Lactic Dehydrogenase: A Biochemical Marker for Preeclampsia–Eclampsia

Objectives

To correlate the severity of the disease, maternal and perinatal outcome with Lactic Dehydrogenase (LDH) levels in serum in patients of preeclampsia and eclampsia.

Methods

A prospective comparative study was conducted in the department of Obstetrics and Gynecology in the collaboration with department of Pathology, CSM Medical University, Lucknow. Out of 146 women studied, 39 were normal pregnant women, 35 were of mild preeclampsia, 36 of severe preeclampsia and 36 of eclampsia. The statistical analysis was done by Chi-square test (for proportional data) analysis of variance and sample “t” test (for parametric data).

Results

LDH levels were significantly elevated in women with preeclampsia and eclampsia (<0.001). Higher LDH levels had significant correlation with high blood pressure (P < 0.10) as well as poor maternal and perinatal outcome.

Conclusion

High serum LDH levels correlate well with the severity of the disease and poor outcomes in patients of preeclampsia and eclampsia.     

Peripartum hysterectomy in 38 hospitals in China: a population-based study

Objective

To investigate the incidence, indications, risk factors and transfusions of peripartum hysterectomy in China.

Methods

A population-based study was conducted using inpatient records of 38 hospitals between 1 January 2011 and 31 December 2011; multivariate logistic regression analysis was used to identify independent risk factors for peripartum hysterectomy.

Results

During the study period, there were 43 peripartum hysterectomy cases out of 114,420 deliveries (0.38 ‰). Abnormal placentation was major indication for peripartum hysterectomy. Several factors significantly increased the risk of peripartum hysterectomy in this population: placenta previa/accreta [adjusted odds ratio (aOR) 49.7, 95 % CI 25.0–98.9], maternal age ≥35 years (aOR 8.1, 95 % CI 4.0–16.0), preeclampsia/eclampsia (aOR 7.5, 95 % CI 2.6–21.7), cesarean delivery (aOR 3, 95 % CI 1.1–8.0), and multiparity (aOR 2.7, 95 % CI 1.2–5.4). In contrast, multiple gestations did not.

Conclusions

Placenta previa/accreta, maternal age ≥35 years, preeclampsia/eclampsia, cesarean delivery and multiparity were risk factors of peripartum hysterectomy.     

eNOSI4 and EPHX1 polymorphisms affect maternal susceptibility to preeclampsia: analysis of five polymorphisms predisposing to cardiovascular disease in 279 Caucasian and 241 African women

Purpose

The aim of this study was to evaluate possible associations of genetic polymorphisms predisposing to cardiovascular disease with the development and/or the severity of preeclampsia.

Methods

A two hospital-based prospective case–control study was performed in Germany and Ghana. 470 blood samples of 250 Caucasian and 220 black African have been genotyped by pyrosequencing and fragment length analysis. We evaluated the distribution of the epoxide hydrolase 1 (EPHX1) polymorphism on exon 3, the endothelial nitric oxide synthase (eNOS) polymorphisms on exon 7 and on intron 4, the angiotensinogen polymorphism on exon 2 and the estrogen receptor 1 polymorphism in intron 1.

Results

74 Caucasian and 84 African were classified as preeclampsia with 27 Caucasian developing a hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and 17 African women experiencing eclampsia. Multivariate logistic regression analysis adjusting for ethnicity, age and parity revealed for carriers of eNOSI4 VNTR4a a 1.7-fold increased (95 % CI 1.10–2.711, p = 0.016) risk to develop preeclampsia and a 3.6-fold increase for carriers of the EPHX1 113Tyr (95 % CI 1.366–8.750, p = 0.009) to develop severest preeclampsia.

Conclusion

Our finding of eNOSI4 polymorphism predisposing to preeclampsia independently of ethnicity, age and parity supports the concept of NO being involved in the endothelial disorder preeclampsia. Since EPHX1 is highly expressed in the liver, can interact with various signaling pathways and is involved in central nervous system disorders, the association of EPHX1 polymorphism with the HELLP syndrome and eclampsia may hint to EPHX being a further key player in the pathogenesis of preeclampsia.     

Maternal serum leptin as a marker of preeclampsia

Purpose

To assess maternal leptin levels as a marker for preeclampsia (PE) and to explore the possibility of leptin being a marker of severity of preeclampsia.

