Management Of Hypertensive Disorders Research Articles

109. Using blood pressure self-monitoring in pregnancy: A systematic review and individual patient data meta-analysis

Introduction Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure might improve the detection and management of hypertensive disorders of pregnancy but few data are available, including regarding appropriate thresholds. Objective This systematic review and individual patient data analysis aimed to assess the current evidence regarding differences between clinic and self-monitored blood pressure through pregnancy. Methods MEDLINE and ten other electronic databases were searched for articles published up to and including July 2016 using a strategy designed to capture all the literature concerning self-monitoring of blood pressure during pregnancy. Investigators of included studies were contacted requesting individual patient data: self-monitored and clinic blood pressure and demographic data. Results Twenty-one studies that utilised self-monitoring of blood pressure during pregnancy were identified. Individual patient data from self-monitored and clinic readings were available from seven plus one unpublished paper (eight studies, n = 758) and two further studies published summary data. Analysis revealed a mean self-monitoring -clinic difference of ⩽1.2 mmHg systolic BP throughout pregnancy, though there was significant heterogeneity (difference in means I2 > 80% throughout pregnancy). Although the overall population difference was small, though levels of ‘white coat hypertension’ were high, particularly towards the end of pregnancy. Discussion The available literature includes no evidence of a systematic difference between self and clinic readings, suggesting that appropriate treatment and diagnostic thresholds for self-monitoring during pregnancy would be equivalent to standard clinic thresholds.

Hypertensive Disorders of Pregnancy: Overview and Current Recommendations.

Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. These disorders are an important cause of maternal and fetal morbidity and mortality. Although advances in effective treatments have been made, current research has yet to identify a biochemical or diagnostic imaging marker to reliably predict preeclampsia. Despite current guidelines that address diagnosis and management of hypertensive disorders in pregnancy, health care providers may overlook or be unaware of signs that require immediate evaluation and treatment. This article reviews the definitions of hypertensive disorders of pregnancy, diagnosis, pathophysiology of preeclampsia, indications for treatment, neurologic sequelae, and counseling about the implications of hypertension in pregnancy for subsequent health.

Determinants of Low Birth Weight among Mothers Who Gave Birth in Debremarkos Referral Hospital, Debremarkos Town, East Gojam, Amhara Region, Ethiopia

Background: World Health Organization defines low birth weight as weight at birth of less than 2500 g. Low birth weight could be the result of either preterm birth or restricted intrauterine growth. Globally, out of 139 million live births, about 20 million of them are low birth weight and nearly 95.6% of them are in developing countries. Ethiopia, having an infant mortality rate of 59/1000 live births, has limited data on low birth weight estimates as most deliveries take place at home. According to Ethiopian Demographic and Health Survey, 2011, only 5% of children were weighed at birth. The aim of this study was to assess determinants of low birth weight in Debremarkos referral hospital. Methods: Facility based case control study was undertaken from June to November 2015. The total sample size was 287 (191 controls and 96 cases). Data was collected through interview using structured questioner, actual measurements and review of clinical records. After checking for completeness and accuracy, data was entered in to Epi-info version 7 and was analyzed by SPSS version 20. Variables with P-value <0.2 in bivariate analysis were entered to multivariate analysis and variables with p-value <0.05, 95% CI were considered statistically significant. Results: Cases and controls were similar in almost all socio demographic characteristics. About 79.2% of cases and 93.2% of controls had ante natal care at least once. However, majority of cases (73.7%) had ANC visit of three or less, whereas more than half of controls (59.6%) had four or more. Parity (AOR=4.93, 95% CI, 2.55-9.52), three or less ANC visits (AOR=3.81, 95% CI, 1.82-7.99), anemia (AOR=3.91, 95% CI, 1.73-8.87), hypertensive disorders (AOR=6.13, 95% CI, 2.69-13.98) and frequency of meals per day (AOR=2.61, 95% CI, 1.26-5.38) were found significantly associated with low birth weight. Conclusions: Parity, three or less ante natal care visits, anemia, hypertensive disorders of pregnancy and frequency of meals per day were found significantly associated with low birth weight. Emphasis should be given to ante natal service utilization, prevention of anemia, early detection and management of hypertensive disorders and feeding practice of pregnant women.

