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1.
Front Endocrinol (Lausanne) ; 13: 924070, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35846290

RESUMO

Introduction: Emerging evidence has shown that in-vitro fertilization (IVF) is associated with higher risks of certain placental abnormalities or complications, such as placental abruption, preeclampsia, and preterm birth. However, there is a lack of large population-based analysis focusing on placental abnormalities or complications following IVF treatment. This study aimed to estimate the absolute risk of placental abnormalities or complications during IVF-conceived pregnancy. Methods: We conducted a retrospective cohort study of 16 535 852 singleton pregnancies with delivery outcomes in China between 2013 and 2018, based on the Hospital Quality Monitoring System databases. Main outcomes included placental abnormalities (placenta previa, placental abruption, placenta accrete, and abnormal morphology of placenta) and placenta-related complications (gestational hypertension, preeclampsia, eclampsia, preterm birth, fetal distress, and fetal growth restriction (FGR)). Poisson regression modeling with restricted cubic splines of exact maternal age was used to estimate the absolute risk in both the IVF and non-IVF groups. Results: The IVF group (n = 183 059) was more likely than the non-IVF group (n = 16 352 793) to present placenta previa (aRR: 1.87 [1.83-1.91]), placental abruption (aRR: 1.16 [1.11-1.21]), placenta accrete (aRR: 2.00 [1.96-2.04]), abnormal morphology of placenta (aRR: 2.12 [2.07 to 2.16]), gestational hypertension (aRR: 1.55 [1.51-1.59]), preeclampsia (aRR: 1.54 [1.51-1.57]), preterm birth (aRR: 1.48 [1.46-1.51]), fetal distress (aRR: 1.39 [1.37-1.42]), and FGR (aRR: 1.36 [1.30-1.42]), but no significant difference in eclampsia (aRR: 0.91 [0.80-1.04]) was found. The absolute risk of each outcome with increasing maternal age in both the IVF and non-IVF group presented two patterns: an upward curve showing in placenta previa, placenta accreta, abnormal morphology of placenta, and gestational hypertension; and a J-shape curve showing in placental abruption, preeclampsia, eclampsia, preterm birth, fetal distress, and FGR. Conclusion: IVF is an independent risk factor for placental abnormalities and placental-related complications, and the risk is associated with maternal age. Further research is needed to evaluate the long-term placenta-related chronic diseases of IVF patients and their offspring.


Assuntos
Descolamento Prematuro da Placenta , Eclampsia , Hipertensão Induzida pela Gravidez , Placenta Prévia , Pré-Eclâmpsia , Nascimento Prematuro , Descolamento Prematuro da Placenta/epidemiologia , Descolamento Prematuro da Placenta/etiologia , Feminino , Fertilização , Sofrimento Fetal/complicações , Retardo do Crescimento Fetal , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Recém-Nascido , Placenta , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos
2.
Obstet Gynecol ; 140(1): 83-86, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35849460

RESUMO

Hypertensive disorders of pregnancy affect up to 8% of pregnancies, but updated national trends are lacking. We performed a repeated cross-sectional analysis of individuals with singleton pregnancies who delivered at greater than 20 weeks of gestation, with data in the U.S. National Vital Statistics System from 1989 to 2020. Temporal trends in hypertensive disorders of pregnancy, chronic hypertension, and eclampsia were characterized using joinpoint regression. Overall, 122,329,914 deliveries were included. Hypertensive disorders of pregnancy increased from 2.79% in 1989 to 8.22% in 2020, representing an average annual percentage change (AAPC) of 3.6% (95% CI 3.0-4.1%). Chronic hypertension increased (AAPC 4.1%, 95% CI 3.3-4.9%), whereas eclampsia decreased (AAPC -2.5%, 95% CI -4.0% to -1.0%). Hypertensive disorders of pregnancy are associated with significant morbidity and mortality; the rising incidence is concerning.


Assuntos
Eclampsia , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Estatísticas Vitais , Estudos Transversais , Eclampsia/epidemiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Incidência , Pré-Eclâmpsia/epidemiologia , Gravidez , Estados Unidos/epidemiologia
3.
Contrast Media Mol Imaging ; 2022: 4332006, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35854775

