A Case Report On: Incomplete Abortion with Chronic Hypertension

Introduction: Abortion is a distressing experience that affects the mother in a variety of ways by influencing on emotional status that can finally result in psychological disorders such as depression [1]. An incomplete abortion occurs when the products of conception are lost in the first 20 weeks of pregnancy. Moderate to severe vaginal bleeding, as well as lower abdomen and/or pelvic pain, are common symptoms of incomplete abortion [2]. Substantial evidence indicates that women with a history of spontaneous abortion have a greater risk of non-communicable diseases, including hypertension, cardiovascular diseases, and type 2 diabetes [3]. In low and middle-income nations, abortion is one of the most common causes of maternal death [4]. In general, incomplete abortions are unavoidable, with chromosomal abnormalities accounting for 50% of all occurrences. Age, maternal disorders (diabetes, hypertension, renal disease, thyroid issue, polycystic ovarian syndrome, lupus, thrombophilia), under or overweight, aberrant uterus, teratogen exposure (drug, alcohol, caffeine, radiation), and infections are all changeable etiologies and risk factors (human immunodeficiency virus, sexually transmitted infections, Listeria monocytogenes) [2]. Case Presentation: A 30-year-old woman's case study with 15 weeks pregnant admitted in the obstetric and gynecological unit on the date 11 June 2021 with complaints of amenorrhea since 4 months, bleeding per vaginam, passage of clots, blurring of vision, pain in abdomen, breathlessness and her blood pressure was noted as 140/100mm of Hg. Interventions: Generally, the patient with abortion and raised blood pressure is hospitalized and care is provided in the obstetric and gynecological unit or ward. The goals during this phase are saving a life of mother, maintaining and restoring hemodynamic stability and preventing the spread of infection or correcting the complication. Outcomes: During the period of five days treatment, the client was having raised blood pressure but significantly the client’s health was improved with further treatment and management .After a hospital stay of five days the markable progress was seen further before returning to the home. Discussion: Although the patient reacted well to treatment, more interventions and health education could be used in the future to help the patient to achieve the better health results.

Download Full-text

Management of the Index COVID -19 Obstetric Patient at the University of Benin Teaching Hospital

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2021/v42i1730528 ◽

2021 ◽

pp. 16-21

Author(s):

Okojie Nkechiyerim Quincy ◽

Ehiarimwian Oisamoje Ruth ◽

Nte Stanley

Keyword(s):

Blood Pressure ◽

Chronic Hypertension ◽

The Novel ◽

Strict Adherence ◽

Pedal Oedema ◽

Clinical Presentations ◽

Full Complement ◽

History Of ◽

Novel Coronavirus ◽

The University

Introduction: The novel coronavirus (COVID-19) was first identified in Wuhan City, Hubei province of China, November 2019. As at September 2020, over 28 million infections have been identified with almost a million deaths worldwide causing an alarming pandemic. Clinical presentations in pregnant patients with COVID-19 could be atypical with normal temperature (56%) and leukocytosis. This is further masked by the features of pregnancy. We present the management of a COVID-19 parturient in our obstetric unit. Case Report: A 32 year old unbooked G₃P₁⁺1 lady at 32 weeks who presented via referral from a private facility with a history of elevated blood pressure and ++ of protein in urine. Also, complaints of cough and difficulty with breathing. On examination she was noted to be anxious, afebrile, not pale, anicteric, acyanosed, not dehydrated. Had bilateral pedal oedema. Tachypnic with a respiratory rate of 28 cycles per min with basal crepitations. Pulse rate was 96bpm full and regular. Blood pressure was 180/100 mmHg. Heart sounds S₁S₂only.An impression of Chronic hypertension with superimposed pre-eclampsia at 32 wks GA in a primipara with one previous CS with pulmonary edema. Keep in view COVID-19. She was managed with oxygen, antihypertensives, steroids, while observing strict infection control protocol. She had an emergency caesarean section under subarachnoid block and was delivered of a live female neonate. A confirmatory positive result for covid-19 was obtained 24hrs later. Neonate was however negative. None of the staff became positive also. Conclusion: The management of suspected cases of COVID-19 infection should be same as cases already confirmed. As the epidemic persists, numbers will continue to rise andhence our index of suspicion should be heightened. Pregnant women will also present with symptoms masked by the features of a sick parturient. Full complement of PPE must be worn by all staff attending to both confirmed and suspicious cases of COVID-19 infection and strict adherence to stated protocols must be observed.

