1
|
Coral-Almeida M, Sánchez ME, Henríquez-Trujillo AR, Barriga-Burgos M, Alarcón-Moyano E, Tejera E. Ethnic, geographical and altitude considerations and maternal mortality associated with HELLP syndrome in Ecuador: a population-based cohort study. BMC Pregnancy Childbirth 2024; 24:585. [PMID: 39244549 PMCID: PMC11380354 DOI: 10.1186/s12884-024-06778-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/23/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Eclampsia and pre-eclampsia rank as the third leading causes of maternal death in Ecuador, following pre-existing chronic diseases and postpartum haemorrhage, as reported by the Ecuadorian National Institute of Statistics and Census (INEC). In contrast, HELLP (Haemolysis, Elevated Liver enzymes, Low Platelet count) syndrome remains underexplored epidemiologically, not only in Latin America but globally. This study marks the first population-based investigation into HELLP syndrome incidence and mortality in Ecuador, examining geographical variations, altitude influences and ethnic backgrounds. METHODS Conducted as a retrospective population-based cohort study from 2015 to 2017, this research delves into the incidence, risk factors and maternal mortality associated with HELLP syndrome in Ecuador. Utilising data from INEC and the Ecuadorian Ministry of Health, we identified HELLP syndrome cases through ICD-10 (International Classification of Diseases, tenth revision) coding in hospitalised individuals. Logistic regression analysis was employed to explore association, whilst geospatial statistical analysis focused on cantons to identify significant spatial clusters. Primary outcome measures include HELLP syndrome incidence and maternal mortality, supplying crucial insights into the syndrome's impact on maternal health in Ecuador. RESULTS The incidence of HELLP syndrome is 0.76 (0.69-0.84)/ 1000 deliveries. Afro-Ecuadorian communities have a higher risk (Odds Ratio (OR) = 2.18 (1.03-4.63)) compared to Indigenous Ecuadorian communities. Living at mid-level or high altitude is a significant risk factor OR of 2.79 (2.19-3.55) and an OR 3.61 (2.58-5.03), respectively. Being an older mother was also identified as a risk factor. Women living more than 20 km from the obstetric unit have an OR of 2.55 (2.05-3.18). Moreover, we found that cantons with higher crude HELLP syndrome incidence also have lower numbers of physicians (R = 0.503, p-value < 0.001). The mortality incidence of women with HELLP syndrome is 21.22 (12.05-20.59)/1000 deliveries with HELLP syndrome diagnoses. CONCLUSIONS High altitude, advanced maternal age and geographical distance between residence and health centres are risk factors for HELLP syndrome. Maternal mortality in women with HELLP syndrome is higher than pre-eclampsia and eclampsia but comparable with previous reports in other countries.
Collapse
Affiliation(s)
- Marco Coral-Almeida
- Facultad de Ciencias de la Salud, Carrera de Medicina Veterinaria, Universidad de Las Américas, Quito, Ecuador.
- Grupo de Bioquimioinformática, Universidad de Las Américas, Quito, Ecuador.
| | | | | | - María Barriga-Burgos
- Facultad de Ciencias de la Salud, Carrera de Medicina Veterinaria, Universidad de Las Américas, Quito, Ecuador
| | - Evelyn Alarcón-Moyano
- Facultad de Medicina Veterinaria, Máster en Salud Global, Universidad de Zaragoza, Zaragoza, Spain
| | - Eduardo Tejera
- Facultad de Ingeniería y Ciencias Aplicadas, Universidad de Las Américas, Quito, Ecuador.
- Grupo de Bioquimioinformática, Universidad de Las Américas, Quito, Ecuador.
| |
Collapse
|
2
|
De Oliveira L, Korkes H, Rizzo MD, Siaulys MM, Cordioli E. Magnesium sulfate in preeclampsia: Broad indications, not only in neurological symptoms. Pregnancy Hypertens 2024; 36:101126. [PMID: 38669914 DOI: 10.1016/j.preghy.2024.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
The role of magnesium sulfate for treatment of eclampsia is well established. The medication proved to be superior to other anticonvulsants to reduce the incidence of recurrent convulsions among women with eclampsia. Additionally, magnesium sulfate has been indicated for women with preeclampsia with different severe features. However, despite these recommendations, many clinicians are still not confident with the use of magnesium sulfate, even in settings with high incidence of preeclampsia and unacceptable rates of maternal mortality. This review brings basic science and clinical information to endorse recommendations to encourage clinicians to use magnesium sulfate for patients with all severe features of preeclampsia, not only for women with neurological symptoms. Additionally, other benefits of magnesium sulfate in anesthesia and fetal neuroprotection are also presented. Finally, a comprehensive algorithm presents recommendations to manage patients with preeclampsia with severe features between 34 and 36+6 weeks.
