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PubMedDate not supplied

[The role of oxidative stress in the etiology of pre-eclampsia: changes at the GSH and GSH-Px levels in normal pregnancy and pre-eclampsia].

Several recent studies have reported that there is an imbalance of increased oxidant status and decreased antioxidant system in women with preeclampsia and that factor might contribute to the pathogenesis of the disease. The following study examined blood levels of some of the antioxidants (glutathione, glutathione-peroxidase and -SH groups) as markers of lipid peroxidation in women with preeclampsia compared with normal gestation. Blood levels of these antioxidants were found significantly decreased in women with preeclampsia, which allowed us to speculate that there were abnormally increased levels of lipid peroxides. We believe that lipid peroxides are toxic compounds that damage endothelial cells, increase peripheral vasoconstriction and increase thromboxane synthesis and decrease prostacyclin synthesis. We consider that lipid peroxides are not the cause but the effect of oxidative stress induced by ischaemic placenta and leukocytes activation, so the contribute but not induce pathogenesis in preeclampsia.

Adolescent↗
PubMed2004

Is pre-eclampsia more than one disease?

OBJECTIVES: The clinical characteristics of pre-eclampsia (gestational hypertension and proteinuria) may represent separate pathogenetic conditions. Pre-eclampsia accompanied by restricted fetal growth may originate from abnormal implantation, and appropriate or high birthweights may indicate a mixture of conditions, ranging from mild pre-eclampsia with modest placental involvement to hypertensive conditions without placental disease. DESIGN: Prospective, observational study. SETTING: General population. POPULATION: We used data from the Medical Birth Registry of Norway, a population-based registry that has recorded births since 1967. For this study, we used information on length of gestation and presence of pre-eclampsia among 1,679,205 singletons born between 1967 and 1998. Pre-eclampsia was diagnosed in 44,220 (2.6%) pregnancies. METHODS: We studied the risk of pre-eclampsia in relation to standardised measures (z scores) of birthweight, adjusted for length of gestation, and stratified by term and preterm delivery. We also explored whether gestational diabetes was more prevalent in conjunction with preterm than term pre-eclampsia. MAIN OUTCOME MEASURES: Pre-eclampsia diagnosed at term or preterm. RESULTS: For pre-eclampsia diagnosed around term, there was a U-shaped association with birthweight. Compared with appropriate birthweights for gestation, the risk of term pre-eclampsia was more than fourfold higher (relative risk [RR] 4.5, 95% confidence interval [CI], 4.3 to 4.7) if the baby's birthweight was lower than two standard deviations under the mean. For birthweights three standard deviations or higher than the mean, pre-eclampsia was more than twice as likely (RR 2.6, 95% CI 2.2-2.9). In contrast, the risk of preterm pre-eclampsia displayed an L-shaped association with birthweight. Low birthweight (less than -2 standard deviations) was associated with greatly increased risk (RR 9.9, 95% CI 9.1-10.9), but for high birthweights (>or=3 standard deviations), there was no association with the risk of preterm pre-eclampsia (RR 1.2, 95% CI 0.7-2.1). The prevalence of gestational diabetes was three times (prevalence ratio 3.3, 95% CI 2.6-3.6) higher in preterm than term pre-eclampsia. CONCLUSION: Whereas pre-eclampsia with preterm delivery associated with low birthweight may be caused by underlying placental abnormality, pre-eclampsia delivered at term may represent a mixture of conditions, ranging from mild pre-eclampsia with moderate placental affection to hypertensive conditions in pregnancy without placental dysfunction.

Adult↗
PubMedDate not supplied

Magnesium sulphate in the prophylaxis and treatment of eclampsia.

BACKGROUND: Magnesium Sulphate is considered to be the agent of choice for the control of eclamptic seizures in pregnant women. Our objectives were to determine frequency of eclampsia and pre-eclampsia in our unit and to determine the effect of initial loading dose of magnesium sulphate on maternal and fetal outcome. METHODS: This study was carried out in Department of Gynaecology at Lady Reading Hospital, Peshawar. In the year 2000 only 133 patients received magnesium sulphate out of 228 cases of eclampsia and pre eclampsia due to the problems with the continuous supply of the drug. This included 53 cases of eclampsia and 80 cases of pre-eclampsia. Information regarding the dosage of magnesium sulphate labor out come, maternal and fetal outcome, side effects and complications of therapy were evaluated from hospital case records. The magnesium sulphate regimen consisted of 4 gm loading dose as 20% solution intravenously over 10-15 minutes followed immediately by 5 gm into each buttock. Dose of 5 gm intramuscularly was repeated only if the patient developed convulsions. RESULTS: Eclampsia and pre-eclampsia occurred in 1 in 25.5 and 1 in 34.4 deliveries respectively. Majority of patients received the initial loading dose of magnesium sulphate, but in 2 patients' dose had to be repeated. In two patients of pregnancy induced hypertension convulsions occurred soon after delivery unheralded by any signs and symptoms of impending eclampsia. Perinatal mortality was 19 (35.8%) and 16 (20%) in eclampsia and pre-eclampsia respectively. High perinatal mortality was attributed to prematurity as only 16.98% of eclampsia and 57.5% of pre-eclampsia were more than 37 weeks. One patient of severe pre-eclampsia developed postpartum hemorrhage and acute renal failure, but she recovered while another one developed sudden postpartum collapse immediately after delivery and died due to cerebrovascular accident. 8 patients of eclampsia died despite intensive management. All of them were referred from periphery with history of multiple fits and were brought in a serious state. CONCLUSION: Frequency of eclampsia and pre-eclampsia is high in this region with high perinatal and maternal morbidity and mortality. Magnesium sulphate is an effective drug to prevent and control seizures. It is easy to administer and subsequent nursing is easy. Seizures usually terminate after the initial loading dose of magnesium sulphate.

