scholarly journals Evaluation of the diagnostic possibility of hemorrhagic risk in pregnant women with severe preeclampsia by rotational thromboelastography

2021 ◽  
Vol 70 (2) ◽  
pp. 37-44
Author(s):  
Ilya S. Peretyatko ◽  
Elena V. Mozgovaya
Keyword(s):  
Pregnant Women ◽  
Normal Pregnancy ◽  
Diagnostic Value ◽  
Reference Intervals ◽  
Severe Preeclampsia ◽  
Screening Tests ◽  
Control Group ◽  
Hemorrhagic Complications ◽  
Hemorrhagic Risk ◽  
Coagulation Pathway

AIM: The aim of this study was to determine the risk of hemorrhagic complications in pregnant women with severe preeclampsia using rotational thromboelastometry (ROTEM) in two screening tests EXTEM and INTEM. MATERIALS AND METHODS: We examined 30 pregnant women with severe preeclampsia, who were observed in the intensive care unit, the Department of Obstetrics and Perinatology, the Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott, Saint Petersburg. The control group consisted of 10 patients with normal pregnancy, delivered by caesarean section for reasons not related to obstetric complications. RESULTS: When interpreting the ROTEM results, the reference intervals for pregnant women in the third trimester were used, as determined in the study by J. Lee et al. (2019). According to the analysis of thromboelastograms of pregnant women with severe preeclampsia, 9 (30%) of them had a tendency towards hypocoagulation. Of these, 3 thromboelastograms had deviations via the intrinsic coagulation pathway (in the INTEM tests), 3 thromboelastograms via the extrinsic coagulation pathway (in the EXTEM tests), and the rest combined both options. Two patients with severe preeclampsia developed a complication in the form of HELLP syndrome, and the phenomena of hypocoagulation, according to the results of ROTEM performed before delivery, were observed in only one patient. A comparative analysis of ROTEM parameters among pregnant women with severe preeclampsia and normal pregnancy did not reveal statistically significant differences. CONCLUSIONS: The use of the ROTEM method with the main screening tests (EXTEM and INTEM) did not show diagnostic value in assessing the risk of hemorrhagic complications of severe preeclampsia.

scholarly journals Matrix Metalloproteinases MMP-2 and MMP-9 Occupy a New Role in Severe Preeclampsia

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Elena Timokhina ◽  
Alexander Strizhakov ◽  
Sapiyat Ibragimova ◽  
Evgeny Gitel ◽  
Irina Ignatko ◽  
...  
Keyword(s):  
Matrix Metalloproteinases ◽  
Pregnant Women ◽  
Blood Vessels ◽  
Late Onset ◽  
Plasma Concentrations ◽  
Normal Pregnancy ◽  
Severe Preeclampsia ◽  
Control Group ◽  
Threatening Condition ◽  
Early Onset Preeclampsia

Introduction. Preeclampsia (PE) is a life-threatening condition for the mother, the fetus, and the newborn. Matrix metalloproteinases (MMP) participate in the two primary stages of PE: remodeling of blood vessels at the stage of placental formation and the development of hypertension due to damage to the basement membrane of blood vessels. The object of the present study was to reveal the role of MMP-2 and MMP-9 in the development of severe preeclampsia. Materials and Methods. We conducted a retrospective study that included 92 pregnant women at a gestational age of 26-38 weeks, of which the principal group consisted of 61 patients with severe PE. We divided the principal group into two subgroups: the first subgroup was designated the severe early-onset preeclampsia (EO-PE) group and consisted of 30 pregnant women. The second group was designated the severe late-onset preeclampsia (LO-PE) group, comprising 31 patients. We determined the plasma concentrations of MMPs 2 and 9 in the groups with an ELISA. Results. In the group of PE patients with both EO-PE and LO-PE, the level of MMP-2 was significantly higher compared to the women undergoing normal pregnancy; and we observed no significant differences when we compared the levels of MMP-2 in the subgroups with EO-PE and LO-PE. Analysis of the concentrations of MMP-9 in EO-PE and LO-PE subgroups revealed attenuated levels of MMP-9 in both groups relative to the control group. We also noted a diminished level of MMP-9 in the EO-PE group compared to the LO-PE group. Conclusions. The significantly increased levels of MMP-2 in women—both in the EO-PE and LO severe PE subgroups—explain the participation of this enzyme in endothelial dysfunction in the second stage of severe PE. A diminution in MMP-9 in the EO-PE group confirmed the participation of MMP-9 in the process of spiral artery transformation.

