Uso de labetalol frente a nifedipino en la preeclampsia / Use of labetalol vs nifedipine in preeclampsia

Fundamento: La preeclampsia es un estado de vasoconstricción generalizado asociado a la disfunción del epitelio vascular en vez de vasodilatación propia del embarazo, caracterizada por la hipertensión proteinuria a partir de la semana 20, acompañada a veces de edemas; asimismo constituye un peligro de salud para la madre y el feto. El tratamiento clínico tradicional utiliza fármacos antihipertensivos por vía oral, entre los que se mencionan el labetalol y nifedipino de liberación prolongada. Objetivo: Analizar la efectividad del labetalol y del nifedipino como tratamiento antihipertensivo relacionado con preeclampsia. Metodología: Se recurrió a fuentes de consulta encontradas en Google Scholar, Science Direct, SciELO, Pubmed, Medes y Elsevier. De 211 fuentes se seleccionaron 31 de acuerdo con criterios de inclusión y exclusión. Conclusiones: Por consenso se ha determinado que en la mayor parte de fuentes de consulta el nifedipino por vía oral es más efectivo que el labetalol en el tratamiento de la preeclampsia.

Background: Pre-eclampsia is a generalized vasoconstriction state associated with vascular epithelial dysfunction rather than the vasodilation characteristic of pregnancy, characterized by proteinuric hypertension from the 20th week of pregnancy, sometimes associated with edema; it also causes health risks to the mother and fetus. Traditional clinical treatment uses oral antihypertensive drugs, among these labetalol and extended-release nifedipine are included. Objective: To analyze the efficacy of labetalol and nifedipine as an antihypertensive treatment in pre-eclampsia. Methodology: Reference sources found in Google Scholar, Science Direct, SciELO, Pubmed, Medes and Elsevier were used. Out of 211 sources, 31 were selected according to inclusion and exclusion criteria. Conclusions: It has been determined by majority consensus that oral nifedipine is more effective than labetalol in pre-eclampsia treatment.

Salient Beliefs in the Intention for Self-Care Behaviors when Facing Hypertensive Disorders in Pregnant Women / Creencias salientes en la intención de comportamientos de autocuidado ante los trastornos hipertensivos en mujeres embarazadas / Crenças relevantes na intenção de comportamentos de autocuidado para síndromes hipertensivas gestacionais

Introduction: Hypertensive disorders of pregnancy represent a maternal and perinatal health problem. Therefore, it is important to identify the beliefs preceding the determinants of health behaviors during pregnancy. Objective: To identify the salient beliefs in the intention for self-care behaviors when facing hypertensive disorders in pregnant women. Materials and Methods: A descriptive study with a quantitative approach guided by the Theory of Planned Behavior. Each questionnaire was designed and its semantic validity was assessed. The sample was convenience one and included 114 pregnant women enrolled in prenatal control at a health institution from Piedecuesta, Santander, who answered the questionnaire via telephone calls between January and February of 2022. Data analysis was descriptive, resorting to absolute and relative frequencies. Results: The positive behavioral beliefs were focused on the mother's proper nutrition, the baby's healthy growth and development, disease prevention and control during pregnancy, the mother's relaxation and peace of mind, and blood pressure control and monitoring. Regarding normative beliefs, health personnel, mothers, husbands, and family members exert positive influences on each behavior. The following were acknowledged among the control beliefs: visiting family members promotes the practice of physical exercises; at the nutritional level, there is a habit of preferring low-salt preparations; both family and social support and habit and preference favor the consumption of fruit, vegetables, legumes and meats; lack of habit avoids the consumption of fats, flours, sugars, caffeine, alcohol, and cigarettes; purchase power favors calcium intake; taking a previous shower promotes rest and sleep, and going to pharmacies allows controlling blood pressure. Conclusions: Identifying the salient beliefs allowed determining those that need to be reinforced, negotiated, or restructured in achieving self-care behaviors when facing hypertensive disorders in pregnancy.

Introducción: los trastornos hipertensivos del embarazo representan un problema en la salud materna y perinatal. Por lo tanto, es importante identificar las creencias que preceden a los determinantes de los comportamientos en salud durante el embarazo. Objetivo: identificar las creencias salientes en la intención de comportamientos de autocuidado ante los trastornos hipertensivos por parte de la mujer embarazada. Materiales y métodos: estudio descriptivo de enfoque cuantitativo guiado por la teoría del comportamiento planificado. Se diseñó y evaluó la validez semántica de cada cuestionario. La muestra por conveniencia fue de 114 embarazadas inscritas en el control prenatal de una institución de salud de Piedecuesta, Santander, las cuales respondieron el cuestionario a través de entrevista telefónica, entre enero y febrero de 2022. El análisis de los datos fue descriptivo, utilizando frecuencias absolutas y relativas. Resultados: las creencias conductuales positivas se enfocaron en la adecuada nutrición de la madre; en el sano crecimiento y desarrollo del bebé; la prevención y control de enfermedades durante el embarazo; la relajación y la tranquilidad de la madre; y el control y seguimiento de la presión arterial. En las creencias normativas, el personal de salud, la madre, el esposo y familiares influyen positivamente en cada comportamiento. Entre las creencias de control, se admite que: visitar familiares promueve la práctica del ejercicio; a nivel nutricional existe el hábito por preparaciones bajas en sal; tanto el apoyo familiar y social como el hábito y el gusto favorecen el consumo de frutas, verduras, legumbres y carnes; la falta de hábito evita el consumo de grasas, harinas, azúcares, cafeína, alcohol o cigarrillo; la capacidad económica favorece la ingesta del calcio; tomar una ducha previa promueve el sueño y descanso; y asistir a farmacias permite el control de la presión arterial. Conclusiones: la identificación de las creencias salientes permitió demostrar aquellas que necesitan ser reforzadas, negociadas o reestructuradas en el logro de comportamientos de autocuidado ante los trastornos hipertensivos del embarazo.

