Vascular risk in women with a history of severe preeclampsia.

UNLABELLED: BACKGROUND. To assess markers of vascular dysfunction and risk in postpartum women with a history of severe preeclampsia. METHODS: Carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) measured by ultrasonography, and lipid profile and insulin resistance evaluated by biochemical assays were compared between 34 women with a history of severe preeclampsia and 42 women with a prior normal pregnancy at least 12-24 months postpartum. RESULTS: CIMT was higher and FMD lower in the preeclamptic than in the control group. We found a significant inverse correlation between CIMT and FMD in the preeclamptic group, but no difference in lipid profiles and insulin resistance between the groups. CONCLUSIONS: Women with a history of severe preeclampsia exhibit early structural and functional preatherosclerotic vascular impairment, which might explain their higher risk of future cardiovascular disease.

First trimester diagnosis of parapagus diprosopus dibrachius dipus twins with cranirachischisis totalis by three-dimensional ultrasound.

Parapagus (laterally fused), diprosopus (two faces), dibrachius (two upper extremities), dipus (two lower extremities) conjoined twinning is extremely rare. The coexistence of anencephaly with a contiguous spinal defect (craniorachischisis totalis) makes the present case one of the rarest of the published cases. In our case, it was difficult to make the final diagnosis by two-dimensional abdominal and vaginal ultrasound. Three-dimensional ultrasound was helpful for final diagnosis and post-abortal examination confirmed the prenatal ultrasound diagnosis. The heart, diaphragm, liver and perineum were all united. Fine dissection of the heart showed four vessels arising from the ventricles and a membranous type ventricular septal defect.

An analysis of HELLP syndrome cases: does platelet count predict adverse maternal and fetal outcomes in women with HELLP syndrome?

PURPOSE: To evaluate the maternal and fetal outcome in 44 pregnancies complicated with HELLP syndrome and to investigate the role of platelet counts in its prognosis. METHODS: A retrospective analysis of the medical records of 44 patients with the diagnosis of hemolysis elevated liver enzymes and low platelet count between June 1997 and January 2009 was performed. The patients were divided into two groups according to blood platelet count: platelet count <50,000 mm(3) formed Group I and platelet count 50,000-100,000 mm(3) formed Group II. Clinical findings and laboratory characteristics, maternal complications, perinatal outcomes and comparison of maternal and fetal morbidity according to platelet counts were analyzed. RESULTS: During the period of 12 years, 44 (0.54%) of 8,132 deliveries had HELLP syndrome. Among 44 patients, the most common complications were disseminated intravascular coagulopathy (18.2%), acute renal failure (15.9%), abruptio placentae (11.4%), and cerebral hemorrhage/infarction (11.4%). Maternal and perinatal mortality rates in HELLP syndrome were 9.1 and 40.9%, respectively. Aspartate aminotransferase levels were found to be statistically significantly higher in Group I (p = 0.04). While disseminated intravascular coagulopathy and acute renal failure were statistically significantly higher in Group I (p = 0.01; p = 0.03 respectively), fetal growth restriction was statistically significantly higher in Group II (p = 0.04). CONCLUSIONS: HELLP syndrome is associated with high incidences of maternal and fetal morbidity and mortality and patients with low platelet counts might have a much increased risk.

Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of a tertiary care center.

OBJECTIVE: The aim of the study was to determine the risk factors, prevalance, epidemiological parameters and maternal-perinatal outcome in pregnant women with hypertensive disorder. MATERIALS AND METHODS: A retrospective analysis was undertaken on 255 consecutive cases of hypertensive disorder in pregnancy who were managed at Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology from June 1997 to November 2004. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally delivery route, indications of cesarean section, fetal and maternal complications were determined. Statistical analysis was performed by SPSS programme using Kruskal Wallis nonparametric test, ANOVA (Analysis of variance) and chi-square tests. RESULTS: Of 5,155 deliveries in our clinic during the defined period, 438 cases (8.49%) were managed as hypertensive disorder of pregnancy. Medical records of 255 cases could be avaliable. Of 255 cases, 138 patients (54.11%) were found to have severe preeclampsia while 88 cases (34.50%) were diagnosed as mild preeclampsia. Twenty-nine patients (11.37%) were suffering from chronic hypertension. Of 138 severely preeclamptic cases, 28 cases (11%) had eclamptic convulsion and another 28 patients (11%) were demonstrated to have HELLP syndrome. Intrauterine growth restriction, oligohydramnios, placental ablation were the obstetric complications in 75 (29.4%), 49 (19.2%), 19 (7.5%) cases, respectively. Additionally multiple pregnancy and gestational diabetes mellitus were noted in 5.9% (n:15) and 3.9% (n:10) of the patients. Delivery route was vaginal in 105 patients (41.2%) while 150 patients (58.8%) underwent cesarean section with the most frequent indication to be fetal distress in 69 cases (46%). Cesarean section rate seemed to be the lowest (48.3%) in chronic hypertensive women while the highest (63.8%) in severe preeclamptic patients. Maternal mortality occured in 3 cases (1.2%) and all of those cases were complicated with HELLP syndrome. Intracranial bleeding was the cause of maternal death in one case while the other two cases were lost due to acute renal failure and disseminated intravascular coagulation, respectively. Intrauterine fetal demise was recorded in 24 cases on admission. Ten fetuses died during the intrapartum period. Mean gestational age and birth weight were 28 +/- 3.5 and 1000 +/- 416 g, respectively in this group. In these ten women, five cases were diagnosed as HELLP syndrome, two were severely preeclamptic and three were eclamptic. Perinatal mortality rate was found to be 144/1,000 births CONCLUSION: Hypertensive disorder of pregnancy is associated with increased risk of maternal-perinatal adverse outcome. The complications of severe preeclampsia and eclampsia could be prevented by more widespread use of prenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.