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Query: UMLS:C0033687 (proteinuria)
 24,015 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Data from 38,636 pregnant women were studied to determine the best criteria for diagnosing pregnancy hypertension based on the constellation of clinical factors yielding poorest perinatal and long-term results to the offspring. It was found that the combination of maximum diastolic blood pressure and maximum proteinuria, as observed during the interval 28 weeks to term, provided the closest correlation with outcome. This information offered an objective means for establishing a classification of hypertension-hypotension in late pregnancy.
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PMID:Hypertension-hypotension in pregnancy. Correlation with fetal outcome. 65 Aug 4

In a prospective study regarding conservative treatment of mild to moderate hypertension in pregnancy 5244 women were evaluated at delivery. Two hundred and fifty-eight (4.9%) were registered as hypertensive during pregnancy with a blood pressure (BP) greater than or equal to 140/90 mmHg. One hundred and ninety-six of these continued their pregnancy without medication and 96/196 were defined as preeclamptic (PE), 45/196 as chronic hypertensive (CH), and 55/196 as having gestational hypertension (GH). In 62/258 women antihypertensive treatment was initiated in the mean 6.5 (+/- 8.7) days after onset of hypertension, due to a BP greater than or equal to 150/100 mmHg. There was a later onset of hypertension in the untreated group, and BP at delivery differed in the untreated groups (p less than 0.001) with the lowest BP in women with mild GH. There was no difference in cesarean section rate in the mild hypertensive group as compared to the normal population. Birth weight and length of pregnancy were significantly lower in the untreated mild hypertensive group as compared to normal pregnant women (p less than 0.05). But in the subgroup with mild GH pregnancy length and birth weight did not differ from normal pregnancy. The conclusion from our study is that women with mild hypertension in pregnancy might refrain from antihypertensive therapy if they are closely observed during pregnancy and delivery, especially if there has been no hypertension before pregnancy and no proteinuria develops.
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PMID:Conservative treatment of mild and moderate hypertension in pregnancy. 132 42

Our aim was to assess the effect of the introduction of a day-care unit on the care of women with non-proteinuric hypertension in pregnancy. A randomised controlled trial was carried out on 54 women who presented at 26 weeks of pregnancy or later with non-proteinuric hypertension (systolic blood pressure 150-170 mm Hg and/or diastolic pressure 90-105 mm Hg on two occasions at least 15 min apart). 30 women were allocated to care by the day unit and 24 were managed according to the established practice of their clinicians without access to the day unit (control group). Women in the control group spent on average 4.6 times longer as inpatients (difference in mean stay 4.0 days [95% confidence interval 2.1-5.9 days]) than the day-unit group and were 8.8 times (95% CI 3.0-25.8) more likely to be admitted to hospital. Induction of labour was 4.9 times (95% CI 1.6-13.8) more likely in the control than in the day-unit group and the development of proteinuria 11.4 times (95% CI 1.8-71.4) more likely. The control group had a mean of 1.5 fewer hospital outpatient visits (95% CI 0.36-2.64). The groups did not differ in their use of antihypertensive drugs. Day-unit care for hypertension in pregnancy significantly reduced the need for and the length of antenatal inpatient admissions and the number of medical interventions, at the cost of an increase in outpatient attendances. Our results are further evidence that inpatient care does not improve outcomes or prevent the development of proteinuria in this disorder.
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PMID:Randomised controlled trial of day care for hypertension in pregnancy. 134 41

The literature dealing with screening for hypertension in pregnancy was reviewed. No level of blood pressure or any other factor provides a guarantee of no risk for the development of preeclampsia. However, higher blood pressure in early pregnancy and a failure to decrease blood pressure in mid-pregnancy are both associated with the development of preeclampsia. The development of proteinuria, rather than the level of blood pressure, is the best predictor of poor pregnancy outcome. Multiparas, especially those with severe chronic hypertension who develop preeclampsia, are at greatest risk of poor pregnancy outcome.
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PMID:Screening for hypertension in pregnancy. 142 47

