Role of uterine artery doppler in prediction of pre-eclampsia

Background: Approximately 5-10 % of pregnancies are complicated by pre- eclampsia and it is a prime cause for maternal and perinatal mortality and morbidity worldwide, particularly in developing countries. In pre-eclampsia insufficient invasion of maternal spiral arteries by the trophoblast early in gestation due to abnormal implantation or maternal vascular disease results in impaired placental perfusion. Aspirin is a potent anti-inflammatory drug, has been shown to inhibit the biosynthesis and release of prostaglandins, even in low dosage. Ingestion of low dose aspirin may result in a decrease in the incidence of pre-eclampsia and fetal growth restriction and the precise mechanism by which it prevents preeclampsia in some women is also uncertain.Methods: The present prospective observational study was carried out in females between 18-20 weeks of gestation with raised uterine artery PI attending antenatal clinic in obstetrics and gynaecology department in SVP Hospital Ahmedabad from May 2023 to December 2023 using Microsoft excel and SPSS version 23.Results: In this study all the females were with raised uterine artery PI in 18-20 weeks ultrasound among them 51.85% were normotensive in later pregnancy. 48.14% developed pre-eclampsia in later pregnancy. In our study the middle cerebral artery indices in doppler ultrasound showed increased diastolic flow (including brain sparing effect) among 37% of the patients. The umbilical artery doppler showed that 62.9% of subjects were having normal umbilical artery indices, 18.5% of the patients were having decreased diastolic flow, 11.1% of the patients were having reversal of diastolic flow and 7.4% of the patients were having absent end diastolic flowConclusions: Doppler study for fetal surveillance in pre-eclampsia is a very useful and non-invasive method and abnormal uterine artery velocimetry lead to the worse pregnancy outcomes in the present study. The knowledge of uterine and umbilical artery doppler is very helpful to improve pregnancy management and to identify and assess hypertensive disorder of the pregnancy at early gestational age compared to other antepartum test modalities.

A rare case report on complications in pregnancy with systemic lupus erythematosus in a post-renal transplant patient

To preview the feto-maternal outcome in post-renal transplant pregnant women with systemic lupus erythematosus (SLE). To distinguish preeclampsia from hypertension in renal transplant recipients as diagnosis is not always straightforward and all differentials need a thorough evaluation. Hypertension is a prevalent issue among kidney transplant recipients, with reported incidence rates ranging from 52% to 69%. Additionally, the occurrence of pre-eclampsia in renal transplant recipients falls within the range of 24% to 38%, demonstrating a significantly elevated risk compared to the 4-5% incidence rate seen in the general population. A 29-year-old female para 1 IUFD 1 abortion 1, in a known case of SLE with hypothyroidism with lupus nephritis with post renal transplant status with thrombocytopenia with preeclampsia with day 7 of emergency LSCS done in view of non-progress of labor with intrauterine fetal demise with abruptio placenta referred in view of query SLE flare or severe preeclamptic features with rectus sheath hematoma. Renal transplant restores fertility; thus, pregnancy requires careful planning and affected women should be managed in tertiary care obstetrics centers working in tight multidisciplinary cooperation with transplant physicians.

Association of abruptio placenta in patient with pre-eclampsia with severe features and without severe features

Background: Placental abruption is responsible for increased risk of maternal and fetal morbidity and mortality worldwide. Studies specific to placental abruption in pregnancy-induced hypertension (PIH) are still lacking. This study is designed to focus on collecting data on placental abruption and to objectively determine its impact on the outcome of pregnancy complicated with PIH in terms of improving fetal and maternal morbidity and mortality.Methods: This was retrospective observational study conducted at Cheluvamba Hospital, Mysore Medical College and Research Institute (MMCRI), Mysore, in the department of obstetrics and gynaecology. All pregnant women with diagnosis of abruptio placenta over 28 weeks and with PIH between January 2022 to August 2023 were included. Data was collected from medical records department and results were analysed.Results: During the study period there were total of 14027 deliveries. Of this 63 (0.44%) occurred in patients with placental abruption with PIH. Mean age group was 24.57 years; majority were multigravida (58.46%) Majority were preterm (77.77%). 61.90% had pre-eclampsia with severe features. Mean systolic blood pressure (SBP) was 151.90 mmHg, diastolic blood pressure (DBP) was 98.73 mmHg. 65.08% delivered by caesarean section. 47.61% was the perinatal mortality, perinatal asphyxia was 45.71%, prematurity was 65.71%, low birth weight was 84.12%. 71.42% was the neonatal intensive care unit (NICU) admission rate. Maternal complications seen was postpartum haemorrhage (PPH) (31.74%), requiring blood and blood products transfusion (63.49%), coagulopathy (14.28%), shock (12.69%). 4 women developed severe features of pre-eclampsia in postpartum period, 2 of them needed MgSO4. 58.73% had requirement of antihypertensives in postpartum period.Conclusions: Abruption is one of the obstetric emergencies. In our study severe adverse maternal and perinatal outcomes were more pronounced in pre-eclampsia with severe features and it needs an individual and intense surveillance and management to have better maternal and perinatal outcome.

