Autopsy Brain Findings in Preeclampsia and Eclampsia at Kenyatta National Hospital

Abstract

Background Preeclampsia and eclampsia are common pregnancy disorders and are the second most common cause of maternal mortality. They have diverse neuropathological presentations including stroke, intracranial haemorrhages, and vasculopathies which may result in maternal morbidity or mortality. An autopsy examination of the brain findings in pre-eclampsia and eclampsia at Kenyatta National Hospital will contribute to the understanding of the relationship between gross pathological changes and clinical neurological presentations. Study objective: To describe the autopsy brain findings in preeclampsia and eclampsia at KHN Study design: Descriptive cross-sectional autopsy study Study area: Autopsies were done at the Kenyatta National Hospital farewell funeral home and tissue processing done at the University of Nairobi Anatomic Pathology Laboratory Materials and methods The study was conducted on decedents of pre-eclampsia and eclampsia who were identified on admission to the farewell home and informed consent sought from next of kin. Clinical and demographic information was obtained through interviews of the next of kin and abstraction of medical records. Autopsies were carried out using standard techniques. The brains were eviscerated, examined, and fixed by immersion in 15% neutral buffered formalin for two weeks and thereafter dissected. Tissue samples obtained from standard sites for histopathological evaluation were processed, sectioned, and stained with Hematoxylin and Eosin. Other sections xiii were stained with Masson’s Trichrome (stain for differentiating between collagen and other cells). These were examined by the principal investigator and study pathologists. Results: The study included 23 decedents out of whom 18 had eclampsia and 4 with preeclampsia with severe features. The gross brain findings included 12(52.2%) cases with features of raised intracranial pressure, 9(39.1%) cases with cerebral oedema, 8(34.8%) with haemorrhage and 1(4.3%) had liquefactive necrosis. There were 14(60.9%) cases with vascular findings on histology while 9(39.1%) cases had no vascular findings. The microscopic parenchymal findings included gliosis in 14(60.9%) cases, haemorrhage in 11(47.8%) cases and infarcts in 5(21.7%) cases. Conclusion: The common histological parenchymal findings identified included neural changes due to hypoxic ischemia, cerebral oedema, haemorrhage, and old infarcts healing with gliosis while vascular changes identified were arteriosclerosis, thrombotic microangiopathy and vascular congestion. The laboratory parameters including liver function tests, activated partial thromboplastin time and prothrombin, and platelet count for majority of the decedents were deranged denoting a concurrent haemolysis, elevated liver enzymes, low platelet count syndrome. The relation of these lab parameters and the histology findings was not found to be statistically significant.