Download Full-text

Abstract 16606: Home Blood Pressure Monitoring Postpartum Detects Masked Hypertension in Women With a History of Preeclampsia

Circulation ◽

10.1161/circ.142.suppl_3.16606 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Virginia R Nuckols ◽

Amy K Stroud ◽

Debra Brandt ◽

Mark K Santillan ◽

Donna A Santillan ◽

...

Keyword(s):

Blood Pressure ◽

Disease Risk ◽

Blood Pressure Monitoring ◽

Cardiovascular Disease Risk ◽

Home Blood Pressure ◽

Chronic Hypertension ◽

Masked Hypertension ◽

Home Blood Pressure Monitoring ◽

Pressure Monitoring ◽

History Of

Introduction: One-third of women with a history of preeclampsia (hxPE), a hypertensive pregnancy disorder, develop chronic hypertension (HTN) within five years postpartum. Twenty-four hour ambulatory blood pressure monitoring (ABPM) shows that 12% of women with hxPE have ‘masked’ HTN. Masked HTN is undetected in routine clinical assessment but is associated with elevated cardiovascular disease risk. ABPM (gold-standard) or home blood pressure monitoring (HBPM) is needed to identify masked HTN. HBPM is a well-tolerated, inexpensive alternative to ABPM. However, the ability of HBPM to detect masked postpartum HTN using new AHA/ACC HTN guidelines is unknown. The purpose of this study was to compare ABPM and HBPM in the identification of masked and sustained HTN among young women with hxPE and healthy pregnancy (HP) controls 1-3 years postpartum. Methods: Women with hxPE (N=22; age 33 ± 5 yrs) and HP controls (N=26; age 34 ± 4 yrs) were assessed 18 ± 6 months postpartum. Seated office blood pressure (BP) was collected with an automated brachial cuff and averaged over three trials. ABPM (Mobil-o-graph) was conducted with a portable, automated brachial cuff and averaged over 38 ± 2 awake and asleep BP recordings. Participants completed HBPM (Microlife) morning and evening for seven consecutive days. BP thresholds for HTN were determined according to 2017 AHA/ACC clinical guidelines. Results: HTN was more prevalent among women with hxPE compared with HP assessed by office BP (59 vs. 15 %, P=0.002) and ABPM (68 vs. 31 %, P=0.01) but not HBPM (41 vs 19 %, P=0.10). The prevalence of masked HTN did not differ between women with hxPE and HP (14 vs. 19%, P=0.71) assessed by ABPM. In the entire cohort, HBPM detected 50% of masked HTN cases identified by ABPM. HBPM agreed with ABPM on HTN status (κ = 0.49, P=0.002). HBPM and ABPM detected uncontrolled HTN in three of four women with hxPE prescribed anti-hypertensive medication. Conclusion: HxPE is associated with a higher prevalence of HTN 1-3 yrs postpartum compared with controls, but the prevalence of masked HTN did not differ. ABPM and HBPM showed concordant classification of HTN using current BP guidelines. These findings indicate that HBPM may be a valuable pre-screening tool for early identification and management of HTN postpartum.

