Pentraxin-3 is a candidate biomarker on the spectrum of severity from pre-eclampsia to HELLP syndrome: GenPE study.

Pentraxin-3 has been reported as a promising biomarker of pre-eclampsia and its severity; however, available studies have small sample sizes, and analyses are not always adjusted for confounders. The aim of this study is to establish the strength of the association between maternal Pentraxin-3 level and pre-eclampsia or HELLP syndrome. It was a case-control study. Women with pre-eclampsia or HELLP syndrome were defined as cases, and women with healthy pregnancies at term (>37 weeks) were classified as controls. Plasma concentrations of Pentraxin-3 were determined at the time of delivery by quantitative enzyme immunoassay. Associations between Pentraxin-3 and pre-eclampsia and HELLP syndrome were assessed by multinomial logistic regression. Subsidiary analysis for the time of disease onset was also carried out. Odds ratios and 95% confidence intervals are reported. A total of 1024 pregnant women were included (461 controls, 368 pre-eclampsia, 195 HELLP). A positive log-linear relationship was found between the top pentraxin-3 quintile and HELLP syndrome. After adjustment for confounders (maternal age, ethnicity, socioeconomic position, date and place of recruitment, family history of pre-eclampsia, smoking, body mass index at beginning of pregnancy, gestational age and multiple pregnancy), the strength of the association was higher for HELLP syndrome [OR 1.13 (95% CI 1.08; 1.18)] than for pre-eclampsia [OR 1.03 (95% CI 1.03; 1.10)]. No difference according to time of onset or pentraxin-3 level was found. In summary, pentraxin-3 level was associated with pre-eclampsia, but it was more strongly associated with HELLP syndrome. Longitudinal studies with a lower probability of residual confounding are necessary to improve our knowledge about the role of pentraxin-3 in pre-eclampsia.

Association of pre-eclampsia risk with maternal levels of folate, homocysteine and vitamin B12 in Colombia: A case-control study.

BACKGROUND: Maternal serum concentrations of folate, homocysteine, and vitamin B12 have been associated with pre-eclampsia. Nevertheless, reported studies involve limited number of cases to reliably assess the nature of these associations. Our aim was to examine the relation of these three biomarkers with pre-eclampsia risk in a large Colombian population. MATERIALS AND METHODS: Design: A case-control study. Setting: Cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight different Colombian cities between 2000 and 2012. Population or Sample: 2978 cases and 4096 controls were studied. Maternal serum concentrations of folate, homocysteine, and vitamin B12 were determined in 1148 (43.6%) cases and 1300 (31.7%) controls. Also, self-reported folic acid supplementation was recorded for 2563 (84%) cases and 3155 (84%) controls. Analysis: Adjusted odds ratios (OR) for pre-eclampsia were estimated for one standard deviation (1SD) increase in log-transformed biomarkers. Furthermore, we conducted analyses to compare women that reported taking folic acid supplementation for different periods during pregnancy. Main Outcomes Measures: Odds ratio for pre-eclampsia. RESULTS: After adjusting for potential confounders in logistic regression models, the OR for pre-eclampsia was 0.80 (95% CI: 0.72, 0.90) for 1SD increase in log-folate, 1.16 (95%CI: 1.05, 1.27) for 1SD increase in log-homocysteine, and 1.10 (95%CI: 0.99, 1.22) for 1SD increase in log-vitamin B12. No interactions among the biomarkers were identified. Women who self-reported consumption of folic acid (1 mg/day) throughout their pregnancy had an adjusted OR for pre-eclampsia of 0.86 (95%CI: 0.67, 1.09) compared to women that reported no consumption of folic acid at any point during pregnancy. CONCLUSIONS: Maternal serum concentrations of folate were associated as a protective factor for pre-eclampsia while concentrations of homocysteine were associated as a risk factor. No association between maternal vitamin B12 concentrations and preeclampsia was found.

