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

The most important advancement in perinatology during the past few years has been the possibility to selectively establish a criterion to judge high risk pregnancies, which still represent the great majority of cases of materno-infant morbimortality. Social, economic, and cultural factors, age, biological antecedents of the mother, previous pregnancies, and medical history, have all a great influence in the evaluation of gestation. Through the years several models have been constructed to evaluate high perinatal risks; excluding complications due to danger of congenital abnormalities only 19% of women are exposed to high risk pregnancy. Among prenatal risk factors the most common are toxemia, chronic hypertension, severe cardiopathy, and diabetes; risk factors that may become more evident during delivery or shortly before it are toxemia again, premature rupture of membranes, meconial amniotic fluid, and abnormal presentation.
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PMID:[Perinatal medicine. Medico-social implications. I. Technics used in the identification of high risk pregnancy]. 45 11

142 determinations of leucocyte alkaline phosphatase (LAP) activity have been done in 103 cases of high risk pregnancy. A statistically significant elevation of LAP score has been found in high risk pregnancies due to diabetes mellitus, toxaemia, renal diseases and third trimester haemorrhage, but not in pregnancies complicated by cardiac disease, chronic hypertension, Rh sensitization or anaemia.
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PMID:Leucocyte alkaline phosphatase activity during high risk pregnancies. 67 79

We have developed a telemetric technique whereby maternal blood pressure, which is self-measured by pregnant women in their own homes using a Dinamap 1846 automated blood pressure recorder, can then be transmitted over the commercial telephone network into the Rosie Maternity Hospital in Cambridge, where it is computer-processed. The maternal blood pressure is then reviewed by the obstetrician as part of the clinical management protocol. We have used this telemetric technique on 90 occasions, from the homes of 10 pregnant hypertensive women. On almost every occasion, the blood pressure measured at home was lower than that previously measured in the hospital antenatal clinic. This technique offers great promise, both in terms of health economics and also in terms of reducing pregnant women's unhappiness about their being admitted to hospital whenever they exhibit moderate to severe hypertension in the antenatal clinic. Indeed, in the antenatal period, home telemetry should allow the vast majority of hypertensive pregnancies to be managed just as safely at home as in hospital. In the management of high risk pregnancy, home telemetry of maternal blood pressure complements three other home telemetric techniques which have already been described: fetal heart rate, maternal blood glucose and uterine contractions.
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PMID:Computerized home telemetry of maternal blood pressure in hypertensive pregnancy. 367 78

For women whose health cannot support pregnancy, the author's obstetrics department has formed a multidisciplinary team to counsel couples on psychological and practical aspects of contraception and abortion. High risk pregnancies are those occuring in women with such disorders as cardiopathy, nephropathy, hypertension, diabetes, cancer, Rhesus isoimmunization and psychosis. Two approaches are used: to prevent or terminate pregnancy. Contraception must be explained concretely, addressing the couples' particular situation and personality. Pills are often contraindicated, in high risk patients as are IUDs in nulliparas and those taking anticoagulants. Many couples used to careful medical surveillance can adjust to temperature rhythm or diaphragms. For women who must have Tubal ligation, the decision is made jointly by the couple, obstetrician, psychotherapist and specialist. Counseling is usually necessary to prevent psychological or sexual dysfunction, particularly in those sterilized during caesarean section if the infant's survival is also at risk. A similar multidisciplinary team is consulted for therapeutic abortion alone or combined with tubal ligation.
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PMID:[Fecundity and high risk pregnancy]. 507 55

The best management of respiratory distress syndrome (RDS) is prevention. Prenatal administration of Cortico-steroids has been proved to be a valuable way for accelerating fetal lung maturation. In case of high risk pregnancy, however, where acceleration of lung maturation is most needed, there may be a relative contraindication for using steroids. According to the theory that the increase in the phospholipid component of surfactant may be mediated by intra-amniotic thyroxin administration, its use for accelerating human fetal lung maturation has been tested. Seven samples of amniotic fluid were obtained in order to determine the lung maturity in seven pathological pregnancies (pre-eclamptic toxemia, diabetes, infection, hypertension, placental insufficiency) prior to elective caesarean section. Since thyroxin does not cross the placenta, it has to be injected directly into the amniotic sac. 20 ml of clear fluid were obtained by amniocentesis prior to each injection of 250 micrograms of Levothyroxin through the same needle. Each of the infants was delivered before 34 weeks. Birth weights of the premature infants were between 1220-1870 grams. In all cases the Lecithin/Sphingomyelin Ratio (L/S) in amniotic fluid analysis was immature. After thyroxin administration L/S Ratio was mature in pharyngeal aspirate examination after delivery in 6 cases. RDS was seen in only one infant. The interval between intraamniotic administration of T4 and delivery ranged from 72 hours to 2 weeks in 6 cases. In one case with clinical and radiological signs of RDS the injection-delivery interval was less than 48 hours: the L/S Ratio in pharyngeal aspirate was immature 2,8 (normal greater than 3).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prevention of hyaline membrane disease by intraamniotic administration of thyroxine]. 653 84

