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OS026. Study of neuroradiological and biochemical abnormalities in 100 women with preeclampsia-eclapmsia
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Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 175–239
OS026. Study of neuroradiological and biochemical abnormalities in 100 women with preeclampsiaeclapmsia R. Tatapudi 1,2,*, M. Tripurasundari 2, K. Asra 2, N.L.N. Moothi 3 (1 Obstetrics and Gynecology, Andhra Medical College, Visakhapatnam, India, 2 Obstetrics and Gynecology, 3 Radiology, Gandhi Medical College, Secunderabad, India) Introduction: The posterior reversible encephalopathy syndrome—PRES is recognised as the neuro radiologic abnormality in Eclampsia and with prompt treatment and delivery is usually reversible. Objectives: To study neuro radiological and biochemical abnormalities in severe preeclampsia and eclampsia and their reversibility following delivery. Methods: 100 Women with severe pre-eclampsia and eclampsia admitted to High risk unit at Gandhi Hospital, Secunderabad were studied between September 2008 and September 2010. Preeclamptic women who presented with complications of pre eclampsia were included. Patients with convulsions in the absence of proteinuria and hypertension such as epileptics and other central nervous disorders and known intracranial pathology were excluded . All the women were investigated for laboratory parameters such as renal function tests, platelet counts, liver function tests, coagulation profile, fundoscopy, in antepartum period and abnormal results were re-evaluated one week after delivery and in cases with persistent abnormal results at one week postpartum were again evaluated at the end of two weeks. Fifty women with eclampsia among the study group underwent MR imaging of brain before delivery and thirty of these women who showed PRES underwent MR imaging postpartum. The different types images used are (i) T1 weighted image (ii) T2 weighted image – highly sensitive (iii) Flair image (iv) Diffusion Weighted image (DW) with Apparent Diffusion Co-efficient (ADC). MRI studies were performed in axial, coronal and sagittal axes in varying thickness of 5–10 mm. The machine used was 1.5 Tesla Aves Siemens. The biochemical parameters and results of neuro imaging were studied antepartum and postpartum. Results: Thirty six out of 50 women showed abnormal MRI findings. In 30 women (83%) findings were consistent with PRES. 3 cases (8%) showed infarction, 1 case showed CSVT , 1 cerebral hemorrhage and 1 showed glioma undiagnosed in antenatal period . Out of 30 cases of PRES, 18(77%) cases showed reversal within 1 week postpartum, and 9(33%) cases within 2 weeks postpartum. 80–90% of the abnormal laboratory parameters reversed to normal within 1 week post partum. Abnormal persistent parameters reversed to normal in all cases at the end of 2 weeks. Conclusion: Posterior Reversible Encephalopathy Syndrome (PRES) is a new clinico radiological entity resulting from vasogenic edema in almost all cases of eclampsia but rare with preeclampsia. In fact eclampsia may be considered as clinical manifestation of PRES. Though MRI brain is a valuable diagnostic tool in evaluation of eclampsia it is expensive, and less available. Repeat MRI investigations may not be necessary, as almost all cases of PRES are reversible. MRI brain in cases of eclampsia also
help to identify rare pathologies in the brain other than PRES, wrongly attributed to eclampsia Though preeclampsia and eclampsia are reversible, duration required for reversal is 1–2 week period, during which period pathology is resolving but not recovered completely and complications can still occur. Hence, close observation is required in the first 1–2 week postpartum.
Disclosure of interest None declared. doi:10.1016/j.preghy.2012.04.027
OS027. Ethnicity and adverse pregnancy outcomes: A cohort study A. Khalil *, Asma Khalil, Argyro Syngelaki, Juliana Rezende, Kypros H. Nicolaides (Fetal Medicine Unit, Institute for Women’s Health, University College London, London, United Kingdom) Introduction: Women who develop pregnancy complications are more likely to develop cardiovascular disorders later in life. A history of pre-eclampsia (PE) is associated with a four-fold increased risk of hypertension and twice the risk of future ischaemic heart disease and stroke. Early identification of women at risk of developing pregnancy complications is likely to facilitate targeted antenatal surveillance and possibly intervention. Maternal ethnicity affects the risk of developing some of these complications, and so is likely to be an important variable in the risk assessment. Objectives: The main aim of this study was to quantify the ethnicity-related risk of adverse pregnancy outcomes. Methods: This was a multicentre cohort study in singleton pregnancies at 11+0–13+6 weeks of gestation. Data on maternal characteristics, medical and obstetric history were collected and pregnancy outcomes ascertained. Racial origin was classified into Caucasian, African, South Asian, East Asian and mixed. The adverse pregnancy outcomes in this study included PE, gestational hypertension (GH), gestational diabetes (GDM), preterm delivery (PTD), small for gestational age (SGA), large for gestational age (LGA), stillbirth, obstetric cholestasis (OC) and emergency Caesarean section (CS). The diagnosis of PE and GH was made according to the guidelines of the International Society for the Study of Hypertension in Pregnancy. The neonate was considered SGA if the birthweight was less than the 5th percentile and LGA if the birthweight was more than the 90th percentile for gestation at delivery. The diagnosis of GDM was made if the fasting plasma glucose level was at least 6 mmol/L or the plasma glucose level 2 h after oral administration of 75 g glucose was 7.8 mmol/L or more (WHO). Stillbirth was defined as the death of a fetus before birth after the 24th week of pregnancy. The diagnosis of OC was made when there was pruritus in association with abnormal liver function in the absence of any other identifiable liver pathology which resolved after delivery. Multiple regression anal-
