Baroreflex control of heart rate is impaired in pre-eclampsia.

Autonomic nervous dysfunction, such as parasympathetic and sympathetic impairment, has been suggested as possible cause of pre-eclampsia, but the studies are not conclusive. Our purpose was to assess non-invasively if pre-eclampsia is associated with a decreased baroreflex function. Nine women with pre-eclampsia (PE), eight normotensive pregnant women, and seven healthy normotensive non-pregnant women were studied. Continuous finger blood pressure was recorded by a Portapres device in the left lateral recumbent position and active standing. Baroreflex gain was evaluated by cross-spectral analysis of systolic blood pressure and pulse interval. The result was that baroreflex gain at rest was lower in pre-eclamptic women both compared to non-pregnant and healthy pregnant subjects (P<0.05). Moreover, a decrease of the baroreflex sensitivity was present in all pregnant women in the orthostatic position (P<0.05). In conclusion pregnancy per se is associated with a decrease in the baroreflex control of the heart, whereas in pre-eclampsia, the baroreflex sensitivity is impaired further.

Re-appraisal of treatment of congenital club foot.

Residual deformity following the treatment of club foot is still very common and in many cases it is the result of the treatment itself. The traditional treatment of this condition is undergoing a critical reappraisal with a swing towards surgery in the earlier stages. The Turco technique is discussed and the results in seventeen patients over one year of age are presented.

24-hour blood pressure monitoring to evaluate the effects of nifedipine in pre-eclampsia and in chronic hypertension in pregnancy.

OBJECTIVE: To investigate the effect of 7 to 14 days of therapy with nifedipine (sustained-release preparation) on the 24-hour blood pressure patterns of pregnant women with pre-eclampsia or chronic hypertension, and to test the utility of blood pressure monitoring in modulating the timing and dosage of the drug. DESIGN: 24-hour automatic blood pressure monitoring of pregnant women with pre-eclampsia or chronic hypertension before and after nifedipine treatment. SETTING: Centre for Prevention, Diagnosis and Treatment of Hypertension in Pregnancy, University of Turin, Italy. POPULATION: Sixteen pregnant women with pre-eclampsia and 17 with chronic hypertension. METHODS: 24-hour blood pressure monitoring was performed before the beginning of the therapy and after 7 to 14 days of treatment with sustained-release nifedipine. MAIN OUTCOME MEASURES: Chronobiological analysis of systolic and diastolic blood pressure values was performed; MESOR, amplitude, acrophase, hyperbaric index, percent time elevation and significance of rhythm were calculated before and after treatment. RESULTS: 6336 blood pressure measurements were analysed. Systolic and diastolic MESOR values were significantly decreased after nifedipine treatment both in pre-eclampsia and in chronic hypertension. However, the antihypertensive effect of nifedipine in pre-eclampsia was especially pronounced during evening and night, while in chronic hypertension it was more constant during the 24-hour period. 24-hour blood pressure monitoring allowed adjustment, when necessary, to the timing and dosage of nifedipine in accordance with the blood pressure patterns of each patient, using the hyperbaric index and percent time elevation as objective parameters for the evaluation of treatment efficacy. CONCLUSIONS: 24-hour blood pressure monitoring is a good method to optimise treatment, and confirms that nifedipine is useful for the control of maternal blood pressure in pregnancy.

Twenty-four hour blood pressure monitoring in early pregnancy: is it predictive of pregnancy-induced hypertension and preeclampsia?

OBJECTIVE: To investigate whether a chronobiological analysis applied to automated 24-hour blood pressure monitoring in early pregnancy provides objective parameters enabling detection of single patients at risk of pregnancy-induced hypertension or preeclampsia. METHODS: 24-hour automatic blood pressure monitoring was performed at 8-16 and 20-25 gestational weeks in 104 women at risk of pregnancy-induced hypertension or preeclampsia. The subjects were hospitalized to be synchronized to rest-activity and meal-timing schedules. All women were followed longitudinally until post-partum. Chronobiological analysis of blood pressure values was performed; sensitivity, specificity and predictive values of MESOR and hyperbaric index were also calculated. Incidence of pregnancy-induced hypertension or preeclampsia, gestational week at delivery and birthweight were recorded. RESULTS: Nine thousand nine hundred and eighty-four blood pressure measurements were analyzed. In patients who later developed overt hypertension, systolic and diastolic blood pressure MESOR, hyperbaric index and percent time elevation were already significantly higher in early pregnancy than in those who remained normotensive. The best sensitivity and specificity was obtained between 20-25 weeks of gestation with systolic single cosinor MESOR and Hyperbaric Index using as cut-off 103 mmHg (sensitivity: 88%; specificity: 75%) and 10 mmHg/24 hour (sensitivity: 70%; specificity: 92%), respectively. CONCLUSIONS: The chronobiological analysis applied to 24-hour blood pressure monitoring during pregnancy allows definition of objective cut-off values which can be particularly useful in the routine clinical practice when the risk of developing pregnancy-induced hypertension or preeclampsia must be calculated in the individual subject.

Corticotropin-releasing hormone increases prostaglandin F2 alpha activity on human myometrium in vitro.

OBJECTIVE: Our purpose was to study the capability of synthetic corticotropin-releasing hormone to directly stimulate human myometrium and to modulate the activity of prostaglandins F2 alpha and E2. STUDY DESIGN: Strips from human myometrium were obtained from 127 elective cesarean sections at term. The in vitro effect of human rat corticotropin-releasing hormone on myometrial contractility has been studied in resting myometrial strips mounted in a two-chamber bath for isolated organs. Stimuli (corticotropin-releasing hormone, prostaglandins F2 alpha and E2, and oxytocin) were administered as one single dose in the perfusion chamber. In each experiment one myometrial strip was used as a control. RESULTS: Corticotropin-releasing hormone significantly increases (p < 0.01) the myometrial response to prostaglandin F2 alpha. The hormone neither has a direct inotropic effect nor is it able to enhance the effect of prostaglandin E2 and oxytocin on myometrial strips. CONCLUSION: The positive effect of corticotropin-releasing hormone on the myometrial response to prostaglandin F2 alpha adds new support to the theory that placental corticotropins may modulate the onset of labor.