Complication Of Severe Preeclampsia Research Articles

Emergency Caesarean Section in a Patient with HELLP Syndrome and Intramural Myoma: A Case Report

Introduction: The syndrome of HELLP, often a complication of severe pre-eclampsia, is influenced by factors like multiparity, advanced maternal age, and potential genetic associations. Intramural Myoma have been linked to a 44% increased risk of hypertension in pregnant women, potentially contributing to the initiation and progression of pre-eclampsia, particularly due to their rapid expansion during pregnancy. This study reported a patient with intramural myoma and HELLP Syndrome in 35-36 weeks of gestation age. Case Presentation: A 40-year-old woman in her 35-36 weeks of gestation sought emergency care at General Hospital Dr. Saiful Anwar Malang due to escalating severe headaches. As a third-time expectant mother with a history of five antenatal visits, she presented with elevated blood pressure (219/110 mmHg), a BMI of 32 kg/m2, and various concerning findings, leading to a diagnosis of impending eclampsia, severe preeclampsia (HELLP syndrome), fetal distress, severe hypoalbuminemia, intrauterine growth restriction (IUGR), and other complications. The patient underwent an urgent cesarean section, revealing an intramural uterine myoma, followed by bilateral ligation of uterine arteries to address bleeding and myomectomy. Postoperatively, she received a magnesium sulfate infusion, her blood pressure stabilized at 143/92 mmHg and Hemoglobin 12,40 g/dl. Conclusion: Intramural myoma increases the risk of preeclampsia during pregnancy. Emergency C-section is an effective measure to address complications for both the mother and the baby, and bilateral ligation of uterine arteries can minimize surgical bleeding.

ROLE OF MATERNAL SERUM FIBROBLAST GROWTH FACTOR 21 LEVEL IN PREDICTION OF PREECLAMPSIA

Pregnancy complications resulting from hypertensive disorders are a serious problem that impact 2-10 % of all pregnanciesglobally. Preeclampsia is defi ned as new onset hypertension and proteinuria after 20 weeks of gestation which may be associated with other maternal organ dysfunction, such as liver or renal insuffi ciency, hematological or neurological complications, uteroplacental dysfunction and fetal growth restriction.Aim of the Work: Primary outcome is to determine the correlation between fi broblast growth factor 21 level and preeclampsia & signifi cance of serum fi broblast growth factor 21 levels as a predictive tool for preeclampsia. Secondary outcome is to establish the relationship between maternal serum fi broblast growth factor 21 level and Maternal complictions: - Eclampsia (tonic clonic fi ts after 20 weeks with elevated blood pressure and proteinuria)- HELLP syndrome (hemolysis, elevated liver enzymes and low platelet occur as a complication of severe preeclampsia)- placental abruption (bleeding after 20 weeks gestation due to premature separation of a normally situated placenta)Patients and Methods: This was a Nested case-control study that was conducted on 90 primigravidas at Ain Shams University maternity hospital from April 2021 to April 2022. Ethical approval was obtained from the ethical committee at Ain- Shams university maternity hospital. Data was recruited from patient attending obstetric clinic at Ain Shams University Maternity Hospital. Blood samples were collected after 20 weeks to 28 weeks gestation. Patients was followed up until delivery and grouped according to development of preeclampsia.Random samples from 45 patients (group who develop PE) and 45 random samples from control group were assessed forfi broblast growth factor 21. Serum fi broblast growth factor 21 levels were measured by a commercially available enzyme- linked immunosorbent assay kit.Results: our study showed that there was a significant difference in FGF21 levels between the groups, patients withpreeclampsia having higher levels than controls, 15.9 % of patients with preeclampsia experienced maternal complicationscompared to none in the control group. Meanwhile, 18.2 % of patients with preeclampsia experienced fetal complicationscompared to 0 % in the control group.Conclusion: Serum FGF-21 levels are signifi cantly higher in preeclamptic pregnant women compared to healthy normotensive pregnant women. So, it can be used as a predictor for preclampsia and maternal complicationsFunding information: The article was written and published without any fi nancial support.Confl ict of interest disclosure: The authors of the article have noconfl ict of interest related to the publication of the article

