Evaluation of the quality of life of pregnant women from 2005 to 2015.

Over the past two decades, quality of life has become an essential preoccupation in the care of patients. Many measuring instruments are available to assess physical, psychological and social quality of life. These tools allow healthcare professionals to determine the best quality of their patients. However, the quality of life for the pregnant woman seems to be little studied. This article presents the results of a bibliographic review of publications between 2005 and 2015 - referenced in PUBMED and COCHRANE - on the quality of life of pregnant women giving birth after the 22nd week of amenorrhea. The articles were selected by a reading committee. 195 publications responding to keywords were identified. 75 articles on the problem were selected. The main countries that have published on this subject are Iran (n=11) and Brazil (n=9). France ranks 17th with only one publication. 74% of articles deal with quality of life for pathological pregnancies (gestational or pre-existing pathologies). 23 pathologies were identified, mainly depression (20% of items). This review reveals a growing global interest in quality of life in pregnant women. However, few studies evaluate the impact of care in terms of quality of life in pregnant women, contrary to the recommendations of different health authorities. Finally, the analysis of the various articles shows that, in general, few measurements are made to evaluate the quality of life, not requiring a standardized curve of quality of life during pregnancy. There is thus a significant lack of data to establish a standardized curve for the quality of life of pregnant women, which allows a simple comparison of quality of life measures according to the different clinical management.

Leptin and gestational weight gain: relation of maternal and cord blood leptin to birth weight.

OBJECTIVES: To determine maternal serum leptin concentrations throughout normal pregnancy, as well as cord blood leptin concentration, and to correlate serum and cord blood leptin levels with gestational weight gain and birth weight, respectively. METHODS: This study comprised 52 normal pregnant women, including 11 in the first, 19 in the second, and 22 in the third trimester, in addition to 30 healthy, fertile nonpregnant women of comparable age and with normal body mass index (BMI). Maternal blood and fetal cord blood samples were withdrawn from the normal, healthy pregnant women and the nonpregnant controls for the determination of serum leptin by a specific radioimmunoassay. RESULTS: Maternal serum leptin concentrations in the first trimester did not differ significantly from those of healthy nonpregnant control subjects, whereas leptin concentrations in the second and third trimesters were elevated significantly. There were significant positive correlations between maternal serum leptin concentration and gestational age, gestational weight, and BMI. Cord blood leptin concentration correlated positively with birth weight and third trimester maternal serum leptin. CONCLUSION: Elevated serum leptin is associated with maternal adiposity and risk of developing large for gestational age infants.

Staged basilic vein transposition for dialysis angioaccess.

BACKGROUND: To find out a suitable procedure to dissect an arterialised thick walled vein to create secondary angioaccess for dialysis. Delicacy of the vein wall, high rate of thrombosis and difficulty to find out a suitable vein are the main obstacles to vascular surgeons during the creation of secondary angioaccess. METHODS: Forty patients in need for secondary angioaccess for dialysis were admitted for basilic vein transposition. They were classified randomly into two equal groups matched for age and sex. Group A patients were submitted to traditional basilic vein transposition. In group B, the operation was done in two stages. In the first stage, brachiobasilic anastomosis was done. Two to four weeks later the second stage was done to 19 patients (one patient had occluded shunt before the second stage) in the form of superficialization of the vein to be placed in the subcutaneous tissue. RESULTS: Follow-up period for 6-24 months revealed that in the early postoperative period (4 weeks after operation) patency rate was 12/20 (60%) in group A and 18/20 (90%) with significant difference (p<0.05) between the two groups. Later, occlusion occurred in two patients in each group. At the end of the study the overall patency was 10/20 (50%) and 16/20 (80%) in group A and B respectively with significant difference between them. Both groups were similar in minor complications. CONCLUSIONS: The staged basilic vein transposition is superior to the traditional operation in the patency rate and is recommended as a safe operation for a successful secondary angioaccess.

The clinical value of assaying maternal serum and amniotic fluid intercellular adhesion molecule 1 (ICAM-1) in cases of premature rupture of membranes.

