Fundus changes in pregnancy induced hypertension

AIM: To determine the prevalence of retinal changes in pregnancy induced hypertension (PIH) and any association between the retinal changes and blood pressure, proteinuria, and severity of the disease. METHODS: All the patients admitted with diagnosis of PIH were included in this study. Age, race, gravida, gestation period, blood pressure, and proteinuria were noted from the case records. After taking history for any eye symptoms, fundus examination was done after dilating the pupils with direct ophthalmoscope in the ward itself. All the findings were noted on a data sheet, and were analyzed using SPSS programme. RESULTS: A total of 78 patients of PIH were examined. Majority (75.6%) were Malays. The mean age of patients was 30.2 years (range 21-45 years). The gestation period ranged from 25 weeks to 41 weeks; 34 (43.5%) were primi gravida. Thirty (38.4%) patients had mild preeclampsia, 46 (59%) had severe preeclampsia and 2(2.5%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in 46 (59%) patients --- grade I in 41 (52.6%) and grade II in 5 (6.4%). Haemorrhages or exudates or retinal detachment were not seen in any patient. There was statistically significant positive association of retinal changes and blood pressure (P =0.001), proteinuria (P =0.018) and severity of the PIH (P =0.024). CONCLUSION: Retinal changes (grade I and II hypertensive retinopathy) were seen in 59% of patients with PIH and they were significantly associated with blood pressure, proteinuria and severity of the disease. Fundus examination helps in assessing the severity of PIH.

Expression of Endothelial Nitric Oxide Synthase Traffic Inducer in the Placenta of Pregnancy Induced Hypertension

The expression of endothelial nitric oxide synthase traffic inducer （NOSTRIN） in the placenta of the patients with pregnancy induced hypertension （PIH） was detected and its role in the pathogenesis of PIH was studied. The pathological changes in placental vessels were observed by HE staining. NO2-/NO3- , the stable metabolic end products of NO, was measured with nitrate reductase. The eNOS activity in placental tissues was assayed by spectrophotometry. Western blot analysis was applied to detect NOSTRIN expression. The incidence of thickening and fibronoid necrosis of placental vessels was significantly higher in women with PIH than in the normal group （P〈 0.01）. The levels of placental NO2-/NO3- in PIH patients （27. 53±7.48 μmol/mg） were significantly lower than in normal group （54. 27±9.53 μmol/mg, P〈0.01）. The activity of eNOS was significantly decreased in PIH group （12. 826±3.61 U/mg） as compared with that in normal group （21. 72±3.83 U/mg, P〈0.01）. Western blot analysis revealed that both groups expressed 58 kD NOSTRIN, but the protein level was significantly higher in women with PIH than in the normal group （P〈0.01）. A significant negative correlation existed between the expression of NOSTRIN protein and the activity of eNOS in placental tissue of women with PIH （r=-0.57, P〈0.01）. It was concluded that the level of NOSTRIN expression in placenta of women with PIH was increased, which may play an important role in the pathogenesis of PIH.

A Cross-Sectional Study on Current Practice of the Management of Pregnancy Induced Hypertension and Its Maternal and Foetal Complications and Outcome in the Western Part of the State of Libya

Background: Maternal and perinatal mortality and morbidity are mainly affected by hypertension during pregnancy (pre-eclampsia). Haemorrhage and cerebral bleeding are the primary and significant complications of pre-eclampsia. Abruption of the placenta and renal failure are among the major complications caused by this disease. The perinatal complications include Intrauterine Growth Restriction (IUGR), Intrauterine Foetal Death (IUFD), neonatal death, and prematurity. Objective: The purpose of the present study was to examine the incidence of Pregnancy-Induced Hypertension (PIH), pre-eclampsia, the management of PIH, including the early diagnosis, the pharmacological drug management used, and the prevalence of maternal and perinatal complications. Methods and Patients: This cross-sectional study took place in Aljalaa maternity hospital, which represented the west of the state of Libya in the period from 1st January 2012 to 31st December 2012, with patients who were diagnosed, managed, and terminated according to protocol management of the hospital. Results: In the present study, from the total deliveries in Aljalaa Maternity hospital, the incidence of PIH is 8.4% and pre-eclampsia is 5.1%. No maternal mortality, CNS haemorrhaged, hepatic failure, or renal failure. The reported maternal complications included: Eclampsia, HELLP syndrome (Haemolysis, Elevated Liver enzymes and Low platelets), abruption placenta, and pulmonary oedema see in eighteen percent, six percent, nine percent, four percent and less than one percent, respectively. The foetal complications were preterm babies and Intrauterine Growth Restriction (IUGR) in nineteen percent, Low Birth Weight (LBW) in twenty-five percent, Intrauterine Foetal Death (IUFD) in five percent, neonatal death in two percent and, perinatal death in six percent. In the PIH patients, the presence of associated symptoms such as headache, blurred vision, irritability, and the presence of signs such as severe hypertension, generalized oedema, exaggerated reflexes, and abnormal investigations (protein urea, high uric acid, abnormal LFT, haemoconcentration, and low pits) increased the risk of maternal and foetal complications. Conclusion: To decrease mother and newborn mortality and morbidity in PIH patients, a rigorous management protocol is required to implement evidence-based guidelines.

