Relationship between lupus anticoagulant (LAC) and pregnancy-induced hypertension

Lupus anticoagulant (LAC), a serum antiphospholipid autoantibody, is believed to be one of the causes of infertility or fetal loss. The purpose of the present study was to evaluate the role of LAC in the pathogenesis of hypertension during pregnancy. In this study, 20 pregnant women with hypertension were classified into two groups: 14 patients who did not have hypertension before the pregnancy but developed it during the pregnancy (pregnancy-induced hypertension; Group A) and 6 patients who had hypertensive or renal disease before the pregnancy, and developed further hypertension during the pregnancy (pregnancy-aggravated hypertension; Group B). A LAC coagulation assay was performed, and the presence of LAC in each group was compared. All 14 patients in group A were LAC-negative. In contrast, 3 of the 6 patients in group B were LAC-positive, and had clinical autoimmune diseases. The incidence of pregnancy-induced hypertension was also examined in 15 pregnancies from 9 LAC-positive women who had a history of repeated fetal loss but no systemic autoimmune disease (Group C). None of these 15 pregnancies had hypertensive complications, even when they reached term. In the placentas of LAC-positive women, no characteristic changes other than fibrinoid degeneration and microscopic infarction were observed upon histological examination. These results suggest that LAC does not relate with the onset of hypertension during pregnancy.

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COMPARISON OF INTRAVENOUS LABETALOL AND ORAL NIFEDIPINE IN MANAGEMENT OF BLOOD PRESSURE IN PATIENTS WITH SEVERE PREGNANCY INDUCED HYPERTENSION

Journal of University Medical & Dental College ◽

10.37723/jumdc.v10i4.79 ◽

2019 ◽

Vol 10 (4) ◽

pp. 26-30

Author(s):

Tehseen Aslam ◽

Nuzhat Parveen ◽

Shakeela Irfan ◽

Uzma Riaz ◽

Amin Anjum

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

Pregnancy Induced Hypertension ◽

Achieve Blood Pressure Control ◽

Achieve Blood Pressure ◽

Induced Hypertension ◽

Group A ◽

Group B ◽

Mean Time

ABSTRACT:It is estimated that 6-12% of all the pregnancies are complicated by hypertension and even all improvements pre eclempsia is a signiﬁcant reason of maternal and perinatal morbidity and mortality worldwide. Nifedipine, Labetalol and hydralazine are mostly being used in acute management of hypertension in pregnancy but so far there is no evidence that anyone drug is more eﬀective. OBJECTIVE: To compare the mean time to achieve blood pressure control of oral Nifedipine with intravenous Labetalol for management of severe pregnancy induced hypertension. METHODOLOGY: This randomized control trial was done in Obstetrics and Gynaecology department of Hilal-e-Ahmer hospital, Faisalabad over a period of 6 months from 01-07-2016 to 31-12-2016. Total 100 patients (group-A and group–B having 50 in each) were included in study. In group A, females were given 40mg oral Nifedipine and in group, females were given 20ml intravenous Labetalol. Time at administration was followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 min. The total donation time to achieve B.P was noted (as per operational deﬁnition).The collected data was analyzed by using SPSS version 17.0. Baseline blood pressure were presented in the form of mean+SD. Both groups were compared for mean time to achieve blood pressure control by applying t- test and consider signiﬁcant at p value <5%.RESULTS: Patients were ranged between 20-40 years. Mean age of the patients was calculated as 26.98+4.54 and 27.36+4.43 years in group-A and B respectively. Gestational age shows that 64%(n=32) in Group-A 74%(37%) in Group–B were between 20-30 weeks of gestation while 36%(n=18) in Group-A were between 31-40 weeks of gestation mean±SD was calculated as 28.92+4.91 and 28.94+4.72 weeks in Group-A and B respectively. Mean time to achieve B.P control in group A was 31.24+5.62 and in group B 45.5+4.63 with p value <0.05. CONCLUSION: Mean time to achieve blood pressure control was shorter with oral Nifedipine when compared to I/V Labetalol for management of female presenting with severe pregnancy induced hypertension.

