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Trastornos hipertensivos del embarazo Hypertensive disorders of pregnancy
Alfredo Vázquez Vigoa,Goliat Reina Gómez,Pedro Román Rubio,Roberto Guzmán Parrado
Revista Cubana de Medicina , 2005,
Abstract: Los trastornos hipertensivos del embarazo son problemas médicos importantes que explican una proporción elevada de complicaciones maternas y fetales. La preeclampsia constituye la más grave de las complicaciones hipertensivas del embarazo y puede resultar catastrófica si pasa inadvertida, sin tratamiento o si evoluciona hacia una eclampsia. El tratamiento adecuado requiere tener presente los cambios normales de la presión arterial y del volumen intravascular que tienen lugar durante el embarazo. La preeclamsia se caracteriza por vasoconstricción extrema, aumento de la reactividad vascular y disminución del volumen intravascular. El desafío mayor es enfrentar el tratamiento por el hecho de estar en riesgo 2 vidas y porque no existen estudios de vigilancia prolongada con los diferentes fármacos antihipertensivos. En esta revisión se presenta una propuesta de tratamiento donde se discuten las pautas terapéuticas fundamentales basadas en la correcta utilización de los pilares principales de terapia antihipertensiva, con eficacia y seguridad reconocida, que incluye la metildopa, la hidralacina, los bloqueadores a y (labetalol), los anticálcicos y los betabloqueadores. The hypertensive disorders of pregnancy are important medical problems that explain a great number of maternal and fetal complications. Preeclampsia is the most severe of the hypertensive complications of pregnancy and it may be catastrophic if it is not treated or if it evolves towards eclampsia. The adequate treatment requires to have in mind the normal changes of arterial hypertension and of the intravascular volume taking place during pregnancy. Preeclampsia is characterized by an extreme vasoconstriction, increase of the vascular reactivity and decrease of the intravascular volume. The greatest challenge is to face the treatment, due to the fact that two lives are at risk and that no studies of prolonged surveillance have been conducted with the different antihypertensive drugs. In this review, a treatment is proposed and the fundamental therapeutic guidelines are discussed based on the correct utilization of the main milestones of antihypertensive therapy with efficacy and recognized safety, inlcuding methyldopa, hydralazine, a and b blockers (labetalol), calcium antagonists and betablockers.
Psychiatric disorders and pregnancy
"SH. Akhondzadeh,L. Kashani "
Tehran University Medical Journal , 2006,
Abstract: Psychiatric disorders are common in women during their childbearing years. Special considerations are needed when psychotic disorders present during pregnancy. Early identification and treatment of psychiatric disorders in pregnancy can prevent morbidity in pregnancy and in postpartum with the concomitant risks to mother and baby. Nevertheless, diagnosis of psychiatric illnesses during pregnancy is made more difficult by the overlap between symptoms of the disorders and symptoms of pregnancy. In majority of cases both psychotherapy and pharmacotherapy should be considered. However, psychiatric disorders in pregnancy are often under treated because of concerns about potential harmful effects of medication. This paper reviews findings about the presentation and course of major psychiatric disorders during pregnancy.
Patología médica y embarazo: Trastornos gastrointestinales, neurológicos, cardiovasculares y dermatológicos Medical disorders and pregnancy: Gastrointestinal, neurological, cardiovascular and dermatological disorders  [cached]
A.F. Pérez Rodríguez,M. Roche,C. Larra?aga
Anales del Sistema Sanitario de Navarra , 2009,
Abstract: En la mujer embarazada se pueden presentar patologías médicas similares a la no gestante, si bien el cuadro clínico de algunas patologías así como el proceso diagnóstico o terapéutico puede estar alterado por los cambios que el embarazo produce en ella, así como por la presencia del feto, que en algunos casos puede limitar los métodos diagnósticos o las terapias a aplicar. En este trabajo se exponen las patologías digestivas, cardiovasculares, del sistema nervioso y dermatosis más relevantes por su frecuencia o por su gravedad, que pueden presentarse en una consulta de urgencias, con un enfoque práctico sobre el manejo inicial y sobre el pronóstico para la madre y el feto. A pregnant woman can present medical pathologies similar to a woman who is not pregnant. However, the clinical features of some pathologies and the diagnostic or therapeutic process might be altered due to changes produced by pregnancy and the presence of the foetus. In some cases this can limit the diagnostic methods or the therapies to be applied. This article sets out the digestive and cardiovascular pathologies, pathologies of the nervous system and dermatoses of greatest relevance due to their frequency or severity, which might be encountered in an emergency consultation. It also offers a practical approach for the initial handling and the prognosis for the mother and the foetus.
Patología médica y embarazo: Trastornos respiratorios, urológicos, infecciosos y endocrinológicos Medical disorders and pregnancy: Respiratory, urologic, infectious and endocrinologic disorders  [cached]
M. Roche,A. F. Pérez Rodríguez,M.A. García Mutiloa,I. Martínez Montero
Anales del Sistema Sanitario de Navarra , 2009,
Abstract: El embarazo constituye una situación que modifica la fisiología de distintos órganos y sistemas. La aparición de enfermedades concomitantes o la presencia de las mismas previa a la gestación obliga al clínico a conocer estas modificaciones y su influencia en la enfermedad, así como la repercusión de la enfermedad y de los medios diagnósticos y terapéuticos en la mujer embarazada y en el feto. El objetivo de este trabajo es exponer de manera concisa las pautas de actuación más recomendadas ante gestantes que acuden al Servicio de Urgencias presentando síntomas de patología concomitante no específica del embarazo. Se presentan algunas de las patologías más frecuentes clasificadas por sistemas. Pregnancy is a state that changes the physiology of various organs and systems. The occurrence of concomitant diseases, or their presence prior to pregnancy, requires an understanding of such changes and their influence on the disease, the impact of the disease and the diagnostic and therapeutic measures on pregnant women and on the foetus. The aim of this paper is to provide a concise outline of the course of action recommended in dealing with pregnant women who attend the emergency department presenting symptoms of non-specific morbidity of pregnancy. Some of the most frequent pathologies classified by systems are presented.
Hypertensive Disorders of Pregnancy in Jimma University Specialized Hospital
Z Wolde, H Segni, M Woldie
Ethiopian Journal of Health Sciences , 2011,
Abstract: Background: Hypertensive disorders represent the most common medical complications of pregnancy with a reported incidence between 5 and 10%. The disorders are major causes of maternal and perinatal morbidities and mortalities. This study was conducted to determine the pattern and outcomes of pregnancies complicated by hypertensive disorders. Methods: Hospital based cross-sectional study was conducted on all mothers who gave birth in the labor ward of Jimma University Specialized Hospital from April 1, 2009 to March 31, 2010. Data was collected by interviewing the mothers and review of their medical records using structured questionnaire and checklist, respectively. Data analysis was performed using SPSS for windows version 16.0. Result: Majority (52.5%) of the mothers were in the age group of 25 - 34 years. The overall prevalence of hypertensive disorders of pregnancy was 8.5%. Severe preeclampsia accounted for 51.9% of the cases followed by eclampsia (23.4%). Residential area of the mothers (urban/rural) was found to have statistically significant association with severity of the disorder. Most (66.5% and 74.7%) of the mothers were nulliparous and had antenatal care follow-up during the index pregnancy, respectively. Antenatal care follow-up and parity had no statistically significant association with severity of the disease. The case fatality rate of hypertensive disorders of pregnancy was 1.3% with perinatal mortality of 317.1/1000 births. Conclusion: Pregnancies complicated by hypertensive disorders have poor maternal and perinatal outcomes and rural women were more affected. Quality antenatal care services with good obstetric and neonatal care at delivery are essential for early recognition and management of hypertensive disorders of pregnancy.
