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1.
Pregnancy Hypertens ; 17: 12-14, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487627

RESUMO

Estimates of adherence to antihypertensive treatment in pregnancy are limited; identifying non-adherence could facilitate intervention and optimise blood pressure control. This study aimed to evaluate adherence to antihypertensive treatment amongst pregnant women with chronic hypertension using high-performance liquid chromatography-tandem mass spectrometry instrumentation. Spot urine samples collected from women who were randomised to labetalol or nifedipine were assessed. Samples from 74 women were included; documented prescribing and urine metabolite detection were concordant in 88% (n = 65). Evidence of self-administration of alternative treatment was observed in 8% (n = 6). Measurement of urinary antihypertensive metabolites in pregnancy provides insight into treatment adherence.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adesão à Medicação , Pré-Eclâmpsia/prevenção & controle , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Cuidado Pré-Natal , Adulto , Anti-Hipertensivos/administração & dosagem , Determinação da Pressão Arterial , Cromatografia Líquida de Alta Pressão , Estudos de Coortes , Feminino , Humanos , Hipertensão/urina , Labetalol/administração & dosagem , Labetalol/uso terapêutico , Nifedipino/administração & dosagem , Nifedipino/uso terapêutico , Gravidez , Resultado do Tratamento
2.
Pregnancy Hypertens ; 17: 209-215, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487643

RESUMO

OBJECTIVE: This study aimed to evaluate the relationship between endogenous CYP3A markers and plasma amlodipine (AML) exposure and metabolism parameters in early postpartum and non-peripartum women. METHODS: Twenty-four AML-treated early postpartum women with hypertensive disorders of pregnancy and 30 non-peripartum women with essential hypertension were enrolled. Blood samples for determination of CYP3A markers including total cholesterol-adjusted 4ß-hydroxycholesterol (4ß-OHC/TC), 25-hydroxyvitamin D (25-OHD), and AML and its metabolites in plasma were collected at 24 h after the AML treatment. RESULTS: The plasma 4ß-OHC/TC in postpartum women was higher than that in non-peripartum women, while the plasma 25-OHD was lower. The postpartum women had a lower plasma AML concentration and its metabolic ratio was higher. The plasma 4ß-OHC/TC decreased as the number of days post-delivery increased. The plasma AML concentration increased as the number of days post-delivery increased, while the metabolic ratio of AML declined slightly. Tendency toward negative correlations between the plasma 4ß-OHC/TC but not 25-OHD, and AML concentration were observed in both postpartum and non-peripartum women. In both groups, the plasma 4ß-OHC/TC was correlated with the metabolic ratio of AML. CONCLUSIONS: The early postpartum women had higher plasma 4ß-OHC and AML metabolism. The plasma 4ß-OHC had positive relationships with amlodipine metabolism in both women groups. AML metabolism and plasma 4ß-OHC may be useful as CYP3A markers in early postpartum and non-peripartum women.


Assuntos
Anlodipino/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Citocromo P-450 CYP3A/sangue , Hipertensão/tratamento farmacológico , Pré-Eclâmpsia/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Anlodipino/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/sangue , Pessoa de Meia-Idade , Período Periparto , Pré-Eclâmpsia/sangue , Gravidez , Complicações Cardiovasculares na Gravidez/sangue , Cuidado Pré-Natal , Adulto Jovem
3.
Pregnancy Hypertens ; 17: 54-58, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487657