scholarly journals Is There a Relationship Between the Severity of Preeclampsia and Fetal Renal Doppler Indices?

2021 ◽  
Vol 9 (4) ◽  
pp. 263-267
Author(s):  
Elnaz Afsari ◽  
Fatemeh Abbasalizadeh ◽  
Zahra Fardiazar ◽  
Saeedeh Shahali ◽  
Yousef Soltan Ahmadi
Keyword(s):  
Renal Artery ◽  
Pregnant Women ◽  
Pregnancy Termination ◽  
Resistance Index ◽  
Normal Pregnancy ◽  
Severe Preeclampsia ◽  
Control Group ◽  
Amniotic Fluid Index ◽  
High Prevalence ◽  
Doppler Indices

Objectives: Preeclampsia is a high prevalence complication in pregnancy and is responsible for 36% of maternal mortality worldwide. The offspring of mothers with preeclampsia face many problems after birth and in their lifetime. The fetal renal is one of the most vulnerable organs following maternal preeclampsia. In this regard, the present study investigated the relationship between the severity of preeclampsia and fetal renal artery resistance and pulsatility. Materials and Methods: In general, 91 pregnant women were included and divided into control and preeclampsia groups. The control group included 43 women with normal pregnancy and the preeclampsia group consisted of 48 pregnant women who suffered from preeclampsia and were classified into patients in severe and non-severe preeclampsia groups each containing 24 cases. Renal artery Doppler ultrasound was performed, and then the systole/diastole ratio (S/D), pulsatility index (PI), and resistance index (RI) were measured as well. Results: The S/D ratio, RI, and PI significantly decreased in the preeclampsia group (P<0.001) compared to the control group. The S/D ratio in severe preeclampsia was significantly lower in comparison with non-severe preeclampsia (P<0.001). Finally, the amniotic fluid index was related to the PI (P<0.05), and severe preeclampsia significantly increased the pregnancy termination before 34 weeks (P<0.001). Conclusions: Preeclampsia deceased the resistance of renal arteries by altering the fetal renal blood flow. These changes can intensify in patients with severe preeclampsia compared to non-severe preeclampsia.

Pathological features of the sequence in pregnant women with delayed fetal growth

2019 ◽  
pp. 50-54
Author(s):  
V.O. Golyanovskiy ◽  
◽  
Ye.O. Didyk ◽  
Keyword(s):  
Pregnant Women ◽  
Intrauterine Growth Restriction ◽  
Normal Development ◽  
Intrauterine Infection ◽  
Normal Pregnancy ◽  
Growth Restriction ◽  
Control Group ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Infection And Inflammation