Introdução: as síndromes hipertensivas gestacionais representam um problema na saúde materna e perinatal. Portanto, é importante identificar as crenças que precedem os determinantes dos comportamentos de saúde durante a gravidez. Objetivo: identificar as crenças relevantes na intenção de comportamentos de autocuidado diante de distúrbios hipertensivos por parte das gestantes. Materiais e método: estudo descritivo com abordagem quantitativa orientada pela teoria do comportamento planejado. A validade semântica de cada questionário foi elaborada e avaliada. A amostra de conveniência foi composta de 114 gestantes inscritas no pré-natal de uma instituição de saúde em Piedecuesta, Santander (Colômbia), que responderam ao questionário por meio de entrevista telefônica entre janeiro e fevereiro de 2022. A análise dos dados foi descritiva, usando frequências absolutas e relativas. Resultados: as crenças comportamentais positivas se concentraram em nutrição adequada para a mãe; crescimento e desenvolvimento saudáveis do bebê; prevenção e controle de doenças durante a gravidez; relaxamento e tranquilidade para a mãe; e controle e monitoramento da pressão arterial. Nas crenças normativas, a equipe de saúde, a mãe, o companheiro e os membros da família influenciam positivamente cada comportamento. Entre as crenças de controle, admite-se que visitar parentes promove a prática de exercícios; no nível nutricional, há o hábito de preparações com pouco sal; tanto o apoio familiar e social quanto o hábito e o gosto favorecem o consumo de frutas, verduras, legumes e carnes; a falta de hábito evita o consumo de gorduras, farinhas, açúcares, cafeína, álcool ou cigarros; a capacidade econômica favorece a ingestão de cálcio; tomar banho antes da gravidez promove o sono e o descanso; e ir a farmácias permite o controle da pressão arterial. Conclusões: a identificação das crenças relevantes nos permitiu demonstrar aquelas que precisam ser reforçadas, negociadas ou reestruturadas na obtenção de comportamentos de autocuidado diante de síndromes hipertensivas gestacionais.

Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal

Background: The worldwide phenomenon of teenage pregnancy among 13­9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy. Objective: The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers. Methods: As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics. Results: Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives. Conclusion: Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).

Myoinositol supplementation in the prevention of gestational diabetes mellitus among high-risk pregnant women: A meta-analysis / Philippine Journal of Obstetrics and Gynecology

Objective@#The objective of the study was to determine the effectiveness of myoinositol (MI) supplementation in the prevention of gestational diabetes mellitus (GDM) among high-risk patients.@*Materials and Methods@#Comprehensive and systemic online searches were performed on PubMed, MEDLINE, Ovid, and Cochrane. Cross-referencing from related articles was also done. Only studies published in English were included in the study. We selected all randomized controlled trials on MI and singleton pregnant women with high risk for GDM.@*Data Collection and Analysis@#Five randomized controlled trials were evaluated by two independent reviewers. For each comparison, the quality of evidence was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Cochrane Collaboration tool. Review Manager 5.3 was used to generate the risk of bias evaluation and the analysis of the results.@*Main Results@#The present study identified five randomized controlled trials involving 871 participants. The comparison of the studies showed a statistically significant reduction in the incidence of GDM in MI supplementation versus the control group (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.19–0.53, P = 0.0001, Z = 4.36) by 68%. Similarly, there is a greater reduction in the incidence of fetal macrosomia among patients in the MI group than the controlled group (OR = 0.24, 95% CI = 0.07–0.78; P = 0.02, Z = 2.36) by 78%. However, there was no difference in terms of incidence of gestational hypertension (OR = 0.61, 95% CI = 0.19–2.01; P = 0.42, Z = −0.81), cesarean section (OR = 0.89, 95% CI = 0.65–1.22; P = 0.47, Z = 0.72), and neonatal hypoglycemia (OR = 0.35, 95% CI = 0.01–8.80; P = 0.53, Z = 0.63) outcomes.@*Conclusion@#MI supplementation taken at 4 g daily would decrease the incidence of GDM and fetal macrosomia. There was no statistically significant reduction in the risk of gestational hypertension, cesarean section, and neonatal hypoglycemia in the supplementation of MI.

