Increased Cardiac Arrhythmia After Pregnancy‐Induced Hypertension: A South Korean Nationwide Database Study

Background Although pregnancy‐induced hypertension (PIH) is associated with an elevated cardiovascular risk, long‐term studies or prepregnancy baseline data are scarce. Therefore, using a large nationwide cohort with prepregnancy periodic health screening data, we investigated whether clinically significant arrhythmia incidence increases after PIH. Methods and Results Data were extracted from the Korea National Health Insurance database and combined with the National Health Screening Examination database; women who gave birth between 2007 and 2015 and underwent the national health screening test within a year before pregnancy were followed up until 2016. We excluded women who had a diagnosis of arrhythmia within 1 year before pregnancy. The primary outcome was significant arrhythmia during the year after delivery. Secondary analysis included only specific diagnostic codes of arrhythmia with clinical significance. Additionally, the risk of arrhythmia was stratified by the use of magnesium sulfate. Of 2 035 684 women (PIH; n=37 297 versus normotensive pregnancy; n=1 998 387), the PIH group had a higher prepregnancy risk profile and showed a higher incidence of arrhythmia than women with normotensive pregnancies within 1 year. Women with PIH had a significantly higher risk of atrial flutter/fibrillation and atrioventricular block, but not lethal arrhythmias. Other predictors of arrhythmia development included advanced maternal age and cesarean section. Stratified analysis showed a higher risk of arrhythmia with magnesium sulfate use. Conclusions PIH was significantly associated with the development of arrhythmia within 1 year after delivery. Nevertheless, the incidence of lethal arrhythmias was not increased by PIH. Arrhythmia, especially atrial fibrillation, may largely contribute to increasing the future cardiovascular risk in women with a PIH history.

Determinants of adverse birth outcomes among women delivered in public hospitals of Ethiopia, 2020

Background Adverse birth outcome is a common health problem consisting of several health effects involving pregnancy and the newborn infant. Infants with one or more adverse birth outcomes are at greater risk for mortality and a variety of health and developmental problems. Factors such as the age of the mother, antepartum hemorrhage, history of abortion, gestational age, anemia, and maternal undernutrition have predisposed the mother to adverse birth outcome. For appropriate prevention of the adverse birth outcomes, data pertaining to determinants of adverse birth outcomes are important. Therefore, this study was aimed to assess the determinants of adverse birth outcomes among women who give birth in public hospitals of western Ethiopia. Methods An institutional-based unmatched prospective case-control study was conducted from February 15 to April 15, 2020, in selected public hospitals of western Ethiopia. From mothers who gave birth in public hospitals of Wollega zones, 165 cases and 330 controls were selected. Mothers with adverse birth outcomes were cases and mothers without adverse birth were controls. Data was collected by structured interviewer-administered questionnaires. In addition to the interview, the data collectors abstracted clinical data by reviewing the mother and the babies’ medical records. The collected data were entered into Epi info version 7 and exported to SPSS version 21 for analysis. Finally, multivariable logistic regression was used to identify determinants of adverse birth outcomes at P-value < 0.05. Results A total of 495 mothers (165 cases and 330 controls) were included in the study with a mean age of 28.48 + 5.908. Low ANC visit (AOR = 3.92: 95% CI; 1.86, 8.2), premature rupture of membrane (AOR = 2.83: 95% CI; 1.72,4.64), being Anemic (AOR = 2: 95% CI; 1.16,3.44), pregnancy induced-hypertension (AOR = 2.3:95% CI; 1.4,3.85), not getting dietary supplementation (AOR = 2.47:95% CI; 1.6,3.82), and physical abuse (AOR = 2.13: 95% CI; 1.05,4.32) were significantly associated with the development of the adverse birth outcome. Conclusion Low antenatal care visit, being anemic, premature rupture of membrane, pregnancy-induced hypertension, not getting dietary supplementation, and physical abuse were determinants of adverse birth outcomes. The clinicians should play a pivotal role to improve antenatal care follow up, counsel, and supplement recommended diets and minimize violence and abuse during pregnancy.

Serum Lactate Dehydrogenase Level in Pregnancy Induced Hypertension and Fetomaternal Outcome