RESUMO

We aimed to explore the association of BMI in pre-pregnant women with metabolic syndrome in pregnancy in advanced maternal age. A total of 229 maternal women and 536 maternal women participated in this study. Pregnancy women underwent a 75 g-oral glucose tolerance test and maternal lipid profile test between 24 and 28 weeks. Data about biological and sociodemographic characteristics were recorded for each case. The metabolic equivalent (Met) was 9.6% in the maternal age ≥35 group, 5.4% in the age 20-34 group (P = 0.027), and 6.7% in all pregnant women. Results also demonstrated that gestational diabetes mellitus (GDM) and MetS were more likely to appear in the maternal age ≥35 years group than the maternal age 20-34 years group (41.5% vs. 30.6%; P = 0.001, 9.6% vs. 5.4%, P = 0.027). Risk for preterm delivery and eclampsia were increased with raised MetS (RR 3.434 and RR 1.800); MetS in women aged ≥35 years had the largest area under the curve (AUC) (AUC 0.925, 95% CI 0.885-0.965), and its optimal cutoff point was ≥24.998 kg/m2, and the optimal cutoff point for total cholesterol (TC) (AUC 0.686, 95% CI 0.571-.802) predicting MetS was ≥4.955 mmol/l. MetS in pregnancy are associated with the occurrence of preterm delivery and eclampsia, and pre-BMI and TC can predict MetS in the maternal age ≥35 group.


Assuntos
Eclampsia , Síndrome Metabólica , Nascimento Prematuro , Índice de Massa Corporal , Feminino , Humanos , Recém-Nascido , Lipídeos , Idade Materna , Síndrome Metabólica/epidemiologia , Gravidez
4.
World J Emerg Surg ; 17(1): 40, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804368

RESUMO

BACKGROUND: Spontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood. The goal was to summarize and define the etiology, risk factors, clinical presentation, appropriate diagnostic methods, and therapeutic options for spontaneous hepatic rupture during pregnancy/puerperium (SHRP) complicated by the hypertensive disorder. METHODS: Literature search of all full-text articles included PubMed (1946-2021), PubMed Central (1900-2021), and Google Scholar. Case reports of a spontaneous hepatic rupture or liver hematoma during pregnancy or puerperium as a complication of hypertensive disorders (preeclampsia, eclampsia, HELLP syndrome) were searched. There was no restriction of language to collect the cases. Additional cases were identified by reviewing references of retrieved studies. PRISMA guidelines for the data extraction and quality assessment were applied. RESULTS: Three hundred and ninety-one cases were collected. The median maternal age was 31 (range 17-48) years; 36.6% were nulliparous. Most (83.4%) occurred in the third trimester. Maternal and fetal mortality was 22.1% and 37.2%, respectively. Maternal and fetal mortality was significantly higher 1) before the year 1990, 2) with maternal hemodynamic instability, and 3) eclampsia. The most important risk factors for SHRP were preeclampsia and HELLP syndrome. Most women had right lobe affected (70.9%), followed by both lobes in 22.1% and left lobe in 6.9%. The most common surgical procedure was liver packing. Liver transplantation was performed in 4.7% with 100% survival. Maternal mortality with liver embolization was 3.0%. Higher gestational age increases fetal survival. CONCLUSION: The diagnosis and treatment of SHRP are often delayed, leading to high maternal and fetal mortality. SHRP should be excluded in hemodynamically unstable patients with preeclampsia/eclampsia or HELLP syndrome and right upper abdominal pain. Liver embolization and liver transplantation contribute to maternal survival. Maternal and fetal mortality was significantly higher before the year 1990. Hemodynamic instability, preeclampsia, and eclampsia have a significant negative influence on maternal survival. LEVEL OF EVIDENCE: Level V.


Assuntos
Eclampsia , Síndrome HELLP , Hipertensão Induzida pela Gravidez , Hepatopatias , Pré-Eclâmpsia , Adolescente , Adulto , Feminino , Hematoma/cirurgia , Humanos , Hepatopatias/complicações , Hepatopatias/diagnóstico , Pessoa de Meia-Idade , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Gravidez , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-35805359

RESUMO

The HELLP syndrome (hemolysis, liver damage and thrombocytopenia) is a rare (0.5-0.9%) but serious complication of pregnancy or puerperium associated with a higher risk of maternal and fetal mortality and morbidity. Liver and spleen hematomas rarely entangle (<2%) HELLP cases, but rupture of the hematomas presents an immediate threat to life. We present the history of a 35-year old pregnant woman (at the 31st week) admitted to our hospital due to the risk of premature delivery. On the first day, the patient did not report any complains, and the only abnormality was thrombocytopenia 106 G/L. However, within several hours, tests showed platelet levels of 40.0 G/L, LDH 2862.0 U/L and AST 2051.6 U/L, and the woman was diagnosed with severe HELLP syndrome, complicated by hematomas of the liver and spleen, seizures (eclampsia), severe arterial hypertension and coagulation disorders. The purpose of this article is to highlight the need for early investigation of the causes of thrombocytopenia and the differentiation of HELLP from other thrombotic microangiopathies (TMAs).


