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Pregnancy is often associated with ocular changes, most often transient in nature, though occasionally permanent. It can be associated with development of new conditions, or can exacerbate pre-existing conditions. The ocular effects of pregnancy may be divided into physiologic changes, pathologic conditions or modifications of pre-existing conditions. Pathologic conditions include entities such as pre-eclampsia and eclampsia, along with conditions that are seen with increased frequency during pregnancy such as central serous retinopathy. The most significant modified pre-existing condition is diabetes mellitus. The various effects of pregnancy on the eye will be reviewed in this article.
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PMID:Ocular complications of pregnancy. 1173 86

From January 1982-December 1986, researchers reviewed 1130 patients who had 7 or more viable pregnancies at the University Teaching Hospital in Al-Khobar, Saudi Arabia. The majority of the patients (90%) received regular prenatal care and most of the remaining patients attended a prenatal clinic 3-4 times. For the grand multipara, the rate of spontaneous abortion was higher (24%) compared to total deliveries (13%) in that hospital during the study period. Anemia was the leading predelivery complication for the study group (16.6% vs. 3.5% for total deliveries). Preeclampsia followed as the 2nd leading complication (6.1% vs. 5.2% for total deliveries). In 1 case a 45 year old gravida 13 had eclampsia, and both mother and infant survived. Antepartum hemorrhage occurred in 5.8% of the multiparous women (2.3% for total deliveries) due to abruptio placentae in 43 patients and placenta previa in 34 others. 5.6% of the multiparous patients (1.2% for total deliveries) experienced unstable lie, while successful induction of labor at term occurred in 60% of these women. Diabetes mellitus caused the least predelivery complications (4.8% vs. 2.8%). 73.3% of all deliveries to grand multiparous women resulted in normal deliveries. Delivery complications were higher for the study group, however, than for total deliveries: breech deliveries, 7% vs. 2.7%; premature labor, 7.5% vs. 2.7; cesarean section, 11.4% vs. 8.9%; and postpartum hemorrhage. 6.5% vs. 3.1%. The perinatal mortality rate of 62/1000 for the grand multiparous women was 3 times the overall rate for the hospital (21/1000). Stillbirt accounted for 50% of perinatal deaths for the remaining deliveries. 1 maternal death occurred among the grand multigravida.
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PMID:Obstetric problems in the grand multipara: a clinical study of 1330 cases. 1231 19

A symposium held 3-5 May 1990 commemorated the anniversary of the "Network" by presentations on the health aspects of reproduction in Africa. Prof. Sambra Diarra of the Ivory Coast presented a paper on "Health of Reproduction in Africa, Bi-Dimensional Problems: Biomedical and Social." He stressed the need to emphasize both maternal (MM) and infant mortality (IM) in Africa, where MM rates are 640/100,000 and IMR are 130/1000, because they remain so high. Prof. Fadel Diadhiou of Senegal followed with a paper on "Operations Research on Women's Reproductive Health in Africa." The major themes were that problems in reproductive health have resulted because of the fragmentation between the ecosystem and development and the lack of research is due to the isolation of institutions that lack human and material resources. The 3rd presentation by Prof. Mouhamadou Fall of Senegal on "The Health of Children and the Perspectives for Senegal," focused on the increasing infant and child mortality rates in Senegal (238/1000 in 1981) due to the combination of factors caused by the mother-child syndrome. These are: 1) congenital malformations caused by incest, young or advanced age of mothers; 2) diseases of the mother that cause fetal mortality: diabetes, arterial hypertension, eclampsia; 3) lack of breastfeeding and illiteracy of mothers; 4) public health diseases such as measles, malaria, diarrhea; 5) streptococcic infections and their complications such as anemia and tuberculosis. The last presentation made by Prof. Eusebe Alihonou from Benin on the "Perspectives and Priorities of Reproductive Health in Africa," concluded that the research priorities in Africa should be on health systems that lower utilization rates of services and resources and on epidemiological studies that identify health problems and analyze the risk factors. The Symposium concluded that the research priorities should be: maternal morbidity and mortality; adolescents and reproduction and the morbidity and mortality of infants and children.
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PMID:[Network of researchers on the health aspects of reproduction]. 1234 30

