INTRODUCTION: Pre-eclampsia affects ~5%-7% of pregnancies. Although improved obstetric care has significantly diminished its associated maternal mortality, it remains a leading cause of maternal morbidity and mortality in the world. Term pre-eclampsia accounts for 70% of all cases and a large proportion of maternal-fetal morbidity related to this condition. Unlike in preterm pre-eclampsia, the prediction and prevention of term pre-eclampsia remain unsolved. Previously proposed approaches are based on combined third-trimester screening and/or prophylactic drugs, but these policies are unlikely to be widely implementable in many world settings. Recent evidence shows that the soluble fms-like tyrosine kinase-1 (s-Flt-1) to placental growth factor (PlGF) ratio measured at 35-37 weeks' gestation predicts term pre-eclampsia with an 80% detection rate. Likewise, recent studies demonstrate that induction of labour beyond 37 weeks is safe and well accepted by women. We hypothesise that a single-step universal screening for term pre-eclampsia based on sFlt1/PlGF ratio at 35-37 weeks followed by planned delivery beyond 37 weeks reduces the prevalence of term pre-eclampsia without increasing the caesarean section rates or worsening the neonatal outcomes. METHODS AND ANALYSIS: We propose an open-label randomised clinical trial to evaluate the impact of a screening of term pre-eclampsia with the sFlt-1/PlGF ratio followed by planned delivery in asymptomatic nulliparous women at 35-37 weeks. Women will be assigned 1:1 to revealed (sFlt-1/PlGF known to clinicians) versus concealed (unknown) arms. A cut-off of >90th centile is used to define the high risk of subsequent pre-eclampsia and offer planned delivery from 37 weeks. The efficacy variables will be analysed and compared between groups primarily following an intention-to-treat approach, by ORs and their 95% CI. This value will be computed using a Generalised Linear Mixed Model for binary response (study group as fixed effect and the centre as intercept random effect). ETHICS AND DISSEMINATION: The study is conducted under the principles of Good Clinical Practice. This study was accepted by the Clinical Research Ethics Committee of Hospital Clinic Barcelona on 20 November 2020. Subsequent approval by individual ethical committees and competent authorities was granted. The study results will be published in peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER: NCT04766866.

• MeSH
• biologické markery MeSH
• císařský řez MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• novorozenec MeSH
• placentární růstový faktor MeSH
• prediktivní hodnota testů MeSH
• preeklampsie * diagnóza   prevence a kontrola   epidemiologie   MeSH
• randomizované kontrolované studie jako téma MeSH
• receptor 1 pro vaskulární endoteliální růstový faktor MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

This Special Issue mainly focuses on preeclampsia (PE), haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, gestational diabetes mellitus (GDM), foetal growth restriction (FGR), small-for-gestational-age foetuses (SGA), miscarriage, stillbirth, first-episode psychosis (FEP) during pregnancy, and pregnancy-related acute kidney injury (PR-AKI) [...].

• MeSH
• gestační diabetes * MeSH
• komplikace těhotenství * MeSH
• lidé MeSH
• narození mrtvého plodu MeSH
• preeklampsie * MeSH
• růstová retardace plodu MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• úvodníky MeSH

Transmembránová serinová proteáza II. typu corin, která se vyskytuje ve významném množství v srdci, aktivuje natriuretické peptidy. Do oběhu je corin uvolňován z myocytů. Cirkulující solubilní corin je spojen s hypertenzí, srdečním selháním, infarktem myokardu, preeklampsií i s cévními mozkovými příhodami. Naše výsledky naznačují, že solubilní corin může fungovat jako senzitivní a specifický biomarker predikující riziko rozvoje kardiovaskulárních onemocnění (KVO). Cirkulující solubilní corin lze bohužel obtížně použít v klinické praxi. Tento přehled shrnuje výsledky nejnovějších studií zkoumajících souvislost mezi corinem a KVO a naznačuje směry dalšího výzkumu s cílem zpřesnit predikci rizika, prognózu a farmakoterapii KVO a podpořit jeho rutinní stanovování v rámci laboratorního vyšetření.

