History Of Chronic Hypertension Research Articles

Approach to a patient with iatrogenic coronary dissection during percutaneous intervention

This case report presents a conservative management approach to a potentially hazardous complication, iatrogenic coronary artery dissection (ICAD), occurring during percutaneous coronary intervention (PCI). The patient, a 60-year-old woman with a history of chronic hypertension and type II diabetes mellitus, presented with non-ST-segment elevation myocardial infarction. During the PCI, an antegrade coronary dissection was observed, leading to the termination of the procedure. Post-procedure, the patient was managed conservatively with standard coronary artery disease treatment. Follow-up angiography showed complete healing of the dissection area, and no adverse cardiovascular events occurred during a 3-month follow-up period. This report highlights the importance of early diagnosis and careful management of ICAD. It stresses the need for further research into long-term outcomes and effectiveness of different treatment approaches for patients with ICAD.

The Characteristics of Preeclampsia and Eclampsia Patients at Dr. T.C. Hillers Regional Hospital Maumere

Preeclampsia can occur from the time the mother is pregnant until 48 hours to 6 weeks after giving birth and is associated with an increased complication rate of 2-8% during pregnancy, contributing to 9 - 26% of maternal deaths. This condition can have significant prolonged effects on both the mother and the baby. Considering the high rates of morbidity and mortality in mothers and babies due to preeclampsia, this study aims to understand the characteristics of patients with preeclampsia at T.C. Hillers Regional Hospital of Maumere within the period of January 1st to December 31st, 2022. This study is a retrospective descriptive study using secondary data. The data collection was performed on patients diagnosed with preeclampsia and eclampsia during the study period. The results showed that most participants were between 20-34 years old, had a body mass index (BMI) of ≥ 25, multigravida (had multiple pregnancies), housewives, High School graduates, and had a history of chronic hypertension. Based on risk factors, 35.5% of the subjects were ≥ 35 years old, 31% were primigravida (first-time pregnant), 26% were obese, 21% had a history of hypertension in previous pregnancies, 10,5% had chronic hypertension, 3% had multiple gestations, 1% of the subjects had a pregnancy interval >10 years, and 0.5% had diabetes mellitus. This study provides an overview of the characteristics and risk factors of pregnant women with preeclampsia in Maumere.

Association of Maternal Serum Gamma-Glutamyltransfetase Level at First Trimester as a Predictive Biomaker of Gestational Diabetes Mellitus

Introduction: The prevalence of GDM is increasing globally. GDM is associated with many maternal and fetal complications. Hence identifying and treating maternal hyperglycemia is beneficial for both mother and baby. Proper monitoring of women is necessary during pre-conceptional and early pregnancy period to prevent GDM and its complication. Objective: To assess the level of maternal serum Gamma-glutamyltransferase (GGT) as predictor of Gestational Diabetes Mellitus (GDM). Methods: A Prospective cohort study was carried out at Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka from January 2021 to December 2021. Total sample size was 144. Pregnant women attending Obstetric OPD, DMCH at her 1st trimester (8 -12 weeks) without the evidence of GDM, DM, or any comorbid condition and drugs that affects blood glucose level. Data regarding demographic profile, medical and family history (history of chronic hypertension, diabetes mellitus, autoimmune disease, and CKD) were recorded. Obstetric history regarding gravity, parity, past obstetric history was documented. Then a complete physical examination of the subjects including height, weight, blood pressure level was carried out with an appropriate procedure. Period of the gestation was confirmed by recording CRL in early USG. Patient’s fasting blood sugar and 2hrs after 75- gram glucose at first trimester was measured. Results: In the current study 144 pregnant women, at their first trimester (8-12 week) were included, but during follow up about 12 patients were dropped out due to mid trimester abortion, migration to another place and so on. Most of them were primi (56.1%) housewife (75%), had completed their secondary education (59.1%), and about 61.4% belong to middle class family. The clinical parameter like BMI 25.80±4.56kg/m2, gestational age at delivery 38.09±1.28 weeks. The mean ±SD BMI 27.52±4.72 kg/m in GDM group 25.40±4.46 kg/m in Non GDM group. The mean ± SD birth weight was 3.07±0.37 kg in GDM group and 2.86±0.33 in Non GDM group. The difference was statistically non- significant (p>0.05) between two groups. Among 45.45% subjects had GGT level <10 U/L,34.09% had 11-20 U/L and 20.45% had GGT >20 U/L. Among total 132 respondents 25 respondents (18.94%) developed GDM. The total population divided in two groups, Group I (GDM) and Group II (non GDM). Shows that in group A (GGT ≥12.5 U/L) total respondents were 61, GDM developed in 29.50% (n=18), GDM not developed in 70.49% (n=43). On the Other hand in Group B (GGT <12.5 U/L) total respondents were 71, GDM developed in 9.85% (n=07) and GDM not developed in 90.14% (n=64) and p value was 0.004. Conclusion: The result of our study indicated that pregnant women with high GGT (>12.5 U/L) at booking visit had greater risk of developing GDM (72%).Sensitivity, Specificity, PPV ,NPV of this diagnostic test was 72% , 59.81%, 29.50%, 90.14% respectively and accuracy is 94.69%. Among these 132 respondents, those having GGT>12.5IU/L relative risk (RR) of development of GDM is 3.01. As measurement of GGT is easy, inexpensive and easy to carry out, it can be used as a predictive biomarker who are at increased risk for the subsequent development of GDM.

