Estudio piloto de los factores de riesgo en la preeclampsia / Pilot study of risk factors in pre-eclampsia

La preeclampsia es una patología que surge de forma desconocida comprometiendo el estado de salud del binomio materno ­ neonatal, provocando daño multiorgánico. La característica principal es la relación con múltiples factores de riesgo tales como la hipertensión en familiares de primer grado, obesidad, alimentación, falta de controles obstétricos durante la gestación, entre otros; Objetivo: Validar el cuestionario diseñado para evaluar los factores que influyen en preclamsia, Determinar los factores de riesgo que influyen en su incidencia. Materiales y métodos: Se aplico una metodología cuanti cualitativa, corte transversal, exploratorio; la validación se efectuó a través del juicio de expertos, utilizando dos tipos de instrumentos uno para cada tipo de investigación, se valoran por separado, en el plan piloto se utiliza parte de la muestra seleccionada para la investigación macro. En el caso de la cualitativa se utiliza una técnica de entrevista a saturación, con una investigación de tipo fenomenológica, organizada por categorías. Resultados: El instrumento cuantitativo obtiene un puntaje 93% de confiabilidad, con un alfa de crombach de 0,7, el instrumento cualitativo 95%, dentro de los factores de riesgo se distingue los trastornos hipertensivos del embarazo, se asocia con un espectro de gravedad que va desde la hipertensión leve inducida por el embarazo hasta la eclampsia. Conclusión: Durante el estudio piloto se obtiene los datos con rapidez y efectividad, no existen conflictos en su comprensión, su confiabilidad garantiza el trabajo científico, la validación de instrumentos justifica el proceso, de inicio resultó conflictivo por la ausencia de instrumentos para medir los factores que influyen en esta patología, se encuentran los valores causales y en especial en las vivencias de cada uno de los actores e involucrados, La preeclampsia es un fenómeno frecuente cuya patología conlleva graves complicaciones para la madre y el feto con este tipos de estudio se aporta a su control y erradicación(AU)

Preeclampsia is a pathology that arises in an unknown way, compromising the health status of the maternal-neonatal binomial, causing multi-organ damage. The main characteristic is the relationship with multiple risk factors such as hypertension in first degree relatives, obesity, diet, lack of obstetric controls during pregnancy, among others; Objective: to validate the questionnaire designed to evaluate the factors that influence preeclampsia, to determine the risk factors that influence its incidence. Materials and methods: A quantitative, qualitative, cross-sectional, exploratory methodology was applied; The validation was carried out through the judgment of experts, using two types of instruments, one for each type of research, they are valued separately, in the pilot plan part of the selected sample is used for the macro research. In the case of qualitative, a saturation interview technique is used, with a phenomenological type investigation, organized by categories. Results: The quantitative instrument obtains a 93% reliability score, with a crombach alpha of 0.7, the qualitative instrument 95%, within the risk factors distinguishes hypertensive disorders of pregnancy, it is associated with a spectrum of severity ranging from mild pregnancy-induced hypertension to eclampsia. Conclusion: During the pilot study the data is obtained quickly and effectively, there are no conflicts in its understanding, its reliability guarantees scientific work, the validation of instruments justifies the process, initially it was conflictive due to the absence of instruments to measure the factors that influence this pathology, are the causal values ​​and especially in the experiences of each of the actors and involved, Preeclampsia is a frequent phenomenon whose pathology entails serious complications for the mother and the fetus with this type of study is provided to its control and eradication(AU)

Morphometric and Macroscopic Observations of Human Placenta in Eclampsia.

Objective: To assess some macroscopic changes in the placentas of eclamptic mothers in a tertiary care setting of eastern India. Design: Cross-sectional observational type of study. Methods: 44 placentas from 15 normotensive and 29 eclamptic mothers were collected after delivery at term and studied for area, weight and volume. Foetal surface was studied for insertion of umbilical cord, insertion of membranes and subchorionic fibrosis. Maternal surface was studied for retroplacental blood clot, calcification and infarct. Necessary statistical tests were done. Result: Statistically significant differences were observed in placental area, weight and volume between normotensive and eclamptic mothers. These showed that placental area, weight and volume were more in the former group with some exceptions. Subchorionic fibrosis, retroplacental blood clot, calcification and infarct were also more in placentas of eclamptic mothers. Conclusion: Eclampsia adversely affects the foetus through its harmful effects on placenta. The study agrees well with the findings of other investigators.

Placental morphology in pre-eclampsia and eclampsia and the likely role of NK cells.

