Pregnancy among women with kidney transplantation: a 20-years single-center registry / Gravidez em transplantadas renais: registro de 20 anos de um centro de referência

Abstract Objective To assess maternal and perinatal outcomes in pregnancies after kidney transplantation in a tertiary center in Brazil. Methods Retrospective cohort of pregnancies in women with kidney transplantation at the Universidade Estadual de Campinas, from January 1995 until December 2017. Medical charts were reviewed, andmaternal and perinatal outcomes were described as means and frequencies. Renal function and blood pressure were evaluated during pregnancy and postpartum. Results A total of 22 women had at least 1 pregnancy during the considered timeinterval, and 3 of them had > 1 pregnancy, totalizing 25 pregnancies. The mean age at transplantation was of 24.6 ± 4.2 years old, and the mean time interval until pregnancy was of 67.8 ± 46.3months. Themost frequent complication during pregnancywas hypertension, which affected 11 (64.7%)women. The gestational age at delivery was 34.7 ± 4weeks, and 47% of these pregnancies were preterm (< 37 weeks). A total of 88.2% of the women delivered by cesarean section. Renal function, measured by serum creatinine, remained stable during pregnancy, and the systolic blood pressure increased significantly, while the diastolic blood pressure did not differ during pregnancy. Conclusion Pregnancy after kidney transplantation is a rare event. Pre-eclampsia and prematurity were frequent complications, and cesarean section rates were very high. A specialized antenatal and postpartum care with a multiprofessional approach and continuous monitoring of graft function are essential for the early diagnosis of complications and improved outcomes.

Resumo Objetivo Avaliar os resultados maternos e perinatais de gestações em mulheres transplantadas renais em um centro terciário no Brasil. Métodos Coorte retrospectiva de gestações entre mulheres transplantadas renais na Universidade Estadual de Campinas, de Janeiro de 1995 a Dezembro de 2017. Os prontuários médicos foram revisados, e os resultados maternos e perinatais foram descritos como médias e frequências. A função renal e a pressão arterial foram avaliadas durante a gravidez e o puerpério. Resultados Um total de 22 mulheres tiveram ao menos 1 gravidez durante o período avaliado, e 3 delas tiveram > 1 gestação, totalizado 25 gestações. A idade média no momento do transplante foi 24.6 ± 4.2 anos, e o tempo médio de intervalo até a gravidez foi de 67.8 ± 46.3 meses. A complicação mais frequente durante a gravidez foi a hipertensão, que acometeu 11 (64.7%) mulheres. A idade gestacional no parto foi de 34.7 ± 4 semanas, e 47% das gestações encerraram-se prematuramente (< 37 semanas). Umtotal de 88.2% das gestações terminou com uma cesárea. A função renal, avaliada pela creatinina sérica, permaneceu estável durante a gravidez, enquanto a pressão arterial sistólica aumentou significativamente. A pressão arterial diastólica não diferiu ao longo dos períodos avaliados. Conclusão Gestação após o transplante renal é um evento raro. Pré-eclâmpsia e prematuridade foram as complicações mais frequentes, e as taxas de cesárea foram muito altas. O cuidado multiprofissional no pré-natal e no puerpério e a constante monitoração da função do enxerto são fundamentais para diagnosticar precocemente complicações e melhorar os resultados.

La hemorragia obstétrica en el servicio de Anestesiología del Hospital Dr. Agostinho Neto / Obstetric Hemorrhage in Anesthesia Service at Dr. Agostinho Neto Hospital

