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[ Abstract] Objective To investigate the relationship between single nucleotide polymorphism (SNP) Fok (rs2228570 / rs10735810) of vitamin D receptor (VDR) gene and hypertensive disorder complicating pregnancy (HDCP) in Han nationality women of Qinghai province. Methods A total of 137 Han nationality HDCP subjects (HDCP group) and 146 Han nationality normal pregnant subjects (control group) were selected from Qinghai province. The Fok polymorphism typing in HCDP group and control group was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) . The mutation was confirmed by sequencing. SPSS 19. 0 statistical software was used to test whether there were significant differences between two groups in general clinical data, genotype and allele frequency distribution. Results The frequency of FF Ff ff genotype of Fok in HDCP group and control group were 51. 82%, 37. 96%, 10. 22% and 34. 93%, 43. 15%, 21. 92% respectively (
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Background: Hypertensive disorders are major factors responsible for morbidity and mortality in pregnancy and pre-eclampsia is the leading cause. The etiopathology of pre-eclampsia is not known even after significant research done on it. A strong strategy in its management is to try to reduce the incidence and severity by predicting its occurrence. In this study, the effect of serum calcium and serum magnesium levels is being investigated with occurrence pre-eclampsia.Methods: Total 120 pregnant patients attending Tirath Ram Shah Hospital were included in the study. They were divided into two groups namely normotensive and hypertensive of 60 each. The serum calcium and serum magnesium levels were estimated and the correlation of these levels was studied with the pre-eclampsia related factors. The data was analysed by application of statistical test of significance.Results: Mean serum calcium level in the normotensive group was 10.119±1.27 mg/dl while mean serum calcium level in the hypertensive group was 9.461±1.164. Mean serum magnesium level in the normotensive women in the study was 1.979±0.405 mg/dl. In the hypertensive women, mean serum magnesium level was 1.723±0.414 mg/dl.Conclusions: This study shows that low levels of calcium and magnesium are found in serum of pre-eclampsia patients as compared to normotensive cases of the study population. The severity of pre-eclampsia is inversely proportional to the levels of serum calcium and magnesium.
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Background: Hypertensive disorders of pregnancy are an elusive group of diseases with multifactorial etiopathologies and varied manifestation. Abnormal pre pregnancy lipid profile is shown to have a positive correlation with endothelial dysfunction which in turn leads to development of hypertensive disorder of pregnancy.Methods: A total of 222 pregnant women who were aged between 18-35 years, with no obstetric and medical risk factors and less than 16 weeks of gestation who gave informed written consent were recruited for the study. Their baseline demographics and fasting blood samples were collected, blood samples were centrifuged, and serum was stored at -80-degree celsius. Patients were followed up till delivery and those with hypertensive disorders in pregnancy (n=22) was identified, defined as case. Control was selected after matching for body mass index and frozen serum samples were analyzed.Results: Overall incidence of hypertensive disorders in pregnancy in the study group was 12.4%. The mean early trimester fasting lipid values were higher in patients who developed hypertensive disorders, difference in mean between cases and controls was TC - 16.25 mg/dl (p-0.061), TGL- 21.45 mg/dl (p-0.143), LDL- 2.4 mg/dl (p-0.82) and for HDL 4.55 mg/dl (p-0.25). However, on stratification of early trimester fasting lipid level based on National Cholesterol Education Program (NCEP) criteria, Total cholesterol level greater than 160 mg/dl showed an odds ratio of 12.66 (p-0). Patients with early trimester fasting total cholesterol levels greater than 160mg/dl has a higher risk of developing hypertensive disorder in pregnancy.
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Background: Pregnancy, although being considered a physiological state, carries risk of serious maternal morbidity and at times death. This is due to various complications that may occur during pregnancy, labor, or thereafter. The major causes of maternal mortality are mostly preventable through regular antenatal check-up, proper diagnosis, and management of labor complications. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The aim is to study the incidence of MMR, assess the epidemiological aspects, causes of maternal mortality and avoidable factors that can prevent maternal deaths.Methods: A retrospective hospital-based study was conducted in obstetrics and gynecology department, SLN MCH, a tertiary care referral hospital in a tribal area of southern Odisha over a period of 2 years from April 2017 to March 2019.Results: A total of 108 deaths were analyzed over 2 years period and MMR was calculated to be 1124/1 lakh live births. Most of the maternal deaths occurred in the age group of 20-24 years (35.1%), majority of maternal deaths were observed in multipara (46.3%), 70.3% deaths occurred within 24 hours of admission. Hypertensive disorders in pregnancy (37%) were the leading direct cause followed by hemorrhage (14.8%) and sepsis (11.1%). Among the indirect causes jaundice (7.4%) and anaemia (3.7%) were the leading cause.Conclusions: MMR in our study was very high as compared to national average of 167/1,00,000 live births, being a tertiary care hospital as most of the patients were referred from peripheral centers. Most maternal deaths are preventable by intensive health education, basic obstetric care for all, strengthening referral and communication system and emphasizing on overall safe motherhood.
