Preeclampsia

Hoy en día, la hipertensión inducida por el embarazo se clasifica en una variante pura (hipertensión gestacional) y en otra que cursa con albuminuria (preeclampsia-eclampsia), con la pretensión de que se trata de dos enfermedades distintas. Sin embargo, los estudios de los últimos años informan que entre 15 y 46% de los casos de hipertensión gestacional evolucionan a preeclampsia. Este hecho plantea la posibilidad de que ambas afecciones representen estadios evolutivos distintos del mismo proceso mórbido. La albuminuria puede no estar presente, aun en casos graves de la enfermedad, como el síndrome HELLP y la eclampsia. Cabe entonces la siguiente reflexión: si la albuminuria no es condición indispensable para formular el diagnóstico de formas graves de la enfermedad, ¿por qué la hipertensión pura, es decir, sin albuminuria, ha de llevar a pensar en un diagnóstico distinto (hipertensión gestacional)? En este artículo se realiza una revisión de la bibliografía médica de las diferencias y similitudes entre ambas enfermedades a fin de reflexionar si se justifica sostener el concepto, aún vigente, que clasifica a la hipertensión inducida por el embarazo en dos padecimientos diferentes.

Purpose: The aim of this study is represented by the assessment of the intrarenal vascularization, using color Doppler ultrasonography of the interlobar renal arteries.
Material and methods: The study was performed on two groups of pregnant women: group A, formed by 10 healthy pregnant women, and group B, formed by 10 pregnant women with preeclampsia. Assessment of the intrarenal vascularization was done by color Doppler ultrasonography of the interlobar renal arteries, using ALOKA 4000 SSD with 3.5 MHz convex transducer. Resistive index (RI), pulsatility index (PI), and acceleration time (AT) were determined in all cases. All data were expressed as mean ± standard deviation. Statistical analysis was done using Student’s t-test, p<0.05 was considered to be statistically significant.
Results: The mean age of patients was 32.15±3.41 years (group A), respective 34.02±5.01 years (group B), and the gestational age was 27.7±2.8 weeks (group A), respective 26.9±1.7 weeks (group B). The values of RI were 0.64±0.03 (group A), 0.65±0.02 (group B) (p>0.05). The values of PI were 1.13±0.06 (group A), 1.11±0.04 (group B) (p>0.05). The values of AT were 70.1±8.78 msec. (group A), 122.2±24.58 msec. (group B) (p<0.001).
Conclusion: In pregnant women with preeclampsia, resistive index and pulsatility index have normal values, but acceleration time is prolonged, due to arterial renal vasoconstriction.

Objective: Hypertensive disorders are among the main causes of maternal and perinatal morbidity and mortality, and the findings regarding the occurrence of preeclampsia (PE) and eclampsia (E) in adolescent pregnancy are conflicting. We performed a systematic review and meta-analysis aimed to determining the prevalence of PE and E in adolescent pregnancy considering socioeconomic and temporal characteristics. Study design: MEDLINE, EMBASE and SciELO databases, with no time span restrictions. Studies that reported the occurrence of PE and E in adolescent pregnancy. Study selection, data extraction and bias assessment were performed by three independent investigators. Meta-analysis techniques comprised random-effects model and double-arcsine transformation; χ 1 and I 2 tests were used to assess heterogeneity. Meta-regression used Hunter-Schmidt model; publication bias were assessed by funnel and Baujat plots. Results: Seventy studies were included, ranging from 1969 to 2019 and comprising 30 countries and 291,247 adolescents. The overall prevalence rate of PE/E was 6.7 % (95 % CI = 5.8-7.6). Subgroup analysis revealed association of PE/E (P = 0.050) and E (P = 0.0113) with country income, and the highest prevalences were found in low-and medium-income country groups (11.5 %, 95 % CI=7.8-15.8 and 10.6 %, 95 % CI=6.05-16.2). Association of PE with publication year (P = 0.0022) was also found with an observable reduction in prevalence rate across the years. Conclusions: The findings seem to confirm that socioeconomic and demographic characteristics play a role for the risk of PE/E in adolescent pregnancy. Although the occurrence of PE has declined worldwide, the problem has broader dimensions beyond health issues.

En el embarazo, de forma precoz y antes de la placentación completa (semanas 20-22), se produ-ce una disminución del nivel de presión arterial (PA) media y de las resistencias periféricas en relación con la instauración del flujo sanguíneo útero-placentario y del aumento de síntesis de ciertas sustancias vasodilatadoras (prostaciclinas, óxido nítrico) 1 . En respuesta a la vasodilatación renal y la activación del eje renina-angiotensina-aldosterona, aumentan el gasto cardíaco, el volumen plasmático, el flujo plasmático renal y la tasa de filtración glomerular generando un descenso sostenido del nivel de PA hasta la segunda mitad de la gestación 2 . A partir de entonces la PA alcanza progresivamente sus niveles habituales a finales

Keywords: hypertension pregnancy pre-eclampsia maternal outcome perinatal outcome long-term prognosis Hypertensive disorders are the most common medical complication of pregnancy. As such, a large part of antenatal care is dedicated to the detection of pre-eclampsia, the most dangerous of the hyper-tensive disorders. The highlights of this chapter include progress in the use of out-of-office blood pressure measurement as an adjunct to office blood pressure measurement, pre-eclampsia defined as proteinuria or relevant end-organ dysfunction, antihypertensive therapy for severe and non-severe hypertension and post-partum follow-up to mitigate the increased cardiovascular risk associated with any of the hypertensive disorders of pregnancy.

