Management Of Pregnancy-induced Hypertension Research Articles

Comparative sonographic assessment of renal volume and arterial Doppler velocimetric indices among women with pregnancy-induced hypertension and normotensive controls in Northern Nigeria

Introduction: Pregnancy-induced hypertension is a global public health problem, worsening maternal morbidity and mortality. Renal complications have additional devastating consequences on maternal morbidity. Renal Doppler ultrasound is a valuable tool in the management of pregnancy-induced hypertension. It helps in the assessment of renal hemodynamics with the potential to monitor renal function and predict complications. We aimed to determine the relationship between the renal volume and arterial Doppler velocimetric indices in pregnancy-induced hypertension and matched normotensive controls. Methods: Following the documentation of demographic and basic obstetric characteristics of 150 women with pregnancy-induced hypertension and an equal number of their matched controls, a 3.5-MHz convex transducer was used to measure the maternal renal volumes and renal arterial Doppler velocimetric indices (peak systolic velocity, end diastolic velocity, resistive index, pulsatility index, and systolic–diastolic radio). Student’s t-test and linear regression were used to determine the differences and relationships between the quantitative variables among women with pregnancy-induced hypertension and their controls. The association chi-square test was used to determine the association between the qualitative and categorical variables. A p-value of less than 0.05 was considered significant. Results: The mean renal volume of pregnancy-induced hypertension patients is higher bilaterally when compared to normotensive women. The mean peak systolic velocity and resistive index in pregnancy-induced hypertension patients were significantly higher compared to normotensives (59.13 ± 13.5 vs 54.19 ± 9.8 cm/s; p < 0.001) and (0.74 ± 0.2 vs 0.68 ± 0.3). Conclusion: The maternal renal volume and peak systolic velocity of the renal arteries are significantly higher in women with pregnancy-induced hypertension compared to normotensives.

Systematic Review of Hyrtl’s Anastomosis of Umbilical Arteries and Placenta in Pregnancy Induced Hypertension

ABSTRACT Background: Pregnancy-Induced hypertension (PIH) is a common health problem that occurs during pregnancy and may lead to limited fetal growth and other major health problems. Being a serious public health issue, PIH is responsible for a significant number of deaths across the globe. Hyrtl’s anastomosis of the umbilical arteries and placenta is a blood vessel system that can affect the growth and development of the fetus. The studies conducted earlier have suggested that the abnormalities in Hyrtl’s anastomosis may be associated with the development of PIH and other adverse pregnancy outcomes. Aim: The aim of the current systematic literature review is to investigate the potential advantages and restrictions of Hyrtl’s anastomosis as a medical diagnosis and treatment tool for PIH by reviewing the available evidence. Materials and Methods: The current study is a systematic literature review that involves the selection of 10 articles published in or after 2019 from reputed journals that evaluated the effectiveness of Hyrtl’s anastomosis in PIH. The inclusion criteria for this review are as follows: studies that involved human subjects, were published in English, were randomized controlled trials, case-control studies, observational studies, or systematic reviews, and evaluated the effectiveness of Hyrtl’s anastomosis. The exclusion criteria are as follows: studies published in other languages did not involve human subjects and did not measure the effectiveness of Hyrtl’s anastomosis in PIH. The search strategy includes a comprehensive search of the relevant databases using keywords related to Hyrtl’s anastomosis, umbilical artery, placenta, and PIH. Both data collection and analysis were conducted when the authenticity and validity of the articles used in this study were maintained. Data extraction was carried out by identifying the key findings of the articles selected for review in this particular study. The quality of the studies included in this review was assessed based on the JADAD scale. Findings and Conclusion: The aim of the systematic literature review is to evaluate the effectiveness of Hyrtl’s anastomosis in the detection and management of PIH. The current study design involved the selection of 10 articles published in or after 2019, with inclusion and exclusion criteria defined for the selection process. The search strategy included a comprehensive search of relevant databases. Both data collection and analysis were conducted when the authenticity and validity of the chosen articles were maintained. The quality of the studies included in the review was assessed based on the JADAD scale.

