Modulatory effect of two regimens of magnesium sulfate on the systemic inflammatory response in pregnant women with imminent eclampsia.

OBJECTIVE: This study compared the modulatory effect of two intravenous magnesium sulfate (MgSO4) regimens on the systemic inflammatory response in pregnant women diagnosed with imminent eclampsia. STUDY DESIGN: In a single-blind cross-sectional study, 33 women were allocated according to the Zuspan (n = 16) and Sibai (n = 17) MgSO4 regimens, and treated for 24 h. Blood samples were collected pre-administration of the loading dose, at 24 h of the maintenance dose of MgSO4, and at 48 h, when patients were without treatment. Plasma was used to determine interleukin (IL)-1 beta (IL-1ß), IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), heat shock protein (Hsp70), and heme oxygenase-1 (HO-1) by ELISA. RESULTS: The treatment with the Zuspan's regimen didn't change plasma concentrations of TNF-α, IL-10, and Hsp70 in the three-time points studied. However, it decreased IL-1ß at 24 h and 48 h and IL-6 at 48 h, and increased HO-1 concentration at 48 h. On the other hand, compared to the pre-treatment period, Sibai's regimen induced a significant decrease in TNF-α, IL-1ß, IL-6, and Hsp70, while increased HO-1 levels both at 24 h and 48 h and, IL-10 concentration at 48 h. CONCLUSIONS: Sibai's regimen determined an early and efficient immunoregulatory effect on systemic inflammatory response in preeclampsia, suggesting that the maintenance dose of two grams of MgSO4 was better than one gram in the treatment of imminent eclampsia.

Group B streptococci colonization in pregnant women: risk factors and evaluation of the vaginal flora.

OBJECTIVE: To determine the prevalence of group B streptococci (GBS) in our population, and to assess the association between risk factors and vaginal flora with maternal rectovaginal colonization. METHOD: Samples were obtained from 405 patients between 35 and 37 weeks of gestation. Swabs from the vaginal and perianal regions were cultured in Todd Hewitt and subcultured in blood agar. Colonies suggestive of GBS were submitted to catalase and CAMP test. The vaginal flora was evaluated on Gram stain vaginal smears. Socio-demographic and obstetric data were obtained by designed form. Considering maternal GBS colonization as the response variable, a logistic regression model was fitted by the stepwise method with quantitative and qualitative explanatory variables. RESULTS: The prevalence of GBS colonization was 25.4%. The most frequent vaginal flora abnormalities were cytolytic vaginosis (11.3%), followed by bacterial vaginosis (10.9%), candidosis (8.2%) and intermediate vaginal flora II (8.1%). Logistic regression analysis revealed that maternal age, number of sexual intercourse/week, occurrence of previous spontaneous abortion, presence of candidosis and cytolytic vaginosis were associated with streptococcal colonization. CONCLUSION: The prevalence of GBS is high in pregnant women and is associated with sexual intercourse frequency, previous spontaneous abortion and the presence of candidosis or cytolytic vaginosis.

Assessment of structural cardiac abnormalities and diastolic function in women with gestational diabetes mellitus.

BACKGROUND: The main manifestation of hyperglycaemia during pregnancy is gestational diabetes mellitus. It can herald diabetes mellitus type 2 and its deleterious long-term effects, such as hypertension and cardiovascular disease. The aim of this study was to assess diastolic function in women with gestational diabetes mellitus, one of the first signs of future cardiovascular disease. METHODS: A total of 21 women with gestational diabetes mellitus and 23 healthy pregnant women (control group) between 34 and 37 weeks of gestation underwent echocardiographic assessment. The diagnosis of gestational diabetes mellitus was made in agreement with the American Diabetes Association criteria. Echocardiographic images obtained were analysed according to the criteria of the American Society of Echocardiography. Data were analysed using Pearson correlation coefficient, analysis of variance and Student's t-test. RESULTS: Women with gestational diabetes mellitus had higher posterior wall and interventricular septum thickness, increased left ventricular mass and left ventricular mass index, lower early diastolic annular velocity and early diastolic annular velocity/late diastolic annular velocity ratio. There was a positive correlation between left ventricular mass index and fasting glucose and pregnancy body mass index. CONCLUSION: Patients with gestational diabetes mellitus seem to have a different diastolic profile as well as a mildly dysfunctional pattern on echocardiogram, which may show a need for greater glycaemic control.

High levels of heat shock protein 70 are associated with pro-inflammatory cytokines and may differentiate early- from late-onset preeclampsia.

Preeclampsia (PE), a specific syndrome of pregnancy, can be classified into early and late onset, depending on whether clinical manifestations occur before or after 34 weeks' gestation. We determined whether plasma concentrations of Hsp60 and Hsp70 were related to circulating cytokine levels, as well as kidney and liver functions, in early- and late-onset PE. Two hundred and thirty-seven preeclamptic women (95 with early- and 142 with late-onset PE) were evaluated. Plasma levels of Hsp60, Hsp70, and their specific antibodies, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1, IL-10, IL-12, and soluble TNF-α-receptor I (sTNFRI) concentrations, were determined by enzyme-linked immunosorbent assay (ELISA). Concentrations of Hsp70, TNF-α, IL-1ß, IL-12, and sTNFRI were significantly elevated in patients with early-onset PE compared with women with late-onset PE; IL-10 levels were significantly lower in the early-onset PE group. Concentrations of urea, uric acid, proteinuria, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and lactate dehydrogenase (LDH) were also significantly higher in early-onset PE. The percentage of infants with intrauterine growth restriction was also significantly higher in women with early-onset PE. There were positive correlations between Hsp70 levels and TNF-α, TNFRI, IL-1ß, IL-12, GOT, GPT, LDH, and uric acid concentrations in early-onset PE group. Thus, early-onset PE was associated with greater maternal and fetal impairment. There are differences in pathophysiology between early- and late-onset PE, highlighting by the difference in Hsp70 levels.