Preeclampsia and its determinants in Ethiopia: A systematic review and meta-analysis.

Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is uncertain. Therefore, the purpose of this review was to find the prevalence of pre-eclampsia and its determinants in Ethiopia. To find primary studies, PubMed, Google Scholar, HINAR, Scopus, the Web of Sciences, and grey literature searches were used between January 1, 2013, and January 1, 2023, in Ethiopia. A Microsoft Excel sheet was used to extract data. The pooled prevalence of pre-eclampsia was predicted using a random-effect model. Twenty-nine studies were included. The pooled prevalence of pre-eclampsia was 11.51% (95% CI: 8.41, 14.61). Age > 35 years old (AOR = 2.34, 95%CI, 1.74-2.94; p-value = 0.64), housewife (AOR = 2.76, 95%CI, 1.2-4.32; p-value = 0.37), previous history of pre-eclampsia (AOR = 4.02, 95%CI, 2.91-5.55; p-value = 0.09), family history of hypertension (OR = 1.84, 95%CI, 1.39-2.3; p-value = 0.4), history of chronic hypertension (AOR = 2.44, 95%CI, 1.8-3.08; p-value = 0.67), history of multiple pregnancies (AOR = 1.45, 95%CI, 1.09-1.8; p-value = 0.38), and alcohol intake during pregnancy (AOR = 1.53, 95%CI, 1.03-2.04; p-value = 0.03) were the determinants of pre-eclampsia. When compared to previous studies, the overall pooled prevalence of pre-eclampsia was high. Pre-eclampsia is associated with maternal age >35 years, being a housewife, having a history of preeclampsia, having a history of chronic hypertension, having a family history of hypertension, having diabetes mellitus, drinking alcohol during pregnancy, and having multiple pregnancies.

Provider adherence to aspirin prophylaxis prescription guidelines for preeclampsia

ObjectiveTo evaluate provider adherence to aspirin prophylaxis prescription guidelines for patients at risk. Study DesignA retrospective chart review was performed at Henry Ford Health (HFH) between October 2015 and December 2020. In October 2015, low-dose aspirin was recommended for women who met high risk criteria for preeclampsia at HFH; in February 2019, aspirin recommendation expanded to include women who met either moderate or high-risk criteria. A total of 46,016 pregnancies occurred between Oct 2015 and Dec 2020 of which 15,167 (33.0%) met high and moderate risk criteria. ResultsFrom the population at risk, 1,255 (8.3%) had a history of preeclampsia, 2,534 (16.7%) had a history of chronic hypertension, 1,418 (9.3%) had a history of diabetes, 7,470 (49.3%) were nulliparous, 4,038 (26.6%) were 35 years of age or older, 6,395 (42.2%) had a body mass index greater than 30 kg/m2, and 8,174 (54.5%) were African Americans. Only 630 out of 3,584 (17.6%) of women meeting the high-risk criteria for preeclampsia between Oct 2015 and Jan 2019 received low-dose aspirin and only 891 out of 5,874 (15.2%) of women meeting the high or moderate risk criteria for preeclampsia between Feb 2019 and Dec 2020 received low-dose aspirin prophylaxis. ConclusionAdherence to aspirin prophylaxis guidelines was low. Most urban healthcare systems serve diverse, high-risk populations with multiple comorbidities rendering many women at risk for preeclampsia. Educational efforts to improve provider knowledge regarding this important preventative measure are indicated. Recommendation for implementing universal aspirin in such high-risk populations should also be considered.

Risk Factors for Severe-Critical COVID-19 in Pregnant Women.

