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Jones C, Jakubowski BE, Stevens R, Roberts N, McManus RJ, Tucker KL. The diagnostic Accuracy of Visual versus automated dipstick proteinuria testing in Pregnancy: A systematic review and Meta-Analysis. Pregnancy Hypertens 2024; 35:73-81. [PMID: 38262144 DOI: 10.1016/j.preghy.2024.01.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of point-of-care (POC) tests for detecting proteinuria in pregnant women. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE and EMBASE databases were searched from inception to 13 November 2020. ELIGIBILITY CRITERIA AND DATA ANALYSIS Included studies measured the sensitivity and specificity ofPOC proteinuria testing compared to laboratory reference standards (protein-creatinine ratio (PCR), 24-hour urine collection). Bivariate meta-analyses determined pooled sensitivity and specificity. Random-effects inverse-variance model determinedheterogeneity. MAIN OUTCOME MEASURES The primary outcome was overall sensitivity and specificity, stratified by method of POC testing and reference standard. Secondary outcomes were sensitivity and specificity within thesubgroupstest brand, reference standard, and hypertension status. RESULTS 1078 studies were identified, 17 studies comprising 23 comparisons were included. The meta-analysis included 13 studies with 19 comparisons. Pooled sensitivity and specificity of visual dipsticks against PCR was 72 % (95 % CI: 56 % to 84 %) and 92 % (95 % CI: 76 % to 98 %), respectively. Pooled sensitivity and specificity of visual dipsticks against 24-hour collection was 69 % (55 % to 80 %) and 70 % (51 % to 84 %), respectively. Pooled sensitivity and specificity for automated readers against PCR was 73 % (53 % to 86 %) and 91 % (83 % to 95 %), respectively. Pooled sensitivity and specificity of automated readers against 24-hour collection was 65 % (42 % to 83 %) and 82 % (46 % to 96 %), respectively. CONCLUSION Visual dipsticks have comparable accuracy to automated readers, yet are notadequate as a rule-out test for proteinuria. Proteinuria POC testing maybe beneficial inantenatal care when repeatfollow-up tests are performed. PROSPERO Registration Number: CRD42021231914.
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Affiliation(s)
- C Jones
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - B E Jakubowski
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, Kings College London, UK
| | - R Stevens
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - N Roberts
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, Kings College London, UK
| | - R J McManus
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - K L Tucker
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK.
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Rui M, Liping H, Yanmin W, Tingting Z, Shi C, Yingdong H. Regional differences in clinical characteristics and fetal and maternal outcomes of hypertensive disorders in pregnancy in China: a retrospective study. Hypertens Pregnancy 2023; 42:2234490. [PMID: 37439006 DOI: 10.1080/10641955.2023.2234490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Hypertensive disorders in pregnancy (HDPs) are the leading causes of maternal and perinatal death worldwide, and appropriate prenatal care is beneficial toward improve pregnancy outcomes in populations at high risk of preeclampsia. OBJECTIVE To describe variations in regional manifestations and outcomes of HDPs among the Chinese population to aid in the development of region-specific perinatal management guidelines. METHODS This is a retrospective study. The clinical data of patients with HDP in 3 different regions were collected to explore the characteristics of HDP patients in different regions of China. RESULTS In Peking University First Hospital, a regional rescue center for prenatal care and delivery, the proportion of patients with high-risk factors for PE was considerably high; 37.8% were of advanced maternal age, and 14.7% were obese. Among the patients, at this hospital, the proportion of comorbidities (e.g., chronic hypertension) in HDP patients was higher than that in the other 2 specialized maternal and child health care hospitals. CONCLUSION Targeted prenatal care procedures should be established based on regional characteristics to improve the quality of perinatal health care and reduce the incidence of HDP. [Figure: see text].
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Affiliation(s)
- Ma Rui
- Department of Obstetrics and Gynecology, Peking University First Hospital Ningxia Women and Children's Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, PR. China
| | - Huang Liping
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, PR. China
| | - Wang Yanmin
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, PR. China
- Department of Obstetrics and Gynecology, Luanzhou People's Hospital, Luanzhou, PR. China
| | - Zhao Tingting
- Department of Obstetrics and Gynecology, Peking University First Hospital Ningxia Women and Children's Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, PR. China
| | - Chen Shi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, PR. China
| | - He Yingdong
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, PR. China
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Lau KGY, Kountouris E, Salazar-Rios L, Nicolaides KH, Kametas NA. Prediction of adverse outcome by ophthalmic artery Doppler and angiogenic markers in pregnancies with new onset hypertension. Pregnancy Hypertens 2023; 34:110-115. [PMID: 37925874 DOI: 10.1016/j.preghy.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 07/31/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To compare the ophthalmic artery Doppler peak systolic velocity ratio (OA PSV-ratio) and soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF ratio) in predicting adverse maternal and perinatal outcomes in women presenting with new onset hypertension. STUDY DESIGN Prospective cohort study in a specialist hypertension clinic, within a tertiary referral centre. MAIN OUTCOME MEASURES Comparison between the OA PSV-ratio and sFlt-1/PlGF ratio in predicting delivery within one week from presentation and adverse maternal and perinatal outcomes e.g. severe hypertension, neonatal unit admission, small for gestational age. RESULTS Women who delivered within one week, compared to those who did not, had a higher OA PSV-ratio (0.82 vs 0.71, p < 0.01) and sFlt-1/PlGF ratio (93.3 vs 40.5, p = 0.08). Independent predictors of the OA PSV-ratio included mean arterial pressure and maternal weight and predictors of the sFlt-1/PlGF ratio included diastolic blood pressure and use of antihypertensive medications. Prediction of adverse outcomes with both ratios were similar and only modest e.g. AUROC for predicting delivery within one week for OA PSV-ratio was 0.57 (95% CI 0.47-0.67) and for sFlt-1/PlGF ratio was 0.61 (95% CI 0.52-0.70) (p = 0.53). CONCLUSIONS In women presenting with new onset hypertension, the OA PSV-ratio and sFlt-1/PlGF ratio have similar and modest performance in predicting adverse outcomes.
