Low-molecular-weight heparin and preeclampsia—does the sword cut both ways?Three case reports and review of literature

BACKGROUND Low-molecular-weight heparins(LMWH)are the most commonly used anticoagulants during pregnancy.It is considered to be the drug of choice due to its safety in not crossing placenta.Considering the beneficial effect in the improvement of microcirculation,prophylactic application of LMWH in patients with preeclampsia became a trend.However,the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated.This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia.CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy.All the cases experienced catastrophic hemorrhagic events.After reviewing the twenty-one meta-analyses,the bleeding risk related with LMWH seems ignorable.Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH.Other studies reported minor bleeding risks,none of these were serious enough to stop LMWH treatment.Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored.Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial.CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.

Analysis of risk factors for postpartum depression after cesarean section in women with early-onset preeclampsia

BACKGROUND Early-onset preeclampsia significantly increases maternal and fetal morbidity and mortality.Many pregnant women with early onset preeclampsia choose cesarean section as their delivery method.Although extensive research has explored the association between postpartum depression(PPD)and cesarean section,few studies have investigated the risk factors after cesarean section in women with early-onset preeclampsia.AIM To examine these risk factors through a retrospective,observational analysis of 287 women who underwent a cesarean section for early preeclampsia between June 2014 and March 2024.METHODS Participants were assessed in person during the 32nd week of pregnancy,2 days post-cesarean,and 6 weeks postpartum.According to the Edinburgh Postnatal Depression Scale(EPDS),participants who underwent cesarean section were divided into PPD(n=60)and non-PPD groups(n=227).Furthermore,PPD was diagnosed at 6 weeks postpartum according to depressive symptoms(EPDS score≥11).The demographic and clinical features of PPD were screened.Multivariate logistic regression analysis was used to identify PPD risk factors.RESULTS The prevalence of PPD was 20.9%(60/287)among the 287 women who underwent cesarean section for early-onset preeclampsia.Multivariate logistic regression analyses revealed that advanced age(age>40 years)[odds ratio(OR)=1.93,95%CI:1.31-2.82],previous preeclampsia(OR=7.15,95%CI:5.81-8.85),pre-pregnancy obesity(OR=2.42,95%CI:1.62-3.63),gestational diabetes mellitus(OR=3.52,95%CI:2.51-4.92),preexisting hypertension(OR=1.35,95%CI:1.03-1.89),PPD symptoms(EPDS≥11)at 2 days postpartum(OR=6.15,95%CI:1.32-28.35),high prenatal self-rating anxiety scale score(OR=1.13,95%CI:1.06-1.18),and pain at 6 weeks postpartum(OR=2.16,95%CI:1.28-3.66)were independently associated with PPD.CONCLUSION Risk factors for PPD after cesarean section in women with early-onset preeclampsia include advanced age(age>40 years),pre-pregnancy obesity,previous preeclampsia,gestational diabetes mellitus,preexisting hypertension,PPD symptoms(EPDS≥11)at 2 days postpartum,prenatal anxiety,and pain at 6 weeks postpartum.The early identi-fication of these factors and interventions can mitigate the risk of PPD.

The Hidden Side of the Story between the Placenta and Preeclampsia: Preliminary Results of a Prospective Cohort of Pregnant Women in Cameroon

Introduction: Pre-eclampsia is a complication of pregnancy that generally occurs in the third trimester. It is associated with a maternal and foetal mortality rate of around 27%. In view of the grim picture painted by this condition for both mother and newborn, studies have been carried out into the early detection of patients at risk of developing pre-eclampsia. These make it possible to introduce pregnancy-specific monitoring and preventive strategies to reduce the incidence of the condition. Objective: To establish the link between placental ultrasound characteristics and the onset of pre-eclampsia. Methodology: A multicentre prospective cohort study was conducted in two hospitals in Yaoundé, namely the Yaoundé Gynaecological Obstetrics and Paediatrics Hospital and the Nkolndongo Health and Social Animation Centre, in the gynaecology and radiology departments over a period of 11 months, from October 2022 to August 2023. It included pregnant women who had undergone obstetric ultrasound between 12 and 18 weeks’ gestation. In addition to routine obstetric ultrasound, we performed obstetric Doppler measurements in these patients. The resistance index of the left and right uterine arteries, the umbilical artery and the placental volume were the characteristics sought. At the end of this examination, two groups were formed: cases (pathological Doppler group) and controls (normal Doppler group). Blood pressure and urine dipstick were taken at each antenatal visit until delivery, then during the immediate postpartum period and finally at 7 days, 21 days and 42 days after delivery. Results: Sixty-seven (67) patients were included. Of these, 35 (47.8%) had pathological Dopplers. Sixteen patients had arterial hypertension associated with proteinuria and were therefore labelled as pre-eclampsia (PE). This gives a prevalence of 23.9%. Fifteen (42.8%) of these patients belonged to the exposed group and one to the unexposed group. The mean IR of the pre-eclampsia patients was significantly higher than that of the patients without pre-eclampsia;respectively 0.74 ± 0.096 and 0.49 ± 0.097 for the right uterine arteries and 0.71 ± 0.13 and 0.52 ± 0.089 for the left uterine arteries. We found that an increase in the uterine artery resistance index was significantly associated with the onset of pre-eclampsia, with a relative risk of 13.7 and a p value Conclusion: Abnormal Doppler ultrasound between 12 and 18 weeks of amenorrhoea had good overall sensitivity for predicting pre-eclampsia. Among the Doppler indices, the uterine artery resistance index was the only one significantly associated with pre-eclampsia.

