Eclamptic Cases Research Articles

Maternal Outcomes of Eclampsia at the Lagos University Teaching Hospital: A Six-Year Retrospective Review

Background: Eclampsia is one of the leading causes of maternal morbidity and mortality.
 Objectives: To determine the incidence as well as the maternal outcomes of eclampsia at the Lagos University Teaching Hospital (LUTH).
 Methods: This was a retrospective review.
 Results: During the six-year review period, 4182 women gave birth at our facility, out of which 67 cases of eclampsia were diagnosed (16 per 1000 deliveries). Four women died constituting a case fatality rate of 5.9%. Fifteen women were admitted to the intensive care unit, 6 women had acute kidney injury while 5 had abruptio placentae. Further comparison of our data with previous studies from our institution decades ago showed a continuous decrease in total number of eclamptic cases presenting to our facility (572 eclamptics in 1977 - 1986, 299 ECLAMPTICS IN 1986 - 1995, 165 IN 1996-2005 AND 67 IN 2015-2020).
 Conclusion: The case fatality rate from eclampsia is still high in our hospital. Increased utilisation of antenatal care may play an important role in improving the maternal outcomes from this life-threatening obstetric condition. There is need for maternal education and increase awareness on the importance of antenatal care and early referral to tertiary level of care in order to reverse this trend.
 Authors
 A A Oluwole 1 2, A O Ugwu 2, A P Soibi-Harry 2, S R Garba 2, K S Okunade 1 2, C C Makwe 1 2, E Owie 2, S I Omisakin 1 2, N K Ani-Ugwu 3, I T Okafor 2, U Ifezue 4, J A Olamijulo 1 2

Consequences of Zuspan Protocol Applications in Eclampsia Pregnant Women and Seizures

Backgraund: Magnesium sulfate is the preferred anticonvulsant in the prevention and control of eclamptic convulsions. The Zuspan Regime is one of the most popular protocols used. However, due to toxicity concerns, several low-dose regimens have been implemented, given the low body mass index of Asian women. In our hospital, Zuspan Protocol is generally applied. Objective: We aimed to compare the results, effectiveness and reliability of 6-hour and 12-hour intravenous (i.v) MgSO4 infusions in the Zuspan Protocol in our hospital. Methods and Materials: A total of 700 cases of eclampsia were examined and these cases were treated with the Zuspan Protocol. The patients in the first group received 6 hours of treatment (n: 400), while the second group (n: 300) received the 12-hour treatment with magnesium sulfate. Recurrent convulsion rates, maternal and perinatal results of both regimens were evaluated and compared using unpaired t-test and chi-square test, respectively, for continuous and categorical variables. Result: We detected 700 eclamptic cases among 50.620 births in our hospital during the 7-year working period and this rate was found as 80.5 % of 700 women were in the 19-30 age group. Despite the fact that MgSO4 was infused in 700 eclamptic pregnant women, the rate of seizures was found to be total 3.57 %. Conclusion: The 12-hour intravenous Zuspan Protocol was found to be more effective and more preventive and safer than the eclamptic seizure compared to the 6-hour Zuspan Protocol.

Fetomaternal outcome of eclamptic parturient in a tertiary care center: A descriptive cross-sectional study

Background: Eclampsia is still a leading cause of maternal death second to postpartum hemorrhage in developing countries. It is also associated with poor perinatal outcome.
 Aims and Objective: The objective of this study was to find the incidence, maternal and perinatal outcome of patients admitted in a tertiary hospital, Pokhara with diagnosis of eclampsia.
 Materials and Methods: A descriptive cross sectional study was conducted in department of obstetrics and gynecology, MTH, Pokhara for duration of 1 year from 1st January 2020 to 30th December 2020. A total of 22 patients were enrolled in the study irrespective of timing of occurrence of fits, age, parity, gestational age and status of booking on admission.
 Results: During the study period the incidence of eclampsia at our center was 0.85% .Majority of the patients 17(77.27%) were primigravida and 16(72.68%) delivered at less than 37 weeks of gestation. Only 4 patients had her antenatal checkup done in MTH. According to timing of occurrence of fits Antepartum and postpartum eclampsia comprise 50% each with no cases of intrapartum eclampsia. Caesarean section was done in 17(77%) cases. Among the cases 10, (45.45%) patients required ICU admission and 6(27.27%) required ventilator support. HELLP, acute renal failures, PRES, PPH were causes of maternal morbidity. Three (13.63%) babieswere born stillbirth. Sixteen (72.72%) babies were born preterm and 13(59.09%) had birth weight less than 2.5kg. Six (27.27%) babies needed NICU admission.
 Conclusion: Eclampsia continues to be one of the prime etiological factors for maternal and perinatal morbidity and mortality in developing countries like ours. This is mostly due to the delay in seeking and reaching the care. Regular antenatal checkup, early recognition, its prevention and proper management of eclamptic cases are vital to tackle this challenge.

