Prediction Of Pregnancy-induced Hypertension Research Articles

Pregnancy-induced hypertension awareness, knowledge and its risk factors: A cross-sectional study.

Pregnancy-induced hypertension (PIH) has severe implications for maternal morbidity and mortality; thus, boosting pregnant women's awareness and knowledge of this medical condition is crucial for improving the mother's and foetus's health. This study assessed the awareness and knowledge of PIH and its risk factors among pregnant women in Mdantsane, South Africa. This cross-sectional study involved 249 conveniently selected and consenting pregnant women attending antenatal care clinics in Mdantsane, Buffalo City Metropolitan Municipality, South Africa. A self-designed questionnaire was utilised to collect data. Descriptive statistics, chi-square (χ2) test and multivariate logistic regression analysis were performed. The significance level was 0.05. Over 50% of the women were knowledgeable about PIH and associated risk factors ((χ2=4.92; p = 0.04). The prevalence of PIH was 51.8%, and married women were more aware of the PIH risk factors (71.1%). Women with previous pregnancies were more likely to be aware of PIH (OR = 17.1, 95%; CI = 9.09 to 32.15) compared to first time mothers. Women in age group 36-45 were 2.5 times more likely to be aware of PIH (OR = 2.5, 95% CI: 1.19-3.24) compared to women aged <35 years. Likewise, women aged 36-45 years were two times more likely to be knowledgeable about risk factors for PIH (OR = 2.3, 95% CI: 1.14-2.81) compared to women aged <35 years. Married women were more likely to be aware of PIH risk factors (OR = 2.70, 95% CI = 1.35-5.47) than unmarried women. Moreover, pregnancy increases the likelihood (OR=12.8, 95% CI: 6.97-23.58) of being aware of PIH risk factors. There was a significant difference between the mean ages of women who knew about PIH risk factors and those who do not (t=3.49, Mean difference = 3.49, p=0.0001, 95% CI (2.54; 4.44)). The prevalence of PIH was high. Age, history of PIH, previous pregnancy, and marital status were predictors of PIH knowledge/awareness and risk factors for PIH. Context-specific health education programmes during prenatal visits are crucial to improving pregnant women's knowledge of PIH.

To Study Serum β-HCG in Early Second Trimester as Predictors of Pregnancy Induced Hypertension

Background: Hypertensive disorders of pregnancy are a mysterious and clinically complex category of pregnancy problems that account for a significant burden of disease in both industrialized and less industrialized nations. The aim of this study is to estimate Serum β-HCG levels in early second trimester as predictors of pregnancy-induced hypertension. Methodology: A cross-sectional study was conducted among pregnant females in their second trimester attending the OPD clinic in the Department of Obstetrics &amp; Gynaecology, JK Hospital, LNMC &amp; RC, Bhopal, from January 2019 to June 2020. A total of 150 pregnant women were included in the study based on inclusion and exclusion criteria. Data was collected and entered into an Excel sheet and analyzed using EpiInfo software with appropriate statistical methods. Result: The study observed that the majority of pregnant women (52%) were in the 26-30 years age group. The highest number of women were at 17-18 weeks of gestation, and most of them were primigravida (39.3%). The mean β-HCG level of mothers in the pregnancy induced hypertension (PIH) group was 54297.8±22302.7, while that of mothers in the normal group was 27018.2±11255.7. The difference between the means was statistically very highly significant (P&lt;0.001). The sensitivity and specificity of elevated β-HCG levels as a predictor of PIH were 67.2% and 75%, respectively, with a positive predictive value of 62.9% and a negative predictive value of 78.4%. Conclusion: Pregnancy-induced hypertension remains a little understood entity, despite the enormous impact of its complications on maternal and fetal outcomes. The study concludes that the frequency of pregnancy-induced hypertension at a tertiary care hospital is 38.6%. Elevated serum β-HCG levels in women with second trimester pregnancy indicate an increased risk of gestational hypertension and preeclampsia, and higher β-HCG levels are associated with the severity of the disease. Women with raised β-HCG levels should be arefully followed up for hypertension, and appropriate referrals to a tertiary care center for better treatment should be made.

