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2022 DEC 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on drugs and therapies is the subject of a new [...]

The case: A previously healthy 37-year-old woman (gravida 3, para 1 with 2 first-trimester miscarriages) had an unremarkable pregnancy until the 35th week. Her blood pressure readings during pregnancy were [...]

The changes of brachial to ankle distensibility are examined by using pulse wave velocity (PWV) throughout pregnancy and its difference between normal pregnancy and pregnancy-induced hypertension (PIH) groups. The results have shown that the predictive value of PWV and blood pressure for PIH is higher than that of blood pressure alone, indicating the usefulness of measuring PWV to predict PIH.

Practice recommendations * Screening for gestational diabetes using urine dipsticks for glycosuria is ineffective with low sensitivities. False-positive tests outnumber true positives 11:1. A 50-g oral glucose challenge is a [...]

Epidural analgesia is more effective than intravenous analgesia in relieving labor pain in pregnant women with hypertension but it has more side effects. It prolongs the second stage of labor and increases the risk of a forceps delivery and an infection called chorioamnionitis.

An update of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure is presented. It focuses on the classification of hypertensive disorders of pregnancy, their pathophysiology, differential diagnosis, and their treatment, including postpartum counseling.

The babies of older women with mild hypertension early in pregnancy do not appear to be at greater risk compared with the babies of mildly hypertensive younger women. Researchers compared outcomes between 379 mildly hypertensive pregnant women aged 35 or more with 379 similar women aged 20 to 30. Similar numbers of women experienced serious complications. Average length of pregnancy, birth weights, percentages of underweight babies, and percentages admitted to newborn intensive care were similar. There were five stillbirths in the mature group versus none in the younger group, but this may be due to chance.

Outpatient management of pregnant teenagers with mild gestational hypertension appears to be adequate in reducing the risks of complications from preeclampsia. Researchers followed 60 pregnant teenagers and 120 pregnant adults in an outpatient clinic. All of the women had mild pregnancy-induced hypertension. They had their blood pressure checked four times a day and were also weighed, tested for protein in their urine and assessed for fetal movement. Most were delivered postterm and birth weights were similar in both groups of women. None developed eclampsia and there were no stillbirths in either group. Teenagers with gestational hypertension are believed to have a higher risk of premature birth and low-weight-birth infants, but many teens are not compliant with hospital treatment. Outpatient management might guarantee that these teens will give birth to healthy babies.

The hypertensive disorders of pregnancy remain an enigma. Biologically speaking, pregnancy is the time when women are the most important to the species. One feels instinctively that any condition that [...]

More women than men eventually develop hypertension, but they suffer less cardiovascular damage as a consequence. Primary hypertension in women has a greater volume component, often related to commonly associated obesity. Most lifestyle modifications have more to offer women, but women respond in a similar manner to various antihypertensive drugs. However, women appear to receive less benefit from antihypertensive therapy, as measured by morbidity and mortality data in multiple large clinical trials. Women who take oral contraceptives typically have a small rise in blood pressure, and in a small percentage, the rise is sufficient to induce hypertension. The prevalence is likely lower with currently used low-dose estrogen formulations. The use of estrogen for postmenopausal replacement therapy almost never raises the blood pressure, so that concerns about hypertension should not interfere with the use of this valuable therapy. (Arch Intern Med. 1995;155:563-567)

Severe hypertension--diastolic blood pressure (BP) higher than 120 mmHg or systolic BP higher than 180 mmHg may be accompanied by significant symptoms and signs of damage to target organs. In [...]

Outpatient monitoring of women with gestational hypertension may result in shorter periods of hospitalization and contribute to good outcomes for mothers and infants. Gestational hypertension is persistent high blood pressure in pregnancy that is often associated with decreased blood flow to the fetus. Gestational hypertension is usually managed in the hospital with bed rest and monitoring. A total of 592 women with mild hypertension at an average of 32 weeks' gestation were given a device to monitor their blood pressure. The women also monitored their weight, protein in their urine, rest periods and fetal movements on an outpatient basis. The pregnancies of these women were prolonged an average of 27 days, which is similar to pregnancies of women with hypertension managed in the hospital. The outpatient group had significantly less hospitalization time than women monitored as inpatients. Eighty-four percent of the infants weighed more than 2,000 grams, and only 13% had nursery stays of longer than one week.

Pheochromocytoma accounts for only 0.1% of hypertension found in adults between 40 and 70 years of age. Although it is extremely rare in pregnancy, if it occurs and is unrecognized [...]