Pregnant women with intrauterine growth restriction (IUGR) have an increased risk of adverse perinatal and long-term complications compared with the birth of children with normal body weight. Thus, IUGR is one of the main challenges for the global health system, especially in poor and developing countries. Morpho-functional studies of the placentas help in determining the causes of IUGR, and therefore, timely prevent complications in pregnant women with IUGR. The objective: The purpose of this study is to investigate various morphometric and pathomorphological changes in the placenta, including inflammatory, in cases of IUGR, and to establish a correlation of these results with the etiology and complications for the fetus. Materials and methods. In the current study, 54 placentas of the fetuses with IUGR (the main group) were compared with 50 placentas of the fetuses with normal development (control group). The criteria for the inclusion of IUGR were gestational age more than 30 weeks and all fetuses with a weight less than 10th percentile for this period of pregnancy. The placenta material was studied pathomorphologically with laboratory screening for infection and inflammation. Similarly, the results were determined for placentas of the fetuses with normal development compared to placentas with IUGR. Results. The placenta study showed the presence of calcification in the case of IUGR, as well as in the case of prolonged pregnancy. However, calcification of the placenta in the case of IUGR was more progressive compared with placenta in the normal pregnancy. In addition, the presence of intrauterine infection and inflammation was observed, which could also lead to an adverse outcome for the further progression of pregnancy with IUGR. Conclusion. A comparative macro- and microscopic pathomorphological study of the placentas in the two groups has shown a significant increase in the pathological changes in all the anatomical structures of the fetuses with IUGR. Key words: Intrauterine growth restriction (IUGR), fetal weight, pathomorphological changes of the placenta.

scholarly journals Hematological Changes, Serum Interferon Gamma and Interleukin-4 Alterations in Normal Pregnancy and Preeclampsia

2020 ◽  
Vol 9 (1) ◽  
pp. 44-51
Author(s):  
Shilan Anwar Mawlood ◽  
Bakhtiar Mohamed Mahmoud
Keyword(s):  
Pregnant Women ◽  
Antiphospholipid Antibodies ◽  
Study Groups ◽  
Normal Pregnancy ◽  
Anticardiolipin Antibodies ◽  
Interleukin 4 ◽  
Control Group ◽  
Immunological Parameters ◽  
Immunological Changes ◽  
Hematological Changes

Background: Various hematological and immunological changes can occur in pregnancy which could be beneficial for the growth of the fetus and the maintenance of the pregnancy although some of these changes could be hazardous to the fetus and can cause complications during pregnancy. Thus, this study was conducted to investigate the hematological and immunological changes in normal pregnancy and preeclampsia (PE). Materials and Methods: To this end, hematological and immunological changes were evaluated in 62 normal pregnant women and 56 pregnant women with PE. Moreover, 58 healthy non-pregnant women were studied as the control group. The study was done between December 1, 2018 to May 1, 2019 in Chwarbakh Private Clinic and Shorsh Teaching Hospital. The venous peripheral blood from the antecubital vein was used in this study. Results: The results revealed a significant increase in the number of granulocytes, monocytes, and mean platelet (PLT) volume in both normal pregnant women and PE patients in comparison to normal (non-pregnant) controls (P<0.01). In addition, there was a significant correlation between a reduction in their hematocrit (HCT), PLT, and lymphocytes (P<0.01). With regard to immunological changes, a significant increase was also observed in the serum interleukin-4 (IL-4) levels in both normal pregnancy and preeclamptic patients when compared to non-pregnant controls (P<0.01), but gamma interferon was not significantly different. Conversely, there were no significant associations between the serum level of antiphospholipid antibodies and anticardiolipin antibodies in the study groups except for antiphospholipid antibodies which were significantly lower in the third trimester of pregnancy in the preeclamptic patients (P<0.05). Conclusion: In general, significant changes in hematological and immunological parameters were observed in both normal pregnant and PE patients although further studies are required to include more immunological parameters.

Gestational age-specific reference intervals for 15 biochemical measurands during normal pregnancy in China

2017 ◽  
Vol 55 (4) ◽  
pp. 446-452 ◽  
Author(s):  
Yanpeng Dai ◽  
Junjie Liu ◽  
Enwu Yuan ◽  
Yushan Li ◽  
Quanxian Wang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Parametric Method ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Reference Intervals ◽  
Specific Reference ◽  
Gamma Glutamyl Transpeptidase ◽  
Cross Sectional ◽  
Laboratory Results

