子痫前期并发胎儿生长受限的临床特征及妊娠结局分析

目的 探讨子痫前期并发胎儿生长受限(fetal growth restriction,FGR)的临床特征及母儿结局.方法 回顾性分析2009年1月1日至2019年12月31日在广州医科大学附属第三医院产科就诊并分娩的单胎子痫前期患者的病例资料,根据是否合并FGR,分为FGR组和对照组,分析两组的临床特征及母儿结局.结果...     

早发型与晚发型子痫前期的临床特点及母儿结局分析

目的 分析早发型与晚发型子痫前期的临床特征及母儿结局.方法 收集2015年1月至2020年12月6年间在广州医科大学附属第三医院分娩的诊断为子痫前期的单胎孕产妇2693例的临床资料,采用回顾性研究方法分析早发型(873例)与晚发型子痫前期孕妇(1820例)的临床特征及母儿结局.结果 早发型和晚发型子痫前期患者孕次比较[...     

Maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital,Ghana

Objective

To determine maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.

Methods

A cross-sectional study was conducted between January 1 and February 28, 2013. All women delivering at KBTH whose pregnancies were complicated by hypertensive disorders were identified. A structured questionnaire was administered, and the women were followed up on a daily basis until discharge from hospital. Medical records were also reviewed to identify any complications of hypertensive disorders.

Results

A total of 368 women were analyzed. Of 10 maternal deaths, 3 (30.0%) were due to hypertensive disorders in pregnancy, and specifically pre-eclampsia. Overall, 168 (45.7%) women with hypertensive disorders in pregnancy delivered by cesarean, 16 (4.3%) had placental abruption, 11 (3.0%) had pulmonary edema, 3 (0.8%) had HELLP syndrome, 2 (0.5%) had acute renal failure, 3 (0.8%) had an intracerebral hemorrhage or cerebrovascular accident, 21 (5.7%) were admitted to the intensive care unit, 7 (1.9%) had disseminated intravascular coagulation, and 58 (15.8%) had eclampsia. Cesarean delivery, admission to intensive care unit, and eclampsia were significantly more common in women with pre-eclampsia than in those with other hypertensive disorders.

Conclusion

Hypertensive disorders in pregnancy are associated with high incidences of adverse maternal outcomes in Ghana, with significantly increased frequencies in women with pre-eclampsia.     

Maternal serum CA-125 level is elevated in severe preeclampsia

AimThe aim of this study was to determine the relationship between serum concentrations of cancer antigen-125 (CA-125) and pre-eclampsia severity.MethodsWe evaluated 91 females with a singleton pregnancy. Serum CA-125 levels were measured in subjects with severe pre-eclampsia (n = 34) and those with mild pre-eclampsia (n = 24). Females with healthy pregnancies (n = 31) served as the control group. The three study groups were statistically similar in terms of maternal age, gestational age, and body mass index.ResultsThe CA-125 level was significantly higher in the severe pre-eclampsia group than that in the mild pre-eclampsia and control groups (p < 0.05). No significant difference in CA-125 levels between the mild pre-eclampsia and control groups was observed. CA-125 level was positively correlated with proteinuria (r = 0.489, p = 0.000), systolic blood pressure (r = 0.503, p = 0.018), and diastolic blood pressure (r = 0.532, p = 0.000). In contrast, CA-125 was negatively correlated with birth weight (r = 0.266, p = 0.012) and gestational age at birth (r = 0.250, p = 0.018).ConclusionsCA-125 level increased in severe pre-eclampsia, which reflected abnormal trophoblastic invasion and chronic inflammation. Elevated levels of CA-125 in pre-eclamptic patients may be a marker of the disease severity.     

Trophoblast calcyclin is elevated in placental tissue from patients with early pre-eclampsia

The aetiology of pre-eclampsia is thought to originate from aberrant spiral artery remodelling and invasion evoking cellular oxidative stress. Previously, we discovered differentially expressed proteins in trophoblast cells of pre-eclamptic pregnancies. One of these proteins is calcyclin (S100A6); a Ca²⁺-binding protein associated with cellular stress response.By immunohistochemistry on formalin-fixed paraffin-embedded placental tissue, calcyclin expression was compared between women with early pre-eclampsia (n = 72) and non-hypertensive control patients (n = 66) (χ², p = 0.006) blindly by two observers.Significantly more intense staining was seen in trophoblast cells of pre-eclamptic pregnancies compared to control placentas suggesting that trophoblast calcyclin is elevated in early pregnancy.     

