Eclampsia: A Continuous Scourge in a Tertiary Hospital in Southern Nigeria

Background: Eclampsia is responsible for over 50,000 maternal deaths with incidence of 1 death in about 100 - 1500 deliveries in developing nations. In sub-Saharan Africa, Nigeria accounts for the highest maternal mortality ratio of 512 deaths per 100,000 live deliveries and the highest neonatal fatality of 67 per 1000 live births. Factors such young age, nulliparity, multifetal gestation, unbooked cases, preterm delivery (<32 weeks), lack of proper access to antenatal care, poor hospital care, financial constraints and inappropriate diagnosis, have all been identified as risk factors promoting eclampsia. Objectives: In this study, we investigated the prevalence of eclampsia in Rivers State, Nigeria and established the correlation between social demographic factors and the feto-maternal outcomes among the eclampsia patients. Methodology: A prospective observational study using a detailed data sheet was conducted on 1244 pregnant women admitted at the Obstetrics and Gynecology Department of University of Port Harcourt Teaching Hospital, for 1-year duration. Data analysis was conducted using statistical packages for social sciences (SPSS) version 22. Results: Demography showed that age range (20 - 24) occurred in 40.7%, nulliparous mothers were dominant with 40.7% while 70.1% of the study population had secondary level of education. 27 cases of eclampsia were diagnosed from the 1244 pregnant women, which signified 2.13% prevalence among the studied population. The feto-maternal outcome showed that out of the 27 mothers, 19 were alive (70.4%) while 8 died (29.6%), while fetal outcome showed that 16 were alive (59.3%) and 11 died (40.7%). Only parity and education showed significant correlation at 0.01 and 0.05 levels respectively with maternal outcome. Conclusion: The prevalence of eclampsia with associated poor feto-maternal outcome rates is high in this study. Its contribution to the maternal and perinatal morbidities and mortalities necessitates the narrative of eclampsia being a scourge, as hypertensive disease remains an obstetric dilemma in both developed and developing countries.

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.

Postpartum Eclampsia in the Department of Obstetrics Gynecology and Reproductive Medicine of the Souro Sanou University Hospital;Burkina Faso: About 76 Cases

Background: Postpartum eclampsia is a life-threatening obstetric emergency. Its management is multidisciplinary. Despite measures taken to accelerate the reduction of maternal, fetal and infant mortality in Burkina Faso, maternal deaths related to postpartum eclampsia persist. The aim of the study was to investigate the epidemiological, clinical and prognostic aspects of postpartum eclampsia in the obstetrics department of the Sourô Sanou University Hospital in Bobo-Dioulasso. Method: This was a descriptive cross-sectional study with retrospective data collection covering the period from June 1, 2018 to May 31, 2019. We included 76 patients in the study;the variables studied were the epidemiological, clinical and prognostic aspects. The data collected were entered on a microcomputer and analyzed with the EPI info version 7.2 software. Results: The prevalence of postpartum eclampsia was 0.87% compared to admissions to the obstetrics department. The average age of the patients was 23 years old with the extremes of 15 and 39 years old. Primiparas accounted for 39.47%, housewives 53%, and home births accounted for 15.79%. Seizures accounted for 55% of the reasons for admission, the average time to onset of these seizures postpartum was 3.8 days with extremes of 1 and 30 days with 45% of seizures occurring postpartum immediately. Maternal complications were noted in 42.10% of cases with 5 cases of Hellp syndrome, 3 cases of renal failure, and 3 cases of acute pulmonary edema. We recorded 4 cases of maternal death, representing a case fatality rate of 5.2%. Conclusion: Postpartum eclampsia is common in the obstetrics department of the Souro Sanou University Hospital Center with a significant case fatality rate. Emphasis should be placed on monitoring and prevention, especially women at risk of developing postpartum eclampsia for better maternal prognosis.

