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)

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)

Retinal changes among pre-eclamptic patients in University of Benin Teaching Hospital, Benin, Nigeria

Background: Preeclampsia is one of the hypertensive disorders in pregnancy that contributes significantly to maternal and fetal morbidity and mortality, with the impact felt more in developing countries. It is characterized by endothelial dysfunction and vasospasm of vessels which can be observed by an ocular fundal examination. The aim of this study was to determine the ocular fundus findings of women with preeclampsia. Methods: This was a cross-sectional study, carried out at the University of Benin Teaching Hospital involving a total of 220 pregnant women. The women were divided into two groups of 110 pregnant women (A&B).Their Age and Gestational age was cross-matched and retinopathy graded according to Keith and Wagner classification. Group A was made up of Preeclamptic women and Group B was made up of healthy pregnant women. Visual acuity was measured using Snellens' chart, and the fundus was examined with direct ophthalmoscope. Results: This showed that the retinal changes observed in the preeclamptic women were associated with their age (P = 0.009), gestational age (P = 0.044), blood pressure (P = 0.001), Proteinuria (P = 0.001), Severity of the disease (P = 0.001), visual acuity (P = 0.035) as well as with the visual symptoms (P = 0.001) but not statistically significant with the gravida (P = 0.799). Conclusion: Our study highlights the importance of timely ophthalmoscopy which helps to assess severity of disease (pre-eclampsia) which affects the decision of induction of delivery to predict and prevent possible complications which in turn immensely helps in judicious management of disease. Also, the study revealed that preeclamptic women who are multigravida are more likely to have retinopathy than primigravid

An Evaluation of Risk Factors Associated with Pregnancy Related Acute Kidney Injury in Women Admitted to the High Dependency Care Unit at Women and Newborn Hospital, Lusaka-Zambia

Objective:To evaluate factors associated with Pregnancy-related KidneyInjury(PRAKI) inwomen admitted to high dependency care unit at Women and Newborn Hospital in Lusaka, ZambiaMethodology:This was an unmatched case-control study conducted in the high-dependency care unit at Women and Newborn Hospital in Lusaka. Study participantswererecruitedconsecutivelybyconveniencesampling.Participants'medicalrecords were reviewed to capture serum creatinine levels;whileastructuredquestionnairewasadministeredto eligible andconsentedstudy participants to capture data on sociodemographic, obstetric, and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaningandStatav13usedforanalysis.Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was usedand p value of<0.05 was consideredsignificant.Results:Thestudy comprised of185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3%of the study participants wereinmarriagerelationships.Pre-existinghypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle celldisease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most common condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetricfactorssuch as eclampsia (AOR = 5.12, 95% CI [2.14 ­ 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 ­ 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI.

Tratamiento de la eclampsia y miastenia gravis: reporte de un caso y revisión de la literatura / Eclampsia treatment and myasthenia gravis: case report and review of literature

OBJETIVO: Reportar el caso de una gestante con miastenia grave (MG) más preeclampsia-eclampsia y crisis miasténica en el puerperio mediato, y realizar una revisión de la literatura sobre el manejo farmacológico. MÉTODO: Se presenta el caso de una mujer de 26 años con MG, primigesta de 36 semanas de gestación, quien cursó con eclampsia y recibió fenitoína por 24 horas. Tuvo parto espontáneo sin complicaciones y crisis miasténica al día 11 del puerperio asociada a infección de vías urinarias y sepsis. Se realiza revisión de la literatura en PubMed, Cochrane, Embase, LILACS y Scopus, empleando los términos "Hypertension, Pregnancy-Induced", "Preeclampsia" y "Eclampsia", combinados con "Myasthenia Gravis", durante el periodo de publicación de 1960 a junio 2020, en inglés y español. RESULTADOS: Se encontraron 12 reportes de caso, dos con eclampsia y MG; el caso aquí reportado es el número 13. Ocho pacientes no recibieron medicamentos profilácticos de eclampsia y tres de ellas convulsionaron. En las que se usó sulfato de magnesio, todas cursaron con crisis miasténica. CONCLUSIONES: La evidencia actual en cuanto a la profilaxis y el tratamiento de la eclampsia y la MG corresponde a reportes de casos. El uso de sulfato de magnesio está contraindicado en pacientes con MG, por lo que se han utilizado fenitoína y levetiracetam.

