Mild Pregnancy-induced Hypertension Research Articles

Treatment for mild hypertension in pregnancy with different strategies: A systematic review and meta-analysis.

To synthesize the evidence from randomized controlled trials (RCTs) of antihypertensive treatment for mild pregnancy hypertension. We searched various databases from inception to June 2022, using keywords including hypertension; pregnancy; therapy; treatment; pregnancy outcomes; maternal outcomes; and perinatal outcomes. Only RCTs of antihypertensive treatment for mild hypertension in pregnancy comparing placebo/no therapy were included. We used Review Manager version 5.3 for statistical analyses. In all, eight studies were eligible, with a total of 4211 participants. Compared with control, the active treatment significantly prevented preeclampsia (OR 0.55; 95%CI, 0.39-0.78), placental abruption (OR 0.39; 95%CI, 0.17-0.91), severe hypertension (OR 0.35; 95%CI, 0.17-0.71), end-organ dysfunction (OR 0.34; 95%CI, 0.19-0.62) and preterm birth (OR 0.69; 95%CI, 0.59-0.82), with no increased risk of small for gestational age (SGA) (OR 1.25; 95%CI, 0.78-2.00), or admission to the NICU (OR 0.83; 95%CI, 0.54-1.28). Subgroup analyses demonstrated that the tight control group did not show an advantage over the less-tight control group in improving pregnancy outcomes. In pregnant women with mild pregnancy-induced hypertension or chronic hypertension, antihypertensive treatment still provided precise benefits of improving pregnancy outcomes without increased risk in fetal outcomes.

Assessment Of Platelet Count And Its Correlation With Severity Of Pre-Eclampsia

Background: Pregnancy induced hypertension (PIH) is the most common medical disorder of pregnancy. The present study wasconducted to assess platelet count and its correlation with severity of pre-eclampsia.Materials & Methods: 108 suspected cases of pregnancy induced hypertension (cases) and group II had controls were assessed forplatelet count.Results: Age group 20-25 years had 14 cases of mild PIH, 24 of moderate and 6 of eclampsia. 26-30 years had 16 cases of mild, 22 ofmoderate and 4 cases of eclampsia and 31-35 years had 6 of mild, 14 of moderate and 2 of eclampsia. Group II had 56, 42 and 10respectively.Conclusion: Estimation of platelet count being simple economical and rapid investigation can be used for early detection of severity ofpreeclampsia. There were more cases of preeclampsia with low platelets.

Role of Doppler Waveforms in Pregnancy-Induced Hypertension and Its Correlation With Perinatal Outcome.

ObjectivesThe present study aims to measure the role of Doppler waveforms in pregnancy-induced hypertension (PIH) and its relationship with the perinatal outcome.MethodsWe have studied 50 pregnant women with PIH with gestational age (GA) 30-40 weeks for Umbilical Artery (UmA), Middle Cerebral Artery (MCA) and Uterine Artery (UtA) Doppler waveforms. Comparison between the various Doppler indices, i.e., Pulsatility Index (PI), Resistive Index (RI) and S/D ratio, with the severity of the disease and the perinatal outcomes were evaluated using appropriate statistical tests considering a threshold value of p-value <0.05 as significant. The Statistical Package for the Social Sciences (SPSS) version-16 (SPSS Inc, Chicago, USA) and MedCalc software (MedCalc Software Ltd, Ostend, Belgium) were used for data analysis.ResultsHalf (50%) of the cases attributed to the 26 to 30 years age group were at 38 to 40 weeks of gestation. Out of the 50 patients, 68% were primigravida, and 74% had severe PIH. Mean UmA PI, mean MCA PI, mean MCA RI, and mean Cerebro Placental Ratio (CPR) were differed significantly among mild and severe PIH patients (p-value<0.05). Perinatal outcomes in 33 (66%) cases were adverse. The abnormal UmA RI, MCA RI, MCA PI, MCA S/D were significantly linked with poor pregnancy outcomes (p-value <0.05). PIH cases with the presence of early diastolic notch of UtA (p-value <0.01), abnormal PI CPR (p-value <0.001) and S/D CPR (p-value <0.003) were observed to have more adverse outcomes. PI CPR had the highest sensitivity (84.8%), and the existence of early diastolic notch of UtA and MCA-PI were most specific in diagnosing adverse perinatal outcomes.ConclusionCPR-PI is a valuable indicator of adverse perinatal outcomes in PIH. Doppler studies of multiple vessels may help manage high-risk pregnancies as it may provide helpful information about the fetus at risk of hypoxia and placental insufficiency.

