Severe Pregnancy-induced Hypertension Research Articles

Comparison of the efficacy of intravenous labetalol versus oral nifedipine in patients with severe pregnancy-induced hypertension beyond 30 weeks of gestation.

It is a retrospective observational study, intravenous labetalol 20 mg was given initially in escalating doses of 40 mg, 80 mg, 80 mg, and 80 mg every 15 mins up to a maximum dose of 5 or until the goal BP ≤150/100 mmHg was reached. Some women with severe pregnancy-induced hypertension were given oral nifedipine to control their BP according to the choice of the attending consultant. Nifedipine 10 mg tablet was given initially in repeated doses of 10 mg every 15 mins up to a maximum of five doses or until the goal of BP ≤150/100 mmHg was reached. In our study, we found that there was a strong statistical significance in stabilizing the BP with oral nifedipine than with intravenous labetalol drug used. The majority of the patients in the oral nifedipine group got to normal BP quicker when compared to intravenous labetalol group patients. From this study, both drugs were found to be safe and effective in the reduction in BP. The use of nifedipine may be recommended in low-resource settings since it has an oral regimen and dosage is simple when compared to incremental intravenous dosing of labetalol.

Long-Term Predictors of Gestational Hypertension: Placental Growth Factor, Pregnancy-Associated Plasma Protein-A and Free Beta-Hcg Versus Mean Arterial Pressure and Uterine Artery Doppler Versus a Combination of Both: A Comparative Study.

According to WHO, hypertensive disease is the leading cause of direct maternal mortality accounting for 10-25% in developing countries (James in Heart, 90(12):1499-504). This study compares the combinations of mean arterial pressure (MAP) and uterine artery doppler (UAD) versus serum-free β HCG, pregnancy-associated plasma protein-A, and placental growth factor (PlGF) versus a combination of all variables at 11 to 13+6 as long-term predictors of pregnancy-induced hypertension (PIH). A prospective, observational cohort study recruited 97 primigravidae at 11 to 13+6weeks gestation at GMCH. Follow-up was done at 32-34weeks and before delivery. Development of PIH, mode of delivery, birthweight, maternal and fetal adverse outcomes were documented, analyzed and compared among three groups. In Group A-biophysical markers, Group B-biochemical markers and in Group C all variables were used. The mean age, maternal weight, height and BMI of patients developing gestational hypertension were 30 ± 5years, 64.3 ± 12.5kg, 155.8 ± 5.5cm and 26.4 ± 4.1, respectively. Out of the 3, Group C is the best screening test for predicting the overall chance of development of gestational hypertension with a sensitivity of 97.37% and specificity of 38.98% (p < 0.0001). A mild negative correlation is seen between PlGF levels and severity of PIH (p-0.0382). MAP and UAD can be easily incorporated into the infrastructure of most hospitals. If the biochemical test kits are made available at a low cost through available programs such as JSSK, it can bring down the MMR by preventing gestational hypertension.

Comparing Intravenous Labetalol and Intravenous Hydralazine for Managing Severe Gestational Hypertension.