A cluster randomized controlled trial of an electronic decision-support system to enhance antenatal care services in pregnancy at primary healthcare level in Telangana, India: trial protocol

BackgroundIndia contributes 15% of the total global maternal mortality burden. An increasing proportion of these deaths are due to Pregnancy Induced Hypertension (PIH), Gestational Diabetes Mellitus (GDM), and anaemia. This study aims to evaluate the effectiveness of a tablet-based electronic decision-support system (EDSS) to enhance routine antenatal care (ANC) and improve the screening and management of PIH, GDM, and anaemia in pregnancy in primary healthcare facilities of Telangana, India. The EDSS will work at two levels of primary health facilities and is customized for three cadres of healthcare providers – Auxiliary Nurse Midwifes (ANMs), staff nurses, and physicians (Medical Officers).MethodsThis will be a cluster randomized controlled trial involving 66 clusters with a total of 1320 women in both the intervention and control arms. Each cluster will include three health facilities—one Primary Health Centre (PHC) and two linked sub-centers (SC). In the facilities under the intervention arm, ANMs, staff nurses, and Medical Officers will use the EDSS while providing ANC for all pregnant women. Facilities in the control arm will continue to provide ANC services using the existing standard of care in Telangana. The primary outcome is ANC quality, measured as provision of a composite of four selected ANC components (measurement of blood pressure, blood glucose, hemoglobin levels, and conducting a urinary dipstick test) by the healthcare providers per visit, observed over two visits. Trained field research staff will collect outcome data via an observation checklist.DiscussionTo our knowledge, this is the first trial in India to evaluate an EDSS, targeted to enhance the quality of ANC and improve the screening and management of PIH, GDM, and anaemia, for multiple levels of health facilities and several cadres of healthcare providers. If effective, insights from the trial on the feasibility and cost of implementing the EDSS can inform potential national scale-up. Lessons learned from this trial will also inform recommendations for designing and upscaling similar mHealth interventions in other low and middle-income countries.Trial Registration.ClinicalTrials.gov, NCT03700034, registered 9 Oct 2018, https://www.clinicaltrials.gov/ct2/show/NCT03700034CTRI, CTRI/2019/01/016857, registered on 3 Mar 2019, http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=28627&EncHid=&modid=&compid=%27,%2728627det%27

Pregnancy-Induced Hypertension - Ayurvedic Understanding

Pregnancy-induced hypertensive disorders are included among the most common medical complications of pregnancy with an incidence of 5–10%. Hypertension that develops as a direct result of gravid state is referred to as ‘pregnancy-induced hypertension’. The timely management of pregnancy complicated with hypertensive disorders is significant, otherwise it can lead to adverse fetal, neonatal and maternal outcomes. The basic pathology in pre-eclampsia, one of the types of hypertensive disorders is endothelial dysfunction and intense vasospasm due to abnormal placentation compromising blood flow to the foetoplacental unit. There is no direct reference of pregnancy-induced hypertension in Ayurveda classics, but the manifested symptoms can be explained within the purview of Ayurveda. Abnormality in placentation can be considered as impairment in the normal functioning of Vata dosha and when the pathology progresses further; Kapha, Pitta also play their own roles. In a woman with or without a previous history of pre-eclampsia, intervention should begin from pre-conceptional period. Planned pregnancy after pre-conceptional care followed by Garbhini paricharya along with the use of Garbhasthapaka dravya, Rasayana dravya, Masanumasika Garbhasravahara dravya can play significant roles in the prevention as well as management of pregnancy-induced hypertension thus improving the maternal and foetal outcomes.

A Cross-Sectional Study on Current Practice of the Management of Pregnancy Induced Hypertension and Its Maternal and Foetal Complications and Outcome in the Western Part of the State of Libya

