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.

HLA-G14 bp polymorphism Hainan Li nationality and severe preeclampsia susceptibility related research

Objective:To explore the correlation between the distribution of 14bp polymorphism in exon 8 of human leukocyte antigen-G(HLA-G)gene in Hainan Li nationality and susceptibility to severe preeclampsia.Methods:100 cases of severe preeclampsia inpatients(experimental group)admitted to our hospital from June 2018 to September 2019 were selected.Among them,50 were Li and 50 were Han,and 100 were admitted to our hospital during the same period Normal pregnant women were the control group,including 50 cases of Li nationality and 50 cases of Han nationality.Venous blood was collected to detect the 14bp polymorphism in HLA-G gene exon 8,and the correlation between the 14bp polymorphism in HLA-G gene exon 8 and susceptibility to severe preeclampsia was analyzed.Results:There was a statistically significant difference in the 14-bp genotyping and allele frequency in HLA-G exon 8 of the Li ethnic group in the control group and the experimental group(P<0.05).The SBP and DBP of the Li 14-14/14bp typing,+14bp/-14bp typing,and allele-14bp typing were lower in the experimental group than in the Han group in the experimental group(P<0.05),and the SBP of+14bp/-14bp typing DBP was higher than that of Han patients in the experimental group(P<0.05).Binary Logistic Regression Analysis+14bp/-14bp was associated with the incidence of severe preeclampsia in Li women in Hainan region(P<0.05).The-14bp/-14bp classification was a protective factor for severe preeclampsia in Li women in Hainan region(P<0.05).Conclusion:The HLA-G gene exon 8 carrying a 14bp deletion polymorphism in the Hainan Li nationality is associated with preeclampsia susceptibility and progression.

Impact of Adding Midazolam to Bupivacaine 0.5% in Regional Spinal Anesthesia on Maternal Middle Cerebral Artery Velocimetry in Parturients with Severe Preeclampsia

Severe preeclampsia is a challenging issue facing both intensivist and anesthetic team carrying both maternal and fetal morbidity and mortality. Termination of pregnancy after blood pressure control is the golden key in management. Cerebral complications due to diffuse cerebral vasospasm are most common and serious. Intrathecal midazolam with its gamma amino butyric action may antidote glutamate mediated sympathetic surge and decreasing cerebral vasospasm. Temporal view transcranial Doppler imaging maternal middle cerebral artery is used to examine blood flow indices namely pulsatility index and resistive index. One hundred ladies with severe preeclampsia scheduled for urgent caesarian section were recruited in 2 groups, both received 10 mg bupivacaine 0.5%, Midazolam group received 1 mg midazolam and the other group received 0.2 ml sterile saline 0.9% NaCl. All vascular indices were significantly better in midazolam group, less ICU stay.

A follow-up study of women with a history of severe preeclampsia： relationship between metabolic syndrome and preeclampsia

Background Women with a history of preeclampsia have twice the risk of cardiovascular diseases, and there is a graded relationship between the severity of preeclampsia and the risk of cardiac disease. Moreover, metabolic scores are associated with developing preeclampsia. However, since there are no diagnostic criteria for metabolic syndrome during pregnancy and pregnant women undergo metabolic changes, it is difficult to elucidate the relationship between preeclampsia and metabolic syndrome. We carried out a cross-sectional study to investigate the relationship between metabolic syndrome and preeclampsia among women with a history of severe preeclampsia shortly after an indexed pregnancy.Methods We recruited 62 women with a history of severe preeclampsia 1 to 3 years after an indexed pregnancy. Blood pressure and body compositional indices were recorded. Fasting blood samples were tested for glucose, total cholesterol high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, triglycerides, and insulin. A questionnaire was used to collect demographic data including pre-pregnancy weight and family history of diseases associated with cardiovascular diseases. Criteria for metabolic syndrome were defined by the National Cholesterol Education Program, Adult Treatment Panel III 2001 （NCEP III） and International Diabetes Federation 2005 （IDF）. Data were analyzed by the （α2 test and multivariate Logistic regression.Results According to NCEP III and IDF standards, 17 （27%） and 24 （39%） women, respectively, were identified as having metabolic syndrome. Being overweight pre-pregnancy and currently overweight were risk factors, and currently overweight was an independent risk factor. A combination of blood pressure and waist circumference was predictive of metabolic syndrome with a sensitivity of 91.67% and specificity of 94.74%. Conclusions An unfavorable metabolic constitution in women may lead to metabolic syndrome, preeclampsia, and long-term cardiovascular disease. In women with severe preeclampsia, therapeutic interventions should include weight-control shortly after pregnancy, especially among women who were previously overweight.

