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Korb D, Azria E, Sauvegrain P, Carbillon L, Langer B, Seco A, Chiesa-Dubruille C, Bouvier-Colle MH, Deneux-Tharaux C. Population-based study of eclampsia: Lessons learnt to improve maternity care. PLoS One 2024; 19:e0301976. [PMID: 38696427 PMCID: PMC11065303 DOI: 10.1371/journal.pone.0301976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes. OBJECTIVE 1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway. METHODS It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012-2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia. RESULTS The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0-4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate. CONCLUSION The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP.
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Affiliation(s)
- Diane Korb
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
- Department of Obstetrics and Gynaecology, Robert Debré Hospital, AP-HP, Université de Paris, Paris, France
| | - Elie Azria
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
- Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU PREMA, Université de Paris, Paris, France
| | - Priscille Sauvegrain
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
- Department of Obstetrics and Gynaecology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Lionel Carbillon
- Department of Obstetrics and Gynaecology, Jean Verdier Hospital, AP-HP, Bondy, Sorbonne North Paris University, Paris, France
| | - Bruno Langer
- Pôle de Gynécologie-Obstétrique, Hôpital de Hautepierre, Avenue Molière, Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Aurélien Seco
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
- Clinical Research Unit Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Coralie Chiesa-Dubruille
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
| | - Marie Hélène Bouvier-Colle
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
| | | | - Catherine Deneux-Tharaux
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
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Mayrink J, Reis ZSN. Pre-eclampsia in low and middle-income settings: What are the barriers to improving perinatal outcomes and evidence-based recommendations? Int J Gynaecol Obstet 2024; 164:33-39. [PMID: 37329226 DOI: 10.1002/ijgo.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To discuss the points that still challenge low- and middle-income countries (LMICs) and strategies that have been studied to help them overcome these issues. METHODS Narrative review addressing 20 years of articles concerning pre-eclampsia morbidity and mortality in LMICs. We summarized evidence-based strategies to overcome the challenges in order to reduce the pre-eclampsia impact on perinatal outcomes. RESULTS Pre-eclampsia is the first or second leading cause in the ranking of avoidable causes of maternal death, and approximately 16% of all maternal deaths are attributable to eclampsia and pre-eclampsia. Considering the social and economic contexts, it represents a major public health concern, and prevention and early detection of pre-eclampsia seem to be a major challenge. Reducing maternal mortality related to hypertensive disturbances depends on public policies to manage these preventable conditions. Early and continuous recognition of signs of severity related to hypertensive disorders during pregnancy and childbirth, self-monitoring of symptoms and blood pressure, as well as preventive approaches such as aspirin and calcium, and magnesium sulfate, are lifesaving procedures that have not yet reached a universal scale. CONCLUSION This review provides a vision of relevant points to support pregnant women in overcoming the constraints to healthcare access in LMICs, and strategies that can be applied in primary prenatal care units.
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Affiliation(s)
- Jussara Mayrink
- Federal University of Minas Gerais, Department of Obstetrics and Gynecology, Belo Horizonte, Brazil
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Shahnaz S, Hassanuzzaman M, Mazumder S, Rashid F, Hira HM, Hussain R, Barua S. Association of Posterior Reversible Encephalopathy Syndrome (PRES) with Preeclampsia with Severe Symptoms and Eclampsia in South East Part of Bangladesh. Mymensingh Med J 2024; 33:267-278. [PMID: 38163803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a pathology seen not only in precelampsia with severe symptoms and eclampsia but in a varicty of diseases/ conditions. With the availability of neuroimaging, it is possible to know the exact underlying Central nervous system (CNS) pathology in preeclampsia with severe symptoms and eclampsia and thus therapy can be targeted. Preeclampsia with severe symptoms and eclampsia remains to be an important cause of maternal morbidity and mortality in both the developing and developed world. The objective of this study was to evaluate the association of Posterior reversible encephalopathy syndrome (PRES) by MRI (Magnetic resonance imaging) with preeclampsia with severe symptoms and eclampsia in south east part of Bangladesh. This cross-sectional observational study was performed among women suffering from preeclampsia with severe symptoms and eclampsia who attended at Obstetrics & Gynaecology department of Chittagong Medical College Hospital (CMCH), Bangladesh from January 2021 to June 2021. According to inclusion/exclusion criteria 50 samples were taken by convenient sampling for this study. A detail history was taken and complete general physical and gynecological examination was performed. Required data was collected through preset questionnaire. Neuroimaging reports were reviewed by both neurologist and radiologist. Data was analyzed by using windows based computer software device, SPSS 25.0. Results obtained from this study will be used to make a statement regarding aggressive management for cerebral vasospasm in severe preeclampsia and eclamptia related PRES. PRES has been reported to be reversible but late recognition or incorrect treatment can cause irreversible brain damage. Institution of early treatment leads to resolution of symptoms without any neurologic deficit and thus reduces maternal morbidity and mortality. PRES is a cliniconeuroradiologic entity. This study can aware doctors regarding prompt diagnosis of PRES in peripartum period among patient suffering from preeclampsia with severe symptoms and eclampsia by imaging aside clinical findings. A conclusive decision can be made to improve the outcome in this potentially life threatening but reversible condition.
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Affiliation(s)
- S Shahnaz
- Dr Shoyela Shahnaz, Assistant Professor, Department of Obstetrics & Gynaecology, Chittagong Medical College (CMC), Chittagong, Bangladesh; E-mail:
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Ridout AE, Moses FL, Herm-Singh S, Turienzo CF, Seed PT, Goodhart V, Vousden N, Sam B, Momoh M, Kamara D, Kuhrt K, Samura S, Beoku-Betts C, Hurrell A, Bramham K, Kenneh S, Smart F, Chappell L, Sandall J, Shennan A. CRADLE-5: a stepped-wedge type 2 hybrid implementation-effectiveness cluster randomised controlled trial to evaluate the real-world scale-up of the CRADLE Vital Signs Alert intervention into routine maternity care in Sierra Leone-study protocol. Trials 2023; 24:590. [PMID: 37723530 PMCID: PMC10506317 DOI: 10.1186/s13063-023-07587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/16/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The CRADLE Vital Signs Alert intervention (an accurate easy-to-use device that measures blood pressure and pulse with inbuilt traffic-light early warning system, and focused training package) was associated with reduced rates of eclampsia and maternal death when trialled in urban areas in Sierra Leone. Subsequently, implementation was successfully piloted as evidenced by measures of fidelity, feasibility and adoption. The CRADLE-5 trial will examine whether national scale-up, including in the most rural areas, will reduce a composite outcome of maternal and fetal mortality and maternal morbidity and will evaluate how the CRADLE package can be embedded sustainably into routine clinical pathways. METHODS CRADLE-5 is a stepped-wedge cluster-randomised controlled trial of the CRADLE intervention compared to routine maternity care across eight rural districts in Sierra Leone (Bonthe, Falaba, Karene, Kailahun, Koinadugu, Kono, Moyamba, Tonkolili). Each district will cross from control to intervention at six-weekly intervals over the course of 1 year (May 2022 to June 2023). All women identified as pregnant or within six-weeks postpartum presenting for maternity care in the district are included. Primary outcome data (composite rate of maternal death, stillbirth, eclampsia and emergency hysterectomy) will be collected. A mixed-methods process and scale-up evaluation (informed by Medical Research Council guidance for complex interventions and the World Health Organization ExpandNet tools) will explore implementation outcomes of fidelity, adoption, adaptation and scale-up outcomes of reach, maintenance, sustainability and integration. Mechanisms of change and contextual factors (barriers and facilitators) will be assessed. A concurrent cost-effectiveness analysis will be undertaken. DISCUSSION International guidance recommends that all pregnant and postpartum women have regular blood pressure assessment, and healthcare staff are adequately trained to respond to abnormalities. Clinical effectiveness to improve maternal and perinatal health in more rural areas, and ease of integration and sustainability of the CRADLE intervention at scale has yet to be investigated. This trial will explore whether national scale-up of the CRADLE intervention reduces maternal and fetal mortality and severe maternal adverse outcomes and understand the strategies for adoption, integration and sustainability in low-resource settings. If successful, the aim is to develop an adaptable, evidence-based scale-up roadmap to improve maternal and infant outcomes. TRIAL REGISTRATION ISRCTN 94429427. Registered on 20 April 2022.
