scholarly journals Morphological and morphometrical study of placenta in normal and hypertensive pregnancies.

2014 ◽  
Vol 03 (01) ◽  
pp. 24-28
Author(s):  
Pushpa Gowda ◽  
Jayanthi KS
Keyword(s):  
Surface Area ◽  
Fetal Outcome ◽  
Control Group ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Group ◽  
Hypertensive Disorders ◽  
The Mean ◽  
Placental Volume ◽  
Morphometrical Study

Abstract Background and Aim: Placenta is the main channel in utero, through which the fetus receives its nutrition from the mother. Hypertensive disorders of pregnancy are fairly common and affect the growth and development of the placenta and fetus in many ways. Knowledge of these changes in placenta due to hypertension in pregnancy is essential as many of these changes can be diagnosed prenatally by available techniques to improve the fetal outcome and reduce perinatal morbidity and mortality. Materials and Methods: The present study was conducted to note the morphometrical and morphological parameters in the placenta of normal and hypertensive pregnancies and to correlate them with fetal outcome. The study was done on 30 placentae as control group, obtained after delivery of normotensive women and 30 placentae as study group, which were obtained after delivery of hypertensive mothers which included chronic hypertension, pre eclampsia and eclampsia. The placental specimens were collected from the department of obstetrics and gynecology, KIMS, Bangalore and new bom parameters were taken from their records. Results: The placental morphometrical parameters were significantly less in hypertensive group as compared to the control group. The mean placental weight was 458.33±70.47 gms; mean placental surface area was 215.82±27.83 sqcms, the mean placental volume was 583.67+66.21 cc and mean decidual thickness was 2.50 ±0.24 cms in hypertensive group while in the control group the values were 561.67±77.33 gms, 241.91±37.23 sqcms, 674.00±88.50 cc and 2.83±0.34 cms respectively. The mean birth weight (kg) of newborn was 2.92 ± 0.45 in control group and it was and 2.47 ±0.40 in hypertensive group. Conclusion: Thus hypertensive disorders of pregnancy affects the placenta in a major way by decreasing its weight, surface area, thickness and volume and by increasing pathological changes like placental infarcts and calcified areas which adversely affect fetal parameters like weight and APGAR score.

scholarly journals Doppler interrogation of fetoplacental circulation in hypertensive disorder of pregnancy and their perinatal outcomes

2017 ◽  
Vol 5 (6) ◽  
pp. 2687 ◽  
Author(s):  
Jyoti Devi ◽  
Devender Kumar ◽  
Mala Shukla ◽  
P. K. Jain3
Keyword(s):  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Control Group ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Diastolic Flow ◽  
Hypertensive Group ◽  
Hypertensive Disorders ◽  
Significant Difference ◽  
Hypertensive Disorder Of Pregnancy

Background: Hypertensive disorders of pregnancy are one of the major causes of maternal morbidity-mortality leading to 10-15% of maternal deaths especially in developing areas of the world. The Doppler examination makes it possible by providing a unique, non-invasive and safe method of studying blood flow characteristics in both the fetoplacental and uteroplacental circulations that is being used in clinical evaluation of high risk pregnancies. The aim was to study early detection of fetoplacental compromise in hypertensive disorder of pregnancy with Doppler indices and to know its role in predicting perinatal outcomes and interventional strategies in these patients.Methods: This prospective study was conducted on 100 subjects, 50 patients in study group with hypertensive disorders and 50 patients in control group with normotensive pregnancy. Doppler studies of umbilical and middle cerebral artery done and parameters recorded were systolic/diastolic ratio, pulsatility index and resistance index at 28-37 weeks of gestation. Perinatal outcomes of both groups compared, analyzed statistically. Multiple pregnancy, chronic hypertension, fetal congenital anomalies, systemic disease and those lost to follow up till delivery were excluded from study.Results: Statistically significant difference in the incidence of induction of labour (p=0.012) and caesarean delivery (p=0.049), preterm delivery (p=0.004), low birth weight (p=0.003), low apgar score (p=0.045) and NICU admission in the patients with abnormal umbilical artery doppler of hypertensive group were seen .66.66% and 100% perinatal mortality seen in absent end diastolic flow and reverse end diastolic flow of umbilical artery in hypertensive group respectively.Conclusions: Abnormal umbilical artery had highest sensitivity 76% and positive predictive value 84% in predicting adverse perinatal outcome and MCA Doppler having highest specificity 96% to exclude the false positive results of abnormal UA. The sequential study of both vessels useful in predicting interventional strategies and improving perinatal outcomes.