PLACENTAL DIAMETER AND THICKNESS AND NUMBER OF COTYLEDONS IN MILD AND SEVERE PREGNANCY INDUCED HYPERTENSIVE WOMEN VERSUS NORMOTENSIVE WOMEN OF DISTRICT D.I.KHAN, PAKISTAN

Background: Pregnancy induced hypertension (PIH) adversely affects the development of placenta and growth of fetus. The objectives of this study were to compare the placental diameter, placental thickness and number of cotyledons in mild PIH and severe PIH women versus normotensive women of District D.I.Khan, Pakistan.Material Methods: This comparative cross-sectional study was conducted in Department of Anatomy, Gomal Medical College, D.I.Khan, Pakistan from January to October 2014. Three samples were selected; each of size 50, group 1 normotensive/ control, group 2 with mild PIH and group 3 with severe PIH. Three research variables; placental diameter (cm), thickness (mm) and number of cotyledons were measured on ratio scale for three groups. Descriptive analysis included mean± SD with 95% confidence intervals for each group separately. With three groups on ratio data, one way-ANOVA test was applied to see significance of difference between three groups. Post hoc Dunnett’s t test was applied at alpha 0.05 to see difference of mild PIH group 2 to normotensive/ control group 1 and of severe PIH group 3 to normotensive/ control group 1separately.Results: Mean placental diameter was 18.28±2.15, 16.57±1.94 and 16.18±1.75 cm and mean placental thickness was 19.33 ±3.70, 19.18±2.78 and 17.60±3.52 mm in group 1, 2 and 3 respectively. Mean number of cotyledons was 14.42±2.25, 14.08±2.30 and 13.16±2.15 in group 1, 2, and 3 respectively. Placental diameter was statistically significantly lower in group 2 (p=.00001) and 3 (p=.00001) than group 1. Placental thickness in group 2 (p=.957) was similar to group 1, while in group 3 (p=.019) it was lower than group 1. Number of cotyledons in group 2 (p=.666) was similar to group 1, while in group 3 (p=.011) it was lower than group 1.Conclusion: In mild pregnancy induced hypertension (PIH), placental diameter was lower than normotensives, while placental thickness and number of cotyledons were similar to normotensives. In severe PIH, placental diameter, placental thickness and number of cotyledons were all lower than normotensives. It is concluded that in mild PIH, the development of placenta is mildly affected, while in severe PIH, the development of placenta is severely affected.

INSULIN RESISTANCE AND UTERINE ARTERY DOPPLER AS PREDICTORS OF PREGNANCY INDUCED HYPERTENSION

Background: In second trimester, pregnant women with Pregnancy Induced Hypertension (PIH) have different indices of uterine artery Doppler and different value of insulin resistance (IR) than normal pregnant women. Aim: This work aims to ascertain the role of uterine artery Doppler ultrasound and insulin resistance ratio in prediction of PIHPatients and methods: This cohort study(type of diagnostic test study) was done on 211 women during pregnancy in the period between 18-28wk, and the pregnant were followed until delivery. They were coming for antenatal care in the obstetric outpatient clinic at Al-Zahra University Hospital from January 2016 to December 2018.Results: In the current study, The mean age, Body Mass Index (BMI), gestational age, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) among the studied group were 30.24(years), 25.08 (kg/m2), 22.40(wks),106.7(mmHg), 69.12(mmHg) , respectively, there were 9.5%of the studied group were hypertensive, 5.7%mild PIH and 3.4% severe PIH. There were highly significance difference statistically of uterine artery Doppler Indices between normotensive and PIH group and between IR and PIH. Cut value of IR as predictor for PIH patients is 1.2 with 70%sensetivity &70% specificity in the current study. Also, there were 42.8% of the severe hypertensive patients have diastolic notch, 28.5% have reversed diastolic flow and 28.5% have absent diastolic flow.Conclusion: IR was a good predictor for PIH. There was a highly statistically significant difference between IR and PIH group. Abnormal uterine artery Doppler had a high rate of detection of maternal and fetal complications. Uterine artery Doppler is a good diagnostic test for development of preeclampsia.Keywords: Pregnancy Induced Hypertension, uterine artery Doppler, insulin resistance.

