scholarly journals A Proposed Plan for Prenatal Care to Minimize Risks of COVID-19 to Patients and Providers: Focus on Hypertensive Disorders of Pregnancy

2020 ◽  
Vol 37 (08) ◽  
pp. 837-844 ◽  
Author(s):  
John R. Barton ◽  
George R. Saade ◽  
Baha M. Sibai
Keyword(s):  
Pregnant Women ◽  
Disease Progression ◽  
Complete Blood Count ◽  
Gestational Hypertension ◽  
Epigastric Pain ◽  
Signs And Symptoms ◽  
Health Care Facilities ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 0/7 weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 0/7 weeks of gestation in the setting of preeclampsia with severe features. Key Points

scholarly journals Maternal and perinatal outcomes of hypertensive disorders of pregnancy in Ethiopia: systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amanual Getnet Mersha ◽  
Tadesse Melaku Abegaz ◽  
Mohammed Assen Seid
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Maternal Death ◽  
Hellp Syndrome ◽  
Perinatal Death ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Pooled Prevalence

Abstract Background Hypertensive disorders of pregnancy complicate around 6% of pregnancies and accounts for 19% of maternal death in Ethiopia. The current review aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Ethiopia. Methods A systematic review and meta-analysis was done on the outcome of hypertensive disorder among pregnant women in Ethiopia. Literature search was made in five databases and Statistical analyses were carried out by using Stata 14 software. The pooled prevalence of maternal death, HELLP syndrome, perinatal death, and low birth weight was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. Result Thirteen studies included in the review, with an overall sample size of 5894 women diagnosed to have hypertensive disorder of pregnancy. The pooled prevalence of maternal death was estimated to be 4% (95% CI: 2, 6%). The pooled prevalence of HELLP syndrome was 13% (95% CI: 10, 16%). Other complications such as pulmonary edema, kidney injury, hepatic injury, placental abruption, and aspiration pneumonia were also reported. Perinatal death was observed in one-fourth of women with HDP 25% (95% CI: 18, 32%). The pooled prevalence of low birth weight neonate in a woman with HDP is 37% (95% CI, 27, 48%). Conclusions In Ethiopia, the prevalence of perinatal and maternal mortality among pregnant women with one of the hypertensive disorders were found to be higher than rates reported from high income as well as most of the low and middle income countries. For instance, one in four of pregnancies complicated by hypertensive disorder end up in perinatal death in Ethiopia. HELLP syndrome, placental abruption, pulmonary edema, renal damage, prematurity, perinatal asphyxia, and low birth weight were also commonly reported. To improve the health outcomes of hypertensive disorders of pregnancy, it is recommended to improve utilization of maternal health service; early detection and early referral of pregnant women with hypertensive disorder; advocating policies and strategies that improves the quality of health care that a pregnant woman and her newborn receive.

scholarly journals Furosemide for Accelerated Recovery of Blood Pressure Postpartum in Women with a Hypertensive Disorder of Pregnancy

Hypertension ◽  
2021 ◽  
Vol 77 (5) ◽  
pp. 1517-1524 ◽  
Author(s):  
Joana Lopes Perdigao ◽  
Jennifer Lewey ◽  
Adi Hirshberg ◽  
Nathanael Koelper ◽  
Sindhu K. Srinivas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Relative Risk ◽  
Gestational Hypertension ◽  
Controlled Trial ◽  
Severe Disease ◽  
Hypertensive Disorder ◽  
Adjusted Relative Risk ◽  
Hypertensive Disorders Of Pregnancy ◽  
Double Blind ◽  
Hypertensive Disorders

Persistent postpartum hypertension is a significant cause of maternal morbidity. Our objective was to study the effect of furosemide on postpartum blood pressure recovery in women with hypertensive disorders of pregnancy. We performed a randomized, double-blind, placebo-controlled trial of a 5-day course of 20 mg oral furosemide versus placebo in women with gestational hypertension and preeclampsia with/without severe features from June 2018 to October 2019. Primary outcomes were persistent hypertension at 7 days postpartum (using generalized linear models to calculate adjusted relative risk) and days to resolution of hypertension (Kaplan-Meier curves), stratified by severe/nonsevere hypertensive disease. Secondary outcomes included readmissions and need for additional hypertensive medication.We randomized 384 women (192 per group). Baseline characteristics were similar except cesarean delivery rate was higher in the furosemide group (29% versus 20%; P =0.04). In women randomized to furosemide, there was a 60% reduction in the prevalence of persistently elevated blood pressure at 7 days when controlling for cesarean (adjusted relative risk, 0.40 [95% CI, 0.20–0.81]). The magnitude of reduction was greater in women with nonsevere disease (adjusted relative risk, 0.26 [95% CI, 0.10–0.67]). Number of days to blood pressure resolution was significantly shorter among women with nonsevere disease randomized to furosemide (8.5 versus 10.5; P =0.001). There were no significant differences in readmissions or need for additional antihypertensive medication postpartum between groups. In this double-blinded randomized trial, a short course of postpartum furosemide significantly improved blood pressure control in women with hypertensive disorders of pregnancy, mostly among women without severe disease. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT035556761.