Background: Maternal and perinatal mortality and morbidity are mainly affected by hypertension during pregnancy (pre-eclampsia). Haemorrhage and cerebral bleeding are the primary and significant complications of pre-eclampsia. Abruption of the placenta and renal failure are among the major complications caused by this disease. The perinatal complications include Intrauterine Growth Restriction (IUGR), Intrauterine Foetal Death (IUFD), neonatal death, and prematurity. Objective: The purpose of the present study was to examine the incidence of Pregnancy-Induced Hypertension (PIH), pre-eclampsia, the management of PIH, including the early diagnosis, the pharmacological drug management used, and the prevalence of maternal and perinatal complications. Methods and Patients: This cross-sectional study took place in Aljalaa maternity hospital, which represented the west of the state of Libya in the period from 1st January 2012 to 31st December 2012, with patients who were diagnosed, managed, and terminated according to protocol management of the hospital. Results: In the present study, from the total deliveries in Aljalaa Maternity hospital, the incidence of PIH is 8.4% and pre-eclampsia is 5.1%. No maternal mortality, CNS haemorrhaged, hepatic failure, or renal failure. The reported maternal complications included: Eclampsia, HELLP syndrome (Haemolysis, Elevated Liver enzymes and Low platelets), abruption placenta, and pulmonary oedema see in eighteen percent, six percent, nine percent, four percent and less than one percent, respectively. The foetal complications were preterm babies and Intrauterine Growth Restriction (IUGR) in nineteen percent, Low Birth Weight (LBW) in twenty-five percent, Intrauterine Foetal Death (IUFD) in five percent, neonatal death in two percent and, perinatal death in six percent. In the PIH patients, the presence of associated symptoms such as headache, blurred vision, irritability, and the presence of signs such as severe hypertension, generalized oedema, exaggerated reflexes, and abnormal investigations (protein urea, high uric acid, abnormal LFT, haemoconcentration, and low pits) increased the risk of maternal and foetal complications. Conclusion: To decrease mother and newborn mortality and morbidity in PIH patients, a rigorous management protocol is required to implement evidence-based guidelines.

Combination of Dexmedetomidine and Tramadol in Patient-Controlled Intravenous Analgesia Strengthens Sedative Effect in Pregnancy-Induced Hypertension.

Objective: The aim of the present study is to explore the combination of dexmedetomidine (DXM) and tramadol (TMD) on sedative effect in patients with pregnancy-induced hypertension (PIH). Methods: A total of 356 patients with pregnancy-induced hypertension (PIH) were randomly divided into three groups: DXM, TMD and DXM + TMD groups. These patients were treated with different doses of DXM, TMD or combination of DXM and TMD by a patient-controlled intravenous injection device. The scores of static pain and dynamic pain, sedation degree, and adverse reaction were recorded. The plasma levels of inflammatory mediators IL-10 and C-reactive protein (CRP), and the serum level of p-p38-MAPK were evaluated. Results: It was found that administration with DXM 1.0 µg/kg/h + TMD 700 mg and DXM 2.0 µg/kg/h + TMD 600 mg result in stronger sedative effect than single administration with DXM or TMD. The mean arterial pressure (MAP) and heart rate (HR) of patients with PIH were decreased with the combinational treatment of DXM and TMD. Interestingly, the PIH patients injected with DXM 1.0 µg/kg/h + TMD 700 mg and DXM 2.0 µg/kg/h + TMD 600 mg showed stronger sedative effect. In addition, the plasma level of level of IL-10 was increased and CRP decreased. The serum level of p-p38/MAPK was decreased. Conclusion: Taken together, our study indicates that combination of DXM and TMD effectively lowers blood pressure and reduces inflammation through increasing the level of IL-10, reducing CRP and inhibiting p-p38/MAPK in patients with PIH. This study suggests that the combination of DXM and TMD could be an anesthetic choice in the management of PIH.

Assessment of Prevalence of Hypertension in pregnant women with its Complications: A Cross Sectional Study

Introduction: World Health Organization has reported that pregnancy induced hypertension is one of the main causes for mortality and morbidity in maternal and fetal deaths. About 60% of deaths accounted of eclampsia. Aims and Objectives: To diagnose for hypertension in pregnant women. To evaluate the knowledge of pregnancy induced hypertension among the pregnant women. To investigate the complications reported in Pregnancy induced hypertension (PIH) women, during and after labor. Study area and period: The present study was conducted in Chittoor government hospital, Chittoor, during the period of Jan 2016 and Dec 2017. The information and materials required for the study have been collected from the gynecology and obstetrics departments of the respective hospital. Results: During the study period of Jan 2016 and Dec 2017, about 2234 number of pregnant women have visited the obstetrics and gynecology department. All the 2234 pregnant women were tested for blood pressure. Among which 198 women were found to have hypertension, which may be of early onset PIH or chronic hypertension (HTN). Different variables of the study population like period of gestation [<20 weeks, ≥20 weeks], previous cesarean section if present, previous preterm delivery if present, hypertension in previous pregnancy, history of paternal hypertension, history of abortions if have been, history of any still births, family history of PIH have been noted and reported in table 2. More than 8% of women were found to been falling in <20 weeks of gestational age (GA). Conclusion: The study included 2234 pregnant women, in which 198 women were diagnosed with hypertension. Thus, prior investigation and identification hypertension in pregnant women helps in better management of PIH and to overcome the complications that are reported due to PIH during and after labor. Better knowledge and treatment is required for managing hypertension in maternal women in gynecology and obstetrics department for maternal and fetal care.

