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Introduction: Gestational age at delivery seems to be a risk factor of recurrence of preeclampsia. The objective of this study was to analyze adverse pregnancy outcomes and recurrence of preeclampsia during the subsequent pregnancy in women with a history of pre-eclampsia delivered before 26 weeks of gestation., Material and Method: We performed a retrospective study in two French tertiary care hospitals between 2000 and 2018. Patients with a history of pre-eclampsia delivered before 26 weeks of gestation were analyzed. Information on the immediate subsequent pregnancy was collected. Adverse composite outcome was defined as recurrent preeclampsia, HELLP syndrome, placental abruption, fetal growth restriction <3rd percentile or <10 e percentile with Doppler abnormalities, maternal death and fetal death., Results: Among the 107 patients who met the criteria, 48 were analyzed for a subsequent pregnancy. Seventeen women (35.4 %) developed an adverse composite outcome, occurring for 15 women (31.2 %) before 34 weeks. Ten women (20.8 %) developed a recurrent preeclampsia occurring for 5 women (10.4 %) before 34 weeks. We related 3 HELLP syndromes, 1 placental abruption, 9 fetal growth restrictions, 3 fetal deaths and no maternal death. Compared to baseline normotensive women, chronic hypertension was significantly associated with an increased risk of adverse composite outcome (19.3 vs 58.8 %, p-value 0.014)., Conclusion: In our population, preeclampsia with delivery before 26 weeks is associated with 35.4 % of adverse composite outcomes and 20.8 % of recurrent preeclampsia during the immediate subsequent pregnancy. These results justify the importance of an ongoing monitoring of these patients during subsequent pregnancy., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier Masson SAS.)

Objective: To determine maternal and perinatal outcome in women with severe preeclampsia at <26 weeks according to gestational age at the onset of expectant management and the presence of severe fetal growth restriction (<5th percentile)., Study Design: Fifty-one patients (53 fetuses; 2 twins) were retrospectively studied., Results: Median prolongation was 7 days (2-55). Maternal morbidity rate was 43%. Perinatal survival rate was 42%. Severe fetal growth restriction complicated 17 fetuses (33%). There were no perinatal survivors in those managed at <24 weeks (n = 12). For those at 24-24(6/7) and 25-25(6/7) weeks, the perinatal survival rates were 50% and 57%, respectively, and in the presence of severe fetal growth restriction 0% and 30%, respectively., Conclusion: Perinatal outcome in severe preeclampsia in the midtrimester is dependent on gestational age and/or the presence of severe fetal growth restriction. Given the high maternal morbidity and the extremely low perinatal survival rates, we do not recommend expectant management before 24 weeks and/or in those with severe fetal growth restriction at any gestational age <26 weeks., (Copyright © 2011 Mosby, Inc. All rights reserved.)

The suspicion of small for gestational age fetus before 37 weeks of gestation implies to discriminate those who are physiologically small from those who have an underlying pathology leading to growth retardation. A labor induction can be needed if the risks associated to the prolongation of the pregnancy are estimated to be higher than those of prematurity and cesarean. In this case, labor induction can be discussed if the fetal vitality is normal. A continuous fetal heart monitoring during induction and labor is, in this case, strongly recommended. However, even in these optimal conditions, the risk of cesarean in case of labor induction for small for gestational age fetus before 37 weeks of gestation is of about 50 % in the rare published studies., (Copyright 2010. Published by Elsevier SAS.)

Objective: To evaluate a possible effect of Mifepristone on amniotic fluid volume in near term pregnant macaque monkeys., Study Design: Six pregnant near term monkeys (144 +/- 11 days of gestation) were either treated intramuscularly by Mifepristone (10 mg/kg, n = 3) or a placebo (n = 3). Amniotic fluid volumes were measured by a dilution technique using blue Evans, just prior to the injection of Mifepristone or placebo (t0h) and 24 h later (t24h)., Results: Amniotic fluid volume (AFV) measured at t0h was found to be statistically the same in placebo and Mifepristone-treated macaque monkeys (95 +/- 31 vs. 126 +/- 25 ml, respectively, P > 0.05). AFV was found to be lower at t24h when compared to AFV at t0h in placebo-treated (88 +/- 31 vs. 95 +/- 31 ml, respectively, P < 0.05) and in Mifepristone-treated macaque monkeys (72 +/- 7 vs. 126 +/- 25 ml, respectively, P < 0.05). Moreover, the ratio of AFV (t24h/t0h) was found to be significantly lower in Mifepristone-treated monkeys when compared to the placebo group (57.9 +/- 5.7% vs. 92.2 +/- 2.1%, P < 0.05) indicating a specific effect of the antiprogestin on AFV., Conclusion: In near term macaque monkeys, Mifepristone at 10 mg/kg induces a significant decrease of amniotic fluid volume within 24 h.