SCREENING FOR PREECLAMPSIA: A EVIDENCE-BASED REVIEW

Pre-eclampsia is part of a spectrum of conditions known as the hypertensive disorders of pregnancy and is defined as hypertension and proteinuria detected for the first time in the second half of pregnancy, after 20 weeks’ gestation. Pre-eclampsia complicates 2–10% of pregnancies and is one of the important causes of maternal mortality and death perinatal, special focus on the developing country. However, the majority of deaths due to pre-eclampsia and eclampsia can be avoidable through the provision of timely and effective care to the women presenting with these complications, especially in women with high risk factors of pre-eclampsia. Optimizing to manage this disoders are screening and preventing women who is in high risk to develop preeclampsia. WHO and obstetrics and gynecology associations have developed and updated the recommendations for prevention and treatment of pre-eclampsia. This review base on the WHO and obstetrics associations recommendations as well as a series studies were performed and published in Viet Nam from 2014 to 2016. The review contributes to provid evidence-based recommendations for clinical practice and management of hypertensive disorders in pregnancy, this is a necessary step towards achieving the Millennium Development Goals. Key words: preeclampsia, hypertension disorder, screening, high risk pregnancy, evidence-based

Modelling stillbirth mortality reduction with the Lives Saved Tool

BackgroundThe worldwide burden of stillbirths is large, with an estimated 2.6 million babies stillborn in 2015 including 1.3 million dying during labour. The Every Newborn Action Plan set a stillbirth target of ≤12 per 1000 in all countries by 2030. Planning tools will be essential as countries set policy and plan investment to scale up interventions to meet this target. This paper summarises the approach taken for modelling the impact of scaling-up health interventions on stillbirths in the Lives Saved tool (LiST), and potential future refinements.MethodsThe specific application to stillbirths of the general method for modelling the impact of interventions in LiST is described. The evidence for the effectiveness of potential interventions to reduce stillbirths are reviewed and the assumptions of the affected fraction of stillbirths who could potentially benefit from these interventions are presented. The current assumptions and their effects on stillbirth reduction are described and potential future improvements discussed.ResultsHigh quality evidence are not available for all parameters in the LiST stillbirth model. Cause-specific mortality data is not available for stillbirths, therefore stillbirths are modelled in LiST using an attributable fraction approach by timing of stillbirths (antepartum/ intrapartum). Of 35 potential interventions to reduce stillbirths identified, eight interventions are currently modelled in LiST. These include childbirth care, induction for prolonged pregnancy, multiple micronutrient and balanced energy supplementation, malaria prevention and detection and management of hypertensive disorders of pregnancy, diabetes and syphilis. For three of the interventions, childbirth care, detection and management of hypertensive disorders of pregnancy, and diabetes the estimate of effectiveness is based on expert opinion through a Delphi process. Only for malaria is coverage information available, with coverage estimated using expert opinion for all other interventions. Going forward, potential improvements identified include improving of effectiveness and coverage estimates for included interventions and addition of further interventions.ConclusionsKnown effective interventions have the potential to reduce stillbirths and can be modelled using the LiST tool. Data for stillbirths are improving. Going forward the LiST tool should seek, where possible, to incorporate these improving data, and to continually be refined to provide an increasingly reliable tool for policy and programming purposes.

Current best practice in the management of hypertensive disorders in pregnancy.

