Maternal soluble human leukocyte antigen-G levels in pregnancies complicated by foetal intrauterine growth restriction with and without preeclampsia

ObjectiveThe aim of this study was to investigate the maternal serum of soluble human leukocyte antigen-G (sHLA-G) levels in pregnant women with an isolated intrauterine growth restricted foetus (IUGR) and in preeclamptic pregnancies with and without IUGR.Patients and methodsThe study was conducted on 31 normotensive patients with pregnancy complicated by IUGR, 17 preeclamptic patients with appropriate-for-gestational-age foetal intrauterine growth, 21 with preeclampsia complicated by IUGR, and 32 healthy pregnant controls. Maternal serum sHLA-G levels were calculated using the enzyme-linked immunosorbent assay.ResultsMaternal serum sHLA-G levels tended to be higher in both groups of preeclamptic patients, and were highest in patients with IUGR in the course of severe preeclampsia. Lower serum levels of sHLA-G were observed in the group of normotensive pregnant women with an intrauterine growth restricted foetus, but these differences were not statistically significant. The mean values were 22.759 ± 14.151 units/mL in the IUGR group, 25.948 ± 18.888 units/mL in preeclamptic patients with normal intrauterine foetal growth, 31.646 ± 27.576 units/mL in preeclamptic pregnant women with IUGR, and 24.178 ± 24.828 units/mL in the healthy controls.ConclusionsOur findings suggest that the increased levels of sHLA-G in the maternal serum may play a significant role in the pathogenesis of preeclampsia, especially in preeclampsia complicated by intrauterine foetal growth restriction. These associations may offer a better insight into the etiology and pathogenesis of preeclampsia with and without IUGR. It seems that sHLA-G does not play a clinically significant role in the pathogenesis of isolated intrauterine foetal growth restriction in normotensive pregnancies.     

Serum S100B in pregnancy complicated by preeclampsia: A case-control study

BackgroundSerum S100B is a protein produced and released primarily by astrocytes of the Central Nervous System (CNS). Elevated levels of serum S100B are associated with several types of pathological conditions of the brain, including the eclampsia in pregnant women. The aim of this study was to compare serum S100B concentrations in pregnant women with severe and mild preeclampsia (PE) with S100B serum levels in normotensive pregnant women.Material and methodsSerum S100B protein was measured in normotensive pregnant women (n = 15) and in women with mild PE (n = 12) or severe PE (n = 34). The serum S100B level (μg/L) was determined by an luminometric assay.ResultsSixty-one expectant mothers were studied, aged 26.6 ± 8.7 (mean ± SD) years and with a gestational age of 33.3 ± 4.2 weeks. The severe PE group demonstrated higher S100B levels (0.20 ± 0.19), as compared with mild PE (0.07 ± 0.05) or normotensive groups (0.04 ± 0.05).ConclusionElevated serum S100B levels in pregnant women with severe PE suggest that some kind of neural damage and subsequent astrocytic release of S100B is not dependent on the progression from severe preeclampsia to eclampsia.     

Interleukin-18 concentrations in pregnancies complicated by preeclampsia with and without IUGR: A comparison with normotensive pregnant women with isolated IUGR and healthy pregnant women

ObjectiveThe aim of present study was to assess the maternal serum levels and clinical significance of interleukin-18 (IL-18) in pregnancies complicated by preeclampsia and/or intrauterine growth restriction (IUGR).Patients and methodsThe study was carried out on 30 patients with pregnancy complicated by severe preeclampsia (15 patients with IUGR and 15 with appropriate-for-gestational-age weight fetuses), 11 normotensive pregnant patients with pregnancy complicated by isolated IUGR and 32 healthy normotensive women with uncomplicated pregnancies. The interleukin-18 levels were determined using an ELISA assay.ResultsDecreased levels of maternal serum IL-18 in preeclamptic patients with and without IUGR were observed. Contrary to the preeclamptic women, no difference was found in the maternal serum levels of IL-18 in normotensive patients with pregnancies complicated by isolated fetal growth restriction. These levels were the same as observed in the healthy controls. The mean values of maternal serum IL-18 were 219.118 ± 180.079 pg/mL in the PRE group, 438.170 ± 229.657 pg/mL in the group of women with isolated IUGR, and 457.053 ± 528.142 pg/mL in the control group. The levels of maternal serum IL-18 were similar in both study preeclamptic subgroups. The mean values of IL-18 were 204.823 ± 188.171 pg/mL in the group PI and 233.414 ± 176.995 pg/mL in the P group.ConclusionsOur findings suggest that decreased levels of IL-18 in maternal serum play a significant role in etiology and pathogenesis of preeclampsia. But normotensive pregnancies complicated by isolated IUGR are not associated with the altered interleukin 18 levels in maternal serum.     