Placental overproduction of anti-angiogenic soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) has a key role in the development of preeclampsia (PE). Circulating endothelin-1 (ET-1) levels are also elevated in PE. In this study, we investigated the correlation between ET-1 and sFlt-1, placental growth factor (PlGF), sEng levels during uncomplicated normotensive pregnancy and PE. A total of 218 pregnant primigravid women were enrolled: 110 with PE and 108 uncomplicated normotensive pregnancies. PE was defined as new onset of elevated blood pressure (BP) >140/90 mm Hg and 2+ proteinuria on two occasions after 20 weeks of gestation in previously normotensive pregnant women. Circulating ET-1, sFlt-1, sEng and PlGF levels were estimated using enzyme immunoassays, and correlation between variables was ascertained. Women with PE showed higher levels of sFlt-1 (41.5±15.7 vs 6.15±3.4 ng ml(-1), P<0.001), sEng (84.9±38.8 vs 13.2±6.3 ng ml(-1), P<0.001), ET-1 (1.52±0.55 vs 0.88±0.35 pg ml(-1), P<0.001) and sFlt-1:PlGF ratio (591.1±468.4 vs 18.3±2.1, P<0.001); and lower levels of PlGF (96.3±47.2 vs 497.6±328.2pg ml(-1), P<0.001). BP levels showed an independent relationship with sFlt-1:PlGF ratio in normotensive pregnant women and with sFlt-1:PlGF ratio and ET-1 in PE. sFlt-1 and sFlt-1:PlGF ratio correlated with proteinuria. ET-1 correlated significantly with sFlt-1, sEng and sFlt-1:PlGF ratio in PE. Our results show an association between elevation of sFlt-1 and sEng and ET-1 in the maternal circulation in PE, and strengthen the possibility that ET-1 may be a mediator in genesis of PE syndrome secondary to anti-angiogenic factors released by the placenta.Journal of Human Hypertension advance online publication, 31 March 2011; doi:10.1038/jhh.2011.29.

La preeclampsia es un trastorno multisistémico caracterizado por hipertensión inducida por el embarazo, asociada a proteinuria, edema e incremento de la permeabilidad vascular. Aparece en la segunda mitad de la gestación y es característicamente reversible en el post parto. Además puede presentar múltiples complicaciones llegando incluso a la muerte del feto o de su progenitora.

Hipertensi pada kehamilan sering terjadi (6-10 %) dan meningkatkan risiko morbiditas dan mortalitas pada ibu, janin dan perinatal. Pre-eklampsia/eklampsia dan hipertensi berat pada kehamilan risikonya lebih besar.
Hipertensi pada kehamilan dapat digolongkan menjadi pre-eklampsia/ eklampsia, hipertensi kronis pada kehamilan, hipertensi kronis disertai pre-eklampsia, dan hipertensi gestational.
Pengobatan hipertensi pada kehamilan dengan menggunakan obat antihipertensi ternyata tidak mengurangi atau meningkatkan risiko kematian ibu, proteinuria, efek samping, operasi caesar, kematian neonatal, kelahiran prematur, atau bayi lahir kecil. Penelitian mengenai obat antihipertensi pada kehamilan masih sedikit.
Obat yang direkomendasikan adalah labetalol, nifedipine dan methyldopa sebagai first line terapi. Penatalaksanaan hipertensi pada kehamilan memerlukan pendekatan multidisiplin dari dokter obsetri, internis, nefrologis dan anestesi. Hipertensi pada kehamilan memiliki tingkat kekambuhan yang tinggi pada kehamilan berikutnya.

Background: Hypertensive disorders are the most common medical complications during pregnancy and are associated with high maternal and fetal mortality and morbidity.One way to reduce the impact of arterial hypertension on maternal mortality is to establish the correct diagnosis of preeclampsia, and to proceed with an early intervention when it is diagnosed. The clinical signs are considered to be a late manifestation of a disease. The utility of two biochemical markers like hyperuricemia and hypocalcemia for the diagnostic purposes and for the prognosis remains largely to be explored. Objectives: [1] To determine the role of calcium & uric acid in the pathogenesis of preeclampsia. [2] To determine the serum level of calcium and uric acid & its correlation with the severity with preeclampsia. which serves a rural population where majority of the patients belong to the tribal groups. Mild pre eclamptic patient defined as blood pressure of at least 140/90 mm of Hg. at least on two occasions at least 6 hrs apart accompanied by proteinuria of at least 300 mg per 24 hrs or at least 1+ on dipstick testing. 64 Severe preeclamptic patient defined as having one or more criteria of the following- BP ≥160/110 mm of Hg at least on two occasions at least 6 hrs apart  Proteinuria of ≥5gm/24hrs or at least 3+ on dipstick testing  Oliguria<500ml/24hrs or Cerebral or visual disturbances or Pulmonary edema or any other features of end organ damage. Statistical Analysis: Student's t test, Chi square test and statistical software Medcalc 11.3.0, Q1 Macros 2012.

Depending on the effect of dexmedetomidine in haemodynamic stability, it was started to be used as a sedative prior to and/or during surgical and other procedures in non-intubated adult and pediatric patients. In 2009, dexmedetomidine has been successfully used in laboring parturients. It provides maternal hemodynamic stability, anxiolysis, and stimulation of uterine contractions. Literature describes that dexmedetomidine has a high placental retention and does not cross the placenta, with less incidence of fetal bradycardia. We hypothesized that dexmamedetomidine would be effective in reducing the maternal hemodynamic responses to elective cesarean section in preeclmaptic patients without adverse neonatal effects.