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MMR being an important index for evaluation of obstetric care of that area has a little information regarding actions to be taken to negotiate the maternal health issues of that area. Hence more number of cases who were moribund and critical but fortunately escaped death grouped as near miss was being studied to find out the shadowed causes of maternal mortality. Methods: All 312 near miss cases women were evaluated out of total 6040 admissions in obstetric ward of this institute during a period of one year from April 2017 to March 2018 to know the steps to be taken for improvement of maternal health in tribal and low resource newly started medical college. Result: Hypertensive disorders of pregnancy are the main culprit of maternal mortality whereas hemorrhage and its aftereffects are proved to be the most important cause of near miss. Incomplete abortion is the most common cause of hemorrhage and over the counter sell and misuse of Mifegest is found mainly responsible for incomplete abortion. Conclusion: To improve the obstetric care we have to educate the public for proper antenatal checkup. It will help health workers to identify the high risk pregnancies and their timely management. Apart from public awareness program there is necessity of well-equipped government health set ups where the poor tribal and also the other needy ones can report easily with all faith and confidence. Scarcity of skilled staff is also a subject to be noticed.
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Objective Find abnormal changes of plasma lipid metabolism-related proteins before 20 weeks of gestation in patients with hypertensive disorder of pregnancy(HDP), and preliminarily investigate the role of plasma apolipoprotein C4 elevation in HDP. Methods A nested case-control study was used. The plasma were collected from pregnant women who underwent routine prenatal examination in Guangzhou Women and Children's Medical Center from November 2014 to March 2017. Label-free mass spectrometry was used to detect the differences in plasma lipid metabolism-related proteins before 20 weeks of gestation between 12 pairs of HDP patients and normal controls, and different 48 pairs of samples were used for verification. The protein with the most significant difference multiples was screened to study its effects on monolayer permeability and nitric oxide secretion of endothelial cells. One-way ANOVA was used for comparison between groups, and P<0.05 was considered as statistically significant difference. Results Compared with the control, the lipid metabolism-related proteins, APOC4, Fatty acid-binding protein 4 (FABP4), Apolipoprotein E (APOE), Apolipoprotein C3 (APOC3) and Beta-2-glycoprotein 1(APOH) raised to 1.94, 1.82, 1.59, 1.55 and 1.38 times, phospholipid transfer protein (PLTP) decreased to 0.78 times in plasma before 20 weeks of pregnancy of patients with HDP (t value were 2.499, 2.497, 2.081, 2.098, 2.426 and 2.564, respectively, P<0.05). Cell experiments results showed that 50 ng / ml APOC4 significantly increased 20％ HUVEC single layer cell permeability to FITC-labeled dextran (F=455.4, P<0.01), and significantly decreased the level of nitric oxide in the supernatant of HUVEC culture by 25％ (F=61.92, P<0.01). Conclusions Before diagnosis, plasma protein levels involved in lipid metabolism in HDP patients have been changed, resulting in abnormal lipid metabolism. APOC4 can increase the permeability of vascular endothelial cells, inhibit endothelial source of NO secretion, cause endothelial dysfunction.
