Latest & greatest articles for preeclampsia

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Top results for preeclampsia

141. Circulating angiogenic factors and the risk of preeclampsia. Full Text available with Trip Pro

Circulating angiogenic factors and the risk of preeclampsia. The cause of preeclampsia remains unclear. Limited data suggest that excess circulating soluble fms-like tyrosine kinase 1 (sFlt-1), which binds placental growth factor (PlGF) and vascular endothelial growth factor (VEGF), may have a pathogenic role.We performed a nested case-control study within the Calcium for Preeclampsia Prevention trial, which involved healthy nulliparous women. Each woman with preeclampsia was matched to one (...) . These changes occurred earlier and were more pronounced in the women in whom preeclampsia later developed. The sFlt-1 level increased beginning approximately five weeks before the onset of preeclampsia. At the onset of clinical disease, the mean serum level in the women with preeclampsia was 4382 pg per milliliter, as compared with 1643 pg per milliliter in controls with fetuses of similar gestational age (P<0.001). The PlGF levels were significantly lower in the women who later had preeclampsia than

2004 NEJM

142. Antiplatelet agents for preventing pre-eclampsia and its complications. (Abstract)

Antiplatelet agents for preventing pre-eclampsia and its complications. Pre-eclampsia is associated with deficient intravascular production of prostacyclin, a vasodilator, and excessive production of thromboxane, a platelet-derived vasoconstrictor and stimulant of platelet aggregation. These observations led to the hypotheses that antiplatelet agents, low-dose aspirin in particular, might prevent or delay the development of pre-eclampsia.To assess the effectiveness and safety of antiplatelet (...) pregnancy. Quasi-random study designs were excluded. Participants were pregnant women considered to be at risk of developing pre-eclampsia. Interventions were any comparisons of an antiplatelet agent (such as low-dose aspirin or dipyridamole) with either placebo or no antiplatelet agent.Two reviewers assessed trials for inclusion in the review and extracted data. We entered data into the Review Manager software and double checked.Fifty-one trials involving 36,500 women are included in this review

2004 Cochrane

143. Endothelial dysfunction and raised plasma concentrations of asymmetric dimethylarginine in pregnant women who subsequently develop pre-eclampsia. (Abstract)

Endothelial dysfunction and raised plasma concentrations of asymmetric dimethylarginine in pregnant women who subsequently develop pre-eclampsia. Maternal endothelial dysfunction is a feature of established pre-eclampsia but whether this is a cause or consequence of the disorder is not clear. We tested the hypothesis that endothelial dysfunction and raised plasma concentrations of asymmetric dimethylarginine (ADMA), the endogenous inhibitor of endothelial nitric oxide synthase, precede (...) (33%) developed intrauterine growth restriction of the fetus (IUGR), and pre-eclampsia arose in ten (23%). Women who developed pre-eclampsia had significantly lower flow-mediated dilation than did women who had normal outcome (3.58% [SD 2.76] vs 8.59% [2.76]; p<0.0001). Irrespective of pregnancy outcome, women with evidence of impaired placental perfusion had significantly higher levels of ADMA than did women with normal doppler waveforms (2.4 micromol/L [IQR 1.97-3.14] vs 0.81 micromol/L [0.49

2003 Lancet

144. Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review

Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review Coomarasamy A, Honest H, Papaioannou S, Gee H, Khan K S CRD summary This review examined the effectiveness of aspirin in preventing perinatal death and pre-eclampsia in women with predisposing factors (...) . The authors concluded that aspirin can reduce the risk of pre-eclampsia and perinatal death in women who have known historical risk factors. Statements on the safety of aspirin were derived largely from observational studies, which were not part of the current systematic review. Authors' objectives To examine the effectiveness of aspirin in preventing perinatal death and pre-eclampsia in women with predisposing factors. Searching MEDLINE (from 1966 to 2001), EMBASE (from 1980 to 2001), the Cochrane

2003 DARE.

145. Pre-eclampsia and expression of heparin-binding EGF-like growth factor. (Abstract)

Pre-eclampsia and expression of heparin-binding EGF-like growth factor. Pre-eclampsia is a disorder of pregnancy associated with poor extravillous cytotrophoblast invasion and above-normal rates of apoptosis in the trophoblast. Heparin-binding epidermal-growth-factor-like growth factor (HB-EGF) has strong cytoprotective activity and is an important signalling protein that regulates trophoblast invasion during early placentation. We aimed to establish whether HB-EGF expression is altered (...) in placentae from women who delivered preterm. Similar levels of HB-EGF protein were found in the placentae of women who were not in labour. HB-EGF expression was reduced about five-fold (p=0.0001) in pre-eclamptic pregnancies. Fetal growth retardation, which has been linked with shallow trophoblast invasion and moderate apoptosis, was associated with placentae expressing intermediate levels of HB-EGF.In pre-eclampsia, deficient HB-EGF signalling during placental development could impair trophoblast

