Pregnancy-induced Hypertension Patients Research Articles

Circulating vascular endothelial growth factor receptor-3, a pro-lymphangiogenic and pro-angiogenic mediator, is decreased in pre-eclampsia.

To compare circulating levels of vascular endothelial growth factor receptor 3 (VEGFR-3) in women with pregnancy-induced hypertension (PIH) and in non-pregnant (NP) and healthy pregnant (HP) women. We conducted a case-control study including PIH (n = 135), HP (n = 68), and NP (n = 49) women from southeastern Brazil. PIH were diagnosed according to international guidelines, and defined as gestational hypertension (GH, n = 61) or pre-eclampsia (n = 74). VEGFR-3 was measured in plasma using ELISA. Plasma VEGFR-3 was increased in HP (1207 pg/mL) compared with NP (133 pg/mL) women; however, PIH (729 pg/mL) patients exhibited lower levels than HP women (both p < 0.05). In addition, plasma VEGFR-3 was decreased in pre-eclampsia compared with GH (537 versus 980 pg/mL; p < 0.05). When pre-eclampsia was classified according to different clinical presentations, plasma VEGFR-3 was further decreased in the cases identified as pre-eclampsia with severe features, preterm pre-eclampsia, and pre-eclampsia accompanied by small for gestational age (all p < 0.05). Our data indicate reduced circulating VEGFR-3 levels in patients with PIH, specifically in those diagnosed with pre-eclampsia. Moreover, decreased VEGFR-3 was associated with adverse clinical outcomes in pre-eclampsia. These findings expand previous evidence of reduced VEGFR-3 expression in pre-eclampsia. Future studies should investigate whether it can be used as a predictive biomarker and/or therapeutic target for pre-eclampsia.

SERUM 25 (OH) VITAMIN D AND CALCIUM LEVELS AND ADVERSE MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY INDUCED HYPERTENSION

Objectives: Incidence of hypertensive disorders in pregnancy is about 5–10% of all pregnancies [1]. Pre-eclampsia alone or superimposed on chronic hypertension is the most threatening. This study is done to evaluate the levels of serum 25 (OH) Vitamin D and Calcium in normal antenatal patients and patients with pregnancy-induced hypertension and their effects on perinatal and maternal outcome. Hence, that timely intervention can prevent adverse perinatal and maternal outcomes. Methods: The present prospective observational study was done in the Department of Obstetrics and Gynecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India from May 2018 to April 2019. The study was conducted on 80 antenatal patients. Patients were divided into two groups with 40 patients in each group. Group I included patients with pregnancy-induced hypertension and Group II included normal antenatal patients. Serum levels of calcium and 25 (OH) Vitamin D were evaluated in both groups. Adverse perinatal and maternal outcomes were assessed in relation to the serum levels of calcium and 25 (OH) Vitamin D in patients with pregnancy-induced hypertension and normal antenatal patients. Categorical variables were analyzed by Chi-square test and Fisher’s exact test. The analysis of continuous variable was done by ANOVA. The data were analyzed using SPSS version 22 and Microsoft Excel. p≤0.05 is taken as statistically significant. Results: The mean value of serum Vitamin D level in Group I was 22.30±6.11 ng/ml and 36.68±9.34 ng/ml in Group II giving p=0.016 which was highly significant. In Group I, mean calcium levels were 8.58±0.63 mg/dl and 9.27±0.40 mg/dl in Group II giving p=0.018 which was highly significant. The Pearson’s correlation coefficient was −0.753 for serum Vitamin D and systolic blood pressure (BP) and the same for serum Vitamin D and diastolic BP with p=0.001 which was highly significant. The Pearson correlation coefficient was −0.537, −0.514 for serum calcium and systolic BP and serum calcium and diastolic BP, respectively, giving p=0.001. Conclusion: Serum levels of 25 (OH) Vitamin D and calcium have a significant relationship with pregnancy-induced hypertension. Low levels of calcium and 25 (OH) Vitamin D cause an increased risk of pregnancy-induced hypertension and supplementation of these reduces the incidence of pregnancy-induced hypertension. Hence, their supplementation can be used as a possible intervention strategy in preventing one of the most common causes of perinatal and maternal morbidity and mortality around the world.