Introducción: La hemorragia obstétrica es una de las complicaciones más temidas y una de las principales causas de mortalidad materna. Objetivo: Caracterizar la hemorragia obstétrica en el servicio de Anestesiología y Reanimación del Hospital Dr. Agostinho Neto de Guantánamo. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en el mencionado servicio de salud desde 2015 - hasta 2017. De un universo de 388 pacientes que tuvieron diagnóstico de morbilidad materna extremadamente grave, la muestra quedó constituida por las diagnosticadas con hemorragia obstétrica (n= 71). Para el procesamiento estadístico se utilizó el porcentaje, la media y la desviación estándar. Resultados: La hemorragia obstétrica se precisó en 18,2 por ciento de las pacientes; de ellas, 0,7 por ciento fallecieron. La edad media de las pacientes fue de 24,2 ± 6,2 años. La edad gestacional fue de 34,2 ± 6,2 años y la estadía en días fue de 5,9 ± 4,2 [IC 95 por ciento 5,3 - 6,5]. La atonía uterina (50,8 por ciento) fue la causa más común de la hemorragia. El 91,5 por ciento de las pacientes presentó inestabilidad hemodinámica, lo que condicionó el uso de altos volúmenes de fluidos y hemoderivados para su reanimación. La coagulación intravascular diseminada fue la causa de muerte fundamental. Conclusiones: La hemorragia obstétrica continúa una causa importante de morbilidad y mortalidad en el mencionado servicio de salud(AU)

Introduction: Obstetric hemorrhage is one of the feared complications and it is one of the main causes of maternal mortality. Objective: To characterize obstetric hemorrhage in the service of Anesthesiology and Reanimation at Dr. Agostinho Neto Hospital in Guantanamo, Cuba from 2015 to 2017. Methods: A descriptive, longitudinal and prospective study was carried out in the aforementioned health service from 2015 to 2017. Three hundred eighty eight (388) patients that had diagnostic of extremely serious maternal morbidity were the universe of this study. The sample was constituted by those diagnosed with obstetric hemorrhage (n = 71). Percentage, mean and standard deviation were used for the statistical analysis. Results: Obstetric hemorrhage occurred in 18.2 percent of the patients. 0.7 percent died. The mean age was of 24.2 ± 6.2 years; the pregnancies age was of 34.2 ± 6.2 years and hospital stay was of 5.9 ± 4.2 [IC 95 percentage 5.3 - 6.5]. Uterine atony (50.8 percent) was the most common cause of the hemorrhage. 91.5 percent of the patients had hemodynamic unsteadiness that conditioned the use of high volumes of fluids and hemoderivates for reanimation. Clotting intravascular was the main cause of death. Conclusions: Obstetric hemorrhage constitutes an important cause of morbidity and mortality in the mentioned health service(AU)

Lipoprotein profile modifications during gestation: A current approach to cardiovascular risk surrogate markers and maternal-fetal unit complications / Modificações do perfil lipoproteico durante a gestação: uma abordagem atual demarcadores sugestivos de risco cardiovascular e complicações materno-fetais

Abstract Several changes occur in lipid metabolism during gestation due to hormonal and metabolic changes, which are essential to satisfy the nutritional demands of the maternal-fetal unit development. The gestation shows two distinct periods that begin with fat accumulation, mainly in maternal adipose tissue, and the late phase, characterized by accelerated catabolism, with the increase of fatty acids in the circulation that causes hyperlipidemia, especially the one characterized as hypertriglyceridemia. Maternal hyperlipidemia may be associated with the development of maternal-fetal complications (preterm birth, preeclampsia, vascular complications) and the development of long-term cardiovascular disease. The cardiovascular risk may not only be related to lipoproteins cholesterol content, but also to the number and functionality of circulating lipoprotein particles. This review reports themajor changes that occur in lipoprotein metabolismduring pregnancy and that are associated with the development of dyslipidemias, lipoprotein atherogenic phenotype, and maternal-fetal unit complications.