The Hidden Side of the Story between the Placenta and Preeclampsia: Preliminary Results of a Prospective Cohort of Pregnant Women in Cameroon

Introduction: Pre-eclampsia is a complication of pregnancy that generally occurs in the third trimester. It is associated with a maternal and foetal mortality rate of around 27%. In view of the grim picture painted by this condition for both mother and newborn, studies have been carried out into the early detection of patients at risk of developing pre-eclampsia. These make it possible to introduce pregnancy-specific monitoring and preventive strategies to reduce the incidence of the condition. Objective: To establish the link between placental ultrasound characteristics and the onset of pre-eclampsia. Methodology: A multicentre prospective cohort study was conducted in two hospitals in Yaoundé, namely the Yaoundé Gynaecological Obstetrics and Paediatrics Hospital and the Nkolndongo Health and Social Animation Centre, in the gynaecology and radiology departments over a period of 11 months, from October 2022 to August 2023. It included pregnant women who had undergone obstetric ultrasound between 12 and 18 weeks’ gestation. In addition to routine obstetric ultrasound, we performed obstetric Doppler measurements in these patients. The resistance index of the left and right uterine arteries, the umbilical artery and the placental volume were the characteristics sought. At the end of this examination, two groups were formed: cases (pathological Doppler group) and controls (normal Doppler group). Blood pressure and urine dipstick were taken at each antenatal visit until delivery, then during the immediate postpartum period and finally at 7 days, 21 days and 42 days after delivery. Results: Sixty-seven (67) patients were included. Of these, 35 (47.8%) had pathological Dopplers. Sixteen patients had arterial hypertension associated with proteinuria and were therefore labelled as pre-eclampsia (PE). This gives a prevalence of 23.9%. Fifteen (42.8%) of these patients belonged to the exposed group and one to the unexposed group. The mean IR of the pre-eclampsia patients was significantly higher than that of the patients without pre-eclampsia;respectively 0.74 ± 0.096 and 0.49 ± 0.097 for the right uterine arteries and 0.71 ± 0.13 and 0.52 ± 0.089 for the left uterine arteries. We found that an increase in the uterine artery resistance index was significantly associated with the onset of pre-eclampsia, with a relative risk of 13.7 and a p value Conclusion: Abnormal Doppler ultrasound between 12 and 18 weeks of amenorrhoea had good overall sensitivity for predicting pre-eclampsia. Among the Doppler indices, the uterine artery resistance index was the only one significantly associated with pre-eclampsia.

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.

Rationale of a Cross Sectional Analytic Study on Determinants of Recurrent Preeclampsia at University Clinics of Kinshasa (Democratic Republic of Congo) and at Victor Dupouy Hospital Center (France)

Research Background: Pre-eclampsia is one of main causes of materno-foetal mortality and morbidity worldwide, with a prevalence of 3% - 7%. Although considered a primiparous condition, it can nevertheless recur. Several factors appear to be associated with risk of recurrence of pre-eclampsia, such as the term of delivery of previous pregnancy, severity of disease, the existence of co-morbidities and the inter-genital space. Purpose: The aim of our study will be to analyse and identify in a population of pregnant women with a history of preeclampsia risk factors associated with occurrence of recurrent preeclampsia at University clinics of Kinshasa (Democratic Republic of Congo) and at Victor Dupouy Hospital Center (France). Methods: In this study, pregnant women with an history of preeclampsia who will give birth between November 2018 and October 2024 at University Clinics of Kinshasa (UCK) and Victor Dupouy Hospital Center (VDHC) will be included. This will be a cross-sectional analytical study, data from previous and subsequent pregnancies will be studied. Expected Result: The prevalence of recurrent preeclampsia in the study population will be determined. And we will highlight the factors that will determine the recurrence of preeclampsia by analysing the risk factors. Conclusion: Knowledge of the factors associated with recurrent preeclampsia could be an excellent tool for predicting and preventing the disease.

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.

