Homocisteína plasmática en la preeclampsia y eclampsia durante el pre y posparto

Objective

To compare plasma homocysteine concentrations in preeclamptic, eclamptic and normotensive pregnant patients before and after delivery.

Methods

We included 30 patients with mild preeclampsia (group A), 30 patients with severe pre-eclampsia (group B), and 30 patients with eclampsia (group C). A control group of 35 normotensive women (group D) was selected with a similar age and body mass index as the study groups. In all groups, blood samples were collected in all patients before delivery, and post-partum follow-up samples were collected at 7 days and 6 weeks.

Results

Statically significant differences were found between controls and the three study groups in birthweight (P<.05). Before delivery, the highest concentrations were seen in eclamptic patients followed by those with severe preeclampsia. Concentrations were significantly higher in the three study groups than in controls (P<.05). At 7 days and 6 weeks, mean homocysteine concentrations were significantly higher in groups A, B and C than in group D (P<.05).

Conclusions

Homocysteine concentrations were significantly higher in pre-eclamptic and eclamptic patients than in normotensive pregnant women and remained higher at 6 weeks after delivery.     

Factor de crecimiento de hepatocitos plasmático en preeclampsia y eclampsia

Objective

To compare plasma hepatocyte growth factor concentrations in eclamptic, preeclamptic and normotensive pregnant women.

Materials and method

We included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (group C). A control group of 30 healthy pregnant women (group D) was selected with a similar age and body mass index to participants in the study groups. Only nulliparous patients were included. Blood samples were collected for plasma hepatocyte growth factor determination in all patients before delivery and in the study groups immediately after diagnosis.

Results

Plasma hepatocyte growth factor values were highest in eclamptic patients and in severe preeclamptic patients and were lowest in mild preeclamptic patients. Hepatocyte growth factor values were significantly higher in the study groups than in controls (P<.05). Linear regression analysis revealed that 24-hour proteinuria significantly affected plasma hepatocyte growth factor concentrations (P<.05).

Conclusion

The findings of this research showed that plasma hepatocyte growth factor concentrations were higher in eclamptic and preeclamptic patients than in normotensive pregnant women.     

Preeclampsia y eclampsia de presentación atípica

Objective

To contribute to the diagnosis and management of atypical preeclampsia-eclampsia.

Case report

A puerperal woman was admitted to hospital with hemolysis. During her hospital stay she developed hypertension and other complications of preeclampsia, as well as tonic-clonic seizures. The literature on the topic was reviewed through an electronic search of the Ebsco, Medline and Scielo databases.

Conclusions

Unusual presentations of preeclampsia-eclampsia should be considered to avoid a missed diagnosis and adverse outcomes.     

Rotura hepática asociada a preeclampsia y síndrome HELLP,con resultados catastróficos

We present the case of a 41 years old pregnant, diagnosed of preeclampsia in her 39 weeks with catastrophic result, ending in maternal death. We show the deterioration of this patient since the diagnosis of preeclampsia, with evolution to eclampsia, HELLP syndrome, respiratory distress, septic shock and finally, maternal death.     

Diagnóstico diferencial entre lupus eritematoso sistémico y preeclampsia en una gestante

We report the case of an 18 year-old woman that during the third trimester of her pregnancy developed high blood pressure and proteinuria, being diagnosed of preeclampsia. The pregnancy ended successfully having being the hypertension satisfactorialy controlled with treatment. One week after delivery she developed a HELLP syndrome, an acute renal failure and respiratory insufficiency, being diagnosed then of systemic lupus erithematosus and starting a treatment with steroids, plasmapheresis, hemodyalisis and cyclophosphamide. The clinical situation got more complicated due to a pneumony by acynetobacter. We believe that it was a preeclampsia superimposed to an underlying lupus nephritis.     