Assuntos
Transtornos da Coagulação Sanguínea , Eclampsia , Síndrome HELLP , Hipertensão , Pré-Eclâmpsia , Trombocitopenia , Adulto , Feminino , Síndrome HELLP/diagnóstico , Hematoma , Humanos , Fígado/diagnóstico por imagem , Gravidez , Baço , Trombocitopenia/etiologia
6.
Nursing (Säo Paulo) ; 25(289): 7930-7939, jun.2022.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1379593

RESUMO

Objetivo: identificar as evidências disponíveis na literatura sobre o papel da enfermagem na assistência as gestantes com síndromes hipertensivas na gestação. Método: Trata-se de uma revisão integrativa baseada na estratégia PICO, realizada com 13 artigos indexados nas bases de dados LILACS, SciELO, BDENF, MEDLINE. Os critérios de inclusão consideraram artigos disponíveis na íntegra e publicados entre 2009 a junho de 2021. Resultados: Para análise, os estudos foram divididos em 3 categorias: 1. O conhecimento dos profissionais de enfermagem sobre as síndromes hipertensivas na gestação; 2. Os cuidados de enfermagem à gestante com síndromes hipertensivas na gestação e seus neonatos; 3. A sistematização da assistência em enfermagem no cuidado as síndromes hipertensivas na gestação. Conclusão: Os estudos analisados demonstram as interfaces e desafios da enfermagem no cuidado às gestantes com síndromes hipertensivas na gestação, apontando o papel primordial da enfermagem na atenção à saúde da gestante.(AU)


Objective: to identify the evidence available in the literature on the role of nursing in assisting pregnant women with hypertensive syndromes during pregnancy. Method: This is an integrative review based on the PICO strategy, carried out with 13 articles indexed in the LILACS, SciELO, BDENF, MEDLINE databases. Inclusion criteria considered articles available in full and published between 2009 and June 2021. Results: For analysis, the studies were divided into 3 categories: 1. Nursing professionals' knowledge about hypertensive syndromes during pregnancy; 2. Nursing care for pregnant women with hypertensive syndromes during pregnancy and their newborns; 3. The systematization of nursing care in the care of hypertensive syndromes during pregnancy. Conclusion: The analyzed studies demonstrate the interfaces and challenges of nursing in the care of pregnant women with hypertensive syndromes during pregnancy, pointing out the primordial role of nursing in the health care of pregnant women.(AU)


Objetivo: identificar las evidencias disponibles en la literatura sobre el papel de la enfermería en la asistencia a las gestantes con síndromes hipertensivos durante el embarazo. Método: Se trata de una revisión integradora basada en la estrategia PICO, realizada con 13 artículos indexados en las bases de datos LILACS, SciELO, BDENF, MEDLINE. Los criterios de inclusión consideraron artículos disponibles en su totalidad y publicados entre 2009 y junio de 2021. Resultados: Para el análisis, los estudios fueron divididos en 3 categorías: 1. Conocimiento de los profesionales de enfermería sobre los síndromes hipertensivos durante el embarazo; 2. Atención de enfermería a las gestantes con síndromes hipertensivos durante el embarazo y sus recién nacidos; 3. La sistematización de los cuidados de enfermería en la atención de los síndromes hipertensivos durante el embarazo. Conclusión: Los estudios analizados demuestran las interfaces y desafíos de la enfermería en el cuidado de la gestante con síndromes hipertensivos durante el embarazo, señalando el papel primordial de la enfermería en el cuidado de la salud de la gestante.(AU)


Assuntos
Pré-Eclâmpsia , Enfermagem , Hipertensão Induzida pela Gravidez , Eclampsia , Cuidados de Enfermagem
7.
Eur J Obstet Gynecol Reprod Biol ; 274: 175-181, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35661540

RESUMO

During normal pregnancy, blood volume increases by nearly two liters. Distinctively, the absence coupled with the extreme extent regarding the volume expansion, are likely accompanied with pathological conditions. Undoubtedly, preeclampsia, defined as the appearance of hypertension and organ deficiency, such as proteinuria during the second half of pregnancy, is not a homogenous disease. Clinically speaking, two main types of preeclampsia can be distinguished, in which a marked difference between them is vascular condition, and consequently, the blood volume. The "classic" preeclampsia, as a two-phase disease, described in the first, latent phase, in which, placenta development is diminished. Agents from this malperfused placenta generate a maternal disease, the second phase, in which endothelial damage leads to hypertension and organ damage due to vasoconstriction and thrombotic microangiopathy. In this hypovolemia-associated condition, decreasing platelet count, signs of hemolysis, renal and liver involvement are characteristic findings; proteinuria is marked and increasing. In the terminal phase, visible edema develops due to increasing capillary transparency, augmenting end-organ damages. "Classic" preeclampsia is a severe and quickly progressing condition with placental insufficiency and consequent fetal growth restriction and oligohydramnios. The outcome of this condition often leads to fetal hypoxia, eclampsia or placental abruption. The management is limited to a diligent prolongation of pregnancy to accomplish improved neonatal pulmonary function, careful diminishing high blood pressure, and delivery induction in due time. The other subtype, associated with relaxed vasculature and high cardiac output, is a maternal disease, in which obesity is an important risk factor since predisposes to enhanced water retention, hypertension, and a weakened endothelial dysfunction. Initially, enhanced water retention leads to lowered extremity edema, which oftentimes progresses to a generalized form and hypertension. In several cases, proteinuria appears most likely due to tissue edema. This condition already fully meets preeclampsia criteria. Laboratory alterations, including proteinuria, are modest and platelet count remains within the normal range. Fetal weight is also normal or frequently over average due to enhanced placental blood supply. It is very likely, further water retention leads to venous congestion, a parenchyma stasis, responsible for ascites, eclampsia, or placental abruption. During the management of this hypervolemia-associated preeclampsia, the administration of diuretic furosemide treatment seemingly offers promise.


