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İnan C, Uygur L, Alpay V, Ayaz R, Şahin Uysal N, Biri A, Yıldırım G, Sayın NC. Hypertensive Disorders of Pregnancy: Diagnosis, Management and Timing of Birth. Balkan Med J 2024; 41:333-347. [PMID: 39239931 DOI: 10.4274/balkanmedj.galenos.2024.2024-7-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
Hypertensive disorders of pregnancy are significant contributors to maternal and perinatal morbidity and mortality. The definition, classification, and management of these disorders have evolved over time. Notably, the disease classification enables caretakers to manage the disease as well as safeguard maternal and fetal health. The approach and management for pregnancies with gestational and chronic hypertension or pre-eclampsia with or without severe features should be adequately elucidated to mitigate adverse perinatal outcomes. This review aimed to present the most recent definition and classification of hypertensive disorders of pregnancy to address their management, determine the optimal timing of birth, and establish short- and long-term follow-up protocols following parturition.
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Affiliation(s)
- Cihan İnan
- Department of Obstetrics and Gynecology, Division of Perinatology, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Lütfiye Uygur
- Clinic of Obstetrics and Gynecology, University of Health Sciences Türkiye, Zeynep Kamil Women's and Child Health Training and Research Hospital, İstanbul, Türkiye
| | - Verda Alpay
- Clinic of Obstetrics and Gynecology, University of Health Sciences Türkiye, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
| | - Reyhan Ayaz
- Department of Obstetrics and Gynecology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Türkiye
| | - Nihal Şahin Uysal
- Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Ankara, Türkiye
| | - Aydan Biri
- Clinic of Obstetrics and Gynecology, Koru Hospital, Ankara, Türkiye
| | | | - Niyazi Cenk Sayın
- Department of Obstetrics and Gynecology, Division of Perinatology, Trakya University Faculty of Medicine, Edirne, Türkiye
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Song Y, Qian X, Du W. Postoperative residual neuromuscular block in a woman with severe preeclampsia treated with magnesium sulfate and nicardipine: A case report and literature review. Front Surg 2023; 10:1093969. [PMID: 36911609 PMCID: PMC9995428 DOI: 10.3389/fsurg.2023.1093969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Calcium channel blockers and magnesium sulfate are frequently used together, particularly in women with underlying chronic hypertension and pre-eclampsia. A review of the literature showed prolonged neuromuscular blockade after treatment with magnesium sulfate. Since magnesium and calcium have opposite effects on the neuromuscular junctions, muscle weakness may become a postoperative manifestation of magnesium sulfate and calcium antagonist treatment in the obstetric population; however, limited information is available regarding this postulation. Here, we report a case wherein rocuronium activity was markedly prolonged due to pretreatment with magnesium sulfate and nicardipine after general anesthesia during an emergency cesarean delivery.
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Affiliation(s)
- Yingcai Song
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaozhe Qian
- Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weijia Du
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Magee LA, Smith GN, Bloch C, Côté AM, Jain V, Nerenberg K, von Dadelszen P, Helewa M, Rey E. Directive clinique n o 426 : Troubles hypertensifs de la grossesse : Diagnostic, prédiction, prévention et prise en charge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:572-597.e1. [PMID: 35577427 DOI: 10.1016/j.jogc.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIF La présente directive a été élaborée par des fournisseurs de soins de maternité en obstétrique et en médecine interne. Elle aborde le diagnostic, l'évaluation et la prise en charge des troubles hypertensifs de la grossesse, la prédiction et la prévention de la prééclampsie ainsi que les soins post-partum des femmes avec antécédent de trouble hypertensif de la grossesse. POPULATION CIBLE Femmes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en œuvre des recommandations de la présente directive devrait réduire l'incidence des troubles hypertensifs de la grossesse, en particulier la prééclampsie, et des issues défavorables associées. DONNéES PROBANTES: La revue exhaustive de la littérature a été mise à jour en tenant compte des nouvelles données probantes jusqu'en décembre 2020 et en suivant la même méthodologie que pour la précédente directive de la Société des obstétriciens et gynécologues du Canada (SOGC) sur les troubles hypertensifs de la grossesse. La recherche s'est limitée aux articles publiés en anglais ou en français. Les recommandations relatives aux traitements s'appuient d'abord sur les essais cliniques randomisés et les revues systématiques (lorsque disponibles), ainsi que sur l'évaluation des résultats cliniques substantiels chez les mères et les bébés. MéTHODES DE VALIDATION: Les auteurs se sont entendus sur le contenu et les recommandations par consensus et ont répondu à l'examen par les pairs du comité de médecine fœto-maternelle de la SOGC. Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE) et se sont gardé l'option de désigner certaines recommandations par la mention « bonne pratique ». Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). Le conseil d'administration de la SOGC a approuvé la version définitive aux fins de publication. PROFESSIONNELS CIBLES Tous les fournisseurs de soins de santé (obstétriciens, médecins de famille, sages-femmes, infirmières et anesthésistes) qui prodiguent des soins aux femmes avant, pendant ou après la grossesse. RECOMMANDATIONS
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Magee LA, Smith GN, Bloch C, Côté AM, Jain V, Nerenberg K, von Dadelszen P, Helewa M, Rey E. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:547-571.e1. [PMID: 35577426 DOI: 10.1016/j.jogc.2022.03.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This guideline was developed by maternity care providers from obstetrics and internal medicine. It reviews the diagnosis, evaluation, and management of the hypertensive disorders of pregnancy (HDPs), the prediction and prevention of preeclampsia, and the postpartum care of women with a previous HDP. TARGET POPULATION Pregnant women. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may reduce the incidence of the HDPs, particularly preeclampsia, and associated adverse outcomes. EVIDENCE A comprehensive literature review was updated to December 2020, following the same methods as for previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines, and references were restricted to English or French. To support recommendations for therapies, we prioritized randomized controlled trials and systematic reviews (if available), and evaluated substantive clinical outcomes for mothers and babies. VALIDATION METHODS The authors agreed on the content and recommendations through consensus and responded to peer review by the SOGC Maternal Fetal Medicine Committee. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a "good practice point." See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).The Board of the SOGC approved the final draft for publication. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, and anesthesiologists) who provide care to women before, during, or after pregnancy. RECOMMENDATIONS
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Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, Kenny LC, McCarthy F, Myers J, Poon LC, Rana S, Saito S, Staff AC, Tsigas E, von Dadelszen P. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2022; 27:148-169. [DOI: 10.1016/j.preghy.2021.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
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von Dadelszen P, Vidler M, Tsigas E, Magee LA. Management of Preeclampsia in Low- and Middle-Income Countries: Lessons to Date, and Questions Arising, from the PRE-EMPT and Related Initiatives. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Abstract
"Pregnancy-induced hypertension" (HDP) describes a spectrum of disorders, including gestational hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. Each of these disease processes can progress to a more pathologic case with worsening hypertensive disease, end-organ damage, and concerning clinical sequelae. Risk factors for HDP include nulliparity, a prior pregnancy complicated by hypertension, and obesity. Close blood pressure monitoring, serologic and urine testing, and prompt clinical follow-up remain the gold standard for antenatal diagnosis and surveillance. Optimizing maternal and neonatal outcomes involves early prenatal diagnosis, a multidisciplinary team-based approach, and referral to an experienced provider for cases with advanced pathology.
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Affiliation(s)
- Whitney A Booker
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th Street, PH-16, New York, NY 10032, USA.
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Abstract
PURPOSE OF REVIEW Hypertension affects approximately 10% of pregnancies and may persist in the postpartum period. Furthermore, de novo hypertension may present after delivery, but its exact prevalence is not verified. Both types of hypertension expose the mother to eventually severe complications like eclampsia, stroke, pulmonary edema, and HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome. RECENT FINDINGS Until today, there are limited data regarding the risk factors, pathogenesis, and pathophysiology of postpartum hypertensive disorders. However, there is certain evidence that preeclampsia may in large part be responsible. Women who experienced preeclampsia during pregnancy, although considered cured after delivery and elimination of the placenta, continue to present endothelial and renal dysfunction in the postpartum period. The brain and kidneys are particularly sensitive to this pathological vascular condition, and severe complications may result from their involvement. Large randomized trials are needed to give us the evidence that will allow a timely diagnosis and treatment. Until then, medical providers should increase their knowledge regarding hypertension after delivery because many times there is an underestimation of the complications that can ensue after a misdiagnosed or undertreated postpartum hypertension.
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Affiliation(s)
- V Katsi
- Cardiology Department, Hippokration Hospital, Athens, Greece
| | - G Skalis
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece.
| | - G Vamvakou
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| | - D Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - T Makris
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
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Zhao F, Ai F, Wu J, Dong X. Changes and clinical significance of serum inflammatory factors in the treatment of pregnancy hypertension syndrome with magnesium sulfate combined with nifedipine. Exp Ther Med 2020; 20:1796-1802. [PMID: 32742411 DOI: 10.3892/etm.2020.8863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Curative effect of magnesium sulfate combined with nifedipine on pregnancy-induced hypertension and the effect of serum inflammatory factors were investigated. A total of 188 cases of patients were collected as the research subjects. They all had pregnancy-induced hypertension, and were admitted to The First People's Hospital of Yunnan Province hospital from June 2016 to February 2018. There were, 94 patients treated with magnesium sulfate in the control group, and further 94 patients treated with magnesium sulfate combined with nifedipine in the study group. ELISA was used to detect the expression levels of suppressors of cytokine signaling-3 (SOCS-3), interleukin-10 (IL-10) and interleukin 18 (IL-18), and the relationship between serum inflammatory factors and efficacy was analyzed. The curative effect and eutocia rate in the study group were significantly higher than those in the control group (P<0.05), and the cesarean section rate was lower than that of the control group (P<0.05). In the study group, the adverse reactions were significantly lower than those in the control group (P<0.05). After treatment, the expression levels of serum SOCS-3 and IL-10 in the study group were significantly higher than those in the control group (P<0.05), while the expression level of serum IL-18 was significantly lower than that in the control group (P<0.05). The area under the curve (AUC) of the predictive value of SOCS-3, IL-10 and IL-18 in pregnancy-induced hypertension was 0.717, 0.727 and 0.725, respectively. The best specificity was 76.19, 52.98 and 61.90%, respectively, when the cut-off value was <0.553 ng/l, 48.06 ng/ml and 269.46 ng/ml, and their sensitivity was 70.00, 94.74 and 85.00%, respectively. In conclusion, magnesium sulfate combined with nifedipine significantly improved the disease course of pregnancy-induced hypertension. The levels of SOCS-3, IL-10 and IL-18 in patients are correlated with the curative effect of pregnancy-induced hypertension, suggesting that they have important value in the treatment and monitoring of gestational hypertension.
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Affiliation(s)
- Feifei Zhao
- Obstetrics Department, The First People's Hospital of Yunnan Province (The Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, P.R. China
| | - Fang Ai
- Obstetrics Department, The First People's Hospital of Yunnan Province (The Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, P.R. China
| | - Jie Wu
- Obstetrics Department, The First People's Hospital of Yunnan Province (The Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, P.R. China
| | - Xudong Dong
- Obstetrics Department, The First People's Hospital of Yunnan Province (The Affiliated Hospital of Kunming University of Science and Technology), Kunming, Yunnan 650032, P.R. China
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10
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ACOG Committee Opinion No. 767: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period. Obstet Gynecol 2019; 133:e174-e180. [PMID: 30575639 DOI: 10.1097/aog.0000000000003075] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30-60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Intravenous labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available. In the rare circumstance that intravenous bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal-fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended.
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Bottom-up development of national obstetric guidelines in middle-income country Suriname. BMC Health Serv Res 2019; 19:651. [PMID: 31500615 PMCID: PMC6734520 DOI: 10.1186/s12913-019-4377-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background Obstetric guidelines are useful to improve the quality of care. Availability of international guidelines has rapidly increased, however the contextualization to enhance feasibility of implementation in health facilities in low and middle-income settings has only been described in literature in a few instances. This study describes the approach and lessons learned from the ‘bottom-up’ development process of context-tailored national obstetric guidelines in middle-income country Suriname. Methods Local obstetric health care providers initiated the guideline development process in Suriname in August 2016 for two common obstetric conditions: hypertensive disorders of pregnancy (HDP) and post partum haemorrhage (PPH). Results The process consisted of six steps: (1) determination of how and why women died, (2) interviews and observations of local clinical practice, (3) review of international guidelines, (4) development of a primary set of guidelines, (5) initiation of a national discussion on the guidelines content and (6) establishment of the final guidelines based on consensus. Maternal enquiry of HDP- and PPH-related maternal deaths revealed substandard care in 90 and 95% of cases, respectively. An assessment of the management through interviews and labour observations identified gaps in quality of the provided care and large discrepancies in the management of HDP and PPH between the hospitals. International recommendations were considered unfeasible and were inconsistent when compared to each other. Local health care providers and stakeholders convened to create national context-tailored guidelines based on adapted international recommendations. The guidelines were developed within four months and locally implemented. Conclusion Development of national context-tailored guidelines is achievable in a middle-income country when using a ‘bottom-up’ approach that involves all obstetric health care providers and stakeholders in the earliest phase. We hope the descriptive process of guideline development is helpful for other countries in need of nationwide guidelines. Electronic supplementary material The online version of this article (10.1186/s12913-019-4377-6) contains supplementary material, which is available to authorized users.
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Leavitt K, Običan S, Yankowitz J. Treatment and Prevention of Hypertensive Disorders During Pregnancy. Clin Perinatol 2019; 46:173-185. [PMID: 31010554 DOI: 10.1016/j.clp.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article reviews the pharmacology of the most commonly used antihypertensive medications during pregnancy; their mechanism of action; and the effects on the mother, the fetus, and lactation. Each class of antihypertensive pharmacologic agents have specific mechanisms of action by which they exert their antihypertensive effect. β-Adrenoreceptor antagonists block these receptors in the peripheral circulation. Calcium channel blockers result in arterial vasodilation. α-Agonists inhibit vasoconstriction. Methyldopa is a centrally acting adrenoreceptor antagonist. Vasodilators have a direct effect on vascular smooth muscle. Diuretics decrease intravascular volume. Medications acting on the angiotensin pathway are avoided during pregnancy because of fetotoxic effects.
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Affiliation(s)
- Karla Leavitt
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA.
| | - Sarah Običan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA
| | - Jerome Yankowitz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA
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Grześk G, Wołowiec Ł, Walukiewicz M, Rogowicz D, Gilewski W, Banach J. The importance and safety of calcium antagonists in the treatment of hypertension in pregnant women. Pregnancy Hypertens 2019; 16:85-88. [PMID: 31056164 DOI: 10.1016/j.preghy.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Grzegorz Grześk
- 2nd Department of Cardiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Łukasz Wołowiec
- 2nd Department of Cardiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Marcin Walukiewicz
- 2nd Department of Cardiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland.
| | - Daniel Rogowicz
- 2nd Department of Cardiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Wojciech Gilewski
- 2nd Department of Cardiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Joanna Banach
- 2nd Department of Cardiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
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Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report. JA Clin Rep 2019; 5:28. [PMID: 32025988 PMCID: PMC6966907 DOI: 10.1186/s40981-019-0248-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background We present a rare case of prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in a pregnant patient being treated with magnesium sulfate and nifedipine undergoing cesarean section under general anesthesia. Case presentation A 37-year-old woman at 34 weeks gestation, weighing 42.5 kg, and receiving magnesium sulfate 94 mg/kg for preeclampsia and nifedipine 20 mg, underwent cesarean section under general anesthesia for abruptio placentae. Her trachea was intubated after administering rocuronium 0.94 mg/kg. Postoperatively, sugammadex 4.7 mg/kg was administered at post-tetanic count 2, 163 min after rocuronium administration. However, 9 min after sugammadex administration, the train-of-four ratio only reached 0.7. Fifteen min after sugammadex administration, extubation was successfully performed when the train-of-four ratio reached 0.9 after administration of atropine 0.5 mg and neostigmine 1.0 mg. Conclusions Caution is required in pregnant women on high-dose magnesium sulfate with nifedipine, which may cause prolongation of neuromuscular blockade and insufficient reversal.
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Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med 2019; 7:2050312119843700. [PMID: 31007914 PMCID: PMC6458675 DOI: 10.1177/2050312119843700] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.
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Affiliation(s)
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
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Tamargo J, Caballero R, Delpón E. Pharmacotherapy for hypertension in pregnant patients: special considerations. Expert Opin Pharmacother 2019; 20:963-982. [PMID: 30943045 DOI: 10.1080/14656566.2019.1594773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) represent a major cause of maternal, fetal and neonatal morbidity and mortality and identifies women at risk for cardiovascular and other chronic diseases later in life. When antihypertensive drugs are used during pregnancy, their benefit and harm to both mother and fetus should be evaluated. AREAS COVERED This review summarizes the pharmacological characteristics of the recommended antihypertensive drugs and their impact on mother and fetus when administered during pregnancy and/or post-partum. Drugs were identified using MEDLINE and the main international Guidelines for the management of HDP. EXPERT OPINION Although there is a consensus that severe hypertension should be treated, treatment of mild hypertension without end-organ damage (140-159/90-109 mmHg) remains controversial and there is no agreement on when to initiate therapy, blood pressure targets or recommended drugs in the absence of robust evidence for the superiority of one drug over others. Furthermore, the long-term outcomes of in-utero antihypertensive exposure remain uncertain. Therefore, evidence-based data regarding the treatment of HDP is lacking and well designed randomized clinical trials are needed to resolve all these controversial issues related to the management of HDP.
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Affiliation(s)
- Juan Tamargo
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Ricardo Caballero
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Eva Delpón
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
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Zulfeen M, Tatapudi R, Sowjanya R. IV labetalol and oral nifedipine in acute control of severe hypertension in pregnancy-A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2019; 236:46-52. [PMID: 30878897 DOI: 10.1016/j.ejogrb.2019.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the efficacy of intravenous labetalol with oral nifedipine in the treatment of severe hypertension in pregnancy with blood pressure ≥160/110 mm Hg. DESIGN, SETTING AND PARTICIPANTS We conducted a parallel double-blinded randomized controlled trial between December 2014 to December 2016 in 120 antenatal women of gestational age >28 weeks, admitted with severe hypertension of blood pressure ≥160/110 mm Hg to maternity ward at a tertiary hospital. The labetalol group received 20 mg initially followed by escalating doses of 40 mg, 80 mg, 80 mg and 80 mg (5 doses) every 15 min to a maximum of 300 mg. Nifedipine group received 10 mg initially followed by repeated doses of 20 mg every 15 min (total 5 doses) to a maximum of 90 mg. Vital signs were recorded every 15 min. -The time taken and the number of doses required to achieve the target blood pressure (150/100 mmHg). Survival analysis was used to compare the efficacy of treatment regimens. RESULTS Sixty women were randomised to each group and none were lost to follow-up. None of the patients in nifedipine group required labetalol, whereas three patients in labetalol group achieved target BP only after receiving nifedipine was administered after the maximum dose of labetalol.The mean time taken to achieve the target blood pressure in the labetalol group was higher (36.75 min) than in the nifedipine group (27.25 min) [mean difference 9.5 min,p = 0.002]. Nifedipine group required significantly lower doses (1.82 ± 0.83) as compared to labetalol (2.45 ± 1.32) [p = 0.002]. Nifedipine was 1.8 times more likely to achieve target blood pressure (Hazard Ratio = 1.8). CONCLUSIONS Both intravenous Labetalol and oral Nifedipine were effective in controlling blood pressure. Nifedipine reduced BP more rapidly than Labetalol. Oral Nifedipine may be a better alternative because of its ease of oral administration and a flat dosing regimen.
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Affiliation(s)
- Momina Zulfeen
- Kasturba Medical College, Manipal University, Manipal, India.
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18
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Abstract
Importance Preterm delivery represents an important cause of infant morbidity and mortality. Various tocolytics have been studied with the objective of stopping preterm labor, increasing gestational age at delivery, and preventing complications related to preterm birth. Objective This review aims to summarize the major classes of tocolytics and review the evidence regarding use of each. Evidence Acquisition A PubMed search of the following terms was performed to gather relevant data: "tocolytic," "preterm labor," "preterm delivery," "PPROM," "magnesium," "indomethacin," "nifedipine," and "betamimetics." Results The benefits and risks of nonsteroid anti-inflammatory drugs, calcium channel blockers, magnesium, and betamimetics are reviewed. Calcium channel blockers afford superior outcomes in terms of prolonging gestation and decreasing neonatal morbidity and mortality with the fewest adverse effects. Conclusions and Relevance Tocolytics, particularly calcium channel blockers, may provide benefit to pregnant women and their infants. Their use should be tailored to the particular clinical circumstances of the patient and used in conjunction with other management strategies (e.g., administration of corticosteroids for fetal lung maturation or magnesium for neuroprotection and transfer to a tertiary medical center). Further research and professional guidelines are needed on optimal use of these agents.
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Cox AG, Marshall SA, Palmer KR, Wallace EM. Current and emerging pharmacotherapy for emergency management of preeclampsia. Expert Opin Pharmacother 2019; 20:701-712. [PMID: 30707633 DOI: 10.1080/14656566.2019.1570134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Preeclampsia is a disease specific to pregnancy characterised by new onset hypertension with maternal organ dysfunction and/or fetal growth restriction. It remains a major cause of maternal and perinatal morbidity and mortality. For fifty years, antihypertensives have been the mainstay of treating preeclampsia, reducing maternal morbidity and mortality. With increased knowledge of the mechanisms underlying the disease has come opportunities for novel therapies that complement antihypertensives by protecting the maternal vasculature. Areas covered: In this review, the authors consider, in detail, the antihypertensives commonly used today in the emergency care of women with severe preeclampsia. They also review less common anti-hypertensive agents and discuss the role of magnesium sulphate in the management of preeclampsia and the prevention of eclampsia. Finally, they explore novel therapeutics for the acute management of preeclampsia. Expert opinion: The rapid control of maternal hypertension will, and must, remain the mainstay of emergency treatment for women with severe preeclampsia. The role of magnesium sulphate as a primary prevention for eclampsia is context dependant and should not displace a focus on correcting blood pressure safely. The exploration of novel adjuvant therapies will likely allow us to prolong pregnancy longer and improve perinatal outcomes safely for the mother.
