How Do Home and Clinic Blood Pressure Readings Compare in Pregnancy?

Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure (BP) might improve the detection and management of hypertensive disorders of pregnancy, but few data are available, including regarding appropriate thresholds. This systematic review and individual patient data analysis aimed to assess the current evidence on differences between clinic and self-monitored BP through pregnancy.

Perspectives on Pregnancy in Women With CKD: A Semistructured Interview Study.

Background: Women with chronic kidney disease (CKD) often have difficulty achieving pregnancy and are at increased risk for adverse pregnancy outcomes. Given the medical, ethical, and emotional complexities of pregnancy in CKD, the clinical approach should involve explicit consideration of women's values, for which there are sparse data. This study aims to describe the beliefs, values, and experiences of pregnancy in women with CKD to inform prepregnancy counseling and pregnancy care.

Running and setting up a Renal Supportive Care program.

To date no consistent model of care has been available for supporting patients and their families on a conservative non-dialysis pathway. Broadly speaking the United Kingdom appears to have embraced this pathway more than most other countries but even there, there are divergent views on what models of care should be implemented. One model, developed at St.

Predictive Modelling Risk Calculators and the Non Dialysis Pathway.

This guideline will review the current prediction models and survival/mortality scores available for decision making in patients with advanced kidney disease who are being considered for a non-dialysis treatment pathway. Risk prediction is gaining increasing attention with emerging literature suggesting improved patient outcomes through individualised risk prediction (1). Predictive models help inform the nephrologist and the renal palliative care specialists in their discussions with patients and families about suitability or otherwise of dialysis.

Acid sensitization of esophageal mucosal afferents: implication for symptom perception in patients across the gastroesophageal reflux disease spectrum.

Background: Sensitization of esophageal chemoreceptors, either directly by intermittent acid exposure or indirectly through esophagitis-associated inflammatory mediators, is likely to be the mechanism underlying the perception of heartburn.

Aims: To compare basal esophageal sensitivity with electrical stimulation and acid, and to compare the degree of acid-induced sensitization in controls and in patient groups across the entire spectrum of gastroesophageal reflux disease: erosive oesophagitis (EO), nonerosive reflux disease (NERD), and functional heartburn (FH).

Methods: Esophageal sensory and pain thresholds to electrical stimulation were measured before, 30, and 60 minutes after an intraesophageal infusion of saline or HCl.

The management of pre-eclampsia: what we think we know.

The focus of this article is to review and challenge some current concepts surrounding the diagnosis and management of pre-eclampsia as well as considering where our management might head in the future. Pre-eclampsia is a syndrome defined by the new onset of hypertension in the 2nd half of pregnancy that is generally, but not always, accompanied by proteinuria. Whilst in recent times our understanding and management of this condition have improved there are some areas where evidence and opinions differ.

A prospective randomized study of automated versus mercury blood pressure recordings in hypertensive pregnancy (PRAM Study).

Background: Mercury sphygmomanometry is being replaced with automated blood pressure (BP) recording. We tested the potential impact of this change on the outcomes of pregnant women with hypertension.

Methods: Following routine detection of hypertension by mercury sphygmomanometry, 220 pregnant women with hypertension were randomized to have all subsequent BPs recorded with either mercury sphygmomanometry or an automated BP device (Omron HEM-705CP) for the remainder of their pregnancy.

The role of lumbar puncture as a diagnostic tool in 2005.

Analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP) is fundamental to the management of inflammatory disease of the central nervous system (CNS), particularly that due to infection. This review summarises the role of lumbar puncture, anatomy and pathophysiology of CSF, techniques of obtaining CSF, indications, contraindications and complications of LP, methods of analysis and some of the implications of specific changes in CSF. The CNS is protected by unique immunological barriers, and has some unique responses to processes that breach these barriers.

Microscopic hematuria in pregnancy: relevance to pregnancy outcome.

Background: The significance of dipstick or microscopic hematuria in pregnancy is uncertain, with some studies suggesting this is associated with a greater risk for preeclampsia. We sought to determine the prevalence and clinical significance of microscopic hematuria during pregnancy.

Methods: This was a prospective case-control study in the antenatal Clinic of St George Hospital, Kogarah, Australia, a teaching hospital without tertiary referral antenatal care, with approximately 2,600 deliveries per year.

A prospective study of the impact of automated dipstick urinalysis on the diagnosis of preeclampsia.

Objective: To determine prospectively in hypertensive pregnant women 1) the accuracy of dipstick testing for proteinuria using automated urinalysis, 2) factors that might affect such accuracy, and 3) the potential impact of automated dipstick testing on the accuracy of diagnosis of preeclampsia according to acceptance of proteinuria at either 1 + or 2 + level.

Design: Prospective study.

Setting: Antenatal day assessment unit and antenatal ward of St George Hospital, a teaching hospital in Sydney, Australia.

Is resistant hypertension really resistant?

Background: Managing resistant hypertension is difficult and mostly involves expensive testing seeking an underlying secondary cause. This study was undertaken to determine 1) the extent of the white-coat phenomenon in patients with resistant hypertension, and 2) whether 24-h ambulatory blood pressure (BP) monitoring (ABPM) or having BP recorded by a nurse instead of the referring doctor could clarify how many apparently resistant hypertensives actually have controlled BP.

Methods: This study involved 611 patients with BP > or = 140/90 mm Hg who were referred for 24-h ABPM by their specialist or general practitioner, including 277 patients who were taking no antihypertensives (group 1), 216 taking one or two antihypertensive drugs (group 2), and 118 taking at least three antihypertensives in combination (group 3).