Resumo Diversas mudanças ocorrem no metabolismo lipídico durante a gestação em função das alterações hormonais e metabólicas, que são essenciais para satisfazer a demanda nutricional ocasionada pelo desenvolvimento da unidade feto-placentária. O período da gestação apresenta dois momentos distintos que iniciam com acúmulo de gordura principalmente no tecido adiposo materno, e a fase tardia, caracterizada por catabolismo acelerado, com aumento de ácidos graxos na circulação causando hiperlipidemia, principalmente a aquela caracterizada como hipertrigliceridemia. A hiperlipidemia materna pode estar associada ao desenvolvimento de complicações materno-fetais (parto prematuro, pré-eclâmpsia, complicações vasculares) e de doenças cardiovasculares, a longo prazo. O risco pode estar relacionado não apenas ao teor de colesterol contido nas frações lipoprotéicas, mas também ao número e a funcionalidade das partículas lipoproteicas. Esta revisão aborda as principais mudanças que ocorrem no metabolismo lipoproteico durante a gravidez, e que estão associadas ao desenvolvimento de dislipidemias, fenótipo aterogênico e complicações maternofetais.

comparative study to evaluate the role of alpha tocopherol in pregnancy induced hypertension

To assess the role of alpha tocopherol in Pregnancy Induced Hypertension [PIH] by comparing pregnancy induced hypertensive patients on routine anti-hypertensive measures with pregnancy induced hypertensive patients on alpha tocopherol plus routine antihypertensive measures. Retrospective Randomizing Study. This study was conducted at the Department of pharmacology and Therapeutics, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from April 2004 to Sept. 2004. Two groups each comprising of 25 pregnancy induced hypertensive females, age ranging from 18-40 years were studied in this study. Changes in systolic and diastolic blood pressure were assessed from 24-28 weeks of pregnancy and were followed at every 15 days till the time of delivery in Control Group-I [G-I] and Test Group-II [G-II]. On day-0 systolic blood pressure on average showed higher value in G-II compared to G-I. On day 30, 60 and day final, the mean systolic blood pressure showed lower values in G-II although the difference was found statistically insignificant. When diastolic blood pressure studied, it showed on the average same readings for G-I and G-II on day-0. On day 30, day 60 and day final, it also showed statistically insignificant difference between G-I and G-II with higher mean diastolic blood pressure in G-I. Alpha tocopherol exerted better effect on systolic and diastolic blood pressure in test group when compared with control group

Testosterona séiica en trastornos hipertensivos del embarazo / Serum testosterone in hypertensive disorders of pregnancy

OBJETIVO: Se ha comunicado asociación de hiperandrogenemia y preeclampsia; además de confirmarlo se pretende dilucidar si también hay esa asociación con embarazadas con hipertensión arterial crónica esencial (HACE). MÉTODOS: 45 mujeres con gestación de tercer trimestre separadas en 3 grupos: 1) 15 normotensas, 2) 16 preeclámpticas, 3) 14 HACE. Se registró edad, paridad, índice de masa corporal (IMC), presión arterial sistólica y diastólica (mm de Hg), proteinuria en 24 horas, semanas de gestación, y niveles séricos de testosterona total (Tt), RIA de testosterona libre (Tl), proteína ligante sexual (SHBG), índice de andrógenos libres (IAL). RESULTADOS: Los 3 grupos estudiados, normotensas, preeclámpticas y HACE, presentaron los siguientes valores séricos, respectivamente: Tt (nmol/L) 2,3±1,4; 5,2±3,0; 1,9±1,5 (p=0,001). IAL (pmol/L) 0,5±0,3; 1,1±0,9; 0,4±0,2 (p=0,001). No hubo diferencias significativas en Tl (pmol/L) 7,2±4,7; 7,39±4,5; 4,5±2,6; ni en SHBG (nmol/L) 468±112; 503±134; 512±96. CONCLUSIONES: Las embarazadas con HACE presentaron niveles séricos de Tt y de IAL similares a las embarazadas normotensas. En cambio, las mujeres con preeclampsia presentaron niveles de Tt sérica e IAL claramente aumentados en comparación con las embarazadas normotensas. Se concluye que existiría una asociación de hiperandrogenemia con preeclampsia; asociación que no fue encontrada en embarazadas con HACE.