BACKGROUND: Decorin, a leucine-rich proteoglycan that is produced by decidual cells, limits invasion and endovascular differentiation of extravillous trophoblast cells during early placentation by binding to multiple tyrosine kinase receptors, in particular, vascular endothelial growth factor receptor-2. OBJECTIVE: Because many studies have reported an association between poor trophoblast invasion and endovascular differentiation with preeclampsia, the studies reported here tested (1) whether decorin over-expression in the chorionic villi and/or basal decidua is associated with preeclampsia and, if so, (2) whether this association results in a hypoinvasive placenta, and (3) whether elevated plasma decorin concentration in the second trimester is a predictive biomarker for preeclampsia. STUDY DESIGN: Decorin messenger RNA expression was measured with quantitative polymerase chain reaction at the tissue level and with in situ hybridization at the cellular level using 35 S-labeled antisense com-plimentary RNA probe in placentas from healthy control subjects and subjects with preeclampsia (14 each, 23-40 weeks of gestation). Tissue sections of the same placentas were also immunostained for decorin protein. A decorin over-expressing human endometrial stromal cell line was tested for invasion-regulatory effects on an invasive first-trimester extravillous trophoblast cell line HTR-8/SVneo plated in cocultures that were separated by a semipermeable membrane. Furthermore, we conducted retrospective measurements of plasma decorin levels during the second trimester (15-18 weeks of gestation) in a cohort of 28 body mass indexematched pairs of control subjects and subjects with preeclampsia before the onset of clinical disease. RESULTS: First, decorin messenger RNA expression at the cellular level measured with in situ hybridization exhibited profoundly higher expression levels in basal plate decidual cells within the placentas from preeclamptic

Background: Preeclampsia is a major obstetric problem and a significant source of maternal and neonatal morbidity and mortality. Preeclampsia is associated with increased risks of placental abruption, acute renal failure, cerebrovascular and cardiovascular complications, disseminated intravascular coagulation, and maternal death. Consequently, early diagnosis of preeclampsia and close observation are imperative. In these cases of preeclampsia, combination of Doppler flowmetry and circulating angiogenic factors levels are recorded. Stepan et al examined endoglin, a cell-surface co-receptor for transforming growth factor in patients with Doppler flow patterns of preeclampsia at 19-24 weeks. Soluble endoglin levels were elevated in second trimester pregnancies with abnormal uterine perfusion in women who experienced preeclampsia. The aim of this study was to test if there is correlation between the level of serum endoglin in pregnant women with severe preeclampsia to the maternal and fetal outcome. Methods: This study was conducted on a group of 90 pregnant women attended to the Antenatal clinic and selected from the preeclampsia unit of EL-Shatby Maternity University Hospital, The selected patients were subdivided in two groups. Group A (control group): 30 cases of normotensive pregnant ladies. Group B (case group): 60 cases of severe preeclamptic pregnant ladies. Routine investigations, maternal serum soluble endoglin and ultrasound results were analysed and compared for both groups. Results: Significant correlation was found between severe preeclampsia and high level soluble endoglin. Significant correlation was found between high level of soluble endoglin and the occurrence of IUGR among the severe preeclamptic patients. Positive correlation was found between serum level of soluble endoglin and uterine artery PI and uterine artery RI, the higher the serum level of soluble endoglin the higher the uterine artery pulsatility and resistance index. Significant correlation was found between high level of soluble endoglin and the occurrence of specific complications, the higher the level of soluble endoglin the higher the risk of exposure to preeclampsia complications as the occurrence of eclamptic fits, the development of HELLP syndrome, the admission to the ICU, the admission of the baby to the NICU, and the fetal death. Conclusions: From our study, it is evident that serum endoglin rises during normal as well as preeclamptic pregnancy and that the rise in preeclampsia is much higher, the rise in endoglin levels may occur as early as the first trimester in pregnancies which later develop preeclampsia. Hence, used alone or in combination with uterine artery Doppler flowmetry, the measurement of soluble serum endoglin has the potential for use as a predictive clinical test for preeclampsia risk assessment and could potentially improve the outcome of pregnancy.

Adrenomedullin is a novel vasodilatory peptide isolated first in 1993. It was originally isolated from human phaeochromocytoma from adrenal glands of Zona glomerulosa region. This plueripotent hormone increases when implantation occurs and during late gestation decreases. Many promising opportunites for prevention and treatment of aberrant pregnancies made through the introduction of receptors and to manage its clinical treatments in early stage of prenanacy. Adrenomedullin (ADM), Calcitonin Gene related peptide (α-and β-CGRPs),Calcitonin, Amylin and Adrenomedullin -2/intermedin (IMD/ADM) are the six receptors present on the Plasma membrane of the cell. Adrenomedullin contributes to angiogenesis, functions as a growth factor, and helps regulate vascular tone during rat gestation. With this understanding the review summarizes a clear cut view of Adrenomedullin receptor and its pathway.

La Preeclampsia-Eclampsia constituyen un trastorno hipertensivo multisistémico que complica aproximadamente el 10% de todos los embarazos con una incidencia ligeramente mayor en los países en desarrollo. En México representa la principal causa de muerte materna y en Chiapas, la preeclampsia es la principal complicación de emergencia obstétrica en las mujeres 15 a 49 años.