Collapse
Affiliation(s)
- Leandro De Oliveira
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil; Department of Gynecology & Obstetrics, Sao Paulo State University (UNESP), Medical School, Botucatu, SP, Brazil.
| | - Henri Korkes
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil; Department of Obstetrics and Gynecology, Faculty of Medicine, Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brazil
| | - Marina de Rizzo
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil
| | - Monica Maria Siaulys
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil
| | - Eduardo Cordioli
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil
| |
Collapse
|
3
|
Adeyeye OV, Ebubechukwu NV, Olanrewaju OF, Eniayewun AG, Nwuta C, Effiong FB, Unim B. Management and Prevention of Pre-Eclampsia in Nigeria. Healthcare (Basel) 2023; 11:1832. [PMID: 37444666 DOI: 10.3390/healthcare11131832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This research paper analyses the management and prevention of pre-eclampsia in Nigeria. Although efforts have been made to reduce outcomes due to pre-eclampsia, it still rears its head in the form of high maternal and perinatal morbidity and mortality. The aim of this review was to identify the main obstacles, gaps, and interventions related to the prevention and management of pre-eclampsia in order to be fully knowledgeable of the magnitude of the issue at the national level, to assess if current government policies are adequate and to recommend solutions. A search was performed on online databases and it was completed with hand searches related to the subject matter. Screening tests for early detection of pre-eclampsia are hardly available in Nigeria as many hospitals rely on the history of previous and current pregnancies, blood pressure monitoring and urinalysis-proteinuria. The administration of low-dose aspirin, antihypertensive drugs and magnesium sulphate, coupled with calcium in calcium deficit regions, was recommended. The main barriers to the wider implementation of these strategies are inadequacy of the antenatal care services in providing appropriate care, lack of resources and trained personnel, high healthcare costs, and low antennal care attendance. Improving education and awareness, use of low-cost screening modalities and low-dose aspirin can be deployed in developing countries to curb pre-eclampsia.
Collapse
Affiliation(s)
- Oluwabunmi Victoria Adeyeye
- Directorate of Research, TORASIF, Calabar 540004, Nigeria
- Department of Medicine and Surgery, University of Ibadan, Ibadan 200005, Nigeria
| | - Nwikwu Vivian Ebubechukwu
- Directorate of Research, TORASIF, Calabar 540004, Nigeria
- Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Nsukka 410001, Nigeria
| | - Omotayo Faith Olanrewaju
- Directorate of Research, TORASIF, Calabar 540004, Nigeria
- Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Nsukka 410001, Nigeria
| | - Aderayo Grace Eniayewun
- Directorate of Research, TORASIF, Calabar 540004, Nigeria
- Department of Medicine and Surgery, University of Ibadan, Ibadan 200005, Nigeria
| | - Chidinma Nwuta
- Directorate of Research, TORASIF, Calabar 540004, Nigeria
- Department of Medicine and Surgery, University of Ibadan, Ibadan 200005, Nigeria
| | - Fortune Benjamin Effiong
- Directorate of Research, TORASIF, Calabar 540004, Nigeria
- Faculty of Medical Laboratory Science, University of Calabar, Calabar 540004, Nigeria
- African Community for Systematic Reviews and Meta-Analyses (ACSRM), Kigali 4285, Rwanda
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162 Rome, Italy
| |
Collapse
|
4
|
Preeclampsia: Narrative review for clinical use. Heliyon 2023; 9:e14187. [PMID: 36923871 PMCID: PMC10009735 DOI: 10.1016/j.heliyon.2023.e14187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Aim Preeclampsia is a very complex multisystem disorder characterized by mild to severe hypertension. Methods PubMed and the Cochrane Library were searched from January 1, 2002 to March 31, 2022, with the search terms "pre-eclampsia" and "hypertensive disorders in pregnancy". We also look for guidelines from international societies and clinical specialty colleges and we focused on publications made after 2015. Results The primary issue associated with this physiopathology is a reduction in utero-placental perfusion and ischemia. Preeclampsia has a multifactorial genesis, its focus in prevention consists of the identification of high and moderate-risk clinical factors. The clinical manifestations of preeclampsia vary from asymptomatic to fatal complications for both the fetus and the mother. In severe cases, the mother may present renal, neurological, hepatic, or vascular disease. The main prevention strategy is the use of aspirin at low doses, started from the beginning to the end of the second trimester and maintained until the end of pregnancy. Conclusion Preeclampsia is a multisystem disorder; we do not know how to predict it accurately. Acetylsalicylic acid at low doses to prevent a low percentage, especially in patients with far from term preeclampsia. There is evidence that exercising for at least 140 min per week reduces gestational hypertension and preeclampsia. Currently, the safest approach is the termination of pregnancy. It is necessary to improve the prediction and prevention of preeclampsia, in addition, better research is needed in the long-term postpartum follow-up.
Collapse
|
5
|
Yousefzadeh Y, Soltani-Zangbar MS, Kalafi L, Tarbiat A, Shahmohammadi Farid S, Aghebati-Maleki L, Parhizkar F, Danaii S, Taghavi S, Jadidi-Niaragh F, Samadi Kafil H, Mahmoodpoor A, Ahmadian Heris J, Hojjat-Farsangi M, Yousefi M. Evaluation of CD39, CD73, HIF-1α, and their related miRNAs expression in decidua of preeclampsia cases compared to healthy pregnant women. Mol Biol Rep 2022; 49:10183-10193. [PMID: 36048381 DOI: 10.1007/s11033-022-07887-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Preeclampsia (PE) molecular mechanisms are not fully revealed and different biological processes are involved in the pathogenesis of PE. We aimed to evaluate adenosine and hypoxia-related signaling molecules in PE patients in the current study. METHODS Decidua tissue and peripheral blood samples were taken from 25 healthy pregnant and 25 PE women at delivery time. CD39, CD73, and Hypoxia-inducible factor-alpha (HIF-α) were evaluated in mRNA and protein level using real-time PCR and western blotting techniques, respectively. Also, miR-30a, miR-206, and miR-18a expression were evaluated by real-time PCR. At last, secretion levels of IGF and TGF-β in the taken serum of blood samples were measured by ELISA. RESULTS Our results revealed that Expression of CD39 is decreased in PE cases versus healthy controls at mRNA and protein levels (p = 0.0003 for both). CD73 and HIF-α showed an increased level of expression in PE patients at RNA and protein status (p = 0.0157 and p < 0.0001 for protein evaluation of CD73 and HIF-α, respectively). The miRNA-30a (p = 0.0037) and miR-206 (p = 0.0113) showed elevated expression in the decidua of the PE group. The concentration of secreted IGF-1 (p = 0.0002) and TGF-β (p = 0.0101) in serum samples of PE cases compared to the healthy group were decreased. CONCLUSION In conclusion, our results showed that aberrant expression of molecules that are involved in ATP catabolism and the hypoxic conditions is observed in PE cases and involved in their hypertension and inflammation could be served as PE prognosis by more confirming in comprehensive future studies. miR-206 and miR-30a play a role by regulating CD39 and CD73 as molecules that are involved in ATP catabolism as well as regulating the production of IGF-1 in the process of hypertension, which is the main feature in patients with preeclampsia. On the other hand, decreased level of miR-18a lead to upregulation of HIF-1a, and the consequence condition of hypoxia increases hypertension and inflammation in these patients.
