scholarly journals Preeclampsia: From Etiopathology to Organ Dysfunction

2021 ◽  
Author(s):  
Nissar Shaikh ◽  
Seema Nahid ◽  
Firdous Ummunnisa ◽  
Ifrah Fatima ◽  
Mohamad Hilani ◽  
...  

Preeclampsia is a hypertensive disorder of pregnancy affecting 6–12% of the population. There are various risk factors for the development of preeclampsia, ranging from advanced maternal age to genetics. The proposed etiologies for preeclampsia are abnormal placentation, immunological intolerance, endothelial damage, and genetic inheritance. The pathogenesis includes endothelial activation and dysfunction leading to vasospasm. Preeclampsia is divided into two stages: asymptomatic and symptomatic stages. Preeclampsia causes multiple organ involvement, namely central nervous system, respiratory, cardiovascular, hematological dysfunction, HELLP (hemolysis elevated liver enzymes, low platelets) syndrome, endocrine, renal, hepatic, and uteroplacental dysfunction. These organ dysfunctions increase morbidity and mortality in preeclamptic pregnant patients.

Author(s):  
Ritu . ◽  
Mini .

Background: The objective of this study was to compare the adverse obstetric and perinatal outcome of pregnancies in women with advanced maternal age > 35 years with that of younger women in age group 20-34 years.Methods: A retrospective comparative study was carried out in department of obstetrics and gynecology at Adesh Medical College over the period of one year from June 2017 to June 2018. The obstetric and perinatal outcome of 100 women with advanced maternal age (study group) was compared with those of 100 younger women aged 20-34 years (control group).Results: Among antenatal complications, women of advanced maternal age had increased incidence of hypertensive disorder of pregnancy (26.6% versus 4.4%; p = 0.00009) and breech presentation (8.8% versus 1.1%; p = 0.04).  The rate of caesarean delivery was significantly higher in advanced maternal age (28.8% versus 17.7%; p = 0.05). In perinatal outcome, older women had significantly higher incidence of perinatal death (7.7% versus 0%; p = 0.01).Conclusions: Thus, from this study, it can be concluded that advanced age women had higher incidence of hypertensive disorder of pregnancies and mal presentation, were more likely to deliver by caesarean section and had increased incidence of perinatal death.


Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4810-4810
Author(s):  
Maria Vinogradova ◽  
Tatiana Kirsanova ◽  
Roman Shmakov

Abstract Several serious disorders may present during pregnancy or postpartum with thrombotic microangiopathy (p-TMA). Signs of microangiopathic hemolytic anemia and thrombocytopenia may arise due to pregnancy complications such as severe preeclampsia (sPE) and HELLP-syndrome (hemolysis, elevated liver enzymes, and low platelets) or severe independent diseases: atypical hemolytic uremic syndrome (aHUS), thrombotic thrombocytopenic purpura (TTP). Recent evidence and clinical similarities suggest a link sPE/HELLP to aHUS, a disease of excessive activation of the alternative complement pathway. Pregnancy-associated aHUS is a severe disorder with a high risk of maternal and fetal morbidity and mortality, defined by the occurrence of comlement-mediated TMA without ADAMTS13 deficiency. Triggered by pregnancy and another complement-amplifying conditions women develop the syndrome, leading to a disastrous hemolytic disease characterized by diffuse endothelial damage and platelet consumption. Delivery is the treatment of choice of sPE and HELLP, but can lead to progression in case of aHUS: even now it is associated with unfavorable outcomes. We observe 116 women with p-TMA: 43 aHUS, 36 HELLP, 35 sPE, 2 TTP. PE diagnosed in accordance with the WHO criteria of 2008. HELLP- in accordance with Tenessee criteria (laboratory parameters normalized beyond 48-72 hours after delivery). TTP was associated with ADAMTS 13 deficiency <10%. We compare results with those of 28 healthy pregnant women. All patients with aHUS and TTP received plasma therapy (30-40ml/kg), in 20 cases of aHUS eculizumab was administered. The overall outcomes differed depending on the TMA type. Condition of PE/HELLP patients improved only with supportive treatment in 28-72 hours after delivery. Women with TTP received successful prolonged plasma exchange. Survival was the worst in aHUS patients 32(74.4%), among other patients with TMA no one died. Neonates survived in 33(76,7%) mothers with aHUS, 70(98,6%) with PE and HELLP. Sepsis diagnosed only in aHUS-15(34,9%). Acute kidney injury registered in 100% aHUS patients, neurological symptoms had 61%, respiratory distress syndrome- 55%, dilated cardiomyopathy- 16,7%. 61,3% required hemodialysis, 51,8%- respiratory care. All of patients who died had 2 "waves" of TMA: first wave damaged 2-5 organs without any proved infections, but treated with combination of antibiotics. Second TMA wave was fatal due to superimposed septic disorders, resistant to antibiotic therapy. Patients on eculizumab treatment had more severe disease at debut with shorter history of aHUS and responded well to eculizumab (recovery of TMA laboratory signs - 87,2%, but a full course was not held anyone). Survival of aHUS patients on eculizumab treatment was 81,4%, without it - 66,5%. All p-TMA are life-threatening disorders with different therapeutic approaches. Start therapy before specification of the diagnosis can be carried out with the use of plasma exchange for 24-48 hours. Patients with aHUS have a worst prognosis and require the rapid differential diagnosis. The revealed regularities allow us to assume the presence of the following triggers for the development of aHUS: surgical interventions and gestational complications. Early specific therapy complement inhibitor in complex with escalation treatment of multiple organ failure can contribute to the improvement of aHUS outcomes. Table. Table. Disclosures No relevant conflicts of interest to declare.


