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Postpartum preeclampsia

M Patabendige, G Barnasuriya, I Mampitiya
Antiphospholipid syndrome (APS) is associated with vascular thrombosis and pregnancy complications. It causes recurrent miscarriage and it is associated with other adverse pregnancy outcomes such as preterm delivery, intrauterine growth restriction, preeclampsia, and HELLP syndrome. Obstetric morbidity is one of the major manifestations of APS with a wide variety of clinical manifestations. This case describes a case of a severe preeclampsia in a 16-year-old primigravida at 29 weeks resulting in a caesarean delivery and subsequent finding of an ulnar artery thrombosis in postpartum period...
2018: Case Reports in Obstetrics and Gynecology
Oscar A Viteri, Mesk A Alrais, Claudia Pedroza, Maria Hutchinson, Suneet P Chauhan, Sean C Blackwell, Baha M Sibai
OBJECTIVE: To evaluate whether torsemide reduces the rate of persistent postpartum hypertension in women with preeclampsia. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of women with preeclampsia at a tertiary center from August 2016 to September 2017. Those with gestational hypertension or renal or cardiopulmonary failure were excluded. Within 24 hours of delivery, women were randomized one to one to oral torsemide, 20 mg/d, or placebo, for 5 days...
October 5, 2018: Obstetrics and Gynecology
Nicole L Veltri, Michelle Hladunewich, Arrti Bhasin, Jocelyn Garland, Benjamin Thomson
Background: De novo antineutrophil cytoplasmic antibody-associated vasculitis typically arises in post-reproductive years, but can occur during pregnancy. Concerns of treatment-related teratogenicity persist, while efficacy and safety of new therapies including intravenous immunoglobulin (IVIG) and rituximab are uncertain. There remains a paucity of maternal, fetal and pregnancy outcome data in these women, and therefore a lack of guidance on safe treatment for clinicians. Methods: We conducted a systematic review of the literature and a local, retrospective chart review of women with de novo antibody-associated vasculitis (AAV) in pregnancy...
October 2018: Clinical Kidney Journal
Nathan Campbell, Babbette LaMarca, Mark W Cunningham
Preeclampsia is the leading cause of death and morbidity world-wide for the mother and fetus during pregnancy. Preeclampsia does not only effect the mother and the baby during pregnancy, but can also have long-term effects, such as the increase risk of hypertension and cardiovascular disease, on the offspring and the postpartum mother later in life. The exact cause of preeclampsia is unknown, but women with preeclampsia have elevated concentrations of agonistic autoantibodies against the angiotensin II type 1 receptor (AT1-AA)...
September 25, 2018: Current Pharmaceutical Biotechnology
Mieke Cathy Elisabeth Hooijschuur, Chahinda Ghossein-Doha, Abraham A Kroon, Peter W de Leeuw, Adrienne A M Zandbergen, Sander M J van Kuijk, Marc E A Spaanderman
OBJECTIVE: To identify former preeclamptic (PE)women with worse cardiovascular risk profile with necessity for tailored postpartum follow up, we studied the association between postpartum metabolic syndrome and different PE phenotypes. METHODS: In this cohort study, cardiovascular and cardiometabolic evaluation was performed in 1102 former preeclamptic women at least 6 months postpartum. Women were subdivided in 4 subgroups based on disease resulting in delivery at 34 weeks or earlier and after 34 weeks (early onset vs late onset PE, respectively), and whether or not small for gestational age infancy (SGA) co-occurred...
September 23, 2018: Ultrasound in Obstetrics & Gynecology
Shutan Liao, Hao Wu, Ruiying Chen
Background: Preeclampsia (PE) is a serious maternal complication during pregnancy. Associated arterial stiffness in PE patients leads to increased risks of cardiovascular diseases later in life. Cholesterol efflux capacity, especially ATP binding cassette transporter A1 (ABCA1) dependent capacity, has been proposed to be a likely mediator of arterial stiffness. In the present study, we aimed to evaluate the effect of an apolipoprotein A1 mimetic peptide ATI-5261 on arterial stiffness in a mouse model of PE...
