Presión coloidosmótica plasmática, índice de Briones y ascitis en preeclampsia-eclampsia / Plasma colloid osmotic pressure, Briones index and ascites in preeclampsia-eclampsia

Introducción: La fuga capilar en la preeclampsia-eclampsia se puede evaluar calculando la presión coloidosmótica de las proteínas plasmáticas (PCO) y el índice de Briones. El objetivo de la presente investigación fue informar los valores de la PCO y del índice de Briones en preeclampsiaeclampsia, y comparar su correlación con ascitis. Material y métodos: Se estudiaron 225 pacientes gestantes con preeclampsia-eclampsia. Se calculó la PCO y el índice de Briones como grupo total y en tres categorías: a) preeclampsia severa sin síndrome HELLP, b) preeclampsia severa con síndrome HELLP y c) eclampsia. Se comparó la correlación de ambos parámetros entre sí y con la ascitis. Pruebas estadísticas: t de Student, coeficiente de correlación de Pearson (r). Resultados: La PCO total fue de 20.14 ± 2.52 mm Hg, en 148 casos (65.78 %) resultó normal (21.54 ± 1.60 mm Hg) y en 77 (34.22 %) fue baja (17.55 ± 1.71 mm Hg) (p = 0.058). No hubo diferencia entre las tres categorías (p > 0.05). El índice de Briones total fue de 0.18 ± 0.03, en 87 casos (38.67 %) resultó normal (0.22 ± 0.01) y en 138 (61.33 %) se encontró bajo (0.16 ± 0.01) (p = 0.07). No hubo diferencia entre las tres categorías (p > 0.05). Se documentó ascitis (627.27 ± 85.21 ml) en 11 pacientes (4.89 %). La r de la PCO versus índice de Briones fue de 0.55, PCO versus ascitis fue de −0.03 y del índice de Briones versus ascitis fue de −0.43. Conclusiones: Se encontraron valores bajos de la PCO en 34.22 % y del índice de Briones en 61.33 %. Ambos parámetros tuvieron correlación negativa con la ascitis.

BACKGROUND: Capillary leak in preeclampsia-eclampsia (P-E) can be evaluated by calculating the plasma colloid osmotic pressure (COP) and the Briones index (BI). We undertook this study to report the values of plasma COP and BI in patients with P-E. We compared their correlation with ascites. METHODS: We studied 225 pregnant patients with P-E. We calculated plasma COP and BI as a total group and in three categories: 1) severe preeclampsia (SP) patients without HELLP syndrome, 2) SP patients with HELLP syndrome and 3) patients with eclampsia. We compared the correlation of both parameters as well as the correlation of each with ascites. Student's t test and Pearson correlation coefficient (r) were used for statistical analysis. RESULTS: Total COP was 20.14 +/- 2.52 mmHg. In 148 cases (65.78%) the results were normal (21.54 +/- 1.60 mmHg) and in 77 cases (34.22%) results were low (17.55 +/- 1.71 mmHg) (p = 0.058). There was no difference among the three categories (p >0.05). Total BI was 0.18 +/- 0.03, in 87 cases (38.67 %) it was normal (0.22 + 0.01) and in 138 cases (61.33 %) it was low (0.16 +/- 0.01) (p = 0.07). There were no differences among the three categories (p >0.05). We documented ascites of 627.27 +/- 85.21 ml in 11 patients (4.89%). The r of the COP vs. BI was 0.55, COP vs. ascites was -0.03 and BI vs. ascites was -0.43. CONCLUSIONS: We found low levels of COP in 34.22% and BI in 61.33% of patients. Both parameters had negative correlation with ascites.