To evaluate the incidence and the foetal effects of gestational hypertension, we studied 2 996 pregnancies with a single live birth in mothers selected on the basis of 1) a documented diastolic blood pressure (DBP) less than 90 mmHg before the 16th week of amenorrhea and 2) no history of hypertension or kidney disease. In 38,4% of the gravidas, the highest DBP during pregnancy was greater than or equal to 90 mmHg, and in 15,4% this level was reached twice or more. Gestational hypertension (two DBP readings greater than or equal to 90 mmHg) was more frequent in nullipara than in mothers with previous pregnancies (17,9 versus 12,4%, p less than 0,01) and its incidence tended to decrease with increasing maternal age. Irrespective of parity or maternal age, a significant increase in the percentage of small for gestational age infants was associated with increasing DBP levels: 3,2, 6,4 and 8,5% when the highest recorded DBP was less than 90 mmHg, equal to 90 mmHg (even at one single reading), or greater than or equal to 100 mmHg respectively (p less than 0,001). Very similar percentages were obtained in non-proteinuric pregnancies: 3,3, 6,5 and 7,8 respectively (p less than 0.001). Non-proteinuric gestational hypertension, even mild or transitory, is indicative of a high risk pregnancy and requires close medical supervision.
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PMID:[Incidence and fetal impact of hypertension in pregnancy: study of 2996 pregnancies]. 681 Aug 28

The incidence of pregnancy induced hypertension (PIH), prolonged pregnancy, prolonged labor, macrosomia and the rate of operative delivery were analysed in 76 overweight women and in 436 women with normal body weight admitted at the same period to the hospital. The results showed that the occurrence of risk factors mentioned above was significantly higher in the overweight group, particularly in those with excessive weight gain during pregnancy than that of normal weight group (P < 0.001-0.05). To reduce high risk pregnancy, operative delivery, perinatal mortality and morbidity in overweight women especially associated with excessive weight gain during pregnancy the importance of perinatal care with nutritional advice is evident.
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PMID:[Clinical analysis of the relation between maternal body weight and high risk factors during pregnancy and delivery]. 828 22

In some countries, the incidence of obesity doubles every 10 years. For the obstetrician-gynecologist, there are many different situations where the patient's excess body weight calls for an adapted diagnostic and therapeutic approach. Obesity does not in itself appear to be a factor lowering fertility. However obesity-induced hormone disorders could contribute, in certain cases, to biological imbalance and thus favor the development of ovulation dysfunction. Pregnancy in obese women should be managed as a high risk pregnancy. The incidence of gestational diabetes and hypertension is increased. Macrosomatia is frequent. There is a 2- to 3-fold increase in the rate of cesarean sections with more complications. Fetal morbidity does not appear to be changed when maternal weight gain is limited. With obesity, there is an increased risk for breast and endometrial cancer due, for most authors, to elevated levels of circulating estrogens resulting from aromatization of male sex steroids in adipose tissue and decreased levels of sex hormone-binding globulin. Anesthesia and surgery in obese patients can be problematic and special care must be taken to prevent further morbidity. Laparoscopic surgery is possible under certain conditions, although its role remains to be determined. Prescription of hormone replacement must take into consideration several parameters which determine its usefulness and surveillance. Obesity is not a contraindication for hormone replacement therapy but is frequently a non-indication.
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PMID:Obesity in obstetrics and gynaecology. 957 82

Cardiolipin IgG and IgM antibodies (CAb) were studied in 116 cases of high-risk pregnancy. All the women were undergoing examination or treatment in regional perinatal center. CAb occurred more frequently in antenatal fetal death (50%). In blood hypertension, habitual abortions, history of infertility, gestational gestosis, CAb were encountered in 21.4, 20, 20 and 15.2% of cases, respectively. Intrauterine growth retardation was associated with CAb in 33.3% of cases. CAb occurred in pregnant women of different groups who had high uterine vascular resistance. The above findings indicate CAb contribution to genesis of gestational complications in high risk pregnancy.
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PMID:[Cardiolipin antibodies in pregnancy of high risk]. 1035 11

The number of women over 40 who get pregnant and have a child has constantly decreased in France since 1970; in 1979 it was only 1.2%. This phenomenon is not general; in other countries, such as Finland, the number of late pregnancies is on the increase. According to some endocrinologists fertility after 40 is almost absent due to deficiencies of the ovarian function. Pregnancy after 40 is almost always a high risk pregnancy. The most common risk is that of congenital abnormalities; amniocentesis and echography can check how serious such a risk can be. Other problems can be caused by the quality of the uterine musculature, or by maternal hypertension. Prematurity and dystocic delivery are not a rare occurrence. Prevention, and a strict surveillance of the mother, are absolutely essential; it must be remembered that risk of perinatal mortality is 28-88% in women over 40, while it is 14-16% for younger women.
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PMID:[Fertility of the woman over 40 and the risks of late pregnancy]. 1226 84


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