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

Case records of 206 pregnant patients who had not had a viable pregnancy for 10 years or more, are presented. In the antenatal period, 59.7% of patients went through their pregnancy with no complications. The commonest complications were pre-eclampsia and non-proteinuric hypertension. Labour was essentially normal in the majority of cases, and of the 183 patients who were allowed to labour, 171 (93.4%) were delivered vaginally. Caesarean section was performed in 17% of cases, which is 3 times the over-all Caesarean section rate for the hospital during the same period. The indications for Caesarean section are appreciably less restricted in these patients. There was a two-fold increase in the incidence of breech presentation. This may be partly explained by the higher incidence of premature births found in this group of patients. The over-all risk to the infant is increased, mainly because of prematurity, but also owing to a slight increase in the number of congenital abnormalities.
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PMID:Viable pregnancy after prolonged periods of secondary infertility. 125 Dec 75

The human placenta contains a significant amount of histamine, a potent vasoconstrictor of the placental vasculature, shown by the author to be stored within the tissues' mast cells. The proposed hypothesis suggests that placental mast cells may have an important role in normal and, or pathological processes during pregnancy. This suggestion will be applied to the confounding problem of pre-eclampsia, a complication of pregnancy characterised by hypertension, oedema and proteinuria, which is associated with increased morbidity and mortality of mother and baby. It is postulated that pre-eclampsia reflects an inflammatory-type reaction, in which mast cell-mediated events play a significant role. The mediators released upon mast cell activation, such as histamine and prostaglandins, may be involved in the vasospasm that characterises pre-eclampsia; while processes such as uptake and clearance of vasoactive mediators by mast cells may be important in normotensive pregnancies and upset in those women who develop pre-eclampsia.
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PMID:Human placental mast cells: a role in pre-eclampsia? 128

To evaluate recent management of pregnancy in women with sickle cell hemoglobinopathy, pregnancy outcomes of 29 women with homozygous (HbSS) disease, 52 with double heterozygous (HbSC) disease, and 51 normal (HbAA) women were assembled. The case series was 132 singleton births to 132 Ghanaian women, 81 of whom were from the Korle-bu Teaching Hospital, Accra, from June 1988 to October 1991. Controls had no history of hypertension, diabetes, rhesus isoimmunization, or pre-eclampsia, and their infants with significantly lower birth weight (mean 2.59 kg), at lower gestational age (35.2 weeks) than controls. Doubly heterozygous sickle cell mothers had infants with a shorter gestational age (36.4 weeks) than controls (37.25 weeks), yet averaging the same birthweight as controls (3.10 kg). The placental weights were not significantly different between the 3 groups. The results were interpreted to suggest that children of HbSC mothers were large for gestational age (LGA). Continuous sickling of the mother's red blood cells is thought to be the cause of poor outcomes in homozygous sickle cell pregnancy.
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PMID:Comparative studies of live neonates in maternal sickle cell haemoglobinopathy in Ghana. 129 39

A retrospective study of 1989 records of 10,594 pregnant women registered at 47 primary health care (PHC) centers in Al-Hassa, Saudi Arabia, aimed to evaluate the performance of their prenatal care services and to gather baseline data to conduct future evaluations. These women represented 58% of pregnant women in Al-Hassa in 1989. The other pregnant women may have received prenatal care at medical facilities of the Arabian American Oil Company (ARAMCO), the National Guard, or the private sector. 53.1% of the registered women had made more than 5 prenatal care visits. 66.7% and 40.3% of all registered women received the first and second dose of tetanus toxoid, respectively. PHC center staff identified 46.2% of women as having high-risk pregnancies, but they only referred 17.5% of these women to King Fahad Hofuf Hospital for obstetric consultation. However, at least 6 major PHC centers had an obstetrician on staff. Causes in reproductive history were responsible for classifying 67.4% of the high-risk pregnancies. These causes included grandmultiparity (65%), abortion (12%; 8.3% - 2 abortions), previous Cesarean section (5.8%), RH negative (4.8%), young primipara (4.5%), and other causes, including history of preeclampsia, neonatal death, congenital anomalies, and low birth weight. Associated medical conditions made up the next highest class of high-risk pregnancies (25.4%). These conditions were sickle cell anemia (69.7%), diabetes (17.1%), hypertension (10.4%), and other causes (e.g., chronic bronchitis). Causes in current pregnancy comprised 7.2% of high-risk pregnancies and included non-sickle cell anemia (34.6%), bleeding (12%), malpresentation (17%), twins (14%), urinary tract infection (7%), and other causes (e.g., ectopic pregnancy). 67.7% of women with high-risk pregnancies delivered at King Fahad Hofuf Hospital, 28.8% at PHC centers, 7.1% at medical services of ARAMCO, and 2.4% outside of Al-Hassa area. 94% and 0.8% of high-risk pregnancy cases had unassisted and assisted vaginal births, respectively. The remaining cases delivered by Cesarean section.
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PMID:Prenatal care in primary health care centers of Al Hassa, Saudi Arabia. 129 49