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Affiliation(s)
- Annie G Cox
- a Ritchie Centre, Department of Obstetrics and GynaecologySchool of Clinical Sciences , Monash University , Clayton , Australia.,b The Ritchie Centre , Hudson Institute of Medical Research , Clayton , Australia
| | - Sarah A Marshall
- a Ritchie Centre, Department of Obstetrics and GynaecologySchool of Clinical Sciences , Monash University , Clayton , Australia.,b The Ritchie Centre , Hudson Institute of Medical Research , Clayton , Australia
| | - Kirsten R Palmer
- a Ritchie Centre, Department of Obstetrics and GynaecologySchool of Clinical Sciences , Monash University , Clayton , Australia
| | - Euan M Wallace
- a Ritchie Centre, Department of Obstetrics and GynaecologySchool of Clinical Sciences , Monash University , Clayton , Australia.,b The Ritchie Centre , Hudson Institute of Medical Research , Clayton , Australia
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Magee LA, von Dadelszen P. State-of-the-Art Diagnosis and Treatment of Hypertension in Pregnancy. Mayo Clin Proc 2018; 93:1664-1677. [PMID: 30392546 DOI: 10.1016/j.mayocp.2018.04.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/12/2018] [Accepted: 04/20/2018] [Indexed: 12/20/2022]
Abstract
Hypertension complicates up to 10% of pregnancies worldwide. Pregnancy hypertension is defined as systolic blood pressure (BP) equal to or greater than 140 mm Hg or diastolic BP equal to or greater than 90 mm Hg, usually on the basis of measurements in office/clinic settings and using various BP devices. Hypertensive disorders of pregnancy are classified into (1) chronic hypertension diagnosed before pregnancy or before 20 weeks' gestation, (2) gestational hypertension diagnosed at equal to or greater than 20 weeks, or (3) preeclampsia, defined restrictively as gestational hypertension with proteinuria or broadly as gestational hypertension with proteinuria or an end-organ manifestation consistent with preeclampsia. Absolute BP values equal to or greater than 140/90 mm Hg are associated with increased maternal and perinatal risks, particularly with preeclampsia. This review focuses on antihypertensive therapy of hypertensive disorders of pregnancy as a specific management strategy. Underpinning this therapy is the need for accurate measurement of BP, agreed-upon classification of pregnancy hypertension, agreed-upon BP thresholds for enhanced surveillance and antihypertensive treatment, and collaborative teamwork in management. Challenges relate to the methodology of studies on which care is based, as well as aspects of the care itself, particularly the unregulated use of home BP monitoring. Pitfalls include the unsubstantiated belief that nifedipine and magnesium sulfate cannot be used together and the perception that severe hypertension and nonsevere hypertension are separate entities rather than lying along a spectrum of BP values. The following must be addressed by future research: guidance for nuanced care as women transition between severe and nonsevere hypertension, personalized antihypertensive therapy, and incorporation of women's values into research priorities and clinical practice when antihypertensive care is chosen.
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Affiliation(s)
- Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Odigboegwu O, Pan LJ, Chatterjee P. Use of Antihypertensive Drugs During Preeclampsia. Front Cardiovasc Med 2018; 5:50. [PMID: 29896480 PMCID: PMC5987086 DOI: 10.3389/fcvm.2018.00050] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023] Open
Abstract
Treatment of pregnancy-related hypertensive disorders, such as preeclampsia (PE), remain a challenging problem in obstetrics. Typically, aggressive antihypertensive drug treatment options are avoided to prevent pharmacological-induced hypotension. Another major concern of administering antihypertensive drugs during pregnancy is possible adverse fetal outcome. In addition, management of hypertension during pregnancy in chronic hypertensive patients or in patients with prior kidney problems are carefully considered. Recent studies suggest that PE patients are at increased cardiovascular risk postpartum. Therefore, these patients need to be monitored postpartum for the subsequent development of other cardiovascular diseases. In this review article, we review the antihypertensive drugs currently being used to treat patients with PE and the advantages or disadvantages of using these drugs during pregnancy.
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Affiliation(s)
- Obinnaya Odigboegwu
- Department of Internal Medicine, Scott and White Medical Center-Temple, Texas A&M Health Science Center, Temple, TX, United States
| | - Lu J Pan
- Department of Internal Medicine, Scott and White Medical Center-Temple, Texas A&M Health Science Center, Temple, TX, United States
| | - Piyali Chatterjee
- Department of Internal Medicine, Scott and White Medical Center-Temple, Texas A&M Health Science Center, Temple, TX, United States
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Folk DM. Hypertensive Disorders of Pregnancy: Overview and Current Recommendations. J Midwifery Womens Health 2018; 63:289-300. [PMID: 29764001 DOI: 10.1111/jmwh.12725] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 11/12/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. These disorders are an important cause of maternal and fetal morbidity and mortality. Although advances in effective treatments have been made, current research has yet to identify a biochemical or diagnostic imaging marker to reliably predict preeclampsia. Despite current guidelines that address diagnosis and management of hypertensive disorders in pregnancy, health care providers may overlook or be unaware of signs that require immediate evaluation and treatment. This article reviews the definitions of hypertensive disorders of pregnancy, diagnosis, pathophysiology of preeclampsia, indications for treatment, neurologic sequelae, and counseling about the implications of hypertension in pregnancy for subsequent health.
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Shawahna R. Which information on women's issues in epilepsy does a community pharmacist need to know? A Delphi consensus study. Epilepsy Behav 2017; 77:79-89. [PMID: 29127865 DOI: 10.1016/j.yebeh.2017.09.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to develop and achieve consensus on a core list of important knowledge items that community pharmacists should know on women's issues in epilepsy. METHODS This was a consensual study using a modified Delphi technique. Knowledge items were collected from the literature and from nine key contacts who were interviewed on their views on what information community pharmacists should have on women's issues in epilepsy. More knowledge items were suggested by five researchers with interest in women's issues who were contacted to rate and comment on the knowledge items collected. Two iterative Delphi rounds were conducted among a panel of pharmacists (n=30) to achieve consensus on the knowledge items to be included in the core list. Ten panelists ranked the knowledge items by their importance using the Analytical Hierarchy Process (AHP). RESULTS Consensus was achieved to include 68 knowledge under 13 categories in the final core list. Items ranked by their importance were related to the following: teratogenicity (10.3%), effect of pregnancy on epilepsy (7.4%), preconception counseling (10.3%), bone health (5.9%), catamenial epilepsy (7.4%), menopause and hormonal replacement therapy (2.9%), contraception (14.7%), menstrual disorders and infertility (8.8%), eclampsia (2.9%), breastfeeding (4.4%), folic acid and vitamin K (5.9%), counseling on general issues (14.7%), and sexuality (4.4%). CONCLUSION Using consensual knowledge lists might promote congruence in educating and/or training community pharmacists on women's issues in epilepsy. Future studies are needed to investigate if such lists can improve health services provided to women with epilepsy (WWE).
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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Sharma C, Soni A, Gupta A, Verma A, Verma S. Hydralazine vs nifedipine for acute hypertensive emergency in pregnancy: a randomized controlled trial. Am J Obstet Gynecol 2017; 217:687.e1-687.e6. [PMID: 28867601 DOI: 10.1016/j.ajog.2017.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/12/2017] [Accepted: 08/23/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a paucity of good quality evidence regarding the best therapeutic option for acute control of blood pressure during acute hypertensive emergency of pregnancy. OBJECTIVE We sought to compare the efficacy of intravenously administered hydralazine and oral nifedipine for acute blood pressure control in acute hypertensive emergency of pregnancy. STUDY DESIGN In this double-blind, randomized, controlled trial, pregnant women (≥24 weeks period of gestation) with sustained increase in systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥110 mm Hg were randomized to receive intravenous hydralazine injection in doses of 5, 10, 10, and 10 mg and a placebo tablet or oral nifedipine (10 mg tablet up to 4 doses) and intravenous saline injection every 20 minutes until the target blood pressure of 150 mm Hg systolic and ≤100 mm Hg diastolic was achieved. Crossover treatment was administered if the initial treatment failed. The primary outcome of the study was time necessary to achieve target blood pressure. The secondary outcomes were the number of dosages required, adverse maternal and neonatal effects, and perinatal outcome. RESULTS From December 2014 through September 2015, we enrolled 60 patients. The median time to achieve target blood pressure was 40 minutes in both groups (intravenous hydralazine and oral nifedipine) (interquartile interval 5 and 40 minutes, respectively, P = .809). The median dose requirement in both groups was 2 (intravenous hydralazine and oral nifedipine) (interquartile range 1 and 2 doses, respectively, P = .625). Intravenous hydralazine was associated with statistically significantly higher occurrence of vomiting (9/30 vs 2/30, respectively, P = .042). No serious adverse maternal or perinatal side effects were witnessed in either group. CONCLUSION Both intravenous hydralazine and oral nifedipine are equally effective in lowering of blood pressure in acute hypertensive emergency of pregnancy.
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Affiliation(s)
| | - Anjali Soni
- Dr Rajendra Prasad Government Medical College, Tanda (HP), India
| | - Amit Gupta
- Dr Rajendra Prasad Government Medical College, Tanda (HP), India
| | - Ashok Verma
- Dr Rajendra Prasad Government Medical College, Tanda (HP), India
| | - Suresh Verma
- Dr Rajendra Prasad Government Medical College, Tanda (HP), India
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Bolnick AD, Bolnick JM, Kohan-Ghadr HR, Kilburn BA, Hertz M, Dai J, Drewlo S, Armant DR. Nifedipine Prevents Apoptosis of Alcohol-Exposed First-Trimester Trophoblast Cells. Alcohol Clin Exp Res 2017; 42:53-60. [PMID: 29048755 DOI: 10.1111/acer.13534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal alcohol abuse leading to fetal alcohol spectrum disorder (FASD) includes fetal growth restriction (FGR). Ethanol (EtOH) induces apoptosis of human placental trophoblast cells, possibly disrupting placentation and contributing to FGR in FASD. EtOH facilitates apoptosis in several embryonic tissues, including human trophoblasts, by raising intracellular Ca2+ . We previously found that acute EtOH exposure increases trophoblast apoptosis due to signaling from both intracellular and extracellular Ca2+ . Therefore, nifedipine, a Ca2+ channel blocker that is commonly administered to treat preeclampsia and preterm labor, was evaluated for cytoprotective properties in trophoblast cells exposed to alcohol. METHODS Human first-trimester chorionic villous explants and the human trophoblast cell line HTR-8/SVneo (HTR) were pretreated with 12.5 to 50 nM of the Ca2+ channel blocker nifedipine for 1 hour before exposure to 50 mM EtOH for an additional hour. Intracellular Ca2+ concentrations were monitored in real time by epifluorescence microscopy, using fluo-4-AM. Apoptosis was assessed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), accumulation of cytoplasmic cytochrome c, and cleavage rates of caspase 3 and caspase 9. RESULTS The increase in intracellular Ca2+ upon exposure to EtOH in both villous explants and HTR cells was completely blocked (p < 0.05) when pretreated with nifedipine, accompanied by inhibition of EtOH-induced release of cytochrome c, caspase activities, and TUNEL. CONCLUSIONS This study indicates that nifedipine can interrupt the apoptotic pathway downstream of EtOH exposure and could provide a novel strategy for future interventions in women with fetuses at risk for FASD.
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Affiliation(s)
- Alan D Bolnick
- Departments of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Jay M Bolnick
- Departments of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Hamid-Reza Kohan-Ghadr
- Departments of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Brian A Kilburn
- Departments of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Michael Hertz
- Departments of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Jing Dai
- Departments of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sascha Drewlo
- Departments of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - D Randall Armant
- Departments of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan.,Anatomy& Cell Biology, Wayne State University School of Medicine, Detroit, Michigan
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Duro-Gómez J, Rodríguez-Marín AB, Giménez de Azcárete M, Duro-Gómez L, Hernández-Angeles C, Arjona-Berral JE, Castelo-Branco C. A trial of oral nifedipine and oral labetalol in preeclampsia hypertensive emergency treatment. J OBSTET GYNAECOL 2017; 37:864-866. [PMID: 28531362 DOI: 10.1080/01443615.2017.1308321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This observational retrospective cohort study was conducted to compare oral nifedipine and labetalol for emergency treatment of hypertension in preeclamptic patients. Time (minutes) and necessary doses were outlined to achieve blood pressure lower than 150/95 mmHg. In 14 patients with preeclampsia, 55 hypertensive emergencies were identified (BP >150/95). Of these emergencies, 43 were treated with oral nifedipine 10 mg (10 patients) and 12 with oral labetalol 100 mg (4 patients). To achieve a target blood pressure under 150/95, these doses were repeated as necessary every 20 min, up to a maximum of 4 doses. Oral nifedipine reduced BP more rapidly (31.30 vs. 53.50 min, p = .03). No maternal or foetal adverse events were observed and no major differences were found according to the type of delivery. Oral nifedipine is faster than and at least as safe as labetalol in pre-eclampsia hypertensive emergency treatment.
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Affiliation(s)
- Jorge Duro-Gómez
- a Obstetrics and Gynaecology Unit , Hospital Universitario Reina Sofía , Córdoba , Spain
| | - Ana B Rodríguez-Marín
- a Obstetrics and Gynaecology Unit , Hospital Universitario Reina Sofía , Córdoba , Spain
| | | | - Lourdes Duro-Gómez
- a Obstetrics and Gynaecology Unit , Hospital Universitario Reina Sofía , Córdoba , Spain
| | - Claudio Hernández-Angeles
- b Gynaecology and Obstetrics Hospital Number 4 "Luis Castelazo Ayala," Instituto Mexicano del Seguro Social , México , México
| | - José E Arjona-Berral
- a Obstetrics and Gynaecology Unit , Hospital Universitario Reina Sofía , Córdoba , Spain
| | - Camil Castelo-Branco
- c Department of Gynaecology and Obstetrics , Hospital Clinic, Universitat de Barcelona, IDIBAPS , Barcelona , Spain
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Xiao X, Xiao F, Zhao M, Tong M, Wise MR, Stone PR, Chamley LW, Chen Q. Treating normal early gestation placentae with preeclamptic sera produces extracellular micro and nano vesicles that activate endothelial cells. J Reprod Immunol 2017; 120:34-41. [PMID: 28441551 DOI: 10.1016/j.jri.2017.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/09/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Preeclampsia is characterised by systemic endothelial cell dysfunction thought to be triggered by toxic/dangerous factors from the placenta, including placental extracellular vesicles (EVs). Why placental EVs become toxic is unknown. We previously reported that preeclamptic sera produced toxic/dangerous placental macrovesicles but whether small EVs are also toxic/dangerous in preeclampsia is unknown. STUDY DESIGN First trimester placental explants were treated with 10% preeclamptic or control sera (n=10) for 24h. Micro- and nano-vesicles were harvested by sequential centrifugation. Micro- or nano-vesicles were also exposed to monolayers of endothelial cells in the presence or absence of nifedipine (50μg/ml) or labetalol (0.5μg/ml) which are well-known anti-hypertensives in clinical practices. MAIN OUTCOMES MEASURES The number and size of micro- and nano-vesicles were counted. Endothelial cell-surface intercellular adhesion molecule 1 (ICAM-1) and high mobility group box 1 (HMGB1) levels in micro- or nano-vesicles were measured by immunoassays. RESULTS Neither the amount nor size of both micro- and nano-vesicles was different after treating placental explants with preeclamptic or control sera. The levels of HMGB1 were significantly increased in both micro- and nano-vesicles from preeclamptic sera treated placental explants (p<0.03). Exposing endothelial cells to micro- or nano-vesicles from preeclamptic sera-treated placental explants induced endothelial activation, but it was reversed by co-incubation with nifedipine (p=0.004) or labetalol (p=0.002). CONCLUSION Our data demonstrate that preeclamptic sera produce toxic/dangerous micro- and nano-placental EVs which activated endothelial cells. This effect was reversed by antihypertensives. The increased levels of HMGB1 in EVs may contribute to endothelial cell activation.
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Affiliation(s)
- Xirong Xiao
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Fengyi Xiao
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Mingzhi Zhao
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Mancy Tong
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Michelle R Wise
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Peter R Stone
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Qi Chen
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand.
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Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period. Obstet Gynecol 2017; 129:e90-e95. [DOI: 10.1097/aog.0000000000002019] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Usman S, Foo L, Tay J, Bennett PR, Lees C. Use of magnesium sulfate in preterm deliveries for neuroprotection of the neonate. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/tog.12328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sana Usman
- Imperial College of Science, Technology and Medicine; Institute of Reproductive Developmental Biology; Du Cane Road London W12 0NN UK
| | - Lin Foo
- Imperial College of Science, Technology and Medicine; Institute of Reproductive Developmental Biology; Du Cane Road London W12 0NN UK
| | - Jasmine Tay
- Imperial College of Science, Technology and Medicine; Institute of Reproductive Developmental Biology; Du Cane Road London W12 0NN UK
| | - Phillip R Bennett
- Imperial College Healthcare NHS Trust; The Bays, South Wharf Road, St Mary's Hospital London W2 1NY UK
- Institute of Reproductive Developmental Biology; Queen Charlottes and Chelsea Hospital; Du Cane Road London W12 0HS UK
| | - Christoph Lees
- Imperial College Healthcare NHS Trust; The Bays, South Wharf Road, St Mary's Hospital London W2 1NY UK
- Institute of Reproductive Developmental Biology; Queen Charlottes and Chelsea Hospital; Du Cane Road London W12 0HS UK
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ElFarra J, Bean C, Martin JN. Management of Hypertensive Crisis for the Obstetrician/Gynecologist. Obstet Gynecol Clin North Am 2016; 43:623-637. [DOI: 10.1016/j.ogc.2016.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marret S, Ancel PY. Protection cérébrale de l’enfant né prématuré par le sulfate de magnésium. ACTA ACUST UNITED AC 2016; 45:1418-1433. [DOI: 10.1016/j.jgyn.2016.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 12/15/2022]
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Xuan RR, Niu TT, Chen HM. Astaxanthin blocks preeclampsia progression by suppressing oxidative stress and inflammation. Mol Med Rep 2016; 14:2697-704. [PMID: 27484589 DOI: 10.3892/mmr.2016.5569] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 07/15/2016] [Indexed: 11/06/2022] Open
Abstract
To investigate the antioxidative effect of astaxanthin on Nω-nitro-L-arginine methyl ester (L-NAME)-induced preeclamptic rats. Cell survival, the level of reactive oxygen species (ROS) and the changes in mitochondrial membrane potential (MMP) were examined in astaxanthin and H2O2-treated human umbilical vein endothelial cells (HUVECs). The preeclamptic Sprague-Dawley (SD) rat model was established by injection of L‑NAME and treatment with astaxanthin. The activities of malondialdehyde (MDA), superoxide dismutase (SOD) and nitric oxide synthase (NOS) in serum were analyzed. Pathological changes were examined by hematoxylin and eosin (H&E) staining. The expression of nuclear factor (NF)‑κB, Rho‑associated protein kinase II (ROCK II), heme oxygenase‑1 (HO‑1) and caspase 3 in preeclamptic placentas were examined by immunohistochemistry. Astaxanthin significantly reduced H2O2‑induced HUVEC cell death, decreased ROS and increased MMP. Astaxanthin significantly reduced blood pressure and the content of MDA, but significantly increased the activity of SOD in preeclamptic rats. The urinary protein and the level of NO and NOS were also decreased. H&E staining revealed that the thickness of the basilar membrane was increased, while the content of trophoblast cells and spiral arteries were reduced following astaxanthin treatment. Immunohistochemistry results showed that the expression of NF‑κB, ROCK II and caspase 3 in preeclamptic placentas was significantly decreased after astaxanthin treatment, while HO‑1 expression was increased. In conclusion, astaxanthin inhibited H2O2‑induced oxidative stress in HUVECs. Astaxanthin treatment significantly improved L‑NAME‑induced preeclamptic symptoms and reduced the oxidative stress and inflammatory damages in preeclamptic placentas. Astaxanthin treatment may effectively prevent and treat preeclampsia.
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Affiliation(s)
- Rong-Rong Xuan
- Department of Gynecology and Obstetrics, The Affiliated Hospital of Medical College of Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Ting-Ting Niu
- School of Marine Science, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
| | - Hai-Min Chen
- School of Marine Science, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
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Hypertensive disorders of pregnancy. Can J Anaesth 2016; 63:1075-97. [PMID: 27443376 DOI: 10.1007/s12630-016-0689-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/26/2016] [Accepted: 06/16/2016] [Indexed: 01/13/2023] Open
Abstract
PURPOSE In this continuing professional development module, we review recent Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines for the classification and diagnosis of hypertensive disorders of pregnancy (HDP) as well as review the clinical features, laboratory investigations, and outcomes of HDP. We explore the evidence for anesthetic management and prevention of end-organ damage in women with HDP and describe the role and contribution of anesthesiologists as part of a multidisciplinary care team. PRINCIPAL FINDINGS Hypertensive disorders of pregnancy can have variable presentations with clinical signs and symptoms that often do not correlate with the underlying severity and progression of the disease. Failure of timely diagnosis and treatment contributes significantly to adverse maternal (neurologic complications, pulmonary edema, and postpartum hemorrhage) and neonatal (respiratory and neurologic complications and stillbirth) outcomes. In the Canadian context, improvements in medical care have led to better maternal and neonatal outcomes. Timing of delivery is crucial in balancing maternal risks and fetal benefits of ongoing pregnancy. Evidence-based SOGC guidelines regarding diagnosis and management of HDP address many aspects of clinical care relevant to anesthesiologists, who have an important role in the multidisciplinary care team. CONCLUSIONS Hypertensive disorders of pregnancy are on the rise worldwide, and this trend is expected to continue. The major contributors to maternal mortality are failure to recognize HDP promptly or to treat the condition adequately. It is essential that anesthesiologists understand the disease process and acquire knowledge of the guidelines governing current obstetrical care in order to provide evidence-based multidisciplinary quality care to these patients. Anesthetic management helps prevent potentially deleterious maternal and fetal outcomes.
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Quiroz DL. PREVENCIÓN PRENATAL DE DAÑO NEUROLÓGICO EN PREMATURO EXTREMO. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Pre-eclampsia affects 3-5% of pregnancies and is traditionally diagnosed by the combined presentation of high blood pressure and proteinuria. New definitions also include maternal organ dysfunction, such as renal insufficiency, liver involvement, neurological or haematological complications, uteroplacental dysfunction, or fetal growth restriction. When left untreated, pre-eclampsia can be lethal, and in low-resource settings, this disorder is one of the main causes of maternal and child mortality. In the absence of curative treatment, the management of pre-eclampsia involves stabilisation of the mother and fetus, followed by delivery at an optimal time. Although algorithms to predict pre-eclampsia are promising, they have yet to become validated. Simple preventive measures, such as low-dose aspirin, calcium, and diet and lifestyle interventions, show potential but small benefit. Because pre-eclampsia predisposes mothers to cardiovascular disease later in life, pregnancy is also a window for future health. A collaborative approach to discovery and assessment of the available treatments will hasten our understanding of pre-eclampsia and is an effort much needed by the women and babies affected by its complications.
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Affiliation(s)
- Ben W J Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia.
| | - Claire T Roberts
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Laura A Magee
- BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | | | - G Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, University of Fort Hare, and Eastern Cape Department of Health, East London, South Africa
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Abstract
While hemorrhage is the leading cause of maternal death in most of the world, hypertensive disorders of pregnancy are the leading cause of maternal mortality in the United States. The opportunity to improve outcomes lies in timely and appropriate response to severe hypertension. The purpose of this article is to review the diagnostic criteria for severe hypertension, choice of antihypertensive agents, and recommended algorithms for evaluation and management of acute changes in clinical status. Adhering to standard practices ensures that care teams can timely and appropriate care to these high risk patients. With heightened surveillance and prompt evaluation of signs and symptoms of worsening hypertension, maternal morbidity and mortality can be decreased.
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Affiliation(s)
- Leslie A Moroz
- Department of Obstetrics and Gynecology, Columbia University Medical Center, PH 16-66 622 W 168th St, New York, NY 10032.
| | - Lynn L Simpson
- Department of Obstetrics and Gynecology, Columbia University Medical Center, PH 16-66 622 W 168th St, New York, NY 10032
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, North Shore-LIJ Health System, Manhasset, NY
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Clark SM, Dunn HE, Hankins GDV. A review of oral labetalol and nifedipine in mild to moderate hypertension in pregnancy. Semin Perinatol 2015; 39:548-55. [PMID: 26344738 DOI: 10.1053/j.semperi.2015.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hypertension is the most commonly encountered medical condition in pregnancy, contributing significantly to maternal and perinatal morbidity and mortality. Mild to moderate hypertension in pregnancy is defined as systolic blood pressure of 140-159 mmHg or diastolic blood pressure of 90-109 mmHg (7-9% of pregnancies). When treating hypertension in pregnancy, not only do physiologic changes of pregnancy have an effect on the pharmacokinetics and pharmacodynamics of the drugs used, but the pathophysiology of hypertensive disorders of pregnancy also have an effect. To date, evidence is lacking on the pharmacokinetics and pharmacodynamics of commonly used antihypertensive drugs, which often times leads to suboptimal treatment of hypertensive pregnant women. When considering which agents to use for treatment of mild to moderate hypertension, specifically in gestational and chronic hypertension, oral labetalol and nifedipine are valid options. An overview of the profile for use, safety, and current pharmacokinetic data for each agent is presented here.
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Affiliation(s)
- Shannon M Clark
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The University of Texas Medical Branch-Galveston, 301 University Blvd., Route 0587, Galveston, TX 77550.
| | - Holly E Dunn
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The University of Texas Medical Branch-Galveston, 301 University Blvd., Route 0587, Galveston, TX 77550
| | - Gary D V Hankins
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The University of Texas Medical Branch-Galveston, 301 University Blvd., Route 0587, Galveston, TX 77550
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Abstract
The prevalence of hypertensive disorders in pregnancy is increasing. The etiology and pathophysiology of hypertensive disorders in pregnancy remain poorly understood. Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality. Treatment of hypertension decreases the incidence of severe hypertension, but it does not impact rates of preeclampsia or other pregnancy complications. Several antihypertensive medications are commonly used in pregnancy, although there is a lack of randomized controlled trials. Severe hypertension should be treated immediately to prevent maternal end-organ damage. Appropriate antepartum, intrapartum, and postpartum management is important in caring for patients with hypertensive disorders.
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Affiliation(s)
- Courtney Olson-Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY 14642, USA
| | - Neil S Seligman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY 14642, USA.
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Magee LA, Namouz-Haddad S, Cao V, Koren G, von Dadelszen P. Labetalol for hypertension in pregnancy. Expert Opin Drug Saf 2015; 14:453-61. [PMID: 25692529 DOI: 10.1517/14740338.2015.998197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Labetalol is one of the most commonly used antihypertensive medications for the treatment of hypertension during pregnancy, an increasingly common and leading cause of maternal mortality and morbidity worldwide. AREAS COVERED The literature reviewed included the 2014 Canadian national pregnancy hypertension guideline and its references. The additional published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library using appropriate controlled vocabulary (e.g., pregnancy, hypertension, pre-eclampsia, pregnancy toxemias) and key words (e.g., diagnosis, evaluation, classification, prediction, prevention, prognosis, treatment, and postpartum follow-up).Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies published in French or English, Jan-Mar/14. The unpublished literature was identified by searching websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. We evaluated the impact of interventions on substantive clinical outcomes for mothers and babies. EXPERT OPINION Labetalol is a reasonable choice for treatment of severe or non-severe hypertension in pregnancy. However, we should continue our search for other therapeutic options.