Download Full-text

Abstract 049: De Novo Postpartum Hypertension In A Safety-net Hospital: Incidence And Risk Factors

Circulation ◽

10.1161/circ.143.suppl_1.049 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Samantha E Parker ◽

Ayodele Ajayi ◽

Christina Yarrington

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Maternal Morbidity ◽

De Novo ◽

Medical Center ◽

Safety Net ◽

Chronic Hypertension ◽

Increased Risk ◽

Safety Net Hospital ◽

History Of

Introduction: Postpartum hypertension can be persistent, following a pregnancy complicated by hypertension, or new onset ( de novo ), following a normotensive pregnancy. The postpartum period is traditionally defined as six weeks after delivery, yet accruing evidence shows that hypertension underlies the majority of severe maternal morbidity events through a year postpartum. While guidelines for enhanced monitoring of women at risk of persistent postpartum hypertension exist, less is known about risk factors for de novo postpartum hypertension. The aim of this study is to estimate the incidence of and identify risk factors for de novo postpartum hypertension among a diverse safety-net hospital population through the entire year postpartum. Hypothesis: We assessed the hypothesis that women with de novo postpartum hypertension share similar demographic and reproductive characteristics to women at increased risk of cardiovascular related maternal morbidity. Methods: We conducted a cohort study of 8,531 deliveries at Boston Medical Center from 2016-2018. Data on demographics, reproductive history, and labor and delivery were obtained from medical records. All documented blood pressure measures from pregnancy through 12 months postpartum were extracted. Women with chronic hypertension or hypertensive disorders of pregnancy were excluded. De novo postpartum hypertension was defined as two separate blood pressure readings with systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg at least 48 hours after delivery. Severe de novo hypertension was defined using criteria of SBP ≥160 and/or DPB ≥110. We examined the distribution of demographic and pregnancy characteristics among women with and without de novo postpartum hypertension. Secondary analyses restricting to women with healthcare visits after six weeks postpartum were also conducted. Results: Among the 6,631 women without a history of hypertension, 10% (n=660) developed de novo postpartum hypertension; a third of whom had severe hypertension (n=225). Compared to women without de novo hypertension; cases were more likely to be non-Hispanic Black; delivered via cesearean section; have had a preterm delivery; and be multiparous. In analyses restricted to women with visits extending past six weeks postpartum (n=3,272), the incidence of de novo postpartum hypertension was 16.6%. Approximately 30% of these cases were diagnosed after the traditionally used six week period. Conclusion: In conclusion, 1 in 10 women with normotensive pregnancies experience de novo hypertension in the year after delivery, with a third of these cases developing after six weeks. Opportunities to monitor and manage women at the highest risk of de novo hypertension throughout the entire year postpartum could mitigate cardiovascular related maternal morbidity.

Download Full-text

Abstract 3051: Blood Pressure Thresholds to Predict the Cause of Intracerebral Hemorrhage

Stroke ◽

10.1161/str.43.suppl_1.a3051 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Sevan R Komshian ◽

