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

To determine the values of individual and combined biophysical fetal surveillance tests in a general high-risk population, we examined 1000 consecutive pregnancies complicated by either postdatism, hypertension, intrauterine growth retardation, or diabetes mellitus. Nonstress tests, amniotic fluid pocket measurements, and umbilical artery Doppler velocimetry were performed on each patient; each test was rated against gestational age-adjusted standards. Clinical end points included perinatal mortality, intrapartum fetal distress, 5-minute Apgar score less than 7, and neonatal acidosis in pregnancies without major anomalies or extreme prematurity (age at birth greater than 32 weeks), delivered within 72 hours of final tests. Each testing method had specificity greater than 90%. Sensitivities ranged from 69% (nonstress test) to 21% (Doppler velocimetry). Negative predictive values of each method exceeded 85%; positive predictive values ranged from 81% (nonstress test) to 42% (amniotic fluid measurements). The positive predictive value for any abnormal test was 54% and increased to 100% when all tests were abnormal; this latter condition occurred in only 2% of the total population. Amniotic fluid measurements or Doppler velocimetry, when compared with the nonstress test, appeared to be less powerful "stand-alone" screening tests. The performance of all tests in a single session confers little improvement in detection of fetal compromise if the nonstress test is normal; however, this approach may aid decision-making in the management of pregnancies when fetal maturity is not established.
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PMID:The diagnostic values of concurrent nonstress testing, amniotic fluid measurement, and Doppler velocimetry in screening a general high-risk population. 220 56

The effect of severity of hypertension on fetal heart rate tracing changes and neonatal outcomes was evaluated on all patients with hypertension seen in 1980 and 1981 (666 cases, 10% of the pregnant population) in the Chicago-Lying In Hospital. The patients were grouped according to severity of hypertension, and the fetal heart rate monitoring, drugs administered, mode of delivery, and neonatal outcome were analyzed. Half of the patients (326) had mild hypertension and 13% (87) had severe hypertension; the remainder (253) had moderate hypertension. There were 49% primiparous and 51% multiparous women. The diagnosis of preeclampsia was made in 76% of cases, and chronic hypertension in 19%. Only 12% of the total were premature by dates, but 47% of this group were among the severe group. Oxytocin was given to 50%, whereas delivery was spontaneous in 56% of cases, and by cesarean section in 22%. This was higher among the severe hypertension group (37%), and the prematurity rate was 47%. Nonstress testing was done in one third of cases and only nonreactivity was associated with neonatal death. Neonatal depression (Apgar score less than 6 at 5 minutes) was significantly associated with intrapartum fixed baseline and late decelerations; these were the best predictors of fetal outcome. The administration of magnesium sulfate, hydralazine, meperidine, or morphine did not predictably affect the fetal heart rate pattern. The perinatal mortality was 21% in the mild group and 36% and 138%, respectively, among moderate and severe cases of hypertension. Close antepartum and intrapartum surveillance, including proper fetal monitoring, should help to reduce risks for mother and fetus through timely intervention.
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PMID:Effects of hypertension on pregnancy monitoring and results. 222 Sep 23

Severe pregnancy-induced hypertension complicated by hemolysis, elevated liver enzymes and low platelets (HELLP) is considered an indication for immediate delivery, often resulting in premature or even previable infants. In five cases, temporary reversal of the HELLP syndrome was achieved using low-dose aspirin and corticosteroids. Pregnancy was prolonged an average of 4 weeks; three pregnancies were prolonged, beginning at less than or equal to 25 weeks, for an average of 5.5 weeks. Two of seven infants died, one from pulmonary hypoplasia due to oligohydramnios and the other from complications of prematurity. No long-term maternal morbidity was encountered, though one patient had peripartum disseminated intravascular coagulation and a seizure. A review of the literature supports the usefulness of low-dose aspirin in this setting; the impact of corticosteroids as part of the reversal strategy has not been discussed previously.
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PMID:Prolongation of premature gestation in women with hemolysis, elevated liver enzymes and low platelets. A report of five cases. 229 13

