Plasma active and inactive renin and fetal complications in women with high risk pregnancies

1991 ◽  
Vol 69 (9) ◽  
pp. 1321-1326 ◽  
Author(s):  
Paola Ferraris ◽  
Patrizia Quorso ◽  
Gabriella Gazzano ◽  
Massimo Cianci ◽  
Carla Sala ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical History ◽  
Fetal Outcome ◽  
Normal Weight ◽  
Second Trimester ◽  
Term Infants ◽  
Active Renin ◽  
Fetal Complications ◽  
History Of ◽  
Inactive Renin

To examine whether the activation of the renin system, which occurs during pregnancy, may be relevant for the development and the outcome of the fetus, we measured active and inactive renin throughout gestation in 29 women having a pregnancy defined as "high risk" because of a clinical history of hypertension, nephropathy, and unexplained abortions. In 23 of these women who delivered full-term infants with normal weight and status, we found that active renin increased progressively from early pregnancy until the end of the second trimester and then declined slightly thereafter. In contrast, in the remaining six women who had fetal complications consisting of either signs of distress requiring cesarean section or growth retardation, the increase in active renin failed to occur. In all women the levels of inactive renin were more elevated throughout gestation than those observed in nonpregnant women, and were higher, although not significantly, in women without fetal complications than in those with fetal complications. Thus, a blunted activation of the renin system during pregnancy is associated with alteration in fetal development and may possibly contribute to it.Key words: active and inactive renin, pregnancy, fetal outcome.

scholarly journals Risk factors of the previa placenta formation

2016 ◽  
Vol 65 (3) ◽  
pp. 25-31
Author(s):  
Natalya I Fadeeva ◽  
Olga A Belnitskaya ◽  
Irina A Myadelets ◽  
Galina V Serdyuk ◽  
Maria G Nikolaeva
Keyword(s):  
Risk Factors ◽  
Comparative Analysis ◽  
High Risk ◽  
Placenta Previa ◽  
Intrauterine Device ◽  
Adverse Outcomes ◽  
Second Trimester ◽  
Gynecological Disorders ◽  
History Of ◽  
Autoimmune Processes

Placenta previa is associated with a high risk of adverse outcomes for the fetus and mother. The aim of our study was to identify risk factors form a complete placenta previa. A comparative analysis of clinical and paraclinical characteristics of 70 patients with placenta previa in time delivery, 150 women with favorable migration in the second trimester placenta previa at baseline and 100 women with physiological placentation. It was found that a history of hormone-dependent gynecological disorders (p < 0.001), infertility (p < 0.001), contraceptive intrauterine device (p < 0.05), as well as hypertensive syndrome (p < 0.001), presence of hemostasis and folate metabolism defective alleles genes associations (p < 0.01) hepatitis B and C (p < 0.001), and autoimmune processes (p < 0.001) are risk factors of conservation of total placenta previa to delivery.

scholarly journals The Biochemical Profile of Familial Hypocalciuric Hypercalcemia and Primary Hyperparathyroidism during Pregnancy and Lactation: Two Case Reports and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
S. A. Ghaznavi ◽  
N. M. A. Saad ◽  
L. E. Donovan
Keyword(s):  
Primary Hyperparathyroidism ◽  
Case Reports ◽  
Diagnostic Error ◽  
Calcium Handling ◽  
Familial Hypocalciuric Hypercalcemia ◽  
Second Trimester ◽  
Clearance Ratio ◽  
Fetal Complications ◽  
Pregnancy And Lactation ◽  
History Of

