Serum heat shock protein 70 in preeclampsia and normal pregnancy: a systematic review and meta-analysis

Background: Preeclampsia, a severe complication of human pregnancy is one of the main causes of maternal, fetal, and neonatal morbidity and mortality with unclear pathogenesis. Heat shock protein 70 [HSP70] is one of the factors that can mediate cytoprotective, antiapoptotic, and immune regulatory effects

Objective: This meta-analysis was performed with aim to evaluate HSP70 in preeclampsia and normal pregnancy

Materials and Methods: The original publications reporting the serum HSP70 levels in preeclampsia and normal pregnancies published before November 2015 were identified by searching PubMed Central, Scopus, and ISI Web of Knowledge databases by two researchers, separately. The keywords were[ preeclampsia] and [HSP70] or [Heat shock protein 70] Statistical analyses were performed using STATA software [version 11]

Results: Out of 127 studies, seven eligible case-control studies were identified which consists of 350 preeclampsia and 429 normal pregnancies. Our pooled analysis of data from 7 studies which met the inclusion criteria, provides evidence that there is a significant association between HSP70 and preeclampsia. Cochran's test results showed the heterogeneity of the studies [p<0.001] and the I2 index was 91%. The standardized mean differences [SMD] based on a random effect model with trim and fill method was 0.92 [95% CI: 0.33-1.51]; also there was a significant association between HSP70 and preeclampsia [Z=3.07, p=0.002]

Conclusion: The results showed that serum HSP70 concentration was significantly higher in preeclamptic patients than the control group. Therefore HSP70 may be identified as a diagnostic factor

Preventive and therapeutic effects of tranexamic acid on postpartum bleeding

Postpartum hemorrhage is among the leading causes of maternal mortality throughout the world. Severe blood loss contributes to the increased blood transfusion risk with its concerned inherent adverse events and therefore increased rate of emergency re-operative interventions such as arterial ligation or hysterectomy. It also can lead to protracted anemia, particularly in low or median income countries. Extended application of antifibrinolytic agents such as tranexamic acid has been customary for long years to stop or reduce blood loss in postpartum period. However, there are not enough reliable evidence to approve the real efficacy of these drugs. In this brief and summary review, we pointed to a few conducted studies. The PubMed was searched for keyword including postpartum hemorrhage, tranexamic acid, cesarean section, vaginal delivery, and blood loss prevention. The articles with language other than English were excluded from our review. We concluded that more convincing information is needed to determine the precise effects of tranexamic acid, and its benefits against adverse effects

Efficacy of rectal misoprostol for prevention of postpartum hemorrhage

Postpartum hemorrhage is an important cause of maternal morbidity and mortality after delivery. Active management of postpartum hemorrhage by an uterotonic drug decreases the rate of postpartum hemorrhage. The aim of this study is to evaluate the efficacy of rectal misoprostol for prevention of postpartum hemorrhage. This double blind randomized clinical trial was performed on full term pregnant women candidate for vaginal delivery, referred to Zahedan Imam Ali Hospital during 2008-2009. They were randomly divided into two groups of rectal misoprostol and oxytocin. The women in misoprostol group received 400 micro g rectal misoprostol after delivery and the women in oxytocin group received 3 IU oxytocin in 1 L ringer serum, intravenously. Rate of bleeding, need to any surgery interventions, rate of transfusion and changes in hemoglobin and hematocrite were compared between two groups. A total of 400 patients [200 cases in misoprostol group and 200 in oxytocin group] entered to the study. Rate of bleeding > 500 cc was significantly higher in oxytocin group than misoprostol group [33% vs. 19%] [p = 0.005]. Also, need to excessive oxytocin for management of postpartum hemorrhage was significantly lower in misoprostol group than oxytocin group [18% vs. 30%] [p = 0.003]. Decrease in hematocrite was significantly more observed in oxytocin group than misoprostol group [mean decrease of hematocrite was 1.3 +/- 1.6 in misoprostol group and 1.6 +/- 2.2 in oxytocin group]. Two groups were similar in terms of side-effects. Rectal misoprostol as an uterotonic drug can decrease postpartum hemorrhage and also can prevent from decrease of hemoglobin as compared to oxytocin