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.

Actualización sobre las principales guías clínicas de manejo en trastornos hipertensivos del embarazo

Introducción: Los trastornos hipertensivos del embarazo, en especial la preeclampsia, son un problema de salud pública local e internacional, debido al incremento de los factores de riesgo en mujeres de edad fértil. Objetivo: Evaluar la relevancia de los trastornos hipertensivos y su estudio por los profesionales obstetras y médicos de primer nivel de atención en el Ecuador. Método: Se realizó revisión de artículos científicos actualizados en diferentes bases de datos donde se abordaron las generalidades de su clasificación, fisiopatología, predicción de preeclampsia, prevención de los trastornos hipertensivos, tratamientos de estos trastornos, tratamiento de la crisis o emergencia hipertensiva, eclampsia, manejo expectante de la preeclampsia severa. Resultados: Según se plantea, la hipertensión y la preeclampsia pueden surgir por primera vez posparto, y la hipertensión posparto representa hasta el 25 % de todos los trastornos hipertensivos. La hipertensión severa se asocia con una morbilidad y mortalidad materna significativa, incluido un mayor riesgo de enfermedades cerebrovasculares. Por lo tanto, se recomienda terapia antihipertensiva urgente para reducir la presión arterial. Consideraciones finales: Es de suma importancia realizar tamizaje de riesgo a todas las pacientes embarazadas, junto con una evaluación cardiovascular detallada para detectar la presencia de factores de riesgo o condiciones cardiometabólicas que favorezcan la aparición de las enfermedades hipertensivas durante el embarazo.

Introduction: Hypertensive disorders of pregnancy, especially preeclampsia, are a local and international public health problem, due to the increase in risk factors in women of childbearing age. Objective: To evaluate the relevance of hypertensive disorders and their study by obstetricians and first-level medical professionals in Ecuador. Method: A review of updated scientific articles was carried out in different databases where the generalities of their classification, pathophysiology, prediction of preeclampsia, prevention of hypertensive disorders, treatments of these disorders, treatment of hypertensive crisis or emergency, eclampsia, were addressed and expectant management of severe preeclampsia. Results: It is hypothesized that hypertension and preeclampsia may first arise postpartum, and postpartum hypertension accounts for up to 25% of all hypertensive disorders. Severe hypertension is associated with significant maternal morbidity and mortality, including an increased risk of cerebrovascular diseases. Therefore, urgent antihypertensive therapy is recommended to reduce blood pressure. Final considerations: It is extremely important to perform risk screening on all pregnant patients, along with a detailed cardiovascular evaluation to detect the presence of risk factors or cardiometabolic conditions that favor the appearance of hypertensive diseases during pregnancy.

Introdução: As doenças hipertensivas da gravidez, especialmente a pré-eclâmpsia, constituem um problema de saúde pública local e internacional, devido ao aumento de fatores de risco em mulheres em idade fértil. Objetivo: Avaliar a relevância dos distúrbios hipertensivos e seu estudo por obstetras e profissionais médicos de primeiro nível no Equador. Método: Foi realizada uma revisão de artigos científicos atualizados em diferentes bases de dados onde foram abordadas as generalidades de sua classificação, fisiopatologia, predição de pré-eclâmpsia, prevenção de distúrbios hipertensivos, tratamentos desses distúrbios, tratamento de crise ou emergência hipertensiva, eclâmpsia. manejo da pré-eclâmpsia grave. Resultados: Supõe-se que a hipertensão e a pré-eclâmpsia possam surgir inicialmente no pós-parto, e a hipertensão pós-parto é responsável por até 25% de todos os distúrbios hipertensivos. A hipertensão grave está associada a morbidade e mortalidade materna significativa, incluindo um risco aumentado de doenças cerebrovasculares. Portanto, recomenda-se terapia anti-hipertensiva urgente para reduzir a pressão arterial. Considerações finais: É de extrema importância a realização de triagem de risco em todas as gestantes, juntamente com uma avaliação cardiovascular detalhada para detectar a presença de fatores de risco ou condições cardiometabólicas que favoreçam o aparecimento de doenças hipertensivas durante a gravidez.

