Prevalence of Preeclampsia in Brazil: An Integrative Review / Prevalência de pré-eclâmpsia no Brasil: Uma revisão integrativa

Abstract Objective To review literature and estimate the occurrence of preeclampsia and its complications in Brazil. Methods We performed an integrative review of the literature, and included observational studies published until August 2021 on the SciELO and PubMed databases that evaluated preeclampsia among pregnant women in Brazil. Other variables of interests were maternal death, neonatal death, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and eclampsia. Three independent reviewers evaluated all retrieved studies and selected those that met inclusion criteria. A metanalysis of the prevalence of preeclampsia and eclampsia was also performed, to estimate a pooled frequency of those conditions among the studies included. Results We retrieved 304 studies after the initial search; of those, 10 were included in the final analysis, with a total of 52,986 women considered. The pooled prevalence of preeclampsia was of 6.7%, with a total of 2,988 cases reported. The frequency of eclampsia ranged from 1.7% to 6.2%, while the occurrence of HELLP syndrome was underreported. Prematurity associated to hypertensive disorders ranged from 0.5% to 1.72%. Conclusion The frequency of preeclampsia was similar to that reported in other international studies, and it is increasing in Brazil, probably due to the adoption of new diagnostic criteria. The development of a national surveillance network would be essential to understand the problem of hypertensive disorders of pregnancy in Brazil.

Resumo Objetivo Revisar a literatura e estimar a ocorrência de pré-eclâmpsia e suas complicações no Brasil. Métodos Foi realizada uma revisão integrativa da literatura, com a inclusão de estudos observacionais publicados até agosto de 2021, nas bases de dados PubMed e SciELO, que avaliavam pré-eclâmpsia em mulheres brasileiras. Outras variáveis de interesse foram morte materna, morte neonatal, síndrome de hemólise, enzimas hepáticas elevadas e plaquetopenia (hemolysis, elevated liver enzymes, and low platelet count, HELLP, em inglês) e eclâmpsia. Três revisores independentes avaliaram os estudos identificados e selecionaram aqueles que preenchiam os critérios de inclusão. Foi realizada uma meta-análise da prevalência de pré-eclâmpsia e eclâmpsia, para estimar sua frequência acumulada com relação aos estudos incluídos. Resultados Foram identificados 304 estudos, 10 dos quais foram incluídos na análise final, num total de 52.986 mulheres. A frequência acumulada de pré-eclâmpsia foi de 6,7%, com um total de 2.988 casos. A frequência de eclâmpsia variou de 1,7% a 6,2%, ao passo que a ocorrência de síndrome de HELLP foi pouco relatada. A prematuridade associada a hipertensão foi de 0,5% a 1,7%. Conclusão A frequência de pré-eclâmpsia foi similar à de estudos internacionais; no entanto, ao longo dos últimos anos, ela vem aumentando no Brasil, possivelmente como reflexo da adoção de novos critérios diagnósticos. A criação de uma rede nacional de vigilância seria fundamental para entender o problema da hipertensão na gestação no país.

Desenlaces materno-fetales de los embarazos con trastornos hipertensivos: un estudio transversal / Maternal and fetal outcomes of pregnancies with hypertensive disorders: a cross-sectional study

INTRODUCCIÓN Y OBJETIVO: Los trastornos hipertensivos asociados al embarazo son considerados un problema de salud pública. Se busca describir las características clínicas y desenlaces materno-fetales de las pacientes con esta patología, atendidas en el Hospital Universitario de Santander (HUS) durante el primer semestre de 2017. MÉTODOS: Estudio observacional retrospectivo de corte transversal. Se incluyeron las pacientes en estado de embarazo o puerperio con diagnóstico o sospecha de trastorno hipertensivo; se excluyeron aquellas que no pudieron ser clasificadas o no correspondían a éstos. RESULTADOS: Se analizaron 181 historias clínicas; la edad de las pacientes osciló entre 14 y 44 años; el 43,7% eran primigestantes; el 40,3% tuvo un control prenatal inadecuado y el 27,5% tenía antecedente de trastorno hipertensivo en gestaciones previas. El 75,1% de las pacientes fueron clasificadas como preeclampsia, 18,2% con hipertensión gestacional, 4,4% con hipertensión más preeclampsia sobreagregada y 2,2% con hipertensión crónica. El 16,9% de las pacientes con preeclampsia debutaron antes de la semana 34, de las cuales el 91,3% tenían criterios de severidad; mientras que entre las demás, el 84% presentaron criterios de severidad. CONCLUSIONES: La preeclampsia fue el trastorno hipertensivo más frecuente, predominó la presentación tardía y severa con importantes tasas de complicación maternas y fetales. Mediante la implementación de estrategias de detección temprana y adecuada atención de los trastornos hipertensivos asociados al embarazo podrían mejorarse los desenlaces materno-fetales.

