Endoglin is an auxiliary receptor for ligands of TGF-β receptor superfamily, present in endothelial cells and the placental syncytiotrophoblast. The expression of placental membrane endoglin (mEng) is further increased during preeclampsia, a pregnancy-specific hypertensive syndrome. We hypothesize that the soluble form of endoglin (sEng) released from the placenta leads to endothelial dysfunction and hypertension by disrupting normal BMP-9 signaling. We show that cell surface mEng inhibits TGF-β1, BMP-2, and BMP-7 induced Smad1,5,8 phosphorylation while potentiating BMP-9 induced signaling. sEng has been shown to be elevated in the sera of preeclamptic women and is postulated to interfere with endothelial cell function. We show that sEng binds to BMP-9 with a 2 nM affinity and can compete for its binding to endothelial cells, inhibiting downstream Smad1,5,8 phosphorylation. Our results suggest that sEng is contributing to endothelial dysfunction by dysregulating BMP-9 signaling.

Background: The incidence of Hypertensive Disorders in Pregnancy (HDP) is increasing in the US and is linked to serious long and short-term health problems for both mother and fetus. Vitamin D has been shown to have direct influence on molecular pathways involved in pregnancy. However a link between vitamin D status and HDP in Pregnant women has not been established. Objectives: The purpose of this study is to determine (1) the association between vitamin D deficiency and the occurrence of (HDP) and (2) whether non-Hispanic Black women (NHB) are at greater risk for HDP due to low vitamin D status. Methods: Pregnant females in the National Health and Nutrition Examination Survey (NHANES) study from 2001 to 2006 were used in this study. Participant’s response to interview questions and laboratory results were taken into account to determine HDP status. Logistic regression was used to determine the association between vitamin D status and HDP. Results: Pregnant women with low vitamin D status (25(OH)D < 20ng/ml) were 1.123 (95%CI: 0.808-1.56) times more likely to have HDP compared to women who were vitamin D sufficient. This association was not significant. NHB women did not show a significant increased risk for HDP. Conclusions: Low vitamin D status during pregnancy may lead to an increased risk for Hypertensive Disorders in Pregnancy. However more research on larger sample size is needed to determine the true extent of the association of vitamin D status with HDP in the general population and that of non-Hispanic Black women.

No description available.

Objetivo: Determinar el valor predictivo del sistema de calificación de Stamilio modificado para identificar Preeclampsia. Materiales y Métodos: Estudio retrospectivo, transversal, descriptivo en 53 puérperas seleccionadas por conveniencia con diagnóstico médico de Preeclampsia y mínimo con cuatro Controles Prenatales, realizado en el servicio de hospitalización en puérperas del Instituto Nacional Materno Perinatal entre los meses de octubre - noviembre 2006. Se analizó con estadística descriptiva e inferencial y para determinación del valor predictivo a través de la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo en cada semana de atención prenatal con el sistema de calificación. Resultados: La edad gestacional mínima al momento del diagnóstico de Preeclampsia fue 32 semanas. El 60.4% fueron primigestas. Las puérperas con diagnóstico de Preeclampsia obtuvieron presión arterial media >106 mmHg en los controles prenatales: 3ro, 4to, 5to, 7mo, 8vo; sin embargo, la media en ningún control prenatal fue >106 mmHg. En el sistema de calificación de Preeclampsia el 68% de las puérperas obtuvieron un puntaje ≥8. De estas los factores de riesgo estadísticamente significativas fueron edad materna, sobrepeso, y antecedentes familiares de Preeclampsia. El sistema fue válido a las 29 semanas que en el estudio correspondió al cuarto Control Prenatal con una sensibilidad (Se) del 50%, especificidad (Esp) 21%, valor predictivo positivo (VPP) 5% y valor predictivo negativo (VPN) 83%. Conclusión: El sistema de calificación de Preeclampsia tiene valor predictivo a las 29 semanas de gestación (Se: 50%, Esp: 21%, VPP: 5% y VPN: 83%). Palabras Claves: Valor Predictivo, Preeclampsia, Puérperas.

