Pregnancies in women with uterine malformation, treated obstruction of hemivagina and ipsilateral renal agenesis

Purpose

The aim of this study was to evaluate the outcome of pregnancies in women who had uterine malformation and surgically treated obstructed hemivagina with ipsilateral renal agenesis.

Methods

The study group comprised 21 women with malformed uterus (12 didelphic, 6 septate and 3 bicornuate uterus). All of them had a history of surgical excision of the longitudinal vaginal septum caused obstructed hemivagina and ipsilateral renal agenesis. All pregnancies and possible surgical interventions were evaluated during the follow-up period (median 13.2 years).

Results

Thirteen out of 21 women attempting pregnancy conceived. They produced 22 pregnancies, 17 (77 %) were contralateral to the treated obstructed hemivagina and unilateral renal agenesis. The median interval between surgical treatment of obstructed hemivagina and the first pregnancy was 10.5 years. Twenty (91 %) pregnancies ended in delivery of a living infant. Preeclampsia (14 %), preterm delivery (36 %), high frequency (38 %) of fetal breech presentation and the cesarean section rate (67 %) were found.

Conclusions

Accurate diagnosis and appropriate surgery to open an obstructed hemivagina in adolescence assure fertility. Preterm birth is associated with malformed uterus and unilateral renal agenesis may predispose to preeclampsia.     

Renal disease in women with severe preeclampsia or gestational proteinuria

OBJECTIVE: To identify women with severe preeclampsia or severe gestational proteinuria at high risk of having underlying renal disease. METHODS: Between 1980 and 1999, 86 Japanese women who had severe hypertension, severe proteinuria, or both during pregnancy had postpartum needle biopsies of their kidneys. Diagnoses before biopsies were severe preeclampsia in 74 women and severe gestational proteinuria in 12. We compared clinical characteristics, such as antepartum hematuria and postpartum proteinuria, and maternal and neonatal outcomes with regard to presence of renal disease. RESULTS: Nineteen of 86 women (22.1%, 95% confidence interval [CI] 13.9%, 32. 3%) were diagnosed with underlying renal disease. Immunoglobulin A nephropathy was present in 12. Women with renal disease had a significantly earlier onset of proteinuria than those without (median 11 versus 32 weeks' gestation, P <.001). Eighteen of 19 women with renal disease had proteinuria, hypertension, or both before 30 weeks' gestation. Ten of 12 women with severe gestational proteinuria (83.3%, 95% CI 51.6%, 97.9%) had underlying renal disease. Eight of the 19 women had antepartum hematuria, and seven had elevated serum immunoglobulin A levels. In women with severe preeclampsia, onset before 30 weeks' gestation was the best predictor of underlying renal disease (odds ratio 34.1, 95% CI 3.8, 304.5). Women with renal disease had lower rates of severe hypertension (nine of 19 versus 59 of 67, P <.01) and small-for-gestational-age infants (four of 19 versus 34 of 67, P <.05) than those without renal disease. CONCLUSION: Women who had gestational proteinuria or preeclampsia before 30 weeks' gestation were more likely to have had underlying renal disease.     

