Andleeb Kanwal et al PHARMACEUTICAL SCIENCES SJIF Impact Factor: 7.187 STUDY OF RELATIONSHIP OF URIC ACID WITH PROGRESSION TO PRE-ECLAMPSIA AND DEVELOPMENT OF ADVERSE CONDITIONS IN PREGNANCIES HAVING GESTATIONAL HYPERTENSION (original) (raw)
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Biochemical Profile of women with pregnancy induced hypertension
Innovative publication, 2016
Background: Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection. Pre-eclampsia is a syndrome of generalized endothelial dysfunction initiated by abnormal placentation and consequent placental under perfusion, release of cytokines, peroxidants and vasoconstriction and platelet activation. It is characterized by hypertension, reduced uteroplacental blood flow, proteinuria and edema. Pre-eclampsia is associated with increased lipid Peroxidation in maternal circulation and placenta. Material and Methods: A hospital based cross sectional study was carried out among 65 women of age 18 to 30 years who were in third trimester of pregnancy with singleton fetus. Informed consent was taken from each and every study participant. It was ensured that the study participants did not receive any medication for hypertension. Blood pressure was measured as per the standard guidelines. Urine for protein was determined by Dip sticks method. Serum uric acid, Malondialdehyde and birth weight was measured. Results: The two groups were similar in the parameters like age, gestational age at blood sampling, and gestational age at delivery. Systolic and diastolic blood pressure, mean arterial blood pressure, proteinuria, serum uric acid and Malondialdehyde were increased in eclampsia group than pre-eclampsia group. These parameters were also increased in pre eclampsia & eclampsia group as compared to the controls. Serum uric acid and Malondialdehyde levels in pregnant women with pre eclampsia & eclampsia showed a statistically significant increase as compared to the control group (p<0.001). Mean birth weight was less in eclampsia group than pre-eclampsia group. Induction of labor, preterm delivery and C/Section, were obstetric outcome affecting maternal morbidity. Conclusion: Serum uric acid & Malondialdehyde were increased in pre eclampsia & eclampsia cases. The eclampsia group was more at risk of delivery by caesarean section than the pre-eclampsia group. The birth weight was also less in eclampsia cases as compared to pre-eclampsia and normal pregnancy.
Management of Gestational Hypertension and mild Pre-eclampsia at term
2011
The studies in this thesis discuss the best treatment option in women with a singleton (nearly) term pregnancy who are complicated with mild hypertensive disease. Part I-The randomised trial: HYpertension and Pre-eclampsia Intervention Trial At Term (HYPITAT)-describes the (cost-) effectiveness of induction of labour and expectant monitoring in such women. Part II-Characteristics and tests in prediction of severe maternal morbidity in gestational hypertension or (mild) pre-eclampsia-focuses on risk indicators, prognostic models and test accuracy for identification of the individual woman with GH or PE with increased risk of developing severe maternal complication. Part III contains the-General discussion, future perspectives and summary. Part I The randomised trial: HYpertension and Pre-eclampsia Intervention Trial At Term (HYPITAT) Chapter 2 contains the study protocol of a Dutch multicentre randomised clinical trial assessing the (cost-) effectiveness of induction of labour compared to expectant management under regular monitoring in women with a singleton pregnancy complicated by GH or mild PE beyond 36 weeks' gestation (the HYPITAT trial). Chapter 3 describes the clinical results of the HYPITAT trial. Chapter 4 describes the maternal health-related quality of life (HR-QoL) after induction of labour versus expectant monitoring in women with GH or PE beyond 36 weeks' gestation. Chapter 5 describes the cost-effectiveness of induction of labour compared to expectant monitoring in high-risk pregnancies due to hypertensive disorders beyond 36 weeks' gestation. 16 1 chapter Part II Prediction of severe maternal morbidity in gestational hypertension or (mild) pre-eclampsia Chapter 6 describes a cohort study in which parameters obtained before labour are identified to predict progression to severe disease in women with a singleton pregnancy complicated with GH or mild PE beyond 36 weeks' gestation. Chapter 7 describes a case-control study in which risk indicators for the occurrence of eclampsia are identified in women with a singleton pregnancy diagnosed with GH or mild PE beyond 36 weeks' gestation. Chapter 8 describes a cohort study in which parameters obtained before and during labour are identified to predict postpartum haemorrhage in women with a singleton pregnancy complicated with GH or mild PE beyond 36 weeks' gestation. Chapter 9 presents a meta-analysis and decision analysis of the accuracy of serum uric acid as a predicting test for severe maternal morbidity in women diagnosed with PE. Chapter 10 presents a systematic review in which precise estimates of maternal serum liver enzyme levels are obtained to predict adverse maternal and fetal outcomes in women with PE.