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Objective To investigate the effect of self-made traditional Chinese medicine(TCM) decoction on pregnancy outcome in patients with hypertensive disorder complicating pregnancy. Methods A total of 124 pregnant hypertensive patients admitted to the Department of Critical Care of Guizhou Provincial People's Hospital from October 2016 to October 2018 were enrolled. The 62 patients who were treated with western medicine conventional method;62 patients who were treated with self-made TCM decoction on the basis of western medicine conventional method. The western medicine conventional treatment group was given magnesium sulfate combined with nicardipine; the self-made TCM treatment group was supplemented with TCM decoction on the basis of conventional western medicine treatment (composition: uncaria, raw oyster 20 g, gastrodia elata, eucommia, salvia miltiorrhiza, medlar rehmannia glutinosa each 15 g, rhizoma, mulberry parasitic, astragalus, ophiopogonis each 10 g. Severe headache and dizziness plus tortoise shell, gentian grass 15 g, anemarrhenae 10 g; severe edema plus cassia twig, aristolochiae 15 g, astragali, ginger skin 10 g), be decocted in water for oral dose, morning and evening oral, one dose a day, 1 week for a course of treatment, the two groups were continued for 4 weeks after the evaluation of clinical efficacy. The changes of blood pressure and blood coagulation parameters, placental bed arterial hemodynamics, pregnancy outcome index were observed before and after treatment; antihypertensive effects and adverse reactions after treatment were recorded. Results After treatment, the systolic blood pressure (SBP), diastolic blood pressure (DBP), Fibrinogen (Fib), placental bed arterial pulsation index (PI), end-systolic blood flow velocity and end-diastolic blood flow velocity ratio (S/D) and resistance index (RI) in both groups were lower than those before treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly longer than before treatment, and the time-averaged flow rate (TAV) increased than that before treatment; SBP, DBP, Fib, PI, S/D and RI were significantly lower in self-made TCM treatment group than those in western medicine conventional treatment group [SBP (mmHg, 1 mmHg = 0.133 kPa): 114.26±17.07 vs. 132.72±17.64, DBP (mmHg): 82.98±6.24 vs. 90.09±6.48, Fib (g/L): 3.21±0.45 vs. 3.64±0.31, PI: 0.59±0.14 vs. 0.75±0.15, S/D: 1.70±0.21 vs. 1.93±0.25, RI: 0.43±0.08 vs. 0.54±0.12, all P < 0.05], PT, APTT, TAV in self-made TCM treatment group were significantly higher than western medicine conventional treatment group [PT (s): 12.26±0.57 vs. 11.72±0.44, APTT (s): 27.11±1.34 vs. 25.69±1.48, TAV (cm/s): 15.64±2.88 vs. 12.49±2.76, all P < 0.05]. The rate of cesarean section, postpartum hemorrhage, fetal heart abnormality and neonatal asphyxia in self-made TCM treatment group were significantly lower than those in western medicine conventional treatment group [cesarean section rate: 9.84% (6/61) vs. 27.78% (15/54), postpartum hemorrhage rate: 1.64% (1/61) to 14.81% (8/54), fetal heart abnormal rate: 3.28% (2/61) vs. 16.67% (9/54), the incidence of neonatal asphyxia: 1.64% (1/61) vs. 12.96% (7/54), all P < 0.05]. The total effective rate of the self-made TCM treatment group was significantly higher than that of western medicine conventional treatment group [98.39% (61/62) vs. 87.10% (54/62), P < 0.05]. However, there was no significant difference in the incidence of adverse reactions between the self-made TCM treatment group and western medicine conventional treatment group [16.39% (10/61) vs. 16.67% (9/54), P > 0.05]. Conclusion Self-made TCM decoction can improve the maternal and infant outcomes by improving the hypercoagulable state and placental hemodynamics in hypertensive patients with hyperthyroidism, the antihypertensive effect is remarkable and the safety is good.
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Background: Hypertensive disorders are also responsible for perinatal mortality and morbidity. Preeclampsia is a risk factor for stillbirth, IUGR, LBW, Preterm delivery, Respiratory distress syndrome, and admission in the neonatal intensive care unit. Hypertensive disorders account for 8-10% of all preterm births. Aim of the study: This study was conducted to predict gestational hypertension by using serum beta HCG and thereby to follow up the risk patients and to reduce both maternal and perinatal morbidity and mortality. Materials and methods: A prospective study was done to determine the role of βHCG in 100 pregnant women in their second trimester (13-20) weeks, attending Tirunelveli medical college OPD. Duration of study was from March 2018- January 2019. Routine antenatal investigations were done. 5 ml of venous blood sample was collected and tests were carried out. Estimation of serum beta HCG level was done by enzyme-linked fluorescence immunoassay. In the antenatal clinic, the patients were followed up. Results: From the study, it was found, women who have elevated βHCG values in 13-20 weeks were at increased risk of developing PIH. For any test to be used as screening test it should have good sensitivity, specificity, and positive predictive value. In this study, β HCG had Sensitivity – 71.4%, Specificity - 87.1%. Conclusion: While comparing patients with normal BP and pre-eclampsia - βHCG values are elevated in patients with preeclampsia. The sensitivity and specificity of βHCG are very low to be Sheba Rosatee Victor, D Jayalakshmi. Serum β HCG as a predictor and potent marker for pregnancy induced hypertension. IAIM, 2019; 6(3): 38-43. Page 39 useful as a mass screening marker on its own and therefore it should be combined with other serum markers and ultrasound parameters like Doppler study of uterine vessels, which will help in improving its role as a screening tool.