Global and regional estimates of preeclampsia and eclampsia: a systematic review

Reduction of maternal mortality is a target within the Millennium Development Goals. Data on the incidence of preeclampsia and eclampsia, one of the main causes of maternal deaths, are required at both national and regional levels to inform policies. We conducted a systematic review of the incidence of hypertensive disorders of pregnancy (HDP) with the objective of evaluating its magnitude globally and in different regions and settings. We selected studies using pre-specified criteria, recorded database characteristics and assessed methodological quality of the eligible studies reporting incidence of any HDP during the period 2002–2010. A logistic model was then developed to estimate the global and regional incidence of HDP using pre-specified predictor variables where empiric data were not available. We found 129 studies meeting the inclusion criteria, from which 74 reports with 78 datasets reporting HDP were analysed. This represents nearly 39 million women from 40 countries. When the model was applied, the overall estimates are 4.6% (95% uncertainty range 2.7–8.2), and 1.4% (95% uncertainty range 1.0–2.0) of all deliveries for preeclampsia and eclampsia respectively, with a wide variation across regions. The figures we obtained give a general idea of the magnitude of the problem and suggest that some regional variations might exist. The absence of data in many countries is of concern, however, and efforts should be made to implement data collection and reporting for substantial statistics. The implementation of large scale surveys conducted during a short period of time could provide more reliable and up-to-date estimations to inform policy.     

Adverse maternal and fetal outcomes and deaths related to preeclampsia and eclampsia in Haiti

ObjectiveThe purpose of this study was to define the prevalence and clinical characteristics of preeclampsia and eclampsia at a hospital in rural Haiti.MethodsThis is a retrospective review of women presenting to Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti with singleton pregnancy and diagnosis of preeclampsia or eclampsia from January 1, 2011 through December 31, 2012. Hospital charts were reviewed to obtain medical and prenatal history, hospital course, delivery information, and fetal/neonatal outcomes. The outcomes included placental abruption, antepartum eclampsia, postpartum eclampsia, maternal death, birthweight <2500 g and stillbirth. Data are presented as median (quartile 1, quartile 3) or n (%) and risk ratios.ResultsDuring the study period, 1743 women were admitted to the maternity service at HAS and 290 (16.6%) were diagnosed with preeclampsia or eclampsia. Only singleton pregnancies were analyzed (N = 270). Nearly all (95.0%) patients admitted with preeclampsia had severe preeclampsia. There were 83 patients with eclampsia (30.7%) of which 61 (73.4%) had antepartum eclampsia. There were 48 stillbirths (17.8%) and 5 maternal deaths (1.9%). Patients with antepartum eclampsia were younger, more likely to be nulliparous and had less prenatal care compared to women with antepartum preeclampsia. Antepartum eclampsia was associated with placental abruption and maternal death.ConclusionsThe rates of preeclampsia and its associated complications, such as eclampsia, placental abruption, maternal death and stillbirth, are high at this facility in Haiti. Such data are essential to developing region-specific systems to prevent preeclampsia-related complications.     

Homocisteína sérica en neonatos de preeclámpticas y de embarazadas normotensas

Objective

To compare serum homocysteine concentrations in the newborns of preeclamptic patients and normotensive pregnant women.

Methods

Thirty-five preeclamptic patients and their newborns (group A; cases) and 35 normotensive pregnant women and their newborns (group B; controls) were selected. Maternal-neonatal homocysteine concentrations and neonatal weight were evaluated in both groups.

Results

Statistically significant differences were found in gestational age, systolic and diastolic blood pressure and the presence of proteinuria (p<0.05). Maternal homocysteine concentrations were higher in group A than in group B (p<0.05). Mean neonatal weight was significantly lower in group A than in group B (p<0.05). Neonatal homocysteine concentrations were higher in group A than in group B (p<0.05). When the homocysteine concentrations of newborns were correlated, there was a moderate, positive and significant correlation with maternal homocysteine concentrations and a moderate, negative and significant correlation with neonatal weight (p<0.05).

Conclusion

Homocysteine concentrations were significantly higher in the newborns of preeclamptic patients than in those of normotensive pregnant women.     

