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Berhan Y, Berhan A. Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia. J Obstet Gynaecol Res 2015; 41:831-42. [DOI: 10.1111/jog.12697] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Yifru Berhan
- Hawassa University College of Medicine and Health Sciences; Hawassa Ethiopia
| | - Asres Berhan
- Hawassa University College of Medicine and Health Sciences; Hawassa Ethiopia
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Hlimi T. Association of anemia, pre-eclampsia and eclampsia with seasonality: A realist systematic review. Health Place 2015; 31:180-92. [DOI: 10.1016/j.healthplace.2014.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 12/04/2014] [Accepted: 12/07/2014] [Indexed: 10/24/2022]
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Beltran AJ, Wu J, Laurent O. Associations of meteorology with adverse pregnancy outcomes: a systematic review of preeclampsia, preterm birth and birth weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 11:91-172. [PMID: 24362545 PMCID: PMC3924438 DOI: 10.3390/ijerph110100091] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 11/24/2022]
Abstract
The relationships between meteorology and pregnancy outcomes are not well known. This article reviews available evidence on the relationships between seasonality or meteorology and three major pregnancy outcomes: the hypertensive disorders of pregnancy (including preeclampsia, eclampsia and gestational hypertension), gestational length and birth weight. In total 35, 28 and 27 studies were identified for each of these outcomes. The risks of preeclampsia appear higher for women with conception during the warmest months, and delivery in the coldest months of the year. Delivery in the coldest months is also associated with a higher eclampsia risk. Patterns of decreased gestational lengths have been observed for births in winter, as well as summer months. Most analytical studies also report decreases in gestational lengths associated with heat. Birth weights are lower for deliveries occurring in winter and in summer months. Only a limited number of studies have investigated the effects of barometric pressure on gestational length or the effects of temperature and sunshine exposure on birth weight, but these questions appear worth investigating further. Available results should encourage further etiological research aiming at enhancing our understanding of the relationships between meteorology and adverse pregnancy outcomes, ideally via harmonized multicentric studies.
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Affiliation(s)
| | - Jun Wu
- Program in Public Health, Anteater Instruction & Research Bldg (AIRB), 653 East Peltason Drive, University of California, Irvine, CA 92697, USA.
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Adu-Bonsaffoh K, Oppong SA, Samuel OA, Binlinla G, Obed SA, Samuel OA. Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana. Int J Gynaecol Obstet 2013; 123:110-3. [PMID: 23969337 DOI: 10.1016/j.ijgo.2013.05.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/01/2013] [Accepted: 07/25/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the contribution of hypertensive disorders of pregnancy to maternal deaths at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. METHODS The retrospective descriptive study conducted at KBTH during 2010-2011 involved a comprehensive review of all maternal deaths attributable to hypertensive disorders. RESULTS There were 21 385 deliveries, 21742 live births, and 199 maternal deaths, resulting in a maternal mortality ratio of 915.3 per 100000 live births. In total, 63 (31.7%) maternal deaths were attributable to hypertensive disorders with a case fatality rate of 3.9%. The incidence of hypertensive disorders of pregnancy was 7.6%. Hypertensive disorders were the most common direct cause of maternal death followed by obstetric hemorrhage (26.6%), unsafe abortion (11.1%), and puerperal sepsis (3.5%). Most (38.1%) hypertension-related maternal deaths occurred within 24hours of admission and the majority (79.4%) had been referred. Eclampsia was the leading immediate cause of hypertension-related death (23.8%), followed by acute renal failure (20.6%), intracerebral hemorrhage (15.9%), and pulmonary edema (12.7%). CONCLUSION Hypertensive diseases are the leading cause of maternal death at KBTH, having overtaken obstetric hemorrhage, with eclampsia, acute renal failure, intracerebral hemorrhage, and pulmonary edema representing the major immediate causes of hypertension-related maternal death.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana.
