Prediction and prevention of preeclampsia and IUGR.
ABSTRACT Preeclampsia, being one of the leading causes of maternal and perinatal morbidity and mortality, has been the subject of extensive research since its description. Preeclampsia has been called the disease of theories due to the enigma surrounding its exact pathophysiology. Despite the absence of treatment that reverses the disease process once started, screening for preeclampsia and intrauterine growth restriction (IUGR) has been a major clinical and research issue since the disease was first reported. This review evaluates the current evidence for prediction and prevention of preeclampsia and IUGR using clinical tests, maternal serum markers, and uterine artery Doppler screening. In addition, we critically evaluate the evidence regarding the different therapeutic strategies for the prevention of preeclampsia and IUGR and the latest clinical recommendations for their use.
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ABSTRACT: Objectives A previous study demonstrated that the increase in diastolic blood pressure during pregnancy was reduced by supplementation with magnesium. The present study was undertaken to explore if increases in diastolic blood pressure could be useful for early identification of pre-eclampsia. Study design Hospital records of nulliparous, singleton normal pregnancies (n = 100) and those diagnosed with pre-eclampsia (n = 109) were obtained from a register at an antenatal health care unit. Data on blood pressure at the regular visits to the unit were collected and analysed. Results The systolic and diastolic blood pressures were significantly higher at pregnancy week 12 among those who developed pre-eclampsia (p = 0.046 and 0.001, resp). An increase in diastolic blood pressure ≥15 mmHg occurred more frequently among women with pre-eclampsia. In 93 % of the cases, this increase was present before and at the same time as the clinical diagnosis of pre-eclampsia was established. Conclusion The results suggest that a base-line diastolic blood pressure of ≥80 mmHg and an increase in diastolic blood pressure of ≥15 mmHg could be used to identify women at risk of pre-eclampsia (sensitivity 92 %, specificity 44 %) and as a selection criterion in treatment or prevention assays.Archives of Gynecology and Obstetrics 09/2014; 291(4). DOI:10.1007/s00404-014-3476-1 · 1.28 Impact Factor
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ABSTRACT: Exposure to tobacco smoke during pregnancy may result in intrauterine growth restriction (IUGR). In the study, the effect of tobacco smoke on vascular flows in the middle cerebral artery, umbilical artery, ductus venosus in fetuses and uterine artery in pregnancies complicated by IUGR was investigated. The study subjects were divided into three groups: smoking women with IUGR (n=31), women with idiopathic IUGR (n=28) and healthy controls (n=50). Fetal biometry and flow parameters were measured. Concentration of heavy metals and antioxidants was tested in maternal blood and fetal umbilical cord blood. The Student t test and multiple regression analysis were used. Cotinine and cadmium concentrations were significantly higher in smokers (55.23±54.23, 1.52±0.9), while metallothionein was significantly higher (22.94±8.64) in the idiopathic IUGR group. Strong correlations between cotinine and cadmium concentrations and cerebral-umbilical index were found. Long-term exposure to tobacco smoke deteriorates flows in vital fetal vessels. Copyright © 2014. Published by Elsevier Inc.Reproductive Toxicology 10/2014; 50C:27-35. DOI:10.1016/j.reprotox.2014.10.002 · 2.77 Impact Factor
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ABSTRACT: Hypertension in pregnancy is one of the prevalent disorder resulting in maternal death. The aim of this study was to investigate the effect of stretching exercise and walking on changes of blood pressure in nulliparous women during pregnancy. This was a quasi-experimental trial that consisted three groups of women who took part in pre- and post-tests. We used a simple randomized sample, including 118 pregnant females (walking: 29 subjects, stretching exercise: 30 subjects control: 59 subjects). The data were collected using the demographic checklist and blood pressure was measured every week. SPSS 16 was used to analyze the data by one-way analysis of variance (ANOVA) and repeated measure ANOVA. No significant difference was found in the demographic characteristics of the three groups of women. Mean systolic and diastolic blood pressure in the three groups (stretching exercises, walking, and routine care) at three intervals (pre-test, first post-test, and second post-test) were significantly different (P < 0.05). In this case, Tukey's test showed significant improvement of systolic and diastolic blood pressure in stretching exercise group. Walking and control groups showed no change or significant reduction (P < 0.05). No significant difference was found between the walking and control groups (P > 0.05). The results of the study showed that stretching exercise versus walking reduces systolic and diastolic blood pressure in the second trimester of pregnancy and controls it in the third trimester of pregnancy. In contrast, walking has no effect on blood pressure during pregnancy.Iranian journal of nursing and midwifery research 03/2015; 20(2):205-10.