Hypertension in Pregnancy
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Association of Induced Abortion with Hypertensive Disorders Of
www.nature.com/scientificreports OPEN Association of induced abortion with hypertensive disorders of pregnancy risk among nulliparous women in China: a prospective cohort study Yinhua Su1,2, Xiaoping Xie3, Yanfang Zhou1, Hong Lin1, Yamei Li1, Na Feng1 & Jiayou Luo1* The relationship between induced abortion(IA) and hypertensive disorders of pregnancy(HDP) is inconclusive. Few studies have been conducted in China. In order to clarify the association between previous IA and risk of HDP, including gestational hypertension(GH) and pre-eclampsia(PE), we performed a community-based prospective cohort study enrolling 5191 eligible nulliparous women in selected 2 districts and 11 towns of Liuyang from 2013 to 2015. Multivariable logistic regression was conducted to examine whether IA was associated with HDP, GH and PE. Of the gravidea, 1378(26.5%) had a previous IA and 258(5.0%) diagnosed with HDP, including 141(2.7%) GH and 117(2.3%) PE. The diference in the incidence of GH and PE between gravidae having one versus those with two or more IAs was minimal. After adjustment for maternal age, body mass index at frst antenatal visit, education, virus infection and history of medical disorders, previous IA was signifcantly associated with HDP (OR = 0.67, 95%CI = 0.49 to 0.91) and PE (OR = 0.61, 95%CI = 0.38 to 0.97), but not with GH (OR = 0.73, 95%CI = 0.49 to 1.10). Additional adjustment for occupation, living area, anemia, gestational diabetes mellitus, psychological stress, conception climate and infant sex, multivariable analysis provided similar results. In conclusion, previous IA was associated with a lower risk of PE among nulliparous women. -
Module 2: Hypertensive Disorders of Pregnancy and Gestational Diabetes FINAL Description Text
Module 2: Hypertensive Disorders of Pregnancy and Gestational Diabetes FINAL Description Text Welcome to the module Hypertensive Disorders of Pregnancy and Gestational Diabetes. In this module, we will be discussing hypertensive Slide 1 disorders of pregnancy, including pregnancy induced hypertension and preeclampsia. We will also discuss Gestational Diabetes as well as nutrition solutions related to these issues Slide 2 We will begin by discussing hypertensive disorders in pregnancy. There are at least 5 distinct categories of hypertension and related disorders that occur during pregnancy. These categories are: preeclampsia/eclampsia, chronic hypertension, preeclampsia Slide 3 superimposed upon chronic hypertension, gestational hypertension and transient hypertension. Each of these will be discussed individually throughout the module, with recommendations based on best practices provided. Blood pressure is the force of blood on the walls of the arteries. Systolic blood pressure is measured when the ventricles are contracting while diastolic pressure is measured when the ventricles are relaxed. Normal Slide 4 blood pressure is typically 120/80 mm Hg.The general definition of high blood pressure in adults is a systolic BP > 140 mg HG or a diastolic blood pressure > 90 mm Hg. These criteria should be used for women throughout pregnancy. Chronic hypertension often exists prior to pregnancy and continues throughout pregnancy. It may not be noticed until the second trimester of pregnancy if prenatal care is delayed or if women have suffered from prolonged nausea and vomiting or morning sickness. If hypertension is Slide 5 diagnosed in early pregnancy and persists past 6 weeks postpartum, it would be considered to be a chronic health condition. -
Management of Prolonged Decelerations ▲
OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others. -
00005721-201907000-00003.Pdf
2.0 ANCC Contact Hours Angela Y. Stanley, DNP, APRN-BC, PHCNS-BC, NEA-BC, RNC-OB, C-EFM, Catherine O. Durham, DNP, FNP-BC, James J. Sterrett, PharmD, BCPS, CDE, and Jerrol B. Wallace, DNP, MSN, CRNA SAFETY OF Over-the-Counter MEDICATIONS IN PREGNANCY Abstract Approximately 90% of pregnant women use medications while they are pregnant including both over-the-counter (OTC) and prescription medications. Some medica- tions can pose a threat to the pregnant woman and fetus with 10% of all birth defects directly linked to medications taken during pregnancy. Many medications have docu- mented safety for use during pregnancy, but research is limited due to ethical concerns of exposing the fetus to potential risks. Much of the information gleaned about safety in pregnancy is collected from registries, case studies and reports, animal studies, and outcomes management of pregnant women. Common OTC categories of readily accessible medications include antipyretics, analgesics, nonsteroidal anti- infl ammatory drugs, nasal topicals, antihistamines, decongestants, expectorants, antacids, antidiar- rheal, and