Maternal and perinatal outcomes of pregnancies complicated by chronic hypertension followed at a referral hospital / Resultados maternos e perinatais de gestantes hipertensas crônicas acompanhadas em pré-natal especializado

Abstract Objective To assess maternal and perinatal outcomes of pregnancies in women with chronic hypertension (CH). Methods Retrospective cohort of women with CH followed at a referral center for a 5 year period (2012-2017). Data were obtained from medical charts review and described as means and frequencies, and a Poisson regression was performed to identify factors independently associated to the occurrence of superimposed preeclampsia (sPE). Results A total of 385 women were included in the present study; the majority were > than 30 years old, multiparous, mostly white and obese before pregnancy. One third had pre-eclampsia (PE) in a previous pregnancy and 17% of them had organ damage associated with hypertension, mainly kidney dysfunction. A total of 85% of the patients used aspirin and calcium carbonate for pre-eclampsia prophylaxis and our frequency of sPE was 40%, with an early onset (32.98 ± 6.14 weeks). Of those, 40% had severe features of PE, including 5 cases of HELLP syndrome; however, no cases of eclampsia or maternal death were reported. C-section incidence was high, gestational age at birth was 36 weeks, and nearly a third (115 cases) of newborns had complications at birth One third of the women remained using antihypertensive drugs after pregnancy. Conclusion Chronic hypertension is related with the high occurrence of PE, C-sections, prematurity and neonatal complications. Close surveillance and multidisciplinary care are important for early diagnosis of complications.

Resumo Objetivo Avaliar os resultados maternos e perinatais em gestação de mulheres com hipertensão crônica. Métodos Coorte retrospectiva de mulheres hipertensas crônicas acompanhadas em hospital de referência por 5 anos (2012-2017). Foi realizada revisão dos prontuários médicos e os resultados são descritos em médias e frequências. A regressão de Poisson foi usada para identificar os fatores independentemente associados à ocorrência de pré-eclâmpsia superajuntada. Resultados Um total de 385 mulheres foram incluídas no presente estudo, e amaioria tinha idade > 35 anos, era multípara, majoritariamente brancas e obesas antes da gravidez. Um terço teve pré-eclâmpsia em gestação anterior, e 17% apresentavam lesão de órgão-alvo associada à hipertensão, majoritariamente disfunção renal. Um total de 85% das pacientes usaram ácido acetilsalicílico e carbonato de cálcio para a profilaxia de pré-eclâmpsia, sendo que a frequência de pré-eclâmpsia superajuntada foi de 40%, com um início prematuro (32.98 ± 6.14 semanas). Destas, 40% apresentaram sinais de gravidade associados à pré-eclâmpsia, com 5 casos de síndrome HELLP; entretanto sem nenhum caso de eclampsia ou morte materna. A incidência de cesárea foi alta, comidade gestacional de 36 semanas ao parto, e umterço dos recém-nascidos tiveram complicações ao nascimento. Um terço das mulheres permaneceu usando medicamentos anti-hipertensivos ao fim da gravidez. Conclusão A hipertensão crônica se relaciona comalta prevalência de pré-eclâmpsia, cesárea, prematuridade e complicações neonatais. Vigilância e cuidado multidisciplinar são importantes para o diagnóstico precoce das complicações.

Desenlaces materno-fetales de los embarazos con trastornos hipertensivos: un estudio transversal / Maternal and fetal outcomes of pregnancies with hypertensive disorders: a cross-sectional study

INTRODUCCIÓN Y OBJETIVO: Los trastornos hipertensivos asociados al embarazo son considerados un problema de salud pública. Se busca describir las características clínicas y desenlaces materno-fetales de las pacientes con esta patología, atendidas en el Hospital Universitario de Santander (HUS) durante el primer semestre de 2017. MÉTODOS: Estudio observacional retrospectivo de corte transversal. Se incluyeron las pacientes en estado de embarazo o puerperio con diagnóstico o sospecha de trastorno hipertensivo; se excluyeron aquellas que no pudieron ser clasificadas o no correspondían a éstos. RESULTADOS: Se analizaron 181 historias clínicas; la edad de las pacientes osciló entre 14 y 44 años; el 43,7% eran primigestantes; el 40,3% tuvo un control prenatal inadecuado y el 27,5% tenía antecedente de trastorno hipertensivo en gestaciones previas. El 75,1% de las pacientes fueron clasificadas como preeclampsia, 18,2% con hipertensión gestacional, 4,4% con hipertensión más preeclampsia sobreagregada y 2,2% con hipertensión crónica. El 16,9% de las pacientes con preeclampsia debutaron antes de la semana 34, de las cuales el 91,3% tenían criterios de severidad; mientras que entre las demás, el 84% presentaron criterios de severidad. CONCLUSIONES: La preeclampsia fue el trastorno hipertensivo más frecuente, predominó la presentación tardía y severa con importantes tasas de complicación maternas y fetales. Mediante la implementación de estrategias de detección temprana y adecuada atención de los trastornos hipertensivos asociados al embarazo podrían mejorarse los desenlaces materno-fetales.

