Hypertensive Pregnant Patients Research Articles

Use of antihypertensive medications at discharge and in the immediate postpartum period: observations from a cohort of hypertensive pregnant patients at a Canadian tertiary centre

Use of antihypertensive medications at discharge and in the immediate postpartum period: observations from a cohort of hypertensive pregnant patients at a Canadian tertiary centre

Patient counselling mediated by clinical pharmacists on hypertensive patients

Hypertension has become a significant problem in developing countries which is associated with aging of the population, urbanization, socio economic changes favouring sedentary habits, obesity, alcohol consumption, and salt intake etc. The management of hypertension involves long term treatment & life style modification which will have greater impact on HRQoL. This study aims to give patient counselling regarding risk factors, life style modifications, pharmacological therapy & medication adherence in hypertension which in turn improves HRQoL. Methodology: Prospective interventional study. The study was conducted in Jayabharath Hospital, located in Nellore district which was conducted for a period of 6 months. Hypertensive patients, of either sex, above 18 years of age, with or without co-morbidities and Patient willing to give there informed consent to participate in the study are included in our study and the Pregnant hypertensive patients are excluded from the study Results and Discussion: At baseline there was no significance difference between the blood pressures, QoL score, adherence score, and KAP of the test and control groups. As patient in both group continued to see their physician regularly, both showed in improvement in blood pressure control at final follow up. However improvement in the test group blood pressure was more significant reduction (p<0.05).

Clinical and Educational Aspects of Neuroimaging in Microsurgery of the Posterior Fossa: A Comprehensive Review.

The clinical and educational value of modern high-resolution magnetic resonance imaging (MRI) and image processing in neurovascular diseases of the posterior fossa with regard to preoperative planning and intraoperative comparison with the actual anatomical situation was consecutively evaluated. Patients with trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GN) and arterial hypertension (HTN) were analyzed. The high-resolution MRI data was segmented and visualized three-dimensionally using computer graphics methods. New anatomical insights were gained, such as the classification of neurovascular compression (NVC) in HFS and GN. It was also possible to visualize the pathognomonic cerebrospinal fluid signal in patients with TN for the first time. Using the new imaging methods, pregnant hypertensive patients were examined and the existence of NVC was confirmed for the first time, and the findings were compared to other studies dealing with NVC syndromes. This review gives an overview on the established methods of neuroimaging and image processing of neurovascular structures in the posterior fossa with the focus on clinical and educational aspects.

NIGHTTIME ARTERIAL PRESSURE PHENOTYPES AND THEIR PROGNOSTIC VALUE IN PREGNANT WOMEN AS PREDICTORS FOR FUTURE MATERNAL AND NEONATAL EVENTS

Objective: We have previously demonstrated that some ambulatory blood pressure monitoring (ABPM) values can predict maternofoetal evens in hypertensive pregnant women. The analysis of the different nighttime blood pressure (BP) phenotypes in pregnant women is still an unknown topic. Design and method: A retrospective cohort study which followed a sequential number of 274 hypertensive pregnant patients (mean age of 32 years) from 2007 to 2022, who underwent ABPM made with a Spacelabs 90207. Data was collected and analysed in SPSS Statistics through different parametric tests. Nocturnal BP phenotypes were defined for both systolic and diastolic values as: reverse dipper (RD); non-dipper (ND); dipper (DP); and extreme dipper (ED). An event was defined as the composite endpoint of multiple adverse events: preeclampsia or eclampsia, foetal or neonatal death, prematurity, low weight at birth, gestational diabetes, and maternal death. Results: A Kaplan-Meier survival curve analysis was performed between systolic DP and ND groups, with ND showing a worse survival with a long rank of 11.331 (p<0.001); and for diastolic DP and ND groups, again with ND showing a worse survival with a long rank of 15.335 (p<0.001). In a further systolic nocturnal phenotypes Kaplan-Meier analysis, RS (n=6) showed the worse survival, followed by ND (n=87), while DP (n=162) and ED (n=19) showed better survival, with a log rank of 8.4 (p=0.038). For the diastolic nocturnal phenotypes Kaplan-Meier analysis, ND (n=33) showed the worse survival, followed by DP (157), while ED (81) showed better survival, with a log rank of 21.3 (p<0.001). Diastolic RD showed no events, likely due to the small sample size (n=3). (Fig 1) Conclusions: This study further exemplifies the importance of ABPM in the evaluation of hypertensive pregnant women, both for its major role in diagnosis as well as prognostic value. Different nocturnal phenotypes show different survival rates, and patients without systolic or diastolic dipping seem to be at a major risk.

