ACTUALIZACIÓN EN EL DIAGNÓSTICO Y MANEJO DE ALTERACIONES HEMATOLÓGICAS DEL FETO

Presentamos una revisión de la literatura de los problemas hematológicos del feto más relevantes, con especial enfoque del diagnóstico y tratamiento prenata

ACTUALIZACIÓN EN EL DIAGNÓSTICO Y MANEJO DE ALTERACIONES HEMATOLÓGICAS DEL FETO

Presentamos una revisión de la literatura de los problemas hematológicos del feto más relevantes, con especial enfoque del diagnóstico y tratamiento prenatalWe present a literature review of most relevant fetal hematologic disorders, with special approach for the diagnosis and prenatal treatmen

First trimester prediction of gestational diabetes mellitus using plasma biomarkers: a case-control study

Objectives To evaluate the first trimester maternal biomarkers for early pregnancy prediction of gestational diabetes mellitus (GDM). Methods The study was a case-control study of healthy women with singleton pregnancies at the first trimester carried out at the Obstetrics and Gynecology Unit, Clinica Davila, Santiago, Chile. After obtaining informed consent, peripheral blood samples of pregnant women under 14 weeks of gestation were collected. At 24-28 weeks of pregnancy, women were classified as GDM (n=16) or controls (n=80) based on the results of a 75-g oral glucose tolerance test (OGTT). In all women, we measured concentrations of fasting blood glucose, insulin, glycated hemoglobin, uric acid, cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), triglycerides, aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), alkaline phosphatase (AP), sex hormone-binding globulin (SHBG), adiponectin, tissue plasminogen activator (t-PA), leptin and placental growth factor (PGF). Results The GDM group displayed an increased median concentration of cholesterol (P=0.04), triglycerides (P=0.003), insulin (P=0.003), t-PA (P=0.0088) and homeostatic model assessment (HOMA) (P=0.003) and an increased mean concentration of LDL (P=0.009) when compared to the control group. The receiver operating characteristic (ROC) curve for significant variables achieved an area under the curve (AUC) of 0.870, a sensitivity of 81.4% and a specificity of 80.0%. The OGTT was positive for GDM according to the IADPSG (International Diabetes in Pregnancy Study Group) criteria. Conclusion Women who subsequently developed GDM showed higher levels of blood-borne biomarkers during the first trimester, compared to women who did not develop GDM. These data warrant validation in a larger cohort

First trimester prediction of early onset preeclampsia using demographic, clinical, and sonographic data: a cohort study

Objective The aim of this research was to evaluate the performance of a predictive model for early onset preeclampsia (PE) during early gestation.Method Prospective multicenter cohort study was performed in women attending 11-14 weeks ultrasound. Medical history and biometrical variables were recorded and uterine artery Doppler was performed. All patients were followed until postpartum period. Constructed predictive models were compared using the area under the associated receiver operating characteristic curve. Sensitivity, specificity, and likelihood ratios were estimated for each outcome.Results A total of 627 patients were enrolled. Sixty-five (10.4%) developed gestational hypertension, of which 29 developed PE (4.6% of the total sample) and nine occurred before 34 weeks (1.5% of total sample). Prediction model generated for early onset PE (ePE) with 5% false positive achieve sensitivity of 62.5% and specificity of 95.5%. The positive and negative likelihood ratios for ePE were 13.9 and 0.39, respectively. Development of ePE was significantly associated with history of preterm labor (p = 0.002) and diabetes mellitus (p = 0.02).Conclusions This study confirms the advantage of combining multiple variables for prediction of ePE. (C) 2013 John Wiley & Sons, Ltd

Diagnostic Performance of First Trimester Screening of Preeclampsia Based on Uterine Artery Pulsatility Index and Maternal Risk Factors in Routine Clinical Use

Preeclampsia is a pregnancy-specific disorder defined by new onset of hypertension and proteinuria after 20 weeks of gestation. The early detection of patients at risk of developing preeclampsia is crucial, however, predictive models are still controversial. We aim to evaluate the diagnostic performance of a predictive algorithm in the first trimester of pregnancy, in order to identify patients that will subsequently develop preeclampsia, and to study the effect of aspirin on reducing the rate of this complication in patients classified as high risk by this algorithm. A retrospective cohort including 1132 patients attending prenatal care at Clínica Dávila in Santiago, Chile, was conceived. The risk of developing preeclampsia (early and late onset) was calculated using algorithms previously described by Plasencia et al. Patients classified as high risk, in the first trimester of pregnancy, by these algorithms, were candidates to receive 100 mg/daily aspirin as prophylaxis at the discretion of the attending physician. The overall incidence of preeclampsia in this cohort was 3.5% (40/1132), and the model for early onset preeclampsia prediction detected 33% of patients with early onset preeclampsia. Among the 105 patients considered at high risk of developing preeclampsia, 56 received aspirin and 49 patients did not. Among those who received aspirin, 12% (7/56) developed preeclampsia, which is equal to the rate of preeclampsia (12% (6/49)) of those who did not receive this medication. Therefore, the diagnostic performance of an algorithm combining uterine artery Doppler and maternal factors in the first trimester predicted only one third of patients that developed preeclampsia. Among those considered at high risk for developing the disease using this algorithm, aspirin did not change the incidence of preeclampsia, however, this could be due either to the small study sample size or the type of the study, a retrospective, non-interventional cohort study