OBJECTIVE: Association between hyperandrogenemia and preeclampsia was communicated. This study was designed to explain if also there is association between hyperandrogenemia and pregnant with essential chronic arterial hypertension (HACE). METHODS: To 45 women with gestation of third trimester were separated in 3 groups: 1) normal arterial pressure (n=15), 2) preeclampsia (n=16), 3) HACE (n=14). It was registered age, parity, body mass index (IMC), systolic and diastolic arterial pressure (mm of Hg), proteinuria in 24 h, weeks of gestation, and seric level of total testosterone (Tt), free testosterone (Tl), free androgen index (IAL). RESULTS: The studied groups, normal arterial pressure, preeclampsia, and HACE, displayed the following serics values, respectively: Tt (nmol/L) 2.3±1.4; 5.2±3.0; 1.9±1.5; (p=0.001). IAL (pmol/L) 0.5±0.3; 1.1±0.9; 0.4±0.2; (p=0.001). Not significant differences were found in: Tl (pmol/L) 7.2±4.7; 7.4±4.5; 4.5±2.6. SHBG (nmol/L) 468±112; 503±134; 512±96. CONCLUSIONS: The pregnant women with HACE presented similar seric level of T than pregnant women with normal arterial pressure. However, the women with preeclampsia displayed significant increased levels of seric Tt and increased IAL. We conclude that the association observed of hyperandrogenemia with preeclampsia was not found in pregnant with HACE.

Niveles elevados de andrógenos plasmáticos en mujeres con hipertensión asociada al embarazo / High androgen plasmatic levels in women affected with pregnancy-induced hypertension

Objective. To compare the plasmatic levels of free testosterone (FT), total testosterone (TT), and dehydroepiandrosterone sulphate (DHEAs) obtained from women with pregnancy-induced hypertension (PIH) and from uncomplicated pregnant women in the third trimester of pregnancy. Methods. FT, TT and DHEAs were measured by radioimmunoassay in plasma samples from 30 women with PIH (PIH group) defined as mean blood pressure > 105 mm Hg, and proteinuria > 100 mg/dL and < 300 mg/dL, and in 30 women with uncomplicated pregnancies (control group). Gestational age at the time of the study in the PIH group was 37 weeks +2 days (28+0 - 40+1), and in the control group, 37 weeks +1 day (28+0 - 41+6). The plasmatic androgen levels and the perinatal outcome were analysed in both groups. Results. There was no difference in the gestational age at birth. In the PIH group there were increased number of caesarean sections due to fetal distress (PIH group; n = 10, control group; n = 2; p = 0.05), lower birthweight (PIH group 2549 g [800-3400 g], control group 3242 g [2400-4200 g]; p = 0.02) and increased number of neonatal intensive unit care admissions (PIH group; n = 3, control group; n = 0). In the PIH group, FT and TT levels were significantly higher than controls (mean, SD) (FT PIH group, 5.94 (0.9) pg/mL; FT control group, 0.44 (0.2) pg/mL; p = 0.002. TT PIH group, 5.28 (2.4) nmol/L; TT control group, 3.6 (0.6) nmol/L; p = 0.02. There was no difference in DHEAs levels between the groups (mean, SD) (PIH group, 51.13 (23.7) µg/dL; control group, 70.0 (13.5) /igldL). Conclusions. In women complicated with PIH there is an increment in the plasmatic levels of FT and TT. This might contribute to the clinical findings and the adverse perinatal outcome observed in this patients.

