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.

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.

Factors Associated with Maternal and Perinatal Complications of Preeclampsia at the Central Hospital of Yaoundé: A Cross-Sectional Analytical Study

Introduction: Pre-eclampsia (PE) is a public health problem especially in developing countries due to its incidence and severity. It is responsible for high maternal and perinatal morbidity and mortality. Accordingly, the objective of this work was to study the factors associated with the occurrence of maternal and perinatal complications of preeclampsia. Method: This was an analytical cross-sectional study with prospective and retrospective data collection including all patients, pregnant or postpartum, admitted for pre-eclampsia to the maternity ward of the Yaoundé Central Hospital. It took place over a period of seven (07) months. The data collected was analyzed using CS Pro 7.4, SPSS 20.0 and Microsoft Office Excel 2010 software. We compared the group with complications to the group without complications. We calculated the odds ratio to look for associations between variables and their 95% confidence intervals. The threshold for statistical significance was set at p Results: We recruited 214 cases of preeclampsia in our series. There were maternal complications in 44.4% of cases, dominated by eclampsia (31.8%). We recorded 07 maternal deaths, representing a maternal lethality of 3.3%. We had at least one perinatal complication in 105 cases (49.1%). The predominant perinatal complication was prematurity. We recorded 32 cases of intrauterine fetal demise and 13 cases of early neonatal death, giving a perinatal lethality of 21%. After logistic regression, the factors associated with maternal complications were residing in a rural area (OR = 2.217 [1.054 - 3.09];p < 0.036);a nurse-aid as prenatal consultation provider (PNC) (OR = 5.059 [2.175 - 36.162];p - 4.029]). Conclusion: Complications of preeclampsia are very common in our setting. Several identified factors are associated with the occurrence of these complications. We suggest building the capacity of providers of PNC and sensitization of women on the use of PNC services.

Association between Placenta Malaria Parasites and Preeclampsia/Eclampsia among Parturient Mothers in Alex Ekwueme Federal University Teaching Hospital Abakaliki

In tropical countries, malaria and preeclampsia/eclampsia are common diseases of pregnancy;and placenta have been implicated in the pathophysiology of both disease processes. The two diseases have pathophysiologic similarities in the placenta such as placenta ischaemia, endothelial dysfunction and production of pro-inflammatory cytokine. Yet, there is paucity of studies on the association of these two disease processes. Determining the association between the two disease processes may help to unravel the pathogenesis of preeclampsia and also help in its prevention and patient management. Objective: Determined the association between placenta malaria parasitemia and preeclampsia/eclampsia among parturients at Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods: This was a case control study that was conducted in the Labour wards of department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA) and Mile 4 Missionary Hospital Abakaliki, a comprehensive health care centre in Abakaliki, Ebonyi state. It was conducted over a period of 6 months between 1st October 2021 and 31st March, 2022. The cases in this study were parturients that developed preeclampsia/eclampsia in the course of pregnancy, while the controls were parturient without preeclampsia/eclampsia. Interviewer-administered questionnaires were used to collect data on socio-demographic characteristics, obstetrics and medical histories. Histological examinations were conducted to isolate plasmodium falciparum parasites from placenta samples obtained from the maternal surface of the placenta. The data was processed using Epi Info software. Categorical variables were analyzed using Mc Nemar X2 test, with a p-value of 0.05 considered statistically significant. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between placenta malaria parasites and preeclampsia/eclampsia was conducted. Relative risk with 95% CI was used to determine both fetal and maternal outcomes. Results: The prevalence of preeclampsia during the study period was 2.9%. Placenta malaria was positive in twenty one (21) of the 67 cases of preeclampsia/eclampsia analyzed, giving a prevalence of 31.3% and in eleven (11) out of 68 controls (normotensive) patients analyzed, giving a prevalence of 16.2%. The presence of placenta malaria significantly increased the odds of developing preeclampsia/eclampsia among parturients (OR = 2.4, 95% CI = 1.0 - 5.4, P value = 0.04). Presence of placenta malaria in mothers with preeclampsia/eclampsia was associated with adverse pregnancy outcomes such as cerebrovascular accident (RR = 19.2, 95% CI = 1.1 - 341.7, P value = 0.04), DIC (RR = 10.9, 95% CI = 1.4 - 88.0, P value = 0.02), abruptio placenta (RR = 2.4, 95% CI = 1.2 - 4.8, P value = 0.01), pulmonary edema (RR = 2.7, 95% CI = 1.1 - 25.9, P value = 0.03), IUGR (RR = 2.1, 95% CI = 1.1 - 4.5, P value = 0.03) and IUFD (RR = 3.8, 95% CI = 1.3 - 11.7, P value = 0.02). Presence of placenta malaria also increased the risk of NICU admission (RR = 2.6, 95% CI = 1.1 - 6.0, P value = 0.03), Low 1st minute APGAR score (RR = 2.7, 95% CI = 1.2 - 6.1, P value = 0.02) and Low 5th minute APGAR score (RR = 3.0, 95% CI = 1.0 - 8.6, P value = 0.04) among neonates delivered by mothers with preeclampsia/eclampsia. However, presence of placenta malaria did not significantly increase maternal and perinatal mortalities. Conclusion: There is a higher prevalence of placenta malaria among mothers with preeclampsia/eclampsia when compared with normotensive controls and this was associated with increased risk of certain maternal and perinatal morbidities. Placental malaria was not associated with increased risk of either maternal or perinatal mortality.

Magnesium Sulfate Effect on Fetal Umbilical Artery and Middle Cerebral Artery Doppler Indicies in Women with Severe Preeclampsia and Eclampsia

Objective: To study MgSO4 effect on fetal MCA and UA blood flow changes using Doppler ultrasound in cases of severe PET and eclampsia. Materials and Methods: A total of 40 patients with severe PET admitted to El-Shatby Maternity University Hospital, Alexandria (Egypt) were examined before and after administration of MgSO4 using Doppler study to measure fetal MCA and UA blood flow changes. Results: After administration of MgSO4, the mean RI of UA, PI of UA showed a statistically significant decrease (P < 0.001) also the systolic-diastolic ratio (p = 0.001). Mean resistivity index (RI) cerebral showed a statistically significant increasing (P = 0.001), pulsatility index (PI)-cerebral and the systolic-diastolic ratio showed a statistically significant increasing (P < 0.001). The C/U (cerebroumblical) ratio increased after the treatment (P < 0.001). Conclusions: Infusion of MgSO4 significantly decreases the fetal RI, PI, SDR umbilical and increases the fetal RI, PI, SDR MCA and increases cerebroumblical ratio indices obtained by Doppler examinations.

Eclampsia: A Continuous Scourge in a Tertiary Hospital in Southern Nigeria

Background: Eclampsia is responsible for over 50,000 maternal deaths with incidence of 1 death in about 100 - 1500 deliveries in developing nations. In sub-Saharan Africa, Nigeria accounts for the highest maternal mortality ratio of 512 deaths per 100,000 live deliveries and the highest neonatal fatality of 67 per 1000 live births. Factors such young age, nulliparity, multifetal gestation, unbooked cases, preterm delivery (<32 weeks), lack of proper access to antenatal care, poor hospital care, financial constraints and inappropriate diagnosis, have all been identified as risk factors promoting eclampsia. Objectives: In this study, we investigated the prevalence of eclampsia in Rivers State, Nigeria and established the correlation between social demographic factors and the feto-maternal outcomes among the eclampsia patients. Methodology: A prospective observational study using a detailed data sheet was conducted on 1244 pregnant women admitted at the Obstetrics and Gynecology Department of University of Port Harcourt Teaching Hospital, for 1-year duration. Data analysis was conducted using statistical packages for social sciences (SPSS) version 22. Results: Demography showed that age range (20 - 24) occurred in 40.7%, nulliparous mothers were dominant with 40.7% while 70.1% of the study population had secondary level of education. 27 cases of eclampsia were diagnosed from the 1244 pregnant women, which signified 2.13% prevalence among the studied population. The feto-maternal outcome showed that out of the 27 mothers, 19 were alive (70.4%) while 8 died (29.6%), while fetal outcome showed that 16 were alive (59.3%) and 11 died (40.7%). Only parity and education showed significant correlation at 0.01 and 0.05 levels respectively with maternal outcome. Conclusion: The prevalence of eclampsia with associated poor feto-maternal outcome rates is high in this study. Its contribution to the maternal and perinatal morbidities and mortalities necessitates the narrative of eclampsia being a scourge, as hypertensive disease remains an obstetric dilemma in both developed and developing countries.

