Effect of Vitamin A and D in Hypertensive Disorder of Pregnancy

Background: Severe preeclampsia is the main cause of maternal mortality. The correlation between vitamin D and hypertensive disorder of pregnancy is a controversial topic at present. Whether vitamin D can be used as an index to predict the risk of preeclampsia and when to supplement vitamin D in clinic has become a relatively popular research content. This study aimed to correlate vitamin A and D with hypertensive disorder of pregnancy and to reduce the risk of hypertension in pregnancy. Methods: This is a Prospective cohort study on 958 pregnant females. The patients were divided into two groups, namely, treatment group and Pregnancy Induced Hypertension (PIH) group. Liquid chromatography-tandem mass spectrometry and highperformance quid gel electrophoresis were used to find vitamin A and D in the blood of each group (HPLC). Results: There has not been a big difference in between PIH group and the placebo group (p>0.5). Preeclampsia collection and simple preeclampsia group there has been a statistical change in cesarean unit amount and impulsive transfer (p<0.05). The study further found that There is no rise in the likelihood of mild pregnancy complications, and the thing that is different would not be statistically important (p>0.05). Serum vitamin D level is less than 20 ng/ml, which is a risk factor for preeclampsia. Conclusion: The lack of vitamin A may be associated with the occurrence of hypertensive disorders during pregnancy and the progression of the disease. The lack of vitamin A may increase the risk of severe preeclampsia risk increased.

A Review on Correlation of Vitamin A and D in Hypertensive Disorder of Pregnancy: Current Concepts

Vitamin A is essential for the health of the mother as well as for the health and development of the fetus. Vitamin A deficiency has affected 19 million pregnant women with the highest burden found in the WHO regions of Africa and South-East Asia. Vitamin A is available in multiple vitamin formulations for prenatal care in some countries. When provided alone, the compounds most commonly used are retinyl palmitate and retinyl acetate in tablet form or oil-based solutions. Hypertension is common in pregnancy and causes high maternal mortality. This includes gestational hypertension, preeclampsia, severe preeclampsia, and pregnancy with chronic hypertension. Preeclampsia is a high-mortality disease among the common complication of hypertensive disorder of pregnancy. in particular, severe preeclampsia possess a serious threat to the safety of mothers and children, and there are great difficulties in the treatment of hypertensive disorders of pregnancy during clinical work. therefore, we are adequate in dealing with hypertensive disorders of pregnancy. Any adverse pregnancy outcomes associated with hypovitaminosis D should be accessed through the perspective of immune dysregulation both at the systemic and placental levels. It signifies the supplementation of vitamin D in pregnancy have a role in the improvement of maternal hypertensive complication and improve the fetal outcome.

Preeclampsia de presentación grave asociada a hígado graso agudo del embarazo / Severe preeclampsia associated with acute fatty liver of pregnancy / Pré-eclâmpsia grave associada a fígado gorduroso agudo da gravidez

La preeclampsia se puede asociar a una patología poco frecuente como es el hígado graso agudo del embarazo. Se reporta el caso clínico de una paciente de 35 años, tercigesta, cursando embarazo gemelar que presenta preeclampsia con elementos de gravedad, asociada a hígado graso agudo del embarazo. Se realiza diagnóstico y tratamiento precoz de ambas patologías, presentando buena evolución materno-fetal.

Preeclampsia can be associated with acute fatty liver of pregnancy, a rare disease. This report describes the case of a 35-year-old patient, gravida 3, pregnant with twins, who presented with severe pre-eclampsia associated with acute fatty liver of pregnancy. Early diagnosis and treatment of both pathologies was performed, resulting in good maternal-fetal evolution.

A pré-eclâmpsia pode estar associada a uma patologia rara, como o fígado gorduroso agudo da gravidez. Neste relato, apresentamos uma paciente de 35 anos, terciária, em gestação gemelar, apresentando pré-eclâmpsia grave, associada a esteatose hepática aguda na gestação. É realizado diagnóstico e tratamento precoces de ambas as patologias, apresentando boa evolução materno-fetal.