PERINATAL OUTCOME IN BABIES IN RELATION TO SEVERITY OF MATERNAL HYPERTENSION

Background and objectives: Hypertensive disorder of pregnancy is a major cause of maternal and neonatal mortality and morbidity worldwide. This study prospectively examined the immediate neonatal outcome of women with hypertensive disorder of pregnancy .Objectives were to study the effects of maternal hypertension on APGAR score at birth and the need for neonatal resuscitation as well as to study neonatal morbidity profile and mortality pattern.
 Methods: Observational study was conducted on 125 babies born to mothers with hypertension in the neonatal intensive care unit of jubilee mission medical college. To study the effects of maternal hypertension and perinatal outcome, frequency and percentages were applied. Following parameters like prematurity, IUGR, low birth weight, hypoglycemia, hypocalcemia, hyperbilirubinemia will be studied .Chi square test will be applied for categorical variables and independent two sample t test will be applied for numerical variables.
 Results: Study population had male predominance.60% underwent LSCS.SGA babies maximum with eclampsia(45.5%),IUGR babies maximum with pre-eclampsia(9.4%).Prematurity seen in all babies born to eclamptic and 40.6% born to pre-eclamptic mothers(p-0.001).1 and 5minute APGAR were<7 in 15.9%,15.6%,18.2% and 12.2%,9.4%,9.1% of babies born to mothers with PIH, pre-eclampsia and eclampsia respectively. Other variables not statistically significant. Death was maximum in babies born to pre-eclamptic mothers (9.4 %).
 Conclusions: Maternal hypertension was associated with higher risk of adverse perinatal outcomes; necessitating need to strengthen prevention, early diagnosis and management of pregnancy-induced hypertension.
 Keywords: APGAR; prematurity; low birth weight; hypoglycemia; hyperbilirubinemia; hypocalcemia; respiratory distress

Medication for management of pregnancy-induced hypertension

Hypertension refers to increased arterial blood pressure and can be divided into two categories: primary and secondary. Primary hypertension caused by angiogenic degenerative changes is a degenerative disease. With liberalization of China’s reproduction policy and increases in maternal age, the prevalence of pregnancy-induced hypertension (PIH) in China has increased gradually. PIH is not a type of primary hypertension, but there are differences in the treatment of these two types of hypertension. Here, we review the choice and use of drugs for PIH management using drugs for the management of primary hypertension as a reference. First-line drugs such as labetalol, nifedipine, or methyldopa should be taken via the oral route if blood pressure is ≥ 150/90 mmHg. For chronic hypertension, other drugs should be added after the first drug at the highest concentration has been revealed to be ineffective. If the blood pressure of patients with acute hypertension is ≥ 160/110 mmHg, maternal stroke or eclampsia can result. If PIH patients are about to deliver, they can be given labetalol (i.v.), hydralazine (i.v.) or nifedipine (p.o.). Moreover, all anti-hypertensive treatments should be based on considerations of maternal and fetal safety.

Effectiveness of planned teaching program on knowledge about management of pregnancy-induced hypertension and birth preparedness among antenatal mothers with pregnancy-induced hypertension

Background: Hypertension is one of the common complications and contributes significantly to maternal and perinatal morbidity and mortality. Pregnancy-induced hypertension (PIH) is defined as sustained increased level of blood pressure >140/90 after the 20th week of pregnancy. Objective: The aim of this study is to assess the presence of contributing factors of PIH and effectiveness of structured teaching program (STP) on the management of PIH and birth preparedness. Materials and Methods: Quantitative research approach with one group pre-test–post-test design was used to carry out the study. A total of 60 antenatal mothers with PIH were selected by non-probability convenient sampling technique. Demographic performa, questionnaire to assess the risk factors, and structured knowledge questionnaire were used to collect the data. Data were collected by interview method. Results: The contributing factors of PIH identified in the study were age (26-30), period of gestation of more than 28 weeks, primigravida, vegetarian, and body mass index (BMI) more than 25. The mean pre-test knowledge score was 14.36 ± 3.46, and post-test knowledge score was 24.63 ± 3.42. The post-test mean knowledge score was found significantly higher than the mean pre-test knowledge score. There was no significant association found between the demographic variables with knowledge level and contributing factors except the factors gestational age, gravida, and BMI. Conclusion: The findings of the study revealed that STP was effective in enhancing the knowledge of antenatal mothers with PIH.

