Pregnancy-induced Hypertension Patients Research Articles

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.

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

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

Doppler Ultrasound Imaging Combined with Fetal Heart Detection in Predicting Fetal Distress in Pregnancy-Induced Hypertension under the Guidance of Artificial Intelligence Algorithm.

This study was to improve the feasibility and economic benefits of intelligent medical system Doppler ultrasound (DUS) imaging technology combined with fetal heart detection to predict the fetal distress in pregnancy-induced hypertension (PIH), so as to reduce the risk of deterioration of the patient's condition. The characteristics of DUS images were analyzed, and a diffusion filter reducing the specificity was adopted to improve the smooth speckle noise of DUS images. 120 pregnant women in hospital were the subjects of the study, all of whom received ultrasound cord blood flow testing and fetal heart monitoring. 88 PIH patients with fetal distress were diagnosed and included in the observation group, and 32 healthy pregnant women tested during the same period were identified as the control group. Clinical data were reviewed and analyzed. The diagnostic rates of fetal distress by simple fetal heart monitoring and DUS detection combined with fetal heart monitoring were compared. The results showed that 26.7% of fetal distress were diagnosed by fetal heart monitoring alone, and 73.3% of fetal distress were diagnosed by combined testing, so the diagnostic accuracy of the combined detection method was greatly higher than the single fetal heart detection (P < 0.05). The Pulsatility index (PI), resistance index (RI), and S/D values detected by the umbilical artery in the observation group were 1.48, 0.85, and 4.31, respectively. The PI, RI, and S/D values detected by the umbilical artery in the control group were 0.96, 0.64, and 3.59, respectively. The results of arterial detection were significantly higher than those of the control group, and the difference was of significant scientific significance (P < 0.05). In summary, the PI and RI values of the middle cerebral artery (MCA) detected by DUS diagnosis can effectively reflect the current status of the fetus in the uterus and reduce the mortality of the fetus. The images guided by DUS imaging technology can clearly show the current status of the fetus in the uterus, effectively improve the medical diagnostic efficiency, and have important reference value for the development of intelligent medical equipment.

Feto-Maternal Outcomes and Treatment Compliance in Metformin Versus Insulin-Treated Gestational Diabetic and Non-Diabetic Patients at the Rehman Medical Institute, Peshawar.

IntroductionGestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The diagnosis is made on the basis of the oral glucose tolerance test (OGTT) which according to the guidelines of ACOG regards a blood glucose level higher than 190mg/dL after the one-hour test as the criteria for GDM. The first-line agent for GDM is insulin injections; however, it has high costs and also causes its own feto-maternal complications which can include weight gain and polyhydramnios. On the contrary, metformin has fewer complications, is cheaper, and is emerging as a better alternative for the first-line agent for the treatment of diabetes mellitus type 2. GDM had a prevalence of 11.8% in the year 2018 in all trimesters of pregnancy in Pakistan. This study was thus conducted to determine the feto-maternal outcomes of non-GDM and GDM patients on insulin, metformin, and combined treatment respectively admitted to gynecology ward Rehman Medical Institute (RMI) Khyber Pakhtunkhwa, Pakistan in the year 2019.ObjectivesTo determine the feto-maternal outcomes in patients of GDM on metformin treatment and the feto-maternal outcomes in patients of GDM on insulin treatment and to compare the feto-maternal outcomes of mothers with GDM to those without GDM.MethodologyThis is a retrospective study conducted from January to April 2020 on patients of gestational diabetes mellitus undergoing either metformin, insulin, or both therapies admitted to the gynecology ward, Rehman Medical Institute (RMI). After getting ethical approval from the institutional ethical approval board, data were collected for the entire year of 2019 on the basis of proforma with the variables: demographic data, glycemic control (via OGTT), mode of labor, primary open-angle glaucoma (POAG), and feto-maternal outcomes. Data was entered and analyzed via SPSS version 21.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY) and the data were run through various tests including descriptive statistics, cross-tabulations, and chi-square. Results were formulated on the basis of these reports which were then presented in the form of graphs and tables.ResultsOut of 150 mothers who were admitted for delivery at the gynecology ward, 123 (82.0%) women were 30-40 years of age. Non-gestational diabetics patients were 78 (52%) whereas gestational diabetic mothers were 72 (48%); within these GDM-positive mothers 44 (61.1%) were on metformin, 21 (29.1%) were on insulin and seven (9.7%) were on combined treatment. Among modes of delivery, C-section was the most common (113 [76%]), mostly in non-GDM mothers (95 [45.1%]) followed by those on metformin treatment (36 [31.8%]). Considering fetal outcomes there was a significant association between NICU admissions, neonatal jaundice, and breech presentation with insulin-treated mothers (p=0.06, p=0.003, p=0.004, respectively CI=95%). Among maternal outcomes, there was a significant association between pregnancy-induced hypertension (PIH) and insulin-treated patients (p=0.02 CI=95%), premature rupture of membranes (PROM), and metformin-treated patients (p=0.01 CI=95%) whereas eclampsia was significantly associated with mothers not having GDM (p=0.001 CI=95%).ConclusionBased on this preliminary data and considering feto-maternal outcomes, metformin appears to be a safer drug as compared to insulin in the treatment of GDM with more compliance.