T Lymphocyte Subpopulations in Normal Pregnancies and Those Complicated by Eclampsia in Kaduna State, Nigeria

Background: Eclampsia, the occurrence of generalized convulsion(s) in association with signs of preeclampsia [PE] (hypertension and proteinuria) in pregnancy has remained a significant public threat in Nigeria, contributing to maternal and perinatal morbidity and mortality. This study was a comparative cross-sectional study conducted in some selected hospitals in Kaduna State, between April 2014 and November 2015. Subjects and Methods: Blood (3 mls) was collected into an ethylenediaminetetraaccetic acid (EDTA) vacutainer tube from third trimester women diagnosed with eclampsia (EC;n = 38) and healthy pregnant controls (PC;n = 38)—age and parity matched and healthy non-pregnant controls (NPC;n = 38)—age matched. T Cell subpopulations and Complete Blood Count levels were measured by Sysmex, Auto blood analyzer and flow cytometry respectively. Participants with smear positive malaria, seropositive for human immunodeficiency virus (HIV), any other clinical infection or refused consent were excluded from this study. Data obtained were analyzed using analysis of variance (ANOVA) and Post Hoc test. A p-value of less than 0.05 was considered to be significant. Result: Overall, results showed a depressed (mean ± Standard deviation (SD): CD3+ T cell (65.6 ± 15.5%;1225.5 ± 401.5 cell/μL), CD4+ T cell (36.1 ± 8.7%;657.1 ± 189.9 cell/μL), and a low CD4/CD8 value in women with EC (1.4 ± 0.5) and PC (1.5 ± 0.3) compared to NPC (1.9 ± 0.6) control (p < 05), while the total white blood cell count, and differential percentage neutrophils count were noted to be elevated among the eclamptic women (9.8 ± 4.9 × 109/L;70.3 ± 12.0%) compared to PC (6.9 ± 3.6 × 109/L;64.6 ± 8.1%) and NPC (5.6 ± 2.0 × 109/L;48.5 ± 10.7%), p < 0.05. Conclusion: Eclampsia was associated with significantly depressed CD3+ and CD4+ T lymphocyte, and increased percentage differential neutrophil counts.

可逆性后部白质脑病综合征合并重度子痫前期或子痫临床分析

目的探讨重度子痫前期、子痫患者中可逆性后部白质脑病综合征(RPLS)的发病率,总结RPLS临床特征和妊娠结局。方法60例诊断为重度子痫前期或子痫的产妇,根据MRI结果分为RPLS组和非RPLS组,收集2组相关临床特征和妊娠结局信息,并进行回顾性分析。结果重度子痫前期、子痫产妇的RPLS发生率分别为47.06%(16/34)和46.15%(12/26)。与非RPLS组相比,RPLS组头痛(85.71%比23.81%)、重度高血压(42.86%比18.75%)的发生频率均明显增加(P<0.05)。枕顶叶是RPLS患者最常见的病变部位(89.29%)。RPLS组剖宫产率(92.86%比62.50%)、早产率(35.71%比9.38%)均高于非RPLS组(P<0.05),住院时间(13.14±3.01比5.41±2.50)、低蛋白血症发生率(21.43%比6.25%)高于非RPLS组(P<0.05)。结论重度子痫前期或子痫患者RPLS发生率高,临床症状及重度高血压对预测RPLS有帮助。RPLS影响分娩方式和妊娠结局,最常见的病变部位是枕叶和顶叶。

超声不同模态下妊娠晚期胎盘参数评估子痫前期-子痫的临床价值

目的探讨二维剪切波弹性成像(2D-SWE)联合三维彩色能量多普勒(3D-CPA)检查下妊娠晚期胎盘参数对子痫前期-子痫(PEE)的诊断价值。方法选取2020年12月至2021年10月内蒙古科技大学包头医学院第二附属医院收治的30例PE-E妊娠晚期孕妇作为实验组,选取同期30名正常单胎妊娠晚期孕妇作为对照组。两组均采用2D-SWE及3D-CPA检查。比较两组2D-SWE参数(胎盘硬度值)及3D-CPA参数[血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)],采用ROC曲线分析VI、FI、VFI、胎盘硬度值单项及联合检查对PE-E的诊断效能。结果实验组胎盘硬度值高于对照组,差异有统计学意义(P<0.05)。实验组FI、VI、VFI均小于对照组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,VI、FI、VFI单项检查诊断PE-E的AUC分别为0.949、0.817、0.951,3D-CPA参数联合的AUC为0.957,胎盘硬度值、2D-SWE参数联合3D-CPA参数的AUC均为1.000,胎盘硬度值、2D-SWE参数联合3D-CPA参数的诊断价值最高。结论2D-SWE与3D-CPA均可诊断临床PE-E,但两者结合诊断效能更高,且能避免操作偏倚造成的异常值,此方法稳定性高,临床成本低、效益高且操作方便,可有效预测临床PE-E的发生,具有良好的临床应用价值。