Up-regulation of Trim28 in pregnancy-induced hypertension is involved in the injury of human umbilical vein endothelial cells through the p38 signaling pathway.

The present study is to analyze the regulation and potential molecular mechanism of Trim28 on vascular endothelial injury induced by pregnancy-induced hypertension (PIH). Trim28 mRNA in placental tissues and peripheral blood from PIH patients were determined by quantitative real-time polymerase chain reaction. The serum from PIH was used to stimulate human umbilical vein endothelial cells (HUVECs). After silencing Trim28 in HUVECs, we used CCK-8 assay, Transwell assay and flow cytometry to investigate proliferation, migration and apoptosis. Western blotting was used to measure Trim28 protein level and p38 phosphorylation level. After addition of p38 inhibitor, the proliferation, migration and apoptosis of HUVECs with silenced Trim28 were studied again. Trim28 expression in placental tissues and peripheral blood from PIH patients is elevated, and serum from these patients can up-regulate the expression of Trim28 in HUVECs in vitro. Trim28 silencing significantly inhibits the proliferation and migration of HUVECs by affecting the cell cycle. Down-regulation of Trim28 expression promotes the apoptosis of HUVECs. Trim28 regulates the biological function of HUVECs by affecting the activity of the p38 signaling pathway. The present study demonstrates that Trim28 is up-regulated in peripheral blood of patients with PIH and participates in HUVECs injury through the p38 signaling pathway.

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

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

MicroRNA-195-5p Attenuates Pregnancy-Induced Hypertension by Inhibiting Oxidative Stress via OTX1/MAPK Signaling Pathway.

Pregnancy-induced hypertension (PIH) is a hypertensive disorder during pregnancy and can induce perinatal death of human infants. MicroRNA (miR)-195-5p was validated to display low expression in severe preeclampsia placentas, but the role of miR-195-5p in pregnancy-induced hypertension (PIH) has not been investigated. The study emphasized on the functions and mechanism of miR-195-5p in PIH. A reduced uterine perfusion pressure (RUPP) rat model was established to mimic PIH in vivo. Adenovirus (Ad)-miR-195-5p agomir and/or Ad-OTX1 were further injected into some model rats. RT-qPCR was conducted to assess the expression of miR-195-5p and orthodenticle homeobox 1 (OTX1) in rat placental tissues, the isolated aortic endothelial cells (AECs), and in serum samples of PIH patients. Western blot analysis was implemented to measure the protein levels of OTX1, VEGFA, and key factors involved in the MAPK signaling pathway. The concentrations of oxidative stress markers (superoxide dismutase, catalase, and lipid hydroperoxide) in AECs and placental tissues of RUPP rats were measured by corresponding kits. The binding relation between miR-195-5p and OTX1 was verified using the dual-luciferase reporter assay. Hematoxylin-eosin staining was conducted to evaluate the pathological features of rat placental tissues. MiR-195-5p was downregulated, while OTX1 was upregulated in rat placental tissues and human serum samples of PIH patients. MiR-195-5p could target OTX1 and inversely regulate OTX1 expression in AECs and rat placental tissues. In addition, miR-195-5p can negatively regulate VEGFA level. Furthermore, miR-195-5p inactivates oxidative stress and the MAPK signaling by downregulating OTX1 in AECs. In vivo experiments revealed that OTX1 overexpression reversed the protective effect of miR-195-5p overexpression on placental damage and oxidative stress. MiR-195-5p alleviates PIH by inhibiting oxidative stress via targeting OTX1 and inactivating MAPK signaling.

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.

Gut Microbiota Dysbiosis and Increased NLRP3 Levels in Patients with Pregnancy-Induced Hypertension

Pregnancy-induced hypertension (PIH) is one of the most common diseases, causing high maternal morbidity and mortality. However, the correlation of gut microbiota in PIH has not been reported. Our aim was to characterize the intestinal microbiota of patients with PIH compared with healthy people. We analyzed and compared the gut microbiota communities in the feces of 28 PIH patients with pregnancy(not pre-pregnancy) body mass index (including height and weight)-matched healthy controls using 16S rRNA gene sequencing and then investigate the relationships among gut microbiota, cytokines, and PIH. Compared with the healthy group, microbial α diversity was lower in the PIH group, but not statistically significant different. At the phylum level, Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria exhibited obvious differences between the PIH and control groups. LEfSe analysis found 33 differentially abundant taxa between the two groups. The production of pro-inflammatory cytokines in PIH serum or placenta tissues was higher than that of the control group. In addition to alterations in gut microbiota composition, we also found that the Bac_Prevotellaceae, Pre_Prevotella bacteria were positively correlated with NLRP3 level, but negatively correlated with Bac_Bacteroidaceae, Bac_Bacteroides. PIH patients had gut microbiota dysbiosis and increased NLRP3 levels, which will lead to a better understanding of the relationship between the gut microbiota and PIH.

Determination of the association between excessive intake of Rasa and Retinal vascular changes in Pregnancy-Induced Hypertension- A Pilot Study

Background: Pregnancy-induced hypertension (PIH) is a hypertensive disorder in pregnancy that occurs in the absence of other causes of elevated blood pressure. There are many complications documented for PIH and associated retinal vascular changes in one of them. During pregnancy if proper antenatal care along with diet is not followed, patient may land into complications like PIH related retinopathy. Aim: To determine the retinal changes in pregnancy induced hypertension (PIH) and any association between the retinal changes and excess intake of specific Rasa. Methods: All the patients admitted in ward with diagnosis of PIH were included in this study. Age, race, gravida, gestation period, blood pressure, and proteinuria along with dietary habit were noted from the case records. After taking history for any eye symptoms, fundus examination was done after dilating the pupils with direct ophthalmoscope in the ward itself. All the findings were noted on a data sheet, and were analyzed. Results: A total of 24 patients of PIH were examined. Majority were urban (75%) and remaining are from rural area (25%). The majority of patients are from 24-28 years age group followed by below 20 years age group. The gestation period ranged from 20 weeks to 38 weeks; 16 (66.6%) were primi gravida. Nineteen (79.1%) patients had mild preeclampsia, 03 (12.5%) had severe preeclampsia and 2 (8.33%) had eclampsia. Retinal changes (hypertensive retinopathy) were not seen in any of these patients Haemorrhages or exudates or retinal detachment were not seen in any patient. There was no association of retinal changes and Rasa Sevan a found in present pilot study. Conclusion: Retinal changes were not seen in any of the patients with PIH in present study sample and there was not found to be associated with excess intake of specific Rasa and severity of the disease. Fundus examination is necessary in assessment of the PIH patient.

Interventions required and outcome in pregnancy induced hypertension patients in Intensive Care Unit: An observational study

