scholarly journals The role of cystatin c in the prediction of outcome in hypertensive disorders of pregnancy

2017 ◽  
Vol 6 (5) ◽  
pp. 1825 ◽  
Author(s):  
Cimona Lyn Saldanha ◽  
Shabnum Ara ◽  
Tabassum Parvez
Keyword(s):  
Uric Acid ◽  
Pregnant Women ◽  
Cystatin C ◽  
Gestational Hypertension ◽  
Serum Levels ◽  
Hypertensive Disorders Of Pregnancy ◽  
Serum Cystatin C ◽  
Hypertensive Disorders ◽  
Foetal Outcome ◽  
And Function

Background: Hypertensive disorders of pregnancy greatly influence the maternal and foetal outcome in terms of morbidity and mortality. Complications include involvement of the kidney and progression of the disease which leads to deterioration of renal parameters and function. If left unattended, oliguria and renal shutdown are serious sequelae. Hence the importance of monitoring serum concentrations of cystatin C, creatinine and uric acid. The present study was designed to understand the variations of these markers in pregnant women in this part of India.Methods: Serum levels were therefore determined in samples from 75 healthy women at term as well as in 38 samples of patients with Gestational hypertension and in 30 patients with pre-eclampsia (PE). The values were analysed after tabulation and results subjected to statistical analysis using SPSS software programme.Results: The levels of all three components were significantly higher in pre-eclamptic patients when compared to healthy controls with the mean±SD being 1.86±0.82 vs. 1.08±0.33 for cystatin C, 0.93±0.18 vs. 0.62±0.07 for creatinine and 7.02±1.92 vs. 4.04±1.06 for uric acid respectively. In gestational hypertension, cystatin C was significantly higher, 1.42±1.1 unlike creatinine, 0.84±0.16 and uric acid, 5.26±1.40.Conclusions: In view of significant increase in serum cystatin C, creatinine and uric acid in hypertensive disorders of pregnancy compared to those of healthy pregnant women, in our study, we conclude that these parameters are of significant value if used as markers to predict the onset of GH/PE. This can be established after further and larger clinical trials.

scholarly journals Serum Galectin-3 in Women With Gestational Hypertension and Preeclampsia and Its Association With Preterm Birth

2021 ◽  
Author(s):  
Dolina Gencheva ◽  
Fedya Nikolov ◽  
Ekaterina Uchikova ◽  
Rosen Mihaylov ◽  
Blagovesta Pencheva ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Premature Birth ◽  
Gestational Hypertension ◽  
Serum Levels ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Significant Difference ◽  
Galectin 3

Hypertensive disorders of pregnancy are one of the leading causes of fetal and maternal mortality worldwide. Aside from the immediate risk they pose for the pregnant woman, there is significant evidence that women after such a pregnancy have a long-term risk for the development of cardiovascular diseases. On the other hand, Galectin-3 is a biomarker that has proven its role in cardiac remodeling, fibrosis, and heart failure. To determine the levels of Galectin-3 in women with gestational hypertension, preeclampsia, and in healthy pregnant women and test for association with premature birth. A prospective single-center clinical, epidemiological study was performed, and data were analyzed for 123 pregnant women-36 with gestational hypertension, 37 with preeclampsia, and 50 controls. ELISA method was used to determine the serum levels of Galectin-3. Mean Galectin-3 level was 6,53 ng/ml in the controls, 7.30 ng/ml in the gestational hypertension group, and 7,59 ng/ml in the preeclampsia group. There was a significant difference in the levels between the controls and each of the pathological groups (P<0,05), while the two pathological groups were not statistically different from each other. Additionally, higher Galectin-3 levels were associated with an OR~2.5 for even preterm birth after adjustment for the presence of the two hypertensive disorders of pregnancy. Gestational hypertension and preeclampsia were associated with significantly higher levels of Galectin-3, which could be indicative of cardiovascular dysfunction in those women, and were also related to premature birth.

scholarly journals A Proposed Plan for Prenatal Care to Minimize Risks of COVID-19 to Patients and Providers: Focus on Hypertensive Disorders of Pregnancy

2020 ◽  
Vol 37 (08) ◽  
pp. 837-844 ◽  
Author(s):  
John R. Barton ◽  
George R. Saade ◽  
Baha M. Sibai
Keyword(s):  
Pregnant Women ◽  
Disease Progression ◽  
Complete Blood Count ◽  
Gestational Hypertension ◽  
Epigastric Pain ◽  
Signs And Symptoms ◽  
Health Care Facilities ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 0/7 weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 0/7 weeks of gestation in the setting of preeclampsia with severe features. Key Points

scholarly journals Thrombocytopenia in hypertensive disorders of pregnancy

2018 ◽  
Vol 7 (3) ◽  
pp. 848
Author(s):  
Rupakala B. M. ◽  
Ritika Gupta ◽  
Vishma H. Shetty ◽  
Sailakshmi M. P. A.
Keyword(s):  
Hellp Syndrome ◽  
Gestational Hypertension ◽  
Severe Thrombocytopenia ◽  
Hypertensive Disorders Of Pregnancy ◽  
Medical College ◽  
Normal Platelet ◽  
Hypertensive Disorders ◽  
Gestational Thrombocytopenia ◽  
Mild Preeclampsia ◽  
Foetal Outcome

