Pre-eclampsia is known to cause considerable maternal morbidity and mortality. Thus, many studies have examined the etiopathogenesis of pre-eclampsia. While many pathophysiological factors related to pre-eclampsia have been identified, the precise etiopathogenesis of pre-eclampsia remains unclear. Numerous studies have identified factors for the early prediction for pre-eclampsia to lead to preparation and closer observation on pre-eclampsia when it occurs. This article reviews on current studies of biomarkers and genetic factors related to pre-eclampsia, which may be important for developing strategies for early prediction of pre-eclampsia.
Biomarkers* ; Early Diagnosis ; Mortality ; Pre-Eclampsia*

Pre-eclampsia is a major cause of maternal and perinatal mortality and morbidity worldwide, but remains unclear about the underlying disease mechanisms. Pre-eclampsia is currently believed to be a two-stage disease. The first stage involves shallow cytotrophoblast invasion of maternal spiral arteriole, resulting in placental insufficiency. The hypoxic placenta release soluble factors, cytokines, and trophoblastic debris into maternal circulation, which induce systemic endothelial damage and dysfunction. This cause the second stage of the disease: maternal syndrome. Epidemiological research has consistently demonstrated a familial predisposition to pre-eclampsia. Intensive research efforts have been made to discover susceptibility genes that will inform our understanding of the pathophysiology of pre-eclampsia and that may provide direction for therapeutic or preventative strategies. In this review, we summarize the current understanding of the role of genetic factors in the pathophysiology of pre-eclampsia and explain the molecular approach to search for genetic clues in pre-eclampsia.
Arterioles ; Cytokines ; Perinatal Mortality ; Placenta ; Placental Insufficiency ; Pre-Eclampsia ; Trophoblasts

Pregnancy and the puerperium are associated with an increased risk of stroke, and stroke is considered an important cause of maternal morbidity and mortality during this time. Pregnancy and delivery can lead to substantial alterations in systemic arterial and venous hemodynamics that may predispose to cerebrovascular disorders. We present one case of cerebral hemorrhage in puerperium after a normal pregnancy without any manifestation of preeclampsia or eclampsia and the other case with recurred cerebral hemorrhage in 16 gestational weeks pregnancy with previous cerebral hemorrhage history.
Cerebral Hemorrhage* ; Cerebrovascular Disorders ; Eclampsia ; Female ; Hemodynamics ; Mortality ; Postpartum Period* ; Pre-Eclampsia ; Pregnancy ; Stroke

Adult ; Cause of Death ; China ; epidemiology ; Embolism, Amniotic Fluid ; mortality ; Female ; Humans ; Maternal Mortality ; Postpartum Hemorrhage ; mortality ; Pre-Eclampsia ; mortality ; Pregnancy

Clinical observation was performed on 1412 cases of neonates which was seen at S.N.U.H. during the past 2years from Jan. 1975 to Dec. 1976. The results ware as following: 1. The incidence of prematurity (below 38wks) was 12.1% and the incidence of S.B.W. was 9.8% 2. The mortality rate of prematurity and L.B.W. was 7.35%. 3. The average sex ration of male to female was: Total neonates: 1.14:1 Prematurity: 1.06:1 : 0.88:1 4. High incidence of prematurity and L.B.W. was peaked on Dec. and Feb. 5. The mortaity rate was: under 1000gm: 100% under 1500gm: 50% under 24wks:100% under 30wks: 63% So liability was increased after 30wks and 1500gm. 6. The aberage duration of admission date was: 1000~1500gm: 30days 1500~2000gm: 20days 2000~2500gm: 5~8days 7. The relating factors to prematurity and L.B.W. was C-section, preeclampsia and eclampsia, twin, breech delivery and congenital syhpilis. 8. Autopsy was done only one cases, and the diagnosis ws primary atelecasis. 9. High mortality was seen from Dec. to Feb. and nearly within 24 hours. 10. Low incidence was seen 20~24 maternal age group. 11. High incidence rate in primipars (49.5%). 12. The physiologic weight loss was seen about 4~% days, aerage 9% (167.0gm). 13. Weight gain was: under 1250gm: 14.2gm/d over 1250gm: 27.5gm/d 14. Average discharge weight was (over 5 days admission): 2150gm.
Autopsy ; Diagnosis ; Eclampsia ; Female ; Humans ; Incidence ; Infant, Newborn ; Male ; Maternal Age ; Mortality ; Pre-Eclampsia ; Pregnancy ; Twins ; Weight Gain ; Weight Loss

Acute fatty metamorphosis is a rare but potentially fatal complication of the third trimester of pregnancy. In 20~40% of cases, acute fatty metamorphosis is associated with preeclampsia and may be difficult to distinguish from preeclamptic liver involvement. Recent reports suggest that the mortality has decreased to 25% fo both mother and fetus, due to largely to early delivery and to the recognition of a higher proportion of mild and nonfatal cases. We experienced one case of acute fatty liver metamorphosis that caused fulminant hepatitis and complete resolution, so we report the case and review of literature briefly.
Fatty Liver ; Female ; Fetus ; Hepatitis ; Humans ; Liver ; Mortality ; Mothers ; Pre-Eclampsia ; Pregnancy ; Pregnancy Trimester, Third

