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PubMed1976

Renal prostaglandins for induction of labour-a dual clinical advantage in toxemia of pregnancy.

Prostaglandin A is known to be an antihypertensive vasodepressor agent produced by the kidney and has the basic potentialities of a hormone. No information is available at present concerning its effect on the human pregnant uterus and whether it can be used as an oxytocic compound to induce labour. The uterine stimulating and labour inducing ability of PGA1 was evaluated in 10 cases; seven patients were suffering from pregnancy toxemia while three were normal pregnancies near full term. Cardiotocographic tracings showed that uterine activity was markedly stimulated to a degree sufficient to induce labour. Continuous i.v. infusions at a rate of 0.25-1.0 mug/Kgm/min given over a fixed period of only 6 hours resulted in delivery in all cases except one following the discontinuation of administration. Beneficial effects on blood pressure were observed in toxemic subjects. Potentially serious FHR patterns and occasional hypertonus during therapy were seen and stress the need for more information to evaluate the safety, optimum dosage and duration of infusion as well as the place of this approach in clinical practice for the management of pregnancy toxemia. The absence of antidiuretic effect, the hypotensive response and uterine stimulating property of PGA1 indicate a possible advantage in toxemia of pregnancy as compared to oxytocin infusions.

Blood Pressure↗
PubMedDate not supplied

Changes in placental atrial natriuretic peptide receptors associated with severe toxemia of pregnancy.

We have previously demonstrated the presence of atrial natriuretic peptide (ANP) specific receptors in normal human placentas. Since toxemia of pregnancy may affect important metabolic, transport and hemodynamic functions of placentas, we have asked the question whether binding properties of human placental ANP receptors are changed in patients with severe toxemia of pregnancy when compared to normal patients. ANP receptors in plasma membranes from normal and severely toxemic patients were characterized by in vitro radioligand assays utilizing [125I]-alpha-hANP. In all cases, we identified specific, high affinity, low capacity ANP binding sites in a microsomal fraction of human placentas. Although the total concentration of receptors did not differ between the two groups, the dissociation constant, KD, was significantly higher in placentas from severely toxemic patients than from normal controls. From the above we conclude that placental ANP receptors are dynamically modulated and their characteristics may be altered in severe toxemia of pregnancy.

Acute Disease↗
PubMedDate not supplied

Postpartum toxemia: hypertension, edema, proteinuria and unresponsiveness in an unknown female.

Eclampsia, or toxemia of pregnancy, is a disorder of pregnancy characterized by seizures associated with hypertension, edema, and proteinuria. Toxemia of pregnancy carries significant maternal and fetal morbidity and mortality. Eclampsia most commonly occurs in the antepartum period. A minority of cases, however, may initially manifest in the postpartum period. We present the case of a 28-year-old female with postpartum eclampsia presenting to the Emergency Department with altered mental status. A review of the literature concerning postpartum toxemia and a discussion of appropriate management strategies follows.

Adult↗
PubMed1979

Effect of prostaglandin A1 on renal hemodynamics in pregnancy toxemia.

PGA1 was infused at a constant rate for 2 hours in 35 pregnant women in the third trimester. Twenty-five patients had clinical manifestations of pregnancy toxemia and 10 served as control subjects. Two dose levels (0.5 to 1.0 mug/kg/min) were investigated and obstetric aspects as well as renal hemodynamics were evaluated. At the high-dose level, the drug induced labor in half the subjects (toxemia patients and control subjects) and elicited a hypotensive response only in hypertensive cases. A marked increase in GFR and RPF was achieved at both dose levels in all cases. Plasma electrolytes, osmolality, and urea levels were unaltered. Also, the infusions did not induce any appreciable diuresis or natriuresis. Tph mechanisms of the induced changes and possible etiologic involvement of PGA1 in toxemia are discussed.

Blood Pressure↗
PubMed2000

Pregnancy toxemia of ewes, does, and beef cows.

Pregnancy toxemia commonly affects pregnant ewes and does during late gestation. This metabolic disease is thought to result from disruption of the dam's glucose homeostatic mechanism in response to increased nutritional demands of the rapidly developing fetal placental unit. Commercial production systems are comprised of a variety of nutritional, metabolic, genetic, physiologic, environmental, economic, health, and management factors that singularly or as a group influence the clinical expression of pregnancy toxemia. Recognizing the role management plays in controlling these inputs is crucial to pregnancy toxemia prevention and treatment programs.

