Cardiac adaptation to pregnancy in women with a history of preeclampsia and a subnormal plasma volume

In former preeclamptics, a subnormal plasma volume (LPV) predisposes to hemodynamic maladaptation to pregnancy. Here, we assessed the initial cardiovascular response to pregnancy in LPV (n = 20), in former preeclamptics with normal plasma volume (NPV) (n = 35) and in parous controls (CONTR) (n = 9) by echocardiography, blood pressure and heart rate (HR), before pregnancy, and by 5 and 7 weeks amenorrhea. Data analysis was by nonparametric tests. LPV differed from NPV and CONTR, by a consistently lower E/A ratio (ratio of peak mitral flow velocity in early diastole [E] and that during atrial contraction [A]) and an early-pregnancy rise in left atrial diameter (LAD). Both NPV and LPV differed from CONTR by an early-pregnancy rise in HR. The consistently lower E/A ratio together with the early-pregnancy LAD rise in LPV indicate diastolic dysfunction. The early-pregnancy rise in HR suggests sympathetic dominance in the autonomic control of the circulation.     

Positively reframing perceptions of the menstrual cycle among women with premenstrual syndrome

OBJECTIVE: To positively reframe perceptions of menstrual cycle experiences to diminish reports of negative perimenstrual symptoms among women with premenstrual syndrome (PMS). DESIGN/SAMPLE: A longitudinal quasi-experimental research design; data were collected on 28 women. SETTING: Treatment sessions were conducted in a university classroom in the northeastern United States. INTERVENTION: The intervention consisted of a health promotion program that provided social support and a psychoeducational intervention with a positive reframing psychotherapeutic maneuver. MAIN OUTCOME MEASURES: To describe (a) perceptions of biologic, psychologic, and social outcomes related to perimenstrual changes and (b) compare biologic, psychologic, and social outcomes of women participating in a health promotion intervention with women not participating. RESULTS: Negative perimenstrual symptom reports decreased for women in the experimental group. In addition, the participants' personal resources increased significantly. CONCLUSIONS: Participation in a peer support group that provides women with information on positive concomitants of the menstrual cycle can benefit women with PMS.     

Physical well-being in women with a history of severe preeclampsia

Objective.?To evaluate the physical and mental health of women with a history of severe preeclampsia.

Methods.?In a historical cohort study 131 former patients with a history of severe preeclampsia and 127 control patients received questionnaires about experienced physical and mental complaints after delivery. At a follow-up visit blood pressure, body mass index, and proteinuria were measured and venous blood was drawn.

Results.?Former patients experienced significantly (p?<?0.001) more frequent problems of headache (31% vs. 2%), right upper quadrant pain (16% vs. 1%), visual disturbances (21% vs. 1%), tiredness (66% vs. 27%), subjective loss of concentration (37% vs. 16%), and mental health (37% vs. 6%) compared with controls. When present, these health problems, except for tiredness, lasted significantly more often beyond six months postpartum compared to controls. Admittance to the intensive care unit was associated with headache, and subjective loss of memory and concentration over a longer period of time. The risk of recurrence of severe preeclampsia was a subject of concern in 20% of former patients. At follow-up, systolic and diastolic blood pressures were significantly higher (p?<?0.001) among former patients.

Conclusion.?Patients with a history of severe preeclampsia more frequently reported physical and mental complaints, also during a longer period of time.     

Changes in menstrual symptoms among sterilized and comparison women: a prospective study

Changes in menstrual parameters after tubal sterilization were analyzed in ethnically diverse, poor women from three geographic areas in the United States. Two large suitable comparison groups were similarly studied. Menstrual cycles, duration of menstrual flow, and bleeding between periods were unchanged in the sterilization and comparison groups. The prevalence of dysmenorrhea increased in 10.8% of sterilized women, compared with 2.1% in the comparison groups. This difference was even more significant--16.4 and -0.5%--when usage of oral contraceptives and intrauterine devices was discounted. There was a nonsignificant increase in noncyclic pelvic pain.     

Changes in copper and zinc plasma concentrations during the normal menstrual cycle in women

Objective.?To investigate whether there is a fluctuation of the copper and zinc plasma levels during the menstrual cycle and if this correlates to the physiological fluctuations of estradiol and progesterone plasma concentrations in eumenorrhoic women.