2020 ◽  
Author(s):  
Abera Mersha ◽  
Gistane Ayele ◽  
Tilahun Worku ◽  
Zerihun Zerdo ◽  
Shitaye Shibiru ◽  
...  

Abstract Background: Advanced maternal age significantly increased the risk of adverse obstetric outcomes. So, adequate and updated information on the status of advanced maternal age and their effect on obstetric outcomes is vital for effective policy and program formulation in Ethiopia. Pockets of studies conducted, but most are retrospective and record reviews. Thus, studies that show the status of advanced maternal age and their effect on obstetric outcomes is very limited in Ethiopia. As such, this study fills those gaps in our set up.Methods: A community-based prospective cohort study was conducted among 709 study participants from October 15, 2018, to September 30, 2019. A pretested interviewer-administered structured Open Data Kit survey tool was used to collect the data. The downloaded data from the Open Data Kit aggregate was exported to SPSS version 25 for analysis. Log-linear regression was used to compare obstetric outcomes among women aged 20–34 years and ≥ 35 years. The model was adjusted for educational and occupational status, party, wealth index, body mass index, household food insecurity, habits, distance to health care institution, and sex of the neonate, antenatal care, postnatal care, and place of delivery. The model fitness was tested by the log-likelihood ratio.Results: In this study, 209(29.5%) of the women were aged ≥ 35 years, and 500(70.5%) aged 20–34 years. Women aged ≥ 35 years were at increased risk of miscarriage (β = 0.29, 95%CI: 0.02, 0.56), and hypertensive disorder (β = 0.07, 95%CI: 0.004, 0.13).Conclusions: Advanced maternal age was independently associated with miscarriage and hypertensive disorder after controlling for possible cofounders. As such, different intervention programs should be designed to create awareness and to provide counseling services for women with advanced age or delayed childbearing.Plain English summaryWomen who bear a child at the age of ≥35 years old are stated as advanced maternal age. At this age, the risk of different obstetric complications is increased. This study was aimed to assess the effect of advanced maternal age on obstetric outcomes in the study settings.A prospective follow-up study was conducted among pregnant women during the study period. The women were followed from the time pregnancy was confirmed up to the immediate postpartum period. Seven hundred forty-four women were interviewed in the baseline and 24 participants became lost to follow-ups during the follow-up period, and 11 excluded from the analysis because of incomplete information.Of the study participants, 209 of the women were beard children at the age of ≥35 years (advanced maternal age), and 500 were age group from 20-34 years old.This study found that advanced maternal age increased risk of miscarriage (termination of pregnancy before fetal viability) and hypertensive disorder during pregnancy, the intrapartum and immediate postpartum period after controlled for possible confounders.In brief, this study showed that a significant number of women became pregnant during advanced maternal age. Therefore, different strategies should be designed for the women who planned to bear child, and information should be provided for women who are advanced age or delayed childbearing to alert them.


2020 ◽  
Vol 16 ◽  
Author(s):  
Reza Omani-Samani ◽  
Saman Maroufizadeh ◽  
Nafise Saedi ◽  
Nasim Shokouhi ◽  
Arezoo Esmailzadeh ◽  
...  

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.


2021 ◽  
Vol 60 (1) ◽  
pp. 119-124
Author(s):  
M. Guarga Montori ◽  
A. Álvarez Martínez ◽  
C. Luna Álvarez ◽  
N. Abadía Cuchí ◽  
P. Mateo Alcalá ◽  
...  

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