Morbimortalidad materna y fetal en pacientes con preeclampsia grave

Objective

The presence of preeclampsia, combination of hypertension and proteinuria after 20 weeks of gestation, would noticeably increase the risk of maternal and fetal morbi-mortality.

Subject and methods

The objective of the study is to determine the perinatal outcome and maternal morbidity and mortality in women with severe preeclampsia at Albacete hospital.

Conclusions

Analyzing our results we observed in our sample both maternal and fetal mortality was lower than that observed by other authors and infants of women who develop severe preeclampsia admitted to the ICU, with eclampsia or HELLP syndrome had a higher morbidity.     

Indicaciones y contraindicaciones del ejercicio físico en la mujer embarazada

This article reviews the potential positive and negative health effects of physical exercise on pregnant women and the fetus reported in the most recent literature published in high impact journals. One important finding is that physical exercise during pregnancy helps to avoid preeclampsia, high blood pressure, significant weight gain–together with appropriate nutrition–and gestational diabetes. This form of diabetes can be effectively controlled by an appropriate diet and physical exercise, sometimes avoiding the need for medication with insulin. Most of the articles reviewed agree that intense physical exercise performed until the end of pregnancy leads to lower birthweight. Lowering the intensity of physical exercise in the last trimester or performing moderate exercise throughout pregnancy did not significantly reduce birthweight and increased birthweight has even been reported. Vascularization and fetal oxygenation are not affected by physical activity while the remaining blood flow to the uterus guarantees intrauterine development. Swimming has a certain protective effect against preterm birth. As a safety measure, all contact sports and those with a potential risk of falls and abdominal trauma should be avoided, as well as long periods of standing or heavy physical work.     

Concentraciones de interleucina-16 en pacientes con preeclampsia y gestantes normotensas sanas

Objective

To compare interleukin-16 concentrations in patients with preeclampsia and healthy normotensive pregnant women.

Method

A total of 100 patients were selected. Fifty patients with preeclampsia were selected as the study group (group A) and 50 healthy normotensive pregnant women with the same age and body mass index as the study group were selected as controls (group B). Blood samples were extracted from all patients before labor and immediately after diagnosis in group B to determine interleukin-16 concentrations.

Results

There was statistically significant difference in interleukin-16 concentrations between group A (211.9 ± 78.7 pg/ml) and group B (83.6 ± 9.9 pg/ml; p < 0.05). There was a strong, positive and significant correlation with systolic blood pressure values (r = 0.282; p < 0.05) and with diastolic blood pressure values (r = 0.320; p < 0.05). A cutoff value of 180 pg/ml had an area under the curve of 0.95, sensitivity of 94.0%, specificity of 70.0%, a positive predictive value of 75.8% and a negative predictive value of 92.1%, with a diagnostic accuracy of 75.0%.

Conclusions

Interleukin-16 concentrations were significantly higher in patients with preeclampsia than in healthy normotensive pregnant women.     

Diabetes insípida transitoria en gestante con disfunción hepática y embarazo gemelar. Revisión del síndrome polidipsia-poliuria en gestación

Diabetes insipidus (DI) is a rare endocrine complication of pregnancy. Traditionally, DI has been considered to be either central or nephrogenic. However, in pregnancy, a specific type has been described: transient DI or gestational DI. This entity occurs mainly in the third trimester of pregnancy and resolves spontaneously between the first and fourth week after delivery. The physiopathology of gestational DI has a placental origin, with excessive levels of placental vasopressinase leading to excessive catabolism of vasopressin and secondarily to polydipsia-polyuria syndrome in the pregnant woman. Screening for subclinical pregestational DI (central or nephrogenic) or transient gestation is mandatory whenever this entity is suspected clinically. Diagnosis is simple and treatment with desmopressin acetate significantly decreases the maternal and fetal risks of this disease. It is also necessary to exclude other frequently associated disorders (preeclampsia, HELLP syndrome, liver dysfunction) and to carry out close fetal monitoring, because of the risk of intrauterine growth retardation secondary to placental dysfunction.     

