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

Hypertensive disease in pregnancy remains a major cause of maternal and perinatal morbidity and mortality. Control of maternal hypertension with antihypertensive therapy improves maternal and foetal outcome. If the blood pressure is elevated in early pregnancy, complications are more likely to occur to both mother and foetus, and the outcome may not be favourable. In labour the threat of severe pre-eclampsia or eclampsia is a constant hazard.
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PMID:The treatment of hypertension in pregnancy. 73 51

Estetrol (15alpha-hydroxyestriol or E4) is considered to be a specific product of fetal liver and has been suggested as a good indicator of fetal well-being. The concentration of unconjugated estetrol (E4) was measured by rapid and specific radioimmunoassay in 1 ml of maternal plasma. E4 levels prior to the 18th week of pregnancy were often undetectable (smaller than 50 pg/ml). The mean plasma E4 level at term of 1.2 ng/ml was 7-fold higher than that observed at 24 weeks of gestation, and no diurnal variations were found. E4 levels in fetal plasma at term were 12-fold higher than those in maternal plasma and no fetal arterial venous differences were found. Umbilical vein but not maternal plasma levels of patients undergoing vaginal delivery were higher than those undergoing cesarean section (P smaller than 0.05) suggesting increased adrenal output of E4 precursors during labor. In patients with severe Rh-isoimmune disease plasma E4 levels were not helpful in assessing fetal well-being. However, in patients with chronic hypertension or pre-eclampsia, subnormal plasma E4 concentrations always preceded intrauterine fetal death. Plasma E4 appears to be a good indicator of fetal well-being in patients with hypertensive disease of pregnancy.
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PMID:Plasma estetrol as an index of fetal well-being. 80 56

With improving standards of antenatal care, severe pre-eclampsia dn eclampsia are becoming less common and experience in the management of these conditions is lessening. Co-ordinated plans for the care of patients should be established by obstetricians and anaesthetists working as a team. A suitable regime for drug therapy in severe pre-eclampsia or eclampsia is the following: Initial management Diazepam 10 mg slowly i.v. Pethidine 100-150 mg i.m. or i.v. in incremental dosage, or extradural blocks, if analgesia is also required. Hydrallazine 20 mg i.v. initially, followed by 5 mg at intervals of 20 min until the diastolic pressure is less than 110 mm Hg. Then, preferably by syringe pump in a concentration of 2 mg/ml, at a rate of 2-20 mg/h. If vomiting occurs this can be controlled by administration of atropine. Subsequent management Sedation and anticonvulsant therapy. Continue diazepam and, in severe cases, institute chlormethiazole infusion. Continue analgesia with pethidine or extradural block. Control of hypertension by adjusting the dose of hydrallazine. If tachycardia exceeds 120 beat/min give propanolol 2-4 mg i.v. Plasma protein depletion with groww oedema is treated by administration of salt-free albumin or plasma protein fraction. Diuretic therapy is indicated if there is gross oedema or signs suggestive of acute renal failure. Oliguria associated with increased blood urea may be a result of renal failure or dehydration. The latter should be evident from the patient's condition and central venous pressure, but i.v. fluids and frusemide 20-40 mg can be used as a therapeutic test. Mannitol reduces cerebral oedema and may be given if diuresis has been first produced with frusemide. Potassium chloride is given if the plasma potassium decreases to less than 3 mmol/litre. Heparin therapy is considered if there is clinical evidence of disseminated intravascular coagulation.
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PMID:The management of severe pre-eclampsia and eclampsia. 83 44

Hypertension is a major risk factor for cardiovascular-related morbidity and death. Antihypertensive therapy markedly reduces the risk caused by elevated blood pressure. Earlier treatment of hypertensive patients should reduce deaths and morbidity even further. The obstetrician-gynecologist has the opportunity and responsibility to identify hypertensive patients early in the course of their disease. He must also confront the problem of elevated blood pressure associated with the use of oral contraceptives. In addition to its impact on the general population, chronic hypertension presents special problems during pregnancy. Pregnant women with elevated blood pressure have an increased fetal mortality rate and develop pre-eclampsia more frequently and earlier than nonhypertensive women. Antihypertensive treatment possibly increases fetal survival; when used appropriately, it definitely does not decrease fetal salvage. The appropriate use of antihypertensive therapy during pregnancy requires an understanding of the mechanism of action of these agents and recognition of side effects, especially those important during pregnancy.
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PMID:Hypertension and the obstetrician-gynecologist. 83 27

Progesterone (2.5 mg per kilogram) caused sustained hypertension in rabbits. When the same dose of progesterone was administered together with prolactin (1.25 mg. per kilogram), there was no increase in the blood pressure. In rabbits with progesterone-induced hypertension, the addition of prolactin caused a sharp drop in blood pressure. It is suggested that prolactin acts by reducing the sensitivity of the blood vessels to circulating pressor substances and further that a reduced prolactin response may be the cause of heightened sensitivity to pressor substances observed in pre-eclampsia.
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PMID:Prolactin and hypertension. 84 88