Immunohistochemical Analysis of Globulin and Complements in Blood Vessels of Placental Villi during Pregnancy Induced Hyperte

The changes of globulin and complements in placental villi blood vessels were immunohistochemically studied in pregnancy induced hypertension patients and normal pregnant patients by a randomized , double-blind approach. The immunostaining of IgG, IgE, C3, C4, and 5-HT was seen in the villous blood vessels and the helicine arteries of pregnancy induced hypertensive placental villi.The strong positive rates were 100%, 90%, 100%, 100% and 90% in seriouspregnancy induced hypertensive patients, accompanied by aggregation of mastocytes and vasculopathy of villous blood vessels and the helicine arteries. It is concluded that the immuno-pathological damage took place in the villous blood vessels and helicine arteries, resulting in vasculopathy and villous regressive changesand that the immunological factors were closely related to pregnancy induced hypertension.

Association of in-vitro fertilization twin pregnancy with maternal and perinatal complications

Objective: To analyze maternal and perinatal complication rates in in-vitro fertilization (IVF) twins and spontaneous twin pregnancies. Methods: The information on obstetric and perinatal outcomes and complications covering 95 IVF twins and 165 spontaneous twin pregnancies was collected from the medical records of Riga Maternity Hospital. Statistical analysis and adjustment for confounders was performed using the SPSS v24.0 software. The continuous data were compared using the t-test and Mann-Whitney U test for parametrical and non-parametrical data accordingly. The nominal data were analyzed using Pearson's Chi-square test and Fisher's exact test. Results: The preterm labor risk, intrauterine growth restriction, fetus weight between IVF and spontaneous twins were not statistically significant (P>0.005). At the same time our study revealed a statistically significant association of gestational diabetes and pregnancy induced hypertension with IVF twin pregnancies (P=0.025 and P=0.003, respectively). Moreover, IVF twins had higher odds to be delivered by cesarean section (P=0.001). Conclusions: IVF twin pregnancies are associated with a higher risk of development of gestational diabetes and gestational hypertension than spontaneous twin pregnancies.

SELENIUM SUPPLEMENT IN THE PREVENTION OF PREGNANCY INDUCED HYPERTENSION

The effect of selenium (Se) supplement on pregnancy was studied in 52 pregnant women with high risk factors of pregnancy induced hypertension (PIH). They were given natural Se dietetic liquid (100 μg / d) for 6-8 weeks during late pregnancy, and 48 controls were given placebo. They received similar routine prenatal care. The results revealed that Se supplement on the pregnant women prevented and decreased the incidence of PIH and gestational edema, and elevated the mother's blood Se level by 0.1008± 0.091 ppm in the treated group while decreased by 0.0402±0.046 ppm in the control group (P<0.01). The umbilical blood Se level was 0.2756± 0.100 ppm in the treated group and 0.1544 ± 0.051 ppm in the control (P<0.01). The differences of the neonatal birth weight and the amount of postpartum hemorrhage between the two groups were not significant.

CALCIUM SUPPLEMENTATION DURING PREGNANCY FOR REDUCING PREGNANCY INDUCED HYPERTENSION

Pregnancy induced hypertension (PIH) is a common complication in pregnancy and prenatal stage. Because the direct and indirect relationship between low calcium intake and many diseases, such as rachitis, young age myopia and hypertension, calcium supplementation has been a hot topic among nutritionists, Randomized trials of calcium supplementation during pregnancy were conducted in 212 healthy primipara. They were divided into 4 groups and pave 120mg, 240mg, Ig or 2g of calcium daily from 20 to 28wks of gestation up to delivery respectively. As a result, the incidence of PIH was 8.9%, 7.5%, 8% and 4% respectively in these groups, The control group (106 pregnant women) who did not receive calcium gave an incidence of 18%. Supplementation of 2g of calcium daily showed significant resutls in lowering the incidence of PM (P<0.05) without any adverse effects. In 1992 calcium supplementation was widely used in antenatal clinic. 200 cases with intake of 2g calcium were compared with corresponding non-calcium supplementation cases, and the incidence of PIH was 7.5% and 16.5% (P< 0.005) respectively. Mediating parathyroid hormone and renin activity are thought to be the effect of calcium on decreasing the incidence of PIH,

Observation of Mailuoning Injection (脉络宁注射液)in Treating 46 Patients with Pregnancy Induced Hypertension

Objective: To observe the effect of treatment of Mailuoning Injection (MI) for pregnancy induced hypertension (PIH). Methods: Forty six PIH patients in the treated group were treated with intravenous dripping of MI and 40 patients in the control group treated with intravenous dripping of 25% magnesium sulfas. Results: Headache and edema were ameliorated significantly in the MI treated group in comparison with the control （P＜ 0.05）. Both methods could the decrease levels of mean arterial pressure, improve hemorheologic change, and lower the hematocrit, but the effects of the former was better than those of the latter. No difference was found in albuminuria, delivery pattern, postpartum bleeding and neonatal Apgar Score between the two groups. Conclusion: MI could prevent the progress of pathological process of the PIH. The therapeutic mechanism of MI might be relevant to the dilatation of the arteriospasm, improvement of the abnormal microcirculation and hemorheologic character of the patients.

Hormone Secretion by Cell Culture of Human GH-PRL Secreting Pituitary Adenomas: Effects of Bromocriptine

To study the relationship between constitutive nitric oxide synthase (cNOS) and pregnancy induced hypertension (PIH), cNOS expression and localization in placental villi of PIH patients (n=15) and normal pregnancy patients (n=15) were immunohistochemically studied. The positive immunostaining of cNOS was located in trophocytes and cytoplasm of vascular endothelial cells. The positive rate in PIH patients was much higher than that in cases of normal pregnancy. The positive rates were 34. 40 % in mild, 44. 74 % in middle and 50. 14% in severe PIH patients respectively. There was a significant difference in positive rate among the mild, middle and severe PIH patients (P<0. 01). It is concluded that the increase of cNOS activity probably was the results of protective or compensatory mechanism of PIH course.