Eclampsia
Magnesium Sulfate
Pre-Eclampsia
Maternal Mortality
HELLP Syndrome
Pregnancy
Puerperal Disorders
Hypertension, Pregnancy-Induced
Pregnancy Complications, Cardiovascular
Posterior Leukoencephalopathy Syndrome
Abruptio Placentae
Pregnancy Outcome
Obstetric and neonatal outcome following chronic hypertension in pregnancy among different ethnic groups. (1/2035)
We retrospectively studied pre-eclampsia rate and obstetric outcome in a cohort of 436 pregnancies amongst 318 women of different ethnic backgrounds attending an antenatal hypertension clinic from 1980-1997, identifying 152 women (213 pregnancies) with chronic essential hypertension. The ethnic breakdown was: White, 64 (30.0%) pregnancies in 48 (31.5%) women; Black/Afro-Caribbean, 79 (37.1%) pregnancies in 56 (36.8%) women; and Indo-Asians, 70 (32.3%) pregnancies in 48 (31.6%) women. The prevalences of pre-eclampsia in White, Black and Indo-Asian women were 17.2%, 12.7% and 18.6%, respectively (p = 0.58). Pregnancies of Indo-Asian women were of shorter gestation, and babies in this group also had lower birth weight and ponderal index compared to those of White and Black women (all p < 0.05). The proportions of overall perinatal mortality were 1.6% for Whites (1/64), 3.8% for Blacks (3/79) and 10.0% for Indo-Asians (7/70), suggesting increased risk in the Indo-Asian group. Indo-Asian women with chronic essential hypertension need careful antenatal care and observation during pregnancy. (+info)Maternal second trimester serum tumor necrosis factor-alpha-soluble receptor p55 (sTNFp55) and subsequent risk of preeclampsia. (2/2035)
Preeclampsia is characterized by diffuse vascular endothelial dysfunction. Tumor necrosis factor-alpha (TNF-alpha), which plays a key role in the cytokine network responsible for immunoregulation, is also known to contribute to endothelial dysfunction and other metabolic disturbances noted in preeclampsia. Results from cross-sectional studies and one longitudinal study indicate that TNF-alpha (or its soluble receptor, sTNFp55) is increased in the peripheral circulation and amniotic fluid of women with preeclampsia as compared with normotensive women. Between December 1993 and August 1994, prediagnostic sTNFp55 concentrations (a marker of excessive TNF-alpha release) were measured in 35 women with preeclampsia and 222 normotensive women to determine whether elevations precede the clinical manifestation of the disorder. Logistic regression procedures were used to calculate maximum likelihood estimates of odds ratios and 95% confidence intervals. Mean second trimester (15-22 weeks' gestation) serum sTNFp55 concentrations, measured by enzyme-linked immunosorbent assay, were 14.4% higher in preeclamptic women than in normotensive controls (716.6 pg/ml (standard deviation 193.6) vs. 626.4 pg/ml (standard deviation 158.0); p = 0.003). The relative risk of preeclampsia increased across successively higher quintiles of sTNFp55 (odds ratios were 1.0, 1.3, 2.1, and 3.7, with the lowest quintile used as the referent; p for trend = 0.007). After adjustment for maternal age, adiposity, and parity, the relative risk between extreme quintiles was 3.3 (95% confidence interval 0.8-13.4). These findings indicate that the level of TNF-alpha in maternal circulation is increased prior to the clinical manifestation of the disorder, and they are consistent with the hypothesized role of cytokines in mediating endothelial dysfunction and the pathogenesis of preeclampsia. Further work is needed to identify modifiable risk factors for the excessive synthesis and release of TNF-alpha in pregnancy, and to assess whether lowering of TNF-alpha concentrations in pregnancy alters the incidence and severity of preeclampsia. (+info)Outcome of pregnancy in women with congenital shunt lesions. (3/2035)
OBJECTIVE: To evaluate the outcome of pregnancy in women with congenital shunt lesions. SETTING: Retrospective study in a tertiary care centre. METHODS: Pregnancy history was obtained by a standardised questionnaire and medical records were reviewed. PATIENTS: 175 women were identified, at a mean (SD) age of 42 (14) years. Pregnancies occurred in 126 women: 50 with an atrial septal defect, 22 with a ventricular septal defect, 22 with an atrioventricular septal defect, 19 with tetralogy of Fallot, and 13 with other complex shunt lesions. RESULTS: 309 pregnancies were reported by 126 woman (2.5 (1.6) pregnancies per woman). The shortening fraction of the systemic ventricle was 40 (8)%, and 98% were in New York Heart Association class I-II at last follow up. Spontaneous abortions occurred in 17% of pregnancies (abortion rate, 0.4 (0.9) per woman). Gestational age of the 241 newborn infants was 8.8 (0.8) months. There were no maternal deaths related to pregnancy. Pre-eclampsia and embolic events were observed in 1.3% and 0.6%, respectively of all pregnancies. Women with complex shunt lesions more often underwent caesarean section (70% v 15-30%, p = 0.005) and gave birth to smaller babies for equivalent gestation (2577 (671) g v 3016 (572) to 3207 (610) g, p < 0.05). The recurrence risk of congenital heart disease was 2.5%. CONCLUSIONS: The outcome of pregnancy is favourable in women with congenital shunt lesions if their functional class and their systolic ventricular function are good. Such patients can be reassured. (+info)Liver disease in pregnancy. (4/2035)
Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of acute hepatitis is unaffected by pregnancy, except in patients with hepatitis E and disseminated herpes simplex infections, in which maternal and fetal mortality rates are significantly increased. Chronic hepatitis B or C infections may be transmitted to neonates; however, hepatitis B virus transmission is effectively prevented with perinatal hepatitis B vaccination and prophylaxis with hepatitis B immune globulin. Cholelithiasis occurs in 6 percent of pregnancies; complications can safely be treated with surgery. Women with chronic liver disease or cirrhosis exhibit a higher risk of fetal loss during pregnancy. Preeclampsia is associated with HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome, acute fatty liver of pregnancy, and hepatic infarction and rupture. These rare diseases result in increased maternal and fetal mortality. Treatment involves prompt delivery, whereupon the liver disease quickly reverses. Therapy with penicillamine, trientine, prednisone or azathioprine can be safely continued during pregnancy. (+info)A strategy for reducing maternal mortality. (5/2035)
A confidential system of enquiry into maternal mortality was introduced in Malaysia in 1991. The methods used and the findings obtained up to 1994 are reported below and an outline is given of the resulting recommendations and actions. (+info)Expression of the erythropoietin receptor by trophoblast cellsin the human placenta. (6/2035)
Nonclassical sites of erythropoietin (EPO) and erythropoietin receptor (EPO-R) expression have been described that suggest new physiological roles for this hormone unrelated to erythropoiesis. The recent finding of EPO expression by trophoblast cells in the human placenta prompted us to consider whether these cells also express EPO-R. With use of immunocytochemistry, EPO-R was identified in villous and extravillous cytotrophoblast cells, as well as in the syncytiotrophoblast at all gestational ages. EPO-R was also expressed by cells within the villous core, including endothelial cells of fetoplacental blood vessels. Placental tissues and isolated and immunopurified trophoblast cells, as well as trophoblast-derived choriocarcinoma Jar cells, expressed immunoreactive EPO-R on Western blot. EPO-R mRNA was also detected in the same placental tissues and trophoblast cells by nested-primer reverse transcription-polymerase chain reaction. Finally, EPO-R was functional insofar as the receptor was phosphorylated on tyrosine residues in response to exogenous EPO treatment of cultured trophoblast or Jar cells. Thus, the present findings support the hypothesis that trophoblast cells of the human placenta express EPO-R. In view of these results, taken together with previous work demonstrating EPO expression by the same cells, an autocrine role for this hormone in the survival, proliferation, or differentiation of placental trophoblast cells is proposed. (+info)Patients with preeclampsia develop agonistic autoantibodies against the angiotensin AT1 receptor. (7/2035)
Immune mechanisms and the renin-angiotensin system are implicated in preeclampsia. We investigated 25 preeclamptic patients and compared them with 12 normotensive pregnant women and 10 pregnant patients with essential hypertension. Antibodies were detected by the chronotropic responses to AT1 receptor-mediated stimulation of cultured neonatal rat cardiomyocytes coupled with receptor-specific antagonists. Immunoglobulin from all preeclamptic patients stimulated the AT1 receptor, whereas immunoglobulin from controls had no effect. The increased autoimmune activity decreased after delivery. Affinity-column purification and anti-human IgG and IgM antibody exposure implicated an IgG antibody directed at the AT1 receptor. Peptides corresponding to sites on the AT1 receptor's second extracellular loop abolished the stimulatory effect. Western blotting with purified patient IgG and a commercially obtained AT1 receptor antibody produced bands of identical molecular weight. Furthermore, confocal microscopy of vascular smooth muscle cells showed colocalization of purified patient IgG and AT1 receptor antibody. The protein kinase C (PKC) inhibitor calphostin C prevented the stimulatory effect. Our results suggest that preeclamptic patients develop stimulatory autoantibodies against the second extracellular AT1 receptor loop. The effect appears to be PKC-mediated. These novel autoantibodies may participate in the angiotensin II-induced vascular lesions in these patients. (+info)Color Doppler waveforms of maternal cervical internal carotid arteries in normotensive and preeclamptic gravidas. (8/2035)
