oxytocin and Eclampsia

We report of a woman with post-partum cerebral angiopathy (PCA), in whom we repetitively performed transcranial Doppler sonography (TCD), MR imaging (MRI), and MR angiography (MRA) to evaluate the underlying pathophysiology. A 31-year-old woman, Gemini pregnant, complained of severe throbbing frontal headache four days after an uneventful delivery by Cesarean section. Blurred vision occurred eight days after delivery, followed by three generalized tonic-clonic seizures. Neurological examination revealed a somnolent woman without focal neurological deficits. At the day of the seizures increased flow velocities and disturbed flow were observed in the right posterior and anterior cerebral artery on transcranial Doppler (TCD). MRI showed infra- and supratentorial patchy hyperintensities in T2-weighted images and in the FLAIR sequence. Diffusion-weighted imaging revealed corresponding multi-focal hyperintense areas indicating increased diffusion and MRA showed a diffuse multisegmental narrowing of all pial arteries. MRI at day 10 was completely normal, but MRA still revealed vascular narrowing in the right posterior cerebral artery. General slight flow accelerations in all basal arteries occurred after 10 days and lasted for three weeks. PCA is apparently associated with a vascular narrowing causing cerebral ischemia with increased diffusion. Later reactive cerebral hyperperfusion is observed. Vascular narrowing and cerebral hyperperfusion still persist after MRI has normalized.

Topics: Acetates; Adult; Amines; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Aspirin; Brain Edema; Cerebral Angiography; Cerebral Arteries; Cerebral Hemorrhage; Cerebrovascular Circulation; Cyclohexanecarboxylic Acids; Echoencephalography; Eclampsia; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Observer Variation; Oxytocin; Postpartum Period; Pregnancy; Sensitivity and Specificity; Time Factors; Ultrasonography, Doppler, Transcranial

Maternal hypertensive disorder is one of the most common and severe medical complications during pregnancy. Epidural analgesia administration is widely used during labor process.. To evaluate the potential advantage or disadvantage of continuous epidural analgesia's on labor and neonates for maternal hypertensive disorder patients comprehensively.. We have retrospectively analyzed 232 patients who diagnosed as maternal hypertensive disorder in our hospital since 2015. Among which, 126 patients including 28 cases of severe preeclampsia were administrated with continuous epidural analgesia (Analgesia group), the other 106 patients were untreated (Control group). We have compared the maternal age, body weight, gestational weeks, period for the first and second labor stage; the incidence of eclampsia, natural labor, cesarean section, forceps delivery and postpartum hemorrhage between these two groups respectively; furthermore, we recorded patients who received oxytocin and antihypertensive treatment during the delivery progress as well as evaluated the neonate body weight, Apgar score and performed umbilical cord blood gas analysis.. Continuous epidural analgesia does not affect the first and second labor stage period (p=0.36), However, there is a significantly higher demand for oxytocin treatment (36.5% Vs 19.8%, p<0.01) and a significantly lower requirement for antihypertensive treatment (22.2% Vs 81.1%, p<0.001) in analgesia group compared to control group. We also notice that the natural delivery ratio in analgesia group is higher than control group and most importantly, continuous epidural analgesia can increase 1min Apgar score and has no other effect on neonates' body weight, umbilical cord blood gas parameters, 5min and 10min Apgar score.. Our result based on a large cohort comprehensive analysis indicates that continuous epidural analgesia can benefit both maternal hypertensive disorder patients and neonates without any side effect.

Topics: Analgesia, Epidural; Analgesia, Obstetrical; Antihypertensive Agents; Apgar Score; Birth Weight; Body Weight; Cesarean Section; Eclampsia; Female; Fetal Blood; Gestational Age; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Labor, Obstetric; Maternal Age; Obstetrical Forceps; Oxytocin; Postpartum Hemorrhage; Pregnancy

To determine whether the use of uterotonics, including oxytocin and prostaglandins, increases the risk of abruptio placentae and eclampsia.. A retrospective analysis was conducted among 260,174 Japanese women at term. Demographic characteristics were studied as possible candidates for risk factors of abruptio placentae and eclampsia using multivariate logistic regression analyses.. A total of 1,058 (0.41 %) and 147 (0.06 %) women developed abruptio placentae and eclampsia, respectively. Abruptio placentae and eclampsia occurred in 177 (0.29 %) and 42 (0.07 %) of the 61,857 women treated with uterotonics, respectively. Multivariate regression analyses indicated that uterotonics did not increase risk of developing either abruptio placentae or eclampsia. Primiparity [odds ratio (95 % confidence interval) 1.41 (1.24-1.60)], age ≥35 years [1.17 (1.03-1.33)], and presence of hypertension [2.42 (1.93-3.03)] were significant independent risk factors for abruptio placentae, while advancing gestation [0.67 (0.63-0.71)] decreased risk of abruptio placentae. Primiparity [odds ratio (95 % confidence interval) 4.06 (2.49-6.63)], age <20 years [2.44 (1.07-5.58)], presence of hypertension [28.7 (20.5-40.1)], and advancing gestation [1.28 (1.11-1.47)] were significant independent risk factors for eclampsia.. The use of uterotonics did not increase the risk of abruptio placentae and eclampsia.