Analysis of the Application Effect and Value of Dydrogesterone in The Treatment of Preeclampsia for Fetal Preservation

Objective: To analyze the application effect and value of dydrogesterone in the fertility preservation treatment of preeclampsia. Methods: Forty cases of patients with preeclampsia admitted to our hospital between January 2023 and January 2024 were divided randomly into a control group and an observation group of 20 cases each. The control group applied progesterone to preserve the fetus, and the observation group applied dydrogesterone. The symptom relief time, hormone levels before and after treatment, as well as adverse drug reactions, and the effect of fetal preservation between the two groups were compared. Results: The time to relieve vaginal bleeding, abdominal pain. and lumbago in the observation group was shorter than that in the control group (P < 0.05). After treatment, the progesterone levels and incidence of adverse drug reactions in the observation group were lower than those in the control group (P < 0.05). The success rate of fertility preservation in the observation group was higher than that in the control group (P < 0.05). Conclusion: In the treatment of fetal preservation of preeclampsia, the application of dydrogesterone positively alleviated vaginal bleeding, abdominal pain, and lumbago, with mild adverse reactions and a good effect on fetal preservation.

Rationale of a Cross Sectional Analytic Study on Determinants of Recurrent Preeclampsia at University Clinics of Kinshasa (Democratic Republic of Congo) and at Victor Dupouy Hospital Center (France)

Research Background: Pre-eclampsia is one of main causes of materno-foetal mortality and morbidity worldwide, with a prevalence of 3% - 7%. Although considered a primiparous condition, it can nevertheless recur. Several factors appear to be associated with risk of recurrence of pre-eclampsia, such as the term of delivery of previous pregnancy, severity of disease, the existence of co-morbidities and the inter-genital space. Purpose: The aim of our study will be to analyse and identify in a population of pregnant women with a history of preeclampsia risk factors associated with occurrence of recurrent preeclampsia at University clinics of Kinshasa (Democratic Republic of Congo) and at Victor Dupouy Hospital Center (France). Methods: In this study, pregnant women with an history of preeclampsia who will give birth between November 2018 and October 2024 at University Clinics of Kinshasa (UCK) and Victor Dupouy Hospital Center (VDHC) will be included. This will be a cross-sectional analytical study, data from previous and subsequent pregnancies will be studied. Expected Result: The prevalence of recurrent preeclampsia in the study population will be determined. And we will highlight the factors that will determine the recurrence of preeclampsia by analysing the risk factors. Conclusion: Knowledge of the factors associated with recurrent preeclampsia could be an excellent tool for predicting and preventing the disease.

Predictive Value of the Neutrophil to Lymphocyte Ratio (NLR) to Predict the Development of Preeclampsia and Pregnancy Induced Hypertension at 1st Trimester

Introduction: Hypertensive disorder in pregnancy affects 4 to 6 percent of all pregnancies and carries risks for the both baby and the mother. Only a few groups of women who are at high-risk pregnancies are received prophylaxis Aspirin, more than 15 percent of women develop pre-eclampsia with a single minor risk factor. Methods: This descriptive cross-sectional study was conducted to compare the 1st trimester NLR value of normotensive, pregnancy induced hypertensive and pre-eclamptic pregnant women. The study was conducted with a sample of 416, antenatal patients who were admitted to ward 25, at Colombo North Teaching Hospital Ragama. Data was collected as separated three groups. NLR value was calculated separately and ANOVA test was used to analyze the 3 categorical data. Post HOC test was done to assess the multiple comparison. Results: The prevalence rates of pregnancy induced hypertension and pre-eclampsia among the pregnant women were 8.6% and 5.7%. The mean NLR values of normotensive group was 2.708, pregnancy induced hypertensive group was 2.650 and pre eclamptic group was 3.789. There was a significant difference in NLR value between pre eclamptic group and other two groups with P value of Conclusion: The 1st trimester NLR value of pre eclamptic patients significantly increased compared to normotensive women.