BACKGROUND AND OBJECTIVE: Hypertensive disorders of pregnancy are considered a public health issue. The aim is to describe the clinical features, maternal - fetal outcomes of patients with this disease, who were admitted at the University Hospital of Santander (Bucaramanga, Colombia) during the first half of 2017. METHOD: Cross-sectional retrospective observational study. Patients in pregnancy or puerperium with diagnosis of hypertensive disorder were included; those who could not be classified or did not correspond were excluded. RESULTS: 181 clinical charts were analyzed, the age of the patients ranged between 14 and 44 years, 43.7% were nulliparous, 40.3% had an inadequate prenatal control and 27.5% had history of hypertensive disorder in previous pregnancies. 75.1% were classified as preeclampsia, 18.2% as gestational hypertension, 4.4% as hypertension and superimposed preeclampsia and 2.2% with chronic hypertension; 16.9% of the patients were of an early-onset preeclampsia before week 34, of which 91.3% had criteria of severity; among the others, 84% presented criteria of severity. CONCLUSION: Preeclampsia was the most frequent hypertensive disorder, late and severe presentation prevailed with important maternal and fetal complication rates. Through the implementation of early detection strategies and adequate care of hypertensive disorders associated with pregnancy maternal and fetal outcomes could be improved.

Complicaciones neurológicas en la materna crítica / Neurological complications in critically ill pregnant women

Introducción: Las pacientes obstétricas pueden presentar numerosas complicaciones que ponen en peligro sus vidas con necesidad de ingreso en unidades de cuidados intensivos. Objetivo: Caracterizar clínicamente las maternas críticas con complicaciones neurológicas. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo en el Hospital Clínico Quirúrgico Hermanos Ameijeiras durante el período de enero de 2007 a diciembre de 2016. Para el análisis de los datos se efectuó el cálculo de frecuencias absolutas y relativas, se aplicaron medidas de tendencia central (media) y dispersión (rango) y para conocer la posible asociación entre las variables cualitativas se aplicó el Test de chi-cuadrado con una significación de p<0,05. Resultados: Las complicaciones neurológicas se presentaron en 33,3 por ciento de las pacientes, las más frecuentes fueron: eclampsia (65,7 por ciento), infarto cerebral (9,0 por ciento) y la trombosis venosa cerebral (8,6 por ciento). Las nulíparas (51,4 por ciento) y la edad mayor de 35 años (42,8 por ciento) fueron los factores de riesgo más observados. La hipertensión arterial fue el antecedente patológico personal principal y se evidenció asociación entre las complicaciones neurológicas y la causa directa de la muerte (p=0,00043). Conclusiones: Las complicaciones neurológicas fueron frecuentes en las maternas críticas y constituyen causa directa de muerte. Como complicación más frecuente se presentó la eclampsia(AU)

Introduction: Obstetric patients can present numerous complications that put in danger their lives, and they need of admission in intensive care units. Objective: To characterize in a clinical way the critically ill pregnant women with neurological complications. Methods: An observational, descriptive, retrospective study was conducted in Hermanos Ameijeiras. Clinical-Surgical Hospital during the period from January, 2007 to December, 2016. There was carried out the calculation of absolute and relative frequencies for the analysis of the data; there were applied measures of central (average) trends and dispersion (range), and to know the possible association between the qualitative variables the Chi-square´s Test was performed with a significance of p < 0.05. Results: The neurological complications appeared in 33,3 percent of the patients and the most frequent were: eclampsia (65,7 percent), cerebral infarction (9,0 percent) and cerebral venous thrombosis (8,6 percent). Being a nulliparous women (51,4 percent) and age of more than 35 years (42,8 percent) were the most common risk factors. Arterial hypertension was the main pathological background and the association between the neurological complications and the direct cause of the death (p=0.00043) was demonstrated. Conclusions: The neurological complications were frequent in critically ill pregnant women and they constitute a direct cause of death. The most frequent complication was eclampsia(AU)

Prevalencia de Síndrome de Hellp en el servicio de ginecología y obstetricia del Hospital Central del Instituto de Previsión Social. 2017 / Prevalence of Hellp Syndrome in the gynecology and obstetrics service of the Central Hospital of the Instituto de Previsión Social