Uterine artery velocimetry in patients with gestational hypertension

OBJECTIVE: To evaluate whether abnormal uterine artery velocimetry in patients with pregnancy-induced hypertension is more predictive of the outcome of pregnancy than the presence of proteinuria and the severity of hypertension. METHODS: A retrospective study was conducted on 344 hypertensive pregnant women who underwent uterine artery Doppler investigation. Patients were classified as either preeclamptic or with gestational hypertension at follow-up 2 months after delivery. Pregnancy outcomes of patients with preeclampsia and gestational hypertension were correlated to uterine artery velocimetry. A further analysis was done dividing patients into mild and severe groups. RESULTS: An abnormal uterine Doppler was related to a significantly earlier week of delivery (32.5 versus 35.3 in preeclampsia, 33.6 versus 38.1 in gestational hypertension), a lower mean birth weight (1494 g versus 2320 g in preeclampsia, 1690 g versus 2848 g in gestational hypertension), and a higher number of growth-restricted fetuses (70% versus 23% in preeclampsia, 75% versus 20% in gestational hypertension). In both mild and severe hypertensive groups, abnormal uterine velocimetry was associated with a worse pregnancy outcome (delivery at week 33.1, versus 37.9 in the mild group; 32.7 versus 37.3 in the severe group; birth weight 1574 g versus 2741 g in the mild group; 1539 g versus 2742 g in the severe group). A multivariable analysis of the presence of proteinuria, severity of hypertension, and uterine Doppler revealed that only an abnormal uterine Doppler was significantly related to adverse perinatal outcome (P <.001). CONCLUSION: Abnormal uterine Doppler was the variable that was more frequently associated with adverse pregnancy outcome.     

Pregnancy outcome of women who developed proteinuria in the absence of hypertension after mid-gestation

Abstract Objective: To characterize the clinical features of women with singleton pregnancies who develop proteinuria in the absence of hypertension after mid-gestation. Methods: Seventy-nine women who developed proteinuria and/or hypertension at and after 20 weeks of gestation were reviewed, focusing on the gestational week at which significant proteinuria (>0.3 g/day) and/or hypertension developed. Results: Thirty-seven (47%) women exhibited new-onset proteinuria (>0.3 g/day) in the absence of hypertension, 33 (42%) exhibited new-onset hypertension in the absence of proteinuria, and 9 (11%) exhibited both proteinuria and hypertension. Nineteen (51%) of 37 women who exhibited new proteinuria in the absence of hypertension and 5 (15%) of 33 women who exhibited new hypertension in the absence of proteinuria progressed to preeclampsia (P=0.002). Among women who exhibited new proteinuria, 10 (77%) out of 13 women and 9 (38%) out of 24 women who developed proteinuria at <32 weeks and >/=32 weeks, respectively, progressed to preeclampsia (P=0.022). Conclusions: Women with new-onset proteinuria in the absence of hypertension may be more likely to progress to preeclampsia than women with a presumptive diagnosis of gestational hypertension, and the likelihood of progression may be significantly greater among women with earlier presentation.     

Abnormal uterine artery Doppler in small-for-gestational-age pregnancies is associated with later hypertension

In a cohort of normotensive small-for-gestational-age (SGA) pregnancies, we aimed to determine the prevalence of later preeclampsia and gestational hypertension. We hypothesised that (i) uterine artery Doppler abnormalities would increase in severity from those with normotension to gestational hypertension to preeclampsia and (ii) the severity of uterine artery Doppler abnormalities would be related to the severity of fetal disease. Serial uterine and umbilical artery Doppler studies were performed on 224 normotensive women with SGA pregnancies, from detection of SGA until delivery. Outcomes were compared between groups that remained normotensive (n = 174) and those that developed gestational hypertension and preeclampsia. Of the women studied, 50 (22%) subsequently developed hypertension [(3% (n = 8) preeclampsia, 19% (n = 42) gestational hypertension)] at a median (interquartile range) of 19 (12-32) days after recognition of SGA. Mean uterine artery resistance indices (RI) increased from women who remained normotensive (n = 174) to those who later developed gestational hypertension or preeclampsia [0.51 (SD 0.09), 0.55 (0.09), 0.62 (0.13), p < 0.001], as did the proportion of abnormal uterine RI (33%, 39%, 88%, p = 0.007) and umbilical RI (28%, 40%, 75% p = 0.007). Mean uterine RI correlated negatively with z score birthweight (R2 = 0.069, p < 0.001) and positively with umbilical RI (R2 = 0.16, p < 0.001).     

Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia.