scholarly journals Placental damages from ultrasonic changes to histopathological findings in maturing placenta in pregnancy complicated with hypertension: an observational clinical study

2017 ◽  
Vol 6 (5) ◽  
pp. 1834
Author(s):  
Amit Dutta ◽  
Ramesh Kumar Sahu ◽  
Kripasindhu Chatterjee ◽  
Sanjay Kothari ◽  
S. K. Rafikul Rahaman ◽  
...  
Keyword(s):  
Mode Of Delivery ◽  
Control Group ◽  
Delivery Mode ◽  
Study Group ◽  
Fibrinoid Necrosis ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Group ◽  
Hypertensive Disorders ◽  
Grade Iii ◽  
In Pregnancy

Background: The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. Obstetric ultrasound provides a cornerstone to other modalities used for assessing hypertensive disorders of pregnancy. Placental architecture is modified in PE and eclampsia. This study was designed to detect the placental changes in hypertensive disorders of pregnancy and correlation with ultrasonic and histopathological changes.Methods: The study group comprised of 42 patients with pregnancy complicated with hypertension with period of gestation above 20 weeks and B.P. more than 140/90 mm of Hg measured on two occasions 6 hours or more apart. The control group consists of 42 normotensive patients matched with age and parity. One ultrasonic examination was performed between 28 weeks and 34 weeks and another after 34 weeks till term. Apart from routine parameters i.e. BPD, AC, FL, Amniotic fluid index, EBW and gestational age routine placental grading were performed according to the classification proposed by Grannum and associates. To evaluate perinatal outcome following measurement were studied birth weight immediately after delivery, mode of delivery, perinatal morbidity and mortality, APGAR score, presence of fetal distress.Results: In 97.62% cases (41 out of 42) of control group showed Grade–II changes as opposed to 57.14% of cases (24 out of 42) in study group before 34 weeks. All 21 cases in study group showing Grade ‘III’ changes before 34 weeks had infarction, calcification, increased syncytial knots, fibrinoid necrosis from 95.23 to 100% of these cases showed all these changes. Only 2 cases (9.52%) showed perivascular hemorrhage having Grade ‘III’ before 34 weeks.Conclusions: Accelerated maturation of placenta in pregnancy complicated with hypertension are more common in the hypertensive group. Increased histopathological degenerative changes e.g. calcification, fibrinoid necrosis etc., are more marked even before 34 weeks of gestation in hypertensive group.

Abstract 15788: Hypertensive Disorders of Pregnancy in Urban Black Women: The Biosocial Impact on Black Births (bibb) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rhonda Dailey ◽  
Ashleigh Peoples ◽  
Brooke Rengers ◽  
Ana C Wong ◽  
Kristen Daughters ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Black Women ◽  
Gestational Age ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Hypertensive Disorder Of Pregnancy ◽  
The Mean ◽  
Prenatal Visits

