Eclamptic Pregnant Women Research Articles

The predictive role of neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and other complete blood count parameters in eclampsia and HELLP syndrome

Background/Aim: Previous studies declared the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and other routine complete blood count (CBC) components as sensitive preeclampsia biomarkers. We speculated that the same associations existed with eclampsia and HELLP syndrome. Methods: This retrospective case-control study was conducted on 120 pregnant women between the ages of 18 and 40 years. Forty-nine patients with HELLP syndrome, 40 patients with eclampsia/preeclampsia, and 40 healthy pregnant women were included in the study. All groups were evaluated in terms of clinical characteristics and first-trimester hematological parameters. The primary outcomes were neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and the secondary results were hemoglobin, red blood distribution width, mean platelet volume, platelet count, neutrophil count, and lymphocyte count. Results: The median gestational age was 34 weeks (ranging between 23 and 41), with a median birth weight of 2300 grams. The median NLR was 3.9 (1.3-25.1), and the median PLR was 113.6 (20.7-693). The NLR and PLR values were significantly different between the three groups (P=0.014, P=0.002, respectively). NLR was different between normotensive and eclamptic pregnant women. PLR values were higher in normotensive pregnant women than in pregnant women with a history of HELLP. The median red cell distribution width was 44.6 in normotensive women, 41.5 in women with eclampsia, and 44.3 in women with a history of HELLP (P=0.017). Conclusion: TLR value was higher in pregnant women who had eclampsia. Platelet count and MPV were significantly lower in the HELLP group.

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.

Do platelet indices play a role in assessing severity of pre-eclampsia and eclampsia?

Background: Pre-eclampsia and eclampsia is a multisystem disorder affecting approximately 2-7% of all pregnancies and is a significant cause of maternal and fetal morbidity and mortality. Many hemostatic abnormalities have been reported in association with hypertensive disorder of pregnancy. We conducted this prospective case-control study to assess and analyze the platelet parameters in 3rd-trimester normotensives, pre-eclamptic, and eclamptic pregnant women. Materials and methods: This study was conducted in the hematology division of the Department of Pathology, in a rural population-based medical institute over 2 years. In all subjects (cases and controls) 2 ml of blood sample was collected in EDTA vials for platelet counts and platelet indices. The blood samples were run on an automated blood cell counter (Beckman coulter) within 2 hours of collection. The data obtained were tabulated and statistical analyses were performed. Results: The mean platelet count was significantly decreased in cases as compared to controls with increased frequency of thrombocytopenia associated with progression of the disease. Platelet indices, mean platelet volume, and platelet distribution width were increased, whereas the plateletcrit was decreased in cases as compared to the controls. However, the statistically significant difference was found only in platelet distribution width and plateletcrit. Conclusions: We concluded that platelet indices like platelet distribution width and plateletcrit can be useful along with platelet count in early detection of pre-eclampsia and eclampsia instead of relying on platelet count alone.

Correlation of Serum Cystatin-C and Creatinine as Predictive Prognostic Markers for Renal Impairment in Pre Eclamptic Patients

Background: Renal impairment is becoming more common as adverse effect of preeclampsia in emerging nations. Preeclampsia is a complication of pregnancy that can be prevented by using Cystatin C as a better and earlier renal biomarker than creatinine in order to evaluate the renal function. Method: The study was done on 150 women in the Obstetrics and Gynecology Department at LUMHS Jamshoro, dividing them into three gestational age groups. The ANNOVA test was used to determine if cystatin-c is a superior marker to serum creatinine. SPSS version 21 was used to analyze the data without any dropout of the patients. Results: In this study, one hundred fifty (150) pre eclamptic pregnant women in the 20–35-year-old age range were chosen. The cystatin-c level was 1.2 ± 0.7 at 36th weeks of gestation in the forty of the patients of age 20-25, while creatinine was 1 ± 0.7. In sixty-eight (68) patients of age between 25-30 years, cystatin-c levels ranged from 1.6 ± 0.8 ng/mL, while creatinine levels ranged from 1.1 ± 0.9 ng/mL. In patients above > 30 years’ age group, the serum cystatin C level was found to be 1.9 ± 0.8, while the creatinine level was found to be 1.2±0.6 at 36th week of gestation. Conclusion: This research shows that cystatin C levels rise early and proved to be a better predictor of renal problems as compared to serum creatinine, which didn't increase considerably. Keywords: Cystatin-C, Preeclampsia, kidney impairment