OBJECTIVE: The current literature emphasizes increased risk of adverse outcomes in the presence of proteinuria and hypertension. The objective of this study was to compare the frequency of adverse fetal outcomes in women who developed hypertensive disorders with or without proteinuria. STUDY DESIGN: The study design was a secondary analysis of data from women who had preeclampsia in a previous pregnancy (n = 598) who were enrolled in a multicenter trial of aspirin for the prevention of preeclampsia. The women had no history of chronic hypertension or renal disease and were normotensive at study inclusion. The maternal and perinatal outcome variables assessed were preterm delivery at <37 and <35 weeks of gestation, rate of small-for-gestational-age infants, and abruptio placenta. Data were analyzed by using the chi-square test, and women who remained normotensive or who had mild gestational hypertension were considered as a single group because they had similar outcomes. RESULTS: As compared to mild preeclampsia, women who developed severe gestational hypertension (without proteinuria) had higher rates of both preterm delivery at <37 weeks of gestation and small-for-gestational-age infants. In addition, when compared to women with mild preeclampsia, for women with severe gestational hypertension, gestational age and birth weight were significantly lower at delivery (P <.003 for both age and birth weight). Moreover, women who developed severe gestational hypertension had higher rates of preterm delivery at <37 weeks of gestation (54.2% vs 17.8%, P =.001) and at <35 weeks of gestation (25.0% vs 8.4%, P =.0161), and delivery of small-for-gestational-age infants (20.8% vs 6.5%, P =.024) when compared to women who remained normotensive or those who developed mild gestational hypertension. There were no statistically significant differences in perinatal outcomes between the normotensive/mild gestational hypertension and the mild preeclampsia groups. Overall, women who had severe gestational hypertension had increased rates of preterm delivery and delivery of small-for-gestational-age infants than women with mild gestational hypertension or mild preeclampsia. In the presence of severe hypertension, proteinuria did not increase the rates of preterm delivery or delivery of small-for-gestational-age infants. CONCLUSIONS: In women who have gestational hypertension or preeclampsia, increased rates of preterm delivery and delivery of small-for-gestational-age infants are present only in those with severe hypertension. In these women, the presence of proteinuria does not influence perinatal outcome.     

Clinical implications of the didelphic uterus: long-term follow-up of 49 cases

OBJECTIVE: The aim of the study was to evaluate reproductive performance of women with didelphic uterus and to consider possible long-term consequences associated with this uterine anomaly. STUDY DESIGN: Forty-nine women were diagnosed as having a didelphic uterus with a longitudinal vaginal septum at Tampere University Hospital, Finland between 1962 and 1998. The presence of other anomalies, gynecologic disorders, fertility and outcome of pregnancies were reviewed. The long-term clinical implications associated with a didelphic uterus were evaluated during the mean (S.D.) follow-up period of 9.1 (6.3) years. RESULTS: An obstructed hemivagina was found in nine (18%) out of forty-nine cases; eight of these had ipsilateral renal agenesis. A longitudinal vaginal septum was excised in twenty-six (53%) cases, but metroplasty in none. Five (13%) patients had primary infertility. Thirty-four (94%) out of thirty-six women who wanted to conceive had at least one pregnancy, and they produced seventy-one pregnancies; 21% miscarried, and ectopic pregnancy occurred in 2%. The fetal survival rate was 75%, prematurity 24%, fetal growth retardation 11%, perinatal mortality 5. 3%, and cesarean section rate 84%. Pregnancy located more commonly (76%) in the right uterus than in the left. During the follow-up period endometriosis was observed in seven (16%) out of forty-five cases. Ovarian neoplasm was found in four (9%) cases, one of them had ovarian cancer. CONCLUSIONS: Fertility in women with didelphic uterus is not notably impaired. The prognosis of pregnancy is comparatively good, while prematurity and fetal growth retardation indicate meticulous prenatal care. Long-term follow-up did not reveal that didelphic uterus is associated with increased frequency of endometriosis or genital neoplasm.     