Hypertensive disorders of pregnancy, particularly preeclampsia, eclampsia remain one of the leading causes of maternal morbidity and mortality worldwide. We studied the association between the risk factors, interventions required, diagnosis and outcome in these patients admitted to the Intensive Care Unit (ICU).: We conducted a prospective, observational study after the Institutional Scientific and Ethics committee approval. The Institutional record was taken to identify 70 women with Pregnancy Induced Hypertension (PIH) admitted to ICU after meeting the inclusion and exclusion criteria. Socio-demographic details, indication and timing of ICU admission were noted. On ICU admission; baseline vitals, detailed history, duration of complications, therapeutic interventions, laboratory parameters and imaging were compiled. Maternal outcome was assessed in terms of interventions needed, complications encountered and mortality or discharge and follow up was done up to 6 weeks postpartum. Fetal outcome was assessed in terms of live births or Intrauterine fetal death (IUFD), Apgar score, term/preterm and followed up to 7 postnatal days.: It was observed that out of 70 women enrolled in our study, 48 women were diagnosed with preeclampsia, 54 belonged to the age group of 21-30 years, 61 were unregistered for antenatal checkup, 46 had term gestation, 52 were nulliparous and 64 underwent Lower segment caesarean section (LSCS). 60 of them had postpartum ICU admission, all of them had significant rise in blood pressure. Most common interventions were transfusion of blood products (n=30) and mechanical ventilation (n=6). HELLP syndrome was the most common complication (n=7). Maternal mortality was seen in 6 women. 35 neonates had low birth weight, 6 had intra uterine growth retardation (IUGR), 19 were preterm and Apgar score was significant at 5 minutes.: From our observations, it can be concluded that majority of the women were diagnosed with preeclampsia, were relatively of younger age group, nulliparous with no antenatal checkup, underwent LSCS and were admitted postpartum to ICU. Transfusion of blood products was the most common intervention &amp; HELLP syndrome was most common complication. Maternal mortality was higher in women with preeclampsia although overall mortality was low. The incidence of low birth weight, IUGR and preterm neonates was more in eclamptic women. Neonatal mortality was more in preeclamptic women.

A clinical study of perinatal and maternal morbidity and mortality in gestational hypertension, preeclampsia and eclampsia

In India, hypertensive disorders complicating pregnancy are common and continue to be responsible for the largest proportion of perinatal deaths resulting from prematurity and IUGR and are major contributors to perinatal and maternal morbidity and mortality.&#x0D; The aim: The present study is undertaken to analyse the cases of preeclampsia and eclampsia, including consequences concerning preterm delivery, IUGR, IUD and stillbirth and for the evaluation of a safe motherhood program at the population level.&#x0D; Materials and methods: The present study was conducted on 105 selected cases from the census (sample of 12,589 patients) of pregnancy-induced hypertension (gestational hypertension, preeclampsia and eclampsia).&#x0D; Results: Hypertensive cases complicating pregnancy of the foetal deliveries conducted during the study period, out of which Gestational hypertension (GTN) cases reported were 44. Preeclampsia (PE) cases were 39, severe preeclampsia (SPE) were 1 and Eclampsia cases were 21. Labetalol alone was used in 62 cases, and 44 babies were born without any complications. As an anticonvulsant magnesium sulphate (MgSO4, 7H2O) was used in all cases of imminent eclampsia and eclampsia (MgSO4 PRITCHARD Regime) in a total number of 38 cases. Preterm / prematurity was the most common cause of perinatal death. The total number of NICU admissions was 42 (40 %).&#x0D; Conclusions: The early use of anti-hypertensive drugs, the optimum timing of delivery, strict fluid balance, and anticonvulsants in cases of eclampsia will help to achieve a successful outcome. Early transfer to a specialist centre is important, and the referral centres should be well-equipped to treat critically ill patients.

Study on coagulation profile in women with pregnancy-induced hypertension in South Indian population

Background: Pregnancy-induced hypertension (PIH) complicates about 6–10% of pregnancies around the world. According to the WHO, PIH is one of the leading causes of maternal, fetal, and neonatal mortality and morbidity. PIH causes many hematological aberrations in women and any abnormalities in the coagulation of blood lead to hemorrhages. Aims and Objectives: The objectives of this study were as follows: 1. To study the coagulation profile which includes platelet count, bleeding time (BT), clotting time, prothrombin time, and activated partial thromboplastin time (aPTT) in PIH patients. 2. To compare the above parameters between the normal pregnant subjects and pregnancy-induced hypertensive patients. 3. To compare the above parameters between preeclampsia (PE) and eclampsia patients. Materials and Methods: A cross-sectional study was conducted on 120 pregnant women. Among them, 60 patients (Cases) who were diagnosed with PIH, and another 60 (controls) having age and anthropometrically-matched healthy pregnant women were taken as control. Their coagulation profile, which includes total platelet count (TPC), prothrombin time (PT), aPTT coagulation time (CT), and BT were studied. The parameters were compared using Student’s t-test. Results: There was a significantly lower TPC, and increased PT, aPTT, CT, and BT in women with PIH when compared to normal pregnant women. However, there was no significant difference between women with PE and eclampsia. Conclusion: The present study shows significant changes in coagulation profile in women with PIH.