Methods.?We studied 14 eumenorrhoic women. Copper (Cu), zinc (Zn), estradiol (E2) and progesterone (Prg) plasma concentrations, during time of menstruation (time 1), midfollicular phase (time 2), time of ovulation (time 3) and midluteal phase (time 4) were determined.

Results.?We observed significant changes in both copper plasma concentrations and zinc plasma concentrations during the four times studied (p?<?0.05). The changes of Cu during the various phases correlated negatively with the changes in E2 (r?>?0.5, p?<?0.05), whereas the changes of Zn correlated positively with those of E2 (r?>?0.8, p?<?0.05). We were unable to demonstrate any statistically significant correlation between Cu and Prg or Zn and Prg.

Conclusions.?This study indicates that there is a cyclic fluctuation of Cu and Zn concentrations in plasma during the menstrual cycle, in healthy eumenorrhoic women. This cyclic fluctuation might be due to the cyclic fluctuation of plasma levels of E2.     

Physical well-being in women with a history of severe preeclampsia.

OBJECTIVE: To evaluate the physical and mental health of women with a history of severe preeclampsia. METHODS: In a historical cohort study 131 former patients with a history of severe preeclampsia and 127 control patients received questionnaires about experienced physical and mental complaints after delivery. At a follow-up visit blood pressure, body mass index, and proteinuria were measured and venous blood was drawn. RESULTS: Former patients experienced significantly (p < 0.001) more frequent problems of headache (31% vs. 2%), right upper quadrant pain (16% vs. 1%), visual disturbances (21% vs. 1%), tiredness (66% vs. 27%), subjective loss of concentration (37% vs. 16%), and mental health (37% vs. 6%) compared with controls. When present, these health problems, except for tiredness, lasted significantly more often beyond six months postpartum compared to controls. Admittance to the intensive care unit was associated with headache, and subjective loss of memory and concentration over a longer period of time. The risk of recurrence of severe preeclampsia was a subject of concern in 20% of former patients. At follow-up, systolic and diastolic blood pressures were significantly higher (p < 0.001) among former patients. CONCLUSION: Patients with a history of severe preeclampsia more frequently reported physical and mental complaints, also during a longer period of time.     

Hormonal monitoring of the menstrual cycle among sterile women. III.]

This paper attempts to assess the value of the dynamical examinations of the concentrations of the ovary hormones progesterone and estradiol in the menstrual cycle. RIA were made on 22 sterile women with the monophasic cycle and 119 sterile women with the biphasic cycle in comparison with 17 women who delivered at least one child without previous treatment (control group). The dynamical RIA were made on all women between the 5th and 26th day of the menstrual cycle. The results of these assays were compared on the 8th, 14th, 15th, 16th, 21st and 25th day of the menstrual cycle. The examinations confirmed a markedly lower concentrations of estradiol throughout all the time of the cycle among sterile women with the monophasic cycle and a little higher concentrations among sterile women with the biphasic cycle. Markedly lower concentrations of progesterone were observed throughout all the time of the cycle among sterile women with the monophasic cycle and a little higher concentrations of it were found among sterile women with the biphasic menstrual cycle.     

Orthostatic stress response during the menstrual cycle is unaltered in formerly preeclamptic women with low plasma volume

Plasma volume (PV) varies with the menstrual cycle not only in healthy parous controls (CON) but also in formerly preeclamptic women with a subnormal PV (LPV). It is unknown whether formerly preeclamptic women with LPV are more susceptible to orthostatic stress than healthy controls. In this study, the authors compared autonomic responses to acute (standing from supine position) and gradual (menstrual cycle) orthostatic stress between LPV and CON. In 11 LPV (PV相似文献   

Monitoring hormones during the menstrual cycle among sterile women. I.]

