We conducted a prospective and serial study of blood pressure (BP) and of the changes in the renin-angiotension-aldosterone system (RAAS) and of one factor in the kallikrein-kinin system during normal pregnancy and in patients with pre-existing or developing hypertension in pregnancy. Strict diagnostic criteria were used to define pre-BP in the hypertensive pregnant groups was measured as in the normal pregnant group, 'BP in the non-pregnant group was measured in the supine position, **Reference values from our laboratory (MeaneSD).
Acto Obstet Gynecol Scand Suppl118
In order to obtain reference values during normal pregnancy 24 women with strict criteria for health and normal pregnancy were studied. Greatest interest was focused on blood pressure (BP) measurements and renal function tests. Investigations were made in early second trimester and in the 30th, 33rd and 36th gestational weeks. Gestational age was estimated by ultrasound measurement of crown-rump length before the 14th gestational week. Both systolic and diastolic BP measured in the right arm were about 10 mmHg lower in the left lateral position than when supine or standing. The difference is suggested to be dependent on hydrostatic factors. Diastolic BP should be defined at the fourth phase of the Korotkoff sounds in order to be reliable because of the common phenomenon of late or non-disappearance of the sounds during pregnancy. Diastolic BP in phase IV increased in up to 25% of the cases with 15 mmHg or more from early second trimester to the 36th gestational week in all three positions. Serum creatinine concentration was low in early second trimester and did not change during pregnancy, while serum urea decreased and serum urate increased during pregnancy. The results emphasize the importance of using reference values from a normal pregnant population obtained at different gestational weeks for comparison in studies on certain pathological conditions during pregnancy, especially pre-eclampsia.
Cord blood IgE levels and the development of allergy were studied in 29 children born by mothers who had been treated with the β-adrenergic receptor blocking agent, metoprolol, during the pregnancy and in 23 children of placebo-treated mothers. In 13 (45%) of the former and 3 (15%) of the placebo group elevated cord blood IgE levels, i.e. more than 0.9 kU/l and/or obvious or probable allergy developed (p = 0.03). The findings support previous experimental observations that β-blocking agents may enhance IgE antibody formation. It also adds to the number of environmental factors that may increase the risk for atopic disease in children.
In a two-stage ultrasound screening program the gestational age was assessed by measurement of the fetal crown-rump length in early pregnancy. At an adjusted gestational age between 32 and 35 completed weeks the biparietal diameter, the abdominal circumference, the abdominal area and the ratio between fetal head area and abdominal area were estimated by means of ultrasound measurement. 'Acute' fetal weight was estimated by calculations from biparietal diameter and abdominal diameters. Percentile curves were constructed for these parameters and cut-off limits were tested for the predictability of intra-uterine growth retardation of the fetus. The abdominal circumference and area estimations were equally good for the detection of intra-uterine growth retardation. The biparietal diameter alone is of limited value for the detection of intra-uterine growth retardation but the combination with abdominal diameters in 'acute' fetal weight estimation can well be used. The ratio between the skull and abdominal areas seems to be of little use for the detection of intra-uterine growth retardation of two reasons: difficulty in measurement and low sensitivity. We consider that the assessment of gestational age in early pregnancy is a necessity both for the identification of suspected IUGR by means of ultrasound and the diagnosis of IUGR by measurement of fetal weight at birth. It is concluded that if the gestational age has been assessed by crown-rump length measurement in early pregnancy, a single estimation of the fetal abdominal circumference between 32 and 35 completed gestational weeks and a cut-off limit at the 15th percentile offers a detection rate of about 90% of the growth retarded infants.
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