Pregnancy outcome in women with reflux nephropathy and the inheritance of vesico-ureteric reflux

In women with reflux nephropathy, we investigated whether pre-existing hypertension and impaired renal function influence the rates of preeclampsia, renal function deterioration and preterm birth. The infants were investigated for vesico-ureteric reflux (VUR). A prospective audit of 54 pregnancies in 46 women with reflux nephropathy was performed. Preeclampsia complicated 24% of pregnancies and was increased in women with pre-existing hypertension (42%) compared with normotensive women (14%), (RR 3.0 (95% CI 1.1-7.8)). Nine (18%) women experienced deterioration in renal function during pregnancy Women with mild or moderate renal impairment were at increased risk of renal function deterioration (RR 12.7 (95% CI 1.6-98.5); RR 19.8 (95% CI 2.6-155)), respectively A third of infants were delivered preterm. The risk of preterm birth was increased if the mother had pre-existing hypertension (p = 0.01) or moderate renal impairment (p = 0.002). Seventeen (43%) of the 40 infants who underwent micturating cystourethrography had VUR, consistent with autosomal dominant inheritance with reduced penetrance. In reflux nephropathy, pre-existing hypertension was associated with an increased risk of preeclampsia and pre-existing renal impairment with deterioration in renal function. Infants of women with reflux nephropathy should be screened for VUR.     

Proteinuria and outcome of 444 pregnancies complicated by hypertension

The purpose of this study was to determine the role of proteinuria on pregnancy outcome in 444 hypertensive women with singleton pregnancies. The patients were divided into three hypertensive groups: 98 with chronic hypertension, 199 with nonproteinuric gestational hypertension, and 147 with proteinuric preeclampsia and chronic hypertension with superimposed proteinuric preeclampsia. The presence of increased proteinuria (greater than 0.3 gm/L) predicted an adverse pregnancy outcome. Furthermore, the majority of small-for-gestational-age infants occurred in the group with proteinuric preeclampsia (52%), whereas the rate of small-for-gestational-age infants was 18% and 12% in the group with nonproteinuric gestational hypertension and chronic hypertension, respectively. The group with chronic hypertension did not show any increased risk for fetal outcome. Perinatal mortality rate was extremely poor in the group with proteinuric preeclampsia at 129 per 1000, four times higher than those of the other two groups.     

Acetylsalicylic Acid for the Prevention of Preeclampsia and Intra-uterine Growth Restriction in Women with Abnormal Uterine Artery Doppler: A Systematic Review and Meta-analysis

BackgroundPreeclampsia is a major global cause of maternal, neonatal and perinatal mortality. From studies of placental pathophysiology in women with preeclampsia, a potentially important role of low-dose acetylsalicylic acid (ASA) in the prevention of preeclampsia was expected, but the results from clinical trials have been disappointing. While recent evidence has shown that uterine Doppler can predict preeclampsia as early as in the first trimester of pregnancy, most clinical trials have evaluated ASA in the second and third trimesters.ObjectivesWe performed a meta-analysis to assess the influence of gestational age at the time of introduction of ASA on the incidence of preeclampsia in women at increased risk, on the basis of abnormal uterine artery Doppler.MethodsComputerized searches of randomized controlled trials were conducted to retrieve studies in which pregnant women at increased risk of preeclampsia had been identified on the basis of abnormal uterine Doppler measurements. The trials compared women who received ASA with a control group. The primary outcome was preeclampsia. Secondary outcomes included severe preeclampsia, gestational hypertension, preterm birth, intrauterine growth restriction, placental abruption, birth weight and gestational age at delivery. Statistical analyses used fixed effects of risk ratio (RR) with the Mantel-Haenszel method and 95% confidence intervals.ResultsNine randomized controlled trials with a total of 1317 women met the inclusion criteria. ASA treatment beginning in early gestation was associated with a greater reduction in the incidence of preeclampsia than treatment beginning in late gestation: ASA treatment started at ≤16 weeks’ gestation resulted in RR 0.48 (95% CI 0.33 to 0.68), at 17–19 weeks RR 0.55 (95% CI 0.17 to 1.76), and at ≥ 20 weeks RR 0.82 (95% CI 0.62 to 1.09). ASA treatment started before 16 weeks was also linked with a significant reduction in the incidence of severe preeclampsia (RR 0.10; 95% CI 0.01 to 0.74), gestational hypertension (RR 0.31; 95% CI 0.13 to 0.78) and IUGR (RR 0.51; 95% CI 0.28 to 0.92).ConclusionASA treatment initiated early in pregnancy is an efficient method of reducing the incidence of preeclampsia and its consequences in women with ultrasonographic evidence of abnormal placentation diagnosed by uterine artery Doppler studies.     