RESUMEN Objetivo: Comparar la morbilidad y mortalidad materna en pacientes con preeclampsia severa-eclampsia en dos hospitales de la ciudad de México, con diferente manejo antenatal. Población y métodos: Pacientes con preeclampsia/ eclampsia, Hospital A (n = 108) Hospital B (n = 192). En un estudio de seguimiento, longitudinal y prospecti-vo, de septiembre de 1999 a diciembre del año 2000, se realizaron mediciones de la evolución de las variables demográficas y características gineco-obstétricas, y las complicaciones médicas desarrolladas. Resultados: No existió diferencia estadística al medir el grado de severidad de la preeclampsia severa/ eclampsia entre las pacientes de ambos grupos. La incidencia de complicaciones comparando al Hospital A contra el Hospital B mostró insuficiencia renal aguda 14.8% vs 9.4%, la recurrencia de urgencia hi-pertensiva 9.3% contra 3.6%. La recurrencia de con-vulsiones fue más frecuente en las pacientes con eclampsia en el hospital A contra el hospital B. No existieron diferencias en la incidencia de síndrome de HELLP, coagulación intravascular diseminada, o he-matoma hepático. La regresión logística múltiple mos-tró que las mujeres que reciben el protocolo de tratamiento del hospital A tienen un RR = 3.19 de de-sarrollar complicaciones asociadas a la preeclampsia severa, comparada con las del Hospital B, p = 0.008. SUMMARY Objective: To compare the development and prognosis of two different treatment protocols for the preeclampsia-eclampsia management of two obstetric intensive care units of Mexico. Material and methods: 300 patients of the intensive care units from two institutions were studied; Hospital A (108 patients), Hospital B (192 patients), with preeclampsia-eclampsia diagnosis. The treatment protocols of both institutions differ in the prenatal approach, antihypertensive therapy and hydric management. Demographic characterics, clinical and laboratory variables were compared at the moment to be entered, after birth, and 24 and 72 hours, as well as the complications that were presented in both groups of patients in different time of measurement. Results: There was statistic difference between the demographic variables at the moment of comparing both groups of patients. Hospital A mean age 23.8 years old, gestational age 35 weeks, weight at birth 2,334 grams. Hospital B, mean age 28.8 years old, mean gestation weeks 32.8 and weight at birth 1,815 grams. There was no difference in severity degree at the moment to be entered, when comparing means of clinical variables and laboratory. There was significant difference in the complications incidence at Hospital A compared to Hospital B; renal failure 14.8% versus 9.4%, recurrence of hypertensive urgency or emergency was 9.3% versus 3.6% there was more recurrence of convulsive crisis in eclamptic patient at the Hospital A than B (15 versus 3). The best explanatory pattern of multiple logistic regression showed that those women who are attended at Hospital A have RR = 3.19 (95 percent confidence interval 1.3 to 7.59) to develop any complication associated with severe preeclampsia, compared to those women attended at Hospital B, p = 0.008. Artemisa medigraphic en línea

Introduction: There is documented evidence pointing to the fact that there are numerous challenges with postoperative pain (POP) management globally. However, these challenges with POP management are more profound in developing countries. Purpose: The purpose of this study is to examine the knowledge, attitude, and practices of nurses concerning POP management in four selected district hospitals in Ghana. Methodology: A descriptive, cross-sectional survey was employed to evaluate nurse's knowledge, attitude, and practices pertaining to POP management. Multistaged sampling was used to draw the respondents. An adapted version of the Nurses Knowledge and Attitudes Survey Regarding Pain instrument was used to test the knowledge, attitude, and practices of nurses and midwives. Descriptive statistics were used to analyze the data in order to present quantitative descriptions of variables in this study. Results: This study showed that nurses in the four district hospitals had knowledge deficits regarding POP management. Eighty-one representing 48% of nurses had low knowledge on POP management. An overwhelming majority of nurses (97.6%) relied on routinely rendered basic nursing skills to relieve POP and a few used pharmacological interventions. However, nurses had good attitudes toward POP management. Conclusions: POP is ineffectively managed by nurses in district hospitals in Ghana. Nurses and midwives in Ghana need to adhere to best practices in POP management by increasing their theoretical and practical knowledge, so that there will be tangible positive change in POP management in Ghana. Recommendations: Nurses must be empowered through continuous development programs to keep abreast with changing trends that pertain to POP management.

The objective of this review is to compare different studies concerning
pathogenesis, clinical manifestation, classification, natural history and treatment for HELLP syndrome. This obstetric pathology needs to be recognized early, in order to avoid severe complications and maternal and foetal mortality. The first studies by authors who dealt with the description of this syndrome cited the association between HELLP syndrome and pre-eclampsia, the risk factors for these two pathologies. Special attention is paid to exposition of liver involvement and to three major criterias of this syndrome, because these identify the pathology and permit an early diagnosis: hemolysis, elevated liver enzymes and low platelets. Two international classifications based on these criterias are reported. Some secondary symptoms that can complicate the HELLP syndrome moreover and others pathology for differential diagnosis are also described. Lastly, as justified by some reported cases, corticosteroids, the treatment, are considered the gold standard because these assure the improvement of the maternal condition as well as foetal lung maturity. However, the authors do not agree with plasmapheresis. Management and delivery indications are based on gestational age as well as maternal and foetal risks.