Comparative study of early neonatal outcome in low birth weight babies in hypertensive disorders complicating pregnancies with the mode of delivery

Pregnancy induced Hypertension (PIH) is strongly associated with intrauterine fetal growth restriction (IUGR), low birth weight (LBW) and admission to NICU. PIH is not by itself an indication for caesarean delivery. However, the incidence of caesarean is high because of the development of complications in mother and the need to deliver prematurely. To compare the immediate morbidity and survival advantage of LBW vertex presenting babies with the mode of delivery in hypertensive disorders complicating pregnancies. This was a comparative cross-sectional study done on women admitted to the labour ward during the study period with PIH delivering a baby through either a vaginal delivery or a caesarean section with a birthweight of &amp;#60;2.5kgs. A detailed history taking and clinical examination was done. Babies were followed up for one week following delivery to note down the early neonatal outcome. In this study, over all there was no statistically significant difference in neonatal outcome in both vaginal delivery and caesarean section groups. However, there was slight increased incidence of prematurity (68% vs 64%), Birth Asphyxia (14% vs 8%), Sepsis (8% vs 6%), IVH (6% vs 2%) and Hyperbilirubinemia (16% vs 14%) in vaginal delivery group. While, RDS (20% vs 14%) and NEC (4% vs 2%) had higher incidence in caesarean delivery group. Overall, prematurity and IUGR resulting in LBW, contributed to these neonatal complications. Caesarean delivery offers no short-term survival advantage compared with vaginal delivery for LBW vertex presenting foetuses in PIH patients. Neonatal outcomes are not worsened by spontaneous or induced vaginal delivery in women with hypertension with good control and also decreases morbidity due to caesarean section to the mother.

Correlation of Doppler Findings with Perinatal Outcome Among Patients with Pregnancy Induced Hypertension