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Affiliation(s)
- Katherine G Y Lau
- Antenatal Hypertension Clinic, King's College Hospital, London, UK; Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | | | | | - Kypros H Nicolaides
- Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Nikos A Kametas
- Antenatal Hypertension Clinic, King's College Hospital, London, UK; Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK.
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Peeyananjarassri K, Ratipann N, Suwanrath C, Pinjaroen S, Chainarong N, Choobun T. An in-depth analysis of maternal mortality in a quaternary university hospital in Southern Thailand: A 16-year experience. Int J Gynaecol Obstet 2023; 163:579-585. [PMID: 37177786 DOI: 10.1002/ijgo.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To perform an in-depth analysis and evaluate the causes of maternal deaths in a university hospital in Southern Thailand. METHODS A retrospective descriptive study was conducted. Medical records of all women who died during pregnancy or within 42 days of termination of pregnancy at Songklanagarind Hospital from January 2006 to December 2021 were reviewed. RESULTS There were 51 910 live births during the 16-year period and 68 maternal deaths (31 of direct cause, 36 of indirect cause, and one of unknown cause). The maternal mortality ratio was 131 per 100 000 live births. There was a decreasing trend in the maternal mortality ratio, especially during the past 4 years. The leading causes of death were cardiac disease (n = 17), hypertensive disorders in pregnancy (n = 9), and postpartum hemorrhage (n = 7). The most common indirect causes of maternal death were cardiac disease, hematologic disease, and dengue hemorrhagic fever. There was a decreasing trend in indirect to direct deaths ratios during three study periods. Ratios in 2006 to 2010, 2011 to 2015, and 2016 to 2021 were 1.6, 1.4, and 0.5, respectively. CONCLUSIONS The three leading causes of death were cardiac disease, hypertensive disorders in pregnancy, and postpartum hemorrhage. Improvements in the quality of obstetric care at all hospital levels are required.
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Affiliation(s)
- Krantarat Peeyananjarassri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ninizna Ratipann
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sutham Pinjaroen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Natthicha Chainarong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thanapan Choobun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Cramer EM, Chung JE, Li J. #Preeclampsiasurvivor and symbolic interactionism in women's maternal health. Health Care Women Int 2022:1-20. [PMID: 36542786 DOI: 10.1080/07399332.2022.2142226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
A hypertensive disorder of pregnancy and leading cause of maternal mortality worldwide, preeclampsia (PE) impacts approximately one in 25 pregnancies. Biomedical researchers continue to look for concrete causes and effective treatments for PE, but the experience of PE-the personal and socially constructed meanings surrounding the condition-remains under-researched. Using a symbolic interactionism approach, we examined Instagram posts accompanying the #preeclampsiasurvivor hashtag during Preeclampsia Awareness Month. Themes emerging from interpretive analysis of 98 posts (160 images) included the role of PE in redefining a woman's relationship to her body, reifying a woman's connection to her child, and illuminating the transitive aspects of a childbearing woman's identity. Additionally, PE survivors turned to Instagram to speak to an imagined, 'generalized sisterhood' of women sharing a common set of experiences. Our study is unique in its examination of the lived experiences of PE survivors.
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Affiliation(s)
- Emily M Cramer
- Department of Strategic, Legal and Management Communication, Howard University, Washington, DC, USA
| | - Jae Eun Chung
- Department of Strategic, Legal and Management Communication, Howard University, Washington, DC, USA
| | - Jiang Li
- Department of Electrical Engineering and Computer Science, Howard University, Washington, DC, USA
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Shennan AH, Green M, Ridout AE. Accurate surveillance of maternal deaths is an international priority. BMJ 2022; 379:o2691. [PMID: 36384947 DOI: 10.1136/bmj.o2691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Andrew H Shennan
- Women's Health Academic Centre, King's College London, London, SE1 7EH, UK
| | | | - Alexandra E Ridout
- Women's Health Academic Centre, King's College London, London, SE1 7EH, UK
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Costa ML, Cavalli RDC, Korkes HA, Cunha Filho EVD, Peraçoli JC. Diagnosis and Management of Preeclampsia: Suggested Guidance on the Use of Biomarkers. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:878-883. [PMID: 35468644 PMCID: PMC9948147 DOI: 10.1055/s-0042-1744286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE It is a challenge to consider preeclampsia (PE) diagnosis and management in low and middle-income settings, where it represents a major public health concern. The placenta is the underlying cause of disease, and the plasma concentrations of proangiogenic and antiangiogenic factors released by the placenta can reflect the risks of disease progression. Antiangiogenic proteins, such as soluble fms-like tyrosine kinase 1 (sFlt-1), and proangiogenic, like placental growth factors (PlGF), are directly and inversely correlated with the disease onset, respectively. METHODS Narrative review on the use of biomarkers (sFlt-1 to PlGF ratio) with a suggested guidance protocol. RESULTS Key considerations on the use of biomarkers: the sFlt-1/PlGF ratio is mainly relevant to rule out PE between 20 and 36 6/7 weeks in cases of suspected PE; however, it should not replace the routine exams for the diagnosis of PE. The sFlt-1/PlGF ratio should not be performed after confirmed PE diagnosis (only in research settings). In women with suspected PE, sFlt-1/PlGF ratio < 38 can rule out the diagnosis of PE for 1 week (VPN = 99.3) and up to 4 weeks (VPN= 94.3); sFlt-1/PlGF ratio > 38 does not confirm the diagnosis of PE; however, it can assist clinical management. In cases of severe hypertension and/or symptoms (imminent eclampsia), hospitalization is imperative, regardless of the result of the sFlt-1/PlGF ratio. CONCLUSION The use of biomarkers can help support clinical decisions on the management of suspected PE cases, especially to rule out PE diagnosis, thus avoiding unnecessary interventions, especially hospitalizations and elective prematurity.
