- Email: [email protected]
W247 MATERNAL AND PERINATAL OUTCOME OF SEVERE PREECLAMPSIA AT THREE TEACHING HOSPITALS IN ADDIS ABABA
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
W246 HAEMODYNAMIC CHARACTERISTICS AT PREGNANT WOMEN WITH OBESITY M. Skvortsova1 . 1 Departament of Obstetrics and Gynecology, Russian Medical Academy for Postgraduate Education, Moscow, Russian Federation Objectives: Estimation of parameters of central haemodynamics at pregnant women with obesity and hypertension frustration. Materials: 110 pregnant for the second time women have been surveyed in term of 26 weeks of pregnancy. From them 2 groups were generated: the basic group (80 patients with Body Mass Index 30.0–43.8) and control group (30 women with BMI 20.0– 24.8). The patients from the basic group were separated into subgroups (depending on presence/absence arterial hypertension at the subsequent current of pregnancy): subgroup 2A included 40 pregnant for the second time women with obesity and a normal level of arterial pressure; subgroup 2B included 40 pregnant for the second time women with obesity and arterial hypertension. Methods: Together with traditional clinical and laboratory-tool inspection, parameters of central haemodynamics noninvasively by means of the monitor of impedance cardiography Niccomo (Medis, Germany) were studied. For the analysis of reliability of research p-criterion suitable was used. Results: The cardiac index (in norm of 2.5–4.7 l/min/m2), in groups of control and 2A was comparable (4.2±0.5 l/min/m2 and 4.3±0.5 l/min/m2 accordingly). At patients of group 2B it authentically decreased to 3.0±0.4 l/min/m2 . On the basis of a cardiac index (CI) an estimation of type of haemodynamics at pregnant women has been made. Thus, in group of control 85% of women have revealed norm kinetic haemodynamics type, and 15% of cases – hyperkinetic. In group 2A in 70% of cases the hyperkinetic type of haemodynamics has been revealed; and in 30% – norm kinetic. At a combination of obesity and arterial hypertension in 75% of supervised women norm kinetic type is revealed, and 25% of cases show hypokinetic type of haemodynamics, and that at the further progressing of pregnancy, it was accompanied by preeclampsia. Conclusions: Our research of parameters of central haemodynamics by a noninvasive method has allowed us to reveal cardinal distinctions in characteristics of blood circulation at pregnant women with obesity and normal arterial pressure and at pregnant women with obesity and arterial hypertension and to postulate that on the basis of an estimation of type of haemodynamics (in 26 weeks) at patients with obesity, it is possible to reveal the signs testifying to possibility of development of preeclampsia. W247 MATERNAL AND PERINATAL OUTCOME OF SEVERE PREECLAMPSIA AT THREE TEACHING HOSPITALS IN ADDIS ABABA B.K. Dina1 . 1 Obstatric, Yekatit 12 Hospital, Addis Ababa, Ethiopia Objectives: To determine the maternal and perinatal outcome of severe preeclampsia; to describe maternal and perinatal outcome at different gestational ages; to describe maternal and perinatal outcome of conservative versus aggressive management and to describe clinical and biochemical predictors of adverse perinatal outcome. Materials: Structured questionnaire, patient charts and interview regarding important clinical and obstetric parameters and subsequent pregnancy outcome. Methods: This is a 6 month prospective cross sectional study between October 2, 2006-April 2, 2007 at the three teaching hospitals of AAU-MF (Tikur Anbesa Hospital, Saint Paul Hospital, and Gandhi Memorial Hospital). A p-value of 0.05 was taken as significant in comparisons. OR and 95% CI estimates were also used to compare important outcome predictors. Logistic regression
S785
computed to detect poor biochemical and clinical predictors of adverse perinatal outcome. Results: Among 5610 deliveries attended during the study period, 193 patients were found to have severe preeclampsia making rate of severe pre eclampsia of 3.4%. The incidence of HELLP syndrome in the study was 0.85% of total deliveries and 24.9% among cases of severe pre eclampsia. Case fatality rate was 2.6% with a high incidence of maternal morbidities including renal failure, pulmonary edema, eclampsia, abruption and disseminated intravascular coagulation. Intensive care unit admission rate was 13%. PNMR was 306 per thousand births. There was no perinatal survival below 28 wks and below 1000 gm. The intrauterine growth restriction rate was 25.5% among singleton births. Better perinatal outcome and a significant prolongation of pregnancy were achieved in the conservative management group compared with those managed expeditiously. Admission diagnosis, platelet count and qualitative urine albumin were found to have statistically significant association with perinatal outcome. Conclusions: The rate of severe pre eclampsia is much higher than that reported from other studies, both local and international. Prevalence of HEELP syndrome was also found to be higher than other reported rates. Pregnancy outcome was worse in our setting compared to other reported series. W248 ECLAMPSIA, PATIENT CHARACTERISTICS AND CONTRIBUTION TO MATERNAL AND PERINATAL MORBIDITY AND MORTALITY: A THREE YEAR REVIEW AT THE JOS UNIVERSITY TEACHING HOSPITAL, NIGERIA C.O. Egbodo1 , T. Oyebode2,1 . 