Predictive Value of the Neutrophil to Lymphocyte Ratio (NLR) to Predict the Development of Preeclampsia and Pregnancy Induced Hypertension at 1st Trimester

Introduction: Hypertensive disorder in pregnancy affects 4 to 6 percent of all pregnancies and carries risks for the both baby and the mother. Only a few groups of women who are at high-risk pregnancies are received prophylaxis Aspirin, more than 15 percent of women develop pre-eclampsia with a single minor risk factor. Methods: This descriptive cross-sectional study was conducted to compare the 1st trimester NLR value of normotensive, pregnancy induced hypertensive and pre-eclamptic pregnant women. The study was conducted with a sample of 416, antenatal patients who were admitted to ward 25, at Colombo North Teaching Hospital Ragama. Data was collected as separated three groups. NLR value was calculated separately and ANOVA test was used to analyze the 3 categorical data. Post HOC test was done to assess the multiple comparison. Results: The prevalence rates of pregnancy induced hypertension and pre-eclampsia among the pregnant women were 8.6% and 5.7%. The mean NLR values of normotensive group was 2.708, pregnancy induced hypertensive group was 2.650 and pre eclamptic group was 3.789. There was a significant difference in NLR value between pre eclamptic group and other two groups with P value of Conclusion: The 1st trimester NLR value of pre eclamptic patients significantly increased compared to normotensive women.

Increased Spot Urinary Protein-to-Creatinine Ratio Can Be a Useful Predictor of Preeclampsia

Objectives: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early diagnosis of preeclampsia is important to help patients with preeclampsia. However, 24-hour urine collection is the gold standard diagnostic method at present. Recently, the spot urinary protein-to-creatinine ratio (P/C ratio) has been used to detect suspected preeclampsia, because it can be used to estimate the amount of 24-hour urinary protein. The aim of this study is to investigate whether an increase in P/C ratio precedes emergence of hypertension among inpatients with preeclampsia. Method: The P/C ratio in normotensive (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) pregnant women was measured during regular prenatal checkups and in inpatients with preeclampsia between April 1, 2013 and March 31, 2014. Results: We included in this study 4074 normotensive pregnant women. The 95th percentile values for the trimester of pregnancy were 0.100, 0.157, and 0.195, respectively. The 95th percentile value for each trimester of pregnancy and gestational age were determined as criterion (Y) and predictive variables (X), respectively. In a simple regression analysis, the regression line was calculated as Y = 0.0035X + 0.0849 (R2 = 0.9913). Twenty-one women were diagnosed with preeclampsia. In 14 patients with preeclampsia, the timing of the increase in P/C ratio to higher than the regression line preceded the emergence of hypertension. Six patients had no data on P/C ratio, and 1 patient had hypertension before the increase in P/C ratio. Conclusions: An increase in P/C ratio to higher than the 95th percentile value can be a useful predictor of preeclampsia.

Why does a high-fat diet induce preeclampsia-like symptoms in pregnant rats?

Changes in neurotransmitter levels in the brain play an important role in epilepsy-like attacks after pregnancy-induced preeclampsia-eclampsia. Metabotropic glutamate receptor 1 participates in the onset of lipid metabolism disorder-induced preeclampsia. Pregnant rats were fed with a high-fat diet for 20 days. Thus, these pregnant rats experienced preeclampsia-like syndromes such as hyper-tension and proteinuria. Simultaneously, metabotropic glutamate receptor 1 mRNA and protein ex-pressions were upregulated in the rat hippocampus. These findings indicate that increased expres-sion of metabotropic glutamate receptor 1 promotes the occurrence of high-fat diet-induced pree-clampsia in pregnant rats.

Preeclampsia and eclampsia: Etiopathogenesis and perioperative management

Preeclampsia is a pregnancy specific syndrome of elusive etiology, developing in 2nd trimester and associated with high maternal and perinatal morbidity and mortality. The spectrum ranges from mild preeclampsia with no systemic involvement to multi-system involvement. The course is unpredictable and delivery is the only curative treatment. Elevated blood pressure(> 160/110 mm Hg) should be reduced gradually to a safe level(140/90) using antihypertensive drugs. Prophylaxis and treatment of convulsions using Mg SO4 is indicated for severe preeclampsia. Fluid therapy is controversial due to potential delicate balance between constricted plasma volume and risk of fluid overload and pulmonary oedema secondary to increased capillary permeability and reduced colloid osmotic pressure. Single shot spinal anaesthesia is the technique of choice for caesarean delivery unless contraindicated. General anaesthesia is indicated in patients with coagulopathy or eclampsia but is associated with risk of difficult airway and exaggerated sympathetic response during laryngoscopy. Epidural analgesia and anaesthesia is safe in absence of coagulopathy.

Severe eclampsia and HELLP syndrome at 18 weeks of pregnancy in a patient with chronic hypertension

Preeclampsia is a pregnancy specific disease characterized by hypertension and proteinuria, by definition, developing after 20 weeks of pregnancy. Here we present an atypical case of severe preeclampsia complicated by generalized convulsions (eclampsia) and hemolysis, elevated liver enzymes, and low platelet count syndrome in an 18 weeks pregnant patient with chronic hypertension. Occurrence of these complications was preceded by upper right quadrant abdominal pain and severe hypertension. In this case no evidence of autoimmunity disorders or molar pregnancy was found.

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.

Factors Associated with Maternal and Perinatal Complications of Preeclampsia at the Central Hospital of Yaoundé: A Cross-Sectional Analytical Study

Introduction: Pre-eclampsia (PE) is a public health problem especially in developing countries due to its incidence and severity. It is responsible for high maternal and perinatal morbidity and mortality. Accordingly, the objective of this work was to study the factors associated with the occurrence of maternal and perinatal complications of preeclampsia. Method: This was an analytical cross-sectional study with prospective and retrospective data collection including all patients, pregnant or postpartum, admitted for pre-eclampsia to the maternity ward of the Yaoundé Central Hospital. It took place over a period of seven (07) months. The data collected was analyzed using CS Pro 7.4, SPSS 20.0 and Microsoft Office Excel 2010 software. We compared the group with complications to the group without complications. We calculated the odds ratio to look for associations between variables and their 95% confidence intervals. The threshold for statistical significance was set at p Results: We recruited 214 cases of preeclampsia in our series. There were maternal complications in 44.4% of cases, dominated by eclampsia (31.8%). We recorded 07 maternal deaths, representing a maternal lethality of 3.3%. We had at least one perinatal complication in 105 cases (49.1%). The predominant perinatal complication was prematurity. We recorded 32 cases of intrauterine fetal demise and 13 cases of early neonatal death, giving a perinatal lethality of 21%. After logistic regression, the factors associated with maternal complications were residing in a rural area (OR = 2.217 [1.054 - 3.09];p < 0.036);a nurse-aid as prenatal consultation provider (PNC) (OR = 5.059 [2.175 - 36.162];p - 4.029]). Conclusion: Complications of preeclampsia are very common in our setting. Several identified factors are associated with the occurrence of these complications. We suggest building the capacity of providers of PNC and sensitization of women on the use of PNC services.

Magnesium Sulfate Effect on Fetal Umbilical Artery and Middle Cerebral Artery Doppler Indicies in Women with Severe Preeclampsia and Eclampsia

