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The sFlt-1/PlGF ratio is a biomarker used in the prediction, diagnosis and management of hypertensive disorders of pregnancy. In preeclampsia, there is an imbalance between angiogenic and anti-angiogenic factors, leading to decreased levels of PlGF and to increased levels of sFlt-1. An elevated sFlt-1/PlGF ratio is associated with an increased risk of developing preeclampsia within the subsequent four weeks. The aim of this article was to review the recent evidence regarding the utility of sFlt-1/PlGF ratio in fetal growth restriction, stillbirth and preterm birth. Although the clinical utility of sFlt-1, PlGF and the sFlt-1/PlGF ratio is high, and it has been known to be valuable in pregnancies complicated by preeclampsia, further research with a higher number of cases needs to be done in order to implement the biomarkers in guidelines for other issues such as fetal growth restriction, stillbirth and other adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia is a life-threatening complication of pregnancy that occurs in approximately 7% of all pregnancies. In India, the incidence of preeclampsia is 8%--10% and the prevalence is 5.4%, whereas the prevalence of hypertensive disorders of pregnancy is 7.8%. Aim and Objectives: This study was aimed at evaluating the diagnostic accuracy of serum glycosylated fibronectin (S. GlyFn) in the prediction of preeclampsia. Methods: A nested case--control study was carried out for 16 months in the department of obstetrics and gynecology. A total of 240 women were recruited and followed after written consent and ethical clearance. Six were lost to follow-up, 15 had second-trimester abortions (excluded from the study), and 32 women developed hypertensive disorders of pregnancy (cases), out of which 1 woman developed antepartum eclampsia, 10 women developed preeclampsia with severe features, and 21 women developed preeclampsia without severe features. One hundred and eighty-seven women remained normotensive throughout the pregnancy until 6 weeks postpartum. After randomization, out of these samples, 54 were analyzed and considered controls. Levels of S. GlyFn were estimated using an ELISA kit using the ELISA technique. Results: The mean S. GlyFn level was significantly higher at the time of enrollment among those women who later developed preeclampsia (127.59 ± 27.68 ng/m) as compared to controls (107.79--53.51 ng/mL). GlyFn at a cutoff value of 126.70 ng/mL significantly (P = 0.034) discriminates cases of preeclampsia with severe features from healthy controls with a sensitivity of 90.00%, a specificity of 63.00%, a 31.03% positive predictive value, and 97.14% negative predictive value. Conclusion: S. GlyFn, at a cutoff value of 126.70 ng/mL, had good sensitivity to discriminate PE from normotensive and was also a good prognostic marker. [ABSTRACT FROM AUTHOR]

Preeclampsia is a major cause of increased maternal and perinatal morbidity and mortality with an incidence between 2% and 8% of all pregnancies. The association of preeclampsia with fetal intrauterine growth restriction and prematurity often leads to long-term consequences. Administration of low molecular weight heparin (LWMH) may improve placental development and inhibit the reactive pathways involved in pre-eclampsia and intrauterine growth restriction (IUGR). We conducted a retrospective observational study, over a 12-month period, in a third-degree maternity in the Clinical Emergency County Hospital from Craiova. The study included a number of 1200 patients examined starting with the first trimester of pregnancy. A combined screening algorithm was applied to these patients. This algorithm included: maternal history of preeclampsia, mean blood pressure values, Doppler assessment of the uterine arteries and serum level of the placental growth factor (PIGF). During this screening we identified a number of 82 patients at high risk of preeclampsia. The objective of the study was to evaluate the impact of the antiplatelet therapy compared to combined antiplatelet and anticoagulant therapy in the occurrence of preeclampsia and intrauterine growth restriction. The results of the study showed an outcome improvement by reducing the risk of preeclampsia and IUGR in patients who were treated with combined therapy vs monotherapy. [ABSTRACT FROM AUTHOR]

Preeclampsia, affecting 5-10% of pregnancies, is a major cause of maternal and fetal morbidity and mortality, characterized by elevated blood pressure and proteinuria after 20 weeks of gestation. The complications include intrauterine growth restriction, eclampsia, placental abruption, and HELLP syndrome. Effective first-trimester screening, recommended by international societies, considers maternal risk factors such as the PlGF (placental growth factor) value, the pulsatility index of the uterine arteries, and the mean blood pressure. Advances in soluble biomarkers, especially the sFlt-1/PlGF ratio, offer improved early diagnosis and management by predicting preeclampsia weeks before the symptoms appear. Preventive measures – notably, low-dose aspirin – have been validated by the ASPRE study, showing a 62% reduction in preterm preeclampsia risk when administered from 11-14 weeks of gestation. Implementing these screening and prevention strategies nationwide, especially in resource-limited areas, is essential to reduce the incidence and to improve the outcomes for mothers and babies. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE), a chronic autoimmune disease predominantly affecting women during their reproductive years, presents unique challenges during pregnancy. This retrospective study, conducted at the Obstetrics and Gynecology Department of the Emergency University Hospital Bucharest, between 2021 and 2023, analyzes three cases of SLE in pregnancy to elucidate maternal and neonatal outcomes. Through the analysis of three compelling cases, the study navigates the complexities of severe preeclampsia, SLE flares, thrombocytopenia, intrauterine growth restriction and preterm delivery, each demanding a nuanced approach. The findings underscore the critical role of interdisciplinary collaboration and meticulous medication management, with a specific focus on the compatibility and efficacy of hydroxychloroquine. By unraveling the diverse clinical presentations and outcomes, the study contributes with valuable insights into optimizing pregnancy care for women grappling with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