Concentraciones de interleucina 1 beta en pacientes con preeclampsia y embarazadas normotensas sanas

Objective

To compare concentrations of interleukin-1 beta in patients with preeclampsia and healthy normotensive pregnant women.

Material and methods

One hundred patients were selected. Fifty preeclamptic patients were selected as cases (group A) and 50 healthy pregnant women with a similar age and body mass index to those in the study group were selected as controls (group B). Blood samples for interleukin-1 beta determination were collected in all patients before labor and immediately after diagnosis in the study group.

Results

No significant differences were found in maternal age, gestational age or body mass index at sample collection (p=ns). Significant differences were observed between groups in mean values of systolic and diastolic blood pressure (p<0.05). Interleukin-1 beta concentrations were significantly higher in group A than in group B (18.2±7.3 pg/ml compared with 13.6±5.4 pg/ml; p<0.05) and showed a slight, positive and significant correlation with values of systolic blood pressure and diastolic blood pressure (p<0.05).

Conclusions

Concentrations of interleukin-1 beta were significantly higher in preeclamptic patients than in healthy normotensive pregnant women.     

Flujo sanguíneo de las arterias renales fetales en preeclámpticas graves y embarazadas normotensas sanas

Objective

To compare the blood flow in fetal renal arteries in severe preeclamptic and healthy normotensive pregnant women.

Method

The sample consisted of 30 women with severe preeclampsia (group A) and 30 healthy normotensive pregnant women (group B) with single pregnancies of more than 30 weeks. The pulsatility and resistance indexes of the uterine, umbilical, fetal middle cerebral and fetal renal arteries were measured.

Results

There were no significant differences in maternal age, gestational age or newborn weight (p = ns). Pulsatility and resistance index values in the uterine and umbilical arteries were significantly higher and both measurements for the fetal middle cerebral artery were significantly lower in group A than in group B (p = 0.0001). Pulsatility and resistance index values in the fetal renal artery were significantly higher in group A than in group B (p = 0.0001). The fetal renal artery pulsatility index was significantly correlated with the pulsatility index of the uterine artery (p = 0.011) and the fetal middle cerebral artery (p < 0.007). The fetal renal artery resistance index was correlated with the resistance index of the three vessels (p < 0.05).

Conclusion

Women with severe preeclampsia show blood flow alterations in the fetal renal arteries compared with healthy normotensive pregnant women.     

Modificaciones del flujo sanguíneo de las arterias uterina, umbilical y cerebral media fetal en preeclámpticas tratadas con parches de nitroglicerina

Objective

To identify modifications in blood flow in uterine, umbilical and fetal middle cerebral arteries in preeclamptic patients treated with nitroglycerin patches.

Method

The sample consisted of 31 preeclamptic nulliparous patients with pregnancies of more than 25 weeks who attended the obstetric emergency service at the Dr. Urquinaona Central Hospital. The pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine, umbilical and fetal middle cerebral arteries were measured before treatment and after 24 and 48 h of treatment administration. Treatment consisted of 5 mg transdermal nitroglycerin patches, applied in the anterior thoracic and lumbar region of patients for 12 h (total time of 48 h).

Results

The pulsatility index, resistance index and systolic/diastolic blood flow ratio significantly decreased after the use of nitroglycerin patches (p<0.05). There were no significant modifications in the umbilical and fetal middle cerebral arteries at 24 and 48 h when compared with initial values (p=ns). There were no adverse effects.

Conclusion

Nitroglycerin patches decreased resistance to blood flow in the uterine arteries of preeclamptic patients without producing significant modifications in the umbilical and fetal middle cerebral arteries.     

Efecto de las hormonas sexuales sobre las concentraciones de homocisteína en preeclámpticas y embarazadas normales

Objective

To establish the effects of sexual hormones on plasma homocysteine concentrations in preeclamptic and normotensive pregnant women.

