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Background: Recent studies show that vascular endothelial growth factor (VEGF) downregulation is implicated in preeclampsia (PE) pathophysiology. This study assessed the relationship between PE and VEGF levels produced by peripheral blood mononuclear cells (PBMCs) and their serum levels., Methods: A cross-sectional design was performed in 36 patients who had hypertensive disorders during pregnancy. We also used a longitudinal design with 12 pregnant women with risk factors for PE development and/or abnormal uterine arteries by Doppler study. VEGF and soluble fms-like tyrosine kinase-1 (sFlt-1) levels were measured for all patients in both designs., Results: sFlt-1 serum was higher in preeclamptic patients (n = 26), whereas VEGF produced by stimulated PBMCs was lower than in healthy pregnant women and VEGF levels produced by stimulated PBMCs were even lower (p <0.003) in severe PE (n = 16). The receiver-operating characteristic curve analysis allowed establishing a cut-off value to identify patients with PE. VEGF production by PBMCs was 339.87 pg/mL. In addition, a robust linear regression model was performed to adjust the variance in VEGF levels. The patients' age decreased VEGF levels and was adjusted by weeks of gestation (WG) in our model. In the longitudinal study, 7/12 patients developed PE. VEGF produced by PBMCs cells was significantly lower in PE at 24-26 WG., Conclusions: VEGF production by PBMCs is inhibited during PE, creating a downregulation of the microenvironment; this deficiency may contribute to the pathogenesis of disease., (Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.)

Background: Preeclampsia that occurs at < 20 weeks of gestation is rare and has been usually reported with molar or hydropic degeneration of the placenta and antiphospholipid syndrome., Case Report: To describe the clinical presentation of atypical preeclampsia of a patient of 37 years old at her first gestation who developed this entity at 18.5 weeks of gestation. She had history of pre-existing hypertension and infertility. This pregnancy was obtained through in vitro fertility. She reported a severe headache and was admitted to our hospital secondary to elevated blood pressure of 160/110 mm Hg. The laboratory evaluation revealed platelet count 51,000, alanine aminotransferase of 331 UI/L, aspartate aminotransferase of 285 UI/L, lactate dehydrogenase 421 UI/L and urinalysis with +2 proteinuria, soluble fms-like tyrosine kinase-1/placental growth factor ratio 895.5. The diagnosis of chronic hypertension and superimposed preeclampsia and incomplete HELLP syndrome was supported. After termination of pregnancy, the patient improved rapidly. She was discharged home on postoperative day 7 with a blood pressure of 120/70 mm Hg with normal laboratory., Conclusions: Clinicians should consider the diagnosis of preeclampsia and HELLP syndrome before 20 weeks of gestation in women presenting with clinical or laboratory abnormalities consistent with this disease.

Background: 15 to 25% of patients with gestational hypertension progress to preeclampsia., Objective: To determine the number of patients with gestational hypertension who developed preeclampsia., Materials and Methods: Observational prospective comparative and longitudinal study realized between november 2010 to december 2012. We included pregnant patients diagnosed with mild gestational hypertension who were followed during pregnancy to observe the progression to preeclampsia. We compared the clinical features of each group among those who developed and not the disease., Results: We included a total of 146 patients, of whom 36 (25%, IC 95% 17.7-31.7%) progress to preeclampsia. In this group 3 (8%) developed mild preeclampsia and 33 (92%) severe preeclampsia, of which 8 (24%) account HELLP syndrome. The remaining 110 patients (75%), did not develop preeclampsia. From 12 (8%) patients with gestational age < to 28 weeks, 7 (58%) developed preeclampsia, 46 (31%) patients between 28-33 weeks, 12 (26%) evolved into preeclampsia, 39 (27%) patients between 34-36 weeks, 11 (28%) progressed to preeclampsia and finally 49 (34%) with pregnancy > 37 weeks, 6 (12%) developed to preeclampsia. When comparing these groups we found that a lower gestational age was more frequent the progression to preeclampsia (p < 0.004). The onset of gestational hypertension before 28 weeks was significantly associated with the progression of preeclampsia (OR 5.1 IC 95% 1.5-17.2). The weight of infants and gestational age was lower in children of women who developed the disease in comparison that those who did not (p < 0.001). There were no significance differences between both groups in relation with body mass index, maternal age, parity and antecedent of preeclampsia., Conclusions: The progression of gestational hypertension into preeclampsia appreciated in one of each four patients. The progression of gestational hypertension in preeclampsia was more common in preterm pregnancy. Most of the patients developed the severe form of the disease.