Background: Hypertensive conditions are the most widely recognized medical complications during pregnancy. Aims and Objectives: In the current study, an attempt was made to understand the significance of Doppler studies in pregnancy induced hypertension and to correlate with the perinatal outcome and to offer better strategies of prevention and early detection and management. Methods: The study comprised of 138 patients admitted in a tertiary care centre at or beyond 28 weeks of gestation with pregnancy induced hypertension (PIH). To determine and monitor a favorable or worsening fetal wellbeing status, follow up Doppler studies were performed though the results of only last Doppler ultrasound within one week of delivery were used for analysis. Patients were followed up till delivery. The maternal and perinatal outcome was studied thereafter. Results: Umbilical Artery (UA) Doppler findings disclosed 26.8% had abnormal umbilical artery S/D ratio, 31.1% had abnormal umbilical artery Recoiling Index (RI) and 2.90% had abnormal umbilical artery Pulsatality Index (PI). Perinatal mortality in the abnormal umbilical artery PI category was found to be the highest (100%) compared to abnormal umbilical S/D artery ratio (66.7%)to be the highest (100%) compared to abnormal umbilical S/D artery ratio (66.7%) and umbilical artery RI ratio (66.7%). In the estimation of adverse perinatal outcome, the predictive accuracy of the umbilical artery S/D ratio in the prediction of adverse perinatal outcome was found to be 73.91%while that of UA RI ratio was 68.12% and the UA PI was 61.59%.Itwas found that in prediction of adverse perinatal outcome, the Umbilical artery PI had higher specificity (97.65%) than the UA S/D ratio (88.24%) and UA RI (80.00%). Fetal middle cerebral artery Doppler studies revealed that 15.2% patients had abnormal MCA S/D ratio, 13.0% had abnormal MCA RI and 15.21% had abnormal MCA PI of which maximum perinatal mortality was seen in abnormal MCA S/D ratio (66.7%) followed by MCA PI (33.3%). Most specific predictor of adverse perinatal outcome was Cerebroplacental ratio (MCA PI/UA PI be (97.65%) The cerebroplacental index has the highest specificity (97.65%)and positive predictive value (93.55%) in predicting adverse perinatal outcome, compared to that of Umbilical artery pusatility index (97.65% and 1.60%) and MCA Pulsatility Index (91.76 and 84.62%) in the present study. Conclusion: The present study noted the prominance of Doppler ultrasound studies in PIH patients, detecting compromised fetuses in utero and taking fitting action in a timely manner.In the present study, the predictive accuracy of the umbilical artery S/D ratio in predicting adverse perinatal outcome was found to be high relative to UA RI and UA PI. In addition, the umbilical artery PI had the highest specificity compared to other Doppler parameters. Absent end diastolic flow and Reversal of end diastolicflow were associated with significant perinatal.

Stress Induced Cardiomyopathy (Takotsubo) in a Post-Operative Pregnancy Induced Hypertension Patient Operated for Caesarean Section: A Case Report

This is a case of a 30 year old female, with Pregnancy Induced Hypertension and history of psychiatric illness in the past, subsequently developed TCM in the intra-operative period. ECG showed subtle fresh changes. There were multiple stressors for our patient namely acute blood loss, spinal anaesthesia and history of psychiatric illness. The decision on the timing and mode of delivery should be guided by obstetrical reasons. A multidisciplinary team of cardiologists, obstetricians, neonatologists, and psychologists should be involved. This case highlights the importance of being extra vigilant in patients having psychiatric disorders undergoing any surgical procedure especially caesarean section.

English

BACKGROUND Post caesarean section pain requires effective analgesia. Effective analgesia is integral to improvement of quality and patient care among lower segment caesarean section (LSCS) patients. Magnesium, an N-methyl-D-aspartate receptor antagonist along with calcium-channel blocker, has previously been investigated for its analgesic properties. But there is scanty previous literature available for intramuscular magnesium sulphate in the analgesic role in post caesarean mothers. The purpose of this study was to evaluate the effect of existing MgSO4 regimens (among severe pregnancy induced hypertension patients, excluding eclampsia) during early 1st 24 hours’ postoperative analgesic requirements in caesarean section patients comparing to only analgesic group. METHODS It is a retrospective observational study, conducted from January 2019 to June 2020. Patients were randomly selected, normal patients as control = 50 who got post-operative inj. diclofenac 75 mg IM twice a day and rescue analgesia inj. diclofenac 75 mg IM. Test sample comprised of 50 randomly selected severe pregnancy induced hypertension (PIH) patients who got prophylactic inj. magnesium sulphate by Pritchard regimen for 24 hrs. post delivery with 4 gm 20 % inj. magnesium sulphate intravenous with 10 gm 50 % intramuscular in both buttocks as loading dose followed by 5 gm 50 % inj. magnesium sulphate intramuscular 4th hourly for 24 hrs. along with inj. diclofenac 75 mg IM twice a day. Visual analogue scale for pain was noted among both the groups, and were compared for the effect of analgesics in the study groups. RESULTS There was a decrease in analgesic consumption and immediate post-operative pain in the group receiving MgSO4 with analgesic (inj. diclofenac 75 mg), in comparison to control group of inj. diclofenac 75 mg. (P &lt; 0.0001). CONCLUSIONS There was a decrease in analgesic consumption in the group receiving MgSO4 plus analgesic, in comparison to control group (analgesic group). Pain severity assessment 2, 6, 12 and 24 hours post operatively showed that there was a statistically significant decrease in pain scores between the study and the control groups (P &lt; 0.0001). It established the role of magnesium sulphate as an adjuvant analgesic along with diclofenac or other traditionally used pain medications among the post caesarean mothers in early post-operative period. KEYWORDS Analgesia, Pregnancy, Post-Operative Analgesia, Magnesium Sulphate, Lower Segment Caesarean Section (LSCS), Pain Relief, Obstetrics