Background Hypertensive disorders of pregnancy are the leading causes of both maternal morbidity and maternal mortality. Hypertensive disorders are acute obstetric emergencies, which refer to various life-threatening medical challenges known to develop during pregnancy, labor, and delivery,requiring urgent attention to reduce blood pressure (BP) for the benefit ofthe affected mothers and infants. Hydralazine and labetalol have been widely used as the first-line medications in themanagement of severe hypertension during pregnancy. However, the choice between these two drugs lacks clear evidence regarding their safety and superiority. Several studies have attempted to study intravenous (IV) labetalol versus hydralazine, but very fewsuch comparison studies havebeen conducted in Africa. Objective To compare the effectiveness of IV labetalol and IV hydralazine in reducing systolic and diastolic BP in pregnant women with severe hypertension. Also, to determine thetime required for hydralazine and labetalol to lower BP to ≤150/100 mmHg, the number of doses needed for each drug, and evaluating maternal and perinatal outcomes. Study design This study employed an open-label randomized clinical trial design conducted in the labor, delivery, and antenatal ward of the Central and Stella Obasanjo Hospital in Benin City. A total of 120 women with severe pregnancy-induced hypertension were randomly assigned to two groups: Group X, consisting of 60 pregnant women, received IV hydralazine at a slow rate of 5 mg for five minutes, repeated every 20 minutes (maximum of five doses) until a blood pressure of ≤150/100 mmHg was achieved. Group Y, also consisting of 60 pregnant women, received IV labetalol in escalating doses of 25, 50, 75, 75, and 75 mg (maximum of 300 mg) every 20 minutes until the blood pressure reached ≤150/100 mmHg. Statistical analysis was performed using SPSS version 23(IBMInc., Armonk, New York). Result IV hydralazine achieved the target BP in an average time of 45.80 +/- 25.17 minutes, while IV labetalol took an average of 72.67 +/- 41.80 minutes (p=0.001). The number of doses required to reach the target BP differed significantly between the two drugs. Hydralazine required an average of 1.72 +/- 0.904 doses, whereas labetalol required an average of 3.72 +/- 1.782 doses (p=0.0001). While 45% of women in the hydralazine group attained the target BP with a single dose of hydralazine, only 31.1% of women in the labetalol group were able to attain the target BP with asingle doseof labetalol(p=0.02). Overall, target BP was achieved in 55 out of 60 women (91.7%) who were randomized to receive IV hydralazine, whereas 45 out of 60 women (75%) who received IV labetalol achieved the target blood pressure. While hydralazine demonstrated more favorable results in terms of achieving target blood pressure, there were higher incidences of maternal adverse effects in the hydralazine group compared to the labetalol group. However, these adverse effects were not severe enough to warrant discontinuation of the medication. Conclusion IV hydralazine showed faster achievement of the target BP and a lower number of doses required compared to IV labetalol. Additionally, a higher percentage of women in the hydralazine group achieved the target BP with a single dose. However, there were more maternal adverse effects associated with hydralazine, although they were not severe. Perinatal outcomes did not differ significantly between the two groups.

A Clinical Study of Low Molecular Weight Heparin Sodium Injection Combined with Magnesium Sulfate Injection and Labetalol Tablets in the Treatment of Severe Pregnancy-Induced Hypertension

Objective: To investigate the clinical effect of low molecular weight heparin sodium injection combined with magnesium sulfate injection and labetalol in the treatment of severe pregnancy-induced hypertension. Methods: A total of 48 patients with severe pregnancy-induced hypertension admitted from February 2021 to February 2023 were selected, and the patients were divided into two groups by simple sampling, with 24 cases in each group. Patients in the control group received labetalol orally and intravenous infusion of magnesium sulfate, whereas those in the observation group received subcutaneous injection of low molecular weight heparin sodium on the basis of the control group. The two groups of patients underwent 5 days of treatment, and the blood pressure control, vascular endothelial function, renal function, and blood coagulation were compared between the two groups. Results: Before treatment, there were no significant differences in blood pressure readings, endothelin-1 (ET-1) and nitric oxide (NO) levels, serum creatinine (SCr) and blood urea nitrogen (BUN) levels, and the four coagulation indices between the two groups (all P &gt; 0.05). After treatment, the blood pressure readings in the observation group were lower than those in the control group (P &lt; 0.05); ET-1 in the observation group was lower than that in the control group, and the NO level in the observation group was higher than that in the control group (P &lt; 0.05); compared with the control group, the observation group had lower SCr and BUN (P &lt; 0.05), longer prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT), and lower fibrinogen (Fib) level (P &lt; 0.05). Conclusion: Low molecular weight heparin sodium injection combined with magnesium sulfate injection and labetalol in the treatment of severe pregnancy-induced hypertension can help control blood pressure levels, promote the recovery of vascular endothelial function and renal function, and effectively correct coagulation function.

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.