RESUMO

OBJECTIVE: To assess the maternal and fetal outcome in women with mild to moderate chronic hypertension on antihypertensive drug (methyldopa or nifedipine) therapy compared to no medication. METHODS: This multicenter randomized clinical trial was conducted at Menoufia University hospital, Shibin El-kom Teaching hospital and 11 Central hospitals at Menoufia governorate, Egypt.490 pregnant women with mild to moderate chronic hypertension were randomized into three groups; methyldopa group (n = 166), nifedipine group (n = 160) and control or no medication group (n = 164) who were followed from the beginning of pregnancy till the end of puerperium to record maternal and fetal outcome. RESULTS: Mothers in the control (no medication) group were more prone for the development of severe hypertension, preeclampsia, renal impairment, ECG changes, placental abruption and repeated hospital admissions (p < 0.001) when compared to mothers in both treatment groups (methyldopa and nifedipine). Neonates in the control (no medication) group were more prone for prematurity and admission to neonatal ICU (p < 0.001). CONCLUSION: Antihypertensive drug therapy is advisable in mild to moderate chronic hypertension during pregnancy to decrease maternal and fetal morbidity. When considering which agents to use for treatment, oral methyldopa and nifedipine are valid options.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão/tratamento farmacológico , Metildopa/uso terapêutico , Nifedipino/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Administração Oral , Adulto , Anti-Hipertensivos/administração & dosagem , Egito , Feminino , Humanos , Recém-Nascido , Metildopa/administração & dosagem , Nifedipino/administração & dosagem , Gravidez , Diagnóstico Pré-Natal , Resultado do Tratamento , Adulto Jovem
4.
Rev Cardiovasc Med ; 20(2): 53-58, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31344997

RESUMO

Peripartum cardiomyopathy is a type of non-ischemic cardiomyopathy with a high rate of thromboembolic events. Guiding strategies for anticoagulation in patients with peripartum cardiomyopathy and thromboembolic events are limited. Literature for all cases of peripartum cardiomyopathy with intracardiac thrombi were reviewed and summarized from twelve case reports. Based on the available literature, we conclude that patients with peripartum cardiomyopathy with ejection fraction of less than 30% should strongly consider anticoagulation therapy to avoid thromboembolic events. Future studies may be able to further elucidate the optimal indication and duration of anticoagulation.


Assuntos
Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Cardiomiopatias/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Trombose/tratamento farmacológico , Adulto , Anticoagulantes/efeitos adversos , Cardiomiopatias/sangue , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/sangue , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Trombose/sangue , Trombose/diagnóstico , Trombose/fisiopatologia , Resultado do Tratamento , Adulto Jovem
5.
Am J Emerg Med ; 37(8): 1604.e1-1604.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31155170

RESUMO

Supraventricular Tachycardias are the most common cardiac rhythm disturbances in pregnant patients. Adenosine is the recommended medication to treat these arrhythmias in part because the medication is projected to be metabolized prior to crossing the placenta and producing any fetal effects. Reported here is a case of a pregnant patient treated with adenosine in which the fetal heart activity was monitored through point of care ultrasonography with documentation of no fetal impact from this medication. This is the first documentation of a lack of fetal effect from adenosine.


Assuntos
Adenosina/administração & dosagem , Antiarrítmicos/administração & dosagem , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Taquicardia Supraventricular/tratamento farmacológico , Administração Intravenosa , Adulto , Eletrocardiografia , Feminino , Monitorização Fetal/métodos , Frequência Cardíaca Fetal , Humanos , Testes Imediatos , Gravidez , Ultrassonografia Pré-Natal
6.
Eur J Obstet Gynecol Reprod Biol ; 238: 7-11, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31082745

RESUMO

A meta-analysis based on published literature was undertaken to evaluate the efficacy of anticoagulant drugs for the treatment of venous thromboembolism during pregnancy. PubMed, Cochrane and Embase databases were searched from inception to September 2018 for relevant studies using indexed words, including qualified case-control and cohort studies. The meta-analysis used odds ratios (OR) and 95% confidence intervals (95% CI) to analyse the primary results. Nine studies were included in this meta-analysis, with a total of 834 cases and 3424 controls. There were no significant differences in the incidence of prenatal haemorrhage (OR 1.08, 95% CI 0.84-1.40), venous thromboembolism (OR 1.30, 95% CI 0.72-2.33) or caesarean section (OR 1.16, 95% CI 0.69-1.98) between the case group and the control group. The incidence of pulmonary embolism was significantly higher in the case group than in the control group (OR 3.90, 95% CI 1.23-12.34). However, there were a few limitations that may have influenced the results, so more randomized double-blind controlled studies of high quality are warranted to confirm the efficacy of anticoagulant therapy for venous thromboembolism in pregnancy.