Concentraciones de homocisteína y perfil lipídico en preeclámpticas

El objetivo de la investigación fue comparar las concentraciones plasmáticas de homocisteína y perfil lipídico en preeclámpticas y controles además establecer la relación entre la homocisteína y las concentraciones de colesterol, triglicéridos y lipoproteínas. Setenta pacientes fueron seleccionadas y divididas en dos grupos, preeclámpticas (grupo A) y embarazadas normotensas (grupo B), consideradas como controles, estudiadas en forma consecutiva. Se midieron las concentraciones de colesterol total, triglicéridos, lipoproteínas de alta densidad (HDL- C), baja densidad (LDL-C), muy baja densidad (VLDL) y homocisteína. Se encontraron diferencias estadísticamente significativas en las concentraciones de triglicéridos, HDL-C, VLDL, y homocisteína (P < 0,05). No se encontraron diferencias significativas en las concentraciones plasmáticas de colesterol y LDL-C (p=ns). Al analizar exclu ivamente al grupo de las preeclámpticas se encontró que la única correlación significativa y positiva fue observada entre la homocisteína y triglicéridos (r = 0,229; P < 0,05). Se concluye que existen diferencias significativas en las concentraciones de triglicéridos, H D L-C, V LDL y homocisteína entre las preeclámpticas y los controles normotensas. Además, existe una correlación positiva y significativa entre las concentraciones de homocisteína y de triglicéridos en las preeclámpticas

The objective of the research was to compare plasma concentrations of homocysteine and lipid profile in preeclamptic and control patients and establish the relation between homocysteine and cholesterol, triglycerides and lipoprotein concentrations. Seventy patients were selected and divided in two groups, preeclamptic (group A) and normotensive pregnant women (group B) considered as controls, studied in consecutive way. Concentrations of total cholesterol, triglycerides, high-density (HDL-C), low-density (LDL-C), very-low density lipoproteins (VLDL) and homocysteine were measured. There were significant statically differences in triglycerides, HDL-C, VLDL and homocysteine (P < 0.05). There were no significant differences in cholesterol and LDL-C concentrations. When preeclamptic group was analyzed exclusively, there were observed only significant and positive correlation between homocysteine and triglycerides (r=0.229; P < 0.05). It is concluded that there are significant differences in triglycerides, HDL-C, VLDL and homocysteine between preeclamptic and normotensive controls. More over, there is a positive a significant correlation between homocysteine and triglycerides in preeclamptic patients

Serum homocysteine in pre-eclampsia and eclampsia.

Pre-eclampsia and eclampsia are common obstetrical problem causing adverse effects on pregnancy outcome. Large bodies of evidences suggest that hyperhomocysteinemia is a causal factor of pre-eclampsia/eclampsia. This study designed to explore the association between hyperhomocysteinemia and pre-eclampsia/eclampsia, the knowledge of which expected to be used for prevention of pre-eclampsia and eclampsia. In a case-control study serum homocysteine was measured in 136 controls (healthy pregnant), 84 pre-eclamptic and 120 eclamptic pregnant women. Serum homocysteine in patients with pre-eclampsia (9.54 +/- 3.21 micromol/L) and eclampsia (10.57 +/- 3.39 micromol/L) found to be significantly increased compared to controls (6.86 +/- 2.47 micromol/L) (p < 0.001). Between pre-eclampsia and eclampsia, homocysteine found to be raised more in eclampsia compared to pre-eclampsia (p < 0.03). In conclusion, hyperhomocysteinemia is associated with pre-eclampsia as well as eclampsia, but in eclampsia the severity of homocysteine elevation is more compared to that in pre-eclampsia.

Adiponectina plasmática en preeclampsia y eclampsia / Plasma adiponectin in preeclampsia and eclampsia

Antecedentes: La adiponectina, una de las proteínas específicas del tejido adiposo, se ha considerado que mejora la sensibilidad a la insulina, inhibe la inflamación vascular y tiene efectos antiaterogénicas, ya que se correlacionan negativamente con la obesidad y dislipidemia. Objetivo: Comparar las concentraciones de adiponectina plasmática en eclámpticas, preeclámpticas y embarazadas normotensas. Método: Se incluyeron 30 pacientes con preeclampsia leve (grupo A), 30 pacientes con preeclampsia severa (grupo B) y 30 pacientes con eclampsia (grupo C). El grupo control fue seleccionado por tener edad e índice de masa corporal similar con los grupos en estudio y consistió en 35 embarazadas sanas (grupo D). Solo se incluyeron pacientes nulíparas. Las muestras de sangre se recolectaron antes del parto y en los grupos en estudio inmediatamente después del diagnóstico para la determinación de adiponectina plasmática. Resultados: Los valores más bajos de adiponectina se observaron en el grupo de pacientes eclámpticas junto con las preeclámpticas severas. Se encontraron valores mas altos en las preeclámpticas leves. Los grupos en estudio presentaron valores de adiponectina significativamente inferiores que los controles (p<0,05). El análisis de regresión lineal, mostró que los factores que afectaban significativamente la concentración plasmática de adiponectina fueron: contaje de plaquetas, ácido úrico y proteinuria en 24 horas (p < 0,05). Conclusión: Las pacientes eclámpticas y preeclámpticas presentan concentraciones de adiponectina plasmática más bajas que las embarazadas normotensas y es posible que esta disminución puede contribuir a la resistencia a la insulina y a la aterogénesis acelerada observada en la preeclampsia.