Serum Lactate Dehydrogenase Level in Pregnancy Induced Hypertension and Fetomaternal Outcome

Hypertensive disorders complicate 5-10% of all pregnancies and associated with potentially dangerous maternal and fetal complications. Studies have shown that pre-eclamptic patients with higher levels of lactate dehydrogenase (LDH) are at high risk of developing subsequent complications with poor maternal and fetal outcome. So with the aim to correlate serum LDH level in pregnancy induced hypertension (PIH) with fetomaternal outcome this hospital based observational descriptive study was done at Tribhuvan University Teaching Hospital (TUTH) for the duration of 1 year from 15th May, 2018 to 14th May, 2019. Women with PIH fulfilling inclusion criteria were enrolled in the study. Serum LDH level was measured and severity of PIH, maternal and perinatal outcome were studied according to the levels of LDH. Results were analyzed using SPSS 18. The incidence of hypertensive disorder in pregnancy was 4.74% in this study and total 180 cases were enrolled. The mean serum LDH level increased with increase in severity of PIH. Thirty two (17.7%) cases had maternal complications and hemolysis elevated liver enzymes and low platelet (HELLP) syndrome was most common complication. More than 2/3rd (62.5%) of cases with LDH level &gt;800 IU/L had complications. The most common perinatal complication was intrauterine growth restriction (IUGR). The perinatal morbidity and mortality were significantly high in patients with PIH with LDH level &gt;800 IU/l. As with the increase in serum LDH level increase in maternal and fetal complications was observed, LDH can be a useful biochemical marker that reflects the severity 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.

Ocular manifestation of pregnancy-induced hypertension

Background and Objectives: Pregnancy-induced hypertension (PIH) is a challenging obstetric condition that can result in grave complications. The retina is a unique site where the vasculature in the human body is visualized directly with the help of an ophthalmoscope. Progression of retinal changes generally correlates with the progression of PIH. The purpose of this study was to determine the prevalence and association of retinal changes with the progression of PIH. Materials and Methods: This is a hospital-based, prospective, observational study. A total of 100 admitted cases diagnosed with PIH was included in the study. Ocular and systemic history, age, blood pressure, and proteinuria were noted. A dilated indirect ophthalmic examination was done at the bedside of the patient. Results: A total of 100 patients with PIH were examined. The mean age of the patients was 24.8 years; the mean gestational age was 36.5 weeks. Out of the total 100 patients with PIH who were examined, retinal changes were noted in 43 patients. The prevalence of retinopathy changes was more pronounced among patients with severe preeclampsia (76.5%) and eclampsia (88.9%). As the severity of the PIH increased, the odds of women developing retinopathy also increased substantially and this association between the severity of PIH and the development of retinopathy changes was found to be statistically significant. A significant correlation was also seen between albuminuria and the severity of retinopathy. Conclusion: Cases of severe preeclampsia and eclampsia showed higher grades of retinal changes. Thus fundus examination plays an important role in assessing the severity of PIH.

PLACENTAL DIAMETER AND THICKNESS AND NUMBER OF COTYLEDONS IN MILD AND SEVERE PREGNANCY INDUCED HYPERTENSIVE WOMEN VERSUS NORMOTENSIVE WOMEN OF DISTRICT D.I.KHAN, PAKISTAN

Background: Pregnancy induced hypertension (PIH) adversely affects the development of placenta and growth of fetus. The objectives of this study were to compare the placental diameter, placental thickness and number of cotyledons in mild PIH and severe PIH women versus normotensive women of District D.I.Khan, Pakistan.Material Methods: This comparative cross-sectional study was conducted in Department of Anatomy, Gomal Medical College, D.I.Khan, Pakistan from January to October 2014. Three samples were selected; each of size 50, group 1 normotensive/ control, group 2 with mild PIH and group 3 with severe PIH. Three research variables; placental diameter (cm), thickness (mm) and number of cotyledons were measured on ratio scale for three groups. Descriptive analysis included mean± SD with 95% confidence intervals for each group separately. With three groups on ratio data, one way-ANOVA test was applied to see significance of difference between three groups. Post hoc Dunnett’s t test was applied at alpha 0.05 to see difference of mild PIH group 2 to normotensive/ control group 1 and of severe PIH group 3 to normotensive/ control group 1separately.Results: Mean placental diameter was 18.28±2.15, 16.57±1.94 and 16.18±1.75 cm and mean placental thickness was 19.33 ±3.70, 19.18±2.78 and 17.60±3.52 mm in group 1, 2 and 3 respectively. Mean number of cotyledons was 14.42±2.25, 14.08±2.30 and 13.16±2.15 in group 1, 2, and 3 respectively. Placental diameter was statistically significantly lower in group 2 (p=.00001) and 3 (p=.00001) than group 1. Placental thickness in group 2 (p=.957) was similar to group 1, while in group 3 (p=.019) it was lower than group 1. Number of cotyledons in group 2 (p=.666) was similar to group 1, while in group 3 (p=.011) it was lower than group 1.Conclusion: In mild pregnancy induced hypertension (PIH), placental diameter was lower than normotensives, while placental thickness and number of cotyledons were similar to normotensives. In severe PIH, placental diameter, placental thickness and number of cotyledons were all lower than normotensives. It is concluded that in mild PIH, the development of placenta is mildly affected, while in severe PIH, the development of placenta is severely affected.