1 Obstetrics and Obstetrics, University of Jos, Jos, Jos, Plateau, Nigeria; 2 Department of Obstetrics and Gynaecology, University of Josl, Jos, Plateau, Nigeria Objectives: To determine the incidence of eclampsia in Jos University Teaching hospital, the booking status, parity, maternal and foetal outcome of the eclamptics and its contribution to Maternal and foetal morbidity and Mortality. Materials: This was a retrospective study in which the case notes of 70 patients with diagnosis of eclampsia between the period of January 2001 and December 2003 at Jos University Teaching Hospital, Jos, North central Nigeria were retrieved and total number of deliveries within the period as well as facilities in which the patients booked for their antenatal care was also retrieved from the delivery records. Methods: The informations obtained from the materials above were analysed for age, parity, booking status, type of eclampsia, mode of delivery, gestational age at presentation, birth weight of babies, one minute APGAR scores, length of hospital stay and maternal outcomes. The data was analyzed with the use of Epi info statistical package/simple percentages. Results: The incidence of eclampsia during the period of study in JUTH was 0.98% of total Maternity Admissions. Teenagers contributed 5.6% of the cases while 2% of them were primipara. The incidence among unbooked patients accounted for 16.39% while incidence among booked patients contributed 4.6%. Intrapartum eclampsia occurred in 62.9% of cases. The complications found to have occurred included preterm deliveries in 62.3% of patients, Mild asphyxia in 57.1%, severe asphyxia 19.1%, while stillborn occurred in 14.4%. Febrile morbidity occurred among women and accounted for 28.6% of cases followed by wound sepsis in 23.8% of cases. Maternal death occurred despite Intensive unit care in 5.1% cases of eclampsia managed in this hospital. Conclusions: Eclampsia is commoner among teenagers, Primigravida and women who had no antenatal care. Maternal and perinatal morbidity and mortality is high among eclamptic patients. Adopting strategies that will enable women to utilize antenatal care and hospital delivery will reduce the incidence of eclampsia and impact on maternal and foetal mortality rates in Nigeria. This is a
W246 HAEMODYNAMIC CHARACTERISTICS AT PREGNANT WOMEN WITH OBESITY M. Skvortsova1 . 1 Departament of Obstetrics and Gynecology, Russian Medical Academy for Postgraduate Education, Moscow, Russian Federation Objectives: Estimation of parameters of central haemodynamics at pregnant women with obesity and hypertension frustration. Materials: 110 pregnant for the second time women have been surveyed in term of 26 weeks of pregnancy. From them 2 groups were generated: the basic group (80 patients with Body Mass Index 30.0–43.8) and control group (30 women with BMI 20.0– 24.8). The patients from the basic group were separated into subgroups (depending on presence/absence arterial hypertension at the subsequent current of pregnancy): subgroup 2A included 40 pregnant for the second time women with obesity and a normal level of arterial pressure; subgroup 2B included 40 pregnant for the second time women with obesity and arterial hypertension. Methods: Together with traditional clinical and laboratory-tool inspection, parameters of central haemodynamics noninvasively by means of the monitor of impedance cardiography Niccomo (Medis, Germany) were studied. For the analysis of reliability of research p-criterion suitable was used. Results: The cardiac index (in norm of 2.5–4.7 l/min/m2), in groups of control and 2A was comparable (4.2±0.5 l/min/m2 and 4.3±0.5 l/min/m2 accordingly). At patients of group 2B it authentically decreased to 3.0±0.4 l/min/m2 . On the basis of a cardiac index (CI) an estimation of type of haemodynamics at pregnant women has been made. Thus, in group of control 85% of women have revealed norm kinetic haemodynamics type, and 15% of cases – hyperkinetic. In group 2A in 70% of cases the hyperkinetic type of haemodynamics has been revealed; and in 30% – norm kinetic. At a combination of obesity and arterial hypertension in 75% of supervised women norm kinetic type is revealed, and 25% of cases show hypokinetic type of haemodynamics, and that at the further progressing of pregnancy, it was accompanied by preeclampsia. Conclusions: Our research of parameters of central haemodynamics by a noninvasive method has allowed us to reveal cardinal distinctions in characteristics of blood circulation at pregnant women with obesity and normal arterial pressure and at pregnant women with obesity and arterial hypertension and to postulate that on the basis of an estimation of type of haemodynamics (in 26 weeks) at patients with obesity, it is possible to reveal the signs testifying to possibility of development of preeclampsia. W247 MATERNAL AND PERINATAL OUTCOME OF SEVERE PREECLAMPSIA AT THREE TEACHING HOSPITALS IN ADDIS ABABA B.K. Dina1 . 1 Obstatric, Yekatit 12 Hospital, Addis Ababa, Ethiopia Objectives: To determine the maternal and perinatal outcome of severe preeclampsia; to describe maternal and perinatal outcome at different gestational ages; to describe maternal and perinatal outcome of conservative versus aggressive management and to describe clinical and biochemical predictors of adverse perinatal outcome. Materials: Structured questionnaire, patient charts and interview regarding important clinical and obstetric parameters and subsequent pregnancy outcome. Methods: This is a 6 month prospective cross sectional study between October 2, 2006-April 2, 2007 at the three teaching hospitals of AAU-MF (Tikur Anbesa Hospital, Saint Paul Hospital, and Gandhi Memorial Hospital). A p-value of 0.05 was taken as significant in comparisons. OR and 95% CI estimates were also used to compare important outcome predictors. Logistic regression
S785
computed to detect poor biochemical and clinical predictors of adverse perinatal outcome. Results: Among 5610 deliveries attended during the study period, 193 patients were found to have severe preeclampsia making rate of severe pre eclampsia of 3.4%. The incidence of HELLP syndrome in the study was 0.85% of total deliveries and 24.9% among cases of severe pre eclampsia. Case fatality rate was 2.6% with a high incidence of maternal morbidities including renal failure, pulmonary edema, eclampsia, abruption and disseminated intravascular coagulation. Intensive care unit admission rate was 13%. PNMR was 306 per thousand births. There was no perinatal survival below 28 wks and below 1000 gm. The intrauterine growth restriction rate was 25.5% among singleton births. Better perinatal outcome and a significant prolongation of pregnancy were achieved in the conservative management group compared with those managed expeditiously. Admission diagnosis, platelet count and qualitative urine albumin were found to have statistically significant association with perinatal outcome. Conclusions: The rate of severe pre eclampsia is much higher than that reported from other studies, both local and international. Prevalence of HEELP syndrome was also found to be higher than other reported rates. Pregnancy outcome was worse in our setting compared to other reported series. W248 ECLAMPSIA, PATIENT CHARACTERISTICS AND CONTRIBUTION TO MATERNAL AND PERINATAL MORBIDITY AND MORTALITY: A THREE YEAR REVIEW AT THE JOS UNIVERSITY TEACHING HOSPITAL, NIGERIA C.O. Egbodo1 , T. Oyebode2,1 . 1 Obstetrics and Obstetrics, University of Jos, Jos, Jos, Plateau, Nigeria; 2 Department of Obstetrics and Gynaecology, University of Josl, Jos, Plateau, Nigeria Objectives: To determine the incidence of eclampsia in Jos University Teaching hospital, the booking status, parity, maternal and foetal outcome of the eclamptics and its contribution to Maternal and foetal morbidity and Mortality. Materials: This was a retrospective study in which the case notes of 70 patients with diagnosis of eclampsia between the period of January 2001 and December 2003 at Jos University Teaching Hospital, Jos, North central Nigeria were retrieved and total number of deliveries within the period as well as facilities in which the patients booked for their antenatal care was also retrieved from the delivery records. Methods: The informations obtained from the materials above were analysed for age, parity, booking status, type of eclampsia, mode of delivery, gestational age at presentation, birth weight of babies, one minute APGAR scores, length of hospital stay and maternal outcomes. The data was analyzed with the use of Epi info statistical package/simple percentages. Results: The incidence of eclampsia during the period of study in JUTH was 0.98% of total Maternity Admissions. Teenagers contributed 5.6% of the cases while 2% of them were primipara. The incidence among unbooked patients accounted for 16.39% while incidence among booked patients contributed 4.6%. Intrapartum eclampsia occurred in 62.9% of cases. The complications found to have occurred included preterm deliveries in 62.3% of patients, Mild asphyxia in 57.1%, severe asphyxia 19.1%, while stillborn occurred in 14.4%. Febrile morbidity occurred among women and accounted for 28.6% of cases followed by wound sepsis in 23.8% of cases. Maternal death occurred despite Intensive unit care in 5.1% cases of eclampsia managed in this hospital. Conclusions: Eclampsia is commoner among teenagers, Primigravida and women who had no antenatal care. Maternal and perinatal morbidity and mortality is high among eclamptic patients. Adopting strategies that will enable women to utilize antenatal care and hospital delivery will reduce the incidence of eclampsia and impact on maternal and foetal mortality rates in Nigeria. This is a