Hypertensive Complications Of Pregnancy Research Articles

Screening for Hypertensive Pregnancy Complications through Maternal Serum PAPP-A 5th and 10th Percentiles during the 11-14 Weeks Gestational Age Interval

The aim of our study was to assess the predictive values for hypertensive complications of pregnancy of the multiples of median (MoM) of serum pregnancy associated plasma protein A (PAPP-A), measured in 128 pregnant patients between 11 and 14 weeks gestational age. The 5th and the 10th percentile for MoM PAPP-A were 0.27 and 0.33, respectively. The detection rate for pregnancy induced hypertension, mild preeclampsia, severe preeclampsia, all preeclampsia and all hypertensive complications was 0%, 9.09%, 0%, 7.69%, and 6.25% for MoM PAPP-A below the 5th percentile (for a false positive rate of 5%), and 33.33%, 9.09%, 0%, 7.69%, and 12.5% for MoM PAPP-A below the 10th percentile (for a false positive rate of 10%), respectively. The specificity ranged from 89.57% to 95.73%, the positive predictive value from 0% to 16.67%, and the negative predictive value from 87.70% to 98.36%.

Preeclampsia as predisposing factor for hypertensive retinopathy: Participation by the RAAS and angiogenic factors

Preeclampsia (PE) is a hypertensive complication of pregnancy. Its cause is still unknown and it could be a risk factor for future ophthalmic problems. Retinal vascular bed alterations have been described as a consequence of PE, suggesting a retinopathy. Factors related to angiogenesis and vascular permeability, such as vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) or components of the renin angiotensin aldosterone system (RAAS), prorrenin/renin receptor ((P)RR) and angiotensin II type I receptor (AT1R) have been located in the retina, participating in other retinopathies, but it is unknown if they could participate in PE. Our aim was to elucidate whether VEGF, PEDF, (P)RR and AT1R could be modified during PE and during hypertension induced in rats with a history of PE. We used female Wistar rats and subrrenal aortic coarctation to induce PE, and after delivery, we induced a second hit by Nω-nitro-L-arginine methyl ester (L-NAME) administration. We measured blood pressure, proteinuria and pups development. In both models, eye fundal exploration and immunoblot for VEGF, PEDF, (P)RR and AT1R were performed. We found that the development of hypertension occurred faster in previously PE rats than in normal animals. VEGF, PEDF, (P)RR and AT1R were increased in PE, but in L-NAME-induced hypertension only (P)RR and AT1R were altered. Eye fundal data indicated that PE induced a level I retinopathy, but L-NAME induced a faster and more severe retinopathy in previously PE animals compared to previously normal pregnancy rats. These results indicate that PE predisposes to development of a faster and more severe retinopathy after a second hit. They also suggest that VEGF and PEDF seem to participate only in PE retinopathy, but in both models, RAAS components seem to have a more critical participation.

Endothelial dysfunction in context of women’s health disorders from menarche to menopause

Endothelial function is an essential component of providing homeostasis, which allows controlling the state of the vascular bed and ensuring blood supply to organs both under physiological conditions and under the influence of various damaging factors. Endothelial dysfunction is associated with a wide range of pathological conditions and diseases, in the pathogenesis of which the vascular link is involved. Understanding the unifying role of endothelial dysfunction in the pathology of different fields of medicine allows, firstly, to predict the development of serious socially significant diseases, such as cardiovascular diseases, which remain the main cause of death among women. In particular, over the past decade, several cardiovascular risk factors specific to the female population have been identified, such as hypertensive pregnancy complications and menopausal vasomotor symptoms, which, in turn, are caused by endothelial dysfunction. Secondly, timely treatment of endotheliosis suspends or completely prevents both transient disorders associated with endothelial dysfunction and their serious consequences. In this regard, the drug group of glycosaminoglycans and its representative sulodexide are of interest.

Hypertensive Complications of Pregnancy and Risk of Venous Thromboembolism.