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TO COMPARE THE EFFICACY OF LABETALOL AND METHYLDOPA IN TREATMENT OF PREGNANCY INDUCED HYPERTENSION

10.36106/gjra/0710001 ◽

2020 ◽

pp. 54-55

Author(s):

Ashish Yadav ◽

Rohitash Kularia ◽

Subash Chandra ◽

Anita Sharma

Keyword(s):

Antihypertensive Drugs ◽

Pregnancy Induced Hypertension ◽

Inclusion Criteria ◽

Hypertension In Pregnancy ◽

Induced Hypertension ◽

Group A ◽

The Mean ◽

Group B ◽

Labour Room ◽

New Onset

Background- The present study is undertaken with limited available facilities to find out the efficacy of two oral antihypertensive drugs namely labetalol and methyldopa in management of pregnancy induced hypertension. Methods- The study consisted of 100 patients with pregnancy induced hypertension attending outpatient department and admitted in ANW, or who directly came to labour room. These patients were randomly selected on lottery basis after they fulfilled the inclusion criteria. Total 100 patients were taken for the study and divided into 2 groups of 50 patients in each group. Results- The mean SBP before treatment in methyldopa group was161.33 ± 8.97 mmHg and 160.03 ± 8.23 mmHg in labetalol group which showed a fall to 138.61 ± 6.67 mmHg (methyldopa group) and 138.08 ± 5.37 mmHg (labetalol groups) after treatment. Fall of SBP was significant in both the groups. But inter group difference was not significant (p > 0.05). The mean DBP before treatment was 106.85 ± 4.33 mmHg in methyldopa group and 105.63 ± 5.23 mmHg in labetalol group which decreased to 89.31 ± 6.51 mmHg and 89.68 ± 5.26 mmHg respectively after treatment. Fall of DBP was significant in both the groups. But inter group difference was not significant (p > 0.05). Fall of MAP was significant in Group A and Group B. But inter group difference was not significant (p > 0.05). Conclusion-Labetalol and methyldopa are equally efficacious in controlling blood pressure in new onset hypertension in pregnancy.

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Outcome of Labetalol and Methyldopa as Oral Antihypertensive Agent in the Treatment of Pregnancy Induced Hypertension

Mediscope ◽

10.3329/mediscope.v8i1.52200 ◽

2021 ◽

Vol 8 (1) ◽

pp. 19-26

Author(s):

Kakali Rani Ghosh ◽

Shamima Akhter ◽

Adhir Kumar Das ◽

Naznin Naher ◽

Suma Rani Paul ◽

...

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Antihypertensive Drugs ◽

Treated Group ◽

Mean Blood Pressure ◽

Pregnancy Induced Hypertension ◽

Mortality And Morbidity ◽

Induced Hypertension ◽

Group A ◽

Group B

Background: In a developing country like Bangladesh pregnancy induced hypertension is an important medical problem and a major cause of maternal and perinatal mortality and morbidity. Antihypertensive drugs are often used to lower blood pressure and also help in reducing maternal and fetal complications. Objective: To compare the efficacy and safety of labetalol and methyldopa in management of pregnancy induced hypertension. Methods: A total of 100 patients having newly onset hypertension during pregnancy were taken and divided randomly into two groups. Group A was given labetalol and group B methyldopa. In both groupsmean blood pressure was measured on 1stday as pretreatment and at 48th hour and 8th day as post-treatment measurement, total dose of each drug require per day and side effects were recorded.Reduction in blood pressure, doseand side effects were compared. Results: Labetalol treated group of patients showed significant fall in mean blood pressure from 1st day to 48th hour and 1st day to 8th day.In patients treated with labetalol mean blood pressure on 1st day was 123.9 ± 17.11 mmHg and was controlled to 100.03 ± 6.38 mmHg on 48th hour and 94.13 ± 4.3 mmHg on day 8, while in methyldopa treated group on 1st day was 121.23 ± 13.597 mmHg which was reduced to 105.8 ± 6.53 mmHg on 48th hour and 97.96 ± 4.11 mmHg on day 8.The mean drug dosage required to control BP in group A was 380 ± 259.5 mg and in group B was 1540 ± 503.45 mg. Group A had less side effects. Conclusion: Labetalol is safe more efficacious and quicker control of blood pressure withless maternal adverse effects and thus advantageous over methyldopa. Mediscope Vol. 8, No. 1: January 2021, Page 19-26

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INDUCTION OF LABOUR;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.04.1530 ◽

2017 ◽

Vol 24 (04) ◽

pp. 522-525

Author(s):

Nadia Taj ◽

Rahat Akhtar ◽

Sumera Mehnaz ◽

Aamir Furqan

Keyword(s):