Introducción: En la actualidad, la mortalidad materna va aumentando, debido a ciertas complicaciones producidas durante la gestación, una de ellas es el Síndrome de HELLP que es considerada una de las complicaciones más severas de las enfermedades hipertensivas del embarazo que mayoritariamente se presenta en embarazadas que cursan con preeclampsia. Objetivo: Determinar la prevalencia de Síndrome de HELLP en el Servicio de Ginecología y Obstetricia del Hospital Central del Instituto de Previsión Social durante el año 2017. Materiales y método: Estudio observacional descriptivo de corte transversal, muestreo probabilístico aleatorio simple. Fueron incluidas las fichas clínicas de las embarazadas que acudieron al servicio de Ginecología y Obstetricia del Hospital Central del Instituto de Previsión Social desde enero a diciembre del 2017. Resultados: Fueron incluidas en el estudio 177 embarazadas; de las cuales el 14,2% presentó Síndrome de HELLP. La mediana de edad fue de 28 años; el estado civil predominante fue unión libre en un 49,15%; el 62,71% de las gestantes procedieron de áreas urbanas, mayoritariamente del departamento Central y el 33,90% de ellas son ama de casa. La edad gestacional estuvo comprendida predominantemente entre las 33,2 a 37,6 semanas; la mediana del número de controles prenatales fue de 5. Con respecto a las enfermedades hipertensivas del embarazo la mayor parte de las gestantes presentaron preeclampsia. Conclusión: La prevalencia de Síndrome de HELLP en las embarazadas que acudieron al servicio de Ginecología y Obstetricia en el Hospital Central del Instituto de Previsión Social durante el año 2017 fue del 14,2%; dato similar a otros estudios realizados.

A prospective review of eclampsia at a regional hospital, eastern Ethiopia: incidence, clinical correlates, management and pregnancy outcome

Objective: The aims of the study were to determine the incidence of eclampsia and describe its clinical correlates and pregnancy outcomes.Patients and Methods: A one-year prospective study of 93 cases of eclampsia using a structured questionnaire which included socio-demographic data, clinical presentation, work-up, management and feto-maternal outcomes was done at Karamara Regional Hospital, Eastern Ethiopia.Results: The incidence of eclampsia was 2.7% (93 in 3500 deliveries). Most of the cases were young (45%), nulliparous (70%) women who had not received any antenatal care (63%). Almost two thirds of the women (n=57, 61%) presented with eclampsia in antepartum, whereas 26 cases (28%) occurred in intrapartum, and there were 10 cases (11%) with eclampsia postpartum. Preceding symptoms were reported in 78.5 % of patients with severe hypertension recorded in 66%. The average gestational age at presentation was 32 weeks. Hydralazine was used for emergency control of hypertension in 91% of the cases. Magnesium was administered to 92 (99%) of the patients. Delay greater than 12h from admission to delivery occurred in 45% of the women with eclampsia. Cesarean section (CS) was performed in 14 (17%) and instrumental delivery in 15 (18%). The maternal and perinatal case fatality rates of eclampsia were 34.7% and 11% respectively.Conclusion: The incidence of eclampsia was very high with corresponding high maternal and perinatal deaths. The presentation of patients was late and the work up and management of cases substandard. Hence capacity building of health facilities, implementation of standard guidelines and criteria based auditing are recommended

Ingresos a Unidad de Cuidados Intensivos de mujeres durante el embarazo y periodo puerperal / Admission of women to an intensive care unit during pregnancy or the postpartum period

Introducción: las complicaciones del embarazo y parto constituyen las principales causas de muerte entre las mujeres en edad reproductiva. Las embarazadas o puérperas que ingresan a Unidad de Cuidados Intensivos (UCI) son en su mayoría casos agudos críticos con riesgo de muerte, que necesitan tratamiento especializa do y complejo. Constituyen un grupo significativo de la práctica obstétrica. Objetivo: determinar las características clínicas y demográficas de las pacientes gestantes o puérperas que ingresaron a UCI del Hospital Nacional de Itauguá durante 5 años (2011-2015) Materiales y métodos: diseño observacional descriptivo de corte trasverso. Fueron incluidas gestantes y puérperas que requirieron ingreso a UCI por complicaciones obstétricas y no obstétricas, descompensación materna, con y sin morbilidad previa. Resultados: necesitaron ingreso a UCI 135 pacientes (0,48%). La edad media fue 27 ± 6,7 años. La muestra estuvo conformada por 21 gestantes (15,5%), 85 puérperas (63%), 27 mujeres con post aborto (20%) y 2 con embarazo ectópico (1,5 %). La complicación obstétrica más frecuente que motivó el ingreso a UCI fue la sepsis y entre las no obstétricas la cardiopatía descompensada. El tiempo medio de internación en la UCI fue 6,47 ± 8,5 días y 50 pacientes (37,03%) necesitaron asistencia respiratoria mecánica. Hubo 19 óbitos (14%) Conclusiones: el ingreso a UCI se observó en 0,48%. La mortalidad en UCI fue 14%.