OBJECTIVE: To report a case of pregnant women with myasthenia gravis (MG), plus preeclampsia-eclampsia and myasthenic crisis in the mediate puerperium; to conduct a literature review regarding its pharmacological management. METHOD: 26-year-old primigravida with 36 weeks of gestation and previous history of MG, who developed eclampsia and was treated with phenytoin for 24 hours, with later spontaneous delivery without any complications nor new seizures; and myasthenic crisis on day 11 of the puerperium associated with urinary tract infection and sepsis. A literature review was conducted in PubMed, Cochrane, Embase, LILACS and Scopus, using the controlled vocabulary "Hypertension, Pregnancy-Induced", "Preeclampsia" and "Eclampsia", combined with "Myasthenia Gravis", between 1960 and June 2020, in English and Spanish. RESULTS: 12 case reports were found, two of these with eclampsia and MG, the case reported here was number 13. In eight cases patients did not receive any prophylactic drugs for eclampsia and three of them had convulsions. In the cases where magnesium sulfate was used, all developed myasthenic crisis. CONCLUSIONS: The current evidence regarding prophylactic management and treatment corresponds to case reports. The use of magnesium sulfate is contraindicated in patients with MG, therefore phenytoin and levetiracetam have been used.

Patología hipertensiva durante el embarazo y el producto de la concepción / Hypertensive pathology during pregnancy and the product of conception

El Hospital Nacional Dr. Mario Catarino Rivas (hospital de segundo nivel de atención), sirve como centro de atención para embarazos de alto riesgo de la zona noroccidental de Honduras; reportó 1,702 casos de trastor-nos hipertensivos del embarazo en 2017 y 2,070 casos en 2018. Se caracterizó pacientes con signos y síntomas de trastornos hipertensivos del embarazo agrupadas desde un punto de vista obstétrico, epidemiológico y clínico. Se realizó un estudio, descriptivo de corte transversal en gestantes que presentaron cefalea, cifras tensionales elevadas (≥ 140/90mmHg); registrando ausencia o presencia de proteinuria, atendidas en la emergencia de labor y parto de un hospital nacional de segundo nivel de atención en San Pedro Sula, Honduras, desde junio hasta octubre del 2019. Se incluyeron 110 pacientes de entre 18-43 años, mestizas y amas de casa, la edad gestacional promedio por fecha de ultima menstruación de 37.7 semanas; el 28.2% presentó preeclampsia severa. Las manifestaciones clínicas frecuentes fueron edema de miembros inferiores y cefalea. El 57.3% desarrolló trabajo de parto espontá-neo, la resolución del embarazo fue cesárea en el 57.3% de las gestantes. Respecto al producto de la concepción, 66.4% tenían peso normal y talla apropiada para la edad gestacional, un APGAR de 8 al primer minuto y de 9 a los 5 minutos. En este estudio, se reporta una prevalencia del 13.72% con respecto a los trastornos hipertensivos del embarazo. Particularmente en pacientes mayores de 35 años, multípara, con índice de masa corporal ≥ 32 kg/m2, presentando antecedentes de hipertensión arterial, diabetes mellitus y preeclampsia.

The National Hospital Dr. Mario Catarino Rivas (second-level care hospital), serves as a care center for high-risk pregnancies in the northwestern part of Honduras; it reported 1,702 cases of hypertensive disorders of pregnancy in 2017 and 2,070 cases in 2018. Patients with signs and symptoms of hypertensive disorders of preg-nancy were characterized grouped from an obstetric, epidemiological and clinical point of view. A descriptive cross-sectional study was carried out in pregnant women who presented headache, high blood pressure (≥ 140 / 90mmHg); registering the absence or presence of proteinuria in urine, attended in the labor and delivery emer-gency of a national hospital of second level of care in San Pedro Sula, Honduras; from June to October 2019. 110 patients between 18-43 years old, mixed race and housewives were included, the average gestational age by date of last menstruation of 37.7 weeks, 28.2% presented severe preeclampsia. The frequent clinical manifestations were lower limb edema and headache. 57.3% developed spontaneous labor, the pregnancy termination route was cesarean section in 57.3% of pregnant women. Regarding the product of conception, 69.1% had weight and height appropriate for gestational age, an APGAR of 8 at the first minute and of 9 at 5 minutes. In this study, a prevalence of 13.72% is reported with respect to hypertensive disorders of pregnancy. Particularly in patients older than 35 years, multiparous, with a body mass index ≥ 32 kg / m2, presenting a history of arterial hypertension, diabetes mellitus and pre-eclampsia.

Sulfato de magnésio: principais utilizações na obstetrícia contemporânea / Magnesium sulphate: main uses in contemporary obstetrics

O sulfato de magnésio tem sido utilizado em obstetrícia por décadas e milhares de mulheres já foram incluídas em ensaios clínicos que estudaram sua eficácia em uma variedade de condições gestacionais. Os principais usos do medicamento na atual prática obstétrica incluem prevenção e tratamento de convulsões eclâmpticas, prolongamento da gravidez para administração antenatal de corticosteroides e neuroproteção fetal na iminência de interrupção prematura da gravidez. Em função da alta qualidade e da consistência dos resultados de importantes ensaios clínicos, a indicação do sulfato de magnésio para profilaxia e terapia das convulsões eclâmpticas está bem estabelecida. Entretanto, tal unanimidade não ocorre com relação ao seu emprego como tocolítico, tanto pela discussão sobre sua efetividade quanto pelas doses mais altas usualmente utilizadas para esse fim. Em relação à importância do sulfato de magnésio como agente neuroprotetor fetal, a paralisia cerebral é a causa mais comum de deficiência motora na infância e tem como fator de risco mais importante a prematuridade, cuja incidência tem aumentado significativamente. Diretrizes nacionais e internacionais mais recentes, baseadas em resultados de ensaios clínicos randomizados e metanálises de boa qualidade, mostraram que a administração antenatal de sulfato de magnésio na iminência de parto pré-termo precoce é uma intervenção eficiente, viável, segura, com boa relação custo-benefício e pode contribuir para a melhoria dos desfechos neurológicos neonatais.