This review summarises the issues raised by recent advances in the genetics of pre-eclampsia (PE), and in particular highlights the clear discrepancy between the high heritability of this disease (~50%) and the variance explained by the handful of genes identified, through various approaches (genome wide associations studies, genetic linkage analysis in families and analysis of genetic variants present in candidate genes). A broader examination of missing heritability in complex traits is presented. The aim of this article is to provide a personal view of some of the major issues raised by genetic studies of preeclampsia in relation to important questions about the heritability of complex phenotypes. [ABSTRACT FROM AUTHOR]

Nowadays, preeclampsia is a common condition, with up to 5-10% of pregnancies being associated with this disease. In addition to the devastating effects preeclampsia can have on the pregnant woman, by increasing her risk of thromboembolic events, intracerebral hemorrhage, HELLP syndrome, eclampsia or damage to other organs, the fetus is also at risk if the disease is not diagnosed and controlled on time. We present a review of the effects of maternal preeclampsia on the newborn. Due to the placental hypoperfusion caused by preeclampsia, the fetus may have restricted intrauterine growth, iatrogenic premature birth, oligoamnios, neonatal respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, neurodevelopmental sequelae, including cerebral palsy, gastrointestinal disorders, such as necrotizing enterocolitis, sepsis or even intrauterine death. Thus, the diagnosis and monitoring of this pathology as early as possible become an important obligation of the obstetrician, as these are crucial for the benefit of both the mother and the newborn. The treatment of preeclampsia also represents a challenge, given the fact that, until now, there are no therapeutic management protocols, and all drug options come with the associated reactions or complications, delivery representing the only curative outcome. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La prise en charge de la prééclampsie est bien codifiée en phase aigüe, mais le devenir des patientes en post-partum l'est bien moins. Pourtant, la prééclampsie est associée à un excès de risque de morbimortalité cardiovasculaire au long cours. Un parcours de soin a été créé au Centre Hospitalier Universitaire de Nantes pour évaluer à distance de l'accouchement les facteurs de risque cardiovasculaires des patientes ayant présenté une prééclampsie. Notre étude en présente les premiers résultats. Nous avons inclus 134 patientes entre octobre 2016 et janvier 2019 qui ont présenté une prééclampsie dans la région nantaise et qui ont bénéficié de ce dépistage dans l'année suivant leur accouchement. L'hypertension artérielle était persistante chez 28 patientes (20,9 %). Trente-quatre patientes étaient obèses (25,3 %) et un diabète a été diagnostiqué chez une patiente. L'hypertension artérielle était à prédominance diastolique, légère et dans plus d'un tiers des cas masquée (35,7 % de pression artérielle normale lors de la consultation mais élevée sur les mesures à domicile). Une hypertension artérielle secondaire (cause hormonale ou rénale) a été identifiée dans un tiers des cas (32,1 %). L'hypertension survenait plus souvent chez les patientes plus âgées (OR : 2,26 ; IC 95 % : 1,25- 4,11, p = 0,072), originaire d'Afrique sub-saharienne (OR : 11,52 ; IC 95 % : 2,67- 49,86, p = 0,01) et multipares (OR : 7,82 ; IC 95 % : 1,15- 53,21, p = 0,035). Ce parcours de soins permet donc de dépister et de prendre en charge précocement les facteurs de risque cardiovasculaire de ces jeunes femmes. The medical treatment of preeclampsia is well structured in its acute phase but the required follow-up with patients in post-partum is discussed. However, preeclampsia is associated with an increased risk of cardiovascular morbi-mortality in the long term. In order to optimize the post-partum treatment, a care program has been developed for these patients in the city of Nantes, France. This includes a check-up of the cardiovascular risks at a day hospital. Our study presents the first results of this program. The study included 134 patients who were diagnosed with preeclampsia between October 2016 and January 2019 in the Nantes area, France, and took part in the program within the year following their childbirth. A descriptive analysis was first carried out and then a multivariate logistic regression model was used to investigate the risk factors for persistent high blood pressure after preeclampsia. The study detected 28 cases of persistent hypertension (20.9%), 34 cases of obesity (25.3%) and 1 case of diabetes. Hypertension was predominantly diastolic, mild and sometimes masked (35.7%). In a third of the cases (32.1%), the hypertension was secondary. High blood pressure was found to be more frequent in older patients (OR: 2.26; 95% CI: 1.25-4.11, p = 0.072), patients from sub-Saharan Africa (OR: 11.52; 95% CI: 2.67-49.86, p = 0.01) and multiparous patients (OR: 7.82; 95% CI: 1.15-53.21, p = 0.035). The study confirmed that this care program enables an earlier detection and therefore treatment of the cardiovascular risk factors of these young women. [ABSTRACT FROM AUTHOR]

