摘要:

Objective: To examine the hormonal and clinical effects of intravenous volume expansion therapy in women with pregnancy-induced hypertension (PIH).Methods: Fifteen untreated women with PIH, six of whom had significant proteinuria, were randomized to receive a 500 ml infusion of either Haemaccel (n = 7) or a control solution (hypotonic saline, n = 8), and the acute response of the following hormones was examined: plasma atrial natriuretic peptide (ANP), angiotensin II (ANG II), adrenaline (Adr), and noradrenaline (NA). These were measured by radiomimmunoassay or enzyme immunoassay as appropriate following plasma extraction. Blood pressure (BP) and pulse rate (PR) were measured before, during, and after the infusion as well as 24 and 48 h later.Results: The infusion of Haemaccel but not hypotonic saline was associated with a significant decrease in plasma albumin and hematocrit. Plasma ANP increased significantly in those who received Haemaccel but not in controls, while there were no significant changes in plasma ANG II, Adr, or NA in response to either infusion. There were no acute changes in blood pressure or pulse rate in response to intravenous volume expansion.Conclusions: Intravenous volume expansion therapy in women with PIH is associated with an increase in plasma ANP which does not acutely decrease blood pressure but may have a role in the more chronic effects of such treatment.

ISSN:1064-1955    

DOI:10.3109/10641959309079447

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Objective: Normal pregnant women are characterized by decreases in blood pressure and dramatic falls in systemic vascular resistance. This vasodilation is lost in pregnancies complicated by proteinuric hypertension (preeclampsia). Because gamma-amino butyric acid (GABA) is considered to be both an inhibitory neurotransmitter and an antihypertensive amino acid, we hypothesized that GABA levels might increase throughout gestation and might play a role in the vasodilatory alterations observed in normal pregnancy.Methods: Blood samples for measurement of plasma GABA by high-pressure liquid chromatography (HPLC) were obtained from 4 normal nonpregnant women, from 39 pregnant women at various times throughout gestation, and from 5 women with preeclampsia (37-40 weeks).Results: Normal pregnancy was associated with progressive increases (p<0.01) in plasma GABA levels after the first trimester, reaching maximum values by 27-33 weeks of gestation. In term hypertensive pregnant women, GABA levels were 13±3% lower (p<0.048) as compared to gestational age-matched controls. During the second and third trimesters of pregnancy, alterations in plasma GABA levels generally mirror changes in plasma volume and correspond inversely with known cardiovascular changes, for example, decreases in blood pressure and especially systemic vascular resistance.Conclusions: These changes in plasma GABA concentrations suggest a potential role for GABA in modulating cardiovascular adaptations in normal pregnancy and a possible role in the development of pregnancy-induced hypertension.

ISSN:1064-1955    

DOI:10.3109/10641959309079448

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Objective: We have quantitated renin activity and angiotensinogen and measured the expression of renin and angiotensinogen genes in placentas from normal and preeclamptic subjects to determine if tissue renin system parameters are elevated in preeclampsia.Methods: Tissue renin activity and tissue levels of angiotensinogen were measured by enzymatic techniques, and renin and angiotensinogen mRNA were quantitated by blot hybrodization in placentae from young nulliparous black women with preeclampsia and normal controls.Main Outcome: Placental ischemia is considered one of the etiological factors of preeclampsia. All components of the renin system are present in human placenta, and enhanced expression of this system may contribute to placental ischemia.Results: Tissue active renin concentration was slightly elevated in preeclamptics (130±20 ng Al/mg protein/h) versus controls (80±20), but angiotensinogen levels did not differ. In preeclamptic placentae renin mRNA was also elevated (249±35 versus 207±42 arbitrary density units/jig total RNA), and angiotensinogen mRNA levels were the same as normal placentae. In normal, but not in preeclamptic placentae, a significant linear correlation was apparent between renin mRNA and total renin concentration (r = 0.87, p<0.002).Conclusions: Tissue renin systems may well contribute to the hypertension associated with pregnancy; however, larger study populations will be required to verify this.

