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Postpartum preeclampsia

Yong-Gang Zhang, Hong-Ling Yang, Yi-Peng Zhang, Qing-Ling Ma, Yan Long, Zao-Xiong Zheng
BACKGROUND: Imbalance of circulating factors related to angiogenesis plays a central role in the pathogenesis of preeclampsia (PE). OBJECTIVE: The aim of this study was to discover and validate a cutoff value of pigment epithelium-derived factor (PEDF)/vascular endothelial growth factor (VEGF) ratio for early prediction of PE before 20 weeks of gestation. STUDY DESIGN: This prospective multicenter study was performed in mainland China, and was divided into 3 phases to discover, develop, and validate a cutoff value of PEDF/VEGF ratio that could predict PE prior to diagnosis in pregnant women at high risk of PE (12 weeks 0 days to 19 weeks 6 days of gestation)...
October 2018: Pregnancy Hypertension
Elie Sader, Melissa Rayhill
Headache is a neurologic disorder that displays gender dichotomy. It is well established that there is a strong link between migraine headache and sex hormones, specifically estrogen, which influences the severity of migraines during the menstrual cycle, pregnancy, and menopause. Furthermore, the epidemiology of headaches during pregnancy and the postpartum period is very distinct from that in males or nonpregnant females, in part due to the hemodynamic and hematologic changes that occur during pregnancy. These changes put women at higher risk for cerebral venous thrombosis, hemorrhagic stroke, and hypertensive disorders of pregnancy like preeclampsia, eclampsia, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome...
December 2018: Seminars in Neurology
Unzila Ali Nayeri, Catalin S Buhimschi, Guomao Zhao, Irina A Buhimschi, Vineet Bhandari
We aimed to test the hypothesis that determinants of the perinatal clinical exposome related to the underlying etiology of premature birth (PTB) impact differently on select neonatal outcomes. We conducted a prospective longitudinal study of 377 singleton preterm neonates [gestational age (GA) at birth: 23-34 weeks] separated into three distinct contemporaneous newborn cohorts: i) spontaneous PTB in the setting of intra-amniotic infection/inflammation (yes-IAI, n = 116); ii) spontaneous PTB in the absence of IAI (no-IAI, n = 130), and iii) iatrogenic PTB for preeclampsia (iPTB-PE, n = 131)...
2018: PloS One
Raanan Meyer, Raoul Orvieto, Ariel Israel, Aya Mohr-Sasson, Yael Timerman, Tal Gorodesky, Shlomo Toussia-Cohen, Israel Hendler, Michal J Simchen, Ronit Machtinger
BACKGROUND: Pregnancies in the fifth and sixth decades of life have been increasing, but current data are limited regarding the outcomes of twin compared with singleton pregnancies in this age group and to twin pregnancies at younger age. OBJECTIVE: To compare obstetrical and neonatal outcomes of IVF conceived pregnancies, in twin gestations of women who were ≥45 years old at delivery to singletons at similar age and twin gestations at the age of <35 years, and to assess if the complications are mainly influenced by the very advanced maternal age or by the multifetal pregnancy...
November 6, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Jose R Navas-Blanco, Ileana Lopez-Plaza, Dragos M Galusca
Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic syndrome during pregnancy with overlapping features of severe preeclampsia and is associated with high morbidity and mortality. We present a case of postpartum TTP, associated with severe preeclampsia. Therapeutic approach for this case included corticosteroids, plasma exchange therapy, and immunomodulatory therapy. We describe the pathophysiology of TTP in pregnancy and its similarities with other disorders that constitute the thrombotic microangiopathy syndrome, as well as other clinical factors which made the final diagnosis challenging...
October 2018: Saudi Journal of Anaesthesia
Caiyuan Mai, Bin Wang, Rong Chen, Dongmei Duan, Lijuan Lv, Qiong Lei, Xiaohong Lin, Jiying Wen, Jianmin Niu
HELLP syndrome is a combination of symptoms described as hemolysis, elevated liver enzymes and low platelets. HELLP is a common life-threatening complication of pregnancy thought to be a variant or complication of preeclampsia. In this case report, we aimed to present a woman with acute postpartum HELLP syndrome complicated by pulmonary edema after caesarean section following severe preeclampsia. Our experience suggests that early detection of HELLP syndrome and timely management will bring good outcomes.