Assuntos
Anticoagulantes/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Cesárea/estatística & dados numéricos , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Embolia Pulmonar/epidemiologia , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia
7.
Expert Opin Pharmacother ; 20(13): 1625-1636, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31136204

RESUMO

Introduction: Atrial fibrillation (AF) is rare during pregnancy but its incidence is expected to rise in parallel to increasing age of women in pregnancy and fraction of pregnant women with structural heart disease. Areas covered: The authors provide a review of the contemporary evidence on diagnostic work-up and optimal pharmacotherapeutic management of AF in pregnancy. The authors have performed a systematic search for relevant articles using MEDLINE, the COCHRANE LIBRARY, and ClinicalTrials.gov. Expert opinion: New-onset AF during pregnancy is usually an indication of underlying heart disease and should lead to hospital admission. Patients should be evaluated by an experienced cardiologist or an electrophysiologist. Direct cardioversion is highly effective and safe in pregnant women and should be prioritized over pharmacologic cardioversion with intravenous ibutilide or flecainide. Amiodarone should be avoided if possible. Digoxin and beta-blockers are the rate-control pharmaceutic agents with the widest experience of use. Catheter ablation during pregnancy should be considered in selected cases of atrial flutter refractory to medication and only performed using fluoroless techniques, preferably during the second trimester. Vitamin K antagonists (VKAs) can be used after the first trimester, while low molecular weight heparin should be accompanied by periodic evaluation of anti-Xa factor. Non-VKA oral anticoagulants should be avoided because of limited experience in pregnancy.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Anticoagulantes/uso terapêutico , Ablação por Cateter , Cardioversão Elétrica , Feminino , Fibrinolíticos/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Gravidez
8.
Ann Vasc Surg ; 59: 313.e1-313.e3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009730

RESUMO

BACKGROUND: Pregnancy is a hypercoagulable state associated with a fivefold increase in the risk of venous thromboembolism. Thrombolysis is the preferred level of care for patients with acute iliofemoral deep vein thrombosis (DVT); however, most studies exclude pregnant patients, highlighting the lack of data regarding the efficacy and safety of thrombolytic therapy for mother and fetus. METHODS: We describe the successful use of thrombolytic therapy in conjunction with ultrasound to remove a large ileofemoral DVT in a first-trimester patient with phlegmasia cerulea dolens. The procedure was performed safely for both mother and fetus. RESULTS: No radiation or contrast dye was used, and intravascular ultrasound confirmed patency of the entirety of the venous system. She delivered a healthy term baby after the procedure and had no further sequalae. CONCLUSION: Thrombolysis with intravascular ultrasound may be considered in first-trimester pregnant patients with threatened limb due to DVT.


Assuntos
Veia Femoral/efeitos dos fármacos , Fibrinolíticos/administração & dosagem , Veia Ilíaca/efeitos dos fármacos , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Terapia Trombolítica , Tromboflebite/tratamento farmacológico , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Nascimento Vivo , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Tromboflebite/diagnóstico por imagem , Tromboflebite/fisiopatologia , Resultado do Tratamento , Ultrassonografia de Intervenção , Ultrassonografia Pré-Natal/métodos , Grau de Desobstrução Vascular
10.
BMJ ; 364: k5287, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700415

RESUMO

Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying sarcomere gene mutation. More than half of affected women recover systolic function, although some are left with a chronic cardiomyopathy, and a minority requires mechanical support or cardiac transplantation (or both). Other potential complications include thromboembolism and arrhythmia. Currently, management entails standard treatments for heart failure with reduced ejection fraction, with attention to minimizing potential adverse effects on the fetus in women who are still pregnant. Bromocriptine is one potential disease specific treatment under investigation. In this review, we summarize the current literature on peripartum cardiomyopathy, as well as gaps in the understanding of this condition and future research directions.