Risk factors associated with severe-critical COVID-19 (coronavirus disease 2019) are based on findings in the general population. Pregnant women are at increased risk of severe-critical infection, and few reports are based on these women. A multicentric case-control study was conducted at the Mexican Institute of Social Security, State of Mexico, during the COVID-19 pandemic. We included pregnant women who were consecutively admitted to respiratory care units and were followed until 30 days after the resolution of pregnancy. A total of 758 pregnant women with a positive RT-PCR test for SARS-CoV-2 were enrolled from June 2020 to July 2021. We defined groups using the World Health Organization Severity Classification; cases were pregnant women with severe-critical COVID-19 (n = 123), and controls were subjects with non-severe COVID-19 (n = 635). Data was gathered from clinical files. A multivariate logistic regression analysis was used to adjust odds ratios and their 95% confidence intervals of factors associated with severe-critical COVID-19. Risk factors associated with severe-critical COVID-19 in pregnancy were non-vaccination (OR 10.18), blood type other than O (OR 6.29), maternal age > 35 years (OR 5.76), history of chronic hypertension (OR 5.12), gestational age at infection ≥ 31 weeks (OR 3.28), and multiparity (OR 2.80).

Longitudinal Associations between Ambient Air Pollution and Angiogenic Biomarkers among Pregnant Women in the LIFECODES Study, 2006-2008.

Exposures to ambient air pollution during pregnancy have been linked to adverse pregnancy outcomes such as preeclampsia and fetal growth restriction. Although evidence has shown that women with preeclampsia have higher ratio of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF ratio), the potential impact of air pollution on markers of placental growth and function has not been well studied. We aimed to examine longitudinal associations between ambient air pollution exposure and angiogenic factors among pregnant women in LIFECODES, a prospective birth cohort and biorepository in Massachusetts in the United States. PlGF and sFlt-1 were measured among pregnant women using plasma samples collected around 10, 18, 26, and 35 wk' gestation. Women's exposures to ozone (), fine particulate matter with aerodynamic diameter (), and nitrogen dioxide () within 1, 2, 4, and 8 wk prior to each plasma sample collection were estimated based on geocoded residential addresses, and mixed effect linear regression models were fitted to assess their associations with sFlt-1/PlGF ratio, sFlt-1 (ng/mL), and PlGF (pg/mL). Percent changes in outcomes associated with each interquartile range increase in exposures were reported, along with their 95% confidence intervals. A total of 1,066 pregnant women were included. In the multipollutant models, significant associations were observed for increased sFlt-1/PlGF ratio ( 3-8 wk' gestation, : 35-39 wk' gestation), elevated sFlt-1 (: 26-34 wk' gestation, : 3-8 wk' gestation), decreased sFlt-1 (: 4-8 wk' gestation), and decreased PlGF (: 34-39 wk' gestation) after adjusting for sociodemographic status, smoking, drinking, body mass index, parity, history of chronic hypertension, and conception time. Exposures to during early pregnancy and exposures to and during late pregnancy were associated with increased sFlt-1/PlGF ratio, elevated sFlt-1 and with decreased PlGF, which may be a potential mechanism underlying ambient air pollution's impacts on adverse pregnancy and birth outcomes. https://doi.org/10.1289/EHP11909.

Risk Factors of Pre-eclampsia: A Hospital-Based Case-Control Study.

Introduction Pre-eclampsia is a pregnancy-specific hypertensive disorder and is one of the leading causes of maternal and infant morbidity and mortality in India and worldwide. Evidence of the association between various risk factorsand pre-eclampsia is scarce in developing countries. As pre-eclampsia remains a leading cause of maternal mortality and morbidity, focusing on the causes and risk factors of pre-eclampsia during antenatal surveillance would prevent maternal deaths and reduce the maternal mortality rate. Our study aimed to determine the risk factors of pre-eclampsia. Materials and methods An unmatched case-control study was conducted at Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Odisha, taking 100 cases of pre-eclampsia and 100 controls without pre-eclampsia from January 2021 to January 2023. The study population included patients admitted to the Obstetrics & Gynecology labor room. Study participants were selected randomly from the labor room thrice weekly. Data were collected using a predesigned pre-tested questionnaire and case report format. Data were analyzed using IBMSPSSStatistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States).Appropriate statistical tests (Odds ratio, proportions, Chi-square test) were applied, and the final interpretation was made. Results Family history of hypertension (AOR = 4.2), history of chronic hypertension (AOR = 13.7), and AB blood group (AOR = 3.6) were found to be significant risk factors for pre-eclampsia. No significant association was found between pre-eclampsia and factors such as mother's age, caste, mother's education, type of family, socioeconomic status, education and occupation of husband, family history of diabetes mellitus, parity, history of abortion, and anemia. Conclusion Risk factors identified in the present study can be used to identify women at risk of pre-eclampsia during antenatal check-ups to minimize the complications of pre-eclampsia in both the mother and the fetus.