Valores de la gasometría arterial en pacientes embarazadas con preeclampsia severa / Arterial blood gas parameters in pregnant patients with severe preeclampsia

Resumen OBJETIVO: Determinar e interpretar los valores de la gasometría arterial en pacientes embarazadas con preeclampsia severa. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo y descriptivo llevado a cabo en pacientes con más o menos 20 semanas de embarazo y diagnóstico establecido de preeclampsia severa atendidas en la unidad de cuidados intensivos entre el 1 de julio y el 31 de diciembre del 2019. Los datos generales, la condición obstétrica, los estudios de laboratorio clínico y los valores de la gasometría arterial se documentaron conforme a lo registrado en los expedientes clínicos. Se utilizó estadística descriptiva y los datos se procesaron en el programa SPSS versión 20. RESULTADOS: Se estudiaron 30 pacientes con media de edad de 31.6 ± 6.85 años, mediana de paridad 1, todas con feto único de 33.89 ± 3.43 semanas y residencia en la Ciudad de México. Los valores de la gasometría arterial fueron: pH 7.41 ± 0.08, presión parcial de dióxido de carbono 25.51 ± 6.12 mmHg, presión parcial de oxígeno 85.24 ± 41.81 mmHg, hematocrito 33.86 ± 7.51%, ión carbonato 16.95 ± 5.13 mmol/L, patrón de bicarbonato estandarizado 19.04 ± 2.50 mmol/L, gases de efecto invernadero 16.94 ± 2.51 mmHg, exceso de base del fluido extracelular -7.72 ± 5.60 mmol/L, BE (B) -7.36 ± 3.07 mmol/L, porcentaje de saturación de oxígeno 93 ± 8.29, hemoglobina total en la gasometría arterial 10.64 ± 2.36 g/dL, gradiente alvéolo-arterial de oxígeno 49.43 ± 10.98 mmHg, presión parcial de oxígeno 140.43 ± 106.93 mmHg, concentraciones de dióxido de carbono 0.79 ± 0.28 mmHg e Índice respiratorio 0.95 ± 2.57. CONCLUSIONES: Los resultados corresponden a un patrón gasométrico de acidosis metabólica compensada.

Abstract OBJECTIVE: To determine and interpret arterial blood gas values in pregnant patients with severe preeclampsia. MATERIALS AND METHODS: study carry out in a series of 30 patients with a pregnancy ≥ 20 weeks and an established diagnosis of SP admitted to the Intensive Care Unit from July 1 to December 31, 2019, in whom arterial blood gases are part of the routine studies upon admission to the ICU. Patients with recurrence of preeclampsia, eclampsia and HELLP syndrome or with metabolic, respiratory, cardiological and renal morbidities affecting arterial blood gas values were excluded. The general data, obstetric condition, clinical laboratory and arterial blood gas values were documented from the clinical records. Statistical analysis: descriptive statistics were used with the statistical package SPSS version 20. RESULTS: Thirty patients were studied, with a mean age of mean age 31.6 ± 6.85 years, median parity 1, all with a single product of 33.89±3.43 weeks and residence in Mexico City 31.37 ± 7 years. Arterial blood gas values were: pH 7.41 ± 0.08, PCO2 25.51 ± 6.12 mmHg, PO2 85.24 ± 41.81 mmHg, Hct 33.86 ± 7.51%, HCO3- 16.95 ± 5.13 mmol/L, HCO3- std 19.04 ± 2.50 mmol/L, TCO2 16.94 ± 2.51 mmHg, BE ecf -7.72 ± 5.60 mmol/L, BE (B) -7.36 ± 3.07 mmol/L, SO2c% 93 ± 8.29%, THbc 10.64 ± 2.36 g/dL, Aa DO2 49.43 ± 10.98 mmHg, pAO2 140.43 ± 106.93 mmHg, PaO2/PAO2 0.79 ± 0.28 mmHg and Respiratory Index 0.95 ± 2.57. CONCLUSIONS: The results correspond to a gasometric pattern of compensated metabolic acidosis.

Preeclampsia asociada a debut de lupus eritematoso sistémico y edema vulvar masivo gestacional / Severe preeclampsia associated with the onset of systemic lupus erythematosus and massive gestational vulvar edema / Pré-eclâmpsia grave associada a lúpus eritematoso sistêmico e edema vulvar gestacional maciço

El debut del lupus eritematoso sistémico (LES) durante el embarazo, intrincado con preeclampsia grave, asociado a edema vulvar masivo gestacional, es raro y de difícil diagnóstico. Se reporta una paciente de 19 años, con 35 semanas de gestación, que debutó con LES durante el tercer trimestre del embarazo, y que consulta por manifestaciones cutáneas, dadas por eritemas en pulpejos de dedos de manos. Se constata preeclampsia severa. Se realiza cesárea de urgencia, e ingresa a la unidad de cuidados intensivos. Instala edema de vulva masivo que incapacita la deambulación.