The placental transfer of phenobarbital was investigated in 35 mother-infant pairs at birth. The drug was administered prenatally to the mothers for maternal epilepsy (group 1, n = 5), gestational hypertension and preeclampsia (group 2, n = 20) and prophylaxis of intraventricular hemorrhage in premature deliveries (group 3, n = 10). The phenobarbital levels in arterial cord blood were 100 +/- 2.8% in group 1, 89 +/- 21% in group 2 and 77 +/- 16% in group 3 with respect to the levels observed in the mothers. The most important factor influencing the transplacental passage was the duration of maternal treatment in the infant of group 1 (r = 0.80, p < 0.01), the gestational age in the infants of group 2 (r = 0.74, p < 0.01) and the arterial cord pH in the infants of group 3 (r = 0.89, p < 0.001).
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PMID:Placental transfer of phenobarbital: what is new? 130 42

HELLP syndrome continues to be a clinical entity of difficult diagnosis. Weinstein first defined it in 1982 giving the practicing obstetrician a sequence of useful initials (H = hemolysis; EL = elevated liver enzymes; LP = low platelets). Since then a lot has been written and it has become clear that the syndrome is a form of severe preeclampsia. The American College of Obstetrics and Gynecology does not include HELLP in the description of severe pre-eclampsia as such but does accept each of its components as being part of severe pre-eclampsia. The case presented deals with a 33 year old white female, admitted at 27 weeks gestation with nausea, epigastric pain resembling acute abdomen, nose bleeding and mild hypertension. The analysis revealed an abnormal liver profile with elevated GOT, GPT and LDH, heavy proteinuria (14.4 g/day), decreased platelet count (92000/mm3) and elevated total bilirubin. Pregnancy was terminated by cesarean section 24 hours after admission because the patient's condition was deteriorating. Obviously in pre-eclampsia/eclampsia there is a systematic injury to all tissues. Proof of this is the hypertension as a consequence of vascular spasm and proteinuria due to glomerular injury. In HELLP the sequence of events is probably altered; hepatic injury precedes vascular and renal injury of conventional preeclampsia. The syndrome results from many clinical and pathological symptoms derived from endothelial microvascular injury which determine a rapid platelet activation causing vascular spasm, platelet aggregation and further endothelial injury through a feedback mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Massive proteinuria and HELLP syndrome]. 130 8

1. Pregnancy-induced hypertension (or pre-eclampsia) is characterized by vasoconstriction, platelet aggregation and altered capillary permeability, implying disordered endothelial function and/or structure. Serum from women with pregnancy-induced hypertension has been reported by others to be cytotoxic to endothelial cells in vitro. We hypothesized that such serum contains a factor that limits the ability of endothelial cells to produce and/or release prostacyclin. 2. Prostacyclin production by intact and damaged cultured human umbilical vein endothelial cells was measured after incubating these cells with serum from non-pregnant and normal pregnant women and women with pregnancy-induced hypertension. Confluent human umbilical vein endothelial cell monolayers (intact and damaged) were incubated with sera for 24 h at 37 degrees C followed by 1 h of incubation with added thrombin (stimulated production) or media (basal production). Supernatants were then collected for measurement of 6-keto-prostaglandin F1 alpha by radioimmunoassay. 3. Basal production of 6-keto-prostaglandin F1 alpha was greater in response to serum from non-pregnant women than to that from pregnant women. Within each group, sub-lethally damaged cells had a similar basal production of 6-keto-prostaglandin F1 alpha to that of intact cells. 4. Basal production of 6-keto-prostaglandin F1 alpha by intact or damaged cells incubated with sera from normal pregnant women and from women with pregnancy-induced hypertension was similar. 5. In all groups the addition of thrombin to intact endothelial cells increased 6-keto-prostaglandin F1 alpha production approximately 15-30-fold over basal levels, but only three- to five-fold in damaged endothelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Endothelium-derived prostacyclin: effect of serum from women with normal and hypertensive pregnancy. 131 48

