Recent developments in the pathophysiology and management of pre-eclampsia

Mushambi, Mary; Halligan, Aidan; Williamson, Karin

doi:10.1093/bja/76.1.133

Cited by 115 publications

(81 citation statements)

References 94 publications

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“…No measures are currently available to predict or prevent this clinical syndrome (3 ). Histological examination of the placental bed from preeclamptic pregnancies suggests incomplete trophoblastic invasion of uterine spiral arteries as a primary pathology.…”

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confidence: 99%

Innate Immune Response by Ficolin Binding in Apoptotic Placenta Is Associated with the Clinical Syndrome of Preeclampsia

Wang¹,

Yim²,

Poon

et al. 2007

Clinical Chemistry

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Background: Unidentified circulating factors derived from placenta are thought to be responsible for the exaggerated systemic inflammation leading to preeclampsia. Our aim was to identify the circulating factors present in preeclampsia and to investigate their relationship to the underlying systemic immune response responsible for the associated clinical manifestations. Methods: We obtained blood samples from pregnant women with and without preeclampsia and performed comparative proteomic analyses to identify the abnormal circulating factors by 2-dimensional polyacrylamide gel electrophoresis and matrix-assisted laser desorption ionization time of flight for protein separation and identification. In placentas from preeclamptic pregnancies, we evaluated the potential role of the candidate proteins identified by Western and immunohistochemical analysis. We also used proinflammatory cytokine antibody arrays to investigate local and systemic immune responses. Results: We found that ficolins, the pattern-recognition proteins involved in the lectin-complement pathway, were differentially expressed in plasma from preeclamptic pregnancies. Ficolins were present in low concentrations in plasma but at high concentrations in the placenta, particularly in syncytiotrophoblasts undergoing apoptosis. The binding of ficolins in apoptotic

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confidence: 99%

Innate Immune Response by Ficolin Binding in Apoptotic Placenta Is Associated with the Clinical Syndrome of Preeclampsia

Wang¹,

Yim²,

Poon

et al. 2007

Clinical Chemistry

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“…Endothelial dysfunction is considered to be central to the multiple-organ pathophysiology of preeclampsia-eclampsia. 21,22 Patients who had brain edema also had evidence of more severe systemic disease than those who had normal MR imaging findings. Serum, Serum AST, Serum ALT levels and white blood cell concentration, were significantly higher, in patients with radiologic abnormalities, as compared with those without radiologic abnormalities, these changes suggest significantly greater hepato-renal insult in patients having positive findings on MR scan.…”

Section: Discussionmentioning

confidence: 99%

Cranial MR Imaging in Eclampsia and Severe Preeclampsia: A Prospective Study

Sharma¹,

Joshi²,

Purohit³

et al. 2014

jemds

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BACKGROUND: This study was planned with an aim to identify the nature and distribution of cranial lesions on magnetic resonance imaging (MRI) and its correlation with clinical and laboratory data in eclampsia and severe preeclampsia. MATERIAL AND METHODS: 40 patients admitted for indication of severe preeclampsia or eclampsia with or without neurological signs were first stabilized and then underwent cranial MRI. Following MRI they were divided into two groups; Group MP (n=24) including patients with positive finding on the cranial MRI and Group MN (n=16) which included patients with normal Cranial MR imaging. Nature and distribution of the lesions were documented and statistical comparison was made on the basis of clinical findings, arterial blood pressure and laboratory data in both the groups. Patient with cerebral changes in the MRI were also called back for repeat MRI postnatal after two 2 months. RESULTS: Out of the 40 patients who underwent cranial MRI 24 patients had cerebral changes (Group MP) whereas 16 patients had normal scan (Group MN). In 21 out of 24 (87.5%) MRI finding positive patients the finding was consistent with diagnosis of posterior reversible encephalopathy syndrome (PRES). The most commonly involved areas in patients with PRES were parietal (85.7%,), frontal (71.42%) and occipital lobe (71.42), followed by temporal lobe (38.09) and basal ganglia (33.33) and cerebellum. All the patients who were diagnosed with PRES had a normal MR scan on the follow up at two months after the initial presentation. There was a significantly greater incidence of seizures and neurological disturbances in patients with positive MRI findings as compared to patients with no MRI findings (p<0.001). There was no statistical difference between the blood pressure measurements of the two groups. Markers of endothelial dysfunction like Serum LDH (p=0.002) Serum creatinine (p=0.006) and abnormal red blood cell morphology (0.002) was significantly higher in patients with positive MRI findings compared to MRI Finding Negative group. CONCLUSION: Our study suggests that PRES is the core component of the pathogenesis of cerebral findings of eclampsia and development of PRES is associated with endothelial dysfunction and not elevated blood pressure alone.

