Previous History Of Preeclampsia Research Articles

#1728 New onset proteinuria in two pregnancies: glomerulopathy or preeclampsia?

Abstract Background and Aims Distinguishing between preeclampsia in pregnant women and a new onset glomerulonephritis could be challenging. Method Here, we present two cases on new onset proteinuria during pregnancy which were diagnosed with primary membranous nephropathy and their treatment. Results Case 1. A 27-year-old patient, G6P5A1, was referred to our attention at the 14th week of gestation (wg) for new onset proteinuria of about 5 g/day. She had a personal history of preeclampsia and was already under low-dose Aspirin since the beginning of this pregnancy. She was normotensive, her serum albumin was about 1.8 g/dl (Fig. 1A) and showed no edema. Due to the timing of pregnancy, a glomerular disease was suspected, and she was started on oral prednisolone 20 mg/day. Complementary explorations found a normal SFlT-1 to PlGF ratio as well as normal renal function and positive anti-PLA2R antibodies. A diagnosis of membranous nephropathy diagnosis was, therefore, made. Cyclosporine (CsA) 300 mg twice daily was started, prednisolone was rapidly tapered, and partial remission was rapidly attained. The rest of her pregnancy was uneventful until the 36 wg when hypertension, increase in proteinuria and findings of IUGR developed; on the account of the diagnosis of superimposed preeclampsia, delivery was decided (caesarian section) giving birth to a healthy female baby weighting 1.9 kg (1st Intergrowth centile). After the delivery the patient underwent two injection of Rituximab (Rtx) (1 g 2 weeks apart) and CsA was discontinued. The patient achieved partial remission, and her antibody titer decreased but remained positive. A renal biopsy is scheduled to guide future treatment options. Case 2. A 44-year-old patient, G3P2A1, without history of previous preeclampsia, was referred to our attention at 32 wg for new onset proteinuria around 5 g/day first discovered at 10 wg. Her blood pressure was normal. She was already under Aspirin treatment, based on a suspicion of preeclampsia, which was however ruled out by the timing of proteinuria onset. At referral additional investigations revealed an increase in proteinuria up to 19 g/l, normal renal function, gestational diabetes, normal SFlT-1 to PlGF ratio and a serum albumin around 1.4 g/dl (Fig. 1B). Anti-PLA2R antibodies were positive, and a membranous nephropathy was diagnosed at 34 wg. Immunosuppression treatment was waived considering the timing of pregnancy and supportive treatment by LMW heparin was started. The patient delivered at 37 wg by urgent cesarian section on the account of onset of hypertension, giving birth to a male baby weighting 2760 g (37th Intergrowth centile). CsA treatment was started 5 days after delivery and Rtx infusion followed 2 weeks after delivery, on the account of her decision to breastfeed. CsA was discontinued 2 months after Rtx first injection with complete sustained remission and undetectable PLA2R antibodies. Conclusion Preeclampsia is the most frequent complication of pregnancy. In particular before the 20 wg the distinction between an hypertensive disorder of pregnancy (HDP) and primary glomerular disease is fundamental but may be difficult. In our cases, the early onset of proteinuria was in favor of a primitive disease of the kidney. Complementary explorations allowed diagnosing membranous nephropathy. The treatment of glomerulonephritides, either of new onset or chronic, during pregnancy is challenging. Renal biopsy has a higher risk of complications, especially in mid-pregnancy, and finding positive anti PLA2R antibodies may allow avoiding the histological examination. It is worth noting that preeclampsia developed in both cases towards the end of gestation, stressing the role of chronic kidney disease as a major risk factor for HDP. The SFlT-1 to PlGF ratio could come in handy both for differential diagnosis and for diagnosis of superimposed preeclampsia.

Maternal Cardiac Functional and Structural Changes in Preeclampsia: an Echocardiographic Study