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KAYEM GILLES, KURINCZUK JENNIFERJ, SPARK PATSY, BROCKLEHURST PETER, KNIGHT MARIAN. Maternal and obstetric factors associated with delayed postpartum eclampsia: a national study population. Acta Obstet Gynecol Scand 2011; 90:1017-23. [DOI: 10.1111/j.1600-0412.2011.01218.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Koopmans CM, Zwart JJ, Groen H, Bloemenkamp KW, Mol BW, Van Pampus MG, Van Roosmalen J. Risk Indicators for Eclampsia in Gestational Hypertension or Mild Preeclampsia at Term. Hypertens Pregnancy 2010; 30:433-46. [DOI: 10.3109/10641955.2010.506236] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rudra CB, Williams MA. Monthly variation in preeclampsia prevalence: Washington state, 1987–2001. J Matern Fetal Neonatal Med 2009; 18:319-24. [PMID: 16390791 DOI: 10.1080/14767050500275838] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We investigated the extent of monthly variation in preeclampsia prevalence among primiparous women in Washington State who delivered from 1987 through 2001. METHODS We identified all primiparae who gave birth to a singleton live infant during the study period using state birth records linked to hospital inpatient discharge data. We obtained a random sample and excluded women with pre-existing hypertension, renal disease, or diabetes mellitus or missing information on estimated date of conception (EDC) (n = 79 298). We defined preeclampsia (n = 6680) according to maternal birth hospitalization diagnosis codes and birth records. We calculated adjusted prevalence odds ratios (PR) and 95% confidence intervals (95% CI) of preeclampsia in each month of conception, relative to the month of lowest prevalence. RESULTS The prevalence of preeclampsia among primiparae was lowest among those conceiving in January (7.7%) and peaked among February, April, and July conceptions (8.9%). After adjustment, prevalence was significantly higher among women conceiving in February and April through August (PRs versus January: 1.14-1.19). CONCLUSIONS The prevalence of preeclampsia among primiparous women in Washington peaks among those conceiving in spring and summer. Exposures with similar monthly fluctuations may contribute to the etiology of preeclampsia.
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Affiliation(s)
- Carole B Rudra
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, WA , USA.
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Abstract
OBJECTIVE To assess seasonal variability in antenatal blood pressure (BP). METHODS We studied 1919 pregnant women who contributed 21,119 antenatal BP measurements. RESULTS BP peaked in winter and reached a nadir in summer. After confounder adjustment, systolic BP was 1.0 to 1.7 mm Hg higher January to May, 0.6 mm Hg higher in September and October, and 0.8 mm Hg higher in November and December compared with August. After stratifying by overweight status, BP showed strong seasonal variability among lean women, whereas there were no seasonal trends among overweight women. CONCLUSION Environmental factors may regulate gestational BP and may be relevant to seasonality of hypertensive disorders of pregnancy.
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Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Ducarme G, Herrnberger S, Pharisien I, Carbillon L, Uzan M. [Eclampsia: retrospective study about 16 cases]. ACTA ACUST UNITED AC 2008; 37:11-7. [PMID: 19119047 DOI: 10.1016/j.gyobfe.2008.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 11/19/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the etiologic factors, circumstances of diagnosis, obstetrical management and complications of eclampsia and to value the maternal and perinatal outcomes. PATIENTS AND METHODS We conducted a retrospective descriptive study, from January 1996 to December 2006 in a maternity type IIB. RESULTS Sixteen cases of eclampsia were studied. The prevalence of eclampsia over the study period was 8.1 per 10,000 births, without annual change in the incidence. The mean age of the patients was 27.8+/-6.7 years. The major risk factor was the primipaternity (87.5%). The eclampsia occurred in ante-, peri- and post-partum in 56, 6 and 38% of the cases, respectively. In cases of eclampsia, 75% of the patients had elevated blood pressure, 93% presented headache, but 62% presented with an atypical form with less than three functional symptoms (headache, visual trouble, hyperreflexia). Various treatments had been started: antihypertensive treatment (75%), antiepileptic treatment (69%) and magnesium sulphate (94%). Eleven patients had developed complications, mainly HELLP syndrome (10 patients). No maternal death was noted. The mean birth weight was 2366+/-818 g, 43.8% of children had birth weight less than the 10th percentile, and 87.5% of children were girls. One fetal and one perinatal death at day 19 had been noted. DISCUSSION AND CONCLUSION Nowadays, the physiopathology of eclampsia remains misunderstood. It is difficult to establish risk factors, the primipaternity being certainly one of these. Eclampsia may occur in an atypical and unforeseeable form in well followed patients, without risk factor. The diagnosis should be done quickly for an adapted treatment and obstetrical management.
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Affiliation(s)
- G Ducarme
- Service de chirurgie gynécologique et d'obstétrique, CHU Jean-Verdier, Assistance publique-Hôpitaux de Paris, université Paris-XIII, Bondy, France.