2018: Open Medicine (Warsaw, Poland)
Charalampos Karachalios, Panagiotis Bakas, Anastasia Beta, Efthimios Deligeoroglou
Postpartum nephrotic syndrome in a pregnant woman with rheumatoid arthritis in long-standing remission is rare. Systemic lupus erythematosus can remain undiagnosed, especially in the absence of clinical manifestations. We present the case of a 34-year-old woman (gravida 2, para 1) who underwent a lower-segment cesarean section at 34 weeks and 6 days of gestation because she had developed preeclampsia and nephrotic syndrome. The concomitant presence of significant hypoproteinemia, hypoalbuminemia, uremia, elevated creatinine serum levels, hyperuricemia and hypertriglyceridemia is indicative of impaired renal function and nephrotic syndrome...
October 2018: Case Reports in Women's Health
Naina Kumar, Amit K Singh
OBJECTIVE: Assess the relationship between maternal serum uric acid and severity of Hypertensive disorders of pregnancy in a rural tertiary care centre. MATERIALS AND METHODS: Present study was conducted in Obstetrics and Gynaecology department of rural tertiary care centre of Northern India over seven months (October 2016-May 2017) on 110 women admitted with a Hypertensive disorder of pregnancy (Gestational hypertension, Pre-eclampsia, Eclampsia) at ≥34 weeks gestation...
November 12, 2018: Current Hypertension Reviews
Olivier Mulisya, Mbusa Mastaki, Tambavira Gertrude, Kyakimwa Tasi, Jeff K Mathe
Spontaneous massive vulvar edema in pregnancy is unusual and a cause for concern. This condition should be taken seriously since it might be caused by some conditions such as preeclampsia, diabetes, vulvovaginitis, severe anemia, and neoplasms. We report a case of massive vulvar edema in a 15-year-old primigravida following tocolysis therapy at 33 weeks of gestation. Other causes of vulvar edema were excluded. The vulvar edema appeared spontaneously after tocolysis and rapidly increased in size, associated with severe vulvar pains...
2018: Case Reports in Obstetrics and Gynecology
Kedra Wallace, Cynthia Bean, Teylor Bowles, Shauna-Kay Spencer, Wisdom Randle, Patrick B Kyle, James Shaffery
Abstract- Hypertension and inflammation during pregnancy are suggested to contribute to the development of postpartum depression and anxiety. Using a rat model of severe preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome, which displays both hypertension and inflammation during pregnancy, we evaluated whether rats were prone to develop depression or anxiety in the postpartum period. On gestational day 12, miniosmotic pumps infusing sFlt-1 (soluble fms-like tyrosine kinase-1) and sEng (soluble endoglin) were placed into rats, a subset of these rats was infused with 2 mg/kg of Orencia (abatacept) the following day to determine whether immune suppression via T-cell depletion prevented any changes in maternal depression or anxiety-like behavior...
October 2018: Hypertension
M Patabendige, G Barnasuriya, I Mampitiya
Antiphospholipid syndrome (APS) is associated with vascular thrombosis and pregnancy complications. It causes recurrent miscarriage and it is associated with other adverse pregnancy outcomes such as preterm delivery, intrauterine growth restriction, preeclampsia, and HELLP syndrome. Obstetric morbidity is one of the major manifestations of APS with a wide variety of clinical manifestations. This case describes a case of a severe preeclampsia in a 16-year-old primigravida at 29 weeks resulting in a caesarean delivery and subsequent finding of an ulnar artery thrombosis in postpartum period...
2018: Case Reports in Obstetrics and Gynecology
Oscar A Viteri, Mesk A Alrais, Claudia Pedroza, Maria Hutchinson, Suneet P Chauhan, Sean C Blackwell, Baha M Sibai
OBJECTIVE: To evaluate whether torsemide reduces the rate of persistent postpartum hypertension in women with preeclampsia. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of women with preeclampsia at a tertiary center from August 2016 to September 2017. Those with gestational hypertension or renal or cardiopulmonary failure were excluded. Within 24 hours of delivery, women were randomized one to one to oral torsemide, 20 mg/d, or placebo, for 5 days...
October 5, 2018: Obstetrics and Gynecology
Nicole L Veltri, Michelle Hladunewich, Arrti Bhasin, Jocelyn Garland, Benjamin Thomson
Background: De novo antineutrophil cytoplasmic antibody-associated vasculitis typically arises in post-reproductive years, but can occur during pregnancy. Concerns of treatment-related teratogenicity persist, while efficacy and safety of new therapies including intravenous immunoglobulin (IVIG) and rituximab are uncertain. There remains a paucity of maternal, fetal and pregnancy outcome data in these women, and therefore a lack of guidance on safe treatment for clinicians. Methods: We conducted a systematic review of the literature and a local, retrospective chart review of women with de novo antibody-associated vasculitis (AAV) in pregnancy...
