COMPARATIVE STUDY OF FIBRINOGEN LEVEL IN NORMAL PREGNANCY, HYPERTENSIVE DISORDERS OF PREGNANCY AND INTRAUTERINE FOETAL DEATH.

Introduction: Haemostatic failure as a result of Obstetric complication of hypertensive disorders of pregnancy and intrauterine foetal death is an important cause of maternal mortality and morbidity. The assessment of the coagulation parameters is important to diagnose the severity of the disease. To compare Aims and Objectives- serum brinogen in normal pregnancy and in hypertensive disorder of pregnancy and intrauterine foetal death. This study was conducte Materials and Methods: d in the department of Obstetrics and Gynaecology, RIMS, Ranchi during the period of April'16 to September'17. A total of 450 patients after 28 weeks of gestation were taken for the study. 150 were cases of hypertensive disorder of pregnancy and 150 were intrauterine foetal death. 150 patients were taken as control for the comparative analysis. The brinogen levels in present study decrea Results: sed signicantly in patients with hypertensive disorder of pregnancy and IUD. The mean value of brinogen in normal patient was 446.72±38.35 mg/dl, in patients with hypertensive disorder of pregnancy was 413.96±74.07 mg/dl and in patients with IUD was 360.07±95.23mg/dl. There was a signicant difference noted in routine blood parameters such as Haemoglobin, Platelets and Total Leucocyte count in study group. The coagulation prole was also found to be deranged in the study population. The maternal and perinatal outcome in PIH and IUD was worse than in control group. The Conclusion: estimation of plasma brinogen is helpful not only in the early diagnosis of haemostatic failure but also to guide replacement therapy during the brinogen depletive state.

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Hypertension, pregnancy and weather: is seasonality involved?

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.60.02.006 ◽

2014 ◽

Vol 60 (2) ◽

pp. 105-110 ◽

Cited By ~ 3

Author(s):

Brena Melo ◽

Melania Amorim ◽

Leila Katz ◽

Isabela Coutinho ◽

José Natal Figueiroa

Keyword(s):

Relative Humidity ◽

Correlation Coefficient ◽

Pearson Correlation ◽

Hypertensive Disorder ◽

Air Humidity ◽

Hypertensive Disorders Of Pregnancy ◽

Monthly Temperature ◽

Hypertensive Disorders ◽

Relative Air Humidity ◽

Hypertensive Disorder Of Pregnancy

Objective: The present study aimed at assessing the association between environmental temperature and the relative humidity of the air with frequency of hypertensive disorders of pregnancy. Methods: A prospective and retrospective, descriptive, ecological study was held at a teaching maternity in Recife, Brazil. Data from all 26.125 pregnant women admitted between 2000 and 2006 were analysed and 5.051 had the diagnosis of hypertensive disorder of pregnancy. The incidence percentages were calculated monthly per deliveries. Data on mean monthly temperature and relative humidity of the air were collected and monthly comparisons were conducted. February was chosen as the reference month due to its lowest incidence of the disease. The relative chance of hypertensive disorders of pregnancy for each other month was estimated by odds ratio and Pearson's correlation coefficient was used to calculate the relation between the incidence of hypertensive disorders of pregnancy and the mean monthly temperature and relative air humidity. Results: February presented the lowest mean monthly incidence (9.95%) and August the highest (21.54%). Pearson correlation coefficient revealed a higher incidence of hypertensive disorders of pregnancy in the cooler months (r= -0.26; p=0.046) and no significant effect of relative air humidity (r=0.20; p=0.128). Conclusion: The incidence of hypertensive disorders of pregnancy may be affected by variations in temperature, increasing during cooler periods.

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Coronavirus Disease 2019 (COVID-19) And The Risk of Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study

10.21203/rs.3.rs-583136/v1 ◽

2021 ◽

Author(s):

Michael Baracy ◽

Fareeza Afzal ◽

Susanna Szpunar ◽

MaKenzie Tremp ◽

Karlee Grace ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hypertensive Disorder ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Increased Risk ◽

