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Objective:To investigate the change of left atrial volume and function in patients with hypertensive disorders of pregnancy (HDPs) by four-dimensional automatic left atrial quantitative analysis (4D LAQ) and analyze the predictive value of risk stratification.Methods:A total of 60 patients diagnosed with hypertensive disorder of pregnancy in Henan Provincial People′s Hospital from March to December 2021 were randomly enrolled, which were divided into gestational hypertension group (low risk group, n=30) and preeclampsia group (medium and high risk group, n=30) according to the disease development and risk stratification method reported in the literature; another 30 healthy pregnant women matched for age, gestational weeks and body mass index were selected as the control group. Left atrial anteroposterior diameter (LAd), interventricular septum thickness (IVSd), left ventricular end diastolic diameter (LVd), left ventricular ejection fraction (LVEF), left ventricular myocardial mass index (LVMI), peak early diastolic (E) and late diastolic (A) velocities of mitral inflow, and e′ values on the septal and lateral mitral annulus sides were routinely measured to calculate E/A and E/e′ values. Left atrial volume and strain parameters were obtained using 4D LAQ technique, including left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial presystolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial inflation index (LAEI), left atrial stroke volume (LAEV), left atrial fraction (LAEF), longitudinal strain of left atrial reserve, conduit and systolic period (LASr, LAScd, LASct), circumferential strain of left atrial reserve, conduit and systolic period(LASr-c, LAScd-c, LASct-c). The differences among the three groups were compared. Multiple Logistics regression analysis was used to obtain the relevant indicators of risk stratification of HDPs and ROC curves were used for assessment. Results:Compared with the control group, E/e′, LAVmin, LAVpreA, LAScd, and LAScd-c increased, and LAEI, LAEF, LApEF, LASr, and LASr-c decreased in the gestational hypertension group (all P<0.05). Compared with the control group and gestational hypertension group, LAd, IVSd, LVd, LVMI, E/e′ LAVmin, LAVmax, LAVpreA, LAVImax, LAEV, LAScd, and LAScd-c increased, and LVEF, LAEF, LAEI, LApEF, LASr, and LASr-c decreased in the preeclamptic group, and the differences were statistically significant (all P<0.05). The results of multiple Logistics regression showed that LAVmax, LAScd-c and LASr were the indicators relevant to risk stratification of HDPs(β=0.344, 0.216 and -0.249, respectively, all P<0.05). ROC analysis showed when the cut-off value of left atrial strain parameter LASr was 30.5%, the AUC, sensitivity, and specificity were 0.725, 0.58, 0.90, respectively; when the cut-off value of LAVmax was 44.5 ml, the AUC, sensitivity, and specificity were 0.662, 0.80, and 0.56, respectively; and when the cut-off value of LAScd-c was -17.5%, the AUC, sensitivity, and specificity were 0.706, 0.56, and 0.78, respectively. Conclusions:Left atrial remodeling occured in pregnant women with hypertensive disorders, their reserve and conduit function were impaired, and aggravated with the progress of the disease. The four-dimensional parameters LASr, LAVmax, and LAScd-c were relevant indicators for risk stratification of HDPs. In predicting the severity of HDPs, LASr has high diagnostic value and good specificity; LAVmax and LAScd-c can be considered as supplementary parameters to predict the risk stratification of HDPs.
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Abstract@#Hypertensive disorders of pregnancy (HDP) are a common severe complication during pregnancy, which is characterized by complex etiology, unclear pathogenesis and lack of effective tools for early diagnosis and prediction. Recently, the development of omics technology provides new insights into the research into HDP. Based on national and international publications from 2011 to 2022, this review summarizes the application of genomics, proteomics, metabolomics, and microbiomics in the pathogenesis and prediction of HDP, so as to provide insights into the prediction, prevention and precise treatment of HDP.
