Severe Pre-eclamptic Toxaemia Research Articles

The Efficacy of the Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients

Background: In Bangladesh, severe preeclamptic toxemia and eclampsia are life-threatening conditions in pregnancy that are the leading cause of perinatal maternal and neonatal mortality and morbidity. Objective: in this study our main aim is to evaluate the efficacy of the Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients. Method: This cross sectional study was carried out at tertiary medical hospital from January 2021 to January 2022. Total 200 cases of severe PET (n=110) and eclampsia (n=100) patients were selected by subarachnoid block for emergency LUCS. Each patient was given magsulph as prophylactic or maintenance dose and judiciously preloaded by crystalloid fluid. Results: Most of the patients belong to 31-40 years age group, 52% and 95.8% cases were multigravida. In severe PET group, intraoperative hypotension was observed in 32% cases and postoperative period hypotension was observed in 8% cases. Whereas preeclampsia group, intraoperative hypotension was observed in 31% cases and postoperative period hypotension was observed in 9% cases. In addition,maternal morbidity where acute renal failure seen in 5%, syndrome 7%, DIC 7%, abruptio placentae 12%, pulmonary edema 4%, septicemia 13%, PPH 10% and postpartum eclampsia 15%.In severe PET group, 21% cases transferred to eclampsia ward, followed by 9% shifted to ICU, 1% case was expired. Whereas, in preeclampsia group 20% cases transferred to eclampsia ward, followed by 8% shifted to ICU, 2% case was expired. In eclamptic group 7% cases were transferred to NCU, whereas 8% had PET. Neonatal mortality was observed in 3% cases. p value was found 0.000 which is very highly significant. Conclusion: With close monitoring of perioperative events, spinal anesthesia may be used as a safe alternative technique to GA or epidural in severe preeclampsia and eclampsia, even in cases of altered consciousness or restlessness in the presence of an expert and skilled anesthesiologist, reducing perioperative maternal and neonatal morbidity and mortality

Vitamin D Status and Pregnancy Complications: Serum 1,25-di-hydroxyl-Vitamin D and its Ratio to 25-hydroxy-Vitamin D are Superior Biomarkers than 25-hydroxy-Vitamin D.

Vitamin D (VitD) deficiency during pregnancy has been associated with adverse neonatal outcomes and increased risk of late pregnancy complications. We planned to correlate serum VitD biomarkers; 25-hydroxyvitamin D (25-OH-VitD) and 1,25-dihydroxyvitamin D (1,25-diOH-VitD) levels; and their ratio with the frequency of feto-maternal pregnancy complications. A prospective cross-sectional case-control study was conducted at Aljouf Maternity and Children Hospital, Sakaka, Saudi Arabia, during the period of September 1, 2017 to September 30, 2019. 322 pregnant women were stratified into 2 groups: controls (110 cases) and complicated group (212 cases). The later comprised severe preeclamptic toxemia associated with intrauterine growth restriction (58 cases), gestational diabetes mellitus (GDM; 82 cases), abortion (26 cases), undisturbed ectopic pregnancy (16 cases), premature rupture of membranes (PROM; 14 cases), and, inevitable preterm labour (16 cases). After clinical assessment, peripheral blood samples were collected. Serum biomarkers were measured using specific immunoassays. The direct 1,25-diOH-VitD/25-OH-VitD ratio was calculated. Serum 25-OH-VitD indicated widely spreading VitD deficiency among participants with significantly higher levels in controls vs. GDM subgroup only. 1,25-diOH-VitD levels and the ratio were markedly reduced in the six complicated subgroups vs. controls, with non-significant differences amongst the complicated subgroups. ROC analysis showed very high sensitivity and specificity, to differentiate patients from controls, only for 1,25-diOH-VitD (AUC = 0.965; 0.947 - 0.983, p <0.001) followed by the ratio but not 25-OH-VitD. In conclusions, 25-OH-VitD did not show significant changes except for GDM. 1,25-diOH-VitD levels and the ratio showed strong associations with pregnancy complications. Serum 1,25-di-OH-VitD and its ratio to 25-OH-VitD are more reliable and physiologically relevant biomarkers for VitD status in pregnancy.