Determining the risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes in patients with antenatal lower threshold blood pressure elevations: A retrospective cohort study / Philippine Journal of Obstetrics and Gynecology

Background@#Diagnosing hypertensive disorders in pregnancy utilizes systolic blood pressure (BP) of >140 mmHg and/or diastolic of >90 mmHg. However, since 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) have been endorsing lower BP thresholds for diagnosing hypertension.@*Objectives@#This study determines if antenatal lower threshold BP elevations under elevated BP and Stage 1 hypertension from ACC/AHA show an increased risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes.@*Materials and Methods@#This retrospective cohort study included service patients with prenatal consultations and deliveries at a private tertiary-level hospital from February 2016 to 2020. Antenatal BP measurements, categorized into “normal,” “elevated BP,” and “Stage 1 hypertension” under ACC/AHA classifications, had crude and adjusted relative risks (aRRs) and 95% confidence intervals (CIs) estimated to determine their associations with hypertensive disorders of pregnancy.@*Results@#Stage 1 hypertension was twice more likely to develop gestational hypertension (aRR: 2.314, 95% CI: 1.08–4.98) and thrice more likely to develop preeclampsia (aRR: 3.673, 95% CI: 2.30–5.86), whether without (aRR: 3.520, 95% CI: 1.33–9.29) or with severe features (aRR: 3.717, 95% CI: 2.16–6.41). There was a slightly increased risk for adverse perinatal outcomes from Stage 1 hypertension, as well as all outcomes from elevated BP, but was not statistically significant. Majority of BP elevations were during the third trimester.@*Conclusion@#Lower threshold Stage 1 hypertension showed an increased risk of developing hypertensive disorders of pregnancy, with a three-fold increased risk for preeclampsia. There may be advantages in its application for diagnosing preeclampsia or having increased monitoring for these patients.

Orientação nutricional como forma preventiva do diabetes mellitus gestacional e hipertensão gestacional: influência das escolhas alimentares / Nutritional guidance as a preventive measure for gestational diabetes mellitus and gestational hypertension: the influence of food choices

O Diabetes Mellitus Gestacional (DMG) e a Hipertensão Gestacional (HG) são duas comorbidades que podem ocorrer durante o período gestacional, acarretando expressiva morbimortalidade materno-fetal, com relevância mundial. Na gestação ocorrem algumas modificações fisiológicas no organismo, aumentando a necessidade de mais nutrientes essenciais e sendo a orientação nutricional mais efetiva quando há nutricionista na equipe multidisciplinar. Objetivo: Investigar a importância da orientação nutricional como forma preventiva do DMG e da HG. Métodos: estudo retrospectivo, com 40 gestantes, de 18 a 39 anos, atendidas no ambulatório de nutrição do pré-natal do IFF/Fiocruz no ano de 2019. Resultados: Há associação entre o estado nutricional de excesso de peso e um ganho de peso gestacional superior ao adequado, associação entre excesso de peso e DMG e entre excesso de peso e HG. A dieta das gestantes quando ingressaram no ambulatório de nutrição do pré-natal estava inadequada em vários nutrientes relevantes para o controle das patologias estudadas. Conclusão: É necessário investir num retorno das gestantes a maior quantidade de consultas nutricionais, de forma que se sintam acolhidas e engajadas, visando a diminuição da prevalência do DMG e da HG.(AU)

Gestational Diabetes Mellitus (GDM) and Gestational Hypertension (HG) are comorbidities that can occur during the gestational period, leading to significant maternal-fetal morbidity and mortality, with worldwide relevance. During pregnancy, some physiological changes occur in the body, increasing the need for more essential nutrients and being the most effective nutritional guidance when the nutritionist is part of the multidisciplinary team. Objective: To investigate the importance of nutritional guidance as a preventive form of GDM and HG. Methods: retrospective study with 40 pregnant women, aged 18 to 39 years, attended at the IFF/Fiocruz prenatal nutrition outpatient clinic in 2019. Results: Inferences of the associations of nutritional status of overweight and gestational weight gain greater than adequate; overweight and GDM; overweight and HG. The diet of pregnant women when they entered the prenatal nutrition outpatient clinic was inadequate in several nutrients considered relevant for the control of indicated pathologies. Conclusion: It is emphasized the relevance in the return of pregnant women to nutritional consultations so that they feel welcomed, minimizing the prevalence of GDM and HG.(AU)

Regional analysis of high risk factors of hypertensive disorders in pregnancy with organ or system impairment / 中华妇产科杂志