Platelet count estimation in pregnancy-induced hypertension and assessment of the degree of thrombocytopenia

Background: Gestational thrombocytopenia is the most common cause of thrombocytopenia and pregnancy-induced hypertension (PIH) is the second common cause. The degree and the incidence of thrombocytopenia depend on the severity of the disease process. Lower is the platelet count, greater will be the maternal and fetal morbidity and mortality. Early diagnosis and assessment of severity of PIH is necessary to prevent complications such as HELLP syndrome and maternal and fetal morbidity and mortality. Therefore, platelet count plays an important role in the functional evaluation of the hemostatic system. Aims and Objectives: The aims of the study were as follows: (i) To estimate the platelet count in PIH and (ii) to assess the degree of thrombocytopenia in PIH based on platelet count. Materials and Methods: The study group consisted of 120 pregnant women, of which 90 were diagnosed to be with PIH, with varying severity. Thirty subjects were control group with no signs of hypertension. Blood pressure (BP) was recorded and platelet count was assessed by peripheral smear method (PM) in all 120 pregnant women. Results: Platelet numbers done by peripheral smear were found to be 2.56 ± 0.89 lac/mm3 in mild PIH, 1.95 ± 1.12 lac/mm3 in pre-eclampsia, 1.34 ± 0.91 lac/mm3 in eclampsia, and 3.13 ± 0.96 lac/mm3 in control group. The platelet count by the automatic analyzer was 2.47 ± 0.10 lac/mm3 in mild PIH, 1.82 ± 1.02 lac/mm3 in pre-eclampsia, 1.29 ± 0.83 lac/mm3 in eclampsia, and 2.92 ± 0.98 lac/mm3 in control group. This shows that there is a decrease in platelet count with increase in severity of the disease. No statistical significant difference seen in both methods. Conclusion: Platelet count serves as an important tool for diagnosing the severity of the disease. Estimation of platelets from PM is a simple, rapid, easier, and cheaper method which can be used even at rural setup where automated counters are not available.

Histopathological findings of pregnancy-induced hypertension: histopathology of early-onset type reflects two-stage disorder theory.

The placental tissues of pregnancy-induced hypertension (PIH) patients exhibit multiple infarctions, acute atherosis, distal villous hypoplasia, and increased syncytial knots. However, these findings are not observed in all cases of PIH; thus, the significance of these changes in PIH is still unclear. We studied the frequency of histopathological changes of placental tissue in the subgroups of PIH, such as mild and severe PIH and early-onset (< 34weeks) and late-onset (≥ 34weeks) PIH. One hundred seven cases of PIH diagnosed at the Shinshu University Hospital, Matsumoto, Japan, between 2008 and 2014 were collected. PIH includes preeclampsia and gestational hypertension. The pathologic changes evaluated in the placenta were multiple infarctions, acute atherosis, distal villous hypoplasia, and increased syncytial knots. Placental tissues of patients with early-onset PIH demonstrated acute atherosis resulting from the incomplete remodeling of the spiral arteries and distal villous hypoplasia and increased syncytial knots reflecting placental hypoxia/ischemia much more frequently than those with late-onset PIH (all p < 0.001). The frequencies of multiple infarctions did not show a statistical difference between early-onset PIH and late-onset PIH. Moreover, there were no significant differences in the frequencies of histopathological features of placental tissue between mild PIH and severe PIH. Early-onset PIH exhibited histopathological changes of placental tissue consistent with the two-stage disorder theory more frequently than late-onset PIH. These findings support the idea that early-onset PIH and late-onset PIH are distinct entities or different extremes of the PIH spectrum.

