Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health最新文献

Objectives

Study design

Main outcome measures

Results

Conclusions

Objective

Study design

Main outcome

Conclusion

Objectives

Study design

Main outcome measures

Results

Conclusions

Literature with regards to pregnancy related outcomes in persons with the presence of a solitary kidney of any cause is scarce. Most of the available information has been extrapolated from persons who have been renal donors. Unilateral renal agenesis affects 1 in 1500 people and can present with resistant hypertension. When a woman with a solitary kidney presents in pregnancy, it may be both a challenging diagnostic and therapeutic problem. Eplerenone, a selective aldosterone blocker has been prescribed for resistant hypertension and in the presence of pregnancy, been useful in persons with primary hyperaldosteronism and resistant hypertension due to obstructive sleep apnoea. We describe the use of Eplerenone in a patient with resistant hypertension in pregnancy, due to secondary hyperaldosteronism precipitated by renal agenesis.

Several studies have demonstrated that predicting complications of preeclampsia up to 48 h before their occurrence enhances clinical management. This predictive ability allows for rational approaches in dealing with groups at high risk of maternal-fetal complications.

Objective

This study aims to identify the clinical parameters strongly associated with maternal-fetal complications during preeclampsia in Congolese pregnant women.

Method

A descriptive and analytical study was conducted in the provincial city of Kinshasa from July 2018 to December 2021. The study population consisted of pregnant women with preeclampsia in three maternity units in Kinshasa. Determinants of complications were assessed using univariate and multivariate logistic regression.

Results

In univariate logistic regression models, obesity, a history of hypertension, severe hypertension, and SpO₂ < 90 % were identified as determinants of maternal-fetal complications. Conversely, a history of preeclampsia, treatment with MgSO₄, or a combination of AntiHTA and MgSO₄ reduced the risk of complications.

In the multivariate model, after adjusting for all significant variables in the univariate model, severe hypertension, obesity, and SpO₂ < 90 % were identified as independent determinants of maternal-fetal complications. The risk of complication was multiplied by 5 for severe hypertension, by 4 for obesity, and by 2 for SpO₂ < 90 %. However, treating women with MgSO₄ or a combination of AntiHTA and MgSO₄ reduced the risk of complications by a factor of 4 and 6, respectively.

Conclusion

The presence of symptoms is more useful in predicting complications of preeclampsia than their absence in ruling out adverse events.

Objectives

To investigate the relationship between the severity of proteinuria and adverse maternal and neonatal outcomes in patients with preeclampsia (PE).

Design

Prospective cohort study conducted in Gauteng, South Africa over 12 months. Patients with PE 18 years or older with singleton pregnancies were recruited. We included 248 in the final analysis.

Methods

Proteinuria was quantified using urine protein: creatinine ratio (UPCR). Preeclamptic patients’ outcomes were compared according to the UPCR values using regression models and by generating receiver operator characteristic (ROC) curves. Primary maternal outcomes were gestational age (GA) at diagnosis, GA at delivery, development of eclampsia, development of severe features and the need for more than one antihypertensive agent. Neonatal outcomes were admission to neonatal unit, 5-min APGAR score, need for ventilatory support and early neonatal death.

Results

There was a weak but significant negative correlation between GA at delivery and UPCR (Spearman’s correlation coefficient (SCC) −0.191, p = 0.002). Most patients (77 %) required >1 agent to control their blood pressure, however there was no correlation between UPCR and the need for additional agents (SCC −0.014, p = 0.828). There was a statistically significant correlation between UPCR and severe features, especially the development of haemolysis, elevated liver enzymes and low platelet (HELLP) syndrome (p = 0.005). There was no significant correlation between neonatal outcomes and UPCR.

Conclusion

Severity of proteinuria correlated with earlier delivery and development of severe features, specifically HELLP syndrome and pulmonary oedema. There was no correlation between UPCR and requiring additional antihypertensive agents or neonatal outcomes.

Objectives

Blood pressure control in severe hypertension of pregnancy is crucial for mother and neonate. In absence of evidence, guidelines recommend either intravenous labetalol or nicardipine. We compared the effectiveness and safety of these two drugs in women with severe hypertension in pregnancy.

Study design

We performed an open label randomized controlled trial. Women with a singleton pregnancy complicated by severe hypertension (systolic ≥ 160 mmHg and/or diastolic ≥ 110 mmHg) requiring intravenous antihypertensive treatment were randomized to intravenous labetalol or intravenous nicardipine. The primary outcome was a composite adverse neonatal outcome defined as severe Respiratory Distress Syndrome (RDS), Broncho Pulmonary Dysplasia (BPD), Intraventricular Hemorrhage (IVH) IIB or worse, Necrotizing Enterocolitis (NEC), or perinatal death defined as fetal death or neonatal death before discharge from the neonatal intensive care unit (NICU).

Based on a power analysis, we estimated that 472 women (236 per group) needed to be included to detect a difference of 15% in the primary outcome with 90% power. The study was halted prematurely at 30 inclusions because of slow recruitment and trial fatigue.

Results

Between August 2018 and April 2022, we randomized 30 women of which 16 were allocated to intravenous nicardipine and 14 to intravenous labetalol. The composite adverse neonatal outcome was not significantly different between the two groups (25 % versus 43 % OR 0.28 (95 % CI 0.05–1.43), p = 0.12)). Respiratory distress syndrome occurred more often in the labetalol group than in the nicardipine group (42.9 % versus 12.5 %). Neonatal hypoglycemia occurred more often in the nicardipine group than in the labetalol group (31 % versus 7 %). Time until blood pressure control was faster in women treated with nicardipine than in women treated with labetalol (45 (15–150 min vs. 120 (60–127,5) min).

Conclusion

In our prematurely halted small RCT, we were unable to provide evidence for the optimal choice of treatment for severe hypertension to improve neonatal outcome and/or to obtain faster blood pressure control. Differences in Respiratory distress syndrome and neonatal hypoglycemia between the groups might be the result of coincidental finding due to the small groups included in the study. A larger randomized trial would be needed to determine the safest and most efficacious (intravenous) therapy for severe hypertension in pregnancy. This study emphasizes the challenges of conducting a RCT for the optimal treatment for these women.