Hypertension in Pregnancy

Hypertension in Pregnancy

George Saade, S. Thornton

Language: English

Pages: 397

ISBN: 2:00183458

Format: PDF / Kindle (mobi) / ePub


Covers gestational and chronic hypertension in addition to severe preeclampsia, eclampsia, and HELLP syndrome and discusses the interaction with the renal, hematological, neurological, and hepatic systems of pregnant women.

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mediated by an endotheliumderived relaxing factor, identified in 1987 as nitric oxide (37). However, as knowledge of endothelium-dependent responses has advanced, it has become clear that the endothelial release of nitric oxide cannot account for all endotheliumdependent relaxation. Long before nitric oxide was described it was known that ACh caused hyperpolarization of smooth muscle (38), the endothelial dependence of this response was first described in the mesenteric artery of the guinea pig by

relationships. In the evolutionary theory, by a mechanism to prevent propagation of their own genetic bloodline, males would imprint their sperm more ‘‘aggressively’’ when they do not expect to have offspring with that female or if a mother already has existing children by another man. In this view, the sperm exposure theory to habituate the female to paternal antigens becomes irrelevant. It is important to keep in mind that the paternal factor is not the only determinant of preeclampsia. Also Li

base reflective of the great interest in this pregnancy complication. Terminology and diagnostic criteria used to describe and diagnose the syndrome have been inconsistent and confusing. This is in part due to differences in laboratory testing methods, disagreements regarding laboratory thresholds for disease diagnosis, heterogeneity among patient presentations, and variations in sampling times during the course of disease. Fundamentally there are three general diagnostic criteria required to make

typically diagnosed by the presence of an absolute blood pressure у140 mmHg systolic and/or у 90mmHg diastolic. Previously the definition included a rise in blood pressure from preconception or firsttrimester values of more than 25–30 mmHg systolic and/or 15 mmHg diastolic. It is uncertain how these discriminant levels of blood pressure were chosen. It is known that a diastolic blood pressure у 90 mmHg is associated with a higher incidence of proteinuria (21) and that systolic blood pressure is

preeclampsia or eclampsia encountered in a tertiary referral center. Due to referral bias, with most published studies from tertiary care centers, and because of 148 Martin et al. difficulties with the diagnosis, the true incidence of HELLP syndrome is difficult to determine. We estimate from the available data that approximately 1 per 1000 pregnancies in the United States is affected. VI. PATIENT SERIES AND DISEASE CLASSIFICATION Investigators at the Universities of Mississippi (Jackson)

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