Ocular manifestations of pregnancy induced hypertension

Background: Pregnancy Induced Hypertension (PIH) is a challenging stigma in the field of obstetrics and one of the major contributors to maternal and perinatal mortality. Hence; the present study was undertaken for assessing ocular manifestations in patients with pregnancy induced hypertension. Materials & Methods: A total of 100 patients with pregnancy induced hypertension were enrolled. Patients with the chronic hypertension, preexisting renal diseases, diabetes mellitus, hematological disorders, infectious diseases and any prior ocular diseases were excluded. Anterior segment examination was carried out with torch light. Pupils were dilated with tropicamide and fundus examination was carried out with indirect ophthalmoscope. All the results were recorded and analysed by SPSS software. Results: Defective vision was seen in 19 percent of the patients. Macular oedema was seen in 11 percent of the patients. Lid oedema and choroidal infarcts were seen in 2 percent and 3 percent of the patients respectively. Arteriolar narrowing was seen in 14 percent of the patients. Conclusion: Ocular symptoms were seen in 32% of preeclampsia. Frequent and prompt screening of retina in PIH patients is indicated.

Correlation of Component Blood Transfusion of Hypertension Patients with Pregnancy and Postpartum Hemorrhage.

To analyze the correlation of component blood transfusion and prognosis of patients with pregnancy-induced hypertension (PIH) and postpartum hemorrhage (PPH) in assisted reproductive technology (ART). A retrospective analysis of clinical data on 85 pregnant women with ART-induced PIH and PPH was completed. They were divided into observation group and control group based on whether there was component transfusion after massive hemorrhage. The plasma coagulation and blood platelet-related indexes of the two groups of patients were assayed before blood transfusion, 24 hours after blood transfusion, and 12 weeks post-partum. The incidence of adverse reactions of blood transfusion within one week of blood transfusion, the proportion of patients transferred to the general ward, the blood pressure, and biochemical indexes at 12 weeks postpartum were recorded. There was no significant difference in coagulation function before blood transfusion between the two groups of patients (p > 0.05). After 24 hours of massive blood transfusion, APTT, PT, and TT in the observation group were obviously shorter than those in the control group (p < 0.001), whereas FIB and PLT were higher than the control group (p < 0.01). In contrast to the control group at 12 weeks postpartum, the APTT, TT, and PT of the observation group were shortened (p < 0.05), while the FIB level was higher (p < 0.01). The probability of adverse reactions of transfusion in the observation group was lower than the control group (p < 0.05). The correlation between component transfusion and disease improvement after one week of transfusion and 12 weeks postpartum was 0.350 (0.159 - 0.530) (p < 0.01) and 0.441 (0.258 - 0.608) (p < 0.001). Component blood transfusion in ART-induced PIH patients can improve their coagulation function, reduce the probability of adverse reactions caused by massive blood transfusion, and improve their prognosis.

