Non-cirrhotic portal hypertension in pregnancy.

OBJECTIVE: To study the outcome of pregnancy in women with non-cirrhotic portal hypertension (NCPH). METHOD: A retrospective analysis of 50 pregnancies in 27 women with NCPH was carried out. Pregnancy outcome was compared in extra hepatic portal vein obstruction (EHPVO) and non-cirrhotic portal fibrosis (NCPF). RESULTS: The mean maternal age was 24.60+/-2.857 years, and the disease was diagnosed during pregnancy in 15 (55.6%) patients. Variceal bleeding occurred in 17/50 (34%) pregnancies and the majority (88.2%) of them responded to endoscopic sclerotherapy. Incidence of variceal bleeding during pregnancy was lower in pregnancies where the disease was diagnosed prior to pregnancy (8.6%), and it was 43.5% in EHPVO and 25.9% in NCPF. The mean birth weight of the neonates was 2668.4+/-427.42 g, and the incidence of abortion, prematurity, small for gestational age babies and perinatal death was 20, 17.5, 12.5 and 20%, respectively. Variceal bleeding during pregnancy was associated with a higher incidence of abortion (29.4%) and perinatal death (33.3%). CONCLUSION: Variceal bleeding is the most common complication in pregnancies with NCPH. Pregnancies can be allowed and managed successfully in patients with NCPH.     

Impact of hypertensive disorders of pregnancy at term on infant birth weight

This study was performed to investigate the impact of hypertensive disorders of pregnancy at term on neonatal birth weight. All singleton live births delivered between 37 and 42 weeks of gestation complicated by hypertensive disorders over a 7-year period (n = 362) was compared to 34 783 uncomplicated singleton deliveries in the same period. The individualized gestation-related optimal weight (GROW) was calculated for each individual case adjusted for the effects of maternal booking weight, height, parity, gestation at delivery, and fetal sex. Small-for-gestational-age (SGA) was defined as a birth weight less than the 10th percentile of the GROW. The incidence of SGA babies was significantly higher in subjects with preeclampsia and eclampsia than in control subjects (24.6 versus 11.3%; odds ratio = 2.55; 95% CI: 1.84, 3.55). Preeclampsia significantly reduced fetal birth weight by 130 g or 4.3%. Those with eclampsia on average had a neonatal birth weight 349 g or 11.0% below that of the GROW. In contrast, there was no significant difference in the incidence of SGA babies or degree of deviation from GROW between those with or without gestational hypertension.     

Pregnancy following the surgical treatment of portal hypertension

The course and results of 10 pregnancies in 7 patients who had undergone surgical treatment up to 9 years previously for portal hypertension are described. Four patients had extrahepatic portal hypertension, two had noncirrhotic intrahepatic portal hypertension, and one had frank biliary cirrhosis. Eight live babies were produced with no maternal deaths; the commonest complication was anemia during pregnancy, but only one patient bled from esophageal varices after shunting. Pregnancy after decompression operations and in extrahepatic obstruction is reviewed, and the particular hazards associated with pregnancy are discussed.     

Should parity be included in customised fetal weight standards for identifying small-for-gestational-age babies? Results from a French multicentre study

Objective  Parity is one of several parameters used to customise fetal growth norms. However, it is uncertain whether the lower birthweight of babies born to primiparous women reflects physiological or pathological variation. Our aim was to assess the impact of adjusting for parity in identification of small-for-gestational-age (SGA) births.
Design  Comparison of two customised definitions of SGA with and without parity.
Setting  Routinely collected data in five tertiary maternity hospitals in France.
Population  A total of 51 126 singleton births without malformations from 1997 to 2002.
Methods  Characteristics of mothers and babies and adverse pregnancy outcomes for SGA and non-SGA births were compared using customised definitions with and without parity.
Main outcome measures  Neonatal morbidity and mortality.
Results  SGA births among primiparas increased from 14.9 to 18.0% when parity was excluded. Overall rates of SGA rose from 14.4 to 15.0%. Newly defined cases of SGA were babies of primiparas. They had higher rates of admission to a neonatal unit and caesarean section than babies reclassified as non-SGA. Perinatal mortality was 9.1‰ (parity included) and 9.7‰ (parity excluded) and did not differ significantly from babies classified as non-SGA by both standards (5.4‰).
Conclusions  Adjustment for parity markedly decreased the proportion of primiparas diagnosed with SGA babies but did not appear to improve the identification of high-risk babies. Removing parity would simplify the customised definition of SGA and would eliminate the need for the assumption that lower birthweight for primiparous women is normal.     

