Ganong's review of medical physiology , Ganong's review of medical physiology , کتابخانه دیجیتال جندی شاپور اهواز

Ganong's review of medical physiology

Problem Pre-eclampsia (PE), preterm birth (PTB) and intra-uterine growth restriction (IUGR) affect 5%-12% of pregnancies. They have been associated with placental inflammation, although the detection of inflammatory mediators in the maternal circulation is still controversial. Our goal was to determine the inflammatory changes occurring in the second part of pregnancy to identify profiles distinguishing pathological pregnancies from each other. Method of study We performed a nested case-control study of 200 women randomly selected from a cohort recruited at the CHU de Quebec-Universite Laval, Quebec, Canada. Women with uncomplicated term pregnancy (CTRL); PE (severe or not); PTB or IUGR (N = 50/each) were included. Plasma samples, obtained from the late second trimester and at delivery, were analysed for over 30 selected mediators (including cytokines/alarmins), by multiplex, ELISA or specific assays. Demographic and obstetrical information were obtained for classification. Results In CTRL, we observed significant differences between 2nd trimester and delivery, with increased levels of inflammatory mediators (ex. MCP-1, IL-6), supporting an inflammatory profile towards term. Increased levels of IL-6, CXCL10 and CRP were observed in PE as compared to CTRL. In PTB, we observed increased CXCL9 in 2nd trimester and decreased progesterone at delivery. In IUGR, increased HMGB1 and IL-1α were observed only in the 2nd trimester. Conclusions Our work showed significant inflammatory changes in uncomplicated pregnancies towards delivery, supporting that normal delivery is pro-inflammatory, although not to the same extent as in pathological pregnancies. Inflammatory profiles are specific to each pregnancy complication which may help to understand the contribution of inflammation to the clinical presentation of these conditions.

Specific inflammatory profile in each pregnancy complication: A comparative study.

Background and objective Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Uric acid (UA) is filtered, reabsorbed and secreted by the kidney. Thus, this study was conducted to assess the serum UA levels in PIH and to evaluate the diagnostic value of serum UA level in PIH. Materials and methods This is a hospital based comparative cross-sectional study conducted in BPKIHS. Ninety study participants were included; forty five participants were diagnosed of PIH and forty five in control group after obtaining informed consent from study participants from August 2014 to May 2015. Serum UA was done by Uricase method and serum creatinine was done by Jaffe's alkaline picrate method in cobas c311 autoanalyser. Data were expressed in frequency, percentage, mean ± S.D., median (IQR), and Independent t-test, Mann–Whitney U test were applied. p Value Results Mean serum UA levels was higher in PIH compared to control group (5.46 ± 1.51 vs 4.03 ± 0.69) respectively. ROC curve demonstrated that serum UA showed a superior diagnostic efficiency (Sensitivity – 79.07%, Specificity – 71.19%) compared to creatinine (Sensitivity – 62.75%, Specificity – 27.45%) in PIH respectively. Conclusion The present study shows that serum UA is significantly raised in PIH compared to the control group. Assessment of uric acid is a convenient and cost-effective method for determination of severity in PIH. Thus, serum uric acid can still be used as prevalent marker for risk assessment in PIH.

Significance of Serum Uric Acid in Pregnancy Induced Hypertension.

Objectives Compare serum uric acid and calcium levels among normotensive and hypertensive pregnant women, to compare maternal and perinatal outcomes in two groups. Materials and methods Prospective case control study was conducted after ethical approval in Obstetrics and Gynaecology department of rural tertiary care centre of Northern India, over seven months. Total 220 antenatal women ≥34 weeks of gestation with 110 cases having hypertensive disorder of pregnancy and 110 controls with normal blood pressure were compared for maternal uric acid and calcium levels and maternal, perinatal outcomes. Results Mean ± SD values of uric acid and calcium in control group was 4.42 ± 1.42 mg/dl and 8.94 ± 0.6 mg/dl, whereas in cases they were 6.8 ± 2.72 mg/dl and 8.61 ± 0.78 mg/dl (p  Conclusion Maternal hyperuricemia and hypocalcaemia was associated with adverse maternal, perinatal outcomes in women with hypertensive disorder of pregnancy as compared to healthy normotensive women.