Background & objective: Preeclampsia is a pregnancy-induced multi-organ syndrome of acute cardiovascular manifestations with significant short and long-term sequelae. However, there is a relative lack of knowledge with respect to cardiac functional and structural changes in women with preeclampsia Therapeutic interventions used in the management of preeclampsia may cause iatrogenic adverse consequences due to this lack of knowledge. The present study was therefore designed to evaluate the echocardiographic changes in cardiac structural and functional indices in pregnant women with PE. Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH), and Shaheed Suhrawardy Medical College Hospital (SSMCH) in collaboration with National Institute of Cardiovascular Diseases (NICVD), Dhaka over a period of one year from July 2013 to June 2014. A total of 30 single-tone pregnant women of 20-40 weeks gestation with preeclampsia were taken as cases. An equal number of gestationally-matched healthy pregnant (HP) women of similar age cohorts having no history of preexisting hypertension were included as controls. Preeclampsia was defined as SBP ≥140and/or DBP ≥ 90 mmHg after 20 weeks gestation in a woman with previously normal blood pressure and with proteinuria≥1 + in the dipstick test. Pregnant women with systolic and diastolic blood pressures within the normal range (< 140mmHg and > 90 mmHg respectively), trace or absence of proteinuria by dipstick test were defined as controls. All thesubjects were investigated with ECG, standard two-dimensional, M-mode, and Doppler transthoracic echocardiography. The cardiac functional and structural changes were measured in terms of interventricular septal thickness (IVSTd),posterior wall thickness (PWTd), left ventricular internal diameter at the end of diastole (LVIDd), ejection fraction (EF), transmitral velocity (MV E/A ratio), MV deceleration time (MV DecT). Result: Half of the women with preeclampsia were primigravidae and there was no association between gravidity and the occurrence of preeclampsia. Prepregnancy overweight or obesity (in terms of BMI) was found to be strongly associated with preeclampsia. One in 10 PE women had a previous history of preeclampsia as opposed to none in the HP women. A substantial proportion (56.7%) of PE women had a family history of hypertension in comparison to healthy pregnant women (16.3%). The women with PE had significantly higher SBP, DBP, & MAP than the HP women. Parameters of diastolic dysfunction, like mitral E/A ratio was reduced and deceleration time was prolonged in PE with diastolic dysfunction (mean E/A ratio < 0.73 and mean DceT >178 ms respectively) than those in PE with normal diastolic function (mean E/A ratio 1.2 and mean DceT 192.4 ms respectively) healthy pregnant women (mean E/A ratio 1.3 and mean DecT 186.5 ms respectively). Over one-third (36.7%) of women with PE met the criteria of diastolic dysfunction compared to none in healthy pregnant women. The LVH appears to be a frequent occurrence in pregnancies complicated by preeclampsia (43.3%) as compared to none in healthy pregnant women. In the present study, the systolic function was assessed with the help of EF, which was well-preserved both in PE and HP with no significant intergroup difference. Conclusion: Preeclampsia is associated with left ventricular diastolic dysfunction and hypertrophy preserving the systolic function. These structural and functional changes are primarily adaptive in nature for maintaining cardiac systolic function. Ibrahim Card Med J 2022; 12 (2): 32-39

Abstract 17788: Long-Term Impact of Previous Severe Preeclampsia on Heart and Large Artery Structure and Function

Introduction: Women with previous history of preeclampsia (PE) are at risk of cardiovascular events. Hypothesis: To evaluate subclinical cardiovascular repercussions by noninvasive methods in women with previous severe PE. Methods: Cross-sectional study was carried out in a tertiary hospital. Women evaluated 2 to 5 years after delivery and divided into 3 groups: isolated preeclampsia (IPE=30), superimposed preeclampsia and/or chronic hypertension (Sup/HC)=60 and normal gestation (NG) =30. Variables analyzed: age, body mass index (BMI), systolic blood pressure (SBP) and diastolic BP (DBP) by ambulatory blood pressure monitoring (ABPM-24h) and office, central pressure (BPc) by Sphigmocor®; pulse wave velocity-PWV by Complior® e echocardiogram (ViviDI-GE®). Results: Clinical : Age (years): (Sup/HC=38 vs NG=34,6 vs IPE= 31, p <0,001). BMI (kg/m2): Sup/HC=32,6 vs NG=27,1 vs IPE=28,4, p< 0,001); SBP (mmHg): ABPM-24h (awake): (Sup/HC=128,4 vs NG=117,5, p<0,004); office: (IPE=124,8, Sup/HC=133,6 vs NG=114,6, p <0,001). DBP (mmHg) : office (IPE=80,4;Sup/HC=87,8 vs NG= 73,3) and (Sup/HC=87,8 vs IPEH= 80,4), (p<0,001); SBPc (IPE=115,4, Sup/HC=124,4 vs NG 105,8, p < 0,001). DBPc: (Sup/HC=88,8 vs NG= 75; Sup/HC=88,8 vs IPEH=81,8, p<0,001); Vascular : PWV (m/s) (Sup/HC=8,1 vs NG=6,8, IPE=7,0, p<0,012); Echocardiogram : Septum wall thickness (mm) (IPE=9,2 vs Sup/HC=9,7, NG=8,4, p<0,004); left atrium (mm) (Sup/HC=38 vs IPE=36 vs 34, p<0,005); left ventricle mass index (g/m2) (Sup/HC=81 vs IPE=80 vs. NG=66, p<0,002), Conclusions: Women with previous IPE had elevated BP values and cardiac repercussions compared to previous normal gestation while previous superimposed or chronic hypertension had also elevated BP, vascular and cardiac impairment compared to other previous gestational conditions.

