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.

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.

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.

Outcome and risk factors of early onset severe preeclampsia

Background Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women. Methods Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows： group A （less than 32 weeks, 73 cases）, group B ,（between 32 and 34 weeks, 71 cases）, and group C （greater than 34 weeks, 269 cases）. The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively. Results The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome. Conclusions Early onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.

Incidence and Clinical Risk Factors for Preeclampsia and Its Subtypes:A Population-Based Study in Beijing,China

Objective:This study aimed to evaluate the incidence and associated clinical risk factors for preeclampsia(PE)and its subtypes in a large multicentre retrospective study of Beijing,China.Methods:This study was conducted as a secondary analysis from the Gestational diabetes mellitus Prevalence Survey(GPS),a multicentre retrospective cohort study,which included 15 hospitals in Beijing,China.This analysis included 15,003 pregnant women who delivered in Beijing from June 20th to November 30th,2013.The incidence of PE was calculated.Risk factors for PE,including maternal age,pre-gestational body mass index(BMI),parity,chronic hypertension,pre-existing diabetes,and gestational diabetes mellitus,were assessed.PE was defined as early-or late-onset PE based on clinical manifestations during the week of delivery,and mild or severe PE based on the severity of the disease.Logistic regression analysis was used to quantify the association with the risk factors,and data were displayed as odds risks(OR)and 95%confidence interval(CI).Results:The overall incidence of PE was 2.65%(397/15,003).The prevalence of early-onset and late-onset PE was 0.36%(54/15,003)and 2.29%(343/15,003),respectively.The prevalence of mild and severe PE was 0.91%(137/15,003)and 1.73%(260/15,003),respectively.Risk factors including high BMI considered overweight(adjusted odds risk(aOR):1.48;95%CI:1.06-2.05;P=0.02)and obesity(aOR:2.15;95%CI:1.50-3.08;P<0.001),nulliparity(aOR:1.73;95%CI:1.32-2.25;P<0.001),multiple gestation(aOR:4.58;95%CI:2.86-7.32;P<0.001),and chronic hypertension(aOR:34.95;95%CI:26.60-45.93;P<0.001),were associated with increased risk for PE.Only chronic hypertension(aOR:13.75;95%CI:4.78-39.58;P<0.001)was a significant risk factors for early-onset PE,whereas high BMI considered both overweight(aOR:1.54;95%CI:1.09-2.18;P=0.01)and obesity(aOR:2.23;95%CI:1.53-3.27;P<0.001),nulliparity(aOR:2.00;95%CI:1.49-2.68;P<0.001),multiple gestation(aOR:4.11;95%CI:2.40-7.05;P<0.001),and chronic hypertension(aOR:35.57;95%CI:26.66-47.47;P<0.001)were more relevant risk factors for late-onset PE.Risk factors including obesity(aOR:2.20;95%CI:1.28-3.76;P<0.01 and aOR:1.80;95%CI:1.16-2.80;P=0.01),nulliparity(aOR:2.28;95%CI:1.44-3.60;P<0.001 and aOR:1.48;95%CI:1.09-2.02;P=0.01),multiple gestation(aOR:5.50;95%CI:2.87-10.67;P<0.001 and aOR:3.51;95%CI:1.93-6.41;P<0.001),and chronic hypertension(aOR:33.98;95%CI:22.20-52.01;P<0.001 and aOR:35.03;95%CI:25.40-48.31;P<0.001)were associated with mild and severe PE.Moreover,we found that women with an increasing number of these risk factors had a higher risk of developing PE than pregnant women without any identified risk factors.Conclusion:The incidence of PE in this study is consistent with previous reported studies.Our findings indicate chronic hypertension and multiple gestation are the most important risk factors for PE in Chinese pregnant women.The risk for developing PE is associated with both the type and abundance of risk factors.These factors are valuable when monitoring patients at risk for PE,as this can help ensure an earlier diagnosis and prediction in women who are more likely to develop PE.