SAT-028 Leptin, Leptin Soluble Receptor and FLI in Healthy and Preeclamptic Pregnancies

ContextLeptin is an adipokine involved in many pleiotropic and key physiological actions and circulates free and active, or inactive bound to the leptin binding protein and sOB-r. Thus, the ratio Leptin/sOB-r or free leptin index (FLI) is commonly used as a marker of leptin sensitivity in different pathologies.ObjectiveEvaluate serum concentrations of leptin and sOB-r and determine FLI in healthy pregnant and mild pre – eclamptic women in the three trimesters of gestation.DesignA nested case-control study within a prospective cohort study of pregnant women, enrolled in the Department of Obstetrics and Gynecology of the School of Medicine at Universidad Nacional.Main Outcome Measure and MethodsFrom the initial cohort, 46 healthy pregnant women and 19 mild pre – eclamptic pregnant women were randomly selected. Anthropometric, biochemical and clinical parameters were determined during three stages of pregnancy [1st (11.3±2.3 weeks), 2nd (24.4±3.10 weeks) and 3rd (34.84±4.41 weeks) periods of gestation]. Data were presented as mean ± SD. A p value <0.05 was considered to be statistically significant.ResultsSerum leptin levels and sOB-r levels rose significantly throughout pregnancy in both healthy women [Leptin (1st 23.28±9.87 ng/mL; 2nd 34.58±18.45 ng/mL; 3rd 38.27±19.64 ng/mL trimester) (p=0.0001); sOB-r (1st 32.12±7.29 ng/mL; 2nd 43.26±9.25 ng/mL; 3rd 45.16±10.70 ng/mL trimester) (p<0.0000)] and preeclamptic women [Leptin (1st 29.91±9.91 ng/mL; 2nd 47.10±25.70 ng/mL; 3rd 63.00±3012 ng/mL trimester) (p<0.0000); sOB-r (1st 32.09±6.97 ng/mL; 2nd 37.54±6.33 ng/mL; 3rd 36.96±7.66 ng/mL trimester) (p=0.0380)].Serum leptin levels were significantly higher in preeclamptic pregnant women compared to healthy pregnant women at 2nd (p=0.029) and 3rd trimesters of pregnancy (p<0.000). Additionally, serum sOB-r levels were also significantly lower in pre - eclamptic pregnant women during the 2nd (p=0.017) and 3rd trimester (p=0.0036) of pregnancy compared to healthy pregnant women. As a result, the FLI index did not vary significantly during any of the three periods of pregnancy studied in healthy pregnant women [(1st 7.99±4.85; 2nd 8.72±6.5; 3rd 9.15±5.84 trimester) (p >0.05)], whereas, in contrast, this index markedly increased throughout pregnancy in pre - eclamptic women [(1st 8.69±4.96; 2nd 13.54±8.78; 3rd 18.06±10.35 trimester) (p=0.0044)]. Indeed, the FLI index was significantly higher at 2nd (p=0.0186) and 3rd (p<0.000) trimesters of pregnancy in pre - eclamptic women compared to healthy pregnant.ConclusionsThe present results demonstrate for the first time in a longitudinal study that FLI increases significantly in pre - eclamptic pregnant women towards the end of pregnancy. Hence, high FLI index values should be further explored as a potentially valuable indicator for the clinical manifestations of this pathology.