A successfully treated case of an acute presentation of congenital thrombotic thrombocytopenic purpura (Upshaw–Schulman syndrome) with decreased ADAMTS13 during late stage of pregnancy

We herein report the case of a 28-year-old pregnant woman with an acute presentation of remarkable petechiae on her lower extremities and severe thrombocytopenia (16 000/mm3 ) at the 35th week of gestation. Although idiopathic thrombocytopenic purpura was initially suspected, subsequent examinations revealed that her ADAMTS13 (a Disintegrin And Metalloprotease, with ThromboSpondin type 1 repeats, member 13) titer was extremely decreased, while she was negative for antibodies against ADAMTS13. Infusion of fresh frozen plasma was immediately performed, and the platelet count was observed to increase. However, severe pregnancy-induced hypertension and proteinuria emerged at 36 weeks and 2 days of gestation, and a male infant was delivered by emergency cesarean section on the 37th week of gestation. The postnatal development was uncomplicated. After delivery, although the mother's platelet count and ADAMTS13 activity decreased temporarily, both values increased following fresh frozen plasma transfusion. This case showed interesting aspects of congenital thrombocytopenic purpura (Upshaw-Schulman syndrome) in pregnancy. Moreover, the rapid measurement of the patient's ADAMTS13 activity and the subsequent accurate diagnosis of congenital thrombocytopenic purpura made it possible to treat the patient with fresh frozen plasma infusion and avoid contraindicated platelet infusion. Close cooperation between obstetricians, hematologists and pediatricians is necessary to achieve successful outcomes in cases of thrombocytopenic purpura during pregnancy.

Primary cesarean section in term, low-risk multiparous women: a single clinic retrospective observational study

Background: Multiparous women who have previously delivered vaginally are generally considered to be at low risk for cesarean section. We aimed to determine the incidence rate and indications for primary cesarean section and operative vaginal deliveries among multiparous women with previous vaginal births. Patients and methods: Multiparous women who had delivered their babies in our clinic between January 2004 and December 2019 were enrolled in this retrospective observational study. The inclusion criteria were as follows: delivery at 37 weeks of gestation or more, singleton pregnancy with a live fetus, had one or more past vaginal deliveries including instrumental vaginal birth, and no history of previous cesarean section. Women with placenta previa, abruptio placentae, severe pregnancy-induced hypertension, and uncontrolled medical diseases were referred to tertiary hospitals and excluded from this study. The frequency of occurrence and indications for cesarean section and vacuum extraction, duration of labor, and the effect of induction of labor on the cesarean section rates were analyzed. Results: A total of 3094 multiparous women were enrolled. Primary cesarean section was performed in 30 women (30/3094=0.97%). The indications for cesarean section included the following: breech presentation in 28 women, myomectomy after the first vaginal birth in one (of 29 elective cesarean sections), and failed vacuum extraction after a prolonged second stage in one (one emergency cesarean section). Vacuum extraction was performed in 61 women (61/3094=2.0%), the indications for which were non-reassuring fetal status (n=38), prolonged 2nd stage of labor (n=10), and narrow pelvic outlet (n=10). Vaginal breech delivery occurred in 11 women. Induction of labor (n=402) did not affect the cesarean section rate. Conclusion: In multiparous women, breech presentation was the main indication for primary cesarean sections, and the cesarean section rate was very low in women with cephalic presentation.

