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

The relation of perinatal mortality to plasma-urate concentrations and blood-pressure was studied in 332 pregnant patients with hypertension. Perinatal mortality was markedly increased when maternal plasma-urate concentrations were raised, generally in association with severe pre-eclampsia of early onset. Plasma-urate was a better indicator than blood-pressure of prognosis for the fetus. Maternal hypertension, even severe, without hyperuricaemia, was associated with an excellent prognosis for the fetus. Conversely, when maternal hypertension was mild and hyperuricaemia was severe, the prognosis for the fetus was poor. These findings suggest that, in terms of fetal health, changes in renal handling of urate may be a more important feature of pre-eclampsia than the hypertension.
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PMID:Plasma-urate measurements in predicting fetal death in hypertensive pregnancy. 5 13

82 initially normotensive pregnant women with no known history of renal disease were seen at monthly intervals from 16 weeks' amenorrhoea onwards, and their blood-pressure (B.P.) was measured sitting and lying on their left side. 15 developed hypertension (B.P. greater than 135/85 mm Hg lying on the left side) in late pregnancy. When these women were compared with the 67 who remained normotensive throughout, their B.P.s were found to be significantly higher even in early pregnancy, although individual patients were not always separable in this way. When B.P. measured in this rigidly standardised manner was compared with routine antenatal clinic values, it was apparent that the latter did not detect the difference between the two groups. Women who develop hypertension in the third trimester of pregnancy (pre-eclampsia) may represent a separate group from entirely normal pregnant women from the beginning of pregnancy.
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PMID:Predicting the development of pregnancy-associated hypertension. The place of standardised blood-pressure measurement. 6 80

In 50 women with high-risk pregnancies, increased factor-VII consumption, as estimated by the difference between the levels of factor-VIII-related antigen and factor-VIII clotting activity, correlated with the severity of pre-eclampsia, particularly when measured by increases in plasma-urate. Longitudinal studies of the evolution of pre-eclampsia demonstrated that increased factor-VIII consumption usually but not always developed before hyperuricaemia. The earliest time that abnormal factor-VIII consumption was demonstrated was at 18 weeks' gestation in a woman who had had two previous stillbirths. Subcutaneous heparin and oral dipyridamole failed to reverse the coagulation abnormality, and the fetus died in utero at 28 weeks' gestation. The renal and coagulation changes characteristic of pre-eclampsia were also seen in a patient without hypertension. This suggests that the concept of pre-eclampsia may need to be widened to include a non-hypertensive syndrome characterised by these changes in clotting and renal function.
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PMID:Factor-VIII consumption in pre-eclampsia. 7 51

Alterations in the concentrations of the cholesterol and triglyceride moieties of lipoproteins separated by ultracentrifugation and precipitation methods were studied at frequent intervals throughout pregnancy and the puerperium in a group of 43 women. The plasma cholesterol concentration rose on the average by about 50 per cent, the major increase occurring in the second trimester. The plasma triglyceride concentration rose threefold, reaching its peak during the third trimester. All major lipoproteins participated in these changes: in very-low-density lipoproteins, both lipids rose in proportion to the ratio in nonpregnant women, but in low-density and high-density lipoproteins, the ratio of triglyceride to cholesterol rose. The triglyceride enrighment in low-density lipoproteins reflected the inclusion of intermediate-density lipoproteins (d 1.006 to 1.019). The occurrence of hypertension or pre-eclampsia led to a further increase in lipids in very-low-density lipoproteins. Hypercholesterolemia was greatest in women with pre-existing hypercholesterolemia, and women in the third pregnancy showed higher plasma cholesterol concentrations than women in the first pregnancy. Both cholesterol and triglyceride concentrations decreased significantly within 24 hours of delivery and this was reflected in all lipoproteins. However, while triglyceride levels continued to decrease rapidly returning to nonpregnant levels during the puerperium, cholesterol in low-density lipoprotein remained elevated for at least six to seven weeks post partum.
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PMID:The hyperlipidemia of pregnancy in normal and complicated pregnancies. 21 73

In a series of 26,209 patiens, the incidence of pre-eclampsia was 9.3%, being significantly higher in primiparae (14.1%) than multiparae (5.7%) (P less than 0.001). In patients with early-onset pre-eclampsia there were highly significant (P less than 0.001) increases in the incidences of proteinuria, severe hypertension, placental abruption, fetal growth retardation, neonatal asphyxia and perinatal mortality. There were no significant differences between the incidences of these complications in primiparae and multiparae. The incidence of subnormal oestriol excretion was increased before the emergence of early-onset pre-eclampsia with equal to significance (P less than 0.001) in primiparae and multiparae. Eclampsia was more common in patients with late-onset pre-eclampsia, but not significantly so.
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PMID:Parity and pre-eclampsia. 29 36

