Pre-eclampsia at Laquintinie hospital (Douala): survey of prevalence and morbidity from 2010 to 2015

Objective: to determine the prevalence of pre-eclampsia and describe its complications at Laquintinie Hospital in Douala. Methods: We conducted a descriptive study with retrospective data collection for 03 months (January 18, 2016 to April 18, 2016) from the records of pregnant women received at the gynecology-obstetrics department over a 6-year period from 1st January 2010 to 31st December 2015 at Laquintinie Hospital in Douala. We identified pregnant women with BP≥140 / 90 mmHg combined with proteinuria> 0.3g / 24h or significant albuminuria (2+) on urine strips after 20 weeks of amenorrhea. Results: Of the 17644 deliveries recorded during our study period, we found 1080 cases of PE, a frequency of 6.12%. PE was common among primi-parous women (46.7%) in the age group [20-29] years. Pregnant women under the age of 20 were the most affected by eclampsia. Preeclampsia was frequently found in pregnant women with twin pregnancies and those with macrosomic fetuses with 10.1% and 8.9% frequency, respectively. Multiparous women with preeclampsia often had a history of PE (43 cases or 4%), arterial hypertension (55 cases or 5.1%) and / or diabetes (5 cases or 0.5%). Eclampsia was the principal maternal complication (29.7%). The maternal case fatality rate was 0.5%. Fetal complications were dominated by induced prematurity (19.5%) and intra-uterine fetal death (9.4%). Conclusion: This study reveals that pre-eclampsia is frequent in Douala Laquintinie hospital with high maternal-fetal morbidity and mortality rate and therefore remains a major public health problem

Síndrome de leucoencefalopatía posterior reversible por preeclampsia / Posterior reversible leukoencephalopathy syndrome caused by pre-eclampsia

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Resultados obstétricos asociados al incremento del índice de masa corporal durante el embarazo en el Hospital Clínico de la Universidad de Chile / No disponible

Introducción: Estudios previos muestran que el incremento en la categoría del índice de masa corporal (IMC) se asocia a un mayor riesgo de complicaciones obstétricas. Objetivo: Investigar el impacto que tiene el incremento del IMC durante el embarazo en los resultados obstétricos en el Hospital Clínico de la Universidad de Chile. Material y métodos: Estudio retrospectivo que incluye a embarazadas atendidas en el hospital entre el año 2001 y 2006. Las mujeres con embarazos únicos fueron clasificadas en las distintas categorías de IMC. El incremento del IMC se calculó como la diferencia entre el IMC del inicio y el del final de la gestación. Para comparar las variables categóricas se usó el test exacto de Fisher y para las variables continuas el test de la t para comparación de 2 medias. Resultados: El estudio incluyó a 5.478 mujeres: 568(10,48%) no incrementaron su categoría de IMC y4.910 (89,51%) aumentaron su IMC en 1 o más categorías. El incremento del IMC se asoció a mayor riesgo de preeclampsia (p = 0,004) y operación cesárea (p =0,009) en las pacientes con sobrepeso, no así en las pacientes con normopeso al inicio del embarazo. Las pacientes obesas presentan mayor riesgo de preeclampsia(p = 0,008), diabetes gestacional (p < 0,001), operación cesárea (p < 0,001) e infección posparto (p = 0,009).Conclusión: El incremento en la categoría de IMC se asocia a un aumento del riesgo de complicaciones obstétricas (AU)

Background: Previous studies have shown that an increase in body mass index (BMI) is associated with a greater risk of obstetric complications. Aim: To investigate the effect of an increase in BMI category on obstetric outcomes in Hospital Clínic of the University of Chile. Material and methods: A retrospective study was conducted of women followed-up in the hospital from2001 to 2006. Women with singleton pregnancies were placed in standard BMI categories. Increases in BMI were calculated as the difference between initial BMI and that at delivery. Fisher’s exact test was used to compare categorical variables and the t test between two means was used for continuous variables. Results: This study included 5,478 women: 568(10.48%) had no change in BMI category and 4.910(89.51%) increased their BMI by >= 1 category. An increase in BMI category was associated with higher rates of preeclampsia (p = 0.004) and cesarean delivery(p = 0.009) in overweight women but not in women with a healthy weight at the beginning of pregnancy. Obese women had a higher risk of preeclampsia (p =0.008), gestational diabetes (p < 0.001), cesarean delivery(p < 0.001), and postpartum infection (p = 0.009).Conclusions: An increase in BMI category is associated with a greater risk of obstetric complications (AU)