This paper attempts to estimate the endocrinological function of the following glands: pituitary, thyroid, adrenal, pancreas, and ovary. An examination only once of their hormones was made between the 8th and 10th day of the follicular phase of the menstrual cycle. This examination was performed on 22 sterile women with monophasic menstrual cycle, 119 sterile women with biphasic menstrual cycle and 17 women who delivered at least one child without previous treatment (control group). Radioimmunoassays (RIA) of 11 hormones: LH, FSH, PRL, estradiol, progesterone, cortisol, aldosterone, insulin, T3, T4, and testosterone were made. It was confirmed that the marked differences showed only the examinations of LH and estradiol among sterile women with monophasic menstrual cycle in comparison to the group of sterile women with biphasic cycle and the control group. RIA of the concentrations of the thyroid, pancreas and adrenal hormones among women without endocrinopathy have not a mark diagnostical value. RIA of the level of the testosterone is not appropriate in clinical cases which do not carry symptoms a hyperandrogenism.     

Hormonal monitoring during the menstrual cycle among sterile women. II.]

This paper attempts to assess the value of the dynamical examinations of the concentrations of the pituitary gonadotropin LH, FSH, PRL in the menstrual cycle. RIA were made on 22 sterile women with monophasic cycle and 119 sterile women with biphasic cycle in comparison with 17 women who delivered at least one child without previous treatment (control group). The dynamical RIA were made on all women between the 5th and the 26th day of the menstrual cycle. The results of these assays were compared in the 8th, 14th, 15th, 16th, 21st and 25th day of the menstrual cycle. It was confirmed that the lower levels of PRL are maintained through all the time of the menstrual cycle among sterile women with monophasic cycle. It is shown that higher level of LH is maintained through all the time of the menstrual cycle but it is particularly higher in the secretary phase of the cycle among sterile women with monophasic cycle. A lower level of FSH was observed at the beginning of the follicular phase of the cycle and a markedly higher concentration of FSH was found on the secretary phase of the cycle among sterile women with monophasic cycle.     

Fibrinolysis parameters in Sudanese women with severe preeclampsia

Background: Although preeclampsia remains a major cause of maternal and fetal morbidity and mortality, its pathogenesis is not fully understood. Coagulation and fibrinolysis changes were suggested to have a role in the pathogenesis of preeclampsia. Objectives: A case-control study was conducted in Medani Hospital, Sudan, to investigate thrombin-activatable fibrinolysis inhibitor (TAFI) and plasminogen-activated inhibitor (PAI) in women with severe preeclampsia. Obstetrics and medical history was gathered using questionnaire. TAFI, PAI-1, and PAI-2 levels were measured using ELISA. Results: In comparison with the controls, women with severe preeclampsia had significantly higher levels [mean (SD)] of TAFI [3.4 (1.1) vs. 3.0(0.7) ng/ml, P = 0.019], PAI-1 [3.2 (1.3) vs. 2.5(1.0), IU/ml, P = 0.001], and significantly lower PAI-2 level [4.2(1.3) vs. 5.8(2.6) ng/ml, P < 0.001]. In linear regression, severe preeclampsia was significantly associated with TAFI (0.408 ng/ml, P = 0.038), PAI-1 (0.722, IU/ml P = 0.003), and PAI-2 (?1.745, ng/ml, P < 0.001). Conclusion: The current study revealed a significant increase level of TAFI and PAI-1, coupled with a decrease in PAI-2 in women with severe preeclampsia in comparison with the control group.     

Prolactin measurement in the investigation of infertility in women with a normal menstrual cycle

Basal serum prolactin concentrations were compared with mid-luteal serum progesterone concentrations and prospectively studied conception rates up to 12 months in women with otherwise unexplained infertility including a normal menstrual cycle. There were altogether 188 women with mean prolactin levels up to 3075 mU/l: 47 with prolactin up to 200 mU/l, 100 with prolactin 201-400 mU/l, 18 up to 600 mU/l, 16 up to 800 mU/l, and 7 greater than 800 mU/l. There were no significant differences in the mean progesterone values or chance of conception between any of the groups. The findings indicate that prolactin measurement is generally of no value in normally menstruating women, except possibly in the unusual event of evidence of persistent distinct luteal deficiency (not found in the present study).     

Sensitivity of spontaneous baroreflex control of the heart and hemodynamic parameters are not influenced by the menstrual cycle.

