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Second trimester ambulatory blood pressure in nulliparous pregnancy: A useful screening test for preeclampsia?
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Citations from the literature/
Int. J. Gynecol. Obstet. 46 (1994) 83-91
group; P = 0.01). Conclusions. Low-dose aspirin decreases the incidence of preeclampsia among nulliparous women, primarily through its effect in those who have elevated systolic blood pressure initially. This treatment does not decrease perinatal morbidity but increases the risk of abruptio placentae. Second trimester ambulatory blood pressure in nulliparous pregnancy: A useful screening test for preeclampsia?
Kyle P.M.: Clark S.J.; Buckley D.; Kissane J.; Coats A.J.S.; De Swiet M.; Redman C.W.G. GBR BR J OBSTET GYNAECOL 1993 100/10(914-919) Objective: To assess the effectiveness of second trimester 24-h ambulatory blood pressure measurement as a screening test for pre-eclampsia. Design: Prospective interventional study. Setting: John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte’s and Chelsea Hospital, London. Subjects: One hundred and sixty-two normotensive nulliparous women recruited at hospital booking clinics. Intervention: Ambulatory blood pressure was measured at I8 and 28 weeks gestation using the TM2420 monitor. Main outcome measure: The development of pre-eclampsia. Results: Awake systolic and mean arterial pressures were significantly increased (P < 0.02) at I8 weeks in those who later developed pre-eclampsia. Those differences were more apparent at 28 weeks at which time the diastolic pressure was also increased (P < 0.01). At both stages of gestation the higher readings were sustained during sleep so that the awake-sleep differences were similar in relation to each outcome. The group with incipient pre-eclampsia had a signilicantly faster heart rate at both I8 and 28 weeks (P < 0.002) The sensitivity in predicting pre-eclampsia for a mean arterial pressure of 85 mmHg or greater at 28 weeks was 65%. with a positive predictive value of 31%. The sensitivity and positive predictive value for a test combining a mean arterial pressure of 85 mmHg or greater and a heart rate of 90 bpm or greater were 53% and 45%. respectively. Conclusion: Although second trimester ambulatory blood pressure is significantly increased in women who later develop pre-eclampsia, the predictive values for blood pressure alone are low. The efficiency of the test is increased by combining the awake ambulatory heart rate and blood pressure measurement together. If an effective method for preventing pre-eclampsia becomes available (commencing at 28 weeks gestation). then awake ambulatory blood pressure and heart rate may have some clinical value as a screening test.
Measles in pregnancy: A descriptive study of 58 cases
Eberhart-Phillips J.E.; Frederick P.D.; Baron R.C.: Mascola USA OBSTET GYNECOL 1993 82/5(797-801)
L.
Objective: To describe the effects of measles in pregnancy using a laser case series. Methods: Pregnant women with measles were identified by county health department records, and their hospital and clinic records were reviewed. When available, records for the infants of case patients were also reviewed. Results: Fifty-eight pregnant women with measles were identified. Thirty-live (60%) were hospitalized for measles, I5(26’%,) were
diagnosed with pneumonia, and two (3%) died of measles complications. Excluding three induced abortions, I8 pregnancies (31%) ended prematurely; live were spontaneous abortions and I3 were preterm deliveries. All but two of the I8 pregnancies that terminated early did so within I4 days of rash onset. Two term infants were born with minor congenital anomalies, but their mothers had measles late in the third trimester. No newborns were diagnosed with congenital measles. Conclusions: The incidence of death and other complications from measles during pregnancy may be higher than expected for agecomparable, nonpregnant women. Measles in pregnancy may lead to high rates of fetal loss and prematurity, especially in the first 2 weeks after the onset of rash. Early-pregnancy
proteinuria in diabetes related to preeclampsia