Serum Cystatin C Level for Evaluation of Renal Functions in Women with Severe Preeclamptic Toxemia

Abstract Background: Preeclampsia is a complex and serious multisystem disorder of pregnancy with a worldwide incidence of 5-7% and contributes significantly to maternal and perinatal morbidity and mortality. Altered renal function is an essential component of the pathophysiological process in PE, so close monitoring of renal function is important to ensure a timely delivery before serious renal damage occurs. Aim of the Work: To evaluate diagnostic value of cystatin C serum levels as an alternative marker of renal function in women with severe preeclamptic toxemia versus matching cases of normal pregnancy and compare it with the traditional markers of renal function, Creatinine, urea and serum uric acid. Patients and Methods: A case-control study includes 80 Primigravidae with singleton pregnancy and gestation ≥28 weeks and were divided into two groups, Group 1: (40 patients) with severe preeclampsia and Group 2: (40 patients) as a control group (normotensive and nonproteinuric). Markers of kidney function were investigated in two groups of pregnant women and comparison between both groups as regards to cystatin C serum levels, creatinine, blood urea and serum uric acid was done. Results: The difference in the mean serum uric acid level (5.10±0.96 versus 4.70±0.63mg/dl) was significantly higher in preeclampsia (p=0.027), the specificity was 100% and sensitivity of the test was 87.5%, the difference in the mean serum concentration of creatinine (0.94±0.16 versus 0.86± 0.12mg/dl) was significantly higher in preeclampsia (p=0.028), the specificity of the test was 100% and the sensitivity was 82.5%. Serum cystatin C level has a mean (1.26±0.21 versus 0.75±0.05mg/l) which was significantly higher in preeclampsia (p=0.001) with a specificity 100% and sensitivity 96%. Conclusion: It is concluded that among serum creatinine, blood urea, serum uric acid & serum cystatin C, Serum cystatin C is the earliest & a better marker of renal dysfunction in preeclampsia.

The Fibrinogen / CRP Ratio as a New Parameter for the Prediction of Disseminated Intravascular Coagulation in Patients with HELLP Syndrome

Background: The syndrome of Hemolysis, elevated Liver enzymes, and Low Platelet count (HELLP) is a life-threatening variant of preeclampsia, and may be accompanied by disseminated intravascular coagulation (DIC). Recently the fibrinogen/C-reactive protein (CRP) ratio has been suggested as a measurement that predicts onset of DIC. The authors sought to analyze the fibrinogen/CRP ratio among obstetric patients who developed DIC due to HELLP syndrome. Aim: the aim of this study is to determine if the fibrinogen/C-reactive protein (CRP) ratio could be used as a predictor for disseminated intravascular coagulation in obstetrics patients with the HELLP syndrome. Patients and Methods: this study was conducted as a prospective observational study at Ain Shams Maternity Hospital from November 2014 to November 2016 .The study included Patients diagnosed to have Severe Pre Eclamptic Toxemia SPET according to ACOG (2013).Patients was diagnosed with the HELLP syndrome according to the Martin classification of HELLP syndrome. Results: the results of our study suggest that replacing the use of fibrinogen levels alone with the fibrinogen/CRP ratio would enhance the diagnostic and prognostic power for DIC in patients with HELLP syndrome. Conclusion: in light of the physiologic changes of the coagulation cascade during gestation, the International Society on Thrombosis and Hemostasis ISTH score could not be implemented in pregnant women alone for the diagnosis and prediction of DIC. Recommendations: further evaluation of the fibrinogen/ CRP ratio is required to determine the generalizability of this marker’s use in DIC because of causes such as placental abruption, septic abortion, and failed abortion. Furthermore, prospective studies should be performed to determine the best method to predict if there any new method to predict DIC in patients with the HEELP syndrome.