Magnesium sulfate has been used in obstetrics for decades and thousands of women have already been included in clinical trials that have studied its effectiveness in a variety of gestational conditions. The main uses of the drug in current obstetrical practice include prevention and treatment of eclamptic seizures, prolongation of pregnancy for antenatal administration of corticosteroids, and fetal neuroprotection in the imminence of premature termination of pregnancy. Because of the high quality and consistency of the results of important clinical trials, the indication of magnesium sulfate for prophylaxis and therapy of eclamptic seizures is well established. However, such unanimity does not occur regarding its use as tocolytic, either by the discussion of its effectiveness or by the higher doses usually used for this purpose. Regarding the importance of magnesium sulfate as a fetal neuroprotective agent, cerebral palsy is the most common cause of motor deficits in childhood and has a significantly higher incidence of prematurity as a major risk factor. More recent national and international guidelines, based on results from randomized controlled trials and good quality meta-analyzes, have shown that the antenatal administration of magnesium sulfate at the imminence of early preterm delivery is a cost-effective, viable, efficient intervention and safe and can contribute to the improvement of neonatal neurological outcomes.

Perfil epidemiológico de gestantes de alto risco / Epidemiological profile of high risk pregnant women

Introdução: Mundialmente, a saúde materna e neonatal tem sido motivo de preocupação e estudos, e no Brasil é considerada prioridade .Objetivo: traçar o perfil de gestantes de alto risco, segundo variáveis demográficas, socioeconômicas, histórico de saúde e assistência prénatal. Método: transversal, observacional, descritivo, no período de janeiro a julho de 2017 com 314 gestantes de alto risco, dados coletados por meio de questionário estruturado e analisados por frequência absoluta e relativa. O estudo foi aprovado pelo Comitê de Ética em Pesquisa Envolvendo Seres Humanos da Unicentro. Resultados: 66,9% tinham de 20 a 34 anos; 48,4% eram brancas; 89,2% possuiam companheiro; 47,1% tinham escolaridade entre 5 e 9 anos; 54,5% eram desempregadas/do lar; 42% possuiam renda de 2 salários mínimos; 46,2% portavam doenças crônicas não transmissíveis; 56,1% referam rara procura pelos serviços de saúde; 28% eram primigestas; 33,4% tiveram reincidência de alto risco; 48,4% não realizava planejamento familiar; 58,8% referiram gestações não planejadas; 36,7% tinham índice de massa corporal gestacional de obesidade; 19,3% tiveram Pré eclâmpsia; 78% não tinham acompanhamento da atenção primária; 76,1% não participaram de educação em saúde. Conclusão: o perfil revela que população feminina necessita de ações não somente no período gestacional, mas de promoção à saúde da mulher.

Introduction: Worldwide, maternal and neonatal health has been a cause for concern and research and in Brazil it is considered a priority. Objective: to profile high-risk pregnant women considering demographic, socioeconomic, health history and prenatal care variables. Method: cross-sectional, observational, descriptive study, from January to July 2017 with 314 high-risk pregnant women, data collected through structured questionnaire and analyzed for absolute and relative frequency. The study was approved by the Research Ethics Committee Involving Humans. Results: 20 to 34 years (66.9%); white (48.4%); with partner (89.2%); education between 5 and 9 years old (47.1%); unemployed/ housewife (54.5%); income of 2 minimum wages (42%); with chronic noncommunicable diseases (46.2%); rare demand for health services (56.1%); first-born (28%); high risk recurrence (33.4%); without family planning (48.4%) unplanned pregnancies (58.8%); gestational body mass index of obesity (36.7%); pregnancy-specific hypertensive disease (19.3%); unaccompanied by primary care (78%); did not participate in health education (76.1%). Conclusion: the profile reveals that the female population needs actions not only during pregnancy, but also to promote women's health.

