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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A group of 20 pregnant women requesting therapeutic abortion received a single transcervical intrauterine instillation of 5 mg prostaglandin F2alpha in 5 ml of saline between 38 and 46 days after the onset of their last menses. Of the 20 women, 13 (65%) had a successful termination of pregnancy, while the other 7 patients did not abort. A total of 7 patients, 2 of whom aborted, had severe adverse reactions, including fever, hemorrhage and hypertension. 3 of the 5 women who did not abort developed septic incomplete abortions. The low incidence of success and high incidence of complications noted in the study indicate that this method should not be utilized to terminate early pregnancy.
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PMID:Intrauterine administration of prostaglandin F2alpha as an outpatient procedure for termination of early pregnancy. 444 83

The present status of oral contraceptive steroids and the IUD, the 2 most effective and increasingly popular contraceptive methods (used by 41.6% of all U.S. married couples practicing contraception in 1970), is presented. Oral steroid contraceptives with varying quantity and activity of estrogen (ethinyl estradiol or mestranol) and progestogen (norethindrone, norethynodrel, ethynodiol diacetate, or norgestrel), are of 3 types: combination, sequential, and minidose progestogen alone. The most effective contraceptive available is the combined oral pill with a pregnancy rate of less than .2 % per 100 women after 1 year. Contraceptive action is exerted primarily through inhibition of ovulation and secondarily by alterations in cervical mucus, endometrial glands, the ovary, and in the oviduct and uterine muscle. In comparison, sequential oral contraceptives are less effective with greater side effects, and should only be used in women with amenorrhea. Effects of oral contraceptives other than contraception include those on the (1) the primary targets of the female reproductive system, (2) on other endocrine oragans and (3) on the remainder of the body. In the first group, changes may include transitory stromal fibrosis in the ovary, enlarged fibromyomata, intermenstrual bleeding or amenorrhea, increased amount of cervical mucus, polypoid hyperplasia of the endocervical glands, breast tenderness, and changes in lactation. Changes in the second category which may occur affect the adrenal glands, hypothalamus, the thyroid (increased thyroid-binding globulin), and pancreas (alterations in glucose metabolism). Effects on the rest of the body may include increase in serum lipids and changed atherogenic index, abnormalities in liver function, thromboembolism (incidence in oral contraceptive users 4.4 times that in non-users), melasma, alterations in the central nervous system with increased incidence of cerebral vascular accidents, hypertension, and increased body weight. Absolute contraindications to oral contraceptive therapy include cancer of the breast and uterus, pregnancy, active liver disease, hyperlipidemia, and history of gestational diabetes, thromboembolic phenomena or coronary artery disease. Relative contraindications include depression, migraine, myomata of the uterus, hypertension, epilipsy, oligomenorrhea and amenorrhea. Reliable epidemiologic data on IUDs from the Cooperative Statistical Program indicated first year pregnancy rate of 2.5%. Problems with the IUD include: 1) pregnancy with device in situ, which is associated with a higher incidence of spontaneous abortion; 2) ectopic pregnancy, which is prevented at a rate of only 90% compared with intrauterine pregnancies prevented in 97-98%; and 3) expulsions (20% of which are unnoticed), the expulsion rate being higher with decreasing age and parity, higher in the first than second year of use, and higher with smaller than larger devices. A major problem is discontinuation for medical reasons (15% rate in the first year), mainly bleeding and pain. Perforation, another serious complication, occurs initially at time of insertion with an incidence of 1 per 2500 insertions for the loop. IUDs were found to produce a sterile inflammatory tissue reaction, which is postulated as the primary causative factor for their contraceptive effect in humans.
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PMID:Current status of contraceptive steroids and the intrauterine device. 459 80