基于知识图谱的早发型子痫前期发病预测模型相关研究的可视化分析

目的:基于CiteSpace软件绘制知识图谱,进行早发型子痫前期发病预测模型相关研究的可视化分析。方法:检索2004年1月1日—2023年12月31日中国知网(CNKI)、万方(Wanfang)、维普(VIP)、PubMed及Web of Science(WoS)数据库关于早发型子痫前期发病预测模型相关研究,利用CiteSpace软件对文献的作者、机构、关键词进行可视化分析,采用对数似然率(logarithmic likelihood rate,LLR)聚类对中文、英文文献关键词进行聚类分析。结果:共纳入693篇文献,中文文献327篇,英文文献366篇。国内及国外发文量大体均呈上升趋势,英文文献数据库作者及机构合作相对紧密,中文文献数据库作者及机构合作相对分散。中文文献得到2个聚类,为早发型及预测;英文文献得到7个聚类,为DNA甲基化、早孕期筛查、早发型子痫前期、氧化应激、多重免疫测定、胎儿体质量估计及HELLP综合征。突现词分析显示中文文献数据库2019年及以前主要侧重于分析早发型子痫前期疾病临床特点及治疗策略;2020年及之后,着重于用子痫发病传统标志物构建预测模型。英文文献数据库以早发型子痫前期独立性风险因素为重点,不仅明确了母体因素(子痫前期病史、妊娠期高血压及胎儿生长受限等)、传统指标(子宫动脉多普勒超声、生化标志物、血管生长因子及胎盘生长因子等)等临床可靠且实用特异性指标,还尝试从免疫、DNA甲基化、氧化应激等方向着手发掘临床可广泛应用的特异性指标,且在传统统计方法基础上创新性融合机器学习算法构建模型预测早发型子痫前期的发生。结论:目前构建早发型子痫前期发病预测模型仍为国内外的研究热点,所发掘的特异性指标在融合机器学习算法大背景下构建的预测模型的可靠效力有望进一步提升。

信号转导和转录激活因子3和长链非编码RNA肿瘤易感候选基因11在子痫前期胎盘中的表达及与胎盘螺旋动脉重铸的关系

目的 探究子痫前期(PE)病人胎盘组织中信号转导及转录活化因子3(STAT3)、长链非编码RNA肿瘤易感候选基因11(lncRNA CASC11)表达水平与胎盘螺旋动脉重铸的关系。方法 选取2019年1月至2022年4月于沧州市人民医院行剖宫产分娩的68例PE病人为PE组,并选取同期该院行剖宫产分娩的68例健康孕妇为健康组。比较PE组、健康组一般资料及胎盘组织中STAT3 mRNA、lncRNA CASC11表达水平;分析PE病人胎盘组织中STAT3 mRNA表达水平与lncRNA CASC11的相关性;比较健康组与PE组胎盘螺旋动脉管壁厚度、管腔面积;分析PE病人胎盘组织中STAT3 mRNA、lncRNA CASC11表达水平与胎盘螺旋动脉管壁厚度、管腔面积的相关性。结果 PE组病人舒张压、收缩压高于健康组(P<0.05),胎盘组织中STAT3mRNA、lncRNA CASC11表达水平分别为0.40±0.14、0.46±0.15,低于健康组的1.04±0.35、1.01±0.34(P<0.05),胎盘螺旋动脉管壁厚度高于健康组(P<0.05),管腔面积小于健康组(P<0.05);PE病人胎盘组织中STAT3 mRNA表达水平与lncRNA CASC11,及STAT3 mRNA、lncRNA CASC11表达水平与胎盘螺旋动脉管腔面积均呈正相关(P<0.05),STAT3 mRNA、lncRNA CASC11表达水平与胎盘螺旋动脉管壁厚度呈负相关(P<0.05)。结论 PE病人胎盘组织中STAT3 mRNA、lncRNA CASC11表达水平均较低,二者均与胎盘螺旋动脉重铸关系密切,可能为临床诊治PE提供新方向。