Perinatal Consequences of Gestational Hypertensive Disorder

Objective: Our aim in this study was to compare the perinatal outcomes of patients with gestational hypertensive disorder in a tertiary health institution of our country. It was aimed to compare the pregnancy outcomes and the relationship of the disease according to the clinical weights of these patients. Methods: In this study, 451 patients diagnosed with gestational hypertensive disorder and 122 control patients were evaluated retrospectively in Mersin University Obstetrics and Gynecology Clinic between 2010-2018. The patients were subdivided according to their diagnosis as hypertensive. The patients were averaged according to the age birth weeks. Additional disorders related to pregnancy were recorded in patients diagnosed with gestational hypertensive disorder. Multiple pregnancies were not listed, the control group was taken from maid pregnancies over 37 weeks. In the study, all groups were compared with the control group. P &lt;0.05 was accepted as statistically significant Results: When the demographic characteristics of the patients are examined, it was observed that mothers with chronic hypertension and gestational hypertension were in older ages; eclampsia was observed in younger patients. It was found that patients with severe preeclampsia, eclampsia and hellp, whose disease severity increased, had earlier births and had lower birth weight. When the perinatal results of the patients are compared, just like fetal weight; As disease severity increased, intrauterine growth retardation (IUGR) increased. Only in gestational hypertensive patients, unlike fetal weight, 52% of patients were diagnosed with IUGR. Likewise, in gestational hypertensive disorder groups where disease severity increased, excessive low birth weight (LBW) fetus and delivery rate below 34 weeks were increased. Conclusions: In our hospital, which is a tertiary health institution, gestational hypertensive disorder insi dance was found to be 6%. In our study, preeclampsia was the most common group in 69% of gestational hypertensive disorder. It was observed that pregnant women with chronic hypertension were older, and eclamptic pregnant women were younger. As the severity of the disease increased, the rates of co-morbidity (such as IUGR) increased and the patients were delivered in earlier weeks. As the severity of the disease increased, the rate of very low birth weight infant increased proportionally due to preterm delivery and IUGR. Keywords: Gestational hypertensive disorder, Preeclampsia, perinatal outcomes DOI: 10.7176/JSTR/6-05-01

Effects of Hyperuricemia on Fetal Outcome in Preeclamptic Patients

Background: A raised serum uric acid is recognized as an unfavourable fetal outcome of pre-eclampsia. The objective of this study was to determine the relationship between hyperuricemia and fetal outcome in preeclamptic patients.&#x0D; Methods: This observational study was carried out in the Department of Gynecology and Obstetrics of BIRDEM General Hospital from July 2015 to June 2016. Fifty pre eclamptic pregnant women with hyperuricemia (group A) and 50 preeclamptic pregnant women with normal serum uric acid level (group B) were taken as study subjects. Data were analyzed by SPSS where p value less than 0.05 was considered significant.&#x0D; Results: Mean age of the patients was 25.88 ± 4.52 years and 24.30 ± 5.09 years in group A and group B respectively. Mean serum uric acid level was 7.19±0.62 mg/dl in group A and 4.83±0.73 mg/dl in group B. Maximum (66%) patients were primigravida in group A and 34% in group B. In this study, intra-uterine death (IUD) occurred in 4 (8%) cases in group A and in 1 (2%) case in group B, intra-uterine growth retardation (IUGR) was 20 (40%) cases in group A and 4 (8%) cases in group B, low birth weight was in 38 (76%) cases in group A and 21(42%) cases in group B. Occurrence of IUGR and low birth weight was significantly higher in group A than group B. APGAR score was significantly lower in group A (5.10±1.61) than that of group B (6.36±1.32). Neonatal intensive care unit (NICU) referral was more in group A (60%) than group B (20%).&#x0D; Conclusion: It can be concluded that hyperuricemia is a predictor of poor fetal outcome in pre-eclamptic women.&#x0D; Birdem Med J 2019; 9(2): 117-120

Seric Calcium and Magnesium in Normal and Pre Eclamptic Pregnant Women: A Case-Control Study in Kinshasa, D R Congo

Goal: The present study aimed to determine the profile of seric calcium and magnesium in pre-eclamptic and eclamptic pregnant women of Kinshasa province in the Democratic Republic of Congo where preeclampsia is characterized not only by a high incidence, but also by a seasonal variation probably related to nutritional intake. Study Design: This is a case-control study that took place during the period from September 2014 to March 2015 in four quaternary and tertiary maternity hospitals in Kinshasa. A total of 113 healthy pregnant women (controls) and 112 pre-eclamptic and eclamptic pregnant women (cases) were included in this study. Seric calcium and magnesium were measured in all these gravidas by the principle of spectrophotometry with a HUMALYSER Primus semi-automaton. Results: The mean age of those gravidas was 26.8 ± 6.3 years (26.7 vs 26.9, p = 0.11). The majority of these gravidas were primiparous. The mean gestational age in both groups was 31.35 ± 0.9 weeks (32.1 vs 30.6, p = 0.21). The average seric calcium value was 4.47 ± 0.23 mEq /L in healthy pregnant women compared to 3.80 ± 0.71 mEq/l in pre-eclamptics (P 0.001). The mean of seric magnesium was 1.56 ± 0.15 mg/dL in healthy pregnant women compared to 1.20 ± 0.41 mg/dL in pre eclamptics (P 0.001). Seric calcium and magnesium values were low in the pre-eclamptic group and lower in the eclamptic group (P 0.001). Conclusion: This study establishes a relationship between the low concentration of seric calcium and magnesium with pre-eclampsia and eclampsia, which could be one of the determinants of the high prevalence and seasonality of the disease in Kinshasa.

