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1.
Hypertension ; 74(5): 1089-1095, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31495278

RESUMO

We estimated changes in the prevalence of chronic hypertension among pregnant women and evaluated the extent to which changes in obesity and smoking were associated with these trends. We designed a population-based cross-sectional analysis of over 151 million women with delivery-related hospitalizations in the United States, 1970 to 2010. Maternal age, year of delivery (period), and maternal year of birth (birth cohort), as well as race, were examined as risk factors for chronic hypertension. Prevalence rates and rate ratios with 95% CIs of chronic hypertension in relation to age, period, and birth cohort were derived through age-period-cohort models. We also examined how changes in obesity and smoking rates influenced age-period-cohort effects. The overall prevalence of chronic hypertension was 0.63%, with black women (1.24%) having more than a 2-fold higher rate than white women (0.53%; rate ratio, 2.31; 95% CI, 2.30-2.32). In the age-period-cohort analysis, the rate of chronic hypertension increased sharply with advancing age and period from 0.11% in 1970 to 1.52% in 2010 (rate ratio, 13.41; 95% CI, 13.22-13.61). The rate of hypertension increased, on average, by 6% (95% CI, 5-6) per year, with the increase being slightly higher among white (7%; 95% CI, 6%-7%) than black (4%; 95% CI, 3%-4%) women. Adjustments for changes in rates of obesity and smoking were not associated with age and period effects. We observed a substantial increase in chronic hypertension rates by age and period and an over 2-fold race disparity in chronic hypertension rates.


Assuntos
Afro-Americanos/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Idade Materna , Obesidade/complicações , Fumar/efeitos adversos , Adolescente , Adulto , Fatores Etários , Doença Crônica , Estudos Transversais , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Pessoa de Meia-Idade , Gravidez , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estados Unidos , Adulto Jovem
2.
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
3.
Lancet ; 394(10203): 1011-1021, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31378394

RESUMO

BACKGROUND: Hypertension is the most common medical disorder in pregnancy, complicating one in ten pregnancies. Treatment of severely increased blood pressure is widely recommended to reduce the risk for maternal complications. Regimens for the acute treatment of severe hypertension typically include intravenous medications. Although effective, these drugs require venous access and careful fetal monitoring and might not be feasible in busy or low-resource environments. We therefore aimed to compare the efficacy and safety of three oral drugs, labetalol, nifedipine retard, and methyldopa for the management of severe hypertension in pregnancy. METHODS: In this multicentre, parallel-group, open-label, randomised controlled trial, we compared these oral antihypertensives in two public hospitals in Nagpur, India. Pregnant women were eligible for the trial if they were aged at least 18 years; they were pregnant with fetuses that had reached a gestational age of at least 28 weeks; they required pharmacological blood pressure control for severe hypertension (systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg); and were able to swallow oral medications. Women were randomly assigned to receive 10 mg oral nifedipine, 200 mg oral labetalol (hourly, in both of which the dose could be escalated if hypertension was maintained), or 1000 mg methyldopa (a single dose, without dose escalation). Masking of participants, study investigators, and care providers to group allocation was not possible because of different escalation protocols in the study groups. The primary outcome was blood pressure control (defined as 120-150 mm Hg systolic blood pressure and 70-100 mm Hg diastolic blood pressure) within 6 h with no adverse outcomes. This study is registered with ClinicalTrials.gov, number NCT01912677, and the Clinical Trial Registry, India, number ctri/2013/08/003866. FINDINGS: Between April 1, 2015, and Aug 21, 2017, we screened 2307 women for their inclusion in the study. We excluded 1413 (61%) women who were ineligible, declined to participate, had impending eclampsia, were in active labour, or had a combination of these factors. 11 (4%) women in the nifedipine group, ten (3%) women in the labetalol group, and 11 (4%) women in the methyldopa group were ineligible for treatment (because they had only one qualifying blood pressure measurement) or had treatment stopped (because of delivery or transfer elsewhere). 894 (39%) women were randomly assigned to a treatment group and were included in the intention-to-treat analysis: 298 (33%) women were assigned to receive nifedipine, 295 (33%) women were assigned to receive labetalol, and 301 (33%) women were assigned to receive methyldopa. The primary outcome was significantly more common in women in the nifedipine group than in those in the methyldopa group (249 [84%] women vs 230 [76%] women; p=0·03). However, the primary outcome did not differ between the nifedipine and labetalol groups (249 [84%] women vs 228 [77%] women; p=0·05) or the labetalol and methyldopa groups (p=0·80). Seven serious adverse events (1% of births) were reported during the study: one (<1%) woman in the labetalol group had an intrapartum seizure and six (1%) neonates (one [<1%] neonate in the nifedipine group, two [1%] neonates in the labetalol group, and three [1%] neonates in the methyldopa group) were stillborn. No birth had more than one adverse event. INTERPRETATION: All oral antihypertensives reduced blood pressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs-methyldopa, nifedipine, and labetalol-are viable initial options for treating severe hypertension in low-resource settings. FUNDING: PREEMPT (University of British Columbia, Vancouver, BC, Canada; grantee of Bill & Melinda Gates Foundation).