Objetivo: El objetivo del estudio fue determinar los resultados del manejo expectante de la preeclampsia severa en embarazos menores de 34 semanas. Material y métodos: Se realizó un estudio descriptivo, observacional, retrospectivo de corte transversal con 79 gestantes preeclámpticas severas entre las 23 – 34 semanas que recibieron manejo expectante durante el período comprendido entre el 01 de enero del 2002 y el 31 de diciembre de 2006,llevado a cabo en el Hospital Nacional Docente Madre Niño “San Bartolomé”,el análisis estadístico se realizó con el programa 14.0. Resultados: El antecedente personal más frecuente fue la preeclampsia (22,8%), mientras que el antecedente familiar más importante fue la hipertensión arterial (58,2%). Las complicaciones maternas más frecuentes en fueron la falla renal aguda (16,5%) y el síndrome HELLP (13,9%). La restricción de crecimiento intrauterino (81%) y la muerte intraparto (6,3%) fueron las principales complicaciones fetales, mientras que la asfixia neonatal (7,6%) fue la complicación neonatal más frecuente. Las indicación más frecuente para terminar el embarazo fue la preeclampsia refractaria al tratamiento (26,6%). En el 57% de casos el tiempo de prolongación del embarazo con el manejo expectante fue de 1 – 3 días. La vía del parto en el 89,9% fue por cesárea y el peso promedio de los recién nacidos estuvo comprendido entre los 1000 – 1499 gramos en el 31,6% de casos y en el 30,4% entre los 1500 – 1999 gramos.Resultados: Se concluyó que el manejo expectante de la preeclampsia severa entre las 23 – 34 semanas de gestación fue factible, debiendo realizarse en forma selectiva y en instituciones que garanticen una estricta vigilancia materno – fetal. Palabras Clave: Preeclampsia severa, manejo expectante, embarazo pretérmino.

Se trata de un estudio caso control , el cual tuvo como objetivo el determinar la relación que pudiera existir entre la infección urinaria ,el broncoespasmo y el intervalo intergenésico con el desarrollo de preeclampsia .Este estudio se realizó en el Instituto Especializado Materno Perinatal, entre los meses de agosto y noviembre del 2003, en donde se comparó 75 puérperas que tuvieron preeclampsia con 75 puérperas que no tuvieron la enfermedad, pareadas con respecto a la edad materna. Se analizó los factores potenciales asociados a preeclampsia usando la prueba de asociación Odd Ratio (OR), pruebas de diferencias de proporciones Chi cuadrada y pruebas de diferencia de medias “t student” . Resultados: La preeclampsia estuvo asociada a infección urinaria durante el embarazo con un OR : 5.4 (IC 95% 1.7 – 17.4) , constituyendo el principal factor asociado. La infección vaginal mostró también asociación a preeclampsia : OR: 4.6 (IC 95 % 1.3-14.0) . El intergenésico largo (>48 meses) estuvo asociado a preeclampsia con un OR: 4.6 (IC 95 % 1.4-15.3) . Conclusiones: El intervalo intergenésico largo y las infecciones ( urinaria y vaginal ) constituyen factores de riesgo para el desarrollo de preeclampsia. Las mujeres que tienen alguno de estos factores poseen un riesgo incrementado para que su embarazo sea complicado con preeclampsia. Palabras Claves: Preeclampsia / Hipertensión / Embarazo

Preeclampsia is associated with placental insufficiency and fetal growth restriction. Fetal growth restriction is associated with an increased risk for language deficits at 2-5 years of age. However, fetal auditory processing in pregnancies complicated by preeclampsia has not been examined and is the focus of this study. Spontaneous and auditory elicited fetal behaviours were compared in 40 mother-fetal pairs (n=20 preclamptic and n=20 low-risk normotensive pregnancies) from 33 to 39 weeks gestational age (GA). Spontaneous fetal heart rate, body and breathing movements and muscle tone were observed and an estimate of amniotic fluid was made. To test if the fetuses could hear, six 2.5s trials (3, 110 dB pink noise; 3, no-sound control) were intermixed and randomly presented; fetal heart rate was recorded for 30 s following trial onset and body movements were observed for 5 s. Finally, the mother’s voice recorded reading a children’s story was presented: 2 min of no sound, 2 min of mother’s voice (95 dB A) and 2 min of no sound. Sounds were delivered through a speaker 10cm above the abdomen. During the 6 min procedure, fetal heart rate was recorded continuously and body movements were video recorded. Fetuses in the preeclamptic group were born earlier, t(37)=4.79, p<0.000. There were no differences in birth weight at delivery. Testing showed no differences between groups for any measure of spontaneous behaviour. There was increased heart rate, F(1,36)=37.47, p<0.001, and number of body movements, F(1, 35)=54.04, p<0.001, in response to the pink noise compared no-sound control trials, indicating that both groups could hear external sounds. No differences in fetal heart rate or body movement responses to the playing of the mother’s voice were found between the two groups; although, there was a suggestion that gestational age affected responding. There were no differences found in spontaneous behaviours or auditory processing behaviours in fetuses of pregnancies complicated by mild to moderate preeclampsia compared to those in low-risk, normotensive pregnancies. It is suggested that future studies examining fetal auditory processing in preeclamptic pregnancies employ sufficient sample size for analyses by gestational age at time of testing. / Thesis (Master, Nursing) -- Queen's University, 2008-09-26 11:06:27.498