Disorders associated with hypertension during pregnancy, which are often linked with oedema and/or proteinuria and are variously termed toxaemia of pregnancy, EPH gestosis, pre-eclampsia, and eclampsia, are of unknown etiology, although they have been known for a long time and many attempts have been made to classify and explain them. In this paper, the author draws attention to the problems of standardizing values for blood pressure, proteinuria, and oedema and of determining their value in the diagnosis of the disorder. Different classification schemes are described and the problems of comparison between them are stressed. The frequency of the hypertensive disorders of pregnancy in different countries and groups at special risk are discussed. Finally, recommendations are made on the types of research and health care needed to combat the problem.
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PMID:Epidemiology of the hypertensive disorders of pregnancy. 31 51

Approximately 1% of pregnancies are complicated by essential hypertension. During pregnancy the blood pressure often stabilizes or improves. In patients with sustained hypertension, prospective controlled studies have demonstrated enhanced fetal survival when the blood pressure was controlled with antihypertensive medication. Such medication must be chosen carefully to avoid fetal and mateerial toxicity, and diuretics and salt restriction during pregnancy should be avoided. Among patients with essential hypertension the problem accelerates late in pregnancy in 2% to 11%; the acceleration may be predicted by determination of maternal mean arterial pressures and intravascular volumes early in pregnancy. The treatment of accelerated hypertension is identical to that of severe pre-eclampsia. Fetal loss is considerable but can be lessened by careful fetal and maternal monitoring and early controlled delivery. The risks of pregnancy in most patients with essential hypertension are small, and essential hypertension is not a uniform contraindication to pregnancy.
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PMID:Essential hypertension and pregnancy. 34 89

Simultaneous determinations of unconjugated estriol and 15alpha-hydroxyestriol (E4) levels in maternal serum were studied serially to ascertain the relative usefulness of these estrogens as indicators of fetal welfare. Complicated pregnancies included 16 patients with pre-eclampsia and/or hypertension, six patients with severe Rh-isoimmunization, 12 patients with diabetes mellitus, of which four had vascular disease, three patients with fetal death in utero, and three twin pregnancies. Retrospective analysis failed to indicate a clinically useful role for serum E4 determinations in the evaluation of fetal welfare during high-risk pregnancies.
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PMID:Unconjugated estriol and 15alpha-hydroxyestriol in complicated pregnancies. 40 91

Sixty-six patients with chronic hypertension were cared for during a total of 72 pregnancies. Patients were treated at home primarily by greater than or equal to 4 hours of bed rest daily in the left recumbent position. Only patients whose diastolic blood pressures remained greater than 110 mmHg were treated with hydralazine (Apresoline, Ciba). With this plan of treatment there were only 3 perinatal deaths for an uncorrected perinatal mortality of 4.1% (1.4% corrected). Twenty-nine percent of the patients had babies that were small for gestational age, 13.8% had positive oxytocin challenge tests, and 36.8% developed superimposed preeclampsia. When compared with the outcome of previous pregnancies, the program of bed rest lowered perinatal mortality from 16.8 to 8.8%. Thus, it is suggested that bed rest together with the avoidance of diuretics and the judicious use of hydralazine results in the most favorable fetal outcome.
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PMID:Evaluation of a program of bed rest in the treatment of chronic hypertension in pregnancy. 42 5

The frequency of the severe forms of gestosis (preeclampsia) may be reduced by early recognition of this disease. By predicting hypertensive disorders of pregnancy, maternal and infantile perinatal mortality rates are expected to be lowered. The supine pressor test ("roll-over test") is recommended as an appropriate and simple method for routine screening during primigravid pregnancy. This test is rarely false-negative (2--9%; Bonn 3%), but a high percentage of false-positive results has been found in patients studied in Bonn. The angiotensin sensitivity test shows less false-positive pressor responses, but it is not practical for routine use either as infusion test nor as bolus test. The rate of false-negative results is sufficiently low in both methods. The routine determination of uric acid concentration in serum seems to be of no great value for predicting pregnancy-induced hypertension, compared with the roll-over test or with the angiotensin sensitivity test; however, it gives an additional information (a) in pregnancy women with questionable gestosis, and (b) in the differential diagnosis of pregnancy-induced versus pre-existing essential hypertension.
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PMID:[Methods for the early recognition of gestosis]. 43 53


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