Cases Of PIH Research Articles

Platelet count and platelet indices in patients of pregnancy-induced hypertension at a rural tertiary care hospital in western India

Background: Pregnancy-induced hypertension is a serious complication during pregnancy causing maternal and fetal morbidity and mortality. Pregnancy-induced hypertension associated with thrombocytopenia can help in predicting the severity of the disease. The study aimed to study the platelet count, and platelet indices in Pregnancy induced hypertension patients and compare them with normotensive pregnant women. Materials and methods: This was a case control study, conducted on patients visiting antenatal care (ANC) at a Tertiary care rural hospital in western India. Study population included a total of 82 patients, which were divided into 2 groups with 41 patients in each control (healthy pregnant women) and study groups (pregnant women with PIH). Patients with chronic hypertension and known case of thrombocytopenia were excluded from the study. The blood samples collected were processed on fully automated cell counter for estimation of platelet count and indices. Results: The platelet count in the study group ranged from 186434.1±81086.9 whereas in the control group it was 268659±72206.9, showing that the platelet count was significantly lower in women with Pregnancy induced hypertension than in the control group. The MPV, PDW, systolic BP, diastolic BP was found to be significantly elevated in the study group as compared to the control group. Conclusions: The present study concludes that blood parameter such as platelets count and platelet indices can be considered as an early, economical and easily available parameter for assessment of severity of PIH cases.

Hypertension in Pregnant Females Promotes Thrombocytopenia

Objective: To determine how often pregnant hypertensive women get thrombocytopenia during the pregnancy. Study Design: Retrospective study Place and Duration: People university of Medical and Health Sciences for Women Nawabshah. January 2022 to December 2022. Methods: Total 63 pregnant females were presented. All the presented females had pregnancy induced hypertension with age group 18-46 years. All cases included platelet estimate, and thrombocytopenia was diagnosed in individuals with a reported platelet count of less than 1,50,000/cumm. All data were analyzed with SPSS 24.0. Results: Pregnant females had mean age 28.6±4.35 years and had mean BMI 26.4±3.29 kg/m2. Frequency of primigravida was 27 (42.9%) and 36 (57.1%) cases were multi-gravida. Majority of the patients 55 (87.3%) had blood pressure 140-160/90-110 mmHg and 8 (12.7%) cases had Bp > 160/110 mmHg. Frequency of thrombocytopenia was found in 17 (26.98%) cases. Among 17 cases of thrombocytopenia mild PIH was found in 3 cases, moderate in 5 cases and 8 cases had severe PIH. Conclusion: In particular, in third-trimester hypertensive pregnant women, gestational thrombocytopenia (GT) is recognized as a primary cause of thrombocytopenia. For those women, careful monitoring both during and after pregnancy is advised. Keywords: Thrombocytopenia, Gestational hypertension, Pregnancy

Retrospective analysis of causes of death in severe PIH, Preeclampsia & Eclampsia cases in a tertiary medical care centre from January 2015 to December 2016

: PIH, preeclampsia and eclampsia cases are one of the leading cause of maternal death especially in underdeveloped countries. Substandard maternity care is thought to be the reason behind it. Hypertensive disorders in pregnancy is a multi-organ involving disease of unknown etiology. Early detection, timely intervention, strict vigilance and intensive monitoring is needed to prevent maternal mortality and morbidity.: Our aim was to detect the cause of death among pregnant women admitted with hypertensive disorders so that measures can be taken to improve the maternity service.: It was a Retrospective analytical study of causes of maternal death among hypertensive disorders in pregnancy cases admitted in our institution from 1 January 2015 to 31 December 2016.Data were collected from case sheets, death certificates and review report on maternal death cases and were analysed and presented. It was found that pulmonary oedema was the most common (75%) cause of maternal death in PIH cases. Improper antepartum care and delay in seeking medical help, moreover, lack of proper utilization of maternity services was the main cause behind the high maternal mortality in PIH cases (89.6%).: Substandard maternity care was found to be responsible for so high maternal death in PIH cases. This result was similar to the other studies in this context. These deaths are preventable to a large extent.