Hypertensive Disorders In Pregnancy ◽

Hypertensive Disorder Of Pregnancy ◽

The Impact

Abstract Purpose: To evaluate the association of hypertensive disorders of pregnancy with SARs-CoV-2 infection in pregnant women.Methods: We conducted a retrospective cohort study of all pregnant patients with positive SARs-CoV-2 molecular test at four participating hospitals located in a large metropolitan city and who delivered between February 1st and November 24th, 2020. Patients who tested positive during their pregnancy and delivered (index cases) were compared to the three subsequent deliveries of patients who tested negative (controls) at the same institution. We evaluated the impact of COVID-19 on the development of hypertensive disorders of pregnancy.Results: A total of 280 patients were included in the study: 70 patients who tested positive for Coronavirus Disease-2019 and 210 matched controls. Compared with pregnancies negative for SARS-CoV-2 infection, COVID-19 was associated with an increased risk of developing a hypertensive disorders of pregnancy (OR 3.68, 95% CI 1.67 -8.10). Overall rates of preeclampsia with severe features were significantly higher in patients with a COVID-19 diagnosis (18.6% vs 7.1%, p=0.006). Of COVID-19 positive patients, an early SARS-CoV-2 infection (prior to 32 week’s gestation) conferred a higher risk of hypertensive disorders in pregnancy (OR=6.29, CI 1.64-24.07; p=0.007). There was no difference in route of delivery, preterm birth, intrauterine growth restriction, intrauterine fetal demise, or pregnancy and fetal outcomes.Conclusion: COVID-19 is a risk factor for hypertensive disorders of pregnancy.Tweetable AbstractPatients who test positive for COVID-19 during their pregnancy are at increased risk of developing a hypertensive disorder of pregnancy compared to pregnant patients who test negative for COVID-19. Earlier SARs-CoV-2 infection results in increased risk of developing a hypertensive disorder. Furthermore, even patients who are asymptomatic but positive for SARs-CoV-2 during their pregnancy have a higher risk of developing a hypertensive disorder of pregnancy.

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Doppler interrogation of fetoplacental circulation in hypertensive disorder of pregnancy and their perinatal outcomes

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172471 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2687 ◽

Cited By ~ 2

Author(s):

Jyoti Devi ◽

Devender Kumar ◽

Mala Shukla ◽

P. K. Jain3

Keyword(s):

Umbilical Artery ◽

Perinatal Outcomes ◽

Control Group ◽

Chronic Hypertension ◽

Hypertensive Disorder ◽

Diastolic Flow ◽

Hypertensive Group ◽

Hypertensive Disorders ◽

Significant Difference ◽

Hypertensive Disorder Of Pregnancy

Background: Hypertensive disorders of pregnancy are one of the major causes of maternal morbidity-mortality leading to 10-15% of maternal deaths especially in developing areas of the world. The Doppler examination makes it possible by providing a unique, non-invasive and safe method of studying blood flow characteristics in both the fetoplacental and uteroplacental circulations that is being used in clinical evaluation of high risk pregnancies. The aim was to study early detection of fetoplacental compromise in hypertensive disorder of pregnancy with Doppler indices and to know its role in predicting perinatal outcomes and interventional strategies in these patients.Methods: This prospective study was conducted on 100 subjects, 50 patients in study group with hypertensive disorders and 50 patients in control group with normotensive pregnancy. Doppler studies of umbilical and middle cerebral artery done and parameters recorded were systolic/diastolic ratio, pulsatility index and resistance index at 28-37 weeks of gestation. Perinatal outcomes of both groups compared, analyzed statistically. Multiple pregnancy, chronic hypertension, fetal congenital anomalies, systemic disease and those lost to follow up till delivery were excluded from study.Results: Statistically significant difference in the incidence of induction of labour (p=0.012) and caesarean delivery (p=0.049), preterm delivery (p=0.004), low birth weight (p=0.003), low apgar score (p=0.045) and NICU admission in the patients with abnormal umbilical artery doppler of hypertensive group were seen .66.66% and 100% perinatal mortality seen in absent end diastolic flow and reverse end diastolic flow of umbilical artery in hypertensive group respectively.Conclusions: Abnormal umbilical artery had highest sensitivity 76% and positive predictive value 84% in predicting adverse perinatal outcome and MCA Doppler having highest specificity 96% to exclude the false positive results of abnormal UA. The sequential study of both vessels useful in predicting interventional strategies and improving perinatal outcomes.

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Incidence of Hypertensive Disorders of Pregnancy in Women with COVID-19

American Journal of Perinatology ◽

10.1055/s-0041-1727167 ◽

2021 ◽

Author(s):

Rebecca Chornock ◽

Sara N. Iqbal ◽

Tiffany Wang ◽

Samantha Kodama ◽

Tetsuya Kawakita ◽

...

