Effect of antihypertensive therapy with α‐methyldopa on uterine artery Doppler in pregnancies with hypertensive disorders

Khalil, Asma; Harrington, Kevin; Muttukrishna, Shanthi; Jauniaux, Eric

doi:10.1002/uog.7611

Cited by 26 publications

(22 citation statements)

References 37 publications

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“…In a study done by Günenç et al, treatment with methyldopa lowered the uterine artery resistance in preeclamptic patients but did not affect the resistance of umbilical and fetal middle cerebral artery [9]. In two separate studies done by Khalil et al and Muračević et al, they did not find change in flow resistance of umbilical artery after administration of methyldopa [10, 11]. …”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Middle Cerebral Artery to Uterine Artery Pulsatility Index Ratio in Hypertensive Disorders of Pregnancy

Adiga

Kantharaja

Hebbar

et al. 2015

International Journal of Reproductive Medicine

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Aims and Objectives. (i) To determine the predictive value of cerebrouterine (CU) ratio (middle cerebral artery to uterine artery pulsatility index, MCA/UT PI) in assessing perinatal outcome among hypertensive disorders of pregnancy. (ii) To compare between CU ratio and CP ratio (MCA/Umbilical artery PI) as a predictor of adverse perinatal outcome. Methods. A prospective observational study was done in a tertiary medical college hospital, from September 2012 to August 2013. One hundred singleton pregnancies complicated by hypertension peculiar to pregnancy were enrolled. Both CU and CP ratios were estimated. The perinatal outcomes were studied. Results. Both cerebrouterine and cerebroplacental ratios had a better negative predictive value in predicting adverse perinatal outcome. However, both CU and CP ratios when applied together were able to predict adverse outcomes better than individual ratios. The sensitivity, specificity, positive predictive value, and the negative predictive values for an adverse neonatal outcome with CU ratio were 61.3%, 70.3%, 56%, and 78.9%, respectively, compared to 42%, 57.5%, 62%, and 76% as with CP ratio. Conclusion. Cerebrouterine ratio and cerebroplacental ratio were complementary to each other in predicting the adverse perinatal outcomes. Individually, both ratios were reassuring for favorable perinatal outcome with high negative predictive value.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of Middle Cerebral Artery to Uterine Artery Pulsatility Index Ratio in Hypertensive Disorders of Pregnancy

Adiga

Kantharaja

Hebbar

et al. 2015

International Journal of Reproductive Medicine

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“…(2) From the first trimester onwards, HT patients were medicated with 750 mg methyldopa and low-dose acetylsalicylic acid daily, medications that were previously shown not to affect the uterine and umbilical arteries impedance [53–55]. (3) The second Doppler measurement was made just after blockade was achieved, which introduces light variations in time.…”

Section: Discussionmentioning

confidence: 99%

The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study

Guedes-Martins

Graça

Saraiva

et al. 2014

BMC Pregnancy Childbirth

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BackgroundDespite the known effects of neuraxial blockade on major vessel function and the rapid decrease in uterine vascular impedance, it is unclear how the blockade affects the utero-placental circulation in the near-term. We hypothesize that among women with chronic hypertension, a loss of sympathetic tonus consequent to spinal block may cause significant changes in the utero-placental haemodynamics than the changes typical in normal pregnant women. Therefore, the main study objective was to analyse the effect of spinal anaesthesia for caesarean section on uterine and umbilical arterial impedance in pregnant women at term diagnosed with stage-1 chronic hypertension.MethodsA prospective, longitudinal study was performed in singleton pregnant women (203 low-risk and 33 with hypertension) scheduled to undergo elective caesarean section. The mean arterial blood pressure and pulsatility indexes for the uterine and umbilical arteries were recorded before and after spinal anaesthesia was performed using 8–9 mg hyperbaric bupivacaine (5 mg/mL) and 2–2.5 μg sufentanil (5 μg/mL). Multiple linear regression models with errors capable of correlation or with unequal variances were fitted using the generalized least squares.ResultsIn normotensive women, the mean arterial blood pressure decreased after administering spinal anaesthesia (p < 0.05). The pulsatility index of the uterine and umbilical arteries did not change after spinal anaesthesia. In the hypertensive women, the mean arterial blood pressure (p < 0.05) and uterine artery pulsatility index (p < 0.05) decreased. In both groups, the umbilical artery pulsatility index did not change after spinal anaesthesia.ConclusionsIn stage-1 chronic hypertensive pregnant women at term, spinal anaesthesia for caesarean section reduces uterine artery impedance but not umbilical artery impedance.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-291) contains supplementary material, which is available to authorized users.

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“…Methyldopa has a record of safety in pregnancy, as established by follow-up studies in the 1980’s of children exposed to the drug in utero [31]. More recent studies indicate that in hypertensive pregnancy disorders, treatment with methyldopa does not affect the maternal uterine artery Doppler pulsatility and resistance indices, suggesting that it does not impair uteroplacental circulation and consequent fetal growth [32]. The doses of methyldopa recommended in pregnancy are similar to those used in non-pregnant patients [33].…”

Section: Profiles Of Recommended Drug Therapiesmentioning

confidence: 99%

Drug Treatment of Hypertension in Pregnancy

Brown

Garovic

2014

Drugs

106

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Hypertensive disorders represent major causes of pregnancy related maternal mortality worldwide. Similar to the non-pregnant population, hypertension is the most common medical disorder encountered during pregnancy and is estimated to occur in about 6–8% of pregnancies [1]. A recent report highlighted hypertensive disorders as one of the major causes of pregnancy-related maternal deaths in the United States, accounting for 579 of the 4693 (12.3%) maternal deaths that occurred between 1998 and 2005 [2]. In low-income and middle-income countries, preeclampsia and its convulsive form, eclampsia, are associated with 10–15% of direct maternal deaths [3]. The optimal timing and choice of therapy for hypertensive pregnancy disorders involves carefully weighing the risk-versus-benefit ratio for each individual patient, with an overall goal of improving maternal and fetal outcomes. In this review we have compared and contrasted the recommendations in different treatment guidelines and we have outlined some newer perspectives on management. We have aimed to provide a clinically orientated guide to the drug treatment of hypertension in pregnancy.

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Effect of antihypertensive therapy with α‐methyldopa on uterine artery Doppler in pregnancies with hypertensive disorders

Cited by 26 publications

References 37 publications

Predictive Value of Middle Cerebral Artery to Uterine Artery Pulsatility Index Ratio in Hypertensive Disorders of Pregnancy

Predictive Value of Middle Cerebral Artery to Uterine Artery Pulsatility Index Ratio in Hypertensive Disorders of Pregnancy

The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study

Drug Treatment of Hypertension in Pregnancy

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