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Affiliation(s)
- Alexandra E Ridout
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Francis L Moses
- Reproductive Health and Family Planning, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | | | - Nicola Vousden
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Betty Sam
- Welbodi Partnership, Freetown, Sierra Leone
| | - Mariama Momoh
- Reproductive Health and Family Planning, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Katy Kuhrt
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sorie Samura
- National Emergency Medical Service, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Candace Beoku-Betts
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Alice Hurrell
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Kate Bramham
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sartie Kenneh
- Reproductive Health and Family Planning, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Francis Smart
- Reproductive Health and Family Planning, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Lucy Chappell
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK
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Abstract
The reported incidence of eclampsia is 1.6 to 10 per 10,000 deliveries in developed countries, whereas it is 50 to 151 per 10,000 deliveries in developing countries. In addition, low-resource countries have substantially higher rates of maternal and perinatal mortalities and morbidities. This disparity in incidence and pregnancy outcomes may be related to universal access to prenatal care, early detection of preeclampsia, timely delivery, and availability of healthcare resources in developed countries compared to developing countries. Because of its infrequency in developed countries, many obstetrical providers and maternity units have minimal to no experience in the acute management of eclampsia and its complications. Therefore, clear protocols for prevention of eclampsia in those with severe preeclampsia and acute treatment of eclamptic seizures at all levels of healthcare are required for better maternal and neonatal outcomes. Eclamptic seizure will occur in 2% of women with preeclampsia with severe features who are not receiving magnesium sulfate and in <0.6% in those receiving magnesium sulfate. The pathogenesis of an eclamptic seizure is not well understood; however, the blood-brain barrier disruption with the passage of fluid, ions, and plasma protein into the brain parenchyma remains the leading theory. New data suggest that blood-brain barrier permeability may increase by circulating factors found in preeclamptic women plasma, such as vascular endothelial growth factor and placental growth factor. The management of an eclamptic seizure will include supportive care to prevent serious maternal injury, magnesium sulfate for prevention of recurrent seizures, and promoting delivery. Although routine imagining following an eclamptic seizure is not recommended, the classic finding is referred to as the posterior reversible encephalopathy syndrome. Most patients with posterior reversible encephalopathy syndrome will show complete resolution of the imaging finding within 1 to 2 weeks, but routine imaging follow-up is unnecessary unless there are findings of intracranial hemorrhage, infraction, or ongoing neurologic deficit. Eclampsia is associated with increased risk of maternal mortality and morbidity, such as placental abruption, disseminated intravascular coagulation, pulmonary edema, aspiration pneumonia, cardiopulmonary arrest, and acute renal failure. Furthermore, a history of eclamptic seizures may be related to long-term cardiovascular risk and cognitive difficulties related to memory and concentration years after the index pregnancy. Finally, limited data suggest that placental growth factor levels in women with preeclampsia are superior to clinical markers in prediction of adverse pregnancy outcomes. This data may be extrapolated to the prediction of eclampsia in future studies. This summary of available evidence provides data and expert opinion on possible pathogenesis of eclampsia, imaging findings, differential diagnosis, and stepwise approach regarding the management of eclampsia before delivery and after delivery as well as current recommendations for the prevention of eclamptic seizures in women with preeclampsia.
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Affiliation(s)
- Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
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Jurga S, Urbaniak Ł, Pilichowska-Ujma E. Posterior Reversible Encephalopathy in a Patient with Eclampsia. Neurol India 2022; 70:369-371. [PMID: 35263917 DOI: 10.4103/0028-3886.338687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A case of a patient admitted to the hospital for preterm labor, who was diagnosed with and treated for posterior reversible encephalopathy (PRES) is presented in detail. During labor, the patient experienced a sudden increase in blood pressure with disturbance of consciousness and visual disturbances. Medical imaging examination revealed vasogenic edema in multiple locations in the brain. After administering treatment neurological symptoms receded. The presented case proves that PRES should always be considered in similar cases.
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Affiliation(s)
- Szymon Jurga
- Kliniczny Oddział Neurologii, Szpital Uniwersytecki Imienia Karola Marcinkowskiego w Zielonej Górze, ul. Zyty 26, Zielona Góra, Poland
| | - Łukasz Urbaniak
- Kliniczny Oddział Neurologii, Szpital Uniwersytecki Imienia Karola Marcinkowskiego w Zielonej Górze, ul. Zyty 26, Zielona Góra, Poland
| | - Emilia Pilichowska-Ujma
- Kliniczny Oddział Neurologii, Szpital Uniwersytecki Imienia Karola Marcinkowskiego w Zielonej Górze, ul. Zyty 26, Zielona Góra, Poland
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Joshi A, Beyuo T, Oppong SA, Moyer CA, Lawrence ER. Preeclampsia knowledge among postpartum women treated for preeclampsia and eclampsia at Korle Bu Teaching Hospital in Accra, Ghana. BMC Pregnancy Childbirth 2020; 20:625. [PMID: 33059625 PMCID: PMC7566025 DOI: 10.1186/s12884-020-03316-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preeclampsia/eclampsia is a major cause of maternal morbidity and mortality worldwide, yet patients' perspectives about their diagnosis are not well understood. Our study examines patient knowledge among women with preeclampsia/eclampsia in a large urban hospital in Ghana. METHODS Postpartum women diagnosed with preeclampsia or eclampsia were asked to complete a survey 2-5 days after delivery that assessed demographic information, key obstetric factors, and questions regarding provider counseling. Provider counseling on diagnosis, causes, complications, and future health effects of preeclampsia/eclampsia was quantified on a 4-point scale ('Counseling Composite Score'). Participants also completed an objective knowledge assessment regarding preeclampsia/eclampsia, scored from 0 to 22 points ('Preeclampsia/Eclampsia Knowledge Score' (PEKS)). Linear regression was used to identify predictors of knowledge score. RESULTS A total of 150 participants were recruited, 88.7% (133) with preeclampsia and 11.3% (17) with eclampsia. Participants had a median age of 32 years, median parity of 2, and mean number of 5.4 antenatal visits. Approximately half of participants reported primary education as their highest level of education. While 74% of women reported having a complication during pregnancy, only 32% of participants with preeclampsia were able to correctly identify their diagnosis, and no participants diagnosed with eclampsia could correctly identify their diagnosis. Thirty-one percent of participants reported receiving no counseling from providers, and only 11% received counseling in all four categories. Even when counseled, 40-50% of participants reported incomplete understanding. Out of 22 possible points on a cumulative knowledge assessment scale, participants had a mean score of 12.9 ± 0.38. Adjusting for age, parity, and the number of antenatal visits, higher scores on the knowledge assessment are associated with more provider counseling (β 1.4, SE 0.3, p < 0.001) and higher level of education (β 1.3, SE 0.48, p = 0.008). CONCLUSIONS Counseling by healthcare providers is associated with higher performance on a knowledge assessment about preeclampsia/eclampsia. Patient knowledge about preeclampsia/eclampsia is important for efforts to encourage informed healthcare decisions, promote early antenatal care, and improve self-recognition of warning signs-ultimately improving morbidity and reducing mortality.
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Affiliation(s)
- Avina Joshi
- University of Massachusetts Medical School, 55 N. Lake Ave, Worcester, MA, 01655, USA
| | - Titus Beyuo
- University of Ghana School of Medicine and Dentistry, Slater Avenue, Accra, Ghana.
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Guggisberg Avenue, Accra, Ghana.
| | - Samuel A Oppong
- University of Ghana School of Medicine and Dentistry, Slater Avenue, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Guggisberg Avenue, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
- Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
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Garcia Rodriguez A, Marcos Contreras S, Fernandez Manovel SM, Marcos Vidal JM, Diez Buron F, Fernandez Fernandez C, Riveira Gonzalez MDC. SARS-COV-2 infection during pregnancy, a risk factor for eclampsia or neurological manifestations of COVID-19? Case report. BMC Pregnancy Childbirth 2020; 20:587. [PMID: 33023500 PMCID: PMC7538036 DOI: 10.1186/s12884-020-03275-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and Severe Acute Respiratory Syndrome (SARS) Coronavirus (COV) 2 (SARS-COV-2) infection. We do not just face new and unknown manifestations, but also how different patient groups are affected by SARS-COV-2 infection, such as pregnant women. Coronavirus Disease 2019 (COVID-19), preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. CASE PRESENTATION A 35-year-old pregnant woman was admitted for tonic-clonic seizures and SARS-COV-2 infection. She had a normal pregnancy control and no other symptoms before tonic-clonic seizures development. After a Caesarean section (C-section) she developed high blood pressure, and we initiated antihypertensive treatment with labetalol, amlodipine and captopril. Few hours later she developed symptoms of cortical blindness that resolved in 72 h with normal brain computed tomography (CT) angiography. CONCLUSION The authors conclude that SARS COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.
