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preeclampsia in postpartum

Linling Zhu, Yu Zhang, Yifeng Liu, Runjv Zhang, Yiqing Wu, Yun Huang, Feng Liu, Meigen Li, Saijun Sun, Lanfeng Xing, Yimin Zhu, Yiyi Chen, Li Xu, Liangbi Zhou, Hefeng Huang, Dan Zhang
This study was carried out to explore associations between assisted reproductive technology (ART) and maternal and neonatal outcomes compared with similar outcomes following spontaneously conceived births. We conducted a retrospective cohort study of pregnancies conceived by ART (N = 2641) during 2006-2014 compared to naturally conceived pregnancies (N = 5282) after matching for maternal age and birth year. Pregnancy complications, perinatal complications and neonatal outcomes of enrolled subjects were investigated and analysed by multivariate logistic regression...
October 20, 2016: Scientific Reports
Vahid Davoudi, Kiandokht Keyhanian, Riley M Bove, Tanuja Chitnis
Anti-aquaporin-4 (AQP4) autoantibody plays a key role in the pathogenesis of neuromyelitis optica (NMO). Studies have shown increased relapse rates in patients with NMO during pregnancy and postpartum. High estrogen levels during pregnancy can increase activation-induced cytidine deaminase expression, which is responsible for immunoglobulin production. Additionally, sex hormones may influence antibody glycosylation, with effects on antibody function. Estrogen decreases apoptosis of self-reactive B cells, through upregulation of antiapoptotic molecules...
December 2016: Neurology® Neuroimmunology & Neuroinflammation
Kathryn J Sharma, Tania F Esakoff, Alyson Guillet, Richard M Burwick, Aaron B Caughey
OBJECTIVE: To determine whether adverse outcomes were more common in late preterm pregnancies complicated by preeclampsia and growth restriction compared to those affected by preeclampsia alone. METHODS: This was a retrospective cohort study of 8,927 singleton pregnancies with preeclampsia. Pregnancies with small for gestational age (SGA) neonates (birthweight <10(th) percentile) were compared to those appropriate for gestational age (AGA) neonates. Maternal outcomes included cesarean delivery (CD) rate, CD for fetal heart rate (FHR) abnormalities, abruption, postpartum hemorrhage (PPH), maternal transfusion, acute renal failure, and peripartum cardiomyopathy...
October 19, 2016: Journal of Maternal-fetal & Neonatal Medicine
Andrea G Edlow, Brian L Edlow, Jonathan A Edlow
Acute neurologic symptoms in pregnant and postpartum women may be caused by exacerbation of a preexisting neurologic condition, the initial presentation of a non-pregnancy-related problem, or a new neurologic problem. Pregnant and postpartum patients with headache and neurologic symptoms are often diagnosed with preeclampsia or eclampsia; however, other etiologies must also be considered. A team approach with close communication between emergency physicians, neurologists, maternal-fetal medicine specialists, and radiologists is the key to obtaining best outcomes...
