Pregnancy-induced hypertension and acute fatty liver of pregnancy: atypical presentations

Article Abstract:

Preeclampsia, pregnancy-induced hypertension, is a common and serious complication of pregnancy. Acute fatty liver occurring during pregnancy may be another manifestation of the same disease. A case is described of a 29-year-old woman who developed hypertension and acute fatty liver in two consecutive pregnancies. Results of laboratory tests of liver function were atypical. The patient had a history of two miscarriages, and she developed hypertension at 29 weeks' gestation. Ultrasound scanning showed fetal death. The only abnormal laboratory test was of one liver enzyme, proteins that are important in liver function and are released into the blood when the liver is damaged. Usually, liver disease is accompanied by elevated blood levels of three or more liver enzymes. Except for a slight elevation of antibodies associated with autoimmune diseases, a follow-up examination two months later revealed no obvious disease states. The patient became pregnant again, and blood pressure remained normal throughout the pregnancy. Liver function tests were repeated at 30 weeks, and levels of the same liver enzyme, alkaline phosphatase, were again elevated and continued to rise for the next five weeks. Noninvasive tests of liver structure and function were normal. The patient gave birth to a healthy infant following elective cesarean section at 35 weeks, and liver biopsy taken during surgery showed features of acute fatty liver. The report suggests that acute fatty liver of pregnancy can occur with abnormalities in alkaline phosphatase only, and supports the idea that preeclampsia and acute fatty liver are associated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Fatty liver, Preeclampsia

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Urinary tract dilatation in pregnancy

Article Abstract:

While dilatation of the ureters (the tubes carry urine from kidney to bladder) and renal pelvis (the part of the kidney where urine collects) are considered normal in pregnancy, there is no standard criteria that defines the normal limits of such changes. The case report is presented of a 29-year-old woman who developed extensive enlargement of one ureter and renal pelvis, to a point where kidney function could have been compromised. This occurred in the patient's fourth pregnancy; two normal previous pregnancies had been preceded by one in which mild hypertension (high blood pressure) developed. Labor was induced at 36 weeks' gestation because of the growth of the renal pelvis, and a healthy infant was delivered. After delivery, the renal pelvis and ureter returned to their normal sizes. Although massive enlargement as seen in this case could indicate disease of the ureter, this was not found; the changes were only the result of pregnancy. Induction of labor was probably not necessary, and patients with these alterations should be allowed to continue to term unless signs of kidney impairment are noted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Physiological aspects, Pregnancy, Kidney diseases, Urinary organs, Urinary tract, Kidney diseases in pregnancy

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Ambulatory blood pressure in pregnancy: comparison of the Spacelabs 90207 and Accutracker II monitors with intraarterial recordings

Article Abstract:

The Suntech Medical Instrument's Accutracker II and the Spacelabs 90207 ambulatory blood pressure monitors may not provide accurate blood pressure readings in pregnant women. Researchers studied 39 pregnant third-trimester white women with hypertension, 18 of which were taking oral antihypertensive medication. Intraarterial pressures were recorded and compared with ambulatory machines. The Accutracker II substantially underestimates systolic pressure. The Spacelabs 90207 substantially overestimates diastolic pressure. However, measurements were not significantly less accurate than those obtained by mercury sphygmomanometers.

Equipment and supplies, Measurement, Testing, Pregnant women, Blood pressure, Hemodynamic monitoring, Blood pressure measurement

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