Natural history of chronic proteinuria complicating pregnancy.

OBJECTIVE: Although the significance of proteinuria is well-documented for pregnancy complicated by preeclampsia or diabetes, protein excretion of up to 300 mg per day is considered normal for uncomplicated pregnancy. Our purpose was to determine the significance of otherwise "asymptomatic" proteinuria identified during pregnancy. STUDY DESIGN: We reviewed the perinatal outcome of 65 pregnancies in 53 women with the following criteria: (1) proteinuria exceeding 500 mg per day, (2) no previously known renal disease, (3) no reversible renal dysfunction, and (4) no evidence for preeclampsia at discovery. RESULTS: Renal insufficiency coexisted in 62% of women, and 40% had chronic hypertension. Excluding 8 abortions, 53 (93%) of 57 pregnancies resulted in live infants; 45% of infants were delivered preterm and 23% had growth retardation. Of these 57 women, 62% demonstrated clinical evidence compatible with superimposed preeclampsia, and although the incidence of preeclampsia was increased with isolated proteinuria (29%), it was increased even more when there was associated chronic hypertension (incidence 100%) or renal insufficiency (incidence 58%). All 21 women who eventually underwent renal biopsy had histologic evidence of renal disease. To date, with only a limited follow-up of these 53 women, 11 (20%) have progressed to end-stage renal disease. CONCLUSION: "Asymptomatic" proteinuria is associated with a number of adverse pregnancy outcomes and serious long-term maternal morbidity.     

Rectovesical ligament and fusion defect of the uterus with or without obstructed hemivagina and ipsilateral renal agenesis

Objective

The rectovesical ligament is a peritoneal band in women with failure of fusion of the two Müllerian ducts. The aim was to evaluate existence of this abnormal structure in women with dysfused uterus and its possible relations to concomitant vaginal and renal anomalies.

Study design

The study group comprised 47 women with uterine fusion defect (37 didelphic and 10 bicornuate uterus). They had undergone laparoscopy or laparotomy to visualize the pelvic cavity, and imaging for renal evaluation. The rectovesical ligament was present if inspection of the pelvic cavity revealed a broad peritoneal band between the two hemiuteri, attached anteriorly to the bladder and posteriorly to the sigmoid. Presence or absence of the ligament was reported, and concomitant renal and vaginal anomalies were evaluated.

Results

The rectovesical ligament was not visualized in 14 patients with didelphic or complete bicornuate uterus associated with unilateral renal agenesis: of these 13 had a previously treated obstructive longitudinal vaginal septum. A peritoneal band was found in 27 women with didelphic uterus with longitudinal vaginal septum with no obstruction and normal bilateral kidneys. Six women with bicornuate uterus had normal kidneys and an identified rectovesical ligament between the uterine hemicorpora, except for one with partial bicornuate uterus.

Conclusion

The rectovesical ligament is not merely a consequence of the failed fusion of two Müllerian ducts, but its relation to uterine malformation with or without vaginal and renal anomalies indicates some share of this structure in the early development of the urogenital system.     