Caesarean Section ◽

Gestational Age ◽

Expectant Management ◽

Induction Of Labour ◽

P Value ◽

Pregnancy Induced Hypertension ◽

Induction Group ◽

Induced Hypertension ◽

Group A ◽

Group B

Objectives: To compare maternal outcome in planned induction of laborversus expectant management in pregnancy induced hypertension between 36 to 40 weeks ofgestation. Study Design: Randomized controlled trial. Setting: Obstetrics and Gynecology UnitII of Nishter Hospital Multan. Period: January 2016 to July 2016. Materials and Methods: Onehundred and thirty six (136) women with diagnosis of mild pregnancy induced hypertension,having gestational age 36 to 40 weeks were selected for this study. The selected patients wereallocated randomly into two equal groups i.e. Group A (Induction group) & Group B (Expectantgroup). The primary outcomes of this study were rate of cesarean section delivery anddevelopment of severe pre-eclampsia. Independent sample t-test was used to compare agebetween the groups. Chi-square test was used to compare age groups and study endpointsbetween the groups. Results: Mean gestational age at the time of delivery was 38.3 ± 0.75weeks for group A and 39.2 ± 0.55 weeks for group B (P-value >0.05). Mode of delivery was 52(76.47%) patients by vaginal and 16 (23.53%) by caesarean section in group A. While in groupB, out of 68 deliveries, 40 (58.82%) patients delivered by vaginal and 28 (41.18%) by caesareansection (p-value <0.05). Regarding maternal outcomes, severe pre-eclampsia occurred in 05(7.35%) women of group A while in group B, it was noted 15 (22.05%) women (p-value<0.05).The final outcome was considered satisfactory in 76.47% patients in Induction group regardingvaginal delivery and severe pre-eclampsia while in Expectant group satisfactory outcomes wereachieved in only 23.53% women (p-value <0.05). Conclusion: Induction of labour is associatedwith improved maternal outcome in terms of caesarean section and pre-eclampsia in womenwith mild PIH beyond 36 weeks of gestation as compared to the expectant management.

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Comparison between methyldopa and combination of methyldopa and nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension

10.53350/pjmhs211571703 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1703-1705

Author(s):

Bilqees Akhtar Malik ◽

Shahzad Bashir Momina ◽

Tazeen Ashraf

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Gestational Age ◽

Low Dose ◽

High Dose ◽

Pregnancy Induced Hypertension ◽

Induced Hypertension ◽

Group A ◽

Group B ◽

In Pregnancy

Objective: Comparison between Methyldopa and combination of Methyldopa and Nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension. Material and methods: This randomized controlled trial was conducted at Department of Obstetrics and Gynecology, Combined Military Hospital Bahawalpur from February 2020 to August 2020 over the period of 6 months. Total 80 patients with pregnancy induced hypertension as per operational definition having age 20-40 years and having gestational age ≥ 20 weeks assessed on LMP were selected. Results: Mean age of the patients was 30.81 ± 5.670 years, mean age of patients of group A was 31.50 ± 5.809 years and mean age of group B was 30.13 ± 5.515 years. Mean gestational age was 30.17 ± 5.981 weeks, mean gestational age of patients of group A was 29.70 ± 6.329 weeks and mean gestational age of patients of group B was 30.65 ± 5.65 weeks. In group A, mean diastolic blood pressure was decrease from 101.2250 ± 4.97938 to 84.5000 ± 3.26599 and in group B from 107.7750 ± 7.18434 to 82.5000 ± 2.25320. Comparison of mean decrease in diastolic blood pressure between group A (High dose Methyldopa) and group B (Low dose Low dose Methyldopa with Nifedipine) was done. Mean decrease in diastolic blood pressure in group A was 16.72 ± 3.935 and in group B was 25.28 ± 6.876. Statistically significant difference of mean decrease in diastolic blood pressure between the both groups was noted with p value 0.000. Conclusion: Results of this study showed that Low dose Methyldopa with Nifedipine combination is more effective as compared to High dose Methyldopa to reduce diastolic blood pressure in pregnant women suffering from pregnancy induced hypertension. Keywords: Diastolic blood pressure, Methyldopa, Nifedipine, Pregnancy induced hypertension, Systolic blood pressure

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Comparison of the biophysical profile and modified biophysical profile in prediction of the fetal outcome in pregnancy induced hypertension

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170935 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1206

Author(s):

Amir Babansab Shaikh ◽

Yogiraj Vaijanathrao Chidre

Keyword(s):