The case report of a fatal result in an abortion requested because X-ray diagnostic studies of the gallbladder and intestine had been made during an undiagnosed early pregnancy is presented. A uterine vacuum aspirator had not been purchased by the hospital. A portable laboratory vacuum pump with an appropriate suction trap was used. The apparatus had been used previously in several abortion cases. After dilatation of the cervix and insertion of the aspirating cannula, the pump was turned on. A sudden massive effusion of bloody froth issued from around the cannula. The cannula was removed immediately. It was found that the tubing had been incorrectly connected. The aspirator tube was connected with the pressure outlet of the pump. The tubing was then correctly placed and the uterus emptied. The patient was given succinyl choline, intubated, placed in the Trendelenburg position, and monitored cardiographically. About 30 seconds after the uterine insufflation blood pressure became unobtainable. The pulse slowed to 50 beats/minute and respiration diminished. Cardiac ausculation revealed no sounds. Respiration was maintained using oxygen through an endoctracheal tube. The pulse was still palpable and the EKG showed abnormal QRS complexes. Cyanosis then became evident. Closed chest cardiac massage was used for 1 minute but the patient became pulseless and QRS complexes were bizarre. Then the chest was opened and each ventricle was needled. From each ventricle of the distended heart air hissed under pressure through the needle vent site. The ascending aorta was needled and air escaped under pressure. Cardiac color and action improved when aided by massage. Iv isoproterenol and intracardiac epinephrine were given. An electric defibrillator converted the cardiac rhythm to a sinus rhythm. Norepinephirne brought about hypertension. Blood and albumin were given iv. The patient never regained consciousness. Tracheostomy and a feeding gastrostomy were required. Urinary and respiratory infections followed and the patient died after 2 1/2 months. Autopsy revealed tracheobronchitis, bronchopneumonia, and pulmonary edema. The brain showed extensive cerebral cortical necrosis. The heart was normal. This maternal death was preventable.
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PMID:Air embolism and maternal death from therapeutic abortion. 502 50

For women whose health cannot support pregnancy, the author's obstetrics department has formed a multidisciplinary team to counsel couples on psychological and practical aspects of contraception and abortion. High risk pregnancies are those occuring in women with such disorders as cardiopathy, nephropathy, hypertension, diabetes, cancer, Rhesus isoimmunization and psychosis. Two approaches are used: to prevent or terminate pregnancy. Contraception must be explained concretely, addressing the couples' particular situation and personality. Pills are often contraindicated, in high risk patients as are IUDs in nulliparas and those taking anticoagulants. Many couples used to careful medical surveillance can adjust to temperature rhythm or diaphragms. For women who must have Tubal ligation, the decision is made jointly by the couple, obstetrician, psychotherapist and specialist. Counseling is usually necessary to prevent psychological or sexual dysfunction, particularly in those sterilized during caesarean section if the infant's survival is also at risk. A similar multidisciplinary team is consulted for therapeutic abortion alone or combined with tubal ligation.
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PMID:[Fecundity and high risk pregnancy]. 507 55

24 women aged 17-34 received therapeutic abortions at the obstetric clinic of Clermont-Ferrand between 1958 to 1969. Indications were cardiopathies (9), hypertension (7), nephropathies (3), uncontrollable vomiting (2), diabetes (1), bronchial dilatation (1), and risk of uterine rupture (1). These indications correspond to those reported in 2 other studies. The 2 abortions necessitated by vomiting occurred in 1959 and might have been otherwise controllable by current techniques. 75% of the abortions were performed by "microcesaerean," and were follow ed by sterilization if the couple consented. Data on each patient are p resented in a table showing age, parity, antecedent conditions, indications for the abortion, and operative techniques used.
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PMID:[Therapeutic abortion at the obstetrical clinic of Clermont-Ferrand from 1958 to 1969. 24 cases]. 553 54

Several British and U.S. retrospective studies on thromboembolism among users of oral contraceptives prompted the Dunlop Committee to recommend that pills with over 50 mcg mestranol or ethinyl estradiol be avoided to reduce mortality risks by 50%. It is noted that the incidence of idiopathic cases of thromboembolism seems to be increasing, and cigarette smoking may be a cause. Possible etiologic factors, such as lesions in the endothelium of the blood vessels, clotting factors, blood lipids, hypertension, all due to estrogen intake, are discussed. A thromboembolism is sometimes predictable in individuals if there is migraine, visual disturbance, or certain predispositions seen in pregnancy such as toxemia or hypertension. The risks should be weighed against those of other methods of contraception, and against those of pregnancy, but not against those of illegal abortion, which is an unrelated social problem. Women with serious medical indications for effective contraception should be considered differently from those who desire family planning only.
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PMID:[What is to be thought of the Dunlop Committee recommendation concerning the anti-ovulation pills?]. 554 11

