China
Africa
Explore chapters and articles related to this topic
Multiple gestation
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Regardless of the inherent changes in maternal physiology due to the multiple pregnancy, some maternal disease conditions are more frequent in multiple gestations. The best example is the two to three times increased incidence of hypertensive disorders (8,9) and their most dangerous complication—eclampsia—is six times more frequent among mothers of multiple gestations (10). Moreover, pre-eclampsia occurs earlier in multiples than in singletons and often occurs in a more severe form. It appears that a plurality-dependent risk of pre-eclampsia exists. For example, with the current epidemic dimensions of multiple gestations, it has been shown that the risk of hypertensive disorders in triplets is higher than that in twins, and the risk in twins is higher than that in singletons (8). In addition, numerous reports exist on the resolution of severe pre-eclampsia following intrauterine demise of a twin. Interestingly, the reason for the increased risk of hypertensive disorders among multiples is still unclear, but data seem to support an association with the increased placental mass, that is, hyperplacentosis (8,11). At this point it is important to mention that several rare but potentially pre-eclampsia-related conditions such as acute fatty liver of pregnancy are also more frequent in multiple gestations and seem to demonstrate the plurality-dependent risk pattern.
Acute Fatty Liver of Pregnancy
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Janaka de Silva, Sanjeewa Padumadasa
Acute fatty liver of pregnancy is more frequent in primigravida, older women, women with low Body Mass Index, multiple pregnancy and apparently, also in the presence of a male fetus. The pathogenesis of AFLP, although still not completely elucidated, has been attributed to defective mitochondrial β-oxidation of fatty acids – a mitochondrial cytopathy. Mutations in genes coding fetal fatty acid oxidation have been found to be associated with AFLP. Levels of free fatty acids increase during pregnancy, especially during the third trimester, to ensure that the fetus has an adequate source of energy. When fetuses are either homozygous or heterozygous (to a lesser extent) for long-chain 3-hydroxyacyl-coenzyme A dehydrogenase (LCHAD) deficiency, they have deranged fatty acid metabolism that leads to impaired uptake and oxidation of fatty acids. In these instances, the unmetabolized medium and long-chain fatty acids re-enter the maternal circulation and overwhelm the fatty acid β-oxidation enzymes of the woman if she is heterozygous for LCHAD deficiency and brings about microvesicular fatty infiltration of her hepatocytes (steatosis).
Hypertension and pre-eclampsia (PET)
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Diagnosis is achieved by identifying signs and symptoms on a criteria list (see Box 3.12). The Swansea Criteria for diagnosis of Acute Fatty Liver of Pregnancy is accepted at present for a clear diagnosis, but other markers may also be taken into consideration42,49. Liver biopsy is the gold standard diagnostic test but is rarely done due to coagulopathy. Following stabilisation of the woman’s condition, the baby will be delivered and, as the woman with AFLP is usually very ill, she will be cared for initially in a critical care or intensive care unit. In very serious cases a liver transplant may be considered.
Higher baseline alanine aminotransferase level is associated with lower live birth rate after freeze-thawed embryo transfer
Published in Gynecological Endocrinology, 2022
Shuping Zhang, Hongyi Xu, Juan Chen, Ying Zhang, Zhifeng Sun, Lijuan Luo, Xiaoning Wang, Xing Jiang, Chenglong Jiang, Kai Deng, Changjun Zhang
Liver diseases affect about 3% of pregnancies and can be directly related to the pregnancy (e.g. hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, preeclampsia, eclampsia, and HELLP syndrome) or be unrelated to the pregnancy, either already present before pregnancy or occurring during pregnancy (e.g. cirrhosis, portal hypertension, chronic hepatitis B or C, autoimmune liver diseases, and history of liver transplantation) [12]. Such conditions will affect the pregnancy outcomes and can even be fatal to the fetus and the mother [12, 20]. Still, subclinical liver conditions that never develop into overt liver dysfunction can also affect the pregnancy outcomes [20, 21], and such conditions might manifest as elevated ALT without other symptoms. Furthermore, unexplained ALT elevation in pregnancy is associated with the development of gestational diabetes and preeclampsia [22]. In women with cholestasis, high ALT levels are associated with adverse perinatal outcomes [23]. Still, the exact causes of elevated ALT elevation in the absence of a clear diagnosis of liver disease should be further investigated.
Physiological characterization of an arginine vasopressin rat model of preeclampsia
Published in Systems Biology in Reproductive Medicine, 2022
Sapna Ramdin, Thajasvarie Naicker, Virushka Pillay, Sanil D. Singh, Sooraj Baijnath, Blessing N Mkhwanazi, Nalini Govender
Liver diseases are reported to affect approximately 3% of pregnancies, resulting in maternal and fetal mortality (Mikolasevic et al. 2018), hence it is important to not rule out these variations in the liver injury enzymes. It may be potential indicators of liver dysfunction such as intrahepatic cholestasis of pregnancy or acute fatty liver of pregnancy manifesting in late pregnancy (Mikolasevic et al. 2018). This is typical in patients who present with HELLP syndrome, which is seen in severe cases of PE, however, our data indicates mild AVP induced blood pressure elevations, suggestive of mild PE onset. HELLP syndrome is a pregnancy-associated liver disease and is a predisposing factor for the progression of PE to eclampsia (Barton and Sibai 2004; Jeyabalan 2013; Brown et al. 2018). Reproducing this HELLP phenotype in animal models of PE will support the investigation of mechanisms implicated in PE development and its progression from severe PE to eclampsia.
Hsa_circRNA_102682 is closely related to lipid metabolism in gestational diabetes mellitus
Published in Gynecological Endocrinology, 2022
Hangyu Wu, Xufeng Zheng, Yan Liu, Jun Shen, Mei Ye, Yisheng Zhang
A retrospective case–control study was conducted at Li Huili Hospital, Ningbo Medical Center, China, between January 10 2018, and February 20 2019. Plasma samples were obtained from women with and without GDM at 36–40 weeks of pregnancy. In this study, we excluded other pregnancy-related diseases, chronic hypertension, multiple pregnancy, viral hepatitis, chronic nephritis, pancreatitis, internal and surgical infections, acute fatty liver, pre-pregnancy type 1 or type 2 women with diabetes or obesity (body mass index [BMI] ≥ 30). The study was approved by the Ethics Committee of Ningbo Medical Center Li Huili Hospital. All participants provided informed consent for the use of their blood samples in clinical studies. Pregnant women were screened for GDM at 24–28 weeks of gestation. The one-step method is used as the screening standard of 75 g oral glucose tolerance test (OGTT). GDM can be diagnosed when the blood glucose value reaches the following parameters at any time: fasting blood glucose 5.1 mmol/L, 1 h postprandial blood glucose 10.0 mmol/L, and 2 h postprandial blood glucose 8.5 mmol/L.