Keyword(s):

Task Force ◽

Chronic Hypertension ◽

Hypertensive Disorder ◽

Washington Dc ◽

Labor And Delivery ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Universal Testing ◽

Hypertensive Disorder Of Pregnancy ◽

Time Of Admission

Objective The study aimed to examine the incidence of hypertensive disorders of pregnancy in women diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, also known as COVID-19). Study Design This was a retrospective cohort study of all women who delivered at MedStar Washington Hospital Center in Washington, DC from April 8, 2020 to July 31, 2020. Starting April 8, 2020, universal testing for COVID-19 infection was initiated for all women admitted to labor and delivery. Women who declined universal testing were excluded. Hypertensive disorders of pregnancy were diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions.1 Maternal demographics, clinical characteristics, and labor and delivery outcomes were examined. Neonatal outcomes were also collected. Laboratory values from admission were evaluated. Our primary outcome was the incidence of hypertensive disorders of pregnancy among women who tested positive for COVID-19. The incidence of hypertensive disorders of pregnancy was compared between women who tested positive for COVID-19 and women who tested negative. Results Of the 1,008 women included in the analysis, 73 (7.2%) women tested positive for COVID-19, of which 12 (16.4%) were symptomatic at the time of admission. The incidence of hypertensive disorders of pregnancy was 34.2% among women who tested positive for COVID-19 and 22.9% women who tested negative for COVID-19 (p = 0.03). After adjusting for race, antenatal aspirin use, chronic hypertension, and body mass index >30, the risk of developing any hypertensive disorder of pregnancy was not statistically significant (odds ratio: 1.58 [0.91–2.76]). Conclusion After adjusting for potential confounders, the risk of developing a hypertensive disorder of pregnancy in women who tested positive for COVID-19 compared with women who tested negative for COVID-19 was not significantly different. Key Points

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Myocardial Mechanics in Hypertensive Disorders of Pregnancy: a Systematic Review and Meta-Analysis

Hypertension ◽

10.1161/hypertensionaha.121.18123 ◽

2021 ◽

Author(s):

Jamie M. O’Driscoll ◽

Veronica Giorgione ◽

Jamie J. Edwards ◽

Jonathan D. Wiles ◽

Rajan Sharma ◽

...

Keyword(s):

Weighted Mean Difference ◽

Meta Analysis ◽

Global Longitudinal Strain ◽

Normal Pregnancy ◽

Evidence Base ◽

Pooled Analysis ◽

Mean Difference ◽

Control Group ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders

Global longitudinal strain (GLS) is becoming routinely used to direct the medical management of various cardiac diseases, but its application in pregnancy is unclear. Our objective was to perform a meta-analysis and pool multiple study data to consolidate the evidence base for the role of GLS in the assessment of women with hypertensive disorders of pregnancy (HDP). Electronic database searches were performed in PubMed/Medline and EMBASE for research articles reporting GLS in pregnancies complicated by HDP and normotensive pregnancies that have been published up to September 2021. The meta-analysis included 17 studies with a pooled sample size of 1723 participants, which included 951 women with HDP, of which 680 were preeclamptic, and 772 controls. The primary random-effects pooled analysis demonstrated a statistically significant weighted mean difference in GLS between the HDP and control group (mean difference: 3.08% [CI, 2.33–3.82], P <0.001). When analyzed including only preeclamptic studies, there was also a statistically significant mean difference (mean difference: 2.98% [95% CI, 1.97–3.99], P <0.001). This meta-analysis demonstrates that HDP is associated with greater cardiac maladaptation, evidenced by a significantly reduced GLS compared with normal pregnancy. Echocardiography should be considered as a screening tool in women with HDP to enable early cardiovascular risk prevention through national initiatives.

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Evaluation of Implementation and Unit Impact of a Hypertensive Disorder of Pregnancy Guideline: A Model-Based Approach

Journal of Doctoral Nursing Practice ◽

10.1891/jdnp-d-20-00028 ◽

2021 ◽

pp. JDNP-D-20-00028

Author(s):

Nora Drummond ◽

Alissa Carver ◽

Joanne Bailey

Keyword(s):