Maternal and Perinatal Outcome Associated With Gestational Hypertension
Introduction: Hypertensive disorders of pregnancy are the most common causes of adverse maternal & perinatal outcomes. Such investigations in resource limited settings would help to have great design strategies in preventing maternal and perinatal morbidity and mortality. All women who presented with hypertensive disorders of pregnancy and delivered in the hospital and whose records were complete, were included in the study and divided into 5 groups namely, Gestational hypertension (GH), Mild pre-eclampsia (PE), Severe pre-eclampsia, Eclampsia and Chronic hypertension with superimposed pre-eclampsia (CHPE) based on their clinical presentation at admission. After excluding all incomplete data entries, the sample size was finalized at 200. Results: In this study, records of 2,989 women who delivered in our tertiary hospital were reviewed and of these, 256 women had hypertensive disorders of pregnancy. Fifty six of these women had either left the hospital against medical advice or their records were incomplete so their outcome could not be followed and hence were excluded from the study. Conclusion: Pre-eclampsia and Eclampsia still remains a major problem in developing countries. Pregnancy induced hypertension is one of the most extensively researched subjects in obstetrics. Still the etiology remains an enigma to us. Though the incidence of pre-eclampsia and eclampsia is on the decline, still it remains the major contributor to poor maternal and foetal outcome. The fact that pre-eclampsia, eclampsia is largely a preventable disease is established by the negligible incidence of pre-eclampsia and eclampsia with proper antenatal care and prompt treatment of pre-eclampsia. In preclampsia and eclampsia, pathology should be understood and that i-involves multiorgan dysfunction should be taken into account. The early use of antihypertensive drugs, optimum timing of delivery and strict fluid balance, anticonvulsants in cases of eclampsia will help to achieve successful outcome. Early transfer to specialist centre is important and the referral the referral centers should be well equipped to treat such critically ill patients.
Correlation of Various Biochemical Parameters with the Severity of Pregnancy Induced Hypertension
University Journal of Pre and Paraclinical Sciences, 2017
INTRODUCTION Pre-eclampsia (PE) is the most common and deadly complication which occurs during pregnancy, which is fatal to both the mother and the fetus. The study of various biochemical parameters is gaining ground in the pathophysiology of hypertension and to assess the severity of PE. AIMS AND OBJECTIVES To determine the correlation of various biochemical parameters, that is serum lipid profile, electrolytes, uric acid, hsCRP in the pathogenesis and severity of PE. MATERIALS AND METHODS Includes 100 cases which is divided into two groups GROUP 1includes 50 women in the third trimester of pregnancy with PE at the time of admission, which is subdivided in to GROUP 1A - 30 women in the third trimester of pregnancy with mild PE at the time of admission. GROUP 1B - 20 women in the third trimester of pregnancy with severe PE were included. GROUP 2 - 50 healthy normotensive women in the third trimester of pregnancy were included. 5ml of fasting blood sample was collected and estimation...
Journal of Clinical Medicine
Preeclampsia (PE) is characterized by the new onset of hypertension (HT) and proteinuria beyond the 20th week of gestation. We aimed to find the best predictor of PE and find out if it is different in women with or without HT. Consecutively attended pregnant women were recruited in the first trimester of pregnancy and followed-up. Laboratory and office and 24 h-ambulatory blood pressure (BP) data were collected. PE occurred in 6.25% of normotensives (n = 124). Both office mean BP and 24 h-systolic BP in the first trimester were higher in women with versus those without PE (p ≤ 0.001). In women with chronic hypertension (cHT), PE occurred in 55%; office SBP (p = 0.769) and 24 h-SBP (p = 0.589) were similar between those with and those without PE. Regarding biochemistry, in cHT, plasma urea and creatinine were higher in PE women than in those without cHT (p = 0.001 and p = 0.004 for the differences in both parameters). These differences were not observed in normotensives. In normotens...
