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Parker SE, Ajayi A, Yarrington CD. De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital. Hypertension 2023; 80:279-287. [PMID: 36377603 DOI: 10.1161/hypertensionaha.122.19275] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Postpartum hypertension can be persistent, following a pregnancy complicated by hypertension, or new onset (de novo), following a normotensive pregnancy. The aim of this study is to estimate the incidence and identify risk factors for de novo postpartum hypertension (dn-PPHTN) among a diverse safety-net hospital population. METHODS We conducted a retrospective cohort study of 3925 deliveries from 2016 to 2018. All blood pressure (BP) measures during pregnancy through 12 months postpartum were extracted from medical records. Patients with chronic hypertension or hypertensive disorders of pregnancy were excluded. dn-PPHTN was defined as 2 separate BP readings with systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg at least 48 hours after delivery. Severe dn-PPHTN was defined as systolic BP ≥160 and diastolic BP ≥110. We examined risk factors individually and in combination and timing of diagnosis. RESULTS Among the 2465 patients without a history of hypertension, 12.1% (n=298) developed dn-PPHTN; 17.1% of whom had severe dn-PPHTN (n=51). Compared to those without dn-PPHTN; cases were more likely to be ≥35 years, delivered via cesarean, or be current or former smokers. Patients with all of these characteristics had a 29% risk of developing dn-PPHTN, which was elevated among non-Hispanic Black patients (36%). Approximately 22% of cases were diagnosed after 6 weeks postpartum. CONCLUSIONS More than 1 in 10 patients with normotensive pregnancies experience dn-PPHTN in the year after delivery. Opportunities to monitor and manage patients at the highest risk of dn-PPHTN throughout the entire year postpartum could mitigate cardiovascular related maternal morbidity.
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Affiliation(s)
- Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, MA (S.E.P., A.A.)
| | - Ayodele Ajayi
- Department of Epidemiology, Boston University School of Public Health, MA (S.E.P., A.A.)
| | - Christina D Yarrington
- Department of Obstetrics and Gynecology, Boston University School of Medicine, MA (C.D.Y.)
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2
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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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3
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Mahajan A, Kemp A, Hawkins TLA, Metcalfe A, Dowling S, Nerenberg K. Postpartum hypertensive disorders in the Emergency Department - A retrospective review of local practice in Calgary, Alberta. Pregnancy Hypertens 2019; 19:212-217. [PMID: 31870742 DOI: 10.1016/j.preghy.2019.11.009] [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] [Received: 07/09/2019] [Revised: 10/15/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) commonly occur postpartum and are associated with preventable maternal morbidity and mortality. HDP is the most common reason for presentation to the Emergency Department (ED) after delivery. However, given the broad range of non-specific symptoms, recognition and management of postpartum HDP may be delayed leading to serious adverse clinical outcomes. OBJECTIVES To describe: (1) the clinical presentation; (2) ED physician's diagnosis; and (3) current ED management of women with HDP in Calgary ED's. METHODS A retrospective review of postpartum women (within 42 days of delivery) attending three Calgary EDs between 2011 and 2012 was performed. Administrative data was used to randomly select 119 women; 44 with diagnostic codes for any HDP (labeled "HDP") and 75 with diagnostic codes for related diagnoses (e.g., abdominal pain, headache) (labeled "non-HDP"). Charts were reviewed for: maternal demographics; obstetrical history; and ED clinical findings, investigations and management. RESULTS Maternal characteristics were similar between groups. There was considerable overlap in clinical presentation between groups, with no significant difference for any presenting symptom. Only 52.3% (CI 40.0-64.3%) of women in the "HDP" group had HDP investigations (bloodwork and urinalysis) vs. 30.4% (CI 18.7-58.5%) of "non-HDP" (p = 0.072). HDP was diagnosed by the ED team in 42.9% (CI 31.1-55.5%) of the HDP group of whom only 40.3% (CI 28.7-53.1) received antihypertensive therapy. CONCLUSIONS Postpartum HDP is commonly under-recognized and under-treated in the ED, highlighting opportunities for interventions to improve the recognition and management of postpartum HDP.
