Pregnancy Management of Preeclampsia

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (25 January 2024) | Viewed by 1544

Special Issue Editors

Department of Obstetrics and Perinatology, Medical University of Lublin, Jaczewskiego 8, 20-950 Lublin, Poland
Interests: preeclampsia; maternal-fetal and neonatal medicine; HELLP; placenta; fetal growth restriction (FGR)
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Department of Obstetrics and Perinatology, Medical University in Lublin, Lublin, Poland
Interests: maternal nutrition; high fat diet; overfeeding
Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland
Interests: bioanalytics; pathobiochemistry; environmental and food chemistry; diets; trace elements; heavy metals; toxicity; selenium and iodine in autism; spectrum disorders; obesity; thyroid pathologies; clinical samples; medical applications of modern instrumental techniques; validation studies
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Special Issue Information

Dear Colleagues,

Severe preeclampsia is a complex disease process and serious pregnancy complication characterized by hypertension often accompanied by proteinuria and multiorgan dysfunction, occurring in 2% to 8% of all pregnancies.

In severe cases, an attack of eclamptic seizures, premature separation of the placenta, DIC, intracranial hemorrhage, HELLP syndrome, renal failure, and even maternal and fetal death may occur. Preeclampsia and eclampsia are two of the most serious pregnancy-related complications and the main causes of death of pregnant and delivering women. The mortality rate of young mothers reaches 5–20%. The mortality rate of fetuses and infants associated with this severe pregnancy complication is estimated at 7–40 %, and this is mainly the result of such complications as preterm placental abruption, placental insufficiency, intrauterine death of fetus, and complications arising from prematurity.

Although we currently know several pathogenetic mechanisms that may lead to the development of preeclampsia, the exact etiology of these specific for human pregnancy diseases is not fully explained. Currently, there is no effective treatment to stop the progress of clinical deterioration. Delivery is the only definitive treatment. Although other treatment options are limited, childbirth is not always favorable for the fetus, especially at a time far from the expected date of delivery, originating prematurity-associated consequences for the newborn.

The aim of this Special Issue is to present an updated approach to clinical issues around pregnancy complicated by preeclampsia with special focus on diagnosis, clinical management, complications, timing, and mode of delivery.

Clinical researchers, gynecologists–obstetricians, and maternal–fetal medicine specialists are welcomed to submit their works that contribute to improve pregnancy outcomes in preeclamptic women and lowering maternal and fetal mortality and morbidity.

Thus, all original research articles or reviews on topics related to pregnancy in women with preeclampsia and HELLP syndrome are welcome in this Special Issue. Topics will include:

  1. Clinical management of preeclampsia, eclampsia, and severe hypertension in pregnant women—diagnosis, complications, surveillance, mode of delivery.
  2. HELLP syndrome—diagnosis, emergency management, timing and mode of delivery, surveillance. Corticosteroid therapy—advantages and disadvantages.
  3. Preeclampsia—complications such as acute kidney insufficiency, eclampsia seizures, pulmonary oedema, and fetal growth restriction.

Dr. Marzena Laskowska
Prof. Dr. Oleszczuk Jan
Dr. Anna Błażewicz
Guest Editors

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Keywords

  • preeclampsia
  • eclamptic convulsions
  • HELLP syndrome
  • pregnancy complicated by hypertension
  • emergency complications
  • fetal growth restriction in preeclampsia

Published Papers (2 papers)

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Research

11 pages, 868 KiB  
Article
Preeclampsia Management and Maternal Ophthalmic Artery Doppler Measurements between 19 and 23 Weeks of Gestation
J. Clin. Med. 2024, 13(4), 950; https://doi.org/10.3390/jcm13040950 - 07 Feb 2024
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Abstract
Background: The ophthalmic Doppler is a reliable and impartial way to assess the severity of preeclampsia (PE). The study aimed to assess the potential utility of Doppler measurements of the maternal ophthalmic arteries during the weeks 19–23 of gestation, both independently and [...] Read more.
Background: The ophthalmic Doppler is a reliable and impartial way to assess the severity of preeclampsia (PE). The study aimed to assess the potential utility of Doppler measurements of the maternal ophthalmic arteries during the weeks 19–23 of gestation, both independently and in combination with established biomarkers for PE. Methods: A prospective cohort study was conducted involving women who were recruited from a variety of standard appointments, including booking, scanning, and regular prenatal visits. A total of 200 women that were divided into high-risk and low-risk groups for developing PE were involved during the period between April 2023 and November 2023. Results: The ophthalmic ratio had significantly higher values in high-risk patients than in low-risk women (p = 0.000). There was a significant relationship between PSV2/PSV1 and gestational age at birth in women with PE compared to the ones who did not develop PE. Conclusions: An ophthalmic artery Doppler can play a crucial role in the early detection of PE, allowing for timely intervention and management. Incorporating the ophthalmic artery Doppler as a screening tool for PE in Bulgaria has the potential to improve early detection, risk stratification, and overall maternal and fetal health outcomes. Full article
(This article belongs to the Special Issue Pregnancy Management of Preeclampsia)
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9 pages, 865 KiB  
Article
Pregnancy Outcomes of Conservative Management in Preeclampsia with Severe Features
J. Clin. Med. 2023, 12(19), 6360; https://doi.org/10.3390/jcm12196360 - 04 Oct 2023
Viewed by 845
Abstract
Objective: To study the pregnancy outcomes of conservative treatment for preeclampsia with severe features. Methods: A retrospective study was conducted on pregnancies with preeclampsia with severe features at gestational age 23–34 weeks and that received conservative management at Chiang Mai University Hospital between [...] Read more.
Objective: To study the pregnancy outcomes of conservative treatment for preeclampsia with severe features. Methods: A retrospective study was conducted on pregnancies with preeclampsia with severe features at gestational age 23–34 weeks and that received conservative management at Chiang Mai University Hospital between January 2014 and August 2020. The women were divided into two groups: (1) pregnancy prolongation of at least 48 h and (2) pregnancy prolongation of less than 48 h. Results: Of the 100 recruited pregnancies, the median gestational age was 29 weeks (range 23–34). Of these, 65 cases (65%) had pregnancy prolongation of at least 48 h, and 35 cases (35%) had prolongation of less than 48 h. The median pregnancy prolongation was 2.9 days (range 4 h–27.7 days). Eighty-seven (88%) pregnant women experienced no complications. Multivariate analysis shows that high urine protein/creatinine ratio (UPCI) at admission was significantly associated with pregnancy prolongation of less than 48 h with an odds ratio for prolongation for at least 48 h of 0.86 (95% CI 0.75–0.99: p-value 0.04). Kaplan–Meier analysis shows that the mean time of prolongation was 3.6 days vs. 6.7 days, and median time of prolongation was 2.1 days vs. 4.4 days in the group of high and low UPCI (using cut-off 1.0), respectively. The number of prolonged days was significantly lower in the high UPCI group than in the low UPCI group (log-rank test, p = 0.01). The maternal and fetal outcomes between the two groups were not significantly different. The cesarean section rate was also comparable. The mean birth weight and gestational age at delivery were not significantly different, though they had a higher trend in the group of successful conservative management. Conclusion: The rate of pregnancy prolongation of at least 48 h with conservative management was 65%, with a median prolongation time of 2.9 days. A new insight gained from this study is that high UPCI at admission is an independent factor for prolongation of less than 48 h with conservative treatment. Nevertheless, the maternal and fetal outcomes between the two groups were not significantly different. Therefore, the benefit and risk of expectant management in actual practice of service settings in terms of maternal and fetal morbidity is still unclear. Full article
(This article belongs to the Special Issue Pregnancy Management of Preeclampsia)
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