objective Ascites in severe pre-eclampsia may impact foetal and maternal outcomes. The objective was to determine the prevalence of ascites in women with severe pre-eclampsia by point of care (POC) ultrasound and to determine whether it correlates with higher perinatal risks.methods Prospective cohort study of patients admitted with severe pre-eclampsia at 2 teaching hospitals in Kigali, Rwanda. Serial POC ultrasound was performed to document ascites. Patients were stratified by the presence of ascites in perinatal period. Maternal demographics and complications were recorded and compared between groups.results There were 112 patients with severe pre-eclampsia, and ascites was found in 53.5% (76.7% antepartum, and 23.3% postpartum). Antepartum ascites correlated with an earlier delivery (32.2 AE 0.51 vs. 33.8 AE 0.47 weeks, P = 0.022) as well as lower birthweight (1587.3 AE 77.03 vs. 2011.6 AE 103.5 g, P = 0.002). Antepartum ascites was associated with higher stillbirth rates (P = 0.034) and NICU admission (87.2% vs. 68%, P = 0.034). Maternal hospital stay was increased in the ascites group (P < 0.0001).conclusions Ascites is common in severe pre-eclampsia in Rwanda and maybe a prognosticator for poor outcomes. A larger sample is necessary to determine whether ascites is independently associated with maternal morbidity and mortality and whether documenting its presence aids in the management of the foetus and mother.keywords pre-eclampsia, ascites, point of care ultrasound 1018
function in pregnancy. In this study, we made a comprehensive evaluation of in vivo vascular function (including flow-mediated dilatation (FMD), peripheral arterial tonometry (PAT), and arterial stiffness) in pre-eclamptic patients and compared them to normal pregnancies. In addition, we assessed the evolution of vascular function during normal pregnancy and the trend in vascular function after pre-eclamptic pregnancies. Methods: 14 patients with pre-eclampsia (PE) and 14 healthy pregnant controls were included. Endothelial function was determined by FMD and PAT, arterial stiffness by carotid-femoral pulse wave velocity (cfPWV) and augmentation index (AIx). Results: The reactive hyperemia index (RHI) assessed using PAT is decreased at the third trimester in comparison to the first trimester in an uncomplicated pregnancy (1.5±0.3 vs 2.3±0.6, p=0.001). Arterial stiffness is significantly higher in PE versus normal pregnancy (cfPWV 7.7±0.9 vs 6.0±0. Objectives:The aim was to determine the predictive role of combined screening for late-onset gestational hypertension by fetal ultrasound measurements, third trimester uterine arteries (UtAs) Doppler imaging, and maternal history. Methods: This prospective study on singleton pregnancies was conducted at the tertiary centre of Maternal and Fetal Medicine of the University of Padua during the period between January 2012 and December 2014. Ultrasound examination (fetal biometry, fetal wellbeing, maternal Doppler study, fetal abdominal aorta intima-media thickness [aIMT], and fetal kidney volumes), clinical data (mother age, pre-pregnancy body mass index [BMI], and parity), and pregnancy outcomes were collected. The P value <0.05 was defined significant considering a 2-sided alternative hypothesis. The distribution normality of variables were assessed using Kolmogorov-Smirnoff test. Data were presented by mean (±standard deviation), median and interquartile range, or percentage and absolute values. We considered data from 1381 ultrasound examinations at 29 to 32 weeks gestation, and in 73 cases late gestational hypertension developed after 34 weeks' gestation. Results: The final multivariate model found that fetal aIMT as well as fetal umbilical artery pulsatility index (PI), maternal age, maternal pre-pregnancy BMI, parity, and mean PI of maternal UtAs, assessed at ultrasound examination of 29 to 32 weeks' gestation, were significant and independent predictors for the development of gestational hypertension after 34 weeks' gestation. The area under the curve of the model was 81.07% (95% confidence interval, 75.83%-86.32%). A nomogram was developed starting from multivariate logistic regression coefficients.Conclusions: Late-gestational hypertension could be independently predicted by fetal aIMT assessment at 29 to 32 weeks' gestation, ultrasound Doppler waveforms, and maternal clinical parameters. Objectives: The presence of ascites in patients with severe pre-eclampsia may impact fetal and maternal outcomes compared to patients with severe pre-eclampsia without ascites....
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