Between 2016 and 2018, 13 maternal deaths were due to hypertensive disorders. During this period, the maternal mortality ratio was 0.6/100 000 live births. Hypertensive disorders were responsible for 4.8% of maternal deaths during the first year, 5.1% up to 42 days postpartum and for 13.5% of direct maternal mortality. Maternal deaths due to hypertensive disorders increased close to signification (p=0.09) compared to the last triennium (MMR=0.2/100.000). Classification of the hypertensive disorders was: 5 severe preeclampsia, 3 eclampsia, 4 HELLP syndromes et 1 undefined hypertension. In five cases, a stroke was associated. Mode of delivery was a cesarean section when the hypertensive disorder started before the labour (8/13, 62%). Six women were older than 35years old and 5/12 were nulliparous. Among the 12 cases where place of birth was known, 5 were born foreigners. BMI was over 30 for 46%. Medical care were estimated non optimal in 11/13 of the cases. Among these deaths, 66% (8/12) seemed to be preventable versus 82% for the last period 2013-2015. The main causal factor of suboptimal management was inappropriate management by the obstetrical or anesthetist/intensive care squads, respectively: 3 lack of diagnosis, 8 delays for diagnosis and 5 underestimated severity. Four cases corresponded to inappropriate health care organization. This study offers the opportunity to stress major points to optimize medical management and health care organization facing hypertensive disorders during pregnancy., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Le syndrome miroir ou syndrome de Ballantyne est une entité pathologique rare, définit par l'association d'une anasarque fœtale et d'un œdème maternel généralisé pouvant se compliquer d'une prééclampsie. L'objectif de ce travail est de mettre en exergue les particularités diagnostic et thérapeutique de cette entité clinique grave, qui, en dépit de sa rareté, ne doit pas être méconnu. Et ceux à travers la description d'un cas clinique d'une parturiente de 35 ans qui s'est présentée aux urgences, à 26 semaines d'aménorrhée, dans un tableau de syndrome miroir idiopathique dont l'évolution fut rapidement marquée par la survenue d'un décès in utéro puis régression de la symptomatologie clinico-biologique maternelle une fois la vacuité utérine obtenue. En effet, un traitement spécifique in utéro est vivement souhaitable. Quoique dans certains cas graves idiopathiques, seule l'obtention de la vacuité utérine permet l'amélioration du pronostic maternel voire fœtale.

l s'agit d'une études observationnelle descriptive, portant sur une période de cinq années, qui s'étalent du 1er janvier 2012 au 31 décembre 2016, ayant comme l'objectif principal était d'estimer la prévalence de la prééclampsie (PE) dans la région du grand Casablanca (Maroc). Cette étude a été réalisée sur la base de l'activité du service de gynécologie-obstétrique du centre hospitalier universitaire Ibn Rochd de Casablanca au Maroc, où 1034 cas de prééclampsie ont été colligés. Durant la période d'étude, 14719 femmes ont accouché dans notre structure, pendant cette même période, nous avons recensé 1034 cas de prééclampsie. La prééclampsie était plus fréquemment rencontrée dans la tranche d'âge 30-39 ans (46%), il s'agissait le plus souvent de primigestes (57%). Dans notre série, les complications maternelles étaient représentées par l'hématome rétro-placentaire (HRP) dans 100cas (9,67%) dont 30 ont développé une coagulation intra vasculaire disséminée (CIVD), l'éclampsie dans 63 cas (6%), le HELLP syndrome dans 24 cas (2,3%). Les principales complications fœtales étaient représentées par la mort fœtale in utero dans 96 cas soit 9,3% (dont 40 étaient en rapport avec un HRP), la prématurité dans 88 cas (8,5%). Le taux de 7% retrouvé dans notre série est élevé par rapport à la prévalence globale de la prééclampsie qui est chiffrée entre 3 et 5% des grossesses dans le monde. L'absence de consultation pré natale, la sensibilisation des femmes quant à la grossesse expliquent que les pré-éclamptiques arrivent à des stades avancés des complications.

Placental anomalies have been associated with a higher incidence of maternal and fetal morbidity and mortality. Succenturiate placenta is a rare morphological abnormality of the placenta in which there are one or more accessory lobes connected to the main placental mass by blood vessels. We report the case of a 23-year-old woman who was referred to the prenatal diagnosis center at 20 weeks of gestation due to early fetal growth restriction. This pregnancy was also complicated by preeclampsia and placental abruption. Postpartum, there was an incidental finding of succenturiate placental lobe. The diagnosis of succenturiate placenta in the prenatal period is essential in order to allow an adequate pregnancy follow-up, as well as to avoid pre- and postnatal complications. [ABSTRACT FROM AUTHOR]

Pregnancy-induced hypertension is diagnosed by an increase in systolic blood pressure above 140 mmHg and diastolic blood pressure above 90 mmHg, after 20 weeks of gestational age, in a normotensive pregnant woman before pregnancy. The preeclamptic syndrome is specific to gestation, can affect all organs, and is characterized by the association of hypertension, proteinuria and oedemas. The aim of this paper is that, through early clinical-paraclinical and especially ultrasound monitoring, to achieve an adequate completion of pregnancy and childbirth, with at least three fundamental objectives: minimal maternal and foetal trauma; the birth of a child with the highest chances of survival, with an immediate and distant good functional prognosis; the complete restoration of the mother’s health condition, allowing an optimal life, with a good, reproductive and maternal prognosis in the future. Early clinical- paraclinical and especially ultrasound monitoring ensure an adequate completion of the pregnancy to term and childbirth. The foetal ultrasound, the foetal biophysical score and the multivascular Doppler velocimetry are of major importance in determining the obstetrical attitude – vaginal birth or foetal removal by caesarean section, in correlation with foetal intrauterine vitality, weight and Apgar score. The foetal, vital and functional prognosis, immediate and distant, was good. The complete restoration of the mother’s health allows an optimal life, with a good reproductive and maternal prognosis in the future. [ABSTRACT FROM AUTHOR]

