Fetal and maternal outcome of severe pre-eclampsia remote from term: expectant versus interventional management

Background: This study was conducted to compare the safety and effect on maternal and perinatal outcome of expectant versus interventional management in women with preterm severe preeclampsia with gestational age between 28 to 34 weeks.Methods: This was a non-blinded prospective analytical study carried out in the department of obstetrics and gynaecology, SSG hospital, Vadodara from January 2021-December 2021. 40 women diagnosed with severe pre-eclampsia remote from term meeting the inclusion criteria were divided in two groups (20 in each). First group comprised of women undergoing interventional management i.e. prompt delivery and the second group comprised of women undergoing expectant management till 34 completed weeks. The women in the expectant management underwent pregnancy termination before 34 weeks if any complication arises (e.g. anhydramnios, abruption, eclampsia etc).Results: The mean prolongation of pregnancy in the expectant management group was 11.45 days (range: 4-35 days). There was no increase in incidence of maternal complications (p value: 0.003). The fetal outcome was favourable in the expectant management group in terms of higher gestational age at delivery (33 versus 31 weeks; p value: 0.001), higher birth weight (1.7 versus 1.5 kg; p value: 0.05), higher APGAR score at 1 minute (7.5 versus 7; p value :0.05), lesser incidence of neonatal complications (55% versus 95%; p value 0.003).Conclusions: Considering the results of this study, it can be concluded that expectant management is recommended in patients with severe preeclampsia remote from term with intensive monitoring.

Expression and Clinical Significance of NGF and Syncytin - 1 in Pregnant Women with Severe Preeclampsia / 医学研究杂志

Objective To study the expression levels and clinical significance of nerve growth factor(NGF)and Syncytin-1 in ser-um and placental tissues of pregnant women with severe preeclampsia(SPE).Methods A total of 90 pregnant women who underwent ce-sarean delivery in the Department of Obstetrics,the Affiliated Hospital of Xuzhou Medical University in December 2021 to June 2022 were selected,and they were divided into 30 cases of early-onset SPE(early-onset group),30 cases of late-onset SPE(late-onset group),and 30 cases of normal women in the same period(control group).The maternal blood and placental tissues of the three groups were collected,and the expression levels of NGF and Syncytin-1 in each group were detected by enzyme-linked immunosorbent assay(ELISA)and immunohistochemical(IHC)staining,and their clinical significance was analyzed.Results The results of the ELISA showed that compared with healthy pregnant women in the third trimester,the expression of NGF and Syncytin-1 in the serum of pregnant women with SPE was reduced,and the early-onset group was lower than those in the late-onset group(P<0.05).The results of IHC staining showed that compared with healthy pregnant women in the third trimester,the expression levels of NGF and Syncytin-1 in pla-cental tissues were reduced in pregnant women with SPE,early-onset group was lower than those in the late-onset group(P<0.05).Conclusion The expression of NGF and Syncytin-1 in serum and placental tissues of the three groups of pregnant women was succes-sively reduced,and the expression was successively reduced in normal pregnant women,late-onset SPE and early-onset SPE,which may be involved in the occurrence and development of SPE by affecting the normal development of the placenta.

Association of Maternal C-Reactive Protein in Severe Pre-Eclampsia.

Endothelial cell dysfunction and inflammation are considered to have a role in the pathophysiology of pre-eclampsia(1).A generalized activation of circulating leukocytes (characteristic of inflammation) has been found during pre-eclampsia. Moreover, increased concentration of CRP and inflammatory markers has been reported in pre-eclampsia(2). We wanted to determine the serum CRP level in preeclampsia and assess the platelet dysfunction in pre-eclampsia and evaluate its association with severity of the disease. METHODSThe study was conducted at a tertiary care centre from November 2015 to August 2017. The study included a total of 200 singleton pregnant patients. After collecting basic demographic data and brief history, detailed clinical examination was carried out, routine investigations along with serum C - reactive protein were done. Results were recorded and maternal and foetal outcomes were noted. RESULTSAmong the 200 patients who were included in the study, it was found that majority of them were primigravidae. 88% of the patients showed increase in the C-reactive protein, which also correlated with the severity of the disease. Platelet count showed a decreasing trend with increasing severity of the disease and platelet distribution width showed an increasing trend with the increasing severity of the disease. CONCLUSIONSSerum C- reactive protein concentration increases in pre-eclampsia more than that compared to normal pregnancy. The serum C-reactive protein levels also helps in assessing the severity of the disease and its further prognosis. Further the abnormalities in platelet indices caused due to the disease process in pre-eclampsia is worsened due to thrombocytopenia. The morphological features of platelets as studied by Mean platelet volume and platelet distribution width are not consistent with the severity of the disease.