A comparative analysis of antihypertensive drugs for hypertension and gestational hypertension among women in tertiary care hospitals in Lahore, Pakistan

Hypertension, characterized by persistently elevated blood pressure, poses severe risks, such as heart damage, artery hardening, and reduced blood and oxygen flow to the heart, which can also lead to kidney damage and stroke. Antihypertensive therapy for pregnant women differs from that for nonpregnant women because most antihypertensive medications used for nonpregnant hypertensive women are contraindicated for pregnant hypertensive patients. This study aimed to compare therapeutic regimens for treating hypertension between pregnant and nonpregnant women in various healthcare facilities. This cross-sectional study was conducted at several tertiary care hospitals in Lahore, Pakistan, recruiting 500 pregnant or nonpregnant female patients aged 18-55 years with hypertension. The data were collected through structured interviews and medical records reviews. Descriptive statistics and chi-square tests were used to analyze the data, with significance set at p < 0.05. A significant difference in area of residence was observed, with 83.2% of nonpregnant women residing in urban areas compared to 52.4% of pregnant women residing in urban areas. A systolic blood pressure between 120 and 139 mmHg was observed in 82.8% of pregnant women, compared to 51.2% of nonpregnant women (p < 0.001). Diastolic blood pressure between 80-99 mmHg was observed in 84.4% of pregnant women and 76.8% of nonpregnant women (p < 0.001). CVDs were more prevalent among nonpregnant women (38.8%), while anemia was more common in pregnant women (25.6%). Pregnant women were primarily prescribed methyldopa (58%), labetalol (56%), and amlodipine (40.4%), whereas nonpregnant women were more frequently prescribed valsartan (39.2%), metoprolol (28.8%), nebivolol (28%), and a combination of furosemide and spironolactone (24%). This study highlighted significant differences in comorbid conditions and antihypertensive treatment regimens between pregnant and nonpregnant women, emphasizing the need for tailored hypertension management approaches. Moreover, safer antihypertensive agents were prescribed to both groups, considering the Food and Drug Administration (FDA) drug categories and the observed comorbid conditions.

Prevalence of Hypertensive Disorders, Antihypertensive Therapy and Pregnancy Outcomes among Pregnant Women: A Retrospective Review of Cases at Tamale Teaching Hospital, Ghana.

Hypertensive disorders associated with pregnancy are a major health concern and a leading cause of maternal indisposition and transience. The main objective of this study was to assess the prevalence of hypertension in pregnancy as well as antihypertensive therapy and pregnancy outcomes among pregnant women at Tamale Teaching Hospital (TTH) in Ghana. This was a retrospective study conducted using data from the folders of pregnant hypertensive patients. The study was conducted at the maternity ward of TTH from 1 June 2018 to 31 May 2019. Participants were all pregnant women with a diagnosis of hypertensive disorders. The prevalence of hypertensive disorders in pregnancy was 12.5%. The most common antihypertensive medication prescribed was sustained-release oral nifedipine, which was prescribed for 548 (81.4%) participants either alone or with methyldopa, followed by oral methyldopa: 506 (75.2%), intravenous hydralazine: 94 (14.0%), intravenous labetalol: 28 (4.2%) and diuretics: 10 (1.5%). Thirty-eight (5.7%) babies died before delivery, whereas 635 (94.3%) babies were born alive. Twenty-six out of the 38 dead babies (68.4%) were babies of pregnant women with elevated BP, whereas 12 (31.6%) were babies of those with normal BP. There was a statistically significant association between BP control and delivery outcomes. The study observed adherence to antihypertensive medicines recommended by the standard treatment guidelines of Ghana for the management of hypertensive disorders in pregnancy. The BPs of about two-thirds of the study participants were well controlled with the antihypertensive therapy. The majority of the study participants with well-controlled BP had positive delivery outcomes.

