Von Willebrand factor multimeric levels and patterns in patients with severe preeclampsia

Article Abstract:

Three conditions affecting pregnant women that require different treatments can be confused diagnostically, with grave consequences. These are preeclampsia (severe hypertension and edema, or swelling, of the extremities, with other symptoms); acute thrombotic thrombocytopenic purpura (a reduction in platelets, blood cells essential for clotting, and the presence of small blood clots in all organs); and the hemolytic uremic syndrome (increased blood urea, associated with destruction of red blood cells). The prognosis for the latter two conditions, if untreated, is not good. Thrombocytopenia (reduced levels of platelets), hemolytic anemia (destruction of red blood cells) and neurologic changes, however, may be present in severe preeclampsia; proper treatment usually prevents death. A constellation of symptoms in preeclamptic patients is labeled the 'HELLP syndrome' (HELLP stands for hemolysis, elevated liver functions, and low platelets). Von Willebrand factor is a blood clotting factor (a protein that is part of clotting factor VIII) that promotes the adhesion of platelets to endothelial cells (such as the cells lining the blood vessels) that may be altered in the HELLP syndrome. Accordingly, blood samples from seven patients with the HELLP syndrome were evaluated for the content of von Willebrand factor. Results showed that the levels of von Willebrand factor were significantly elevated in the six preeclamptic patients. One patient, ultimately diagnosed with chronic relapsing thrombotic thrombocytopenic purpura, had extremely high levels of von Willebrand's factor. However, the von Willebrand factor multimeric forms (where the factor molecules are larger than normal) of the HELLP patients were similar to those identified in a group of normal, nonpregnant females. The thrombotic thrombocytopenic patient had unusually large multimers. Screening for von Willebrand factor can help detect chronic relapsing thrombotic thrombocytopenia, a rare disorder, in patients with the HELLP syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Measurement, Preeclampsia, Blood coagulation factors, Thrombocytopenia, Pregnancy, Complications of, Pregnancy complications, Von Willebrand factor

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Antepartum and intrapartum events in women exposed in utero to diethylstilbestrol

Article Abstract:

Women who were exposed to diethylstilbestrol (DES) in utero as a consequence of their mothers' ingestion of the drug have a higher-than-average rate of poor pregnancy outcomes (miscarriage, premature delivery, or cervical incompetence). To learn more regarding this issue, researchers assessed 45 women with a history of intrauterine DES exposure who delivered 49 infants at one hospital. The control group was composed of women with similar parity (number of children previously delivered) who reported an absence of DES exposure. The medical records of subjects and controls were reviewed, with attention to factors related to fertility, DES-associated abnormalities, and labor and delivery complications. Results showed that DES-exposed women were significantly older than controls, were more likely to have a history of infertility, an abnormal uterine cavity, and to have undergone X-ray studies of the fallopian tubes (through which the egg travels en route to the uterus). No differences were noted in the rates of previous miscarriage, preeclampsia (a complication of pregnancy associated with high blood pressure, edema, and headache), glucose intolerance, or premature rupture of the membranes surrounding the fetus. DES-exposed women were more likely to have undergone cesarean section and manual removal of the placenta. Their blood loss during vaginal delivery was higher than that of controls; four women developed hemorrhage, three requiring transfusions. Graphs that related the amount of cervical dilation to the hours in labor (labor curves) were similar for subjects and controls who were delivering their first baby; however, of the women with previous deliveries, DES-exposed women dilated more slowly than controls. Overall, DES-exposed women experienced more complications during the third stage of labor (the placental stage). Clinicians should be aware of this possibility. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Complications and side effects, Physiological aspects, Labor, Complicated, Labor complications, Diethylstilbestrol

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Prolife perinatologist - paradox or possibility?

Article Abstract:

It may be possible for physicians who are prolife to practice perinatal medicine, or maternal-fetal medicine. Individuals who are prolife believe that human life begins at conception. Those who are prochoice believe that the rights of the mother are more important than those of the fetus. Perinatal medicine started with the development of amniocentesis to diagnosis and treat fetal conditions during the third trimester. Development of diagnostic tests performed during the second trimester made it possible to diagnose untreatable abnormalities, and increased the number of abortions. Ending a pregnancy may save woman's life or decrease her emotional burden. Ending a pregnancy also has risks, or may not decrease emotional suffering. Individuals considering specializing in perinatal medicine should resolve their feelings about abortion before they enter this subspeciality. Perinatologists who are prolife may have a different political agenda than their colleagues who are prochoice.Each should respect their colleagues' and patients' opinions, and provide patients with objective information on different treatment options.

Column, Ethical aspects, Abortion, Perinatology

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