Background: Placenta has long been a neglected organ as far as its pathology is concerned. This study is an attempt to observe the morphological features of placentae both gross and microscopic in normal pregnancy, preeclampsia, and eclampsia. Materials and Methods: A total of 150 placentae were collected; of these, 50 belonged to normal pregnancy, 50 belonged to pre-eclamptic women, and 50 were from patients of eclampsia. Results: Placental trimmed weight was seen to be decreased in patients of preeclampsia and eclampsia. Placental infarcts were more commonly seen in the diseased group and they were more centrally located. Hypertrophy of the spiral arterioles was observed in the decidual portion found in placental disc and membranes. Distal villous hypoplasia was also frequently seen in the diseased group. Fetal membranes were thickened and showed infarcts in preeclampsia and eclampsia. Conclusions: Morphological features seen in eclamptic placentae were similar but exaggerated compared to preeclampsia. In conclusion, the pathological changes were found to be more severe and frequent in preeclampsia and eclampsia, but more so in eclamptic placentae as compared with placenta of normal pregnancy. CD56 immunomarker was also used to identify NK cells. They were found to be present only in the diseased group and were located in the decidual portion of the basal plate, implicating their role in the development of the disease.

Changes of placental diameter thickness and cotyledon in eclampsia.

The study was done to see the changes of placental diameter, thickness and number of cotyledons in eclapmsia. A total 45 placenta, 25 from eclamptic mother and 20 from normal pregnant mother were collected from Gynaecology and Obstetric department of Mymensingh Medical College and Hospital (MMCH). Study was done in Anatomy department of Mymensingh Medical College (MMC). Macroscopic study of the formol saline fixed placentas revealed that, compared to the controls there was trend of less placental diameter in eclamptic group(p=0.0004). Cotyledon number was found to be significantly less in eclampsia (p=0.0001). However there was no significant difference in placental thickness in eclamptic placenta than that of normal group. Statistical significance of difference between two groups was calculated by using Students "t" test. A difference between the two groups was considered to be significant when p<0.005. The morphological changes in placenta are possibly due to reduced uteroplacental blood flow in eclampsia.

Placental changes in eclampsia and fetal outcome.

Eclampsia-a common pregnancy induced disorder that poses a great threat to the fetus secondary to the placental changes. Since placenta is mostly vascular organ, the present comparative study was designed to examine microscopic vascular changes as well as to observe their impact on the macroscopic dimensions of the placenta and on the fetus in eclamptic and normal pregnant women. The study was carried out in the department of Anatomy, Bangabandu Sheik Mujib Medical University (BSMMU) during the period of October 2000 to August 2001. Forty human placentas were collected just after Caesarian section at 37 to 40 weeks of gestation: 20 from mothers with eclampsia and 20 from non-diabetic, non-eclamptic, normotensive control mothers. Compared to the Control group the value regarding weight, volume, diameter and thickness were significantly smaller values in the Eclampsia group (p<0.001). Microscopically there was a general tendency of increased intimal thickness due to atherosclerotic type of changes in eclampsia in 1st, 2nd and last branching sites of chorionic arteries. Statistical significance difference was observed more in case of the 1st and 2nd branching site (p<0.001). The positive correlation between placental and neonatal weight reached a significant level. Although not all the significant findings support each other. Considering the tendencies of increased intimal thickness and suggestions from other studies, it seems that in the eclamptic placentas, successful compensatory effort against chorionic arterial atherosclerosis fails to protect the fetuses and placentas face more severe forms of atherosclerosis, and consequently gave rise to smaller babies.

Placenta in PIH.

A variety of changes in placental villi are known to occur in Pregnancy Induced Hypertension. In this study an attempt is made to study 49 placentae from PIH and its correlation to perinatal outcome. Quantification of villous lesions was carried out. The striking villious changes were cytotrophoblastic proliferation, paucity of vasculosyncytial membrane, trophoblastic basement membrane thickening and fibrinoid necrosis of villi. The changes were directly proportional to the severity of disease and perinatal outcome was worse with advancing grades of PIH.

Correlación clínica y neuro-radiológica en la eclampsia / Clinical and neuroradiographic correlates in eclampsia

Brain computed tomography, magnetic resonance imaging and magnetic resonance angiography were performed in five eclamptic patients. Three of them had HELLP syndrome. The findings on the imaging studies showed bilateral lesions affecting regions of the brain, such as cortico-subcortical either posterior and anterior circulation territories, white matter, talamic or mesencephalic-protuberancial areas. No vasospasm in middle size arteries were observed with magnetic resonance angiography. Although visual disturbance and occipital lobe involvement were correlated, no other mentioned lesions had clinical manifestations.

