葛根素治疗妊娠期高血压疾病的研究

目的　探讨葛根素治疗妊娠期高血压疾病患者的母婴结局和血浆中一氧化氮 (NO)、血栓素B2(TXB2)、内皮素(ET)、6 酮 前列腺素F1α(6-Keto-PGF1α)的变化。方法　2001年 1月至 2004年 6月广东省妇幼保健院用葛根素(A组)和硫酸镁(B组)分别治疗 50例重度子疒间前期的患者,观察两组平均动脉压、尿蛋白、胎心率异常、新生儿窒息和产后出血、羊水混浊、新生儿出生体重等情况以及治疗前后血浆NO、TXB2、ET、6 Keto PGF1α的变化情况。结果　A组治疗前后平均动脉压分别为 ( 125.5±13.3 )mmHg( 1mmHg=0 133kPa)和(103.0±15.4)mmHg,血压有显著性下降 (P<0.05 ),B组治疗前后平均动脉压为 ( 123.0±12.3 )mmHg和(119.0±13 7)mmHg,差异无显著性(P>0.05),两组治疗前后 24h尿蛋白分别为A组 (3 91±0.46)g和 (1.53±0 61)g;B组(3.89±0.39)g和(1.50±0.35)g,两组治疗前后均有显著差异性 (P<0.05)。两组血浆细胞因子治疗前后均有显著差异性(P<0.05)。B组胎心异常率为 22%,明显高于A组(P<0.05)。结论　葛根素治疗妊娠期高血压疾病时能有效降低平均动脉压,改善母血中NO、TXB2、ET、6-Keto-PGF1α的水平,对治疗有积极的作用。     

Facility and personnel factors influencing magnesium sulfate use for eclampsia and pre-eclampsia in 3 Indian hospitals

Objective

To identify factors at the health facility and health professional levels that might hinder or facilitate the appropriate use of magnesium sulfate for the treatment of pre-eclampsia and eclampsia.

Methods

Seven focus group discussions were conducted with a purposively sampled group of obstetricians/gynecologists, medical residents, and nurses at 3 hospitals in Nagpur, India. Data were collected on facility and drug availability, criteria for diagnosis and management of pre-eclampsia and eclampsia, attitudes about magnesium sulfate use, and perceived barriers to the treatment of pre-eclampsia and eclampsia.

Results

Senior gynecologists seemed to encourage the use of magnesium sulfate, especially management prior to transfer to a higher facility. However, clinicians noted a lack of specific institutional guidelines on dose, timing, and indications, particularly in cases in which delivery was not imminent. In all facilities, service providers noted that their clinical care decisions were sometimes influenced by political and social factors, making management of eclampsia and pre-eclampsia cases difficult. Care was further challenged by limited drug availability, particularly at the tertiary-care center.

Conclusion

Limited drug supply and lack of specific institutional guidelines, equipment, and trained staff hinder the translation of evidence-based policy on magnesium sulfate into practice.     

Managing hypertensive disorders during pregnancy in low resource settings

ABSTRACT

Background: Maternal deaths caused by hypertensive disorders are preventable. The purpose was to assess midwives’ perceived knowledge and skills on the implementation of maternal health guidelines when managing hypertensive disorders during pregnancy.

Methods: Quantitative, cross-sectional method was used. Population comprised of 200 midwives. Data was collected through self-report questionnaires and analysed through Statistical Package for Social Sciences 24.

Results: Midwives (63.5%) possessed knowledge and skills of implementing maternal guidelines. While 77.5% experienced shortage of human and material resources. Non-compliance to ambulance services led to delayed initiation of treatment.

Recommendations: Continuous in-service training and education must be conducted. More resources to be provided to implement guidelines accurately.     

