The effects of posture on abnormalities of forearm venous tone in women with pregnancy-induced hypertension

1. Forearm venous tone was measured in the left lateral supine position and in response to passive leg elevation in a group of women with pregnancy-induced hypertension and compared with a group of normotensive pregnant women and a group of non-pregnant women. 2. The women with pregnancy-induced hypertension were venoconstricted in the supine position compared with the normal pregnant women (P less than 0.002). There was no difference in forearm venous tone between the women with pregnancy-induced hypertension and the non-pregnant women. 3. In response to passive leg elevation the women with pregnancy-induced hypertension venodilated (P less than 0.002) whereas there was no change in forearm venous tone in the normotensive pregnant women and the non-pregnant women. There was no change in blood pressure in any of the women after 35 min of leg elevation. 4. These results demonstrate that the abnormal venous vasoconstriction that occurs in women with pregnancy-induced hypertension in the supine position is corrected by passive leg elevation, a manoeuvre which leads to an increase in central blood volume.     

Serum levels of adhesion molecules in women with pregnancy-induced hypertension

In a matched pair study, we investigated the serum levels of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), platelet endothelial cell adhesion moleculae-1 (PECAM-1) and P-selectin in 40 nulliparous patients with pregnancy-induced hypertension (PIH) and in 40 normotensive pregnant controls by using an enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression models were used to analyze the influence of elevated serum levels of adhesion molecules on the occurrence of PIH and on the association with the severe form of the disease. The median serum levels of ICAM-1, VCAM-1 and PECAM-1 were significantly elevated in women with PIH compared to controls (296 and 222 ng/ml, p = 0.003, 633 and 505 ng/ml, p = 0.02 and 7.7 and 6.6 ng/ml, p < 0.0001, respectively), whereas the differences of the median serum levels of P-selectin were not significantly between groups. In a multivariate logistic regression model, the serum levels of ICAM-1 and PECAM-1 revealed a significant influence on the occurrence of PIH versus healthy pregnant women (p = 0.04 and p = 0.006, respectively), whereas VCAM-1 and P-selectin serum levels were not associated with the occurrence of pregnancy-induced hypertension (p = 0.3 and p = 0.2, respectively). In a multivariate logistic regression model, the serum levels of PECAM-1 were associated with severe disease (p = 0.002). Our data indicate that the expression of ICAM-1 and PECAM-1 is upregulated in patients with pregnancy-induced hypertension. Elevated serum levels of PECAM-1 were associated with the development of severe disease.     

Elevated serum concentrations of androgens in women with pregnancy-induced hypertension

Alterations of steroid hormone profiles have been suggested to be involved in the pathophysiology of pregnancy-induced hypertension (PIH). The aim of our study was first to investigate serum concentrations of testosterone, dihydrotestosterone, androstenedione and dehydroepiandrostenedione sulfate in women with PIH and normotensive pregnant women and secondly to evaluate an association between elevated serum concentrations of androgens and the development of severe disease. Serum concentrations of androgens were measured in 40 patients with PIH and 40 normotensive pregnant women, matched for gestational age, determined by enzyme linked immunosorbent assay. Multivariate logistic regression models were used to analyze the influence of elevated serum concentrations of androgens on the occurrence of PIH and the development of severe disease. The median serum concentrations of androstenedione and testosterone were significantly elevated in women with PIH compared to controls (6.3 and 5.0 ng/ml, 1.8 and 1.1 ng/ml, p = 0.005 and p = 0.04, respectively). The difference between the median serum concentrations of dihydrotestosterone and dehydroepiandrostenedione sulfate in women with PIH and controls was not significant. Elevated serum concentrations of androstenedione revealed a significant influence on the odds of presenting with PIH (p = 0.043) and were significantly associated with the development of severe disease (p = 0.014). Women with PIH have elevated serum concentrations of androstenedione and testosterone. Moreover, elevated serum concentrations of androstenedione are associated with development of severe disease.     

Factors associated with pregnancy-induced hypertension

This article reports the results of a correlational study that explored the association between the three factors of pregravid weight, prenatal weight gain at 28 weeks and maternal age, and the subsequent development of pregnancy-induced hypertension (PIH). A significant relationship between low maternal age and PIH development was found. Further data analysis showed that PIH occurred significantly more often when the second trimester mean arterial pressure (MAP) did not drop to a level lower than the first trimester MAP. Clinically, emphasis should be placed on early detection of women at high risk for PIH development. Analysis of the MAP changes could prove to be a low-cost, effective and low-risk predictive test for PIH development.     