Association of metabolic syndrome with gestational hypertension

Background: Metabolic syndrome is a group of clinical, metabolic and biochemical abnormalities with negative impact on global health. The aim of the study was to determine the association between metabolic syndrome and pregnancy induced hypertension, and incidence and effects of metabolic syndrome in pregnant patients.Methods: Prospective observational study, performed in the Department of Obstetrics and Gynecology, Holy Family Hospital, New Delhi. Antenatal women before 20 weeks of gestation were enrolled in the study. Metabolic syndrome was diagnosed by utilizing the pregnancy adaptation of MeS criteria of NCEPATP III laboratory and clinical criteria. Cases were followed throughout pregnancy to observe their progression into hypertensive disorders of pregnancy i.e. gestational hypertension, pre-eclampsia and eclampsia.Results: Out of 100 cases with metabolic syndrome 37% developed PIH, 21 developed pre-eclampsia and 14 developed gestational hypertension, 2 patients developed eclampsia as compared to controls in which only 10% developed PIH among which only 3% developed pre-eclampsia.Conclusions: Our study demonstrates a higher rate of complicated pregnancy with higher incidence of PIH in association with metabolic syndrome compared to control group. Each component of metabolic syndrome increases the probability of PIH. The addition of components of metabolic syndrome exacerbates this probability, especially the combination of increased BMI, increased blood sugar levels and increased triglycerides.

Complicaciones maternas y embarazo adolescente en América Latina: Revisión sistemática y metaanálisis / Maternal complications and adolescent pregnancy in Latin America: A systematic review and meta-analysis

RESUMEN Objetivo: Evaluar el riesgo de complicaciones maternas en el embarazo adolescente en Latinoamérica y El Caribe durante el periodo 2012 al 2021. Métodos: Se realizó una búsqueda sistemática en 6 bases de datos: PubMed, SCOPUS, Web Of Science, EMBase, LILACS y Scielo. Los artículos incluidos fueron procedentes de paises de Latinoamérica y contaron con cualquiera de las siguientes variables: preeclampsia, eclampsia, hemorragia puerperal y sepsis puerperal publicados desde el 2012 al 2021 y que compararan adolescentes y adultas embarazadas. Se excluyeron artículos que no presentaron hallazgos separados de Latinoamérica y/o El Caribe, que no se encontraban disponibles la versión completa y que estaban enfocados en pacientes con alguna enfermedad en específico. Para el riesgo de sesgo se empleó la Escala de Newcasttle-Ottawa para estudios de casos y controles. La medida de resumen empleada fue el Odds Ratio con un intervalo de confianza al 95% para cada estudio. Resultados: Se incluyeron 4 estudios. No se evidenció el riesgo de preeclampsia en adolescentes embarazadas (OR = 0.93, IC 95% 0.69 - 1.25) ni hemorragia puerperal (OR = 0.86, IC 95% 0.74 - 0.99). Por otro lado, se mostró el riesgo de eclampsia (OR = 2.43, IC 95% 1.29 - 4.58) en adolescentes embarazadas, pero con alta heterogeneidad entre los estudios (I2 = 76%). Conclusiones: Se evidenció un riesgo de eclampsia en adolescentes embarazadas, pero no en preeclampsia ni hemorragia puerperal; sin embargo, estos resultados deben de tomarse con cautela. Registro de protocolo: CRD42021286725 (PROSPERO)

ABSTRACT Objective: To assess whether maternal complications are a risk in adolescent pregnancy in Latin America and the Caribbean during the period 2012 to 2021. Methods: A systematic search was carried out in 6 databases: PubMed, SCOPUS, Web of Science, EMBase, LILACS and Scielo. The articles included were from Latin American countries and had any of the following variables: preeclampsia, eclampsia, puerperal hemorrhage and puerperal sepsis published from 2012 to 2021 and comparing pregnant adolescents and adults. Articles that did not present separate findings from Latin America and/or the Caribbean, that the full version was not available, and that were focused on patients with a specific disease were excluded. For risk of bias, the Newcastle-Ottawa Scale Case-Control Studies was used. The summary measure used was the Odds Ratio with a 95% confidence interval for each study. Results: 4 studies were included. The risk of preeclampsia in pregnant adolescents and postpartum hemorrhage (OR = 0.86, 95% CI 0.74 - 0.99) were not evidenced (OR = 0.93, 95% CI 0.69 - 1.25). On the other hand, the risk of eclampsia (OR = 2.43, 95% CI 1.29 - 4.58) in pregnant adolescents was shown, but with high heterogeneity between studies (I2 = 76%). Conclusions: A risk of eclampsia was evidenced in pregnant adolescents, but not in preeclampsia nor postpartum hemorrhage. However, these results should be taken with caution. Protocol record: CRD42021286725 (PROSPERO)

Prevención de la preeclampsia y su relevancia en el contexto latinoamericano: una revisión narrativa / Prevention of preeclampsia and its relevance in the Latin American context: a narrative review