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Affiliation(s)
- Maria Laura Costa
- Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Ricardo de Carvalho Cavalli
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Henri Augusto Korkes
- Department of Human Reproduction and Childhood, Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brazil
| | | | - José Carlos Peraçoli
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil
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Raia-Barjat T, Edebiri O, Ni Ainle F. Preeclampsia and Venous Thromboembolism: Pathophysiology and Potential Therapy. Front Cardiovasc Med 2022; 9:856923. [PMID: 35345482 PMCID: PMC8957069 DOI: 10.3389/fcvm.2022.856923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/11/2022] [Indexed: 12/23/2022] Open
Abstract
Preeclampsia (PET) is a multisystem inflammatory disorder that represents a leading cause of feto-maternal morbidity and mortality, complicating 2–5% of all pregnancies. PET incurs an increased risk of venous thromboembolism, which is one of the leading causes of death in pregnancy and in the postpartum period. This prothrombotic phenotype is attributable to the maternal phase of PET, which is characterized by a systemic inflammatory response and coagulation activation. Research continues to be undertaken in terms of preventative measures, however, currently revolves around pharmacological low dose aspirin initiated in the first trimester of pregnancy for those with risk factors. Treatment involves antenatal corticosteroids for fetal lung development in preterm birth, parenteral magnesium sulfate for fetal neuroprotection and maternal seizure prophylaxis, and timely birth of the fetus and placenta being the only definitive treatment of PET. Patients with a venous thromboembolism (VTE) risk deemed to be >1–3% are treated with pharmacological thromboprophylaxis in the form of low molecular weight heparin. Completing each woman’s VTE risk assessment is crucial, particularly in the setting of PET, as there is also a proven associated competing hemorrhagic risk.
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Affiliation(s)
- Tiphaine Raia-Barjat
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
- INSERM U1059, SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
- *Correspondence: Tiphaine Raia-Barjat,
| | - Osasere Edebiri
- Department of Haematology, Mater Misericordiae University Hospital, Rotunda Hospital, Dublin, Ireland
| | - Fionnuala Ni Ainle
- Department of Haematology, Mater Misericordiae University Hospital, Rotunda Hospital, Dublin, Ireland
- UCD School of Medicine, University College Dublin, Dublin, Ireland
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Wang F, Liu M, Lin P, Wang J, Zhang L, Zhang H, Qu M, Chen S, Man D. Astragaloside IV protects human trophoblast HTR8/SVneo cells from H2O2-Induced oxidative stress via Nrf2-Keap1-p62 feedback loop. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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10
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Hinton L, Chisholm A, Jakubowski B, Greenfield S, Tucker KL, McManus RJ, Locock L. "You Probably Won't Notice Any Symptoms": Blood Pressure in Pregnancy-Discourses of Contested Expertise in an Era of Self-Care and Responsibilization. QUALITATIVE HEALTH RESEARCH 2021; 31:1632-1644. [PMID: 34116606 PMCID: PMC8438769 DOI: 10.1177/10497323211003067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Pregnancy is not a disease or illness, but requires clinical surveillance as life-threatening complications can develop. Preeclampsia, one such potentially serious complication, puts both mother and baby at risk. Self-monitoring blood pressure in the general population is well established, and its potential in pregnancy is currently being explored. In the context of self-monitoring, the information and guidance given to women regarding hypertension, and the literature they themselves seek out during pregnancy, are vital to perceptions of disease risk and subsequent responses to, and management of, any symptoms. Drawing on online, offline, official, and unofficial sources of information, discourses are examined to provide analysis of how self-responsibilization is reflected in contemporary information, advice, and guidance drawn from multiple sources. A paradox emerges between the paternalistic and lay discourses that seek to challenge and regain control. Findings are discussed in the context of Foucault's governmentality and medical power.
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Affiliation(s)
- Lisa Hinton
- University of Cambridge, Cambridge, United Kingdom
- Lisa Hinton, The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge CB2 0AH, UK.
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Beardmore-Gray A, Vousden N, Silverio SA, Charantimath U, Katageri G, Bellad M, Chinkoyo S, Vwalika B, Goudar S, Sandall J, Chappell LC, Shennan AH. Planned early delivery for late preterm pre-eclampsia in a low- and middle-income setting: a feasibility study. Reprod Health 2021; 18:110. [PMID: 34078408 PMCID: PMC8173959 DOI: 10.1186/s12978-021-01159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity globally. Planned delivery between 34+0 and 36+6 weeks may reduce adverse pregnancy outcomes but is yet to be evaluated in a low and middle-income setting. Prior to designing a randomised controlled trial to evaluate this in India and Zambia, we carried out a 6-month feasibility study in order to better understand the proposed trial environment and guide development of our intervention. METHODS We used mixed methods to understand the disease burden and current management of pre-eclampsia at our proposed trial sites and explore the acceptability of the intervention. We undertook a case notes review of women with pre-eclampsia who delivered at the proposed trial sites over a 3-month period, alongside facilitating focus group discussions with women and partners and conducting semi-structured interviews with healthcare providers. Descriptive statistics were used to analyse audit data. A thematic framework analysis was used for qualitative data. RESULTS Case notes data (n = 326) showed that in our settings, 19.5% (n = 44) of women with pre-eclampsia delivering beyond 34 weeks experienced an adverse outcome. In women delivering between 34+0 and 36+6 weeks, there were similar numbers of antenatal stillbirths [n = 3 (3.3%)] and neonatal deaths [n = 3 (3.4%)]; median infant birthweight was 2.2 kg and 1.9 kg in Zambia and India respectively. Lived experience of women and healthcare providers was an important facilitator to the proposed intervention, highlighting the serious consequences of pre-eclampsia. A preference for spontaneous labour and limited neonatal resources were identified as potential barriers. CONCLUSIONS This study demonstrated a clear need to evaluate the intervention and highlighted several challenges relating to trial context that enabled us to adapt our protocol and design an acceptable intervention. Our study demonstrates the importance of assessing feasibility when developing complex interventions, particularly in a low-resource setting. Additionally, it provides a unique insight into the management of pre-eclampsia at our trial settings and an understanding of the knowledge, attitudes and beliefs underpinning the acceptability of planned early delivery.
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Affiliation(s)
- Alice Beardmore-Gray
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
| | - Nicola Vousden
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Sergio A Silverio
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Umesh Charantimath
- Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, JNMC, Belagavi, Karnataka, India
| | - Geetanjali Katageri
- BVV Sangha's S Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, Karnataka, India
| | - Mrutyunjaya Bellad
- Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, JNMC, Belagavi, Karnataka, India
| | - Sebastian Chinkoyo
- Department of Obstetrics and Gynaecology, Ndola Teaching Hospital, Ndola, Zambia
| | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia, Lusaka, Zambia
| | - Shivaprasad Goudar
- Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, JNMC, Belagavi, Karnataka, India
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Ramotsababa M, Setlhare V. Late registration for antenatal care by pregnant women with previous history of caesarean section. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 34082552 PMCID: PMC8182559 DOI: 10.4102/phcfm.v13i1.2776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background Despite good access to antenatal care (ANC) services for most women, and regular training of healthcare workers in obstetrics and gynaecology, many pregnant women with a previous history of caesarean section (C/S) still presented late for ANC services at Letsholathebe II Memorial Hospital (LIIMH) in Maun, Botswana. This may increase morbidity and mortality in women with previous C/S delivery and neonates. Knowing why women with previous C/S present late for ANC may help in the formulation of interventions that decrease morbidity and mortality amongst these women and neonates. Aim The aim of this study was to explore the reasons why pregnant women with a previous history of C/S registered late for ANC, at LIIMH. Setting This study was performed at LIIMH, a district hospital situated in Maun, Botswana. Methods This was a descriptive qualitative study. Consenting pregnant women with previous C/S who presented at LIIMH after the 20 weeks of pregnancy were interviewed until data saturation. The data was analysed for themes. Results The reasons for late registration at LIIMH include lack of information, misconception on the appropriate booking time and venue, dissatisfaction with the quality of ANC clinic services, use of alternative ANC providers, delayed referral, and pregnancy experience. Conclusion Lack of knowledge of ANC delivery venue, using alternative ANC providers, and dissatisfaction with ANC clinic services, contributed to late registration. Pregnant women with previous history of C/S should be informed about ANC, delivery plans, and the assistance of alternative ANC providers should be explored.
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Key Points to Early Action for Preventing and Monitoring the Syndrome of Preeclampsia. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ebert LM, Guilhermino M, Flenady T, Dwyer T, Jefford E. Australian Midwives' Recognition of and Response to Maternal Deterioration: A Literature Review. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDConfidential inquiries into maternal deaths have reported that recognition and timely interventions can reduce maternal morbidity and mortality. Although research has been undertaken that examines factors impacting registered nurses recognition of and response to the deteriorating patient, there is less literature identifying the factors impacting midwives' recognition of and response to the deteriorating maternal patient in the clinical context.OBJECTIVETo identify, summarize, and critically evaluate peer-reviewed studies that explored factors impacting clinical practice of Australian midwives in relation to maternal deterioration.DESIGNReviewers searched Maternity and Infant Care, EBSCOhost, Medline, CINAHL, SCOPUS, EMCARE, and EMBASE for published literature reporting on factors impacting Australian registered midwives' ability to recognize and respond to maternal deterioration.FINDINGSOf the articles identified and screened (n = 2,412), no studies met the inclusion criteria. This review revealed a lack of published research examining factors impacting Australian midwives' capability to recognize and respond to the deteriorating maternal patient.CONCLUSION AND IMPLICATIONS FOR PRACTICEWhile research shows, for registered nurses, that high workloads and poor skill mix can negatively impact capability to respond to the deteriorating patient, little is known of registered midwives' capability during similar health events. This review highlights a major gap in current knowledge regarding Australian registered midwives' experiences surrounding the recognition of and response to the deteriorating maternal patient. Increasing understanding in this area can inform and support the Australian midwifery education, practice, and National health policies to improve health outcomes for childbearing women. Further research in this area is therefore required.