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“…Alfentanil has been used to prevent the hypertensive response to laryngoscopy and intubation in patients undergoing general anaesthesia for Caesarean section 23 . For hypertensive disorders of pregnancy, many agents have been used to attenuate the cardiovascular response to laryngoscopy, including labetolol, alfentanil and fentanyl 24 . These agents appear to be safe in the context of acute cocaine intoxication.…”

Section: Discussionmentioning

confidence: 99%

Unrecognized “crack” cocaine abuse in pregnancy

Campbell

Parr

Shutt

1996

British Journal of Anaesthesia

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SummaryWe report a case of "crack" cocaine abuse in a pregnant patient associated with haematuria, proteinuria, haemolytic anaemia, renal impairment, thrombocytopenia and pulmonary oedema. The case illustrates the problems for clinicians where unrecognized cocaine abuse interferes with the diagnosis and management of a complicated pregnancy. In addition, we discuss the principles for the safe conduct of anaesthesia in the pregnant cocaine abuser. (Br. J. Anaesth. 1996;77:553-555) Key words Anaesthesia, obstetric. Complications, cocaine abuse. Pregnancy."Crack" cocaine abuse in pregnancy is well recognized in the USA. In the UK the level of awareness to this increasingly common problem needs to be improved 1 . This case illustrates the difficulties in differentiating the effects of cocaine abuse from the more usual complications of pregnancy. Cocaine has complex effects on many systems. It was not apparent until post-partum that the patient continued to abuse crack cocaine even while an inpatient. In retrospect the relationship between drug abuse and the course of her illness became clear.Crack cocaine abuse increases maternal morbidity, fetal morbidity and death [2][3][4] . It is likely that maternal crack cocaine abuse will be an increasing problem in the UK and at present the clinical effects may not be fully recognized. Case reportA 32-yr old, gravida 5, para 3, Afro-Caribbean woman presented to her general practitioner for antenatal assessment at 10 weeks' gestation. Her haemoglobin concentration was 10.1 g dl 91 and the blood film showed macrocytosis. Cervical and high vaginal swabs were infected with Gonococcus and Trichomonas. Her infection was treated and she attended again at 19 weeks' gestation when urinalysis showed moderate haematuria and mild proteinuria. Arterial pressure was 120/70 mm Hg.She did not attend again until 31 weeks' gestation when she complained of fatigue and dyspnoea on exercise. On physical examination her conjunctivae were pale, arterial pressure was 125/70 mm Hg and she had bilateral pitting oedema of the ankles. Cardiovascular and respiratory system examinations were otherwise unremarkable. Abdominal examination was consistent with a 31-week pregnancy with normal fetal heart sounds and movements. Urinalysis showed excessive blood and moderate protein. The full blood count result a week later showed haemoglobin 6.8 g dl 91, mean cell volume 110 fl and platelets 63 10 9 litre 91, and therefore hospital admission was arranged.In hospital, physical examination revealed an apical ejection systolic murmur. Deep tendon reflexes were normal. Her blood film showed a reticulocyte count of 4.9%. Serum creatinine concentration was 99 mmol litre 91 , which is high for a pregnant patient. Urea and electrolyte concentrations, liver function tests, uric acid and clotting screen were within normal limits. Autoimmune profile, lupus and platelet antibodies and haemosiderin were within normal limits but haptoglobin concentrations were low at 0.2 g litre 91. The 24-h urine volume was 2125 ml and p...

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Recent developments in the pathophysiology and management of pre-eclampsia

Cited by 115 publications

References 94 publications

Innate Immune Response by Ficolin Binding in Apoptotic Placenta Is Associated with the Clinical Syndrome of Preeclampsia

Innate Immune Response by Ficolin Binding in Apoptotic Placenta Is Associated with the Clinical Syndrome of Preeclampsia

Cranial MR Imaging in Eclampsia and Severe Preeclampsia: A Prospective Study

Unrecognized “crack” cocaine abuse in pregnancy

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