Human leucocyte antigen status in African women with eclampsia

Summary. Investigation of the HLA system in 53 African eclamptic or imminently eclamptic women showed that they were significantly more likely to be heterozygous at the B locus than were normal controls. This did not apply to the A or D related loci.     

Head computed tomographic scans in women with eclampsia

From 1980 to 1986, head computed tomographic scans were performed in 49 women with eclampsia managed according to the standardized regimen used at Parkland Memorial Hospital. Abnormal radiographic findings were seen in 14 (29%). Although this incidence may have been affected by the temporal relationship of the scan to the seizure, it was greatly impacted by technical resolution obtained with succeeding improved equipment. In the last 3 years of the study more than a third of these scans showed some abnormality, and in 1986, using "fourth-generation" equipment, half were abnormal. These areas of radiographic hypodensity correspond to those with petechial hemorrhages and local edema that have been described at autopsy in women who died after eclamptic episodes. All women recovered fully despite ominous findings in some. We conclude that the clinical utility of tomography in women with otherwise "uncomplicated eclampsia" is limited because these findings seldom alter management.     

Counseling for women with preeclampsia or eclampsia

Preconception counseling may address issues such as nutrition, prevention and prediction of preeclampsia, utility of prenatal visits and fetal surveillance, risk of superimposed preeclampsia, recurrence risks for future gestation, diagnosis of underlying predisposing factors, and potential impact on future maternal and fetal health. Although certainty is lacking in medicine, it appears that minimal risk to either mother or fetus is attributable to mild chronic hypertension complicating pregnancy. Increased maternal and fetal morbidity is associated with superimposed preeclampsia. Unfortunately, we are unable to predict which of these gravidas will have superimposed preeclampsia and thus suffer added morbidity. There appears to be a greater than 50% chance of maternal or fetal morbidity for those women entering pregnancy with severe chronic hypertension in association with other renocardiovascular complications. Unfortunately, for the majority of women whose medical condition falls between these two extremes, the current predictive value remains vague. The best option is to review the existing literature with patients in a nondirective manner, allow them their decisions, and provide them the best available prenatal care.     

Human leucocyte antigens in pregnant women with pre-eclampsia associated with intrauterine growth retardation and in normal controls

Objective: To investigate the association between maternal HLA class II and intrauterine growth retardation with associated birthweight of the newborn, in women with preeclampsia. Methodology: Thirty preeclamptics and 30 normotensive matched for age, parity and gestation were investigated for HLA class II profile using Terasaki microlymphocytotoxicity test as the typing technique. The outcome of the pregnancy in terms of intrauterine growth retardation, birthweight and placental weight, were investigated to elucidate a susceptibility factor in the HLA Class II profile of the preeclamptic women. Results: HLA class II DR2, DR4, DRw11, DRw14 and DQw2 were more common in the preeclamptic women (p<0.04, 0.03, 0.05, 0.03, 0.05), while DQw3 was more common in the controls (p<0.05). Mean birthweight was 2.71±0.73 kg with preeclampsia compared to 3.4±0.4 kg for controls (p<0.01). Low birthweight was 56.7% versus 6./% (p<0.001) and mean placental weight was 474.8±100.8 gm versus 692.1±107.3 gm (p<0.01). DR4 and DQW2 were significantly associated with intrauterine growth retardation with associated low birthweight and placental weight (p<0.01). Conclusion: HLA class II hyaplotypes DR4, and DQw2 are associated with intrauterine growth retardation with associated low birthweight and placental weight through preeclampsia. The association between intrauterine growth retardation and HLA may be a direct susceptibility factor. This needs further elucidation. Received: 13 May 1997 / Accepted: 22 September 1997     