Maternal and Neonatal Complications of Methamphetamine Use during Pregnancy.

Background Methamphetamine abuse has been a significant problem in Thailand. The methamphetamine abuse problem also affects pregnant women. The study of pregnancy outcomes among methamphetamine users during pregnancy is currently limited. Objective To determine maternal and neonatal complications among methamphetamine-abusing parturients. Materials and method. This historical cohort study was conducted at Bhumibol Adulyadej Hospital (BAH), Bangkok, Thailand, between January 2017 and December 2019. The total number of women was 206 who were equally divided into a study and control group. Pregnant women who tested positive for methamphetamine in urine tests during the intrapartum period were compared to the control group with no history of drug abuse. Results Maternal outcomes: gestational hypertension was found to be significantly increased in the study group compared to the control group at 14.6 vs. 1.0% (OR 17.4, 95%CI 2.5-134.3). Preeclampsia with and without severe features were found at higher rates in the study group without statistical significance. There were no eclamptic cases in this study. Neonatal outcomes: preterm birth rate of pregnant women who have tested positive in their urine methamphetamine test was significantly higher than in the control group (33.3%, 11.7%, OR 3.7, 95%CI 1.8-7.7). Average birth weight in the study and control group was 2779.1 ± 486.7 and 3049.5 ± 510 gm, respectively (p value < 0.001). Low APGAR score rates of both groups also had no significant difference. Conclusion Methamphetamine use during pregnancy increased both maternal and neonatal complications in terms of gestational hypertension, preterm birth, and average birth weight.

Morbidities among Eclamptic Women of Lower Socioeconomic Community in a Selected Area of Bangladesh

Eclampsia is a serious obstetric emergency with new onset of grand mal seizure during pregnancy or postpartum women having signs symptoms of pre-eclampsia. The sequel of severe pre-eclampsia and eclampsia includes organ failure, loss of consciousness and finally loss of lives of both mother and fetus. This study aimed to evaluate morbidity of eclamptic women at lower socioeconomic community in a selected area of Bangladesh. This descriptive cross sectional study was conducted at Sheikh Hasina Medical College Hospital (SHMC.T) of Tangail district during the period of January to December 2019. During this period 7918 admitted patients from different sub-districts (Upazilas) of this district in obstetrics ward of SHMC.T were observed and 205 diagnosed eclamptic patients were selected as respondents for this study to detect morbidities. The prevalence rate of eclampsia among the obstetrics patients was 2.6%, where 81% of them were found during antepartum/ intrapartum and rest of them during postpartum period. The mean age of the eclamptic cases was 23.78±4.94 years and more than half of them were in age group 21-30 years. Most of the cases (84%) were from primary level or able to sign or illiterate and rest was secondary level of education. Mean age of marriage and first pregnancy were 17.81±SD2.19 and 19.39±SD2.5 years respectively, where majority of patients were primigravida. Among the multi gravida about one fourth had 2-4 children, 16.09% had 5-6 children, where 1.46% had ≥7 children and more than three-fourth of cases had 34-37 weeks of gestational period. Among cases 95.1% had hypertension, 94.6% edema, 83.9% convulsion, 39.5% headache with blurring of vision, 22.4% severe abdominal pain, 79.0% proteinuria and 9.76% unconsciousness. Incidence of maternal morbidity during study period was 14.36%, among them 9.4% pulmonary edema, 1.5% renal failure, 0.98% HELLP (Hemolysis, Elevated liver enzyme level and Low Platelet level) syndrome, 0.98% coma and 1.5% placental abruption. Caesarean delivery was 79.2% and 11.70% was detected as postpartum haemorrhage. Among fetal morbidity 19.5% intrauterine growth restriction, 48.8% low birth weight, 39.6% birth asphyxia, and 58.5% preterm baby. During follow up only persistent hypertension was found as morbidity of eclampsia, 19.5%, 9.8% and 7.32% at 2nd week, at 6th week and at 6th months respectively. Regarding health care services 93.7% had available facility and 41.5%, 47.8% and 10.7% lived in &gt;10 kilometers (kms), 5-10 kms and less than 5 km distance respectively. Regarding MCH services; only 5.9% patient received antenatal care (ANC) ≥4 times; more than half of them incompletely received ANC &lt;4 times and 42.0% never visited for ANC. This study reveals various matters of maternal and fetal morbidities commencing from eclamptic condition in lower socioeconomic community. Here important factors for morbidities in eclamptic women like lack of ANC/ PNC, availabilities of MCHC services and others. Pulmonary edema, renal failure, HELLP syndrome, coma and placental abruption are important maternal morbidities. Prematurity, low birth weight, intrauterine growth restriction and birth asphyxia are foremost fetal morbidities. Availabilities of MCH services, complete visit for ANC/ PNC and early diagnosis and management of eclamptic women positively reduce morbidity and will prevent eclampsia.&#x0D; Bangladesh Med J. 2020 Jan; 49 (1): 7-13