Plasma adiponectin concentration in early pregnancy and subsequent risk of hypertensive disorders

OBJECTIVE: Adiponectin is an exclusively adipose tissue-derived protein. Low plasma adiponectin levels have been found in hypertensive men. Our objective was to evaluate whether low first-trimester plasma adiponectin values were predictive of hypertensive disorders later in pregnancy. METHODS: A nested case-control study was carried out on a cohort of 1,842 pregnant women who participated in the first-trimester Down syndrome screening program; 34 developed preeclampsia and 48 gestational hypertension. A control group of 82 nonhypertensive uneventful pregnancies was selected. Plasma adiponectin was determined using an enzyme-linked immunosorbent assay (ELISA). RESULTS: Adiponectin median concentrations in the group which subsequently became hypertensive were significantly lower than those in the control group (7.6 versus 13.0 microg/mL) (P < .001). When the 2 hypertensive subgroups were considered, the plasma adiponectin median value in the preeclampsia group was significantly lower than that in the gestational hypertension group (6.6 versus 9.3 microg/mL) (P = .01). Regression analysis showed an inverse correlation between plasma adiponectin concentrations and maternal age, gestational age, body mass index, systolic blood pressure, and proteinuria. Approximately 34% of hypertensive pregnancies, compared with 7% of controls (P < .001), had plasma adiponectin concentrations less than 6.4 microg/mL (mean value of lower quartile of distribution among control patients). After adjusting for maternal age, all these women experienced a 6.6-fold (95% confidence interval 2.5-17.8) increased risk of pregnancy hypertension, compared with those women who had higher concentrations. CONCLUSION: Our findings suggest a strong association between hypoadiponectinemia and the risk of hypertensive disorders in pregnancy, especially with preeclampsia.     

Assisted reproduction in women with uterine anomalies

A retrospective analysis was performed to evaluate the reproductive performance of 17 women with uterine anomalies who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). Eight women had a unicornuate uterus, and two a didelphic uterus. Seven women with a subseptate uterus underwent metroplasty before assisted reproduction. Ten (58.8%) out of 17 women achieved 11 (18.0%) pregnancies out of 61 embryo transfers in 55 stimulated cycles. The implantation rate per embryo was 8/83 (9.6%) for women with a unicornuate uterus, one of 17 (5. 9%) for those with didelphic uterus and four of 48 (8.3%) for those with subseptate uterus. Pregnancy rates per embryo transfer were 19. 4, 11.1 and 19.0%, respectively. Three out of 11 pregnancies were ectopic, three were miscarriages and five were full-term deliveries, two sets of twins. Delivery rate per embryo transfer was 5.0% in patients with unicornuate or didephic uterus and 14.3% in women who had a subseptate uterus operated prior to assisted reproduction. Women with uterine anomalies treated by IVF or ICSI had low implantation rates. Pregnancy in a subseptate uterus which has been previously operated had a trend to end more frequently in delivery than that in a unicornuate uterus or in a didelphic uterus.     

Maternal complications and perinatal outcomes associated with gestational hypertension and severe preeclampsia in Taiwanese women.

