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

It is possible to induce labour in pathological pregnancies after artificial ripening of the cervix. The present study concerns 70 patients (45 primipara, 25 multipara). The main pathologies are hypertension of pregnancy and pregnancies past dates. Prostaglandin F2 alpha has been used with a Tylose gel containing 5 mg of PGF2 alpha introduced by the extra-amniotic route. The cervical change was noted using Bishop's score. The mean increase of the cervical score was 0.8 with the first PGF2 alpha gel. The total mean increase was 1.2. Two cases of hyperstimulation of the uterus were observed and they led to Caesarean section. Prostaglandin gel induced labour in 56% of the patients. The mean time between the introduction of the gel and the delivery was 14 h for primipara and 10 h for multipara. Other patients were induced with oxytocin on the following day. Epidural analgesia was widely used in this study (in 64% of cases). The mean duration of labour was 6 h 10 for primipara and 4 h 30 for multipara. 30% of the patients needed Caesarean section but there was a marked difference between primipara (36%) and multipara (4%). After a review of the literature the authors conclude that it is useful to ripen the cervix prostaglandin but, as foreign authors do, they think that PGE2 should be more efficient.
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PMID:[Maturation of the cervix uteri using prostaglandin F2 alpha before induction of labor in pathologic pregnancies]. 657 95

A case is presented of a 32-year old gravida 3, para 1, ab 1, presented at 26 weeks with chief complaints of periorbital edema, headaches, and blurred vision for about 1 week. 2 weeks prior to admission she had experienced shortness of breath and decreased fetal movement. Admission was at 28 weeks with uncontrolled hypertension, blood pressure 190/120, pulse 100/min. Temperature was 98.8 degrees. Attempted induction of labor with oxytocin was unsuccessful. A hydralazine infusion decreased the blood pressure to 180/100 and a 20 mg prostaglandin (PG) E2 suppository was inserted. A few hours later the blood pressure had dropped to 100/60 and the hydrazaline infusion was discontinued. About 3 hours later a stillborn female infant was born; post delivery examination revealed a large gap in the wall of the uterus extending into the lateral vaginal fornix. A total abdominal hysterectomy and right salpingo-oophorectomy was then performed and recovery was uneventful. PGE2 reliably initiates labor even in the presence of an "uninducible cervix" and is prone to increase intrauterine pressure to a level beyond that of normal labor with a lag in cervical changes. The 2 most common traumata reported following PG administration for therapeutic abortion are either cervico-vaginal fistulas or lateral tears. In this case since there was no indication of any congenital weakness of the uterine wall, it is reasonable to assume that the mechanism leading to the rupture was intense and prolonged uterine contractions combined with a rigid cervix.
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PMID:Uterine rupture associated with the use of vaginal prostaglandin E2 suppositories. 658 51

The potential role of central neuroendocrine changes in the development of spontaneous hypertension was evaluated. The developmental changes in blood pressure and hypothalamic and plasma levels of vasopressin (AVP) and oxytocin (OT) were determined in groups of SHR and WKY animals from 3 to 24 weeks of age. Hypothalamic OT content was significantly lower in 3-, 6-, and 12-week-old SHR rats compared to age-matched WKY animals. Hypothalamic AVP content was not different at 3 weeks of age, but was lower in the SHRs at 6 and 12 weeks. To localize strain differences in AVP and OT, specific hypothalamic nuclei were removed from 300 microns frozen brain sections, and hormone content measured. Paraventricular AVP and OT content was lower in the SHRs which had increased blood pressure (6, 12, and 24 weeks of age) but not in the prehypertensive groups (3 weeks of age). Neuropeptide content was unchanged in the supraoptic nucleus or median eminence. Plasma levels of AVP were increased in the SHR, while OT was unchanged. Thus, genetic hypertension is associated with specific and localized changes in hypothalamic AVP and OT. The fact that the peptide deficit occurred in the paraventricular nucleus, a region thought to be involved in the control of autonomic function, may have important implications in terms of the pathogenesis of hypertension.
Hypertension
PMID:Changes in paraventricular vasopressin and oxytocin during the development of spontaneous hypertension. 686 74

Experiments were performed to evaluate the effect of dehydration on neurohypophyseal hormone secretion, both vasopressin and oxytocin, fluid balance, and blood pressure in male spontaneously hypertensive rats (SHR) and their normotensive controls, Wistar Kyoto (WKY). Metabolic studies showed that the antidiuretic response to dehydration (24 and 48 hours of water deprivation) was significantly depressed (p less than 0.01) in the hypertensive animals. They responded inappropriately to dehydration with a greater loss of water and sodium and a larger increase in hematocrit. In contrast, the vasopressin response (both urinary excretion and plasma levels) was increased. The peak plasma levels were 25.3 pg/ml (SHR) compared to 16.6 pg/ml (WKY), while the urinary excretion was 22.5 ng/24 hrs (SHR) vs 9.0 ng/24 hrs (WKY). Dehydration also elicited a stimulation of oxytocin secretion, with no differences observed in the responses of the groups. Blood pressure was significantly greater in the SHR and it did not change during dehydration. These results provide further support for the idea that hypertension is associated with abnormalities in the control of fluid/electrolyte balance.
Hypertension
PMID:Neurohypophyseal response to dehydration in the spontaneously hypertensive rat. 706 Nov 23

