cardiovascular-agents and Hypertension--Pregnancy-Induced

Hypertensive disorders of pregnancy are major health issues affecting mothers and infants. General anesthesia is inevitable for certain mothers with these conditions and they may exhibit pronounced hemodynamic instability, especially during induction and airway manipulation. The aims of this study are to combine direct and indirect comparisons of the efficacies of different medications used in attenuating reflex hemodynamic responses and generate intervention ranking by network meta-analysis (NMA).. A systematic and comprehensive search will be performed using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases, beginning from their inceptions to November 2019. Only randomized clinical trials evaluating the efficacy and safety of pharmacologic interventions for preventing hemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy will be included. The primary endpoints will be maximal mean arterial pressure (MAP) and maximal heart rate after intubation. Maximal systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and maternal/fetal blood gas analysis, as well as safety issues, including Apgar score at 1 minute and 5 minutes after delivery, will be also assessed.We will conduct both pairwise meta-analysis and network meta-analysis. We will use surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX).. The results of this systematic review and NMA will be published in a peer-reviewed journal.. This NMA will enable us to determine the order of effectiveness and safety of pharmacological interventions used in attenuating hemodynamic responses for mothers with hypertensive disorders of pregnancy.. CRD42019136067.

Topics: Cardiovascular Agents; Female; Humans; Hypertension, Pregnancy-Induced; Intubation, Intratracheal; Meta-Analysis as Topic; Pregnancy; Systematic Reviews as Topic

To use the Theory of Planned Behavior (TPB) combined with action and coping planning plus global relationship with husband to explain the aspirin adherence in a sample of women with high-risk pregnancy.. A total of 535 Iranian women (mean age = 32.29 ± 4.98; year of marriage = 6.89 ± 3.61) completed the study. Each participant filled out several questionnaires on TPB (i.e., a widely applied theory describing how behaviors are influenced by beliefs, attitudes, perceived behavioral control and behavioral intentions), action planning, coping planning and relationship with husband at baseline. Eight weeks later, each participant completed the Five-item Medication Adherence Rating Scale (MARS-5) and underwent the blood test on aspirin serum level to provide the subjective and objective aspirin adherence information, respectively. Structural equation modeling (SEM) was applied to test three proposed models on aspirin adherence.. The TPB with planning plus relationship with husband was supported (comparative fit index = 0.969; Tucker-Lewis index = 0.950). Behavioral intention was the mediator in the associations of aspirin adherence and the following variables: attitude, perceived behavioral control, and relationship with husband. Action and coping planning mediated the associations of aspirin adherence and the two variables of behavioral intention and perceived behavioral control. Relationship with husband mediated the association of subjective norm and aspirin adherence.. The TPB model with (action and coping) planning plus relationship with husband serves a potential mechanism to explain the aspirin adherence for women with high risk of pregnancy. Possible implications are discussed based on our results.

Topics: Adaptation, Psychological; Adult; Aspirin; Cardiovascular Agents; Female; Health Knowledge, Attitudes, Practice; Humans; Hypertension, Pregnancy-Induced; Intention; Interpersonal Relations; Iran; Male; Medication Adherence; Middle Aged; Models, Psychological; Pregnancy; Prospective Studies; Psychological Theory; Risk Assessment; Risk Factors; Spouses

Cardiovascular drugs are used in pregnancy to treat maternal and fetal conditions. Mothers may also require drug therapy postpartum. Most cardiovascular drugs taken by pregnant women can cross the placenta and therefore expose the developing embryo and fetus to their pharmacologic and teratogenic effects. These effects are influenced by the intrinsic pharmacokinetic properties of a given drug and by the complex physiologic changes occurring during pregnancy. Many drugs are also transferred into human milk with potential adverse effects on the nursing infant. This article summarizes some of the literature concerning the risks and benefits of using cardiovascular drugs during pregnancy.

Topics: Abnormalities, Drug-Induced; Anti-Arrhythmia Agents; Anticholesteremic Agents; Anticoagulants; Arrhythmias, Cardiac; Cardiac Glycosides; Cardiovascular Agents; Female; Fibrinolytic Agents; Humans; Hypertension, Pregnancy-Induced; Maternal-Fetal Exchange; Platelet Aggregation Inhibitors; Pregnancy; Pregnancy Complications, Cardiovascular