scholarly journals A correlation of lactate dehydrogenase enzyme levels in pregnancy induced hypertensive disorders with severity of disease, maternal and perinatal outcome

2017 ◽  
Vol 6 (10) ◽  
pp. 4302 ◽  
Author(s):  
Neha V. Bhave ◽  
Parmanand K. Shah
Keyword(s):  
Lactate Dehydrogenase ◽  
Pregnant Women ◽  
Vascular Function ◽  
Perinatal Outcome ◽  
Gestational Hypertension ◽  
Hypertensive Disorder ◽  
Severity Of Disease ◽  
Hypertensive Disorders ◽  
Dehydrogenase Enzyme ◽  
In Pregnancy

Background: A spectrum of hypertensive disorders in pregnancy contribute to maternal and perinatal morbidity and mortality. For prediction and early diagnosis of preeclampsia various biochemical markers, vascular function test and renal markers have been developed. The objective of the study is to measure the lactate dehydrogenase enzyme (LDH) levels in pregnant women with pregnancy induced hypertensive disorders and correlate the levels with the severity of condition, maternal and the perinatal outcome.Methods: In this prospective observational study, a total of 150 pregnant women were studied. Out of these 150 women, 30 women had normal blood pressure, 30 women had gestational hypertension, 30 women had mild preeclampsia, 30 women had severe preeclampsia and 30 women had eclampsia. The serum LDH levels were measured in third trimester and patients followed up until early postpartum period and babies were followed up till early neonatal period to assess the maternal and neonatal outcomes.Results: Higher lactate dehydrogenase enzyme (LDH) levels were observed in pregnant women with severe form of hypertensive disorder and those who had a poor maternal and perinatal outcome. This is statistically significant (p<0.001).Conclusions: Lactate dehydrogenase enzyme (LDH) level is a useful biochemical marker to assess and predict the severity of disease, maternal and perinatal outcome as higher levels of the enzyme are associated with worsening severity of disease, a poor maternal and perinatal outcome.

scholarly journals Postnatal assessment for renal dysfunction in women with hypertensive disorders of pregnancy

2021 ◽  
Author(s):  
Emmanouil Kountouris ◽  
Katherine Clark ◽  
Polly Kay ◽  
Nadia Roberts ◽  
Kate Bramham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Postpartum Visit ◽  
Protein Excretion ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy are associated with chronic kidney disease. Early detection of renal dysfunction enables implementation of strategies to prevent progression. International guidelines recommend review at 6–8 weeks postpartum to identify persistent hypertension and abnormal renal function, but evidence for the efficacy of this review is limited. Methods All women attending a specialist fetal-maternal medicine clinic for hypertensive disorders of pregnancy (pre-eclampsia, chronic hypertension, gestational hypertension) were invited for a 6–8 weeks postpartum review of their blood pressure and renal function in order to establish the prevalence and independent predictors of renal dysfunction. Renal dysfunction was defined as low estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m2) or proteinuria (24-h protein excretion > 150 mg or urinary albumin-to-creatinine ratio > 3 mg/mmol). All women attending a specialist clinic for hypertensive disorders were invited for a 6–8 weeks postpartum review of their blood pressure and renal function. Demographics, pregnancy and renal outcomes were prospectively collected. Results Between 2013 and 2019, 740 of 1050 (70.4%) women who had a pregnancy complicated by a hypertensive disorder attended their 6–8 weeks postpartum visit. Renal dysfunction was present in 32% of the total cohort and in 46% and 22% of women with and without pre-eclampsia, respectively. Multivariate logistic regression demonstrated that independent predictors were pre-eclampsia, chronic hypertension, highest measured antenatal serum creatinine, highest measured antenatal 24-h urinary protein, and blood pressure ≥ 140/90 mmHg at the postnatal visit. Conclusions Renal dysfunction was present in one in three women with hypertensive disorders of pregnancy at 6–8 weeks postpartum. This includes women with gestational hypertension and chronic hypertension without superimposed pre-eclampsia, and thus these women should also be offered postnatal review. Graphic abstract

scholarly journals Prevalence of hypertensive disorders of pregnancy and its maternal outcome in a tertiary care hospital, Salem, Tamil Nadu, India

2019 ◽  
Vol 9 (1) ◽  
pp. 236
Author(s):  
Subha Sivagami Sengodan ◽  
Sreeprathi N.
Keyword(s):  
Tamil Nadu ◽  
Gestational Hypertension ◽  
Tertiary Care ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Care Hospital ◽  
Hypertensive Disorders Of Pregnancy ◽  
Maternal Complications ◽  
Hypertensive Disorders ◽  
Obstetrics And Gynaecology

