Justo Alonso

Carotid-radial pulse wave velocity as an alternative tool for the evaluation of endothelial function during pregnancy: Potential role in identifying hypertensive disorders of pregnancy

Preeclampsia/eclampsia syndrome, a major cause of maternal mortality and morbidity, has been recognized as a condition with a globally impaired endothelial function (EF). The possibility of identifying early subclinical endothelial damage during pregnancy could be of value in classifying the different hypertensive states of pregnancy, and have a positive impact in the understanding of this syndrome, as well as on the appropriate treatment of these patients. Reactive hyperemia-related changes in carotid-radial pulse wave velocity (PWVcr) were proposed as an alternative tool for the evaluation of EF in patients with cardiovascular risk factors. If impaired EF, which follows hypertensive disorders of pregnancy can be assessed using PWVcr changes remains still unknown. Aims: To assess and compare reactive hyperemia-related changes in PWVcr and FMD in pregnant women (healthy and with hypertensive disorders) and non pregnant women. Methods: Healthy pregnant (HP; n=13), preeclamptic (PE; n=7), non-proteinuric hypertensive (NPH; n=6) and non-pregnant (NP; n=32) women were included. Left PWVcr (strain gauge mechano-transducers), left brachial arterial diameter (B-Mode ultrasound) and blood flow velocity (Doppler ultrasound) were measured before (baseline) and after the transient ischemia of the left forearm were determined. Results: One minute after the cuff deflation, PWVcr decreased in HP (6.9 ± 1.5 to 6.0 ± 0.9 m/s, <;0.001) and in NP (8.1 ± 0.9 to 7.4 ± 0.9 m/s; <;0.001). NPH showed a blunted hyperemic PWVcr response (6.6 ± 1.4 to 6.7 ± 1.0 m/s; p=0.91), whereas PE showed a tendency to increase (6.0 ± 0.7 to 6.4 ± 0.8 m/s; p=0.10). Reactive hyperemia PWVcr response (ΔPWVcr in %) differed comparing HP with NPH (-12% vs. +2%; <;0.01) and with PE (-12 vs. +6%; p<;0.01), whereas no differences were found between NHP and PE (p=1.00). Conclusion: HP showed an enhanced PWVcr reduction, whereas PE and NPH showed a blunted hyperemic PWVcr response. Carotid-radial PWVcr analysis could have a potential role in the assessment of pregnancy to study EF with a potential clinical application in predicting pregnancy induced hypertension and preeclampsia.

Preeclampsia Is Associated with Increased Central Aortic Pressure, Elastic Arteries Stiffness and Wave Reflections, and Resting and Recruitable Endothelial Dysfunction.

Introduction. An altered endothelial function (EF) could be associated with preeclampsia (PE). However, more specific and complementary analyses are required to confirm this topic. Flow-mediated dilation (FMD), low-flow-mediated constriction (L-FMC), and hyperemic-related changes in carotid-radial pulse wave velocity (PWVcr) offer complementary information about “recruitability” of EF. Objectives. To evaluate, in healthy and hypertensive pregnant women (with and without PE), central arterial parameters in conjunction with “basal and recruitable” EF. Methods. Nonhypertensive (HP) and hypertensive pregnant women (gestational hypertension, GH; preeclampsia, PE) were included. Aortic blood pressure (BP), wave reflection parameters (AIx@75), aortic pulse wave velocity (PWVcf) and PWVcr, and brachial and common carotid stiffness and intima-media thickness were measured. Brachial FMD and L-FMC and hyperemic-related change in PWVcr were measured. Results. Aortic BP and AIx@75 were elevated in PE. PE showed stiffer elastic but not muscular arteries. After cuff deflation, PWVcr decreased in HP, while GH showed a blunted PWVcr response and PE showed a tendency to increase. Maximal FMD and L-FMC were observed in HP followed by GH; PE did not reach significant arterial constriction. Conclusion. Aortic BP and wave reflections as well as elastic arteries stiffness are increased in PE. PE showed both “resting and recruitable” endothelial dysfunctions.

Vaginal group B streptococcus status during intrapartum antibiotic prophylaxis

To assess maternal group B streptococcus (GBS) colonization status and the pharmacokinetic profile of penicillin G in the umbilical cord and amniotic fluid compartment during 4 hours of intrapartum antibiotic prophylaxis (IAP).

Comparison of placental alpha microglobulin-1 in vaginal fluid with intra-amniotic injection of indigo carmine for the diagnosis of rupture of membranes

Abstract Aims: The purpose of this study was to compare the diagnostic performance of an immunoassay for placental alpha microglobulin-1 (PAMG-1) in vaginal fluid with the intra-amniotic instillation of indigo carmine for the diagnosis of membrane rupture in patients with an equivocal status. Methods: A prospective multi-site study was performed involving women reporting signs, symptoms, or complaints suggestive of rupture of membrane (ROM) between 21 and 42 weeks of gestation without obvious leakage of fluid from the cervical os during sterile speculum examination and without confirmation of ROM by traditional methods. Results: A total of 140 patients were recruited with a prevalence of ROM of 19.3%. The PAMG-1 test had a sensitivity of 100.0% [confidence interval (CI) 0.87–1.0], specificity of 99.1% [(CI) 0.95–0.99], positive predictive value of 96.3% [(CI) 0.82–0.99], negative predictive value of 100.0% [(CI) 0.97–1.0], and ± likelihood ratios of 74.6 [(CI) 20.31–274.51] and 0.0 [(CI) 0.00–0.98]. Conclusions: The PAMG-1 immunoassay in vaginal fluid yielded results that were comparable to those of the instillation of indigo carmine into the amniotic cavity; therefore, we propose that PAMG-1 is a sensitive and specific test to assess ROM in patients with an equivocal diagnosis based on simple tests. This finding prompts consideration for the use of the noninvasive PAMG-1 test in situations where the use of the invasive dye test is not practical.