The objective of this study was to investigate and determine fitted percentiles of blood flow resistance of cervical internal carotid arteries in normal pregnancies from gestational weeks 20 to 42 and to compare the resistance indices and mean velocities of the these arteries in normotensive and preeclamptic gravidas. A duplex color apparatus with pulsed Doppler ultrasound scanner (7.5 MHz) was used to determine the resistance index and mean velocity values of maternal cervical internal carotid arteries in 310 healthy singleton gravidas (group 1) and 74 singleton preeclamptic gravidas (group 2). The resistance index and mean velocity values of the maternal cervical internal carotid arteries decrease as the gestational age increases in normal gravidas, whereas in preeclamptic pregnancies these values are no different from those in normal gravidas during the second half of the gestational period. (+info)Eclampsia is a serious pregnancy complication characterized by the onset of seizures or convulsions in a woman who has already developed preeclampsia, which is a condition marked by high blood pressure and damage to organs such as the liver and kidneys. Eclampsia can occur before, during, or after delivery and is considered a medical emergency that requires immediate treatment. It can pose significant risks to both the mother and the baby, including premature birth, fetal growth restriction, and even maternal and fetal death.
The exact causes of eclampsia are not fully understood, but it is thought to be related to problems with the placenta and abnormal blood vessel development in the uterus. Risk factors for developing eclampsia include preexisting medical conditions such as chronic hypertension or diabetes, a history of preeclampsia or eclampsia in previous pregnancies, multiple gestation (carrying more than one baby), and certain genetic factors.
Treatment for eclampsia typically involves delivering the baby as soon as possible to prevent further complications. In some cases, medication may be given to manage seizures and prevent their recurrence. Close monitoring of both the mother and the baby is essential to ensure the best possible outcomes.
Magnesium Sulfate is an inorganic salt with the chemical formula MgSO4. It is often encountered as the heptahydrate sulfate mineral epsomite (MgSO4·7H2O), commonly called Epsom salts. Magnesium sulfate is used medically as a vasodilator, to treat constipation, and as an antidote for magnesium overdose or poisoning. It is also used in the preparation of skin for esthetic procedures and in the treatment of eclampsia, a serious complication of pregnancy characterized by seizures.
Pre-eclampsia is a pregnancy-related disorder, typically characterized by the onset of high blood pressure (hypertension) and damage to organs, such as the kidneys, after the 20th week of pregnancy. It is often accompanied by proteinuria, which is the presence of excess protein in the urine. Pre-eclampsia can lead to serious complications for both the mother and the baby if left untreated or unmanaged.
The exact causes of pre-eclampsia are not fully understood, but it is believed that placental issues, genetic factors, and immune system problems may contribute to its development. Risk factors include first-time pregnancies, history of pre-eclampsia in previous pregnancies, chronic hypertension, obesity, older age (35 or older), and assisted reproductive technology (ART) pregnancies.
Pre-eclampsia can progress to a more severe form called eclampsia, which is characterized by the onset of seizures. HELLP syndrome, another severe complication, involves hemolysis (breaking down of red blood cells), elevated liver enzymes, and low platelet count.
Early detection and management of pre-eclampsia are crucial to prevent severe complications. Regular prenatal care, including frequent blood pressure checks and urine tests, can help identify early signs of the condition. Treatment typically involves close monitoring, medication to lower blood pressure, corticosteroids to promote fetal lung maturity, and, in some cases, delivery of the baby if the mother's or baby's health is at risk.
Maternal mortality is defined by the World Health Organization (WHO) as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes."
This definition highlights that maternal mortality is a preventable death that occurs during pregnancy, childbirth, or in the postpartum period, and it can be caused by various factors related to or worsened by the pregnancy or its management. The WHO also collects data on maternal deaths due to direct obstetric causes (such as hemorrhage, hypertensive disorders, sepsis, and unsafe abortion) and indirect causes (such as malaria, anemia, and HIV/AIDS).
Maternal mortality is a significant public health issue worldwide, particularly in low- and middle-income countries. Reducing maternal mortality is one of the Sustainable Development Goals (SDGs) set by the United Nations, with a target to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.
HELLP syndrome is a serious complication in pregnancy, characterized by Hemolysis (the breakdown of red blood cells), Elevated Liver enzymes, and Low Platelet count. It is often considered a variant of severe preeclampsia or eclampsia, although it can also occur without these conditions.
