Arctigenin mitigates vascular endothelial injury in rats with pregnancy-induced hypertension via autophagy-NLRP3 inflammasome pathway / 中国中药杂志

This study aims to investigate the effect and mechanism of arctigenin(ARC) in the treatment of vascular endothelial injury in rats with pregnancy-induced hypertension(PIH). Fifty SD rats pregnant for 12 days were randomly assigned into a control group, a model group, an ARC group, a rapamycin(RAP, autophagy inducer) group, and an ARC+3-methyladenine(3-MA, autophagy inhibitor) group, with 10 rats in each group. The rats in the other groups except the control group were intraperitoneally injected with nitrosyl-L-arginine methyl ester(50 mg·kg~(-1)·d~(-1)) to establish the PIH model on the 13th day of pregnancy. On the 15th day of pregnancy, the rats in ARC, RAP, and ARC+3-MA groups were intraperitoneally injected with ARC(50 mg·kg~(-1)·d~(-1)), RAP(1 mg·kg~(-1)·d~(-1)), and 3-MA(15 mg·kg~(-1)·d~(-1))+ARC(50 mg·kg~(-1)·d~(-1)), respectively. The pregnant rats in the control group and the model group were intraperitoneally injected with the same amount of normal saline. The blood pressure and 24 h urine protein(24 h-UP) of pregnant rats in each group were measured before and after intervention. Cesarean section was performed to terminate pregnancy on day 21, and the body weight and body length of fetal rats were compared among groups. Hematoxylin-eosin(HE) staining was employed to observe the pathological changes of placenta. The expression of endothelin-1(ET-1) and endothelial nitric oxide synthase(eNOS) in placenta was detected by immunohistochemistry. The serum levels of ET-1 and nitric oxide(NO) were determined with corresponding kits. The expression of microtubule-associated protein 1 light chain 3(LC3), Beclin-1, NOD-like receptor protein 3(NLRP3), apoptosis-associated speck-like protein with CARD domain(ASC), caspase-1, interleukin(IL)-1β, and IL-18 was determined by immunofluorescence and Western blot. The level of reactive oxygen species(ROS) in placenta was measured by fluorescence staining. The results showed that on day 12 of pregnancy, the blood pressure and 24 h-UP had no significant differences among groups. On days 15, 19, and 21, the blood pressure and 24 h-UP in the model group were higher than those in the control group(P<0.05). On days 19 and 21, the blood pressure and 24 h-UP in ARC group and RAP group were lower than those in the model group(P<0.05), and they were higher in the ARC+3-MA group than in the ARC group(P<0.05). On day 21, the model group had lower body weight and body length of fetal rats(P<0.05), higher serum level of ET-1, and lower serum level of NO(P<0.05) than the control group. Moreover, the placental tissue showed typical pathological damage, down-regulated expression of LC3-Ⅱ/LC3-Ⅰ, Beclin-1 and eNOS(P<0.05), up-regulated expression of ET-1, NLRP3, ASC, caspase-1, IL-1β, and IL-18(P<0.05), and elevated ROS level. Compared with the model group, ARC and RAP groups showed increased body weight and body length of fetal rats(P<0.05), lowered serum level of ET-1, elevated serum level of NO(P<0.05), reduced pathological damage of placental tissue, up-regulated expression of LC3-Ⅱ/LC3-Ⅰ, Beclin-1, and eNOS(P<0.05), down-regulated expression of ET-1, NLRP3, ASC, caspase-1, IL-1β, and IL-18(P<0.05), and lowered ROS level. Compared with ARC group, 3-MA reversed the effects of ARC on the above indicators. In conclusion, ARC can inhibit the activation of NLRP3 inflammasome and mitigate vascular endothelial damage in PIH rats by inducing autophagy of vascular endothelial cells.

Hematological disorders in preterm newborns born to mothers with pregnancy-induced hypertension / Alteraciones hematológicas en recién nacidos pretérmino de madres con enfermedad hipertensiva del embarazo

Abstract Background: Pregnancy-induced hypertension (PIH) has been related to impaired fetal growth, possibly by affecting hematopoiesis. This study aimed to analyze the most frequent hematological alterations in preterm infants born to mothers with PIH. Methods: We conducted a cross-sectional study in newborns born to mothers with PIH. We reviewed 130 hemograms of preterm infants: 45 from mothers with PIH, 71 with preeclampsia, and 14 with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Normality, cytosis conditions, or cytopenia values were adjusted for gestational ages. Differences between groups were analyzed with classical and Bayesian statistics (BF01 = null/alternative hypothesis ratio). Results: Anemia was found in only 1.2% of newborns. In the white blood cell count, the most frequent finding was lymphopenia (56.2%) and monocytosis (38.5%) (p = 0.6, FB01 = 249 y p = 0.81, FB01 = 19.9). Thrombocytopenia was found in 12.5% (p = 0.56, FB01 = 67). No significant differences were observed among PIH groups. Conclusions: Hematological alterations of newborns born to mothers with PIH are frequent and do not show a distinct pattern related to the severity of the affection in the mother. We recommend a full hematological evaluation in these preterm neonates.

Resumen Introducción: La enfermedad hipertensiva del embarazo (EHE) se ha relacionado con alteraciones en el crecimiento fetal, posiblemente porque afecta la hematopoyesis. El objetivo de este estudio fue analizar las alteraciones hematológicas más frecuentes en los recién nacidos prematuros hijos de madres con EHE. Métodos: Se llevó a cabo un estudio transversal en recién nacidos de madres con EHE. Se revisaron los hemogramas de 130 neonatos prematuros: 45 madres con hipertensión gestacional, 71 con pre-eclampsia y 14 con síndrome de HELLP (hemólisis, enzimas hepáticas elevadas y bajo recuento de plaquetas). Las cifras de normalidad, condiciones de citosis o citopenia fueron ajustadas a las edades gestacionales. Las diferencias entre los grupos se analizaron con estadística clásica y bayesiana (FB01= relación hipótesis nula/alterna). Resultados: Se encontró anemia en solo el 1.2% de los recién nacidos. En la serie blanca el hallazgo más frecuente fue la linfopenia (56.2%) y monocitosis (38.5%) (p = 0.6, FB01 = 249 y p = 0.81, FB01 = 19.9). La plaquetopenia se encontró en el 12.5% (p = 0.56, FB01 = 67). No se observaron diferencias significativas entre los grupos de EHE. Conclusiones: Las alteraciones hematológicas en recién nacidos de madres con EHE son frecuentes sin mostrar un patrón distinto con relación a la gravedad del padecimiento de la madre. Aun así, es recomendable la valoración hematológica en estos neonatos.

