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Background: Hypertensive disorder is one of the commonestmedical complications of pregnancy. It is assumed that serumuric acid elevation is a specific laboratory finding for thedisease.Objectives: To assess the effect of raised Serum uric acidlevel on outcome of pregnancy in cases of PIH (PregnancyInduced Hypertension).Methods: A Prospective study was conducted to pregnantpatients (between 28-40 weeks of pregnancy with PIH). Total100 patients were selected, who were separated into twogroups. Those who had Serum uric acid level more than6mg/dl (67 participants) are classified as Group A and thosewho had Serum uric acid level less than 6mg/dl (33participants) are classified as Group B.Results: Age of PIH patients were within 16-40 years. Theserum uric acid was significantly elevated in all the patients.Concentration of Serum uric acid is much higher in Eclampsiagroups, which is 4.5-12.0 mg/100ml (7.36 ± 2.17), incomparison to Preeclampsia patients, which is 2.6-9.6mg/100ml (6.28 ± 1.64). Comparing maternal outcome withSerum uric acid level between group A and group B patients,percentage of PPH and Abruptio placenta was higher in groupA than group B. In addition, Postpartum eclampsia, HELLPsyndrome and Pulmonary oedema were present in group A(each 2 in number); but these complications are not found ingroup B. In perinatal outcome, the better consequence wasobserved in group B in case of birth weight, intrauterine growthretardation, still birth and neonatal death rate. There wasstatistical significant association between Serum uric acid andbirth weight of group A & B (p= 032).Conclusion: The degree of hyperuricemia increases with theseverity of preeclampsia. Perinatal mortality was markedlyincreased when maternal serum uric acid concentration wereraised. Serum uric acid was an important indicator for maternalcomplications and prognosis of fetus.
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Background: PPH is responsible for quarter of maternal deaths occurring worldwide and its incidence is increasing in developed world. According to Confidential Enquiries into Maternal and Child Health (CEMACH) report obstetric hemorrhage occurs in around3.7 per 1000 births. The objective of the study is that it was a prospective randomized comparative study of misoprostol and balloon tamponade via condom catheter to prevent postpartum hemorrhage in normal delivered patients at MYH.Methods: A sample size of 200 normal delivered patients between age group 18 and 45 years is chosen with excessive bleeding after third stage of labour and after administration of oxytocics. These 200 patients are divided into two groups: First group receiving Misoprostol and applying condom catheter in other group. Both groups are evaluated for PPH.Results: It was found that CG balloon condom catheter was a much better and more effective alternative in controlling PPH than Misoprostol as the failure rate with CG balloon condom catheter were much less than that with misoprostol. Due to its cost effectiveness and being easily available at primary health center and due to absence of any drug reactions and easy technique of formation makes it a better modality in controlling PPH even at PHC.Conclusions: Patients with condom catheter in situ must show better result than patients receiving misoprostol.
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Objective The evaluate action of serum L-arginine levels for predicting development of pregnant women with PIH,and analyze its effectiveness as clinical predictor.Methods Collecting 186 patients was performed a retrospective study.The PIH pregnant women was the experiment group,and the health pregnant women was the control group.In order to analyse the effect,the levels of L-arginine were measured in the early,middle and late period of pregnant women.Compared with the serum L-arginine in different groups with x2-test and t-test based on data type.Results Experimental group and control group subjects in age (x2 =2.426,P=0.119;t=1.218,P=0.229) and smoking before pregnancy (x2 =2.088,P=2.088),there was no significant differences,but the two groups of patients with BMI (x2 =8.772,P=0.003) and parity (x2 =6.083,P=0.014) was statistically.In different stages of pregnancy,the concentration of serum L-arginine had no statistical differences,and in the concentration of umbilical cord blood,serum L-arginine also had no statistical difference.There was a statistical differences in the serum L-arginine concentration of the cord blood for different number of pregnancies,but the concentrations of L-arginine in cord blood and in serum L-arginine.There were no significant difference in age,BMI and smoking pregnant.According to ROC curve analysis,for the diagnostic of concentration in serum L-arginine and in umbilical cord blood,the results indicate low efficiency to the diagnosis of pregnancy hypertension during pregnancy.Conclusion L-arginine level and the development of PIH and body mass index and maternal correlation for the pregnant women.Because the sample size limitations,L-arginine in the diagnosis of PIH also needs to be further research to determine the effectiveness of predicting.