A study of neurological disorders during pregnancy and puerperium
Gupta S,Rohatgi A,Sharma S,Gurtoo A
Annals of Indian Academy of Neurology , 2006,
Abstract: Objective: To study the clinical profile of patients presenting with primary and secondary neurological disorders during pregnancy and puerperium. Materials and Methods: This study was carried out at the Lady Harding Medical College between February 2004 and January 2005. All patients in pregnancy, postabortal or postpartum period attending to the Lady Harding Medical College between February 2004 and January 2005 and requiring neurological consultation were included in this study. Women with eclampsia were excluded. Results: There were 76 women included in this study (incidence of neurological disorders was 584 per 100,000 deliveries), with 46 cases of primary and 30 of secondary neurological disorders. The former included epilepsy (22), CNS infections (12), cerebrovascular disorders (9) [cerebral venous thrombosis - CVT (5), arterial infarctions (3) and haemorrhage (1)], CNS glioma (1), traumatic quadriparesis (1) and acute disseminated encephalomyelitis (1). The latter included hepatic encephalopathy [HE] (28), enteric encephalopathy (1) and critical illness polyneuropathy (1). In patients of epilepsy, the seizures had an equitable distribution in the trimesters and post-partum period, were mainly of generalized type (77.27%) and were controlled in the majority (90.9%). No fetal congenital malformations were seen. Tubercular meningitis [TBM] (7), pyogenic meningitis (4) and viral encephalitis (1) were the CNS infections encountered and pregnancy outcome was good in most cases. All cases of CVT presented in the postpartum period with fever and neurological signs following home delivery. Outcomes included recovery (2), residual deficits (1), persisting seizures (1) and death (1). HE affected patients mainly during the latter half of pregnancy or the post-partum period and was associated with 64.3% mortality. Death in HE showed correlation with grade of HE ( P =0.007); Glasgow Coma Scale ( P =0.006); Liver span ( P =0.049); bilirubin ( P =0.005) and retained foetus ( P =0.044). Conclusion: The incidence of neurological disorders in pregnancy and puerperium was fairly high. Epilepsy and hepatic encephalopathy were the commonest primary and secondary neurological disorders, respectively.
Depression in Medical Disorders: Diagnostic Problems  [PDF]
Mehmet Hamid Boztas,Ozden Ar?soy
Psikiyatride Guncel Yaklasimlar , 2010,
Abstract: Depressive symptoms are very common among referrals to general hospital and comprise the most frequent cause for psychiatric consultation. Comorbidity of medical and psychiatric disorders are common among uneducated, unemployed people with low income. These conditions make it difficult to recognize and treat such patient group. The prevalence of medical disorders increase when there is a difficulty in reaching health services. The depressive mood may decrease the person’s willingness to access health service. Additionally, the problems in most of the people seeking for medical help are not recognized by the health providers. It is quiet difficult to diagnose depression in patients with medical disorders. Being sick, being in an hospital, inability to work, loss of functionality lead to a change in social roles which may cause mourning-like symptoms, symptoms quite similar to depression’s. Besides, vegetative and somatic symptoms used for the diagnosis of depression can be direct consequences of the medical disorder itself. Thus such phenomenological signs and symptoms are suggested not to be considered as sufficient criteria for a diagnosis of depression among patients with medical disorder. This diagnostic complexity is also reflected in the studies searching for depression prevalence in medical disorders. For instance, the prevalence of depression ranges between 0% to 100% among renal patients. The physical signs and symptoms of medical conditions can overlap with the symptoms of depression and this overlap stands as one of the major diagnostic challenge for researchers. There are several other reasons that might explain the discrepancies in depression prevalence among patients with medical disorders such as changes in diagnostic criteria over time, use of different diagnostic scales for depression, and studying the prevalence of