Transient blindness in pregnancy induced hypertension

Transient blindness associated with pregnancy induced hypertension without neurological symptoms is a rare phenomenon. The blindness in these cases is postulated to be of "cortical blindness". Two such cases occurring immediately after childbirth are presented. The ophthalmic manifestations of this complication of pregnancy induced hypertension and the importance of an urgent evaluation are discussed.     

Platelets,inflammation, and prediction of the hypertension disorders of pregnancy

Objective.?To assess the features of the platelets (PLTs) of hypertensive disorders of pregnancy (HDP) and to determine whether they have a predictive value for the disorders during the preclinical stage.

Methods.?This study included 461 HDPs and 827 normal pregnancies. Platelet counts were compared between the two groups by an independent samples t test; a Fisher's linear discriminant analysis and receiver operator characteristic curve were performed to analyze the diagnostic effects of the variables in developing HDP.

Results.?Women with HDP had significantly higher PLT before the second trimester. When exceeding the cut-off, it had a specificity (SPE) of 81.67% (95% CI: 81.63%–81.72%) for predicting a HDP. The discriminant function had a sensitivity of 69.1 (95% CI: 69.04–69.16), a SPE of 73.60% (95% CI: 73.569–73.64), a positive prediction value of 61.32% (95% CI: 61.25–61.39), a negative prediction value of 79.93% (95% CI: 79.88–79.98), and 71.50% of gravidas were correctly classified.

Conclusion.?These results show that HDP is associated with increased systemic inflammation as depicted by the PLT and white blood cells in gravidas. The discriminant function of blood cells in a mathematical model may be helpful for predicting a HDP in presymptomatic patients, however, which is not sufficiently to use in clinical practice; a prospective study about the predicting is still needed.     

Lipoprotein levels in patients with pregnancy induced hypertension

The purpose of this prospective study was to investigate the levels of Lp(a), Apo(a), VLDL, LDL and HDL in 23 patients with pregnancy induced hypertension (PIH) and in 20 control. The Mann-Whitney U tests was used for comparisons between the two groups. Serum Lp(a) and Apo(a) levels were sigificantly raise in the PIH group (p < 0.05 andp < 0.05 respectively) and no significant correlations could be demonstrated for other lipoproteins.     

妊娠高血压综合征患者肾脏穿刺结果分析

目的：探讨妊娠高血压综合征(妊高征)患者行肾脏穿刺活检的安全性及了解肾脏病理改变与临床表现的关系。方法：对2000年8月至2002年2月13例妊高征患者于产后2周内(9例)及2周后(4例)采用16G弹射针B超引导下行肾脏穿刺活检，标本分别进行光镜、免疫荧光及部分行透射电镜检查。结果：妊高征肾脏的病理改变表现多样，其中表现为毛细血管内增生性肾小球肾炎3例，膜性肾病改变3例，肾小球轻微病变2例，系膜增生性肾小球肾炎2例，妊娠性肾病2例，局灶性硬化性肾小球肾炎1例。结论：妊高征患者肾脏穿刺活检是安全可行的，妊高征患者的肾脏病理改变可表现为各种病理类型，与临床病情无相关性，符合继发性肾病综合征改变。应对有肾脏损害的妊高征患者作相应随访，以发现妊娠诱发的肾脏疾病。     

妊娠高血压综合征病因学研究进展与展望

妊娠高血压综合征 (妊高征 )是导致孕产妇和围产儿病率及死亡率升高的主要原因。近半个世纪来 ,国际国内学者 ,对妊高征的病因及发病机理、治疗及预防进行了大量的研究工作。我国妇产科学界始终瞄准着国际科技前沿 ,对妊高征的病因学和发病机理进行了深入的研究 ,并取得了可喜的进展。为妊高征的有效防治奠定了理论基础。目前 ,公认的妊高征的主要发病机理是内皮细胞激活和损伤学说。1988年 ,Rodger等发现妊高征患者血清中存在细胞毒性因子 ,可导致血管内皮激活、功能障碍和结构损伤。继而大量研究表明 ,血管内皮细胞激活导致内皮细胞合成…     