Effects of genetic polymorphisms of CYP2J2, CYP2C9, CYP2C19, CYP4F2, CYP4F3 and CYP4A11 enzymes in preeclampsia and gestational hypertension

IntroductionThe aim of this study was to investigate the effects of cytochrome P450 (CYP) 2J2, CYP2C9, CYP2C19 and CYP4F2, CYP4F3 and CYP4A11 genetic polymorphisms in preeclampsia and gestational hypertension (GHT) patients in a sample of Turkish population. Materials-methodsPatients (n = 168; 110 GHT and 58 preeclampsia) and healthy pregnant women (n = 155, controls) participated in the study. For genotyping, polymerase chain reaction (PCR) and restriction analysis (RFLP) were used. Substance levels were measured using LC-MS. ResultsPlasma DHET levels in GHT and preeclampsia patients were significantly lower than those in the control group (62.7%, 66.3% vs.100.0%, respectively, p < 0.0001). An increase in CYP2J2*7 allele frequency was observed in the preeclampsia group, as compared to GHT group (12.1% vs. 4.5%; odds ratio, O.R. = 2.88, p < 0.01). The frequencies of CYP2C19*2 and*17 alleles were higher in GHT group as compared to the control group (17.7% vs. 11.6%, O.R. = 1.99, p < 0.01; and 28.6% vs.18.4%, O.R. = 2.03, p < 0.01, respectively). An increased frequency of CYP4F3 rs3794987 G allele was found in GHT group as compared to the control group (48.0% vs. 38.0%; O.R. = 1.53, p < 0.01). DiscussionDHET plasma levels were significantly reduced in hypertensive pregnant groups as compared to the control group. The allele frequency distributions for CYP2J2*7, CYP2C19 *2, *17 and CYP4F3 rs3794987 were significantly different in hypertensive pregnant patients as compared to the healthy control subjects. Our results may suggest that investigated genetic polymorphisms may be useful in diagnosis and clinical management of GHT and preeclampsia patients.

Hypertension: what's new in 2022

Our article summarizing the most important studies of the past year emphasizes the difficulty of controlling blood pressure (BP) in hypertensive patients. In addition, it discusses factors such as temperature and sodium that may influence BP, proposes new targets in pregnant hypertensive patients, and challenges the usefulness of taking an antihypertensive drug nightly. Finally, a strategy targeting endothelin blockade in resistant hypertension is presented.

Role of CA-125 Level as a Marker in the Management of Severe Pre-Eclampsia.