Dyslipoproteinaemia in postmenopausal women with a history of eclampsia

Objective To test the hypothesis that postmenopausal women with a history of eclampsia manifest a more high risk lipid profile than postmenopausal women with a history of normal pregnancy.
Setting The Department of Obstetrics and Gynaecology, National University Hospital, Reykjavik, Iceland, and the Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.
Participants Thirty Icelandic women with a history of eclampsia, aged between 50 and 67 years at the time of re-examination (cases) were individually matched for current age, and for age and parity at index pregnancy, to 30 unrelated Icelandic women with a history of normal pregnancy (controls).
Methods The participating women completed a health and family history questionnaire and underwent a physical examination. Fasting plasma low density lipoprotein diameter, serum lipids, insulin, and glucose were measured.
Results Mean low density lipoprotein size was significantly smaller and apolipoprotein B concentration was higher in women with prior eclampsia. The percentage of cases receiving blood pressure medication (33%) was significantly greater than controls (6.7%). Thirteen cases had had hypertensive complications in at least one other pregnancy (recurrent subgroup); postmenopausally, these women displayed significantly increased diastolic blood pressures, smaller-sized low density lipoprotein, increased apolipoprotein B, decreased high density lipoprotein₂ (HDL₂) cholesterol, and increased total cholesterol: HDL cholesterol ratio compared with their controls. Fourteen cases were normotensive in all other pregnancies (nonrecurrent); these showed no differences from their controls.
Conclusions Dyslipoproteinaemia is more prevalent among postmenopausal women with prior eclampsia, especially with recurrent hypertension in pregnancy, than in postmenopausal women with prior normal pregnancies.     

Absence of Factor V Leiden,thrombomodulin and prothrombin gene variants in Black South African women with pre-eclampsia and eclampsia

It has been suggested that gene aberrations may contribute to vascular endothelial dysfunction of pre-eclampsia in Caucasian and Japanese women. This study was undertaken to examine the association between pre-eclampsia in Black Zulu speaking South African women and the Factor 5 Leiden mutation. 100 patients with pre-eclampsia comprised the study group. The control group comprised 110 normotensive pregnant women of the same population group. Genotyping was performed to detect the G or A allele at residue 506 of the Factor V gene, and the C or T allele at residue 455 of the thrombomodulin gene. Our findings demonstrate that these particularly genetic loci are of little use in disease association studies for pre-eclampsia in homogenous Zulu speaking Africans.     

Risk factors in Mozambican women with eclampsia: a case-referent study

In Maputo 133 consecutive eclamptic patients were compared with 393 non-eclamptic referent women. Significant risk factors for eclampsia were age < or = 18 years, household size < or = 3 individuals, unwanted pregnancy, walking to antenatal clinics and, in the thrid trimester, headache, foot oedema, hand or face oedema, epigastric pain, visual disturbance, ear buzzing and dizziness. Significantly more cases than referents reported no blood pressure measurements in antenatal clinics. It is concluded that the quality of antenatal clinics can be improved by enhanced community awareness of danger signs, by early recognition of risk factors and by better management of prodromal symptoms of eclampsia.     

Magnesium sulfate compared with lytic cocktail for women with eclampsia.

OBJECTIVE: To compare magnesium sulfate with lytic cocktail for the treatment of eclampsia. METHODS: The register of trials kept by the Cochrane Pregnancy and Childbirth Group and the Cochrane Controlled Trials Register were searched for randomized trials comparing magnesium sulfate with lytic cocktail for the treatment of eclampsia. RESULTS: Two studies were included (a total of 199 women). Magnesium sulfate was more effective than lytic cocktail at preventing further convulsions [relative risk (RR) 0.09, 95% confidence interval (C.I.)=0.03-0.24; risk difference=0.43, 95% C.I.=-0.53 to -0.34; number needed to treat=3, 95% C.I.=2-3) and was associated with less respiratory depression (RR=0.12, 95% C.I.=0.02-0.91) and fewer baby deaths (RR=0.26, 95% C.I.=0.26-0.79). There were non-significantly fewer maternal deaths associated with magnesium sulfate (RR=0.25, 95% C.I.=0.04-1.43). CONCLUSIONS: Magnesium sulfate is the anticonvulsant of choice for eclampsia. Lytic cocktail should be abandoned.     

Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia

Objective To compare retrospectively the outcome of caesarean section under epidural anaesthesia with that of general anaesthesia in "stable" women with eclampsia.
Design Retrospective review.
Method Over the five–year study period, there were 533 women with eclampsia and of these 66 women (12.4%), fulfilled the criteria of being 'stable'. Of the 66 women, 37 received epidural, 27 general, and 2 spinal anaesthesia.
Results There were no major complications with either general or epidural anaesthesia. Epidural anaesthesia was associated with higher one–minute Apgar scores.
Conclusion This study indicates that both maternal and neonatal outcomes are not affected adversely by the use of epidural anaesthesia in selected cases of eclampsia.     

Human leucocyte antigen (HLA) A2 as a negative clinical prognostic factor in patients with advanced ovarian cancer

OBJECTIVES: Major histocompatibility complex antigens are mandatory for the immune response, and a genetic imbalance may be linked to tumor escape. We have previously characterized a cluster of ovarian cancer patients with high incidence of HLA-A2. To find a prognostic relevance, the presence of HLA-A2 was correlated to defined clinical parameters. METHODS: A population-based set of 97 patients with confirmed epithelial ovarian cancer were recorded in a database by age, histology, stage, surgery and treatment. At the time the study was initiated, the majority of the patients were not alive and HLA-A2 expression was therefore determined by PCR/sequence-specific oligonucleotide hybridization using DNA extracted from paraffin-imbedded tissue specimens. RESULTS: 88 patients with a median age of 65 years (36-87) could be evaluated. 44% were serous adenocarcinomas, 28% endometrioid, 6% mucinous, 13% clear cell carcinomas, 7% undifferentiated and 2% other epithelial tumors. Stages I-II comprised 33% and stages III-IV 67%. In stages III-IV and serous histology, 73% were HLA-A2 positive. Cox analysis, in this group, showed high univariate (HR7.16; CI 2.04-25.03; P = 0.002) and multivariate (HR 6.8; CI 2.10-22.4; P = 0.001) Hazard Ratios. None of the HLA-A2 positive patients survived 5 years, compared to more than 50% of the HLA-A2 negative patients. CONCLUSIONS: HLA-A2 is a negative factor for survival in women with serous adenocarcinomas of the ovary in stages III-IV. This finding has implications for clinical patient management. Association with known oncogenes needs further analysis.     

T594M mutation of the epithelial sodium channel beta-subunit gene in pre-eclampsia and eclampsia in Black South African women

The possible role of the beta-subunit of the epithelial sodium channel T594M polymorphism in hypertensive disorders of pregnancy has not been examined. This study compared Black South African women with pre-eclampsia (n= 204), early onset pre-eclampsia (n= 67), eclampsia (n= 120) and gestational hypertension (n= 78) with 338 women from the same ethnic group who had full-term normotensive pregnancies, for the presence of the T594M polymorphism. The variant allele was detected in 1.7% to 3.8% of the various patient groups and in 3.6% of the control group reflecting no significant difference. These results suggest that the T594M polymorphism in the sodium channel beta-subunit is not associated with the pathogenesis of pre-eclampsia or gestational hypertension.     

