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1.
Ceska Gynekol ; 84(5): 361-370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826634

RESUMO

DESIGN: Review article. SETTING: Department of Clinical Biochemistry, University Hospital Olomouc; Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child and 3rd Faculty of Medicine Charles University, Prague; G-CENTRUM Olomouc, Olomouc; Genetika Plzeň, Pilsen. Methods, results: Preeclampsia (PE) is a multisystem disorder complicating pregnancy. It is the leading cause of maternal and perinatal mortality and morbidity worldwide. Recent studies have shown that high-risk pregnant women may benefit from low-dose acetylsalicylic acid early therapy in prevention of the development of severe forms of the disease. The risk group of pregnant women should be identified in 11-13 gestational week for effective prevention. The only procedure validated in many studies for performing PE screening with sufficient diagnostic accuracy in the first trimester of pregnancy is given by The Fetal Medicine Foundation (FMF) and has been adopted and published in a new recommendation by The International Federation of Gynecology and Obstetrics (FIGO). CONCLUSION: This article summarizes the recent findings and recommendation for performing screening of preeclampsia in 1st trimester of pregnancy and how to prevent the development of severe forms of PE by low-dose acetylsalicylic acid therapy.


Assuntos
Aspirina/administração & dosagem , Programas de Rastreamento/métodos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Biomarcadores/sangue , Feminino , Humanos , Pré-Eclâmpsia/sangue , Gravidez , Primeiro Trimestre da Gravidez , Cuidado Pré-Natal , Fatores de Risco
2.
Ceska Gynekol ; 84(4): 276-282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31818110

RESUMO

AIM OF STUDY: Aim of study was to find out the possibility of prediction of pre-eclampsia in the first trimester among patients with risk factors. TYPE OF STUDY: Prospective study. Name and seat of workplace: 1st Department of Gynecology and Obstetrics, Comenius University in Bratislava, the University Hospital of Bratislava. METHODS: Study included 77 women, who were examined in first trimester between 11+0 and 13+6 weeks of gestation from 1. 6. 2016 to 1. 6. 2017 in 1st Department of Gynecology and Obstetric in the Comenius University Hospital in the Bratislava and enlisted patients delivered until 31. 2. 2018. The study was approved by Hospital Ethics Committee and all patients signed consent form. We included patients, who ran at least one risk factor for developing pre-eclampsia, nulliparous, pregnancy after assisted reproduction technology, body mass index 25 in the beginning of pregnancy, age of patients and multiple gestation pregnancy. In addition, an ultrasound scans were performed in the first trimester. Doppler ultrasound pulsality index of uterine artery, pregnancy-associated plasma protein and mean arterial pressure were used for prediction of the pre-eclampsia. Sensitivity and specificity of test were calculated. We assessed pre-eclampsia according to diagnostic criteria of the American College Obstetricians and Gynecologists. In the last part, we compared perinatal and maternal outcomes in the pre-eclampsia group and in the control group. STATISTICAL ANALYSIS: Statistical analysis was realized by the IBM SPSS Statistics 25 Software. Risk factors were analysed by using Fisher exact test and Odds ratio. Mann-Whitney test and a one way analysis of variance were used for comparison the pre-eclampsia group and the control group. RESULTS: Patients, whose had got conceived after assisted reproduction technology, had significant higher probability of pre-eclampsia (Odds ratio = 7.7, p = 0.028). Patients with multiple gestation pregnancy had also significant higher risk of pre-eclampsia (Odds ratio = 16.5, p = 0.031). Mean arterial pressure was only significant as predictive test in 12th weeks of gestation. Adverse perinatal outcomes and higher rate of cesarean section were in the preeclampsia group. CONCLUSION: Mean arterial pressure is easy to use and cost-effective predictor, but sensitivity was only 66.6% and specificity 49%.


Assuntos
Pré-Eclâmpsia , Biomarcadores , Cesárea , Feminino , Humanos , Projetos Piloto , Pré-Eclâmpsia/diagnóstico , Gravidez , Primeiro Trimestre da Gravidez , Proteína Plasmática A Associada à Gravidez , Estudos Prospectivos
3.
Medicine (Baltimore) ; 98(51): e18496, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861035

RESUMO

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) is one of the markers of systemic inflammation. Recent studies have associated NLR with diagnosis of preeclampsia (PE). However, due to small sample sizes and different research design, the diagnostic value of NLR in PE patients is not well understood. In this study, we evaluate the potential diagnostic value of NLR in PE. METHODS: We searched PubMed, Embase, Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI) databases, Wanfang data, VIP database and China Biomedical Literature Database systematically for relevant literatures up to May 20, 2018. All analyses were conducted using Meta-DiSc1.4 and Stata 12.0 software. Sensitivity, specificity and other measures of accuracy of NLR for the diagnosis of PE were pooled. Meta-regression was performed to identify the sources of heterogeneity. RESULTS: This meta-analysis included a total of 7 studies. The pooled sensitivity and specificity were 0.74 (95% CI 0.71-0.76) and 0.64 (95%CI 0.61-0.68), positive likelihood ratio, 2.62 (95%CI1.79-3.84); negative likelihood ratio, 0.34 (95%CI 0.24-0.48); diagnostic odds ratio, 8.44 (95%CI 4-17.78), and area under the curve was 0.82. Meta regression showed that sample size was the main source of heterogeneity. Deeks funnel plot showed that there was no statistical significance for the evaluation of publication bias (P = .16). CONCLUSION: Current evidence suggests that the diagnostic accuracy of NLR has unsatisfactory specificity but acceptable sensitivity for diagnosis of PE. Further large-scale prospective studies are required to validate the potential applicability of using NLR alone or in combination other markers as PE diagnostic biomarker and explore potential factors that may influence the accuracy of NLR for PE diagnosis.


Assuntos
Pré-Eclâmpsia/imunologia , Feminino , Humanos , Contagem de Linfócitos , Pré-Eclâmpsia/diagnóstico , Gravidez
5.
Harefuah ; 158(11): 742-747, 2019 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-31721519

RESUMO

INTRODUCTION: Preeclampsia is a serious complication of pregnancy affecting 3-8% of all pregnancies. It increases the morbidity and mortality of both the fetus and the pregnant woman, especially in developing countries. It deleteriously affects several vital organs, including the kidney, heart, liver, brain, and lung. Although, the pathogenesis of preeclampsia has not yet been fully understood, growing evidence suggests that aberrations in the angiogenic factors levels/activity and coagulopathy are responsible for the clinical manifestations of the disease. The common nominator of tissue damage of all these target organs is endothelial injury, which impedes their normal function. At the renal level, glomerular endothelial injury leads to the development of maternal hypertension and proteinuria. Similarly, this disease can cause hepatic and neurologic dysfunction due to vascular damage. The current review summarizes the recent development in the pathogenesis of this disease state with special focus on novel diagnostic biomarkers and their relevance to potential therapeutic options for preeclampsia. Specifically, we will highlight the renal manifestations of the diseases with emphasis on the involvement of angiogenic factors in vascular injury and how restoration of the angiogenic balance affects the renal and cardiovascular outcome of preeclamptic women.


Assuntos
Pré-Eclâmpsia , Feminino , Humanos , Rim , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/terapia , Gravidez , Proteinúria
6.
Hypertension ; 74(5): 1144-1151, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31564161

RESUMO

Preeclampsia is a common cause of acute kidney injury (AKI) in low- and middle-income countries, but AKI incidence in preeclampsia, its risk factors, and renal outcomes are unknown. A prospective observational multicenter study of women admitted with preeclampsia in South Africa was conducted. Creatinine concentrations were extracted from national laboratory databases for women with maximum creatinine of ≥90 µmol/L (≥1.02 mg/dL). Renal injury and recovery were defined by Kidney Disease Improving Global Outcomes creatinine criteria. Predefined risk factors, maternal outcomes, and neonatal outcomes were compared between AKI stages. Of 1547 women admitted with preeclampsia 237 (15.3%) met AKI criteria: 6.9% (n=107) stage 1, 4.3% (n=67) stage 2, and 4.1% (n=63) stage 3. There was a higher risk of maternal death (n=7; relative risk, 4.3; 95% CI, 1.6-11.4) and stillbirth (n=80; relative risk, 2.2; 95% CI, 1.8-2.8) in women with AKI compared with those without. Perinatal mortality was also increased (89 of 240; 37.1%). Hypertension in a previous pregnancy was the strongest predictor of AKI stage 2 or 3 (odds ratio, 2.24; 95% CI, 1.21-4.17). Renal recovery rate reduced with increasing AKI stage. A third of surviving women (76 of 230 [33.0%]) had not recovered baseline renal function by discharge. Approximately half (39 of 76; 51.3%) of these women had no further creatinine testing post-discharge. In summary, AKI was common in women with preeclampsia and had high rates of associated maternal and perinatal mortality. Only two-thirds of women had confirmed renal recovery. History of a previous hypertensive pregnancy was an important risk factor.