Assuntos
Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/etiologia , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/etiologia , Animais , Cardiomiopatias/diagnóstico , Cardiomiopatias/epidemiologia , Aconselhamento Diretivo , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Prognóstico , Fatores de Risco
11.
A A Pract ; 13(2): 44-47, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30807301

RESUMO

Cardiac disease is one of the leading causes of maternal mortality in developed countries. The presence of a mechanical valve is a predictor of cardiac complications in obstetric patients, likely due to the challenges associated with pregnancy hypercoagulability and the imperative of meticulous management of anticoagulation throughout pregnancy, delivery, and the postpartum and to prevent the devastating event of a mechanical valve thrombosis. We report on the management of a pregnant woman with a mechanical aortic valve found to have a thrombus at 37 weeks gestation. It was decided to perform cesarean delivery to allow for a reoperative mechanical aortic valve replacement 24 hours thereafter.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Trombose/cirurgia , Adulto , Cesárea , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/tratamento farmacológico , Implante de Prótese de Valva Cardíaca , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/etiologia , Trombose/etiologia , Resultado do Tratamento
12.
J Am Coll Cardiol ; 73(4): 457-476, 2019 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-30704579

RESUMO

Cardiovascular disease complicating pregnancy is rising in prevalence secondary to advanced maternal age, cardiovascular risk factors, and the successful management of congenital heart disease conditions. The physiological changes of pregnancy may alter drug properties affecting both mother and fetus. Familiarity with both physiological and pharmacological attributes is key for the successful management of pregnant women with cardiac disease. This review summarizes the published data, available guidelines, and recommendations for use of cardiovascular medications during pregnancy. Care of the pregnant woman with cardiovascular disease requires a multidisciplinary team approach with members from cardiology, maternal fetal medicine, anesthesia, and nursing.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Aleitamento Materno , Fármacos Cardiovasculares/farmacocinética , Doenças do Tecido Conjuntivo/complicações , Feminino , Fármacos Hematológicos/uso terapêutico , Hemodinâmica , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Teratogênios
13.
Medicine (Baltimore) ; 98(5): e14331, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702617

RESUMO

BACKGROUND: Phenylephrine is the current "gold standard' vasopressor used to treat maternal hypotension in women undergoing cesarean delivery with spinal anesthesia. Since 2015, various studies have explored the use of norepinephrine to manage maternal hypotension. We conducted this systematic review and meta-analysis of available randomized controlled trials (RCTs) to compare the efficacy and safety of norepinephrine and phenylephrine for the prevention and treatment of maternal hypotension. METHODS: A systematic literature search was conducted using electronic databases, including PubMed, MEDLINE, Embase (Embase.com), and the Cochrane CENTRAL register of controlled trials. Parturients underwent cesarean delivery with spinal anesthesia and received norepinephrine to prevent or treat hypotension were considered. Maternal outcomes, including incidences of hypotension, hypertension, bradycardia, intraoperative nausea and vomiting (IONV), maternal cardiac output (CO), and blood pressure (BP) control precision, as well as neonatal Apgar scores and umbilical cord blood analyses, were compared between groups. RESULTS: Three RCTs in 4 reports published between 2015 and 2018 were finally identified with a total of 294 parturients. We found there was no difference in effectiveness between norepinephrine and phenylephrine for the treatment of maternal hypotension (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.37-1.10, P = .11), and there was no difference in the occurrence of hypertension (OR 0.74; 95% CI 0.33-1.62, P = .45). Of note, compared to the phenylephrine group, parturients in the norepinephrine group were less likely to experience bradycardia (OR 0.29; 95% CI 0.12-0.68, P = .005) and IONV (OR 0.54; 95% CI, 0.29-0.99, P = .04). Further, we did not observe a difference between the two vasopressors in the incidence of neonatal Apgar scores < 7 at 1  and 5 minutes or in umbilical vein (UV) blood gas. However, evidence is insufficient to draw conclusions regarding the greater maternal CO and better BP control precision with the use of norepinephrine. CONCLUSION: This systematic review and meta-analysis shows norepinephrine provides similar efficacy to manage maternal hypotension compared to phenylephrine; additionally, showing advantage regarding certain side effects like bradycardia and IONV reduction. Accordingly, norepinephrine is a promising alternative to phenylephrine. However, before routine clinical application, more studies are warranted.


Assuntos
Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Hipotensão/tratamento farmacológico , Norepinefrina/uso terapêutico , Fenilefrina/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Vasoconstritores/uso terapêutico , Feminino , Humanos , Hipotensão/etiologia , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia
16.
Turk Kardiyol Dern Ars ; 47(1): 63-68, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30628904

RESUMO

Pregnancy is associated with an increased risk of valve thrombosis in patients with a mechanical prosthetic heart valve. The administration of low molecular weight heparin (LMWH) with regular anti-factor Xa assessment is a recommended treatment modality for these patients. Presently described are 3 cases of therapy with LMWH during pregnancy. Despite frequent anti-factor Xa monitoring, not surprisingly, all of them developed prosthetic valve thrombosis.


