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

To assess maternal mortality in New York City, birth certificates and mortality records for New York City from 1988 through 1994 were linked and examined. During these 7 years, maternal mortality in New York City (defined by the International Classification of Diseases, 9th edition [ICD-9], as 630-676) per 100,000 live births significantly exceeded that of the country as a whole (20.2 vs. 8.2, respectively). Within New York City, an even greater variation of maternal mortality by race/ethnicity was noted, with the mortality ratio of whites, blacks, and Hispanics being 7.1, 39.5, and 14.4 per 100,000 live births, respectively. Socioeconomic characteristics such as educational attainment, marital status, and income influenced maternal mortality more in non-blacks than blacks. Analyses of cause-specific mortality revealed that, overall, ectopic pregnancy, embolism, and hypertension were the leading causes of death. However, the major factors explaining the excess maternal mortality among blacks were hypertension (mortality ratio of blacks to whites 5.57, 95% confidence interval 2.30-13.39), ectopic pregnancy (4.78, 95% confidence interval 2.40-9.51), and abortion (4.58, 95% confidence interval 1.72-12.22). These findings confirm a persisting gap in maternal death between black and white women. Indeed, if all New Yorkers who became pregnant enjoyed the survival of the city's non-Hispanic white residents, the difference in maternal mortality between the city and the nation would be eliminated.
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PMID:Maternal mortality in New York City: excess mortality of black women. 1119 13

Ubiquitin is a small protein involved in many intracellular processes. We have previously shown that levels of ubiquitin change during the process of decidualisation in the human uterus at the beginning of pregnancy. Other workers have shown that the ubiquitin system may be essential for normal murine placental development. In this investigation we employed immunohistochemistry and immunoblotting techniques to study the distribution and abundance of ubiquitin and ubiquitin-protein conjugates within human placental specimens from throughout gestation. Trophoblast from two pathological conditions, ectopic pregnancy and pregnancy-induced hypertension (PIH), was also investigated. Ubiquitin was detected within both the cytoplasm and nucleus of the cytotrophoblast layer only. Both monomeric and conjugated forms of ubiquitin were detected. The relative abundance of ubiquitin did not change through gestation or in the two disorders of pregnancy studied. Ubiquitin cross-reactive protein was not detected in the tissues of interest. This is the first report to demonstrate the cell-specific localisation of ubiquitin and ubiquitin-protein conjugates in the human cytotrophoblast and provides supportive evidence that ubiquitin may be important during placental development.
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PMID:Ubiquitin and ubiquitin-protein conjugates are present in human cytotrophoblast throughout gestation. 1174 19

It is sometimes difficult to plan contraception with a woman who has just delivered a baby, because she is sometime not motivated in the week following delivery, feeling unable to contemplate intercourse because of perineal pain and other discomforts. Effective contraception should be used beginning with the 25th postpartum day because of the subsequent strong possibility of ovulation before the return of menstruation. The woman should be provided with as much information on contraception as possible during this period, and possible contraindications to specific methods should be sought, such as thromboembolic accidents, hyperlipidemia, hypertension, diabetes, infection, ectopic pregnancy, abortion, and desire for subsequent pregnancy. No request for contraception should be ignored and the same method should not be imposed on all women. The topic of contraception should not be deferred until the postpartum check-up in the 2nd month, because 50% of women will have had intercourse by the end of the 2nd month, often unprotected. Local methods such as spermicides and condoms are effective when the couple is motivated and they are well accepted. The thromboembolic risk appears minimal when oral contraceptives (OCs) are begun on the 15th postpartum day for non-breastfeeding women. OCs should not be prescribed for women after prolonged bedrest, and women who previously used pills should have lipid and glucose tests before the 2nd month postpartum consultation. The low dose progestin pill should be preferred to the low dose combined pill if a potential thromboembolic risk exists. Infants of breastfeeding women using pills receive 1/500 of the estrogen dose administered to the mother and 1/1000 of the progestin dose. No effects of these doses have been found on the growth or genital development of infants, and modifications of milk composition are not constant. A low dose progestin pill beginning on postpartum day 20 may however be preferred. It is better to await the return of menses before inserting an IUD because of the danger of expulsion prior to that time. Local methods should not be the only ones recommended in the immediate postpartum period because of the possibility of poor acceptance and unwanted pregnancy resulting from incorrect use. Very high dose OCs should not be prescribed. Long acting injectable progestins should be avoided for breastfeeding women except in cases of serious psychic disturbance because the quantity of hormones entering the milk is much greater than with pills.
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PMID:[Do's and don'ts in post-partum contraception]. 1226 12