Background: Hypertensive disorders complicate 5-10% of all pregnancies and together forms the deadly triad- along with hemorrhage and heart disease that contributes greatly to maternal morbidity and mortality. Objective of this study was to determine the prevalence of hypertensive disorders of pregnancy and its maternal complications in patients attending obstetrics and gynaecology department, Government Mohan Kumaramangalam Medical College Hospital, Salem.Methods: This is a prospective study conducted from August 2018 to July 2019 in the department of obstetrics and gynaecology. Patients diagnosed with hypertensive disorders of pregnancy was evaluated and data were collected.Results: A total of 19,383 pregnant women visited obstetrics and gynaecology department over a period of one year, out of which 2028 were diagnosed with hypertensive disorders of pregnancy. Hence the prevalence of hypertensive disorders in pregnancy is 10.4%. Among 2028 hypertensive disorder cases, Gestational hypertension were 962 cases (47.4%), pre-eclampsia 661 cases (32.6%), chronic hypertension 166 cases (8.2%) and pre-eclampsia superimposed on chronic hypertension 239 cases (11.8%). The prevalence was highest among primigravida (54%) compared to multigravida (46%). Hypertensive disorders were highest among the age group of 18-22 years in our study. Most common maternal complication in our study was HELLP syndrome.Conclusions: Prevalence of hypertensive disorders was high in our study. Early detection and timely intervention decrease the maternal complications.

Perinatal Outcome in Women with Hypertensive Disorders of Pregnancy in Rural Tertiary Center of Northern India: A Retrospective Cohort Study”

2020 ◽  
Vol 16 (1) ◽  
pp. 71-78
Author(s):  
Naina Kumar ◽  
Ashu Yadav
Keyword(s):  
Perinatal Outcome ◽  
Gestational Hypertension ◽  
Severe Disease ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Northern India ◽  
Hypertensive Disorders ◽  
Tertiary Center ◽  
Group 2

Background: Hypertensive disorder of pregnancy is associated with adverse maternal, perinatal outcome. Objective: To know the perinatal outcome in women with hypertensive disorders of pregnancy. Methods: Present retrospective cohort study was conducted in the Obstetrics and Gynecology department of the rural tertiary center of Northern India over one year (January-December 2018) on 205 antenatal women with hypertensive disorders of pregnancy at gestation ≥28 weeks. All the participants on the basis of diagnosis were divided into four groups: Group 1 Gestational hypertension; Group 2 Pre-eclampsia; Group 3 Eclampsia and Group 4 with Chronic Hypertension. Demographic features, gestational age, the onset of labor, mode of delivery and perinatal outcome including birthweight, Apgar scores, morbidity and mortality were recorded and compared between four groups. Statistical analysis was done using software SPSS 22.0. version. Results: Of 205 participants, 93 had Gestational Hypertension, 68 Pre-eclampsia; 36 Eclampsia, 06 Chronic Hypertension. The mean age of presentation was 24.96±3.535 years. Average gestation at birth for group 1 was 37.91±2.38 weeks, group 2: 36.50±3.312 weeks, group 3: 34.44±4.062 weeks and group 4: 37.97±1.524 weeks. The majority of participants had induced labor especially in preeclampsia and eclampsia groups with a spontaneous vaginal delivery as the most common mode. 1 and 5-minute Apgar scores, birth weight were lower in eclampsia and pre-eclampsia women. Severe disease was associated with the adverse perinatal outcome with maximum neonatal morbidity and mortality in eclampsia and pre-eclampsia group. Conclusion: Hence, hypertensive disorder of pregnancy was associated with adverse perinatal outcome, especially in women with severe disease (Eclampsia and Pre-eclampsia).

scholarly journals Maternal morbidity of adolescent pregnant women

2021 ◽  
Vol 64 (6) ◽  
pp. 10-12
Author(s):  
Carlos Arturo Paniagua Coahuila ◽  
◽  
José Anaya Herrera ◽  
Dulce Alejandra Alonso Lozano ◽  
Lenny Pinña Guerrero ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gestational Hypertension ◽  
Severe Preeclampsia ◽  
Advanced Trauma Life Support ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Obstetric Hemorrhage ◽  
Childbearing Age ◽  
Adolescent Population ◽  
Hypertensive Disorders

