P166 Tumor necrosis factor-alpha, a prognosis factor in preeclampsia

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Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729

Conclusions: Family history of hypertensive disorders increases the risk of eclampsia and HELLP syndrome in a Brazilian population. P164 Circulating VEGF serum profile during pregnancy in prediction of preeclampsia – is it helpful? K. Biskupska Bodova1 , K. Dokus1 , P. Zubor1 , J. Ivankova2 , J. Stasko2 , J. Danko1 . 1 Dept. of Gynecology and Obstetrics of Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia, 2 Dept. of Hematology and Blood Transfusion of Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia Objectives: VEGF has been previously implicated as a likely candidate preeclampsia factor. Several studies have shown a tendency of VEGF serum levels to rise during normal pregnancies, while dropping levels were seen in women with preeclampsia. The aim of this study was to explore whether different VEGF profiles in pregnant women could be exploited in the prediction of preeclampsia. Materials and Methods: The prospective case–control study was set at the Dept. of Gynecology and Obstetrics of Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia. In total, 87 pregnant women were enrolled, 16 with preeclampsia and 71 with normal uncomplicated pregnancy served for controls. Preeclampsia was defined as a maternal blood pressure of 140/90 mmHg or greater with proteinuria (300 mg/24 hod). VEGF serum levels were determined by enzyme-linked immunoabsorbent assay (ELISA) 3 times in each pregnancy at 8–10 weeks, 15–17 weeks and 25–27 weeks. All data were statistically analyzed using parametric Student’s t-test and the statistical software Medcalc 10.2, Mariakerke, Belgium. A p-value less than 0.05 was considered significant. Results: Circulating serum VEGF levels at 8–10 weeks were 45.5±20.2 pg/mL in preeclampsia and 52.0±17.7 pg/mL in controls (p = 0.231). At 15–17 weeks the corresponding values were 29.2±9.8 pg/mL and 34.8±14.6 pg/mL (p = 0.22), and finally, at 25–27 weeks, 22.3±7.0 pg/mL and 22.5±6.9 pg/mL (p = 0.86). We have found no significant differences in VEGF levels among women with or without preeclampsia. Moreover, and contradictory to some of the previously published studies, VEGF levels during normal pregnancies and in preeclampsia had similar declining trends. Conclusions: Similar serum VEGF profiles during normal pregnancies and in preeclampsia probably do not support its use as an effective predictive tool of preeclampsia. P165 Imitators of severe preeclampsia – A case report of a postpartum hemolytic uremic syndrome and a review from the literature M. Brito, F. Santos, A. Paiva Introduction: Severe preeclampsia with hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and other obstetric, medical and surgical disorders produce similar clinical presentations and laboratory study results to preeclampsia. Imitators of severe preeclampsia-HELLP syndrome are life-threatening emergencies that can develop during pregnancy or in the postpartum period. They have a common pathophisiologic process that includes hemolytic anemia, thrombotic microangiopathy and thrombocytopenia. Despite of rare, these conditions are associated with high maternal mortality and morbidity. The differential diagnosis should always include acute fatty liver of pregnancy (AFLP), thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS) and acute exacerbation of systemic lupus erythematosus (ELSE). Sometimes, the overlap of several clinical and laboratorial findings makes diagnosis impossible. However, an accurate differential diagnosis should be made because complications and management are different. Case report: We report a case of HUS occurring 3 days after delivery in a 22 years old primigravida without previous hypertensive

disease. The diagnosis was based on abrupt renal failure and laboratorial evidence of hemolytic anemia and thrombocytopenia. Plasma exchange was started with fresh frozen plasma and 4 consecutive plasmapheresis sessions were given. A brief review from literature was made focused on diagnosis and management of these rare conditions. P166 Tumor necrosis factor-alpha, a prognosis factor in preeclampsia N. Costin, D. Mihu, L. Sabau, C. Mihu, L. Blaga. “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania Preeclampsia is an exacerbation of a generalized inflammatory response, physiologically present in the third trimester of pregnancy. The aim of the study consists on the evaluation of proinflammatory cytokine TNF-a in preeclampsia. The study was performed using following groups: Group 1 (preeclampsia) – 40 women; Group 2 (normal pregnancy) – 40 women; Group 3 (control group) – 30 healthy non-pregnant women. The pregnant women were followed up during the pregnancy, birth period and for 12 weeks postpartum. Serum TNF-a levels were determined by the immunometric sandwich EIA technique. The detection limit was 1.5 pg/ml. Acquired data were analyzed from statistical point of view using Student and ANOVA tests. The mean serum TNF-a concentration was: Group 1 – 14.15 pg/ml; SD ± 8.37; Group 2 – 5.71 pg/ml; SD±3.38; Group 3 – 2.01 pg/ml; SD±1.29. The results obtained confirm a significant increase (p < 0.01) in circulating TNF-a levels in the last trimester of pregnancy, compared to the non-pregnant status. Significantly increased serum TNF-a concentrations (p < 0.001) were also found in pregnant patients with preeclampsia, compared to normotensive pregnant women. The conclusions are: 1) Serum immunoreactive TNF-a concentrations were significantly increased in the last trimester of gestation in preeclampsia. 2) The positive and significant correlation of TNF-a with diastolic blood presure and uric acid levels makes this cytokine a potential marker of the severity of the preeclampsia. P167 Relation between consumption of foods which contain vitamin C and leukocyte ascorbic acid concentration with preeclampsia risk M. Ghabel1 , S. Mohammadalizadeh2 , T. Khadivzadeh3 , R. Dr Mahdavi2 . 1 Islamic Azad University of Bojnourd, 2 Tabriz University of medical Science, 3 Mashhad Univercity of Medical Science Background: Preeclampsia is a common disorder in pregnancy which threaten maternal and fetus life. Hypertension disorders are the third major cause of maternal mortality. Oxidative stress has an important role in pathophisiology of preeclampsia and the toxicity of free radical oxygen is neutralized at presence of antioxidants such as vitamin C, E and b-caroten. Method: In this case control study, 103 woman with preeclampsia and 100 women with normal pregnancy have been studied during postpartum hospital stay. Food Frequency Questionnaire was completed by them and their blood sample was collected in order to determine the concentration of intra leukocyte ascorbic acid. Data have been analyzed by suing of statistical test such frequency, valid percent, mean, standard deviation, standard Error, student t-test, Mann Whitney U, Pearson, chi-square. Result: The daily mean number of fruits and vegetables consumption, in the control group was higher than the case group. However the difference between two groups was not significant.Only 17.5% of cases and 16% of controls consumed less than the recommended five serving of fruits and vegetables daily. The daily mean consumption of ascorbic acid in the case group was significantly lower than the control group (P = 0.04). 18.4% of cases and 13% of controls consumed vitamin C less than the daily