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

Extensive clinical studies have documented the effectiveness of recombinant human erythropoietin (rHuEPO) in correcting the anemia of adult dialysis patients, but the safety and efficacy of rHuEPO in children with renal anemia cannot yet be confirmed, due to the relative deficiency of reported studies involving pediatric subjects. To date, published experience with rHuEPO therapy in children has totaled 257 patients, although the majority of these reports have appeared only as abstracts. Overall experience has been favorable, with renal anemia and transfusion dependency successfully resolved in almost all pediatric patients reported. However, controlled clinical trials have not been performed, so it is not yet possible to clearly define the risks associated with rHuEPO therapy in children. Hypertension appears to occur or become worse in up to one third of treated children, but it is unclear to what extent rHuEPO therapy is accompanied by an increased risk of seizures, thrombosis of vascular access, hyperkalemia, hyperphosphatemia, or peritonitis (when administered via the intraperitoneal route). Only preliminary and somewhat conjectural recommendations can be offered regarding pediatric rHuEPO dosing, route of administration, special precautions, and adjunctive monitoring and therapy. Fortunately, a multicenter controlled clinical trial is underway that is designed to address these issues. Because the harmful effects of renal anemia are typically more profound for children than they are for adults, the benefits of rHuEPO promise to be even greater among pediatric patients. Whether rHuEPO therapy will substantially improve growth and neurologic and psychosocial development remains to be seen, but the potential is there for rHuEPO to dramatically improve the lives of children who suffer from the effects of the anemia of chronic renal failure. Other non-renal anemias that afflict pediatric patients, such as the anemia of prematurity, also may be amenable to rHuEPO therapy.
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PMID:Pediatric uses of recombinant human erythropoietin: the outlook in 1991. 192 79

Current methods for estimating gestational age using clinical parameters can be inaccurate in prematurity. A simplified ultrasonographic system, based on cerebral sulcal development, for clinically determining fetal maturation in newborns was developed and studied in 148 newborns (92 appropriate-for-gestational-age, 54 small-for-gestational-age and 2 large-for-gestational age). This ultrasonographic sulcal method correlates better with the gestational age by dates than by the Dubowitz scoring system in the neonates less than 30 weeks' gestation. There are significant correlations between gestational age assessed by dates and by sonographic sulcal age in both appropriate-for-gestational-age (R = 0.91, P less than 0.001) and small-for-gestational-age newborns (R = 0.92, P less than 0.001). Maternal hypertension during pregnancy is a significant risk factor associated with accelerated fetal cerebral maturation in 12 neonates. Although overestimate of gestational age may occur in neonates born to mothers with hypertension, cranial ultrasonography is an accurate and convenient method of estimating gestational age in neonates.
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PMID:Assessment of gestational age in newborns by neurosonography. 193 42

Successful renal transplantation improves fertility with 1 in 50 women of childbearing age becoming pregnant. Pregnancy following renal transplantation is associated with increased maternal and fetal complications. In Belfast 118 women of childbearing age (15-45 yrs) have received a renal allograft and of these 14 (12%) have become pregnant. Twenty-seven pregnancies have resulted in 23 live births (including one set of identical twins), 1 still birth and 4 first trimester abortions. The most frequent complications were hypertension and prematurity. In this group of patients, whose sole immunosuppressive therapy was azathioprine and prednisolone, pregnancy post transplantation was associated with frequent successful outcome and a low incidence of maternal and fetal complications.
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PMID:Outcome of pregnancy following renal transplantation. 193 14

This population-based study examined whether the neonatal outcome of primiparae is determined by maternal age or by her socioeconomic background. Data on all births in Israel during a three-month period was made available from a nation-wide census. Primiparae 30 years of age or older had a significantly (P less than 0.001) higher risk of low birthweight and prematurity. Perinatal mortality rates and low 5-min Apgar scores were not associated with maternal age, but were significantly (P less than 0.001) increased for the socioeconomically disadvantaged parturients. Our results suggest the growth retardation and short gestation among older primiparae may reflect biological aging of maternal tissues and the effect of diseases of pregnancy such as hypertension and preeclampsia, found significantly (P less than 0.001) more common for these mothers. Excessive perinatal mortality, on the other hand, may be attributable to environmental disadvantage of socioeconomically deprived populations.
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PMID:The effect of maternal age and socioeconomical background on neonatal outcome. 197 36