孕妇血清中可溶性endoglin水平变化与重度子痫前期及子痫患者发病的关系

目的 探讨孕妇血清中可溶性endoglin水平变化与重度子痫前期及子痫发病的关系.方法 2005年12月至2007年12月在北京大学第一医院分娩的重度子痫前期孕妇42例和子痫孕妇4例为研究组,孕(35±4)周,年龄(29.3±5.7)岁,体系指数(30.1±4.1)ks/m2;其中早发型子痫前期25例,晚发型子痫前期21例,并发胎儿生长受限(FGa)8例,并发溶血、肝酶升高和低血小板计数(HELLP)综合征5例.选择同期妊娠结局正常的29例孕妇为对照组,孕(33±4)周,年龄(30.7±3.4)岁,体重指数(27.2±2.2)ks/m2.采用酶联免疫吸附试验检测两组孕妇血清中可溶性endoglin水平,分析血清中可溶性endoglin水平变化与孕周的相关性.结果 (1)对照组孕妇在27～37孕周血清中可溶性endoglin水平与孕周有正相关关系(r=0.79,P<0.05),研究组无明显相关性(r=0.31,P>0.05).(2)研究组孕妇血清中可溶性endoglin水平为(14.2 ±5.6) μg/L,高于对照组的(10.9±4.2)μg/L,两组比较,差异有统计学意义(P<0.01).(3)研究组中早发型子痫前期孕妇血清中可溶性endoglin水平为(14.3±5.7)μg/L,晚发型子痫前期孕妇为(13.6±5.0)μg/L,两者比较,差异无统计学意义(P>0.05).(4)并发HELLP综合征孕妇血清中可溶性endoglin水平为(10.1±2.9)μg/L,无HELLP孕妇为(14.4±5.4)μg/L,两者比较,差异无统计学意义(P>0.05).(5)并发FGR孕妇血清中可溶性endoglin水平为(17.3±6.1)μg/L,无FGR孕妇为(13.0±4.8)μg/L,两者比较.差异有统计学意义(P<0.05).结论 孕妇血清中可溶性endoglin水平升高,可能与重度子痫前期及子痈、FGR的发病有关,但与发病时间无明显关系.     

Recovery of gonadotropin-secreting function of the pituitary in the puerperal women with eclampsia

Recovery of gonadotropin-secreting function of the pituitary has been studied in 4 puerperal women with episodes of eclampsia during the last pregnancy, delivery and/or the first 24 hours after delivery. On day 20 postpartum, hypertension, edema and proteinuria were improved in all the puerperal women. Serum FSH and LH responses to LH-RH on day 20 postpartum in 3 puerperal women with less than 6 eclamptic attacks during pregnancy or delivery were at a comparable level to those on day 20 postpartum in 4 puerperal women with premature labor between 31 and 33 weeks' gestation and in 9 normal puerperal women. Serum FSH response to LH-RH on day 20 postpartum in a puerperal woman with 10 eclamptic attacks during pregnancy and the first 24 hours after delivery was lower than those in 4 puerperal women with premature labor and in 9 normal puerperal women. In the puerperal woman with 10 eclamptic attacks, the lowered FSH response to LH-RH on day 20 postpartum was apparently improved on day 55 postpartum. However, the FSH response to LH-RH on day 55 postpartum was still lower in the puerperal woman with 10 eclamptic attacks than in 7 normal puerperal women. These results indicate that many eclamptic attacks during pregnancy, delivery and/or the first 24 hours after delivery may cause perturbation to some extent in recovery of FSH-secreting function of the pituitary during the puerperium.     

Risk factors for abruptio placentae and eclampsia: Analysis of 445 consecutively managed women with severe preeclampsia and eclampsia