Improved sensitivity and specificity of radioimmunoassays (RIAs) for hCG, hCG alpha and hCG beta have allowed measurements of these substances to become a powerful diagnostic aid applicable to several clinical disorders of pregnancy. In threatened abortion of the 1st trimester, the doubling time of hCG concentrations is significantly slower than in early normal pregnancies. Low levels of hCG are uniformly encountered in case of impending abortion. The overall predictive value of hCG determinations is 75-97%, whereas the predictive value of hCG alpha and hCG beta levels 88%. In patients progressing slowly to inevitable abortion, an increase in hCG alpha and/or the ratio hCG alpha: hCG is frequently observed. In ectopic pregnancies, sensitive new-generation tube tests and RIAs can detect urine or serum hCG in almost 100% of the cases. Abnormally low levels of hCG are encountered in about 85% of the patients. A significant increase in the ratio hCG alpha: hCG is observed. Toxemia of pregnancy is abided by significantly higher maternal levels of serum hCG, hCG alpha and hCG beta and by a lower ratio hPL: hCG than in normal pregnancies, or pregnancies complicated by isolated or chronic hypertension. It is concluded that in the above-mentioned pathological conditions of pregnancy, hCG is a reliable trophoblastic marker and that, additionally, hCG alpha could prove to be an index of chronic placental hypoxia.
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PMID:[Human chorionic gonadotropin and its subunits in normal and pathologic pregnancies]. 608 38

Thirteen patients with Takayasu's arteritis had 30 pregnancies between 1970 and 1982. The 11 pregnancies occurring before the disease became clinically evident were uneventful. Eleven patients had 19 pregnancies after manifestation of the disease. Four ended in abortion, four in cesarean section, and 11 in uneventful vaginal delivery at term. There was no major obstetric problem apart from hypertension, and there was no maternal death directly related to the pregnancy per se. All 15 babies were born without asphyxia and congenital abnormality. The nine with some evidence of intrauterine growth retardation could be predicted by a prognostic score taking into account the timing of therapy, the severity of the hypertension, and the extent of arterial involvement.
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PMID:Pregnancy and Takayasu's arteritis. 613 52

The use of beta-blocking drugs in the treatment of hypertension during pregnancy has been the subject of controversies on the basis of theoretical hazards due to the pharmacology and pharmacokinetic characteristics of these drugs. A review of the literature on the subject shows that: The danger of premature contractions, abortion or premature delivery does not seem to increase with the use of beta-blockers. The blood supply is not more impaired with beta-blockers than with other antihypertensive drugs according to fetal growth, birth-weight, frequency of perinatal deaths or APGAR score. Although beta-blocking drugs pass into fetal circulation, neonatal bradycardia, respiratory distress or hypoglycemia do not seem more frequent with beta-blockers. Beta-blockers pass from maternal plasma into milk but the 24 hour dose brought to the newborn by maternal feeding is so slight as to be negligible. Thus, the cumulative data and the favorable opinions of many authors, the greater efficiency of beta-blockers authorizes the use of these drugs in the treatment of hypertension in pregnancy, where it seems to improve the outcome of the pregnancy and the state of the fetus at birth.
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PMID:[Are the theoretical drawbacks of beta-blocker treatment in pregnancy being confirmed? A review of the literature]. 613 64

Plasma cAMP was determined using the method of Tovey et al. in normal pregnant women with a mean concentration of 18.9 +/- 0.8 pmol/ml (x- +/- SEM). Between weeks 9-12 and 33-36 of gestation, there were two peaks, with a mean cAMP of 22.5 +/- 2.4 which were significantly increased in comparison to the other weeks of pregnancy. Significantly decreased values were found in patients with threatened abortion (weeks 12-28) which terminated in abortion (11.6 +/- 2.4; p < 0.01). In premature labor no differences were found. During therapy with fenoterol there were highly significantly increased plasma cAMP levels (48.2 +/- 2.8; p < 0.0005). During thyroid hormone therapy in euthyroid goiter, cAMP was significantly decreased (14.0 +/- 1.4; p < 0.05). 1 week after cessation of therapy a highly significant increase of cAMP was observed (38.2 +/- 6.9; p < 0.0005). There was a negative linear regression between T3 and cAMP (2p < 0.01). In pregnancy with hypertension cAMP was significantly elevated (30.5 +/- 3.8 p < 0.0005), but nearly normal under antihypertensive therapy. In pregnancy with edema only, no difference was found. Induction of labor with PGE2 alpha was followed by a decrease of plasma cAMP.
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PMID:Plasma cAMP in normal and abnormal human pregnancy. 625 65


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