topical dermatological medications. We review the safety categories for medications related to pregnancy and provide an overview of OTC medications a pregnant woman may consider for management of common conditions. Key words: Pharmacology; Pregnancy; Safety; Self-medication. Shutterstock 196 volume 44 | number 4 July/August 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. he increased prevalence of pregnant women identifi ed risks in animal-reproduction studies or completed taking medications, including over-the-counter animal studies show no harm. The assignment of Category (OTC) medications presents a challenge to C has two indications; (1) limited or no research has been nurses providing care to women of childbear- conducted about use in pregnancy, and (2) animal studies ing age. -
Dermatology and Pregnancy* Dermatologia E Gestação*
RevistaN2V80.qxd 06.05.05 11:56 Page 179 179 Artigo de Revisão Dermatologia e gestação* Dermatology and pregnancy* Gilvan Ferreira Alves1 Lucas Souza Carmo Nogueira2 Tatiana Cristina Nogueira Varella3 Resumo: Neste estudo conduz-se uma revisão bibliográfica da literatura sobre dermatologia e gravidez abrangendo o período de 1962 a 2003. O banco de dados do Medline foi consul- tado com referência ao mesmo período. Não se incluiu a colestase intra-hepática da gravidez por não ser ela uma dermatose primária; contudo deve ser feito o diagnóstico diferencial entre suas manifestações na pele e as dermatoses específicas da gravidez. Este apanhado engloba as características clínicas e o prognóstico das alterações fisiológicas da pele durante a gravidez, as dermatoses influenciadas pela gravidez e as dermatoses específi- cas da gravidez. Ao final apresenta-se uma discussão sobre drogas e gravidez Palavras-chave: Dermatologia; Gravidez; Patologia. Abstract: This study is a literature review on dermatology and pregnancy from 1962 to 2003, based on Medline database search. Intrahepatic cholestasis of pregnancy was not included because it is not a primary dermatosis; however, its secondary skin lesions must be differentiated from specific dermatoses of pregnancy. This overview comprises clinical features and prognosis of the physiologic skin changes that occur during pregnancy; dermatoses influenced by pregnancy and the specific dermatoses of pregnancy. A discussion on drugs and pregnancy is presented at the end of this review. Keywords: Dermatology; Pregnancy; Pathology. GRAVIDEZ E PELE INTRODUÇÃO A gravidez representa um período de intensas ções do apetite, náuseas e vômitos, refluxo gastroeso- modificações para a mulher. Praticamente todos os fágico, constipação; e alterações imunológicas varia- sistemas do organismo são afetados, entre eles a pele. -
Single Stage Release Surgery for Congenital Constriction Band in a Clubfoot Patient Managed at a Teaching Hospital in Uganda: a Case Report G
Case report East African Orthopaedic Journal SINGLE STAGE RELEASE SURGERY FOR CONGENITAL CONSTRICTION BAND IN A CLUBFOOT PATIENT MANAGED AT A TEACHING HOSPITAL IN UGANDA: A CASE REPORT G. Waiswa, FCS, J. Nassaazi, MD and I. Kajja, PhD, Department of Orthopaedics, Makerere University, Kampala, Uganda Correspondence to: Dr. Judith Nassaazi, Department of Orthopaedics, Makerere University, Kampala, Uganda. Email: [email protected] ABSTRACT Congenital constriction band or amniotic band syndrome is a rare condition with a prevalence of 1:11200. It is characterized by presence of strictures around a body part, commonly around the distal part of the extremities. These bands can be treated with a single or staged approach. This study presents the case of a 3 month old infant who presented with a type III constriction band localized on the right leg and surgery was indicated. A single stage multiple Z-plasty was performed. The postoperative course was uneventful and the outcome was satisfactory at 10 months of follow-up. A single-stage constriction band release approach provided satisfactory results; both functional and aesthetic results and is feasible in our setting. Key words: Constriction bands, Single stage release, Stricture INTRODUCTION of worsening right leg deformity since birth (Figure 1). The mother reported that the child had been born Congenital constriction band or commonly referred to after a full-term pregnancy and normal delivery. This as amniotic band syndrome or Streeter dysplasia is a was the mother’s fifth child and there was no history rare condition characterized by congenital strictures of illness or drug use during pregnancy. No one else that can be partial or circumferential. -
Placental Abruption in Each Phenotype of Hypertensive Disorders of Pregnancy: a Retrospective Cohort Study Using a National Inpatient Database in Japan