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Affiliation(s)
- Alejandro Garcia Rodriguez
- Department of Anaesthesiology and Critical Care, University Complex Hospital of Leon, 24071, City Leon, Spain
| | - Sergio Marcos Contreras
- Department of Anaesthesiology and Critical Care, University Complex Hospital of Leon, 24071, City Leon, Spain.
| | | | - Jose Miguel Marcos Vidal
- Department of Anaesthesiology and Critical Care, University Complex Hospital of Leon, 24071, City Leon, Spain
| | - Fernando Diez Buron
- Department of Anaesthesiology and Critical Care, University Complex Hospital of Leon, 24071, City Leon, Spain
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England N, Madill J, Metcalfe A, Magee L, Cooper S, Salmon C, Adhikari K. Monitoring maternal near miss/severe maternal morbidity: A systematic review of global practices. PLoS One 2020; 15:e0233697. [PMID: 32470099 PMCID: PMC7259583 DOI: 10.1371/journal.pone.0233697] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/11/2020] [Indexed: 12/03/2022] Open
Abstract
There is international interest in monitoring severe events in the obstetrical population, commonly referred to as maternal near miss or severe maternal morbidity. These events can have significant consequences for individuals in this population and further study can inform practices to reduce both maternal morbidity and mortality. Numerous surveillance systems exist but we lack a standardized approach. Given the current inconsistencies and the importance in monitoring these events, this study aimed to identify and compare commonly used surveillance methods. In June 2018, we systematically searched MEDLINE, EMBASE, and CINAHL using terms related to monitoring/surveillance and maternal near miss/severe maternal morbidity. We included papers that used at least three indicators to monitor for these events and collected data on specific surveillance methods. We calculated the rate of maternal near miss/severe maternal morbidity in hospitalization data obtained from the 2016 US National Inpatient Sample using five common surveillance methods. Of 18,832 abstracts, 178 papers were included in our review. 198 indicators were used in studies included in our review; 71.2% (n = 141) of these were used in <10% of included studies and only 6.1% (n = 12) were used in >50% of studies included in our review. Eclampsia was the only indicator that was assessed in >80% of included studies. The rate of these events in American hospitalization data varied depending on the criteria used, ranging from 5.07% (95% CI = 5.02, 5.11) with the Centers for Disease Control criteria and 7.85% (95% CI = 7.79, 7.91) using the Canadian Perinatal Surveillance System. Our review highlights inconsistencies in monitoring practices within and between developed and developing countries. Given the wide variation in monitoring approaches observed and the likely contributing factors for these differences, it may be more feasible for clinical and academic efforts to focus on standardizing approaches in developed and developing countries independently at this time. PROSPERO Registration: CRD42018096858.
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Affiliation(s)
- Natalie England
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- * E-mail:
| | - Julia Madill
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Laura Magee
- King’s College London, London, United Kingdom
| | - Stephanie Cooper
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Charleen Salmon
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- University of Limerick, Limerick, Ireland
| | - Kamala Adhikari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Musits A, Wing R, Simoes M, Style M, Petrone G, Musisca N, Brown L. Interdepartmental Collaboration for Simulation-based Education: Obstetric Emergencies for Emergency Medicine. R I Med J (2013) 2020; 103:42-45. [PMID: 32357593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Simulation in medical education is a well-accepted educational modality that allows for practice of high risk, low frequency events. The Obstetric Emergencies for Emergency Medicine course was developed to prepare trainees for challenging scenarios. METHODS Six clinical scenarios were chosen: spontaneous vaginal delivery, neonatal resuscitation, pre- eclampsia, neonatal resuscitation with cardiopulmonary resuscitation (CPR), shoulder dystocia and postpartum hemorrhage. Development and facilitation was an interdepartmental effort with contributions from Emergency Medicine, Obstetrics and Gynecology, and Pediatric Emergency Medicine. Each case was allotted 35 minutes, including debriefing. Participants completed an evaluation survey for each scenario. RESULTS All participants responded yes to the question "Would you recommend this simulation become part of the standard curriculum." The means of ratings for "scenario overall" and "relevance to training/duties" ranged from 4.95-5 out of 5 across all simulation groups. CONCLUSION An interdepartmental and collaborative approach can optimize the success of a simulation educational program.
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Affiliation(s)
- Andrew Musits
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI
| | - Robyn Wing
- Warren Alpert Medical School of Brown University, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Providence, RI
| | - Meera Simoes
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, RI
| | - Michele Style
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, RI
| | - Gianna Petrone
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI
| | - Nick Musisca
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, RI
| | - Linda Brown
- Warren Alpert Medical School of Brown University, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Providence, RI
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Macuácua S, Catalão R, Sharma S, Valá A, Vidler M, Macete E, Sidat M, Munguambe K, von Dadelszen P, Sevene E. Policy review on the management of pre-eclampsia and eclampsia by community health workers in Mozambique. Hum Resour Health 2019; 17:15. [PMID: 30819211 PMCID: PMC6396495 DOI: 10.1186/s12960-019-0353-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pre-eclampsia is one of the leading causes of maternal death in Mozambique. Limited access to health care facilities and a lack of skilled health professionals contribute to the high maternal morbidity and mortality rates in Mozambique and indicate a need for community-level interventions. The aim of this review was to identify and characterise health policies related to the role of CHWs in the management of pre-eclampsia and eclampsia in Mozambique. METHODS The policy review was based on three methods: a desk review of relevant documents from the Mozambique Ministry of Health (n = 7), contact with 28 key informants in the field of health policy in Mozambique (n = 5) and literature review (n = 699). Policy documents obtained included peer-reviewed articles, government and institutional policies, reports and action plans. Seven hundred and eleven full-text documents were assessed for eligibility and included based on pre-defined criteria. Qualitative analysis was done to identify main themes using content analysis. RESULTS A total of 56 papers informed the timeline of key events. Three main themes were identified from the qualitative review: establishment of the community health worker programme and early challenges, revitalization of the CHW programme and the integration of maternal health in the community health tasks. In 1978, following the Alma Alta Declaration, the Mozambique government brought in legislation establishing primary health care and the CHW programme. Between the late 1980s and early 1990s, this programme was scaled down due to several factors including a prolonged civil war; however, the decision to revitalise the programme was made in 1995. In 2010, a revitalised programme was re-launched and expanded to include the management of common childhood illnesses, detection of warning signs of pregnancy complications, referrals for maternal health and basic health promotion. To date, their role has not included management of emergency conditions of pregnancy including pre-eclampsia and eclampsia. CONCLUSION The role of CHWs has evolved over the last 40 years to include care of childhood diseases and basic maternal health counselling. Studies to assess the impact of CHWs in providing services to reduce maternal morbidity and mortality are recommended.
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Affiliation(s)
- Salésio Macuácua
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Ministério de Saúde, Maputo, Mozambique
| | - Raquel Catalão
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia (UBC), Vancouver, British Columbia Canada
| | - Anifa Valá
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia (UBC), Vancouver, British Columbia Canada
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Ministério de Saúde, Maputo, Mozambique
| | - Mohsin Sidat
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique
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Abstract
RATIONALE Eclampsia is a life-threatening complication of pregnancy. Eclampsia is a leading cause of maternal and neonatal morbidity and mortality with most injury being associated with the seizures that mark the onset of the disease. It is vital that medical worker managing eclampsia have an understanding of the disease process. PATIENT CONCERNS A 28-year-old female, G4P1, with history of caesarean section was admitted at GA34+6, in addition to headache and severe hypertension (180/120 mm Hg) and proteinuria (+++). The evaluation of coagulation parameters showed positive D-dimer and increased fibrinogen and fibrinogen degradation product (FDP) and PT percent activity. Her biochemical analysis showed a decrease in total protein and an increase in alanine transaminase (ALT) and lactate dehydrogenase (LDH) and high serum uric acid and hyperlipidemia. DIAGNOSES She was diagnosed with severe preeclampsia (PE). INTERVENTIONS First, the patient received magnesium sulfate therapy for convulsions control. Next, antihypertensive management of labetalol orally at a dose 100 mg and nifedipine orally at a dose 10 mg and glycerin trinitrate10 mg iv were used to maintain blood pressure in a safe range. Then, corticosteroid was given for enhancing fetal lung maturation. During preparation for cesarean section, the patient experienced suddenly seizures that lasted approximately 2 to 8 minutes. The immediate therapy is to stop the convulsions and reduce blood pressure. OUTCOMES The patient and her baby were discharged from the hospital on the 7th day after the operation with normal blood pressure and being in a satisfactory condition. LESSONS Eclampsia is defined as the occurrence of convulsions superimposed on the preeclampsia. The awareness of eclampsia enhances early diagnosis and timely administration of magnesium sulfate and calmative drug which are critical to avoid feto-maternal complications.
