TEALE FENNING

nibbs07 · Joined: 03 Dec 2007 Posts: 9 Location: Hampshire

Could not find any discussion on this subject -

severe PIH is characteristically associated with

abnormally high concentration of cortisol - F
(no reference)

Hypernatraemeia -F

(or does it increase)

please feel open to discuss
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Nibbs

himanshu · Joined: 28 Jan 2008 Posts: 11

hi nibbs, these r difficult questions, can u plz tell me the source
i did some research and found the answer which i think is correct

cortisol levels are increased in normal pregnancy but a small study showed that it was decreased in PIH
ref http://www.journalarchive.jst.go.jp/english/jnlabstract_en.php?cdjournal=tjem1920&cdvol=149&noissue=1&startpage=21

converse is true for sodium ie. its level is decreased in normal pregnancy but increased in PIH
ref http://www.ncbi.nlm.nih.gov/pubmed/1783100

hope this is helpful

nibbs07 · Joined: 03 Dec 2007 Posts: 9 Location: Hampshire

Hi Himanshu
Thanks for ur effort,these are from past papers march 1997
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Nibbs

Shinelkimo · Joined: 25 Apr 2007 Posts: 55

T 32.Reduced renal uric acid clearance (busy,uk)
F 33. Elevated maternal serum cortisol concentration (busy + teale,uk)
F 34. Hypernatraemia (busy,uk)
F Hyperkalaemia
32. reduced uric acid clearance. True.
It is due to a reduced clearance by PCT of kidney. This effect occurs earlier than a decreased GFR, which later on contributes. So, a rising serum uric acid is predictive of complications like IUGR, fetal distress, LBW fetuses, increased perinatal morbidity and mortality. Here, I got ref that in severe PIH with the impending above-mentioned complications, the values in serial estimation may be seen to rise above 300 mmol/l.

33. abnormal high cortisol. False.
Here I mention an abstract of a study I found on the net.
‘measured the serum cortisol levels in 15 normal and 8 pregnancy induced hypertension (PIH) primigravidas. The normal pregnancy had a significant (p<0.05) higher cortisol level than that of PIH patient. Especially, 4 severe PIH patients had a significantly (p<0.05) lower cortisol level. The lower maternal cortisol level of PIH patients became more significant with the severity of clinical symptoms of PIH. After the onset of labor, the cortisol levels of PIH patients did not elevate compared with normal pregnancy. These data suggest that in the PIH patient the reactivity of the adrenal cortex to adrenocorticotropic hormone (ACTH) may be blunted or the cortisol production in the adrenal cortex may be decreased by the tissue circulation insufficiency due to PIH.’

34. hypernatremia. False.
Acc. To William’s Obstetrics 22nd ed. Ch. 34 (I quote as such)
‘electrolyte conc. Do not differ appreciably in women with pre-eclampsia (please understand, it is not simple “uncomplicated PIH.”) compared with normal pregnant women unless there has been vigorous diuretic therapy, sodium restriction or adm. Of free water with sufficient oxytocin to produce antidiuresis.’

Comment:
There is an increased accumulation of sodium in normal preg. but serum sod. Conc. are only slightly decreased (due to hemodilution) but are in fact much closer to non-pregnant levels.

In PIH in all its spectra of severity, the Sodium accu. is furthermore accentuated. But here the accu. is in the extra-vascular space, due to endothelial damage. Thus, the clinical importance of this is: any alteration in the serum electrolyte levels is an ominous sign and may hearld an imminent eclampsia.