Introduction: complications of pregnancy and childbirth are the main causes of death among women of childbearing age. Pregnant women or postpartum women entering the Intensive Care Unit (ICU) are mostly acute cases with a high risk of death, which require specialized and complex treatment. They constitute a significant group of obstetric practice. Objective: to determine the clinical and demographic characteristics of the pregnant or puerperal patients who entered the ICU of the National Hospital of Itauguá for 5 years (2011-2015) Materials and methods: descriptive observational cross-sectional design. Pregnant women and postpartum women who required admission to the ICU due to obstetric and non-obstetric complications, maternal decompensation, with and without prior morbidity were included. Results: 135 patients required admission to the ICU. The mean age was 27 ± 6.7 years. The sample consisted of 21 pregnant women (15.5%), 85 postpartum women (63%), 27 women with post abortion (20%) and 2 with ectopic pregnancy (1.5%). The most frequent obstetric complication that led to ICU admission was sepsis and non-obstetric heart disease was decompensated. The mean ICU admission time was 6.47 ± 8.5 days and 50 patients (37.03%) required mechanical ventilation. There were 19 deaths (14%) Conclusions: ICU admission was observed at 0.48%. Mortality in ICU was 14%.

Postpartum eclampsia is defined as eclampsia that occurs after delivery within 48 h. Now-a-days, the incidence of antenatal and intrapartum.

Postpartum eclampsia is defined as eclampsia that occurs after delivery within 48 h. Now-a-days, the incidence of antenatal and intrapartum eclampsia is reduced considerably due to good antenatal care, and preeclampsia diagnosed early and treated well. However, postpartum cases nowadays show a unique pattern occurring too late, which can be nearly missed and difficult to diagnose. Postpartum eclampsia has to be differentiated from other causes such as cerebral malaria, cerebral tumor, cerebral hemorrhage, cerebral venous thrombosis, cerebral aneurysm, brainstem syndrome, posterior reversible encephalopathy syndrome, epilepsy, thrombotic thrombocytopenic purpura, strychnine poisoning, chronic hypertension, chronic renal disease and hemolytic uremic syndrome. Postpartum eclampsia requires prompt treatment. Left untreated can result in seizures and other serious complications. Here, we present a unique and interesting case of atypical delayed onset postpartum eclampsia. Hence that such unique cases should not be missed in the diagnosis and management.

Resultados perinatales relacionados con trastornos hipertensivos del embarazo / Perinatal results related to pregnancy hypertensive disorders

Introducción: los trastornos hipertensivos del embarazo se relacionan con una elevada morbilidad y mortalidad perinatal. Objetivo: determinar la incidencia de resultados perinatales desfavorables asociada con los distintos trastornos hipertensivos del embarazo. Métodos: estudio observacional descriptivo prospectivo, realizado en el Hospital General Docente Enrique Cabrera, del 1ro. de enero al 31 de diciembre de 2010. La muestra fue de 108 pacientes con diagnóstico de hipertensión y en ellas se determinó, edad gestacional al parto, peso y apgar del neonato, diagnóstico de sufrimiento fetal y necesidad de cuidados intensivos neonatales. Se usaron porcentajes y test de Chi-cuadrado para variables cualitativas, utilizando el sistema estadístico para Windows SPSS-11.5. Resultados: la prematuridad fue más frecuente en las pacientes con eclampsia (4/100 por ciento) y preeclampsia (16/66,7 por ciento), el peso medio de los neonatos fue inferior en las pacientes con eclampsia (1540 ± 1160), hipertensión crónica con preeclampsia sobreañadida (2226,2 ± 1236,2) y preeclampsia (2442 ± 917), la mayor frecuencia de mortinatos, ocurrió en las pacientes con eclampsia y en aquellas con preeclampsia sobreañadida (25 por ciento cada una). Conclusiones: la preeclampsia-eclampsia se asoció con elevada morbilidad y mortalidad perinatal, durante el periodo estudiado

