Postpartum preeclampsia occurring after resolution of antepartum preeclampsia

Preeclampsia is a syndrome characterized by hypertension, proteinuria and edema in a pregnant female after 20 weeks of gestation, including occurring in the postpartum period. Delivery of the infant is usually considered the definitive treatment for preeclampsia. Preeclampsia in a prior pregnancy is associated with an increased risk of recurrence in a subsequent pregnancy. However, it is unusual for preeclampsia to resolve with delivery of the infant and then recur in the same pregnancy in the postpartum period. We present here a case report of a woman who had antepartum preeclampsia treated with delivery. She then had a recurrence of the classic signs of preeclampsia in the postpartum period. Ultimately she was admitted and treated with magnesium with a final diagnosis of recurrent preeclampsia.     

重度子痫前期发病类型对妊娠结局影响的研究

目的探讨重度子痫前期发病类型对妊娠结局的影响。方法回顾性分析收治的106例诊断为重度子痫前期的患者,根据发病孕周分为两组,孕周≤34周的为早发型组(63例),而孕周>34周的为晚发型组(43例)。分析比较两组孕妇并发症的发生情况及围生儿情况。结果两组患者保守治疗时间比较,早发组和晚发组平均治疗时间分别为(7.52±4.3)d、(4.21±1.6)d,差异有统计学意义。两组孕产妇并发症发生情况比较,早发组有58例,晚发组有32例,并发症发生率差异有统计学意义。两组不同类型重度子痫对围生儿的影响:早发组中有50例胎儿生长受限,晚发组中有21例,早发组的胎儿生长受限率显著较高。结论早发型重度子痫患者对孕产妇及胎儿的影响较晚发型大,较易发生各种并发症和多器官损害。     

子痫前期对围生儿的影响

目的探讨子痫前期对围生儿的影响。方法对2003年7月至2005年12月在我院分娩的229例子痫前期围生儿情况与随机抽取同期住院分娩的230例正常孕妇的围生儿情况进行回顾性分析。结果子痫前期早产儿、小于胎龄儿、新生儿窒息发生率及围生儿死亡率高于正常孕妇（P〈0．05），重度子痫前期早产儿、小于胎龄儿、新生儿窒息发生率及围生儿死亡率高于轻度子痫前期（P〈0．05）。结论子痫前期是影响围生儿结局的主要原因之一，且围生儿结局不良与子痫前期病情严重程度相一致。必须加强产前监护，积极防治子痫前期，并适时终止妊娠。以改善围生儿结局，降低围生儿死亡率。     

孕早期补充叶酸与先兆子痫发生危险性的关系

目的 探讨孕早期服用叶酸与随后先兆子痫发生危险性的关系.方法 选取2012年10月-2013年5月在渭南市妇幼保健院就诊单胎先兆子痫患者69例,按照孕早期是否服用叶酸分为药物干预组（36例）及未干预组（33例）,于孕32-35周检测其血清叶酸含量.结果 ①通过比较药物干预组与未干预组患者进食含有叶酸的食物（绿叶蔬菜、水果、谷类食物、奶、肉、蛋等）对叶酸值检测的影响,结果表明两组叶酸差异无明显统计学意义（9.75 ng/ml vs 9.68 ng/ml,t=0.54,P=0.37）.②采用Logistic回归分析,调整了体重指数、年龄、饮食习惯、教育程度等混合因素后,服用叶酸对预防先兆子痫发生的危险因子OR=1.17（95％置信区间1.08-1.33）.结论 孕早期口服叶酸不能降低先兆子痫发生的危险性.     

