbilact) are prescribed for this purpose.

Deficiency of serum l-arginine levels in severe preeclampsia; a consideration for supplementation

The purpose of this study was to compare serum levels of l-arginine in normal pregnant women, severe preeclampsia, and severe preeclampsia with complications. It was an observational study with a cross-sectional design, 88 third trimester of pregnancy became the sample which consisted of 46 normal pregnant women, 30 severe preeclampsia, and 12 severe preeclampsia with complication. This study conducted in four hospitals in the city of Makassar: Dr. Wahidin Sudirohusodo hospital, education Hospital of Hasanuddin University, Fatimah, and Sitti Khadijah 1 Mothers and Children hospital. Serum blood samples were taken from the antecubital venous blood Assessment of serum l-arginine levels was carried out using the Human l-Arginine Assay Kit. There were significant mean differences between normal, severe preeclampsia and severe preeclampsia with complications. The lowest serum levels of l-arginine were severe preeclampsia with complications (28.33ng/mL), then severe preeclampsia group (34.66ng/mL), and the highest was normal pregnant woman (60.91ng/mL). Severe preeclampsia with complications had the lowest l-arginine level. Role l-arginine level should be considered in the prevention and treatment of severe preeclampsia.

Preeclampsia management: different insight from hospital to hospital approach in Indonesia

Introduction: The incidence of preeclampsia quite high and can cause high morbidity and mortality rates for pregnant women thereby preeclampsia is still a problem experienced worldwide. Preeclampsia in Indonesia still gives a frightening impression for both the mother and the fetus. The key to success in the treatment of preeclampsia is prevention and adequate therapy to reduce morbidity and mortality. Indonesia itself, which is an archipelagic country resulting in far apart geographical location between one central hospital to another central hospital that will cause some differences related to the treatment of preeclampsia itself.Aim: The purpose of this review is to give an overview of the different approaches to handling preeclampsia in hospitals in Indonesia, especially Sanglah General Hospital Denpasar and Kandou General Hospital Manado.Conclusion: There are several differences in the treatment of severe preeclampsia at Sanglah General Hospital Denpasar Bali and Prof. Dr. R.D. Kandou Hospital Manado. The differences found were ways to induce labor, use of corticosteroids, detail of MGSO4 administration, and the selection of antihypertensive drugs.Â

Effects of compound Danshen injection combined with magnesium sulfate on serum MPO and hs-CRP in patients with severe preeclampsia.

Effects of compound Danshen injection combined with magnesium sulfate on serum myeloperoxidase (MPO) and hypersensitive C-reactive protein (hs-CRP) in patients with severe preeclampsia (PE) were investigated. Five hundred patients with severe PE were randomly divided into early-onset observation, early-onset control, late-onset observation and late-onset control groups. Control group was treated with magnesium sulfate, while patients in observation group were treated with magnesium sulfate combined with compound Danshen injection. Serum levels of MPO and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA) and turbidimetric assay. The effects of compound Danshen injection combined with magnesium sulfate on the above indexes were observed. Serum levels of MPO and hs-CRP significantly decreased in early-onset observation, late-onset observation, early-onset control and late-onset control groups after treatment (p<0.05). After treatment, levels of MPO and hs-CRP were significantly lower in early-onset observation group than in early-onset control group (p<0.05), and levels of MPO and hs-CRP were also significantly lower in late-onset observation group than in late-onset control group (p<0.05). Total effective rate of early-onset observation group and late-onset observation group were higher than that of early-onset control group and late-onset control group. Compound Danshen injection combined with magnesium sulfate achieved better treatment outcomes in the treatment of severe PE than magnesium sulfate alone. The combined treatment can effectively reduce the serum levels of MPO and hs-CRP.