Assuntos
Anti-Hipertensivos/administração & dosagem , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Labetalol/administração & dosagem , Metildopa/administração & dosagem , Nifedipino/administração & dosagem , Administração Oral , Adulto , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Resultado do Tratamento , Adulto Jovem
4.
Cardiol Clin ; 37(3): 345-354, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279428

RESUMO

Hypertensive disorders of pregnancy are common and contribute inordinately to maternal and fetal morbidity and mortality. Although not completely understood, recent clinical trials have provided important insights into pathogenesis of preeclampsia. Preeclampsia is considered a systemic disease with generalized endothelial dysfunction and risk of future cardiovascular disease. This review revisits the definitions and classifications of hypertensive disorders of pregnancy; discusses updates on pathophysiology, prevention, and early prediction of preeclampsia; reviews current management guidelines; and discusses potential risks and benefits associated with treatment. Improvement in management and outcomes of women with hypertensive disorders of pregnancy seems in sight in the near future.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Induzida pela Gravidez , Feminino , Saúde Global , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Incidência , Gravidez , Fatores de Risco
6.
Ophthalmic Surg Lasers Imaging Retina ; 50(6): 393-397, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31233158

RESUMO

A 27-year-old woman with type 2 diabetes mellitus had mild diabetic retinopathy (DR) during the early gestation period. Optical coherence tomography angiography (OCTA) showed microaneurysms and small capillary nonperfusion with little change until before delivery. The patient later developed pregnancy-induced hypertension, which continued after delivery, and the DR worsened markedly. OCTA showed onset and recovery of paracentral acute middle maculopathy. Macular edema (ME) also developed, and OCTA showed irregular dilation in the radial peripapillary capillaries. After starting antihypertensive therapy, the capillary dilation and ME decreased. OCTA enables close follow-up of DR related to pregnancy during the perinatal period. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:393-397.].


Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico por imagem , Angiofluoresceinografia/métodos , Hipertensão Induzida pela Gravidez , Tomografia de Coerência Óptica/métodos , Adulto , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Edema Macular/tratamento farmacológico , Gravidez
7.
Int. j. morphol ; 37(2): 739-743, June 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1002287

RESUMO

La preeclampsia (PE) es un trastorno hipertensivo inducido por el embarazo donde se reduce la presión de la perfusión uterina. Investigaciones avalan el uso de dosis baja de aspirina (DBAAS) y su utilidad en la prevención de PE en gestantes con factores de riesgo. Sus beneficios en modelos animales sometidos a esta reduccción no están determinados. El objetivo de la investigación fue analizar la presión arterial sistémica y los hallazgos morfológicos a nivel renal en fetos de ratas con reducción de la presión de perfusión uterina (RPPU) expuestas a DBAAS en comparación a las no expuestas. Se conformaron cuatro grupos de ratas hembras preñadas Sprague Dawley (n=5). A los 14,5 días post-concepción (dpc), vía quirúrgica se indujo RPPU, ligando arterias uterinas, conformándose el grupo RPPU y el grupo RPPU+DBAAS al que se le administró 5 mg/kg/día de aspirina vía oral. El grupo control lo conformaron las no operadas y el grupo DBAAS se le administró aspirina en igual dosis desde el 14,5 dpc. A los 18,5 dpc, previo a la eutansia se midió la presión arterial sistémica con pletismógrafo caudal Insight v2.11 y se extrajeron los fetos. Se midió la longitud céfalo-caudal (LCC), se procesaron y tiñeron con hematoxilina-eosina, describiéndose cortes histológicos transversales a nivel renal. Se determinó que en la presión arterial media, hubo diferencias significativas entre el grupo RPPU y RPPU+DBAAS (p<0,05). El tamaño de los fetos fue menor en el grupo RPPU (p<0,0001), donde 1 feto presentó hernia umbilical congénita. La cuantificación de vesículas renales también fue menor (p<0,005). En conclusión, la administración de DBAAS disminuye los efectos inducidos por la RPPU en cuanto al tamaño fetal, morfología renal y malformaciones congénitas como hernia umbilical. En cuanto a la presión arterial sistémica, tendría efectos sólo en presión arterial media.