With the objective of determining if specific sexually transmitted diseases (STDs) are associated with prematurity (birth weight less than or equal to 2500 g and gestational age less than or equal to 36 weeks), a case-control study was conducted to evaluate women for serologic evidence of syphilis and human immunodeficiency virus infection and microbiologic evidence of cervical infection with Neisseria gonorrhoeae, Chlamydia trachomatis, and Haemophilus species and vaginal infection with genital mycoplasma, Streptococcus agalactiae, and Enterobacteriaceae. Gram stains of vaginal secretions were evaluated for bacterial vaginosis. Among 166 cases and 175 controls, infection with N. gonorrhoeae was associated with preterm birth. Four percent of controls and 11% of cases were infected with N. gonorrhoeae (odds ratio 2.9, 95% confidence interval 1.2-7.2). This association was independent of age, rupture of membranes, and hypertension. Other STDs were not associated with preterm birth. The attributable risk of gonococcal infection was 14%. Gonococcal infection appears to be responsible for a substantial proportion of premature births and is theoretically preventable by antenatal case detection and treatment.
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PMID:Maternal gonococcal infection as a preventable risk factor for low birth weight. 231 31

The obstetric outcome of 1328 deliveries in a tertiary level hospital was examined, focusing on the results of the women over 35. The study group were all pregnant women over 20 primarily cared for and delivered at the New York Hospital-Cornell Medical Center from September 1984- February 1985, excluding those transferred from other institutions for complications. Among the older women, there was a higher incidence of previous abdominal operations, cesarean sections, previous perinatal death, infertility and alcohol abuse, but relatively few had comorbid conditions or obesity. Most were of higher socioeconomic status and had private physicians. The older group tended to begin prenatal care early, and elect to have amniocentesis. They had a higher risk of gestational glucose intolerance, hypertension and hospitalization during this pregnancy. 45% had cesarean delivery, and their hospital stays were longer. Their rates of vertex presentation, prematurity, postmaturity, macrosomia, induced or augmented labor were similar to those of younger women. There were no maternal deaths. The older group had 1 multiple birth, fewer than the younger women. Perinatal mortality was lowest in the older women. There was 1 intrauterine death and 1 congenital anomaly, lower rates than seen in younger women. This series demonstrates that women over 35 are not at greater risk of adverse pregnancy outcomes if they are cared for early and carefully.
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PMID:Impact of advanced maternal age on the outcome of pregnancy. 238 14

During a 12-year period, 254 cases of eclampsia were managed at this center. Eighty patients (32%) did not have edema, 58 (23%) had "relative hypertension," and 49 (19%) did not have proteinuria at the time of convulsions. Eclampsia developed at less than or equal to 20 weeks in 6 patients and beyond 48 hours post partum in 40 (16%). Convulsions developed in 33 while they were receiving standard doses of magnesium sulfate for preeclampsia during or after birth, and subsequent seizures developed in 36 (14%) after magnesium sulfate therapy was started. There was one maternal death (0.4%) and morbidity was frequent (acute renal failure, 4.7%; pulmonary edema, 4.3%; cardiorespiratory arrest, 3.1%; and aspiration, 2%. The use of multiple drug therapy was associated with significant maternal and neonatal complications. The total perinatal mortality was 11.8%, with the majority of them related to either abruptio placentae or extreme prematurity. These findings emphasize the need for intensive monitoring of women with preeclampsia throughout hospitalization and underscore the importance of maternal stabilization before and during transfer.
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PMID:Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. 240 30

Cesarean section (CS) rates for primiparas, multiparas with and without previous CS were investigated in seven obstetrical settings. Despite the great diversity of global CS rates (5.3 to 17.4%), common CS odds ratios of 3.0 and 37 have been found for primiparas and multiparas with previous CS, respectively. Internal links between CS odds ratios have also been investigated for some anomalies associated with CS (fetal distress, non-vertex presentation, hypertension, dystocia, small for dates new born and prematurity), suggesting that perinatal services may be evaluated on CS aspects according to a single general interventionist/conservative clinical attitude. Data from two additional obstetrical settings were used to verify the findings in terms of perinatal evaluation.
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PMID:Cesarean section odds ratios. 240 65