Evaluation of Platelet Count’s Role in the Prediction of Pregnancy-Induced Hypertension

Pregnancy-induced hypertension (PIH) is the main pregnancy-specific disease that causes maternal and perinatal death. In recent years, active treatment of pre-eclampsia after 34 weeks of gestation has resulted in good maternal and perinatal outcomes, but the treatment of early-onset pre-eclampsia patients is still unsatisfactory. So the prediction of PIH has become a research hot spot. Therefore, this study attempted to evaluate if a change in platelet count during pregnancy can be used to predict the development of PIH. A comparative cross-sectional study was conducted among 30 healthy normotensive pregnant women and 30 women with PIH. Face-to-face interviews’ using a structured questionnaire and physical examination supplemented with laboratory investigations were used for data collection. Statistical data analysis was done using an independent t-test, linear regression, and one-way ANOVA. The ROC curve was used to determine the optimal cut-off point of platelet count for the prediction of the development of PIH. The mean platelet count in the case was found to be 154.87 (± 42.56) × 103/µL while in controls the mean platelet count was 273.47 (± 34.08) × 103/µL. The ROC analysis showed that platelet count < 225 × 103/µL was a cut-off point to differentiate whether the pregnant women develop PIH or not with a sensitivity of 96.7% and specificity of 90%. In conclusion, a decrease in platelet count was significantly associated with the development and severity of PIH.

A Case Control Study on Socio-Demographic Profile and Risk Factors Associated with Pregnancy Induced Hypertension at a Tertiary Health Care Centre, Hyderabad

Introduction: Pregnancy induced hypertension (PIH)is a significant public health threat. It increases the risk of cardiac failure, renal failure and cerebrovascular accidents. Objectives: To study the socio-demographic profile among the study population and to study the factors associated with pregnancy induced hypertension among the study population.Method: A Case control study was done among 100 pregnant women attending the tertiary centre. Cases and controls were selected in the ratio of 1:1 with 50 cases and 50 controls.The study participants were selected randomly and interviewed using a pretested questionnaire. Data was be entered in MS excel and analysis was done using Epi info 7.2.2.16. Results: Out of the total study participants 64% of the cases and 54% of the controls were Hindu by religion. Majority (72%) of the cases and 54% of the controls were multigravida. Majority (36%) of the cases belong to class II socio-economic status and majority of the controls (36%) belong to class III socio-economic status according to modified B.G Prasad classification.Majority(63%) of the subjects were multi-gravida and 71.2% have parity greater than two.LowerSocio-economic status,Physical Inactivity and History of PIH were found to be significant factors for Pregnancy induced hypertension among the cases. Conclusion: Lower socio-economic status, lack of exercise and past history of PIH were found to be significant among the study population.Anemia as a predictor of PIH needs further research as only few studies showed significant association between PIH and anemia. Although association between diet and PIH was present, it was not significant and needs further research.

Role of Body Mass Index, Mean Arterial Pressure, and Uterine Artery Doppler at 11-14 Weeks in Prediction of Pregnancy-Induced Hypertension in Low-Risk Population

Role of Body Mass Index, Mean Arterial Pressure, and Uterine Artery Doppler at 11-14 Weeks in Prediction of Pregnancy-Induced Hypertension in Low-Risk Population

Second-Trimester Maternal Serum Beta-Human Chorionic Gonadotropin and Lipid Profile as a Predictor of Gestational Hypertension, Preeclampsia, and Eclampsia: A Prospective Observational Study.