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Background: Perinatal outcome is strongly influenced by gestational age and the severity of hypertension as expressed by the need for antihypertensive treatment, irrespective of the underlying syndrome. Severe preeclampsia is associated with different degrees of fetal injury. The main impact on the fetus is under nutrition as a result of uteroplacental vascular insufficiency, which leads to growth retardation. There are short and long-term effects. The immediate impact observed is altered fetal growth resulting in greater fetal liability. Fetal health, as well as its weight, is highly compromised, leading to various degrees of fetal morbidity, and fetal damage may be such as to cause fetal death. Aim of the study: To compare maternal outcomes between normal and PIH mothers in correlation with a serum albumin level. Materials and methods: The study was conducted in Obstetrics and Gynecology OPD of Tirunelveli Medical College. Duration of study was from March 2018 to November 2018. Routine antenatal investigations were done. The maternal outcomes were analyzed between two categories Results: The normal, forceps and LSCS deliveries among the total mothers were 42.4%, 2.0%, and 55.6% respectively. The difference between PIH and normal mothers was not statistically significant (P>0.05). The pre and term among the total mothers were 12.1%, and 87.9% respectively. The difference between the pre and term babies among the PIH and normal was very highly statistically significant (P>0.001). The pre and term among the total mothers were 11.1%, and 88.9% respectively. The difference between the APO and NPO of babies between the PIH and normal mothers was very D Jayalakshmi, Sheba Rosatee Victor. Comparative study on maternal outcomes between normal and PIH mothers with serum albumin level. IAIM, 2019; 6(3): 32-37. Page 33 highly statistically significant (P>0.001). The complicated and normal outcome among the total mothers was 4.0%, and 96.0% respectively. The difference between the complicated and normal outcome between the PIH and normal mothers was very highly statistically significant (P>0.001). Conclusion: Perinatal outcome is strongly influenced by gestational age and the severity of hypertension as expressed by the need for antihypertensive treatment, irrespective of the underlying syndrome. Severe preeclampsia is associated with different degrees of fetal injury. The main impact on the fetus is under nutrition as a result of uteroplacental vascular insufficiency, which leads to growth retardation. There are short and long-term effects. The immediate impact observed is altered fetal growth resulting in greater fetal liability. Fetal health, as well as its weight, is highly compromised, leading to various degrees of fetal morbidity, and fetal damage may be such as to cause fetal death.
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Los síntomas premonitorios de la eclampsia se pueden ver englobados como verdaderos síntomas de afectación cerebral dentro del síndrome de leucoencefalopatía posterior reversible, y la eclampsia como un síntoma severo. Objetivo. Revisar las características epidemiológicas de los casos con eclampsia, enfatizando el análisis de las manifestaciones neurológicas asociadas, en un hospital nacional. Diseño. Serie de casos. Institución. Hospital Nacional Daniel A. Carrión (HNDAC), Lima, Perú. Pacientes. Mujeres con eclampsia. Metodología. Estudio de todas las pacientes con eclampsia en un periodo de 5 años y 6 meses. Se excluyó aquellas con eclampsia extrainstitucional o con datos insuficientes. Principales medidas de resultados. Características generales, síntomas asociados, complicaciones y valores laboratoriales en pacientes eclámpticas. Resultados. Se halló 39 casos. La incidencia fue 0,19% del total de gestantes. La edad media fue 21 años, 75,8% fueron primíparas, 44,4% por debajo de las 34 semanas y en 69,7% ocurrió antes del parto; 51,5% tuvo presión arterial mayor a 160/110 mmHg y 12,1% no presentó hipertensión arterial; 93,9% tuvo síntomas, siendo los más frecuentes cefalea (87,9%), alteraciones visuales (27,2%) y auditivas (12,1%). Hubo dos casos de pacientes con cefalea y presión arterial normal, y 2 casos sin sintomatología. Las complicaciones fueron trastorno de sensorio, desprendimiento prematuro de placenta (15,2%), síndrome HELLP (15,2%) e HTA de difícil control (39,4%). No hubo casos de mortalidad materno perinatal. Conclusiones. La sintomatología neurológica que antecede a la eclampsia en la gestante con preeclampsia es muy variable y su correlación con la severidad de la hipertensión arterial materna no es constante.