Background: Thrombocytopenia is defined as a platelet count of less than 150×103 μl. It is commonly diagnosed and has attracted more interest from researchers during recent years, especially in Hypertensive disorders of pregnancy. This study was done to estimate the incidence of thrombocytopenia in pregnant women diagnosed with hypertensive disorders of pregnancy and to correlate its severity with the degree of thrombocytopenia.Methods: In the study 150 women admitted in the OBG Department at Rajarajeswari Medical College and Hospital, Bengaluru during August 2015-August 2016 were included. Hypertensive disorders of pregnancy cases were classified into: Gestational hypertension, mild preeclampsia, severe preeclampsia, haemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome and eclampsia. The incidence and severity of thrombocytopenia along with maternal and foetal complications encountered in the five groups were analysed. Data were arranged in Microsoft Excel version 2010, and statistically analysed by SPSS version 23.Results: Preeclampsia- mild (29.25%) and severe (22.5%), accounted for most of the cases followed by eclampsia (3%) and gestational HTN (1.5%). Among these hypertensive patients, mild thrombocytopenia was noted in 60 cases (40%), moderate thrombocytopenia 48 (32%), severe thrombocytopenia 12 (8%), and normal platelet counts 30 (20%) were noted. Poor maternal outcome was seen 10.67% cases due to HELLP syndrome and postpartum haemorrhage. Poor foetal outcome was seen in 16% cases due to intrauterine growth restriction and perinatal mortality.Conclusions: Hypertensive disorders of pregnancy is recognized as a major cause of gestational thrombocytopenia. Careful follow up during and after pregnancy is recommended.

scholarly journals P0263A NEPHROLOGIST'S LOOK AT HYPERTENSIVE DISORDERS OF PREGNANCY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Bianca Covella ◽  
Luigi Rossi ◽  
Domenico Caringella ◽  
Maurizio Guido ◽  
Giorgina Piccoli ◽  
...  
Keyword(s):  
Uric Acid ◽  
Kidney Disease ◽  
Gestational Diabetes ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Coagulation Abnormalities ◽  
Family Medical History ◽  
High Prevalence

Abstract Background and Aims Preeclampsia (PE) is a pregnancy-related syndrome of variable severity that falls under the broad category of hypertensive disorders of pregnancy (HDP). The relationship between PE and chronic kidney disease (CKD) is not entirely understood. Once considered a self-limited disease healed by delivery, it is now acknowledged that PE is a marker of cardiovascular and kidney health in the long term. The aim of this study was to review the data of women with hypertensive disorders of pregnancy at our institution, to identify need and to organize a conjoint nephrology and obstetrical activity in our setting Method We retrospectively reviewed all the medical charts of the patients hospitalized in the last two years for hypertensive disorders of pregnancy and who delivered in our Hospital. The cohort was divided into two groups: gestational hypertension (GH) and PE. A descriptive analysis of the clinical-laboratoristic was performed (t-test for continuous data with normal distribution). Results We identified 93 cases of hypertensive disorders of pregnancy on a total of 3279 deliveries (2.8%), 47 GH and 46 PE [2 cases of HELLP syndrome and 1 of eclampsia included in the PE group]. These two groups showed similar mean age: 33.5±6 vs 34.9±6 years (p value= 0.25); serum creatinine (sCr) and uric acid at admission were statistically different, and higher in the PE group (sCr 0.57±0.15 and 0.66±0.2 – p=0.01 and uric acid 4.5±1.38 and 5.6±1.47 – p=0.01). Comorbidities were frequent in the PE group: thyroid disfunction was found in 17% of cases (7 hypothyroidism and 1 hyperthyroidism, all under treatment), coagulation abnormalities were present in 15% of cases (4 MTHFR mutation, 1 protein S deficiency, 1 prothrombin-gene mutation, 1 patient was positive for LLAC); gestational diabetes was diagnosed in 13% of the cases. We identified 1 renal transplant recipient, 1 IgA-vasculitis patient, 1 patient with family medical history positive for PE (in her twin sister); none of these patients had been identified as at high risk for PE. At hospital admission, 54% of the patients were on antihypertensive treatment, 7 of them for chronic hypertension and 18 for gestational hypertension (12 of these patients underwent a previous hospitalization during the same pregnancy, diagnosed with gestational hypertension); at admission only 24% of PE patients were treated with anticoagulant or antiplatelet prophylaxis. Caesarean section was performed in 36 cases (78%). All but one children live-born, the exception being a child from a multiple pregnancy (quadruplets). Conclusion A multidisciplinary approach and a nephrological follow-up are increasingly indicated in PE. Our series underlines a high prevalence of comorbidity or risk factors, including thyroid disfunction, gestational diabetes and coagulation abnormalities. The high prevalence (7/46) of chronic hypertension and the fact that the two patients with kidney disease were not identified as at risk for PE underlines the potential role for developing a synergic approach between nephrologist and obstetricians.