BACKGROUND AND OBJECTIVE: Hypertensive disorders of pregnancy are considered a public health issue. The aim is to describe the clinical features, maternal - fetal outcomes of patients with this disease, who were admitted at the University Hospital of Santander (Bucaramanga, Colombia) during the first half of 2017. METHOD: Cross-sectional retrospective observational study. Patients in pregnancy or puerperium with diagnosis of hypertensive disorder were included; those who could not be classified or did not correspond were excluded. RESULTS: 181 clinical charts were analyzed, the age of the patients ranged between 14 and 44 years, 43.7% were nulliparous, 40.3% had an inadequate prenatal control and 27.5% had history of hypertensive disorder in previous pregnancies. 75.1% were classified as preeclampsia, 18.2% as gestational hypertension, 4.4% as hypertension and superimposed preeclampsia and 2.2% with chronic hypertension; 16.9% of the patients were of an early-onset preeclampsia before week 34, of which 91.3% had criteria of severity; among the others, 84% presented criteria of severity. CONCLUSION: Preeclampsia was the most frequent hypertensive disorder, late and severe presentation prevailed with important maternal and fetal complication rates. Through the implementation of early detection strategies and adequate care of hypertensive disorders associated with pregnancy maternal and fetal outcomes could be improved.

Management of cervical heterotopic pregnancy with inevitable miscarriage

The objective is to report a case of successful treatment of heterotopic cervical pregnancy resulting from IVF–ICSI conception. Case report from Amrita Institute of Medical sciences: a tertiary care referral hospital. A 47-year-old Primigravida, diagnosed with heterotopic cervical pregnancy at 6 weeks of gestation, presented with significant first trimester vaginal bleeding. Under IV sedation, Transvaginal ligation of descending cervical branches of the uterine arteries arrested the bleeding. The cervical pregnancy was successfully aborted with minimal bleeding and the intrauterine pregnancy was successfully maintained till 32 weeks, after which she required emergency preterm LSCS in view of Severe preeclampsia superimposed on chronic hypertension a non-reassuring non-stress test (NST). The intervention applied maybe used in treatment of heterotopic cervical pregnancy in a low resource setting to control the bleeding.

Hemorragia Talámica Bilateral / Bilateral Thalamic Hemorrhage

Resumen Las hemorragias talámicas representan a un pequeño grupo de enfermedades cerebrovasculares del cual solo el 0.7-3% se manifiesta de manera bilateral, siendo la hipertensión arterial crónica el factor clave para su desarrollo. El siguiente es un reporte de caso de un paciente de 45 años de edad con hipertensión arterial de 10 años de evolución que presento deterioro motor braquiocrural acompañado de disartria, disnea, vómitos en número de dos, con aumento de su presión arterial basal. Al realizar el estudio por imágenes se observó una imagen compatible con un hematoma bilateral talámico.

Abstract Thalamic hemorrhages represent a small group of cerebrovascular diseases of which only 0.7-3% is manifested bilaterally, being chronic hypertension the key factor for its development. We report a case of a 45-year-old patient with 10-years history of arterial hypertension who presented with brachiocrural motor deterioration accompanied by dysarthria, dyspnea, vomiting in number of two, with increased basal blood pressure. Neurimaging demostrated a bilateral thalamic hematoma.

Utilidad de la albúmina oxidada y los sulfihidrilos séricos como marcadores de estrés oxidativo en pacientes embarazadas con hipertensión crónica / Usefulness of oxidized albumin and serum sulfhydryles as oxidative stress markers in pregnant women with chronic hypertension

Resumen OBJETIVO: determinar la utilidad de la albúmina oxidada y de los sulfihidrilos como marcadores de estrés oxidativo en pacientes embarazadas con y sin hipertensión crónica. MATERIALES Y MÉTODOS: estudio de cohorte prospectiva efectuado en pacientes con 28-30 semanas de gestación, con y sin hipertensión crónica. Medición por espectrofotometría directa y determinación de variables demográficas y concentraciones séricas de albúmina, albúmina oxidada, índice albúmina oxidada-albúmina sérica y sulfihidrilos. Determinación de medias y desviación estándar de las variables numéricas y proporciones de variables cualitativas. Tablas de contingencia y medidas de asociación mediante χ2 para variables cualitativas y U de Mann Whitney para variables cuantitativas. Los valores de p < 0.005 se considerarán significativos. RESULTADOS: se incluyeron 24 pacientes embarazadas: 10 con hipertensión crónica y 14 controles. En el grupo de hipertensión crónica 3 de cada 10 pacientes tuvieron preeclampsia. La variable resultado fue preeclampsia, diagnosticada según los criterios de la ACOG 2013. En el grupo de hipertensión crónica, en relación con el grupo control, no se encontraron diferencias significativas entre las concentraciones séricas de albúmina oxidada, índice albúmina oxidada-albúmina sérica y las concentraciones de sulfihidrilos totales. CONCLUSIONES: quizá debido al escaso número de pacientes no se encontraron diferencias significativas en las concentraciones séricas de estrés oxidativo en mujeres con y sin hipertensión crónica. Para descartar o aceptar esta hipótesis se requieren estudios con mayor población.