Mirror syndrome or Ballantyne syndrome is a rare disease, characterized by the association between fetal anasarca and maternal generalized edema. This may be complicated by pre-eclampsia. The purpose of this study was to highlight the diagnostic and therapeutic features of this severe clinical entity, which, despite its rarity, should be suspected. We here report the clinical case of a 35-year-old parturient woman at 26 weeks of amenorrhea presenting to the Emergency Department with idiopathic mirror syndrome whose progression was rapidly marked by the occurrence of intrauterine fetal death and remission of maternal clinical-biological symptoms, once uterine vacuity was obtained. Indeed, a specific treatment in uterus is necessary, although in some severe idiopathic cases, only uterine vacuity can improve maternal and fetal prognosis. [ABSTRACT FROM AUTHOR]

Preeclampsia is a disease characteristic only to human pregnancy, birth being its only healing method. The morbidity and mortality associated with this condition are considerable, therefore therapies aimed at preventing the development of preeclampsia, which could delay the onset of the disease or decrease its severity, are essential. Pregnant women with an increased risk of thromboembolic disease require anticoagulant treatment throughout pregnancy. The effects and pharmacokinetics of the anticoagulant treatment used are mandatory to be known, given that in some cases the teratogenic effect may be present and in all cases the adaptation of the treatment near and during labor must be individualized. The low-molecular-weight heparin (LMWH) response is more predictable than unfractionated heparin, and in the context of adverse effects and unlikely overdose, routine monitoring by biological tests is not required. For each patient undergoing anticoagulant treatment during pregnancy for the purpose of preventing thrombotic injury, there should be explained the signs and symptoms of thrombosis, taking into account the fact that, even though the thrombotic risk is very low under anticoagulant treatment, a degree of risk still persists in pregnancy. Preeclampsia risk assessment project aims to gather all the data regarding the personal and familial history, obsterical and clinical data that impact the risk of developing a hypertensive pathology in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. Hypertensive complications of pregnancy can often lead to serious, even life-threatening situations for the mother and fetus. First-trimester uterine artery Doppler can be a predictive tool for such complications. Materials and method. We examined 305 pregnant patients, from 11 weeks to 13 weeks+6 days gestational age, by ultrasound, in our hospital, both as inpatients and outpatients, and we have assessed the evolution of their pregnancy. Results. There were 21 patients with hypertensive pregnancy complications (6.89%) and 284 patients with normal outcome (93.11%). Three patients had pregnancy- induced hypertension (0.98%), and 18 had preeclampsia (PE; 5.9%), with 12 cases of mild PE (3.95%) and six cases of severe PE (1.97%). The sensitivity for uterine artery PI above the 95th percentile, for uterine artery RI above the 95th percentile, and for uterine artery PI/RI above the 95th percentile was 0%, 0-33.33% and 0%, respectively. The specificity was 94.72- 95.03%, 94.98-95.42% and 94.98-95.03%, respectively. The positive predictive value was 0%, 0-13.33% and 0%, respectively. The negative predictive value was 92.76-98.97%, 93.45-99.31% and 92.76-98.97%, respectively. Odds ratios were 0.453-3.966, 1.147-10.286 and 0.453-3.966, respectively. Conclusions. Uterine artery Doppler indices above the 95th percentile during the 11-14 week gestational age offers low to medium detection rates, the best index being the resistivity index. [ABSTRACT FROM AUTHOR]

Physiological changes during normal pregnancy may contribute to the clinical onset of a variety of pregnancy-related complications. In the third trimester of pregnancy or in the first week postpartum, there is a higher risk of viral reactivation, as well as much more frequent pregnancy complications, such as hypertensive disorders and gestational diabetes. Considerably higher than in nonpregnant population, Bell’s palsy or the idiopathic peripheral facial palsy has a higher rate in pregnancy, especially in the third trimester or postpartum. The condition usually resolves spontaneously or with minimal treatment, although in some cases it may require a complex management. Further studies that compare treatment dosage, therapeutic agents and time of recovery when treating Bell’s palsy are needed to update the currently management. [ABSTRACT FROM AUTHOR]