Mild Hypertension ◽

Fetal Distress ◽

Fetal Outcome ◽

Pregnancy Induced Hypertension ◽

Time Saving ◽

Biophysical Profile ◽

Induced Hypertension ◽

Group A ◽

Group B ◽

Sensitivity Specificity

Background: Pregnancy induces hypertension is one of the major causes of fetal morbidity and mortality. Biophysocal profile is one of the tests performed to predict the fetal outcome which though is simple, is time consuming and costly. This study was performed to compare the modified biophysical profile to the biophysical profile.Methods: 200 patients over the gestation period of 34 weeks with pregnancy induced hypertension were divided into Group A consisting of 100 patients who were studied with biophysical profile (BPP) and Group B consisting of 100 patietns who were studied by the modified biophysical profile (MBPP).Results: Mild hypertension was found in 80% of the cases while 20% of the cases had severe hypertension. Most of the patients were primigravida while very few of them were fourth gravidae. 78 patients had a score of BPP 8-10, out of which 7 had fetal distress while 71. Abnormal BPP score (<6) was observed among 22% of the patients in group A. Of these 22 patients, 9 patients had a score of <2 and all of them delivered by LSCS due to chronic fetal distress. Among the MBPP score, IUGR was seen among 4 fetuses who had a low score. Out of the 5 patients who had fetal distress, 2 fetuses were still born. Both BPP and MBPP were comparable to each other in terms of sensitivity, specificity and the predictive negative and positive values.Conclusions: Since BPP requires more expertise than MBPP in terms of processing and time saving, MBPP can be used as a substitute to BPP.

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Folic acid intake during pregnancy reduced the incidence of pregnancy-induced hypertension in Tibetan Nationality of Tibet Plateau: a population based cohort study

10.21203/rs.3.rs-40850/v1 ◽

2020 ◽

Author(s):

Xiaohong Xu ◽

Ming Wang ◽

Ziyi Zhao ◽

Zhuoma Pubu ◽

Yang Ge ◽

...

Keyword(s):

Cohort Study ◽

Folic Acid ◽

Pregnant Women ◽

Tibet Plateau ◽

Pregnancy Induced Hypertension ◽

Folic Acid Supplement ◽

Acid Supplement ◽

Induced Hypertension ◽

Group A ◽

Group B

Abstract Objective The objective of this study was to investigate the effect of maternal supplementation with folic acid on pregnancy induced hypertension (PIH) and fetal outcomes in Tibetan Nationality of Tibet Plateau . Design A retrospective cohort study. Setting Lasha People's Hospital, China Participants Pregnant mothers of Tibetan Nationality on Tibet Plateau from Jan 2012 to Jan 2016. Primary and secondary outcomes Negative maternal and fetal outcomes between mothers who received folic acid supplement and mothers did not. Frequency of pregnancy induced hypertension were main outcome. Results 6700 pregnant women were included in the study, 18.37% (1231/6700) mothers (group A)received folic acid supplement during pregnancy and 24.37%(300/1231) of them(group A1) having supplement of folic acid longer than 3months. 1230 mothers did not receive folic acid supplement were selected as control (group B) through propensity score matching. In comparison, mothers of group A have a lower frequency of PIH than group B ( 5.8 % vs.19.3 %, P<0.001), including gestational hypertension (1.87%vs.4.47 % ), mild Pre-eclampsia (2.11 %vs.5.69 % ) ,severe Pre-eclampsia(1.87% vs.8.54 %) and Eclampsia(0% vs.0.57% ). However, Longer duration of folic acid supplement did not reduced the incidence of PIH. Before delivery, mothers of group A had less anemia ( 31.7 %vs.20.1%, P <0.001) and much higher hemoglobin (122.3±16.02g vs.115.5±16.76g, P <0.001) than group B. After delivery, more preterm infants, more neonatal asphyxia , lighter weight, shorter height , smaller head circumference and pediatric admission were observed in infants of group B than group A. Conclusion Among pregnant women of Tibetan Nationality on Tibet Plateau , folic acid supplement could reduce the incidence of pregnancy induced hypertension, anemia and related negative outcomes of infants.