Prenatal care aims to preserve the health of the fetus and mother. It screens for indications of illness or pregnancy-related complications and tries to prevent them from becoming emergencies. Sufficient referral services are needed for prenatal screening to be effective. Women and their families must be motivated to go to them promptly. Often prenatal care is the first time women receive any medical care. Thus, quality care is imperative so women will again request medical care when necessary. Prenatal care providers must ask women about signs and symptoms of placenta previa and placental abruptio. They should also tell them about the gravity of hemorrhaging in late pregnancy. Referral facilities must have operative capabilities and be able to provide adequate transfusion to treat severe hemorrhage. Health workers must prevent and treat anemia in pregnant women to improve their chances of recovery from blood loss; they must also measure blood pressure and periodically test for proteinuria and edema to diagnose preeclampsia, eclampsia, and hypertension. Health workers must screen women at high risk for cephalopelvic disproportion (e.g. by assessing, height, foot size, and age) and for a malpositioned fetus and multiple pregnancies (e.g. via abdominal examination). They must also educate mothers about the importance of hygienic delivery and provide sanitary delivery kits. Unhygienic delivery conditions and untreated sexually transmitted diseases (STDs) can cause puerperal sepsis. STDs can also have other adverse effects such as ectopic pregnancy and blindness, death, or retardation of the fetus/ infant. STD screening could prevent needless suffering in many women; 5-15% of pregnant women in some developing countries have syphilis. Prenatal care should include screening for urinary tract infections which can cause preterm delivery and low birth weight. Antibiotics can treat these infections. Some pregnant women have infectious diseases which may undetected without prenatal care.
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PMID:How prenatal care can improve maternal health. 1228 37

During 1988-1992, physicians used two study protocols to follow 612 women who had accepted the subdermal contraceptive implant Norplant at the Rabta Maternity Hospital of Tunisia. They used WHO criteria to select 375 women aged 18-40 (i.e., healthy women with no contraindications). The remaining 237 women and their infants underwent regular clinical and paraclinical examinations. 58 of these women had heart disease. 13 had diabetes mellitus. 11 women had hypertension. 22 women were breast feeding. The women's mean age was 30. They weighed on average 61 kg. Mean family size was three. 35% and 21% of the women used oral contraceptives or IUDs, respectively, before accepting Norplant. 57% experienced menstrual disturbances after accepting Norplant. 162 women (26.5%) asked for Norplant to be removed. Menstrual disturbances were the reason for removal among 37% of them. This rate was the same for both groups. 1.79% of the women conceived during Norplant use. None of these women had an ectopic pregnancy, however. None of the infants being breast fed had any problems with growth. Norplant appeared to have no adverse effects on lactation. Side effects occurred at the same rate in the healthy women as the women at risk. These findings show that women at risk tolerated Norplant well.
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PMID:[Norplant contraception at the Rabta Tunis maternity hospital]. 1229 Jan 76

To identify the most significant determinants of maternal mortality in Kenya, a prospective study involving 49,335 deliveries occurring at Kenyatta National Hospital from January 1978-87 was conducted. There were 156 maternal deaths in this series, for a maternal mortality rate of 3.2/1000 deliveries. The 5 most frequent causes of death were abortion (24%), hypertensive disease of pregnancy (13%), sepsis (13%), anemia (10%), and cardiac disease (7%). 24% of women who died were age 19 years or under, 27% were 20-24 years, 23% were 25-29 years, and 11% were 30-34 years. The largest percentage (24%) of deaths involved nulliparous women; 16% were to women of parity 5 and above. 28% of the women who died were single, and single women contributed the majority of deaths from abortion. 66% of the women who died had received no prenatal care. The proportion of avoidable deaths was 19% among clinic attenders compared to 29% among non-attenders. Overall, age, parity, and marital status--traditionally regarded as the key factors associated with maternal mortality--vary in their impact, given the cause of death and medical services received. The assumption that high parity is associated with maternal mortality was not confirmed in this study due to the significant number of deaths from abortion that involved single, nulliparous women. In addition, many women who died were in the optimum age group for childbearing, but were more prone to suffer from anemia, hypertension, ectopic pregnancy, and cardiac disease than women over 30 years old. Overall, 126 deaths were considered avoidable. Contributory factors were slowness of surgical management of emergencies, prolonged confinement of women with cardiac disease, and a lack of emergency supplies of blood and drugs for complicated deliveries.
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PMID:Medico-social and socio-demographic factors associated with maternal mortality at Kenyatta National Hospital, Nairobi, Kenya. 1231 13

