scholarly journals Comparative study of labetalol and nifedipine in management of non- severe preeclampsia and its fetomaternal outcome

2019 ◽  
Vol 8 (5) ◽  
pp. 2034
Author(s):  
Delphine T. Rose ◽  
Jeyarani P.
Keyword(s):  
Blood Pressure ◽  
Tamil Nadu ◽  
Neonatal Outcome ◽  
Developed Countries ◽  
Severe Preeclampsia ◽  
Chronic Hypertension ◽  
Maternal Deaths ◽  
Medical College ◽  
Hypertensive Disorders ◽  
Significant Difference

Background: In developed countries, 16 percent of maternal deaths were attributed to hypertensive disorders. Of hypertensive disorders, the preeclampsia syndrome, either alone or superimposed on chronic hypertension, is the most dangerous. The incidence of preeclampsia in nulliparous populations ranged from 3 to 10 percent.Methods: The present study was conducted at Government Raja Mirasudhar Hospital, Thanjavur Medical College, Thanjavur, Tamil Nadu, India from October 2017 to October 2018. The study consisted of 100 antenatal women with non-severe preeclampsia. The efficacy of labetalol verses nifedipine in its management was studied along with the fetomaternal outcome.Results: In this study, in the labetalol and in the nifedipine groups adequate control of blood pressure was achieved. However, labetalol was well tolerated by our women without much side effects.Conclusions: The present study indicates both labetalol and nifedipine are equally efficacious in the control of hypertension in non-severe preeclampsia. Pathology of the disease was not altered significantly in both the groups. There was no significant difference in the neonatal outcome between the two groups.

scholarly journals Hypertensive Disorders in Pregnancy and its Diagnosis and Treatment

2020 ◽  
pp. 1-1
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Salt Intake ◽  
Developed Countries ◽  
Pharmacologic Therapy ◽  
Chronic Hypertension ◽  
Hypertensive Disorders ◽  
Obstetric Medicine ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

While motherhood may be a positive and enjoyable experience, many ladies are experiencing suffering, illness, and death. During pregnancy, at delivery or post-partum around 15% of pregnant women are expected to develop life-threatening complications and among these Hypertensive Disorders of Pregnancy (HDP) are significant contributors and sufferings [1]. Hypertension term is used to describe high Blood Pressure (BP). Hypertension in pregnancy is defined as: “Systolic blood pressure greater than or adequate to 140 mmHg and/or diastolic blood pressure greater than or adequate to 90 mmHg which usually confirmed within four hours apart measurement”. Pre-existing hypertension, Gestational Hypertension (GH), Pre-eclampsia (PE)/eclampsia, and superimposed hypertension are spectrum of conditions encompasses by hypertension disorder in pregnancy. The range in which these conditions occur is from a mild increase in blood pressure at term with no additional signs or symptoms to severe complications with potential for significant maternal, fetal and neonatal harm. A significant number of women die every year from pregnancy-related causes globally. Hypertensive disorders in pregnancy causes approximately 12% of the maternal deaths. This is the reason why hypertension complications are among the main public health issues worldwide. Hypertensive disorders in pregnancy vary in different populations. This problem is generally more common in the developing countries compared to developed countries [2]. BP measurement before pregnancy is necessary for differential diagnosis; otherwise, diagnosis cannot be sure. Chronic hypertension is describe as a disturbance detected before 20 weeks of gestation by American College of Obstetrician and Gynaecologist (ACOG), Royal College of Obstetricians and Gynaecologists (RCOG), Society of Obstetricians and Gynaecologists of Canada (SOGC), Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), in line with ISSHP. Women should be positioned seated, without crossed legs, with feet touching the floor and the back completely resting on the chair during BP measurement. The pressure value can be underestimated because of lying or supine or side position. Women must refrain from talking, consulting the telephone, watching television and reading etc. The arm should not be stretched; it should be at heart level. After at least 5 minutes of sitting position at rest, the first measurement must be taken. The cap should be of the right size and it should not be placed over clothes. BP measurement should be done several times [3]. A reduction in salt intake and weight loss are of proven benefit in non-pregnant hypertensive patients. There is currently no evidence that instituting an exercise program during pregnancy is effective in preventing preeclampsia in at risk individuals, although in an animal model some benefit has been seen. Similarly, no evidence that instituting a weight loss program in pregnancy can prevent preeclampsia. Pharmacologic therapy during pregnancy may prevent progression to severe hypertension and maternal complications while improving fetal maturity by permitting prolongation of pregnancy. In pregnancy methyldopa is one of the medications with the longest track record. No increased incidence of general health problems or cognitive problems was found from a study on children born to women treated with methyldopa during pregnancy. Methyldopa can have many side effects, including sedation and impaired sleep patterns as it acts centrally by decreasing sympathetic tone. Methyldopa may cause mild elevations of liver enzymes, which can lead to diagnostic confusion with HELLP syndrome. Methyldopa is not a potent BP lowering agent, it is relatively safe. It can be combined with other anti-hypertensives, such as a diuretic to achieve target blood pressure values. Beta-blockers are generally well-tolerated and these are safe in pregnancy. One of the favored therapies for hypertension disorders in pregnancy is labetalol. Labetalol is a non-selective beta blocker that antagonizes both beta and alpha-1 receptors. Diuretics are the most commonly used medication. A woman can be continued on diuretic medication during pregnancy if she is on a diuretic prior to pregnancy. But, with the exception of spironolactone, which may have fetal anti-androgen effects [4].