Preeclampsia is a condition that can develop during pregnancy characterized by an increase in blood pressure (hypertension), fluid retention (edema), an increase in the amount of protein excreted in the urine (proteinuria), and impaired liver and kidney function. In severe cases it can lead to blood vessel spasms, convulsions, blood clotting, and extreme hypertension. In most cases, it appears after the 20th week of pregnancy. The exact cause of preeclampsia is unknown. A standard treatment for hypertension involves drugs that dilate the blood vessels. To determine if these drugs can reduce blood pressure during pregnancy and prevent the symptoms associated with preeclampsia, 36 pregnant women with hypertension were studied. Seventeen of the women were treated with atenolol, methyldopa, and bendrofluazide to lower blood pressure, and 19 were untreated. An increase in the amount of protein in the urine was used as an indicator of preeclampsia. Blood pressure was measured before and during drug treatment. Drug treatment resulted in a decrease in blood pressure. Six of the 19 women who did not receive drug treatment developed proteinuria compared with only 1 of the 17 women who received drug treatment. These results suggest that drug treatment to reduce blood pressure may reduce or prevent the symptoms of preeclampsia. However, it is not known if these drugs will harm the fetus. Therefore, it is recommended that hypertension during pregnancy be treated only to the point necessary to protect the mother from serious physiological damage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Eclampsia is a potentially fatal complication of pregnancy associated with seizures, high blood pressure (hypertension), coma, and other physiological changes. Although many deaths of eclamptic women are due to cerebral hemorrhage (bleeding into the brain), other direct causes of death have not been characterized. The possibility that cardiac arrhythmias (irregularities in the heartbeat) accompany eclampsia was investigated in 21 patients who were either eclamptic (convulsions, hypertension, excess protein in the urine) or in a state of imminent eclampsia (stomach pain, blurred vision, headache, and nervous system abnormalities). The women underwent standard treatment, as well as continuous cardiac monitoring for 24-hours. Premature ventricular contractions (extra heartbeats, also called ventricular extrasystoles) were counted and ranked according to their frequency and pattern of occurrence. A control group, consisting of pregnant women with normal blood pressure, were also examined. The eclampsia group was at an earlier stage of pregnancy (average, 32 weeks) than the control group (38 weeks). Results showed that cardiac arrhythmias were present in five control patients, and in all eclamptic or imminent-eclamptic patients. The arrhythmias of all controls and of five eclamptic patients were of the lowest grade, consisting of isolated ventricular extrasystoles. The remaining 15 patients had frequent ventricular extrasystoles and complex arrhythmias ranked as grades III or IV (the highest grades in the ranking scale). These abnormalities decreased during delivery (14 deliveries were by cesarean section under optimal physiologic maintenance), but reappeared afterwards, and disappeared only several hours after blood pressure returned to normal. The results indicate the development of life-threatening ventricular arrhythmias in 71 percent of the patients, but were not a result of electrolyte imbalance or similar physiologic derangement. Drugs that lower blood pressure and control cardiac arrhythmias may be beneficial for pregnant women in hypertensive crises. Complex ventricular arrhythmias may be a cause of sudden death in such cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

A report is presented from a working group of obstetricians and internists, appointed by the National High Blood Pressure Education Program of the National Heart, Lung, and Blood Institute and the American College of Obstetricians and Gynecologists, concerning high blood pressure in pregnancy. This complication occurs in almost 10 percent of pregnancies; it is categorized as chronic hypertension, preeclampsia (symptoms of hypertension, headache, excess protein in the urine, and swelling of the legs), preeclampsia superimposed upon hypertension, or transient hypertension. Hypertension is a significant cause of maternal death, usually resulting from eclampsia (associated with seizures and coma). The physiological characteristics of the hypertensive patient and the pathophysiology of hypertension itself are explained. Diagnostic issues are discussed. Management begins with advising hypertensive women of the possibility of complications should they become pregnant. When pregnant, patients are treated without medication whenever possible, and restriction of activity, home blood pressure monitoring, and elimination of alcohol and tobacco are prescribed. Dietary control, recommended for nonpregnant women, is not usually advised in pregnancy. Even among women with severe hypertension, most infants will be healthy and full-term. The rationale for drug therapy and the drugs preferred in such cases are discussed. Whether treatment of chronic hypertension prevents preeclampsia is not known, in spite of extensive research on the subject. Little is known regarding the prevention of this complication; a review of the medical literature on this subject is presented. Acute hypertension that develops during delivery can be treated pharmacologically, in most cases. Drugs used in this context are evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

The article discusses the key aspects and features of the latest guidelines published by the National Institute for Health and Clinical Excellence's (NICE's) guidelines for midwives, general practitioners (GPs) and obstetricians for the management of hypertensive disorders in women who are pregnant. The key research recommendations for the same are also highlighted.

The article discusses the proposed updated Australian and New Zealand guidelines that have been set for the management of pre-eclampsia and other hypertensive disorders among pregnant women. The issues remains important, as pre-eclampsia and hypertension are the main causes of premature delivery and mortality for both mother and neonate.

Abstract Introduction: Preeclampsia-eclampsia has been one of the main cause of maternal morbidity-mortality in developing countries, affecting 10% of pregnancies. In Mexico, in the recent years it has been estimated [...]

Considering the number of severe maternal and fetal complications that can result from untreated hypertension, ob/gyns must be vigilant about recognizing the chronic form of the disease. Anything less puts [...]

A Systematic Review of the Evidence * BACKGROUND There is uncertainty about the best management of mild (blood pressure [is less than] 160/110) chronic hypertension during pregnancy. Our objective was [...]

Hypertensive disorders are not only a source of severe complications in mothers and unborn babies, they are the second leading cause of maternal death, after embolisms. Here's an overview of [...]

Hypertension in pregnancy is not a single entity[1] but comprises: * Chronic hypertension, which complicates 1%-5% of pregnancies and is defined as a blood pressure greater than 140/90 mm Hg [...]

Hypertensive disorders of pregnancy cover a spectrum of conditions, including chronic (preexisting) hypertension, pre-eclampsia, and gestational hypertension. They cause one in 50 stillbirths in normal babies and 10% of all [...]

Research shows that major stress especially early in pregnancy can increase the risk of preterm birth, low birth weight and autism in children. The six simple techniques are presented which helps ease normal anxiety or even high stress levels in pregnant woman.

Hypertension Caring for the Hypertensive Pregnant Patient Hypertension may occur during pregnancy in various clinical circumstances. The most frequent cause is toxemia (synonymous with preeclampsia). This systemic disease is unique […]

A woman experiencing her first pregnancy had an expected due date of December 5. She had been attending her prenatal appointments regularly with the defendant obstetrician/gynecologist. In October, she presented [...]

While hypertension that develops during the third trimester of pregnancy clearly merits treatment, the importance of treating mild or moderate essential hypertension in pregnant women has been a source of [...]