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The effect of introduction of misoprostol for induction of labour on pregnancy in gravidas with pre-eclampsia  [PDF]
Horace Fletcher, Marvin Reid, Nadine Johnson
Open Journal of Obstetrics and Gynecology (OJOG) , 2011, DOI: 10.4236/ojog.2011.12013
Abstract: Misoprostol has revolutionized labour induction since the early 1990’s, because it is inexpensive and very effective. Eclampsia is common unless the pregnancy can be terminated by induction or by caesarean section. This study was done to determine the impact of Misoprostol used for induction of labour, on the outcome in patients with pre-eclampsia (PE) at the University of the West Indies Kingston Jamaica. This was a retrospective analysis of pre-eclamptic women who were managed before and after the introduction of misoprostol into routine usage for induction of labour. We compared 793 women (controls) in the pre misoprostol era (1986-1991) with 709 in the misoprostol era (1993-1998). Outcome variables were the frequency of mild and severe PE, eclampsia, misoprostol and syntocinon inductions, foetal complications and use of caesarean section (CS). Analysis of frequency of eclampsia, neonatal admissions and CS, during the misoprostol years, was also done to eliminate other confounding variables because of the influence of each era. Logistic regression was used to determine the impact of all variables. In comparison to controls, patients induced in the misoprostol years had a greater incidence of severe PE (p < 0.05), neonatal admissions (p = 0.007), foetal distress (p < 0.05); a higher CS rate (p < 0.05); but fewer oxytocin inductions (p < 0.05). However, sub group analysis of the misoprostol years alone, showed a reduction in the incidence of CS, eclampsia, and neonatal admissions in women who were induced with misoprostol (p < 0.05). Logistic regression revealed a lower odds of CS delivery (OR 0.867, 95% confidence interval .02, .37) using misoprostol. These findings suggest that in patients with PE, induction of labor with Misoprostol had a beneficial effect on pregnancy outcome with a decreased incidence of CS, eclampsia and neonatal admissions, but it has not had a significant impact on the main problems in these patients between the two eras as other factors may be important in the management of these patients independent of misoprostol induction.
Serum Magnesium Levels in Healthy Pregnant and Pre-Eclamptic Patients
—A Cross-Section Study
 [PDF]

D. A. Adekanle, O. T. Adeyemo, A. A. Adeniyi, R. A. Okere, A. K. Jimoh, I. O. Adebara, A. Bakare, A. S. Atiba, A. Adelekan, B. A. Olofinbiyi
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.49080
Abstract:

Background: Pre-eclampsia complicates 2% - 8% of pregnancies. Various efforts have been put forward for its prevention and treatment. Magnesium sulphate is presently the recommended drug for the prevention and treatment of eclampsia and severe pre-eclampsia. Objectives: The study aimed to compare the serum magnesium in a healthy pregnant women and pre-eclamptic women. It determined demographic characteristic of the study population and recommended the prophylactic usage of magnesium sulphate in pregnancy in our environment. Method: This was a prospective case control study comparing the serum magnesium levels in pre-eclampsia and normal pregnancy tertiary hospitals. The women who satisfied the inclusion criteria were recruited in the two groups (seventy five in the healthy pregnant women and seventy five in the pre-eclamptic women). The blood samples were collected and analysed for the serum magnesium and urine sample for urinalysis. Result: Total of 150 patients comprises 75 normal pregnant women and 75 cases of pre-eclampsia. The mean serum magnesium in the normal pregnant women was 0.73 (±0.14) mmol/L while in preeclampsia the level was 0.58 (±0.17) mmol/L. This is statistically significant (t = 6.120, p = 0.000). There was significance difference in the mean age of patients with pre-eclampsia and normal pregnancy. The mean parity in the pre-eclampsia was 0.80 and in the normal pregnancy was 1.4 and was statistically significant (t = 3.40, p value < 0.001). The mean gestational age of the pre-eclamptic was 36.5 weeks while it was 28.7 weeks in the normal pregnant women (t = 10.80, p = 0.000). Conclusion: The findings in this research work revealed that the pre-eclamptic women have lower serum magnesium level compared to the normal pregnant women, and it may therefore be interesting to do a larger multicenter study with possibility of developing a marker for this disease of theories.

Prevention of Pre-Eclampsia and Eclampsia. A Systematic Review  [PDF]
Sabiha Khanum, Najma Naz, Maria de Lourdes de Souza
Open Journal of Nursing (OJN) , 2018, DOI: 10.4236/ojn.2018.81003
Abstract:
Every pregnant woman needs continuous, timely and supportive care throughout during pregnancy for safe motherhood. The objective of this study was to analyze and evaluate the available medications and techniques for the prevention and treatment of pre-eclampsia and eclampsia. The standard methodology of systematic review without meta-analysis was followed and only RCTs and systematic reviews were included in the review. Three electronic data sources (PubMed/Medline, CINAHL, and Cochrane) were searched for studies, published between 1986 and 2016 on the prevention and control of pre-eclampsia and eclampsia. 47 studies were finally included in the review, of which 18 were systematic reviews and 29 were RCTs. Technologies and techniques used in the included studies for the prevention and control of pre-eclampsia and eclampsia are Magnesium Sulphate, Aspirin, Antioxidant (Vitamin C, E and Lycopene), Calcium supplementation, Chinese Herbal Medicine, physical activities, Nitric Oxide, Marine Food Oils, Low Salt Diet, Garlic, Plasma Volume Expansion, Low-dose Dopamine, Progesterone, Smoking, and Diuretics. Magnesium sulfate appears to be the most effective treatment which reduces the risk of eclampsia by more than 50%. However, its best dose and route are still controversial and need further research. The knowledge and experience of nurses in properly using the protocols and evidence-based interventions are necessary for the wellbeing of pregnant women.
A review of HELLP syndrome, in 17 patients  [PDF]
Davut Güven, Kadir Bakay, ?dris Ko?ak, Cazip üstün
Open Journal of Obstetrics and Gynecology (OJOG) , 2012, DOI: 10.4236/ojog.2012.23066
Abstract: Introduction Preeclampsia is a well known obstetric complication characterized with hypertension and proteinuria whereas HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) which was first stated by Prichard in 1954 and described by Weinstein in 1982, is a multisystemic disease usually seen in the third trimester and in the postpartum period, usually in 48 - 72 hours following delivery [1]. Aim In this study we aim to share our experience in 17 patients with HELLP syndrome treated in our clinic between January 2005 and March 2008 in regard of the current literature. Material and Methods 17 patients diagnosed with HELLP syndrome between January 2005 and March 2008 were retro-spectively re-evaluated in regard of symptoms, treatment options and prognosis. As such this is a retro-spective study focusing on case reports. Conclusion As noted before main focus of treatment should be on patient stability, in other words, palliative care under intensive care conditions.
Anesthesiological Management of Eclampsia in Tropical Africa: Experience of the University Hospital Center of Bouake  [PDF]
Kouadio Konan Stéphanie, Irié Bi Gohi Serge, Pete Yaich, Koffi N’Guessan, Yao Kouassi Christian, Ogondon Bernard, Nda-Koffi Cinthia, Samake Yaya, Kouame Konan Edmond, Brouh Yapo
Open Journal of Anesthesiology (OJAnes) , 2018, DOI: 10.4236/ojanes.2018.83010
Abstract: Introduction: Eclampsia is a common cause of maternal mortality in developing countries. The objective of this study is to evaluate the practice of anesthesia for eclampsia in tropical Africa. Patients and Methods: Retrospective descriptive study on the parturients who benefited from eclampsia anesthesia in the operating theaters of the gynecology and obstetrics department, the University Hospital Center (CHU) of Bouake over a two-year period (January 2015 to December 2016). The parameters studied were: anesthetic risk assessment, anesthetic management, immediate anesthetic and post-anesthetic accidents and incidents. Results: Out of a total of 3831 emergency cesarean sections, 65 were for eclampsia, or 1.69% of obstetrical surgical activity. The mean age of the patients was 20.30 ± 3.34 years (range: 14 years and 39 years). Prenatal consultation was not performed in 70% of cases and 85% of patients were primiparous. Patients classified as ASA IIIU accounted for 75% of the population and in 62% of cases, the Glasgow score was between 9 and 12. Induction was achieved with thiopental in 98% of patients and vecuronium was the only muscle relaxant used. The most common fetal complications were hypotrophy (50%), prematurity (30%) and respiratory distress (40%). Postoperative anesthetic complications were agitation (70%) and wake delay (15%). Maternal mortality was 5% and the neonatal death rate was around 7.69%. The elements of poor maternal prognosis were the ASA IVU class (P = 0.015) and the Aldrete awakening score between 3 and 5 awakening (P = 0.001). Conclusion: Anesthesia for eclampsia at CHU of Bouake is difficult. It needs to be improved thanks to better equipment of the health structures.
Bilateral serous retinal detachment in a case of eclampsia  [PDF]
Shiny Varghese, Jacob Koshy, Kumkum Avasthi
Health (Health) , 2012, DOI: 10.4236/health.2012.41003
Abstract: Serous retinal detachment is a rare complication occurring in less than 1% of patients with eclampsia. We here report such a case. We strongly recommend the need for an eye check up in all patients of pregnancy induced hypertension especially in community based setup.
