Evaluating the predictive value of fetal Doppler indices and neonatal outcome in late-onset preeclampsia with severe features: a cross-sectional study in a resource-limited setting.

BACKGROUND: Preeclampsia constitutes a major health problem with substantial maternal and perinatal morbidity and mortality. The aim of this study was to detect the diagnostic efficacy of fetal Doppler in predicting adverse outcomes in severe late onset preeclampsia (LOP). METHODS: A prospective study was conducted among childbearing women who presented with severe LOP and matched controls. Umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) and cerebroplacental ratio (CPR) were measured. RESULTS: All UA indices were significantly higher in the case group compared to the controls (p < 0.001). UA PI and RI were significantly correlated with all neonatal adverse outcomes except cord pH status (p < 0.05). Abnormal CPR was the most sensitive index that positively correlated with intrauterine growth retardation (IUGR), low 5- minute Apgar score and neonatal intensive care unit admission (79, 72.8 and 73.3%, respectively). In the same context, Abnormal UA PI and RI represented the most specific tool for predicting IUGR, low 1- and 5- minutes Apgar score with positive predictive values were 52, 87 and 57%, respectively. CONCLUSION: In severe LOP, UA Doppler remains the preferential indicator for adverse birth outcomes with CPR is the best index that could be solely used for predicting such outcome.

Exercise-heat acclimation in young and older trained cyclists.

OBJECTIVES: The purpose of this study was to investigate the effect of age on the capacity to acclimatise to exercise-heat stress. This study hypothesised that age would not affect body temperature and heat loss effector responses to short-term exercise-heat acclimation in trained subjects. DESIGN: Seven young subjects (19-32 years) were matched with 7 older subjects (50-63 years). Subjects were highly trained but not specifically heat acclimated when they exercised for 60 min at 70%VO2max in hot-dry (35 °C, 40%RH) and thermoneutral (20 °C, 40%RH) conditions, pre and post 6 days of exercise-heat acclimation (70%VO2max, 35 °C, 40%RH). METHODS: Rectal temperature (Tr), skin temperature (Tsk), heart rate (HR), cutaneous vascular conductance (CVC) and whole body sweat loss (Msw) were measured during each testing session and Tr and HR were measured during each acclimation session. RESULTS: Tr, Tsk, %HRmax, CVC and Msw were similar across age groups both pre and post heat acclimation. Following heat acclimation relative decreases and increases in Tr and Msw, respectively, were similar in both subject groups. There was a significant reduction in heart rate (%HRmax) and increase in final CVC following the acclimation programme in the young group (all p < 0.05) but not the older group. CONCLUSIONS: When comparing young and older well trained adults we found age affected the cardiovascular adaptation but not body temperature or whole body sweat loss to exercise-heat acclimation. These data suggest age does not affect the capacity to acclimatise to exercise-heat stress in highly trained adults undergoing short-term heat acclimation.