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Hurrell A, Beardmore-Gray A, Duhig K, Webster L, Chappell LC, Shennan AH. Placental growth factor in suspected preterm pre-eclampsia: a review of the evidence and practicalities of implementation. BJOG 2020; 127:1590-1597. [PMID: 32701207 DOI: 10.1111/1471-0528.16425] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/29/2022]
Abstract
Despite extensive research, the pathophysiology and prevention of pre-eclampsia remain elusive, diagnosis is challenging, and pre-eclampsia remains associated with adverse maternal and perinatal outcomes. Angiogenic biomarkers, including placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1), have been identified as valuable biomarkers for preterm pre-eclampsia, accelerating diagnosis and reducing maternal adverse outcomes by risk stratification, with enhanced surveillance for high-risk women. PlGF-based testing is increasingly being implemented in clinical practice in several countries. This review provides healthcare providers with an understanding of the evidence for PlGF-based testing and describes the practicalities and challenges to implementation. TWEETABLE ABSTRACT: Placental growth factor in pre-eclampsia: evidence and implementation of testing.
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Affiliation(s)
- A Hurrell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A Beardmore-Gray
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - K Duhig
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - L Webster
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - L C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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16
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Kelliher S, Maguire PB, Szklanna PB, Weiss L, Ewins K, O'Doherty R, Angelov D, Ní Áinle F, Kevane B. Pathophysiology of the Venous Thromboembolism Risk in Preeclampsia. Hamostaseologie 2020; 40:594-604. [PMID: 32450576 DOI: 10.1055/a-1162-3905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Preeclampsia complicates up to 8% of pregnancies and is a leading cause of fetomaternal morbidity andmortality. Treatment options are limited, with supportive care and delivery of the placenta representing the cornerstone of current management strategies. Derangements in blood coagulation are wellrecognised in this disorder and appear to favour an increased risk of venous thromboembolism among affected women. This risk appears to be most significant in the postpartum period. The mechanisms underlying this increased thrombosis risk remain to be fully elucidated although increased expression of procoagulant factors, endothelial dysfunction, attenuation of endogenous anticoagulant activity and increased platelet activity have been implicated in the prothrombotic tendency. Preeclampsia is also occasionally complicated by life-threatening haemorrhagic events and current evidence suggests that in some severe manifestations of this disease a coagulopathy with a clinical bleeding tendency may be the predominant haemostatic abnormality. Identifying affected women at significant risk of thrombosis and managing the competing thrombotic and haemorrhagic risks continue to be a significant clinical challenge. Derangements in blood coagulation are also implicated in the pathogenesis of preeclampsia; however, the role of antiplatelet or anticoagulant drugs in the prevention and treatment of this disorder remains a source of considerable debate. In addition, the potential role of specific haemostatic markers as diagnostic or screening tools for preeclampsia has also yet to be determined. Further characterisation of the underlying molecular mechanisms would likely be of major translational relevance and could provide insights into the pathogenesis of this disease as well as the associated haemostatic dysfunction.
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Affiliation(s)
- Sarah Kelliher
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland.,Irish Network for VTE Research (INViTE), Dublin, Ireland
| | - Patricia B Maguire
- Irish Network for VTE Research (INViTE), Dublin, Ireland.,UCD Conway SPHERE Research Group, Dublin, Ireland.,School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Paulina B Szklanna
- UCD Conway SPHERE Research Group, Dublin, Ireland.,School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Luisa Weiss
- UCD Conway SPHERE Research Group, Dublin, Ireland.,School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Karl Ewins
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland.,Irish Network for VTE Research (INViTE), Dublin, Ireland.,Department of Haematology, Rotunda Hospital, Dublin, Ireland
| | - Roseann O'Doherty
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Daniel Angelov
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fionnuala Ní Áinle
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland.,Irish Network for VTE Research (INViTE), Dublin, Ireland.,UCD Conway SPHERE Research Group, Dublin, Ireland.,Department of Haematology, Rotunda Hospital, Dublin, Ireland.,School of Medicine, University College Dublin (UCD), Dublin, Ireland
| | - Barry Kevane
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland.,Irish Network for VTE Research (INViTE), Dublin, Ireland.,UCD Conway SPHERE Research Group, Dublin, Ireland.,School of Medicine, University College Dublin (UCD), Dublin, Ireland
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17
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Farrar D, Tuffnell D, Sheldon TA. An evaluation of the influence of the publication of the UK National Institute for health and Care Excellence's guidance on hypertension in pregnancy: a retrospective analysis of clinical practice. BMC Pregnancy Childbirth 2020; 20:101. [PMID: 32050920 PMCID: PMC7017474 DOI: 10.1186/s12884-020-2780-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background The UK National Institute for health and Care Excellence (NICE) publish guidance aimed at standardising practice. Evidence regarding how well recommendations are implemented and what clinicians think about guidance is limited. We aimed to establish the extent to which the NICE Hypertension in pregnancy (HIP) guidance has influenced care and assess clinician’s attitudes to this guidance. Methods Five maternity units in the Midlands and North of England took part in the retrospective evaluation of 2490 birth records from randomly selected dates in 2008–2010 and 2013–2015. The proportion of women where care was adhered to before (2008–2010) and after (2013–2015) guidance publication was examined and differences estimated. Eleven midwives and obstetricians employed by Bradford Hospitals were interviewed. Results The proportion of high risk women prescribed Aspirin rose (before 14%, after 54%, p = < 0.01 (confidence interval of change (CI) 37, 43%) as well as for moderate risk women (before 3%, after 54%, p = < 0.01, CI 48, 54%) following guidance publication. Three quarters had blood pressure and a third proteinuria measured at every antenatal visit before and after guidance. Early birth < 37 weeks and ≥ 37 weeks gestation was more frequently offered after guidance publication than before (< 37 weeks: before 9%, after 18%, p = 0.01, CI 2, 16% and ≥ 37 weeks before 30%, after 52%, p = < 0.01, CI 9, 35%). Few were informed of future risk of developing a hypertensive disorder or had a documented postnatal review; however there was an increase in women advised to see their GP for this review (58% before and 90% after guidance p = < 0.01, CI 24, 39%). All clinicians said the NICE HIP guidance was informative and provided robust evidence, however they said length of the document made use in practice challenging. They did not always access NICE guidance, preferring to use local guidance at least initially; both obstetricians and midwives said they accessed NICE guidance for in-depth information. Conclusions NICE HIP guidance is valued, used by clinicians and has influenced important aspects of care that may help improve outcomes for women who develop hypertension or pre-eclampsia, however some recommendations have had limited impact and therefore interventions are required to improve adherence.
