Relationship between the G894T polymorphism of endothelial nitric oxide synthase gene and lipid metabolism among hypertensive disorder complicating pregnancy patients / 解剖学报

Objective To investigate the relationship between the G894T polymorphism of the endothelial nitric oxide synthase (eNOS) gene and the lipid metabolism in patients with irypertensive disorder complicating pregnancy (HDCP). Methods The 528 cases of HDCP patients admitted to the Xingtai Third Hospital from January 2016 to January 2020 were selected as the research objects, and 128 normal pregnant women during the same period were selected as the control group. The fasting peripheral venous blood of all stud)' subjects in the early morning was collected, and blood lipid indexes, cystatin C (CysC) and uric acid levels and other biochemical index levels were measured. According to the blood lipid level, it was divided into normal blood lipid group and dyslipidemia group. The dyslipidemia group included 4 subgroups [ hyper triglyceride (TG) blood group (T G

Comparing difference in mean total protein, albumin and globulin based on severity of rhesus isoimmunization: a prospective study

Background: Maternal RBC alloimmunization results from exposure and response to a foreign RBC antigen. Transplacental fetal to maternal hemorrhage is the most common cause of alloimmunization. Rh incompatibility can lead to either fetuses with hydropic features or non-hydropic. The precise mechanism leading to the development of hydrops is uncertain. Biochemical markers have the potential to be used to assess the severity of problem. But of the mechanisms proposed none have been able to totally explain the phenomenon or predict the prognosis. Objective of this study wads to compare the difference in mean total protein, albumin and globulin bases on severity of isoimmunization and comparing it with normal controls.Methods: A Total of 40 pregnant patients were enrolled which included 10 hydropic fetuses of Rh isoimmunised mothers, 10 non hydropic fetuses of Rh isoimmunized mothers. Control group included 18 Rh positive women without any fetal complication and 2 fetuses in women undergoing cordocentesis. Blood sampling was done at time of intrauterine transfusion and sent for estimation of total proteins, albumin, globulin in fetal blood. Pregnancies were followed up till delivery and fetal outcome noted.Results: Mean total protein, albumin and globulin between hydropic, non hydropic group and control group (3.25, 2.17 and 1.18 g/dl) in hydropic, (4.14, 2.70 and 1.44 g/dl) in non hydropic and (4.42, 2.95 and 1.47 g/dl) in control group respectively. Mean total protein, albumin and globulin between mild hydropic (3.43, 2.30 and 2.10 g/dl) and severe hydropic group (2.59, 1.6 and 1.3 g/dl) respectively.Conclusions: There was significantly lower levels of serum total proteins, albumin and globulin in hydropic fetuses as compared to non hydropic fetuses. Thus, hypoproteinemia can be considered a strong marker for development of hydrops in Rh isoimmunized fetuses.

Study of perinatal outcomes in normal and borderline oligamnios

Background: Oligamnios is a common cause of perinatal mortality and morbidity, but the outcome of borderline oligamnios, defined as Amniotic Fluid Index (AFI) between 5 and 8, is less clear. This study aims to find out the effect of borderline oligamnios on perinatal outcomes in pregnancies beyond 37 weeks.Methods: An observational prospective study of 131 antenatal mothers with AFI between 5 and 8, after 37 weeks of gestation was conducted in Sree Gokulam Medical College and Research Foundation from October 2017 to September 2019. These observations were compared with that of 131 antenatal mothers with normal AFI beyond 37 weeks of gestation. The observations according to fetal heart rate abnormalities, meconium staining of amniotic fluid, mode of delivery, low birth weight babies, APGAR score, the need of neonatal intensive care unit (NICU) admissions due to neonatal complications were statistically analysed.Results: Both groups were comparable with respect to age, parity and gestational age. In those with borderline oligamnios, fetal heart rate abnormality was seen in 21% (28), meconium stained amniotic fluid in 18% (23), 70% (91) delivered vaginally and 30% (40) underwent caesarean section, 31% (41) babies weighed below 2.5 kg and 21% (27) neonates needed NICU admissions. In those with normal AFI, none showed fetal heart rate abnormality, 2% (3) showed meconium staining, 93% (122) delivered vaginally and 7% (9) underwent caesarean section, 11% (14) babies weighed below 2.5 kg and 3% (4) neonates needed NICU admissions.Conclusions: Borderline oligamnios is associated with poor perinatal outcome. AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome.