Evaluation of metalloproteinases 2 and 9 and their inhibitors in physiologic and pre‐eclamptic pregnancy

Matrix metalloproteinases (MMPs) are a family of zinc and calcium‐dependent endopeptidases involved in remodeling and physiological homeostasis of extracellular matrix (ECM). The metalloproteinases activity is predominantly modulated by specific tissue inhibitors of matrix metalloproteinases (TIMPs). The balance between MMPs and TIMPs is likely to play an important role in remodeling uterine arteries in pregnancy, and it may represent means by which vasodilatation is maintained in later pregnancy. Moreover, increased levels of MMPs and in particular MMP‐2 play a role in the vascular alterations induced by hypertension. The aim of this study was the evaluation of MMP‐2 and ‐9, along with their inhibitors TIMP‐1 and ‐2, in pre‐eclamptic women compared with normotensive pregnancy and non‐pregnant women. Fourteen pre‐eclamptic women were compared with 37 normotensive women in different gestational age and 21 non‐pregnant women. Multiplexed sandwich enzyme‐linked immunosorbent assay was used to measure MMPs and TIMPs simultaneously. MMP‐2 levels were significantly higher in pre‐eclamptic women vs. both non‐pregnant and physiologic pregnant women. MMP‐9 concentrations were significantly higher in physiologic pregnant vs. non‐pregnant women. The serum levels of TIMP‐1 were significantly higher in pre‐eclamptic vs. both non‐pregnant and physiologic pregnant women. TIMP‐2 values were higher in physiologic pregnant women and pre‐eclamptic women vs. non‐pregnant women. A positive correlation between MMP‐9 values and gestational age was observed in normal pregnant women. Results of the present investigation confirm that MMP‐2 and TIMP‐1 values are significantly higher in preeclampsia. We confirm that the modification of the fine balance between MMPs and their inhibitors plays a greater role in the structural and functional vascular changes of women with complicated pregnancies. J. Clin. Lab. Anal. 23:88–92, 2009. © 2009 Wiley‐Liss, Inc.     

重度妊高征终止妊娠孕周对围生儿的影响

目的：探讨重度妊高征患者终止妊娠孕周对围生儿结局的影响。方法：对1996年1月～2004年5月分娩的154例重度妊高征患者的临床资料进行回顾性分析，并按发病孕周分为小于32周、满32周未满34周、满34周未满36周、达到或超过36周4组。比较不同孕周重度妊高征患者围产儿结局。结果：各组围生儿死亡率分别为66．7％(小于32周)、40％(满32周未满34周)、10．3％(满34周未满36周)、9．5％(达到或超过36周)。孕龄不满34周重度妊高征患者围生儿死亡率明显高于满34周以上的患者。结论：重度妊高征患者孕龄达34周以上为终止妊娠的合适时机。     

羟乙基淀粉和白蛋白扩容治疗对重度子痫前期并发毛细血管渗漏综合征肺功能的影响

目的：通过脉搏指示剂连续心排量（PICCO）监护仪和血气分析,观察6%羟乙基淀粉（万汶）和5%白蛋白扩容治疗后对重度子痫前期并发毛细血管渗漏综合征（CLS）患者肺功能的影响。方法：选取62例重度子痫前期并发CLS产后患者,随机分为万汶组（30例）和白蛋白组（32例）,采用PICCO监护仪,在扩容前、在扩容后8、16、24h记录血管外肺水指数（EVLWI）、取动脉血测定血气、计算氧合指数和肺泡动脉氧分压差（P（A-a）O2）及呼吸指数（RI）。结果：万汶组扩容后8、16、24h不同时间点EVLWI、P（A-a）O2和呼吸指数显著低于治疗前（P〈0.05）,万汶组扩容后氧合指数明显高于扩容前（P〈0.05）。白蛋白组扩容后8、16、24hEVLWI、P（A-a）O2和呼吸指数显著高于万汶组（P〈0.05）;白蛋白组氧合指数明显低于万汶组（P〈0.05）。结论：万汶扩容治疗不影响重度子痫前期并发CLS的肺功能,与其治疗毛细血管渗漏综合征有关。     

The role of platelet parameters for the diagnosis of preeclampsia among pregnant women attending at the University of Gondar Comprehensive Specialized Hospital antenatal care unit,Gondar, Ethiopia