Clinical characteristics and subsequent need for anti-hypertensive agents in the postpartum period for hypertensive disorders of pregnancy.

The objective of this study was to identify clinical characteristics of patients with hypertensive disorders of pregnancy associated with requiring multiple anti-hypertensive medications to optimize blood pressure in the postpartum setting. We performed a retrospective cohort study of all women who had a diagnosis of hypertensive disorders of pregnancy who delivered at a single institution between October 1, 2017 and May 1, 2021. Demographics and clinical characteristics including category of anti-hypertensive medication and number of medications were collected. Models were adjusted for race. A total of 1,708 women were identified for inclusion. Of this cohort, 64.9% did not require any anti-hypertensive medications, while 24.8% used one medication and 10.2% required two or more medications. When comparing women by the number of medications that were required, their demographics were similar except for race (p<0.001). Women taking two or more medications were most prescribed a beta blocker (94.9%) followed by a calcium channel blocker (88.6%). Women with a history of chronic hypertension had the highest risk of requiring two or more medications for blood pressure control (adjusted RR 11.19, 95% CI 2.63-47.60). Chronic kidney disease also significantly increased the risk of requiring two or more medications (adjusted RR 3.09, 95% CI 1.24-7.69). Women with chronic hypertension and chronic kidney disease are at increased risk for requiring multiple anti-hypertensive medications in the postpartum setting. We recommend frequent postpartum visits, either in person or implementing telemedicine platforms to optimize blood pressure control for this high-risk cohort.

LEGACY OF ARTERIAL HYPERTENSION OF WOMEN WITH A PAST HISTORY OF PREECLAMPSIA

Objective: Preeclampsia increases the longterm risk of cardiovascular disease. Some of the women affected by this condition remain hypertensive after delivery. Hypertensive phenotypes can be detected with ambulatory BP monitoring (ABPM). This study aimed to determine the prevalence of hypertension using ABPM and office measurements. Design and method: We conducted a cross- sectional study which included women who delivered between January 2015 and June 2021 and were diagnosed and followed up for preeclampsia in three major obstetrical and gynaecologic units in Yaounde. We excluded from the study all women who had a history of chronic hypertension or a known Cardiopathy. Sociodemographic data and past history were recorded, a physical exam,ecg, an ultrasound and ABPM was performed to all participants. Results: 101 participants were included. The mean age was 30.56 years. 40.6% of women had hypertension (sustained hypertension, with sometime masked hypertension) with ABPM. Sustained hypertension was most common (26.7%), followed by masked hypertension (11.9%) and white-coat hypertension (2%). With office BP measurement, only 28.7% of women would have been diagnosed hypertensive. 29.8% of women had a disadvantageous dipping pattern. Among those that develop chronic hypertension, 18.8% had LVH at electrocardiography, 7.9% had both LVH and an abnormal left ventricular geometry on ultrasound while in normotensive women 1.9% had LVH at Ecg with 1% having both LVH and abnormal geometry at ultrasound. 20.8% of these women were obese during the follow up compared to 11.9% in the normotensive group. We had 26 patients (25,74%) with severe office hypertension and 32,3% were obeses. The fundus was normal in the majority of cases and we had no signs of neurological deficits or impaired cognition. Renal function was always normal or subnormal. Finally, we had two cases of heart failure. Conclusions: Many women affected by preeclampsia remain hypertensive after delivery. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. It is important to provide adequate follow-up for these women in order to intervene on the factors leading to this outcome.