Objective: Several studies have reported the association of genes related to vascular tone, hypertension, oxidative stress and preeclampsia. We investigated the possible association among three polymorphisms in eNOS (as well their haplotypes): one of MTHFR, one of GSTP1 and one of AGT, with severe preeclampsia in Mexican-Mestizo women., Methods: Two hundred thirty women with severe preeclampsia and 350 control subjects were genotyped; for rs2070744 and rs1799983 of eNOS, rs1801133 of MTHFR, rs1695 of GSTP1 and rs699 of AGT we used real-time PCR allelic discrimination and for VNTR of eNOS, PCR. Allele frequency differences were assessed by χ(2). Logistic regression was used to test for associations and for haplotype frequencies using Haploview 4.2., Results: Genotypic and allelic distribution of the polymorphisms was similar between cases and controls; likewise, haplotype frequencies of the three polymorphisms of eNOS did not differ significantly., Conclusions: To our knowledge, this is the first time that these polymorphisms have been analyzed together and exclusively in women with severe preeclampsia. However, we did not find an association between polymorphisms of eNOS, MTHFR, GSTP1 and AGT with severe preeclampsia in our population. Additionally, we observed differences in the distribution of the alleles and genotypes of these polymorphisms in our population in comparison to those described in other ethnic groups., (Copyright © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)

Due to the fact that studies seeking associations of polymorphisms in regulatory regions of cytokine genes with pre-eclampsia (PE) have not always been consistent in different population analyses, the aim of this study was to investigate the possible association between rs1800896 of interleukin-10 (IL-10), rs1800795 of interleukin-6 (IL-6), and the variable number of tandem repeats (VNTR) in intron 2 of interleukin-1 receptor antagonist (IL-1Ra), as well as gene-gene interactions between these three polymorphisms with the presence of PE in Mexican-Mestizo women and one Amerindian population from México (Maya). A case-control study was performed where 411 pre-eclamptic cases and 613 controls were genotyped. For the rs1800896 of IL-10 and rs1800795 of IL-6, we used real-time polymerase chain reaction (PCR) allelic discrimination and for the VNTR of IL-1Ra, PCR. Allele frequency differences were assessed by Chi-squared test; logistic regression was used to test for associations; a gene-gene interaction was conducted. Genotypic and allelic distribution of the polymorphisms was similar in our population. The estimated of the gene-gene interaction between the polymorphisms did not differ significantly. However, we observed important differences in the distribution of the alleles and genotypes of the three polymorphisms analyzed between Mestiza-Mexicanas and Maya-Mestizo women. In conclusion, we did not find an association between polymorphisms in IL-10, IL-6, and IL-1Ra and PE in Mexican-Mestizo and Maya-Mestizo women. To our knowledge, this is the first time that these three polymorphisms were analyzed together with gene-gene interaction in women with PE.

Preeclampsia remains a major cause of worldwide pregnancy related maternal and neonatal mortality and morbidity, it accounts for more than 50,000 maternal deaths each year. The World Health Organization estimates that at least one woman dies every 7 minutes from a complication of preeclampsia. It is the main cause of maternal death in Mexico and Latin America. Standarized assessment and surveillance of women with preeclampsia is associated with reduced maternal risk. Standarized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of preeclampsia-eclampsia. The working group selected clinical practice guidelines found in the Cochrane Library, Medline and PubMed. The results were expressed as levels of evidences and grade of recommendation. Evidence suggests, that treatment of severe hypertension, seizures prophylaxis with magnesium sulfate, and management by experienced health-care professionals will improve maternal, fetal and neonatal outcomes. Treatment remains supportive with pregnancy termination being the only definitive cure.

Background: Although the etiology of preeclampsia is still unclear, recent work suggests that changes in circulating angiogenic factors play a key role in its pathogenesis. In the trophoblast of women with preeclampsia, hypoxia-inducible factor 1 alpha (HIF-1α) is over-expressed, and induces the expression of non-angiogenic factors and inhibitors of trophoblast differentiation. This observation prompted the study of HIF-1α and its relation to preeclampsia. It has been described that the C1772T (P582S) and G1790A (A588T) polymorphisms of the HIF1A gene have significantly greater transcriptional activity, correlated with an increased expression of their proteins, than the wild-type sequence. In this work, we studied whether either or both HIF1A variants contribute to preeclampsia susceptibility., Results: Genomic DNA was isolated from 150 preeclamptic and 105 healthy pregnant women. Exon 12 of the HIF1A gene was amplified by PCR, and the genotypes of HIF1A were determined by DNA sequencing.In preeclamptic women and controls, the frequencies of the T allele for C1772T were 4.3 vs. 4.8%, and the frequencies of the A allele for G1790A were 0.0 vs. 0.5%, respectively. No significant differences were found between groups., Conclusion: The frequency of the C1772T and G1790A polymorphisms of the HIF1A gene is very low, and neither polymorphism is associated with the development of preeclampsia in the Mexican population.