The 1993 Gallup Survey (in a follow-up to its 1985 survey) shows a reduction in the number of women who believed oral contraceptives (OCs) were associated with substantial risks (76-54%, 1985-1993). Highly educated women were just as likely to associate OCs with substantial risks as less educated women. Current OC users were less likely to associate OCs with substantial risks than were users of other methods (34% vs. 56%). The main perceived substantial risk was cancer. Women still believed that OC use was as risky as childbirth (65% and 64%). Just 6% knew that OCs protect against some cancers. 42% thought that OCs provide no noncontraceptive health benefits. More women in 1993 than in 1985 incorrectly believed that the OCs' failure rate was at least 10% (41% vs. 31%). The actual failure rate is between 3% and 8.3%. In the 1991 Yale Health Services Study, 49% of women associated OCs with substantial risks. Yet, 84% believed that OCs did provide substantial benefits. 75-80% of women did not know the major noncontraceptive health benefits of OCs. The leading perceived risk of OC use was cancer. The mass media focusing on side effects of OCs and former high-dose OC users and some health professionals may have handed down their misperceptions to today's potential users. The US Food and Drug Administration still requires labels to have data not relevant to the low-dose OCs. Study results are unclear about OCs' effect on the risk of breast cancer. OCs do decrease the risk of ovarian and endometrial cancers. OCs protect against pelvic inflammatory disease, ectopic pregnancy, iron deficiency anemia, and benign breast disease. The current low-dose OCs appear to have little to no adverse effect on the risk of developing hypertension, clotting problems, myocardial infarction, and stroke. OC users should not smoke because smoking does increase the risk of developing these vascular diseases. The findings of these 2 studies reflect the need for clinicians to assure patients that low-dose OCs are effective and safe.
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PMID:Dispelling OC myths and misperceptions. 1234 74

Multiple pregnancies (MP) outcomes are often complicated. They deliver premature infants and provoke high blood pressure. A retrospective study was carried out in 1998 at the Maternity Hospital of Befelatanana, Antananarivo in order to assess MP frequency and to specify the most important favourising factors and difficulties during labor and the quality of the labor management. All pregnancies with a MP were included in this survey. 143 MP were registered: 142 twin pregnancies and 1 triplet pregnancy. 2.0 per cent of cases were recurrent MP. The average age of pregnancies was 26 years old. Among these 143 MP, 48.0 per cent were primiparas. Poor quality of prenatal visits is frequently encountered. As antecedents there are abortion, hormonal contraceptive taking, preterm delivery, gravidic toxemia, cicatricial uterus, ectopic pregnancy. 6.3 per cent of the first twin had breech presentation, 2.0 per cent transversal labor presentation. As events during labor 40.0 per cent dynamic dystocia, 26.0 per cent acute fetal suffering, 27.0 per cent hyperthermia, 23.0 per cent high blood pressure, some of them as eclampsia or pre-eclampsia were noted. 60.0 per cent of the first twin delivery were easy. Whatever his labor presentation, version by internal manipulations following by breech extraction was performed on the second twin (67.0 per cent of cases). 18.2 per cent of parturient women had cesaretomy. 11 maternal deaths were noted. Infant perinatal mortality rate was of 35.7 per cent. Infant morbidity and mortality are essentially due to infections. The authors conclude that complications prevention will be obtained by improvement of standard of living of all female able to procreate. It needs also correct cares at prenatal visits and during labor. Health education must be focalized on strict and correct surveillance of pregnancies and intergenesic periods by the reinforcement of planning family.
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PMID:[Management of multiple pregnancies at the Befelatanana Antananarivo University Hospital Center (Madagascar): report of 143 cases]. 1247 72