Hypertension during pregnancy and preeclampsia are associated with increased arterial thrombotic risk in later life. Whether these complications are associated with risk of venous thromboembolism (VTE) on the short term after pregnancy and on the long term, that is, outside pregnancy, is largely unknown. We conducted a nationwide cohort study in women with at least 1 pregnancy and their first VTE risk by linking the Dutch perinatal registry (Perined) to anticoagulation clinics. We used Cox proportional hazard models to estimate hazard ratios (HRs) and corresponding 95% CI for VTE risk in women with hypertension during pregnancy, women with preeclampsia, compared with women with uncomplicated pregnancies (reference). A total of 1 919 918 women were followed for a median of 13.7 (interquartile range, 7.6–19.2) years for a total of 24 531 118 person-years in which 5759 first VTEs occurred; incidence rate: 2.3 (95% CI, 2.3–2.4) per 10 000 person-years. In the first pregnancy and 3-month postpartum period, VTE risk was higher in women with hypertension, HR, 2.0 (95% CI, 1.7–2.4), and highest among women with preeclampsia, HR, 7.8 (95% CI, 5.4–11.3), versus the reference group. On the long term, women with hypertension during pregnancy and preeclampsia had a higher VTE risk: HR, 1.5 (95% CI, 1.4–1.6) and HR, 2.1 (95% CI, 1.8–2.4), respectively, versus the reference group. When excluding events during pregnancy and postpartum, these HRs were 1.4 (95% CI, 1.3–1.5) and 1.6 (95% CI, 1.4–2.0), respectively. In conclusion, hypertension during pregnancy and preeclampsia are associated with an increased VTE risk during pregnancy and postpartum period and in the 13 years after.

The predictive value of 11-14 week uterine artery Doppler indices for hypertensive pregnancy complications

Introduction. Hypertensive complications of pregnancy can often lead to serious, even life-threatening situations for the mother and fetus. First-trimester uterine artery Doppler can be a predictive tool for such complications. Materials and method. At the Department of Obstetrics and Gynecology of the Arad County Emergency Clinical Hospital, we examined 305 pregnant patients, from 11 weeks to 13 weeks+6 days gestational age, by ultrasound, both as inpatients and outpatients, and we have assessed the evolution of their pregnancy. Results. There were 21 patients with hypertensive pregnancy complications (6.89%) and 284 patients with normal outcome (93.11%). Three patients had pregnancy-induced hypertension (0.98%), and 18 had preeclampsia (PE; 5.9%), with 12 cases of mild PE (3.95%) and six cases of severe PE (1.97%). The sensitivity for uterine artery PI above the 95th percentile, for uterine artery RI above the 95th percentile, and for uterine artery PI/RI above the 95th percentile was 0%, 0-33.33% and 0%, respectively. The specificity was 94.72-95.03%, 94.98-95.42% and 94.98-95.03%, respectively. The positive predictive value was 0%, 0-13.33% and 0%, respectively. The negative predictive value was 92.76-98.97%, 93.45-99.31% and 92.76-98.97%, respectively. Odds ratios were 0.453-3.966, 1.147-10.286 and 0.453-3.966, respectively. Conclusions. Uterine artery Doppler indices above the 95th percentile during the 11-14 week gestational age offers low to medium detection rates, the best index being the resistivity index.

Структурные основы развития гипертензивных осложнений беременности, наступившей в результате донации ооцитов у суррогатных матерей

Структурные основы развития гипертензивных осложнений беременности, наступившей в результате донации ооцитов у суррогатных матерей

Risk prediction of maternal cardiovascular disease one year after hypertensive pregnancy complications or gestational diabetes mellitus.