Assuntos
Descolamento Prematuro da Placenta , Eclampsia , Hipertensão , Pré-Eclâmpsia , Diuréticos/uso terapêutico , Feminino , Humanos , Hipertensão/complicações , Recém-Nascido , Placenta , Pré-Eclâmpsia/diagnóstico , Gravidez , Proteinúria/etiologia , Água
8.
Environ Res ; 212(Pt D): 113596, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35661733

RESUMO

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal mortality and morbidity. We evaluate the effects of ambient temperature on risk of maternal hypertensive disorders throughout pregnancy. We used birth register data for all singleton births (22-43 weeks' gestation) recorded at a tertiary-level hospital in Johannesburg, South Africa, between July 2017-June 2018. Time-to-event analysis was combined with distributed lag non-linear models to examine the effects of mean weekly temperature, from conception to birth, on risk of (i) high blood pressure, hypertension, or gestational hypertension, and (ii) pre-eclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets). Low and high temperatures were defined as the 5th and 95th percentiles of daily mean temperature, respectively. Of 7986 women included, 844 (10.6%) had a hypertensive disorder of which 432 (51.2%) had high blood pressure/hypertension/gestational hypertension and 412 (48.8%) had pre-eclampsia/eclampsia/HELLP. High temperature in early pregnancy was associated with an increased risk of pre-eclampsia/eclampsia/HELLP. High temperature (23 °C vs 18 °C) in the third and fourth weeks of pregnancy posed the greatest risk, with hazard ratios of 1.76 (95% CI 1.12-2.78) and 1.79 (95% CI 1.19-2.71), respectively. Whereas, high temperatures in mid-late pregnancy tended to protect against pre-eclampsia/eclampsia/HELLP. Low temperature (11°) during the third trimester (from 29 weeks' gestation) was associated with an increased risk of high blood pressure/hypertension/gestational hypertension, however the strength and statistical significance of low temperature effects were reduced with model adjustments. Our findings support the hypothesis that high temperatures in early pregnancy increase risk of severe hypertensive disorders, likely through an effect on placental development. This highlights the need for greater awareness around the impacts of moderately high temperatures in early pregnancy through targeted advice, and for increased monitoring of pregnant women who conceive during periods of hot weather.


Assuntos
Eclampsia , Síndrome HELLP , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Eclampsia/epidemiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Placenta , Pré-Eclâmpsia/epidemiologia , Gravidez , África do Sul/epidemiologia , Temperatura
9.
Ceska Gynekol ; 87(2): 93-99, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35667859

RESUMO

OBJECTIVE: Analysis of maternal morbidity in the Slovak Republic in the years 2012-2018. METHODS: The analysis of selected maternal morbidity data prospectively collected in the years 2012-2018 from all obstetric units in the Slovak Republic. RESULTS: In the years 2012-2018, incidence of severe peripartum bleeding was 2.17, peripartum hysterectomy was 0.89, maternal admission to intensive care units was 1.59, eclampsia was 0.21, HELLP syndrome was 0.73, abnormally invasive placentation was 0.37, uterine rupture was 0.68, severe sepsis in pregnancy and puerperium was 0.18 and nonfatal amniotic fluid embolism was 0.027 per 1,000 births. CONCLUSION: Incidence of total severe acute maternal morbidity in the Slovak Republic was 6.84 per 1,000 births. In Slovak local conditions, there is still room for reduction of severe acute maternal morbidity.