The onset of systemic lupus erythematosus during pregnancy, complicated with severe preeclampsia, associated with massive gestational vulvar edema, is rare and difficult to diagnose. A 19-year-old patient is reported, with 35 weeks of gestation, who started with systemic lupus erythematosus during her third trimester of pregnancy, and consulted due to cutaneous manifestations caused by erythema on the pads of the fingers. Severe preeclampsia was observed. An emergency cesarean section was performed, and the patient was admitted to the Intensive Care Unit. She developed a massive vulvar edema that disabled ambulation.

O aparecimento de lúpus eritematoso sistêmico durante a gravidez, intrincado com pré-eclâmpsia grave é raro e de difícil diagnóstico. É relatada uma paciente de 19 anos, com 35 semanas de gestação, que estreou com lúpus eritematoso sistêmico no terceiro trimestre de gestação, e que se consultou por manifestações cutâneas causadas por eritema nas pontas dos dedos das mãos. Também existe uma pré-eclâmpsia grave. E realizada cesárea de emergência e ela é internada na Unidade de Terapia Intensiva. Instala um edema vulvar maciço que impede a deambulação.

Association of Maternal C-Reactive Protein in Severe Pre-Eclampsia.

Endothelial cell dysfunction and inflammation are considered to have a role in the pathophysiology of pre-eclampsia(1).A generalized activation of circulating leukocytes (characteristic of inflammation) has been found during pre-eclampsia. Moreover, increased concentration of CRP and inflammatory markers has been reported in pre-eclampsia(2). We wanted to determine the serum CRP level in preeclampsia and assess the platelet dysfunction in pre-eclampsia and evaluate its association with severity of the disease. METHODSThe study was conducted at a tertiary care centre from November 2015 to August 2017. The study included a total of 200 singleton pregnant patients. After collecting basic demographic data and brief history, detailed clinical examination was carried out, routine investigations along with serum C - reactive protein were done. Results were recorded and maternal and foetal outcomes were noted. RESULTSAmong the 200 patients who were included in the study, it was found that majority of them were primigravidae. 88% of the patients showed increase in the C-reactive protein, which also correlated with the severity of the disease. Platelet count showed a decreasing trend with increasing severity of the disease and platelet distribution width showed an increasing trend with the increasing severity of the disease. CONCLUSIONSSerum C- reactive protein concentration increases in pre-eclampsia more than that compared to normal pregnancy. The serum C-reactive protein levels also helps in assessing the severity of the disease and its further prognosis. Further the abnormalities in platelet indices caused due to the disease process in pre-eclampsia is worsened due to thrombocytopenia. The morphological features of platelets as studied by Mean platelet volume and platelet distribution width are not consistent with the severity of the disease.

Comparative maternal outcomes of oral nifedipine and intravenous labetalol for severe hypertension during pregnancy: an open label randomized controlled trial

Background: Hypertensive diseases are commonly seen during pregnancy and remain one of the leading causes of maternal morbidity and mortality. Mostly commonly preferred drugs by health care providers for treatment of severe hypertension during pregnancy are labetalol and hydralazine. However, they require proper storage, intravenous access, and adequately trained staff for usage. Oral nifedipine in contrast is easier to use and widely available.  Objective of this study was to report the efficacy and safety of oral nifedipine as compared to intravenous labetalol for treatment of severe hypertension during pregnancy.Methods: It was an open label randomized controlled trial in which 100 women with severe hypertension during pregnancy were enrolled. They were randomized to receive either incremental doses of intravenous labetalol every 20 minutes (total 300 mg) or 10 mg oral nifedipine every 20 minutes (up to 50 mg) to lower the blood pressure to safer levels.Results: Women receiving oral nifedipine took significantly less time to achieve target blood pressure [(37.6±23.3) minutes (SD) as compared to those receiving intravenous labetalol (52.0 minutes±27.95 (SD)]. Women receiving nifedipine for treatment also required significantly lesser doses to control the blood pressure [mean dose 1.8±1.1 (SD) versus 2.6±1.2 (SD) p=0.006]. There were two failures in labetalol group and one failure in nifedipine group. No serious adverse events were reported in either group.Conclusions: Oral nifedipine is equally efficacious to I.V. labetalol for treatment of severe hypertension during pregnancy and is easier to use in low resource settings.