Hypertensive disorders of pregnancy remain one of the leading causes of morbidity and mortality in maternal-fetal medicine worldwide, particularly in low-resource settings. Despite extensive research in the last decades, pre-eclampsia prediction and, thus, effective prevention remains an unsolved problem. Current evidence suggests that CA-125, an already recognised tumoral marker and, lately, a valuable severity marker of heart failure, can be used to evaluate pre-eclampsia severity and thus improve the identification and management of high-risk patients; Materials and Methods: This is a case-control study involving 100 pregnant patients over 25 weeks of gestation, grouped based on the severity of hypertension in gestational hypertension (n = 22), non-severe pre-eclampsia (n = 11), severe pre-eclampsia (n = 17), and a control group (normotensive) (n = 50). Clinical and biochemical parameters recommended by the international guidelines for evaluating hypertensive pregnant patients were gathered from every patient in addition to CA-125 levels. The correlation was analysed. Mean CA-125 levels increased with the severity of hypertension from a mean of 8.97 U/mL (±2.84) in the normotensive group to a mean of 21.23 U/mL (±11.18) in the severe pre-eclampsia group. Significant differences were observed between each group. The correlation of CA-125 levels with the assessed clinical and biochemical parameters showed positive correlations with MAP, 24 h proteinuria, and LDH values and negative correlations with platelet count, gestational age at birth, and birth weight Conclusions: The reported results support this marker's promising role as a severity marker and its potential to improve pre-eclampsia management allowing a better selection of high-risk patients, aiding in decision making related to hospitalisation and/or timing of birth. Further studies are needed to improve the accuracy of the obtained results, identify an accurate cut-off and an optimal time of measurement, and achieve standardisation in measuring the marker.

Immersive, cross-departmental simulation – mapping emergency obstetric care from admission to delivery

‘Translational’ simulation activities are effective at improving patient safety when directed towards a specific patient journey [1]. North Bristol NHS Trust cares for around 6,000 obstetric patients per annum, with around 1,000 infants delivered by unplanned caesarean section each year. The in-situ simulation presented here facilitated an in-depth exploration of our cross-departmental response to a hypertensive pregnant patient presenting to the Emergency Department (ED). Severe pre-eclampsia in a preterm patient is a complex clinical scenario which, akin to previous successes seen with trauma care, may benefit from simulation focused on teamwork behaviours. The potential for benefit was optimised by application of the ASPiH Standards for Simulation-Based Education [2]. The aim of the simulation was to prospectively identify latent safety threats to emergency obstetric care in patients presenting to the Emergency Department at Southmead Hospital. An in-situ simulation was conducted to simulate a pre-term woman presenting with pre-eclampsia and reduced conscious level. The high-fidelity scenario involved collaboration from 28 staff in emergency medicine, radiology, obstetrics, neonatal medicine, anaesthetics, and theatres as the patient journey evolved, ending in emergency caesarean section in the non-obstetric emergency theatre complex. Members of the expert panel acted as passive observers to record an accurate log of events during the scenario. A formal debriefing was conducted at the conclusion of the simulation where participants were invited to discuss potential hazards arising from the scenario. Failure modes and effects analysis was employed to assess the identified latent risks [3]. Ten latent safety threats were identified from the simulation. These were stratified according to severity and action plans were agreed to address them. Cross-departmental changes are being instigated and tested. These include amendments to emergency grab-bags, implementation of site-wide tools for location mapping in clinical emergencies, wider availability of the obstetric WHO checklist in emergency theatres, and clarification on the availability of blood for neonatal transfusion in non-obstetric theatres. This immersive scenario engaged clinical teams from a number of specialities and clinical areas across the hospital. Reflecting a real-life patient journey allowed for a rich and nuanced understanding of the response to an evolving emergency scenario. Cross-departmental collaboration in simulation-based training can be effective in assessing latent safety threats, particularly where staff operate in unfamiliar environments. Through carefully conducted debriefing, task allocation and follow-up, it is possible to diagnose and treat a broad range of latent threats to workflow, systems and processes. 1. Brazil V. Translational simulation: not ‘where?’ but ‘why?’ A functional view of in-situ simulation. Advances in Simulation. 2017; 2(1):1–5. 2. Association for Simulated Practice in Healthcare. Simulation-based education in healthcare: standards framework and guidance (2016). 3. Davis S, Riley W, Gurses AP, Miller K, Hansen H. Failure Modes and Effects Analysis Based on In-Situ Simulations: A Methodology to Improve Understanding of Risks and Failures. In: Henriksen K, Battles JB, Keyes MA, Grady ML (Eds). Advances in Patient safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville(MD): Agency for Healthcare Research and Quality (US); 2008.

Body composition in term neonates of mothers with hypertensive disorders of pregnancy.

