Pregnancies in women with childhood vesicoureteral reflux.

OBJECTIVE: The frequency of pregnancy complications together with renal scarring and voiding dysfunction-related risk factors were investigated in a cohort of women with a history of childhood vesicoureteral reflux (VUR). DESIGN: A retrospective cross-sectional cohort study. POPULATION: Eighty-seven primi- or multiparous middle-aged women diagnosed with primary non-obstructive VUR in childhood. METHODS: Pregnancy outcome was assessed from case records and from patient interviews. Urine flow tests for voiding patterns, renal ultrasound for detecting scars, and blood samples for renal function were investigated. The median follow-up time was 38 years. MAIN OUTCOME MEASURES: Prevalence of pregnancy complications in women with childhood VUR in relation to renal scars and voiding abnormalities. RESULTS: Maternal complications were seen in 64% of the women and fetal complications in 13%. The women with renal scars (48/87) more often had hypertension (33%), proteinuria (40%) and urinary tract infections (42%) during pregnancy than women without scarring. The frequency of fetal complications was not increased by renal scarring or proteinuria during pregnancy. Urinary tract infections during pregnancy (33% of the women) and voiding abnormalities (18%) did not increase the frequency of fetal or maternal complications. The women with fetal complications were more predisposed to frequent urinary tract infections during adult life (55%) than were those without fetal complications (24%) (p = 0.04). CONCLUSIONS: The maternal complication rates in women with childhood VUR were increased only by renal scarring. Frequent urinary tract infections during adulthood seemed to predict an elevated risk of fetal complications.

[Osteomyelitis in pregnancy]. / Osteomyeliitti synnyttäjän häpyluissa.

Osteomyelitis is an infection of bone, which most frequently is found in weight-bearing bones of lower extremities. Only 4% of acute osteomyelitis cases have been found in the pubic bones in Finland. These cases of the pubic bones are usually related to gynecological or urological procedures or trauma. Osteitis, which is much more common than osteomyelitis, is a differential diagnosis for pregnant or postpartum women. These two diseases are difficult to distinguish based on the symptoms, even if it is important because osteomyelitis needs to be cured with antibiotics but to cure osteomyelitis NSAIDs are enough. The diagnosis of osteomyelitis is based on clinical examination, radiological imaging and laboratory tests.

Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis.

OBJECTIVE: To determine whether early administration of aspirin prevents severe and mild preeclampsia. STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials were performed. Studies in which women were randomized at or before 16 weeks' gestation to low-dose aspirin versus placebo or no treatment were included. The outcomes of interest were severe preeclampsia and mild preeclampsia. Pooled relative risks with their 95% confidence intervals (CIs) were calculated. RESULTS: Among 7941 citations retrieved, 352 were completely reviewed and four studies (392 women) fulfilled the inclusion criteria and were analyzed. When compared with controls, aspirin started at ≤16 weeks was associated with a significant reduction in severe (relative risk: 0.22, 95% CI: 0.08 to 0.57) but not mild (relative risk: 0.81, 95% CI: 0.33 to 1.96) preeclampsia. CONCLUSION: Low-dose aspirin initiated at or before 16 weeks reduces the risk of severe preeclampsia, but not mild preeclampsia.

Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis.

OBJECTIVE: To compare the effect of early administration of aspirin on the risk of preterm and term preeclampsia. METHOD: A systematic review and meta-analysis of randomized controlled trials were performed. Women who were randomized to low-dose aspirin or placebo/no treatment at or before 16 weeks of gestation were included. The outcomes of interest were preterm preeclampsia (delivery <37 weeks) and term preeclampsia. Pooled relative risks (RR) with their 95% confidence intervals (CI) were computed. RESULTS: The search identified 7,941 citations but only five trials on a combined total of 556 women fulfilled the inclusion criteria. When compared to controls, aspirin initiated ≤16 weeks of gestation was associated with a major reduction of the risk of preterm preeclampsia (RR 0.11, 95% CI 0.04-0.33) but had no significant effect on term preeclampsia (RR 0.98, 95% CI 0.42-2.33). CONCLUSION: Low-dose aspirin administrated at or before 16 weeks of gestation reduces the risk of preterm but not term preeclampsia.

