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10 results

  • 7 - HYPERTENSION: ENQUIRIES, TRIALS AND RECOMMENDATIONS

  • James Owen Drife, University of Leeds, Gwyneth Lewis, University College London, James P Neilson, University of Liverpool, Marian Knight, National Perinatal Epidemiology Unit, Oxford, Griselda Cooper, University of Birmingham, Roch Cantwell, Southern General Hospital, Glasgow
  • Book:
    Why Mothers Died and How their Lives are Saved
    Published online:
    05 April 2023
    Print publication:
    30 March 2023, pp 89-94

  • Summary

    Hypertension associated with proteinuria occurs in pre-eclampsia, which can progress to eclampsia (convulsions) and is a major cause of maternal death globally. CEMD Reports reminded doctors that high blood pressure may have other, much rarer, causes. Early diagnosis is important but in the 1950s signs of pre-eclampsia were sometimes taken lightly, allowing eclampsia to occur. The 1979-81 Report recommended that each region should have a specialist team to advise about preventing respiratory and clotting complications. Adherence to guidelines required a major culture shift. Deaths from these complications almost disappeared and by the year 2000 the main cause of death was brain haemorrhage. The Report emphasised the need for prompt administration of antihypertensive drugs. In 1995 a controlled trial showed that magnesium sulphate, the treatment favoured in the USA, was more effective than UK treatments for eclampsia. In 2002 the MAGPIE trial, led by Prof Lelia Duley in Oxford and involving 10,000 women in 33 countries, showed that it is also effective in pre-eclampsia. The rate of fits has fallen and, since 2010, the number of deaths has been in single figures.

  • The association between selenium levels and hypertensive disorders of pregnancy: a systematic review of the literature

  • Isa Silva, Isabella Bracchi, Elisa Keating
  • Journal:
    British Journal of Nutrition / Volume 130 / Issue 4 / 28 August 2023
    Published online by Cambridge University Press:
    21 November 2022, pp. 651-665
    Print publication:
    28 August 2023
    • Article
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  • Selenium (Se) is essential for selenoprotein synthesis, being thus important for immune and thyroid function, and for antioxidant defence. Some studies have shown that low levels of Se may associate with hypertensive disorders of pregnancy (HDP). Nevertheless, evidence supporting Se supplementation in pregnant or childbearing-age women is still lacking. In this context, this work aimed to systematically review the most recent scientific evidence to understand the relationship between Se levels and HDP. We performed a systematic review (protocol number: CRD42022310424) with literature of the last decade. PubMed, Scopus, Web of Science, registers and grey literature were searched to identify studies reporting measurement of Se levels in normotensive and hypertensive pregnant women (supplemented or not with Se). Study quality was assessed using the National Heart, Lung, and Blood Institute Study Quality Assessment Tools. Among the thirty included studies, a majority, 61 % (n 19) of the ‘good’ or ‘fair’ studies, reported a negative association between Se and HDP, and some studies, 39 % (n 11) of the ‘good’ or ‘fair’ studies, reported a lack of association. This review provides an important amount of quality evidence suggesting that low Se levels associate with the occurrence of HDP. Nevertheless, the gathered information is not enough to underlie a recommendation for Se supplementation in pregnancy to protect against HDP. Thus, this review emphasises the need for further well-designed randomised controlled trials that may provide blunt evidence regarding the benefits of Se supplementation during pregnancy.