BackgroundPreeclampsia (PE) is a pregnancy‐related illness characterized by high blood pressure (BP) and proteinuria after the 20th gestational week (GW). Platelet (PLT) parameter changes are the common hematological abnormalities observed in PE patients. The main aim of this study was to assess the role of PLT parameters for PE diagnosis among pregnant women.MethodsA comparative cross‐sectional study was conducted at the University of Gondar Specialized Hospital. A total of 126 pregnant women (63 normotensive [NT] and 63 PE) were recruited using a convenient sampling method. Three milliliter blood was collected from each participant, and PLT parameters were determined using Sysmex XS‐500i analyzer. An independent t‐test supplemented with receiver‐operating characteristics (ROC) were used for comparisons and diagnostic value of PLT parameters between the study groups.ResultsPlatelet count (PC) was significantly lower in the PE group compared to that in the NT group, whereas mean platelet volume (MPV), platelet large cell ratio (P‐LCR), and platelet distribution width (PDW) were significantly higher in PE. MPV had the largest area under the curve (AUC) [0.91: 95% CI; 0.85–0.96] followed by PC [0.79: 95% CI; 0.72–0.87]. MPV can differentiate PE patients from NT pregnant women at cut‐off value ≥12.10 fl (84.1% sensitivity and 87.3% specificity) while PC can indicate PE at a cut‐off value ≤176.5 × 10⁹/L (65.1% sensitivity and 87.3% specificity).ConclusionA decreased PC and an increased MPV, P‐LCR, and PDW can be used as a simple, cost‐effective, quick, and reliable method of PE screening. Of them, MPV is the best indicator of PE.     

HLA-G检测及先兆子痫产前预诊指标建立

目的通过检测孕妇血清sHLA-G产前预诊先兆子痫病人并预先分型,为临床提前干预提供依据。方法产前血清sHLA-G用ELISA法检测;产后胎盘组织HLA-G mRNA用RT-PCR法回顾性检测。结果先兆子痫病人胎盘HLA-G mRNA及血清可溶性HLA-G(sHLA-G)表达均较正常孕妇降低;不同型别先兆子痫sHLA-G浓度差异显著。结论孕妇血清sHLA-G水平可在产前预诊潜在的不同型别的先兆子痫。     

健康教育及心理护理对子痫前期轻度病人焦虑的影响

目的:探讨护理干预对子痫前期病人焦虑的影响。方法:将我院住院治疗的120例子痫前期轻度孕妇随机分为观察组与对照组,对照组给予常规护理,观察组在常规护理基础上,加强对孕妇的心理干预及健康教育。应用焦虑自评量表(SAS)对病人干预前后进行评估。结果:对照组与观察组护理干预后SAS评分分别为(52.26±7.26),(40.08±5.62),差异比较有统计学意义(P<0.01)。结论:对子痫前期轻度孕妇实施心理干预及健康教育,可有效缓解孕妇焦虑情绪,有助于改善病人愈后。     

子痫前期患者血清微小RNAs的差异表达研究

目的探讨子痫前期患者血清微小RNAs(miRNAs)不同的表达水平,分析子痫前期相关标志物。方法选择10个子痫前期患者胎盘中差异表达的miRNA,分别收集该院30例子痫前期患者和30例正常妊娠孕妇孕早期(12~14周)、孕中期(20~24周)和孕晚期(28~32周)血清miRNAs,采用SYBR Green qRT-PCR法检测血清中10个miRNAs的表达量。结果子痫前期胎盘中高表达的3个miRNAs(miR-152、miR-183、miR-210)在子痫前期孕中、晚期血清中表达显著升高,而胎盘中高表达的miR-182仅在子痫前期孕晚期表达显著升高;子痫前期胎盘中低表达的6个miRNAs(miR-1、miR-328、miR-363、miR-377、miR-500、miR-584)在子痫前期各个孕期的表达,差异均无统计学意义(P0.05)。结论 miR-152、miR-183、miR-210在子痫前期孕中、晚期血清中表达显著升高,可能是预测子痫前期发生的良好生物标志物。     