MATERNAL AND FETAL OUTCOMES IN HELLP SYNDROME AT 23 WEEKS GESTATION: SYSTEMATIC REVIEW

Introduction: Hypertensive disorders, affecting 5-10 of pregnancies, are a leading cause of maternal and perinatal mortality. Preeclampsia-eclampsia, a syndrome contributing to significant global deaths, demands prompt identification and management, particularly in resource-limited settings. Detecting and addressing early and late-onset preeclampsia are crucial for maternal and neonatal well-being. HELLP syndrome, a severe complication of preeclampsia, presents diverse symptoms and risks, with a maternal mortality rate as high as 24 Understanding its outcomes in pregnancies before 23 weeks is essential to guide better management strategies for improved maternal and neonatal health in such critical cases. Methods: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: Our search produced 15 results. After looking at the titles and summaries, we found 6 papers that fit our criteria. At first, we excluded one articles because they were written in a review style. But after reading the full papers carefully, we included four papers in our final analysis. These papers included a retrospective observational study and several case reports. Conclusion: Occurrences of HELLP syndrome without associated hypertensive disorders and recurrent intrahepatic ruptures at extremely premature gestational ages are rare but pose significant risks to mothers and newborns. Swift diagnosis, pregnancy termination, and continuous monitoring are crucial to address early-onset HELLP syndrome, emphasizing the need for immediate attention and prompt management.

Oral nifedipine and phytosterol, intravenous nicardipine, and oral nifedipine only: Three-arm, retrospective, cohort study for management of severe preeclampsia.

The treatment of preeclampsia is delivering women and extracting the placenta, but the Chinese Society of Obstetrics and Gynecology guidelines do not recommend the delivery of babies without severe features. The objectives of the study were to compare the effectiveness and safety of nifedipine and phytosterol in combination with nicardipine for the management of severe preeclampsia. Women (19-32 years; gestation age ≥ 30 weeks) with the complication of severe preeclampsia have received 10 mg of oral nifedipine (pregnant women received 10 mg of oralnifedipine, n = 112) or 1 mg/h intravenous nicardipine (pregnant women received 1 mg/h intravenous nicardipine (ND cohort), n = 115) or oral 10 mg nifedipine and 500 mg phytosterol (pregnant women received oral 10 mg nifedipine and 500 mg phytosterol (np cohort), n = 111) until 150/100 mmHg blood pressure was achieved. The time required to achieve the desired blood pressure control was 13 minutes shorter in the NP cohort compared to the NF (p < 0.0001, t = 11.605), and 3 minutes shorter compared to the ND (p < 0.0001, t = 2.79) cohorts. Stillbirths were reported in 14 (13%), 28 (24%), and 10 (9%) infants, and 13 (12%), 26 (23%), and 10 (9%) infants died from the NF, ND, and NP cohorts, respectively. The undesirable tocolytic effect was reported in 17 (15%) women of the ND cohort. Phytosterol with nifedipine has a synergistic or additive effect on the management of preeclampsia with fewer adverse outcomes.

Neonatal Complications of Severe Pre-Eclampsia and Eclampsia in Rural Area in Sénégal

Neonatal Complications of Severe Pre-Eclampsia and Eclampsia in Rural Area in Sénégal

Subcapsular hepatic hematoma as a complication of severe preeclampsia: a case report

BackgroundSubcapsular hepatic hematoma is a rare and life-threatening complication of pregnancy. It is most commonly associated with severe preeclampsia and hemolytic anemia, elevated liver enzymes, and low platelets syndrome. Patients with subcapsular hepatic hematoma typically present with epigastric, right upper quadrant or shoulder pain, nausea and vomiting, and/or shortness of breath. Here we describe a patient with a classic pain presentation, a large unruptured hematoma, and an unusual postpartum course.CaseA 40-year-old gravida 1 para 0 Caucasian woman presented at 39 + 6 weeks gestational age with a 3-day history of new onset pain in an otherwise uncomplicated pregnancy. She described the pain along her right torso as severe, shooting, and sharp, but at times pleuritic in nature. She was found to have new onset preeclampsia and hemolytic anemia, elevated liver enzymes, and low platelets syndrome. Induction of labor was initiated and eventually she delivered by cesarean section. Her pain persisted in the postpartum period and abdominal computed tomography scan revealed a 16 cm subcapsular hepatic hematoma. Despite the hematoma being thin walled, conservative management was recommended by the general surgeon. She then re-presented on postpartum day 15 with tachypnea, dyspnea, and pleuritic chest pain. Secondary to the subcapsular hepatic hematoma, she then developed an infected and loculated, large pleural effusion. This required video-assisted thoracoscopic surgery before her eventual discharge home on postpartum day 21.ConclusionsThere should be high clinical suspicion of subcapsular hepatic hematoma in patients with persistent pain in the right upper quadrant of the abdomen. Urgent imaging to investigate for subcapsular hepatic hematoma is then indicated. Cesarean delivery without labor and treatment for severe preeclampsia should be undertaken if subcapsular hepatic hematoma is found. Conservative management and serial imaging are reasonable for the follow-up of a large, unruptured hematoma. Hepatic artery embolization should also be considered. Subcapsular hepatic hematoma may be complicated by infected pleural effusions and require video-assisted thoracoscopic surgery.