2002 Lancet

146. Pre-eclampsia, antiretroviral therapy, and immune reconstitution. (Abstract)

Pre-eclampsia, antiretroviral therapy, and immune reconstitution. Antiretrovirals are standard treatment for HIV-1-positive women during pregnancy in the UK, but little is known about maternal or fetal safety. In our cohort study of 214 pregnant women with HIV-1 infection, those who received no antiretroviral therapy had a rate of pre-eclampsia significantly lower (none of 61) than those on triple antiretroviral therapy (8 of 76; odds ratio 15.3, 95% CI 0.9-270, p=0.0087). However, the rate (...) of pre-eclampsia in HIV-1-positive women on treatment did not differ from that in uninfected controls (12 of 214; p=0.2). The association of HIV-1-related immune deficiency with a low rate of pre-eclampsia, and the restoration of this rate in women treated with triple antiretroviral therapy to the expected rate indicates a pivotal role of the immune system in the pathogenesis of pre-eclampsia. The clinical presentation of pre-eclampsia and toxic effects of antiretroviral therapy could overlap

2002 Lancet

147. Surgically obtained sperm, and risk of gestational hypertension and pre-eclampsia. (Abstract)

Surgically obtained sperm, and risk of gestational hypertension and pre-eclampsia. The cause of pre-eclampsia is unknown, although a partner-specific immune maladaptation might be involved. We compared rates of pre-eclampsia and gestational hypertension in women whose genital tracts had and had not been exposed to their partner's sperm cells. Our aim was to ascertain whether or not protective partner-specific immune-tolerance is conveyed by sperm cells, rather than seminal fluid. Our findings (...) indicate that, compared with women exposed to their partner's sperm cells and seminal fluid--ie, those treated with in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) with ejaculated sperm--the risk of hypertension was doubled and the risk of pre-eclampsia tripled in those never exposed to their partner's sperm--ie, those treated with ICSI done with surgically obtained sperm.

2002 Lancet

148. The interval between pregnancies and the risk of preeclampsia. (Abstract)

The interval between pregnancies and the risk of preeclampsia. The risk of preeclampsia is generally lower in second pregnancies than in first pregnancies, but not if the mother has a new partner for the second pregnancy. One explanation is that the risk is reduced with repeated maternal exposure and adaptation to specific antigens from the same partner. However, the difference in risk might instead be explained by the interval between births. A longer interbirth interval may be associated (...) . The risk in a second or third pregnancy was directly related to the time that had elapsed since the preceding delivery, and when the interbirth interval was 10 years or more, the risk approximated that among nulliparous women. After adjustment for the presence or absence of a change of partner, maternal age, and year of delivery, the odds ratio for preeclampsia for each one-year increase in the interbirth interval was 1.12 (95 percent confidence interval, 1.11 to 1.13). In unadjusted analyses

2002 NEJM

149. Interventionist versus expectant care for severe pre-eclampsia before term. (Abstract)

Interventionist versus expectant care for severe pre-eclampsia before term. Severe pre-eclampsia can cause significant mortality and morbidity for both mother and child, particularly when it occurs well before term. The only known cure for this disease is delivery. Some obstetricians advocate early delivery to prevent the development of serious maternal complications, such as eclampsia (fits) and kidney failure. Others prefer a more expectant approach in an attempt to delay delivery (...) less likely to be small for gestational age (RR 0.36, 95% CI 0.14 to 0.90). There were no statistically significant differences between the two strategies for any other outcomes.There are insufficient data for any reliable recommendation about which policy of care should be used for women with severe early onset pre-eclampsia. Further large trials are needed.

