Comparison of Serum Calcium Level in Hypertensive and Normotensive Pregnant Women

Background: Calcium deficiency in pregnancy is linked to the risk of development of hypertensive disorders of pregnancy. At present,hypertensive disorders of pregnancy are among leading causes of maternal death in Nigeria. This study was aimed to compare the serumcalcium level of women with hypertensive disorders of pregnancy and normotensive controls. Methodology: This was a comparative descriptive study among patients with hypertensive disorders of pregnancy (45 pre‑eclampsia [PE] and 45 gestational hypertension [GH]) and comparative group of 45 normotensive pregnant women at Federal Medical Center, Abeokuta. Results: The serum calcium level in normotensive controls (mean ± standard deviation) was 2.64 ± 1.38 mmol/l, women with GH was 2.39 ± 1.15 mmol/l, and PE was 2.08 ± 0.76 mmol/l (P = 0.065). Hypocalcemia was found to have an incidence rate of 33% in normotensive  controls, 51.1% among GH, and 51.1% among PE. Conclusion: Pregnant women with hypertensive disorders of pregnancy showed nonsignificant difference in mean serum calcium level. Keywords: Calcium, gestational hypertension, hypertensive, normotensive, preeclampsi

Hypoxaemia during tracheal intubation in patients with hypertensive disorders of pregnancy: analysis of data from an obstetric airway management registry

Background In South Africa, hypertensive disorders of pregnancy are the leading cause of maternal mortality. More than 50% of anaesthesia-related deaths are attributed to complications of airway management. We compared the prevalence and risk factors for hypoxaemia (SpO2<90%) during induction of general anaesthesia in parturients with and without hypertensive disorders of pregnancy. We hypothesised that hypertensive disorders of pregnancy are associated with desaturation during tracheal intubation. Methods Data from 402 cases in a multicentre obstetric airway management registry were analysed. The prevalence of peri-induction hypoxaemia (SpO2<90%) was compared in patients with and without hypertensive disorders of pregnancy. Quantile regression of SpO2 nadir was performed to identify confounding variables associated with, and mediators of hypoxaemia.Results In the cohort of 402 cases, hypoxaemia occurred in 19% with and 9% without hypertension (estimated risk difference, 10%; 95% CI 2% to 17%; P=0.005). Quantile regression demonstrated a lower SpO2 nadir associated with hypertensive disorders of pregnancy as body mass index increased. Room-air oxygen saturation, Mallampati grade, and number of intubation attempts were associated with the relationship. Conclusions Clinically significant oxygen desaturation during airway management occurred twice as often in patients with hypertensive disorders of pregnancy, compounded by increasing body mass index. Intermediary factors in the pathway from hypertension to hypoxaemia were also identified

Pregnancy outcome in South Australia:Population and cohort studies

Adverse pregnancy outcome, including preterm birth, small for gestational age, gestational diabetes mellitus and hypertensive disorders of pregnancy affect a quarter of first pregnancies, but their pathophysiology is not fully understood. The studies presented in this thesis describe long-term trends, sexual dimorphism, seasonality of these adverse pregnancy outcome and maternal haemodynamics in pregnancy in South Australia. - In many Western countries, such as (South) Australia, the preterm birth rate has increased, mostly due to increased iatrogenic delivery, particularly in pregnancies complicated by hypertensive disorders of pregnancy, small for gestational age, and preterm prelabour rupture of the membranes. This was also seen in South Australia. However, overall and preterm stillbirth rates have declined. - Fetal sex is an independent risk factor for adverse pregnancy outcome. A male disadvantage is observed in most but not all adverse pregnancy outcomes. - The incidence of gestational diabetes mellitus and hypertensive disorders of pregnancy in South Australia showed seasonality. Winter conceptions had higher gestational diabetes mellitus rates, while gestational diabetes mellitus rates were the lowest for summer conceptions. Meanwhile, spring conceptions had higher hypertensive disorders of pregnancy rates, while hypertensive disorders of pregnancy rates were the lowest for autumn conceptions. New perspectives in exposures with these conditions can be sought in periodicity. - Maternal haemodynamic maladaptation to pregnancy differs between subtypes of hypertensive disorders of pregnancy, indicating a different pathophysiology between these subtypes. Being intermittent hypertensive in pregnancy is not benign. Monitoring haemoynamic adaptation throughout pregnancy could potentially identify women at risk for hypertensive disorders of pregnancy

