Diagnosis and treatment of hypertensive disorders in pregnancy according to changes from guidelines / 中国实用内科杂志

Hypertensive disorders in pregnancy(HDP)is a group of diseases including high blood pressure during pregnancy. Strengthening clinical monitoring, risk factors assessment and early intervention would promote outcomes of women and their children. Blood pressure and proteinuria are key monitoring during pregnancy. Antihypertensive drugs recommended for pregnancy include methyldopa, labellol, or nifedipine. Early screening and intervention of preeclampsia is one of the keys to the prevention of cardiovascular risk during pregnancy. In addition to medication, weight control, screening and treatment of obstructive sleep apnea(OSA), lifestyle intervention and so on can not be ignored.

Relationship of lipid metabolism and homocysteine with hypertensive disorders in pregnancy / 中国综合临床

Objective To explore the association of lipid metabolism and bomocysteine with hypertensive disorders in pregnancy and observe the inflammatory reaction and the pathological change of placenta.Methods We conducted a prospective randomized placebo-controlled study.Seventy-four cases with hypertensive disorders in pregnancy were recruited as the experimental group and 77 cases of normal pregnant women were recruited as matched control group from Aug.2008 to Mar.2010.The relationship between lipid metabolism and homocysteine was analyzed.Results There was significant difference between the two groups in body-mass index before pregnancy(29.03±4.52 vs.23.99±5.90,t =5.88),cholesterol[(6.16±1.48)mmol/L vs.(5.01±1.05) mmmol/L,t =5.52],low density lipoprotein[(3.46±1.35) mmol/L vs.(2.26±0.86) mmol/L,t =6.54]and C-reactive protein[(29.04±14.90) mmol/L vs.(15.48±4.57) mmol/L,t =7.62](P ＜ 0.05).No significant difference was found on triglycerides[(3.29±1.03) mmol/L vs.(3.49±1.37) mmol/L],high density lipoprotein[(1.84±0.40) mmol/L vs.(1.88±0.35) mmol/L],homocysteine [(8.77±2.65) mmol/L vs.(8.40±2.03) mmol/L]and neonatal weight[(3547±519)g vs.(3431±461)g](P ＞ 0.05).Significant difference exists in placenta pathology of infarction(54.55％ vs.31.04％),villi dysplasia,fit nodules form and hypoxia(65.46％ vs.39.66％)(P ＜0.05).Conclusion We should detect lipid,homocysteine and C-reactive protein by dynamic combinational ways,pay more attention to women with high BMI before pregnancy,and value placenta pathology research on hypertensive disorders in pregnant women.This has high clinical significance in revealing the etiology of hypertensive disorders in pregnant women and improving pregnant outcomes.

Changes and significance of the level of serum TNF-α and IL-6 in hypertensive disorders in pregnancy / 中国基层医药

ObjectiveTo observe the changes of the levels of serum TNF-α and IL-6 in patients with hypertensive disorders in pregnancy(HDIP),to explore the significance of serum TNF-α and IL-6 in HDIP.MethodsThe levels of serum TNF-α and IL-6 in 30 patients with HDIP( 11 cases with gestational hypertension,11 casses with mild preeclampsia,8 cases with severe preeclampsia) and 18 healthy pregnant women were detected.ResultsThe levels of serum TNF-α in HDIP were( 1.88 ±0.48) μg/L,(2.32 ±0.40) μg/L and(2.35 ± 0.42) μg/L,The levels of serum IL-6 of HDIP were (99.54 ± 31.62) ng/L,( 120.53 ± 26.42)ng/L,( 140.83 ± 22.13 ) ng/L respectively,the serum levels of TNF-α and IL-6 in healthy pregnant women were( 1.63 ± 0.32)μg/L and(95.82 ± 30.65 )ng/L,there was significant difference among them ( all P ＜ 0.05 ).ConclusionThe serum levels of TNF-α and IL-6 in HDIP were higer than those in healthy pregnant women,and vascular endothelium cell injury should play an important role in the pathogenesis and development of HDIP.

Clinical evaluation of anesthesia for cesarean section of the patients with hypertensive disorders in pregnancy: retrospective study for 10 years

BACKGROUND: There are many difficulties in anesthetic management for cesarean section of the patients with hypertension.The anesthetic management of hypertensive disorders in pregnancy has been controversial. METHODS: We reviewed the medical records of the patients with hypertensive disorders in pregnancy from Jan., 1998 to Dec., 2007, and made clinical analysis of the anesthesia for cesarean section. RESULTS: Of the total 775 parturients with hypertensive disorders, 638 (82.3%) was delivered by cesarean section.Indications for cesarean section were, in order of frequency, hypertensive disorders in pregnancy (36.9%), multiple pregnancy (13.8%), previous cesarean section (11.6%), etc.Of the total cesarean section, 468 (73.4%) were emergency cases.The majority of preoperative systolic blood pressures were 141-160 mmHg (36.2%) and 161-180 mmHg (35.2%). The majority of preoperative diastolic blood pressures were 91-100 mmHg (28.6%) and 101-110 mmHg (25.0%). 350 (54.9%) had epidural anesthesia, 195 (30.5%) had general anesthesia, and 93 (14.6%) had spinal anesthesia.Estimated blood loss was significantly lower after regional anesthesia than after general anesthesia.In patients received magnesium sulfate (MgSO4), (40.0% of total) 83.5% had regional anesthesia and 16.5% had general anesthesia.In the cases with MgSO4 1 min Apgar score was lower and neonatal birth weight was smaller than in cases without MgSO4. CONCLUSIONS: Anesthesiologist must have much attention on the prevention, treatment and anesthetic management for cesarean section of patients with hypertensive disorders in pregnancy.

Comparative study between pregnancies with and without hypertensive disorders in placental abruption / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to compare the clinical characteristics of placental abruption according to the presence or absence of hypertensive disorders in pregnancy. METHODS: The retrospective analysis was performed in total 363 cases of placental abruption among 25,895 deliveries during 5 years from January, 2003 to December, 2007 in 8 hospitals of Catholic university in Korea. Maternal characteristics and neonatal outcomes were compared with parametric test. RESULTS: The incidence of placental abruption was 1.40% during the study period. The proportion of patients complicated with hypertensive disorders was 33.1%. There was no difference in maternal age and the number of previous pregnancy between two groups with or without hypertensive disorders. As expected, mean gestational age at delivery was lower in placental abruption with hypertensive disorders compared to those without the diseases (237.1 days vs 239.1 days). The incidence of abnormal fetal presentation, multiple gestation, PPROM, and polyhydramnios were more common in patients with placental abruption without hypertensive disorders. On the other hand, the incidence of maternal thrombophilia was significantly higher in patients with placental abruption with hypertensive disorders. The patients with placental abruption with hypertensive disorders had higher incidence of abdominal pain, fetal distress, uterine contraction, and uterine hypertonus (p<0.05). In terms of maternal complication, the patients with placental abruption with hypertensive disorders had more severe complications including shock, coagulopathy and renal failure (p<0.05) and had worse perinatal outcome including FDIU (fetal death in uterus) and neonatal death (10.8% vs 10.3%). CONCLUSION: In patients with placental abruption with hypertensive disorders in pregnancy, maternal complications were more common and prenatal outcome was worse compared to patients with placental abruption without hypertensive disorders.