The premonitory symptoms of eclampsia can be interpreted as actual symptoms of cerebral involvement within the posterior reversible leukoencephalopathy syndrome, and eclampsia as a severe symptom of the same syndrome. Objective: To review the characteristics of women with eclampsia in a national hospital, with emphasis on the associated neurological manifestations. Design: Case series. Institution: Hospital Nacional Daniel Alcides Carrion (HNDAC), Lima, Peru. Patients: Women with eclampsia. Methodology: Study of all patients with eclampsia over a period of 5 years and 6 months. Eclampsia cases that occurred outside the institution or with insufficient data were excluded. Main outcome measures: General characteristics, associated symptoms, complications and laboratory values in eclamptic patients. Results: Thirty-nine cases were reported. The incidence of eclampsia in pregnant women was 0.19%. The mean age was 21 years; 75.8% of the women were primiparous and 44.4% were less than 34 weeks pregnant. 69.7% of them were diagnosed before delivery; 51.5% had blood pressure above 160/110 mmHg and 12.1% had no hypertension. 93.9% presented symptoms, mainly headache (87.9%), as well as visual (27.2%) and auditory (12.1%) disturbances. Two patients had headache and normal blood pressure, and 2 cases were asymptomatic. Complications were: sensory alterations, abruptio placentae (15.2%), HELLP syndrome (15.2%) and difficult-to-control hypertension (39.4%). There were neither maternal nor perinatal deaths. Conclusions: The neurological manifestations that precede eclampsia are variable and do not have a constant correlation with the severity of maternal hypertension.
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Resumen El síndrome de HELLP es una complicación multisistémica del embarazo que se distingue por el trastorno hipertensivo más la triada: Hemólisis microangiopática, elevación de enzimas hepáticas y disminución del conteo de plaquetas. Está asociado con la aparición de graves complicaciones perinatales e incremento de la mortalidad materna. Ocurre en 0,5 a 0,9% de todos los embarazos y en 10 a 20% de las pacientes con preeclampsia-eclampsia. Complicaciones obstétricas como ésta pueden pasarse por alto en la práctica clínica, generando situaciones de alto riesgo tanto para la madre como para el embrión, por lo que debe tenerse en cuenta su sintomatología y semiología dadas las dificultades en el diagnóstico diferencial.
Abstract HELLP syndrome is a multisystem complication of pregnancy that is characterized by hypertensive disorder plus the triad: microangiopathic hemolysis, elevation of liver enzymes, and decreased platelet count. It is associated with the appearance of serious perinatal complications and increased maternal mortality. It occurs in 0.5 to 0.9% of all pregnancies and in 10 to 20% of patients with pre-eclampsia/eclampsia. Obstetric complications can be overlooked in clinical practice, generating high risk situations for both the mother and the embryo, therefore, its symptoms and semiology should be taken into account given the difficulties in the differential diagnosis.
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Objective To investigate the effect of pregnant women with hypertensive disorders of COOK cervical dilatation balloon and Dinoprostone Suppositories on the gestation effect and safety of induction.MethodsThe research object from June 2013 to June 2015 in our hospital for pregnant women with hypertensive disorders in pregnancy in 68 cases (all patients with gestational hypertension and mild preeclampsia) were randomLy divided into the observation.Group and control group, 34 cases in each group.The observation group received COOK cervical dilatation balloon induced labor, the control group to implement Dinoprostone Suppositories induction, comparative analysis of observation group and control group, maternal and perinatal situation, mode of delivery, the cervical Bishop score, the degree of pain.Resultsabnormal fetal heart and uterine hyperstimulation, uterine tonic contraction rate of observation group were significantly lower than the control group(P<0.05).The cesarean section rate in the observation group and the control group had no significant difference.After placement, the cervical Bishop score of observation group was significantly higher than that of control group(P<0.05).The pain degree of observation group was significantly lower than that in control group(P<0.05).ConclusionCOOK balloon dilatation of the cervix and Dinoprostone Suppositories, fewer complications, can significantly improve maternal, perinatal and cervical ripening score of Bishop.
