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Preeclampsia is a pregnancy-specific condition of increased blood pressure accompanied by proteinuria, edema, or both. The incidence of preeclampsia has been reported as ranging from 2.5% to 7%. Risk factors for the development of preeclampsia include young maternal age, previous preeclampsia, twin pregnancy, chronic hypertension, diabetes mellitus, and hydatidiform mole. Vasospasm is considered central to the pathologic changes of preeclampsia, and the data suggest that this process is triggered by an imbalance between prostacyclin (prostaglandin I2) and thromboxane Ax, biologically active metabolites of arachidonic acid. Preeclampsia has a wide clinical spectrum ranging from mild to severe forms and, potentially, eclampsia with symptoms occurring primarily with severe disease. Preventive strategies under investigation include calcium supplementation and low-dose aspirin supplementation. Prenatal screening, monitoring, and management of preeclampsia are presented.
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PMID:Preeclampsia. 837 57

Diabetes mellitus (or type 1) is a long-lasting disease (even twenty years or more) which causes kidney disease and, in the event of pregnancy, it can make differential diagnostic difficult even fort the most expert clinician. Metabolic changes caused by this type of diabetes (e.g., hypoglycemia, hyperglycemia, ketoacidosis) and their difficult compensation can often lead to the onset of eclampsia or convulsion. The diagnostic suspicion of diabetes is supported by the finding of proteinuria, edema and hypertension that are strictly correlated with the evolution of diabetic disease and sometimes exist prior to pregnancy. This cas report focuses on the diagnostic importance of clotting tests, especially in clarifying diagnostic doubts.
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PMID:[Diabetic nephropathy and pregnancy]. 854 41

The pregnancy complication characterized by proteinuric hypertension is called preeclampsia. Preeclampsia, an important cause of maternal and perinatal death, has an onset and progression impossible to predict. Termination of pregnancy is the only cure of preeclampsia. It is indicated when the fetus can survive outside the uterus or when the maternal condition deteriorates to such a condition that continuation would bring greater harm to the mother. The etiology of preeclampsia is unknown. Preeclampsia appears to be linked to abnormal trophoblastic implantation. In normal pregnancies, implantation effects changes in the spiral arteries that supply the intervillous space and fibrin-containing trophoblast, and amorphous matrix replace the endothelium and the internal elastic lamina. These changes do not occur or are limited in pre-eclamptic women. There appears to be a familial tendency to preeclampsia. Impaired formation of blocking antibodies to antigenic sites on the placenta increases the risk of pre-eclampsia. Risk factors are primigravidity, short duration of sexual cohabitation before conception, abundance of trophoblastic tissue (e.g., multifetal and molar pregnancies), and underlying vascular disease as in diabetes. Poor placental perfusion may account for the increase in maternal blood pressure. Preeclampsia can lead to eclampsia, cerebral hemorrhage, coagulopathy, and death. Poor utero-placental circulation retards fetal growth and causes fetal distress and maybe even perinatal death. When the diastolic blood pressure is higher than 110 mmHg, pre-eclamptic women should be administered antihypertensive drugs (e.g., methyldopa, beta-blockers, calcium channel blockers, hydralazine, labetatol, or diazoxide) to prevent maternal complications, but these drugs do not improve utero-placental blood flow nor do they prevent proteinuria. Diuretics should not be administered. Proteinuria indicates that the kidneys have been affected. A large randomized trial shows that aspirin does not effectively prevent preeclampsia. Routine calcium supplementation does appear to prevent it and preterm delivery.
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PMID:Pre-eclampsia. 875 7

