Nematode infections: is it wise to withhold medical treatment during pregnancy? I. Biliary complications.
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Adult↗
Biomedical subjects
M A Villar
Publications and source records attributed to M A Villar.
Acute renal failure in hypertensive disorders of pregnancy. Pregnancy outcome and remote prognosis in thirty-one consecutive cases.
The purpose of this study is to report short-term pregnancy outcome, subsequent pregnancy outcome, and remote prognosis (follow-up from 0.3 to 9.8 years) in 31 cases complicated by acute renal failure. Eighteen patients had "pure" preeclampsia and 12 patients (13 pregnancies) had chronic hypertension, parenchymal renal disease, or both before pregnancy. All patients had serial evaluation of renal function, urine microscopy, and electrolyte studies at the onset of acute renal failure and on follow-up. There were three immediate maternal deaths (two in the pure preeclampsia group and one in the other group). Nine patients (50%) in the "pure" group required dialysis during hospitalization and all 18 patients had acute tubular necrosis. Five patients (42%) in the other group required immediate dialysis and three patients had bilateral cortical necrosis. The majority of pregnancies in both groups were complicated by abruptio placentae and hemorrhage. All 16 surviving patients in the pure preeclampsia group had normal renal function on long-term follow-up (average 4.0 +/- 3.1 years). Conversely, nine of the 11 surviving patients in the second group required long-term dialysis on follow-up and four of them ultimately died of end-stage renal disease. We conclude that proper management of acute renal failure in patients with pure preeclampsia-eclampsia does not result in residual function impairment.
Acute Kidney Injury↗
A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy.
Three hundred women with mild chronic hypertension at 6 to 13 weeks' gestation were randomly allocated to receive either methyldopa or labetalol or be in the control group. Thirty-seven women (12%) were excluded for various reasons. Of the remaining 263 patients, 90 received no drug, 87 received methyldopa, and 86 received labetalol. All 263 were followed throughout pregnancy with serial renal function tests and serial assessment of fetal status. There were no differences among the three groups in mean systolic or diastolic blood pressures, mean gestational age, or initial laboratory findings at time of entry. Patients treated with medications had significantly lower (p less than 0.0001) systolic and diastolic blood pressures throughout gestation compared with the no-medication group. Among the control group there was a spontaneously significant lowering (p less than 0.0001) of both systolic and diastolic blood pressures at 14 to 26 weeks' gestation. However, there were no differences among the three groups regarding the incidences of either superimposed preeclampsia (15.6%, 18.4%, and 16.3%, respectively), abruptio placentae (2.2%, 1.1%, and 2.3%, respectively), or preterm delivery (10%, 12.5%, and 11.6%, respectively). In addition, there were no differences among the groups regarding gestational age at delivery, birth weight, incidence of fetal growth retardation, or neonatal head circumference. There was one midtrimester loss in the methyldopa group and one stillbirth in each of the other groups. We conclude that treatment of maternal blood pressure in mild chronic hypertension during pregnancy did not improve perinatal outcome.
Adult↗
Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial.
Four hundred young normotensive primigravid women between 13 and 24 weeks' gestation were randomly allocated to one of two study groups. One group received placebo tablets and the other group received 365 mg of elemental magnesium daily (as magnesium aspartate hydrochloride). Three hundred seventy-four patients completed the study, 189 in the placebo group and 185 in the treatment group. There were no significant differences between the two groups regarding serum calcium, uric acid, or electrolyte levels. However, the magnesium-supplemented group had significantly higher magnesium levels at delivery (1.68 +/- 0.03 mg/dl vs. 1.56 +/- 0.03 mg/dl, p less than 0.01). There were no significant differences in either systolic or diastolic blood pressures between both groups either at time of enrollment or at subsequent gestational ages later during pregnancy. Analysis of variance for repeated measurements and Fisher's least significant difference testing indicated a significant increase (p less than 0.01) in blood pressure from the level at the time of enrollment to the level achieved at or beyond 37 weeks' gestation in each group. There were no significant differences between the two groups regarding any of the following parameters: incidences of preeclampsia, fetal growth retardation, preterm labor, birth weight, gestational age at delivery, or number of infants admitted to the special care unit. Magnesium supplementation during pregnancy did not improve pregnancy outcome in our population.