The symptoms of HELLP syndrome include headache, nausea and vomiting, upper right abdominal pain, and visual disturbances. It can lead to serious complications for both the mother and the baby, such as liver failure, placental abruption, disseminated intravascular coagulation (DIC), and even death if not promptly diagnosed and treated.
The exact cause of HELLP syndrome is not known, but it is thought to be related to problems with the blood vessels that supply the placenta. Treatment typically involves delivering the baby as soon as possible, even if the baby is premature. Women who have had HELLP syndrome are at increased risk for complications in future pregnancies.
Pregnancy is a physiological state or condition where a fertilized egg (zygote) successfully implants and grows in the uterus of a woman, leading to the development of an embryo and finally a fetus. This process typically spans approximately 40 weeks, divided into three trimesters, and culminates in childbirth. Throughout this period, numerous hormonal and physical changes occur to support the growing offspring, including uterine enlargement, breast development, and various maternal adaptations to ensure the fetus's optimal growth and well-being.
Puerperal disorders are a group of medical conditions that can affect women during the period following childbirth, also known as the puerperium. The puerperium typically lasts for six to eight weeks after delivery. These disorders can be complications of childbirth or postpartum infections and include:
1. Puerperal fever: This is a febrile illness that occurs during the puerperium, usually caused by a bacterial infection. The most common causative organisms are group A streptococcus, Staphylococcus aureus, and Escherichia coli.
2. Puerperal sepsis: This is a severe form of puerperal fever characterized by the presence of bacteria in the blood (bacteremia) and widespread inflammation throughout the body. It can lead to organ failure and even death if not treated promptly with antibiotics.
3. Puerperal endometritis: This is an infection of the lining of the uterus (endometrium) that occurs during the puerperium. Symptoms may include fever, abdominal pain, and foul-smelling vaginal discharge.
4. Puerperal mastitis: This is an inflammation of the breast tissue that can occur during lactation, often caused by a bacterial infection. It is more common in women who are breastfeeding but can also occur in non-lactating women.
5. Puerperal psychosis: This is a rare but serious mental health disorder that can occur after childbirth. It is characterized by symptoms such as delusions, hallucinations, and disorganized thinking.
6. Puerperal thromboembolism: This is a blood clot that forms during the puerperium, usually in the deep veins of the legs (deep vein thrombosis) or in the lungs (pulmonary embolism). It can be a serious complication of childbirth and requires prompt medical attention.
Overall, puerperal disorders are a significant cause of maternal morbidity and mortality worldwide, particularly in low-income countries where access to healthcare is limited. Prompt diagnosis and treatment are essential for improving outcomes and reducing the risk of long-term complications.
Pregnancy-induced hypertension (PIH), also known as gestational hypertension, is a condition characterized by the new onset of high blood pressure (≥140 mm Hg systolic or ≥90 mm Hg diastolic) after 20 weeks of pregnancy in a woman who was normotensive before. It can sometimes progress to more severe conditions like preeclampsia and eclampsia, which are associated with damage to other organ systems such as the liver and kidneys.
PIH is typically classified into two types:
1. Gestational hypertension: This is when a woman develops high blood pressure after 20 weeks of pregnancy without any protein in the urine or evidence of damage to other organ systems. Women with gestational hypertension are at increased risk for preeclampsia and may require closer monitoring.
2. Preeclampsia: This is a more severe form of PIH, characterized by high blood pressure and proteinuria (≥0.3 g in a 24-hour urine collection) after 20 weeks of pregnancy. Preeclampsia can also involve damage to other organ systems, such as the liver, kidneys, or brain, and may progress to eclampsia, a life-threatening condition characterized by seizures.
The exact causes of PIH are not fully understood, but it is thought to be related to problems with the development and function of the blood vessels that supply the placenta. Risk factors for developing PIH include first-time pregnancies, obesity, older age, a history of chronic hypertension or kidney disease, and carrying multiples (twins, triplets, etc.).
Treatment for PIH depends on the severity of the condition and the gestational age of the pregnancy. In mild cases, close monitoring of blood pressure, urine protein levels, and fetal growth may be sufficient. More severe cases may require medication to lower blood pressure, corticosteroids to promote fetal lung maturity, or early delivery of the baby to prevent further complications.