改良截石位在妊娠高血压综合征产妇分娩中的应用研究

目的探讨改良截石位在妊娠高血压综合征（PHI,简称妊高征）产妇分娩中的应用价值。方法将326例单胎初产采用截石位自然分娩的妊高征产妇随机分为观察组163例和对照组163例,观察组产妇采用改良截石位方式分娩,而对照组产妇则采用传统截石位方式分娩,分别统计两组产妇产后下肢深静脉血栓形成的发生率及腓总神经损伤的发生率。结果产妇产后下肢深静脉血栓形成的发生率观察组为3．07％,对照组为10．43％;产妇产后腓总神经损伤的发生率观察组为9．82%,对照组为23．31％,两组比较,差异有显著意义（P〈0．01）。结论改良截石位可降低妊高征产妇产后下肢深静脉血栓形成及腓总神经损伤的发生率,值得推广应用。     

1例妊娠期高血压合并HELLP综合征和脑静脉血栓形成的护理体会

正妊娠期高血压综合征以妊娠后20周出现高血压、蛋白尿、水肿为特点,并伴有全身多器官功能损害,严重者可出现昏迷、抽搐、心脑血管意外甚至合并HELLP综合征(hemolysis,elevated liver enzymes,and low platelets syndrome,HELLP)、弥散性血管内凝血(disseminated intravascular coagu-     

综合护理干预在妊娠高血压综合征患者围产期护理中的应用

目的探讨综合护理干预在妊娠高血压综合征(PIH)患者围产期护理中的应用效果。方法患者95例PIH产妇随机分为对照组47例和干预组48例,对照组采取常规护理,干预组在对照组基础上实施综合护理干预。观察2组围产期血压变化情况,统计妊娠结局并采用SF-36生活质量表评估产妇分娩后生活质量。结果分娩前2组血压较入院时下降,且干预组舒张压改善优于对照组(P0.05);干预组胎儿窘迫发生率6.3%(3/48),低于对照组的25.5%(12/47),差异有统计学意义(P0.05);对照组围生儿死亡4例(8.5%),干预组无围生儿死亡。出院时,2组SF-36量表各维度评分均较分娩后升高,且干预组高于对照组(P0.05)。结论综合护理干预对稳定PIH产妇血压,改善妊娠结局和提高产后生活质量具有积极意义。     

糖代谢紊乱与头颈部鳞癌放射性皮炎相关性研究

目的探讨重度妊娠高血压综合征患者的护理方法.方法对42例重度妊娠高血压综合征患者进行精心的心理护理、健康指导、药物治疗,控制及预防抽搐,针对先兆子痫及子痫进行护理,合理掌握终止妊娠的时间,并做好分娩前后的护理.结果本组34例行剖宫产终止妊娠,8例经阴道自然分娩,新生儿健康.本组均痊愈出院.结论对重度妊娠高血压综合征患者进行精心护理,可提高治疗效果及产科护理质量.     

妊娠期高血压疾病流行病学调查

妇女妊娠期所患有的高血压疾病统称为妊娠期高血压疾病（pregnancy—induced hypertension），是产科最常见的并发症。也是导致孕产妇和围产儿发病率和死亡率增加的常见原因之一。虽然随着围产检查的普及和加强，全世界范围内严重先兆子痫和子痫逐年减少，全球对妊娠期高血压疾病的研究不断广泛和深入，但目前妊娠期高血压疾病的流行病学特点仍不甚明了，限制了对妊娠期高血压疾病的有效干预。本文就妊娠期高血压疾病的流行病学研究介绍如下。     

Effect of cadralazine on brachial artery hemodynamics and forearm venous tone in essential hypertension

Forearm venous tone and brachial artery hemodynamics, including determinations of the arterial diameter and compliance by the use of pulsed Doppler systems, were measured in 16 patients with sustained essential hypertension before and after acute oral cadralazine dosing. Systolic and diastolic blood pressures significantly decreased, whereas heart rate increased. Brachial artery diameter and vascular resistance decreased, respectively, from 0.501 +/- 0.015 to 0.485 +/- 0.015 cm (P less than 0.001) and from 124.8 +/- 13.8 to 99.3 +/- 11.9 mm Hg/ml . sec (P less than 0.01). Blood flow velocity increased (P less than 0.05) but volumic flow, pulse wave velocity, and brachial artery compliance did not change. Forearm venous tone increased but the increase was inversely related to the degree of arteriolar vasodilatation. Our results indicate that, with cadralazine, forearm vascular resistance decreased while forearm blood flow was unchanged, the dilatation of small arteries contrasted with a significant reduction in the diameter of the large brachial artery, and the decrease in blood pressure was associated with a lack of increase in arterial compliance and changes in venous tone. This suggests an overriding influence of the activation of the autonomic nervous system on the action of cadralazine on large arteries and veins.     

Serum digoxin-like substances in pregnancy-induced hypertension

1. Endogenous digoxin-like immunoreactivity (EDLI) was measured in the serum of 85 normotensive pregnant (NTP) women and 77 women with pregnancy-induced hypertension (PIH) by a radioimmunoassay (New England Nuclear). All women were in the third trimester. 2. EDLI, which was undetectable in serum from non-pregnant women, was present in NTP and PIH and was significantly higher in PIH. EDLI correlated with gestational age in NTP, but not in PIH. 3. Ouabain-sensitive Na+ transport was estimated in normal peripheral blood leucocytes after incubation with sera from 50 NTP and 42 PIH women. Significant inhibition of active Na+ transport occurred only with the serum of hypertensive patients without proteinuria. 4. EDLI did not correlate with the effect of the sera on active Na+ transport. The radioimmunoassay therefore provides a poor index of Na+ transport inhibitory activity in PIH.     