Collapse
Affiliation(s)
- Yousef Yousefzadeh
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, PO Box: 516-6615573, Tabriz, Iran
| | - Mohammad Sadegh Soltani-Zangbar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, PO Box: 516-6615573, Tabriz, Iran
| | - Ladan Kalafi
- Gynecology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Tarbiat
- Department of Cardiology, Medical Faculty, Urmia University of Medical Sciences, Urmia, Iran
| | - Sima Shahmohammadi Farid
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, PO Box: 516-6615573, Tabriz, Iran
| | | | - Forough Parhizkar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Danaii
- Gynecology Department, Eastern Azerbaijan ACECR ART Center, Eastern Azerbaijan Branch of ACECR, Tabriz, Iran
| | - Simin Taghavi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Jadidi-Niaragh
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, PO Box: 516-6615573, Tabriz, Iran
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Ahmadian Heris
- Department of Allergy and Clinical Immunology, Pediatric Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hojjat-Farsangi
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, PO Box: 516-6615573, Tabriz, Iran.
| |
Collapse
|
6
|
Lazo-Vega L, Toledo-Jaldin L, Badner A, Barriga-Vera JL, Castro-Monrroy M, Euser AG, Larrea-Alvarado A, Lawrence I, Mérida C, Mizutani R, Pérez Y, Rocabado S, Vargas M, Vasan V, Julian CG, Moore LG. ACOG and local diagnostic criteria for hypertensive disorders of pregnancy (HDP) in La Paz-El Alto, Bolivia: A retrospective case-control study. LANCET REGIONAL HEALTH. AMERICAS 2022; 9:100194. [PMID: 35719175 PMCID: PMC9205446 DOI: 10.1016/j.lana.2022.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal death in low- to middle-income countries (LMIC). The American College of Obstetricians and Gynecologists (ACOG) updated diagnostic guidelines to align signs and symptoms with those associated with maternal death. We performed an observational study to ask whether ACOG guidelines were employed and associated with adverse outcomes in La Paz-El Alto, Bolivia, an LMIC. Methods Medical records for all HDP discharge diagnoses (n = 734) and twice as many controls (n = 1647) were reviewed for one year at the three largest delivery sites. For the 690 cases and 1548 controls meeting inclusion criteria (singleton, 18-45 maternal age, local residence), health history, blood pressures, symptoms, lab tests, HDP diagnoses (i.e., gestational hypertension [GH]; preeclampsia [PE]; haemolysis, low platelets, high liver enzymes [HELLP] syndrome, eclampsia), and adverse outcomes were recorded. Bolivian diagnoses were compared to ACOG guidelines using accuracy analysis and associated with adverse outcomes by logistic regression. Findings Both systems agreed with respect to eclampsia, but only 27% of all Bolivian HDP diagnoses met ACOG criteria. HDP increased adverse maternal- or perinatal-outcome risks for both systems, but ACOG guidelines enabled more pre-delivery diagnoses, graded maternal-risk assessment, and targeting of HDP terminating in maternal death. Interpretation Bolivia diagnoses agreed with ACOG guidelines concerning end-stage disease (eclampsia) but not the other HDP due mainly to ACOG's recognition of a broader range of severe features. ACOG guidelines can aid in identifying pregnancies at greatest risk in LMICs, where most maternal and perinatal deaths occur. Funding NIH TW010797, HD088590, HL138181, UL1 TR002535.