The aim of this paper is to discuss, on the basis of an extensive literature review, the role of magnesium in health and disease. Magnesium is an essential cation playing a crucial role in many physiological functions. It is critical in energy-requiring metabolic processes, in protein synthesis, membrane integrity, nervous tissue conduction, neuromuscular excitability, muscle contraction, hormone secretion, and in intermediary metabolism. Serum magnesium concentration is maintained within a narrow range by the small intestine and kidney which both increase their fractional magnesium absorption under conditions of magnesium deprivation. If magnesium depletion continues, the bone store helps to maintain serum magnesium concentration by exchanging part of its content with extracellular fluid. The abundance of magnesium within cells is consistent with its relevant role in regulating tissue and cell functions. Recent data suggest that large fluxes of magnesium can cross the cell plasma membrane in either direction following a variety of hormonal and non-hormonal stimuli, resulting in major changes in total and, to a lesser extent, in free magnesium content within tissues. Imbalances of magnesium are common and are associated with a great number of pathological situations responsible for human morbidity and mortality. A large part of the population may have an inadequate magnesium intake, and in particular elderly subjects and athletes may be prone to chronic latent magnesium deficiency. Magnesium deficit is frequently observed in alcoholics and diabetic patients, in whom a combination of factors contributes to its pathogenesis. We will discuss some of the aspects of the involvement of magnesium in the etiology of some pathological situations, such as cardiovascular diseases, diabetes, pre-eclampsia, eclampsia, sickle cell disease and chronic alcoholism.
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PMID:Role of cellular magnesium in health and human disease. 1476 64

Besides cyclooxygenase and NO-synthase, another distinct endothelial pathway, endothelium-dependent hyperpolarization (EDHF), is involved in the relaxation of the vascular smooth muscle cells. EDHF has been demonstrated unequivocally in various blood vessels from different species, including human, and is likely to play an important role in cardiovascular physiology. This alternative pathway involves the activation of two populations of endothelial potassium channels, the small conductance and intermediate conductance calcium-activated potassium channels (SK(Ca) and IK(Ca), respectively). EDHF-mediated responses are clearly altered in various pathological conditions (ageing, hypertension, atherosclerosis, hypercholesterolemia, heart failure, ischemia-reperfusion, angioplasty, eclampsia, diabetes, sepsis). Therapeutic or adjutant interventions (angiotensin converting enzyme inhibitors, antagonist of the angiotensin receptor, estrogen, omega-3 polyunsaturated fatty acids, polyphenol derivatives, potassium and/or calcium intake) can restore these responses, suggesting that the improvement of the EDHF pathway contributes to the observed beneficial effect of these various substances. However, the improvement or restoration of EDHF responses has not been, yet, the direct purpose of any pharmaceutical effort. Activating endothelial IK(Ca) and/or SK(Ca) or increasing their expression as well as improving myo-endothelial communication, for instance by increasing the expression of connexin(s), could become interesting therapeutic targets.
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PMID:EDHF: new therapeutic targets? 1502 34