Participants and methods

Comparative prospective study was conducted among a total of 72 pregnant women at 28–38 weeks of gestation. They were divided into two groups (control and study) according to the absence or presence of clinical parameters of preeclampsia. Leptin was measured for both groups at the time of presentation, once weekly and at the termination of pregnancy.

Results

Leptin levels were found to be significantly higher among all preeclampsia patients when compared to the control group; whether at admission or at the time of delivery. Mean serum leptin level at admission in control group was 9.8?ng/ml versus 10.9 ng/ml in mild cases and 17.6 ng/ml in severe cases. At the time of delivery, mean serum leptin in control group decreased to 4.7 ng/ml while in preeclampsia patients it increased up to 22 ng/ml in mild cases and 42.6 ng/ml in severe cases. ROC curve analysis has shown that a cut off value >13.7 ng/ml can be used to detect presence of preeclampsia with a sensitivity of 91 % and specificity 100 % while a cut off value >22.5 ng/ml can be used to detect severity of preeclampsia with a sensitivity of 85 % and specificity 100 %.

Conclusion

Maternal serum leptin is significantly elevated in preeclampsia, also it can be used as a marker for the presence of preeclampsia and to differentiate patients with mild preeclampsia from those with severe disease.     

Examining the Use of Magnesium Sulfate to Treat Pregnant Women with Preeclampsia and Eclampsia: Results of a Program Assessment of Emergency Obstetric Care (EmOC) Training in India

Background

The aim of this study is to examine rates of magnesium sulfate utilization by emergency obstetric care trainees to treat preeclampsia–eclampsia in India. Secondarily, structural barriers are identified which limit the use of magnesium sulfate, highlighting limitations of emergency obstetric care training, which is a commonly implemented intervention in resource-poor settings.

Methods

Trainees’ curriculum specified magnesium sulfate treatment for eclampsia and severe preeclampsia. Case records were analyzed for preeclampsia–eclampsia diagnosis, magnesium sulfate utilization, delivery route, and maternal and neonatal outcomes from 13,238 reported deliveries between 2006 and 2012 across 75 district hospitals in 12 Indian states.

Results

Of 1320 cases of preeclampsia–eclampsia, 322 (24.4%) had eclampsia. Magnesium sulfate was given to 12.9% of preeclamptic and 54.3% of eclamptic women, with lower usage rates in rural communities. Among the 1308 women with preeclampsia–eclampsia, only 24 deaths occurred (1.8%). In contrast, among the 17,179 women without preeclampsia–eclampsia, there were 95 reported deaths (0.6%). Both maternal mortality ratios were found to be much higher than the Millennium Development Goal target of 0.15%. Magnesium sulfate administration was associated with a higher death rate in preeclamptic but not eclamptic women, representing possible confounding by severity.

Conclusion

To optimize resources spent on emergency obstetric care training, the consistent availability of magnesium sulfate should be improved in India. Increasing drug availability, implementing clinical guidelines around its administration, and training health-care providers on the identification and treatment of preeclampsia–eclampsia could lead to notable improvements in maternal and infant mortality.

     

Comparison of clinical and perinatal outcomes in early- and late-onset preeclampsia

Purpose

To compare the clinical and laboratory findings and maternal–perinatal outcomes between women with early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE).

Methods

One hundred and fifty-four women with preeclampsia (PE) who delivered in our clinic were included in the study. Perinatal and obstetric outcomes were evaluated.

Results

The incidence of abnormal uterine artery (UtA) velocity waveform was significantly higher in the EO-PE group (71.4 vs 30.1 %) (p < 0.001). The incidences of small-for-gestational age, oligohydramnios, Apgar score <7 at 5 min, stillbirth and early neonatal death rates were significantly higher in women with EO-PE compared to LO-PE (p < 0.01). Maternal complications were only recorded in women with severe PE.

Conclusion

EO-PE, especially with abnormal UtA Doppler findings defines a placentation abnormality with higher perinatal adverse outcomes.     

Preeclampsia and depression: a case–control study in Tehran

Purpose

This study was conducted to determine the correlation between preeclampsia and depression.

Methods

Participants in this study included 156 cases with preeclampsia and 156 controls without any history of preeclampsia who were all newly admitted to antepartum wards, emergency room wards, and labor and delivery wards of the study hospitals (Valieasr, Shariatti, Mirza Koochak Khan, Shahid Akbar Abadi, Baharloo and Arash). They consented and completed a questionnaire on demographic characteristics, obstetric, delivery and infant information and Patient Health Questionnaire (PHQ-9) to assess their depression status. Data were analyzed through independent t test, Mann–Whitney U test, Chi-squared test, Fisher’s exact test and multiple regression by SPSS and STATA.