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Abstract Objective To evaluate the fetal and maternal effects of the severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection in women with hypertensive disorders of pregnancy. Methods Patients with hypertensive disorders of pregnancy and SARS-CoV-2 polymerase chain reaction (PCR) positivity (n = 55) were compared with cases with similar characteristics and PCR negativity (n = 53). The study group was further divided into two groups as severe (n = 11) and nonsevere (n = 44) coronavirus disease 2019 (COVID-19). The groups were compared in terms of clinical characteristics and perinatal outcomes. Results The study and control groups were similar in terms of maternal age, parity, gestational age at diagnosis, type of hypertensive disorders, magnesium sulfate administration rate, gestational age at birth, birth weight, Apgar scores, and maternal complications. However, all cases of fetal loss (n = 6) were observed in the SARS-CoV-2 positive group (p = 0.027). From the 6 cases, there were 5 in the nonsevere group and 1 patient in the severe SARS-CoV-2 positive group. Moreover, higher rates of maternal complications, lower oxygen saturation values, and intensive care unit admissions were observed in the severe COVID-19 group. Conclusion Physicians should be cautious about the management of hypertensive disorders of pregnancy cases with SARS-CoV-2 positivity. Fetal loss seems to be more common in cases with SARS-CoV-2 positivity and severe COVID-19 seems to be associated with higher rates of maternal complications. Close follow-up for fetal wellbeing and active management of severe cases in terms of maternal complications seem to be favorable.
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Humans , Female , Pregnancy , Pre-Eclampsia , Perinatal Care , COVID-19/complications , HypertensionABSTRACT
Introduction/Context: Hypertensive disorders of pregnancy (HDP) are major complications of pregnancy and seen in about 5% to 10% of all pregnancies. Among these, pre-eclampsia is a leading cause of perinatal and fetal morbidity and mortality. It is a multifactorial and multisystemic disorder that results in a variety of histomorphologic features, some of which may be missed if a diligent examination is not performed. Aims and Objectives: The present study aimed to propose a checklist and novel scoring system to ensure comprehensive placental examination. We also aimed to evaluate the correlation, if any, between histopathological and morphometric findings in HDP and with fetal growth. Materials and Methods: A total of 100 placentas of women diagnosed with hypertensive disorders of pregnancy were included in our cross-sectional, observational study. Morphometric features and histological features that are known to be seen in HDP were analyzed, and each of them was given a numerical score based on their severity. Statistical Analysis Used: Pearson correlation coefficient test was applied to correlate these findings, and ANOVA test was used to assess the correlation of these findings with fetal growth restriction (FGR). Results: More than 50% of the placentas studied recorded maximum scores for weight and volume. At least 25% of the placentas showed the presence of all histo-pathological features under study. The association of total morphometric and histological scores was not found to be statistically significant (P-value = 0.239). We found a significant difference between means of morphometric scores of cases with normal fetal growth and cases showing FGR (P-value = 0.008). Conclusion: Uneven distribution and presentation of the lesions in these cases may lead to the absence of correlation between morphometry and histopathology, as seen in our study. Morphometric derangements in the placenta correlate with FGR. Our proposed checklist and scoring system can be utilized to standardize reporting of placental specimens in the evaluation of placentas with HDP, in order to facilitate and standardize the placental reporting.
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OBJECTIVES@#To study the effect of hypertensive disorders of pregnancy on peripheral venous blood cell count in preterm infants with a gestational age of 28-34 weeks.@*METHODS@#A total of 227 preterm infants with a gestational age of 28-34 weeks who were admitted to the Department of Pediatrics, the First Hospital Affiliated to Kunming Medical University, from January to December 2020, and whose mothers had hypertensive disorders of pregnancy were enrolled as the study group. A total of 227 preterm infants with a gestational age of 28-34 weeks who were admitted during the same period and whose mothers did not have hypertensive disorders of pregnancy were enrolled as the control group. According to maternal blood pressure during pregnancy, the study group was divided into three subgroups: gestational hypertension (n=75), mild preeclampsia (n=81), and severe preeclampsia (n=71). According to the birth weight of the preterm infants, the study group was divided into two subgroups: small for gestational age (SGA) (n=113) and appropriate for gestational age (AGA) (n=114). Peripheral blood cell count on day 1 after birth was compared between the study and control groups, as well as between the subgroups of the study group.@*RESULTS@#Compared with the control group, the study group had significantly lower white blood cell count, absolute neutrophil count, and blood platelet count (P<0.05) and significantly higher incidence rates of leucopenia and neutropenia (P<0.05). The subgroup analysis showed that the mild preeclampsia and severe preeclampsia subgroups had significantly lower white blood cell count, absolute neutrophil count, and blood platelet count than the gestational hypertension subgroup (P<0.05), and that the SGA subgroup had significantly lower white blood cell count, absolute neutrophil count, and blood platelet count than the AGA subgroup (P<0.05).@*CONCLUSIONS@#Hypertensive disorders of pregnancy can affect the peripheral venous blood cell count of preterm infants, which is more significant in infants with maternal preeclampsia and SGA infants.