The vascular placental pathology (VPP) is associated with many etiologies. Some are the consequence of a maternal genetic or acquired predisposition. Others are associated with a chronic maternal disease (hypertension, lupus, obesity, diabetes, ...). Finally, some others are associated with placental implantation leading to fetal ischemia (multiple pregnancy, chorioangioma, primiparity, feto-placental hydrops) or to environmental (altitude) or nutritional factors (famine and specific alimentary depressions). We classify these factors into three categories according to the risk level (moderate, significant and elevated). While any of these factors can increase the risk of VPP, no one is sufficiently sensitive or specific in predict inevitable onset of VPP. In most cases VPP results from a combination of two (or more) risk factors. The risk factors of VPP classified as moderate include age (> or = 35 years), increased blood pressure during the second trimester of pregnancy, a new paternity, dietetic factors or environmental factors, smoking and controlled diabetes (class B, C), or inactive systemic diseases. Risk is significantly elevated among obese (BMI > or = 25), primiparous women, women with a past familial history (first degree) of preeclampsia or eclampsia, cocaine use or association of tobacco and caffeine use, increased placental mass (associated with twin pregnancy, fetal hydrops or molar pregnancy), uncontrolled diabetes, lupus, active scleroderma. Risk is considered to be high among patients with chronic hypertension, women with a past history of preeclampsia, diabetes (class D, F, R), patients with active systemic disease or with antiphospholipid antibodies or women with lupus or renal lesions and/or proteinuria as well as chronic kidney disease resulting in proteinuria, hypertension and renal insufficiency. Finally, the risk of VPP is considered to be increased in the presence of acquired thrombophilia. It remains moderate in the presence of isolated genetic thrombophilia, except in forms presenting with multiple genetic mutations or associated with an hyperhomocysteinemia. A "high-risk group" is defined among women with past history of deep venous thromboembolic events outside pregnancy, or with a past history of placental vascular pathology (intra-uterine death, placental abruptio, severe and precocious placental, intra-uterine growth retardation, early and repetitive fetal loss) and who, in addition, present with acquired thrombophilia (antiphospholipid antibodies, thrombocytemia), unique homozygous genetic thrombophilia, amultiple genetic thrombophilia or unique heterozygous genetic thrombophilia associated with hyperhomocysteinemia. Prophylactic treatment of acquired thrombophilia and of the multiple genetic forms or associated with hypercysteinemia is a logical rationale, particularly among women with a past history of placental vascular pathology, or with a past history of venous thromboembolic events. On the contrary, prophylaxis using low-molecular-weight heparin in the event of asymptomatic genetic thrombophilic mutations and for women without a past history of deep venous thromboembolism or vascular placental pathology remains controversial.
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PMID:[Vascular placental pathology in high-risk groups: definition and synopsis]. 1502 87

Hypertensive diseases in pregnancy are common and are associated with significant maternal and perinatal mortality and morbidity. Risk factors for pre-eclampsia include socio-demographical factors (extremes of reproductive age, socio-economic status, ethnic group), genetic factors, pregnancy factors (multiple pregnancies, primigravidae, previous pre-eclampsia) or personal medical history (obesity, chronic renal disease, chronic hypertension, diabetes mellitus, thrombophilia). These risk factors and Doppler screening can help target interventions such as aspirin and calcium that have been proven to reduce the incidence of pre-eclampsia in high risk women. Expectant management is the mainstay of treatment for pre-eclampsia. Hypertension should be controlled by oral or intravenous antihypertensive agents as necessary. Magnesium sulphate is the agent of choice for both the treatment and prevention of eclampsia. Fluid balance and thromboprophylaxis are also both important elements in the management of severe pre-eclampsia.
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PMID:Risk factors, prevention and treatment of hypertension in pregnancy. 1617 Feb 83

Although nitric oxide (NO) is recognized as the primary vasodilator derived from vascular endothelium in regulating the vascular tone, another factor, i.e. the endothelium-derived hyperpolarizing factor (EDHF), has recently gained much attention and has been demonstrated to participate in vasodilatation in various blood vessels from different species, despite its unidentified nature. Most of the studies were conducted in animals and the knowledge of this factor in the human vasculature is relatively limited. This review attempts to address the relevance of EDHF-mediated function in humans with the possible identity of EDHF and mechanisms involved. We consider the human vasculature where EDHF involvement has been documented including the systemic, coronary, and visceral (gastrointestinal, renal and reproductive) circulation. In these vascular systems, EDHF plays a role under physiological conditions either as another mechanism or as the "back-up" for NO. Furthermore, the contribution of EDHF changes under certain physiological conditions, such as ageing and pregnancy. In addition, altered EDHF function has been suggested in various pathological conditions including heart diseases, atherosclerosis, hypertension, diabetes, eclampsia, glaucoma, chronic renal failure, erectile dysfunction and ischemia-reperfusion period during open heart surgery. Pharmacological agents such as potassium channel openers or cytochrome P450 metabolites have been used to either protect or recover EDHF-dependent mechanisms. To further develop new therapeutic strategies that target EDHF, a better understanding is essential with regard to the function of EDHF under pathophysiological conditions in humans. Furthermore, the interaction between NO and EDHF as well as their relative contributions in various conditions are critical.
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PMID:The significance of endothelium-derived hyperpolarizing factor in the human circulation. 1726 16