妊娠期高血压疾病患者子宫蜕膜组织中Th1/Th2比率变化研究

目的研究妊娠期高血压疾病患者子宫蜕膜组织中Th1和Th2细胞比率变化,探讨其变化在发病中的作用。方法河北医科大学第二临床医学院于2004年2～9月采集12例正常妊娠孕妇,10例妊娠期高血压和25例子疒间前期患者子宫蜕膜组织,采用流式细胞技术分别检测Th1/Th2细胞比率。结果(1)子疒间前期组和妊娠期高血压组Th1/Th2细胞比率明显高于正常妊娠组(P<0.05)。(2)子疒间前期组Th1/Th2比率明显高于其他两组(P<0.01),妊娠期高血压组明显高于正常妊娠组(P<0.05)。在子疒间前期组,随病情的严重程度的增加,其比率变化呈加重趋势,但与孕周无明显关系。(3)子疒间前期患者Th1/Th2比率与平均动脉压、24h尿蛋白量呈正相关(P均<0.01)。结论Th1/Th2比率变化可能是妊娠期高血压疾病发病的重要原因。     

D-二聚体定量检测对妊娠期高血压疾病患者产后出血的预测价值

目的探讨D-二聚体定量检测对妊娠期高血压疾病患者产后出血的预测价值。 方法潮州市潮州医院妇产科2013年1月至2013年12月收治150例妊娠期高血压疾病患者,对其分娩前24 h内D-二聚体进行定量测定,并准确计量其分娩24 h内出血量,依出血量将其分为产后出血组及对照组。单因素方差分析其分娩前24 h内D-二聚体测量值与分娩后24 h内出血量的相关性,以ROC曲线分析其对妊娠期高血压疾病患者产后出血的预测截断值。 结果产后出血组28例,产后出血发生率18.67%(28/150)。与对照组比较,产后出血组D-二聚体水平(9.56±11.97)mg/L显著高于对照组(1.96±1.06) mg/L,(F＝48.61,P<0.01)有统计学意义。ROC曲线下方面积为0.848,其标准误差为0.042,95%CI为0.766～0.930。最佳临界值为2.26 mg/L,此时特异度为66.4%,灵敏度为92.9%,youden指数0.593。 结论D-二聚体定量测定对妊娠期高血压疾病产后出血预测有较高价值,以2.26 mg/L作为预测截断值较为适合。     

Lessons for low-income regions following the reduction in hypertension-related maternal mortality in high-income countries

Objectives

To evaluate pre-eclampsia/eclampsia-associated maternal mortality in high-income countries to understand better the potential improvements in pre-eclampsia/eclampsia-related mortality in low-income countries.

Methods

We searched Medline, PubMed, and the Cochrane Database (1900-2010) using relevant search terms. Studies of the incidence of pre-eclampsia/eclampsia and case fatality rates in various geographic regions were included. The incidence of pre-eclampsia/eclampsia and the pre-eclampsia/eclampsia-associated case fatality rates are presented by location and year.

Results

Most declines in maternal mortality associated with pre-eclampsia/eclampsia in high-income countries occurred between 1940 and 1970 and were associated with a 90% reduction in the incidence of eclampsia and a 90% reduction in the case fatality rate in women with eclampsia. The most important interventions were widespread use of prenatal care with blood pressure and urine protein measurement, and increased access to hospital care for timely induction of labor or cesarean delivery for women with severe pre-eclampsia or seizures.

Conclusions

A substantial reduction in pre-eclampsia/eclampsia-related mortality could be made in low-income countries by widespread hypertension and proteinuria screening and early delivery of women with severe disease. Magnesium sulfate may reduce mortality, but should not be the cornerstone of maternal mortality reduction programs.     

Maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital,Ghana

Objective

To determine maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.

Methods

A cross-sectional study was conducted between January 1 and February 28, 2013. All women delivering at KBTH whose pregnancies were complicated by hypertensive disorders were identified. A structured questionnaire was administered, and the women were followed up on a daily basis until discharge from hospital. Medical records were also reviewed to identify any complications of hypertensive disorders.