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 175–239
OS026. Study of neuroradiological and biochemical abnormalities in 100 women with preeclampsiaeclapmsia R. Tatapudi 1,2,*, M. Tripurasundari 2, K. Asra 2, N.L.N. Moothi 3 (1 Obstetrics and Gynecology, Andhra Medical College, Visakhapatnam, India, 2 Obstetrics and Gynecology, 3 Radiology, Gandhi Medical College, Secunderabad, India) Introduction: The posterior reversible encephalopathy syndrome—PRES is recognised as the neuro radiologic abnormality in Eclampsia and with prompt treatment and delivery is usually reversible. Objectives: To study neuro radiological and biochemical abnormalities in severe preeclampsia and eclampsia and their reversibility following delivery. Methods: 100 Women with severe pre-eclampsia and eclampsia admitted to High risk unit at Gandhi Hospital, Secunderabad were studied between September 2008 and September 2010. Preeclamptic women who presented with complications of pre eclampsia were included. Patients with convulsions in the absence of proteinuria and hypertension such as epileptics and other central nervous disorders and known intracranial pathology were excluded . All the women were investigated for laboratory parameters such as renal function tests, platelet counts, liver function tests, coagulation profile, fundoscopy, in antepartum period and abnormal results were re-evaluated one week after delivery and in cases with persistent abnormal results at one week postpartum were again evaluated at the end of two weeks. Fifty women with eclampsia among the study group underwent MR imaging of brain before delivery and thirty of these women who showed PRES underwent MR imaging postpartum. The different types images used are (i) T1 weighted image (ii) T2 weighted image – highly sensitive (iii) Flair image (iv) Diffusion Weighted image (DW) with Apparent Diffusion Co-efficient (ADC). MRI studies were performed in axial, coronal and sagittal axes in varying thickness of 5–10 mm. The machine used was 1.5 Tesla Aves Siemens. The biochemical parameters and results of neuro imaging were studied antepartum and postpartum. Results: Thirty six out of 50 women showed abnormal MRI findings. In 30 women (83%) findings were consistent with PRES. 3 cases (8%) showed infarction, 1 case showed CSVT , 1 cerebral hemorrhage and 1 showed glioma undiagnosed in antenatal period . Out of 30 cases of PRES, 18(77%) cases showed reversal within 1 week postpartum, and 9(33%) cases within 2 weeks postpartum. 80–90% of the abnormal laboratory parameters reversed to normal within 1 week post partum. Abnormal persistent parameters reversed to normal in all cases at the end of 2 weeks. Conclusion: Posterior Reversible Encephalopathy Syndrome (PRES) is a new clinico radiological entity resulting from vasogenic edema in almost all cases of eclampsia but rare with preeclampsia. In fact eclampsia may be considered as clinical manifestation of PRES. Though MRI brain is a valuable diagnostic tool in evaluation of eclampsia it is expensive, and less available. Repeat MRI investigations may not be necessary, as almost all cases of PRES are reversible. MRI brain in cases of eclampsia also
help to identify rare pathologies in the brain other than PRES, wrongly attributed to eclampsia Though preeclampsia and eclampsia are reversible, duration required for reversal is 1–2 week period, during which period pathology is resolving but not recovered completely and complications can still occur. Hence, close observation is required in the first 1–2 week postpartum.
Disclosure of interest None declared. doi:10.1016/j.preghy.2012.04.027
OS027. Ethnicity and adverse pregnancy outcomes: A cohort study A. Khalil *, Asma Khalil, Argyro Syngelaki, Juliana Rezende, Kypros H. Nicolaides (Fetal Medicine Unit, Institute for Women’s Health, University College London, London, United Kingdom) Introduction: Women who develop pregnancy complications are more likely to develop cardiovascular disorders later in life. A history of pre-eclampsia (PE) is associated with a four-fold increased risk of hypertension and twice the risk of future ischaemic heart disease and stroke. Early identification of women at risk of developing pregnancy complications is likely to facilitate targeted antenatal surveillance and possibly intervention. Maternal ethnicity affects the risk of developing some of these complications, and so is likely to be an important variable in the risk assessment. Objectives: The main aim of this study was to quantify the ethnicity-related risk of adverse pregnancy outcomes. Methods: This was a multicentre cohort study in singleton pregnancies at 11+0–13+6 weeks of gestation. Data on maternal characteristics, medical and obstetric history were collected and pregnancy outcomes ascertained. Racial origin was classified into Caucasian, African, South Asian, East Asian and mixed. The adverse pregnancy outcomes in this study included PE, gestational hypertension (GH), gestational diabetes (GDM), preterm delivery (PTD), small for gestational age (SGA), large for gestational age (LGA), stillbirth, obstetric cholestasis (OC) and emergency Caesarean section (CS). The diagnosis of PE and GH was made according to the guidelines of the International Society for the Study of Hypertension in Pregnancy. The neonate was considered SGA if the birthweight was less than the 5th percentile and LGA if the birthweight was more than the 90th percentile for gestation at delivery. The diagnosis of GDM was made if the fasting plasma glucose level was at least 6 mmol/L or the plasma glucose level 2 h after oral administration of 75 g glucose was 7.8 mmol/L or more (WHO). Stillbirth was defined as the death of a fetus before birth after the 24th week of pregnancy. The diagnosis of OC was made when there was pruritus in association with abnormal liver function in the absence of any other identifiable liver pathology which resolved after delivery. Multiple regression anal-