Maternal and Perinatal Outcomes of Early-onset and Late-onset Preeclampsia at a Tertiary Center Hospital

Overproduction of reactive oxygen species (ROS) and, as a result, uncontrolled oxidative stress (OS) can play a central role in disorders of fetal hemodynamics and subsequent development of adverse perinatal outcomes in newborns with fetal growth restriction (FGR). Given the epigenetic nature of such disorders, the aim of our study was to evaluate the expression of miRNAs associated with OS and endothelial dysfunction (miR-27a-3p, miR-30b-5p, miR-125b-5p, miR-221-3p, miR-451a and miR-574-3p) in umbilical cord blood using real-time quantitative RT-PCR. ΜiRNA expression was evaluated in patients with FGR delivery before (n = 9 pregnant) and after 34 weeks of gestation (n = 13 pregnant), and the control groups corresponding to the main groups by gestational age (13 pregnant women in each group, respectively). A significant increase in miR-451a expression was detected in late-onset FGR and correlations with fetoplacental and cerebral circulation were established (increase of resistance in the umbilical artery (pulsatility index, PI UA (umbilical artery): r = −0.59, p = 0.001) and a decrease in cerebral blood flow (CPR: r = 0.48, p = 0.009)). The change in miR-125b-5p expression in the placenta is associated with reduced Doppler of cerebral hemodynamics (CPR: r = 0.73, p = 0.003; PI MCA (middle cerebral artery): r = 0.79, p = 0.0007), and newborn weight (r = 0.56, p = 0.04) in early-onset FGR. In addition, significant changes in miR-125b-5p and miR-451a expression in umbilical cord blood plasma were found in newborns with neonatal respiratory distress syndrome (NRDS) (in early-onset FGR) and very low birth weight (VLBW) (in late-onset FGR). A number of key signaling pathways have been identified in which the regulation of the studied miRNAs is involved, including angiogenesis, neurotrophin signaling pathway and oxidative stress response. In general, our study showed that changes of the redox homeostasis in the mother-placenta-fetus system in FGR and subsequent perinatal outcomes may be due to differential expression of oxidative stress-associated miRNAs.

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MATERNAL CARDIAC TWIST PRE-PREGNANCY: POTENTIAL AS A NOVEL MARKER OF PRE-ECLAMPSIA

Fetal and Maternal Medicine Review ◽

10.1017/s0965539513000156 ◽

2013 ◽

Vol 24 (4) ◽

pp. 289-295 ◽

Cited By ~ 5

Author(s):

VICTORIA L. MEAH ◽

JOHN R. COCKCROFT ◽

ERIC J. STÖHR

Keyword(s):

Early Onset ◽

Late Onset ◽

Perinatal Outcomes ◽

First Trimester ◽

Physiological Adaptation ◽

Mortality And Morbidity ◽

Healthy Pregnancy ◽

Adverse Perinatal Outcomes ◽

Lower Cardiac Output ◽

In Pregnancy

Healthy pregnancy is characterised by progressive physiological adaptation of the maternal cardiovascular (CV) system that facilitates optimal fetal development. The adaptations that constitute a healthy or normal progression are not always evident, and, in particular, CV adaptation to pregnancy is highly individualised. Some women develop pregnancy-related CV dysfunction such as pre-eclampsia (PE). Typically, PE is diagnosed by the development of hypertension and proteinuria after 20 weeks of pregnancy and is the leading cause of maternal and perinatal mortality and morbidity. Despite continued efforts to improve the understanding of the aetiology, pathophysiology and subsequently treatment for the disease, CV changes in PE are not well understood. PE before 34 weeks (early onset PE) is believed to differ in pathogenesis from late onset PE (>34 weeks) and can be characterised by a haemodynamic profile of increased systemic vascular resistance (SVR) and lower cardiac output (CO). Early onset PE is more often associated with uteroplacental insufficiency and significant adverse maternal and perinatal outcomes. In contrast, late onset PE (>34 weeks) involves an increased CO and lower SVR and is less likely to be associated with uteroplacental insufficiency and adverse perinatal outcomes. It is not known if PE develops secondary to the CV maladaptation in pregnancy or if a preexisting CV dysfunction predisposes some women to develop PE. Screening, diagnosis and disease management would be vastly improved if more were known about the onset of the maladaptive process associated with PE. To date, a combination of maternal factors including medical history, body mass index, age, parity and blood pressure (BP) have been used to predict the development of PE. In the first trimester, arterial stiffness is significantly increased in women who develop PE. Current hypotheses speculate that CV dysfunction is evident very early in pregnancy in PE and precedes the clinical manifestation at a later stage but whether CV dysfunction is present before pregnancy remains to be elucidated.