Abstract BACKGROUND: Oxidative stress is an altered balance between antioxidant and oxidant systems, leading to cellular damage. In pregnant women with chronic hypertension, oxidative stress has been associated as an important phenomenon for the development of preeclampsia. OBJECTIVE: To determine the usefulness of oxidized albumin and sulfhydryles as an oxidative stress marker in pregnant patients with and without chronic hypertension. METHODS: Cohort study, which included pregnant women from 28 to 30 weeks of gestation, with and without chronic hypertension. Demographic variables serum levels of albumin; oxidized albumin; oxidized albumin/serum albumin index and sulfhydryl were measured by direct spectrophotometry. The final outcome was preeclampsia, diagnosed according to 2013 ACOG Task force. Mean and standard deviation were determined for numerical variables and proportions for qualitative variables. Contingency tables and association measures were performed using χ2 for qualitative variables and Mann-Whitney U test for quantitative variables. p <0.005 was considered significant. RESULTS: A total of 24 pregnant women were included, 10 with chronic hypertension and 14 controls. In the chronic hypertension group 3/10 patients developed preeclampsia. No significant differences were found between serum levels of oxidized albumin, oxidized albumin-serum albumin index, and total sulfhydryl levels in the chronic hypertension group in relation to the control group. CONCLUSIONS: In this study, no significant differences were found in oxidative stress molecules serum levels in women with and without chronic hypertension. This may be due to the small number of cases, which requires studies with larger population to rule out this hypothesis.

Impacto de los trastornos hipertensivos, la diabetes y la obesidad materna sobre el peso, la edad gestacional al nacer y la mortalidad neonatal / Impact on neonatal mortality, birth weight and gestational age, hypertensive disorders, diabetes and obesity in pregnancy

Antecedentes: Los trastornos hipertensivos, la diabetes y la obesidad en el embarazo, afectan el peso, la edad gestacional al nacer y la mortalidad neonatal. Objetivo: Evaluar el impacto sobre la mortalidad neonatal, peso al nacer y edad gestacional, de los trastornos hipertensivos (preeclampsia e hipertensión arterial crónica), diabetes (gestacional y no gestacional) y obesidad en la gestación, en un grupo de neonatos nacidos en un hospital colombiano, entre 2005 y 2015. Métodos: Estudio de cohorte retrospectiva, con gestantes con preeclampsia (n: 326), hipertensión arterial crónica (n: 104), diabetes gestacional (n: 246) y obesidad (n: 216). Los datos fueron analizados en Stata® 11.0, empleando mediana o promedio y sus medidas de dispersión, Pruebas t, ranksum, ANOVA o Kruskal Wallis, medidas de frecuencia absolutas y relativas, Pruebas de Chi2 o exacta de Fisher. Para estimar la correlación entre las variables de exposición empleamos el Coeficiente de Correlación de Pearson y para estimar las asociaciones, empleamos riesgo relativo (RR) con su intervalo de confianza de 95%. La significancia estadística fue definida como un valor p<0,05. Resultados: Hallamos asociación significativa entre bajo peso al nacer y prematuridad con preeclampsia e hipertensión arterial crónica, y mayor peso al nacer con diabetes y obesidad. Hubo también asociación significativa entre mortalidad neonatal e hipertensión arterial crónica y diabetes. Conclusiones: Los trastornos hipertensivos y metabólicos afectan el peso y la edad gestacional al nacer, existiendo asociación significativa entre mortalidad neonatal e hipertensión arterial crónica y diabetes.

Background: Hypertensive disorders, diabetes and obesity in pregnancy, affect weight, gestational age at birth and neonatal mortality. Objective: Assess the impact on neonatal mortality, birth weight and gestational age, hypertensive disorders (pre-eclampsia and chronic hypertension), diabetes (gestational and non-gestational) and obesity in pregnancy of infants born colombian hospital between, 2005 and 2015. Methods: Retrospective cohort study with pregnant women with preeclapmsia (n: 326), chronic hypertension (n: 104), gestational diabetes (n: 246) and obesity (n: 216). The data were analyzed in Stata 11.0 using median or average and dispersion measures, t tests, ranksum, ANOVA or Kruskal Wallis, measures absolute and relative frequency, Chi2 tests or Fisher exact. To estimate the correlation between exposure variables we used the Pearson correlation coefficient and to estimate associations employ relative risk (RR) with confidence interval of 95%. Statistical significance was defined as p <0.05. Results: We found a significant association between low birth weight and prematurity with preeclampsia and chronic hypertension, and higher birth weight with diabetes and obesity. There was also significant association between neonatal mortality and chronic diabetes and hypertension. Conclusions: Hypertensive and metabolic disorders affect weight and gestational age at birth, and there is significant association between neonatal mortality and chronic diabetes and hypertension.