Combs CA.; Rosenn B.; Kitzmiller J.L.; Khoury J.C.; Wheeler B.C.; Miodovnik M. USA OBSTET GYNECOL 1993 82/5(802-807) Objective: To test the hypothesis that the risk of preeclampsia in diabetic mothers is increased with incipient diabetic nephropathy as well as with overt nephropathy. Methods: Pregnancy outcome was studied in 31 I women with class B-RF diabetes from two institutions. Using I04 women without chronic hypertension followed at the University of California, San Francisco, we constructed a receiver operating characteristic curve relating 24-h urinary total protein before 20 weeks’ gestation to the subsequent development of preeclampsia. From the curve, a predictive cutoff level of proteinuria was selected and tested in two validation groups not used to construct the curve: 158 women without chronic hypertension followed at the University of Cincinnati and 49 women with chronic hypertension from both institutions. Results: The receiver-operating characteristic curve showed an increased risk of preeclampsia with early-pregnancy proteinuria of 190 mg/day or more. In the Cincinnati validation group, the rate of preeclampsia was 7% in women with early-pregnancy proteinuria of less than 190 mg/day, 31% with proteinuria of 190-499 mg/day, and 38% with proteinuria of 500 mg/day or more. In the chronichypertension validation group, the rates were 0, 50, and 58%, respectively. By multiple logistic regression, the increased risk of preeclampsia with proteinuria above 190 mg/day persisted after controlling for the effects of parity, chronic hypertension, retinopathy, and glycemic control. Conclusions: Diabetic gravidas with early-pregnancy proteinuria of 190-499 mg/day are at increased risk for preeclampsia. The risk is comparable to that in women with overt diabetic nephropathy and is independent of chronic hypertension. We speculate that diabetic women with proteinuria in this range have incipient or subclinical diabetic nephropathy. Hepatitis C virus in pregnancy: Seroprevalence and risk factors for infection
Silverman USA
N.S.: Jenkin
B.K.: Wu C.: McGillen
P.: Knee G.
AM J OBSTET GYNECOL 1993 16913(583-587) Objectives: Our purpose was to define the prevalence of antibodies to hepatitis C virus among inner-city prenatal patients.
Citations from the literature/
Int. J. Gynecol. Obstet. 46 (1994) 83-91
group; P = 0.01). Conclusions. Low-dose aspirin decreases the incidence of preeclampsia among nulliparous women, primarily through its effect in those who have elevated systolic blood pressure initially. This treatment does not decrease perinatal morbidity but increases the risk of abruptio placentae. Second trimester ambulatory blood pressure in nulliparous pregnancy: A useful screening test for preeclampsia?
Kyle P.M.: Clark S.J.; Buckley D.; Kissane J.; Coats A.J.S.; De Swiet M.; Redman C.W.G. GBR BR J OBSTET GYNAECOL 1993 100/10(914-919) Objective: To assess the effectiveness of second trimester 24-h ambulatory blood pressure measurement as a screening test for pre-eclampsia. Design: Prospective interventional study. Setting: John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte’s and Chelsea Hospital, London. Subjects: One hundred and sixty-two normotensive nulliparous women recruited at hospital booking clinics. Intervention: Ambulatory blood pressure was measured at I8 and 28 weeks gestation using the TM2420 monitor. Main outcome measure: The development of pre-eclampsia. Results: Awake systolic and mean arterial pressures were significantly increased (P < 0.02) at I8 weeks in those who later developed pre-eclampsia. Those differences were more apparent at 28 weeks at which time the diastolic pressure was also increased (P < 0.01). At both stages of gestation the higher readings were sustained during sleep so that the awake-sleep differences were similar in relation to each outcome. The group with incipient pre-eclampsia had a signilicantly faster heart rate at both I8 and 28 weeks (P < 0.002) The sensitivity in predicting pre-eclampsia for a mean arterial pressure of 85 mmHg or greater at 28 weeks was 65%. with a positive predictive value of 31%. The sensitivity and positive predictive value for a test combining a mean arterial pressure of 85 mmHg or greater and a heart rate of 90 bpm or greater were 53% and 45%. respectively. Conclusion: Although second trimester ambulatory blood pressure is significantly increased in women who later develop pre-eclampsia, the predictive values for blood pressure alone are low. The efficiency of the test is increased by combining the awake ambulatory heart rate and blood pressure measurement together. If an effective method for preventing pre-eclampsia becomes available (commencing at 28 weeks gestation). then awake ambulatory blood pressure and heart rate may have some clinical value as a screening test.