La preeclampsia es un trastorno hipertensivo de la gestación que se evidencia durante las últimas semanas de esta. Globalmente, la preeclampsia es la segunda causa de mortalidad materna. Se estima que su incidencia es de aproximadamente un 16% en los países en vías de desarrollo, y llega a superar el 25% en algunos países de Latinoamérica. Se describirán las principales estrategias de prevención de la preeclampsia y su relevancia en el contexto latinoamericano. La búsqueda de información tuvo lugar en PubMed y BVS para las publicaciones realizadas sobre prevención de la preeclampsia, utilizando la expresión de búsqueda (“Disease Prevention” OR “Primary Prevention”) AND (Pre-eclampsia OR Preeclampsia OR “Pre eclampsia”) AND (“Latin America” OR “Central America” OR “South America” OR Caribbean). En PubMed se encontraron 60 y en BVS 42 resultados que responden a la expresión de búsqueda, y fueron seleccionados 18 artículos que discuten estrategias de prevención de la preeclampsia en Latinoamérica. Con estos resultados, se pueden afirmar que, describir las mejores estrategias de prevención de la preeclampsia en Latinoamérica es una tarea pendiente, pues existe una relativa carencia de publicaciones. En consecuencia, se espera que esta revisión motive futuras investigaciones y sea un recurso útil en la actualización médica.

Preeclampsia is a hypertensive disorder of pregnancy that is evident during the last weeks of it. Globally, preeclampsia is the second leading cause of maternal mortality. It is estimated that the incidence is approximately 16% in developing countries, and reaches over 25% in some Latin American countries. The main strategies for the prevention of preeclampsia and their relevance in the Latin American context will be described. The search for information took place in PubMed and BVS for publications on preeclampsia prevention, using the search expression (“Disease Prevention” OR “Primary Prevention”) AND (Pre-eclampsia OR Pre-eclampsia OR “Pre eclampsia”) AND (“Latin America” OR “Central America” OR “South America” OR Caribbean). In PubMed we found 60 and in VHL 42 results that respond to the search expression, and 18 articles were selected that discuss prevention strategies for preeclampsia in Latin America. With these results, it is possible to afirm that describing the best strategies for the prevention of preeclampsia in Latin America is a pending task, since there is a relative lack of publications. Consequently, it is hoped that this review will motivate future research and be a useful resource in medical updating.

Prevención de la preeclampsia: desde la dieta hasta la aspirina: revisión de la literatura / Prevention of preeclampsia: from diet to aspirin: review of the literature

Introducción y objetivo: Explorar las estrategias de prevención de la preeclampsia que se han propuesto a lo largo de la historia. Método: Revisión narrativa de la literatura sobre la evidencia científica histórica disponible entre 2016 y 2023 acerca de la aspirina y otras estrategias de prevención de la preeclampsia, en bases de datos bibliográficas computarizadas de estudios publicados en revistas indexadas. Resultados: Varios estudios confirman la efectividad de la aspirina para prevenir la preeclampsia en población de alto riesgo, siendo un medicamento con bajo riesgo de complicaciones, con mayor evidencia de efectividad si se inicia antes de las 16 semanas de gestación y con un aparente efecto dependiente de la dosis. Intervenciones como la disminución del consumo de sal, el reposo en cama, la suplementación con ácidos grasos, antioxidantes, L-arginina, zinc o magnesio, y el uso de diuréticos o de inhibidores de la bomba de protones, no han mostrado su utilidad en la prevención de la preeclampsia. Conclusiones: La aspirina a dosis baja es un medicamento seguro en el embarazo y efectivo para prevenir la preeclampsia en población de alto riesgo. Es la estrategia de prevención más ampliamente estudiada a lo largo de la historia para la disfunción endotelial durante la gestación.

Introduction and objective: To explore the different prevention strategies for preeclampsia that have been proposed throughout the history. Method: A narrative review of the historical, scientific evidence available between 2016 and 2021 on aspirin and other preeclampsia prevention strategies in computerized bibliographic databases of studies published in indexed journals. Results: Several studies confirm the effectiveness of aspirin to prevent preterm preeclampsia in high-risk populations, considering this as a safe drug with low risk of complications, with greater evidence of effectiveness when started before 16 weeks of gestation and apparently with a dose-dependent effect. Interventions such as reducing salt intake, bed rest, supplementation with fatty acids, antioxidants, L-arginine, zinc, magnesium, the use of diuretics or proton pump inhibitors have not shown its usefulness in the prevention of high risk preeclampsia patients. Conclusions: Low-dose aspirin is a safe drug in pregnancy and is effective to prevent preeclampsia in high-risk populations. Is the most widely studied throughout history prevention strategy for endothelial dysfunction during pregnancy.

