Severe Eclampsia Research Articles

SULPROSTONE FOR PREGNANCY TERMINATION IN WOMEN WITH SEVERE (PRE-) ECLAMPSIA

Condensation: Sulprostone, used in a continuous low-dose intravenously, is effective for pregnancy termination. Caution is necessary when using this drug in severely preeclamptic patients. Objective: To evaluate the safety and efficacy of induction of labor with a prostaglandin analogue in women with severe (pre-) eclampsia. Study Design: A retrospective analysis of a 12-year cohort in which labor was induced in women with severe (pre-) eclampsia with sulprostone (a prostaglandin E2 analogue) in a continuous intravenous low-dose intravenous dose of 1 μg/min. Results: In 30 severely preeclamptic and one eclamptic women, labor was induced on maternal indication with sulprostone. The median gestational age at induction was 28 weeks (range 16–37 weeks). The fetuses were either dead (n=19) or considered not viable (n=12). All women delivered vaginally after a median induction–expulsion interval of 14 hr (range 6–57 hr). In all but one woman, a delivery was achieved within 37 hr. Two of the nine women who suffered dyspnea at the time induction was started, experienced deterioration during infusion of sulprostone. In one of these women, infusion had to be discontinued after 2 hr and the pregnancy was terminated by dilatation and evacuation. One woman gave birth after 57 hr of sulprostone infusion. We did not observe any cardiovascular complications. All but one woman recovered after pregnancy termination: a severely eclamptic woman died 10 days after delivery, after developing adult respiratory distress syndrome, sepsis and multiple organ failure. Conclusion: Sulprostone, in a continuous low-dose intravenously, is effective for termination of pregnancy in the critically ill preeclamptic woman. Our study, including two patients with serious deterioration of pulmonary function during and one maternal death after induction, does not permit definitive conclusions regarding the safety in these patients.

The first micturition times of the newborns whose mothers were treated with magnesium sulfate.

The aim of this study was to determine whether magnesium sulfate used for the treatment of severe pre-eclampsia or eclampsia had an effect on the first micturition time of the newborn. The first group included 20 newborns all of whose mothers had severe pre-eclampsia or eclampsia, and all mothers had been treated with magnesium sulfate according to the Parkland Memorial Hospital eclampsia regimen. The second group included 20 newborns all of whose mothers were normal pregnants, and did not receive any drug that had an effect on the contractility of smooth muscles. The first micturition times of all newborns in two groups were determined following delivery and were compared statistically. All newborns urinated in the first 24 hours. There were no statistically significant differences in the micturition times between the two groups (p > 0.05). There was no residual urine after the first micturition, and none of them had any urinary tract abnormality and neurological pathology. From the results, it was concluded that magnesium sulfate had no effect on the first micturition time of the newborns, when applied according to the Parkland Memorial Hospital eclampsia regimen in severe pre-eclamptic or eclamptic pregnants.

▪ The Safety and Utility of Pulmonary Artery Catheterization in Severe Preeclampsia and Eclampsia

▪ The Safety and Utility of Pulmonary Artery Catheterization in Severe Preeclampsia and Eclampsia

Caesarean morbidity and mortality at Maiduguri, Nigeria

A total of 2456 deliveries took place at the University of Maiduguri Teaching Hospital, Maiduguri, between January 1995 and December 1996 inclusive. Two hundred and five women were delivered by caesarean giving a caesarean section rate of 8.3%. One hundred and ninety-eight (96.6%) case records were retrieved for analysis. Eighty-eight patients (44.4%) had one or more intra- and/or postoperative complications. Sepsis was the commonest complication involving 62 (70.4%) women. All were cases of emergency caesarean section. The incidence of other complications were anaemia, 59 (67%); hemorrhage, 38 (43.2%); and wound dehiscence, 11 (12.5%). There were two maternal deaths (2.3%) due to an anaesthetic accident and septicaemia respectively. The factors resulting in complications of the caesarean deliveries were prolonged obstructed labour, prolonged rupture of fetal membranes, previous caesarean sections, antepartum haemorrhage and severe pre-eclampsia and eclampsia. A review of the use of prophylactic antibiotics in selected cases, early recourse to operation in cases with cephalo-pelvic disproportion, and the acquisition of trained anaesthetists are advocated.

Magnesium and cardiovascular disease.

Magnesium and cardiovascular disease.

Vorübergehende psychogene Amaurose im Rahmen eines postpartalen HELLP-Syndroms

Visual disturbances of physical origin are not uncommon during the course of severe preeclampsia or eclampsia. We report on a case of temporary psychogenic blindness in a patient with postpartum HELLP syndrome.

