A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology MMed(O&G) Johannesburg, April 2015 / Background Pre-eclampsia and its complications remain a significant cause of maternal and perinatal morbidity and mortality on a global level. There are few data regarding the maternal and fetal outcome of pre-eclampsia at term. Studies suggest that poor maternal outcome is more prevalent as one approaches term, while there are conflicting findings regarding the outcomes of the babies born to term pre-eclamptic patients. Objective To determine the prevalence of pre-eclampsia in term pregnancies at Rahima Moosa Mother and Child Hospital (RMMCH), a hospital that provides district and higher level referral services, and to assess the severity of maternal disease in pre-eclampsia at term, as well as fetal outcomes. Methods This was a prospective cross-sectional, descriptive study on women giving birth at term with pre-eclampsia. All women were followed up until delivery. The indication for and mode of delivery, maternal progress and complications, as well as fetal outcome, were recorded. Results Seventy-eight patients were entered into the study, giving a hospital prevalence rate of pre-eclampsia at term of 1.2%. The major maternal complications were those of severe hypertension (75.6%), eclampsia (9%), HELLP syndrome (3.8%), and pulmonary oedema (7.7%). There was one maternal death. Fifty-one patients (65%) delivered by caesarean section. Major fetal complications encountered were respiratory distress (7.5%) and birth asphyxia (3.7%). There was one neonatal death from meconium aspiration.

Made available in DSpace on 2014-07-02T12:58:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O organismo materno sofre intensas adaptações para o desenvolvimento adequado do feto. Entretanto, essas adaptações podem ocorrer de forma inadequada e predispor ao desenvolvimento de patologias na gravidez. Dentre estas destaca-se a pré-eclâmpsia, decorrente da má-adaptação circulatória, na qual observa-se expansão volumétrica inadequada. A água corporal total (ACT) está estritamente relacionada com o volume plasmático e a bioimpedância (BIA), como técnica indireta de avaliação das medidas de água corporal, pode ser utilizada para avaliar a variação gravídica do mesmo. A BIA fornece diretamente valores de resistência e reactância que avaliam indiretamente a composição dos compartimentos corporais. Esta avaliação pode ser método eficaz na determinação do grau de comprometimento do organismo materno pelo processo da pré-eclâmpsia, visto que a avaliação dos níveis de ACT durante a gravidez pode fornecer informações sobre a qualidade dessa adaptação. O presente estudo foi proposto com o objetivo de analisar os parâmetros diretos (resistência e reactância) e indiretos (água corporal total, intra e extracelular) da BIA, em gestantes portadoras de pré-eclâmpsia, comparando-os com os resultados obtidos em pacientes normais. Os dados foram ajustados para as covariáveis idade gestacional, idade materna e índice de massa corporal prégestacional. Foram analisadas as covariancias (ANCOVA) e aplicado o teste de Tuckey e para as variáveis independentes sem influencia das covariaveis foi aplicado o teste T. O valor de significância adotado foi de 5%. Avaliou-se 51 gestantes controle (grupo C) e 65 gestantes com pre-eclâmpsia (grupo PE) do HC-FMB- UNESP. O grupo PE apresentou menores valores de R (448Ω v 542 Ω ), Rc (40Ω v 53 Ω) e AIC (49,45% v 51%) quando comparados com o grupo C. O grupo PE apresentou maiores valores de ACT (49% v 47%) , ACTcor (41,6% v 34%), AEC (50% v 47%). Conclui-se que existem diferenças entre os grupos tanto para os parâmetros diretos, como para os indiretos. Embora os segundos sejam melhores para ilustrarem os processos fisio-patológicos, auxiliando na compreensão dos mecanismos envolvidos na pré-eclâmpsia, os primeiros, de mais fácil obtenção, foram suficientes e podem ser úteis na atenção a mulheres com alto risco de pré-eclâmpsia. / The maternal body undergoes significant adaptations to ensure adequate fetal development. However, inadequate adaptations play a leading role in the development of obstetrics disorders. Among these, the most important is preeclampsia, which may result from circulatory maladaptation. Nonetheless, total body water is closely related to plasma volume and bioimpedance (BIA), as an indirect method to measure body water, may be useful for the assessment of variations in plasma volume during pregnancy. BIA directly measures resistance and reactance values, which indirectly evaluate body compartments. Thus, this technique may effectively determine the level of maternal body involvement in preeclampsia, given that the measurement of total body water during pregnancy can provide information about the quality of this adaptation. This study aimed at comparing resistance, reactance, total body water, intra- and extracellular water between primigravidas diagnosed with preeclampsia and normal primigravidas at the third trimester of gestation. Outcome variables between groups were compared by ANCOVA with gestational age, maternal age and pre-gestational body mass index considered as confounding variables. Independent outcome variables between groups were compared by the t test of Student at a significance level of 0.05. Fifty-one control pregnant women (group C) and 65 pregnant women with preeclampsia (group PE) from Botucatu Medical School Hospital were submitted to the bioimpedance test (BIA). Data collected included resistance and reactance, total body water (TBW), pregnancy-corrected body water (TBWcor), extracellular water (ECW) and intracellular water (ICW). When compared to controls, PE values of resistance (448Ω v 542 Ω ) and reactance (40Ω v 53 Ω) were smaller; TBW (49% v 47%), TBWcor (41,6% 34%), ECW (50% v 47%) were higher; and ICW (49,45% v 51 %) was smaller. In conclusion, PE showed smaller resistance, reactance and ICW values and higher TBW, PBWcor and ECW. It can be concluded there are differences among the groups as to the direct parameters and also as to the indirect ones. Although the second ones were the best to illustrate the physiopathological process, helping in understanding the involved mechanisms of preeclampsia, the first ones, obtained in an easier way were enough and can be useful for care of the women with preeclampsia.

