Association between Placental Malaria and Severe Pre-Eclampsia in Two University Hospitals of Yaounde City

Context: Pre-eclampsia and placental malaria, are two diseases that share pathophysiological similarities, such as placental ischemia, endothelial dysfunction and production of pro-inflammatory cytokines. Objective: The objective of our study was to investigate the association between placental malaria lesions and severe pre-eclampsia. Methodology: We conducted a prospective analytical cross-sectional study in two University Hospitals in the city of Yaounde (Yaounde Central Hospital and the Gynaecological Obstetrics and Paediatrics Hospital), and in the laboratory of the Centre Pasteur in Yaounde over an eight-month period (1st January 2021 – 1st September 2021). All patients with pre-eclampsia diagnosed according to the criteria of the International Society for the Study of Hypertension (ISSHP) and free of chronic metabolic or infectious pathology were included in this study. The patients were divided into two groups: group 1 (mild pre-eclampsia) and group 2: severe pre-eclampsia. Socio-demographic, clinical and histopathological characteristics specific to pre-eclampsia and placental malaria were investigated. Statistical analysis was performed with SPSS 23.0 software, Chi 2 was used to compare categorical variables, Student t-test was used to compare means, and logistic regression was used to assess the association between placental malaria lesions and PES. Results: The mean age of our study population was 29.93 ± 7.36 years versus 28.28 ± 7.18 years in patients with mild and severe pre-eclampsia respectively. Pre-eclampsia placental lesions (accelerated villous maturation, infarction) were significantly greater in patients with severe pre-eclampsia (p Conclusion: Placental malaria lesions were significantly associated with severe pre-eclampsia and increased the risk of developing severe pre-eclampsia placental lesions by a factor of 10.

Right heart modified myocardial performance index and ductus venosus spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes

Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and DV PI for predicting adverse pregnancy outcomes in pre-eclampsia cases was 0.897 and 0.848,respectively,without significant difference(Z=0.460,P=0.400).Conclusion Changes of right heart Mod-MPI and DV spectrum parameters in pre-eclampsia fetuses had high value for predicting adverse pregnancy outcomes.

Prevalence and Demographic Distributions of Pre-Eclampsia among Pregnant Women at Ho Teaching Hospital

Background: In Sub-Saharan Africa, pre-eclampsia remains a major health problem contributing to high rates of maternal mortality. Despite this condition having adverse effects on maternal and child health, its prevalence and associated risk factors are still significant, especially in developing countries including Ghana. This study aimed to assess the prevalence and demographic distributions associated with pre-eclampsia among pregnant women at the Ho Teaching Hospital. Methods: A facility-based retrospective study was conducted by reviewing available data or hospital records of pregnant mothers admitted to the labor and maternity wards from January 2018 to December 2020. All pregnant women who were diagnosed with pre-eclampsia within this period were included in the study. The data were collected using a structured checklist. Results: 5609 data on pregnant women from 2018 to 2020 were recorded. Out of the 5609 data recorded, 314 pre-eclampsia cases were recorded giving an overall prevalence of 5.6%. The yearly prevalence for 2018, 2019, and 2020 were 4.6%, 5.6%, and 6.6%, respectively. The most recorded pre-eclampsia cases were seen among women within the age group of 18 - 24 years. The data showed that 112 (35.7%) of the pregnant women who had pre-eclampsia were nulliparous. Pre-eclampsia-associated maternal and fetal complications were;preterm delivery 221 (70.4%), intrauterine fetal death 62 (19.7%), eclampsia 9 (2.9%), HELLP syndrome 5 (1.6%) and maternal death 17 (5.4%). Associated factors of pre-eclampsia were parity, level of education, and occupation (p ≤ 0.05). Conclusion: The findings of this study showed a rising trend in the incidence of pre-eclampsia over the years at the Ho Teaching Hospital. Parity, level of education, and occupation were found to be associated with developing pre-eclampsia.