Background: Adiponectin, a specific protein from adipose tissue, is considered that improves the sensibility to insulin, inhibits vascular inflammation and has antiatherogenic effects, cause it correlate negatively with obesity and dyslipidemia. Objective: To compare plasma adiponectin concentrations in eclamptic, preeclamptic and normotensive pregnant women. Method: There were included 30 patients with mild preeclampsia (group A), 30 patients with severe spreeclampsia (group B) and 30 patients with eclampsia (group C). A control group was selected for having similar age and body mass Índex to studied groups and consisted in 35 healthy pregnant women (group D). There were included only nuliparous patients. Blood samples were collected in all patients before delivery and in studied groups immediately after diagnosis for plasma adiponectin determination. Results: Lower values of adiponectin were observed in eclamptic patients together with severe preeclamptic patients. Higher valúes were found in mild preeclamptic patients. Studied groups presented significant lower valúes of adiponectin compared with controls (p<0.05). Linear regression analysis, found that factors who affected significantly plasma adiponectin concentrations were: platelet count, uric acid and 24-hour proteinuria. Conclusión: The findings of this research showed that eclamptic and preeclamptic patients had lower plasma adiponectin concentrations than normotensive pregnant women and it is possible than this lower concentration can contribute to insulin resistance and accelerated atherogenesis observed in preeclampsia.

correlation between the serum testosterone level and insulin sensitivity in patients with pre-eclampsia-eclampsia syndrome

To study serum testosterone level, insulin sensitivity and their correlation in mild, severe pre-eclasmpsia and eclampsia compared to normal pregnant women. The study included sixty patients. All were primigravidae, in 3[rd] trimester, they were divided into two groups, the first was normal control group [15 cases] and the second group [45 cases] was subdivided equally into three subgroups mild, severe pre-eclampsia and eclamptic cases. All cases were subjected to fasting venous blood sampling to measure glucose, insulin, total and free testosterone. The mean fasting serum testosterone [total and free] increased in pre-eclamptic toxemia cases significantly compared to the control group and in between subgroups, P was = 0.027 and 0.000 respectively. The mean fasting insulin level increased in pre-eclamptic toxemia significantly compared to control group and in subgroups p= 0.013. Mean fasting levels of testosterone, [total and free] were significantly higher in primigravidae with pre-eclampsia-eclampsia syndrome than in normotensive women with similar gestational ages. Levels of mean fasting insulin also were significantly higher than normotensive women. So there is positive correlation between hyperandrogenism and hyperinsulinemia or insulin resistance in preeclampsia-eclampsia syndrome

Serum uric acid: a predictor of hellp syndrome

The study was conducted to determine the changes in uric acid level in pre-eclamptic and eclamptic women. One hundred and fourteen females of reproductive age group 15-45 years were included in the study. The study group comprised of 27 pre-eclamptic and eclamptic women each and the control group consisted of 30 pregnant and 30 non pregnant women. All pregnant women included in the study were in third trimester of pregnancy. Serum uric acid was determined by kit method. Uric acid level increases highly significantly in pre-eclamptic and eclamptic women as compared to control groups. The study concluded that uric acid can be an economical biochemical parameter in pre-eclamptic patients and is the predictor of HELLP syndrome in eclamptic women

Clinical management and outcome of eclampsia at Rajavithi Hospital.