The incidence of foetal macrosomia and method of delivery for a two-year period in the University Hospital of Obstetrics and Gynecology Maichin Dom--Sofia

The authors carried out a retrospective study on the incidence of foetal macrosomia and the method of delivery on the 6157 consecutive births for a two-year period in the University Hospital of Obstetrics and Gynecology "Maichin Dom"- Sofia, Bulgaria. The incidence of foetal macrosomia (birth weight > 4000 g) among these births was 4,45% (274/6157 births). There was a coincidence between the admission diagnosis Macrosomia and the birth weight only in 8% of the cases. By Cesarean Section were delivered 117 macrosomic babies (42,7%): elective cesarean section had 89 patients - 32,48% (89/274) and emergency Cesarean section was done in 28 cases -10,2% Vaginal delivery had 157 patients - 57,3%. In this group 136 patients (86,33%) had normal vaginal delivery and 21 (13,37%) had operative vaginal delivery. (vacuum extractor, forceps, manual removal of the placenta). The authors found that the highest incidence of birth trauma was found in the cases where operative vaginal delivery was undertaken.     

An analysis of the obstetric outcome of 125 consecutive pregnancies conceived in vitro and resulting in 100 deliveries

One hundred twenty-five consecutive pregnancies conceived in vitro resulted in 100 deliveries of 115 babies. There were 23 clinical abortions (18.4%) and two tubal pregnancies. During the same interval 30 preclinical pregnancies occurred, but these pregnancies did not progress. There were 26 multiple pregnancies (37.1%) before the twelfth week; these reduced spontaneously to 14 (22.2%) multiple births at delivery. Eight infants were delivered prematurely, and three of these died. Three babies had some congenital abnormality. Vaginal bleeding occurred during pregnancy in 59% of patients. Cesarean section was the method of delivery in 56% of patients. Other complications of pregnancy were similar to those of comparable populations.     

Hypertension during pregnancy in South Australia, part 2: risk factors for adverse maternal and/or perinatal outcome - results of multivariable analysis

OBJECTIVE: To identify factors associated with adverse pregnancy outcomes among women with hypertension during pregnancy. DESIGN: A population-based retrospective multivariable analysis using the South Australian perinatal data collection. METHODS: Perinatal data on 70,386 singleton births in 1998-2001 were used in multivariable analyses on three groups: all women combined, all hypertensive women and women with pregnancy hypertension only, in order to identify independent risk factors for requirement for level II/III care, preterm birth, small for gestational age (SGA) birth and maternal length of stay greater than 7 days. RESULTS: The risks for the four morbidities were all increased among women with hypertension compared with normotensive women. Those with pre-existing hypertension had the lowest risk (with odds ratios (OR) 1.26-2.90). Pregnancy hypertension held the intermediate position (OR 1.52-5.70), while superimposed pre-eclampsia was associated with the highest risk (OR 2.00-8.75). Among women with hypertension, Aboriginality, older maternal age, nulliparity and pre-existing or gestational diabetes increased the risk for level II/III nursery care, preterm birth and prolonged hospital stay. Smokers had shorter stays, which may be related to their decreased risk of having a Caesarean section or operative vaginal delivery. Asian women, Aboriginal women, smokers and unemployed women had an increased risk for having an SGA baby, while women with pre-existing or gestational diabetes had a reduced risk. CONCLUSIONS: Among hypertensive pregnant women, nulliparity, older maternal age, Aboriginality, unemployment and diabetes are independent risk factors for one or more major adverse pregnancy outcomes. Smoking does not always worsen the outcome for hypertensive women except for SGA births.     