Collapse
Affiliation(s)
- Litzi Lazo-Vega
- Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia
| | | | - Abraham Badner
- Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia
| | | | | | - Anna G. Euser
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, MS 8913, 12700 E 19th Avenue, Aurora, CO 80045, USA
| | | | - Ian Lawrence
- University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Carola Mérida
- Universidad Major de San Andrés, Escuela de Medicina, La Paz, Bolivia
| | | | | | - Sebastian Rocabado
- Universidad Nuestra Señora de La Paz, Escuela de Medicina, La Paz, Bolivia
| | | | - Vikram Vasan
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Colleen G. Julian
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Lorna G. Moore
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, MS 8913, 12700 E 19th Avenue, Aurora, CO 80045, USA
| |
Collapse
|
7
|
De Barros JFS, Amorim MM, De Lemos Costa DG, Katz L. Factors associated with severe maternal outcomes in patients with eclampsia in an obstetric intensive care unit: A cohort study. Medicine (Baltimore) 2021; 100:e27313. [PMID: 34559147 PMCID: PMC8462604 DOI: 10.1097/md.0000000000027313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/04/2021] [Indexed: 01/05/2023] Open
Abstract
To describe the clinical profile, management, maternal outcomes and factors associated with severe maternal outcome (SMO) in patients admitted for eclampsia.A retrospective cohort study was carried out. All women admitted to the Obstetric Intensive Care Unit (ICU) at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Northeast of Brazil, from April 2012 to December 2019 were considered for inclusion and patients with the diagnosis of eclampsia were selected. Patients who, after reviewing their medical records, did not present a diagnosis of eclampsia were excluded from the study. Severe maternal outcome (SMO) was defined as all cases of near miss maternal mortality (MNM) plus all maternal deaths during the study period. The Risk Ratio (RR) and its 95% confidence interval (95% CI) were calculated as a measure of the relative risk. Multiple logistic regression analysis was performed to control confounding variables. The institute's internal review board and the board waived the need of the informed consent.Among 284 patients with eclampsia admitted during the study period, 67 were classified as SMO (23.6%), 63 of whom had MNM (22.2%) and 5 died (1.8%). In the bivariate analysis, the following factors were associated with SMO: age 19 years or less (RR = 0.57 95% CI 0.37-0.89, P = .012), age 35 years or more (RR = 199 95% CI 1.18-3.34, P = .019), the presence of associated complications such as acute kidney injury (RR = 3.85 95% CI 2.69-5.51, P < .001), HELLP syndrome (RR = 1.81 95% CI 1.20-2.75, P = .005), puerperal hemorrhage (PPH) (RR = 2.15 95% CI 1.36-3.40, P = .003) and acute pulmonary edema (RR = 2.78 95% CI 1.55-4.96, P = .008). After hierarchical multiple logistic regression analysis, the factors that persisted associated with SMO were age less than or equal to 19 years (ORa = 0.46) and having had PPH (ORa = 3.33).Younger age was a protective factor for developing SMO, while those with PPH are more likely to have SMO.
Collapse
Affiliation(s)
- Joanna Francyne Silva De Barros
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
- Stricto Sensu Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira , Recife, Pernambuco, Brazil
| | - Melania Maria Amorim
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
- Stricto Sensu Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira , Recife, Pernambuco, Brazil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
- Stricto Sensu Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira , Recife, Pernambuco, Brazil
| |
Collapse
|
8
|
Wang L, Tang D, Zhao H, Lian M. Evaluation of Risk and Prognosis Factors of Acute Kidney Injury in Patients With HELLP Syndrome During Pregnancy. Front Physiol 2021; 12:650826. [PMID: 33790806 PMCID: PMC8005627 DOI: 10.3389/fphys.2021.650826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome complicated with acute renal failure (AKI) is an important cause of maternal mortality and morbidity. The present retrospective study aims to identify risk and prognosis factors that are associated with AKI in patients with HELLP syndrome during pregnancy. A total of 110 pregnant HELLP patients with or without AKI from an 8-year period were studied. 65 of the patients were diagnosed with AKI based on the Kidney Disease Outcomes Quality Initiative criteria. Levels of the lowest hemoglobin and highest serum creatinine and bleeding incidence were identified as independent risk factors for AKI onset. Infection and serum creatinine level were identified as independent risk factors for maternal mortality. In addition, we also found that these factors were significantly different in AKI patients of different severity. The overall complete recovery rate was 67.7% (44 out of 65) for patients with AKI. The overall death rate was 4.5% (5 out of 110), where one of the patient was from the non-AKI group and the other four were from the AKI group. Our results provide valuable indications for clinical doctors during their diagnosis, treatment, and monitoring of recovery status in HELLP patients complicated with AKI.
Collapse
Affiliation(s)
- Lijuan Wang
- Department of Emergency, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Dongjie Tang
- Department of Emergency, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Haijun Zhao
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China
| | - Mingfeng Lian
- Department of Emergency, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| |
Collapse
|
9
|
Nyuydzefon B, Bonaventure J, Raissa Bifouna I, Agnes E. Complications of severe pre-eclampsia associated with acute intestinal intussusception—A case report. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.4103/joacc.joacc_93_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
10
|
Verschueren KJC, Paidin RR, Broekhuis A, Ramkhelawan OSS, Kodan LR, Kanhai HHH, Browne JL, Bloemenkamp KWM, Rijken MJ. Why magnesium sulfate 'coverage' only is not enough to reduce eclampsia: Lessons learned in a middle-income country. Pregnancy Hypertens 2020; 22:136-143. [PMID: 32979728 DOI: 10.1016/j.preghy.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Determine the eclampsia prevalence and factors associated with eclampsia and recurrent seizures in Suriname and evaluate quality-of-care indicator 'magnesium sulfate (MgSO4) coverage'. STUDY DESIGN A two-year prospective nationwide cohort study was conducted in Suriname and included women with eclampsia at home or in a healthcare facility. MAIN OUTCOME MEASURES We calculated the prevalence by the number of live births obtained from vital registration. Risk factor denominator data concerned hospital births. Descriptive statistics and multivariate regression analysis were performed. RESULTS Seventy-two women with eclampsia (37/10.000 live births) were identified, including two maternal deaths (case-fatality 2.8%). Nulliparity, African-descent and adolescence were associated with eclampsia. Adolescents with eclampsia had significantly lower BPs (150/100 mmHg) than adult women (168/105 mmHg). The first seizure occurred antepartum in 54% (n = 39/72), intrapartum in 19% (n = 14/72) and postpartum in 26% (n = 19/72). Recurrent seizures were observed in 60% (n = 43/72). MgSO4 was administered to 99% (n = 69/70) of women; however 26% received no loading dosage and, in 22% of cases MgSO4 duration was <24 h, i.e. guideline adherence existed in only 43%. MgSO4 was ceased during CS in all women (n = 40). Stable BP was achieved before CS in 46%. The median seizure-to-delivery interval was 27 h, and ranged from four to 36 h. CONCLUSION Solely 'MgSO4 coverage' is not a reliable quality-of-care indicator, as it conceals inadequate MgSO4 dosage and timing, discontinuation during CS, stabilization before delivery, and seizure-to-delivery interval. These other quality-of-care indicators need attention from the international community in order to reduce the prevalence of eclampsia.