Evaluation of Incidence and Risk Factors of Severe Preeclampsia in a Tertiary Hospital Centre.

Aims: To evaluate the incidence of severe preeclampsia, eclampsia and HELLP syndrome in a tertiary Hospital Centre of Obstetrics and Gynaecology and to identify the impact of risk factors associated with severe preeclampsia. Study Design: Retrospective cross-sectional study. Place and Duration of Study: University Hospital of Obstetrics and Gynaecology “Koço Gliozheni”, Tirana, Albania between January 2009 and December 2013. Methodology: To collect the data for this study we used the medical records of births of a period of five years. The standard inclusion criteria in the study were pregnant women diagnosed with preeclampsia that had delivered in this hospital after 24 weeks’ gestation despite the number of the babies, fetal presentation and mode of delivery. The exclusion criteria in this study were: pregnancies with confirmed fetal anomalies non-viable, pregnancies with missing data, and pregnancies with unknown gestational age. The maternal variables collected from the medical records were: maternal age, parity, gestational age at delivery, multiple pregnancy, pre-existing (chronic) hypertension, pre-existing diabetes mellitus, renal diseases and preeclampsia in previous pregnancy. The data collected for the variables were compared with the statistical data for all the deliveries during the study period. Fisher’s exact test, Chi-squared test and SPSS program were used as statistical methods. Results: The study found differences between the severe preeclampsia group and the general population for the maternal risk factors: severe preeclampsia was evaluated 16.8% vs. 3.5% (P< 0.01), pre-existing hypertension 7.8% vs. 2.3% (P = 0.02), renal diseases 1.9% vs. 1.1%, diabetes mellitus 5.8% vs. 4.6% and multiple pregnancies 7.1% vs. 2.7% respectively. Conclusion: Identification of these risk factors is very important for the calculation of risk for preeclampsia in early pregnancy and early treatment to prevent the maternal and perinatal morbidity and mortality from this disease.

Hipertensos e diabéticos com insuficiência renalcrônica no Brasil cadastrados no SIS/HIPERDIA / Hypertensive and diabetic individuals with chronic renal failure in Brazil registered in SIS/HIPERDIA

Segundo as Diretrizes Brasileiras de doença renal crônica (DRC), os maiores fatores de risco para o desenvolvimento da doença são hipertensão arterial sistêmica (HAS), diabetes mellitus e história familiar de DRC. Diante das evidências, o objetivo deste estudo foi descrever e analisar os índices de insuficiência renal crônica (IRC) por estado e região brasileira e compará-los com o Índice de Desenvolvimento Humano (IDH). Este é um estudo epidemiológico descritivo do tipo ecológico, no qual foi extraído o índice de IRC do SIS/HIPERDIA, de janeiro de 2002 a fevereiro de 2013, por estado brasileiro. Os dados coletados foram transferidos para um banco de dados no aplicativo Microsoft® Excel 2010, e foram realizadas as análises descritivas, com frequências absolutas e relativas. De acordo com a análise dos dados, destaca-se que a Região Sudeste apresentou maior prevalência de doença renal; dentre as comorbidades, a HAS foi responsável pelo maior acometimento de IRC. Asregiões Sudeste e Centro-Oeste tiveram maiores IDHs, e houve uma elevada prevalência de IRC no sexo feminino. Nesse contexto, verificou-se que o maior índice de IRC nas regiões com maior IDH em comparação a outras pode estar relacionado à concentração de centros de nefrologia nas regiões mais desenvolvidas do país.