RETINAL CHANGES IN PREGNANCY INDUCED-HYPERTENSION

Objective: The aim is to determine the prevalence of retinal changes in Pregnancy Induced Hypertension (PIH) and its association with age, parity, proteinuria, blood pressureand severity of PIH.&#x0D; Methods: This is a tertiary hospital based Cross-Sectional study including all patients, clinically diagnosed with Pregnancy Induced Hypertension. General demographic details along with age, gravida, gestation period, proteinuria, blood pressure and severity of PIH were noted. Ophthalmic examination was performed and detailed fundus examination was done.&#x0D; Results: A total of 52 patients were included in this study. Their mean age was 24.9 y; 32 out of 52 patients were primigravida (61%) and 20 patients were multi gravida (39%). Out of 52 patients 34 (65.38%) had Gestational Hypertension, 16 (30.76%) had preeclampsia, and 2 (3.8%) had eclampsia. 3 (5.76%) out of 29 patients with BP&lt;160/100 mmHg and 10 (19.23%) out of 23 patients with BP&gt;160/100 mmHg had developed Hypertensive Retinopathy. Hypertensive Retinopathy was seen in 13 (25%). Proteinuria was seen in 10 (19.23%) patients ranging between+to+++on the dipstick.&#x0D; Conclusion: Statistically significant correlation between retinal changes and proteinuria, blood pressure and severity of Disease.The most important requisite in a case of Pregnancy Induced Hypertension is Fundoscopic examination of retina. The retinal vessels during PIH form a gateway to visualize changes in the body and placental vessels, and may play a key role in early detection and treatment of PIH for protection of the mother as well as the fetus.

Association between serum beta-human chorionic gonadotropin and inflammation, oxidative stress in pregnancy-induced hypertension

The aberrant increase of circulating beta-human chorionic gonadotropin (β-HCG) at early stages of pregnancy can be used to predict gestational hypertension. However, the association of β-HCG and inflammation, oxidative stress in pregnancy-caused hypertensive disorder on perinatal stage remains unclear. A case-controlled study was performed, with 133 adult pregnant women participated in their perinatal stage. Participants in this research included 45 with mild preeclampsia, 40 with severe preeclampsia and 48 without hypertension. Higher circulating β-HCG level was correlated with severer pregnancy-induced hypertension. Independent contribution of inflammatory factors including interleukin-6, tumor necrosis factor-α and interferon-γ and oxidative stress factors including thiobarbituric acid reactive substance and total antioxidant capacity to severe pregnancy-induced hypertension was significant (P < 0.001). The correlation of circulating β-HCG levels with inflammatory and oxidative stress markers in patients with pregnancy-induced hypertension in perinatal stage was statistically significant.

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.

Pregnancy Induced Hypertension in Women and its associated Complications and Counter Measures: A Detailed Analysis

Hypertension has become common disorder in almost in human beings. Due to several factors such as mental tension, smoking, drug addiction, work pressure etc., humans are beings suffered from many hypertensions related disorders. One of the most common yet severe hyper tension disorders is PIH (Pregnancy induced hypertension). Many women all over the world are being suffered from this disorder. In this article, preliminary overview on PIH along with its complications associated has been described. Further, several counter measures are described for preventing this severe PIH.

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.

Study of platelet indices in pregnancy-induced hypertension

BackgroundHypertension encountered during pregnancy could be the first sign of a preexisting pathology that can significantly attribute to unfavorable maternal, fetal, and neonatal outcomes. Resolving hypertensive disorders at an early age may not alter the course and proficiency of the disease, but timely detection and treatment can not only prevent hypertensive crisis but also alter unfavorable fetal outcomes. Ipso facto, an early cataloging plays an essential role in predicting the outcome of pregnancy, both for mother and baby. Platelet indices correlate with functional status of platelets and are an emerging risk marker for detecting an impending adverse outcome in pregnancy-induced hypertension (PIH). The aim of this study was to analyze the consociation between platelet indices and severity of PIH. MethodsA prospective hospital-based study was undertaken on 100 cases diagnosed with PIH (preeclampsia [PE; 88 cases] and eclampsia [12 cases and 100 controls]). ResultsMost cases occurred in the age group of 22–26 years (43.3%) and in primigravidae (55.8%). Analysis of platelet volume indices (PVI) indicated mean platelet volume (MPV), platelet distribution width (PDW), and platelet–large cell ratio (P-LCR) as significant risk factors for developing hypertensive crisis. This was in concordance with the elevated blood pressures. ConclusionThe study concludes that platelet indices are raised in patients who have PIH as compared with normal pregnancies.