Objective: Our purpose was to characterize the clinical presentation or laboratory variables predictive of either abruptio placentae or eclampsia in women with severe preeclampsia. Study Design: Prospective collection of perinatal data from 445 consecutively managed women with severe preeclampsia and eclampsia. Univariate analysis was used to determine which of the independent variables were significantly different between the groups (abruptio placentae vs no abruptio placentae; eclampsia vs no eclampsia). Those with significant differences were then entered into multiple logistic regression analysis to determine those characteristics that were independently related to the outcome variable (abruptio placentae or eclampsia). Before multivariate analysis, the independent variables with an interval scale of measurement were converted to a dichotomous scale, with the receiver-operator characteristic curve used to determine a cutoff level. Results: Univariate analysis revealed statistical significance for the following variables associated with eclampsia: uric acid concentration, > 8.1 mg/dL; proteinuria (>3+); headache; visual symptoms; deep tendon reflexes >3+; serum albumin concentration, <3 mg/dL; and serum creatinine concentration, >1.3 mg/dL. However, with subsequent multivariate analysis, only headache and deep tendon reflexes >3+ remained significant. Univariate analysis for variables associated with abruptio placentae revealed an association between bleeding and platelet count <60,000/mm³. There was no association between abruptio placentae and eclampsia and systolic, diastolic, or mean arterial pressure, quantitative proteinuria, epigastric pain, bleeding, gestational age at delivery, history of preeclampsia, or chronic hypertension. Conclusion: Quantitative proteinuria and degree of blood pressure elevation were not predictive of either abruptio placentae or eclampsia, as has previously been suggested. The greatest morbidity associated with eclampsia occurred in women with preterm gestations not receiving medical attention. (Am J Obstet Gynecol 1999;180:1322-9.)     

Cerebral edema on MRI in severe preeclamptic women developing eclampsia

OBJECTIVE: The aim of this study is to identify suitable applications for cerebral MR (magnetic resonance) scanning in cases of severe preeclampsia and eclampsia through comparison of clinical course and easily accessible parameters. METHODS: From January 2001 to December 2003, cerebral MR scans were performed on 43 women with severe preeclampsia; of those 41 were enrolled in data analyses. Twenty clinical parameters, including age, body mass index, blood pressure, liver and renal function, and coagulation status, were compared for each patient. Data were analyzed using the SPSS program on a VAX main frame. RESULTS: Among 41 severe preeclamptic women, abnormal MR images were observed in 11 cases including six with systemic seizures. Predictive accuracy of eclampsia with abnormal cerebral MR imaging was 84.9% (P=0.00001), while only 14.3% of severe preeclampsia cases had been diagnosed radiologically. Statistical analysis suggests diastolic BP and serum AST as predictive parameters for abnormal MR images with 82.9% predictive accuracy (P=0.0007). CONCLUSIONS: Cerebral edema can be observed in preeclamptic patients developing eclampsia. Rapid delivery is indicated when diastolic BP and AST are elevated. MR scanning is useful when delivery is delayed due to fetal immaturityin cases of severe preeclampsia.     

Selective magnesium sulfate prophylaxis for the prevention of eclampsia in women with gestational hypertension

OBJECTIVE: To describe the incidence of eclampsia in women with mild gestational hypertension when only women with severe gestational hypertension are given magnesium sulfate prophylaxis. METHODS: This is a prospective 4(1/2)-year observational study. Those women who met our criteria for severe gestational hypertension received intravenous magnesium sulfate prophylaxis, and women with nonsevere hypertension did not. Data were collected at delivery to ascertain the incidence of eclampsia and maternal and neonatal morbidity. RESULTS: A total of 72,004 women were delivered during the study period, 6,431 had gestational hypertension, 3,935 met the criteria for severe disease and were given magnesium sulfate prophylaxis, 2,496 women with nonsevere hypertension were not treated. Eighty-seven women developed eclampsia, for an overall incidence of 1 in 828 deliveries, a 50% increase when compared with 5 preceding years where all women with gestational hypertension were given magnesium sulfate prophylaxis. Of the 2,496 women with nonsevere hypertension who were not treated, 27 had eclampsia (1 in 92). Women with eclampsia were more likely to require general anesthesia for cesarean delivery compared with hypertensive women without eclampsia (23% versus 4%, P < .001), but they had no additional morbidity. Infants of eclamptic mothers had more adverse outcomes than those without convulsions (12% versus 1%, P < .04). CONCLUSION: Selective magnesium sulfate prophylaxis results in an increased overall incidence of eclampsia because of more seizures in women with nonsevere gestational hypertension who are not given magnesium sulfate prophylaxis. LEVEL OF EVIDENCE: II-3.