Acceptability and adoption of clinical practice guidelines and treatment protocols on preeclampsia/eclampsia in the Dominican Republic / Aceptabilidad y adopción de guías de práctica clínica y protocolos de atención sobre preeclampsia-eclampsia en la República Dominicana / Aceitabilidade e adoção de diretrizes de prática clínica e protocolos de atenção para pré-eclâmpsia e eclâmpsia na República Dominicana

ABSTRACT Objective. Estimate the acceptability and adoption by health care workers of clinical practice guidelines and treatment protocols for women with preeclampsia/eclampsia and identify the facilitating factors and barriers to their implementation. Methods. A qualitative study was conducted, using semi-structured interviews and focus groups in five maternity hospitals. Interviews were compiled for analysis, and barriers and facilitators were characterized. Results. Seventy health professionals (52 female and 18 male) participated, representing different levels of the health system. The majority of workers and managers were aware of the existence and content of clinical practice guidelines (CPGs) for preeclampsia/eclampsia, especially the participants with more time in the health service. With respect to facilitating factors, both medical and nursing staff were positive about continued development and implementation of high-quality CPGs. There was consensus that limitations exist, especially with respect to a lack of the necessary medicines, supplies, and equipment to meet and implement the established recommendations. Discussion. The results of the study show the need to strengthen strategies that help close the gap between research and public policy. Studies suggest that research should focus on users, policymakers, and decisionmakers in the health system. The actors in the Dominican health system recognize the GRADE methodology as an appropriate instrument for the development and implementation of CPGs. Implementation barriers require systemic and comprehensive approaches.

RESUMEN Objetivo. Estimar la aceptabilidad y adopción de las guías de prática clínica (GPC) y protocolos de atención a la mujer con preeclampsia-eclampsia por parte del personal prestador de los servicios de salud, e identificar los factores facilitadores y las barreras para su implementación. Métodos. Se desarrolló un estudio cualitativo por medio de entrevistas semiestructuradas y grupos focales en cinco maternidades. Se recopilaron las entrevistas para su análisis y se caracterizaron las barreras y facilitadores. Resultados. Participaron 70 profesionales de la salud (52 de sexo femenino y 18 de sexo masculino) que se desempeñan en distintos niveles del sistema de salud, participaron. La mayoría de los prestadores y gerentes conocen la existencia de las GPC de eclampsia-preeclampsia y su contenido, sobre todo los participantes con más tiempo en el servicio. Para los facilitadores, se estableció una valoración positiva entre el personal médico y de enfermería ante el proceso de continuar con la elaboración e implementación de GPC de alta calidad. Hubo consenso en cuanto a la existencia de limitaciones, sobre todo, por la falta de medicamentos, insumos y equipos requeridos, para cumplir y aplicar las recomendaciones formuladas. Discusión. Los resultados del estudio exponen la necesidad de fortalecer estrategias que ayuden a cerrar la brecha entre la investigación y la política pública. Estudios fundamentan la investigación en priorizar la atención a los usuarios, y los encargados de formular políticas y los tomadores de decisiones en el sistema de salud. Los actores del sistema de salud dominicano reconocen la metodología GRADE como un instrumento apropiado para la formulación e implementación de GPC. Las barreras de implementación requieren de abordajes sistémicos e integrales.

RESUMO Objetivo. Estimar a aceitabilidade e a adoção de diretrizes de prática clínica (DPCs) e protocolos de atenção para mulheres com pré-eclâmpsia e eclâmpsia por profissionais da saúde e identificar os fatores facilitadores e barreiras à sua implementação. Métodos. Desenvolvemos um estudo qualitativo baseado em entrevistas semiestruturadas e grupos focais em cinco maternidades. As entrevistas foram coletadas para análise, sendo caracterizadas as barreiras e fatores facilitadores. Resultados. O estudo contou com a participação de 70 profissionais da saúde (52 mulheres e 18 homens) que trabalham em diferentes níveis do sistema de saúde. Em sua maioria, os profissionais e administradores estão cientes da existência de DPCs para pré-eclâmpsia e eclâmpsia e conhecem seu conteúdo, especialmente os que têm mais tempo de experiência. Em relação aos fatores facilitadores, os profissionais médicos e de enfermagem consideraram positivo o processo de elaboração e implementação de DPCs de alta qualidade. Houve consenso sobre a existência de limitações, especialmente no que diz respeito à falta de medicamentos, insumos e equipamentos necessários para cumprir e implementar as recomendações. Discussão. Os resultados do estudo deixam clara a necessidade de reforçar as estratégias que ajudam a estabelecer vínculos entre a pesquisa e as políticas públicas. A pesquisa futura deve priorizar a atenção aos usuários e o apoio aos decisores e responsáveis pela elaboração de políticas no sistema de saúde. Os atores do sistema de saúde dominicano reconhecem a metodologia GRADE como um instrumento apropriado para a formulação e implementação de DPCs. As barreiras à implementação exigem abordagens sistêmicas e abrangentes.