scholarly journals Maternal and perinatal outcome in pregnant women with hypertensive disorders: a population-based study

2019 ◽  
Vol 9 (1) ◽  
pp. 194
Author(s):  
S. Shruthi ◽  
G. Thenmozhi
Keyword(s):  
Gestational Hypertension ◽  
Blood Pressure Monitoring ◽  
Population Based ◽  
Severe Preeclampsia ◽  
Chronic Hypertension ◽  
College Hospital ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Hypertensive Disorders ◽  
Fetal Complications

Background: Hypertension during pregnancy is one of the well-known complications of dating from ancient times. It remains as one of the leading causes of maternal mortality and morbidity through its myriad complications. To study the risk factors, prevalence and epidemiological parameters of antenatal mothers presenting with hypertension during pregnancy.Methods: This study was on hypertensive disorders of pregnancy including mild, severe preeclampsia, eclampsia, and chronic hypertension at Chengalpattu Medical College Hospital, Chengalpattu in a period of 1st year from October 2016 to September 2017.Results: Out of 450 hypertensive pregnancies, the majority were severe preeclampsia (39.6%). There were 78 women with gestational hypertension (17.3%), 125 women with mild preeclampsia (27.8%), 178 women with severe preeclampsia (39.6%), 64 women with eclampsia out of which 52 were AP eclampsia (11.6%), 1 case was IP eclampsia (0.2%) and 11 women were PP eclampsia (2.4%). 5 women were chronic hypertensives (1.1%)Conclusions: Complications can affect all maternal systems including central nervous system, renal system, and hematological systems. Apart from these, the fetus also faces the brunt of insult. Fetal complications include prematurity, low birth weight, stillbirths, intrauterine deaths, and intrauterine growth restrictions. However, such vast complications can be prevented by simple blood pressure monitoring and proper antenatal mother follow-up.

scholarly journals Lipid Profile, Glycaemic and Anthropometric Status of Students of a Private Medical College in Dhaka City

2014 ◽  
Vol 5 (1) ◽  
pp. 23-28
Author(s):  
Roksana Yeasmin ◽  
Nazmun Nahar ◽  
Khadiza Begum ◽  
Sultana Parveen ◽  
Farzana Akhter ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lipid Profile ◽  
Central Obesity ◽  
Communicable Disease ◽  
Developed Countries ◽  
Overweight And Obesity ◽  
Noncommunicable Diseases ◽  
Cross Sectional ◽  
Medical College ◽  
Significant Difference

Over weight and obesity are recognized as recent threat which affecting both developing and developed countries. Obesity and its associated morbidities are leading cause of most noncommunicable diseases. Few recent studies have indicated the presence of increasing in over weight and obesity among children and adolescent but there is no study among adult groups. This cross sectional study was done to assess the prevalence of overweight, obesity and metabolic variables with their relation among medical students. Our result reveals that 8.6% & 1.9% male and 15% & 3.2% female are suffering from overweight and obesity (based on BMI) respectively. More females (31.3% and 65.2%) are centrally obese than males (3.5% and 34.8%) (According to Waist Hip ratio and Waist Height ratio respectively). But according to Waist circumference more males (30.7%) are obese than females (24%). There is also significant difference of male and female BP. DBP & SBP of male (79.22mmHg & 118.9 mmHg) have high normal level than female (72.71mmHg & 108.67mmHg) (P<0.001). There is no significant difference of glycaemic status and lipid profile with central obesity. Although male students have high upper level of blood pressure, female students are more obese than males (both according to BMI and central obesity). High blood pressure and obesity both acts as risk factors for the development of non communicable disease. Student's awareness therefore should be increased to reduce central obesity & BP within normal range. DOI: http://dx.doi.org/10.3329/akmmcj.v5i1.18837 Anwer Khan Modern Medical College Journal Vol. 5, No. 1: January 2014, Pages 23-28