New Approaches for Managing Preeclampsia: Clues From Clinical and Basic Research

PurposeOne of the most common, and most vexing, obstetric complications is preeclampsia—a major cause of maternal and perinatal morbidity. Hallmarked by new-onset hypertension and a myriad of other symptoms, the underlying cause of the disorder remains obscure despite intensive research into its etiology. Although the initiating events are not clear, one common finding in preeclamptic patients is failure to remodel the maternal arteries that supply the placenta, with resulting hypoxia/ischemia. Intensive research over the past 2 decades has identified several categories of molecular dysfunction resulting from placental hypoxia, which, when released into the maternal circulation, are involved in the spectrum of symptoms seen in these patients—in particular, angiogenic imbalance and the activation of innate and adaptive immune responses. Despite these new insights, little in the way of new treatments for the management of these patients has been advanced into clinical practice. Indeed, few therapeutic options exist for the obstetrician treating a case of preeclampsia. Pharmacologic management is typically seizure prophylaxis, and, in severe cases, antihypertensive agents for controlling worsening hypertension. Ultimately, the induction of labor is indicated, making preeclampsia a leading cause of premature birth. Here, the molecular mechanisms linking placental ischemia to the maternal symptoms of preeclampsia are reviewed, and several areas of recent research suggesting new potential therapeutic approaches to the management of preeclampsia are identified.     

Low-Dose Aspirin for the Prevention of Preeclampsia

Preeclampsia is a hypertensive disorder specific to pregnancy that remains a significant cause of maternal and neonatal morbidity and mortality. Identification of women who are most at risk for preeclampsia is imprecise. Because of the potential negative health consequences of preeclampsia for women and newborns and the lack of effective screening mechanisms preventing preeclampsia is an important component of prenatal care. Researchers have documented that low-dose aspirin, taken daily after the first trimester, can decrease the development of preeclampsia and reduce the incidence of preterm birth and birth of small-for-gestational-age infants. This column includes an overview of low-dose aspirin in pregnancy and a review of current recommendations from leading national organizations.     

重度子痫前期孕妇所生早产儿脑损伤的超声评价

目的 分析重度子痫前期孕妇所生早产儿的颅脑超声检查结果,探讨超声对脑损伤疾病的诊断价值,以期为临床早期诊断、治疗及干预提供依据.方法 对36例重度子痫前期孕妇和40例无高危围产因素孕妇所生早产儿行颅脑超声检查,分析两组脑损伤发病率和疾病分布构成的差异性.结果 重度子痫前期组36例早产儿中颅脑超声图像异常者26例,声像图异常率72.2％;对照组40例早产儿中颅脑超声图像异常者19例,声像图异常率47.5％,两者比较差异有统计学意义(P＜0.05).两组超声异常图像脑室周围-脑室内出血和早产儿脑室周围白质损伤的分布构成比较差异无统计学意义.结论 重度子痫前期孕妇可增加其早产儿脑损伤疾病的发生率,超声是一种有效的新生儿脑异常的检出手段,能为临床早期诊断、治疗及干预提供依据.     

广州地区妊娠中晚期妇女AT-Ⅲ检测参考值范围调查

目的：对广州地区中晚期妊娠妇女抗凝血酶Ⅲ（AT-Ⅲ）参考值范围的调查,初步探讨AT-Ⅲ检测在妊娠妇女中的应用价值。方法选取健康妊娠妇女250例及同期体检的健康非妊娠妇女118例,将健康妊娠妇女按孕周分组：孕周14∽27周组设为中孕组,共124例,＞27周组设为！孕组,共126例。将上述各组按年龄再分为小于29岁组和大于或等于29岁组。收集所有入组人员抗凝静脉血1．8 mL,检测其血浆AT-Ⅲ水平,调查其相应的参考值范围。结果中孕组、晚孕组及健康对照组血浆AT-Ⅲ水平分别为99．0％（68．1％∽117．0％）、92．0％（71．1％∽112．0％）、103％（76．0％∽127．8％）,差异有统计学意义（P＜0．05）。＜29岁的中孕组、晚孕组及健康对照组血浆 AT-Ⅲ水平分别为96．85％（71．20％∽116．85％）、93．60％（70．53％∽136．48％）、103．75％（80．68％∽139．48％）,差异有统计学意义（P＜0．05）;≥29岁的中孕组、晚孕组及健康对照组血浆AT-Ⅲ水平分别为95．47％（77．40％∽113．54％）、92．40％（69．20％∽113．00％）、102．08％（75．20％∽123．80％）,差异有统计学意义（P＜0．05）。妊娠妇女AT-Ⅲ水平在不同孕期组间差异有统计学意义（P＜0．05）,应制订不同的参考范围,而同一孕期内不同年龄段妊娠妇女AT-Ⅲ水平差异无统计学意义（P＞0．05）,制订参考范围时可不考虑年龄因素。结论该研究为广州地区中晚期妊娠妇女人群AT-Ⅲ的参考值范围制订提供了一定的参考依据。     