Results

Moderate to severe depression was found in 31.2% of the cases and 24.8% of the controls. Women with no depression in comparison with women with mild depression had a 1.81-fold (95% CI 1.05–3.14; P = 0.03) increased risk of preeclampsia, while moderate to severe depression correlated with a 2.52-fold increase (95% CI 1.05–6.02; P = 0.03) after adjustment of the probable confounding variables.

Discussion

With regard to the high prevalence of moderate to severe depression and its association with preeclampsia, our findings support and suggest efforts for screening depression among pregnant women and appropriate educational studies for mental and psychological problems during pregnancy.     

Low-dose magnesium sulphate in the control of eclamptic fits: a randomized controlled trial

Context

Magnesium sulphate is now the gold standard for the control of eclamptic fits. The place of low-dose magnesium sulphate for the control of eclamptic seizures is yet to be determined.

Objectives

To determine the effectiveness of low-dose magnesium sulphate in controlling eclamptic fits.

Study design

Randomized controlled trial comparing low-dose with standardized dosing regimen.

Setting

Labour Unit of the department of Obstetrics and Gynecology Federal Medical Centre Azare, north-eastern Nigeria.

Protocol

Thirty-nine patients randomized into the low-dose regimen group received 9 g loading dose (4 g iv and 5 g im) and im maintenance of 2.5 g four hourly for 24 h post-delivery or post last fit, while the 33 patients in the standard dose regimen group received loading dose of 14 g followed by im maintenance dose of 5 g four hourly. In both study groups, 2 g iv of magnesium sulphate is given for breakthrough fits and 10 ml of 10 % calcium gluconate (slowly iv) was administered in the event of toxicity. Outcome measures include recurrent fits, mode of delivery, mean Apgar Score at 5 min, perinatal death, maternal complications including death.

Result

The mean age of the 72 patients was 22.3 ± 5.4 years and 60 % were primigravidas. Intrapartum eclampsia was encountered in 44 % of the patients followed by antepartum eclampsia (26 %). Overall 4.2 % recurrent convulsion rate was documented and it is not different among the study groups. There were also no differences in both foetal and maternal outcomes in the two study groups.

Conclusion

The effectiveness of low-dose regimen of magnesium sulphate appeared comparable to the ‘standard dose regimen’. Low-dose regimen may guarantee more safety and in an environment (such as ours) where cost is an important determinant of accessibility to qualitative health services, it is certainly attractive. More studies are needed to establish the place of low-dose regimen of magnesium sulphate in the management of eclampsia.     

Morbimortalidad materna y fetal en pacientes con preeclampsia grave

Objective

The presence of preeclampsia, combination of hypertension and proteinuria after 20 weeks of gestation, would noticeably increase the risk of maternal and fetal morbi-mortality.

Subject and methods

The objective of the study is to determine the perinatal outcome and maternal morbidity and mortality in women with severe preeclampsia at Albacete hospital.

Conclusions

Analyzing our results we observed in our sample both maternal and fetal mortality was lower than that observed by other authors and infants of women who develop severe preeclampsia admitted to the ICU, with eclampsia or HELLP syndrome had a higher morbidity.     

Placental Growth Factor: As an Early Second Trimester Predictive Marker for Preeclampsia in Normal and High-Risk Pregnancies in a Turkish Population

Objective

Placental growth factor (PlGF) is an angiogenetic factor and inducts the development of preeclampsia in a hypoxic environment. In this study, we examined maternal blood PlGF levels in a pregnant population between 16 and 19 weeks of gestation for determining the prospective value for early diagnosis of preeclampsia as a screening test.

Materials and Methods

In this prospective cross-sectional study, 114 nulliparous normotensive pregnant women were selected for the control group and 34 patients who have chronic hypertension or had a medical history of hypertensive disorders in previous pregnancies were selected for the study group.

Results

In the study group, the risk of preeclampsia increased 3.2 times when compared with the control with a confidence interval of 95 %. The cut-off value for PlGF for discriminating preeclamptic and non-preeclamptic patients was found to be 62.5 pg/ml.

Conclusion

Patients with a medical history of hypertensive disorders and low PIGF levels in early second trimester have an increased risk for preeclampsia.     

Prevalence of Overt and Subclinical Thyroid Dysfunction Among Pregnant Women and Its Effect on Maternal and Fetal Outcome

Aim

To determine the current prevalence of thyroid dysfunction in normal pregnant women and to study the impact of thyroid dysfunction on maternal and fetal outcome.

