Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
alert for PE in this group of pregnant women with high-risk for PE, especially because most of them have more than one risk factor. Disclosure of interest: None declared.
doi:10.1016/j.preghy.2012.04.223
PP113. NT-Pro-BNP: A predictor of adverse maternal outcomes in hypertensive gestational syndromes? M.C. Cabo Fustaret *, A.M. Escobar, R. Illia, M. Uranga, C. Rivas, G. Lobenstein, P. Olejnik, H. Mayer, T.P. Ramilo (Cardiology-Obstetrician, Hospital Aleman, Buenos Aires, Argentina) Introduction: BNP (brain-type natriuretic peptide) is released by cardiomyocytes, as a pro-hormone, in response to parietal stress augmentation and systemic endothelial dysfunction, and then Pro-BNP is cleaved into: NT-Pro-BNP and BNP fragment in 1:1 ratio. BNP is considered an important component of the adaptative mechanism that helps to reduce the load on the myocardium, through systemic vasodilatation, reduction in venous return and reduction in vascular volume. Hypertensive Gestational Syndromes (HGS) are considered to share those mechanisms, but the role of NT-Pro-BNP to evaluate maternal outcomes, is not well defined. Objectives: Evaluate the correlation between NT-Pro-BNP: in Normotensive Pregnant Women (NPW) and HGS with established markers of adverse maternal outcomes in HGS. Methods: We performed a transversal case–control study to analyze NT-Pro-BNP in 68 patients with HGS vs 80 NPW admitted at a private hospital, and to evaluate its correlation with established clinical and blood markers of maternal outcomes at hospital admission. Patients with renal chronic failure, previous cardiac disease and mola were excluded. We used the Pearson and Kendall correlation test for quantitative variables and the non-parametrical Mann–Whitney test for qualitative variables. Results: The average maternal age was: NPW 33.2 years, HGS 33.8 years; average gestational age at delivery: NPW 38.5 weeks, HGS 35.3 weeks; first pregnancy: NPW 36%, HGS 56%; birth average weight: NPW 3351.6 g, HGS 2615.5 g; media NT-Pro-BNP: NPW 59.7 pg/ml, HGS 704.8 pg/ml. None of the NPW had high levels of NT-ProBNP. In the HGS group: 57% had preeclampsia, 10% HELLP, 25% gestational hypertension and 8% chronic hypertension. In the HGS media values for: proteinuria 1.5 g/24 h, glutamic-oxalacetic transaminase 86 UI/L, platelets 231,688/ mm3, glutamic-pyruvic transaminase 100 UI/L, uric acid 48 mg/dl, hematocrit 33%, alkaline phosphatase 152 UI/L, lactic dehydrogenase 284 UI/L. In the HGS the following significant correlations were found: for NT-Pro-BNP relation to: proteinuria (0.34 p = 0.001), glutamic–oxalacetic transaminase (0.375 p = 0.001), platelets ( 0.353 p = 0.001), glutamic–pyruvic transaminase (0.317 p = 0.001), uric acid (0.398 p = 0.001), hematocrit ( 0.183 p = 0.048), gestational age at delivery ( 0.29 p = 0.002), birth average weight ( 0.23 p = 0.018), cardiac failure ( p = 0.001), number of
301
used anti-hypertensive drugs (0.367 p = 0.004), lactic dehydrogenase (0.65 p = 0.001). The media NT-Pro-BNP was: 936 pg/ml in preeclampsia , 1909 pg/ml in HELLP, 150 pg/ ml in gestational hypertension and 107 pg/ml in chronic hypertension. The highest NT-Pro-BNP level was 12,386 pg/ml in a patient with systolic dysfunction (LVEF: 35%) associated with preeclampsia. After delivery, 13% HGS women had persistent hypertension post-partum, and this did not correlate with the level of NT-Pro-BNP at hospital admission. Conclusion: NT-Pro-BNP significantly correlates with established markers of adverse maternal outcomes in HGS, probing to be useful in routine maternal evaluation in this setting. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.224
PP114. First trimester multi-parameter prediction of preeclampsia J.A. Gurgel Alves 1, S.P. Brennecke 2,3, F. Da Silva Costa 2,3,* (1 Department of Public Health, State University of Ceara, Fortaleza, Brazil, 2 Department of Perinatal Medicine, Royal Women’s Hospital, Australia, 3 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia) Introduction: Pre-eclampsia (PE), which affects about 3– 5% of pregnant women, is the most frequent serious medical complication in pregnancy and a major cause of maternal and perinatal morbidity and mortality. During the past three decades, numerous clinical, biophysical, and biochemical screening tests have been proposed for the early detection of PE. Literature shows large variations in the sensitivity and predictive value of these tests. No single screening test used for PE prediction has gained widespread acceptance into clinical practice. Instead, panels of tests, which combine several clinical measurements, seem to be of more value for increasing the predictive value for PE. Objectives: The aim of this study was to examine a combination of maternal risk factors, mean arterial blood pressure, and uterine artery Doppler for pre-eclampsia prediction during the first trimester of pregnancy. Methods: Prospective study with singleton pregnancies examined at 11–14 weeks of gestation, presenting consecutively for antenatal care in a tertiary Brazilian hospital. The base-cohort population was 487 singleton pregnancies, including nine case subjects who developed PE requiring delivery before 34 weeks (early PE) and 22 with late PE, 47 with gestational hypertension, and 409 cases subjects (84%) who were unaffected by PE or gestational hypertension. Maternal history, body mass index (BMI), mean arterial pressure (MAP), and uterine artery pulsatility index were recorded in all of the cases. Univariate and logistic regression analysis was used to derive algorithms for the prediction of hypertensive disorders. Results: The maternal characteristics selected by regression analysis to be part of the final predictive model were
alert for PE in this group of pregnant women with high-risk for PE, especially because most of them have more than one risk factor. Disclosure of interest: None declared.