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Child , Female , Humans , Infant , Infant, Newborn , Pregnancy , Gestational Age , Hypertension, Pregnancy-Induced , Infant, Premature , Infant, Small for Gestational Age , Platelet CountABSTRACT
Objective:To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics.Methods:The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized.Results:A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360).Conclusions:The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.
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@#AIM: To explore the incidence and high risk factors of retinopathy of prematurity(ROP).<p>METHODS:Retrospective study. A total of 161 neonates in Gaozhou People's Hospital from January 2018 to January 2021 who met the screening guidelines for retinopathy of prematurity in China(2014)were selected as subjects. Retcam Ⅲ was used for fundus screening. Clinical data of neonates and their mothers were analyzed retrospectively. Univariate analysis and Logistic regression analysis were used to analyze the risk factors for ROP.<p>RESULTS: Among 161 neonates meeting the inclusion criteria, 26(16.1%)were in the ROP group and 135(83.9%)were in the non-ROP group. Gestational age, neonatal red blood cell count, birth weight, maternal age, gestational hypertension, method of conception showed statistical significance between the two groups(<i>P</i><0.05)in Univariate analysis. Multivariate Logistic regression analysis revealed that age(<i>OR</i>=0.549, 95%<i>CI</i>: 0.391-0.770, <i>P</i>=0.001)is a protective factor of ROP, however, hypertension during pregnancy(<i>OR</i>=3.947, 95%<i>CI</i>: 1.049-14.852, <i>P</i>=0.042)and assisted reproductive(<i>OR</i>=4.632, 95%<i>CI</i>: 1.112-19.305, <i>P</i>=0.035)are risk factors of ROP.<p>CONCLUSION: Gestational age is a protective factor for ROP, and assisted reproduction is a risk factor for ROP. High attention should be paid to the neonates with low gestational age, assisted reproductive technology and whose mother has hypertensive disorders of pregnancy. Early screening, early detection, and early treatment of neonatal fundus may reduce blindness caused by ROP.
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Background: CPR is emerging as an important predictor of adverse pregnancy outcome and helps in management of high risk pregnancy. Therefore we undertook the study to find the correlation of CPR with perinatal outcomes in women with hypertensive disorder complicating during third trimester.Methods: 128 patients with hypertensive disorder of pregnancy, ≥32 weeks of singleton gestation, were randomly selected during their hospital visit. They were subjected to USG Doppler study to calculate MCA/UA pulsatility index-CPR. The CPR<1 was considered abnormal and >1 as normal. These results were compared with the perinatal outcome and adverse fetal outcome.Results: The present study revealed that the incidence of adverse outcomes like Apgar score <7 (36.5%), still birth (15.9%), NICU admission (69.8%) and LBW i.e. <2500 gm (68.3%) were significantly higher in abnormal CPR than normal CPR.Conclusions: Abnormal CPR is valuable in predicting the outcome of hypertensive disorders in pregnancy. CPR is an easy procedure which can be included in the routine antenatal sonographic evaluation to predict poor perinatal outcome and to detect or recognize those fetuses at risk.