Obiectiv. Identificarea modificărilor calitative şi cantitative ale mutaţiile factorilor de coagulare implicate în complicaţii materne şi fetale, determinarea nivelului de corelaţie dintre acestea şi gradul de implicare al trombofiliei ereditare în rândul femeilor însărcinate. Material şi metodă. Articolul se bazează pe 92 de publicaţii din 1995 până în 2017, incluzând 49.127 de paciente cu trombofilie, dintre care 1.272 au fost martori, având drept criterii de includere în studiu prezenţa preeclampsiei, retardul de creştere intrauterină sau pierderea timpurie sau tardivă a sarcinii. Rezultate. 31 studii bazate pe preeclampsie demonstrează implicarea mutaţiei genei G1691A factor V Leiden, a mutaţiei genei G20210A a protrombinei şi a mutaţiei genei C677T şi A1298C MTHFR ca factori principali în dezvoltarea acestei complicaţii. 10 studii se concentrează asupra gradului de restricţie de creştere intrauterine, iar mutaţia genei G20210A a factorului V Leiden, mutaţia genei G20210A a protrombinei, mutaţia genei C677T şi A1298C MTHFR, deficitul de proteina C şi proteină S fiind principalii factori implicaţi. Alte 32 de studii citează implicarea mutaţiei factorului V Leiden, a mutaţiei protrombinei şi a mutaţiei MTHFR în dezvoltarea pierderilor de sarcină precoce sau tardive. Concluzii. Pe baza a 92 de publicaţii riguros selectate, am putut demonstra relaţia dintre trombofilia cu risc mediu/crescut şi rezultatul sarcinii, în special din cauza prezenţei mutaţiei genei factor V Leiden, a mutaţiei genei protrombinei, dar şi a statusului homozigot al mutaţiei genei MTHFR.

Preeclampsia is an increasingly frequent condition that affects pregnant women and, if undetected in a timely fashion, can be a source of morbidity and mortality for both mother and child. Both PlGF and Flt-1 have been involved in the mechanisms behind this pathology, and are currently being used both as diagnostic markers and possible therapeutic targets. [ABSTRACT FROM AUTHOR]

Hypertension is a relatively common finding during pregnancy, complicating up to 10% of pregnancies and rank as the second most common cause of maternal death in developed countries. Hypertensive disorders of pregnancy represent an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia. The goal of blood pressure control in hypertensive pregnancy disorders is to reduce the risk of end-organ damage, the maternal and fetal morbidity and mortality. The aim of our study is to review the pathophysiology and management of hypertensive disorders of pregnancy, according to the current guidelines. [ABSTRACT FROM AUTHOR]

Preeclampsia is one of the adverse outcomes of pregnancy. The Gram-negative anaerobes harbored in gingival pockets of pregnant women suggest that maternal periodontal disease might be a risk factor. However, the epidemiological studies are oscillating between positive and no association of preeclampsia with chronic marginal periodontitis. The periodontal treatment during pregnancy aiming to suppress the outcome of pathogenic mechanisms developed by periopathogens is thought to be beneficial for the general status of preeclamptic women. Nevertheless, at present, it is not clear to what extent the maternal periodontal disease might be a risk factor of preeclampsia or only an epiphenomenon of the systemic inflammatory response. [ABSTRACT FROM AUTHOR]

Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. The cause of preeclampsia is not yet fully understood, but the disorder is thought to be due to placental malperfusion resulting from abnormal remodelling of maternal spiral arteries. Abnormal remodelling of maternal spiral arteries is observed in women with subsequent preeclampsia, leading to placental hypoperfusion and systemic endothelial dysfunction. Angiogenic factors are associated with the pathophysiology of preeclampsia. More evidence supports a role for angiogenic factors in the pathogenesis of preeclampsia, and sFlt-1 levels are strongly correlated with the severity of the syndrome. [ABSTRACT FROM AUTHOR]

Preeclampsia is a pregnancy-specific systemic disorder characterised by various manifestations of organ dysfunction, associated with different medical conditions that have been shown to increase the risk for this condition, including chronic high blood pressure, diabetes, renal diseases, obesity, and hypercoagulable states. Women who had preeclampsia in a previous pregnancy are also at a higher risk to develop preeclampsia during future pregnancies. In spite of all attempts to predict which patients are more likely to develop preeclampsia and eclampsia, no significant prevention method has been identified yet that could ensure better planning and intervention strategies in case of complications. [ABSTRACT FROM AUTHOR]

Pregnancy incidence in patients affected by chronic kidney disease (CKD) is increasing, despite the fact that renal disease is associated with high maternal and fetal morbidity. From an obstetrical perspective, the main complications for the developing pregnancy are often represented by preeclampsia or preterm delivery, in addition to the progression of their underlying renal dysfunction on a continuously increasing physiologic demands. If a pregnancy is considered, preconception counseling is advised. The lower the stage of CKD, the safer it is to consider in conceiving; however, in recent years, pregnancy in advanced or end-stage renal disease (ESRD), while on dialysis, is not a rare event, as overall outcome for those with advanced CKD has improved over time. The final risk of negative maternal-fetal outcomes is inversely related to renal function and increases with proteinuria. A multidisciplinary approach involving obstetricians, nephrologists and also neonatologists is needed in order to improve pregnancy outcomes in women with chronic kidney disease. The frequency of nephrological and obstetrical examination for pregnant CKD patients should be individualized for each patient. [ABSTRACT FROM AUTHOR]

The pathogenic mechanism of preeclampsia involves endothelial dysfunction due to impaired angiogenesis, with an imbalance between pro-angiogenic and anti-angiogenic circulating factors. Angiogenesis occurs under both normal and pathological conditions and has an essential role in embryonic and placental development. One of the most important growth factors with a role in the regulation of angiogenesis is the Vascular Endothelial Growth Factor (VEGF), which exerts its function after binding to three receptors, VEGFR-1 (vascular endothelial growth factor receptor 1; flt-1), VEGFR-2 (vascular endothelial growth factor receptor 2; KDR) and VEGFR-3 (vascular endothelial growth factor receptor 3; flt-4). The binding of VEGF to the soluble form of VEGFR (sVEGFR or sflt-1) has an antiangiogenic effect. Preeclamptic placenta overexpresses sflt-1, which enters the maternal circulation, binds VEGF, and determines hypertension and proteinuria in the later stage of pregnancy. Sflt-1 levels could be used as a routine diagnostic test for preeclampsia, to differentiate preeclampsia from other diseases, and as a prognostic factor for imminent delivery in preeclamptic women. Also, sflt-1 could be a target for drug action in the treatment of preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: the pourpose of the study was to determine if there are any differences between placenta derived plasmatic levels of messenger RNA in normal and future preeclamptic pregnancies and if these placental transcripts can predict preeclampsia long before clinical onset