Collapse
Affiliation(s)
- Kim J C Verschueren
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands.
| | - Rubinah R Paidin
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Annabel Broekhuis
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | - Lachmi R Kodan
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands; Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname; Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Humphrey H H Kanhai
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Joyce L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands.
| | - Marcus J Rijken
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands; Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
| |
Collapse
|
11
|
Yifu P, Lei Y, Yujin G, Xingwang Z, Shaoming L. Shortened postpartum magnesium sulfate treatment vs traditional 24h for severe preeclampsia: a systematic review and meta-analysis of randomized trials. Hypertens Pregnancy 2020; 39:186-195. [PMID: 32338165 DOI: 10.1080/10641955.2020.1753067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: This meta-analysis aimed to compare the benefits and risks of shortened magnesium sulfate with traditional 24 h for severe postpartum preeclampsia.Methods: We systematically searched the Cochrane, Embase, Web of science and Pubmed database from inception till May 15 2019. Studies included type is limited to randomized controlled trial (RCT). Pooled risks difference (RDs), odds risks (ORs), mean difference (MD), standard mean difference (SMD) and 95% confifidence intervals (CIs) were used to summarize the effect sizes.Results: Totally studies included are 7 randomized controlled trials (RCTs). Shortened magnesium sulfate treatment has the same risk as eclampsia (RD 0.00, 95%CI-0.01-0.01) and total complications (OR 0.78, 95% CI 0.53-1.15), however, significant difference was observed in both groups pertaining to flushing (OR 0.40, 95% CI 0.20-0.82), and the need for prolonged treatment (RD 0.05, 95% CI 0.01 - 0.1), Others factors,namely the benefits of shortened magnesium sulfate treatment,showed differences in both groups.Conclusions: Shortened postpartum magnesium sulfate treatment was as effective as traditional 24 h magnesium sulfate in seizure prevention and total complications. But flushing and needed for prolonged treatment in the shortened groups warrants further research.
Collapse
Affiliation(s)
- Pu Yifu
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China
| | - Yan Lei
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China.,School of Medicine, Shandong University, Jinan, China
| | - Guo Yujin
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China
| | - Zhu Xingwang
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China
| | - Lu Shaoming
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affifiliated to Shandong University, Jinan, China
| |
Collapse
|
12
|
González-Fernández D, Pons EDC, Rueda D, Sinisterra OT, Murillo E, Scott ME, Koski KG. Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort. Front Public Health 2020; 8:86. [PMID: 32292772 PMCID: PMC7121149 DOI: 10.3389/fpubh.2020.00086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Ambulatory blood pressure is a potential tool for early detection of complications during pregnancy, but its utility in impoverished settings has not been assessed. This cross-sectional study aimed to determine whether maternal infections, nutrient deficiencies and inflammation (MINDI) were associated with four measures of maternal blood pressure (BP) and to determine their association with symphysis-fundal-height (SFH). Methods: Environmental and dietary factors, intake of iron and a multiple-nutrient supplement (MNS), markers of inflammation, protein, anemia, folate, vitamins B12, A and D status, and urogenital, skin, oral and intestinal nematode infections were measured in indigenous pregnant Panamanian women. Stepwise multiple linear and logistic regression models explored determinants of systolic and diastolic blood pressure (SBP, DBP), hypotension (SBP < 100 and DBP < 60), mean arterial pressure (MAP), elevated MAP (eMAP), and pulse pressure (PP). Associations of BP with intestinal nematodes and with SFH Z scores (≥16 wk) were also explored. Results: Despite absence of high SBP or DBP, 11.2% of women had eMAP. Furthermore, 24.1% had hypotension. Linear regression showed that hookworm infection was associated with higher SBP (P = 0.049), DBP (P = 0.046), and MAP (P = 0.016), whereas Ascaris was associated with lower DBP (P = 0.018) and MAP (P = 0.028). Trichomonas was also associated with lower SBP (P < 0.0001) and MAP (P = 0.009). The presence of Trichuris (OR: 6.7, 95% CI 1.0-44.5) and folic acid deficiency (OR: 6.9, 95% CI 1.4-33.8) were associated with increased odds of eMAP. The odds of low BP was higher in the presence of Ascaris (OR: 3.63 ± 2.28, P = 0.040), but odds were lowered by MNS (OR: 0.35 ± 0.11, P = 0.001), more intake of animal-source foods/wk (OR: 0.7, 95% CI 0.5-0.9) and by higher concentrations of IL-17 (OR: 0.87 ± 0.05, P = 0.016). Conclusion: MINDI were bi-directionally associated with blood pressure indicators. In this MINDI cohort, infections, nutrients and cytokines both raised, and lowered BP indices. The presence of eMAP identified pregnant women at risk of hypertension whereas low PP was associated with lower SFH. Therefore, MAP and PP may help in detecting women at risk of adverse pregnancy outcomes in settings with limited access to technology.