Preeclampsia (PE) is a hypertensive disorder induced by pregnancy where there is a reduction in the uterine perfusion pressure. Research supports the use of low dose aspirin (LDAAS) and its usefulness in the prevention of PE in pregnant women with risk factors. Their benefits in animal models subject to RUPP are not determined. The objective of the investigation was to analyze the systemic blood pressure and the morphological findings at renal level in fetuses of rats with reduction of uterine perfusion pressure (RUPP) exposed to LDAAS compared to those not exposed. Four groups of pregnant female rats Sprague Dawley (n=5) were formed. At 14.5 days post-conception (dpc), surgical RUPP was induced, ligating uterine arteries, with the RUPP group and RUPP+LDAAS group being given 5 mg/kg/day of aspirin orally. The control group was made up of those not operated and the LDAAS group was administered aspirin in the same dose from 14.5 dpc. A 18.5 dpc, prior to euthanasia systemic blood pressure was measured with flow plethysmograph Insight v2.11 and fetuses were extracted. The cephalo-caudal length (CCL) was measured, processed and stained with hematoxylin-eosin, describing transverse histological sections at the kidney level. It was determined that in the mean arterial pressure, there were significant differences between the group RUPP and RUPP+LDAAS (p <0.05). The size of the fetuses was lower in the RUPP group (p <0.0001), where one fetus presented congenital umbilical hernia. The quantification of renal vesicles was also lower (p <0.005). In conclusion, the administration of LDAAS decreases the effects induced by RUPP in terms of fetal size, renal morphology and congenital malformations such as umbilical hernia. Regarding the systemic blood pressure, effects would only mean arterial pressure.


Assuntos
Animais , Feminino , Gravidez , Ratos , Pressão Sanguínea/efeitos dos fármacos , Aspirina/administração & dosagem , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Perfusão , Fluxo Sanguíneo Regional , Útero/irrigação sanguínea , Aspirina/farmacologia , Estudos Prospectivos , Estudos Longitudinais , Ratos Sprague-Dawley , Feto , Pressão Arterial/efeitos dos fármacos
8.
Optom Vis Sci ; 96(5): 372-375, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31046021

RESUMO

SIGNIFICANCE: Pregnancy-induced hypertension is a unique yet common complication in pregnant women and may cause retinopathy. Optical coherence tomography (OCT) may help find the features of retinopathy that are difficult to observe through fundus examination. Not all patients can fully recover from retinopathy. PURPOSE: This report describes a case of pregnancy-induced hypertension with retinopathy and represents the features of retinopathy in OCT and fundus fluorescein angiography. CASE REPORT: A 29-year-old pregnant woman presented with bilateral blurred vision and xanthopsia 2 days before her induced labor; she was also diagnosed as pre-eclamptic in the obstetrics department. The vision in her right eye was 20/33, and that in her left eye was 20/20. Fundus fluorescein angiography showed scattered-dot hypofluorescence around the disc at an early stage, and needle-like hyperfluorescence gradually appeared near the disc with late-stage fluorescein leakage in both eyes. Optical coherence tomography revealed multiple shallow retinal detachments with hyperreflective bright spots in the outer retina and clumped hyperreflective materials on the retinal pigment epithelium (RPE). CONCLUSIONS: Typical findings and some tiny changes in the outer retina and RPE can be observed through spectral-domain OCT. The clumped hyperreflective deposits in the outer retina may be by-products of RPE swelling and necrosis that lead to barrier dysfunctions and fluid leakage. These described features may help diagnose retinopathy from pregnancy-induced hypertension. Although it is a self-limited disease, the disruptions in the ellipsoid and interdigitation zones may not fully recover and result in reduced visual dysfunction. Therefore, control of hypertension is indicated.


