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

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

Plasma renin concentration, renin activity and angiotensin II (AII) have been studied in 35 primigravidae at or near term immediately prior to surgical induction of labour. A highly significant positive correlation was established between diastolic blood pressure at the time of sample collection and plasma AII. This relationship was observed over the range of diastolic pressure studied irrespective of the diagnosis made at the time of admission to hospital. In patients with hypertension, a significant negative relationship was established between plasma renin concentration and renin activity and AII. Furthermore, plasma AII levels were higher for a given plasma renin activity or plasma renin concentration in the hypertensive women than in the normotensive group. These findings suggest that the renin-angiotensin system is actively involved in hypertensive disease of pregnancy and that suppressed levels of renin concentration and activity may result from elevated angiotensin levels. It is suggested that the utero-placental complex may be the source of the elevated AII levels.
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PMID:Changes in the renin-angiotensin system in primigravidae with hypertensive disease of pregnancy. 118 Sep 53

The pregnancy disorder preeclampsia continues as a major cause of maternal and infant mortality and morbidity. Despite intensive research since its recognition 100 years ago, our lack of understanding is evidenced by therapy which remains empiric, early delivery. Part of our failure to more completely understand the syndrome is due to excessive attention to the blood pressure elevation which accompanies the disorder, to the exclusion of a panoply of other physiologic aberrations. Although hypertension, if markedly elevated, can lead to maternal morbidity, it is not usually an important contributor to the pathophysiology of preeclampsia. It is primarily important as a marker for vasoconstriction, which in association with activation of coagulation reduces perfusion to many organs, including the fetal-placental unit. The earliest and likely most important pathophysiologic change is reduced placental perfusion secondary to abnormal implantation and/or a relative increase in placental mass. We propose that reduced placental perfusion results in the production of agent(s) by this organ, which injures or activates endothelial cells. The resulting endothelial cell dysfunction increases sensitivity to normal endogenous pressors, activates the coagulation cascade, and increases vascular permeability. These changes produce the characteristic pathophysiologic changes of the disorder. Evidence supporting this hypothesis includes abnormal endothelial morphology long recognized in glomerular capillaries, increased circulating fibronectin, and increased plasma mitogenic activity that long antedates the clinical disorder. In addition, an agent(s) is present in the blood of these women which activates endothelial cells in vitro as evidenced by increased release of [51Cr] chromium and increased production of PDGF. Preeclampsia is clearly more than "pregnancy induced hypertension."
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PMID:Clinical and biochemical evidence of endothelial cell dysfunction in the pregnancy syndrome preeclampsia. 193 Aug 53

Sodium nitroprusside has been used to alter blood pressure in severe hypertensive disease of pregnancy; however, concern exists in regard to potential lethal complications from cyanide toxicity in both mother and fetus. We recently evaluated levels of cyanide in the liver of an infant stillborn to a woman in whom sodium nitroprusside was used to control gestational hypertension secondary to mitral valve disease. The fetal liver demonstrated levels of cyanide below toxic ranges. Biologic activity, potential toxicity, and treatment of toxic symptoms of nitroprusside are discussed.
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PMID:Sodium nitroprusside for control of severe hypertensive disease of pregnancy: a case report and discussion of potential toxicity. 672 Jul 94

A program designed to achieve normal plasma glucose concentrations before meals was tested in 83 insulin-dependent diabetic women during 110 pregnancies. The women rigidly controlled their carbohydrate intake but not their total energy intake, and twice daily they injected a combination of short-acting (Toronto) and intermediate-acting (NPH or Lente) insulin. Obstetric care was highly individualized and was aimed at avoiding or minimizing the impact of complications, such as hypertension, on the fetus and ensuring fetal lung maturity before delivery. The mean plasma glucose levels before meals (+/- standard error of the mean) were 136 +/- 9, 117 +/- 5 and 101 +/- 2 mg/dl during the first, second and third trimesters respectively. Obstetric complications included hypertensive disease of pregnancy (in 30.0%) and hydramnios (in 16.4%). The mean gestational age (+/- standard deviation [SD]) was 38.1 +/- 1.8 weeks, the cesarean section rate 45.4% and the mean stay in hospital for diabetes control before delivery (+/- SD) 15.7 +/- 9.6 days. The perinatal mortality rate was 0.9%. Neonatal problems included congenital anomalies in 3.6%, somatomegaly in 24.6%, hypoglycemia in 26.5%, hypocalcemia in 17.3% and hyperbilirubinemia in 39.4%. There were nine cases (8.2%) of the respiratory distress syndrome, four (3.6%) of which were severe. These findings lend support to the importance of a policy aimed at achieving normoglycemia and fetal lung maturity before delivery, goals that are attainable without lengthy antenatal hospitalization.
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PMID:Pregnancy in diabetic women: outcome with a program aimed at normoglycemia before meals. 702 11

Twenty-two primiparous women with hypertensive disease of pregnancy (HDP) associated with intra uterine growth retardation (IUGR) were compared with 20 parous women in whom HDP associated with IUGR appeared for the first time in a second or a later pregnancy. Both groups of women were followed up for 10-13 years. The course of the disease among the parous women was more severe as compared to the primiparous women; the mean gestational age at the first increase in blood pressure and gestational age at delivery were significantly earlier in the parous group (33.3 weeks +/- 3.5 v.s. 35.3 +/- 3.2 weeks, p < 0.01, 36.2 weeks +/- 2.2 v.s. 37.6 +/- 1.9 p < 0.01 accordingly). Maternal indication for induction of labor because of uncontrollable hypertension was present in 77% of the cases in the parous group as compared to 31% in the primiparous group (p < 0.05). These complications were present in 66% of subsequent pregnancies in the parous group as compared with 31% in the primiparous group (p < 0.05). Chronic hypertension developed in 33% of the parous group as compared with 20% in the primiparous group. These differences show that the manifestation of HDP is more severe in women in whom HDP with IUGR occur for the first time in a second or a later pregnancy than in those in whom this complication occurs for the first time in a second or a later pregnancy than in those in whom this complication occurs for the first time in their first pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The prognosis of hypertensive disease of pregnancy accompanied by intrauterine growth retardation in relation to parity. 821 98