Intercellular adhesion molecule 1 (ICAM-1) expression and upregulation induced by pro-inflammatory cytokines may be of interest in defining human response to inflammation and infection. This study was initiated to determine the levels of ICAM-1 in sera and amniotic fluid of cases of premature rupture of membranes (PROM). Serum and amniotic fluid ICAM-1 levels were determined by ELISA in 33 cases of PROM and 10 cases of normal pregnancies of matched gestational age (controls). Both serum and amniotic fluid ICAM levels were significantly elevated in 76% and 85% of cases of PROM with mean fold increments of 3.13 and 3.95, respectively. This elevation was associated with intra-amniotic infection which was detected by microbiological culture and histopathological evidence of chorioamnionitis. Increased ICAM-1 in cases of PROM may be attributed to neutrophil activation and ICAM-1 expression on fetal membranes and mononuclear cells of amniotic fluid. These results demonstrate that determination of ICAM-1 may be a valuable biomarker for early detection of acute chorioamnionitis and the possibility of PROM.

Clinical significance of urinary human tissue non-specific alkaline phosphatase (hTNAP) in pre-eclampsia and eclampsia.

The aim of this work was to determine the levels of urinary human tissue non-specific alkaline phosphatase (hTNAP) in pre-eclampsia and eclampsia in order to assess renal tubular damage. Urine samples were collected from 26 mild pre-eclamptic, 26 were pre-eclamptic, 20 eclamptic patients and 20 healthy pregnant women (controls) in their late third trimester. Urinary hTNAP/creatinine (hTNAP/cr) in severe pre-eclampsia and eclampsia were significantly higher than in controls. Urinary hTNAP/cr was increased in 23%, 77% and 90% of cases of mild pre-eclampsia, severe pre-eclampsia and eclampsia, respectively, indicating that the increase correlates with the severity of the disease. Marked elevation or urinary hTNAP/cr was also associated with bad fetal outcome. These results provide additional evidence for renal tubular damage in pre-eclampsia and eclampsia.

The prevalence of serum antineutrophil cytoplasmic autoantibodies in preeclampsia and eclampsia.

OBJECTIVES: The purpose of this study was to evaluate the prevalence of antineutrophil cytoplasmic autoantibodies (ANCAs) in preeclampsia and eclampsia. METHODS: Blood samples were obtained from 26 mildly preeclamptic, 26 severely preeclamptic, and 20 eclamptic, and 20 normal pregnant women (controls) in the late third trimester for the determination of serum cytoplasmic pattern ANCA (cANCA) and perinuclear pattern ANCA (pANCA) by the corresponding enzyme immunoassay. RESULTS: Significant elevations of serum cANCA and pANCA were found in mild and severe preeclampsia and eclampsia. The extent of rise correlated well with the severity of the disease. Both ANCAs were detected in 80% of eclamptic cases versus 38.5 and 69.3% of mild and severe preeclampsia, respectively. Marked elevations of serum ANCAs were associated with poor fetal outcome. CONCLUSION: ANCAs may be involved in the pathogenesis of glomerulonephritis in preeclampsia and eclampsia and their presence may be attributed to an autoimmune mechanism initiated by autoantibody-mediated activation of neutrophils.

Physiologic changes during CO2 and N2O pneumoperitoneum in diagnostic laparoscopy. A comparative study.

The aim of this work was to study the cardiovascular effects, the acid-base balance in serum electrolytes and chlorides in 50 patients during diagnostic laparoscopy, comparing the use of CO2 and N2O for pneumoperitoneum. The CO2 group showed a significant decrease in pH, a significant increase in pCO2 and a significant decrease in pO2, while the changes in HCO3 and base change were insignificant. In the N2O group, the changes in pH, pCO2, pO2, HCO 3 and base excess were statistically insignificant. The heart rate during CO2 and N2O pneumoperitoneum revealed that both groups showed a significant increase, but in the recovery stage there was a significant increase in the CO2 group (p less than 0.025) and insignificant increase in the N2O group (p greater than 0.05). The other circulatory and electrocardiographic changes are described. CO2 pneumoperitoneum induced a significant decrease in serum chlorides but an insignificant increase in Na and an insignificant decrease in potassium, while the N2O pneumoperitoneum group did not show any significant change in serum electrolytes.