Objetivo. Comparar los valores plasmáticos de testosterona libre (TL), testosterona total (TT) y sulfato de dehidroepiandrosterona (DHEAs) entre mujeres con hipertensión asociada al embarazo (HAE) y mujeres con embarazos normales en el tercer trimestre de la gestación. Mátodos. Se midieron TL, TT y DHEAs en el plasma de 30 mujeres con diagnóstico de HAE (grupo HAE), definida como tensión arterial media > 105 mm Hg y proteínas en orina >100 mg/dL y < 300 mg/ dL, y en 30 mujeres embarazadas sin HAE (grupo control) y los valores obtenidos se compararon entre ambos grupos. La edad gestacional de las pacientes del grupo control fue lo más similar posible a las pacientes del grupo con HAE. Resultados. TL y TT resultaron significativamente más altas en el grupo con HAE (media, DS). TL grupo HAE 5.94 (0.9) pg/mL; TL grupo control 0.44 (0.2) pg/mL; p = 0.002. TT grupo HAE 5.28 (2.4) nmol/L; TT grupo control 3.6 (0.6) nmol/L; p = 0.02. No hubo diferencias significativas en los valores de DHEAs (media, DS) grupo HAE 51.13 (23.7) µg/dL; grupo control 70.0 (13.5) µg/dL. La edad gestacional al momento del estudio en el grupo HAE fue de 37 semanas + 2 días (28 + 0 -40+1) y en el grupo control de 37 semanas +1 día (28+0 - 41+6). No hubo diferencia en la edad gestacional al nacimiento. El grupo con HAE presentó un mayor número de cesáreas por indicación fetal (grupo HAE n = 10; grupo control n = 2; p = 0.05), menor peso al nacimiento (grupo HAE 2549 g [800-3400 g]; grupo control 3242 g [2400-4200 g]; p = 0.02) y mayor número de ingresos a la unidad de cuidados intensivos neonatales (grupo HAE n = 3; grupo control n = 0). Conclusiones. En embarazadas con HAE, TL y TT están elevadas, pudiendo contribuir en las manifestaciones clínicas y en el peor resultado perinatal que tienen estas pacientes.

Glycemia in newborns of hypertensive mothers according to maternal treatment

OBJETIVO: Avaliar o comportamento da glicemia em recém-nascidos (RN) de mães hipertensas conforme o tratamento materno. MÉTODOS: Estudo prospectivo, randomizado, incluindo 93 RN de mães tratadas com isradipina(n=39), atenolol (n=40) ou dieta - controle (n=14). Determinou-se a glicemia ao nascimento (mãe e RN, pela glicose oxidase) e na 1ª., 3ª., 6ª., 12ª. e 24ª. horas (RN, por fita reagente). A evolução da glicemia, em cada grupo, foi analisada (Teste de Friedman). Os grupos foram comparados, quanto às glicemias, em cada momento (Teste de Kruskall-Wallis) e foram ajustados modelos de regressão linear para as glicemias (variável independente = glicemia materna; variáveis dependentes = glicemias de cordão, 3ª. e 6ª. horas). RESULTADOS: Não houve diferença estatisticamente significante entre as glicemias médias dos 3 grupos, em qualquer uma das coletas. Houve correlação entre as glicemias materna e de cordão umbilical nos grupos isradipina (r =0,61; p<0,05) e controle (r =0,84; p<0,05); entre as glicemias materna e 3ª. e 6ª. horas, houve apenas no grupo controle (materna X 3ª.hora: r = 0,65; p<0,05; materna X 6a.hora: r =0,68; p<0,05). Não houve correlação em nenhum momento no grupo atenolol. Detectou-se hipoglicemia em 51,3% (Isradipina), 60% (Atenolol) e 35,7% (Controle), mais freqüentemente na 1ª. hora de vida, em todos os grupos. CONCLUSÕES: Os resultados sugerem efeito semelhante dos 3 tipos de terapêutica sobre a glicemia do RN. As análises de correlação sugerem que a isradipina possa ter efeitos sobre a glicemia somente após o nascimento (correlação apenas em cordão umbilical), enquanto o atenolol, possa atuar mais precocemente (não se correlacionou em nenhum momento). Também reforçam a necessidade de controle glicêmico desde a 1ª. hora de vida em RN de mães hipertensas, submetidas ou não a tratamento medicamentoso.