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Background: Eclampsia is one of the leading causes of maternal mortality in India.Methods: A prospective observational study was done on 200 pregnant women admitted with antepartum eclampsia in Malda Medical College from 1 April 2017 to 30 October 2019. Group A included patients who delivered through vaginal route within 10 to 12 hrs of eclampsia by stabilisation of patients while Group B included subjects who underwent early caesarean section for uncontrolled convulsions or poor Bishop score. Maternal and perinatal outcomes were compared between the groups. Data was recorded in a pretested performa and was analyzed using appropriate statistical methods with SPSS.Results: Caesarean section (group B) was done in 130 cases (65%) while vaginal delivery (group A) was done in 65 cases (37.5%). Group A had higher maternal mortality (10.7%) in comparison to group B (4.6%) which was statistically not significant (p=0.1075). There were 32 neonatal deaths (24.6%) and 11 still births (8.46%) in group A while there were 12 neonatal deaths (18.46%) and 3 still births (4.61%) in group B. There was a statistically significant difference (p<0.0001) between the groups with respect to total perinatal deaths.Conclusions: Antenatal and intranatal eclampsia should be managed by early termination of pregnancy preferably with Caesarean section. Early presentation and timely decision to terminate pregnancy will improve the maternal and perinatal outcome.
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Background: A major challenge in obstetrics is early identification of hypertensive disorders of pregnancy (HDP). This study was performed to determine the association between elevated maternal serum β-hCG levels and HDP, the correlation between serum β-hCG level and severity of preeclampsia and to determine the value of serum β-hCG level as a diagnostic marker for early diagnosis of HDP.Methods: This was a hospital based observational study conducted in the department of obstetrics and gynecology, Rajendra Institute of Medical Sciences, Ranchi on 375 pregnant women with period of gestation more than 20 weeks, including 250 pregnant women with HDP as study group and 125 normotensive pregnant women as controls. Serum β-hCG concentration was measured and its level was compared between two groups.Results: The maternal mean serum β-hCG levels (51161.08±30038.21 IU/L) of study group of HDP were higher than the normotensive control group (17603.23±16748.21 IU/L). In non-severe preeclampsia, the mean serum levels were 36417.32±23876.74 IU/L while in severe preeclampsia, 60030.34±28771.31 IU/L. There was statistically significant difference (p<0.001) with higher levels in early onset preeclamptic mothers than late onset preeclampsia. The cut-off point of β-hCG for predicting HDP was 32077 IU/L with sensitivity of 65% and specificity of 86%.Conclusions: Serum β-hCG level is higher in HDP when compared to normotensive women. Higher levels of β-hCG are associated with increasing severity of hypertensive disorders of pregnancy. The utility of serum β-hCG as a diagnostic test is limited because of low sensitivity and difficulty in deciding the cut-off value.
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IUFD is a major obstetrical complication and is an important indicator of perinatal health in a given population. Literally, intrauterine foetal death (IUFD) is considered as all foetal deaths weighing 500 g or more occurring both during pregnancy and during labour. We wanted to asses maternal and foetal factors associated with intrauterine death, and formulate effective strategies for prevention of IUFD. MethodsThis was a prospective study carried out in a GMC Jagdalpur from July 2019 to mid-November 2019. All the admitted patients of our department with gestational age >28 weeks (confirmed by LMP or by USG) diagnosed as having IUFD (confirmed by USG) were included in the study. ResultsTotal number of deliveries during the study was 1455 and total number of IUFD was 109. Incidence of intrauterine death was 7.49%. Majority of the cases were of age group 26-30 years that is 39.44% (43/109) while teenager (16-20 years) pregnancies were only 11.92%. Most of the cases were preterm (67/109) around 61.46% and only 2.75% cases were post term. In 22.01% (24/109) cases, causes were not identified while in 77.99% cases (85/109) causes were identified. Hypertensive disorder was the major cause of IUFD (27.5%) followed by unknown aetiology (22.01%), infection (14.67%) and rupture uterus (10.09%). Rural population was 66.97% and urban population was only 33.02%. Most of the cases were primipara 43.11% (47/109) while least number of cases 8.25% (9/109) was of grand multipara. ConclusionsDespite being a tertiary center, incidence of IUFD is much higher than other areas of our country. Cause may be attributed to lack of awareness, illiteracy, and poor infrastructure in periphery, and this being a referral centre for a large area.