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Affiliation(s)
- Laura A Magee
- University of British Columbia, BC Women's Hospital and Health Centre , 4500 Oak Street, Room 1U59, Vancouver, BC V6H 3N1 , Canada +1 604 875 3054; +1 604 875 2424; Ext: 6012 ; +1 604 875 3212 ;
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Audibert F, Bujold E, Côté AM, Douglas MJ, Eastabrook G, Firoz T, Gibson P, Gruslin A, Hutcheon J, Koren G, Lange I, Leduc L, Logan AG, MacDonell KL, Moutquin JM, Sebbag I. The hypertensive disorders of pregnancy (29.3). Best Pract Res Clin Obstet Gynaecol 2015; 29:643-57. [DOI: 10.1016/j.bpobgyn.2015.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
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Shekhar S, Gupta N, Kirubakaran R, Pareek P. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta-analysis. BJOG 2015; 123:40-7. [PMID: 26113232 DOI: 10.1111/1471-0528.13463] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral nifedipine is recommended along with labetalol and hydralazine for treatment of severe hypertension during pregnancy by most authorities. Although nifedipine is cheap and easily administered, the usage pattern among health care providers suggests a strong preference for labetalol despite lack of evidence for the same. OBJECTIVES To determine the efficacy and safety of oral nifedipine for treatment of severe hypertension of pregnancy compared with intravenous labetalol. SEARCH STRATEGY We systematically searched for articles comparing oral nifedipine with intravenous labetalol for the treatment of severe hypertension during pregnancy in any language, over Medline, Cochrane Central Register of Clinical Trials and Google Scholar from inception till February 2014. SELECTION CRITERIA We included all RCTs that compared intravenous labetalol with oral nifedipine for treatment of severe hypertension during pregnancy, addressing relevant efficacy and safety outcomes. DATA COLLECTION AND ANALYSIS Eligible studies were reviewed, and data were extracted onto a standard form. We used Cochrane review manager software for quantitative analysis. Data were analysed using a fixed effect model. MAIN RESULTS The pooled analysis of seven trials (four from developing countries) consisting of 363 woman-infant pairs showed that oral nifedipine was associated with less risk of persistent hypertension (RR 0.42, 95% CI 0.18-0.96) and reported maternal side effects (RR 0.57, 95% CI 0.35-0.94). However, on sensitivity analysis the outcome 'persistent hypertension' was no longer significant. Other outcomes did not reach statistical significance. CONCLUSION Oral nifedipine is as efficacious and safe as intravenous labetalol and may have an edge in low resource settings. TWEETABLE ABSTRACT Although studies to date are few in number and small, nifedipine shows promise for severe hypertension in pregnancy.
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Affiliation(s)
- S Shekhar
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - N Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - R Kirubakaran
- South Asian Cochrane Network, Christian Medical College Vellore, Vellore, India
| | - P Pareek
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, India
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Foo L, Tay J, Lees CC, McEniery CM, Wilkinson IB. Hypertension in Pregnancy: Natural History and Treatment Options. Curr Hypertens Rep 2015; 17:36. [DOI: 10.1007/s11906-015-0545-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Morris R, Sunesara I, Darby M, Novotny S, Kiprono L, Bautista L, Sawardecker S, Bofill J, Anderson B, Martin JN. Impedance cardiography assessed treatment of acute severe pregnancy hypertension: a randomized trial. J Matern Fetal Neonatal Med 2014; 29:171-6. [DOI: 10.3109/14767058.2014.995081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rachael Morris
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Imran Sunesara
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Marie Darby
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Sarah Novotny
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Luissa Kiprono
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Leody Bautista
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Sandip Sawardecker
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - James Bofill
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Belinda Anderson
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - James N. Martin
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
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The use of intravenous magnesium in non-preeclamptic pregnant women: fetal/neonatal neuroprotection. Arch Gynecol Obstet 2014; 291:969-75. [DOI: 10.1007/s00404-014-3581-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
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Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations. J Hypertens 2014; 32:454-63. [PMID: 24384846 DOI: 10.1097/hjh.0000000000000069] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review evaluates the guideline recommendations for the management of hypertension in pregnancy as presented by 25 national/international guidelines developed for the management of arterial hypertension in adults. There is a general consensus that oral α-methyldopa and parenteral labetalol are the drugs of choice for nonsevere and severe hypertension in pregnancy, respectively. Long-acting nifedipine is recommended by various guidelines as an alternative for first-line and second-line therapy in nonsevere and severe hypertension. The safety of β-blockers, atenolol in particular, in early and late stages of pregnancy is unresolved; their use is contraindicated according to several guidelines. Diuretic-associated harmful effects on maternal and fetal outcomes are controversial: their use is discouraged in pregnancy. It is important to develop specific guidelines for treating hypertension in special groups such as adult females of childbearing age and sexually active female adolescents to minimize the risk of adverse effects of drugs on the fetus. In several guidelines, the antihypertensive classes, recommended drug(s), intended drug formulation, and route of administration are not explicit. These omissions should be addressed in future guideline revisions in order to enhance the guidelines' utility and credibility in clinical practice.
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Firoz T, Magee LA, MacDonell K, Payne BA, Gordon R, Vidler M, von Dadelszen P. Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review. BJOG 2014; 121:1210-8; discussion 1220. [PMID: 24832366 PMCID: PMC4282072 DOI: 10.1111/1471-0528.12737] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pregnant and postpartum women with severe hypertension are at increased risk of stroke and require blood pressure (BP) reduction. Parenteral antihypertensives have been most commonly studied, but oral agents would be ideal for use in busy and resource-constrained settings. OBJECTIVES To review systematically, the effectiveness of oral antihypertensive agents for treatment of severe pregnancy/postpartum hypertension. SEARCH STRATEGY A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed. SELECTION CRITERIA Randomised controlled trials in pregnancy and postpartum with at least one arm consisting of a single oral antihypertensive agent to treat systolic BP ≥ 160 mmHg and/or diastolic BP ≥ 110 mmHg. DATA COLLECTION AND ANALYSIS Cochrane RevMan 5.1 was used to calculate relative risk (RR) and weighted mean difference by random effects. MAIN RESULTS We identified 15 randomised controlled trials (915 women) in pregnancy and one postpartum trial. Most trials in pregnancy compared oral/sublingual nifedipine capsules (8-10 mg) with another agent, usually parenteral hydralazine or labetalol. Nifedipine achieved treatment success in most women, similar to hydralazine (84% with nifedipine; relative risk [RR] 1.07, 95% confidence interval [95% CI] 0.98-1.17) or labetalol (100% with nifedipine; RR 1.02, 95% CI 0.95-1.09). Less than 2% of women treated with nifedipine experienced hypotension. There were no differences in adverse maternal or fetal outcomes. Target BP was achieved ~ 50% of the time with oral labetalol (100 mg) or methyldopa (250 mg) (47% labetelol versus 56% methyldopa; RR 0.85 95% CI 0.54-1.33). CONCLUSIONS Oral nifedipine, and possibly labetalol and methyldopa, are suitable options for treatment of severe hypertension in pregnancy/postpartum.
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Affiliation(s)
- T Firoz
- Department of Medicine, University of British ColumbiaVancouver, BC, Canada
- Child and Family Research Institute, University of British ColumbiaVancouver, BC, Canada
| | - LA Magee
- Department of Obstetrics and Gynaecology, University of British ColumbiaVancouver, BC, Canada
- Department of Medicine, British Columbia Women's Hospital and Health Sciences CentreVancouver, BC, Canada
| | - K MacDonell
- College of Physicians & Surgeons of British ColumbiaVancouver, BC, Canada
| | - BA Payne
- Child and Family Research Institute, University of British ColumbiaVancouver, BC, Canada
- Department of Obstetrics and Gynaecology, University of British ColumbiaVancouver, BC, Canada
| | - R Gordon
- Department of Obstetrics and Gynaecology, University of British ColumbiaVancouver, BC, Canada
| | - M Vidler
- Child and Family Research Institute, University of British ColumbiaVancouver, BC, Canada
- Department of Obstetrics and Gynaecology, University of British ColumbiaVancouver, BC, Canada
| | - P von Dadelszen
- Child and Family Research Institute, University of British ColumbiaVancouver, BC, Canada
- Department of Obstetrics and Gynaecology, University of British ColumbiaVancouver, BC, Canada
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Affiliation(s)
- Ellen W Seely
- Endocrinology, Diabetes, and Hypertension Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W.S.); and Maternal Fetal Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.E.)
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