Serum placental growth factor levels and uterine artery pulsatility index at 11-13+6 weeks gestation as early predictors of pre-eclampsia: prospective observational study

Background: To detect serum placental growth factor levels and uterine artery doppler pulsatility index for predicting pre-eclampsia and assess their association with the severity of pre-eclampsia.Methods: A prospective observational study involving 160 antenatal women, from 11-13+6 weeks gestation attending antenatal clinic at tertiary care center during study period of 18 months. Serum placental growth factor levels and uterine artery doppler mean pulsatility index measured and patients were followed upto delivery and observed for the development of pre-eclampsia and its severity.Results: Placental growth factor value cut-off was 40.33pg/ml with the sensitivity of 97.5 % and specificity was 98.3%. For the pulsatility index value of 1.85, the sensitivity was found to be 74.4% and specificity was found to be 92.5%. Mean serum placental growth factor levels for pre-eclampsia patients was 25.09pg/ml and for normotensive patients mean level was 65.05pg/ml. Mean uterine artery doppler pulsatlity index for pre-eclampsia patients was 2.02 and for normotensive patients was 1.39. Mean PI value increased with increasing severity of preeclampsia.Conclusions: Early recognition of women will help initiation of prophylactic measures and enhanced surveillance. First trimester uterine artery doppler with serum placental growth factor together with maternal characteristics can be used as a reliable screening test for preeclampsia prediction and to reduce feto-maternal morbidity.

Assessment of prevalence and risk factors of pre-eclampsia and eclampsia in tertiary care hospital

Background: Pre-eclampsia and eclampsia are two conditions in which high blood pressure essentially complicates pregnancy by causing oedema and/or albuminuria. The present study was undertaken among pregnant women to determine the prevalence of pre-eclampsia and eclampsia as well as to assess the association between risk factors and pre-eclampsia, risk factors and eclampsia and to determine the complications of pre-eclampsia and eclampsia.Method: A prospective observational study was conducted over a period of six months at obstetrics inpatient department of Basaveshwara Medical college and hospital, Chitradurga.Results: Total of 583 pregnant women who visited the inpatient department were enrolled, out of which study showed that the prevalence of pre-eclampsia was 91 (15.67%) and eclampsia was 54 (9.26%). A statistically varied significance level of p=0.00001 to 0.05 for risk factors such as age, primigravida, birth interval, pre-existing disease, placental abnormalities, multiple pregnancy, past history, proteinuria were found to be associated with pre-eclampsia and eclampsia. The complications such as pre-term birth, neonatal death HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), Foetal growth restriction were found. Out of which pre-term birth was the most observed complication in both pre-eclampsia and eclampsia.Conclusions: Considering the significant association between the risk factors and pre-eclampsia, eclampsia from the study we conclude that early diagnosis is essential. Lack of antenatal care, limited access to medical facility and lack of resources have influenced in late diagnosis in our set up. As evidenced by study proper awareness should be provided to the pregnant women.

Expression levels of methylated SIM2,GNA12 and CTGF in pregnant women with preeclampsia and its predictive value for disease / 国际检验医学杂志

Objective To investigate the plasma levels of methylated DNA in the pregnant women with preeclampsia and its predictive value for the occurrence of preeclampsia.Methods A total of 82 pregnant women with preeclampsia admitted to the hospital from January to December 2022 were included as the obser-vation group,and another 82 healthy pregnant women were included as the control group.Total DNA was ex-tracted,and the relative expression levels of methylated single-intention homolog 2(SIM2),guanine nucleo-tide-binding protein(GNA12),and connective tissue growth factor(CTGF)genes in plasma were detected by real-time fluorescence quantitative PCR(qRT-PCR)after DNA bisulfite modification.The value of methyla-ted DNA in predicting preeclampsia was evaluated by correlation analysis and receiver operating characteristic(ROC)curve.Results The relative expression levels of methylated SIM2,GNA12 and CTGF in plasma in the observation group were significantly higher than those in the control group(P＜0.05),and the relative expres-sion levels of methylated SIM2,GNA12 and CTGF in severe preeclampsia group was higher(P＜0.05).Corre-lation analysis showed that the relative expression levels of methylated SIM2,GNA12 and CTGF in plasma were significantly positively correlated with the occurrence of preeclampsia in pregnant women(P＜0.05).ROC curve analysis results showed that the relative expression levels of plasma methylation SIM2,GNA12,and CTGF,both individually and in combination,had good predictive efficacy in predicting preeclampsia in pregnant women,and the combined detection of the three had the highest predictive efficacy(area under the curve was 0.888,95％CI:0.827-0.949).Conclusion Compared with healthy pregnant women,the relative expression levels of methylated SIM2,GNA12 and CTGF in plasma are higher in pregnant women with pre-eclampsia,which are positively correlated with the occurrence of preeclampsia and the severity of the disease.The relative expression levels of methylated SIM2,GNA12 and CTGF are expected to be important predicting indicators for preeclampsia.