Atuação do enfermeiro a pacientes portadoras de síndrome hipertensiva específica da gestação / Nursing's action against patients with specific hypertensive management syndrome

Objetivo: Identificar a importância da assistência de enfermagem às gestantes com Síndrome Hipertensiva Gestacional. Método: Estudo bibliográfico, descritivo e exploratório, realizado busca no banco de dados da Biblioteca Virtual em Saúde (BVS), Sistema Latino-Americano e do Caribe de Informações em Ciências da Saúde (LILACS), Scientific Eletrônic Library Online (SCIELO) e Bancos de dados em enfermagem (BDENF). Resultados: A Síndrome Hipertensiva da Gravidez (SHEG) apresenta como uma das mais importantes complicações durante o ciclo gravídicopuerperal e a sua etiologia ainda permanece desconhecida. A pré-eclâmpsia evolui naturalmente e quando não tratada/interrompida a gestação, ocorre o desenvolvimento para as formas mais graves, especialmente, a eclampsia e a síndrome HELLP. É de grande importância que o profissional de enfermagem atue de forma mais efetiva e presente, para que as reais necessidades das pacientes sejam supridas, havendo melhora do quadro clínico e eventuais complicações sejam evitadas. Conclusões: A assistência efetiva durante o pré-natal, pelos profissionais, diminui os índices de SHEG em gestantes e as tiram do grupo de risco, principalmente as que possuem fatores predisponentes e etiológicos. Assim, é possível descrever a atuação do enfermeiro frente à patologia, observando a necessidade de um trabalho conjunto à uma equipe multidisciplinar para que ocorra um atendimento eficaz à gestante (AU)

This study aimed to identify and characterize the importance of nursing care for pregnant women with Gestational Hypertensive Syndrome. Method: Bibliographic,descriptive and exploratory study, searches the database of the Virtual Health Library (VHL), Latin American and Caribbean Health Sciences Information System (LILACS), Scientific Electronic Library Online (SCIELO) and Banks. of Nursing Data (BDENF). Results: Hypertensive Pregnancy Syndrome (SHEG) is one of the most important complications during the pregnancy-puerperal cycle and its etiology is still unknown. Preeclampsia evolves naturally and when untreated / interrupted pregnancy develops into the most severe forms, especially eclampsia and HELLP syndrome. It is of great importance that the nursing professional acts more effectively and present, so that the real needs of patients are met, with improvement of the clinical picture and eventual complications are avoided. Conclusions: The effective prenatal care by professionals reduces the rates of SHEG in pregnant women and remove them from the risk group, especially those with predisposing and etiological factors. Thus, it is possible to describe the role of nurses in the pathology, noting the need for a joint work with a multidisciplinary team for effective care to pregnant women (AU)

Gestantes con índice de pulsatilidad alterado en ecografía Doppler / Pregnant women with altered pulsatility index in Doppler echography

Introducción: La ecografía Doppler de las arterias uterinas es una técnica propuesta para predecir el riesgo de preeclampsia, retardo del crecimiento intrauterino y otras alteraciones perinatales adversas. Objetivos: Determinar la frecuencia de gestantes con alteración en las arterias uterinas durante el primer trimestre e identificar la presencia de preeclampsia/eclampsia, así como sus principales características clínicas. Métodos: Se efectuó un estudio descriptivo y longitudinal de 168 gestantes en el primer trimestre de embarazo, pertenecientes al municipio de Tercer Frente en Santiago de Cuba, evaluadas en una pesquisa de Genética realizada en el Policlínico Docente Cruce de los Baños, de abril a noviembre de 2018. A todas se les realizó ecografía Doppler para calcular el índice de pulsatilidad de las arterias uterinas. Resultados: En la casuística, 16 pacientes presentaron alterado el índice de pulsatilidad y, de ellas, solo en 3 se desarrolló preeclampsia, para 18,7 %; la edad promedio en estas últimas fue de 29 años y 2 eran nulíparas (66,6 %). Respecto al índice de pulsatilidad, el promedio fue de 2,5. Conclusiones: Se mantuvo un estrecho seguimiento, hasta el parto, de las pacientes con resultados patológicos, y se destacó la importancia de estudiar el índice de pulsatilidad de las arterias uterinas durante el primer trimestre del embarazo, sobre todo en las nulíparas.

Introduction: The Doppler echography of the uterine arteries is a technique suggested to predict the risk of pre-eclampsia, the intrauterine growth retardation and other adverse perinatal disorders. Objectives: To determine the frequency of pregnant women with disorder in the uterine arteries during the first trimester and to identify the pre-eclampsia/eclampsia presence, as well as their main clinical characteristics. Methods: A descriptive and longitudinal study of 168 pregnant women in the first trimester of pregnancy, belonging to the Tercer Frente municipality in Santiago de Cuba was carried out, they were evaluated by investigation of Genetics in Cruce de los Baños Teaching Polyclinic from April to November, 2018. To determine the pulsatility index of the uterine arteries, a Doppler echography was carried out. Results: In the case material 16 patients presented this parameter altered and just 3 pregnant women presented pre-eclampsia, for 18.7 %; the average age of these last ones was of 29 years and 2 were nonparous (66.6 %). Regarding the pulsatility index, the average was of 2.5. Conclusions: There was a close follow up of the patients with pathological results, until the childbirth, and the importance of studying the pulsatility index of the uterine arteries in the first trimester of the pregnancy, mainly in the nonparous, was emphasized.