Aims Physiological changes that occur during pregnancy can influence biochemical parameters. Therefore, using reference intervals based on specimens from non-pregnant women to interpret laboratory results during pregnancy may be inappropriate. This study aimed to establish the essential reference intervals for a range of analytes during pregnancy. Methods A cross-sectional study was performed in 13,656 healthy pregnant and 2634 non-pregnant women. Fifteen biochemical measurands relating to renal and hepatic function were analysed using an Olympus AU5400 analyzer (Olympus, Tokyo, Japan). All the laboratory results were checked for outliers using Dixon’s test. Reference intervals were established using a non-parametric method. Results Alanine aminotransferase, aspartate aminotransferase, albumin, cholinesterase, creatinine, direct bilirubin, gamma-glutamyl transpeptidase, total bilirubin, total bile acid and total protein showed a decrease during the whole gestational period, while alkaline phosphatase and uric acid increased. Urea nitrogen, β2-microglobulin and cystatin-C fell significantly during the first trimester and then remained relatively stable until third trimester. Reference intervals of all the measurands during normal pregnancy have been established. Conclusions The reference intervals established here can be adopted in other clinical laboratories after appropriate validation. We verified the importance, for some measurands, of partitioning by gestational age when establishing reference intervals during pregnancy.

scholarly journals Distribution of thyroid peroxidase positivity and its effects on thyroid function in normal pregnant women during 1st trimester in Dhaka city

2014 ◽  
Vol 4 (1) ◽  
pp. 15-20
Author(s):  
Ohida Sultanaa ◽  
Nasim Jahan ◽  
Nayma Sultana ◽  
Farzana Mahmudad ◽  
Tazdik G Chowdhurye
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Control Group ◽  
Thyroid Peroxidase ◽  
Study Group ◽  
Cross Sectional ◽  
Total Study Population ◽  
Group B

Objective: To measure the distribution of TPO-Ab positivity and to observe the effect of thyroid peroxidase positivity on thyroid function during first trimester in normal pregnancy. Method: A cross sectional among 120 subjects were taken in this study and divided into control and study groups. Control group (Group A) consisted of 60 healthy non pregnant women age ranged between 20 to 35 years. Study group (Group B) consisted of 60 normal pregnant women of same age range. Group B was further subdivided into group B1 and group B2according to the level of TPO-Ab. Group B1 consisted of TPO-Ab positive pregnant women and group B2 consisted of TPO- Ab negative pregnant women. Control group was selected from personal contacts and study group from Out Patient Department (OPD) of Obstetrics and Gynecology of Sir Salimullah Medical College and Mitford Hospital. For assessment of thyroid function, serum free thyroxine (FT4), thyroid stimulating hormone (TSH) were measured. Serum FT4, TSH were measured by Enzyme link immunosorbant (ELISA) method. Again, serum TPO-Ab of total study population and hCG of all the pregnant women were measured. Serum TPO-Ab by Micro particle Enzyme Immunoassay (MEIA) method and hCG was estimated by ELISA. Statistical analysis was done by SPSS version 17. Results: In this study, serum FT4 and was significantly (P<0.001) higher and TSH level was significantly (P<0.001) lower in normal pregnant women during 1st trimester in comparison to those of non pregnant women. Again, 18% of pregnant women showed TPO-Ab positivity. However, serum FT4 level was significantly (P<0.001) lower whereas, TSH level was significantly (p<0.001) higher in TPO-Ab positive pregnant women in comparison to those of TPO-Ab negative pregnant women. Conclusion: TPO-Ab positivity increases during 1st trimester of normal pregnancy which decreases the hyper functional state of thyroid hormones. So, thyroid screening should be done routinely during pregnancy. DOI: http://dx.doi.org/10.3329/updcj.v4i1.21160 Update Dent. Coll. j: 2014; 4 (1): 15-20

PROTEIN C AND PROTEIN S IN MILD AND MODERATE PREECLAMPSIA

1987 ◽  
Author(s):  
P Hopmeier ◽  
M Halbmayer ◽  
H P Schwarz ◽  
F Heuss ◽  
M Fischer
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Total Protein ◽  
Protein C ◽  
Protein S ◽  
Normal Liver ◽  
Normal Pregnancy ◽  
Severe Preeclampsia ◽  
Wilcoxon Rank Sum Test