Obstet Gynecol

OBJECTIVETo evaluate trends and associations of hypertensive disorders of pregnancy with stroke risk and test the hypothesis that hypertensive disorders of pregnancy-associated stroke results in higher rates of stroke-related complications than pregnancy-associated stroke without hypertensive disorders.METHODSA cross-sectional study was performed using 81,983,216 pregnancy hospitalizations from the 1994\u20132011 Nationwide Inpatient Sample. Rates of stroke hospitalizations with and without these hypertensive disorders were reported per 10,000 pregnancy hospitalizations. Using logistic regression, adjusted odds ratios (OR) with 95% confidence intervals were obtained.RESULTSBetween 1994\u20131995 and 2010\u20132011, the nationwide rate of stroke with hypertensive disorders of pregnancy increased from 0.8 to 1.6 per 10,000 pregnancy hospitalizations (103%), whereas the rate without these disorders increased from 2.2 to 3.2 per 10,000 pregnancy hospitalizations (47%). Women with hypertensive disorders of pregnancy were 5.2 times more likely to have a stroke than those without. Having traditional stroke risk factors (eg, congenital heart disease, atrial fibrillation, sickle cell anemia, congenital coagulation defects) substantially increased the stroke risk among hypertensive disorders of pregnancy hospitalizations: from adjusted OR 2.68 for congenital coagulation defects to adjusted OR 13.1 for congenital heart disease. Stroke-related complications were increased in stroke with hypertensive disorders of pregnancy compared with without (from adjusted OR 1.23 for nonroutine discharge to adjusted OR 1.93 for mechanical ventilation).CONCLUSIONHaving traditional stroke risk factors substantially increased the stroke risk among hypertensive disorders of pregnancy hospitalizations. Stroke with hyper-tensive disorders in pregnancy had two distinctive characteristics: a greater increase in frequency since the mid-1990s and significantly higher stroke-related complication rates.20152015-05-27T00:00:00ZERV8/Intramural CDC HHS/United States871

Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records: A CALIBER Study.

BACKGROUND: The associations between pregnancy hypertensive disorders and common cardiovascular disorders have not been investigated at scale in a contemporaneous population. We aimed to investigate the association between preeclampsia, hypertensive disorders of pregnancy, and subsequent diagnosis of 12 different cardiovascular disorders. METHODS: We used linked electronic health records from 1997 to 2016 to recreate a UK population-based cohort of 1.3 million women, mean age at delivery 28 years, with nearly 1.9 million completed pregnancies. We used multivariable Cox models to determine the associations between hypertensive disorders of pregnancy, and preeclampsia alone (term and preterm), with 12 cardiovascular disorders in addition to chronic hypertension. We estimated the cumulative incidence of a composite end point of any cardiovascular disorder according to preeclampsia exposure. RESULTS: During the 20-year study period, 18 624 incident cardiovascular disorders were observed, 65% of which had occurred in women under 40 years. Compared to women without hypertension in pregnancy, women who had 1 or more pregnancies affected by preeclampsia had a hazard ratio of 1.9 (95% confidence interval 1.53-2.35) for any stroke, 1.67 (1.54-1.81) for cardiac atherosclerotic events, 1.82 (1.34-2.46) for peripheral events, 2.13 (1.64-2.76) for heart failure, 1.73 (1.38-2.16) for atrial fibrillation, 2.12 (1.49-2.99) for cardiovascular deaths, and 4.47 (4.32-4.62) for chronic hypertension. Differences in cumulative incidence curves, according to preeclampsia status, were apparent within 1 year of the first index pregnancy. Similar patterns of association were observed for hypertensive disorders of pregnancy, while preterm preeclampsia conferred slightly further elevated risks. CONCLUSIONS: Hypertensive disorders of pregnancy, including preeclampsia, have a similar pattern of increased risk across all 12 cardiovascular disorders and chronic hypertension, and the impact was evident soon after pregnancy. Hypertensive disorders of pregnancy should be considered as a natural screening tool for cardiovascular events, enabling cardiovascular risk prevention through national initiatives

