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

Premature separation of the normally implanted placenta is a serious complication of pregnancy and a leading cause of maternal and perinatal morbidity and mortality. Using data from the National Hospital Discharge Survey, we estimated rates of abruptio placentae in the United States for the years 1979-1987 and examined the association of this condition with several demographic risk factors and coexisting obstetric conditions. In 1987, the national rate was 11.5 cases per 1000 deliveries. The rate of abruptio placentae increased significantly between the years 1979-1987 among women of all racial groups. The increase in the rate of placental abruption occurred mainly among women under the age of 25, unmarried women, and women on Medicaid compared with those who had private insurance. Women with placental abruption were 54 times more likely to have coagulopathies and 11 times more likely to have stillbirths than those without placental abruption. Twin gestations, preterm premature rupture of membranes, chorioamnionitis, chronic hypertension, and preeclampsia/eclampsia were also associated with placental abruption. Although the cause for the increase in the incidence of abruptio placentae is not known, most of the increase occurred among women likely to be financially and socially disadvantaged.
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PMID:National trends in the incidence of abruptio placentae, 1979-1987. 194 12

To study the effects of illicit drug use during pregnancy on maternal health, we reviewed the records of women who delivered at the University of Texas Medical Branch between June 1, 1989, and February 28, 1990, for peripartum history and results from drug urinalysis screens. After controlling for age at delivery, gravidity, race/ethnicity, and use of alcohol or tobacco, elevated relative risk estimates were observed among women who had positive urinalysis for syphilis, gonorrhea, pregnancy-induced hypertension, chorioamnionitis, asthma, and postpartum hemorrhage. These findings confirm that pregnant women who use illicit drugs are at increased risk for serious health complications.
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PMID:Substance use during pregnancy and peripartum complications in a triethnic population. 775 68

Coexistent hydatidiform mole (46, XX) and live fetus (46, XY) in the second trimester is a rare phenomenon. In this case, the clinical manifestations presented as pregnancy-induced hypertension, including hypertension, proteinuria and oliguria. Ultrasonic examination found an enlarged placenta with a typical honeycomb picture, placenta previa and a normal developing fetus. The patient underwent an emergency cesarean section at 23 weeks' gestation on a preliminary diagnosis of acute chorioamnionitis. A 700 g immature male baby was delivered with Apgar scores of 3 at one minute, and 7 at five minutes. The placenta was composed of two parts: one was a molar pregnancy and the other was a normal placenta, both were separated by the membrane. The membrane consisted of one chorion and two amnions. Postmolar persistence of human chorionic gonadotropin was found one month after termination of this pregnancy. Chemotherapy with a single agent (methotrexate) was given. The patient is doing well and has no evidence of recurrence after one year of follow-up.
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PMID:Twin pregnancy with hydatidiform mole (46, XX) and a coexistent fetus (46, XY): report of a case. 791 78

The use of drugs for common pregnancy complications like premature labor, hypertensive diseases, and premature rupture of membranes with chorioamnionitis is reviewed. In addition, new publications on antiviral drugs in HIV-positive pregnant patients are also discussed. Among the drugs, suppressing premature labor side-effects of beta-mimetics are of growing concern. The effectiveness of other agents like magnesium, indomethacin, and sulindac are addressed. The various mechanisms explaining the beneficial effect of magnesium in pre-eclampsia are reviewed and new data on antihypertensives, such as labetalol, calcium channel blockers, and methyldopa are presented. The evidence from various clinical trials on the value of low-dose aspirin as a prophylactic agent against pregnancy-induced hypertension, pre-eclampsia, and intrauterine growth retardation in high-risk and low-risk patients is compared. Pharmacokinetic data including transplacental transfer of antibiotics and anti-HIV nucleosides are part of this review.
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PMID:Drug treatment in pregnancy. 818 Mar 51

This study was undertaken to investigate whether physical assault was independently associated with an adverse obstetric outcome. 512 women examined at the low-risk prenatal clinic of the University of Texas Medical Branch in Galveston, Texas, were interviewed. The final cohorts consisted of 32 (7.3%) physically abused women and 352 (80.0%) control subjects without any abuse history. Demographic and socioeconomic differences were found to be insignificant among the respondents. Results revealed that women assaulted in the current pregnancy were twice as likely to have preterm labor as compared with those without assault history. In addition, crude odd ratios showed a twofold increased risk of chorioamnionitis in assault victims. No difference between abused and nonabused women was noted in the prevalence of preterm delivery, pregnancy-induced hypertension, cesarean section, meconium staining, infant birth weight, Apgar scores, intrauterine growth retardation, fetal distress, fetal death, neonatal seizures, sepsis, or admission to the intensive care unit. In conclusion, physical assault was associated with preterm labor and chorioamnionitis and screening for assault must be incorporated during routine prenatal care to identify women at risk of complications.
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PMID:Perinatal morbidity associated with violence experienced by pregnant women. 761 58

A study of 147 nulliparous adolescents 15 years of age or younger who sought prenatal care at the University of Texas Medical Branch at Galveston during 1992-94 investigated whether young adolescents were more likely to develop perinatal complications than older adolescents and adult women. 287 adolescents 16-17 years of age and 107 women 20-22 years old who delivered at the same facility during the study period were used for the comparison. Younger adolescents were significantly more likely to develop anemia and less likely to deliver an infant who required admission to the intensive care unit than their older counterparts. There were no differences between the three groups, however, in terms of the prevalence of pregnancy-induced hypertension, preterm labor, preterm premature rupture of membranes, chorioamnionitis, meconium staining, endometritis, preterm delivery, low birth weight, low Apgar score, or fetal death. This study suggests that young age is not an independent risk factor for most perinatal complications.
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PMID:Adverse perinatal outcomes in young adolescents. 933 51