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Affiliation(s)
- Amita Mahajan
- Department of Medicine - Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Canada.
| | - Anne Kemp
- Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Canada
| | - T Lee-Ann Hawkins
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Shawn Dowling
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Kara Nerenberg
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
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4
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Torsemide for Prevention of Persistent Postpartum Hypertension in Women With Preeclampsia: A Randomized Controlled Trial. Obstet Gynecol 2019; 132:1185-1191. [PMID: 30303905 DOI: 10.1097/aog.0000000000002941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate whether torsemide reduces the rate of persistent postpartum hypertension in women with preeclampsia. METHODS We conducted a randomized, double-blind, placebo-controlled trial of women with preeclampsia at a tertiary center from August 2016 to September 2017. Those with gestational hypertension or renal or cardiopulmonary failure were excluded. Within 24 hours of delivery, women were randomized one to one to oral torsemide, 20 mg/d, or placebo, for 5 days. Our primary outcome was blood pressure greater than or equal to 150 mm Hg systolic or 100 mm Hg diastolic (or both) on two occasions at least 4 hours apart by postpartum day 5 or by the time of hospital discharge. Assuming a 50% rate of persistent hypertension in women with preeclampsia, 118 participants were required to detect a 50% rate reduction. Analyses were by intention to treat. RESULTS From August 2016 to September 2017, 118 women were randomized: 59 were allocated to torsemide and 59 to placebo. Overall, 43 (73%) women in the torsemide and 45 (76%) in the placebo group had either preeclampsia with severe features or preeclampsia superimposed on chronic hypertension. The rate of persistent postpartum hypertension was 44% in the torsemide and 58% in the placebo group (relative risk 0.76, 95% CI 0.5-1.1). No differences were seen in rate of hypertension 7-10 days or 6 weeks postpartum, severe hypertension, length of postpartum hospital stay, readmission for hypertension, or adverse events. There were no cases of severe composite morbidity or deaths. CONCLUSION In this trial of women with preeclampsia, a 5-day course of postpartum torsemide did not have a significant effect on the rate of postpartum hypertension. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02813551.
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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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6
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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: 80] [Impact Index Per Article: 16.0] [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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7
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Robbins KS, Krause M, Nguyen AP, Almehlisi A, Meier A, Schmidt U. Peripartum Cardiomyopathy: Current Options for Treatment and Cardiovascular Support. J Cardiothorac Vasc Anesth 2019; 33:2814-2825. [PMID: 31060943 DOI: 10.1053/j.jvca.2019.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 12/17/2022]
Abstract
Peripartum cardiomyopathy is a rare form of acute heart failure but the major cause of all deaths in pregnant patients with heart failure. Improved survival rates in recent years, however, emphasize the importance of early recognition and initiation of heart failure treatment. This article, therefore, attempts to raise awareness among cardiac and obstetric anesthesiologists as well as intensivists of this often fatal diagnosis. This review summarizes theories of the pathophysiology and outcome of peripartum cardiomyopathy. Based on the most recent literature, it further outlines diagnostic criteria and treatment options including medical management, mechanical circulatory support devices, and heart transplantation. Earlier recognition of this rare condition and a new generation of mechanical circulatory devices has contributed to the improved outcome. More frequently, patients in cardiogenic shock who fail medical management are successfully bridged to recovery on extracorporeal circulatory devices or survive with a long-lasting implantable ventricular assist device. The outcome of transplanted patients with peripartum cardiomyopathy, however, is worse compared to other recipients of heart transplants and warrants further investigation in the future.
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Affiliation(s)
- Kimberly S Robbins
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
| | - Martin Krause
- Department of Anesthesiology, Division of Critical Care, University of Colorado, Aurora, CO.