Previous preeclampsia, gestational hypertension and gestational diabetes mellitus show a firm epidemiological association to maternal cardiovascular disease risk. Cardiovascular disease risk assessment is recommended in women after these pregnancy complications, but not offered in most countries. We therefore wanted to evaluate the applicability of currently recommended cardiovascular disease risk scores for women one-year postpartum of such pregnancy complications. We tested applicability of three scoring systems, the Atherosclerotic Cardiovascular Disease (ASCVD) score, the Joint British Societies for the Prevention of Cardiovascular Disease (JBS3) score and Framingham 30 year Risk Score-Cardiovascular Disease (FRS-CVD) in 235 women one-year postpartum (controls: 94, gestational hypertension: 35, preeclampsia: 81, gestational diabetes mellitus: 25). Statistical analysis was performed with Mann-Whitney U test for continuous and Fisher's mid-corrected p and Pearson's r for dichotomous variables. A value of p < 0.050 was considered significant. Most women (87.7%) were below 40 years of age, rendering 10-year risk estimations recommended by American and European societies inapplicable. FRS-CVD could be assessed in all women. Significantly fewer could be assessed by the ASCVD (81.5%) and JBS3 (91.6%). All scoring systems showed small, but significant increases in risk scores for one or more of the pregnancy complication groups, but none at the risk magnitude for cardiovascular disease shown in epidemiological studies. We demonstrate that ASCVD, JBS3 and FRS-CVD are inadequate in assessing cardiovascular disease risk one-year postpartum. We suggest that pregnancy complications need to be considered separately when evaluating maternal cardiovascular disease risk and need for postpartum follow-up.

Maternal Cardiac Function after Normal Delivery, Preeclampsia, and Eclampsia: A Prospective Study.

Introduction The aim of this study is to assess maternal cardiac function in the postpartum period, after 2 and 6 months in the parturient with preeclampsia and eclampsia. Materials and Methods Prospective study: 90 postpartum women after preeclampsia and eclampsia and 55 patients after an uncomplicated pregnancy. The parameters of maternal hemodynamics were recorded on days 1, 3, 5, 9, and 14 of postpartum period, after 2 and 6 months. The cardiac parameters were assessed. Results PE is accompanied by increased peripheral vascular resistance. The indicator of vascular resistance, SVR, is elevated for both mild and severe PE. With mild PE, a significant increase in SVR is observed up to 5 days of postpartum period, with severe PE/E up to 9 days. We found that in case of severe PE, SVR remains elevated to 6 months after delivery. The parameters of the contractile function of the heart (ESV, EDV, SV, SI, CO, СI, MVCF) were significantly decreased: with mild PE up to 5-9 days, with severe up to 9-14 days of puerperia. ESV, SV, SI, CO, and CI remain low with severe PE up to 6 months. The revealed decreasing of contractile function of the heart is a sign of asymptomatic heart failure. Conclusions The hemodynamics of the puerperas after PE and E is characterized by impaired contractility of the myocardium and an increase in the indices of peripheral resistance. The degree of deviation in the parameters of cardiac hemodynamics and vascular resistance depended on the severity of hypertensive complications of pregnancy.

Defining early vs late fetal growth restriction by placental pathology.

Although early and late fetal growth restriction have been suggested to be distinct entities, the optimal gestational age cut-off that differentiates the two conditions is currently unclear and has been arbitrarily set in previous studies between 32 and 37weeks. We aimed to use placental pathology findings to determine that optimal gestational age cut-off between early and late fetal growth restriction. A retrospective cohort study of all women with singleton gestation who gave birth to a neonate diagnosed as small-for-gestational age (small-for-gestational age, defined as birthweight <10th percentile for gestational age) at a tertiary referral center between January 2001 and December 2015, and for whom placental pathology was available. Placental abnormalities were classified into lesions associated with maternal vascular malperfusion (MVM), fetal vascular malperfusion, placental hemorrhage and chronic villitis. Placental findings were analyzed as a function of gestational age at birth. The analysis was repeated in the subgroups of women without hypertensive complications of pregnancy (to reflect changes associated with isolated small-for-gestational age) and of neonates with severe small-for-gestational age (defined as birthweight <5th percentile), which are more likely to represent true fetal growth restriction. A total of 895 women met the inclusion criteria. The only histological finding that changed with gestational age was MVM pathology, which decreased in frequency with increasing gestational age. We identified a considerable drop in the rate of MVM lesions at 33weeks of gestation. The rate of MVM pathology in placentas of infants born before 330/7 weeks was significantly higher than that observed in placentas of infants born at 330/7 weeks or longer: 71.6% vs 27.4%, P<0.001 for ≥2 MVM lesions, and 35.5% vs 3.5%, P<0.001 for ≥3 MVM lesions. These findings persisted in the subgroups of women without hypertensive complications of pregnancy (n=662) and of neonates with severe small-for-gestational age (n=464). Using placental pathology as a direct measure of the mechanisms underlying fetal growth restriction, the optimal gestational age at birth cut-off which differentiates early from late fetal growth restriction appears to be 330/7 weeks.

