Continuous electrocardiographic monitoring in hypertensive crises in pregnancy
Article Abstract:
Eclampsia is a potentially fatal complication of pregnancy associated with seizures, high blood pressure (hypertension), coma, and other physiological changes. Although many deaths of eclamptic women are due to cerebral hemorrhage (bleeding into the brain), other direct causes of death have not been characterized. The possibility that cardiac arrhythmias (irregularities in the heartbeat) accompany eclampsia was investigated in 21 patients who were either eclamptic (convulsions, hypertension, excess protein in the urine) or in a state of imminent eclampsia (stomach pain, blurred vision, headache, and nervous system abnormalities). The women underwent standard treatment, as well as continuous cardiac monitoring for 24-hours. Premature ventricular contractions (extra heartbeats, also called ventricular extrasystoles) were counted and ranked according to their frequency and pattern of occurrence. A control group, consisting of pregnant women with normal blood pressure, were also examined. The eclampsia group was at an earlier stage of pregnancy (average, 32 weeks) than the control group (38 weeks). Results showed that cardiac arrhythmias were present in five control patients, and in all eclamptic or imminent-eclamptic patients. The arrhythmias of all controls and of five eclamptic patients were of the lowest grade, consisting of isolated ventricular extrasystoles. The remaining 15 patients had frequent ventricular extrasystoles and complex arrhythmias ranked as grades III or IV (the highest grades in the ranking scale). These abnormalities decreased during delivery (14 deliveries were by cesarean section under optimal physiologic maintenance), but reappeared afterwards, and disappeared only several hours after blood pressure returned to normal. The results indicate the development of life-threatening ventricular arrhythmias in 71 percent of the patients, but were not a result of electrolyte imbalance or similar physiologic derangement. Drugs that lower blood pressure and control cardiac arrhythmias may be beneficial for pregnant women in hypertensive crises. Complex ventricular arrhythmias may be a cause of sudden death in such cases. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1991
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National High Blood Pressure Education Program Working Group report on high blood pressure in pregnancy
Article Abstract:
A report is presented from a working group of obstetricians and internists, appointed by the National High Blood Pressure Education Program of the National Heart, Lung, and Blood Institute and the American College of Obstetricians and Gynecologists, concerning high blood pressure in pregnancy. This complication occurs in almost 10 percent of pregnancies; it is categorized as chronic hypertension, preeclampsia (symptoms of hypertension, headache, excess protein in the urine, and swelling of the legs), preeclampsia superimposed upon hypertension, or transient hypertension. Hypertension is a significant cause of maternal death, usually resulting from eclampsia (associated with seizures and coma). The physiological characteristics of the hypertensive patient and the pathophysiology of hypertension itself are explained. Diagnostic issues are discussed. Management begins with advising hypertensive women of the possibility of complications should they become pregnant. When pregnant, patients are treated without medication whenever possible, and restriction of activity, home blood pressure monitoring, and elimination of alcohol and tobacco are prescribed. Dietary control, recommended for nonpregnant women, is not usually advised in pregnancy. Even among women with severe hypertension, most infants will be healthy and full-term. The rationale for drug therapy and the drugs preferred in such cases are discussed. Whether treatment of chronic hypertension prevents preeclampsia is not known, in spite of extensive research on the subject. Little is known regarding the prevention of this complication; a review of the medical literature on this subject is presented. Acute hypertension that develops during delivery can be treated pharmacologically, in most cases. Drugs used in this context are evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1990
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Magnesium sulfate versus phenytoin for seizure prophylaxis in pregnancy-induced hypertension
Article Abstract:
Although pregnant women with hypertension are usually given magnesium sulfate to prevent seizures, it is possible that other anticonvulsants, such as phenytoin, would also be effective. To investigate this further, a prospective, controlled study was carried out with 47 hypertensive patients who are at 36 weeks or more gestation (70 percent were only mildly hypertensive). The subjects were randomly assigned to receive either magnesium sulfate (24 patients) or phenytoin (23 patients) intravenously; blood levels of the drugs were monitored. After delivery, patients and nurses completed questionnaires concerning the side effects of the drugs. The neonatal outcome was also evaluated. Results showed that both drugs were safe and tolerated well by the women. No seizures occurred and no negative neonatal outcomes were noted. The blood levels of free phenytoin (not bound to albumin) were within the therapeutic range in 22 cases, while the total phenytoin levels (free plus bound) were higher than the usual levels in nonpregnant patients. The results show that both phenytoin and magnesium sulfate are safe and effective for seizure prophylaxis. Because less patient monitoring is needed with phenytoin than magnesium sulfate, patients with mild pregnancy-induced hypertension and low risk of seizures may be better suited for phenytoin treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Obstetrics and Gynecology
Subject: Health
ISSN: 0002-9378
Year: 1991
User Contributions:
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