Pregnancy Outcomes in Women with Preeclampsia Superimposed on Chronic Hypertension with and without Severe Features

Moussa, Hind N.; Leon, M.G.; Martí, Ana Oliva; Chediak, Alissar El; Pedroza, Claudia; Sibai, Bahaeddine M

doi:10.1055/s-0036-1592134

Cited by 13 publications

(9 citation statements)

References 10 publications

(13 reference statements)

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“…The high rate of preeclampsia in our methyldopa cohort (26%), a well-known complication of chronic hypertension, is comparable to findings of other studies on chronic hypertension (≈25% 38 and 28% 39 ). The rate of C-sections (59%) is higher than reported for pregnant women with uncomplicated chronic hypertension 40 and corresponds to rates reported for severe preeclampsia.…”

Section: Pregnancy Complicationssupporting

confidence: 89%

“…The rate of C-sections (59%) is higher than reported for pregnant women with uncomplicated chronic hypertension 40 and corresponds to rates reported for severe preeclampsia. 39 The higher risk of gestational diabetes mellitus in the methyldopa group, that was also reported in other studies, 41 may be explained, at least in parts, by the higher BMI in this group.…”

Section: Pregnancy Complicationssupporting

confidence: 62%

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Pregnancy Outcome After First Trimester Use of Methyldopa

et al. 2017

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Published experience on first trimester exposure to methyldopa is still limited, although it is recommended as first-line treatment for hypertensive disorders in pregnancy in most countries. The primary aim of this prospective observational cohort study was to analyze the rate of major birth defects and spontaneous abortions in women with methyldopa therapy for chronic hypertension. Outcomes of 261 pregnancies with first trimester exposure to methyldopa and 526 comparison pregnancies without chronic hypertension reported to the German Embryotox pharmacovigilance institute were evaluated. The rate of major birth defects in the exposed cohort was not significantly increased compared with the comparison cohort (3.7% versus 2.5%; adjusted odds ratio, 1.24; 95% confidence interval, 0.4–4.0). There was a tendency toward a higher rate of spontaneous abortions in exposed women. The risk of preterm birth was significantly higher, and adjusted birth weight scores were significantly lower in the methyldopa group. Head circumferences were significantly reduced in exposed boys only. There was neither evidence for an increased risk for birth defects or increase in early pregnancy loss nor evidence for growth restriction or a reduced head circumference in a sensitivity analysis comparing monotherapies with methyldopa to metoprolol. However, the significantly increased risk of preterm birth in methyldopa-treated pregnancies was confirmed. In conclusion, our study does not indicate a teratogenic risk of methyldopa. Further studies are needed to confirm its safety in the first trimester and clarify the influence of hypertension and methyldopa on preterm birth and intrauterine growth. Clinical Trial Registration— URL: https://drks-neu.uniklinik-freiburg.de/drks_web/ . Unique identifier: DRKS00010502.

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Section: Pregnancy Complicationssupporting

confidence: 89%

Section: Pregnancy Complicationssupporting

confidence: 62%

Pregnancy Outcome After First Trimester Use of Methyldopa

et al. 2017

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“…The results of this study showed that the probability of cesarean section during pregnancy with preeclampsia is relatively increased, which is significantly different from the vaginal delivery group (χ 2 ¼ 4.405, p < 0.05). [8][9][10] Fetal growth restriction could not tolerate uterine contraction and was prone to fetal distress, so cesarean section was needed to terminate the pregnancy, which was significantly different from the vaginal delivery group (χ 2 ¼ 4.740, p < 0.05). However, there was no significant difference between the cesarean section and the vaginal delivery groups with gestational diabetes and SCH (χ 2 ¼ 0.188, 3.125, P > 0.05).…”

Section: Discussionmentioning

confidence: 99%

Clinical Study on Different Delivery Methods of Twin Pregnancy

Hu¹

2021

Am J Perinatol

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Objective To investigate the effect of different methods of delivery on the outcome of twin pregnancies. Methods This is a retrospective cohort review of 627 twin pregnancies with delivery from January 2016 to December 2019. According to the clinical guidelines for cesarean section, the cesarean section and vaginal delivery groups were determined. Finally, the baseline information, delivery method, pregnancy outcome, and maternal and infant complications of the two groups were compared. Results For different delivery methods, the incidence of preeclampsia was significantly higher in the cesarean section group than in the vaginal delivery group (χ2 = 4.405, p < 0.05). There were 23 fetal growth ratios (FGR) in the cesarean section group, which were significantly higher than the vaginal delivery group (χ2 = 4.740, p < 0.05). However, the incidence of preterm premature rupture of membranes (PPROM) in the vaginal delivery group was significantly higher than in the cesarean section group (χ2 = 5.235, p < 0.05). In addition, the volume of postpartum bleeding in the vaginal delivery group was significantly higher than in the cesarean section group (t = 4.723, p < 0.001). The neonatal weights and 5-minute Apgar scores of the vaginal delivery group were lower than the cesarean section group, and the difference was statistically significant. In the vaginal delivery group, 48 and 26 neonates were transferred to the intensive care and neonatal units, respectively, which were significantly higher than in the cesarean section group (χ2 = 5.001, p < 0.05). Conclusion The major complications of a twin pregnancy are gestational diabetes mellitus and PPROM. Cesarean section can reduce the rate of neonatal asphyxia in twins and improve the pregnancy outcome. Key Points

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“…In the cohort study of Moussa et al [ 21 ] including 2539 pregnant women, it was observed that the mean systolic blood pressure of pregnant women with superimposed preeclampsia was higher than pregnant women with chronic HT. However, it was not statistically significant, but the mean diastolic blood pressure was significantly higher in superimposed HT than chronic HT.…”

Section: Discussionmentioning

confidence: 99%

The effect of thromboembolic prophylaxis after cesarean section in patients with hypertensive disorders

YILMAZ¹

2021

North Clin Istanbul

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OBJECTIVE This study aims to compare the effect of thromboembolic prophylaxis in patients diagnosed with hypertensive disorders of pregnancy undergoing cesarean section. METHODS Three hundred and eighty-six patients were included in the study. The patients were divided into groups according to the type of hypertensive disorders of pregnancy and whether thromboembolism prophylaxis was applied or not. The thromboembolic event incidence and other pregnancy outcomes were compared. RESULTS Nonadministration of thromboprophylaxis was recorded in 210 patients. Eleven patients had thromboembolic events (5%). Among 176 patients who received thromboprophylaxis, only two patients (1%) had a thromboembolic event (p<0.05). CONCLUSION There is an increased tendency to thromboembolism in pregnancy. The incidence increases in the presence of hypertension accompanying pregnancy. In our study, the importance of thromboembolism prophylaxis on peri-postnatal complications in patients with hypertensive disorders of pregnancy was emphasized.

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Pregnancy Outcomes in Women with Preeclampsia Superimposed on Chronic Hypertension with and without Severe Features

Cited by 13 publications

References 10 publications

Pregnancy Outcome After First Trimester Use of Methyldopa

Pregnancy Outcome After First Trimester Use of Methyldopa

Clinical Study on Different Delivery Methods of Twin Pregnancy

The effect of thromboembolic prophylaxis after cesarean section in patients with hypertensive disorders

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