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

Reference values are usually based on blood samples from healthy men or non-pregnant women. Blood samples from pregnant women may be compared with these reference values. Correct references for pregnancy can be extremely important for clinical decisions such as ablatio placentae, appendicitis, premature rupture of membranes and preeclampsia. Previous studies of normal variations during third-trimester pregnancy are incomplete. Blood samples during pregnancy weeks 33, 36 and 39 as well as 1-3 h postpartum were collected from pregnant women with dietary iron supplement and at least one previous pregancy without a history of hypertension or preeclampsia. When the sampled values were compared with the present reference values from men and non-pregnant women, the following differences were found during normal pregnancy: Haemoglobin and ferritin were reduced, CRP was slightly elevated, WBC (white blood cell count) and HNL (human neutrophilic lipocalin) were elevated during pregnancy and significantly increased postpartum. Albumin was reduced. ALT and AST were slightly elevated and GGT was unchanged during pregnancy. ALP, D-dimer and fibrinogen were elevated. Uric acid increased during the third trimester and thrombocyte count decreased. Separate reference values for pregnant women are essential for correct diagnostic decisions during third-trimester pregnancy. Elevated levels of D-dimer do not necessarily indicate ablatio placentae. A diagnosis of progressive preeclampsia cannot be based on increasing uric acid levels and reduced platelet count in a stable clinical condition. HNL signals activation of neutrophilic granulocytes and can thereby offer a helpful tool for diagnosing infection during pregnancy and postpartum.
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PMID:New reference values for routine blood samples and human neutrophilic lipocalin during third-trimester pregnancy. 1176 17

With improved technology in assisted reproductive medicine, there has been an absolute increase in the numbers of twin pregnancies with an associated increase in perinatal mortality and morbidity. This increase in perinatal mortality and morbidity is largely due to a higher incidence of delivering preterm as compared to singletons. Twin pregnancies have their unique complications that include abnormal placental communication and discordant growth which are associated with perinatal mortality and morbidity. The objectives of this study were two-fold: i) to determine if the morbidity/mortality outcome at 18-24 months corrected age seen in a cohort of twins born between 24-30 weeks gestation was significantly different as compared to singleton preterm infants of the same gestation; and ii) to determine and evaluate any differences between monochorionic (MC) and dichorionic (DC) twins. Twins 24-30 weeks gestation at birth born between 01/01/97-30/06/99 were identified and prospectively followed to 18-24 months corrected age (c.a.). They were matched with a singleton infant of the same gender and within 1 week of the same gestation. Obstetrical, neonatal and neurodevelopmental data were gathered and analyzed. The primary outcome was death or the presence of a severe neurodevelopmental deficit at 18-24 months corrected age. Of the 56 sets of twins identified, 52 sets were followed prospectively with 101 infants available for matching. In this cohort, twin pregnancies had a lower incidence of pregnancy-induced hypertension and premature rupture of membranes than singletons (p < 0.05). The two groups were comparable in neonatal characteristics. The incidence of death or severe disability was 29.7% in twins vs. 22.8% in singletons (p = 0.337, Fisher's exact test). The major area of defect was in the cognitive category for both groups, 9.9% vs. 7.9% respectively. MC twins made up 35.6%; DC twins 64.4%. Twin to twin transfusion syndrome (TTTS) occurred in 6.9%. Discordant growth occurred more frequently in MC pregnancies (p = 0.016). MC twins tended to be more premature, lower in birth weight, and experience neonatal morbidity in the form of patent ductus arteriosus and sepsis (p < 0.05) as compared to DC twins. However, the primary outcome of death or severe neurodevelopmental deficit at 18-24 months c.a. was not significantly different between the two groups, 38.9% (MC) vs. 24.6% (DC), (p = 0.173, Fisher's exact test). Neurodevelopmental morbidity or mortality in twins with TTTS was 42%. Mortality and severe neurodevelopmental morbidity were not signif cantly higher in twins as compared to singletons in this cohort. However, the trend is slightly higher in twins, which may have clinical significance. Though not statistically significant, the incidence of 38.9% in adverse outcome wth MC twins may be clinically significant. With the number of twins steadily increasing, further monitor ng is required to determine future directions in intervention and research. Early recognition of monochorionicity remains essential to optimize care and neurodevelopment for these infants.
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PMID:Evaluating 2 year outcome in twins < or = 30 weeks gestation at birth: a regional perinatal unit's experience. 1178 Sep 34

