Prenatal Hypertension Research Articles

MATERNAL DEATHS DUE TO ECLAMPSIA AND HELLP SYNDROME: A SYSTEMATIC REVIEW

Background: Hypertensive disorders in pregnancy affect 10 of women and are a main cause of maternal morbidity and mortality worldwide. Preeclampsia, eclampsia, and Hemolysis, Elevated Liver Enzyme Levels and Low Platelet Levels (HELLP) syndrome are life-threatening hypertensive conditions that occur in pregnant woman. The aim: This study aims to show maternal deaths due to eclampsia and HELLP syndrome. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 39 articles, whereas the results of our search on SagePub brought up 106 articles. The results of the search conducted for the last year of 2013 yielded a total 25 articles for PubMed and 50 articles for SagePub. The result from title screening, a total 10 articles for PubMed and 22 articles for SagePub. In the end, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: The higher maternal age; prenatal history of hypertension and hypoproteinemia; and conditions requiring oral prednisolone, oral anticoagulants, and oral antiplatelets were identified as significant risk factors underlying critical obstetric bleeding, together with other obstetric complications. Prenatal hypertension may predispose patients to HELLP syndrome, eclampsia, and subsequent development of critical bleeding, but it may not predispose the patients to atonic bleeding.

Prenatal hypertension as the risk of eclampsia, HELLP syndrome, and critical obstetric hemorrhage

Critical bleeding is a common cause of maternal mortality in obstetric patients. However, the non-obstetric factors underlying critical obstetric bleeding remain uncertain. Therefore, this study aimed to clarify the impact of chronic hypertension on obstetric hemorrhage by evaluating a nationwide administrative database in Japan. Women who gave birth between 2018 and 2022 were enrolled. The primary outcome was critical hemorrhage requiring massive red blood cell (RBC) transfusion during childbirth. In total, 354, 299 eligible women were selected from the database. The maternal mortality rate was >1.0% among those who received a massive RBC transfusion (≥4000 cc), and this amount was used as the cutoff of the outcome. Critical hemorrhage was less frequent with elective Caesarean section (CS) compared with vaginal childbirth or emergent CS (odds ratio [OR], 0.38; 95% confidence interval, 0.30–0.47). Multiple logistic regression analysis adjusting for these obstetric risks revealed that a higher maternal age (adjusted OR [aOR] per 1 year, 1.07 [1.05–1.09]); oral medications with prednisolone (aOR, 2.5 [1.4–4.4]), anti-coagulants (aOR, 10 [5.4–19]), and anti-platelets (aOR, 2.9 [1.3–6.4]); and a prenatal history of hypertension (aOR, 2.5 [1.5–4.4]) and hypoproteinemia (aOR, 5.8 [1.7–20]) are the risks underlying critical obstetric hemorrhage. Prenatal history of hypertension was significantly associated with obstetric disseminated intravascular coagulation (OR, 1.9 [1.5–2.4]); Hemolysis, Elevated Liver enzymes, and Low platelet count (HELLP) syndrome (OR, 3.3 [2.7–4.2]); and eclampsia (OR, 6.1 [4.6–8.1]). In conclusion, a maternal prenatal history of hypertension is associated with the development of HELLP syndrome, eclampsia, and resultant critical hemorrhage.The incidence of HELLP syndrome and eclampsia increased more than fivefold in the presence of prenatal hypertension. However, the likelihood of subsequently developing DIC or experiencing critical bleeding did not change by the presence of prenatal hypertension.

Eclampsia and Its Treatment Modalities: A Review Article.

Hypertension in pregnancy is one of the major contributors to mortality and morbidity. Pregnant women and fetuses are both at high risk of the severe complications of preeclampsia known as eclampsia. Eclampsia is a disorder that requires immediate detection and treatment. Eclampsia and preeclampsia during pregnancy are known to cause morbidity and even death in both the mother and fetus if not properly diagnosed. Chronic hypertension, prenatal hypertension, preeclampsia on top of chronic hypertension, and eclampsia are the four types of hypertension. Preeclampsia is the precursor to eclampsia. Associated with end-organ failure and proteinuria after 20 weeks of pregnancy, preeclampsia is characterized by the development of hypertension with systolic blood pressure (BP) of at least 140 mmHg and/or diastolic BP of at least 90 mmHg. It can lead to the failure of the liver, thrombocytopenia, pulmonary edema, central nervous system (CNS) abnormalities, and renal dysfunction. The emergence of new generalized tonic-clonic seizures in a pregnant woman with preeclampsia is known as eclampsia. Eclamptic seizures can happen prior to delivery, 20 weeks following conception, during delivery, and after delivery. Although rare, gestational trophoblastic illness has been associated with seizures that start before 20 weeks. In this article, we examine the pathogenesis, causes, signs, symptoms, and treatment modalities in patients with eclampsia.

