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.

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.

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.

妊娠合并慢性乙型肝炎血清HBV pgRNA、PreS1抗原表达与肝内胆汁淤积症的相关性分析

目的 探究妊娠合并慢性乙型肝炎病人血清乙型肝炎病毒(HBV)前基因组RNA(HBV pgRNA)、前S1抗原(PreS1Ag)水平变化及与妊娠期肝内胆汁淤积症(ICP)发生的相关性。方法 选取2017年6月至2020年6月在雅安市人民医院进行孕期检查的慢性乙型肝炎孕妇279例作为研究对象,根据入组病人是否患有ICP分为合并ICP组43例、未合并ICP组236例。比较两组病人血清中HBV pgRNA、PreS1 Ag水平,并分析两组血清HBV pgRNA、PreS1 Ag表达与HBV DNA表达水平相关性;比较两组病人妊娠结局,并分析合并ICP组病人血清HBV pgRNA表达水平及PreS1 Ag阳性表达率与妊娠结局的关系。受试者操作特征(ROC)曲线分析血清HBV pgRNA、PreS1 Ag光密度[D(λ)]值诊断慢性乙型肝炎孕妇合并ICP的效能。结果 合并ICP组慢性乙型肝炎病人血清HBV表面抗原(HbsAg)水平[(3.71±0.92)log IU/mL]、HBV e抗原(HbeAg)阳性率[65.12%(28/43)]、HBV DNA含量[(8.03±1.69)log copies/mL]、天冬氨酸转氨酶(AST)[(79.68±15.73)U/L]、丙氨酸转氨酶(ALT)[(72.08±16.95)U/L]、PreS1 Ag阳性表达率[88.37%(38/43)]、PreS1 Ag D(λ)值水平(1.24±0.25)及HBV pgRNA表达水平[(5.17±1.25)log copies/mL]明显高于未合并ICP组[(2.26±0.74)log IU/mL、24.15%(57/236)、(5.19±1.07)logcopies/mL、(23.01±12.47)U/L、(21.76±10.51)U/L、67.80%(160/236)、(0.92±0.23)、(3.02±0.98)logcopies/mL](P<0.05)。血清HBV pgRNA诊断慢性乙型肝炎孕妇合并ICP的曲线下面积(AUC)为0.89,灵敏度为81.40%,特异度为80.50%。PreS1 Ag D(λ)值诊断慢性乙型肝炎孕妇合并ICP的AUC为0.83,灵敏度为76.70%,特异度为79.20%。二者联合诊断的AUC为0.91,灵敏度为93.00%,特异度为78.40%。合并ICP组、未合并ICP组血清PreS1 Ag阳性的慢性乙型肝炎病人血清HBV DNA、HBV pgRNA表达水平均明显高于PreS1 Ag阴性表达病人(P<0.05)。合并ICP组、未合并ICP组血清HBV pgRNA、PreS1 Ag D(λ)值均与HBV DNA表达水平呈正相关(P<0.05)。合并ICP组产后出血、早产的发生率明显高于未合并ICP组(P<0.05)。发生不良妊娠结局的慢性乙型肝炎合并ICP病人血清PreS1 Ag阳性表达率、PreS1 Ag D(λ)值、HBV pgRNA表达水平均明显高于未发生不良妊娠结局病人(P<0.05)。结论 合并ICP的慢性乙型肝炎病人血清HBV pgRNA表达水平、PreS1 Ag阳性表达率及D(λ)值水平均明显升高,对ICP有一定诊断价值,且两者水平变化均与HBV DNA含量有关,并可能预示病人不良妊娠结局的发生。

血清preS1水平与慢性乙型肝炎患者肝纤维化的关系及对癌变的诊断价值

目的分析血清乙型肝炎病毒(hepatitis B virus,HBV)前S1蛋白(precursor S1 protein,preS1)与慢性乙型肝炎(chronic hepatitis B,CHB)肝纤维化及癌变进展的相关性。方法对2019年10月—2021年10月期间在青海红十字医院接受检查的228例乙肝表面抗原(hepatitis B surface antigen,HBsAg)阳性慢性HBV感染者进行回顾性分析,其中CHB患者75例、肝硬化(liver cirrhosis,LC)患者93例(LC组)、肝细胞癌(hepatocellular carcinoma,HCC)患者60例(HCC组)。根据LC和HCC组肝组织活检分析肝脏炎症活动及肝纤维化程度。结果HCC组血清preS1水平[496.32(457.63,988.0)ng/mL]和LC组[338.72(247.93,554.61)ng/mL]血清preS1水平均显著高于CHB组[113.69(87.09,177.40)ng/mL],且差异具有统计学意义(P均<0.05)。HCC组血清preS1水平亦高于LC组(P=0.002)。经受试者工作特征曲线分析,血清preS1水平鉴别诊断CHB与LC的曲线下面积(area under the curve,AUC)是0.881(95%CI:0.830~0.932),鉴别诊断CHB/LC与HCC的AUC是0.861(95%CI:0.815~0.908)。3组患者的血清preS1水平与HBsAg(rs=0.799,P<0.001)呈强正相关和Log HBV DNA(rs=0.262,P<0.001)呈弱正相关。此外LC组和HCC组血清preS1水平与肝脏炎症活动分级(rs=0.201,P=0.009)及肝纤维化分期也呈弱正相关性(rs=0.295,P<0.001)。结论血清preS1水平与血清HBsAg、HBV DNA水平和肝脏炎症和纤维化进展呈正相关,有可能成为鉴别诊断HBV相关慢性肝病肝硬化或癌变的候选标志物。

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.

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.

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.

Prevention of Pre-Eclampsia and Eclampsia. A Systematic Review

Every pregnant woman needs continuous, timely and supportive care throughout during pregnancy for safe motherhood. The objective of this study was to analyze and evaluate the available medications and techniques for the prevention and treatment of pre-eclampsia and eclampsia. The standard methodology of systematic review without meta-analysis was followed and only RCTs and systematic reviews were included in the review. Three electronic data sources (PubMed/Medline, CINAHL, and Cochrane) were searched for studies, published between 1986 and 2016 on the prevention and control of pre-eclampsia and eclampsia. 47 studies were finally included in the review, of which 18 were systematic reviews and 29 were RCTs. Technologies and techniques used in the included studies for the prevention and control of pre-eclampsia and eclampsia are Magnesium Sulphate, Aspirin, Antioxidant (Vitamin C, E and Lycopene), Calcium supplementation, Chinese Herbal Medicine, physical activities, Nitric Oxide, Marine Food Oils, Low Salt Diet, Garlic, Plasma Volume Expansion, Low-dose Dopamine, Progesterone, Smoking, and Diuretics. Magnesium sulfate appears to be the most effective treatment which reduces the risk of eclampsia by more than 50%. However, its best dose and route are still controversial and need further research. The knowledge and experience of nurses in properly using the protocols and evidence-based interventions are necessary for the wellbeing of pregnant women.

The Level of Soluble FMS-Like Tyrosinkinase-1, Placental Growth Factor and Vitamin E in Pre-Eclampsia and Normotensive Pregnancy

Background: This study aims to determine the differences of angiogenic markers sFlt-1 (soluble FMS-like tyrosine kinase-1), Placental Growth Factor (PlGF) and antioxidant (vitamin E) levels in pre-eclampsia compared with normotensive pregnancies. Methods: In a cross-sectional study performed on 40 normotensive pregnancies and 40 pre-eclampsia women, serum levels of sFlt-1, PlGF and vitamin E were measured with ELISA methods. Statistical analysis used Mann Whitney. Results: The serum levels from the group of normotensive pregnancy and pre-eclampsia women consecutively are as follows: sFlt-1 2251.32 ± 416.17 pg/mL and 2950.78 ± 221.34 pg/mL, having a very significant difference (p = 0.00);PlGF 391.67 ± 293.92 pg/mL and 150.15 ± 105.34 pg/mL, having a very significant difference;vitamin E 8537.21 ± 6299.74 unit and 700.61 ± 233.70 unit, having a very significant difference. Conclusion: There is a very significant difference between an-giogenic markers and antioxidant levels in pre-eclampsia and normotensive pregnancies.

Relationship between Uricemia and Other Biochemical Markers with the Materno-Fetal Complications during Pre-Eclampsia

Goal: Determining the place of Uricemia associated with other biochemical makers in the prediction of fetal-maternal complications during preeclampsia. Material and method: This is a prospective, cross-sectional study of 75 pre-eclamptic women in three maternities in Kinshasa, Democratic Republic of Congo, during the January to December 2013. The values of the following biochemical markers: uricemia, proteinuria and creatinemia were correlated with maternal and fetal prognosis. Results: This study showed that hyper uricemia associated with massive proteinuria and a high creatinine level correlated with an unfavorable pregnancy outcome and the occurrence of major materno-fetal complications such as eclampsia (X-squared = 24.3598, ddl = 2, p-value = 0.000005) and low birth weight (p = 0.001, R2 = 0.08). Conclusion: In view of these results, it appears necessary to ensure these biochemical markers systematically in the monitoring of pre-eclampsia.

FRIOS Parameters, Key to Reduce Feto-Maternal Mortality in Pre-Eclampsia

Objective(s): To evaluate the role of free radical induced oxidative stress in predicting, prevent and prompt management of pre-eclampsia. Method(s): This prospective study was conducted on 320 pregnant women of which 240 women with pregnancy induced hypertension taken as study group and 80 normal pregnant women were taken as control. Free radical status was evaluated by estimating lipid peroxidation product malonyladehyde and antioxidants-superoxide dismutase, catalase, glutathione reductase. Statistical analysis was done by using SPSS software. Result(s): Pre-eclampsia is significantly associated with free radical induced oxidative stress. Serum level of lipid peroxidation product malondialdehyde increased in pre-eclamptic women. Serum level of antioxidants SuperOxide Dismutase, Catalase level, Glutathione Reductase were reduced. Results are statistically significant. Conclusion(s): Free radical induced oxidative stress is increasing in pre-eclampsia and plays a critical role in etiopathogenesis of pre-eclampsia.

Spot urine protein/creatinine ratio—A quick and accurate method for diagnosis of pre-eclampsia

Objective(s):To assess the diagnostic accuracy of spot urine protein-creatinine (P/C) ratio and its compareson with 24-hour urine proteinuria for predicting eclampsia. Method(s): Spot urine P/C ratio was determined in a mid-stream urine sample, and the 24-hour urine protein was measured. The correlation between the spot P/C ratio and 24-hour urine protein amount was done. Logistic regression analysis and ROC curve analysis have been used to analyse data. Result(s): There was a strong correlation between the spot P/C ratio and 24-hour urine protein excretion (pearson’s correlation coefficient r = 0.71;P < 0.0001). The optimal spot P/C ratio cutoff point was 0.25, for 300 mg/24 h of protein excretion, with sensitivity and specificity of 69% and 75% respectively. Conclusion(s): Spot urine P/C ratio is a quick and reliable tool which can be used as an alternative method for evaluation of proteinuria for diagnosis of pre-eclampsia.

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.