Animals↗
PubMed2002

Induction of labor in toxemia with misoprostol.

BACKGROUND: To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in toxemia of pregnancy with a modified Bishop score of < or =4. METHODS: A hundred preeclamptic women with a modified Bishop score of < or =4 were randomized into two groups of 50 patients one group receiving 50 microg intravaginal misoprostol 4 times at 4 hour intervals, the second group receiving oxytocin infusion for induction of labor starting from 1 mIU/per minute, increasing it every 30 minutes with 2 mIU/per minute increments up to maximum of 30 mIU/per minute. Modified Bishop scores 12 hours after induction, the time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann Whitney-U, Chi-Square and hypothesis tests about differences for two proportions (t test) to determine differences between the two groups. p< or =0.05 was considered significant. RESULTS: Misoprostol was significantly superior for induction of labor in toxemia of pregnancy with modified Bishop score of < or =4. After 12 hours median modified Bishop scores of misoprostol administered group and oxytocin administered group were 7 and 4 respectively. Misoprostol administered group 1 was significantly better than oxytocin administered group 2 (p=0.027). The rate of patients who were in labor after 12 hours were 94% and 80% in group 1 and 2 respectively and the difference showed significant difference (p<0.05). The median time from induction to delivery was 14 hours and 16 hours in the misoprostol and oxytocin administered group respectively with significant difference between the groups (p=0.003). The rate of vaginal delivery was significantly higher in the misoprostol administered group 1 (82%) when compared with the oxytocin administered group 2 (66%) (p<0.05). The 1 and 5 minutes median Apgar scores were 5-7 and 6-7.5 in group 1 and 2, respectively with no significant differences between the groups (p=0.96, p=0.64). The rate of admission to neonatal intensive care unit was similar in both groups. The complication rates were similar in all groups and no significant detrimental effects were noted. CONCLUSIONS: Intravaginal misoprostol is an efficacious, cheap and safe method of induction of labor in toxemia of pregnancy with modified Bishop score of < or =4.

Administration, Intravaginal↗
PubMed2000

Role of nutrition in the prevention of toxemia.

Toxemia of pregnancy is called the disease of theories because, over decades of research, numerous causes have been proposed but none proved. Although many nutritional factors have been suggested as playing a causal role in the etiology of toxemia, mortality from this disease has not varied over time or between circumstances as one would expect a nutritional disease to do. This does not mean that there is no nutritional influence, but it does mean that the available evidence does not show that nutrition makes a major difference in maternal mortality from toxemia of pregnancy.

Female↗
PubMed1981

Retinopathy in toxemia of pregnancy.

Two cases of toxemia of pregnancy are presented, with color photographic documentation of the accompanying retinopathy. Although both pregnancies resulted in delivery of a viable infant and resolution of other systemic manifestations of toxemia, both patients were left with severe visual impairment. The retinopathy of toxemia is emphasized as a potential source of permanent morbidity in this complication of pregnancy.

Adolescent↗
PubMedDate not supplied

Retinal pigment epithelium tear following toxemia of pregnancy.

A 28-year-old woman with toxemia during the 34th week of pregnancy complained of visual loss in one eye. Two weeks after abruptio placentae and delivery a retinal pigment epithelium (RPE) tear which presumably followed a RPE detachment (PED) was found in the macular region of the right eye. Visual acuity was 0.8 at the time of diagnosis but was 1.0 in both eyes one year after the delivery. Some authors have described peculiar choroidal lesions associated with central serous chorioretinopathy (CSC) in pregnancy and ischemic exudative choroidal lesions during severe toxemia. However, the findings we describe are highly unusual, indicating that the mechanisms of choroidal and RPE pathology are still poorly understood. We also demonstrate that a pathological tear following toxemia of pregnancy is compatible with good acuity in spite of the anatomical damage.

Abruptio Placentae↗
PubMed1980

Urinary fibrinolysis in toxemia of pregnancy.

Serial determinations of urinary plasmin level by radiocaseinolytic assay were performed in 40 healthy women and 29 patients with various types of toxemia throughout pregnancy, labor and the puerperium. The results indicate that: 1. The urinary plasmin level in normal pregnancy increased significantly from the third trimester to the early puerperium. 2. In mild pre-eclampsia, a significant rise in urinary plasmin level from 26 weeks of gestation to the 4th day post-partum. 3. In severe pre-eclampsia, a progressive decrease in late pregnancy was found. After delivery, in the early puerperium, the urinary plasmin level of the patients with a rapid clinical was significantly higher than that of the patients with the sequelae of toxemia. Our study showed that serial assays of urinary plasmin activity can provide a reliable and sensitive index of severity, progression and natural history of toxemia of pregnancy.