Corin, a type II transmembrane serine protease present in significant amounts in the heart, activates natri-uretic peptides. Corin enters the circulation from myocytes. Hypertension, heart failure, myocardial infarction, preeclampsia, and stroke are linked to circulating soluble corin. Our results suggest that circulating soluble corin may be a sensitive and specific cardiovascular disease (CVD) risk and predictive biomarker. Unfortunately, circulating soluble corin is difficult to use clinically. This review summarizes recent corin and CVD studies and suggests future corin research to improve risk prediction, prognosis, and medical treatment of CVDs and encourage its use as a regular laboratory test.

• Klíčová slova
• Corin,
• MeSH
• biologické markery krev   MeSH
• cévní mozková příhoda prevence a kontrola   MeSH
• hypertenze patofyziologie   prevence a kontrola   MeSH
• kardiovaskulární nemoci * diagnóza   prevence a kontrola   MeSH
• lidé MeSH
• preeklampsie prevence a kontrola   MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• serinové proteasy krev   metabolismus   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

We performed longitudinal examinations of the arterial retinal microvasculature using Adaptive Optics Retinal Imaging in a 30-year-old healthy woman with twin pregnancy from the 23rd week of gestation (wog) to three days postpartum. Two blinded graders recorded the average wall-to-lumen ratio (WLR) of the examined retinal artery. There was a significant increase in the mean WLR over the course of pregnancy followed by a decreasing WLR from the 37th wog. The demonstrated changes in WLR may be an expression of vascular remodeling and adaptation to volume load which indicates that pregnancy can be viewed as a cardiovascular stress test.

• MeSH
• arteria centralis retinae * MeSH
• dospělí MeSH
• hypertenze * MeSH
• krevní tlak MeSH
• lidé MeSH
• preeklampsie * MeSH
• srdce MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

We established efficient first trimester prediction models for small-for-gestational age (SGA) and fetal growth restriction (FGR) without the presence of preeclampsia (PE) regardless of the gestational age of the onset of the disease [early FGR occurring before 32 gestational week or late FGR occurring after 32 gestational week]. The retrospective study was performed on singleton Caucasian pregnancies (n = 6440) during the period 11/2012-3/2020. Finally, 4469 out of 6440 pregnancies had complete medical records since they delivered in the Institute for the Care of Mother and Child, Prague, Czech Republic. The study included all cases diagnosed with SGA (n = 37) or FGR (n = 82) without PE, and 80 selected normal pregnancies. Four microRNAs (miR-1-3p, miR-20a-5p, miR-146a-5p, and miR-181a-5p) identified 75.68 % SGA cases at 10.0 % false positive rate (FPR). Eight microRNAs (miR-1-3p, miR-20a-5p, miR-20b-5p, miR-126-3p, miR-130b-3p, miR-146a-5p, miR-181a-5p, and miR-499a-5p) identified 83.80 % SGA cases at 10.0 % FPR. The prediction model for SGA based on microRNAs was further improved via implementation of maternal clinical characteristics [maternal age and BMI, an infertility treatment by assisted reproductive technology (ART), first trimester screening for PE and/or FGR and for spontaneous preterm, both by FMF algorithm]. Then 81.08 % and 89.19 % pregnancies developing SGA were identified at 10.0 % FPR in case of utilization of 4 microRNA and 8 microRNA biomarkers. Simplified prediction model for SGA based on limited number of maternal clinical characteristics (maternal age and BMI, an infertility treatment by ART, and 4 microRNAs) does not improve the detection rate of SGA (70.27 % SGA cases at 10.0 % FPR) when compared with prediction model for SGA based just on the expression profile of 4 or 8 microRNAs biomarkers. Seven microRNAs only (miR-16-5p, miR-20a-5p, miR-145-5p, miR-146a-5p, miR-181a-5p, miR-342-3p, and miR-574-3p) identified 42.68 % FGR cases at 10.0 % FPR (AUC 0.725). However, the combination of 10 microRNAs only (miR-16-5p, miR-20a-5p, miR-100-5p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-181a-5p, miR-195-5p, miR-342-3p, and miR-574-3p) reached a higher discrimination power (AUC 0.774). It identified 40.24 % FGR cases at 10.0 % FPR. The prediction model for any subtype of FGR based on microRNAs was further improved via implementation of maternal clinical characteristics [maternal age and BMI, an infertility treatment by ART, the parity (nulliparity), the occurrence of SGA or FGR in previous gestation, and the occurrence of any autoimmune disorder, and the presence of chronic hypertension]. Then 64.63 % and 65.85 % pregnancies destinated to develop FGR were identified at 10.0 % FPR in case of utilization of 7 microRNA biomarkers or 10 microRNA biomarkers. When other clinical variables next to those ones mentioned above such as first trimester screening for PE and/or FGR and for spontaneous preterm, both by FMF algorithm, were added to the prediction model for FGR, the detection power was even increased to 74.39 % cases and 78.05 % cases at 10.0 % FPR.