Effect of physiological overload on pregnancy in women with mitral regurgitation.

OBJECTIVES: to evaluate the structural and functional heart abnormalities in women with mitral regurgitation during pregnancy. INTRODUCTION: Women with mitral regurgitation progress well during pregnancy. However, the effects on the heart of the association between pregnancy and mitral regurgitation are not well established. METHODS: This is a case-control, longitudinal prospective study. Echocardiograms were performed in 18 women with mitral regurgitation at the 12th and 36th week of pregnancy and on the 45th day of the puerperium. Twelve age-matched healthy and pregnant women were included as controls and underwent the same evaluation as the study group. RESULTS: Compared with controls, women with mitral regurgitation presented increased left cardiac chambers in all evaluations. Increasing left atrium during pregnancy occurred only in the mitral regurgitation group. At the end of the puerperium, women with mitral regurgitation showed persistent enlargement of the left atrium compared with the beginning of pregnancy (5.0 ± 1.1 cm vs 4.6 ± 0.9 cm; p < 0.05). Reduced left ventricular relative wall thickness (0.13 ± 0.02 vs 0.16 ± 0.02; p < 0.05) and an increased peak of afterload (278 ± 55 g/cm² vs 207 ± 28 g/cm²; p < 0.05) was still observed on the 45th day after delivery in the mitral regurgitation group compared with controls. CONCLUSIONS: Pregnancy causes unfavorable structural alterations in women with mitral regurgitation that are associated with an aggravation of the hemodynamic overload.

Digitalis-like induced arrhythmia in a patient with rheumatic mitral regurgitation complicated by preeclampsia.

OBJECTIVE: To report a case of cardiac arrhythmia related to a low dose of endovenous lanatoside C. CASE REPORT: A 23-year-old pregnant woman with mitral regurgitation complicated with preeclampsia and pulmonary edema presented 2 episodes of atrial tachycardia induced by a intravenous digitalis (2 mg, IV and 1 mg, IV, respectively). CONCLUSION: This case calls attention to the need for further studies analysing the security of digoxin use in preeclampsia.

Zuspan's scheme versus an alternative magnesium sulfate scheme: Randomized clinical trial of magnesium serum concentrations.

OBJECTIVE: The purpose of this study was to determine whether magnesium serum concentrations in patients with severe preeclampsia or eclampsia treated with two different magnesium sulfate schemes were different. METHODS: Fourteen patients were randomly assigned in the alternative scheme group and 15 in the Zuspan's group. The difference between the groups was that the intravenously administered maintenance dose was done with 1 g/h by continuous intravenous infusion in the Zuspan's group and 2g in bolus every two hours in the alternative scheme. Blood samples were collected previously to treatment and every 15 minutes during four hours after the beginning of treatment. The primary outcome measure was area under the curve and the t-test was used for statistical analysis with level of statistical significance of 5%. The evaluation of the punctual means at all moments in the alternative group was done with the repeated measures analysis of variance. RESULTS: There was no significant difference in the baseline characteristics between groups. In both schemes, magnesium serum concentration reaches a peak within 15 minutes and a new peak was observed after maintenance dose in the alternative scheme. The area under the curve was significantly lower in the alternative scheme than in the Zuspan's scheme (702.1 +/- 73.5 mg/dL vs 796.1 +/- 94.6 mg/dL). CONCLUSION: The serum magnesium concentration of this randomized clinical trial doesn't support the use of the alternative scheme of magnesium sulfate to prevent or treat eclampsia.

Effect of physiological overload on pregnancy in women with mitral regurgitation

OBJECTIVES: to evaluate the structural and functional heart abnormalities in women with mitral regurgitation during pregnancy. INTRODUCTION: Women with mitral regurgitation progress well during pregnancy. However, the effects on the heart of the association between pregnancy and mitral regurgitation are not well established. METHODS: This is a case-control, longitudinal prospective study. Echocardiograms were performed in 18 women with mitral regurgitation at the 12th and 36th week of pregnancy and on the 45th day of the puerperium. Twelve age-matched healthy and pregnant women were included as controls and underwent the same evaluation as the study group. RESULTS: Compared with controls, women with mitral regurgitation presented increased left cardiac chambers in all evaluations. Increasing left atrium during pregnancy occurred only in the mitral regurgitation group. At the end of the puerperium, women with mitral regurgitation showed persistent enlargement of the left atrium compared with the beginning of pregnancy (5.0 ± 1.1 cm vs 4.6 ± 0.9 cm; p<0.05). Reduced left ventricular relative wall thickness (0.13 ± 0.02 vs 0.16 ± 0.02; p<0.05) and an increased peak of afterload (278 ± 55 g/cm² vs 207 ± 28 g/cm²;p<0.05) was still observed on the 45th day after delivery in the mitral regurgitation group compared with controls. CONCLUSIONS: Pregnancy causes unfavorable structural alterations in women with mitral regurgitation that are associated with an aggravation of the hemodynamic overload.