Abruptio Placentae↗
PubMed1999

Pregnancy toxemia in the European ferret (Mustela putorius furo).

BACKGROUND AND OBJECTIVE: Pregnancy toxemia may lead to appreciable mortality among jills and their offspring. The objective of this report was to increase awareness of the disease, its likely cause, and practical prevention and treatment measures. METHODS: Ten cases of pregnancy toxemia were evaluated. Jills were in late gestation (mean, 38 days; range, 34 to 42 days) and had large litters (mean, 11.5 kits; range, 7 to 15 kits). RESULTS: The most common clinical signs of disease were lethargy, inappetence, dehydration, and excess shedding. Hematologic and clinical biochemical abnormalities included anemia (4 of 8 jills tested), hypoproteinemia (5 of 7), azotemia (7 of 7), hypocalcemia (5 of 6), hyperbilirubinemia (3 of 3), and high liver enzyme activities (6 of 6). Two jills were found dead; two jills were euthanized, six received supportive treatment, and cesarean section was performed on five. The three jills that survived tended to have less pronounced azotemia, hypoproteinemia, and liver enzyme activity increases and were not anemic. Hepatic lipidosis was observed grossly in all jills that died and was confirmed by histologic examination in four jills. CONCLUSIONS: Pregnancy toxemia in ferrets resembles metabolic diseases in several other animal species and requires aggressive treatment, including supportive care, nutritional supplementation, and cesarean section. Maintaining adequate nutrition and avoiding stress late in gestation may prevent the disease.

Anemia↗
PubMed1999

[Bilateral retinal detachment in toxemia of pregnancy].

In this article, we present two cases of bilateral retinal detachment in toxemia of pregnancy. The first case describes 31-year old patient admitted to hospital due to toxemia of pregnancy in the 38th week of the second pregnancy. Medical examination following admission showed blood pressure 180/130 mm Hg oedema of face and legs. Accessory investigations displayed proteinuria, leukocyturia, bacteriuria. At the fundus of eye the features of initial retinopatia hypertonica were discovered. On the fifth day of the patient's hospitalization because of the worsening of general health condition and sudden blood pressure increase, the pregnancy was delivered by cesarean section. Some hours after awakening the patient reported the loss of vision of both eyes. Ophthalmological examination showed the occurrence of retinal detachment. Tearing wasn't found. When the protein deficiency was supplemented and antiinflammatory and oedema--reducing treatment was administered the blood pleasure stabilized retina attached itself and visual functions returned. In the second case 22-year old patient was admitted to hospital at term of labour with blood pressure 150/90 mm Hg and a little proteinuria. On the second day of hospitalization the pregnancy was delivered through natural passages. A few hours after the delivery the patient reported indistinct vision and blurring of the image. Through ophthalmological examination retinal detachment was stated. Tearing was not found. Thanks to bed regime and resorbing treatment total retinal attachment was gained and visual functions returned. This case suggests that retinal detachment of pregnant woman does not have to be proceeded by symptoms of toxemia of pregnancy and the period of delivery may accelerate and release mechanisms damaging choriocapillaries, which causes the flow of liquid from vessels of chorioidea to subretinal space.

Adult↗
PubMed2005

[Maternal and foetal prognostic during severe toxemia].

Severe gravidic toxemia gives heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognostic. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and a blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematome and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28.8%. The rate of delay intra-uterine growth was 43.8% and the prematurity 65.9%. More toxemia appears early during pregnancy more maternal and foetal prognostic is compromised.

Adult↗
PubMed1990

[The role of middle-weight molecules in the pathogenesis of late pregnancy toxemia].

Serum levels of plasma-derived toxic protein components, the median weight molecules (MWM), have been assayed in 206 women with third-trimester pregnancy and in their newborns. Toxemia of various severity was present in 194 women and had developed in the presence of an extragenital disease in 84.2% (pyelonephritis, glomerulonephritis, essential hypertension, etc.). Concentrations of MWM were found to increase with deterioration of renal function and to correlate with severity of nephropathy. In every second pregnancy with toxemia, interventions included extracorporeal detoxication: ultraviolet-irradiated blood autotransfusion (UIBA) and hemosorption. The rates of intra- and postpartum complications or requirement for surgery were 1.5-2-fold lower in these patients, and their newborns has better neonatal progress. Perinatal mortality of these patients was two times as low as that in the rest of the population (31.9:1000 versus 62.6:1000). The use of UIBA is recommended for mild and moderate toxemia and in combination with hemosorption for severe nephropathy.

