Effect of Prior History of Dementia and a Diagnosis of COVID-19 on Delirium in the ICU

Background: Delirium occurred in nearly two out of every three patients in the ICU from prior studies. It is associated with poor health outcomes, including long-term cognitive and motor decline, increased risk of dementia, and increased mortality. In the context of COVID-19, patients are more likely to develop delirium due to the severity of the illness involving multiple organ systems. Our study evaluates factors contributing to the occurrence of delirium in the ICU for patients with or without a history of dementia and with or without a recent diagnosis of COVID-19. Methods: We performed a retrospective chart review of ICU patients in Fort Wayne, IN from January through the end of June of 2020. Patients were grouped by whether they developed delirium or not and whether they had pre-existing dementia. We recorded age, sex, race, BMI, level of education, high risk medications, comorbidities, enteric/NPO feeding, mechanical ventilation, mobility, and lab results including CBC and BMP at the onset of delirium. Additionally, we included severity of delirium, length of stay, functional status at time of discharge, and COVID-19 status. Results: We were unable to collect data at the time. However, we hypothesized that the incidence and severity of ICU delirium is associated with the severity of dementia and COVID status, among other factors. Potential Impact: This study can shed light on the contribution of dementia history to ICU delirium and potential factors contributing to delirium incidence and severity. The COVID pandemic offers opportunities to differentiate effects of neurological (dementia) versus non-neurological factors (respiratory, renal, cardiovascular, and metabolic) on ICU delirium.

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Association Between Anticoagulation Outcomes and Venous Thromboembolism History in Chronic Thromboembolic Pulmonary Hypertension

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.628284 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yong-Jian Zhu ◽

Yu-Ping Zhou ◽

Yun-Peng Wei ◽

Xi-Qi Xu ◽

Xin-Xin Yan ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Venous Thromboembolism ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Prior History ◽

Anticoagulation Treatment ◽

Increased Risk ◽

Thromboembolic Pulmonary Hypertension ◽

History Of ◽

Recurrent Vte ◽

Potential Factors

Background: The association between anticoagulation outcomes and prior history of venous thromboembolism (VTE) in chronic thromboembolic pulmonary hypertension (CTEPH) has not been established. This study aimed to compare the efficacy and safety of anticoagulation treatment in CTEPH patients with and without prior history of VTE.Methods: A total of 333 CTEPH patients prescribed anticoagulants were retrospectively included from May 2013 to April 2019. The clinical characteristics were collected at their first admission. Incidental recurrent VTE and clinically relevant bleeding were recorded during follow-up. The Cox proportional regression models were used to identify potential factors associated with recurrent VTE and clinically relevant bleeding.Results: Seventy patients (21%) without a prior history of VTE did not experience recurrent VTE during anticoagulation. Compared to CTEPH patients without a prior history of VTE, those with a prior history of VTE had an increased risk of recurrent VTE [2.27/100 person-year vs. 0/100 person-year; hazard ratio (HR), 8.92; 95% confidence interval (CI), 1.18–1142.00; P = 0.029] but a similar risk of clinically relevant bleeding (3.90/100 person-year vs. 4.59/100 person-year; HR, 0.83; 95% CI, 0.38–1.78; P = 0.623). Multivariate Cox analyses suggested that a prior history of VTE and interruption of anticoagulation treatments were significantly associated with an increased risk of recurrent VTE, while anemia and glucocorticoid use were significantly associated with a higher risk of clinically relevant bleeding.Conclusions: This study is the first to reveal that a prior history of VTE significantly increases the risk of recurrent VTE in CTEPH patients during anticoagulation treatment. This finding should be further evaluated in prospective studies.

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Pre-Existing Cardiovascular Disease Increases Risk of Atrial Arrhythmia in Cancer Patients Treated with Ibrutinib

10.21203/rs.3.rs-401031/v1 ◽

2021 ◽

Author(s):

Juan Carlo Avalon ◽

Jacob Fuqua ◽

Tyler Miller ◽

Seth Deskins ◽

Chelby Wakefield ◽

...