The Association between Ophthalmic Artery Doppler Variables and the Severi-ty of Pre-eclampsia:a Meta-analysis / 实用妇产科杂志

Objective:To investigate the association between the Doppler variables of the ophthalmic artery with the severity of preeclampsia(PE).Methods:Systematic literature was searched between January 1995 and March 2023 in PubMed,Web of Science,Embase,and the Cochrane Library.Studies comparing ophthalmic artery Doppler variables,including peak systolic velocity(PSV),end-diastolic velocity(EDV),resistive index(Rl),pulsa-tility index(PI),and peak ratio(PR,the ratio of the flow velocity of the second peak to that of the initial peak)in patients with PE,severe preeclampsia(sPE),and healthy pregnant women were included.The random-effects model was adopted as the method of pooled analysis,and the I2value was used to assess heterogeneity.The pooled standardized mean difference(SMD)with 95％confidence interval(CI)was used to estimate the associa-tion between ophthalmic artery Doppler variables and PE patient's characteristics.Results:Eight retrospective studies were eventually included in this Meta-analysis.Our pooled results suggested that compared with PE ca-ses,sPE patients had lower PI levels(SMD-0.56,95％CI-0.92～-0.20,P=0.000),higher EDV levels(SMD 0.47,95％CI 0.12～0.83,P=0.028)and higher PR levels(SMD0.96,95％CI 0.13～1.78,P=0.023).Howev-er,there was no significant difference between PE and sPE patients about the PSV and RI(P=0.361,P=0.626).Conclusions:This review demonstrates that ophthalmic artery Doppler variables(PI,EDV and PR)could be useful for predicting PE and PE development(especially in identifying sPE),which in turn may help the practitioner in the management of these complicated cases and in taking early necessary precautions.

Efficacy analysis of a preeclampsia risk prediction model based on exosomal multiple miRNA expression levels / 天津医药

Objective To investigate the feasibility of constructing a preeclampsia(PE)risk model based on multiple exosomal micrornas(miRNA)expression levels and to verify its efficacy in predicting PE.Methods A total of 1037 pregnant women who were archived in our hospital from June 2019 to December 2021 and whose gestational weeks were less than or equal to 20 weeks were selected as the research subjects.The expression of exosomal miRNA(including miR-155-5p,miR-215-5p,miR-203a-3p,miR-199a-5p and miR-125a-3p)in all samples was detected by qRT-PCR.Then,all patients were followed up to the end of pregnancy.The occurrence of PE during the follow-up period was counted,and all samples were divided into the PE group and the control group according to results.Cox regression was used to analyze the influencing factors of PE.The multi-miRNA risk model was constructed with ggrisk package,and the predictive effect of the model on PE was evaluated by receiver operating characteristic(ROC)curve.Results By the end of follow-up on October 31,2022,974 cases were finally followed up,and the follow-up completion rate was 93.92%.Among all the 974 patients who completed the follow-up,65 patients developed PE,so they were finally divided into the PE group,and 909 cases were used as the control group.The age,pre-pregnancy BMI and waist circumference at 12 weeks of gestation were higher in the PE group than those in the control group(P＜0.05).The proportions of smoking history and drinking history were higher in the PE group than those of the control group(P＜0.05).The contents of triglyceride(TG),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),alanyl aminotransferase(ALT),aspartate aminotransferase(AST),platelet distribution width(PDW),mean platelet volume(MPV),miR-155-5p,miR-199a-5p and miR-215-5p were higher in the PE group than those in the control group,while contents of thyroid stimulating hormone(TSH),miR-125a-3p and miR-203a-3p were lower in the PE group than those in the control group(P＜0.05).The expression levels of miR-125a-3p,miR-155-5p,miR-199a-5p and miR-215-5p were independent predictors of PE(P＜0.05).The predictive risk model constructed from the above miRNAs had good predictive value in the occurrence of PE(AUC=0.998),with a sensitivity of 98.46%(63/65)and a specificity of 93.94%(854/909).Conclusion miR-125a-3p,miR-155-5p,miR-199a-5p,miR-203a-3p and miR-215-5p are significantly related to the occurrence of PE,and the PE prediction model constructed with the above five miRNAs has better effect.

The predictive value of MP hypertension monitoring system combined with PLGF and PI for preeclampsia / 天津医药

Objective To establish a clinical prediction model for preeclampsia by monitoring risk rating of MP gestation and levels of placental growth factor(PLGF)combined with uterine artery pulsatility index(PI)measured during examination of fetal nuchal translucency(NT).Methods Twenty-four patients with preeclampsia who met the inclusion criteria were selected as the case group,and 95 healthy pregnant women during the same period were randomly selected as the control group.Serum concentrations of PLGF,uterine artery PI values measured by quantitative immunofluorescence assay at 11-14 weeks of gestation,risk ratings for MP hypertension monitoring at 11-20 weeks of gestation,and other relevant data,BMI,age,gestation,mode of delivery,neonatal birth weight and Apgar score were collected in the two groups.Results Results of univariate regression analysis showed that BMI,age,high risk of PI,MP and PLGF<12 were influencing factors for adverse outcomes.Results of multivariate regression analysis showed that high PI,medium high risk in MP and PLGF<12 were independent risk factors for adverse outcomes.The prediction model of PE established was logit(P)=-15.767 + 0.020×PI + 0.072×MP risk(medium-high risk = 1,low risk = 0)+ 0.181×PLGF classification(＜12 = 1,≥12 = 0),with an AUC area of 0.883,specificity of 0.816 and sensitivity of 0.846.Conclusion The combination of PI,MP risk and PLGF to establish a clinical predictive model for preeclampsia has certain value,and its combined predictive value is higher than that of single application.