ÖZET:Preeklampsi ve Fetal büyüme kısıtlanması gibi sağlık problemlerinin kökeninde plasenta gelişiminin yetersiz olması yatmaktadır.Plasenta gelişimi bir çeşit immunolojik olaylar zincirinin doğru çalışmasına bağlıdır.İmmunolojik olaylar zinciri,Trofoblastik embriyonel hücrelerin HLA-1(HLA-C ve HLA-G) antijenlerinin doğal immun sistemi uyarmasıyla başlar.Sağlıklı Plasenta gelişimi için doğal immun sistem elemanı olan Natural Killer(uNK) hücrelerin aktifleşerek trofoblastların myometriuma invazyonunu uyarması zorunludur.Bunun yanında;yine doğal bağışıklık elemanı olan Dentritik hücrelerin(DC) tolerojenik yönde aktifleşerek(tDC); embriyonik antijenlere karşı anerjik bir ortam yaratmasıyla, allogreft embriyonik dokuya yönelik selektif bir immun tolerans sağlanmalıdır.Kısacası,immun sistem hem kendi myometrial dokusuna karşı kendinden olmayan(allogreft) trofoblastların invazyonunu teşvik etmeli, hem de allogreft dokuya karşı oluşması beklenen Th1,Th17 aracılı inflamatuar immun yanıtı baskılamalıdır. Natural Killerlara ait KIR reseptörleri genetik varyasyon göstermektedir.HLA-G ve HLA-C'yle birleşen bazı KIR reseptör tiplerinin cevabı doğal immun sistemin inhibitör yanıt vermesine neden olur.İnhibitör yanıt nedeniyle doğal immun sistem elemanlarının(uNK,tDC) aktifleşemez.Bu nedenle embriyonik dokuya karşı immun toleransın sağlanamaz.Sonuç olarak inflamatuar yanıt gelişir; plasental gelişim baskılanır.

Background: Prenatal health disparities exist for African Americans and low socioeconomic status (SES) individuals when compared to non-Hispanic Whites and people of higher SES, particularly in cardio-metabolic diseases. Furthermore, having had a pregnancy-specific cardio-metabolic disease, e.g. preeclampsia, increases risk for future cardio-metabolic disease. Although these factors (race, SES and pregnancy cardio-metabolic disease) are interrelated, studies have rarely considered their combined effect on postpartum cardio-metabolic risk. The purpose of this study was to assess whether SES, race/ethnicity, and prenatal cardio-metabolic disease interact in the prediction of postpartum cardio-metabolic risk.

Methods: A sample of 1,753 low-income women of African American, Latina, non-Hispanic White race/ethnicity was recruited after a birth in 5 US sites. Household income was used to categorize poverty status as Poor (< Federal Poverty Level; FPL), near poor (100–200% FPL), or low/middle income (> 200% FPL). Three prenatal cardio-metabolic disease diagnoses (preeclampsia, gestational hypertension, gestational diabetes) were identified from medical records. Four biomarkers (mean arterial pressure, glycosylated haemoglobin, total cholesterol:HDL ratio, and waist-hip ratio) were collected at 6 and 12 months postpartum, and combined into an average postpartum cardio-metabolic risk index. Maternal age, pre-pregnancy body mass index, parity, health behaviors and employment status were covariates.

Results: Analyses revealed interactions of race/ethnicity, poverty status, and prenatal cardio-metabolic diseases in the prediction of postpartum cardio-metabolic risk. African American women had higher postpartum cardio-metabolic risk, which was exacerbated following a prenatal cardio-metabolic disease. Low/middle income African American women had higher cardio-metabolic risk compared to poor African American, and all Latina and White women.

Conclusions: African American women, and especially those who experienced pregnancy complications, emerged as vulnerable, and greater household income did not appear to confer protection against worse postpartum cardio-metabolic risk for this group. These results highlight the complex interplay between socioeconomic status and race/ethnicity with respect to understanding health disparities.

Preeclampsia is a complex and life threatening pregnancy disorder is mojor cause of maternal and neonatal
morbidity and mortality. A growing body of evidence has demonstrated that low vitamin D is associated with the
pathophysiology of preeclampsia. As such, identification of the mechanisms behind this relationship and placental
vascular endothelial dysfunction presents itself as a significant modifiable disease risk factor, which if identified and
managed appropriately, may make a significant impact in reducing the burden of disease.

Background: Anemia in pregnancy may not only be associated with maternal morbidity and mortality but can also be detrimental to the fetus. A definitive diagnosis of anemia is a prerequisite to unravelling possible cause(s), to allow appropriate treatment intervention. It is hypothesised that measured hemoglobin (HGB), complemented by biochemical and other hematological parameters would enhance anemia diagnosis. Methods: This was a cross-sectional study among 400 pregnant women comprising 253 anemic and 147 non-anemic pregnant women, attending an antenatal clinic at Bolgatanga Regional Hospital, Ghana. Venous blood was collected and hemoglobin genotype, complete blood count and biochemical parameters [ferritin, iron, total iron binding capacity (TIBC), transferrin saturation (TfS), C-reactive protein (CRP) and bilirubin] were determined. Thick blood films were prepared for malaria parasitemia, while early morning stool and midstream urine samples were examined for enteric and urogenital parasites, respectively. Results: There were significantly reduced levels of HGB (p < 0.0001), HCT (p < 0.0001), MCV (p < 0.0001), iron (0.0273), ferritin (p = 0.018) and transferrin saturation (0.0391) and increased WBC (p = 0.006), RDW (p = 0.0480), TIBC (p = 0.0438) and positivity of CRP in anemic, compared to non-anemic pregnant women. Anemic women were associated with increased proportion of hemoglobinopathies (AS, SS and SC), Plasmodium falciparum, Schistosoma hematobium and intestinal parasite infections.