Serum LDH in Preeclampsia &amp; Eclampsia and Maternal Outcomes

The study was undertaken to determine the correlation of serum LDH in pre eclampsia and eclampsia and perinatal outcome. This is a hospital based comparative case control study done in Department of Obstetrics & Gynaecology SMS Medical College, Jaipur between March 2014 to Oct 2015 on 140 subjects including normotensive , mild pre eclamptic , severe pre eclamptic and eclamptic pregnant women after 28 weeks of gestation before termination of pregnancy. Serum LDH levels were recorded and perinatal outcomes observed. The mean value of serum LDH in control group was 391.4 ± 10.9 IU/L, in mild pre eclampsia 531.5 ± 24.5 IU/L, in severe preeclampsia 922.1± 515.5 IU/L and in eclampsia 1497.6 ± 602.1 IU/L. The difference in serum LDH level was highly significant (P<0.001).Higher LDH levels were associated with High Blood Pressure and had significant correlation with poor perinatal outcome. Thus we conclude that High serum LDH levels correlate well with poor maternal and perinatal outcomes in patients of Preeclampsia and Eclampsia.

Pregnancy Specific Beta-1 Glycoprotein in Women with Eclampsia, Kaduna State, Nigeria

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.

Maternal outcomes of magnesium sulphate and diazepam use in women with severe pre-eclampsia and eclampsia in Ethiopia.

Preferred anticonvulsant used to treat and prevent fits in eclampsia currently is magnesium sulphate. Clinical monitoring of tendon reflexes, respiration rate and measuring hourly urine output should be done to ensures safe administration of magnesium sulphate. This study was conducted to evaluate maternal outcomes of magnesium sulphate and diazepam use in the management of severe pre-eclampsia and eclampsia in Jimma University Specialized Hospital. A retrospective hospital based cross-sectional comparative study was conducted using data collection format. Data was collected from the hospital delivery care register and patient chart records of all pregnant women who presented with the diagnosis of severe pre-eclampsia and eclampsia in two years and three months period from January, 2010 to April, 2012. Data analysis was done by SPSS version 16.0. A P-value of <0.05 was considered statistically significant in all tests. A total of 357 patient charts, 217 from magnesium sulphate and 140 from diazepam treated pregnant women group, were reviewed and analyzed. Three pregnant women from the magnesium sulphate treated group and eleven pregnant women from diazepam treated group had at least one convulsion after taking the drug. Greater proportion of patients in the magnesium sulphate treated group had less than four days postpartum stay as compared to the diazepam treated patients (82.3% versus 66.2%). Seizure occurrence, duration of postpartum hospital stays and birth outcome had a statistically significant association with the type of anticonvulsant used. Magnesium sulphate is more effective than diazepam in the management of severe pre-eclamptic and eclamptic pregnant women in terms of seizure prevention, shortening postpartum hospital stay and reducing maternal morbidities.

Birth Outcomes of Pre-Eclamptic Pregnant Women With Vitamin E Supplementation A Population-Based Study

Objectives. To study the efficacy of vitamin E supplementation for the reduction of preterm birth/low birth- weight newborns in pre-eclamptic pregnant women. Design. Comparison of the rate of preterm birth and low birthweight in pre-eclamptic pregnant women with or without vitamin E treatment. Setting. Hungarian Case-Control Surveillance Sys- tem of Congenital Abnormalities, 1980-1996. Population. Newborn infants in Hungarian population. Methods. Medically recorded pre-eclampsia and birth outcomes of pregnant women were evaluated. Main outcome measures. Preterm birth, low birthweight. Results. There was no lower incidence of pre-eclampsia after vitamin E treatment. Pregnant women with pre-eclampsia and without vitamin E treatment had a higher rate of preterm births (10.4% vs. 9.3%) and low birthweight newborns (7.8% vs. 5.6%) than the reference sample of 34,928 pregnant women without pre-eclampsia and without vita- min E treatment. The newborns of 936 pregnant women with pre-eclampsia and without vitamin E treatment had higher rate of preterm birth (10.4% vs. 8.6%; OR with 95% CI: 0.8, 0.7-0.9) than 81 pregnant women with pre-eclampsia but with vitamin E treatment. However, the rate of low birthweight newborns was somewhat but not significantly higher (8.6% vs. 7.8%; OR with 95 CI: 1.1, 0.8-1.4) in pregnant women with pre-eclampsia and with vitamin E treatment. There was very high rate of threatened abortion (45.7% vs. 15.3%) and threatened preterm delivery (27.2% vs. 13.5%) in 81 pre- eclamptic pregnant women with vitamin E treatment compared to the reference group. Conclusions. Vitamin E treatment reduced the rate of preterm birth in pregnant women with pre-eclampsia but not the rate of low birthweight newborns.