Objective: Our purpose was to determine whether the onset of the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome in women at < or =28.0 weeks' gestation is associated with an increased risk of adverse maternal and perinatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age.Study Design: Sixty-four patients with either the HELLP syndrome (n = 32) or severe preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted at < or =28.0 weeks' gestation between July 1, 1992, and April 30, 1999, were studied. Maternal and perinatal outcomes were compared between the 2 groups. Statistical analysis was performed by the Student t test and the Fisher exact test.Results: There were no significant differences between the 2 groups regarding African-American race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids (59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome had a liver hematoma. The rate at which transfusion of blood products was required was significantly greater in women with the HELLP syndrome than in those with severe preeclampsia only (25% vs 3%; P <.05). There were no significant differences between the 2 groups with respect to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%), disseminated intravascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%), acute renal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%). No significant differences were found between the 2 groups with respect to neonatal death (11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal morbidity.Conclusions: Except for the need for transfusion of blood products in women with the HELLP syndrome, onset at < or =28.0 weeks' gestation is not associated with an increased risk of adverse maternal or neonatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. [ABSTRACT FROM AUTHOR]

The possibility of using first trimester maternal serum human chorionic gonadotrophin (HCG) profiles to predict fetal growth retardation (FGR) was tested in 236 women with singleton pregnancies obtained after in-vitro fertilization (IVF). Pregnancies were monitored by serial analysis (two or more) of serum HCG at at least 48 h intervals. Serum was obtained between the 13th and the 35th day after conception (i.e. on the day of IVF). Early miscarriage occurred in 23.7% and FGR in 10.9% of pregnancies. Serum HCG profiles were higher than the 90th and lower than the 10th percentile in 12.3% and 19.5% of the cases respectively. FGR was significantly more frequent in women with serum HCG profiles lower than the 10th percentile than in women with normal profiles (45.5% versus 7.2%; P < 0.001), with a relative risk of 6.5 (95% confidence interval 2.7-15.6). FGR rates were similar in women with normal and high profiles of serum HCG. Pre-eclampsia and premature delivery rates were similar in women with normal and abnormal profiles of serum HCG. First trimester serum HCG should be further investigated as a potential marker of FGR. [ABSTRACT FROM AUTHOR]

Abstract: Few studies establishing clear criteria for the medical interruption of a pregnancy complicated by PE are available today. Most of these studies are either retrospective or observational. When combining an analysis of the available literature together with the experts’ opinions, one can propose the following set of criteria for therapeutic interruption of pregnancy in the setting of PE, which apply mainly for the severe forms of the disease. These criteria can be subdivided into maternal and fetal criteria. Maternal criteria are a severe uncontrollable HT, eclampsia, acute pulmonary edema, retro placental haematoma, oligura (<100ml in 4hours) resistant to appropriate fluid expansion, persistent signs of imminent eclampsia (headache or visual disturbances), persistent epigastric pain, HELLP syndrome, new-onset renal failure and a gestation time within the first 24weeks. The fetal criteria are prolonged and variable fetal heart rate (FHR) decelerations, a short term variability in FHR <3bpm, a Manning score ≤4 on two separate occasions, severe oligohydramnios, an estimated fetal weight below the 5th percentile beyond the 32nd week of amenorrhea and an inverted diastolic flow in the umbilical artery beyond the 32nd week of amenorrhea. In case of non-severe PE beyond the 36th week of amenorrhea, interruption of the pregnancy must be considered. [Copyright &y& Elsevier]