Results

A total of 368 women were analyzed. Of 10 maternal deaths, 3 (30.0%) were due to hypertensive disorders in pregnancy, and specifically pre-eclampsia. Overall, 168 (45.7%) women with hypertensive disorders in pregnancy delivered by cesarean, 16 (4.3%) had placental abruption, 11 (3.0%) had pulmonary edema, 3 (0.8%) had HELLP syndrome, 2 (0.5%) had acute renal failure, 3 (0.8%) had an intracerebral hemorrhage or cerebrovascular accident, 21 (5.7%) were admitted to the intensive care unit, 7 (1.9%) had disseminated intravascular coagulation, and 58 (15.8%) had eclampsia. Cesarean delivery, admission to intensive care unit, and eclampsia were significantly more common in women with pre-eclampsia than in those with other hypertensive disorders.

Conclusion

Hypertensive disorders in pregnancy are associated with high incidences of adverse maternal outcomes in Ghana, with significantly increased frequencies in women with pre-eclampsia.     

肾上腺髓质素在妊娠高血压疾病中的表达及意义

目的:通过对妊娠高血压疾病患者血浆及胎盘组织中肾上腺髓质素含量的测定,探讨肾上腺髓质素在妊娠高血压疾病中的变化及可能机制。方法:放射免疫分析法测定非孕妇女(30例)、妊娠高血压疾病妇女(50例)、正常晚孕妇女(30例)血浆中肾上腺髓质素的含量;放射免疫分析法测定后两组胎盘组织提取液中肾上腺髓质素含量。结果:(1)妊娠高血压疾病组血浆肾上腺髓质素含量明显高于正常晚孕组及非孕组,与正常晚孕组的差异有统计学意义(P<0.05),与非孕组的差异具有极显著的统计学意义(P<0.01),并且,随病情加重而增加,病情越重,升高越明显;(2)妊娠高血压疾病组胎盘组织中肾上腺髓质素含量明显高于正常晚孕组,差异有统计学意义(P<0.05);(3)血浆肾上腺髓质素含量、胎盘肾上腺髓质素含量与平均动脉压呈正相关(r=0.75,P<0.01;r= 0.73,P<0.01)。结论:肾上腺髓质素在妊娠高血压疾病患者中升高,它可能作为一种代偿机制参与了妊娠高血压疾病的发生。     

Rudimentary horn pregnancy associated with pre-eclampsia

The unusual association of pre-eclampsia with a pregnancy in the rudimentary horn of the uterus in a multigravid patient is reported. The infrequent development of rudimentary horn pregnancy beyond the twentieth week of gestation may explain the rarity of this complication. The possible effect of rapid distension of the rudimentary horn with exposure of the myometrial surface to overwhelming fetal antigenic proteins may be of relevance in the development of pre-eclampsia in this case.     

子痫前期和正常妊娠代谢综合征变量的对比

目的:研究妊娠期高血压疾病中代谢综合征变量的发生情况。方法:前瞻性对比年龄、孕周、产次相匹配的65例妊娠期高血压,60例子痫前期,30例子痫及33例正常妊娠孕妇的各项指标。主要测量指标包括血压、血脂、血糖及尿酸水平。结果:患者年龄19～40岁,平均28.5±4.6岁;妊娠期高血压,子痫前期和子痫患者的血压较对照组明显增加(收缩压P0.01;舒张压P0.01);子痫前期组和子痫组的血浆总胆固醇、甘油三酯、血糖和尿酸均明显高于妊娠期高血压组及对照组(P0.05);妊娠期高血压组、子痫前期组及子痫组代谢综合征的发生率分别为13.8%、23.3%及26.7%。结论:妊娠期高血压疾病患者有代谢综合征的标志,推断两种情况相互关联。     

Association of COMT G675A and MTHFR C677T polymorphisms with hypertensive disorders of pregnancy in Mexican mestizo population

