viernes, 24 de julio de 2009

Pre-eclampsia

Valores de proteinuria y daño vascular en gestantes sanas, preeclámpticas y con hipertensión no proteinúrica, evaluados por ultrasonografía vascular

Keisy López Molina, Julio E. Valdivia-Silva, Juan C. González Altamirano

a Grupo de Investigación en Inmunología. Facultad de Medicina. Universidad Nacional San Agustín de Arequipa. Arequipa. Perú

b Instituto de Investigaciones Biomédicas. Universidad Nacional Autónoma de México. México DF. México

c División de Cardiología y Cirugía de Tórax. Hospital Nacional del Sur. CASE EsSalud. Arequipa. Perú 

ABSTRACT

Objective

To compare the effectiveness of vascular ultrasonography and proteinuria in diagnosing systemic vascular damage.

Subjects and methods

Forty healthy pregnant women, 35 with preeclampsia, and 35 with non-proteinuric hypertension in the Yanahuara and Nacional del Sur hospitals in Arequipa (Peru) underwent measurement of blood pressure, proteinuria, and ultrasonographic studies in the humeral artery to obtain their flow-mediated dilation (FMD). Comparisons between the three groups were made using ANOVA or Kruskal-Wallis tests, depending on whether the distribution was normal or non-normal, respectively. Values of P<0.05 were considered statistically significant.

Results

Proteinuria values were 0.05 g/24 h, 2.57 g/24 h and 0.21 g/24 h while FMD values showed mean values of 0.66mm, 0.25mm, and 0.45mm for healthy pregnant women, women with preeclampsia and women with non-proteinuric hypertension, respectively. Comparison of FMD among groups showed significant differences among the groups (P<.01). However, proteinuria values in the group with non-proteinuric hypertension were within the normal range (< 0.03 g/24 h). No relation was found between FMD and proteinuria.

Conclusions

Ultrasonographic evaluation of FMD detected vascular damage even in the group of pregnant women with pregnancy-induced hypertension without proteinuria.

Progresos de Obstetricia y Ginecología 01/2009; 52(1). DOI:10.1016/S0304-5013(09)70139-6  

Md PhD Julio E Valdivia-Silva. Fundador del GII

Md Keisy López-Molina. Ex miembro del GII


Pre-eclampsia

Effect of early L-arginine therapy on intrauterine growth restriction in preeclampsia. A randomized controlled trial in Latin-American women

Julio E Valdivia-Silva a, Keisy López-Molina b, Rodney Macedo b

a Oncoinmunología y Biología Vascular. Facultad de Medicina. Universidad Nacional San Agustín. Arequipa. Perú. Departamento de Inmunología. Instituto de Investigaciones Biomédicas. México DF. México.
b Oncoinmunología y Biología Vascular. Facultad de Medicina. Universidad Nacional San Agustín. Arequipa. Perú.

 

Abstract

Objective: To assess the benefit of early L-arginine administration in preeclampsia on the relative risk to fetal growth. Patients and methods: One-hundred women with preeclampsia were randomized to receive either L-arginine or placebo until the day of delivery. To evaluate the relative risk of intrauterine growth restriction (IUGR) and the effect of L-arginine on this process, 96 live singleton infants of women with preeclampsia (50 with treatment and 46 without treatment) were compared; these infants were also compared with a further 50 control infants of healthy women. Gestational age-related birth weight was compared using standard growth curves. Infants smaller than the 10th percentile were classified as IUGR. The Mann-Witney U-test, ANOVA, and chi-square test were used to evaluate statistically significant differences (P<.05) between the groups. Results: No significant differences were found between the groups with preeclampsia before randomization. Preeclampsia was associated with a 21% reduction in birth weight. The risk of IUGR was five times higher in infants born after preeclampsia without L-arginine therapy than in control pregnancies (RR = 5.0; 95%IC: 1.5-16.2) and was two times higher in infants born after preeclampsia with L-arginine therapy (RR = 2.0; 95% CI: 1.9-7.6). The fetal biophysical profile and Apgar score were significantly more favorable in the L-arginine group (P<.05). Conclusion: Fetal growth markedly improves with early L-arginine therapy in women with preeclampsia.

Progresos de Obstetricia y Ginecología 02/2009; 52(2). DOI: 10.1016/S0304-5013(09)70342-5 

http://www.elsevier.es/es-revista-progresos-obstetricia-ginecologia-151-articulo-efecto-terapia-temprana-con-l-arginina-13133124

Md PhD Julio E Valdivia-Silva. Fundador del GII

Md Keisy López-Molina. Ex miembro del GII

Md PhD Rodney Macedo. Past president del GII