October 2018: Clinical Kidney Journal
Nathan Campbell, Babbette LaMarca, Mark W Cunningham
Preeclampsia is the leading cause of death and morbidity world-wide for the mother and fetus during pregnancy. Preeclampsia does not only effect the mother and the baby during pregnancy, but can also have long-term effects, such as the increase risk of hypertension and cardiovascular disease, on the offspring and the postpartum mother later in life. The exact cause of preeclampsia is unknown, but women with preeclampsia have elevated concentrations of agonistic autoantibodies against the angiotensin II type 1 receptor (AT1-AA)...
September 25, 2018: Current Pharmaceutical Biotechnology
Mieke Cathy Elisabeth Hooijschuur, Chahinda Ghossein-Doha, Abraham A Kroon, Peter W de Leeuw, Adrienne A M Zandbergen, Sander M J van Kuijk, Marc E A Spaanderman
OBJECTIVE: To identify former preeclamptic (PE)women with worse cardiovascular risk profile with necessity for tailored postpartum follow up, we studied the association between postpartum metabolic syndrome and different PE phenotypes. METHODS: In this cohort study, cardiovascular and cardiometabolic evaluation was performed in 1102 former preeclamptic women at least 6 months postpartum. Women were subdivided in 4 subgroups based on disease resulting in delivery at 34 weeks or earlier and after 34 weeks (early onset vs late onset PE, respectively), and whether or not small for gestational age infancy (SGA) co-occurred...
September 23, 2018: Ultrasound in Obstetrics & Gynecology
Shutan Liao, Hao Wu, Ruiying Chen
Background: Preeclampsia (PE) is a serious maternal complication during pregnancy. Associated arterial stiffness in PE patients leads to increased risks of cardiovascular diseases later in life. Cholesterol efflux capacity, especially ATP binding cassette transporter A1 (ABCA1) dependent capacity, has been proposed to be a likely mediator of arterial stiffness. In the present study, we aimed to evaluate the effect of an apolipoprotein A1 mimetic peptide ATI-5261 on arterial stiffness in a mouse model of PE...
2018: Clinical Hypertension
Nidhi Sharma, Sunayana Srinivasan, K Jayashree Srinivasan, Kulasekaran Nadhamuni
Background: Preeclampsia is a heterogeneous disorder prevalent in 3-10% of pregnant women globally. The etiology is multifactorial. There is a initial stage of endothelial dysfunction and placental ischemia (Stage 1); this leads to maternal syndrome of hypertension, edema, and proteinuria (Stage 2). Drugs acting on immunomodulatory, anti-inflammatory, antioxidant and proresolving pathways can minimize the complications of preeclampsia. The therapeutic effect of aspirin is based on acetyl group and salicylate group...
October 2018: Journal of Obstetrics and Gynaecology of India
Lucy Neave, Marie Scully
Thrombotic microangiopathies (TMAs) are associated with microangiopathic hemolytic anemia and thrombocytopenia, resulting in microvascular thrombosis and end-organ damage. In pregnancy, this may be the result of pregnancy-related TMAs such as preeclampsia; hemolysis, elevated liver enzymes, and low platelets; or pregnancy-associated TMAs, specifically thrombotic thrombocytopenic purpura (TTP) or complement-mediated hemolytic uremic syndrome (CM HUS). TTP and CM HUS are rare disorders, and their diagnosis may be missed, no less because features at presentation may be misdiagnosed as a pregnancy-related TMA, such as hypertension, proteinuria, fetal growth restriction, or in utero fetal death...
October 2018: Transfusion Medicine Reviews
Reza Masoomi, Zubair Shah, Zoltan Arany, Kamal Gupta
OBJECTIVE: Peripartum cardiomyopathy (PPCM) can present during pregnancy and up to months post-delivery. Most large-scale epidemiologic studies have reported on cases occurring during pregnancy or the first few days postpartum (termPPCM). Limited information is available on PPCM in the later postpartum period (latePPCM). We studied the incidence, predictors, and hospital outcome of peripartum cardiomyopathy (PPCM) in the prepartum and immediate post delivery period versus up to 3 months post-delivery...
July 2018: Pregnancy Hypertension
Michael M Aziz, Ankita Kulkarni, Leena Shah, Susan Lashley, Yinka Oyelese
The urine protein to creatinine ratio (PC) is a sensitive and specific means of diagnosing preeclampsia in the antepartum period, but the 0.3 g protein per gram of creatinine threshold may be non-specific postpartum due to physiologic proteinuria after delivery. The objective of this study was to examine the reliability of PC in labor and postpartum and to determine if PC is affected by mode of delivery. This is the first study of its kind to examine physiologic proteinuria by catheterized PC in individual patients before and after delivery...
July 2018: Pregnancy Hypertension
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