Assuntos
Eclampsia , Embolia Amniótica , Hemorragia Pós-Parto , Complicações na Gravidez , Ruptura Uterina , Eclampsia/epidemiologia , Feminino , Humanos , Histerectomia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Eslováquia/epidemiologia , Ruptura Uterina/epidemiologia
10.
Best Pract Res Clin Anaesthesiol ; 36(1): 107-121, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35659948

RESUMO

Preeclampsia is a severe manifestation of maternal hypertensive disease affecting 2-8% of pregnancies. The disease places women at risk of women at risk of life-threatening events, including cerebral hemorrhage, pulmonary edema, acute kidney injury, hepatic failure or rupture, disseminated intravascular coagulation, eclampsia, and placental abruption. In addition to the maternal disease burden, increased fetal morbidity and mortality occurs due to iatrogenic preterm delivery, fetal growth restriction, and placental abruption. Magnesium therapy for seizure prophylaxis and blood pressure control to limit cardiovascular and cerebrovascular morbidity are the cornerstone of treatment. Interdisciplinary planning and management are crucial to optimizing patient outcomes.


Assuntos
Descolamento Prematuro da Placenta , Eclampsia , Pré-Eclâmpsia , Eclampsia/diagnóstico , Eclampsia/terapia , Feminino , Humanos , Recém-Nascido , Placenta , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Gravidez
11.
J Hypertens ; 40(7): 1257-1264, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35762468

RESUMO

Hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are a worldwide health problem. Hypertensive disorders of pregnancy affect more than 10% of pregnancies and are associated with increased mortality and morbidity for both mother and fetus. Although patients' outcomes and family's experience will always be the primary concern regarding hypertensive complications during pregnancy, the economic aspect of this disease is also worth noting. Compared with normotensive pregnancies, those related with hypertension resulted in an excess increase in hospitalization and healthcare cost. Hence, the focus of this review is to analyze hypertensive disorders of pregnancy and to present practical tips with clear instructions for the clinical management of hypertensive disorders of pregnancy. This overview offers a detailed approach from the diagnosis to treatment and follow-up of a pregnant women with hypertension, evidence based, to support these instructions.


Assuntos
Eclampsia , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Pressão Sanguínea , Feminino , Hospitalização , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/terapia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Gravidez
12.
FASEB J ; 36(7): e22413, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35696055

RESUMO

Pregnancy-induced hypertension (PIH) is a multifactorial and severe pregnancy complication including preeclampsia/eclampsia, gestational hypertension, chronic (pre-existing) hypertension, and preeclampsia/eclampsia variants superimposed on chronic hypertension. PIH-induced maternal mortality accounts for approximately 9% of all maternal deaths over the world. A large number of case-control studies have established the importance of various genetic factors in the occurrence and development of PIH. In this narrative review, we summarized the genetic risk factors involved in the renin-angiotensin system, endothelin system, inflammatory factors, oxidative stress, and other functional networks, with the aim of sorting out the genetic factors that may play a potential role in PIH and providing new ideas to elucidate the pathogenesis of PIH.


Assuntos
Eclampsia , Hipertensão Induzida pela Gravidez , Hipertensão , Pré-Eclâmpsia , Feminino , Humanos , Hipertensão/genética , Hipertensão Induzida pela Gravidez/genética , Polimorfismo Genético , Pré-Eclâmpsia/genética , Gravidez , Fatores de Risco
13.
Int J Clin Pract ; 2022: 6990974, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685575

RESUMO

Objective: This study aimed to investigate the risk factors of reversible posterior leukoencephalopathy syndrome (RPLS) in pregnant women with severe preeclampsia or eclampsia (SPE/E) based on a predicting model and to analyze the perinatal outcomes. Methods: From January 2015 to March 2020, 78 pregnant women data diagnosed with severe preeclampsia or eclampsia with cranial magnetic resonance imaging (MRI) and transcranial Doppler (TCD) screening in Xiangyang No. 1 People's Hospital and Jiangsu Province Hospital of Chinese Medicine were analyzed retrospectively. They were divided into the RPLS group (n = 33) and non-RPLS group (n = 45) based on the MRI results. The general clinical data (blood pressure, BMI, symptoms, and so forth), laboratory examination, TCD results, and perinatal outcomes in the two groups were compared. The risk factors of severe preeclampsia or eclampsia complicated with RPLS were analyzed by multivariate logistic regression. The prediction model and decision curve (DCA) were established according to the clinical-imaging data. Results: The univariate analysis showed that poor placental perfusion, hypertension emergency, use of two or more oral antihypertensive drugs, headache, white blood cell (WBC) count, platelet (PLT) count, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), uric acid (UA), serum albumin (ALB), average flow velocity, and resistance index of the posterior cerebral and basilar arteries were significantly different in the RPLS group compared with the non-RPLS group (all P < 0.05). The multivariate logistic regression analysis showed that hypertensive emergency, headache, WBC, PLT, ALT, and average flow velocity of the basilar artery (BAAFV) were the risk factors in the RPLS group. The aforementioned clinical-imaging data modeling (general data model, laboratory examination model, TCD model, and combined model) showed that the combined model predicted RPLS better. DCA also confirmed that the net benefit of the combined model was higher. In addition, the incidence of postpartum hemorrhage, stillbirth, and preterm infants was higher in the RPLS group than in the non-RPLS group (all P < 0.05). Conclusions: More postpartum complications were detected in pregnant women with severe preeclampsia or eclampsia complicated with RPLS. Hypertensive emergency, headache, WBC, PLT, ALT, and BAAFV were the important risk factors for RPLS. The combined model had a better effect in predicting RPLS.