The treatment of hypertension in pregnancy is justified by the need to reduce blood pressure in order to avoid the onset of preeclampsia, eclampsia, retarded intrauterine growth and even neonatal, perinatal and maternal death. The value of using drugs to treat slight-moderate hypertension in pregnancy is, however, not clearly defined in the literature. In fact, from an etiopathogenetic point of view, the significance of increased blood pressure in pregnancy has not yet been satisfactorily explained, and above all the positive significance of increased blood pressure not be forgotten since, up to diastolic levels of 90 mmHg, it is accompanied by an increase in birth weight. The aim of the present study was to verify the efficacy of pharmacological treatment in cases of slight-moderate hypertension during pregnancy in a population of 121 pregnant women attending the Obstetrics-Gynecological Clinic of the "Istituto per l'Infanzia" in Trieste during the period from 14-11-1984 to 24-4-1991. Data for this retrospective study were extrapolated from an analysis of medical records and then memorized in a data-base file. The degree of hypertension was classified as slight, moderate and severe according to blood pressure levels measured on hospitalisation. Clinical signs taken into account included: edema, proteinuria and hypoprotidemia. Anti-hypertensive therapy was selected between one or more associated drugs belonging to the following classes: central action and peripheral action anti-adrenergic drugs, beta-blockers, calcium channel blockers, vasodilators, diuretics, ACE-inhibitors and sedatives. Moreover, patients also received non-pharmacological treatment in the form of low sodium diets and bed-rest.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Moderate arterial hypertension in pregnancy: therapeutic aspects]. 148 Mar 1

64 pregnancies were analyzed in 41 women with biopsy-proven lupus nephritis between 1965-91; fetal and maternal outcome were evaluated and risk factors for poor outcome were identified. Of 65 fetuses, 22 (34%) were lost (including therapeutic abortions). 19 (30%) were liveborn but premature (or= 36 weeks gestation) and 24 (37%) were term. Fetal loss after 20 weeks gestation was 195. 12% of 25 fetuses whose birthweight was recorded were small for gestational age. Maternal renal function deteriorated in 19% of the pregnancies but was irreversible postpartum in only 1 woman (2%). Hypertension was recorded in 44% of pregnancies, developed early (or= 32 weeks gestation) in 28%, and was severe in 13%. Treated hypertension predated 17% of the pregnancies and in 6% (included in the overall incidence of hypertension) exacerbation occurred during pregnancy despite continued antihypertensive medication. 9 women (22%) who developed de novo hypertension in pregnancy had permanent hypertension postpartum. Increased proteinuria was recorded in 485 of pregnancies and was irreversible postpartum in 5%. The comparison of pregnancies occurring before or after diagnosis was made by renal biopsy and failed to show any significant difference in fetal outcome. Pregnancies which occurred after the diagnosis of glomerulonephritis were associated with a significantly lower incidence of maternal hypertension, early hypertension, severe hypertension, and increased proteinuria. The presence of circulating lupus anticoagulant was clearly associated with a significantly higher fetal loss rate although the incidence of maternal complications did not differ significantly between mothers positive or negative for lupus anticoagulant.
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PMID:Lupus nephritis and pregnancy. 163 Dec 63