2002 Cochrane

150. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. (Abstract)

Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Anticonvulsants are used for pre-eclampsia in the belief they prevent eclamptic convulsions, and so improve outcome. Evidence supported magnesium sulphate as the drug to evaluate.Eligible women (n=10141) had not given birth or were 24 h or less postpartum; blood pressure of 140/90 mm Hg or more, and proteinuria of 1+ (30 mg/dL) or more; and there was clinical (...) uncertainty about magnesium sulphate. Women were randomised in 33 countries to either magnesium sulphate (n=5071) or placebo (n=5070). Primary outcomes were eclampsia and, for women randomised before delivery, death of the baby. Follow up was until discharge from hospital after delivery. Analyses were by intention to treat.Follow-up data were available for 10,110 (99.7%) women, 9992 (99%) of whom received the allocated treatment. 1201 of 4999 (24%) women given magnesium sulphate reported side-effects

2002 Lancet Controlled trial quality: predicted high

151. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. Full Text available with Trip Pro

Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. To assess whether mothers and fathers have a higher long term risk of death, particularly from cardiovascular disease and cancer, after the mother has had pre-eclampsia.Population based cohort study of registry data.Mothers and fathers of all 626 272 births that were the mothers' first deliveries, recorded in the Norwegian medical birth registry from 1967 to 1992. Parents were divided into two cohorts (...) based on whether the mother had pre-eclampsia during the pregnancy. Subjects were also stratified by whether the birth was term or preterm, given that pre-eclampsia might be more severe in preterm pregnancies.Total mortality and mortality from cardiovascular causes, cancer, and stroke from 1967 to 1992, from data from the Norwegian registry of causes of death.Women who had pre-eclampsia had a 1.2-fold higher long term risk of death (95% confidence interval 1.02 to 1.37) than women who did not have

2001 BMJ

152. Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis

Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Coomarasamy A, Papaioannou S, Gee H, Khan K S Authors' objectives To assess the effect of aspirin in preventing pre-eclampsia in women identified as being at high risk (...) developing proteinuric hypertension (pre-eclampsia) and the difference in birth weight. The secondary outcomes were non-proteinuric hypertension, small for gestational age (any definition), gestational age at delivery, and foetal or maternal complications. How were decisions on the relevance of primary studies made? Two authors independently reviewed the citations for relevance. Those citations deemed definitely or possibly relevant were retrieved in full and two authors then independently assessed

2001 DARE.

153. Abdominal decompression for suspected fetal compromise/pre-eclampsia. (Abstract)

Abdominal decompression for suspected fetal compromise/pre-eclampsia. Abdominal decompression was developed as a means of pain relief during labour. It has also been used for complications of pregnancy, and in healthy pregnant women in an attempt to improve fetal wellbeing and intellectual development.The objective of this review was to assess the effects of antenatal abdominal decompression for maternal hypertension or impaired fetal growth, on perinatal outcome.The Cochrane Pregnancy (...) and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: February 1998.Randomised or quasi-randomised trials comparing abdominal decompression with no decompression in women with pre-eclampsia and/or fetuses thought to be compromised.Eligibility and trial quality were assessed by one reviewer.Three studies were included, all with the possibility of containing serious bias. Therapeutic abdominal decompression was associated with the following

2000 Cochrane

154. Anticonvulsants for women with pre-eclampsia. (Abstract)

Anticonvulsants for women with pre-eclampsia. Pre-eclampsia is a relatively common complication of pregnancy. Anticonvulsants are used in the belief they help prevent eclamptic fits and subsequent poor outcomes for mother and infant.The objective of this review was to assess the effects of anticonvulsants for women with pre-eclampsia on the women and their children.We searched the Cochrane Pregnancy and Childbirth Group trials register, and the Cochrane Controlled Trials Register, 1999 Issue 3 (...) .Randomised trials comparing anticonvulsants with placebo or no anticonvulsants or comparisons of different anticonvulsants in women with pre-eclampsia.Trial quality was assessed and data were extracted independently by two reviewers.Nine studies were included. Comparing magnesium sulphate with placebo/no anticonvulsant the relative risk (RR) of eclampsia was 0.33, 95% confidence interval (CI) 0.11 to 1.02. There was no significant difference detected in the risk of caesarean section (RR 1.04, 95% CI 0.92

2000 Cochrane

155. Antiplatelet agents for preventing and treating pre-eclampsia. (Abstract)

Antiplatelet agents for preventing and treating pre-eclampsia. Pre-eclampsia is associated with deficient intravascular production of prostacyclin, a vasodilator, and excessive production of thromboxane, a platelet-derived vasoconstrictor and stimulant of platelet aggregation. These observations led to the hypotheses that antiplatelet agents, and low dose aspirin in particular, might prevent or delay the development of pre-eclampsia.To assess the effectiveness and safety of antiplatelet agents (...) when given to women at risk of developing pre-eclampsia, and to those with established pre-eclampsia.This review drew on the search strategy developed for the Pregnancy and Childbirth Group as a whole. The Cochrane Controlled Trials Register was also searched, The Cochrane Library 1999 Issue 1, Embase was searched from 1994-1999 and hand searches were performed of the congress proceedings of the International and European Societies for the Study of Hypertension in Pregnancy.All randomised trials