How accurate are placental growth factor,urate, lactate dehydrogenase and proteinuria in diagnosing preeclampsia and its severity?

ObjectiveThe objective was to assess the diagnostic accuracy of serum and urinary placental growth factor (sPlGF and uPlGF, respectively), urate, lactate dehydrogenase (LDH), and proteinuria for diagnosing and differentiating between women with preeclampsia and women with a normal healthy pregnancy, gestational hypertension, and gestational proteinuria.Study designUrine and blood samples were taken from pregnant women diagnosed with late-onset severe preeclampsia (30 patients), mild preeclampsia (30 patients), gestational hypertension without meeting the criteria for preeclampsia (30 patients), gestational proteinuria without meeting the criteria for preeclampsia (30 patients), and healthy pregnant control women (30 patients). A receiver operating characteristic (ROC) curves analysis was performed to evaluate the diagnostic accuracy and to select the optimal cutoff points for different markers.ResultssPlGF is the best test for differentiating women with severe preeclampsia from women in all of the other groups (p = 0.001). However, there was no significant difference between sPlGF and proteinuria in the 24-h urine collection (p = 0.329) in this differentiation. uPlGF can be used to differentiate women with severe preeclampsia from women in all of the other groups. However, proteinuria in the 24-h urine collection is better than uPlGF for this differentiation (p = 0.013).ConclusionsPlGF and uPlGF can be used to diagnose women with severe preeclampsia and should be considered at least as important as proteinuria in the diagnosis of preeclampsia. A large study that considers the cost-effectiveness of adding these markers to the diagnosis of preeclampsia should be conducted before our recommendation is applied.     

Is there any relationship between ABO/Rh blood group and patients with pre-eclampsia?

ObjectivesThe purpose of the present study was to evaluate the association between pre-eclampsia and blood groups in a group of pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil – Hospital São Lucas (HSL)/PUCRS.Study designOur sample consisted of 10,040 pregnant women admitted to the maternity department of HSL between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Medical records of 414 women were diagnosed as preeclampsia/eclampsia and 9611 women were identified to the control group. The patients were divided into two groups: the group with preeclampsia/eclampsia and the control group, and their blood groups were considered. Data were analyzed using SPSS for Windows version 17.0. Categorical data were summarized by counts and percentages, with the statistical significance evaluated by the Chi-square test. The null hypothesis was rejected when p < 0.05.Main outcome measuresMaternal parameters were compared between control group and pre-eclampsia, respectively, Systolic Blood Pressure (117 ± 19.98 vs. 165 ± 19.99); Diastolic Blood Pressure (73 ± 14.23 vs. 106 ± 14.24) and maternal weight at booking (73 ± 33 vs. 83 ± 33). For all data: mean + SD; p < 0.05. In relation to blood groups, firstly they were stratified by Rh and ABO phenotypes, separately. After that the groups were put together.ResultsNo differences in blood group distribution were observed between controls and pre-eclampsia for any analysis. (p > 0.05).ConclusionsWhen we adopted stricter criteria for pre-eclampsia and a large sample from the same region we noted that the results did not show any association between blood groups and the development of pre-eclampsia.     