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

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

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

Maternal deaths due to eclampsia in teenagers: lessons from assessment of maternal deaths in South Africa

Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014­2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014­2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia

Medico-social characteristics of patients with eclampsia in a metropolitan hospital in North western Nigeria: is there a changing pattern?

Background: Eclampsia is a recognized cause of maternal and neonatal morbidity and mortality in North western Nigeria. It's a preventable obstetrics calamity were adequate antenatal care services are provided. Objective: To review medico-social characteristics of patients with eclampsia at a metropolitan Specialist Hospital in North-western Nigeria. Methodology: Eighty consecutive patients that presented with eclampsia at Murtala Mohammed Specialist Hospital were recruited for the study from 1st December, 2016 to 28th February, 2017. Data were collected using structured questionnaire, administered by research assistants. Information obtained included sociodemographic data, duration of fits before presentation and maternal-fetal outcome. Results: A total of 1931 patients delivered within the study period, among them 80 had eclampsia. This gives an incidence of 4.0%. Teenage pregnancy accounted for 35%. Forty-nine patients (61.2%) were primigravidae and up to 95% were booked. Majority of the patients 40(50%) had antepartum eclampsia while only 10(12.5%) had postpartum eclampsia. Most of the patients (73.8%) presented within 12 hours of convulsions and (87%) had vaginal delivery. There were 3 maternal deaths with case fatality rate of 3.8%. Live birth was achieved in 65%. Fresh still birth and Macerated still births were recorded in 20% and 12.5% respectively. Conclusion: The incidence of eclampsia is still high despite introduction of free maternity care services. Socio medical factors and poor quality of Antenatal Care services may be the contributing factors to development of eclampsia. There is need to review and improve the quality of antenatal care services offered at the primary health care centers

Preeclampsia - eclampsia diagnóstico y tratamiento / Preeclampsia - eclampsia diagnosis and treatment

La preeclampsia - eclampsia es una de las complicaciones que puede presentarse durante el embarazo parto o puerperio que aumentan la morbimortalidad materno perinatal y neonatal, siendo estas patologías las primeras causas de muerte materna en el país y una de las principales causas de muerte materna a nivel mundial. Se caracteriza por hipertensión asociada a proteinuria, o hipertensión y afectación de órganos blanco con o sin proteinuria en la última mitad del embarazo. Su oportuno diagnóstico y manejo ayudará a disminuir el riesgo de complicaciones que pueden presentarse como convulsiones, accidente cerebrovascular, síndrome de HELLP entre otros. Las acciones que se realicen para su diagnóstico y el manejo adecuado y oportuno pueden influir directamente en el pronóstico futuro de la paciente y de su hijo. En esta revisión se ha seleccionado artículos en idioma inglés o español que fueron los más relevantes sobre este tema

Preeclampsia - eclampsia is one of the complications that can occur during pregnancy, childbirth or puerperium, these ones increase perinatal and neonatal maternal morbidity and mortality, these pathologies being the first causes of maternal death in the country and one of the main causes of maternal death around the world. It is characterized by hypertension associated with proteinuria or hypertension, and involvement of white organs with or without proteinuria in the last half of pregnancy. Its timely diagnosis and management will help reduce the risk of complications that may occur such as seizures, stroke, HELLP syndrome and others. The actions taken for diagnosis and proper and timely management can directly influence the future prognosis of the patient and her child. In this review it has been selected articles in English and Spanish language that were the most relevant on this topic.Keywords: preeclampsia, eclampsia, seizures.

Consideraciones y actualización sobre definición, etiopatogenia y diagnóstico de los desórdenes hipertensivos del embarazo / Considerations and update on definition, pathophysiology and diagnosis of hypertensive disorders of pregnancy

RESUMEN Los desórdenes hipertensivos del embarazo se encuentran dentro de las tres primeras causas de morbimortalidad materna y perinatal a nivel mundial, hasta el año 2016. Diferentes estudios realizados en los últimos 5 años e importantes organizaciones científicas han abordado este tema en el que existen discrepancias en cuanto a su etiopatogenia. Sin embargo, los avances logrados en la misma, la profundización en sus manifestaciones clínicas, los modos de presentación y los elementos diagnósticos han permitido el reconocimiento precoz y la efectividad del tratamiento. Esto ha ocasionado, principalmente en lo referente a los desórdenes hipertensivos tipo I, cambios que afectan desde la definición hasta el tratamiento. De esta manera, el presente documento pone al alcance de la comunidad médica una amplia revisión científica que facilita un mejor diagnóstico de la preeclampsia y de otras formas de hipertensión arterial en la etapa grávido-puerperal. Asimismo, contribuirá a reducir el error diagnóstico y logrará una intervención temprana para la obtención de mejores resultados maternos y perinatales (AU).