Comparison of oral nifedipine and oral labetalol as a single drug therapy for control of blood pressure in preeclampsia

Background: Worldwide hypertension during pregnancy is a common cause of maternal and fetal morbidity and mortality. Effective control of blood pressure is one of the important steps in management of preeclampsia. Few drugs like nifedipine, labetalol, methyldopa, and hydralazine have acceptable high safety profile during pregnancy.Methods: In this study 120 antenatal women with non-severe preeclampsia were compared by giving either nifedipine or labetalol as a single drug therapy for control of blood pressure. Various parameters like control of blood pressure, side effects of drugs, gestational age at the time of delivery, mode of delivery, any complication and perinatal outcome were assessed.Results: In this study authors found that in both group, adequate control of blood pressure was achieved. This study shows slightly higher rate of pre term delivery and LSCS with labetalol and minimal side effects with nifedipine but difference in each group is insignificant.Conclusions: Labetalol and nifedipine both the drugs are equally effective in reducing blood pressure and any of it can safely be used as a first choice of drug for management of hypertension in preeclampsia and it can be decided as per clinician’s experience and familiarity with drug.

Comparative study: normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester of pregnancy

Background: This prospective study compares the maternal and fetal outcome in normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester. This prospective study was conducted in the department of obstetrics and gynaecology, Government Theni Medical College, Tamil Nadu, India in 2019.Methods: A total 100 antenatal mothers were selected for the study. Group A - 50 known case of preeclampsia presented with imminent symptoms. Group B-50 previously normotensive patients present with imminent symptoms of eclampsia. Maternal and fetal outcome were analysed.Results: Incidence of eclampsia - 0.1%, HELLP syndrome - 0.04%, pulmonary edema - 0.06%, PRES - 0.07%, abruptio placenta - 0.14% and maternal death in Group A was 2% and in Group B was 8%. Maternal complications are more in normotensive women (46%) presented with imminent symptoms than in preeclampsia women (26%) with imminent symptoms. Incidence of IUGR in Group A was 46%, whereas in Group B 12%. Incidence of preterm babies in Group A was 18%, whereas in Group B was 42%. Perinatal death incidence was 2.2% in imminent eclampsia.Conclusions: Because known preeclampsia patients were aware of imminent symptoms and presented early to hospital. Early identification and treatment of this dreadful outcome at the imminent state itself can reduce the complications. In current status on preventive aspect of eclampsia, atypical presentation should also be considered for which new screening and diagnostic tools has to be developed.

Evaluation of Antihypertensive Efficacy of Intravenous Hydralazine and Intravenous Labetalol in the Management of Severe Preeclampsia and Eclampsia..

Hypertensive disorders of pregnancy are one of the most common obstetrical problems and affect 5-10% of all pregnancies. Severe preeclampsia is a multi-system disorder and causes many complications like intracranial haemorrhage, hypertensive encephalopathy, abruptio placentae, heart failure, pulmonary oedema and eclampsia. Intravenous hydralazine and labetalol are considered as first line antihypertensive agents for management of hypertensive crisis. The objective of this study was to compare efficacy of intravenous hydralazine and labetalol in lowering blood pressure in severe pregnancy induced hypertension, as well as to find out frequency of maternal adverse reactions and foetal impacts.METHODSThe study was conducted at Calcutta National Medical College and Hospital over a period of one year. 100 women with severe preeclampsia were included in the study and randomly divided into two groups of 50 each. One group received intravenous hydralazine while the other group was treated with intravenous labetalol. The time and number of doses taken to achieve target blood pressure were noted. Number of patients having persistent severe hypertension after receiving maximum drug dosage were also taken into account.RESULTSThe pre-treatment systolic blood pressure was 168.80 mmHg in hydralazine group and 173.64 mmHg in labetalol group whereas the diastolic blood pressure was 143.92 mmHg and 142.6 mmHg in hydralazine and labetalol group respectively. Mean time to achieve blood pressure control was 22.20 minutes in hydralazine group and 26.04 minutes in labetalol group. There were 3 cases of persistent severe hypertension in hydralazine group and 2 cases in labetalol group. No statistically significant difference was found between the two groups in terms of efficacy, maternal adverse effects and perinatal outcome. However, maternal tachycardia and headache was found to be significantly higher in patients treated with hydralazine.CONCLUSIONSThus, both hydralazine and labetalol are effective and safe antihypertensive drugs which can be used to treat pregnancy induced hypertensive crisis. No significant difference is found between these two agents.