The application of serum cystatin C in estimating the renal function in women with severe preeclamptic toxemia

Abstract Introduction Preeclampsia is a medical condition where hypertension arises in association with significant amount of proteinuria. It appears likely that there are substances from the placenta that can cause endothelial dysfunction in the maternal blood vessels of susceptible women. Preeclampsia usually develops from 20 weeks and it is the most common of the dangerous pregnancy complications; it may affect both the mother and the fetus so the ability to predict the appearance of preeclampsia later in pregnancy would be of great value, although the only known treatment for eclampsia or advancing preeclampsia is delivery. Early prediction of the complication will allow close monitoring and early intervention. Aim The present study aimed at evaluating the role of cystatin C in the evaluation of renal function in the severe preeclampsia. Subjects Twenty normal primigravidae with singleton pregnancy and another 40 with severe preeclampsia recruited from preeclamptic unit of El-Shatby Maternity University Hospital, Egypt in the third trimester of gestation with exclusion of any medical disease. Methods They are selected and subject to full history taking, complete clinical examination, laboratory investigation with special emphasis on serum uric acid, creatinine and serum cystatin C, obstetric abdominal ultrasound and Doppler. Results of the study were tabulated and statistically analyzed. Results The difference in the mean serum uric acid level (3.55 ± 0.58 versus 6.76 ± 1.06 mg/dl) was significantly higher in the preeclampsia (p = 0.001), the specificity was 100% and sensitivity of the test was 97.5%, the difference in the mean serum concentration of creatinine (1.55 ± 0.89 versus 0.66 ± 0.12) was significantly higher in preeclampsia (p = 0.001), the specificity of the test was 100% and the sensitivity was 60%. Serum cystatin C level has a mean (0.98 ± 0.29 versus 0.70 ± 0.06) which was significantly higher in preeclampsia (p = 0.001) with a specificity 100% and sensitivity 72.5%. We found a positive significant correlation between serum concentration of cystatin, and PI of umbilical artery Doppler (p = 0.05). Also, a significant correlation was found between serum concentration of cystatin and both PI and RI of middle cerebral artery Doppler (p = 0.05); this indicates the relation of serum cystatin C level with the severity of preeclampsia. Therefore, the past results demonstrate that the serum cystatin C and uric acid are having a good diagnostic accuracy for renal function of preeclampsia when compared to creatinine. Conclusion This indicates that cystatin C serum levels may have a significant role as a marker of preeclampsia and alternative marker of renal function in preeclampsia even more so when used in combination with uric acid levels which is still the most accurate predictor of preeclampsia and most accurate indicator of renal function of preeclampsia.

Sheehan′s syndrome with acute renal failure and severe preeclamptic toxemia

Sheehan's syndrome is a well-known cause of panhypopituitarism secondary to pituitary apoplexy, which generally occurs after an intrapartum or postpartum bleeding episode characterized by severe hypertension or hemorrhagic shock. The diagnosis can be difficult and is often formulated after some years from the syndrome occurrence. We report the case of a woman with an early diagnosis of early onset Sheehan's syndrome associated with severe preeclamptic toxemia complicated by acute renal failure.

Unique case of successful twin pregnancy after spontaneous conception in a patient with uterus bicornis unicollis

Abnormal fusion of the mullerian ducts or failure of absorption of the septum causes varying degrees of congenital uterine malformation. Twin gestation in a case of bicornuate uterus is extremely rare. We are reporting this case because of its extremely rare presentation, where twins have managed to reach term after spontaneous conception. A 28-year-old second gravida, para one was initially diagnosed to have diamniotic dichorionic twins on ultrasound. At term, she was referred to us with severe preeclamptic toxaemia. On examination, she was found to have a bicornuate uterus with one fetus in each horn. Both siblings were successfully delivered by caesarean section. So far, only one similar case has been reported following in vitro fertilisation. Although poor reproductive performance has been documented in previous reports of bicornuate uterus with twin gestation, our patient managed to reach term with delivery of healthy siblings by caesarean section.

Case report: post partum class 1 HELLP syndrome

The objective of this case report is to highlight the lack of screening tests that is capable of predicting HELLP syndrome before its occurrence. The patient developed severe pre-eclamptic toxaemia at 34+ weeks gestation. The foetus was growth retarded. The patient received anti-hypertensive therapy and was delivered by an emergency caesarean section. The patient developed post partum HELLP syndrome that required supportive treatment and renal haemodialysis; nevertheless, the patient fully recovered.

