Uncomplicated Preeclampsia Research Articles

Pathogenesis Specifics of Allergic Reactivity in Hypertensive Conditions of Pregnants

Introduction: Significant allergic reactions and anaphylactic type cytotoxicity are registered in thepathogenesis of cell damage in pregnant women with hypertensive conditions. Determining role ofindirect mast cell degranulation and allergic changes in neutrophils during pregnancy that complicated bypreeclampsia, allows to identify the allergic status of the body, which is very importance for improvingthe quality of early diagnosis, treatment and prevention. The purpose of the study was to identify theallergic reactivity of pregnant women suffering from hypertensive disorders and to develop practicalrecommendations to improve the quality of early diagnosis.Materials and Method: We observed 6 group of participants: pregnant women with clear allergy clinic,uncomplicated preeclampsia, pregnant women with light stage of preeclampsia, latent sensitization, pregnantwomen with preeclampsia combined with clear allergy clinic, conditionally healthy pregnant women – 1stcontrol group, practically healthy non-pregnant women – 2nd control group, practically healthy men – 3rdcontrol group. Using non-infection allergens, we called different types of allergic reactions and conductedclinical and allergic examinations, general test of bleed, urine, feces, indirect mast cell degranulation testand neutrophil alteration test.Results: Within all control groups, the rate of positive reaction against the allergic agents made up less than10 percent. In all pregnant women with clear clinical picture of allergies complicated or uncomplicatedpreeclampsia, as well as in pregnant women with preeclampsia with latent sensibilization, mast celldegranulation indexes were 4.5-8.6 times higher than that of control group. Among 90 examined pregnantwomen, positive reactions of indirect mast cell degranulation were observed in 204 cases.Conclusion: In cell damage pathogenesis during preeclampsia, anaphylactic and cytotoxic type allergicreactions play important role. The positive reactions of indirect mast cell degranulation in pregnant womenwith an explicit allergy complicated by preeclampsia is significantly higher than in pregnant women withpreeclampsia with hidden sensitization.

Neutrophil gelatinase-associated lipocalin as a diagnostic marker of acute kidney injury in pre-eclampsia.

Neutrophil gelatinase-associated lipocalin (NGAL) is an emerging biomarker for early diagnosis of acute kidney injury (AKI). This study investigated the use of urinary NGAL as a marker of AKI in women with pre-eclampsia. Urine and serum samples were collected over 24 h from 78 healthy and 109 pre-eclamptic women, with baseline samples taken at admission to the maternity unit; NGAL was assayed in serial urine samples. Baseline neutrophil gelatinase-associated lipocalin did not differ significantly between women who were healthy, those with pre-eclampsia, or with AKI (P = 0.55 for trend). When the pre-eclamptic group was divided into those with eclampsia (median, 60.5 ng/mL; IQR, 23.4-173 ng/mL; n = 19), uncomplicated pre-eclampsia (median, 18.8 ng/mL; IQR, 7.5-52.8 ng/mL; n = 48; P < 0.05 vs eclampsia), imminent eclampsia (median, 30.7 ng/mL; IQR, 13.9-49.3 ng/mL; n = 22) and pre-eclampsia with acute kidney injury (median, 60.3 ng/mL; IQR, 23.5-159 ng/mL, n = 14), however, NGAL level did differ. On multivariate regression analysis, the only significant correlate of NGAL level was the presence of eclampsia (beta = 0.22, P < 0.05). On receiver operating characteristic curve analysis, baseline NGAL did not discriminate between subjects with or without AKI (area under the curve, 0.61; 95%CI: 0.43-0.78; P = 0.12). Neutrophil gelatinase-associated lipocalin level at baseline and over a 24-h period does not provide a suitable diagnostic test for AKI in pre-eclamptic subjects.

Construcción y validación de una escala de factores de riesgo para complicaciones de preeclampsia

Introduction and objectiveTo construct and validate a risk factor scale to help predict the complications of preeclampsia in the population attended by the Obstetrics and Gynecology Hospital (HGO) of the Maternity Institute of Mexico (IMIEM). Patients and methodA case-control study was conducted between January 1, 2012 and March 31, 2013 in patients with pre-eclampsia with or without complications. We performed a bivariate analysis and a multivariate analysis with the risk factors obtained to create and validate a tool able to predict the complications of pre-eclampsia. Emergency department and intensive care unit of the Obstetrics and Gynecology Hospital.We reviewed 345 records. There were 115 patients with complications and 230 with uncomplicated pre-eclampsia. Primary endpointsMaternal death, HELLP syndrome, eclampsia, acute kidney injury, thrombocytopenia, coagulopathy, hemorrhage, pulmonary edema, pulmonary embolism, and cerebral vascular events. ResultsThe following 12 variables able to predict complications of preeclampsia were obtained: maternal age <20 years, gestational age at diagnosis of preeclampsia, headache, dyspnea, oliguria, thrombocytopenia, mean platelet volume, international normalized ratio (INR), serum creatinine, uric acid, glutamic oxaloacetic transaminase and lactic dehydrogenase. These risk factors were used to construct the scale. Sensitivity was 93% and specificity was 80%. LR+ was 4.65 and the LR- 0,09. ConclusionThe application of this risk factor scale can predict the complications of preeclampsia.

Hypoproteinemia in the second trimester among patients with preeclampsia prior to the onset of clinical symptoms

Objective: To find a risk factor for “uncomplicated” preeclampsia (PE) comparing blood biochemical parameters between women with uncomplicated PE and healthy pregnant women in each trimester of pregnancy. Methods: A retrospective study was performed on 83 cases of uncomplicated PE, selected from 434 patients with PE, disregarding subjects with other complications relevant to hypertension during pregnancy. The study was limited to women with PE occurring in the third trimester, and records of blood biochemical parameters were evaluated. Controls were recruited from 108 healthy volunteers with normal singleton pregnancies. Results: A significant decrease in total protein was observed in the uncomplicated PE group in the second trimester prior to the onset of clinical symptoms. Conclusion: Hypoproteinemia during pregnancy may be a risk factor for this pathophysiology, and the maintenance of sufficient protein in early pregnancy could contribute to prophylaxis for women with uncomplicated PE.

Perinatal outcome of pre-eclampsia in parous women

Women with a second and recurrent pre-eclampsia pregnancy have more adverse pregnancy outcomes compared with women with pre-eclampsia in the first pregnancy. A retrospective cohort study was performed to compare the clinical characteristics and perinatal outcomes of pre-eclampsia in parous women who had complicated pre-eclampsia in previous pregnancies (n = 69) and uncomplicated pre-eclampsia in previous pregnancies (n = 312) from 2006 to 2010, in the Fujian Maternity and Child Health Hospital. No statistical significant differences were observed between the two groups in terms of: maternal age, admission blood pressure and BMI; prenatal care times, hospitalisation time, laboratory results and incident rates of complications. The incident and delivery weeks were earlier and the renal injury, caesarean section and small for gestational age (SGA) incidence rates were higher in recurrent pre-eclampsia women. Women with recurrent pre-eclampsia had adverse perinatal outcomes when compared with parous women with pre-eclampsia who had not had pre-eclampsia in prior pregnancies.