Moderate Pregnancy-induced Hypertension Research Articles

Placental pathology in different degrees of pregnancy induced hypertension

Introduction: Pregnancy induced hypertension (PIH), a well-known medical complication of pregnancy is potentially morbid for the foeto-maternal health. It is also responsible for perinatal morbidity and mortality due to its effects on the growing foetus. Objectives: The present study was undertaken to analyse the histomorphological and gross features of placenta in pregnancy induced hypertension in relation to severity of hypertension, age of the patient, parity and gestational age. Materials and Methods: The current study was done at Gandhi Hospital, Secunderabad, India on antenatal cases of PIH of varying degrees. The placentas of these patients following delivery were studied and statistic significance between different histologic findings and severity of PIH calculated. Results: Incidence of PIH was highest in women above 26yrs of age (42%) and was found to be almost equal in both multiparous (52%) and primiparous (48%) women. Foetal outcome was worst in severe PIH (IUGR of 28.8% and IUD of 17.85%). The gross abnormalities noted, retroplacental hematomas (42%) and small sized placentae (24%) were more often seen in severe PIH. The consistent histological changes observed include fibrinoid necrosis (86%), thickened basement membrane (74%), increased syncitial knots (72%), stromal fibrosis (54%), cytotrophoblastic proliferation (46%), intervillous haemorrhage (40%), and calcification (34%). Conclusion: The pathological changes in the placenta seen in PIH patients are almost equally prevalent irrespective of the parity. Cases with severe PIH displayed features of placental underperfusion more frequently than with mild to moderate PIH. Hence watchful individualized management of PIH helps reduce the incidence of complications and morbidity.

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.

The study of the correlation of pregnancy-induced hypertension in the case of indexing syndrome and pregnancy outcome

Objective To study the correlation of pregnancy-induced hypertension in the case of indexing syndrome and pregnancy outcome, and to explore their clinical applicability. Methods 30 cases of birth mothers with pregnancy-induced hypertension were selected.According to the severity of hypertension, the patients were divided into the severe pregnancy-induced hypertension group, the moderate pregnancy-induced hypertension and the mild gestational hypertension group.The different levels of pregnancy-induced hypertension maternal outcome indicators, and different maternal outcomes in the two groups were analyzed and compared. Results Preterm birth (58.3%), cesarean section (66.7%), gestational age (33.6±2.8)weeks, baby weight (2 330.3±652.3)g of pregnancy-induced hypertension group were significantly higher than moderate pregnancy-induced hypertension group[18.2%, 18.2%, (36.6±3.7)weeks and (2 892.6±761.4)g], the differences were statistically significant (χ2=3.884 5, χ2=5.490 0, t=2.204 8, t=1.907 1, all P<0.05). The eclampsia (41.7%), postpartum hemorrhage (58.36%), acute renal failure (41.7%) of pregnancy-induced hypertension group were significantly less than the moderate (9.1%, 18.2%, 9.1%), mild maternal gestational hypertension group (0.0%, 14.3%, 0.0%), the differences were statistically significant(χ2=3.158 6, χ2=3.884 5, χ2=3.158 6, all P<0.05). Those of moderate maternal gestational hypertension group were significantly higher than the mild gestational hypertension group, the differences were statistically significant (P<0.05). Conclusion Pregnancy-induced hypertension syndrome has significant effect on pregnancy outcomes, the severity degree of pregnancy-induced hypertension is positively correlated with pregnancy outcomes, so early prevention of pregnancy-induced hypertension can increase overall maternal prognosis. Key words: Pregnancy induced hypertension; Pregnancy outcomes; Relevance

Role of antihypertensive therapy in mild to moderate pregnancy-induced hypertension: a prospective randomized study comparing labetalol with alpha methyldopa

Pregnancy-induced hypertension (PIH) is associated with adverse fetal and maternal outcome. The role of medication to control blood pressure (BP) in mild to moderate PIH is controversial. We conducted a prospective study to investigate whether pharmacological treatment of mild to moderate PIH is effective in improving maternal and fetal outcomes. A total of 150 consecutive pregnant women without proteinuria and with physician-recorded systolic BP of 140-160 mmHg and/or diastolic BP of 90-105 mmHg on two occasions ≥6 h apart between 20 and 38 weeks of gestation were randomly allocated to receive either labetalol or methyldopa (50 patients each) plus standard care (treatment group) or only standard care (50 patients) (control group). As compared to the control group, the treatment group had lower rates of severe PIH (28% vs. 10%, P = 0.005), proteinuria (28% vs. 12%, P = 0.016), hospitalization before term (28% vs. 14%, P = 0.041), and delivery by cesarean section (38% vs. 22%, P = 0.042). In a multivariable logistic regression model that adjusted for maternal age, weight, parity, previous PIH, and baseline hemoglobin, resting heart rate, and BP levels, antihypertensive therapy was associated with a lower incidence of adverse maternal events (P = 0.011). Compared to the control group, the treatment group had lower incidence of SGA babies (40% vs. 23%, P = 0.033), preterm birth (36% vs. 14%, P = 0.002), and admission to neonatal unit (30% vs. 15%, P = 0.036). After adjustment for maternal age, weight, baseline hemoglobin, resting heart rate, BP level, parity and previous history of PIH, fetal death, preterm delivery or SGA baby, antihypertensive therapy was associated with a lower incidence of adverse perinatal events (P = 0.016). Maternal and perinatal mortality rates were not significantly different between treatment and control groups. In conclusion, pharmacological treatment of mild to moderate PIH is associated with lower rate of some maternal and fetal-neonatal non-fatal adverse events compared to no routine use of antihypertensive therapy.