PS-C10-1: BLOOD PRESSURE PROFILE AND CARDIO-VASCULAR FEATURES OF WOMEN WITH A PAST HISTORY OF PREECLAMPSIA

Introduction: Preeclampsia increases the longterm risk of cardiovascular disease. Some of the women affected by this condition remain hypertensive after delivery. Hypertensive phenotypes such as masked hypertension, sustained hypertension, white coat hypertension and an adverse systolic night-today blood pressure (BP) ratio are often unnoticed and can only be detected with ambulatory BP monitoring (ABPM). This study aimed to determine the prevalence of hypertension using ABPM and office measurements. Methods: We conducted a cross- sectional study which included women who delivered between January 2015 and June 2021 and were diagnosed and followed up for preeclampsia in three major obstetrical and gynaecologic units in Yaounde. We excluded from the study all women who had a history of chronic hypertension or a known Cardiopathy. Sociodemographic data and past history were recorded, a physical exam,ecg, an ultrasound and ABPM was performed to all participants. Results: 101 participants were included. The mean age was 30.56 years. 40.6% of women had hypertension (sustained hypertension, with sometime masked hypertension) with ABPM. Sustained hypertension was most common (26.7%), followed by masked hypertension (11.9%) and white-coat hypertension (2%). With office BP measurement, only 28.7% of women would have been diagnosed hypertensive. 29.8% of women had a disadvantageous dipping pattern. Among those that develop chronic hypertension, 18.8% had LVH at electrocardiography, 7.9% had both LVH and an abnormal left ventricular geometry on ultrasound while in normotensive women 1.9% had LVH at Ecg with 1% having both LVH and abnormal geometry at ultrasound. 20.8% of these women were obese during the follow up compared to 11.9% in the normotensive group. We had 26 patients (25,74%) with severe office hypertension and 32,3% were obeses. The fundus was normal in the majority of cases and we had no signs of neurological deficits or impaired cognition. Renal function was always normal or subnormal. Finally, we had two cases of heart failure. Conclusion: Many women affected by preeclampsia remain hypertensive after delivery. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. It is important to provide adequate follow-up for these women in order to intervene on the factors leading to this outcome.

78 FOUR YEARS ECHOCARDIOGRAPHIC FOLLOW-UP OF A LEFT VENTRICULAR PSEUDOANEURYSM

Abstract Introduction Left ventricular pseudoaneurysm is a rare and often fatal complication of myocardial infarction. It has an incidence of 0,2-0,4% of all the STEMI and a very high mortality, particularly in the first month. Symptoms can vary from shortness of breath on exertion, orthopnea, chest pain, fatigue. At least 10% of patients do not present any symptoms and the pseudoaneurysm is diagnosed incidentally during a follow-up appointment. Signs include persistent ST elevation on EKG and its diagnosis can easily be made with a transthoracic echocardiogram and more in depth with a CT scan and a cardiac MRI. Its treatment is surgical, but the choice is up to the anesthesiologist and cardiothoracic surgeon, depending on patient's comorbidity and surgery risk. Surgical treatment has a high rate of death, reaching even the 37%. Background We present the case of a 74 years old patient with an history of chronic hypertension and cerebral vasculopathy, who sustained a STEMI in 2017. Urgent coronarography study was performed, but unfortunately the angioplasty treatment was unsuccessful and the left anterior descending artery could not be recanalized. Therefore, the patient was transferred to the cardiothoracic department in order to undergo bypass surgery: surgery was performed five days after, using left internal mammary artery to the left anterior descending artery and great saphenous vein to the first diagonal. Surgery went well with no complications; the post-operative period passed by without any complications and, after 15 days, patient was discharged with no complains. Two months later, he was admitted to intensive care unit of a hospital of our town, because of dyspnea (NYHA 3), peripheral edema, moderate-severe mitral insufficiency, moderate pleural and pericardial effusion. He underwent a CT-scan that showed “9×6,4 cm cavity with blood that seemed to have a connection with the postero-lateral wall of the left ventricle”. He also underwent a cardiac MRI that displayed a pseudoaneurysm with an endoluminal thrombus. After an accurate evaluation of the case, the Heart Team decided to do not perform surgery because of the high risk of the patient. Thence, we have been followed him with close echocardiographic exams for more than four years. Methods From March 2018 to September 2022, we have been followed the patient with complete echocardiographic follow-ups, done every three-six month. Results and conclusions Patient with left ventricle pseudoaneurysm due to an extensive myocardial infarction has been followed in our echo lab for more than 4 years. He has been stable during these years, NYHA II, in a good clinical and hemodynamical state.

Association between Abnormal Echocardiography and Adverse Obstetric Outcomes in Low-Risk Pregnant Women.

Maternal mortality in the United States is a public health crisis of preventable deaths among young women. The role of echocardiography in the evaluation of pregnant women with cardiovascular symptoms or risk factors without known heart disease is unclear. We retrospectively examined the clinical characteristics of consecutive pregnant patients without established heart disease who underwent echocardiography and evaluated associations between abnormal exam findings and obstetric outcomes. Among low-risk women undergoing echocardiography during pregnancy, older age, higher parity and a history of chronic hypertension are associated with a higher likelihood of echocardiographic abnormalities, which in turn are associated with a higher likelihood of adverse obstetric outcomes including caesarean section and preterm delivery.