Platelet dysfunction in pre-eclamptic mothers

Background: Pre-eclampsia (PE) is a pregnancy-specific hypertensive disorder leading to a high proportion of hospital admission, labor induction, maternal as well as fetal morbidity and mortality. However it is fortunate that with timely detection and prompt management, this disease can often be ameliorated and eclampsia can be prevented. Objective: The objective of this study is to find out the changes in total platelet count (TPC), bleeding time (BT), and clotting time (CT) in pre-eclamptic pregnant women as compared with normal pregnant women. Material and Methods: This was a case–control study which included 60 pregnant women of more than 20 weeks of gestation. Out of these, 30 subjects were normotensive and 30 subjects were diagnosed with pre-eclamptic women. Patients having a past history of hypertension, renal diseases, diabetes during non-pregnant state, drug administration altering hematological profile, and autoimmune disorder were excluded from the study. Blood pressure was measured in all the cases and control subjects and three blood tests, i.e., BT, CT, and TPC were performed for each. Results: There was a significant fall in TPC in PE cases as compared with normal (P < 0.01). But there is significant increase in BT and CT (P < 0.01) in PE as compared with normal pregnant women. Conclusion: From this study, it was observed that BT, CT, and TPC can be used as predictive tests not only for disease process, but also for fetal outcome. This can also help us in early diagnosis and treatment of severe PE in which maternal mortality rate is very high.

138-POS

Objectives The study is intended to analyze determining factors of successful conservative treatment of preeclampsia before 34 weeks of gestation. Methods This is a retrospective analytic observational study. Data were retrieved from medical records of patients admitted to Obstetric Ward of Dr Soetomo Hospital, from July to August 2013. The population of the study was patients with severe preeclampsia going through conservative treatment from January 2008 to December 2012. The inclusion criteria included population with complete medical record and without renal disease, SLE, premature rupture of membrane, and IUGR. The dependent variable in this study is the successful or unsuccessful conservative treatment for severe preeclampsia and the independent variables are gestational age, Esbach protein level, albumin serum level, uric acid level, blood pressure stage, Resistance Index and Pulsatility Index of uterine artery Doppler velocimetry, body mass index, parity, and maternal age. Double regression logistic analysis test was used with significant value if the p n = 15) and those with severe preeclampsia who failed conservative treatment ( n = 43, controls). Results Gestational age was significantly different ( p p = 0.003); the ROC curve obtained a cutoff point value of gestational age 31.5 weeks with sensitivity of 80% and specificity of 76.72%. Therefore, gestational age can be used as a determining factor for conservative treatment. Other determining factors were not significantly different ( p p = 0.226, uric acid p = 0.225, blood pressure p = 0.140, uterine artery PI p = 0.358, uterine artery RI p = 0.292, parity p = 0.133, serum albumin p = 0.943, serum creatinine p = 0.699, body mass index p = 0.962, and maternal age p = 0.589. Conclusions Gestational age is a determining factor for the success of conservative treatment of severe preeclampsia. Disclosures Y. Septivera: None. E. Ernawati: None. M.A. Akbar: None. A. Sulistyono: None. A. Aditiawarman: None. H.T. Joewono: None. E.G. Dachlan: None.

O13. Microvascular and macrovascular hemodynamic effects of nicardipine in the treatment of severe pre-eclampsia

(P = 0.008). aPWV was unaltered, even after adjustment for MAP (P = 0.6). Conclusion: This is the first study to investigate changes in AIx and PWV very early in pregnancy. We have demonstrated profound changes in brachial and central blood pressures and AIx within 2–3 weeks of conception, with no change in aPWV. Furthermore, late first trimester data cannot be used as ‘baseline’ data in order to identify the extent of cardiovascular adaptation in pregnancy as has been hitherto assumed.

Case of asymptomatic portal vein thrombosis after cesarean delivery

We report a case of acute portal vein thrombosis (PVT) after a cesarean delivery. The patient was admitted for treatment of severe pre-eclampsia. On the second day after cesarean delivery, the elevations of aspartic aminotransferase and alanine aminotransferase were observed. Thereafter, acute PVT was diagnosed with ultrasonography. Although early anticoagulant therapy seems to be effective in the treatment of acute PVT, close observation must be made due to the risk of bleeding.

Digoxin Immune Fab Treatment for Severe Preeclampsia

We evaluated the efficacy, safety, and biological mechanisms of digoxin immune Fab (DIF) treatment of severe preeclampsia. Fifty-one severe preeclamptic patients were randomized in double-blind fashion to DIF ( N = 24) or placebo ( N = 27) for 48 hours. Primary outcomes were change in creatinine clearance (CrCl) at 24 to 48 hours and antihypertensive drug use. Serum sodium pump inhibition, a sequela of endogenous digitalis-like factors (EDLF), was also assessed. CrCl in DIF subjects was essentially unchanged from baseline versus a decrease with placebo (-3 +/- 10 and -34 +/- 10 mL/min, respectively, P = 0.02). Antihypertensive use was similar between treatments (46 and 52%, respectively, P = 0.7). Serum sodium pump inhibition was decreased with DIF compared with placebo at 24 hours after treatment initiation (least squares mean difference, 19 percentage points, P = 0.03). DIF appeared to be well tolerated. These results suggest DIF prevents a decline in renal function in severe preeclampsia by neutralizing EDLF. Sodium pump inhibition was significantly improved. Further research is warranted.