The risk of metabolic syndrome after gestational diabetes mellitus - a hospital-based cohort study.

BACKGROUND: Women with gestational diabetes mellitus (GDM) are at an increased risk of developing metabolic syndrome (MetS) after delivery. Recently, the prevalence of both GDM and MetS has increased worldwide, in parallel with obesity. We investigated whether the presentation of MetS and its clinical features among women with previous GDM differs from that among those with normal glucose tolerance during pregnancy, and whether excess body weight affects the results. METHODS: This hospital-based study of two cohorts was performed in Kanta-Häme Central Hospital, Finland. 120 women with a history of GDM and 120 women with a history of normal glucose metabolism during pregnancy, all aged between 25 and 46 were enrolled. They all underwent physical examination and had baseline blood samples taken. All 240 women were also included in subgroup analyses to study the effect of excess body weight on the results. RESULTS: Although the groups did not differ in body mass index (BMI; p = 0.069), the risk of developing MetS after pregnancy complicated by GDM was significantly higher than after normal pregnancy, 19 vs. 8 cases (p  =  0.039). Fasting glucose (p < 0.001) and triglyceride levels (p < 0.001) were significantly higher in women affected. In subgroup analysis, cardiovascular risk factors were more common in participants with high BMI than in those with previous gestational diabetes. CONCLUSIONS: The risk of MetS was 2.4-fold higher after GDM than after normal pregnancy. Cardiovascular risk factors were more common in participants with high BMI than in those with previous GDM. Multivariate analysis supported the main findings. Weight control is important in preventing MetS after delivery.

9 alpha,11 beta-prostaglandin F2 in pregnancies at high risk for hypertensive disorders of pregnancy, and the effect of acetylsalicylic acid.

Our purpose was to determine urinary 9 alpha,11 beta-prostaglandin F2, the primary metabolite of prostaglandin D2, in pregnancies at high risk for hypertensive disorders and the effect of acetylsalicylic acid on 9 alpha,11 beta-prostaglandin F2. Ninety high risk women were randomised to acetylsalicylic acid and placebo groups at 12-14 weeks of gestation, with 43 women in both groups followed up successfully. 9 alpha,11 beta-prostaglandin F2 was determined at baseline, at 24-26, and at 32-34 weeks of gestation. Fifteen normotensive non-pregnant women, 17 normotensive pregnant women at 12-14, and 15 at 30-34 weeks of gestation served as controls. Urinary 9 alpha,11 beta-prostaglandin F2 was significantly higher in pregnant women at 12-14 weeks of gestation as compared to non-pregnant women. High risk pregnancies had higher 9 alpha,11 beta-prostaglandin F2 as compared to normotensive pregnancies at 12-14, and at 30-34 weeks of gestation. Urinary 9 alpha,11 beta-prostaglandin F2 increased throughout pregnancy unrelated to the outcome of the pregnancy or to the treatment.

Bilateral notching of uterine arteries at 12--14 weeks of gestation for prediction of hypertensive disorders of pregnancy.

OBJECTIVE: To assess the value of transvaginal uterine artery Doppler ultrasound at 12--14 weeks of gestation in predicting hypertensive disorders of pregnancy in high-risk women. METHODS: One hundred and twenty high-risk women were evaluated prospectively by Doppler ultrasound of uterine and umbilical arteries at 12--14 weeks of gestation. The presence of bilateral notches, resistance and pulsatility index (PI), mean and maximum flow velocities of uterine arteries, and resistance and PI of umbilical arteries were investigated. Those with bilateral notching were randomized to acetylsalicylic acid (n=43) or placebo groups (n=43) and were followed up twice during pregnancy with the same ultrasound measurements. The women without bilateral notches (n=29) served as controls. In this study, we compared 43 women in the placebo group to 29 controls without bilateral notches. The outcome measures were pregnancy-induced hypertension, pre-eclampsia and intrauterine growth restriction. RESULTS: The sensitivity of bilateral notching in predicting hypertensive disorders of pregnancy decreased with advancing pregnancy from 91 to 35%, and the specificity and the positive predictive values increased from 41 to 94% and from 7 to 70%, respectively. The negative predictive values ranged from 86 to 97%. CONCLUSION: Bilateral notching of uterine arteries at 12--14 weeks is a useful tool in predicting the development of hypertensive disorders in high-risk pregnancies. It is also a suitable test for surveillance of high-risk pregnancies.

