Histopathological Aspects of Placental Lesions in Mild and Severe Pre-Eclampsia in a Population of Cameroonian Women

Background: Pre-eclampsia (PE) frequently leads to adverse maternal and foetal outcomes in our setting. The pathophysiology is strongly linked to placental development. We aimed to study placental lesions associated with PE in a population of Cameroonian women. Methods: We conducted a cross-sectional, analytical study in three university teaching hospitals in Yaounde namely, the Yaounde Central Hospital, the pathology laboratory of the Yaounde University Hospital Centre, and the Yaounde Gynaeco-Obstetric and Paediatric Hospital. The study spanned 8 months from January 1st to September 1st, 2021. Placental analysis was carried out as per standard protocol. The study included 101 parturients with pre-eclampsia. These were divided into two groups, with groups 1 and 2 being made of patients with mild pre-eclampsia (n = 40), and severe pre-eclampsia (n = 61), respectively. Results: The mean ages of the two groups were 29.93 ± 7.36 versus 28.28 ± 7.18 (p = 0.267) for patients with mild and severe pre-eclampsia respectively. Low socioeconomic status was the most frequently identified risk factor in both groups (59%). Patients’ history revealed that the women with severe pre-eclampsia tended to have poor pregnancy follow-up compared to those with mild pre-eclampsia (p < 0.05). Also, the placentas of patients with severe pre-eclampsia weighed significantly less than those of patients with mild pre-eclampsia (454.4 ± 122 vs. 511.7 ± 125;p < 0.05). Pre-eclampsia-related lesions were significantly greater in patients with severe disease (p Conclusion: PE-related placental lesions in our context are multiple and diverse especially in severe disease, and these arise as a result of defective maternal vascular perfusion.

Preventing Stillbirth:A Review of Screening and Prevention Strategies

Stillbirth is a devastating pregnancy complication that still affects many women,particularly from low and middle-income countries.It is often labeled as“unexplained”and therefore unpreventable,despite the knowledge that placental dysfunction has been identified as a leading cause of antepartum stillbirth.Currently,screening for pregnancies at high-risk for placental dysfunction relies on checklists of maternal risk factors and serial measurement of symphyseal-fundal height to identify small for gestational age fetuses.More recently,the first-trimester combined screening algorithm developed by the Fetal Medicine Foundation has emerged as a better tool to predict and prevent early-onset placental dysfunction and its main outcomes of preterm preeclampsia,fetal growth restriction and stillbirth by the appropriate use of Aspirin therapy,serial growth scans and induction of labour from 40 weeks for women identified at high-risk by such screening.There is currently no equivalent to predict and prevent late-onset placental dysfunction,although algorithms combining an ultrasound-based estimation of fetal weight,assessment of maternal and fetal Doppler indices,and maternal serum biomarkers show promise as emerging new screening tools to optimize pregnancy monitoring and timing of delivery to prevent stillbirth.In this review we discuss the strategies to predict and prevent stillbirths based on firsttrimester screening as well as fetal growth and wellbeing assessment in the second and third trimesters.