Endothelial microparticles and the antiangiogenic state in preeclampsia and the postpartum period.

OBJECTIVE: We sought to determine if endothelial microparticles (EMPs), markers of endothelial damage, are associated with soluble fms-like tyrosine kinase 1 (sFlt1), soluble endoglin, and placental growth factor (PlGF) in women with preeclampsia. STUDY DESIGN: A prospective cohort study was conducted on 20 preeclamptic women and 20 controls. EMPs by flow cytometry, sFlt1, soluble endoglin, and PlGF were measured at time of enrollment, 48-hours postpartum, and 1-week postpartum. RESULTS: Preeclamptic CD31(+)/42(-), CD62E(+), and CD105(+) EMP levels were significantly elevated in preeclamptics vs controls at time of enrollment. The sFlt1:PlGF ratio was correlated with CD31(+)/42(-) and CD105(+) EMPs (r = 0.69 and r = 0.51, respectively) in preeclampsia. Levels of CD31(+)/42(-) EMPs remained elevated 1-week postpartum (P = .026). CONCLUSION: EMPs are elevated in preeclampsia. The correlation of EMPs and the sFlt1:PlGF ratio suggests that antiangiogenesis is related to apoptosis of the endothelia. Endothelial damage persists 1 week after delivery.

Clinical significance of borderline amniotic fluid index and oligohydramnios in preterm pregnancy.

OBJECTIVE: To estimate pregnancy and neonatal outcomes in women with decreased amniotic fluid index (AFI) between 24 and 34 weeks of gestation, compared with outcomes in those with normal AFI. METHODS: This is a review of singleton pregnancies that received ultrasound examinations at 24-34 weeks from 1997 to 2008. If more than one ultrasound examination was performed, the lowest AFI was used for analysis. An AFI 5 cm or less was considered oligohydramnios, 5-8 cm was considered borderline, and more than 8 cm to 24 cm was considered normal. Women with hydramnios or ruptured membranes at time of ultrasound examination were excluded. RESULTS: A total of 28,555 pregnancies met inclusion criteria. Ultrasound examination had been performed to estimate gestational age or evaluate fetal growth in 78%. Major malformations were more common in pregnancies with oligohydramnios and borderline AFI than in those with normal fluid-25%, 10%, and 2%, respectively, P<.001. Among nonanomalous fetuses, complications that occurred more often in pregnancies with oligohydramnios and borderline AFI than in those with normal fluid included preterm birth (62%, 37%, 8%), either indicated (20%, 13%, 2%) or resulting from spontaneous preterm labor (42%, 24%, 6%); cesarean delivery for nonreassuring fetal status (9%, 9%, 4%), and birth weight below the third percentile (37%, 21%, 4%), all P<.001. CONCLUSION: Pregnancies with decreased AFI between 24 and 34 weeks, including borderline AFI as well as oligohydramnios, were significantly more likely to be associated with major fetal malformations, and in the absence of malformations, to be complicated by fetal growth restriction and preterm birth. LEVEL OF EVIDENCE: II.