Consenso colombiano para la definición de los criterios de ingreso a unidades de cuidados intensivos en la paciente embarazada críticamente enferma / Colombian consensus for definition of admission criteria to intensive care units in critically ill pregnant patient

Cada una de las decisiones alrededor de pacientes obstétricas críticas requiere un equipo multidisciplinario de especialistas en cuidado crítico de adultos y en medicina materno-fetal para el difícil entendimiento y manejo de la historia natural de las enfermedades y sus complicaciones durante la gestación, el parto y el puerperio. No existen guías detalladas en Colombia que describan los planes de acción frente a una paciente embarazada en condiciones críticas; de ahí la importancia de un consenso que permita establecer el nivel de cuidado crítico requerido por este grupo poblacional especial, estandarizar las condiciones de atención de las gestantes críticas y generar planteamientos académicos y éticos frente a esta estrategia de alto impacto para la reducción de la mortalidad materna.

Each of the decisions about critical obstetric patients requires a multidisciplinary team of specialists in adult critical care and maternal-fetal medicine, for the difficult understanding and management of the natural history of the disease and its complications during pregnancy, childbirth and the postpartum period. There are not detailed guidelines in Colombia that describe the action plans in front of a pregnant or recently pregnant patient in a critical condition. For this reason, it is important to establish a consensus aiming to determine the level of critical care required for this particular population group, standardize care conditions of pregnant women and generate critical academic and ethical approaches to address this high impact strategy for reducing maternal mortality.

Cuidado crítico materno: desenlaces y características de los pacientes de una unidad obstétrica combinada de alta dependencia en Medellín, Colombia / Maternal critical care: outcomes and patient characteristics in a combined obstetric high dependency unit in Medellín, Colombia

The critically ill obstetric patient represents a complex clinical challenge that requires a multidisciplinary approach. The aim of our study wasto assess the utilization rate, admission diagnosis and maternal-fetal outcome of critically ill obstetrical patients admitted in a single institution high dependency/Intensive care Unit in Colombia, Latin America. A 3-year retrospective review of hospital records was completed. Eight hundred and nineteen patients were admitted ina 3 year period, representing 3.3 % of all deliveries, 64 % of the admissions were in the antepartum period. Obstetric complications accounted for 82 % of admissions; the preeclampsia – eclampsia and its complications were the most common diagnosis (50.5 %) and obstetric hemorrhage was the primary cause of severe morbidity and mortality. There were seven deaths (0.85 %). The average length of stay at the unit was 2.41 days (1-15). Nine patients were transferred to a medical/surgical Intensive Care Unit during the study. Uses of an exclusive Obstetric high dependency unit includes the concurrent availability of an obstetric, perinatal and critical care management, with low threshold for admission either antenatal or in the postnatal period, that allow an efficient and opportune management of the complex obstetric patient.

La paciente obstétrica críticamente enferma representa un reto clínico muy complejo, que requiere un manejo multidisciplinario. El objetivo del presente estudio fue establecer las tasasde utilización, los diagnósticos de ingreso y los desenlaces materno-fetales de pacientes obstétricascríticamente enfermas admitidas a una unidad de cuidado intensivo/de alta dependencia en Colombia. Se hizo una revisión retrospectiva de tres años de los registros hospitalarios. Duranteun periodo de tres años fueron admitidas 819 pacientes, que representaron el 3,3 % de todos los nacimientos, y entre las cuales el 64 % fueron preparto. Las complicaciones obstétricas representaron el 82 % de las admisiones: la preeclampsia- eclampsia y sus complicaciones fueronlos diagnósticos más comunes (50,5 %), y la hemorragia obstétrica fue la principal causa de morbilidad severa y mortalidad. Hubo siete muertes (0,85 %). La estancia promedio en la unidad fue de 2,41 días (de 1 a 15). Nueve pacientes fueron transferidas a unidades de cuidado intensivomédico-quirúrgicas durante el periodo estudiado. El uso de una unidad de alta dependencia exclusiva de obstetricia —incluyendo la disponibilidad de manejo obstétrico, perinatal y de cuidadocrítico, en conjunto con unos umbrales bajos de admisión, ya sea prenatal o postnatal— permiten un manejo eficiente y oportuno de las pacientesobstétricas complejas.