Introduction: The pregnancy hypertensive disorders are related to a high perinatal morbidity and mortality. Objective: To determine the incidence of the unfavourable perinatal results associated with different pregnancy hypertensive disorders. Methods: A prospective, descriptive and observational study was conducted in the Enrique Cabrera Teaching and General Hospital from January 1 to December 31, 2020. Sample included 108 patients diagnosed with hypertension and in them it was possible to determine the gestational age at delivery, weight and Apgar score of the neonate, diagnosis of fetal suffering and the need of neonatal intensive cares. Percentages and Chi² test were used for qualitative variables, using the statistical system for Window SPSS-11.5. Results: Prematurity was more frequent in patients presenting with eclampsia (4/100 percent) and pre-eclampsia (16/66,7 percent), the mean weight of neonates was lower in patients with eclampsia (1540 ± 1160), chronic hypertension with addition of pre-eclampsia (2226 ± 1236,2) and pre-eclampsia (2442 ± 917, the great frequency of stillbirths occurred in patients presenting with eclampsia and in those with addition of pre-eclampsia (25 percent each). Conclusions: The pre-eclampsia-eclampsia is associated with a high perinatal morbidity and mortality over the study period

Predictores de la preeclampsia/eclampsia en un grupo de gestantes de alto riesgo / Pre-eclampsia/eclampsia predictors in high risk pregnants

INTRODUCCIËN: Los trastornos hipertensivos durante el embarazo son muy frecuentes y ocurren en más del 10 por ciento de todas las gestaciones a término. OBJETIVO: Determinar los factores de riesgos en este grupo de pacientes que permitan establecer estrategias de trabajo diferenciadas en pro del bienestar materno fetal. MÉTODOS: Se realizó un estudio descriptivo, de corte transversal, en 30 gestantes con riesgo de preeclampsia/eclampsia que acuden a la consulta municipal de atención al riesgo de preeclampsia/eclampsia en la ciudad de Santa Clara, Villa Clara, en el periodo comprendido entre septiembre de 2009 a enero de 2010. RESULTADOS: La mayoría de las pacientes fueron nulíparas (70 por ciento), con malnutrición por exceso (80 por ciento) y en edades extremas (56,6 por ciento) con predominio de la avanzada edad materna (33,3 por ciento), se encontró un gran porcentaje de gestantes con riesgo de síndrome metabólico. Se proponen estrategias de atención con enfoque de riesgo a estas gestantes en la atención prenatal. CONCLUSIONES: La nuliparidad, las cifras de glicemia elevadas en la captación del embarazo y la malnutrición por exceso fueron algunos de los factores de predicción más frecuentemente encontrados para la preeclampsia/eclampsia en el grupo estudiado.

INTRODUCTION: The hypertensive disorders during pregnancy are very frequent and occur in more then the 10 percent of all term pregnancies. OBJECTIVE: To determine the risk factors in this group of patients to allow establishing differential working strategies for the social maternal wellbeing. METHODS: A cross-sectional and descriptive study was conducted in 30 pregnant women with risk of pre-eclampsia/eclampsia in the Santa Clara city, Villa Clara province from September, 2009 to January, 2010. RESULTS: Most of patients were nulliparous (70 percent), with excessive malnutrition (80 percent) and in extreme ages (56.6 percent) with predominance of maternal old age (33.3 percent), as well as a high percentage of pregnants with metabolic syndrome risk. Authors propose care strategies approaching the risk of these patients during the prenatal care. CONCLUSIONS: Nulliparity, figures of a high level glycemia during the pregnancy screening and the excessive malnutrition were some the more frequent prediction factors for the pre-eclampsia/eclampsia in the study group.

Eclâmpsia: diagnóstico e manejo / Eclampsia: diagnosis and treatment

Os autores realizaram uma revisão sobre epidemiologia e quadro clinico, enfatizando a importância dos diagnóstico precoce e do manejo correto da crise eclâmptica na emergência.

Maternal and perinatal outcome of hypertensive disorders of pregnancy at a tertiary care hospital

To study the frequency of various hypertensive disorders of pregnancy and to determine their maternal and perinatal outcome. Retrospective descriptive study. Department of Obstetrics and Gynecology Unit III, Civil Hospital Karachi, from January 2002 to December 2007. A total of 626 cases were reviewed for age, parity, gestational age, diagnosis, antenatal and intra partum complications, mode of delivery and neonatal outcome. Data was analyzed using SPSS software [version 16]. Total number of deliveries during the study period was 11,718 and there were 626 cases of hypertensive disorders of pregnancy giving a frequency of 5.34%. Pre-eclampsia was seen in 308 [49%], severe pre-eclampsia in 85 [13%], eclampsia in 121 [19.2%], chronic hypertension in 41[6%] and postpartum eclampsia in 21 [3.3%] patients. There were 39 maternal deaths [case fatality rate: 6.23%]. The mean ages for pre-eclampsia, severe pre-eclampsia, eclampsia and chronic hypertension were 28, 27, 24 and 29 [27 years] years respectively. The commonest maternal complication of hypertensive disorders was postpartum hemorrhage in 24 women [4.2%]. This was followed by placental abruption in 9 women [1.6%] and pulmonary edema in 8 women [1.4]. The prevalence of prematurity in pre-eclampsia, severe pre-eclampsia and eclampsia in study population was 14%, 5% and 8.6% respectively. Cesarean section was required for pre-eclampsia, severe pre-eclampsia and eclampsia in 46%, 51% and 61% of patients respectively. The main fetal complications were found to be still birth [14% in pre-eclampsia, 18% in severe pre-eclampsia and 15% in eclampsia] and low birth weight [31% in pre-eclampsia, 49% in severe pre-eclampsia and 52% in eclampsia]. Hypertensive disorders in pregnancy are an important cause of maternal and perinatal mortality and morbidity