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Introduction: Placenta “the vital organ” for maintaining healthy pregnancy is unique in its development, being derived from both mother and fetus. Thus hypertensive disorder affecting mother has a deleterious impact on placenta which may lead to poor fetal outcome. Aim: A cross-sectional descriptive study was undertaken to analyze and assess the morphological changes in hypertensive placentae and to clinically correlate it with fetal and maternal parameters. Materials and Methods: 50 placentae were freshly collected from pregnancy induced hypertension (PIH) cases (study group) and 50 from normal pregnancy (control group). Study group was divided into three categories depending upon severity of the disease. Observations and Results: 70% in study group were primigravida and were from rural area.46% were in age group of 15 – 20yrs.50% under low socio-economic status and 60% were without any regular antenatal checkup. Preterm, IUGR, still birth and neonatal death accounted to 10%, 12%, 18% and 10% respectively in study group. The average diameter, thickness, volume and number of cotyledons in study group were 15.91±2.11cm, 2.39±.54cm, 297.64±67.90ml and 10.02±4.13respectively. Mean placental weight was 376.41±17.198gm (mild PIH), 330.72±2.90gm (severe PIH), 329.73±3.19gm (eclampsia) and mean birth weight was 2680.29±198.46gm (mild PIH), 2212.06±36.41gm (severe PIH) and 2073.60±9.47gm (eclampsia) respectively in study group. Various pathological changes like retro placental hematoma, infarction and calcification had been noticed. Conclusion: Placental morphometric parameters were significantly reduced (<.001) in study group as compared to control group. Decreased placental weight was associated with reduced birth weight and feto-placental ratio with increase in severity of hypertension significantly (<.001). A significant increase (<.05) in incidence of preterm, IUGR, still birth and neonatal death were found in study group. Assessment of morphological changes and its clinical relevance can be correlated with transactional study so as to provide the safe confinement and reducing the fetal morbidity and mortality.
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Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension. Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine (n=20), methyldopa (n=20) or labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period. Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h. Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure.
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The present study demonstrates the possibility of increased lipid peroxidation and protein oxidation in both maternal and fetal erythrocytes as markers of oxygen radical activity during pregnancy induced hypertension (PIH). The erythrocyte malondialdehyde (MDA) levels were significantly elevated in mothers with PIH when compared to controls (p<0.001). The endogenous protein damage due to oxidative stress was significantly higher in mothers with PIH when compared to controls (p<0.01). Similarly the proteolytic activity in erythrocyte lysates against oxidatively damaged hemoglobin was significantly increased in mothers with PIH compared to controls (p<0.001). In babies born to mothers with PIH, erythrocyte MDA levels were significantly elevated in comparison those of normal newborns (p<0.01). Both the endogenous oxidative protein damage and erythrocyte proteolytic activity were significantly higher in newborns born to mothers with PIH than in newborns in the control group (p<0.01). The results of this study indicate that oxidative stress is induced both in mothers with PIH as well as their babies which is manifested as increased lipid peroxidation and protein oxidant damage.
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Pregnancy-induced hypertension (PIH) is a common medical complication of pregnancy with a high incidence. The study comprised of 30 normal and 30 PIH cases in their third trimester of pregnancy and the following estimations were done: Serum Malondialdehyde level (MDA), Vitamin E, triglycerides (TG), total cholesterol (TC), HDL-cholesterol (HDL-C) and LDL-C. The PIH cases had significant rise in both systolic and diastolic blood pressure (BP) (P=<0.0001). There was a significant rise in the fasting triglycerides, total cholesterol and LDL-C levels in PIH (P=<0.0001). MDA was twice in the cases and Vitamin E was half the levels that of controls (P=<0.0001). The level of rise of serum lipids did not significantly correlate with the rise or fall in MDA. In PIH cases there was a negative correlation of diastolic BP with MDA (P<0.05). Early detection of these parameters is going to aid in better management of PIH cases.