According to the Brazilian Guidelines for chronic kidney disease (CKD), the higher risk factors for the development of the disease are systemic arterial hypertension (SAH), diabetes mellitus and family history of CKD. Regarding the evidence, the objective of this study was to describe and analyze the indices of chronic renal failure (CRF) per state and Brazilian regions and to compare them with the Human Development Index (HDI). This is a descriptive epidemiological study of the ecological type, in which it was extracted the IRC index of SIS/HIPERDIA from January 2002 to February 2013 per Brazilian state. The collected data were transferred to a database in Microsoft® Excel 2010 and descriptive analyzes were conducted with absolute and relative frequencies. According to the data analysis, we highlight that the Southeast Region showed higher prevalence of kidney disease; among comorbidities, SAH was responsible for the greater involvement of CRF. TheSoutheast and Midwest regions had the highest HDIs and there was a high prevalence of CRF in female individuals. In this context, it was found that the highest rate of CRF in the regions with the highest HDI in comparison with the others may be related to the concentration of nephrology centers in the most developed regions of the country.

Management of chronic hypertension in pregnancy

Chronic hypertension is defined as an elevated blood pressure (BP) that predates conception or is detected before 20 weeks of gestation. It occurs in up to 5% of all pregnancies, and this incidence rate is increasing with the rising prevalence of women who conceive at an older age. Superimposed preeclampsia develops in about 25% of women with chronic hypertension and increases the risks of eclampsia, fetal intrauterine growth restriction, and stillbirth. The management of chronic hypertension remains controversial. According to systematic reviews and meta-analyses, antihypertensive agents are recommended to patients with severe hypertension (systolic BP > or =160 mmHg or diastolic BP > or =105 mmHg). They are not suggested for those with mild hypertension and no evidence of end-organ damage, however, due to the lack of evidence that pharmacologic treatment can improve perinatal outcomes in this population. The optimal BP target is a systolic BP of 120 to 160 mmHg and a diastolic BP of 80 to 105 mmHg. In antenatal care, fetal surveillance should be performed to detect abnormal fetal growth through regular ultrasonography examinations, and in those with fetal intrauterine growth restriction, umbilical arterial Doppler velocimetry should be used. In women at risk of preeclampsia, low-dose aspirin might reduce the possibility of its occurrence. Women with a hypertensive disorder during pregnancy are at increased risk of chronic hypertension, cardiovascular disease, and thromboembolism in later life; therefore, appropriate postnatal BP control and health interventions such as smoking cessation and obesity control should be proposed.

Maternal Plasma Angiopoietin-1 and Angiopoietin-2 in Pregnant Women with Chronic Hypertension / 대한주산의학회잡지

PURPOSE: The aim of this study was to investigate whether plasma angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) concentrations in pregnant women with chronic hypertension are different from those of normotensive pregnant women. METHODS: This hospital-based case-control study consisted of 35 pregnant women with chronic hypertension who delivered at Seoul National University Hospital. Normotensive pregnant women (n=70) were selected as controls, matched with maternal age, gestational age at delivery and birthweight. Maternal blood was drawn at the time of admission for delivery and plasma was separated and stored. The plasma Ang-1 and Ang-2 levels were measured by ELISA. Statistical analysis was done with Mann-Whitney U test, Fisher's exact test and Spearman rank correlation test using SPSS. RESULTS: Median (range) maternal age, gestational age and birthweight were 33 years (24-42), 38 weeks (32-41), and 3.08 kg (1.13-4.01). Pregnant women with chronic hypertension had significantly higher median Ang-1 and Ang-2 levels than normotensive pregnant women (for Ang-1 : median 4,111 pg/mL, range 1,415-30,172 vs. median 2,824 pg/mL range 662-14,512, P=0.015, for Ang-2 : median 5,637 pg/mL, range 1,131-29,327 vs. median 3,345 pg/mL, range 609-24,467, P=0.039). CONCLUSION: Maternal plasma Ang-1 and Ang-2 levels were elevated in pregnant women with chronic hypertension compared with normotensive pregnant women. Further study is needed to determine if this change is a cause or a compensatory mechanism to chronic hypertension.

Riesgo cardiovascular e hipertensión arterial crónica en embarazadas / Cardiovascular risk and chronic hypertension in pregnant women

Se realizó un estudio analítico y observacional de tipo caso-control no pareado de 90 gestantes atendidas en los policlínicos universitarios "Camilo Torres Restrepo" y "Municipal" de Santiago de Cuba, desde junio de 2010 hasta igual mes de 2011, con vistas a determinar el grado de asociación causal entre algunos factores de riesgo cardiovascular y la enfermedad hipertensiva crónica. El grupo de los casos estuvo integrado por 30 embarazadas con hipertensión arterial crónica y el de los controles por 60; estas últimas con características biológicas similares, sin hipertensión, pero con el mismo grado de exposición. Se obtuvo que la malnutrición por exceso, el estrés mantenido y la dislipidemia fueron los factores de riesgo que mostraron mayor asociación causal con la hipertensión arterial crónica.

