Association between Abnormal Serum Lipid Levels in Early Pregnancy and Development of Preeclampsia.

BACKGROUND: Accurate early biomarkers of oxidative stress, placenta perfusion and vascular resistance and endothelial platelet interaction for prediction of preeclampsia have not been shown to be beneficial for routine clinical use. The study of association between abnormal lipid levels in early pregnancy and preeclampsia is thus necessary in a bid to reduce the progression and severity of complications of preeclampsia. OBJECTIVE: To determine the association between abnormal lipid levels in early pregnancy and the development of preeclampsia. MATERIALS AND METHODS: A prospective longitudinal study involving 184 pregnant women with singleton pregnancy who met the inclusion criteria and recruited from the antenatal clinic at gestational age of < 20weeks. Their fasting blood samples were collected for the measurement serum lipid profile. They were monitored until delivery for the development of preeclampsia. The mean values of serum lipid profile were analyzed for association with pre-eclampsia using the statistical package for social sciences (SPSS) version 21.0 and P value of < 0.05 was considered statistically significant. RESULTS: Out of 184 participants, 3 had spontaneous miscarriage and were excluded while 5 were lost to follow up. This left a total of 176 participants who completed the study, 11 of which developed preeclampsia. There was a statistically significant increase in the levels of total cholesterol (TC) and low-density lipoprotein (LDL) in the preeclamptic group. The mean serum lipid levels were 4.8 mmol/L for total cholesterol, 1.87 mmol/L for total triglycerides, 1.3 mmol/L for high-density lipoprotein and 2.67 mmol/L for low-density lipoprotein. Age and parity also showed a causal association with development of preeclampsia. CONCLUSION: There was an association between elevated serum total cholesterol and low-density lipoprotein with development of preeclampsia later in pregnancy.

CONTEXTE: Les biomarqueurs précoces précis du stress oxydatif, de la perfusion et de la résistance vasculaire du placenta et de l'interaction endothéliale-plaquettaire pour la prédiction de la prééclampsie ne se sont pas révélés avantageux pour l'utilisation clinique courante. L'étude de l'association entre les taux anormaux de lipides en début de grossesse et la prééclampsie est donc nécessaire pour réduire la progression et la gravité des complications de la prééclampsie. OBJECTIF: Déterminer l'association entre des taux de lipides anormaux en début de grossesse et le développement de la pré- éclampsie. MATÉRIEL ET MÉTHODES: Une étude longitudinale prospective impliquant 184 femmes enceintes avec une grossesse unique qui répondaient aux critères d'inclusion et qui ont été recrutées à la clinique prénatale à l'âge gestationnel de < 20 semaines. Des échantillons de sang à jeun ont été prélevés pour mesurer le profil lipidique sérique. Elles ont été suivies jusqu'à l'accouchement pour le développement de la pré-éclampsie. Les valeurs moyennes du profil lipidique sérique ont été analysées pour leur association avec la pré-éclampsie à l'aide du progiciel statistique pour les sciences sociales (SPSS) version 21.0 et une valeur P de < 0,05 a été considérée comme statistiquement significative. RÉSULTATS: Sur les 184 participantes, 3 ont fait une fausse couche spontanée et ont été exclues, tandis que 5 ont été perdues de vue. Il restait donc un total de 176 participantes qui ont terminé l'étude, dont 11 ont développé une prééclampsie. On a constaté une augmentation statistiquement significative des taux de cholestérol total (CT) et de lipoprotéines de basse densité (LDL) dans le groupe prééclamptique. Les taux moyens de lipides sériques étaient de 4,8 mmol/L pour le cholestérol total, 1,87 mmol/L pour les triglycérides totaux, 1,3 mmol/L pour les lipoprotéines de haute densité et 2,67 mmol/L pour les lipoprotéines de basse densité. L'âge et la parité ont également montré une association causale avec le développement de la prééclampsie. CONCLUSION: Il y avait une association entre un taux élevé de cholestérol total sérique et de lipoprotéines de basse densité et le développement de la prééclampsie plus tard dans la grossesse. Mots clés: Association, Prééclampsie, Cholestérol sérique, Lipoprotéines de basse densité, Lipoprotéines de haute densité, Triglycérides, Lipides sériques.

Prevalent high-risk HPV infection and vaginal microbiota in Nigerian women.