Objective: To explore the influencing factors of pregnancy-induced hypertensive disorders in pregnancy (HDP) with organ or system impairment in pregnant women, and to analyze and compare the differences of HDP subtypes in different regions of China. Methods: A total of 27 680 pregnant women with HDP with complete data from 161 hospitals in 24 provinces, autonomous regions and municipalities were retrospectively collected from January 1, 2018 to December 31, 2018. According to their clinical manifestations, they were divided into hypertension group [a total of 10 308 cases, including 8 250 cases of gestational hypertension (GH), 2 058 cases of chronic hypertension during pregnancy] and hypertension with organ or system impairment group [17 372 cases, including 14 590 cases of pre-eclampsia (PE), 137 cases of eclampsia, 2 645 cases of chronic hypertension with PE]. The subtype distribution of HDP in East China (6 136 cases), North China (4 821 cases), Central China (3 502 cases), South China (8 371 cases), Northeast China (1 456 cases), Southwest China (2 158 cases) and Northwest China (1 236 cases) were analyzed. By comparing the differences of HDP subtypes and related risk factors in different regions, regional analysis of the risk factors of HDP pregnant women with organ or system impairment was conducted. Results: (1) The proportions of HDP pregnant women with organ or system impairment in Northeast China (79.05%, 1 151/1 456), Central China (68.42%, 2 396/3 502) and Northwest China (69.34%, 857/1 236) were higher than the national average (62.76%, 17 372/27 680); the proportions in North China (59.18%, 2 853/4 821), East China (60.85%, 3 734/6 136) and South China (59.56%, 4 986/8 371) were lower than the national average, and the differences were statistically significant (all P<0.05). (2) Univariate analysis showed that the proportions of primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history in the hypertension with organ or system impairment group were higher than those in the hypertension group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history were independent risk factors for HDP pregnant women with organ or system impairment (all P<0.05). (3) Primipara: the rates of primipara in Northeast China, North China and Southwest China were higher than the national average level, while those in South China, Central China and Northwest China were lower than the national average level. Non-Han nationality: the rates of non-Han nationality in Northeast China, North China and Northwest China were higher than the national average, while those in East China, South China and Central China were lower than the national average. Non-urban household registration: the rates of non-urban household registration in Northeast China, North China, and Southwest China were lower than the national average, while those in East China, Central China were higher than the national average. Irregular prenatal examination: the rates of irregular prenatal examination in North China, South China and Southwest regions were lower than the national average level, while those in Northeast China, Central China and Northwest China were higher than the national average level. History of PE: the incidence rates of PE in Northeast China, North China, South China and Southwest China were lower than the national average level, while those in Central China and Northwest China were higher than the national average level. Conclusions: Primiparas, non-Han, non-urban household registration, irregular prenatal examination, and PE history are risk factors for HDP pregnant women with organ or system impairment. Patients in Northeast, Central and Northwest China have more risk factors, and are more likely to be accompanied by organ or system function damage. It is important to strengthen the management of pregnant women and reduce the occurrence of HDP.

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.

Gestantes em Cruzeiro do Sul, Acre: características demográficas e socioeconômicas, ocorrência e fatores associados aos distúrbios hipertensivos na gravidez / Pregnant women in Cruzeiro do Sul, Acre: demographic and socioeconomic characteristics, occurrence and factors associated with hypertensive disorders in pregnancy

