Preeclampsia in high risk women is characterized by risk group-specific abnormalities in serum biomarkers

ObjectiveWe tested whether women who reported high-risk pregnancies or deliveries were more likely to receive immediate postpartum contraception prior to discharge compared with normal-risk women in Mexico.MethodsThis is a retrospective study using the National Health and Nutrition Survey. We classified women as high-risk based on reported complications in pregnancy and delivery. We used multivariable logistic regression to test the association of high-risk status and receipt of postpartum contraception (any modern method and Tier one methods) prior to discharge.ResultsOur sample included 5030 deliveries (population N=3 923 657). Overall, 19.1% of the sample were high risk. Over 60% of women in the high-risk and normal-risk group received immediate postpartum contraception, but a greater proportion of high-risk women received a method (67% vs 61% normal risk; p<0.001). However, in multivariable models, there were no significant differences in receipt of any modern method or tier 1 method by risk group.ConclusionWomen with high-risk pregnancies were not more likely to receive postpartum contraception than the normal-risk group, once accounting for sociodemographic and clinical factors. Prenatal and postpartum contraception counselling should address the health effects of high-risk pregnancies and interpregnancy intervals to improve maternal health outcomes.

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P5730Do hypertensive women with coronary artery disease benefit from lowering systolic blood pressure under 130 mmHg? Long-term mortality in the INternational VErapamil SR-trandolapril STudy (INVEST)

European Heart Journal ◽

10.1093/eurheartj/ehz746.0670 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R I Sava ◽

Y Chen ◽

Y K Taha ◽

Y Gong ◽

S M Smith ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Coronary Artery Disease ◽

High Risk ◽

Risk Group ◽

Low Risk ◽

High Risk Women ◽

Artery Disease ◽

Long Term Mortality

Abstract Background Hypertension (HTN) and coronary artery disease (CAD) are a prevalent combination in women, however limited data are available to guide blood pressure (BP) management. We hypothesize older women with HTN and CAD may not derive the same prognostic benefit from systolic BP (SBP) lowering <130 mmHg. Purpose To investigate the long-term mortality implications of different achieved SBP levels in hypertensive women with CAD. Methods Long-term, all-cause mortality data were analyzed for 9216 women, stratified by risk attributable to clinical severity of CAD (women with prior myocardial infarction or revascularization considered at high, all others at low risk) and by age (50 - <65 or ≥65 yo). The prognostic impact of achieving mean in-trial SBP <130 (referent group) was compared with 130 to <140 and ≥140 mmHg using Cox proportional hazards, adjusting for demographic and clinical characteristics. Results During 108,838 person-years of follow-up, 2945 deaths occurred. High risk women (n=3011) had increased long-term mortality in comparison to low risk women (n=6205) (adjusted HR 1.38, CI 1.28–1.5, p<0.001). Within risk groups, crude mortality percentages decreased according to BP values (table). As expected, high risk women were more likely to be ≥65 yo (68.68% vs. 50.51%, p<0.0001) or have SBP ≥140 mmHg (43.08% vs. 31.18%, p<0.0001). In adjusted analyses, an SBP ≥140 mmHg was associated with worse outcomes than SBP <130 mmHg in the entire cohort (HR 1.3, CI 1.2–1.5, p<0.0001) and when stratifying by risk (low risk group, HR = 1.47, CI 1.28–1.7, p<0.0001; high risk group, HR = 1.71, CI 1.01–1.35, p=0.03). In analyses stratified by age and risk, women ≥65 years and at high risk had decreased mortality in the 130 - <140 SBP category vs. <130 mmHg (HR 0.812, 95% CI 0.689–0.957, p=0.0133; figure). Women and deaths by risk and SBP group Group SBP category Women (n) Mortality (n) Mortality (%) High risk <130 773 338 44 130–<140 941 414 44 ≥140 1297 694 54 Low risk <130 2187 390 18 130–<140 2083 451 22 ≥140 1935 658 34 SBP = systolic blood pressure; n = number; % = percent per each group. Mortality adjusted HRs Conclusion In women ≥65 yo with hypertension and prior myocardial infarction and/or coronary revascularization enrolled in INVEST, a SBP between 130 to <140 mmHg was associated with lower all-cause, long-term mortality versus SBP <130 mmHg. Acknowledgement/Funding The main INVEST (International Verapamil [SR]/Trandolapril Study) was funded by grants from BASF Pharma, Ludwigshafen, Germany; Abbott Laboratories, A

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Obstetric and neonatal outcome among women presenting with reduced fetal movements in third trimester

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175488 ◽

2017 ◽

Vol 7 (1) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Vidyashree G. Poojari ◽

Sahan S. Kumar ◽

Akhila Vasudeva

Keyword(s):

High Risk ◽

Perinatal Outcome ◽

Neonatal Outcome ◽

Risk Group ◽

Low Risk ◽

High Risk Pregnancy ◽

High Risk Women ◽

Reduced Fetal Movements ◽

Risk Pregnancy ◽

Fetal Movements

Background: Reduced maternal perception of fetal movements allows early identification, timely evaluation and intervention for fetuses at risk of adverse outcome. The primary objective of this study was to assess the pregnancy characteristics and outcomes of pregnant women presenting to hospital with reduced fetal movements (RFM).Methods: Prospective observational study, recruiting all women with singleton pregnancy at or beyond 28 weeks of gestation presenting with a subjective perception of RFM from April 2015 to December 2016. Maternal characteristics, antenatal risk factors, management pathways and perinatal outcome studied.Results: 47% belonged to high risk pregnancy. Among high risk women, although only 39% showed poor BPP at the first presentation, 58% were delivered irrespective of their gestational age, out of which 32.75% had poor neonatal outcome. Among low risk who had >2 episodes of RFM, 50% had poor neonatal outcome. 7% among high risk pregnancies and 18% among low risk, presented with RFM within 48 hours following steroid prophylaxis.24% of high risk women showed liquor volume abnormalities as compared to low risk (6.3%).Conclusions: Significant proportion of those with RFM belonged to high risk pregnancy. Among high risk group, there were high rates of stillbirth and poor BPP at the time of admission when compared to low risk group. Due to early approach to the hospital and timely intervention, significant women with abnormal BPP had good perinatal outcome. All those fetuses who were delivered on first episode of RFM in low risk group did not show evidence of compromise at birth, probably indicating unnecessary delivery. More than 2 episodes of RFM even among low risk group seems significant as good number of fetuses were compromised at birth. Steroids prophylaxis for the fetal lung maturity causes transient changes in BPP, hence unnecessary delivery should be avoided especially those among low risk pregnancy.

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