No description available.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Obstetrics & Gynaecology. Johannesburg, 2017. / Background and objectives Evidence supporting an association between HPV infection and pre-eclampsia has recently been published. Pre-eclampsia is a common, serious complication of pregnancy of complex aetiology that to date has not been fully described. Human papillomavirus (HPV) is a ubiquitous, DNA-virus with tropism for human mucosal commonly found in the female genital tract. Association between placental HPV infection and preterm labour and pregnancy loss has previously been described. This study tested the hypothesis that an association exists between HPV in the placenta or the cervix and clinical pre-eclampsia, or levels of its associated biomarkers, soluble fms-like tyrosine kinase (sFLT1) and placental growth factor (PlGF). Methods Women with pre-eclampsia were matched to healthy controls. All subjects were delivered by caesarean section, and cervical and placental samples were collected at the time of delivery. These samples were tested for HPV using a polymerase chain reaction (PCR) assay. Serum levels of soluble fms-like tyrosine kinase (sFLT1) and placental growth factor (PlGF) at the time of delivery were tested. Placental and cervical HPV was compared to the outcomes of clinical pre-eclampsia and serum sFLT1 and PlGF levels. Results and conclusion While clinically apparent disease was associated with increased levels of sFLT1 and decreased levels of PlGF, HPV was not detected in any of the placental specimens using the PCR assay. As a result, no association was found between placental HPV detection and clinically apparent pre-eclampsia or deranged serum levels of sFLT1 or PlGF. HPV was very common in cervical samples and showed a non-significant trend towards negative association with clinical pre-eclampsia and sFLT1, and a positive association with PlGF. This may be an effect of cervical HPV infection on the vascular endothelial growth factor (VEGF) signalling system that may explain its association with miscarriage. / LG2018

No description available.

No description available.

Thesis (Ph.D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept. of Physiology. Title from title-page of electronic thesis. Bibliography: leaves 118-146.

