Serum Calcium Status among Pregnancies Complicated By Pre-Eclampsia in Bangladesh.
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This case control cross sectional study was carried out in the department of biochemistry, Mymensingh medical college in collaboration with the outpatient department, family planning model clinic and antenatal obstetric ward of Mymensingh medical college hospital, Mymensingh during the period of July 2003 to June 2004. The aim of the study was to explore the status of serum calcium among pregnancies complicated by pre-eclampsia in Bangladesh as a means to monitor the possibility of management of these patients. A total of 82 subjects were selected and were grouped as Group I (32 healthy women with uncomplicated pregnancy as control subjects) and Group II (50 pregnant women with pre-eclampsia as cases). Serum calcium was estimated by colorimetric method from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum calcium were 8.71±1.00 and 10.78±1.44 mg/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum calcium (P<0.001). It is evident from the study that serum calcium level significantly increases among pregnancies complicated by pre-eclampsia in Bangladesh.Keywords:
Outpatient clinic
Cross-sectional study
Statistical Analysis
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The prevalence of hypertension in pregnancy is 4-10 percent. The most serious complication associated with hypertension in pregnancy is pre-eclampsia. In one out of ten pregnancies where pre-eclampsia is present very serious complications develop in the mother or the foetus, or both. Rising blood pressure remains the main indicator of impending pre-eclampsia. The reliability of blood pressure measurement is therefore of particular importance in pregnancy. This is emphasized by the following characteristics of hypertension in pregnancy: limited time to observe the patient; pre-eclamptic complications may be present at any stage where there is a rise in blood pressure, and the indications for and objectives of treatment of pregnancy hypertension are different from those employed in the general population. The measurement of antenatal blood pressure should be standardized. It should be carried out by a limited number of well-qualified health professionals, using only equipment of reknowned quality and technical standard. Rising blood pressure in pregnancy indicates pre-eclampsia until it has been disproved post partum. Because pre-eclampsia is a placental disorder, the foetus may be at risk at any stage in the development of the disease. The status of the foetus should therefore be monitored accordingly.
Hypertension in Pregnancy
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The incidence of pre-eclampsia in a second pregnancy has been studied in 6, 637 women for Aberdeen City whose pregnancies occurred between 1969 and 1978. The rate of pre-eclampsia in second pregnancy is less than in first pregpancy, but this is altered by the outcomp of the first pregnancy with reference to length of gestation, occurrence of pre-eclampsia and abortion.
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Abstract: In this study, the course of 40 pregnancies in 16 women with essential thrombocythaemia (ET) was analysed retrospectively. Of the pregnancies, 45% were complicated, 55% uncomplicated, and 62% resulted in live birth. The most common complication was spontaneous abortion during the first trimester seen in 33% of all pregnancies and comprising 72% of all complications. Two intrauterine foetal deaths occurred at weeks 22 and 28. Three pregnancies were complicated by eclampsia or pre‐eclampsia. Nine of 16 women with 29 pregnancies had at least one complicated pregnancy. In seven of 16 women, all 11 pregnancies were uneventful. The non‐pregnancy‐related symptoms of ET or the platelet count before conception or during pregnancy did not correlate with the risk of pregnancy complications. Treatment with low‐dose acetylsalicylic acid (ASA) alone during pregnancy or platelet‐lowering drugs before or during pregnancy reduced the risk of complications.