In normal pregnancy, total protein S antigen and activity have been reported to be markedly reduced, whereas protein C level was found unaltered. In contrast, in severe preeclampsia protein C antigen was found to be considerably reduced. The presentstudy was done to clarify whether similar changes in protein Cwould alsobe observed for the mildand moderatepreeclamptic state andwhether there would be any effects on the level ofprotein S, since nodata on this cofactor in preeclampsia have been reported to date. 4-0 women in the 3rd trimester of pregnancy - 20 with uncomplicated pregnancies and 20 who had developed a mild (n = 14-) or moderate (n = 6) preeclamptic condition - were included in the study. All groups were well matched in age and gestational age. In addition, 20 healthynon-pregnant women served as controls. All probands had normal liver (SGOT, SGPT) and kidney (BUN, creatinine) values and no other medication than oral vitamins was used. Classification of preeclampsia was done according to a modification of the gestosis index of Goecke using an 11 gradeindex system (0 - 11). ProteinC antigen was measured by an enzyme-linkedimmunosorbent assay and protein S by the Laurell rocket technique.For statistics, the Wilcoxon rank sum test was appliedWe conclude that in comparison tonormal pregnancies, protein S is found elevated at least in the moderate, and protein C in the moderateas well as in the mild preeclamptic state

PHYSIOLOGICAL COAGULATION INHIBITORS (PROTEIN S, PROTEIN C AND ANTITHROMBIN III) IN NORMAL PREGNANCY AND IN SEVERAL HYPERTENSION STATES IN PREGNANCY

1987 ◽  
Author(s):  
J Gilabert ◽  
J A Fernández ◽  
F Espana ◽  
J Aznar ◽  
A Estellés
Keyword(s):  
Protein C ◽  
Protein S ◽  
Normal Pregnancy ◽  
Severe Preeclampsia ◽  
Control Group ◽  
Chronic Hypertension ◽  
At Iii ◽  
Coagulation Inhibitors ◽  
Group A ◽  
Group B

The protein C (PC) - protein S (PS) anticoagulant system and antithrorribin III (AT III) were evaluated in normal pregnancy (group A, n= 53), severe preeclampsia (group B, n= 15) and chronic hypertension with superinposed severe preeclampsia (group C, n= 18). Group A was classified according to the stage of pregnancy as 1st (n=9), 2nd (n=ll) and 3rd (n=33) trimester (tr). A control group comprised 21 normal, non-pregnant women who were non-users of oral contraceptives. In normal pregnancy a significant decrease in the level of free protein S was observed in the 2nd trimester of pregnancy and was sustained throughout the remaining months. The other coagulation inhibitors (protein C and AT III) undergo no significant changes during pregnancy and remain within the limits of normality. In cases of preeclampsia a significant decrease in protein C was observed. It was more evident in severe preeclarrpsia but was also found in chronic hypertension with superiirposed severe preeclanpsia when compared with the normal pregnancy group at similar gestational age. No statistically significant differences in protein S were found when the normal and pathological groups were compared. AT III decreased slightly in the severe preeclamptic group but the decrease was not significant.The decrease in protein C and AT III levels in severe preeclanpsia could be related with the microthrombotic state that these patients may present. However, protein S, which decreases during normal pregnancy, seems to play no role in preeclanpsia.

Vaginal and intestinal microbiocenosis composition in pregnant women

2020 ◽  
Vol 68 (6) ◽  
pp. 29-36
Author(s):  
Alexandr A. Bezmenko ◽  
Natalya D. Sadovaya
Keyword(s):  
Pregnant Women ◽  
Normal Pregnancy ◽  
Main Group ◽  
Control Group ◽  
Microbiological Analysis ◽  
Control Groups ◽  
Threatened Miscarriage ◽  
Intestinal Dysbiosis ◽  
Grade Ii ◽  
And Control

