First trimester screening for pre-eclampsia and targeted aspirin prophylaxis: a cost-effectiveness cohort study.

Objective: Investigate cost-effectiveness of first trimester pre-eclampsia screening using the Fetal Medicine Foundation (FMF) algorithm and targeted aspirin prophylaxis in comparison with standard care.

Design: Retrospective observational study.

Setting: London tertiary hospital.

Chronic hypertension and superimposed preeclampsia: screening and diagnosis.

Superimposed preeclampsia complicates about 20% of pregnancies in women with chronic hypertension and is associated with increased maternal and perinatal morbidity compared with preeclampsia alone. Distinguishing superimposed preeclampsia from chronic hypertension can be challenging because, in chronic hypertension, the traditional criteria for the diagnosis of preeclampsia, hypertension, and significant proteinuria can often predate the pregnancy. Furthermore, the prevalence of superimposed preeclampsia is unlikely to be uniformly distributed across this high-risk group but is related to the severity of preexisting endothelial dysfunction.

A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator.

Background: The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant.

X-linked sideroblastic anaemia in a female fetus: a case report and a literature review.

Background: X-linked sideroblastic anaemia (XLSA) is commonly due to mutations in the ALAS2 gene and predominantly affects hemizygous males. Heterozygous female carriers of the ALAS2 gene mutation are often asymptomatic or only mildly anaemic. XLSA is usually characterized by microcytic erythrocytes (reduced mean corpuscular volume (MCV)) and hypochromia, along with increased red cell distribution width.

First trimester angiogenic and inflammatory factors in women with chronic hypertension and impact of blood pressure control: a case-control study.

Objectives: To assess first trimester serum placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFLT-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), endothelin and vascular cell adhesion molecule (VCAM) in women with chronic hypertension (CH) stratified according to blood pressure (BP) control.

Design: Case-control.

Setting: Tertiary referral centre.

Validation of the BPro radial pulse waveform acquisition device in pregnancy and gestational hypertensive disorders.

Objective: To validate the BPro blood pressure (BP) wrist device for use in pregnancy and preeclampsia according to the Universal Standard protocol.

Participants And Methods: BP was measured sequentially in 45 pregnant women (including 15 with preeclampsia, 15 with gestational hypertension and 15 who remained normotensive) alternating between a mercury sphygmomanometer and BPro device.

Results: The BPro is accurate in pregnancy with a mean device-observer difference of -1.

Chronic hypertension in pregnancy stratified by first-trimester blood pressure control and adverse perinatal outcomes: A prospective observational study.

Introduction: The aim of this study was to assess perinatal outcomes in women with chronic hypertension (CH) stratified into four groups according to their blood pressure (BP) control in the first trimester of pregnancy.

Material And Methods: This was a prospective cohort study between January 2011 and June 2017, based in a university hospital in London, UK. The population consisted of four groups: group 1 included women without history of CH, presenting in the first trimester with BP >140/90 mmHg (n = 100).

First trimester inflammatory mediators in women with chronic hypertension.

Introduction: Chronic hypertension complicates 1%-2% of pregnancies and is one of the most significant risk factors for the development of preeclampsia. Inflammatory mediators, such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), vascular cell adhesion molecule (VCAM) and endothelin have been implicated in the endothelial dysfunction that is pathognomonic of preeclampsia and may serve as useful first trimester biomarkers for the prediction of preeclampsia. The objectives of this study are: first, to investigate differences in serum levels of IL-6, TNF-α, VCAM and endothelin at 11 to 13 weeks' gestation in women with chronic hypertension who developed superimposed preeclampsia with those who did not and normotensive controls and, second, to evaluate the performance of these biomarkers in the prediction of preeclampsia.

First trimester serum angiogenic and anti-angiogenic factors in women with chronic hypertension for the prediction of preeclampsia.

Background: An imbalance between angiogenic and antiangiogenic factors is thought to be a central pathogenetic mechanism in preeclampsia. In pregnancies that subsequently experience preeclampsia, the maternal serum concentration of the angiogenic placental growth factor is decreased from as early as the first trimester of pregnancy, and the concentration of the antiangiogenic soluble fms-like tyrosine kinase-1 is increased in the last few weeks before the clinical presentation of the disease. Chronic hypertension, which complicates 1-2% of pregnancies, is the highest risk factor for the development of preeclampsia among all other factors in maternal demographic characteristics and medical history.

Severe hypertension, preeclampsia and small for gestational age in women with chronic hypertension diagnosed before and during pregnancy.

Objectives: To compare rates of severe hypertension (SH), preeclampsia (PE) birth of small for gestational age (SGA) neonates between women with chronic hypertension (CH) diagnosed during the first trimester of pregnancy and those with pre-pregnancy CH.