1 The cardiovascular effects of intravenous and intracisternal administration of neurohypophysial peptides were compared in dogs anaesthetized with chloralose. 2 Intravenous lysine-vasopressin (0.1 to 100 mu/kg) induced a dose-dependent increase in blood pressure and a decrease in heart rate. In contrast, intracisternal lysine-vasopressin (0.01 to 10 mu/kg induced a dose-related decrease in blood pressure and did not change heart rate. 3 Intracisternal oxytocin (1 and 10 mu/kg) increased blood pressure and did not change heart rate, whereas the same doses injected intravenously were inactive. 4 Pretreatment with guanethidine (15 mg/kg i.v. 24 h beforehand) abolished the hypotensive responses to intracisternal vasopressin but not the pressor action of intravenous vasopressin. 5 The pressor responses to central injections of oxytocin were not modified by guanethidine. 6 Hypotension elicited by intracisternal vasopressin was probably due to a decrease in sympathetic tone whereas the hypertension induced by intracisternal oxytocin was independent of variations in sympathetic tone.
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PMID:Effects of lysine-vasopressin and oxytocin on central cardiovascular control. 712 97

Labor was induced with oral prostaglandin (PGE2) without amniotomy in 20 patients (10 nulliparae and 10 multiparae) with hypertension, whether or not associated with edema and/or proteinuria. An average dose of 8 mg was required to achieve effective uterine contractility in both nulliparae and multiparae. Multiparae required only a mean dose of 12 mg but nulliparae a dose of 18 mg to achieve delivery. The mean duration of labor was slightly longer in both nulliparae and multiparae than that achieved with fast escalating doses of i.v. oxytocin. The need for analgesia was greater in oxytocin-induced patients than in the prostaglandin-induced patients. Otherwise no differences were found between the two groups.
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PMID:Comparison of oral prostaglandin E2 and intravenous oxytocin for induction of labor in hypertensive pregnancies. 718 29

A retrospective study has been undertaken to assess the diagnostic value of plasma estriol (E3) determinations, as compared with determinations of other biochemical parameters, in predicting the outcome of pregnancy. The normal levels of plasma unconjugated and total E3 were determined on weekly samples obtained during the third trimester of 258 normal pregnancies. Weekly concurrent specimens of plasma and 24-hour urine collections were obtained from 17 high-risk pregnancies associated with hypertension, intrauterine growth retardation and diabetes. Determination of plasma unconjugated and total E3 were made along with human placental lactogen (HPL), urinary E3, and other biophysical parameters such as the oxytocin challenge test, non-stressed test, ultrasonography, etc. The results of plasma E3 were not reported nor used for the clinical management of the patient. The data suggests that weekly plasma determinations were of little value in the assessment of feto-placental status. Some observations on the extent of variability of plasma E3 are discussed.
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PMID:Plasma estrogens in the assessment of fetoplacental function. 729 20

The oxytocin challenge test (OCT) has been shown in other studies to be valuable in evaluating high-risk pregnancies. The purpose of this study was to show the relationship of various disease states and clinical conditions with OCT results and fetal performance in labor. Of a group of normal patients, 4% had positive OCTs or late decelerations (LDs) in labor. The incidence of positive OCTs or LDs in labor in patients with diabetes mellitus (DM) class B-R was 23.2%; in DM class A, 27.6%; in intrauterine growth retardation (IUGR), 26.2%; in pregnancy-induced hypertension (PIH), 27.6%; in chronic hypertension (CH), 13.6%; and in prolonged gestation, 10.8%. This study shows that DM of all classes, IUGR and PIH are the most likely conditions in which persistent LDs will occur.
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PMID:Electronic monitoring evidence of fetal distress in high-risk pregnancies. 737 91

Based on analyses of the oxytocin challenge test (OCT) in 293 cases, an OCT-reactivity classification is proposed to improve the predictive value of OCT for fetal outcome. All of the 6 perinatal deaths occurred in the 2 groups associated with nonreactive pattern. The positive nonreactive test had 90% accuracy of predicting a sick infant, and the negative reactive test assured good fetal outcome. A nonreactive pattern seems to reflect a compromised fetus, as a high incidence of this pattern was found in patients with pre-eclampsia-hypertension, intrauterine growth retardation (IUGR), low and falling estriol levels, and suspected fetal problems. A positive OCT seems to reflect the limits of fetoplacental reserve under the stressed condition. A high incidence of positive OCT was associated with IUGR, low estriol levels, and a small placenta.
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PMID:An OCT-reactivity classification to predict fetal outcome. 738 82

Obesity has been associated in the literature with other pregnancy risks such as hypertension and diabetes mellitus, but disagreement persists about the expected course and complications of labor. Also, the effects of obesity on intrauterine growth and gestational duration have not been well defined. This study of 2746 consecutive deliveries used a computer-based uniform perinatal record to compare 300 pregnancy risk and outcome factors for obese and nonobese patients. The 279 obese women (more than 90 kg at some time during the pregnancy) were found to be older and of higher parity than the 2467 who were not obese. Those in the obese group were at increased antepartum risk and had increased frequencies of chronic hypertension, inadequate pregnancy weight gain, twin gestation, and diabetes mellitus. Oxytocin induction and repeat cesarean sections were performed more frequently for the obese patients, with no increase in complications during the current labor. The frequency of labor abnormalities, oxytocin augmentation, and primary cesarean section was similar to that of the comparison group. Examination of infant outcome revealed similar Apgar scores and perinatal mortality in the 2 groups, but fewer low-birth-weight infants (under 2500 g) and more macrosomic babies (over 4000 g) occurred in the obese population. This increase in birth weight was accounted for not only by an increase in the birth weight percentile, but also by a significant lengthening of the period of gestation.
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PMID:Obesity in pregnancy: risks and outcome. 742 89


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