Monthly cosmic activity and pregnancy induced hypertension

Monthly distribution of PIH (Pregnancy Induced Hypertension) was investigated in relation to the number of deliveries and nine specific cosmic and geomagnetic activity parameters during the years 1979-1983. PIH was observed in 3.165% of 19,843 deliveries. Significant (p less than 0.01) inverse correlation between the PIH index and monthly geomagnetic activity level was shown. Moderately significant (p less than 0.05) correlation with monthly maximal (noon hours) gamma-radiowave propagation was evident as was inverse correlation with this parameter in hours of minimal (early morning) propagation.     

Structural changes in umbilical vessels in pregnancy induced hypertension

BACKGROUND: Pregnancy Induced Hypertension (PIH) is associated with placental morphological changes, alterations in the blood flow patterns in the umbilical vessels and adverse fetal and maternal outcome. Studies have demonstrated changes in the structure of the umbilical vessels but these have not been described across the length of the cord or correlated with the severity of disease. STUDY DESIGN: A case control study. SETTING: Kenyatta National Hospital. MATERIALS AND METHODS: Thirty six umbilical cords from newborns of women with and without PIH (18 cases, 18 controls) were obtained and studied with light microscopy. Of the cases 9 women had severe PIH and 9 had mild PIH. Means and standard deviations for the various parameters of the various groups were obtained. Student's t-test and ANOVA were used to compare means, a p value of <0.05 being significant. RESULTS: The structure of the umbilical vessels changes from the placental end to the fetal end. The umbilical vein in PIH had a greater wall thickness and a smaller luminal area than in the controls. The vein's wall-luminal ratio increased from the placental to the fetal end. Duplication of the elastic subintimal lamina (ESL) was higher in the cases. The ESL was more commonly duplicated in the fetal end. There were no structural differences between the umbilical arteries in PIH and in the controls. CONCLUSION: PIH is associated with structural changes in the umbilical vessels. These changes are more predominant in the vein than in the artery and in the vein, they are more obvious in the fetal end. The observed increase in wall-luminal ratio from the placental to the fetal end suggests that the fetal end of the umbilical vein has a more refined role in the regulation of blood flow to the fetus.     

Calcium supplementation in pregnancy to prevent pregnancy induced hypertension (PIH)

Calcium supplementation during pregnancy has been studied since the 80's, epidemiologically and experimentally through laboratory animals and clinical trials. The findings showed the lowering of blood pressure and prevention of PIH in those receiving Calcium Supplementation. There were 22 clinical trials on Calcium supplementation since 1983; there were 5 trials added since Bucher et al made a meta-analysis on 14 of these trials in 1996. Three trials from Japan were added to the trials under study. A review of calcium homeostasis during normal pregnancy and PIH was added to allow a better understanding of physiologic and pathologic processes and how calcium supplementation works. The objective of this review is to show the rationale for supplementation of calcium during pregnancy to prevent PIH, hence the discussion on the latest investigations regarding etiology of PIH and the relation of Calcium to this causation. The USA large multicenter trial reported by Levine in 1997 contradicted the findings of all the previous random placebo controlled trials. Analysis of these trials showed that subjects were different; Levine trial used healthy nulliparas. The studies done in Japan, China and Philippines used a lower dose of Calcium but were effective. The conclusion of this review is Calcium supplementation helps those with high risk to develop PIH especially in countries where the calcium intake is low. Healthy nulliparas residing in countries with high Calcium intake will benefit less.     

The incidence of pregnancy induced hypertension in southeast Turkey

One hundred twenty patients with pregnancy-induced hypertension (PIH) were delivered during 1986. The incidence of pre-eclampsia and eclampsia, per 1000 births, was 103 and 19, respectively. Two-thirds of eclamptics were nulliparous and three-quarters were less than 25 years of age. All patients with eclampsia had convulsions before admission. Although maternal mortality was 4% in patients with pre-eclampsia and 0% in those with eclampsia, the fetal mortality rate was 32% in pre-eclamptic and 60% in eclamptic patients.     