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Objeetive To investigate the clinical significance of combined detection of lipoprotein associated serum phospholipase A2 (Lp-PLa2),homocysteine (Hcy) and cystatin C (CysC) in the diagnosis of hypertensive disorders complicating pregnancy (HDCP).Methods From January 2013 to May 2016 in Changan Hospital,selected 113 cases of pregnancy induced hypertension patients as the observation group,and were divided into three group A,B and C (group A:55 cases of HDCP patients,group B:32 cases of mild preeclampsia and group C for patients with severe preeclampsia 26 cases).At the same period,selected 50 cases of normal college pregnancy as control group,serum Lp-PLa2 (enzyme-linked immunosorbent assay),Hcy (cyclophorase method) and CysC (particle enhanced turbidimetric method),the test results were analyzed and compared.Results Serum Lp-PLa2,Hcy and CysC test results in the control group,the observation group A,observation group B and observation group C increased significantly,in the observation group C increased most obviously.Compared with the control group,the serum levels of Lp-PLa2,Hcy and CysC in the observation group were significantly higher,the difference was statistically significant (F=8.102,7.231 and 6.926,all P＜0.05).Pearson correlation analysis showed that there was a positive correlation between serum Lp-PLa2,Hcy and CysC and blood pressure (r=0.71,0.69,0.63,all P＜0.05).The abnormal rate of serum Lp-PLa2,Hcy and CysC for three joint detection was higher than that of single detection,and the difference was statistically significant (x2 =6.725,P＜0.001).The abnormal rate of serum Lp-PLa2,Hcy and Cys single test results increased with the exacerbation of HDCP,and the difference was statistically significant (x2=9.351,P＜0.000).Conclusion Serum Lp-PLa2,Hey,CysC and pregnancy would be closely related to the occurrence and development of hypertension syndrome,so combined detection of HDCP can improve the detection rate of abnormal results,and it has important clinical significance for early diagnosis and prognosis of HDCP.
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Objective To investigate the association between diet during pregnancy and hypertensive dis-order complicating pregnancy ( HDCP ) , so as to provide a theoretical basis guiding appropriate diet during pregnancy.Methods Using 1∶2 matched case-control study method, we selected pregnant women delivered in Anhui Women and Child Health Care Hospital from January to December 2014, and interviewed them with food frequency questionnaire.The relationship between intake frequency of various food and HDCP was analyzed. Results A total of 543 women were included in this study, including 181 cases and 362 controls.Mann-Whit-ney U test results showed that the frequencies of meat and fish, eggs, beans, nuts, milk, and pickled food con-sumption were significantly different between the cases and the controls (all P0.05).Multivariate Logistic regression analysis showed that higher intake frequencies of beans (OR=0.746, 95%CI:0.645-0.862), eggs (OR=0.789, 95%CI:0.693-0.898), and milk (OR=0.822, 95% CI:0.725-0.931) were associated with lower risk of HDCP; in contrast, higher intake fre-quency of pickled food was associated with higher risk of HDCP (OR=1.190, 95% CI:1.054-1.344). Conclusions Beans, eggs, and milk may be protective factors for HDCP, while pickled food may be risk fac-tor of HDCP.Diet during pregnancy should be appropriate and following scientific guidelines.
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Objective To investigate the clinical effect of magnesium sulfate combined with nifedipine in the treatment of patients with pregnancy induced hypertension( HDCP) .Methods Retrospective study was used in this study and 116 patients with HDCP from January 2013 to July 2015 in department of obstetrics and gynecology from our hospital were divided into two groups, including routine group of 62 patients who received routine treatment +magnesium sulfate) and combination group of 54 patients who received routine treatment +magnesium sulphate +nifedipine.The clinical effect was analyzed after five days’ continuous treatment.Results The systolic blood pressure, diastolic blood pressure,24h urinary protein, random urine protein /creatinine,serum homocysteine (Hcy) and CRP values in combination group were lower than routine group (P<0.05).There were no statistical difference in maternal uterine inertia, neonatal asphyxia, fetal distress, postpartum hemorrhage rate between the two groups after the treatment.But the rate of cesarean section in the combination group(50.00%)was significantly lower than that in the routine group(68.25%)(P <0.05).Conclusion Magnesium sulfate combined with nifedipine in the treatment of patients with HDCP had better antihypertensive effect, and would not increase fetal adverse birth outcomes incidence and significantly reduce the rate of cesarean section.