Methods

400 pregnant women between 13 and 26 weeks of gestation were registered for the study. Apart from routine obstetrical investigations, TSH tests were done. Free T4 and anti-TPO antibody tests were done in patients with deranged TSH. Patients were followed up till delivery. Their obstetrical and perinatal outcomes were noted.

Results

The prevalence of hypothyroidism and hyperthyroidism was 12 and 1.25 %, respectively. Adverse maternal effects in overt hypothyroidism included preeclampsia (16.6 vs. 7.8 %) and placental abruption (16.6 vs. 0.8 %). Subclinical hypothyroidism was associated with preeclampsia (22.3 vs. 7.8 %) as compared to the euthyroid patients. Adverse fetal outcomes in overt hypothyroidism included spontaneous abortion (16.6 vs. 2.39 %), preterm birth (33.3 vs. 5.8 %), low birth weight (50 vs. 12.11 %), intrauterine growth retardation (25 vs. 4.9 %), and fetal death (16.6 vs. 1.7 %) as compared to the euthyroid women. Adverse fetal outcomes in subclinical hypothyroidism included spontaneous abortion (5.5 vs. 2.39 %), preterm delivery (11.2 vs. 5.8 %), low birth weight (25 vs. 12.11 %), and intrauterine growth retardation (8.4 vs. 4.9 %) as compared to the euthyroid women.

Conclusions

The prevalence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening of thyroid dysfunction is recommended to prevent adverse fetal and maternal outcome.     

The relationship between maternal serum prenatal screening combined with epidemiological study and early onset preeclampsia

Objective

To explore the major risk factors and early prediction methods in the pathogenesis of early onset preeclampsia through combining prenatal screening markers and epidemiological characteristics.

Methods

Prenatal screening was performed in second trimester using enzyme-linked immunosorbent assay in 1,011 gravidas and epidemiological correlation factors were got by telephone with prospective cohort study. Predictive model of early onset preeclampsia was established and evaluated by single and multiple factor logistic analysis in 30 cases of preeclampsia and 867 cases of normal gravidas.

Results

As compared with the control group, the maternal serum level of human chorionic gonadotropin (hCG) in second trimester of patients with early onset preeclampsia elevated significantly (P < 0.001). Pregestational BMI ≥ 24 kg/m² (OR = 3.649, 95 % CI 1.600–8.321, P = 0.002), history of hypertension, diabetes and nephritis (OR = 55.724, 95 % CI 8.223–377.614, P < 0.001), family history of hypertension (OR = 6.777, 95 % CI 2.917–15.742, P < 0.001), and risk coefficient for trisomy 21 (OR = 3.688, 95 % CI 1.013–13.429, P = 0.048) were major risk factors of early onset preeclampsia. The sensitivity and specificity of predictive model were 70.0 and 75.1 %, when cutoff point was 0.249. The diagnostic accuracy of the logistic model was better than hCG.

Conclusions

In order to early prevent the onset and development of EOPE, it is necessary to strengthen pregestational and prenatal care for women in these aspects including pregestational BMI ≥?24 kg/m², history of hypertension, diabetes, nephritis, family history of hypertension, and high risk for trisomy 21 syndrom.     

Placental Laterality as a Predictor for Development of Preeclampsia

Objective

To find whether placental laterality as determined by ultrasound can be used as predictor for the development of preeclampsia.

Methods

This prospective study was conducted in the Department of Obstetrics and Gynecology, Govt. Medical College, Jammu from 2006 to 2007. 150 pregnant women attending antenatal clinic both OPD and IPD at 18–24 weeks of gestation without any high risk factor were subjected to ultrasound examination, and placental location was determined. These cases were followed for the development of signs and symptoms of preeclampsia.

Result

Out of the total 150 women, 84 (56 %) had laterally located placenta and of them, 56 (66.6 %) developed preeclampsia, while the remaining 66 (44 %) had centrally located placenta and of them, 24 (36.3 %) developed preeclampsia. So, the overall risk of developing preeclampsia with laterally located placenta was 5.09 (odds ratio) and 95 % confidence interval (2.40–10.88). The difference was found to be statistically significant, p value (0.00002) by χ² test.

Conclusion

From the above study, we concluded that females with laterally located placenta determined by USG at 18–24 weeks of gestation have five times greater risk of developing preeclampsia.     