Urinary kallikrein and kallikrein activity significantly decreased in cases of preeclampsia (u-kall./CRE.index 42.39 +/- 9.66 ng/mg, u-kall. act./CRE.index 0.26 +/- 0.06 ng/min/mg), and urinary kininase II and kininase activity significantly increased (u-kininase/CRE.index 10.91 +/- 1.26 x 10(-3) IU/min/mg, u-kininase act./CRE.index 506.37 +/- 178.45 pg/min/mg) when compared with those of normal gravidas from 28 weeks to 42 weeks of gestation (u-kall./CRE.index 189.31 +/- 14.17 ng/mg, u-kall. act./CRE index 1.08 +/- 0.10 ng/min/mg, u-kininase/CRE.index 6.24 +/- 0.31 x 10(-3) IU/min/mg, u-kininase act./CRE.index 15.64 +/- 0.10 pg/min/mg). Urinary FPA, B beta 5-42, alpha 2-PI, and alpha 2PI-plasmin-complex (PIC) significantly increased in preeclampsia (u-FPA/CRE.index 23.59 +/- 8.47 ng/mg, u-B beta/CRE.index 105.26 +/- 29.30 ng/mg, u-alpha 2PI/CRE.index 121.53 +/- 43.57 ng/mg, u-PIC/CRE index 278.39 +/- 60.50 ng/mg) when compared with those of normal control group (u-FPA/CRE.index 0.92 +/- 0.04 ng/mg, u-B beta/CRE.index 12.15 +/- 0.44 ng/mg, u-alpha 2PI/CRE.index 4.18 +/- 0.33 ng/mg, u-PIC/CRE.index 5.98 +/- 1.15 ng/mg). Urinary urokinase markedly increased and urinary D-dimer was detected in severe cases of preeclampsia (u-UK/CRE.index 58.20 +/- 43.69 ng/mg, u-D-dimer 54.76 +/- 9.89 ng/ml) when compared with those of normal control group. These findings suggest that deficiency in urinary kinin excretion may induce hypertension in addition to the changes of urinary coagulation-fibrinolysis system that represents the occurrence of either the endothelial cell injury in the glomerulus or the renal tulbular damage in mild cases of preeclampsia, eventually resulting in the intra-renal vascular coagulation.
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PMID:Urinary coagulation-fibrinolysis, kallirein-kinin systems and kininase in cases of preclampsia. 133 34

Preeclampsia, a hypertensive disorder of pregnancy, is a major cause of fetal and maternal morbidity and mortality. Epidemiologic studies have shown an inverse relationship between dietary calcium intake and gestational hypertension. A recent large-scale, randomized, double-blind, placebo-controlled clinical trial has shown that supplementation of pregnant women with 2 g calcium per day from the twentieth week of gestation to term can significantly lower the incidence of hypertensive disorders of pregnancy. The beneficial effect of calcium supplementation was apparent as early as the twenty-eighth week of gestation. The mechanism responsible for the effects of calcium on gestational hypertension is unknown.
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PMID:Calcium supplementation prevents hypertensive disorders of pregnancy. 134 35

The effect of increased red blood cell aggregation on uteroplacental blood flow was studied in 11 awake, late-pregnant guinea pigs. The aggregation of the red cells was increased by administering high molecular weight dextran (HMWD) to the previously hemoconcentrated animal. The purpose of the hemoconcentration before HMWD was 1) to use a preeclampsia model in which the hemorheology may be impaired because of the combined effect of polycythemia, an increased red cell aggregation, and an increased plasma viscosity and 2) to potentiate the aggregation-increasing effect of HMWD. Relative to the pre-HMWD condition, arterial blood pressure and systemic vascular resistance increased by 10 and 26%, respectively. The cardiac output fraction shunted across the systemic circulation and the arterial hematocrit decreased by 30 and 4%, respectively. Neither cardiac output nor the weighted organ flows, including those to the placentas, changed in response to the rise in red cell aggregation. We conclude that an imposed increase in red cell aggregation has no appreciable effect on uteroplacental blood flow in the awake and healthy late-pregnant guinea pig. These data do not exclude the possibility that increased red blood cell aggregation potentiates the negative effects on uteroplacental blood flow, e.g. in pregnancy-induced hypertension or preeclampsia, where the placenta is not only marginally perfused but also frequently damaged histologically.
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PMID:Increased red cell aggregation does not reduce uteroplacental blood flow in the awake, hemoconcentrated, late-pregnant guinea pig. 137 30


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