Customised birthweight centiles are useful for identifying small-for-gestational-age babies in women with type 2 diabetes

Background: Customised birthweight centiles identify small-for-gestational-age (SGA) babies at increased risk of morbidity more accurately than population centiles, but they have not been validated in obese populations.
Aims: To compare the rates of SGA by population and customised birthweight centiles in babies of women with type 2 diabetes and examine perinatal outcomes in customised SGA infants.
Methods: Data were from a previous retrospective cohort study detailing pregnancy outcomes in 212 women with type 2 diabetes. Customised and population birthweight centiles were calculated; pregnancy details and neonatal outcomes were compared between groups that delivered infants who were SGA (birthweight < 10th customised centile) and appropriate weight for gestational age (AGA) (birthweight 10–90th customised centile).
Results: Fifteen (7%) babies were SGA by population centiles and 32 (15%) by customised centiles. Two babies of Indian women were reclassified from SGA to AGA by customised centiles. Nineteen babies were reclassified from AGA to SGA by customised centiles; of these, 15 (79%) were born to Polynesian women, five (26%) were born less than 32 weeks and two (11%) were stillborn. Customised SGA infants, compared with AGA infants, were more likely to be born preterm (19 (59%) vs 20 (16%), P  < 0.001) and more likely to be stillborn (4 (13%) vs 0 P  = 0.001). After excluding still births, admission to the neonatal unit was also more common (19 of 28 (68%) vs 43 of 127 (34%), P  < 0.001).
Conclusions: In our population more babies were classified as SGA by customised compared with population centiles. These customised SGA babies have high rates of morbidity.     

妊娠合并肾脏疾病28例的产科处理

目的探讨妊娠合并肾脏疾病的产科处理。方法对妊娠合并肾脏疾病28例病例的产科处理做回顾性分析。结果28例妊娠合并肾脏疾病中合并肾炎的发病率最高(20/28),妊娠并发症中妊娠期高血压疾病发生率最高(10/28)。24例肾功能代偿期孕妇均定期接受产科检查,除1例孕13周时行人工流产术外,其余23例均足月正常分娩,母儿预后良好;3例合并妊娠期高血压疾病子痫前期(重度)、肾功能不全(氮质血症期),除1例早产外,另2例剖宫产终止妊娠,母儿预后良好;另有1例孕期未进行产前检查,孕24周合并妊娠期高血压疾病子痫前期(重度),胎儿宫内发育迟缓,肾功能不全(尿毒症期),以剖宫产终止妊娠,胎儿死亡。结论妊娠结局与妊娠合并肾脏疾病中肾功能的分期和有无妊娠并发症密切相关;孕期检查和适时、适当的产科处理对于围生儿、孕妇的预后至关重要。     

AGA-primed uteri compared with SGA-primed uteri and the success of subsequent in utero fetal programming

OBJECTIVE: To assess whether risk for early mortality is increased with recurrent small for gestational age (SGA) compared with nonrecurrent SGA. METHODS: We used the Missouri maternally linked cohort data containing births from 1978-1997. We identified mothers according to four categories: 1) appropriate for gestational age (AGA)-AGA: both first and second pregnancies were AGA; 2) AGA-SGA: first pregnancy was AGA, second pregnancy outcome changed to SGA (a switch); 3) SGA-AGA: first pregnancy was SGA, second pregnancy outcome AGA (a switch); 4) SGA-SGA: both first and second pregnancies were SGA. We then compared the success of fetal programming in the second pregnancy with a switch compared with a pregnancy without a switch (AGA-SGA compared with SGA-SGA; and SGA-AGA compared with AGA-AGA). We used neonatal mortality as primary outcome with infant and postneonatal mortality as secondary outcomes. RESULTS: Appropriate for gestational age infants from a SGA-primed uterus (SGA-AGA switch) had a 19% (odds ratio 1.19; 95% confidence interval 1.11-1.28) and 29% (odds ratio 1.29; 95% confidence interval 1.17-1.42) greater likelihood of infant and neonatal mortality, respectively, when compared with AGA infants from AGA-primed uterus (AGA-AGA; nonswitch). Approximately the same magnitude of risk elevation for neonatal and infant mortality was noted among SGA infants resulting from AGA-primed uterus (a switch) as among SGA infants from SGA-primed uterus (a nonswitch). Overall, the greatest risk of neonatal, infant, and postneonatal mortality was associated with an AGA-SGA switch. CONCLUSION: Fetal programming switch in subsequent gestation adversely affects early survival of affected infants compared with those with no change in fetal growth pattern.     

Induced abortion and risk of small-for-gestational-age birth

Objective  To investigate the possibility of an association between previous induced abortion and subsequent birth of a small-for-gestational-age (SGA) infant.
Design  Case–control study.
Setting  General and university hospitals.
Methods  Cases were 555 women who delivered SGA babies. Controls were 1966 women who gave birth at term (>37 weeks of gestation) to healthy infants of normal weight on randomly selected days at the hospital where cases had been identified. All women in the case and control categories were interviewed on the obstetric wards by one of a team of six interviewers. During the interviews, information was obtained regarding general socio-demographic factors, personal characteristics and habits, gynaecological and obstetric history, general anamnesis, family history of obstetric and gynaecological diseases, and the age of the father of the child. Further information on current pregnancy and delivery was also collected. We used conditional multiple logistic regression (with age as the matching variable), with maximum likelihood fitting, to obtain odds ratios and their corresponding 95% CIs. Included in the regression equations were terms for education, plus terms significantly associated in this data set with the risk of SGA birth (smoking in pregnancy, history of SGA, gestational hypertension and parity).
Population  Women admitted to a general and a university hospital.
Results  No significant increase in the risk of SGA birth was observed in women with a previous induced abortion [odds ratio (OR) 1.0; 95% CI 0.6–1.7]. The OR for SGA birth was 1.2 (95% CI 0.7–2.1) for preterm and 1.0 (95% CI 0.7–1.4) for term SGA births.
Conclusion  This study found no association between risk of SGA birth and induced abortion.     

Smoking-associated fetal morbidity among older gravidas: a population study

BACKGROUND: We set out to assess the influence of advanced maternal age on fetal morbidity associated with smoking during pregnancy in a population-based retrospective study of 7 792 990 singleton live births between 1995 and 1997 in the United States with documented maternal smoking habit. METHODS: The study group consisted of infants born to mothers aged>or=40 years (older mothers). Two maternal age categories (20-29, "younger mothers"; 30-39, "mature mothers") were constructed as comparison groups. Adjusted odds ratios (ORs) generated from logistic regression models were used to compare fetal morbidity indices associated with smoking across maternal age categories. Main outcome measures included preterm, very preterm, and small for gestational age (SGA). RESULTS: The prevalence of smoking was 13.1%, and decreased with increasing maternal age. Regardless of maternal age, the risk for fetal morbidity was significantly elevated if the mother smoked. The risks for preterm and SGA associated with smoking were significantly higher among older gravidas as compared to younger mothers while mature mothers had risk estimates comparable to those of older mothers. Among smoking mothers only, the risk pattern for fetal morbidity was J-shaped, with babies of older smokers having significantly higher fetal morbidity indices, while those of mature smokers showed lower levels of risk as compared to younger mothers. CONCLUSION: In an era of relatively lower prevalence of smoking during pregnancy, advanced maternal age still increases the risk of smoking-associated fetal morbidity. Our findings reveal new information of elevated risk for very preterm births among older smoking mothers.     

Pregnancy outcome in liver transplant recipients

OBJECTIVE: To evaluate pregnancy course, complications, and outcomes in liver transplant recipients. METHODS: We conducted a retrospective review of 38 pregnancies conceived between 1992 and 2002 in 29 women who underwent liver transplantation at Mount Sinai Medical Center. RESULTS: The most common primary liver disease was autoimmune hepatitis. All patients were on immunosuppressive regimens that included cyclosporine A or tacrolimus. There were four spontaneous first-trimester abortions and ten first-trimester terminations for worsening liver function. The interval from transplantation to pregnancy was shorter in the group that had abortions and terminations (24.4 +/- 24.3 months) as compared with the group that had live births (47.8 +/- 28.7 months), P =.02. There were 24 live births to 20 patients. The mean gestational age at delivery was 36.4 weeks, and the mean birth weight was 2762 g. Pregnancy complications included preeclampsia (20.8%), chronic hypertension (20.8%), hemolysis, elevated liver enzymes, low platelets syndrome (8.3%), creatinine 1.3 mg/dL or more (25.0%), anemia (33.3%), diabetes (37.5%), cesarean delivery (45.8%), preterm birth less than 37 weeks (29.2%), intrauterine growth restriction (16.7%), and biopsy-proven graft rejection during pregnancy (16.7%). There were no intrauterine or neonatal deaths. All 5-minute Apgar scores were greater than 7. Four minor congenital anomalies were noted. Before 1997, there were five maternal deaths, 10-54 months after pregnancy. Pregnancy complications in our population were more common in those patients who delivered from 1992 to 1997 than in those who delivered from 1998 to 2002. CONCLUSION: Pregnancy planned at least 2 years after liver transplantation with stable allograft function can have excellent maternal and neonatal outcome.     

Life events and low birthweight--analysis by infants preterm and small for gestational age

Social stress was assessed in 92 women with low-birthweight babies and 92 controls using the detailed LEDS measure of life events and severe chronic difficulties. The low-birthweight group was divided into preterm delivery (n = 40), small for gestational age (SGA) (n = 40) and mixed groups. Multivariate analysis was performed using a binomial-logit model to examine whether social factors were independently and significantly associated with low birthweight once the effect of demographic factors, obstetric factors and smoking/drinking were taken into account. Comparison of preterm births with controls indicated that three factors were significantly associated: a previous low-birthweight baby, severe life event/difficulty and bleeding during pregnancy. For SGA babies the factors were: previous low-birthweight baby, low social support and smoking. By using a reliable measure of life events and adequate numbers of low-birthweight babies, this study overcame the potential inaccuracies of previous studies and indicates a more specific relation between social stress and low birthweight.     

Birthweight of IVF children is still a current issue and still related to maternal factors

Research questionDoes fresh embryo transfer after IVF with or without intracytoplasmic sperm injection (ICSI) increase the small for gestational age (SGA) rate, and frozen embryo transfer (FET) after IVF with or without ICSI increase the large for gestational age (LGA) rate versus natural conception?DesignRetrospective comparison of an exposed historical group/cohort involving singletons conceived after fresh embryo transfer and after FET with an unexposed group/cohort involving singletons conceived after a natural conception.ResultsA total of 1961 fresh embryo transfer babies and 366 FET babies were compared with 6981 natural conception babies. The SGA rate in fresh embryo transfer babies was not significantly different to natural conception babies (6.9% versus 6.8%, P = 0.856). This outcome was not influenced by the fresh embryo transfer (adjusted odds ratio [aOR] 1.0; 95% confidence interval [CI] 0.8–1.3), but rather by a low rate of multiparity (aOR 0.5; 95% CI 0.3–0.7), advanced maternal age (aOR 1.1; 95% CI 1.0–1.2), maternal underweight (aOR 1.5; 95% CI 1.1–2.1), maternal smoking or cessation during pregnancy (aOR 1.8; 95% CI 1.4–2.3), pre-existing hypertension (aOR 2.3; 95% CI 1.3–4.1) and pregnancy-induced hypertension (aOR 2.5; 95% CI 1.7–3.7). The LGA rate in FET babies was significantly different from natural conception babies (6.6% versus 3.2%, P = 0.012). This outcome was influenced by the transfer of frozen embryos (aOR 2.2; 95% CI 1.3–3.8) and by a high maternal weight (aOR 1.9; 95% CI 1.1–3.6).ConclusionsMaternal background and obstetric parameters are more likely to influence the SGA rate than fresh embryo transfer conception. FET conception could be associated with an increase in LGA rate.     

A favorable outcome of pregnancies in women with primary and secondary recurrent pregnancy loss associated with antiphospholipid syndrome

Objective:To study the outcome of pregnancies in women with primary and secondary recurrent pregnancy loss associated with antiphospholipid syndrome treated with the standard treatment regimes including intravenous immunoglobulin (IV Ig). Methods: Forty three patients with recurrent pregnancy loss associated with antiphospholipid syndrome diagnosed before pregnancy and subdivided into primary (18) and secondary (25) subgroups were closely monitored all through pregnancy with serial blood tests and ultrasonography until the pregnancy ended in miscarriage or delivery. The patients were treated with low-dose aspirin and heparin and or steroids and IV Ig given to some selected patients. The maternal and fetal outcomes were analysed. Results: The mean age of the patients in the primary sub group (24.60±4.30) years was significantly lower than the mean age of the secondary recurrent pregnancy loss group (31.50±4.50) years, (p<0.0001). 85.00% of all the previous miscarriages were in the first trimester. There was no significant difference in the incidence of live births in the primary (77.80%) and secondary (84.00%) groups, (p>0.05); the babies were of normal birth weight. The incidence of caesarean section in the primary and secondary groups, 22.23% and 12.00% respectively, were not significantly different (p>0.05). Intravenous immunoglobulin added to the standard therapy resulted in 100% live births. Maternal complications were negligible. Conclusions: The fetal and maternal outcome of pregnancies in patients with primary and secondary recurrent pregnancy loss associated with antiphospholipid syndrome were virtually identical and quite satisfactory. Intravenous immunoglobulin added to the standard therapy resulted in excellent fetal and maternal outcome, although its definitive role will have to wait for the outcome of randomised trials. Received: 22 November 2000 / Accepted: 19 February 2001     

Detection of small-for-gestational-age fetuses by ultrasound screening in a high risk population: a randomized controlled study.

OBJECTIVE: To assess the value of fetal weight estimation during routine third trimester ultrasound examinations for the identification of small-for-gestational-age (SGA) fetuses, to promote active pregnancy management and so reduce perinatal morbidity. DESIGN: A prospective controlled randomized study. SETTING: Outpatient clinic at the Department of Obstetrics, Herlev University Hospital, Denmark. SUBJECTS: One thousand pregnant women considered at risk were selected consecutively from April 1985 to September 1987 and randomized to either a revealed-results group or a withheld-results group. INTERVENTION: All the women had an early ultrasound examination for estimation of gestational age. Both groups had routine ultrasound estimates of fetal weight after 28 weeks and then every third week until delivery. The results were available for clinical use only in the revealed group. MAIN OUTCOME MEASURES: Number of interventions during pregnancy (admission to hospital, elective delivery), emergency intervention during labour, and fetal outcome. RESULTS: Revealing the results of ultrasound estimates of fetal weight for gestational age during the third trimester resulted in statistically significantly increased diagnosis of SGA fetuses, of elective deliveries based on this diagnosis, and of healthy preterm babies admitted to the neonatal care unit, but no detectable overall improvement in weight for gestational age at birth, or in neonatal morbidity or mortality. CONCLUSION: This method of screening improved the diagnosis of SGA fetuses, but this was not followed by improved fetal outcome.     

Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies.

OBJECTIVE: To compare the obstetric outcome of in vitro fertilization pregnancies with normally conceived pregnancies. STUDY DESIGN: The obstetric outcome of in vitro fertilization pregnancies achieved in 763 British residents at two in vitro fertilization clinics resulting in the births of 961 babies were compared by means of the relative risk statistic with a control group of naturally conceived primiparous pregnancies matched by maternal age and multiplicity of pregnancy. RESULTS: Twenty-five percent of in vitro fertilization pregnancies were multiple pregnancies. The incidence of singleton term breech presentation was similar to that among controls. As compared with controls there was an increased incidence among in vitro fertilization pregnancies of vaginal bleeding and hypertension requiring hospitalization (p less than 0.001) and cesarean births (p less than 0.001) and, among in vitro fertilization singleton pregnancies, an increased incidence of intrauterine growth retardation (p less than 0.05), placenta previa (p less than 0.05), and preterm delivery (p less than 0.001). The congenital malformation, stillbirth, and perinatal mortality rates were comparable with maternal age-standardized national rates. CONCLUSIONS: Although the majority of in vitro fertilization pregnancies have a satisfactory obstetric outcome, there are a number of increased obstetric risks that may reflect the history of infertility, the relatively high incidence of poor obstetric history, and the lower threshold for obstetric intervention in in vitro fertilization patients.     

Maternal and neonatal outcome following cerebrovascular accidents during pregnancy.

OBJECTIVE: To assess the clinical characteristics of maternal and neonatal outcome among women with cerebrovascular accidents (CVA) during pregnancy. METHODS: Our computerized database was used to identify patients with CVA during pregnancy and puerperium from January 1988 to March 2004. Their medical records were identified and reviewed. RESULTS: There were 16 cases of CVA among 173,803 deliveries, giving a risk of almost one case per 10,000 pregnant women. Out of 16 patients, 14 (88%) had a stroke and the remaining two cases were diagnosed with venous thrombosis. Of those 14 cases, nine (64%) had ischemic strokes and five (36%) had hemorrhagic strokes. Ten of the CVAs occurred antepartum, two intrapartum and four postpartum. Hypertensive disorders were diagnosed in 75% (12/16) of the patients. Out of these 12 patients with hypertension, 9 (75%) suffered from preeclampsia. One woman had a history of chronic hypertension. Smoking was associated with 63% (10/16) of the cases. There were two maternal deaths, both in women who had hemorrhagic strokes, and both in the first half of the study (1994 and 1996). Nine out of 16 women (56%), were delivered within 48 hours of the CVA including 7 (78%) antepartum, and two (22%) intrapartum. Cesarean deliveries were performed in 11/16 women (69%) including 8/10 with CVAs occurring antepartum, 1/2 intrapartum and 2/4 postpartum. One case of neonatal mortality was identified in a patient who was delivered at 24 gestational weeks. CONCLUSIONS: (1) Hypertensive disorders and smoking were the most important factors associated with CVA during pregnancy. (2) Maternal mortality was high among patients with CVA during pregnancy. (3) Neonatal outcome was considered generally good in cases of CVA.     

The effect of hypertension in pregnancy on fetal and neonatal condition

The aim of this prospective study was to determine the effect of hypertension in pregnancy (PH) on fetal and neonatal condition via other mechanisms than retarded intrauterine growth and preterm delivery. Sixty-six preterm and 175 full-term babies born to PH mothers were compared, respectively, with 183 preterm and 220 full-term babies born to non-hypertensive (non-PH) mothers over a 22-month period in 1984-1986. Small-for-gestational-age (SGA) children were examined separately from appropriate-for-gestational-age (AGA) children. Percentages of preterm babies and of both preterm and full-term SGA babies born to hypertensive mothers were twice as great as the percentages of such babies born to non-hypertensive mothers. Hypertension in pregnancy directly increased neonatal morbidity, but the effect was minor. In preterm babies it was related to intrauterine growth retardation and to pre-eclampsia. In full-term babies the effect was unrelated to the severity of hypertension.