Research Utilization ◽

Guideline Implementation ◽

Practice Change ◽

Hypertensive Disorder ◽

Hypertensive Disorders Of Pregnancy ◽

Mortality And Morbidity ◽

Model Based ◽

Hypertensive Disorders ◽

Blood Pressures ◽

Comprehensive Evaluations

BackgroundHypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. To address this, a large Midwestern hospital initiated a practice guideline. Practice guidelines should improve outcomes, but implementation of these remains challenging. At the time of initiation of the guideline, no implementation or evaluation plan was conceived.ObjectiveEvaluate the implementation and unit impact of a guideline for the management of hypertensive disorders of pregnancy in a large academic health system in the Midwest.MethodsSix objectives, guided by the constructs of the Ottawa Model of Research Utilization, were operationalized to evaluate the implementation and unit impact of the guideline.ResultsThe guideline implemented was consistent with national recommendations. Intervention education was inconsistent across provider types. A survey of staff revealed insight into a unit in the midst of practice change. A chart review revealed below-target management of patients with severe range blood pressures. Not following the guideline was associated with hospital readmission.ConclusionsGuideline implementation can be efficiently and holistically evaluated with a model-based framework, even in projects that were not initiated with such an approach.Implications for Nursing PracticeNurses provide expertise in model-based approaches that result in comprehensive evaluations of quality improvement processes.

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Hypertensive disorders of pregnancy: a clinical study in a rural tertiary care centre of western Uttar Pradesh, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190884 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1087

Author(s):

Neelam Swaroop ◽

Mamta Singh ◽

Kalpana Kumari ◽

Vandana Verma

Keyword(s):

Clinical Outcome ◽

Tertiary Care ◽

Uttar Pradesh ◽

Hypertensive Disorder ◽

Care Centre ◽

Tertiary Care Centre ◽

Mortality And Morbidity ◽

High Risk Factors ◽

Hypertensive Disorders ◽

Hypertensive Disorder Of Pregnancy

Background: The aim of study was to find out the frequency and clinical outcome in hypertensive disorder of pregnancy (HDP) in a rural tertiary care centre. Hypertensive disorder of pregnancy is a commonest medical disorder which constitutes about 12-22% of all pregnancies and it is a major cause of maternal morbidity as well as mortality world wide.Methods: It is a retrospective hospital-based study to find out the clinical outcome in different hypertensive disorder of pregnancy in a rural tertiary care centre of western Uttar Pradesh.Results: Present study showed the prevalence of HDP was 4.01% among the study population. Most of the patients were primipara ,unbooked and less than 25 years of age. The most common HDP was mild preeclampsia and HELLP was its commonest complication.Conclusions: Hypertensive disorder of pregnancy (HDP) is still a major cause of maternal mortality and morbidity. Authors intend to aware the pregnant women regarding high risk factors of pregnancy and motivate them for regular antenatal care so that complications of hypertensive disorders can be managed timely.

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Abstract 15788: Hypertensive Disorders of Pregnancy in Urban Black Women: The Biosocial Impact on Black Births (bibb) Study

Circulation ◽

10.1161/circ.142.suppl_3.15788 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Rhonda Dailey ◽

Ashleigh Peoples ◽

Brooke Rengers ◽

Ana C Wong ◽

Kristen Daughters ◽

...

Keyword(s):

Cardiovascular Disease ◽

Black Women ◽

Gestational Age ◽

Chronic Hypertension ◽

Hypertensive Disorder ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Hypertensive Disorder Of Pregnancy ◽

The Mean ◽

Prenatal Visits

Introduction: Black women experience significant maternal mortality (3.3 times higher) compared to White women, and experience higher adverse outcomes. In the United States, cardiovascular disease is the second leading cause of maternal mortality for Black women. Hypertensive disorders of pregnancy (HDOP) falls under the cardiovascular disease spectrum. Objective: To explore differences in women diagnosed with a HDOP compared to those that do not have HDOP. Methods: A total of 226 African American women from Metro-Detroit and Columbus, Ohio enrolled in a cross-sectional study who had recently gave birth. Women enrolled in a mixed methods study on social and biological stressors to preterm birth with a completed medical record abstraction were identified as having chronic hypertension or a hypertensive disorder of pregnancy (HDOP) prior to the current pregnancy. HDOP is defined as chronic hypertension, chronic hypertension with superimposed preeclampsia, gestational hypertension, preeclampsia or eclampsia. Perinatal complications and birth outcomes were explored. Sociodemographic was derived from completed prenatal questionnaires. Chi square was used for categorical variable and T-test was used for continuous variables. Significance is defined as p ≤ 0.05. Results: The mean age was 26.8±5.9 years. Approximately 70.4% (n=159) were from Detroit, MI and 29.6% were from Columbus, OH. The mean previous live births were 1.9±1.8 (range 0-8). The average number of prenatal visits with a physician were 9.2±2.9 (range 2-19) and the total number of any prenatal visits were 16.0±6.9 (range 1-44). Average baby gestational age is 37.9±2.2 weeks (range 15-26 weeks), and weight is 2998±703.4 grams. Approximately 60 women (26.5%) were identified with a hypertensive disorder of pregnancy. Compared to women not diagnosed with a HDOP, women with a HDOP had an older mean age (28.3±6.4 vs 26.3±5.6), p=0.023; had more prenatal visits (18.2±7.6 vs 15.6±6.5) p=0.007; had babies at a younger gestational age (37.2±2.1 vs 38.2±2.1), p=0.002. Conclusion: These findings will aid in determining factors associated with HDOP in our population, and aid in determining next steps to reduce historic mortality in this group.