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Tam WH, Sahota DS, Lau TK, Li CY, Fung TY. Seasonal Variation in Pre-Eclamptic Rate and Its Association with the Ambient Temperature and Humidity in Early Pregnancy. Gynecol Obstet Invest 2008; 66:22-6. [DOI: 10.1159/000114252] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 10/05/2007] [Indexed: 12/16/2022]
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Affiliation(s)
- Baha M Sibai
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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Oghagbon EK, Okesina AB, Adebisi SA. Awareness of atherosclerosis risk factors in Nigeria. ACTA ACUST UNITED AC 2004; 124:180-3. [PMID: 15301317 DOI: 10.1177/146642400412400411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Non-communicable diseases, which include hypertension and diabetes mellitus, have become an important cause of morbidity and mortality in Nigeria. The determination of serum lipid levels is used routinely to assess the risk of atherosclerosis. This study was performed in order to determine the frequency of serum lipid requests in the community. Information on both lipid and total chemical pathology requests for the study period (May 1998 to April 2000) was obtained from the Department of Chemical Pathology, University of Ilorin Teaching Hospital, whilst data on the total hospital attendance was obtained from the hospital's Record Department. The number of serum lipid requests increased from year to year (May 1998 to April 1999 = 780; May 1999 to April 2000 = 1,357; May 2000 to April 2001 = 1,382). The percentages of total requests for serum Lipids when compared with the total laboratory requests for the period of study were 12.0%, 13.3% and 14.0% for the first, second and third year respectively. More men than women had their serum lipid levels determined; 31.3% of the patients had hyper-cholesterolaemia (> 5.2 mmol/L), while 9.9% had values > or = 6.2 mmol/L. Industrial disputes (strikes) affected our results. For the three-year period there was no remarkable increase in the use of the lipid profile facilities available in the centre. This reflects the inadequate awareness of lipid disorders as a risk factor for atherosclerosis.
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Affiliation(s)
- E K Oghagbon
- Department of Chemical Pathology and Immunology, University of Ilorin Teaching Hospital, PMB 1459, Ilorin, Nigeria
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Sibai BM. Magnesium sulfate prophylaxis in preeclampsia: Lessons learned from recent trials. Am J Obstet Gynecol 2004; 190:1520-6. [PMID: 15284724 DOI: 10.1016/j.ajog.2003.12.057] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the US, the routine use of magnesium sulfate for seizure prophylaxis in women with preeclampsia is an ingrained obstetric practice. During the past decade, several observational studies and randomized trials have described the use of various regimens of magnesium sulfate to prevent or reduce the rate of seizures and complications in women with preeclampsia. There are only 2 double-blind, placebo-controlled trials evaluating the use of magnesium sulfate in mild preeclampsia. There were no instances of eclampsia among 181 women assigned to placebo, and there were no differences in the percentage of women who progressed to severe preeclampsia (12.5% in magnesium group vs 13.8% in the placebo group, relative risk [RR] 0.90; 95% CI 0.52-1.54). However, the number of women enrolled in these trials is too limited to draw any valid conclusions. There are 4 randomized controlled trials that compare the use of no magnesium sulfate, or a placebo vs magnesium sulfate, to prevent convulsions in patients with severe preeclampsia. The rate of eclampsia was 0.6% among 6343 patients assigned to magnesium sulfate vs 2.0 % among 6330 patients assigned to a placebo or control (RR 0.39; 95% CI 0.28-0.55). However, the reduction in the rate of eclampsia was not associated with a significant benefit in either maternal or perinatal outcome. In addition, there was a higher rate of maternal respiratory depression among those assigned magnesium sulfate (RR 2.06; 95% CI 1.33-3.18). The evidence to date confirms the efficacy of magnesium sulfate in reduction of seizures in women with eclampsia and severe preeclampsia; however, this benefit does not affect overall maternal and perinatal mortality and morbidities. The evidence regarding the benefit-to-risk ratio of magnesium sulfate prophylaxis in mild preeclampsia remains uncertain, and does not justify its routine use for that purpose.
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Affiliation(s)
- Baha M Sibai
- Department of Obstetrics and Gynecology, University of Cincinnati, Ohio 45267, USA
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Mokoka V. Early postpartum eclampsia complicated by subarachnoid haemorrhage, cerebral oedema and acute hydrocephalus. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2003. [DOI: 10.1080/22201173.2003.10873020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE To obtain evidence for seasonal variability in pre-eclampsia using the assumption that environmental factors may have a role in the causal mechanisms. DESIGN Cross sectional population-based study. POPULATION All 1,869,388 deliveries in Norway in the years 1967 to 1998. METHOD For each month, the percentage of births complicated by pre-eclampsia was calculated. The relative risks of pre-eclampsia by month of delivery were estimated as odds ratios using the month with lowest risk as the reference category. RESULTS Mothers of children born in August had the lowest risk of pre-eclampsia, and the risk was highest in the winter months (for December adjusted OR: 1.26, 95% CI 1.20-1.31). This pattern was independent of parity. maternal age, year and place of living. CONCLUSION The finding may provide a new clue for understanding the causes of pre-eclampsia. Environmental factors that show a similar seasonal variation should be investigated as possible causes.
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Affiliation(s)
- P Magnus
- Section of Epidemiology, National Institute of Public Health, Oslo, Norway
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Dumont A, de Bernis L, Bouvier-Colle MH, Bréart G. Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. Lancet 2001; 358:1328-33. [PMID: 11684214 DOI: 10.1016/s0140-6736(01)06414-5] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Rates of caesarean sections in more-developed countries have been rising since 1970, and vary greatly between less-developed countries. Present estimates, based on data from more-developed countries need to be validated with data from less-developed countries. We estimated the need for caesarean section for maternal indication in a population of pregnant women in west Africa (MOMA survey). METHODS The expected caesarean section rate was calculated from the rate of obstetric risk in the MOMA population, and rates of caesarean section in published work. FINDINGS Three-quarters of women from hospitals of sub-Saharan Africa were delivered by caesarean section for maternal reasons. Such intervention was needed for six main reasons, protracted labour, abruptio placentae, previous caesarean section, eclampsia, placenta praevia, and malpresentation. Although the observed rate of caesarean section in west African women is 1.3%, our results, combined with those of published work suggest a range of 3.6-6.5% (median, 5.4%). INTERPRETATION Our method might not be strictly accurate, but it is simple and provides informative findings that can help policy makers and health planners in sub-Saharan Africa to design and follow up programmes to reach the optimum caesarean section rate. Moreover, application of this method to hospital data could improve practitioners' assessments in these countries.
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Affiliation(s)
- A Dumont
- Epidemiological Research Unit on Women and Children's Health, National Institute of Health and Medical Research (INSERM), Paris, France.
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Muckart DJ, Bhagwanjee S. Ventilation and the critically ill parturient. Best Pract Res Clin Obstet Gynaecol 2001; 15:545-56. [PMID: 11478814 DOI: 10.1053/beog.2001.0199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Positive-pressure ventilation is the keystone in the management of pulmonary dysfunction in the critically ill. An increased understanding of both the benefits and hazards has led to a general consensus regarding the optimal techniques to ensure adequate gas exchange. Unfortunately, the same cannot be said for ventilation terminology which, due to a lack of standardization, lends itself to confusion. Pulmonary dysfunction in the parturient may arise from thoracic or extra-thoracic pathologies but both may be defined as acute lung injury. In its most severe form this constitutes acute respiratory distress syndrome. Acute lung injury results in reduced lung compliance and a marked decrease in the volume of functional lung. Ventilation strategies are now designed to recruit as much available lung tissue as possible while simultaneously minimizing the injurious effects of alveolar over-distension. Upon resolution of the underlying pathology mechanical ventilation may be withdrawn. Recent evidence suggests that this final stage need not be protracted, and if certain criteria are fulfilled, rapid weaning is feasible.
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Affiliation(s)
- D J Muckart
- Department of Surgery, Nelson R Mandela Medical School, University of Natal, Durban, South Africa
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Abstract
In developing countries, obstetric practice, including the performance of caesarean section, is complicated by problems that are no longer seen in developed countries. The various indications for caesarean section might be the same but the operation is often technically more difficult to perform in developing areas. Developing countries lack resources. This chapter highlights the problems encountered in the developing world. Because cephalopelvic disproportion is one of the main indications for performing caesarean section in our sub-region, the technique of delivery of the impacted fetal head is discussed and alternatives to caesarean section are also suggested. The current view on myomectomy at caesarean section is described; including the technique of bloodless myomectomy at caesarean section. It is hoped that, with the training of postgraduate doctors in anaesthesia and obstetrics, the delivery of obstetric care will be accessible to rural areas in the developing world.
