New clue to predicting pre-eclampsia
An indication of whether a mother will develop pre-eclampsia, the most common and severe pregnancy-related disease, has been identified by a University of Sydney study.
The findings, published in the latest edition of the Journal of Reproductive Immunology could allow the early detection of pre-eclampsia, is currently unable to be diagnosed by symptoms before the disease occurs.
The research also suggests the womb may have a lasting impact on a child’s immune system.
“Pre-eclampsia affects an estimated 5000 to10000 women in Australia every year,” said Professor Ralph Nanan, senior author of the study, from Sydney Medical School Nepean.
“It develops in mothers out of the blue, usually in the last three months of pregnancy, causing high blood pressure, kidney and liver damage and severe blood changes. Delivering the baby as soon as possible is the only way to stop it.”
In pre-eclampsia the mother’s immune system appears to attack the foetus.
“Our study looked at the thymus of the foetus, a structure which sits behind the baby’s breastbone and is known as the ‘cradle’ of an important set of white blood cells called thymus-derived lymphocytes or T cells,” said Professor Nanan.
No previous study has looked at the effect of the disease on the fetal organ systems.
“Surprisingly we found the thymus of babies whose mother developed pre-eclampsia was significantly smaller than in babies of healthy pregnant women.”
What further surprised the researchers was that these changes were obvious in mid-pregnancy, long before the mother developed any signs of pre-eclampsia.
“This is a very interesting finding as the thymus plays a central role in shaping the child’s immune system and protecting it against the development of allergies, autoimmune disease and cancers later in life,” Professor Nanan said. .
The group is now conducting a prospective study with over 1200 pregnant women to confirm the findings with the long-term prospect of developing a test for pre-eclampsia. It is also conducting studies which aim to describe the short and long-term effects that early thymus changes have on the child’s immune system and on the development of immune diseases.
The study was conducted by David Eviston, and Ann Quinton and a team of researchers from Sydney Medical School Nepean.
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Source: University of Sydney
Mirror syndrome. A case report.
Water retention in a pregnant woman can mirror fetal hydropic changes. This clinical presentation has been named “mirror syndrome.” Awareness of the syndrome is important due to the associated fetal and maternal risks.
A 26-year-old woman, gravida 3, para 1011, presented at 31 weeks’ gestation with significant edema and a 7-km weight gain in one week. Sonographic evaluation revealed hydramnios and fetal ascites. Maternal workup was negative for preeclampsia, diabetes, or cardiac or renal dysfunction. A workup for nonimmune hydrops was also negative. Over the next three days there was progression of maternal edema. With diagnosis of mirror syndrome, the decision for delivery was made. Both neonate and mother subsequently did well, with normalization of ascites and edema, respectively.
Our case, along with 19 reviewed in the literature, reiterate the features of mirror syndrome and provide an opportunity to dispel some of the misconceptions in the literature. The condition is frequently mistaken for preeclampsia, although distinguishing characteristics can be identified. Mirror syndrome is a manifestation of extremely severe fetal hydrops. When the specific cause of fetal hydrops cannot be identified and corrected, immediate delivery is necessary in order to avoid fetal death and maternal complications.
The name “mirror syndrome” refers to the similarity between maternal oedema and fetal hydrops. It was first described in 1892 by John William Ballantyne
The etiology may be any of the variety of obstetric problems that range from immunological disorders, including Rh-isoimmunization, to fetal infections, metabolic disorders, and fetal malformations.
The etiopathogenetic mechanism of Ballantyne syndrome remains unknown.
Signs and symptoms
Ballantyne syndrome has several characteristics:
- edema, always a key feature
- albuminuria of the mother, usually mild
- preeclampsia, unusual
The fetal symptoms are related to fluid retention, including ascites and polyhydramnios.Fetal hydrops suggests the presence of an important and probably fatal fetal pathology. It can be associated with twin-to-twin transfusion syndrome.
Although the exact etiopathogenetic mechanism of Ballantyne syndrome remains unknown, several authors have reported raised uric acid levels, anemia, and low hematocrit without hemolysis.
The problem of distinguishing (or not) between Ballantyne syndrome and preeclampsia is reflected in the diversity of terminology used and in the debate that surrounds the subject. It seems much more likely that an etiology of severe fetal hydrops may cause Ballantyne syndrome when the fetal status greatly worsens and that the syndrome is only a manifestation of the extreme severity of the fetus-placental pathology. Platelet count, aspartate transaminase, alanine transaminase, and haptoglobin are usually unaffected and may be used to distinguish mirror syndrome from HELLP syndrome.