Comparative maternal outcomes of oral nifedipine and intravenous labetalol for severe hypertension during pregnancy: an open label randomized controlled trial

Background: Hypertensive diseases are commonly seen during pregnancy and remain one of the leading causes of maternal morbidity and mortality. Mostly commonly preferred drugs by health care providers for treatment of severe hypertension during pregnancy are labetalol and hydralazine. However, they require proper storage, intravenous access, and adequately trained staff for usage. Oral nifedipine in contrast is easier to use and widely available.  Objective of this study was to report the efficacy and safety of oral nifedipine as compared to intravenous labetalol for treatment of severe hypertension during pregnancy.Methods: It was an open label randomized controlled trial in which 100 women with severe hypertension during pregnancy were enrolled. They were randomized to receive either incremental doses of intravenous labetalol every 20 minutes (total 300 mg) or 10 mg oral nifedipine every 20 minutes (up to 50 mg) to lower the blood pressure to safer levels.Results: Women receiving oral nifedipine took significantly less time to achieve target blood pressure [(37.6±23.3) minutes (SD) as compared to those receiving intravenous labetalol (52.0 minutes±27.95 (SD)]. Women receiving nifedipine for treatment also required significantly lesser doses to control the blood pressure [mean dose 1.8±1.1 (SD) versus 2.6±1.2 (SD) p=0.006]. There were two failures in labetalol group and one failure in nifedipine group. No serious adverse events were reported in either group.Conclusions: Oral nifedipine is equally efficacious to I.V. labetalol for treatment of severe hypertension during pregnancy and is easier to use in low resource settings.

Serum lactate dehydrogenase: a prognostic factor in pre-eclampsia

Background: Pre eclampsia is responsible for significant maternal and perinatal morbidity and mortality worldwide .Serum LDH level is a useful biomarker for cellular injury which may reflect the severity of pre eclampsia and its level might be a guideline for management of patients. The aim of study was to find out the role of serum LDH in prediction of adverse outcome of pre eclampsia, severity of disease and occurrence of complications.Methods: This prospective observational study was conducted in the department of Obstetrics and Gynecolog, RIMS, Ranchi, Jharkhand, India. A total of 300 cases were studied.150 cases were non severe preeclamptic and 150 cases were severe pre eclamptic patients. Serum LDH was done in both non severe and severe eclamptic patients .Data entry was done in Microsoft excel 2007. Results were analysed by chi square test.Results: Higher LDH levels had significant correlation with high blood pressure as well as poor maternal and perinatal outcome.Conclusions: High serum LDH level correlate well with the severity of disease and poor outcome in patients of pre eclampsia. Detection of high risk patients with increased levels of LDH mandate close monitoring and management to prevent maternal and fetal morbidity and mortality.

Abruptio placenta retrospective study: maternal and fetal outcome

Background: Placental abruption is the most common cause of antepartum haemorrhage. Incidence appears to be increasing due to increase in prevalence of risk factors like age, parity, anaemia, poor nutrition, Preeclampsia, PROM, previous MTP. Abruption may be partial or total. Pain and Vaginal bleeding hallmark of abruption.Methods: Retrospective observational study carried out during period of October 2017 to October 2018 at Govt Theni medical college- tertiary care institute. To investigate incidence, cause, maternal and perinatal outcome. Maternal Data includes incidence, age, parity, gestational age, risk factors, intra-operative events, amount of blood loss. Other causes of APH-Placenta praevia and extra-placental causes are excluded. Neonatal data includes Term/preterm, Birth weight, NICU admission, perinatal morbidity and mortality.Results: Total number of deliveries from October 2017 to September 2018 were 7010. Total number of abruptio placenta cases were 55. This study shows increased incidence of severe preeclampsia with abruption. Increasing age as predisposing factor. Mean age of abruption was 26-30 years mainly seen in term pregnancy. Mode of delivery varied. Major complication were PPH and shock managed with blood products.Conclusions: This study reveals increasing age, parity, severe preeclampsia are risk factors. Routine and regular antenatal checkup early detection and correction of Preeclampsia, anemia helps to deduce no of abruption and improving maternal and fetal outcome though maternal morbidity is reduced with modern management of abruption, Timely diagnosis and intervention is necessary. Team efforts by obstetricians, anesthetist and neonatologist is required for better maternal and fetal outcome.