A clinical study of McIndoe vaginoplasty in vaginal agenesis

Background: The aim of this study is to determine the effectiveness of McIndoe Vaginoplasty in the creation of a neovagina for patients with vaginal agenesis.Methods: this is a retrospective study of 50 cases of vaginal agenesis, who underwent McIndoe Vaginoplasty over a period of 8 years (2004-2012) by using skin graft in 25 cases and amnion as graft in the remaining.Results: McIndoe Vaginoplasty was performed successfully in all 50 patients and post-surgical result was acceptable to the patient psychologically, sexually and aesthetically.Conclusions: McIndoe Vaginoplasty is a safe and effective procedure for providing a satisfactory and functional vagina in patients with MRKH syndrome.

A study of oral Nifedipine and intravenous Labetalol in severe hypertension in pregnancy at teaching hospital

Background: Hypertensive disorders of pregnancy, including preeclampsia, complicate up to 10% of pregnancies worldwide, constituting one of the greatest causes of maternal and perinatal morbidity and mortality worldwide. Aim: To compare intravenous Labetalol with oral Nifedipine in their rapidity to control hypertensive emergencies of pregnancy. Materials and methods: Pregnant woman with severe gestational hypertension ≥ 160/110 mm of Hg were randomized to receive intravenous Labetalol injection (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg) or Nifedipine (10mg tab orally upto 5 doses ) until the target blood pressure of 150/90mm of Hg was achieved. Crossover treatment was effected if the initial treatment regimen was unsuccessful. Results: Mean time required 47 ± 14 mins in the Labetalol groups and 45 ± 15minutes in the Nifedipine group. This comparison showed no difference in the two groups with a „P‟ value of >0.05. The mean amount of drugs required to achieve BP 150/90mm of Hg were 96 ± 38in the Labetalol group and 23 ± 13mg in the Nifedipine group. And this comparison showed no difference statistically with a „P‟ value of >0.05. Most of the patients were controlled by 2 doses of each drug, 56% in the Labetalol group and 62% in the Nifedipine group. 12% and 14% in the Labetalol and Nifedipine group respectively were not controlled by 5 doses of either drug and required crossover drug therapy. Most of the patients were controlled by two doses of each drug, 50% in the Labetalol group and 60% in the Nifedipine group. 12.5% and 17.5% in the Labetalol & Nifedipine group respectively were not controlled by 5 doses of either drug andrequires crossover drug therapy.

A study on the knowledge and management practices on hypertension in pregnancy among midwives in the different public health centers of Cebu City / Philippine Journal of Obstetrics and Gynecology

ABSTRACT:BACKGROUND: The Millennium Development Goal (MDG) for 2015 has a target MMR of 52/100,000 live births but this goal been difficult to achieve. In the Philippines, 11 mothers die everyday from pregnancy related complications, a bulk contributed by Hypertension. Public health midwives sometimes attend to these obsterical emergencies often in the absence of a physician. this led to the BEmONC program, which addresses the rising morbidities from far-flung areas where resources are scarce, and helps train midwives in essential obsterical emergency care. The midwives are our allies in providing the best standard of care every mother and child rightfully deserves. Only thru periodic evaluation can we help strengthen BEmONC program, making it crucial to evaluate the midwives' knowledge and management practices in hypertension to help identify the setbacks that have impeded our progress in achieving the MDG.GENERAL OBJECTIVE: To access the knowledge and management practices of midwives in the management of hypertension in pregnancy in accourdance to the BEmONC protocol.STUDY DESIGN: Descriptive StudySTUDY SETTING: The 69 public health centers of Cebu CitySTUDY POPULATION: Public Health MidwivesMETHODOLOGY:This is descriptive study where a survey questionnaire was used and convenience sampling was done. Chi square and Fischer exact tests were employed to compare proportions. Descriptive statistics was used to summarize the data in proportion.RESULT: More than 70% of the midwives were knowledgeable regarding expected competencies, where BEmONC-trained midwives were 5-14x more likely to identity appropriate function. However, Only a dismal 22-36% will actually administer Magnesium Sulfate, which shows that knowledge is not translated into practice. Also, more than 70% were knowledgeable on the risk factors and danger signs of hypertension in pregnancy. It also showed that the midwives agreed to give antihypertensive medications- where Methyldopa was commonly given. Among those who agreed too give Methyldopa, majority were BEmONC-trained. A number also agreed to give hydralazine and diazepam in the setting of sever preeclampsia and eclampsia, where more non-BEmONC midwives agreed. Alarmlingly, only less than 50% will refer to a physician in the management og gestational hypertension and mild preeclampsia, and only 50%-60% agreed to facilitate hospital transport in the setting of severe preeclampsia and eclampsia.CONCLUSION: The BEmONC manual must be updated to keep up with current guidelines and ensure the conversation of knowledge into practice. The BEmONCcoverage of training must also be expanded so that all practicing midwives know the protocol. However, the DOH must further strengthen their role in the active surveillance of public health midwives and review the retention of their skills and regular practice of knowledge. Midwives must also be certified proficient, not merely trained. The must also be consulted to explore their problems in the implementation of current guidelines so we can better understand their situation as to why knowledge is not put into practice. By identifying deficiencies, we can improve and address setbacks that have impeded our progress towards achieving the Millennium Development Goal.