Pregnancy-induced hypertension is a common disease with important effects in maternal and fetal morbidity and mortality. The continuous study of its evolution in the population can help us to highlight new risk factors, the possible natural growth trend of the disease in pregnant women and the curative measures that can be taken. The purpose of this study is to observe the changes in the incidence of pregnancy-induced hypertension and its complications at a distance of 10 years. In order to achieve this goal, two study groups were compiled, including the births from 2007 and those from 2017 at the "Prof. Dr. Panait Sîrbu" Clinical Hospital of Obstetrics and Gynecology. The main findings of the study revealed an increasing trend of the incidence of pregnancy-induced hypertension, an apparent stagnation of the HELLP incidence, and a decrease in eclampsia. [ABSTRACT FROM AUTHOR]

A normal pregnancy progression leads towards a prothrombotic phenotype in order to prepare the mother for delivery. When the physiological adaptation overlaps to abnormal changes, such as thrombophilic factor mutations, the risk for adverse pregnancy outcome becomes increasingly higher. Doppler ultrasound velocimetry of utero-placental and fetal vessels represents a method of antenatal monitoring, thus being a noninvasive evaluation method. We analyzed 145 pregnant women, recruited over a period of 6 months, from January 2016 to June 2016, in the Obstetrics and Gynecology Department of the Bucharest University Emergency Hospital, who underwent clinical and ultrasound evaluation according to their gestational age. We encountered five cases with middle cerebral artery/ umbilical artery pulsatility indices ratio smaller than 1, representing the population at risk for a higher maternal and fetal morbidity and mortality. Also, intrauterine growth restriction was more frequent in the aforementioned group (60%) versus the rest of the patients (7.9%). An extensive literature review highlights the role of inherited thrombophilic disorders and obstetric complications affecting the normal placental vascular function; however, appropriate treatment can improve pregnancy outcome. Future research regarding thrombophilic pregnant patients should focus on close clinical and ultrasound monitoring for the best maternal and fetal results. [ABSTRACT FROM AUTHOR]

Résumé Longtemps considérée comme une pathologie purement obstétricale demeurant l’apanage de la gynécologie en raison de son implication sur le pronostic périnatal à court terme, il est maintenant admis que la prééclampsie constitue une authentique maladie vasculaire systémique de la grossesse et représente un authentique facteur de risque majeur de survenue de pathologie cardiovasculaire à long terme. Le but de cette mise au point est de synthétiser les actualités et les apports de la littérature récente en termes de définitions, d’identification et de prévention de la prééclampsie. Nous exposerons également les enjeux majeurs qui justifient que le cardiologue soit être pleinement impliqué dans le dépistage et la prévention de la maladie, ainsi que dans le suivi ultérieur des femmes ayant présenté une prééclampsie. Due to its short-term consequences on perinatal outcome, preeclampsia has been long regarded as an obstetrical disease, strictly confined to a management by OB/GYNs. It has been now widely accepted that preeclampsia is most a systemic inflammatory and systemic vascular disease during pregnancy and then a lifelong risk factor for subsequent cardiovascular event in women's life. The aim of this review is to propose an overview in the current state-of-art in definition, early identification and management of preeclampsia. We will also discuss the growing evidence that support that cardiologists must be fully involved in screening and prevention of preeclampsia during pregnancy and beyond in the subsequent medical follow-up of women who have experienced a preeclampsia. [ABSTRACT FROM AUTHOR]

High blood pressure in pregnancy is a pathology with increasing incidence. Through the complexity of the manifestations and the severity of the maternal and fetal complications, it is a difficult clinical entity. The recommendations of the different guides are not uniformly harmonized and are not based on strong evidence, so the need for data revisions becomes an important objective. The clinical implementation of different clinical trial results requires a permanent update and a standardized approach. [ABSTRACT FROM AUTHOR]

Objective. To identify qualitative and quantitative changes involving coagulation factors engaged in maternal and fetal complications, to determine the level of correlation between them, and to highlight the involvement of hereditary thrombophilia among pregnant women. Material and method. The article is based on 92 publications from 1995 to 2017, including a total of 49,127 thrombophilic patients, of whom 1272 were controls, with inclusion criteria as preeclampsia, intrauterine growth retardation, or early or late pregnancy loss Results. 31 studies based on preeclampsia- demonstrate the involvement of G1691A factor V Leiden gene mutation, G20210A Prothrombin gene mutation and/or C677T and A1298C MTHFR gene mutation as the main factors in the development of this complication. 10 studies focuses on the intrauterine growth restriction place G20210A Factor V Leiden gene mutation, G20210A Prothrombin gene mutation, C677T and A1298C MTHFR gene mutation, protein C and protein S deficiency as the main factors involved. Another 32 studies cite the involvement of factor V Leiden mutation, Prothrombin mutation and MTHFR mutation in the development of early or late pregnancy losses. Conclusion. Based on 92 rigorously selected publications, we were able to demonstrate the relationship between medium/increased risk thrombophilia and pregnancy outcome, especially due to the presence of factor V Leiden gene mutation, Prothrombin gene mutation but also MTHFR gene mutation homozygous status. [ABSTRACT FROM AUTHOR]