Fetal Intracranial Haemorrhage

Achiron, R.; Pinchas, O. Hamiel; Reichman, B.; Heyman, Z.; Schimmel, M.; Eidelman, A.; Mashiach, S. Author Information

Fetal intracranial haemorrhage: clinical significance of in utero ultrasonographic diagnosis

To review in utero detection of fetal intracranial haemorrhage. Retrospective survey of pregnant women presenting to the ultrasonographic unit in whom the diagnosis of fetal intracranial haemorrhage was reached. The Chaim Sheba Medical Center in Ramat Gan, and Shaare Zedek Medical Center in Jerusalem; two large district general hospitals, each with 6000 maternity patients per year. Five fetuses with gestational ages ranging from 26 to 36 weeks. Maternal complications, fetal monitoring, prenatal Doppler ultrasound studies, postnatal imaging studies, neonatal morbidity and mortality. Transabdominal sonography showed hyperechoic lesions in the brain parenchyma, and the lateral ventricle in three of five fetuses. In the remaining two fetuses, transvaginal sonography enhanced the visualisation of ventriculomegaly with intraventricular haemorrhage in one and periventricular leukomalacia was identified in the second. Three fetuses were appropriate for gestational age, and two were severely growth retarded. In one woman severe pre-eclamptic toxaemia may explain intracranial haemorrhage. Abnormal nonstress test and abnormal flow velocity waveforms in the umbilical and cerebral arteries were present in the two growth retarded fetuses, and in one who was appropriate for gestational age. The two growth retarded fetuses died shortly after birth. Of the three surviving infants, two had normal long term development, and one developed hydrocephalus with subsequent severe neurodevelopmental retardation, dying at the age of seven months. This small series shows that intracranial haemorrhage has a broad spectrum of manifestations with diverse prognosis. Following an antenatal diagnosis of intracranial haemorrhage, the obstetrician must give special consideration to electronic fetal heart monitoring and Doppler velocity waveforms. The prenatal diagnosis of intracranial haemorrhage has medico-legal implications suggesting that neurological outcome may not necessarily be due solely to intrapartum events and management.

Influence of maternal levels of blood glucose on fetal outcome

The effect of maternal levels of fasting blood glucose on fetal outcome was studied in 500 women with normal and toxemic pregnancies. Forty percent of the mothers with low glucose levels gave birth to low birth weight infants. In cases of severe preeclamptic toxemia, low fasting glucose levels were associated with a higher incidence of low birth weight, prematurity and stillbirths. Thus, in a population subsisting on poor caloric and protein intake, maternal levels of fasting blood glucose may be an important index in predicting high-risk pregnancy.

Progesterone therapy in pregnancy induced hypertension therapeutic value and hormonal profile.

The study was carried on 25 primigravidae with severe pre-eclamptic toxaemia (PET) and 19 normal pregnancies as a control group. 15 cases of PET were treated by 600 mg. progesterone daily for variable duration between one and six weeks. Daily blood samples were assayed for progesterone, dihydroprogesterone, estriol, estradiol, placental lactogen and prolactin. Under progesterone therapy there was a significant decrease in both systolic and diastolic blood pressure, significant increase in urinary output, amelioration of the edema, slight reduction in weight gain, but no change in the proteinuria. Prolactin was the only hormone that showed significant rise in the group of PET when compared with normal pregnancy.

Severe Antithrombin III Deficiency in a Patient with Pre‐Eclampsia.

Severe acquired antithrombin III (AT III) deficiency was observed in a patient with severe pre-eclamptic toxaemia. Plasma AT III concentration of 0.25 U/ml was found in both functional and immunological assays. The patient was treated with human AT III concentrate as a result of the development of progressive disseminated intravascular coagulation (DIC), the further deterioration of renal function, the risk for thromboembolic complications and the possible adverse effects of heparin therapy. The selective correction of AT III activity resulted in a rapid disappearance of coagulation abnormalities. The patient underwent uncomplicated caesarian section. This observation indicates that acquired severe AT III deficiency may occur as an early feature of DIC in severe pre-eclamptic toxaemia.