Neonates of gravidas with hypertensive disorders of pregnancy (HDP) are at increased lifelong risk of cardiometabolic complications. Neonatal adiposity measured by body composition (BC) is a better surrogate of nutritional status than birth weight. Data comparing BC in term neonates of hypertensive and normotensive pregnant patients is lacking. Our objective was to compare body composition in both groups of neonates. This was a retrospective cohort study from March 2018 to June 2019 at our tertiary institution where term neonatal BC are routinely measured. Neonates of patients with HDP and matched controls were included. Skin fold thickness (SFT) and percent body fat (PBF) were calculated using a validated anthropometric formula and compared using Mann-Whitney U and chi-square tests. One hundred and forty-two neonates of patients with HDP were compared to 150 controls. Demographic characteristics were similar except for higher pre-pregnancy BMI (29.7 ± 8.4 vs 26.75 ± 7.1, p = <0.01) in the HDP group. SFT was not significantly different (4.6 vs 4.4 mm, p = 0.09) but PBF was higher in the hypertensive group (13.15 vs 11.72, p = 0.01). PBF is higher in neonates of mothers with HDP, which may contribute to an increased risk of cardiometabolic complications later in life. Birth weight percentiles do not explain the predisposition to cardiovascular complications in offspring of hypertensive mothers. Body composition estimation may provide an explanation for this increased risk. Percent body fat is higher in term neonates of mothers with hypertensive disorders of pregnancy than neonates of normotensive mothers. Body composition is different in term neonates of mothers with hypertensive disorders of pregnancy.

Optimal blood pressure target to prevent severe hypertension in pregnancy: A systematic review and meta-analysis.

Severe hypertension in pregnancy is a hypertensive crisis that requires urgent and intensive care due to its high maternal and fetal mortality. However, there is still a conflict of opinion on the recommendations of antihypertensive therapy. This study aimed to identify the optimal blood pressure (BP) levels to prevent severe hypertension in pregnant women with nonsevere hypertension. Ovid MEDLINE and the Cochrane Library were searched, and only randomized controlled trials (RCTs) were included if they compared the effects of antihypertensive drugs and placebo/no treatment or more intensive and less intensive BP-lowering treatments in nonsevere hypertensive pregnant patients. A random effects model meta-analysis was performed to estimate the pooled risk ratio (RR) for the outcomes. Forty RCTs with 6355 patients were included in the study. BP-lowering treatment significantly prevented severe hypertension (RR, 0.46; 95% CI, 0.37-0.56), preeclampsia (RR, 0.82; 95% CI, 0.69-0.98), severe preeclampsia (RR, 0.38; 95% CI, 0.17-0.84), placental abruption (RR, 0.52; 95% CI, 0.32-0.86), and preterm birth (< 37 weeks; RR, 0.81; 95% CI, 0.71-0.93), while the risk of small for gestational age infants was increased (RR, 1.25; 95% CI, 1.02-1.54). An achieved systolic blood pressure (SBP) of < 130 mmHg reduced the risk of severe hypertension to nearly one-third compared with an SBP of ≥ 140 mmHg, with a significant interaction of the BP levels achieved with BP-lowering therapy. There was no significant interaction between the subtypes of hypertensive disorders of pregnancy and BP-lowering treatment, except for placental abruption. BP-lowering treatment aimed at an SBP < 130 mmHg and accompanied by the careful monitoring of fetal growth might be recommended to prevent severe hypertension.

Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Qazi Hussain Ahmed Medical Complex, Nowshera

Objectives: To determine the prevalence, risk factors with maternal and fetal outcomes of hypertension in pregnancy. Type of Study: Retrospective cross-sectional study. Place of Study: Gynae A ward,Qazi Hussain Ahmed Medical Complex, Nowshera. Duration of Study: 1 year from 1st Jan,2019 to 31st Dec, 2019. Methodology: 552 patients who had hypertensive disorders in pregnancy were recruited. Self- administered and structured questionnaire was used for data collection. The risk factors in patients and the fetomaternal outcomes were manually extracted from the history sheets and evaluated. SPSS version 22.0 was used for data analysis. Results: The prevalence of hypertensive disorders in pregnancy was 13.9% in this study. Pregnancy induced hypertension was the most frequent hypertensive disorder with a prevalence of 57.97%. 61% of the total hypertensive patients had no antenatal booking making it the most common risk factors in pregnant hypertensive patients.38% of patients had high blood pressure in previous pregnancies as well. 56.5% of patients admitted had normal vaginal delivery,4.5% of patients had instrumental deliveryand 39% had lower segment caesarean section. 17.75% of the total patientsdeveloped maternal complications and among them the most frequent maternal complication was post-partum hemorrhage (7.4%).49.3% newborns developed neonatal complications where the most common neonatal complication was preterm deliveries (21.9%). Conclusion: The prevalence of hypertensive disorders was relatively high in our cohort. However, to reduce the feto-maternal morbidities and mortalities, awareness regarding hypertensive disorders should be increased at the community and hospital level and screening of this disorder should be proposed at early gestation. Keywords: Hypertension, Pregnancy induced hypertension, Pre-eclampsia, Eclampsia, maternal complications, fetal complications.

Significance of Protein: Creatinine value in PIH

Objectives: To evaluate the significance of the urine protein to creatinine value in hypertensive pregnant patients. Design: This is a single group comparison study of a single group of 240 subjects. Setting: This study was conducted in the Department of OBG, JIPMER, Pondicherry, a tertiary care hospital south India, from April 2010 to march 2013. Materials and Methods: Morning urine sample was sent for urine protein and creatinine value. Rest of the 24 hour urine collected and tested for 24-hour urine protein value. Main Outcome Measures: The spot urine protein to creatinine value significantly correlates with 24-hour urine protein value. (r=0.98; P Results: The urine protein to creatinine value for significant proteinuria was 0.285. Conclusion: The urine protein to creatinine value can be used as an alternative to 24 hour urine protein for clinical purposes. Keywords: Protein to creatinine value, Hypertension in pregnancy.

EFFECT OF CLINICAL PHARMACIST MEDIATED COUNSELLING IN HYPERTENSIVE PATIENTS ON HEALTH RELATED QUALITY OF LIFE

Background: Hypertension has become a significant problem in developing countries. The management of hypertension involves long term treatment &amp; life style modification which will have greater impact on HRQoL. This study aims to give patient counseling regarding risk factors, life style modifications, pharmacological therapy &amp; medication adherence in hypertension which in turn improves HRQoL.&#x0D; Aim and objectives: To assess the effect of clinical pharmacist mediated counselling in hypertensive patients on health related quality of life. Specific objectives: To assess the disease related knowledge of hypertensive patients, To assess the medication adherence of hypertensive patients,To design suitable patient information leaflet (PIL) on hypertension and its management use the same to educate the patients,To assess the effect of education on outcome of treatment (blood pressure level) and quality of life of these patients.&#x0D; Methodology: Prospective observational study. The study was conducted in Jayabharath hospital, Nellore. which was conducted for a period of 6 months from June 2019- November-2019.Hypertensive patients, of either sex, above 18 years of age, with or without co-morbidities and Patient willing to give there informed consent to participate in the study are included in our study and the Pregnant hypertensive patients are excluded from the study.&#x0D; Results and Discussion: At baseline there was no significant difference between the blood pressures, QoL score, adherence score, and KAP of the test and control groups. As patient in both group continued to see there physician regularly, both showed in improvement in blood pressure control at final follow up. However improvement in the test group blood pressure was more significant reduction (p&lt;0.05). At final follow up, a significantly (p&lt;0.05) some large number of patients in the test group had achieved better blood pressure control compared to the base line.