Pregnancy Specific Beta-1 Glycoprotein in Women with Eclampsia, Kaduna State, Nigeria  [PDF]
Jim M. Banda, Geoffrey C. Onyemelukwe, Bolanle O. P. Musa, Oladapo S. Shittu, Zulai A. Sarkin-Pawa, Aliyu A. Babadoko, Aisha I. Mamman, Adamu G. Bakari, Suraj Junaid
Open Journal of Immunology (OJI) , 2015, DOI: 10.4236/oji.2015.55021
Abstract: This was a comparative cross-sectional study of eclamptic and normal healthy pregnant women conducted in kaduna State, Nigeria to determine Pregnancy Specific beta-1 Glycoprotein (PSG-1) levels in the peripheral blood of third trimester women with eclampsia (EC; n = 38), normal healthy pregnant and non pregnant women controls (PC; n = 25 and NPC; n = 25 respectively), age and parity matched, attending labour rooms/wards and Antenatal Clinics (ANC) of Ahmadu Bello University Teaching Hospital Shika, Zaria and four other Hospitals in Kaduna state, Nigeria. Participants with smear positive malaria, seropositive for human immunodeficiency virus (HIV) or any other known clinical infection were excluded from this study. Pregnancy specific beta-1 glycoprotein levels were estimated using Quantikine ELISA kits. Data obtained were analyzed using SPSS version 20.0 (Chicago, USA) and Graph pad Prism 6.0. Results were expressed as mean ± standard deviation while Kruskal Wallis test was used to determine the significant differences. A p-value of less than 0.05 was considered to be significant. The mean serum level of PSG-1 in EC was 2.53 ± 0.11 pg/ml, PC; 2.56 ± 0.03 pg/ml) and NPC; 0.62 ± 0.20 pg/ml. There was no significant difference between EC and PC (P > 0.05). Pregnant women (with and without EC) had significantly higher mean serum values compared to NPC p < 0.05. While pregnancy was associated with high levels of PSG-1, the study did not support the hypothesis of low PSG-1 level in EC. A longitudinal study to capture changes in PSG-I levels in the course of pregnancy as they manifest is recommended.
T Lymphocyte Subpopulations in Normal Pregnancies and Those Complicated by Eclampsia in Kaduna State, Nigeria  [PDF]
J. M. Banda, B. O. P. Musa, G. C. Onyemelukwe, S. O. Shittu, A. A. Babadoko, A. G. Bakari, A. I. Mamman, A. Sarkin-Pawa, Surajudeen A. Junaid
Open Journal of Immunology (OJI) , 2016, DOI: 10.4236/oji.2016.63010
Abstract: Background: Eclampsia, the occurrence of generalized convulsion(s) in association with signs of preeclampsia [PE] (hypertension and proteinuria) in pregnancy has remained a significant public threat in Nigeria, contributing to maternal and perinatal morbidity and mortality. This study was a comparative cross-sectional study conducted in some selected hospitals in Kaduna State, between April 2014 and November 2015. Subjects and Methods: Blood (3 mls) was collected into an ethylenediaminetetraaccetic acid (EDTA) vacutainer tube from third trimester women diagnosed with eclampsia (EC; n = 38) and healthy pregnant controls (PC; n = 38)—age and parity matched and healthy non-pregnant controls (NPC; n = 38)—age matched. T Cell subpopulations and Complete Blood Count levels were measured by Sysmex, Auto blood analyzer and flow cytometry respectively. Participants with smear positive malaria, seropositive for human immunodeficiency virus (HIV), any other clinical infection or refused consent were excluded from this study. Data obtained were analyzed using analysis of variance (ANOVA) and Post Hoc test. A p-value of less than 0.05 was considered to be significant. Result: Overall, results showed a depressed (mean ± Standard deviation (SD): CD3+ T cell (65.6 ± 15.5%; 1225.5 ± 401.5 cell/μL), CD4+ T cell (36.1 ± 8.7%; 657.1 ± 189.9 cell/μL), and a low CD4/CD8 value in women with EC (1.4 ± 0.5) and PC (1.5 ± 0.3) compared to NPC (1.9 ± 0.6) control (p < 05), while the total white blood cell count, and differential percentage neutrophils count were noted to be elevated among the eclamptic women (9.8 ± 4.9 × 109/L; 70.3 ± 12.0%) compared to PC (6.9 ± 3.6 × 109/L; 64.6 ± 8.1%) and NPC (5.6 ± 2.0 × 109/L; 48.5 ± 10.7%), p < 0.05. Conclusion: Eclampsia was associated with significantly depressed CD3+ and CD4+ T lymphocyte, and increased percentage differential neutrophil counts.