Preeclampsia is a potentially serious complication of pregnancy with increasing significance worldwide. Preeclampsia is the cause of 9%–26% of global maternal mortality and a significant proportion of preterm delivery, and maternal and neonatal morbidity. Incidence is increasing in keeping with the increase in obesity, maternal age, and women with medical comorbidities entering pregnancy. Recent developments in the understanding of the pathophysiology of preeclampsia have opened new avenues for prevention, screening, and management of this condition. In addition it is known that preeclampsia is a risk factor for cardiovascular disease in both the mother and the child and presents an opportunity for early preventative measures. New tools for early detection, prevention, and management of preeclampsia have the potential to revolutionize practice in the coming years. This review presents the current best practice in diagnosis and management of preeclampsia and the hypertensive disorders of pregnancy.

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Objectives To assess the feasibility of a multi-country Community Level Interventions for Pre-eclampsia (CLIP) Trial in the African and South Asian contexts. Methods A mixed methodology approach guided by normalization process theory was used in Nigeria, Mozambique, Pakistan, and India. Multiple methods of data collection were employed to explore enabling and impeding factors for the CLIP package utilization. Qualitative data were collected through participatory observation, document review, focus group discussions and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility assessments and community health workers’ assessments, self-administered questionnaires, and community surveillance. Qualitative thematic analysis was conducted using QSR NVivo v10. Quantitative descriptive analyses was performed on SPSS v19/Epi Info 7. Results Qualitative themes underscored knowledge deficits about pre-eclampsia and poor understanding of progression of illness from pre-eclampsia to eclampsia. Myths and misperceptions widely prevailed surrounding the causes of pre-eclampsia, whereas community practices related to prevention, as well as, case management were deeply rooted in their cultural beliefs, past experiences and perceptions of severity of pre-eclampsia/eclampsia. The quantitative findings from survey highlighted areas for health system capacity building needed to ensure availability of magnesium sulfate at health facilities, equipping community care providers with blood pressure monitoring devices, and training of care providers for diagnosis and management of hypertensive disorders during pregnancy. Conclusions Feasibility assessment for the CLIP Trial was a resource-intensive, but essential, exercise to understand communities prior to the trial. The methodology used in our research work, can be used to inform future trials of this magnitude in high burden countries and elsewhere. Disclosure A.R. Khowaja: None.

Hypertension—Management of Hypertensive Disorders of Pregnancy According to International Guidelines: A Panel Discussion (Case 1: Role of Proteinuria)

Hypertension—Management of Hypertensive Disorders of Pregnancy According to International Guidelines: A Panel Discussion (Case 1: Role of Proteinuria)

Hypertension—Management of Hypertensive Disorders of Pregnancy According to International Guidelines: A Panel Discussion (Case 4: HELLP Syndrome)

Hypertension—Management of Hypertensive Disorders of Pregnancy According to International Guidelines: A Panel Discussion (Case 4: HELLP Syndrome)

Hypertension—Management of Hypertensive Disorders of Pregnancy According to International Guidelines: A Panel Discussion (Case 2: Severe Gestational Hypertension)

Hypertension—Management of Hypertensive Disorders of Pregnancy According to International Guidelines: A Panel Discussion (Case 2: Severe Gestational Hypertension)

Management of hypertensive disorders in pregnancy.

Hypertensive disorders are the most common medical complication of pregnancy, with an incidence of 5-10%, and a common cause of maternal mortality in the USA. Incidence of pre-eclampsia has increased by 25% in the past two decades. In addition to being among the lethal triad, there are likely up to 100 other women who experience 'near miss' significant maternal morbidity that stops short of death for every pre-eclampsia-related mortality. The purpose of this review is to present the new task force statement and novel definitions, as well as management approaches to each of the hypertensive disorders in pregnancy. The increased understanding of the pathophysiology of hypertension in pregnancy, as well as advances in medical therapy to minimize risks of fetal toxicity and teratogenicity, will improve our ability to prevent and treat hypertension in pregnancy. Fetal programming and fetal origins of adult disease theories extrapolate the benefit of such therapy to future generations.