Screening of characteristic genes in early-onset pre-eclampsia and analysis of their association with immune cell infiltration based on bioinformatics analysis and machine-learning algorithms / 中华围产医学杂志

Objective:To screen the characteristic genes of early-onset pre-eclampsia (EOSP) and to analyze their association with immune cell infiltration based on bioinformatics analysis and machine learning methods.Methods:In the Gene Expression Omnibus (GEO) database, the mRNA sequences of placental tissues from women with EOSP and normal pregnancy were retrieved using the term "early-onset pre-eclampsia". The R language was used for background correction, standardization, summarization, and probe quality control. Annotation packages were downloaded for ID conversion and the expression matrices were extracted. The differentially expressed genes (DEGs) between the EOSP and the normal pregnancy in the metadata were analyzed after correcting for batch effects using the limma package. Characteristic genes were identified through the support vector machine (SVM) -recursive feature elimination (RFE) method and the LASSO regression model. The area under the curve (AUC) was calculated to judge the diagnostic efficiency of the characteristic genes. Placental tissues were retrospectively collected for verification from 15 patients with EOSP and 15 with normal pregnancy who were delivered at Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 1, 2022, to February 28, 2023. The expression of characteristic genes was verified using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot, which were further validated in the validation dataset. Finally, the CIBERSORT algorithm was used to analyze the relative proportion of infiltrating immune cell in EOSP. A t-test was used for differential analysis. Results:Three gene datasets were downloaded, including GSE44711 (eight cases each for EOSP and normal pregnancy), GSE74341 (seven cases for EOSP and five cases for normal pregnancy), and GSE190639 (13 cases each for EOSP and normal pregnancy). A total of 29 DEGs were screened after combining the GSE44711 and GSE74341 datasets, including 27 upregulated and two downregulated genes. Gene ontology enrichment analysis showed that these genes are mainly involved in the secretion of gonadotropins, female pregnancy, regulation of endocrine processes, secretion of endocrine hormones, and negative regulation of hormone secretion. Eight characteristic genes ( EBI3, HTRA4, TREML2, TREM1, NTRK2, ANKRD37, CST6, and ARMS2) were screened using the LASSO regression algorithm combined with SVM-RFE algorithm and the expression differences of these characteristic genes were verified as statistically significant by qRT-PCR and Western blot (all P<0.05, except for CST6). Logistic regression algorithm showed that the AUC (95% CI) of TREML2, ANKRD37, NTRK2, TREM1, HTRA4, EBI3, and ARMS2 were 0.979 (0.918-1.000), 0.969 (0.897-1.000), 0.969 (0.892-1.000), 0.979 (0.918-1.000), 0.990 (0.954-1.000), 0.990 (0.954-1.000), and 0.903 (0.764-1.000). Immune cell infiltration analysis indicated that the infiltration ratio of M2 macrophages in the placental tissue from EOSP was significantly lower than that in the normal pregnancy (0.167±0.074 vs. 0.462±0.091, P=0.002), but the infiltration ratios of monocytes and eosinophils were significantly higher (0.201±0.004 vs. 0.085±0.006; 0.031±0.001 vs. 0.001±0.000, both P<0.05). The correlation analysis between characteristic genes and infiltrating immune cells found that the seven characteristic genes were closely related to the immune cells (all P<0.05). Conclusion:Seven characteristic genes that are critical for the prediction and early diagnosis of EOSP are screened using bioinformatics analysis and machine-learning algorithms in this study, which provides new research targets and a basis for the prevention and treatment of preeclampsia in the future.

Expression of TFDP2 in placentas of women with preeclampsia and its effect on apoptosis of trophoblast cells / 中华围产医学杂志