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Affiliation(s)
- Diane Farrar
- Bradford Institute for Health Research, Bradford, UK.
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18
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Worton SA, Greenwood SL, Wareing M, Heazell AE, Myers J. The kynurenine pathway; A new target for treating maternal features of preeclampsia? Placenta 2019; 84:44-49. [PMID: 31076094 DOI: 10.1016/j.placenta.2019.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/08/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022]
Abstract
In preeclampsia, vasospasm, oxidative stress, endothelial dysfunction, and immune dysregulation are key mediators of maternal disease. A new time-of-disease treatment is needed with the potential to treat these areas of pathophysiology. A review of the literature has indicated that metabolites of the kynurenine pathway have the potential to; (i) induce vasorelaxation of resistance arteries and reduce blood pressure; (ii) exert antioxidant effects and reduce the effects of poly-ADP ribose polymerase activation (iii) prevent endothelial dysfunction and promote endothelial nitric oxide production; (iv) cause T cell differentiation into tolerogenic regulatory T cells and induce apoptosis of pro-inflammatory Th1 cells. This has led to the hypothesis that increasing Kynurenine pathway activity may offer a new treatment strategy for preeclampsia.
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Affiliation(s)
- Stephanie A Worton
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
| | - Susan L Greenwood
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Mark Wareing
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Alexander Ep Heazell
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jenny Myers
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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19
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MacDonald EJ, Lepine S, Pledger M, Geller SE, Lawton B, Stone P. Pre‐eclampsia causing severe maternal morbidity – A national retrospective review of preventability and opportunities for improved care. Aust N Z J Obstet Gynaecol 2019; 59:825-830. [DOI: 10.1111/ajo.12971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Evelyn Jane MacDonald
- Women's Health Research CentreFaculty of HealthVictoria University of Wellington Wellington New Zealand
| | - Sam Lepine
- Wellington Regional Hospital Wellington New Zealand
| | - Megan Pledger
- Health Services Research CentreFaculty of HealthVictoria University of Wellington Wellington New Zealand
| | - Stacie E. Geller
- Centre for Research on Women and GenderUniversity of Illinois Chicago Illinois USA
| | - Bev Lawton
- Women's Health Research CentreFaculty of HealthVictoria University of Wellington Wellington New Zealand
| | - Peter Stone
- Department of Obstetrics and GynaecologyUniversity of Auckland Auckland New Zealand
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20
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Vousden N, Lawley E, Seed PT, Gidiri MF, Goudar S, Sandall J, Chappell LC, Shennan AH. Incidence of eclampsia and related complications across 10 low- and middle-resource geographical regions: Secondary analysis of a cluster randomised controlled trial. PLoS Med 2019; 16:e1002775. [PMID: 30925157 PMCID: PMC6440614 DOI: 10.1371/journal.pmed.1002775] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/05/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In 2015, approximately 42,000 women died as a result of hypertensive disorders of pregnancy worldwide; over 99% of these deaths occurred in low- and middle-income countries. The aim of this paper is to describe the incidence and characteristics of eclampsia and related complications from hypertensive disorders of pregnancy across 10 low- and middle-income geographical regions in 8 countries, in relation to magnesium sulfate availability. METHODS AND FINDINGS This is a secondary analysis of a stepped-wedge cluster randomised controlled trial undertaken in sub-Saharan Africa, India, and Haiti. This trial implemented a novel vital sign device and training package in routine maternity care with the aim of reducing a composite outcome of maternal mortality and morbidity. Institutional-level consent was obtained, and all women presenting for maternity care were eligible for inclusion. Data on eclampsia, stroke, admission to intensive care with a hypertensive disorder of pregnancy, and maternal death from a hypertensive disorder of pregnancy were prospectively collected from routine data sources and active case finding, together with data on perinatal outcomes in women with these outcomes. In 536,233 deliveries between 1 April 2016 and 30 November 2017, there were 2,692 women with eclampsia (0.5%). In total 6.9% (n = 186; 3.47/10,000 deliveries) of women with eclampsia died, and a further 51 died from other complications of hypertensive disorders of pregnancy (0.95/10,000). After planned adjustments, the implementation of the CRADLE intervention was not associated with any significant change in the rates of eclampsia, stroke, or maternal death or intensive care admission with a hypertensive disorder of pregnancy. Nearly 1 in 5 (17.9%) women with eclampsia, stroke, or a hypertensive disorder of pregnancy causing intensive care admission or maternal death experienced a stillbirth or neonatal death. A third of eclampsia cases (33.2%; n = 894) occurred in women under 20 years of age, 60.0% in women aged 20-34 years (n = 1,616), and 6.8% (n = 182) in women aged 35 years or over. Rates of eclampsia varied approximately 7-fold between sites (range 19.6/10,000 in Zambia Centre 1 to 142.0/10,000 in Sierra Leone). Over half (55.1%) of first eclamptic fits occurred in a health-care facility, with the remainder in the community. Place of first fit varied substantially between sites (from 5.9% in the central referral facility in Sierra Leone to 85% in Uganda Centre 2). On average, magnesium sulfate was available in 74.7% of facilities (range 25% in Haiti to 100% in Sierra Leone and Zimbabwe). There was no detectable association between magnesium sulfate availability and the rate of eclampsia across sites (p = 0.12). This analysis may have been influenced by the selection of predominantly urban and peri-urban settings, and by collection of only monthly data on availability of magnesium sulfate, and is limited by the lack of demographic data in the population of women delivering in the trial areas. CONCLUSIONS The large variation in eclampsia and maternal and neonatal fatality from hypertensive disorders of pregnancy between countries emphasises that inequality and inequity persist in healthcare for women with hypertensive disorders of pregnancy. Alongside the growing interest in improving community detection and health education for these disorders, efforts to improve quality of care within healthcare facilities are key. Strategies to prevent eclampsia should be informed by local data. TRIAL REGISTRATION ISRCTN: 41244132.
