scholarly journals Induction of labor versus expectant management of patients with gestational hypertension at term.

2021 ◽  
Vol 29 (01) ◽  
pp. 57-61
Author(s):  
Fozia Mohammad Bakhsh ◽  
Khanda Gul ◽  
Safia Bibi ◽  
Palwasha Gul

Objective: To compare maternal morbidity in planned induction of labour versus expectant management in women with gestational hypertension at term. Study Design: Randomized Clinical Trial. Setting: Department of Obstetrics and Gynecology, Bolan Medical Complex Hospital Quetta. Period: January 2017 to December 2017. Material & Methods: 240 pregnant women with the diagnosis of gestational hypertension with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg without proteinuria were included. Patients were equally divided into two groups; group A (the intervention group) and group B (the expectant group). In group A, cervical ripening was stimulated with use of intravaginal prostaglandins. In group B, patients were monitored until the onset of spontaneous Labour. In both groups intervention was recommended in case of non-optimal FHR, the diastolic blood pressure ≥110mmHg or the systolic blood pressure ≥170 mmHg and eclampsia. Results: Out of 120 deliveries, 87 (72.5%) delivered by vaginal and 33 (27.5%) by caesarean section in group A. While in group B, out of 120 deliveries, 66 (55%) delivered by vaginal and 54 (45%) by caesarean section. The frequency of maternal outcome like mild preeclampsia present in 15% and 40% of women in group A and in group B respectively. Severe preeclampsia was noted 7.5% and 22.5% in group A and in group B respectively. Seizures were found in 2.5% of women in group A and 10% of women in group B. Conclusion: Complications like mild and severe preeclampsia and eclampsia could be prevented by induction of labour at term and also by widespread use of prenatal care education, prompt diagnosis and treatment of gestational hypertension.

Author(s):  
Rishman Tandi ◽  
Tanvi Kumar ◽  
Amritpal Singh Kahlon ◽  
Aaftab Sethi

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed.   Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.


2016 ◽  
Vol 4 (1) ◽  
pp. 24-30
Author(s):  
Nasir Uddin Ahmed ◽  
Masuda Islam Khan ◽  
Aynul Islam Khan ◽  
AKM Akhtaruzzaman

Background: Spinal anaesthesia induced hypotension, a common problem during caesarean section, is associated with maternal nausea and vomiting and the risk of neonatal acidosis. Low dose local anaesthetic combined with opioids spinal anaesthesia better preserves maternal haemodynamic stability, resulting in equally efficacious anaesthesia.Objectives: To investigate whether this synergistic action could be used to provide effective anaesthesia while preventing hypotension during caesarean operation.Materials and method: This prospective study included 60 pregnant mothers scheduled for caesarean operation who were then divided into two groups (thirty in each). Group-A received a spinal injection of 12.5 mg of standardized 0.5% hyperbaric bupivacaine and group-B received 8 mg of 0.5% hyperbaric bupivacaine with 20 ?gm fentanyl. Hypotension was defined as the systolic blood pressure drops below 90 mm of Hg or a decrease of systolic blood pressure 25% from pre anaesthesia level and hypotension was treated with a bolus of 5 to 10 mg of intravenous ephedrine. The quality of anaesthesia and postoperative analgesia were evaluated.Results: The mean time required to reach peak sensory level was earlier in group-B than group-A and was statistically significant (p<0.05). The decrease in systolic blood pressure in group-A was significantly more than group-B (p<0.05) and vasopressor requirement was also significantly more in group-A compared to group-B (p<0.05). Mean time of two segment regression of sensory analgesia and complete sensory recovery was significantly early in group-B (p<0.05). Duration of motor recovery in group-B was significantly earlier (p<0.05). The duration of effective analgesia was significantly more in group-B (p<0.05).Conclusion: Low dose Bupivacaine with fentanyl provided excellent intraoperative sensory and motor blockade, haemodynamic stability, and effective postoperative analgesia for caesarean delivery.Delta Med Col J. Jan 2016 4(1): 24-30