Levonorgestrel-releasing implants are long acting contraceptives, approved for 5 years of continuous use. Two marketed systems, the six capsule Norplant use of tradenames is for product identification purposes only and does not imply endorsement. and the two rod Jadelle, have essentially equal rates of drug release, pregnancy and adverse events over 5 years of use. Randomised clinical trials and controlled cohort observations indicate that for the first 3 years, when pregnancy rates are at or almost zero, no other contraceptive system is more effective, although etonogestrel implants provide equal effectiveness. Annual pregnancy rates rise in the fifth year of continuous use but remain below 1 per 100 women. Annual pregnancy rates of Norplant users remain below 1 per 100 throughout 7 years of continuous use. Levonorgestrel implants provide low progestogen doses; 40-50 microg/day at 1 year of use, decreasing to 25-30 microg/day in the fifth year. Serum levels of levonorgestrel at 5 years are 60-65% of those levels measured at 1 month of use. Adverse effects with levonorgestrel implants are similar to those observed with progestogen only and combined oral contraceptives. Risks of ectopic pregnancy, other pregnancy complications and pelvic inflammatory disease are reduced in comparison with those of women using copper or non-medicated intrauterine devices. Risks of developing gallbladder disease and hypertension or borderline hypertension, although small, are about 1.5 and 1.8 times greater, respectively, in women using levonorgestrel implants than in women not using hormonal contraception. Other serious diseases have not been found to occur significantly more frequently in levonorgestrel implant users than in women not using hormonal contraception. The great majority of levonorgestrel implant users experience menstrual problems, but serious bleeding problems are not more frequent than in controls. Other health problems reported more frequently by levonogestrel implant users than by women not using hormonal contraception in a study of 16000 women included skin conditions, headache, upper limb neuropathies, dizziness, nervousness, malaise, minor visual disturbances, respiratory conditions, arthropathies, weight change, anxiety and non-clinical depression. Clinical depression is not more frequent in women using implants compared with those not using hormonal contraception (i.e. using intrauterine devices, sterilisation). Removal problems occur less frequently with Jadelle than with Norplant. The mean removal time for Jadelle is half that of Norplant. Levonorgestrel implants in nationally representative scientific samples, in randomised trials, and in controlled cohort studies have continuation rates as high as or higher than any other reversible contraceptive over a duration of 5 years. This would imply that the satisfaction women derive from the contraceptive effectiveness of levonorgestrel implants greatly outweighs the dissatisfaction that may accompany menstrual disturbances and other adverse effects associated with implants.
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PMID:Risks and benefits, advantages and disadvantages of levonorgestrel-releasing contraceptive implants. 1265 Jun 33

Because pregnancy is rare in women with end-stage renal disease, dialysis patients have not been reported to present with acute abdominal symptoms related to pregnancy including ectopic pregnancy. A 41-year-old woman treated with hemodialysis for over 18 years was brought to the emergency room at our institution because of acute abdominal pain. Ultrasonography detected an abdominal fluid collection, and her anemia had worsened (hematocrit 18%). Emergency laparoscopic exploration disclosed a hemorrhagic corpus luteum of pregnancy, causing ovarian bleeding on the left. Coagulation of bleeding points was carried out. At this time, pregnancy at 7 weeks of gestation was discovered. After the procedures, hemodialysis frequency was increased to 5 times weekly, and an erythropoietin derivative was administered to maintain a hematocrit above 30%. The patient developed no hypertension. At 33 weeks of gestation, cesarean section was performed because of a decrease in amniotic fluid and frequent late deceleration of the fetal heart rate. A live baby girl weighing 1,422 g was born. The successful pregnancy reflects remarkable progress in dialysis technology. Pregnancy, then, can underlie an acute abdomen in childbearing-age women (14 - 44 years old) undergoing long-term dialysis.
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PMID:A patient with pregnancy-related acute abdomen after hemodialysis for over 18 years. 1928 51


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