This review reflects both the variable presentation and the systemic nature of preeclampsia. Recommendations for the comprehensive evaluation and management of organ dysfunction associated with pre-eclampsia are included. The main points in the review are that: (1) Preeclampsia is a systemic disorder that may affect many organ systems. (2) For preeclampsia remote from term (<34 weeks), expectant management improves perinatal outcomes, but requires obsessive surveillance to mitigate maternal risks and is a "package." (3) Initial assessment and ongoing surveillance of women with preeclampsia should include assessment of all vulnerable maternal organs as well as of the fetus. (4) Initiate antihypertensive drug treatment immediately if sBP >160 mmHg or dBP more than 110 mmHg, or if sBP 140-159 mmHg and/or dBP 85-109 mmHg (prepregnancy renal disease or diabetes). (5) The treatment of nonsevere pregnancy hypertension should include a treatment goal of dBP 80-105 mmHg (depending on practitioner preference), with one of the following agents, Methyldopa, Labetalol, Nifedipine, or, with special indications (renal or cardiac diseases), diuretics. (6) Drugs to avoid: angiotensin-converting enzyme inhibitors; angiotensin II receptor antagonists; and atenolol. (7) For the acute management of severe hypertension, initially reduce dBP by 10 mmHg and maintain the blood pressure at or below that level with either Nifedipine or Labetalol. (8) For both prophylaxis against and treatment of eclampsia, MgSO4 (4 g IV stat, then 1 g/hr). (9) For recurrent seizures, MgSO4 (2g IV stat, then increase to 1.5 g/hr). (10) Total fluid intake should not exceed 80 ml/hr; tolerate urine outputs as low as 10 ml/hr. (11) Early-onset and/or severe preeclampsia predict later cardiovascular morbidity and mortality; it would seem prudent to offer such women screening and lipid lowering interventions.
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PMID:Evidence-based management for preeclampsia. 1748 66

Preeclampsia is defined as the association of pregnancy-induced hypertension and proteinuria of 300 mg/24h or more after 20 weeks gestation. It complicates 0.5 to 7% of pregnancies. It is a severe complication of pregnancy, which leads to persisting fetal morbidity and mortality. It is also responsible for maternal morbidity as placental abruption, HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) and eclampsia. Without treatment, maternal risks are high. Once the disease is confirmed, the treatment consists of ending the pregnancy. Corticosteroids for lung maturity have to be prioritized depending on the term. Antihypertensive drugs are used to limit maternal complications, in particular, in neurological form. Calcium pump inhibitors are increasingly used as a first line choice. Magnesium sulfate, which is probably not used enough in France, needs to be administered with care and strict monitoring. It can be used to prevent a recurrence of eclamptic fits or in the context of early severe preeclampsia with neurological irritability where an eclamptic fit seems imminent. Preventive treatment of preeclampsia consists essentially of low dose aspirin. The efficacy of this treatment is real but moderate. It decreases the risk of recurrence of preeclampsia by 10 to 15%, of prematurity by 8% and of perinatal mortality by 14%. These figures were recently corrected to 10% for the risk of recurrence of preeclampsia: RR=0.95; 90% CI; (0.84-0.97) and prematurity: RR=0.95; 90%CI; (0.83-0.98). It seems that it has no significant effect on intra-uterine growth restriction (IUGR) and perinatal death prevention. For the main outcome of preeclampsia, there was no evidence that women in any of subgroups as preexisting renal disease, preexisting diabetes or hypertension benefited more or less from the use of antiplatelet agents than those in any other subgroup.
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PMID:[Latest developments: management and treatment of preeclampsia]. 1805 75


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