Numerous studies in recent decades have attempted to demonstrate a link between reproductive factors and breast cancer risk, with conflicting results. In recent years, epidemiological studies have attempted to find an association between perinatal or intrauterine events and breast cancer risk. The most carefully studied were pregnancy hypertensive disorders and prematurity, knowing that through the hormonal changes these two pathologies can influence the risk of breast cancer. Extreme prematurity (<32 weeks of gestation) is associated with an increased risk of breast cancer, whereas for each week that prolongs pregnancy this risk falls substantially. In the case of iatrogenic prematurity associated with Pregnancy-induced hypertension, this risk does not validate studies demonstrating that Preeclampsia and Gestational hypertension during first pregnancy are associated with a low breast cancer risk, regardless of gestation length. Women who were born prematurely also appear to be at increased risk for breast cancer, but this association has to be confirmed by further studies, because so far only one study addressed this issue. [ABSTRACT FROM AUTHOR]

The rising incidence of using reproductive technology in humans is followed by pregnancies at an advanced maternal age. Pregnancies achieved by reproductive technology are generally multiples pregnancies at ages over 40 years and they have a higher risk of developing preeclampsia, gestational diabetes and preterm birth. We will present the case of a 44 years old patient who has a twin pregnancy achieved by egg donation who develop severe preeclampsia and gestational diabetes. [ABSTRACT FROM AUTHOR]

Hypertensive disorders of pregnancy, including preeclampsia, complicate up to 10% of pregnancies worldwide, being one of the major causes of maternal and perinatal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Hypertension during pregnancy is one of the common causes of maternal and foetal morbidity and mortality. Therefore, it requires careful monitoring of pregnant women in order to identify risk factors and an early diagnosis of hypertension, to determine organ damage, the potential risk of preeclampsia and eclampsia. Non-pharmacological and pharmacological treatment has certain peculiarities, the drugs used must take account of the maternal risks, but also of the foetus. Besides complications during pregnancy, hypertension is an indicator of increased risk for women to develop hypertension, stroke, coronary artery disease and venous thrombosis in the next 5-15 years. [ABSTRACT FROM AUTHOR]

Preeclampsia is a major health problem because it determines higher incidence in maternal and perinatal morbidity. Early prediction of preeclampsia in pregnancy can improve both the maternal and perinatal outcome by ensuring appropriate management. There are multiple algorithms using maternal risk factors, biophysical markers, biochemical markers and they try to predict preeclampsia. Low doses of aspirin can improve the prognostic of preeclampsia. [ABSTRACT FROM AUTHOR]

Introduction. ecause the clinical manifestation of preeclampsia can be heterogeneous, laboratory tests can be very useful for early preeclampsia diagnosis in pregnancy induced hypertension patients. Method. A total 110 patients with clinical diagnosis of pregnancy induced hypertension (PIH) were included in the study. Complete blood count, urine examination, biochemical tests (ALT, AST, LDH, T-bilirubin, uric acid) and coagulation tests were done in all patients. The urinary test checked the usual parameters and proteinuria (24-hour urine collection). In addition, protein-creatinine ratio was evaluated in urinary specimen with a rapid test Results. In our study, 66 patients had mild PIH and 44 severe PIH. Headache was the predominant symptom followed by giddiness. Pathological changes of the biochemical, hematological and coagulation parameters were observed mainly in severe PIH. Conclusion. Patients significantly younger, low parity had significantly increased systolic and diastolic pressure and changes of values of liver enzymes, uric acid, urine protein, and LDH levels. Abnormalities (qualitative and quantitative abnormalities) of red blood cells and platelets are frequently seen in PIH. Spot urinary P/C ratio in pregnancy induced hypertension patients can be used as a screening test as a good predictor for significant proteinuria and could not be used for diagnostic tests to replace 24-h urine protein measurements. [ABSTRACT FROM AUTHOR]

Intolérance au glucose survenant lors de la grossesse, le diabète gestationnel se traduit par une augmentation de la glycémie. La surveillance scrupuleuse de la femme enceinte est indispensable et un traitement adapté permet d'éviter les risques de complications. Le pharmacien doit bien connaître cette forme de diabète afin de pouvoir rassurer, conseiller et accompagner les patientes qui en sont atteintes. [ABSTRACT FROM AUTHOR]

Even though pregnancy is a physiological state and delivery is a natural phenomenon, their possible complications, even rare, are severe and costly enough as to generate a perpetual quest for efficient remedies. Before becoming evidence-based medicine, most of these therapeutic or prophylactic interventions are based on simple and direct clinical observations. The purpose of this paper is to investigate the multitude of administered and self-administrated supplements during pregnancy in a search for proved benefits. Therefore, we have selected a few of the most significant obstetrical complications (preeclampsia, premature delivery, gestational diabetes, early pregnancy loss) and we have analyzed the results of different clinical trials and meta-analyses regarding the outcome of routinely recommended supplements (vitamins, calcium, omega 3 fatty acids, progesterone, metformin). Results are largely heterogeneous and are related greatly to the construction of the clinical trials, the number and selection of patients. Conclusion. Clinical judgment is recommended in most cases, but therapeutic options are widely available for an important number of obstetrical complications, and there is sufficient good quality data as to apply them in clinical practice. [ABSTRACT FROM AUTHOR]