Management of Eclampsia and Imminent Eclampsia, Maternal and Perinatal Outcome in 666 Cases—2003-2007 at Government Maternity Hospital in Hyderabad  [PDF]
Pratibha Devabhaktuni, Mahita Reddy Addula, Malati Ponnur, Bhavana Kasu, Shobha Ramakoti, Harita Reddy
Open Journal of Obstetrics and Gynecology (OJOG) , 2017, DOI: 10.4236/ojog.2017.72021
Abstract: Objective: This is an audit to evaluate the maternal and perinatal outcome in eclampsia and imminent eclampsia with the management adopted at a tertiary hospital. Methods: During a period of 34 months, from 2003-2007 at Government maternity hospital, Osmania medical college, Hyderabad, 666 women with eclampsia and imminent eclampsia were managed. The number of eclampsia and imminent eclampsia (IE) was 532 and 134, respectively. We have analyzed the clinical profile, parity, age, degree of proteinuria, the period of gestation in weeks, the antenatal care, the number of antenatal visits, referrals from other hospitals, the diastolic B.P. at the time of admission, the recurrence of convulsions and the complications. 1) All the cases of eclampsia and IE were managed with magnesium sulphate as an anticonvulsant. 2) Oral nifedipine, IV labetalol, sublingual nifedipine and nitroglycerine infusion were used to control severe hypertension. 3) Prostaglandin E1 (PGE1) was used for induction of labour (IOL), 25 mcg × 4th hrly, vaginal route and 50 mcg for less than 28 weeks gestation, in 290/424 cases of IOL. Other methods of IOL were employed in 134 cases. Results: Eclampsia (n = 532) occurred antepartum in 407 (75.56%), intrapartum in 76 (14.28%), post partum in 46 (8.64%) and intercurrent in 3 (0.5%) patients. The period of gestation was <28 weeks in 86, 28 - 34 weeks in 228, >34 weeks in 340 patients. Induction of labour with misoprostol was done in 290 with vaginal delivery in 235 (81%) and lower segment caesarean section (LSCS) for failed IOL in 55 (19%) and other methods of IOL were used in 134. The total number of deliveries was 656, with vaginal deliveries in 336 (66.46%) patients, ceasarean deliveries in 220 (33.54%) patients. Ten patients died undelivered. Maternal mortality was 17/666—2.55%. Cerebrovascular events were responsible in 13/17 (76.46%) patients, pulmonary embolisim in 2, aspiration pneumonia in one and sepsis in one. The perinatal mortality was 167/582 (28.69%), PNM when birth weight was >1.5 kg was 59/426 (13.84%), intrauterine fetal deaths at admission were 54 (8.5%), there were four sets of twins. Conclusions: 1) More effective measures to control hypertension and routine administration of anticonvulsant, magnesium sulphate to women with eclampsia should be practised from the first referral unit itself. 2) Our caesarean delivery rate of 33.54% in the very high risk cases of eclampsia and imminent eclampsia is very low compared to others. 3) Induction
Umbilical Artery Resistance Index in the Surveillance of Pregnancies at Risk of Fetal-Maternal Hemodynamic Disorders in Lomé (Togo)  [PDF]
Sonhaye Lantam, Kolou Bérésa, Boube Abarchi Habibou, Bah Ousmane Aminata, Amadou Abdoulatif, Gbande Pihou, Assih Kouméabalo, Tchaou Mazamaesso, Ntimon Bidamin, Adjenou Komlanvi
Open Journal of Radiology (OJRad) , 2018, DOI: 10.4236/ojrad.2018.83018
Abstract: Objective: Evaluate the role of umbilical artery Doppler ultrasound in the surveillance of pregnancies at risk of vascular disorders in Lomé. Study Method: The study was a cross-sectional analytical study carried out in the department of radiology of Campus teaching hospital over a period of 6 months. This study was based on the measurement of the resistance index of the umbilical artery in pregnant women presenting vascular risk and other pregnant women without vascular risk. The correlation between the pathological index and the at-risk pregnancies was assessed by the Odds Ratio as well as the correlation between the resistance index and the Apgar score at birth. Results: The resistance index was measured in 209 at-risk pregnant women and in 425 pregnant women without vascular risk. The average age of pregnant women was 26.31 years for “the at-risk pregnant” versus 25.38 years for the “pregnant-witnesses”. The association between the pathological resistance index (RI) and the gestational pathologies studied, had been positive and significant with an odds ratio of 1.57 for a 95% confidence interval of [1.07 - 2.20]. A pathological RI is a risk factor for the occurrence of a pathological Apgar score at birth because this association was positive and significant for “pregnant-cases” as for “pregnant-witnesses”. Conclusion: Measuring the index of resistance is not a common practice in our communities. However, it could be an important tool in the surveillance of at-risk pregnancies for diseases such as malaria, pre-eclampsia, and maternal anemia.
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