During the last decade, 89 sets of triplets were born in Denmark with a gestational age of more than 25 completed weeks. Fifteen pregnancies (16.9%) were complicated by fetal death in the third trimester, with a total of 17 intrauterine deaths. Six neonatal deaths occurred, leaving 22 survivors among these 15 patients. Four triplet gestations were diagnosed as twins until delivery. Eight women conceived spontaneously, two gestations followed assisted fertilization and embryo transfer, and five women had had various forms of ovulation stimulation. The mean maternal age was 27.8 years (range 17-38). Seven women were parous and eight wer nulliparous. Maternal complications included hydramnios (three), preeclampsia/hypertension (three), and anemia (nine). All women delivered preterm. Of the 11 gestations diagnosed as triplets, fetal death was diagnosed at 32.2 +/- 2.9 weeks (mean +/- SD) and delivery occurred at 32.6 +/- 3.0 weeks. Nine of 11 women had cesarean deliveries. Continuation of pregnancy after fetal death could be considered in only three subjects. In eight women, obstetric reasons required immediate delivery. Fetal death was associated with monochorionic or dichorionic placentation, and growth retardation was a frequent complication before fetal death. Anencephaly of one fetus, umbilical cord problems in two, and severe hydrops in two were the only obvious causes of fetal death. Fetal death should not be the sole indication for delivery. In cases with severe prematurity and a stable intrauterine situation, frequent assessments of fetal well-being are recommended, with prompt delivery when indicated.
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PMID:Third-trimester fetal death in triplet pregnancies. 198 28

Obstetric outcome in 88 women with a past history of three or more consecutive pregnancy losses was studied. The results were compared to those in our total obstetric population for the same period (control group). The incidence of small-for-gestational-age infants, prematurity, low-birth-weight infants and toxemia in the study group was not significantly different from that in the control group. Gestational diabetes and chronic hypertension, however, occurred more frequently in the study group than in the control group (P less than .001). These data could be helpful in counseling women with repeated pregnancy loss.
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PMID:Obstetric outcome in women after multiple spontaneous abortions. 203 Apr 89

In contrast with a generation ago when preeclampsia was misdiagnosed as medical or surgical disease unrelated to pregnancy, today's diagnostic errors are those that consider surgical and medical problems as either pregnancy-induced hypertension or as the hemolysis, elevated liver enzymes, and low platelet count syndrome. Eleven case histories are presented of significant medical or surgical problems that were initially diagnosed as hemolysis, elevated liver enzymes, and low platelet count syndrome or pregnancy-induced hypertension. The incorrect diagnosis of medical-surgical cases during pregnancy often meant that appropriate therapy was delayed and that the rate of iatrogenic prematurity was increased.
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PMID:Preeclampsia as the great impostor. 204 5

Mortality and morbidity of diabetic pregnancy have decreased markedly during the last decades. Abortions occur more frequently than in control women. Perinatal mortality has declined, especially in large centers. Morbidity remains important: two thirds of the infants experience some morbidity, mainly due to prematurity and malformations. Among factors of prognosis, careful control of maternal diabetes before conception until delivery is the main point. For each period of pregnancy, a bad glycemic control in the mother is associated with a complication in the infant. Hypertension and diabetic neuropathy are risk factors of prematurity. Congenital malformations become in the large centers the main source of mortality and morbidity in infants of diabetic mothers.
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PMID:[Maternal and fetal prognosis during pregnancy in diabetic women]. 219 59

A review of the literature concerning sport during pregnancy is presented. The mother's heart rate, arterial blood pressure, systolic ejection fraction and cardiac output undergo the same changes during exercise in the pregnant and non-pregnant patient. The increase in the fetal heart rate during maternal physical exercise does not adversely affect the fetal outcome. The uterine blood flow is diminished during exercise. The respiratory rate increases equally in pregnant and non-pregnant women. The maternal response to effort is also modified by weight gain during pregnancy, by changes in the musculo-skeletal system, and by maternal temperature control during exercise. Weight gain, uterine contractility, duration of pregnancy, labour and neo-natal conditions are not altered by sport during pregnancy. Contra-indications to sport during pregnancy include threatened premature labour, and conditions associated with an increased risk of prematurity. A previous history of fetal growth retardation, acute fetal distress, or the presence of diabetes or arterial hypertension is a contra-indication to sport during pregnancy. The advice which should be given to a pregnant woman wishing to continue her sporting activities during pregnancy is outlined.
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PMID:[Sports and pregnancy. A review of the literature]. 208 69

It used to be rare for multiple pregnancies to occur but we have seen a spectacular rise in them in France between 1970 and 1986. Triplet deliveries increased threefold. The authors analyse a personal series of 23 pregnancies (19 triplets, 3 quadruplets and 1 quintuplet pregnancy). Sixteen of these 23 were medically induced. The main complications that have been observed were: threatened premature delivery in 86%, high blood pressure in 34.7%, anaemia in 50%, and urinary tract infections in 30.4%, 6.8% of the babies had congenital malformations. Reviewing the literature has made it possible to discern the epidemiological factors causing multi-fetal pregnancies: family history, high female fertility, maternal age, ethnic factors, hormonal contraception etc... At present it is medically assisted reproduction that is the big supplier of multi-fetal pregnancies in developed countries. We have reviews of several maternal as well as fetal complications: the ovarian hyperstimulation syndrome, extra-uterine pregnancy, hypertension, anaemia, spontaneous abortion, prematurity, intra-uterine growth retardation and malformations.
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PMID:[Multiple pregnancies. II. Epidemiology, clinical aspects]. 219 59


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