Rotura esplénica posparto asociada a preeclampsia / Post-partum splenic rupture associated with pre-eclampsia

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Leucomalacia y ecogenicidad periventricular en prematuros de muy bajo peso al nacer / Leukomalacia and periventricular echogenicity invery low birth weight premature infants

Introducción. La leucomalacia periventricular cística (c-LPV) y la ecogenicidad periventricular persistente (EPVP)son lesiones de la sustancia blanca de etiología multifactorial, de alta frecuencia en prematuros y con potencial efecto deletéreo en el neurodesarrollo. Objetivos. Determinar la incidencia de EPVP y c-LPV y evaluar posibles predictores. Pacientes y métodos. Cohorte de 164 neonatos de menos de 1.500 g de peso y edad gestacional igual o inferior a 32 semanas, ingresados en la Unidad de Neonatología del Hospital Clínico Regional de Valdivia, Chile. Se realizó ecografía cerebral durante la primera semana, a los 15 y 30 días de vida, y se diagnosticaron las lesiones según la clasificación de Volpe. Se evaluó la asociacióncon distintos factores perinatales y se efectuó estimación de riesgo univariado –riesgo relativo (RR) e intervalo de confianza al 95% (IC 95%)– y análisis multivariado mediante regresión logística múltiple –odds ratio (OR) ajustadas–.Resultados. La incidencia de EPVP y c-LPV fue del 13,4 y 23,8%, respectivamente. El 66,7% de los casos de c-LPV ocurrió en menores de 28 semanas (RR = 4,83; IC 95% = 2,72-8,58). Se encontró significativa reducción del riesgo de c-LPV con la edad gestacional por cada semana adicional (OR = 0,5; IC 95% = 0,38-0,65) e hipertensión del embarazo (OR = 0,27; IC 95% = 0,08-0,87). Seobservó significativa reducción del riesgo de EPVP con la mejor puntuación Apgar al minuto y el sexo masculino. No hubo asociación con corioamnionitis, uso de corticoides prenatales ni otros factores perinatales. Conclusiones. Se confirma una alta incidencia de trastornos de la sustancia blanca, y la edad gestacional es un potente predictor de c-LPV. Se precisan estudiosadicionales para esclarecer el efecto de la hipertensión del embarazo sobre la c-LPV

Introduction. Cystic periventricular leukomalacia (c-PVL) and persistent periventricular echogenicity (PPVE) are white matter injuries of multifactorial etiology, high incidence in premature infants and with harmful effect in neurodevelopment.Aims. To determine PPVE and c-PVL incidence, and to assess potential predictors. Patients and methods. Cohort of 164 very low birth weight premature infants (< 1,500 g and with gestational age equal or below 32 weeks), admitted to the Neonatal Care Unit of Hospital Clínico Regional de Valdivia, Chile. Cerebral ultrasound within the first week, at day 15 and day 30 of life was performed, and diagnosis of the lesions was made according Volpe’s classification. The association of PPVE and c-PVL with several perinatal factors was evaluated by univariate risk estimation –relative risk (RR), and 95% confidence interval (95% CI)–, and then, multivariate analysis through multiple logistic regression –adjusted odds ratio (OR)– was carried out. Results. The incidence of PPVE and c-PVL was 13.4 and 23.8%, respectively. 66.7% of c-PVL cases were observed in infants lower than 28 weeks (RR = 4.83; 95% CI = 2.72-8.58). The risk of c-PVL was lower with gestationalage for each additional week (OR = 0.5; 95% CI = 0.38-0.65) and maternal hypertension (OR = 0.27; 95% CI = 0.08-0.87). A significant decrease of PPVE risk was found with better Apgar score after 1 minute and male sex. No association was found with either chorioamnionitis, antenatal corticosteroids nor other perinatal factors. Conclusions. This study confirms highincidence of white matter lesions, being gestational age a strong predictor of c-PVL. Studies are needed to clarify maternal hypertension effect on c-PVL development

Parálisis facial posparto / No disponible

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Pápulas y nódulos violáceos en caras anteriores de manos / Violaceous papules and nodules on the palmar aspects of the hands

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Edema vulvar masivo en preeclampsia severa / Massive vulvar edema in severe preeclampsia