Introduction: Black women experience significant maternal mortality (3.3 times higher) compared to White women, and experience higher adverse outcomes. In the United States, cardiovascular disease is the second leading cause of maternal mortality for Black women. Hypertensive disorders of pregnancy (HDOP) falls under the cardiovascular disease spectrum. Objective: To explore differences in women diagnosed with a HDOP compared to those that do not have HDOP. Methods: A total of 226 African American women from Metro-Detroit and Columbus, Ohio enrolled in a cross-sectional study who had recently gave birth. Women enrolled in a mixed methods study on social and biological stressors to preterm birth with a completed medical record abstraction were identified as having chronic hypertension or a hypertensive disorder of pregnancy (HDOP) prior to the current pregnancy. HDOP is defined as chronic hypertension, chronic hypertension with superimposed preeclampsia, gestational hypertension, preeclampsia or eclampsia. Perinatal complications and birth outcomes were explored. Sociodemographic was derived from completed prenatal questionnaires. Chi square was used for categorical variable and T-test was used for continuous variables. Significance is defined as p ≤ 0.05. Results: The mean age was 26.8±5.9 years. Approximately 70.4% (n=159) were from Detroit, MI and 29.6% were from Columbus, OH. The mean previous live births were 1.9±1.8 (range 0-8). The average number of prenatal visits with a physician were 9.2±2.9 (range 2-19) and the total number of any prenatal visits were 16.0±6.9 (range 1-44). Average baby gestational age is 37.9±2.2 weeks (range 15-26 weeks), and weight is 2998±703.4 grams. Approximately 60 women (26.5%) were identified with a hypertensive disorder of pregnancy. Compared to women not diagnosed with a HDOP, women with a HDOP had an older mean age (28.3±6.4 vs 26.3±5.6), p=0.023; had more prenatal visits (18.2±7.6 vs 15.6±6.5) p=0.007; had babies at a younger gestational age (37.2±2.1 vs 38.2±2.1), p=0.002. Conclusion: These findings will aid in determining factors associated with HDOP in our population, and aid in determining next steps to reduce historic mortality in this group.

A STUDY OF SERUM URIC ACID LEVELS IN PREECLAMPSIA

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Sushma Goad ◽  
Anita Verma ◽  
Subhash Chandra
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Uric Acid Level ◽  
Acid Level ◽  
Serum Uric Acid Level ◽  
Control Group ◽  
Age Group ◽  
Hypertensive Disorders Of Pregnancy ◽  
Level Elevation ◽  
The Mean

Background: To Study Serum Uric Acid level elevation in Hypertensive Disorders of Pregnancy. Methods: 50 Patients diagnosed as having Pre-eclampsia with age between 18-37 years and 50 controls with similar age group. Results: The mean serum uric acid level in control group was 3.41 ± 0.62 and in patient 7.01 ± 0.58 which was statistically significant (p =0.001). Conclusion: Serum uric acid levels were significantly higher in preeclampsia could be a useful indicator of fetal complication in preeclampsia patients. Keywords: serum uric acid, preeclampsia, laboratory.

Basal Plate Myometrial Fibers and Hypertensive Disorders of Pregnancy: A Case–Control Study

2017 ◽  
Vol 21 (3) ◽  
pp. 296-299 ◽  
Author(s):  
Ann A Wang ◽  
Linda M Ernst ◽  
Emily S Miller
Keyword(s):  
Case Control Study ◽  
Gestational Hypertension ◽  
Case Control ◽  
Basal Plate ◽  
Common Finding ◽  
Pathological Examination ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Control Study

Introduction Basal plate myometrium (BPMYO), the pathological presence of myometrial fibers in the basal plate, is a common finding on pathological examination of the placenta, yet its clinical correlates are not well studied. As myometrial fibers are frequently located in proximity to poorly converted maternal spiral arteries, our objective was to determine whether BPMYO is associated with hypertensive disorders of pregnancy (HDP), a well-known clinical sequela of abnormal maternal artery remodeling. Methods This case–control study included women who delivered a live-born singleton gestation whose placentas were sent for pathological examination. Cases were women with HDP (gestational hypertension, preeclampsia, or HELLP syndrome) as defined by American College of Obstetricians and Gynecologists. Controls were women without HDP. Women with chronic hypertension were excluded. The primary outcome was the presence of BPMYO. Secondary outcomes included the pathologic stage of BPMYO and the incidence of pathologically defined accreta. Each outcome was compared between cases and controls in bivariable and multivariable analyses. Results Of the 306 women who met inclusion criteria, 230 (75%) had HDP. BPMYO was present in 99 (32%) of placentas. Compared to controls, cases were younger, had higher body mass index, and were more likely to have diabetes, be nulliparous, deliver preterm, and have had a prior cesarean. There were no differences in the incidence of BPMYO, stage of BPMYO, or incidence of pathologically defined accreta between cases and controls. These findings persisted after controlling for potential confounders. Conclusions Although BPMYO may be more common in the setting of abnormal placental vasculature, there is no significant association between BPMYO and HDP.

scholarly journals Fetal Outcome in Hypertensive Disorders of Pregnancy.