Determine the Diagnostic Accuracy of High Beta HCG Levels in Predicting Pregnancy Induced Hypertension

Aim: To determine the diagnostic accuracy of high beta HCG levels (>2 median concentration measured) in predicting pregnancy induced hypertension. Study design: Cross-sectional analytical study. Place and duration of study: Department of Obstetrics & Gynaecology, Social Security Hospital, Lahore from 1st January 2021 to 31st December 2021. Methodology: One hundred and fifty pregnant females at 13-20 weeks of gestation were included. A 3cc blood sample was withdrawn from each women and serum was separated. The serum was stored at -20°C until analysis of β HCG test. This test was analyzed via enzyme-linked immunosorbent assay. The sensitivity of the test was 86.5% and specificity was 96.8%. Each woman was followed till delivery and her status of hypertension which was induced due to pregnancy was observed. Results: The mean age was 31.5±6.2 years. The value of 2 median concentration measured showed that 23 cases had a value less or equal to 2 while 60 cases were those having a value greater than 2. The diagnostic accuracy of this test was 92.6%. There were 69.8% cases of PIH having beta HCG levels greater than 71000 mIU/ml and six cases with level of beta HCG higher than 100000 mIU/ml. Conclusion: Pregnancy induced hypertension is significantly associated with higher level of beta HCG and has an efficient diagnostic accuracy. Key words: Beta HCG, Pregnancy, Hypertension

Study on Histomorphological Findings in Placenta in Cases of Pregnancy Induced Hypertension

Introduction: PIH is a common condition associated with changes in placenta. It leads to increased perinatal mortality. The present study was conducted to assess the morphological and histopathological changes in placenta in cases of pregnancy induced hypertension. Subjects and Methods: The present comparative study included 49 cases of PIH and 49 normotensive mothers. Clinical details and placental morphology were noted. Results: That the two groups are similar with no significant difference. Placental weight and diameter were similar in PIH and control groups (p>0.05). However, placental thickness and number of cotyledons were greater in PIH group (p=0.00) while placental volume was lower with significant difference (p=0.01). PIH group showed greater proportion of infarction, calcification, hyalinised area per 10 lpf and intervillous haemorrhage (p=0.00). Conclusion: PIH leads to gross and microscopic changes in placental morphology.

Clinical profile of pregnant women with pregnancy induced hypertension

Multisystem disorders of unknown aetiology characterized by development of HTN to the extent of 140/90 mm Hg or more with Proteinuria after 20thwk of pregnancy in a previously normotensive and non proteinuric patient. May appear before 20wks in cases of hydatidiform mole, acute polyhydramnios and multiple pregnancies. BP≥ 140/90 mm Hg before pregnancy or diagnosed before 20 weeks gestation not attributable to gestational trophoblastic disease (OR) Hypertension first diagnosed after 20 weeks gestations and persistent after 12 weeks postpartum. In chronic HTN, the foetus is more prone for growth restriction, preterm delivery, and death of foetus. 50% of the cases belong to The Labetalol Group, while the other 50% comprise The Nifedipine Group, selected randomly. Each group comprised a total of 62 cases, 50 of them are Mild PIH cases while the other 12 cases are the cases of Severe Hypertension, Imminent Eclampsia, Eclampsia, Placental Abruption etc. Most of the cases of Labetalol Group progressed up to term, of which one case crossed the EDD. This woman was discharged at her request and she reported to the hospital only after crossing the EDD. As many as 69.35% (43 cases) delivered vaginally in Labetalol Group, whereas the Caesarean section rate for Nifedipine group is about 48.39%. Emergency Caesarean section rate was 25.80% in Labetalol group where as it was 37.10% in the Nifedipine Group

Study of fundus findings in pregnancy induced hypertension

Study of fundus findings in pregnancy induced hypertension - IJOOO- Print ISSN No: - 2581-5024 Online ISSN No:- 2581-5016 Article DOI No:- 10.18231/j.ijooo.2019.045, IP International Journal of Ocular Oncology and Oculoplasty-IP Int J Ocul Oncol Oculoplasty

Role of Vitamin E as a Preventive measure Against Platelet Aggregation In Pregnancy Induced Hypertension

Objective: To correlate the preventive role of vitamin E levels and platelet count in patients with different grades of pregnancy induced hypertension. The secondary objective was to compare these grades with normal pregnant patients. Study Design and Setting: This study was conducted in Obstetric OPD of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from April 2002 through April 2004. Methodology: The study group included 110 patients divided in three groups as Group A: n=40 Normotensive patients, Group B: n=40 Mild hypertensive (test group I), Group C: n=30 Severe hypertensive (test group II). All women were advised not to take any multivitamin supplements. Result: Serum alpha tocopherol (vitamin E) was significantly low in severe and mild cases (0.32±0.00 mg/dl, 0.74±0.03 mg/dl respectively), when compared with normal pregnant women levels (0.78±0.040). The decreased platelet count (246820±1493.51) in mild cases and (135460±387.2) in severe cases was significant (P<0.01) as compared to the normal pregnant women (348000±574.35). The decrease platelet count values for severe cases were again significant (P<0.01) when compared with mild cases of PIH. Conclusion: In patients with risk of preeclampsia adequate antioxidant nutrients may have a role in cessation of free radicalmediated cell disturbances, and thereby protecting against endothelial cell damage, which is the key factor in preeclampsia development