  • Chapter 7.2 - Eclampsia and Strokes during Pregnancy and Postpartum

  • from 7 - Vasospastic Conditions and Other Vasculopathies
  • Edited by Derya Uluduz, Istanbul Üniversitesi
  • Anita Arsovska
  • Book:
    Rare Causes of Stroke
    Published online:
    06 October 2022
    Print publication:
    01 September 2022, pp 299-304

  • Summary

    Typical neuroimaging presentation of preeclampsia/eclampsia are posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS).Eclampsia carries a high risk for stroke, both hemorrhagic and ischemic. Besides eclampsia, pregnancy-specific causes of ischemic stroke are peripartum cardiomyopathy, postpartum benign angiopathy, amniotic fluid embolization and choriocarcinoma.The incidence of cerebral venous thrombosisis the highest during postpartum and is increased in older women, cesarean delivery, or epidural anesthesia, in the presence of infection, obesity or thrombophilia. Risk factors for hemorrhagic stroke during pregnancy and postpartum are older age, pregestational and gestational hypertension, preeclampsia/eclampsia, coagulopathies, and smoking

  • 3.9.2 - Pre-eclampsia and Eclampsia

  • from Section 3.9 - Obstetrics and Maternal Peripartum Complications
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 316-319

  • Summary

    Key Learning Points

    1. 1. Pre-eclampsia is a major cause of mortality in developing countries. It remains a cause of significant morbidity and is a common reason for critical care admissions in the obstetric population in the UK.

    2. 2. Careful adherence to national guidelines on the treatment and prevention of pre-eclampsia should be followed when a patient is admitted to critical care and this requires a multidisciplinary approach.

    3. 3. Acute pulmonary oedema occurs in 3 per cent of patients with severe pre-eclampsia, and early diagnosis is essential to differentiate between hypertensive disease of pregnancy and other causes.

    4. 4. Haemolysis, elevated liver enzymes and low platelets (HELLP) is associated with pre-eclampsia and carries high maternal and neonatal morbidity.

    5. 5. Eclampsia can complicate severe pre-eclampsia or occur in stable or undiagnosed pre-eclampsia. Prompt delivery of the fetus should occur as soon as the mother has been stabilised.

  • 40 - The surgical abdomen

  • from Section 6 - Gastrointestinal emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 268-273

  • Summary

    This chapter discusses the diagnosis, evaluation and management of hypertensive emergencies. It describes special considerations for aortic dissection, acute ischemic stroke, acute intracerebral hemorrhage (ICH), and preeclampsia and eclampsia. The critical management of hypertensive emergencies depends on the presence of end-organ damage. Only patients with a diagnosis of hypertensive emergency require immediate interventions in the emergency department for lowering blood pressure. Patients with chronically elevated blood pressure may suffer detrimental consequences if their blood pressure is lowered too quickly. Dramatic and rapid decreases in blood pressure can result in critical hypoperfusion of the brain, heart, and kidneys, resulting in ischemia or infarction. Patients with hypertensive urgency can be managed as outpatients as long as reliable follow-up can be arranged. They are usually started on oral antihypertensives with a goal of lowering their blood pressure to less than 160/100 mmHg over 12-48 hours.

  • 15 - Emergency caesareansection

  • from Section 3 - Intrapartum Emergencies
  • Edited by Edwin Chandraharan, Sabaratnam Arulkumaran
  • Book:
    Obstetric and Intrapartum Emergencies
    Published online:
    05 November 2012
    Print publication:
    11 October 2012, pp 107-114

  • Summary

    This chapter discusses the pathophysiology, key implications, diagnostic signs and management of severe preeclampsia and eclampsia in an obstetric setting. Preeclampsia may affect multiple organ systems. Blood pressure greater than or equal to160/110 mmHg, severe headache with visual disturbance, epigastric pain, clonus and papilloedema are some of the diagnostic signs of severe preeclampsia. Patients should be managed in a high-dependency obstetric care setting with one-to-one experienced midwifery care. Hourly measurement and documentation of maternal observations like (blood pressure, pulse, respiratory rate, oxygen saturation, temperature, urine output, and neurological status) should be done. Magnesium sulphate should be commenced at diagnosis of severe preeclampsia/eclampsia; continuing until 24 hours following delivery/last seizure/commencement of magnesium sulphate therapy, whichever is the later. Antihypersensitives should be administered, and fluid management should be considered. Postpartum haemorrhage should be anticipated and managed efficiently. Regular 'skills drills' should be conducted on management of severe preeclampsia/eclampsia.