Care of Women with Obesity in Pregnancy

Care of Women with Obesity in Pregnancy

Arterial stiffness in normal pregnancy as assessed by digital pulse wave analysis by photoplethysmography - A longitudinal study.

It might in the future be valuable to screen for increased maternal arterial stiffness, i.e. low compliance, since it is associated with development of hypertensive complications in pregnancy. Digital pulse wave analysis (DPA) is an easy and manageable method for arterial stiffness assessment. We aimed to investigate gestational influence on DPA variables longitudinally, and establish gestational age-adjusted reference values in normal pregnancy. DPA measurements were performed longitudinally up to five times during pregnancy in 139 healthy women. Reference curves for DPA variables aging index (AI), b/a and d/a relative to gestational age were calculated with linear and polynomial mixed-effects models, and the influences of age and parity investigated with analysis of variance and analysis of covariance. A p < 0.05 was regarded significant. All DPA variables were significantly associated with GA with best fit for a quadratic model. Arterial compliance peaked in the late second trimester. Age and parity independently influenced DPA variables but did not change the associations with gestational age. DPA reflects longitudinal changes in arterial compliance in normal pregnancy but individual variance of DPA changes were greater than the influence of GA. Normal distributions of AI, b/a and d/a at 14-24 weeks are presented, but it remains to show whether these can be used to detect pathological hemodynamic alterations in pregnancy.

Reflux nephropathy and the risk of preeclampsia and of other adverse pregnancy-related outcomes: a systematic review and meta-analysis of case series and reports in the new millennium.

Reflux nephropathy is a common urinary tract malformation, and a substantial cause of morbidity in women of childbearing age. While recent studies provide further new information on pregnancy-related outcomes, their results are heterogeneous and a systematic meta-analysis may help the interpretation. The aim of this review was to analyze pregnancy-related outcomes in the recent literature on reflux nephropathy (2000-2016), to perfect the estimation of risks, and to identify specific research needs. We searched Medline, EMBASE and the Cochrane review databases for the period 2000-2016 (PROSPERO registration no. 42016042713). all case series and case reports dealing with reflux nephropathy and reporting on at least one pregnancy outcome. Data were extracted from eligible case series (≥ 6 cases). For the outcomes preeclampsia (PE), pregnancy-induced hypertension (PIH), preterm birth, and newborns small for gestational age, we employed as a control group the low-risk pregnancies from a multicenter database including 1418 live-born singletons. Case reports were analyzed narratively. The search retrieved 2507 papers, of which 7 case series and 4 case reports were retained. The series report on 434 women with 879 pregnancies; no study reported controls. Compared to the low-risk controls, the meta-analysis showed an increased risk of PIH (odds ratio, OR 5.55; confidence interval, CI 3.56-8.66), PE (OR 6.04; CI 2.41-15.13), and all hypertensive disorders combined (OR 10.43; CI 6.90-15.75). No difference was observed in preterm delivery and caesarean sections. A higher incidence of stillbirth was reported in one paper. Conversely, the 4 case reports (on 10 pregnancies) alert us to a potentially severe complication, hydro(uretero)nephrosis with or without infection. Reflux nephropathy is associated with an increased risk of PIH and PE, but not of preterm delivery, suggesting the occurrence of late 'maternal' PE. The finding of a higher incidence of stillbirths in one series requires further analysis. Strict follow-up of these women is needed, in particular in late pregnancy stages, to avoid and manage in particular hypertensive pregnancy complications.

