Prediction of maternal predisposition to preeclampsia

in Hypertension in Pregnancy : Official Journal of the International Society for the Study of Hypertension in Pregnancy (2008), 27(3), 237-45

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 ... [more ▼]

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 patient's 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. [less ▲]

La prevention de la prematurite en Communaute francaise a l'approche de l'an 2000

in Revue Médicale de Liège (1999), 54(5), 440-3

The actual results confirm the dominating influence of psychosocial factors on prematurity and low birth weight. The study performed in Liege indicates that these factors must be taken into account for ... [more ▼]

The actual results confirm the dominating influence of psychosocial factors on prematurity and low birth weight. The study performed in Liege indicates that these factors must be taken into account for better care of the future mother. The systematic use of a prenatal questionnaire on psychosocial factors draws attention towards the personal situation of the future mother. Detection of some organic or psychosocial risk factors must prompt prophylactic measures even in the absence of any sign of pathologies. Prevention of prematurity has, over the last 30 years, been the primary objective of prenatal follow-up. Its importance must be further emphasized. [less ▲]

Les effets de l'induction du travail sur le déroulement de l'accouchement

in Revue Médicale de Liège (1998), 53(11), 665-8

Labour induction has become a common practice. Given the significant number of induced deliveries carried out each year, it is important to know the consequences of this induction policy. The effects of ... [more ▼]

Labour induction has become a common practice. Given the significant number of induced deliveries carried out each year, it is important to know the consequences of this induction policy. The effects of labour induction on the childbirth are still the subject of considerable controversy. The increase of the caesarean and instrumental extraction rates has already been emphasized in previous studies. This article is based on an analysis of 10,045 deliveries carried out in the CHR Obstetrical Clinic of La Citadelle, between 1991 and 1997. The conclusions are instructive. Thus a departmental policy of setting an induction level of 35% will allocate 2/3 of the workload between 8:00 AM and 8:00 PM during the week, with a preponderance on Friday. The Caesarean rate is not increased but peridurals and recourse to instrumental extraction are more frequent. [less ▲]

Attitudes obstétricales: Consensus de Département ULg. Document des cours de troisième cycle, octobre 96

in Revue Médicale de Liège (1997), 52(3), 142-8

Blunted erythropoietin production and decreased erythropoiesis in early pregnancy.

in Blood (1991), 78(1), 89-93

After decreasing in the first trimester of pregnancy, the total red blood cell mass increases in the second and third trimesters to peak at term at about 120% to 125% of nonpregnant values, but how this ... [more ▼]

After decreasing in the first trimester of pregnancy, the total red blood cell mass increases in the second and third trimesters to peak at term at about 120% to 125% of nonpregnant values, but how this is brought about by changes in the rate of erythropoiesis is not known. We evaluated erythropoiesis by measuring serum transferrin receptor (TfR) levels in 406 women during normal pregnancy (N = 317), at delivery (N = 63), or in the early postpartum (N = 27). Despite the presence of the placenta and the frequent occurrence of iron deficiency, TfR levels remained low in the first two trimesters and increased in the third trimester and at delivery. To explain why erythropoiesic activity was relatively low in early pregnancy, we also measured serum immunoreactive erythropoietin (Epo) in relation to the degree of anemia. There was a very strong correlation between serum TfR and Epo levels in the entire group (r = .59, P less than .0001) as well as in each period of pregnancy. Epo levels remained low for the degree of anemia and did not correlate with hematocrit in the first two trimesters, but recovered afterwards. In the early postpartum, Epo production and erythropoiesis were normal. We conclude that: (1) erythropoiesis is decreased in the first part of pregnancy but increases afterwards; and (2) blunted Epo production in early pregnancy could be responsible for that observation. [less ▲]