The purpose of this clinical study was to review experience in the management, and outcome of eclamptic patients at Rajavithi Hospital. Standardized treatment for all cases of eclampsia has consisted of magnesium sulfate intravenously and intramuscularly to control convulsions by means of Chesley and Tepper's regimen, intravenous hydralazine intermittently to lower diastolic blood pressure when it exceeds 110 mmHg, and initiation of delivery as soon as the patient has regained consciousness and is stable. During a ten-year period there were 167,200 deliveries and 90 eclamptic patients, yielding an incidence of eclampsia of 1 in 1,857 deliveries. There were three maternal deaths (3.3%) due to intracerebral hemorrhage. Serious adverse maternal outcomes were more frequent in women whose convulsions occurred before delivery. Excluding postpartum cases, perinatal mortality of fetuses weighing 1,000 g or more was 11.7 per cent. Magnesium sulfate is the drug of choice for treatment of eclamptic convulsions. In most situations, clinical assessment of deep tendon reflexes, respirations, and urine output is adequate to monitor maternal magnesium toxicity without the need to determine actual maternal serum magnesium levels.

Antitrombina-III en la preeclampsia-eclampsia: estudio piloto / Antithrombine III in preeclampsia-eclampsia: pilot study

Se estudiaron los niveles funcionales de antitrombina-III en los siguientes grupos: A) mujeres sanas no embarazadas: 11 casos, promedio 107 por ciento; rango 88-120 por ciento; desviación estandar +/- 9.904; pacientes con AT-III menor a 80 por ciento, 0 por ciento B) mujeres sanas embarazadas en el 3er trimeste sin complicaciones: 13 casos, promedio 106 por ciento; rango 89-129 por ciento; desviación estandar +/- 11.647; pacientes con AT-III menor a 80 por ciento, 0 por ciento C) mujeres con preeclampsia leve a severa: 6 casos, promedio 100 por ciento; rango 81-114 por ciento; desviación estandar +/- 10.621; pacientes con AT-III menor a 80 por ciento, 0 por ciento D) mujeres con eclampsia o síndrome de HELLP: 5 casos, promedio 79 por ciento; rango 75-96 por ciento; desviación estandar +/- 10.085; pacientes con AT-III menor a 80 por ciento, 80 por ciento. Prueba estadística F=9.27 valor de p menor a 0.0003. Los niveles plasmáticos de antitrombina-III disminuidos en pacientes con diversos grados de toxemia parecen deberse a coagulación intravascular de bajo grado en preeclampsia y de alto grado de eclampsia y HELLP como principal causa. Debería investigarse su utilidad como prueba de tamizaje para etapas preclínicas y en pruebas de detección temprana y como un indicador de la gravedad de la enfermedad. Estos resultados preliminares justifican la realización de estudios propectivo con mayor número de casos

Dímero-D en las diferentes etapas de la toxemia del embarazo: estudio piloto / D-Dimer in different Pre-eclampsia stages: pilot study

Se estudiaron los niveles de dímero-d en las diferentes etapas de la toxemia del embarazo. Esta prueba es la más eficaz para detectar coagulación intravascular diseminada. Los niveles encontrados fueron los siguientes: A.- Mujeres sanas no embarazadas (10 pacientes) 550 ng/ml promedio. B.- mujeres sanas embarazadas (8 pacientes) 875 ng/ml promedio. C.- mujeres con preeclampsia leve y severa (8 pacientes) 1625 ng/ml promedio y D.- mujeres con eclampsia y sindrome de Hellp (6 pacientes) 3000 ng/ml promedio. Estos resultados fueron estadísticamente significativos con p < 0.05. Esto parece indicar que realmente hay una activación progresiva del sistema de coagulación y fibrinólisis secundaria en todo embarazo normal que se exagera en casos de toxemia. En indispensable realizar estudios con mayor número de casos y con otros marcadores de daño vascular endotelial y de coagulación intravascular diseminada

Mycotoxins [aflatoxins and ochratoxins] in blood of pre-eclamptic and eclamptic egyptian patients and their relation to myocotoxins in the umbliocal cord blood and the fetal outcome umblical