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Oral Nifedipine Versus Intravenous Labetalol in the Management of Severe Pregnancy Induced Hypertension: A Randomized Control Trial

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v20i1.53589 ◽

2021 ◽

Vol 20 (1) ◽

pp. 55-61

Author(s):

Farah Naz Mabud ◽

Serajun Noor ◽

Shahanara Chowdhury

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Mode Of Delivery ◽

Multiple Pregnancy ◽

Drug Dose ◽

Time Interval ◽

Pregnancy Induced Hypertension ◽

Induced Hypertension ◽

Group A ◽

Group B

Background : Pregnancy-also known as gestation is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can occur through assisted reproductive technology protedures. To assess the efficacy of oral Nifedipine and I/V Labetalol for lowering BP in severe PIH after 28 weeks of pregnancy. Materials and methods: In this study 100 subjects were selected with severe pregnancy induced hypertension as per inclusion criteria. After taking informed written consent they were randomly allocated into two groups, A & B. Group A received initially tablet nifedipine 10 mg orally with repeated doses of 20 mg every 20 minutes upto five doses while Group B received intravenous labetalol 20 mg initially followed by escalating doses of 40, 80, 80 and 80 mg every 20 minutes until the therapeutic goal blood pressure Systolic £ 150 mmHg & diastolic £ 100 mmHg was achieved. Primary outcomes were the time interval and the number of doses needed to achieve a blood pressure of £ 150/100 mmHg, Secondary outcomes were fetomaternal safety, efficacy and side effects of both drugs. The outcomes were recorded in a preformed data collection sheet. All the data were analyzed by computer based software SPSS version 19 (SPSS Inc, Chicago, IL, USA). P <0.05 at 95% level was taken as statistically significant. Results: A total of 100 patients of different ages with mean age of 27.41 years were taken in the study. Primi patients were more in Group A the Group B and mode of delivery was commonly caesarian section (66% vs 78%) in both groups. Proportion of target BP achievement were 100% in Group A and it was 72% in Group B. Need of drug dose and time of reduction was found significantly less among Group A women. Change of mean ± SD, SBP was more rapid in Group A ( 174.90 ± 20.01 vs 158.40 ± 11.13) women who were on Group A oral nifedipine than Group B ( 179.80 ± 16.54 vs 167.40 ± 15.02) i/v labetalol group after first dose. It was same for DBP also. Need of mean dose were less in group A than Group B (1.72 vs 3.30) also total time needed to achieve target BP was less in Group A (34.40 vs 66.0 mins). There was no need of doses exceeding third dose who were on oral nifidipine than i/v labetolol. Both maternal and fetal heart rate was not influenced by both the drugs. Side effects of drugs were found more in Group B (8% vs 4%) and fetal death also more common in there (8% vs 16%). Value of APGAR scores was found higher both at 1 minute and at 5 minutes among Group A neonates than Group B. Significant urine output volume was found in Group A patients than Group B at first hour. Conclusion: Oral nifedipine and intravenous labetalol both the regimens are found to be effective in the management of severe PIH. But Nifidipine lowers blood pressure more rapidly with fewer doses with minimum fetomaternal side-effects. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 55-61

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Effect of raised serum uric acid level on perinatal and maternal outcome in cases of pregnancy-induced hypertension

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v10i2.31910 ◽

2017 ◽

Vol 10 (2) ◽

pp. 58 ◽

Cited By ~ 2

Author(s):

Qumrun Nassa Ahmed ◽

Farhana Dewan

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Uric Acid Level ◽

Acid Level ◽

Serum Uric Acid Level ◽

Pregnancy Induced Hypertension ◽

Maternal Complications ◽

Induced Hypertension ◽

Group A ◽

Group B

<p>The aim of this study was to find out the effects of raised serum uric acid level on perinatal and maternal outcome in cases of pregnancy-induced hypertension. One hundred pregnant women with gestational period beyond 28 weeks with pregnancy-induced hypertension-preeclampsia and eclampsia were included in this study and divided into two groups. Group A (n=65) patients with a serum uric acid level >6 mg/dL was compared to Group B (n=35) patients with a uric acid level <6 gm/dL. It revealed that high uric acid level in patients with pregnancy-induced hypertension was a risk factor for several maternal complications like postpartum hemorrhage (Group A, 17.4%; Group B, 22.6%), postpartum eclampsia (Group A, 10.1%; Group B, 9.7%), abruptio placentae (Group A, 8.7%; Group B, 6.4%), HELLP syndrome (Group A, 2.9%; Group B, 0%) and pulmonary edema (Group A, 4.3%; Group B, 0%). In case of perinatal outcome, the birth weight, intrauterine growth retardation, intrauterine death, stillbirth and neonatal death rate were worse in Group A 1.9 kg, 66.7, 19, 7 and 8% in comparison to Group B, where those were 2.1, 13, 6, 2, and 2% respectively. In conclusion, high uric acid in blood in patient with hypertensive disorders in pregnancy is a risk factor for several maternal complications.</p>

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