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

A retrospective analysis was undertaken of 128 pregnancies (131 infants) complicated by diabetes; 66 (51 per cent) were Class A and 62 (49 per cent) Class B-D-F-R. 53.9 per cent of all infants were large for gestational age (LGA) and there were no differences between the classes of diabetics. LGA infants occurred with equal frequency in those diabetic patients with pregnancy-induced or chronic hypertension. Congenital anomalies occurred in 9.7 per cent with 11/12 in Class A, B, or C. Major neonatal morbidity included: 1) hypoglycemia: two (3 per cent) Class A and 21 (32.8 per cent) insulin-dependent mothers (P less than 0.01); and 2) respiratory distress syndrome: seven (5.3 per cent) and all were in classes B-F (P less than 0.05). Modern management of diabetes in pregnancy has, for unknown reasons, increased the incidence of LGA infants.
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PMID:Large for gestational age: dilemma of the infant of the diabetic mother. 350 63

A case of a woman with pneumococcal peritonitis 3 months after insertion of a Nova-T copper IUD is described and the 5 other cases in the literature are reviewed. The 38-year old woman was multiparous, and had no related history other than recurrent right nephrolithotomy. She had acute peritonitis of 8 hours duration when admitted, with acute abdominal pain, fever, tachycardia and hypertension. She was treated with penicillin, gentamycin and chloramphenicol, and the IUD was removed. Her blood pressure fell to 70/40 and she developed acidosis and septic shock. Laparotomy, drainage, continued antibiotics, artificial ventilation and intensive hemodynamic treatment for 3 days were necessary to reverse coma and respiratory distress. Primary pneumococcal peritonitis only occurs in girls; in women it is though to arise from IUDs, pelvic infection or perhaps from the bowel. The other cases showed no preference for any type of IUD (3 Lippes loops, 1 Dalkon shield and 1 Gravigard) or length of use (1.5-5.5 years). 1 of the women died, and another had recurrent pneumococcal peritonitis. Therapy should include surgical drainage, instillation of antibiotics, and removal of the IUD.
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PMID:Severe pneumococcal peritonitis complicating IUD: case report and review of the literature. 354 5

Renal transplantation is usually accompanied by an improvement in reproductive function. The possibility of conception in women of childbearing age emphasizes the need for counseling, and couples who want a child should be encouraged to discuss all implications, with the advice based on strict guidelines. If a recipient becomes pregnant, she must be monitored as a high-risk patient. Management requires particular attention to BP control, renal function, and all infection, as well as fetal surveillance. Just under 40% of conceptions do not go beyond the first trimester, but of those that do, greater than 90% end successfully. In most patients, renal hemodynamics improve during gestation, but permanent impairment occurs in 15% of pregnancies. Other patients may experience transient deterioration in late pregnancy (with or without proteinuria). Patients have a 30% chance of developing hypertension, preeclampsia, or both. Despite its pelvic location, the transplanted kidney rarely produces dystocia and experiences no apparent mechanical injury during vaginal delivery. Thus, cesarean section should be reserved for obstetric reasons only. Aseptic technique, bacterial prophylaxis even for trivial surgery, and steroid augmentation are necessary. Preterm deliveries occur in 45% to 60%, and intrauterine growth retardation in at least 20%, of gestations. Neonatal complications include respiratory distress syndrome, leukopenia, thrombocytopenia, adrenocortical insufficiency, and infection. No predominant or frequent developmental abnormalities have been described, and data on infancy and childhood are encouraging. Future goals should be to improve prepregnancy assessment criteria, to reassess the rationale and implications of immunosuppression during pregnancy, and to monitor the remote effects of pregnancy on both renal prognosis and the offspring.
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PMID:Renal transplantation and pregnancy. 355 13

Renovascular hypertension is more common in hypertensive children than in hypertensive adults, and renal artery stenosis is second only to coarctation of the thoracic aorta as a cause of surgically correctable hypertension. Three infants presented with uncontrollable hypertension secondary to renal artery thrombosis due to umbilical artery catheterization for respiratory distress in the neonatal period. They all responded to nephrectomy. A fourth infant had stenosis of a polar vessel secondary to umbilical artery catheterization and was cured by partial nephrectomy. Two infants with renal artery stenosis secondary to fibromuscular dysplasia benefited from revascularization and, at last follow-up, were normotensive and off all blood pressure medication. Ultrasonography, isotope scanning, angiography and selective renal vein renin assays should be used to identify patients with surgically correctable lesions. The use of fine suture material and microvascular surgical techniques, including ex vivo revascularization and autotransplantation, can salvage renal parenchyma and relieve hypertension. Infants with less than 10 percent renal function on the involved side should have a nephrectomy. The infant with an umbilical arterial catheterization line needs blood pressure monitoring and aggressive evaluation and treatment of persistent hypertension.
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PMID:Early diagnosis and management of renovascular hypertension. 355 43

This study attempted to determine if placental size has implications for fetal/neonatal health and for subsequent childhood growth and development. 38,351 placentas were trimmed and weighed in a standardized way. The following factors were found to be associated with low placental weight: low maternal pregravid body weight, low pregnancy weight gain, high maternal hemoglobin levels during pregnancy, gestational hypertension, paid employment outside the home during pregnancy, and low parity. Taking these factors into consideration, placentas that were underweight for birth weight were associated with high hemoglobin values in neonates and lower-than-expected body size in later childhood. Overweight placentas, largely a result of villous edema, were associated with the following neonatal evidences of acute antenatal hypoxia: low Apgar scores, the respiratory distress syndrome, neurologic abnormalities, and neonatal death. Some of the neurologic abnormalities persisted so that at patient age of 7 years, they were 33 per cent more frequent when placentas had been overweight than when they had been of normal weight (P less than .001).
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PMID:Do placental weights have clinical significance? 355 41