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Background: Hypertensive disorders of pregnancy are among the most common medical complications of pregnancy and major cause of maternal, fetal and neonatal morbidity and mortality. The purpose of this study was to compare the efficacy and safety of intravenous hydralazine and labetalol for management of severe hypertensive disorders of pregnancy.Methods: This prospective study was conducted among 100 women admitted with SBP ≥ 160 or DBP ≥ 110 mmHg or both. Patients were divided into 2 groups randomly: labetalol and hydralazine group.Results: Majority of patients (38%) were in the age group of 21-25 years and primigravida (52%). There was more significant decrease in the systolic, diastolic and mean arterial blood pressure at the end of 15 and 30 minutes in labetalol group. Labetalol required fewer doses as compared to hydralazine to achieve the target blood pressure (average 1.95 versus 3.1). Total numbers of term deliveries were 19 (38%) in hydralazine group and 16 (32%) in labetalol group. Pre-term deliveries in hydralazine and labetalol group were 14 (28%) and 15 (30%) respectively. Headache was significantly more common in hydralazine treated patients than labetalol group.Conclusions: Both hydralazine and labetalol were effective and well-tolerated in the treatment of severe hypertensive disorders of pregnancy. Labetalol may be preferred because it was more effective in lowering the systolic blood pressure, diastolic blood pressure and mean arterial pressure to achieve target levels with less number of doses.
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Aims: To identify the possible effects of hypertensive disorders of pregnancy (HDP) on maternal health outcomes of women attended primary health care centers (PHCCs) in Gaza Strip –Palestine.Study Design:A cross-sectional comparative design.Place and Duration of Study:The study was conducted at 6 PHCCs from August 2016 to May 2017.Methodology:Two groups of 215 hypertensive mothers and 215 normotensive mothers in the last pregnancy were recruited by 3-stage stratified random sampling technique. A detailed questionnaire filled through face to face interviews in addition to medical records revision in 2017. Pearson's Chi-square and t-tests were used to compare the outcomes between the two groups.Results:HDP in 215 women were classified as pregnancy-induced hypertension (n = 153, 71.2%) and chronic hypertension (n = 62, 27.8%). The mean age of HDP women was 28.8 ± 6.8 years. About 40.9% live in refugee camps; 23.7% had gravida ≥ 7; 54.6% had BMI > 30 and 21.9% had a history of twice or more abortions. Only 20% of HDP women received preconception care. Cesarean section and assisted delivery were significantly higher among hypertensive mothers (37.2% and 26.9%) compared with non-hypertensive (16.3% and 8.4%) respectively (P= 0.001). Incidence of preeclampsia/eclampsia, antepartum hemorrhage and postpartum hemorrhage, were significantly higher among HDP women (29.3%, P= 0.001; 14%, p=0.001; 7%, P= 0.003 respectively) while no significant differences in abrupio placenta (0.9%; P= 0.25), placenta previa (0.5%, P= 0.75) HELLP syndrome (0.9%, P= 0.24) were found between the two groups. 20.9% mothers with pregnancy-induced hypertension were not recovered and developed chronic hypertension.Conclusion:Women with HDP are at higher risk to have adverse maternal outcomes compared to normotensive women in GS. Preconception care, early diagnosis and prenatal follow-up would improve maternal and fetal prognosis
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RESUMEN Los desórdenes hipertensivos del embarazo se encuentran dentro de las tres primeras causas de morbimortalidad materna y perinatal a nivel mundial, hasta el año 2016. Diferentes estudios realizados en los últimos 5 años e importantes organizaciones científicas han abordado este tema en el que existen discrepancias en cuanto a su etiopatogenia. Sin embargo, los avances logrados en la misma, la profundización en sus manifestaciones clínicas, los modos de presentación y los elementos diagnósticos han permitido el reconocimiento precoz y la efectividad del tratamiento. Esto ha ocasionado, principalmente en lo referente a los desórdenes hipertensivos tipo I, cambios que afectan desde la definición hasta el tratamiento. De esta manera, el presente documento pone al alcance de la comunidad médica una amplia revisión científica que facilita un mejor diagnóstico de la preeclampsia y de otras formas de hipertensión arterial en la etapa grávido-puerperal. Asimismo, contribuirá a reducir el error diagnóstico y logrará una intervención temprana para la obtención de mejores resultados maternos y perinatales (AU).