Two Types of Anesthesia and Hemodynamic Changes in Patients Over 60 Years of Age Who Need Artificial Femoral Head Replacement: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Weiqi Ke ◽  
Yuting WANG ◽  
Xukeng GUO ◽  
Ronghua HUANG ◽  
Xiangdong ZHANG ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Femoral Head ◽  
Elderly Patients ◽  
The Elderly ◽  
Hemodynamic Changes ◽  
Medical College ◽  
Replacement Surgery ◽  
Elder Patients ◽  
Significant Difference ◽  
And Gender

Abstract Background:Artificial femoral head replacement is one of the most effective methods for treatment of severe diseases of femoral joint in the elderly. The ideal anesthetic effect is one of the key elements for the success of the operation because it brings fast recovery. However, the multiple comorbidities of the elder patients make them too weak to tolerate the hemodynamic changes after anesthesia. In this case, the most suitable anesthesia method for patients undergoing femoral head replacement surgery is of great significance.Objective:To compare the post-anesthetic hemodynamic changes between combined lumbar plexus and sciatic nerve block(CLPSB) and combined spinal and epidural anesthesia(CSEA) in elderly patients undergoing unilateral artificial femoral head replacement.Methods:We reviewed records of the patients who aged over 60 years old (age 62-103 years) and received unilateral artificial femoral head replacement between January 2015 and December 2020 in the first affiliated hospital of Shantou University Medical College. After adjustment according to the inclusion criteria, 477 patients were included and divided into CLPSB group (n=90) and CSEA group (n=387). The primary outcome was comparison of the hemodynamic changes after anesthesia, including the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). The second outcome was the comparison of the vasopressor used during the surgery.Results:We established three models to compare the two anesthesia methods on hemodynamic changes. Crude model included all variates for analysis, while model I adjusted age and gender. Model II adjusted other comorbidities in addition to model I. All three models exhibit that changes of MAP (∆MAP) after CSEA were higher than that after CLPSB(β= 6.88, 95% CI: 4.33 - 9.42, P < 0.0001), with significant difference, which indicated that CSEA causes higher fluctuation of MAP. Concurrently, the use of vasopressors increased by 137% (OR=2.37, 95%CI: 1.24-4.53, P=0.0091) in the CSEA group, which is statistically significant. However, the changes of HR (∆HR) between the CLPSB and CSEA was not significant(β= 0.50, 95% CI: 1.62 - 2.62, P = 0.6427). Conclusions:Both CLPSB and CSEA are ideal anesthesia methods for patients receiving femoral head eplacement, though CLPSB is more suitable for elderly patients with advanced hemodynamic stability.

scholarly journals Study of Inter-arm Variation of Blood Pressure in Normal and Diabetic In-dividual in Out Patient Department of Nepal Medical College

2021 ◽  
Vol 1 (1) ◽  
pp. 12-16
Author(s):  
Pragati Poudyel ◽  
Seerina Adhikari
Keyword(s):  
Blood Pressure ◽  
Cuff Pressure ◽  
Developed Countries ◽  
Sitting Posture ◽  
Medical College ◽  
Arterial Blood ◽  
Measure Blood Pressure ◽  
Normal Individuals ◽  
Blood Pressures ◽  
The Comparative Study

