RESUMEN
The activity of ADAMTS13, the von Willebrand factor (VWF) cleaving protease is low in several conditions, including HELLP (haemolysis, elevated liver enzymes, and low platelet count) syndrome. As HELLP syndrome develops in most cases on the basis of preeclampsia, our aim was to determine whether plasma ADAMTS13 activity is decreased in preeclampsia. Sixty-seven preeclamptic patients, 70 healthy pregnant women and 59 healthy non-pregnant women were involved in this case-control study. Plasma ADAMTS13 activity was determined with the FRETS-VWF73 assay, while VWF antigen (VWF:Ag) levels with an enzyme-linked immunosorbent assay. The multimeric pattern of VWF was analyzed by SDS-agarose gel electrophoresis. There was no significant difference in plasma ADAMTS13 activity between the preeclamptic and the healthy pregnant and non-pregnant groups (median [25-75 percentile]: 98.8 [76.5-112.8] %, 96.3 [85.6-116.2] % and 91.6 [78.5-104.4] %, respectively; p > 0.05). However, plasma VWF:Ag levels were significantly higher in preeclamptic patients than in healthy pregnant and non-pregnant women (187.1 [145.6-243.1] % versus 129.3 [105.1-182.8] % and 70.0 [60.2-87.3] %, respectively; p < 0.001). The multimeric pattern of VWF was normal in each group. Primiparas had lower plasma ADAMTS13 activity than multi-paras (92.6 [75.8-110.6] % versus 104.2 [92.1-120.8] %; p = 0.011). No other relationship was found between clinical characteristics, laboratory parameters and plasma ADAMTS13 activity in either study group. In conclusion, plasma ADAMTS13 activity is normal in preeclampsia despite the increased VWF:Ag levels. However, further studies are needed to determine whether a decrease in plasma ADAMTS13 activity could predispose preeclamptic patients to develop HELLP syndrome.
Asunto(s)
Proteínas ADAM/sangre , Síndrome HELLP/etiología , Preeclampsia/sangre , Factor de von Willebrand/análisis , Proteína ADAMTS13 , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Síndrome HELLP/sangre , Síndrome HELLP/enzimología , Humanos , Paridad , Preeclampsia/enzimología , Embarazo , Multimerización de Proteína , Regulación hacia Arriba , Adulto JovenRESUMEN
It has been previously reported that circulating anti-heat-shock-protein (Hsp) antibody levels are elevated in cardiovascular disorders. The aim of the present study was to determine circulating antihuman Hsp60, antimycobacterial Hsp65, and antihuman Hsp70 antibody levels in healthy pregnant women and preeclamptic patients and to investigate their relationship to the clinical characteristics of the study subjects, as well as to the markers of inflammation (C-reactive protein (CRP)), endothelial activation (von Willebrand factor antigen), or endothelial injury (fibronectin), oxidative stress (malondialdehyde) and to serum Hsp70 levels. Ninety-three preeclamptic patients and 127 normotensive healthy pregnant women were involved in this case control study. Serum anti-Hsp60, anti-Hsp65, anti-Hsp70, and Hsp70 levels were measured with enzyme-linked immunosorbent assay (ELISA). Serum CRP levels were determined by an autoanalyzer using the manufacturer's kit. Plasma von Willebrand factor antigen levels were quantified by ELISA, while plasma fibronectin concentration by nephelometry. Plasma malondialdehyde levels were measured by the thiobarbituric-acid-based colorimetric assay. For statistical analyses, nonparametric methods were applied. Anti-Hsp60, anti-Hsp65, and anti-Hsp70 antibodies were detected in all of our serum samples. There were no significant differences in serum anti-Hsp60, anti-Hsp65, and anti-Hsp70 antibody levels between the control and preeclamptic groups. Serum levels of Hsp70 and CRP, as well as plasma levels of VWF antigen, fibronectin, and malondialdehyde, were significantly higher in preeclamptic patients than in normotensive healthy pregnant women. Serum anti-Hsp60 antibody levels showed significant correlations with serum anti-Hsp65 antibody levels both in the control and the preeclamptic groups (Spearman R = 0.55 and 0.59; p < 0.001, respectively). However, no other relationship was found between clinical features (maternal age, smoking status, parity, body mass index, gestational age at blood draw, systolic and diastolic blood pressure, gestational age at delivery, and fetal birth weight) and measured laboratory parameters of the study subjects and serum anti-Hsp antibody levels in either study group. In conclusion, anti-Hsp60 and anti-Hsp70 antibodies as naturally occurring autoantibodies are present in the peripheral circulation of healthy pregnant women. Nevertheless, humoral immunity against heat shock proteins was not associated with preeclampsia. Further studies are warranted to explore the role of heat shock proteins and immune reactivity to them in the immunobiology of normal pregnancy and preeclampsia.
