Does volume expansion in pre-eclampsia help or hinder?

Article Abstract:

Preeclampsia is a complication of pregnancy marked by high blood pressure, swelling and protein in the urine, and, in the case of eclampsia, which can develop out of preeclampsia, convulsions. The mechanism causing preeclampsia is not well understood. There is some conflicting evidence regarding the hemodynamic characteristics of preeclampsia. Patients with high blood pressure of pregnancy may fall into two different hemodynamic categories. Patients are thought to have either low cardiac output (measured in terms of amount of blood ejected from the heart in one minute) and high vascular resistance (opposition to blood flow), or else high cardiac output and low vascular resistance. An article by Belfort et al. in the June 1989 issue of the British Journal of Obstetrics and Gynecology clarifies this issue. It was found that the few women with very low cardiac output and very high vascular resistance did not stand out clinically and may have been missed if they were not monitored with a cardiac catheter placed directly in the heart. The idea of expanding the blood volume is to improve the circulation through the placenta to the fetus. Drugs that dilate the blood vessels were useful in increasing the cardiac output. The cardiac output was increased further by volume expanders. Although the therapeutic benefit is unclear, the controlled use of volume expanders does not appear to worsen the high blood pressure. Close invasive monitoring of the heart must accompany treatment of women with severe preeclampsia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Drug therapy, Preeclampsia, Vasodilators, Vasodilator agents, Hypertension in pregnancy, Gestational hypertension, Blood plasma substitutes, editorial

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Pregnancy following simple repair of the ruptured gravid uterus

Article Abstract:

When a pregnant (gravid) uterus ruptures, usually as a result of a scar in the uterine muscle, total abdominal hysterectomy (surgical removal of the uterus, fallopian tubes and sometimes the ovaries) has been the treatment of choice as a means of preventing another uterine rupture in a future pregnancy. More recently a simple repair of a rupture in a pregnant uterus and a tubal ligation (ligation of the fallopian tubes rendering the woman sterile) have been performed. These researchers, in a retrospective study, assert that, in carefully selected patients who have had only simple repair of a uterine rupture, subsequent pregnancies can have successful outcomes. Fifteen patients with previous uterine repair due to rupture were followed during 18 pregnancies. There were no cases of repeated uterine rupture and 17 pregnancies had a positive outcome. All of the infants were delivered by cesarean section between the thirty-fifth and fortieth weeks of pregnancy. The failed pregnancy was due to intrauterine death and was not related to the previous repair. It is recommended that patients be carefully assessed for uterine repair versus total hysterectomy procedures when uterine rupture occurs. In subsequent pregnancies early delivery by cesarean section is advised for these patients.

Surgery, Hysterectomy, Labor, Complicated, Labor complications, Uterus, Pregnant, Pregnant uterus

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Morphometric differences between the placental vasculature of non- smokers, smokers and ex-smokers

Article Abstract:

Smoking during pregnancy has been associated with lower birth weight and growth retardation in infants. Early reports indicate that there are fewer blood vessels available in placentas of women who smoke, decreasing the amount of oxygen available for the fetus. To investigate how the placenta, the organ responsible for fetal nourishment, is effected by smoking during pregnancy the placentas of 15 nonsmokers, 15 moderate smokers, 15 heavy smokers, and 13 ex-smokers (seven of whom stopped smoking during pregnancy) were studied to confirm whether smoking effects the placental blood vessels and to observe if the changes return to normal when the women stop smoking. Compared to women who stopped smoking after learning of their pregnancy, measurements of the placentas of women who smoked during pregnancy revealed a reduced amount of capillaries (small blood vessels) and increased thickness of the surrounding membranes. These measurements are less severe than those previously described. However, these changes were absent in non-smokers and in women who stopped smoking before conception. The researchers continue to advise women to stop smoking before conception.

Maternal-fetal exchange, Complications and side effects, Physiological aspects, Tobacco, Smoking and women, Women smokers

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