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A Cut-off Value for Gestational Week at Birth for Better Perinatal Outcomes in Early- and Late-Onset Fetal Growth Restriction

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-0882-7425 ◽

2019 ◽

Vol 223 (05) ◽

pp. 289-296

Author(s):

Mehmet Sinan Beksac ◽

Erdem Fadiloglu ◽

Atakan Tanacan ◽

Apostolos Mamopoulos ◽

Merve Basol ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Early Onset ◽

Late Onset ◽

Perinatal Outcomes ◽

Expectant Management ◽

Growth Restriction ◽

Apgar Scores ◽

First Choice ◽

Gestational Week

Abstract Objective Prediction of cut-off value for gestational week at birth for better perinatal outcomes in early- and late-onset fetal growth restriction (FGR). Materials and Methods This study consists of 83 singleton pregnancies with FGR that were diagnosed antenatally and confirmed postnatally between January 2017–April 2018. We used the 34th gestational week as a cut-off for early- and late-onset FGR discrimination. Results Early- and late-onset FGRs were detected in 22 (26.5%) and 61 (73.5%) of the cases, respectively. Expectant management significantly improved birth weight and Apgar scores at the 1st, 5th, and 10th minute in early-onset FGR cases (p=0.001, p=0.019, p=0.002, and p=0.001,respectively). Similar analysis revealed no significant improvements in late-onset FGR (p=0.151, p=0.727, p=0.951 and p=0.477, respectively). Umbilical cord blood gas pH was found to be similar between management modalities in both the early- and late-onset groups (p=0.186 and p=0.456, respectively). Gestational week 33.5 was found to be the threshold for better Apgar scores at the 1st, 5th, and 10th minute according to ROC curve analysis. Percentiles of 4.5, 2.5, and 4.5 were cut-off values for better Apgar scores at the 1st, 5th, and 10th minute, respectively. Conclusion Expectant management must be the first choice to improve Apgar scores in early-onset FGR cases, and gestational week 33.5 must be considered as a threshold for delivery. Immediate delivery might be the choice in late-onset FGR in necessary cases. However, etiology-based management and perinatal surveillance might also be considered to improve prematurity-related neonatal complications.

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Early onset and late onset preeclampsia-maternal and perinatal outcomes in a rural teritiary health center

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182333 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2266 ◽

Cited By ~ 7

Author(s):

Gomathy E. ◽

Lahari Akurati ◽

Kondareddy Radhika

Keyword(s):

Early Onset ◽

Perinatal Outcome ◽

Late Onset ◽

Perinatal Outcomes ◽

Retrospective Data ◽

Perinatal Complications ◽

Medical College ◽

Gestation Age ◽

Early Onset Preeclampsia ◽

Singleton Pregnancies

Background: Preeclampsia is main cause of morbidity and mortality both mother and fetus. Preeclampsia occurs in 10-17% of pregnancies. Preeclampsia was divided into early onset preeclampsia is occur at less <34 weeks of gestation age and late onset preeclampsia is occur at >34 weeks of gestation age. Early and late onset preeclampsia have different etiology and should be considered as different disease as there are difference in clinical manifestation, maternal and perinatal outcome, prognosis and complication.Methods: An analytic observational study involving retrospective data done at RL Jalappa Hospital, Sri Devaraj Urs Medical College, Kolar. 217 women with singleton pregnancies with Pre eclampsia who were admitted and delivered in our hospital between June 2016 and May 2017 were recruited for this retrospective study.Results: The results showed that the incidence of EOPE (27.6%) was lower than LOPE (72.4%). Diastolic blood pressure is significantly higher in EOPE compared to LOPE. Complications in perinatal outcomes such as low birth weight (<2500 gram) are more in EOPE (98.3%) compared to LOPE (45.2%) and asphyxia is more on EOPE (11.7%) compared to LOPE (1.3%). Stillbirth in EOPE (15%) is more than LOPE group (3.2%).Conclusions: It is observed that EOPE incidence rate is lower than LOPE. Maternal and perinatal complications are greater in the EOPE group.

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NEONATAL SEPSIS AND IDENTIFICATION OF RISK FACTORS: STUDY IN AVBRH HOSPITAL SAWANGI

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i6.1215 ◽

2019 ◽

Vol 3 (6) ◽

Author(s):

Pramod P. Singhavi

Keyword(s):

Risk Factors ◽

Neonatal Sepsis ◽

Early Onset ◽

Late Onset ◽

Signs And Symptoms ◽

Premature Rupture ◽

Maternal Risk ◽

Late Onset Sepsis ◽

Early Onset Sepsis ◽

Meconium Stained Amniotic Fluid

Introduction: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. Material and Methods: This study was carried out using institution based cross section study . The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. Results: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days (Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. Conclusion: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

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