Background. Primary hyperparathyroidism (PHPT) and Familial Hypocalciuric Hypercalcemia (FHH) result in different maternal and fetal complications in pregnancy. Calcium to creatinine clearance ratio (CCCR) is commonly used to help distinguish these two conditions. Physiological changes in calcium handling during pregnancy and lactation can alter CCCR, making it a less useful tool to distinguish PHPT from FHH. Cases. A 25-year-old female presented with hypercalcemia and an inappropriately normal PTH. Her CCCR was 0.79% before pregnancy and rose to 1.99% in her second trimester. The proband’s mother and neonate had asymptomatic hypercalcemia. Genetic analysis revealed a CaSR mutation consistent with FHH. A 19-year-old female presented with a history of nephrolithiasis who underwent emergent caesarean section at 29 weeks of gestation for severe preeclampsia. At delivery, she was diagnosed with hypercalcemia with an inappropriately normal PTH and a CCCR of 2.67%, which fell to 0.88% during lactation. Parathyroidectomy cured her hypercalcemia. Pathology confirmed a parathyroid adenoma. Conclusion. These cases illustrate the influence of pregnancy and lactation on renal calcium indices, such as the CCCR. To avoid diagnostic error of women with hypercalcemia during pregnancy and lactation, calcium biochemistry of first-degree relatives and genetic testing of select patients are recommended.

scholarly journals Maternal determinants and fetal outcome of twin pregnancy: a five-year survey

2017 ◽  
Vol 6 (6) ◽  
pp. 2459
Author(s):  
Rachel Mathew ◽  
Vinitha Wills ◽  
Jacob Abraham
Keyword(s):  
Perinatal Mortality ◽  
Twin Pregnancy ◽  
Mode Of Delivery ◽  
Age Groups ◽  
Fetal Outcome ◽  
Normal Weight ◽  
Maternal Risk ◽  
Younger Age ◽  
Fetal Complications ◽  
Twin Pregnancies

Background: Study prevalence of twin pregnancy, maternal risk factors and fetal outcome in twin pregnancy.Methods: A retrospective study of mothers with twin pregnancies who delivered during the period of 5 years. There were 109 mothers who gave birth to 218 babies. Maternal details, antenatal complications and fetal outcomes were analysed.Results: There were 5432 deliveries which included 109 twin births. Prevalence of twinning was 20/1000 deliveries. The mean age was 28.11 (±SD 4.89) with 69.7% in the younger age groups. No association with parity, BMI and ovulation induction was found. Most common complication was preterm delivery (64.2%) with mean gestational age being 35.07 (±SD 2.32). Others were diabetes (25.7%), hypertension (22.9%), hypothyroidism (14.6%) and postpartum hemorrhage (13.7%). Cesarean section was the commonest mode of delivery (78.0%) with fetal malpresentation (26.6%), fetal distress (20.2%) and hypertension (12.0%) being the commonest indications for termination. Among the hypertensive mothers, 23 delivered by Cesarean and only 2 delivered vaginally which was statistically significant (p- 0.03 OR 5.20). Dichorionicity was commoner than monochorionicity (66.1% vs. 33.9%). Among 218 fetuses delivered, 214 were live births and 4 still born. There were low birth weight Babies (70.6%), normal weight (15.3%), VLBW babies (11.5%) and 2.7% ELBW babies. Fetal complications were IUGR (11.46%), discordant twins (6.8%), congenital anomalies (1.8%), single fetal demise (1.8%) and Intra uterine death of a twin (0.4%). Perinatal mortality rate was 1.65 per thousand births.Conclusions: Prevalence of twin pregnancy was 20/1000 deliveries. Twin pregnancies were seen to be more in the younger age group. Preterm labor, diabetes and hypertension were the main complications with cesarean the most common mode of delivery. Dichorionicity led to less fetal complications and low perinatal mortality.

scholarly journals Curative resection of an aldosteronoma causing primary aldosteronism in the second trimester of pregnancy

2020 ◽  
Vol 2020 ◽  
Author(s):  
Skand Shekhar ◽  
Rasha Haykal ◽  
Crystal Kamilaris ◽  
Constantine A Stratakis ◽  
Fady Hannah-Shmouni
Keyword(s):  
Primary Aldosteronism ◽  
Secondary Hypertension ◽  
Uncontrolled Hypertension ◽  
List Type ◽  
Second Trimester ◽  
Unilateral Adrenalectomy ◽  
Fetal Complications ◽  
Common Etiology ◽  
History Of ◽  
In Pregnancy