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Department of Obstetrics and Gynaecology, University of Aberdeen, and Medical Sociology Unit, Institute of Medical Sociology, Aberdeen, Scotland
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Objective To investigate whether pre-eclampsia is more common in first pregnancies solely because fewer affected women, who presumably have a higher risk of recurrence, go on to have subsequent pregnancies. Design Prospective cohort study. Setting Swedish Medical Birth Register. Participants 763 795 primiparous mothers who had their first births in Sweden, 1987-2004. Main outcome measures Pre-eclampsia. Results The risk of pre-eclampsia was 4.1% in the first pregnancy and 1.7% in later pregnancies overall. However, the risk was 14.7% in the second pregnancy for women who had had pre-eclampsia in their first pregnancy and 31.9% for women who had had pre-eclampsia in the previous two pregnancies. The risk for multiparous women without a history of pre-eclampsia was around 1%. The incidence of pre-eclampsia associated with delivery before 34 weeks’ gestation was 0.42% in primiparous women, 0.11% in multiparous women without a history of pre-eclampsia, and 6.8% and 12.5% in women who had had one or two previous pregnancies affected, respectively. The proportion of women who went on to have a further pregnancy was 4-5% lower after having a pregnancy with any pre-eclampsia but over 10% lower if pre-eclampsia was associated with very preterm delivery. The estimated risk of pre-eclampsia in parous women did not change with standardisation for pregnancy rates. Conclusions Having pre-eclampsia in one pregnancy is a poor predictor of subsequent pregnancy but a strong predictor for recurrence of pre-eclampsia in future gestations. The lower overall risk of pre-eclampsia among parous women was not explained by fewer conceptions among women who had had pre-eclampsia in a previous gestation. Early onset pre-eclampsia might be associated with a reduced likelihood of a future pregnancy and with more recurrences than late onset pre-eclampsia when there are further pregnancies. Findings are consistent with the existence of two distinct conditions: a severe recurrent early onset type affected by chronic factors, genetic or environmental, and a milder sporadic form affected by transient factors.
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Women with a multiple pregnancy are at increased risk of developing hypertensive disorders of pregnancy. We describe a case of a dichorionic triamniotic triplet pregnancy complicated by severe hypertension, proteinuria and maternal symptoms, fitting with the diagnosis of pre-eclampsia, apart from the early gestational age of only 16 weeks. After reduction of the monochorionic pair, the disease resolved and pre-eclampsia was diagnosed again at 30 weeks of gestation, resulting in a delivery on maternal indication at 33 weeks of gestation. In a review of the literature, we found six papers including eight cases on multifetal pregnancy reduction on maternal indication. Multifetal pregnancy reduction resulted in a prolongation of pregnancy of two to 21 weeks and may be considered in extreme early onset pre-eclampsia in dichorionic multiple pregnancies.
Gestational hypertension
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A total population of pregnant women from Aberdeen City District 1967-1978 has been studied. There were 29 851 pregnancies and 6637 women had a first recorded pregnancy between 1967 and 1978 and had two or more pregnancy events. As expected the incidence of pre-eclampsia in a second pregnancy was less than that in a first pregnancy, but it was dependent on the outcome of the first pregnancy. If the first pregnancy was complicated by proteinuric pre-eclampsia than the incidence of the condition in the second pregnancy was similar to that in a first pregnancy, but women who were normotensive in the first pregnancy had a reduced incidence of the condition in the second pregnancy. The incidence of proteinuric pre-eclampsia after early abortion (less than 13 weeks), either spontaneous or induced was similar to the population incidence in a first pregnancy, but after a late spontaneous abortion the risk of proteinuric pre-eclampsia was significantly reduced. Change of civil status of the offspring from first to second pregnancy did not affect the incidence of pre-eclampsia in a second pregnancy. There was an effect of birthweight in that women who had proteinuric pre-eclampsia in conjunction with a low-birthweight baby (less than 2500 g) in their first pregnancy had double the incidence of proteinuric pre-eclampsia in their second pregnancy. Only a pregnancy of 37 weeks or more is likely to offer protection or 'immunity' to pre-eclampsia in a second pregnancy and even then the effect is moderated by the development of pre-eclampsia in the first pregnancy.
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Objective To explore treatment approaches for hypertensive disorders in pregnancy.Methods The study analyzed the past 37 hypertensive disorders in pregnancy cases that received treatment in Yanbian Women and Children's Hospital during the period from Jan 2009 to Jul 31,2010.Results Out of all the 37 cases,gestational hypertension 2 cases,mild preeclampsia 9 cases,severe preeclampsia 24 cases,eclampsia 1 case,after having received anticonvulsant,lowering blood pressure and symptomatic treatments,except for one case of maternal and fetal death,patients of all the rest cases were cured and discharged.Conclusion The treatment of hypertensive disorders in pregnancy should be varied in accordance with patient's condition and the number of gestational weeks.
Gestational hypertension
Hypertensive disorder
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