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Affiliation(s)
- E Y Kwawukume
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
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Abstract
This review relates nutritional status to pregnancy-related death in the developing world, where maternal mortality rates are typically >/=100-fold higher than rates in the industrialized countries. For 3 of the central causes of maternal mortality (ie, induced abortion, puerperal infection, and pregnancy-induced hypertension), knowledge of the contribution of nutrition is too scanty for programmatic application. Hemorrhage (including, for this discussion, anemia) and obstructed labor are different. The risk of death is greatly increased with severe anemia (Hb <70 or 80 g/L); there is little evidence of increased risk associated with mild or moderate anemia. Current programs of universal iron supplementation are unlikely to have much effect on severe anemia. There is an urgent need to reassess how to approach anemia control in pregnant women. Obstructed labor is far more common in short women. Unfortunately, nutritional strategies for increasing adult stature are nearly nonexistent: supplemental feeding appears to have little benefit after 3 y of age and could possibly be harmful at later ages, inducing accelerated growth before puberty, earlier menarche (and possible earlier marriage), and unchanged adult stature. Deprived girls without intervention typically have late menarche, extended periods of growth, and can achieve nearly complete catch-up growth. The need for operative delivery also increases with increased fetal size. Supplementary feeding could therefore increase the risk of obstructed labor. In the absence of accessible obstetric services, primiparous women <1.5 m in height should be excluded from supplementary feeding programs aimed at accelerating fetal growth. The knowledge base to model the risks and benefits of increased fetal size does not exist.
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Affiliation(s)
- D Rush
- School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
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Abstract
OBJECTIVE This study was undertaken to characterize aspects of the natural history of eclampsia. STUDY DESIGN A retrospective analysis was performed on the records of patients with eclampsia who were delivered at two tertiary care hospitals. RESULTS Fifty-three pregnancies complicated by eclampsia were identified. Thirty-seven of the women were nulliparous. The mean age was 22 years (range, 15-38 years). Mean gestational age at the time of seizures was 34.2 weeks' gestation (range, 22-43 weeks' gestation). Twenty-eight women had antepartum seizures (53%); 23 of the 28 had seizures at home. Nineteen women had intrapartum seizures (36%). Eight of these women had seizures while receiving magnesium sulfate, and 7 had therapeutic magnesium levels. Six women had postpartum seizures (11%), 4 >24 hours after delivery. Headache preceded seizures in 34 cases. Visual disturbance preceded seizures in 16 cases. The uric acid level was elevated to >6 mg/dL in 43 women. There were no maternal deaths or permanent morbidities. There were 4 perinatal deaths. Two patients had intrauterine fetal deaths at 28 and 36 weeks' gestation. These mothers had seizures at home. One infant died of complications of prematurity at 22 weeks' gestation and one died of respiratory complications at 26 weeks' gestation. There were 4 cases of abruptio placentae, 1 of which resulted in fetal death. Of the 53 cases of eclampsia, only 9 were potentially preventable. One of these was that of a woman who was being observed at home. The other 8 women were hospitalized and had hypertension and proteinuria. Only 7 women could be considered to have severe preeclampsia before seizure (13%), and 4 of these 7 women were receiving magnesium sulfate. CONCLUSIONS Eclampsia was not found to be a progression from severe preeclampsia. In 32 of 53 cases (60%) seizures were the first signs of preeclampsia. In this series eclampsia appeared to be more of a subset of preeclampsia. Only 9 cases of eclampsia were potentially preventable with current standards of practice. Our paradigm for this disease, as well as our approach to seizure prophylaxis, should be reevaluated.