Uric Acid as a Predictor of Adverse Maternal and Perinatal Outcomes in Women Hospitalized With Preeclampsia

ObjectiveElevated serum uric acid is commonly observed in women with preeclampsia, but its utility in predicting adverse outcomes has recently been disputed. Our goal was to analyze data from a large cohort of women with preeclampsia to determine the utility of serum uric acid in predicting adverse maternal and perinatal outcomes.MethodsData were obtained from an ongoing international prospective study of women admitted to hospital with preeclampsia (Pre-eclampsia Integrated Estimate of RiSk). Univariate logistic regression was used to determine the relationship between serum uric acid concentration (both absolute and gestational-age corrected [Z score]) and adverse outcomes (maternal and perinatal). Analyses were conducted to compare cohorts of women with preeclampsia as defined by hypertension and proteinuria versus hypertension and hyperuricemia.ResultsUric acid Z score was associated with adverse perinatal outcome (OR 1.5; 95% CI 1.4 to 1.7) and had a point estimate > 0.7 (area under the curve receiver operating characteristic 0.72; 95% CI 0.69 to 0.74). Serum uric acid concentration also showed a significant association with adverse maternal outcomes, but the point estimate was < 0.7. No significant differences were observed between groups in which preeclampsia was defined by hypertension and proteinuria and by hypertension and hyperuricemia.ConclusionIn women admitted to hospital with preeclampsia, the serum uric acid concentration, corrected for gestational age via a Z score, is clinically useful in predicting adverse perinatal outcomes but not maternal outcomes.     

Spot urine protein–creatinine ratio and 24-h urine protein excretion: Diagnostic accuracy in women with pre-eclampsia

ObjectiveTo compare the efficacy of spot urinary protein/creatinine ratio with 24 h urinary protein excretion in women with pre-eclampsia.MethodsA total of 85 women with hypertensive disorders during pregnancy were prospectively studied. Urine protein/creatinine ratio in spot urine sample was compared with 24 h urinary protein. Sensitivity and specificity for urinary spot P/C (protein/creatinine) ratio was assessed, and receiver operating curve was used to determine the value against the gold standard of >300 mg proteinuria in 24 h urinary sample.ResultsOf 85 women, complete data were available for 81 women. There was a strong correlation between spot urinary P/C ratio and 24 h urine protein excretion (r = 0.81, P value <0.000). The optimal spot P/C ratio cut-off point was 0.14 for 300 mg/24 h of protein excretion (preeclampsia) with a sensitivity of 82% and specificity of 79%.ConclusionWe found a strong correlation between spot urinary P/C and 24 h urinary protein. Spot urinary protein/creatinine ratio is a good predictor of proteinuria for pre-eclampsia.     

Comparison of maternal serum levels of interleukin-10, interleukin-12, and interleukin-2 in normal and preeclamptic pregnancies

ObjectiveThe aim of this study was 2 fold: (1) to compare the maternal serum levels of IL-10, IL-12, and IL-2 in preeclamptic and normal pregnant women, and (2) to study the serum levels of these cytokines in preeclamptic pregnancies with and without intrauterine growth retardation.Study designForty women with singleton pregnancies complicated by preeclampsia (32 severe and 8 mild) and 29 normotensive healthy pregnant women were included in the study. Preeclamptic patients were further divided into 2 groups according to the presence or absence of intrauterine growth retardation. Maternal serum levels of IL-10, IL 12, and IL-2 were compared between these groups using enzyme-linked immunosorbent assays.ResultsMaternal serum levels of IL-10 were significantly higher in the preeclampsia group than in controls (p < 0.001). There were no statistically significant differences in maternal serum concentrations of IL-2 and IL-10 between the study and control groups (p > 0.05). Serum levels of IL-2 and IL-10 in the patients with preeclampsia complicated by IUGR were elevated in comparison with the uncomplicated preeclampsia group. These differences were statistically significant (p < 0.05 for both).ConclusionsIL-10 may be involved in the pathologic process of preeclampsia. Increased serum levels of IL-10 and IL-2 in preeclampsia complicated with IUGR suggests a possible role of these cytokines in IUGR.     