Relationship between erythrocyte catalase and serum adenosine deaminase activities in eclampsia

Objective. To examine the relationship between antioxidant status and T-cell activation in the pathogenesis of eclampsia by measuring the activities of erythrocyte catalase, an enzyme of antioxidant mechanism, and serum adenosine deaminase (ADA), regarded as a marker of T-cell activation.Methods. A total of 60 patients [20 eclamptic (E) pregnant women, 20 healthy pregnant (HP) women and 20 non-pregnant (NP) women] were included in the study. Maternal venous blood samples were obtained from each patient during weeks 28–37 of gestation, and biochemical analyses of catalase activity in erythrocytes and ADA activity in serum were carried out.Results. Erythrocyte catalase activity was significantly lower and serum ADA activity was significantly higher in the E pregnant women when compared with the HP women and NP women (P <0.001). No significant correlation was observed between erythrocyte catalase activity and serum ADA activity.Conclusions. Erythrocyte catalase and serum ADA activities may at least in part contribute to the pathogenesis of eclampsia. However, more studies are needed to verify and clarify the relationship between antioxidant status and T-cell activation in eclampsia.

Comparison of cerebral magnetic resonance and electroencephalogram findings in pre‐eclamptic and eclamptic women

To compare the cerebral magnetic resonance (MR) and electroencephalogram (EEG) findings in pre-eclamptic and eclamptic pregnant women. A total of 38 pregnant women with mild pre-eclampsia (n = 15), severe pre-eclampsia (n = 11) and eclampsia (n = 12) were included in this study. Cranial MR without contrast and EEG were performed in these women on admission or within 3 days of onset. Follow-up control MR or EEG evaluations were performed 4-6 weeks postpartum in women with MR or EEG abnormalities in the initial examination. To compare differences, X(2) test, Fisher exact or Mann-Whitney U-tests were used. Abnormal cranial MR findings were found in one (6%) pre-eclamptic woman, in four (36%) severe pre-eclamptic women, and in 11 (92%) eclamptic women. Cranial MR findings were consistent with ischaemia in 15 (39%) patients and haemorrhage in one (3%) case. Two (5%) severe pre-eclamptic women showed cerebral infarction during the follow-up period. MR and EEG abnormalities were totally resolved in 88% of cases. The MR findings of 12 (71%) patients were located in the occipital lobes followed by the parietal lobes in six (40%) cases. Three (20%) mild pre-eclamptic women, four (36%) severe pre-eclamptic women and 10 (83%) eclamptic women had abnormal EEGs. The EEG changes were totally resolved in 13 of 14 (93%) patients after the first month. In one patient with cerebral haemorrhage, the EEG changes lasted for a duration of 6 months. A correlation between EEG abnormalities and MR findings was found in this study. The combined use of MR and EEG may help to determine the prognosis for these patients, but the interictal EEG findings recorded in eclampsia were non-specific.

Using village theatre to increase knowledge about eclampsia in Bangladesh.

To assess the impact of a theatre based educational initiative on the knowledge and attitudes to eclampsia and its treatment in a rural Bangladeshi village. An established theatre company, Theatre Centre for Social Development, performed scenarios regarding eclamptic pregnant women to a diverse audience of village observers. Before the performance 15 men and 15 women were randomly selected from the audience and asked a series of questions regarding eclampsia. After the performance the series of questions were repeated to the same people. The plays were enthusiastically received by the villagers. The level of knowledge of the villagers interviewed increased significantly after seeing the two plays. The intervention successfully raised both the awareness of eclampsia and the level of knowledge of effective treatments for eclampsia. Village theatre has shown the potential to be a very effective tool in Bangladeshi rural society.