Outcome and risk factors of early onset severe preeclampsia

Background Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women. Methods Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows： group A （less than 32 weeks, 73 cases）, group B ,（between 32 and 34 weeks, 71 cases）, and group C （greater than 34 weeks, 269 cases）. The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively. Results The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome. Conclusions Early onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.

Management of a Parturient with Preeclampsia and HELLP Syndrome Complicated by Gestational Diabetes Insipidus

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is considered to be a variant or severe form of pre-eclampsia, a life threatening complication of pregnancy. Gestational Diabetes Insipidus (GDI) can coexist with severe preeclampsia and HELLP syndrome. The combination of these two conditions presents a unique challenge to the anesthesiologist and the obstetric team, caring for this parturient. We present the case of a parturient with an unusual presentation of GDI, coexisting with severe preeclampsia and HELLP syndrome. She had two days history of polyuria and polydipsia as well as lethargy and rapidly rising serum sodium in addition to acute renal failure without any neurologic symptoms. Expeditious delivery of the baby and supportive management is essential for optimal outcomes. She underwent a repeat Cesarean section under combined spinal epidural (CSE) anesthesia. This patient was discharged on postoperative day five after clinical resolution of her signs and symptoms.

早发型重度子痫前期期待治疗的护理进展

子痫前期是妊娠期特有的疾病,对于早发型重度子痫前期的孕妇来说,会增加孕妇以及胎儿在围产期的病死率,早发型重度子痫前期患者在期待治疗中采用预见性评估、一般处理、预见性护理干预、降压、解痉、用药观察、促胎肺成熟及会阴护理等方法。实施期待治疗,期待治疗可有效改善母婴结局,可有效地提高护理质量,达到良好的治疗效果并提高患者满意度。

ED50 and ED95 of Intrathecal Bupivacaine Coadministered with Sufentanil for Cesarean Delivery Under Combined Spinal-epidural in Severely Preeclamptic Patients

Background： Spinal anesthesia was considered as a reasonable anesthetic option in severe preeclampsia when cesarean delivery is indicated, and there is no indwelling epidural catheter or contraindication to spinal anesthesia. However, the ideal dose of intrathecal bupivacaine has not been quantified for cesarean delivery for severe preeclamptic patients. This study aimed to determine the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery. Methods： Two hundred severely preeclamptic patients are undergoing elective cesarean delivery under combined spinal-epidural anesthesia enrolled in this randomized, double-blinded, dose-ranging study. Patients received 4 rag, 6 mg, 8 mg, or 10 mg intrathecal hyperbaric bupivacaine with 2.5 μg sufentanil. Successful spinal anesthesia was defined as a T6 sensory level achieved within 10 minutes after intrathecal drug administration and/or no epidural supplement was required during the cesarean section. The ED50 and ED95 were calculated with a logistic regression model. Results： ED90 and ED95 ofintrathecal bupivacaine for successful spinal anesthesia were 5.67 mg （95% confidence interval [C/]： 5.20-6.10 mg） and 8.82 mg （95% CI： 8.14-9.87 mg） respectively. The incidence of hypotension in Group 8 mg and Group 10 mg was higher than that in Group 4 mg and Group 6 mg （P 〈 0.05）. The sensory block was significantly different among groups 10 minutes after intrathecal injection （P 〈 0.05）. The use of lidocaine in Group 4 mg was higher than that in other groups （P 〈 0.05）. The use of phenylephrine in Group 8 mg and Group 10 mg was higher than that in the other two groups （P 〈 0.05）. The lowest systolic blood pressure before the infant delivery of Group 8 mg and Group 10 mg was lower than the other two groups （P 〈 0.05）. The satisfaction of muscle relaxation in Group 4 mg was lower than other groups （P 〈 0.05）. There was no significant difference in patients＇ satisfaction and the newborns＇ Apgar score and the blood gas analysis of umbilical artery serum （P 〉 0.05）. Conclusion： Our study showed that the EDs0 and ED~ of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery were 5.67 mg and 8.82 mg, respectively. In addition, decreasing the dose of intrathecal bupivacaine could reduce the incidence of maternal hypotension.

Incidence and Clinical Risk Factors for Preeclampsia and Its Subtypes:A Population-Based Study in Beijing,China