Risk Factors of Body Mass Index and Hypertension on Preeclampsia during the Covid-19 Pandemic

Preeclampsia, known as the "new onset of persistent hypertension," can increase the morbidity and mortality of mothers and fetus. The Indonesian Health Profile shows that the maternal mortality rate (MMR) due to preeclampsia in Indonesia reaches 25%. The Corona Virus Disease 2019 impacted the access to, and quality health services, including for maternal and neonatal. This study aim to determine the risk factors for preeclampsia at Budhi Asih Hospital during the Covid-19 pandemic. This was a retrospective, observational case-controlled study, using medical records of woman on antenatal care from March 2020 – March 2022. Samples size was 128 participants (64 cases and 64 controls) using a simple random technique. Data analysis used the Chi-square test and logistic regression. The results showed that the variables associated with the incidence of preeclampsia were maternal age (p=0.049), parity status (p=0.041), chronic hypertension (p=0.000), and BMI (p=0.003). Variables that were not related to the incidence of preeclampsia were previous history of preeclampsia (p=0.094), pregnancy interval (p=0.367), and family history of preeclampsia (p=0.154). The most dominant variable was chronic hypertension (OR 36.162; 95% CI 4.453-293.655). This study concludes that chronic hypertension, obesity, age at risk (<20 years or >35 years), and nullipara or primipara are risk factors for preeclampsia at Budhi Asih Hospital during the Covid-19 pandemic.

Determinants of pre-eclampsia among pregnant women attending antenatal care and delivery services at Bahir Dar public hospitals, northwest Ethiopia: A case-control study.

Pre-eclampsia (PE) is a pregnancy-related syndrome that occurs after 20 weeks of pregnancy. The current study was designed to evaluate the determinants of PE in pregnant women following antenatal and delivery services. An institution-based case-control study was performed in governmental hospitals of Bahir Dar city. The data were collected using an interview-administered questionnaire and analyzed by SPSS version 20 software. Bivariate and multivariable logistic regression models were utilized for the analysis of variables. A p < 0.05 was used to declare the level of significance. In this study, the mean ages (in years) of cases and controls were 28.20 ± 5.66 and 27.52 ± 4.70, respectively. Factors such as: being primiparous (adjusted odds ratio [AOR]: 3.19 at 95% confidence interval [CI]: 1.71, 5.97), family history of hypertension (HTN) (AOR: 4.14 at 95% CI: 1.71, 10.05), previous history of PE (AOR: 7.97 at 95% CI: 2.42, 26.63), number of antenatal care (ANC) visits (AOR: 5.43 at 95% CI: 2.86, 10.33), not taking iron and folic acid supplement (AOR: 4.46 at 95% CI: 1.59, 12.48), body mass index ≥25 kg/m2 (AOR: 3.47 at 95% CI: 1.78, 6.77), not consuming vegetables (AOR: 1.99 at 95% CI: 1.07, 3.69) and not consuming egg, milk and milk products (AOR: 3.00 at 95% CI: 1.47, 6.11) were the determinants of PE. In this study, different determinants of PE were identified. Hence, special attention should be given for primiparous women, women having previous history of PE and family history of HTN. Moreover, nutritional counseling should be given for pregnant women during ANC visits. Besides, higher officials should design an appropriate strategy to increase the number of mothers to complete their ANC visits and to take iron and folic acid supplements. Furthermore, to verify the determinants of PE, community-based cohort studies are warranted.

Severe Acute Respiratory Syndrome-Coronavirus-2 Antibody Status at the Time of Delivery and the Risk of Preeclampsia.

Our objective was to evaluate the association between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) serologic status in immunologically naive patients and the risk of preeclampsia at the time of delivery. We conducted a retrospective cohort study of pregnant patients admitted to our institution from August 1 to September 30, 2020. We recorded maternal medical and obstetric characteristics and SARS-CoV-2 serologic status. Our primary outcome was the incidence of preeclampsia. Antibody testing was performed, and patients were classified into seropositive groups: immunoglobulin (Ig)G + , IgM + , or both IgG+ and IgM + . Bivariate and multivariable analyses were performed. We included 275 patients that were negative for SARS-CoV-2 antibodies, and 165 that were positive. Seropositivity was not associated with higher rates of preeclampsia (p = 0.183) or with preeclampsia with severe features (p = 0.916) even after adjusting for maternal age >35, BMI ≥ 30, nulliparity, and previous history of preeclampsia, and type of serologic status. Previous preeclampsia had the greatest association with the development of preeclampsia (odds ratio [OR] = 13.40; 95% confidence interval [CI]: 4.98-36.09; p < 0.05) and with preeclampsia with severe features (OR = 5.46; 95% CI: 1.65-18.02; p < 0.05). We found that in an obstetric population, there was no association between SARS-CoV-2 antibody status and the risk of preeclampsia. · Pregnant people with acute COVID-19 are at an increased risk of developing preeclampsia.. · Seroconversion during pregnancy was not associated with an increased risk of preeclampsia.. · Further study regarding the timing of infection and its association with preeclampsia is necessary..

