Relationship between maternal obesity and increased risk of preeclampsia

The incidence of obesity has risen over the past several decades and in spite of advancement in modern medicine, it remains a risk factor for maternal morbidity and mortality. To determine the association between obesity [increased body mass index] and increased risk of preeclampsia. The possible role of serum leptin was also evaluated. 250 pregnant women were included in this study. They were selected according to their BMI at 20 weeks of gestation and allocated into 5 study groups [each n= 50]. At 20 weeks of gestation, BMI, mean arterial blood pressure was calculated. Proteinuria, serum uric acid and leptin were measured. At 28 weeks of gestation reevaluation of BMI, mean arterial blood pressure and serum uric acid were done. While serum leptin estimation was only reevaluated on the 37 weeks. Cases of preeclampsia were diagnosed and classified either mild or severe. It was found that preeclampsia was diagnosed in 20 cases. Among them 12 cases were diagnosed as mild preeclampsia in group A, 2 cases [4% of normal BMI], 2 cases in group C [4% of obese class 1], 6 cases in group D [12% of obese class 11] and 2 cases in group E [4% of obese class 111]. Severe preeclampsia was diagnosed in 4 cases of group C [8% of obese class 1], 2 cases of group D [4% of obese class 11] and 2 cases of group E [4% of obese class 111]. The relative risk of preeclampsia in cases of increased BMI was 2.25. The cases that developed preeclampsia had statistically significant elevated serum uric acid when compared to the normotensive cases at 28 and 37 weeks of gestation. Serum leptin level increased significantly with the increase in BMI and preeclamptic cases had statistically significant higher mean serum leptin at 28 and 37 weeks than normotensive cases. Maternal obesity is associated with a higher risk of adverse maternal and perinatal outcomes including preeclampsia. The dyslipidemia and the exaggerated inflammatory response associated with maternal obesity are thought to contribute to widespread endothelial dysfunction and the subsequent maternal syndrome in preeclampsia. Obesity is associated with higher mean serum leptin level. The levels of serum leptin are significantly higher in pre-eclampsia when compared to normotensive pregnant women and may contribute to endothelial dysfunction involved in the pathogenesis of preeclampsia

Current practices of normal and cesarean delivery at Shatby Maternity University hospital as compared to evidence-based practices

The study was undertaken to assess current obstetric practices of both normal vaginal and Cesarean delivery at Shatby Maternity University Hospital in Alexandria as compared to evidence-based obstetric practices. A cross-sectional approach was used to assess 250 women having normal vaginal deliveries and 500 women undergoing Cesarean deliveries. Practices performed during normal labour were assessed including: the first stage: perineal shaving, enema, intravenous cannula insertion, position, amniotomy and oxytocin infusion. -During the second stage: position, timing of pushing, fundal pressure, and perineal sutures. -During the third stage: placental delivery and uterine exploration. Practices performed during Cesarean deliveries were assessed including: -Practices performed before the operation [whether or not a doctor ordered to give: Prophylactic antibiotics, thromboprophylaxis, antacids, antiemetics. -Practices performed during the operation [if the surgeon used double gloves, the use of separate surgical knives to incise the skin and the deeper tissues, the use of 5 IU oxytocin by slow intravenous drip to encourage uterine contraction and decrease blood loss, the mode of placental delivery; cord traction or manual removal, intraperitoneal repair of the uterine wound, uterine repair in two or single layers, closure or not of the visceral and parietal peritoneum, closure or not of subcutaneous tissue, timing of removal of urinary catheter and start oral feeding.] Shatby Maternity University Hospital in Alexandria is the largest Obstetric hospital with nearly 15,000 admissions per year and 9,000 deliveries [2002]. A questionnaire was done the morning following delivery and before discharge. Data were obtained from cases themselves in comparison to data from the files and attending obstetricians. Various procedures and techniques of normal vaginal delivery and C.S performed and compared to evidence-based practices. Almost all the cases had pubic shaving at home [94.0%]. 8% of cases had a rectal enema done, furthermore, intravenous infusions was administered to 83.2% and 25% had their membranes artificially ruptured in pre-labor ward. 49.6% of the sample mentioned that, there was a lot of fundal pressure applied to them during the second stage of labour. 95.2% of the studied sample stated that, uterine exploration was performed to them after delivery of the placenta. This figure is to be taken with caution as most of the women could not differentiate between uterine exploration and vaginal exploration. The reality is a much less number of uterine exploration as according to attending obstetricians, uterine exploration is rarely done. As regard Cesarean deliveries: Almost all the mothers did not receive antibiotics nor thromboprophylaxis. As regards intraoperative procedures; the surgeons were not wearing double gloves in 90.0% of cases, nor used separate surgical knives to incise the skin and the deeper tissues in 100.0% of the cases. Nearly all cases [98.1%] had their uteri repaired after exteriorization and 96.1% of cases had a double layer closure of the uterus. In 95.0% of cases closure of the visceral and parietal peritoneum was done. It seems that current practices of normal vaginal delivery and C.S at Shatby Maternity University Hospital are not that far of the evidence-based practice. Some modifications when applied can make such practices up to the evidence-based practice

Relationship between abdominal pain and sonographic findings of the maternal liver in cases of severe preeclampsia-HELLP syndrome

To find the relationship between upper abdominal pain and sonographic findings of the maternal liver in cases of severe preeclampsia-HELLP syndrome. The present study was performed on 30 pregnant women with severe preeclampsia-HELLP syndrome and acute right upper quadrant or epigastric pain. Serial sonographic examinations were done at admission and 2 to 3 days postpartum. Laboratory evaluation included serial measurements of lactic dehydrogenase [LDH], glutamic oxaloacetic transaminase [SGOT], glutamic pyruvic transaminase [SGPT], total bilirubin and complete blood cell count. Sonographic hepatic abnormalities occurred in 70% of patients with upper abdominal pain and severe PET-HELLP syndrome. No statistically significant differences of clinical characteristics and laboratory evaluations were found between patients with normal and abnormal sonographic hepatic changes. Fifty five and half percent of patients with HELLP syndrome [5 patients] had abnormal sonographic changes. Abnormal sonographic hepatic changes were even before laboratory changes in cases of HELLP syndrome [16.6%]. No significant association between number of PET or HELLP syndrome patients and abnormal hepatic sonographic changes [p=0.39]. Patients with upper abdominal pain in cases of PET-HELLP syndrome may show sonographic hepatic changes. The abnormalities in liver function test results do not accurately reflect the presence of abnormal sonographic hepatic findings in severe preeclampsia-HELLP syndrome. The hepatic sonographic changes may show abnormalities that can precede the biological abnormalities in this syndrome