November 2016: Emergency Medicine Clinics of North America
Christina M Nowik, Jessica Pudwell, Graeme N Smith
OBJECTIVE: At Kingston General Hospital, women who have pregnancy-related cardiovascular risk indicators (e.g., preeclampsia, gestational hypertension, gestational diabetes) are offered standardized six-month postpartum follow-up for cardiovascular disease risk screening and counselling. We sought to assess how patient characteristics predict attendance at follow-up. METHODS: We undertook a chart review of 650 patients who delivered between April 2011 and December 2014 and had preeclampsia, gestational hypertension, or gestational diabetes...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Melanie Wittwer, Yann York Chow, Gus Dekker, Vicki Clifton, Margaret Arstall
INTRODUCTION: Preeclampsia is a multisystem disorder characterised by endothelial and microvascular dysfunction that develops in ∼10% of pregnancies. This study will characterise skin microvascular reactivity using laser Doppler flowmetry in women with preeclampsia compared to matched controls during pregnancy and early postpartum. METHODS: Women were recruited and studied on the diagnosis of preeclampsia and followed up for 6-months during postpartum period. Controls were matched for age, gestation and comorbidities...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
J Ambrozic, K Prokselj, M Lucovnik
INTRODUCTION: The ability to judge intravascular volume is fundamental in the management of patients with severe preeclampsia. Insufficient intravascular volume can result in decreased oxygen delivery to tissues and exacerbates organ dysfunction. On the other hand, fluid excesses can lead to fluid extravasation and pulmonary edema. Outside of pregnancy, transthoracic echocardiography and lung ultrasonography have become important diagnostic and monitoring tools in critically ill patients...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
Y Chow, M Wittwer, G Dekker, Clifton, V M Arstall
INTRODUCTION: Preeclampsia is associated with vascular dysfunction and long-term cardiovascular disease. A novel technique, TensioMed measuring Pulse Wave Velocity (PWV) and Augmentation index (Aix) to estimate arterial stiffness and vasoconstriction respectively during pregnancy and 6 months postpartum. Targets: Our aim was to evaluate vascular function during pregnancy and the postpartum period in women with preeclampsia compared to uncomplicated pregnancy. We evaluated 11 preeclampsia women, diagnosed with hypertension (4140/90 mmHg) and proteinuria (spot urine protein/creatine ratio 430 mg/mmol) and 7 women with uncomplicated pregnancy...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
Ogochukwu Chantelle Umadia, Dimuthu Vinayagam, Juan Gutierrez Henares, Asma Khalil
AIM: To identify the independent risk factors for PE development in twin pregnancies and explore the associated perinatal outcomes. METHODS: A retrospective cohort study of twin pregnancies was performed at St George's University Hospital, London. Maternal and neonatal data were obtained from the hospital's computerised database. The Chi-square test, Mann-Whitney U test and univariate and multiple-logistic regression analyses were performed. RESULTS: We identified a total of 1250 twin pregnancies who were under the care of SGH from 1999 to 2015...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
Jin-Wan Park, Su-Mi Kim, Gyu-Bong Yu, Yun-Dan Kang
Aortic dissection is very rare in obstetrics, but it is a fatal disease. A 37-weeks primigravida woman with dyspnea and pitting edema presented to our emergency room. The patient was diagnosed with preeclampsia and underwent an emergency cesarean section under spinal anesthesia. The patient complained of severe dyspnea after the cesarean section, and the chest computed tomography scan was done. With the finding of aortic dissection, cardiopulmonary arrest occurred 5 hours after the cesarean section, and the patient died without reaction to cardio-pulmonary resuscitation...
September 2016: Obstetrics & Gynecology Science
Laura A Magee, Peter von Dadelszen, Joel Singer, Terry Lee, Evelyne Rey, Susan Ross, Elizabeth Asztalos, Kellie E Murphy, Jennifer Menzies, Johanna Sanchez, Amiram Gafni, Michael Helewa, Eileen Hutton, Gideon Koren, Shoo K Lee, Alexander G Logan, Wessel Ganzevoort, Ross Welch, Jim G Thornton, Jean-Marie Moutquin
: To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×10(9)/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum...
November 2016: Hypertension
Caroline B Van Den Berg, Johannes J Duvekot, Coşkun Güzel, Stefan R Hansson, Thomas G DE Leeuw, Eric A P Steegers, Johannes Versendaal, Theo M Luider, Marcel P Stoop
PURPOSE: To investigate the cerebrospinal fluid proteome of patients with preeclampsia and normotensive pregnant women, in order to provide a better understanding of brain involvement in preeclampsia. EXPERIMENTAL DESIGN: 98 cerebrospinal fluid samples (43 women with preeclampsia and 55 normotensive controls) were analyzed by LC-MS/MS proteome profiling. Cerebrospinal fluid was obtained during the spinal puncture before Caesarean delivery. RESULTS: Eight proteins were higher abundant and 17 proteins were lower abundant in patients with preeclampsia...