Preeclampsia (PE) is a leading cause of perinatal morbidity and mortality. Our aim of the study was to evaluate the association of oxidative stress and antioxidant defence systems with preeclampsia during pregnancy and after delivery. The study comprises a total of 52 subjects including PE women (n=27) and uncomplicated pregnant women (n=25) matched by age. Serummalondialdehyde (MDA), phospholipid hydroperoxide (PHP), superoxide dismutase (SOD), vitamin C and total antioxidant status (TAS) were estimated by spectrophotometric methods. Serum levels of MDA and PHP were significantly higher (p<0.001, respectively) while SOD, vitamin C and TAS were significantly lower (p<0.001, respectively) in patients both during and after delivery. The systolic and diastolic blood pressure significantly decreased among patients after delivery. On the other hand, the MDA and PHP concentrations non-significantly decreased in PE women after delivery whereas the antioxidant system non-significantly increased. Our results suggested that the raise in oxidative stress and reduction in antioxidant defence systems persisted after delivery for 1 to 3 days. Therefore, evaluation of oxidative status and antioxidant defence systems may be a useful tool for diagnosis and treatment of preeclampsia during and after pregnancy.

Background

Preeclampsia (PE) is a serious hypertensive pregnancy disorder with a significant genetic component. Numerous genetic studies, including our own, have yielded many susceptibility genes from distinct functional groups. Additionally, transcriptome profiling of tissues at the maternal-fetal interface has likewise yielded many differentially expressed genes. Often there is little overlap between these two approaches, although genes identified in both approaches are significantly associated with PE. We have thus taken a novel integrative bioinformatics approach of analysing pathways common to the susceptibility genes and the PE transcriptome.

Methods

Using Illumina Human Ht12v4 and Wg6v3 BeadChips, transcriptome profiling was conducted on n = 65 normotensive and n = 60 PE decidua basalis tissues collected at delivery. The R software package libraries lumi and limma were used to preprocess transcript data for pathway analysis. Pathways were analysed and constructed using Pathway Studio. We examined ten candidate genes, which are from these functional groups: activin/inhibin signalling—ACVR1, ACVR1C, ACVR2A, INHA, INHBB; structural components—COL4A1, COL4A2 and M1 family aminopeptidases—ERAP1, ERAP2 and LNPEP.

Results/Conclusion

Major common regulators/targets of these susceptibility genes identified were AGT, IFNG, IL6, INHBA, SERPINE1, TGFB1 and VEGFA. The top two categories of pathways associated with the susceptibility genes, which were significantly altered in the PE decidual transcriptome, were apoptosis and cell signaling (p < 0.001). Thus, susceptibility genes from distinct functional groups share similar downstream pathways through common regulators/targets, some of which are altered in PE. This study contributes to a better understanding of how susceptibility genes may interact in the development of PE. With this knowledge, more targeted functional analyses of PE susceptibility genes in these key pathways can be performed to examine their contributions to the pathogenesis and severity of PE.

Objective: To evaluate the efficacy of 5-methyl-tetrahydrofolate (5-MTHF) supplementation in prevention of recurrent preeclampsia.
METHODS:
Retrospective cohort of women who received daily oral 5-MTHF 15 mg supplementation as prophylactic treatment since first trimester for recurrent preeclampsia were compared with women who did not. All asymptomatic singleton gestations with prior preeclampsia (in the previous pregnancy) were included. Women with chronic hypertension were excluded. The primary outcome was the incidence of preeclampsia.
RESULTS:
Three hundred and three singleton gestation met the inclusion criteria: 157 received 5-MTHF, while 146 did not (control group). Women who received 5-MTHF had a significantly lower incidence of recurrent overall preeclampsia (21.7% versus 39.7%; odds ratio (OR) 0.57, 95% confidence interval (CI) 0.25, 0.69), severe preeclampsia (3.2% versus 8.9%; OR 0.44, 95% CI 0.12-0.97) and early-onset preeclampsia (1.9% versus 7.5%; OR 0.34, 95% CI 0.07-0.87) compared to control. The intervention group delivered about 10 d after the control and had higher birth weight.
CONCLUSION:
This retrospective study showed that women with prior preeclampsia who received daily oral 5-MTHF 15 mg supplementation had a significantly lower incidence of overall preeclampsia, severe preeclampsia and early-onset preeclampsia. Randomized controlled trials are needed to confirm our findings.

Cell-free fetal DNA in the maternal circulation is a potential noninvasive marker for fetal aneuploidies. In previous studies with Y DNA as a fetal-specific marker, levels of circulating fetal DNA were shown to be elevated in women carrying trisomy 21 fetuses. The goal of this study was to determine whether cell-free fetal DNA levels in the serum of pregnant women carrying fetuses with tri-somies 13 or 18 are also elevated. Archived maternal serum samples from five cases of male trisomy 13 and five cases of male trisomy 18 were studied. Each case was matched for fetal gender, gestational age, and duration of freezer storage to four or five control serum samples presumed to be euploid after newborn medical record review. Real-time quantitative polymerase chain reaction amplification of DYS1 was performed to measure the amount of male fetal DNA present. Unadjusted median serum fetal DNA concentrations were 97.5 GE/ml (genomic equivalents per milliliter; 29.2–187.0) for the trisomy 13 cases, 31.5 GE/ ml (18.6–77.6) for the trisomy 18 cases, and 40.3 GE/ml (3.7–127.4) for the controls. Fetal DNA levels in trisomy 13 cases were significantly elevated (P=0.016) by analysis of variance of the ranks of values within each matched set. In contrast, fetal DNA levels in trisomy 18 cases were no different from the controls (P=0.244). Second trimester maternal serum analytes currently used in screening do not identify fetuses at high risk for trisomy 13. Fetal DNA may facilitate noninvasive screening for trisomy 13 provided that a gender-independent fetal DNA marker can be developed.