Group B streptococcus colonization among pregnant women in Uruguay

Group B streptococcus (GBS) is one of the most common causes of neonatal sepsis. In the United States, 5%–10% of neonatal deaths are caused by this organism [1]. Early-onset GBS disease is defined as an infection occurring in the first week of life and accounts for approximately 70% of all GBS diseases in the first 3 months of life [2]. Sepsis develops in approximately 1% of neonates born to colonized women. It has been estimated that between 10%–30% of pregnant women are colonized by GBS. These figures have been reported mainly from high-income countries, with few studies from Latin America [1]. The objective of the present study was to determine the prevalence of GBS colonization in pregnant women using the method recommended by the Centers for Disease Control and Prevention (CDC) [2].

Normal Pregnancy Is Associated with Changes in Central Hemodynamics and Enhanced Recruitable, but Not Resting, Endothelial Function

Introduction. Flow-mediated dilation (FMD), low flow-mediated constriction (L-FMC), and reactive hyperemia-related changes in carotid-to-radial pulse wave velocity (ΔPWVcr%) could offer complementary information about both “recruitability” and “resting” endothelial function (EF). Carotid-to-femoral pulse wave velocity (PWVcf) and pulse wave analysis-derived parameters (i.e., AIx@75) are the gold standard methods for noninvasive evaluation of aortic stiffness and central hemodynamics. If healthy pregnancy is associated with both changes in resting and recruitable EF, as well as in several arterial parameters, it remains unknown and/or controversial. Objectives. To simultaneously and noninvasively assess in healthy pregnant (HP) and nonpregnant (NP) women central parameters in conjunction with “basal and recruitable” EF, employing new complementary approaches. Methods. HP (n = 11, 34.2 ± 3.3 weeks of gestation) and age- and cardiovascular risk factors-matched NP (n = 22) were included. Aortic blood pressure (BP), AIx@75, PWVcf, common carotid stiffness, and intima-media thickness, as well as FMD, L-FMC, and ΔPWVcr %, were measured. Results. Aortic BP, stiffness, and AIx@75 were reduced in HP. ΔPWVcr% and FMD were enhanced in HP in comparison to NP. No differences were found in L-FMC between groups. Conclusion. HP is associated with reduced aortic stiffness, central BP, wave reflections, and enhanced recruitable, but not resting, EF.

W071 PROCALCITONIN AND ROUTINE BIOMARKERS IN THE DIAGNOSIS OF MATERNAL AND FETAL INFLAMMATORY RESPONSE IN PREGNANT WOMEN WITH PPROM

67% had past medical problems such as asthma, Hypothyroid, depression. All had ITU admissions and average stay was 5 days. In relation to presenting symptoms all had tiredness/lethargy and 80% had cough, fever and 10% complained of breathlessness. There were 50% non immune (not vaccinated) women. All women were treated with Zanamivir and 2 patients had ECMO. Majority of them delivered at term and among these half had caesarean sections. Average birth weight was 2.9 kg. Conclusions: There should be a high index of clinical suspicion in pregnant women developing fever. There is good evidence of safety for both flu vaccines and antiviral medication and therefore pregnant women should be constantly reassured and advised to take flu vaccine.

Effect of whole-body pH changes on thoracic duct lymph flow in anesthetized sheep

Physiologic alterations of pH in vitro produce alterations of the oncotic pressure of both plasma and interstitial proteins, the effect being more marked in the latter. Therefore we postulated that by changing an animals pH we could produce alterations in fluid distribution and affect the whole-body lymph flow rate. To test this hypothesis, we infused seven acutely nephrectomized anesthetized sheep with 2% body weight/volume isosmotic lactated Ringers solution and bicarbonate (200 mEq) after a 30-minute control period. The fluid was infused over a 10-minute period with 20-minute recovery intervals. To another group of seven ewes, we infused the same volume of lactated Ringers solution and hydrochloric acid (40 mEq). Throughout the experiment, we continuously measured arterial and venous pressures and lymph flow rate. Every 10 minutes we obtained samples for arterial pH, for hematocrit, and for plasma and lymph protein and osmolality. The infusion of bicarbonate was associated with a comparatively lower peak lymph flow rate (383% over baseline compared with 757% for acid infusion). Also the lymph flow rate after acid infusion started to increase approximately 5 minutes after the beginning of the infusion, as compared with approximately 10 minutes after the base infusion. Acid infusion did not increase arterial pressure, in contrast to the other infusions. The changes in pH obtained with the infusions were insignificant for the Ringers infusion, +0.17 for the base, and -0.16 for the acid. The plasma/lymph protein concentration ratios at the end of the infusion were no different for acid or base: 112.4% +/- 4.4% and 101.9% +/- 5% (difference from control, mean +/- SEM) respectively (p greater than 0.1). In conclusion, minimal alterations of pH produced alterations in the cardiovascular and lymph flow rate responses to fluid challenge in anesthetized animals.