A renal biopsy study in toxaemia of pregnancy.

Renal biopsy specimens from 11 women with severe pre-eclamptic toxaemia were examined by light and electron microscopy linked with immunofluorescence and immuno-electron microscopy. The part played by the mesangium in causing capillary loop thickening is stressed, and the progress of this 'strangulation' is illustrated. In contrast to the findings of most previous authors, IgM was demonstrated by direct immunofluorescence in all biopsy specimens, and its presence and site within the glomerulus were shown by immuno-electron microscopy in three cases.

Immunological studies in pre-eclamptic toxaemia.

Although five patients with severe pre-eclamptic toxaemia (PET) had increased anticomplementary activity in their serum, there was no evidence of complement activation in the plasma of four of the five patients. These results are not implicated in the pathogenesis of PET. No significant correlation was found between anticomplementary activity and pregnancy-associated alpha2-glycoprotein.

Pre-eclampsia in pregnancies by different fathers: immunological studies.

Immunological studies were performed on a woman with severe pre-eclamptic toxaemia in a second pregnancy. This pregnancy followed a normal twin pregnancy by a different father four years earlier. Both fathers were also studied. In the mixed lymphocyte culture the patient's lymphocytes reacted eight times as strongly against father 2's cells as against those from father 1. If studies along these lines are performed when a women has toxaemic and non-toxaemic pregnancies by different fathers information may be obtained on immunogenetic aetiological factors which may be of more value than that derived from the study of large unselected populations.

Amniotic fluid mucoprotein in severe pre-eclamptic toxemia

Amniotic fluid mucoprotein in severe pre-eclamptic toxemia

Placental infarction and toxemia of pregnancy

Six-hundred and seventy-nine consecutive placentas were serially “large-sectioned” to determine the incidence of placental infarction. Seventy-seven of the placentas were from cases of mild pre-eclamptic toxemia of pregnancy and 12 were from cases of severe pre-eclamptic toxemia. Red infarcts were found in 1.3 per cent of all placentas, older true infarcts in 6.2 per cent, mottled (fetal) infarcts in 6.5 per cent, and perivillous fibrin deposition in 27 per cent of cases. There was a marked increase in red infarction and older true infarction in the severe toxemic group (67 per cent), and a moderate increase in older true infarction in the mild toxemic group (11.7 per cent). The incidence of perivillous fibrin deposition and mottled infarction was the same in the normal and in the toxemic groups. The gross and histologic appearances of the various types of infarct have been described. Clinically, an increase in maternal antepartum hemorrhage, stillbirths, and fetal morbidity was noted in the toxemic groups, particularly the severe one.

Assays of human chorionic gonadotrophin in relation to clinical practice.

Summary. Suitable biological methods for the estimation of human chorionic gonadotrophin (hcg) in body fluids include those involving ovarian hyperaemia and prostatic weight in rats. Immunological assays depending on haemagglutination-inhibition and complementfixation tests lack specificity and cannot be recommended for the quantitative determination of the hormone. In normal pregnancy hcg levels are high in the first trimester and much lower in the second and third trimesters. hcg activity appears in urine shortly after conception and disappears rapidly following delivery. In patients with hydatidiform mole hcg levels in body fluids are generally but not invariably well above the normal range. Following surgical treatment of mole and of trophoblastic tumours of the uterus hcg assays may be a valuable guide to prognosis. hcg readings in blood and urine are often abnormally high in women with severe pre-eclamptic toxaemia. In mild and moderate toxaemia levels are generally within the normal range. Patients with hyperemesis gravidarum usually fail to show the peak period of hcg excretion in early pregnancy. hcg readings in such cases bear no definite relationship to the duration and severity of the vomiting. In diabetic pregnancy and in threatened and habitual abortion assays of hcg are of little diagnostic or prognostic value. The administration of stilboestrol to pregnant diabetics causes a transient fall in hcg output.

Severe pre-eclamptic toxaemia

Severe pre-eclamptic toxaemia