Assuntos
Eclampsia , Síndrome da Leucoencefalopatia Posterior , Pré-Eclâmpsia , Eclampsia/diagnóstico por imagem , Eclampsia/epidemiologia , Feminino , Cefaleia/complicações , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Imageamento por Ressonância Magnética/efeitos adversos , Placenta , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Pré-Eclâmpsia/diagnóstico , Gravidez , Gestantes , Estudos Retrospectivos
14.
Am J Emerg Med ; 58: 223-228, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35716535

RESUMO

INTRODUCTION: Eclampsia is a rare partum and puerperal condition that carries a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of the care of patients with eclampsia, including presentation, evaluation, and evidence-based management in the emergency department (ED). DISCUSSION: Eclampsia is a hypertensive disease of pregnancy defined by new onset tonic-clonic, focal, or multifocal seizures or unexplained altered mental status in a pregnant or postpartum patient in the absence of other causative etiologies. However, signs and symptoms of preeclampsia and prodromes of eclampsia are often subtle and non-specific, making the diagnosis difficult. Thus, it should be considered in pregnant and postpartum patients who present to the ED. Laboratory testing including complete blood cell count, renal and liver function panels, electrolytes, glucose, coagulation panel, fibrinogen, lactate dehydrogenase, uric acid, and urinalysis, as well as imaging to include head computed tomography, can assist, but these evaluations should not delay management. Components of treatment include emergent obstetric specialist consultation, magnesium administration, and blood pressure control in patients with hypertension. Definitive treatment of eclampsia requires emergent delivery in pregnant patients. If consultants are not in-house, emergent stabilization and immediate transfer are required. CONCLUSIONS: An understanding of eclampsia can assist emergency clinicians in rapid recognition and timely management of this potentially deadly disease.


Assuntos
Eclampsia , Hipertensão , Pré-Eclâmpsia , Eclampsia/diagnóstico , Eclampsia/epidemiologia , Eclampsia/terapia , Feminino , Humanos , Hipertensão/complicações , Período Pós-Parto , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/terapia , Gravidez , Prevalência , Convulsões/etiologia
15.
Cells ; 11(9)2022 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-35563854

RESUMO

Obesity has been steadily increasing over the past decade in the US and worldwide. Since 1975, the prevalence of obesity has increased by 2% per decade, unabated despite new and more stringent guidelines set by WHO, CDC, and other public health organizations. Likewise, maternal obesity has also increased worldwide over the past several years. In the United States, pre-pregnancy rates have increased proportionally across all racial groups. Obesity during pregnancy has been directly linked to obstetric complications including gestational diabetes, HTN, hematomas, pre-eclampsia, and congenital defects. In the particular case of pre-eclampsia, the incidence rate across the globe is 2.16%, but the condition accounts for 30% of maternal deaths, and a robust body of evidence underscored the relationship between obesity and pre-eclampsia. More recently, attention has focused on the identification of reliable biomarkers predictive of an elevated risk for pre-eclampsia. The aim of this literature review is to elucidate the relationship between obesity and these predictive biomarkers for future prediction and prevention of pre-eclampsia condition in women at risk.


Assuntos
Diabetes Gestacional , Eclampsia , Pré-Eclâmpsia , Biomarcadores , Feminino , Humanos , Obesidade/complicações , Gravidez , Estados Unidos
16.
J Ayub Med Coll Abbottabad ; 34(2): 269-272, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35576284