| | - Albert P Nguyen
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
| | - Abdulaziz Almehlisi
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
| | - Angela Meier
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
| | - Ulrich Schmidt
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
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8
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Rymer-Haskel N, Schushan-Eisen I, Hass Y, Rahav R, Maayan-Metzger A, Hendler I. Characteristics and severity of preeclampsia in young and elderly gravidas with hypertensive disease. Eur J Obstet Gynecol Reprod Biol 2018; 228:120-125. [DOI: 10.1016/j.ejogrb.2018.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/05/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022]
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9
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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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10
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Kang E, Sugarman R, Ramadan H, Mueller A, Shahul S, Perdigao JL, Louis DJ, Narcisse R, Sannon H, Magee L, Rana S. Prevalence, risk factors and associated complications of postpartum hypertension in rural Haiti. Pregnancy Hypertens 2017; 10:135-142. [PMID: 29153666 DOI: 10.1016/j.preghy.2017.07.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/10/2017] [Accepted: 07/21/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The prevalence of hypertensive disorders during pregnancy is high in developing countries such as Haiti, however little is known about postpartum hypertension (PPHTN). METHODS This is a prospective study done at Hospital Albert Schweitzer in rural Haiti among pregnant women age 18 or older who were admitted for labor. Blood pressures were collected before and after delivery and medical charts were reviewed to gather delivery characteristics and fetal/neonatal outcomes. Differences between groups are presented based on postpartum blood pressures (BP) as mild PPHTN (systolic BP≥140 or diastolic BP≥90) and severe PPHTN (systolic BP≥160 or diastolic BP≥110). RESULTS Of 175 women, the prevalence of PPHTN during the two-month study period was 57.1% (97/172) and included 56 parturients with mild and 41 with severe PPHTN. Severe PPHTN was associated with a higher proportion of complications including abruption (14.6%), fetal (14.6%) and neonatal death (7.3%). Thirty-nine (69.6%) patients with mild PPHTN and 9 (21.9%) patients with severe PPHTN did not receive any antihypertensive medications postpartum. Patients with severe PPHTN had prolonged hospitalization compared to the normal group (3.5 vs. 2.0days, p=0.0003). There was a strong correlation between antepartum and postpartum systolic and diastolic BP's (r=0.62 and 0.54, p<0.0001, respectively). CONCLUSION In this study, we identified a high prevalence of PPHTN in rural Haiti. Severe PPHTN was associated with adverse outcomes and treatment is not universal. This data is a starting point to develop region-specific protocols to treat and control PPHTN.
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Affiliation(s)
- Eleanor Kang
- University of Chicago, Chicago, IL, United States
| | | | - Hadi Ramadan
- Department of Obstetrics and Gynecology/Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - Ariel Mueller
- Department of Obstetrics and Gynecology/Division of Maternal Fetal Medicine, University of Chicago, IL, United States; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Sana Shahul
- University of Chicago, Chicago, IL, United States
| | - Joana Lopes Perdigao
- Department of Obstetrics and Gynecology/Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - David Jean Louis
- Department of Obstetrics and Gynecology, Hospital Albert Schweitzer, Deshapelles, Haiti
| | - Rulx Narcisse
- Department of Obstetrics and Gynecology, Hospital Albert Schweitzer, Deshapelles, Haiti
| | - Herriot Sannon
- Department of Obstetrics and Gynecology, Hospital Albert Schweitzer, Deshapelles, Haiti
| | - Laura Magee
- St. George's, Hospitals NHS Foundation Trust, University of London, London, UK
| | - Sarosh Rana
- Department of Obstetrics and Gynecology/Division of Maternal Fetal Medicine, University of Chicago, IL, United States.
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Labor therapeutics and BMI as risk factors for postpartum preeclampsia: A case-control study. Pregnancy Hypertens 2017; 10:177-181. [PMID: 29153674 DOI: 10.1016/j.preghy.2017.07.142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/14/2017] [Accepted: 07/23/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aims at identifying associations between therapeutics used during labor and the occurrence of postpartum preeclampsia (PPPE), a poorly understood entity. STUDY DESIGN AND MAIN OUTCOME MEASURES This is a case-control study of women who received an ICD-9 code for PPPE (cases) during the years 2009-2011, compared to women with a normotensive term pregnancy, delivery and postpartum period until discharge (controls), matched on age (±1year) and delivery date (±3months). Cases were defined as women having a normotensive term pregnancy, delivery and initial postpartum period (48h post-delivery) but developing hypertension between 48h and 6weeks postpartum. Single variable and multiple variable models were used to determine significant risk factors. RESULTS Forty-three women with PPPE were compared to 86 controls. Use of vasopressors and oxytocin did not differ between cases and controls, but rate of fluids administered during labor (OR=1.68 per 100cc/h; 95% CI: 1.09-2.59, p=0.02) and an elevated pre-pregnancy/first trimester BMI (OR=1.18 per kg/m2, 95% CI: 1.07-1.3, p=0.001) were identified as significant risk factors in multivariate analysis. CONCLUSIONS We identified two potentially modifiable risk factors for PPPE; further studies are needed to better define the role of these two variables in the development of PPPE.