Background:Hypertensive disorders of pregnancy are important complications of pregnancy and are associated with high maternal and perinatal mortality and morbidity. Early diagnosis may improve maternal and perinatal outcome by ensuring appropriate management.Aim:Our aim is to assess the serum beta-human chorionic gonadotropin (hCG) and serum lipid profile in the early and late trimesters of at-risk mothers and to analyze whether these parameters can be used to predict pregnancy-induced hypertension (PIH) and its time of onset.Materials and Methods:A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Tata Main Hospital, Jamshedpur, India. Two hundred antenatal women were screened for serum beta-hCG and lipid profile in their early (14–18 weeks) and late (24–28 weeks) second trimesters. All patients were followed up till delivery and observed for the development of PIH. Results were evaluated and analyzed statistically.Results:The incidence of PIH in our study was 14.67% (n = 27). Most of the patients had late-onset PIH (88.88%, n = 27), whereas 11.12% (n = 3) had an early onset of the disease. Of 27 patients, 6 patients developed preeclampsia and none had eclampsia. The mean beta-hCG level in the study population at the early second trimester was 91,723.97, whereas in the late second trimester, it was 22,456.25. In PIH patients, a significant increase in the level of serum cholesterol, triglyceride, and very-low-density lipoprotein was noted in both the early and late second trimesters.Conclusion:This study showed that serum beta-hCG and lipid profile in the second trimester are useful indicators to identify women who are likely to develop PIH, preeclampsia, or eclampsia.

Usefulness of blood pressure monitoring in patients with gestational diabetes mellitus

Background and objectiveGestational diabetes mellitus (GDM) is associated to an increased risk of pregnancy-induced hypertension (PIH). Ambulatory blood pressure monitoring (ABPM) has been used to detect PIH and preeclampsia, but few data are currently available on its use in women with GDM. The aim of this study was to achieve early identification in women with GDM of BP profiles (detected by ABPM) that could define a population at greater risk of developing PIH and preeclampsia. Material and methodsA prospective study of 93 normotensive women with GDM in whom 24-h ABPM was performed (using a Spacelabs 90207 monitor) at 28–32 weeks of pregnancy. Clinical and laboratory variable and obstetric and perinatal outcomes were analyzed. ResultsMean age was 34.8±4.39years, and 5.4% of patients developed PIH. Higher levels of HbA1c (p=0.005) and microalbumin (p=0.001) were seen in patients with PIH. Patients with non-dipper patterns (50.5%) had higher values of night-time systolic BP (106.7 vs. 98.4mmHg) and night-time diastolic BP (64.8 vs. 57.2mmHg) (p<0.001). Lower birth weights (3084.57 vs. 3323.7) (p=0.021) and shorter gestational age at delivery (38.67 vs. 39.27 weeks) (p=0.04) were found in women with non-dipper pattern. High night-time systolic BP significantly increased the chance of developing PIH (OR: 1.18; 95%CI: 1.00–1.39; p=0.043). ConclusionsPatients with GDM have BP changes, with predominance of the non-dipper pattern and higher night-time systolic and diastolic BP, changes that could be useful predictors of PIH. High night-time systolic BP values increase the risk of developing PIH. Further studies are needed to ascertain the relationships between BP changes and obstetric and perinatal complications.

Utilidad de la monitorización ambulatoria de la presión arterial en mujeres con diabetes mellitus gestacional

Background and objectiveGestational diabetes mellitus (GDM) is associated to an increased risk of pregnancy-induced hypertension (PIH). Ambulatory blood pressure monitoring (ABPM) has been used to detect PIH and preeclampsia, but few data are currently available on its use in women with GDM. The aim of this study was to achieve early identification in women with GDM of BP profiles (detected by ABPM) that could define a population at greater risk of developing PIH and preeclampsia. Material and methodsA prospective study of 93 normotensive women with GDM in whom 24-h ABPM was performed (using a Spacelabs 90207 monitor) at 28-32 weeks of pregnancy. Clinical and laboratory variable and obstetric and perinatal outcomes were analyzed. ResultsMean age was 34.8±4.39years, and 5.4% of patients developed PIH. Higher levels of HbA1c (P=.005) and microalbumin (P=.001) were seen in patients with PIH. Patients with non-dipper patterns (50.5%) had higher values of night-time systolic BP (106.7 vs 98.4mmHg) and night-time diastolic BP (64.8 vs 57.2mmHg) (P<.001). Lower birth weights (3,084.57 vs 3,323.7) (P=.021) and shorter gestational age at delivery (38.67 vs 39.27 weeks) (P=.04) were found in women with non-dipper pattern. High night-time systolic BP significantly increased the chance of developing PIH (OR: 1.18; 95%CI: 1.00-1.39; P=.043). ConclusionsPatients with GDM have BP changes, with predominance of the non-dipper pattern and higher night-time systolic and diastolic BP, changes that could be useful predictors of PIH. High night-time systolic BP values increase the risk of developing PIH. Further studies are needed to ascertain the relationships between BP changes and obstetric and perinatal complications.