Influence of serum HMW adiponectin level in patients with pregnancy-induced hypertension syndrome on the occurrence of eclampsia in secondary pregnancy.

In the present study, we studied the influence of serum high-molecular weight adiponectin (HMWA) levels in patients with pregnancy-induced hypertension (PIH) on the occurrence of eclampsia in secondary pregnancy and its related mechanisms. In total, 130 patients who were diagnosed with PIH for the first time were selected for this study; the median interval of the secondary pregnancy was 28.5 months. The serum HMWA and leptin levels both times were detected, and the insulin resistance indexes (HOMA-IR) were calculated. The serum inflammatory indexes in the secondary pregnancy included interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, and the oxidative stress indexes included methane dicarboxylic aldehyde (MDA) and oxidized low-density lipoprotein (ox-LDL) levels. The expression levels of adiponectin receptor 2 and cyclooxygenase-2 (COX-2) in placental tissue were detected. In secondary pregnancy, there were a total of 20 cases of eclampsia (15.38%), including 2 cases of mild PIH, 8 cases of moderate PIH and 10 cases of severe PIH; differences were statistically significant when compared to patients without eclampsia (p<0.001). The serum HMWA levels in patients with severe PIH in the first pregnancy were significantly lower than those in patients with mild and moderate PIH, and the serum levels in patients with mild PIH were the highest. The leptin levels in patients with severe PIH were significantly higher than those in patients with mild and moderate PIH, and the leptin levels in patients with mild PIH were the lowest (p<0.05). The HMWA levels in patients with eclampsia in the secondary pregnancy was significantly lower than those in patients without eclampsia, and the leptin levels in patients with eclampsia were significantly increased. The HMWA levels in patients with eclampsia in the secondary pregnancy were lower than that in the first pregnancy, whereas the leptin levels were higher than that in the first pregnancy (p<0.05). HOMA-IR, IL-6, TNF-α, MDA and ox-LDL levels in patients with eclampsia were significantly higher than those in patients without eclampsia (p<0.05), and the adiponectin receptor 2 and COX-2 expression levels in the placental tissue were significantly higher than those in patients without eclampsia (p<0.05). Therefore, the serum HMWA levels are closely related to the occurrence of eclampsia in PIH patients in secondary pregnancy, and it influences insulin resistance, inflammatory response and oxidative stress response, which is correlated with increased adiponectin receptor 2 and COX-2 protein expression in placental tissue. Consequently, HMWA may be an important target for the intervention of preventing eclampsia for PIH patients in secondary pregnancy.

Oxidative Stress Marker and Pregnancy Induced Hypertension.

Background:Pregnancy induced hypertension (PIH) is a state of extremely increased oxidative stress. Hence, research and test of role and significance of oxidative stress in hypertensive disturbance in pregnancy is very important.Aim:Aims of this research were to determine a level of thiobarbituric acid reactive substance (TBARS) as oxidative stress marker in blood of pregnant woman with pregnancy induced hypertension and to analyze correlation of TBARS values with blood pressure values in pregnancy induced hypertensive pregnant women.Patients and methods:Research has been performed at the Clinic of Gynecology and Obstetrics, University Clinical Centre in the Republic of Srpska. It covered 100 pregnant women with hypertension and 100 healthy pregnant women of gestation period from 28 to 40 weeks. Level of TBARS is determined as an equivalent of malondialdehyde standard, in accordance with recommendations by producer (Oxi Select TBARS Analisa Kit).Results:Pregnancy induced hypertension is a state of extremely increased oxidative stress. All pregnant women experiencing hypertension had increased TBARS values in medium value interval over 20 µmol, 66%, whereas in group of healthy pregnant women, only 1% experienced increased TBARS value. Pregnant women with difficult preeclampsia (32%) had high TBARS values, over 40 µmol, and with mild PIH, only 4.9% pregnant women.Conclusion:Pregnant women with pregnancy induced hypertension have extremely increased degree of oxidative stress and lipid peroxidation. TBARS values are in positive correlation with blood pressure values, respectively the highest TBARS value were present in pregnant women with the highest blood pressure values.