2017 ◽  
Vol 2 (2) ◽  
pp. 9-14
Author(s):  
Ninik Mas Ulfa

ABSTRAKHipertensi adalah peningkatan tekanan darah sistolik lebih dari 140 mmHg dan tekanan darah diastolik lebih dari 90 mmHg pada dua kali pengukuran dengan selang waktu lima menit dalam keadaan cukup istirahat. Faktor penyebab hipertensi adalah faktor gaya hidup, faktor genetika dan faktor usia. Hipertensi termasuk dalam penyakit degeneratif dimana terjadi penurunan organ tubuh. Tujuan dari penelitian ini adalah untuk mengetahui efektifitas kontrol penurunan teakanan darah dari terapi obat Candersartan, Valsartan dan Kalium Losartan. Pada penelitian ini dilakukan di RS X wilayah Surabaya Selatan dan RS Y wilayah Surabaya Timur. Penelitian ini bersifat retrospektif dengan pengamatan observasioanl. Penelitian ini terbagi dalam 3 kelompok terapi dengan jumlah total populasi adalah 57 pasien. Data tekanan darah sistolik-diastolik diamati selama 5 bulan terapi darimasing-masing kelompok terapi A (Candersartan n = 19), kelompok terapi B (Valsartan n= 19), dan kelompok terapi C (Kalium Losartan n= 19).Hasil penelitian menunjukkan bahwa terjadi penurunan tekanan darah sistolik pada kelompok A sebesar 21,18%, kelompok B = 24,20%, dan kelompok C = 22,51%. Penurunan tekanan darah diastolic pada kelompok A sebesar 12,14%, kelompok B = 14,04% dan kelompok C = 10,98%. Berdasarkan hasil analisa statistik diperoleh hasil p = 0,967 > α = 0,05 yang berarti tidak ada perbedaan yang bermakna dari ketiga kelompok terapi tersebut dalam penurunan tekanan darah sistolik maupun diastolik pada pasien hipertensi. Hal ini berarti bahwa efektifitas ketiga obat tersebut dalam kontrol penurunan tekanan darah pada pasien Hipertensi mempunyai efektifitas yangKata Kunci: Candersartan, Valsartan, Kalium Losartan, HipertensiABSTRACTHypertension is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements with an interval of five minutes in a resting state. Factors causing hypertension are lifestyle factors, genetic factors and age factors. Hypertension is included in degenerative diseases where there is a decrease in body organs. The purpose of this study was to determine the effectiveness of blood pressure control of Candersartan, Valsartan and Potassium Losartan. This research was conducted in RS X of South Surabaya and RS Y of East Surabaya. This study is retrospective with observational. The study was divided into 3 therapeutic groups with a total population of 57 patients. Data on systolic-diastolic blood pressurewere observed for 5 months of therapy from each of the therapy groups A (Candersartan n = 19), therapy group B (Valsartan n = 19), and therapy group C (Potassium Losartan n = 19). That there was a decrease in systolic blood pressure in group A of 21,18%, group B = 24,20%, and group C = 22,51%. Diastolic blood pressure decrease in group A was 12,14%, group B = 14,04% and group C = 10,98%. Based on the results of statistical analysis obtained results p = 0.967> α = 0.05 which means there is no significant difference of the three groups of therapy in the reduction of systolic blood pressure and diastolic in hypertensive patients. This means that the effectiveness of the three drugs in the control of blood pressure reduction in hypertensive patients has the same effectiveness.Key Words: Candersartan, Valsartan, Potasium Losartan, Hypertesion


2010 ◽  
Vol 14 (Number 1) ◽  
pp. 32-35
Author(s):  
N Habib ◽  
Md. R Amin ◽  
US N Begum ◽  
N Akhter ◽  
D Akther ◽  
...  

This descriptive study was done in the Deponment of Physiology. Dhaka Medical College, Dhaka. during the period of January 2008 to December 2008. The objective of the study was to measure pulse and blood pressure in smokers and nonsmoker adult male stroke patients and to find out changes in pulse and blood pressure among the smoker and non-smoker stroke patients. To accomplish this purpose 105 patient of over 20 years of age were selected. They were divided into two groups: Group A consisting of thirty n on-smoker and group B consisting of seven,' five smoker stroke patients. The finding showed that smoking caused no statistical significant difference 1p>0.05) in pulse and systolic blood pressure among she groups. Diastolic blood pressure was significantly higher (p<0.05) fill smokers than non-smokers. The study therefore provides the scope to understand the altered physiology of smoker stroke pollen's.