Maternal and fetal outputs in pregnant women with severe pre-eclampsy diagnosis

This study aims to evaluate maternal and perinatal outcomes among cases of planned and emergency cesarean section in PE with severe features. Retrospective cohort study with 202 women diagnosed with severe pre-eclampsia, with gestational age greater than 32 weeks. They were divided according to the mode of delivery: vaginal delivery, planned cesarean section and emergency cesarean section. Were analyzed the sociodemographic characteristics, obstetric history and clinical conditions at admission, post operatory maternal and perinatal outcomes and complications according to the type mode of delivery. A total 202 patients were included in the study, 78.7% of whom underwent planned cesarean section, 21.3% emergency cesarean sections and only 11.8% induced labor was performed and of the total. Only 2% of total progressed to vaginal delivery. Patients living in the interior (53.5%, P 0.040), primiparous (OR 1.4, P &lt;0.001), history of previous pre-eclampsia (OR 1.3, P = 0.020) and presence of signs of severity (OR 10.1, P &lt;0.001) had a higher risk of evolving to an emergency cesarean section. Postpartum hemorrhage was greater in the programmed cesarean section (OR 2.4, P 0.049). Regarding perinatal complications, the time of fetal hospitalization in days was longer in the programmed cesarean section (OR 6.7, P 0.035). These results demonstrate that there is a high rate of indication for cesarean sections (98%) in patients with severe preeclampsia. A high rate of cesarean section does not positively affect the indicators of maternal and neonatal morbidity and mortality. In addition, in women in whom delivery was induced, there was no increase in neonatal risks..

Combined maternal risk factors and the Quadruple test to predict late-onset preeclampsia in pregnant Thai women

BackgroundThis study aimed to evaluate the predictive power of a model combining maternal risk factors and the Quadruple screen test for late-onset preeclampsia (PE).MethodsAll pregnant women that received the Quadruple test for Down syndrome at 15+ 0-20+ 6 weeks’ gestation were recruited. Maternal serum α-fetoprotein, β-human chorionic gonadotropin, unconjugated estriol, and inhibin A were measured as multiples of the median. A logistic regression model was used to identify predictors associated with late-onset PE with severe features. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the model’s predictive ability.ResultsFifty-five of the 2,000 pregnant women had PE, and 31 of 55 women had late-onset PE. Multivariate analysis identified maternal age ≥ 35 years, inhibin A, history of previous PE, history of infertile, cardiac disease, chronic hypertension, and thyroid disease as significant risk factors. The area under the curve of the receiver operating characteristic curve was 0.78. The likelihood ratio to predict late-onset PE was 49.4 (total score > 60).ConclusionsOur model combining serum inhibin A with maternal risk factors was useful in predicting late-onset PE. Close monitoring of these patients is recommended.

The Effect of Factors Causes Preeclampsia Towards Left Ventricle Mass Index on Preeclampsia Patient in Undata Regional Hospital of Palu

Background: Preeclampsia is an idiopathic multisystem disorder specific to pregnancy and the puerperium in which multiorgan abnormalities occur in at-risk pregnancies resulting in hypertension and multiorgan dysfunction in the form of an increase in left ventricular mass index which leads to diastolic heart failure.&#x0D; Aim: Determine the relationship the effect of factors causes preeclampsia towards left ventricle mass index on preeclampsia patient in Undata Regional Hospital of Palu&#x0D; Methods: This study used a cross sectional research approach. These variables are measured by research instruments where data can be analyzed according to statistical procedures.&#x0D; Results: From total sample, there were pregnant women of abnormal age 37.67 years (27.3%) and normal age 28.12 years (72.7%) with a mean age of 30.73 ± 5.89 years with history preeclampsia. There were 21 patients (95.5%) with previous obesity and 1 patient (4.5%) had no history of obesity, 14 patients (63.6%) with a history of primigravida and 8 patients with multigravida (36.4%). One patient with multiple pregnancies (4.5%) and 21 patients (95.5% with no history of multiple pregnancies, 3 patients (13.64%) with chronic disease and 19 patients (86 .36%) no history of chronic disease, There are 16 patients (72.7%) patients who use contraception and while 6 patients (27,3%) did not use contraception. Statistical tests risk factors for preeclampsia associated with cardiovascular disease events, hypertension which causes an increase in the Left Ventricle Mass Index (LVMI) it can be seen that in all preeclampsia patients causes uncontrolled hypertension and increase in LVMI above normal values ​​(description according to table), the incidence of preeclampsia with a previous history of preeclampsia 1 (25%) showed a significant relationship with a value of p = 0.001.&#x0D; Conclusion: Factors that cause significant preeclampsia, pregnant women who have a history of preeclampsia and who have a history of multiple pregnancies affect the occurrence of hypertension and an increase in left ventricular mass index.

Spontaneous subcapsular hepatic hematoma in pregnant patients.

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.