Vitamin D is a fat-soluble vitamin and a presteroid hormone synthesized in the dermis under UVB rays. In terms of its endocrine functions, it has an important role in mineral homeostasis. Besides these effects, recent studies have found a series of non-calciotropic actions of vitamin D: modulation of autoimmune processes, promoting secretion and insulin action, pulmonary development, inhibition of malignant cells proliferation in various cancers, implications in maternal-fetal pathology. Recent studies have identified the association of vitamin D deficiency in pregnancy with a series of maternal complications (preeclampsia, bacterial vaginosis, gestational diabetes, increased risk of cesarean delivery) and fetal complications (affecting skeletal development and tooth enamel, impaired fetal growth). Also, newborns from mothers with vitamin D deficiency have an increased risk of tetany, hypocalcemia, with or without seizures and an increased susceptibility to respiratory diseases (asthma, bronchiolitis RSV). Conclusions: There is no current consensus on routine screening of vitamin D deficiency in pregnancy, nor the required dosage for vitamin D supplementation in pregnant women. All pregnant women should have a balanced diet and get vitamin D as part of prenatal vitamins. Their purpose is to increase the availability of calcidiol to the fetus and newborn with a beneficial role over the classic effects of vitamin D and possibly over the non-calciotropic ones. [ABSTRACT FROM AUTHOR]

Monitoring the pregnant woman in the first weeks of her pregnancy by an interdisciplinary team (family physician, gynecologist and cardiologist) is essential. The accurate measurement of hypertension can determine early diagnosis of preeclampsia and efficient patient follow-up. Dynamics of proteinuria allows to assess the therapeutic plan depending on the therapeutic form of preeclampsia, state health of the mother and fetus, gestational age of the pregnancy. Postpartum monitoring allows the control of cardiovascular risk factors and the establishment of personalized management of the case, in order to reduce the risk of CVD in the future. [ABSTRACT FROM AUTHOR]

Résumé Objectifs L’objectif principal était d’estimer la prévalence de la prééclampsie (PE) dans la région de Tizi-ouzou (Algérie). Les objectifs secondaires étaient d’estimer la fréquence des facteurs de risque de PE, et l’incidence des complications materno-fœtales. Patients et méthodes Étude prospective observationnelle descriptive, incluant les femmes enceintes consultant pour un suivi de grossesse systématique, dans les 2 maternités de Tizi-ouzou, entre janvier 2012 et juin 2013. La PE était définie par l’apparition d’une HTA gestationnelle associée à une protéinurie > 300 mg/24 h, après 20 semaines d’aménorrhée. Résultats Sur 3225 femmes enceintes examinées, 252 ont développé une PE, soit une prévalence de 7,8 % (IC 95 % : 6,9 %–8,7 %). Les facteurs de risque de PE les plus fréquents étaient : primigestité (56 %), âge > 40 ans (27 %), obésité (26 %) et antécédents personnels d’HTA gestationnelle (21 %). Au total, 28,7 % des patientes ont développé au moins une complication dont 5 décès. Les taux de prématurité, de retard de croissance intra-utérin et de mort fœtale étaient de 58,2 %, 49,7 % et 6,7 % respectivement. Conclusion La prévalence de la PE chez les femmes enceintes à Tizi-ouzou est de l’ordre de 8 % et l’incidence des complications maternelles et fœtales demeure élevée. Seuls un diagnostic plus précoce et une surveillance plus étroite pourraient améliorer le pronostic de nos patientes, puisque le traitement de la PE demeure actuellement l’accouchement. Objectives The main objective was to estimate the prevalence of pre-eclampsia (PE) in pregnant women in Tizi-ouzou (Algeria). Secondary objectives were to estimate the frequency of PE risk factors, and the incidence of maternal and fetal complications. Methods Our study was observational, prospective and descriptive, including all pregnant women at the prenatal appointment in the 2 maternity units of Tizi-ouzou, between January 2012 and June 2013. PE was diagnosed if gestational hypertension was associated with proteinuria > 300 mg/24 h, after 20 weeks of gestation. Results We had 252 cases of PE on 3225 pregnant women. The prevalence of PE was 7.8% (CI 95%: 6.9%–8.7%). The most frequent PE risk factors were nulliparity (56%), age > 40 years (27%), obesity (26%) and PE in any previous pregnancy (21%). The incidence of maternal adverse events was 28.7% (CI 95%: 23.1%–34.3%), including 5 deaths. The rates of prematurity, small for gestational age infant and fetal death were 58.2%, 49.7% and 6.7%, respectively. Conclusion The prevalence of PE in pregnant women in Tizi-ouzou is around 8%. The incidence of maternal and fetal adverse outcomes remains high. Only earlier diagnosis and closer monitoring could improve the prognosis of our patients, since the treatment of PE remains currently childbirth. [ABSTRACT FROM AUTHOR]