A clinical evaluation of placental growth factor in routine practice in high-risk women presenting with suspected pre-eclampsia and/or fetal growth restriction.

OBJECTIVE: To evaluate the use of plasma Placental Growth Factor (PlGF), recommended by the recent NICE guidance, in women with suspected pre-eclampsia (PE) and/or fetal growth restriction (FGR). STUDY DESIGN: Non-randomised prospective clinical evaluation study in high-risk antenatal clinics in a tertiary maternity unit. METHODS: PlGF testing was performed in addition to routine clinical assessment in 260 women >20 weeks' gestation with chronic disease (hypertension, renal disease ±â€¯diabetes) with a change in maternal condition or in women with suspected FGR to determine the impact on clinical management. Results were revealed and standardised care pathways followed. MAIN OUTCOME MEASURES: Outcome of pregnancies with a low PlGF (<12 pg/ml and 13-100 pg/ml), impact on clinical service and the diagnostic accuracy of alternative PlGF cut-offs. RESULTS: 206/260 (79.2%) women had an adverse outcome (PE/birthweight < 10th centile/preterm birth). In our cohort, a low PlGF (<12 pg/ml) was associated with a shorter test-birth interval and universally (100% PPV) with an adverse pregnancy outcome, although 29/61 (47.5%) of women with PlGF < 12 pg/ml continued their pregnancy >14 days. The PlGF result altered clinical management (surveillance or timing of birth) in 196/260 (75.4%) cases. Alternative PlGF thresholds did not significantly improve diagnostic performance. CONCLUSIONS: Our evaluation confirms the value of PlGF as a diagnostic tool for placental dysfunction. However, low PlGF in isolation should not trigger iatrogenic delivery. Further research linking placental pathology, maternal disease and maternal PlGF levels is urgently needed before this test can be implemented in routine clinical practice.

The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy.

AIM: To compare the blood pressure (BP) lowering effects of labetalol and nifedipine modified release (MR) in hypertensive pregnant women. We also investigated the effect on the heart rate (HR) and determined the proportion of time spent in target. METHODS: This was an exploratory study. Women with chronic hypertension taking either labetalol or nifedipine were offered 24-h ambulatory blood pressure monitoring (ABPM). Sleep, wake and drug ingestion times were self-reported. An indirect response model was used to analyse the systolic BP (SBP), diastolic BP (DBP) and HR time-series; the effect of gestation and type of drug was evaluated. RESULTS: Forty-eight women were recruited: 24 in each group. There was no difference in clinical characteristics. In women taking nifedipine there was a positive association between the dose of nifedipine and pre-dose BP p = .002, this was not present in the labetalol group. There was a difference between the drug effects on both the SBP and DBP time-series (p = .014). In comparison to labetalol, there was less variation in day time BP in those women prescribed nifedipine. Women on labetalol spent a larger proportion of time with their DBP below target (<80 mmHg). The HR dynamics were qualitatively different, a stimulatory effect was found with nifedipine compared to an inhibitory effect with labetalol. CONCLUSION: There are significant and important differences between the BP lowering effects of nifedipine and labetalol. A large randomised control trial is required to investigate the relationship between BP variability and time in target on pregnancy outcomes.

[Carbamazepine presence in plasma lipoproteins]. / Dyspozycja karbamazepiny w lipoproteinach osocza.

The aim of this study was to define the disposition of carbamazepine (CBZ) in serum lipoproteins. The examination was conducted using the serum of 51 patients treated with carbamazepine the concentration of which was monitored 51 patients, 22 women and 29 men, 1.5-35 years old/mean 13.0 +/- 6.7 years/weighing 10.2-90.0 kg/mean 46.5 +/- 23.6/participated in the study. Every patient received carbamazepine in an individual oral dose. Concentrations of cholesterol, triglicerides, proteins and CBZ were determined. Lipoprotein fractions (VLDL, LDL, HDL and LPDS) were separated by ultracentrifugation of serum. Carbamazepine concentrations were measured by fluorescence polarization immunoassay technique on a TD x analyzer. Cholesterol, triglicerides and proteins levels were measured on Bayer--Technicon apparaturs. Carbamazepine is distributed in plasma lipoproteins, mainly in HDL fraction (mean 45.2 +/- 9.0%) and in LPDS (mean 43.2 +/- 9.3%) fraction. Ratio of carbamazepine concentration to cholesterol (RcCH), triglicerides (RcTG) and proteins concentration (RcP) and carbamazepine concentration (%) to cholesterol (R% CH), triglicerides (R% TG) and proteins concentration (%/R% P) are different in different fractions. The obtained results suggest that the disposition of CBZ in lipoprotein fractions may have a significant importance in the therapy and fat metabolism disorders make the changes of drug dose urgent.

[The evaluation of the bioavailability of isosorbide 5-mononitrate]. / Ocena dostepnosci biologicznej 5-monoazotanu izosorbidu.

UNLABELLED: The aim of this study was to investigate the bioavailability of isosorbide mononitrate (IS-5MN) after oral administration of Monocard 20 mg-capsules, made in "Synteza" â Pharmaceutical-Chemical Company in Poznan. Effox 20 mg, coated tablets from Schwarz Pharma, was used as an counterpart of Monocard 20 mg. The concentrations of IS-5MN in healthy volunteers' plasma were determined by using Hewlett Packard gas chromatography. CONCLUSIONS: The bioavailability of IS-5MN after oral administration of Monocard 20 mg is the same as after oral administration of Effox 20 mg, whose clinical efficacy was tested before. This conclusion confirms the same value of AUC, tmax, cmax and other pharmacokinetic parameters of Monocard 20 mg and Effox 20 mg.