EARLY MANAGEMENT OF SEVERE PRE-ECLAMPTIC AND ECLAMPTIC REFFERAL PATIENT AT KOTABARU REGENCY

ABSTRACTBackground: The maternal mortality rate is 305 per 100,000 live births in Indonesia. The most common cause of maternal death is preeclampsia / eclampsia. The maternal mortality rate is 247 per 100,000 live births in 2017 in Kotabaru Regency. Most preeclamptic referral patients are in critical condition when they arrive at the hospital. Method: This type of research is an observational descriptive study. The population is all patients with severe preeclampsia and eclampsia in the delivery room of RS Pangeran Jaya Sumitra Kabupaten Kotabaru from January - December 2018. The sample is total sampling.Results: PEB referral patients was 57 cases. Most of those are in the group age of 20 - 35 years which are 35 people (61.4%), not nullipara is 31 people (54,4%), 34-40 weeks of gestation is 43 people (75,4%), as many as 44 people (77,2%) with previous severe preeclampsia/ hypertension, 41 people (71,9%) brought referral letters, referred by Puskesmas are 47 people (82.5%), most of the locations of referral is from Pulau Laut as many as 35 referrals (61,4%). The initial management of PEB and eclampsia: IV Pathway in 11 patients (19.3%) of severe preeclamptic and eclamptic patients, 50 patients (87.7%) were not given MgSO4, 51 people (89.5% ) did not get anti-hypertension, 52 patients (91.2%) were not installed catheters. Conclusion: Early management of severe preeclamptic and eclamptic patients is not optimal and does not fulfil the standard yet. Proper and appropriate early management can reduce morbidity and maternal mortality from complications of severe preeclampsia and eclampsia that can be prevented by providing right initial management.

Evaluation of the diagnostic possibility of hemorrhagic risk in pregnant women with severe preeclampsia by rotational thromboelastography

AIM: The aim of this study was to determine the risk of hemorrhagic complications in pregnant women with severe preeclampsia using rotational thromboelastometry (ROTEM) in two screening tests EXTEM and INTEM.&#x0D; MATERIALS AND METHODS: We examined 30 pregnant women with severe preeclampsia, who were observed in the intensive care unit, the Department of Obstetrics and Perinatology, the Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott, Saint Petersburg. The control group consisted of 10 patients with normal pregnancy, delivered by caesarean section for reasons not related to obstetric complications.&#x0D; RESULTS: When interpreting the ROTEM results, the reference intervals for pregnant women in the third trimester were used, as determined in the study by J. Lee et al. (2019). According to the analysis of thromboelastograms of pregnant women with severe preeclampsia, 9 (30%) of them had a tendency towards hypocoagulation. Of these, 3 thromboelastograms had deviations via the intrinsic coagulation pathway (in the INTEM tests), 3 thromboelastograms via the extrinsic coagulation pathway (in the EXTEM tests), and the rest combined both options. Two patients with severe preeclampsia developed a complication in the form of HELLP syndrome, and the phenomena of hypocoagulation, according to the results of ROTEM performed before delivery, were observed in only one patient. A comparative analysis of ROTEM parameters among pregnant women with severe preeclampsia and normal pregnancy did not reveal statistically significant differences.&#x0D; CONCLUSIONS: The use of the ROTEM method with the main screening tests (EXTEM and INTEM) did not show diagnostic value in assessing the risk of hemorrhagic complications of severe preeclampsia.