Preeclampsia grave de aparición precoz confirmada con biomarcador / Severe early-onset biomarker-confirmed preeclampsia

RESUMEN La aparición de preeclampsia antes de las 20 semanas de gestación es rara y generalmente se asocia con enfermedades trofoblásticas o con el síndrome antifosfolípido. Presentamos el caso de una paciente con preeclampsia severa asociada al síndrome de distress respiratorio del adulto (SDRA) de forma precoz en la semana 15 de gestación en ausencia de los trastornos antes mencionados. Su confirmación diagnóstica se realizó mediante el empleo del biomarcador sFlt-1/P1GF.

ABSTRACT The occurrence of preeclampsia before 20 weeks of gestation is rare and usually associated with trophoblastic diseases or antiphospholipid syndrome. We present the case of a patient with severe preeclampsia associated with adult respiratory distress syndrome early in week 15 of gestation in the absence of the aforementioned disorders. Its confirmation was carried out through the use of biomarker sFlt-1/P1GF.

Effect of magnesium sulfate on arterial blood flow in preeclampsia pregnant woman and fetuses / 重庆医学

Objective To investigate the changes of arterial blood flow in pregnant women with severe preeclampsia(SPE) and fetuses and the effect of magnesium sulfate on it.Methods One hundred and seventy-four SPE pregnant women in our hospital from January 2013 to January 2015 were selected as the observation group and 174 normal pregnant women as the control group.The observation group was given the magnesium sulfate treatment for 2 d.The arterial blood flow changes of middle cerebral artery,uterine artery,uterine spiral artery,umbilical artery,fetal middle cerebral artery before and after treatment in the observation group were observed.And maternal blood pressure,dizziness symptoms,no load test(NST) changes were also observed.Results The RI,PI and S/D values of pregnant women and fetal middle cerebral artery before and after treatment had no statistical differences between the control group and observation group(P＞0.05).The RI,PI and S/D values of uterine artery and uterine spiral artery before treatment in the observation group were significantly higher than those in the control group(P＜0.05);the RI,PI and S/D values of uterine artery and uterine spiral artery after treatment in the observation group were significantly lower than those before treatment(P＜0.05).The umbilical artery RI,PI and S/D values before treatment in the observation group were higher than those in the control group(P＜0.05);the PI and S/D values after treatment were lower than those before treatment,but difference was statistically significant(P＞0.05).The systolic pressure,diastolic pressure and mean arterial blood pressure after treatment in the observation group were decreased compared with treatment,and the proportion of dizziness was decreased compared with before treatment,but the difference was not statistically significant(P＞0.05),while the incidence rate of NST no response was significantly lower than that before treatment(P＜0.05).Conclusion The magnesium sulfate therapy can significantly improve the blood flow situation of uterine artery and uterine spiral artery in the patients with SPE and can improve fetal intrauterine reserve.

Clinical Study on Tianma Gouteng Decoction Combined with Routine Western Therapy in the Treatment of Early Onset Severe Pre-eclampsia / 中国中医药信息杂志

Objective To observe clinical efficacy of Tianma Gouteng Decoction combined with Western medicine for early onset severe pre-eclampsia. Methods Sixty patients were randomly divided into treatment group with 30 cases and control group with 30 cases. Two groups were both given the routine Western therapy, while the treatment group was added with Tianma Gouteng Decoction. Indicators were observed and compared between two groups including blood pressure, 24 h UAE, D-dimer, fibrinogen and their effects on pregnancy. Results Compared with the control group, the blood pressure, 24 h UAE, fibrinogen, D-dimer, hypoproteinemia, and liver and kidney function were reduced obviously in the treatment group (P<0.05);fibrinogen and D-dimer of control group were not changed significantly;gestational weeks of treatment group were extended (15.2 ± 4.8)d, and neonatal asphyxia was 7 cases;gestational weeks of control group were extended (9.3 ± 2.2)d, and neonatal asphyxia was 11 cases. There was no significant difference about cesarean section rate between the two groups. Conclusion Tianma Gouteng Decoction combined with Western medicine for treatment of early onset severe pre-eclampsia have better clinical efficacy.