Using continuous wave Doppler ultrasound, we studied the umbilical and uterine flow velocity waveforms in 68 pregnant women who had chronic hypertension and/or preeclampsia. The systolic-diastolic (S/D) ratio was considered an expression of vascular resistance peripheral to the point of insonation. Abnormal umbilical artery S/D ratio (greater than 95th percentile) alone or with abnormal uterine artery S/D ratio was associated with poor pregnancy outcome as judged by incidence of intrauterine growth retardation (IUGR), cesarean section rate, birth weight, perinatal morbidity and mortality, and prematurity. In patients with preeclampsia and abnormal Doppler values, pregnancy outcome was poor, whereas in those with normal Doppler values, pregnancy outcome approached normal. The same relationship was also found in patients with chronic hypertension. The sensitivity and specificity for the prediction of IUGR by the umbilical artery S/D ratio alone was 71% and 93%, respectively. The uterine artery S/D ratio alone yielded a 66% sensitivity and 64% specificity, and when both tests were taken into account, the sensitivity increased to 75% and the specificity to 100%. Abnormal umbilical and uterine artery S/D ratios were associated with 100% IUGR and 25% perinatal mortality. We conclude that in pregnant women with hypertensive disorders there is a significant difference in pregnancy outcome between those with normal and those with abnormal Doppler values. Umbilical artery S/D ratio alone is a better predictor of IUGR and poor pregnancy outcome than the uterine artery S/D ratio.
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PMID:Uterine and umbilical artery flow velocity waveform analysis in pregnancies complicated by chronic hypertension or preeclampsia. 240 30

Six thousand, one hundred and thirty-five consecutive live births in six major health centres in the city of Ibadan were studied between September 1982 and March 1983 in order to assess the incidence, distribution and causes of low birthweight (LBW) in an urban community in Nigeria. Of the 6135 live births, 504 (8.2%) were of LBW. Two hundred and thirty-six (62%) of the LBW were small-for-gestational-age (SGA), while 146 (38%) were appropriate-for-gestational-age (AGA). Two hundred and five (87%) of the SGA were term while 115 (79%) of the AGA infants were preterm. Multiple pregnancy was an important cause of LBW, occurring in 4.4% of pregnancies. One hundred and forty-six (2.6%) of the 5631 infants who weighed 2500 g or over and 122 (24.2%) of the LBW infants were products of multiple pregnancy (P less than 0.001). The young (less than 20 years), short statured (less than 155 cm) and primigravid mothers were more likely than the others to give birth to LBW infants (P less than 0.001). Of the obstetric and medical factors examined, pre-eclamptic toxaemia (PET) (P less than 0.01), ante-partum haemorrhage (APH) (P less than 0.01) and anaemia (P less than 0.02) significantly increased the risk of LBW. Pre-eclamptic toxaemia, eclampsia, hypertension and renal diseases tended to be associated with SGA while APH and anaemia were found more often with prematurity. Multiple pregnancy contributed equally to the delivery of preterm and growth-retarded infants. Although no obvious cause could be identified in about two-thirds of the cases, pre-conceptional maternal malnutrition and poor diet in pregnancy might play an important role.
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PMID:Low birthweight in an urban community in Nigeria. 240 6

In a population of 134 hypertensive pregnant women, 66 per cent of whom had chronic (permanent) arterial hypertension, the frequency of essential hypertension in the pregnant women's fathers or mothers was 60 per cent. The rate of unfavourable foetal outcome, i.e. late abortion, still-birth, neonatal death, birth weight below 1,500 g, severe prematurity or severely stunted growth, was 21 per cent. This rate was the same in the presence or absence of a family history of essential hypertension. It was higher in women with hypertension in pregnancy than in women with chronic hypertension (30 vs 16 per cent; p less than 0.05), but a family history of hypertension (mostly in the mother) was more frequent among pregnant women with chronic hypertension (69 vs 43 per cent; p less than 0.01). A multivariate analysis of the entire population studied showed that a family history of hypertension was not an independent variable predictive of foetal outcome; however, hypertension in the father was such a variable. The influence of family history of hypertension on the foetal outcome was studied separately in women with chronic hypertension and in those with hypertension in pregnancy. The results showed statistically significant differences the other way round: a better foetal outcome was observed in cases of hypertension in pregnancy with a family history of hypertension (more rarely associated with pre-eclampsia), and a poorer foetal outcome was observed in cases of chronic hypertension with a similar family history (mostly in the father, and associated with a more severe hypertension). This study suggests that a family history of essential hypertension and the type of hypertension observed in the patient must be taken into account when evaluating the severity of hypertension in pregnant women.
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PMID:[Relations between family history of essential hypertension and fetal prognosis in hypertension in pregnancy]. 253 33


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