Pregnancy after the fifth delivery is viewed with anxiety, especially by obstetricians in developing countries working with inadequate facilities. High parity is still common with serious consequences to the fetus, the mother, the family and society. In the last 40 years, non-governmental, national and international efforts have been made to reduce fertility rates. We therefore intended to determine the trend in the grandmultiparity rates from 1 January 1987 to 31 December 1994 in the South Western part of Nigeria. The obstetric performance of these grandmultiparae in two different settings were to be compared. This was a retrospective, case-note analysis of all the grandmultiparae delivered at the University College Hospital (UCH) (Group A) and the Oluyoro Catholic Hospital (OCH) (Group B), both in Ibadan city. The former is a tertiary health care centre while the latter is a secondary centre. The socio-clinico-demographic characteristics of these patients were collated and analysis and comparison performed using EPI-INFO software. In Group A, 828 grandmultiparae were seen among 9215 deliveries, a rate of 8.99% (10.90% in 1987 to 3.36% in 1994). In Group B, there were 1940 cases among 22 587 deliveries, i.e. 8.59% (12.75% to 6.07%), respectively. The modal age group was 31-35 years, and women above 35 years formed one-third of cases. The parity group 5-7 was the most frequent in both groups (91.6% vs. 94.9%). Only two mothers (both in group B) had parity above 10. Booked patients formed a larger percentage in Group B than in Group A (85.8% vs. 69.7%, respectively). In Group B 85.9% had spontaneous vertex delivery as opposed to 66.3% in Group A. Caesarean section was the mode of delivery in 9.0% and 24.2% in Groups B and A, respectively. Equal percentages had breech delivery. The modal birth weight was 2.51-3.00 kg in both groups. Macrosomic babies formed 3.7% in Group A and 2.4% in Group B, while low birth weight babies formed 17.7% and 11.7% in Groups A and B, respectively. The crude perinatal death ratio was 123/1000 in Group A and 68/1000 in Group B. Antepartum haemorrhage, anaemia and premature rupture of membranes in Group A and anaemia, hypertension and antepartum haemorrhage in Group B were the most common pregnancy complications noted. In labour, abnormal lie/presentation, prolonged labour and premature labour in Group A and abnormal lie/presentation, antepartum haemorrhage and birth asphyxia in Group B formed the majority of the complications. The most common puerperal complications were primary postpartum haemorrhage, wound/genital sepsis in Group A and anaemia and primary postpartum haemorrhage in Group B, respectively. Maternal death ratio was 10.85/100 000 total deliveries in Group A and 35.42/100 000 in Group B. High parity is still common in developing countries, although the incidence is declining, with rates of 3.4% and 6.1% of total deliveries in Groups A and B, respectively. More patients are delivered per abdomen at UCH compared to OCH. The perinatal mortality rate is higher at UCH than OCH but the maternal mortality rates follow the reverse. Recommendations are made concerning the reduction in high parity rates and its associated complications.
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PMID:Grandmultiparity--trends and complications: a study in two hospital settings. 1252 27

Current guidelines for dialysis in pregnant women have been developed in response to occasional dialysis patients who unexpectedly become pregnant. These include prolonged dialysis times, generally 20 or more hours per week. The increased dialysis time requires careful monitoring of phosphorus and potassium which may be removed in excessive amounts. Target serum bicarbonate for a pregnant woman is 18-20 mEq/L. Patients require increased supplementation of water soluble vitamins particularly folate. Increased doses of erythropoietin are needed to meet the demands for increased red cell production occasioned by pregnancy. Hypertension is the greatest danger to the mother and extreme vigilance is required up to six weeks postpartum. Volume status is difficult to predict and can only be determined by repeated clinical assessment. Only 50% of pregnancies result in a surviving infant and in the best subgroups, no more than 75% of pregnancies are successful. Over 80% of live born infants are premature, often severely premature. The key to improving the outcome of pregnancy in dialysis patients lies in decreasing premature labor and premature rupture of membranes in the late second and early third trimester. To this end, it is important for obstetricians to recognize that the risk of prematurity in pregnant dialysis patients is as higher or higher than in any other group and that any intervention, including such measures as progesterone and oxytocin antagonists, used to prevent premature labor in other groups should be considered in dialysis patients.
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PMID:Pregnancy in dialysis patients: where do we go from here? 1296 89