Background: Natural Killer (NK) cells are the most abundant lymphocytes in the decidua during early gestation. The interactions of NK cells with the extravillous cytotrophoblast have been associated with a normal spiral artery remodeling process, an essential event for a successful pregnancy. Recent data indicate that alterations in the amount of decidual NK (dNK) cells contribute to the development of preeclampsia (PE). Moreover, genetic studies suggest that Killer Immunoglobulin-like Receptors (KIR) expressed in dNK cells influence the susceptibility to PE. Although dNK cells have been well characterized during early pregnancy, they have been scarcely studied in the third trimester of gestation. The aim of this work was to characterize dNK cells at the last trimester of gestation and to analyze the KIR genotype of healthy and PE women., Methods: Decidual samples were obtained during Caesarean section from control (n = 10) and PE (n = 9) women. Flow cytometric analysis of CD3, CD56, CD16 and CD9 was used to characterize and quantify dNK cells in both groups. Cell surface markers from decidual leukocytes were compared with PBMC from healthy donors.KIR genotyping was performed in genomic DNA (control, n = 86; PE, n = 90) using PCR-SSP., Results: The results indicate that dNK cells persist throughout pregnancy. They represented 20% of total leukocytes in control and PE groups, and they expressed the same cell surface markers (CD3-, CD56+, CD16- and CD9+) as dNK in the first trimester of gestation. There were no significant differences in the percentage of dNK cells between control and PE groups. The analysis of KIR gene frequencies and genotypes was not statistically different between control and PE groups. The ratio of activating to inhibitory genes indicated that the overall inhibitory balance (0.2-0.5) was more frequent in the PE group (control, 31.3% vs PE, 45.5%), and the activating balance (0.6-1.1) was more frequent in the control group (control, 68.6% vs PE, 54.4%). However this difference was not significant., Conclusion: We demonstrated the persistence of dNK cells in PE and control women at the third trimester of pregnancy; these dNK cells had a similar phenotype to those found during early pregnancy. The predominance of a KIR inhibitory balance in the PE group could be associated to the physiopathology of PE.

Preeclampsia (PE) is one of the most severe complications of pregnancy. PE is responsible for the highest rates of morbidity and mortality for both pregnant women and the neonate. In this review, we first address general aspects of PE and its diagnosis, along with some epidemiological aspects of this disease in the mexican population, in particular the experience from the Instituto Mexicano del Seguro Social. Even though over the last 20 years a great deal of evidence has accumulated regarding PE's pathophysiology, an exact mechanism to explain its etiology has not been established. This review aims to cover the status of two of the most important hypotheses in the etiology of PE: the immunological and the placental ischemia hypotheses. Recent data suggest that Natural Killer cells (NK) play a major role in the decidual spiral arteriole remodeling and in normal placental development. In genetic studies, KIR receptors present in NK cells have been involved in the susceptibility for the disease. In this review, we discuss data of our group regarding the presence of NK cells in the decidua, at the end of pregnancy and the genotypes of KIR receptors in normal and preeclamptic Mexican population. PE is characterized by abnormal placentation and hypoxia with an increase of anti-angiogenic factors; the Hypoxia-inducible factor 1-alfa (HIF1-alfa) is over expressed in PE. In this review, we also included some of our results concerning the polymorphisms and regulation of HIF in preeclamptic women.