RESUMO

BACKGROUND: Pregnancy poses some stress on normal homeostasis of the human body and brings changes in the body which predisposes the individual towards various pathological conditions as well. Objective: Objective of the study was to determine the magnetic resonance imaging (MRI) changes and clinical symptoms associated with these changes among patients of eclampsia and preeclampsia managed at tertiary care unit. It was a cross-sectional study, conducted at Gynaecology and obstetrics department Pak Emirates Military Hospital (PEMH) Rawalpindi. January to June 2019. METHODS: A total of 80 pregnant women who were diagnosed by consultant obstetrician for eclampsia or pre-eclampsia were included in the study. All the patients underwent Plain MRI brain including TIWI, T2WI, FLAIR, DWI, ADC, GRE and SWI sequences at radiology department of PEMH RWP. Positive MRI findings were defined as presence of cerebral oedema, infarction, cerebral venous sinus thrombosis and cerebral haemorrhage. Headache, seizures, altered mental status and visual problems were correlated with MRI changes among the target population. RESULTS: Out of 80 pregnant women with eclampsia or preeclampsia, 49 (61.2%) had no changes on MRI while 31 (38.8%) had significant changes on MRI. Cerebral oedema 12 (15%) was the most common MRI finding followed by cerebral haemorrhage 8 (10%). Mean age of participants was 36.33±2.238 years. With Pearson chi-square analysis, it was found that presence of seizures and altered mental state had statistically significant relationship with presence of MRI findings among the target population. CONCLUSIONS: MRI changes were a common finding among the patients of eclampsia or pre-eclampsia. Cerebral oedema was the commonest finding in our study. Patients with serious clinical symptoms like seizures and altered mental state had more chances of having MRI changes as compared to patients without the serious clinical symptoms.


Assuntos
Edema Encefálico , Eclampsia , Pré-Eclâmpsia , Adulto , Hemorragia Cerebral , Estudos Transversais , Eclampsia/diagnóstico por imagem , Eclampsia/epidemiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pré-Eclâmpsia/diagnóstico por imagem , Pré-Eclâmpsia/epidemiologia , Gravidez , Convulsões
17.
J. obstet. gynaecol. Can ; 44(5): 547-571, 20220501.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1372812

RESUMO

This guideline was developed by maternity care providers from obstetrics and internal medicine. It reviews the diagnosis, evaluation, and management of the hypertensive disorders of pregnancy (HDPs), the prediction and prevention of preeclampsia, and the postpartum care of women with a previous HDP. Implementation of the recommendations in these guidelines may reduce the incidence of the HDPs, particularly preeclampsia, and associated adverse outcomes. A comprehensive literature review was updated to December 2020, following the same methods as for previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines, and references were restricted to English or French. To support recommendations for therapies, we prioritized randomized controlled trials and systematic reviews (if available), and evaluated substantive clinical outcomes for mothers and babies. The authors agreed on the content and recommendations through consensus and responded to peer review by the SOGC Maternal Fetal Medicine Committee. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a "good practice point." See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).The Board of the SOGC approved the final draft for publication. All health care providers (obstetricians, family doctors, midwives, nurses, and anesthesiologists) who provide care to women before, during, or after pregnancy.


Assuntos
Humanos , Feminino , Gravidez , Pré-Eclâmpsia/prevenção & controle , Eclampsia/prevenção & controle , Monitorização Ambulatorial da Pressão Arterial , Anti-Hipertensivos/uso terapêutico
18.
Int J Cardiol ; 359: 54-60, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35427704

RESUMO

INTRODUCTION: Hypertrophic cardiomyopathy (HCM) is a genetic disorder that can be complicated by heart failure and sudden cardiac death. Pregnancy causes hemodynamic changes, which may be deleterious in patients with HCM. Existing cohort studies, analyzing maternal and fetal outcomes of pregnant HCM patients, are limited by small sample sizes. We performed a systematic review of maternal and fetal outcomes of pregnancy in patients with HCM. METHODS: We performed a literature search for studies reporting maternal or fetal outcomes in pregnant women with HCM. Primary outcomes included maternal death, stillbirth, and fetal death. Secondary maternal outcomes included both sustained and non-sustained ventricular tachycardia (VT), atrial fibrillation, heart failure (HF), syncope, cesarean delivery, and preeclampsia/eclampsia. The secondary fetal outcome was preterm birth. We used a random-effects model to determine pooled incidences of outcomes. RESULTS: We identified a total of 18 studies with 1624 pregnancies. The incidence of maternal death was 0.2%. The rates of sustained VT, any VT (including non-sustained), AF, HF, and syncope were 1% (0-1%), 6% (4-8%), 4% (2-6%), 5% (3-8%), and 9% (3-14%), respectively. Postpartum hemorrhage, preeclampsia/eclampsia, and cesarean section complicated 2% (1-4%), 4% (2-6%), and 43% (32-54%) of pregnancies, respectively. Neonatal death occurred in 0.2% of pregnancies. Stillbirth complicated 1% (95% CI, 0-3%) of pregnancies, whereas the incidence of preterm birth was 22% (95% CI, 18-25%). CONCLUSIONS: Women with HCM considering pregnancy can be reassured that the risk of maternal, fetal, or neonatal death is low. However, they are at risk of several non-fatal cardiac and pregnancy-related complications.