Keyword(s):

Cardiovascular Disease ◽

Hematological Malignancies ◽

Kinase Inhibitor ◽

Retrospective Chart Review ◽

Atrial Arrhythmia ◽

Prior History ◽

Increased Risk ◽

All Cause Mortality ◽

History Of ◽

Atrial Fibrillation And Flutter

Abstract Background: Ibrutinib is a Bruton’s tyrosine kinase inhibitor used in the treatment of hematological malignancies. The most common cardiotoxicity associated with ibrutinib is atrial arrhythmia (atrial fibrillation and flutter). It is known that patients with cardiovascular disease (CVD) are at an increased risk for developing atrial arrhythmia. However, the rate of atrial arrhythmia in patients with pre-existing CVD treated with ibrutinib is unknown. Objective: This study examined whether patients with pre-existing CVD are at a higher risk for developing atrial arrhythmias compared to those without prior CVD. Methods: A single-institution retrospective chart review of patients with no prior history of atrial arrhythmia treated with ibrutinib from 2012 to 2020 was performed. Patients were grouped into two cohorts: those with CVD (known history of coronary artery disease, heart failure, pulmonary hypertension, at least moderate valvular heart disease, or device implantation) and those without CVD. The primary outcome was incidence of atrial arrhythmia, and the secondary outcomes were all-cause mortality, risk of bleeding, and discontinuation of ibrutinib. Results: Patients were followed for a median of 1.1 years. Among 217 patients treated with ibrutinib, the rate of new-onset atrial arrhythmia was nearly threefold higher in the cohort with CVD compared to the cohort without CVD (17% vs 7%, p = 0.02). Patients with CVD also demonstrated increased adjusted all-cause mortality (OR 1.9, 95% CI 1.06–3.41, p = 0.01) and decreased survival probability (43% vs 54%, p = 0.04) compared to those without CVD over the follow-up period. Conclusions: Pre-existing cardiovascular disease was associated with significantly higher rates of atrial arrhythmia and mortality in patients with hematological malignancies managed with ibrutinib.

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Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.14 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Wesley T O’Neal ◽

J’Neka Claxton ◽

Richard MacLehose ◽

Lin Chen ◽

Lindsay G Bengtson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulant ◽

Cox Regression ◽

Prior History ◽

Cancer Type ◽

Patients With Cancer ◽

Increased Risk ◽

History Of ◽

Reduced Risk ◽

History Of Cancer

Background: Early cardiology involvement within 90 days of atrial fibrillation (AF) diagnosis is associated with greater likelihood of oral anticoagulant use and a reduced risk of stroke. Due to variation in cardiovascular care for patients with cancer, it is possible that a similar association does not exist for AF patients with cancer. Methods: We examined the association of early cardiology involvement with oral anticoagulation use among non-valvular AF patients with history of cancer (past or active), using data from 388,045 patients (mean age=68±15 years; 59% male) from the MarketScan database (2009-2014). ICD-9 codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill and Cox regression was used to estimate the risk of stroke and major bleeding. Results: A total of 64,016 (17%) AF patients had a prior history of cancer. Cardiology involvement was less likely to occur among patients with history of cancer than those without (relative risk=0.92, 95% confidence interval (0.91, 0.93)). Similar differences were observed for cancers of the colon (0.90 (0.88, 0.92)), lung (0.76 (0.74, 0.78)), pancreas (0.74 (0.69, 0.80)), and hematologic system (0.88 (0.87, 0.90)), while no differences were observed for breast or prostate cancers. Patients with cancer were less likely to fill prescriptions for anticoagulants (0.89 (0.88, 0.90)) than those without cancer, and similar results were observed for cancers of the colon, lung, prostate, pancreas, and hematologic system. However, patients with cancer were more likely to fill prescriptions for anticoagulants (1.48 (1.45, 1.52)) if seen by a cardiology provider, regardless of cancer type. A reduced risk of stroke (hazard ratio=0.89 (0.81, 0.99)) was observed among all cancer patients who were seen by a cardiology provider than among those who were not, without an increased risk of bleeding (1.04 (0.95, 1.13)). Conclusion: AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.

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Abstract 27: Statin use and risk of hemorrhagic stroke in a community-based cohort of aging women: The Women’s Health Initiative

Circulation ◽

10.1161/circ.129.suppl_1.27 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Elena Salmoirago-Blotcher ◽

Kathleen M Hovey ◽

Judith K Ockene ◽

Chris A Andrews ◽

Jennifer Robinson ◽

...