Methods

There were two groups: group A consisted of 35 preeclamptic patients and group B of 35 normotensive pregnant women used as controls. Blood samples were collected before labor in both grops and immediately after diagnosis in group A. Concentrations of testosterone, free testosterone, dehidroepiandrosterone sulphate, androstenodione, estradiol and homocysteine were measured.

Results

There were statistically significant differences in gestational age, the presence of proteinuria, birthweight and systolic and diastolic blood pressure (p < 0.05). Testosterone, free testosterone and dehidroepiandrosterone sulphate were significantly higher in group A than in group B (P<.05). Estradiol concentrations were significant lower in the group A than in group B (P<.05). Strong positive and significant correlations were found between testosterone, dehidroepiandrosterone sulphate and free testosterone and a moderate negative correlation was found between estradiol and plasma homocysteine concentrations (P<.05).

Conclusions

In preeclamptic and normotensive pregnant women, plasma homocysteine concentrations are positively affected by testosterone, dehidroepiandrosterone sulphate and free testosterone and are negatively affected by estradiol.     

Velocimetría Doppler del flujo sanguíneo de la arteria uterina y riesgo de muerte perinatal en preeclámpsicas

Objective

To determine the association between Doppler velocimetry values of uterine artery blood flow with the risk of perinatal death in preeclamptic patients.

Materials and method

We selected 80 patients with a diagnosis of preeclampsia. Preeclamptic patients were divided into those with perinatal deaths and those without. The variables analyzed were the pulsatility index, the resistance index, and the systolic/diastolic flow ratio of the uterine arteries.

Results

There were no differences in maternal age, height or weight between preeclamptic patients with or without perinatal deaths (p = ns), or between gestational age at the time of Doppler ultrasound and systolic and diastolic blood pressure (p = ns). The pulsatility index (1.206 ± 0.140) and resistance index (0.684 ± 0.098) of the uterine arteries were significantly higher in women with perinatal deaths than in those without (1.113 ± 0.109 and 0.605 ± 0.116, respectively; P<.05). No significant differences were found in mean values of the systolic/diastolic flow ratio of the uterine arteries (p = ns).

Conclusion

A high value of the pulsatility index and resistance index of the uterine arteries on Doppler velocimetry in preeclamptic patients is associated with an increased risk of perinatal death.     

Lack of association between the CYP11B2 gene polymorphism and preeclampsia, eclampsia, and the HELLP syndrome in Turkish women

OBJECTIVES: It is possible that altered control of aldosterone synthase gene (CYP11B2) expression or translation may be responsible for hypertension. Hypertension is one of the major components of preeclampsia. We present here a study investigating the association between the CYP11B2 gene polymorphism in the promoter region at the position of -344 and preeclampsia. STUDY DESIGN: We analyzed a group of Turkish women for preeclampsia (n=143), eclampsia (n=36), and the HELLP syndrome (n=55) and compared them with controls (n=147). Genotypes for CYP11B2 were determined by polymerase chain reaction followed by digestion with BsuRI restriction enzyme. RESULTS: The -344T/T, -344C/T, and -344C/C genotypes were found at comparable frequencies among the study groups, between the study and control groups, and between the study groups combined and the control group (p>0.05). We combined the genotypes of TC and CC (polymorphic) and compared them with the TT (wild-type) genotype. There was no significant difference in the frequency of the TC plus CC genotypes among the study groups, between the study and control groups, and between the study groups combined and the control group (p>0.05). There was no association of the CYP11B2 polymorphism among the preeclampsia, eclampsia, and HELLP groups and controls. CONCLUSIONS: The CYP11B2 gene polymorphism is not directly associated with preeclampsia, eclampsia, and the HELLP syndrome in women with these conditions. Therefore, this polymorphism may not be a risk factor for these disorders, at least not in the Turkish population.