This study included 172 primigravid mothers, 98 had preeclampsia, 22 had eclamptic fits, and 52 were normal pregnants. Aflatoxins were detected in 70.4% and 90.9% in maternal blood samples of preeclamptic and eclamptic patients, respectively, compared with none in the control. They were detected in 67.3%, 90.95%, and 1.9% in the fetal blood of preeclamptic, eclamptic and control groups, respectively. There was no significant difference in Aflatoxins [Afs] between maternal and fetal blood. Ochratoxin A could not be detected in maternal blood of the control group or in the fetal blood samples of all groups. Aflatoxin B1 was the most abundant aflatoxin in the maternal and fetal blood samples. Aflatoxin M1 and M2 could not be detected in the umbilical cord blood samples. There was significant high level of AfB1 in the umbilical cord blood of unhealthy babies [small for date, neonatal distress and neonatal jaundice] compared with healthy babies

Anticuerpos anticardiolipina en la preeclampsia/eclampsia / Anticardiolipine antibodies in preeclampsia/eclampsia

Introducción. Los anticuerpos antifosfolípidos se han encontrado elevados en pacientes con preeclampsia/eclamplsia. Objetivo. Determinar la presencia de anticuerpos anticardiolipina en pacientes con preeclampsia/eclampsia. Pacientes y métodos. Estudiamos prospectivamente 65 pacientes, 35 con preeclampsia/eclampsia (grupo problema, A) y 30 con embarazo normal (grupo control, B) en una UCI. Se efectuó determinación en sangre de IgM e IgG utilizando el método modificado de Harris al segundo y tercer trimestre de embarazo en los dos grupos. Resultados. Encontramos al 2o. y 3er. trimestre de embarazo: en el grupo A, lgG 1.3 ñ 0.9 U y 1.52 ñ 1.1, respectivamante (cuatro pacientes) y la lgM fue de 2.2 ñ 0.9 U y 2.06 ñ 0.81 U (nueve pacientes). En el grupo B (30 pacientes) la lgG fue 1.2 ñ 0.7 U y 0.2 ñ 0.1 U, y la lgM 2.1 ñ U y 1.7 ñ 1 U en los mismos periodos. Conclusión. Los anticuerpos anticardiolipinas se elevan frecuentemente en pacientes con preeclampsia/eclampsia

Pregnancy induced hypertension and antithrombin-III.

This study was undertaken to determine the coagulation profile of women with pregnancy induced hypertension and to evaluate the changes in the level of AT-III in pre-eclampsia and eclampsia and its correlation with severity of disease in order to evaluate if it can be used as a marker for severity of PIH. 119 women with PIH in the third trimester of pregnancy constituted the study group. Age and parity matched 25 normal pregnant and 25 non-pregnant women were taken as control group. No significant difference between the coagulation profile of non-pregnant and normal pregnant women was seen. There is evidence of consumption coagulopathy in PIH patients and AT-III activity shows a gradual and almost linear reduction in various groups ranging from normal pregnant women to eclampsia. Reduction in AT-III activity has positive correlation with PIH and it can be a useful marker for severity of PIH.

Hyperferritinemia in pregnancy induced hypertension and eclampsia.

A study of serum iron and ferritin levels in Indian women with pregnancy induced hypertension (PIH) (mild/severe) and eclampsia compared with controls of similar gestational ages, revealed that mean serum iron was elevated slightly in PIH and significantly in eclampsia as compared to controls. Mean ferritin levels were significantly elevated both in PIH and eclampsia as compared to controls indicating that ferritin measurement in PIH and eclampsia would not reflect iron nutritional status. Lack of significant changes in liver enzymes and in hemoconcentration in PIH and eclampsia indicate that liver damage and altered hemodynamics only play a partial role in causing hyperferritinemia. Possible role of placental ferritin, being released as a result of placental damage in these conditions seems to be an area needing further research.

Radial immuno diffusion estimation of maternal serum alpha feto-protein in normal pregnancy and pregnancy-induced hypertension.

Maternal Serum Alphafeto Protein (AFP) levels were measured in maternal serum of normal pregnancy & pregnancy induced hypertension (PIH) by using M-partigen immuno diffusion plates. A total of 80 cases (30 normal pregnancy and 50 of PIH) were taken for study. AFP levels were significantly lower in pre-eclamptic and eclamptic pregnancies as compared to normal pregnancy. Strong positive correlation between gestational age and maternal AFP levels was observed in normal pregnancy. While in PIH no significant positive or negative relationship was found. Observations suggest that estimation of maternal serum AFP may help in early detection of PIH.