doi:10.1016/j.preghy.2012.04.223
PP113. NT-Pro-BNP: A predictor of adverse maternal outcomes in hypertensive gestational syndromes? M.C. Cabo Fustaret *, A.M. Escobar, R. Illia, M. Uranga, C. Rivas, G. Lobenstein, P. Olejnik, H. Mayer, T.P. Ramilo (Cardiology-Obstetrician, Hospital Aleman, Buenos Aires, Argentina) Introduction: BNP (brain-type natriuretic peptide) is released by cardiomyocytes, as a pro-hormone, in response to parietal stress augmentation and systemic endothelial dysfunction, and then Pro-BNP is cleaved into: NT-Pro-BNP and BNP fragment in 1:1 ratio. BNP is considered an important component of the adaptative mechanism that helps to reduce the load on the myocardium, through systemic vasodilatation, reduction in venous return and reduction in vascular volume. Hypertensive Gestational Syndromes (HGS) are considered to share those mechanisms, but the role of NT-Pro-BNP to evaluate maternal outcomes, is not well defined. Objectives: Evaluate the correlation between NT-Pro-BNP: in Normotensive Pregnant Women (NPW) and HGS with established markers of adverse maternal outcomes in HGS. Methods: We performed a transversal case–control study to analyze NT-Pro-BNP in 68 patients with HGS vs 80 NPW admitted at a private hospital, and to evaluate its correlation with established clinical and blood markers of maternal outcomes at hospital admission. Patients with renal chronic failure, previous cardiac disease and mola were excluded. We used the Pearson and Kendall correlation test for quantitative variables and the non-parametrical Mann–Whitney test for qualitative variables. Results: The average maternal age was: NPW 33.2 years, HGS 33.8 years; average gestational age at delivery: NPW 38.5 weeks, HGS 35.3 weeks; first pregnancy: NPW 36%, HGS 56%; birth average weight: NPW 3351.6 g, HGS 2615.5 g; media NT-Pro-BNP: NPW 59.7 pg/ml, HGS 704.8 pg/ml. None of the NPW had high levels of NT-ProBNP. In the HGS group: 57% had preeclampsia, 10% HELLP, 25% gestational hypertension and 8% chronic hypertension. In the HGS media values for: proteinuria 1.5 g/24 h, glutamic-oxalacetic transaminase 86 UI/L, platelets 231,688/ mm3, glutamic-pyruvic transaminase 100 UI/L, uric acid 48 mg/dl, hematocrit 33%, alkaline phosphatase 152 UI/L, lactic dehydrogenase 284 UI/L. In the HGS the following significant correlations were found: for NT-Pro-BNP relation to: proteinuria (0.34 p = 0.001), glutamic–oxalacetic transaminase (0.375 p = 0.001), platelets ( 0.353 p = 0.001), glutamic–pyruvic transaminase (0.317 p = 0.001), uric acid (0.398 p = 0.001), hematocrit ( 0.183 p = 0.048), gestational age at delivery ( 0.29 p = 0.002), birth average weight ( 0.23 p = 0.018), cardiac failure ( p = 0.001), number of
301
used anti-hypertensive drugs (0.367 p = 0.004), lactic dehydrogenase (0.65 p = 0.001). The media NT-Pro-BNP was: 936 pg/ml in preeclampsia , 1909 pg/ml in HELLP, 150 pg/ ml in gestational hypertension and 107 pg/ml in chronic hypertension. The highest NT-Pro-BNP level was 12,386 pg/ml in a patient with systolic dysfunction (LVEF: 35%) associated with preeclampsia. After delivery, 13% HGS women had persistent hypertension post-partum, and this did not correlate with the level of NT-Pro-BNP at hospital admission. Conclusion: NT-Pro-BNP significantly correlates with established markers of adverse maternal outcomes in HGS, probing to be useful in routine maternal evaluation in this setting. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.224
PP114. First trimester multi-parameter prediction of preeclampsia J.A. Gurgel Alves 1, S.P. Brennecke 2,3, F. Da Silva Costa 2,3,* (1 Department of Public Health, State University of Ceara, Fortaleza, Brazil, 2 Department of Perinatal Medicine, Royal Women’s Hospital, Australia, 3 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia) Introduction: Pre-eclampsia (PE), which affects about 3– 5% of pregnant women, is the most frequent serious medical complication in pregnancy and a major cause of maternal and perinatal morbidity and mortality. During the past three decades, numerous clinical, biophysical, and biochemical screening tests have been proposed for the early detection of PE. Literature shows large variations in the sensitivity and predictive value of these tests. No single screening test used for PE prediction has gained widespread acceptance into clinical practice. Instead, panels of tests, which combine several clinical measurements, seem to be of more value for increasing the predictive value for PE. Objectives: The aim of this study was to examine a combination of maternal risk factors, mean arterial blood pressure, and uterine artery Doppler for pre-eclampsia prediction during the first trimester of pregnancy. Methods: Prospective study with singleton pregnancies examined at 11–14 weeks of gestation, presenting consecutively for antenatal care in a tertiary Brazilian hospital. The base-cohort population was 487 singleton pregnancies, including nine case subjects who developed PE requiring delivery before 34 weeks (early PE) and 22 with late PE, 47 with gestational hypertension, and 409 cases subjects (84%) who were unaffected by PE or gestational hypertension. Maternal history, body mass index (BMI), mean arterial pressure (MAP), and uterine artery pulsatility index were recorded in all of the cases. Univariate and logistic regression analysis was used to derive algorithms for the prediction of hypertensive disorders. Results: The maternal characteristics selected by regression analysis to be part of the final predictive model were