Preliminary Outcome of the Management of Eclampsia at the Imo State University Teaching Hospital

Background: Eclampsia continues to be a major cause of maternal and perinatal mortality in developing countries. Early identification and management of pre-eclampsia will help reduce the mortality due to eclampsia. Aim: This study aims at determining the prevalence and management outcome of eclampsia in our centre with a view to proffering solutions for an optimal or near optimal care.Methods: A retrospective review of the case records of patients managed for eclampsia at the Imo State University Teaching Hospital (IMSUTH); Orlu from 1st October 2004 to 30th September 2009 was carried out. Data on socio-demographic characteristics as well as clinical management and outcome were extracted and analyzed.Results: The prevalence of eclampsia was 2.7of all the deliveries. The prevalence was significantly higher in the unbooked than the booked patients (p0.05). The prevalence was also significantly higher in primigravidae than in multiparae (p0.05). Twenty-eight (93.3) of the eclampsia occurred antepartum. Twenty-eight (93.3) had severe hypertension on presentation. Twenty nine (95.8) of the patients had 2-5 episodes of convulsions prior to presentation to the hospital. Twenty-six (86.7) of the patients had emergency Caesarean section was carried out; mostly for unfavourable cervix. The perinatal mortality was 6.7while maternal mortality was 3.3. Complications included acute renal failure; aspiration pneumonitis and abruptio placentae. Conclusion: The prevalence of eclampsia is unacceptably high in our centre. Early antenatal booking; antenatal care follow-up to identify the imminent signs and prompt treatment of cases of pre-eclampsia will reduce the burden of eclampsia in this environment

Morbimortalidad materna en la preeclampsia complicada / Maternal morbidity and mortality related to complicated pre-eclampsia

Los trastornos hipertensivos incluyen diversas perturbaciones vasculares que aparecen antes o durante el embarazo, el parto y/o el puerperio. Junto a la hemorragia y la infección constituyen la tríada más letal de la medicina humana. Se realizó un estudio descriptivo transversal para caracterizar la morbimortalidad materna secundaria a preeclampsia complicada en el Hospital Provincial Ginecobstétrico "Ana Betancourt de Mora" desde enero 2006 _ septiembre 2007. El universo estuvo conformado por 312 gestantes que presentaron algún trastorno hipertensivo. Se seleccionó una muestra de 82 embarazadas con diagnóstico de preeclampsia complicada que cumplieron los criterios de inclusión y exclusión. Predominó la preeclampsia grave (89,02 por ciento), las menores de 20 años (31,71 por ciento) y las nulíparas con 51 señoras. El mayor número de gestantes (48) fueron evaluadas como normopeso, mientras que 27 evidenciaron un aumento exagerado de este. La curva plana de tensión arterial incidió con 57,32 por ciento. Al 96,34 por ciento de las gestantes se les practicó cesárea, de éstas, a un 70 por ciento de forma electiva. No se reportó muerte materna. La caracterización de la morbimortalidad materna de la preeclampsia complicada en nuestro medio nos permitió realizar propuestas encaminadas a correlacionar un grupo de factores que influyen en la calidad del cuidado y sus resultados en la atención a estas gestantes complicadas(AU)

Hypertensive disorders include many vascular alterations appearing before or during pregnancy, delivery and/or puerperium. Together with hemorrhage and infection they are the more lethal triad of human medicine. We made a cross-sectional and descriptive study to characterize maternal morbidity and mortality secondary to a complicated pre-eclampsia in "Ana Betancourt de Mora" Gynecology and Obstetrics Provincial Hospital from January 2006 to September 2007. Sample included 312 pregnants presenting with some hypertensive disorder. We selected a sample including 82 pregnants diagnosed with complicated pre-eclampsia fulfilling inclusion and exclusion criteria. There was a predominance of severe pre-eclampsia (89,02 percent),), aged under 20 (31,71 percent), and nullipara with 51 ladies. Most of pregnants (48) was assessed as of normal weight, whereas 27 showed an exaggerated weight gain. Plain wave of arterial tension incidence was of 57, 32 percent. In 96,34 percent of pregnants we performed a cesarean section, from these, in a 70 percent in a elective way. There was not maternal death. Characterization of maternal morbidity and mortality of a complicated pre-eclampsia in our practice allow us to make proposal aimed to collect a series of risk factors influencing in care quality and its results in care to these complicated pregnants(AU)

Malonildialdehido y peso al nacer en la pre-eclampsia: breve revisión y asociación entre ambos / Malondialdehyde and birth weight in preeclampsia. Brief review and association between them

Los trastornos hipertensivos del embarazo (THE), causan frecuente morbilidad y mortalidad perinatal en el mundo y en Cuba y se han vinculado al estrés oxidativo. Objetivos: determinar las características evolutivas de las concentraciones de malonildialdehido en las gestantes sanas (GS) entre las 16-20 semanas (MDA 1) y= 36 semanas (MDA 2), las características de la concentración plasmática de malonildialdehido [MDA] determinadas en las muestras de las preeclámpticas (MPE) al ingreso, en comparación con las gestantes sanas (MDA 2), así como la relación de [MDA] con el peso al nacer (PN) en preeclámpticas (PE). MÉTODOS: se hallaron las [MDA] en 25 gestantes de acuerdo a criterios de inclusión. Estadísticas: Se determinó medias y desviaciones estándar, comparando resultados de las [MDA] (Mann-Whitney, IC: 94 por ciento, p< 0,06). Se analizó la edad, el IMC, las presiones arteriales diastólica y media, la paridad y el PN (Kruskall-Wallis, IC: 95 por ciento, p< 0,05). Lugar: Departamento de Investigaciones Especiales del Hospital Dr Luis Díaz Soto. Período: enero 2004-enero 2007. Resultados: las [MDA] fueron mayores en M2 con relación a las muestras M1. Las [MDA] en PE (MPE) (n= 15) > [MDA] en gestantes sanas (n= 10) (M2). Las [MDA] (MPE) se correlacionaron inversamente con el PN en las preeclámpticas. CONCLUSIONES: la [MDA] se incrementó significativamente (p< 0,06) en las gestantes controles entre las muestras M1 y M2. El peso al nacer se correlacionó inversamente con [MDA] y MPE, cuando se comparó con lo ocurrido en las gestantes sanas. Es necesario profundizar en el estudio del estrés oxidativo en la preeclampsia lo que permitiría incrementar su comprensión y diseñar estrategias de intervención para disminuir sus efectos.

The hypertensive disorders of pregnancy (HDP) cause frequent perinatal morbidity and mortality in the world and in Cuba and they have been linked with oxidative stress. Objectives: to determine the evolutive characteristics of the concentrations of malondialdehyde in healthy pregnant women between 16 and 20 weeks (MDA 1) and = 36 weeks (MDA 2), the characteristics of the plasmatic concentration of malondialdehyde [MDA] determined in the sample of the preeclamptic women (SPE) on admission compared with healthy pregnant women (MDA 2), as well as the association of MDA concentrations with birth weight in preeclamptic patients (PE). Methods: The MDA concentrations were calculated in 25 pregnant women according to inclusion criteria. Statistics: Means and standard deviations were determined by comparing the results of the MDA concentrations (Mann-Whitney, CI: 94 percent, p< 0.06). Age, BMI, diastolic and mean arterial pressures, parity and birth weight were analyzed (Kruskall-Wallis, CI: 95 percent, p< 0.05). Place: Department of Special Research of "Dr. Luís Díaz Soto Hospital. Period: January 2004-January 2007. RESULTS: MDA concentrations were higher in M2 in comparison with the samples M1. MDA concentrations in preeclamptic patients (SPE) (n= 15) > MDA concentrations in healthy pregnant women (n= 10) (M2). The MDA concentrations (SPE) were inversely correlated with birth weight in the preeclamptic patients. Conclusions: MDA concentrations were significantly higher (p < 0.06) in the controls between M1 and M2. Birth weight was inversely correlated with MDA concentrations (SPE) in the preeclamptic patients when it was compared with what happened in the healthy pregnant women. It is necessary to go deep into the study of oxidative stress in preclampsia in order to increase its understanding and to design intervention strategies to reduce its effects.