Hypertensive disorders complicate 5-10% of all pregnancies and associated with potentially dangerous maternal and fetal complications. Studies have shown that pre-eclamptic patients with higher levels of lactate dehydrogenase (LDH) are at high risk of developing subsequent complications with poor maternal and fetal outcome. So with the aim to correlate serum LDH level in pregnancy induced hypertension (PIH) with fetomaternal outcome this hospital based observational descriptive study was done at Tribhuvan University Teaching Hospital (TUTH) for the duration of 1 year from 15th May, 2018 to 14th May, 2019. Women with PIH fulfilling inclusion criteria were enrolled in the study. Serum LDH level was measured and severity of PIH, maternal and perinatal outcome were studied according to the levels of LDH. Results were analyzed using SPSS 18. The incidence of hypertensive disorder in pregnancy was 4.74% in this study and total 180 cases were enrolled. The mean serum LDH level increased with increase in severity of PIH. Thirty two (17.7%) cases had maternal complications and hemolysis elevated liver enzymes and low platelet (HELLP) syndrome was most common complication. More than 2/3rd (62.5%) of cases with LDH level >800 IU/L had complications. The most common perinatal complication was intrauterine growth restriction (IUGR). The perinatal morbidity and mortality were significantly high in patients with PIH with LDH level >800 IU/l. As with the increase in serum LDH level increase in maternal and fetal complications was observed, LDH can be a useful biochemical marker that reflects the severity of PIH.

Effect of maternal high body mass index on outcome of pregnancy in women with recurrent miscarriages

The epidemic of obesity is spreading worldwide and subsequently, rate of obesity during pregnancy has also increased. Maternal overweight and obesity are widely associated with adverse pregnancy outcomes. Recurrent miscarriage is an important reproductive health issue, because it affects many couples. So the present study is planned to study the relationship between maternal obesity and pregnancy outcome in women with recurrent miscarriages. Observational Cross sectional study was conducted in a tertiary care hospital. 111 Postnatal women between 18 to 44 years of age with history of two or more miscarriages less than 20 weeks of gestation in previous pregnancy were included in the study. First trimester weight at the first visit (registration) was recorded, BMI was calculated & women were divided into obese and non obese groups. The outcome of present pregnancy was noted as Mode of delivery, Gestational diabetes mellitus, Pregnancy induced hypertension, Preterm delivery etc. Statistical tests were used to quantify the risk. Gestational diabetes (OR= 13.6) and pregnancy induced hypertension (OR=4.2) were significantly associated with obesity in women with recurrent miscarriages. [At 95% CI] The incidence of LSCS and preterm delivery was more in overweight and obese mothers, though not statistically significant. Maternal obesity significantly contributes to poor prognosis for the mother and the baby during delivery. Hence the women of this group should be regarded as ‘high risk’ and counselling and the risk assessment should be done during ANC visits.

Failed induction of labour and associated factors among women delivered in Jigjiga University Sheik Hassan Yabare Referral Hospital: a cross-sectional study

Introduction: Induction of labour is one component of comprehensive obstetrics care services that is increasing employed in modern day obstetrics to decrease the risk of maternal and neonatal morbidity and mortality. However, it has been strongly associated with poor maternal and perinatal outcomes. Therefore, his study was aimed to assess the magnitude of failed induction of labour and associated factors among mothers delivered at Jigjiga University Sheik Hassan Yabare referral Hospital, Eastern Ethiopia from June 1 to June 30, 2021.Methods: An institutional based cross-sectional study was carried out among 364 women’s delivered at Jigjiga University Sheik Hassan Yabare Referral Hospital from 2018 to 2021. A checklist was used to collect the data from the women’s chart. To isolate independent predictors related to failed induction of labour, multivariate logistic regression analyses were performed.Result: Our study participants were 364 women’s. The magnitude of failed induction of labour was 36.8% (95% CI: 31.8, 42.0). Age of the mother (<30 years) (AOR= 3.2; CI: 1.78, 5.75), rural residency (AOR=2.28; CI:1.29, 4.01), being primi-para (AOR= 2.76; CI: 1.55, 4.91), gestational age less than 37 or greater than 42 year (AOR= 2.65; CI: 1.44, 4.89) , multiple ton of pregnancy (AOR= 2.36; CI: 1.01, 5.55), premature rapture of membrane (AOR= 4.88; CI: 2.33, 10.21), pregnancy induced hypertension (AOR= 5.11; CI: 2.67, 9.79), and bishop score less than six (AOR= 1.95; CI: 1.15, 3.32) were significantly associated with failed induction of labour.Conclusion: The magnitude of failed induction of labour among mothers undergoing labor induction was relatively high in the study settings compared with previous studies in the country. Failed induction of labour was significantly associated with age of the mother (<30 years), rural residency, being primi-para, gestational age less than 37 or greater than 42 years, multiple ton of pregnancy, premature rapture of membrane, pregnancy induced hypertension, and bishop score less than six.