Resumo: O novo conceito de pré-eclâmpsia precoce e tardia estabeleceu a hipótese de que essas duas entidades possam estar associadas a diferentes modelos de adaptação vascular. A tonometria de aplanação é capaz de avaliar, de forma não invasiva, diversas características vasculares e pode ser utilizada para estudar a fisiopatologia das diferentes formas de pré-eclâmpsia. Comparar as características vasculares de gestantes portadoras de pré-eclâmpsia precoce e tardia, determinadas por meio da tonometria de aplanação. Estudo transversal e analítico realizado em 85 gestantes portadoras de pré-eclâmpsia (PE) que, no momento do diagnóstico, foram estratificadas em PE precoce e tardia, de acordo com a idade gestacional da manifestação clínica da doença. O cálculo do tamanho amostral foi baseado no estudo de Khalil et al. (2009) e estimado em 33 pacientes por grupo. Considerou-se o nível de significância de 5% (α = 0,05) e o poder de 80% (β = 0,20). Foram avaliadas a pressão arterial periférica e central, a pressão de pulso periférica e central, o índice de amplificação, a pressão de aumento, o índice de viabilidade subendocárdica e a duração de ejeção. Todos os índices foram determinados por meio da tonometria de aplanação (SphygmoCor®). A análise estatística foi feita no programa SPSS 10.5. As variáveis foram representadas por média e desvio padrão, mediana e porcentagem. A média foi utilizada para variáveis com distribuição normal e a mediana para variáveis que não apresentaram distribuição normal. Para a comparação das médias dos grupos pré-eclâmpsia precoce e tardia foi utilizado o teste t de Student e, quando necessário, o teste de Mann-Whitney. Para comparação das proporções foi utilizado o teste de qui-quadrado. Foi considerado nível de significância de 5%. Considerando-se as características da população estudada verificou-se... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The new concept of early and late preeclampsia established the hypothesis that these two entities may be associated with different models of vascular adaptation. The applanation tonometry is able to evaluate, noninvasively, several vascular features and can be used to study the pathophyology of different forms of preeclampsia. To compare vascular characteristics of pregnant women with early and late preeclampsia, determined by applanation tonometry. Cross sectional and analytical study conducted in 85 pregnant women with preeclampsia (PE) that, at the time of diagnosis, were stratified into early and late PE, according to the gestational age of the clinical manifestation of the disease. The calculation of the sample size was based on the study of Khalil et al. (2009) and estimated at 33 patients per group. It was considered the significance level of 5% (α = 0.05) and 80% power (β = 0.20). It was also evaluated the peripheral and central blood pressure, peripheral and central pulse pressure, augmentation index, the augmentation pressure, subendocardial viability ratio and the ejection duration. All indexes were determined by applanation tonometry (SphygmoCor ®). Statistical analysis were done using SPSS 10.5. Variables were presented as mean and standard deviation, median and percentage. The mean was used for variables with normal distribution and median for variables that did not show normal distribution. For the comparison of the mean in the group with early and late preeclampsia it was used a student t test and, when necessary, the Mann-Whitney test. To compare proportions it was used the qui-quadrado test. It was considered a significance level of 5%. Considering the characteristics of the population studied it was verified that body mass index, proteinuria and gestational age were significantly different between the groups. As for the vascular features determined by applanation... (Complete abstract click electronic access below) / Orientador: José Carlos Peraçoli / Coorientador: Vera Theresinha Medeiros Borges / Banca: Maria Letícia Sperandéo de Macedo Luminoso / Banca: Ricardo de Carvalho Cavalli / Mestre

There is currently no clinically useful screening test available to identify nulliparous women at high risk of developing pre-eclampsia. This study aimed to identify novel biomarkers using hypothesis generating proteomic methods applied to plasma samples obtained prior to clinical diagnosis of pre-eclampsia. Plasma samples taken at 15 weeks gestation from women who subsequently developed late pre-eclampsia (> 34 weeks), early pre-eclampsia (< 34 weeks) and two distinct groups of women with uncomplicated pregnancies (each n=12) were pooled. Pooled plasma was immunodepleted, labelled using iTRAQ-8 plex reagent and separated into fractions using high pH reverse phase chromatography. Fractions were analysed by LC-MS/MS and data interrogated using ProteinPilot 3.0. The merits of two immunodepletion systems were compared; the Seppro® IgY 14 -SuperMix LC column system removes up to 100 highly abundant plasma proteins and the Multiple Affinity Removal LC column depletes 14 highly abundant plasma proteins. Removal of more high abundance proteins allowed identification of more, potentially interesting, low abundance proteins, but was less reproducible than removing fewer proteins. Two methods of LC-MS/MS analysis were assessed; the QStar XL qTOF and 5800 MALDI-TOF-TOF. The protein identifications and the quantification data acquired by each method was comparable and complementary and increased the total number of proteins identified. A total of 502 proteins were identified. A stringent two stage analysis was developed to identify candidate proteins which changed in abundance in plasma from women who later developed pre-eclampsia compared to women with uncomplicated pregnancies. Analysis identified a total of 113 proteins which were both reproducibly quantified and changed by more than the expected range of biological variation. Six candidate proteins changed in abundance in the plasma taken from women who subsequently developed early pre-eclampsia were selected for further validation. A high throughput, low cost, method of multiple reaction monitoring which allows relative quantitation without the use of costly isotopically labelled peptides was developed to validate candidate proteins. Candidate proteins were also assessed by western blot and ELISA. Only one candidate protein; platelet basic protein, was validated by all three methods and demonstrated similar increases in the abundance. This investigation suggests that measurement of platelet basic protein at 15 weeks gestation is a novel candidate predictive marker for pre-eclampsia. Validation of platelet basic protein in a large, independent, sample set is required to confirm changes in protein expression and to evaluate potential, alongside other factors, to identify nulliparous women at high risk of developing pre-eclampsia later in pregnancy.