Seasonal variation of the onset of preeclampsia and eclampsia

Preeclampsia is one of the three leading causes of maternal mortality. Studies have suggested that the incidence of preeclampsia may be partially dependent on the month or season of delivery. This study was conducted to evaluate whether seasonal variation has any effect on the incidence of eclampsia or preeclampsia. From 1999 to 2001, a cross-sectional study in Alzahra Hospital was performed using all deliveries with gestational age more than 20 weeks. Variables of maternal age, parity, occurrence of preeclampsia and eclampsia, and season were evaluated and analyzed by chi-square test in SPSS 10. During the period of the study, there were 12,142 deliveries at Alzahra Hospital in Rasht. There were 2,579 [21.3%] deliveries in spring, 2,696 [22.2%] in summer, 3,645 [30%] in autumn, and 3,222 [26.5%] in winter. There was no statistically significant relationship between the age, parity and season. Hypertensive disorder was reported in 609 pregnancies [5%], with 11,533 [95%] having no hypertensive disorder. Data showed that 397 patients [3.3%] had preeclampsia and eclampsia. The highest rate of preeclampsia was in spring [3.6%], and the lowest rate was in summer [3%], but it revealed no statistical difference in the incidence of preeclampsia with season. We found no correlation between preeclampsia or eclampsia and season. It may be due to relative similarities between seasons in North of Iran. For example, there are relative similarities between spring and summer, and between autumn and winter

Eclampsia

To evaluate incidence, morbidity and mortality associated with eclampsia. A prospective study. The study which was carried out at PAF Hospital Rafiqui, Shorkot spanned over a period of 2% years from Jun 2002-Dec 2004. The study comprises of 55 eclamptic cases diagnosed out of 3391 consecutive deliveries, carried out in our hospital. The incidence of eclampsia, in this study, was found to be 1.62%. Out of 55 cases 38[69.1%] patients were primigravida. Forty three [78.2%] of the patients were between the ages of 21 to 30 years. In 50[90.9%] patients gestational age was less than 35 weeks. Thirty seven [67.3%] cases had antepartum eclampsia. Forty four [80%] patients received diazepam while the remaining 11[20%] received magnesium sulphate [MgSO4] as anticonvulsant. Commonest mode of delivery was spontaneous vaginal delivery [31 cases, 56.4%] followed by lower caesarean section [21 cases, 38.2%]. Fetal loss was seen in 12[20.7%] cases. T wo patients died of eclampsia, maternal mortality rate being 3.6%. Eclampsia is a life threatening complication of pregnancy. However an improvement in antenatal care, upgrading the neonatal facilities and early delivery by cesarean section can improve the perinatal outcome

Epidemiological study of eclampsia in a referral teaching hospital.

The present study is a retrospective analysis of 864 eclampsia patients managed at RG Kar Medical College and Hospital, Kolkata during the period January 1999 to December 2001. The incidence of eclampsia was seen in about 2.27% cases. Majority (51.97%) of eclampsia patients were between 20 and 29 years though 41.43% were below 20 years of age. They were mostly primigravida (88.19%) and Hindus (69.1%). About 44.56% were antepartum eclampsia patients. All the patients were treated with magnesium sulphate. Caesarean section rate is quite high (46.18%) in this present study. Maternal case fatality rate was 7.29%. Still birth rate was 9.92% with an early neonatal death rate of 14.15% resulting in a perinatal mortality of 24.07%. Ignorance regarding antenatal check-up, lack of transport and lack of early communication with tertiary hospital play an important role for high incidence of eclampsia in our developing country.

Changing trends in the management of eclampsia from a teaching hospital.

Eclampsia is a major source of both maternal and perinatal mortality. In the management of eclampsia, the role of magnesium sulphate as anticonvulsant and early delivery are well established. The present study is an analysis of maternal and perinatal outcomes after the introduction of magnesium sulphate and liberalisation of caesarean section over a period from August 2002 to September 2004. The observations were compared with statistics from the same hospital from 1995-1997. The incidenceof eclampsia has remained relatively constant but postpartum cases of eclampsia have increased. The case fatality rate of eclampsia has fallen from 11.3% to 5.3%. The perinatal mortality has also fallen from 54.8% to 24.3%. The caesarean section rate for eclampsia has increased from near 10% to 49.7%. Both maternal mortality and perinatal mortality are lowest in the caesaean section group. But the improved perinatal salvage in caesarean section babies may partially reflect the tendency to avoid caesarean section in gross prematurity. The ideal anaesthesia for eclampsia remains unknown but the results with use of general anaesthesia in all cases with precautions produced favourable results.

Prevalência da eclâmpsia em parturiente / Prevalence of eclampsia during labor

Objetivos: identificar a prevalência e o número de crises convulsivas nas parturientes com síndrome hipertensiva; verificar os níveis pressóricos, os sinais e sintomas que precederem a crise convulsiva; identificar a idade gestacional e o período da ocorrência da crise...