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OBJECTIVE: The purposes of this study are to evaluate the obstetric outcome in pregnancies resulting from oocyte donation and to assess the factors related to the obstetric complications. METHODS: The obstetric outcome in pregnancies from the oocyte donation (n=37) was compared with that in pregnancies from conventional IVF program (n=137) in our IVF center between January 1995 and December 2000. Control group was selected by age, parity, and order of gestation matched to the study group. Pregnancy induced hypertension (PIH) was defined as blood pressure >140/90 mmHg on two or more occasions at least 6 hours apart with or without proteinuria after 20 weeks of gestation and not associated with chronic hypertension. Small for gestational age (SGA) was defined as birth weight below tenth percentile for gestational weeks. The data was analyzed using the Statistical Package for Social Sciences (SPSS). RESULTS: Early pregnancy loss rates were 37.8% (14/37) and 23.4% (32/137) in study and control group, respectively (P>0.05). PIH related factors such as mean age, parity and order of gestation were not significantly different among the two groups. However, the incidence of PIH in oocyte donation group (30.0%, 6/20) was significantly higher than control group (8.8%,9/102). There was no significant difference in the incidence of SGA between the two groups. When oocyte donation group was stratified by relationship of oocyte donor to infertile patient (sibling versus non-sibling), the incidence of early pregnancy loss and PIH was significantly higher (chi square test, P<0.05) in non-sibling group (42.3%, 11/26; 38.5%, 5/13) than in control group (23.4%, 32/137; 8.8%, 9/102). CONCLUSION: The incidence of PIH was significantly higher in pregnancies after oocyte donation. Notably, the pregnancies from non-sibling oocyte donors had much higher incidence of early pregnancy loss and PIH than pregnancies from sibling oocyte donors or control group. Therefore, the occurrence of early pregnancy loss and PIH may be related to other factors than age, parity or multiple pregnancy.
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Female , Humans , Pregnancy , Birth Weight , Blood Pressure , Gestational Age , Hypertension , Hypertension, Pregnancy-Induced , Incidence , Oocyte Donation , Oocytes , Parity , Pregnancy, Multiple , Primary Ovarian Insufficiency , Proteinuria , Siblings , Social Sciences , Tissue DonorsABSTRACT
OBJECTIVE: The purposes of this study was to evaluate the frequency of Leiden mutation (missense mutation in the factor V gene at exon 10, 1691 CGA to CAA) in Korean women with well characterized pregnancy-induced hypertension (PIH) compared with normotensive gravid women. METHODS: Genomic DNA from 121 PIH cases and 98 normotensive pregnant control cases were used for polymerase chain reaction (PCR). To genotype Leiden mutation (missense mutation in the factor V gene, exon 10 (1691 G to A)), primers (5'-TGC CCA GTG CTT AAC AAG ACC A-3', 5'-TGT TAT CAC ACT GGT GCT AA-3') were employed to make 267 base pair (bp) PCR product. There was an initial denaturation at 94 degrees C 5 min, followed by 30 cycles of one minute at 94 degrees C, one minute at 55 degrees C, and one minute at 72 degrees C. A 267 bp PCR product was further digested with Mnl I for 2 hour at 37 degrees C and analysed through 12% polyacrylamide gel electrophoresis to determine genotype. Allele 1691G yielded 37 bp, 67 bp, 163 bp fragment and allele 1691A yielded 67 bp, 200 bp fragment. RESULTS: We examined the genotypes of factor V of 121 Korean women with pregnant induced hypertension and 98 normal pregnant women. None of the 219 Korean women carried the factor V Leiden mutation. CONCLUSION: The factor V Leiden mutation is absent and not a common cause of PIH in Korean women.
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Female , Humans , Pregnancy , Alleles , Base Pairing , DNA , Electrophoresis, Polyacrylamide Gel , Exons , Factor V , Genotype , Hypertension , Hypertension, Pregnancy-Induced , Polymerase Chain Reaction , Pregnant WomenABSTRACT
PURPOSE: This study was undertaken to review the clinical and hematologic findings of the preterm infants delivered from pregnancy induced hypertension(PIH) mothers. METHODS: The data were collected by reviewing the medical records on the current prognosis of preterm birth and sending questionnaires on the status of NICU. We reviewed the medical records from two university hospitals and two resident training hospitals in Gwangju-Chonnam to evaluate the neonatal prognosis of preterm birth from Jan. 1, 1995 to Dec. 31, 1997. RESULTS: The average survival rate of total preterm babies was 79.6%. According to birth weights, survival rate from less than 1,000 gm was 10%, 1,000-1,499 gm was 55.3%, 1,500-1,999 gm was 82.2%. Maternal risk factors were pretmature rupture of membrane(42.2%), preterm labor (21.3%), PIH(10.7%), multiple pregnancy(8.2%) and incompetent internal os of cervix(4.2%). The average gestational age and birth weight were 34.2+/-2.3 weeks and 1,940+/-620 gm in the preterm infants born to mothers with PIH. The death rate was 12.9% in the preterm infants born to mothers with PIH. There were no significant differences in the incidence of RDS, use of assisted ventilation and surfactant, and frequency of the blood transfusion between the preterm infants born to normotensive mothers and those to mothers with PIH. There were significant differences in the total WBC count, platelet count and the concentration of the Mg, Ca and P between the preterm infants born to normotensive mothers and those to mothers with PIH. CONCLUSION: Our results may be helpful to predict the perinatal complications and manage the preterm infants by considering the clinical and hematologic findings of preterm infants born to mothers with PIH.