Assuntos
Lesão Renal Aguda/epidemiologia , Morte Materna/tendências , Morte Perinatal , Pré-Eclâmpsia/epidemiologia , Natimorto/epidemiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Adolescente , Adulto , Comorbidade , Intervalos de Confiança , Creatinina/sangue , Países em Desenvolvimento , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Testes de Função Renal , Razão de Chances , Pobreza , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Gravidez , Prevalência , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , África do Sul , Análise de Sobrevida
7.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593290

RESUMO

Due to a low level of understanding of mechanisms involved in spontaneous preterm delivery there is a lack of reliable biomarkers. Existing biomarkers have a low positive predictive value but a high negative predictive value. Use of tests with high negative predictive value will reduce unnecessary interventions and hospitalization of women with threatening preterm delivery. When given to the right pregnant women, antenatal corticosteroid treatment are still the most important obstetrical intervention and reduces both neonatal mortality and short- and long-term morbidity.Several ongoing national Swedish multicenter studies may increase the understanding of the roles of cervical length, preeclampsia screening and magnesium sulfate dosage in the context of preterm delivery in a Nordic setting. Major development has been achieved in prediction and prevention of preterm preeclampsia at the cost of a 10% screen positive rate.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Biomarcadores/análise , Cerclagem Cervical , Medida do Comprimento Cervical , Colo do Útero/anatomia & histologia , Feminino , Fibronectinas/análise , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Sulfato de Magnésio/administração & dosagem , Pessários , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/terapia , Cuidado Pré-Natal/métodos , Progesterona/administração & dosagem , Suécia , Tocolíticos/administração & dosagem
8.
Hypertension ; 74(5): 1124-1135, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31522621

RESUMO

Preeclampsia is a systemic syndrome that seems to originate from the placenta and is associated with an imbalance between angiogenic factors in the maternal circulation. One of the well-studied and widely used factors is PlGF (placental growth factor), the levels of which drop in women destined to develop preeclampsia. This drop is known to precede the development of actual signs and symptoms of preeclampsia, thus proving to be a useful screening tool in predicting the disease. The literature varies widely in terms of the clinical usefulness of the test. We conducted a meta-analysis to study the predictive accuracy of PlGF in asymptomatic women. Our analysis included 40 studies with 3189 cases of preeclampsia and 89 498 controls. The overall predictive odds ratio of the test was 9 (6-13). Subgroup analysis evaluating various PlGF thresholds demonstrated that the predictive values were highest for PlGF levels between 80 and 120 pg/mL with a high predictive odds ratio of 25 (7-88), a sensitivity of 0.78 (95% CI, 0.67-0.86), a specificity of 0.88 (95% CI, 0.75-0.95), a positive likelihood ratio of 6.3 (95% CI, 2.7-14.7), and a negative likelihood ratio of 0.26 (95% CI, 0.16-0.42). Additionally, the accuracy was higher when the test was performed after 14 weeks of gestation (OR, 10 [7-15]) and for prediction of early onset preeclampsia (OR, 18 [9-37]). We conclude that PlGF is a useful screening tool to predict preeclampsia. Nonetheless, its utility should be judged with caution and randomized controlled trials are warranted to explore if its implementation improves perinatal outcomes in asymptomatic women.


Assuntos
Programas de Rastreamento/métodos , Pré-Eclâmpsia/diagnóstico , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Biomarcadores/análise , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Razão de Chances , Pré-Eclâmpsia/metabolismo , Valor Preditivo dos Testes , Gravidez , Proteínas da Gravidez/metabolismo , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Valores de Referência , Sensibilidade e Especificidade , Reino Unido
10.
Int J Mol Sci ; 20(17)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31480243

RESUMO

Preeclampsia, a systemic vascular disorder characterized by new-onset hypertension and proteinuria after 20 weeks of gestation, is the leading cause of maternal and perinatal morbidity and mortality. Maternal endothelial dysfunction caused by placental factors has long been accepted with respect to the pathophysiology of preeclampsia. Over the past decade, increased production of placental antiangiogenic factors has been identified as a placental factor leading to maternal endothelial dysfunction and systemic vascular dysfunction. This review summarizes the recent advances in understanding the molecular mechanisms of endothelial dysfunction caused by placental antiangiogenic factors, and the novel clinical strategies based on these discoveries.


Assuntos
Inibidores da Angiogênese/metabolismo , Placenta/fisiopatologia , Pré-Eclâmpsia/fisiopatologia , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/terapia , Gravidez , Fatores de Risco , Fator A de Crescimento do Endotélio Vascular/metabolismo
11.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(3): 95-101, jul.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182714

RESUMO

Objetivo: Medir la frecuencia con la que resultan positivos los marcadores del laboratorio clínico en pacientes con preeclampsia severa (PS) admitidas en una unidad de cuidados intensivos (UCI). Diseño: Estudio transversal. Ámbito: UCI de la Unidad Médica de Alta Especialidad Hospital de Ginecología y Obstetricia N.o 3 del Centro Médico Nacional La Raza del Instituto Mexicano del Seguro Social, Ciudad de México, México. Pacientes: Un total de 212 pacientes embarazadas con PS admitidas en la UCI del 1 de junio al 31 de diciembre del 2016. Intervenciones: Se consultaron los resultados del laboratorio clínico de su admisión a la UCI para identificar el porcentaje de aparición de los marcadores positivos de la PS. Variables de interés: Marcadores de la PS: hemoglobina (Hb) <10g/dL, cuenta plaquetaria (Plaq) <100.000plaquetas/μL, glucosa ˃180mg/dL, creatinina sérica (Cr) >1,1mg/dL, ácido úrico (Au) >4,0mg/dL, aspartato aminotransferasa (AST) >70U/L, deshidrogenasa láctica (DHL) >600U/L, pH arterial <7,32, déficit de base del fluido extracelular (DB fec) >8mmol/L y lactato >4mmol/L. Resultados: Marcadores positivos en el 93,39% (n=198) de los casos con la siguiente distribución: Au ˃4mg/dL, 88,48% (n=169, media de 6,2±1,04mg/dL); AST˃70U/L, 25,13% (n=48, media de 180,4±73,08U/L); Plaq<100.000plaquetas/μL, 24,08% (n=46, media de 71.600±22.970plaquetas/μL); DHL˃600U/L, 21,98% (n=42, media de 1.021,3±476U/L); Cr˃1,1mg/dL, 13,08% (n=25, media de 1,33±0,34mg/dL); pH arterial <7,32, 7,32% (n=14, media de 7,30±0,01); DB fec ˃8mmol/L, 6,28% (n=12, media de 9±0,2mmol/L); glucosa ˃180mg/dL, 3,30% (n=7, media de 187,85±2,67mg/dL); lactato ˃4mmol/L, 1,04% (n=2), y Hb˂10g/dL, 0%. Conclusiones: Los marcadores positivos más frecuentes fueron Au, AST, Plaq, DHL y Cr