Objective:This study aimed to evaluate the incidence and associated clinical risk factors for preeclampsia(PE)and its subtypes in a large multicentre retrospective study of Beijing,China.Methods:This study was conducted as a secondary analysis from the Gestational diabetes mellitus Prevalence Survey(GPS),a multicentre retrospective cohort study,which included 15 hospitals in Beijing,China.This analysis included 15,003 pregnant women who delivered in Beijing from June 20th to November 30th,2013.The incidence of PE was calculated.Risk factors for PE,including maternal age,pre-gestational body mass index(BMI),parity,chronic hypertension,pre-existing diabetes,and gestational diabetes mellitus,were assessed.PE was defined as early-or late-onset PE based on clinical manifestations during the week of delivery,and mild or severe PE based on the severity of the disease.Logistic regression analysis was used to quantify the association with the risk factors,and data were displayed as odds risks(OR)and 95%confidence interval(CI).Results:The overall incidence of PE was 2.65%(397/15,003).The prevalence of early-onset and late-onset PE was 0.36%(54/15,003)and 2.29%(343/15,003),respectively.The prevalence of mild and severe PE was 0.91%(137/15,003)and 1.73%(260/15,003),respectively.Risk factors including high BMI considered overweight(adjusted odds risk(aOR):1.48;95%CI:1.06-2.05;P=0.02)and obesity(aOR:2.15;95%CI:1.50-3.08;P<0.001),nulliparity(aOR:1.73;95%CI:1.32-2.25;P<0.001),multiple gestation(aOR:4.58;95%CI:2.86-7.32;P<0.001),and chronic hypertension(aOR:34.95;95%CI:26.60-45.93;P<0.001),were associated with increased risk for PE.Only chronic hypertension(aOR:13.75;95%CI:4.78-39.58;P<0.001)was a significant risk factors for early-onset PE,whereas high BMI considered both overweight(aOR:1.54;95%CI:1.09-2.18;P=0.01)and obesity(aOR:2.23;95%CI:1.53-3.27;P<0.001),nulliparity(aOR:2.00;95%CI:1.49-2.68;P<0.001),multiple gestation(aOR:4.11;95%CI:2.40-7.05;P<0.001),and chronic hypertension(aOR:35.57;95%CI:26.66-47.47;P<0.001)were more relevant risk factors for late-onset PE.Risk factors including obesity(aOR:2.20;95%CI:1.28-3.76;P<0.01 and aOR:1.80;95%CI:1.16-2.80;P=0.01),nulliparity(aOR:2.28;95%CI:1.44-3.60;P<0.001 and aOR:1.48;95%CI:1.09-2.02;P=0.01),multiple gestation(aOR:5.50;95%CI:2.87-10.67;P<0.001 and aOR:3.51;95%CI:1.93-6.41;P<0.001),and chronic hypertension(aOR:33.98;95%CI:22.20-52.01;P<0.001 and aOR:35.03;95%CI:25.40-48.31;P<0.001)were associated with mild and severe PE.Moreover,we found that women with an increasing number of these risk factors had a higher risk of developing PE than pregnant women without any identified risk factors.Conclusion:The incidence of PE in this study is consistent with previous reported studies.Our findings indicate chronic hypertension and multiple gestation are the most important risk factors for PE in Chinese pregnant women.The risk for developing PE is associated with both the type and abundance of risk factors.These factors are valuable when monitoring patients at risk for PE,as this can help ensure an earlier diagnosis and prediction in women who are more likely to develop PE.

Investigation of diagnosis and treatment of hemolysis-elevated liver enzymes-low platelet counts （HELLP） syndrome： clinical analysis of 59 cases

Background Hemolysis-elevated liver enzymes-low platelet counts （HELLP） syndrome is a clinical condition occurring in middle and late stage pregnancy. It is characterized by hemolysis, elevated liver enzymes and low platelet counts. This study involves the analysis of the diagnosis, clinical characteristics and treatment of 59 cases of HELLP syndrome as well as the clinical classification, method of delivery and gestational age at delivery. Methods Clinical data from 59 cases of HELLP syndrome occurring from January 2000 to December 2009 were analyzed retrospectively. Thirty-five cases were classified as complete HELLP syndrome and 24 cases were considered partial HELLP syndrome. Results Twenty-six of the 59 analyzed patients （44%） with complete HELLP syndrome showed rapid onset, severe signs, symptoms, and complications in addition to a poor clinical outcome. Complications included multiple organ dysfunction syndrome （MODS） occurring in 18 cases, eclampsia （3 cases）, placental abruption （3 cases）, and perinatal death （4 cases）. The remaining 33 cases （24 with partial and 9 with complete HELLP） were characterized by less severe signs, symptoms, complications and progression of the condition. Two of these cases were complicated with MODS （6.1%）, and 1 with perinatal death （3.0%）.Twelve non-radical-type cases received conservative treatment. The remaining 4 patients had recurring HELLP syndrome （6.78%）. Conclusions HELLP syndrome is classified as the radical type and non-radical-type according to clinical characteristics and outcome. Classification of HELLP syndrome cases according to clinical features can help in the monitoring and treatment of the disease. Active termination of pregnancy should be considered for radical-type cases. Non-radical-type cases can undergo conservative treatment with close monitoring in an attempt to improve perinatal outcome without increasing maternal morbidity.