Study of sociodemographic profile, maternal, fetal outcome in preeclamptic and eclamptic women: a prospective study

Background: Preeclampsia is pregnancy specific disease, lead to maternal, perinatal morbidity and mortality. This study is conducted to identify the socio demographic profile of subjects suffering from preeclampsia and its effect on maternal and fetal health.Methods: This prospective study was conducted at department of obstetrics and gynecology, Kamla Nehru State Hospital, Shimla, in this, 100 preeclamptic women were included. Preeclampsia was diagnosed with blood pressure of ≥140/90 mmHg noted for the first-time during pregnancy, after 20 wks of gestation and proteinuria. Demographic details were collected. Investigations i.e. hemogram, liver and renal function tests, coagulation profile and fundoscopy were done. Maternal and perinatal outcomes were recorded.Results: In this study, majority of the subjects were primigravida 65. In this, 11 subjects had systolic blood pressure of 140-159 mmHg and 89 subjects had systolic blood pressure of > 160 mmHg. 25 subjects had diastolic blood pressure of 90-109 mmHg and 75 subjects had diastolic blood pressure of > 110 mmHg. In this, 82 subjects had warning symptoms, mainly headache 49. 14 subjects showed hypertensive changes in fundus. Unfavorable Bishop Score, observed in 86 subjects and 78 subjects were induced after controlling blood pressure. Majority of subjects had vaginal delivery 73. Majority of the subjects had deranged liver function 61. Maternal morbidity was reported in 54 subjects. Intrauterine death reported in 14 subjects. Birth weight was < 2.5 kg was observed in 70 babies. Out of 74 live births, 53 neonates required admission in NICU and 16 neonates died in NICU.Conclusions: It may be concluded that, maternal and neonatal morbidity and mortality can be reduced by early identification of risk factors and timely intervention is the hall mark in preventing the maternal and perinatal morbidity and mortality.

Combinación del ácido úrico y albúmina sérica como biomarcadores predictivos de preeclampsia severa / Combination of uric acid and serum albumin as predictive biomarkers of severe preeclampsia

Resumen: OBJETIVO: Establecer si la la combinación de las concentraciones séricas de ácido úrico y albúmina en las semanas 20 a 24 del embarazo es predictora de preeclampsia severa. MATERIALES Y MÉTODOS: Estudio de casos y controles, retrospectivo y observacional, en el que se analizaron las concentraciones de ácido úrico y de albúmina coexistentes en las semanas 20 a 24; posteriormente se compararon las diferencias con pacientes con preeclampsia severa. Se recabaron los datos en Microsoft Excel para Mac versión 2019 y el análisis estadístico se realizó en SPSS para Mac versión 25. RESULTADOS: Se obtuvieron 122 casos y 199 controles. La elevación de las concentraciones de ácido úrico (≥ 4.9 mg/dL) y la hipoalbuminemia (menos de 3.5 mg/dL) tuvieron significación estadística para preeclampsia severa versus el grupo control (p < 0.001). El modelo de regresión logística obtuvo una razón de momios para predecir preeclampsia con datos de severidad de 6.736 (IC95%: 2.5-17.7) para la elevación del ácido úrico y razón de momios de 11.337 (IC95%: 4.5-28.3) para la hipoalbuminemia (p < 0.001). CONCLUSIÓN: El aumento en las concentraciones de ácido úrico (medidas entre las semanas 20 a 24 de embarazo) en combinación con la albúmina sérica tiene utilidad predictora de preeclampsia severa. Sin embargo, deben efectuarse más estudios clínicos para comprobar su eficacia y poder reducir la prevalencia de esta enfermedad.

Abstract: OBJECTIVE: To determine if the combination of serum uric acid and albumin levels from weeks 20 to 24 of gestation are predictors of severe preeclampsia. MATERIALS AND METHODS: A retrospective and observational case-control study was carried out, in which the levels of uric acid and albumin taken during the 20th to 24th week were analyzed and compared with patients who developed severe preeclampsia. The data was collected in Microsoft Excel for Mac version 2019 and the statistical analysis was performed in SPSS for Mac version 25. RESULTS: 122 cases and 199 controls were obtained. Elevation of uric acid levels (≥4.9 mg/dL) and hypoalbuminemia (<3.5 mg/dL) obtained statistical significance for severe preeclampsia compared to the control group (p <0.001). The logistic regression model obtained an OR to predict severe preeclampsia of 6.736 (CI95% 2.5-17.7) for uric acid elevation and OR of 11.337 (CI95% 4.5-28.3) for hypoalbuminemia (p <0.001). CONCLUSION: In this study the statistically significant relationship was observed between the increase in uric acid levels and serum hypoalbuminemia from weeks 20 to 24 as predictive biomarkers of severe preeclampsia. However, more studies should be carried out to verify its clinical utility.

