Assessment of left ventricular structure and function in preeclampsia by echocardiography and cardiovascular biomarkers.

AIM: To assess left ventricular (LV) structure and function in preeclampsia, a serious vascular-related pregnancy disorder, by Doppler tissue imaging (DTI) in combination with the levels of cardiovascular biomarkers. MATERIAL AND METHODS: Thirty-five pregnant women with preeclampsia and 30 with normal pregnancy, matched for age and gestational age were examined during pregnancy and 3-6 months after delivery. Transthoracic echocardiography and DTI were performed and blood levels of amino-terminal pro-brain natriuretic peptide (NT-pro-BNP), C-reactive protein (CRP), cystatin C and troponin I were analyzed. RESULTS: There were significant differences in LV and left atrial dimensions and function between the groups. A higher septal and lateral E/E' ratio (E = early transmitral diastolic flow velocity and E' = early diastolic myocardial velocity) (P < 0.0001, 0.0008) and higher levels of NT-pro-BNP, cystatin C, and lower cystatin C estimated GFR in ml/min per 1.73 m(2) (P < 0.0001) were seen in the preeclampsia both during pregnancy and at follow-up. In addition the levels of E/E' ratio lateral and NT-pro-BNP were higher in pregnant women with early-onset preeclampsia necessitating delivery before 34 weeks of gestation than those who developed preeclampsia and delivered at or after 34 weeks (P = 0.0004, 0.005). CONCLUSION: In pregnancies complicated by preeclampsia, especially early-onset preeclampsia, the diastolic LV function is impaired and levels of biomarkers, NT-pro-BNP and cystatin C, are increased in comparison to normal pregnancy.

Aberrant uterine natural killer (NK)-cell expression and altered placental and serum levels of the NK-cell promoting cytokine interleukin-12 in pre-eclampsia.

PROBLEM: Natural killer (NK) cells are the most abundant lymphocyte population at the maternal-fetal interface. They are suggested to be important during placentation by controlling trophoblast invasion. If placentation is suboptimal, pre-eclampsia can occur. METHOD OF STUDY: Decidual NK (dNK) cells were examined at delivery in 46 women, 22 pre-eclamptic women and 24 healthy controls, by staining for CD56 and CD94 with immunohistochemistry (IHC). Furthermore, we investigated the placental expression and the serum levels of the NK-cell activating cytokines interleukin(IL)-12, IL-15, IL-18 and the anti-inflammatory cytokine IL-10 by IHC and enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS: Pre-eclamptic women had higher number of CD56+ and CD94+ cells in the decidua, indicating an altered receptor expression of dNK cells. We also demonstrate for the first time that the villous trophoblasts show strong immunostaining for IL-12 in placentae from healthy controls, while women suffering from pre-eclampsia have significantly less IL-12. However, pre-eclamptic women had significantly elevated IL-12 and IL-15 levels in serum. CONCLUSION: Results show increased numbers and altered phenotype of dNK cells in pre-eclampsia, supporting the importance of these cells for a healthy pregnancy. The altered receptor expression of dNK cells together with diminished placental IL-12 expression could implicate an altered NK cell-regulation in pre-eclampsia.

Risk factors for persistent trophoblastic activity after surgery for ectopic pregnancy.

BACKGROUND: The purpose of this study was to explore the value of preoperative ultrasound and human chorionic gonadotropin (hCG) monitoring to predict the occurrence of residual trophoblastic tissue after laparoscopic conservative surgery for tubal pregnancy. METHODS: During the period from January 1998 to December 1999 all 206 women undergoing treatment for ectopic pregnancy at the Karolinska hospital were included in the study. A vaginal ultrasound examination was performed and the ectopic size was measured. Serum-hCG levels were recorded preoperatively, and at days 1-2 and 14-21 after surgery. RESULTS: A diameter of 8 mm or less was observed in 13 of the 14 patients needing secondary treatment. The risk of second surgery if the finding at the preoperative ultrasound was larger than 8 mm was 1/73 resulting in a negative predictive value of 0.01. A considerable overlap in the hCG levels was found on days 1-2 after surgery between women with and without second surgery. CONCLUSIONS: Using a single cutoff point for hCG seems to be of little value as residual trophoblastic tissue can manifest itself at different times--early or late--during the postoperative period. Women with a small ectopic pregnancy as detected by preoperative vaginal ultrasound are at high risk of developing residual trophoblastic tissue. These patients should be considered by the surgeon and monitored with hCG levels until values decline and become undetectable. Management of patients with slowly but declining values can be conservative. If hCG levels are rising or do not decline, methotrexate (MTX) can be an alternative.