SUMMARY Hypertensive disorders of pregnancy are among the first three causes of maternal and perinatal Morbimortality in the world until 2016. Important scientific organizations and several studies carried out in the last five years have approached the theme, but there are still discrepancies with respect to etiopathogeny. Nevertheless, advances in it and deepening in its clinical manifestations, presentation ways and diagnostic elements have allowed its precocious recognition and diagnostic elements, causing changes from its definition up to its treatment, mainly in the case of the hypertensive disorders type I. In the current article, the authors put at reach of the medical community a wide scientific review facilitating a better diagnosis of preeclampsia and other forms of arterial hypertension in the pregnancy-puerperal stage that will contribute to reducing diagnosis error and making an early intervention, leading to better maternal and perinatal results (AU).

Avaliação de aplicativos móveis para promoção da saúde de gestantes com pré-eclâmpsia / Análisis de aplicaciones móviles para la promoción de la salud de mujeres embarazadas con preeclampsia / Evaluation of mobile Apps for health promotion of pregnant women with preeclampsia

Resumo Objetivo Avaliar os aplicativos móveis disponíveis sobre pré-eclâmpsia (PE) nos principais sistemas operacionais para a promoção da saúde de gestantes. Métodos Estudo avaliativo dos aplicativos móveis disponíveis nas plataformas (iOS e Android). Foi realizada uma busca sistemática nas lojas virtuais dos principais sistemas operacionais: Play Store (Android, Google ) e App Store (iOS, Apple ) de abril a junho de 2018, delimitando-se as seguintes etapas: estabelecimento dos objetivos da avaliação e dos critérios de inclusão e exclusão de aplicativos (seleção da amostra), definição das informações a serem extraídas, análise dos resultados, discussão e apresentação da avaliação. Para tanto, foram utilizados dois dispositivos: um Samsung Galaxy S8, compatível com Android e um Iphone 8, compatível com iOS versão 10.2.1. Três buscas foram realizadas em cada loja virtual, utilizando-se individualmente cada uma das seguintes palavras-chaves: Pré-eclâmpsia; eclâmpsia e promoção da saúde de gestantes com pré-eclâmpsia. Resultados 11 aplicativos foram elegíveis para o estudo. Todos estavam presentes no sistema operacional Android e apenas um estava disponível nos dois sistemas operacionais, Android e iOS. Dos 11, seis aplicativos abordavam características da pré-eclâmpsia; apenas um abordava o manejo clínico da PE. A avaliação do aplicativo variou de 14 a 29 pontos em um escore que varia de 6 a 30 pontos. Apenas dois aplicativos possuíam versões em português. Conclusão Foi possível verificar que os aplicativos possuem informações importantes que podem esclarecer eventuais dúvidas que as gestantes possam ter.

Resumen Objetivo Analizar las aplicaciones móviles disponibles en los principales sistemas operativos sobre preeclampsia para la promoción de la salud de mujeres embarazadas. Métodos Estudio evaluativo de las aplicaciones móviles disponibles en las plataformas iOS y Android. Se realizó una búsqueda sistemática en las tiendas virtuales de los principales sistemas operativos: Play Store (Android, Google) y App Store (iOS, Apple) de abril a junio de 2018. Se definieron las siguientes etapas: establecimiento de los objetivos de la evaluación y de los criterios de inclusión o exclusión de aplicaciones (selección de muestra), definición de la información que será extraída, análisis de los resultados, debate y presentación del análisis. Para eso, se utilizaron dos dispositivos: un Samsung Galaxy S8, compatible con Android, y un iPhone 8, compatible con iOS versión 10.2.1. En cada tienda virtual, se realizaron tres búsquedas, mediante la utilización de las siguientes palabras clave de forma individual: preeclampsia, eclampsia y promoción de la salud de mujeres embarazadas con preeclampsia. Resultados 11 aplicaciones fueron elegidas para el estudio. Todas estaban presentes en el sistema operativo Android y solo una estaba disponible en los dos sistemas operativos Android e iOS. De las 11 aplicaciones, 6 abordaban características de la preeclampsia y solo una trataba el manejo clínico de la preeclampsia. La evaluación de la aplicación estuvo en el rango de 14 a 29 puntos, en una escala de 6 a 30 puntos. Solo dos aplicaciones tenían versión en portugués. Conclusión Fue posible verificar que las aplicaciones contienen información importante que puede esclarecer posibles dudas que las mujeres embarazadas puedan tener.