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Affiliation(s)
- Weiping Cao
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang
| | - Xinzhi Wang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing
| | - Tingmei Chen
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang
| | - Mingmei Qin
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang
| | - Zuxian Wang
- Department of Nursing, School of Medicine, Jiangsu University, Zhenjiang
| | - Qin Wang
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang
| | - Bing Xie
- Department of Obstetrics, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang
| | - Wenlin Xu
- Central Laboratory of Medicine, Maternity and Child Health Hospital of Zhenjiang, Zhenjiang, Jiangsu, P.R. China
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Abstract
Preeclampsia continues to afflict 5% to 8% of all pregnancies throughout the world and is associated with significant morbidity and mortality to the mother and the fetus. Although the pathogenesis of the disorder has not yet been fully elucidated, current evidence suggests that imbalance in angiogenic factors is responsible for the clinical manifestations of the disorder, and may explain why certain populations are risk. In this review, we begin by demonstrating the roles that angiogenic factors play in pathogenesis of preeclampsia and its complications in the mother and the fetus. We then continue to report on the use of angiogenic markers as biomarkers to predict and risk-stratify disease. Strategies to treat preeclampsia by correcting the angiogenic balance, either by promoting proangiogenic factors or by removing antiangiogenic factors in both animal and human studies, are discussed. We end the review by summarizing status of the current preventive strategies and the long-term cardiovascular outcomes of women afflicted with preeclampsia.
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Affiliation(s)
- Belinda Jim
- Division of Nephrology, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| | - S Ananth Karumanchi
- Departments of Medicine, Obstetrics, and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Hossain MA, Karmoker RK, Rahman MS, Rashid HO, Khan SH, Rahman MA. Comparison of Outcome of Eclamptic Patient Following Vaginal Delivery versus Caeserian Delivery by Spinal Anaesthesia. Mymensingh Med J 2018; 27:275-279. [PMID: 29769490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Eclampsia is a common problem in pregnancy in Bangladesh. It is a severe form of preeclampsia which affects 5 to 7% of pregnancies is a significant cause of maternal & neonatal morbidity & mortality. Pre-eclampsia when complicated with generalized tonic-clonic convulsions and/or coma is called eclampsia. The term eclampsia is derived from a Greek word, meaning "like a flash of lightening". It may occur quite abruptly, without any warning manifestations. Eclampsia is a major cause of maternal mortality & morbidity as well as foetal loss worldwide, particularly in the third world. Appropriate measures & effective treatment of eclamptic patient in proper time reduce maternal mortality & morbidity. The mainstay of treatment of eclampsia is delivery of the foetus. Two methods are usually applied for delivery of foetus in eclampsia i.e. vaginal delivery & caesarean delivery. This study was done in the department of Gynae & Obs and department of Anaesthesiology, Mymensingh Medical College Hospital from 1st January 2016 to 30th June 2016 to observe the incidence, complications (morbidity) & mortality of eclamptic patients & which method (vaginal delivery versus caesarean delivery by spinal anaesthesia) is safe, better for the eclamptic patients as well as foetal mortality. Successful vaginal delivery is dependant on complex interactions of three variables (3 P) that is power (uterine contraction), passenger (foetus) & passage (birth canal) but power is less effective in eclamptic patient than normal partuents. Vaginal delivery requires prolong times compared with cesarean delivery. Anaesthetic technique is also an important factor for maternal mortality & morbidity of caesarean delivery. Spinal anaesthesia is widely regarded as a reasonable anaesthetic option for caesarean delivery in eclamptic patients. Currently the safety of spinal anaesthesia is well established and it can provide better obstetrical outcome when chosen properly. In this observation caesarean delivery by spinal anesthesia is safer, less complications, less maternal & neonatal mortality than vaginal delivery in eclamptic patients.
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Affiliation(s)
- M A Hossain
- Dr AKM Abul Hossain, Associate Professor, Department of Gynae & Obs, Mymensingh Medical College (MMC), Mymensingh, Bangladesh
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Bojja V, Keepanasseril A, Nair PP, Sunitha VC. Clinical and imaging profile of patients with new-onset seizures & a presumptive diagnosis of eclampsia - A prospective observational study. Pregnancy Hypertens 2018; 12:35-39. [PMID: 29674196 DOI: 10.1016/j.preghy.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/18/2018] [Accepted: 02/23/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the clinical and imaging profile of patients with new-onset seizures with a presumptive diagnosis of eclampsia. METHODS This was a cross-sectional study, conducted in a tertiary teaching hospital, on pregnant women presenting with new onset seizures with presumptive diagnosis of eclampsia excluding those with pre-existing neurological conditions. Demographic details, medical and obstetric examination findings were noted. All women underwent neuroimaging within 5 days of onset seizures. RESULTS Presumptive diagnosis of eclampsia was made in 0.7% (n = 186) of women delivering during the time period. Most women (55.4%) presented with seizures in the antenatal period. Neuroimaging is performed in 130 cases and it was found to be abnormal in 45.4% of women (59/130). Most common associated neurological condition was Posterior Reversible Encephalopathy Syndrome in 20% (n = 26) followed by Cerebral Venosus Sinus Thrombosis in 10% (n = 14). All six women with primary intracerebral haemorrhage succumbed to the disease. CONCLUSION New-onset seizures may be the initial presentation of uncommon and unpredictable complication of pregnancy with serious maternal/ fetal morbidity and mortality. Neuroimaging will help in these patients to avoid the delay or misdiagnosis, resulting in early initiation of specific treatment which will help to improve and optimize outcomes.
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Affiliation(s)
- Vandana Bojja
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry 605006, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry 605006, India.
| | - Pradeep P Nair
- Department of Neurology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry 605006, India
| | - V C Sunitha
- Department of Radiodiagnosis, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry 605006, India
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Bernstein PS, Martin JN, Barton JR, Shields LE, Druzin ML, Scavone BM, Frost J, Morton CH, Ruhl C, Slager J, Tsigas EZ, Jaffer S, Menard MK. Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. J Midwifery Womens Health 2017; 62:493-501. [PMID: 28697534 DOI: 10.1111/jmwh.12647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 11/29/2022]
Abstract
Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.
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von Dadelszen P, Magee LA. Preventing deaths due to the hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 36:83-102. [PMID: 27531686 PMCID: PMC5096310 DOI: 10.1016/j.bpobgyn.2016.05.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/25/2016] [Accepted: 05/29/2016] [Indexed: 02/08/2023]
Abstract
In this chapter, taking a life cycle and both civil society and medically oriented approach, we will discuss the contribution of the hypertensive disorders of pregnancy (HDPs) to maternal, perinatal and newborn mortality and morbidity. Here we review various interventions and approaches to preventing deaths due to HDPs and discuss effectiveness, resource needs and long-term sustainability of the different approaches. Societal approaches, addressing sustainable development goals (SDGs) 2.2 (malnutrition), 3.7 (access to sexual and reproductive care), 3.8 (universal health coverage) and 3c (health workforce strengthening), are required to achieve SDGs 3.1 (maternal survival), 3.2 (perinatal survival) and 3.4 (reduced impact of non-communicable diseases (NCDs)). Medical solutions require greater clarity around the classification of the HDPs, increased frequency of effective antenatal visits, mandatory responses to the HDPs when encountered, prompt provision of life-saving interventions and sustained surveillance for NCD risk for women with a history of the HDPs.
