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Objective We sought to perform validation studies of previously published and newly derived first-trimester metabolomic algorithms for prediction of early preeclampsia (PE). Study Design Nuclear magnetic resonance–based metabolomic analysis was performed on first-trimester serum in 50 women who subsequently developed early PE and in 108 first-trimester controls. Random stratification and allocation was used to divide cases into a discovery group (30 early PE and 65 controls) for generation of the biomarker model(s) and a validation group (20 early PE and 43 controls) to ensure an unbiased assessment of the predictive algorithms. Cross-validation testing on the different algorithms was performed to confirm their robustness before use. Metabolites, demographic features, clinical characteristics, and uterine Doppler pulsatility index data were evaluated. Area under the receiver operator characteristic curve (AUC), 95% confidence interval (CI), sensitivity, and specificity of the biomarker models were derived. Results Validation testing found that the metabolite-only model had an AUC of 0.835 (95% CI, 0.769–0.941) with a 75% sensitivity and 74.4% specificity and for the metabolites plus uterine Doppler pulsatility index model it was 0.916 (95% CI, 0.836–0.996), 90%, and 88.4%, respectively. Predictive metabolites included arginine and 2-hydroxybutyrate, which are known to be involved in vascular dilation, and insulin resistance and impaired glucose regulation, respectively. Conclusion We found confirmatory evidence that first-trimester metabolomic biomarkers can predict future development of early PE.

The purpose of this study was to evaluate the prediction capacity of uterine artery Doppler investigation for maternal and neonatal complications in women who are admitted with severe early-onset preeclampsia.A uterine artery Doppler examination was performed at admission for patients with severe early-onset (34 weeks of gestation) preeclampsia. The maternal and neonatal outcome of women with abnormal uterine Doppler results was compared with those with normal Doppler results.One hundred twenty patients were included. In 53% of them, uterine Doppler results were abnormal. This group had a lower gestational age at delivery (30.2 vs 32.7 weeks; P.001) and a higher proportion of small-for-gestational age infants (87.5% vs 67.9%; P = .009). Neonatal (40.6% vs 14.3%; P = .01) and maternal (28.1% vs 5.4%; P = .001) complications were more common in the abnormal uterine Doppler group.Women with severe early-onset preeclampsia are at higher risk of maternal and neonatal complications if abnormal uterine blood flow is present.

An open, randomized, prospective, multicenter trial was conducted to compare the efficacy and safety of intravenous ketanserin, a selective serotonin 2 receptor blocker, with that of intravenous dihydralazine in the management of severe early-onset (32 weeks' gestation) preeclampsia. End points of this study were blood pressure control and maternal outcome.Patients with a diastolic blood pressure110 mm Hg were randomly assigned to receive either ketanserin (n = 22) or dihydralazine (n = 22) as initial therapy. Plasma volume expansion preceded antihypertensive treatment, which was administered according to a fixed schedule.The reductions in blood pressure with the 2 drugs were similar; however, adequate blood pressure control was reached significantly earlier with ketanserin (84 +/_ 63 vs 171 +/- 142 minutes, P = .017). Occurrence of maternal complications was significantly lower among patients who received ketanserin than among patients who received dihydralazine (n = 6 vs n = 18, P =.0007). A significant difference in favor of ketanserin was noted in daily fluid balance.Antihypertensive efficacies of ketanserin and dihydralazine were comparable, but significantly fewer maternal complications were noted among the patients receiving ketanserin. Ketanserin is an attractive alternative in the management of severe early-onset preeclampsia.

STUDY DESIGN: Human placental BP and CV samples were obtained from singleton pregnancies (24-41 weeks gestation). PE samples (n1⁄48) were gestational-age matched to CTL (n1⁄48). Term CTL samples were used for the labor (n1⁄48) and non-labor (n1⁄48) samples. Tissues were dissected, rinsed and frozen after delivery (