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Shanmugalingam R, Reza Pour N, Chuah SC, Vo TM, Beran R, Hennessy A, Makris A. Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review. BMC Pregnancy Childbirth 2016; 16:164. [PMID: 27422677 PMCID: PMC4947248 DOI: 10.1186/s12884-016-0953-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 07/09/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Arterial dissection is a rare complication of pregnancy and puerperium. There have been reports of aortic, coronary and cervical artery dissection in association with preeclampsia, however, vertebral artery dissection is rarely reported particularly in the antenatal setting in the presence of a Hypertensive Disorder of Pregnancy (HDP).The general annual incidence of symptomatic spontaneous cervicocephalic arterial dissection is 0.0026 % and a data registry reported that 2.4 % of these occurred in the post-partum period. The actual incidence of vertebral artery dissection in HDP is unknown as the current literature consists of case series and reports only with most documenting adverse outcomes. Given the presence of collateral circulation, unilateral vertebral artery dissections may go unrecognised and may be more common than suspected. CASE PRESENTATION We present a case series of four patients with vertebral artery dissection in association with HDP, two of which occurred in the antenatal setting and two in the post-partum setting. All our patients had favourable outcome with no maternal neurological deficit and live infants. Our discussion covers the proposed pathophysiology of vertebral artery dissection in HDP and the management of it. CONCLUSION Our case series highlights the need to consider VAD an important differential diagnosis when assessing pregnant women with headache and neck pain particularly in the context of HDP.
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Affiliation(s)
- Renuka Shanmugalingam
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
- Western Sydney University, Penrith, Australia
- Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney Australia
| | - Nina Reza Pour
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
| | - Siang Chye Chuah
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
| | - Thi Mong Vo
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
| | - Roy Beran
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
| | - Annemarie Hennessy
- Campbelltown Hospital, Therry Road, Campbelltown, 2560 NSW Australia
- Western Sydney University, Penrith, Australia
- Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney Australia
| | - Angela Makris
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
- Western Sydney University, Penrith, Australia
- University of New South Wales, Sydney, Australia
- Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney Australia
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Ni Y, Cheng W. Clinical characteristics of early-onset pre-eclampsia in singleton versus multiple pregnancies. Int J Gynaecol Obstet 2015; 132:325-8. [DOI: 10.1016/j.ijgo.2015.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 07/13/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
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14
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Goel A, Maski MR, Bajracharya S, Wenger JB, Zhang D, Salahuddin S, Shahul SS, Thadhani R, Seely EW, Karumanchi SA, Rana S. Epidemiology and Mechanisms of De Novo and Persistent Hypertension in the Postpartum Period. Circulation 2015; 132:1726-33. [PMID: 26416810 DOI: 10.1161/circulationaha.115.015721] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/06/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The pathophysiology of hypertension in the immediate postpartum period is unclear. METHODS AND RESULTS We studied 988 consecutive women admitted to a tertiary medical center for cesarean section of a singleton pregnancy. The angiogenic factors soluble fms-like tyrosine kinase 1 and placental growth factor, both biomarkers associated with preeclampsia, were measured on antepartum blood samples. We then performed multivariable analyses to determine factors associated with the risk of developing postpartum hypertension. Of the 988 women, 184 women (18.6%) developed postpartum hypertension. Of the 184 women, 77 developed de novo hypertension in the postpartum period, and the remainder had a hypertensive disorder of pregnancy in the antepartum period. A higher body mass index and history of diabetes mellitus were associated with the development of postpartum hypertension. The antepartum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor positively correlated with blood pressures in the postpartum period (highest postpartum systolic blood pressure [r=0.29, P<0.001] and diastolic blood pressure [r=0.28, P<0.001]). Moreover, the highest tertile of the antepartum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor was independently associated with postpartum hypertension (de novo hypertensive group: odds ratio, 2.25; 95% confidence interval, 1.19-4.25; P=0.01; in the persistent hypertensive group: odds ratio, 2.61; 95% confidence interval, 1.12-6.05; P=0.02) in multivariable analysis. Women developing postpartum hypertension had longer hospitalizations than those who remained normotensive (6.5±3.5 versus 5.7±3.4 days; P<0.001). CONCLUSIONS Hypertension in the postpartum period is relatively common and is associated with prolonged hospitalization. Women with postpartum hypertension have clinical risk factors and an antepartum plasma angiogenic profile similar to those found in women with preeclampsia. These data suggest that women with postpartum hypertension may represent a group of women with subclinical or unresolved preeclampsia.