Collapse
Affiliation(s)
- Doris González-Fernández
- School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University (Macdonald Campus), Ste-Anne-de-Bellevue, QC, Canada
| | | | - Delfina Rueda
- "Comarca Ngäbe-Buglé" Health Region, Ministry of Health, San Félix, Panama
| | | | - Enrique Murillo
- Department of Biochemistry, University of Panama, Panama City, Panama
| | - Marilyn E Scott
- Faculty of Agricultural and Environmental Sciences, Institute of Parasitology, McGill University, Ste-Anne-de-Bellevue, QC, Canada
| | - Kristine G Koski
- School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University (Macdonald Campus), Ste-Anne-de-Bellevue, QC, Canada
| |
Collapse
|
13
|
Ye W, Shu H, Wen Y, Ye W, Li H, Qin Y, Chen L, Li X. Renal histopathology of prolonged acute kidney injury in HELLP syndrome: a case series and literature review. Int Urol Nephrol 2019; 51:987-994. [PMID: 30989562 DOI: 10.1007/s11255-019-02135-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Acute kidney injury (AKI) is a severe complication of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. However, renal pathological investigation of AKI in this syndrome has rarely been reported. We aimed to evaluate the renal pathological changes of persistent AKI and its relationship with renal outcomes in HELLP syndrome. METHODS Women with HELLP syndrome who had a renal biopsy because of persistent AKI were investigated. The cases describing renal pathology of AKI in HELLP syndrome reported in PubMed were also reviewed. RESULTS Among the 41 patients diagnosed with AKI complicated by HELLP syndrome, 6 patients had renal biopsy. Four of these patients had anuria and required renal replacement therapy. Renal histopathology showed thrombotic microangiopathy (TMA) that coexisted with acute tubular necrosis (ATN) (3), acute renal cortical necrosis (ARCN) (1), and glomerular disease (2). Two patients who had ARCN and ATN with TMA lesions developed chronic renal dysfunction. Ten cases reported in the literature showed ATN (4), TMA (1), TMA with ATN (1), ARCN (2) and mesangial proliferative glomerulonephritis (1). All of them required temporary renal replacement therapy. Two patients developed chronic renal dysfunction including one patient with ARCN. CONCLUSIONS ATN was the most common finding for persistent AKI in HELLP syndrome. Patients with ARCN or TMA with ATN may have the potential to develop chronic renal dysfunction. Renal biopsy should be performed in patients with prolonged AKI to determine the renal prognosis and guide the appropriate treatment.
Collapse
Affiliation(s)
- Wenling Ye
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuifuyuan 1, Wangfujing, Beijing, 100730, China
| | - Hong Shu
- Department of Nephrology, Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Yubing Wen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuifuyuan 1, Wangfujing, Beijing, 100730, China
| | - Wei Ye
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuifuyuan 1, Wangfujing, Beijing, 100730, China
| | - Hang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuifuyuan 1, Wangfujing, Beijing, 100730, China
| | - Yan Qin
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuifuyuan 1, Wangfujing, Beijing, 100730, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuifuyuan 1, Wangfujing, Beijing, 100730, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuifuyuan 1, Wangfujing, Beijing, 100730, China.
| |
Collapse
|
14
|
Acute kidney injury in patients with HELLP syndrome. Int Urol Nephrol 2019; 51:1199-1206. [PMID: 30989565 DOI: 10.1007/s11255-019-02111-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the risk factors and renal prognosis of acute kidney injury (AKI) in patients with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. METHODS Women with HELLP syndrome over a 15-year period at Peking Union Medical College Hospital, China, were retrospectively studied. RESULTS A total of 108 patients with HELLP syndrome were included. Fifty-two (48.1%) patients were diagnosed with AKI (median serum creatinine, 139.72 µmol/L; range, 89.00-866.00); 11 (21.2%) required hemodialysis. The AKI group had significantly more multiparity (p = 0.034), hemorrhage > 400 mL (p = 0.027), severe systolic hypertension ≥ 160 mmHg (p = 0.005), infection (p < 0.001), and low hemoglobin (p = 0.002) than non-AKI patients. Multivariate logistic regression showed that infection (OR 36.441, 95% CI 3.819-347.732, p = 0.002), severe systolic hypertension (OR 5.295, 95% CI 1.795-15.620, p = 0.003), and low hemoglobin (OR 0.960, 95% CI 0.932-0.988, p = 0.006) were independent risk factors for AKI. Six patients with AKI died (mortality rate: 11.5%); no death occurred among patients without AKI. In addition to infection (OR 16.268, CI 1.334-198.385, p = 0.029) and eclampsia (OR 69.895, CI 2.834-1723.910, p = 0.009), elevated serum creatinine (OR 1.006, CI 1.001-1.011, p = 0.031) was an independent predictor of maternal mortality. Renal function in 43 (82.7%) patients completely recovered. Two (3.8%) patients developed chronic renal dysfunction after 1 to 2 years of follow-up. CONCLUSIONS Elevated creatinine was an independent predictor of maternal mortality in HELLP syndrome. AKI severely affects renal prognosis and mortality in pregnant women. The occurrence of AKI was related to infection, severe hypertension, and renal ischemia.