The complexity of perioperative management of acute limb ischemia in elderly with multiple comorbidities and underlying diseases: A case report

Background: Aging process commonly associated with multiple comorbidities such as metabolic disorders, vascular, visual, gait, balance and psycho-social problems. Atherosclerosis is one of comorbidities that could occur as a pre-existing condition in elderly with peripheral artery disease (PAD). Elderly patients associated with complex and multi-factorial medical conditions need to be addressed in a comprehensive approach. Here we report the complexity of perioperative management of an elderly with acute limb ischemia in elderly with multiple comorbidities and underlying diseases.&#x0D; Case Presentation: An elderly woman, 77-year-old, was referred to emergency room due to decreased level of consciousness. There were complaints of loss appetite, inactivity, bedridden, pain, paresthesia and muscle weakness in the right lower limb. There was history of chronic hypertension and dyspepsia. Since there was a sign of right lower limb acute limb ischemia, the patient was discussed with the multi-discipline team, planned for primary amputation, and received systemic anticoagulant treatment. Due to multiple comorbidities and underlying diseases, the patient died prior to amputation surgery.&#x0D; Conclusion: Surgery is not contraindication to elderly; however, from this case it shed light the needs of multi-discipline approach to decide the best treatment options for patient’s needs. Utilizing a Comprehensive Geriatric Assessment (CGA) could be an alternative to non-invasive, simple, and effective approach available in any healthcare setting.

Risk factors and adverse pregnancy outcomes in older pregnant women with hypertensive disorders of pregnancy

To assess the independent risk factors and pregnancy outcomes of hypertensive disorders of pregnancy (HDPs) in Chinese advanced age pregnancy women. Secondary analysis of international published data. PubMed, Web of Science, Scopus, Embase, Cochrane library, and Chinese databases from inception to February 23, 2022 were searched to identify eligible studies. Meta-analysis was conducted to provide meaningful summative outcomes. The quality evaluation of included study was performed. The analyses were done with Review Manager 5.3 and Stata 14.0 software. Totally, 13 eligible articles were included, among which 3 articles investigated the risk factors, 6 articles studied pregnancy outcomes, and 4 articles examined both risk factors and pregnancy outcomes. Chinese older pregnant women with the HDPs had high pooled incidences of abnormal body mass index, maternal education, family history of hypertension, history of chronic hypertension, gestational diabetes, irregular delivery inspection, psychosocial factors, and primiparity compared to those without HDPs. The incidence of cesarean delivery, placental abruption, premature rupture of membranes, postpartum hemorrhage, preterm birth, fetal asphyxia, fetal distress, fetal growth restriction, and low birth weight in Chinese older pregnant women with HPDs were significantly higher than those without HDPs. This study identified several possible risk factors which promoted the onset of HDPs in Chinese older pregnant women, and HDPs significantly increases risk of adverse pregnancy outcomes (APOs). Further research is needed to take targeted measures to prevent HDPs and explore efficient management methods to minimize the risk of APOs associated with HDPs in Chinese older pregnant women.

Preeclampsia among women with COVID-19 during pregnancy and its impact on maternal and perinatal outcomes: Results from a national multicenter study on COVID in Brazil, the REBRACO initiative.

ObjectiveTo evaluate the prevalence of preeclampsia among cases of COVID-19 infection during pregnancy and the association between both conditions, in a multicenter cohort of Brazilian women with respiratory symptoms.Study designAncillary analysis of the Brazilian Network of COVID-19 in Obstetrics (REBRACO) study. We performed a nested case-control analysis selecting all women with COVID-19 and compared outcomes between women with and without PE.Main outcomesMaternal, gestational, and clinical characteristics and perinatal outcomes.MeasuresPrevalence ratio (PR) and its 95%CI for each of the predictors and outcomes.ResultsA total of 203 women were included: 21 (10.3%) in PE group and 182 (89.7%) in non-PE group. Preeclampsia was not different among women with and without COVID-19 (10.3% vs 13.1%, p-value = 0.41), neither complication such as eclampsia and HELLP syndrome. Chronic hypertension (33.4%) (p < 0.01) and obesity (60.0%) (p = 0.03) were the most frequent comorbidities in PE group, and they were significantly more frequent in this group. Women with PE had more cesarean section (RR 5.54 [1.33 – 23.14]) and their neonates were more frequently admitted to neonatal intensive care unit (PR 2.46[1.06 – 5.69]), most likely due to preterm-birth-related complications.ConclusionThe prevalence of PE among women with COVID-19 infection during pregnancy was around 10%; women with COVID-19 and a history of chronic hypertension or obesity are more likely to have preeclampsia. Cesarean section is increased among women with PE and COVID-19, with increased rates of neonatal admission to intensive care units, mostly due to prematurity.