2000 Cochrane

156. Plasma volume expansion for treatment of women with pre-eclampsia. (Abstract)

Plasma volume expansion for treatment of women with pre-eclampsia. Plasma volume is reduced amongst women with pre-eclampsia. This association has led to the suggestion that expanding the plasma volume might improve maternal and uteroplacental circulation, and so potentially improve outcome for both the woman and her baby.The aim of this review was to assess the effects of plasma volume expansion for the treatment of women with pre-eclampsia.The register of trials maintained by the Cochrane (...) independently by two reviewers. Discrepancies were resolved by discussion. There was no blinding of authorship or results.Three trials involving 61 women were included in this review. All compared a colloid solution with no plasma volume expansion. For every outcome reported, the confidence intervals are very wide and cross the no effect line.There is insufficient evidence for any reliable estimates of the effects of plasma volume expansion for women with pre-eclampsia.

2000 Cochrane

157. Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial. (Abstract)

Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial. Oxidative stress has been implicated in the pathophysiology of pre-eclampsia. This randomised controlled trial investigated the effect of supplementation with vitamins C and E in women at increased risk of the disorder on plasma markers of vascular endothelial activation and placental insufficiency and the occurrence of pre-eclampsia.283 women were identified as being at increased risk (...) of pre-eclampsia by abnormal two-stage uterine-artery doppler analysis or a previous history of the disorder and were randomly assigned vitamin C (1000 mg/day) and vitamin E (400 IU/day) or placebo at 16-22 weeks' gestation. Plasma markers of endothelial activation (plasminogen-activator inhibitor 1 [PAI-1]) and placental dysfunction (PAI-2) were measured every month until delivery. Pre-eclampsia was assessed by the development of proteinuric hypertension. Analyses were done by intention to treat

1999 Lancet Controlled trial quality: predicted high

158. Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. (Abstract)

Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Whether low-dose aspirin prevents preeclampsia is unclear. It is not recommended as prophylaxis in women at low risk for preeclampsia but may reduce the incidence of the disease in women at high risk.We conducted a double-blind, randomized, placebo-controlled trial in four groups of pregnant women at high risk for preeclampsia (...) , including 471 women with pregestational insulin-treated diabetes mellitus, 774 women with chronic hypertension, 688 women with multifetal gestations, and 606 women who had had preeclampsia during a previous pregnancy. The women were enrolled between gestational weeks 13 and 26 and received either 60 mg of aspirin or placebo daily.Outcome data were obtained on all but 36 of the 2539 women who entered the study. The incidence of preeclampsia was similar in the 1254 women in the aspirin group and the 1249

1998 NEJM Controlled trial quality: predicted high

159. Magnesium sulfate therapy in preeclampsia and eclampsia

Magnesium sulfate therapy in preeclampsia and eclampsia Magnesium sulfate therapy in preeclampsia and eclampsia Magnesium sulfate therapy in preeclampsia and eclampsia Witlin A G, Sibai B M Authors' objectives To review the available evidence regarding efficacy, benefits and risks of magnesium sulphate seizure prophylaxis in women with pre-eclampsia or eclampsia. Searching MEDLINE (1966 to February, 1998). The search terms are given. Bibliographies of retrieved articles were scanned and experts (...) included in the review Women with pre-eclampsia or eclampsia and hypertensive disorders of pregnancy. Outcomes assessed in the review Incidence of seizures or recurrent seizures. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection. Assessment of study quality Studies were assessed in terms of the U.S. Preventive Services Task Force levels of evidence (Fisher, 1989

1998 DARE.

160. Randomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia. (Abstract)

Randomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia. Pre-eclampsia is associated with extensive endothelial-cell damage and platelet activation, resulting in lower production of vasodilator prostaglandins and increased release of the vasoconstrictors thromboxane A2 and serotonin. Damage to endothelial-cell serotonin-1 receptors leaves vasoconstriction and platelet aggregation mediated by serotonin-2 receptors unopposed. We investigated the role of ketanserin (...) , a selective serotonin-2-receptor antagonist, in lowering the rate of pre-eclampsia among pregnant women with mild to moderate hypertension.We recruited 138 pregnant women into a double-blind, randomised, placebo-controlled trial. They had diastolic blood pressure persistently more than 80 mm Hg before 20 weeks' gestation. 69 women received ketanserin and 69 received placebo. Both groups also received aspirin. Patients were initially given two tablets daily, increased to four tablets daily in diastolic

1997 Lancet Controlled trial quality: predicted high