We measured cardiopulmonary function at rest and during exercise in 15 healthy survivors of neonatal respiratory distress syndrome (RDS) and compared the results with those in 15 normal subjects. The mean birth weight of the RDS group was 1,771 g, and 12 of the 15 patients had required endotracheal intubation. The oxygen scores ranged from 79 to 3,322. Five of the 15 RDS patients had abnormal results of pulmonary function studies at rest. Peak expiratory flow was lower (P less than 0.05) in the RDS group (2.98 liters/min) than in the control group (3.57 liters/min). A negative correlation was noted between the forced expiratory flow between 25 and 75% of vital capacity and the oxygen score in these patients. Exercise tolerance was below normal in two of the RDS patients, both of whom also had abnormal pulmonary function at rest. One patient in the RDS group had systemic arterial hypertension at rest and during exercise. No significant differences in exercise tolerance or the cardiorespiratory response to exercise were observed between the two groups.
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PMID:Cardiorespiratory function in asymptomatic survivors of neonatal respiratory distress syndrome. 360 40

The most frequently used set of gestational age-birth weight curves in the United States is the Colorado (C) standard published in 1963. To investigate the usefulness of this standard in an urban population at sea level, we examined the birth weight vs gestational age data from 56,675 singleton liveborn infants born between 1982 and 1985 in the University of Illinois (UI) perinatal network of 13 hospitals. Between 32 and 42 weeks, the UI 10th, median, and 90th percentile weights were significantly higher than those of Colorado. At term gestations the Colorado 10th and 90th percentile weights were the same as the UI 3rd and 80th percentile weights, respectively. Using the UI and Colorado standards for 10th and 90th percentile weights, the study sample was divided into five subgroups. To evaluate the risk prevalence, we examined the frequency of neonatal death, low, and very low Apgar scores (below seven and three, respectively), respiratory distress, maternal hypertension, and diabetes in the five subgroups. The highest frequency of adverse factors was seen in infants classified as small for gestational age (SGA) by both standards, but overall, the size-for-gestation grouping was better accomplished using the UI rather than the C standard. In 9188 infants (16.2%) classified into wrong weight-gestation subgroups using the Colorado standard, the prevalence of actual risk factors was at variance with the group to which they were assigned. This included 3632 (6.4%) SGA infants who were grouped as appropriate for gestational age (AGA), and 5556 (9.8%) AGA infants grouped as large for gestational age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Birth weight and gestational age standards based on regional perinatal network data: an analysis of risk factors. 360 60

The differential leukocyte count was studied within the first 24 hours of life in 115 infants of diabetic mothers (IDMs) appropriate for gestational age (AGA), 16 IDMs large for gestational age (LGA), 104 infants of non-diabetic mothers (INM's) AGA, and 22 INMs-LGA. A significant "shift to the left" was found in IDM's-LGA only. The usual cause of "shift to the left" such as maternal hypertension or fever, respiratory distress syndrome, meconium aspiration, neonatal asphyxia, sepsis, convulsions, or hypoglycemia could not explain this finding. It is hypothesized that increased glucocorticoid secretion may possibly play a role.
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PMID:Differential leukocyte count in infants of diabetic mothers. Increased band count associated with macrosomia. 373 70

We investigated the antidiuretic hormone (ADH) response in 12 infants with bronchopulmonary dysplasia during acute respiratory distress. All of the infants had hypoxemia with air-trapping in the chest at the time of admission to the hospital. None had documented infection. There was a dramatic increase in the plasma levels of ADH during acute respiratory distress, with a subsequent reduction of levels toward normal when the respiratory distress decreased to the preadmission well state. Three of 12 infants manifested hyponatremia at 24 hours after admission, with two of them exhibiting persistent hypertension for up to three days. The mechanism for elevated ADH levels is air-trapping in the chest, causing pulmonary hypovolemia and decreased left atrial filling and/or decreased transmural pressure of the left atrium.
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PMID:Antidiuretic hormone response in children with bronchopulmonary dysplasia during episodes of acute respiratory distress. 375 83

In an open, controlled trial, treatment with a combination of metoprolol and hydralazine was compared with non-pharmacological management of mild and moderate hypertension in pregnancy. One hundred and sixty-one women participated in the study. The drug-treated group showed significantly better blood pressure control than the group not given antihypertensives. Induction of labor before term, because of maternal or fetal complications, was somewhat more frequent in the control group. Nine women in the treatment group and 5 in the control group developed albuminuria. Three infants in the drug-treated group died perinatally, and one in the control group. The outcome for the newborns was similar in both groups concerning birth weight, head circumference and Apgar score and in the frequencies of respiratory distress, bradycardia and hypoglycemia. The better blood pressure control achieved with these drugs makes it possible to treat the patient at home and reduce the risk of emergency delivery, but treatment does not seem to be mandatory for a good outcome of the pregnancy in cases of mild and moderate hypertension during pregnancy.
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PMID:A prospective controlled trial of metoprolol-hydralazine treatment in hypertension during pregnancy. 390 22


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