Engagement frequency and C-section rates among users of a smartphone-based pregnancy tracking application
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We evaluated maternal complications in relation to number of previous caesarean sections in Princess Badea Teaching Hospital, Irbid, Jordan. Analysis of the medical records of 1739 patients delivered by caesarean section was conducted. It revealed a 14-fold increase in the risk of caesarean hysterectomy in patients with placenta praevia and previous caesarean section compared to patients with placenta praevia and no previous caesarean section. The risk of caesarean hysterectomy increased with increasing number of previous caesarean sections. Those with 3 or more previous caesarean sections were at significantly higher risk of blood transfusion. Post-operative pyrexia was commoner in women with 3 or more previous caesarean sections compared to those undergoing their first one.
Elective caesarean section
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Background. Cytokine imbalance in preeclampsia may be one of the etiological factors for preeclampsia. Objectives. The study was conducted to investigate interferon gamma (IFN-γ), interleukin-4 (IL-4) and interleukin-10 (IL-10) in preeclampsia. Enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of these three pro-inflammatory cytokines in sera from 33 Sudanese women with preeclampsia (at presentation and 7 days later) and 32 women with normal pregnancy as a control group. Results. The levels of IFN-γ and IL-4 were slightly—not statistically significant— higher in the women with preeclampsia. IL-10 was significantly higher in the women with preeclampsia. Women with preeclampsia had significantly lower levels of IFN-γ and IL-4 and significantly higher levels of IL-10 7days later in comparison with the presenting levels. Conclusion. Thus, the significantly raised levels of IL-10 in women with preeclampsia suggest its role in pathogenesis of preeclampsia, and further research is needed.
Etiology
Pathogenesis
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Preeclampsia is a devastating pregnancy-associated hypertensive syndrome. Although it is quite common, the pathophysiology of preeclampsia is not yet clear and remains “a disease of theory”. Angiogenic defect hypotheses have been intensively investigated, and some biomarkers have been independently analyzed as pathogenic clinical target molecules without direct proof of their roles in preeclampsia. In this review, we assessed an up-to-date list of proposed angiogenic defects for their relevance to preeclampsia. In addition, we introduce our working hypothesis of preeclampsia pathophysiology, which involves interactions between metabolic and angiogenic defects.
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Pathophysiology
Clinical Significance
Maternal morbidity
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UNLABELLED The pathophysiology of preeclampsia remains largely unknown. A number of circulating placenta-produced factors have been implicated in causing the endothelial dysfunction and the clinical phenotype characteristic of preeclampsia. AIM Determination of serum levels of placental soluble fms-like tyrosine-kinase-1 (sFlt-1) in pregnant women with preeclampsia. Eleven pregnant women with preeclampsia and 11 healthy women (controls) were included in the study. Determination of sFlt-1 was done with ELISA. The mean serum sFlt-1 levels of pregnant women with preeclampsia were twice as high as that of women with normal pregnancy. The highest level of sFlt-1 was found in women with severe preeclampsia. In women with mild form of preeclampsia the sFlt-1 level was close to that of the controls. sFlt-1 appears to be involved in the pathogenesis of preeclampsia and its serum levels can be used as a diagnostic marker of preeclampsia.
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Endothelial Dysfunction
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HELLP syndrome
Etiology
Oliguria
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This study was performed to investigate the possible association between preeclampsia and the plasma concentrations of Lp(a) lipoprotein and TGF‐β 1 in a large series of patients. Additionally, correlation between the concentrations of these molecules and the severity of preeclampsia or fetal growth retardation was evaluated. Following clinical examination and biochemical analyses, both electroimmunoassay and RIA technique were used for quantitative determinations of plasma Lp(a) lipoprotein. ELISA technique was used to measure the active form of TGF‐β 1 in plasma of pregnant normotensive and preeclamptic women. We examined 154 women with preeclampsia (preeclampsia group) and 76 healthy, pregnant normotensive women (control group). The preeclampsia group was further divided into the following subgroups: mild preeclampsia, severe preeclampsia and preeclampsia with fetal growth retardation. Plasma levels of Lp(a) lipoprotein were lower in the total preeclampsia group as well as in all preeclampsia subgroups (5.45 ± 7.41, 5.58 ± 8.02, 5.08 ± 5.38, and 4.32 ± 5.28 mg/dl in the total preeclampsia group, and in subgroups with mild preeclampsia, severe preeclampsia, and preeclampsia with fetal growth retardation, respectively) than in the control group (7.84 ± 9.26 mg/dl) as determined by quantitative electroimmunoassay. Corresponding results were obtained with a radioimmunoassay (166.03 ± 200.2 U/l in the total preeclampsia group vs. 229.18 ± 257.7 U/l in controls). There was good correlation between the two methods used for Lp(a) lipoprotein measurement. The differences between controls and the total preeclampsia group as well as each preeclampsia subgroup were statistically significant by a non‐parametric test (one‐way Kruskal‐Wallis test). Plasma concentrations of the active form of TGF‐β 1 were increased in all preeclampsia subgroups as well as in the total group (5.63 ± 1.68 ng/ml) compared to controls (4.67 ± 1.33 ng/ml). This increase in TGF‐β 1 was statistically highly significant. Plasma concentrations of Lp(a) lipoprotein and the active form of TGF‐β 1 did not differ significantly between the preeclampsia subgroups. The outcome of this study may suggest involvement of both parameters in the pathophysiology of preeclampsia and may substantiate the notion of a multifactorial etiology of the disease.
Lipoprotein(a)
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Background: Women with history of preeclampsia have reportedly higher risk of development of preeclampsia in subsequent pregnancies, along with other adverse pregnancy outcomes. Authors aimed to study the incidence of recurrent preeclampsia and compare the pregnancy outcome in women with history of preeclampsia in previous pregnancy with those who were normotensive in previous pregnancy and further compare outcomes in women with recurrent preeclampsia between their previous and index pregnancy.Methods: Pregnancy outcome was studied in women with preeclampsia in previous pregnancy (cases) and compared with women normotensive in previous pregnancy (controls). Further analysis of cases was done by dividing them into subgroups: those with recurrent preeclampsia in index pregnancy (A1) and those normotensive in index pregnancy despite being pre-eclamptic in previous pregnancy (A2). Total 100 cases and 100 controls were enrolled in the study, which was conducted at present tertiary care centre from January 2012 to June 2013.Results: Out of total 200 participants (100 cases, 100 controls) enrolled in the study; 58 out of 100 cases had recurrent preeclampsia and remaining 42 remained normo-tensive in index pregnancy. Among 100 controls, 93 were normotensive in index pregnancy.Conclusions: Women with history of preeclampsia in previous pregnancy had adverse maternal and perinatal outcome in subsequent pregnancy when compared to the women who were normotensive in the previous pregnancy. But when compared with their own previous preeclamptic pregnancy, they had better pregnancy outcome with good perinatal outcome in their index pregnancy.
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Placental abruption
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Fetal macrosomia
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( Am J Obstet Gynecol . 2016;215:243.e1–243.e7) Gestational diabetes mellitus (GDM) can lead to other pregnancy-related adverse effects such as macrosomia and birth trauma. To prevent these maternal and neonatal risks, labor is usually induced at term in women with GDM. However, the risks and benefits of induction of labor (IOL) have been inadequately analyzed. The objective of this study was to assess the correlation between IOL, gestational age and rates of cesarean delivery (CD) in women who have GDM.
Cesarean delivery
Fetal macrosomia
Labor Induction
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