SUMMARY Hypertensive disorders of pregnancy are among the first three causes of maternal and perinatal Morbimortality in the world until 2016. Important scientific organizations and several studies carried out in the last five years have approached the theme, but there are still discrepancies with respect to etiopathogeny. Nevertheless, advances in it and deepening in its clinical manifestations, presentation ways and diagnostic elements have allowed its precocious recognition and diagnostic elements, causing changes from its definition up to its treatment, mainly in the case of the hypertensive disorders type I. In the current article, the authors put at reach of the medical community a wide scientific review facilitating a better diagnosis of preeclampsia and other forms of arterial hypertension in the pregnancy-puerperal stage that will contribute to reducing diagnosis error and making an early intervention, leading to better maternal and perinatal results (AU).
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Humans , Female , Pregnancy , Pre-Eclampsia , Hypertension, Pregnancy-Induced/classification , Eclampsia , Hypertension, Pregnancy-Induced/diagnosis , Hypertension, Pregnancy-Induced/etiology , Hypertension, Pregnancy-Induced/pathologyABSTRACT
Background: Hypertensive disorders of pregnancy are a major cause of both maternal and foetal morbidity and mortality. Although pregnancy induced hypertension (PIH) is still regarded as a disease of theories and unknown etiology, elevated homocysteine level has been hypothesized as a key risk factor. Abnormally raised homocysteine has been significantly associated with increased risk of PIH, abruption, intrauterine growth restriction, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present case control study was conducted among 180 pregnant women (90 cases and 90 controls) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of ascertaining the role of homocysteine in pregnancy related hypertensive disorders. Socio-demographic, clinical, biochemical including homocysteine level, laboratory and ultrasonographic parameters of all the participants were documented.Results: The mean homocysteine level of cases (18.30±10.81) was significantly higher than the controls (8.70±2.64). About 62.2% cases had abnormally raised homocysteine level (>15 µmol/L), while only 1.1% controls had such level. The odds of a case having abnormally elevated homocysteine level were 146.6 (CI: 19.52-1101) times to that of controls. Eclamptics had the highest homocysteine level followed by preeclamptics and controls.Conclusions: The present study significantly associates the abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and demands much needed robustly designed studies to further explore the phenomenon. A simple intervention like estimating the much neglected homocysteine levels prior to pregnancy can definitely aid in predicting and preventing perinatal outcomes.
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@#Introduction: Hypertensive Disorders of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with endothelial dysfunction postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in HDP. Disturbances in nitric oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. The study aims to determine serial ET-1 and NO levels in patients with HDP and its role in persistent endothelial dysfunction. Materials and Methods: Thirty-six pregnant women from the following categories (i) normal pregnant women (Control) (ii) chronic hypertension during pregnancy (CH) and (iii) pregnancy induced hypertension (PIH) participated in this study. Blood pressure indices measurements and sample collection were done at antepartum (32 weeks) and postpartum (8 weeks and 12 weeks). ET-1 and serum NO were measured using the Human ET-1 (Endothelin-1) ELISA Kit and Nitric Oxide (total) detection kit respectively. Results: Serum ET-1 was significantly higher in patients with CH (55.3 pg/ml) and PIH (35.6 pg/ml) compared to Control (11.8 pg/ml) during antenatal until 3 months postpartum (CH 38.3 pg/ml, PIH 29.5 pg/ml, Control 1.9 pg/ml). This was accompanied by significantly lower levels of serum NO in HDP patients. Conclusion: Persistently higher than normal levels of ET-1 and lower than normal levels of NO up to 3 months postpartum in patients with history of HDP indicate presence of persistent endothelial dysfunction despite BP normalisation in PIH patients. Long term NO/ET-1 imbalance may account for the increased CVS disease risk.