An analytical and observational unmatched case-control study including 90 pregnant women assisted in "Camilo Torres Restrepo" and "Municipal" university polyclinics in Santiago de Cuba was carried out from June of 2010 to the same month of 2011, with the objective of determining the degree of causal association between some factors of cardiovascular risk and the chronic hypertensive disease. The group of cases was formed by 30 pregnant women with chronic hypertension and that of controls was formed by 60; the last ones with similar biological characteristics, without hypertension, but with the same exposure degree. It was obtained that the excessive malnutrition, the maintained stress and dyslipidemia were the risk factors showing higher causal association with the chronic hypertension.

L-arginina: suplemento nutricional sin beneficios demostrados en patologías del embarazo / L-arginine supplementation in patients with disorders of pregnancy

Objetivo: análisis crítico de estudios clínicos randomizados para determinar si el suplemento con L-arginina mejora el resultado perinatal en pacientes embarazadas en riesgo o que presenten patologías como parto prematuro, síndrome hipertensivo del embarazo o restricción de crecimiento fetal intrauterino. Métodos: se realizó una búsqueda bibliográfica en base de datos Pubmed, Tripdatabase y una multibúsqueda en el Sistema de Bibliotecas de la Pontificia Universidad Católica de Chile con posterior análisis crítico de los estudios seleccionados. Resultados: se seleccionaron 14 estudios clínicos randomizados; 4 de ellos corresponden a estudios de L-arginina en hipertensión gestacional, 5 estudios de L-arginina en preeclampsia, 1 estudio de L-arginina en parto prematuro, 1 estudio de L-arginina en hipertensión crónica y 4 estudios de L-arginina en restricción de crecimiento intrauterino. Solo dos de los estudios son de buena calidad metodológica, pero uno de ellos estudia un resultado intermedio y no clínicamente relevante. El resultado más promisorio muestra que el uso de L-arginina asociada a vitaminas antioxidantes reduce significativamente la incidencia de preeclampsia en mujeres de riesgo (antecedente personal o familiar de preeclampsia). Conclusiones: no se ha demostrado la efectividad de la suplementación antenatal con L-arginina para mejorar el resultado perinatal en embarazadas en riesgo o que presentan patologías como parto prematuro, síndrome hipertensivo del embarazo o restricción de crecimiento fetal. Se requieren estudios de buen diseño que permitan conclusiones definitivas.

Objective: critical analysis of randomized clinical trials to determine whether supplementation with L-arginine improves perinatal outcome in pregnant patients at risk or presenting conditions such as preterm labor, hypertensive disorders or intrauterine fetal growth restriction. Methods: we performed a literature search in Pubmed, Tripdatabase and multisearch in the Library System of the Pontifical Catholic University of Chile to further critical analysis of selected studies. Results: We selected 14 randomized trials, 4 of them are for studies of L-arginine in gestational hypertension, 5 studies of L-arginine in preeclampsia, one study of L-arginine in preterm labor, one study of L-arginine in chronic hypertension and 4 studies of L-arginine in intrauterine growth restriction. Only two of the studies were of good methodological quality, but one these studies analyzes an intermediate result that is not clinically relevant. The most promising result shows that the use of L-arginine associated with antioxidant vitamins significantly reduced the incidence of preeclampsia in women at risk (personal or family history of preeclampsia). Conclusions: is not shown the effectiveness of antenatal supplementation with L-arginine to improve perinatal outcome in pregnant women at risk or with pathological conditions such as premature labor, hypertensive disorders and fetal growth restriction. More studies of good design are needed to allow definitive conclusions.

Algunos factores biosociales y obstétricos de la enfermedad hipertensiva gravídica en el Hospital de Chitungwiza, Zimbabwe / Some biosocial and obstetric factors of gestational hypertensive disease in Chitungwiza Hospital, Zimbabwe

Se efectuó un estudio descriptivo y transversal de 181 gestantes con enfermedad hipertensiva, atendidas por los médicos cubanos en el Hospital de Chitungwiza en Zimbabwe, desde enero hasta diciembre del 2007, a fin de caracterizarles según algunos factores biosociales y obstétricos. Predominaron las embarazadas con edades entre 20-24 años y la preeclampsia, eclampsia e hipertensión crónica como formas de la hipertensión arterial, así como las captaciones tardías, la nuliparidad y el bajo peso al nacer. Se recomendó realizar estudios en otros hospitales de ese país para profundizar en las manifestaciones de este indicador y poder establecer estrategias de intervención comunitaria que disminuyan la morbilidad y mortalidad

hA descriptive and cross-sectional study was carried out in 181 pregnant women with hypertensive disease, attended by Cuban doctors at the Hospital of Chitungwiza in Zimbabwe, from January to December 2007, in order to characterize them according to some biosocial and obstetric factors. Pregnant woman between 20-24 years and preeclampsia, eclampsia and chronic hypertension as forms of arterial hypertension predominated as well as late recruitment of women, nuliparity and low birth weight. It was recommended to carry out studies in other hospitals of that country to increase knowledge of manifestations of this condition and to draw up strategies of community intervention that reduce morbidity and mortality