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Affiliation(s)
- Peter von Dadelszen
- Institute of Cardiovascular and Cell Sciences, St George's University of London, UK; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Laura A Magee
- Institute of Cardiovascular and Cell Sciences, St George's University of London, UK; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
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Priso EB, Njamen TN, Tchente CN, Kana AJ, Landry T, Tchawa UFN, Hentchoya R, Beyiha G, Halle MP, Aminde L, Dzudie A. Trend in admissions, clinical features and outcome of preeclampsia and eclampsia as seen from the intensive care unit of the Douala General Hospital, Cameroon. Pan Afr Med J 2015; 21:103. [PMID: 26523163 PMCID: PMC4613832 DOI: 10.11604/pamj.2015.21.103.7061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 05/25/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Hypertensive disorders in pregnancy (HDP) are a major cause of maternal morbidity and mortality. We aimed at determining the trends in admission, profiles and outcomes of women admitted for preeclampsia and eclampsia to an intensive care unit (ICU) in Cameroon. METHODS A retrospective study involving 74 women admitted to the ICU of the Douala General Hospital for severe preeclampsia and eclampsia from January 2007 to December 2014. Clinical profiles and outcome data were obtained from patient records. Statistical analysis was performed using SPSS version 20. RESULTS Of the 74 women admitted to ICU (72.5% for eclampsia), mean age was 30.2years and the majority (90.5%) were aged 20-39 years. While overall trend in admission for HDP increased over the years, mortality remained stable. Mean gestational age (GA) on admission was 34.0 weeks (33.5 for preeclampsia vs 35.4 for eclampsia). Most patients presented with complications of which acute kidney injury was most frequent (66.7%). Visual problems were more common in patients with eclampsia compared to preeclampsia (p = 0.01). HELLP syndrome and acute pulmonary oedema (APO) were predominant in patients with preeclampsia, while cerebrovascular accidents (CVA) occurred more in patients with eclampsia. Overall mortality was 24.3%. Presence of APO was associated with mortality in multivariable analysis (O.R.= 0.03, p = 0,01). CONCLUSION Trends in admission for HDP were increasing with high but stable mortality rate. Patients presented late most of whom with complications. Interventions improving antenatal care services and multidisciplinary management approach may improve maternal outcome in patients with HDP.
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Affiliation(s)
- Eugene Belley Priso
- Department of Obstetrics and Gynaecology, Douala General Hospital, Douala, Cameroon
| | | | - Charlotte Nguefack Tchente
- Department of Obstetrics and Gynaecology, Douala General Hospital, Douala, Cameroon ; Department of Surgery and Specialties, University of Douala, Douala, Cameroon
| | | | - Tchuenkam Landry
- General intensive care unit, Douala General Hospital, Douala, Cameroon
| | | | - Romuald Hentchoya
- General intensive care unit, Douala General Hospital, Douala, Cameroon
| | - Gerard Beyiha
- General intensive care unit, Douala General Hospital, Douala, Cameroon
| | - Marie Patrice Halle
- Department of Nephrology and Hemodialysis, Douala General Hospital, Douala, Cameroon
| | - Leopold Aminde
- Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon ; Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa ; Cardiology unit, Department of Internal Medicine, Douala General Hospital and Faculty of Health Sciences, University of Buea, Buea, Cameroon
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20
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Wahab KW, Sanya EO, Ademiluyi BA, Bello AH. Posterior reversible encephalopathy syndrome complicating postpartum eclampsia in a Nigerian: case report. Niger Postgrad Med J 2014; 21:266-268. [PMID: 25331246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS AND OBJECTIVES This is a case of posterior reversible encephalopathy syndrome (PRES) associated with postpartum eclampsia in a primiparous Nigerian. CASE PRESENTATION A 20-year-old primiparous woman presented to the emergency unit of the department of obstetrics and gynaecology of our hospital with symptoms and signs consistent with postpartum eclampsia. While being managed for this, she developed weakness of the left limbs with associated altered sensorium. Significant findings on physical examination were hypertension, left-sided hemiparesis and cortical blindness. She had a computed tomographic (CT) scan of the brain which showed features consistent with posterior reversible encephalopathy syndrome. She was given full supportive care with control of her blood pressure and she made a significant improvement. She was discharged home about 3 weeks after admission with improvement in clinical condition and is currently being followed up in our neurology clinic. CONCLUSION PRES complicating eclampsia is a clinicoradiological diagnosis. In most cases neurological symptoms improve with good supportive care and adequate treatment of the underlying condition as was the case in this patient. However permanent neurological sequelae can result from delayed diagnosis and treatment; therefore a high index of suspicion, early diagnosis and treatment are essential.
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Affiliation(s)
- K W Wahab
- Department of Medicine, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Chaturvedi S, Upadhyay S, De Costa A. Competence of birth attendants at providing emergency obstetric care under India's JSY conditional cash transfer program for institutional delivery: an assessment using case vignettes in Madhya Pradesh province. BMC Pregnancy Childbirth 2014; 14:174. [PMID: 24885817 PMCID: PMC4075933 DOI: 10.1186/1471-2393-14-174] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 05/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to emergency obstetric care by competent staff can reduce maternal mortality. India has launched the Janani Suraksha Yojana (JSY) conditional cash transfer program to promote institutional births. During implementation of the JSY, India witnessed a steep increase in the proportion of institutional deliveries-from 40% in 2004 to 73% in 2012. However, maternal mortality reduction follows a secular trend. Competent management of complications, when women deliver in facilities under the JSY, is essential for reduction in maternal mortality and therefore to a successful program outcome. We investigate, using clinical vignettes, whether birth attendants at institutions under the program are competent at providing appropriate care for obstetric complications. METHODS A facility based cross-sectional study was conducted in three districts of Madhya Pradesh (MP) province. Written case vignettes for two obstetric complications, hemorrhage and eclampsia, were administered to 233 birth attendant nurses at 73 JSY facilities. Their competence at (a) initial assessment, (b) diagnosis, and (c) making decisions on appropriate first-line care for these complications was scored. RESULTS The mean emergency obstetric care (EmOC) competence score was 5.4 (median = 5) on a total score of 20, and 75% of participants scored below 35% of the maximum score. The overall score, although poor, was marginally higher in respondents with Skilled Birth Attendant (SBA) training, those with general nursing and midwifery qualifications, those at higher facility levels, and those conducting >30 deliveries a month. In all, 14% of respondents were competent at assessment, 58% were competent at making a correct clinical diagnosis, and 20% were competent at providing first-line care. CONCLUSIONS Birth attendants in the JSY facilities have low competence at EmOC provision. Hence, births in the JSY program cannot be considered to have access to competent EmOC. Urgent efforts are required to effectively increase the competence of birth attendants at managing obstetric complications in order to translate large gains in coverage of institutional delivery services under JSY into reductions in maternal mortality in Madhya Pradesh, India.
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Affiliation(s)
- Sarika Chaturvedi
- Department of Public Health and Environment, R D Gardi Medical College, Ujjain, India
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Sourabh Upadhyay
- Department of Public Health and Environment, R D Gardi Medical College, Ujjain, India
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Rouzi AA, Almrstani AM. Near death of a pregnant Somali woman due to neglected eclampsia. CLIN EXP OBSTET GYN 2014; 41:93-94. [PMID: 24707695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To report a case of cardiac arrest of a Somali woman in labor due to neglected eclampsia. MATERIALS AND METHODS A 16-year-old Somali primigravida was seen because of convulsions at 28 weeks gestation. She had two attacks of convulsions at home before coming to the hospital. She suffers from diabetes and is insulin-dependent. Her convulsions were controlled with diazepam. Vaginal examination showed a seven cm dilated cervix with high-breech. In the operating room, cardiac arrest occurred. RESULTS Cesarean section was performed during resuscitation. The patient's maternal condition improved and was diagnosed with pulmonary edema and diabetic ketoacidosis. She was admitted to the intensive care unit (ICU) then transferred to the postnatal ward. She was discharged home and is in good general condition. CONCLUSION Inadequate or lack of antenatal care of Somali pregnant women due to many factors, including ignorance, can result in medical catastrophic situations as illustrated in the current case.