Presentamos el caso clínico de una gestante, diabética pregestacional, que en la semana 22 de gestación presenta una preeclampsia severa con edema masivo agudo de la vulva y un edema agudo de pulmón. Se realiza una revisión bibliográfica, mediante búsqueda informática, en el sistema de Medline, de los trabajos publicados relacionados.El edema vulvar agudo en una gestante puede ser predictor de graves complicaciones, lo que nos obliga a una vigilancia intensa. En nuestra paciente se tuvo que terminar la gestación mediante cesárea en la semana 26, debido a las graves complicaciones maternas

We report the case of a pregnant woman with pregestational diabetes who developed severe preeclampsia in week 22 of pregnancy culminating in acute massive edema of the vulva and acute edema of the lung. A Medline search was performed to identify published studies related to this topic. Acute vulvar edema in pregnancy can be predictive of serious complications and consequently intense monitoring is mandatory. In our patient, Cesarean delivery was performed at week 26, due to serious maternal complications

Paciente con convulsiones en el postparto. Diagnóstico diferencial / Patient with postpartum seizures: differential diagnosis

La preeclampsia es una patología obstétrica grave con una elevada morbimortalidad materno-fetal. Presentamos el caso de una paciente, con antecedentes de diabetes mellitus insulinodependiente y convulsiones en posible relación con episodios de hipoglucemia, que ingresa para cesárea urgente por preeclampsia severa y feto macrosómico. En el postparto inmediato presenta pérdida brusca de consciencia y convulsión asociada a hemorragia vaginal y shock hipovolémico. Ante una paciente pluripatológica y con embarazo de alto riesgo es necesario extremar la vigilancia y llevar a cabo las medidas profilácticas necesarias para disminuir la morbimortalidad maternofetal. A propósito de este caso analizamos la valoración preanestésica, diagnóstico diferencial y elección de la técnica anestésica en este tipo de pacientes

Pre-eclampsia is a serious obstetric complication associated with a high rate of maternal and fetal morbidity and mortality. We report the case of a woman with a medical history of insulin-dependent diabetes mellitus and seizures possibly related to hypoglycemia who was admitted for an emergency cesarian due to severe pre-eclampsia and macrosomic fetus. In the first hour after delivery she experienced loss of consciousness and seizure, with vaginal bleeding and hypovolemic shock. Maximum vigilance is required for a patient with several concomitant diseases and a high-risk pregnancy. All prophylactic measures to lower the risk to mother and fetus should be undertaken. We analyze preanesthetic assessment, differential diagnosis, and choice of anesthesia in relation to this case

Problemática del embarazo post-trasplante renal / Renal post transplantation pregnancy: problems

El embarazo después del trasplante renal debe considerarse de alto riesgo tanto por las complicaciones maternas como por las fetales que puedan producirse. No obstante, siguiendo una serie de recomendaciones es posible y las complicaciones pueden minimizarse realizando un abordaje multidisciplinar. El embarazo puede considerarse seguro si se da en pacientes con buena micción renal, son proteinuria, sin HTA y sin evidencia de rechazo 2 años después del trasplante renal

Pregnancy after transplantation should be considered a high-risk pregnancy and should be monitored by a multidisciplinar team. Pregnancy could be considered safe about 2 years after transplantation in women with good renal function, without proteinuria, without arterial hypertension and with no evidence of ongoing rejection

Hepatopatías en la gestación. Revisión bibliográfica / Liver diseases in pregnancy

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Proteinuria / Proteinuria

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Aumento de la gestación múltiple. Repercusión en la morbimortalidad maternofetal / Increase multiple gestations. The repercussions on maternal and foetal morbidity

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An audit of the use of magnesium sulphate in severe pre-eclampsia and eclampsia.

