Subendocardial stress in pre‐eclampsia

A primigravida 26‐year‐old woman who had developed pre‐eclampsia with malignant hypertension at 30 weeks of gestation suffered acute myocardial infarction two days postpartum. Electrocardiogram demonstrated diffuse ST‐segment depression suggestive of subendocardial ischemia. Echocardiography demonstrated focal asymmetric left ventricular hypertrophy, with a characteristic “basal septal bulge”, and a left ventricular mid‐cavitary gradient of 51 mmHg. Coronary angiography revealed normal coronary arteries and vascular flow. Peripartum acute myocardial infarction is rare and portends a high mortality. However, to date, only one case of acute myocardial infarction associated with asymmetric left ventricular hypertrophy and pre‐eclampsia has been described in the literature.     

Current and emerging pharmacotherapy for emergency management of preeclampsia

Introduction: Preeclampsia is a disease specific to pregnancy characterised by new onset hypertension with maternal organ dysfunction and/or fetal growth restriction. It remains a major cause of maternal and perinatal morbidity and mortality. For fifty years, antihypertensives have been the mainstay of treating preeclampsia, reducing maternal morbidity and mortality. With increased knowledge of the mechanisms underlying the disease has come opportunities for novel therapies that complement antihypertensives by protecting the maternal vasculature.

Areas covered: In this review, the authors consider, in detail, the antihypertensives commonly used today in the emergency care of women with severe preeclampsia. They also review less common anti-hypertensive agents and discuss the role of magnesium sulphate in the management of preeclampsia and the prevention of eclampsia. Finally, they explore novel therapeutics for the acute management of preeclampsia.

Expert opinion: The rapid control of maternal hypertension will, and must, remain the mainstay of emergency treatment for women with severe preeclampsia. The role of magnesium sulphate as a primary prevention for eclampsia is context dependant and should not displace a focus on correcting blood pressure safely. The exploration of novel adjuvant therapies will likely allow us to prolong pregnancy longer and improve perinatal outcomes safely for the mother.     

Metabolomics revealed decreased level of omega‐3 PUFA‐derived protective eicosanoids in pregnant women with pre‐eclampsia

Pre‐eclampsia (PE) is considered a leading cause of mortality and morbidity in pregnant women worldwide. Eicosanoids derived from polyunsaturated fatty acids (PUFAs) might play an important role in the occurrence and development of PE. Omega‐3 PUFAs are nutrients that are popular supplements for pregnant women and can reduce blood pressure. However, the levels of eicosanoids derived from omega‐3 PUFAs in women with PE is not clear. The purpose of this study was to investigate the eicosanoid metabolic signature of PE. We performed a case–control study using data for pregnant women (n = 10) with PE and normotensive pregnant women (n = 10). We investigated the difference in eicosanoid profile between the groups by LC‐MS/MS‐based metabolomics. The plasma levels of arachidonic acid metabolites and some of the lipoxygenase metabolites of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) showed an increasing trend, and those of the cytochrome P450 metabolites of EPA and DHA were decreased in women with PE. Levels of leukotriene B4, 14,15‐dihydroxy‐eicosatetraenoate, 16‐hydroxydocosahexaenoic acid and 8,9‐epoxy eicosatetraenoic acid were significantly correlated with PE occurrence. These eicosanoids might take part in the progression of PE in pregnant women.     

广东籍汉族妇女抗凝血酶Ⅲ和FactorⅤ基因多态性与子痫前期和子痫的相关性研究

目的探讨抗凝血酶III（AT-III）、凝血因子Ⅴ（FactorV）基因多态性与广东籍汉族早孕期妇女子痫前期和子痫发生的关系。方法回顾性分析567例早孕期广东籍汉族妇女AT-III及FactorV基因的突变情况,将其中54例妊娠20周后发生子痫前期和子痫的患者作为观察组,513例正常妊娠者作为对照组。基因突变检测分别采用DdeI和MnlI限制性内切酶片段长度多态性分析。结果观察组ATIIIDdeI＋＋、DdeI＋-及DdeI--基因型频率分别为51.9%、27.8%和20.4%,对照组则分别为66.7%、25.5%和7.8%。观察组AT III DdeI-基因型频率显著高于对照组（34.3%,20.6%,P〈0.01）,AT III DdeI--基因型在子痫前期和子痫发病中的相对风险率为3.025。观察组和对照组均未检出Factor VLeiden突变。结论 ATIII基因多态性可能与广东籍汉族妇女子痫前期和子痫发病相关,而Factor VLeiden突变与其发病无关。