2013 ◽  
Vol 25 (1) ◽  
pp. 28-31
Author(s):  
N Habib ◽  
M Rashid ◽  
USN Begum ◽  
N Ahter ◽  
D Akhter

This cross-sectional study was carried out to assess blood pressure parameters among adult male smokers and smokeless tobacco users. For this purpose, 105 male respondents were selected. They were divided into two groups; Group A-consisting of 30 were smokeless tobacco users and group B consisting of 75 smoker patients The participants were selected from medicine outdoor of Dhaka Medical College Hospital. In this study, the mean (±SD) of systolic blood pressure were 154.50±26.793 mm of Hg in Group A and 151.67±19.248 mm of Hg in group B respectively. Statistical analysis was done by unpaired‘t’ test, there were no statistical significant differences (P>0.05) of systolic blood pressure between Group A and Group B. The mean (±SD) of diastolic blood pressure were 96.67±10.933 mm of Hg in Group A and 86.47±14.745 mm of Hg in group B respectively. The mean (± SD) of diastolic blood pressure were significantly higher (P<0.05) in Group A than Group B. DOI: http://dx.doi.org/10.3329/medtoday.v25i1.16066 Medicine Today 2013 Vol.25(1): 28-31


2010 ◽  
Vol 17 (03) ◽  
pp. 425-430
Author(s):  
GHULAM RASOOL BHURGRI ◽  
HUSSAIN BUX KOREJO ◽  
MUHAMMAD ALI QURESHI ◽  
Raj Kumar ◽  
Nasrullah Aamir

Objective: To compare the efficacy and tolerability of Losartan and Atenolol in alone and combination in treatment of hypertension. Study Design: Comparative study. Setting: Medical out patients department of Jinnah Postgraduate Medical Centre Karachi from January 2007 to June 2007. Methods: There were 60 patients previously untreated with mild and moderate essential hypertensions were registered for study. The selected patients were divided into three groups. Group A was given atenolol, Group B was given Losartan, and Group C was given both drugs. The target blood pressure was 120-140/80-90 mmHg. There were 42 males and 18 females with age range 25-65 years. Results: The mean baseline score of groups A, B and C were showed systolic blood pressure 182±19, 174 ± 20 and 168 ± 12 respectively. The diastolic blood pressure was 104.5±11, 102.5±9 and 104.5±10 respectively. The difference in mean systolic and diastolic blood pressure was not significant statistically as P = 0.06 and 0.76 respectively. After 4 months of treatment with atenolol, systolic blood pressure decreased to 147±17, and diastolic blood pressure fell to 87±4. Losartan decreased systolic blood pressure 138±13 and diastolic blood pressure 87±4 in 4 months of treatment. The combined therapy decreased systolic blood pressure 115±4.6 and diastolic blood pressure 75±4.7. The effect of treatments on systolic and diastolic blood pressure was significantly different as (p < 0.001) and ( p = 0.036) respectively. Side effects observed in 2 (10%) patients from group C, 8 (40%) in group A and 4 (20%) in group B. Combination therapy proved more effective in controlling hypertension than mono therapy and also fewer side effects. Patients showed better control on combination therapy as compared to mono therapy. Losartan proved a little better in controlling hypertension then atenolol and was more expensive. Conclusion: Patients showed better results with combination therapy for hypertension compared to individual drug.


2020 ◽  
Vol 27 (08) ◽  
pp. 1565-1569
Author(s):  
Saima Ashraf ◽  
Hajira Sultana ◽  
Saima Yasmin Qadir ◽  
Muhammad Khalid