Summary A 29-year-old primigravida woman with a known history of primary aldosteronism due to a right aldosteronoma presented with uncontrolled hypertension at 5 weeks of estimated gestation of a spontaneous pregnancy. Her hypertension was inadequately controlled with pharmacotherapy which lead to the consideration of surgical management for her primary aldosteronism. She underwent curative right unilateral adrenalectomy at 19 weeks of estimated gestational age. The procedure was uncomplicated, and her blood pressure normalized post-operatively. She did, however, have a preterm delivery by cesarean section due to intrauterine growth retardation with good neonatal outcome. She is normotensive to date. Learning points: Primary aldosteronism is the most common etiology of secondary hypertension with an estimated prevalence of 5–10% in the hypertensive population. It is important to recognize the subtypes of primary aldosteronism given that certain forms can be treated surgically. Hypertension in pregnancy is associated with significantly higher maternal and fetal complications. Data regarding the treatment of primary aldosteronism in pregnancy are limited. Adrenalectomy can be considered during the second trimester of pregnancy if medical therapy fails to adequately control hypertension from primary aldosteronism.

scholarly journals Effectiveness of Prenatal Ultrasound Examination at Second Trimester in Detecting Fetal Congenital Abnormalities-A Preliminary Study

2019 ◽  
Vol 2 (2) ◽  
pp. 173-177
Author(s):  
Madan Thapa ◽  
Shyam Sundar Parajuly ◽  
Rajesh Adhikari ◽  
Manish Kiran Shrestha
Keyword(s):  
High Risk ◽  
Ultrasound Examination ◽  
Descriptive Analysis ◽  
Previous History ◽  
Anatomical Study ◽  
Prenatal Ultrasound ◽  
Second Trimester ◽  
High Risk Patients ◽  
Risk Patients ◽  
History Of

Objective: Anomaly scan at the second trimester provides the detail anatomical study of fetus. Any structural or morphological defects detected prenatally guides the parents and doctors for further counseling. The main objective of this study was to detect the fetal congenital anomalies in high risk patients at 18-22 weeks and highlight the effectiveness of prenatal ultrasound examination. Materials and Methods: This was a hospital based descriptive study done during the period of 2017 January to 2019 January in the department of Radiology, ultrasound unit, Pokhara Academy of Health Sciences, Nepal. Pregnant women who were first examined and evaluated by the Obstetrician during the ante-natal check up (ANC) either by asking the patient history or by mother age or any symptoms or chance of being abnormalities or high risk patients during that time frame (18-22 weeks) were enrolled for the study. Maternal age, parity, any history of previous anomalies, previous history of miscarriage/Intra Uterine Fetal Demise ( IUFD) or any exposure to radiation or drugs, history of other disease were recorded during the filling of consent form. High risk patients were identified by the Obstetrician and anomaly examination was prescribed at second trimester (18-20 weeks). Descriptive analysis was done using SPSS 20. Results: There were two hundred and twenty four patients who had undergone anomaly (targeted fetal anatomy) examination which were referred for “anomaly scan” from the gynaecology and obstetrics department during that period. Among all the cases, fourteen cases had anomalies detected during the scan (18-22 weeks). Out of which seven cases had central nervous system related anomalies, two cases had skeletal deformities (dysplasia), two case had urinary tract related anomalies, one had lungs related anomalies and one had single umbilical artery with polyhydroamnios associated with duodenal atresia and one case had malformation of lymphatic system ( cystic hygroma ) Conclusion: Our study revealed that ultrasound scan performed between 18-22 weeks of pregnancy is effective in diagnosing major fetal abnormalities in the high-risk patients.