Collapse
|
15
|
Vousden N, Lawley E, Seed PT, Gidiri MF, Goudar S, Sandall J, Chappell LC, Shennan AH. Incidence of eclampsia and related complications across 10 low- and middle-resource geographical regions: Secondary analysis of a cluster randomised controlled trial. PLoS Med 2019; 16:e1002775. [PMID: 30925157 PMCID: PMC6440614 DOI: 10.1371/journal.pmed.1002775] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/05/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In 2015, approximately 42,000 women died as a result of hypertensive disorders of pregnancy worldwide; over 99% of these deaths occurred in low- and middle-income countries. The aim of this paper is to describe the incidence and characteristics of eclampsia and related complications from hypertensive disorders of pregnancy across 10 low- and middle-income geographical regions in 8 countries, in relation to magnesium sulfate availability. METHODS AND FINDINGS This is a secondary analysis of a stepped-wedge cluster randomised controlled trial undertaken in sub-Saharan Africa, India, and Haiti. This trial implemented a novel vital sign device and training package in routine maternity care with the aim of reducing a composite outcome of maternal mortality and morbidity. Institutional-level consent was obtained, and all women presenting for maternity care were eligible for inclusion. Data on eclampsia, stroke, admission to intensive care with a hypertensive disorder of pregnancy, and maternal death from a hypertensive disorder of pregnancy were prospectively collected from routine data sources and active case finding, together with data on perinatal outcomes in women with these outcomes. In 536,233 deliveries between 1 April 2016 and 30 November 2017, there were 2,692 women with eclampsia (0.5%). In total 6.9% (n = 186; 3.47/10,000 deliveries) of women with eclampsia died, and a further 51 died from other complications of hypertensive disorders of pregnancy (0.95/10,000). After planned adjustments, the implementation of the CRADLE intervention was not associated with any significant change in the rates of eclampsia, stroke, or maternal death or intensive care admission with a hypertensive disorder of pregnancy. Nearly 1 in 5 (17.9%) women with eclampsia, stroke, or a hypertensive disorder of pregnancy causing intensive care admission or maternal death experienced a stillbirth or neonatal death. A third of eclampsia cases (33.2%; n = 894) occurred in women under 20 years of age, 60.0% in women aged 20-34 years (n = 1,616), and 6.8% (n = 182) in women aged 35 years or over. Rates of eclampsia varied approximately 7-fold between sites (range 19.6/10,000 in Zambia Centre 1 to 142.0/10,000 in Sierra Leone). Over half (55.1%) of first eclamptic fits occurred in a health-care facility, with the remainder in the community. Place of first fit varied substantially between sites (from 5.9% in the central referral facility in Sierra Leone to 85% in Uganda Centre 2). On average, magnesium sulfate was available in 74.7% of facilities (range 25% in Haiti to 100% in Sierra Leone and Zimbabwe). There was no detectable association between magnesium sulfate availability and the rate of eclampsia across sites (p = 0.12). This analysis may have been influenced by the selection of predominantly urban and peri-urban settings, and by collection of only monthly data on availability of magnesium sulfate, and is limited by the lack of demographic data in the population of women delivering in the trial areas. CONCLUSIONS The large variation in eclampsia and maternal and neonatal fatality from hypertensive disorders of pregnancy between countries emphasises that inequality and inequity persist in healthcare for women with hypertensive disorders of pregnancy. Alongside the growing interest in improving community detection and health education for these disorders, efforts to improve quality of care within healthcare facilities are key. Strategies to prevent eclampsia should be informed by local data. TRIAL REGISTRATION ISRCTN: 41244132.
Collapse
Affiliation(s)
- Nicola Vousden
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Elodie Lawley
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Muchabayiwa Francis Gidiri
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shivaprasad Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Jane Sandall
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Lucy C. Chappell
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Andrew H. Shennan
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | | |
Collapse
|
16
|
Añez-Aguayo MY, Vigil-De Gracia P. Dexamethasone in HELLP syndrome: experience in Bolivia. J Matern Fetal Neonatal Med 2018; 33:1-4. [PMID: 29804488 DOI: 10.1080/14767058.2018.1482272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: To demonstrate the utility of dexamethasone, used according to the criteria of the attending physician, in patients with HELLP syndrome.Methods: This cross-sectional study was conducted in patients with HELLP syndrome and was based on the daily, real-life management of HELLP syndrome. Patients who received dexamethasone had it administered immediately after giving birth at a dosage of 8 mg every 8 hours for 72 hours, for a total of 72 mg. The analysis was conducted between patients who received corticosteroids and those who did not, with complete or partial HELLP.Results: There were 97 women who suffered complications from HELLP syndrome, there were 43 (44.3%) received dexamethasone. The groups were comparable except for the initial platelet count because this was the criterion used to divide the groups. In addition, the group without corticosteroids comprised more patients with partial HELLP. The platelet count shows that on the third day was similar in both groups, following a difference of more than 40,000 at the beginning of the study. The average platelet increase was 27,448 in the group without corticosteroids and 88,408 in the corticosteroid group; p = .001.Conclusions: This study demonstrates that the administration of postpartum dexamethasone at a dosage of 8 mg every 8 hours for 72 hours in HELLP syndrome is associated with a significant increase in platelet count.