Jonathan T Kleinman ◽

Ryan W Snider ◽

Irina Eyngorn ◽

Didem Aksoy ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Chronic Phase ◽

Clinical Information ◽

Roc Curves ◽

Final Diagnosis ◽

Chronic Hypertension ◽

Spontaneous Intracerebral Hemorrhage ◽

Contrast Angiography ◽

History Of

Introduction: Chronic hypertension is a common cause of spontaneous intracerebral hemorrhage (ICH), but not all patients who are hypertensive on hospital presentation have an ICH caused by hypertension (htnICH). We sought to determine blood pressure (BP) thresholds that correlated with a presumed htnICH in a prospective cohort. Methods: The NIH-funded Diagnostic Utility of MRI in Spontaneous Intracerebral Hemorrhage (DASH) study prospectively enrolled consecutive ICH patients to determine the utility of routine MRI in the diagnosis and management of these patients. Contrast angiography was pursued in a predefined patient subset. At 3 months, ICH cause was determined by the treating stroke physician after review of all clinical information, including MRI in the acute and chronic phase, pathology, and clinic follow-up, as available. Statistical analyses were done using SPSS: χ2; 2 tailed t-tests; and Mann-Whitney U tests were used as appropriate. Receiver operator characteristic (ROC) curves were created and results expressed as area under curve (AUC). Results: We included 136 patients in this report (age: 63±17yrs; ICH volume: 22±27cc; NIHSS: 9±8; GCS: 13±3). Of these, 70% had a history of hypertension, 40% had an admission SBP> 180mmHg, and 22% an admission SBP >200mmHg. Sixty patients (44%) had htnICH as their final diagnosis. A history of hypertension was associated with htnICH (χ2=11.8, p<0.001), but 48% (46/95) of patients with a history of hypertension did not have a htnICH. Patients with a htnICH had: higher SBP (189 vs 157mmHg, p<0.0001); higher MAP (131 vs 110mmHg, p<0.0001), higher NIHSS (12 vs 6.5, p<0.0001); smaller ICH volumes (16.6 vs 26.0cc, p=0.03); and non-lobar hematomas (χ2=62.3, p180mmHg was 74% specific and 58% sensitive for a subsequent diagnosis of htnICH, a SBP> 200mmHg was 90% specific and 37% sensitive, and a MAP >132mmHg was 90% specific and 45% sensitive. Using ROC analysis, MAP predicted hypertensive etiology with an AUC of 0.75 (p<0.0001, 95% CI: 0.67-0.83). Patients with htnICH and MAP 132mmHg based on age, NIHSS, gender, ICH volume, or ICH location (lobar vs non-lobar). Conversely, patients with non-htnICH and MAP >132mmHg on admission tended to have larger ICH volumes (44 vs 24cc, p=0.07) and higher NIHSS (10 vs 6, p=0.21), but did not differ by location from those with a MAP<132mmHg. Non-lobar location alone was 74% specific and 93% sensitive for htnICH, and a non-lobar ICH or a MAP>132mmHg was 64% specific and 95% sensitive for htnICH. Conclusions: In our cohort, a history of hypertension predicted htnICH no better than chance. An admission SBP >200mmHg or a MAP >132mmHg predicted htnICH in 90% of these patients, but missed two-thirds of cases. ICH location alone was a sensitive predictor of htnICH, but blood pressure thresholds were more specific.

Download Full-text

Nitric Oxide in Different Types of Hypertension during Pregnancy

Clinical Science ◽

10.1042/cs0930413 ◽

1997 ◽

Vol 93 (5) ◽

pp. 413-421 ◽

Cited By ~ 14

Author(s):

Jenny V. Garmendia ◽

Ylse Gutiérrez ◽

Isaac Blanca ◽

N. E. Bianco ◽

J. B. De Sanctis

Keyword(s):

Nitric Oxide ◽

Blood Pressure ◽

Platelet Count ◽

Pregnant Women ◽

Normal Pregnancy ◽

Chronic Hypertension ◽

Different Types ◽

History Of ◽

Family History Of Hypertension ◽

Positive Correlations

1. Serum nitric oxide (NO) levels (determined by its products of oxidation) were assessed in nonpregnant women, normal pregnant women and patients suffering from mild pre-eclampsia (MPE), severe pre-eclampsia (SPE), chronic hypertension (CHT) and CHT with pre-eclampsia (CHT+PE). The levels of NO products were significantly reduced during pregnancy in MPE (P < 0.001), CHT+PE (P < 0.01) and SPE (P < 0.05). Significant reductions of NO products were also observed in puerperium (P < 0.001) in all groups except CHT+PE (P < 0.05). 2. In normal pregnancy, three events were related to NO levels: (1) negative correlations were found between the levels of nitrite (r = −0.73, P = 0.0003), nitrate (r = −0.53, P = 0.017) and the number of weeks of gestation; (2) in the caesarean section group, the levels of NO at puerperium were significantly lower (P < 0.05) than those during pregnancy; and (3) there was a significant reduction in NO levels in the pregnant women carrying male fetuses as compared with female fetuses (P < 0.05). 3. In SPE, the patients with a family history of hypertension had lower levels of NO compared with the patients without such a history (P < 0.05). 4. A negative correlation was observed between systolic blood pressure, diastolic blood pressure and NO levels in MPE (r = −0.62, P = 0.013 and r = −0.68, P = 0.0049 respectively) and SPE (r = −0.72, P = 0.004 and r = −0.53, P = 0.037 respectively). 5. In SPE, positive correlations were observed between platelet count and nitrite (r = 0.67, P = 0.006) and nitrate levels (r = 0.56, P = 0.028). 6. In MPE, patients with anti-hypertensive treatment showed significantly (P < 0.05) higher levels of NO compared with the non-treated patients. 7. NO may be important in the physiopathology of hypertension during pregnancy, although several factors may affect its levels.

