Rose Gasnier

Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome

To examine, in patients with premature rupture of the amniotic membranes (PROM) at < 34 weeks of gestation, the relationship between fetal myocardial performance measured by the Tei index and fetal inflammatory response syndrome (FIRS).

Calciuria and preeclampsia: a case-control study.

Aim:  Calciuria has been reported to decrease in preeclampsia. We compared calciuria among groups of normal, hypertensive and preeclamptic pregnant women, and assessed its correlation with the severity of the disease.

Natriuria and calciuria levels in preeclampsia : a cross-sectional study

CONTEXT AND OBJECTIVE Sodium excretion abnormalities in preeclampsia have been studied in relation to several factors. The objective of this study was to compare natriuria (mEq/24 h) and calciuria levels (mg/24 h) in preeclamptic patients. DESIGN AND SETTING An analytical cross-sectional study with a control group was conducted in the obstetric center and the high-risk pregnancy outpatient clinic at a university hospital in southern Brazil, and in a primary healthcare unit in the same city, including pregnant women with mild preeclampsia, severe preeclampsia or chronic hypertension, and women with normal pregnancies (14 patients in each group). METHOD Natriuria was measured using an ion-selective electrode in an automated clinical chemistry analyzer (Hitache 917, Roche). All the patients collected 24-hour urine, at home or at the hospital, for analysis of proteins, creatinine, calcium, sodium and uric acid. Quantitative variables with asymmetrical distribution were described using the median, minimum and maximum, and were compared using the Kruskal-Wallis test. The results were logarithmically transformed, with one-way analysis of variance (ANOVA) by ranks and then the post-hoc Tukey test, and were analyzed by means of the Spearman correlation and receiver operating characteristic (ROC) curve. The significance level used was 0.05. RESULTS There were significant differences between the groups in comparing severe preeclampsia with chronic hypertension and severe preeclampsia with controls (P < 0.0001 for both measurements). CONCLUSION Natriuria levels may be lower in preeclampsia when associated with calciuria. Natriuria assessment is an additional test for differential diagnosis of hypertensive diseases in pregnancy, but is a poor predictor when used alone.

Antihypertensive drugs in pregnancy

Chronic hypertension complicates 3%-5% of pregnancies and gestational hypertension occurs in 6% of pregnancies. Preeclampsia complicates 25% of the pregnancies with chronic hypertension, and approximately 15%-45% of the patients with gestational hypertension will develop preeclampsia, a dangerous condition that harms the maternal and fetal safety. Antihypertensive medication is used to treat severe hypertension to prevent serious maternal and fetal complications, but there is no consensus on when and how to treat mild-to-moderate hypertension in pregnancy. This article reviews the usage, effect and safety of first, second and third line antihypertensive drugs for mild-to-moderate hypertension in pregnancy.

Calcium-to-creatinine ratio in pregnancy-induced hypertension☆

OBJECTIVES Hypocalciuria has been correlated with preeclampsia. This study compared the calcium-to-creatinine ratio among the groups, and the correlation with the 24-h measurement of this ratio and a diagnosis of preeclampsia. STUDY DESIGN Case-control study including mild and severe preeclampsia, chronic hypertension and normal pregnancy. MAIN OUTCOME MEASUREMENTS The calcium-to-creatinine ratio differentiates severe preeclampsia from mild preeclampsia, chronic hypertension and normal pregnancy. RESULTS There were statistically significant differences between the groups when comparing severe preeclampsia and chronic hypertension, severe preeclampsia and normal pregnancy, and mild and severe preeclampsia (p<0.0001). The Spearman index between the calcium-to-creatinine ratio and 24-h calciuria was 0.65 (high correlation). CONCLUSIONS The calcium-to-creatinine ratio can reliably estimate 24-h calciuria, differentiating severe preeclampsia from mild preeclampsia, chronic hypertension and normal pregnancy.