Prospective analytical study on acute pulmonary edema in obstetric intensive care unit

Background: Acute pulmonary oedema is an uncommon,but life threatening event in pregnancy. It causes significant morbidity and mortality due to pathophysiology of pre‐eclampsia and physiological changes of pregnancy which may aggravate certain pre-existing heart disease.Methods: This study was conducted to describe the clinical and epidemiological profile of antenatal women with acute pulmonary edema in obstetric ICU from January 2017 to December 2018 (2 years) in Mahathma Gandhi Memorial Government Hospital, Trichy, Tamil Nadu, India.Results: Acute pulmonary edema (n=31) accounts for 2.7% of ICU/HDU admissions in the study period. Most common etiology observed was severe preeclampsia (12 cases) followed by cardiogenic pulmonary edema (11 cases). Fluid overload, sepsis accounted for 7 cases and one mother with preexisting RHD had severe pre-eclampsia with acute pulmonary edema.Conclusions: Hypertensive disorders of pregnancy and heart disease contributes to major proportion of acute pulmonary edema in this study and it is imperative to recognize signs of critical illness. Skilled multidisciplinary teamwork plays an important role in optimizing maternal and fetal health.

Comparative study of labetalol and nifedipine in management of non- severe preeclampsia and its fetomaternal outcome

Background: In developed countries, 16 percent of maternal deaths were attributed to hypertensive disorders. Of hypertensive disorders, the preeclampsia syndrome, either alone or superimposed on chronic hypertension, is the most dangerous. The incidence of preeclampsia in nulliparous populations ranged from 3 to 10 percent.Methods: The present study was conducted at Government Raja Mirasudhar Hospital, Thanjavur Medical College, Thanjavur, Tamil Nadu, India from October 2017 to October 2018. The study consisted of 100 antenatal women with non-severe preeclampsia. The efficacy of labetalol verses nifedipine in its management was studied along with the fetomaternal outcome.Results: In this study, in the labetalol and in the nifedipine groups adequate control of blood pressure was achieved. However, labetalol was well tolerated by our women without much side effects.Conclusions: The present study indicates both labetalol and nifedipine are equally efficacious in the control of hypertension in non-severe preeclampsia. Pathology of the disease was not altered significantly in both the groups. There was no significant difference in the neonatal outcome between the two groups.

Hydralazine versus Labetalol for acute control of blood pressure in patients with severe pre-eclampsia: a randomized controlled trial

Background: Authors sought to compare the effectively of intravenous hydralazine and intravenous labetalol in controlling acute rise in blood pressure in patients with severe preeclampsia.Methods: In this double-blind randomized controlled trial, all pregnant women with sustained increase in blood pressure (BP) of 160 mmHg systolic or 110 mmHg diastolic or higher were randomized to receive intravenous (IV) hydralazine 5 mg (max. 4 doses) or IV labetalol in escalating doses of 20mg, 40mg, 80mg, 80mg to achieve target blood pressure of 150 mmHg systolic and 100 mmHg diastolic or lower. The primary objective of the study was to assess the time taken to control blood pressure. Secondary agendas were the number of repeat doses required and other side effect profile.Results: In the study duration of September 2015 to September 2017, authors enrolled 60 participants for our trial. The median time taken to achieve the target blood pressure was 22.4 minutes in both the groups. Close to half of the participants did not require repeat doses (46.66% with labetalol and 50% with hydralazine). No serious maternal or foetal side effects were noted during the study. Statistical tests were performed using SPSS for Windows version 22.Conclusions: As operated in the study, the efficacy of hydralazine and labetalol to control the acute rise in blood pressure is similar.