Asunto(s)
Anticuerpos/inmunología , Chaperonina 60/inmunología , Proteínas HSP70 de Choque Térmico/inmunología , Proteínas de Choque Térmico/inmunología , Preeclampsia/inmunología , Adulto , Anticuerpos/sangre , Femenino , Humanos , Preeclampsia/sangre , EmbarazoRESUMEN
AIM: The aim was to evaluate familial early-onset cardiovascular disorders as potential risk factors for severe preeclampsia. STUDY DESIGN: A case-control study was carried out by interviewing 162 primiparous severely preeclamptic women and 521 primiparous healthy control patients after delivery to determine the frequency of cardiovascular disorders (chronic hypertension, myocardial infarction, stroke) developed before the age of 50 among their parents. The chi2-test was utilized to estimate odds ratios (OR) and 95% confidence intervals (95% CI). The association was adjusted for pre-pregnancy body mass index, maternal age, and smoking habits before pregnancy using logistic regression analysis. RESULTS: Maternal and paternal early-onset chronic hypertension (adjusted OR: 3.84, 95% CI: 2.25-6.54; and adjusted OR: 3.26, 95% CI: 1.76-6.05) as well as paternal early-onset myocardial infarction (adjusted OR: 3.33; 95% CI: 1.51-7.32) were independent risk factors for severe preeclampsia. Early-onset stroke affected only the fathers of severely preeclamptic patients. Among the severely preeclamptic patients a positive family history of cardiovascular disorders developed before the age of 50 increased the risk of early-onset preeclampsia (developing before the 32nd gestational week) by 5.05-fold (95% CI: 3.08-8.31) compared with the control group. CONCLUSION: Our results suggest that the presence of familial early-onset cardiovascular disorders is a predisposing factor for severe preeclampsia.
Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Predisposición Genética a la Enfermedad , Preeclampsia/etiología , Adulto , Edad de Inicio , Enfermedades Cardiovasculares/genética , Estudios de Casos y Controles , Salud de la Familia , Femenino , Humanos , Embarazo , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: A rare type of placentation leading to cesarean delivery and hysterectomy is described. CASE: A young multigravida in the 26th week of gestation was referred to our department with a history of vaginal bleeding and suspected placenta previa. Three previous children were delivered by elective cesarean. Ultrasonographic examination suggested placenta previa increta with hypervascularization and with pulsatile lacunar flow. In the 38th week of gestation, an elective cesarean delivery and hysterectomy were performed. Morphological studies showed that most of the placenta developed in the anterior portion of the cervix. The implantation took place in the scar tissue, promoting infiltration of the increted growth and thus ensuring the normal development of the amnionic sac and fetus in the uterine cavity. CONCLUSION: Variations in placental implantation may result in unique situations at birth.
Asunto(s)
Cesárea/efectos adversos , Placenta Previa/patología , Placenta Previa/cirugía , Resultado del Embarazo , Adulto , Cesárea/métodos , Cesárea Repetida/métodos , Femenino , Estudios de Seguimiento , Humanos , Histerectomía/métodos , Paridad , Placenta Previa/diagnóstico por imagen , Placentación/fisiología , Embarazo , Segundo Trimestre del Embarazo , Medición de Riesgo , Ultrasonografía Prenatal , Hemorragia Uterina/etiología , Hemorragia Uterina/cirugíaRESUMEN
INTRODUCTION: Rather few papers are about first trimesters pathology. The reason of this roots in the technical difficulties. The first trimesters pathology can not be separated from prenatal diagnostics. OBJECTIVES: The authors summarized the molecular basis of embryology, malformations, and published cases that had been diagnosed prenatally. MATERIALS AND METHODS: In the I. Department of Obstetrics and Gynecology, Semmelweis University in Budapest between 1995. and 2000. altogether sixty embryos 70 gms or smaller were examined. RESULTS: Malformations included neural tube defects, disorders of twinning, body stalk defect, chromosome aberrations, hydrops, omphalocele and gastroschisis. CONCLUSIONS: Examination of early embryos may discover many results on the fields of prenatal diagnosis and the pathomechanism of developmental abnormalities.