English

BACKGROUND: Pregnancy induced Hypertension (PIH) is one of the common complications which contributes to significant maternal and perinatal morbidity and mortality. Effective management improves outcome of both mother and the baby OBJECTIVES: To study the morbidity and mortality in babies born to mothers with pregnancy induced hypertension, assess the reasons for the outcome of the baby and monitor the growth and development till the age of 6 months. METHODS: This study was conducted at Niloufer Institute of Child Health, Hyderabad a teaching institution which caters to high risk obstetric patients and also has a tertiary level NICU care. Study was conducted over a period of 9 months and 100 cases of PIH were included over a period of 3 months and the babies were followed up till the age of 6 months. A structured proforma was designed and analyzed using Epi info for window statistical software. RESULTS: Out of 1461 deliveries, we enrolled 100 PIH cases as per inclusion criteria and studied during 3 months period. Of the study group, 48% were with mild PIH (n=48) and 52% were with severe PIH (n=52). When compared to mild PIH, severe PIH was associated with higher rates of preterm deliveries and it was statistically significant (P 2). In NICU admissions Meconium aspiration syndrome (MAS), Hyaline membrane disease (HMD), Birth asphyxia (BA) and sepsis were observed. All the complications were more in severe PIH than mild PIH. After discharge infants were fallowed up till the age of 6 months. Out of 75 babies discharged, 24 cases were lost to follow up and in the remaining 51 babies, 33 were born to mild PIH mothers, 18 were born to severe PIH mothers. CONCLUSION: PIH is one of the major causes of morbidity and mortality in the fetus and newborn. The more severe the PIH, the more adverse is the outcome. Our goal is early detection and prompts Management.

Prevalence of Ocular Changes in Pregnancy Induced Hypertension

Objective: The aim was to study the correlation of grade of pregnancy induced hypertension (PIH) with retinal changes in PIH. Materials & Methods: A total of 50 patients were observed for correlation of the grade of PIH with retinal changes in PIH on fundus examination. All the patients admitted with diagnosis of PIH were included in this study. Patients were divided into 2 groups according to the grade of PIH, i.e., mild and severe. Retinal changes in the form of attenuation of arterioles, AV crossing changes, hemorrhages or exudates were reported. These changes were observed from 24th to 34th week of gestation. Parameters like age, gestation period, gravida, BP and proteinuria were documented. After taking history of any ocular symptoms, fundus examination under mydriasis was done with direct ophthalmoscope in the ward itself. Findings were noted on a data sheet. Results: A total of 50 patients of PIH were examined. Mean age of patient was 29.5±3 years (21–38 years). Gestation period ranges from 25 and 36 weeks in which 34 (68%) patients were primigravida. 30 (60%) had mild PIH, 20 (40%) had severe PIH. Retinal changes (hypertensive retinopathy) were noted in 13 (26%) patients. A positive correlation was observed between grade of PIH and retinal changes. Most changes are observed in severe PIH. Conclusion: Grade of PIH from 24th to 34th week of gestational age can be used as an indication in assessment of retinal changes. Fundus examination helps in assessing the severity of PIH.

Change of hs–CRP, sVCAM–1, NT–proBNP levels in patients with pregnancy-induced hypertension after therapy with magnesium sulfate and nifudipine

ObjectiveTo investigate the change of the hs–CRP, sVCAM–1, NT–proBNP levels of the patients with pregnancy–induced hypertension (PIH) syndrome. MethodsA total of 200 patients with PIH were divided into mild, moderate and severe group, and 50 healthy pregnancy patients served as the control group. The serum sVCAM–1 levels were detected by enzyme–linked immunosorbent assay, hs–CRP were detected by immunity transmission turbidity, and NT–proBNP levels were determined by the colloidal gold method. Patients were treated with magnesium sulfate and nifudipine and the contrastive analysis was performed before and after treatment. And the pathological changes in placental of PIH patients were detected by hematoxylin–eosin staining at the same time. ResultsThe hs–CRP, sVCAM–1, NT–proBNP levels of patients in the mild, moderate and severe PIH group were significantly higher than that in the control group (P<0.05). The hs–CRP, sVCAM–1, NT–proBNP levels in the severe group were significantly higher than the mild group and the moderate group, the difference was statistically significant (P<0.05). The hs–CRP, sVCAM–1, NT–proBNP of the moderate group were significantly higher than the mild group (P<0.05). There was a positive correlation between hs–CRP, sVCAM–1, NT–proBNP expression levels and the degree of the PIH. The expression of hs–CRP, sVCAM–1, NT–proBNP levels of the moderate and the severe group were significantly decreased (P<0.05). The number of placental villi and interstitial blood vessel in the moderate and severe PIH group were significantly less than the control group (P<0.05). ConclusionsThe increased levels of serum hs–CRP, sVCAM–1, NT–proBNP may be involved in the process of vascular endothelial cell injury of the PIH, and the hs–CRP, sVCAM–1, NT–proBNP can be used as the auxiliary index for diagnosis of PIH and determination of PIH severity.

Severe pre-eclampsia and hypertensive crises

Hypertensive disorders of pregnancy are one of the leading causes of peripartum morbidity and mortality globally. Hypertensive disease in pregnancy is associated with a spectrum of severity, ranging from mild pregnancy-induced hypertension to eclampsia. Although most cases of pre-eclampsia may be managed successfully, severe pre-eclampsia is a life-threatening multisystem disease associated with eclampsia, HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome, acute kidney injury, pulmonary oedema, placental abruption and intrauterine foetal death. Management of severe pre-eclampsia includes identification of high-risk patients, optimisation of antenatal care, early intervention and the identification and early management of complications. In the first instance, oral anti-hypertensive agents, including labetalol, nifedipine and methyldopa, should be tried. If oral anti-hypertensive agents have failed to adequately control blood pressure, intravenous anti-hypertensives should be considered. Commonly used intravenous anti-hypertensives include labetalol, hydralazine and glyceryl trinitrate. In addition to anti-hypertensive agents, close attention should be given to regular clinical examination, assessment of fluid balance, neurologic status and monitoring of other vital signs. Magnesium sulphate should be considered early to prevent seizures. Delivery of the baby is the definitive management of severe pre-eclampsia.

Does induction of labour increase the risk of caesarean section? A systematic review and meta‐analysis of trials in women with intact membranes

Recent literature on the effect of induction of labour (compared with expectant management) has provided conflicting results. Reviews of observational studies generally report an increase in the rate of caesarean section, whereas reviews of post-dates and term prelabour rupture of membrane (PROM trials suggest either no difference or a reduction in risk. To evaluate with a systematic review and meta-analysis of randomised controlled trials (RCTs) whether or not the induction of labour increases the risk of caesarean section in women with intact membranes. Literature search using electronic databases: MEDLINE, EMBASE, and the Cochrane Database of Clinical Trials. RCTs comparing a policy of induction of labour with expectant management in women with intact membranes. A total of 37 trials were identified and reviewed. Quantitative analyses with fixed- and random-effects models were performed with revman 5.1. Of the 37 RCTs, 27 were trials of uncomplicated pregnancies at 37-42weeks of gestation. The remaining ten evaluated induction versus expectant management in pregnancies with suspected macrosomia (two), diabetes in pregnancy (one), oligohydramnios (one), twins (two), intrauterine growth restriction (IUGR) (two), mild pregnancy-induced hypertension (PIH) (one), and women with a high-risk score for caesarean section (one). Meta-analysis of 31 trials determined that a policy of induction was associated with a reduction in the risk of caesarean section compared with expectant management (OR 0.83, 95%CI 0.76-0.92). Induction of labour in women with intact membranes reduces the risk of caesarean section. Review of the trials suggests that this effect may arise from non-treatment effects, and that additional trials are needed.

