scholarly journals Transient gestational hypertension and pre-eclampsia: Two case reports and literature review on the need for stringent monitoring

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Nnabuike C. Ngene ◽  
Ghadah Daef
Keyword(s):  
Platelet Count ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Induction Of Labour ◽  
Rapid Review ◽  
Foetal Death ◽  
Elevated Liver Enzymes ◽  
Hospital Bed ◽  
Adverse Pregnancy

Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid review of the literature. Two cases are presented: Firstly, a 25-year-old primigravida at 30 gestational weeks who had an isolated TGH with high blood pressure (BP) of 141/87 mmHg, which was not investigated. Four weeks later, she presented with a BP of 202/128 mmHg, imminent eclampsia and intrauterine foetal death and had an uncomplicated induction of labour and delivered a 1400 g macerated male stillborn. Secondly, a 30-year-old primigravida at 30 gestational weeks who developed PE but her monitoring was compromised initially by inadequate healthcare capacity including unavailability of hospital bed-space for inpatient care and later by poor clinic attendance as a result of poor finances. At 32 gestational weeks, she presented with decreased foetal movement and was diagnosed as haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and intrauterine foetal death. She was stabilised, had induction of labour and delivered a 1400 g male macerated stillborn. Thereafter, the need for her to go home to complete the cultural burial rites of her baby and the pressure from her workplace resulted in an inadequate postpartum follow-up care. In conclusion, transient gestational hypertension is associated with adverse maternal and foetal outcomes, including foetal demise. Unavailability of hospital bed-space and poor personal finances interfere with stringent monitoring of hypertensive disorders and can be associated with adverse pregnancy outcomes. Stringent laboratory monitoring in these cases is defined by the authors as testing at least blood levels of serum Creatinine, Haemoglobin concentration, Alanine transaminase and Platelet count (abbreviated as ‘CHAP’) weekly.

scholarly journals Impact of Wildfire Smoke on Adverse Pregnancy Outcomes in Colorado, 2007–2015

2019 ◽  
Vol 16 (19) ◽  
pp. 3720 ◽  
Author(s):  
Mona Abdo ◽  
Isabella Ward ◽  
Katelyn O’Dell ◽  
Bonne Ford ◽  
Jeffrey Pierce ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Wildfire Smoke ◽  
Secondary Outcomes ◽  
Adverse Pregnancy ◽  
The Impact ◽  
Zip Code

Colorado is regularly impacted by long-range transport of wildfire smoke from upwind regions. This smoke is a major source of ambient PM2.5. Maternal exposure to total PM2.5 during pregnancy has been linked to decreased birth weight and other adverse outcomes, although the impact of wildfire smoke contribution has only recently been investigated. The objective of this study was to estimate associations between adverse pregnancy outcomes and ambient wildfire smoke PM2.5. Wildfire smoke PM2.5 exposures were estimated using a previously published method incorporating ground-based monitors and remote sensing data. Logistic regression models stratified by ZIP code and mixed models with random intercept by ZIP code were used to test for associations. The primary outcomes of interest were preterm birth and birth weight. Secondary outcomes included gestational hypertension, gestational diabetes, neonatal intensive care unit admission, assisted ventilation, small for gestational age, and low birth weight. Exposure to wildfire smoke PM2.5 over the full gestation and during the second trimester were positively associated with pre-term birth (OR = 1.076 (μg/m3)−1 [95% CI = 1.016, 1.139; p = 0.013] and 1.132 (μg/m3)−1 [95% CI = 1.088, 1.178]; p < 0.0001, respectively), while exposure during the first trimester was associated with decreased birth weight (−5.7 g/(μg/m3) [95% CI: −11.1, −0.4; p = 0.036]). Secondary outcomes were mixed.

scholarly journals The Impact of Gestational Weight Gain on the Risks of Adverse Maternal and Infant Outcomes among Normal BMI Women with High Triglyceride Levels during Early Pregnancy