Preeclampsia is a complex, baffling and unpredictable syndrome. The condition affects the lives of approximately one in every twenty pregnant women. Most cases are mild but some are serious enough to threaten the life of mother and baby. Medical research has yet to identify a cause, and the search for a cure continues. Delivery remains the only method of resolving this dangerous complication of pregnancy and may need to be effected before the foetus has become mature enough to avoid the risks associated with preterm birth. Women's experience of preeclampsia has received little attention in midwifery and obstetric literature. This hermeneutic phenomenological study has been designed to answer the question "What is women's experience with preeclampsia before 34 weeks of gestation?" Eight women who had experienced severe preeclampsia were interviewed. Their narratives are analyzed to uncover the meaning of the lived experience of preeclampsia from diagnosis to postpartum recovery. Three data chapters reveal some of the ways that preeclampsia reveals itself as the disease progresses. The findings of this study indicate that there are many atypical presentations of preeclampsia and that sometimes early "showing" goes unrecognized. The woman may in fact feel better as the disease progresses. Late diagnosis leaves the woman and her family shocked and may compromise foetal and maternal safety. Having preeclampsia changes the reality of pregnancy and early parenting for a woman. Emotional consequences are significant and include an increased risk of post-traumatic stress disorder. The unpredictable manner in which preeclampsia first "shows itself" is analyzed in the first data chapter and the following two chapters explore the way in which a woman's life may be thrown out of control by diagnosis and management of the disease. Paradoxically, women with severe preeclampsia often lose continuity of care with their midwife at a time when they most need the support of a familiar and trusted professional. Provision of continuity creates a challenge for the midwife when the woman's care is taken over by secondary services. Innovative ideas to enhance the safety and holistic quality of care for women with preeclampsia are discussed.

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archives@tulane.edu / Placental insufficiency is a term used to describe the reduced transport of gases and nutrients across the placenta. As a result of placental insufficiency, preeclampsia and intrauterine growth restriction (IUGR) can develop. Preeclampsia is diagnosed by the onset of high blood pressure and proteinuria after 20 weeks of gestation and complicates 2-8% of all pregnancies. Having preeclampsia is also a risk-factor for developing IUGR, which is defined as an estimated fetal weight below the 10th percentile. These conditions can negatively impact the immediate outcomes of pregnancy by reducing placental perfusion and causing placental ischemia. Currently, there is a need for reliable, inexpensive tools that can monitor placental function bedside. Spectral photoacoustic (PA) imaging presents a solution to this need. Photoacoustic imaging uses nanosecond light pulses to excite photoabsorbers within tissue. These photoabsorbers undergo thermal expansion and relaxation, emitting a pressure wave that can then be read by an ultrasound transducer. In this study, the photoabsorbers of interest include hemoglobin, deoxyhemoglobin, and indocyanine green (ICG). Various ultrasound contrast agents are available for clinical use; however, indocyanine green-loaded nanodroplets present various advantages over other contrast agents due to their smaller size and longer in vivo stability. Upon laser irradiation, these droplets experience a liquid-to-gas phase change and provide improved photoacoustic contrast. These nanodroplets are a focus of this work, as they have the ability to be targeted to specific tissues and can act as oxygen carriers. In this case, they are targeted to folate receptor α, which is highly expressed on the placenta. Thus, the first aim of this work is to validate the folate receptor α targeting mechanism using an in vitro tissue phantom model. As oxygen carriers, they are able to release oxygen once activated by the laser. The second aim is to validate localized oxygen delivery via these nanodroplets by using multiplex imaging to determine ICG accumulation and measure their effect on placental oxygen saturation in vivo. Another contrast agent, 2-Deoxy-D-Glucose (2DG-ICG), could be utilized in conjunction with photoacoustic imaging as a tool to monitor glucose transport, a major indicator of placental function. By conjugating ICG to 2DG, a glucose analog, it is possible to target glucose transporter 1, which is the primary glucose transporter on the placenta. The final aim of this work is to determine the feasibility of using 2DG-ICG as an indicator of glucose transport in the placenta using an in vitro model. / 1 / Sarah Nwia