OBJECTIVE: The purpose of this study was to evaluate if hemodynamic parameters and sympathetic activity vary between the follicular and luteal phase of the menstrual cycle before using sympathetic activity in pre-pregnancy risk assessment for preeclampsia. METHODS: We studied 39 healthy women at days 5 to 10 and days 18 to 25 of the menstrual cycle. Blood pressure, heart rate, cardiac output, and total peripheral resistance were measured continuously using noninvasive finger arterial pressure waveform registration (Portapres Model 2, BMI, The Netherlands). Baroreflex sensitivity (BRS) and sympathetic activity by phase angle difference were studied using spectral analysis and xBRS. RESULTS: There were no differences in hemodynamic parameters, BRS, and phase angle difference. CONCLUSION: There is no difference in blood pressure, BRS, and sympathetic activity between the first and second half of the menstrual period. We recommend using the first half of the cycle to be certain that no pregnancy exists, as the influence of very early pregnancy is unknown.     

Quantitative hemodynamic effects of acute volume expansion in severe preeclampsia

In a study of eight patients with severe preeclampsia, cumulative rapid infusions of 500 mL (set of eight patients) and 1000 mL (subset of five patients) of 5% albumin in normal saline were followed with invasive hemodynamic measurements at 5 and 30 minutes. Pulmonary capillary wedge pressure and central venous pressure rose. Cardiac index rose 23 and 34% at 5 minutes after the 500-mL and 1000-mL infusions, respectively; at 30 minutes, it remained at 17 and 34%, respectively, above control. The systemic vascular resistance index fell 24 and 29% below control values at 5 minutes after the respective infusions; at 30 minutes, it remained at 15 and 25%, respectively, below control. Mean systemic arterial pressure was unchanged, except for a small reduction shortly after the initial 500-mL infusion. In contrast, mean pulmonary arterial pressure rose significantly. Hence, the dominant effects of acute volume expansion in severe preeclampsia include an unchanged (or slightly reduced) mean systemic arterial pressure, resulting from marked elevations in cardiac index and concomitant, proportionate declines in systemic vascular resistance index.     

Altered metabolic profiles among older mothers with a history of preeclampsia

Preeclampsia has been linked to increased risk for cardiovascular disease and, more recently, to reduced risk for breast cancer later in life. The altered chronic disease risk associated with prior preeclampsia may reflect underlying metabolic differences. In this case-control study, we examined the metabolic profiles of older mothers with and without a history of preeclampsia in their first pregnancies. At the time of the study, subjects were non-pregnant, non-smoking women who completed their first pregnancies at age 30 or older, were pre-menopausal, and were free of serious chronic disease. Cases were 13 women who experienced preeclampsia in their first pregnancies; controls were 13 women with uncomplicated first pregnancies, frequency matched to cases on race/ethnicity, current age, and age at delivery. A fasting blood sample was collected from each subject during the luteal phase (day 19-22) of the menstrual cycle and assayed for specific factors thought to be linked to hypertensive disease or breast cancer. Compared to women with uncomplicated pregnancies, those with a history of preeclampsia had significantly elevated levels of fasting serum triglycerides, insulin and glucose, and a higher fasting insulin resistance index, suggesting that women with prior preeclampsia were relatively insulin resistant. In addition, cases had higher levels of insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) and a higher molar ratio of IGFBP-3 to IGF-1 than did controls. Adjustment for obesity and other potential confounders did not appreciably alter the magnitude of these associations. This preliminary study suggests that women with a history of preeclampsia have persistent metabolic abnormalities consistent with their observed excess risk for cardiovascular morbidity and mortality, and their apparent reduced risk for breast cancer later in life.     

Changes in the uterine vasculature during the menstrual cycle

The uterine vasculature of 15 uteri, which were hysterectomized for cervical cancer, has been studied. The removed uteri were immediately cannulated with four catheters inserted into the uterine arteries and veins and the vasculature was flushed with a saline-heparin solution. The vessels were clearly visualized by injection of radioopaque medium or of 5-10 ml prevulcanized natural latex, followed by tissue digestion. Histological studies of uterine specimens were also carried out for histomorphologic studies. The results show differences in the architecture of uterine vasculature, related to the cyclic hormonal changes. Most of the modifications occur in the radial and coiled arteries as well as in "venous lakes" of the endometrium.