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Objective To investigate the quality of life of patients with hypertensive disorder complicating pregnancy, analyze the possible influencing factors, and propose corresponding intervention measures. Methods From October 2017 to February 2018, one hundred patients with gestational hypertension were included in the obstetric wards as subjects. Semi-structure interviews were used to evaluate the quality of life and influencing factors. Results Among the quality of life of patients with hypertensive disorder complicating pregnancy, The scores of physiological function (RP), general health (GH), emotional function (RE) and mental health (MH) were lower than the norm, which were (22.45 ± 32.01), (59.40 ± 19.28), (37.07 ± 38.55). ), (65.63 ± 19.72) points, the norm scores were (57.00 ± 19.35), (64.09 ± 14.08), (65.78 ± 22.35), (70.04 ± 16.25) points, and the difference between the two groups was statistically significant (t=-10.687--2.212, both P<0.05 or 0.01). Univariate analysis found that the differences in physical health scores between patients with different places of residence and whether they had received assisted reproductive technology were statistically significant (F=6.860, t=-2.112, P<0.01 or 0.05). The differences in mental health scores between pregnant women, gestational weeks, place of residence, and whether they had received assisted reproductive patients were statistically significant (F=-4.798-3.463,P<0.05 or 0.01). Multiple linear regression analysis found that the place of residence was an independent influencing factor of patients' physiological health (P=0.003), and whether or not assisted reproductive technology was an independent influencing factor of patients′ mental health (P=0.005). Conclusion The quality of life of patients with hypertensive disorders during pregnancy is poor, and appropriate interventions should be actively taken to improve the quality of life of patients.
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Introducción: Los trastornos hipertensivos del embarazo siguen siendo una preocupación central de la salud pública en todo el mundo debido a que son una de las principales causas de mortalidad materna. Su tratamiento adecuado depende en gran medida del diagnóstico oportuno e intervención temprana. Objetivo: Identificar los principales biomarcadores para el diagnóstico temprano de los trastornos hipertensivos inducidos por el embarazo. Método: Se revisaron artículos científicos en MedLine, Pubmed, Cochrane, Scielo, entre otras bases de datos. Resultados y discusión: Niveles elevados de kinasa de tirosina símil FMS (sFtl-1), niveles bajos de factor de crecimiento placentario (PIGF) o factor de crecimiento endotetelial vascular (VEGF) libre y niveles altos de (PlGF/sFtl-1) tienen un alto valor predictivo positivo para el diagnóstico de preeclampsia. También parace demostrar resultados efectivos la combinación de ultrasonido doppler y niveles alterados de biomarcadores como proteína placentaria 13 (PP13) y endoglina soluble (sEng). Conclusiones: El uso de biomarcadores abre una nueva era en el diagnóstico y tratamiento de trastornos hipertensivos del embarazo.
Background: Hypertensive disorders of pregnancy constitute a public health concern throughout the world, mainly because they are one of the main causes of maternal mortality. Their adequate treatment depends on a great extent on an early diagnosis and oportune intervention. Objective: To identify the most important biomarkers for the early diagnosis of hypertensive disorders induced by pregnancy. Methodology: Review of academic articles available in MedLine, Pubmed, Cochrane, Scielo, among others. Results and discusión: Elevated levels of Fms-like tyrosine kinase 1 (sFtl-1), low levels of placental growth factor (PlGF) or free vascular endotelial growth factor (VEGF), and elevated levels of (PlGF/sFtl-1) have a high positive predictive value for the diagnosis of preeclampsia. Similarly, it seems equally efective the combination of doppler ultrasound and altered levels of biomarkers including placental protein 13 (PP13) and soluble endolgin (sEng). Conclusions: The use of biobarkers opens a new era for the early diagnosis and treatment hypertensive disorders of pregnancy.