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3454
Author(s):  
Xia-Fei Jiang ◽  
Hui Wang ◽  
Dan-Dan Wu ◽  
Jian-Lin Zhang ◽  
Ling Gao ◽  
...  
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Gestational Weight ◽  
Adverse Pregnancy ◽  
The Impact

A high maternal triglyceride (mTG) level during early pregnancy is linked to adverse pregnancy outcomes, but the use of specific interventions has been met with limited success. A retrospective cohort study was designed to investigate the impact of gestational weight gain (GWG) on the relationship between high levels of mTG and adverse pregnancy outcomes in normal early pregnancy body mass index (BMI) women. The patients included 39,665 women with normal BMI who had a singleton pregnancy and underwent serum lipids screening during early pregnancy. The main outcomes were adverse pregnancy outcomes, including gestational hypertension, preeclampsia, gestational diabetes, cesarean delivery, preterm birth, and large or small size for gestational age (LGA or SGA) at birth. As a result, the high mTG (≥2.05mM) group had increased risks for gestational hypertension ((Adjusted odds ratio (AOR), 1.80; 95% CI, 1.46 to 2.24)), preeclampsia (1.70; 1.38 to 2.11), gestational diabetes (2.50; 2.26 to 2.76), cesarean delivery (1.22; 1.13 to 1.32), preterm birth (1.42, 1.21 to 1.66), and LGA (1.49, 1.33 to 1.68) compared to the low mTG group, after adjustment for potential confounding factors. Additionally, the risks of any adverse outcome were higher in each GWG subgroup among women with high mTG than those in the low mTG group. High mTG augmented risks of gestational hypertension, preeclampsia, preterm birth, and LGA among women with 50th or greater percentile of GWG. Interestingly, among women who gained less than the 50th percentile of GWG subgroups, there was no relationship between high mTG level and risks for those pregnancy outcomes when compared to low mTG women. Therefore, weight control and staying below 50th centile of the suggested GWG according to gestational age can diminish the increased risks of adverse pregnancy outcomes caused by high mTG during early pregnancy.

Placental Growth Factor and Adverse Obstetric Outcomes in a Mixed-Risk Cohort of Women Screened for Preeclampsia in the First Trimester of Pregnancy

2021 ◽  
pp. 1-9
Author(s):  
Charlotte Kvist Ekelund ◽  
Line Rode ◽  
Ann Tabor ◽  
Jon Hyett ◽  
Andrew McLennan
Keyword(s):  
Growth Factor ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcome ◽  
First Trimester ◽  
Placental Growth Factor ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Obstetric Outcomes ◽  
Adverse Pregnancy

<b><i>Objective:</i></b> The study aimed to investigate the association between placental growth factor (PlGF) and adverse obstetric outcomes in a mixed-risk cohort of pregnant women screened for preeclampsia (PE) in the first trimester. <b><i>Methods:</i></b> We included women with singleton pregnancies screened for PE between April 2014 and September 2016. Outcome data were retrieved from the New South Wales Perinatal Data Collection (NSW PDC) by linkage to the prenatal cohort. Adverse outcomes were defined as spontaneous preterm birth (sPTB) before 37-week gestation, birth weight (BW) below the 3rd centile, PE, gestational hypertension (GH), stillbirth, and neonatal death. <b><i>Results:</i></b> The cohort consisted of 11,758 women. PlGF multiple of the median (MoM) was significantly associated with maternal sociodemographic characteristics (particularly smoking status and parity) and all biomarkers used in the PE first trimester screening model (notably pregnancy-associated plasma protein A MoM and uterine artery pulsatility index [PI] MoM). Low levels of PlGF (&#x3c;0.3 MoM and &#x3c;0.5 MoM) were independently associated with sPTB, low BW, PE, GH, and a composite adverse pregnancy outcome score, with odds ratios between 1.81 and 4.44 on multivariable logistic regression analyses. <b><i>Conclusions:</i></b> Low PlGF MoM levels are independently associated with PE and a range of other adverse pregnancy outcomes. Inclusion of PlGF should be considered in future models screening for adverse pregnancy outcomes in the first trimester.