Biophysical markers in prediction of PIH

Gestational hypertension (GHTN), formerly known as pregnancy induced hypertension, is defined as a new rise in blood pressure (BP) ≥140/90mm Hg, presenting at or after 20 weeks gestation without significant proteinuria (≥ 300mg/24 hour urine collection of urine, or 2 specimens of urine collected ≥ 4 hours apart with ≥ 2+ on the protein reagent strip. It is the most frequent cause of hypertension during pregnancy, constituting approximately 70%, and complicating about 6–17% pregnancies in healthy nulliparous women and 2–4% in multiparous women1. According to World Health Organization, Pregnancy Induced Hypertension(PIH) is one of the main causes of maternal, fetal and neonatal mortality and morbidity. The condition is estimated to account for 10% to 15% of maternal deaths worldwide. Disorders of high blood pressure are the second leading cause of stillbirths and early neonatal deaths in developing countries. Predicting Pregnancy Induced Hypertension(PIH) and treating the condition early will reduce the maternal as well as perinatal mortality and morbidity. Mean Arterial Pressure (MAP), Uterine Artery Pulsatality Index (UtA PI), Resistive Index (RI) and Systolic/Diastolic (S/D) ratio are an effective screening tools to identify the risk of PIH through uSG done in I and II trimester of pregnancy.

Serum Beta-human Chorionic Gonadotropin and Lipid Profile in Early Second Trimester as Predictor of Pregnancy-induced Hypertension

Serum Beta-human Chorionic Gonadotropin and Lipid Profile in Early Second Trimester as Predictor of Pregnancy-induced Hypertension

Prediction of Pregnancy-induced Hypertension by Maternal Serum Beta Human Chorionic Gonadotropin Levels in Early Second Trimester of Pregnancy

Prediction of Pregnancy-induced Hypertension by Maternal Serum Beta Human Chorionic Gonadotropin Levels in Early Second Trimester of Pregnancy

Can umbilical artery Doppler findings at 36 weeks’ gestation predict maternal hypertension at later gestation?

Objectives: To clarify whether ultrasonographic evaluations of fetoplacental underperfusion using umbilical artery (UmA) Doppler indices at 36 weeks’ gestation can predict maternal hypertension at later gestation.Methods: Normotensive pregnant women who underwent an ultrasound scan at 36 weeks’ gestation and delivered singleton infants at term between 2012 and 2013 were prospectively enrolled. UmA Doppler and maternal blood pressure results at 36 weeks’ gestation in cases with pregnancy-induced hypertension (PIH) at later gestation were compared with a control group.Results: Thirty-nine and 775 cases were classified into the PIH and control group, respectively. The UmA pulsatility index (PI) and maternal systolic blood pressure (SBP) at 36 weeks’ gestation were higher in the PIH group than in control group (UmA-PI: 0.88 vs. 0.80, p = 0.002; SBP: 126 mmHg vs. 112 mmHg, p < 0.001). The area under the ROC curve for the prediction of PIH by combining the UmA-PI and SBP was 0.867 (95% confidence interval (CI): 0.781, 0.954). The detection rate for PIH was 64.0% with a 10% false-positive rate.Conclusions: An increased UmA-PI at 36 weeks’ gestation is associated with the occurrence of PIH at later gestation. This result may indicate the possibility to detect fetoplacental underperfusion ultrasonically.

