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Risk factors for adverse outcomes after intraabdominal surgery during pregnancy
Risk Factors for Adverse Outcomes after Intraabdominal Surgery during Pregnancy
Role of Coenzyme Q10 in Regenerating ␥-Tocopherol in Preeclampsia
Kevin J. Stepp, MD
Prabhudas R. Palan, PhD
MetroHealth Medical Center, Cleveland, OH
Kimberly A. Sauchak, BS, David M. O’Malley, MD, and Brian Mercer, MD OBJECTIVE: To identify perioperative factors associated with adverse outcomes following antenatal intraabdominal surgery. METHODS: During the period from January 1, 1992, to June 31, 2001, 59 patients underwent antenatal intraabdominal surgery. The authors collected history and perioperative and perinatal outcomes. An adverse outcome was defined as delivery within 14 days of surgery, delivery of a nonviable fetus, or preterm delivery at less than 37 weeks of gestation. For this analysis, the population was divided into those with surgery at less than 13 weeks of gestation, between 13 and 23 weeks, and at 24 weeks or greater. The authors evaluated delivery within 7 days, 14 days, before viability (24 weeks), and preterm. Chi-square, Fisher exact test, and Student unpaired t test were used as appropriate; P less than 0.05 was considered significant. RESULTS: Women undergoing surgery before 13 weeks of gestation were at increased risk for delivery before 20 weeks (62.5% vs 4.2%, P ⫽ 0.002). Preterm birth was more common with surgery after 24 weeks than before 13 weeks or between 13 and 23 weeks (46.7%, 0.0%, 16.1%, P ⫽ 0.047). Women with peritonitis were at increased risk for delivery within 14 days and for preterm delivery (57% vs 7.8%, P ⫽ 0.005, and 66.7% vs 19%, P ⫽ 0.03). Length of the surgical procedure increased the risk for delivery at less than 24 weeks (126 vs 71 minutes, P ⫽ 0.001). The authors failed to detect a significantly increased risk of early delivery with emergent or gynecologic surgery. CONCLUSION: Factors most highly associated with previable delivery, delivery within 14 days, delivery less than 24 weeks, and preterm birth after intraabdominal surgery in pregnancy are first-trimester surgery, peritonitis, procedure length, and surgery after 24 weeks, respectively.
VOL. 99, NO. 4 (SUPPLEMENT), APRIL 2002
Bronx–Lebanon Hospital Center/Albert Einstein College of Medicine, Bronx, NY
Danny W. Shaban, MD, and Magdy S. Mikhail, MD OBJECTIVE: To investigate the serum levels of three antioxidants, coenzyme Q10 (CoQ10), a-tocopherol (AT), and ␥-tocopherol (GT) in women with preeclampsia. METHODS: Venous blood samples were collected from 41 women (median age 25.0 y; estimated age of gestation [EGA] 39.0 wk) with uncomplicated pregnancies, 25 with mild preeclampsia (median age 22.5 y, EGA 38.1 wk) and 29 with severe preeclampsia (median age 33.0 y, EGA 38.4 wk). Levels of CoQ10, AT, and GT in fresh serum samples were measured by high-performance liquid chromatography. RESULTS: Data are presented in the table as mean ⫾ SD; P value by Kruskal–Wallis Rank test.
n
CoQ10 (g/dL)
AT (mg/L)
GT (mg/L)
P value
Normal pregnancy 41 0.63 ⫾ 0.3 7.40 ⫾ 2.1 1.20 ⫾ 0.9 0.000 Mild preeclampsia 25 0.31 ⫾ 0.1 6.10 ⫾ 2.2 1.41 ⫾ 0.7 0.012 Severe preeclampsia 29 0.30 ⫾ 0.1 5.90 ⫾ 2.2 1.30 ⫾ 0.9 0.387
CONCLUSION: The results demonstrate a significant decrease in serum levels of CoQ10 and AT in women with preeclampsia compared to levels observed in normal pregnancy. ␥-Tocopherol levels were comparable among the different groups. Coenzyme Q10 and AT are potent antioxidants, and their decreased serum levels in preeclampsia may alter the normal redox balance, reducing the ability of antioxidant defenses to protect against free radical damage. This could be a factor in the endothelial cell damage observed in preeclampsia.