Over the last decade there has been an increase in the use of MgSO4 for the prevention of seizures in women with severe pre-eclampsia or eclampsia. At the Rotunda Hospital it is regularly used for this purpose. The aim of this study was to audit the use of MgSO4 at the hospital, to determine whether the drug was being used according to the hospital's protocol and to observe its effectiveness in the prevention of eclampsia in our population. A retrospective chart review over the two years from 1/1/2000 to 31/12/2001 was undertaken. Outcome measures assessed were; Patient selection, Administration of the drug - whether recommended protocols were adhered, Effectiveness of therapy for seizure prophylaxis, Maternal and neonatal outcomes. There were 12,910 deliveries at the Rotunda hospital over this period of time. Fifty of these women were treated with MgSO4 (0.4%). Patient selection was appropriate in all cases. The correct loading dose of MgSO4 was administered in all cases, however MgSO4 levels were recorded in only 30 (60%) of women. There were no seizures in the treated group. Two women presented with seizures (one was antenatal the other post-natal period), both were treated with MgSO4. There were no maternal or neonatal mortality. Seventy two percent (36) of these women were delivered by lower segment caesarean section. The mean gestation at delivery was 36 weeks (range 28-41 weeks). Thirty eight percent (13) of babies required admission to the neonatal intensive care unit. The mean birth weight at delivery was 2.54 kg (range 1.11-3.68 kg). MgSO4 use in the Rotunda hospital appears to be safe and effective for the prevention of seizures in women with severe pre-eclampsia or eclampsia. Serum MgSO4 levels were only recorded in 60% of patients and the hospital's protocol was not adhered to regarding monitoring of patients on treatment. This needs to be addressed.

Presentación atípica de síndrome de Sheehan en el posparto inmediato / Atypical presentationof Sheehan's syndrome in the immediate postpartum

Presentamos un caso de instauración atípica de síndrome de Sheehan en el postparto inmediato en una paciente con hemorragia masiva por atonía uterina. El síndrome de Sheehan se produce como consecuencia de la necrosis de la adenohipófisis, desarrollando un cuadro clínico que incluye fallo para la lactancia por déficit en la secreción de la prolactina y amenorrea secundaria, que puede aparecer de forma tardía. Progresivamente aparecen síntomas relacionados con otros déficit de hormonas hipofisarias. Existen casos de presentación atípica del síndrome de Sheehan que comprometen selectivamente la secreción de una sola hormona hipofisaria, como el que presentamos

We present a case of atypical Sheehan's syndrome in a patient with massive postpartum hemorrhage secondary to uterine atony. Sheehan's syndrome is caused by anterior pituitary necrosis resulting in failure to lactate due to prolactin deficiency and amenorrhea, which may show late presentation. Deficiencies of other specific anterior pituitary hormones progressively appear. Cases of atypical Sheehan's syndrome have been reported, with selective dysfunction of a single pituitary hormone, as in the present case

Actualizaciones en anestesia regional obstétrica / Update in obstetric regional anestesia

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Comparison of referral and non-referral hypertensive disorders during pregnancy: an analysis of 271 consecutive cases at a tertiary hospital.

BACKGROUND: This retrospective cohort study analyzed the clinical manifestations in patients with preeclampsia and eclampsia, assessed the risk factors compared to the severity of hypertensive disorders on maternal and perinatal morbidity, and mortality between the referral and non-referral patients. METHODS: 271 pregnant women with preeclampsia and eclampsia were assessed (1993 to 1997). Chi-square analysis was used for the comparison of categorical variables, and the comparison of the two independent variables of proportions in estimation of confidence intervals and calculated odds ratio of the referral and non-referral groups. Multivariate logistic regression was used for adjusting potential confounding risk factors. RESULTS: Of the 271 patients included in this study, 71 (26.2%) patients were referrals from other hospitals. Most of the 62 (87.3%) referral patients were transferred during the period 21 and 37 weeks of gestation. Univariate analysis revealed that referral patients with hypertensive disorder were significantly associated with SBP > or =180, DBP > or =105, severe preclampsia, haemolysis, elevated liver enzymes, low platelets (HELLP), emergency C/S, maternal complications, and low birth weight babies, as well as poor Apgar score. Multivariate logistic regression analyses revealed that the risk factors identified to be significantly associated with increased risk of referral patients included: diastolic blood pressure above 105 mmHg (adjusted odds ratio, 2.09; 95 percent confidence interval, 1.06 to 4.13; P = 0.034), severe preeclampsia (adjusted odds ratio, 3.46; 95 percent confidence interval, 1.76 to 6.81; P < 0.001), eclampsia (adjusted odds ratio, 2.77; 95 percent confidence interval, 0.92 to 8.35; P = 0.071), HELLP syndrome (adjusted odds ratio, 18.81; 95 percent confidence interval, 2.14 to 164.99; P = 0.008). CONCLUSION: The significant factors associated with the referral patients with hypertensive disorders were severe preeclampsia, HELLP, and eclampsia. Lack of prenatal care was the major avoidable factor found in referral and high risk patients. Time constraints relating to referral patients and the appropriateness of patient-centered care for patient safety and better quality of health care need further investigation on national and multi-center clinical trials.