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Kulikov AV, Shifman EM, Belomestnov SR, Levit AL. [Emergency care for eclampsia and its complications. Eclampsia, HELLP-syndrome]. Anesteziol Reanimatol 2013:75-81. [PMID: 24624864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Duan T. [Retrospect and prospect of preeclampsia-eclampsia]. Zhonghua Fu Chan Ke Za Zhi 2013; 48:268-271. [PMID: 23902808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kurdoglu Z, Ay G, Sayin R, Kurdoglu M, Kamaci M. Eclampsia with neurological complications: a five-year experience of a tertiary centre. CLIN EXP OBSTET GYN 2013; 40:240-242. [PMID: 23971249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The neurological signs and symptoms in 107 pregnant women with eclampsia in the last five years at the Department of Obstetrics and Gynecology at the Yuzuncu Yil University School of Medicine are presented. MATERIALS AND METHODS The medical records of 107 pregnant women with eclampsia in the Clinic of Obstetrics and Gynecology at the Yuzuncu Yil University consulted with neurology clinic from September 2005 to December 2010, were evaluated. RESULTS The most common symptoms of the patients were seizure, headache, and seeing spots of light. Although neurologic examination was normal in 81 patients, 26 had pathological signs. The most common neurologic pathologic signs determined were alterations in consciousness. CONCLUSION In eclamptic patients, brain scanning might reveal pathological results in spite of normal neurological examination. With neurological examination and brain scanning, it may be possible to diagnose and treat severe complications that may otherwise result in maternal mortality.
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Affiliation(s)
- Z Kurdoglu
- Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey.
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Abstract
BACKGROUND Simulation is now the educational standard for emergency training in residency and is particularly useful on a labor and delivery unit, which is often a stressful environment for learners given the frequency of emergencies. However, simulation can be costly. PURPOSE This study aimed to assess the feasibility and effectiveness of low-cost simulated obstetrical emergencies in training family medicine residents. METHODS The study took place in a community hospital in an urban underserved setting in the northeast United States. Low-cost simulations were developed for postpartum hemorrhage (PPH) and preeclampsia/eclampsia (PEC). Twenty residents were randomly assigned to the intervention (simulated PPH or PEC followed by debriefing) or control (lecture on PPH or PEC) group, and equal numbers of residents were assigned to each scenario. All participants completed a written test at baseline and an oral exam 6 months later on the respective scenario to which they were assigned. The participants provided written feedback on their respective teaching interventions. We compared performance on pretests and posttests by group using Wilcoxon Rank Sum. RESULTS Twenty residents completed the study. Both groups performed similarly on baseline tests for both scenarios. Compared to controls, intervention residents scored significantly higher on the examination on the management of PPH but not for PEC. All intervention group participants reported that the simulation training was "extremely useful," and most found it "enjoyable." CONCLUSIONS We demonstrated the feasibility and acceptability of two low-cost obstetric emergency simulations and found that they may result in persistent increases in trainee knowledge.
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Affiliation(s)
- Susanna R Magee
- Memorial Hospital, Family Medicine, Pawtucket, Rhode Island 02860, USA.
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Romero-Arauz JF, Morales-Borrego E, García-Espinosa M, Peralta-Pedrero ML. [Clinical guideline. Preeclampsia-eclampsia]. Rev Med Inst Mex Seguro Soc 2012; 50:569-579. [PMID: 23282276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Preeclampsia remains a major cause of worldwide pregnancy related maternal and neonatal mortality and morbidity, it accounts for more than 50,000 maternal deaths each year. The World Health Organization estimates that at least one woman dies every 7 minutes from a complication of preeclampsia. It is the main cause of maternal death in Mexico and Latin America. Standarized assessment and surveillance of women with preeclampsia is associated with reduced maternal risk. Standarized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of preeclampsia-eclampsia. The working group selected clinical practice guidelines found in the Cochrane Library, Medline and PubMed. The results were expressed as levels of evidences and grade of recommendation. Evidence suggests, that treatment of severe hypertension, seizures prophylaxis with magnesium sulfate, and management by experienced health-care professionals will improve maternal, fetal and neonatal outcomes. Treatment remains supportive with pregnancy termination being the only definitive cure.
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Wagner SJ, Acquah LA, Lindell EP, Craici IM, Wingo MT, Rose CH, White WM, August P, Garovic VD. Posterior reversible encephalopathy syndrome and eclampsia: pressing the case for more aggressive blood pressure control. Mayo Clin Proc 2011; 86:851-6. [PMID: 21878596 PMCID: PMC3258001 DOI: 10.4065/mcp.2011.0090] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the prevalence, clinical presentations, and neuroimaging abnormalities in a series of patients treated for eclampsia at Mayo Clinic in Rochester, MN. PATIENTS AND METHODS We reviewed the records of all pregnant patients diagnosed as having eclampsia at Mayo Clinic in Rochester, MN, between January 1, 2001, and December 31, 2008. All patients who underwent neuroimaging were identified, and all studies were reviewed by an independent neuroradiologist. Comparisons were made between groups who did and did not undergo imaging to identify differentiating clinical or laboratory variables. RESULTS Thirteen cases of eclampsia were found, with neuroimaging studies available for 7: magnetic resonance imaging (n=6) and computed tomography (n=1). All 7 patients developed eclamptic seizures, and 2 of 7 patients had severe hypertension, with recorded systolic blood pressures exceeding 180 mm Hg. Neuroimaging showed characteristic changes of posterior reversible encephalopathy syndrome (PRES) in all patients. Follow-up imaging showed resolution in 2 of 3 patients; 1 patient had residual neuroimaging abnormalities. CONCLUSION Our results suggest that the clinical syndrome of eclampsia is associated with an anatomical substrate that is recognizable by neuroimaging as PRES. The levels of blood pressure elevation are lower than those reported in cases of PRES because of hypertensive encephalopathy. Further studies are needed to determine whether more aggressive blood pressure control and early neuroimaging may have a role in the management of these patients.
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Affiliation(s)
- Steven J Wagner
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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West H. Quick recertification series. Pregnancy-induced hypertension. JAAPA 2011; 24:62. [PMID: 21434502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Holly West
- Department of Physician Assistant Studies, University of Texas Medical Branch at Galveston, USA
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Zetina F. [Preeclampsy and eclampsia. 1956]. Ginecol Obstet Mex 2011; 79:156-162. [PMID: 21966798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Milan A, Puglisi E, Ferrari G, Fabbri A, Rabbia F, Mulatero P, Veglio F. [Hypertensive emergency and urgency: clinical update]. G Ital Cardiol (Rome) 2010; 11:835-848. [PMID: 21348321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hypertensive crises (i.e., blood pressure > 180/120 mmHg) are common issues in the emergency department. This term is used to indicate both emergencies and urgencies, characterized by presence and absence of target organ damage, respectively. A wide range of therapeutic options are available. The aim of this article is to review current knowledge and treatment trends in the literature to provide clinicians with diagnostic and therapeutic tools.
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Affiliation(s)
- Alberto Milan
- S.C.U. Medicina Interna 4, Dipartimento di Medicina e Oncologia Sperimentale, Centro Ipertensione Arteriosa, A.O.U. San Giovanni Battista, Università degli Studi, Torino.
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Wandabwa J, Doyle P, Kiondo P, Campbell O, Maconichie N, Welishe G. Risk factors for severe pre-eclampsia and eclampsia in Mulago Hospital, Kampala, Uganda. East Afr Med J 2010; 87:415-424. [PMID: 23057275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine the risk factors for severe pre-eclampsia and eclampsia in Mulago Hospital, Kampala, Uganda. DESIGN A case control study. SETTING Mulago Hospital labour ward SUBJECT One hundread and fourty three women with severe pre-eclampsia/eclampsia and 500 women with normal delivery. RESULTS The predictors of severe pre-eclampsia/eclampsia were: low socio - economic status (OR 7.6, 95%CI 3.9 - 26.9), chronic hypertension (OR 26.9, 95% CI 4.3-170.4), family history of hypertension (OR 1.9, 95% CI 1.2-2.9), nulliparity (OR 2.2, 95% CI 1.2-4.3) and delivery of male babies (OR 1.5, 95% CI 1.0 to 2.3). CONCLUSION Severe pre- eclampsia is one of the main causes of maternal morbidity and mortality in Mulago hospital. The predictors of severe pre - eclampsia were chronic hypertension, family history of hypertension, low socio - economic status, nulliparity and delivering male babies. Health workers need to identify women at risk and offer them counseling and, those who develop pre - eclampsia be referred and managed in hospitals with expertise and facilities. Those who develop severe pre-eclampsia should be delivered immediately so as to reduce the morbidity and mortality associated with this condition.