Placental nitric oxide synthase (NOS) activity and nitric oxide (NO) production in normal pregnancy, pre-eclampsia and eclampsia

Objectives: To measure nitric oxide synthase (NOS) activity and total nitrites levels (as an index of nitric oxide ‘NO’ production) in placental villous homogenate of normal, pre-eclamptic and eclamptic pregnant women. Design: Two groups were studied cross-sectionally: late pregnant women with pre-eclampsia and eclampsia ( n=31) and normal pregnant women (all late) as controls ( n=32). Two tissue blocks of whole placenta, each 1×1×1 cm, were collected at delivery and assayed for NOS activity and total nitrite levels. Setting: Department of Obstetrics and Gynecology, Assiut University Hospitals, Egypt. Methods: Placental tissues were homogenized and villous homogenates were assayed for NO production by Griess reaction which measures the combined oxidation products for NO (nitrites and nitrates) after reduction with nitrate reductase. NOS activity was determined by measuring NO synthesis by tissue extracts spectrophotometrically using the oxidation of oxyhemoglobin to methemoglobin by NO. Results: Placental villous homogenates of pregnancies complicated by pre-eclampsia and eclampsia had significantly higher NOS activity and total nitrites levels compared with those of normal pregnancy [for NOS ( P<0.0001) and for total nitrites ( P<0.001)]. Conclusions: (1) Placental NOS activity and NO production are significantly increased in pre-eclampsia and eclampsia than those of normal pregnancy; this increase was directly related to the severity of this disorder. (2) Such increase possibly represents a physiologic adaptive response to overcome the increased placental vascular resistance and to minimize platelet and leukocyte adhesion to the surface of placental villi or within the intervillous spaces.

Serum homocysteine in pre-eclampsia and eclampsia

Pre-eclampsia and eclampsia are common obstetrical problem causing adverse effects on pregnancy outcome. Large bodies of evidences suggest that hyperhomocysteinemia is a causal factor of pre-eclampsia/eclampsia. This study designed to explore the association between hyperhomocysteinemia and pre-eclampsia/eclampsia, the knowledge of which expected to be used for prevention of pre-eclampsia and eclampsia. In a case-control study serum homocysteine was measured in 136 controls (healthy pregnant), 84 pre-eclamptic and 120 eclamptic pregnant women. Serum homocysteine in patients with pre-eclampsia (9.54 +/- 3.21 micromol/L) and eclampsia (10.57 +/- 3.39 micromol/L) found to be significantly increased compared to controls (6.86 +/- 2.47 micromol/L) (p < 0.001). Between pre-eclampsia and eclampsia, homocysteine found to be raised more in eclampsia compared to pre-eclampsia (p < 0.03). In conclusion, hyperhomocysteinemia is associated with pre-eclampsia as well as eclampsia, but in eclampsia the severity of homocysteine elevation is more compared to that in pre-eclampsia.

Association of Serum Homocysteine and Serum Lipid with Eclampsia

Eclampsia is one of the most common pregnancy complications causing high mortality and morbidity for both mother and foetus especially in developing countries. Many studies suggest that elevated homocysteine level is an important risk factor for eclampsia. The aim of this study was to explore the association between serum homocysteine with eclampsia and to establish serum homocysteine measurement as a reliable test for early detection of eclampsia. In a case control study serum homocysteine and lipid profile were measured in 52 controls (healthy uncomplicated pregnant women) and 50 eclamptic pregnant women. Serum homocysteine in eclampsia cases (10.44±4.08 μmol/L) found to be significantly increased (p &lt; 0.001) compared to controls (7.97±3.46 μmol/L). Serum HDL-cholesterol concentration found to be significantly decreased (p &lt; 0.001) in the cases (35.98±6.35 mg/dl) compared to controls (42.69±6.09 mg/dl). A significant negative correlation (r-.801, p &lt; 0.01) was found between serum homocysteine and HDL-cholesterol concentration among cases. It can be concluded that elevated serum homocysteine and HDL-cholesterol deficiency were associated with eclampsia. But elevated homocysteine itself might be a factor associated with eclampsia irrespective of lipid profile status. Key Words: Homocysteine, Eclampsia. doi: 10.3329/jafmc.v5i1.2842 JAFMC Bangladesh. Vol 5, No 1 (June) 2009 pp.7-10