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

We sought to determine whether hypertensive pregnancies can be considered a distinct subgroup of premature births. All women in our centre who had had singleton preterm spontaneous deliveries over an 8-year period were divided into hypertensive and normotensive groups and compared for maternal characteristics and neonatal outcome. Of the 4175 eligible women, 9.8% (n = 410) had pre-eclampsia. These patients had higher rates of small-for-gestational-age neonates (19%, 78/410), abruptio placenta (7.8%, 32/410) and caesarean section rate (52.7%, 216/410) than the normotensive women (4.3%, 158/3765; 4.6%, 172/3765; and 19.6%, 739/3765, P < 0.001, respectively. The rate of preterm premature rupture of membranes was significantly lower in the hypertensive than in the normotensive group (5.9% vs. 17%, respectively; P < 0.001). We concluded that hypertensive women who deliver prematurely belong to a subgroup with particular characteristics. The increased rate of small-for-gestational-age neonates in pre-eclamptic women suggests that reduced uteroplacental perfusion may cause fetal growth impairment before the onset of the hypertensive disorder.
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PMID:Increased rate of small-for-gestational-age neonates in pre-eclamptic women with preterm deliveries. 1551 52

Trace element deficiencies have been documented to play an important role in determination of the fetal outcome. Pregnant women in developing countries have been reported to consume diets with a lower density of minerals and vitamins. Deficiencies of trace elements like zinc, copper and magnesium have been implicated in various reproductive events like infertility, pregnancy wastage, congenital anomalies, pregnancy induced hypertension, placental abruption, premature rupture of membranes, still births and low birth weight. The present review article highlights the important of role played by zinc, copper and magnesium during pregnancy and its outcome. The role of individual trace elements and in combination with other trace elements has not been completely documented. There is a need to undertake further studies in this field.
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PMID:Role of trace elements zinc, copper and magnesium during pregnancy and its outcome. 1557 21

The objective is to specify epidemiological profile of pre term labour birth and evaluate the efficiency of the tocolysis protocol of Dakar University Teaching Hospital. It's a retrospective study which included 155 cases of spontaneous premature birth registered from January 1st 2000 to December 31 2002 in obstetrician clinic. The incidence is 15 per 1000 childbirth. The epidemiological profiles on a pauciparous woman (mean age: 25 years), of low economic and social level (90%), admitted with a bad antenatal follow-up and a pathology associated with pregnancy dominated by arterial hypertension (25%). The mean age of gestation is 30 weeks; severe forms are prevalent and tocolysis score of Baumgarten is equal or higher than 4 in 71.6%. The three principal etiologists are toxaemia, premature rupture of membranes and infections. An association Salbutamol-Phloroglucinol is carried out in 28 cases (18%) or with Phloroglucinol in 25 cases (16.1%). In summary, 138 patients (89%) were finally confined by low way after 5 hours a median time. Perinatal mortality was 347.2 per 1000; it's related to the large premature ones particularly having a weight of birth less than or equal to 1300 grams (78%). The threats of pre term labour are often diagnosed tardily. The access to the tocolysis in emergency is limited and it's effectiveness practises very weak. Use of calcic inhibitors and the systematisation of corticotherapy should improve the forecast of prematurity.
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PMID:[Threatened preterm labour: assessment of its management at the Dakar University Teaching Hospital]. 1577 Aug 6

A case of pregnancy in a 27-year-old woman on peritoneal dialysis is presented. The case report is a detailed description of her course including changes in her peritoneal dialysis regimen and the use of continuous cycling to maximize dialysis adequacy while addressing the patient's recurrent abdominal pain and fullness. Also described is the management of complications including hypertension, gestational diabetes, and premature rupture of membranes. The discussion reviews the diagnosis of pregnancy, factors that may relate to outcome, and a detailed comparison of pregnancy outcomes in patients on dialysis to the general population.
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PMID:Pregnancy in peritoneal dialysis: a case report and review of adequacy and outcomes. 1613 78

With the aim of collecting evidence on repetition of low birth weight, intra-uterine growth retardation (IUGR), and prematurity in successive pregnancies, a systematic review was conducted on MEDLINE, LILACS, PAHO, and MedCarib from 1965 to 2004, using as descriptors: "low birth weight and recurrence, repetition or previous", "risk factors and repetition, recurrence or previous LBW", "IUGR and recurrence, repetition or previous", "risk factors and repetition, recurrence or previous IUGR", "prematurity and recurrence, repetition or previous", and "risk factors and repetition, recurrence or previous prematurity". Of 24 studies, 18 were excluded due to inconsistency between the title and the actual subject investigated (obstetric history as a risk factor rather than a selection criterion). The most important risk factors associated with repetition of low birth weight were maternal age > 30 years, smoking, short inter-gestational interval, and black skin color; those associated with IUGR were maternal age < 20 or > 35 years, low maternal education, high blood pressure, drug addiction, and non-technical/non-professional paternal occupation; and with preterm birth, premature rupture of membranes, chorioamnionitis, preeclampsia, preterm labor, and inter-gestational interval less than 12 months.
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PMID:[Risk factors for repetition of low birth weight, intrauterine growth retardation, and prematurity in subsequent pregnancies: a systematic review]. 1675 52


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