Monitoring in obstetric critical care (“maternal near miss”) in the Northwestern Federal District of the Russian Federation in 2018-2019

This article presents data of monitoring critical obstetric conditions (maternal near miss) for the purpose of auditing the quality of medical care and prevention of maternal mortality, obtained on the basis of an analysis of statistical data from eleven federal subjects of the Northwestern Federal District of the Russian Federation for 2018-2019. We characterized the critical obstetric conditions that allow avoiding maternal mortality cases, which, in modern legal practice, most often require forensic examinations on the fact of providing obstetric and gynecological medical care of inadequate quality. We determined that the main causes of maternal mortality cases (83.1% in 2018 and 84.0% in 2019) were massive obstetric bleeding and complications of severe preeclampsia, which more often occurred during childbirth and the first days of the postpartum period. All patients who survived a near death condition belonged to the group of high obstetric and perinatal risk, but most of them were delivered in obstetric hospitals of the second level, with more than half of the women by caesarean section.&#x0D; We discussed the main ways of preventing and reducing the incidence of critical obstetric conditions and maternal mortality based on the improved modern integral model of internal quality control of medical care in obstetric institutions. We also discussed the findings based on the introduction into practice of medical, organizational and methodological (including telecommunication and other) technologies aimed at increasing professional competencies in the regions of the country. Special attention is drawn in this article to the need to systematize and develop uniform and clear criteria for assessing critical obstetric conditions.

Гостра жирова дистрофія печінки вагітних, ускладнена абдомінальним компартмент- і ДВЗ-синдромами (Випадок із практики)

The problem of late preeclampsia still remains its relevance today, considering the variety of possible severe complications of this obstetric pathology. In this context, acute fatty liver of pregnancy (AFLP) is considered as one of the most challenging complications of severe preeclampsia (or as a separate nosology) [frequency: 1 case per 7–16 thousand deliveries], which can possibly lead to the development of abdominal compartment syndrome (ACS) and coagulopathic changes. This complications combination is currently potentially fatal for the pregnant woman or those in labor and remains an urgent call for perinatologists. The article presents modern ideas about the etiology, diagnosis, treatment and delivery in case of this obstetric pathology on the example of an experienced clinical case. The aim of the study is to research the potential algorithm for AFLP diagnosis and treatment with analysis of the effectiveness of measures proposed. At the first stage, a retrospective review of publications on this issue was conducted with further analysis of the case of AFLP complicated by ACS and DIC syndrome, which was successfully conducted at the Department of Obstetrics and Gynecology №1. Successful outcome and recovery of a patient in a very serious condition was achieved with to the use of a basic algorithm of actions with delivery of a pregnant woman with AFLP, complex post-syndrome therapy of multiple organ failure, ACS surgical treatment, extraordinary approach to generalized fibrinolysis treatment, therapy with transfusion of whole single-group donor blood. Keywords: preeclampsia, acute fatty liver of pregnancy, abdominal compartment syndrome, DIC syndrome, hepato-renal dysfunction.