Prostacyclin, thromboxane A and the effect of low-dose ASA in pregnancies at high risk for hypertensive disorders.

BACKGROUND: The aim of this study was to investigate the prostanoid production in pregnancies at high risk for hypertensive disorders, and the effect of low-dose acetylsalicylic acid (ASA) on prostanoids. MATERIAL AND METHODS: Ninety women with a bilateral notching in uterine arteries screened by Doppler ultrasound at 12-14 gestational weeks were randomized to the ASA (0.5 mg/kg/day) or placebo group. Forty-three women in both groups were followed up throughout the pregnancy. Urine samples were taken at baseline, and at 24-26 and 32-34 weeks of gestation to determine the urinary 11-dehydrothromboxane B(2) (u-11-dehydro-TxB(2)) and 2,3-dinor-6-keto-prostaglandin F(1alpha) (u-2,3-dinor-6-keto-PGF(1alpha)), the metabolites of thromboxane A(2) and prostacyclin, respectively. RESULTS: In the pregnancies with pregnancy-induced hypertension (PIH) before 37 gestational weeks, the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydro-TxB(2) ratio did not increase as much as in other pregnancies (P = 0.028). In the placebo group pregnancies with preeclampsia had significantly lower 2,3-dinor-6-keto-PGF(1alpha) (P = 0.019) at 12-14 weeks of gestation compared to other pregnancies. In the placebo group the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydroTxB(2) ratio remained unchanged throughout the pregnancy, with no significant difference between pregnancies with a normal or an adverse outcome. In the ASA group the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydro-TxB(2) ratio increased (P < 0.001, early vs. midpregnancy). Again, the changes were similar in pregnancies with a normal or an adverse outcome. CONCLUSION: The balance of prostacyclin and thromboxane A(2) shifted in an unfavorable direction in pregnancies complicated by PIH. ASA had a favorable effect on the prostanoids.

Low dose acetylsalicylic acid in prevention of pregnancy-induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches.

OBJECTIVE: To evaluate the efficacy of low-dose acetylsalicylic acid in the prevention of pregnancy-induced hypertension and intrauterine growth retardation in high-risk pregnancies as determined by transvaginal Doppler ultrasound study of the uterine arteries at 12 to 14 weeks of gestation. DESIGN: Randomised, double blind and placebo-controlled trial. SETTING: The Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland. POPULATION: One hundred and twenty pregnant women considered to be at high risk of pre-eclampsia or intrauterine growth retardation were screened by transvaginal Doppler ultrasound at 12 to 14 weeks of gestation. METHODS: Ninety pregnant women with bilateral notches in the uterine arteries were randomised to receive acetylsalicyclic acid 0.5mg/kg/day (n = 45) or placebo (n = 45) from 12 to 14 weeks of gestation. MAIN OUTCOME MEASURES: Hypertensive disorders of pregnancy and intrauterine growth retardation. RESULTS: Forty-three women on acetylsalicyclic acid and 43 on placebo were successfully followed up. The use of acetylsalicyclic acid was associated with a statistically significant reduction in the incidence of pregnancy-induced hypertension (11.6% vs 37.2%, RR = 0.31, 95% CI 0.13-0.78) and pre-eclampsia (4.7% vs 23.3%, RR = 0.2, 95% Cl 0.05-0.86). The incidence of hypertension before 37 weeks of pregnancy was also significantly reduced (2.3% vs 20.9%, RR = 0.22, 95% CI 0.05-0.97). The reduction in the incidence of intrauterine growth retardation (2.3% vs 7%) was not statistically significant. Acetylsalicyclic acid was not associated with excess risk of maternal or fetal bleeding. CONCLUSION: In women rated in Doppler velocimetry waveform analysis to be at high risk of pre-eclampsia, low-dose acetylsalicyclic acid reduces the incidence of pregnancy-induced hypertension and especially proteinuric pre-eclampsia.