The effect of folic acid supplementation on serum homocysteine of egyptian post menopausal women: A randomized controlled trial

ObjectiveTo evaluate the effect of folic acid supplementation on serum homocysteine (HCY) level in Egyptian post-menopausal women.Patients and methodsThe current randomized controlled trial was conducted at the Ain Shams University Maternity Hospital, Cairo, Egypt. 100 included women were divided into three groups: group C; 20 premenopausal women while the rest 80 women were postmenopausal (who were randomly divided into two groups; group A who received 5 mg folic acid for 6 weeks and group B who received placebo). Blood samples were collected from 100 women. Other samples were collected from 80 women (postmenopausal) 6 weeks after treatment. Serum was analyzed for HCY.ResultsSerum HCY was significantly higher in postmenopausal than premenopausal women (14.7 ± 6.4 μmol/L versus 6.3 ± 1.4 μmol/L, in group A and group C, respectively) and (15.3 ± 5.4 μmol/L versus 6.3 ± 1.4 μmol/L, in group B and group C, respectively).HCY was significantly reduced in postmenopausal women after receiving folic acid (14.7 ± 6.4 μmol/L versus 12.4 ± 6.4 μmol/L, before and after treatment, respectively), while there was a decrease in serum HCY level of postmenopausal women after receiving placebo but not to reach a statistical significant level (15.3 ± 5.4 μmol/L versus 14.9 ± 7.6 μmol/L, before and after placebo, respectively). There was a statistical significant reduction in serum HCY in group A after receiving 5 mg folic acid compared to group B after receiving placebo (12.4 ± 6.4 μmol/L versus 14.9 ± 7.6 μmol/L, respectively).ConclusionSerum HCY level was significantly higher in Egyptian postmenopausal than premenopausal women. Postmenopausal Folic acid supplementation seems to reduce serum HCY, but not to premenopausal level.     

Evaluation of the value of the first and third trimester maternal mean platelet volume (MPV) for prediction of pre-eclampsia

IntroductionPre-eclampsia is one of the most serious complications of pregnancy and one of the major causes of maternal mortality. Thus its prediction is a matter for serious concern.ObjectiveThe purpose of the present study is to determine the value of mean platelet volume (MPV) measurement in the first and third trimesters of pregnancy for the prediction of pre-eclampsia.MethodA prospective nested case–control study was performed on pregnant women who were at 9–12 weeks of pregnancy. In the first trimester and again in 26–28 weeks, MPV was calculated. All eligible women were then monitored to delivery and the MPV of women who were pre-eclamptic was compared with the MPV of normotensive women.ResultsPre-eclamptic women were compared with 269 normotensive women. MPV at the first trimester of pre-eclamptic women was significantly higher than normotensive women (10.2 ± 1.06 fl VS 9.68 ± 1.09 fl, P = 0.008). Also, MPV at the third trimester of pregnancy of pre-eclamptic women was more than normotensives (10.16 ± 1.23 fl VS 9.62 ± 1.12 fl, P = 0.009).Area under the curve in receiver operating characteristics (ROC) curve was calculated as 0.64 for the predictive value of MPV at the first and third trimesters of pregnancy, which showed a low value of this test for predicting of pre-eclampsia.ConclusionMPV at the first and third trimesters of pregnancy are higher in women who eventually would be pre-eclamptic, but has low predictive value and is not a good predictor of pre-eclampsia.     

Cardiovascular risk markers in pregnancies complicated by diabetes mellitus or preeclampsia

ObjectiveTo explore biomarkers indicating cardiovascular disease in pregnant women with diabetes or preeclampsia, since these women are at increased risk for future cardiovascular disease.Study designEDTA-plasma from 262 women in gestational week 24–42 (healthy pregnancies n = 71, preeclampsia n = 105, type 2 diabetes n = 17, gestational diabetes n = 61, diabetes with preeclampsia n = 8) was analyzed by immunoassay for neopterin, midregional pro-adrenomedullin (MR-proADM) and C-terminal pro-arginine vasopressin (CT-proAVP). The diabetes groups were also analyzed for midregional pro-atrial natriuretic peptide (MR-proANP), and compared to previously reported MR-proANP concentrations for healthy, normotensive and preeclamptic patients.ResultsIn contrast to preeclampsia, median plasma MR-proANP was not increased in pregnancies complicated by diabetes, but in fact lower, compared to healthy pregnancies. Neopterin was increased in diabetic pregnancies and in late onset preeclampsia, compared to healthy pregnancies. Median plasma MR-proADM was increased in pregnancies complicated by gestational diabetes or preeclampsia, compared to healthy pregnancies. Median plasma MR-proANP was increased in diabetic pregnancies complicated by preeclampsia compared to pregnant women with diabetes only.ConclusionWomen with pregnancies complicated by diabetes mellitus or preeclampsia are at risk for future cardiovascular disease, but differ in circulating cardiovascular biomarker profile. A cardiovascular biomarker profiling during pregnancy might prove helpful in identifying women at risk for future cardiovascular disease, thus enabling targeted prophylactic interventions and follow-up.     

