Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study

Article Abstract:

Preeclampsia (a disease of pregnancy associated with high blood pressure, edema, and protein in the urine), affects 6 percent of first pregnancies and complicates many others. If untreated, it can progress to a life-threatening condition. To learn more concerning the physiological alterations that occur in preeclampsia, a longitudinal study was performed with 179 pregnant women enrolled during or before their 22nd week of pregnancy. They underwent hemodynamic evaluation at intervals throughout the study, including measurement of blood pressure, cardiac output (volume of blood pumped by the heart per minute), diameter of the aorta (the artery that carries all blood away from the heart to the body as it pumps), and other parameters. Three hypotheses guided the research: high cardiac output is the main hemodynamic abnormality in preeclampsia; this elevation occurs early in pregnancy, before preeclampsia is suspected; and increased vascular resistance (which, for instance, may be caused by blood vessel constriction) sometimes posited as a cause of the disorder, is really only found in some very extreme cases. Results showed that 9 and 81 women developed preeclampsia or gestational hypertension (high blood pressure), respectively, while the rest had normal blood pressure. The women with preeclampsia had elevated cardiac output throughout their pregnancies, and it remained elevated six weeks after they gave birth. Vascular resistance was lower in these women than in women with normal blood pressure. Taken together, the results indicate that increased cardiac output precedes vasoconstriction in preeclampsia, producing vasodilatation. Dilated blood vessels are then particularly vulnerable to injury; when injury occurs to the cells that line blood vessels, the changes associated with preeclampsia follow. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Hemodynamics

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Urinary calcium as an early marker for pre-eclampsia

Article Abstract:

Preeclampsia is a toxic condition during pregnancy that is characterized by increasing hypertension, or abnormally high blood pressure; headaches; albuminuria, or albumin in the urine; and tissue fluid accumulation in the lower extremities. Studies show that aspirin and calcium supplements may be beneficial in patients with a high risk of developing preeclampsia. However, accurate methods are needed to identify those women at risk of preeclampsia. Patients with preeclampsia were shown to excrete lower amounts of calcium in the urine than healthy pregnant women did. It is not known whether the decrease in urinary calcium excretion develops before or after hypertension. Urinary calcium excretion was measured in 103 pregnant women thought to be at risk of preeclampsia. Measurements were made at 10 to 24 weeks, 25 to 32 weeks, and 33 weeks to term during the pregnancy. The results showed that women who developed preeclampsia tended to have lower urinary calcium excretion throughout pregnancy as compared with women who did not develop preeclampsia. The value of urinary calcium excretion rate below which hypertension could be predicted was 195 milligrams per 24 hours. The risk of developing preeclampsia in patients with a calcium excretion rate below this threshold was estimated. These findings show that urinary calcium excretion rate may help to identify patients at risk of developing preeclampsia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Calcium in the body, Calcium (Nutrient)

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Protein/creatinine ratio in random urine specimens for quantitation of proteinuria in preeclampsia

Article Abstract:

Preeclampsia is a condition of pregnancy in which hypertension (high blood pressure), headaches, protein in the urine, and edema (swelling) of the face and extremities occur; if not treated, it can progress to eclampsia, a life-threatening condition, characterized by convulsions and coma. The concentration of protein in the urine is one important indicator of the degree to which preeclampsia has progressed, so a test that determines this quickly and accurately is desirable. Results from a proposed test for measuring the urinary protein/creatinine ratio are reported. Thirty-five pregnant women with preeclampsia were studied, and the findings were compared with those of 70 healthy subjects. Each subject collected all urine excreted during a 24-hour period, as well as an additional sample (random sample) at the end of that time. The protein/creatinine ratio was dramatically elevated among the preeclamptic women and the ratio was strongly correlated with the protein concentration in the 24-hour sample. Thus, it appears that the protein/creatinine ratio is a good indicator of the extent of proteinuria, with the added benefits of greater ease of collection and reliability, since collection of 24-hour urine samples are often incomplete. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Testing, Proteinuria

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