Hypertension Research (2021) 44:250–252 https://doi.org/10.1038/s41440-020-00557-2 COMMENT Placental abruption in each phenotype of hypertensive disorders of pregnancy: a retrospective cohort study using a national inpatient database in Japan 1 1,2 2,3 Nelson Sass ● Gilberto Nagahama ● Henri Augusto Korkes Received: 24 August 2020 / Revised: 2 September 2020 / Accepted: 3 September 2020 / Published online: 7 October 2020 © The Japanese Society of Hypertension 2020 In a very interesting paper, Naruse et al. [1] analyzed a ret- Therefore, it is plausible to claim that PE is also a “bloody rospective cohort from a Japanese database, identifying a business” (Fig. 1). higher incidence of placental abruption in women with severe Advances in the knowledge of the pathological changes preeclampsia (PE) when admitted at less than 34 weeks associated with PE, especially in the early onset forms, gestational age (GA). Abruption of the placenta is an obstetric suggest that poor trophoblastic invasion in the early stages emergency that is usually catastrophic and requires prompt triggers an inflammatory syndrome with abnormal meta- 1234567890();,: 1234567890();,: diagnosis and immediate intervention, usually by emergency bolic pathways, including placental release of large amounts cesarean section, to save the fetus and reduce the risk of antiangiogenic factors such as soluble forms-like tyrosine of bleeding complications in the mother. The results from kinase-1 (sFlt-1). High plasma levels of these factors hinder Naruse et al. [1] highlight that this serious condition has the action of vascular endothelial growth factor (VEGF) and occurred after hospital admission in expectant patients with placental growth factor (PLGF) on receptors on the endo- early onset PE at a GA less than 34 weeks. -
Clinical Guideline Home Births
Clinical Guideline Guideline Number: CG038 Ver. 2 Home Births Disclaimer Clinical guidelines are developed and adopted to establish evidence-based clinical criteria for utilization management decisions. Oscar may delegate utilization management decisions of certain services to third-party delegates, who may develop and adopt their own clinical criteria. The clinical guidelines are applicable to all commercial plans. Services are subject to the terms, conditions, limitations of a member’s plan contracts, state laws, and federal laws. Please reference the member’s plan contracts (e.g., Certificate/Evidence of Coverage, Summary/Schedule of Benefits) or contact Oscar at 855-672-2755 to confirm coverage and benefit conditions. Summary Oscar members who chose to have a home birth may be eligible for coverage of provider services. An expectant mother has options as to where she may plan to give birth including at home, at a birthing center, or at a hospital. The American College of Obstetricians and Gynecologists (ACOG) believes that an at home birth is riskier than a birth at a birthing center or at a hospital, but ACOG respects the right of the woman to make this decision. A planned home birth is not appropriate for all pregnancies, and a screening should be done with an in-network provider to evaluate if a pregnancy is deemed low-risk and a home birth could be appropriate. Screening may include evaluating medical, obstetric, nutritional, environmental and psychosocial factors. Appropriate planning should also include arrangements for care at an in-network hospital should an emergent situation arise. Definitions “Certified Nurse-Midwife (CNM)” is a registered nurse who has completed education in a midwife program. -
Pregnancy Problems in Primary Care
Moneli Golara Consultant Obstetrician and Gynaecologist Barnet Hospital 680000 babies born in the UK Pregnancy associated with change of physiology Changes results in common symptoms of pregnancy for which patients may see health care professionals Considered a ‘stress test’ on womens’ health Organ specific Skin Mucous membranes Cardiovascular Respiratory Renal GI Endocrine Specific conditions in pregnancy with cases Pigmentation Pathogenesis not completely understood Linea alba becomes nigra Areola darkens Axilla, genitalia, perineum, anus, inner thighs and neck Recent scars, freckles May take several months to recover postpartum Naevi can look suspicious during pregnancy Melasma occurs in 75% of women Oestrogen causes vascular distension and proliferation of blood vessels Spider angiomas and Naevi Mostly resolve within 3 months Palmar erythema Varicosities Venous distension of vestibule and Vagina and vulval varicosities Oedema and water retention of extremeties Purpura Striae gravidarum Hirsuitism Arms, legs back and suprapubic region Anagen and telogen hair Scalp hair appears thicker during pregnancy but hair loss and thinning 1-5 months post partum This may resolve by 15 months but never to the same state in some people Androgen alopecia involving frontal scalp may occur Blue discolouration of vagina and cervix Gingival changes, and gingivitis, bleeding ulceration and pain Hyperaemia of nasal mucosa causing congestion CO Plasma volume To encourage optimum growth of fetus Increase in red cell -