A3348 PIH and its effects on Pregnancy & Placental Morphology

Objectives: PIH results in placental dysfunction. PIH in women can lead to abruption placentae, organ failure and cerebrovascular events while their fetuses have an increased risk of intrauterine growth retardation as well as IUD. This study analyses the role of PIH in bringing about the histomorphological changes in Placenta and subsequently maternal and fetal effects. Methods: The study was carried out over a 3 year period from Jan 2014-Feb 2017 in a tertiary care hospital as an observational case-control study. Two groups were formed each with 120 patients, one included the women diagnosed PIH while the other contained women with normal gestation. In order to assess the morphological parameters, placental specimens from term gestations (37–42 weeks) as well as from normal full term gestations were studied. Results: The study consisted of 120 normotensive women and equal number of women with PIH. Out of the latter group 79 were Hypertensive, 28 had preeclampsia and 13 were cases of eclampsia. 12% of the cases were found to have liver infarcts while 5% had renal failure, another 5% got postpartum haemorrhage. No maternal mortality was recorded in this study. 42 cases resulted in premature delivery while 11 intrauterine deaths were documented. IUGR caused low birth weight in majority of the cases at 38%. PIH cases had a mean placental weight of 407 g, much lesser than that of the control group placenta. Placental specimens from PIH group were observed with multifocal infarcts, fibrinoid necrosis, and retroplacental clots. Conclusion: The major role players remain preeclampsia and eclampsia on the maternal and foetal outcome. The fetomaternal complications and mortality can be minimized through regular antenatal checkups, multi-disciplinary treatment, timing of delivery and swift perinatal management.

Reduced Maternal Cotyledons in Placenta of PIH

Background: The placenta reflect the status of maternal hypertension as it is mirror of maternal and fetal health. Aim: The aim of this original research article is to present status of maternal cotyledons in placenta of Pregnancy induced hypertensive women compare to Normotensive women. Method: This study was done in Rama Medical College Kanpur. Placentas from forty cases of PIH and forty cases of normotensive women delivered collected and studied. Result: Macroscopic study revealed that compare to normotensive women’s placenta, PIH women’s have lower number of maternal cotyledons. Conclusion: - Hypertension during the pregnancy lead to reduced number of maternal cotyledons.

Histomorphometric study for volume proportion of certain parameters in placenta of pregnancy induced hypertension

Introduction: placenta is vital link between mother and fetus. The organ for pregnancy serves as exchange membrane and hormone synthesizing apparatus for both mother and fetus. All physiological processes occurring in fetus or mother are reflected on placenta. Pregnancy induced hypertension is such a co-morbid condition which affects mother and fetus as well as placenta. Aim and objective: To study the desired histomorphometrical parameters in control and experimental (PIH) group of placentae after staining with Hematoxylin & Eosin(H/E) and Masson’s trichrome to find out the statistical relevance of the comparative findings. Material and method: Forty (40) control and forty (40) experimental placentae (PIH) were collected and processed for routine histological techniques. Paraffin sections were stained with routine H/E and Masson’s trichrome stain. Light microscopy for histological and histomorphometrical study was performed to obtain volume proportion of fibrinoid degeneration and microscopic calcification. Observation: volume proportion of fibrinoid degeneration and microscopic calcification were significantly increased in PIH cases in comparison to control. Conclusion: Like other diseases the PIH also affects the structural and functional unit of placenta. The changes appear to be compensatory to hypoxia and altered metabolism in tissue space.

Maternal outcome in relation to Biochemical parameters in Hypertensive disorders in Pregnancy

The aim of the present study was to correlate biochemical parameters like serum uric acid, LDH, AST, ALT, prothrombin time and APTT with maternal outcomes in Hypertensive diseases in pregnancy. Out of the 328 PIH cases, 9 (2.74%) maternal deaths were recorded during this study and 166 mothers were having complications and 194 mothers were having preterm delivery. All the 9 maternal death cases were admitted during emergency, 8(88.8%) came from rural areas, belonged to low socioeconomic class and had not taken antenatal care, 7 were primigravidas and from the 20-25 years age group. Serum levels of uric acid, LDH, AST, ALT and APTT were statistically significant with maternal deaths in comparison to mothers who survived.