Objective: this study is conducted to compare the maternal outcomes of expectant management versus induction of labour within 24 hours of premature rupture of membranes. Study Design: Randomized controlled trial. Setting: Obstetrics and Gynaecology Department, Nishtar Hospital, Multan. Period: From 15 March 2018 to 15 September 2018. Material & Methods: A total of 130 pregnant women with parity 0 – 4 having singleton pregnancy, ≥37 weeks pregnant and having premature rupture of membranes were taken in the study. Women having previous caesarean section, with history of hypertension or diabetes, features suggestive of chorioamnionitis, preterm pre-labour rupture of membranes and women with foetal distress were excluded from the study. Two groups were made. In Group (A) women were subjected to expectant management in which patients were observed for uterine contractions for a period of 24 hours. In Group (B) women were induced with tab dinoprostone 2 doses each 3 mg given 6 hours apart. Information regarding caesarean section, vaginal delivery and chorioamnionitis was recorded on a specially designed proforma. Results: In this study age range was from 18 to 35 years while in both groups most patients were 28 – 35 years old. In Group (A) mean gestational age was 38.246 ± 0.84 weeks while in Group (B) it was 37.953 ± 0.95 weeks. In Group (A) mean parity was 1.076 ± 1.16 and in Group (B) it was 1.815 ± 1.16. in Group (A) 2.092 ± 0.67 hours was mean duration of PROM while in Group (B) it was 2.092 ±0.67 hours. Mean BMI in Group (A) was 26.088 ±3.80 kg/m2 and in Group (B) it was 26.361 ±4.33 kg/m2. In Group (A), 24 patient (36.9%) delivered vaginally while 42 (64.6%) patient delivered vaginally in Group (B). 41 patients (63%) had cesarean section in Group (A) while in Group (B) 23 patients (35.4%) had cesarean section. Chorioamnionitis was seen in 14 patients (21.5%) in Group (A) while 3 patients (4.6%) had chorioamnionitis in Group (B). Conclusion: Our study concluded that induction of labour with twenty four hours of premature rupture of membranes does causes a reduction in occurrence of chorioamnionitis. By this approach patients are usually delivered within 24 hours and caesarean section rate is not increased. This approach also causes a reduction in augmentation of labour by oxytocin.


Author(s):  
Md Harun-or-Rashid ◽  
ASM Meftahuzzaman ◽  
Manirul Islam ◽  
AKM Aktaruzzaman

To compare the haemodynamic changes between LMA insertion & endotracheal intubation, 60 patients were assigned randomly to one of the two groups of thirty each. They were grouped randomly by card sampling. Every patient included in the study was allowed a card preoperatively. According to the card number patients were grouped. Group A. Airway was maintained by LMA. Group B: Airway was maintained by ETT. Haemodynamic parameter i.e. pulse rate, systolic blood pressure, diastolic blood pressure and presence of any dysrhythmia were monitored after 1,3,5 & 10 minutes after LMA insertion or ETT intubations. There was statistically significant changes (P<0.05) in pulse rate, systolic blood pressure, diastolic blood pressure and (appearance of dysrhythmia in some patients) in group ti patients whereas there was less changes in pulse rate, systolic blood pressure, diastolic blood pressure whose airway was maintained by LMA insertion (Group-A). We conclude that LMA insertion causes less Haemodynamic changes than that of endotracheal intubation. So LMA insertion is safer than ETT intubations in some selected patients.   Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.28-32


Author(s):  
Anjuman Alam ◽  
Poonam Choubey

Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.


2021 ◽  
Vol 15 (9) ◽  
pp. 2282-2284
Author(s):  
Nayyer Sultana ◽  
Rana Abid Ali ◽  
Uzma Zia ◽  
Shirin Gul ◽  
Abida Riaz ◽  
...  

Aim: To compare the control of blood pressure after oral alpha methyldopa versus oral labetalol for management of gestational hypertension. Study design: prospective, comparative, observational study. Place & duration: The study was conducted at Department of Obstetrics & Gynecology, Central Park Teaching hospital, Lahore for six months i.e. 1st May 2018 to 31st October 2018. Methodology: Total 150 females were included in the study from OPD after fulfilling the inclusion and exclusion criteria. Then females were randomly divided in two groups by using lottery method. In group A, females were given labetalol orally 100mg 2 times a day for 7 days. In group B, females were given 250mg methyldopa 3 times a day for 7 days. The females were followed-up in OPD after 8 days. After 8 days, females were evaluated for systolic blood pressure (SBP) & diastolic blood pressure (DBP). Results: In this study we compared labetalol with methyldopa for management of gestational hypertension. SBP (Labetalol: 123.41±7.42 vs. Methyldopa: 126.62±7.33, p-value=0.009) as well as DBP (Labetalol: 77.18±4.39 vs. Methyldopa: 79.64±5.9, p-value=0.005) were better controlled in patients received labetalol than alpha methyldopa. Conclusion: Labetalol is better than methyldopa in lowering blood pressure (systolic & diastolic) in women for management of gestational hypertension. Keywords: Management, gestational Hypertension, Systolic, Diastolic, Blood pressure, Alpha methyldopa


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