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The coagulation and fibrinolytic mechanisms were investigated in a group of patients with severe pre-eclampsia and eclampsia and the findings were compared with those of healthy women in late pregnancy. In patients with pre-eclampsia the following significant differences were found: (1) greater depression of plasma fibrinolytic activity (euglobulin lysis time) than in normal pregnancy, (2) a higher level of inhibitor to urokinaseinduced lysis, (3) increased levels of serum fibrin degradation products, and (4) reduced platelet counts.In patients with eclampsia a progressive increase of the level of serum fibrin degradation products was found over the three days following eclamptic seizures. No such increase occurred after grand mal seizures in late pregnancy. The findings in this study support the view that intravascular clotting is taking place in pre-eclampsia and that this disturbance of the balance between coagulation and fibrinolysis may be localized to certain areas of the vascular compartment, particularly the placental and renal circulations. Fibrin deposition in the maternal vessels supplying the placenta would impair the placental blood flow, which may explain the placental insufficiency which occurs in pre-eclampsia. Likewise fibrin deposition in the renal vasculature will result in glomerular damage and proteinuria. Hypertension may be related to the renal ischaemic changes or a compensatory response to the presence of fibrin deposition in the vascular compartment. This evidence of intravascular fibrin deposition raises the question of the possible therapeutic value of antithrombotic agents to inhibit the clotting process. On a theoretical basis such treatment might be expected to improve blood flow to the placenta and thereby fetal growth.
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PMID:Coagulation and fibrinolytic systems in pre-eclampsia and eclampsia. 499 19

Recovery of gonadotropin-secreting function of the pituitary has been studied in 4 puerperal women with episodes of eclampsia during the last pregnancy, delivery and/or the first 24 hours after delivery. On day 20 postpartum, hypertension, edema and proteinuria were improved in all the puerperal women. Serum FSH and LH responses to LH-RH on day 20 postpartum in 3 puerperal women with less than 6 eclamptic attacks during pregnancy or delivery were at a comparable level to those on day 20 postpartum in 4 puerperal women with premature labor between 31 and 33 weeks' gestation and in 9 normal puerperal women. Serum FSH response to LH-RH on day 20 postpartum in a puerperal woman with 10 eclamptic attacks during pregnancy and the first 24 hours after delivery was lower than those in 4 puerperal women with premature labor and in 9 normal puerperal women. In the puerperal woman with 10 eclamptic attacks, the lowered FSH response to LH-RH on day 20 postpartum was apparently improved on day 55 postpartum. However, the FSH response to LH-RH on day 55 postpartum was still lower in the puerperal woman with 10 eclamptic attacks than in 7 normal puerperal women. These results indicate that many eclamptic attacks during pregnancy, delivery and/or the first 24 hours after delivery may cause perturbation to some extent in recovery of FSH-secreting function of the pituitary during the puerperium.
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PMID:[Recovery of gonadotropin-secreting function of the pituitary in the puerperal women with eclampsia]. 642 68

A new case of the rare association of scleroderma and pregnancy is reported. The pregnancy was complicated by renal failure in the last month of gestation which was initially well controlled by anti-hypertensive therapy but then suddenly progressed to pre eclampsia with signs of foetal distress necessitating emergency caesarian section. A moderately hypotrophic child was delivered. The mother progressively recovered; diuresis and blood pressure returned to normal and the proteinuria disappeared. In the light of previously reported cases and of recent advances in our knowledge of scleroderma, especially scleroderma renal disease, the authors discuss their attitude to the management of women with scleroderma wishing to become pregnant. They review the role and place of renal biopsy in the detection of subclinical renal lesions due to the scleroderma, the presence of which would be a decisive factor in assessing the risks of pregnancy. Scleroderma renal disease is, in fact, a major contraindication to pregnancy because of the very poor foetal prognosis and the risk of maternal death due to a lethal progression of renal failure.
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PMID:[Scleroderma and pregnancy. New case and review of the literature]. 650 47

A toxemia-like syndrome was induced in pregnant beagles by intraperitoneal inoculation of concentrates prepared from placentas of patients with preeclampsia-eclampsia and hydatidiform mole, which contained an agent, Hydatoxi lualba, that stained in a unique fashion with toluidine blue-O-. The pregnant dogs inoculated with either of these concentrates progressively developed hypertension, eyeground changes consistent with hypertensive retinopathy, proteinuria, disseminated intravascular coagulation, and hepatic dysfunction in addition to intrauterine growth retardation and intrauterine fetal death. Hepatic periportal hemorrhage and glomeruloendotheliosis, lesions usually seen in preeclampsia-eclampsia, were also noted to occur in pregnant beagles inoculated with these concentrates. A significant increased sensitivity to angiotensin II infusion was also noted. The toxemia-like syndrome did not develop in pregnant beagles when inoculated in a similar fashion with concentrates prepared from placentas from normal term pregnancies which were free of Hydatoxi lualba or in nonpregnant beagles inoculated with concentrates containing Hydatoxi lualba. Although the agent was not injected in pure form, the inoculation of concentrates containing Hydatoxi lualba appears to be required for the manifestation of the toxemia-like syndrome.
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PMID:Experimental induction of a toxemia-like syndrome in the pregnant beagle. 684 42