Objective:To investigate the expression level of transcription factor dimerization partner 2 (TFDP2) in the placentas of women with preeclampsia, and analyze its effect on the apoptosis of trophoblast cells.Methods:Placental tissues from thirty puerperae with preeclampsia who gave birth by cesarean section in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between January 2018 and December 2022 (preeclampsia group) and 30 healthy puerperae undergoing cesarean section during the same period (control group) were retrospectively selected. Immunohistochemistry was used to localize TFDP2 in the placental tissues. Real-time quantitative-polymerase chain reaction (qRT-PCR) and Western blot were used to detect the differences in expression of TFDP2 at mRNA and protein levels in placental tissues between the two groups. Forskolin-exposed BeWo cells were transfected with small interfering RNA (siRNA) to knockdown TFDP2 and the changes in the expression of apoptosis-related indicators, B cell lymphoma 2 (Bcl2) and Bcl2 associated X (Bax), at protein and mRNA levels were analyzed by Western blot and qRT-PCR, respectively. Besides, the change in the apoptosis level of BeWo cells was detected using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining and flow cytometry. Downstream signaling pathways were analyzed to understand the involved molecular mechanisms. Two independent samples t-test, Wilcoxon rank-sum test, and Chi-square test were used for statistical analysis. Results:TFDP2 was mostly localized in the syncytiotrophoblasts and the extravillous trophoblasts in the normal placentas. TFDP2 expression in the syncytiotrophoblasts was lower in the preeclampsia group than in the control group at both mRNA (0.722±0.239 vs. 1.000±0.348, t=3.61, P=0.001) and protein (0.728±0.185 vs. 1.000±0.206, t=2.41, P=0.037) levels. Comparing the group without knockdown of TFDP2, the knockdown of TFDP2 in BeWo cells elevated the Bax/Bcl2 ratio (mRNA: 1.755±0.452 vs. 1.000±0.279, t=3.48, P=0.006; protein: 3.206±0.922 vs. 1.000±0.290, t=3.95, P=0.017), and increased cell apoptosis both in number and ratio (TUNEL staining: 4.556±1.740 vs. 2.444±1.130, t=3.05, P=0.008; flow cytometry: 21.37%±1.66% vs. 12.61%±0.38%, t=8.92, P=0.001). Furthermore, following TFDP2 knockdown, a decrease in the phosphorylation activity of catalytic subunit of protein kinase A (PKAc) at the Thr197 site was observed in the cytoplasm of BeWo cells (0.466±0.035 vs. 1.000±0.075, t=11.19, P<0.001) and a reduction in the expression of β-catenin in the cell nucleus was also detected (0.250±0.093 vs. 1.000±0.269, t=4.57, P=0.010). Conclusion:The expression of TFDP2 decreased significantly in the placentas of patients with preeclampsia, which may promote the apoptosis of syncytiotrophoblasts by inhibiting the PKAc/β-catenin signaling pathway.

Evaluation of left ventricular function in patients with pregnancy-induced hypertension using echocardiography / 中国基层医药

Objective:To investigate the clinical value of tissue Doppler echocardiography in the evaluation of left ventricular function in patients with pregnancy-induced hypertension.Methods:This is a case-control study, including 100 patients with pregnancy-induced hypertension who received treatment at the Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to May 2022, and an additional 100 healthy pregnant women who underwent physical examination during the same period. All participants underwent two-dimensional echocardiography, pulsed Doppler echocardiography, and tissue Doppler echocardiography. Ultrasound parameters related to left ventricular morphology and function were collected from all participants. The ultrasound parameters related to left ventricular morphology and function between patients with different types of pregnancy-induced hypertension and healthy controls were compared. The correlation between left ventricular function ultrasound parameters and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels was investigated.Results:Patients with pregnancy-induced hypertension, patients with mild preeclampsia, patients with severe preeclampsia, and healthy controls demonstrated differences in interventricular septum thickness during diastole [(10.24 ± 1.18) mm, (11.39 ± 1.24) mm, (11.57 ± 1.29) mm, (8.81 ± 0.95) mm], left ventricular end-diastolic diameter [(47.31 ± 2.81) mm, (49.82 ± 2.89) mm, (52.03 ± 2.94) mm, (46.82 ± 2.76) mm], left ventricular posterior wall thickness [(9.73 ± 1.06) mm, (10.62 ± 1.13) mm, (11.75 ± 1.21) mm, (8.96 ± 0.97) mm], left ventricular inner diameter [(32.82 ± 2.34) mm, (35.48 ± 2.39) mm, (36.04 ± 2.45) mm, (30.41 ± 2.27) mm], and left ventricular mass index [(98.41 ± 7.83) g/m 2, (105.73 ± 8.26) g/m 2, (108.63 ± 8.57) g/m 2, (96.59 ± 7.69) g/m 2]. All of these parameters showed significant differences between patients with different types of pregnancy-induced hypertension and healthy controls ( F = 13.47, 12.61, 16.59, 13.26, 19.73, all P < 0.001). Significant differences were also observed in echocardiographic indices of left ventricular function such as peak velocity ratio of E and A waves, systolic motor amplitude, early peak diastolic velocity to late peak diastolic velocity, and Tei index between patients with different types of pregnancy-induced hypertension and healthy controls ( F = 12.84, 11.27, 14.64, 21.43, all P < 0.001). In patients with pregnancy-induced hypertension, peak velocity ratio of E and A waves, systolic motor amplitude, and early peak diastolic velocity to late peak diastolic velocity were moderately negatively correlated with serum NT-proBNP level ( r = -0.56, -0.43, -0.54, P = 0.029, 0.042, 0.031), while Tei index showed a positive correlation with serum NT-proBNP level ( r = 0.77; P = 0.003). Conclusion:Two-dimensional echocardiography, pulsed Doppler echocardiography combined with tissue Doppler echocardiography can be used to effectively evaluate the changes in left ventricular structure and function in patients with different types of pregnancy-induced hypertension. Monitoring the Tei index using tissue Doppler echocardiography can accurately reflect myocardial injury and functional changes, which has a great clinical application value.