Maternal and Neonatal Outcomes in Hypertensive Disorders during Pregnancy

Context: Pregnancy is a physiological phenomenon, and each pregnancy is unique and valuable in its own way. Hypertensive diseases during pregnancy begin throughout pregnancy and disappear entirely after birth. Hypertensive disorders in pregnancy (HDP), including pregnancy-induced hypertension (HTN), chronic HTN (CHTN), (superimposed) preeclampsia, and eclampsia, are responsible for increased perinatal morbidity and mortality. Aim: The aim of this study was to investigate the prevalence and perinatal effects in women with hypertensive disease during pregnancy. Setting and Design: Hospital based cross section study was conducted on pregnant women. Methods and Materials: A hospital-based cross-sectional study was carried out from September 2019 to August 2021 on women whose pregnancies were complicated by HTN disorders. Mothers of the baby suffering from systemic diseases were excluded from the study. Statistical analysis used: Descriptive and inferential statistical analysis was conducted. Results: In the present study results the prevalence of gestational HTN at 8.49%, preeclampsia at 18.10%, severe preeclampsia at 8.75%, and CHTN was 2.28%. It was shown that the prevalence of hypertensive disease is 38%. A significant difference was found between the maternal age group of mothers suffering from HTN disorders during pregnancy with mean gestational age in weeks F = 124.6477, P = 0.0001 at a 5% level. Furthermore, a significant statistical difference was observed with different maternal age groups having different mean Apgar scores at 1 min with F = 81.0233, P = 0.0001. Conclusion: Prenatal HTN is one of the leading causes of maternal and neonatal death. Despite having all of the resources and several government programs in both urban and rural areas, many women suffer from HDP in both locations (rural and urban). Hence, management, as well as awareness among pregnant women regarding hypertensive diseases in pregnancy, is required.

Evidence of Anxiety, Depression and Learning Impairments following Prenatal Hypertension.

Background: Hypertensive disorders of pregnancy, such as Preeclampsia (PreE) and HELLP (hemolysis, elevated liver enzyme, low platelet) syndrome, affects approximately 5–10% of pregnancies and increases the risk of women developing disorders, such as anxiety or depression, in the postpartum period. Using preclinical rodent models, we set out to determine whether rats with a history of PreE or HELLP had evidence of anxiety, depression or cognitive impairment and whether immune suppression during pregnancy prevented these changes in mood and/or cognition. Methods: Timed-pregnant rats were infused with sFlt-1 and/or sEng to induce PreE or HELLP beginning on gestational day 12. After delivery, a battery of validated behavioral assays was used to assess post-partum depression, anxiety and learning. Results: There was no negative effect on maternal pup interaction due to PreE or HELLP; however, hypertensive dams spent more time immobile in the forced swim test (p < 0.0001). Hypertensive dams also spent less time in the open area of the open field (p = 0.001). There were no significant changes in recognition memory (p = 0.08); however, spatial learning was impaired in hypertensive dams (p = 0.003). Immobility time in the forced swim test was positively correlated with increased circulating S100B (p = 0.04), while increased time spent in the outer zones of the open field was negatively correlated with BDNF levels (p < 0.0001). Conclusion: The results from this study suggest that hypertensive pregnancy disorders are associated with depression, anxiety and learning impairments in the post-partum period.

Abstract 573: Mechanical Stress Alters Cell Signaling and Extracellular Matrix Genes in Fetal Cardiac Valves

Objective: Prenatal hypertension leads to mitral annular dilation and is linked to changes in valvular extracellular matrix (ECM) and cell cycle genes including TGFβ-1, BMPs and FGF. We hypothesized that these changes are exacerbated by additional mechanical stress. Methods: Fetal sheep received 8 days of plasma infusion to induce hypertension (HTN, n=5) or lactated ringers solution (CTRL, n=4) starting at 126±2 days gestational age (dGA; term~145 days). Fetal mitral valve interstitial cells (VICs) were isolated at 134±1dGA, cultured in flexible, collagen-coated wells and subjected to 0% (static) or 18% equibiaxial stretch (1 Hz, 24 hrs). mRNA was isolated and qPCR was used to determine the effects of HTN and stretch on gene expression. Statistical analysis was performed via two-way ANOVA with Bonferroni correction. Results: Plasma infusion significantly increased the MAP of HTN fetuses (44.3±2.4 vs 61.6±1.1mmHg, p= 0.002). Change in gene expression is shown in Fig. 1; data are expressed relative to the CTRL/static group. Stretch, but not HTN, significantly increased FGF expression (p&lt;0.05). HTN and stretch each significantly increased expression of TGFβ-1, BMP-1 and -2. Stretch amplified the hypertension-induced increase in these 3 genes (p&lt;0.05 for all). Versican was unaltered by HTN or stretch. Conclusion: Our study demonstrates that early exposure to mechanical stress can shape cell signaling pathway responses in developing fetal cardiac valves, and these changes are amplified when exposed to a secondary stress. These data indicate that the prenatal environment has implications for postnatal cardiac valve function and risk for valvular disease in adulthood.

Risk Factors on Hypertensive Disorders among Jordanian Pregnant Women

Eight percent of pregnancies involve hypertensive disorders, which can have serious complications for mothers and children. There has only been minimal research into hypertension in pregnancy in developing countries, including Jordan. Therefore, this study aimed to identify how frequent certain risk factors that apply to hypertensive disorders during pregnancy were among women in the Jordanian capital of Amman. A prospective case-control study was conducted on 184 Jordanian pregnant patients with hypertensive disorders and 172 age-matched control subjects recruited from the maternity ward of a tertiary public hospital in Ammn city; they were followed-up until 85 days after the birth (late puerperium). A standardized questionnaire pilot-tested was completed by participants that included demographic data and known risk factors for hypertension in pregnancy. Statistical analysis SPSS was conducted to compare the frequency of risk factors using Fisher’s exact test, chi-square, Student’s t-tests, as well as multivariate logistic regression was conducted to identify independent risk factors. The results showed that chronic hypertension, prenatal hypertension, family history of preeclampsia, diabetes, high BMI, nulliparity, previous preeclampsia history and low education level were identified as risk factors for hypertensive disorders in pregnancy in this population; Moreover, diabetes, chronic hypertension and family history of preeclampsia were found to be independent risk factors. The results of the study contribute to the currently limited knowledge about the modifiable risk factors for hypertensive disorders during pregnancy among the Jordanian population, and could therefore be extremely useful for clinicians providing prenatal care.

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