Objective: To measure the frequency of positive results for clinical laboratory markers in patients with severe preeclampsia (SP) admitted in an intensive care unit (ICU). Design: Cross-sectional study. Setting: ICU of the High-Specialty Medical Unit, Hospital of Gynecology and Obstetrics No. 3, National Medical Center La Raza, Mexican Institute of Social Security, Mexico City, Mexico. Patients: 212 pregnant patients with SP admitted to the ICU between June 1 and December 31, 2016. Interventions: Laboratory results were consulted to identify the percentage of positive markers of SP. Variables of interest: SP markers: hemoglobin (Hb) <10g/dL, platelet count (Plat) <100,000 platelets/μL, glucose ˃180mg/dL, serum creatinine (Cr) >1.1mg/dL, uric acid (Ua) >4.0mg/dL, aminotransferase aspartate (AST) >70U/L, lactic deshydrogenase (LDH) >600U/L, blood pH <7.32, deficit of base of extra cellular fluid (DB ecf) >8mmol/L and lactate >4mmol/L. Results: Positive markers 93.39% (n=198) with the following distribution: Ua˃4mg/dL, 88.48% (n=169, mean 6.2±1.04mg/dL); AST˃70U/L, 25.13% (n=48, mean 180.4±73.08U/L); Plat<100,000platelets/μL, 24.08% (n=46, mean 71,600±22,970platelets/μL); LDH˃600U/L, 21.98% (n=42, mean 1,021.3±476U/L); Cr˃1.1mg/dL, 13.08% (n=25, mean 1.33±0.34mg/dL); blood pH<7.32, 7.32% (n=14, mean 7.30±0.01); DB ecf˃8mmol/L, 6.28% (n=12, mean 9±0.2mmol/L); glucose ˃180mg/dL, 3.30% (n=7, mean 187.85±2.67mg/dL); lactate ˃4mmol/L, 1.04% (n=2), and Hb˂10g/dL, 0%. Conclusions: The most frequent positive markers of SP were Ua, AST, Plat, LDH and Cr


Assuntos
Humanos , Feminino , Gravidez , Adulto , Pré-Eclâmpsia/diagnóstico , Unidades de Terapia Intensiva , Biomarcadores/análise , Técnicas de Laboratório Clínico , Estudos Transversais , Síndrome HELLP/diagnóstico , México
12.
Hypertension ; 74(4): 983-990, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401877

RESUMO

The ratio of maternal serum sFlt-1 (soluble fms-like tyrosine kinase 1) to PlGF (placental growth factor) has been used retrospectively to rule out the occurrence of preeclampsia, a pregnancy hypertensive disorder, within 7 days in women presenting with clinical suspicion of preeclampsia. A prospective, interventional, parallel-group, randomized clinical trial evaluated the use of sFlt-1/PlGF ratio in women presenting with suspected preeclampsia. Women were assigned to reveal (sFlt-1/PlGF result known to clinicians) or nonreveal (result unknown) arms. A ratio cutoff of 38 was used to define low (≤38) and elevated risk (>38) of developing the condition in the subsequent week. The primary end point was hospitalization within 24 hours of the test. Secondary end points were development of preeclampsia and other adverse maternal-fetal outcomes. We recruited 370 women (186 reveal versus 184 nonreveal). Preeclampsia occurred in 85 women (23%). The number of admissions was not significantly different between groups (n=48 nonreveal versus n=60 reveal; P=0.192). The reveal trial arm admitted 100% of the cases that developed preeclampsia within 7 days, whereas the nonreveal admitted 83% (P=0.038). Use of the test yielded a sensitivity of 100% (95% CI, 85.8-100) and a negative predictive value of 100% (95% CI, 97.1-100) compared with a sensitivity of 83.3 (95% CI, 58.6-96.4) and negative predictive value of 97.8 (95% CI, 93.7-99.5) with clinical practice alone. Use of the sFlt-1/PlGF ratio significantly improved clinical precision without changing the admission rate. Clinical Trial Registration- URL: http://www.isrctn.com. Unique identifier: ISRCTN87470468.


Assuntos
Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/diagnóstico , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto , Biomarcadores/sangue , Feminino , Humanos , Pré-Eclâmpsia/sangue , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade
13.
BMC Res Notes ; 12(1): 500, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409378

RESUMO

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal morbidity and mortality, especially in low-resource settings. Identifying mothers and babies at greatest risk of complications would enable intervention to be targeted to those most likely to benefit from them. However, current risk prediction models have a wide range of sensitivity (42-81%) and specificity (87-92%) indicating that improvements are needed. Furthermore, no predictive models have been developed or evaluated in Zimbabwe. This proposal describes a single centre retrospective cross-sectional study which will address the need to further develop and test statistical risk prediction models for adverse maternal and neonatal outcomes in low-resource settings; this will be the first such research to be carried out in Zimbabwe. Data will be collected on maternal demographics characteristics, outcome of prior pregnancies, past medical history, symptoms and signs on admission, results of biochemical and haematological investigations. Adverse outcome will be defined as a composite of maternal morbidity and mortality and perinatal morbidity and mortality. Association between variables and outcomes will be explored using multivariable logistic regression. Critically, new risk prediction models introduced for our clinical setting may reduce avoidable maternal and neonatal morbidity and mortality at local, national, regional and international level.