scholarly journals Obstetric Outcome After Surgical Treatment of Endometriosis: A Review of the Literature

2021 ◽  
Vol 3 ◽  
Author(s):  
Samantha S. Mooney ◽  
Vanessa Ross ◽  
Catharyn Stern ◽  
Peter A. W. Rogers ◽  
Martin Healey
Keyword(s):  
Preterm Birth ◽  
Surgical Treatment ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Placenta Praevia ◽  
Obstetric Outcomes ◽  
Obstetric Outcome ◽  
Adverse Pregnancy ◽  
The Impact

A diagnosis of endometriosis is associated with increased risks of adverse pregnancy outcomes including placenta praevia and preterm birth. Some studies have also suggested associations with gestational hypertension, foetal growth restriction, gestational diabetes, perinatal death, and obstetric haemorrhage. This review aims to assess the impact of pre-pregnancy surgical treatment of endometriosis on future obstetric outcomes. A search of the Medline, Embase and PubMed electronic databases was performed to identify studies reporting pre-pregnancy surgery for endometriosis and subsequent pregnancy outcome compared to controls with unresected endometriosis. Three studies met the inclusion criteria. The studies were heterogenous in design, definition of study groups and outcome measures. All three studies were judged at critical risk of bias. Pre-pregnancy excision of endometriosis was associated with an increased risk of caesarean section in one of two studies, OR 1.72 (95% CI 1.59–1.86) and OR 1.79 (95% CI 0.69–4.64). Placenta praevia rates were also increased in one of two studies OR 2.83 (95% CI 0.56–12.31) and OR 2.04 (95% CI 1.66–2.52). One study found increased risks of preterm birth, small for gestational age, gestational hypertension, and antepartum and postpartum haemorrhage (all p &lt; 0.05) with pre-pregnancy excision of endometriosis. There is insufficient evidence examining the role of pre-pregnancy endometriosis surgery in ameliorating adverse pregnancy outcomes, and thus reliable conclusions cannot be drawn. Prospectively designed studies are needed to assess the relationship between surgical treatments for endometriosis and obstetric outcome and examine potential confounders such as comorbid adenomyosis and infertility.

Sleep Disorders in Pregnancy

2017 ◽  
Vol 37 (06) ◽  
pp. 661-668 ◽  
Author(s):  
Mihaela Bazalakova
Keyword(s):  
Sleep Disorders ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Chronic Hypertension ◽  
Short Sleep Duration ◽  
Risk Pregnancy ◽  
Obstructive Sleep ◽  
Adverse Pregnancy ◽  
In Pregnancy

AbstractSleep and pregnancy are dynamic processes with unique and evolving physiological substrates. Given the “restorative hypothesis” of sleep as an anabolic process essential for cellular and tissue regeneration, the largely unexplored role of sleep in gestational physiology and pregnancy outcomes promises to be a fascinating topic. Emerging literature suggests that objectively measured or self-reported short sleep duration may be a risk for adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), gestational hypertension, and cesarean delivery. In this review, we discuss obstructive sleep apnea (OSA) and restless legs syndrome (RLS), two sleep disorders prevalent in pregnancy. OSA is especially likely in high-risk pregnancy where it is associated with comorbid cardiovascular and metabolic disturbances. We review new data strongly suggesting that OSA is an independent risk factor for GDM and gestational hypertension. It remains to be seen if sleep disruption, whether or not in the context of gestational RLS and gestational OSA, is a modifiable factor for adverse pregnancy outcomes. Clinicians are encouraged to query sleep symptoms in pregnant women and to have a low threshold to pursue investigations for OSA, including the subjective symptoms of snoring, witnessed apneas, and daytime sleepiness, and also medical comorbidities, such as chronic hypertension.