September 11, 2016: Proteomics. Clinical Applications
Hind N Moussa, Mateo G Leon, Ana Marti, Alissar Chediak, Claudia Pedroza, Sean C Blackwell, Baha M Sibai
Objective The American Congress of Obstetricians and Gynecologists (ACOG) task force on hypertension in pregnancy introduced a new definition of superimposed preeclampsia (SIP) adding severe features (SF) as new criteria to define severe disease. They also recommended that those with SIP be delivered ≥ 37 weeks, whereas those with SF be delivered ≤ 34 weeks. Our aim was to investigate the validity of this new definition by comparing adverse pregnancy outcomes in SIP with (SIP-SF) and without SF (SIP)...
September 8, 2016: American Journal of Perinatology
L D Levine, C Nkonde-Price, M Limaye, S K Srinivas
OBJECTIVE: To determine factors associated with lower 6-week postpartum follow-up rates and persistent hypertension among women with preeclampsia with severe features (PEC-S). STUDY DESIGN: Planned secondary analysis of a retrospective cohort study of women with PEC-S. Outcomes were (1) attendance at the 6-week postpartum visit and (2) persistent hypertension. RESULTS: One hundred ninety-three women were in the final cohort. The 6-week follow-up rate was 52...
September 1, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
T Kaleta, A Stock, D Panayotopoulos, O Vonend, D Niederacher, M Neumann, T Fehm, W Kaisers, M Fleisch
Objective. The purpose of this prospective study was to investigate the predictive value of single prepartum findings combined with serum biomarkers sFlt-1 (soluble fms-like tyrosine kinase-1) and PlGF (placental growth factor) indicating severity of preeclampsia (PE) for occurrence and extent of impaired postpartum kidney function. Study Design. In this prospective, single center study 44 PE patients were compared to 39 healthy controls (similar in age and gestational age with singleton pregnancy) evaluated at time of delivery and at 6 months and 12 months postpartum...
2016: Disease Markers
Anne S Ersbøll, Peter Damm, Finn Gustafsson, Niels G Vejlstrup, Marianne Johansen
Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease defined by heart failure towards the end of pregnancy or in the months following delivery. We aim to raise awareness of the condition and give the clinician an overview of current knowledge on the mechanisms of pathophysiology, diagnostics and clinical management MATERIAL AND METHODS: Systematic literature searches were performed in PubMed and Embase up to June 2016. Cohorts of more than 20 women with PPCM conducted after 2000 were selected to report contemporary outcomes and prognostic data...
August 22, 2016: Acta Obstetricia et Gynecologica Scandinavica
Cathi Phillips, Margaret Boyd
Early-onset preeclampsia is a serious condition of pregnancy with the potential for adverse maternal and fetal health outcomes. A strong body of evidence supports the need for postpartum follow-up and health counseling, because these women and their offspring are at risk for future cardiovascular disease; nurses play a key role in this education. An understanding of the diagnosis, risk screening for, pathogenesis, and management of severe preeclampsia and its sequelae, such as intrauterine growth restriction and pulmonary edema, enables nurses to develop a comprehensive plan of care that will support women and their families through this challenging and dynamic complication of pregnancy...
August 2016: Nursing for Women's Health
Stephen E Lapinsky
Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient...
September 2015: Obstetric Medicine
Xin Y Foo, Ristan M Greer, Sailesh Kumar
BACKGROUND: The aim of this study was to evaluate the influence of maternal body mass index on intrapartum and neonatal outcomes at one of the largest maternity hospitals in Australia. METHODS: A retrospective cross-sectional study of 55,352 term singleton deliveries at the Mater Mothers' Hospital in Brisbane, Australia, was conducted. The study cohort was stratified into six groups based on the World Health Organization's body mass index classification. The normal body mass index category was the reference group for all comparisons...
August 8, 2016: Birth
Veronica Agatha Lopes van Balen, Julia Jeltje Spaan, Tom Cornelis, Marc Erich August Spaanderman
BACKGROUND: Preeclampsia (PE), an endothelial disease that affects kidney function during pregnancy, is correlated to an increased future risk of cardiovascular and chronic kidney disease. The Kidney Disease Improving Global Outcomes (KDIGO) 2012 guideline emphasizes the combined role of glomerular filtration rate (GFR) and albuminuria in determining the frequency of monitoring of kidney function. OBJECTIVES: In this study we evaluated the prevalence of CKD in women with a history of PE...
August 5, 2016: Journal of Nephrology
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