The disparate results reported in the literature on the effects of low dose aspirin in preventing pre-eclampsia might be caused by non-compliance in the more recent large trials in low-risk patients. All the earlier small trials were done on identified high-risk patients who consider themselves as patients, as do their doctors. Compliance in these patients will be very high. In fact, the only study in healthy subjects in which aspirin intake was controlled for (Hauth et al 1993) showed a marked reduction in the incidence of pre-eclampsia. However, the recent large trials have demonstrated, without any doubt, that low dose aspirin is not a miracle drug. The combined literature points at a 25% reduction in the incidence of pre-eclampsia in association with the use of aspirin (Collins, 1994). The correct indication for the use of low-dose aspirin appears to be the patient that is at very high risk of developing early-onset (less than 32 weeks gestation) pre-eclampsia. Since early-onset pre-eclampsia can begin at any time after 20 weeks gestation, it is necessary to initiate low-dose aspirin therapy early in pregnancy, preferably at 10-14 weeks gestation. The results of the recent large trials emphasize the need for a reliable, sensitive method of predicting or detecting pre-eclampsia at a very early gestational age (Dekker and Sibai, 1991). Valensise et al (1993) recently confirmed earlier studies (McParland et al, 1990) on the useful combination of uteroplacental Doppler flow velocimetry and aspirin in low-risk primigravidae. Results from current large-scale trials, such as the ECPPA, the BLASP, the WHO Jamaica and the second NICHHD studies, will be available in the near future. The results of especially the second NICHHD study on low-dose aspirin, in more than 2000 high-risk women (previous pre-eclampsia/eclampsia, chronic hypertension, class B to F diabetes or multiple gestation), will hopefully give us a more definitive picture on the potential benificial effects of low-dose aspirin in high-risk patients. The effect of aspirin on placental TXA2 deserves further studies. It might be that the optimal level to inhibit placental TXA2 and lipid peroxide production is actually higher than the minimal effective doses of aspirin that are needed to inhibit platelet TXA2 production (Walsh, 1994). Low-dose aspirin appears to be safe for the fetus and neonate. If there is an increased risk of abruptio placentae, this risk appears to be minimal. The final word on the use of low-dose aspirin has not yet been reached; however, we may be getting closer to profiling patients for whom the therapy may be efficacious and beneficial to both mother and fetus. Further studies are also necessary on combinations of aspirin and other antithrombotic drugs, such as heparin or ketanserin (Tanaka et al, 1993; Bolte et al, 1994; North et al, 1994). North et al (1994) demonstrated that treatment of women with severe renal disease with heparin plus aspirin reduced the prevalence of superimposed pre-eclampsia, compared with no treatment or aspirin alone. Next to low-dose aspirin, there appear to be several new and promising pharmaceutical approaches for reducing the consequences of EC dysfunction. Among these are selective TXA2-synthetase or TXA2-receptor antagonists, Serotonin2-receptor blockers, stable PGI2 analogues and NO donors.
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PMID:The pharmacological prevention of pre-eclampsia. 884 53

The purpose of this study is to examine the correctness of the clinical data from the computerized perinatal database (PC-Log) at a Mayo Health System hospital. This computerized database is used for electronic transmission of birth certificates in Wisconsin. The paper medical record is chosen for the comparison. Random selection of 99 charts from a total of 893 births at a tertiary perinatal center during 1995. Of 310 fields in the database, 32 variables were compared to a hand abstraction of the paper medical record. PC-Log had 100% positive-predictive value (PPV) for eclampsia, prolonged rupture of membranes, pre-existing diabetes, cesarean section, and transports. The sensitivity, specificity, and PPV for other variables (abortion, congenital anomalies, gestational diabetes, maternal hypertension, and maternal employment) showed moderate to high agreement, but was poor for maternal ethanol use during pregnancy. Compared to hand abstraction, PC-Log had no recorded cases of substance abuse, antenatal steroids, hyaline membrane disease, circumcision, maternal and infant length of stay. Means for birth weight 5 minute Apgar scores did not differ, and the correlations were r = 0.982 and r = 0.960. The PC-Log showed good agreement for many but not all the variables of clinical interest.
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PMID:The computerized perinatal database: are the data reliable? 975 14

We examined the underlying causes of fetal deaths reported for 1993 through 1995 in relation to the mother's ethnicity, reproductive history, and medical factors listed on birth and fetal death certificates. The overall fetal mortality rate (FMR) was 6.3 per 1000 live births plus fetal deaths, and 5.6, 5.9, and 9.8 per 1000, respectively in pregnancies of white, hispanic, and black women. Preterm birth (low birth weight) was a major predictor (or consequence) of fetal death, and extremes of maternal age, increased parity, and plural pregnancies were also associated with increased FMRs, especially in black women. The underlying causes reported on fetal death certificates were complications of the placenta, cord, and membranes (36%); ill-defined conditions arising in the perinatal period (23%); fetus affected by maternal complications of pregnancy (10%); fetus affected by maternal conditions unrelated to pregnancy (6%); and short gestation and unspecified low birth weight (5%); 14% of fetal deaths were associated with congenital abnormalities. Factors reported most frequently were premature rupture of the membranes, disorders of amniotic fluid volume, pregnancy-associated hypertension, diabetes, anemia, previous preterm or small-for-gestational-age births, incompetent cervix, chronic hypertension, and sexually transmitted diseases. More than 40% of fetal deaths were not associated with any medical risk factor. FMRs associated with maternal anemia, cardiac disease, pregnancy-associated hypertension, eclampsia, and previous birth weighing more than 4 kg were at least 1.5 times higher in pregnancies of black women than in the other 2 ethnic groups. The underlying causes of fetal death provide few targets for their primary prevention; preventive efforts might better be directed to the closer surveillance and care of pregnant women with demographic, reproductive, and medical factors associated with increased risk.
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PMID:Factors associated with fetal mortality in the triethnic population in texas, 1993 through 1995. 1062 8