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Affiliation(s)
- Arvind Goel
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - Manish R Maski
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - Surichhya Bajracharya
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - Julia B Wenger
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - Dongsheng Zhang
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - Saira Salahuddin
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - Sajid S Shahul
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - Ravi Thadhani
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - Ellen W Seely
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.)
| | - S Ananth Karumanchi
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
| | - Sarosh Rana
- From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
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15
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Naito T, Kubono N, Deguchi S, Sugihara M, Itoh H, Kanayama N, Kawakami J. Amlodipine passage into breast milk in lactating women with pregnancy-induced hypertension and its estimation of infant risk for breastfeeding. J Hum Lact 2015; 31:301-6. [PMID: 25447596 DOI: 10.1177/0890334414560195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/28/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few clinical reports have been published on amlodipine passage into breast milk in lactating women. OBJECTIVES The aims of this study were to evaluate the plasma concentration of amlodipine and its passage into breast milk in lactating women with pregnancy-induced hypertension and to estimate the risk for breastfeeding infants. METHODS Thirty-one lactating women receiving oral amlodipine once daily for pregnancy-induced hypertension were enrolled. Pre-dose plasma and milk concentrations of amlodipine were determined at day 6 or later after starting the medication. Relative infant dose (RID) as an infant risk for breastfeeding was calculated by dividing the infant dose via milk by the maternal dose. RESULTS The mean maternal dose of amlodipine was 6.0 mg. The medians of the plasma and milk concentrations of amlodipine were 15.5 and 11.5 ng/mL, respectively. Interindividual variation was observed in the amlodipine dose and body weight-adjusted milk concentrations (interquartile range [IQR], 96.7-205 ng/mL per mg/kg). The median and IQR of the amlodipine concentration ratio of milk to plasma were 0.85 and 0.74 to 1.08, respectively. The medians of infant birth weight and daily amlodipine dose via milk were 2170 g and 4.2 μg/kg, respectively. The median of the RID of amlodipine was 4.2% (IQR, 3.1%-7.3%). CONCLUSION Lactating women with pregnancy-induced hypertension had higher plasma concentrations of amlodipine during the early postpartum period. Oral amlodipine transferred into breast milk at the same level as that of plasma. However, the RID of amlodipine in most patients was less than 10%.
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Affiliation(s)
- Takafumi Naito
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naoko Kubono
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shuhei Deguchi
- Biological Research Department, Sawai Pharmaceutical Co, Ltd, Osaka, Osaka, Japan
| | - Masahisa Sugihara
- Biological Research Department, Sawai Pharmaceutical Co, Ltd, Osaka, Osaka, Japan
| | - Hiroaki Itoh
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Junichi Kawakami
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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16
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Taguchi T, Ishii K, Hayashi S, Mabuchi A, Murata M, Mitsuda N. Clinical features and prenatal risk factors for hypertensive disorders in twin pregnancies. J Obstet Gynaecol Res 2015; 40:1584-91. [PMID: 24888920 DOI: 10.1111/jog.12408] [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] [Received: 10/17/2013] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to identify the incidence, clinical features, and prenatal risk factors for hypertensive disorders, including gestational hypertension (GH) and pre-eclampsia (PE), in twin pregnancies. MATERIAL AND METHODS We carried out a retrospective cohort study of twin pregnancies managed from the first trimester onward at a single center from 2002 through 2011. We retrospectively evaluated the incidence, severity, time-point onset of GH or PE, as well as maternal and neonatal outcomes. Prenatal risk factors for disease were also analyzed with a multivariable logistic regression model. RESULTS Of 742 twin pregnancies, 165 (22%) were diagnosed with GH or PE. Five women developed GH or PE at <32 weeks' gestation (early onset), and the remaining 160 developed them at ≥ 32 weeks (late onset). Of all 165 cases, 110 women (66.7%) developed their disease during the intrapartum or postpartum period. The significant risk factors associated with developing a hypertensive disorder in a twin pregnancy were primiparity (adjusted odds ratio [aOR]: 1.77; 95% confidence interval [CI]: 1.21-2.61), pregestational high body mass index (aOR 1.35, 95%CI: 1.08-1.70), family history of hypertension (aOR: 1.50; 95%CI: 1.02-2.17) and previous history of GH or PE (aOR 8.85; 95%CI: 2.70-29.0). CONCLUSIONS One-fifth of the twin pregnancies developed GH or PE. Furthermore, more than half of the patients were diagnosed with the disease during the intrapartum or postpartum period. Significant risk factors for GH or PE in twin pregnancies were primiparity, pregestational body mass index, family history of hypertension, and history of a hypertensive disorder during a previous pregnancy. The significance of monitoring blood pressure after delivery for a twin pregnancy is stressed.
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Affiliation(s)
- Takako Taguchi
- Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
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17
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Erkoç SK, Kayacan Ü, Can A, Çöplüoğlu HE, Tosun A. Atypical Presentation of Posterior Reversible Encephalopathy Syndrome in a Patient Diagnosed with Postpartum Gestational Hypertension. Turk J Anaesthesiol Reanim 2015; 43:119-22. [PMID: 27366479 DOI: 10.5152/tjar.2014.88557] [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: 07/08/2014] [Accepted: 08/11/2014] [Indexed: 11/22/2022] Open
Abstract
Hypertensive disorders of pregnancy are a major cause of maternal mortality and morbidity. Preeclampsia and eclampsia are among the most common causes of posterior reversible encephalopathy syndrome (PRES). Clinically, PRES is characterised by visual disturbances, headache, nausea, change in mental status and seizure. Although treatment of the underlying cause provides clinical and radiological healing, a delay in the diagnosis and treatment can result in permanent brain damage and death. The exact incidence of new-onset postpartum hypertension is difficult to ascertain. Women with mild hypertension are usually asymptomatic; therefore, patients either can not be diagnosed or are diagnosed with late complications. With this case, we would like to present a patient who had no diagnosis of maternal hypertension or preeclampsia-eclampsia during pregnancy but, after a postpartum seizure, was diagnosed with PRES.
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Affiliation(s)
- Süheyla Karadağ Erkoç
- Clinic of Anaesthesiology and Reanimation, Şanlıurfa Gynecology and Obstetrics Hospital, Şanlıurfa, Turkey
| | - Ülkü Kayacan
- Clinic of Anaesthesiology and Reanimation, Şanlıurfa Gynecology and Obstetrics Hospital, Şanlıurfa, Turkey
| | - Alper Can
- Clinic of Anaesthesiology and Reanimation, Şanlıurfa Gynecology and Obstetrics Hospital, Şanlıurfa, Turkey
| | - Halil Ertuğrul Çöplüoğlu
- Clinic of Anaesthesiology and Reanimation, Şanlıurfa Gynecology and Obstetrics Hospital, Şanlıurfa, Turkey
| | - Ali Tosun
- Clinic of Radiology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
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18
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Biteker M, Kayatas K, Duman D, Turkmen M, Bozkurt B. Peripartum cardiomyopathy: current state of knowledge, new developments and future directions. Curr Cardiol Rev 2014; 10:317-26. [PMID: 24646160 PMCID: PMC4101196 DOI: 10.2174/1573403x10666140320144048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 01/30/2014] [Accepted: 02/06/2014] [Indexed: 11/22/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a form of idiopathic dilated cardiomyopathy affecting women in late pregnancy or early puerperium. Although initially described in the late 1800s, it has only recently been recognized as a distinct cardiac condition. The reported incidence and prognosis varies according to geography. The clinical course varies between complete recovery to rapid progression to chronic heart failure, heart transplantation or death. In spite of significant improvements in understanding the pathophysiology and management of the PPCM many features of this unique disease are poorly understood, including incidence, etiology, epidemiology, pathophysiology, predictors of prognosis and optimal therapy. The present article revisits these concepts and recent advances in PPCM.
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Affiliation(s)
| | | | | | | | - Biykem Bozkurt
- Bankalar Caddesi, Horoz Apt, 4/7 Cevizli/Kartal, Istanbul/Turkey.
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19
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Dahale AB, Chandra PS, Sherine L, Thippeswamy H, Desai G, Reddy D. Postpartum psychosis in a woman with Graves' disease: a case report. Gen Hosp Psychiatry 2014; 36:761.e7-8. [PMID: 25194170 DOI: 10.1016/j.genhosppsych.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 07/11/2014] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Thyroid dysfunction is common during pregnancy and the postpartum period and is known to cause psychiatric disturbances. A woman with Graves' disease and psychosis in the postpartum period is described. METHODS A 22-year-old woman with Graves' disease developed fluctuating orientation, catatonia, delusions of persecution and auditory hallucinations 3 days following childbirth. RESULTS The report discusses the clinical presentation. Treatment of both conditions led to the resolution of symptoms. CONCLUSION Graves' disease with postpartum psychosis may present with delirium, catatonia and prominent auditory hallucinations and responds well to a combination of psychotropic and antithyroid drugs. Thyroid dysfunction should be assessed for and managed adequately in postpartum psychosis.
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Affiliation(s)
- Ajit Bhalchandra Dahale
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India.
| | - Linda Sherine
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India
| | - Dharma Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health and, Neuro Sciences (NIMHANS) Bangalore-560029, India
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20
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Impact of non-steroidal anti-inflammatory drugs on hypertensive disorders of pregnancy. Pregnancy Hypertens 2014; 4:259-63. [DOI: 10.1016/j.preghy.2014.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/11/2014] [Accepted: 06/10/2014] [Indexed: 11/22/2022]
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21
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Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Watkins H, Shah AJ, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJ. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2014; 12:767-78. [PMID: 20675664 DOI: 10.1093/eurjhf/hfq120] [Citation(s) in RCA: 586] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Karen Sliwa
- Hatter Cardiovascular Research Institute; University of Cape Town; Cape Town South Africa
| | | | - Mark C. Petrie
- Golden Jubilee National Hospital; West of Scotland Regional Heart Centre; Glasgow UK
| | - Alexandre Mebazaa
- Inserm U 942, Hôpital Lariboisière; Université Paris Diderot; Paris France
| | - Burkert Pieske
- Deparment of Cardiologie; Medical University Graz; Graz Austria
| | - Eckhart Buchmann
- Department of Obstetrics and Gynaecology; University of the Witwatersrand and Chris Hani Baragwanath Hospital; Johannesburg South Africa
| | | | - Maria Schaufelberger
- Department of Medicine; Sahlgrenska University Hospital Ostra; Gothenburg Sweden
| | - Luigi Tavazzi
- Maria Cecilia Hospital - GVM Care & Research; Ettore Sansavini Health Science Foundation; Cotignola Italy
| | - Dirk J. van Veldhuisen
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Hugh Watkins
- University of Oxford; John Radcliffe Hospital; Oxford UK
| | - Ajay J. Shah
- BHF Centre of Excellence; UK King's College London; UK
| | | | - Uri Elkayam
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Sabine Pankuweit
- Department of Internal Medicine/Cardiology; Philipp's University Marburg; Marburg Germany
| | - Zoltan Papp
- Division of Clinical Physiology, Faculty of Medicine, Institute of Cardiology; University of Debrecen, Medical and Health Science Center; Debrecen Hungary
| | - Frederic Mouquet
- Polyclinique du Bois, et Pole des maladies cardiovasculaires; Hoptial Cardiologique, Centre Hospitalier Universitaire; Lille France
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre; University of Glasgow; Glasgow UK
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22
