The detection, investigation and management of hypertension in pregnancy: full consensus statement

Brown, Mark; Hague, William; Higgins, John R.; Löwe, Sandra; McCowan, Lesley; Oats, Jeremy; Peek, Michael; Rowan, Janet; Walters, Barry N J

doi:10.1111/j.1479-828x.2000.tb01137.x

Cited by 284 publications

(187 citation statements)

References 102 publications

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“…The measurement of blood pressure has been poorly reported, and the importance of recording diastolic blood pressure with Korotkoff phase V (which is more reliably recorded and reflects true diastolic blood pressure) has been underestimated. [31][32][33] Third, for intrauterine growth restriction, there is still no agreement on the best definition of the condition at birth, nor on the best predictor of future infant and childhood morbidity and mortality for term infants. Although population-based birth-weight standards have been used most commonly, they do not distinguish between the small healthy infant and the compromised infant.…”

Section: Overall Intrauterine Growth Restrictionmentioning

confidence: 99%

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Cnossen¹,

Morris²,

Riet³

et al. 2008

Canadian Medical Association Journal

626

398

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Background: : Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters. Methods: :We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios. Results:We identified 74 studies of pre-eclampsia (total 79 547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients.Interpretation: Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests. Abstract CMAJ 2008;178(6):701-11From the Departments of General Practice (Cnossen, ter Riet, Bindels), of Obstetrics and Gynaecology (Cnossen, Mol, van der Post) and

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Section: Overall Intrauterine Growth Restrictionmentioning

confidence: 99%

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Cnossen¹,

Morris²,

Riet³

et al. 2008

Canadian Medical Association Journal

626

398

View full text Add to dashboard Cite

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“…This disease is responsible for high maternal and perinatal morbidity and mortality rates, and is one of the main public health problems (1)(2) . According to the Health Ministry, hypertension during pregnancy, depending on the severity level, is considered a risk factor, which, associated with individual characteristics, unfavorable socioeconomic conditions, certain obstetric histories and clinical problems could trigger harms to the maternal-fetal binomial (3) .…”

Section: Introductionmentioning

confidence: 99%

“…According to the Health Ministry, hypertension during pregnancy, depending on the severity level, is considered a risk factor, which, associated with individual characteristics, unfavorable socioeconomic conditions, certain obstetric histories and clinical problems could trigger harms to the maternal-fetal binomial (3) . For the conceptus, the most common consequences associated with hypertension diseases are the restriction of intra-uterine growth, low birth weight, and prematurity (2,4) . The changes in fetal growth are assessed by means of anthropometric measurements, such as, birth weight and gestational age.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy-induced hypertension and the neonatal outcome

2008

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Objectives:This cross-sectional study were to identify the prevalence of pregnancy-induced hypertension and to verify diastolic blood pressure (DBP) association with type of birth and perinatal outcome. Methods: The data were collected from the mothers' records, in the governmental maternity hospital indicated for high-risk pregnancies, in São Paulo city. Results: During hospitalization, 62.1% had systolic blood pressure > 160 mmHg and 49.6% had a DBP < 110 mmHg. There was no significant association of DBP (p=0.799). The frequency of caesarean section was 64.5%, 28.9% for normal birth, and 6.6% for forceps; 93.4% were live born, 81.0% weighed ≥ 2,500 g, 10.6% were premature, 68.1% were born with adequate gestational age, 84.0% and 99.2% had APGAR score ≥7 at 1st and 5th minutes, respectively. Conclusion: The DBP e" 110 mmHg was associated with low birth weight (p=0.002) and prematurity (p=0.013). Keywords: Hypertension; Pregnancy complications; Pregnancy outcome; Pre-eclampsia; Infant, newborn RESUMOObjetivos: Identificar a prevalência da hipertensão arterial na gravidez e associar a pressão arterial diastólica (PAD) materna com tipo de parto e condições do neonato ao nascimento. Métodos: Estudo transversal, retrospectivo realizado por meio de análise de dados de prontuários de parturientes internadas em uma maternidade pública, da cidade de São Paulo, referência para gestação de alto risco. Resultados: A prevalência de hipertensão foi de 13,9%. Verificou-se que 62,1% das parturientes apresentaram pressão arterial sistólica > 160mmHg; 49,6% PAD > 110mmHg na internação. A PAD não apresentou associação significativa com o tipo de parto (p=0,799). A freqüência de cesárea foi 64,5%, normal 28,9% e fórcipe 6,6%. Dos recém-nascidos, 93,4% foram nativivos, 81% apresentaram pêso > 2.500g, 10,6% eram prematuros, 68,1% adequados para idade gestacional, índice de APGAR 1. 0 e 5. 0 minutos > 7 em 84,0% e 99,2%, respectivamente. Conclusão:A PAD > 110mmHg apresentou associação significativa com baixo peso (p=0,002) e prematuridade (p=0,013). Descritores: Hipertensão; Complicações na gravidez; Resultado da gravidez; Pré-eclâmpsia; Recém-nascido RESUMEN Objetivos: Identificar la prevalencia de la hipertensión arterial en el embarazo y asociar la presión arterial diastólica (PAD) materna con el tipo de parto y condiciones del neonato al nacer. Métodos: Estudio transversal, retrospectivo realizado por medio del análisis de datos de historias clínicas de parturientas internadas en una maternidad pública, de la ciudad de Sao Paulo, referencia para la gestación de alto riesgo. Resultados: La prevalencia de hipertensión fue de 13,9%. Se verificó que 62,1% de las parturientas presentaron presión arterial sistólica > 160mmHg; 49,6% PAD > 110mmHg en el internamiento. La PAD no presentó asociación significativa con el tipo de parto (p=0,799). La frecuencia de cesárea fue 64,5%, normal 28,9% y con forcep 6,6%. De los recién nacidos, 93,4% fueron nativivos, 81% presentaron peso > 2.500g, 10,6% eran prematuros, 68,1% adecuados para ...

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“…In contrast, the chromosome 10 and 22 peaks were absent in the HELLP families, whereas the peak on 12q increased to 2.1. This may indicate that HELLP syndrome is a separate genetic entity, in contrast to the latest full consensus statement of the Australasian Society of the Study of Hypertension in Pregnancy, 31 which states that HELLP-syndrome is a severe form of preeclampsia and therefore an even stronger strict disease criterium for thè preeclampsia-phenotype' than preeclampsia alone. The only peak that appeared to contain contributions from both preeclampsia and HELLP families, was on Xq.…”

Section: European Journal Of Human Geneticsmentioning

confidence: 47%