Assuntos
Hipertensão Induzida pela Gravidez/diagnóstico por imagem , Descolamento Retiniano/diagnóstico por imagem , Epitélio Pigmentado da Retina/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adulto , Pressão Sanguínea/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Angiofluoresceinografia/métodos , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Sulfato de Magnésio/uso terapêutico , Nifedipino/uso terapêutico , Gravidez , Descolamento Retiniano/tratamento farmacológico , Epitélio Pigmentado da Retina/efeitos dos fármacos , Vasodilatadores/uso terapêutico , Acuidade Visual/fisiologia
10.
Clin Perinatol ; 46(2): 173-185, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010554

RESUMO

This article reviews the pharmacology of the most commonly used antihypertensive medications during pregnancy; their mechanism of action; and the effects on the mother, the fetus, and lactation. Each class of antihypertensive pharmacologic agents have specific mechanisms of action by which they exert their antihypertensive effect. ß-Adrenoreceptor antagonists block these receptors in the peripheral circulation. Calcium channel blockers result in arterial vasodilation. α-Agonists inhibit vasoconstriction. Methyldopa is a centrally acting adrenoreceptor antagonist. Vasodilators have a direct effect on vascular smooth muscle. Diuretics decrease intravascular volume. Medications acting on the angiotensin pathway are avoided during pregnancy because of fetotoxic effects.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão/tratamento farmacológico , Pré-Eclâmpsia/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Aspirina/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doença Crônica , Clonidina/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Diuréticos/uso terapêutico , Feminino , Humanos , Hidralazina/uso terapêutico , Hipertensão Induzida pela Gravidez/prevenção & controle , Troca Materno-Fetal , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/tratamento farmacológico
11.
Expert Opin Pharmacother ; 20(8): 963-982, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30943045

RESUMO

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) represent a major cause of maternal, fetal and neonatal morbidity and mortality and identifies women at risk for cardiovascular and other chronic diseases later in life. When antihypertensive drugs are used during pregnancy, their benefit and harm to both mother and fetus should be evaluated. AREAS COVERED: This review summarizes the pharmacological characteristics of the recommended antihypertensive drugs and their impact on mother and fetus when administered during pregnancy and/or post-partum. Drugs were identified using MEDLINE and the main international Guidelines for the management of HDP. EXPERT OPINION: Although there is a consensus that severe hypertension should be treated, treatment of mild hypertension without end-organ damage (140-159/90-109 mmHg) remains controversial and there is no agreement on when to initiate therapy, blood pressure targets or recommended drugs in the absence of robust evidence for the superiority of one drug over others. Furthermore, the long-term outcomes of in-utero antihypertensive exposure remain uncertain. Therefore, evidence-based data regarding the treatment of HDP is lacking and well designed randomized clinical trials are needed to resolve all these controversial issues related to the management of HDP.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Feminino , Humanos , Período Pós-Parto , Gravidez
12.
J Coll Physicians Surg Pak ; 29(3): 231-234, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30823948

RESUMO

OBJECTIVE: To investigate the effect of magnesium sulfate combined with phentolamine and nifedipine for the treatment of gestational hypertension and on the levels of serum LIF and Apelin. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Obstetrics and Gynecology Clinics, The Affiliated Hospital North China University of Science and Technology, China, from September 2016 to February 2018. METHODOLOGY: One hundred and sixty patients with gestational hypertension were randomly divided into a control group and an observation group, 80 patients in each group. Control group was given magnesium sulfate alone, while observation group was added with phentolamine and nifedipine on the basis of the treatment in control group. Curative effects, pregnancy outcomes, and levels of serum LIF and Apelin were compared. RESULTS: The total effective rate of treatment in the observation group was higher than that in the control group (p=0.005). After treatment, level of serum LIF in the observation group was higher than that in the control group (p<0.001), and level of serum Apelin in the observation group was lower than that in the control group (p<0.001). Incidence of premature birth, cesarean section and neonatal asphyxia in the observation group were all lower than those in the control group (p=0.005, p<0.001 and p=0.005, respectively), while there was no significant difference in the incidence of neonatal death between the two groups (p=0.316). CONCLUSION: Magnesium sulfate combined with phentolamine and nifedipine has a better therapeutic effect on gestational hypertension, which can effectively regulate the levels of serum LIF and Apelin and improve pregnancy outcomes.