Study of free radicals (malondialdehyde) in pre-eclampsia and eclampsia in correlation with uric acid and total proteins

Introduction: Oxidative stress is a normal phenomenon in normotensive pregnancy; however, in preeclampsia, oxidative stress is exaggerated may result in a greater potential for endothelial oxidative damage. It has been reported that higher MDA (Malondialdehyde) /total antioxidant capacity (TAC) ratio is indicative of oxidative stress in women with pre-eclampsia. Materials and Methods: Prospective study was done for duration of 2 years i.e, from January 2015 to December 2017 in the department of Biochemistry at Kakatiya Medical College, Hanmakonda, CKM hospital Warangal. A total number of 60 pregnant women were included in the study. Among these, 20 pregnant women were clinically diagnosed as pre-eclampsia and 20 are eclamptic cases and the remaining 20 were selected as control group and are normotensive antenatal women who are also in third trimester of pregnancy. Results: The mean MDA, serum uric acid, 24 hr urinary protein were higher in pre-eclampsia and eclampsia compared to controls. Conclusion: Increased lipid peroxidation products levels clearly shows that oxidation stress is more in pre-eclampsia and eclampsia than in control subjects and it plays a significant role in etiopathogensis of PIH. Serum uric acid levels are significantly higher in cases than in controls and by estimating the uric acid levels we can assess the severity of the disease and we can avoid further progress of the disease process by early detection and prompt treatment. Total serum protein levels are drastically reduced in pre-eclampsia and eclampsia cases compared to controls. Keywords: MDA, Serum uric acid, Proteins, Eclampsia, Pre-eclampsia.

69. Eclampsia at a tertiary facility offering free maternity services in south-western Nigeria – A five-year review

Introduction Eclampsia is a leading cause of maternal mortality in developing countries like Nigeria. The Mother & Child Hospital Akure (MCHA), Ondo State, south-western Nigeria was established in February, 2010 as a State-funded tertiary facility which offered completely free maternal and child (0–5 years) care services from inception till December 2014. During this period, it institutionalised protocol management of eclamptics and became one of the busiest maternity centres in Nigeria. The resultant data could assist care providers and policy-makers in eradicating the scourge. Objectives Determine prevalence of eclampsia at the MCHA from 2010 to 2014. Determine its contribution to the facility-based maternal mortality ratios. Determine its case fatality rates (CFR) during period of study. Methodology This retrospective study was conducted in the MCHA. Data from February 2010 to December 2014 were retrieved from the medical records register and folders of patients. Analysis was through Microsoft Excel and SPSS. Results Total deliveries in the 5-year period of study was 30,031 increasing by 108% from 3,673 in 2010 to 7,634 in 2013 before dipping to 6,234 in 2014. Number of eclamptics treated was 384, from 56 in 2010 to 107 in 2012 (a 91% increase), before dipping to 74 and 58 in 2013 and 2014, respectively. The overall prevalence was 1.3% with a downward trend from 1.5% in 2010 to 0.9% in 2014. Eclampsia contributed 36 out of 115 (31%) maternal deaths while the CFR was 9.4%. Discussion This study’s CFR was among the lowest in Nigerian literature. It showed that offering free maternity services premised on protocol management could result in a steady reduction in number and prevalence of eclamptic cases after an initial spike, though the volume of deliveries could increase. It is recommended that the MCHA model be adopted in other tertiary maternity centres.