Introdução: A gravidez é um período de várias alterações fisiológicas, anatômicas, psicológicas e sociais na vida da mulher. As gestantes e seus bebês necessitam de cuidados específicos. A assistência adequada à saúde durante o período de gestacional é essencial para a prevenção ou diminuição dos agravos a saúde materno-infantil. Objetivos: a) Identificar as evidências disponíveis na literatura sobre o papel da enfermagem na assistência as gestantes com síndromes hipertensivas na gestação (Artigo 1); b) Analisar a concordância entre dados de peso pré-gestacional, peso na gravidez, altura e pressão arterial sistólica (PAS) e diastólica (PAD) registradas tanto na caderneta da gestante quanto nas informações obtidas no estudo longitudinal MINA-Brasil (Artigo 2); c) Investigar a ocorrência e fatores associados aos distúrbios hipertensivos na gravidez (DHG) e complicações neonatais no município de Cruzeiro do Sul, Acre (Artigo 3); d) Investigar as características socioeconômicas e obstétricas de parturientes adolescentes e suas complicações sobre a saúde materna e neonatal entre participantes da coorte de nascimentos MINA-Brasil (Artigo 4). Método: Trata-se de análise de dados da linha de base do estudo MINA-Brasil. Entre fevereiro de 2015 e maio de 2016, gestantes inscritas no pré-natal da área urbana foram rastreadas e duas avaliações foram realizadas: 1ª avaliação no segundo trimestre e a 2ª avaliação no terceiro trimestre de gravidez. Informações sobre condições socioeconômicas e demográficas, histórico de saúde e estilo de vida e medidas antropométricas foram obtidas pela equipe de pesquisa. Posteriormente, entre julho de 2015 e junho de 2016, foi realizado registro diário das internações para parto na única maternidade do município, dando início a coorte de nascimento de base populacional do estudo MINA-Brasil. As análises utilizadas neste estudo incluíram uma análise integrativa da literatura (Artigo 1), análise de concordância entre as medidas antropométricas e de pressão arterial registradas na caderneta da gestante e aferidas pela equipe do estudo MINA-Brasil (Artigo 2). Também foram utilizados modelos de regressão múltiplos de Poisson com variância robusta para avaliar os fatores associados aos distúrbios hipertensivos no parto (Artigo 3) e os fatores associados a parturientes adolescentes (Artigo 4). O nível de significância estatística adotado nas análises foi p <0,05. Resultados: No Artigo 1, ao todo, 13 estudos foram selecionados para a análise, 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. No Artigo 2, foram analisados dados de 428 gestantes. Houve concordância moderada entre as informações para o peso pré-gestacional autorreferido (0,935) e altura (0,913), e concordância substancial para o peso da gestante no segundo (0,993) e terceiro (0,988) trimestres de gestação. Verificou-se baixa concordância da PAS e PAD no segundo (PAS=0,447; PAD=0,409) e terceiro (PAS=0,436; PAD=0,332) trimestres gestacionais. No Artigo 3 (n=1521), a prevalência de DHG foi de 11,0% (IC 95%: 9,5-12,7). Os fatores associados à prevalência de DHG foram idade materna ≥ 35 anos (RP: 1,9; IC 95%: 1,3-3,0), ser primigesta (RP: 2,0; IC 95%: 1,5-2,7), obesidade pré-gestacional (RP: 2,7; IC 95%: 1,9-4,0), maior ganho de peso gestacional (RP do quartil mais alto: 2,5; IC 95%: 1,6-3,8), hipertensão crônica (RP: 3,6; IC 95%: 2,7-4,9) e parto cesáreo (RP: 1,8; IC 95%: 1,6-2,0) e prematuridade (RP: 2,0; IC 95%: 1,3-3,2). No Artigo 4, entre as puérperas estudadas (n=1525), 26,2% (IC95%: 24,0-28,4) eram adolescentes. Quando comparadas com as parturientes adultas, os fatores associados à maior prevalência de parto na adolescência foram ter 9 anos ou menos de estudo (RPaj:1,36; IC95%: 1,14-1,61), pertencer aos menores quartis do índice de riqueza (1° quartil: RPaj:1,40; IC95%: 1,08-1,80) (2° quartil: RPaj:1,37; IC95%: 1,08-1,74), ser primigesta (RPaj:3,69; IC95%: 2,98-4,57), apresentar baixo IMC pré-gestacional (RPaj:1,28; IC95%: 1,04-1,57), infecção urinária na gravidez (RPaj:1,25; IC95%: 1,07-1,46) e menos de 6 consultas de pré-natal (RPaj:1,42; IC95%: 1,21-1,66). Conclusões: Nossos resultados reforçam a importância de conhecer as características das gestantes e seus neonatos e os desfechos adversos que afetam sua saúde na Amazônia Ocidental Brasileira. Esses resultados poderão contribuir para o planejamento e melhoria de programas de assistência à saúde materno-infantil nos mais diversos níveis de atenção, configurando-se em uma ferramenta importante, baseada em evidencias cientificas, que abrange várias reflexões sobre a saúde materna e neonatal.