Association between pregnancy-induced hypertension, cesarean delivery and perinatal mortality: a prospective study

To examine the relationship between pregnancy-induced hypertension (PIH) and risks of perinatal mortality. A population-based, retrospective cohort study was conducted based on 134 858 women registered in a perinatal health care surveillance system and delivered singleton births between 1995 to 2000 in Zhejiang province, China. Multivariate logistic regression models were employed to estimate the relative risk (OR) and 95%CI. The perinatal mortality rate (95%CI) was 7.6 per thousand (7.1 - 8.1) in normotensive women and 9.2 per thousand (7.7 - 10.8) in PIH women. The cesarean delivery rate was 45.7% in normotensive women and 55.7% in groups with PIH. When compared with the normotensive women, the unadjusted OR (95%CI) for perinatal mortality was 1.21(1.01 - 1.46) in groups with PIH; 0.97 (0.77 - 1.22) in groups with mild PIH, 1.73 (1.26 - 2.37) in groups with moderate PIH, and 2.01 (1.18 - 3.43) in groups with severe PIH; 0.99 (0.77 - 1.26) in groups with PIH developed before delivery, 1.39 (1.05 - 1.84) in groups with PIH developed in second trimester, and 2.69 (1.54 - 4.69) in groups with PIH developed in third trimester. After controlling for maternal age, occupation, educational attainment, parity, times of prenatal visit, infant's sex, pregnancy complications and cesarean delivery, the OR (95%CI) for perinatal mortality was 1.09 (0.90 - 1.31) in women with PIH when compared with the normotensive groups. The adjusted OR for perinatal mortality was 0.81 (0.64 - 1.02) in groups with mild PIH, 1.94 (1.41 - 2.67) in groups with moderate PIH, and 3.32 (1.92 - 5.75) in groups with severe PIH; 0.82 (0.63 - 1.05) in groups with PIH developed before delivery, 1.51 (1.14 - 2.00) in groups with PIH in second trimester, and 2.67 (1.52 - 4.70) in groups with PIH in third trimester. Moderate and severe PIH early developed during pregnancy could increase the risk of perinatal mortality, while cesarean delivery could decrease the risks in women with PIH.

Study on the expression of angiotensin II (ANG II) receptor subtype 1 (AT 1R) in the placenta of pregnancy-induced hypertension

Objective To study the expression of angiotensin II (ANG II) receptor subtype 1 (AT 1R) in the human placenta with pregnancy-induced hypertension (PIH). Methods Immunohistochemistry was used to detect the expression of AT 1R in placental tissues of 30 patients with PIH and 10 patients with normal pregnancies (control group). The PIH tissues were further divided into 3 groups: mild PIH group, moderate PIH group and severe PIH group. Each group consisted of 10 patients. A high-resolution pathological image analysis system (HPIAS-1000) was used to determine the quantity of AT 1R expression. Results The integral optical density and area of staining in the syncytiotrophoblast (STB) layer and villous endothelium of the placenta were significantly increased in PIH patients, in the moderate and severe PIH groups, as compared with the control group ( P<0.05), indicating that the expression of AT 1R was highly increased in PIH. However, there was no significant difference between normal pregnancy and the mild PIH group ( P>0.05). Furthermore, statistically significant differences in AT 1R expression were observed between mild, moderate and severe PIH groups ( P<0.05). Conclusion The expression of AT 1R is statistically significantly increased in the STB layer and villous endothelium of human placenta with PIH. Expression increases with the severity of the disease. Increased expression may be involved in the pathogenesis of PIH.

Risk factors associated with antepartum fetal death

This study examined risk factors that contribute to antepartum fetal death. The population-based sample included 416 antepartum fetal deaths and 449 normal births as controls, from 29 hospitals in Shanghai, China. In addition to small-forgestational-age and severe pregnancy-induced hypertension, exposure to environmental hazards (radiation, chemicals and pesticides) was significantly associated with fetal death. Elevated relative risk of fetal death was also found in pregnant women whose husbands smoked (adjusted odds ratio = 1.4). Clinico-pathologic evidence further confirmed that exposure to hazards, especially in the first trimester, increased the risks of congenital anomalies (odds ratio = 2.7) and antepartum fetal death from congenital malformations (odds ratio = 3.5). This study also showed that threatened abortion was a significant predictor of risk of fetal death. No significant relationships were identified between sex of fetus, mild or moderate pregnancy-induced hypertension, maternal anemia and antepartum fetal death.

Significance of urinary enzymes in gestosis.

The levels of five enzymes were examined in the urine and the serum of pregnant women. They included leucine aminopeptidase (LAP), alkaline phosphatase (AP), N-acetyl-beta-glucosaminidase (ABG), lactic acid dehydrogenase (LDH) and glutamic-oxaloacetic transaminase (GOT). After establishing the normal curve and upper confidence limits in healthy pregnant patients (138 examinations in 52 women), the the enzymes were examined in the urine and the serum of 21 severe and 23 mildly toxemic cases. The mean urinary levels of ABG, AP and LAP in the severe cases were significantly higher than in the normals, and by examining all three enzymes, at least one of them was found to be above the upper confidence limit in 95% of the severely ill women. The changes did not show up early enough to form a good diagnostic and prognostic sign in moderate pregnancy-induced hypertension, but severe kidney damage may be revealed earlier than by the regular kidney function tests, and patients with a bad remote prognosis can be singled out by this method.