Risk of cardiovascular disease, end-stage renal disease, and stroke in postpartum women and their fetuses after a hypertensive pregnancy.

Women with hypertensive pregnancy complications are at greater risk of developing cardiovascular disease (CVD), metabolic diseases, stroke, and end-stage renal disease (ESRD) later in life. Pregnancy complications affect not only the mother's long-term health but also the health of the fetus immediately after delivery and into adulthood. The health of the fetus until adulthood can be influenced by developmental programming, in which the fetus is exposed to insults that will ultimately affect the growth of the offspring and increase the offspring's risk of developing hypertension, coronary heart disease, metabolic disease, and chronic kidney disease in adulthood. Preeclampsia, the onset of hypertension during pregnancy, is one of the major risk factors for the development of renal disease, cerebral disease, and CVD in the mother. Women with preeclampsia are at a 5-12-fold increased risk of developing ESRD, 2-fold increased risk of stroke, and 2-fold increased risk of developing CVD later in life. In this review article, we discuss 1) preeclampsia, 2) the risk of developing CVD, renal disease, or stroke later in life for women with hypertensive pregnancies, and 3) the effects of a hypertensive pregnancy on the offspring.

Impaired function of cerebral parenchymal arterioles in experimental preeclampsia

Preeclampsia (PE), a dangerous hypertensive complication of pregnancy, is associated with widespread maternal vascular dysfunction. However, the effect of PE on the cerebral vasculature that can lead to stroke and cognitive decline is not well understood. We hypothesized that function of cortical parenchymal arterioles (PAs) would be impaired during PE. Using a high cholesterol diet to induce experimental PE in rats (ePE), we studied the function and structure of isolated and pressurized PAs supplying frontoparietal white matter (WM) tracts and cortex and compared to normal pregnant (Preg) and nonpregnant (Nonpreg) Sprague Dawley rats (n = 8/group). Myogenic reactivity and tone were similar between groups; however, constriction to intermediate-conductance calcium-activated potassium (IK) channel inhibition was diminished and dilation to inward-rectifying K+ (KIR) channel activation was impaired in PAs from ePE rats, suggesting altered ion channel function. Conducted vasodilation was significantly delayed in response to 12 mM KCl, but not 10 μM adenosine, in PAs from ePE rats versus Preg and Nonpreg rats (940 ± 300 ms vs. 70 ± 50 ms and 370 ± 90 ms; p < 0.05). Overall, dysfunction of PAs supplying frontoparietal WM and gray matter was present in ePE. If persistent these changes could potentiate neuronal injury that over time could contribute to WM lesions and early-onset cognitive decline.

Hypertensive pregnancy complications in women with epilepsy and antiepileptic drugs: a population-based cohort study of first pregnancies in Norway

ObjectivesTo estimate the risk of hypertensive pregnancy complications in women with epilepsy, with and without antiepileptic drugs, and assess the risk associated with the four most common antiepileptic drugs.DesignA population-based...

Association between periconceptional weight loss and maternal and neonatal outcomes in obese infertile women.