MATERNAL AND FOETAL OUTCOME IN PREGNANCY INDUCED HYPERTENSION: A STUDY FROM RURAL TERTIARY CARE TEACHING HOSPITAL IN INDIA

Background: Preeclampsia and eclampsia have been recognized as clinical entities since the times of Hippocrates. Pregnancy induced hypertension (PIH) is one of the commonest disorders associated with the increased risk of maternal and fetal complications. It is reported in the world literature that the incidence of eclampsia is on the decline, but still a menace in developing countries. Objectives: To study the maternal and foetal outcome in pregnancy induced hypertension. Material and Methods: A prospective randomized study was carried out from February 2009 to January 2010 in the Department of Obstetrics and Gynecology of Pravara Rural Hospital, Loni, India. A total of 100 pregnant women with PIH were enrolled in the study. A pre-tested interview tool was used to collect necessary information such as detailed history, clinical examination findings and investigations performed. Results were analysed using SPSS 13.0 Results: In the present study, the overall incidence of PIH was 8.96%, which includes preeclampsia in 7.26% and eclampsia in 1.70%. Preterm labour was the commonest maternal obstetrical complication observed in 18% of mild PIH and 48% of severe PIH cases. Prematurity was the commonest foetal complication seen in 17.99%, 47.62% and 52.63% of mild PIH, severe PIH and Eclampsia cases respectively. Conclusion: Pregnancy induced hypertension is a common medical disorder seen associated with pregnancy in the rural population, especially among young primigravidas, who remain unregistered during pregnancy. Maternal and fetal morbidity and mortality can be reduced by early recognition and institutional management.

Prevalence and risk factors for anaemia in pregnant women: a population-based prospective cohort study in China

Maternal anaemia is a common pregnancy complication in developing countries; however, its epidemiology remains largely unexplored in China. This study was designed to explore the epidemiology and risk factors of anaemia during pregnancy. A prospective cohort study was conducted, using data from a population-based pregnancy-monitoring system in 13 counties in East China (1993-96). Women who delivered singleton infants at 20-44 weeks with at least one haemoglobin assessment during pregnancy were included (n = 164 667). The prevalence of anaemia (haemoglobin < 10 g/dL) during pregnancy as well as in each trimester was estimated. Multivariable log-binomial regression models were used to evaluate risk factors. The overall prevalence of anaemia in pregnancy was 32.6%, with substantial variations across trimesters (11.2%, 20.1% and 26.2% in the 1st, 2nd and 3rd trimesters respectively). Risk factors for anaemia included older maternal age, education below junior high school (prevalence rate ratio [RR] 1.10, 95% confidence interval [CI] 1.08, 1.12), farming occupation (1.05, 95% CI 1.03, 1.06), and mild pregnancy-induced hypertension (PIH) (RR 1.09, 95% CI 1.05, 1.13) and severe PIH (RR 1.13, 95% CI 1.06, 1.19). Peri-conception folic acid use was associated with a reduced risk for anaemia in the 1st trimester (RR 0.75, 95% CI 0.72, 0.78). Initiating prenatal care after the 1st trimester was associated with increased risk of anaemia in the 2nd and 3rd trimesters. Our study found anaemia during pregnancy is highly prevalent in this indigenous Chinese population. The risk increases with the severity of hypertensive disorders. Folic acid supplementation during the peri-conception period is associated with reduced risk of 1st trimester anaemia.

Atypical case of reversible posterior leucoencephalopathy syndrome associated with puerperal HELLP syndrome

Reversible posterior lekoencephalopathy syndrome (RPLS) is usually reversible. However, permanent cerebral damage may result if diagnosis is delayed. White matter edema in the posterior cerebral hemispheres is typical on neuroimaging. A 36-year-old primigravid woman underwent induction of labor due to mild pregnancy-induced hypertension. At 5 h after delivery, she developed eclampsia seizures complicated by hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Magnetic resonance imaging showed high-density lesions in anterior regions without any abnormalities in posterior cerebral regions. Cases of postpartum RPLS without involvement of posterior brain regions after eclampsia complicated by HELLP syndrome are very rare. Patients with RPLS do not always show typical manifestations.