妊娠期及产褥期并发脑卒中11例临床病例分析

目的:探讨妊娠期及产褥期并发脑卒中的病因、临床表现与诊断治疗。方法:回顾分析1993年1月至2010年6月本院收治的妊娠期及产褥期并发脑卒中11例患者的临床资料。结果:18 873例分娩孕产妇中,11例妊娠期及产褥期并发脑卒中,7例出血性脑卒中(3例颅内出血,3例蛛网膜下腔出血,1例脑室出血),4例缺血性脑卒中(1例动脉瘤血栓形成伴脑梗死,3例多发性脑梗死)。最常见的症状为头痛、恶心、呕吐、视物模糊、意识障碍,肢体活动障碍等,体格检查阳性结果多为血压增高,瞳孔改变,肌张力异常,病理征阳性等。11例孕产妇中6例重度子痫前期/子痫患者(其中1例合并血小板减少,3例合并胎盘早剥),3例动脉瘤,1例动静脉血管畸形,1例妊娠期血小板减少合并巨幼红细胞贫血。2例行血肿清除术,2例行脑室引流术,1例行DSA下介入栓塞治疗,6例行内科保守治疗。11患者中7例行剖宫产,1例经阴道分娩,1例晚期流产、1例治疗性引产,1例患者未终止妊娠死亡。2例孕产妇死亡,9例孕产妇治疗好转出院。围产儿5例足月儿,4例早产儿(均为低出生体重儿,其中1例轻度窒息,1例重度窒息,1例引产后死亡)。结论:重度子痫前期/子痫和脑血管畸形是妊娠期及产褥期并发脑卒中的最主要原因。卒中发病症状不特异,对于缺血性脑卒中,病理征多延迟出现,及时的CT、MR、血管造影有助于确诊。积极的神经外科治疗对于出血性脑卒中的孕产妇可能是有益的。对于脑卒中的孕妇终止妊娠的方式和时机需个体化、人文化对待。

不同类型妊娠期高血压疾病对妊娠结局的影响

目的:探讨不同类型妊娠期高血压疾病(DHCP)对妊娠结局的影响。方法:采用简单抽样法,选取合并不同类型DHCP孕妇168例为观察组,随机选取同时期的正常孕妇168例为对照组,详细记录、统计并分析产妇、胎儿及新生儿的不良结局。结果:观察组围产妇不良结局总发生率为48.81%,对照组3.57%。2组产妇除妊娠期高血压心脏病并发症发生率差异无统计学意义(P>0.05)外,观察组产妇胎盘早剥等并发症发生率均高于对照组(P<0.05~P<0.01),观察组产妇合并2种并发症发生率高于对照组(P<0.01),而2组产妇合并3种并发症发生率差异无统计学意义(P>0.05)。观察组胎儿不良结局总发生率为58.42%,对照组为6.90%。观察组胎儿死亡、宫内窘迫、胎儿生长受限发生率均高于对照组(P<0.05~P<0.01),观察组胎儿合并2种并发症发生率高于对照组(P<0.01),而2组胎儿合并3种并发症发生率差异无统计学意义(P>0.05)。观察组围新生儿不良结局总发生率为46.55%,对照组为4.93%。观察组新生儿窒息、小于胎龄儿发生率均高于对照组(P<0.01),观察组新生儿合并2种并发症发生率高于对照组(P<0.01),而2组新生儿死亡及合并3种并发症发生率差异无统计学意义(P>0.05)。妊娠期高血压、子痫前期、子痫、妊娠合并慢性高血压和慢性高血压并发子痫前期围产妇胎盘早剥、胎儿死亡、新生儿死亡等不良结局发生率差异均无统计学意义(P>0.05)。结论:DHCP严重影响围产妇母婴预后,且随着疾病进程的发展,影响逐渐增加。临床应加强筛查,尽早发现和干预,改善母婴预后质量。

子痫前期及子痫致可逆性后部脑病综合征的MRI表现

目的:探讨子痫前期及子痫致可逆性后部脑病综合征(PRES)的MRI及临床表现,提高对该病的认识和诊疗水平。方法:回顾性分析22例经临床证实为子痫前期及子痫致PRES患者的影像学和临床资料。结果:22例患者中3例为子痫前期,19例为子痫,主要临床表现为血压升高和头痛,癫痫发作、视觉障碍、精神异常等;MRI典型表现为双侧顶枕叶为主的血管源性水肿,T1为低或等信号,T2/FLAIR高信号,DWI为等或低信号,ADC为高信号。PRES病灶分布模式:顶枕型2例,全半球分水岭型9例,额上回型4例,部分或不对称型6例,中央变异型1例;21例患者住院治疗临床症状消失,预后良好,1例患者死亡。结论:子痫前期及子痫致PRES具有典型的临床和MRI表现,早期诊断可以提高预后和治疗效果。