Predictive Factors for Pre-Eclampsia: A Case-Control Study in Two Hospitals in Yaounde

Introduction: Pre-eclampsia is a major cause of maternal and prenatal morbidity and mortality, that complicates 2% to 8% of pregnancies worldwide. The aim of this study was to determine the predictive factors for pre-eclampsia in two hospitals in the city of Yaoundé. Methods: A case-control study was conducted at the Gynaecology & Obstetrics department of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Main Maternity of the Yaoundé Central Hospital (MM-YCH) from February 1 to July 30, 2022. The cases were all pregnant women presenting with pre-eclampsia. The control group included pregnant women without pre-eclampsia. Descriptive statistics followed by logistic regression analyses were conducted with level of significance set at p-value Results: Included in the study were 33 cases and 132 controls, giving a total of 165 participants. The predictive factors for pre-eclampsia after multivariate analysis were: primiparity (aOR = 51.86, 95% CI: 3.01 - 1230.96, p = 0.045), duration of exposure to partner’s sperm Conclusion: The odds of pre-eclampsia increased with primiparity, duration of exposure to partner’s sperm < 3 months, personal history of pre-eclampsia and maternal history of pre-eclampsia. Recognition of these predictor factors would improve the ability to diagnose and monitor women likely to develop pre-eclampsia before the onset of disease for timely interventions.

Activated Protein C Resistance in Patients with Pre-Eclampsia in Lagos, Nigeria

Background: Preeclampsia is reported to complicate 2% - 8% of pregnancies globally and is an important cause of maternal and perinatal morbidity and mortality. The aetiology and pathogenesis are still poorly understood and substantial improvement has not been made in the prediction, prevention and treatment of the disease. Objective: To compare the frequency of activated protein C resistance (APC-R) in patients with pre-eclampsia to that of normotensive pregnant women and to determine the correlation between activated protein ratio (APC-ratio) and the severity of pre-eclampsia. Methodology: A cross-sectional study was carried out in 100 pre-eclamptic patients and 100 normotensive pregnant controls. The APC-ratio was determined using the modified activated partial thromboplastin time. Study participants with APC-ratio of less than 2.0 were defined as having APC-R. Data was analyzed using SPSS version 22.0. Results: Mean APC-ratio was significantly lower in pre-eclamptics (2.89 ± 1.70) compared to normotensive pregnant women (3.57 ± 1.06) (p = 0.0008) and the levels were also higher in mild (2.95 ± 1.15) compared to severe pre-eclamptics (2.62 ± 1.14). The frequency of APC-R was 26% among women with pre-eclampsia compared to 4% among normotensive controls (p = 0.000). Among 100 pre-eclamptic women 7 (21.2%) out of 33 with mild pre–eclampsia had APC-R, while 19 (28.4%) out of 67 with severe pre-eclampsia had APC-R. APC-ratio had a significant negative correlation with mean arterial blood pressure (r = −0.324;p = 0.000) and proteinuria (r = −0.379;p = 0.000) among study participants. Conclusion: The frequency of activated protein c resistance is significantly higher in pre-eclamptics compared to normotensive pregnant women and this is more pronounced in those with severe pre-eclampsia compared with those with mild disease. APC-R may therefore be used as a marker of severity in the disease.

Effect of Third Interstitial Fluid on Adverse Outcomes in Patients with Severe Pre-eclampsia and Twin Pregnancy:A 5-year Single-center Retrospective Study