Assuntos
Apelina/sangue , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Fator Inibidor de Leucemia/sangue , Sulfato de Magnésio/uso terapêutico , Fentolamina/uso terapêutico , Resultado da Gravidez , Adulto , Biomarcadores/sangue , China , Quimioterapia Combinada , Feminino , Seguimentos , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Medição de Risco
13.
Eur J Obstet Gynecol Reprod Biol ; 236: 46-52, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30878897

RESUMO

OBJECTIVE: To compare the efficacy of intravenous labetalol with oral nifedipine in the treatment of severe hypertension in pregnancy with blood pressure ≥160/110 mm Hg. DESIGN, SETTING AND PARTICIPANTS: We conducted a parallel double-blinded randomized controlled trial between December 2014 to December 2016 in 120 antenatal women of gestational age >28 weeks, admitted with severe hypertension of blood pressure ≥160/110 mm Hg to maternity ward at a tertiary hospital. The labetalol group received 20 mg initially followed by escalating doses of 40 mg, 80 mg, 80 mg and 80 mg (5 doses) every 15 min to a maximum of 300 mg. Nifedipine group received 10 mg initially followed by repeated doses of 20 mg every 15 min (total 5 doses) to a maximum of 90 mg. Vital signs were recorded every 15 min. -The time taken and the number of doses required to achieve the target blood pressure (150/100 mmHg). Survival analysis was used to compare the efficacy of treatment regimens. RESULTS: Sixty women were randomised to each group and none were lost to follow-up. None of the patients in nifedipine group required labetalol, whereas three patients in labetalol group achieved target BP only after receiving nifedipine was administered after the maximum dose of labetalol.The mean time taken to achieve the target blood pressure in the labetalol group was higher (36.75 min) than in the nifedipine group (27.25 min) [mean difference 9.5 min,p = 0.002]. Nifedipine group required significantly lower doses (1.82 ± 0.83) as compared to labetalol (2.45 ± 1.32) [p = 0.002]. Nifedipine was 1.8 times more likely to achieve target blood pressure (Hazard Ratio = 1.8). CONCLUSIONS: Both intravenous Labetalol and oral Nifedipine were effective in controlling blood pressure. Nifedipine reduced BP more rapidly than Labetalol. Oral Nifedipine may be a better alternative because of its ease of oral administration and a flat dosing regimen.


Assuntos
Anti-Hipertensivos/administração & dosagem , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Labetalol/administração & dosagem , Nifedipino/administração & dosagem , Administração Intravenosa , Administração Oral , Método Duplo-Cego , Feminino , Humanos , Gravidez , Estudos Prospectivos , Adulto Jovem
14.
Pak J Pharm Sci ; 32(1): 213-215, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30772811

RESUMO

To evaluate the anti-hypertensive drugs used in pregnancy induced hypertension and to determine the safety of the anti-hypertensive drugs administered in gestational hypertensive patients. Pregnancy induced hypertension are very common in women and if unnoticed may lead to severe complications. The appropriate therapy is very much essential for the welfare of both the mother and the child. Hence this study was undertaken to identify the commonly used and safe drugs in pregnancy induced hypertension. This retrospective study was carried out in the Medical Records Department of a specialized gynecological hospital. Patient details - Name, Age, Sex, Occupation, Body Mass Index (BMI), Social History (SH), Past Medical History (PMH), Diagnosis, mother weight and BP, baby weight, specific anti-hypertensives given, outcome, complication in both mother and baby if any, duration of anti-hypertensive drug use, duration of hospital stay were all recorded in a proforma. Adverse Drug Reactions for anti-hypertensive drugs given were also noted. Nifedipine was the most common drug prescribed both in monotherapy and dual therapy. Adverse drug reaction was seen only in 2% of patients. Pregnancy induced hypertension is one of the riskiest conditions to occur during pregnancy. Dietary modification and lifestyle modification might help in controlling pre-eclampsia.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Adulto , Anti-Hipertensivos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/fisiopatologia , Segurança do Paciente , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
15.
PLoS One ; 14(1): e0208873, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625154

