scholarly journals Hypertensive disorders of pregnancy and impact on in-hospital cardio-obstetric outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Wu ◽  
C Chew-Graham ◽  
A Maas ◽  
L Chappell ◽  
J Potts ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
The United States ◽  
Peripartum Cardiomyopathy ◽  
Assessment Model ◽  
Obstetric Outcomes ◽  
Chronic Hypertension ◽  
Funding Source ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Comorbidity Burden

Abstract Introduction Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity. However, short-term outcomes of HDP subgroups remain unknown. Methods Using the United States National Inpatient Sample database, all delivery hospitalizations between 2004 and 2014 with or without HDP (preeclampsia/eclampsia, chronic hypertension, superimposed preeclampsia on chronic hypertension and gestational hypertension) were analysed to examine the association between HDP and adverse in-hospital outcomes. Results We identified >44 million delivery hospitalizations, within which the prevalence of HDP increased from 8% to 11% over a decade with increasing comorbidity burden. Women with chronic hypertension have higher risks of myocardial infarction, peripartum cardiomyopathy, arrhythmia and stillbirth compared to women with preeclampsia. Out of all HDP subgroups, the superimposed preeclampsia population had the highest risk of stroke (OR 7.83, 95% CI 6.25, 9.80), myocardial infarction (OR 5.20, 95% CI 3.11, 8.69), peripartum cardiomyopathy (OR 4.37, 95% CI 3.64, 5.26), preterm birth (OR 4.65, 95% CI 4.48, 4.83), placental abruption (OR 2.22, 95% CI 2.09, 2.36), and stillbirth (OR 1.78, 95% CI 1.66, 1.92) compared to women without HDP. In conclusion, we are the first to evaluate chronic SH without superimposed preeclampsia as a distinct subgroup in HDP and show that women with chronic SH are at even higher risk of some adverse outcomes compared to women with preeclampsia. Conclusion The chronic hypertension population, with and without superimposed preeclampsia, is a particularly high risk group and may benefit from increased antenatal surveillance and the use of a prognostic risk assessment model incorporating HDP to stratify intrapartum care. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): NIHR

scholarly journals Peripartum cardiomyopathy and hypertensive disorders of pregnancy and cardiovascular events among 1.6 million California pregnancies

2018 ◽  
Author(s):  
Rima Arnaout ◽  
Gregory Nah ◽  
Gregory M. Marcus ◽  
Zian H. Tseng ◽  
Elyse Foster ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Gestational Diabetes ◽  
Intrauterine Growth Restriction ◽  
Fold Increase ◽  
Peripartum Cardiomyopathy ◽  
Growth Restriction ◽  
Hypertensive Disorders Of Pregnancy ◽  
Intrauterine Growth ◽  
Hypertensive Disorders

AbstractBackgroundCardiovascular complications during and soon after pregnancy present an opportunity to assess risk for subsequent cardiovascular disease. We sought to determine whether peripartum cardiomyopathy and hypertensive disorder of pregnancy subtypes predict future myocardial infarction, heart failure, or stroke independent of one another and independent of other risks like gestational diabetes, preterm birth, and intrauterine growth restriction.Methods and ResultsThe California Healthcare Cost and Utilization Project database was used to identify all hospitalized pregnancies from 2005-2009, with follow-up through 2011, for a retrospective cohort study. Pregnancies, exposures, covariates and outcomes were defined by ICD-9 codes. Among 1.6 million pregnancies (mean age 28y; median follow-up time to event 2.7y), 558 cases of peripartum cardiomyopathy, 123,603 cases of hypertensive disorders of pregnancy, 107,636 cases of gestational diabetes, 116,768 preterm births, and 23,504 cases of intrauterine growth restriction were observed. Using multivariable Cox proportional hazards models, peripartum cardiomyopathy was independently associated with a 13.0-fold increase in myocardial infarction [95%CI, 4.1-40.9], a 39.2-fold increase in heart failure [95%CI, 30.0-51.9], and a 7.7-fold increase in stroke [95%CI, 2.4-24.0]. Hypertensive disorders of pregnancy were associated with a 1.4 [95%CI, 1.0-2.0] to 7.6 [95%CI, 5.4-10.7] fold higher risk of myocardial infarction, heart failure, and stroke. Gestational diabetes, preterm birth, and intrauterine growth restriction had more modest associations with CVD.ConclusionsThese findings support close monitoring of women with cardiovascular pregnancy complications for prevention of early subsequent cardiovascular events and further study of mechanisms underlying their development.

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 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 Temporal Changes in Hypertensive Disorders of Pregnancy and Impact on Cardiovascular and Obstetric Outcomes

2020 ◽  
Vol 125 (10) ◽  
pp. 1508-1516
Author(s):  
Pensée Wu ◽  
Carolyn A. Chew-Graham ◽  
Angela HEM Maas ◽  
Lucy C. Chappell ◽  
Jessica E. Potts ◽  
...  
Keyword(s):  
Temporal Changes ◽  
Obstetric Outcomes ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

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 Trends in coronary artery disease screening before kidney transplantation

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005282021
Author(s):  
Xingxing S. Cheng ◽  
Sai Liu ◽  
Jialin Han ◽  
Margaret R. Stedman ◽  
Glenn M. Chertow ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Kidney Transplant ◽  
Temporal Trends ◽  
The United States ◽  
Comorbidity Burden ◽  
Risk Patients ◽  
Artery Disease ◽  
Fatal Myocardial Infarction

Background: Coronary artery disease (CAD) screening in asymptomatic kidney transplant candidates is widespread but not well supported by contemporary cardiology literature. We describe here temporal trends in CAD screening before kidney transplant in the United States. Methods: Using the United States Renal Data System, we examined Medicare-insured adults who received a first kidney transplant from 2000 through 2015. We stratified analysis based on whether the patient's comorbidity burden met guideline definitions of high-risk for CAD. We examined temporal trends in non-urgent CAD tests within the year prior to transplant and the composite of death and non-fatal myocardial infarction in the 30 days after transplant. Results: Of 94,832 kidney transplant recipients, 37,139 (39%) underwent at least one non-urgent CAD test in the 1 year prior to transplant. From 2000 to 2015, The transplant program waitlist volume had increased as transplant volume stayed constant, while patients in the later eras had slightly higher comorbidity burden (older, longer dialysis vintage, and a higher prevalence of diabetes mellitus and CAD). The likelihood of CAD test in the year prior to transplant increased from 2000 through 2003 and remained relatively stable thereafter. When stratified by CAD risk status, test rates decreased modestly in high-risk patients but remained constant in low-risk patients after 2008. Death or non-fatal myocardial infarction within 30 days after transplant decreased from 3.4% in 2000 to 1.5% in 2015. Nuclear perfusion scan was the most frequent modality of testing throughout examined time periods. Conclusions: CAD testing rates before kidney transplantation have remained constant from 2000 through 2015 despite widespread changes in cardiology guidelines and practice.

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 Trends in the Incidence of New‐Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019

2022 ◽  
Author(s):  
Natalie A. Cameron ◽  
Ian Everitt ◽  
Laura E. Seegmiller ◽  
Lynn M. Yee ◽  
William A. Grobman ◽  
...  
Keyword(s):  
United States ◽  
Urban Areas ◽  
The United States ◽  
Hypertensive Disorders Of Pregnancy ◽  
Live Births ◽  
Rural And Urban Areas ◽  
Hypertensive Disorders ◽  
Rural And Urban ◽  
Rate Ratios ◽  
New Onset

Background Hypertensive disorders of pregnancy are growing public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. Given established rural‐urban differences in maternal cardiovascular health, we described contemporary trends in new‐onset hypertensive disorders of pregnancy in the United States. Methods and Results We conducted a serial, cross‐sectional analysis of 51 685 525 live births to individuals aged 15 to 44 years from 2007 to 2019 using the Centers for Disease Control and Prevention Natality Database. We included gestational hypertension and preeclampsia/eclampsia in individuals without chronic hypertension and calculated the age‐adjusted incidence (95% CI) per 1000 live births overall and by urbanization status (rural or urban). We used Joinpoint software to identify inflection points and calculate rate of change. We quantified rate ratios to compare the relative incidence in rural compared with urban areas. Incidence (95% CI) of new‐onset hypertensive disorders of pregnancy increased from 2007 to 2019 in both rural (48.6 [48.0–49.2] to 83.9 [83.1–84.7]) and urban (37.0 [36.8–37.2] to 77.2 [76.8–77.6]) areas. The rate of annual increase in new‐onset hypertensive disorders of pregnancy was more rapid after 2014 with greater acceleration in urban compared with rural areas. Rate ratios (95% CI) comparing incidence of new‐onset hypertensive disorders of pregnancy in rural and urban areas decreased from 1.31 (1.30–1.33) in 2007 to 1.09 (1.08–1.10) in 2019. Conclusions Incidence of new‐onset hypertensive disorders of pregnancy doubled from 2007 to 2019 with persistent rural‐urban differences highlighting the need for targeted interventions to improve the health of pregnant individuals and their offspring.

scholarly journals Evaluation of Postpartum Counseling on Future Health Risks Associated with Hypertensive Disorders of Pregnancy

2020 ◽  
pp. 1-5
Author(s):  
Jourdie Triebwasser ◽  
Elizabeth S. Langen ◽  
Jennifer Lewey ◽  
Jourdie Triebwasser
Keyword(s):  
Primary Care ◽  
Cardiovascular Risk ◽  
Tertiary Care ◽  
Discharge Summary ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Postpartum Visit ◽  
Hypertensive Disorders ◽  
Future Pregnancy

Background: The American College of Obstetricians and Gynecologists and the American Heart Association recommend that women with hypertensive disorders of pregnancy be counseled on lifelong cardiovascular risks and transitioned to primary care for ongoing screening and management. Objective: To assess frequency and content of postpartum counseling regarding cardiovascular risk and follow-up among women with hypertensive disorders of pregnancy. Study Design: A secondary analysis of a randomized trial of women with hypertensive disorders of pregnancy, excluding chronic hypertension, performed at a single tertiary care academic hospital. We abstracted documented counseling on hypertensive disorders from the discharge summary and postpartum visit note in the electronic medical record. We defined counseling as documentation of any one of the following: 1) recommending aspirin in a future pregnancy, 2) follow-up with primary care, or 3) lifelong risk of cardiovascular disease. We used logistic regression models to estimate adjusted odds for receiving counseling. Results: Seventy-four women enrolled in the study. A hypertensive diagnosis was documented for 71 women (96.0%) in the discharge summary, but only 11 (14.9%) had any documented counseling in the discharge summary or postpartum visit note. Of the 11 women counseled, 5 (6.7%) were counseled on taking aspirin in a future pregnancy, 5 (6.7%) were counseled on follow-up with primary care, and only 3 (4.1%) were counseled on the lifelong cardiovascular risk associated with hypertension in pregnancy. Two women (2.7%) were counseled on follow-up with primary care and lifelong cardiovascular risk. There were no participants counseled on all three components. Later gestational age at delivery was associated with lower odds of counseling (adjusted OR 0.49, 95% CI 0.27-0.89). Conclusion: Despite consistent evidence on long-term risks of hypertensive disorders of pregnancy, counseling about those risks is suboptimal. Improved communication of risks is the first step towards improving maternal health in the “fourth trimester” and beyond.

Sign in / Sign up

Export Citation Format

Share Document