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Introduction Posterior reversible encephalopathy syndrome (PRES) is frequently observed in patients with eclampsia, and some of them also develop cerebral vasoconstriction. These radiological changes have been suggested as an essential component of eclampsia-mediated primary central nervous system injury. On the other hand, it is also reported that some pre-eclamptic patients with neurological symptoms develop PRES and cerebral vasoconstriction; however, the incidence is still unclear. Objectives The aim of this study was to determine the incidence of PRES and cerebral vasoconstriction in pre-eclamptic and eclamptic patients and to assess whether these two patient groups share similar pathophysiological backgrounds by comparing clinical and radiological characteristics. Materials & methods This was a retrospective cohort study of 4849 pregnant patients. A total of 49 eclamptic and pre-eclamptic patients with neurological symptoms underwent magnetic resonance imaging (MRI) and magnetic resonance angiography; 10 patients were excluded from further analysis because of a history of epilepsy or dissociative disorder. The age, parity, blood pressure, and routine laboratory data at the onset of symptoms were also recorded. For data that were considered to be normally distributed, unpaired t test or Welch’s test was used based on the homogeneity of variances. Otherwise, the Mann–Whitney U test was used for continuous data. Results Among 39 patients with neurological symptoms, 12 out of 13 (92.3%) eclamptic patients and 5 out of 26 (19.2%) pre-eclamptic patients developed PRES. Among PRES patients, 4 out of 12 (33.3%) eclamptic patients and 2 out of 5 (40.0%) pre-eclamptic patients developed cerebral vasoconstriction. Whereas age and systolic and diastolic blood pressure at onset were not different between PRES and non-MRI abnormality patients, hematocrit, serum creatinine, aspartate transaminase, alanine transaminase, and lactate dehydrogenase were higher in patients with PRES than those without MRI abnormalities. In contrast, eclamptic patients with PRES did not show any significant differences in clinical and laboratory data compared with pre-eclamptic patients with PRES. In addition to the parieto-occipital regions, atypical regions such as the frontal and temporal lobes, and basal ganglia were also involved in both eclamptic and pre-eclamptic patients with PRES. Finally, intraparenchymal hemorrhage was detected in one eclamptic patient, and subarachnoid hemorrhage was observed in one pre-eclamptic patient. Both of them developed PRES and cerebral vasoconstriction. Conclusion Although the incidence of PRES was high in eclamptic patients, nearly 20% pre-eclamptic patients with neurological symptoms also developed PRES. The similarities in clinical and radiological findings of PRES between the two groups indicate a shared pathophysiological background. Similar incidence of cerebral vasoconstriction in eclamptic and pre-eclamptic patients with PRES also supports this hypothesis. PRES was not benign and reversible disease, and coincidence of PRES and cerebral vasoconstriction might be a high-risk group of hemorrhagic complications. Therefore, MRI studies should be considered for patients with the recent onset of neurological symptoms regardless of the development of eclampsia. [ABSTRACT FROM AUTHOR]

Introduction Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure towards the end of pregnancy or in the months following delivery without other causes of heart failure. PPCM is a life-threatening disease, and twin pregnancy and preeclampsia are considered risk factors of peripartum cardiomyopathy. While preeclampsia causes heart failure because of diastolic dysfunction, which is caused by heart remodeling for the adaptation to hypertension, twin pregnancy can also be a stress on maternal heart because twin pregnant women are exposed to more significant hemodynamic changes than singleton pregnant women. However, the effect of preeclampsia on maternal cardiac function in twin pregnant women remains unclear. Objectives The aim of this study was to examine whether preeclampsia had additive effect on maternal cardiac function in twin pregnant women and to investigate longitudinal changes of maternal cardiac function. Methods This was a single center prospective cohort study. A total of 144 patients with twin pregnancy who underwent perinatal check-ups and delivered at our hospital between January 2010 and February 2015 were enrolled in this study. Among the twin pregnant patients, 22 patients had preeclampsia. Thirty-two singleton pregnant women without any complications were enrolled as the control group. Trans-thoracic echocardiography was examined at the early (11–23 gestational weeks), middle (24–33 gestational weeks), and late stages of pregnancy (34–40 gestational weeks), within 5 days postpartum, and one month postpartum. The left ventricular ejection fraction (LVEF) and early transmitral velocity/early diastolic velocity of the mitral annulus (E/e’) were measured to evaluate systolic and diastolic cardiac functions. Results Maternal age and pre-pregnancy BMI were not different among three groups. Although LVEF tended to decrease at late pregnancy in twin patients with preeclampsia, statistically significant changes of LVEF were not detected in all groups. On the other hand, E/e’ elevation was observed at late pregnancy (9.6 ± 2.8, p < 0.01) and within 5 days of delivery (9.7 ± 2.2, p < 0.01) compared with early pregnancy (7.8 ± 1.9) in twin pregnant women without preeclampsia, whereas E/e’ did not significantly change in singleton pregnant women. Twin pregnant women with preeclampsia also developed E/e’ elevation at middle pregnancy (9.6 ± 2.6, p < 0.03), late pregnancy (12.8 ± 4.6, p < 0.01) and within 5 days of delivery (10.8 ± 2.9, p < 0.01) compared with early pregnancy(7.8 ± 1.8). E/e’ of twin pregnant women with preeclampsia at middle pregnancy ( p = 0.02) and late pregnancy ( p = 0.02) were significantly higher than that of twin pregnant women without preeclampsia. The figure shows longitudinal cardiac function changes of twin pregnant women with or without preeclampsia. Conclusions Twin pregnancy and preeclampsia deteriorate maternal cardiac function, and the diastolic function was predominantly affected. Twin pregnant patients compromised by preeclampsia had a risk of earlier and more severe deterioration of maternal cardiac function. Twin pregnant patients with preeclampsia should be considered as a high-risk group of cardiac dysfunction especially from the late stage of pregnancy to the early postpartum period. [ABSTRACT FROM AUTHOR]