RESUMO

Postpartum hemorrhage (PPH) remains a leading cause of maternal death worldwide, and it is important to understand the relative contributions of different risk factors. We assessed the incidence of these among cases of transvaginal delivery. Between June 2013 and July 2016, a prospective cohort study was conducted at a tertiary perinatal medical facility in Japan. Women were administered a questionnaire to ascertain risk factors for PPH, defined as a blood loss of 1,000 ml or more assessed using a calibrated under-buttocks drape and collection vessel at childbirth. We analyzed 1,068 transvaginal deliveries of singleton pregnancies. The incidence of PPH was 8.7%, and of severe PPH (1,500 ml blood loss or more) was 2.1%. Risk factors for postpartum hemorrhage among the deliveries were: fetal macrosomia (over 4000 g); pregnancy-induced hypertension; pregnancy generated by assisted reproductive technology; severe vaginal or perineal lacerations; and weight gain over 15 kg during pregnancy. Such high weight gain significantly increased the incidence of PPH compared with women showing less than 10 kg weight gain during pregnancy. Monitoring these identified risk factors could enable extra vigilance during labor, and preparedness for managing PPH in all women giving birth.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Adulto , Feminino , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão Induzida pela Gravidez/etiologia , Incidência , Japão/epidemiologia , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/tratamento farmacológico , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
16.
Obstet Gynecol ; 133(2): 409-412, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30681541

RESUMO

Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30-60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Intravenous labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available. In the rare circumstance that intravenous bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal-fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Tratamento de Emergência , Feminino , Humanos , Gravidez
17.
Basic Clin Pharmacol Toxicol ; 124(4): 385-393, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30318719

RESUMO

Pre-eclampsia and hypertensive disorders of pregnancy are frequently associated with foeto-placental growth restriction, and that may be triggered by angiogenic imbalance and endothelial dysfunction. Impaired nitric oxide (NO) bioavailability seems to be involved in these pathophysiological changes observed in hypertensive pregnancy. Pravastatin has shown efficacy and to be safe during hypertension in pregnancy. However, NO involvement in pravastatin effects during maternal hypertension and foeto-placental development is unclear. Therefore, we aimed to examine pravastatin effects on placental NO formation, endothelium-dependent vasodilation, systolic blood pressure and foeto-placental development in hypertensive pregnant rats. Biochemical determinants of angiogenesis and oxidative stress were also assessed. Pregnant rats were distributed into four groups: normal pregnancy (Norm-Preg), pregnancy+pravastatin (Preg-Prava), hypertensive pregnancy (HTN-Preg) and hypertensive pregnancy+pravastatin (HTN-Preg+Prava). Our results showed that pravastatin treatment blunts hypertension and foeto-placental growth restriction. Also, increases in placental NO levels were found in the HTN-Preg+Prava group. Pravastatin prevents impaired endothelium-dependent acetylcholine-induced vasodilation, exacerbated contractile response to phenylephrine and increases in oxidative stress in the HTN-Preg+Prava group. Increased soluble fms-like tyrosine kinase-1-to-placental growth factor (sFlt-1/PlGF) ratio is reversed by pravastatin treatment in the HTN-Preg+Prava group. We conclude that NO formation and endothelium-dependent vasodilation underlie pleiotropic effects associated with pravastatin treatment against hypertension in pregnancy, intrauterine growth restriction, vascular dysfunction and angiogenic imbalance.