MONDAY POSTERS
23S
Role of Coenzyme Q10 in Regenerating ␥-Tocopherol in Preeclampsia
Kevin J. Stepp, MD
Prabhudas R. Palan, PhD
MetroHealth Medical Center, Cleveland, OH
Kimberly A. Sauchak, BS, David M. O’Malley, MD, and Brian Mercer, MD OBJECTIVE: To identify perioperative factors associated with adverse outcomes following antenatal intraabdominal surgery. METHODS: During the period from January 1, 1992, to June 31, 2001, 59 patients underwent antenatal intraabdominal surgery. The authors collected history and perioperative and perinatal outcomes. An adverse outcome was defined as delivery within 14 days of surgery, delivery of a nonviable fetus, or preterm delivery at less than 37 weeks of gestation. For this analysis, the population was divided into those with surgery at less than 13 weeks of gestation, between 13 and 23 weeks, and at 24 weeks or greater. The authors evaluated delivery within 7 days, 14 days, before viability (24 weeks), and preterm. Chi-square, Fisher exact test, and Student unpaired t test were used as appropriate; P less than 0.05 was considered significant. RESULTS: Women undergoing surgery before 13 weeks of gestation were at increased risk for delivery before 20 weeks (62.5% vs 4.2%, P ⫽ 0.002). Preterm birth was more common with surgery after 24 weeks than before 13 weeks or between 13 and 23 weeks (46.7%, 0.0%, 16.1%, P ⫽ 0.047). Women with peritonitis were at increased risk for delivery within 14 days and for preterm delivery (57% vs 7.8%, P ⫽ 0.005, and 66.7% vs 19%, P ⫽ 0.03). Length of the surgical procedure increased the risk for delivery at less than 24 weeks (126 vs 71 minutes, P ⫽ 0.001). The authors failed to detect a significantly increased risk of early delivery with emergent or gynecologic surgery. CONCLUSION: Factors most highly associated with previable delivery, delivery within 14 days, delivery less than 24 weeks, and preterm birth after intraabdominal surgery in pregnancy are first-trimester surgery, peritonitis, procedure length, and surgery after 24 weeks, respectively.
VOL. 99, NO. 4 (SUPPLEMENT), APRIL 2002
Bronx–Lebanon Hospital Center/Albert Einstein College of Medicine, Bronx, NY
Danny W. Shaban, MD, and Magdy S. Mikhail, MD OBJECTIVE: To investigate the serum levels of three antioxidants, coenzyme Q10 (CoQ10), a-tocopherol (AT), and ␥-tocopherol (GT) in women with preeclampsia. METHODS: Venous blood samples were collected from 41 women (median age 25.0 y; estimated age of gestation [EGA] 39.0 wk) with uncomplicated pregnancies, 25 with mild preeclampsia (median age 22.5 y, EGA 38.1 wk) and 29 with severe preeclampsia (median age 33.0 y, EGA 38.4 wk). Levels of CoQ10, AT, and GT in fresh serum samples were measured by high-performance liquid chromatography. RESULTS: Data are presented in the table as mean ⫾ SD; P value by Kruskal–Wallis Rank test.
n
CoQ10 (g/dL)
AT (mg/L)
GT (mg/L)
P value
Normal pregnancy 41 0.63 ⫾ 0.3 7.40 ⫾ 2.1 1.20 ⫾ 0.9 0.000 Mild preeclampsia 25 0.31 ⫾ 0.1 6.10 ⫾ 2.2 1.41 ⫾ 0.7 0.012 Severe preeclampsia 29 0.30 ⫾ 0.1 5.90 ⫾ 2.2 1.30 ⫾ 0.9 0.387
CONCLUSION: The results demonstrate a significant decrease in serum levels of CoQ10 and AT in women with preeclampsia compared to levels observed in normal pregnancy. ␥-Tocopherol levels were comparable among the different groups. Coenzyme Q10 and AT are potent antioxidants, and their decreased serum levels in preeclampsia may alter the normal redox balance, reducing the ability of antioxidant defenses to protect against free radical damage. This could be a factor in the endothelial cell damage observed in preeclampsia.
MONDAY POSTERS
23S