Gestational Hypertension & Pre-Eclampsia
Journal of Labor and Childbirth Gestational hypertension & pre-eclampsia Introduction • First, we talk about the definitions • When, how, why the disease occurs? • How diagnose, how to treat and how to prevent according to guidelines Moatasem Bellah Al Farrah • This lecture is to know about the disease in new way. DUMMAR Medical Center, Syria Background : Prompt identification and appropriate management of Hypertensive Disorders in Pregnancy (HDP) are essential for optimal outcomes because HDP: Biography • Are associated with severe maternal obstetric complications and increased maternal mortality risk Moatasem Bellah Al Farrah is a mem- ber of Syrian Doctors Association. He is • Lead to preterm delivery, fetal intrauterine growth restriction, low birthweight and perinatal death currently working as an assistant profes- sor in Dummar Medical center and Red Study made between 2006 and 2008 showed: 70 maternal deaths, showing leading causes of death to Crescent. He is also a member in British be: hypertension (20%), haemorrhage (19%) and embolism (17%). Chronic illness, obesity and prenatal Society for Gynecological Endoscopy, International Urogynecology Associa- risk factors were identified as important circumstances in the cases reviewed. tion, British Society for Urogynecolo- Definition and classification of Hypertensive Disorders in Pregnancy (HDP) gy. His professional interests focus on PCOS and Endometriosis Researches. Hypertensive Disorders in Pregnancy are comprised of a spectrum of disorders typically classified into categories -
Lessons Learned with the Pregnancy and Lactation Labeling Rule- Approaches to Human Data
CDER Prescription Drug Labeling Conference 2017 CDER SBIA REdI Silver Spring, MD - November 1 & 2, 2017 Two Years In: Lessons Learned with the Pregnancy and Lactation Labeling Rule- Approaches to Human Data Miriam Dinatale, DO, LCDR, USPHS Division of Pediatric and Maternal Health Center for Drug Evaluation and Research (CDER) Food and Drug Administration (FDA) Disclaimer • The views and opinions expressed in this presentation represent those of the presenter, and do not necessarily represent an official FDA position. • The labeling examples in this presentation are provided only to demonstrate current labeling development challenges and should not be considered FDA recommended templates. • Reference to any marketed products is for illustrative purposes only and does not constitute endorsement by the FDA. 2 Overview • Introduction • Review of Draft PLLR Guidance Regarding Human Data • Current Approaches to Inclusion of Human Data in Labeling • Conclusion 3 Introduction 4 The Information Gap • Human data about medical product safety in pregnancy at the time of market approval are limited or absent – Pregnant women are usually actively excluded from clinical trials. – Women who become pregnant during clinical trials are discontinued but followed. • Consequently, almost all clinically relevant human data are collected post-approval • Important goal of the PLLR conversion process is to have accurate and up-to-date labeling recommendations which reflect the post-approval experience 5 Human Data Sources for Pregnancy • Clinical Trials – Trials -
Evaluation of the Placenta and Cervix
Evaluation of the Placenta Disclaimer and Cervix • I have no relevant financial relationships Judy A. Estroff, MD with the manufacturer(s) of any commercial product(s) and/or provider(s) of any commercial services discussed in this CME activity. • I do not intend to discuss unapproved or Boston Children’s Hospital investigative use of a commercial Harvard Medical School product/device in my presentation. Boston, MA Overview Everything you need to know in • Amniotic fluid 15 minutes! • Placenta • Umblical cord • Cervix • Membranes Amniotic fluid volume Amniotic Fluid • Increases logarithmically first ½ pregnancy • Definitions • < 10 mL @ 8 weeks gestation • Classification • 630 mL @ 22 weeks gestation • 770 mL @ 28 weeks gestation • 30-36 weeks: volume stable or slowly inc • > 36 weeks: volume decreases • 41 weeks: 515 mL • Decreases 33% each week after 41 weeks Creasy & Resnik: Maternal Fetal Medicine 6th Edition, 2009 1 Measurement of amniotic fluid • AFI= Amniotic fluid index • Subjective assessment • Deepest vertical pocket AFI: Amniotic Fluid Index x • Definition: Summation of the deepest vertical pocket (DVP) in 4 cord and extremity- free quadrants of the gravid uterus • Oligohydramnios: < 5 cm • Polyhydramnios: > 24 cm 27w DVP=13.3 cm Oligohydramnios Oligohydramnios • Definition: Condition in which the amniotic fluid volume (AFV) is • Almost always associated with an decreased relative to gestational age. increased risk of fetal morbidity and mortality • Or: AFI < 300-500 mL in 2nd trimester • MVP < 1-2 cm •AFI < 5 cm • AFI < 5%