Effect of Parity on Cardiovagal Baroreflex Sensitivity and Blood Pressure Variability in Sequential Pregnancies and Postpartum

BackgroundPregnancy is characterized by significant maternal cardiovascular adaptations, mediated in part though autonomic control mechanisms, that differ by parity (number of prior pregnancies ≥20 weeks). Pregnancy‐related cardiovascular changes are more pronounced in parous women compared with women in their first pregnancy, and sympathetic hyperactivity characteristic of late gestation is exaggerated in subsequent compared with prior pregnancy. The long‐term impact of repeated pregnancy‐related adaptations on maternal cardiovascular function is unknown, but may underlie the association between multiparity and elevated cardiovascular disease risk. The objectives of this study were to assess cardiovagal baroreflex sensitivity (BRS) and beat‐by‐beat blood pressure variability (BPV) across gestation and postpartum in consecutive pregnancies to characterize effects of parity on cardiovascular function in young women. We hypothesized that BRS would be blunted and BPV augmented in subsequent pregnancies and this would persist postpartum.MethodsAll women had singleton term pregnancies without undergoing fertility treatment and were free from history of chronic hypertension, diabetes or hypertensive pregnancy disorder. Longitudinal assessments were conducted in the first (T1, 12±2 wks), second (T2, 22±2) and third trimester (T3, 32±3) and early postpartum (10±2 weeks) in a prospective pregnancy cohort. Seven women were enrolled for two consecutive pregnancies (inter‐pregnancy interval 1.0‐1.5 yrs, body mass index Δ = 0.3 kg/m2, P=0.31). Women with one study pregnancy were grouped by current parity: first pregnancy (Preg1, N=45, 29±4 years of age), second (Preg2, N=57, 30±4 yrs) and third‐fifth (Preg3, N=41, 32±4 yrs). BRS and BPV were measured for 10 minutes by finger plethysmography and electrocardiography. BRS was calculated via the sequence technique (ms/mmHg) and BPV by standard deviation (mmHg).ResultsIn consecutive pregnancies, BRS was lower in the second studied pregnancy compared with the first (T1 median Δ = ‐4.1 ms/mmHg, P=0.03; T2 Δ = ‐3.2, P=0.02; T3 Δ = ‐0.6, P=0.06) and postpartum (Δ = ‐3.7, P=0.06). BPV was higher in the second compared with first pregnancy in early‐mid gestation (systolic, T1 median Δ = 0.4 mmHg, P=0.03; T2 Δ = 1.4, P=0.046; T3 Δ = 1.2, P=0.16) but not postpartum (Δ = 1.0, P=0.16). In the women with one study pregnancy, body mass index in T1 did not differ by parity group (P=0.21). Women in Preg3 had lower BRS compared with women in Preg1 or Preg2 in T1, T2 and postpartum independent of age (parity main effect: F(2, 496)=8.3, P&lt;0.001; time*parity interaction, P=0.56). BPV was higher after Preg3 compared with Preg1 and Preg 2 groups postpartum (x̅=1.1 mmHg, adj P=0.04).ConclusionsAcross sequential pregnancies, BRS is blunted and BPV elevated throughout gestation and postpartum in the latter pregnancy. These findings are further supported by blunted BRS in women during and after the ≥third pregnancy compared with a first or second pregnancy, accompanied by a postpartum elevation in beat‐to‐beat BPV. These data indicate that autonomic regulatory mechanisms may be affected by repeated pregnancy and this persists postpartum.

Magnitude of Preeclampsia and Associated Factors Among Women Attending Delivery Service in Debre Tabor Specialized Hospital.