ObjectiveTo investigate the relationship between COMT G675A and MTHFR C677T polymorphisms and hypertension disorders of pregnancy (HDP) in a Mexican mestizo population.Design and methodsThis case-control study involved 194 HDP and 194 normoevolutive pregnant women. The polymorphisms were genotyped by real time PCR.ResultsOur results showed that the COMT AA genotype increases the risk to HDP (OR: 2.67; 95% CI 1.33–5.35), preeclampsia (OR: 2.69; 95% CI 1.00–7.22) and gestational hypertension (OR: 3.87; 95% CI 1.25–12.0). Furthermore, the double mutant genotype (COMTAA/MTHFRTT) potency the risk to HDP more than two times (OR: 5.21; 95% CI 1.12–24.3, p = 0.019).ConclusionOur work provides evidence that COMT 675AA genotype is a risk factor for HDP and that this risk is increased by the presence of MTHFR 677TT genotype in a Mexican mestizo population.     

Present status of clinical care for postpartum patients with hypertensive disorders of pregnancy in Japan: findings from a nationwide questionnaire survey

Objective: To assess the present status of clinical care for postpartum patients with hypertensive disorders of pregnancy (HDP) in Japan. Methods: We conducted a nationwide questionnaire survey of obstetricians, internists and hypertension specialists and analyzed 686 valid responses. Results: Though HDP is widely known as a risk factor for subsequent hypertension and cardiovascular disease, over one-third of obstetricians terminated their postpartum follow-up of HDP patients without referring them to other departments. Conclusion: It is important to establish an effective referral system, whereby patients with HDP can be smoothly transferred to primary care or a specialist physician after childbirth for long-term monitoring and management of blood pressure.     

妊娠期高血压疾病尿液差异蛋白质分析及其Perlecan含量变化

目的:探讨尿液中Perlecan含量变化在妊娠期高血压疾病中的评估价值。方法:选择正常健康足月妊娠女性、妊娠期高血压、轻度子痫前期和重度子痫前期患者各25例。每组取5例尿液标本进行蛋白质组学分析寻找差异蛋白质,取20例尿液标本进行Perlecan浓度检测,并与平均动脉压和24h尿蛋白进行相关性分析。结果:妊娠期高血压患者尿液中Perlecan浓度显著高于正常妊娠女性(P0.05);而轻度子痫前期和重度子痫前期患者尿液中Perlecan浓度均显著低于正常妊娠女性(P0.05),且在重度子痫前期患者中达到最低。Pearson相关分析显示,尿液中Perlecan浓度与24h尿蛋白呈显著负相关(P0.05)。结论:尿液Perlecan含量可以用来评估妊娠期高血压疾病的肾脏损伤水平,在一定程度上反映疾病的严重程度。     

叶酸联合甲古胺对妊娠期高血压疾病患者高同型半胱氨酸血症的影响

目的　研究血浆总同型半胱氨酸 (tHcy)水平与妊娠期高血压疾病的关系及叶酸联合甲古胺对其的影响。方法　 2 0 0 1年 1月至 2 0 0 3年 6月广东省东莞市人民医院采用荧光偏振免疫分析法测定 16 2例妊娠期高血压疾病患者和 15 0例正常晚期妊娠妇女血浆tHcy水平 ,同时采用离子捕捉免疫分析法检测其血清叶酸水平和微粒子酶联免疫分析法检测其血清VitB1 2 水平 ,并对 36例合并高Hcy血症的患者采用叶酸联合甲古胺进行干预治疗 ,4周后再次测定其血浆tHcy水平、血清叶酸和VitB1 2 水平。结果　妊娠期高血压疾病患者血浆tHcy水平显著高于正常妊娠组 (P <0 0 1) ,血清叶酸和VitB1 2 水平显著低于正常妊娠组 (P <0 .0 5 ) ;36例合并高Hcy血症的患者治疗后血浆tHcy水平比治疗前显著下降 (P <0 0 1) ,而血清叶酸和VitB1 2 水平比治疗前则显著升高 (P <0 0 5 )。结论　高Hcy血症是妊娠期高血压疾病发病的重要因素之一 ,应用叶酸联合甲古胺治疗 ,可显著降低妊娠期高血压疾病合并高Hcy血症患者的血浆tHcy水平 ,减少高Hcy对血管的毒性作用 ,有助于改善妊娠期高血压疾病患者的疾病转归。     