Placental Changes in Anemia, Gestational Diabetes and Pregnancy Induced Hypertension

Background: To assess the changes occurring in the placenta due to anemia, pregnancy induced hypertension (PIH), Gestational Diabetes Mellitus (GDM) and whether these changes were reversible with treatment when they were diagnosed in early stages. Subjects and Methods: The study is conducted in the Department of Obstetrics and Gynecology, DVVPF’s Medical College, Ahmednagar on 200 anemic patients, 180 PIH patients and 650 GDM patients. Placentae were collected, stored in a 10% formalin solution. Morphological changes in respect to shape, weight, diameter, thickness, number of cotyledons and site of insertion of the cord are observed and documented. Results: In anemic patients who has undergone treatment, there were a smaller number of irregular (37/100) and round (63/100) round placentae were seen, whereas in the untreated anemic group, round (09/100) round and irregular (91/100) irregular placentae were seen. In PIH group with treatment, round (57/90) placentae and irregular (33/90) placentae were seen, whereas, in the untreated group, 13/100 round/oval placentae were observed and 77/100 irregular placentae were seen. Conclusion: Morphology of placenta is on error mode in untreated anemia, PIH and GDM. Diagnosis in the first trimester and on consequent treatment till the delivery is resulting in decreasing of irregular morphology of placenta and wellbeing of newborns.

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

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

Retinal vascular disorders during pregnancy: An observational study

Aim: To determine the prevalence and pattern of retinal vascular disorders in pregnant women. Materials and Methods: This hospital based, prospective observational study was conducted over a period of two years. Patients were selected from outpatient department and antenatal ward of Department of Obstetrics and Gynecology and outpatient department of Ophthalmology, SS Hospital, IMS, BHU, Varanasi. In all cases detailed obstetric history including age, gravida, gestational age, general and antenatal examination and relevant pathological investigations like blood sugar, blood urea, serum creatinine and urinary protein were carried out. After taking ocular history, detailed ocular examination including visual acuity and fundus examination under mydriasis with 1% tropicamide eye drop was carried out. All the findings were recorded on a data sheet and were analyzed using SPSS programme. The Chi-Square test was used to evaluate the association between the various antenatal factors and retinal vascular changes. Results: Of 210 patients 38.09% patients were primigravida and 28.57% were second gravida. 28.57% had pregnancy induced hypertension (PIH), 13.33 % had gestational diabetes mellitus, 12.38% had preexisting diabetes mellitus. Fundus abnormalities were observed in 110 (52.38%) cases among them commonest retinal pathology was hypertensive retinopathy 38 (34.55%) followed by diabetic retinopathy (32.73%), retinal vein occlusion (16.36%) and central serous chorioretinopathy (7.27%). Out of 60 cases of PIH 38 (63.33%) had retinal abnormalities. Retinal vascular disorders were seen in > 80% cases of severe pre-eclampsia and about 90% cases of eclampsia. Majority (68.42%) of PIH patient had grade I hypertensive retinopathy. The commonest retinal change was arterial attenuation (28.57%) followed by dot and blot hemorrhage (21.90%), A-V crossing changes (20.48%), hard exudates (19.05%), flame shaped hemorrhage (42.56%) and macular edema (18.10%). However in 5.71% cases papill

Periodic Assessment of Antenatal and Post Natal Serum Endothelin-1 (ET-1) and Nitric Oxide (NO) Levels in Hypertensive Disorders of Pregnancy (HDP)