2013 ◽  
Vol 12 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Arju Chand Singh ◽  
Sadikchya Singh Rana
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Antihypertensive Drugs ◽  
Gestational Hypertension ◽  
Fetal Outcome ◽  
Intrauterine Fetal Death ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Study Results ◽  
Low Birth Weight Babies

Introduction: Hypertensive disorders are the most common medical complications of pregnancy, affecting approximately 5-10% of pregnancies and the major cause of maternal and infant disease and death worldwide. Very few researches have been done in Nepal to analyze the effect of hypertension in fetus. The aim of this study was to determine the incidence and perinatal morbidity of hypertensive disorders of pregnancy. Methods: This was a hospital based prospective observational study conducted at Paropakar Maternity and Women’s hospital. The study was conducted from 18th October to 22nd December 2007. All primi and multigravid patient with BP ≥140/90 mmHg after 28 weeks of pregnancy were included in the study. Women with a blood pressure ≥140/90mmHg at or before 20 weeks of gestation, previous hypertension or women on antihypertensive drugs and Intrauterine fetal death (IUFD) were excluded from the study. Results: A total of 126 cases of hypertensive disorders of pregnancy were identifi ed among 3819 obstetric cases. The incidence of hypertensive disorders of pregnancy was 3.3%. Among 100 cases who were included in the study, 42 had pre eclampsia and 58 had gestational hypertension. Among 42 preeclamptic patients, 15(35.71%) had low birth weight babies, and 9(15.5%) babies had low birth weight among 58 gestational hypertensive mothers. Conclusions: Preeclampsia increases the risk of intrauterine growth restriction, low birth weight and stillbirth.Medical Journal of Shree Birendra Hospital; January-June 2013/vol.12/Issue1/8-10DOI:http://dx.doi.org/10.3126/mjsbh.v12i1.9083  

scholarly journals Pregnant women’s experiences with the management of hypertensive disorders of pregnancy: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amyna Helou ◽  
Kay Stewart ◽  
Kath Ryan ◽  
Johnson George
Keyword(s):  
Blood Pressure ◽  
Qualitative Study ◽  
Pregnant Women ◽  
Clinical Management ◽  
Blood Pressure Monitoring ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Pressure Monitoring ◽  
Hypertensive Disorders ◽  
Management Of Complications

Abstract Background Hypertensive disorders are a leading cause of mortality and morbidity during pregnancy. Despite multiple national and international clinical guidelines and a plethora of research in the field of optimising management, there has been limited research describing the perspectives and experiences of pregnant women with the management of hypertensive disorders of pregnancy (HDP). Understanding these perceptions and experiences is imperative to the optimisation of HDP management. Methods A qualitative study involving face-to-face, in-depth interviews were undertaken with 27 pregnant women diagnosed with and being treated for HDP to explore their perspectives of and experiences with clinical management. Written consent was obtained individually from each participant, and the interviews ranged from 16 to 54 min. Inductive codes were generated systematically for the entire data set. Line-by-line analysis was then performed and nodes were created within NVivo, a qualitative data management software. Data collection was continued until thematic saturation was reached. Thematic analysis was employed to interpret the data. Results Three major descriptive themes were discerned regarding the women’s perspectives on and experiences with the management of HDP: attitudes towards monitoring of HDP, attitudes and perceptions towards development and management of complications, and perceptions of pregnant women with chronic hypertension. Trust in the hospital system, positive attitudes towards close blood pressure monitoring as well as self-monitoring of blood pressure, and a realistic approach to emergency antenatal hospital admissions contributed to a positive attitude towards monitoring of HDP. Women with prior experiences of HDP complications, including pre-eclampsia, were more confident in their clinical management and knew what to expect. Those without prior experience were often in shock when they developed pre-eclampsia. Some women with chronic hypertension displayed limited understanding of the potential risks that they may experience during pregnancy and thus lacked comprehension of the seriousness of the condition. Conclusions The clinical management experiences of pregnant women with HDP were varied. Many women did not feel that they were well informed of management decisions and had a desire to be more informed and involved in decision-making. Clear, concise information about various facets of HDP management including blood pressure monitoring, prescription of the appropriate antihypertensive agent, and planning for potential early delivery are required.