Expression of Nogo-A on the retina in rat model with chronic ocular hypertension / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To study the expressive variation of Nogo-A on rat retina in the process of chronic ocular hypertension. · METHODS: Thirty-six healthy adult male Wistars were randomly divided into control group (6 rats) and chronic hypertension group (30 rats). Chronic hypertension was created by cauterizing the superficial scleral veins. Immunohistochemistry technique was used to evaluate the expressive varieties of Nogo-A at different time points during the course of chronic ocular hypertension. · RESULTS: The success of the model was indicated by over 40% of increase in the IOP as compared with normal rats. Compared with control group, as time passed chronic hypertension group gradually had detectable morphology changes in the retina. At the 21st day of chronic ocular hypertension, retinas became thinner and the quantity of retinal ganglion cell (RGC) decreased (P<0.05). Assoicated with the morphological changes, the expression of Nogo-A was strongly increased (P<0.05).CONCLUSION: Myelin associated protein Nogo-A plays a part in the process of chronic ocular hypertension.

Estudo da morfologia vascular do leito placentário na hipertensão arterial crônica / Morphology of the vascular placental bed in chronic arterial hypertension

OBJETIVO: Analisar os padrões histopatológicos das artérias do leito placentário em gestações complicadas por hipertensão arterial crônica (HAC) comparando-os com o de grávidas normais. MÉTODOS: Biópsias de leito placentário, segundo técnica de Robertson et al.1, foram realizadas em pacientes com idade gestacional igual ou superior a 28 semanas, submetidas a cesárea, após a dequitação. O grupo controle (GC) foi composto por 25 pacientes normais e o grupo de estudo composto por 13 pacientes com HAC leve (HL), 11 pacientes com HAC moderada (HM) e 11 pacientes com HAC grave (HG). As classes de hipertensão foram consideradas leve (PAD 90 - 100 mmHg), moderada (PAD 100 - 110 mmHg) e grave (PAD3 > 110mmHg). Os padrões histológicos das artérias espiraladas foram classificados em: padrão inalterado, modificações fisiológicas, desorganização da camada média, alterações hiperplásicas, necrose e aterose aguda. RESULTADOS: 1) Os achados anormais foram predominantes no grupo de hipertensas, sendo mais freqüente nos grupos HM e HG. 2) O achado anormal mais prevalente foi a desorganização da camada média, com distribuição semelhante nos grupos HM e HG. 3) Os padrões normais ocorreram nos grupos GC e HL, com distribuição semelhante entre si.

OBJECTIVES: To analyze histopathological patterns of placental bed arteries in pregnancies complicated by chronic arterial hypertension. Alterations were considered according to clinical classification of the hypertensive disorders as mild (MG); moderate (MoG) and severe (SG) for comparison with uncomplicated pregnancies, control group (CG). METHODS: Placental bed biopsy was performed in 60 pregnant women; the study group was comprised of pregnant women with hypertension, subdivided in 13 with severe chronic hypertension (CH), 11 with moderate CH and 11 with mild CH, and results were compared to 25 placental bed biopsies from uncomplicated pregnancies. All the pregnant women had a gestational age of at least 28 weeks of gestation with a live fetus and were submitted to cesarean section. Hypertension was considered mild with diastolic blood pressure (DBP) 90 I? 100 mmHg, moderate DBP 100 I? 110 mmHg and severe DBP = 110 mmHg. Placental bed variables selected for histological analysis were: unaltered patterns, physiological changes, medial layer disorganization, medial and intimal hyperplasic changes, acute necrosis and atherosis. RESULTS: In cases with SG and MoG there was predominance of abnormal histophysiological findings: medial layer disorganization and hyperplasic changes, with a statistically significant difference when compared to MG and CG. Alteration in the medial layer was observed in these cases. The normal pattern, unaltered patterns and physiologic changes were more frequent in CG and MG. Physiological changes were the most usual finding, further, there was no acute necrosis or atherosis. CONCLUSION: 1. Abnormal histophysiological findings were predominant in hypertensive pregnant women compared to the normotensive ones; 2. These patterns were more frequent, according to the severity of the hypertensive disorders: Severe, Moderate and Mild; 3. More significant abnormal findings were a change in the medial layer, mainly in...