There is an increased interest in the role of magnesium ions in clinical medicine, nutrition and physiology. The characteristics of the binding of magnesium and calcium ions to various components, macromolecules and biological membranes are described. Magnesium affects many cellular functions, including transport of potassium and calcium ions, and modulates signal transduction, energy metabolism and cell proliferation. The mechanism of cellular uptake and efflux of magnesium, its intracellular transport, intestinal absorption, renal excretion and the effect of hormones on these are reviewed. Magnesium deficiency is not uncommon among the general population: its intake has decreased over the years especially in the western world. The magnesium supplementation or intravenous infusion may be beneficial in various diseased states. Of special interest is the magnesium status in alcoholism, eclampsia, hypertension, atherosclerosis, cardiac diseases, diabetes, and asthma. The development of instrumentation for the assay of ionized magnesium is reviewed, as are the analytical procedures for total magnesium in blood and free magnesium in the cytosol. The improved procedures for the assay of different magnesium states are useful in understanding the role of magnesium in health and disease.
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PMID:Magnesium. An update on physiological, clinical and analytical aspects. 1072 69

Magnesium is the second most abundant cation in intracellular fluid and is an essential electrolyte. It has several critically important roles in the body, namely as a cofactor in numerous enzyme systems, and is involved in phosphate transfer, muscle contractility and neuronal transmission. The physiologic role, homeostasis, causes and clinical manifestations of hypo and hypermagnesemia and their therapy are briefly reviewed. Magnesium treatment is emerging as an important adjunct in the management of a few conditions: prevention and control of seizures in eclampsia, cardiovascular diseases, diabetes mellitus, asthma and others.
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PMID:[Magnesium: physiological and clinical relevance. 1: homeostasis and alterations in the metabolism of magnesium]. 1115 89

This study examined risk factors for pre-eclampsia/eclampsia in a population-based sample of pregnant working women in Mexico City. Over a 3-month period, all women who gave birth at three major hospitals and who had worked for at least 3 months during pregnancy were interviewed. After excluding mothers with multiple gestations or infants with birth defects, and previous diagnoses of hypertension, chronic renal disease or diabetes, 131 of 2,436 women (5.4%) had been diagnosed with pre-eclampsia and/or eclampsia. The frequency was much higher among women of low socio-economic status: 12% of uninsured women (SSA) compared with 4.2% of private sector employees (IMSS) and 1.3% of public sector employees (ISSSTE). After adjusting for education, women working in services (OR = 1.68, 95% CI = 1.01, 2.81) and in retail (OR = 1.99, 95% CI = 1.18, 3.37), primiparae (OR = 2.64, 95% CI = 1.65, 4.21) and women whose pregestational weight was > or = 55 kg (OR = 2.02, 95% CI = 1.34, 3.04) were at increased risk. Efforts to develop and evaluate intervention programmes should target hospitals serving the uninsured (SSA) if reduction in the number of preventable maternal deaths in Mexico is to be achieved. Such programmes should also target service and retail workers and identify women with poor glycaemic control early in pregnancy.
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PMID:Risk factors for pre-eclampsia/eclampsia among working women in Mexico City. 1123 14

With the goal to establish a model that relates birth weight to placenta weight, adjusted for the most documented predictors of birth weight, 300 live newborns were studied, all were products of single gestation. Inclusion criteria were newborns with gestational age of 37 weeks or older according to the date of last menstruation, whose mothers did not have diabetes mellitus, high blood pressure, pre-eclampsia, or eclampsia. The weight of the newborn was identified from the anthropometry data collected by previously trained nursing personnel in each of the participating hospitals. Immediately after delivery, the placenta was weighed. Multiple linear regression was used to see the effect of placenta weight and each variable on birth weight. The mean of birth weight was 3,369 g with a standard deviation (SD) of 445 g. Placenta weight had a mean of 537 g (SD: 96 g). The relation between the weight of the placenta and the birth weight was significant, and we found that for each gram increase in placenta weight, birth weight is increased by 1.98 g (SE = 0.25, p < 0.01) and this relation is not linear, since the quadratic term is significant. Placenta weight has a nonlinear relation to the birth weight and is an important predictor of birth weight. Together with the gestational age and the maternal age and size, it explains 32% of the variability of birth weight. Placenta weight can be a 'sentinel' indicator of nutritional and/or environmental problems.
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PMID:Relation between birth weight and placenta weight. 1150 10


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