Hypothesis/aims of study. It is assumed that intestinal dysbiosis, as well as bacterial vaginosis, may be one of the risk factors, and in some cases, the direct cause of pregnancy complications. This study was aimed to assess the intestinal and vaginal microbiocenosis composition in women with threatened miscarriage and normal pregnancy. Study design, materials and methods. The study involved 68 women aged 18 to 35 years (mean age 27.6 0.7 years) in pregnancy from 6 to 18 weeks. The main group consisted of 38 women with threatened miscarriage. The control group included women (n = 30) with normal pregnancy. Patients of the main and control groups were examined in accordance with the requirements of the Ministry of Health order No. 572n. In addition, a qualitative and quantitative microbiological analysis of vaginal discharge and feces was performed using the real-time polymerase chain reaction method. Results. Vaginal dysbiosis was detected in 60.5% of pregnant women of the main group and only 13.3% of women of the control group. In the main group, grade II dysbiosis was found in 23.7% of cases, and grade I dysbiosis in 36.8% of cases, while in the control group, these grades were found only in 3.3% and 10% of cases, respectively. Intestinal dysbiosis was diagnosed in 100% of the examined pregnant women. In patients of the main group, intestinal dysbiosis was detected as follows: grade I in 29% of cases, grade II in 52.6% of cases, and grade III in 18.4% of cases. In patients of the control group, the disorders corresponded mainly to grade I (83.4%) and, to a lesser extent, grade II (16.6%) dysbiosis, there being no cases of severe dysbiosis revealed. Conclusion. Women with threatened miscarriage had the most pronounced dysbiotic changes in vaginal and intestinal microflora compared to the control group. Vaginal dysbiosis was combined with intestinal dysbiosis in 100% of cases in patients of the main and control groups, and the degree of dysbiotic changes in the vaginal microflora was directly proportional to the degree of intestinal dysbiosis.

The Expression and Significance of Matrix Metalloproteinase, Wnt5a and β-Catenin in Placental Tissue of Preeclampsia

2021 ◽  
Vol 11 (12) ◽  
pp. 2375-2380
Author(s):  
Hui Zhang ◽  
Wei Chen ◽  
Shenmiao Chen ◽  
Junrong Wang ◽  
Shunfen Mao
Keyword(s):  
Matrix Metalloproteinase ◽  
Western Blot ◽  
Pregnant Women ◽  
Placental Tissue ◽  
Normal Pregnancy ◽  
Expression Level ◽  
Control Group ◽  
Cytotrophoblast Cell ◽  
Western Blot Method ◽  
Low Expression

In order to investigate the expression and clinical significance of MMPs (Matrix Metalloproteinase) (MPP-2 and MPP-9), Wnt5a as well as β-catenin in placental tissues of preeclampsia (PE) patients, 36 PE patients (PE group) and 25 pregnant women (control group) with normal pregnancy were selected for cesarean delivery. The expression and localization of MPP-2, MPP-9, Wnt5a as well as β-catenin proteins in placental tissue were detected by Western blot method and immunohistochemistry method. The correlation between the poor prognosis of mother and child and the expression level of MMPs, Wnt5a as well as β-catenin is analyzed. The results showed that Western blot results showed that MPP-2, MPP-9, Wnt5a as well as β-catenin proteins were expressed in placental tissue, and the expression level of them of placental tissue in PE group was significantly lower than that in control group (P < 0.01). Immunohistochemistry showed that MMPs, Wnt5a, as well as β-catenin proteins were expressed in the cytotrophoblast cell (CTB) and syncytiotrophoblast cell (STB) of placental tissue, among which Wnt5a proteins as well as β-catenin proteins were mainly expressed in the cytoplasm of STB and CTB respectively. MMPs proteins were mainly expressed in the cytoplasm of these two types of cells. Low expression of MPPs, Wnt5a, β-catenin proteins may be related to blood pressure as well as 24 h urine protein of pregnant women at admission. In conclusion, Low expression of MPPs, Wnt5a, β-catenin proteins may be involved in the PE pathogenesis.

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