Hypertensive Disorders of Pregnancy (HDP) is an independent risk factor of cardiovascular (CVS) disease with endothelial dysfunction postulated to be the pathophysiology. Endothelin-1 (ET-1), a potent vasoconstrictor, has been identified as a pivotal mediator in HDP. Disturbances in nitric oxide (NO) bioavailability found in endothelial dysfunction may increase susceptibility to cardiovascular diseases such as hypertension. The study aims to determine serial ET-1 and NO levels in patients with HDP and its role in persistent endothelial dysfunction. Thirty-six pregnant women from the following categories (i) normal pregnant women (Control) (ii) chronic hypertension during pregnancy (CH) and (iii) pregnancy induced hypertension (PIH) participated in this study. Blood pressure indices measurements and sample collection were done at antepartum (32 weeks) and postpartum (8 weeks and 12 weeks). ET-1 and serum NO were measured using the Human ET-1 (Endothelin-1) ELISA Kit and Nitric Oxide (total) detection kit respectively. Results: Serum ET-1 was significantly higher in patients with CH (55.3 pg/ml) and PIH (35.6 pg/ml) compared to Control (11.8 pg/ml) during antenatal until 3 months postpartum (CH 38.3 pg/ml, PIH 29.5 pg/ml, Control 1.9 pg/ml). This was accompanied by significantly lower levels of serum NO in HDP patients. Persistently higher than normal levels of ET-1 and lower than normal levels of NO up to 3 months postpartum in patients with history of HDP indicate presence of persistent endothelial dysfunction despite BP normalisation in PIH patients. Long term NO/ET-1 imbalance may account for the increased CVS disease risk.

Effect of baicalin on gestational hypertension-induced vascular endothelial cell damage.

ObjectiveBaicalin is a compound extracted from the dried root of Scutellaria baicalensis Georgi. Studies have shown that baicalin has a protective effect on vascular endothelial cells, but whether baicalin could alleviate ascular endothelial cell damage in pregnancy-induced hypertensive patients remains unknown.Materials and methodsWe established a hypertensive pregnant rat model to study vascular endothelial injury during pregnancy-induced hypertension. Plasma epoprostenol (PGI-2), thromboxane A2 (Txa-2), β-human chorionic gonadotropin (β-HCG), and estrogen levels in rats were detected using ELISA. Vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), and C-reactive protein (CRP) expression were detected using western blotting and quantitative PCR (q-PCR).ResultsResults showed that baicalin alleviated symptoms of pregnancy-induced hypertension. CRP, Txa-2, and β-HCG expression were significantly upregulated, while VEGF, eNOS, PGI-2, and estrogen expression was decreased in plasma and placental tissues of hypertensive rats. However, the levels of these injury indicators were significantly decreased after baicalin therapy, while the expression of protective indicators was significantly increased.ConclusionBaicalin reversed vascular endothelial cell injury in pregnant hypertensive rats by promoting VEGF, eNOS, PGI-2, and estrogen expression.

Expression and role of miR-338-3p in peripheral blood and placenta of patients with pregnancy-induced hypertension.

The present study aimed to investigate the role of miR-338-3p in pregnancy-induced hypertension (PIH), and its effects on human trophoblast cells in vitro. Quantitative real-time PCR was used to detect miR-338-3p expression. Human trophoblast HTR8/SVneo cells were transfected with miR-338-3p mimics. Effects of miR-338-3p on cell proliferation, invasion and metastasis, and anoikis resistance were detected by CCK-8 assay, Transwell chamber assay, flow cytometry and western blot analysis, respectively. Bioinformatics analysis was performed to predict the target of miR-338-3p, and the results were confirmed by dual luciferase reporter assay. The expression level of miR-338-3p was significantly upregulated in the peripheral blood and placenta of PIH patients. CCK-8 assay showed that miR-338-3p mimics inhibited the proliferation of HTR8/SVneo cells at indicated time points. Flow cytometry showed that miR-338-3p transfection significantly increased the Ki-67 expression in the HTR8/SVneo cells, indicating enhanced cell proliferation. Transwell chamber assay and western blot analysis showed that the invasion and metastatic abilities of the HTR8/SVneo cells were significantly decreased in the miR-338-3p transfection group, as well as expression levels of MMP-2 and MMP-9. Bioinformatics analysis and dual luciferase reporter assay indicated that AKT3 is a target gene of miR-338-3p. Our results suggest that miR-338-3p is significantly increased in the peripheral blood and placenta of PIH patients, which is correlated with the disease development. miR-338-3p inhibits proliferation, invasion and metastasis, and apoptosis resistance of human trophoblast cells by targeting AKT3.