Revisão sobre alterações hemostáticas na doença hipertensiva específica da gravidez (DHEG) / Hemostatic changes revision in preeclampsia

A doença hipertensiva específica da gravidez (DHEG), na sua forma pura, caracteriza-se pelo aparecimento, em grávida normotensa, após a vigésima semana de gestação, da tríade sintomática: hipertensão, proteinúria e edema. Nessa doença, não ocorrem as alterações hemodinâmicas observadas na gravidez normal, que incluem ajustes na fisiologia renal e cardiovascular. A manifestação mais característica da DHEG é uma vasoconstrição arteriolar acentuada, que acarreta um aumento da resistência vascular periférica e tem como conseqüência imediata o aparecimento da hipertensão. Evidências de aumento do consumo plaquetário e de disfunção das células endoteliais têm sido observadas na DHEG. Conclusões conflitantes com relação ao sistema fibrinolítico foram obtidas, onde um aumento, diminuição ou inalteração da função desse sistema em gestantes com DHEG, comparando-se à gestantes normais, foram relatados. Considerando-se que o diagnóstico da DHEG é essencialmente clínico e, muitas vezes, difícil de ser estabelecido, inúmeros têm sido os esforços para se determinar parâmetros hemostáticos que tenham um valor preditivo no diagnóstico e prognóstico da doença. Nesse sentido, a contagem de plaquetas, a determinação da trombomodulina, do complexo trombina-antitrombina III e do inibidor do ativador do plasminogênio tipo 2 foram propostas como parâmetros auxiliares para o diagnóstico da doença. No entanto há ainda muita controvérsia quanto à utilidade desses possíveis marcadores laboratoriais, e nenhum deles é plenamente aceito. Recentemente, foi sugerida uma associação entre a ocorrência de complicações da gravidez, incluindo-se a DHEG, e a presença de mutações genéticas que favorecem a manifestação de eventos tromboembólicos. Dessa forma, foi proposta a avaliação hemostática das gestantes que manifestaram a DHEG, mesmo sem história de episódio tromboembólico anterior, através da determinação de marcadores de tromboembolismo, como um parâmetro para o planejamento de futuras gestações, uma vez que a recorrência da DHEG é da ordem de 20 por cento

Utilidad del fragmento 1 + 2 de protrombina y del dímero de fibrina en la detección de hipercoagulabilidad en pacientes obstétricos con factores de riesgo de trombosis / Usefulness of 1 + 2 prothrombin fragment and of dimer of fibrin in detecting hyporcoagulability in obstetricial patients with thrombosis risk

La cuantificación del fragmento 1+2 de protrombina se hizo por método inmunoenzimático en 75 mujeres (55 embarazas y 20 post-cesárea) y el dímero D por determinación semicuantitativa mediante aglutinación en placa en 97 casos (77 embarazadas y 20 post-cesárea). El fragmento 1+2 se encontró significativamente elevado en el 85 por ciento de los casos, sin embargo no mostró tener utilidad predictiva de enfermedad tromboembólica. La cuantificación del dímero D no fue detectada en 40 casos, en 33 fluctuó entre 500 y 1000 ng/ml y en los 24 restantes fue superior a los 2000 ng/ml. Valores mayores a 1000 ng/ml fueron observados en el 78 por ciento de las que tenían antecedentes de enfermedad tromboembólica, en las de cesárea 60 por ciento, en el 37 por ciento de las hipertensas y en 23 por ciento de las diabéticas. El dímero D que en el 59 por ciento de las embarazadas y puérperas registró valores superiores a 500 ng/ml tiene valor predictivo, ya que en 24 casos que cursaban con más de 2000 ng/ml, el 25 por ciento presentaron ETE y/o anormalidades de la coagulación sugestivos de actividad trombótica. Estos hallazgos no fueron observados en la 73 mujeres evaluadas que tuvieron dD negativo o < de 1000 ng/ml

Correlation of elevated levels of maternal serum beta-hCG in pregnancy induced hypertension and pregnancy outcomes in these patients.

This prospective randomized controlled study was conducted on 105 cases of pregnancy hypertension and 100 normotensive mothers in third trimester of pregnancy. The aim of the study was to determine the association between the elevated levels of maternal serum beta-hCG (MS-beta-hCG) with type and severity of hypertension and adverse pregnancy outcomes in these patients. Elevated levels were noted in 48.6% cases of pregnancy hypertension compared to controls, where the levels were elevated in 2% cases (P < 0.001). Elevated levels were more commonly seen in proteinuric pregnancy induced hypertension (32.4%) and also when the hypertension was severe (30.4%). The results of this study establish a strong association of elevated MS-beta-hCG levels with pregnancy hypertension and poor pregnancy outcomes in these patients.