One hundred randomly selected nulliparous, normotensive women were subjected to the roll-over test between 28 and 32 weeks' gestation. Twenty-five women had a positive test. Thirteen of those 25 women developed pre-eclampsia requiring magnesium sulfate therapy. Eight had transient hypertension during labor requiring no therapy. Four had no evidence of hypertension during pregnancy. A false-positive rate for the 25 women with a positive roll-over test was 16 per cent. Seventy-five women had a negative roll-over test. Sixty-eight of those women had no evidence of hypertension of pregnancy. Seven had evidence of transient hypertension during labor requiring no therapy. A false-negative test was present in 10 per cent of the 75 patients with a negative roll-over test. In no case did a patient with a negative test develop pre-eclampsia. The roll-over test is recommended as a routine test for every pregnant patient between 28 and 32 weeks' gestation for the early diagnosis of hypertension of pregnancy.
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PMID:Roll-over test. 84 90

The computerized records of all women delivered between July, 1974, and June, 1975, at the Mater Mothers' Hospital were analysed, and the obstetric complications associated with grand multiparity were examined. Hypertension, preeclampsia, unstable lie, malpresentation and retained placenta are found to be more common in women of high parity. The low morbidity associated with these conditions in the data may have been related to the close supervision and active management carried out. Anaemia remained more frequent in the grand multiparous women despite modern antenatal care. Hypertension in the grand multiparous women could not be explained by age in the data presented. The cause for hypertension in this group of women remains obscure. Newborn babies of grand multiparas developed neonatal jaundice more frequently. The association between jaundice and oxytocic usage in the data only partially accounted for this observation.
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PMID:The obstetric performance of the grand multipara. 85 74

The usefulness of plasma estriol concentrations in the management of high-risk pregnancy is controversial. In this study, serial plasma unconjugated estriol (E3) concentrations determined by radioimmunoassay were evaluated in 321 patients with high-risk pregnancy for correlation with fetal and neonatal performance. A plasma E3 concentration of 4 ng. per milliliter or less in late pregnancy correlated significantly with low one-and five-minute Apgar scores and selected neonatal problems in pregnancies complicated by chronic hypertension and intrauterine growth retardation, with a similar trend for pregnancies complicated by moderate and severe pre-eclampsia. Most perinatal deaths in the study were associated with acute problems which began during labor and delivery, or fetal death occurred before early intervention was practical. Therefore, the perinatal mortality rate is not likely to be influenced by the use of E3 values, and the perinatal mortality rate is not a realistic measure of the usefulness of plasma E3 values in management of high-risk pregnancy. Low plasma E3 values were not always ominous, and for this reason it is suggested that clinical indications and the results of other tests for fetal-placental function be considered along with plasma E3 values in the selection of patients for early delivery to reduce the possibility of inappropriate intervention.
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PMID:Plasma unconjugated estriol values in high-risk pregnancy. 86 34

Creatine kinase (EC 2.7.3.2) isoenzymes in extracts of human placenta and in serum from nonpregnant women and women in labor were separated on columns containing diethylaminoethyl-cellulose and assayed. The distribution of the isoenzymes in placenta (n = 10) was 80% BB (200 +/- 66 U/g (wet weight), 19% MM (49 +/- 30 U/g), and 1% MB (2.6 +/- 1.7 U/g); The geometric mean for the serum BB activity of the nonpregnant women (n = 50) was 0.6 +/- 1.5 U/liter, as compared to 3.0 +/- 1.4 U/liter for patients in labor who had normal deliveries (n = 92). The arithmetic mean for serum BB activity of labor patients with induced labor (n = 20), premature labor (n = 7), cesarian section (n = 6), or hypertension and pre-eclampsia (n = 6) did not differ significantly from the arithmetic mean BB activity for serum of labor patients with normal deliveries. However, the arithmetic mean serum BB activity of patients with stillbirths (n = 7) was significantly smaller than the arithmetic mean for normal labor patients.
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PMID:Creatine kinase isoenzyme activity in human placenta and in serum of women in labor. 87 82

The morphology of the placental bed spiral arteries was studied in 68 pregnancies complicated by fetal growth retardation and in 40 pregnancies with a normally grown fetus. When the birth weight was normal the extent and depth of physiological vascular changes were normal except in those pregnancies complicated by pre-eclampsia. When the birth weight was low and the mothers were normotensive the extent and depth of physiological vascular changes were either normal or restricted, and in all patients with hypertension and a baby with low birth weight the physiological changes were restricted to the decidual segments of the spiral (uteroplacental) arteries. Acute atherosis was only found in pregnancies complicated by hypertension, particularly if there was proteinuria. We do not believe that there exists an arteriopathy which is common to hypertensive and normotensive pregnancies complicated by fetal growth retardation.
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PMID:Fetal growth retardation and the arteries of the placental bed. 91 17


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