The duration of hypertension in the puerperium of preeclamptic women: Relationship with renal impairment and week of delivery

Ferrazzani, Sergio; Carolis, Sara De; Pomini, Francesco; Testa, Antonia Carla; Mastromarino, Carmen; Caruso, Alessandro

doi:10.1016/0002-9378(94)90290-9

Cited by 90 publications

(39 citation statements)

References 12 publications

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“…18 The duration of hypertension after a hypertensive pregnancy was similar in women with hypertension and either hyperuricemia or proteinuria and longer than in women with gestational hypertension alone. 19 There seems to be a special interrelationship between the renal lesion of preeclampsia and hyperuricemia. In a study of 62 pregnant women with gestational hypertension without proteinuria, the characteristic preeclamptic renal lesion, termed glomeruloendotheliosis, was only present in women with hyperuricemia.…”

Section: Discussionmentioning

confidence: 99%

Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

et al. 2005

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Abstract-Gestational hypertension is differentiated into higher and lower risk by the presence or absence of proteinuria.We asked if hyperuricemia, a common finding in pregnancy hypertension, might also be an indicator of increased risk. We examined fetal outcome data from 972 pregnancies collected from 1997 to 2002 in a nested case-control study. Participants were nulliparous with no known medical complications. The frequency of preterm birth, the duration of pregnancy, frequency of small-for-gestational-age infants, and birth weight centile were determined for pregnancies assigned to 8 categories by the presence or absence of combinations of hypertension, hyperuricemia, and proteinuria. In women with gestational hypertension, hyperuricemia was associated with shorter gestations and smaller birth weight centiles and increased risk of preterm birth and small-for-gestational-age infants. Hyperuricemia increased the risk of these outcomes in the presence or absence of proteinuria. Risk was also increased in a small group of women with hyperuricemia and proteinuria without hypertension. Women with only hypertension and hyperuricemia have similar or greater risk as women with only hypertension and proteinuria. Those with hypertension, proteinuria, and hyperuricemia have greater risk than those with hypertension and proteinuria alone. The risk of these outcomes increased with increasing uric acid. Hyperuricemia is at least as effective as proteinuria at identifying gestational hypertensive pregnancies at increased risk. Uric acid should be reexamined for clinical and research utility. Key Words: gestational hypertension Ⅲ preeclampsia Ⅲ pregnancy Ⅲ uric acid Ⅲ intrauterine growth restriction Ⅲ preterm birth Ⅲ risk assessment H ypertensive disorders during pregnancy increase maternal and infant risk. The greatest impact is associated with the pregnancy-specific syndrome, preeclampsia. 1 Preeclampsia, conventionally diagnosed by the gestational onset of hypertension and proteinuria, increases perinatal mortality 5-fold 1 and kills 50,000 women yearly worldwide. 2 Its management, delivery to halt the progression of the pathophysiology, is responsible for 15% of preterm births in developed countries. 3 Gestational hypertension without proteinuria has much less of an adverse effect on maternal or fetal outcome, whereas the major risk from hypertension that antedates pregnancy is the superimposition of preeclampsia. 4 The importance of differentiating these conditions is reflected in several classification schemes in which gestational hypertension with proteinuria is separated from gestational hypertension without proteinuria and hypertension that antedates pregnancy. 4 -6 These diagnostic criteria currently used to discriminate high-risk from lower risk women with gestational hypertension are arbitrary. The term "preeclampsia" was coined in the early 20th century when it was recognized that hypertension and proteinuria could be precursors to a pregnancy-specific seizure disorder, eclampsia, which had been recognized for...

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Section: Discussionmentioning

confidence: 99%

Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

et al. 2005

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“…Women with pre-existing hypertension not requiring antihypertensives antenatally may require antihypertensives early in the puerperium [476]. Those at greatest risk of postpartum hypertension are those who delivered preterm, and, for multiparous women, those with higher urate levels [477,478]. Postpartum deterioration of maternal end-organ function occurs in up to 25%, usually in the early puerperium, especially with severe disease [479].…”