Background: Osteopathy is present in a large number of hospitals in Italy, firstly in pediatric departments. It is mainly deals with musculo-skeletal imbalances, but osteopathy states to have a role in improving general health. Few studies about safety and efficacy of osteopathic manipulative treatment (OMT) in Obstetrics have been produced.

pregnancy has been associated with disorders such as pre-eclampsia (PE), short gestation period, and miscarriages. 5,6 Inflammatory cells and immunological mediators, such as components of the complement system, are present in the uterine environment. The development of PE, a disorder that leads to high maternal and fetal mortality, involves inflammatory events and a spectrum of clinical presentations, including an incorrect placentation. 1,7-10 PE is characterized by abnormal vascular response to placentation, increased systemic vascular resistance,

Background: Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs
after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. Pre-eclampsia is a syndrome with multiple
aetiologies which has made it difficult to develop adequate screening tests and treatments. Objective of this study to
assess the level of gamma glutamyl transferase and lactate dehydrogenase as biochemical markers of severity of
preeclampsia in Sudanese pregnant women.
Methods: This is a case control hospitalize base study. The study was conducted in preeclamptic pregnant women in
Omdurman maternity hospital and medical military hospital in Khartoum state. In this study glutamyl transferase and
lactate de-hydrogenase was estimation in 100 Sudanese pregnant women by spectrophotometer method, 50 of them
were diagnosed with preeclampsia 27 from this is severe preeclampsia and 23 is mild preeclampsia was matched in
aged. Serum samples of all the cases were assayed for GGT and LDH. The data was recorded and analyzed using
statistical package for social sciences (SPS –version 16) on programmed computer. The mean standard deviations of
variable were calculated for both the test group and the control group and P value for comparison was obtained.
Results: The mean values of plasma gamma glutamyl transferase in mild and severe preeclamptic pregnant women
were insignificant difference when compared to control P value (0.346 - 0.089) respectively. The mean values of
plasma lactate dehydrogenase in mild and severe preeclamptic pregnant women were significant increase when
compared to control P value (0.008 - 0.001) respectively.
Conclusions: The levels of LDH is raised in Sudanese pregnant women with hypertensive also can be useful
biochemical marker that reflects the severity of and the occurrence of complications of pre-eclampsia. GGT levels
were normal in Sudanese pregnant women with hypertensive preeclampsia

Objective: The objective of this study was to determine the association of obesity with preeclampsia in the Khyber Pakhtunkhwa (KP) Province of Pakistan. Methodology: This is a case-control study conducted in Lady Reading Hospital (LRH), Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC) Peshawar. Forty pregnant females (aged 15-35 years), with a diagnosis of preeclampsia during their third trimester of pregnancy were taken as cases. The basic diagnosis was made on the basis of pregnancy-induced hypertension (systolic 140 mmHg and above, diastolic 90 mmHg and above). For controls, forty pregnant females (aged 15-35 years) who remained normotensive throughout pregnancy and were in their third trimester were taken. BMI was determined using Asian BMI criteria. Tests of normality were performed and the association between obesity and preeclampsia was determined using the Mann Whitney-U test. Results: The results showed that the distribution of BMI varied among cases and controls, p<0.001. Moreover, stats showed, 33 obese among the 40 cases (preeclamptic), that is about 82.5%. And among the 40 controls (normotensives) there were 25 obese, that is, 62.5%. Conclusions: Hence, it is concluded that preeclampsia is more common among obese women.

Normal pregnancy is considered as a Th2 type immunological state that favors an immune-tolerance environment in order to prevent fetal rejection. Preeclampsia (PE) has been classically described as a Th1/Th2 imbalance; however, the Th1/Th2 paradigm has proven insufficient to fully explain the functional and molecular changes observed during normal/pathological pregnancies. Recent studies have expanded the Th1/Th2 into a Th1/Th2/Th17 and regulatory T-cells paradigm and where dendritic cells could have a crucial role. Recently, some evidence has emerged supporting the idea that mesenchymal stem cells might be part of the feto-maternal tolerance environment. This review will discuss the involvement of the innate immune system in the establishment of a physiological environment that favors pregnancy and possible alterations related to the development of PE.

Although the exact pathophysiology of PE is unknown, a large number of studies have shown that abnormalities in nitric oxide (NO) synthesis may contribute to the development of this disorder. There are some evidences that polymorphisms of the endothelial nitric oxide synthase (eNOS) gene affect NO production and have been associated with hypertension and PE in some populations. Therefore the aim of this study was to assess the relation of the Glu298Asp eNOS polymorphism and PE in an Iranian population. We compared the frequency of the Glu298Asp polymorphism in 147 women with PE and 137 healthy pregnant control subjects by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The frequencies of Glu298Asp genotypes were significantly different between PE women and controls (p < 0.001). The frequency of Asp allele was 0.32 in PE patients and 0.20 in controls and was significantly different (p < 0.001). The risk of PE was 2.4 fold in pregnant women with Asp allele. In conclusion, the Asp allele could be a risk factor for PE in South East of Iran.