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Affiliation(s)
- V L Katz
- Center for Genetic and Maternal-Fetal Medicine, Sacred Heart Medical Center, Eugene, OR 97401, USA
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Bhagwanjee S, Paruk F, Moodley J, Muckart DJ. Intensive care unit morbidity and mortality from eclampsia: an evaluation of the Acute Physiology and Chronic Health Evaluation II score and the Glasgow Coma Scale score. Crit Care Med 2000; 28:120-4. [PMID: 10667510 DOI: 10.1097/00003246-200001000-00020] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the maternal morbidity and mortality in patients with eclampsia admitted to an intensive care unit (ICU), and to establish the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the organ system failure score as defined by Knaus, and the Glasgow Coma Scale (GCS) score in predicting outcome. DESIGN Retrospective analysis of a 3.5-yr period. SETTING Surgical ICU in a university hospital. PATIENTS A total of 105 patients who were admitted with a diagnosis of eclampsia were studied. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The data captured included the reason for admission, maternal age, gestational age, parity, number of seizures, duration of ICU stay, anticonvulsant therapy, drug therapy, GCS score, APACHE II score, and the occurrence of organ failure. Of the 126 patients with eclampsia who were admitted to the ICU, records of 105 patients (83%) were found. The overall mortality was 10.5% (n = 11). The mean age, gestation, parity, number of preadmission seizures, and duration of stay were similar in survivors and nonsurvivors. Although the APACHE II score was significantly higher in nonsurvivors, multiple logistic regression analysis suggested that the goodness-of-fit scores for GCS and APACHE II were similar (38.29 vs. 38.01). The GCS scores of survivors were significantly higher than those of nonsurvivors (10.61 vs. 5.0; p<.001). Respiratory failure was the most common organ failure in both groups. The mean number of organ failures was higher in nonsurvivors compared with survivors (2.9 vs. 1.3; p<.001). An occurrence of more than two organ failures that persisted for >48 hrs was invariably associated with a fatal outcome. Anticonvulsant therapy consisted of magnesium sulfate or phenytoin and a midazolam infusion. Only one patient (0.9%) had a seizure, and this occurred en route to the ICU. No seizures occurred after admission to the ICU. CONCLUSIONS The organ system failure score and the GCS score are good predictors of outcome in eclampsia. Apart from the GCS score, other variables in the APACHE II score are not valuable for outcome prediction. The low GCS score in nonsurvivors suggests that closer attention to the neurologic management may be beneficial. A prospective study is indicated to validate these findings.
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Affiliation(s)
- S Bhagwanjee
- Department of Anaesthetics, University of Natal Medical School, Durban, South Africa
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Abstract
Hypertensive disease remains second only to embolic phenomena as a leading cause of maternal mortality. This article covers the major physiologic and pathologic findings to be considered when managing pregnant women with eclampsia. Attention to detail and an increased degree of suspicion will improve fetal and maternal outcomes.
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Affiliation(s)
- K D Ramin
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
OBJECTIVE To measure the incidence of eclampsia, its maternal and perinatal outcomes and patterns of presentation of this disease in our environment. METHOD Retrospective descriptive study of 164 cases of eclampsia managed at the Hospital Universitario del Valle, Cali, Colombia from September 1993 to August 1995. Information was collected from reviews of hospital case-notes. RESULTS The incidence of eclampsia was 8.1/1000 deliveries. Maternal mortality was 6.1%. Fifty-seven percent of seizures occurred antepartum, 22% during labor, and 21% after delivery. Sixty-nine cases (42%) presented preterm. Ninety-eight women (60%) were nulliparous. Approximately one quarter of the women did not have hypertension or significant proteinuria at the time of seizures. Twenty percent of all women had at least one major complication. Perinatal mortality was 12.8%. Antepartum and postpartum cases were more severe than intrapartum cases. CONCLUSION Eclampsia occurs in one in 124 deliveries in Cali, Colombia and is associated with high maternal and perinatal morbidity and mortality.
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Affiliation(s)
- A Conde-Agudelo
- Department of Obstetrics and Gynecology, Carlos Holmes Trujillo Hospital, Cali, Colombia
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Falkowski I, Procopio M, Tosetto P. Obstetric complications and schizophrenia. Br J Psychiatry 1996; 169:383. [PMID: 8879734 DOI: 10.1192/bjp.169.3.383a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
The aim of this study is to investigate the maternal and fetal outcome and the risk factors for developing eclampsia in Kuwait. The study includes all patients with eclampsia observed at the Maternity Hospital, Kuwait during the period from 1981 to 1993. It revealed that the risk factors predisposing to eclampsia were primiparity, a maternal age below 30 years, multiple pregnancy and the presence of preeclampsia. The pregnancy outcome in terms of the stillbirth rate, neonatal death rate and low birth-weight babies was significantly higher in mothers with eclampsia than in noneclamptic mothers. The operative delivery and maternal mortality rates were also significantly higher in these patients.
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