In this study, we evaluated the association between high-risk human papillomavirus (hrHPV) and the vaginal microbiome. Participants were recruited in Nigeria between April and August 2012. Vaginal bacterial composition was characterized by deep sequencing of barcoded 16S rRNA gene fragments (V4) on Illumina MiSeq and HPV was identified using the Roche Linear Array® HPV genotyping test. We used exact logistic regression models to evaluate the association between community state types (CSTs) of vaginal microbiota and hrHPV infection, weighted UniFrac distances to compare the vaginal microbiota of individuals with prevalent hrHPV to those without prevalent hrHPV infection, and the Linear Discriminant Analysis effect size (LEfSe) algorithm to characterize bacteria associated with prevalent hrHPV infection. We observed four CSTs: CST IV-B with a low relative abundance of Lactobacillus spp. in 50% of participants; CST III (dominated by L. iners) in 39·2%; CST I (dominated by L. crispatus) in 7·9%; and CST VI (dominated by proteobacteria) in 2·9% of participants. LEfSe analysis suggested an association between prevalent hrHPV infection and a decreased abundance of Lactobacillus sp. with increased abundance of anaerobes particularly of the genera Prevotella and Leptotrichia in HIV-negative women (P < 0·05). These results are hypothesis generating and further studies are required.

Uterine rupture: trends and feto-maternal outcome in a Nigerian teaching hospital.

OBJECTIVE: To determine the trends, predisposing factors, maternal and fetal outcome of cases of uterine rupture managed at the University of Abuja Teaching Hospital. METHOD: A retrospective review of all cases of ruptured uterus managed at the University of Abuja teaching hospital, Gwagwalada, between January 2006 and December 2010 was conducted. RESULT: There were 9604 deliveries in the hospital during the period of review out of which 82 were cases ruptured uterus, giving an overall incidence of 0.85% or 1 in 117 deliveries. They were mainly women of low parity with a mean age of 31.8 years. The commonest predisposing factor was injudicious use of oxytocin occurring in 38.7% of cases and was followed closely by previous caesarean section scar (28.0%). Prolonged obstructed labour was the third commonest cause of uterine rupture (18.7%) and occurred only in the unbooked patients. There were 11 maternal deaths which gave a maternal case fatality rate of 14.7%. All the deaths occurred in women who had intrapartum care in places other than the teaching hospital. There were 68 perinatal deaths which gave a fetal case fatality rate of 90.7% and all the babies that survived were in patients that had intrapartum care in the teaching hospital. CONCLUSION: Ruptured uterus is a common obstetric emergency in Nigeria's Federal Capital territory and is associated with high maternal and perinatal morbidity and mortality. It is however preventable when the quality of antenatal care, intrapartum care and medical facilities are improved.

Fetal outcome of twin gestations in a Nigerian teaching hospital.

BACKGROUND: Although twin gestation is associated with increased perinatal morbidity and mortality, optimal management of this high risk pregnancy is associated with improved outcome for the mother and her baby. Globally, Nigeria has the highest incidence of twinning. This makes studies on twin gestation important, especially on the outcome of the babies which is reflection of the type of care received during the antenatal and intrapartum period. STUDY OBJECTIVE: This study was designed to determine the fetal outcomes of twin deliveries in a tertiary hospital in Nigeria's Federal Capital Territory. METHOD: This was a retrospective study of babies following twin pregnancies delivered in the hospital from 1st January 1998 to 31st December 2007. RESULTS: Out of the 600 babies reviewed, 10.2% were still births giving a still birth rate of 102 per 1000 births. Majority of the stillbirths (73.8%) occurred amongst the unbooked mothers and was higher amongst the second twins. More of the booked mothers had their babies delivered at term compared to the unbooked ones, 115 (38.3%) Vs 66 (22.0%).There was a statistically significant association between gestational age at delivery and booking status of the paturients. (X2 = 16.257, P = 0.001). The mean fetal weight was 2.395 kg +/- 0.63. There was no statistically significant difference when the weights of the first and second twin were compared. (t = 0.343, P = 0.732). Out of the 539 babies born alive, 85.0% had good Apgar score of = 7 in5 minutes, 13.0% of the first twins had moderate birth asphyxia compared to 16.0% of the second twins. The female to male ratio was 1:1.1. CONCLUSION: Twin gestation is associated with low birth weights and high still birth rate in this centre. Fetal outcome is better in the first twin compared to the second twin. Outcome for babies whose mothers were booked were better compared to the unbooked. Quality antenatal care and intrapartum management will help improve fetal outcome.