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stroke in pregnant women

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https://www.readbyqxmd.com/read/27913487/venous-thromboembolism-and-stroke-in-pregnancy
#1
Kelley McLean, Mary Cushman
Pregnancy and the postpartum period substantially increase the risk for thrombotic events. Although the absolute risk for thrombosis is low, these events comprise a significant portion of maternal morbidity and mortality. The vast majority of such events are venous, although the risk for ischemic stroke also appears to be increased in pregnancy. This review will explore the overlapping and unique risk factors for venous and arterial thrombosis in pregnancy. Diagnosis and prevention will be discussed, and treatment will be briefly touched on...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27854379/longitudinal-maternal-haemodynamics-in-fetal-growth-restriction-in-pregnancies-at-high-risk-for-placental-insufficiency
#2
Daniel Stott, Papastefanou I, Daniela Paraschiv, Katherine Clark, Nikos A Kametas
OBJECTIVE: Fetal growth restriction is a powerful determinant of poor perinatal outcomes. Our previous work in pregnancies at high risk for the development of hypertension found that early in pregnancy maternal haemodynamics show impaired cardiovascular adaptation in gestations destined to deliver growth-restricted infants. In this study, we serially monitored maternal haemodynamics from the first through to the third trimester in a similar high-risk cohort, in order to determine if, in pregnancies complicated by growth-restriction, these distinct haemodynamic profiles found at presentation persisted throughout pregnancy...
October 31, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27803828/a-historic-case-of-cardiac-surgery-in-pregnancy
#3
Said Benlamkaddem, Adnane Berdai, Smael Labib, Mustapha Harandou
Background. Heart disease is the leading cause of nonobstetric mortality in pregnant women. Because of high risk, medical management represents the first line of treatment. However, when medical treatment fails, cardiac surgery becomes necessary. Case Presentation. A 27-year-old female who underwent successfully cardiac surgery three times within 3 years. At the first time, she had an aortic valve replacement at 25 weeks of gestation after an infectious endocarditis complicated with an ischemic stroke. At 39 weeks of gestation, she had delivered, vaginally, a healthy baby boy weighing 2800 g...
2016: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27775757/risk-of-pregnancy-associated-stroke-across-age-groups-in-new-york-state
#4
Eliza C Miller, Hajere J Gatollari, Gloria Too, Amelia K Boehme, Lisa Leffert, Mitchell S V Elkind, Joshua Z Willey
Importance: Older age is associated with increased risk of pregnancy-associated stroke (PAS). Data are limited on age-specific incidence ratios of PAS compared with stroke risk in nonpregnant women. Objectives: To assess the risk of stroke by age group in pregnant and postpartum women compared with their nonpregnant contemporaries and to compare risk factors across age groups in the exposed (pregnant/postpartum) and unexposed (nonpregnant) populations. Design, Setting, and Participants: International Classification of Diseases, Ninth Revision, billing codes from the calendar year 2003-2012 New York State Department of Health inpatient database and population data were used to identify all women aged 12 to 55 years with cerebrovascular events, including transient ischemic attack, ischemic and hemorrhagic stroke, cerebral venous thrombosis, and nonspecified PAS...
October 24, 2016: JAMA Neurology
https://www.readbyqxmd.com/read/27762457/longitudinal-hemodynamics-in-acute-phase-of-treatment-with-labetalol-in-hypertensive-pregnant-women-to-predict-need-for-vasodilatory-therapy
#5
D Stott, M Bolten, D Paraschiv, I Papastefanou, J B Chambers, N A Kametas
OBJECTIVE: Hypertensive pregnant women who do not respond to treatment with labetalol to control blood pressure (BP), but require vasodilatory therapy, progress rapidly to severe hypertension. This could be delayed by early recognition and individualized treatment. In this study, we sought to create prediction models from data at presentation and at 1 h and 24 h after commencement of treatment to identify patients who will not have a sustained response to labetalol and therefore need vasodilatory therapy...
October 20, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27733658/postnatal-cardiovascular-consequences-in-the-offspring-of-pregnant-rats-exposed-to-smoking-and-smoking-cessation-pharmacotherapies
#6
Kathirvel Gopalakrishnan, Amar S More, Gary D Hankins, Tatiana N Nanovskaya, Sathish Kumar
Approximately 20% of pregnant women smoke despite intentions to quit. Smoking cessation drugs, such as nicotine replacement therapy (NRT) and bupropion, are recommended treatments. Adverse cardiovascular outcomes in offspring have raised concerns about NRT's safety during pregnancy. However, the effect of bupropion is unknown. Using a rat model, we determined whether NRT and bupropion interventions during pregnancy are safer than continued smoking on offspring's cardiovascular function. Male offspring of controls and dams exposed to cigarette smoke (1...
October 12, 2016: Reproductive Sciences
https://www.readbyqxmd.com/read/27733586/role-of-tumor-necrosis-factor-%C3%AE-and-natural-killer-cells-in-uterine-artery-function-and-pregnancy-outcome-in-the-stroke-prone-spontaneously-hypertensive-rat
#7
Heather Yvonne Small, Ryszard Nosalski, Hannah Morgan, Elisabeth Beattie, Tomasz J Guzik, Delyth Graham, Christian Delles
Women with chronic hypertension are at increased risk of maternal and fetal morbidity and mortality. We have previously characterized the stroke-prone spontaneously hypertensive rat (SHRSP) as a model of deficient uterine artery function and adverse pregnancy outcome compared with the control Wistar-Kyoto. The activation of the immune system plays a role in hypertension and adverse pregnancy outcome. Therefore, we investigated the role of tumor necrosis factor-α in the SHRSP phenotype in an intervention study using etanercept (0...
November 2016: Hypertension
https://www.readbyqxmd.com/read/27680817/h1-persistent-maternal-cardiac-dysfunction-after-preeclampsia-identifies-patients-at-risk-for-recurrent-pre-eclampsia
#8
D Lo Presti, G Gagliardi, G M Tiralongo, I Pisani, B Vasapollo, G P Novelli, H Valensise
OBJECTIVE: The purpose of our study was to assess cardiac function in non-pregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. METHODS: Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case control study and submitted to echocardiographic examination in the non-pregnant state 12-18 months after the first delivery...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27680815/g4-does-maternal-obesity-have-an-adverse-effect-on-haemodynamics
#9
D Vinayagam, Juan Gutierrez, J Binder, B Thilaganathan, A Khalil
BACKGROUND: The increase in the prevalence of and the adverse risks to both mother and foetus associated with maternal obesity is a global concern. The adverse cardiovascular risk associated with obesity is well-known, however, there is a paucity of data assessing central haemodynamics in class 3 (morbid) obesity (BMI440 kg/m(2)) during pregnancy. OBJECTIVE: To compare the haemodynamic profile in women with class 3 maternal obesity against those with a normal BMI (20-30 kg/m(2)), using ultrasound-based, non-invasive haemodynamic monitoring...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27628530/gestational-changes-in-left-ventricular-myocardial-contractile-function-new-insights-from-two-dimensional-speckle-tracking-echocardiography
#10
Shantanu P Sengupta, Manish Bansal, Leonard Hofstra, Partho P Sengupta, Jagat Narula
The goal of this study was to evaluate the impact of pregnancy and labor on left ventricular (LV) myocardial mechanics using speckle tracking echocardiography (STE). Pregnancy is characterized by profound hormonal and hemodynamic alterations that directly or indirectly influence cardiac structure and function. However, the impact of these changes on left ventricular (LV) myocardial contractile function has not been fully elucidated. In this prospective, longitudinal study, 35 pregnant women underwent serial clinical and echocardiographic evaluation during each trimester and at labor...