Blood Pressure↗
Clinical significance of elevated mean arterial blood pressure in second trimester and threshold increase in systolic or diastolic blood pressure during third trimester.
The purpose of this investigation was to determine the diagnostic value of an average mean arterial blood pressure in the second trimester of greater than or equal to 90 mm Hg and a threshold increase in diastolic blood pressure of greater than or equal to 15 mm Hg or in systolic blood pressure of greater than or equal to 30 mm Hg, on two occasions, 6 hours apart, in predicting preeclampsia. The study population consisted of 700 young normotensive primigravid women who were evaluated prospectively during pregnancy. Systolic and diastolic blood pressures were carefully measured at each prenatal visit, and the mean arterial blood pressure in the second trimester was calculated for each measurement. An average greater than 90 mm Hg was considered abnormal. One hundred thirty-seven patients had preeclampsia, for an overall incidence of 19.6%. An average greater than 90 mm Hg had a sensitivity of 8% and a positive predictive value of 23%. The respective values for a threshold increase of greater than 15 mm Hg in diastolic pressure were 39% and 32%. For a threshold increase of greater than 30 mm Hg in systolic pressure, values were 22% and 33%. The negative predictive values for all tests studied ranged between 81% and 85%. Neither a mean arterial blood pressure in the second trimester of greater than 90 mm Hg nor a threshold increase in systolic or diastolic blood pressure during the third trimester was significantly predictive of the development of preeclampsia.
Blood Pressure↗
Plasma volume, umbilical artery Doppler flow, and antepartum fetal heart testing in high-risk pregnancies.
The purpose of this clinical study is to investigate the diagnostic value of plasma volume (PV), nonstress test (NST), contraction stress test (CST), and umbilical artery Doppler (UAD) in detecting fetal compromise in 81 patients (83 fetuses) at risk for fetal growth retardation. Neither PV nor UAD studies were used in the clinical management. There were two stillbirths and three neonatal deaths for a perinatal mortality of 6%. Twenty-seven infants (32.5%) were small for gestational age (SGA), seven (8.6%) had cord pH 7.20 or less, and five (6.2%) had 5-minute Apgar scores less than 7. Overall, PV had the highest sensitivity and NST the highest specificity regarding delivery of SGA infants. The positive and negative predictive values for infants with low cord pH and low Apgar scores were similar among the various tests. There were nine fetuses with zero or reverse diastolic flow: seven were SGA (four perinatal deaths) and all of them had both nonreactive NST and positive CST. The other two infants were appropriate for gestational age with all other tests being normal. Antepartum fetal heart rate testing appears to be similar to other tests in predicting poor fetal outcome in high-risk pregnancies.
Apgar Score↗
Ampicillin prophylaxis in preterm premature rupture of the membranes: a prospective randomized study.
It is hypothesized that ampicillin may treat subclinical deciduitis and prolong the "effective" latent period in patients with preterm premature rupture of the membranes. We studied 82 patients with preterm rupture of membranes who were managed expectantly and were randomly assigned either to receive ampicillin prophylaxis (n = 43) or not to receive ampicillin prophylaxis (n = 39). Patients were excluded from study entry on admission if they had suspected or frank chorioamnionitis, active preterm labor, a history of penicillin allergy, multiple gestation, or cervical cerclage. There were no significant differences between the groups in duration of membrane rupture prior to admission, gestational age at membrane rupture, use of steroids and tocolysis, and demographic factors. Life-table analysis showed that the risk of delivery was significantly lower for the group of patients receiving prophylactic ampicillin. The incidence of neonatal infection was significantly lower in the ampicillin group, 1 (2%) versus 6 (17%), p less than 0.04.
Ampicillin↗
Eclampsia.
The incidence of eclampsia has decreased over the past two decades. Proper prenatal care with early identification and hospitalization of patients with mild pre-eclampsia is responsible for this reduction. Modifications of current obstetrics teachings designed to heighten awareness of the risk of both midtrimester and late-postpartum eclampsia could further reduce its occurrence. However, there will always be a small number of women in whom eclampsia is not preventable. Eclamptic patients should be counseled regarding the increased risk of pre-eclampsia or eclampsia in their sisters and daughters as well as their increased risk for both recurrence of the disease and perinatal death in subsequent pregnancies.
Counseling↗