Variación de niveles de ácido úrico en los trastornos hipertensivos del embarazo / Uric acid in pregnancy hypertension

El objetivo fue analizar las variaciones del ácido úrico en los trastornos hipertensivos del embarazo. Se estudiaron 137 pacientes internadas en el Hospital "Luis Castelazo Ayala" a consecuencia de algún trastorno hipertensivo de embarazo. Las pacientes fueron clasificadas de acuerdo al Colegio Americano de Ginecología y Obstetricia. Se midieron los niveles séricos de ácido úrico al momento del diagnóstico y se comparó entre cada grupo y un grupo testigo. Los niveles séricos de ácido úrico, en culaquier estado hipertensivo del embarazo, fueron mayores que en el grupo testigo. En las pacientes con hipertensión crónica con preeclampsia-eclampsia sobreagregada. La característica común de los mecanismos propuestos para la hiperuricemia es una disminución de la perfusión renal. El ácido úrico se correlaciona con la severidad de la preeclampsia-eclampsia. Resulta ser un indicador bioquímico útil en los trastornos hipertensivos del embarazo

Hyperuricemia and pregnancy induced hypertension--reappraisal.

Serum uric acid estimation was done in forty primigravidae with pregnancy induced hypertension and twenty normotensive primigravida in the third trimester of pregnancy, at delivery and six weeks postpartum. The mean serum uric acid levels in normotensive women in the antenatal period and at delivery were 4.65 +/- 0.33 and 4.88 +/- 0.23 mg% and in mild PIH were 5.42 +/- 0.55, 6.14 +/- 0.76 mg%, respectively. Level of serum uric acid in mild PIH was significantly higher than normotensive women (P). In severe PIH, the mean serum uric acid levels were 6.65 +/- 0.60, 8.24 +/- 1.09 mg% in antepartum and at delivery respectively which was significantly more than control group and mild PIH group women (P). However, no differences was observed, in the serum uric levels between these groups during the postpartum period. Serum uric acid level of 5.5 mg or more was observed to be an indicator of PIH. Levels of serum uric acid did show a high positive correlation with the severity of PIH in relation to hypertension and proteinuria. Hyper uricemia (more than 5.5 mg% is associated with increased perinatal morbidity and mortality.

Hipertension inducida por el embarazo analisis de 185 casos / Hypertension induced by pregnancy, analysis of 185 cases

Se analizaron 3.369 historias clinicas de embarazadas que acuden a tener su parto en el hospital San Gabriel de la ciudad de La Paz, se encontro que el 5.49 por ciento (185) casos cursan con HIE preeclampsia leve 46 por ciento, preeclampsia severa 47 por ciento, eclampsismo 4 por ciento y eclampsia 3 por ciento. No hubo mortalidad materna, se aplico el tratamiento en base a sulfato de magnesio, nifedipino o alfa metil dopa y diazepan. La mortalidad perinatal fue de 11 casos que corresponde al 6 por ciento. Se confirma que la HIE se presenta en mujeres primigestas nuliparas, la cobertura de prenatal es de un 70 por ciento, la internacion es tardia en un 18 por ciento, la prematurez es 7.2 por ciento, el apgar de nacimiento es de 6 o mas en el 72 por ciento al minuto y 92 por ciento a los 5 minutos. El 100 por ciento de las eclampticas terminaron en cesarea, la frecuencia de estaoperacion fue en el 16 por ciento. Por los datos encontrados la edad, paridad, estado civil, grado de instruccion no tuvieron relevancia a excepcion de la paridad que fue un factor importante la primigestacion en el 58 por ciento, por lo que se concluye que el control prenatal de amplia cobertura, precoz y de calidad se constituye en la mejor estrategia para disminuir la morbimortalidad materna y perinatal por esta causa

Immunoglobulin G and complement C3 levels in pregnancy induced hypertension.