Pregnancy-Induced Hypertension - Ayurvedic Understanding

Pregnancy-induced hypertensive disorders are included among the most common medical complications of pregnancy with an incidence of 5–10%. Hypertension that develops as a direct result of gravid state is referred to as ‘pregnancy-induced hypertension’. The timely management of pregnancy complicated with hypertensive disorders is significant, otherwise it can lead to adverse fetal, neonatal and maternal outcomes. The basic pathology in pre-eclampsia, one of the types of hypertensive disorders is endothelial dysfunction and intense vasospasm due to abnormal placentation compromising blood flow to the foetoplacental unit. There is no direct reference of pregnancy-induced hypertension in Ayurveda classics, but the manifested symptoms can be explained within the purview of Ayurveda. Abnormality in placentation can be considered as impairment in the normal functioning of Vata dosha and when the pathology progresses further; Kapha, Pitta also play their own roles. In a woman with or without a previous history of pre-eclampsia, intervention should begin from pre-conceptional period. Planned pregnancy after pre-conceptional care followed by Garbhini paricharya along with the use of Garbhasthapaka dravya, Rasayana dravya, Masanumasika Garbhasravahara dravya can play significant roles in the prevention as well as management of pregnancy-induced hypertension thus improving the maternal and foetal outcomes.

PS-C30-9: CHALLENGES IN MANAGING PERIPARTUM CARDIOMYOPATHY COMPLICATED WITH SEVERE PRE-ECLAMPSIA IN SUBURBAN AREA: A CASE REPORT

Background: Peripartum cardiomyopathy (PPCM) is a life-threatening condition, refers to rare dilated cardiomyopathy causing heart failure in late pregnancy or early postpartum woman. The diagnosis was based on pregnant/peripartum woman who had sudden cardiac decompensation without any history of cardiac disease. Pre-eclampsia (PE) could be co-existed with PPCM because of similar pathophysiology mechanism, which leads to higher mortality. Hereby we present the challenges of managing PPCM complicated with severe PE in suburban areas. Case Illustration: A 36-year-old woman referred to hospital with shortness of breath. Her past medical history was remarkable for severe-PE and had undergone caesarean section two-day-ago. Upon arrival, her saturation-75%, HR-120x/min, BP-140/80 and RR exceeds-40x/min. She was in respiratory distress with JVP increased, coarse crackles at basal lungs, and leg swelling. Laboratory studies were unremarkable. The x-ray revealed cardiomegaly and ECG showing LVH. Initial echocardiography demonstrated left ventricular systolic dysfunction with ejection fraction-34%. The patient was suggestive for PPCM with previous history of PE. Continuous administration of IV-furosemide-5 mg/h, spironolactone-25 mg, bisoprolol-2.5 mg, and candesartan-8 mg were administered. Her condition improved rapidly with increased saturation from 75% to 95% and significant reduced in dyspnoea. She was transferred to intensive cardiovascular unit for further management and discharged after 7-days for outpatient control. Discussion: PPCM is a devastated diagnosis among pregnancy woman. The diagnosis should be distinguish from PE induced heart failure. In PPCM, the echocardiography findings is related with left ventricular systolic dysfunction and reduced EF, whereas diastolic dysfunction with preserved EF is identified in PE induced heart failure patient. PE is associated with PPCM based on the shared pathophysiology. It is related with the angiogenic imbalance and excess expression of antiangiogenic factor sFlt1 soluble fms-like tyrosine kinase-1, which have found increased in both of the diseases. This is explained why PE has been recorded to occur in 30% of PPCM cases and it contributes to the increasing maternal mortality when most of the causes of maternal death are preventable.

Perceived impacts of pre-eclampsia and eclampsia on health of pregnant mothers being attended to at a general hospital in Southwest, Nigeria

The study focused on the Perceived impacts of pre-eclampsia and eclampsia on health of pregnant women attending Federal Teaching Hospital Ido-Ekiti, ekiti state. It assessed the knowledge of pregnant mothers on the impact of Pre-eclampsia and eclampsia on pregnancy, it also identified the factors responsible for prevalence of pre-eclampsia and eclampsia among pregnant mothers. Furthermore, it assesses the level of perception of pregnant mothers on pre-eclampsia and eclampsia. The relationship between level of education and knowledge of pre-eclampsia, and eclampsia as well as the relationship between level of education and perceived effect of eclampsia were assessed. A cross-sectional descriptive design was employed using a semi structured questionnaire to gather information from 100 women with at least one child. An accidental sampling procedure was employed, and data was collected using interviewer administered questionnaire. Analysis of data was done using appropriate descriptive and inferential statistical techniques. The results of the study revealed that about 47% of the respondents are of age 20 to 30 years while 46% are of age 31 to 40years and 7% are of age 41years and above. Also, 85% of the respondents were married while 15% were single. 80% of the respondents had tertiary education, 16% had secondary while 4% had primary education. All of the respondents were Christians. 52% of them were Primip, 11% had two children, 16% had 3chilldren while 8% had 4 and 13% had 5 children. 65% of the respondents had good knowledge of Pre-eclampsia and Eclampsia, while 35% had poor knowledge. 59% of the respondents submitted that Obesity is a factor influencing the prevalence of Pre-eclampsia and eclampsia. More than 50% of the respondents chose each of Chronic hypertension, previous history of pre-eclampsia as influencing factor. However, 65% of the respondents disagreed that Physical exercise during pregnancy is a factor. Also, 64% submitted they do not know if Having sex during pregnancy can be a factor influencing the prevalence of Pre-eclampsia and eclampsia. 31% of the respondents had good perception of effect of Pre-eclampsia and Eclampsia on mothers, while 69% had poor perception. 64% of the respondents had good perception of effect of Pre-eclampsia and Eclampsia on babies, while 36% had poor perception. there is no significant relationship between level of education and knowledge of pre-eclampsia and eclampsia as chi square is greater than 0.05. There is no significant relationship between level of education and perception of pregnant mothers on effect of Pre-eclampsia and Eclampsia on mothers as chi square is greater than 0.05. there is no significant relationship between level of education and perception of pregnant mothers on effect of Pre-eclampsia and Eclampsia on babies as chi square is greater than 0.05.

Prevalence, maternal characteristics, and birth outcomes of preeclampsia: A cross-sectional study in a single tertiary healthcare center in greater Kuala Lumpur Malaysia.

Preeclampsia is associated with an increased risk of adverse maternal and perinatal outcomes. This study aimed to assess preeclampsia prevalence in a Malaysian referral maternity hospital and the association between preeclampsia and maternal characteristics and outcomes. A cross-sectional study was conducted between January 2010 and December 2020 using secondary data from a single tertiary healthcare center in Greater Kuala Lumpur, Malaysia. A total of 40,212 deliveries were included for analysis to investigate the association between conditions (maternal characteristics and adverse birth outcomes) and preeclampsia. Multivariable logistic regression was conducted to assess the association between multiple independent variables and the outcome variable (preeclampsia). The reported prevalence of preeclampsia was 1.6%. Pregnant women with preeclampsia had a higher risk of preterm delivery (67.7%), instrumental and cesarean delivery (74.7%), neonatal low birth weight (48.5%), neonatal 5-min Apgar score <7 (18.1%), and neonatal intensive care unit (NICU) admission (19.8%). There were significantly higher odds of developing preeclampsia among nullipara [adjusted odd ratio (adjOR) 1.792, 95% CI: 1.518-2.115], women with a previous history of preeclampsia (adjOR 5.345, 95% CI: 2.670-10.698) and women with multiple pregnancies (adjOR 1.658, 95% CI: 1.071-2.566). However, there is a significant association between maternal characteristic variables. There was a significant association when a combination of variables for risk assessment: the presence of anemia and gestational hypertension effect on preeclampsia (OR 26.344, 95% CI: 9.775-70.993, p < 0.002) and gestational hypertension without anemia on preeclampsia (OR 3.084, 95% CI: 2.240-4.245, p < 0.001). Similarly, an association was seen between chronic hypertension and younger age (<35 years old) on preeclampsia (OR 14.490, 95% CI: 9.988-21.021, p < 0.001), and having chronic hypertension with advanced maternal age (≥35 years old) on preeclampsia (OR 5.174, 95% CI: 3.267-8.195, p < 0.001). Both conditions had increased odds of preeclampsia, in varying magnitudes. Overall, the significant interaction effects suggest that a history of chronic or gestational hypertension has a different relationship to the incidence of preeclampsia depending on the maternal age and anemia status. Pregnant women with preeclampsia had significantly higher odds for preterm delivery (adjOR 6.214, 95% CI: 5.244-7.364), instrumental and cesarean delivery (adjOR 4.320, 95% CI: 3.587-5.202), neonatal low birth weight (adjOR 7.873, 95% CI: 6.687-9.271), 5-min Apgar score <7 (adjOR 3.158, 95% CI: 2.130-4.683), and NICU admission (adjOR 8.778, 95% CI: 7.115-10.830). Nulliparity, previous history of preeclampsia, and multiple pregnancies were associated with an increased risk of preeclampsia. The presence of different underlying conditions, such as chronic hypertension, anemia, and extremes of maternal age played an important role in increasing preeclampsia risk in the considered study. Larger samples are needed to validate such findings.

Use of Prophylactic Aspirin in patients with previous history of Pre-eclampsia

Background: Aspirin is considered a safe and secure prophylactic or preventative agent for the treatment of preeclampsia patients. Pre- eclampsia is developed in pregnant women which cause complications in their pregnancy due to high blood pressure and damage to other body organs. The incidence of Pre-eclampsia is 2-8% of pregnancies, but has a higher risk of about 10% in those females suffering from hypertension or autoimmune diseases. Aim: To know how effectively aspirin is used in preventing the pre-eclampsia in pregnant women who have had the previous history of preeclampsia. Methodology: A randomized controlled trial of aspirin and placebo was conducted. The women enrolled in this study have a gestational period of 6 to 32 weeks. All the women were administrated with 80 mg of placebo or aspirin daily. All the continuous and categorial variables were analyzed statistically and the results were presented as mean±S.D. and frequency(%) for these variables, respectively. Results: All the data was gathered from 260 women who were enrolled in this study. It showed that the occurrence of pre-eclampsia was higher in the placebo group as compared to aspirin group (4.1% vs. 1.6%, p=0004). However, in every risk group, the effects of placebo and aspirin were the same for women with hypertension, the incidence was 13.4% in aspirin and 15.7% in placebo and for women with diabetes, the incidence was 6.7% in aspirin and 6.6% in placebo; but for women with previous history of pre-eclampsia, the incidence was 1.6% in aspirin and 4.1% in placebo which was significantly different. Further, the incidence of pre-eclampsia with primary and secondary outcomes in aspirin and placebo were the same. Conclusion: Our research finding reveals that a low dose of aspirin had a considerable therapeutic effect in preventing pre-eclampsia in high-risk pregnant women. Keywords: Pre-eclampsia, aspirin, preventive agent