Adolescent↗
PubMed2001

Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation.

OBJECTIVE: To determine the value of transvaginal color Doppler assessment of the uterine arteries at 23 weeks of gestation in predicting the subsequent development of pre-eclampsia and fetal growth restriction. PATIENTS AND METHODS: Women with singleton pregnancies attending for routine ultrasound examination at 23 weeks in any one of seven hospitals underwent Doppler assessment of the uterine arteries. The presence of an early diastolic notch in the waveform was noted, and the mean pulsatility index of the two arteries was calculated. Screening characteristics in the prediction of pre-eclampsia and the delivery of a low birth-weight infant were calculated. RESULTS: Doppler examination of the uterine arteries was attempted in 8335 consecutive singleton pregnancies, satisfactory waveforms were obtained from both vessels in 8202 (98.4%) cases and complete outcome data were available in 7851 (95.7%) of these. The mean gestational age was 23 (range, 22-24) weeks. The mean uterine artery pulsatility index did not change significantly with gestation (r = -0.0078; P = 0.483); the median value was 1.04 and the 95th centile was 1.63. In 9.3% of cases early diastolic notches in the waveform from both uterine arteries were present and in an additional 11.1% of cases there were notches unilaterally. Pre-eclampsia with fetal growth restriction occurred in 42 (0.5%) cases, pre-eclampsia without fetal growth restriction in 71 (0.9%) and fetal growth restriction without pre-eclampsia in 698 (8.9%). The sensitivity of increased pulsatility index above the 95th centile (1.63) for pre-eclampsia with fetal growth restriction was 69%, for pre-eclampsia without fetal growth restriction was 24%, for fetal growth restriction without pre-eclampsia was 13%, for pre-eclampsia irrespective of fetal growth restriction was 41% and for fetal growth restriction irrespective of pre-eclampsia was 16%. The sensitivity of fetal growth restriction defined by the 5th rather than the 10th centile was higher (19% vs. 16%). The sensitivity for both pre-eclampsia and fetal growth restriction was inversely related to the gestational age at delivery; when delivery occurred before 32 weeks, the sensitivity for all cases of pre-eclampsia with fetal growth restriction, pre-eclampsia without fetal growth restriction and fetal growth restriction without pre-eclampsia increased to 93%, 80% and 56%, respectively. The sensitivity of bilateral notches in predicting pre-eclampsia and/or fetal growth restriction was similar to that of increased pulsatility index but the screen-positive rate with notches (9.3%) was much higher than that with increased pulsatility index (5.1%). CONCLUSIONS: A one-stage color Doppler screening program at 23 weeks identifies most women who subsequently develop severe pre-eclampsia and/or fetal growth restriction.

Adolescent↗
PubMed2000

Review of pre-eclampsia in Taiwan: a multi-institutional study.

BACKGROUND: Because the reported frequency of pre-eclampsia in Taiwan varies significantly, the aims of this study were to measure the current incidence of pre-eclampsia and its correlated morbidity and mortality for both mothers and fetuses in Taiwan. METHODS: We retrospectively studied all reported cases of pre-eclampsia and eclampsia from January 1, 1993 to December 31, 1997 in the 14 tertiary medical centers and regional hospitals in Taiwan. Recruiting criteria were pregnancy-induced hypertension (systolic blood pressure > or = 140 mmHg or diastolic blood pressure > or = 90 mmHg) with proteinuria (> or = 300 mg of urinary protein per 24 hours) and independent part edema. RESULTS: There were 4,193 patients with pre-eclampsia and eclampsia for a frequency of 2.03% of 206,551 deliveries during the study period. Of these, 58.9% of patients were classified as having mild pre-eclampsia while 38.4% had severe pre-eclampsia. Advanced maternal age (> 35 years) (odds ratio [OR] = 4.56; 95% confidence interval [CI] = 4.23-4.90; p < 0.001), primiparity (OR = 1.71; 95% CI = 1.61-1.82; p = 0.02) and twin pregnancy (OR = 1.92; 95% CI = 1.64-2.25; p = 0.01) were significant risk factors for developing pre-eclampsia. However, multivariate analysis showed that only advanced maternal age was a significant risk factor for pre-eclampsia (OR = 3.21; 95% CI = 2.95-3.50; p < 0.001). In contrast to mild pre-eclampsia, severe pre-eclampsia resulted in significantly worse outcomes for both mothers and fetuses. Complications in patients with severe pre-eclampsia included placental abruption, acute renal failure, pulmonary edema, postpartum hemorrhage, pleural effusion, preterm labor, intrauterine growth retardation, stillbirth, neonatal mortality and low birth weight infants, all of which occurred significantly more frequently than in patients with mild pre-eclampsia (p < 0.001). CONCLUSIONS: Pre-eclampsia remains a big challenge in modern obstetrics in Taiwan. Early diagnosis and management of patients with pre-eclampsia to prevent progression would significantly improve outcomes for mothers and fetuses.

Adult↗