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Affiliation(s)
- J Wandabwa
- Walter Sisulu University, Unitra Xl, Mthatha 5117, South Africa
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Leis Márquez MT, Rodríguez Bosch MR, García López MA. [Clinical practice guidelines. Diagnosis and treatment of preeclampsia-eclampsia. Colegio Mexicano de Especialistas en Ginecología y Obstetricia ]. Ginecol Obstet Mex 2010; 78:S461-S525. [PMID: 20939247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Janků P, Janků K, Unzeitig V. [Pre-eclampsia from the perspective of inter-professional collaboration]. Vnitr Lek 2009; 55:1159-1166. [PMID: 20070032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Preeclampsia-eclampsia is a syndrome which covers the area of influence belonging to gynecologists-obstetricians. However the internists, especially those who work as consultants in obstetric departments, are interested in diagnostics and therapy of this problem as well. Though internists working in the outdoor-departments do not face the problems of preeclampsia so often, it will be usefull to inform them about the latest trends in diagnostics and therapy ofthis syndrome, which may be very risky in pregnancy. The physicians in general (except the gynecologists) consider preeclampsia mostely as one form of hypertension that appears sometimes during gravidity and they do not realy appreciate the complex danger ofthis illness for the both, mother and child. The objective ofthis paper is to inform the general medical public, especially the internists and general practitioners about the modern view ofthe main problems of preeclampsia e.g. the pathogenesis, diagnostics and the up to day therapy of this high risky syndrome joined with pregnancy.
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Affiliation(s)
- P Janků
- Gynekologicko-porodnická klinika Lékarské fakulty MU a FN Brno.
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Alauddin M, Bal R, Kundu MK, Dey S, Biswas A. Current trends in delivery of eclampsia patients. J Indian Med Assoc 2009; 107:672-674. [PMID: 20469739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study tried to identify if there was any current trend in delivering eclampsia patients in terms of choice of mode and time of delivery and reasons for such choice and whether they influenced outcomes. Initial assessment findings, choice of mode of delivery, delivery outcomes were analysed in 608 consecutive cases of antepartum and intrapartum eclampsia, caesarean section rate was very high (71.05%). Majority of caesarean sections were done to promptly deliver those patients who were in early labour or not in labour, thus, unlikely to deliver vaginally within about 6 hours. Only those in advanced labour and likely to deliver vaginally within a short period were allowed vaginal delivery indicating considerable selection. Both maternal mortality rate and perinatal mortality rate were much lower with early caesarean section (0.95% and 3.80% respectively) than with vaginal delivery. Both also steadily increased with increasing admission--delivery interval, apparently independent of mode of delivery indicating that improved foetomaternal outcomes associated with early caesarean section actually resulted from prompt delivery. Thus there was a definite trend of liberal use of caesarean section, whenever needed, to ensure prompt delivery of eclamptic patients and this, in turn, improved outcomes.
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Affiliation(s)
- Md Alauddin
- Department of Obstetrics and Gynaecology, Calcutta National Medical College, Kolkata 700014
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Trubuhovich RV. Some prehistory of New Zealand intensive care medicine. Anaesth Intensive Care 2009; 37 Suppl 1:16-29. [PMID: 19705630 DOI: 10.1177/0310057x090370s105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In taking 1960 as the foundation year for the practice of intensive care medicine in New Zealand, this paper briefly looks into the previous two centuries for some interventions in life-threatening conditions. With the help of descriptions in early 19th century journals and books by perceptive observers, the author focuses on some beliefs and practices of the Maori people during pre-European and later times, as well as aspects of medical treatment in New Zealand for early settlers and their descendents. Dr Laurie Gluckman's book Tangiwai has proved a valuable resource for New Zealand's medical history prior to 1860, while the recent publication of his findings from the examination of coroners' records for Auckland, 1841 to 1864, has been helpful. Drowning is highlighted as a common cause of accidental death, and consideration is given to alcohol as a factor. Following the 1893 foundation of the New Zealand Medical Journal, a limited number of its papers which are historically relevant to today's intensive care are explored: topics include tetanus, laryngeal diphtheria, direct cardiac massage, traumatic shock, thiopentone management for fitting and the ventilatory failure due to poliomyelitis.
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Abstract
OBJECTIVE To assess the incidence, risk factors and the outcome of acute renal failure (ARF) associated with eclampsia in intensive care unit (ICU). DESIGN Prospective and analytic study. SETTING A surgical ICU in a university hospital. PATIENTS 178 consecutive women with eclampsia admitted to an intensive care unit during seven years. ARF was defined by a serum creatinine concentration >140 micromol/L. RESULTS The incidence of ARF was 25.8%. In univariate analysis the severity of patient illness, the complications associated with eclampsia (disseminated intravascular coagulation, Hellp syndrome, neurologic complications, abruptio placenta, aspiration pneumonia, delivery hemorrhage) were significantly associated with ARF. In a logistic regression model, risk factors for ARF included organ system failure (OSF) odds ratio (OR)=1.81 confidence interval (CI) [1.08-3.05], bilirubin >12 micromol/L OR=4.42 CI [1.54-12.68], uric acid >5.9 g/dL OR=16.5 CI [3.09-87.94], abruptio placenta OR=0.2 7 CI [0.08-0.99], and oliguria OR=0.10 CI [0.03-0.44]. In contrast, severity of blood pressure or proteinuria on dipstick were not associated with ARF. However, in this series, 15 women required dialysis in the short term and one required long-term dialysis. ARF associated with eclampsia was significantly associated with mortality (32.6% versus 9.1% p=0.0001). CONCLUSION ARF with eclampsia is a frequent situation that required intensive management when risks factors were present. The need for dialysis was a rare condition.
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Affiliation(s)
- Khalid Mjahed
- Service d'anesthésie-réanimation centrale, CHU Ibn Rochd, Casablanca, Morocco.
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Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol 2009; 200:481.e1-7. [PMID: 19019323 DOI: 10.1016/j.ajog.2008.07.048] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/02/2008] [Accepted: 07/28/2008] [Indexed: 11/18/2022]
Abstract
Preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelets syndrome are major obstetric disorders that are associated with substantial maternal and perinatal morbidities. As a result, it is important that clinicians make timely and accurate diagnoses to prevent adverse maternal and perinatal outcomes associated with these syndromes. In general, most women will have a classic presentation of preeclampsia (hypertension and proteinuria) at > 20 weeks of gestation and/or < 48 hours after delivery. However, recent studies have suggested that some women will experience preeclampsia without > or = 1 of these classic findings and/or outside of these time periods. Atypical cases are those that develop at < 20 weeks of gestation and > 48 hours after delivery and that have some of the signs and symptoms of preeclampsia without the usual hypertension or proteinuria. The purpose of this review was to increase awareness of the nonclassic and atypical features of preeclampsia-eclampsia. In addition, a stepwise approach toward diagnosis and treatment of patients with these atypical features is described.
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Affiliation(s)
- Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526, USA.
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Kalim N, Anwar I, Khan J, Blum LS, Moran AC, Botlero R, Koblinsky M. Postpartum haemorrhage and eclampsia: differences in knowledge and care-seeking behaviour in two districts of Bangladesh. J Health Popul Nutr 2009; 27:156-69. [PMID: 19489413 PMCID: PMC2761783 DOI: 10.3329/jhpn.v27i2.3328] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In high- and low-performing districts of Bangladesh, the study explored the demand-side of maternal healthcare by looking at differences in perceived knowledge and care-seeking behaviours of women in relation to postpartum haemorrhage or eclampsia. Haemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. The study was conducted during July 2006-December 2007. Both postpartum bleeding and eclampsia were recognized by women of different age-groups as severe and life-threatening obstetric complications. However, a gap existed between perception and actual care-seeking behaviours which could contribute to the high rate of maternal deaths associated with these conditions. There were differences in care-seeking practices among women in the two different areas of Bangladesh, which may reflect sociocultural differences, disparities in economic and educational opportunities, and a discrimination in the availability of care.