Se estudiaron cinco pacientes con eclampsia mediante tomografía computarizada, resonancia magnéticanuclear y angio-resonancia. Tres de ellas cursaron con síndrome HELLP. Se apreciaron lesiones bilaterales que involucraron áreas córtico-subcorticales dependientes de ambos territorios vasculares, centro oval, talámicas y mesencéfalo-protuberanciales. La angio-resonancia descartó la presencia de imágenes compatibles con vasoespasmo en arterias de mediano calibre. Con excepción de alteraciones visuales coincidentes con el compromiso del lóbulo occipital, otras lesiones descriptas carecieron de expresión clínica.

Hallazgos hemodinámicos en pacientes eclámpsticas

La hipertensión inducida por el embarazo es la principal causa de muerte materna y fetal en nuestro hospital. La literatura describe diferentes patrones hemodinámicos que oscilan desde bajo gasto cardíaco y resistencia sistémica elevada; hasta más recientemente, alto gasto cardíaco y resistencia sistémica disminuida en un estadio subclínico. El objeto de este estudio es identificar el patrón existente al momento del ingreso a la unidad de ciudados intensivos (UCI) para establecer la diferencia, si la hay, entre los patrones entre pacientes sobrevivientes y los que fallecieron y aclarar la correlación entre los parámetros de llenado ventricular. Se revisó la hemodinamia de 15 pacientes eclámpticas enviadas a la UCI para apoyo hemodinámico y/o ventilatorio. Se registraron el índice sistólico (IS), índice de trabajo ventricular (ITV), presión pulmonar media (PPM), índice de resistencia sistémica (IRS), índice de resistencia pulmonar (IRP)(truncado 2500 caracteres)

Plasma B-endorphin in preeclamptic and eclamptic toxaemias

B-endorphin [B-EP] appears to play an important role in central nervous system as well as cardiovascular regulatory functions. B-EP levels were reported to increase progressively in normal gestation with marked increase in cases of pregnancy induced hypertension. This work studied the changes in plasma B-EP in preeclamptic and eclamptic patients. Sixty pregnant females were classified into three groups. Group I included 25 normal pregnant females. Group II included 25 pregnant women with preeclamptic toxemia. Group III comprised 10 pregnant women presented by or had a history of recent eclamptic fits or coma. B-EP was estimated using I125 plasma B-EP radioimmunoassay. Plasma B-EP showed a significant increase [P <0.01] in preeclamptic cases [12.6 +/- 8.5 pmol/l] and [P <0.001] in eclamptic cases [20.7 +/- 16.5 pmol/l] over that level reported in normal pregnancy [6.8 +/- 3.1 pmol/l]. Plasma B-EP levels in eclamptic patients were higher than in preeclamptic ones, but the increase was not statistically significant [P >0.05]. These data indicated that B-EP system is markedly activated in these stressful conditions as a physiological mechanism that might guard against more rise in blood pressure and occurrence of fits

Necrosis hemorrágica hepatocelular y hematoma hepático subcapsular en 20 casos de enfermedad hipertensiva del tercer trimestre del embarazo (Toxemia) / Hepatocellular hemorrhagic necrosis and subcapsular hepatic hematoma in 20 cases of hypertensive disease of third trimestre of pregnancy (Toxemia)

La necrosis hemorrágica hepatocelular se encontró en 11 casos, que corresponden a 55 por ciento de 20 casos fallecidos por enfermedad hipertensiva del tercer trimestre del embarazo: eclampsia;81.8 por ciento fue difusa, 18.1 por ciento focal; se presentó desde los 18 años hasta los 38 años de edad, a los 25.5 años de edad promedio; 36.3 por ciento fueron primíparas, 36.3 por ciento multíparas. El hematoma hepático subcapsular se encontró en cinco casos: 60 por ciento con cápsula conservada y 40 por ciento con cápsula rota. De los cinco casos: 60 por ciento fueron multíparas; 80 por ciento se desarrolló durante el tercer trimestre del embarazo, 20 por ciento durante el segundo trimestre; 80 por ciento cursaron con dolor asociado a vómito; 80 por ciento evolucionaron hacia la eclampsia. Estos cinco casos de hamatoma hepático subcapsular, en principio, desarrollaron un síndrome de hematoma hepático subcapsular, posteriormente con el desarrollo del cheque se constituyó el síndrome de hematoma hepático subcapsular con ruptura de la cápsula. Consideramos a la necrosis hemorrágica hepatocelular, al hematoma hepático subcapsular con cápsula de Glisson conservada y al hematoma hepático con cápsula rota, tres estadios de una misma enfermedad

Mortalidad Materna en el Instituto de Maternidad Natalio Aramayo de La Paz / Maternal mortality at he maternity Institute \"Natalio Aramayo\" of La Paz

Se realiza un estudio longitudenal restrospectivo con el objeto de determinar la tasa de mortalidad materna en el IMNA de La Paz. Revisando los libros de archivo y partes diarios de atenciòn se obtiene el nùmero total de defunciones maternas, partos, cesàreasy recien nacidos vivos entre 1981 a 1990. Relacionando el nùmero de muertes maternas con el nùmero total de recièn nacidos vivos, encontramos una tasa de mortalidad materna de 28o/ooo. Se señalan tambièn las diferentes patologias que ocasionaron el deceso, concluyendose las Toxemias y la Eclampsia, luego estàn las Hemorragias e Infecciones. Se concluye remarcando la disminuciòn de la mortalidad materna, con respecto a la anterior dècada, haciendo alguna consideraciones que expliquen este hecho

Maternal venous concentration of atrial natriuretic peptide at vaginal delivery from pre-eclampsia pregnancies

To investigate the influence of vaginal delivery in preeclamptic women on atrial natriuretic peptide [ANP], its concentration was quantified by radio-immunoassay technique in 30 preeclamptic nulliparous women and 10 comparable normotensive pregnant controls. Plasma ANP levels were increased from 228.56 +/- 20.7 pg/ml during late pregnancy, to 237.46 +/- 22.9 pg/ml during labor and 271.45 +/- 40.3 pg/ml immediately after delivery in preeclamptic women. ANP rose sharply, immediately after delivery [p <0.001]. A positive correlation was found between ANP and mean arterial pressure

Orientacao terapeutica global da eclampsia: resultados da aplicacao de um protocolo de tratamento padronizado / Global therapeutic orientation of eclampsia: results of the application of a standardized treatment protocol

Foi aplicado prospectivamente, entre agosto de 1985 e dezembro de 1990 na Clinica Obstetrica da Faculdade de Medicina da USP, um abrangente protocolo de tratamento da eclampsia. O protocolo baseou-se na obediencia a uma sequencia ordenada de recursos terapeuticos: 1. oxigenacao; 2. sulfato de magnesio; 3. avaliacao materna e fetal; 4. tratamento anti-hipertensivo; 5. correcao de disturbios funcionais; 6. conduta obstetrica e 7. assistencia da Unidade de Terapia Intensiva. Foram estudados 63 pacientes, a maioria primigestas, tendo feito irregularmente pre-natal em outros servicos. As pacientes foram classificadas a admissao em nao complicados (27), complicadas (34) e descompensadas (2). Os resultados gerais de mortalidade materna e perinatal verificados foram 1,5 por cento e 11,1 por cento. Quando discriminadas conforme a classificacao empregada, foram respectivamente: casos nao complicados 0 e 13,0 por cento; casos complicados 2,9 e 18,5 por cento, e casos descompensados 0 e 50,0 por cento. Conclui-se que apesar da gravidade das pacientes assistidas, os resultados obtidos com a aplicacao deste protocolo se equivalem aos melhores relatados na literatura.

Aspectos praticos do tratamento da eclampsia / Practical aspects of the eclampsia treatment

Para o sucesso do tratamento da eclampsia e fundamental que os metodos terapeuticos adequados sejam aplicados no momento exato. A padronizacao e memorizacao de um roteiro terapeutico facilita o desempenho de medicos e enfermeiras que trabalham com eclampsia. E apresentado e discutido um roteiro sequencial de medidas terapeuticas, com enfase a seus aspectos praticos, baseando-se em: 1. oxigenacao; 2. sulfato de magnesio; 3. avaliacao materna e fetal; 4. tratamento anti-hipertensivo; 5. correcao de disturbios funcionais; 6. conduta obstetrica; e 7. assistencia em unidade de terapia intensiva.

Placental pathology in pre-eclampsia eclampsia syndrome.

Quantitative analysis of placental pathology was carried out on 20 placentae from various grades of pre-eclampsia eclampsia syndrome and 20 placentae from control group. Placental weights were lower in the study group. The gross abnormalities noted were the placental infarcts, retroplacental haematoma and calcification. The striking villous lesions observed in the study group were cytotrophoblastic cell proliferation, thickening of villous basement membrane and paucity of vasculosyncytial membrane and these findings correlated well with the severity of maternal disease. These vascular villous lesions were considered secondary to uteroplacental ischaemia.