Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses

Background: We aimed to address which antihypertensives are superior to placebo/no therapy or another antihypertensive for controlling nonsevere pregnancy hypertension and provide future sample size estimates for definitive evidence. Methods: Randomized trials of antihypertensives for nonsevere pregnancy hypertension were identified from online electronic databases, to February 28, 2021 (registration URL: https://www.crd.york.ac.uk/PROSPERO/ ; unique identifier: CRD42020188725). Our outcomes were severe hypertension, proteinuria/preeclampsia, fetal/newborn death, small-for-gestational age infants, preterm birth, and admission to neonatal care. A Bayesian random-effects model generated estimates of direct and indirect treatment comparisons. Trial sequential analysis informed future trials needed. Results: Of 1246 publications identified, 72 trials were included; 61 (6923 women) were informative. All commonly prescribed antihypertensives (labetalol, other β-blockers, methyldopa, calcium channel blockers, and mixed/multi-drug therapy) versus placebo/no therapy reduced the risk of severe hypertension by 30% to 70%. Labetalol decreased proteinuria/preeclampsia (odds ratio, 0.73 [95% credible interval, 0.54–0.99]) and fetal/newborn death (odds ratio, 0.54 [0.30–0.98]) compared with placebo/no therapy, and proteinuria/preeclampsia compared with methyldopa (odds ratio, 0.66 [0.44–0.99]) and calcium channel blockers (odds ratio, 0.63 [0.41–0.96]). No other differences were identified, but credible intervals were wide. Trial sequential analysis indicated that 2500 to 10 000 women/arm (severe hypertension or safety outcomes) to >15 000/arm (fetal/newborn death) would be required to provide definitive evidence. Conclusions: In summary, all commonly prescribed antihypertensives in pregnancy reduce the risk of severe hypertension, but labetalol may also decrease proteinuria/preeclampsia and fetal/newborn death. Evidence is lacking for many other safety outcomes. Prohibitive sample sizes are required for definitive evidence. Real-world data are needed to individualize care.

Cushing’s syndrome in pregnancy caused by an adrenal adenoma

Objective: The description of a rare case of Cushing’s syndrome caused by an adrenal adenoma in pregnancy with successful treatment. Case presentation: 30-ear-old Gravida 3 female was admitted to our hospital with hypertension at the 18th week of gestation. Hormonal analyses revealed primary Cushing’s syndrome with high plasma cortisol levels and low levels of adrenocorticotropic hormone. Magnetic resonance imaging demonstrated a mass on the right-side of the adrenal gland. Adrenalectomy was performed in the 28th week of gestation and the following histopathology revealed an adrenocortical adenoma. Pregnancy continued until the 38th week of gestation with glucocorticoid replacement therapy and the patient gave birth vaginally to a healthy boy in the 38th week of gestation. Conclusion: Cushing’s syndrome in pregnancy rarely occurs; dia gnosis may be dismissed or determined after birth in most cases. Misdia gnosis of Cushing’s syndrome is common because of physiological increase of corticotropin hormones and cortisol levels and overlapping symptoms that can occur even during physiological pregnancy. Cushing’s syndrome should have a place in the diff erential dia gnosis of hypertension in pregnancy (especially before the 20th week of gestation). Analysis of the urinary free cortisol level and circadian rhythm blood cortisol can provide a reasonable strategy to diagnose Cushing’s syndrome in pregnant women. Early dia gnosis and surgical treatment can signifi cantly reduce maternal and fetal complications. Key words: adenoma – Cushing’s syndrome – pregnancy – hypertension

LATERAL POSITION OF PLACENTA DETECTED ON ULTRA-SONOGRAM AT 18 TO 24 WEEKS OF PREGNANCY AS A PREDICTOR FOR DEVELOPMENT OF PREECLAMPSIA

The placenta is an important organ that connects the mother to the fetus. It is a well-known cause of pregnancy hypertension. The position of the placenta and the development of preeclampsia are linked in several studies. The purpose of this study was to determine whether the percentage delay as determined by ultrasound could be used as a predictor of the development of preeclampsia. A retrospective and prospective, and observational study was done in Choithram Hospital & Research Centre, Indore. The study was done on 130 pregnant women, out of which 62 females had laterally located placenta and 68 had centrally located placenta selected randomly from November 2015 to November 2017. Preeclampsia developed in 68.09 percent of women in the lateral placenta group. Only 31.91 percent of women in the group with the central placenta developed preeclampsia. As a result, females with a laterally positioned placenta had a 3.7 times higher risk of having PIH than those with a centrally situated placenta. With a laterally placed placenta, the overall chance of having PIH was 3.769. This study, laterally located placenta increased association of development of preeclampsia in patients than centrally located placenta which reduces the hospital burden, and long term consequences of the disease thereby reducing the huge cost of critical care for mother and newborn. Thus, making ultrasonography a cost effective, practical, painless, beneficial and reliable screening tool.

Study on the Clinical Characteristics and Treatment of Obstetric Hypertension with Sequence Pattern Mining Algorithm

Aiming at the difficulty in setting the support threshold for sequential pattern mining algorithms and improving the effectiveness of the support threshold setting without the guidance of domain experts’ experience, an improved SPADE (sequential pattern discovery using equivalence classes) algorithm is proposed. By analyzing the relationship between the number of frequent sequences and the support threshold, the support threshold is dynamically selected. Using the electronic medical record data from a medical centre, the time-series relationship of the drugs taken by hypertension patients was extracted as the drug sequence dataset. By determining the optimal support threshold of the dataset, the frequent sequence set is mined, and the sequence rules are generated from the obtained regular sequences to visualize the sequence rules. The sequence rules of medication for hypertensive patients were combined with the patients’ physical indicators for the recommendation. For patients with obstetric hypertension, a combination of nifedipine and captopril is recommended. Through the comparison of the observation group and control group, we study the curative effect of various drugs. The results showed that the total effective rate of the observation group was about 96.6%; compared with the control group, the result indicated that the difference was significant ( P < 0.05). The comparison of blood pressure levels between the two groups after treatment also showed that the results of the observation group were ideal ( P < 0.05). In addition, the incidence of postpartum haemorrhage and perinatal complications in the observation group was also significantly reduced ( P < 0.05). Therefore, the combination of medication for pregnancy hypertension syndrome can effectively improve the treatment effect of the disease and reduce the rate of postpartum haemorrhage and the incidence of perinatal complications.

Risk factors of SARS-CoV-2 infection

Background: Review is based on the biggest observational population study of all the risk factors of COVID-19 infection. The study was carried out in Royal College of General Practitioners, Oxford, and covering over 4 million of people. Were studied and analyzed risk factors as: age, sex and ethnicity, socioeconomic level, living space dimensions, rural-urban population, body mass index, smoker status, pregnancy, hypertension, chronic kidney disease, ischemic heart disease, chronic respiratory diseases including asthma, and chronic obstructive pulmonary disease, and type 1 and 2 diabetes. Patient variable with malignancy and immunocompromised status was separated due to the small number of patients in each group. Conclusions: By September 2020 more than 28.000 articles had been published related to COVID-19 in less than 9 months, 211 new papers every day. Most of them had small population of the studies. In the investigated sample, it was found that increasing age, male sex, economic deprivation, urban location and black ethnicity were associated with higher chances of testing positive for SARS-CoV-2. Active smoking decreased the chance of a positive test. The review covers the most important subjects influencing the development of severe infection outcomes.