The clinical effect of low molecular heparin calcium on early onset severe pre-eclampsia / 中国综合临床

Objective To analyze the clinical effects of low molecular heparin calcium on early onset severe pre-eclampsia.Methods Sixty patients with early onset severe pre-eclampsia at 26-34 weeks of gestational age were divided into treatment group(28 cases)and control group(32 cases).The conventional treatment was delivered in control group and low molecalar heparin calcium(LMWHC)was used in treatment group additionally.The time of prolonged gestational age,umbilical arterial S/D ratio,amniotic fluid index,placenta weight,neonatal weight and Apgar score were measured in two groups.Results The time of prolonged gestational age was 10.19 ±4.57days in treatment group and 6.14 ±3.56 days in control group,which were significantly different(P ＜ 0.01).Umbilical arterial S/D ratio,amniotic fluid index,placenta weight and neonatal weight were all significantly different between the two groups(P ＜ 0.05).Neonatal Apgar score in treatment group was remarkably improved(P ＜ 0.01).Conclusion LMWHC treatment in the patients with early onset severe pre-eclampsia could extend gestational age,increase neonatal weight and improve perinatal outcomes.

Applying the new concept of maternal near-miss in an intensive care unit

OBJECTIVES: The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria. METHODS: In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate's correction or Fisher's exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95% confidence intervals. RESULTS: Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially lifethreatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission (67.7% of the cases, 107/158); however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths). CONCLUSIONS: Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care.

Renal hematoma: An unusual cause of acute abdomen and fetal demise in severe Pre-Eclampsia.

Retroperitoneal hematoma occurs rarely in an obstetric patient. Renal hematoma may present with signs and symptoms, which may mimic the clinical presentation of abruptio placentae or rupture uterus. Although renal hematoma is sometimes a surgical emergency due to hypovolemic shock, conservative management by angiographic embolization may be done. Timely diagnosis and management is required to decrease the maternal mortality and morbidity. We hereby report a case of spontaneous renal hematoma in a patient with severe pre-eclampsia who presented with acute abdomen and intrauterine fetal death.

Clinical study of 36 cases with severe pre-eclampsia complicated with ascites / 中国综合临床

Objective To analyse clinical characteristics and preventive methods of pregnancy-induced hypertensive severe pre-eclampsia with ascites.Methods 184 cases of patients with severe pre-eclampsia complicated with ascite were divided into two groups and the clinical characteristics were compared(severe pre-eclampsia complicated with ascite group,n=36;Severe pre-eclampsia group,n=148 cases).Results The average time of the termination of pregnancy was (34±4) weeks in severe pre-eclampsia complicated with ascites group,and (36±3) weeks in severe pre-eclampsia group (t=2.71,P＜0.01).There were 6 cases of intrauterine stillborn (16.67%),14 cases of neonatal mortality (38.89%);22 cases of premature labor (61.11%) in severe pre-eclampsia complicated with aacites group;There were 4 cases of intrauterine stillborn (2.7%);16 cases of neonatal mortality (10.81%);and 35 cases of premature labor (23.65%) in severe pre-eclampsia group (X~2=10.99,16.73,19.01,P＜0.001).There were differences in the total protein,albumin,white/ball ratio,lactic acid dehydregenase,serum creatinine,24-hour urinary protein between the two groups [total protein:(51.68±6.08) g/L vs (59.34±8.28)g/L,albumin:(24.32±4.06) g/L vs (32.16±5.63) g/L,white/ball ratio:(0.92±0.26) vs (1.16±0.26),lactic acid dehydrogenase:(495.87±312.56) U/L vs (323.81±185.00) U /L,serum creatinine:(131.62±95.34) μmol/L vs (91.52±86.83) μmol/L,24 h urinary protein(4.21±3.51)g/24 h vs (2.38±2.57)g/24h,t=6.17,8.77,5.50,4.79,2.72,3.98,P＜0.05 or ＜0.01].Conclusion Tbe condition of severe pre-eclampsia with ascites is extremely serious,so pregnancy should be timely terminated.The aacites can be dissipated after delivery.Early,systematic and regular prenatal care can prevent severe pre-eclampsia and complications in time.