Background: In Mexico, it is estimated that the adolescent population represents 29% of the population of childbearing age. The present study aimed to analyze the obstetric results of 3310 adolescent pregnant women attended in a third level hospital. Material and methods: All records of pregnant women aged 19 years or less up to the date of admission were analyzed at the Mónica Pretelini Saenz Maternal Perinatal Hospital during the period from January 2018 to June 2020, with the following variables: age, pregnancy, resolution obstetric, severe preeclampsia, preeclampsia and gestational hypertension. Results: A total of 13874 pregnant women were attended, of which 3310 (24%) patients were adolescents. The overall frequency of obstetric complications was 21%, including obstetric hemorrhage (13%) and hypertensive disorders of pregnancy (8%). Regarding postpartum obstetric hemorrhage events, classified according to the Advanced Trauma Life Support shock scale, they were categorized as Grade 1 – 338 cases, Grade II – 76 cases, Grade III – 11 cases and Grade IV – 1 case. Hypertensive disorders of pregnancy highlight preeclampsia as the most frequent with a total of 97 cases, followed by 89 cases of severe preeclampsia, 58 cases of gestational hypertension, 14 cases of chronic hypertension and 3 cases of chronic hypertension with preeclampsia. Conclusions: The main complications found in the Mexican pregnant adolescent population were obstetric hemorrhage, which was more frequent in the population aged 15 to 19 years, and hypertensive disorders, which occurred more frequently in the population aged 9 to 14 years.

scholarly journals Changes and Clinical Value of Serum Cortisol Levels in Patients with Hypertensive Disorder in Pregnancy

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Gaoxiang Huo ◽  
Yeqiang Qin ◽  
Xiucui Bao ◽  
Xiaoling Yao ◽  
Zhangwei Pu ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gestational Hypertension ◽  
Serum Cortisol ◽  
Serum Cortisol Level ◽  
Control Group ◽  
Hypertensive Disorder ◽  
Clinical Value ◽  
Hypertensive Disorders ◽  
Research Objects ◽  
Cortisol Levels

Objective: To investigate the changes and the corresponding clinical value of serum cortisol levels in patients with hypertensive disorders during pregnancy. Methods: In this study, 90 patients with different degrees of hypertensive disorders during pregnancy who were admitted from August 2018 to August 2019 in our hospital were set as the research objects. 90 cases were grouped according to the diagnostic criteria in Obstetrics and Gynecology, including 30 cases in each of the hypertension group, the preeclampsia group, and the eclampsia group. Another 30 healthy pregnant women were selected as the control group. The serum cortisol levels of pregnant women in the above four groups were measured. Results: Compared with the control group, the serum cortisol levels in the other three groups were significantly increased. In perinatal outcome, compared with the control group, the three groups of patients had an increase in Apgar score, preterm birth, stillbirth rate, growth restriction rate and neonatal asphyxia rate. There were significant differences between groups (P <0.05), and showed as gestational hypertension <preeclampsia <eclampsia. Conclusion: With the exacerbation of hypertensive disorders during pregnancy, the serum cortisol level continues to increase, which has a serious adverse effect on the prognosis of the perinatal infants.

scholarly journals The role of cystatin c in the prediction of outcome in hypertensive disorders of pregnancy

2017 ◽  
Vol 6 (5) ◽  
pp. 1825 ◽  
Author(s):  
Cimona Lyn Saldanha ◽  
Shabnum Ara ◽  
Tabassum Parvez
Keyword(s):  
Uric Acid ◽  
Pregnant Women ◽  
Cystatin C ◽  
Gestational Hypertension ◽  
Serum Levels ◽  
Hypertensive Disorders Of Pregnancy ◽  
Serum Cystatin C ◽  
Hypertensive Disorders ◽  
Foetal Outcome ◽  
And Function

Background: Hypertensive disorders of pregnancy greatly influence the maternal and foetal outcome in terms of morbidity and mortality. Complications include involvement of the kidney and progression of the disease which leads to deterioration of renal parameters and function. If left unattended, oliguria and renal shutdown are serious sequelae. Hence the importance of monitoring serum concentrations of cystatin C, creatinine and uric acid. The present study was designed to understand the variations of these markers in pregnant women in this part of India.Methods: Serum levels were therefore determined in samples from 75 healthy women at term as well as in 38 samples of patients with Gestational hypertension and in 30 patients with pre-eclampsia (PE). The values were analysed after tabulation and results subjected to statistical analysis using SPSS software programme.Results: The levels of all three components were significantly higher in pre-eclamptic patients when compared to healthy controls with the mean±SD being 1.86±0.82 vs. 1.08±0.33 for cystatin C, 0.93±0.18 vs. 0.62±0.07 for creatinine and 7.02±1.92 vs. 4.04±1.06 for uric acid respectively. In gestational hypertension, cystatin C was significantly higher, 1.42±1.1 unlike creatinine, 0.84±0.16 and uric acid, 5.26±1.40.Conclusions: In view of significant increase in serum cystatin C, creatinine and uric acid in hypertensive disorders of pregnancy compared to those of healthy pregnant women, in our study, we conclude that these parameters are of significant value if used as markers to predict the onset of GH/PE. This can be established after further and larger clinical trials.

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