Study Design: Prospective cohort study of women with CH and singleton pregnancies referred to an Antenatal Hypertension Clinic at 8-14 weeks' gestation. At presentation the patients were subdivided into four groups based on blood pressure (BP) control.

Validation of the Omron HBP-1300 in pregnancy for medium-arm and large-arm circumferences according to the British Hypertension Society protocol.

Objective: The aim of this study was to validate the Omron HBP-1300 oscillometric blood pressure (BP) device according to the British Hypertension Society validation protocol, in pregnant women of both medium-arm and large-arm circumferences.

Participants And Methods: BP was measured sequentially in 72 women of any gestation requiring the use of a large-size (N=36, arm circumference ≥33 cm) or medium-size cuff (N=36, arm circumference <33 cm) alternating between a mercury sphygmomanometer and the Omron HBP-1300 device.

Results: The Omron HBP-1300 is accurate in pregnancy with a mean device-observer difference of 3±6 and 1±6 mmHg for systolic BP and 2±5 and 3±6 mmHg for diastolic BP in women requiring the use of the medium and large cuff, respectively.

Validation of the Microlife WatchBP Home blood pressure device in pregnancy for medium and large arm circumferences.

Objective: The Microlife WatchBP Home automated blood pressure device was assessed for accuracy in pregnant women of medium (<32 cm) and large (≥32 cm) arm circumference.

Materials And Methods: The British Hypertension Society validation protocol was modified for the purpose of this study to include women with arm circumference of less than 32 cm (N=51) and greater than or equal to 32 cm (N=46) as two separate arms.

Results: The device achieved an overall A/A grade for medium arm circumference and B/A grade for large arm circumference.

Chronic hypertension: first-trimester blood pressure control and likelihood of severe hypertension, preeclampsia, and small for gestational age.

Background: There is extensive evidence that prepregnancy chronic hypertension is associated with a high risk of development of severe hypertension and preeclampsia and birth of small-for-gestational-age neonates. However, previous studies have not reported whether antihypertensive use, blood pressure control, or normalization of blood pressure during early pregnancy influences the rates of these pregnancy complications.

Objective: The purpose of this study was to stratify women with prepregnancy chronic hypertension according to the use of antihypertensive medications and level of blood pressure control at the first hospital visit during the first trimester of pregnancy and to examine the rates of severe hypertension, preeclampsia, and birth of small-for-gestational-age neonates according to such stratification.

An inaccurate automated device negatively impacts the diagnosis and treatment of gestational hypertension.

Objectives: Automated blood pressure devices are frequently introduced in maternity care without prior validation for their accuracy in pregnancy. Our objectives were to, firstly, establish the accuracy in pregnancy of a locally used device (Welch Allyn 300) and, secondly, to audit its impact on the diagnosis and treatment of hypertension.

Study Design: Validation study: The device was evaluated using the grading criteria of the European Society of Hypertension International Protocol (ESH-IP) (2010).

Pregnancy outcomes in women with previous gestational hypertension: A cohort study to guide counselling and management.

Objectives: In pregnant women with previous gestational hypertension: to compare the prevalence of preeclampsia as defined by the 2001 versus the 2014 International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria, to determine the rates of fetal growth restriction (FGR) as defined, not only by birthweight centile, but in combination with fetal ultrasound studies and, finally, to determine rates of other related outcomes such as gestational diabetes (GDM) and obstetric cholestasis (OC).

Study Design: This was a retrospective observational study based at the Antenatal Hypertension Clinic, Kings College Hospital, London. Routinely collected data of 773 women booked between 2011 and 2016 with a history of gestational hypertension was analysed.

Validation of the Omron MIT Elite blood pressure device in a pregnant population with large arm circumference.

Objective: The aim of this study was to evaluate the accuracy of the Omron MIT Elite automated device in pregnant women with an arm circumference of or above 32 cm, using the British Hypertension Society validation protocol.

Methods: Blood pressure was measured sequentially in 46 women of any gestation requiring the use of a large cuff (arm circumference ≥32 cm) alternating between the mercury sphygmomanometer and the Omron MIT Elite device.

Results: The Omron MIT Elite achieved an overall D/D grade with a mean of the device-observer difference being 7.

Validation of the Withings BP-800 in pregnancy and impact of maternal characteristics on the accuracy of blood pressure measurement.

Objective: Firstly, to validate the Withings BP-800 automated device for use in pregnancy and, secondly, to assess the impact of maternal somatometric and demographic variables on the accuracy of the device.

Design: Prospective observational study.

Setting: Kings College Hospital, London, UK.