基质金属蛋白酶9在妊娠期高血压疾病中的表达

目的:探讨基质金属蛋白酶9(MMP-9)在妊娠期高血压疾病患者中的表达。方法:ELISA法和免疫组织化学法研究妊娠期高血压疾病患者和正常孕妇血清及胎盘中MMP-9的表达。结果:妊娠期高血压疾病患者血清中MMP-9水平与正常孕妇的差异无统计学意义(P>0.05)。妊娠期高血压疾病患者胎盘MMP-9的表达水平显著低于正常孕妇,差异有统计学意义(P<0.05)。结论:胎盘MMP-9表达下降可能与妊娠期高血压疾病的发生发展相关。     

Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy

This article describes the risks and protective factors for symptoms of depression in pregnancy among low-income African American and Caucasian women. Data were collected from 130 women who were between 16 and 28 weeks' gestation and enrolled in an urban prenatal clinic. The questionnaires used in the face-to-face interviews consisted of sociodemographic items, the Beck Depression Inventory (BDI-II), the Prenatal Psychosocial Profile (PPP), 3 items from the Jarel Spiritual Well-Being Scale, the Spiritual Perspective Scale, and 4 items on health risk behaviors. Twenty-seven percent of the women reported depressive symptoms at levels indicating risk for clinical depression. However, there were no significant differences between African American and Caucasian women. Sociodemographic factors accounted for 13% of the variance (P < .01) in BDI-II scores. Psychosocial and behavioral risk factors accounted for an additional 19% of the BDI-II variance (P < .001), and psychosocial and spiritual resources accounted for 7% of the variance (P < .001), resulting in these variables accounting for 54% of the total variance in BDI-II scores. Higher levels of stress, lower levels of self-esteem and social support, and higher religiosity had a significant relationship with more symptoms of depression. This supports the need to routinely screen for and to assess factors associated with depressive symptoms in pregnant low-income women.     

Risk perception of future cardiovascular disease in women diagnosed with a hypertensive disorder of pregnancy

Objective: The objective of this study is to evaluate a woman’s risk perception for future cardiovascular disease (CVD) after being diagnosed with a hypertensive disorder of pregnancy.

Methods: A prospective cohort of women diagnosed with a hypertensive disorder of pregnancy (HDP) was studied. Each woman completed two surveys, one prior to hospital discharge and one 2 weeks later, designed to assess knowledge of and risk perception for future CVD based on their recent diagnosis of a HDP. Rates of postpartum depression were also assessed.

Results: Of the 146 subjects included, 28% were diagnosed with preeclampsia with severe features, 52.1% with preeclampsia with mild features, and 19.9% had chronic hypertension. Women with severe features and those delivering preterm were more likely to report a perception of increased risk of both recurrent HDP in a future pregnancy (p?=?0.004 and 0.005, respectively) and hypertension later in life (p?=?0.01 and 0.03, respectively). Women delivering preterm were more likely to report an accurate perception of increased risk of myocardial infarction and stroke compared to those delivering at term (p?=?0.006 and 0.002, respectively).

Conclusions: Disease severity and preterm delivery were associated with a higher likelihood of the perception of an increased risk for both recurrent HDP and hypertension in the future. Only preterm delivery was associated with a higher risk perception for stroke and myocardial infarction. Interventions targeted at improved health awareness in women diagnosed with HDP are warranted.