Introduction: Pregnancy is a period of several physiological, anatomical, psychological and social changes in a woman's life. Pregnant women and their babies need specific care. Adequate health care during the gestational period is essential for the prevention or reduction of maternal and child health problems. Objective: a) To identify the available evidence on the role of nursing in assisting pregnant women with hypertensive syndromes during pregnancy (Article 1); b) To analyze the agreement between data on pre-gestational weight, gestational weight gain, height, and systolic (SBP) and diastolic (DBP) blood pressure data recorded both in the prenatal care card and in the information obtained in the MINA-Brazil study (Article 2); c) To investigate the occurrence and factors associated with hypertensive disorders in pregnancy (HDP) and neonatal complications in women living in the Brazilian Western Amazon (Article 3); d) To investigate the socioeconomic and obstetric characteristics of adolescent parturients and their complications on maternal and neonatal health among participants of the MINA-Brasil birth cohort in the municipality of Cruzeiro do Sul, Acre ( Article 4). Methods: Baseline data from the MINA-Brazil cohort study were analyzed. Between February 2015 and May 2016, pregnant women enrolled in prenatal care in the urban area were screened and two evaluations were performed: 1st evaluation in the second trimester and the 2nd evaluation in the third trimester of pregnancy. Information on socioeconomic and demographic conditions, health and lifestyle history, and anthropometric measurements were obtained by the research team. Subsequently, between July 2015 and June 2016, a daily record of admissions for childbirth was carried out in the only maternity hospital in the municipality, starting the population-based birth cohort of the MINA-Brazil study. First, an integrative literature review was performed (Article 1), following data analyzes of agreement between anthropometric and blood pressure measurements recorded in the prenatal care card and measured by the MINA-Brazil study team (Article 2). Multiple Poisson regression models with robust variance were also used to assess factors associated with hypertensive disorders at childbirth (Article 3), and factors associated with adolescent parturients (Article 4). The level of statistical significance adopted was p <0.05. Results: In Article 1, overall 13 studies were selected for analysis, 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. In Article 2, data from 428 pregnant women were analyzed. There was moderate agreement between the information for self-reported pre-pregnancy weight (0.935) and height (0.913), and substantial agreement for the pregnant woman's weight in the second (0.993) and third (0.988) trimesters of pregnancy. There was a low agreement between SBP and DBP in the second (SBP=0.447; DBP=0.409) and third (SBP=0.436; DBP=0.332) trimesters. In Article 3 (n=1521), the prevalence of HDP was 11.0% (95% CI: 9.51-2.7). Factors associated with the prevalence of HDP were maternal age ≥ 35 years (PR: 1.9; 95% CI: 1.3-3.0), being primiparous (PR: 2.0; 95% CI: 1.5- 2.7), pre-gestational obesity (PR: 2.7; 95% CI: 1.9-4.0), greater gestational weight gain (PR of the highest quartile: 2.5; 95% CI: 1.6-3.8), chronic hypertension (PR: 3.6; 95% CI: 2.7-4.9) and diabetes in pregnancy (PR: 1.9; 95% CI: 1.1-3, two). HDP were associated with the risk of cesarean delivery (PR: 1.8; 95% CI: 1.6-2.0) and prematurity (PR: 2.0; 95% CI: 1.3-3.2). In Article 4, among the postpartum women studied (n=1525), 26.2% (95%CI: 24.0-28.4) were adolescents. When compared with adult parturients, the factors associated with a higher prevalence of childbirth in adolescence were: having 9 years or less of schooling (PRaj: 1.36; 95%CI: 1.14-1.61), belonging to the lowest quartiles of the index wealth (1st quartile: RPaj:1.40; 95%CI: 1.08-1.80) (2nd quartile: PRaj:1.37; 95%CI: 1.08-1.74), being a primiparous (PRaj:3.69; 95%CI: 2.98-4.57), having a low pre-gestational BMI (PRaj:1.28; 95%CI: 1.04-1.57), urinary tract infection in pregnancy (PRaj: 1.25; 95%CI: 1.07-1.46) and less than 6 prenatal consultations (PRaj:1.42; 95%CI: 1.21-1.66). Conclusions: Our results reinforce the importance of knowing the characteristics of pregnant women and their newborns and the adverse outcomes that affect their health in the Western Brazilian Amazon. These results can contribute to the planning and improvement of maternal and child health assistance programs at the most diverse levels of care, constituting an important tool, based on scientific evidence, which encompasses several reflections on maternal and neonatal health.

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.

Immature Platelet Fraction and Thrombin Generation: Preeclampsia Biomarkers / Fração de plaquetas imaturas e geração de trombina: Biomarcadores da pré-eclâmpsia

Abstract Preeclampsia, a human pregnancy syndrome, is characterized by elevated blood pressure and proteinuria after the 20th week of gestation. Its etiology remains unknown, and its pathophysiological mechanisms are related to placental hypoperfusion, endothelial dysfunction, inflammation, and coagulation cascade activation. Recently, the role of the complement system has been considered. This syndrome is one of the main causes of maternal and fetal mortality and morbidity. This article discusses the hypothesis of preeclampsia being triggered by the occurrence of inadequate implantation of the syncytiotrophoblast, associated with bleeding during the first stage of pregnancy and with augmented thrombin generation. Thrombin activates platelets, increasing the release of antiangiogenic factors and activating the complement system, inducing the membrane attack complex (C5b9). Immature platelet fraction and thrombin generation may be possible blood biomarkers to help the early diagnosis of preeclampsia.

Resumo A pré-eclâmpsia, uma síndrome da gestação humana, é caracterizada por elevação da pressão arterial e proteinúria patológica após a 20ª semana de gestação. Sua etiologia permanece desconhecida, e seus mecanismos fisiopatológicos estão relacionados à hipoperfusão placentária, disfunção endotelial, inflamação, e ativação da cascata de coagulação. Recentemente, o papel do sistema do complemento foi considerado. Essa síndrome é uma das principais causas de morbidade e mortalidade materna e fetal. Este artigo discute a hipótese de a pré-eclâmpsia ser desencadeada pela ocorrência da implantação inadequada do sinciciotrofoblasto, associada ao sangramento durante o primeiro trimestre da gravidez com aumento da geração de trombina. A trombina ativa plaquetas, aumentando a liberação de fatores antiangiogênicos na circulação e ativando o sistema do complemento, especialmente o complexo de ataque de membrana (C5b9). Portanto, a fração de plaquetas imaturas e a geração de trombina podem ser possíveis biomarcadores sanguíneos para auxílio no diagnóstico precoce da pré-eclâmpsia.