Síndrome HELLP: características clínicas, analíticas y evolutivas observadas en dos años de experiencia

IntroductionHELLP syndrome (H: hemolysis, EL: elevated liver enzymes and LP: low platelets) is a form of severe preeclampsia (PE). The syndrome can be: complete or incomplete (with three analytical criteria, or only one or two); Class i, ii or iii (according platelets < 50,000; 50,000-100,000 or > 100,000/mm3); postpartum or antepartum; with early or late installation (before or after the 34nd week of gestation). We describe and analyze characteristics and evolution observed in hypertensive pregnant patients who developed HELLP. Material and methodsRetrospective cohort with observation period of two years. It included pregnant hypertensive women who developed HELLP, during the course of their hospitalization in the maternity hospital of our tertiary care hospital. ResultsIt included 318 hypertensive pregnant women. We observed 28 HELLP. Maternal age was 25.8 ±7.2 years and gestational age at diagnosis 31 ± 1 week. Hypertension was chronic in 4 and gestational in 24; eight had presented PE in the previous pregnancy. There were 10 complete and 18 incomplete syndromes; according to platelet disease there were 3 Class i, 16 Class ii and 9 Class iii. HELLP was postpartum in 3 and antepartum in 25: 18 early and 7 late. There were 17 patients who required intensive care and 10 developed complications linked to HELLP. No maternal deaths were recorded. ConclusionPresentation was variable, exhibiting mostly in gestational hypertension, antepartum and early. Incomplete form and class II thrombocytopenia were more frequent. Maternal complications were frequent but no deaths were observed.

Effect of comprehensive nursing on pregnancy outcome and quality of life of pregnant hypertension patients

Objective To study and analyze the effect of comprehensive nursing on pregnancy outcome and quality of life in pregnant hypertensive patients. Methods A total of 90 cases of patients with gestational hypertension admitted to this hospital from January 2016 to December 2017 were selected as study objects. All patients were randomly divided into study group and control group. Comprehensive nursing and routine nursing were adopted respectively.The incidence of eclampsia, delivery mode, postpartum convulsion, postpartum hemorrhage and postpartum anemia were analyzed.Anxiety, depression and quality of life before and after nursing were analyzed. Results The incidence of eclampsia, preterm delivery, cesarean section, postpartum convulsion, postpartum convulsion, postpartum hemorrhage and postpartum anemia in the study group was lower than that in the routine care group. After nursing, SAS and SDS scores of patients in the study group and control group were significantly lower than those before nursing, and SAS and SDS scores of patients in the study group were significantly lower than those in the control group. The scores of psychological field, physiological field, environmental field and social relation field in the study group were significantly higher than those in the control group. Conclusions Comprehensive nursing can improve the pregnancy outcome and quality of life of patients with hypertension during pregnancy. Key words: Pregnancy-induced hypertension; Comprehensive nursing; Pregnancy outcome; Quality of life

COMPARISON OF BLOOD PRESSURE VALUES IN PREGNANT HYPERTENSIVES AND NORMOTENSIVE CONTROLS WITH NORMAL PREGNANCY USING SERIAL AMBULATORY BLOOD PRESSURE MONITORING