Paciente embarazada con enfermedad cardiaca: manejo periparto basado en la estratificación del riesgo: serie de casos 2005-2009 / Pregnant patient with cardiac diseases: risk based peripartum management: case series 2005-2009

Objetivo. Reportamos nuestra experiencia en el manejo de una serie de pacientes obstétricas con enfermedad cardiaca de diferentes etiologías, utilizando una estrategia de estratificación del riesgo, para elaborar un plan de manejo periparto en el que está incluido el manejo anestésico. Métodos. Serie de casos. Revisión retrospectiva de 37 pacientes embarazadas con diagnóstico de enfermedad cardiaca de diferentes etiologías, ingresadas a la Unidad de Alta Dependencia Obstétrica de la Clínica del Prado, de Medellín, Colombia entre 2005 y 2009. Resultados. Del total de 37 pacientes, 15 presentaron enfermedad cardiaca congénita; 13, enfermedad cardiaca valvular; 5, cardiomiopatía periparto, y las 4 restantes, trastornos del ritmo y enfermedad isquémica. Se estratificó el riesgo según la clasificación de lesiones anatómicas y el riesgo de eventos cardiacos basados en el CARPREG. Se identificaron ocho pacientes en el grupo de alto riesgo y el resto, en riesgo intermedio y bajo. La mayor parte de las pacientes fueron manejadas con técnicas anestésicas conductivas (89,2 %). La decisión de cesárea (35 %) se dio por indicación obstétrica. Se presentaron complicaciones maternas de origen cardiovascular en el 10,8 % de los casos. No se presentaron muertes maternas. Conclusión. La implementación de un protocolo de estratificación del riesgo de muerte y de la aparición de complicaciones cardiovasculares en la paciente embarazada con cardiopatía le permite al anestesiólogo hacer parte integral del grupo interdisciplinario de manejo y, así, tener impacto en la obtención de un mejor resultado materno y perinatal en este grupo de pacientes.

Objetive. We report a series of obstetric patients with a wide range of cardiac diseases, using a risk based strategy to develop peripartum plans in which the anesthetic management is included.Methodos. Case reports. Retrospective analysis of 37 pregnant patients with a wide range of cardiac diseases admitted to the High Dependency Unit of Clínica del Prado, in Medellín, Colombia from 2005 to 2009. Results. From a total of 37 patients, 15 had congenital heart disease, 13 valvular disease, 5postpartum cardiomyopathy, and the other 4 included rhythm abnormalities and ischemic heart disease. CARPREG study criteria were used for risk stratification. Eight patients were identified in the high risk group, and the rest as intermediate and low risk. Most of the patients had regional anesthesia management (89.2 %). The decision for caesarean section was decided forobstetric indication was performed in 35 % of the cases. There were cardiac complications in 10.8 % of the cases and there were no maternal deaths. Conclusions. The application of a morbidity and mortality cardiac risk stratification protocol in pregnant women allows the anesthesiologist toparticipate in a multispecialty treatment team, and so they are able to achieve the best possible maternal outcome in this group of patients.

Paciente obstétrica de alto riesgo: ¿Dónde debe realizarse su cuidado periparto? / ¿Where should peripartum care of high-risk obstetric patient take place?

Este artículo presenta los patrones que determinaron el ingreso de las gestantes críticamente enfermas ala Unidad de Cuidados Intensivos (UCI) o de Alta Dependencia Obstétrica (UAD), y las causas de complicaciones y muerte más frecuentes, al igual que los factores que afectan el pronóstico perinatal. Se plantea la implementación de las Unidades de Alta Dependencia Obstétrica para el manejo de las gestantes críticamente enfermas, y el entrenamiento del personal involucrado en el manejo obstétrico de estas pacientes.