Expression of vascular endothelial growth factor in serum of umbilical blood from the newborns of women with severe pre-eclampsia / 国际儿科学杂志

Objective To study the expression and significance of vascular endothelial growth factor(VEGF) in serum of umbilical blood from the newborns of women with severe pre-eclampsia.Methods Radioimmunoassay was used to measure the serum VEGF of umbilical blood from 26 newborns of women with severe pre-eclampsia (severe pre-eclmpsia group) and 30 newborns of normal pregnancy women (control group). According to birth weight-gestational age relation,severe pre-eclampsia group included 15 newborns small for gestational age (SGA group) and 11 newborns appropriate for gestational age (AGA group).Results (1)The VEGF level of umbilical vein blood and umbilical artery blood in severe pre-eclmpsia group was significantly higher than that in control group respectively(t = 2.16, P < 0.05;t = 4.82, P < 0.01). (2) In control group and severe pre-eclampsia group, the VEGF level in umbilical artery blood was significantly higher than that in umbilical vein blood (control group: t = 2.24, P < 0.05;severe pre-eclampsia group: t = 3.00, P < 0.01). (3)In both control group and severe pre-eclampsia group, there was no significant correlation respectively between VEGF levels in umbilical vein blood or umbilical artery blood and newborns' gestational age or birth weight. (4)VEGF level of umbilical artery blood in SGA group was significantly higher than that in AGA group as well as in control group(t = 3.22, P < 0.01 ;t = 6.80, P < 0.01). Conclusions The serum VEGF level of umbilical vein blood and umbilical artery blood from the newborns of women with severe pre-eclampsia was significantly higher than that of normal pregnancy women respectively. The VEGF level of umbilical artery blood can reflect the severity degree of the damage of hypertensive disorder complicating pregnancy to their newborns to some degree.

The Significance of Plasma Homocysteine Level in Pregnant Women with Severe Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: The elevated plasma homocysteine concentrations is a independent risk factor of atherosclerosis. We investigated the level of plasma homocysteine is associated with severe preeclampsia. METHODS: 28 pregnant women with severe preeclampsia (study group) and 26 normotensive, healthy pregnant women (control group), matched by maternal age, gestational age, pre-pregnant body mass index and parity were enrolled into this study. Blood samples were collected within 24 hours before delivery and just 24 hours after delivery. The level of plasma homocysteine was measured by fluorescent polarization immunoassay. Statistical analysis was performed using Student t test. RESULTS: Plasma homocysteine levels in the women with severe preeclampsia were significantly elevated than those of control group in antepartum and postpartum 24 hours [7.17 2.71 vs 5.37 1.49 g/mL (mean SD); p<0.05 in antepartum, 6.38 2.03 vs 4.48 +/- 0.40 g/mL (mean SD); p<0.05 in postpartum]. CONCLUSION: In the present study the increase of plasma homocysteine in pregnant women with severe preeclampsia is related the pathogenesis of preeclampsia as like in atherosclerosis and may be used as a marker of preeclampsia by further research.

The Clinical Significance of Absence of Umbilical Artery End-Diastolic Flow in Severe Pre-Eclampsia and Eclampsia / 대한산부인과학회잡지

To determine the perinatal mortality and morbidity of fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery in severe pre-eclampsia and eclampsia, the outcome of 5 fetuses with AEDV was compared with that of 35 fetuses with positive end-diastolic velocities (PEDV). The study population comprised 38 cases of severe pre-eclampsia and 2 cases of eclampsia with structurally normal singletons, who had had umbilical artery Doppler velocimetry weekly from admission to delivery. The Doppler velocimetry result was not used for the clinical management. Perinatal death and neonatal morbidity from both groups were further examined in gestational age category to control the influence of preterm births. The incidence of AEDV of the umbilical artery Doppler velocimetry in severe pre-eclampsia and eclampsia was 12.5% (5/40). The AEDV group had a significantly higher incidence than the PEDV group in terms of ceasarean section due to fetal distress (60% : 17%), Apgar score < 7 at 5 minutes (60% : 14%), perinatal death (25% : 0%) and assisted mechanical ventilation (67% : 9%) both at 32-36 weeks. Time intervals from the detection of AEDV to delivery of live neonates varied from the day to 15 days. In conclusion, AEDV in the umbilical artery might be of clinical value in routine surveillance of pregnancies complicated by severe pre-eclampsia and eclampsia, and predict hypoxic fetal condition which needs operative interventions before or during labor and mechanical ventilation after birth.