Objective: To study MgSO4 effect on fetal MCA and UA blood flow changes using Doppler ultrasound in cases of severe PET and eclampsia. Materials and Methods: A total of 40 patients with severe PET admitted to El-Shatby Maternity University Hospital, Alexandria (Egypt) were examined before and after administration of MgSO4 using Doppler study to measure fetal MCA and UA blood flow changes. Results: After administration of MgSO4, the mean RI of UA, PI of UA showed a statistically significant decrease (P < 0.001) also the systolic-diastolic ratio (p = 0.001). Mean resistivity index (RI) cerebral showed a statistically significant increasing (P = 0.001), pulsatility index (PI)-cerebral and the systolic-diastolic ratio showed a statistically significant increasing (P < 0.001). The C/U (cerebroumblical) ratio increased after the treatment (P < 0.001). Conclusions: Infusion of MgSO4 significantly decreases the fetal RI, PI, SDR umbilical and increases the fetal RI, PI, SDR MCA and increases cerebroumblical ratio indices obtained by Doppler examinations.

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.

T Lymphocyte Subpopulations in Normal Pregnancies and Those Complicated by Eclampsia in Kaduna State, Nigeria

Background: Eclampsia, the occurrence of generalized convulsion(s) in association with signs of preeclampsia [PE] (hypertension and proteinuria) in pregnancy has remained a significant public threat in Nigeria, contributing to maternal and perinatal morbidity and mortality. This study was a comparative cross-sectional study conducted in some selected hospitals in Kaduna State, between April 2014 and November 2015. Subjects and Methods: Blood (3 mls) was collected into an ethylenediaminetetraaccetic acid (EDTA) vacutainer tube from third trimester women diagnosed with eclampsia (EC;n = 38) and healthy pregnant controls (PC;n = 38)—age and parity matched and healthy non-pregnant controls (NPC;n = 38)—age matched. T Cell subpopulations and Complete Blood Count levels were measured by Sysmex, Auto blood analyzer and flow cytometry respectively. Participants with smear positive malaria, seropositive for human immunodeficiency virus (HIV), any other clinical infection or refused consent were excluded from this study. Data obtained were analyzed using analysis of variance (ANOVA) and Post Hoc test. A p-value of less than 0.05 was considered to be significant. Result: Overall, results showed a depressed (mean ± Standard deviation (SD): CD3+ T cell (65.6 ± 15.5%;1225.5 ± 401.5 cell/μL), CD4+ T cell (36.1 ± 8.7%;657.1 ± 189.9 cell/μL), and a low CD4/CD8 value in women with EC (1.4 ± 0.5) and PC (1.5 ± 0.3) compared to NPC (1.9 ± 0.6) control (p < 05), while the total white blood cell count, and differential percentage neutrophils count were noted to be elevated among the eclamptic women (9.8 ± 4.9 × 109/L;70.3 ± 12.0%) compared to PC (6.9 ± 3.6 × 109/L;64.6 ± 8.1%) and NPC (5.6 ± 2.0 × 109/L;48.5 ± 10.7%), p < 0.05. Conclusion: Eclampsia was associated with significantly depressed CD3+ and CD4+ T lymphocyte, and increased percentage differential neutrophil counts.

Atypical eclampsia at primary health care in a remote area:A case report

BACKGROUND Eclampsia is a generalized tonic-clonic seizure induced by pregnancy.It contributes to a high rate of maternal and neonatal morbidity and mortality worldwide.Eclampsia is characterised by classic signs such as elevated blood pressure,proteinuria,and seizures.However,it may occur in the absence of hypertension and/or proteinuria.The uncommon appearance of eclampsia makes it difficult to immediately assess and treat it.In addition,the occurrence of this case in a remote area makes it more challenging to handle.The objective of this case report is to increase awareness of uncommon manifestations of eclampsia,particularly in limited-resource settings.CASE SUMMARY A young primigravida experienced a generalised seizure without hypertension and/or proteinuria.Sudden hearing loss,blurred vision,and vomiting were complained about before the seizure attack.The patient was diagnosed with eclampsia.A loading dose of magnesium sulphate was administered immediately.The patient was referred from community healthcare to a hospital and discharged without any complications.CONCLUSION Atypical eclampsia may be a diagnostic challenge.However,other symptoms may be beneficial,such as awareness of eclampsia signs.