Peripapillary retinal nerve fiber layer thickness in preeclampsia and eclampsia

To evaluate peripapillary retinal nerve fiber layer (RNFL) thickness during and after pregnancy in pregnant women with preeclampsia or eclampsia and compare it with normotensive pregnant women as controls. In a prospective comparative case-control study 35 women (70 eyes) with mild to moderate preeclampsia, 70 women (140 eyes) with severe preeclampsia and eclampsia, and 44 (88 eyes) healthy pregnant women were enrolled in three groups. Peripapillary RNFL thickness in three groups was measured after 28weeks of pregnancy and 2months postpartum by using optical coherence tomography. Mean and quadratic RNFL thickness changes were compared within and among the groups. Mean peripapillary RNFL thickness decreased significantly from 104±10, 104±23, and 106±9µm during pregnancy to 101±10, 96±10, and 103±9µm 2months after pregnancy in the mild to moderate preeclampsia, severe preeclampsia and eclampsia, and healthy pregnant women groups, respectively (P<0.001 for all). While the difference among the groups was insignificant during pregnancy, it reached to a significant level after delivery (P=0.006). The highest reduction in mean RNFL thickness (6±10µm) occurred in the severe preeclampsia and eclampsia groups. In relation to the time of pregnancy, peripapillary RNFL reduced in preeclamptic and eclamptic cases as well as in normotensive pregnant women at 2months postpartum. This reduction was more in the severe forms of pregnancy-induced hypertension.

Study of oxidative stress and uric acid in pregnancy induced hypertension

Background: Pregnancy induced hypertension is a leading cause of morbidity and mortality in pregnant woman. Preeclampsia and Eclampsia Sepsis and Haemorrhage are the prime killers in pregnancy.Aim: This study is aimed to assess the role of oxidative stress by estimating Malondialdehyde(MDA), Glutathione s-transferase (GST) and its severity by estimating serum uric acid levels in PIH.Materials and Methods: The study comprised of 60 third trimester pregnant woman . Among those 24 were clinically diagnosed Preeclamptic cases ,16 were Eclamptic cases and 20 were Normotensive antenatal controls. Plasma MDA, GSTlevels and serum uric acid levels were estimated and compared in them.Results: Mean values of plama MDA, GST and serum uric acid levels in cases were 5.14 1.88nmol/ml, 44.49 14.48IU/L,, 7.211.63mg/dL and in controls mean values were 1.70.87nmol/ml, 70.9812.68IU/L, 4.381.24mg/dL respectively.Conclusion: Mean values of plasma MDA, serum Uric acid levels were significantly higher and plasma GST levels were significantly lower in pregnancy induced hypertension cases when compared with normotensive antenatal controls

Association of pre-eclampsia with dyslipideamia

Background and objective: Pre-eclampsia and eclampsia are claimed to be associated with disturbances in lipid profile. The purpose of this study was to determine any significant association between pre-eclampsia/eclampsia with lipid profile disturbances. Methods: This prospective study evaluated lipid profile in the second half of pregnancy in 38 pre-eclamptic, 21 ecalmptic woman and compared to 41 age matched healthy pregnant women served as a control for the period of February 2010 – January 2011. Results: Pre-eclamptic women showed a significant increase in the mean serum cholesterol concentration (243.9 mg/dL) during the second trimester when compared with the healthy pregnant controls (212.9 mg/dL), eclamptic women had even a significant higher cholesterol level at a mean of (288.1 mg/dL). Triglyceride level significantly increased in pre-eclamptic (281.7 mg/dL) and eclamptic women (307.4 mg/dL) compared to healthy pregnant control (207.5 mg/dL). LDL level also showed significant increase in pre-eclamtic {143.7 mg/dL} and eclamptic cases (156.5 mg/dL). HDL level though was decreased in pre-eclamptic {41.5 mg/dL} and eclamptic (40.8 mg/dL) but these changes were not significant. Conclusion: Pre-eclampsia and eclampsia are associated with dyslipidemia. This association may be significant in understanding the pathologic processes of preeclampsia and may help in developing strategies for prevention or early diagnosis of the disorder.