Abstract MP46: The Associations Between Adverse Pregnancy Outcomes And Cardiovascular Delivery Complications: The National Inpatient Sample

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Anum Minhas ◽  
Michelle Ogunwole ◽  
Michael Miller ◽  
Arthur J Vaught ◽  
Pensee Wu ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Pacific Islanders ◽  
Sample Survey ◽  
National Inpatient Sample ◽  
Sampling Weights ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Adverse Pregnancy

Background: Women with adverse pregnancy outcomes (APOs) are at increased risk of long-term cardiovascular (CV) disease, but less is known about the spectrum of acute CV outcomes in women with various APOs. We evaluated the risk of CV events at delivery in women with gestational diabetes (GDM), gestational hypertension and preeclampsia/eclampsia (PEC), overall and by race/ethnicity, in a US sample. Methods: We used the 2016-2017 National Inpatient Sample survey data from the Agency for Healthcare Research and Quality (AHRQ). ICD10-CM diagnosis codes were used to identify women with a delivery hospitalization and to identify CV outcomes. We examined demographics and prevalence of CV events at delivery by the 3 APOs. Logistic regression was used to determine risk of various adverse CV events at delivery by APO, adjusted for age, income and hospital location. To generate national estimates, sampling weights provided by AHRQ were used. Results: Among 3,776,531 deliveries in 2016-2017, GDM was the most common APO (n=552,975; 7.3%). GDM occurred more frequently in Hispanics and Asians/Pacific Islanders (23% and 11%, respectively), while PEC occurred more frequently in Blacks (20%). While there was greater occurrence of CV events with all 3 APOs, after adjustment, only PEC was significantly associated with increased odds of adverse CV events [peripartum cardiomyopathy: OR 3.87 (95% CI 3.30-4.55), congestive heart failure: OR 4.04 (3.52-4.63), acute ischemic heart disease: OR 3.67 (2.65-5.08) and arrhythmias: OR 1.39 (1.22-1.59)]. Risk was elevated for Whites, Blacks, Hispanics and Asians/Pacific Islanders, although there was heterogeneity of the magnitude of risk by race/ethnicity ( Table ). Discussion: Women with APOs, especially PEC, are more likely to experience acute CV complications at hospital delivery than women without APOs. While Black women are more likely to develop PEC, women of all race/ethnicities with PEC are at risk of CV complications.

scholarly journals Uterine artery Doppler in first trimester in prediction of adverse pregnancy outcome in Dharmapuri district of Tamil Nadu

2020 ◽  
Vol 9 (10) ◽  
pp. 4268
Author(s):  
Bindu S.
Keyword(s):  
Pregnancy Outcomes ◽  
Uterine Artery ◽  
Gestational Hypertension ◽  
First Trimester ◽  
Adverse Pregnancy Outcomes ◽  
Case Group ◽  
Uterine Artery Doppler ◽  
Hypertensive Disorders ◽  
Group 5 ◽  
Adverse Pregnancy

Background: Pregnancies are complicated by hypertensive disorders of about 5-10% and hemorrhage, sepsis, and fetal growth restriction constitute a triad contributing to maternal morbidity and mortality. Hypertensive disorders in pregnancy vary from mildly elevated blood pressure to severe hypertension with multi-organ dysfunction. The study aims to evaluate the first-trimester uterine artery Doppler in the prediction of the development of adverse pregnancy outcomes.Methods: This prospective longitudinal observational was done in Dharmapuri Medical College and Hospital were selected for this study. Totally 150 pregnant women were included in the study. 75 were controls and 75 cases. The study period was from June 2018 to February 2019. Evaluating the optimal definition of abnormal first trimester.Results: Previous obstetric history in the study population. In the study group 3% of bad obstetric history (BOH) present. In the case group, 5% has BOH due to 2 neonatal death and 2 term intrauterine device (IUD), uterine artery Doppler parameters to predict adverse pregnancy outcomes, and association of gestational hypertension in the study groups. In the control group, 1%, and the case group 5% of them had gestational hypertension. Out of 4, 3 had an average uterine artery Doppler more than 2.3 (maximum of 2.7) and 1 had single uterine artery Doppler abnormality.Conclusions: The study showed that first-trimester uterine artery Doppler with single and average uterine artery pulsatility index (PI) >95th centile (2.3) has a better screening value in my population. The overall performance of the first-trimester uterine artery Doppler in the prediction of adverse pregnancy outcomes is valuable.