PMM.27 Unresolved proteinuria after pre-eclampsia: detecting renal disease

Abnormal proteinuria (a urinary protein creatinine ratio (PCR) >30 mg/mmol), combined with new onset hypertension in pregnancy, is the hallmark of pre-eclampsia. NICE guidelines1 recommend that a urine dipstick test...

Guía de Práctica Clínica para el abordaje de las complicaciones hipertensivas asociadas al embarazo

Objetivo: realizar recomendaciones para la atención de las complicaciones hipertensivas en el embarazo como parte integral de la “Guía de Práctica Clínica (GPC) para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia”.Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012 acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta sección fue adaptada de la GPC “Hypertension in pregnancy: the management of hypertensive disorders during pregnancy” (National Institute of Care and Health Excellence - NICE - 2010) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresados por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN).Resultados: se presentan las recomendaciones para la atención de las complicaciones hipertensivas en el embarazo. Estas incluyen cambios en la conducta del personal de salud y las instituciones para aumentar la probabilidad de obtener un resultado materno-fetal exitoso en las gestaciones con estas condiciones.Conclusiones: se presenta una versión resumida de las recomendaciones y evidencia para la atención de las complicaciones hipertensivas en el embarazo, la cual se espera sea adoptada por los profesionales de salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación.

Management of Hypertensive Disorders in Pregnancy- An Update

Hypertensive disorder is the most common medical problem encountered in pregnancy with a high perinatal and maternal mortality &amp; morbidity. According to the onset of hypertension in relation to pregnancy and its duration and the development of proteinuria &amp; convulsion it is categorized into several types. The prognosis depends on duration and severity of hypertension and multi-system involvement. Aim of management is to achieve a gradual and sustained lowering of BP to prevent maternal complications and to allow prolongation of pregnancy for fetal benefit. For management purpose, according to recent NICE clinical guideline gestational hypertension has been classified into mild, moderate and severe hypertension. Till now there is controversy regarding the use of antihypertensives in mild to moderate hypertension. Labetalol, hydralazine &amp; methyldopa are used as first line drugs according to severity of hypertension. Magnesium sulphate is the anticonvulsant of choice and nimodipine is the newer alternative. Obstetric management in all the types of hypertensive disorders is almost same .Expectant management can be considered for women at &lt;34 weeks gestation only in well equipped centers capable of caring very pre-term babies. Antenatal corticosteroid is recommended for enhancing fetal lung maturity. There is a common consensus that the hypertensive patients should be delivered at e”37 weeks as there is no benefit in continuing the pregnancy. For women with any type of hypertensive disorders, vaginal delivery should be considered unless cesarean section is required for the usual obstetric indication. DOI: http://dx.doi.org/10.3329/bjog.v25i1.13729 Bangladesh J Obstet Gynaecol, 2010; Vol. 25(1) : 24-32

Management of Hypertensive Disorders During Pregnancy

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Knowledge of hypertensive disorders in pregnancy among obstetricians and midwives

BackgroundHypertension in pregnancy remains one of the leading causes of maternal deaths in the UK and is associated with an increased lifetime risk of cardiovascular disease.MethodsAn anonymous structured questionnaire, based...

Short- and long-term strategies for the management of hypertensive disorders of pregnancy

The hypertensive disorders of pregnancy include gestational hypertension and preeclampsia, both de novo and superimposed on chronic hypertension. These disorders occur frequently among pregnant woman and are important contributors to maternal and perinatal mortality and morbidity worldwide. In this review, we will focus on recent developments in the prediction and pathogenesis of these disorders, prevention of preeclampsia and current strategies for the treatment of hypertension in pregnancy. We also explore the evidence relating adverse pregnancy outcome to an increased future risk of cardiovascular disease and potential strategies to minimize this risk.