Maternal serum uric acid and calcium as predictors of hypertensive disorder of pregnancy: A case control study.

Background: Preeclampsia is one of the common conditions of unknown etiology which increases the risk of maternal and perinatal morbidity and mortality. According to some studies, serum uric acid lacks sensitivity and specificity as a diagnostic tool whereas another group of the researchers indicated uricemia as a predictor of preeclampsia in pregnant ladies.
Objective: The present study was designed to assess whether serum uric acid can be used as a biochemical indicator or not, in pregnancy induced hypertensive (PIH) patients.
Study period & Method: Total number of 98 PIH patients admitted in GMERS Medical College, Dharpur, from Dec 2013 to Feb 2015 were included in this study and 60 normal healthy pregnant ladies served as control. Serum uric acid levels were estimated using modified Trinder's test.
Results: Out of the 98 cases mild preeclamspsia was 60(61.2±%), severe Preeclampsia 24 (24.5%) and eclampsia 14(14.3%). Serum Uric acid levels significantly increased with the severity of PIH, normal pregnant women (4.58±0.37), mild preeclampsia (5.32+0.40), severe preeclampsia (6.29±0.57) and eclamspsia (7.88±1.26). Out of these women with uric acid levels more than 5.5mg/dl was seen in 28(46.6%) mild preeclampsia, 19(79.2%) severe preeclampsia and 12 (85.7%) eclampsia. Maternal mortality was observed in 05(5.1%)PIH cases and out this 04(80) had uric acid level > 5.5mg/dl. Perinatal mortality was observed in 25 (25.1%) cases, out of these 19(76%) were stillbirths and 06(24%) were neonatal deaths.  Out of the 25 perinatal deaths 18(72%) had uric acid level >5.5mg/dl.
Conclusion: Serum uric acid level could be used as a biochemical indicator of preeclampsia/eclampsia and its complications.

Key words: Preeclampsia, Uric acid, Mortality

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Uric Acid Levels in Pregnancy Induced Hypertension (PIH) in Relation to Maternal and Perinatal Outcomes

Preeclampsia is a serious pregnancy complication characterized by hypertension, proteinuria with or without pathological edema. According to some studies, serum uric acid lacks sensitivity and specificity as a diagnostic tool whereas another group of the researchers indicated uricemia as a predictor of preeclampsia in pregnant ladies. The present study was designed to assess whether serum uric acid can be used as a biochemical indicator or not in preeclamptic patients. Pre-eclamptic patients admitted in Nepal Medical College Teaching Hospital from June 2012 to June 2013 were included in this study. Age matched normal healthy pregnant ladies served as control. The record of their blood pressure and serum uric acid level was evaluated. Results showed significantly high blood pressure [SBP 149.42±12.35 vs 109.00±7.93 mm Hg; DBP 96.85±8.32 vs 72.5±7.10 mm Hg], and serum uric acid level [6.27±1.37 vs 4.27±0.61 mg/dl] in pre-eclamptic patients compared to their healthy counterparts. Uric acid is a terminal metabolite of the degradation of nucleotides, which increases their blood levels in patients with preeclampsia increasing its synthesis by damage and death of trophoblastic cells and proliferation. Uricemia in preeclampsia likely results from reduced uric acid clearance from diminished glomerular filtration, increased tubular reabsorption and decreased secretion. Results of the present study indicated association of elevated serum uric acid level with preeclampsia which could be used as a biochemical indicator of preeclampsia in pregnant women.

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T Pramanik

Papers

Serum uric acid level in normal pregnant and preeclamptic ladies: a comparative study.