Article Abstract:
High blood pressure during pregnancy is not uncommon. But during pregnancy it can compromise the well-being of the fetus or the mother by causing fetal growth retardation, miscarriage or fetal death. It is not clear which women should be treated with blood pressure-reducing drugs and at what point therapy should begin. Drug therapy is required when the diastolic blood pressure (the lower number in a blood pressure reading) exceeds 105-110 millimeters of mercury (mm Hg). The role of antihypertensive agents in preventing fetal growth retardation, miscarriage and fetal death is not well-established. Two treatment protocols for the treatment of pregnancy-induced high blood pressure were compared. Women whose blood pressure remained below 106 mm Hg were given either oxprenolol or oxprenolol plus dihydralazine (the early treatment group) or else they were given a placebo. All women whose blood pressure was above that level received antihypertensive treatment. All 78 women in the early treatment group and 76 in the comparison group were in their 28th week of pregnancy. Seven women in each group developed protein in the urine, an indicator that blood pressure control has not been achieved. Cesarean section was performed on 13 women in the early treatment group and 27 women in the comparison group. Seven of the caesareans in the early treatment group were performed to end a pregnancy complicated by severe high blood pressure and/or fetal distress, compared with 16 in the comparison group. Five of the infants died, two in the early treatment group and three in the comparison group. Treatment did not significantly influence the age or the weight of the fetus at birth. The infants in the treatment group had fewer breathing problems (respiratory distress syndrome) and fewer days spent in the hospital than the comparison group. It is concluded that the antihypertensive agent oxprenolol for the treatment of pregnancy-induced hypertension is safe to the mother and her fetus. Although early administration of the antihypertensive agents offered no additional benefit in terms of fetal growth, treatment may help to reduce cesarean sections by preventing severe high blood pressure later in pregnancy, as well as fetal distress. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Listeriosis is a disease caused by the bacteria Listeria monocytogenes. It can be transmitted to humans when infected food (primarily dairy products, vegetables, meat, poultry and shellfish) is eaten. The number of reported cases has increased in England and France. Patients with depressed immune systems, pregnant women and newborns are at the greatest risk for the infection. The infection is almost always fatal in newborns. The experience of three infants born with listeriosis is reported. In all three cases the fetuses were alive when their mothers arrived at the hospital. All three mothers reported flu-like symptoms and fever before delivery, which developed prematurely. Labor began when the membranes surrounding the fetus, which contained amniotic fluid contaminated with fetal stool (meconium), ruptured prematurely. Meconium-stained amniotic fluid is not a common finding before the 34th week of pregnancy (later in pregnancy it is a sign of fetal distress) and is sometimes a sign that the fetus is infected with Listeria. All three women had eaten foods that might have been contaminated. Soft cheeses, chilled cooked chicken or prepacked salads were suspected contaminants. Two of the newborns died soon after delivery. The third infant suffered severe neurological and developmental impairments. Listeria infection should be suspected if a pregnant woman in early labor has ruptured fetal membranes, unexplained fever and meconium-stained amniotic fluid. Pregnant women should be instructed to eat fully-cooked meats and poultry and should recook food that has been chilled in the refrigerator. Non-refrigerated soft cheeses should be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Preeclampsia is a complication of pregnancy marked by high blood pressure, swelling and protein in the urine, and, in the case of eclampsia, which can develop out of preeclampsia, convulsions. The mechanism causing preeclampsia is not well understood. There is some conflicting evidence regarding the hemodynamic characteristics of preeclampsia. Patients with high blood pressure of pregnancy may fall into two different hemodynamic categories. Patients are thought to have either low cardiac output (measured in terms of amount of blood ejected from the heart in one minute) and high vascular resistance (opposition to blood flow), or else high cardiac output and low vascular resistance. An article by Belfort et al. in the June 1989 issue of the British Journal of Obstetrics and Gynecology clarifies this issue. It was found that the few women with very low cardiac output and very high vascular resistance did not stand out clinically and may have been missed if they were not monitored with a cardiac catheter placed directly in the heart. The idea of expanding the blood volume is to improve the circulation through the placenta to the fetus. Drugs that dilate the blood vessels were useful in increasing the cardiac output. The cardiac output was increased further by volume expanders. Although the therapeutic benefit is unclear, the controlled use of volume expanders does not appear to worsen the high blood pressure. Close invasive monitoring of the heart must accompany treatment of women with severe preeclampsia. (Consumer Summary produced by Reliance Medical Information, Inc.)
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