September 14, 2016: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/27609819/echocardiographic-structure-and-function-in-hypertensive-disorders-of-pregnancy-a-systematic-review
#11
James S Castleman, Ramesh Ganapathy, Fatima Taki, Gregory Y H Lip, Richard P Steeds, Dipak Kotecha
BACKGROUND: Echocardiography is commonly used to direct the management of hypertensive disorders in medical patients, but its application in pregnancy is unclear. Our objective was to define the use of echocardiography in pregnancies complicated by gestational hypertension (GH) and preeclampsia. METHODS AND RESULTS: We performed a systematic review of articles using an electronic search of databases from inception to March 2015, prospectively registered with PROSPERO (CRD42015015700)...
September 2016: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27562782/imaging-of-headache-in-pregnancy
#12
REVIEW
Maryna Skliut, Dara G Jamieson
Pregnant women are most likely to have primary headaches, such as migraine and tension-type headaches, which can be diagnosed and treated without brain imaging. Primary headaches may even start de novo during pregnancy, especially in the first few months. However, when the headache occurs late in pregnancy or in the peripartum period, secondary causes of headaches need to be considered and evaluated by brain and/or vascular imaging, generally using magnetic resonance techniques. There is considerable overlap between the cerebrovascular complications of pregnancy, including preeclampsia/eclampsia, posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), and both hemorrhagic and ischemic strokes; although, their imaging may be distinctive...
October 2016: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/27539791/the-long-term-health-effects-of-fetal-malnutrition-evidence-from-the-1959-1961-china-great-leap-forward-famine
#13
Seonghoon Kim, Belton Fleisher, Jessica Ya Sun
We report evidence of long-term adverse health impacts of fetal malnutrition exposure of middle-aged survivors of the 1959-1961 China Famine using data from the China Health and Retirement Longitudinal Study. We find that fetal exposure to malnutrition has large and long-lasting impacts on both physical health and cognitive abilities, including the risks of suffering a stroke, physical disabilities in speech, walking and vision, and measures of mental acuity even half a century after the tragic event. Our findings imply that policies and programs that improve the nutritional status of pregnant women yield benefits on the health of a fetus that extend through the life cycle in the form of reduced physical and mental impairment...
August 19, 2016: Health Economics
https://www.readbyqxmd.com/read/27508763/-op-5d-07-angiogenic-imbalanced-preeclampsia-versus-clinical-preeclampsia
#14
L Saleh, K Verdonk, A Kaya, A H Danser, A H van den Meiracker, W Visser
OBJECTIVE: The ratio of the maternal plasma angiogenic factors soluble Fms-kinase 1 (sFlt-1) and placental growth factor (PlGF) is a novel diagnostic tool for preeclampsia (PE), with a value <38 predicting short-term absence of PE in women in whom the syndrome is suspected clinically. The clinical implication of a single determination below the sFlt-1/PlGF ratio of 38 beyond 1 week remains to be established. We therefore assessed the evolution of the sFlt-1/PlGF ratio in patients suspected of PE on clinical grounds...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27465979/a-prediction-model-for-the-response-to-oral-labetalol-for-the-treatment-of-antenatal-hypertension
#15
D Stott, M Bolten, M Salman, D Paraschiv, A Douiri, N A Kametas
This prospective observational study aimed to identify at presentation the maternal hemodynamic and demographic variables associated with a therapeutic response to oral labetalol and to use these variables to develop a prediction model to anticipate the response to labetalol monotherapy in women with hypertension. It was set at a maternity unit in a UK teaching hospital. Maternal demographic data from 50 pregnant women, presenting with hypertension between January and August 2013, was collected and blood pressure measured with a device validated for pregnancy and pre-eclampsia...
July 28, 2016: Journal of Human Hypertension
https://www.readbyqxmd.com/read/27438983/reversible-hemianopsia-in-postpartum-due-to-posterior-reversible-encephalopathy-syndrome-in-pregnant-with-late-eclampsia
#16
Marta Ribeiro Hentschke, Alex Oliboni Sussela, Luiz Carlos Porcello Marrone, Bartira Ercília Pinheiro da Costa, Carlos Eduardo Poli-de-Figueiredo, Giovani Gadonski
OBJECTIVES: To describe a case of Posterior Reversible Encephalopathy Syndrome diagnosed in pregnant women with late-eclampsia, as well as its clinical management. CASE DESCRIPTION: A 34 years old patient in her third pregnancy had started with high blood pressure levels during labor; after eleven days postpartum, she presented a decreased right visual acuity; subsequently one episode of seizure followed by partial loss of vision in the right eye. After conducting tests and ruled out stroke, the patient was diagnosed as Posterior Reversible Encephalopathy Syndrome (PRES)...
June 2016: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/27308858/static-and-functional-hemodynamic-profiles-of-women-with-abnormal-uterine-artery-doppler-at-22-24-weeks-of-gestation
#17
Åse Vårtun, Kari Flo, Christian Widnes, Ganesh Acharya
OBJECTIVE: To compare cardiac function, systemic hemodynamics and preload reserve of women with increased (cases) and normal (controls) uterine artery (UtA) pulsatility index (PI) at 22-24 weeks of gestation. MATERIALS AND METHODS: A prospective cross-sectional study of 620 pregnant women. UtA blood flow velocities were measured using Doppler ultrasonography, and PI was calculated. Mean UtA PI ≥ 1.16 (90th percentile) was considered abnormal. Maternal hemodynamics was investigated at baseline and during passive leg raising (PLR) using impedance cardiography (ICG)...
2016: PloS One
https://www.readbyqxmd.com/read/27294333/characteristics-and-outcomes-of-patients-presenting-with-hypertensive-urgency-in-the-office-setting
#18
Krishna K Patel, Laura Young, Erik H Howell, Bo Hu, Gregory Rutecki, George Thomas, Michael B Rothberg
IMPORTANCE: The prevalence and short-term outcomes of hypertensive urgency (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg) are unknown. Guidelines recommend achieving blood pressure control within 24 to 48 hours. However, some patients are referred to the emergency department (ED) or directly admitted to the hospital, and whether hospital management is associated with better outcomes is unknown. OBJECTIVES: To describe the prevalence of hypertensive urgency and the characteristics and short-term outcomes of these patients, and to determine whether referral to the hospital is associated with better outcomes than outpatient management...
July 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27260843/preeclampsia-of-mice-and-women
#19
REVIEW
Jenny L Sones, Robin L Davisson
Preeclampsia (PE) is a devastating disorder of pregnancy that affects up to 8% of pregnant women in the United States. The diagnosis of PE is made by the presentation of new-onset hypertension, ≥140 mmHg systolic blood pressure (BP) or ≥90 mmHg diastolic BP, and either proteinuria or another accompanying sign/symptom, such as renal insufficiency, thrombocytopenia, hepatic dysfunction, pulmonary edema, or cerebral/visual. These signs can occur suddenly and without warning. PE that presents before 34 wk of gestation is considered early onset and carries a greater risk for perinatal morbidity/mortality than late-onset PE that occurs at or after 34 wk of gestation...
August 1, 2016: Physiological Genomics
https://www.readbyqxmd.com/read/27076563/atrial-fibrillation-and-atrial-flutter-in-pregnant-women-a-population-based-study
#20
Ming-Sum Lee, Wansu Chen, Zilu Zhang, Lewei Duan, Angie Ng, Hillard T Spencer, Damon M Kwan, Albert Y-J Shen
BACKGROUND: The goal of this study was to determine the prevalence of atrial fibrillation and atrial flutter (AF) in pregnant women and to examine the impact of AF on maternal and fetal outcomes. METHODS AND RESULTS: Between January 1, 2003 and December 31, 2013, there were 264 730 qualifying pregnancies (in 210 356 women) in the Kaiser Permanente Southern California hospitals, among whom AF was noted in 157 pregnancies (129 women; 61.3 per 100 000 women, or 59...
April 13, 2016: Journal of the American Heart Association
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