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Affiliation(s)
- Nahid Kalim
- Public Health Sciences Division, ICDDR,B, G.P.O. Box 128, Dhaka 1000, Bangladesh.
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Société française d'anesthésie et de réanimation (Sfar)., Collège national des gynécologues et obstétriciens français (CNGOF)., Société française de médecine périnatale (SFMP)., Société française de néonatalogie (SFNN). [Multidisciplinary management of severe pre-eclampsia (PE). Experts' guidelines 2008. Société française d'anesthésie et de réanimation. Collège national des gynécologues et obstétriciens français. Société française de médecine périnatale. Société française de néonatalogie]. ACTA ACUST UNITED AC 2009; 28:275-81. [PMID: 19321292 DOI: 10.1016/j.annfar.2009.02.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Mistovich JJ, Krost WS, Limmer DD. Beyond the basics: preeclampsia and eclampsia. EMS Mag 2008; 37:51-57. [PMID: 19024743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Leeman L, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician 2008; 78:93-100. [PMID: 18649616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy has defined four categories of hypertension in pregnancy: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. A maternal blood pressure measurement of 140/90 mm Hg or greater on two occasions before 20 weeks of gestation indicates chronic hypertension. Pharmacologic treatment is needed to prevent maternal end-organ damage from severely elevated blood pressure (150 to 180/100 to 110 mm Hg); treatment of mild to moderate chronic hypertension does not improve neonatal outcomes or prevent superimposed preeclampsia. Gestational hypertension is a provisional diagnosis for women with new-onset, nonproteinuric hypertension after 20 weeks of gestation; many of these women are eventually diagnosed with preeclampsia or chronic hypertension. Preeclampsia is the development of new-onset hypertension with proteinuria after 20 weeks of gestation. Adverse pregnancy outcomes related to severe preeclampsia are caused primarily by the need for preterm delivery. HELLP (i.e., hemolysis, elevated liver enzymes, and low platelet count) syndrome is a form of severe preeclampsia with high rates of neonatal and maternal morbidity. Magnesium sulfate is the drug of choice to prevent and treat eclampsia. The use of magnesium sulfate for seizure prophylaxis in women with mild preeclampsia is controversial because of the low incidence of seizures in this population.
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Affiliation(s)
- Lawrence Leeman
- University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM 87131, USA.
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Schneider MC, Lapaire O, Hösli I. [Pre-eclampsia and eclampsia]. Anaesthesist 2008; 57:619; author reply 619-20. [PMID: 18537023 DOI: 10.1007/s00101-008-1367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sezik M, Ozkaya O, Sezik HT, Yapar EG. Expectant management of severe preeclampsia presenting before 25 weeks of gestation. Med Sci Monit 2007; 13:CR523-CR527. [PMID: 17968301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The treatment of preeclampsia before 25 weeks of gestation remains controversial. The aim was to evaluate the outcome of expectant management of preeclamptic women presenting prior to 25 weeks of gestation. MATERIAL/METHODS During a five-year period, 55 women presenting with severe preeclampsia at or before 24 weeks and 6 days of gestation were admitted to a high-care unit for expectant management. Indications for delivery were the development of severe maternal morbidity secondary to preeclampsia. Complications were identified from individual patient and infant records. RESULTS Mean prolongation of gestation was 4.8+/-4.1 days (range: 1-13 days) and the mean maternal hospitalization period was 10.0+/-8.3 days (range: 2-31 days). Conservative management was associated with a 94.5% (52/55) intrauterine fetal loss rate. Of the three live-born infants, one died secondary to respiratory distress syndrome followed by neonatal sepsis and the other two survived with cognitive and motor developmental delay. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome was diagnosed in 12 women (21.8%). Nine women (16.3%) required transfusions with blood or blood products. There was 1 case (1.8%) of eclampsia. Overall, 15 women (27.2%) had developed some maternal morbidity without any significant differences between <23 weeks' and >/=23 weeks' gestation. Nulliparity was not associated with stillbirth (p=0.8), HELLP syndrome (p=0.8), or overall maternal morbidity (p=0.7). None of the women died or required any long-term treatment. CONCLUSIONS Conservative management of severe preeclampsia before 25 weeks of gestation is associated with considerable perinatal mortality and morbidity. Maternal complications are relatively common, but generally short-lived.
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Affiliation(s)
- Mekin Sezik
- Department of Obstetrics and Gynecology, Suleyman Demirel University School of Medicine, Isparta, Turkey.
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Suchard JR, Melnick ER. Clinicopathological conference: 29-year-old with visual loss, hypertension, and a seizure. Acad Emerg Med 2007; 14:819-24. [PMID: 17726128 DOI: 10.1197/j.aem.2007.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jeffrey R Suchard
- Department of Emergency Medicine, University of California, Irvine Medical Center, Orange, CA, USA.
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Abstract
INTRODUCTION Pregnancy-induced hypertension, pre-eclampsia and eclampsia are parts of the hypertensive syndrome which is a life-threatening condition both for mother and fetus. Apart from being associated with unpredictable onset, it is incurable, except by ending the pregnancy. Its incidence is approximately between 6 - 10% of pregnant women. There is no unique definition and classification of the hypertensive syndrome in pregnancy, i.e. they differ from one expert group to another. RISKS OF PREGNANCY-INDUCED HYPERTENSION: Pregnancy-induced hypertension syndrome can cause placental abruption, intracranial hemorrhage, liver lesions, acute renal disorders and disseminated intravascular coagulation (DIC), adult respiratory distress syndrome (ARDS), hypervolemia and inhalation of gastric content, due to deep sedation. TREATMENT OF PREGNANCY-INDUCED HYPERTENSION: Delivery is always appropriate therapy for the mother, but may not be a good solution for the fetus. Standard treatment of preeclampsia includes: anticonvulsive therapy, antihypertensive therapy, excessive fluid administration, and if necessary, management of oliguria, DIC, pulmonary edema and recovery of liver function. THE OUTCOME OF PREGNANCY-INDUCED HYPERTENSION (PERINATAL AND MATERNAL MORTALITY): Maternal mortality due to pregnancy-induced hypertension is 15 - 33% out of the total number of maternal deaths. Newborn infants of mothers with pregnancy-induced hypertension present with intrauterine growth retardation, prematurity, dysmaturity and necrotizing enterocolitis. Pregnancy-induced hypertension is one of the major causes of maternal and fetal/neonatal morbidity and mortality.
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Abstract
Eclampsia is an uncommon and serious condition, particularly in the pre-hospital setting. Immediate treatment is required and should include airway control, administration of oxygen, anti-epileptics and magnesium, hypertension control, and urgent delivery of the baby.
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Affiliation(s)
- Alonso A Mateos Rodriguez
- Servicio de Urgencias Medicas de Madrid SUMMA 112, Consejeria de Sanidad, Comurildad de Madrid, Spain.
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Abstract
Hypertensive pregnancy disorders complicate 10% of all pregnancies and cover a spectrum of conditions, namely preeclampsia, eclampsia, and chronic and gestational hypertension. Preeclampsia is a pregnancy-specific disorder clinically characterized by hypertension and proteinuria that occurs after 20 weeks of gestation. It remains a leading cause of both fetal and maternal morbidity and mortality worldwide. Traditionally, hypertensive pregnancy disorders were considered not to have any long-term impact on mothers' cardiovascular health; however, recent studies consistently have supported the role of hypertension in pregnancy as a risk factor for cardiovascular disease later in life. Therefore, improved screening, and preventive and treatment strategies may not only optimize management of hypertensive pregnancy disorders, but may have a long-term impact on women's cardiovascular events and outcomes years after the affected pregnancies. This article will provide a brief review of hypertensive pregnancy disorders and important recent discoveries regarding their pathogeneses, while focusing on current diagnostic and treatment strategies.
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Abstract
We present 2 cases of late postpartum eclampsia in adolescents presenting to the pediatric emergency department, neither of whom had any antepartum symptoms of preeclampsia. The purpose of this report is to discuss the importance of a high index of suspicion for preeclampsia in the postpartum adolescent who complains of headache as well as a need to recognize that seizures and more severe neurological sequelae occurring up to 3 weeks postpartum may be eclamptic in origin.
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Affiliation(s)
- Joseph B Cantey
- Division of Pediatric Emergency Medicine and Critical Care, Medical University of South Carolina, Charleston, SC 29425, USA
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