Latest news with #caesarean
Medscape
20-05-2025
- Health
- Medscape
BBB Injury and Neuroinflammation in Eclampsia
Eclampsia was associated with distinct cerebrospinal fluid (CSF) biomarker profiles, indicating severe disruption of the blood-brain barrier (BBB) and increased neuroinflammation. METHODOLOGY: This investigation focused on BBB injury and neuroinflammation to elucidate mechanisms underlying cerebral injury. A total of 129 women from the Pre-eclampsia Obstetric Adverse Events biobank in South Africa who underwent caesarean delivery between March 2021 and June 2023 were included, of whom 11 had eclampsia, 17 had preeclampsia with end-organ complications, 88 had preeclampsia without end-organ complications, and 13 had normotensive pregnancies. An observational cross-sectional design was used; participants were stratified on the basis of the severity of preeclampsia (with end-organ complications). CSF and plasma samples were collected during spinal anaesthesia; CSF concentrations of claudin-5 and matrix metalloproteinase-9 and the CSF/plasma albumin ratio were measured; cytokine and chemokine levels were measured using the multiplex Bio-Plex assay. BBB injury markers and cytokine levels were compared using the analysis of covariance. Secondary outcomes included correlation analyses between CSF and plasma biomarkers. TAKEAWAY: Women with eclampsia showed 2.7-fold higher claudin-5 concentrations in CSF than those with normotensive pregnancies ( P = .005), with concentrations 4.0-fold higher than those with preeclampsia and end-organ complications and 3.1-fold higher than those with preeclampsia without end-organ complications. = .005), with concentrations 4.0-fold higher than those with preeclampsia and end-organ complications and 3.1-fold higher than those with preeclampsia without end-organ complications. Interleukin (IL)-6 levels were significantly elevated (20.7-fold; P < .001); IL-8 (7.2-fold; P < .001) and IL-10 (2.0-fold; P = .004) levels were also increased. < .001); IL-8 (7.2-fold; < .001) and IL-10 (2.0-fold; = .004) levels were also increased. No correlation was observed between CSF and plasma cytokine levels ( P > .05), but strong associations were noted between IL-6 and IL-8 levels (r = 0.74). > .05), but strong associations were noted between IL-6 and IL-8 levels (r = 0.74). Stem cell factor levels were significantly lower in women with eclampsia (0.5-fold decrease; P = .005) than in those with normotensive pregnancies; leukaemia inhibitory factor levels were 3.8-fold higher in those with eclampsia than in those with preeclampsia without end-organ complications. = .005) than in those with normotensive pregnancies; leukaemia inhibitory factor levels were 3.8-fold higher in those with eclampsia than in those with preeclampsia without end-organ complications. Monocyte chemoattractant protein-1 levels were 4.3-fold higher in women with eclampsia than in those with preeclampsia with end-organ complications; interferon-gamma levels were 2.9-fold higher in those with eclampsia than in those with preeclampsia and end-organ complications; IL-10 levels were 2.0-fold higher in those with eclampsia than in those with preeclampsia without end-organ complications. IN PRACTICE: "Women with eclampsia experience acute neuroinflammation and blood-brain barrier injury, comparable to patterns observed in neurodegenerative diseases such as acute traumatic brain injury, stroke or Alzheimer's disease. Clinical follow-up of women with eclampsia postpartum should be considered," the authors of the study wrote. SOURCE: This study was led by Valentina Bucher, PhD, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. It was published online on May 08, 2025, in eBioMedicine . LIMITATIONS: This study was limited by the fact that samples were collected only after the onset of eclampsia, preventing the determination of whether BBB injury and neuroinflammation were causes or consequences of seizures. Despite having a substantial number of women with eclampsia, the small absolute number may have limited statistical power and introduced false-negative results. DISCLOSURES: This study was supported by the Swedish Research Council, Herbert och Karin Jacobssons Stiftelse, Wilhelm and Martina Lundgrens Foundations, and Swedish Society of Medicine. Some authors reported serving at scientific advisory boards and/or as consultants for several pharmaceutical organisations.
Daily Mail
13-05-2025
- Health
- Daily Mail
I was denied a caesarean despite a scan showing my baby would be a huge 11lb. I ended up with horrific internal damage and lost three pints of blood. This is the appalling reason I was forced to have a natural birth
After enduring a difficult 56-hour labour with the birth of her first child, India Crotty wanted to do whatever possible to ensure the delivery of her second was less traumatic. So when, towards the end of her pregnancy, routine checks revealed that her second baby, a boy, was going to be even larger than her 8lb 15oz daughter, India requested a caesarean.
Daily Mail
08-05-2025
- Health
- Daily Mail
Baby died at just three days old after nurses 'laughed off' mum's plea for C-section which would have saved her life - and congratulated dad moments before admitting girl was 'born dead'
The 'devastated' father of a newborn baby who died after medics ignored multiple warning signs that she was in distress has revealed he shook the hands of staff before discovering the role they played in the tragedy. Dan Russo and his wife Bryony begged for a caesarean section to be carried out when they arrived at the maternity unit as they knew something was wrong. But staff 'laughed off' their concerns, despite red flags including encomium – a baby's faecal matter - in Mrs Russo's waters and scans showing an abnormal foetal heart rate. Baby Emmy was not breathing when she was finally born by emergency C-section 11 hours after the couple turned up at Princess Alexandra Hospital in Harlow, Essex. She died in her father's arms three days later at the neonatal intensive care unit of Addenbrooke's Hospital in Cambridge, where she had been transferred for urgent care. Speaking after an inquest where the coroner said Emmy could have survived if she had been delivered earlier by caesarean section, Mr Russo said: 'We are completely broken by the loss of our beautiful baby girl, Emmy. 'She was our child, so loved, so wanted, and we will never understand where things went so tragically wrong. 'We did everything that we were told, we followed the advice we were given. But deep down we knew something wasn't right. We voiced our concerns again and again but we were dismissed.' He added: 'I shook the hands of the people that played a part in the death of my daughter. 'It wasn't that they weren't nice or the culture wasn't nice. It was that they didn't do their job properly.' Addressing staff directly, he said: 'If you'd done your job properly and noticed what everyone else had noticed, our daughter would be with us today.' Mrs Russo revealed she had lost her job of ten years as a recruitment manager following the shock bereavement, as the terrible grief left her unable to leave the house for four months. She said: 'You lose any direction of life. How I experience grief is a continuous reel of what happened.' They are considering civil action against The Princess Alexandra Hospital NHS Trust now that the inquest has finished. Mrs Russo, 34, was 41 weeks and three days into her pregnancy when she went into labour and travelled the short distance to the hospital from their home in Harlow with her husband at 10am on January 9 last year. She called in advance and told staff she had found what she believed was encomium in her underwear. 'When we knew encomium was starting to show, I felt that Emmy was too high up in my belly,' Mrs Russo said. 'I've never had a baby before, so it was just an instinct, a feeling of I couldn't see my baby naturally coming out that way.' She asked for a C-section but her husband, 36, who is director of a construction company, recalled: 'Bryony was laughed off and she was really upset by this.' But he kept his faith in the staff, adding: 'I kept telling Bryony 'Please trust them, they're professionals, so let them do their job.'' It was seven hours before Mrs Russo was seen by a doctor and given an ultrasound scan, despite a foetal heart rate monitor showing an abnormal trace from the moment it was attached. Essex assistant coroner Thea Wilson said there had been 'miscommunication between doctors and midwives' about the severity of the problems Emmy was facing. Both were 'falsely reassured' by incorrect assumptions about the others' intentions. Emmy was left with a severe brain injury due to oxygen starvation and had to be immediately resuscitated before she was moved to the neonatal unit and later to Addenbrooke's. Mr Russo described a disturbing scene where staff initially congratulated him on becoming a father before telling him his daughter had been 'born dead'. 'In one minute, I went through the emotions of thinking it was all okay, to confusion, to heartbreak,' he told the inquest. The couple suffered further anguish at Addenbrooke's, where they 'had to ask for earplugs' to avoid the 'distressing' sound of being 'surrounded by happy families with their babies'. They eventually decided to allow Emmy's life support to be switched off after an MRI scan showed the extent of her brain injuries. 'She would never know her own name or breathe on her own,' Mrs Russo told the hearing in Chelmsford. 'After trying to think for half an hour, we decided to let Emmy choose [her path] as she had been through enough. 'We held her for two hours without oxygen, she died in Dan's arms. 'It has had a huge impact on us as a family. The prospect of having more children has been shattered. We're consumed by fear that history will repeat itself.' A post-mortem examination gave the cause of death as severe hypoxic-ischemic encephalopathy, where a brain injury is caused to a baby around the time of birth due to oxygen deprivation, with placental dysfunction. During the inquest, midwife Megan Fletcher defended her decision not to escalate concerns to a senior doctor, explaining she had wanted to avoid 'invasive procedures'. But independent expert obstetrician Teresa Kelly said there had been sufficient evidence 'this baby wasn't coping with labour' and staff should have acted sooner. Ms Wilson yesterday said there were multiple missed opportunities for a 'holistic review' of Mrs Russo's condition and that of her unborn child as she recorded a narrative conclusion. Concluding Emmy's chances would have been dramatically improved if delivered even an hour earlier, she added: 'She would have been born in a better condition and, on the balance of probabilities, she would have survived. 'There was a failure to respond adequately to the request for a C-section.' The coroner will be issuing a Prevention of Future Deaths report to the hospital to make sure correct information is given to mothers-to-be about prolonged pregnancies, induction and C-section deliveries. She also requested proof the hospital was improving training and communication between staff. Speaking after the inquest, Sharon McNally, chief nurse and deputy chief executive at The Princess Alexandra Hospital NHS Trust, said: 'We recognise the coroner's findings and we sincerely apologise to baby Emmy's family.' Last year, the trust was criticised after blowing £58,000 sending 14 staff on a fact-finding jolly to a Las Vegas technology conference, including a five-night stay in a casino hotel. It had been rated as 'requires improvement' by the care regulator and ended the previous year with a £13 million deficit.