scholarly journals Study of the serum uric acid level as a prognostic indicator in hypertensive disorders of pregnancy

2021 ◽  
Vol 10 (9) ◽  
pp. 3441
Author(s):  
Smitha Krishnegowda ◽  
G. Nita
Keyword(s):  
Uric Acid ◽  
Disease Severity ◽  
Serum Uric Acid ◽  
Mode Of Delivery ◽  
Prognostic Indicator ◽  
Maternal Serum ◽  
P Value ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

Background: Abnormal uric acid levels in patients with preeclampsia and eclampsia affect both maternal and fetal outcome negatively. This study was done to know the alterations in these serum levels in comparison to normal pregnancy and also among various hypertensive disorders of pregnancies.Methods: Maternal serum uric acid levels were compared among cases and controls in relation to disease severity, mode of delivery, maternal outcome.Results: In group A (cases), 10 patients had raised uric acid levels, of which 5 were severe preeclampsia, 3 were eclampsia and 2 cases of chronic hypertension superimposed preeclampsia. P value is 0.001 (highly significant). Also serum uric acid is significantly elevated in hypertensive disorders of pregnancy compared with controls with a P value of 0.001.Conclusions: Significant correlation was observed between maternal serum uric acid, disease severity and maternal outcome. Our study concludes that uric acid can be considered as a sensitive prognostic indicator of severity in hypertensive disorders of pregnancy.

scholarly journals Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review

10.2196/15095 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e15095 ◽  
Author(s):  
Maria Aquino ◽  
Sarah Munce ◽  
Janessa Griffith ◽  
Maureen Pakosh ◽  
Mikayla Munnery ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Scoping Review ◽  
Underserved Populations ◽  
Current Evidence ◽  
Future Research ◽  
Control Group ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Risk Pregnancy

Background High blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions. Objective The aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP? Methods A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review. Results Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention’s design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles. Conclusions Although current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions.

scholarly journals The evolution of mean arterial pressure in critically ill patients on vasopressors before and during a trial comparing a specific mean arterial pressure target to usual care

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie-Hélène Masse ◽  
Neill K. J. Adhikari ◽  
Xavier Théroux ◽  
Marie-Claude Battista ◽  
Frédérick D’Aragon ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Usual Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intervention Group ◽  
Control Group ◽  
Chronic Hypertension ◽  
The Mean ◽  
Change In Mean

Abstract Background In randomized clinical controlled trials, the choice of usual care as the comparator may be associated with better clinician uptake of the study protocol and lead to more generalizable results. However, if care processes evolve to resemble the intervention during the course of a trial, differences between the intervention group and usual care control group may narrow. We evaluated the effect on mean arterial pressure of an unblinded trial comparing a lower mean arterial pressure target to reduce vasopressor exposure, vs. a clinician-selected mean arterial pressure target, in critically ill patients at least 65 years old. Methods For this multicenter observational study using data collected both prospectively and retrospectively, patients were recruited from five of the seven trial sites. We compared the mean arterial pressure of patients receiving vasopressors, who met or would have met trial eligibility criteria, from two periods: [1] at least 1 month before the trial started, and [2] during the trial period and randomized to usual care, or not enrolled in the trial. Results We included 200 patients treated before and 229 after trial initiation. There were no differences in age (mean 74.5 vs. 75.2 years; p = 0.28), baseline Acute Physiology and Chronic Health Evaluation II score (median 26 vs. 26; p = 0.47) or history of chronic hypertension (n = 126 [63.0%] vs. n = 153 [66.8%]; p = 0.41). Mean of the mean arterial pressure was similar between the two periods (72.5 vs. 72.4 mmHg; p = 0.76). Conclusions The initiation of a trial of a prescribed lower mean arterial pressure target, compared to a usual clinician-selected target, was not associated with a change in mean arterial pressure, reflecting stability in the net effect of usual clinician practices over time. Comparing prior and concurrent control groups may alleviate concerns regarding drift in usual practices over the course of a trial or permit quantification of any change.

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