Effect of hypoxia on expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia

Objective: To study the effect of hypoxia on the expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia. Methods: Trophoblastic cell lines HRT8/SVneo were cultured, SATB1 and β-catenin expression and cell biological behavior were determined after hypoxia reoxygenation treatment; cell biological behavior and the expression of related genes were determined after the transfection of SATB1 and β-catenin siR NA; preeclampsia placenta and normal placenta tissues were collected and the expression of SATB1 and β-catenin were determined. Results: OD value, cell migration rate, m RNA contents of SATB1 and β-catenin of H/R group were significantly lower than those of Nor group, cell apoptosis rate was higher than that of Nor group and the number of invasive cells was less than that of Nor group; OD value and bcl-2 mRNA content of SATB1-siRNA group were lower than those of NC group; cell apoptosis rate as well as Bax, Caspase-3, caspase-6 and caspase-9 mRNA contents were higher than those of NC group; cell migration rate as well as CTSB, CTSD, MMP2 and MMP9 mRNA contents of β-catenin-siRNA group were lower than those of NC group; the number of invasive cells was less than that of NC group; the expression levels of SATB1 and β-catenin in preeclampsia placenta tissue were significantly lower than those in normal placenta tissue. Conclusions: Hypoxia can inhibit the expression of SATB1 and β-catenin in the pathogenesis of preeclampsia, which can affect the proliferation, apoptosis, migration and invasion of cells.

Implication of Expression of Osteopontin and Its Receptor Integrin αvβ3 in the Placenta in the Development of Preeclampsia

To investigate the expression of osteopontin （OPN） and its receptor integrin αvβ3 in the placental tissue from pregnant women complicated with preeclampsia, the expression of OPN and αvβ3 in the placenta of the pregnant women with preeclampsia and healthy pregnant women was detected by immunohistochemistry, Western blotting and RT-PCR. Our results showed that OPN and αvβ3 protein were expressed in the placenta from normal pregnant woman and those with preeclampsia. OPN was located in the placental syncytiotrophoblasts and the cytoplasm of capillary endothelial cells and integrin αvβ3 was mainly expressed on the surface of trophoblast cells. Expression of OPN and integrin αvβ3 in the placental tissue from preeclampsia subjects was significantly lower than that from the control group （P〈0.05）. Compared with the control group, expression of OPN in the placental tissue from preeclampsia group was significantly lower （P〈0.05） but there was no significant difference in the expression of αv and β3 between the preeclampsia group and the controls. It is concluded that OPN and its receptor integrin αvβ3 may be involved in the pathogenesis of preeclampsia.

Increased Spot Urinary Protein-to-Creatinine Ratio Can Be a Useful Predictor of Preeclampsia

Objectives: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early diagnosis of preeclampsia is important to help patients with preeclampsia. However, 24-hour urine collection is the gold standard diagnostic method at present. Recently, the spot urinary protein-to-creatinine ratio (P/C ratio) has been used to detect suspected preeclampsia, because it can be used to estimate the amount of 24-hour urinary protein. The aim of this study is to investigate whether an increase in P/C ratio precedes emergence of hypertension among inpatients with preeclampsia. Method: The P/C ratio in normotensive (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) pregnant women was measured during regular prenatal checkups and in inpatients with preeclampsia between April 1, 2013 and March 31, 2014. Results: We included in this study 4074 normotensive pregnant women. The 95th percentile values for the trimester of pregnancy were 0.100, 0.157, and 0.195, respectively. The 95th percentile value for each trimester of pregnancy and gestational age were determined as criterion (Y) and predictive variables (X), respectively. In a simple regression analysis, the regression line was calculated as Y = 0.0035X + 0.0849 (R2 = 0.9913). Twenty-one women were diagnosed with preeclampsia. In 14 patients with preeclampsia, the timing of the increase in P/C ratio to higher than the regression line preceded the emergence of hypertension. Six patients had no data on P/C ratio, and 1 patient had hypertension before the increase in P/C ratio. Conclusions: An increase in P/C ratio to higher than the 95th percentile value can be a useful predictor of preeclampsia.

Why does a high-fat diet induce preeclampsia-like symptoms in pregnant rats?

Changes in neurotransmitter levels in the brain play an important role in epilepsy-like attacks after pregnancy-induced preeclampsia-eclampsia. Metabotropic glutamate receptor 1 participates in the onset of lipid metabolism disorder-induced preeclampsia. Pregnant rats were fed with a high-fat diet for 20 days. Thus, these pregnant rats experienced preeclampsia-like syndromes such as hyper-tension and proteinuria. Simultaneously, metabotropic glutamate receptor 1 mRNA and protein ex-pressions were upregulated in the rat hippocampus. These findings indicate that increased expres-sion of metabotropic glutamate receptor 1 promotes the occurrence of high-fat diet-induced pree-clampsia in pregnant rats.

Folic acid supplementation attenuates hyperhomocysteinemia-induced preeclampsia-like symptoms in rats

Folic acid participates in the metabolism of homocysteine and lowers plasma homocysteine levels directly or indirectly. To establish a hyperhomocysteinemic pregnant rat model, 2 mL of DL-homocysteine was administered daily by intraperitoneal injection at a dose of 200 mg/kg from day 10 to day 19 of gestation. Folic acid was administered by intragastric administration at a dose of 20 mg/kg during the period of preeclampsia induction. Results showed that systolic blood pressure, proteinuria/creatinine ratio, and plasma homocysteine levels in the hyperhomocysteinemic pregnant rats increased significantly, and that body weight and brain weight of rat pups significantly decreased. Folic acid supplementation markedly reversed the above-mentioned abnormal changes of hyperhomocysteinemic pregnant rats and rat pups. These findings suggest that folic acid can alleviate the symptoms of hyperhomocysteinemia- induced preeclampsia in pregnant rats without influencing brain development of rat pups.

Preeclampsia and eclampsia: Etiopathogenesis and perioperative management

Preeclampsia is a pregnancy specific syndrome of elusive etiology, developing in 2nd trimester and associated with high maternal and perinatal morbidity and mortality. The spectrum ranges from mild preeclampsia with no systemic involvement to multi-system involvement. The course is unpredictable and delivery is the only curative treatment. Elevated blood pressure(> 160/110 mm Hg) should be reduced gradually to a safe level(140/90) using antihypertensive drugs. Prophylaxis and treatment of convulsions using Mg SO4 is indicated for severe preeclampsia. Fluid therapy is controversial due to potential delicate balance between constricted plasma volume and risk of fluid overload and pulmonary oedema secondary to increased capillary permeability and reduced colloid osmotic pressure. Single shot spinal anaesthesia is the technique of choice for caesarean delivery unless contraindicated. General anaesthesia is indicated in patients with coagulopathy or eclampsia but is associated with risk of difficult airway and exaggerated sympathetic response during laryngoscopy. Epidural analgesia and anaesthesia is safe in absence of coagulopathy.

Effect of Lipoxin A_4 on IL-1β Production of Monocytes and Its Possible Mechanism in Severe Preeclampsia

This study examined in vitro effect of lipoxin A 4 (LXA 4) on interleukin-1β (IL-1β) production of monocytes and its possible mechanism in severe preeclampsia (PE).Peripheral venous blood was drawn from 15 patients with severe preeclampsia (PE group) and 20 normal pregnant women (control group) to prepare monocytes which were then treated with LXA 4 at different concentrations of 0,10,100 nmol/L respectively.IL-1β level in the supernatant of monocytes was detected by enzyme linked immunoassay.The [Ca 2+ ] i of monocytes was measured by laser scanning confocal microscopy.The results showed that the IL-1β level and the [Ca 2+ ] i of monocytes in the PE group were significantly higher than those in the control group.LXA 4 significantly decreased the generation of IL-1β in a dose-dependent manner in the PE group.After treatment with 100-nmol/L LXA 4,in the PE group,the [Ca 2+ ] i concentration of monocytes was significantly reduced.It was concluded that LXA 4 may inhibit the IL-1β production of monocytes from severe preeclampsia women by inhibiting extracellular calcium influx.