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Hypertensive disorders of pregnancy: A five-year review in Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria

Babcock University Medical Journal (BUMJ) ◽

10.38029/bumj.v3i1.35 ◽

2020 ◽

Vol 3 (1) ◽

pp. 67-72

Author(s):

Olufemi Adebawojo ◽

Adebayo Akadri ◽

John Imaralu

Keyword(s):

Cesarean Section ◽

Teaching Hospital ◽

University Teaching ◽

Elective Cesarean Section ◽

Delivery Mode ◽

Hypertensive Disorder ◽

Ogun State ◽

Hypertensive Disorders ◽

Hypertensive Disorder Of Pregnancy ◽

The Mean

Objective: To determine the prevalence and outcome of hypertensive disorder of pregnancy in Babcock University Teaching Hospital, Ilishan-Remo, Ogun State Nigeria Method: This was a retrospective descriptive study of all documented cases of hypertensive disorder of pregnancy between the 1st of June 2012 and 31st May, 2017. Information such as age, parity, booking status, level of education, blood pressure at presentation, urinalysis at presentation, gestational age at presentation, and delivery, mode of delivery, baby’s birth weight was extracted from patients’ case files. Result: There were 1,118 deliveries during the study period out of which 55 (4.9%) patients had hypertensive disorders in pregnancy. The mean age was 31.5years ±48.1 and mean parity, 1.2± 1.1. The mean systolic and diastolic blood pressures were 180.4 ± 1.88mmHg and 105.1± 1.5mmHg, respectively. Thirty-four (75.5%) of the women had preeclampsia/ eclampsia, while 7 (15.5%) had gestational hypertension. Most women were delivered preterm (22 patients, 48.7%). The majority of them (33, 73.3%) were delivered by cesarean section, out of which 2 (4.4%) were elective cesarean section and 31 patients (68.8%) were emergency cesarean section. The case fatality rate was 1.8%. Conclusion: Pre-eclampsia was the most prevalent t hypertensive disorder of pregnancy. It was more prevalent among primigravidae patients and the most common complication was preterm delivery. Strengthening antenatal care services will enable early identification of cases. Prompt referral of cases for specialist care will help in reducing the adverse outcomes associated with the condition.

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Machine learning approaches to predict gestational age in normal and complicated pregnancies via urinary metabolomics analysis

10.21203/rs.3.rs-541993/v1 ◽

2021 ◽

Author(s):

Takafumi Yamauchi ◽

Daisuke Ochi ◽

Naomi Matsukawa ◽

Daisuke Saigusa ◽

Mami Ishikuro ◽

...

Keyword(s):

Pregnant Women ◽

Gestational Age ◽

Urinary Metabolites ◽

Normal Pregnancy ◽

Urinary Metabolite ◽

Learning Approaches ◽

Hypertensive Disorders Of Pregnancy ◽

Spontaneous Preterm Birth ◽

Hypertensive Disorders ◽

Pregnancy Status

Abstract The elucidation of dynamic metabolomic changes during gestation is particularly important for the development of methods to evaluate pregnancy status or achieve earlier detection of pregnancy-related complications. Some studies have constructed models to evaluate pregnancy status and predict gestational age using omics data from blood biospecimens; however, less invasive methods are desired. Here we propose a model to predict gestational age, using urinary metabolite information. In our prospective cohort study, we collected 2,741 urine samples from 187 healthy pregnant women, 23 patients with hypertensive disorders of pregnancy, and 14 patients with spontaneous preterm birth. Using gas chromatography-tandem mass spectrometry, we identified 184 urinary metabolites that showed dynamic systematic changes in healthy pregnant women according to gestational age. A model to predict gestational age during normal pregnancy progression was constructed; the correlation coefficient between actual and predicted weeks of gestation was 0.86. The predicted gestational ages of cases with hypertensive disorders of pregnancy exhibited significant progression, compared with actual gestational ages. This is the first study to predict gestational age in normal and complicated pregnancies by using urinary metabolite information. Minimally invasive urinary metabolomics might facilitate changes in the prediction of gestational age in various clinical settings.

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