Knowledge and Attitude of Pregnant Women towards Management of Pregnancy-induced Hypertension in Southwest Nigeria

Knowledge and Attitude of Pregnant Women towards Management of Pregnancy-induced Hypertension in Southwest Nigeria

Pregnancy-induced hypertension and associated factors among pregnant women attending public health facilities in Swaziland

Background/Aims: Pregnancy-induced hypertension is the main cause of morbidity and mortality among pregnant women in Swaziland. The main objectives of this study were to: i) identify the factors contributing to the development of pregnancy-induced hypertension among women attending public health facilities in Swaziland; ii) investigate the association between the development of pregnancy-induced hypertension sociodemographic variables, family history, obstetric history, lifestyle, and access to health care services. Methods: An exploratory, descriptive research design, using a quantitative research approach was used. Data were analysed using SPSS version 20, where a sample frame of 60 women diagnosed with pregnancy-induced hypertension, and a sample of 50 women was selected using simple random sampling. Results: The findings revealed a significant association between sociodemographic variables and obstetric history (p=0.001), marital status (p=0.025) and lifestyle, which in turn predisposes the woman to pregnancy-induced hypertension. Employment status (p=0.044) was significantly associated with access to health care services and level of education (p=0.027). Conclusions: Factors that are significantly associated with the development of pregnancy-induced hypertension include age, multiple pregnancy, a history of pregnancy-induced hypertension in previous pregnancies and limited use of antenatal care services. The authors recommend strengthening pre- and in-service midwifery education on the management of pregnancy-induced hypertension, as well as client education on the risk factors for pregnancy-induced hypertension.

Maternal Death Due to Stroke Associated With Pregnancy-Induced Hypertension

The aim of this study was to clarify the clinical features of maternal death due to stroke associated with pregnancy-induced hypertension (PIH) in Japan. Reported maternal deaths occurring between 2010 and 2012 throughout Japan were analyzed by the Maternal Death Exploratory Committee. Among a total of 154 reports of maternal death, those due to stroke with (n=12) or without (n=13) PIH were compared. Cerebral stroke occurred more frequently in the third trimester and during the second stage of labor in deaths with PIH, whereas it occurred at any time point in deaths not involving PIH. Although 83% of patients with PIH who died had experienced initial symptoms in a hospital, more than half of them required maternal transport due to lack of medical resources. Among the patients without PIH, some vascular abnormalities were identified, but no evidence was found among the patients with PIH. In addition, 58% of PIH cases resulting in stroke were complicated by hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. Appropriate management of PIH during pregnancy and labor, including anti-hypertensive therapy and early maternal transport to tertiary hospital, may reduce the maternal death rate.

Clinical assessment of retinopathy post management of pregnancy induced hypertension

Pregnancy induced hypertension (PIH) is a multi-system disorder and common complication occurring during pregnancy responsible for maternal and fetal mortality and morbidity. PIH also exerts its influence on the eye and visual pathways. Common ocular symptoms being blurring of vision, photopsias, scotomas, diplopia and in severe cases blindness. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent PIH and its complications. The review discusses the after effects of medical management of PIH on the retina.

Differential effects of complement activation products c3a and c5a on cardiovascular function in hypertensive pregnant rats.

