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

Fifty-four women who were delivered of small for gestational age infants were studied antenatally by serially continuous-wave Doppler velocimetry. Outcomes were compared in the normal and abnormal systolic/diastolic ratio groups. Seventy-eight percent had an abnormal systolic/diastolic ratio. The group with an elevated systolic/diastolic ratio had a significantly higher incidence of abnormal fetal heart rate, pregnancy-induced hypertension, oligohydramnios, cesarean section for fetal distress, and admission into the neonatal intensive care unit. One third of the newborns required intermittent positive pressure ventilation. Average birth weight and gestational age at delivery were significantly lower and there were six perinatal deaths in the group with an elevated systolic/diastolic ratio and none in the group with a normal systolic/diastolic ratio. These data suggest that the small for gestational age fetus with normal umbilical artery velocimetry is at significantly lower risk than are those with abnormal ratios. This implies that management of the small for gestational age fetus may now be aided by a functional classification based on the umbilical artery velocity waveform.
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PMID:The clinical significance of Doppler umbilical artery velocimetry in the small for gestational age fetus. 295 46

A case of inadvertent intravascular injection of PGF2alpha during induction of labor by intraamniotic injection for fetal demise, involving alternating extreme hypotension and hypertension, is described. The woman was a 29-year old in late 2nd trimester with oligohydramnios, but no other related history. She was given epidural anesthesia, 7.5 mg midazolam and 5 mg morphine S04 for anxiety. Because of oligohydramnios, 300 ml Ringers lactate was instilled to dilute the PG. A test dose of 1 mg PGF2alpha was tolerated well. 80 g urea and 20 mg PGF2alpha were injected over 10 minutes. A few minutes later contractions began, followed by complaints of burning on face and chest and dyspnea. Oxygen was given by mask. Systolic pressure fell to 70 mm by cuff; peripheral pulses could not be palpated, but the patient remained alert and oriented. She was given 35 mg ephedrine and increased iv fluids. She remained dyspneic, her extremities became mottled, and she complained of chest pressure, severe headache and severe breast tenderness. Blood pressure rose to 220/135 mm Hg; pulse to 95, and respiratory rate to 44. Pulse oximetry, detectable at the earlobe only, was 94% saturation. After 50 mg labetalol, blood pressure fell to 134/77, but symptoms remained. For 2 hours blood pressure swung between 76/50 and 225/125, until delivery of the fetus. An arterial line could not be started because of extreme vasoconstriction. Central venous pressure was 13 cm H20. After artificial rupture of the membranes and removal of remaining PG, blood pressure stabilized. Delivery was accomplished without incident. The symptoms and labile blood pressure were considered to be due to intravascular injection of PGF2alpha, caused by repeated bolus injection at each uterine contraction. In case of PG induction for fetal demise, it is recommended that anesthesiologists be prepared to treat intravascular collapse, hypertension and bronchoconstriction.
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PMID:Life-threatening effects of intravascular absorption of PGF2 alpha during therapeutic termination of pregnancy. 318 4

One hundred fifty-four children aged eighteen years or younger from 83 families with autosomal-dominant polycystic kidney disease were studied by ultrasonography or excretory urography. Twenty-three children had bilateral renal involvement with at least five cysts (ADPKD), 28 children were classified as suspicious (SADPKD), and 103 children had no renal involvement (NADPKD) detected by ultrasound. Seventy-four percent of the ADPKD children had signs or symptoms compatible with the diagnosis of ADPKD, compared to 34% of the NADPKD and 36% of the SADPKD children (both P less than 0.05). Three of the 23 ADPKD children had elevated serum creatinines at the time of diagnosis, while all of the NADPKD and SADPKD children had normal renal function. Renal area by ultrasonography (width X depth) was greater among the ADPKD children compared to the SADPKD and NADPKD groups (P less than 0.05). On follow-up 30 of the 37 NADPKD children remained NADPKD, three were reclassified as SADPKD, and four progressed to ADPKD after 18 years of age. All of the NADPKD children had normal renal function on follow-up. Overall, 14 children had suspicious ultrasounds at some point with follow-up ultrasonography and ten (71%) progressed to ADPKD. All SADPKD children maintained normal renal function. Eight of 18 ADPKD children had progression of the disease manifested by development of hypertension and/or decreased renal function. Three children progressed to end-stage renal disease. Five ADPKD children were diagnosed before one year of age, two of them via prenatal ultrasonography. One fetus was aborted after documentation of oligohydramnios.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Autosomal dominant polycystic kidney disease in childhood: a longitudinal study. 329 57

Perinatal mortality is significantly increased in pregnancies where pre-eclampsia is superimposed on chronic hypertension. Oligohydramnios and intrauterine growth retardation are common in this setting. Although oligohydramnios generally has been assumed to occur gradually the following report pertains to a case of a rapid development of oligohydramnios.
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PMID:Acute development of oligohydramnios in a pregnancy complicated by chronic hypertension and superimposed pre-eclampsia. 351 Jun 29

From the pre-natal follow-up it was remarkable that cases have been admitted relatively late. Hints to a possible development of preeclampsia could be seen from patients history or the routine check up, for example the registration of edema, fetal growth retardation and oligohydramnios. For early diagnosis of preeclampsia we recommend: Calculation of mean arterial blood pressure or its non-invasive measurement; determination of hematocrit, uric acid and total plasma protein (in particular hemorheologic measurements). Hypomagnesemia in preeclampsia, as described by some authors, was also seen in our cases. The complex symptomatology of preeclampsia could be attributed to a generalised disturbance of microcirculation, which leads to definite reactions of the organs concerned. The microcirculatory failure is caused by vasoconstriction, hemoconcentration, hyperviscosity and hypercoagulation (up to DIC and consumption coagulopathy). The resulting symptoms and syndromes can be: EPH, HELLP, hemolytic-uremic Syndrome, hepato-renal Syndrome, thrombocyte and antithrombin III deficiency etc. The drug of choice for treatment of preeclampsia is magnesium sulfate. Its application is based on long-term clinical experience and new aspects on the physiologic and pharmacologic role of magnesium. The recommendations of the German High Blood Pressure League to use calcium antagonists as a basis in the treatment of high blood pressure can be fulfilled particularly in pregnancy by the physiologic calcium antagonist Mg++. Magnesium sulfate should be given in a dosage of 24-72 g daily. The dose should also be made dependent from urinary output. Further treatment patterns of preeclampsia should be adjusted according to each case. The present results also support our hypothesis that magnesium deficiency (besides predisposing factors) could be responsible for the development of preeclampsia (present model shown in detail). Consequently, the early and long-term substitution of magnesium in pregnancy could help reduce preeclampsia.
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PMID:[Pathophysiology and clinical aspects of pre-eclampsia]. 404 84

Preeclampsia, the hypertension of pregnancy, is a high-risk obstetric situation that can be monitored ultrasonically. Ultrasonic features commonly associated with preeclampsia, including decreased total intrauterine volume (TIUV), oligohydramnios, and intrauterine growth retardation (IUGR), are presented and their possible prognostic implications discussed.
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PMID:Ultrasonic features of preeclampsia. 677 6

The Edinburgh Register of the Newborn 1964-1968 and the Edinburgh Scoliosis Clinic 1964-1971 have been used to establish the population frequency in the city of the idiopathic forms of talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile scoliosis. A survey of 165 patients now aged 7 to 11 years showed an aetiological relationship, but with differing environmental factors. These factors were established by comparison with the Edinburgh Register control group of 692 normal infants born over the same period, giving a unique opportunity to obtain more accurate antenatal data than has previously been possible. The principal associations were: talipes equinovarus with antepartum haemorrhage and maternal hypertension; metatarsus varus with twin pregnancies; congenital dislocation of the hip with first born children, older than average fathers, breech presentation, a significant lack of menstrual problems in the mother, and maternal upper respiratory infection during pregnancy; infantile idiopathic scoliosis with breech presentation, prematurity, and the onset of the curve in the winter months. No significant association with raised intrauterine pressure (hydramnios or oligohydramnios) was found among these simple idiopathic deformities. It is concluded that the multifactorial genetic background in likely to be similar in all, but that the additional environmental element is variable.
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PMID:Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis). 714 83

Angiotensin converting enzyme (ACE) inhibitors are extensively used for the treatment of hypertension, to decrease proteinuria, and to mitigate hyperfiltration. These drugs now have been shown to be fetotoxic causing profound fetal hypotension, renal tubular dysplasia, anuria-oligohydramnios, growth restriction, hypocalvaria, and death when used in the second and third trimesters of pregnancy. We recommend that ACE inhibitors not be used in pregnancy. However, if a child is born with ACE inhibitor fetopathy, aggressive therapy with dialysis to remove the inhibitor may mitigate the profound hypotensive effects. Therapy will depend on the specific ACE inhibitor, and care recommendations cannot be generalized for the entire class of drugs as their protein binding and volume of distribution differ substantially.
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PMID:Recognition and management of angiotensin converting enzyme inhibitor fetopathy. 763 38

A comparative, prospective study was in order to diagnose premature aging of placenta and make early diagnosis of perinatal complications. 30 patients were enrolled during the period from march to november 1990 who had unique fetus pregnancy, live fetus, complete membranes, less than 37 weeks gestational age at the beginning of the study. We graded placental maturity by means of ultrasound according to Grannum classification. 22 patients (control group) had Grannum grade III placenta going from 37 to 41 weeks and no perinatal complications for any of them. 8 patients (problem group) showed premature aging of placenta (grade III before 37 weeks) of which 62.5% had perinatal complications (P < 0.05) such as: pregnancy induced hypertension, oligohydramnios and delayed intrauterine growth. With this study it is concluded that premature aging of placenta is associated with high risk pregnancies and lower weight fetus. Observing normal placental maturity for gestational age is associated with good perinatal outcome.
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PMID:[Premature aging of the placenta. Ultrasonic diagnosis]. 766 14

Oligohydramnios is a severe and common complication of pregnancy. The finding of oligohydramnios can be associated with fetal anomalies, PROM, uteroplacental insufficiency (eg, growth retardation, postdatism, abruptio placenta, significant maternal illness), abnormalities of twinning, and idiopathic oligohydramnios. Ultrasound detection of this complication should prompt the clinician to thoroughly evaluate the gravida for hypertension, diabetes, or other significant illness. In addition, a thorough fetal anatomic survey focusing on the genitourinary tract and an attempt at visualizing free amniotic bands should be performed with ultrasound. Karyotype should be considered. The role of amnioinfusion to assist in diagnosis should be considered. Once diagnosed, oligohydramnios with or without associated conditions should lead to intensive fetal biophysical surveillance including frequent ultrasound evaluation. Delivery in the term patients must be considered. The role of amnioinfusion as an adjunct to continuous fetal monitoring in labor to improve neonatal outcome appears beneficial in select series. The role of repetitive amnioinfusion in the preterm patient remote from term may offer marginal clinical benefit to neonatal outcome and is considered experimental at this time.
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PMID:Oligohydramnios: problems and treatment. 769 Sep 90


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