High blood pressure (BP) complicates approximately 10% of all pregnancies. Hypertension in pregnancy falls into four categories: (1) preeclampsia-eclampsia, (2) chronic hypertension of whatever cause, (3) preeclampsia-eclampsia superimposed to chronic hypertension or renal disease, and (4) transient or late hypertension (gestational hypertension). Preeclampsia, the association of hypertension, proteinuria, and edema, accounts for more than 50% of all the hypertensive disorders of pregnancy and is a major cause of fetal and maternal morbidity and mortality. Unfortunately, distinguishing between preeclampsia and other causes of hypertension on clinical grounds can be difficult because of the lack of specific tests for differential diagnosis. Increased vascular resistance has been claimed as the primary cause of preeclampsia; however, a variable hemodynamic profile with relatively high cardiac outputs, normal filling pressures, and inappropriately high systemic vascular resistances is now reported by most investigators. Imbalance between vasodilator and vasoconstrictor eicosanoids may account for platelet activation and increased responsiveness to pressor peptides. Altered prostacyclin (PGI2) to thromboxane A2 (TxA2) ratio in maternal uteroplacental vascular bed may favor local platelet activation and vasoconstriction contributing to placental insufficiency and fetal distress. Alternatively, recent evidence seems to suggest that fetal umbilical placental circulation may be the site of the primary vascular injury. Whether low-dose aspirin prevents preeclampsia because it inhibits the excessive maternal TxA2 or whether the partial inhibition of fetal TxA2 is also of therapeutic value remains to be established. Treatment of severe hypertension in pregnancy is probably important to prevent cardiac failure or cerebrovascular accidents in the mother. The need for pharmacological therapy of mild to moderate hypertension is still debated, since no formal studies are available to clarify whether pharmacological treatment in such instances effectively reduces maternal or fetal risk. For the treatment of preeclampsia, hydralazine and nifedipine may be used when delivery is not applicable. Labetalol and diazoxide are effective for hypertensive emergencies. Life-threatening hypertension that does not respond to more conventional therapy is an indication for the use of sodium nitroprusside. For chronic hypertension, alpha-methyldopa remains the treatment of choice; if ineffective, hydralazine or beta-blockers are suitable. Effectiveness and safety of other molecules remain elusive.
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PMID:Prevention and treatment of pregnancy-associated hypertension: what have we learned in the last 10 years? 188 20

The purpose of the study was to determine if reduction of pregnancy hypertension to normal prevented the clinical maternal manifestations of pre-eclampsia. Thirty-six women with hypertension, but without proteinuria, were allotted at random to a test group of 17 who received intensive treatment, and a control group of 19 who were managed according to routine methods by hospital staff unconnected with the study. The development of proteinuria was chosen as an indicator of pre-eclampsia. Proteinuria developed significantly more often in the control group (in six of the 19 women) than in the test group (in one of the 17 women).
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PMID:The prevention of the maternal manifestations of pre-eclampsia by intensive antihypertensive treatment. 202 61

A prospective study conducted between January, 1985 and September, 1987 involved 60 pregnant women who had previously suffered from hypertension in pregnancy with or without foetal and maternal complications. Thirty women received aspirin 250 mg every other day and dipyridamole 300 mg per day, starting from the 3rd month of pregnancy (group I); 30 women were examined regularly from the onset of pregnancy and received the conventional symptomatic treatment of complications that occurred (group II). Women in these two groups were similar in age, parity and previous obstetrical complications. Twenty-five women of group I had a perfectly normal pregnancy, as against 5 women of group II (P less than 0.001). Hypertension and/or proteinuria were observed in 5 women of group I and 15 of group II (NS). The 13 severe complications recorded (foetal death, eclampsia, retroplacental haematoma) occurred exclusively in women of group II. The duration of pregnancy and weight of the newborn were significantly greater in group I than in group II. Thus, antiplatelets appear to have an uncertain preventive effect on hypertension of pregnancy and a much more obvious prophylactic effect on major foetal and maternal complications.
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PMID:[Prevention of complications of severe arterial hypertension in pregnancy using platelet antiaggregants]. 252 53

The outcome is described for 106 patients with severe hypertension in pregnancy requiring delivery between 26 and 34 weeks. Management was with methyldopa, hydralazine when required and delivery by caesarean section when indicated. Most patients were delivered for cardiotocographic fetal distress or unstable maternal blood pressure. Eighty-five babies (80%) survived and were well at follow-up at 1 year; the perinatal mortality was 123/1000 total births. One patient had postpartum eclampsia, one had pulmonary oedema and one had transient renal failure, but all mothers left hospital well. Stepwise logistic regression analysis showed that the primary positive factor for survival of a healthy baby was gestational age, which was strongly correlated with birthweight. The need for caesarean section as an emergency, hypotension after parenteral hydralazine, intrauterine growth retardation, and severe proteinuria were adverse factors. Intraventricular haemorrhage had a major adverse effect on neonatal survival; it was predisposed to by prolonged maternal hypertension and by low gestational age.
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PMID:Outcome of pregnancies complicated by severe hypertension and delivered before 34 weeks; stepwise logistic regression analysis of prognostic factors. 259 Jun 53


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