The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP)

ObjectiveThere is discrepancy in the literature on the definitions of severe and early-onset pre-eclampsia. We aimed to determine those definitions for clinical purposes and to introduce them in the classification of the hypertensive disorders of pregnancy for publication purposes.MethodsWe circulated a questionnaire to the International Committee of the International Society for the Study of Hypertension in Pregnancy focusing on the thresholds for defining severe preeclampsia and the gestation at which to define early-onset preeclampsia, and on the definition and inclusion of the HELLP syndrome or other clinical features in severe preeclampsia. The questions were closed, but all answers had space for more open detailed comments.ResultsThere was a general agreement to define preeclampsia as severe if blood pressure was >160 mmHg systolic or 110 mmHg diastolic. There was scarce agreement on the amount of proteinuria to define severity. The HELLP syndrome was considered a feature to include in the severe classification. Most investigators considered early-onset preeclampsia as that occurring before 34 weeks.ConclusionsA definition of pre-eclampsia is paramount for driving good clinical practice. Classifications on the other hand are useful to enable international comparisons of clinical data and outcomes. We used the results of this survey to update our previous classification for the purposes of providing clinical research definitions of severe and early onset pre-eclampsia that will hopefully be accepted in the international literature.     

Circulating endothelial progenitor cells and placental abruption in women with preeclampsia

ObjectiveAbnormalities in circulating angiogenic factors and endothelial progenitor cells (EPCs) have been reported in patients with preeclampsia and placental abruption. The objective of this study was to determine whether the number of EPCs is altered in patients with placental abruption.DesignA case control study.SettingHiroshima University Hospital in Japan.SamplePregnant Japanese women with preeclampsia (n = 27) and those without any complications (n = 15).MethodThe EPC (CD45^lowCD34⁺CD133⁺ cells) counts were examined using flow cytometry in peripheral blood collected from 27 women with preeclampsia and 15 normal pregnant women. Among the 27 women with preeclampsia, five subsequently developed placental abruption. All subjects were divided into three groups: normal pregnancy (NP, n = 15), preeclampsia without placenta abruption (PE, n = 22) and preeclampsia with placental abruption (PA, n = 5).Main outcome measuresThe EPC counts were measured in pregnant women with preeclampsia who subsequently developed placental abruption.ResultsThe EPC count in the PE group significantly decreased in comparison to that observed in the NP group (620 cells/ml versus 1918 cells/ml, P < 0.01). In the PA group, the EPC count was found to markedly decrease in comparison to that observed in the PE group (221 cells/ml, P < 0.05).ConclusionsThe number of EPCs was found to significantly decrease in preeclamptic women who subsequently developed placental abruption.     

Intérêt du dosage des d-dimères comme marqueurs de sévérité en cas de prééclampsie

ObjectivesAlterations in blood coagulation and fibrinolysis play a major role in the pathogenesis of preeclampsia. HELLP syndrome is associated with hypercoagulability and leads to maternal and perinatal complications. Our purpose was to evaluate d-dimer as a marker for severity in pregnancies with preeclampsia.Patients and methodsPlasma d-dimer levels were measured using an enzyme-linked immunosorbent assay (ELISA) technique. We studied the association between d-dimer levels and clinical and biological characteristics of pregnancies complicated by preeclampsia.Resultsd-dimer values increased with increasing gestational age. Patients with HELLP syndrome had mean d-dimer values significantly greater than patients with preeclampsia alone (3848 ± 2551 versus 1578 ± 1077, P < 0.001). However, the level of d-dimer at the time of admission was poorly predictive of occurrence of HELLP syndrome. Area under of the ROC curve was 0.69 (CI 95%: 0,59–0,79). The best threshold was 2170 ng/mL with a sensitivity of 0.91 and a specificity of 0.40. Other severity criteria of preeclampsia were not associated with higher levels of d-dimer.Discussion and conclusionIn preeclamptic patients, d-dimer levels were related with gestational age and HELLP syndrome. However, accuracy of this test to predict occurrence of HELLP syndrome or severe preeclampsia was too low to recommend its use routinely.     