ESPECTRO CLÍNICO DE LA PREECLAMPSIA: ESTUDIO COMPARATIVO DE SUS DIVERSOS GRADOS DE SEVERIDAD

Objetivo: Comparar los resultados maternos y perinatales en embarazadas que cursaron con preeclampsia (PE) en sus diversas presentaciones en el período 2001 -2005. Material y Método: Estudio retrospectivo de 7.205 partos asistidos en la maternidad del Hospital Clínico de la Universidad de Chile. 204 mujeres presentaron PE/eclampsia, dividiéndose en 3 grupos: PE modera, severa y síndrome de HELLP. Se analizaron las variables clínicas y de laboratorio de la embarazada y del recién nacido. Se compararon estos resultados en los 3 grupos de estudio. Para variables continuas de distribución normal se empleó el análisis de varianza (ANOVA). Para variables categóricas se empleó la tabla de contingencia de Chi2 o la prueba exacta de Fisher. Resultados: 80 mujeres presentaron PE moderada (39,2%), 114 PE severa (55,8%) y 10 HELLP (4,9%). Se observaron diferencias significativas en la vía de parto, edad gestacional, peso del recién nacido, percentil, morbi-mortalidad neonatal, complicaciones maternas médico-quirúrgicas en los grupos de PE severa y HELLP comparados con las PE moderadas. La PE severa tuvo una mayor proteinuria que los otros dos grupos. Así mismo, se observaron también diferencias significativas en el grupo de síndrome de HELLP en los niveles de enzimas hepáticas, LDH y recuento plaquetario en comparación con el grupo de las PE moderadas y severas. Conclusión: La PE es una entidad clínica que puede presentarse en diversos grados de severidad, por lo que su correcta clasificación de acuerdo a criterios clínicos y de laboratorio, es clave para el tratamiento y pronóstico de las pacientes<br>Objective: The aim of this study was to compare maternal and perinatal outcome in pregnant women with the different spectrum of severity of pre-eclampsia (PE). Methods: A retrospective study in 7205 pregnancies delivered at the University of Chile Hospital. 204 pregnant women were diagnosed preeclampsia, which were divided in three groups: moderate PE, severe PE, and HELLP syndrome, according to standard definitions. The maternal and perinatal outcomes were analyzed between groups and statistically differences were considered when p<0.05. Analyses of variance (ANOVA) and Chi2 or Fisher's exact tests were used for continuous or categorical variables, respectively. Results: 80 women were moderate PE (39.2%), 114 severe PE (55.8%), and 10 HELLP (4.9%). Rate of cesarean section, birthweight, gestational age, fetal percentile, neonatal mortality and morbidity and medical and surgical maternal morbidity were significantly different between severe conditions and moderate one. 24-hours proteinuria was significantly higher in severe PE compared to other groups. Furthermore, levels of liver enzymes and lactate deshydrogenase were higher and platelet count lower in HELLP syndrome compared to moderate and severe cases. Conclusion: This study confirms that there are different clinical and biochemical manifestations according to the grade of severity of the preeclampsia, being worst in those with severe conditions and HELLP syndrome compared to moderate cases. Therefore, a correct classification, according to strict clinical criteria and laboratory parameters, would be essential for appropriate treatment and prognosi

Circulating syndecan-1 is reduced in pregnancies with poor fetal growth and its secretion regulated by matrix metalloproteinases and the mitochondria

Fetal growth restriction is a leading cause of stillbirth that often remains undetected during pregnancy. Identifying novel biomarkers may improve detection of pregnancies at risk. This study aimed to assess syndecan-1 as a biomarker for small for gestational age (SGA) or fetal growth restricted (FGR) pregnancies and determine its molecular regulation. Circulating maternal syndecan-1 was measured in several cohorts; a large prospective cohort collected around 36 weeks’ gestation (n= 1206), a case control study from the Manchester Antenatal Vascular service (285 women sampled at 24–34 weeks’ gestation); two prospective cohorts collected on the day of delivery (36 + 3–41 + 3 weeks’ gestation, n= 562 and n= 405 respectively) and a cohort who delivered for preterm FGR (< 34 weeks). Circulating syndecan-1 was consistently reduced in women destined to deliver growth restricted infants and those delivering for preterm disease. Syndecan-1 secretion was reduced by hypoxia, and its loss impaired proliferation. Matrix metalloproteinases and mitochondrial electron transport chain inhibitors significantly reduced syndecan-1 secretion, an effect that was rescued by co-administration of succinate, a mitochondrial electron transport chain activator. In conclusion, circulating syndecan-1 is reduced among cases of term and preterm growth restriction and has potential for inclusion in multi-marker algorithms to improve detection of poorly grown fetuses