VEGF Deficit is Involved in Endothelium Dysfunction in Preeclampsia

This study examined the association of expression of vascular endothelial growth factor(VEGF),a promoter of angiogenesis,with endothelium dysfunction in preeclampsia.The level of VEGF protein and mRNA in the placenta and peripheral blood samples of 30 preeclampsia patients and 30 normotensive pregnant women was measured by immunohistochemistry,real-time reverse transcriptase-polymerase chain reaction(RT-PCR) and enzyme-linked immunosorbent assay(ELISA),respectively.VEGF expression in the human umbilical vein endothelial cells(HUVECs) was blocked by small interfering RNAs(siRNAs).The monolayer barrier function of HUVECs was determined by measuring the fluorescence intensity of BSA that crossed the HUVEC monolayers.The cell proliferation and cell-secreted nitric oxide(NO) level were detected by MTT method and nitrate reductase assay,respectively.The results showed that VEGF was expressed in the syncytiotrophoblasts and endothelial cells of vessels and capillaries in the placenta tissue.The serum level of VEGF in the preeclampsia patients was significantly decreased as compared with that in normal pregnant subjects,although VEGF mRNA expression in the placenta tissue of preeclampsia patients remained still high.Moreover,VEGF deficit could lead to endothelium cell dysfunction,and the administration of VEGF could protect endothelium cells from injury.It was concluded that lack of VEGF contributes to endothelium dysfunction,which may lead to the occurrence and development of preeclampsia.

Expression of Toll-like Receptor 4 in Neonatal Cord Blood Mononuclear Cells in Patients with Preeclampsia

The expression of Toll-like receptor 4 (TLR4) in neonatal cord blood mononuclear cells (MNCs) and serum TNF-α were investigated in order to explore the roles of TLR4 in the pathogenesis of preeclampsia.The study enrolled 27 patients suffering from preeclampsia (experimental group) and 21 normal pregnancy patients (control group).After MNCs were separated, the expression of TLR4 mRNA and protein was detected by using real-time quantitative PCR and Western blotting respectively, and the expression of TNF-α by using ELISA.The results showed the TLR4 mRNA level in cord blood MNCs (2-CT:0.07±0.17), TLR4 protein expression level (absorbance ratio:0.81%±0.15%) and TNF-α level (9.5±1.73 pg/mL) were all increased in experimental group as compared with control group with the differences being statistically significant (P【0.05).There was a positive correlation between the expression of TLR4 mRNA and TNF-α in both experimental group and control group (r=0.54 and 0.53, respectively, P【0.05).It was concluded that TLR4 expression in the experimental group of cord blood MNCs was increased and there was a positive correlation between the expression of TLR4 mRNA and TNF-α in both groups.TLR4-mediated release of inflammatory cytokines may be one of the important reasons leading to preeclampsia.

Oxidative Stress and Dyslipidemia as Indicators of Pathogenesis of Preeclampsia in Pregnant Sudanese Women

Background: Preeclampsia (PE) still ranks as one of obstetrics major problems and is still a serious threat, mainly in underdeveloped countries where its incidence and mortality rates are higher and is a major cause of preterm birth and intra-uterine growth restriction. Aim: To evaluate the role of oxidative stress and dyslipidemia as indicators of pathogenesis and risks of preeclampsia in pregnant Sudanese women attending Wad-Medani Obstetrics and Gynecology Teaching Hospital. Material and Method: This was a cross-sectional (case-control) study carried out in preeclamptic pregnant Sudanese women attending Wad-Medani Obstetrics and Gynecology Teaching Hospital. A total of 208 pregnant women were enrolled in the study, 111 patients and 97 women with normal pregnancy as controls;pregnant women suffering from any systemic or endocrine disorder were excluded. We compared the serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, nitric oxide, and total antioxidant capacity between preeclamptic and controls. Result and Conclusion: Pregnant women with increase in BMI have a higher chance of developing PE. Low level of high-density lipoprotein cholesterol and high level of low-density lipoprotein cholesterol define that dyslipidemia increases the risk of PE. Decreased levels of NO and TAC might reflect the oxidative stress and likely contribute to the pathophysiological mechanisms of PE.

Preeclampsia from a renal point of view:Insides into disease models,biomarkers and therapy

Proteinuria is a frequently detected symptom,found in 20% of pregnancies.A common reason for proteinuria in pregnancy is preeclampsia.To diagnose preeclampsia clinically and to get new insights into the pathophysiology of the disease it is at first essential to be familiar with conditions in normal pregnancy.Animal models and biomarkers can help to learn more about disease conditions and to find new treatment strategies.In this article we review the changes in kidney function during normal pregnancy and the differential diagnosis of proteinuria in pregnancy.We summarize different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease.We describe the current animal models and give a broad overview of different biomarkers that were reported to predict preeclampsia or have a prognostic value in preeclampsia cases.We end with a summary of treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia.Most of these novel biomarkers for preeclampsia are not yet implemented in clinical use.Therefore,we recommend using proteinuria(measured by UPC ratio) as a screening parameter for preeclampsia.Delivery is the only curative treatment for preeclampsia.In earlypreeclampsia the primary therapy goal is to prolong pregnancy until a state were the child has an acceptable chance of survival after delivery.