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Humans , Female , Pregnancy , Pre-Eclampsia , Biomarkers , Hypertension, Pregnancy-Induced , fms-Like Tyrosine Kinase 3 , Placenta Growth FactorABSTRACT
Introduction: Preeclampsia is the leading cause of maternal and perinatal mortality and morbidity. Several studies have associated oxidative stress with the etiopathogenesis of preeclampsia but there is little evidence to link this with the appearance and severity of complications. Objective: In this study we compared the plasma level of total antioxidant capacity (TAC) and malondialdehyde levels in plasma with the severity of preeclampsia. Material and methods: A transversal comparative study was designed which included 56 patients in two groups, i.e., 28 patients with preeclampsia, of whom 14 had mild preeclampsia and 14 presented severe preeclampsia, and as a control group 28 normotensive women with a pregnancy of more than 28 weeks. Plasmatic antioxidant capacity and malondialdehyde were determined by ELISA. Follow-up was made to determine outcomes. Results: In pregnancies without hypertension, total antioxidant capacity levels were 2679 ± 2014 mEq/l in normal pregnancy, but fell in patients with preeclampsia. However, the greatest impact was in women with severe preeclampsia (p < 0.05), but no significant differences were noticed in malondialdehyde levels between the groups. Conclusion: Women with severe preeclampsia present a marked reduction in total antioxidant capacity
La preeclampsia es la causa principal de morbilidad y mortalidad materna y perinatal, y es la primera causa de admisión obstétrica en terapia intensiva. Varios trabajos asocian el estrés oxidativo con la etiopatogenia de la preeclampsia, pero existen pocas evidencias que lo relacionen con la gravedad y la aparición de complicaciones. Objetivo: Relacionar la capacidad antioxidante total (CAT) y los niveles de malondialdehído en plasma con la gravedad de la preeclampsia. Material y métodos: Se diseñó un estudio observacional, transversal y comparativo que incluyó 56 pacientes distribuidas en dos grupos, 28 mujeres con preeclampsia, de las cuales 14 presentaban preeclampsia moderada y 14 preeclampsia grave, y 28 mujeres normotensas con un embarazo de más de 28 semanas como control. Se determinaron los niveles plasmáticos de capacidad antioxidante total y niveles de malondialdehído por ELISA, dando seguimiento a las pacientes para valorar el desenlace. Resultados: En los embarazos sin hipertensión, los valores de la CAT plasmática fueron de 2679 ± 2014 mEq/l y se redujeron en las pacientes con preeclampsia. Sin embargo, el mayor impacto se presentó en las mujeres con preeclampsia grave (p < 0.05), sin diferencias significativas en los niveles de malondialdehído entre los grupos. Conclusiones: Las mujeres con preeclampsia grave presentan una reducción marcada en la capacidad antioxidante total plasmática
Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia , Oxidative Stress , Hypertension, Pregnancy-InducedABSTRACT
Las malformaciones müllerianas tienen una incidencia mundial de 0,1 % a 0,5 %, siendo en Venezuela de 0.02 %; se asocia de 37 % a 60 % con agenesia renal congénita. Se ha observado que la relación entre malformación mülleriana y agenesia renal aumentan la incidencia de trastornos hipertensivos del embarazo. Se presenta el caso de una paciente de 18 años, IIG, IP, con embarazo de 30 semanas más 2 días por FUR, con diagnóstico de útero bicorne y agenesia renal, quien ingresó con presión arterial elevada, durante su hospitalización presentó proteinuria y síntomas neurológicos. Se diagnosticó preeclampsia grave y se interrumpió el embarazo. La evolución de madre e hijo fue normal, la madre egresó a los tres días y el recién nacido al mes. No encontramos en la literatura venezolana casos similares, por lo que este constituye el primero reportado
Müllerian malformations have a global incidence of 0.1 % to 0.5 %, in Venezuela the incidence is close to 0.02 %; is associated in 37 % to 60% with congenital renal agenesis. It has been observed that the relationship between renal agenesis and Mullerian malformation increases the incidence of hypertensive disorders of pregnancy. We present a case of 18 years old patient of 18, IIG, IP, with a pregnancy of 30 weeks plus 2 days by LMP, diagnosed with bicornuate uterus and renal agenesis, who was admitted with high blood pressure, during hospitalization showed proteinuria and neurological symptoms. Severe preeclampsia was diagnosed and pregnancy termination performed. The mother and child outcome was satisfactory, the mother was discharged after three days and the baby a month. We did not found in the Venezuelan literature similar cases, so this is the first reported