Assuntos
Modelos Estatísticos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/mortalidade , Adulto , Estudos Transversais , Países em Desenvolvimento , Feminino , Hospitais , Humanos , Recém-Nascido , Modelos Logísticos , Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Pré-Eclâmpsia/economia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Zimbábue
14.
Dis Markers ; 2019: 6270187, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31396294

RESUMO

The ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) is elevated and proved to be useful in preeclampsia (PE) diagnosis. Its value in differential diagnosis with other pregnancy complications and prediction of pregnancy duration has yet to be clarified in Chinese population. We retrospectively analyzed 118 singleton pregnancies with suspected or diagnosed PE at the Peking Union Medical College Hospital (PUMCH) in China. Among these, 62 pregnancies were diagnosed as PE (48 early onsets and 14 late onsets, with 39 and 5 severe PE, respectively), 12 gestational hypertension (GH), 15 chronic hypertension (chrHTN), 16 autoimmune diseases, and 13 pregnancies with uncomplicated proteinuria. And 76 normal pregnancies were included as control. The results showed (1) the sFlt-1/PlGF ratio in early onset PE subgroup was significantly higher than that in GH, chrHTN, and control groups; the sFlt-1/PlGF ratio in late onset PE subgroup was significantly higher than that in chrHTN and control groups, but similar as GH group; the sFlt-1/PlGF ratio was similar among GH, chrHTN, and control groups. (2) The sFlt-1/PlGF ratio was significantly increased in the PE group compared with autoimmune disease and uncomplicated proteinuria pregnancies. (3) By ROC curve analysis, the cutoff value of the sFlt-1/PlGF ratio was less than 21.5 to rule out PE and higher than 97.2 to confirm the diagnosis of PE. (4) The sFlt-1/PlGF ratio was higher in PE pregnancies delivering within 7 days than those more than 7 days, either in early onset PE or severe PE. In conclusion, we show that maternal sFlt-1/PlGF ratio is an efficient biomarker in the diagnosis and differential diagnosis of PE. This ratio can be used to predict the timing of delivery for PE pregnancies.


Assuntos
Biomarcadores/sangue , Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/diagnóstico , Complicações na Gravidez/diagnóstico , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto , Estudos de Casos e Controles , China/epidemiologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/classificação , Gravidez , Complicações na Gravidez/sangue , Prognóstico , Curva ROC
15.
Hypertension ; 74(4): 991-997, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31446801

RESUMO

Preeclampsia is characterized by an imbalance in angiogenic factors, including sEng (soluble endoglin). However, the relationship of sEng with the severity of preeclampsia, clinical, and laboratory parameters, and the occurrence of adverse outcomes are not fully elucidated. We studied 1002 women with preeclampsia. Serum concentrations of sEng were measured by ELISA. Serum sEng levels were significantly different (P<0.001) in patients with preeclampsia than in healthy pregnancy. In addition, these factors were markedly different in patients with hemolysis, elevated liver enzymes, low platelet count syndrome and eclampsia than in patients with preeclampsia with or without severe features (P<0.001) and in patients with preeclampsia with severe features than in those without severe features (P<0.001). sEng correlated positively with blood pressure, proteinuria, and levels of creatinine, uric acid, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase; and inversely with gestational age, infant's birth weight, and platelets counts (P<0.001 for all). The risk of combined and specific adverse outcomes (pulmonary edema, acute renal failure, placental abruption, hepatic hematoma or rupture, maternal death, cerebral hemorrhage, thrombocytopenia, elevated liver enzymes, preterm delivery, small for gestational age infant, and need for endotracheal intubation, positive inotropic drug support, and hemodialysis) was higher in patients with sEng values in the highest quartile (odds ratio ≥3.1) compared with the lowest quartile. Patients in the highest quartile of sEng were more likely to deliver early compared with those in the lowest quartile (HR, 2.33; 95% CI, 1.91-2.84). We concluded that circulating concentrations of sEng seem to be a suitable marker to assess the severity of preeclampsia and are associated with increased risk of adverse outcomes.