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Affiliation(s)
- Nicola Vousden
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Elodie Lawley
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Muchabayiwa Francis Gidiri
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shivaprasad Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Jane Sandall
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Lucy C. Chappell
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Andrew H. Shennan
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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21
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Olaya-C M, Garrido M, Hernandez-Losa J, Sesé M, Ayala-Ramirez P, Somoza R, Vargas MJ, Ramón Y Cajal S. The umbilical cord, preeclampsia and the VEGF family. Int J Womens Health 2018; 10:783-795. [PMID: 30568515 PMCID: PMC6276640 DOI: 10.2147/ijwh.s174734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The VEGF family has been identified as abnormal in preeclampsia (PE). Hypertensive disorders of pregnancy (HDP) are major contributors to maternal and neonatal morbidity and mortality worldwide; likewise, umbilical cord anatomical abnormalities (UCAA) are linked to poor neonatal outcomes. Based on the relationship described between PE and UCAA and the role of the VEGF family in PE, this study explored VEGF expression in placental and UC tissued from patients with PE and with UCAA. Methods We performed an observational, analytical study on placentas, comparing protein and mRNA expression in four groups: patients with PE, patients with UC abnormalities, patients with both, and patients with none of them. Using immunohistochemistry, we studied VEGF A, VEGF R1 (FLT1), MMP1, and PLGF. With quantitative reverse transcription polymerase chain reaction we described mRNA expression of PLGF, VEGF and sFLT1, and sFLT1/PLGF ratio. Results Forty newborns were included. Sixty-seven percent of mothers and 45% of newborns developed no complications. Immunohistochemistry was performed on UC and placental disc paraffin-embedded tissue; in the latter, the mRNA of the VEGF family was also measured. Statistically significant differences were observed among different expressions in both HDP and UCAA groups. Interestingly, the UCAA group exhibited lower levels of sFLT1 and VEGF-A in comparison with other groups, with significant P-value for sFLT1 (P=0000.1). Conclusion The origin of UCAA abnormalities and their relation with HDP are still unknown. VEGF family alterations could be involved in both. This study provides the first approach related to molecules linked to UCAA.
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Affiliation(s)
- Mercedes Olaya-C
- Department of Pathology, Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogota, Colombia,
| | - Marta Garrido
- Pathology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Javier Hernandez-Losa
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Marta Sesé
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Paola Ayala-Ramirez
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Rosa Somoza
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Magda Jimena Vargas
- Department of Pathology, The Medical School, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogota, Colombia
| | - Santiago Ramón Y Cajal
- Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia.,Institute of Human Genetics, The Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
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22
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Zhu J, Huang R, Zhang J, Ye W, Zhang J. A prophylactic low-dose aspirin earlier than 12 weeks until delivery should be considered to prevent preeclampsia. Med Hypotheses 2018; 121:127-130. [PMID: 30396465 DOI: 10.1016/j.mehy.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
Clinical trials and meta-analyses have demonstrated that low-dose aspirin can reduce the risk of preeclampsia and fetal growth restriction in high-risk pregnant women. Current obstetric guidelines recommend that the administration of low-dose aspirin to prevent preeclampsia be initiated after 12 weeks' gestation. This starting time was chosen to minimize possible risks of maternal bleeding and fetal anomalies. However, evidence from reproductive medicine, where low-dose aspirin is commonly recommended to use before and in early pregnancy, as well as existing literature, does not support these concerns. On the other hand, defective placentation resulting in a subsequent ischemic placenta is considered as the starting point of preeclampsia. Low-dose aspirin initiated in early pregnancy can balance the levels of thromboxane A2 and prostacyclin and maintain adequate uteroplacental blood flow and, therefore, improve placentation. Thus, an initiation of low-dose aspirin earlier than 12 weeks can be considered. Meanwhile, evidence shows that low-dose aspirin can improve maternal vascular endothelial function without increasing the risks of adverse maternal and perinatal outcomes. Therefore, it appears safe to use low-dose aspirin as a prophylactic until delivery.
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Affiliation(s)
- Jing Zhu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Huang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinwen Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Jiao Tong University School of Public Health, Shanghai, China
| | - Weiping Ye
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Jiao Tong University School of Public Health, Shanghai, China.