Thyroid function in pregnant women with pregnancy induced hypertension

OBJECTIVE: The aim of this study is to investigate thyroid's function in pregnant women with pregnancy induced hypertension. MATERIALS AND METHODS: 42 pregnant women with PIH diagnosed after 20 weeks of gestation (between 22-30 hbd) were hospitalized in Department of Obstetrics and Gynecology of Mother and Child Institute in Warsaw. This group consisted 20 multiparous and 22 primiparous. We measured thyroid hormone levels: TSH, fT4, fT3 and TBG. RESULTS: In 8 pregnant women (5 primiparous and 3 multiparous) thyroid function was normal (normal level of TSH, fT3, fT4) and middle blood pressure in term of beginning of the study was 155/100 mmHg. 34 pregnant women (19 primiparous and 15 multiparous) had abnormal thyroid function. 3 (1 primiparous and 2 multiparous) pregnant women of this group had subclinical hyperthyroidism (middle blood pressure in the beginning of the study was 155/105) and 31 (21 primiparous and 10 multiparous) had fT4 and fT3 levels lower then normal range with normal TBG levels. In this group only one patient TSH level was higher then 5 mlU/l, which allows to recognize overt hypothyroidism. In other cases the results indicate the subclinical hypothyroidism. The middle blood pressure was 140/95 mmHg. CONCLUSION: 1. Thyroid dysfunction in pregnant women was concluded in 78.2% of tested group. 2. Subclinical hypothyroidism was concluded the most frequent in the tested group. 3. The middle blood pressure at the term of beginning of the study was the lowest in pregnant women with hypothyroidism. 4. The thyroid function tests should be performed in all pregnant women with PIH.     

全国妊娠高血压综合征基础与临床研究学术研讨会会议纪要

由中华妇产科杂志编辑委员会主办的全国妊娠高血压综合征 (妊高征 )基础与临床研究学术研讨会 ,于 2 0 0 0年月 11月 8日～ 13日在深圳市召开。中华医学会副会长、中华医学会妇产科分会主任委员曹泽毅教授 ,中华妇产科杂志总编辑郎景和教授 ,中华医学会杂志社原社长、中华妇产科杂志副总编辑田翠华编审 ,及中华医学会深圳市分会的领导出席了开幕式。来自全国各地的 2 0 0多位代表参加了本次会议。会议共收到论文近 2 0 0篇 ,其中大会交流 4 2篇。有关专家就妊高征基础与临床研究的进展进行了专题报告。妊高征是常见的孕期并发症 ,重度妊高征…     

妊娠高血压综合征命名和分类新说

一般说来，一种疾病的命名和临床分类主要依据对疾病的认识。包括对其病因、发病机理、病程、预防、治疗和转归的认识，其目的在于对疾病作更规范诊断与治疗，同时也是为了更好地促进医学的学术交流。因此随着医学科学的发展，随着对疾病认识的深入和防治经验的累积，我们经常面临着对一     

硝酸甘油用于妊娠高血压综合征治疗的研究

目的探讨硝酸甘油在妊娠高血压综合征（妊高征）治疗中的应用价值及其可行性。方法选择中、重度妊高征患者34例;其中单纯用硫酸镁治疗11例（硫酸镁组）,单纯用硝酸甘油治疗11例（硝酸甘油组）,硫酸镁+硝酸甘油联合用药治疗12例（联合用药组）。另选取正常晚期妊娠妇女11例(正常妊娠组)作对照。采用免疫组织化学及图像分析仪测定以上4组产妇胎盘的内皮型一氧化氮合酶（eNOS）含量,血小板聚集仪检测血小板聚集率,彩色多普勒超声检测应用硝酸甘油后脐动脉收缩期及舒张期（S/D）比值和阻力指数,并记录各组应用药物后的血压变化。结果（1）胎盘eNOS含量硫酸镁组为0.24±0.07,硝酸甘油组为0.25±0.08,联合用药组为0.26±0.07,正常妊娠组为0.35±0.08。妊高征各组与正常妊娠组比较,差异均有极显著性(P<0.01)。（2）硝酸甘油组用药后,脐动脉S/D比值及阻力指数较用药前明显降低,用药前后比较,差异有显著性(P<0.05)。（3）血小板聚集率硝酸甘油组、联合用药组用药后明显降低,用药前后比较,差异有极显著性(P<0.01);硫酸镁组则无明显改变。（4）降压作用硫酸镁组用药后,血压变化不明显;硝酸甘油组及联合用药组,用药后血压降低,用药前后比较,差异有显著性(P<0.05)。结论硝酸甘油有抑制血小板聚集、降低胎儿-胎盘循环阻力及降低血压的作用。能改善妊高征患者的病理状态,从而对妊高征引起的胎儿宫内生长迟缓有治疗作用。     