Assuntos
Endoglina/sangue , Pré-Eclâmpsia/diagnóstico , Adulto , Biomarcadores/sangue , Peso ao Nascer/fisiologia , Pressão Sanguínea/fisiologia , Creatinina/sangue , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Pré-Eclâmpsia/sangue , Gravidez , Resultado da Gravidez , Índice de Gravidade de Doença , Ácido Úrico/sangue
16.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352395

RESUMO

When a pregnant woman presents with headaches, visual disturbances, epigastric pain and nausea, preeclampsia quickly springs to mind. This case describes a primigravid 22-year-old female of 32 weeks gestation who presented with the symptoms described but was found to be apparently normotensive. Due to ongoing symptoms and diagnostic uncertainty in the absence of definitive evidence of preeclampsia, the patient was further investigated with an MRI brain scan, which was reported as either an acute stroke or an atypical presentation of posterior reversible encephalopathy syndrome. Together with blood results that showed heterozygosity for Factor V Leiden, we concluded that while the patient's clinical diagnosis was certainly preeclampsia, her investigations also supported an unexpected diagnosis of silent brain infarction. This report outlines a diagnostic dilemma that required multidisciplinary working between obstetricians, neurologists, radiologists and stroke physicians to manage the patient who went on to make a full recovery and deliver a healthy baby.


Assuntos
Dor Abdominal/etiologia , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Pré-Eclâmpsia/diagnóstico , Complicações na Gravidez/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Antagonistas Adrenérgicos beta/uso terapêutico , Aspirina/uso terapêutico , Diagnóstico Diferencial , Fator V , Feminino , Cefaleia , Humanos , Labetalol/uso terapêutico , Náusea , Inibidores da Agregação de Plaquetas/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 19(1): 266, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345176

RESUMO

BACKGROUND: Preeclampsia is a multisystem disorder characterized by vascular endothelial malfunction occurring after 20 weeks of gestation. Placental soluble fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic factor and placental growth factor (PlGF) is a potent angiogenic factor. The imbalance between these factors during placenta and fetal development has been shown to play a role in endothelial damage in preeclampsia. Preeclampsia is the leading cause of maternal mortality in Nepal. This study was designed to compare the sFlt1:PLGF ratio in pregnant women with and without preeclampsia attending Tribhuvan University Teaching Hospital (TUTH). METHOD: An observational cross-sectional study was performed in the Gynecology and Obstetrics Department of TUTH involving forty-four subjects with preeclampsia and forty-four age- and gestational-week-matched normal pregnant subjects as controls. Blood pressure, urinary protein levels, serum sFlt-1 levels, serum PlGF levels and the sFlt-1:PlGF ratio was compared in both the cases and control. The concentrations of sFlt-1 and PlGF were measured with commercially available ELISA kits. SPSS ver. 20.0 was used to analyze the data. RESULTS: There was no significant difference in age or gestational age in either study group. The ratio of the sFlt-1 and PlGF concentrations was significantly higher in women with preeclampsia (31.6 ± 9.6) than in the controls (3.2 ± 1.3). Likewise, diastolic blood pressure was significantly associated (p-value 0.000), whereas the severity of proteinuria was not associated (p-value 0.773) with the sFlt-1:PlGF ratio in women with preeclampsia. The significantly higher ratio (35.51 ± 8.1 versus 25.4 ± 8.7) was found in women with preeclampsia who developed complications than the group of women with preeclampsia who did not develop complication. CONCLUSION: The sFlt-1:PlGF ratio is significantly higher in Nepalese women with preeclampsia than in normal controls and this finding can be applied for further planned clinical trials.


Assuntos
Pré-Eclâmpsia/diagnóstico , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Recém-Nascido Pequeno para a Idade Gestacional/sangue , Nepal , Placenta/metabolismo , Pré-Eclâmpsia/sangue , Gravidez
18.
BMJ Case Rep ; 12(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315841

RESUMO

We present the case of a 30-year-old woman with posterior reversible encephalopathy syndrome (PRES) as a complication of pre-eclampsia in the early postpartum period. PRES is a rare neurological disorder which causes non-specific neurological symptoms such as headache, seizures and visual disturbances. It generally has a good prognosis, but severe complications can arise. Therefore, early recognition and treatment are paramount. Pre-eclampsia is a multiorgan disease and is associated with both maternal and foetal morbidity and mortality. Neurological symptoms occurring in the postpartum period indicate pre-eclampsia until proven otherwise. This case report was written to stress the attention on this rare complication of pre-eclampsia. When a patient in the postpartum period presents with a combination of seizures, disturbed vision and headache, PRES should always be kept in mind.


