RESUMO
BACKGROUND: Platelets are pivotal players in the pathophysiology of pre-eclampsia, with observed lower counts in affected individuals compared to normotensive counterparts. Despite advancements, the elusive cause of pre-eclampsia persists, motivating intense global efforts to identify reliable predictors. The currently recommended predictors of pre-eclampsia are not readily available in many resource-limited regions like Nigeria. This cohort study explores the potential of mean platelet volume (MPV) and platelet distribution width (PDW) as predictive markers of early-onset pre-eclampsia. Both platelet indices are components of the full blood count, a widely available routine test in pregnancy. METHODS: In this prospective cohort study, 648 healthy pregnant women attending antenatal care at Lagos State University Teaching Hospital and General Hospital Ifako-Ijaiye, Lagos, were recruited between 14-18weeks gestational age. Platelet count (PC), MPV and PDW were measured from their venous blood at recruitment. Participants were monitored until 34weeks of gestation, focusing on the occurrence of early-onset preeclampsia as the outcome of interest. Individuals with chronic medical conditions were excluded from the study. Data analysis involved t-test, Chi-Square and Mann-Whitney U tests, with statistical significance set at a confidence level of 95% and p < 0.05. Sensitivity, specificity, and predictive values were determined using receiver operating characteristics (ROC) curves. RESULTS: The incidence of early-onset pre-eclampsia in the study was 5.9%. Women who later developed pre-eclampsia had higher median MPV and PDW at 14-18weeks (10.8 fl. and 24.8 fl.) compared to normotensive women (8.1 fl. and 13.3 fl.)(p < 0.001). The median PC was lower in pre-eclamptics (190 × 103/µl) compared to normotensives(264 × 103/µl)(p < 0.001). Using Youden's test, cut-off values identified: PC < 211.5 × 103/µl, MPV > 9.4 fl., and PDW > 21.3 fl., predicted early-onset pre-eclampsia with 96.6% sensitivity and 65.6% specificity for PC; 79.3% sensitivity and 97.7% specificity for PDW; and 82.8% sensitivity and 96.1% specificity for MPV. Cut-offs of PC < 185 × 103/µl, MPV > 10.7 fl., and PDW > 28.3 fl., predicted severe early-onset pre-eclampsia with 100.0% sensitivity and 90.9% specificity for PC, 100.0% sensitivity and 99.4% specificity for MPV, and 100.0% sensitivity and 99.8% specificity for PDW, with corresponding area under the ROC curves of 0.983, 0.996, and 0.998, respectively. CONCLUSION: The evaluation of MPV and PDW between 14 and 18 weeks of gestation appears to be a reliable predictor of severe early-onset pre-eclampsia.
RESUMO
BACKGROUND: Umbilical cord prolapse is an obstetric emergency which is associated with significant perinatal mortality and morbidity as well as long-term handicap. OBJECTIVES: The objective of this study was to determine the incidence of cord prolapse, elucidate the risk factors as well as the fetal outcome at the Lagos University Teaching Hospital (LUTH). DESIGN AND SETTING: A retrospective study at a tertiary care center in Lagos, Nigeria. MATERIALS AND METHODS: A descriptive retrospective study of all pregnancies complicated by prolapse of the umbilical cord in LUTH from January 1, 2001 to December 31, 2010. RESULTS: A total of 13,592 deliveries were conducted during the study period and 52 of which were complicated by cord prolapse at various cervical dilatations, thus giving an incidence of 3.8/1000 deliveries. Umbilical cord prolapses occurred commonly in women with multiple parities (51.9%), pregnancies with abnormal presentations (breech precisely) in 42.3%, abnormal lie in 30.8% with majority of the cord prolapse occurring after spontaneous membrane rupture (73.1%) while 26.9% occurred following amniotomy. Twenty-nine (55.8%) cases occurred outside the hospital setting; 69.2% of the children affected were term. The mean diagnosis-delivery interval was 53.3 ± 25.5 min, and cesarean section was the mode of delivery in 84.6%. Twenty-five percent of the children had Apgar score of ≥7 at the 1st min of life increasing to 69.2% at 5 min. The perinatal mortality was however 19.2%. CONCLUSION: Umbilical cord prolapse is associated with a significant perinatal mortality in this study, especially in those with spontaneous rupture of membranes that occurred outside the hospital setting.