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23
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Nyfløt LT, Ellingsen L, Yli BM, Øian P, Vangen S. Maternal deaths from hypertensive disorders: lessons learnt. Acta Obstet Gynecol Scand 2018; 97:976-987. [DOI: 10.1111/aogs.13357] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Lill T. Nyfløt
- Norwegian National Advisory Unit on Women's Health; Oslo University Hospital; Oslo Norway
- Department of Obstetrics; Drammen Hospital; Drammen Norway
| | - Liv Ellingsen
- Department of Obstetrics; Rikshospitalet Oslo University Hospital; Oslo Norway
| | - Branka M. Yli
- Department of Obstetrics; Rikshospitalet Oslo University Hospital; Oslo Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology; University Hospital of North Norway; Tromsø Norway
- Institute of Clinical Medicine; The Arctic University of Norway; Tromsø Norway
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
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24
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Saleh L, Samantar R, Garrelds IM, van den Meiracker AH, Visser W, Danser AHJ. Low Soluble Fms-Like Tyrosine Kinase-1, Endoglin, and Endothelin-1 Levels in Women With Confirmed or Suspected Preeclampsia Using Proton Pump Inhibitors. Hypertension 2017; 70:594-600. [PMID: 28716993 DOI: 10.1161/hypertensionaha.117.09741] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 05/31/2017] [Accepted: 06/14/2017] [Indexed: 01/01/2023]
Abstract
Patients with preeclampsia display elevated placenta-derived sFlt-1 (soluble Fms-like tyrosine kinase-1) and endoglin levels and decreased placental growth factor levels. Proton pump inhibitors (PPIs) decrease trophoblast sFlt-1 and endoglin secretion in vitro. PPIs are used during pregnancy to combat reflux disease. Here, we investigated whether PPIs affect sFlt-1 in women with confirmed/suspected preeclampsia, making use of a prospective cohort study involving 430 women. Of these women, 40 took PPIs (6 esomeprazole, 32 omeprazole, and 2 pantoprazole) for 8 to 45 (median 29) days before sFlt-1 measurement. Measurements were only made once, at study entry between weeks 20 and 41 (median 33 weeks). PPI use was associated with lower sFlt-1 levels, with no change in placental growth factor levels, both when compared with all non-PPI users and with 80 gestational age-matched controls selected from the non-PPI users. No sFlt-1/placental growth factor alterations were observed in women using ferrous fumarate or macrogol while, as expected, women using antihypertensive medication displayed higher sFlt-1 levels and lower placental growth factor levels. The PPI use-associated decrease in sFlt-1 was independent of the application of antihypertensive drugs and also occurred when restricting our analysis to patients with hypertensive disease of pregnancy at study entry. PPI users displayed more cases with preexisting proteinuria, less gestational hypertension, and a lower number of neonatal sepsis cases. Finally, their plasma endoglin and endothelin-1 levels were lower while sFlt-1 levels correlated positively with both. In conclusion, PPI use associates with low sFlt-1, endoglin, and endothelin-1 levels, warranting prospective trials to investigate the therapeutic potential of PPIs in preeclampsia.
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Affiliation(s)
- Langeza Saleh
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.S., I.M.G., A.H.v.d.M., W.V., A.H.J.D.) and Division Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology (L.S., R.S., W.V.), Erasmus MC, Rotterdam, The Netherlands
| | - Raaho Samantar
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.S., I.M.G., A.H.v.d.M., W.V., A.H.J.D.) and Division Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology (L.S., R.S., W.V.), Erasmus MC, Rotterdam, The Netherlands
| | - Ingrid M Garrelds
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.S., I.M.G., A.H.v.d.M., W.V., A.H.J.D.) and Division Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology (L.S., R.S., W.V.), Erasmus MC, Rotterdam, The Netherlands
| | - Anton H van den Meiracker
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.S., I.M.G., A.H.v.d.M., W.V., A.H.J.D.) and Division Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology (L.S., R.S., W.V.), Erasmus MC, Rotterdam, The Netherlands
| | - Willy Visser
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.S., I.M.G., A.H.v.d.M., W.V., A.H.J.D.) and Division Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology (L.S., R.S., W.V.), Erasmus MC, Rotterdam, The Netherlands
| | - A H Jan Danser
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.S., I.M.G., A.H.v.d.M., W.V., A.H.J.D.) and Division Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology (L.S., R.S., W.V.), Erasmus MC, Rotterdam, The Netherlands.
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25
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Vangen S, Bødker B, Ellingsen L, Saltvedt S, Gissler M, Geirsson RT, Nyfløt LT. Maternal deaths in the Nordic countries. Acta Obstet Gynecol Scand 2017; 96:1112-1119. [DOI: 10.1111/aogs.13172] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Siri Vangen
- Norwegian National Advisory Unit for Women's Health; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | | | - Liv Ellingsen
- Department of Obstetrics; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Sissel Saltvedt
- Department of Obstetrics; Karolinska University Hospital; Stockholm Sweden
| | - Mika Gissler
- National Institute for Health and Welfare Finland; Helsinki Finland
- Department of Neurobiology, Care Sciences and Society; Division of Family Medicine; Karolinska Institute; Stockholm Sweden
| | - Reynir T. Geirsson
- Landspitali University Hospital/University of Iceland; Reykjavik Iceland
| | - Lill T. Nyfløt
- Norwegian National Advisory Unit for Women's Health; Oslo University Hospital; Oslo Norway
- Department of Obstetrics; Oslo University Hospital Rikshospitalet; Oslo Norway
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