Pathoanatomical Lesions in Placentas With Excessively Hypercoiled Umbilical Cords: Frequent Detection of Massive Perivillous Fibrin Deposition

2019 ◽  
Vol 23 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Henning Feist ◽  
Kais Hussein ◽  
Thordis Blöcker ◽  
Jeremias Wohlschlaeger
Keyword(s):  
Fetal Monitoring ◽  
Fetal Outcome ◽  
Second Trimester ◽  
Fibrin Deposition ◽  
Fetal Demise ◽  
Umbilical Coiling Index ◽  
Pathogenetic Factor ◽  
History Of ◽  
Umbilical Cords ◽  
Adverse Fetal Outcome

This study focused to investigate a possible association of extensive umbilical hypercoiling (displaying an umbilical coiling index [UCI] of at least 1.0 coils/cm), clinical outcome, and associated pathoanatomical placental lesions. Of the 771 singleton placentas from the second and third trimesters submitted for pathoanatomical evaluation, 15 cases (2%) displayed extensive hypercoiling. There was an association of excessive hypercoiling with hypotrophy of fetuses and children (11 cases) and fetal demise (12 cases). Thin cord syndrome and umbilical stricture were observed in 9 cases and 4 cases, respectively. Seven of the 15 cases with excessive umbilical hypercoiling showed increased placental fibrin deposition (47% of the cases with hypercoiling), in 4 cases sufficient for rendering the diagnosis of massive perivillous fibrin deposition. Signs of maternal vascular malperfusion (n = 6) and chorangiosis (n = 2) were also detected in cases with hypercoiling. Recurrence of excessive umbilical hypercoiling was observed in 2 families, suggesting a genetic predisposition for the development of this lesion. Extensive hypercoiling could be a hitherto underrecognized pathogenetic factor for the development of massive perivillous fibrin deposition. A high UCI measured in the second trimester by ultrasound may be predictive of fetal hypotrophy, and intensified fetal monitoring is warranted, particularly if there is a history of hypercoiling and adverse fetal outcome.

Component resolved diagnostics in peanut sensitized children with and without a history of clinical reaction

2020 ◽  
Vol 41 (5) ◽  
pp. 336-340
Author(s):  
Yasmin Hamzavi Abedi ◽  
Cristina P. Sison ◽  
Punita Ponda
Keyword(s):  
Retrospective Chart Review ◽  
Clinical History ◽  
Specific Ige ◽  
Exact Test ◽  
Ara H 1 ◽  
Sige Level ◽  
History Of ◽  
Laboratory Procedures ◽  
Ige Mediated ◽  
The Relationship

Background: Serum Peanut-specific-IgE (PN-sIgE) and peanut-component-resolved-diagnostics (CRD) are often ordered simultaneously in the evaluation for peanut allergy. Results often guide the plans for peanut oral challenge. However, the clinical utility of CRD at different total PN-sIgE levels is unclear. A commonly used predefined CRD Ara h2 cutoff value in the literature predicting probability of peanut challenge outcomes is 0.35kUA/L. Objective: To examine the utility of CRD in patients with and without a history of clinical reactivity to peanut (PN). Methods: This was a retrospective chart review of 196 children with PN-sIgE and CRD testing, of which, 98 patients had a clinical history of an IgE-mediated reaction when exposed to PN and 98 did not. The Fisher's exact test was used to assess the relationship between CRD and PN-sIgE at different cutoff levels, McNemar test and Gwet’s approach (AC1 statistic) were used to examine agreement between CRD and PN-sIgE, and logistic regression was used to assess differences in the findings between patients with and without reaction history. Results: Ara h 1, 2, 3, or 9 (ARAH) levels ≤0.35 kUA/L were significantly associated with PN-sIgE levels <2 kUA/L rather than ≥2 kUA/L (p < 0.0001). When the ARAH threshold was increased to 1 kUA/L and 2 kUA/L, these thresholds were still significantly associated with PN-sIgE levels of <2, <5, and <14 kUA/L. These findings were not significantly different in patients with and without a history of clinical reactivity. Conclusion: ARAH values correlated with PN-sIgE. Regardless of clinical history, ARAH levels are unlikely to be below 0.35, 1, or 2 kUA/L if the PN-sIgE level is >2 kUA/L. Thus, if possible, practitioners should consider PN-sIgE rather than automatically ordering CRD with PN-sIgE every time. Laboratory procedures that allow automatically and reflexively adding CRD when the PN-sIgE level is ≤5 kUA/L can be helpful. However, further studies are needed in subjects with challenge-proven PN allergy.