Study of serum uric acid and creatinine in hypertensive disorders of pregnancy
International Journal of Medical Science and Public Health, 2015
Background-Renal dysfunction, increased xanthine oxidase activity and oxidative stress in placenta contributes to the elevated uric acid levels in preeclampsia (PE). Objective-To determine serum uric acid and creatinine in hypertensive disorders of pregnancy and correlate with fetal outcome. Materials and Methods-Pregnant women ≥32 weeks of gestation. Study population included 3 groups, 31 normotensive pregnant (NP) women as controls, 30 pregnant women with gestational hypertension (GH) and 30 with PE. Result-Serum uric acid and creatinine levels were significantly elevated in PE (6.26±1.19 and 0.94±0.26 mg/dL) when compared with Pregnancy induced hypertension (PIH) (4.27± 1.0 and 0.66 ±0.19 mg/dL) and NP (4.25 ± 0.8 and 0.63± 0.13 mg/dL) (P-value <0.001 and <0.001) respectively. Receiver operation characteristics curves demonstrated greater sensitivity and specificity for uric acid (86.7% and 83.9%, respectively) in PE than for creatinine (80% and 77.4%, respectively). Uric acid had strong and negative correlation with fetal birth weight in PE (r = −0.59, P = 0.006), where as creatinine had negative but weak correlation (r= −0.03, P=0.87). Conclusion-Serum uric acid is a better diagnostic and predictive marker for PE and fetal outcome respectively.
Innovative publication, 2016
Background: Preeclampsia is one of the common conditions of unknown etiology which increases the risk of maternal and perinatal morbidity and mortality. According to some studies, serum uric acid lacks sensitivity and specificity as a diagnostic tool whereas another group of the researchers indicated uricemia as a predictor of preeclampsia in pregnant ladies. Objective: The present study was designed to assess whether serum uric acid can be used as a biochemical indicator or not, in pregnancy induced hypertensive (PIH) patients. Study period & Method: Total number of 98 PIH patients admitted in GMERS Medical College, Dharpur, from Dec 2013 to Feb 2015 were included in this study and 60 normal healthy pregnant ladies served as control. Serum uric acid levels were estimated using modified Trinder's test. Results: Out of the 98 cases mild preeclamspsia was 60(61.2±%), severe Preeclampsia 24 (24.5%) and eclampsia 14(14.3%). Serum Uric acid levels significantly increased with the severity of PIH, normal pregnant women (4.58±0.37), mild preeclampsia (5.32+0.40), severe preeclampsia (6.29±0.57) and eclamspsia (7.88±1.26). Out of these women with uric acid levels more than 5.5mg/dl was seen in 28(46.6%) mild preeclampsia, 19(79.2%) severe preeclampsia and 12 (85.7%) eclampsia. Maternal mortality was observed in 05(5.1%)PIH cases and out this 04(80) had uric acid level > 5.5mg/dl. Perinatal mortality was observed in 25 (25.1%) cases, out of these 19(76%) were stillbirths and 06(24%) were neonatal deaths. Out of the 25 perinatal deaths 18(72%) had uric acid level >5.5mg/dl. Conclusion: Serum uric acid level could be used as a biochemical indicator of preeclampsia/eclampsia and its complications.
Uric acid as a biomarker for pregnancy induced hypertension
IP innovative publication pvt. ltd, 2020
Background: Pregnancy induced hypertension is the most common complication of pregnancy. It affects 5-7% of pregnant women. Pregnancy induced hypertension is characterized by vasospasm which is associated with platelet aggregation and reduced uteroplacental flow. In addition to these, altered renal function tests can also worsens the condition. This influences the maternal as well as fetal outcome. Aims: To prevent the complications of pregnancy induced hypertension and for proper management of these cases present study was conducted. Materials and Methods: The present study was conducted in 300 subjects grouped into 120 cases of normal pregnancy, 150 cases of pregnancy induced hypertensives, 30 cases of eclamptics and serum uric acid level was measured in these. Results and Discussion: elevated level of serum uric acid was seen with increase in gestation period and rise in diastolic blood pressure. The p- value was estimated by student t-test in different groups and was found to be< 0.001 which was highly significant and correlated. Conclusion: Hence Serum Uric acid is the significant and reliable indicator for pregnancy induced hypertension to prevent the fetal and maternal mortality and morbidity.