A study on fetomaternal outcome of hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy are one of the most common medical disorders seen during pregnancy. Early diagnosis of hypertensive disorders in pregnancy by regular antenatal checkup can help in proper management, thus decreasing the maternal and fetal complications related it. Ensuring timely and effective care requires appropriate use of evidence-based clinical and nonclinical interventions, strengthened health infrastructure, and motivated and competent health care providers. The objective of this study was to study the feto-maternal outcome of hypertensive disorders of pregnancy and complications related to them. Methods: A study was conducted in the department of obstetrics and gynecology at JJ Group of hospitals, Mumbai, India for a duration of 18 months from January 2020 to June 2021. This study had a sample size of 500 antenatal patients. Necessary information such as their detailed clinical, and obstetric history, clinical examination, investigations was noted. Results: In our study, the incidence of hypertensive disorders of pregnancy was 10.2%, being most common in age group of 21-25 years (45.1%) and Primigravida patients (47.1%). The most common type of hypertensive disorder in our study was non severe preeclampsia with incidence of 74.50%. The most common complication was oligohydramnios (11.76%), followed by preterm delivery (9.80%) and IUGR (9.80%). The most common drug used in the management of hypertensive disorder was lobetalol. Most common neonatal complication in PIH group was low birth weight, followed by fetal distress (19.6%), prematurity (9.8%) and IUGR (9.8%). Conclusions: Hypertensive disorders of pregnancy are one of the medical conditions affecting pregnancy. Hypertensive disorders of pregnancy are more prevalent in younger and nulliparous mothers. Early diagnosis and appropriate timely management of hypertensive disorders in pregnant women can prevent the maternal and fetal complications and improve the outcome of pregnancy. These women should be monitored carefully to prevent maternal morbidity and mortality

Exploring the role of serum β-HCG levels in predicting hypertensive disorders of pregnancy: a prospective observational study

Background: Hypertensive disorders of pregnancy pose significant risks to maternal and fetal health, contributing to global morbidity and mortality. Despite extensive research, these disorders remain a public health concern, necessitating the identification and prediction of associated risks for effective prevention and management. Methods: A prospective observational study was conducted in a hospital setting, involving 200 antenatal women visiting the Department of Obstetrics and Gynecology for routine checkups over a six-month period. Sample size calculation was based on expected sensitivity and prevalence rates. Inclusion criteria were defined, and clinical examinations were performed on the participants. Results: Higher serum β-HCG levels were significantly associated with hypertensive disorders of pregnancy. Low levels correlated with 12 out of 122 cases, while high levels correlated with 59 out of 78 cases. Two deaths were linked to hypertensive disorders. Age did not show a significant association, but variations were observed among religious groups. Conclusions: This study concludes that higher serum β-HCG levels are significantly associated with the development of hypertensive disorders of pregnancy. Age did not show a significant association with these disorders, suggesting the involvement of other contributing factors. The findings provide valuable insights for clinical management and further research in this field, contributing to a better understanding of the etiology and predictors of hypertensive disorders of pregnancy

Nonsteroidal Antiinflammatory Drug Administration and Postpartum Blood Pressure in Women With Hypertensive Disorders of Pregnancy