BACKGROUND/PURPOSE: The role of proteinuria in disease severity of preeclampsia and gestational hypertension has not been determined. The objective of this study was to compare the effects of disease severity on maternal complications and pregnancy outcome between women with severe preeclampsia and women with gestational hypertension. METHODS: A retrospective case-control study using daily records from the birth registry for the years 1994 to 2003 was conducted. Cases (n = 364) were defined as women with severe preeclampsia. Controls (n = 249) were selected from women with gestational hypertension. The outcome measures were maternal complications and perinatal-related factors. RESULTS: Women with severe preeclampsia had an increased risk of intrauterine growth restriction (adjusted odds ratio [aOR], 2.16; 95% confidence interval [CI], 1.10-4.24; p = 0.026). Risk factors associated with severe preeclampsia patients were lack of prenatal care (aOR, 2.95; 95% CI, 1.45-5.99), systolic blood pressure >or= 180 mmHg (aOR, 14.3; 95% CI, 1.69-121.0), and diastolic blood pressure >or= 105mmHg (aOR, 21.2; 95% CI, 6.99-64.3) compared with women with gestational hypertension in Model I. When we added proteinuria as a variable, two significant risk factors, diastolic blood pressure >or= 105mmHg (aOR, 18.2; 95% CI, 4.85-68.3) and significant proteinuria (aOR, 1.01; 95% CI, 1.006-1.014), were associated with severe preeclampsia patients in Model II. A subgroup of women with gestational hypertension and proteinuria had an increased risk of placental abruption (unadjusted OR, 4.36; 95% CI, 1.05-18.1) and disseminated intravascular coagulation (unadjusted OR, 6.46; 95% CI, 1.05-39.8). Finally, maternal complications (aOR, 2.59; 95% CI, 1.34-5.04) became the single significant factor associated with gestational hypertension and proteinuria. CONCLUSION: Proteinuria may play a role in the progression of gestational hypertension to severe forms of preeclampsia associated with subsequent maternal complications and extremely-low-birth-weight babies.     

Doppler Ultrasound in Pregnancies with Hypertension

Doppler studies of the arcuate and umbilical arteries were performed longitudinally commencing at 24 weeks or less, in 29 pregnant women with chronic hypertension. The hypothesis was that pregnant women with chronic hypertension who develop superimposed gestational proteinuric hypertension and/or deliver small for gestational age babies are those who have abnormal arcuate and/or umbilical flow velocity waveforms. Abnormal arcuate waveforms occurred in 7 women and abnormal umbilical waveforms in 12. Nine babies were small for gestational age, and 6 of them had abnormal arcuate waveforms. Abnormal arcuate waveforms were significantly associated with the delivery of a small for gestational age baby (p = .001) and identified those babies where early delivery was necessary for fetal reasons. All small for gestational age babies had abnormal umbilical waveforms. Superadded gestational proteinuria (or preeclampsia) occurred in 8 pregnancies, however, only 3 had abnormal arcuate waveforms. An abnormal arcuate waveform did not predict the later development of gestational proteinuria. An abnormal umbilical waveform however, was associated with the subsequent development of gestational proteinuria. We consider that these findings need to be confirmed in a larger study.     

C-Type natriuretic peptide levels in women with gestational hypertension and preeclampsia

Objective: To measure plasma levels of C-type natriuretic peptide in women with normal pregnancies and those complicated by gestational hypertension and preeclampsia.Methods: We collected venous plasma samples from 20 women with normal pregnancies, 15 with gestational hypertension, and nine with preeclampsia. Gestational ages ranged from 26–39 weeks. We measured C-type natriuretic peptide concentrations by radioimmunoassay. Statistical comparisons were made by one-way analysis of variance and Tukey test.Results: The mean plasma concentration of C-type natriuretic peptide in the women with normal pregnancy was 7.1 ± 2.5 pg/mL, in those with gestational hypertension 9.6 ± 4.2 pg/mL, and in those with preeclampsia 8.1 ± 2.4 pg/mL. There were no statistically significant differences between groups. The statistical power to detect a difference of 3 pg/mL at the 5% significance level was 78% for the group with gestational hypertension and 64% for the preeclamptic group.Conclusion: Our results suggest that C-type natriuretic peptide plasma levels are not significantly different in normal pregnancies and those complicated by gestational hypertension or preeclampsia. In hypertensive pregnancy disorders, C-type natriuretic peptide showed a distinct course compared with atrial natriuretic peptide and brain natriuretic peptide.     