A low degree of infl ammation has been associated with complications in pregnancies, including preeclampsia (PE). The aim of our study was to determine the serum values of high sensitivity C Reactive Protein (hs-CRP) and Interleukin-6 (IL-6) in the fi rst and second trimesters of pregnancy in pregnant women with risk factors for the development of PE, and to evaluate their relevance for the prediction of this disorder. Material and methods: We performed a prospective longitudinal study on 120 pregnant women, who were divided based on the pregnancy evolution, into two groups: group I -26 pregnant women who developed preeclampsia and group II -94 pregnant women with physiological evolution of pregnancy. Results: Our study has shown an increase in serum levels of hs-CRP and IL-6 in the fi rst and second trimester of pregnancy in patients from group I, signifi cant values being revealed only in the second trimester of pregnancy. The predictive power of the selected infl ammatory markers was signifi cant only for values of hs-CRP in the second trimester of pregnancy, while the association with IL-6 increased the prediction. Conclusions: Increased values of hs-CRP and IL-6 in the second trimester of pregnancy are associated with higher risk for preeclampsia, however the study provided only a modest effi ciency of the prediction capacity.

Objective: Preeclampsia (PE) is known as a considerable reason of maternal polyorganic failure and fetal compromise.
The investigation was aimed to survey the involvement of maternal systemic inflammatory response (SIR)
in fetal and maternal autonomic disturbances in women with severe PE. Materials and methods: 112 patients at
34-38 weeks of gestation were enrolled in the study. And 30 of them had physiological gestation and were involved
in the Group I (control). In Group II 48 pregnant women with mild-moderate PE were observed. 34 patients with
severe PE were monitored in Group III. Maternal and fetal heart rate variability, maternal blood serum CRP and
Il-6 were investigated in the study population. Results: Maternal SIR suppressed autonomic tone of mother and
fetus. The relative increase of VLF domain region in preeclamptic women was a result of intense functioning of
hypothalamic-pituitary-adrenal axis. The result of such autonomic modifications was a transfer to the lower level
of cardiac activity regulation. The most pro-inflammatory activity was determined in maternal LF. Contrary maternal
HF had penetrating immunomodulating ability. Vagal division of autonomic nervous system was possibly
involved in general anti-inflammatory activity. Altogether maternal vagal tone had its speculated protective impact
on adaptive immunity during pregnancy. Conclusions: Maternal and fetal autonomic tone was reduced in PE. PE
was associated with augmented sympathetic and decreased parasympathetic activity of mother and fetus. Maternal
sympathetic tone demonstrated pro-inflammatory ability and vagal division provided immune-adaptive response.

The year 2014 is an important year because it will mark the 25th Anniversary of the founding of the African Association of Physiological
Sciences (AAPS) and initial talks to launch the International Society for Pathophysiology (ISP). Both these organizations had a foothold in
Finland and both occurred during the IUPS Centennial Celebration Congress in 1989. The congress was hosted by the Finnish Physiological
Society in Helsinki, Finland in July 1989. For both organizations, Prof OsmoHänninen was instrumental in the launching and inauguration
of AAPS and also to initiate the creation of ISP. In order to celebrate the 25th Anniversaries of both organizations it was decided to hold the
ISP2014 congress on the African soil. Hence in 2004, at the 4th international congress of AAPS held in Morocco, Wail Benjeloun.the then
secretary general of AAPS, submitted successfully a bid to host ISP2014 in Morocco.
Following the inauguration of AAPS in Helsinki, the 1st Congress of AAPS was held in Nairobi, Kenya in 1992 where the Constitution of
AAPS was drawn up. The Constitution was adopted at the 2nd congress of AAPS in Durban, South Africa in 1997. Following this congress,
the next congress, as scheduled, was held in Pretoria, South Africa in 2000. The last congress (6th) of AAPS was held on 1-5 September 2012
in Ismailia, Egypt. This was an historical congress because of many reasons and amongst these was the appointment of Anthony B. Ebeigbe,
Department of Physiology, University of Benin, Nigeria as its first Editor-in-Chief of its official journal, the Journal of the African association
of Physiological Sciences (JAAPS). He successfully published the first issue in June 2013, as mandated in Ismailia.
The World’s medicine has its initial root in Africa and in fact it was in Memphis, Egypt as early as 2700 BC. During the Ptulomaic period
the seat of medicine was in Alexandria, Egypt and Medical knowledge then spread to the Greeks 330 BC. Many western medical scientists
acknowledge learning medicine and anatomy form the Egyptian experts.
The University of Al Karaouine, in Fez, Morocco, Africa is considered the oldest continuously operating university in the world and has
been a center of learning for more than 1,000 years.
Medicine in Africa has been acknowledged by many authoritarians to be well developed, long before its development in Greece and other
European Countries. Almost every African country has medical and medical sciences societies and associations. According the WHO, African
journals online (AJOL) as the worlds largest collection of peer-reviewed journals. It is also believed that Africa will play a major role in
Sciences in the future, and in fact one of the Worlds leading palaeo-anthropologist was a South African.
© 2013 Elsevier Ireland Ltd. All rights reserved.

10]. Since then, metabolomics were analyzed: in plasma of pregnant women, urine of pregnant women and neonates, amniotic fluid, placenta, vaginal secretion, and cord blood in few studies. Different technologies have been adopted: nuclear magnetic resonance (NMR) spectroscopy, gas chromatographymass spectrometry (GC-MS), and liquid chromatography-mass spectrometry (LC-MS) [9].