• MeSH
• biologické markery MeSH
• dítě MeSH
• gestační stáří MeSH
• infertilita * MeSH
• kojenec MeSH
• lidé MeSH
• mikro RNA * genetika   metabolismus   MeSH
• novorozenec MeSH
• plod metabolismus   MeSH
• preeklampsie * genetika   MeSH
• první trimestr těhotenství MeSH
• retrospektivní studie MeSH
• růstová retardace plodu genetika   diagnóza   MeSH
• těhotenství MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Hypertensive disorders in pregnancy are associated with increased risk of maternal, fetal, and neonatal morbidity and mortality. It is important to distinguish between pre-existing (chronic) hypertension and gestational hypertension, developing after 20 weeks of gestation and usually resolving within 6 weeks postpartum. There is a consensus that systolic blood pressure ≥ 170 or diastolic blood pressure ≥ 110 mmHg is an emergency and hospitalization is indicated. The selection of the antihypertensive drug and its route of administration depend on the expected time of delivery. The current European guidelines recommend initiating drug treatment in pregnant women with persistent elevation of blood pressure ≥ 150/95 mmHg and at values > 140/90 mmHg in women with gestational hypertension (with or without proteinuria), with pre-existing hypertension with the superimposition of gestational hypertension, and with hypertension with subclinical organ damage or symptoms at any time during pregnancy. Methyldopa, labetalol, and calcium antagonists (the most data are available for nifedipine) are the drugs of choice. The results of the CHIPS and CHAP studies are likely to reduce the threshold for initiating treatment. Women with a history of hypertensive disorders in pregnancy, particularly those with pre-eclampsia, are at high risk of developing cardiovascular disease later in life. Obstetric history should become a part of the cardiovascular risk assessment in women.

• MeSH
• antihypertenziva škodlivé účinky   MeSH
• hypertenze indukovaná těhotenstvím * diagnóza   farmakoterapie   epidemiologie   MeSH
• hypertenze * diagnóza   farmakoterapie   epidemiologie   MeSH
• krevní tlak MeSH
• labetalol * škodlivé účinky   MeSH
• lidé MeSH
• novorozenec MeSH
• preeklampsie * MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Cíl: Popsat multioborový přístup, který vedl k úspěšnému zvládnutí závažné ruptury jater v rámci HELLP syndromu v 35. týdnu těhotenství. Kazuistika: Popis průběhu a postupu managementu u pacientky s rupturou jater při HELLP syndromu u 34leté pacientky, která byla přijata pro příznaky trvající cca 4 hod (bolesti v pravém podžebří, nauzea, zvracení, mžitky před očima). Byl proveden akutní císařský řez, při němž byla diagnostikována ruptura subkapsulárního hematomu jater. Následně se u pacientky rozvinul hemoragický šok a koagulopatie s nutností opakovaných operačních revizí krvácení z ruptury jater. Závěr: Ruptura subkapsulárního hematomu je vzácná, ale závažná komplikace HELLP syndromu. Tento případ ukazuje na důležitost včasné diagnostiky a promptní ukončení těhotenství v co nejkratším možném čase u těhotenství po 34. týdnu. Nejzásadnějším faktorem, který ovlivnil výsledný outcome a morbiditu pacientky, byl management multioborové spolupráce a správný timing jednotlivých kroků.

Objective: To describe the multidisciplinary approach that led to the successful management of severe hepatic rupture in HELLP syndrome at 35 weeks of gestation. Case report: The clinical course and management procedure of a 34-year-old female patient with ruptured liver due to HELLP syndrome, who was admitted with symptoms lasting about 4 hours (pain in the right hypochondrium, nausea, vomiting, flashes before the eyes) are described in the form of a case report. An acute caesarean section was performed, during which a rupture of the subcapsular hematoma of the liver was diagnosed. Subsequently, the patient developed hemorrhagic shock and coagulopathy with the need for repeated surgical revisions of bleeding from the rupture of the liver. Conclusion: Subcapsular hematoma rupture is a rare but serious complication of HELLP syndrome. This case shows the importance of early diagnosis and prompt termination of pregnancy in the shortest possible time in pregnancy after 34 weeks. The most fundamental factor that influenced the patient‘s outcome and morbidity was the management of multidisciplinary cooperation and the correct timing of individual steps.