Preeclampsia is among the leading causes of maternal and perinatal morbidity and mortality, and it continues as a global health concern. Therefore, this study was aimed to assess the magnitude of pre-eclampsia and its determinant factors among women attending delivery services in Debre Tabor Comprehensive Specialized Hospital Northwest Ethiopia. Institutional-based cross-sectional study was conducted among 261 women from January 1- 30, 2021. A systematic sampling technique was applied. Data were collected using a structured and pre-tested questionnaire. The collected data were entered using Epi-data version 4.2 and analyzed by statistical package for social science (SPSS) version 23. A significant association was declared at a p-value of < 0.05 with a 95% Confidence interval. Overall 15,7% of women had preeclampsia. Age at menarche (10-15 years) (AOR=4.79; 95% CI: 2.07-15.27), unwanted pregnancy (AOR:1.29; 95% CI: 1.59-8.44), history of chronic hypertension (AOR:2.93; 95% CI: 1.00-6.20), BMI ≥ 30 Kg/m2 (AOR:1.79; 95% CI: 1.06-3.65), and alcohol consumption (AOR:2.12; 95% CI: 4.00-14.14) were significantly associated with preeclampsia. This study showed that the magnitude of preeclampsia was significantly high compared with previous national reports. Early menarche age, the status of current pregnancies, history of chronic hypertension, BMI, and alcohol consumption were significantly associated with preeclampsia. Therefore, the government and respective stakeholders should be strengthening antenatal care services to early identify and manage women with preeclampsia. Besides, health education and promotion should be strengthened regarding the maintenance of appropriate body weight and alcohol intake before pregnancy.

The evolution of mean arterial pressure in critically ill patients on vasopressors before and during a trial comparing a specific mean arterial pressure target to usual care

BackgroundIn randomized clinical controlled trials, the choice of usual care as the comparator may be associated with better clinician uptake of the study protocol and lead to more generalizable results. However, if care processes evolve to resemble the intervention during the course of a trial, differences between the intervention group and usual care control group may narrow. We evaluated the effect on mean arterial pressure of an unblinded trial comparing a lower mean arterial pressure target to reduce vasopressor exposure, vs. a clinician-selected mean arterial pressure target, in critically ill patients at least 65 years old.MethodsFor this multicenter observational study using data collected both prospectively and retrospectively, patients were recruited from five of the seven trial sites. We compared the mean arterial pressure of patients receiving vasopressors, who met or would have met trial eligibility criteria, from two periods: [1] at least 1 month before the trial started, and [2] during the trial period and randomized to usual care, or not enrolled in the trial.ResultsWe included 200 patients treated before and 229 after trial initiation. There were no differences in age (mean 74.5 vs. 75.2 years; p = 0.28), baseline Acute Physiology and Chronic Health Evaluation II score (median 26 vs. 26; p = 0.47) or history of chronic hypertension (n = 126 [63.0%] vs. n = 153 [66.8%]; p = 0.41). Mean of the mean arterial pressure was similar between the two periods (72.5 vs. 72.4 mmHg; p = 0.76).ConclusionsThe initiation of a trial of a prescribed lower mean arterial pressure target, compared to a usual clinician-selected target, was not associated with a change in mean arterial pressure, reflecting stability in the net effect of usual clinician practices over time. Comparing prior and concurrent control groups may alleviate concerns regarding drift in usual practices over the course of a trial or permit quantification of any change.

Robotic Assisted Laparoscopic Wedge Resection of a Large Cornual Ectopic Pregnancy

<h3>Study Objective</h3> To demonstrate the steps of a wedge resection of a large cornual ectopic pregnancy using a robotic assisted approach. <h3>Design</h3> A guided explanation of the surgery using video. <h3>Setting</h3> The surgery was completed at a university hospital using the Da Vinci Xi Robot. <h3>Patients or Participants</h3> A 38-yo G7P1051 with a history of chronic hypertension who was incidentally found to have a cornual ectopic pregnancy measuring 11 weeks 4 days on her initial prenatal ultrasound. <h3>Interventions</h3> Robotic Assisted Laparoscopic Cornual Wedge Resection. <h3>Measurements and Main Results</h3> On initial prenatal ultrasound, the patient was found to have a cornual ectopic pregnancy on the right. Crown rump length measured 47mm corresponding with a gestational age of 11 weeks and 4 days. She was asymptomatic. She presented immediately to the hospital and underwent an urgent robotic assisted laparoscopic cornual wedge resection that evening. Estimated blood loss was 100cc. She did well postoperatively and went home the same day. <h3>Conclusion</h3> We present a case of a robot assisted wedge resection of a large cornual ectopic pregnancy as an alternative to straight stick laparoscopy or laparotomy. Although robotic assisted cases are known to have longer operating times, as with myomectomy, a robot approach can potentially help to decrease blood loss when managing large cornual ectopic pregnancies.