Renal disease in pregnancy

Journal of Renal NursingVol. 4, No. 4 guest editorialRenal disease in pregnancyCatherine Nelson-PiercyCatherine Nelson-PiercySearch for more papers by this authorCatherine Nelson-PiercyPublished Online:29 Sep 2013https://doi.org/10.12968/jorn.2012.4.4.168AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesBramham K, Duncan N, Lightstone L et al. (2010) Pregnancy in kidney-pancreas transplant recipients: report of three cases and review of the literature. Obstet Med 3(2): 73–77 Crossref, Google ScholarNational Institute for Health and Clinical Excellence (2010) Hypertension in Pregnancy: the Management of Hypertensive Disorders during Pregnancy. http://guidance.nice.org.uk/CG107/Guidance/pdf/English (accessed 21 June 2012) Google ScholarWilliams D, Davison J (2008) Chronic kidney disease in pregnancy. BMJ 336(7637): 211–5 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 July 2012Volume 4Issue 4ISSN (print): 2041-1448ISSN (online): 2052-2894 Metrics History Published online 29 September 2013 Published in print 1 July 2012 Information© MA Healthcare LimitedPDF download

Mechanisms of Renal Vasodilation and Hyperfiltration During Pregnancy: Current Perspectives and Potential Implications for Preeclampsia

A thorough understanding of the renal and cardiovascular adaptations to normal gestation is essential for proper diagnosis and management of hypertensive disorders and renal diseases during pregnancy. Here, we briefly review the renal hemodynamic changes of normal pregnancy. In addition, we present new findings and current concepts related to the underlying hormonal and molecular mechanisms. Finally, we speculate on the potential contribution of these insights from normal pregnancy to the pathogenesis of preeclampsia.

Practice variation of test procedures reportedly used in routine antenatal care in The Netherlands

Pregnant women are encouraged to book for antenatal care. However, little is known about the contents of antenatal care, in particular regarding various test procedures. The present descriptive study was conducted to assess the variation in standard test procedures in antenatal care in The Netherlands. A nationwide structured survey by mailed questionnaire was carried out among specialist obstetricians and midwives in The Netherlands. Representatives of each obstetric practice registered with the Dutch Society of Obstetrics and Gynecology (n=132) and a sample of midwives registered with the Dutch Society of Midwives (n=394) were invited to report the standard policy of tests routinely used for antenatal care in their own setting. Furthermore, they were asked to report their views on the potential impact of the antenatal care program on pregnancy outcome. Complete information was available from 105 specialist obstetricians (80%) and 281 midwives (71%). The assessment of maternal blood pressure and weight are reportedly the commonest procedures routinely conducted during the antenatal period. However, within each profession reported definitions and implications of abnormal findings vary markedly, especially in the fields of identification and management of hypertensive disorders in pregnancy. Serial examination of the cervix is not standard policy among both groups. With respect to laboratory tests, considerable intra- and interprofessional variations are reported, in particular those for maternal serum glucose, rubella antibody titer and urinary dipstick for glucose and protein. As to standard ultrasound policies, wide intra- and interprofessional variations are noted. Seventy-two specialist obstetricians (68%) and 92 midwives (33%) routinely estimate the duration of gestation by ultrasound in pregnant women (p<0.001). A fetal anomaly scan at about 18-20 weeks' gestation is routinely offered to pregnant women by 31 specialist obstetricians (30%) and 44 midwives (16%) (p<0.01); 29 obstetricians (28%) and 11 midwives (4%) reportedly use ultrasound in all pregnant women for the detection of fetal growth restriction (p<0.001). Overall, midwives have a more optimistic view about the impact of antenatal care on pregnancy outcome than obstetricians. Although the standard package of antenatal care provided by both specialist obstetricians and midwives in The Netherlands seems to be relatively uniform, wide intra- and interprofessional variations exist with respect to (1) the application of tests in terms of recommendations to test some or all pregnant women, (2) defining normal from abnormal and (3) potential implications of abnormal findings.