OS012. Eclampsia with progressing disease correlates to severe diastolicblood pressure

Eclampsia is MRI-radiologically defined as posterior reversible encephalopathy syndrome (PRES), which indicate cases with eclampsia might improve spontaneously and reversibly. On the other hand the central nervous system is the main target organ affected by the disease of severe preeclampsia. Eclampsia is thought to be one of the severe states of this disease. We should recognise some eclamptic cases to grow worse resulting in disastrous stroke or poor prognosis. Especially the symptoms of long lasting unconsciousness or repeating seizures, or the sings with cerebrovascular vasospasms or brain stem lesion are considered as the progressing disease among the disease of eclampsia. We studied what factors among obstetrics features are related to this progressing disease of eclampsia. Thirty six cases with eclampsia were entered in this study. All cases were managed in our hospital from 1995 to 2011. All cases had hypertensive disorders and 23 cases complicated with preeclampsia or superimposed preeclampsia. Four cases were antepartum eclampsia, 12 cases intrapartum and 10 cases postpartum. 20 cases were diagnosed as progressing disease of eclampsia, and 16 cases were no progressing disease. As obstetric features, the peak values of hypertension at the onset of eclampsia, the proteinuria severity, the organ involvements such as HELLP syndrome or renal failure, parity and maternal age were studied. The values of systolic blood pressure (sBP) and diastolic blood pressure (dBP) were considered as independent parameters each other in this study. Statistical analysis was performed how these obstetric confounding features were to be correlated with progressing disease of eclampsia by logistic regression analysis (LRA). Univaiate and multivariate LRA were performed using with peak sBP, peak dBP, peak proteinuria, or other features as covariates, and progressive disease as dependent variable. Univariate analysis showed that ⩾210mmHg of sBP, ⩾105mmHg of dBP and ⩾10g/day of proteinuria were related to the progressing disease of eclampsia compared with the no progressing disease. And multivariate analysis showed that ⩾105mg of dBP had significantly the highest adjusted odds ratio of 10.0 (95%CI 0.96-103, p=0.05). We had shown previously CNS disorders such as eclampsia had the strongest correlation with severe sBP ⩾200mmHg among 108 cases of preeclampsia with severe hypertension and severe proteinuria, whereas other organ involvements such as HELLP syndrome had the strongest correlation with severe dBP ⩾110mmHg (now not in published, presented in ISSHP 2010). Other studies also strengthen the significance of high sBP in the management of eclampsia [1,2]. Controversially we noticed in this study that the progressing disease of eclampsia significantly related to severe dBP ⩾105mmHg. This indicates that severe dBP are the important marker as for predicting serious organ involvements either in central nervous system or in other organs in the disease of preeclampsia/eclampsia.

HELLP syndrome: The experience at Ile-Ife, Nigeria

SummaryBetween 1 January and 31 December, 2006, 34 consecutive cases of severe pre-eclampsia (12), imminent eclampsia (10) and eclampsia (12) who were admitted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife in the south-western part of Nigeria, were investigated for the development of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in a prospective study. The ages of the women ranged from 18 to 38 years, parity 0–5 and the estimated gestational age from 18–41 weeks at presentation. A total of 26 (76.5%) of the patients were unbooked, six (17.6%) of the 34 cases developed HELLP syndrome. Four (33%) of the 12 eclamptics developed HELLP syndrome, while only one (10%) of the cases of imminent eclampsia and 1 (8.3%) of severe pre-eclamptic cases developed the syndrome. Using the Mississippi Triple class system, none of the HELLP syndrome cases belonged to Class I; 4 were categorised in Class II while 2 were in Class III. All of the four eclamptic cases with HELLP syndrome died giving a 100% fatality rate while none of the imminent eclamptic and severe pre-eclamptic patients with the syndrome died. Furthermore, there were six (15.8%) perinatal deaths among the 38 infants delivered by the 34 mothers with severe pre-eclampsia/eclampsia. Our data suggest that the development of HELLP syndrome is more likely in eclamptic patients and when it occurs in them, it is highly fatal. Most of the cases in this study were unbooked. Substandard care may have contributed to the progression of the disease state and consequently, to maternal mortality. It is imperative to draw up an action plan for the identification of the risk factors for the development of pre-eclampsia/eclampsia at peripheral hospitals and maternity centres and for prompt referral of such cases afterwards. Efforts should also be geared towards the minimising of treatment delay in all phases, so as to minimise both perinatal and maternal morbidity and mortality.