Objective This study aims to identify the effect of third interstitial fluid on adverse outcomes in twin pregnancies with severe pre-eclampsia,and explore the differences in bad ending between twins and singletons.Methods The present retrospective cohort study was conducted on patients with severe pre-eclampsia,who delivered in Tongji Hospital,Wuhan,China,between 2017 and 2022.The adverse outcomes in singleton and twin pregnancies with severe pre-eclampsia were initially investigated.Then,the diverse maternal and fetal consequences between singleton and twin pregnancies in patients with severe pre-eclampsia were compared after merging with the third interstitial fluid.Results A total of 709 patients were included for the present study.Among these patients,68 patients had twin pregnancies,and 641 patients had singleton pregnancies.The rate of postpartum hemorrhage(2.81%vs.13.24%,P<0.001),and admission rate to the Neonatal Intensive Care Unit(NICU)after birth(30.73%vs.63.24%,P=0.011)were significantly higher in twin pregnancies.The neonatal weight of twins was statistically lower than singletons(1964.73±510.61 g vs.2142.92±731.25 g,P=0.008).For the groups with the third interstitial fluid,the delivery week(P=0.001)and rate of admission to the NICU after birth were significantly advanced in twin pregnancy group,when compared to singleton pregnancy group(P=0.032),and the length of hospital stay was shorter(P=0.044).Furthermore,there was no statistically significant difference between the twin pregnancy group and the singletony pregnancy group without the third interstitial fluid.Conclusion The maternal and fetal adverse outcomes of patients with severe pre-eclampsia increased in twin pregnancies,when compared to singleton pregnancies.Thus,when patients develop the third interstitial fluid,twin pregnancies would more likely lead to adverse fetal outcomes,when compared to singleton pregnancies,and there would be no significant difference in maternal adverse outcomes.More attention should be given to patients who merge with the third interstitial fluid.

Factors Predicting Transformation of Non-Severe Pre-Eclampsia into Pre-Eclampsia with Severe Features

Background: Pre-eclampsia (PE), a complex, multisystem, pregnancy-associated hypertensive disorder, typically developing after the 20th week of gestation, that complicates 2% - 8% of pregnancies, is a leading cause of neonatal and maternal mortality and morbidity. Aim of the Work: To identify different factors predicting transformation of non-severe pre-eclampsia in to pre-eclampsia with severe features. Patients and Methods: This prospective cohort study was conducted at tertiary care hospital at Ain Shams University hospitals from June 2021 till January 2022 and performed on total of 100 patients who diagnosed as non-severe pre-eclampsia after exclusion of severity features. Results: The current study revealed that transformation to severe pre-eclampsia occurred in 33% of the studied cases. Body mass index (BMI), past and family histories of preeclampsia statistically were significantly higher in cases transformed into preeclampsia with severe features. Admission blood pressure, albumin dipstick, Oligohydramnios and IUGR statistically were significantly higher in cases with transformation from non-severe pre-eclampsia into pre-eclampsia with severe features. Platelet count statistically was significantly lower in cases with transformation from non-severe pre-eclampsia into pre-eclampsia with severe features Conclusion: Our study results identified the most important clinical risk factors for transformation to severe features of pre-eclampsia from non-severe features and provided new information on the level of risk associated with specific combinations of risk factors (BMI ≥ 35.4, admission systolic blood pressure, admission diastolic blood pressure, albumin dipstick 4+ and platelets count) with low significant diagnostic performance in predicting transformation from non-severe pre-eclampsia into pre-eclampsia with severe features.

Assessment of Nurses’ Knowledge of the Management of Pre-Eclampsia in a Hospital Setting: The Case of the Van Norman Clinic. Bujumbura-Burundi

Background: Pre-eclampsia is one of the pathologies of pregnancy that causes serious maternal and fetal complications. Good nursing management of pre-eclampsia could stabilize and limit possible maternal and fetal complication. Aim: This study aims to assess nurses’ knowledge of the management of pre-eclampsia. This is a descriptive prospective study conducted at the Van Norman Clinic over three-month period from November 1st, 2020 to January 31st, 2021 to assess the knowledge of nurses assigned to the Patient reception service, Emergency service, Gynecological-Obstetrics service and Community Medicine department on the management of pre-eclampsia. Data were treated using Microsoft Word and analyzed by Statistical Package for Social Scientists version 16 (SPSS). During the period of our study, we collected 40 nurses out of 44 nurses, which represents 90.9% (n = 40) of the nurses assigned to the Patient reception service, Emergency service, Gynecological-Obstetrics service and Community Medicine department. Among the 40 cases collected, 30% respondents did not give the true definition of pre-eclampsia. Our study also showed that 70% of nurses had not been trained on the management of pre-eclampsia and 90% had not used nursing theories in their practice while the Inquiry-Based Practice (IBP) and Evidence-Based Practice (EBP) applications were known in 7.5% of cases. With regard to the nursing management of pre-eclampsia, 62.5% of cases knew the first gestures of management while 90% of cases did not know the overall nursing management of pre-eclampsia. Last of continuing education, use of nursing theories and lack of resuscitation were the main obstacles observed in the nursing management of pre-eclampsia. For better nursing management of pre-eclampsia, emphasis should be placed on building staff capacity and executing the care plan by applying nursing theories.

Labetalol versus Hydralazine in the Management of Severe Pre-Eclampsia at Tertiary Hospitals in a Low-Resource Setting: A Randomised Controlled Trial

Objective: Intravenous labetalol and hydralazine are both considered first-line medications for the management of acute-onset, severe hypertension in pregnant and postpartum women. The study compared the efficacy and safety profile of intravenous labetalol and hydralazine in the control hypertension in severe pre-eclampsia. Materials and Methods: One hundred patients who presented with severe pre-eclampsia were randomized into two study groups. The fifty patients in each arm of the study received either intravenous labetalol or intravenous hydralazine for the control of blood pressure. Results: The mean age of the labetalol subjects was 28.6 ± 5.47 years while that of their hydralazine counterparts was 29.12 ± 5.77 years. The majority of respondents in both groups were primigravidae (76% vs. 78%) (P = 0.813). The number of doses of drug needed to significantly lower the mean systolic blood pressure was slightly lower in the labetalol group (2 doses) compared to the hydralazine group (5 doses) (t = 0.803Y, P = 0.977). The incidence of headaches which were the commonest complaints was comparable in both groups 8% and 10% of respondents respectively (P > 0.05). Conclusion: Although both intravenous labetalol and hydralazine are useful in patients with severe pre-eclampsia, the response to labetalol was better with comparable side effects.

Evolution of Proteinuria and Renal Function in Women with Pre-Eclampsia at the Gynecology Department of the Teaching Hospital of Cocody

Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.

Helicobacter pylori's virulence and infection persistence define pre-eclampsia complicated by fetal growth retardation

AIM: To better understand the pathogenic role of Helicobacter pylori (H. pylori) in pre-eclampsia (PE), and whether it is associated or not with fetal growth retardation (FGR). METHODS: Maternal blood samples were collected from 62 consecutive pregnant women with a diagnosis of PE and/or FGR, and from 49 women with uneventful pregnancies (controls). Serum samples were evaluated by immunoblot assay for presence of specific antibodies against H. pylori antigens [virulence: cytotoxin-associated antigen A (CagA); ureases; heat shock protein B; flagellin A; persistence: vacuolating cytotoxin A (VacA)]. Maternal complete blood count and liver enzymes levels were assessed at delivery by an automated analyzer. RESULTS: A significantly higher percentage of H. pyloriseropositive women were found among PE cases (85.7%) compared to controls (42.9%, P < 0.001). There were no differences between pregnancies complicated by FGR without maternal hypertension (46.2%) and controls. Importantly, persistent and virulent infections (VacA/ CagA seropositive patients, intermediate leukocyte blood count and aspartate aminotransferase levels) were exclusively associated with pre-eclampsia complicated by FGR, while virulent but acute infections (CagA positive/ VacA negative patients, highest leukocyte blood count and aspartate aminotransferase levels) specifically correlated with PE without FGR. CONCLUSION: Our data strongly indicate that persistent and virulent H. pylori infections cause or contribute to PE complicated by FGR, but not to PE without feto-placental compromise.

Endothelial Nitric Oxide Synthase Traffic Inducer in the Umbilical Vessels of the Patients with Pre-eclampsia

The expression of endothelial nitric oxide synthase traffic inducer （NOSTRIN） was examined in the umbilical vessels of the patients with pre-eclampsia （PE） to explore its possible role in the pathogenesis of PE. The NOSTR1N rnRNA in umbilical tissues was determined by RT-PCR. The eNOS activity in umbilical vessels was spectrophotometrically detected. NO2 /NO3, the stable metabolic end products of NO, was measured by using nitrate reductase. RT-PCR showed that the expression level of NOSTRIN was significantly higher in women with PE than in the normal group （P〈0.01）. The activity of eNOS was significantly decreased in PE group [（12.83±3.61） U/mg] than in normal group [（21.72±3.83） U/mg] （P〈0.01）. The level of NO2-/NO3- in PE patients （27.53±7.48） pmol/mg was significantly lower than that of normal group （54.27±9.53） μmol/mg （P〈0.01）. The significant negative correlation existed between the expression of NOSTRIN and the activity of eNOS in umbilical vessels of women with PE （r=-0.58, P〈0.01）. It was concluded that the level of NOSTR1N expression was increased in umbilical vessel of women with PE, indicating that it may be involved in the pathogenesis of PE.

Pre-eclampsia with new-onset systemic lupus erythematosus during pregnancy: A case report

BACKGROUND New-onset systemic lupus erythematosus(SLE)during pregnancy and in the postpartum period is rare,especially when complicated with pre-eclampsia,which is difficult to diagnose accurately.Here,we report a patient with newonset SLE and antiphospholipid syndrome during pregnancy,which presented as pre-eclampsia at admission.CASE SUMMARY A 28-year-old primigravid woman was admitted to our hospital in the 27th wk of gestation with the primary diagnosis of severe pre-eclampsia.Although spasmolysis and antihypertensive therapy were administered since admission,the 24-h proteinuria of the 2nd day after admission reached 10311.0 mg.In the 47th h of admission,immunologic examinations revealed increased levels of antidouble stranded DNA antibody,anti-nuclear antibody,anti-cardiolipin antibody,anti-Sj?gren’s syndrome-related antigen A antibody and anti-nucleosome antibody and decreased levels of complement C3 and C4.One hour later,ultrasonography of the lower limbs showed thrombus of the bilateral popliteal veins.The diagnosis of SLE and antiphospholipid syndrome was indicated.In the 54th h,the patient manifested with convulsion,dyspnea and blurred vision.Ten hours later,intrauterine death was revealed by ultrasonography.Emergent surgery consisting of inferior vena cava filter implantation and subsequent cesarean section was performed.Following glucocorticoid and anticoagulation therapy after delivery,the patient had an optimal response with improvements in symptoms and immunological markers.CONCLUSION Obstetricians should be aware of the symptoms and immunological examination results to distinguish pre-eclampsia and underlying SLE for optimal pregnancy outcomes.

Doppler measurements in fetal descending aorta and umbilical artery can predict borderline oxygenation in pre-eclampsia and HELLP syndrome

Objective: To determine diagnostic utility of Doppler measurements in fetal descending aorta and umbilical arteries in predicting intrauterine growth retarded (IUGR) fetuses at risk in pregnancies complicated by preeclampsia and/or HELLP syndrome. Methods: Doppler measurements were taken in fetal descending aorta and umbilical arteries of 53 patients with pre-eclampsia, 10 of whom had HELLP syndrome using fetometry (ACUSON 128XP/10, 3.5 MHz probe). These values were compared with those of 44 appropriate-for-gestational age singleton pregnancies (AGA). Doppler Indices (Resistance Index (RI), Systolic/Diastolic (S/D) ratio) and end-diastolic flows were related to fetal heart rate (FHR) during contraction stress test, to cord blood parameters (pH, Base Excess) and to Apgar Scores. Results: In contrast to AGA fetuses, IUGR fetuses had decreased end-diastolic flow and an increase of Doppler Indices significantly earlier in the descending aorta (p < 0.05), compared to umbilical artery. Increased RI’s, S/D ratios and a decrease of end-diastolic flow in fetal aorta were significantly correlated to frequency of FHR decelerations during contraction stress tests, pH, Base Excess (p < 0.01) and Apgar Scores in IUGR fetuses. Conclusion: A decrease in end-diastolic flow paralleled with an increase in Doppler indices in fetal descending aorta reflect oxygen deprivation in IUGR fetuses during pre-eclamptic pregnancies with or without HELLP syndrome. While ductus venosus and umbilical artery are more frequently used nowadays to determine fetal oxygen deprivation, Doppler measurements in fetal descending aorta provide additional information for early detection of fetuses at risk for IUGR in pregnancies complicated with pre-eclampsia and/or HELLP

Serum Magnesium Levels in Second and Third Trimesters of Pregnancy in Patients That Developed Pre-Eclampsia and Feto-Maternal Outcome

Introduction: Pregnancy is a physiological process that may be complicated by a number of clinical conditions. Gestational diabetes and pre-eclampsia are known complications in pregnancy. Pre-eclampsia is a disease of hypothesis in which the pathogenesis is yet to be fully explained. The role of magnesium in the pathogenesis of pre-eclampsia has been suggested by studies and it is being investigated all over the world. The study aimed to compare serum magnesium levels in pre-eclampsia and control groups from second trimester of pregnancy and assessed maternofetal outcome. Materials and Methods: This was a nested case control study in which consenting three hundred and sixty (360) normal pregnant women were enrolled. These women were recruited in their second trimester of pregnancy. Blood samples for serum magnesium estimation were obtained from subjects and controls at recruitment and after development of pre-eclampsia. Results: Thirty seven pregnant women that developed pre-eclampsia were nested as cases and were matched with 37 controls (apparently healthy pregnant women). The mean serum magnesium at recruitment was 0.75 ± 0.028 mmol/l (cases) and 0.76 ± 0.036 mmol/l (controls) (P = 0.123);this became significant when diagnosis of pre-eclampsia were made with mean of 0.53 ± 0.06 mmol/l (cases) and 0.69 ± 0.08 mmol/l (controls), (P 0.001). There was significant statistical relationship between preterm delivery, low birth weight and need for special care baby unit (SCBU) admission in newborn of mothers with low serum magnesium level (P = 0.001, 0.002 and 0.035 respectively). Conclusion: Findings from this study revealed that hypomagnesaemia appears to be a complication of pre-eclampsia. Serum levels of magnesium were normal until the development of the disease. Serum level of this biomarker affects maternofetal outcome significantly.

Role of Progesterone in TLR4-MyD88-dependent Signaling Pathway in Pre-eclampsia

The role of progesterone in the Toll-like receptor 4 （TLR4）-MyD88-dependent signaling pathway in pre-eclampsia was studied. Peripheral blood mononuclear cells （PBMCs） from pre-eclampsia （PE） patients were subjected to primary culture, and stimulated with different concentra- tions of progesterone （0, 10^-8, 10^-6, and 10^-4 mol/L）. The mRNA expression of TLR4, MyD88 and nu- clear factor-kappaB （NF-κB） was detected by using real-time PCR. The Ikappa-B protein expression was detected by using Western blotting. The expression of tumor necrosis factor-or （TNF-α and inter- leukin-6 （IL-6） in the supernatant was determined by using ELISA. With the concentrations of proges- terone increasing, the mRNA expression levels of TLR4, MyD88 and NF-κB in 2^△△CT value were sig- nificantly decreased, and the IkappaB protein expression levels were significantly increased. The TNF-α and IL-6 expression showed a downward trend when the progesterone concentration increased, and there were significant differences among all of the groups （P〈0.05）. It was suggested that progesterone can inhibit the TLR4-MyD88-dependent signaling pathway in PE significantly and benefit for the preg- nancy.

Placental Isoferritin Action in Pathogenesis of Pre-eclampsia and/or Intrauterine Growth Retardation and Its Earlier Predictive Value

In order to investigate the role of placental isoferritin (PLF) in pathogenesis of pre-eclampsia and/or intrauterine growth retardation (IUGR) and its earlier predictive value, a prospective double-blinded study was performed. In 120 initial normal pregnant women at earlier third trimester (from 24 to 34 weeks), plasma placental isoferritin and nitric oxide (NO) metabolites (nitrite/nitrate) (NO 2 -/NO 3 -) were examined by using ELISA and Criess assay respectively. The outcome of pregnancies and birth weight of their infants were followed up. The receiver operating characteristic curves (ROC) and predictive values of PLF predicting the outcome of pregnancy with IUGR, pre-eclampsia were analyzed. Results showed that in 120 initial normal pregnant women, IUGR occurred in 15 pregnant women (IUGR group) and pre-eclampsia in 19 (pre-eclampsia group), and the remaining 86 had normal pregnancy (normal group). The levels of plasma placental isoferritin were significantly decreased in IUGR group (260.01±58.95) μg/ml and pre-eclampsia group (285.31±53.73) μg/ml as compared with those in normal group (775.62±89.32) μg/ml at earlier third trimester (both P<0.01). The levels of plasma NO were significantly increased in IUGR group (61.57±46.22) μmol/L and pre-eclampsia group (58.37±30.52) μmol/L as compared with those in the normal group (35.29±24.46) μmol/L (both P<0.01). There was no significant difference in plasma placental isoferritin and NO levels between IUGR group and pre-eclampsic group (both P>0 05). The plasma placental isoferritin was negatively correlated with NO levels (r=0.329,P<0 01). The areas under ROC of PLF predicting IUGR and pre-eclampsia were 0.977 and 0.905 respectively. At the cut point of 400 μg/ml PLF level, the sensitivity, specificity, positive predictive value, negative predictive value and Kappa index of PLF levels predicting the outcome of pregnancy with pre-eclampsia were 100 %, 85.15 %, 55.88 %, 100 % and 0.645 respectively. At the cut point of 390 μg/ml PLF level, the sensitivity, specificity, positive predictive value, negative predictive value and Kappa index of PLF levels predicting the outcome of pregnancy with IUGR were 100 %, 81.9 %, 44.12 %, 100 % and 0.663 respectively. It was concluded that the decrease of plasma placental isoferritin levels at earlier third trimester was associated with IUGR and/or pre-eclampsia, and the endothelial cell damage may be one of its mechanisms. The plasma PLF level can be used as an earlier predictor for screening of IUGR and/or pre-eclampsia.

Attrition from care after the critical phase of severe pre-eclampsia and eclampsia: Insights from an intervention with magnesium sulphate in a primary care setting in northern Nigeria

Background: Evidence has shown that Magnesium Sulphate (MgSo4) is the gold standard for treating severe pre-eclampsia and eclampsia (SPE/E), and calls for its widespread use at all levels of health service delivery, including the primary care level. Objective: To determine if administering loading dose of MgSo4 on pregnant women with severe preeclampsia and eclampsia at primary care level would improve maternal and fetal outcomes. Method: Two sets of Primary Health Care (PHC) facilities were identified;one served as experimental one and the other as control. The community health extension workers (CHEWs) and the community health officers (CHOs) at the experimental PHCs were trained to administer the loading dose of MgSo4 for patients with SPE/E, in addition to other supportive treatments, before making a referral while the control PHCs did not give MgSo4, and neither administered diazepam as an alternative or no anti-convulsant at all, before making a referral to higher centers. Patients from the experimental and control facilities were prospectively monitored for fetal and maternal outcomes, namely maternal and fetal deaths, and for toxic effects of MgSo4 in the experimental arm. Results: Of the 150 patients recruited, 82 (55%) were in the experimental group and 68 (45%) were in the control group. 90% of the patients in the experimental group defaulted after receiving the loading dose of MgSo4 while the remaining 10% completed the referral process. 44% of those in the control group completed the referral process. There were 3 maternal and 3 perinatal deaths, all in the control group. No adverse outcome (maternal or fetal death) or toxic effect was recorded among the recipients of MgSo4. Conclusion: This study suggests that lower-cadre health care professionals at PHCs can administer the loading dose of MgSo4 to SPE/E patients to improve maternal and fetal survival in critical states, without significant risk of adverse effects. However, the lack of compliance with referral processes remains a huge challenge.