Abstract Objective Evaluate the available mobile applications (Apps) about preeclampsia (PE) in the main operating systems for the health promotion of pregnant women. Methods Evaluative study of available mobile Apps on platforms (iOS and Android). A systematic search was performed in the virtual stores of the main operating systems: Play Store (Android, Google ) and App Store (iOS, Apple ), from April to June 2018, delimiting the following steps: establishment of evaluation objectives and the criteria for inclusion and exclusion of Apps (sample selection), definition of the information to be extracted, analysis of the results, discussion and presentation of the evaluation. For this, two devices were used: a Samsung Galaxy S8, compatible with Android, and an Iphone 8, compatible with iOS version 10.2.1. Three searches were conducted in each virtual store, using each of the following keywords individually: preeclampsia; eclampsia; and, health promotion of pregnant women with preeclampsia. Results 11 Apps were eligible for the study. All were present on the Android operating system; only one was available on both operating systems, Android and iOS. Of the 11, six Apps addressed PE characteristics; only one addressed the clinical management of PE. The scores for evaluation of the Apps ranged from 14 to 29 points, on a scale that ranged from 6 to 30 points. Only two Apps had Portuguese versions. Conclusion It was possible to verify that the Apps have important information that can clarify doubts that pregnant women may have.

Pré-eclâmpsia/eclâmpsia / Pre-Eclampsia/Eclampsia

A pré-eclâmpsia é uma doença multifatorial e multissistêmica específica da gestação. É classicamente diagnosticada pela presença de hipertensão arterial associada à proteinúria em gestante previamente normotensa após a 20a semana de gestação. A pré-eclâmpsia também é considerada na ausência de proteinúria se houver lesão de órgão-alvo. A presente revisão tem uma abordagem geral focada em aspectos de interesse prático na assistência clínica e obstétrica dessas mulheres. Assim, explora a etiologia ainda desconhecida, aspectos atuais da fisiopatologia e do diagnóstico e diagnóstico diferencial de convulsões, a abordagem da predição da doença, seus resultados adversos e prevenção. A conduta baseia-se em princípios gerais, tratamento clínico não farmacológico e farmacológico de situações graves ou não graves, com ênfase na crise hipertensiva e eclâmpsia. O controle obstétrico se fundamenta na pré-eclâmpsia sem ou com sinais de deterioração clínica e/ou laboratorial, estratificação da idade gestacional abaixo de 24 semanas, entre 24 e menos de 34 semanas e 34 ou mais semanas de gestação e orientação na via de parto. Uma abordagem imediata do puerpério e repercussões na vida futura de gestantes que desenvolvem pré-eclâmpsia também foram apresentadas.(AU)

Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age in < 24 weeks, between 24 and less than 34 weeks, and ≥ 34 weeks of gestation, and guidance on route of delivery. An immediate puerperium approach and repercussions in the future life of pregnant women who develop preeclampsia is also presented.(AU)

Preeclampsia y eclampsia en el período gravídico y puerperal en pacientes ingresadas en cuidados intensivos / Preeclampsia and Eclampsia in the Gravid and Puerperal Period in Patients Admitted To Intensive Care

Introducción: La preeclampsia produce proteinuria, edema e hipertensión arterial. La eclampsia aparece luego de la preeclampsia o de forma aguda con convulsiones. Ambos estados suelen producirse hacia el final de la gestación, durante o después del parto. Objetivo: Caracterizar a gestantes o puérperas con preeclampsia-eclampsia, ingresadas en la unidad de cuidados intensivos. Método: Estudio descriptivo, prospectivo y longitudinal, que incluyó 38 pacientes a las que se les realizó examen físico completo, exámenes complementarios de utilidad para su diagnóstico y el índice APACHE II. Resultados: Predominaron las puérperas con preeclampsia y las edades entre 21 a 35 años. Los factores de riesgo más frecuentes encontrados: las edades extremas, antecedentes personales y la nuliparidad. Con una estadía entre 4 y 5 días de ambos grupos, con 100 por ciento de egresos vivos. Conclusiones: Con una estrategia de seguimiento precoz en gestantes y puérperas con riesgo, se puede llegar al diagnóstico de formas graves e incipientes de preeclampsia(AU)

Introduction: Preeclampsia produces proteinuria, edema and arterial hypertension. Eclampsia appears after preeclampsia or acute with seizures. Both states usually occur towards the end of pregnancy, during or after delivery. Objective: To characterize pregnant or puerperal women with preeclampsia-eclampsia, admitted to the Intensive Care Unit. Methods: A descriptive, prospective and longitudinal study was concluded, in 38 patients who underwent a complete physical examination, complementary tests useful for their diagnosis and APACHE II index. Results: Puerperal pre-eclampsia predominated. The ages between 21 to 35 years prevailed. The most frequent risk factors found were advanced ages, personal history and nulliparity. The stay ranged between 4 and 5 days in both groups, with 100 percent of live hospital discharges. Conclusions: The early diagnosis of severe and initial forms of preeclampsia is possible with a strategy of early follow-up in pregnant and puerperal women at risks(AU)