Topics: Abruptio Placentae; Administration, Intravaginal; Adult; Asian People; Confidence Intervals; Eclampsia; Female; Humans; Hypertension; Japan; Labor, Induced; Logistic Models; Multivariate Analysis; Odds Ratio; Oxytocics; Oxytocin; Parity; Pregnancy; Prostaglandins; Retrospective Studies; Risk Factors; Socioeconomic Factors

PATH, an international nonprofit organization, assessed nearly 40 technologies for their potential to reduce maternal mortality from postpartum hemorrhage and preeclampsia and eclampsia in low-resource settings. The evaluation used a new Excel-based prioritization tool covering 22 criteria developed by PATH, the Maternal and Neonatal Directed Assessment of Technology (MANDATE) model, and consultations with experts. It identified five innovations with especially high potential: technologies to improve use of oxytocin, a uterine balloon tamponade, simplified dosing of magnesium sulfate, an improved proteinuria test, and better blood pressure measurement devices. Investments are needed to realize the potential of these technologies to reduce mortality.

Topics: Africa South of the Sahara; Asia; Blood Pressure Determination; Developing Countries; Diagnostic Techniques, Obstetrical and Gynecological; Eclampsia; Female; Humans; Inventions; Investments; Magnesium Sulfate; Maternal Death; Models, Theoretical; Organizations, Nonprofit; Oxytocin; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy; Proteinuria; Technology, Pharmaceutical; Uterine Balloon Tamponade

To determine the prevalence of drugs for comprehensive management of preeclampsia in national essential medicine lists (EMLs) in low and middle income countries (LMICs). We collected EMLs from the 144 LMICs identified by the World Bank through broad-based Internet searches and in collaboration with the World Health Organization. We identified therapies for hypertension, eclampsia, preeclampsia complications (e.g., pulmonary edema, thrombosis), preterm birth, and labour induction contained in the EMLs.. In 91 EMLs obtained from 144 LMICs, the most commonly listed parenteral antihypertensive therapies were verapamil (63.7%), hydralazine (61.5%), sodium nitroprusside (48.3%), and propranolol (39.6%). The most prevalent oral antihypertensive therapies were nifedipine (95.6%), methyldopa (93.4%), propranolol (90.1%), and atenolol (87.9%). For eclampsia/preeclampsia, magnesium sulphate was present in 84.6% of EMLs and calcium gluconate in 85.7%. For pulmonary edema, most EMLs (94.5%) listed oral furosemide, for thrombosis 92.3% listed heparin, for acceleration of fetal pulmonary maturity 90.1% listed parenteral dexamethasone, and for labour induction 97.8% listed oxytocin or a prostanoid (usually misoprostol, 40.7%).. EMLs of LMICs provide comprehensive coverage of preeclampsia pharmacotherapy. These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country.

Topics: Antihypertensive Agents; Betamethasone; Developing Countries; Dexamethasone; Diuretics; Eclampsia; Female; Fibrinolytic Agents; Glucocorticoids; Heparin; Humans; Magnesium Sulfate; Oxytocics; Oxytocin; Pre-Eclampsia; Pregnancy; Pulmonary Edema; Thromboembolism; Tocolytic Agents

Topics: Cambodia; Eclampsia; Female; Humans; Labor Stage, Third; Magnesium Sulfate; Massage; Maternal Mortality; Oxytocin; Postpartum Hemorrhage; Pregnancy; Surveys and Questionnaires

Topics: Adult; Antihypertensive Agents; Brain Diseases; Delivery, Obstetric; Eclampsia; Female; Follow-Up Studies; Gravidity; Humans; Magnesium Sulfate; Magnetic Resonance Imaging; Nifedipine; Oxytocics; Oxytocin; Paraparesis; Parietal Lobe; Pregnancy; Pregnancy Trimester, Second; Stillbirth; Time Factors; Tocolytic Agents; Tomography, X-Ray Computed; Treatment Outcome

To determine the effectiveness and safety of misoprostol in severe pre-eclampsia and eclampsia patients with unripe cervix.. A prospective observational study was carried out in 135 severe pre-eclampsia and eclampsia patients who required termination of pregnancy at the Department of Obstetrics and Gynecology, Khulna Medical College Hospital, Khulna, Bangladesh during January 2002 to October 2003. Fifty micrograms of misoprostol was used every 4 h in cases of unripe cervix (Bishop score < or = 6) in severe pre-eclampsia and eclampsia patients. Maternal and perinatal outcome as well as any complications were recorded.. In severe pre-eclampsia and eclampsia patients vaginal delivery occurred in 79.3 and 80.5% of cases, and cesarean section was performed in 20.6 and 19.4% of cases, respectively. The maximum required responsive dose was 50-150 microg. Oxytocin augmentation was required in 29.3 and 35% of cases, respectively. Induction to delivery time was median 8 h, interquartile ranges 4.2-8.2 h in the severe pre-eclampsia group, and median 9 h, interquartile ranges 6.8-12.5 h in the eclampsia group, and average hospital stay was 3.4 +/- 1.8 and 3.7 +/- 1.7 days, respectively. The only maternal complications were hyperstimulation which occurred in 6.8 and 5.1% of cases, respectively. Neonatal death occurred in five (11.3%) and eight cases (12.1%), respectively.. Intravaginal misoprostol is well tolerated and very effective for the induction of labor in severe pre-eclampsia and eclampsia patients with unripe cervix.