Objective: Although ambulatory blood pressure monitoring (ABPM) is recommended in pregnant patients with hypertension, few data are available on ABPM values and targets in pregnant hypertensives and in normal normotensive pregnancies. The aim of the study was to evaluate blood pressure (BP) values in normotensive and treated hypertensive pregnant patients using serial ABPM throughout the pregnancy. Design and method: We studied 79 patients with hypertension during pregnancy and 60 healthy pregnant women. In both groups, ABPM was performed at 5, 10, 15, 20, 25, 30, 33, 35, and 37 weeks of gestation. In pregnant hypertensives, drug treatment was initiated of intensified when the mean ambulatory BP was >130/80 mmHg and/or maximum office BP was >160/100 mmHg. Most patients were treated with methyldopa (500–2000 mg/d) and/or labetalol (100–600 mg/d). Healthy pregnant women did not receive any medications except for folic acid. BP values are reported as mean 24-hour ambulatory values in a given group at specific weeks of measurement listed above. Results: The mean ambulatory BP throughout the pregnancy was 122.7–129.0/76.8–79.9 mmHg in pregnant hypertensives and 101.8–115.8/63.4–71.9 mmHg in healthy pregnant women. In pregnant hypertensives, there were 78 singleton pregnancies and one multiple pregnancy. All children were born alive (33 by vaginal delivery, 46 by cesarean section) and were well during further follow-up. The mean gestational age at birth was 38.0 ± 2.1 weeks (range 29–40 weeks), and birth weight was 3242 ± 546 g (range 955–4200 g). No preeclampsia or eclampsia was observed. In healthy pregnant women, there were 60 singleton pregnancies. All children were born alive (23 by vaginal delivery, 37 by cesarean section). The mean gestational age at birth was 38.9 ± 1.9 weeks, and birth weight was 3346 ± 126 g. No complications of pregnancy were observed. Conclusions: In hypertensive women, ambulatory BP was well controlled throughout the pregnancy. No adverse pregnancy outcomes were observed. Ambulatory BP was lower in healthy pregnant women, while gestational age at birth, birth weight, and the proportion of cesarean deliveries were similar in both groups.

Utilidad del índice neutrófilo/linfocito y del índice polimorfonuclear/monomorfonuclear, en la predicción de preeclampsia

IntroductionThe appearance of preeclampsia (PE) would comprise the alteration of endothelial function and activation of the inflammatory response, leading to placental hypoperfusion. The neutrophil/lymphocyte ratio (NLR) and the polymorphonuclear/monomorphonuclear ratio (PMR) could measure the underlying inflammatory component and predict the onset of the disorder. Material and methodsObservational, analytical, case and control study. We retrospectively analysed medical records of pregnant women, hospitalized for hypertension registers. The patients were divided into Group1=with PE development, and Group2=without PE development. Results110 patients were included: Group1=58.2% and Group2=41.8%, observing differences between the NLR means (P=.01) and PMR means (P=.02). An NLR ≥4.5 (P=.002; OR=3.9; 95%CI=1.6-9.5) and a PMR ≥3 (P=.004; OR=3.5; 95%CI=1.4-8.4) was related with PE. ConclusionThe elevation of NLR and PMR in hypertensive pregnant patients, could be considered indicators for the development of PE.

Urine protein-to-creatinine ratio: a point of care for the diagnosis of preeclampsia.

The aim of this study was to determine the correlation between the urine protein-creatinine ratio (UPCR) and the 24-hour urine protein excretion test (UPET), and to identify the optimal threshold values of UPCR for the diagnosis of preeclampsia and its severe form. This prospective cohort study included 81 hypertensive pregnant patients who had a 24-h UPET and a UPCR tests. Two groups were created using a UPCR cut-off of 23.2 mg/mmol (40 negative UPCR, 41 positive UPCR). Forty-nine patients of were diagnosed with preeclampsia, and 23 of them had a severe disease. There was a significant correlation between UPCR and 24-h UPET. A cut-off UPCR value of 23.2 mg/mmol had an area under the curve (AUC) of 0.27, sensitivity of 89%, specificity 88%, positive predictive value 90%, a positive likelihood ratio (+LR) of 7.41 and a negative likelihood ratio (-LR) of 0.13 for the diagnosis of preeclampsia. UPCR value of 325 mg/mmol had an AUC of 0.841, and a sensitivity of 83%, specificity 81%, positive predictive value 81%, +LR of 4.4 and -LR of 0.2 for the diagnosis of severe preeclampsia. The UPCR test is highly correlated with the 24-h UPET. We propose a novel and sensitive cut-off for the diagnosis of preeclampsia by UPCR test. The UPCR test can be used for the identification of hypertensive patients with preeclampsia and severe disease.