ISSN:1064-1955    

DOI:10.3109/10641959309079449

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Objective: To evaluate the absorption, placental transfer, receptor occupancy, and acute hemodynamic effects of a single peroral dose of pindolol in healthy term pregnancy.Methods: Ten pregnant healthy women admitted for cesarean section at term after uneventful pregnancy received each 5 mg of pindolol perorally before operation. The acute hemodynamic responses were measured, and maternal and fetal circulations were assessed with color Doppler ultrasonography. Pindolol concentrations were measured with a sensitive radioreceptor binding assay, and the corresponding beta2-receptor occupancy was determined.Results: Mean maternal concentration of pindolol 1 h after ingestion was 9.4 ng/ml, and it rose to 14.6 ng/ml at the time of cesarean section; respective beta2-receptor occupancies were 91.8% and 98.8%. In the umbilical artery, pindolol concentration was 50% of the maternal concentration. A plasma concentration of 2.5 ng/ml yielded 90% beta2-receptor occupancy, which reflects the high potency of pindolol.Conclusion: Despite almost total blockade of beta2-receptors, no changes in maternal or fetal hemodynamics or Doppler flow velocity waveforms were observed.

ISSN:1064-1955    

DOI:10.3109/10641959309079450

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Objective: To assess the value of a serotonergic receptor antagonist in the management of the HELLP syndrome.Methods: An open, noncontrolled study over a 1-year period (1990–1991) in a tertiary center. We evaluated the effects of ketanserin, a serotonin receptor antagonist, on 15 women suffering from the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count).Main Outcome Measures: Antenatal evolution of platelet count and blood pressure.Results: The platelet count (mean±SD) before delivery increased from 38.513±19.551±109/L to 133.133±68.576±109/L after treatment (p<0.0001). Systolic blood pressure (mean±SD) fell from 157±19 mm Hg to 132±11 mm Hg (p<0.0031), and the diastolic from 99±8 mm Hg to 87.5±10 mm Hg (p<0.0008). Severe epigastric pain was also decreased.Conclusion: Our experiences indicate that ketanserin could be useful in the management of this serious complication of pregnancy.

ISSN:1064-1955    

DOI:10.3109/10641959309079451

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Objective: This study attempted to determine whether mildly elevated blood pressure during late pregnancy showed the“white coat”phenomenon, with recordings outside the office being below those during a recent clinic visit.Methods: The study group consisted of healthy, previously normotensive patients whose blood pressures during the most recent office visit were elevated on recordings taken initially by a nurse, and then by a physician. Each patient's blood pressures were then recorded automatically by an ambulatory blood pressure monitor (Space Labs 90207) for an average of 106 measurements (over 19 h) per subject. The computer-generated diastolic, systolic, and mean arterial pressure recordings for the next day were averaged for the daytime and nighttime, then compared to those obtained in the recent clinic visit.Results: Thirty (8.0%) of 377 patients followed consecutively in a low-risk clinic had elevated blood pressures during an office visit. In 27 (90.0%) patients, the averaged blood pressures outside the clinic were below those measured in the office. Systolic readings of 140 mm Hg or greater were present in 8.8% (280 of 3181) of ambulatory recordings, while diastolic readings of 90 mm Hg or greater were found in 7.9% (251 of 3181). In no case were averaged blood pressures at home higher than those in the clinic, during the daytime or nighttime hours.Conclusion: This form of mild hypertension during pregnancy is frequently specific to a clinic visit and may lead to unnecessary treatment of hypertension.

ISSN:1064-1955    

DOI:10.3109/10641959309079452

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

ISSN:1064-1955    

DOI:10.3109/10641959309079453

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

ISSN:1064-1955    

DOI:10.3109/10641959309079454

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

ISSN:1064-1955    

DOI:10.3109/10641959309079446

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor