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Bhojwani K, Agrawal A. Study of Histopathological Changes in the Placenta in Preeclampsia. Cureus 2022; 14:e30347. [DOI: 10.7759/cureus.30347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
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Rynn KO, Hughes FL, Faley B. An Emergency Department Approach to Drug Treatment of Hypertensive Urgency and Emergency. J Pharm Pract 2016. [DOI: 10.1177/0897190005278748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients who present with hypertensive urgency or emergency require immediate attention to assess the severity of illness. Guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are available but do little to address the management of acute elevations in blood pressure. Various treatment options, both old and new, exist to manage these patients in the emergency department. Decisions on therapy are patient specific and depend on the underlying cause of elevated blood pressure. This article sets out to describe specific patient presentations and reviews current available options in the management of hypertensive urgencies and emergencies.
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Affiliation(s)
- Kevin O. Rynn
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, and Robert Wood Johnson University Hospital, New Brunswick, New Jersey,
| | - Frank L. Hughes
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, and Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Brian Faley
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, and Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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Zahran S, Magzamen S, Breunig IM, Mielke HW. Maternal exposure to neighborhood soil Pb and eclampsia risk in New Orleans, Louisiana (USA): evidence from a natural experiment in flooding. ENVIRONMENTAL RESEARCH 2014; 133:274-81. [PMID: 24981826 DOI: 10.1016/j.envres.2014.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/30/2014] [Accepted: 06/02/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Previous studies link maternal blood lead (Pb) levels and pregnancy-related hypertensive disorders. OBJECTIVE Assess the relationship between neighborhood soil Pb and maternal eclampsia risk. METHODS Zip code summarized high density soil survey data of New Orleans collected before and after Hurricanes Katrina and Rita (HKR) were merged with pregnancy outcome data on 75,501 mothers from the Louisiana office of public health. Cross-sectional logistic regression analyses are performed testing the association between pre-HKR accumulation of Pb in soils in thirty-two neighborhoods and eclampsia risk. Then we examine whether measured declines in soil Pb following the flooding of the city resulted in corresponding reductions of eclampsia risk. RESULTS Cross-sectional analyses show that a one standard deviation increase in soil Pb increases the odds of eclampsia by a factor of 1.48 (95% CI: 1.31, 1.66). Mothers in zip code areas with soil Pb>333 mg/kg were 4.00 (95% CI: 3.00, 5.35) times more likely to experience eclampsia than mothers residing in neighborhoods with soil Pb<50mg/kg. Difference-in-differences analyses capturing the exogenous reduction in soil Pb following the 2005 flooding of New Orleans indicate that mothers residing in zip codes experiencing decrease in soil Pb (-387.9 to -33.6 mg/kg) experienced a significant decline in eclampsia risk (OR=0.619; 95% CI: 0.397, 0.963). CONCLUSIONS Mothers residing in neighborhoods with high accumulation of Pb in soils are at heightened risk of experiencing eclampsia.
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Affiliation(s)
- Sammy Zahran
- Department of Economics, C-312A Clark Building, Colorado State University, Fort Collins, CO, 80523-1771 USA; Robert Wood Johnson Health and Society Scholar, Columbia University, 722 W 168th St, New York, NY 10032, USA.
| | - Sheryl Magzamen
- Department of Environmental and Radiological and Health Sciences, 147 Environmental Health Building, Colorado State University, Fort Collins, CO, 80523-1681 USA.
| | - Ian M Breunig
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th floor, Room 01-209, Baltimore, MD 21201, USA.
| | - Howard W Mielke
- Department of Pharmacology, Tulane University School of Medicine, 1430 Tulane Avenue SL-83, New Orleans, LA, 70112-2699, USA.
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Andrus SS, Wolfson AB. Postpartum Preeclampsia Occurring After Resolution of Antepartum Preeclampsia. J Emerg Med 2010; 38:168-70. [DOI: 10.1016/j.jemermed.2008.04.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 10/04/2007] [Accepted: 11/07/2007] [Indexed: 11/17/2022]
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Okafor UV, Efetie ER, Igwe W, Okezie O. Anaesthetic management of patients with pre-eclampsia/eclampsia and perinatal outcome. J Matern Fetal Neonatal Med 2009; 22:688-92. [DOI: 10.1080/14767050902994473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McCoy S, Baldwin K. Pharmacotherapeutic options for the treatment of preeclampsia. Am J Health Syst Pharm 2009; 66:337-44. [PMID: 19202042 DOI: 10.2146/ajhp080104] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Pharmacotherapeutic options for the treatment of preeclampsia are reviewed. SUMMARY Risk factors for the development of preeclampsia include microvascular diseases, such as diabetes mellitus; vascular and connective tissue disorders; hypertension; antiphospholipid antibody syndrome; and nephropathy. Several pathophysiological factors contribute to the development of the preeclamptic state, including vasospasm onset, coagulation system activation, increased inflammatory response, and ischemia. The specific agents used for the treatment of preeclampsia are dependent on a number of factors including symptom severity, maternal or fetal compromise, the progression to eclampsia, gestational period, and cervical status. The diagnosis of preeclampsia beyond the gestation period of 38 weeks requires delivery. The presence of maternal compromise or eclampsia at gestation greater than 20 weeks also necessitates delivery. In cases of chronic or mild hypertension, oral methyldopa may be administered on an outpatient basis. Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancies. The most common adverse effect of hydralazine administration is unpredictable hypotension. Labetalol decreases heart rate and may be preferred because of a lack of reflex tachycardia, hypotension, or increased intracranial pressure. However, the drug of choice for the prevention and control of maternal seizures in patients with severe preeclampsia or eclampsia during the peripartum period is i.v. magnesium sulfate. Therapeutic serum magnesium levels cause cerebral vasodilation, thereby reversing the ischemia produced by cerebral vasospasm during an eclamptic episode. The results of one study indicated that women receiving magnesium sulfate therapy had a 58% lower risk of eclampsia than placebo. CONCLUSION Magnesium sulfate remains the drug of choice for the prevention and treatment of preeclampsia. Alternative antihypertensive agents may provide additional benefit in the management of hypertension for preeclamptic patients.
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Affiliation(s)
- Stacey McCoy
- Baptist Medical Center and Wolfson Children's Hospital, Jacksonville, FL 32207, USA.
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Abstract
The decision to treat elevated arterial pressure in pregnancy depends on the risk and benefits imposed on the mother and the fetus. Treatment for mild-to-moderate hypertension during pregnancy may not reduce maternal or fetal risk. Severe hypertension, on the other hand, should be treated to decrease maternal risk. Methyldopa and beta-adrenoceptor antagonists have been used most extensively. In acute severe hypertension, intravenous labetalol or oral nifedipine are reasonable choices.
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Affiliation(s)
- Firas A Ghanem
- Section of Cardiology, Department of Medicine, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834, USA
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Abstract
Maternal deaths in developed countries continue to decline and are rare. Maternal mortality statistics are essentially similar in the United States and United Kingdom. However, the situation is completely different in developing countries, where maternal mortality exceeds 0.5 million every year. This article not only assesses morbidity risks in some of the leading causes of maternal death but also highlights strategies to minimize the risks and to prevent maternal morbidity and mortality.
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Cota LOM, Guimarães AN, Costa JE, Lorentz TCM, Costa FO. Association Between Maternal Periodontitis and an Increased Risk of Preeclampsia. J Periodontol 2006; 77:2063-9. [PMID: 17209792 DOI: 10.1902/jop.2006.060061] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Periodontal disease has been considered a systemic exposure implicated in a higher risk of adverse pregnancy outcomes. The aim of the present study was to determine whether maternal periodontitis is associated with an increased risk of preeclampsia. METHODS A case-control study was conducted in a public hospital in Belo Horizonte, Brazil. During the study period, 588 women, aged 14 to 46 years, were deemed eligible and had data available for analysis. Maternal demographic and medical data were collected from medical records. Preeclampsia was defined as blood pressure >140/90 mm Hg and > or =1+ proteinuria after 20 weeks of gestation. A periodontal examination was performed postpartum. Maternal periodontitis was defined as the presence of four or more teeth with one or more sites with a probing depth > or =4 mm and clinical attachment loss > or =3 mm at the same site. The effects of maternal age, chronic hypertension, primiparity, smoking, alcohol use, and number of prenatal visits were analyzed. Adjusted odds ratios (ORs) for preeclampsia were calculated using multivariate logistic regression. RESULTS The prevalence of periodontitis was 63.9% and preeclampsia was 18.5%. Variables associated with preeclampsia were chronic hypertension (OR = 4.10; 95% confidence interval [CI] = 2.0 to 8.4; P = 0.001), primiparity (OR = 2.40; 95% CI = 1.5 to 3.9; P = 0.004), maternal age (OR = 1.07; 95% CI = 1.0 to 1.1; P = 0.001), and maternal periodontitis (OR = 1.88; 95% CI = 1.1 to 3.0; P = 0.001). CONCLUSION Maternal periodontitis was determined to be associated with an increased risk of preeclampsia.
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Troesken W. Lead exposure and eclampsia in Britain, 1883-1934. ENVIRONMENTAL RESEARCH 2006; 101:395-400. [PMID: 16352302 DOI: 10.1016/j.envres.2005.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 10/25/2005] [Accepted: 10/27/2005] [Indexed: 05/05/2023]
Abstract
Eclampsia refers to a coma or seizure activity in a pregnant woman with no prior history of such activity. This paper presents a mix of historical and epidemiological evidence consistent with the hypothesis that chronic lead exposure is a predisposing factor for eclampsia. The historical evidence is based on research conducted by British physicians around 1900 showing that the geographic variation in eclampsia across England and Wales was correlated with lead levels in local drinking water supplies. A formal epidemiological analysis based on a data set of English and Welsh counties observed in 1883 corroborates the evidence presented by historical observers. In particular, the statistical results show that the death rate from eclampsia in counties with high-water-lead levels exceeded the death rate in counties with low-water-lead levels by a factor of 2.34 (95% CI: 1.54-3.14).
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Affiliation(s)
- Werner Troesken
- Department of History, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Ruano R, Fontes RS, Zugaib M. Prevention of preeclampsia with low-dose aspirin -- a systematic review and meta-analysis of the main randomized controlled trials. Clinics (Sao Paulo) 2005; 60:407-14. [PMID: 16254678 DOI: 10.1590/s1807-59322005000500010] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The purpose of this paper is to evaluate the effectiveness of low-dose aspirin in the prevention of preeclampsia in low-risk and high-risk women. We identified randomized clinical trials of the use of low-dose aspirin to prevent preeclampsia through the PUBMED search engine, and through the Cochran Library database. Twenty-two studies met our inclusion criteria, and were divided according to the studied population into 2 groups: trials with women at low risk for preeclampsia and trials with women at high risk. Effects were measured through the incidence of preeclampsia in women taking either placebo or aspirin, in studies where the relative risks and the 95% confidence intervals were calculated for both groups. A total of 33,598 women were studied, comprising 5 trials with 16,700 women at low-risk and 17 trials including 16,898 women at high risk. The incidence of preeclampsia was 3.75% (626/17,700), in the low-risk group, 9.01% (1,524/16,898) in the high-risk group, and 6.40% (2,150/33,598) overall. Low-dose aspirin had no statistically significantly effect on the incidence of preeclampsia in the low-risk group (RR = 0.95, 95% CI = 0.81-1.11), but had a small beneficial effect in the high-risk group (RR = 0.87, 95% CI = 0.79-0.96). Therefore, low-dose aspirin is mildly beneficial in terms of reducing the incidence of preeclampsia in women at high risk of developing preeclampsia.
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Affiliation(s)
- Rodrigo Ruano
- Department o Gynecology and Obstetrics, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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