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Article
Evaluation of Myocardial Function in Cases of Gestational Hypertension Using Myocardial Performance Index

Authors: Zainab A. Al-Rikabi زينب عبد الخالق الركابي --- Ghassan T. Saeed غسان ثابت سعيد --- Ghazi Farhan Haji غازي فرحان
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2017 Volume: 59 Issue: 1 Pages: 65-70
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Gestational hypertension represents a transient period of elevated blood pressure with special effects on the maternal left ventricle that is different from the effects observed in chronic essential hypertension; it affects a previously normal heart and lasts for a maximum of nine months associated with volume and pressure overload on the maternal heart. Tei index (also called myocardial performance index) was found to be a dependent combined index evaluating the systolic and diastolic function of the left ventricle and represents a sensitive indicator for many types of heart diseases.Objective: to evaluate the effects of gestational hypertension on the maternal myocardial function during the third trimester by measuring the Tie index using transthoracic echocardiography.Method: This study was performed in Baghdad teaching hospital in the time period from November 2015 to August 2016. The study included a total of 150 women; 100 women had gestational hypertension, in the third trimester of a singleton pregnancy and with a mean age (29.83 ± 5.33 year), gestational hypertension was identified as elevated systolic or diastolic blood pressure over 140/90 mmHg that emerges after the 20th week of gestation with proteinuria level lower than 300 mg/dl. Another 50 normotensive pregnant women with singleton pregnancy and mean age (28 ± 3.18 year) were used as controls. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured to find the type of hypertrophy in gestational hypertension. Ejection fraction (EF) was measured with 2D directed M mode echocardiography, and isovolumic relaxation time (IVRT), isovolumic contraction rime (ICT) and ejection time (ET) were measured for both groups using pulse wave Doppler echocardiography in order to calculate the myocardial performance index which is also called “Tei index” and equals the sum of IVRT and IVCT divided by the ET (Tei index = IVRT+IVCT/ET).Results: Left ventricular mass index and relative wall thickness were significantly higher in gestational hypertensive women, 41% of gestational hypertensive women had normal geometry and 59% had abnormal geometry (34% eccentric hypertrophy, 19% concentric hypertrophy and 6% concentric remodeling). IVRT and IVCT were significantly higher in gestational hypertensive women with p value of 0.0001 and P = 0.003. ET showed a non-significant lower values (p= 0.34) in gestational hypertensive women. Tei index was significantly higher in Gestational hypertension (P=0.011).Conclusion: Women with gestational hypertension had altered myocardial function characterized by the higher Tei index values associated with eccentric hypertrophy which can be explained by the fact that gestational hypertension poses higher afterload on the left ventricle instead the state of low peripheral resistance that is ysually expected during normotensive pregnancy.Keywords: Echocardiography; Gestational hypertension; Myocardial performance.


Article
PLACENTAS CHANGES IN GESTATIONAL HYPERTENSIVE WOMEN IN DUHOK
تغييرات المشايم في النساء المصابات بفرط ضغط الدم الحملي في دهوك

Authors: SAADI SALEH MOHAMMED BARWARI سعدي صالج محمد البرواري --- GHAZAL HUSSEIN KHALEEL غزال حسين خليل
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2019 Volume: 13 Issue: 1 Pages: 96-111
Publisher: University of Dohuk جامعة دهوك

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Abstract

Background: Placentas impact by hypertensive disorders and contribute significantly to maternal and fetal morbidity and mortality. This study was designed to investigate the gross and histological changes in the placentas of gestational hypertensive women.Patients and Methods: The samples of this cross sectional study were collected from Duhok Obstetrics and Gynecology Hospital, Duhok city, Kurdistan region, Iraq. Total 73 placentas were collected from 20-40 years old women with full-term singleton pregnancies, 25 placentas from normo-tensive mothers having no hypertension before as control group and 48 from gestational hypertension women as gestational hypertension group. The maternal and neonatal data were recorded. Immediately after delivery, the placenta was washed, dried, photographed then weighted and dimensions were measured. Morphological features were recorded. Central biopsies were taken for qualitative and quantitative histopathological examination which included: terminal villi, stromal fibrosis, fibrinoid necrosis, calcification, syncytial knots, hyalinization, medial coat proliferation of medium sized blood vessel, avascular villi, congestion, chorangiosisandvasculosyncytial membrane. Statistical analyses were done by using student t-test and chi- square test.Results: In the gestational hypertension, macroscopically, there was no statistical difference. Microscopic finding revealed a significant increase in calcification, fibrinoid necrosis, stromal fibrosesand congestion; whereas vasculosyncytial membrane and avascular villi increased insignificantly and chorangiosiswas not impacted. The gross and histological qualitative results coincided with the quantitative results.Conclusions: The placentas were significantly and adversely affected by the gestational hypertension.

الخلفية وأهدف البحث: تتأثر المشايم بفرط ضغط الدم الحملي ويسهم بشكل كبير في إمراضية وحدوث الوفيات الأمومية والجنينية. تم تصميم هذه الدراسة لبحث التغيرات العيانية لمشايم اضطراب فرط الضغط.طرق البحث: تم جمع عينات هذه الدراسة من مستشفى دهوك لأمراض التوليد والنسائية في مدينة دهوك. إقليم كوردستان العراق. لقد تم جمع 73 مشيمة من النساء اللواتي تتراوح أعمارهن بين 20-40 سنة ذوات الحمل الكامل المفرد, 25 مشيمة من امهات ضغط الدم السوي لم يصبن سابقا بفرط الضغط كمجموعة تحكم و48 مشيمة من نساء مصاباتبفرطالضغطكمجموعةفرط الضغط الحملي. لقدتم تسجيل بيانات الأمومة والوليدية . بعد الولادة مباشرة ، تمغسل المشيمة بماء الصنبور وجففت وصورت ثم وزنت وقيست الأبعاد. وتم تسجيل الخصائص المورفولوجية . أخذت الخزعات المركزية لفحص النسيج كميا ونوعيا, والكمي يشمل: الزغابات الطرفية ، منطقة التليف السدوي ، منطقة النخر الليفانيني ، منطقة التكلس ، العقد المخلوية ، منطقة التحول الزجاجي ، تكاثر طبقة الإنسي من الأوعية الدموية المتوسطة الحجم ، الزغابات اللاوعائية ، الاحتقان، زيادة تكون الأوعية الشعرية الدمويةchorangiosis والغشاء الوعائي المخلوي vasculosyncytial. لقد تم إجراء التحليلات الإحصائية باستخدام اختبار t , واختبار chi-square.النتائج: في مجموعة فرط ضغط الدم الحملي ، أظهرت النتائج العيانية أنه لا يوجد فرق إحصائي بين مجموعة ارتفاع ضغط الدم ومجموعة التحكم. لقد كشف الفحص المجهري عن حدوث زيادة معنوية في التكلس والنخر الليفانيني ، والتليف السدوى ؛ و الأحتقان . في حين أزداد الغشاء الوعائي المخلوي والزغابات اللاوعائية بشكل غير معنوي ولم يتأثر تكون الأوعية الشعرية الدموية. في مجموعةفرطضغط الدم الحملي ، تطابقت النتائج النوعية العيانية والنسيجية مع النتائج الكمية.الأستنتاجات: تتأثر المشايم بشكل معنوي وعكسي بفرط ضغط الدم الحملي.

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