Measles in pregnancy: A descriptive study of 58 cases
Eberhart-Phillips J.E.; Frederick P.D.; Baron R.C.: Mascola USA OBSTET GYNECOL 1993 82/5(797-801)
L.
Objective: To describe the effects of measles in pregnancy using a laser case series. Methods: Pregnant women with measles were identified by county health department records, and their hospital and clinic records were reviewed. When available, records for the infants of case patients were also reviewed. Results: Fifty-eight pregnant women with measles were identified. Thirty-live (60%) were hospitalized for measles, I5(26’%,) were
diagnosed with pneumonia, and two (3%) died of measles complications. Excluding three induced abortions, I8 pregnancies (31%) ended prematurely; live were spontaneous abortions and I3 were preterm deliveries. All but two of the I8 pregnancies that terminated early did so within I4 days of rash onset. Two term infants were born with minor congenital anomalies, but their mothers had measles late in the third trimester. No newborns were diagnosed with congenital measles. Conclusions: The incidence of death and other complications from measles during pregnancy may be higher than expected for agecomparable, nonpregnant women. Measles in pregnancy may lead to high rates of fetal loss and prematurity, especially in the first 2 weeks after the onset of rash. Early-pregnancy
proteinuria in diabetes related to preeclampsia
Combs CA.; Rosenn B.; Kitzmiller J.L.; Khoury J.C.; Wheeler B.C.; Miodovnik M. USA OBSTET GYNECOL 1993 82/5(802-807) Objective: To test the hypothesis that the risk of preeclampsia in diabetic mothers is increased with incipient diabetic nephropathy as well as with overt nephropathy. Methods: Pregnancy outcome was studied in 31 I women with class B-RF diabetes from two institutions. Using I04 women without chronic hypertension followed at the University of California, San Francisco, we constructed a receiver operating characteristic curve relating 24-h urinary total protein before 20 weeks’ gestation to the subsequent development of preeclampsia. From the curve, a predictive cutoff level of proteinuria was selected and tested in two validation groups not used to construct the curve: 158 women without chronic hypertension followed at the University of Cincinnati and 49 women with chronic hypertension from both institutions. Results: The receiver-operating characteristic curve showed an increased risk of preeclampsia with early-pregnancy proteinuria of 190 mg/day or more. In the Cincinnati validation group, the rate of preeclampsia was 7% in women with early-pregnancy proteinuria of less than 190 mg/day, 31% with proteinuria of 190-499 mg/day, and 38% with proteinuria of 500 mg/day or more. In the chronichypertension validation group, the rates were 0, 50, and 58%, respectively. By multiple logistic regression, the increased risk of preeclampsia with proteinuria above 190 mg/day persisted after controlling for the effects of parity, chronic hypertension, retinopathy, and glycemic control. Conclusions: Diabetic gravidas with early-pregnancy proteinuria of 190-499 mg/day are at increased risk for preeclampsia. The risk is comparable to that in women with overt diabetic nephropathy and is independent of chronic hypertension. We speculate that diabetic women with proteinuria in this range have incipient or subclinical diabetic nephropathy. Hepatitis C virus in pregnancy: Seroprevalence and risk factors for infection
Silverman USA
N.S.: Jenkin
B.K.: Wu C.: McGillen
P.: Knee G.
AM J OBSTET GYNECOL 1993 16913(583-587) Objectives: Our purpose was to define the prevalence of antibodies to hepatitis C virus among inner-city prenatal patients.