Serum Beta-Trace Protein as a Novel Predictor of Pregnancy-Induced Hypertension.

Beta-trace protein (BTP) has emerged as a novel biomarker of cardiovascular risk. However, the level of circulating BTP in pregnancy-induced hypertension (PIH) is still unknown. The aim of this study was to determine the concentration of serum BTP in healthy pregnant women and patients with PIH. No significant difference was found in the serum concentration of BTP in patients with a normal pregnancy. In contrast, serum BTP levels in women with PIH (n=46) were significantly higher than those in women with normal pregnancy (n=57). Receiver operating characteristic analysis revealed that using a serum BTP value of 321.3 ng/mL as a cutoff produced a sensitivity of 91.3% and a specificity of 89.5%. Taken together, these findings suggest that a higher serum BTP concentration in PIH patients compared with those with normal pregnancy and serum BTP might be a novel biomarker in the diagnosis of PIH.

Long-term effect of in utero conditions on maternal survival later in life: evidence from Sub-Saharan Africa

Sub-Saharan African countries have some of the world’s highest rates of maternal mortality. Most research on maternal mortality focuses on factors during pregnancy and delivery. However, consistent with the fetal programming hypothesis, a woman’s maternal survival may also be related to conditions she experienced while in utero. I examine this hypothesis in 14 African countries by relating rainfall when a woman was in utero with her maternal survival later in her life. High levels of rainfall, representing better in utero conditions, decrease the probability of maternal death by 1.1 percentage points, a 58 % decrease from a mean of 1.9 %. Higher rainfall while in utero reduces the probability of anemia during pregnancy, a risk factor for postpartum hemorrhage. Another plausible pathway is through a reduction in body mass index, a predictor of pregnancy-induced hypertension. Improving conditions for pregnant women will have inter-generational effects, benefiting pregnant women today and improving their daughters’ maternal survival.

Maternal plasma TIMP-4 levels combined with clinical risk factors for the early prediction of pregnancy-induced hypertension.

The objective of this study was to create a model for early predicting pregnancy-induced hypertension (PIH) using plasma markers and clinical risk factors. A nested case-control study was performed at the Laboratory Department of Guangzhou Women and Children's Medical Center. From a prospective cohort of tens of thousands of unselected women with singleton pregnancies at 8-20 weeks gestation, maternal plasma samples were obtained from 73 women who subsequently developed PIH (PIH group) and 146 gestational age- and maternal age-matched women with normotensive pregnancies (control group). Proteins extracted from the plasma samples were screened by microchip and verified by ELISA. Clinical risk factor data were analyzed retrospectively. Compared to the control group, high concentrations of tissue inhibitor of metalloproteinase-4 (TIMP-4) were found in women with PIH (P = 0.000). Univariate risk factor analysis identified three variables with significant differences between the groups: family history of PIH (P = 0.031), body mass index (BMI; P < 0.001), and non-glucose-6-phosphate dehydrogenase deficiency-induced anemia (P < 0.027). Multiple regression analyses revealed a significant relationship of PIH with TIMP-4 levels, BMI, and family history (combined area under the receiver operating characteristic curve = 0.820). Upregulation of plasma TIMP-4 might contribute to PIH processes. Potential risk factors of this disease may include a family history of PIH and BMI. The combination of TIMP-4 levels and these risk factors may have some predictive values for PIH. Future multicenter studies including greater numbers of samples, analyzed proteins, and risk factors are needed to obtain a higher predictive value of the model for the clinical diagnosis of PIH.

Association of early maternal hypertriglyceridemia with pregnancy-induced hypertension.