OBJECTIVE: To evaluate whether postpartum nonsteroidal antiinflammatory drug (NSAID) administration is associated with increased blood pressure in women with hypertensive disorders of pregnancy and to estimate the association between NSAID administration and use of opioid medication. METHODS: We conducted a retrospective cohort study of women with hypertensive disorders of pregnancy. Patients were analyzed in two groups according to whether they received NSAIDs postpartum. Study participants were women delivered at a tertiary care center from 2008 to 2015. The primary outcome was change in mean arterial pressure during the postpartum period. Secondary outcomes were postpartum pain scores, cumulative postpartum opioid requirement, initiation or dose escalation of antihypertensive agents, and adverse postpartum outcomes including acute renal failure, change in hematocrit, and maternal readmission for hypertensive disorder. RESULTS: Two hundred seventy-six women with hypertensive disorders of pregnancy were included (129 NSAID-unexposed and 147 NSAID-exposed). Postpartum NSAID administration was not associated with a statistically significant change in mean arterial pressure compared with no NSAID administration (-0.7 vs -1.8; mean difference 1.10, 95% CI -1.44 to 3.64). Similarly, no difference was observed between the cohorts in terms of need for initiation or escalation in dose of antihypertensive agents or maternal readmission for hypertensive disorder. The study was underpowered to determine whether NSAID administration was associated with any difference in less frequent secondary outcomes (eg, incidence of acute renal insufficiency, need for postpartum transfusion) or cumulative opioid use. CONCLUSION: Nonsteroidal antiinflammatory drug administration to postpartum patients with hypertensive disorders of pregnancy is not associated with a change in blood pressure or requirement for antihypertensive medication

Obstetric and perinatal risks after the use of donor sperm : A systematic review and meta-analysis

Donor sperm is widely used in infertility treatments. The purpose of the study was to investigate, whether use of donor sperm in intrauterine insemination (IUI) or in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments affect maternal and perinatal risks compared with spontaneously conceived pregnancies or use of partner sperm in IUI, IVF or ICSI. We provide a systematic review and meta-analyses on the most clinically relevant obstetric and perinatal outcomes after use of donor sperm compared with partner sperm: hypertensive disorders of pregnancy, preeclampsia, low birth weight, and preterm birth. Our meta-analyses showed an increased risk for preeclampsia (pooled adjusted odds ratio (aOR) 1.77, 95% CI 1.26-2.48) and hypertensive disorders of pregnancy (pooled aOR 1.55, 95%, CI 1.20-2.00) in pregnancies resulting from IUI with donor sperm compared with IUI with partner sperm. No increased risk was seen for low birth weight or preterm birth after the use of donor sperm in IUI compared with the use of partner sperm in IUI. Subgroup analysis for singletons only did not change these results. The meta-analysis on low birth weight showed a lower risk after in IVF with donor sperm compared with IVF with partner sperm (pooled aOR 0.89, 95% CI 0.83-0.94). For hypertensive disorders of pregnancy, preeclampsia and preterm birth, no difference was found between IVF with donor sperm vs. partner sperm. Patients need to be informed about the moderately increased risk of hypertensive disorders of pregnancy and preeclampsia in pregnancies after IUI with donor sperm.Peer reviewe

Thrombocytopenia in hypertensive disorders of pregnancy

Background: Thrombocytopenia is defined as a platelet count of less than 150×103 μl. It is commonly diagnosed and has attracted more interest from researchers during recent years, especially in Hypertensive disorders of pregnancy. This study was done to estimate the incidence of thrombocytopenia in pregnant women diagnosed with hypertensive disorders of pregnancy and to correlate its severity with the degree of thrombocytopenia.Methods: In the study 150 women admitted in the OBG Department at Rajarajeswari Medical College and Hospital, Bengaluru during August 2015-August 2016 were included. Hypertensive disorders of pregnancy cases were classified into: Gestational hypertension, mild preeclampsia, severe preeclampsia, haemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome and eclampsia. The incidence and severity of thrombocytopenia along with maternal and foetal complications encountered in the five groups were analysed. Data were arranged in Microsoft Excel version 2010, and statistically analysed by SPSS version 23.Results: Preeclampsia- mild (29.25%) and severe (22.5%), accounted for most of the cases followed by eclampsia (3%) and gestational HTN (1.5%). Among these hypertensive patients, mild thrombocytopenia was noted in 60 cases (40%), moderate thrombocytopenia 48 (32%), severe thrombocytopenia 12 (8%), and normal platelet counts 30 (20%) were noted. Poor maternal outcome was seen 10.67% cases due to HELLP syndrome and postpartum haemorrhage. Poor foetal outcome was seen in 16% cases due to intrauterine growth restriction and perinatal mortality.Conclusions: Hypertensive disorders of pregnancy is recognized as a major cause of gestational thrombocytopenia. Careful follow up during and after pregnancy is recommended