RENAL FUNCTIONS IN PREGNANCY INDUCED HYPERTENSION, PREECLAMPSIA, AND ECLAMPSIA

Background and Objective: A Hypertensive disorder of pregnancy is an important cause of maternal mortality and Eclamptic conditions including renal dysfunctions. The present study is aimed at evaluating and comparing the urinary protein, creatinine and their ratio during Pregnancy Induced Hypertension, Preeclampsia and Eclampsia. Materials and Methods: Defined groups of Pregnancy Induced Hypertension, Pre-eclampsia and eclampsia patients were selected with written informed consent with fifty subjects in each group. The urine was collected and used for the estimation the urinary protein, creatinine and their ratio in normal and experimental groups. The data were expressed as Mean SD. Comparison between patients and controls was performed using unpaired rest. P value less than 0.05 was considered significant. Results: The mean SBP and DBP was significantly higher (p 0.001) in all the experimental groups as compared to normal subjects. The mean urinary protein and creatinine in PIH cases, Preeclampsia and Eclampsia was significantly higher (p 0.001) as compared to normal group. The protein creatinine ratio was also significantly higher (p 0.001) in all the experimental groups as compared to normal subjects. Conclusion: The significant elevation in urinary protein, creatinine and their ratio in the present study suggesting the fact that, the anti-angiogenic factors emanating from the placenta in PIH, Preeclampsia and Eclampsia contribute to glomerular endotheliosis, proteinuria, and hypertension.

692: Improved perinatal outcomes with fetal monitoring in Ghana

692 Improved perinatal outcomes with fetal monitoring in Ghana Frank Anderson, Joseph Seffah, Jocelynn Owusu, Mark Chames, Jerry Coleman University of Michigan, Obstetrics and Gynecology, Ann Arbor, MI, University of Ghana, OBGYN, Accra, University of Michigan Medical Center, Obstetrics and Gynecology, Division of MaternalFetal Medicine, Ann Arbor, MI, University of Ghana, Obstetrics and Gynecology, Accra, Ghana OBJECTIVE: To evaluate the effects of NST on perinatal outcomes in hypertensive disease in Ghana, where electronic fetal monitoring is not routine. STUDY DESIGN: A modified fetal assessment center was established at a major teaching hospital in June 2010. From May 2010 to July 2011, 316 women with preeclampsia or PIH were followed from admission to delivery. PIH was defined as Systolic blood pressure (SBP) 140 mmHg or diastolic blood pressure (DBP) 90 mmHg; preeclampsia included the presence of proteinuria 0.3 grams. Exposure to NST and fetal outcomes were recorded. Prevalence of of Apgar5 7, unexpected stillbirth, and early neonatal mortality were compared for the monitored an unmonitored group. An unexpected stillbirth was defined as a fetus admitted to the hospital live but died in utero. RESULTS: Patients in the unmonitored group received routine care which consisted of ausculation of the fetal heart rate in the antepartum and intrapartum period. Monitored patients received antepartum monitoring. Intrapartum monitoring was per routine. Preliminary results are from 164 unmonitored and 154 monitored patients. There was no significant differences in in gravidity (3.07 / 2.20 vs. 3.16 / 1.85), Parity (1.46 / 1.57 vs. 1.49 / 1.50), SBP (156 / 22 vs. 153 / 21), DBP(101 / 18 vs. 98 / 15). Age (30 / 6.0 vs. 32.8 / 5.6) and gestational age (36.9 / 3.7 vs. 35.6 / 3.3) were statistically different between the two groups (p 0.01). PIH cases had no difference in apgar5 7 (5.7% vs. 4.5%; p 0.54); while 21.6% of infants of unmonitored preeclamptic mothers had Apgar5 7, cf 5.1% in the monitored group (p 0.01). Unexpected stillbirth occurred in 9.2% of unmonitored preeclamptic cases and 3.6% of monitored cases (p 0.11). Perinatal death occurred in 10% of the unmonitored preeclamptic group and 2.5% of the monitored preeclamptic group (p 0.05). CONCLUSION: The introduction of antepartum testing for women with Preeclampsia might significantly reduce perinatal mortaliy in low resource settings and should be adapted to low resource settings to decrease mortality.