Options of severe preeclampsia treatment

Background. Preeclampsia (PE) occurs in 2-8 % of all pregnancies. Every day 210 women die from PE, and neonatal losses are even greater (1380 children per day). Fatal complications of severe PE include cerebral hemorrhage, cerebral edema, pulmonary edema, placental abruption, adrenal hemorrhage, dissecting aortic aneurysm, HELLP syndrome, disseminated intravascular coagulation syndrome. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE.&#x0D; Objective. To describe the options of severe PE treatment.&#x0D; Materials and methods. Analysis of literature data on this issue.&#x0D; Results and discussion. The pathogenesis of PE is based on total damage to the vascular endothelium, which leads to an increase in its permeability, including for albumin molecules. Plasma protein loss is accompanied by a drop in oncotic blood pressure and fluid leakage into the interstitial space. Thus, in patients with PE there is an associated disturbance of fluid and electrolyte balance: along with intravascular dehydration there is extravascular hyperhydration. Infusion therapy (IT) allows to overcome this imbalance and to increase the colloid-osmotic pressure. According to modern views, a restricted IT regimen improves the effects of PE treatment. There are two ways to correct this disorder: an increase in oncotic blood pressure due to infusion of albumin (indicated in case of blood albumin levels &lt;25 g/L) and the administration of osmotically active drugs, such as Reosorbilact (“Yuria-Pharm”). The latter option prevents the loss of fluid from the vascular bed and promotes its return to the vessels from the intercellular space. The total fluid volume should be limited to physiological needs, taking into account pathological losses (not more than 1 ml/kg/h). The maximum IT volume should not exceed 800 ml per day. The drugs of choice for IT before delivery are balanced isotonic saline solutions and solutions containing 6 % sorbitol. Fresh-frozen plasma is not recommended for the correction of colloid-oncotic pressure. Influence on the redistribution of fluid in the interstitial space without the introduction of significant volumes of infusion solutions is the main principle of low-volume IT. Recommendations for the administration of Reosorbilact comply with this principle. The low osmolarity of Reosorbilact and its ability to improve the osmotic properties of blood justify the use of this drug in women with PE.&#x0D; Conclusions. 1. PE occurs in 2-8 % of all pregnancies. 2. Excessive intravenous fluid infusion is one of the causes of pulmonary edema in PE. 3. Restricted IT mode improves the consequences of PE treatment. 4. Osmotically active drugs (Reosorbilact) are prescribed for this purpose.

Coronavirus disease‐2019 in pregnancy with neurological manifestations versus pregnancy with eclampsia: Need for liberal testing to rule out the masquerades

Sir, I read with interest the article by Gidlöf et al1 on the management of a twin pregnancy with severe preeclampsia and Coronavirus disease-2019 (COVID-19) and their call for more liberal testing guidelines in women with high-risk pregnancies, and agree with their suggestion. A severe complication of preeclampsia is eclampsia. Presentations include neurological manifestations such as headache, seizures, and loss of consciousness, along with raised blood pressure. Hemolysis, elevated liver enzymes, thrombocytopenia, and renal dysfunction may also be present. Similar neurological and laboratory manifestations have been reported in patients with COVID-19.2, 3 In a retrospective case series of hospitalized patients with COVID-19, Mao et al reported 36.4% of patients with neurological symptoms including headache, seizures, and loss of consciousness.2 Although this occurred with greater frequency in patients with more severe disease, some patients showed other symptoms of COVID-19 only after neurological manifestations.2 Low platelets and elevated liver enzymes are also seen in patients with COVID-19, including those with acute cerebrovascular manifestations.3 Three scenarios are possible: pregnant women with COVID-19 and neurological manifestations mimicking eclampsia; COVID-19 complicating preeclampsia/eclampsia; and pregnancy with eclampsia without COVID-19. Each scenario has different implications for management strategies and infection control practices. In the first instance, management should follow clinical recommendations for COVID-19 in pregnancy,4 with additional analysis of cerebrospinal fluid and management of cerebrovascular complications. In the second instance, guidelines for managing eclampsia should be followed after ruling out neurological involvement due to COVID-19. However, both of these situations entail proper infection control practices including caring for patients in dedicated COVID-19 areas with full safety measures taken to protect the healthcare providers. In the last instance, management of the patient needs only to follow the eclampsia protocol. All this is possible only if pregnant women presenting with neurological manifestations are screened and tested for COVID-19 in the first instance. As the incidence of eclampsia is high in developing countries,5 there is a possibility of diagnosing every pregnant woman with seizures as eclampsia, and hence the other two situations could easily be missed. This may lead to both inappropriate management and additional infection risk to healthcare providers. I suggest that the COVID-19 testing guidelines should be expanded to include all pregnant women with neurological manifestations to ensure a safe outcome for both patients and healthcare providers.

Pregnancy Outcome in Impaired Liver Function in Pre-eclampsia

Pre-eclampsia induced liver disease is a disorder unique to pregnancy and is frequently seen in third trimester. Severe pre-eclampsia is defined by extreme elevation in systemic blood pressure and evidence of organ compromise. HELLP syndrome is a unique liver related disorder of pregnancy that was first described by Weinstein in1982 as a constellation of clinical and laboratory abnormalities in pregnant women in their third trimester. This disorder was termed HELLP syndrome with (H) for haemolysis, (EL) for elevated liver enzymes and (LP) for low platelet counts. This is a severe variant of pre-eclampsia. Objective of this study was to determine the alteration of liver function in preeclampsia and its correlation with the clinical severity as well as the perinatal outcome. This was a one-year prospective observational cross sectional study included 100 patients with pre-eclampsia. Severity of the pre-eclampsia clarified clinically. Pre-eclampsia patients having history of hepatitis, cirrhosis of liver, gallbladder diseases and other pre-existing medical disorders that altered liver function were excluded from this study. The mean age of the patients was 25.3+4.9 years ranging from 18 to 37 years. One third of the patients (33.3%) were in the age group 28 to 32 years. Out of 100 patients, 58% belongs to poor income group. Among the studied samples 17% had epigastric pain and discomfort, 13% had complaints of vomiting and 43% develop severe pre-eclampsia. Among the Patients with altered hepatic enzyme level, 8.33% had complaints of epigastric pain, 6.66% complains vomiting. Maximum patients (66.6%) with elevated liver enzyme had no major complications whereas 33.4% of patients developed major complications. Patients with severe pre-eclampsia have elevated liver enzyme whereas patients of mild symptoms had normal liver enzymes level. Cases with raised serum biochemical markers had strong association with complications of severe pre-eclampsia. Pregnancy outcome in severe pre-eclampsia with hepatic involvement is grievous. Graves sequlae of pre-eclampsia can be prevented and minimized by timely institutional intervention. Post-partum followup would help to find out other parameters of pregnancy outcome. Bangladesh Med J. 2020 May; 49(2) : 9-13

Maternal and perinatal outcomes related to superimposed pre-eclampsia in a Brazilian cohort of women with chronic hypertension.

To describe maternal and perinatal outcomes for women with chronic hypertension, comparing those with superimposed pre-eclampsia (SPE) with those without pre-eclampsia (NPE). In a retrospective cohort study in a tertiary hospital in Brazil, the records of women with chronic hypertension were reviewed between January 1, 2012, and May 31, 2017, in order to compare maternal and perinatal outcomes among those with and without SPE. Poisson regression was performed to investigate factors independently associated with severe pre-eclampsia. Of 385 women with chronic hypertension included in the study, 167 were in the SPE group and 218 in the NPE group. The majority were white, overweight (body mass index ≥30kg/m2 ), with mean age around 31years. Adverse neonatal outcomes were significantly more prevalent among women with SPE, including small for gestational age (SPE 17.46% vs NPE 9.63%, P=0.01), low birth weight (SPE 2577g±938 vs NPE 3128g±723, P=0.003), neonatal intensive care unit admission (SPE 44.91% vs NPE 18.34%, P=0.08), and incidence of cesarean delivery (SPE 79.64% vs NPE 62.38%, P=0.003). Fetal growth restriction (PR [prevalence ratio] 2.62, 95% confidence interval [CI] 1.39-4.94) and previous pre-eclampsia (PR 1.96, 95% CI 1.17-3.28) were associated with severe pre-eclampsia. SPE is associated with prematurity and higher rates of admission to neonatal intensive care unit. Fetal growth restriction and previous pre-eclampsia are factors associated with severe complications of pre-eclampsia.

The association of lipid profile and uric acid levels in normotensive, preeclamptic pregnancy – A hospital-based study

Background: Eclampsia is a severe complication of preeclampsia (PE). This can create additional complications during pregnancy. It is a rare but serious condition where high blood pressure (BP) results in seizures during pregnancy and associated with risk for mother and fetus. The investigations of serum lipid profile serum uric acid are and BP with body mass index (BMI) highly suggested the feature of disease. Objective: The objective of the study is to find out the association between serum lipid profile and serum uric acid level in normotensive and preeclamptic pregnant women. Materials and Methods: A prospective case–control study was conducted in the Department of Biochemistry at Jawaharlal Nehru Medical College and Datta Meghe Institute of Medical Sciences, Sawangi (Meghe) Wardha, Maharashtra, India, with individuals suffering with severe PE to the obstetric unit of hospital. Serum lipid profile and uric acid levels were done by 159 patients suffer from PE and compare with 150 age-matched normotensive controls. Results: The average BMI in study group (preeclamptic pregnant women) was significantly higher than control group (P < 0.001). The BP was high in preeclamptic pregnant women than normal women. Statistically significant difference was observed in the levels of CH, triglycerides, high-density lipoprotein (HDL), and uric acid in the age group up to 25 and 26–32 years. There was no statically significantly difference observed in the age group of 33–39 years. HDL level was statically insignificant in both the groups. Conclusion: Serum lipid profile and serum uric acid are very useful markers for early detection, to identification of complications, and reduce the risk of occurrence in PE. Early detection is going to aid in better management which is important to improve the maternal and fetal complications.

Maternal complications of severe pre-eclampsia at a tertiary level hospital in Zambia

Objectives: The objective of the study was to describe the maternal outcomes and mode of delivery among women with Severe pre-eclampsia (SPE) admitted to the University teaching Hospitals- Women and Newborn Hospital (UTHWNH).&#x0D; Materials and Methods: This descriptive study analysed cases of 175 women with Severe Preeclampsia admitted to the Mother and New Born Hospital between June and December 2017. Women meeting the criteria were identified antenatal and enrolled into the study after delivery to obtain data using the maternity record book and face-face interviews for clarification. The data was analysed using SPSS to obtain frequency distributions of outcomes of interest that was illustrated in charts and tables.&#x0D; Results: The age range for the women was 15 - 41 years. Frequency of complications from SPE increased with advancing age towards 35 years and above. Unemployment and living in low cost housing was associated with higher risk of complication from SPE. HELLP Syndrome occurred in 10.3% of women with SPE and so did placental abruption. IUFD was a complication in 28% of the pregnant women. Most women (34%) delivered through induction of labour. The 30-34 weeks was the peak gestation period associated with the most complications of SPE in the pregnant women.&#x0D; Conclusion: SPE is a pregnancy condition with serious potential consequences for the mother and the fetus.

Maternal Complications of Severe Pre-Eclampsia at a Tertiary Level Hospital In Zambia

Objectives: The objective of the study was to describe the maternal outcomes and mode of delivery among women with Severe pre-eclampsia (SPE) admitted to the University teaching Hospitals- Women and Newborn Hospital (UTHWNH).&#x0D; Materials and Methods: This descriptive study analysed cases of 175 women with Severe Preeclampsia admitted to the Mother and New Born Hospital between June and December 2017. Women meeting the criteria were identified antenatal and enrolled into the study after delivery to obtain data using the maternity record book and face-face interviews for clarification. The data was analysed using SPSS to obtain frequency distributions of outcomes of interest that was illustrated in charts and tables.&#x0D; Results: The age range for the women was 15 - 41 years. Frequency of complications from SPE increased with advancing age towards 35 years and above. Unemployment and living in low cost housing was associated with higher risk of complication from SPE. HELLP Syndrome occurred in 10.3% of women with SPE and so did placental abruption. IUFD was a complication in 28% of the pregnant women. Most women (34%) delivered through induction of labour. The 30-34 weeks was the peak gestation period associated with the most complications of SPE in the pregnant women.&#x0D; Conclusion: SPE is a pregnancy condition with serious potential consequences for the mother and the fetus.

Epidemiological Aspects and Prognosis of Severe Pre-eclampsia in Bangui, Central African Republic

Introduction: Severe preeclampsia is one of the most serious pathologies during pregnancy, with heavy morbidity and maternal-fetal mortality. The aim of our study was to help improve the management of severe preeclampsia. Methods: We conducted a cross-sectional analytical study from 1st September 2015 to 30th August 2016, at the Obstetrics and Gynecology Department of the Hopital communautaire of Bangui. The study population was pregnant and parturient patients with severe pre-eclampsia. Results: Out of 4021 registered cases, 41 met the inclusion criteria, with a prevalence of 1.0%. The primiparous were the most represented (48.8%). Magnesium sulfate was the most used as an anticonvulsant (70.7%) and dihydralazine was the most used for the High Blood Pressure (HBP). The main complications of pre-eclampsia were eclampsia (29.3%) and acute renal failure (19.5%). Overall, maternal mortality was 9.8% and perinatal mortality was 31.7%. Conclusion: The complications of severe preeclampsia are common in our study. The maternal and fetal prognosis remains a concern. Hence, we suggest early screening of pre-eclampsia symptoms during prenatal consultations to improve pregnancy outcome.

Circulating parameters of oxidative stress and hypoxia in normal pregnancy and HELLP syndrome.

The HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelets) is a complication of severe pre-eclampsia, a condition characterized by oxidative stress elevation caused by disequilibrium between lipid peroxidation and antioxidant defense mechanisms, which, in turn, results in endothelial compromise and free radical-mediated cell damage. While several studies have examined the relationship between pre-eclampsia and oxidative stress, research investigating oxidative and hypoxic status in HELLP syndrome is limited. The aim of this study was to compare the levels of oxidative stress markers - total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and malondialdehyde (MDA) - and a hypoxia marker - carbonic anhydrase IX (CA IX) - in patients with HELLP syndrome and in healthy pregnant women. A total of 23 women with HELLP syndrome and 30 healthy pregnant women were included in the study. Serum levels of oxidative stress markers were determined using colorimetric methods, while serum levels of CA IX were measured using an enzyme-linked immunosorbent assay (ELISA) kit. The TOS, OSI, MDA, and CA IX levels were significantly higher in women with HELLP syndrome than in the controls (p = 0.0001, p = 0.0001, p = 0.0001, and p = 0.008, respectively). Increased levels of oxidative stress and hypoxia markers in women with HELLP syndrome suggest that oxidative stress and hypoxia may be significantly involved in the pathophysiology of the disease. Further follow-up studies are now needed to investigate the prognostic roles of these parameters in patients with HELLP syndrome.

АНАЛИЗ КРИТИЧЕСКИХ СЛУЧАЕВ, УГРОЖАЮЩИХ ЖИЗНИ ЖЕНЩИН: ОТ ВНЕДРЕНИЯ МЕТОДОЛОГИИ ДО ИЗВЛЕЧЕНИЯ УРОКОВ

Objective: Examining the results of implementing a new methodology of analysis of critical cases in the work of an obstetric hospital in order to prevent the occurrence of deadly conditions in the maternity obstetric services and to improving emergency obstetric care. Methods: The comparative analysis of 20 cases of critical states is conducted – exchange cards, childbirth and neonatal histories, critical case analysis (CCA) cards and women’s interviews: 14 cases of massive obstetric haemorrhage and 6 cases of severe hypertensive disorders with complications. Results: The country supported by the WHO initiative on the analysis of critical states in obstetrics aimed at reducing maternal morbidity and mortality (2008). Experts trained the specialists from maternity obstetric service, including the staff of the Tajik Scientific Research Institute of Obstetrics, Gynecology and Perinatology. Using the proposed methodologies, a number of critical cases were examined at the meeting of the working group on the CCA from among specialists of the above-mentioned institution. Each individual subsequent audit session included the implementation report on the previously provided recommendations. The direct case study consisted of a discussing of the interview report and identifying the positive aspects of the patient’s vision, as well as missed opportunities of 20 cases of critical conditions – exchange cards, childbirth and neonatal histories. The study of critical cases of life-threatening women during pregnancy, childbirth and after delivery resulting from massive obstetric haemorrhage (14) and complications of severe pre-eclampsia (6). It turned out that positive moments of assisting in critical situations are the availability of necessary drugs and equipment institution, the introduction of guidelines and standards for the management of obstetric haemorrhage and hypertensive complications, as well as teamwork. Along with the positive moments, the missed opportunities were revealed – insufficient counselling, defects of antenatal and inpatient surveillance need to optimize the existing guidelines in the field of emergency conditions in obstetrics. Based on the decisions taken by the participants of the critical cases and the working group on the CCA, conducted 15 sessions as a senior secondary medical staff on various aspects of emergency obstetric care, prepared 4 draft orders, further signed by the administration and aimed at improving the work of organization and improving the quality of the rendered services. Based on the experience gained, a number of organizational measures aimed at prevention of possible complications were introduced. Conclusion: Based on the results of the audit sessions, conclusions were drawn on the main directions in which the activity should be improved by: adapting some order manuals, orders and standards for the institutions, the establishment of a series of orders, continuously raising the level of knowledge improvement. Keywords: Analysis of critical conditions, maternal mortality, severe hypertensive disorders, obstetric haemorrhages.