Assuntos
Anticoagulantes/uso terapêutico , Próteses Valvulares Cardíacas/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Trombose/tratamento farmacológico , Adulto , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/prevenção & controle , Trombose/prevenção & controle
17.
Harefuah ; 158(1): 53-59, 2019 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-30663295

RESUMO

INTRODUCTION: Venous thromboembolism (VTE) is a potentially life-threatening medical condition during pregnancy and the puerperium. During pregnancy, the risk of VTE is increased four to tenfold compared to non-pregnant women of comparable age. The risk is even higher in the puerperium. Physician awareness followed by adequate treatment may reduce the number of events. The most important risk factors are previous VTE or thrombophilia, although other acquired risk factors may result in similar impacts. Treatment is based on personalized risk assessment at the first patient visit during pregnancy, followed by repeated assessment of complications or at admission and final assessment at delivery. Hydration and mobilization are advised for all women. Pharmacological prevention by low-molecular-weight heparin (LMWH) is advised based on risk stratification. International guidelines differ by indications and range of management options. The purpose of this review is to summarize our knowledge on risk factors for VTE during pregnancy and puerperium and guide management options.


Assuntos
Complicações Cardiovasculares na Gravidez , Tromboembolia Venosa , Anticoagulantes/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Período Pós-Parto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Fatores de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico
18.
Trends Cardiovasc Med ; 29(3): 164-173, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30111492

RESUMO

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period. While the disease is relatively uncommon, its incidence is rising. It is a form of idiopathic dilated cardiomyopathy, defined as pregnancy-related left ventricular dysfunction, diagnosed either towards the end of pregnancy or in the months following delivery, in women without any other identifiable cause. The clinical presentation, diagnostic assessment and treatment usually mirror that of other forms of cardiomyopathy. Timing of delivery and management require a multidisciplinary approach and individualization. Subsequent pregnancies generally carry risk, but individualization is required depending on the pre-pregnancy left ventricular function. Recovery occurs in most women on standard medical therapy for heart failure with reduced ejection fraction, more frequently than in other forms of nonischemic cardiomyopathy. The purpose of this review is to summarize the current state of knowledge with regard to diagnosis, treatment and management, with a focus on long term implications.


Assuntos
Cardiomiopatia Dilatada/tratamento farmacológico , Fármacos Cardiovasculares/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Disfunção Ventricular Esquerda/tratamento farmacológico , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/epidemiologia , Cardiomiopatia Dilatada/fisiopatologia , Fármacos Cardiovasculares/efeitos adversos , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Volume Sistólico/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos
19.
J Matern Fetal Neonatal Med ; 32(14): 2418-2428, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29378443

RESUMO

BACKGROUND: Changes in the coagulation system during pregnancy and puerperium produce a physiological hypercoagulable state. These changes are thought to be the cause of the higher rates of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, and mechanical prosthetic valve thrombosis (PVT) during pregnancy. Thrombolysis can be a treatment option in this case. However, there are no available data from randomized controlled trials in pregnant patients and information about the security of thrombolytics in pregnancy is missing. OBJECTIVE: The aim of this review is to summarize the available data regarding the use of thrombolytic agents in pregnancy, describing maternal and fetal outcomes. METHODS: A systematic review was performed, searching the electronic database MEDLINE for relevant studies published up to April 2017. The search included MeSH terms "thrombolytic therapy" OR "fibrinolysis" OR "streptokinase" OR "tissue plasminogen activator" AND "pregnancy". All publications that reported the use of a thrombolytic agent for DVT, PE, stroke or PVT in pregnancy were included in the review. Data on the type and total dose of the thrombolytic agent, gestational week, outcome of mothers and children, preterm delivery and bleeding complications were described. RESULTS: Sixty-five articles have been published describing outcomes in 141 pregnant women with serious thrombotic events. There have been no randomized trials involving the use of thrombolytics in pregnancy. Only one prospective study was found. Four maternal deaths (2.8%), 12 major bleeding episodes (8.5%), 13 mild/moderate bleeding episodes (9.2%), two fetal death (1.4%), one child death (0.7%), nine miscarriages (6.4%), and 14 preterm delivery (9.9%) were described. CONCLUSIONS: The risk of using thrombolytics in pregnancy seems reasonable taking into account the risk of death in a life-threatening event, with the majority of cases presented in this article resulting in encouraging outcomes. The complication rate of thrombolytic treatment does not seem higher in pregnant women than in the nonpregnant. Poor fetal outcome occurred in mothers with poor prognosis. Specific consensus recommendations are needed in the use of thrombolytics in pregnancy.