ECLAMPSIA

Objective: To evaluate incidence, morbidity and mortalityassociated with eclampsia. Design: A prospective study. Place and Duration: The study which was carried out at PAFHospital Rafiqui, Shorkot spanned over a period of 2½ years from Jun 2002-Dec 2004. Patients and Methods: Thestudy comprises of 55 eclamptic cases diagnosed out of 3391 consecutive deliveries, carried out in our hospital.Results: The incidence of eclampsia, in this study, was found to be 1.62%. Out of 55 cases 38(69.1%) patients wereprimigravida. Forty three (78.2%) of the patients were between the ages of 21 to 30 years. In 50(90.9%) patientsgestational age was less than 35 weeks. Thirty seven (67.3%) cases had antepartum eclampsia. Forty four (80%)patients received diazepam while the remaining 11(20%) received magnesium sulphate (MgSO4) as anticonvulsant.Commonest mode of delivery was spontaneous vaginal delivery \(31 cases, 56.4%) followed by lower caesareansection (21 cases, 38.2%). Fetal loss was seen in 12(20.7%) cases. Two patients died of eclampsia, maternal mortalityrate being 3.6%. Conclusion: Eclampsia is a life threatening complication of pregnancy. However an improvement inantenatal care, upgrading the neonatal facilities and early delivery by cesarean section can improve the perinataloutcome.

Serum Nitric Oxide and Glutathione Levels in Preeclamptic and Normotensive Women during Labor

This study was performed on 38 preeclamptic women, including 26 severely preeclamptic and eclamptic cases, as well as 50 normotensive pregnant controls. Twenty cases in the preeclamptic group and 34 cases in the control group were in labor. Serum nitric oxide levels were measured as total nitrites after reduction of nitrates to nitrites. Among the control subjects, nitric oxide levels were significantly lower in the cases in labor when compared to those not in labor (p < 0.05), but glutathione levels were not significantly different (p >0.05). Among the preeclamptic patients, although nitric oxide levels were not significantly different between the cases in and not in labor (p > 0.05), glutathione levels were significantly higher in the latter group (p < 0.05). Thus, in preeclamptic patients there might be a compensatory increase in nitric oxide production during labor in order to maintain the systemic circulation. Glutathione levels might also be increased to compensate for the marked oxidative stress.

The Prevalence of Serum Antineutrophil Cytoplasmic Autoantibodies in Preeclampsia and Eclampsia

The purpose of this study was to evaluate the prevalence of antineutrophil cytoplasmic autoantibodies (ANCAs) in preeclampsia and eclampsia. Blood samples were obtained from 26 mildly preeclamptic, 26 severely preeclamptic, and 20 eclamptic, and 20 normal pregnant women (controls) in the late third trimester for the determination of serum cytoplasmic pattern ANCA (cANCA) and perinuclear pattern ANCA (pANCA) by the corresponding enzyme immunoassay. Significant elevations of serum cANCA and pANCA were found in mild and severe preeclampsia and eclampsia. The extent of rise correlated well with the severity of the disease. Both ANCAs were detected in 80% of eclamptic cases versus 38.5 and 69.3% of mild and severe preeclampsia, respectively. Marked elevations of serum ANCAs were associated with poor fetal outcome. ANCAs may be involved in the pathogenesis of glomerulonephritis in preeclampsia and eclampsia and their presence may be attributed to an autoimmune mechanism initiated by autoantibody-mediated activation of neutrophils.