• Klíčová slova
• ruptura subkapsulárního hematomu jater,
• MeSH
• dospělí MeSH
• HELLP syndrom * MeSH
• komplikace těhotenství MeSH
• lidé MeSH
• preeklampsie MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

We evaluated the potential of cardiovascular-disease-associated microRNAs for early prediction of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Gene expression profiling of 29 microRNAs was performed on whole peripheral venous blood samples collected between 10 and 13 weeks of gestation using real-time RT-PCR. The retrospective study involved singleton pregnancies of Caucasian descent only diagnosed with HELLP syndrome (n = 14) and 80 normal-term pregnancies. Upregulation of six microRNAs (miR-1-3p, miR-17-5p, miR-143-3p, miR-146a-5p, miR-181a-5p, and miR-499a-5p) was observed in pregnancies destined to develop HELLP syndrome. The combination of all six microRNAs showed a relatively high accuracy for the early identification of pregnancies destined to develop HELLP syndrome (AUC 0.903, p < 0.001, 78.57% sensitivity, 93.75% specificity, cut-off > 0.1622). It revealed 78.57% of HELLP pregnancies at a 10.0% false-positive rate (FPR). The predictive model for HELLP syndrome based on whole peripheral venous blood microRNA biomarkers was further extended to maternal clinical characteristics, most of which were identified as risk factors for the development of HELLP syndrome (maternal age and BMI values at early stages of gestation, the presence of any kind of autoimmune disease, the necessity to undergo an infertility treatment by assisted reproductive technology, a history of HELLP syndrome and/or pre-eclampsia in a previous gestation, and the presence of trombophilic gene mutations). Then, 85.71% of cases were identified at a 10.0% FPR. When another clinical variable (the positivity of the first-trimester screening for pre-eclampsia and/or fetal growth restriction by the Fetal Medicine Foundation algorithm) was implemented in the HELLP prediction model, the predictive power was increased further to 92.86% at a 10.0% FPR. The model based on the combination of selected cardiovascular-disease-associated microRNAs and maternal clinical characteristics has a very high predictive potential for HELLP syndrome and may be implemented in routine first-trimester screening programs.

• MeSH
• biologické markery MeSH
• HELLP syndrom * diagnóza   genetika   MeSH
• kardiovaskulární nemoci * genetika   MeSH
• lidé MeSH
• mikro RNA * genetika   metabolismus   MeSH
• preeklampsie * diagnóza   genetika   MeSH
• první trimestr těhotenství MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• antihypertenziva aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• beta blokátory aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• chronická obstrukční plicní nemoc farmakoterapie   komplikace   MeSH
• diuretika aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• fibrilace síní etiologie   farmakoterapie   komplikace   MeSH
• glifloziny aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• hypertenze * diagnóza   farmakoterapie   komplikace   MeSH
• inhibitory ACE aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• metabolický syndrom farmakoterapie   komplikace   MeSH
• nemoci ledvin farmakoterapie   komplikace   MeSH
• preeklampsie terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

The case report presents an unusual cause of convulsions in a 13-year-old patient. Hypertension was detected in prehospital care. Pregnancy was verified by a gynecologist after presence of obvious abdominal resistance. Acute s.c. was indicated immediately because of persistance of convulsions due to eclampsy.

V kazuistice je prezentována neobvyklá příčina křečí u 13leté pacientky. V přednemocniční péči zjištěna hypertenze, při příjmu patrná rezistence v dutině břišní, gynekologem verifikována gravidita, diagnostikována eklampsie, pro přetrvávání křečí indikován akutní císařský řez.

• MeSH
• císařský řez MeSH
• ischemie MeSH
• lidé MeSH
• mladiství MeSH
• neurozobrazování metody   MeSH
• preeklampsie * diagnóza   farmakoterapie   MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• záchvaty etiologie   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH