Hypertensive disorders of pregnancy

Hypertensive disorders occur in 6% to 8% of all pregnancies, are the second leading cause of maternal death, and contribute to significant neonatal morbidity and mortality. This is a problem not only in inpatient settings, as ambulatory and home-care nurses are increasingly being called upon to monitor women who are at high risk and may have hypertensive disorders. To prevent hypertension-induced problems in pregnant women, nurses must have strong assessment, advocacy, and counseling skills. Nurses also must provide care based on the latest national standards as described in this article.     

Hypertensive disorders of pregnancy.

OBJECTIVES: This study was undertaken to determine the prevalence of hypertensive disorders of pregnancy and evaluate their effects on the mothers and fetuses at Jahrom, a city in southern Iran. METHODS: A retrospective survey was performed on 2300 pregnant women who had referred to Shahid Motahhari Hospital of Jahrom School of Medical Sciences from 22 September 2002 to 21 September 2003. Diagnosis of hypertensive disorders of pregnancy and their probable complications were made according to medical recording files. RESULTS: Among the studied patients, 3.3% were diagnosed as having hypertensive disorders of pregnancy, of which 96% were cases of preeclampsia/eclampsia or transient hypertension. In hypertensive patients, the overall maternal mortality rate was 1.3 per 10,000 and perinatal mortality rate was 53 per 1000 births. Low birth weight neonates were observed in 20% of cases. CONCLUSION: Hypertensive disorders of pregnancy commonly complicate pregnancy and have great influences on maternal and neonatal morbidity and mortality rates and more attention and precision is needed to evaluate the pregnant women for detecting and preventing the complications.     

Hypertensive disorders of pregnancy in Greece

Unique population data on the incidence of hypertension during pregnancy was obtained during the 1983 Greek National Perinatal Survey. Of the 9915 women delivering in April who had their blood pressures measured during pregnancy, only 3.0% had a diastolic pressure of over 90 mmHg. The data can be compared with 11.6% of 15,744 women delivering in the United Kingdom in one week of April 1970 and for whom data on antepartum blood pressures were available (p less than 0.0001). Corresponding rates for proteinuric pre-eclampsia were 0.7 and 3.1% (p less than 0.0001). In Greece, there was no consistent variation with parity but a strong trend with advancing maternal age. The perinatal mortality rate among pregnancies with diastolic pressures of 91 mmHg and more was 6%, three times the national rate. Such cross-cultural comparisons of hypertension in pregnancy form a valuable basis on which to develop hypotheses to explain the aetiology of this condition.     

Hypertensive disorders of pregnancy and risk of screening positive for Posttraumatic Stress Disorder: A cross-sectional study

ObjectivesHypertensive Disorders of Pregnancy (HDP) encompass a spectrum of disorders that affect 6–8% of US pregnancies. We aim to determine the impact of self-reported history of HDP as a risk factor for screening positive for Posttraumatic Stress Disorder (PTSD), which results from exposure to a traumatic event, and to evaluate whether the risk of PTSD differed by severity of HDP.Study designWe conducted an online survey on the Preeclampsia Foundation website that is accessed worldwide by women who have experienced HDP, as well as their friends and family. 1448 women in total responded to the survey, including 1076 women who reported a history of HDP in at least one prior pregnancy and 372 women who reported no history of HDP during any prior pregnancy.Main outcome measuresWe measured PTSD outcome with the Breslau Short Screening Scale for DSM-IV PTSD. We used logistic regression to model the relationship between PTSD and HDP.ResultsWomen who reported a history of HDP were more than four times as likely to screen positive for PTSD than women who reported having a normotensive pregnancy history (OR_adj = 4.46, 95% CI: 3.20–6.20). In addition, there was a marked trend toward increasing risk of screening positive for PTSD as the severity of HDP increased from gestational hypertension to eclampsia (p < 0.001).ConclusionsWomen with a history of HDP may be at increased risk of PTSD, with severe cases most likely to suffer from symptoms. Clinicians should consider implementing routine screenings during post-partum visits in this vulnerable population.     

Hypertensive disorders in pregnancy: risk factors and epidemiologic analysis

OBJECTIVE: To measure the incidence of preeclampsia-eclampsia and its perinatal mortality as they appear in the two major ethnic groups in Thrace: Christian Orthodox and Muslims. STUDY DESIGN: Incidence and perinatal mortality of preeclampsia-eclampsia were studied retrospectively on all women managed in our clinic for hypertensive disorders in pregnancy who were delivered of a stillborn or healthy neonate between 1986 and 1999. We also compared the prevalence of certain risk factors of the disease as they appear in the above-mentioned distinct ethnic groups. RESULTS: The total incidence of preeclampsia-eclampsia in Thrace was 2.3% and the total perinatal mortality 6.4%. Both variables presented higher values and severe preeclampsia-eclampsia had greater prevalence in the Muslim population. Most risk factors presented statistically significant differences between Christians and Muslims (chi2 test, p < 0.05). CONCLUSIONS: There was an ethnic variation in most epidemiologic variables of hypertensive disorders in Thrace between Christians and Muslims.     

Hypertensive disorders in pregnancy: a review of international guidelines

International collaboration could facilitate systematic development of guidelines to regulate and improve clinical practice. Insight into existing international guidelines regarding hypertensive disorders in pregnancy (HDP) is essential. Aim was to evaluate the content and quality of international clinical guidelines on HDP. Quality was assessed with the internationally validated Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument. Six guidelines were identified. Quality was moderate to high. Major flaws were applicability, editorial independence and stakeholder involvement. Recommendations differed considerably, particularly their extensiveness. The number of international HDP guidelines is small and the extensiveness of their recommendations varies considerably.     

Hypertensive disorders during monozygotic and dizygotic twin gestations: A population-based study

Objective: To determine whether the incidence of hypertensive disorders is different in monozygotic compared to dizygotic twin pregnancies. Methods: A registry-based survey of twin pregnancies delivered during 2003 to 2012. We used the best clinical estimate of zygosity based on the concept that all monochorionic twins are monozygotic and all unlike-sex pairs are dizygotic, thus excluding same-sex dichorionic twin gestations for which zygosity cannot be ascertained on clinical grounds. Study cohorts were twin pregnancies with or without preeclampsia and gestational hypertension. Results: A total of 3419 twin gestations met the inclusion criteria, of which 442 (12.9%) were monochorionic and 1255 (36.7%) were unlike-sex twins, excluding 1722 same-sex dichorionic twin gestations (50.4%). There was no significant difference in the incidence of preeclampsia (OR: 0.9; 95% CI: 0.4–2.0 for monozygotic males and OR: 0.6; 95% CI: 0.3–1.4 for monozygotic females) and gestational hypertension (OR: 0.7; 95% CI: 0.2–2.5 for monozygotic males, and OR: 0.7; 95% CI: 0.2–2.3 for monozygotic females) between monochorionic and unlike-sex pairs. Maternal prepregnancy obesity and nulliparity were the only significant associated factors of preeclampsia (OR: 3.8; 95% CI: 2.0–7.0, and OR: 2.5; 95% CI: 1.4–4.4, respectively). Maternal prepregnancy obesity (OR: 5.5; 95% CI: 2.5–12.2), maternal age ≥36 years (OR: 2.5; 95% CI: 1.1–6.1), and family history of hypertension (OR: 2.6; 95% CI: 1.3–5.1) were significantly associated with gestational hypertension. Conclusion: Based on a large population-based dataset and on the best clinical estimate of twin zygosity, it appears that zygosity is not associated with hypertensive disorders in twin gestations.     

妊娠期高血压疾病对围生儿结局影响

文章从多方面阐述了妊娠期高血压疾病对围生儿结局的影响,包括近期影响及远期影响,并介绍了对疾病主动进行干预的方法,及对改善围生儿结局的作用。     

Pre-existing mental health disorders and pregnancy

Mental health conditions are independent risk factors for poor obstetric and neonatal outcomes therefore obstetricians need to be able to manage them well. This review will summarize the management of pre-existing mental health disorders in pregnancy. Explanations will be given as to which women are managed in primary care for their mental health conditions and which women are managed in specialist Perinatal Mental Health Services. When women should be referred to perinatal mental health services is described. The article provides recommendations on the obstetric management of these women as well as information on psychotropic medication in pregnancy and lactation.     

Pre-existing mental health disorders and pregnancy

Mental health disorders are independent risk factors for adverse perinatal and neonatal outcomes. It is estimated that 20% of women may experience symptoms of mental health disorders during or following pregnancy. It is important that obstetricians recognize the presentation of these symptoms and follow pathways for managing these conditions. This article utilizes case vignettes to describe the epidemiology, role of the multi-disciplinary team, clinical presentation, and management of common perinatal mental health disorders both from the obstetric and psychiatric view point. Indications and duration of psychotropic medications including side effects are also discussed as well as safety in pregnancy and lactation.     

Improving health behaviours during pregnancy: a new direction for the pregnancy handheld record

Obstetric documentation processes may influence the clinical, behavioural, and psychological outcomes of pregnancy, although recent alterations to integrate obstetric documentation with pregnancy handheld records have been unsuccessful. Woman-held records as a companion to usual obstetric documentation have the potential to improve pregnancy-related health behaviours with a demonstrated association with maternal and infant health outcomes, and recommendations for their format and content are provided.