Redução da mortalidade materna: expectativa de novas estratégias / Reduction of maternal mortality - expectation of new strategies

A morte materna é aquela que acontece em qualquer mulher em estado gravídico, parturiente ou em período puerperal até 42 dias após o parto por qualquer causa de óbito, exceto causas acidentais ou incidentais, ou por causas obstétricas diretas e indiretas ocorrida até 364 dias após o fim da gestação (BROWN , 2022). Em 2019, a taxa de mortalidade materna (TMM) em Goiás foi de 69,7 por 100 mil nascidos vivos (BRASIL, 2021), estando no limiar da meta estabelecida pela Organização Mundial de Saúde no Objetivo de Desenvolvimento Sustentável 3.1, que é de 70 óbitos por 100 mil nascidos vivos (OMS, 2022). No entanto, a frequência absoluta de óbitos maternos no ano de 2021 teve um incremento de 83,5% em relação ao ano de 2019, tornando-se uma preocupação de saúde pública (SECRETARIA DE VIGILÂNCIA EM SAÚDE, 2022)

Maternal death is one that occurs in any pregnant, parturient or puerperal woman up to 42 days after delivery from any cause of death, except accidental or incidental causes, or from direct and indirect obstetric causes occurring up to 364 days after the birth. end of pregnancy (BROWN , 2022). In 2019, the maternal mortality rate (MMR) in Goiás was 69.7 per 100,000 live births (BRAZIL, 2021), being on the threshold of the goal established by the World Health Organization in the Objective of Sustainable Development 3.1, which is 70 deaths per 100,000 live births (WHO, 2022). However, the absolute frequency of maternal deaths in 2021 increased by 83.5% compared to 2019, making it a public health concern (SECRETARIA DE SURVEILLANCE IN HEALTH, 2022)

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.

Hipotiroidismo subclínico y pérdida de embarazo: una revisión de la literatura / Subclinical Hypothyroidism and Pregnancy Loss: A Literature Review

Existe una alta prevalencia de hipotiroidismo subclínico (SCH) en el embarazo. Está vinculado a una importante morbilidad y mortalidad materna y fetal. Los efectos de SCH sobre el embarazo incluyen mayores riesgos de hipertensión gestacional y ruptura prematura de membranas (PROM). Sus fetos y bebés tenían más probabilidades de sufrir de bajo peso al nacer (LBW) y retraso del crecimiento intrauterino (IUGR). El riesgo de aborto espontáneo se informa alto en varios estudios para SCH no tratado. SCH se asocia directamente con una mayor presencia de anti -cuerpos anti TPO en suero materno. La detección temprana y el tratamiento de SCH han sido testigos de mejores resultados en términos de resultado del embarazo. Esta revisión se centra para establecer la relación de una mayor prevalencia de SCH en los países en desarrollo, así como su asociación con el aumento de los cuerpos anti TPO en suero materna y sacar una conclusión que puede ayudar a reducir las razones y proporcionar una solución. Este estudio concluyó que SCH es más frecuente en los países en desarrollo, ya sea debido a la deficiencia de yodo, una disminución de la conciencia sobre este problema o menos acceso a las instalaciones médicas. Por lo tanto, se sugiere que las hembras con antecedentes de partos prematuros, IUGR anteriores o abortos involuntarios deben someterse a una detección de hipotiroidismo subclínico y niveles de anticuerpos anti TPO durante sus visitas prenatales

There is a high prevalence of subclinical hypothyroidism (SCH) in pregnancy. It is linked to significant maternal and fetal morbidity and mortality. SCH's effects on pregnancy include increased risks of gestational hypertension and premature rupture of membranes (PROM). Their fetuses and infants had been more likely to suffer from low birth weight (LBW) and intrauterine growth retardation (IUGR). The risk of miscarriage is reported high in various studies for untreated SCH. SCH is directly associated with increased presence of anti TPO anti bodies in maternal serum. Early detection and treatment of SCH have witnessed better results in terms of pregnancy outcome. This review focuses to establish the relationship of increased prevalence of SCH in the developing countries as well as its association with increased anti TPO anti bodies in maternal serum and draw a conclusion which can help narrow down the reasons and provide solution. This study concluded that SCH is more prevalent in developing countries, either due to iodine deficiency, decreased awareness about this problem or less access to medical facilities. Therefore, it is suggested that females with history of preterm deliveries, previous IUGRs, or miscarriages should undergo screening for subclinical hypothyroidism and Anti TPO antibody levels during their antenatal visits.

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.

Nursing Diagnoses and Interventions in Women with Hypertensive Disorders of Pregnancy: A Scoping Review / Diagnósticos e intervenciones de enfermería en mujeres con hipertensión inducida en el embarazo: revisión de alcance / Diagnósticos e intervenções de enfermagem em mulheres com distúrbios hipertensivos da gravidez: revisão de escopo

Objective: To map the diverse scientific evidence on nursing diagnoses and interventions in women with pregnancy hypertensive disorders under Primary Health Care. Materials and method: A scoping review was conducted through nine stages in seven databases and the thesis and dissertation catalog of the Coordinating Office for Improving Higher Education Personnel. The search was performed from January to March 2021. Results: A total of 2,505 articles were retrieved, of which five were included in the final review. Nine primary diagnoses from the 2009-2011 version of NANDA-I were identified. Each diagnosis was classified according to physical, psychological, behavioral, and environmental characteristics. The interventions were related to controlling pain, anxiety, hemodynamic dysfunctions, self-esteem level, fluid replacement, patient/environment hygiene, and sleep-rest ratio. Conclusions: The nursing diagnoses and interventions presented in this study corroborate the clinical practice and aid nursing professionals' reasoning.