Introduction Preeclampsia is one of the major causes of maternal and perinatal mortality and morbidities. Pregnancy is characterized by certain structural and functional changes in the cardiovascular systems. However, to date, few studies were conducted about the influence in severity of preeclampsia to maternal cardiac function and the structural changes. Objectives We examined maternal cardiac function in patients with preeclampsia during peripartum period and compared with normal pregnant women. Methods A total of 138 singleton patients with preeclampsia and 18 singleton pregnant women without preeclampsia were enrolled in this study. We defined severe preeclampsia as systolic blood pressure over 160 mmHg or diastolic blood pressure over 110 mmHg. Echocardiography was conducted three times during peripartum period; late stage of pregnancy, early postpartum and one-month postpartum. We did not perform echocardiography at one-month postpartum to the non-preeclamptic women. We measured intraventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (EF), left atrium diameter (LAD) and early transmitral velocity/early diastolic velocity of the mitral annulus (E/e′). Statistical analysis of covariance with age were performed with the SPSS software package. Results There were 87 patients who had severe preeclampsia, 51 patients with mild preeclampsia and 18 normal pregnant women. In these groups, there were no differences in pre-pregnancy BMI. In late stage of pregnancy, whereas only IVST was significantly dilated between the normal pregnant and mild preeclampsia, some parameters were significantly decayed in the patients with severe preeclampsia. All parameters excluded LVIDs and EF were dilated between the normal and severe preeclampsia. IVST, LVIDd and LAD were significantly different between the mild and severe preeclampsia. In early postpartum, there were no differences between the normal and mild preeclampsia. LVIDs was significantly dilated in severe preeclampsia compared with normal pregnant women. LVIDd, LVIDs and LAD were significantly different in the mild and severe preeclampsia. In one-month postpartum, LVIDd and LVIDs were significantly different between the preeclampsia patients. Concerned about EF, there was no significantly difference in three groups through these periods. The table shows these detailed results. Conclusion Mild preeclampsia had influences on maternal cardiac functions and, after delivery, the changes recovered within a few days. However, severe preeclampsia patients got cardiac remodeling and these changes did not recover completely even one-month postpartum. Not only anatomical changes but also left ventricular diastolic function deteriorated in severe preeclampsia compared with mild preeclampsia patients and normal pregnant women. Therefore, the severity of preeclampsia should be considered when examining maternal cardiac function and the risk of future cardiovascular disease in patients with preeclampsia. [ABSTRACT FROM AUTHOR]

Introduction Preeclampsia causes multiple organ damage and 3% of women with severe preeclampsia cause heart failure. Although trans-thoracic echocardiography is essential for the evaluation of cardiac function, it is practically difficult to use echocardiography for the screening of heart failure in preeclamptic women. Brain natriuretic peptide (BNP) is a useful serum maker for the evaluation of cardiac function, and BNP monitoring has a potential to improve management of cardiac dysfunction; however, BNP levels are affected by age, sex, kidney function, and body mass index (BMI). Objectives The aim of this study is to examine the BNP levels in preeclamptic women and confounding factors which affect BNP levels. Methods This was a single-center prospective study from 2013 to 2015. We enrolled 137 preeclamptic women and 773 normal pregnant women. Twin pregnant women were excluded. Serum BNP was examined before delivery: after the diagnosis of preeclampsia in preeclamptic women and at late pregnancy (35–37th gestational week) in normal pregnant women and after delivery: within 4 days postpartum. Echocardiography was also performed at the same timing of BNP monitoring in preeclamptic patients. Baseline characteristics, pre-delivery BNP, and post-delivery BNP between normal pregnant and preeclamptic women were analyzed with independent t-test. Multiple regression analysis was conducted to examine the confounding factors of BNP levels in eclamptic women, and age, pre-pregnancy BMI, serum creatinine, systolic blood pressure, diastolic blood pressure, ejection fraction (EF), and early transmitral velocity/early diastolic velocity of the mitral annulus (E/e’) were used as independent variables. In addition, blood loss at delivery was also included in the analysis of post-delivery BNP. Results Age of normal and preeclamptic women were 34.1 ± 5.2 and 33.6 ± 5.8, p = 0.27. BMI were 21.7 ± 4.0 and 23.1 ± 5.3, p < 0.01. Pre-delivery BNP levels were 17.9 ± 13.7 and 82.9 ± 103.6, p < 0.01. Post-delivery BNP levels were 42.5 ± 35.8 and 63.1 ± 71.8, p < 0.01. The results of multiple regression analysis of pre-delivery and post-delivery BNP are described in the Table. Pre-delivery BNP was related with EF, which is an indicator of left ventricular systolic function. Pre-pregnancy BMI, serum creatinine, and systolic blood pressure also affected pre-delivery BNP levels. On the other hand, post-delivery BNP was related with E/e’, which is an indicator of left ventricular diastolic function. Pre-pregnancy BMI and blood loss at delivery significantly affected post-delivery BNP levels. Conclusions BNP levels deteriorated after delivery in normal pregnant women while BNP levels improved after delivery in preeclamptic women. Delivery causes a stress on maternal heart, but recovery from preeclampsia had bigger impact on BNP levels. Although BNP levels reflected maternal cardiac function, the effect of pre-pregnancy BMI, kidney function, blood pressure, and blood loss at delivery should be considered when using BNP monitoring in preeclamptic women. Besides, pre-pregnancy BMI was negatively related with BNP levels although obesity is a risk factor of heart failure. [ABSTRACT FROM AUTHOR]