depression in non-standardized populations. Depression prevalence is affected from demographic variables, type, severity and chronicity of comorbid medical disorder. The differences in the prevalence rates brings questions about reliability and validity of diagnostic tools used. Though using DSM and ICD as diagnostic tools have standardized the psychiatric diagnosis in many ways, there still remains some difficulties for reaching valid psychiatric diagnosis among patients with medical disorders. Controversies and discussions about reliability and validity problem in this issue still continues. Subclinical depressive symptoms in medical disorders, effect of comorbidity on the diagnostic process and lower interobserver agreemen
The Prevalence of Hypertensive Disorders of Pregnancy in Shiraz, Southern Iran
MJ Zibaeenezhad,M Ghodsi,P Arab,N Gholzom
Iranian Cardiovascular Research Journal , 2010,
Abstract: Background: One of the most important complications during pregnancyis hypertension which is responsible for a widespread range of harms in mothersand fetuses. This investigation was designed to study the prevalence ofhypertensive disorders during pregnancy in Shiraz, Iran.Methods: This is a descriptive cross-sectional study, and comprisedall pregnant women referred to Hafez and Zeinnabieh hospitals affiliated toShiraz University of Medical sciences. Prevalence of various groups ofhypertensive disorders of pregnancy, age proportion and method of delivery wererecorded during one year period.Results: Of a Total of 24196 pregnant women, 563 individuals (2.32%)were hypertensive and the prevalence of chronic hypertension, preeclampsia andeclampsia were 2.13%, 0.17%, 0.03% respectively. Moreover, 45.8% of all patientswith Hypertension disorders of pregnancy experienced caesarian section method ofdelivery.Conclusion: Results of present study showed that the prevalence ofhypertension in the pregnant women in Shiraz is much lower compared with theacceptable universal estimations and many countries.
Anxiety disorders in pregnancy and the postnatal period
B Vythilingum
Continuing Medical Education , 2009,
Abstract: There is a growing realisation that many women suffer from either new onset or worsening of existing anxiety disorders during pregnancy and postnatally (the perinatal period).1 The occurrence of an anxiety disorder during this time has important consequences – it not only impacts on the woman’s mental health, but also increases the risk of other postnatal disorders, as well as having possible effects on the unborn child.2 In this article I will briefly discuss the epidemiology of anxiety disorders in pregnancy and postnatally. I will then focus on the clinical presentation of these disorders and management issues that are specific to pregnancy and the postnatal period.
Sleep disorders in pregnancy
Lopes, Eliane Aversa;Carvalho, Luciane Bizari Coin de;Seguro, Priscila Bernal da Costa;Mattar, Rosiane;Silva, Ademir Baptista;Prado, Lucila B. Fernandes do;Prado, Gilmar Fernandes do;
Arquivos de Neuro-Psiquiatria , 2004, DOI: 10.1590/S0004-282X2004000200005
Abstract: context: the precise function of sleep in animals and human beings is still unknown, and any sort of physical, social or psychological variation may change the normal sleep-wake cycle. purpose: this research aims is to determine the sleep disorders (sd) for each of the three trimesters of the pregnancy comparing them to the pre-pregnancy state (pg). method: sd were investigated in three hundred pregnant women 11- to 40-years-old through with a brief clinical interview based on directed questions. one hundred pregnant women were considered for each trimester. results: the rate of pregnant women with insomnia increased by 23% in the 2nd trimester (p< 0.005); the rate for excessive daytime sleepiness (eds) by 15% in the 1st trimester (p<0.003), 55% in the 2nd trimester (p<0.001) and by 14% in the 3rd trimester (p<0.002); the rate for mild sleepiness increased by 33% in the 2nd trimester (p<0.002) and by 48% in the 3rd trimester (p<0.001); the rate for specific awakenings increased by 63% in the 1st trimester, by 80% in the 2nd trimester and by 84% in the 3rd trimester (p<0.001). conclusion: sd were more frequent during pregnancy comparatively to pg state, mostly at the expenses of eds and specific awakenings.
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