-Preeclampsia is a multisystemic disorder of pregnancy in which the normal vascular adaptations to pregnancy are compromised. Oxidative stress as well as endothelial cell dysfunction have been implicated as pathophysiological features of preeclampsia. Endothelial cells produce the vasorelaxant nitric oxide (NO). However, NO is also known to react with superoxide anions (produced under conditions of oxidative stress), yielding peroxynitrite that may impair vascular function. Our objective was to use immunohistochemical techniques to determine whether there is evidence of peroxynitrite formation in the maternal systemic vasculature of women with preeclampsia. Vessels were obtained from a biopsy of subcutaneous fat at the time of cesarean section from normal pregnant (n=7) and preeclamptic (n=7) women or at the time of hysterectomy from nonpregnant women (n=5). There were significantly more vessels staining with greater intensity for nitrotyrosine and endothelial NO synthase in the endothelium of vessels from women with preeclampsia compared with that of normal pregnant women or nonpregnant women. Both endothelial and smooth muscle cells from all vessels showed evidence for the presence of superoxide dismutase (SOD), an enzyme that scavenges superoxide anions. However, the intensity of staining for SOD in the endothelium was significantly lower in the preeclamptic and nonpregnant women than in normal pregnant women. These data of increased endothelial NO synthase, decreased SOD, and increased nitrotyrosine immunostaining in the maternal vasculature of women with preeclampsia suggest increased peroxynitrite formation. We speculate that peroxynitrite is involved in endothelial cell dysfunction in preeclamptic women and contributes to the pathophysiology of this pregnancy disorder.
Hypertension 1999 Jan
PMID:Evidence for peroxynitrite formation in the vasculature of women with preeclampsia. 993 Oct 86

Ever since a gradual but significant reduction in the estrogenic and progestogenic components of oral contraceptives (OCs) was made, there has been a corresponding decrease in adverse effects associated with the pill. The beneficial effects include prevention of pregnancy, reduction in pelvic inflammatory disease, protection against ovarian/endometrial cancer and benign breast tumors and ovarian cysts, reduction in the occurrence of rheumatoid arthritis among OC users, and regulation of the menstrual cycle. The adverse effects include diseases of the circulatory system (myocardial infarction, venous thromboembolism, subarachnoid hemorrhage, hypertension), possible carcinogenicity (breast, cervix, melanoma), pituitary adenomas, liver disorders, glucose metabolix effects (diabetes), vitamin status alteration, delay in return of menstruation and fertility, and a number of minor side effects (nausea, vomiting). Contraindications to OC use include history of malignancy of the breast or genital tract, venous thromboembolism, cerebrovascular accident, undiagnosed abnormal vaginal bleeding, focal migraine, or familial hyperlipidemia. The following situations require medical assessment before OCs are prescribed, and medical supervision if OCs are prescribed: age 40+, smoking and age over 35, mild hypertension or a history of hypertensive disease of pregnancy (toxemia), epilepsy, diabetes mellitus, history of bouts of depression, history of oligomenorrhea or amenorrhea in nulliparous women, and gallbladder disease. Problems could occur with OC use in the following situations: 1) lactation (ideally, OCs should be withheld until the child is weaned but if not possible, OCs should not be given until lactation is established); 2) drug interaction (other contraceptive form should be used when the patient is taking antibiotics or anticonvulsants); 3) tropical diseases (studies are still underway); 4) adolescence (very young girls should use other contraceptive method until regular menstruation is established); 5) postcoital contraception (limited use of steroids in emergency situation); and 6) hormonal pregnancy tests (use of oral steroids for pregnancy testing is not recommended). The 3 main types of OCs currently used are the combined estrogen and progestagen, the progestagen-only OC, and the triphasic OC. The lowest effective dose of a compound should be used, and healthy women may continue to use OCs for many years.
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PMID:Statement on steroidal oral contraceptives. 1226 73

A meeting in Singapore of principal investigators from 7 countries in a WHO collaborative study on hypertensive disease of pregnancy, also called pre-eclampsia or eclampsia, pointed out women at risk, suggested management guidelines, and summarized operations research projects involving administration of aspirin or calcium supplements. Hypertensive disease of pregnancy may ultimately end in fatal seizures. It is often marked by warning signs of severe headaches and facial and peripheral edema. A survey in Jamaica found that 0.72% of a group of 10,000 pregnant women had eclamptic seizures. These were the cause of almost one-third of all obstetric deaths in the period 1981-1983. 10.4% of the pregnant women had hypertension, and half of these had proteinuria. Associated risk factors were primigravida, age 30, abnormal weight gain, edema, 1+ proteinuria. A phased program of management guidelines for identifying and treating affected women is being instituted in half of Jamaica's parishes. An operations research project involves administration of low-dose aspirin vs. placebo. Another controlled trial, in Peru, is testing calcium supplements. A third trial in Argentina will compare 2 drug regimens.
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PMID:Hypertensive diseases of pregnancy. 1228 29

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


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