The Association between Gut Microbiome and Pregnancy-Induced Hypertension: A Nested Case-Control Study.

(1) Background: Pregnancy-induced hypertension (PIH) is associated with obvious microbiota dysbiosis in the third trimester of pregnancy. However, the mechanisms behind these changes remain unknown. Therefore, this study aimed to explore the relationship between the gut microbiome in early pregnancy and PIH occurrence. (2) Methods: A nested case-control study design was used based on the follow-up cohort. Thirty-five PIH patients and thirty-five matched healthy pregnant women were selected as controls. The gut microbiome profiles were assessed in the first trimester using metagenomic sequencing. (3) Results: Diversity analyses showed that microbiota diversity was altered in early pregnancy. At the species level, eight bacterial species were enriched in healthy controls: Alistipes putredinis, Bacteroides vulgatus, Ruminococcus torques, Oscillibacter unclassified, Akkermansia muciniphila, Clostridium citroniae, Parasutterella excrementihominis and Burkholderiales bacterium_1_1_47. Conversely, Eubacterium rectale, and Ruminococcus bromii were enriched in PIH patients. The results of functional analysis showed that the changes in these different microorganisms may affect the blood pressure of pregnant women by affecting the metabolism of vitamin K2, sphingolipid, lipid acid and glycine. (4) Conclusion: Microbiota dysbiosis in PIH patients begins in the first trimester of pregnancy, and this may be associated with the occurrence of PIH. Bacterial pathway analyses suggest that the gut microbiome might lead to the development of PIH through the alterations of function modules.

A cross-sectional study on the incidence of retinal changes and its correlation with variables like blood pressure, liver function tests, kidney function tests, proteinuria, and pedal edema in patients of pregnancy-induced hypertension in a rural setting.

Pregnancy-induced hypertension is a multisystem disorder that occurs after 20 weeks of pregnancy usually in primigravidas and is characterised by proteinuria, pedal edema, hypertension, and abnormal liver and kidney function tests. Since there exists a close relationship between retinal, cerebral, and renal vessels, fundoscopy gives the opportunity of observing the changes in the vascular tree. We conducted a study on 203 pregnant females over a period of 1.5 years in the rural population of North India. We recorded the baseline data from the patient files, including the biochemical investigations, and conducted a fundoscopic examination of all patients included in the study, and correlation of various variables was established. Out of 203 patients (403 eyes), 60% were primigravidas of mean age 25.71 ± 4.46 years with the mean duration of pregnancy being 36 weeks. The mean systolic and diastolic blood pressure were160 and 101 mmHg, respectively. There was no significant correlation was seen of proteinuria with eclampsia and the fundus findings. But there was a significant correlation between proteinuria and pedal edema and between the fundus findings and deranged LFT and KFT values. Relationship between the variables was calculated by using Chi-square and Fisher's exact test. A P value < 0.05 was taken as significant. Hypertension in pregnancy is the major concern of public health issue worldwide. With proper understanding of the correlating factors such as fundus changes which are directly correlated with whole bo dy vascular changes, which might affect the fetal growth, we can easily predict the outcome and can take appropriate actions as early as possible.

A algorithm for prediction of exudative retinal detachment risk of patients with pregnancy-induced hypertension.