The immunoglobulin G (IgG) and complement C3 (C3) were measured in the maternal as well cord blood sera of 30 cases of pregnancy induced hypertension (PIH) as well as 9 controls with normotensive pregnancy. A depression of IgG as well as C3 level was observed in the maternal as well as cord sera of the mothers with PIH. These findings suggest decreased immunological status of both mother and her offspring in PIH, irrespective of the gestation and intrauterine growth status.

Hyperuricaemia and perinatal outcome in pregnancy induced hypertension.

The effect of hyperuricaemia on perinatal outcome was evaluated in 40 primigravidae with pregnancy induced hypertension and 20 normotensive women in the 3rd trimester of pregnancy. Serum uric acid level was a better indicator than blood pressure as an index of foetal prognosis. Even severe hypertension without hyperuricaemia was associated with better prognosis for the foetus. Conversely when hypertension was mild and hyperuricaemia was severe, the prognosis for the foetus was poor. A rise in serum uric acid level > or = 5.5 mg% is associated with increased perinatal morbidity and mortality. Women in pregnancy induced hypertension group with serum uric acid level > or = 5.5 mg% had a higher incidence of intra-uterine growth retardation, low birthweight, and stillbirth making perinatal mortality rate of 200/1000 total births. The results of this study indicate that serum uric acid level > or = 5.5 mg% can reflect the perinatal outcome.

Can increased platelet turnover predict progressive hypertensive disease in pregnancy?

Platelet activation was assessed in third trimester patients with preeclampsia [n = 12] or chronic hypertensive superimposed with preeclampsia [n = 8] and in healthy pregnant women [n = 8] as control group, by measuring plasma B-thromboglobulin [BTG] in both plasma and urine by [RIA]. The plasma BTG levels differed significantly between patient with preeclampsia [50.1 +/- 10.83 ng/ml. P < 0.01] or chronic hypertension superimposed with preeclampsia [47.6 +/- 11.3 P < 0.01] and the control group [22.5 +/- 4.53 ng/m]. The urinary BTG level increased significantly in preeclamptic patients [33.02 +/- 5.25 ng/ml, P < 0.001] or in chronic hypertensive patients superimposed with preeclampsia [30.1 +/- 4.1 ng/ml, P < 0.001], when compared to control [8.7 +/- 2.48 ng/m]. Plasma BTG in patients with preeclampsia, but not chronic hypertension superimposed with preeclampsia, correlated directly with 24 hours urinary protein loss [r = 0.93, P < 0.01] and serum creatinine levels [r = 0.62, P < 0.05] and inversely with creatinine clearance [r 0.60, P < = 0.05]. This finding may reflect the renal] involvement in preeclamptic patients, the turnover of platelets may be increased which lead to increased BTG, levels in both plasma and urine and the more increase in BTG, level the more sever of kidney involvement

Creatine phosphokinase [C.P.K.] enzyme level in normal pregnancy induced hypertension [P.I.H.]

80 women were studied for serum creatine phosphokinase [C.P.K.]. These include 10 control, 24 normal pregnant women, 30 patients with mild P.I.H. and 16 with severe P.I.H. The study showed a significant change in normal pregnancy. Also there is a definite increase in serum level of C.P.K. in cases of P.I.H. The explanation and clinical significance of these findings are discussed

Radial immuno diffusion estimation of maternal serum alpha feto-protein in normal pregnancy and pregnancy-induced hypertension.

Maternal Serum Alphafeto Protein (AFP) levels were measured in maternal serum of normal pregnancy & pregnancy induced hypertension (PIH) by using M-partigen immuno diffusion plates. A total of 80 cases (30 normal pregnancy and 50 of PIH) were taken for study. AFP levels were significantly lower in pre-eclamptic and eclamptic pregnancies as compared to normal pregnancy. Strong positive correlation between gestational age and maternal AFP levels was observed in normal pregnancy. While in PIH no significant positive or negative relationship was found. Observations suggest that estimation of maternal serum AFP may help in early detection of PIH.