FAKTOR RESIKO PREEKLAMSIA PADA IBU HAMIL: LITERATURE REVIEW

Background: The maternal mortality rate in Indonesia in 2020 reached 462 per 100,000 live births. Preeclampsia is some specific symptoms that only appear during pregnancy at 20 weeks of gestation (except for trophoblastic problems), these symptoms include hypertension accompanied by the presence of protein in the urine. The impact of preeclampsia on pregnant women can cause a decrease in consciousness, if preeclampsia is severe it can be accompanied by seizures. The purpose of this study is to determine the risk factors that influence the occurrence of preeclampsia. Subjects and Methods: This was a literature reviews study. The articles used were obtained from PubMed, and Google Scholar. Several passwords were used: "pregnant women" OR "mothers in labor" AND preeclampsia OR eclampsia OR eclampsia AND "risk factors" OR "risk factors" This method aims to increase understanding of the topics discussed by summarizing the topics to be discussed. This method provides insight into new facts/analyses as well as a literature review providing a summary of good and relevant publications that are further compared with the results that have been presented in the article. Results: of 11 articles that met the inclusion and exclusion criteria, 8 articles with a case-control study design, 2 cross-sectional articles, and 1 retrospective cohort study article. Conclusion: Risk triggers that have a relationship with the incidence of preeclampsia include the age of pregnant women at risk for nulliparity, primigravida, economic factors, previous history of preeclampsia, parity, level, education, use of ANC, gestational period, BMI before pregnancy, history of abortion, history of hormonal contraceptive use, Heredity, Multiple pregnancies, Medical history (chronic hypertension, diabetes, kidney disease, and obesity), Hypertension, Diabetes, Obesity

Prevalence and Risk Factors Associated With Gestational Diabetes Mellitus Among Pregnant Women: A Cross-Sectional Study in Ghana.

Gestational diabetes mellitus (GDM) is a global public health issue that have serious consequences on mother and her child's health. However, limited data is available on the prevalence of GDM and its associated risk factors in Ghana. This study investigated the prevalence and associated risk factors of GDM among women attending selected antenatal clinics in Kumasi, Ghana. This cross-sectional study included 200 pregnant women who attended antenatal clinics from Three-selected health facilities in the Ashanti Region, Ghana. Women already diagnosed of GDM were identified through their medical records and were confirmed based on the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), which uses a fasting blood glucose of ≥ 5.1 mmol/L. A well-structured questionnaire was used to collect data on socio-demographic, obstetric, clinical and lifestyle risk factors. Multivariate logistic regression models were used to determine the independent risk factors of GDM. The overall prevalence of GDM among study participants was 8.5%. GDM was prevalent among age 26 and 30 years (41.2%), married participants (94.1%) with basic education (41.2%) and being Akan by ethnicity (52.9%). Previous history of oral contraceptive use (aOR: 13.05; 95% CI: 1.43-119.23, p=0.023), previous history of preeclampsia (aOR: 19.30; 95% CI: 2.15-71.63; p=0.013) and intake of soda drinks (aOR: 10.05, 95% CI: 1.19-84.73, p=0.034) were found to be independent risk factors of GDM. The prevalence of GDM was found to be 8.5% and this was associated with the previous use of oral contraceptives, history of preeclampsia and intake of soda drinks. Public health education and dietary lifestyle modification may be required for pregnant women who are at risk of GDM.

Risk factors of preeclampsia among pregnant women admitted at labor ward of public hospitals, low income country of Ethiopia; case control study.