Abruptio placenta retrospective study: maternal and fetal outcome

Background: Placental abruption is the most common cause of antepartum haemorrhage. Incidence appears to be increasing due to increase in prevalence of risk factors like age, parity, anaemia, poor nutrition, Preeclampsia, PROM, previous MTP. Abruption may be partial or total. Pain and Vaginal bleeding hallmark of abruption.Methods: Retrospective observational study carried out during period of October 2017 to October 2018 at Govt Theni medical college- tertiary care institute. To investigate incidence, cause, maternal and perinatal outcome. Maternal Data includes incidence, age, parity, gestational age, risk factors, intra-operative events, amount of blood loss. Other causes of APH-Placenta praevia and extra-placental causes are excluded. Neonatal data includes Term/preterm, Birth weight, NICU admission, perinatal morbidity and mortality.Results: Total number of deliveries from October 2017 to September 2018 were 7010. Total number of abruptio placenta cases were 55. This study shows increased incidence of severe preeclampsia with abruption. Increasing age as predisposing factor. Mean age of abruption was 26-30 years mainly seen in term pregnancy. Mode of delivery varied. Major complication were PPH and shock managed with blood products.Conclusions: This study reveals increasing age, parity, severe preeclampsia are risk factors. Routine and regular antenatal checkup early detection and correction of Preeclampsia, anemia helps to deduce no of abruption and improving maternal and fetal outcome though maternal morbidity is reduced with modern management of abruption, Timely diagnosis and intervention is necessary. Team efforts by obstetricians, anesthetist and neonatologist is required for better maternal and fetal outcome.

Effect of transdermal nitroglycerin patch on severe preeclamptic women with abnormal Doppler indices

Background: The aim is to evaluate the effect of maternal transdermal nitro-glycerine patch administration on blood flow resistance on maternal uterine artery, fetal umbilical and middle cerebral arteries in patients with severe pre-eclampsia in early gestational age (24 weeks to 33 weeks) associated with abnormal Doppler indices (placental insufficiency) and also its effect on maternal mean arterial blood pressure.Methods: This is a prospective interventional clinical trial conducted on (50) pregnant women with singleton pregnancy diagnosed with severe pre-eclampsia admitted in high-risk pregnancy unit at the Department of Obstetrics  in Tanta University Hospitals, A 50-mg transdermal GTN patch (Novartis Pharma) was applied to the abdominal skin, releasing nitroglycerin at a rate of 0.4 mg/h. Doppler ultrasonography and measurement of maternal blood pressure were performed before application of transdermal GTN patch, after 4 hours of application, after 24 hours and after 48 hours.Results: the application of a 50-mg transdermal GTN patch to the maternal abdomen was associated with a significant decline in the PI of the uteroplacental and fetoplacental blood flow. No change was observed in the PI of the cerebral circulation. And also, there was a significant decrease in maternal blood pressure (MAP).Conclusions: Nitroderm patch (nitric oxide donors) may be used as initial therapy in cases of severe preeclampsia complicated by placental insufficiency in the form of abnormal Doppler indices.

Expression and significance of TNF?α and M?CSF in placenta tissue of early severe preeclampsia / 中国综合临床

Objective To investigate the expression and clinical significance of macrophage colony stimulating factor ( M?CSF ) and tumor necrosis factor α ( TNF?α ) in placenta of early onset severe preeclampsia (PE)??Methods Immunohistochemical SP method was used to detect the expression of M?CSF and TNF?α in 77 cases paraffin specimens from Department of Pathology,First Affiliated Hospital of Henan University of Science and Technology from September 2015 to September 2017,including 35 cases of early?onset severe PE,42 cases of late?onset severe PE and 30 cases of normal pregnant women??Results (1)The positive expression rates of M?CSF in control group,late?onset severe PE group and early?onset severe PE group were 30%(9／30),61??90%(26／42),82??86%(29／35),respectively??The difference was statistically significant ( χ2 ＝ 18??90, P＜0??05)??The positive expression rates of early?onset severe PE group were significantly higher than those in control group (χ2＝18??59,P＜0??05),and the difference was statistically significant????The positive expression of early?onset severe PE group was higher than that of late?onset severe PE group,and the difference was statistically significant (χ2＝4??017,P＜0??05)??(2) The positive expression rates of TNF?α in control group,late?onset severe PE group and early?onset severe PE group were 33??33%(10／30),69??05%(29／42),91??43%(32／35),respectively??The difference was statistically significant (χ2＝30??21,P＜0??05)??The positive expression of TNF?α in early?onset severe PE group was significantly higher than that in control group (χ2＝21??37,P＜0??05),and the difference was statistically significant??The positive expression of M?CSF and TNF?a in early?onset severe PE group was higher than that in late?onset severe PE group,and the difference was statistically significant (χ2＝4??529,P＜0??05); (3) The expression of M?CSF and TNF?α was positively correlated in PE (r＝0??441,P＝0??000)??Conclusion Placental damage is higher in early?onset severe PE,and is related to the severity of the disease??The levels of M?CSF and TNF?alpha in placenta of PE patients may play a synergistic role in the occurrence and development of PE??