Mild gestational hypertension remote from term: progression and outcome

OBJECTIVE: Limited information is available regarding the progression of disease in women with mild gestational hypertension. Our purpose was to describe the prognostic signs in the natural course of mild gestational hypertension and pregnancy outcomes in women who were remote from term with mild gestational hypertension that was expectantly managed. STUDY DESIGN: Women with mild gestational hypertension participating in an outpatient hypertension monitoring program were studied. Inclusion criteria were patients with a singleton pregnancy between 24 and 35 weeks' gestation who had no proteinuria by dipstick (0 or trace) on the first 2 days of program participation. Progression to preeclampsia was the primary outcome. The rate of progression to severe preeclampsia, obstetric complications, and neonatal outcomes were secondary measures. Data were compared by independent Student t and Fisher exact tests where applicable. RESULTS: A total of 748 patients were studied during the observation period; preeclampsia (persistent proteinuria > or = 1+) developed in 343 (46%), and 72 (9.6%) had antepartum progression to severe preeclampsia. No significant differences in maternal age, race, marital status, or tobacco use were observed between those women in whom persistent proteinuria developed and those in whom it did not develop. Gestational age of the infants at delivery (36.5 +/- 2.4 vs 37.4 +/- 2.0 weeks), birth weight (2752 +/- 767 vs 3038 +/- 715 g), incidence of small-for-gestational-age newborns (24.8% vs 13.8%), and duration of neonatal hospital stay (7.1 +/- 10 vs 5.0 +/- 9.3 days) differed significantly in the patients with versus those without proteinuria (P <.001 for all). CONCLUSIONS: In patients with mild gestational hypertension remote from term, 46% ultimately had preeclampsia, with progression to severe disease in 9.6%. The development of proteinuria is associated with an earlier gestational age at delivery, lower birth weight, and an increased incidence of small-for-gestational age newborns.     

Late normalisation of uterine artery velocimetry in high risk pregnancy

OBJECTIVE: To test whether late normalisation of abnormal uterine velocimetry is a favourable prognostic factor in high risk pregnancies. STUDY DESIGN: Uterine artery colour Doppler velocimetry was performed at 24, 28-30 and 32-34 weeks in 282 high risk pregnancies treated with low dose aspirin. RESULTS: 88 patients had abnormal waveforms at 24 weeks and 77 delivered after the second assessment at 28 weeks. Of these, 38 (49%) had a normalisation of Doppler indices by 34 weeks. Compared with the persistently abnormal Doppler group, these patients delivered fewer small for gestational age babies (5/38 versus 26/39; p=0.0001) and had less gestational hypertension without proteinuria (3/38 versus 15/39; p=0.004). No patients with preeclampsia or other severe complications of pregnancy were observed in the normalised group. CONCLUSIONS: Although abnormal uterine artery velocimetry at 24 weeks is predictive of adverse pregnancy outcome, nearly half have late normalisation of the Doppler indices and a better perinatal outcome. Persistently abnormal waveforms are related to the worst pregnancy outcome.     

子宫畸形合并妊娠母儿妊娠结局临床分析

目的探讨妊娠合并子宫畸形对于母儿妊娠结局的影响。方法选取北京大学人民医院收治的妊娠合并子宫畸形患者108例,并以372例正常子宫妊娠患者作为对照,对其临床资料进行回顾性分析。结果①在29245例分娩的病例中,妊娠合并子宫畸形共108例,发生率约为0.4%。其中以子宫纵膈最为常见,占49.1%,其次为双子宫,占21.3%;②子宫畸形合并妊娠的患者中,胎位异常发生率（46.3%）及剖宫产率（73.2%）均显著升高;③子宫畸形组的平均孕周（37.2周）,新生儿平均出生体重（2873g）显著低于对照组,而早产率（24.1%）及足月低体重儿发生率（6.5%）均显著高于对照组;④纵膈子宫、单角子宫（83.3%合并残角子宫）、双角子宫、及双子宫在终止妊娠方式上存在差异,剖宫产率在纵膈子宫为最低（64.2%）。各组在早产率、孕周、胎儿体重方面差异无统计学意义（P〉0.05）。结论子宫畸形对于妊娠结局可产生不良影响,临床医生应加强孕前及孕期管理。