Pre-eclampsia and gestational hypertension are less common in HIV infected women

ObjectiveTo determine whether pre-eclampsia and gestational hypertension are less common in HIV infected women.MethodsThis prospective cohort study was performed in the Western Cape province of South Africa. HIV negative and positive pregnant women without chronic renal or chronic hypertensive disease were continuously recruited. During the study period HIV positive patients received either mono- or triple (HAART) antiretroviral therapy for prevention of vertical transmission or maternal care. Only routine clinical management was performed. The development of hypertensive disease during pregnancy was recorded.Results1093 HIV positive and 1173 HIV negative cases were identified during pregnancy and evaluated again after delivery. Significantly fewer cases of pre-eclampsia n = 35 (3.2%) were recorded in the HIV positive group than in the HIV negative group, n = 57 (4.9%) (p = 0.045; OR 0.65 95% CI 0.42–0.99). There were also significantly fewer cases of gestational hypertension recorded in the HIV positive group compared to the HIV negative group (p = 0.026; OR 0.53 95% CI 0.30–0.94). Multiple logistic regression analysis confirmed the reductive effect of HIV on pre-eclampsia and gestational hypertension.ConclusionPre-eclampsia and gestational hypertension are less common in HIV infected women being managed with mono- or triple anti-retroviral therapy.     

Bilirubin influences the clinical presentation of pre-eclampsia

Objectives

Pre-eclampsia is a placental, inflammatory disease modified by maternal anti-oxidant status to give a syndrome. In its most severe forms pre-eclampsia is followed by maternal and neonatal mortality and morbidity. Bilirubin is a known antioxidant and as such is associated with a reduced risk of cardiovascular and respiratory disease. Hence we aimed to find an association between maternal bilirubin levels and the clinical severity of the disease.

Study design

A retrospective observational study of 50,712 pregnancies, 925 of which had pre-eclampsia (1999–2010), to examine the association between bilirubin level and perinatal outcome.

Results

In women with pre-eclampsia, those with bilirubin levels in the lowest quintile were more likely to require caesarean section (p = 0.001, aOR 2.59 (1.52–5.72)). The lowest quintile of bilirubin levels is associated with an increased risk of poor maternal (p = 0.002, aOR 3.52 (95%CI 1.6–7.7)) and infant/fetal (p = 0.001, OR = 3.05 (95%CI = 1.63–5.72)) outcome.

Conclusions

Low levels of bilirubin were associated with poor maternal and infant outcomes in women diagnosed with pre-eclampsia. Bilirubin may act as an anti-oxidant in this condition and thus modify the disease.     

子痫前期产妇胎盘组织中的氧化应激对Wiskott-Aldrich综合征关联蛋白2表达的影响

目的 探讨子痫前期产妇胎盘组织存在的氧化应激对胎盘滋养细胞Wiskott-Aldrich综合征关联蛋白2 (Wiskott-Aldrich syndrome related protein 2,WAVE 2)表达的影响. 方法 研究对象为2011年8月15日至2012年2月23日在重庆医科大学附属第一医院分娩的子痫前期产妇20例及正常足月产妇23例(对照组).剖宫产术后取胎盘组织,采用免疫组织化学法检测胎盘组织WAVE2的定位及分布.采用蛋白质印迹法检测胎盘组织WAVE2的表达,实时荧光定量聚合酶链反应法检测胎盘中WAVE2 mRNA的表达,采用组织匀浆法检测2组产妇胎盘组织活性氧(reactive oxygen species,ROS)水平,并对胎盘组织中ROS水平与WAVE2表达水平进行相关性分析.(2)通过构建体外滋养细胞缺氧复氧损伤模型,模拟缺血再灌注诱导的氧化应激损伤.人妊娠早期绒毛外滋养细胞株HTR 8/SVneo细胞贴壁完全后分别置于常氧(常氧组)和缺氧复氧条件(缺氧复氧组)下48 h,采用流式细胞仪分析细胞内ROS水平.采用Transwell实验观察细胞迁移侵袭状况.采用细胞免疫荧光法和蛋白质印迹法检测HTR-8/SVneo细胞内WAVE2的定位及表达水平的变化.采用独立样本t检验及Pearson相关检验对数据进行分析. 结果 (1)子痫前期组24 h尿蛋白、母体收缩压及舒张压均高于对照组,新生儿出生体重及胎盘重量均低于对照组[24 h尿蛋白:(1.96±0.24)g与(0.08±0.05)g,t=19.436;母体收缩压:(154±13) mm Hg与(98±11) mm Hg,t=11.324;母体舒张压:(105±14)mm Hg与(69±8)mm Hg,t=9.612;新生儿出生体重:(2446±187)g与(3207±233)g,t=16.307;胎盘重量:(432±53)g与(536±67)g,t=14.562;均P＜0.05].子痫前期组WAVE2 mRNA表达低于对照组[(0.28±0.07)与(1.01±0.02),t=12.747],WAVE2相对表达量低于对照组[(0.63±0.08)与(1.34±0.19),t=11.648],ROS水平高于对照组[(144.22±12.32) nmol/(mg·prot)与(75.17±8.71)nmol/(mg·prot),t=20.467],差异均有统计学意义(均P＜0.05).子痫前期组胎盘组织中ROS水平与WAVE2表达水平呈显著负相关(r=-0.726,P=0.000).(2)在常氧组中,HTR-8/SVneo细胞内的ROS水平为(82.9±5.8)％,而缺氧复氧组为(155.6±8.1)％,高于常氧组(t=12.747,P＜0.05).缺氧复氧48 h后的HTR-8/SVneo细胞与常氧组相比,迁移和侵袭力明显降低[缺氧复氧组分别为(58.4±4.2)％和(51.9±3.3)％,常氧组为100％,t值分别为11.034和13.839,P均＜0.05].细胞免疫荧光检测结果显示,WAVE2定位于滋养细胞的细胞质中.缺氧复氧48 h后,HTR-8/SVneo细胞中WAVE2的表达强度明显弱于常氧组(0.37±0.05与0.76±0.06,t=8.631,P＜0.05). 结论 子痫前期胎盘组织中存在过度氧化应激,与胎盘组织中WAVE2表达下调密切相关.缺氧复氧致氧化应激损伤可下调滋养细胞WAVE2的表达;WAVE2表达下调可能损伤滋养细胞迁移侵袭能力,从而参与子痫前期的发生发展.     

Acute Renal Insufficiency in Pregnancy: A Review of Thirty Cases

A review of women with acute changes in renal function during pregnancy including cases with only mild or moderate azotemia was performed to determine the etiology, associated disorders and frequency of this problem in an inner-city population. A retrospective review of the clinical and laboratory data of all patients admitted to the Tulane Obstetric Service at Charity Hospital of New Orleans from 1985-1989 that contained a final diagnosis of hypertension, pre-eclampsia/eclampsia or renal disease was performed to determine if acute renal insufficiency or renal failure occurred during that admission. Renal disease was defined as a serum creatinine level of greater than or equal to 1.2 mg/dl with either a rising or falling level during the hospitalization. Thirty cases of either acute renal insufficiency or renal failure during pregnancy were identified with an incidence of one in 450 deliveries. Seventeen women had either pre-eclampsia or eclampsia. Their clinical and biochemical characteristics were reviewed and found to be similar to those of the 13 women who had other causes of acute renal dysfunction complicating their pregnancies. The mean serum creatinine for all patients in this series was 3.4 mg/dl (range: 1.2-16). Four patients required dialysis, two of whom never regained function. There were no cases of cortical necrosis. Most patients still had abnormal renal function at the time of discharge. There were 21 live births and 9 fetal deaths. Fetal death was more likely to occur with shorter gestation, higher serum creatinine, and lower platelet count. Even in cases with mild acute renal insufficiency complicating pregnancy, there was significant maternal morbidity and fetal mortality. Pre-eclampsia/eclampsia was the most common disorder associated with this problem in pregnancy. In an inner-city population, acute renal insufficiency and renal failure in pregnancy occur more frequently than previously reported; recognition of this problem is necessary to provide appropriate follow-up.