2018: Clinical Hypertension
Nidhi Sharma, Sunayana Srinivasan, K Jayashree Srinivasan, Kulasekaran Nadhamuni
Background: Preeclampsia is a heterogeneous disorder prevalent in 3-10% of pregnant women globally. The etiology is multifactorial. There is a initial stage of endothelial dysfunction and placental ischemia (Stage 1); this leads to maternal syndrome of hypertension, edema, and proteinuria (Stage 2). Drugs acting on immunomodulatory, anti-inflammatory, antioxidant and proresolving pathways can minimize the complications of preeclampsia. The therapeutic effect of aspirin is based on acetyl group and salicylate group...
October 2018: Journal of Obstetrics and Gynaecology of India
Lucy Neave, Marie Scully
Thrombotic microangiopathies (TMAs) are associated with microangiopathic hemolytic anemia and thrombocytopenia, resulting in microvascular thrombosis and end-organ damage. In pregnancy, this may be the result of pregnancy-related TMAs such as preeclampsia; hemolysis, elevated liver enzymes, and low platelets; or pregnancy-associated TMAs, specifically thrombotic thrombocytopenic purpura (TTP) or complement-mediated hemolytic uremic syndrome (CM HUS). TTP and CM HUS are rare disorders, and their diagnosis may be missed, no less because features at presentation may be misdiagnosed as a pregnancy-related TMA, such as hypertension, proteinuria, fetal growth restriction, or in utero fetal death...
October 2018: Transfusion Medicine Reviews
Reza Masoomi, Zubair Shah, Zoltan Arany, Kamal Gupta
OBJECTIVE: Peripartum cardiomyopathy (PPCM) can present during pregnancy and up to months post-delivery. Most large-scale epidemiologic studies have reported on cases occurring during pregnancy or the first few days postpartum (termPPCM). Limited information is available on PPCM in the later postpartum period (latePPCM). We studied the incidence, predictors, and hospital outcome of peripartum cardiomyopathy (PPCM) in the prepartum and immediate post delivery period versus up to 3 months post-delivery...
July 2018: Pregnancy Hypertension
Michael M Aziz, Ankita Kulkarni, Leena Shah, Susan Lashley, Yinka Oyelese
The urine protein to creatinine ratio (PC) is a sensitive and specific means of diagnosing preeclampsia in the antepartum period, but the 0.3 g protein per gram of creatinine threshold may be non-specific postpartum due to physiologic proteinuria after delivery. The objective of this study was to examine the reliability of PC in labor and postpartum and to determine if PC is affected by mode of delivery. This is the first study of its kind to examine physiologic proteinuria by catheterized PC in individual patients before and after delivery...
July 2018: Pregnancy Hypertension
Wibke G Janzarik, Ann-Kathrin Gerber, Filiz Markfeld-Erol, Linda Sommerlade, Arthur Allignol, Matthias Reinhard
INTRODUCTION: Preeclampsia is a pregnancy-related hypertensive disorder with strongly impaired cerebral autoregulation in the acute stage. A history of preeclampsia is an independent cardiovascular and cerebrovascular risk factor. It is unclear whether impaired cerebral autoregulation persists after preeclampsia and thus contributes to the known increased cerebrovascular morbidity. METHODS: Using transcranial Doppler, we compared cerebral hemodynamics and dynamic cerebral autoregulation of 25 women with a history of severe preeclampsia and 25 healthy mothers, on average 2-3 years postpartum...
July 2018: Pregnancy Hypertension
Nadja Borisow, Kerstin Hellwig, Friedemann Paul
Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that predominately affect women. Some of these patients are of childbearing age at NMOSD onset. This study reviews, on the one hand, the role NMOSD play in fertility, pregnancy complications and pregnancy outcome, and on the other, the effect of pregnancy on NMOSD disease course and treatment options available during pregnancy. Animal studies show lower fertility rates in NMOSD; however, investigations into fertility in NMOSD patients are lacking...