Assuntos
Fibrinolíticos/administração & dosagem , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Gravidez , Resultado da Gravidez/epidemiologia , Terapia Trombolítica
20.
Ultrasound Obstet Gynecol ; 53(5): 638-648, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29380922

RESUMO

OBJECTIVES: Raised vascular function measures are associated with adverse maternal and perinatal outcomes in low-risk pregnancy. This study aimed to evaluate the association between longitudinal vascular function parameters and adverse outcome in pregnant women with chronic hypertension, and to assess whether these measures vary according to baseline parameters such as black ethnicity. METHODS: This was a nested cohort study of women with chronic hypertension and a singleton pregnancy recruited to the PANDA (Pregnancy And chronic hypertension: NifeDipine vs lAbetalol as antihypertensive treatment) study at one of three UK maternity units. Women had serial pulse-wave analyses performed using the Arteriograph®, while in a sitting position, from 12 weeks' gestation onwards. Statistical analysis was performed using random-effects logistic regression models. Longitudinal vascular parameters were compared between women who developed superimposed pre-eclampsia (SPE) and those who did not, between women who delivered a small-for-gestational-age (SGA) infant (birth weight < 10th centile) and those who delivered an infant with birth weight ≥ 10th centile and between women of black ethnicity and those of non-black ethnicity. RESULTS: The cohort included 97 women with chronic hypertension and a singleton pregnancy, of whom 90% (n = 87) were randomized to antihypertensive treatment and 57% (n = 55) were of black ethnicity, with up to six (mean, three) longitudinal vascular function assessments. SPE was diagnosed in 18% (n = 17) of women and 30% (n = 29) of infants were SGA. In women who developed subsequent SPE, compared with those who did not, mean brachial systolic blood pressure (SBP) (148 mmHg vs 139 mmHg; P = 0.002), mean diastolic blood pressure (DBP) (87 mmHg vs 82 mmHg; P = 0.01), mean central aortic pressure (139 mmHg vs 128 mmHg; P = 0.001) and mean augmentation index (AIx-75) (29% vs 22%; P = 0.01) were significantly higher across gestation. In women who delivered a SGA infant compared to those who delivered an infant with birth weight ≥ 10th centile, mean brachial SBP (146 mmHg vs 138 mmHg; P = 0.001), mean DBP (86 mmHg vs 82 mmHg; P = 0.01), mean central aortic pressure (137 mmHg vs 127 mmHg; P < 0.0001) and mean pulse-wave velocity (9.1 m/s vs 8.5 m/s; P = 0.02) were higher across gestation. No longitudinal differences were found in vascular function parameters in women of black ethnicity compared with those of non-black ethnicity. CONCLUSION: There were persistent differences in vascular function parameters and brachial blood pressure throughout pregnancy in women with chronic hypertension who later developed adverse maternal or perinatal outcome. Further investigation into the possible clinical use of these findings is warranted. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Pressão Sanguínea , Hipertensão/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Análise de Onda de Pulso/estatística & dados numéricos , Adulto , Anti-Hipertensivos/uso terapêutico , Peso ao Nascer , Doença Crônica , Estudos de Coortes , Estudos de Viabilidade , Feminino , Idade Gestacional , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Labetalol/uso terapêutico , Estudos Longitudinais , Nifedipino/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/etnologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/etnologia , Resultado da Gravidez/etnologia , Análise de Regressão , Resultado do Tratamento
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