PP020 Association between renal dysfunction and angiogenic factors in preeclampsia.

INTRODUCTION: Hyperuricemia is a common finding in preeclamptic pregnancies and proteinuria, as well as hypertension are markers of preeclampsia. Production of anti-angiogenic proteins seems to be involved in the pathophysiology of hypertension and proteinuria in preeclampsia. OBJECTIVES: The purpose of this study was to evaluate whether there is an association between renal function and changes in serum levels of angiogenic factors in preeclamptic patients. METHODS: Serum was obtained from 83 preeclamptic patients in the last trimester of pregnancy for determination of uric acid. Placental growth factor (PlGF), vascular endothelial growth factor (VEGF) and soluble form of vascular endothelial growth factor receptor (sVEGFR-1) were evaluated in serum by an enzyme immunoassay. Proteinuria was determined in a 24-h urine collection. The concentration of angiogenic factors was compared with serum uric acid levels (<6mg/dL vs ⩾6mg/dL) and with proteinuria levels (<2g vs ⩾2g). Statistical analysis was performed using non-parametric tests with significance level set at 5%. RESULTS: In 40% of women with preeclampsia serum uric acid levels were ⩾6mg/dL, and proteinuria concentration ⩾2g was detected in 41% of patients. Positive correlation was observed between uric acid and proteinuria levels (r=0.7274; p<0.0001). Serum levels of PIGF were significantly lower in preeclamptic women with serum uric acid level ⩾6mg/dL compared with women with serum uric acid <6mg/dL (median 48.46 vs 117.32pg/mL). Significant difference between proteinuria ⩾2g and <2g was detected in relation to serum levels of PIGF (median 47.58 vs 114.24pg/mL), VEGF (median 25.35 vs 33.74pg/mL) and sVEGFR-1 (median 5386 vs 4605pg/mL). CONCLUSION: Elevation in circulating uric acid as well as proteinuria in preeclamptic women is associated with an altered angiogenic balance, suggesting that angiogenic factors may be involved in kidney dysfunction.

Increased implantation and pregnancy rates obtained by placing the tip of the transfer catheter in the central area of the endometrial cavity.

The influence of endometrial cavity length (ECL) on implantation and pregnancy rates after 400 embryo transfers was studied prospectively in a population with the indication of IVF/intracytoplasmic sperm injection (ICSI). The tip of the transfer catheter was placed above or below the half point of the ECL in a randomized manner. Two analyses were performed: (i) absolute position (AP); embryo transfers were divided into three groups according to the distance between the end of the fundal endometrial surface and the catheter tip (DTC - distance tip catheter): AP1 (n = 212), 10-15 mm; AP2 (n = 158), 16-20 mm; and AP3 (n = 30), > or =21 mm. (ii) relative position (RP)--embryo transfers were divided into four groups according to their RP [RP = (DTC/ECL) x 100]: RP1 (n = 23), < or =40%; RP2 (n = 177), 41-50%; RP3 (n = 117), 51-60%; and RP4 (n = 83), > or =61%. Analysis based on relative distance revealed significantly higher implantation and pregnancy rates (P < 0.05) in more central areas of the ECL. However, analysis based on absolute position did not reveal any difference. In conclusion, the present results demonstrated that implantation and pregnancy rates are influenced by the site of embryo transfer, with better results being obtained when the catheter tip is positioned close to the middle area of the endometrial cavity. In this respect, previous analysis of the ECL is the fundamental step in establishing the ideal site for embryo transfers.

Best site for embryo transfer: the upper or lower half of endometrial cavity?

BACKGROUND: The objective of the present study was to determine the importance of the site of embryo transfer (upper or lower half endometrial cavity) on implantation and clinical pregnancy rates. METHODS: A total of 400 transfers guided by ultrasound were randomly assigned to two groups according to the distance between the uterine fundus and the catheter tip at the time of embryo placement. Group I (n = 200) consisted of transfers corresponding to a distance of < 50% of the endometrial cavity length (ECL), i.e. transfer in upper half of the cavity; and group II (n = 200) consisted of transfers corresponding to a distance of > or = 50%, of the ECL, i.e. transfer in lower half of cavity. The Student's t-test, Mann-Whitney test and Fisher's exact test were used where appropriate. RESULTS: The general characteristics of the study population and the main transfer cycle characteristics had an equal distribution (P > 0.05) between groups I and II. No significant difference in implantation or pregnancy rates was observed between groups I and II. CONCLUSION: The implantation or pregnancy rates were similar whether the embryos were deposited in the upper or lower half of the endometrial cavity.