Assuntos
Cardiomiopatia Hipertrófica , Eclampsia , Insuficiência Cardíaca , Morte Materna , Morte Perinatal , Pré-Eclâmpsia , Nascimento Prematuro , Cardiomiopatia Hipertrófica/epidemiologia , Cesárea , Feminino , Insuficiência Cardíaca/complicações , Humanos , Recém-Nascido , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Natimorto , Síncope/complicações
19.
J Ayub Med Coll Abbottabad ; 34(1): 62-66, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35466629

RESUMO

BACKGROUND: Eclampsia and preeclampsia are among the serious complications of gestation and threaten the lives of both mother and foetus. A protein called visfatin, one of these adipokines, is evaluated for its effects on serum electrolytes, lipid profile and hepatic enzymes in preeclamptic and eclamptic patients. METHODS: A sum of 234 pregnant women were enrolled in this crosssectional study and divided in to 2 main groups, i.e., Group A (eclamptic/preeclamptic) Group B (control) pregnant women respectively. Serum visfatin levels (ng/mL), serum electrolytes and liver enzymes were determined for every patient, using relative diagnostic kits. Anthropometric measurements were also noted. RESULTS: A total of 234 women (cases; n=160, controls; n=74) with gestation age of ≥20 weeks participated in this study. Group A had 86 (36.75%) women with preeclampsia and 74 (31.62%) women with eclampsia whereas Group B had 74 (31.62%) normotensive pregnant women. A strong significantly positive association was recorded for systolic (R2=78.78; p-value <0.000) and diastolic blood pressure (BP) (R2=78.52; p-value <0.000). Similar result was obtained for serum sodium ions (R2=3.09; p-value <0.002) and chloride ions (R2=7.36; p-value <0.000). Alkaline phosphatases (ALP) (R2=63.47; p-value <0.000) had also shown a strong positive and statistically significant association with visfatin levels. CONCLUSIONS: Serum visfatin significantly decreased the sodium and chloride levels whereas the levels of potassium remained unaffected. A very strong and positive association of visfatin levels with levels of bilirubin and alkaline phosphatases was also observed (ALP) but it found no effect on aspartate transferases (AST).


Assuntos
Citocinas/sangue , Eclampsia , Nicotinamida Fosforribosiltransferase/sangue , Pré-Eclâmpsia , Estudos de Casos e Controles , Cloretos , Feminino , Humanos , Fígado , Monoéster Fosfórico Hidrolases , Pré-Eclâmpsia/diagnóstico , Gravidez , Gestantes , Sódio
20.
Medicine (Baltimore) ; 101(13): e29130, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35421066

RESUMO

ABSTRACT: To study the relationship between miR-148a and preeclampsia (PE), and clarify that miR-148a can regulate the endoplasmic reticulum stress (ERS) of placental trophoblasts by targeting the ERS protein X box binding protein 1 (XBP1).Fifty patients with hypertension during pregnancy, patients with mild PE, patients with severe PE, and normal pregnant women were selected, and their placental tissues were collected. RT-polymerase chain reaction was used to detect the expression of miR-148a in placental tissues, and Western blot was used to detect XBP1 in placental tissues. Compare the expression differences of miR-148a and XBP1 in each group, and analyze the correlation between the expressions of the two.Compared with the Neg-miR group, MTT experiment result in pre-miR-148a group was decreased. MTT experiment result in anti-miR-148a group was increased. Cell cycle test result in pre-miR-148a group [G1 (%)] was increased. Cell cycle test result in anti-miR-148a group [S (%)] was increased. Apoptosis test result in pre-miR-148a group [early apoptotic cells (%), late apoptotic cells (%)] was increased. Apoptosis test result in anti-miR-148a group [early apoptotic cells (%), late apoptotic cells (%)] was decreased. XBP1 expression result in pre-miR-148a group was increased. XBP1 expression result in anti-miR-148a group was decreased. Compared with the normal population, XBP1 is expressed in hypertension, mild eclampsia, severe eclampsia increased. GRP78, CHOP, and caspase-12 expression result in pre-miR-148a group was increased. GRP78, CHOP, and caspase-12 expression result in anti-miR-148a group was decreased.miR-148a can regulate the ERS-mediated apoptosis by targeting XBP1, thereby intervening in the occurrence and development of PE.


Assuntos
Eclampsia , Hipertensão , MicroRNAs , Pré-Eclâmpsia , Antagomirs/metabolismo , Apoptose/genética , Caspase 12/metabolismo , Movimento Celular , Estresse do Retículo Endoplasmático/genética , Feminino , Humanos , Hipertensão/metabolismo , MicroRNAs/genética , MicroRNAs/metabolismo , Placenta/metabolismo , Pré-Eclâmpsia/genética , Pré-Eclâmpsia/metabolismo , Gravidez , Trofoblastos/metabolismo , Proteína 1 de Ligação a X-Box/genética , Proteína 1 de Ligação a X-Box/metabolismo
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