We evaluated the utility of a focussed, multidisciplinary adolescent clinic in improving perinatal outcomes. The study population included all delivering unmarried teenagers (13-19 years) from January 1, 1993 to December 31, 1995 attending the focussed adolescent obstetrical clinic compared to a similar cohort of married teenagers (13-19 years), married 20-24 year-old patients, and unmarried 20-24 year-old patients. There were no statistical differences in chorioamnionitis, intrauterine growth retardation (IUGR), postpartum haemorrhage, maternal weight gain, mean gestational age at delivery, preterm delivery rates (<37 weeks), low birth-weight (<2,500 g), Caesarean delivery, postterm delivery rates (>41 weeks), macrosomia (>4,000 g), placental abruption, chronic hypertension, alcohol use, Apgar scores or stillbirth rates or neonatal death rates among the 4 groups studied. Statistical differences were noted in mean delivery weights (p<0.05), preeclampsia (p<0.004), gestational diabetes (p<0.01), history of substance abuse (p<0.0001), tobacco use (p<0.0001), and forceps delivery rates (p<0.004). However, in the teen cohort none of these differences appeared to adversely affect perinatal outcomes in our patients. The focussed, adolescent obstetrical clinic appears to provide perinatal morbidities equal to a low-risk, general population generating better than expected outcomes for pregnant teenagers.
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PMID:Use of a focussed teen prenatal clinic at a military teaching hospital: model for improved outcomes of unmarried mothers. 976 Nov 53

Aside from recognized overgrowth syndromes, instances of visceromegaly are not uncommon at perinatal autopsy. The database of the University of Michigan Teratology Unit was screened for individual viscera exceeding the 90th centile for body and brain weight standards. The data were stratified for several maternal (hypertension, diabetes, obesity), gestational (chorioamnionitis, oligohydramnios, amniorrhaea, polyhydramnios), and fetal (body wall defect, cardiac malformation, renal malformation, diaphragmatic hernia, nonimmune hydrops, twin transfusion syndrome) characteristics and tested for statistically significant excessive numbers of heavy organs. The most striking associations were heavy adrenal glands and liver with chorioamnionitis, heavy heart with polyhydramnios and in the twin transfusion syndrome, and heavy heart and liver with nonimmune hydrops. Excessive brain weight for body weight had a number of correlations, each most likely reflecting growth restriction with sparing of brain growth.
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PMID:Correlates of prenatal visceromegaly. 978 3

Lymphocytic inflammation of the fetal membranes is unusual and has been termed chronic chorioamnionitis. We report the clinicopathologic and immunohistochemical findings in 31 placentas with chronic chorioamnionitis. The most common histopathologic association was chronic villitis of unknown etiology, which was identified in 22 (71%) of the 31 placentas. The severity of the chronic villitis did not correlate with the severity of chronic chorioamnionitis. Additional placental findings included chronic intervillositis in two, fetal vessel thrombosis in five, hemorrhagic endovasculitis in four, decidual chronic vasculitis in three, and atherosis in one. Maternal history included pregnancy-induced hypertension in six and diabetes in one. Twelve infants were preterm, and five had intrauterine growth retardation. There was no neonatal sepsis or death. Immunohistochemical staining in areas of chronic chorioamnionitis showed CD3+ and CD8+ cells present in moderate numbers, and CD4+ cells in smaller numbers. CD20+ and CD56+ cells were rare or absent. Chronic chorioamnionitis is commonly associated with chronic villitis of unknown etiology, shares similar clinical associations, and may have a related cause, possibly immunologic.
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PMID:Chronic chorioamnionitis: a clinicopathologic and immunohistochemical study. 986 33

OBJECTIVE: Recently, it has been suggested that periodontal disease during pregnancy could have a causal relationship with low weight at birth. Our objective was to evaluate the influence of periodontal disease during pregnancy on the birth weight of newborn infants. METHODS: Mothers who gave birth to low-birth-weight infants were randomly selected (Group 1 - G1; n=13). Immediately after inclusion of each mother in group 1, the mother of the next term newborn with birth weight of > 2,500 g (Group 2 - G2; n=13) was included as control. Mothers were examined by a periodontist who was not informed of the group the child belonged to. A probe was used to measure attachment loss of the alveolar bone. The extension index (EI) and severity index (SI) of the periodontal disease were determined. RESULTS: Both groups of mothers were similar in terms of maternal age, parity, color of skin, height, nutrition, smoking, drinking, socioeconomic status, prenatal examinations, premature rupture of membranes, chorioamnionitis, bacteriuria, placenta previa, abruptio placentae, previous hypertensive disease, preeclampsia, and heart disease. The characteristics of the newborns were: birth weight - G1 = 1,804 -/+ 675 g x G2 = 3,030 -/+ 516 g; gestational age - G1 = 33 -/+ 5 weeks x G2 = 39 -/+ 2 weeks; length of stay in the neonatal intensive care unit (NICU) - G1 = 128 days x G2 = 0 days. Average EI: G1 = 89.788 -/+ 18.355 x G2 = 72.420 -/+ 20.717; p=0.033. Average SI: G1 = 1.377 -/+ 0.626 x G2 = 0.754 -/+ 0.413 (OR=18.3; CI95%: 2.5-133.3; p = 0.006). After adjustment for risk factors for low birth weight, such as smoking, maternal height, bacteriuria, and previous hypertension, the odds ratio for SI dropped to 7.2 (CI95% = 0.4-125.4; P = 0.176). CONCLUSION: The multivariate analysis indicated a marked association between periodontal disease measured by SI score and low birth weight. Our data suggested that periodontal disease during pregnancy may be a risk factor for low weight at birth.
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PMID:[Periodontal disease in pregnancy and low birth weight] 1464 15


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