Early-onset pre-eclampsia is characterized by decreased placental perfusion, new-onset hypertension, angiogenic imbalance, and endothelial dysfunction associated with excessive activation of the innate immune complement system. Although our previous studies demonstrated that inhibition of complement activation attenuates placental ischemia-induced hypertension using the rat reduced uterine perfusion pressure (RUPP) model, the important product(s) of complement activation has yet to be identified. We hypothesized that antagonism of receptors for complement activation products C3a and C5a would improve vascular function and attenuate RUPP hypertension. On gestational day (GD) 14, rats underwent sham surgery or vascular clip placement on ovarian arteries and abdominal aorta (RUPP). Rats were treated once daily with the C5a receptor antagonist (C5aRA), PMX51 (acetyl-F-[Orn-P-(D-Cha)-WR]), the C3a receptor antagonist (C3aRA), SB290157 (N(2)-[(2,2-diphenylethoxy)acetyl]-l-arginine), or vehicle from GD 14-18. Both the C3aRA and C5aRA attenuated placental ischemia-induced hypertension without affecting the decreased fetal weight or decreased concentration of free circulating vascular endothelial growth factor (VEGF) also present in this model. The C5aRA, but not the C3aRA, attenuated placental ischemia-induced increase in heart rate and impaired endothelial-dependent relaxation. The C3aRA abrogated the acute pressor response to C3a peptide injection, but it also unexpectedly attenuated the placental ischemia-induced increase in C3a, suggesting nonreceptor-mediated effects. Overall, these results indicate that both C3a and C5a are important products of complement activation that mediate the hypertension regardless of the reduction in free plasma VEGF. The mechanism by which C3a contributes to placental ischemia-induced hypertension appears to be distinct from that of C5a, and management of pregnancy-induced hypertension is likely to require a broad anti-inflammatory approach.

Doppler velocimetry of the orbital vessels in pregnancies complicated by preeclampsia

Hypertension is one of the most common clinical complications during pregnancy. Preeclampsia, in particular, still accounts for high maternal and fetal morbidity and mortality. Hemodynamic studies have shown that general arteriolar vasoconstriction, which leads to hypoperfusion of target organs, including the eye area, remains the most significant pathological change in preeclampsia. Color Doppler imaging is the most appropriate and the commonly used method for the study of ocular circulation, especially during pregnancy. It enables the visualization and flow measurement of retrobulbar blood vessels. The aim of this review is to evaluate studies that investigated the role of Doppler velocimetry of the maternal orbital vessels, especially the ophthalmic artery, as a tool for the differential diagnosis of hypertensive disorders of pregnancy, for the assessment of the degree and severity of preeclampsia, and for the prediction of these disturbances. The analysis of these studies indicates that the Doppler variables are accurate in the differential diagnosis of hypertensive disorders and in assessing the severity and progression of the preeclampsia and may also be useful markers in the treatment and management of pregnancy-induced hypertension. We found no study evaluating the role of orbital vessels Doppler variables in predicting preeclampsia or in the prognosis of maternal-fetal adverse events.

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension

Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension. Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine ( n =20), methyldopa ( n =20) or labetalol ( n =20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period. Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h. Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure.

A case of pregnancy‐induced thrombotic thrombocytopenic purpura with a kidney allograft recipient

A 32-yr-old female patient, who had been suffering from diffuse crescentic glomerulonephritis and a consequent end-stage renal disease, successfully underwent living-related ABO-incompatible kidney transplantation after a desensitization therapy including anti-CD20 monoclonal antibody. Forty-six months after the transplantation, the recipient became pregnant. At the 17th gestational week, the patient was admitted for the management of pregnancy-induced hypertension and aggressive deterioration of kidney graft function. At the 21st gestational week, the patient lost her kidney graft and was re-induced into regular hemodialysis. The patient was also suffering from progressive hemolytic anemia, thrombocytopenia, and neurologic symptoms with decreased activity of von Willebrand factor-cleaving protease, a disintegrin-like and metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS13). From these findings and a kidney allograft biopsy, the patient was diagnosed as thrombotic thrombocytopenic purpura concurrent with acute T-cell-mediated rejection. The patient immediately underwent plasma exchange as well as steroid pulse therapy. Despite these treatments, thrombocytopenia and intrauterine growth retardation progressed. The patient underwent a caesarian section at the 24th gestational week. Consequently, her platelet count recovered drastically. However, the patient lost her neonate five d after giving a birth, and the patient's graft function had never recovered.

P138 Role of labetolol and nifedipine in management of pregnancy-induced hypertension in third trimester of pregnancy – a comparative clinical study

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S450-S451 Poster presentations P138 Role of labetolol and nifedipine in management of pregnancy-induced hypertension in third trimester of pregnancy – a comparative clinical study P. Phukan, P. PhukanSearch for more papers by this authorM. Mali, M. MaliSearch for more papers by this authorA. Medhi, A. MedhiSearch for more papers by this author P. Phukan, P. PhukanSearch for more papers by this authorM. Mali, M. MaliSearch for more papers by this authorA. Medhi, A. MedhiSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)61629-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S450-S451 RelatedInformation

Pregnant Woman with High Blood Pressure

Pregnant Woman with High Blood Pressure