Testosterone is a surrogate and proxy biomarker for severity of late-onset pre-eclampsia: A cross-sectional study

Objective:To find the association between testosterone serum levels and severity of late onset pre-eclampsia.Methods:This case-control study involved 34 patients with pre-eclampsia and 24 healthy control pregnant women matched for gestational and maternal age.The recruited pregnant women were divided into two groups:the pre-eclampsia group(34 pregnant women with pre-eclampsia)and the control group(24 healthy pregnant women).Lipid profile,blood urea,serum creatinine,proteinuria,total serum testosterone,sex hormone binding globulin and free androgen index were evaluated.Moreover,body mass index and blood pressure profile were measured.Results:There were high systolic and diastolic blood pressures in the pregnant women with late-onset pre-eclampsia when compared with healthy pregnant women(P<0.01).Total serum testosterone was higher in women with pre-eclampsia compared with healthy pregnant women(P=0.001).The free androgen index was higher in women with pre-eclampsia compared with healthy pregnant women(P=0.001).Sex hormone binding globulin level was low in women with pre-eclampsia compared with healthy pregnant women(P=0.001).High total serum testosterone was significantly correlated with all measured variables(P=0.001),except for body mass index and pulse pressure(both P=0.070).Smoking habit was low in those patients compared with healthy pregnant women.Meanwhile,total serum testosterone serum level was significantly correlated with number of cesarean sections(r=0.86,P<0.01)and nulliparty(r=0.56,P<0.01).Conclusions:Late onset pre-eclampsia in pregnant women is associated with high serum levels of total serum testosterone,free androgen index,low sex hormone binding globulin,low smoking habit with positive history for nulliparity and caesarean sections that are correlated with high blood pressure profiles.Therefore,high total serum testosterone which is correlated with most of risk factors of late-onset pre-eclampsia is regarded as a proxy biomarker reflecting the severity of late onset pre-eclampsia.

TaVNS reduces inflammatory responses in a L-NAME-induced rat model of pre-eclampsia

Pre-eclampsia is characterized by an excessive maternal inflammatory response.The cholinergic antiinflammatory pathway(CAP)has been shown as the efferent arm of a vagal reflex with the potential to limit inflammatory responses.Therefore,in this study,the CAP regulation through the nervous vagal stimulation(VNS)reduced the severity of NG-nitro-L-arginine methyl ester(L-NAME)-induced pre-eclampsia was determined in a rat model.Rats were given 125 mg/kg/day of L-NAME via subcutaneous injection on gestational day(GD)10–16.In addition,the rats were treated by active or sham electrical stimulation once a day during GD 13–19.Systolic blood pressure(SBP),urinary albumin,and pregnancy outcomes were documented for each rat.The average fetal weights and crown-rump length(CRL)as well as the placental weights of rats in both control and experimental groups were recorded onthe 13th day,16th day and 20th day of gestation.Subsequently,placentas were collected from the rats on GD20 to measure the level of cytokines.In addition,qRT-PCR and Western blot analysis were used to detect the mRNA and protein expression ofα7 nicotinic acetylcholine receptor(α7nAChR)and nuclear factor-κB(NF-κB),respectively.Immunohistochemistry assays were also carried out to determine the location and level ofα7nAChR and NF-κB in placentas.CAP regulation through the transcutaneous auricular nerve stimulation alleviated the clinical symptoms in the rats after L-NAME induction,including hypertension,proteinuria,fetal growth retardation and fetal death.In addition,TaVNS also increasedα7nAChR expression,reduced NF-κB p65 expression,and reversed LNAME-induced proinflammatory cytokines in the placenta tissues,including tumor necrosis factor-alpha(TNF-α),high mobility group box 1(HMGB-1)and interleukin-6(IL-6).The findings of this study showed that TaVNS might be used as a promising tool to attenuate pre-eclampsia-like symptoms.In addition,the protective effect of TaVNS was associated with the improvement ofα7nAChR expression and the inhibition of inflammatory reactions at the maternal-fetal interface through activating cholinergic anti-inflammation pathway.