Keyword(s):

Risk Factors ◽

Women's Health ◽

Hemorrhagic Stroke ◽

Extension Study ◽

Prior History ◽

Health Initiative ◽

Increased Risk ◽

History Of ◽

Statin Use ◽

The Women’S Health Initiative

Background: Statin therapy is recommended for treatment of hypercholesterolemia and prevention of cardiovascular events. Concerns have been raised about a potentially higher risk of hemorrhagic stroke in statin users; however, there is limited information in women and in older populations. We evaluated whether statin treatment was associated with increased risk of hemorrhagic stroke among women enrolled in the Women’s Health Initiative (WHI). Methods: This secondary data analysis was conducted among 68,132 women enrolled in the WHI Clinical Trials (CTs). Participants were 50 to 79 yrs old; postmenopausal; and were followed through 2005 (parent study) and for an additional 5 yrs (through September 30, 2010) in the WHI extension study. Statin use was assessed at baseline and at follow-up (FU) visits at 1, 3, 6, and 9 years. Women brought all medications in original containers for inventory. Strokes were self-reported annually and adjudicated by medical record review. Risk of hemorrhagic stroke by statin use (modeled as a time-varying covariate, with the “no use” category as the referent) was estimated from Cox proportional hazard regression models adjusted for age (model 1); risk factors for hemorrhagic stroke (model 2); and possible confounders by indication (model 3). All models adjusted for enrollment in the different CTs and in the extension study. Participants were censored at the date of last contact or loss to FU. Pre-specified subgroup analyses were conducted according to use or non-use of antiplatelet medications (including aspirin) or anticoagulants, and prior history of stroke. Results: Final models included 67,882 women (mean age at baseline 63 ± 7 yrs). Over a mean FU of 12 yrs, incidence rates of hemorrhagic stroke were 6.4/10,000 person-years among women on statins and 5.0/10,000 person-years among women not taking statins. The unadjusted risk of hemorrhagic stroke in statin users vs. non-users was 1.21 (CI: 0.96, 1.53). The HR was attenuated to 0.98 (CI: 0.76, 1.26) after adjusting for age, hypertension, and other risk factors for hemorrhagic stroke. Planned subgroups analyses showed that women taking both statins and antiplatelet agents had a higher risk of hemorrhagic stroke than women taking antiplatelet medications without statins (HR: 1.59; CI: 1.02, 2.46), whereas women not taking antiplatelet medications had no risk elevation with statins (HR=0.79; CI: 0.58-1.08); P for interaction = .01. No significant interactions were found for anticoagulant use or prior history of stroke, but the statistical power for these analyses was low. Conclusion: Statin use was not associated with an overall increased risk of hemorrhagic stroke among older community-dwelling women. However, women taking statins in conjunction with antiplatelet medications had elevated risk; a finding that warrants further study and potential incorporation into clinical decision making.

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Abstract 18516: Regional Dysfunction of Left Atrial Appendage and its Association with Stroke in Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.18516 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Abdullah A Alissa ◽

Yuko Inoue ◽

Jochen Cammin ◽

Qiulin Tang ◽

Elliot Fishman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Control Group ◽

Prior History ◽

Area Change ◽

Increased Risk ◽

History Of ◽

Regional Dysfunction

Background: Atrial Fibrillation (AF) is associated with an increased risk of cardioembolic stroke. Previous studies demonstrate that the Left atrial appendage (LAA) is the most common site of intracardiac thrombus, and the LAA morphology alone may determine the risk of stroke. We aimed to determine the association between LAA regional dysfunction using novel, noninvasive, image-based motion-estimation CT (iME) and prior history of stroke in patients with AF. Methods: Among the patients with history of AF referred for ablation who underwent pre-ablation CT with retrospective ECG gating, we identified 18 patients with a prior history of stroke or TIA, and 18 age- and gender-matched controls. The patients in AF at the time of CT were excluded. Four-dimensional motion vector field was estimated from reconstructed CT images using iME at every 5% RR interval. To assess myocardial deformation, area change ratio and area change rate were calculated over the endocardial surface of the LA and LAA. Univariate and multivariate comparisons were made by using binary logistic regression model. Results: A total of 36 patients (mean age 67.6 ± 8.1 years, 66.7% male, 16.7% persistent AF) were included in the study. Univariate analysis showed that the LA pre-atrial contraction area change ratio and LAA maximum area change ratio were significantly lower (P= 0.02 and 0.04, respectively) in the stroke/TIA group compared to the control group. These changes remained statistically significant in multivariate analysis (P=0.03 and 0.04, respectively) after adjusting for age, sex, body mass index, LV ejection fraction, type of AF, and CHADS score. Conclusions: LAA regional dysfunction is associated with stroke/TIA in patients with AF. LAA regional dysfunction detected by iME could represent a marker for stroke and a possible therapeutic target.

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Abstract 12563: Retrospective Analysis of Cardiovascular Events With the Use of Immune Checkpoint Inhibitors

Circulation ◽

10.1161/circ.142.suppl_3.12563 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Tushar Tarun ◽

Brian P Bostick ◽

Deepa Baswaraj ◽

Nishchayjit Basra ◽

Meeshal Khan ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Retrospective Analysis ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Multiple Organ ◽

Fulminant Myocarditis ◽

Organ Systems ◽

History Of

Introduction: Immune checkpoint inhibitors have emerged as a promising, novel therapy for multiple malignancies. Immune-related adverse reactions pose a serious concern with use of these agents and reportedly involve multiple organ systems, notably cardiotoxicity. Early identification and management of these adverse events is essential in the prevention of morbidity and mortality. Hypothesis: Immune checkpoint inhibitors cause multiple cardiotoxic effects, and patients with prior cardiac history have a higher likelihood of cardiotoxicity. Methods: 1. A retrospective analysis of 150 patients was performed who had received immunotherapy with either the cytotoxic T lymphocyte associated antigen 4 inhibitors (CTLA4) or with the programmed cell death inhibitors (PD1) or programmed death-ligand 1 (PD-L1) inhibitors for a period of two years at a Tertiary health Care from 7/1/2016-6/30/2018. 2. Patients' cardiac diagnoses prior to the initiation of therapy were noted and included, including history of heart failure, coronary artery disease, atrial fibrillation, and sudden cardiac arrest. 3. Patients’ clinic visits and hospitalizations with admitting and discharge diagnosis, electrocardiogram, echocardiogram, troponin T, and NT-proBNP were reviewed. Results: 6% of patients had new onset heart failure (both preserved and reduced), 1.3% had evidence of myocardial infarction, 2% had new atrial fibrillation with rapid ventricular rate, and 0.6% had fulminant myocarditis. Of patients with new cardiac events, 60% had a history of cardiac disease, which was significantly higher than in patients without (p< 0.05). There were no age or sex differences between the groups with and without cardiotoxicity. Conclusion: Immunotherapy with immune checkpoint inhibitors have broadened the horizon for treatment of multiple solid and hematological malignancies. Nonetheless, new adverse effects on multiple organ systems, specifically cardiac involvement, occur with these therapies, which are important and potentially detrimental toxicities. Patients with a history of prior cardiovascular disease have higher likelihood to develop cardiotoxicity.

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Abstract 16083: Risk of Preserved versus Reduced Ejection Fraction in Women With and Without History of Breast Cancer: The Pathways Heart Study

Circulation ◽

10.1161/circ.142.suppl_3.16083 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jamal S Rana ◽

Heather Greenlee ◽

Richard Cheng ◽

Cecile A Laurent ◽

Hanjie Shen ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Ejection Fraction ◽

Endocrine Therapy ◽

White Women ◽

Cox Regression ◽

Prior History ◽

Reduced Ejection Fraction ◽

Increased Risk ◽

History Of

Introduction: Incidence of heart failure (HF), specifically with preserved ejection fraction (HFpEF), is rising in the general population, yet is understudied. To provide a population-based estimate of HF in breast cancer (BC) survivors, we compared risk of HF in women with and without BC history in the Kaiser Permanente Northern California (KPNC) integrated health system. Methods: Data were extracted from KPNC electronic health records. All invasive BC cases diagnosed from 2005-2013 were identified and matched 1:5 with non-BC controls on birth year, race/ethnicity, and KPNC membership at BC diagnosis. Cox regression models assessed the hazard of HF by EF status: HFpEF (EF ≥ 45%), HF with reduced EF (HFrEF; EF < 45%), and unknown EF. Women with prior history of HF were excluded. Models were adjusted for factors known to affect BC risk or CVD and for prevalent CVD at BC diagnosis. We also examined case subgroups who received cardiotoxic chemotherapy, left-sided radiation therapy, and/or endocrine therapy, versus their controls. Results: A total of 14,804 women diagnosed with invasive BC and with no history of HF were identified and matched to 74,034 women without BC history. Women were on average 61 years at BC diagnosis and 65% white. Women with HFpEF were older and more likely to have hypertension (p<0.05). Among all cases vs. controls, there was increased risk of HFrEF (HR: 1.5, 95% CI: 1.18, 1.98) but not HFpEF or unknown EF (figure). Compared to their controls, women treated with chemotherapy were more than 3-times likely to develop HFrEF (HR: 3.26, 95% CI: 2.2, 4.8) and more than 1.5-times likely to develop HFpEF (HR=1.61, 95% CI: 1.15, 2.24). Women who received left-sided radiation therapy had nearly double the risk of developing HFrEF (HR=1.85, 95% CI: 1.20, 2.84). No associations were found among women who received endocrine therapy. Conclusions: Increased surveillance is warranted for women with BC receiving cardiotoxic chemotherapy for development of both HFrEF and HFpEF.