Three symptoms define the renovascular syndromes during pregnancy: hypertension, edemas and proteinuria. It is essential to detect them as soon as possible during the antepartal examinations. The directions for treatment consist in simple acts which are easy to perform in overseas conditions. They intend to prevent very serious disorders such as abruptio placentae and eclampsia which should not be found any longer.
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PMID:[Detection and treatment of renovascular syndromes of pregnancy excluding their progressive complications]. 685 26

In a consecutive series of 1,201 singleton pregnancies with pre-eclampsia, the onset occurred during labour in 290 (24.1%). There was no difference between the primiparous and parous patient in this respect (25.9% v 20.7%; P less than 0.10). The tendency for pre-eclampsia to develop during labour increased with advancing maturity of the pregnancy and seldom occurred before 38 weeks of gestation; this was again equally true of the primiparous and parous patient, as was the incidence of severe hypertension (diastolic pressure greater than 110mm Hg) (36.1% v 34.1%). The high incidences of severe hypertension (35.5%), proteinuria (41.7%), and eclampsia (2.1%), and the 1 maternal death testified to the severity of the disease process and the need for aggressive management. After delivery, the clinical signs tended to subside rapidly, but the early third stage of labour was a time of maternal risk, irrespective of whether ergometrine or Syntocinon was the oxytocic agent administered. Analysis of perinatal results showed that the risk to the fetus was minimal.
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PMID:Labour-onset pre-eclampsia. 694 18

The diagnosis of preeclampsia is often erroneous in primigravidas and usually so in multiparas. Gestational hypertension, defined as acute hypertension without proteinuria or abnormal edema, is often misdiagnosed as mild preeclampsia. Several follow-up studies are cited as evidence for the conclusions that (1) eclampsia and "true" preeclampsia seldom if ever cause chronic hypertension in women who otherwise never would have developed it; (2) gestational hypertension often is a sign of latent essential hypertension unmasked by pregnancy, and as such it often portends later chronic hypertension; and (3) normotensive pregnancies indicate a low prevalence of later chronic hypertension, and if it does develop, it usually does so at an age later than the average time of onset.
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PMID:The remote prognostic significance of the level of blood pressure in pregnancy. 700 Apr 71

The clinical and renal biopsy findings in a group of 12 patients with mesangial IgA nephropathy who had 22 pregnancies are recorded. Seventeen pregnancies were successful. Hypertension was noted in 9 pregnancies and in 12, features of pre-eclamptic toxaemia developed. One patient had post-partum eclampsia. Proteinuria tended to increase during pregnancy and one patient developed nephrotic syndrome which resolved after delivery. Glomerular lesions in these women differed from those in non-pregnant patients with mesangial IgA nephropathy. Focal and segmental proliferative and hyalinosis-sclerosis changes were seen far more frequently than is usual in biopsies from patients with mesangial IgA nephropathy, suggesting that focal and segmental lesions develop during pregnancy.
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PMID:Mesangial IgA nephropathy in pregnancy. 700 Apr 72

The clinical diagnosis of preeclampsia is often erroneous, for it may be confused with latent hypertension, acute or chronic renal disease, or frank essential hypertension that had abated during much of pregnancy. Eclampsia and "true" preeclampsia run in families with a frequency suggesting that a single recessive gene may be responsible. Eclampsia and "true" preeclampsia do not cause chronic hypertension, whatever their durations. Gestational hypertension is merely hypertension without proteinuria or abnormal edema. It often has been the basis for the diagnosis of mild preeclampsia, although renal biopsy samples almost never show the characteristic lesion in the absence of proteinuria. Gestational hypertension is often a sign of latent hypertension unmasked by pregnancy. Women with gestational hypertension ultimately have a high prevalence of chronic hypertension, whereas all those whose pregnancies are normotensive ultimately have a low prevalence.
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PMID:Hypertension in pregnancy: definitions, familial factor, and remote prognosis. 700 1

A rise in arterial pressure above 140 mmHg systolic or 85 mmHg diastolic is pathological in pregnant women. Such changes may either reveal chronic hypertension or constitute a purely gestational complication. The persistence or regression of abnormally high BP values 3 months after delivery retrospectively indicates whether the hypertension was chronic or pregnancy-related. When BP values are very high (diastolic above 110 mmHg) the mother is exposed to vascular accidents and the most effective anti-hypertensive drugs are required. In the more common moderate hypertension, both the mother (eclampsia) and the foetus (intra-uterine or neonatal death, low birth-weight) are at risk. The risk is better predicted by proteinuria and hyperuricaemia than by the BP values themselves, and whether anti-hypertensive drugs are warranted is uncertain. Studied comparing patients with treated and untreated moderate hypertension have yielded two valuable results: (1) methyldopa administered to the mother is harmless to the foetus, and (2) abortion during the second trimester of pregnancy is probably prevented when methyldopa is prescribed against chronic hypertension. No study has yet afforded evidence that the use of anti-hypertensive drugs in gestational hypertension benefits the foetus. Further therapeutic trials and a better knowledge of the natural history and mechanisms of hypertension in pregnancy are required before adequate management of this condition can be determined.
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PMID:[Kidneys, hypertension and pregnancy. II. Hypertension in pregnancy: significance, prognosis, and treatment (author's transl)]. 709 40


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