H. Thoumsin

Serum immunoreactive erythropoietin during pregnancy and in the early postpartum

Summary We studied 209 women during normal pregnancy, at delivery, or in the early postpartum. to determine whether erythropoietin (EPO) response was appropriate for the degree of anaemia. Serum immunoreactive EPO was measured in 74 nonpregnant women, including 33 normal subjects (16.4 ± 4.1 mU/ml) and 41 women with hypoplastic, haemolytic, dyserythropoietic, or iron‐deficient anaemia. An inverse linear relationship (R=‐0.88. P<0.0001) between log(EPO) and Hct was observed. Predicted EPO values were derived for each Hct and an O/P ratio of observed/predicted log(EPO) was calculated for each sample (1.00 ± 0.10, range 0.80–1.20). Serum EPO levels (mU/ml) were significantly higher during pregnancy (30 ± 16. n=142), at delivery (31 ± 16, n= 41), and on day 7 postpartum (37 ± 35, n= 26) than in normal women (P<0.001). EPO levels increased steadily from 18 ± 6 mU/ml in the first, to 26 ± 14 mU/ml in the second, and to 35 ± 18 mU/ml in the third trimester (P<0.0001). The O/P ratio was normal on day 7 postpartum (1.01 ± 0.16), at delivery (1.03 ± 0.16), and in the third trimester (0.96 ± 0.15), but was significantly reduced in the first two trimesters (0.88+0.15, P<0.001). A significant negative correlation between log(EPO) and Hct was lacking in the first two trimesters, was present but with a reduced slope during the third trimester and at delivery, and was normal postpartum. We conclude that EPO response to anaemia is impaired in early pregnancy, recovers in late pregnancy, and normalizes rapidly in the postpartum.

Prediction of Maternal Predisposition to Preeclampsia

Objective: To derive a prediction index based on the most salient patient history, laboratory, and clinical parameters for identifying women at high risk for developing preeclampsia (PE). Methods: Nonpregnant women with a history of PE (n = 101) were compared with nonpregnant parous women with a history of one or more successful normotensive pregnancies (n = 50) but with comparable age, gestation, and parity profiles. The parameters included a medical examination (demographics, patient history, family history, and clinical and obstetrical findings), laboratory investigations (hemostasis, coagulation, and vitamins), and morphological and functional tests (cardiovascular and renal functions). Stepwise logistic regression analysis was applied to develop a three-step PE prediction index based on the most discriminant parameters. Results: Patients with and without PE differed significantly (p < 0.05) with respect to 1) maternal history of chronic hypertension, body mass index, and blood pressure; 2) APTT, PT, activated factor VIII, homocystein, free protein S and vitamin B1; and 3) relative plasma volume. Based on these three sets of parameters, a three-step PE prediction index was developed. The likelihood ratio of a positive index score was equal to 3.4, 7.3, and 8.8, respectively. Thus, assuming a PE prevalence (or prior probability) of 5%, a patients chances of developing PE when presenting with a positive score on the three-step prediction index were 15%, 28%, and 32%, respectively. Discussion: In the absence of welldefined pre-pregnancy screening guidelines for PE, the present study attempts to proceed in a stepwise fashion by looking at medical examination data first, requesting, if necessary, specific hemostasis and coagulation tests next, and finally measuring the relative plasma volume for confirmatory purposes. This approach offers a satisfactory positive predictive value and cost efficiency ratio.

Preliminary clinical application of a mathematical model for interpreting dehydroepiandrosterone-sulfate loading test in late pregnancy.

In 1967, LAURITZEN proposed a dynamic test to investigate placental steroidogenesis [7]. Intravenous injection of 50 mg dehydroepiandrosteronesulfate (DHEA-S) to pregnant women induced an increase of urinary estriol excretion; but with placental insufficiency this increase was absent or reduced. Since 1973therehave been several studies of the DHEA-S Loading Test (DLT) in which maternal plasma levels of estrogens were determined [l, 2, 3, 4, 5, 6, 8, 12, 13, 14]. After an intravenous injection of 50 mg of DHEA-S, Estrone (Ei) levels increase about threefold within two to four hours and return to baseline values eight to twelve hours later; Estradiol (E2) levels increase two to fivefold within the first hour and return to initial values twelve hours later; unconjugated estriol (E3) sometimes shows an increase of 50% between six and twelve hours after the injection [13]. An adequate method for interpreting the DLT in cUnicaTu.se has not yet been found. The accuracy of the plasmatic DLT to indicate fetal risk has not been proven with certainty. Nevertheless NAGEY and PUPKINS [9, 11] using a mathematical representation of a physiological model of the DHEA to estrogen conversion System, demonstrated the ability of DLT to indicate fetal jeopardy or/and placental insufficiency. Using a similar model, we have attempted to investigate the decrease of placental aromatization in intra-uterine fetal growth retardation. Curriculum vitae

Détermination d'un index prédictif de la prééclampsie en préconceptionnel et propositions thérapeutiques de prévention primaire

OBJECTIVE To derive a prediction index based on the most salient history, laboratory and clinical parameters for identifying women at high risk of developing preeclampsia (PE) and to suggest a primary prevention. MATERIAL AND METHOD Non-pregnant women with a history of PE (n=101) were compared to non-pregnant parous women with a history of one or more successful normotensive pregnancies (n=50) but with comparable age, gestation and parity profiles. The parameters included history and clinical examination; laboratory studies (hemostasis, coagulation, vitamins); and morphological and functional tests (cardiovascular and renal functions). Stepwise logistic regression analysis was applied to develop a three step PE prediction index based on the most discriminant parameters. Strategies to prevent PE in the high-risk group are described. RESULTS Identification of women at high risk of PE can be done efficiently (88% sensitivity and specificity) using a predictive index based on a simple history, laboratory, clinical and functional information. Strategies to prevent PE in our high-risk group have given encouraging results during next pregnancy. CONCLUSION Our study gives a predictive index of PE outside of pregnancy and possibilities to do a primary prevention.