 Introduction: Growing incidence of hypertension and its significant association with diabetes mellitus are being observed in both developing and developed countries around globe. Scanty literature is available about the comparative study of inter-arm variation of blood pressure in normal individuals and diabetic among Nepalese population. This research was performed to determine extent of inter-arm variation in normal individuals and diabetics. Methods: A descriptive observational study was carried out from 2013 January to 2014 January in a tertiary level teaching hospital of Nepal. After taking the consent and giving necessary instructions, blood pressures were measured in both the arms one after another in sitting posture using mercurial sphygmomanometer and Littman cardiosonic stethoscope. Arterial blood pressure was measured by palpatory method followed by auscultatory method The cuff pressure at which the tap sound were first perceived was noted as systolic blood pressure (SBP). Similarly, diastolic blood pressure (DBP) was noted at the point where the sound disappeared. Results: A total of 120 volunteers between ages of 40-80 years were studied. Highly significant inter-arm variation of both SBP and DBP was found in diabetics as compared to normal (p<0.01). Highly significant inter-arm variation was found in diabetic male and female as compared to their normal counter parts (p<0.01). Conclusion: This study showed that there was significant inter-arm variation of SBP and DBP in diabetic and normal individual. So, this study encourages to measure blood pressure (BP) in both arms for proper treatment planning of an individuals.

Hypertension

2020 ◽  
pp. 268-283
Author(s):  
Laura A. Magee ◽  
Peter von Dadelszen
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Disease Risk ◽  
Gestational Hypertension ◽  
Target Organ Damage ◽  
Expectant Management ◽  
Developed Countries ◽  
Chronic Hypertension ◽  
Pregnancy Hypertension ◽  
Premature Cardiovascular Disease

Pregnancy hypertension is associated with an estimated annual toll of 46,000 maternal and 2 million fetal, neonatal, and infant deaths. Over 99% of these deaths occur in less developed countries. The most dangerous form of pregnancy hypertension is pre-eclampsia, which, by international consensus, is defined more broadly than solely by proteinuric gestational hypertension to include markers of systemic target organ damage. Severe pre-eclampsia is defined by adverse features that mandate delivery irrespective of gestational age. There are numerous risk factors for pre-eclampsia and low-dose aspirin and, in women with low intake, calcium replacement appear to reduce the risk of pre-eclampsia and its complications. Time-of-disease risk estimation for women and, to a lesser extent, their fetuses, is possible to guide personalized decision-making and counselling. Heavy proteinuria is not an indication for delivery. Severe pregnancy hypertension must be treated as a matter of urgency. For all women with pregnancy hypertension, blood pressure should be normalized. Magnesium sulphate is the treatment to prevent and treat the seizures of eclampsia. Beyond viability, expectant management of pregnancy hypertension should be offered until 36+6 weeks of pregnancy. Women with either pre-eclampsia or gestational hypertension at more than 37+0 weeks should be offered induction, while induction should be offered to women with chronic hypertension at 38–39 weeks. Blood pressure reaches its maximal postpartum levels on days 3–6 postpartum. All forms of pregnancy hypertension are risk factors for premature cardiovascular disease and mortality, especially if associated with either fetal growth restriction, preterm birth, and/or stillbirth.

scholarly journals Maternal mortality at a tertiary health care: a retrospective study

2018 ◽  
Vol 7 (5) ◽  
pp. 1773
Author(s):  
Sona Singh ◽  
Nagendra Singh ◽  
Jagriti Kiran Nagar ◽  
Sarvesh Jain
Keyword(s):  
Retrospective Study ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Age Group ◽  
Maternal Deaths ◽  
Medical College ◽  
Tertiary Centre ◽  
Hypertensive Disorders ◽  
Mortality Ratio ◽  
One Year

Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and site of pregnancy from any cause related to or aggravated by the pregnancy, but not from accidental or incidental causes. The aim of this study is to find out the causes of maternal mortality and the complications leading to maternal death.Methods: A retrospective study was conducted by reviewing the hospital records to study the maternal deaths and complication leading to maternal death over the period of one year from July 2016 June 2017 in the Department of Obstetrics and Gynecology, Bundelkhand Medical College, and associated hospital Sagar, Madhya Pradesh. All the maternal deaths were scrutinized for various aspects likely to be related to death such as age, locality of residence, antenatal care, admission death interval and the cause of death.Results: The maternal mortality ratio in the present study is 292.33/100,000 live births. There were 28 maternal deaths out of 9578 live birth during the study period. The majority of deaths occurred in the 20-30 age group. hemorrhage (32.14%) and hypertensive disorders (14.28%) are two most common direct cause of maternal deaths. 42.85% of maternal deaths occurred within the first twenty-four hours of admission. Post-operative and post abortal sepsis, amniotic fluid embolism and pulmonary embolism are other direct causes. Indirect causes of maternal deaths account for 21.42%. Severe anemia was the leading indirect causes of maternal deaths.Conclusions: Hemorrhage, hypertensive disorders, and anaemia remain the major cause of maternal deaths. Delay in decision making, provision of treatment and referral to tertiary centre contributed higher maternal mortality. This requires more efforts to recognize the direct and indirect causes of maternal deaths.