The HELLP syndrome: Clinical issues and management. A Review

Background

The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.

Methods

Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases.

Results and conclusion

About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·10⁹/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.     

The Risk Factors for Failure of Labor Induction: A Cohort Study

Purpose

To assess how some factors may influence the failure of labor induction.

Methods

We conducted a prospective observational study from January 2009 to December 2011 with 248 patients who were admitted to the Obstetrics Unit of Ferrara University for labor induction. We selected only patients with unfavorable characteristics such as nulliparity, maternal and gestational age, and Bishop score and specific obstetric conditions such as mild preeclampsia, isolated oligohydramnios, premature rupture membrane, gestational diabetes, and hypertension for the success of labor induction.

Results

The induction was carried out by rapid-release gel dinoprostone. 200 patients (80.6 %) delivered vaginally (Group A), while 48 (19.4 %) underwent a cesarean section (Group B). Maternal age was one independent significant variable (p = 0.01, OR 1.08) determining the risk of cesarean delivery. Patients affected by mild preeclampsia had a three times higher risk for cesarean section. Despite the several unfavorable characteristics of the patients, the cesarean section rate was comparable to that of the normal population.

Conclusions

Several factors and clinical conditions historically considered as negative predictors of induction result should be reassessed. The success of labor induction is determined by many maternal and fetal variables, which must all be taken into account to avoid unnecessary cesarean sections.     

Obstetric outcomes and prognostic factors of lupus pregnancies

Purpose

To determine maternal and fetal outcomes in pregnancies with Systemic Lupus Erythematosus (SLE), and to evaluate the prognostic factors that may affect obstetrical outcomes.

Methods

Sixty-five consecutive cases of SLE and pregnancy were included in this retrospective clinical study, performed in a university hospital which is also a reference center for SLE. Lupus pregnancies followed and delivered during the period from 2002 to 2011 in our department are evaluated. Obstetric outcomes and prognostic factors were main outcome measures.

Results

The mean patient age was 28.8 years and the nulliparity rate was 43.1 %. Disease flare-up occurred in 7.7 % of patients. Lupus anticoagulants, anticardiolipin IgG and IgM antibodies were positive in 27.6, 15.3 and 13.8 % of patients, respectively. Mean gestational age at delivery was 36.6 ± 4.2 and mean birth weight was 2,706 ± 927 g. Stillbirth, fetal growth restriction, preeclampsia and preterm delivery rates were 4.6, 18.5, 9.2 and 27.6 %, respectively. Cases with uterine artery Doppler abnormalities had significantly poorer obstetric outcomes.

Conclusions

Multidisciplinary approach to the care of pregnant women with SLE is mandatory for good maternal and fetal outcomes. Uterine artery Doppler seems to be a good prognostic factor for adverse obstetric outcomes.     

Do uterotonic drugs increase risk of abruptio placentae and eclampsia?

Purpose

To determine whether the use of uterotonics, including oxytocin and prostaglandins, increases the risk of abruptio placentae and eclampsia.

Materials and methods

A retrospective analysis was conducted among 260,174 Japanese women at term. Demographic characteristics were studied as possible candidates for risk factors of abruptio placentae and eclampsia using multivariate logistic regression analyses.

Results

A total of 1,058 (0.41 %) and 147 (0.06 %) women developed abruptio placentae and eclampsia, respectively. Abruptio placentae and eclampsia occurred in 177 (0.29 %) and 42 (0.07 %) of the 61,857 women treated with uterotonics, respectively. Multivariate regression analyses indicated that uterotonics did not increase risk of developing either abruptio placentae or eclampsia. Primiparity [odds ratio (95 % confidence interval) 1.41 (1.24–1.60)], age ≥35 years [1.17 (1.03–1.33)], and presence of hypertension [2.42 (1.93–3.03)] were significant independent risk factors for abruptio placentae, while advancing gestation [0.67 (0.63–0.71)] decreased risk of abruptio placentae. Primiparity [odds ratio (95 % confidence interval) 4.06 (2.49–6.63)], age <20 years [2.44 (1.07–5.58)], presence of hypertension [28.7 (20.5–40.1)], and advancing gestation [1.28 (1.11–1.47)] were significant independent risk factors for eclampsia.

Conclusion

The use of uterotonics did not increase the risk of abruptio placentae and eclampsia.     

Estimation of Serum Uric Acid as an Indicator of Severity of Preeclampsia and Perinatal Outcome

Background

Uric acid is a marker of oxidative stress tissue injury and renal dysfunction, hence a correlation hypothesized.