September 2018: EPMA Journal
Graeme N Smith, Jessica Pudwell, George R Saade
Cardiovascular disease (CVD) is the leading cause of death and disability among women, with more than half occurring in individuals with hypertension. New blood pressure criteria for the diagnosis of hypertension from the American College of Cardiology/American Heart Association recognize that there is no specific blood pressure threshold that is associated with vascular disease. We performed a secondary analysis of two published postpartum databases (the Pre-Eclampsia New Emerging Team [PE-NET] cohort and the Maternal Health Clinic [MHC] cohort) to determine the impact of the change in blood pressure criteria on the diagnosis of hypertension...
August 31, 2018: American Journal of Perinatology
Sarah C MacDonald, Thomas F McElrath, Sonia Hernández-Díaz
Few studies have assessed the risk for adverse pregnancy outcomes in women with multiple sclerosis (MS). We used two large United States administrative databases (2011-2015 Truven Health Marketscan® Database; 2007-2011 Nationwide Inpatient Sample) to identify delivery cohorts. MS and pregnancy outcomes (infections, Cesarean section, preterm delivery, poor fetal growth, preeclampsia, chorioamnionitis, postpartum hemorrhage, stillbirth, infant malformations) were identified during pregnancy and at delivery. We calculated adjusted risk ratios by MS status and relapses in the year before delivery...
August 28, 2018: American Journal of Epidemiology
Jean-Ju Sheen, Jason D Wright, Dena Goffman, Adina R Kern-Goldberger, Whitney Booker, Zainab Siddiq, Mary E D'Alton, Alexander M Friedman
OBJECTIVE: The objective of this study was to characterize the risk for severe maternal morbidity and other pregnancy complications by maternal age during delivery hospitalizations. METHODS: This retrospective cohort analysis used the Perspective database to characterize the risk for adverse maternal outcomes from 2006 to 2015 based on maternal age. Women were divided into seven categories based on maternal age: 15-17 years of age, 18-24, 25-29, 30-34, 35-39, 40-44 and 45-54...
August 25, 2018: American Journal of Obstetrics and Gynecology
Rajendra Singh Tanwar, Dhananjai Agarwal, Rakesh Kumar Gupta, Vinay Rathore, Pankaj Beniwal, Parvati Joshi, Vinay Malhotra
Postpartum acute kidney injury (AKI) is one of the serious complications of pregnancy and is associated with high mortality and morbidity. We conducted this study to determine the characteristics and outcome of the most severe form of postpartum AKI requiring dialysis. This prospective, observational study was conducted in Sawai Man Singh Medical College, Jaipur. All postpartum female suffering from AKI requiring dialysis between July 2014 and December 2016 were included in the study. Demographic, clinical and laboratory data of the patients were recorded...
July 2018: Saudi Journal of Kidney Diseases and Transplantation
Anna E Stanhewicz
Preeclampsia is a hypertensive disorder of pregnancy characterized by new onset hypertension, proteinuria, and edema occurring after 20 weeks of gestation, with a prevalence of ~7-10% of pregnancies in the United States and ~8 million pregnancies worldwide. Despite the postpartum remission of preeclamptic symptoms, women who have had preeclampsia are 2-4 times more likely to develop cardiovascular disease (CVD) and are significantly more likely to die of CVD compared to women with a history of normal pregnancy...
August 22, 2018: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Timothy Wen, Victoria X Yu, Jason D Wright, Dena Goffman, Frank Attenello, William J Mack, Mary D'Alton, Alexander M Friedman
OBJECTIVE: How hospital length of stay after delivery for women with preeclampsia is associated with risk for readmission is unknown. The objective of this study was to evaluate risk for 60-day hypertension-related postpartum readmission based on length of stay after delivery. METHODS: The 2014 Healthcare Cost and Utilization Project's (HCUP) Nationwide Readmissions Database was used to analyze risk for readmission for a hypertension-related diagnosis within 60 days from cesarean delivery hospitalization for women with preeclampsia who underwent cesarean delivery...
August 19, 2018: Journal of Maternal-fetal & Neonatal Medicine
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
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