Resultados clínicos y perinatales de los embarazos con hipertensión arterial en un hospital de referencia de la VIII Región de Chile / Clinical and perinatal outcomes associated with hypertension syndrome in pregnancy

Objetivo: Conocer los resultados clínicos, bioquímicos y perinatales asociados al síndrome de hipertensión del embarazo (SHE) en el Hospital Herminda Martín de Chillan. Métodos: Se realizó un estudio retrospectivo de registros clínicos (n=416) con diagnóstico de SHE en el periodo 2006 a 2008. Los registros disponibles fueron divididos en tres grupos de acuerdo al nivel de presión arterial: Grupo I (n=124) <140/90 mmHg; Grupo II (n=98) ³ 140-159/³ 90-109 mmHg y Grupo III (n=41)³ 160/110 mmHg. Adicionalmente, un subgrupo (n=85) fue dividido considerando el percentil de distribución del nivel de ácido úrico materno en: SHE con niveles bajos (p75). Se analizaron y compararon los grupos estudiados y se correlacionó las variables estudiadas con los resultados perinatales. Resultados: La prevalence de SHE fue de 3,8 por ciento. Las mujeres del grupo II y III muestran peores resultados clínicos y neonatales que las mujeres del grupo I. El índice de masa corporal (IMC), la presión arterial materna y el nivel de ácido úrico están relacionados negativamente con la antropometría neonatal. Además, la antropometría neonatal fue menor en las mujeres con niveles más altos de ácido úrico, situación que no obedece a la severidad de la hipertensión o el IMC materno. Conclusión: La presencia de SHE esta asociada a mayor morbilidad materna y neonatal. Este estudio permitió detectar deficiencias (e.L, falta de cumplimiento en criterio diagnóstico) y hacer recomendaciones sobre probables marcadores de riesgo perinatal (e.L, nivel de ácido úrico).

Aims: To know the clinical and biochemical spectra and perinatal outcomes associated with syndrome of hypertension in pregnancy (HP) in the Herminda Martin Hospital from Chilian. Methods: It is a retrospective study using clinical records with HP diagnosis (N=416) during 2006 to 2008. The available records were divided in three different groups according with arterial blood pressure: Group I (n=124) <140/90 mmHg; Group II (n=98) ³ 140-159/³ 90-109 mmHg and Group III (n=41)³ 160/110 mmHg. Additionally, a subset (n=85) was divided considering the percentile of the uric acid level in the mother as: HP with low (p75th) uric acid levels. The studied groups were analyzed and compared each other and quantitative variables were correlated with perinatal outcomes. Results: The prevalence of HP was 3.8 percent. Women in the groups II and III showed worse clinical and neonatal outcomes compared with women in the group I. Body mass index (BMI), maternal blood pressure and uric acid levels were negatively correlated with neonatal anthropometry. Moreover, neonatal anthropometry was lower in women with high uric acid levels, a situation that was independent of maternal hypertension or BMI. Conclusion: Hypertension in pregnancy was associated with high maternal and neonatal morbidity. This study allowed identifies some weaknesses (e.i., lack of compliance in diagnosis criteria) as well as suggest the potential role of perinatal risk markers (e.i., uric acid levels).