BackgroundObesity in women of reproductive age has deleterious effects on reproductive and offspring health. In this study, we aimed to evaluate the association between the magnitude of periconceptional body-mass index (BMI) change and maternal and neonatal outcomes in obese infertile women who participated in the LIFEstyle study. The LIFEstyle study was a randomized controlled trial, evaluating if a six-month lifestyle intervention program prior to infertility treatment in obese infertile women improved birth rates, compared to prompt infertility treatment.Methods and findingsThis is an exploratory post hoc analysis of the LIFEstyle study. We recorded periconceptional BMI change in women with an ongoing pregnancy, pooling data of all women, regardless of randomization arm. Periconceptional BMI change was calculated using weight at randomization and the periconceptional weight (measured in kilograms 12 weeks before or after conception and expressed as BMI change in units BMI (kg/m2)). Subsequently, women were categorized into quartiles according to the magnitude of their periconceptional change in BMI. The odds of maternal and neonatal outcomes were calculated using logistic regression analysis, comparing women in each of the first three weight change quartiles separately, and combined, to women in the fourth quartile. The fourth quartile was chosen as reference group, since these women had the least weight loss. We adjusted for periconceptional BMI, nulliparity and smoking status. In addition, we performed a subgroup analysis for singleton pregnancies. In the LIFEstyle study, 321 obese infertile women achieved an ongoing pregnancy which was conceived within 24 months after randomization. Periconceptional BMI change was available in 244 of these women (76%). Median BMI at randomization was 35.9 kg/m2. Women in the first quartile (Q1) had a periconceptional BMI change of <-2.1 kg/m2, women in the second quartile (Q2) -2.1 to -0.9 kg/m2, women in the third quartile (Q3) -0.9 to 0.1 kg/m2 and women in the fourth quartile (Q4) gained ≥0.1 kg/m2. There were no significant differences between women in the quartiles regarding rates of excessive gestational weight gain (in term pregnancies), gestational diabetes, preterm birth, induction of labor, spontaneous vaginal birth and Caesarean section. Compared to women in Q4, the adjusted odds ratios, aOR, and 95% confidence interval for a hypertensive complication were; 0.55 (0.22–1.42) for women in Q1, 0.30 (0.12–0.78) for women in Q2, 0.39 (0.16–0.96) for women in Q3 and 0.39 (0.19–0.82) for women in Q1 to Q3 combined. In the subgroup analysis, investigating singleton pregnancies only, the statistically significant decreased rate of a hypertensive complication remained in women in Q2 (aOR 0.27, 95% CI 0.10–0.72) and Q3 (aOR 0.39, 95%CI 0.16–0.98) and when comparing women in Q1 to Q3 together to women in Q4 (aOR 0.38, 95%CI 0.18–0.80). Furthermore, there was a significantly decreased aOR (95%CI) of preterm birth in women in Q2 (0.24, 0.06–0.98) and when combining women in Q1 to Q3 (0.37, 0.14–0.97) compared to women in Q4.ConclusionsThese results suggest that a periconceptional decrease in BMI in obese infertile women could lead to a decrease of the rates of hypertensive pregnancy complications and preterm birth. The results are limited by the exploratory nature of the analyses and further evidence is necessary to provide more definitive conclusions.

Metabolic and Hypertensive Complications of Pregnancy in Women with Nephrolithiasis.

Kidney stones are associated with future development of hypertension, diabetes, and the metabolic syndrome. Our objective was to assess whether stone formation before pregnancy was associated with metabolic and hypertensive complications in pregnancy. We hypothesized that stone formation is a marker of metabolic disease and would be associated with higher risk for maternal complications in pregnancy. We conducted a retrospective cohort study of women who delivered infants at the Massachusetts General Hospital from 2006 to 2015. Women with abdominal imaging (computed tomography or ultrasound) before pregnancy were included in the analysis. Pregnancy outcomes in women with documented kidney stones on imaging (stone formers, n=166) were compared with those of women without stones on imaging (controls, n=1264). Women with preexisting CKD, hypertension, and diabetes were excluded. Gestational diabetes and preeclampsia were more common in stone formers than nonstone formers (18% versus 6%, respectively; P<0.001 and 16% versus 8%, respectively; P=0.002). After multivariable adjustment, previous nephrolithiasis was associated with higher risks of gestational diabetes (adjusted odds ratio, 3.1; 95% confidence interval, 1.8 to 5.3) and preeclampsia (adjusted odds ratio, 2.2; 95% confidence interval, 1.3 to 3.6). Infants of stone formers were born earlier (38.7±2.0 versus 39.2±1.7 weeks, respectively; P=0.01); however, rates of small for gestational age offspring and neonatal intensive care admission were similar between groups (8% versus 7%, respectively; P=0.33 and 10% versus 6%, respectively; P=0.08). First trimester body mass index significantly influenced the association between stone disease and hypertensive complications of pregnancy: in a multivariable linear regression model, stone formation acted as an effect modifier of the relationship between maximum systolic BP in the third trimester and body mass index (P interaction <0.001). In women without preexisting diabetes, hypertension, and CKD, a history of nephrolithiasis was associated with gestational diabetes and hypertensive disorders of pregnancy, especially in women with high first trimester body mass index.

