MMP-9 and miR-181a-5p in serum and placenta are associated with adverse outcomes of patients with severe preeclampsia and their infants

Introduction Preeclampsia, a multifactorial disease with pathophysiology not yet fully understood, is a major cause of maternal and perinatal morbidity and mortality, especially when preterm. The diagnosis is performed when there is an association between arterial hypertension and proteinuria or evidence of severity. There are unanswered questions in the literature considering the timing of delivery once preterm preeclampsia has been diagnosed, given the risk of developing maternal complications versus the risk of adverse perinatal outcomes associated with prematurity. The objective of this systematic review is to determine the best timing of delivery for women diagnosed with preeclampsia before 37 weeks of gestation. Methods Systematic literature review, performed in the PubMed database, using the terms preeclampsia, parturition and timing of delivery to look for studies conducted between 2014 and 2017. Studies that compared the maternal and perinatal outcomes of women who underwent immediate delivery or delayed delivery, in the absence of evidence of severe preeclampsia, were selected. Results A total of 629 studies were initially retrieved. After reading the titles, 78 were selected, and their abstracts, evaluated; 16 were then evaluated in full and, in the end, 6 studies (2 randomized clinical trials and 4 observational studies) met the inclusion criteria. The results were presented according to gestational age range (< 34 weeks and between 34 and 37 weeks) and by maternal and perinatal outcomes, according to the timing of delivery, considering immediate delivery or expectant management. Before 34 weeks, the maternal outcomes were similar, but the perinatal outcomes were significantly worse when immediate delivery occurred. Between 34 and 37 weeks, the progression to severe maternal disease was slightly higher among women undergoing expectant management, however, with better perinatal outcomes. Conclusions When there is no evidence of severe preeclampsia or impaired fetal well-being, especially before 34 weeks, the pregnancy should be carefully surveilled, and the delivery, postponed, aiming at improving the perinatal outcomes. Between 34 and 37 weeks, the decision on the timing of delivery should be shared with the pregnant woman and her family, after providing information regarding the risks of adverse outcomes associated with preeclampsia and prematurity.

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Early onset severe preeclampsia and eclampsia in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe

BMC Research Notes ◽

10.1186/s13104-019-4865-0 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Solwayo Ngwenya ◽

Brian Jones ◽

Desmond Mwembe ◽

Cladnos Mapfumo ◽

Akinbowale Familusi ◽

...

Keyword(s):

Risk Factors ◽

Early Onset ◽

Mode Of Delivery ◽

Adverse Outcomes ◽

Severe Preeclampsia ◽

Central Hospital ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Mpilo Central Hospital

Abstract Objectives Early-onset severe preeclampsia is associated with significant maternal and perinatal morbidity and mortality especially in low-resource settings, where women have limited access to antenatal care. This dataset was generated from a retrospective cross-sectional study carried out at Mpilo Central Hospital, covering the period February 1, 2016 to July 30, 2018. The aim of the study was to determine the incidence of early-onset severe preeclampsia and eclampsia, and associated risk factors in a low-resource setting. The reason for examining the incidence of preeclampsia specifically in a low-resource setting; was to document it as women in these settings appear to suffer from poor outcomes. Data description The dataset contains data of 238 pregnant women who had a diagnosis of early onset severe preeclampsia/eclampsia. There were 243 babies from singleton and twin gestations. There were five sets of twins. There were 21,505 live births during the study period giving an incidence of 1.1%. The dataset contains data on maternal socio-demographic, signs and symptoms, therapeutic interventions and mode of delivery, adverse outcomes characteristics, and fetal characteristics. This large dataset can be used to calculate the incidence and risk factors for adverse maternal and fetal outcomes or develop predictive models in severe preeclampsia/eclampsia.

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Maternal and Infant Adverse Outcomes Associated with Mild and Severe Preeclampsia during the First Year after Delivery in the United States

American Journal of Perinatology ◽

10.1055/s-0039-1679916 ◽

2019 ◽

Vol 37 (04) ◽

pp. 398-408

Author(s):

Thanh G.N. Ton ◽

Mihoko V. Bennett ◽

Devin Incerti ◽

Desi Peneva ◽

Maurice Druzin ◽

...

Keyword(s):

United States ◽

Adverse Outcome ◽

The United States ◽

Population Based ◽

Adverse Outcomes ◽

Severe Preeclampsia ◽

First Year ◽

Inverse Association ◽

Mild Preeclampsia ◽

Collider Bias

Objective The burden of preeclampsia severity on the health of mothers and infants during the first year after delivery is unclear, given the lack of population-based longitudinal studies in the United States. Study design We assessed maternal and infant adverse outcomes during the first year after delivery using population-based hospital discharge information merged with vital statistics and birth certificates of 2,021,013 linked maternal–infant births in California. We calculated sampling weights using the National Center for Health Statistics data to adjust for observed differences in maternal characteristics between California and the rest of the United States. Separately, we estimated the association between preeclampsia and gestational age and examined collider bias in models of preeclampsia and maternal and infant adverse outcomes. Results Compared with women without preeclampsia, women with mild and severe preeclampsia delivered 0.66 weeks (95% confidence interval [CI]: 0.64, 0.68) and 2.74 weeks (95% CI: 2.72, 2.77) earlier, respectively. Mild preeclampsia was associated with an increased risk of having any maternal adverse outcome (relative risk [RR] = 1.95; 95% CI: 1.93, 1.97), as was severe preeclampsia (RR = 2.80; 95% CI: 2.78, 2.82). The risk of an infant adverse outcome was increased for severe preeclampsia (RR = 2.15; 95% CI: 2.14, 2.17) but only marginally for mild preeclampsia (RR = 0.99; 95% CI: 0.98, 1). Collider bias produced an inverse association for mild preeclampsia and attenuated the association for severe preeclampsia in models for any infant adverse outcome. Conclusion Using multiple datasets, we estimated that severe preeclampsia is associated with a higher risk of maternal and infant adverse outcomes compared with mild preeclampsia, including an earlier preterm delivery.

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842Prevention of severe preeclampsia at term gestation among women with chronic hypertension

International Journal of Epidemiology ◽

10.1093/ije/dyab168.394 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Sarka Lisonkova ◽

Jeffrey Bone ◽

Giulia Muraca ◽

Neda Razaz ◽

Amelie Boutin ◽

...

Keyword(s):

Cesarean Delivery ◽

Gestational Age ◽

Preventive Intervention ◽

Perinatal Death ◽

Neonatal Morbidity ◽

Adverse Outcomes ◽

Severe Preeclampsia ◽

Labour Induction ◽

Chronic Hypertension ◽

Preventive Interventions

Abstract Background Chronic hypertension is a strong risk factor for severe preeclampsia/eclampsia (SPE), and timely obstetric intervention can prevent SPE and reduce perinatal complications. We quantified gestational age-specific rates of SPE and estimated the benefits of preventive interventions among women with chronic hypertension at term gestation (≥37 weeks). Methods Women with chronic hypertension and a term, singleton, hospital delivery in Washington State, 2003-2013, were included in the study (N = 9697) with data obtained from birth certificates and hospital records. Adverse outcomes included SPE and composite severe neonatal morbidity (e.g., seizures, intracranial hemorrhage) and perinatal death (SNMM). Preventive interventions included labour induction and pre-labour cesarean delivery. Results There were 1026 cases of SPE (10.6 per 100 women with chronic hypertension). Gestational age-specific SPE rates ranged between 2.8 and 4.1 per 100 ongoing pregnancies; the frequency of preventive intervention at each gestational week ranged between 58% and 66%. Gestational age-specific SPE and SNMM rates were lower following preventive intervention: such intervention reduced the frequency of SPE/SNMM by 28 per 100 additional interventions at 37 weeks, 22 per 100 at 38 weeks, 17 per 100 at 39 weeks, 13 at 40 weeks and 6 per 100 additional interventions at 41 weeks’ gestation. Conclusions Labour induction and pre-labour cesarean delivery at term gestation can prevent a substantial proportion of severe preeclampsia/eclampsia and perinatal death/severe neonatal morbidity among women with chronic hypertension. Key messages SPE occurs in approximately 11% of women with chronic hypertension at term gestation. Obstetric interventions can prevent SPE and improve adverse pregnancy outcomes.

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Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd17.2.43 ◽

2008 ◽

Vol 17 (2) ◽

pp. 43-49

Author(s):

James L. Coyle

Keyword(s):

Treatment Effectiveness ◽

Code Of Ethics ◽

Oropharyngeal Dysphagia ◽

Clinical Importance ◽

Professional Services ◽

Adverse Outcomes ◽

Professional Judgment ◽

Evidence Based ◽

Intervention Selection ◽

Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

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