Expression of Lin28B in the placenta of severe preeclampsia and its clinical significance / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the expression and clinical significance of Lin28 B in placenta of severe preeclampsia(SPE).METHODS: Forty SPE patients were admitted to Shengjing Hospital of China Medical University from August 2017 to August 2018,including 20 patients with early-onset severe preeclampsia(ESPE)and 20 patients with late onset severe preeclampsia(LSPE).Another 40 healthy pregnant women who had termination of pregnancy in late pregnancy due to various reasons were selected as the control group,including 20 cases in early-onset control group(N1) and 20 cases in late-onset control group(N2). RT-qPCR analysis,Western Blot analysis and immunohistochemistry were used to detect the Lin28 B expression levels in placenta of each group.RESULTS: The expression of Lin28 B in placenta was significantly lower in ESPE group than in N1 group(P0.05).The expression of Lin28 B in placenta of ESPE group was lower than that in LSPE group(P<0.05).CONCLUSION: The expression of Lin28 B in placenta of SPE patients is decreased,and the ESPE group was significantly lower than that in LSPE group,suggesting that Lin28 B may be associated with the pathogenesis and development of SPE.

Furosemida en el control de la hipertensión arterial posparto en preeclámpticas severas / Furosemide in the control of postpartum hypertension in severe preeclamptic women

RESUMEN OBJETIVO: Establecer la utilidad de la furosemida en el control de la hipertensión arterial posparto en preeclámpticas severa. MÉTODOS: Se realizó un estudio de casos y controles en el Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Se incluyeron pacientes con preeclampsia severa, las cuales durante el posparto fueron asignadas al azar para ser tratadas con furosemida, alfametildopa y cloruro de potasio oral (grupo A) o alfa-metildopa oral (grupo B) por 48 horas. Los parámetros evaluados fueron: variaciones en los valores de presión arterial y frecuencia cardiaca, persistencia de hipertensión, parámetros de laboratorio y efectos adversos. RESULTADOS: Para el análisis final estaban disponibles los datos de 198 pacientes en el grupo A y 197 pacientes en el grupo B en cada uno de los grupos. Luego de 48 horas de tratamiento se observaron disminuciones estadísticamente significativas en los valores de presión arterial sistólica y diastólica entre las pacientes tratadas con furosemida y las pacientes del grupo control (p < 0,0001). Se observó persistencia de la hipertensión en 52 pacientes (26,3 %) del grupo A y en 134 pacientes (68,0 %) del grupo B (p < 0,0001). No se encontraron diferencias entre los grupos en la frecuencia cardiaca, valores de laboratorio y efectos adversos (p = ns). CONCLUSIÓN: La furosemida produce disminuciones significativas en los valores promedios de presión arterial sistólica y diastólica, al igual que en la frecuencia de persistencia de hipertensión postparto en preeclámpticas severas.

ABSTRACT OBJECTIVE: To establish the utility of furosemide in the control of postpartum blood pressure in severe preeclamptic patients. METHODS: A case-control study was conducted at the Central Hospital "Dr. Urquinaona", Maracaibo, Venezuela. Patients diagnosed with severe preeclampsia were included, who during the postpartum period were randomized to be treated with furosemide, alpha-methyldopa and oral potassium chloride (group A) or oral alpha-methyldopa (group B) for 48 hours. The parameters evaluated were: variations in blood pressure and heart rate values, the persistence of hypertension, laboratory parameters and adverse effects related to treatment. RESULTS: Data of 198 patients in group A and 197 patients in group B in each of the groups were available for the final analysis. After 48 hours of treatment, statistical significant decreases were observed in the values of systolic and diastolic blood pressure between patients treated with furosemide and patients in the control group (p <0.0001). Persistence of hypertension was observed in 52 patients (26.3 %) of group A and in 134 patients (68.0 %) of group B (p < 0.0001). No differences were found between the groups in heart rate, laboratory values and adverse effects (p = ns). CONCLUSION: Furosemide produces significant decreases in the mean values of systolic and diastolic blood pressure, as well as in the frequency of persistence of postpartum hypertension in severe preeclamptic patients.