Flow-mediated Dilation of the Brachial Artery in Women with Hypertensive Disorders of Pregnancy.

Background: Hypertensive disorder of pregnancy (HDP) comprise chronic hypertension, gestational hypertension, preeclampsia/eclampsia, and preeclampsia superimposed on chronic hypertension. HDP complicate up to 10% of pregnancies worldwide and carry significant risks of maternal and perinatal morbidity and mortality. The aim of this study was to evaluate the derangement and characteristics of brachial artery flow-mediated dilation (BAFMD) in women with HDP. Methods: The BAFMD of the right brachial artery of 80 women with HDP (pregnant HDP), 80 normotensive pregnant women (pregnant non-HDP), and 80 healthy nonpregnant women (nonpregnant controls) was evaluated with B-mode ultrasound. The age, blood pressure, body mass index (BMI), brachial artery diameter, and BAFMD of the participants were compared. P ≤ 0.05 was statistically significant. Results: The pregnant HDP group had significantly lower mean BAFMD compared to pregnant non-HDP and nonpregnant controls (6.9% ± 2.53% vs. 8.32% ± 3.4% vs. 9.4% ± 2.68%; P < 0.001). There was no significant difference between the mean BAFMD of the pregnant HDP subgroups: preeclampsia (5.81% ± 1.7%) versus gestational hypertension (6.43% ± 3.02%); P = 0.57. BAFMD diminished with advancing gestational age in both the pregnant HDP and pregnant non-HDP groups. On regression analysis, BAFMD was a poor marker for HDP, while BMI was an independent predictor for HDP. Conclusion: Even though HDP were associated with significantly diminished BAFMD, it was not a good marker for HDP.

Eight-hour versus 24-h urethral catheter removal following elective caesarean section for reducing significant bacteriuria: A randomized controlled trial.

BACKGROUND: There is no consensus on the preferred time to remove urethral catheter post caesarean section. AIM: To compare rate of significant bacteriuria and urinary retention following 8-h (study) and 24-h urethral catheter removal (control) post elective caesarean section. METHODS: A randomized controlled trial of eligible participants that underwent elective caesarean section under spinal anaesthesia between March 2019 and November 2019 was conducted. Participants (150 in each arm) were randomly assigned (1:1 ratio) to either 8-h or 24-h group. Primary outcome measures included rates of significant bacteriuria 48-h post-operatively and acute urine retention 6-h post urethral catheter removal. Analysis was by Intention-to-treat. (www.pactr.org:PACTR202105874744483). RESULTS: There were 150 participants randomized into each arm and data collection was complete. Significant bacteriuria was less in 8-h group (3% versus 6.0%; risk ratio (RR): 0.85 CI: 0.60 to 5.66; p = 0.274), though not significant. Acute urinary retention requiring repeat catheterisation was significantly higher in 8-h group (11(7.3%) versus 0(0.0%); RR: 0.07; CI: 0.87 to 0.97; p = 0.001). Mean time until first voiding was slightly higher in 8-h group (211.4 ± 14.3 min versus 190.0 ± 18.3 min; mean difference (MD): 21.36; CI: -24.36 to 67.08; p = 0.203); but patient in this group had a lower mean time until ambulation (770.0 ± 26.1 min versus 809 ± 26.2 min; MD: -38.8; CI: -111.6 to 34.0; p = 0.300). The 8-h group were significantly more satisfied (82/150 (54.7%) versus 54/150 (36.0%); p = 0.001). CONCLUSIONS: An 8-h group was associated with significant clinical satisfaction and acute urine retention compared to 24-h removal. The timing of urethral catheter removal did not affect rate of significant bacteriuria and other outcomes.

Fetal Gestational Age Determination using Ultrasound Placental Thickness.

BACKGROUND: The purposes of this study are to sonographically measure the placental thickness (PT) in normal fetuses; to correlate it with gestational age (GA), fetal growth parameters, and estimated fetal weight (EFW); and to design a nomogram for the derived PT measurements. METHODS: This was a hospital-based cross-sectional study on 400 women with apparently normal pregnancy within the age range of 18-45 years recruited from the Antenatal Clinic of our hospital. The fetal GA was estimated by the last menstrual period (LMP). The fetal growth parameters were determined using standard sonographic methods while the PT was measured at the level of the umbilical cord insertion site. PT was then correlated with GA, fetal growth parameters, and the EFW. RESULTS: The mean PT (mean ± standard deviation) in the 1st, 2nd, 3rd trimesters and the whole duration of pregnancy were 14.5 ± 0.3 mm, 24.6 ± 3.9 mm, 34.8 ± 2.8 mm, and 29.6 ± 7.1 mm, respectively. PT ranged from 13.5 ± 1.9 mm at 11 weeks to 39.1 ± 0.6 mm at 40 weeks. PT (in mm) had a linear relationship and a statistically significant positive correlation with GA (in weeks) in all the trimesters, with most significant correlation recorded in the 2nd trimester (r = 0.79). There was also a statistically significant positive correlation between PT and the fetal growth parameters (biparietal diameter, head circumference, abdominal circumference, femur length and crown-rump length), and EFW. PT nomogram was developed from 11 to 40 weeks of gestation using a scatter plot with 95% confidence interval for our locality. CONCLUSION: PT has a linear relationship with GA, fetal growth parameters, and EFW and it can be used along with other fetal growth parameters to increase the accuracy for predicting GA in normal pregnancies, especially when the subject is not sure of or does not know her LMP.

Maternal renal artery Doppler sonographic changes in pregnancy-induced hypertension in South West Nigeria.

BACKGROUND: To evaluate the renal arterial hemodynamic changes caused by pregnancy-induced hypertension using Doppler ultrasonography. MATERIALS AND METHODS: Eighty (80) subjects with pregnancy-induced hypertension (PIH) and 160 controls (80 pregnant normotensive women and 80 healthy, non-pregnant women) underwent triplex renal sonography prospectively to determine their renal volumes and right renal artery Doppler indices. RESULTS: The peak systolic velocity, end diastolic velocity, pulsatility index, systolic/diastolic ratio and acceleration time were respectively significantly higher in the PIH group (68.67 cm/s, 21.55 cm/s, 1.23, 3.38, 123.2 ms) than the pregnant, normotensive group (65.19 cm/s, 20.27 cm/s, 0.88, 3.35, 61.14 ms) and healthy, non-pregnant group (52.06 cm/s, 18.27 cm/s, 0.84, 2.90, 68.48 ms). Resistivity index was also increased in the PIH group, but this was not statistically significant. Conversely, the systolic acceleration was significantly lower in the PIH group (6.06 m/s(2)) compared to the pregnant, normotensive group (11.82 m/s(2)) and healthy, non-pregnant group (8.26 m/s(2)). The right renal volume of the PIH group (132.76 cm(3)) was significantly higher that of the pregnant, normotensive group (125.29 cm(3)) and healthy, non-pregnant group (91.66 cm(3)). The same pattern was observed in the left renal volume which was 168.78 cm(3), 164.95 cm(3) and 113.80 cm(3) in the study groups, respectively. CONCLUSION: Renal Doppler ultrasound is clinically relevant in the diagnosis and follow-up of renal complications in patients with pregnancy-induced hypertension.