Placental Release of Distinct DNA-associated Micro-particles into Maternal Circulation: Reflective of Gestation Time and Preeclampsia

BackgroundThe aim of this study was to determine whether DNA-associated micro-particles (MPs) in maternal plasma express fetal-derived human leukocyte antigen-G (HLA-G) or placental alkaline phosphatase (PLAP) and whether the levels differ between women with normotensive pregnancies and preeclampsia.MethodsDNA-associated MPs expressing HLA-G or PLAP were examined in the plasma of normal pregnant women and preeclamptic patients using flow cytometric analysis.ResultsDNA-associated HLA-G⁺ MPs were significantly increased in maternal plasma compared to plasma from non-pregnant controls (p < 0.005), with highest levels found in the first and second trimesters. DNA-associated PLAP⁺ MPs were also increased in maternal plasma compared to plasma from non-pregnant controls (p < 0.006), with highest levels in the second and third trimesters. Term preeclamptic women had higher levels of DNA-associated MPs than control pregnant women. HLA-G⁺ MPs from the plasma of preeclamptic women had more DNA per MP than HLA-G⁺ MPs from the plasma of normal pregnant women (p < 0.03).ConclusionsHLA-G⁺ and PLAP⁺ MPs increase in maternal circulation at different times during gestation. DNA amounts per HLA-G⁺ MP increase in preeclamptic women which might indicate dysfunctional extravillous cytotrophoblasts.     

The Pulmonary Edema Preeclampsia Evaluation (PEPE) Study

BackgroundWomen with preeclampsia may develop pulmonary edema, but the reasons for this are largely unknown.MethodsWe performed a case–control study of women with preeclampsia at two major obstetrical centres in Toronto, ON, between 2005 and 2012. Cases (n = 28) were women with preeclampsia who had pulmonary edema on a chest CT or plain X-ray during the index delivery hospitalization. Control subjects (n = 64) were those with preeclampsia but no diagnosis of pulmonary edema or heart failure in the index hospitalization for delivery. Study variables were abstracted from each woman’s paper chart and electronic medical record. Multivariable logistic regression with backward elimination was used to select a final set of significant predictors.ResultsApproximately one half of the cases of pulmonary edema occurred antepartum. Each 10 × 10⁹/L reduction in platelet count (OR 1.32; 95% CI 1.06 to 1.65) or 10 μmol/ L increase in peak serum uric acid concentration (OR 1.19; 95% CI 1.06 to 1.34) was significantly associated with pulmonary edema, as was receiving magnesium sulphate (OR 10.42; 95% CI 1.39 to 78.22). Multiparity (OR 0.03; 95% CI 0.004 to 0.29) and each 500 mL increase in the volume of intravenous crystalloids received (OR 0.60; 95% CI 0.37 to 0.98) were associated with a lower risk of pulmonary edema.ConclusionWe identified several preliminary risk factors for pulmonary edema in women with preeclampsia. Additional work is needed to better understand the role of these and other factors predicting the development of pulmonary edema in women with preeclampsia.     

Calcium-to-creatinine ratio in pregnancy-induced hypertension

ObjectivesHypocalciuria has been correlated with preeclampsia. This study compared the calcium-to-creatinine ratio among the groups, and the correlation with the 24-h measurement of this ratio and a diagnosis of preeclampsia.Study designCase-control study including mild and severe preeclampsia, chronic hypertension and normal pregnancy.Main outcome measurementsThe calcium-to-creatinine ratio differentiates severe preeclampsia from mild preeclampsia, chronic hypertension and normal pregnancy.ResultsThere were statistically significant differences between the groups when comparing severe preeclampsia and chronic hypertension, severe preeclampsia and normal pregnancy, and mild and severe preeclampsia (p < 0.0001). The Spearman index between the calcium-to-creatinine ratio and 24-h calciuria was 0.65 (high correlation).ConclusionsThe calcium-to-creatinine ratio can reliably estimate 24-h calciuria, differentiating severe preeclampsia from mild preeclampsia, chronic hypertension and normal pregnancy.     