Assuntos
Hipertensão Induzida pela Gravidez/tratamento farmacológico , Estresse Oxidativo/efeitos dos fármacos , Placenta/efeitos dos fármacos , Pravastatina/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Feminino , Retardo do Crescimento Fetal/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Neovascularização Fisiológica/efeitos dos fármacos , Óxido Nítrico/metabolismo , Placenta/metabolismo , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/fisiopatologia , Gravidez , Ratos , Ratos Wistar , Vasodilatação/efeitos dos fármacos
18.
Int J Gynaecol Obstet ; 144(1): 27-36, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30307609

RESUMO

OBJECTIVE: To estimate the effect of locally tailored clinical guidelines on intrapartum care and perinatal outcomes among women with severe hypertensive disorders in pregnancy (sHDP). METHODS: A pre-post study at Zanzibar's low-resource Mnazi Mmoja Hospital was conducted. All labouring women with sHDP were included at baseline (October 2014 to January 2015) and at 9-12 months after implementation of the ongoing intervention (October 2015 to January 2016). Background characteristics, clinical practice, and delivery outcomes were assessed by criterion-based case file reviews. RESULTS: Overall, 188 of 2761 (6.8%) women had sHDP at baseline, and 196 of 2398 (8.2%) did so during the intervention months. The median time between last blood pressure recording and delivery decreased during the intervention compared with baseline (P=0.015). Among women with severe hypertension, antihypertensive treatment increased during the intervention compared with baseline (relative risk [RR] 1.37, 95% confidence interval [CI] 1.14-1.66). Among the neonates delivered (birthweight ≥1000 g), stillbirths decreased (RR 0.56, 95% CI 0.35-0.90) and Apgar scores of seven or more increased during the intervention compared with baseline (RR 1.17, 95% CI 1.03-1.33). CONCLUSION: Although health system strengthening remains crucial, locally tailored clinical guidelines seemed to help work-overloaded birth attendants at a low-resource hospital to improve care for women with sHDP. CLINICALTRIALS.ORG: NCT02318420.


Assuntos
Anticonvulsivantes/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Parto Obstétrico/estatística & dados numéricos , Hidralazina/administração & dosagem , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Guias de Prática Clínica como Assunto , Índice de Apgar , Feminino , Humanos , Recém-Nascido , Tocologia/métodos , Pobreza , Gravidez , Resultado da Gravidez/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Natimorto/epidemiologia , Tanzânia/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
19.
Obstet Gynecol ; 133(2): e174-e180, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30575639

RESUMO

Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30-60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Intravenous labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available. In the rare circumstance that intravenous bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal-fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended.


Assuntos
Anti-Hipertensivos/administração & dosagem , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Tratamento de Emergência , Feminino , Humanos , Período Pós-Parto , Gravidez
20.
J Matern Fetal Neonatal Med ; 32(5): 857-863, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28994336

RESUMO

OBJECTIVE: To examine whether in patients with CH and mild to moderate hypertension the level of control of blood pressure during pregnancy has a beneficial or adverse effect on the risk of PE or SGA. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials of patients with mild to moderate CH in pregnancy that reported the impact of different levels of control of blood pressure on the risk of PE or SGA. We completed a literature search through PubMed, Embase, Cinahl, Web of science, Cochrane CENTRAL Library Relative risks with random effect were calculated with their 95% confidence intervals (95%CI). RESULTS: Six trials including 495 participants provided data on blood pressure (BP) after entry to the study. Four studies compared antihypertensive agents to no treatment and two studies compared antihypertensive agents to placebo. All trials were conducted between 1976 and 1990 and were considered to be at high risk of bias. There was high heterogeneity between studies for mean arterial pressure (MAP) after randomization (I2 = 87%) and SGA (I2 = 60%), but not for PE (I2 = 0%). There were large differences between studies in the inclusion criteria, antihypertensive regimens, targets of therapy, and gestational age range at entry to the trials. In women receiving antihypertensive therapy, compared to those receiving placebo or no treatment, the MAP after entry to the trial was significantly lower (mean difference -4.2 mmHg, 95%CI -6.6 to -1.8; p = .006). However, there was no significant reduction in the risk of PE (relative risks (RR) 1.03, 95%CI 0.63-1.68; p = .90) or SGA (RR 1.01, 95%CI 0.35-2.93; p = .99). CONCLUSIONS: The findings of the meta-analysis suggest that lowering the blood pressure by antihypertensive medication in women with mild to moderate hypertension in the context of CH has no significant effect on the risk of SGA or PE.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Doença Crônica , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Resultado da Gravidez
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