Assuntos
Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/etiologia , Pré-Eclâmpsia/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/terapia , Período Pós-Parto , Gravidez , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Convulsões/etiologia , Resultado do Tratamento , Transtornos da Visão/etiologia
19.
Nat Commun ; 10(1): 3031, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31292453

RESUMO

Maternal immune dysregulation seems to affect fetal or postnatal immune development. Preeclampsia is a pregnancy-associated disorder with an immune basis and is linked to atopic disorders in offspring. Here we show reduction of fetal thymic size, altered thymic architecture and reduced fetal thymic regulatory T (Treg) cell output in preeclamptic pregnancies, which persists up to 4 years of age in human offspring. In germ-free mice, fetal thymic CD4+ T cell and Treg cell development are compromised, but rescued by maternal supplementation with the intestinal bacterial metabolite short chain fatty acid (SCFA) acetate, which induces upregulation of the autoimmune regulator (AIRE), known to contribute to Treg cell generation. In our human cohorts, low maternal serum acetate is associated with subsequent preeclampsia, and correlates with serum acetate in the fetus. These findings suggest a potential role of acetate in the pathogenesis of preeclampsia and immune development in offspring.


Assuntos
Acetatos/sangue , Feto/imunologia , Pré-Eclâmpsia/imunologia , Efeitos Tardios da Exposição Pré-Natal/imunologia , Linfócitos T Reguladores/imunologia , Acetatos/administração & dosagem , Acetatos/imunologia , Acetatos/metabolismo , Adulto , Animais , Animais Recém-Nascidos , Estudos de Casos e Controles , Desenvolvimento Infantil , Pré-Escolar , Suplementos Nutricionais , Feminino , Feto/citologia , Feto/diagnóstico por imagem , Microbioma Gastrointestinal/imunologia , Vida Livre de Germes/imunologia , Humanos , Tolerância Imunológica/imunologia , Lactente , Recém-Nascido , Estudos Longitudinais , Troca Materno-Fetal/imunologia , Camundongos , Tamanho do Órgão/imunologia , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico , Gravidez , Efeitos Tardios da Exposição Pré-Natal/patologia , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Estudos Prospectivos , Timo/citologia , Timo/diagnóstico por imagem , Timo/crescimento & desenvolvimento , Timo/imunologia , Fatores de Transcrição/imunologia , Fatores de Transcrição/metabolismo , Ultrassonografia Pré-Natal , Adulto Jovem
20.
Hypertens Pregnancy ; 38(3): 184-192, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31284791

RESUMO

Objective: To screen for novel predictive serum markers of preeclampsia (PE). Method: Blood samples were collected from seven women with PE and five with healthy pregnancies. Serum proteins were identified using isobaric tags for relative and absolute quantitation (iTRAQ) technology combined with liquid chromatography mass spectrometry analysis. The differentially expressed proteins in the PE samples were identified using the SwissProt database, and functionally annotated by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. The upregulated proteins from iTRAQ result were verified by ELISA. Results: We identified 121 differentially expressed proteins, of which 76 were upregulated and 45 were downregulated, and 14 were differentially expressed by more than two-folds. The top GO terms for Cellular Components (CC) were high-density lipoprotein particles and plasma lipoprotein particles, defense response for Biological Processes (BP), and glycosaminoglycan binding, heparin binding and sulfur compound for Molecular functions (MF). The pathway hsa04979 for Cholesterol metabolism was significantly enriched among the upregulated proteins, while the structural domain was enriched in immunoglobulin subtype 2. The dysregulation of pregnancy-specific beta-1-glycoprotein 2 (PSG2) was confirmed by ELISA. Conclusion: PE pathogenesis is related to lipid metabolism and inflammation, and proteins related to these pathways are potential early diagnostic markers for PE.PSG2 may be a marker of PE.


Assuntos
Biomarcadores/sangue , Biologia Computacional , Pré-Eclâmpsia/diagnóstico , Proteômica , Adulto , Feminino , Humanos , Espectrometria de Massas , Pré-Eclâmpsia/sangue , Gravidez
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