Maternal Mercury Exposure and Hypertensive Disorders of Pregnancy: A Systematic Review / Exposição materna a mercúrio e distúrbios hipertensivos na gestação: Uma revisão sistemática

Abstract Objective The present review aimed to synthesize the evidence regarding mercury (Hg) exposure and hypertensive disorders of pregnancy (HDP). Data Sources The PubMed, BVS/LILACS, SciELO and UFRJ's Pantheon Digital Library databases were systematically searched through June 2021. Study Selection Observational analytical articles, written in English, Spanish, or Portuguese, without time restriction. Data Collection We followed the PICOS strategy, and the methodological quality was assessed using the Downs and Black checklist. Data Synthesis We retrieved 77 articles, of which 6 met the review criteria. They comprised 4,848 participants, of which 809 (16.7%) had HDP and 4,724 (97.4%) were environmentally exposed to Hg (fish consumption and dental amalgam). Mercury biomarkers evaluated were blood (four studies) and urine (two studies). Two studies found a positive association between Hg and HDP in the group with more exposure, and the other four did not present it. The quality assessment revealed three satisfactory and three good-rated studies (mean: 19.3 ± 1.6 out 28 points). The absence or no proper adjustment for negative confounding factor, such as fish consumption, was observed in five studies. Conclusion We retrieved only six studies, although Hg is a widespread toxic metal and pregnancy is a period of heightened susceptibility to environmental threats and cardiovascular risk. Overall, our review showed mixed results, with two studies reporting a positive association in the group with more exposure. However, due to the importance of the subject, additional studies are needed to elucidate the effects of Hg on HDP, with particular attention to adjusting negative confounding.

Resumo Objetivo A presente revisão busca sintetizar as evidências em relação à exposição ao mercúrio (Hg) e os distúrbios hipertensivos da gestação (DHG). Fontes Dos Dados Os bancos de dados PubMed, BVS/LILACS, SciELO e a Biblioteca Digital da UFRJ Pantheon foram sistematicamente pesquisadas durante junho de 2021. Seleção de estudos Artigos observacionais analíticos, escritos em inglês, espanhol ou português, sem restrição temporal. Coleta de Dados A estratégia PICOS foi seguida e a qualidade metodológica foi avaliada usando o checklist Downs and Black. Síntese de dados Foram encontrados 77 artigos, dos quais 6 atenderam aos critérios da revisão. Foram 4.848 participantes, dos quais 80 (16,7%) tinham DHG e 4.724 (97,4%) estavam expostos ambientalmente ao Hg (consumo de peixe e amálgama dental). Os biomarcadores de mercúrio avaliados foram sangue (quatro estudos) e urina (dois estudos). Dois estudos encontraram associação positiva entre Hg e DHG no grupo com maior exposição e os outros quatro não a apresentaram. A avaliação de qualidade metodológica revelou 3 estudos satisfatórios e 3 bons (média: 19,3 ± 1,6 em 28 pontos). A ausência ou não de ajuste adequado para fator de confusão negativo, como consumo de pescado, foi observada em cinco estudos. Conclusão Recuperamos apenas seis estudos, embora o Hg seja um metal tóxico generalizado e a gravidez seja um período de maior suscetibilidade a ameaças ambientais e risco cardiovascular. No geral, nossa revisão mostrou resultados mistos, com dois estudos relatando associação positiva no grupo com maior exposição. No entanto, devido à importância do assunto, estudos adicionais são necessários para elucidar os efeitos do Hg sobre DHG, com atenção especial ao ajuste de confundimento negativo.

Cuidado do enfermeiro às mulheres com síndromes hipertensivas na gestação em maternidade / Nursing care for women with hypertensive syndromes during pregnancy in a maternity hospital

Resumo: Este trabalho teve como produto o desenvolvimento um protocolo institucional denominado "Protocolo de cuidado do enfermeiro às mulheres com Síndromes Hipertensivas na Gestação em maternidade". Dessa forma, teve como objetivo construir um protocolo de cuidado do enfermeiro às mulheres com Síndromes Hipertensivas na Gestação em maternidade de um hospital universitário. Como delineamento metodológico, utilizou-se a Pesquisa Convergente Assistencial proposta por Trentini e Paim, com abordagem qualitativa. A pesquisa foi desenvolvida nos setores Centro Obstétrico; Pronto Atendimento; Alojamento Conjunto de um Hospital Universitário do Sul do Brasil. Participaram da pesquisa 31 enfermeiros assistenciais e gestores da maternidade, lotados em um dos setores de atendimento às mulheres, com no mínimo três meses de atuação. Foram excluídos os enfermeiros que não responderam ao questionário no prazo de 20 dias após envio, que estavam afastados por licenças e os que não participaram de pelo menos uma das quatro oficinas realizadas. A coleta de dados ocorreu nos meses de agosto a novembro de 2021, por meio de um formulário online e quatro oficinas remotas síncronas, norteadas por um roteiro com questões envolvendo o cuidado de enfermagem às mulheres com SHG, e embasadas no processo denominado Quatro Erres, que se divide em quatro fases: concepção, instrumentação, perscrutação e análise. A análise de dados ocorreu mediante análise temática proposta por Bardin com auxílio do software Webqda. O estudo foi aprovado pelo Comitê de Ética e Pesquisa da maternidade local mediante parecer 4.588.214. A partir da análise dos dados coletados a partir das oficinas emergiram duas categorias: necessidade de protocolo para nortear o processo de cuidado; e o cuidado do enfermeiro à mulher com Síndromes Hipertensivas na gestação. Foi possível evidenciar que os enfermeiros demonstram conhecimento atualizado e buscam realizar seu cuidado com competência às mulheres com SHG e voltado para a integralidade; estão em constante busca de evidências; e sentem a necessidade de mais autonomia dentro do seu contexto de atuação na maternidade. Como considerações finais pode-se pontuar que este estudo proporcionou a construção de um protocolo de cuidado que não existia na instituição e que levou em consideração a realidade da instituição, as competências e fragilidades percebidas pelos enfermeiros da maternidade, o que contribui para sua utilização de forma efetiva. A tecnologia desenvolvida pode contribuir na melhoria e uniformização de condutas pelos enfermeiros e não somente em um setor, mas sim em diversos ambientes da maternidade no que diz respeito ao atendimento às mulheres com síndromes hipertensivas, para que assim, o melhor cuidado baseado em evidências seja oferecido e padronizado dentro da instituição, proporcionando segurança para as pacientes e com perspectivas de melhores desfechos obstétricos.