To investigate the risk of exudative retinal detachment (ERD) morbidity in patients with pregnancy-induced hypertension (PIH) by using the logistic regression combined with the receiver operating characteristic (ROC) curve. A total of 46 patients with ERD and 142 patients with non-ERD were diagnosed as PIH from January 2017 to February 2020. A retrospective comparison of the clinical manifestations and laboratory tests were conducted. The risk of ERD morbidity with PIH was predicted by using logistic regression combined with an ROC curve model. There was no significant difference in age and body mass index between the two groups before pregnancy (P>0.05). However, significant differences were found in gestational weeks, duration of hypertension, maximum and minimum systolic and diastolic blood pressure (BP), and plasma total protein (PTP) concentration between the two groups (P<0.05). Binary logistic regression analysis showed that the maximum systolic BP (OR=1.050, 95%CI: 1.016-1.085) and PTP concentration (OR=0.764, 95%CI: 0.702-0.832) were independent prediction risks of ERD in PIH. The sensitivities of maximum systolic BP, PTP concentration and combined diagnosis were 0.717, 0.870, and 0.870, respectively; the specificities were 0.617, 0.837, and 0.908, respectively; the area under the curve (AUC) was 0.707 (95%CI: 0.622-0.792), 0.917 (95%CI: 0.868-0.967), and 0.933 (95%CI: 0.890-0.975), respectively; the AUC of combined diagnosis was higher than that of single diagnosis (P<0.01). Logistic regression and ROC curve model combined with maximum systolic BP and PTP can improve the early identification of high-risk PIH patients in the hospital.

A Study of Ocular Manifestations in Pregnancy Induced Hypertension in a Tertiary Healthcare Centre

Pregnancy Induced Hypertension (PIH) is a perplexing taint in the obstetrics field. Visual symptoms occur in up to 25% of these patients. Ocular manifestations include blurring of vision, sudden inability to focus, photopsia,etc. Aim: To determine the ocular manifestations of PIH, create awareness and promote the need of ophthalmic consult for early diagnosis and optimum feto-maternal care in these patients. Settings and Design: A cross‐sectional study was done by recruiting PIH patients admitted in Obstetrics and Gynaecology department as the subjects, after obtaining ethical approval from the institute and informed consent from the patients. Methods: 100 PIH patients aged 18-35 years who were admitted in Obstetrics and Gynaecology department over a period of 3 months were included in this study. Detailed ophthalmic examination was done and findings recorded. Statistical Package for Social Sciences (SPSS V 26.0, IBM) was used for statistical analysis. P value &lt;0.05 was considered significant. Results: Twenty six(26%)patients had previous history of PIH. Chloasma was seen in eight(8%) patients. 32(32%) patients experienced blurring of vision. Anaemic retinopathy was seen in six patients(6%), grade I hypertensive retinopathy changes were seen in nine patients(9%), grade II hypertensive retinopathy changes were seen in four patients(4%), early papilloedema was seen in one patient(1%) and early Vogt-Koyanagi- Harada disease was seen in one patient(1%). Conclusion: Patient counselling and regular ophthalmic consults are necessary for allaying fears and providing optimum visual care to these patients.

First-Trimester Serum Cytokine Profile in Pregnancies Conceived After Assisted Reproductive Technology (ART) With Subsequent Pregnancy-Induced Hypertension.

Pregnancy-induced hypertension (PIH) is one of the most common pregnancy complications that seriously affects the mother and fetus. The incidence of PIH is higher in pregnancies conceived after assisted reproductive technology (ART) than in spontaneous pregnancies; thus, exploring potential serum biomarkers before PIH onset is of great significance for effective early prediction and prevention of PIH in the ART population. Cytokines are involved in the inflammatory response and immune regulation, which play an essential role in the pathogenesis of PIH. A description of the cytokine profile in the first trimester of pregnancy could help identify new diagnostic tools and develop targeted therapies for PIH in the ART population. The concentrations of classical predictive markers for PIH and another 48 cytokines were measured in the first-trimester pregnancy serum samples from 33 PIH patients and 33 matched normotensive controls (NC), both of whom conceived after ART treatment. The measured values were compared and analyzed between NC and PIH, followed by comprehensive bioinformatic analysis and logistic regression analysis. There was no significant difference in classical predictive markers, including Activin A, PlGF, sFLT1 (VEGFR), and sFLT1/PlGF, between the PIH and NC groups (P > 0.05), while 29 cytokines were significantly lower in the PIH group than in the NC group (P < 0.05). Logistic regression analysis revealed that 17 cytokines (IL-2Rα, M-CSF, IL-6, IL-2, β-NGF, IL-7, IL-12 (p70), SCF, IL-10, IL-9, MIG, GM-CSF, LIF, IL-1α, MCP-3, IL-4, and HGF) in the first-trimester pregnancy serum were significantly negatively correlated with the subsequent onset of PIH. With the top 3 cytokines (IL-7, MIG, and SCF) of receiver operating characteristic (ROC) analysis, we constructed an efficient multifactor combined detection and prediction model for PIH in ART pregnancy. Classical early predictors for hypertensive disorder complicating pregnancy cannot distinguish PIH from their normal peers in ART pregnancy. In comparison, the description of the cytokine profile in the first trimester of pregnancy enables us to distinguish high-risk ART pregnancy for PIH, permitting enough time for PIH prevention therapy. The cytokine profile we described also provides immunological insight into the further mechanistic exploration of PIH.

