#16
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Гипотеза старинная иммунологическая
открываем пабмед и находим несколько статей на эту неоднозначную тему ,вот одна из них,возможно имеется вклад в проблему интервала между беременностями 1: Epidemiology. 2001 Nov;12(6):624-9.Click here to read Links Higher risk of pre-eclampsia after change of partner. An effect of longer interpregnancy intervals? Basso O, Christensen K, Olsen J. The Danish Epidemiology Science Centre at the Department of Epidemiology and Social Medicine, Aarhus University, Denmark. Epidemiologic studies have shown that pre-eclampsia is mainly a disease of first pregnancy, possibly associated with primipaternity. The interpregnancy interval, which is strongly associated with change of partner, has received little attention. In this study, based on Danish hospital records, we evaluated whether the interpregnancy interval may confound or modify the paternal effect on pre-eclampsia. We studied the outcome of the second birth in a cohort of Danish women with pre-eclampsia in the previous birth (8,401 women) and in all women with pre-eclampsia in second (but not first) birth together with a sample of women with two births (26,596 women). A long interpregnancy interval was associated with a higher risk of pre-eclampsia in women with no previous pre-eclampsia when the father was the same. We estimated the risk of pre-eclampsia in second birth according to paternal change in different models. Although partner change was associated with an increased risk of pre-eclampsia in women with no history of pre-eclampsia, this effect disappeared after adjustment for the interpregnancy interval. We saw, however, different results when we stratified on the length of the interval. Our results indicate that the interval between births should be taken into consideration when studying the effect of changing partner on pre-eclampsia |
#17
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вот статья поновее
1: Paediatr Perinat Epidemiol. 2007 Jul;21 Suppl 1:31-5.Click here to read Links Partner change, birth interval and risk of pre-eclampsia: a paradoxical triangle. Zhang J. Epidemiology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA. [Ссылки доступны только зарегистрированным пользователям ] Immunology has been hypothesised to play a critical role in the development of pre-eclampsia. A number of epidemiological studies have shown that multiparous women who changed partner had an increased risk of pre-eclampsia in the following pregnancy compared with multiparous women with the same partner. However, partner change is often associated with a long birth interval. Two recent papers using data from the same birth registry reported that, after controlling for birth interval, partner change was associated with a reduced risk of pre-eclampsia. Based on a causal diagram, the author argues conceptually that birth interval is not a confounder but more likely to be a collider. Controlling for or stratifying birth interval in the association between partner change and risk of pre-eclampsia could be inappropriate and may have produced a spurious association. |
#18
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Цитата:
Говоря о постановке диагноза по клиническим критериям сказать - нет обычно проще, чем сказать - да. Например, в приведенных Вами случаях- 1) Нет , т.к. не соответствует критериям. 2) Нет - повышение давления должно быть документировано минимум дважды (с интервалом от 6 часов до 7 дней) (Working group report on high blood pressure in pregnancy. National Instititutes of Health, Washington, DC 2000. ) 3) Нет- протеинурия в разовом анализе недоказательна, нужно отношение белок/креатинин в разовом анализе или определение суточной протеинурии , в данном случае- в динамике. Значит ли это, что Ваша больная с изолированным набором веса и отсутствием выявляемых нами клинических и лабораторных признаков гарантированно не имеет гистологического "субстрата" преэклампсии при (тьфу-тьфу)исследовании хориона и не разовьет гестоза? Нет, это значит лишь то, что на момент осмотра диагноз преэклампсии ей выставить нельзя (а потом, по мере развития клиники- скорее всего, будет можно). У любых клинических критериев имеется чувствительность и специфичность, никогда не достигающие 100%. Надеемся, что с введением в клинику тестов , максимально приближенных к эпицентру проблем при преэклампсии (растворимая тирозинкиназа и др) чувствительность, специфичность и "предиктив вэлью" очередного пересмотра критериев эклампсии повысится... На всякий случай- имеются критерии "тяжелой" эклампсии New onset proteinuric hypertension and at least one of the following: Symptoms of central nervous system dysfunction: Blurred vision, scotomata, altered mental status, severe headache Symptoms of liver capsule distention: Right upper quadrant or epigastric pain Nausea, vomiting Hepatocellular injury: Serum transaminase concentration at least twice normal Severe blood pressure elevation: Systolic blood pressure 160 mm Hg or diastolic 110 mm Hg on two occasions at least six hours apart Thrombocytopenia: Less than 100,000 platelets per cubic millimeter Proteinuria: 5 or more grams in 24 hours Oliguria <500 mL in 24 hours Severe fetal growth restriction Pulmonary edema or cyanosis Cerebrovascular accident (from Diagnosis and Management of Preeclampsia and Eclampsia. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin #33, January 2002 and Working Group Report on High Blood Pressure in Pregnancy. National Instititutes of Health, Washington, DC 2000 ) |
#19
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По идее, в случаях, пока не попадающих под определение преэклампсии по разным причинам, но подозрительным по развитию данной патологии в будущем желательно искать статьи с проспективными исследованиями, позволяющими примерно оценить риск для данной группы как, например, в этом исследовании группы беременных с диабетом и протеинурией (до 20 недель беременности) :
Methods: Pregnancy outcome was studied in 311 women with class B-RF diabetes from two institutions. Using 104 women without chronic hypertension followed at the University of California, San Francisco, we constructed a receiver-operating characteristic curve relating 24-hour urinary total protein before 20 weeks' gestation to the subsequent development of preeclampsia. From the curve, a predictive cutoff level of proteinuria was selected and tested in two validation groups not used to construct the curve: 158 women without chronic hypertension followed at the University of Cincinnati and 49 women with chronic hypertension from both institutions. Results: The receiver-operating characteristic curve showed an increased risk of preeclampsia with earlypregnancy proteinuria of 190 mg/day or more. In the Cincinnati validation group, the rate of preeclampsia was 7% in women with early-pregnancy proteinuria of less than 190 mg/day, 31% with proteinuria of 190-499 mg/day, and 38% with proteinuria of 500 mg/day or more. In the chronichypertension validation group, the rates were 0, 50, and 58%, respectively. By multiple logistic regression, the increased risk of preeclampsia with proteinuria above 190 mg/day persisted after controlling for the effects of parity, chronic hypertension, retinopathy, and glycemic control. Obstetrics & Gynecology 1993;82:802-807 © 1993 by The American College of Obstetricians and Gynecologists естественно, диагноз в итоге пока ставится все равно по тем же критериям |