Lipid peroxidation in eclampsia

In order to investigate the extent of lipid peroxidation in hypertensive disorders of pregnancy, a case-control study was designed. Eight eclamptic women were matched with women with severe pre-eclampsia (n = 8) and healthy pregnant controls (n = 8). Lipid peroxidation was measured by the malondialdehyde thiobarbituric acid reactive assay (MDA-TBAR) and expressed as nmol/ml. Both severe pre-eclampsia and eclampsia groups had significantly higher MDA-TBAR levels than healthy pregnant women. Eclamptic women before delivery had highest MDA-TBAR levels which decreased after delivery.

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.

A Case of Postpartum Thrombotic Thrombocytopenic Purpura (TTP) with Exacerbations due to Severe Infection

A case of thrombotic thrombocytopenic purpura (TTP) is reported. The patient (32yrs) underwent cesarean section because of severe eclampsia, then developed TTP in the postpartum period. She was treated aggressively with plasma exchange, antiplatelet agents, anticoagulants and steroids. Her platelet count recovered after the second plasma exchange and her condition was well managed for about 10 days. However, TTP became worse on the 21st postoperative day due to infection. Despite further treatment, including plasma exchange, the patient died on the 29th postoperative day.Nine cases of TTP in pregnancy and the postpartum period from the past 10 years are also reviewed.

Phenytoin Prophylaxis in Severe Pre-eclampsia and Eclampsia

Phenytoin Prophylaxis in Severe Pre-eclampsia and Eclampsia

The efficacy of phenytoin in relation to serum levels in severe pre‐eclampsia and eclampsia

Objectives To investigate the efficacy of phenytoin in relation to total and free serum levels in patients with severe pre-eclampsia and eclampsia. Design Prospective descriptive study. Setting Labour Ward, King Edward VIII Hospital, Durban, South Africa. Tertiary referral centre serving an underprivileged community. Subjects Eleven patients admitted with a hypertensive crisis. Four patients had eclampsia and 7 had impending eclampsia. Main outcome measures Free and total phenytoin levels; efficacy of phenytoin as an anticonvulsant and side-effects of therapy. Results Although total phenytoin levels were within the therapeutic range, free phenytoin levels were abnormally high in all patients. Three patients (2 with eclampsia and 1 with imminent eclampsia) each had a seizure after phenytoin treatment had been initiated. Conclusion Neither total nor free phenytoin levels were good predictors of seizure control. It is postulated that the poor performance of phenytoin as an anticonvulsant in severe eclampsia may relate to inadequate distribution of the drug to the brain as a result of cerebral oedema and poor cerebral perfusion rather than paradoxical seizure activity associated with high free phenytoin levels.

The efficacy of phenytoin in relation to serum levels in severe pre-eclampsia and eclampsia.

To investigate the efficacy of phenytoin in relation to total and free serum levels in patients with severe pre-eclampsia and eclampsia. Prospective descriptive study. Labour Ward, King Edward VIII Hospital, Durban, South Africa. Tertiary referral centre serving an underprivileged community. Eleven patients admitted with a hypertensive crisis. Four patients had eclampsia and 7 had impending eclampsia. Free and total phenytoin levels; efficacy of phenytoin as an anticonvulsant and side-effects of therapy. Although total phenytoin levels were within the therapeutic range, free phenytoin levels were abnormally high in all patients. Three patients (2 with eclampsia and 1 with imminent eclampsia) each had a seizure after phenytoin treatment had been initiated. Neither total nor free phenytoin levels were good predictors of seizure control. It is postulated that the poor performance of phenytoin as an anticonvulsant in severe eclampsia may relate to inadequate distribution of the drug to the brain as a result of cerebral oedema and poor cerebral perfusion rather than paradoxical seizure activity associated with high free phenytoin levels.

Neurologic Involvement in Hypertensive Disease of Pregnancy

Neurologic manifestations of pregnancy-induced hypertension (PIH) vary from diffuse symptoms such as headache and confusion to focal signs such as paralysis and visual loss. Recognition of the neurologic symptoms associated with PIH is essential for early diagnosis of severe preeclampsia and eclampsia. The recent advances in neuroradiologic imaging, including the use of computed tomography (CT) scans and magnetic resonance imaging (MRI), have greatly enhanced our understanding of the correlation between neurologic complaints and neuroanatomic pathological changes characteristic of preeclampsia and eclampsia. The aim of this review is to summarize the current knowledge on the pathophysiologic changes in the central nervous system (CNS) caused by PIH. The diagnostic possibilities offered by new imaging techniques are emphasized.