Maternal plasma concentrations of insulinlike growth factor-1 and insulinlike growth factor-binding protein-1 in early pregnancy and subsequent risk of preeclampsia

OBJECTIVES: We investigated the relationship between maternal plasma free insulinlike growth factor-1 (IGF-1) and insulinlike growth factor-binding protein-1 (IGFBP-1) concentrations and risk of preeclampsia. DESIGN AND METHODS: Maternal blood samples were collected at 13 weeks' gestation on average. From the cohort, we selected 53 women who developed preeclampsia and 477 who remained normotensive. Free IGF-1 and IGFBP-1 concentrations were measured using immunoassays. Logistic regression procedures were used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Women who developed preeclampsia had 18% and 27% lower concentrations of free IGF-1 and IGFBP-1, respectively, than controls (P < 0.05). There was a 57% reduced risk of preeclampsia among women with free IGF-1 concentrations of >or= 0.81 ng/mL (OR = 0.43, 95% CI 0.23-0.83) and a 43% reduced risk among women with IGFBP-1 concentrations of >or= 72.36 ng/mL (OR = 0.53, 95% CI 0.23-1.21). CONCLUSIONS: Alterations of free IGF-1 and IGFBP-1 concentrations in maternal plasma during early pregnancy are associated with risk of preeclampsia. These associations may help to further elucidate the pathologic processes of preeclampsia.     

Migraine headaches and preeclampsia: an epidemiologic review

OBJECTIVE: To summarize and evaluate available empirical research on the relationship between migraines and gestational hypertension or preeclampsia and to provide direction for future research in this area. BACKGROUND: Migraines affect a substantial proportion of reproductive-aged women and have been associated with cardiovascular risk factors and ischemic disease in this population. Preeclampsia is a vascular disorder of pregnancy, also linked to adverse cardiovascular outcomes. METHODS: Publications were identified by a MEDLINE search using keywords "migraine,"preeclampsia," and "gestational hypertension," and by examination of the reference lists of identified articles. RESULTS: The literature review yielded 10 studies addressing the association between migraines and preeclampsia or gestational hypertension. Of the 10 studies, 8 reported a positive association between the syndromes. CONCLUSIONS: Available evidence suggests that migraines and preeclampsia may reflect an underlying predisposition toward ischemic injury. More rigorous epidemiologic research is warranted, after consideration of several important methodologic issues.     

低分子肝素钠联合硫酸镁对重度子痫前期患者血清高敏C反应蛋白和D-二聚体的影响分析

目的探讨低分子肝素钠联合硫酸镁对重度子痫前期患者的血清高敏C反应蛋白(hs-CRP)、D-二聚体(D-D)水平的影响。方法选择该院接诊的100例重度子痫前期患者,通过随机数表法分为观察组(50例)和对照组(50例),对照组采用硫酸镁治疗,观察组在硫酸镁治疗的基础上联合低分子肝素钠治疗。观察两组患者治疗前后血清hs-CRP、D-D、收缩压以及舒张压的变化,比较平均治疗时间、终止孕周时间、临床疗效及并发症的发生率。结果治疗后,观察组hs-CRP,D-D水平均低于对照组,差异有统计学意义(P0.05);观察组收缩压、舒张压水平低于对照组,差异具有统计学意义(P0.05);观察组平均治疗时间,终止妊娠孕周时间均短于对照组,差异具有统计学意义(P0.05);观察组总有效率96.00%(48/50)高于对照组74.00%(37/50),并发症发生率6.00%(3/50)低于对照组24.00%(12/50),差异具有统计学意义(P0.05)。结论低分子肝素钠联合硫酸镁可以有效降低重度子痫前期患者体内hs-CRP和D-D水平,抑制炎性反应,使新生儿的预后得到改善,值得在临床上应用推广。