Preeclampsia is a pregnancy-specific, multisystem disorder of unknown etiology, which characterized by new onset of high blood pressure & proteinuria after 20weeks of gestation. Globally, it contributes 76,000 maternal deaths, 500,000 infant deaths annually, and the second common cause of maternal deaths. In Ethiopia, 19% of maternal deaths result from hypertensive disorder of Pregnancy. To assess the risk factors of preeclampsia among pregnant women admitted in labor ward of Public hospitals, Amhara Region Ethiopia, METHODS: A facility based unmatched case-control study design was conducted in two public hospitals of North Wollo Zone. Cases were pregnant women, who had confirmed diagnosis of preeclampsia, controls were those who had no evidence of preeclampsia, and 65 cases and 195 controls were selected by convenience and systematic random sampling techniques respectively. The collected data was interred in to in EPI INFO version 7.1, transferred, and analyzed using SPSS version 20.00 statistical software. Multivariate logistic regression was used to identify independent variables. Factors with P-value<0.05 were taken as statistically significant of pre-eclampsia among pregnant women. All of the respondents of cases and controls were participated in the study. Factors associated with preeclampsia were respondents who had read and write (AOR=3.22, 95% CI: (1.05-9.84)) and attended primary school [AOR=7.02, 95% CI: (1.57-31.45)]. Those pregnant women, who had at least two ANC visit [AOR=8.69, 95%CI: (1.43-52.85)] and those who had three visit [AOR=12.59, 95%CI: (3.06-56.05)]. In addition to these, birth Interval less than 24month [AOR=4.09, 95% CI: (1.33-12.61)]. Birth Interval 24-35month [AOR=2.53, 95% CI: (1.38-11.87], respondents with family history of HPN (AOR=5.93, 95%CI: (2.39-14.67), family history of DM [AOR=2.15, 95%CI: (1.12-6.98)], and respondents with previous history of preeclampsia (AOR=4.14 95%CI: (1.66-10.33) were identified significant factors of preeclampsia among pregnant women attended in labour ward. Educational status, antenatal care, lower birth interval, having family history of chronic HPN and DM, and history of preeclampsia were identified as major risk factors for occurrence of preeclampsia. Early detection of cases and intensive screening of pregnant women in every visit should be done and large-scale study will be done to identify other risk factors of preeclampsia.

Determinants of preeclampsia among mothers attending perinatal care in Gurage zone public hospitals, Ethiopia, matched case control study

BackgroundPreeclampsia is the commonest and most serious type of hypertensive disorder during pregnancy. It is the cause of 10% – 15% of maternal death worldwide. Though maternal mortality in Ethiopia is decreasing, deaths related to pregnancy-induced hypertension is increasing. Identifying the factors associated with preeclampsia helps reduce the incidence of the disease and its adverse outcomes. Therefore, this study aims to assess determinants of preeclampsia among mothers attending perinatal care in Gurage zone public hospitals, Ethiopia, 2020. MethodInstitution-based matched case-control study design was used to assess determinants of preeclampsia among 426 mothers, 142 cases, and 284 controls. The study was conducted in three public hospitals in Gurage Zone. Cases were preeclamptic mothers and Controls were non-preeclamptic mothers. EPI INFO was used to enter the data and then SPSS was used to analyze the data. Bivariate and multivariate logistic regression was used. ResultSignificantly associated factors on multivariate analysis in this study are nulliparity with AOR 3.81; 95% CI (1.55,9.34); multiplicity of pregnancy AOR 3.62; 95%CI (1.08,12.13) having preeclampsia history AOR 10.11; 95%CI (4.06, 25.21); parents history of hypertension had AOR 2.95; 95%CI; (1.11,7.68); and drinking alcohol AOR 4.42; 95%CI (2.15,9.08) ConclusionIn this study determinants’ of preeclampsia are nulliparity, multiplicity of pregnancy, previous history of preeclampsia, family history of hypertension, and alcohol consumption. Providing health education about risk factors of preeclampsia, early initiation, and increased frequency of antenatal follow-up will help early identification of these risk factors, diagnosis of preeclampsia, and preventing its complications.

Acute kidney injury secondary to obstetric complications in the third trimester of pregnancy and the puerperium

Background Acute kidney injury (AKI) in pregnancy is still a frequent health problem in developing countries. The aim of our study is to assess the prevalence and outcome of AKI secondary to obstetric complications during the third trimester of pregnancy and the puerperiumPatients and methods A retrospective study conducted on 80 patients presented with AKI secondary to obstetric complications during the third trimester of pregnancy and the puerperium. All patients were recruited from the National Institute of Nephrology and Urology in Cairo during the period from June 2014 to June 2016. Data was collected from the unit database and patient medical charts including patient’s history and examination findings during admission, laboratory parameters on admission including complete blood count and routine chemistry, hospital course, treatment received including renal replacement therapy and maternal and fetal outcomes.Results Our observational study included 80 patients presented with AKI during late pregnancy and the puerperium. Mean maternal age was 32±6 years and mean gestational age at presentation was 27±9 weeks. Mean serum creatinine was 7.7±2.4 mg/dl. Most of the patients who developed AKI did not receive antenatal care 67.5% (n=54). Also, more than half of the patients had a previous history of preeclampsia 52.5% (n=42). The median duration of hospital stay was 13 (6–51 interquartile range) days. Five (6%) patients underwent renal biopsy; 55 (69%) patients received hemodialysis as a renal replacement therapy while five patients received plasma exchange. The main etiology of AKI in our study was ischemic acute tubular necrosis 50% (n=40). Five (8%) patients developed chronic kidney disease and three patients (4%) progressed to end-stage renal disease. Maternal mortality was 4% (n=3) and fetal mortality was 74% (59 fetus).Conclusion AKI in late pregnancy and puerperium still presents as a health problem in developing countries. Most patients with AKI had a history of preeclampsia. Also, most of them had not received proper antenatal care. Improvement of the antenatal care is crucial for early detection and prevention of such problems.