scholarly journals Association between Physiological Equivalent Temperature (PET) with adverse pregnancy outcomes in Ahvaz, southwest of Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Dastoorpoor ◽  
Narges Khanjani ◽  
Narges Khodadadi
Keyword(s):  
Pregnancy Outcomes ◽  
Linear Models ◽  
Gestational Hypertension ◽  
Epidemiological Studies ◽  
Adverse Pregnancy Outcomes ◽  
Equivalent Temperature ◽  
Physiological Equivalent Temperature ◽  
Increased Risk ◽  
Low Levels ◽  
Adverse Pregnancy

Abstract Background There are few epidemiological studies on the relation between temperature changes and adverse pregnancy outcomes. The purpose of this study was to determine the relation between Physiological Equivalent Temperature (PET) with adverse pregnancy outcomes including stillbirth, low birth weight (LBW), preterm labor (PTL), spontaneous abortion (SA), preeclampsia and hypertension in Ahvaz, Iran. Methods Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on adverse pregnancy outcomes. In this study the effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted. Results High PET (45.4 C°, lag = 0) caused a significant increase in risk of stillbirth. Also, high levels of PET (45.4, 43.6, 42.5 C°, lag = 0–6) and low levels of PET (9.9, 16.9 C°, lags = 0, 0–13, 0–21) significantly increased the risk of LBW. But, low levels of PET (6.4, 9.9, 16.9 C°, lags = 0–6, 0–13) reduced the risk of gestational hypertension. Conclusion The results of this study showed that hot and cold thermal stress may be associated with increased risk of stillbirth, and LBW in Ahvaz.

scholarly journals High risk of adverse pregnancy outcomes in women with a persistent lupus anticoagulant

2019 ◽  
Vol 3 (5) ◽  
pp. 769-776 ◽  
Author(s):  
Johanna Gebhart ◽  
Florian Posch ◽  
Silvia Koder ◽  
Peter Quehenberger ◽  
Thomas Perkmann ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Lupus Anticoagulant ◽  
Adverse Pregnancy Outcomes ◽  
Antiphospholipid Antibody ◽  
Childbearing Age ◽  
Elevated Liver Enzymes ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract Lupus anticoagulant (LA) has been associated with pregnancy complications and pregnancy loss. Identification of predictive factors could aid in deciding on therapeutic management. To identify risk factors for adverse pregnancy outcomes in high-risk women with persistently positive LA, we prospectively followed 82 women of childbearing age, of whom 23 had 40 pregnancies within the Vienna Lupus Anticoagulant and Thrombosis Study. Pregnancy complications occurred in 28/40 (70%) pregnancies, including 22 (55%) spontaneous abortions (&lt;10th week of gestation [WOG]: n = 12, 10th to 24th WOG: n = 10) and 6 deliveries &lt;34th WOG (15%, 3 due to severe preeclampsia/HELLP [hemolysis, elevated liver enzymes, and a low platelet count] syndrome, 3 due to placental insufficiency). One abortion was followed by catastrophic antiphospholipid syndrome. Neither a history of pregnancy complications nor of thrombosis, or prepregnancy antiphospholipid antibody levels were associated with adverse pregnancy outcomes. In logistic regression analysis, higher age was associated with a lower risk of adverse pregnancy outcome (per 5 years’ increase: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.19-0.87), a high Rosner index (index of circulating anticoagulant) predicted an increased risk (OR = 4.51, 95% CI: 1.08-18.93). Live birth rate was 15/28 (54%) in women on the combination of low-molecular-weight heparin and low-dose aspirin and 3/12 (25%) in those with no treatment or a single agent. We conclude that the risk of severe, even life-threatening pregnancy complications and adverse pregnancy outcomes is very high in women with persistent LA. A high Rosner index indicates an increased risk. Improved treatment options for women with persistently positive LA are urgently needed.

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