Original Article

Analysis on Clinical Outcomes of Low-Molecular Weight Heparin Combined with Magnesium Sulfate in Patients with Pre-Eclampsia

Abstract

Background: We aimed to investigate the clinical effect of low molecular weight heparin (LMWH) combined with magnesium sulfate in patients with severe pre-eclampsia (PE).

Methods: A total of 70 patients with severe PE admitted in Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, China from Jun 2020 to May 2021 were enrolled and randomized into observation and control groups. The control group was treated with magnesium sulfate only, and the observation group was treated with small-dose LMWH combined with magnesium sulfate. The clinical effects and artery blood flow index were analyzed.

Results: The observation group had higher coagulation function than that in the control group. RI, S/D, and PI in the observation group after treatment were lower than those in the control group, with statistically significant differences (P <0.05). In serum and placental tissues, both kininase expression and TGF-1 levels of the observation group were higher than those of the control group, with lower PAPP-A, VCAM-1 and E selectin levels than those in the control group.

Conclusion: Small-dose LMWH combined with magnesium sulfate can promote the expression of endogenous kallikrein, weaken the infiltration of cytotrophoblast, and improve the maternal blood clotting state in patients with severe PE. It also improves placental microblood flow and effectively prolong pregnancy, promotes fetal growth, and improves the clinical effects.

1. Lamarca B (2010). The role of immune activation in contributing to vascular dysfunction and the pathophysiology of hypertension during preeclampsia. Minerva Ginecol, 62(2): 105-120.
2. Cunningham FG, Leveno KJ, Bloom SL, et al (2010). Williams Obstetrics. 23rd ed. New York: McGraw-Hill Professional, 2010: 760-765.
3. Farrar D, Tuffnell D, Sheldon TA (2020). An evalua-tion of the influence of the publication of the UK National Institute for health and Care Excellence's guidance on hypertension in pregnancy: a retro-spective analysis of clinical practice. BMC Pregnancy Childbirth, 20: 101.
4. Leblanc S, Ouellet A, Giguère Y, Forest JC, Moutquin JM, Aris A (2012). A positive correlation between hydrogen peroxide and soluble TNF-alpha re-ceptor 2 early in maternal blood and at term in placenta of pregnant women with preeclampsia. Hypertens Pregnancy, 31(3): 357-366.
5. Frias AE Jr, Belfort MA (2003). Post Magpie: how should we be managing severe Preeclampsia? Curr Opin Obstet Gynecol, 15: 489-495.
6. Naljayan MV, Karumanchi SA (2013). New devel-opments in the pathogenesis of preeclampsia. Adv Chronic Kidney Dis, 20(3): 265-270.
7. Zhang H, He Y, Wang JX, (2020). miR-30-Sp-mediated ferroptosis of trophoblasts is implicated in the pathogenesis of preeclampsia. Redox Biol, 29: 101402.
8. Duley L (2009). The global impact of pre-eclampsia and eclampsia. Semin Perinatol, 33(3): 130-137.
9. Knöfler M, Haider S, Saleh L, Pollheimer J, Gamage TKJB, James J (2019). Human Placenta and Trophoblast development: Key Molecular Mech-anisms and Model Systems. Cell Mol Life Sci, 76(18): 3479-3496.
10. Ridder A, Giorgione V, Khalil A, Thilaganathan B (2019). Preeclampsia: The Relationship between Uterine Artery Blood Flow and Trophoblast Function. Int J Mol Sci, 20(13): 3263.
11. Warrington JP, Coleman K, Skaggs C, et al (2014). Heme oxygenase-1 promotes migration and be-ta-epithelial Na+ channel expression in cyto-trophoblasts and ischemic placentas. Am J Physiol Regul Integr Comp Physiol, 306(9):R641-646.
12. Sircar M, Thadhani R, Karumanchi SA (2015). Path-ogenesis of preeclampsia. Curr Opin Nephrol Hyper-tens, 24(2): 131-138.
13. Mayrink J, Costa ML, Cecatti JG (2018). Preeclampsia in 2018: Revisiting Concepts, Physiopathology, and Prediction. Scientific World Journal, 2018: 6268276.
14. García-Hernández V, Sarmiento N, Sánchez-Bernal C,et al (2016). Changes in the expression of LIMP-2 during cerulein-induced pancreatitis in rats: Effect of inhibition of leukocyte infiltration, c AMP and MAPKs early on in its development. Int J Biochem Cell Biol, 72: 109-117.
15. Mello G, Parretti E, Fatini C, et al (2016). Low-molecular-weight heparin lowers the recurrence rate of preeclampsia and restores the physiologi- cal vascular changes in angiotensin-converting en-zyme DD women. Hypertension, 45(1): 86-91.
16. Mostello D, Catlin TK, Roman L, Holcomb WL Jr, Leet T (2002). Preeclampsia in the parous woman: who is at risk. Am J Obstet Gynecol, 187(2): 425-429.
17. Phipps E, Prasanna D, Brima W, Jim B (2016). Preeclampsia: Updates in Pathogenesis, Defini-tions, and Guidelines. Clin J Am Soc Nephrol, 11(6): 1102-1113.
18. Raghuraman N, March MI, Hacker MR,et al (2014). Adverse maternal and fetal outcomes and deaths related to preeclampsia and eclampsia in haiti. Preg-nancy Hypertens, 4(4): 279-286.
19. Yifu P, Lei Y, Yujin G, Xingwang Z, Shaoming L (2020). Shortened postpartum magnesium sulfate treatment vs traditional 24h for severe preeclamp-sia: a systematic review and meta-analysis of ran-domized trials. Hypertens Pregnancy, 39(2): 186-195.
20. de Lima ASD, Holanda IP, Nascimento PRP, Jeron-imo SMB, Ferreira LC (2021). Plasma angiotensin II levels in women with severe preeclampsia un-der magnesium sulfate regimen. Pregnancy Hypertens, 23: 56-58.
21. Wen J, Zhang X, Li C (2019). Clinical Effect of Low Molecular Weight Heparin Sodium Combined with Magnesium Sulfate in the Treatment of Pa-tients with Severe Preeclampsia. J Coll Physicians Surg Pak, 29(2): 119-122.
22. Ueda A, Kondoh E, Kawasaki K, et al (2016). Mag-nesium sulphate can prolong pregnancy in pa-tients with severe early-onset preeclampsia. J Ma-tern Fetal Neonatal Med, 29(19): 3115-3120.
23. Burwick RM, Velásquez JA, Valencia CM,et al (2018). Terminal Complement Activation in Preeclamp-sia. Obstet Gynecol, 132(2): 1477-1485.
24. Almaghamsi A, Almalki MH, Buhary BM (2018). Hypocalcemia in Pregnancy: A Clinical Review Update. Oman Med J, 33(6): 453-462.
25. Francis AP, Chang M, Dolin CD, Chervenak J, Car-donick E (2018). Recurrent Cholangiocarcinoma in Pregnancy: A Case Report. AJP Rep, 8(4): e261-e263.
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IssueVol 51 No 5 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v51i5.9422
Keywords
Pre-eclampsia Low molecular weight heparin Magnesium sulfate Coagulation function Clinical effect
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How to Cite
1.
Wang N, Feng C, Sun M, Pu Y. Analysis on Clinical Outcomes of Low-Molecular Weight Heparin Combined with Magnesium Sulfate in Patients with Pre-Eclampsia. Iran J Public Health. 2022;51(5):1067-1075.