Abstract: This work had as a product the development of an institutional protocol called "Nurse care protocol for women with Hypertensive Syndromes in Pregnancy in maternity ward". In this way, it aimed to build a protocol of nursing care for women with Hypertensive Syndromes in Pregnancy in a maternity hospital of a university hospital. As a methodological design, the Convergent Assistance Research proposed by Trentini and Paim was used, with a qualitative approach. The research was developed in the sectors Obstetric Center; Emergency Service; Rooming-in at a University Hospital in Southern Brazil. Thirty-one care nurses and maternity managers participated in the research, assigned to one of the women's care sectors, with at least three months of experience. Nurses who did not respond to the questionnaire within 20 days of sending it, who were on leave, and those who did not participate in at least one of the four workshops held were excluded. Data collection took place from August to November 2021, through an online form and four synchronous remote workshops, guided by a script with questions involving nursing care for women with SHG, and based on the process called Quatro Erres, which is divided into four phases: design, instrumentation, scrutiny, and analysis. Data analysis took place through thematic analysis proposed by Bardin with the help of Webqda software. The study was approved by the Ethics and Research Committee of the local maternity hospital under opinion 4,588,214. From the analysis of the data collected from the workshops, two categories emerged: need for a protocol to guide the care process; and the nurse's care for women with Hypertensive Syndromes during pregnancy. It was possible to show that nurses demonstrate up-to-date knowledge and seek to perform their care with competence for women with SHG and focused on integrality; they are in constant search of evidence; and feel the need for more autonomy within their context of work in maternity. As final considerations, it can be noted that this study provided the construction of a care protocol that did not exist in the institution and that consider the reality of the institution, the competencies and weaknesses perceived by the maternity nurses, which contributes to their use effectively. The technology developed can contribute to the improvement and standardization of conduct by nurses and not only in one sector, but in different maternity environments about the care of women with hypertensive syndromes, so that the best evidence-based care is provided offered and standardized within the institution, providing safety for patients and prospects for better obstetric outcomes.

Epidemiological characteristics of hypertensive disorders during pregnancy in a high-risk population / Características epidemiológicas de los trastornos hipertensivos durante el embarazo en una población de alto riesgo

Abstract Objectives: the aim is to determine the prevalence of hypertensive disorders and to describe the sociodemographic aspects and risk factors for preeclampsia, gestational hypertension and intrauterine growth restriction. Methods: a descriptive cross-sectional study. Maternal characteristics, history from the first prenatal visit and outcomes were obtained. The prevalence and percentages were calculated and described. Results: the prevalence of hypertensive disorders was 12.7%, preeclampsia was 8.0%, followed by gestational hypertension at 4.7%. Of the preeclampsia, 54.8% were severe and 11.9% were of early onset. Moreover, 56.5% of the severe preeclampsia had preterm deliveries. IUGR had a prevalence of 5.3%. Based on maternal history, the most relevant risk factors were a family and personal history of preeclampsia and IUGR. Conclusions: we found a considerable prevalence of preeclampsia with a high percentage of preterm deliveries, associated with varying severity. This data helps health professionals to be aware of the risk factors that can be followed up for preventing complications. The determination of the risk of developing a hypertensive disorder during pregnancy is fundamental to encouraging proper counseling and care for these women through gestation.

Resumen Objetivos: determinar la prevalencia de trastornos hipertensivos y describir los aspectos sociodemográficos y los factores de riesgo de preeclampsia, hipertensión gestacional y restricción del crecimiento intrauterino (RCIU). Métodos: estudio descriptivo de corte transversal. Se obtuvieron características maternas, antecedentes del primer control prenatal y los resultados obstétricos. Se calcularon y describieron las prevalencias y porcentajes. Resultados: la prevalencia de trastornos hipertensivos fue del 12.7%, la de la preeclampsia fue del 8.0%, seguida de la hipertensión gestacional con el 4.7%. Del total de gestantes con preeclampsia, el 54.8% fueron graves y el 11.9% fue de inicio temprano. Además, el 56.5% de las gestantes con preeclampsia severa tuvieron partos prematuros. La RCIU tuvo una prevalencia del 5.3%. Según los antecedentes maternos, los factores de riesgo más relevantes fueron los antecedentes familiares y personales de preeclampsia y RCIU. Conclusiones: se encontró una prevalencia considerable de preeclampsia con un alto porcentaje de partos prematuros, asociada a una severidad variada. Estos datos ayudan a los profesionales de la salud a conocer los factores de riesgo que se pueden monitorear para prevenir complicaciones. La determinación del riesgo de desarrollar un trastorno hipertensivo durante el embarazo es fundamental para fomentar el asesoramiento y la atención adecuados para estas mujeres durante la gestación.

O papel da enfermagem nas síndromes hipertensivas da gravidez: Revisão integrativa / El papel de la enfermería en los síndromes hipertensivos del embarazo: Una revisión integradora / The role of nursing in pregnancy-associated hypertensive disorders: Integrative review

Objetivo: identificar as evidências disponíveis na literatura sobre o papel da enfermagem na assistência as gestantes com síndromes hipertensivas na gestação. Método: Trata-se de uma revisão integrativa baseada na estratégia PICO, realizada com 13 artigos indexados nas bases de dados LILACS, SciELO, BDENF, MEDLINE. Os critérios de inclusão consideraram artigos disponíveis na íntegra e publicados entre 2009 a junho de 2021. Resultados: Para análise, os estudos foram divididos em 3 categorias: 1. O conhecimento dos profissionais de enfermagem sobre as síndromes hipertensivas na gestação; 2. Os cuidados de enfermagem à gestante com síndromes hipertensivas na gestação e seus neonatos; 3. A sistematização da assistência em enfermagem no cuidado as síndromes hipertensivas na gestação. Conclusão: Os estudos analisados demonstram as interfaces e desafios da enfermagem no cuidado às gestantes com síndromes hipertensivas na gestação, apontando o papel primordial da enfermagem na atenção à saúde da gestante.(AU)

Objective: to identify the evidence available in the literature on the role of nursing in assisting pregnant women with hypertensive syndromes during pregnancy. Method: This is an integrative review based on the PICO strategy, carried out with 13 articles indexed in the LILACS, SciELO, BDENF, MEDLINE databases. Inclusion criteria considered articles available in full and published between 2009 and June 2021. Results: For analysis, the studies were divided into 3 categories: 1. Nursing professionals' knowledge about hypertensive syndromes during pregnancy; 2. Nursing care for pregnant women with hypertensive syndromes during pregnancy and their newborns; 3. The systematization of nursing care in the care of hypertensive syndromes during pregnancy. Conclusion: The analyzed studies demonstrate the interfaces and challenges of nursing in the care of pregnant women with hypertensive syndromes during pregnancy, pointing out the primordial role of nursing in the health care of pregnant women.(AU)

Objetivo: identificar las evidencias disponibles en la literatura sobre el papel de la enfermería en la asistencia a las gestantes con síndromes hipertensivos durante el embarazo. Método: Se trata de una revisión integradora basada en la estrategia PICO, realizada con 13 artículos indexados en las bases de datos LILACS, SciELO, BDENF, MEDLINE. Los criterios de inclusión consideraron artículos disponibles en su totalidad y publicados entre 2009 y junio de 2021. Resultados: Para el análisis, los estudios fueron divididos en 3 categorías: 1. Conocimiento de los profesionales de enfermería sobre los síndromes hipertensivos durante el embarazo; 2. Atención de enfermería a las gestantes con síndromes hipertensivos durante el embarazo y sus recién nacidos; 3. La sistematización de los cuidados de enfermería en la atención de los síndromes hipertensivos durante el embarazo. Conclusión: Los estudios analizados demuestran las interfaces y desafíos de la enfermería en el cuidado de la gestante con síndromes hipertensivos durante el embarazo, señalando el papel primordial de la enfermería en el cuidado de la salud de la gestante.(AU)

Fatores de risco e elementos primitivos no desenvolvimento de síndromes hipertensivas no pré-natal: revisão integrativa / Risk factors and primitive elements in the development of hypertensive syndromes in prenatal care: integrative review / Factores de riesgo y elementos primitivos en el desarrollo de síndromes hipertensivos en la atención prenatal: revisión integradora

Objetivo: identificar os fatores de risco e elementos primitivos associados às síndromes hipertensivas nas gestantes no pré-natal. Método: revisão integrativa nas bases: MEDLINE, SCOPUS, WoS, CINAHL, BDENF e LILACS no período de setembro a outubro de 2020. Para a extração dos dados utilizou-se a ferramenta Poronto. Resultados: incluíram-se 47 estudos, nos quais foram identificados 30 conceitos primitivos inter-relacionados que alertam para as necessidades das gestantes. As investigações permitiram identificar idade de 18 a 50 anos, raça negra, vulnerabilidade socioeconômica, baixa escolaridade e o baixo peso ao nascer como fatores de risco sensíveis de identificação na atenção primária. Conclusão: a literatura apresenta fatores pertinentes quanto ao desenvolvimento da síndrome hipertensiva permitindo clarificar os elementos primitivos e fatores de risco. Além do mais, subsidia o cuidado e aponta para o desenvolvimento de pesquisas que desenvolvam instrumentos voltados ao público estudado.

Objective: to identify the risk factors and primitive elements associated with hypertensive syndromes in pregnant women during prenatal care. Method: integrative review in the databases: MEDLINE, SCOPUS, WoS, CINAHL, BDENF and LILACS from September to October 2020. The Poronto tool was used to extract the data. Results: 47 studies were included, in which 30 interrelated primitive concepts were identified that alert to the needs of pregnant women. The investigations allowed the identification of age from 18 to 50 years, black race, socioeconomic vulnerability, low schooling and low birth weight as sensitive risk factors for identification in primary care. Conclusion: the literature presents relevant factors regarding the development of hypertensive syndrome allowing clarifying the primitive elements and risk factors. Moreover, it subsidizes care and points to the development of research that develops instruments aimed at the studied public.

Objetivo: identificar los factores de riesgo y elementos primitivos asociados a los síndromes hipertensivos en gestantes durante la atención prenatal. Método: revisión integradora en las bases de datos: MEDLINE, SCOPUS, WoS, CINAHL, BDENF y LILACS de septiembre a octubre de 2020. Se utilizó la herramienta Poronto para extraer los datos. Resultados: Se incluyeron 47 estudios, en los que se identificaron 30 conceptos primitivos interrelacionados que alertan a las necesidades de las gestantes. Las investigaciones permitieron identificar la edad de 18 a 50 años, la raza negra, la vulnerabilidad socioeconómica, la baja escolaridad y el bajo peso al nacer como factores de riesgo sensibles para la identificación en atención primaria. Conclusión: la literatura presenta factores relevantes respecto al desarrollo del síndrome hipertensivo permitiendo aclarar los elementos primitivos y factores de riesgo. Además, subvenciona la atención y apunta al desarrollo de investigación que desarrolle instrumentos dirigidos al público estudiado.

Knowledge, attitude and practice about hypertensive gestational syndrome among pregnant women: a randomized clinical trial / Conocimiento, actitud y práctica sobre el síndrome hipertensivo gestacional entre mujeres embarazadas: ensayo clínico aleatorizado / Conhecimento, atitude e prática sobre síndrome hipertensiva gestacional entre gestantes: ensaio clínico randomizado

ABSTRACT Objective: to evaluate knowledge, attitude and practice about Gestational Hypertensive Syndrome among pregnant women, after an educational intervention. Method: a controlled, randomized and longitudinal clinical trial, related to the Knowledge, Attitude and Practice survey on Gestational Hypertensive Syndrome complications, carried out with 120 pregnant women at a public maternity hospital in Fortaleza-CE, Brazil. Data collection was performed at three moments and the pregnant women were separated into two groups with 60 participants each. For quantitative comparisons, the Student's t test or the Mann-Whitney's test were applied. To study qualitative associations, the Chi-square or Fisher's exact tests were employed. Results: adequate assessment of knowledge, attitude and practice was identified in the intervention group, on the seventh and thirtieth days after the intervention (p<0.05), with an increased chance of adequate knowledge on the seventh (Odds Ratio=6.63 - Confidence Interval: 3.5-12.55) and on the thirtieth (Odds Ratio=6.25 - Confidence Interval: 3.13-12.50) days. In this group, the attitude was adequate on the seventh (Odds Ratio=6.11 - Confidence Interval: 3.28-11.39) and on the thirtieth (Odds Ratio=6.44 - Confidence Interval: 3.49-11.89) days. The practice was also adequate on the seventh (Odds Ratio=3.73 - Confidence Interval: 2.21-6.28) and on the thirtieth (Odds Ratio=4.91 - Confidence Interval: 2.90-8.32) days. Conclusion: the pregnant women who participated in the educational intervention presented more adequacy in relation to knowledge, attitude and practice, when compared to those in the control group. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos, REBEC) RBR-8wyp8j

RESUMEN Objetivo: evaluar el conocimiento, la actitud y la práctica sobre el Síndrome Hipertensivo Gestacional entre mujeres embarazadas, después de una intervención educativa. Método: ensayo clínico controlado, aleatorizado y longitudinal, relacionado con la encuesta de Conocimiento, Actitud y Práctica sobre complicaciones del Síndrome Hipertensivo Gestacional, realizado con 120 mujeres embarazadas en una maternidad pública de Fortaleza-CE, Brasil. La recolección de datos tuvo lugar en tres momentos y se separó a las mujeres embarazadas en dos grupos de 60 participantes cada uno. Para las comparaciones cuantitativas, se aplicó la prueba t de Student o la de Mann-Whitney. Para estudiar las asociaciones cualitativas, se empleó la prueba de Chi-cuadrado o la prueba exacta de Fisher. Resultados: se identificó una evaluación adecuada del conocimiento, la actitud y la práctica en el grupo intervención, a los siete y treinta días posteriores a las intervenciones (p<0,05), con un incremento en la probabilidad de conocimiento adecuado al día siete (Odds Ratio=6,63 - Intervalo de Confianza: 3,5-12,55) y al día treinta (Odds Ratio=6,25 - Intervalo de Confianza: 3,13 - 12,50). En este grupo, la actitud fue adecuada al día siete (Odds Ratio=6,11 - Intervalo de Confianza: 3,28 -11,39) y al día treinta (Odds Ratio=6,44 - Intervalo de Confianza: 3,49-11,89). La práctica también resultó adecuada al día siete (Odds Ratio=3,73 - Intervalo de Confianza: 2,21-6,28) y al día treinta (Odds Ratio=4,91 - Intervalo de Confianza: 2,90-8,32). Conclusión: las mujeres embarazadas que participaron en la intervención educativa presentaron más adecuación en relación con el conocimiento, la actitud y la práctica, en comparación las participantes del grupo control. Registro Brasileño de Ensayos Clínicos (REBEC) RBR-8wyp8j

RESUMO Objetivo: avaliar conhecimento, atitude e prática sobre Síndrome Hipertensiva Gestacional entre gestantes, após intervenção educativa. Método: ensaio clínico controlado, randomizado e longitudinal, relacionado ao inquérito Conhecimento, Atitude e Prática sobre complicações da Síndrome Hipertensiva Gestacional, realizado em maternidade pública de Fortaleza-CE, Brasil, com 120 gestantes. A coleta de dados foi realizada em três momentos e as gestantes separadas em dois grupos com 60 participantes cada. Para comparações quantitativas, aplicou-se o teste t de Student ou Mann-Whitney. Para estudar associações qualitativas, empregou-se o teste Qui-quadrado ou exato de Fisher. Resultados: identificou-se avaliação adequada do conhecimento, da atitude e prática no grupo intervenção, no sétimo e trigésimo dia pós-intervenção (p<0,05), com aumento de chance para o conhecimento adequado no sétimo (Odds Ratio=6,63 - Intervalo de Confiança: 3,5-12,55) e no trigésimo dia (Odds Ratio=6,25 - Intervalo de Confiança: 3,13 - 12,50). Neste grupo, a atitude foi adequada no sétimo (Odds Ratio= 6,11 - Intervalo de Confiança: 3,28-11,39) e no trigésimo dia (Odds Ratio=6,44 - Intervalo de Confiança: 3,49-11,89). Prática também adequada no sétimo (Odds Ratio=3,73 - Intervalo de Confiança: 2,21-6,28) e trigésimo dia (Odds Ratio=4,91 - Intervalo de Confiança: 2,90-8,32). Conclusão: as gestantes que participaram da intervenção educativa apresentaram mais adequabilidade em relação ao conhecimento, à atitude e prática, quando comparadas às participantes do grupo controle. Registro Brasileiro de Ensaios Clínicos (REBEC) RBR-8wyp8j

Resultados maternos y neonatales en mujeres con trastornos hipertensivos en embarazos lejos del término / Maternal and neonatal outcomes of women with hypertensive disorders during very preterm pregnancies / Resultados maternos e neonatais em mulheres com síndromes hipertensivas em gravidez longe do termo

ntroducción: el impacto social que generan los trastornos hipertensivos trae repercusiones para la mujer en gestación y los sistemas de salud. Objetivo: describir los resultados maternos y neonatales en mujeres con trastornos hipertensivos de la gestación en embarazos lejos del término en el departamento de Córdoba, Colombia. Métodos: estudio descriptivo exploratorio de tipo retrospectivo. La población estuvo conformada por 90 mujeres con trastornos hipertensivos en embarazos lejos del término (de 26 a 32 semanas de gestación). La información se analizó con el subprograma VALIDATE y el paquete estadístico SPSS versión 23; para el análisis multivariado y univariado se usó el modelo de correspondencias múltiples. Resultados: la preeclampsia fue el trastorno hipertensivo de la gestación de mayor proporción en la muestra de estudio. La mayoría de las mujeres convivían en unión libre, tenían estudios de bachillerato completo y pertenecían al régimen subsidiado. La edad de las gestantes osciló entre 14 y 42 años. La paridad se encontraba entre 1 y 9 hijos; el 75 % de ellas tenían pobres controles prenatales y se encontraban en el tercer trimestre del embarazo. Los resultados maternos muestran que el 64,8 % requirió UCI obstétrica, con una estancia entre 2 y 8 días. Los resultados neonatales evidencian que el 80,2 % de los recién nacidos requirieron UCIN y el 47,3 % fueron pequeños para la edad gestacional, y presentaron prematurez extrema como principal complicación neonatal, seguido del síndrome de dificultad respiratoria. Conclusiones:los desenlaces maternos y neonatales en embarazos lejos del término que cursan con un trastorno hipertensivo se encuentran asociados a altas tasas de morbilidad materna y neonatal

AbstractIntroduction: The social impact of hypertensive disorders has repercussions for pregnant women and health systems. Objective: To describe maternal and neonatal outcomes of women with hypertensive disorders during very preterm pregnancies in the department of Córdoba, Colombia. Methods: A retrospective, exploratory, descriptive study was conducted. The population consisted of 90 women with hypertensive disorders in very preterm pregnancies (26 to 32 weeks of pregnancy). Data were analyzed using VALIDATE subprogram and SPSS software Version 23. For univariate and bivariate analysis, multiple correspondence analysis was performed. Results: Preeclampsia was the most common hypertensive disorder in the study sample. Most of the women were cohabiting, had completed high school, and were registered on the subsidized type of affiliation to the health system. The ages of the pregnant women ranged from 14 to 42 years. Parity was between 1 and 9 offspring; 75% of the women had poor prenatal check-ups and were in the third trimester of pregnancy. Maternal outcomes show that 64.8% required obstetric admissions to ICU, with a length of stay between 2 and 8 days. Neonatal results show that 80.2% of newborns required admission to NICU, and 47.3% were small for gestational age, and extreme prematurity was their main neonatal complication followed by respiratory distress syndrome. Conclusions: Maternal and neonatal outcomes of very preterm pregnancies with hypertensive disorders are associated with high maternal and neonatal morbidity rates.

ResumoIntrodução: o impacto social gerado pelas síndromes hipertensivas repercute nas mulheres gravidas e nos sistemas de saúde. Objetivo: descrever os resultados maternos e neonatais em mulheres com síndromes hipertensivas em gravidez longe do termo no departamento de Córdoba, Colômbia. Métodos: estudo descritivo exploratório retrospectivo. A população consistiu de 90 mulheres com síndromes hipertensivas em gestações longe do termo (de 26 a 32 semanas de gestação). As informações foram analisadas com o subprograma VALIDATE e o pacote estatístico SPSS versão 23; para a análise multivariada e univariada foi utilizado o modelo de correspondência múltipla. Resultados: a pré-eclâmpsia foi a síndrome da gravidez com maior proporção na amostra do estudo. A maioria das mulheres vivia em união livre, tinha ensino médio completo e pertencia ao regime subsidiado. A idade das gestantes variou de 14 a 42 anos. A paridade foi entre 1 e 9 filhos; 75% delas tinham controles pré-natais ruins e estavam no terceiro trimestre de gravidez. Os resultados maternos mostram que 64,8% necessitaram de UTI obstétrica, com permanência entre 2 e 8 dias. Os resultados neonatais mostram que 80,2% dos recém-nascidos necessitaram de UTIN e 47,3% eram pequenos para a idade gestacional, apresentando prematuridade extrema como principal complicação neonatal, seguida da síndrome de angústia respiratória. Conclusões: os resultados maternos e neonatais em gestações longe do termo com síndromes hipertensivas estão associados a altas taxas de morbidade materna e neonatal.

Níveis pressóricos e fatores associados em gestantes do Estudo MINA-Brasil / Blood pressure levels and associated factors among pregnant women of the MINA-Brazil Study

Resumo O objetivo deste estudo foi investigar os fatores associados aos níveis pressóricos em gestantes participantes do Estudo MINA-Brasil, inscritas no pré-natal da Estratégia de Saúde da Família em Cruzeiro do Sul, Acre, Amazônia Ocidental Brasileira. Modelos múltiplos de regressão linear foram utilizados, adotando-se nível de significância de 5%. A maioria das gestantes participantes tinha média de idade de 24 anos (DP 6,3), 44,0% eram primigestas e 59,1% das gestantes apresentaram ganho de peso gestacional semanal excessivo. A ocorrência de hipertensão arterial foi de 0,7%. Os fatores associados positivamente aos níveis de pressão arterial sistólica foram: índice de massa corporal pré-gestacional (β = 0,984, IC95%: 0,768-1,200) e ganho de peso gestacional semanal (β = 6,816, IC95%: 3,368-10,264). Para os níveis de pressão arterial diastólica foram positivamente associados idade da gestante (β = 0,111, IC95%: 0,002-0,221), escolaridade (β = 2,194, IC95%: 0,779-3,609), índice de massa corporal pré-gestacional (β = 0,589, IC95%: 0,427-0,751) e ganho de peso gestacional semanal (β = 3,066, IC95%: 0,483-5,650). Esses resultados reforçam a necessidade de maior atenção pré-natal no cuidado materno para prevenção de distúrbios hipertensivos no final da gravidez.

Abstract The scope of this study was to investigate the factors associated with blood pressure levels among pregnant women participating in the MINA-Brazil Study, registered in the Family Health Strategy in Cruzeiro do Sul in the Western Brazilian Amazon. Multiple linear regression models were used, adopting a level of significance of 5%. The majority of pregnant participants were less than 24 years of age, 44% were primigravidae, and 59.1% had excessive weekly gestational weight gain. The frequency of hypertension was 0.7%. Factors positively associated with systolic blood pressure levels in pregnancy were pre-pregnancy body mass index (β = 0.984, CI95%: 0.768-1.200), and weekly gestational weight gain (β = 6.816, CI95%: 3.368-10.264). Diastolic blood pressure levels in pregnancy were positively associated with maternal age (β = 0.111, CI95%: 0.002-0.221), maternal schooling (β = 2.194, CI95%: 0.779-3.609), pre-pregnancy body mass index (β = 0.589, CI95%: 0.427-0.751), and weekly gestational weight gain (β = 3.066, CI95%: 0.483-5.650). These findings stress the importance of the role of antenatal care to prevent hypertensive disorders during pregnancy.

A study of hypertensive disorders of pregnancy and the fetal outcome in a tertiary care hospital: a prospective study

Background: Pregnancy induced hypertension is one of the major causes of feto maternal morbidity and mortality in pregnancy. The exact cause of PIH is unknown certain factors are known to increase the risk of PIH such as risk factor includes that young women with first pregnancy.Methods: The objective of this study was to assess the socio-demographic and clinico-pathological profile of the patients with hypertensive disorders of pregnancy and its associated fetal outcomes. A prospective study was conducted in department of obstetrics and gynecology Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura Karnataka from 15th July to 15th December 2018. All women admitted to labour ward with diagnosis of hypertensive disorders of pregnancy were included in the study after ruling out the exclusion criteria and thorough history, examination and laboratory evaluation were done and followed till delivery.Results: A total of 123 pregnant women with hypertensive disorder of pregnancy were enrolled in the study. Most of the participants were in the age group of 20 to 30 years. The PIH was seen mostly in primigravida, lower socioeconomic status and with lower educational levels. Emergency LSCS is the most common mode of delivery.Conclusions: The hypertensive disorder in pregnancy affects the majorly younger age group. It is most commonly seen in low socio-economic and uneducated population. Hence, there should be provided with proper antenatal care, early detection of hypertensive disorders for better feto-maternal outcome.

An observational study of early neonatal outcome in babies born to mothers with pregnancy induced hypertension

Background: Hypertensive disorders in pregnancy are a major cause of maternal morbidity and mortality accounting for 15-20% of maternal deaths worldwide. In India the incidence of preeclampsia is reported to be 8-10 percent of the pregnancies objective of this study was to with the above background, this study was carried out to study early neonatal outcome in babies born to PIH mothers, Measure the adverse neonatal outcomes in the early neonatal period and compare the mode of delivery between control group and PIH group.Methods: A total of 58 neonates born to mothers diagnosed having gestational hypertension, preeclampsia, eclampsia were taken as tests (group A), and 100 apparently healthy newborns born to normotensive mothers were enrolled as controls (group B) and followed up to 1st week of life. The outcome measures were compared between groups in terms of mode of delivery, preterm delivery, birth weight, APGAR score, intra uterine growth retardation, early neonatal complications.Results: In group A, 33 had LBW (56.89%) and in group B 18 had LBW (18%). The incidence of preterm deliveries in group A was higher as compared to group B (A- 43.10%, B-17%, p value <0.05). Babies born to PIH mothers had an increased incidence of IUGR, as compared to group B.Conclusions: PIH is one of the major causes of maternal, fetal and early neonatal morbidity and mortality. In this study authors found that risk of LBW, preterm delivery, NICU admission and IUGR in babies born to PIH mothers statistically significant. Early detection of high-risk individual by well trained personnel and timely referral to advanced tertiary center is necessary in bringing down the maternal and neonatal morbidity and mortality.

Neuro-imaging in severe hypertensive disorders of pregnancy: a study from North Indian tertiary health care institution

Background: Hypertensive disorders of pregnancy comprising of pre-eclampsia and eclampsia are a major cause of adverse pregnancy outcomes. Neurological manifestations of pregnancy induced hypertension are the most common cause of maternal and foetal morbidity and mortality. Cranial neuro-imaging reveals focal regions of symmetric hemispheric oedema; with parietal and occipital regions getting most commonly affected.Methods: The study was conducted among 65 antenatal women diagnosed with pre-eclampsia and eclampsia at gestational age >20 weeks in the department of obstetrics and gynecology, Kamla Nehru State Hospital for Mother and Child IGMC Shimla. Clinical signs and symptoms, neuroimaging findings were recorded for study purpose.Results: About 17.6% of severe pre-eclampsia and 100% of eclampsia had findings observed on cranial MRI. Headache and visual complaints were most frequently recorded. PRES was the predominant neuroradiographic finding in present study and occipital lobe was commonly affected region. No significant difference was observed regarding blood pressure parameters between MRI positive and negative subjects.Conclusions: Neuroimaging in antenatal with severe hypertensive disorders might aid in better understanding of the poorly explained phenomenon. In addition, this would be helpful in better management of the disorders along with their much-dreaded complications. Patients with hypertensive disorders of pregnancy should be subjected routinely to cranial imaging for the better perinatal outcomes.

Study of socio-demographic factors in cases of pregnancy induced hypertension and its associated risk factors in a tertiary care hospital

Background: The aim of the study was to study the socio-demographic factors in cases of pregnancy induced hypertension and its associated risk factors in a tertiary care hospital.Methods: The present retrospective study was conducted in the obstetrics and gynecology department of Shrimati Heera Kunwar Baa Memorial Hospital, Jhalawar, Rajasthan from December 2018 to November 2019. A total of 80 cases of pregnant women with PIH were studied. The socio-demographic data like age, parity, gestational age of presentation, mode of delivery, maternal and perinatal complications were noted from the hospital records and studied.Results: The incidence of PIH was found to be 8.16% in pregnant women attending the SHKBM Hospital. Majority of the study subjects were rural dweller (70%). A higher incidence of PIH was found among illiterate women (51.25%). 53.75% cases were in the age group of 25-30 years and 25% were in the age group of 19-24 years. In the present study, incidence of PIH was found to be highest among primigravidas (67.50%) as compared to multigravidas (32.5%). Most cases were delivered by caesarean section (73.75%) and 26.25% were delivered vaginally. Out of 80 cases, 16.25% of cases were complicated by eclampsia, Severe PIH in 12.5%, abruptio placentae in 2.5% and HELLP Syndrome in 1.25% cases.Conclusions: PIH is a very common complication encountered in pregnancy associated with adverse maternal and fetal outcome. The risk is higher among young primigravidas and in rural population. Better health care facilities and awareness among the pregnant women will help in reducing the incidence of PIH and its associated complications.

Incidence of retinal changes in pregnant women due to pregnancy induced hypertension and its correlation with clinical profile

Background: Pregnancy induced hypertension (PIH) is associated with many other pathological complications. Pathological changes of this disease appear to be related to vascular endothelial dysfunction and its consequences. One such complication or effect of PIH is retinal changes.Methods: This observational study was conducted of 110 cases over a period of 12 months from March 2018 to February 2019 in department of obstetrics of gynecology in Kamla Raja Hospital, G. R. Medical College, Gwalior, Madhya Pradesh. All the patients who fulfilled the diagnostic criteria of PIH admitted in the obstetric ward.Results: Retinopathic changes were noted in 36.36% out of which grade I, grade II, grade III and grade IV have 11.82%, 8.18%, 10.19% and 5.45% cases respectively. In + proteinuria 10.9% of cases have positive findings, in ++ proteinuria 18.18% cases have positive findings, in +++ 7.27% cases have retinopathy but severity increases with a grade of proteinuria. 40% cases retinopathic changes of mild preeclampsia have positive finding, 36.36% in severe preeclampsia and 23.64% in cases of eclampsia. As overall severity of PIH increases retinopathies in patients increases.Conclusions: Visual symptoms are few in patients with PIH and often absent unless the macula is involved. Sudden onset of headache, which is resistant to routine therapy in these patients, may be the warning symptom before the onset of first convulsion. By repeated fundus examinations at regular intervals one can assess the severity of the disease and also response to treatment instituted.

Role of obstetric colour doppler studies in predicting perinatal outcome in pregnancy induced hypertension

Background: Pregnancy induced hypertension (PIH) is associated with adverse perinatal outcome. Multi vessel colour Doppler studies are useful in these cases for timely intervention. The aim of present study was to know the significance of umbilical, middle cerebral and uterine artery Doppler in PIH and to analyse their role in predicting perinatal outcome.Methods: This is a study of 150 pregnant women with pregnancy induced hypertension (PIH). These patients were evaluated with colour Doppler and were followed subsequently for any adverse perinatal outcome.Results: Out of 150 cases 70% of cases were found in 20-30 years age group. 98 cases had abnormal uterine artery Doppler indices accounting for 65.3%, while 52 cases had a normal Doppler index accounting for 34.3%. Out of 150 cases, 94 (64.6%) cases had abnormal middle cerebral artery. In our study 53 cases had abnormal umbilical artery Doppler indices accounting for 35.4%, while 97 cases had a normal Doppler index accounting for 64.6%. Out of 150 cases in our study 27 cases had Reversal of a wave in ductus venosus waveform that is in 18%. In this study total 5 cases (35.7%) of perinatal mortality were seen.Conclusions: The knowledge of various doppler parameters may help to improve pregnancy outcome and identification of PIH at earliest gestation age as compared to other antepartum test modalities.

Study on fetomaternal outcome in short interpregnancy interval: case control study

Background: This study was carried out at a tertiary health centre with the aim of studying the effect of short interpregnancy interval on fetomaternal outcome. The maternal complications and fetal complications of short interpregnancy interval were analysed in comparison to normal interpregnancy interval.Methods: This is a case control study. 125 women with short interpregnancy interval seeking healthcare at tertiary health care centre were matched with 125 women with normal interpregnancy interval on the basis of demographic characteristics like age, height, weight and socio-economic status. These were included in the case control study.Results: Short interpregnancy interval is associated with increased risk of anemia, premature rupture of membranes (PROM), scar dehiscence and low birth weight whereas normal interpregnancy interval is associated with increased risk of PIH as compared to short interpregnancy interval.Conclusions: Short interpregnancy interval is associated with increased risk of anemia, PROM, scar dehiscence and low birth weight whereas normal interpregnancy interval is associated with increased risk of PIH.

Doppler ultrasound of umbilical artery in prediction of fetal outcome in pregnancy induced hypertension Sudanese population

The pregnancy induced hypertension increase the fetal mortality and morbidity and the using of Doppler umbilical artery indices decrease the fetal mortality and morbidity however, there is few complete data about the most frequently altered Doppler US parameters to predict fetal outcome in pregnancy induced hypertension . Methods This ia cohort prospective study done in two hundred and six women of second and third trimester presenting to antenatal clinic in Soba University Hospital at the department of Obstetrics & Gynecology, in the fetus unit and critical pregnancy in the period From June 2008 to April 2013 to assess the Doppler indices of umbilical artery in pregnancy induced hypertension for prediction of prenatal outcome; 105 pregnancy induced hypertension patients and 101 women with uneventful pregnancies as normal control group included in this study . Baseline investigations and color Doppler of umbilical artery were done. Statistical analysis of data were done using SPSS, Receiver Operating Characteristic (ROC) curve analysis was performed and the area under the curve (AUC) used to determine sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of umbilical artery Doppler indices to predict fetal outcome. Results The study determine that there was significant difference in Doppler indices in PIH and control group ( p<0.01, the mean indices of umbilical artery is higher in PIH group compared with normal pregnancy group , the mean different of S/D ratio was 0.40, mean difference of RI was 0.06 and the mean different of PI index was 0.16, high percentage of adverse fetal outcome had been reported in in Pregnancy Induced Hypertension group than in control , which was more in absent and reversed flow velocity in umbilical artery in Pregnancy Induced Hypertension compared with group of Pregnancy Induced Hypertension with present end diastolic flow velocity. Systolic/Diastolic ratio was most accurate in predicting adverse outcome in pregnancy induced hypertension patients, followed by the Pulastility index then the Resistance index (75%, 66% and 57% respectively). Conclusion This study concluded that pregnancy induced hypertension leads to worsen placental insufficiently, which appears on the higher Doppler indices of umbilical artery to PIH patients when compared with normal pregnancy. A low diastolic flow and higher indices characterized the pregnancies with abnormal outcomes. Doppler of the umbilical artery was useful to predict fetal well being in PIH patients, high percentage of adverse fetal outcome had been reported in absent and reversed end diastolic flow velocity in umbilical artery compared with group of present flow velocity.

Epidemiology of artherial hypertension in pregnants / Epidemiologia da hipertensão arterial em gestantes

ABSTRACT Objective To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events. Methods Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used. Results Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed). Conclusion After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.

RESUMO Objetivo Pesquisar os dados epidemiológicos da hipertensão arterial em gestantes, bem como identificar seus possíveis eventos associados. Métodos A coleta de dados foi realizada no ambulatório do pré-natal de alto risco e na enfermaria da maternidade em hospital público da cidade de São Paulo, nos períodos matutino e vespertino, de outubro de 2015 a julho de 2016. Foi aplicado um questionário com 22 perguntas elaborado pelos pesquisadores. A margem de erro foi de 5% e o nível de confiança, de 95%. Para o cálculo, foram usados o teste de igualdade de duas proporções, a correlação de Pearson e o teste de ANOVA. Resultados Dentre as entrevistadas, 43% tinham hipertensão crônica, 33,3% se apresentaram com até 20 semanas de gestação, 23,7% se apresentaram após a 20ª semana da gestação, 62,3% tinham idade entre 18 e 35 anos, 78,1% tinham antecedente familiar com hipertensão arterial, 11,4% com idade entre 36 a 45 anos estavam na primeira gestação, e 26,3% com a mesma idade estavam a partir da segunda gestação. Dentre as afecções associadas, prevaleceu o diabetes com 50%; 22,2% se tratavam de obesidade, e dos alimentos mais escolhidos para consumo entre as gestantes, 47,5% possuíam alto teor energético (processados/ultraprocessados). Conclusão Após análise epidemiológica no resultado da prevalência da hipertensão arterial, foram encontradas gestantes com hipertensão arterial crônica, hipertensão arterial preexistente descoberta durante a gestação e doença hipertensiva específica da gestação. Em relação aos possíveis fatores associados à hipertensão arterial, foram encontrados: idade mais elevada, antecedentes familiares de hipertensão, preexistência de hipertensão, gestações tardias, diabetes, obesidade e frequente consumo de alimentos processados/ultraprocessados.

Cerebroumbilical doppler ratio in pregnancy induced hypertension and its prediction for adverse perinatal outcome

Background: To compare the changes in pulsatility index (PI) values of fetal middle cerebral artery (MCA), umbilical artery (UA) and ratio of PI of MCA and UA (cerebroumbilical ratio, C/U ratio) in normal pregnancies with pregnancy induced hypertension (PIH) and to evaluate their usefulness for predicting adverse perinatal outcome.Methods: This was a prospective comparative study carried out over a period of 1 year on total 140 patients between 30-40 weeks of gestation. Study group comprised of 70 patients with PIH. The control group comprised of 70 patients with normal BP. Both the groups were followed by doppler ultrasound and the UA PI, the MCA PI and the C/U ratio were measured. The results of the last doppler ultrasound before delivery were considered in the correlation with various adverse perinatal outcome. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MCA PI and UA PI and C/U ratio were calculated and compared for predicting adverse perinatal outcome.Results: Abnormal C/U ratio was more common in PIH group (42.85%) than control group (5.71%). In the study group, 83.33% patients of abnormal C/U ratio showed adverse perinatal outcome. C/U ratio had highest sensitivity (75.75%), negative predictive value (80%) and diagnostic accuracy (81.42%) compared to MCA PI and UA PI for predicting adverse perinatal outcome in PIH women.Conclusions: Incidence of adverse perinatal outcome was more common with abnormal C/U ratio. C/U ratio is better predictor for adverse perinatal outcome in PIH women than individual MCA PI and UA PI.