Preeclampsia is a hypertensive disorder involving multiple organs during the late gestational period. It may cause maternal and fetal morbidity and mortality. Preeclampsia parturients have an increased risk of cesarean delivery for several reasons including growth retardation of the intrauterine fetus, fetal distress and termination of pregnancy for treatment of severe preeclampsia. The hemodynamic state of preeclampsia varies depending on the onset, the severity of preeclampsia and the involved organs. Spinal anesthesia is recommended for preeclampsia parturients because of its rapid onset, stable hemodynamics and fewer neurologic complications. Hypotension during spinal anesthesia occurs less in preeclampsia, as compared to healthy pregnant women. Hemodynamic monitoring and planned fluid administration are important to anesthetic management of preeclampsia parturients.
Anesthesia, Spinal ; Female ; Fetal Distress ; Fetus ; Hemodynamics* ; Humans ; Hypotension ; Mortality ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women

OBJECTIVE: Preeclampsia is the major cause of prenatal mortality and morbidity. The functional disorder of uteroplacental insufficiecy is caused by the impaired uteroplacental blood flow and diffusion barrier in the villi. Functional disorders like placental circulating disorders results in morphological changes of terminal. villi as functional unit of placenta. We studied to investigate the differences in villous stoma of placental terminal villi and fetal capillary between growth restricted pregnancies with severe preeclampsia and normal preterm pregnancies. METHOD: Terminal villi was examined using light microscopy and by immunohistochemical localization of matrix molecule (alpha-smooth muscle actin and collagenIV) and the immunoreactivity of alpha-smooth muscle actin and collagenIV were evaluated in 17 cases of severe preeclampsia with intrauterine growth restriction as a study group and in 17 cases of gestational age matched normotensive preterm pregnancies as a control group. Fetal capillary congestion in terminal villi was also evaluated by Hematoxylin-Eosin staining. The patterns of immunohistochemical staining were all determinated in a visual qualitative manner (0-25%: -, 25-50%: +, 50-75%: ++, 75-100%: +++) by one pathologist. Congestion was considered to be present in a failed where the majority (>90%) of the capillaries demonstrated densely packed erythrocyte. RESULT: Expression of alpha-smooth muscle actin in the terminal villous stroma was significantly increased in study group compared with control group (P=0.0001). Expression of collagen IV in the terminal villous stroma was significantly increased in study group compared with control group (P=0.0001). Fetal capillary congestion was also significantly increased in study group compared with control group (P=0.049). CONCLUSION: The result suggests that there be the structural or biochemical difference in the villous stroma between normotensive preterm pregnancies and severe preeclampsia with intrauterine growth restriction and that the extravascular contractile system might be in the villous stroma in the severe preeclampsia intrauterine growth restriction.
Actins* ; Capillaries* ; Collagen ; Diffusion ; Erythrocytes ; Estrogens, Conjugated (USP)* ; Gestational Age ; Microscopy ; Mortality ; Placenta ; Pre-Eclampsia* ; Pregnancy*

Placental abruption is defined as the early separation a normal placenta from the wall of the uterus before delivery of the fetus. The incidence of it is known 1% of all pregnancies and perinatal mortality rates from abruption range from 20% to 40% in recent studies. The most common symptom is vaginal bleeding. The causes are associated with preeclampsia, other hypertensive disorders, and premature rupture of membranes. It is diagnosed by clinical symptom, sign, and ultrasonography. Recently we have experienced a case of placental abruption diagnosed at 31 weeks by ultrasonography in bicornuate uterus with a brief review of the literature.
Abruptio Placentae ; Female ; Fetus ; Incidence ; Membranes ; Perinatal Mortality ; Placenta ; Pre-Eclampsia ; Pregnancy ; Rupture ; Uterine Hemorrhage ; Uterus

The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p=0.006), sepsis (85.7% vs. 44%, p =0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p=0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p=0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p=0.0045), IVH (61.9% vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), intensive care (IC) (85.7% vs. 24%, p < 0.0001) and MV rate (80.1% vs. 14%, p < 0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p=0.0192), RDS (30% vs. 8%, p=0.0085), IVH (26% vs. 4%, p=0.0070), sepsis (44% vs. 14%, p=0.0015), IC (78% vs. 24%, p < 0.0001), MV rate (54% vs. 14%, p < 0.0001) and low 5-min APGAR score (50% vs. 16%, p=0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.
Premature Birth/*mortality ; Pregnancy Outcome/*epidemiology ; Pregnancy ; Pre-Eclampsia/mortality ; Male ; Infant, Newborn ; Humans ; HELLP Syndrome/*mortality ; Female ; Adult