Section: Commentsmentioning

confidence: 99%

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

Magee

Pels

Helewa

et al. 2008

Journal of Obstetrics and Gynaecology Canada

421

218

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“…En el posparto se debe confirmar que la disfunción de órganos blanco esté resuelta, no se recomienda el uso de antinflamatorios no esteroideos (AINES), sobre todo si la presión es de difícil de controlar, ya que puede exacerbar la hipertensión, causar daño renal agudo y alterar la función plaquetaria (7). La duración de la terapia antihipertensiva generalmente es hasta 2 semanas posparto, pero hay pacientes sobre todo las que presentaron preeclampsia severa menor de 34 semanas los pueden requerir hasta 6 semanas (38,50).…”

Section: Escenarios Clínicos En La Hipertensión Pospartounclassified

Hipertensión/preeclampsia postparto, Recomendaciones de manejo según escenarios clínicos, seguridad en la lactancia materna, una revisión de la literatura

Martínez

Rendón

Gallego

et al. 2017

Rev. chil. obstet. ginecol.

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Articulo de RevisiónHipertensión/ preeclampsia postparto, Recomendaciones de manejo según escenarios clínicos, seguridad en la lactancia materna, una revisión de la literatura. RESUMENObjetivo: Establecer recomendaciones en el tipo de antihipertensivo que se debe seleccionar según escenarios clínicos en la hipertensión/preeclampsia postparto, dosis y pautas de seguridad en lactancia. Métodos: Se realizó una búsqueda bibliográfica en inglés y español, utilizando las bases de datos PubMed, Ebsco y Science Direct, tomando como palabras clave los descriptores del Decs (español) y Mesh (inglés), realizando combinaciones con la conjunción Y (AND) y la disyunción O (OR), que hubieran evaluado el manejo, seguimiento en hipertensión y preeclampsia posparto. Como criterio de inclusión se tomaron estudios tipo Revisiones sistemáticas, ensayos clínicos, guías de práctica clínica, estudios observacionales, la calidad de los artículos se evaluó por PRISMA, CONSORT y STROBE según corresponda y se utilizó la herramienta Cochrane para la evaluación del riesgo de sesgos.Resultados: Se identificaron 59 artículos que cumplieron con los requisitos preestablecidos, se encontró que el reconocimiento de la hipertensión posparto es de vital importancia por el riesgo de complicaciones maternas, existe un grupo de mayor riesgo: las que presentaron trastorno hipertensivo ante parto sobre todo severo y con parto pretérmino, de ahí la importancia de vigilar la presión arterial en este periodo. La crisis hipertensiva requiere pronto reconocimiento, evaluación y tratamiento estandarizado para prevenir daño en órgano blanco. Los antihipertensivos de primera línea a utilizar durante la crisis son: labetalol, nifedipino, hidralazina, no existiendo diferencias estadísticas entre ellos con respecto al alcance de metas de control de presión arterial, ni en el tiempo de alcance de estas, tampoco diferencias en resultados adversos maternos perinatales, en la hipertensión no crisis el medicamento a elegir depende de la experticia sobre el fármaco que el clínico tenga, no hay un fármaco superior a otro, y finalmente se encontró que la mayoría de los antihipertensivos utilizados son de amplia seguridad en la lactancia materna, se consideran seguros de riesgo muy bajo (nivel 0) y riesgo bajo (nivel 1).REV CHIL OBSTET GINECOL 2017; 82(2) 220 Conclusiones: Los antihipertensivos de primera línea a utilizar durante la crisis son: labetalol, nifedipino, hidralazina, en la hipertensión no crisis el medicamento a elegir depende de la experticia sobre el fármaco que el clínico tenga, no hay un fármaco superior a otro, y en lactancia materna la mayoría de los antihipertensivos son considerados de amplio margen de seguridad.Palabras clave: posparto, preeclampsia, hipertensión, antihipertensivos, lactancia materna. ABSTRACTObjective: To establish recommendations on the type of antihypertensive that should be selected according to clinical scenarios in postpartum hypertension / preeclampsia, doses and safety guidelines in lactation. Methods: A bibliographic search w...

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The duration of hypertension in the puerperium of preeclamptic women: Relationship with renal impairment and week of delivery

Cited by 90 publications

References 12 publications

Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

Hipertensión/preeclampsia postparto, Recomendaciones de manejo según escenarios clínicos, seguridad en la lactancia materna, una revisión de la literatura

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