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General medical disorders with psychiatric implications

10.1093/med/9780199360574.003.0038 ◽

2015 ◽

Author(s):

Erik J. Garcia ◽

Warren J. Ferguson

Keyword(s):

Mental Illness ◽

Psychiatric Symptoms ◽

The United States ◽

Prior History ◽

Medical Illness ◽

Medical Conditions ◽

Presenting Symptoms ◽

Medical Disorders ◽

Increased Risk ◽

History Of

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.

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Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer

The Scientific World JOURNAL ◽

10.1100/tsw.2009.80 ◽

2009 ◽

Vol 9 ◽

pp. 685-690 ◽

Cited By ~ 8

Author(s):

Abraham Morgentaler

Keyword(s):

Prostate Cancer ◽

Cancer Recurrence ◽

Serum Testosterone ◽

High Serum ◽

Prior History ◽

Minimal Risk ◽

Increased Risk ◽

History Of ◽

Dramatic Shift ◽

Risk Of Cancer

There has been a recent dramatic shift in our understanding of the relationship between androgens and prostate cancer (PCa). Whereas for several decades it had been assumed that higher serum testosterone (T) concentrations would lead to ever-greater PCa growth, current literature indicates that PCa growth is unaffected by changes in serum T throughout most of the naturally occurring range. A Saturation Model has been proposed to explain how prostate tissue can be exquisitely sensitive to changes in serum T at the very low end of the concentration range, but appears indifferent to such changes above the near-castrate range. This has special applicability to T-deficient men, since this means that T therapy may not be nearly as risky as once assumed. Indeed, one of the more interesting changes over the last several years has been the growing acceptance of the use of T therapy in men with a prior history of PCa, with early data indicating minimal risk of cancer recurrence or progression. Provocative new evidence suggests that it is not high serum T that is problematic for PCa, butlowserum T that is associated with worrisome cancer features and outcomes, such as high Gleason score, advanced stage of presentation, and increased risk of biochemical recurrence after surgery. It will be interesting to see what changes will occur in this rapidly changing field over the next several years.

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Correlation of lateral placental location with development of preeclampsia

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200867 ◽

2020 ◽

Vol 9 (3) ◽

pp. 1017

Author(s):

Anjali Gupta ◽

Priyanka Bansal ◽

Jyotsna Sen ◽

Savita Rani Singhal

Keyword(s):

Prospective Observational Study ◽

Previous History ◽

Antenatal Clinic ◽

Severe Anaemia ◽

Multiple Organ ◽

Clinical Syndrome ◽

Chronic Hypertension ◽

Singleton Pregnancy ◽

Organ Systems ◽

History Of

Background: Preeclampsia is a complex clinical syndrome which involves multiple organ systems and remains the principle cause of maternal and perinatal morbidity and mortality. Preeclampsia is a disease of trophoblastic tissue. Placental abnormality is one of the initial events in patients who are destined to develop pregnancy induced hypertension subsequently. Objective of this study was to evaluate the association of laterally located placenta on ultrasound with development of preeclampsia.Methods: This prospective observational study was conducted on 200 antenatal women with singleton pregnancy at 18-24 weeks of gestation who attended antenatal clinic of obstetrics and gynaecology, PGIMS Rohtak from October 2017 to October 2018. Detailed antenatal transabdominal ultrasound along with placental location was done between 18-24 weeks of gestation in women who fitted into inclusion criteria. All the antenatal women belonged to 18-24 weeks of gestation were included in the study except those women with chronic hypertension, diabetes mellitus, renal disease, severe anaemia, thyrotoxicosis, low lying placenta, previous history of preeclampsia or eclampsia.Results: Out of 200 antenatal women, 84 had lateral placenta while 116 had central placenta. Out of these 84 women who had lateral placenta, 55 women (65.5%) developed preeclampsia and out of 116 (58%) women who had central placenta, 28 women (24.1%) developed preeclampsia.Conclusions: From the above study, we concluded that women with laterally located placenta by ultrasound at 18-24 weeks of gestation have greater risk of developing preeclampsia.

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