  • Chapter 8 - Coagulation and regional anesthesia

  • Edited by Ian McConachie, University of Western Ontario
  • Book:
    Controversies in Obstetric Anesthesia and Analgesia
    Published online:
    05 December 2011
    Print publication:
    17 November 2011, pp 113-121

  • Summary

    Pre-eclampsia is a multisystem disorder unique to human pregnancy. Over the years, advances in the understanding of the pathophysiology and hemodynamics of the disease have greatly impacted its obstetrical and medical management. Considerable research into the pathophysiology of pre-eclampsia is ongoing and many areas are still debated. Increased heart rate, cardiac output, stroke volume, and left ventricular end-diastolic volume accommodates the growing metabolic needs of the pregnancy. Decreased total peripheral vascular resistance as a consequence of the presence of the low-resistance placental circulation is a physiological characteristic of a normal pregnancy. Current general consensus suggests a combined approach using clinical measurements and serum markers of placental abnormality appropriate for gestational age. Aspirin has been the most widely studied drug therapy in the prevention of pre-eclampsia. Spinal anesthesia is an acceptable option for women with severe pre-eclampsia, especially as an alternative to general anesthesia in emergency cesarean section.

  • Chapter 103 - Reflex epilepsy with higher-level processing

  • from Section 4 - Provoked epilepsies
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 720-722

  • Summary

    This chapter presents a brief description of some uncommon vascular disorders that can characteristically cause epilepsy and/or seizures. The epilepsy is usually not the main clinical problem. In cases with moyamoya syndrome, the prognosis depends upon identification and treatment of the underlying cause of the condition. A seizure, which results in recategorization as eclampsia, may occur before, during, and after delivery. The cerebral vascular changes most commonly occur in the posterior circulation and have features such as hypertensive encephalopathy, including cerebral edema. Thrombosis of the cerebral venous system is less common than in the arterial system. The autoimmune state, characterized by the presence of antiphospholipid antibodies, may cause thrombosis both in arteries and in veins. The isolated angiitis is probably an inflammatory reaction caused by a variety of disorders, such as infections, but also cerebral amyloid angiopathy. Treatment of the arteritis includes corticosteroids, often in combination with other immunosupressive drugs.

  • Conception of Integrative Medicine

  • S. Gorbachev, G.A. Shifrin
  • Journal:
    Prehospital and Disaster Medicine / Volume 20 / Issue S1 / April 2005
    Published online by Cambridge University Press:
    28 June 2012, p. 35
    Print publication:
    April 2005
    • Article
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  • SECTION VI - PREGNANCY-RELATED NEUROLOGICAL EMERGENCIES

    • By Sid M. Shah, Assistant Clinical Professor Michigan State University; Faculty member of Sparrow/MSU Emergency Medicine Residency Program Lansing, Michigan, Kevin M. Kelly, Associate Professor of Neurology Drexel University College of Medicine
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book:
    Principles and Practice of Emergency Neurology
    Published online:
    06 August 2009
    Print publication:
    18 February 2003, pp -

  • Summary

    When convulsions and altered sensorium occur in the pregnant patient past 20 weeks gestation or in the first 2 weeks postpartum, eclampsia is the prime suspect. Phenytoin can be used to control seizures that are resistant to magnesium. Phenytoin is also a good choice if a woman is identified as high risk for eclamptic seizures and needs treatment for a prolonged period of time. Adequate control of hypertension is essential for prevention of central nervous system (CNS) complications in these patients. All patients with eclampsia and many with preeclampsia need hospitalization. Seizures are one of the most frequent neurological disorders encountered in pregnancy and carry an increased risk to the fetus from trauma, hypoxia, and metabolic acidosis. Quite common during pregnancy, headache is generally benign, but it can occasionally herald serious pathology. Chorea gravidarum (CG) is chorea occurring during pregnancy. Myasthenia gravis (MG) worsens in 40% of women with pregnancy.