Collapse
Affiliation(s)
- María Yuly Añez-Aguayo
- Department of Gynecology and Obstetrics, Japanese University Municipal Hospital of Santa Cruz, Santa Cruz, Bolivia
| | - Paulino Vigil-De Gracia
- Department of Gynecology and Obstetrics, Obstetric Pathology, Hospital Complex of the Social Security Fund, National System of Researchers, SENACYT, Panama, Panama
| |
Collapse
|
17
|
Vigil-DeGracia P, Ludmir J, Ng J, Reyes-Tejada O, Nova C, Beltré A, Yuen-Chon V, Collantes J, Turcios E, Lewis R, Cabrera S. Is there benefit to continue magnesium sulphate postpartum in women receiving magnesium sulphate before delivery? A randomised controlled study. BJOG 2018; 125:1304-1311. [DOI: 10.1111/1471-0528.15320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/27/2022]
Affiliation(s)
- P Vigil-DeGracia
- Hospital de la Caja de Seguro Social; Investigador distinguido del Sistema Nacional de Investigación; SENACYT; Panamá City Panama
| | - J Ludmir
- Thomas Jefferson University; Philadelphia PA USA
| | - J Ng
- Hospital José Domingo de Obaldía; Chiriquí Panama
| | - O Reyes-Tejada
- Hospital Santo Tomas; Miembro del Sistema Nacional de Investigacion; SENACYT; Panamá City Panama
| | - C Nova
- Hospital Nuestra Señora de Alta Gracia; Santo Domingo Dominican Republic
| | - A Beltré
- Hospital Las minas; Santo Domingo Dominican Republic
| | - V Yuen-Chon
- Hospital Teodoro Maldonado Carbo; Guayaquil Ecuador
| | | | - E Turcios
- Hospital Primero de Mayo; Seguridad Social; San Salvador El Salvador
| | - R Lewis
- Complejo Hospitalario de la Caja de Seguro Social; Panamá Panama
| | - S Cabrera
- Hospital Nacional Docente Madre Niño; San Bartolomé Lima Peru
| |
Collapse
|
18
|
Mc Lean G, Reyes O, Velarde R. Effects of postpartum uterine curettage in the recovery from Preeclampsia/Eclampsia. A randomized, controlled trial. Pregnancy Hypertens 2017; 10:64-69. [DOI: 10.1016/j.preghy.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/10/2017] [Accepted: 06/04/2017] [Indexed: 10/19/2022]
|
19
|
Magnesium sulfate for 6 vs 24 hours post delivery in patients who received magnesium sulfate for less than 8 hours before birth: a randomized clinical trial. BMC Pregnancy Childbirth 2017; 17:241. [PMID: 28738788 PMCID: PMC5525206 DOI: 10.1186/s12884-017-1424-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the benefits of magnesium sulfate for 24 h (h) postpartum versus 6 h postpartum in patients who received magnesium sulfate (Mg) for less than 8 h before birth. METHODS A randomized, multicenter, open study was conducted between November 2013 and October 2016 in three teaching maternity hospitals in Panama. Pregnant women diagnosed with severe pre-eclampsia or pre-eclampsia with severe features at more than 20 weeks gestation were invited to participate. They were randomized to the following groups in a 1:1 ratio: A- continue Mg for 24 h after birth (control group); and B- receive Mg for 6 h after birth (experimental group). The primary endpoint and variable was seizure (eclampsia) in the first 72 h postpartum. RESULTS During the study period, 284 patients agreed to participate in the study; 143 were randomized to receive Mg for 24 h postpartum and 141 to receive Mg for 6 h postpartum. There were no significant differences in the baseline characteristics of the two groups studied. There was no eclampsia in the entire population; therefore, there was no significant difference in the primary variable. Two secondary variables showed a significant difference: time to onset of ambulation, which was 14 h shorter (p = 0.0001) in the group that received 6 h of postpartum Mg, and time to initiation of breastfeeding, which was 11 h earlier (p = 0.0001) in the group that received 6 h of postpartum Mg. There were not significant differences between the groups with respect to total complications or any particular complication. There were no cases of maternal death. CONCLUSION Maintaining Mg for 6 h postpartum is equally effective in preventing eclampsia as receiving Mg for 24 h postpartum in patients with severe pre-eclampsia who receive less than 8 h of Mg treatment before birth. The onset of maternal ambulation and initiation of breastfeeding are faster in patients who only receive Mg for 6 h postpartum. TRIAL REGISTRATION The study was registered at clinical-trials.gov, number NCT02317146 . Date of registration: December 11, 2014. This study was registered at clinical trials after the beginning of recruitment of patients.
Collapse
|
20
|
Karim HMR, Bhattacharyya P, Kakati SD, Borah TJ, Yunus M. Scrub typhus masquerading as HELLP syndrome and puerperal sepsis in an asymptomatic malaria patient. Qatar Med J 2016; 2016:2. [PMID: 27413718 PMCID: PMC4928108 DOI: 10.5339/qmj.2016.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/15/2016] [Indexed: 11/13/2022] Open
Abstract
Scrub typhus and malaria can involve multiple organ systems and are notoriously known for varied presentations. However, clinical malaria or scrub typhus is unusual without fever. On the other hand, altered sensorium with or without fever, dehydration, hemorrhage and hemolysis may lead to low blood pressure. Presence of toxic granules and elevated band forms in such patients can even mimic sepsis. When such a patient is in the peripartum period, it creates a strong clinical dilemma for the physician especially in unbooked obstetric cases. We present such a case where a 26-year-old unbooked female presented on second postpartum day with severe anemia, altered sensorium, difficulty in breathing along with jaundice and gum bleeding without history of fever. Rapid diagnostic test for malaria was negative and no eschar was seen. These parameters suggested a diagnosis of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet) syndrome with or without puerperal sepsis. Subsequently she was diagnosed as having asymptomatic malaria and scrub typhus and responded to the treatment of it. The biochemical changes suggestive of HELLP syndrome also subsided. We present this case to emphasize the fact that mere absence of fever and eschar does not rule out scrub typhus. It should also be considered as a differential diagnosis in patients with symptoms and signs suggesting HELLP syndrome. Asymptomatic malaria can complicate case scenario towards puerperal sepsis by giving false toxic granules and band form in such situations.
Collapse
Affiliation(s)
- Habib Md. Reazaul Karim
- Department of Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Science, Shillong, Meghalaya, India
| | | | | | | | | |
Collapse
|