The diagnostic value and regulatory mechanism of miR-200a targeting ZEB1 in pregnancy-induced hypertension

ABSTRACT Objective To investigate the diagnostic value and regulatory mechanism of miR-200a targeting ZEB1 in pregnancy-induced hypertension (PIH). Methods The expression of miR-200a and ZEB1 was detected in the placenta of PIH patients, and then the human trophoblastic cell line JEG-3 was transfected and divided into different groups: control group, NC group, ZEB1 siRNA group, miR-200a inhibitor group and miR-200a inhibitor group + ZEB1 siRNA group. After transfection, cell proliferation and migration/invasion were evaluated byMTT and Transwell assays, respectively, whereas apoptosis was assessed byflow cytometry. MiR-200a was measured by qRT-PCR, while ZEB1 was detectedby Western blotting. Results The expression of miR-200a was gradually increased in the placenta of patients with hypertension and mild or severe preeclampsia, while the mRNA and protein levels of ZEB1 were downregulated. A dual-luciferase reporter assay was performed to confirm the targeting relationship between miR-200a andZEB1.Compared to the control, the miR-200a inhibitor caused a strongdecrease in miR-200a andan upregulation of ZEB1, with a significant enhancement ofcell proliferation, migration and invasion and a decrease in apoptosis. However, no significant alteration was observedin the miR-200a level after administration of ZEB1 siRNA, while ZEB1 was downregulated, with significant suppression of growth. Conclusion MiR-200a was upregulated in PIH patients, andinhibition of miR-200a may improve disease progression, as it could facilitatetrophoblastproliferation, migration and invasionandinhibitapoptosisby targeting ZEB1.

Placental pathology in different degrees of pregnancy induced hypertension

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

Pregnancy-induced hypertension is associated with down-regulation of Kir6.1 in human myometrium.

It is generally accepted that activity of K+ channels maintain resting membrane potential and uterine quiescence during pregnancy, which is, at least in part, mediated by down-regulation of ATP-sensitive K+ (KATP) channels. Pregnancy-induced hypertension (PIH) is associated with pre-term and late pre-term labour. Here, we have used real time RT-PCR to compare mRNA levels of KATP channel subunits in PIH parturient and control parturient. We have found that Kir6.1, a pore forming, myometrial KATP channel subunit is down-regulated in PIH patients. This could perfectly explain increased rate of pre-term labour in patients suffering from PIH.

MMP-9 and TIMP-1 in placenta of hypertensive disorder complicating pregnancy.

Expression and characteristics of matrix metalloproteinase-9 (MMP-9) and TIMP metallopeptidase inhibitor-1 (TIMP-1) in the placenta of pregnancy induced hypertension (PIH) were detected in Uygur to analyze its correlation with PIH, and to provide a theoretical basis for clinical work. Ninety cases of placental tissue patients who were hospitalized in the Department of Obstetrics of People's Hospital of Xinjiang Uygur from December 2014 to September 2016 were collected, including 30 cases of severe preeclampsia, 30 cases of mild preeclampsia, and 30 cases of normal group. The distribution of MMP-9 and TIMP-1 in placenta was mainly in the cytoplasm of trophoblast cells, vascular endothelial cells and villous mesenchymal cells. The distribution of MMP-9 positive particles in the placenta tissue of the severe group was significantly reduced. The difference of MMP-9 in the three groups was statistically significant. Severe group was statistically significantly different from normal and mild group. With the aggravation of PIH, positive expression of MMP-9 was gradually decreased. TIMP-1 was expressed in each group, and difference was not statistically significant. Positive expression ratio of MMP-9/TIMP-1 in severe group was lower than that in normal pregnancy and mild group, and positive expression ratio of the two groups became smaller as the condition worsened. Positive expression of MMP-9 in placental tissue of patients with PIH decreased significantly with the severity of PIH. TIMP-1 in placental tissue of PIH patients did not change much in each group, and had no significant correlation with PIH.