Objetivo: mapear las evidencias científicas acerca de los diagnósticos e intervenciones de enfermería en mujeres con hipertensión inducida en el embarazo en la atención primaria de salud. Materiales y método: scoping review en nueve etapas, en siete bases de datos y en el catálogo de tesis de la Coordinación de Perfeccionamiento de Nivel Superior de Brasil. Se realizó la búsqueda de enero a marzo de 2021. Resultados: se recopilaron 2505 artículos, de los cuales cinco se excluyeron en la revisión final. Nueve diagnósticos principales de la versión 2009-2011 de la NANDA-I. Se clasificó cada diagnóstico en cuanto a las características físicas, psicológicas, comportamentales y ambientales. Las intervenciones se relacionaron con el control del dolor, de la ansiedad, de las disfunciones hemodinámicas, del nivel de autoestima, de la reposición hídrica, de la higienización del paciente/ambiente y a la relación sueño-reposo. Conclusiones: los diagnósticos e intervenciones de enfermería presentados en el estudio corroboran la práctica clínica y auxilian en el razonamiento del profesional de enfermería.

Objetivo: mapear as evidências científicas sobre os diagnósticos e intervenções de enfermagem em mulheres com distúrbios hipertensivos da gravidez na atenção primária à saúde. Materiais e método: scoping review em nove etapas, em sete bases de dados e no catálogo de teses e dissertações da Coordenação de Aperfeiçoamento de Nível Superior. Realizou-se a busca de janeiro a março de 2021. Resultados: 2505 artigos foram recuperados, dos quais cinco foram incluídos na revisão final. Nove diagnósticos principais da versão 2009-2011 da NANDA-I. Classificou-se cada diagnóstico quanto às características físicas, psicológicas, comportamentais e ambientais. As intervenções foram relacionadas ao controle da dor, da ansiedade, das disfunções hemodinâmicas, do nível de autoestima, da reposição hídrica, da limpeza do paciente/ambiente e à relação sono-repouso. Conclusões: os diagnósticos e intervenções de enfermagem apresentados neste estudo corroboram a prática clínica e auxiliam no raciocínio do profissional de enfermagem.

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)

Factores de riesgo asociados al trabajo de parto pretérmino en gestantes del Hospital Universitario Maternidad Nuestra Señora de la Altagracia septiembre-diciembre 2018 / Risk factors associated to preterm labor in pregnant patients in teaching Hospital Maternidad Nuestra Señora de la Altagracia September-December 2018

Objetivo: Determinar los factores de riesgo asociados al trabajo de parto pre-término en gestantes del Hospital Universitario Maternidad Nuestra Señora de la Altagracia, periodo septiembre­diciembre 2018. Método: se realizó un estudio retrospectivo, descriptivo y de corte transversal, con una muestra de 52 mujeres. Los datos obtenidos fueron procesados con el sistema Epi-info 7.0. Resultados: el estudio muestra que entre los factores de riesgo más relevantes se encuentra la multiparidad, mostrando que el 65.4 % tuvieron un número mayor a dos embarazos, de las cuales se encontró que el 52.9 % tienen historia de abortos. Otros factores de riesgo asociados a partos prematuros es la enfermedad obstétrica relacionada, con mayor relevancia la anemia, con un 31.6 %, seguida por las infecciones urinarias con un 17.5 %. Conclusión: el estudio demuestra que dentro de los factores de riesgo asociados a partos pretérminos se encuentran la anemia con un 31.6 % y las infecciones urinarias con un 17.5 %, además el 48.1 % de las pacientes tenían una edad gestacional que rondaba entre 33 y 36 semanas de gestación.

Objective: Determine the risk factors associated to preterm labor in pregnant patients in ''Hospital Maternidad Nuestra Señora de la Altagracia'' in Santo Domingo, September­December 2018. Methods: It is a descriptive, retrospective, and a cross-sectional study, with a sample of 52 women. The data collected was processed with the system Epi-info 7.0. Results: The study shows that multiparity is one of the most relevant risk factors for preterm delivery, showing that 65.4% had a number equal or greater than 2 pregnancies, of which 52.9% had a history of abortion. Others risk factors related to preterm delivery is a concomitant diseases within the pregnancy, being the anemia the most relevant with 31.6% and follow up by urinary tract infections with 17.5%. Conclusion: The study shows that within the risk factors associated with preterm delivery, anemia is within 31.6% and the urinary tract infections are 17.5%, Also related to preterm delivery we have the gestational age which was around 33 ­ 36 weeks in 48.1% of the preterm deliveries.

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)