A study of serum magnesium in pre-eclampsia and eclampsia

In animals neuromuscular disorders have been reported due to magnesium deficiency. Severe pre-eclampsia and eclampsia are associated with convulsions. Therefore, we estimated serum magnesium levels in 30 patients with pre-eclampsia and fifteen patients of eclampsia. Statistically significant fall in serum magnesium has been observed in preeclampsia and eclampsia.

Feto‐pelvic disproportion of mimicking placental abruption

An unbooked patient presented with severe eclampsia and sudden onset of abdominal pain, uterine tenderness and fresh vaginal bleeding. Unsuspected macrosomia and multiple congenital fetal malformation were discovered at delivery and a neonate weighing 7.545 kg was delivered. The infant died shortly afterwards.

Eclampsia

Early detection and hospitalization in women with mild preeclampsia may prevent eclampsia. In the event of severe preeclampsia or eclampsia, delivery is indicated for the benefit of both mother and fetus. Thereafter, pathologic changes of preeclampsia and eclampsia, including major multiple organ system dysfunction, undergo complete reversal.

Clinical experience with phenytoin prophylaxis in severe preeclampsia

In North America, magnesium sulfate is the traditional treatment for severe preeclampsia and eclampsia. Its use has been strongly criticized, in that it acts peripherally with no central effect and maternal and neonatal complications are well known. Phenytoin, the mechanism of action of which is clear, seems a logical alternative. Our aim was to develop a safe, practical, effective regimen with the use of phenytoin. In this prospective, descriptive study four dosage regimens were investigated in 104 patients. The initial regimens produced unexpected and unacceptable side effects in comparison with the nonpregnant population. The final regimen (15 mg/kg intravenously, given as 10 mg/kg initially then 5 mg/kg 2 hours later) provided therapeutic levels and had minimal maternal and perinatal side effects. No seizures occurred after its correct usage. This regimen is simple, safe, effective, and provides ongoing anticonvulsant coverage in the postpartum period. We suggest that phenytoin may represent a suitable alternative anticonvulsant in this condition.

Phenytoin shows promise in severe pre-eclampsia and eclampsia

Phenytoin shows promise in severe pre-eclampsia and eclampsia

Severe Preeclampsia with Persistent Oliguria

Nine patients with severe preeclampsia or eclampsia complicated by persistent oliguria failed to respond to fluid challenge and underwent pulmonary artery catheterization to guide further fluid and hemodynamic management. Three hemodynamic subsets of patients were defined. Patients in category I had low pulmonary capillary wedge pressure, hyperdynamic ventricular function, and moderate elevation of systemic vascular resistance. These patients responded to volume infusion with a decline in systemic vascular resistance, a rise in wedge pressure and cardiac output, resolution of oliguria, and no change in blood pressure. Patients in category II had normal or elevated pulmonary capillary wedge pressure and cardiac output and normal systemic vascular resistance; they responded to pharmacologic preload and/or afterload reduction. A single patient (category III) exhibited markedly elevated wedge pressure and systemic vascular resistance and depressed ventricular function. Oliguria in this patient responded to volume restriction and aggressive afterload reduction. Hemodynamic observations in patients in category II imply the presence of selective vasodilator responsive renal arteriospasm in some preeclamptic patients with oliguria.

12. Maternal mortality

Summary. There were 238 maternal deaths. Five deaths occurred after delivery among booked women who had no antenatal complications (0.4 deaths per 1000 deliveries); 14 deaths were among booked women who developed complications during pregnancy (3.7 per 1000); and 219 deaths were in the emergency admissions (28.6 per 1000). Bacterial infections, eclampsia, anaemia, haemorrhage and disproportion together with its consequences, were the leading causes. The principal high‐risk factors were lack of antenatal care, early teenage pregnancy, high parity and high child mortality rate from previous births. In the emergency admissions the operative delivery rate was 25% in the women who survived and 49% in those who died. In severe eclampsia and in neglected obstructed labour, a high haematocrit (≥0.45) and, to a lesser extent, a low haematocrit (≥0.14) were of ominous significance, mortality rate being 25–60% in such cases compared with <10% in most other obstetric complications. Measures to reduce maternal mortality should aim to lower the proportion of high‐risk women (40% at present) and also make it possible for operative deliveries, especially caesarean section, to be performed as soon as the need arises.