Download Full-text

Abstract 541: Blood Pressure at 20 Weeks’ Gestation is Predictive of Hypertensive Disease in Pregnancy and is Independently Associated With 5-year Hypertensive Morbidity Post Delivery

Hypertension ◽

10.1161/hyp.62.suppl_1.a541 ◽

2013 ◽

Vol 62 (suppl_1) ◽

Author(s):

Asako Mito ◽

Naoko Arata ◽

Dongmei Qiu ◽

Naoko Sakamoto ◽

Yukihiro Oya ◽

...

Keyword(s):

Blood Pressure ◽

Physical Examination ◽

Odds Ratio ◽

Multiple Logistic Regression Analysis ◽

Previous History ◽

Antihypertensive Agents ◽

Chronic Hypertension ◽

Hypertensive Disease ◽

History Of ◽

In Pregnancy

[Background] Hypertensive disease in pregnancy (HDP) is associated with a risk of subsequent hypertension. However the influence of normotensive blood pressure (BP) during pregnancy on future BP is not clear. [Purpose] To investigate the association between BP measurements at their lowest levels in pregnancy, 20 weeks’ gestation (20 wks BP), and the risk of hypertension both ①during pregnancy and ②5 years after delivery. [Methods] A total of 1542 women who delivered singletons at the National Center for Child Health and Development and Showa University Hospital were recruited between 2003 and 2007. They were invited to undergo a physical examination 5 years after delivery. Following exclusions (see below), 772 women completed the analysis. The influence of 20 wks BP on HDP and 5-year hypertension was assessed by multiple logistic regression analysis. The odds ratio for HDP was adjusted by age at delivery, pre-pregnancy BMI, familial history of hypertension (FH), previous history of HDP and parity (Model 1) and that for subsequent hypertension was adjusted by existence of HDP in index pregnancy, age, BMI, FH and renal disease (Model 2). [Criteria] HDP was defined as sBP ≥ 140 mm Hg or dBP ≥ 90 mm Hg from 20 weeks’ gestation which remits by 12 weeks postpartum w/o proteinuria. Hypertension at physical examination was defined as average sBP ≥ 140 mm Hg or average dBP ≥ 90 mm Hg or treatment with antihypertensive agents. [Exclusion criteria] Chronic hypertension / Women who were pregnant and nursing when the physical examination was done [Results] There were 26 HDP cases and 25 cases of 5-year hypertension (HDP: 6, normotensive control: 19). ① The odds ratio (95%CI) for HDP (adjusted by Model 1) is sBP:1.11 (for every 1 mmHg rise) (1.05~1.17), dBP:1.15(1.06~1.24) and BP category defined by the American Heart Association : 5.82 (for every 1 category increase)(2.15~15.76). A positive correlation between 20 wks BP and HDP risk was observed. ② The odds ratio for subsequent hypertension (adjusted by Model 2) is sBP: 1.06 (1.01-1.11), dBP:1.15(1.06-1.24) and BP category: 4.50(1.64-12.33). 20 wks BP is associated with subsequent hypertension, independent of HDP . [Conclusions] 20 wks BP may predict both HDP and subsequent hypertension 5 years post delivery.

Download Full-text

Abstract MP65: Increased Sedentary Time Is Associated With Greater Postpartum Blood Pressure In Women With A History Of Preeclampsia

Hypertension ◽

10.1161/hyp.78.suppl_1.mp65 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Virginia R Nuckols ◽

Amy Stroud ◽

Kelsey Gruber ◽

Rumbidzai Ngonyama ◽

Debra Brandt ◽

...