Background: Preeclampsia is a multisystemic syndrome with unknown etiology and characterized by abnormal vascular placentation response. Patients with renal transplantation restore them fertility 10 months after the intervention., Objective: To evaluate incidence of preeclampsia and maternal-perinatal outcome in patients with renal transplantation., Patients and Methods: Comparative, observational and retrospective study performed in pregnant patients with renal transplantation, from December 1999 to April 2008 at Perinatology of Hypertensive Diseases Department of the Unidad Medica de Alta Especialidad de Ginecoobstetricia Luis Castelazo Ayala, IMSS. Davison' guide, descriptive statistic, and Fischer exact test were used., Results: Thirty patients were analyzed, 27 cases satisfy Davison's recommended guidelines, and the rest did not achieve these criteria (p = 0.001). Preeclampsia occurred in 15 cases (50%), preterm delivery in 15 (50%), and fetal growth restriction in 6 (20%). Among the 11 patients with previous chronic hypertension, 8 developed superimposed preeclampsia (72%), and 9 had delivery before 37 weeks of gestation (82%). Malfunction of renal transplantation, before pregnancy, was associated with maternal and perinatal poor outcome (p = 0.006). There were no maternal deaths, but one perinatal (3%), Conclusions: Successful pregnancy is possible in patients with renal transplantation, however there is a high risk of preeclampsia, infection, and fetal growth restriction. Patients with renal transplantation must fulfill Davison's pre-pregnancy guidelines.

Background: Abnormal placentation is a main preeclampsia characteristic. Its cause is a maternal spiral veins trophoblastic invasion failure, which conditions vascular resistances raise and uterus-placental perfusion decrease., Objective: To determine the relationship between umbilical artery Doppler waveform and adverse perinatal outcome in patients with severe preeclampsia., Patients and Method: A prospective, observational and transversal study was done to analyze patients between 27 to 33 weeks of gestation with expectant management of severe preeclampsia from January 2004 to January 2006. Umbilical artery velocimetry studies were performed at least once a week by means of pulsed Doppler equipment with a 3.5 MHz transducer. Only the results of the last Doppler examination performed within 7 days of delivery were considered in the correlation with perinatal outcomes. The indications for delivery were maternal or fetal (non reassuring nonstress test or biophysical profile < or = 4). An abnormal Doppler velocimetry was defined as pulsatility index being higher than percentile 95 for gestational age, or absent or reversed end diastolic velocity waveforms in umbilical artery. The statistical analysis was done with chi2 test and Student t test., Results: There were included 43 patients in this study. Twenty-two (52%) had an abnormal Doppler umbilical artery pulsatility index and 21 (49%) obtained a normal umbilical artery waveform. In the first group 13 (59%) had a positive end diastolic velocities with elevated pulsatility index values, end diastolic velocities were absent in seven cases (32%) and reversed in two cases (9%). Neonates with abnormal pulsatility index had a lower birth weight (1,174 vs 1,728 g), lower Apgar score at 5 minutes, higher admission to the neonatal intensive care unit (86.4 vs 43%), and significant neonatal morbidity compared with those with normal velocimetry (p < 0.05). There were no perinatal deaths with normal umbilical Doppler waveform. There were six perinatal deaths in the abnormal Doppler velocimetry. Two cases occurred with positive end diastolic velocity (15%), two cases with absent end diastolic velocity (28%) and two deaths with reversed flow of the umbilical artery (100%)., Conclusion: An abnormal Doppler umbilical artery waveform is associated with poor perinatal outcome and is a strong predictor of perinatal mortality.

Context: It has been proposed that preeclampsia may result from of an imbalance in angiogenic factors. Although prolactin (PRL) is mainly related to lactation, it is also involved in other biological functions, including angiogenesis., Objective: Our objective was to determine the relationship among preeclampsia, serum and urinary PRL (uPRL) levels, and excretion of antiangiogenic PRL fragments in urine., Study Design: Using a cross-sectional design, uPRL and serum PRL levels, and the presence of PRL isoforms were determined in 546 pregnant women: 207 healthy pregnant, 124 with gestational hypertension, 48 with mild preeclampsia, and 167 with severe preeclampsia (sPE)., Results: uPRL concentrations were significantly (P < 0.001) higher in preeclampsia (11.99 ng/mg creatinine) than in healthy pregnancy (0.20 ng/mg creatinine) and gestational hypertension (0.19 ng/mg creatinine), and were even higher in sPE compared with mild preeclampsia (21.20 vs. 2.77 ng/mg creatinine, respectively; P < 0.001). Antiangiogenic PRL fragments (14-16 kDa) were detected in 21.6% of urine samples from women with sPE but in none from other groups. Patients with hemolysis, elevated liver enzymes, low platelet count syndrome, and/or eclampsia, placental abruption, acute renal failure, and pulmonary edema exhibited highest uPRL concentrations (P < or = 0.028) and frequency of antiangiogenic PRL fragments in urine (P < or = 0.036). High-serum PRL levels were associated with sPE independently of gestational age, proteinuria, and prolactinuria (P = 0.032)., Conclusions: Preeclampsia is characterized by increased uPRL excretion. uPRL concentrations and their isoforms appear to be suitable markers to assess the severity of preeclampsia and occurrence of adverse outcomes. PRL and and/or its isoforms might be involved in the pathophysiology of preeclampsia.

Objective: To assess the maternal and perinatal outcome of patients with antiphospholipid syndrome in pregnancy., Patients and Method: A descriptive and retrospective analysis of patients with antiphospholipid syndrome in pregnancy was made from January 2000 to June 2005., Results: We analyzed 35 patients. Primary and secondary antiphospholipid syndrome occurred in 25 (71%) and 10 (29%) women, respectively. Nine cases were associated with systemic lupus erythematosus and one with scleroderma. Approximately, 48% of women had history of thrombosis, 23% recurrent pregnancy loss, and 15% early onset preeclampsia in previous pregnancies. Twenty-seven patients had positive anticardiolipin antibodies, 6 lupus anticoagulant, and 2 both of them. About 80% of the patients were delivered by cesarean section. There was one spontaneous embryo loss before seven weeks. Eleven (32%) patients had preeclampsia. There were no maternal deaths. All women began treatment since the first trimester of pregnancy. Twenty-three patients (66%) received heparin and low dose aspirin, 8 cases (22%) heparin, low dose aspirin and prednisone, for presenting systemic lupus erythematosus, and the remaining 4 cases (12%) were treated with prednisone and aspirin. Ninety four percent of the cases got a live newborn. There were two neonatal deaths secondary to extreme prematurity and associated with preeclampsia. There was one fetal death related to maternal lupus renal activity. Fifty-eight percent of the newborns were premature. Intrauterine growth restriction was present in 20% of the cases., Conclusions: Early treatment combined with close maternal-fetal surveillance was associated with a 90% chance of a live birth rate. However, prematurity, preeclampsia and intrauterine growth restriction were common.

Objective: To evaluate the usefulness of the fetal biophysical profile as a predictor of early neonatal infection in patients with preterm rupture of membranes in conservative management., Patients and Methods: This is a validation study of a diagnostic test. Between November, 2001 and August, 2003, 75 patients with 27 to 33 weeks of gestation and preterm rupture of membranes in conservative management were studied. Daily, a fetal biophysical profile was applied to them. Statistical analysis was done with chi square test and with a 2 x 2 contingency table that compared the biophysical score of + 8 and < or = 6 versus the presence or absence of early neonatal infection., Results: The biophysical score < or = 6 was associated with early neonatal infection (p < 0.05), with sensitivity, specificity, positive and negative predictive values of 80, 85, 64 and 85%, respectively (OR 9.73, 95% CI: 2.88-34.63; p = 0.0000164)., Conclusions: The biophysical score < or = 6 was significantly associated with early neonatal infection.

Unlabelled: Many markers have been proposed to identify the pregnant woman at risk to develop preeclampsia, without finding at the moment the gold standard., Objective: The main purpose of the present study was to know if the detection of microalbuminuria in early stages of pregnancy is a good predictor of preeclampsia., Methods and Material: One hundred and two women (102) were studied. All of them had risk factors for preeclampsia with a pregnancy between 16 and 18 weeks, an evaluation of microalbuminuria was done through a clean-catch dipstick of the first miction of the day, excluding patients with urinary tract infections and nephropaty, > 20 mg/L was considered a positive value. Diagnosis data of preeclampsia were recopilated from the clinical chart of each patient after the pregnancy was resolved., Results: Of the 102 patients, 53 had a negative microalbuminuria, 6 (11%) developed preeclampsia and 47 (88%) did not. Forty nine women had positive microalbuminuria and 23 (46.9%) of them developed preeclampsia and 26 (53%) did not. The sensitivity was 79%, specificity 63%, the positive predictive value was 46% and the negative predictive value was 88%., Conclusions: The detection of microalbuminuria in early stages of pregnancy could be a good predictor of preeclampsia, moreover it is a simple and feasible procedure to do by the obstetrician.

