enalapril and Pre-Eclampsia

Topics: Double-Blind Method; Enalapril; Feasibility Studies; Female; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy; Renin; Renin-Angiotensin System

Myasthenia gravis is a chronic autoimmune disease of neuromuscular transmission resulting in fatigable skeletal muscle weakness. Preeclampsia is a multisystem disease of pregnancy which is characterised by hypertension and involvement of one or more organ systems. Both diseases are responsible for considerable morbidity and mortality for mother and fetus. The occurrence of both preeclampsia and myasthenia gravis in pregnancy is very rare, and conflicts arise when considering the optimal management of each disease.We present a case of a parturient who was newly diagnosed with both myasthenia gravis and preeclampsia in late pregnancy. Myasthenia treatment was started with prednisolone and pyridostigmine, and delivery was by caesarean section at 37 weeks gestation under spinal anaesthesia. Postnatally, the patient developed worsening of myasthenia and preeclampsia symptoms. We consider the anaesthetic implications for both diseases and describe our approach for the management of this case.

Topics: Adult; Anesthesia, Spinal; Anesthetics, Local; Antihypertensive Agents; Cesarean Section; Cholinesterase Inhibitors; Enalapril; Female; Humans; Immunoglobulins, Intravenous; Infant, Newborn; Male; Myasthenia Gravis; Pre-Eclampsia; Prednisolone; Pregnancy; Pyridostigmine Bromide; Treatment Outcome

Hypertension during preeclampsia is associated with increased maternal vascular sensitivity to angiotensin II (ANGII). This study was designed to determine mechanisms whereby agonistic autoantibodies to the ANGII type I receptor (AT1-AA) enhance blood pressure (mean arterial pressure [MAP]) and renal vascular sensitivity to ANGII during pregnancy. First, we examined MAP and renal artery resistance index in response to chronic administration of ANGII or AT1-AA or AT1-AA+ANGII in pregnant rats compared with control pregnant rats. To examine mechanisms of heightened sensitivity in response to AT1-AA during pregnancy, we examined the role of endogenous ANGII in AT1-AA-infused pregnant rats, and that of endothelin-1 and oxidative stress in AT1-AA+ANGII-treated rats. Chronic ANGII increased MAP from 95±2 in normal pregnant rats to 115±2 mm Hg; chronic AT1-AA increased MAP to 118±1 mm Hg in normal pregnant rats, which further increased to 123±2 mm Hg with AT1-AA+ANGII. Increasing ANGII from 10(-11) to 10(-8) decreased afferent arteriole diameter from 15% to 20% but sharply decreased afferent arteriole diameter to 60% in AT1-AA-pretreated vessels. Renal artery resistance index increased from 0.67 in normal pregnant rats to 0.70 with AT1-AA infusion, which was exacerbated to 0.74 in AT1-AA+ANGII-infused rats. AT1-AA-induced hypertension decreased with enalapril but was not attenuated. Both tissue endothelin-1 and reactive oxygen species increased with AT1-AA+ANGII compared with AT1-AA alone, and blockade of either of these pathways had significant effects on MAP or renal artery resistance index. These data support the hypothesis that AT1-AA, via activation of endothelin-1 and oxidative stress and interaction with endogenous ANGII, is an important mechanism whereby MAP and renal vascular responses are enhanced during preeclampsia.

Topics: Angiotensin II; Angiotensin-Converting Enzyme Inhibitors; Animals; Aorta; Autoantibodies; Blood Pressure; Enalapril; Endothelin-1; Female; Hypertension, Pregnancy-Induced; Kidney; Oxidative Stress; Placenta; Pre-Eclampsia; Pregnancy; Rats; Rats, Sprague-Dawley; Reactive Oxygen Species; Receptor, Angiotensin, Type 1

A case is reported describing severe pre-eclampsia, treated firstly with antihypertensive drugs and Caesarean section. Contrary to expectation blood pressure did not fall and proteinuria still remained. Blood pressure reducing drugs had no effect at all. The patient was then treated with Renitec (enalapril), an ACE-inhibitor, with good result--even when given in a small dosis. No influence on lactation was documented for five weeks. Teratogenicy has been reported using ACE-inhibitors, and only a little is known about their effect on lactation. We found Renitec to have a good effect on reducing blood pressure postpartum and no effect on lactation at all.

Topics: Adult; Cesarean Section; Enalapril; Female; Humans; Infant, Newborn; Lactation; Postpartum Period; Pre-Eclampsia; Pregnancy

Topics: Acute Kidney Injury; Adult; Enalapril; Female; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy