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Postpartum preeclampsia

Linda G Kahn, Leonardo Trasande
PURPOSE OF REVIEW: To assess the strength of evidence for associations between environmental toxicants and hypertensive disorders of pregnancy, suggest potential biological mechanisms based on animal and in vitro studies, and highlight avenues for future research. RECENT FINDINGS: Evidence is strongest for links between persistent chemicals, including lead, cadmium, organochlorine pesticides, and polycyclic biphenyls, and preeclampsia, although associations are sometimes not detectable at low-exposure levels...
August 8, 2018: Current Hypertension Reports
Matthew S Robbins
PURPOSE OF REVIEW: Headache disorders are extraordinarily common and disproportionately impact women of childbearing age. This article reviews the importance of proper diagnosis, natural history, and management of headache disorders in pregnant and postpartum women. RECENT FINDINGS: Red flags for secondary headache specifically among pregnant women include elevated blood pressure and lack of a previous headache history, as well as a prolonged duration of the headache attack in those with a prior history of migraine...
August 2018: Continuum: Lifelong Learning in Neurology
Kiattisak Kongwattanakul, Piyamas Saksiriwuttho, Sukanya Chaiyarach, Kaewjai Thepsuthammarat
Objective: To determine the incidence of preeclampsia with severe features among pregnant women and evaluate the characteristics, maternal complications, and perinatal outcomes between nonsevere preeclampsia versus preeclampsia with severe features and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. Materials and methods: A retrospective descriptive study was conducted at Khon Kaen University's Srinagarind Hospital, a tertiary care facility in northeast Thailand...
2018: International Journal of Women's Health
Antonio Sesar, Ivan Cavar, Anita Pusic Sesar, Irena Sesar
Posterior reversible encephalopathy syndrome (PRES) is a clinical condition that can cause different ophthalmological and neurological symptoms. Preeclampsia toxemia or eclampsia is one of the leading causes of PRES. Herein, we present a study of a 35-year old woman who gave birth to healthy twins at 35 weeks of gestation by cesarean section because of threatened preterm delivery. On the 1st postoperative day, the woman developed a severe headache, arterial hypertension, tachycardia, generalized tonic-clonic seizures, and loss of consciousness that persisted for about 2 min...
April 2018: Taiwan Journal of Ophthalmology
Linda J E Meertens, Hubertina C J Scheepers, Sander M J van Kuijk, Robert Aardenburg, Ivo M A van Dooren, Josje Langenveld, Annemieke M van Wijck, Iris M Zwaan, Marc E A Spaanderman, Luc J M Smits
INTRODUCTION: This study assessed the external validity of all published first trimester prediction models for the risk of preeclampsia (PE) based on routinely collected maternal predictors. Moreover, the potential utility of the best-performing models in clinical practice was evaluated. MATERIAL AND METHODS: Ten prediction models were systematically selected from the literature. We performed a multicenter prospective cohort study in the Netherlands between July 1, 2013, and December 31, 2015...
July 18, 2018: Fetal Diagnosis and Therapy
Jose Ramon Duncan, Ana Marie Tobiasz, Zoran Bursac, Eric Vincent Rios-Doria, Mauro Humberto Schenone, Giancarlo Mari
OBJECTIVE: To compare the uterine artery pulsatility index (UtAPI-AP) before labor and immediate postpartum (UtAPI-PP) in hypertensive disorders of pregnancy (HTNP) and normotensives near term. METHODS: Pregnancies ≥36 weeks admitted for labor induction in our institution from October 2015 to October 2017 were included. We excluded active labor, multiple gestations, fetal demise, and those with inadequate uterine artery sampling. Our primary outcome was to compare the UtAPI-AP and UtAPI-PP between subjects with HTNP (gestational hypertension, preeclampsia with and without severe features) and normotensive participants...
July 18, 2018: Hypertension in Pregnancy
Timothy Wen, Jason D Wright, Dena Goffman, Mary E D'Alton, William J Mack, Frank J Attenello, Alexander M Friedman
BACKGROUND: There are limited data on when postpartum readmissions for thromboembolism occur after delivery hospitalizations on a population basis in the United States. OBJECTIVE: We sought to characterize risk factors for and timing of postpartum venous thromboembolism readmission after delivery hospitalization discharge. STUDY DESIGN: The Healthcare Cost and Utilization Project Nationwide Readmissions Database for calendar years 2013 and 2014 was used to perform a retrospective cohort study evaluating risk for readmission for venous thromboembolism within 60 days of discharge from a delivery hospitalization...
July 11, 2018: American Journal of Obstetrics and Gynecology
Jean Guglielminotti, Ruth Landau, Cynthia A Wong, Guohua Li
Background The incidence of severe maternal morbidity (SMM) during childbirth is increasing in the United States. A better characterization of risk factors for SMM may identify targets for improving maternal outcomes. This study aims to characterize patient-, hospital-, and neighborhood-level factors associated with SMM during childbirth. Methods SMM during childbirth was identified in the 2013-2014 State Inpatients Database for New York. Hospital and neighborhood characteristics were abstracted from the American Hospital Association and the Area Health Resources files...
July 16, 2018: Maternal and Child Health Journal
Marie-Eve Brien, Ines Boufaied, Dorothée Dal Soglio, Evelyne Rey, Line Leduc, Sylvie Girard
Preeclampsia (PE) is a poorly understood pregnancy complication. It has been suggested that changes in the maternal immune system may contribute to PE, but evidence of this remains scarce. Whilst PE is commonly experienced pre-partum, it can also occur in the postpartum period (postpartum PE-PPPE), and the mechanisms involved are unknown. Our goal was to determine whether changes occur in the maternal immune system and placenta in pregnancies complicated with PE and PPPE, compared to normal term pregnancies...
July 13, 2018: Biology of Reproduction
Lennart Rune Fredrik Blomqvist, Annika Margareta Strandell, Fariba Baghaei, Margareta Sofia Elisabet Hellgren
Increased platelet activation is involved in obstetric complications such as preeclampsia and intrauterine growth retardation. It is of interest to study platelet aggregation during pregnancy, since increased aggregation theoretically could be a mechanism associated with placenta-mediated complications, which possibly could be prevented by drugs inhibiting platelet aggregation. There are, however, few robust studies describing platelet aggregation during normal pregnancy. The present longitudinal study was performed in order to study platelet aggregation during normal pregnancy resulting in a healthy child, during the puerperium and in nonpregnant, fertile women...
July 16, 2018: Platelets
Kelly F Cummings, Melissa S Helmich, Songthip T Ounpraseuth, Nafisa K Dajani, Everett F Magann
BACKGROUND: Maternal obesity has been associated with an increased risk for an abnormal progression of labour; however, less is known about the length of the third stage of labour and its relation to maternal obesity. OBJECTIVE: To determine if the length of the third stage of labour is increased in extremely obese women and its possible correlation with an increased risk for postpartum hemorrhage. STUDY DESIGN: This was a retrospective cohort study of deliveries from January 2008 to December 2015 at our university hospital...
July 11, 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Erin K I Murray, Malia S Q Murphy, Graeme N Smith, Charles H Graham, Maha Othman
: Pregnancy is a state of heightened coagulation, exacerbated in pathological conditions such as preeclampsia. We evaluated the role of thromboelastography (TEG), compared with standard haemostasis tests, in identifying in haemostatic alterations in normotensive pregnancies and pregnancies complicated with preeclampsia. Standard haemostasis tests and TEG were performed on 28 normotensive women and 31 with preeclampsia at delivery, 6 weeks and 6 months postpartum. Results were compared between patient groups, and at different collection times...
July 10, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Wieteke M Heidema, Ralph R Scholten, Joris van Drongelen, Marc E A Spaanderman
INTRODUCTION: History of preeclampsia increases the risk of cardiovascular disease in women. Most formerly, preeclamptic women have generally one or even more traditional cardiovascular and/or cardiometabolic risk factors consistent with metabolic syndrome in the first year after delivery. The objective of this study was to analyze the prevalence and persistence of risk factors contributing to metabolic syndrome for the course of years after preeclamptic pregnancy. METHODS: In a longitudinally cohort study, 107 formerly preeclamptic women were assessed for traditional risk factors (insulin resistance, obesity, dyslipidemia, hypertension, and microalbuminuria) of metabolic syndrome (World Health Organization criteria) at two time points: at 3-30 months postpartum (visit 1) and 24-65 months later (visit 2)...
July 3, 2018: Journal of Women's Health
Fung L Foo, Amita A Mahendru, Giulia Masini, Abigail Fraser, Stefano Cacciatore, David A MacIntyre, Carmel M McEniery, Ian B Wilkinson, Phillip R Bennett, Christoph C Lees
Preeclampsia and fetal growth restriction during pregnancy are associated with increased risk of maternal cardiovascular disease later in life. It is unclear whether this association is causal or driven by similar antecedent risk factors. Clarification requires recruitment before conception which is methodologically difficult with high attrition rates and loss of outcome numbers to nonconception/miscarriage. Few prospective studies have, therefore, been adequately powered to address these questions. We recruited 530 healthy women (mean age: 35...
August 2018: Hypertension
Alexandra E Cairns, Katherine L Tucker, Paul Leeson, Lucy H Mackillop, Mauro Santos, Carmelo Velardo, Dario Salvi, Sam Mort, Jill Mollison, Lionel Tarassenko, Richard J McManus
Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring...
August 2018: Hypertension
Zahra Kamali, Mahin Tafazoli, Mahdi Ebrahimi, Mohammadali Hosseini, Azadeh Saki, Mohammad Reza Fayyazi-Bordbar, Zahra Mohebi-Dehnavi, Ala Saber-Mohammad
INTRODUCTION: Posttraumatic stress disorder is an anxiety disorder that occurs after exposure to an event that causes injury or threat. The prevalence of preeclampsia was reported to be 28%. Considering the significant role of spiritual care in physical and psychological outcomes of patients, this study was conducted to determine "the effect of spiritual care education on postpartum stress disorder in women with preeclampsia". MATERIALS AND METHODS: In this randomized clinical trial, 72 pregnant women (36 in each group) were selected in a convenient way between the ages of 34 and 38 weeks who had preeclampsia and admitted to two public hospitals in Mashhad...
2018: Journal of Education and Health Promotion
Kharah M Ross, Christine Guardino, Christine Dunkel Schetter, Calvin J Hobel
BACKGROUND: Prenatal health disparities exist for African Americans and low socioeconomic status (SES) individuals when compared to non-Hispanic Whites and people of higher SES, particularly in cardio-metabolic diseases. Furthermore, having had a pregnancy-specific cardio-metabolic disease, e.g. preeclampsia, increases risk for future cardio-metabolic disease. Although these factors (race, SES and pregnancy cardio-metabolic disease) are interrelated, studies have rarely considered their combined effect on postpartum cardio-metabolic risk...
July 2, 2018: Ethnicity & Health
Svetlana Akinshina, Alexander Makatsariya, Victoria Bitsadze, Jamilya Khizroeva, Nadine Khamani
BACKGROUND: Despite intensive research, thromboembolism still accounts for significant maternal morbidity and mortality. We examined thrombophilia in patients with thromboembolism during pregnancy and evaluated the efficiency of antithrombotic prophylaxis in patients with thrombophilia for the prevention of recurrent thromboembolism. MATERIALS AND METHODS: Sixty-eight women with a history of thromboembolism were managed during pregnancy, in light of their thrombotic history and the result of thrombophilia assessment...
June 27, 2018: Journal of Perinatal Medicine
Christophe Benimana, Maria Small, Stephen Rulisa
OBJECTIVE: Assess the primary causes and preventability of maternal near misses (MNM) and mortalities (MM) at the largest tertiary referral hospital in Rwanda, Kigali University Teaching Hospital (CHUK). METHODS: We reviewed records for all women admitted to CHUK with pregnancy-related complications between January 1st, 2015 and December 31st, 2015. All maternal deaths and near misses, based on WHO near miss criteria were reviewed (Appendix A). A committee of physicians actively involved in the care of pregnant women in the obstetric-gynecology department reviewed all maternal near misses/ pregnancy-related deaths to determine the preventability of these outcomes...
2018: PloS One
Line Malha, Cristina P Sison, Geraldine Helseth, Jean E Sealey, Phyllis August
Pregnant women with chronic hypertension are at risk for increased blood pressure and superimposed preeclampsia (SPE) in late pregnancy. Alterations in the renin-aldosterone system are a feature of normal pregnancy; however, their role in chronic hypertension with and without SPE is less clear. We performed a prospective, longitudinal trial of 108 women with chronic hypertension and measured plasma renin activity (PRA), 24-hour urine sodium, urine potassium, and urine aldosterone (Ualdo) at 12, 20, 28, and 36 weeks and postpartum...
August 2018: Hypertension
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