Use of 1,320 nm Nd:YAG laser for wrinkle reduction and the treatment of atrophic acne scarring in Asians.

The role of 1,320 Nd:YAG in non-ablative skin rejuvenation in Asians is has not been established. Furthermore, no study has investigated the effectiveness of 1,320 Nd:YAG laser in the treatment of atrophic scarring in Asians. The objective of our study was to investigate the effectiveness of 1,320 Nd:YAG laser in wrinkle reduction and the treatment of atrophic acne scarring in Asians. Twenty-seven female patients were included in the study: seven were treated for acne scarring and the others for wrinkle reduction. A 1,320 nm Nd:YAG laser (Cooltouch II, Roseville, CA) was used to treat both the cheeks and forehead for the patients with wrinkles, and both cheeks only for patients with atrophic acne scarring. All patients received treatment in the post-auricular areas. A spot size of 10 mm was used, and three passes were performed (two pre-cooling and one post-cooling). Patients were treated monthly for 6 months. All patients were subjectively assessed before and after their last treatment sessions using a structured questionnaire, and objectively assessed by the use of clinical photographs for by independent observers. A cutometer was used to assess viscoelasticity, and biopsies were taken at the post-auricular site for assessment by a pathologist. The overall degree of patients' satisfaction was rated as 4.9 (range 0-9.8) for wrinkle reduction and 4 (range 0-10) for acne scarring. In terms of objective assessment by independent observers, the degree of improvement was considered to be mild or no change in most cases. The independent pathologist who assessed the degree of improvement in terms of increased collagen production detected no change in 8 patients, mild improvement in 9, and moderate improvement in 10. There was also improvement in term of epidermal thickness in 13 cases. Assessment by viscoelasticity indicated a significant degree of improvement in most parameters in both groups of patients. Blistering occurred in five cases, all in the central facial areas, and post-inflammatory hyperpigmentation occurred in three cases. All cases of PIH resolved after the use of 4% hydroquinoine. There was no scarring or hypopigmentation. The 1,320 nm Nd:YAG laser is effective for wrinkle reduction and atrophic acne scar improvement, but to further enhance the clinical outcome a combination approach with another device such as IPL and a surgical technique such as subcision is necessary.

Primary intracerebral hemorrhage and heart weight: a clinicopathologic case-control review of 218 patients.

The mean heart weight as a measure of arterial hypertension of patients who died from spontaneous intracerebral hemorrhage (primary intracerebral hemorrhage or PIH) was compared with that of controls from the same autopsy population. All patients with valvular or congenital heart disease or disease processes associated with myocardial infiltration were excluded. In 206 cases of PIH, hypertension was diagnosed if heart weight greater than or equal to the mean heart weight of autopsy controls for either sex, plus 1.5 SD. Only 94 (46%) of all cases of PIH were hypertensive by this criterion. However, hypertension was five times more frequent in the cases than in the controls. The site of hemorrhage was clearly defined in 183 cases (88.8%) only. Of these, 80 (43.7%) had lobar hemorrhage and 69 (37.7%) bled in the basal ganglia. Only 26 cases (12.6%) had evidence of previous cerebral or myocardial infarction and there was no instance of previous intracerebral hemorrhage. These data show that arterial hypertension was present in about half the cases of PIH and suggest that other as yet unidentified risk factors for PIH may be more common than is realized. Patients who died from PIH had been healthy all their lives with no evidence of cardiovascular or cerebrovascular disease, and the PIH was their first evidence of disease.

Studies of colloid osmotic pressure in pregnancy-induced hypertension

Pulmonary edema, although infrequently encountered, may cause death in severe cases of PIH. The mechanisms that account for edema in these instances are unclear. With a transducer-membrane system to directly measure serum COP, 22 patients with PIH were compared to 23 normal pregnant patients at term. In the PIH group the antepartum and postpartum COP values were significantly lower (17.9 and 13.7 mm Hg, respectively) than comparable values for the control group (22.0 and 17.2 mm Hg, respectively). Two patients in the PIH group in whom the antepartum COP values were 13.1 and 14.7 mm Hg exhibited clinical and radiographic evidence of pulmonary edema. Pulmonary artery wedge pressure (PAW) recorded in one patient with pulmonary edema was only moderately elevated to 18 mm Hg. We believe that serial COP determinations combined with pulmonary artery pressure monitoring may be helpful to guide fluid therapy in critically ill patients with PIH.