Introduction: Poor perinatal outcome in patients with preeclampsia has been reported. This significant risk reinforces the importance of fetal evaluation., Objective: The purpose of this study was to evaluate the utility of the nonstress test (NST) in preeclampsia., Study Design: Criteria for inclusion in this report comprised pregnancies complicated by preeclampsia of longer than 28 weeks of gestation delivered 24 hours of final NST. The study population were divided into mild and severe preeclampsia. Each of the latter two groups was further subdivided into three subgroups by gestational age at 28-31, 32-34 and > 35 weeks. Measurements of adverse perinatal outcome included meconium staining, oligohydramnios, five-minute Apgar score less than 7 beyond 34 weeks of gestational age, intrauterine growth retardation, and perinatal death., Results: A total of 250 patients with preeclampsia were analyzed, among these 147 with mild and 103 with severe disease. There were no stillbirths. Sensitivity of the NST was low ranged from 39% (mild preeclampsia) to 63% (severe disease). Its positive predictive value was equally low (66 and 45%) respectively. Specificity was quite high in both groups (89 and 64%). Its negative predictive value was 73% for mild disease and 78% for severe preeclampsia., Conclusion: The NST is an important test in antepartum care but based on its low sensitivity should not be considered as a stand alone test.

Objective: To describe the maternal morbidity and mortality in pregnancies complicated by HELLP Syndrome., Study Design: This is a descriptive and prospective study of women with HELLP Syndrome managed at our center from January 1998 through March 2000. Patients are grouped into 3-class system of Mississippi classification., Results: 170 cases were analysed, 156 (92%), ocurred ante partum and 14 (8%) postpartum; 15 cases (9%) developed at < 27 weeks, 112 (66%) between 28 to 36 weeks of gestational age and 43 (25%) at term. Maternal morbidity included acute renal failure (13.5%), abruptio placentae (6.6%), pneumonia (3%), subcapsular liver hematoma (2.3%), pulmonary edema (2.3%), diseminated intravascular coagulopathy (1.7%) and cerebral hemorrhage (1.2%). Maternal mortality was 4.7% (8 patients), 7 deaths ocurred in patients with class I disease and only one with class II HELLP Syndrome. 6 maternal deaths (75%) were associated to eclampsia. Up to 85% of the maternal morbidity and mortality developed with class I disease (platelet nadir < 50,000 mm3., Conclusions: There is a progressive rise in maternal morbidity and mortality as the pregnancy moves from class III to class I HELLP Syndrome. 75% of maternal mortality was associated with eclampsia. Early diagnosis of this syndrome could improve maternal prognosis and outcome.

A case report is presented of one preeclamptic patient with rupture of a big right subcapsular hematoma of the liver which was misdiagnosed with cholecystitis. A cesarean delivery was performed, which resulted is stillbirth, with abruptio placentae of 50%. The emergent treatment of the liver rupture was the right hepatic artery ligation, the postoperative development was favorable. Long term follow-up using ultrasound and liver function values were performed for 14 months and showed that the lesion has regressed with a normal hepatic imaging.

Objective: To determine in multivariate analysis the clinical, social, and demographic factors for preeclampsia., Study Design: A case-control study was designed. Three hundred patients were included, divided in two groups. 150 cases with criteria diagnosis for preeclampsia. 150 patients with normal pregnancy and deliveries. The main variables analyzed were age, schooling, marital status, employment, socioeconomic status, smoking and alcohol consumption, body mass index, familiar history of preeclampsia, history of preeclampsia in previous pregnancy, parity and type of pregnancy (single or multiple)., Statistical Analysis: For comparison of cases and controls on categorical variables, odds ratios and 95% confidence intervals were calculated, and multiple logistic regression analyses., Results: Multiple logistic regression analysis showed that history of preeclampsia in previous pregnancy has OR 23.7, 95% p < 0.001, familiar history of preeclampsia OR 1.62, p < 0.08, high body mass has OR 1.60., Conclusions: The knowledge of the most important risk factors in our population could be useful for the clinical to pre-detect the patient who will develop preeclampsia.

A total of 58 women with severe preeclampsia between 28-33 weeks of gestation were studied during the period from 1 October 1996 to 1 October 1997. Twenty-four women (42%) developed maternal or fetal indications necessitating early delivery within 48 hours, meanwhile the other 34 patients (58%) received expectant management. The average pregnancy prolongation period in the conservative management group was 6.4 days (range 3 to 18). The primary indications for delivery in this group were maternal indications 16 (47%), fetal compromise 13 (39%), 34 weeks of gestation 3 (8%), abruption placentae 1 (3%) and preterm labor 1 (3%). The mean birth weight and Apgar score at 5 minutes were 1520 +/- 310 g and 8, respectively. Expectant management was not associated with fetal death or maternal complications. The only neonatal death was related with sepsis and prematurity. The women in the early delivery group totaled two stillbirths and three neonatal deaths.