Objectives

(1) To evaluate severity of preeclampsia with raised serum uric acid. (2) To evaluate perinatal outcome in preeclampsia with raised serum uric ccid.

Materials and Methods

50 pregnant women with severe preeclampsia and 50 normotensive women were included in the study and maternal serum uric acid was estimated in both the groups.

Results

In the study group comprising of 50 cases of preeclampsia, there is a positive correlation (r = 0.695 & +0.359) between the variables in study group, and as the SBP or DBP increases, the MSUA concentration also increases. In control group, there is a negative correlation (r = ?0.083 & ?0.095). Perinatal complication was more in study group, 54 % were preterm compared to 4 % in control group also as MSUA value increased average gestational age decreased. Mean birth weight in study group was 1.8 kg study group of which 13 (26 %) babies were VLBW, 28 (56 %) were LBW, and 9 (18 %) babies had normal birth weight, in control group mean birth weight was 2.99 kg. There were 6 cases of ELBW babies in study group which were included in VLBW group for statistical calculation. The difference was found to be statistically significant (p < 0.05). In the study group, the MSUA concentration is found higher in LBW and VLBW babies compared to normal birth weight babies.

Conclusion

There is a positive correlation between SUA & severity of preeclampsia, and a significant adverse fetal outcome is observed with raised MSUA in preeclamptic patients.

     

Echocardiographic Assessment of Cardiovascular Hemodynamics in Preeclampsia

Objective

To assess maternal cardiovascular function using echocardiography in normal and preeclamptic women in the third trimester of pregnancy.

Methods

40 subjects, 20 with preeclampsia and 20 normotensive controls with >34 weeks gestation and singleton pregnancy were recruited. Baseline characteristics, maternal and fetal outcome were studied with systolic and diastolic parameters on echocardiography.

Results

The following parameters were higher in preeclamptic subjects as compared to normotensive controls–mean cardiac output (66.85 ± 4.56 ml/min vs. 56.1 ± 1.77 ml/min); mean LV diastolic mass (131.15 ± 16.85 vs. 104.90 ± 23.17 g); systolic mass (88.5 ± 7.34 vs. 83.33 ± 23.84 g); total vascular resistance (1396.85 ± 150.2 vs. 1204.5 ± 71.182 dyne, s cm⁵). Women with preeclampsia delivered smaller babies (2410 ± 426.16 g) as compared to normotensive controls (2895 ± 276.20 g). Student ‘t’ test was used as a test of significance.

Conclusion

Women with preeclampsia have significant systolic and diastolic dysfunction compared to normotensive controls. Blood pressure monitoring alone is insufficient to identify effectively, risk of cardiovascular complications in these subjects.     

Serious Visual (Ocular) Complications in Pre-eclampsia and Eclampsia

Introduction

Complete loss of vision is an uncommon ocular complication of pre-eclampsia/eclampsia. The conditions which lead to visual loss in pre-eclampsia include cortical blindness, retinal detachment, retinal vascular thrombosis and optic nerve atrophy.

Objectives

The objective was to describe the cause, clinical course and prognosis in blindness complicating pre-eclampsia.

Methodology

This is a prospective observational study conducted at the Govt. Hospital for Women and Children, Chennai, from January 2006 to December 2010. Sixteen women who were diagnosed with blindness complicating pre-eclampsia were analysed for the cause of blindness, clinical details and prognosis.

Results

The incidence of blindness among women with pre-eclampsia and eclampsia was 0.17%. The cause of visual loss was cortical blindness in 14 patients and retinal detachment in two patients. Blindness manifested predominantly in the intrapartum and postpartum period in 13/16 cases (81.25%). Seven patients (43.75%) suffered from severe pre-eclampsia, and nine patients (56.25%) suffered from eclampsia. HELLP syndrome, gestational diabetes mellitus (GDM) and anaemia were seen in two patients each. Seven patients also presented with motor deficits. CT scan imaging showed cortical vein thrombosis in five cases, arterial infarcts in two cases, widespread hypodense areas in the occipito-parietal region in six cases. In patients with cortical blindness, recovery of vision occurred within 10 days.

Conclusion

Cortical blindness and retinal detachment are rare complications of pre-eclampsia and eclampsia. The prognosis is usually good especially with cortical blindness where the loss of vision is transient. The mainstay of management is effective treatment of pre-eclampsia/eclampsia along with termination of pregnancy.