Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy
[Show abstract] [Hide abstract] ABSTRACT: Preeclampsia is a hypertensive multisystem disorder of pregnancy that complicates up to 10% of pregnancies worldwide and is one of the leading causes of maternal and perinatal morbidity and mortality.AIM: To evaluate maternal complications associated with severe preeclampsia.METHODS: This is a retrospective cross-sectional study conducted in the UHOG “Koço Gliozheni”, in Tirana. Primary outcomes evaluated: maternal death, eclampsia, stroke, HELLP syndrome, and pulmonary edema. Secondary outcomes: renal failure, admission in ICU, caesarean section, placental abruption, and postpartum hemorrhage. Fisher’s exact test and Chi-squared test were used as statistical methods. RESULTS: In women with severe preeclampsia we found higher rates of complications comparing to the group with preeclampsia. Eclampsia (1.5% vs. 7.1%, P < 0.001), HELLP syndrome (2.4% vs. 11.0%; P < 0.001), stroke (0.5% vs 1.9%, P = 0.105) pulmonary edema (0.25% vs. 1.3%, P = 0.0035), renal failure (0.9% vs. 2.6%, P = 0.107), admission in ICU (19.5% vs. 71.4%, P = 0.007), caesarean section rates (55.5% vs. 77%, P = 0.508), placental abruption (4.3% vs. 7.8%, P = 0.103) and severe postpartum hemorrhage (3.2% vs. 3.9%, P = 0.628). CONCLUSION: Severe preeclampsia is associated with high rates of maternal severe morbidity and early diagnosis and timely intervention can prevent life treating complications.
- "The above mentioned facts has led to widening of the preeclampsia definition including: de novo hypertension after 20 weeks' gestation and new onset of one of the following: a) proteinuria as defined above; b) renal insufficiency (creatinine > 0.09 mmol/L, or oliguria; c) liver disease (elevated transaminases and/or severe right upper quadrant or epigastric pain); d) neurological problems, convulsions (eclampsia), hyperreflexia with clonus, severe headaches, persistent visual disturbances; e) hematological disturbances: thrombocytopenia, DIC (Disseminated Intravascular Coagulation), hemolysis; or f) fetal growth restriction . According to American College of Obstetrics and Gynecology (ACOG) diagnostic criteria, the diagnosis of severe preeclampsia includes severe hypertension (systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 110 mmHg, or both), neurological disturbances (such as headache, visual disturbances, and exaggerated tendon reflexes), epigastric or right upper quadrant pain, oliguria (less than 500 mL in 24 hours), pulmonary edema, cyanosis, impaired liver function, thrombocytopenia or intrauterine growth restriction (IUGR) . Preeclampsia and eclampsia account for 10– 15% of maternal deaths worldwide . "
[Show abstract] [Hide abstract] ABSTRACT: Introduction. All findings of preeclampsia appear as the clinical consequences of diffuse endothelial dysfunction. Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) was recently introduced as a TNF related cytokine in various inflammatory and noninflammatory disorders. sTWEAK was found to be related to endothelial dysfunction in patients with chronic kidney disease. In our study we aimed to compare sTWEAK levels in women with preeclampsia to corresponding levels in a healthy pregnant control group. Materials and Methods. The study was undertaken with 33 patients with preeclampsia and 33 normal pregnant women. The concentration of sTWEAK in serum was calculated with an enzyme linked immunosorbent assay (ELISA) kit. Results. Serum creatinine, uric acid, LDH levels, and uPCR were significantly higher in the patient group compared to the control group. sTWEAK levels were significantly lower in preeclamptic patients (332 ± 144 pg/mL) than in control subjects (412 ± 166 pg/mL) ( p = 0.04 ). Discussion. Our study demonstrates that sTWEAK is decreased in patients with preeclampsia compared to healthy pregnant women. There is a need for further studies to identify the role of sTWEAK in the pathogenesis of preeclampsia and to determine whether it can be regarded as a predictor of the development of preeclampsia.
- "Severe preeclampsia was defined as preeclampsia complicated by either a systolic BP ≥ 160 mm and/or a diastolic BP ≥ 110 mmHg (on 2 occasions at least 4 hours apart while the patient was on bed rest) and/or pulmonary edema and/or renal abnormality (progressive renal insufficiency; serum creatinine > 1.1 mg/dL) and/or cerebral/visual symptoms (persistent headaches, neurological symptoms, and visual disturbances) and/or hepatic abnormality (severe epigastric or right upper quadrant pain and/or liver transaminases at least twice the normal concentration) and/or platelet count < 100,000/microliter. According to the new preeclampsia criteria , patients with new onset hypertension (BP ≥ 140/90) without proteinuria were accepted to have severe preeclampsia if they had one of the above criteria. Exclusion criteria included twin or multiple pregnancies or any evidence of previous medical disease. "
[Show abstract] [Hide abstract] ABSTRACT: Abstract Aim: Familial Mediterranean Fever (FMF) is the most common hereditary monogenic auto-inflammatory disease. Studies suggest that inflammation persists even in attack-free periods in FMF patients. In this study, we aim to investigate the potential of simple blood parameters including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte/ monocyte ratio (LMR), mean platelet volume (MPV), and platelet distributed width (PDW) as emerging inflammatory markers to identify chronic inflammations during symptom-free periods in a group of pregnant patients with FMF. Material and Method: A total of consecutive 65 singleton pregnancies, 33 with FMF and the other 32 healthy women, were followed from the first trimester to the end of the pregnancies. Blood samples for biochemical analyses (C-reactive protein, fibrinogen) and a complete blood count were obtained at 11-13 weeks and at 16-19 weeks following a detailed examination. Results: While the mean, NLR, PLR, PDW, fibrinogen, and LMR values were comparable between the groups, the mean hs-CRP levels were significantly higher and MPV values were significantly lower in the FMF group compared with the control group at both the first and second trimester. There was a significant negative correlation between hs-CRP levels with MPV at second trimester (r= -0.375 p=0.003). Discussion: Since all of our FMF patients had already been on regular colchicine therapy on admission, we admit, at least theoretically, that the anti-inflammatory and potential effects of colchicine on platelets could have altered our results. Otherwise, MPV may be used as a negative acute-phase reactant in pregnant patients with FMF. Keywords:Inflammation;Lymphocyte to Monocyte Ratio;Neutrophil to Lymphocyte Ratio; pregnancy; Platelet
- "None of the patients or controls had a multiple pregnancy, active labor , or pre-existing chronic systemic disease. The diagnosis of preeclampsia was based on a systolic blood pressure of ≥140 mmHg or diastolic blood pressure ≥90 mmHg, measured twice in four-hour intervals while resting, after the 20th gestational week, as well as 300 mg/dL proteinuria detected in a 24-hour urine sample . Preterm birth was defined as delivery before 37 weeks of pregnancy were completed. "
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