Hypertensive diseases are directly responsible for 24 % of maternal deaths in India. A screening method is yet to be discovered to reduce the morbidity and mortality related to it. Serum triglyceride (TG) levels are reported to increase in hypertensive pregnant women. To predict pregnancy-induced hypertension (PIH) by serum triglyceride values. This study is a prospective cohort study that was conducted over three hundred normotensive, primigravida women with singleton pregnancy at 14-20 weeks of gestation. These were divided into two groups on the basis of their TG concentration estimated at 14-20 weeks of gestation. The pregnancy was then followed till delivery and, signs and symptoms of PIH were noted in both the groups. Out of 300 women, 210 women completed the study. Fifty-nine women developed PIH and 151 women remained normotensive. Among 59 women, 45 women had raised TG values i.e., ≥160 mg/dL and 14 women were with normal TG levels i.e., <160 mg/dL. A significant positive correlation was found between serum TG concentration and systolic and diastolic blood pressure. It was observed that a cutoff of 162.50 mg/dL for TG could reliably predict PIH with sensitivity of 76 % and specificity of 85 %. Also, the mothers with hypertriglyceridemia were found to be at higher risk of developing early-onset PIH. Our study supports the evidence that early pregnancy hypertriglyceridemia is associated with an increased risk of PIH.

Association between hyperglycemia in middle and late pregnancy and maternal-fetal outcomes: a retrospective study

BackgroundThe purposes of this study were to explore whether the maternal-fetal outcomes differed among various types of hyperglycemia during pregnancy and whether the values of glycemic screening in the middle phase of pregnancy could predict maternal-fetal outcomes.MethodsA retrospective study was conducted to study the incidence of maternal-fetal outcomes in 383 singleton pregnant women with diabetes or gestational diabetes admitted to our hospital from November 2007 to March 2013. Patients were divided into three groups: DM (Type 1 and Type 2 diabetes mellitus) group, mGDM (mild gestational diabetes mellitus) group and sGDM (severe gestational diabetes mellitus) group. Maternal basic characteristics, results of oral glucose tolerance test (OGTT), antenatal random glycemia and maternal-fetal outcomes were collected. Binary logistic regression was used to estimate the association of blood glucose with the maternal-fetal outcomes. Predictive accuracy was assessed by calculating the areas under the receiver operating characteristic curves.ResultsThe maternal basic characteristics, maternal complications and neonatal complications did not differ significantly between DM group and sGDM group, except neonatal intensive care units admission (NICU). Incidences of preterm, NICU and preeclampsia were significantly lower in the mGDM group than in the DM and sGDM groups (P < 0.05). After adjusted by confounding factors, the value of OGTT 0 h could predict pregnancy induced hypertension (PIH) (OR = 1.24, 95% CI [1.04 to 1.46], P = 0.015), preterm birth (OR = 1.23, 95% CI [1.03 to 1.47], P = 0.025) and stillbirth (OR = 1.55, 95% CI [1.14 to 2.10], P = 0.005); antenatal random glycemia could predict preterm birth (OR = 1.19, 95% CI [1.08 to 1.31], P < 0.001) and stillbirth (OR = 1.41, 95% CI [1.17 to 1.71], P < 0.001).ConclusionsPregnant women in the mGDM group have better outcomes than those in the DM and sGDM groups. The values of OGTT in the middle phase of pregnancy and antenatal random glycemia could predict PIH, preterm birth or stillbirth to some extent.

The Role of Umbilical Artery Doppler in Predicting the Fetal Out Come in Cases of Pregnancy Induced Hypertension

Purpose: To determine and compare the diagnostic performance of Doppler sonography of fetal umbilical artery (UA) for prediction of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and pre eclampsia. Materials and Methods: 100 women with singleton pregnancy between 26 to 30 weeks of gestation were studied in this prospective study over a period of one and half years with color Doppler. UA flow velocity form was studied. In UA systolic/diastolic (S/D) ratio, pulsatility index (PI) and Resistance index (RI) were studied. In UA absent diastolic flow or reversed diastolic flow is noted. Results: Out of 50 clinically suspected pregnancy induced hypertension (PIH) cases, 31 (62%) cases show abnormal PI, 40 (80%) cases show abnormal RI values and 45 (90%) cases show abnormal S/D Ratio’s. Sensitivity and specificity of the S/D ratio in predicting PIH are 90% and 88% respectively followed by positive and Negative predictive value (PPV & NPV) of 88% and 89% whereas sensitivity, Specificity, PPV and NPV of RI & PI are lower than S/D ratio. This shows that S/D ratio has more Sensitivity, Specificity and Predictive values. Sensitivity of PI value in predicting fetal outcome is 75%. 22% (11 out of 50 cases) cases show absent/ reversal of end diastolic velocities, of these four are reversal of end diastolic velocity (RDEV). All four cases of REDV died before 32 weeks of gestation. Absent diastolic flow is seen in 7 cases, 4 cases died and three cases admitted in NICU with severe respiratory distress. Our study shows absent or reversal of end diastolic velocity is more sensitive in predicting adverse fetal outcome. There was no case of eclampsia or maternal death. Conclusion: UA flow velocity waveforms abnormality is more predictive for preeclampsia and IUGR. Hence Doppler is a promising tools in prediction of PIH and IUGR.

Prediction of pregnancy-induced hypertension by a shift of blood pressure class according to the JSH 2009 guidelines

Elevated blood pressure (BP) at early or mid pregnancy is a known risk factor for pregnancy-induced hypertension (PIH). However, the association between BP changes during the first half of pregnancy and subsequent PIH development is unknown. We used changes in maternal BP between 16 and 20 weeks of gestation to evaluate the risk of PIH. A total of 976 pregnant women with BP estimations recorded before 16 weeks and at 20 weeks of gestation participated in this study. BPs were classified by the Japanese Society of Hypertension 2009 Hypertension Treatment Guidelines (JSH 2009). There was a significant trend for future PIH in women whose JSH 2009 BP class increased between 16 and 20 weeks of gestation, and the risk of PIH was highest among women whose BP was Class IV Hypertension (systolic BP≥140 mm Hg and/or diastolic BP≥90 mm Hg). The risk of PIH increased in women whose BPs shifted from Classes I Optimal (systolic BP<120 mm Hg and diastolic BP<80 mm Hg) and II Normal (systolic BP 120-129 mm Hg and/or diastolic BP 80-84 mm Hg) before 16 weeks to Class III High-Normal (systolic BP 130-139 mm Hg and/or diastolic BP 85-89 mm Hg) at 20 weeks of gestation. These shifts in BP class were significantly correlated with the risk of PIH after adjustments for variables (P-value for trend <0.05). Within JSH 2009 Classes I, II and III, a shift in BP from a low to a high class between 16 and 20 weeks of gestation predicts the subsequent development of PIH.

Placental volume and three‐dimensional power Doppler analysis in prediction of pre‐eclampsia and small for gestational age between Week 11 and 13 weeks and 6 days of gestation

To assess three-dimensional placental volume measurement and three-dimensional power Doppler (3D-PD) indices between 10 weeks and 6 days and 13 weeks and 6 days in predicting pregnancy-induced hypertension (PIH) and small for gestational age (SGA). Three hundred and eight women undergoing fetal nuchal translucency measurement were prospectively assessed using three-dimensional ultrasound in order to measure placental volume and 3D-PD indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI), using the VOCAL software. The outcome was scored as normal, PIH, SGA or both. Eight women developed PIH and ten delivered SGA; and 17 developed PIH or SGA. The age, gestational age at the examination or delivery, number of the pregnancy and the nuchal translucency, were similar in all groups. The placental volume, FI and VFI were similar between the groups. The VI was significantly lower when PIH developed (7.86 ± 3.92 vs. 12.02 ± 7.09 in the normal group, P = 0.035). The crown-rump length (CRL) was significantly smaller in the group where either PIH or SGA developed compared to normal outcome (54.29 ± 6.50 and 59.04 ± 8.89, respectively, P = 0.02). Placental volume is not appropriate for early prediction of PIH or SGA, whereas the VI may be of some potential in detection of PIH. The significance of small CRL in these patients should be further tested.