Stepping up detection, response, preparedness and readiness measures for “COVID-19”- A Pandemic

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1042-1047
Author(s):  
Khushbu Balsara ◽  
Deepankar Shukla
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Clinical History ◽  
Frontline Workers ◽  
Diagnostic Assays ◽  
Care Workers ◽  
Short Period ◽  
History Of ◽  
Detection Response ◽  
Care Worker

In a very short period of time, “COVID-19” has seized the consciousness globally by making remarkable changes in our day to day living and has superintended as a public health emergency globally. It has high radar of transmission, affecting an individual at work to frontline workers. The measures and planning for a response plays a key role from drawing up an emergency committee and this follows an equation which broadly deals with epidemiological to clinical history of the patient, management steps from isolation, screening, diagnostic assays for identification and treatment. The application of an organized plan with secure structure aids in better performance, increases efficacy of management and saves time. Also saves time for a health care worker to g through routine levels of channels of administration if already a familiar way of operation is known for such situations. Thus, planning and developing a ‘blueprint of approach’ towards management of patient while facing such situation is a must. This review provides an insight to the measures for detection, response and preparedness of the hospital and health care workers should largely be inclusive of; also highlights the measures to be taken at every step after coming in contact with a positive case of “COVID-19”.

THE RISK FACTORS OF MOLAR PREGNANCY

2017 ◽  
pp. 53-58
Author(s):  
Lam Huong Le
Keyword(s):  
High Risk ◽  
Gestational Trophoblastic Disease ◽  
Living Standard ◽  
Control Group ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Health It ◽  
Pregnancy Risk ◽  
History Of ◽  
And Control

Objectives: Molar pregnancy is the gestational trophoblastic disease and impact on the women’s health. It has several complications such as toxicity, infection, bleeding. Molar pregnancy also has high risk of choriocarcinoma which can be dead. Aim: To assess the risks of molar pregnancy. Materials and Methods: The case control study included 76 molar pregnancies and 228 pregnancies in control group at Hue Central Hospital. Results: The average age was 32.7 ± 6.7, the miximum age was 17 years old and the maximum was 46 years old. The history of abortion, miscarriage in molar group and control group acounted for 10.5% and 3.9% respectively, with the risk was higher 2.8 times; 95% CI = 1.1-7.7 (p<0.05). The history of molar pregnancy in molar pregnancy group was 9.2% and the molar pregnancy risk was 11.4 times higher than control group (95% CI = 2.3-56.4). The women having ≥ 4 times births accounted for 7.9% in molar group and 2.2% in control group, with the risk was higher 3.8 times, 95% CI= 1.1-12.9 (p<0.05). The molar risk of women < 20 and >40 years old in molar groups had 2.4 times higher than (95% CI = 1.1 to 5.2)h than control group. Low living standard was 7.9% in molar group and 1.3% in the control group with OR= 6.2; 95% CI= 1.5-25.6. Curettage twice accounted for 87.5%, there were 16 case need to curettage three times. There was no case of uterine perforation and infection after curettage. Conclusion: The high risk molar pregnancy women need a better management. Pregnant women should be antenatal cared regularly to dectect early molar pregnancy. It is nessecery to monitor and avoid the dangerous complications occuring during the pregnancy. Key words: Molar pregnancy, pregnancy women

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