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Backround: Although neonatal morbidity and mortality rates are fallen in recent decades, the prevalence of preterm deliveries has increased especially late preterm births. Late preterm deliveries are at increased risk of various neonatal complications compared to term deliveries. This study was carried out to identify the maternal characteristics and co-morbidites found with late preterm births and feto-maternal outcome in terms of indication of delivery, route of delivery, Apgar score and NICU admissions. Methods: A retrospective study was conducted in a tertiary care teaching hospital of Indian armed forces between Jan 2011 to Dec 2012 where 248 late preterm deliveries were analysed. Results: 56% women had spontaneous late preterm births and 44% women were induced. 23% of patients had history of 1 or more prior abortion and 13% patients had previous fetal deaths among the patients had late preterm delivery. Common maternal morbidities in mother delivering late preterm were hypertensive disorders of pregnancy (20.6%), anaemia (14.5%) and preterm premature rupture of membrane (13.7%). 4.8% newborns had Apgar ≤ 7 and 10% newborns required NICU admissions. Conclusion: Higher incidences of hypertensive disorders of pregnancy, anaemia and preterm premature rupture of membrane were found with late preterm birth and 10% of newborns required NICU care.
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Objective To observe the change of protein levels of large conductance calcium activated potassium channel (BK‐Ca) in placental arteriole smooth muscle cells from hypertensive disorder complicating pregnancy and discuss its role .Methods Western blot analysis was used to examine protein expression of α subunit andβ1 subunit of BKCa channels in placental arteriole smooth muscle cells from hypertensive disorder complicating pregnancy .Results The relative protein expression level of α‐subunit in the HDCP group was 1 .001 2 ± 0 .169 8(n=15) ,and the NT group was 1 .028 2 ± 0 .180 6 (n=15) .There was no significant differences between the two groups (P> 0 .05);the relative protein expression level of β1 subunit in the HDCP group was 0 .418 1 ± 0 .080 8 (n=15) ,and the NT group was 1 .616 8 ± 0 .012 6 (n=15) ,theβ1‐subunit protein expression levels of HDCP group were significantly lower (P<0 .05) .Conclusion The protein expression ofβ1‐subunit ,but notα‐subunit ,was reduced in pla‐cental arteriole smooth muscle cells from hypertensive disorder complicating pregnancy .Therefore ,BKCa channel activity may have been involved in hypertensive disorder complicating pregnancy ;and the abnormal expression ofβ1 subunit maybe an important basis in hypertensive disorder complicating pregnancy .
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Objective To investigate the correlation factors of neonatal lenticulostriate vasculopathy. Method Four hundred and forty-seven newborns from Guangdong Women and Children Hospital were enrolled in this study. Clinical data of the newborns were obtained . Brain ultrasound studies of lenticulostriate artery were performed on the newborns. The logistic regression was performed for screening the correlation factors of neonatal lenticulostriate vasculopathy (P < 0.05). Results Results of the univariate logistic regression reveal the correlation factors tcontributing to LSV include congenital cytomegalovirus infection、neonatal asphyxia、congenital heart disease (CHD),hypertensive disorder in pregnancy (P < 0.05, respectively). Multivariate logistic regression analysis was performed on these factors. The congenital cytomegalovirus infection, neonatal asphyxia, CHD,hypertensive disorder in pregnancy were significantly associated with LSV (P < 0.05). Conclusion The congenital cytomegalovirus infection,neonatal asphyxia,CHD,hypertensive disorder in pregnancy are the correlation factors of neonatal lenticulostriate vasculopathy. LSV could be a predictive marker for the future development of neuropsychiatric disorders. The brain ultrasound studies of lenticulostriate artery is suggested to be performed on all infants with the correlation factors.
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Objective To investigate and evaluate the correlation between brain natriuretic peptide (BNP) and gestational hypertension and preeclampsia of hypertensive disorder complicating pregnancy (HDCP).Methods Fifty cases with HDCP and 46 cases with mild and 83 cases with sever stage preeclampsia were selected as our subjects.And 33 cases with regular pregnancy and 31 with irregular pregnancy were served as control group.Plasma brain natriuretic peptide,urinary protein quantity(UBQ),24-hour urinary protein assay (UPA) were measured.The correlations of brain natriuretic peptide and UBQ,UPA,systolic pressure (SP),diastolic pressure (DP) were analyzed.Results The levels of brain natriuretic peptide in the group with gestational hypertension and mild,severe preeclampsia groups were (48.54± 18.27),(79.46± 32.18) and (292.24±213.08) ng/L,higher than that in normal pregnancy and non pregnant group ((27.84± 14.58) and (20.63± 8.28) n/L;F =49.583,P＜0.05).While no significant difference exists between normal pregnancy group and non pregnant group.Grouped on the median values (199) of brain natriuretic peptide of the severe preeclampsia group,the levels of 24-hour UPA,systolic pressure and diastolic pressure were (5.46±2.68) g,(174.55± 13.58) mmHg,(113.74±9.91) mmHg in patients with brain natriuretic peptide ≥ 199 ng/L(n=42),significant higher than those in patients with brain natriuretic peptide ＜ 199 ng/L(n =41;(4.34± 1.95)g,(165.31±11.12) mmHg,(106.05±8.02) mmHg;t=2.603,3.396,2.308;P=＞0.010,0.001,0.024).The levels of 24-hour UPA,systolic pressure and diastolic pressure of patients with brain natriuretic peptide ≥ 86ng/L(n=20) in mild preeclampsia were (1.68±0.27) g,(163.69±8.29) mmHg,(105.45±6.71) mmHg,significant higher than those in patients with brain natriuretic peptide ＜ 86 ng/L (n =26;(1.16 ± 0.31) g,(152.90±7.32) mmHg,(99.19 ± 5.25) mmHg;t =3.180,2.508,2.32;P =0.010,0.016,0.025).Brain natriuretic peptide was closely correlated with UPA,systolic pressure and diastolic pressure in hypertensive disorder complicating pregnancy (HDCP) (r =0.29,0.30;P ＜ 0.01).Brain natriuretic peptide was closely correlated with UPA systolic pressure and diastolic pressure in mild preeclampsia (r =0.39,0.37,0.40;P ＜0.01).And correlation efficacy of brain natriuretic peptide with UPA,systolic pressure and diastolic pressure were 0.44,0.42 and 0.53 (P＜0.01).Conclusion The level of brain natriuretic peptide is closely associated with the severity of gestational hypertension and preeclampsia of hypertensive disorder complicating pregnancy.Correlation of brain natriuretic peptide to the severity of gestational hypertension and preeclampsia is independent of urinary protein and hypertension.Brain natriuretic peptide is an important indicator for the severity of gestational hypertension and preeclampsia of hypertensive disorder complicating pregnancy.
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Objective:To investigate the changes of the levels of CD 4+CD25+Foxp3+regulatory T cells in HDCP peripheral blood and its significance.Methods: From 2013 January to 2014 August 46 hypertensive disorder complicating pregnancy ( HDCP ) patients treated in our hospital ,including 22 patients with mild preeclampsia ,24 cases of severe preeclampsia ,and 25 normal pregnant women,used flow cytometry detected each group patient peripheral blood CD 4+CD25+Foxp3+regulatory T cells.Results: Severe preeclampsia group CD4+CD25+T cell ratio was (5.01±1.04)%,lower than mild preeclampsia group (7.38±1.26)% and normal pregnant women group ( 12.59 ±2.48 )%, the difference was statistically significant ( P<0.05 );Mild preeclampsia and severe preeclampsia group CD4+CD25+Foxp3+T cell absolute number respectively were (0.96±0.11) ×107 and (0.63±0.12) ×107,CD4+CD25+Foxp3+Treg/CD4+T were (2.58±0.93)%and (1.84±0.85)%,were lower than that of normal pregnant women group (1.85± 0.17) ×107 and(5.11±0.99)%,the difference was statistically significant (P<0.05);Mild preeclampsia group and severe preeclampsia blood estriol were (6.16±2.17) mg/L and (3.27±1.15) mg/L,significantly lower than that of normal pregnant women group (11.34±2.4) mg/L,the difference was statistically significant (P<0.05).Conclusion: Hypertensive disorder complicating pregnancy diseases patient CD 4+CD25+Foxp3+regulatory T cells was significantly reduced ,but also serum estriol reduced ,which may be related to the pathogenesis of gestational hypertension disease and immune tolerance .