Prevalence and determinants of preterm delivery in an inner city referral hospital, Greater Accra Region, Ghana-2016

Introduction : globally, preterm delivery contributes about 30% to 40% of neonatal mortality and 20% to 30% of infant and under-five mortality. The world’s preterm birth rate has been on the rise since the last two decades; with an increase of 20% since 1990 in high-income countries. Accurate data on prevalence and determinants of preterm delivery from low-income countries are not readily available. We assessed prevalence and determinants of preterm delivery in an inner city referral hospital in Ghana. Methods : a descriptive study followed by 12 unmatched case-control study was conducted from October 2015 to May 2016. A case of preterm was a baby in the hospital delivered during the study period at a gestational age between 28 and 36 weeks and a control was a baby delivered after 37 completed weeks of gestation. We interviewed mothers of cases and controls and reviewed maternal and fetal health records. Univariable analysis of categorical variables was expressed as frequencies and relative frequencies. At 95% confidence level, bivariable analysis and multiple logistic regression were done to determine associations between selected independent variables and preterm delivery. Results : of 5,215 deliveries, 796(15.3%) were preterm with 361(45.4%) of preterm babies being males. Mean gestational age was 32(+/-2.4) weeks. Determinants of preterm delivery were hypertensive complications in pregnancy [Odds ratio (OR)= 2.1, 95%CI 1.1-4.5], antepartum hemorrhage in index pregnancy (OR = 2.1, 95%CI 1.1-4.5), premature rupture of membranes (OR = 1.7, 95%CI 1.1-2.6) and Caesarean section delivery (OR = 1.4, 95%CI 1.2-4.6). Compared to controls, preterm babies were less likely to be delivered by mothers who had more than four antenatal clinics (ANC) attendance (OR = 0.2, 95%CI 0.0-0.1) and those with partner support (OR = 0.4, 95%CI 0.2-0.9) Conclusion : the proportion of preterm delivery was high, more likely in complicated pregnancies and less likely in ANC attendees and women with partner support. We educated mothers on need for ANC attendance and partner support.

Роль митохондриальных молекул, ассоциированных с повреждением, в манифестации гипертензивных осложнений беременности

Роль митохондриальных молекул, ассоциированных с повреждением, в манифестации гипертензивных осложнений беременности

Hypertensive complications of pregnancy: A clinical overview

Hypertensive disorders in pregnancy are a worldwide health problem for women and their infants complicating up to 10% of pregnancies and associated with increased maternal and neonatal morbidity and mortality. In Europe, 2.3–3% of pregnancies are complicated by preeclampsia. Gestational diabetes, obesity, no previous or multiple births, maternal age less than 20 or greater than 35years old and thrombophilia can be some of the possible factors related to increased risk for hypertension in pregnancy. Complications of hypertension during pregnancy affect both mothers and their infants. Ambulatory blood pressure monitoring helps to distinguish true hypertension from the white coat as pregnant women with office abnormal values may have normal out of office blood pressure. Imbalance between proangiogenic and antiangiogenic factors in placenta may lead to endothelial dysfunction, vasoconstriction, activation of the coagulation system, and hemolysis. Carotid intima-media thickness, pulse wave velocity, augmentation index, and arterial wall tension were found to be significantly increased in women with preeclampsia compared to normotensive pregnant women. Uterine artery Doppler and serum biomarkers can be used to evaluate the probability of hypertension and complications during pregnancy, but further research in the field is needed. Lately, micro ribonucleic acids have also been the focus of research as potential biomarkers.