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Aortic Stiffness ◽

Leisure Time ◽

Sedentary Time ◽

Late Pregnancy ◽

Chronic Hypertension ◽

Increased Risk ◽

Pregnancy And Postpartum ◽

History Of

Introduction: Women with a history of preeclampsia (hxPE) are at a four-fold increased risk for chronic hypertension and have elevated aortic stiffness compared withhealthy pregnancy (HP). Higher sedentary time (ST) is related to higher odds of hypertension in clinic among young women regardless of the amount of moderate-to-vigorous physical activity (MVPA). As pregnancy and postpartum are uniquely vulnerable times of increased sedentary behavior, the objectives of this study were to determine whether ST is associated with higher blood pressure (BP) and aortic stiffness in women with hxPE compared with HP 1-3 years postpartum, and if change in ST from late pregnancy to postpartum is related to change in BP or aortic stiffness. Methods: Women with hxPE (N=33) and HP (N=46) completed the Pregnancy Physical Activity Questionnaire (PPAQ) 18±6 months postpartum. BP was assessed in triplicate in clinic and by 24-hour ambulatory blood pressure monitoring and aortic stiffness by carotid-femoral pulse wave velocity (CFPWV). In a subset of women (N=20), clinic BP, CFPWV and the PPAQ were previously evaluated in the third trimester. Results: Women with hxPE reported more leisure-time ST compared with HP (18 [7-19] vs 7 [5-7] MET-hr/wk, P<0.001), whereas MVPA did not differ (77 [39-106] vs 56 [35-88] MET-hr/wk, P=0.13). 24-hour ambulatory BP was higher in women with hxPE (120 [114-126] vs 114 [109-120] mmHg, P=0.049; 78 [72-82] vs 74 [70-77] mmHg, P=0.056), but CFPWV did not differ independently of BP (6.1 vs 5.5 m/s, P=0.33). Postpartum ST, but not MVPA, was associated with higher 24-hr systolic (ρ=0.24, P=0.04) and diastolic BP (ρ=0.27, P=0.02) and higher CFPWV (ρ=0.31, P=0.008) independent of body mass index. Increases in ST from late pregnancy to postpartum (0 [-3-2] ΔMET-hr/wk, P=0.22) was related to increased BP (systolic ρ=0.42, P=0.06; diastolic ρ=0.44, P=0.050) and increases in CFPWV (ρ=0.54, P=0.02) despite a reported increase in MVPA (21.5 [-0.5-63] ΔMET-hr/wk, P=0.04). Conclusions: Greater ST is related to higher BP and aortic stiffness 1-3 years postpartum, and women with hxPE report greater leisure-time ST compared with HP controls. Reduction in ST may represent an achievable interventional strategy to improve cardiovascular health in women with hxPE.

Download Full-text

History of vascular reactivity models and their involvement in hypertension pathogenesis

VASA ◽

10.1024/0301-1526/a000659 ◽

2017 ◽

Vol 46 (6) ◽

pp. 431-439 ◽

Cited By ~ 4

Author(s):

Ana Gabriela Conceição-Vertamatti ◽

Filipy Borghi ◽

Fernando Canova ◽

Dora Maria Grassi-Kassisse

Keyword(s):

Blood Pressure ◽

Adrenergic Receptors ◽

Vascular Reactivity ◽

Multifactorial Disease ◽

Pharmacological Treatments ◽

Beta Adrenergic Receptors ◽

Vascular Area ◽

History Of ◽

Record Blood Pressure ◽

Advance Knowledge

Abstract. Hypertension is a silent and multifactorial disease. Over two centuries ago, the first device to record blood pressure was developed, making it possible to determine normotension and to establish criteria for hypertension. Since then, several studies have contributed to advance knowledge in this area, promoting significant advances in pharmacological treatments and, as a result, increasing survival of hypertensive people. The main models developed for the study of hypertension and the main findings in the vascular area are included in this review. We considered aspects related to vascular reactivity, changes in the population, and action of beta adrenergic receptors in the pathogenesis of hypertension.

Download Full-text