Hypertension in pregnancy.
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Drugs used in obstetrics which affect carbohydrate metabolism are reviewed in regard to their mode of action and their effects on diabetic pregnancies. Hyperglycemic reactions can be expected following administration of diuretics (especially with long acting thiazides), diazoxide, beta-adrenergic stimulants (tocolytics), glucocorticoids, and prolactin. Hypoglycemic reactions can occur with high doses of acetylsalicylic acid and in the presence of insulin with beta-adrenergic blockers or other inhibitors of the sympathetic system such as guanethidine. Other drugs affecting the carbohydrate metabolism are listed in regard to their hypo- or hyperglycemic effects.
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Serum alpha 2-macroglobulin (alpha 2-M) levels were measured in cord sera of Chinese, Caucasian and Ghurka babies in Hong Kong by the antibody-agar radial immunodiffusion technique. The values for male babies of the three ethnic groups were 293 +/- 59, 323 +/- 79 and 303 +/- 72 mg./100 ml., respectively; those for female babies were 287 +/- 74, 315 +/- 74 and 317 +/- 7) mg./100 ml., respectively. Although a general similarity of cord serum alpha 2-M levels was evident at birth, it was noted that ethnic differences in the level of this serum protein only become apparent later in life. The value obtained for Caucasian cord serum alpha 2-M in Hong Kong was significantly lower than a published value for Caucasians elsewhere.
Determination of ABO and HL-A antigens and sex ratio of infants born to 46 women with preeclampsia or eclampsia, in comparison with normal controls, disclosed no predominant blood group, HL-A haplotype, or qualitative difference in maternal-fetal incompatibility. These results suggest that a link between immunologic mechanisms and the pathogenesis of toxemia syndromes, if present at all, must be associated with feto-placental tissue-specific antigens.
Having plotted a curve showing the normal values of Alpha-Foeto-protein (AFP) concentration in maternal serum and amniotic fluid, its significance in the monitoring of "at risk" pregnancies was examined and critically judged in the light of statements found in the literature. According to the results gained AFP determination in maternal serum or amniotic fluid can only be used with reservation as a monitoring test in "at risk" pregnancies. In particular in Rhesus Incompatibility it was impossible to establish the degree of foetal Haemolysis or to determine the best time for premature induction. In addition an intra-uterine death could not be predicted with certainty.
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From 1973 to 1975, 287 serum levels of alpha 1 fetoprotein in women with pre-eclamptic toxemia were determined. Pre-eclamptic toxemia was classified according to modified scheme of Goecke and Rippmann. 161 patients had mild pre-eclamptic toxemia (index 1-3), 72 patients had moderate pre-eclamptic toxemia (index 4-6), 54 patients had severe pre-eclamptic toxemia (index 7). In all types of severity of pre-eclamptic toxemia more levels of alpha fetoprotein were lower or higher than the normal levels including the standard deviations. The number of abnormal values rose with an increasing toxemia index. There was no statistically significant difference between too high values and too low values. Significantly more values were above and also below the normal values. Our investigations appear to indicate that the determination of the alpha fetoprotein is not only valuable as screening method for neural tube defects but also of value in the diagnosis and management of pre-eclamptic toxemia. Too high and too low values should not be differentiated but values both above and below the normal levels should be considered.
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Renal biopsies in 14 patients with P.E.T. or eclampsia showed constant I.F. reactions for IgM and fibrin, with frequent reactions for C1q and C3. The glomeruli showed reversible mesangial proliferation and swelling, with characterictic E.M. deposits, and segmental lesions were present in seven patients. Similar I.F. reactions occurred in three other patients with clinical diagnoses of P.E.T. whose biopsies demonstrated coexistent glomerular disease. Serum complement studies showed a significant rise in C3 in the third trimester of normal pregnancies and a further significant elevation in C1q and C3 in the third trimester of a series of unselected P.E.T. patients. In contrast, four patients from the biopsy series with eclampsia or severe P.E.T. showed profound depression of serum C3 and C4, at the time of maximum clinical severity, which was shown to return to normal in two patients. The I.F. findings confirm those of Petrucco et al (6), and, with the other data, suggest that immune-complex deposition and activation of the classical complement pathway could interrect with intravascular coagulation to produce the glomerular lesions of P.E.T. and eclampsia.