Topics: Adult; Cesarean Section; Delivery, Obstetric; Eclampsia; Female; Humans; Infant Mortality; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prospective Studies; Time Factors

We sought to determine risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum.. We performed a population-based case-control study. All Olmsted County, Minnesota, residents with a first lifetime deep vein thrombosis or pulmonary embolism during pregnancy or post partum from 1966 to 1990 were identified (N = 90). Where possible, a resident without deep vein thrombosis or pulmonary embolism was matched to each patient by date of the first live birth after the patient's child. The medical records of all remaining patients and all control subjects were reviewed for >25 baseline characteristics, which were tested as risk factors for deep vein thrombosis or pulmonary embolism.. In multivariate analysis smoking (odds ratio, 2.4) and prior superficial vein thrombosis (odds ratio, 9.4) were independent risk factors for deep vein thrombosis or pulmonary thrombosis during pregnancy or post partum.. Venous thromboembolism prophylaxis may be warranted for pregnant women with prior superficial vein thrombosis. Smoking cessation should be recommended, especially during pregnancy and the postpartum period.

Topics: Bed Rest; Body Mass Index; Case-Control Studies; Delivery, Obstetric; Eclampsia; Female; Heart Diseases; Humans; Hypertension; Obstetric Labor, Premature; Odds Ratio; Oxytocin; Parity; Pre-Eclampsia; Pregnancy; Pulmonary Embolism; Risk Factors; Smoking; Venous Thrombosis

Topics: Cervix Uteri; Dilatation; Eclampsia; Female; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Wettability

Presented is a case of an eclamptic patient whose primary clinical presentation was cortical blindness. The patient was not known to be preeclamptic during her prenatal course, but she was lost to follow up one month prior to her presentation. Computed tomographic scan of the head was consistent with hypertensive encephalopathy. She was treated as an eclamptic patient. Her blood pressure was controlled with hydralazine, and she was given magnesium sulfate intravenously and intramuscularly. Labor was induced with a pitocin infusion. After delivery of a term infant, her vision returned and all other symptoms resolved without sequelae. The etiology and pathophysiology of cortical blindness as a symptom of eclampsia are discussed.

Topics: Adult; Blindness; Eclampsia; Female; Humans; Hydralazine; Hypertension; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications; Tomography, X-Ray Computed

Topics: Abortion, Therapeutic; Eclampsia; Female; Humans; Infusions, Parenteral; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, Second; Urea

Topics: Adolescent; Adult; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Blood Urea Nitrogen; Disseminated Intravascular Coagulation; Eclampsia; Erythrocytes, Abnormal; Female; Fibrinogen; Heparin; Humans; Infant, Newborn; Kidney; Liver; Magnesium Sulfate; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Rupture; Thrombin

Topics: Adolescent; Adult; Amniotic Fluid; Cervix Uteri; Delivery, Obstetric; Eclampsia; Female; Humans; Injections, Intravenous; Labor, Induced; Labor, Obstetric; Magnesium Sulfate; Oxytocin; Pregnancy; Prognosis; Uterus

Topics: Adrenal Insufficiency; Ascites; Brain Injuries; Diabetes Insipidus; Eclampsia; Endocrine System Diseases; Female; Humans; Liver Cirrhosis; Oxytocin; Pregnancy; Vasopressins; Water-Electrolyte Balance

Topics: Eclampsia; Female; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy in Diabetics

Topics: Adolescent; Adult; Amniotic Fluid; Eclampsia; Female; Humans; Oxytocin; Pregnancy; Uterus

Topics: Amobarbital; Antihypertensive Agents; Cesarean Section; Eclampsia; Female; Humans; Hydralazine; Hypertension; Infant; Infant Mortality; Labor, Induced; Labor, Obstetric; Maternal Mortality; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Reserpine; Seasons

Topics: Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Antihypertensive Agents; Anuria; Coma; Eclampsia; Female; Hibernation; Humans; Hypertension; Hypothermia, Induced; Labor, Induced; Labor, Obstetric; Oxytocin; Pre-Eclampsia; Pregnancy; Seizures

Topics: Aerosols; Amnion; Cesarean Section; Eclampsia; Female; Fetal Death; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy, Prolonged; Surgical Procedures, Operative; Uterine Hemorrhage

Topics: Administration, Intranasal; Blood Pressure; Blood Pressure Determination; Eclampsia; Female; Heart Defects, Congenital; Humans; Hypertension; Oxytocin; Pharmacology; Pregnancy; Pregnancy Complications; Preventive Medicine; Puerperal Disorders