Plasma P selectin (GMP-140) and glycocalicin are elevated in preeclampsia and eclampsia: Their significances

OBJECTIVE: We measured the concentrations of plasma P selectin (or GMP-140) and glycocalicin in preeclamptic and eclamptic women. Correlations between these two parameters and blood pressures, platelet counts, or plasma thrombin-antithrombin complex values were evaluated. STUDY DESIGN: By use of enzyme-linked immunosorbent assays we measured the plasma GMP-140 and glycocalicin levels in normal pregnancies ( n = 10) and preeclamptic ( n = 10) and eclamptic ( n = 20) pregnancies. The glycocalicin index was calculated as follows: (glycocalicin × [250 × 10 6/ml])/(Individual platelet counts). Correlations between plasma GMP-140, glycocalicin, glycocalicin index values, blood pressures, platelet counts, and plasma thrombin-antithrombin complex values were analyzed. RESULTS: Plasma GMP-140 levels were found to be significantly elevated in preeclamptic ( p < 0.0005) and eclamptic cases ( p < 0.0001) compared with normotensive controls. Plasma glycocalicin ( p = 0.01, 0.007) and glycocalicin index ( p = 0.005, 0.002) values were also markedly elevated in preeclamptic and eclamptic patients compared with normal pregnant patients. Significant correlations between platelet counts or plasma thrombin-antithrombin complex levels and their corresponding plasma GMP-140 and glycocalicin and glycocalicin index values have been found in preeclamptic and eclamptic cases. However, blood pressures had correlations with GMP-140, glycocalicin, and glycocalicin index values in eclamptic cases. CONCLUSIONS: We demonstrated an elevation of plasma GMP-140 and platelet glycocalicin in preeclampsia and eclampsia. This study also reflects the usefulness of glycocalicin as a marker of platelet activation or turnover and endothelial dysfunction in these diseases. (A M J O BSTET G YNECOL 1996;174:272-7.)

Correlated plasma elastase and sera cytotoxicity in eclampsia A possible role of endothelin-1 induced neutrophil activation in preeclampsia-eclampsia

The activation of neutrophils was studied in preeclampsia (n = 10) and eclampsia (n = 20) compared to normotensive controls (n = 10) and nonpregnant essential hypertensives (n = 10). Plasma elastase levels were raised in preeclampsia (0.53 +/- 0.32 microgram/mL, P < .002) and eclampsia (1.26 +/- 0.8 microgram/mL, P < .001) respectively compared to normal pregnancies (0.032 +/- 0.009 microgram/mL). The plasma elastases were more elevated in eclamptic cases compared to essential hypertensive (0.53 +/- 0.27 microgram/mL; P = .01) patients. We analyzed the correlation among elastase values, systolic (SBP), mean blood pressures (MBP), endothelin-1 (ET-1) levels and sera cytotoxicity (as measured by fura-2 release from human umbilical venous endothelial cell culture) in eclamptic cases. SBP and MBP were significantly correlated with plasma elastase levels in preeclampsia (r = 0.67, 0.63, respectively; P < .03) and eclampsia (r = 0.49, 0.49, respectively; P < .02). ET-1 levels were correlated with SBP (P = .003) and MBP (P = .001) and corresponding elastase levels (r = 0.606, P < .003) in eclamptic patients. Doses of 10, 25, and 50 pmol/mL of ET-1 increased elastase release in human neutrophil cultures dose and time dependently. Cytotoxicity of eclamptic sera correlated (P < .001) to the corresponding plasma elastase values. Therefore, this study suggests that neutrophil activation and ET-1 induced neutrophil activation occurs in this disease.

Postpartum eclampsia with death from cerebral hemorrhage and encephalomalacia limited to the left frontal lobe

Eclamptic patients are more liable to cerebral hemorrhage than we were wont to believe and if autopsy always included examination of the brain we would probably find more cases that clinically had gone unrecognized. Large hemorrhage may occur anywhere in the brain, most commonly in the parietal lobe, corpora striata and ventricles and least frequently in the pons, optic thalamus, and frontal lobe.Many small focal hemorrhages with surrounding areas of necrosis may form into one large hemorrhagic and necrotic area. This may be due to the solvent action of a circulating enzyme acting on the endothelial lining of the terminal blood vessels (Welch).4Hemorrhage in the frontal lobe may give no clinical evidence other than hysteria and is confusing with puerperal toxic psychosis.Blood transfusion, preceded by phlebotomy, given to eclamptic cases may arrest further extension of hemorrhage.I wish to thank Dr. S. A. Cosgrove, attending obstetrician to the Jersey City Hospital, for his courtesy in permitting me to follow up and report this case. My appreciation is extended to the pathologist, Dr. Brownstein, for his complete report.