Blood↗
PubMed1987

Proliferative retinopathy and toxemia of pregnancy.

Retinopathy occurring during toxemia of pregnancy generally shows the features of hypertensive retinopathy. The authors describe the case of a patient with bilateral peripheral neovascularizations following toxemia of pregnancy. The likely pathogenesis is ascribed to the development of ischemic areas, which can be determined by microthrombus formation. Presently, low-grade disseminated intravascular coagulation is considered very important in the pathogenesis of toxemia of pregnancy. After panretinal fluorangiography, a selective photocoagulation of ischemic areas was performed. The regression of neovascularizations was observed after one month. No similar case report could be found in the literature.

Adult↗
PubMed1987

Scanning electron microscopic study on the angioarchitecture of glomeruli in experimental toxemia of pregnancy in the rabbit.

Experimental toxemia of pregnancy in late gestation in rabbits was induced by constricting the aorta below the renal arteries on day 21 of gestation. Light and transmission electron microscopic examination of glomeruli on day 29 revealed only a slight swelling of endothelial cells. The angioarchitecture was also investigated using scanning electron microscopic examination of methyl methacry corrosion casts of the glomeruli. The kidney in experimental toxemia was characterized by a reduction of glomerular vessel diameter compared to that of normal pregnant rabbits. This probably resulted from enlargement of the endothelial cells, suggesting a reduced blood supply to the glomerulus. These findings suggest that interference with the blood supply to the pregnant uterus is an important factor in the development of the renal lesion of experimental toxemia of pregnancy in the rabbit.

Animals↗
PubMed1984

[A morphological study on the placenta in toxemia of pregnancy].

The morphological changes in 64 placentas in toxemia of pregnancy were studied by means of histological (HE, Azan and PAM stains) and morphometrical methods. The author tried to compare these results with inter-typical differences in toxemia classified into H, P and PH type according to the main symptoms, and examined the influence of these results on fetal development. The histological findings were as follows: In comparison with the inter-typical differences, fibrin deposition, damaged basement membrane and swelling of the endothelial cells of villous capillaries were conspicuous in P and PH types. However, prominent syncytial knots, stromal fibrosis and villous atrophies were main findings in H type. The morphometrical findings were as follows: On evaluation of the results of the point count method, both the intervillous space and the volume of the terminal villi decreased in proportion to the degree of toxemia. On evaluation of the results obtained with the Digigramer-G (Mutoh Kohgyo Co. Ltd., Tokyo), the cross-sectional area of terminal villus, the area of the capillary lumina and the number of capillaries per villus showed the same tendency as the results obtained with the point count method. Thus the severity of morphological changes in the toxemic placenta correlated with the extent of fetal development.

Birth Weight↗
PubMed1983

[Fibrinolysis in pregnancy toxemia].

Pathogenesis of toxemia of pregnancy has been studied of late in terms of coagulation and fibrinolysis, and the results show evidence of hypercoagulability but not of fibrinolysis which has remained unclarified. Our study aims to elucidate the fibrinolytic kinetics of toxemia in normal pregnant women divided into mild and severe types and eclampsia, and also to study changes in the coagulation and fibrinolytic system in toxemia given urokinase. In the affected group the following 1)--3) parameters characteristics were more significant than in other groups. 1) Decreased platelet count. 2) Prolonged ELT. 3) Increased AT-III. 4) There was no significant difference between the groups examined in PT, APTT, Fbg., serum FDP, alpha 2-antipl., alpha 1-AT, alpha 2-MG, C1-INA, and plg. 5) Signs in eclampsia, with region slightly distributed, tended to resemble those in the serious group. 6) alpha 2-antipl., and alpha 1-AT in the case given urokinase tended to decrease. 7) There was observed a case of accelerating and lowering fibrinolysis that appeared simultaneously with the following signs: decreased alpha 2-antipl., increased serum FDP, and prolonged ELT; and also the case whose signs widely changed even after a relatively small dose of urokinase. The results obtained suggest the possibility of variable fibrinolytic kinetics.

Female↗