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Female , Humans , Infant, Newborn , Pregnancy , Birth Weight , Blood Transfusion , Gestational Age , Hospitals, University , Hypertension, Pregnancy-Induced , Incidence , Infant, Premature , Medical Records , Mortality , Mothers , Obstetric Labor, Premature , Platelet Count , Premature Birth , Prognosis , Surveys and Questionnaires , Risk Factors , Rupture , Survival Rate , VentilationABSTRACT
BACKGROUND/AIM: Recent studies have suggested an association between genetic background of renin-angiotensin(RA) system and the pathogenesis of pregnancy induced hypertension(PIH). Even though various single nucleotide polymorphism(SNP) such as M235T, T174M polymorphism in angiotensinogen gene(AGT) and I/D polymorphism in angiotensin I-converting enzyme gene(ACE) have been studied extensively among essential hypertension and PIH in various population, its association was still inconclusive. Previous studies within Korean PIH patients also revealed that M235T or T174M single nucleotide polymorphism in AGT gene or I/D polymorphism in ACE gene were not linked tightly with PIH. However, recent studies on angiotensin II type I receptor(AT1) polymorphism A1166C with PIH in Polish or in Chinese suggested its possible correlations to a pathogenesis of PIH. Thus the aim of the present study was to determine the frequency of genotypes of A1166C mu-tation in women with PIH and to establish the role of this polymorphism on the susceptibility to the PIH development. PATIENTS AND METHODS: We have analysed 121 women with PIH and 98 healthy normotensive gravid women as a control. Genomic DNA was used for PCR. To genotype the A1166C polymorphism in angiotensin II receptor(AT1) gene, primers(sense 5'-CGA CTA CTG CTT AGC ATA-3', antisense 5'-GCA CCA TGT TTT GAG GTT-3') were employed to make 546bp PCR product. There was an initial denaturation at 94degrees C 5 minutes, followed by 30 cycles of one minute at 94degrees C, one minute at 58degrees C, and two minutes at 7degrees C. A 546bp PCR product was further digested with DdeI for 2 hour at 37degrees C and analysed through 2% agarose gel electrophoresis to determine genotype. Allele C1166 yielded 435bp, 111bp fragment and allele A1166 yielded intact 546 bp fragment RESULTS: We found that frequency of genotype A1166/C1166 and A1166/A1166 in PIH were 9.9% (12) and 90.1%(109), while in controls were 17.3%(17) and 82.7%(81). There was no statistical significance between development of PIH and A1166C polymorphism in type I receptor for Angiotensin II. Homozygous mutated genotype(C1166/C1166) was not detected in this study. CONCLUSION: Our results found no possible correlation of A1166C polymorphism in angiotensin II receptor(AT1) with PIH in Korean and found that allele C might behave as a protective factor rather than as a risk factor in the pathogenesis of PIH. We suggest a large-scale study to evaluate relevance to this polymorphism for PIH.
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Female , Humans , Pregnancy , Alleles , Angiotensin II , Angiotensinogen , Angiotensins , Asian People , DNA , Electrophoresis, Agar Gel , Genotype , Hypertension , Peptidyl-Dipeptidase A , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length , Polymorphism, Single Nucleotide , Risk FactorsABSTRACT
To evaluate the predictive value of serum fibronectin and roll-over test for pregnancy induced hypertension (PIH), we studies 79 patients between the twenty-eighth and thirty-second week of gestation from October 1995 to May 1996. The results were as follows . 1) There was no significant difference of mean diastolic pressure difference in roll-over test and serum fibronectin levels between 13 PIH patients and 66 controls. Between two groups of patients, mean diastolic blood pressure differences were 14.3+/-3.9mmHg, 12.0+/-4.4mmHg and mean serum fibronectin levels were 231.2+/-90.8 pg/ml, 196.5+/-61.2 pg/ml respectively(p> 0.1). 2) For prediction of PIH, the sensitivity, the positive predictive value and the negative predictive value of roll-over test were 8%, 14% and 83%.
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Female , Humans , Pregnancy , Pregnancy , Blood Pressure , Fibronectins , Hypertension, Pregnancy-InducedABSTRACT
0.05).It is suggested that because of higher immu-nologic function in young adults, the delivery age should not be too late so as to enhance the immunologic function of newborn infants.