Macular thickness measured by optical coherence tomography correlates with proteinuria in pre-eclampsia

ObjectivesPre-eclampsia is associated with ocular changes. The aim of this study was to examine the macular changes of patients with early-onset severe pre-eclampsia using optical coherence tomography (OCT).MethodsThis prospective study was performed at Tygerberg Academic Hospital, a secondary and tertiary referral centre in Cape Town, South Africa. Twenty women with early onset pre-eclampsia and 20 women without hypertensive or vascular complications, matched for gestational age, were examined before and after delivery.ResultsThere was a trend showing a positive correlation between increased central retinal thickness and increasing proteinuria in patients with pre-eclampsia antepartum (left eye r = 0.52, p = 0.04) and postpartum (left eye r = 0.60, p = 0.01). A positive correlation between average central 1 mm and proteinuria was noted antepartum (left eye r = 0.63, p = 0.01) and postpartum (right eye r = 0.52, p = 0.03). There were no significant correlations between blood pressure and any of the retinal parameters. Two of the 23 patients with pre-eclampsia developed serous retinal detachments, both of which resolved completely postpartum.ConclusionsMacular thickness parameters measured using OCT correlated with the degree of proteinuria in pre-eclampsia. These changes reversed soon after delivery.     

Placental angiogenin inhibitor (ribonuclease inhibitor), a novel gene in pre-eclampsia

There is convincing evidence that imbalance between angiogenic and anti-angiogenic factors play an important role in the pathophysiology of pre-eclampsia. Angiogenin, a member of the RNase A super family, is a potent inducer of angiogenesis and serum levels are shown to be elevated in pre-eclampsia. We hypothesize that placental expression of angiogenin inhibitor which binds and blocks the activity of angiogenin is altered in pre-eclampsia and may play a role in its pathophysiology.Placental expression of angiogenin inhibitor was measured in term placentae of 15 women with preeclampsia and 16 normal pregnant controls. The women were matched for age, parity and gestational age. Placental tissue was collected immediately after delivery and stored at ?80°C until studied. Angiogenin inhibitor gene expression was measured using real-time quantitative polymerase chain reaction (rt-QPCR). The results were standardized using the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as reference gene.The mRNA expression of angiogenin inhibitor gene was significantly increased in preeclamptic placentae compared to normal pregnant controls [0.44 (0.174–1.048) versus 0.091 (0.029–0.301), median and interquatile range, p = 0.027 for pre-eclampsia and normal controls respectively]. There was no correlation between angiogenin inhibitor gene expression and maternal age, blood pressure, platelet count, gestation age, birth weight of the baby in pre-eclampsia and normal pregnancy.This study showed that placental expression of the angiogenin inhibitor gene is significantly increased in pre-eclampsia and may play a role in its pathophysiology.     

Expectant management in pregnant women with early and severe preeclampsia and concomitant risk factors

AimThe aim of this study was to demonstrate that women with severe early-onset preeclampsia and concomitant risk factors benefit from expectant management.MethodsThis retrospective study was conducted between January 2009 and December 2010. Stable women with severe preeclampsia between 23 + 6 and 33 + 6 weeks of gestation were admitted to the IOCU for conservative management. They were classified into two groups: those with concomitant risk factors, i.e. associated medical conditions, HELLP syndrome, severe oligohydramnios, fetal growth restriction and multiple pregnancies (group A) and those without (group B). P values lesser than 0.05 were considered statistically significant.ResultsNo significant differences were found in maternal and perinatal outcomes between groups. Neither were differences observed in pregnancy prolongation (mean: 8.42 days (SD ± 7.462) in group A and 10.5 days (SD ± 8.235) in group B (p = 0.391)). At the start of expectant management, 31.8% of fetuses had an abnormal middle cerebral artery Doppler; prior to delivery, this percentage was 77.4%.ConclusionPregnant women with severe early-onset preeclampsia and associated risk factors benefited from expectant management. During expectant management using a continuous magnesium sulfate regimen, the majority of fetuses showed cerebral vasodilatation. The exact clinical value of this finding should be clarified in further studies