Made available in DSpace on 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-22Bitstream added on 2014-06-13T19:35:50Z : No. of bitstreams: 1 silva_eg_me_botfm.pdf: 504986 bytes, checksum: 7886cf3f829ed694ababaaa6122a9a77 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Gestantes com pré-eclâmpsia apresentam alterações nas vias aéreas superiores e no sistema cardiovascular quando comparadas com gestantes normais. O objetivo do presente estudo foi avaliar as pressões respiratórias máximas, a espirometria e a capacidade funcional de exercício em gestantes com pré-eclâmpsia, através de manovacuometria, espirometria e teste de caminhada de seis minutos. Foram avaliadas 74 gestantes, sendo 37 normais (controle) e 37 com pré-eclâmpisa, entre estas 16 com préeclâmpsia leve e 21 com pré-eclâmpsia grave. As pressões respiratórias máximas e a maioria das variáveis espirométricas foram semelhantes entre os grupos pré-eclâmpsia e controle, exceto o maior volume minuto [14 (12; 16) x 12 (10; 14)] e menor capacidade vital forçada [100 (97; 106) x 106 (98; 111)] verificados no grupo pré-eclâmpsia, quando comparado com o grupo controle, respectivamente. A capacidade funcional de exercício representada pela distância percorrida no teste de caminhada de seis minutos foi menor no grupo pré-eclâmpsia (421±59 m) quando comparado com o grupo controle (497± 39 m). A análise de regressão múltipla identificou a presença de pré-eclâmpsia e a capacidade vital forçada como preditores da distância percorrida no teste de caminhada de seis minutos (R2= 98,5%). Conclui-se que, a pré-eclâmpsia está associada com menor tolerância ao exercício, quando avaliada pelo teste de caminhada de seis minutos. Apenas dois parâmetros espirométricos, volume minuto e capacidade vital forçada, apresentaram alterações significativas no grupo com pré-eclâmpsia, sendo que a capacidade vital forçada influenciou no desempenho durante o exercício. A pré-eclâmpsia não interfere nas funções musculares respiratórias representadas pelas pressões inspiratória e expiratória máximas. / Pregnants with pre-eclampsia present upper airway and cardiovascular dysfunctions when compared with healthy pregnants. The aim of the current study was to assess maximal respiratory pressures, spirometry and functional exercise capacity in pregnants womem with pre-eclampsia, by evaluation of manovacuometer, spirometry and six-minute walk test. Seventy-four pregnants were evaluated, 37 healthy (control) and 37 with preeclampsia: 16 with mild and 21 with severe pre-eclampsia. Maximal respiratory pressures and most of spirometrics variables were similar between pre-eclampsia and control groups, exception the higher minute ventilation [14 (12;16) x 12 (10;14)] and the minimal forced vital capacity [100 (97;106) x 106 (98;111)] observed in pre-eclampsia compared with control group, respectively. Functional exercise capacity represented by the distance performed for the six-minute walk test, was lower in pre-eclampsia group (421±59 m) compared with control group (497± 39 m). Multiple regression analysis identified pre-eclampsia and forced vital capacity as predictors of distance performed on the six-minute walk test (R2= 98,5%). Therefore it was concluded that pre-eclampsia is associated with lower exercise tolerance when assessed by the six-minute walk test. Only two spirometrics variables presented significative alteration in pre-eclampsia group, minute ventilation and forced vital capacity which influenced the exercise performance. Pre-eclampsia does not interfere in respiratory muscle function, represented by the maximal inspiratory and expiratory pressures.