Structural Changes in Umbilical Vessels in Pregnancy Induced Hypertension

Background Pregnancy Induced Hypertension (PIH) is associated with placental morphological changes, alterations in the blood flow patterns in the umbilical vessels and adverse fetal and maternal outcome. Studies have demonstrated changes in the structure of the umbilical vessels but these have not been described across the length of the cord or correlated with the severity of disease. Study design A case control study. Setting Kenyatta National Hospital. Materials and methods Thirty six umbilical cords from newborns of women with and without PIH (18 cases, 18 controls) were obtained and studied with light microscopy. Of the cases 9 women had severe PIH and 9 had mild PIH. Means and standard deviations for the various parameters of the various groups were obtained. Student's t-test and ANOVA were used to compare means, a p value of <0.05 being significant. Results The structure of the umbilical vessels changes from the placental end to the fetal end. The umbilical vein in PIH had a greater wall thickness and a smaller luminal area than in the controls. The vein's wall-luminal ratio increased from the placental to the fetal end. Duplication of the elastic subintimal lamina (ESL) was higher in the cases. The ESL was more commonly duplicated in the fetal end. There were no structural differences between the umbilical arteries in PIH and in the controls. Conclusion PIH is associated with structural changes in the umbilical vessels. These changes are more predominant in the vein than in the artery and in the vein, they are more obvious in the fetal end. The observed increase in wall-luminal ratio from the placental to the fetal end suggests that the fetal end of the umbilical vein has a more refined role in the regulation of blood flow to the fetus.

Teenage pregnancies and their obstetric outcomes

This study was conducted to evaluate the obstetric performance of teenage women in India. In total, 13,210 women were included in the study, of whom 840 were teenagers (<19 years) and 12,370 were > or =20 years. Antepartum, intrapartum and postpartum events were recorded and comparative analysis was done. We found that teenage women were at a significantly higher risk for development of severe anaemia (relative risk [RR] 1.61, P value <0.02), eclampsia (RR 1.95, P value <0.05), preterm labour (RR 1.25, P value <0.001), intrauterine growth retardation (RR 2.29, P value <0.001) and low birth weight (RR 1.24, P value <0.001). Assisted delivery (11.78% versus 2.23%, P value <0.001) was significantly more common and caesarean delivery (9.64% versus 17.18%, P value <0.001) was significantly less common in teenagers. Moderate anaemia, mild pregnancy-induced hypertension, preeclampsia, premature rupture of membranes, antepartum haemorrhage and post dates were all significantly higher in > or =20 years group. To conclude, we found that teenage women are a high-risk group, which is aggravated by social and cultural factors. Special attention is required to educate these women for more positive outcomes.

The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study.

BackgroundHypertensive disorders in pregnancy are leading causes of maternal, fetal and neonatal morbidity and mortality worldwide. However, studies attempting to quantify the effect of hypertension on adverse perinatal outcomes have been mostly conducted in tertiary centres. This population-based study explored the frequency of hypertensive disorders in pregnancy and the associated increase in small for gestational age (SGA) and stillbirth.MethodsWe used information on all pregnant women and births, in the Canadian province of Nova Scotia, between 1988 and 2000. Pregnancies were excluded if delivery occurred < 20 weeks, if birthweight was < 500 grams, if there was a high-order multiple pregnancy (greater than twin gestation), or a major fetal anomaly.ResultsThe study population included 135,466 pregnancies. Of these, 7.7% had mild pregnancy-induced hypertension (PIH), 1.3% had severe PIH, 0.2% had HELLP (hemolysis, elevated liver enzymes, low platelets), 0.02% had eclampsia, 0.6% had chronic hypertension, and 0.4% had chronic hypertension with superimposed PIH. Women with any hypertension in pregnancy were 1.6 (95% CI 1.5–1.6) times more likely to have a live birth with SGA and 1.4 (95% CI 1.1–1.8) times more likely to have a stillbirth as compared with normotensive women. Adjusted analyses showed that women with gestational hypertension without proteinuria (mild PIH) and with proteinuria (severe PIH, HELLP, or eclampsia) were more likely to have infants with SGA (RR 1.5, 95% CI 1.4–1.6 and RR 3.2, 95% CI 2.8–3.6, respectively). Women with pre-existing hypertension were also more likely to give birth to an infant with SGA (RR 2.5, 95% CI 2.2–3.0) or to have a stillbirth (RR 3.2, 95% CI 1.9–5.4).ConclusionsThis large, population-based study confirms and quantifies the magnitude of the excess risk of small for gestational age and stillbirth among births to women with hypertensive disease in pregnancy.