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

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

Visual morbidity and spectrum of ophthalmic changes in pregnancy induced hypertension.

ABSTRACTAim:To determine the prevalence of ocular changes in pregnancy-induced hypertension (PIH) and co-relate the ophthalmic changes and severity of the disease with visual outcome.Methods and Material:This is a retrospective study conducted from a hospital-based cohort of pregnant women, who delivered from June 2018 to December 2020. A total of 153 patients who fulfilled the diagnostic criteria of PIH admitted in the obstetric ward were included in this study. History with regard to age, parity, gravida, gestational age, medical history, and ocular findings were noted from the patient’s case records. Anterior segment examination, dilated fundus evaluation, blood pressure (BP) recordings, urine proteinuria were done. All data were analyzed using the satistical package for social science (SPSS) program.Results:Out of 153 patients, 78 (50.98%) were primigravida, 55 (35.95%) were gravida 2, and 20 (13.07%) were multigravida. Gestational age ranged from 23–40 weeks. Ocular changes were seen in 57% of the PIH patients. Hypertensive retinopathy was seen in 23.53% of PIH patients with a mean age of 29.06 ± 4.36 years. Grade 1 hypertensive retinopathy was the most common manifestation in PIH patients (51.16%). The visual loss occurred in 72% of eclampsia and12% of pre-eclampsia which was statistically significant (P = 0.03). Papilledema was seen in 6% and refractive error in 41% of the patients.Conclusions:Ocular examination of PIH patients reveals important objective information concerning the disorder. The presence of retinal change is a marker of the severity of PIH and is the most common ocular feature. Detection of progression of these changes reflects ischemic changes of the placenta. Fundus examination in PIH patients is important to predict adverse fetal outcomes, and risks to mother’s life.

Dyslipidemia and other parameters in women with pregnancy induced hypertension.

Several investigations have confirmed changes in lipid profiles and other markers (interleukin [IL]-6, C-reactive protein [CRP]) in women with pregnancy induced hypertension (PIH). Although, the cause an effect correlations between these lipid profiles and other markers with the PIH are yet unknown. To study the relationship of serum lipid profile, CRP, and IL-6 with PIH. A cross-sectional study was done on 60 pregnant women with PIH treated in the General Salah Alden Hospital in Tikrit city, Iraq, from January 2021 to April 2021. Another group of 60 pregnant women who were normal, at the same period, were selected as the control group. The average age of the participants was (27.1 ± 5.0) years. All the blood samples taken were examined for lipid profile, CRP, and IL-6. The results statistically showed significant differences in IL-6 level and CRP. Whereas, in the Lipid profile (triglyceride [TG], low density lipoprotein cholesterol [LDL-C], high density lipoprotein [HDL]-C, total cholesterol [TC], and very low density lipoprotein cholesterol [VLDL]) were found. Also, it was found that there were significant differences in PIH patients as compared to the control group. The findings revealed that the lipid profile was aberrant, and the amount of IL-6 protein was positively linked with blood pressure.

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

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