Cardiovascular complications in pregnancy refer to conditions that affect the heart and blood vessels, which can arise during pregnancy, childbirth, or after delivery. These complications can be pre-existing or new-onset and can range from mild to severe, potentially threatening the life of both the mother and the fetus. Some examples of cardiovascular complications in pregnancy include:
1. Hypertension disorders: This includes chronic hypertension (high blood pressure before pregnancy), gestational hypertension (high blood pressure that develops after 20 weeks of pregnancy), and preeclampsia/eclampsia (a pregnancy-specific disorder characterized by high blood pressure, proteinuria, and potential organ damage).
2. Cardiomyopathy: A condition in which the heart muscle becomes weakened, leading to an enlarged heart and reduced pumping efficiency. Peripartum cardiomyopathy is a specific type that occurs during pregnancy or in the months following delivery.
3. Arrhythmias: Irregularities in the heart's rhythm, such as tachycardia (rapid heartbeat) or bradycardia (slow heartbeat), can occur during pregnancy and may require medical intervention.
4. Valvular heart disease: Pre-existing valve disorders, like mitral stenosis or aortic insufficiency, can worsen during pregnancy due to increased blood volume and cardiac output. Additionally, new valve issues might develop during pregnancy.
5. Venous thromboembolism (VTE): Pregnancy increases the risk of developing blood clots in the veins, particularly deep vein thrombosis (DVT) or pulmonary embolism (PE).
6. Ischemic heart disease: Although rare, coronary artery disease and acute coronary syndrome can occur during pregnancy, especially in women with risk factors such as obesity, diabetes, or smoking history.
7. Heart failure: Severe cardiac dysfunction leading to fluid accumulation, shortness of breath, and reduced exercise tolerance may develop due to any of the above conditions or other underlying heart diseases.
Early recognition, monitoring, and appropriate management of these cardiovascular complications in pregnancy are crucial for maternal and fetal well-being.
Posterior Leukoencephalopathy Syndrome (PLS) is a neurological disorder characterized by the presence of vasogenic edema (swelling due to leakage of fluid from blood vessels) in the white matter (part of the brain that contains nerve fibers) of the posterior regions (occipital and parietal lobes) of the brain.
The symptoms of PLS can vary but often include headache, altered mental status, seizures, visual disturbances, and hypertension (high blood pressure). The exact cause of PLS is not fully understood, but it has been associated with certain conditions such as eclampsia, preeclampsia, kidney failure, autoimmune disorders, and the use of certain medications.
PLS is typically diagnosed based on clinical symptoms and imaging studies such as MRI or CT scans. Treatment usually involves addressing the underlying cause of PLS, controlling hypertension if present, and managing seizures if they occur. With prompt and appropriate treatment, most patients with PLS have a good prognosis and recover completely. However, in severe cases, PLS can lead to permanent neurological damage or even death.
Abruptio placentae, also known as placental abruption, is a medical condition that occurs when the placenta separates from the uterus before the baby is born. The placenta is an organ that develops in the uterus during pregnancy to provide oxygen and nutrients to the growing fetus.
In abruptio placentae, the separation of the placenta from the uterus can cause bleeding, which can be serious or life-threatening for both the mother and the baby. The severity of the condition depends on how much of the placenta has separated from the uterus and how much bleeding has occurred.
Abruptio placentae can cause a range of symptoms, including vaginal bleeding, abdominal pain, contractions, and fetal distress. In severe cases, it can lead to preterm labor, low birth weight, and even stillbirth. The exact cause of abruptio placentae is not always known, but risk factors include high blood pressure, smoking, cocaine use, trauma to the abdomen, and advanced maternal age. Treatment may involve hospitalization, bed rest, medication to prevent contractions, or delivery of the baby if the pregnancy is at term.
Pregnancy outcome refers to the final result or status of a pregnancy, including both the health of the mother and the newborn baby. It can be categorized into various types such as:
1. Live birth: The delivery of one or more babies who show signs of life after separation from their mother.
2. Stillbirth: The delivery of a baby who has died in the womb after 20 weeks of pregnancy.
3. Miscarriage: The spontaneous loss of a pregnancy before the 20th week.
4. Abortion: The intentional termination of a pregnancy before the fetus can survive outside the uterus.
5. Ectopic pregnancy: A pregnancy that develops outside the uterus, usually in the fallopian tube, which is not viable and requires medical attention.
6. Preterm birth: The delivery of a baby before 37 weeks of gestation, which can lead to various health issues for the newborn.
7. Full-term birth: The delivery of a baby between 37 and 42 weeks of gestation.
8. Post-term pregnancy: The delivery of a baby after 42 weeks of gestation, which may increase the risk of complications for both mother and baby.
The pregnancy outcome is influenced by various factors such as maternal age, health status, lifestyle habits, genetic factors, and access to quality prenatal care.