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.

Platelet count estimation in pregnancy-induced hypertension and assessment of the degree of thrombocytopenia

Background: Gestational thrombocytopenia is the most common cause of thrombocytopenia and pregnancy-induced hypertension (PIH) is the second common cause. The degree and the incidence of thrombocytopenia depend on the severity of the disease process. Lower is the platelet count, greater will be the maternal and fetal morbidity and mortality. Early diagnosis and assessment of severity of PIH is necessary to prevent complications such as HELLP syndrome and maternal and fetal morbidity and mortality. Therefore, platelet count plays an important role in the functional evaluation of the hemostatic system. Aims and Objectives: The aims of the study were as follows: (i) To estimate the platelet count in PIH and (ii) to assess the degree of thrombocytopenia in PIH based on platelet count. Materials and Methods: The study group consisted of 120 pregnant women, of which 90 were diagnosed to be with PIH, with varying severity. Thirty subjects were control group with no signs of hypertension. Blood pressure (BP) was recorded and platelet count was assessed by peripheral smear method (PM) in all 120 pregnant women. Results: Platelet numbers done by peripheral smear were found to be 2.56 ± 0.89 lac/mm3 in mild PIH, 1.95 ± 1.12 lac/mm3 in pre-eclampsia, 1.34 ± 0.91 lac/mm3 in eclampsia, and 3.13 ± 0.96 lac/mm3 in control group. The platelet count by the automatic analyzer was 2.47 ± 0.10 lac/mm3 in mild PIH, 1.82 ± 1.02 lac/mm3 in pre-eclampsia, 1.29 ± 0.83 lac/mm3 in eclampsia, and 2.92 ± 0.98 lac/mm3 in control group. This shows that there is a decrease in platelet count with increase in severity of the disease. No statistical significant difference seen in both methods. Conclusion: Platelet count serves as an important tool for diagnosing the severity of the disease. Estimation of platelets from PM is a simple, rapid, easier, and cheaper method which can be used even at rural setup where automated counters are not available.

A4190 Relationship between plasma N-terminal pro-atrial natriuretic peptide and Corin levels and disease severity in patients with pregnancy induced hypertension

Objectives: We investigate the plasma N-terminal atrial natriuretic peptide (NT-proANP) and corin in pregnancy induced hypertension (PIH) and studies the correlation between plasma NT-proANP/ corin levels and adverse events. Methods: A total of 77 PIH who admitted in hospital were enrolled. 48 normotensive pregnancies in the same gestational weeks were chosen as control. Clinical characteristics were collected. Plasma was collected for laboratory examination Results: NT-proANP and corin was significantly increased in PIH compared with control (P = 0.003 and P < 0.001). The association between plasma NT-proANP/corin and the adverse event demostrated that 1) In PIH, NT-proANP and corin were increased significantly in preterm compared with that in full-term birth (P < 0.001 and P = 0.023); 2) Weeks of gestation in PIH patients were dramatically reduced compared with control, and it was negative correlated to NT-proANP and corin (R = −0.487, P < 0.001 and R = −0.383, P = 0.000); 3) The weight of newborns in PIH was significantly lower than that in control, and it was negatively correlated with NT-proANP and corin (R = −0.487, P < 0.001 and R = −0.383, P = 0.001); 4) The APGARP score of PIH was significantly lower than that of control, and it was negatively correlated with NT-proANP (R = −0.359, P = 0.001). NT-proANP/Corin and target organ function demonstrated that 1) The eGFR of PIH was significantly lower than that of control (P < 0.001), and it was negatively correlated with NT-proANP and corin (R = −0.490, P < 0.001 and R = −0.415, P < 0.001); 2) The urinary protein in PIH was significantly increased than that in control (P < 0.001), and it was positively correlated with NT-proANP and corin (R = 0.386, P = 0.001 and R = 0.401, P < 0.001). Conclusion: The plasma NT-proANP and corin was increased in PIH, and both of them may associate with the severity of PIH.