scholarly journals Maternal morbidity of adolescent pregnant women

2021 ◽  
Vol 64 (6) ◽  
pp. 10-12
Author(s):  
Carlos Arturo Paniagua Coahuila ◽  
◽  
José Anaya Herrera ◽  
Dulce Alejandra Alonso Lozano ◽  
Lenny Pinña Guerrero ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gestational Hypertension ◽  
Severe Preeclampsia ◽  
Advanced Trauma Life Support ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Obstetric Hemorrhage ◽  
Childbearing Age ◽  
Adolescent Population ◽  
Hypertensive Disorders

Background: In Mexico, it is estimated that the adolescent population represents 29% of the population of childbearing age. The present study aimed to analyze the obstetric results of 3310 adolescent pregnant women attended in a third level hospital. Material and methods: All records of pregnant women aged 19 years or less up to the date of admission were analyzed at the Mónica Pretelini Saenz Maternal Perinatal Hospital during the period from January 2018 to June 2020, with the following variables: age, pregnancy, resolution obstetric, severe preeclampsia, preeclampsia and gestational hypertension. Results: A total of 13874 pregnant women were attended, of which 3310 (24%) patients were adolescents. The overall frequency of obstetric complications was 21%, including obstetric hemorrhage (13%) and hypertensive disorders of pregnancy (8%). Regarding postpartum obstetric hemorrhage events, classified according to the Advanced Trauma Life Support shock scale, they were categorized as Grade 1 – 338 cases, Grade II – 76 cases, Grade III – 11 cases and Grade IV – 1 case. Hypertensive disorders of pregnancy highlight preeclampsia as the most frequent with a total of 97 cases, followed by 89 cases of severe preeclampsia, 58 cases of gestational hypertension, 14 cases of chronic hypertension and 3 cases of chronic hypertension with preeclampsia. Conclusions: The main complications found in the Mexican pregnant adolescent population were obstetric hemorrhage, which was more frequent in the population aged 15 to 19 years, and hypertensive disorders, which occurred more frequently in the population aged 9 to 14 years.

Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy

2020 ◽  
Author(s):  
Madeleine Caplan ◽  
Lauren S. Keenan-Devlin ◽  
Alexa Freedman ◽  
William Grobman ◽  
Pathik D. Wadhwa ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Psychosocial Stress ◽  
Gestational Hypertension ◽  
Primary Objective ◽  
Mediation Effect ◽  
Chronic Hypertension ◽  
Stress Exposure ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Increased Risk

Objective Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship. Study Design A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 206/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP. Results Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06–2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03–2.20). No mediation effect by inflammation was observed. Conclusion Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP. Key Points

scholarly journals Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046638
Author(s):  
Sk Masum Billah ◽  
Abdullah Nurus Salam Khan ◽  
S M Rokonuzzaman ◽  
Nafisa Lira Huq ◽  
Marufa Aziz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Hypertensive Disorders ◽  
Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

scholarly journals Changes in Urinary and Serum Levels of Novel Biomarkers after Administration of Gadolinium-based Contrast Agents

2016 ◽  
Vol 11 ◽  
pp. BMI.S39199 ◽  
Author(s):  
Habib Mawad ◽  
Louis-Philippe Laurin ◽  
Jean-François Naud ◽  
François A. Leblond ◽  
Nathalie Henley ◽  
...  
Keyword(s):  
Renal Function ◽  
Contrast Agents ◽  
Cystatin C ◽  
Normal Renal Function ◽  
Serum Levels ◽  
Serum Cystatin C ◽  
Baseline Serum ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Novel Biomarkers ◽  
Neutrophil Gelatinase

Objective The aim of our study is to describe the changes in urinary and serum levels of novel biomarkers after gadolinium contrast administration in patients with normal renal function. Methods We measured four biomarkers in 28 volunteers: interleukin-18 (IL-18), N-acetyl-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin, and cystatin C. Urinary and serum samples were collected at 0, 3, and 24 hours following gadolinium administration. Results Baseline serum creatinine was 57.8 ± 34.5 μmol/L and remained stable. Urinary IL-18 levels increased significantly at three hours (10.7 vs. 7.3 ng/mg creatinine; P < 0.05). Similarly, urinary NAG levels increased significantly at three hours (3.9 vs. 2.2 IU/mg creatinine; P < 0.001). For both these markers, the difference was no longer significant at 24 hours. No statistically significant differences were observed for urinary and serum neutrophil gelatinase-associated lipocalin levels and for serum cystatin C levels. Conclusions Urinary IL-18 and NAG levels increased transiently after administration of gadolinium-based contrast agents in patients with normal renal function.

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