scholarly journals A Clinical Study of 100 Cases of Eclampsia In Rajshahi Medical College Hospital

1970 ◽  
Vol 17 (2) ◽  
pp. 80-83 ◽  
Author(s):  
Marina Khanum ◽  
Fatema Ashraf ◽  
Humaira Sahrin
Keyword(s):  
Developing Countries ◽  
Clinical Study ◽  
Perinatal Mortality ◽  
Developed Countries ◽  
Normal Vaginal Delivery ◽  
Age Group ◽  
College Hospital ◽  
Maternal Deaths ◽  
Medical College ◽  
Group 12

Eclampsia is the occurrence of one or more convulsion in association with the syndrome of pre eclampsia. It is relatively uncommon in developed countries where it complicates about one in every 200 deliveries. Eclampsia can be 20 times more common in developing countries and it probably accounts for more than 50,000 maternal deaths worldwide each year. Which anticonvulsant for women with eclampsia Evidence from the collaborative Eclampsia Trial lancet 1995, 345, 1445-63. The main objective of this study was to observe the clinical profile of antepartum eclampsia cases. The study was carried out with 100 cases that were selected randomly during year 2004. 58% of the patients were primigravida; among them 25% patients were in age group 15-14 years. About 95% patients were illiterate, low socio economic group, and in 53% patients' convulsion occurred in 32-37 weeks of pregnancy.Among 100 patients, 71 patients had normal vaginal delivery and 25% patients needed Caesarean section. Maternal mortality rate was 2%, perinatal mortality was 38%. Perinatal mortality was higher in vaginal group (12%) than LSCS group (7%). doi: 10.3329/taj.v17i2.3450 TAJ 2004; 17(2): 80-83

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 Hypertensive disorders in pregnancy at the federal medical centre, Yenagoa, South-South Nigeria: a 5 year review

2021 ◽  
Vol 9 (10) ◽  
pp. 2923
Author(s):  
Peter Chibuzor Oriji ◽  
Dennis Oju Allagoa ◽  
Akaninyene Eseme Ubom ◽  
Amos Kattey Kattey ◽  
Datonye Christopher Briggs ◽  
...  
Keyword(s):  
Perinatal Outcomes ◽  
Case Fatality ◽  
Medical Centre ◽  
Morbidity And Mortality ◽  
Chronic Hypertension ◽  
Maternal Deaths ◽  
Hypertensive Disorders ◽  
Hypertensive Disorders In Pregnancy ◽  
Gestational Age At Delivery ◽  
In Pregnancy

Background: Hypertensive disorders complicate 5.2%-8.2% of pregnancies, and contribute significantly to perinatal and maternal morbidity and mortality worldwide. To determine the incidence, clinical characteristics, maternal and perinatal outcomes of hypertensive disorders in pregnancy at the Federal medical centre, Yenagoa, Bayelsa State, South-South Nigeria.Methods: This retrospective study was conducted between 1 January, 2016 and 31 December, 2020. Relevant data was retrieved, entered into a pre-designed proforma, and analysed using IBM SPSS version 25.0.Results: Out of the 4,571 obstetric patients that were managed in our Centre in the period under review, 335 of them had HDP, giving an incidence rate of 7.32%.The most common HDP were pre-eclampsia (189, 56.4%) and eclampsia (82, 24.5%), while the least common was chronic hypertension (3, 0.9%). A little more than one-half (171, 51.0%) of the women delivered preterm, with a mean gestational age at delivery of 35.5 weeks. The most common route of delivery was emergency Caesarean section (205, 61.2%). There were three maternal deaths, giving a case fatality rate of 0.9%. Two of the maternal deaths were due to eclampsia, and one, from pre-eclampsia.Conclusions: Women should be adequately counseled to embrace preconception care, and early and regular antenatal care visits, with proper monitoring of blood pressure and urine protein. Prompt diagnosis and management are key in preventing the maternal and perinatal morbidity and mortality that are associated with these disorders. 

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