How can we reduce maternal mortality due to preeclampsia? The 4P rule

Abstract In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention - Vigilant Prenatal Care - Timely Delivery (Parturition) - Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management.

Complicaciones anestésicas en pacientes con preeclampsia con criterios de severidad / Anesthetic complications in patients with preeclampsia with severity criteria

Resumen OBJETIVO: Describir las complicaciones anestésicas en pacientes con preeclampsia con criterios de severidad. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, transversal y descriptivo llevado a cabo en un centro de atención terciaria de la ciudad de Medellín, Colombia, entre enero de 2016 y enero de 2021. La fuente de información fueron las historias clínicas. Criterios de inclusión: pacientes embarazadas, con preeclampsia con criterios de severidad que recibieron anestesia neuroaxial o general. Criterios de exclusión: pacientes con diagnóstico previo de coagulopatías y con otros trastornos hipertensivos del embarazo no relacionados con la preeclampsia con características graves. Se hizo un muestreo no probabilístico de casos consecutivos y un análisis univariado. RESULTADOS: Se incluyeron 508 pacientes; el 69% finalizaron el embarazo mediante cesárea. El 89.4% recibió anestesia neuroaxial y el 10.6% anestesia general. El 29.9% ingresó a cuidados intensivos, 4.7% tuvo hipotensión, 3.9% requirió soporte vasopresor, 3.7% con vía aérea difícil, 0.98% requirió ventilación mecánica. Una paciente resultó con edema pulmonar y otra con accidente cerebrovascular hemorrágico. El 1.5% de quienes recibieron anestesia espinal tuvo retención urinaria. La frecuencia de anestesia neuroaxial fallida fue del 1.4% para parto y 1.3% para cesárea. No se registraron casos de muerte, meningitis, aracnoiditis, paraplejia, punción de la duramadre accidental o reacción alérgica. CONCLUSIONES: La anestesia neuroaxial sigue siendo la técnica anestésica de elección en pacientes con preeclampsia con criterios de severidad. Las complicaciones anestésicas evidenciadas con más frecuencia fueron el ingreso a cuidados intensivos, hipotensión y requerimiento de soporte vasopresor.

Abstract OBJECTIVE: To describe anesthetic complications in patients with pre-eclampsia with severity criteria. MATERIALS AND METHODS: Observational, retrospective, cross-sectional, descriptive study conducted in a tertiary care center in the city of Medellin, Colombia, between January 2016 and January 2021. The source of information was medical records. Inclusion criteria: pregnant patients, with pre-eclampsia with severity criteria, who received neuroaxial or general anesthesia. Exclusion criteria: patients with previous diagnosis of coagulopathies and with other hypertensive disorders of pregnancy unrelated to pre-eclampsia with severe characteristics. Non-probability sampling of consecutive cases and univariate analysis were performed. RESULTS: Fifty-eight patients were included; 69% terminated the pregnancy by cesarean section. Eighty-nine.4% received neuroaxial anesthesia and 10.6% general anesthesia. 29.9% were admitted to intensive care, 4.7% had hypotension, 3.9% required vasopressor support, 3.7% had difficult airway, 0.98% required mechanical ventilation. One patient had pulmonary edema and one patient had hemorrhagic stroke. Urinary retention occurred in 1.5% of patients receiving spinal anesthesia. The incidence of failed neuroaxial anesthesia was 1.4% for labor and 1.3% for cesarean section. There were no cases of death, meningitis, arachnoiditis, paraplegia, accidental dura puncture, or allergic reaction. CONCLUSIONS: Neuroaxial anesthesia remains the anesthetic technique of choice in patients with pre-eclampsia with severity criteria. The most common anesthetic complications were ICU admission, hypotension, and need for vasopressor support.

Early and late-onset preeclampsia: effects of DDAH2 polymorphisms on ADMA levels and association with DDAH2 haplotypes

Abstract Objective: To examine whether the DDAH2 promoter polymorphisms -1415G/A (rs2272592), -1151A/C (rs805304) and -449G/C (rs805305), and their haplotypes, are associated with PE compared with normotensive pregnant women, and whether they affect ADMA levels in these groups. Methods: A total of 208 pregnant women were included in the study and classified as early-onset (N=57) or late-onset PE (N =49), and as normotensive pregnant women (N = 102). Results: Pregnant with early-onset PE carrying the GC and GG genotypes for the DDAH2 -449G/C polymorphism had increased ADMA levels (P=0.01). No association of DDAH2 polymorphisms with PE in single-locus analysis was found. However, the G-C-G haplotype was associated with the risk for late-onset PE. Conclusion: It is suggested that DDAH2 polymorphisms could affect ADMA levels in PE, and that DDAH2 haplotypes may affect the risk for PE.