Selective termination of a twin pregnancy as a treatment of severe pre-eclampsia

Selective termination of a twin pregnancy as a treatment of severe pre-eclampsia

The first micturition times of the newborns whose mothers were treated with magnesium sulfate.

The aim of this study was to determine whether magnesium sulfate used for the treatment of severe pre-eclampsia or eclampsia had an effect on the first micturition time of the newborn. The first group included 20 newborns all of whose mothers had severe pre-eclampsia or eclampsia, and all mothers had been treated with magnesium sulfate according to the Parkland Memorial Hospital eclampsia regimen. The second group included 20 newborns all of whose mothers were normal pregnants, and did not receive any drug that had an effect on the contractility of smooth muscles. The first micturition times of all newborns in two groups were determined following delivery and were compared statistically. All newborns urinated in the first 24 hours. There were no statistically significant differences in the micturition times between the two groups (p > 0.05). There was no residual urine after the first micturition, and none of them had any urinary tract abnormality and neurological pathology. From the results, it was concluded that magnesium sulfate had no effect on the first micturition time of the newborns, when applied according to the Parkland Memorial Hospital eclampsia regimen in severe pre-eclamptic or eclamptic pregnants.

▪ A New Treatment of Severe Pre-eclampsia by Long-Term Epidural Anaesthesia

▪ A New Treatment of Severe Pre-eclampsia by Long-Term Epidural Anaesthesia

Management of complicated preeclampsia

The complicated preeclamptic patient represents a challenge for the clinician faced with her antepartum or postpartum care. The most serious sequelae of preeclampsia account for a significant portion of maternal morbidity and mortality. Severe preeclampsia also results in an appreciable portion of perinatal morbidity and mortality. In this review, developing trends in the treatment of severe preeclampsia are discussed. Expectant treatment of the patient remote from term, anesthesia choices, and delivery route are reviewed. Developing trends in the pharmacological approach to complicated preeclampsia are discussed. New concepts in the treatment of cerebrovascular preeclampsia and hepatic rupture are outlined and reviewed.

Antioxidants in the treatment of severe pre-eclampsia: An explanatory randomised controlled trial: Metin Gulmezoglu A.; Justus Hofmeyr G.; Oosthuisen M.M.J. GBR Br J Obstet Gynecol 1997 104/6 (689–696)

International Journal of Gynecology & ObstetricsVolume 60, Issue 1 p. 96-96 Citations from the literature Dermatology Antioxidants in the treatment of severe pre-eclampsia: An explanatory randomised controlled trial Metin Gulmezoglu A.; Justus Hofmeyr G.; Oosthuisen M.M.J. GBR Br J Obstet Gynecol 1997 104/6 (689–696) First published: 18 May 2004 https://doi.org/10.1016/S0020-7292(98)90452-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume60, Issue1January 1998Pages 96-96 RelatedInformation

Critical care management of severe pre-eclampsia

Severe pre-eclampsia is a common disorder in developing countries but still remains a significant problem in developed societies. The management of severe pre-eclampsia in developing countries is frequently hampered by lack of adequate facilities; paradoxically those countries with sufficient resources have a lower incidence of the disease and consequently lack experience in the treatment of severe pre-eclampsia. The management of these patients is further compromised because obstetricians generally lack the necessary knowledge and skills in critical care and conversely critical care specialists may lack appreciation and knowledge of pregnancy physiology and pathophysiology. Patients with severe pre-eclampsia therefore present an interdisciplinary challenge to obstetricians and physicians, who need to be familiar with pregnancy physiology and the current concepts in the pathogenesis and pathophysiology of severe pre-eclampsia. Patients who develop multisystem disease are most appropriately managed by an experienced obstetrician in an obstetric intensive care unit with a physician in consultation.

634 Nifedipine in the Second-Line Treatment of Severe Pre-eclampsia Reduces the Amount of Proteinuria

634 Nifedipine in the Second-Line Treatment of Severe Pre-eclampsia Reduces the Amount of Proteinuria