母胎界面血管内皮生长因子水平在妊娠高血压综合征中的意义

目的:血管内皮生长因子是一种对血管内皮细胞有特异高效的促有丝分裂因子,试验通过检测血管内皮生长因子在母血、脐带血以及胎盘母面和子面的水平,探索妊娠高血压综合征的发病因素和胎儿宫内发育迟缓发生的机制。方法:①试验对象:选取2006-10/2007-03在深圳市沙井医院就诊的正常孕妇及患有妊娠高血压综合征的孕妇各30人分别作为正常孕妇组和妊娠高血压综合征组,均为初产妇,两组孕妇年龄、孕周及体质量差异无显著性。纳入标准:正常孕妇及妊娠高血压综合征孕妇均无其他妊娠合并症或疾患,年龄24～35岁。患者对试验知情同意。②试验方法及评估:取母亲外周静脉血、新生儿脐带血及胎盘母面、子面标本各一块,酶联免疫吸附法检测母血、脐带血、胎盘母面及子面组织匀浆中的血管内皮生长因子含量,免疫组织化学染色及荧光染色观察血管内皮生长因子的表达。实验结果采用Excel2003软件进行两独立样本的t检验和Pearson相关分析。结果:纳入正常孕妇及患有妊娠高血压综合征的孕妇各30人,均进入结果分析。①免疫组织化学染色及荧光染色显示正常产妇胎盘子面内皮生长因子表达强阳性。②酶联免疫吸附结果显示,两组受试者胎盘母面、母血血管内皮生长因子含量差异无显著性(P>0.05);妊娠高血压综合征组胎盘子面、脐带血血管内皮生长因子含量与正常妊娠胎盘子面、脐带血相比较,差异显著(P<0.05)。结论:妊娠高血压综合征患者胎盘子面血管内皮生长因子水平下降,脐带血中血管内皮生长因子水平升高,提示母胎界面的异常可能与妊娠高血压综合征的发生有关。     

Comparison of three neuraxial anesthesia approaches in parturient women with obesity and pregnancy-induced hypertension who underwent cesarean section

ObjectiveTo compare the effectiveness of different approaches of neuraxial anesthesia in parturient women with obesity and pregnancy-induced hypertension (PIH) who undergo cesarean section (CS).MethodsWe retrospectively analyzed data from 108 parturient women with obesity and PIH who underwent CS. All women were divided into the following three groups according to the neuraxial anesthesia approach: spinal anesthesia (SA), epidural anesthesia (EA), and combined spinal–epidural anesthesia (CSE). Clinical variables were compared.ResultsThe mean age of the patients was 27.3 ± 2.2 years. Women in the CSE group had a longer duration from puncture to surgery, smaller intraoperative change in mean arterial pressure, higher Apgar scores at 1 and 5 minutes, shorter surgery time, lower rates of nausea and vomiting, and lower rate of intraoperative hypotension compared with those in the SA and EA groups.ConclusionCSE takes longer to administer in parturient women with obesity and PIH who undergo CS compared with those who have SA or EA. However, CSE has several advantages over SA or EA, including a shorter surgery time, more stable intraoperative mean arterial pressure, lower rates of nausea, vomiting, and intraoperative hypotension, and better Apgar scores at 1 and 5 minutes.     

Abnormal membrane cation transport in pregnancy-induced hypertension

An abnormality of sodium handling has been suggested as one of the mechanisms responsible for the development of pregnancy-induced hypertension. We analysed the plasma and urinary concentrations, and the intraerythrocyte activities of Na and K, and the RBC membrane Na+/K+-ATPase activity of 77 hypertensive and 133 normal pregnant women. Umbilical cord blood of infants from 21 hypertensive and 28 control women was studied. The Na+/K+-ATPase activity was determined by measuring the inorganic phosphate released by incubation in a reaction medium in the presence and absence of K ions or ouabain. The intra-erythrocyte sodium and potassium activities were measured by ion-selective electrode analysis of the haemolysates, after washing the RBCs in 110 mmol/l MgCl2. We found a significant increase in intracellular sodium and a reduction in Na+/K+-ATPase activity in the hypertensive women in comparison with the control subjects during pregnancy. No difference was observed in early puerperium. Cord blood from infants of pregnancy-induced hypertensive women showed an increase in intracellular Na+ activity and a decrease in the erythrocyte membrane Na+/K+-ATPase activity in comparison with cord blood samples from control subjects. The observed abnormalities in the plasma membrane sodium transport may play a major role in the pathophysiology of pregnancy-induced hypertension.