The Effect of Pregnancy-Induced Hypertension on Uteroplacental Vasculature Hemodynamic Changes and Pregnancy Outcome

Background: Among the various complications of pregnancy, pregnancy-induced hypertension is found to be the most common which may affect maternal and fetal outcome. Pregnancy induced hypertension can cause growth retardation of fetus. Aim and Objective: This study aims to assess hemodynamic variations in uteroplacental circulation in pregnancy-induced hypertension and its effect on fetal outcome. Materials and Methods: The study was carried out at tertiary care hospital of nawab shah for the period of 06 months at Department of Radiology in association with Department of Gyne and Obs. Total 106 participants were selected for the study and all females were pregnant with 1st or 2nd trimester gestational record and medical history was taken from all participants and co-morbidities was also evaluated. Blood pressure was checked from all participants from their right arm in lying position and Ultrasound test was repeated as per requirement through color Doppler ultrasound machine and Data was analyzed by using statistical software SPSS. 24.00 version. Results: After collection of research data from all participants, the entire data was assembled for the analysis. Participants were divided into various age groups as 26 were in 18-21yeras, 34 in 22-25years, 21 in 26-29years and only 07 were from 34-37years. 26 participants were belongs to 1st trimester, 34 among 2nd trimester and 21 in third trimester. PI was also noted with three different readings 32 in Umbilical artery, 21 in middle cerebral artery and 37 in uterine artery. RI was also noted among different arteries 41 in umbilical, 36 in middle cerebral and 39 in uterine arteries. S/D was also noted, 33 in umbilical artery, 49 in middle cerebral artery and 30 in uterine arteries. Conclusion: Pregnancy-induced hypertension causes hemodynamic variations in uteroplacental vasculature which may be responsible for causing impaired fetal growth in some cases.

Incidence of Pregnancy Induced Hypertensive Women and its Associated Factors

Background: Pregnancy induced hypertension is a fetal disease resulting into morbidity and mortality of female as well as its neonate. Objective: To find the incidence of pregnancy induced hypertension in Pakistani women. Study Design: Cross sectional study Place and Duration of the Study: Department of Obstetrics & Gynaecology, Sandeman Provincial Hospital, Quetta from 1st March 2019 to 31st March 2021. Methodology: Seven hundred and twenty eight females were identified with pregnancy induced hypertension from all the pregnant women attending the outdoor were enrolled. Each female was checked for their protein urea as well as systolic and diastolic blood pressure according to standard operating protocol. Socio-demographic, clinical and family history were documented. Results: Among all pregnant women, 150 were identified as pregnancy induced hypertensive with a 20.6% incidence of pregnancy induced hypertension. The mean value systolic blood pressure value was 144.3±5.2 and of diastolic as 83.1±5.2 in pregnancy induced hypertension women. Conclusion: Family history, obesity and renal diseases are the main factors associated with pregnancy induced hypertension with an incidence of 20.6% among pregnant women. Keywords: Pregnancy induced hypertension, Body mass index, Pregnant women, Hypertension

How to evaluate and treat the spectrum of TMA syndromes in pregnancy

Thrombotic microangiopathy (TMA) is the broad definition for thrombocytopenia, microangiopathic hemolytic anemia, and end-organ damage. Two important categories are thrombotic thrombocytopenic purpura (TTP) and complement-mediated hemolytic-uremic syndrome (CM-HUS). Pregnancy and the immediate postpartum period are associated with TMAs specific to pregnancy in rare situations. These include pregnancy-induced hypertension, preeclampsia, and hemolysis, elevated liver enzymes, and low platelets. TTP and CM-HUS may present in pregnancy. However, the diagnosis may not be immediately obvious as they share characteristics of pregnancy-related TMAs. Within this review, we discuss investigations, differential diagnosis of TMAs in pregnancy, and management. The importance is a risk of maternal mortality but also poor fetal outcomes in relation to TTP and CM-HUS. Treatment of these disorders at presentation in pregnancy is discussed to achieve remission and prolong fetal viability if possible. In subsequent pregnancies, a treatment pathway is presented that has been associated with successful maternal and fetal outcomes. Critical to this is a multidisciplinary approach involving obstetricians, the fetal medicine unit, and neonatologists.

Pregnancy Complications in Women with PCOS: A Meta-Analysis

Polycystic ovary syndrome (PCOS) is a hormonal disorder which affects women in their reproductive ages. There might have association between maternal and neonatal complications with PCOS. The goal of this study is to look for the association between polycystic ovary syndromes (PCOS) and obstetric complications through meta-analysis on the basis of previously published studies from 2000 to 2019. In the current endeavour 17 studies involving 1975 women with PCOS and 10812 controls were selected for pooling. During pregnancy period women who have PCOS showed a significantly higher risk of developing gestational diabetes mellitus (GDM) (RR 2.51; 95% CI: 1.71-3.65), pregnancy induced hypertension (PIH) (RR 2.76; 95% CI: 2.04-3.72), preeclampsia (RR 2.14; 95% CI: 1.34-3.40), preterm birth (RR 1.41; 95% CI: 1.08-1.85) compared to controls. Neonatal birth weight is significantly lower (SMD -0.18; 95% CI: -0.33 to -0.03) compared to controls. It is concluded that women who have PCOS have greater chance of having pregnancy complications as well as risk of neonatal complications such as having low birth weight. Dhaka Univ. J. Sci. 69(2): 82-87, 2021 (July)