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Noronha-Neto C, Katz L, Coutinho IC, Maia SB, Souza ASR, Amorim MMR. Clonidine versus captopril for treatment of postpartum very high blood pressure: study protocol for a randomized controlled trial (CLONCAP). Reprod Health 2013; 10:37. [PMID: 23899372 PMCID: PMC3735451 DOI: 10.1186/1742-4755-10-37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The behavior of arterial blood pressure in postpartum of women with hypertension and pregnancy and the best treatment for very high blood pressure in this period still need evidence. The Cochrane systematic review assessing prevention and treatment of postpartum hypertension found only two trials (120 patients) comparing hydralazine with nifedipine and labetalol for the treatment of severe hypertension and did not find enough evidence to know how best to treat women with hypertension after birth. Although studies have demonstrated the effectiveness of treatment with captopril, side effects were reported. Because of these findings, new classes of antihypertensive drugs began to be administered as an alternative therapy. Data on the role of clonidine in this particular group of patients, its effects in the short and long term are still scarce in the literature. OBJECTIVES To determine the effectiveness of clonidine, compared to captopril, for the treatment of postpartum very high blood pressure in women with hypertension in pregnancy. METHODS/DESIGN The study is a triple blind randomized controlled trial including postpartum women with diagnosis of hypertension in pregnancy presenting very high blood pressure, and exclusion criteria will be presence of heart disease, smoking, use of illicit drugs, any contraindication to the use of captopril or clonidine and inability to receive oral medications.Eligible patients will be invited to participate and those who agree will be included in the study and receive captopril or clonidine according to a random list of numbers. The subjects will receive the study medication every 20 minutes until blood pressure is over 170 mmHg of systolic blood pressure and 110 mmHg diastolic blood pressure. A maximum of six pills a day for very high blood pressure will be administered. In case of persistent high blood pressure levels, other antihypertensive agents will be used.During the study the women will be subject to strict control of blood pressure and urine output. This proposal has already obtained approval of the local Institutional Review Board of the coordinating center (IMIP, Recife, Brazil) and of the National Council for Ethics in Research (CONEP) of the Brazilian Ministry of Health. TRIAL REGISTRATION Clinical Trials Register under the number NCT01761916.
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Affiliation(s)
- Carlos Noronha-Neto
- Obstetric Intensive Care Unit, Instituto de Medicina Integral Prof, Fernando Figueira, Recife, PE, Brazil
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23
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Sibai BM. Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol 2012; 206:470-5. [PMID: 21963308 DOI: 10.1016/j.ajog.2011.09.002] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/17/2011] [Accepted: 09/06/2011] [Indexed: 11/18/2022]
Abstract
Postpartum hypertension can be related to persistence of gestational hypertension, preeclampsia, or preexisting chronic hypertension, or it could develop de novo postpartum secondary to other causes. There are limited data describing the etiology, differential diagnosis, and management of postpartum hypertension-preeclampsia. The differential diagnosis is extensive, and varies from benign (mild gestational or essential hypertension) to life-threatening such as severe preeclampsia-eclampsia, pheochromocytoma, and cerebrovascular accidents. Therefore, medical providers caring for postpartum women should be educated about continued monitoring of signs and symptoms and prompt management of these women in a timely fashion. Evaluation and management should be performed in a stepwise fashion and may require a multidisciplinary approach that considers predelivery risk factors, time of onset, associated signs/symptoms, and results of selective laboratory and imaging findings. The objective of this review is to increase awareness and to provide a stepwise approach toward the diagnosis and management of women with persistent and/or new-onset hypertension-preeclampsia postpartum period.
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Affiliation(s)
- Baha M Sibai
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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24
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Rho M. Quiz page March 2012: postpartum hypertension. Am J Kidney Dis 2012; 59:A27-9. [PMID: 22340911 DOI: 10.1053/j.ajkd.2011.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/18/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Mira Rho
- Section of Nephrology, Department of Medicine, Saint Mary's Hospital, Waterbury, and Yale University School of Medicine, New Haven, CT
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