Maternal Periodontal Disease and Risk of Preeclampsia:A Meta-analysis

Research on the association between maternal periodontal disease and the risk of pree- clampsia has generated inconsistent results. This meta-analysis was conducted to evaluate the asso- ciation between maternal periodontal disease and the risk of preeclampsia. A literature search of PubMed and Embase was performed to identify relevant papers published before March 2013. Only observational studies that assessed maternal periodontal disease and the risk of preeclampsia were selected. Patients＇ periodontal status was examined at different time points during pregnancy or after delivery （at 14-32 weeks of gestation, within 48 h prior to or within 5 days after delivery）. Pooled odds ratios （ORs） and corresponding 95% confidence intervals （CIs） were calculated for cases and controls. Cases were defined as women with concurrent hypertension and proteinuria after 20 weeks of gestation. Eleven studies involving 1118 women with preeclampsia and 2798 women without preeclampsia were identified and analyzed. Women with periodontal disease before 32 weeks of ges- tation had a 3.69-fold higher risk of developing preeclampsia than their counterparts without perio- dontal disease （OR=3.69; 95% CI=2.58-5.27）. Periodontal disease within 48 h prior to delivery was associated with a 2.68-fold higher risk of preeclampsia （OR=2.68; 95% CI=1.39-5.18）. Pregnant women with periodontal disease within 5 days after delivery had a 2.22-fold higher risk of pree- clampsia than women without periodontal disease （OR=2.22; 95% CI= 1.16-4.27）. In conclusion, this meta-analysis suggests that maternal periodontal disease is an independent predictor ofpreeclampsia.

Involvement of haptoglobin in prevention of oxidative stress cause by hemoglobin in preeclampsia

Haptoglobin (Hp) is a hemoglobin (Hb) binding protein which plays an important role in neutralizing oxidation reactions stimulated by heme-derived iron. Differences in Hp types due to the polymorphic nature of the gene have led to the discovery that individuals carrying the Hp 2-2 genotype are at increased risk of developing vascular complications in the setting of diabetes. Preeclampsia is a pregnancy related disease that is thought to be caused by increases in oxidative stress. The role of Hp polymorphism is determining preeclampsia has been addressed by several clinical studies but the results have been contradictory. Larger longitudinal studies are needed to answer this important question.

Maternal and Foetal Outcomes Associated with Caesarean Deliveries in Patients with Severe Preeclampsia in Two Teaching Hospitals, Yaoundé

Introduction: Severe preeclampsia is a frequent cause of maternal death, and also a frequent indication for caesarean deliveries when faced with the need to expedite delivery. We sought complications specific to caesarean deliveries in patients with severe preeclampsia. Methods: It was a case-control study carried out over 6 months, from December 1st, 2015 to May 31st, 2016 at the Yaoundé Central and the Yaoundé Gynaeco-Obstetric and Paediatric Hospitals. We evaluated 159 women undergoing a caesarean delivery to assess the risk of maternal and foetal postoperative complications in patients with severe preeclampsia. Significance level was set at 0.05. Results: The incidence of postoperative complications stood at 26.4%. Maternal and foetal complications were more frequent in preeclamptic women at 54.5% versus 11.5% (p < 0.05) and 47.3% versus 27.9% (p < 0.05) respectively. The incidence of adverse events was greater in women with preeclampsia: pruritus and limb pain (RR = 2.96;p < 0.001), the persistence of high blood pressure (RR = 4.51, p < 0.001), maternal death (RR = 2.93, p < 0.001), postpartum convulsions (RR = 3, p < 0.001) headaches resistant to first-line analgesics (RR = 3, p < 0.001), Disseminated Intravascular Coagulation (DIC) (RR = 2.92, p < 0.001), a cute pulmonary oedema (RR = 2.92, p < 0.001), prematurity (RR = 4.43, p < 0.001), neonatal asphyxia (RR = 2.93, p < 0.001), and hyaline membrane disease (RR = 2.93, p Conclusion: Severe preeclampsia is associated with an increased risk of postoperative complications.