妊娠相关脑卒中临床病例分析

目的探讨妊娠相关脑卒中的临床表现,研究其发病时间、病因、危险因素与母儿预后的关系。方法回顾性分析1995年7月至2005年6月在本院收治的妊娠相关脑卒中的病例共8例。脑卒中分为脑梗死、脑出血和蛛网膜下腔出血。所有的患者至少有一次CT或MR I检查。结果8例妊娠相关脑卒中的病例,确诊脑出血2例,脑出血伴梗死2例,多发性脑梗死2例,单纯脑梗死2例。均发生在分娩前后,1例合并巨幼红细胞性贫血,叶酸、维生素B12水平明显降低;7例重度子痫前期(子痫)患者,其中3例合并血小板减少,1例有一过性高糖血症,1例合并脑血管畸形。产妇均保守治疗好转出院,围产儿1例胎死宫内,5例早产儿。结论本研究发现妊娠相关脑卒中好发于重度子痫前期(子痫)、脑血管畸形、合并血液疾患及营养状况差的孕产妇,多发生于分娩前后,当出现神经症状及体征时,临床医生应考虑到脑卒中的可能,急行MR I、血管造影、CT确诊。多数孕产妇及时治疗可取得较良好结局。

广东籍汉族妇女N5,10-MTHFR基因和eNOS基因多态性与子痫前期和子痫相关性的研究

目的:探讨N5,10-亚甲基四氢叶酸还原酶(MTHFR)基因及内皮型一氧化氮合酶(eNOS)基因多态性与广东籍汉族妇女子痫前期和子痫发病的关系。方法:567例广东籍汉族妇女中54例诊断为子痫前期或子痫,513例为正常妊娠(对照组)。应用PCR-RFLP方法,检测567例早孕期妇女外周血MTHFR基因C677T突变和eNOS基因G894T突变,计算各基因型的相对风险率。结果:子痫前期和子痫组MTHFR C/C、C/T及T/T基因型频率分别为59.2%、20.4%及20.4%,其中T/T基因型频率显著高于对照组(5.5%)(P<0.001),并且T等位基因频率为30.6%,显著高于对照组(20.5%)(P<0.05),T/T基因型在子痫前期或子痫发病中的相对风险率为4.431。子痫前期和子痫组的eNOS基因频率与对照组无显著差异。结论:广东籍汉族妇女MTHFR基因C677T多态性可能与子痫前期或子痫发病的易感性相关,eNOS基因G894T多态性与子痫前期或子痫发病的易感性无关。

子痫前期/子痫病因学研究进展

妊娠期高血压疾病是妊娠期特有的疾病,子痫前期/子痫属于妊娠期高血压疾病,是导致孕产妇和围生儿发病率及病死率增高的主要原因。目前认为,其发病主要与胎盘浅着床、免疫因素、遗传因素、血管内皮损伤、氧化应激、凝血与纤溶系统失衡、营养失调、胰岛素抵抗等有关。

子痫前期及子痫所致可逆性后部白质脑病综合征影像表现与临床分析

目的：探讨子痫前期及子痫所致可逆性后部白质脑病综合征（reversible posterior leukoenphalopathy syn-drome ，RPLS ）影像学表现与临床特点。方法回顾性分析我院2009年8月～2011年12月8例子痫前期及子痫患者致可逆性后部白质脑病综合征影像表现与临床资料。结果 RPLS影像学病灶分布，顶枕叶8例，颞叶4例，额叶6例，丘脑1例，基底节1例，CT表现两侧顶枕叶区斑片状的低密度区，灰白质界限模糊，脑回样对称分布，可伴有额叶、颞叶部位脑白质低密度影，灰质一般不受累，MRI表现为T1WI等或低信号，T2WI高信号，FLAIR序列呈高信号，DWI呈等或高信号，ADC呈高信号影，临床表现癫痫发作5例，头痛4例，意识障碍5例，视物模糊1例，高血压8例，所有患者经治疗症状消失，无后遗症。结论认识RPLS特有的影像表现，结合子痫前期及子痫临床特点能得出正确诊断。

内毒素在子痫前期发病中的作用

为了解内毒素在子痫前期和子痫发生、发展及转归中的作用,查阅并整理了国内外文献,发现内毒素与子痫前期有一定联系,内毒素在子痫前期和子痫的发生、发展及转归中具有重要地位。