妊娠高血压综合征诊断标准合理性的探讨

目的探讨我国现行的妊娠高血压综合征(妊高征)诊断标准的合理性.方法回顾性分析我院收治的916例妊高征患者的临床资料,分别按我国现行的妊高征诊断标准和国外的妊高征诊断标准重新分类,并对两种标准分类的孕产妇和围产儿结局进行分析.结果 (1)两种诊断标准的妊高征分类构成比比较按我国标准,轻、中、重度妊高征的构成比分别是46.6%(427例)、18.4%(169例)、34.9%(320例);按国外标准,轻、中、重度妊高征的构成比分别是47.6%(436例)、14.3%(131例)、38.1%(349例).两者比较,差异有显著性(P<0.05).两种诊断标准分类在轻度妊高征的符合率为85.0%;重度妊高征的符合率为93.8%;而中度妊高征的符合率仅40.2%.(2)孕产妇结局早产、产后出血和胎盘早剥的发生率,按我国标准比较,差异均有显著性(P<0.05);按国外标准比较,差异也有显著性(P<0.05);但两种诊断标准对应组间比较,差异无显著性(P>0.05).(3)围产儿结局胎儿生长受限(FGR)、新生儿窒息和围产儿死亡发生率及新生儿病率, 按我国标准比较, 差异有显著性(P<0.05);按国外标准比较,差异也有显著性(P<0.05);但以上3项指标在两种诊断标准间比较,差异无显著性(P>0.05).结论我国现行妊高征诊断标准具有其合理性.但缺少早期诊断和全面评估病情的客观指标,有其局限性.应采纳更多的客观指标,以完善妊高征诊断标准.     

胰岛素抵抗与妊娠高血压综合征发病的关系

目的　探讨胰岛素抵抗与妊娠高血压综合征 (妊高征 )发病的关系。方法　选取 1998年在上海市第一人民医院进行产前妊娠期糖尿病筛选异常的 199例孕妇为研究对象 ,进行 75g葡萄糖耐量试验 ,同时进行胰岛素释放试验 ,计算胰岛素曲线下面积及胰岛素敏感性指数 ,并随访至妊娠晚期发生妊高征的情况 ,比较 199例孕妇中 ,发生妊高征者和血压正常者胰岛素敏感性的差异。结果　 (1)妊高征发病有 39例 ,空腹血糖为 (4 .2± 0 .7)mmol/L ,空腹胰岛素为 (10 7.8± 48.8)pmol/L ,胰岛素敏感性指数为 - 3.2 5± 0 .2 7。血压正常的孕妇 16 0例 ,空腹血糖为 (3.8± 0 .7)mmol/L ,空腹胰岛素为 (5 0 .4± 40 .5 )pmol/L ,胰岛素敏感性指数为 - 2 .5 8± 0 .6 6 (P <0 .0 5 )。 (2 )胰岛素曲线下面积 ,妊高征患者为 112 5 .6± 331.0 ,血压正常孕妇为 10 5 7.6± 44 2 .2 ,两者比较 ,差异无显著性 (P >0 .0 5 )。结论　孕中期胰岛素抵抗可能是妊高征发病的原因之一。妊娠中期存在胰岛素抵抗可以作为一项预测妊高征的指标