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1.
Article in English | WPRIM | ID: wpr-928574

ABSTRACT

Preeclampsia (PE) is a unique complication of pregnancy that affects the health of the mother and the infant. Intestinal flora plays an important regulatory role in human body's metabolism and immunity and is associated with many diseases. Studies have shown that the development and progression of PE can lead to alterations in intestinal flora in the mother and are even closely associated with the colonization and development of intestinal flora in the offspring. This article reviews related studies on the effect of PE on maternal-infant intestinal flora, so as to provide new ideas for the prevention and treatment of maternal and infant complications associated with PE.


Subject(s)
Female , Gastrointestinal Microbiome , Humans , Infant , Pre-Eclampsia/prevention & control , Pregnancy
2.
Revagog ; 3(3): 80-87, Jul-Sept. 2021. ilus.
Article in Spanish | LILACS, LIGCSA | ID: biblio-1343841

ABSTRACT

Caminar durante el embarazo, la actividad física preferida entre las mujeres embarazadas, tiene múltiples beneficios para la salud del binomio materno - fetal en comparación con otras modalidades de actividad física. El no requerir tanto esfuerzo, la facilidad de ejecución, posibilidad de interacción social y de integrarse de manera muy significativa en algunas actividades, como los desplazamientos y las actividades ocupacionales, cuando a las embarazadas les es imposible realizar actividad física en su tiempo libre, son algunas de las ventajas que la convierten en la elegida por la mayor parte de las embarazadas. La falta de tiempo, las molestias físicas, la fatiga o la falta de energía, son algunos de los factores que impiden caminar a las gestantes. Dados los múltiples beneficios que tiene caminar para las embarazadas, las autoridades sanitarias deberían fomentar campañas de concienciación que promovieran la importancia de la práctica de actividad física por las mujeres embarazadas, entre las cuales, debería estar muy presente caminar.


Walking during pregnancy, the preferred physical activity among pregnant women, has multiple health benefits for the maternalfetal pairing compared to other forms of physical activity. Not requiring so much effort, the ease of execution, the possibility of social interaction and of integrating in a very significant way in some activities, such as travel and occupational activities, when it is impossible for pregnant women to perform physical activity in their free time, are some of the advantages that make it the one chosen by most pregnant women. Lack of time, physical discomfort, fatigue or lack of energy are some of the factors that prevent pregnant women from walking. Given the multiple benefits that walking has for pregnant women, health authorities should promote awareness campaigns that promote the importance of practicing physical activity by pregnant women, among whom walking should be very present.


Subject(s)
Humans , Female , Exercise , Walking , Pregnant Women , Maternal Health , Pre-Eclampsia/prevention & control , Fetal Macrosomia/prevention & control , Infant, Newborn , Diabetes, Gestational/prevention & control , Obstetric Labor, Premature/prevention & control
4.
In. Fernández, Anabela. Manejo de la embarazada crítica y potencialmente grave. Montevideo, Cuadrado, 2021. p.65-83.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1377601
5.
Rev. bras. ginecol. obstet ; 42(10): 659-668, Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144153

ABSTRACT

Abstract Objective To identify the most effective procedures recommended for the prevention of preeclampsia. Data Sources A systematic review was performed in the following databases: Pubmed/MEDLINE, CINAHL, Web of Science, Cochrane and LILACS via the Virtual Health Library (VHL). A manual search was also performed to find additional references. The risk of bias, the quality of the evidence, and the classification of the strength of the recommendations were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Selection of Studies In the initial search in the databases, the total number of articles retrieved was 351, and 2 were retrieved through the manual search; after duplicate articles were removed, 333 citations remained. After a thorough review of the titles and abstracts, 315 references were excluded. Accordingly, 18 articles were maintained for selection of the complete text (phase 2). This process led to the exclusion of 6 studies. In total, 12 articles were selected for data extraction and qualitative synthesis. Data Collection The articles selected for the study were analyzed, and we inserted the synthesis of the evidence in the online software GRADEpro Guideline Development Tool (GDT) (McMaster University and Evidence Prime Inc. All right reserved. McMaster University, Hamilton, Ontário, Canada); thus, it was possible to develop a table of evidence, with the quality of the evidence and the classification of the strength of the recommendations. Data Synthesis In total, seven studies recommended the individual use of aspirin, or aspirin combined with calcium, heparin or dipyridamole. The use of calcium alone or in combination with phytonutrients was also highlighted. All of the studies were with women at a high risk of developing preeclampsia. Conclusion According to the studies evaluated, the administration of aspirin is still the best procedure to be used in the clinical practice to prevent preeclampsia.


Resumo Objetivo Identificar quais são as condutas recomendadas para a prevenção de pré-eclâmpsia em gestantes. Fontes de Dados Foi feita uma revisão sistemática da literatura, e foram desenvolvidas estratégias detalhadas de busca individual nas bases de dados PubMed/MEDLINE, CINAHL, Web of Science, Cochrane e LILACS pela Biblioteca Virtual em Saúde (BVS). Uma pesquisa manual também foi realizada para encontrar referências adicionais. O risco de viés, a qualidade da evidência, e a classificação da força das recomendações foram avaliadas usando a abordagem Classificação de Recomendações, Avaliação, Desenvolvimento e Análises (Gradings of Recommendations, Assessment, Development and Evaluations, GRADE). Seleção dos Estudos No total, foram encontrados 351 artigos na busca inicial nas bases de dados consultadas e 2 na busca manual; após exclusões por duplicidade, 333 artigos permaneceram. Após a leitura de títulos e resumos, 315 referências foram excluídas. Portanto, 18 artigos foram mantidos para a seleção do texto completo (fase 2); esse processo levou à exclusão de 6 artigos. Após as exclusões por incompatibilidade com os critérios de inclusão, 12 artigos compuseram a amostra. Coleta de Dados Os artigos selecionados para o estudo foram analisados, e a digitação da síntese das evidências foi realizada no software online GRADEpro Guideline Development Tool (GDT) (McMaster University and Evidence Prime Inc. Todos os direitos reservados. McMaster University, Hamilton, Ontário, Canadá), o que possibilitou a elaboração de uma tabela de evidências, com a qualidade das evidências e a classificação da força das recomendações. Síntese dos Dados No total, sete estudos recomendaram o uso individual de aspirina, ou aspirina combinada com cálcio, heparina ou dipiridamol. O uso de cálcio isolado ou em combinação com fitonutrientes também foi destacado. Todos os estudos foram realizados com mulheres com alto risco de desenvolver pré-eclâmpsia. Conclusão De acordo com os estudos avaliados, a administração de aspirina ainda é a melhor conduta a ser utilizada na prática clínica para prevenir a pré-eclâmpsia.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/prevention & control , Prenatal Care
6.
Rev. bras. ginecol. obstet ; 42(7): 390-396, July 2020. tab, graf
Article in English | LILACS | ID: biblio-1137855

ABSTRACT

Abstract Objective Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. Methods Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria weremultiple pregnancy andmajor fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of earlyonset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150mg at night) was offered to these women from screening until 36 weeks. Results From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. Conclusion There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.


Resumo Objetivo A pré-eclâmpsia é uma causa importante de morbi-mortalidade materna e perinatal. Os objetivos do nosso estudo foram avaliar a implementação do rastreio combinado de pré-eclâmpsia no primeiro trimestre e o uso profilático de aspirina em baixa dose. Métodos Estudo prospetivo das mulheres referenciadas ao nosso hospital para realização do rastreio do primeiro trimestre de aneuploidias, entre março de 2017 e fevereiro de 2018 (n = 1.297). Os critérios de exclusão foram gravidez múltipla e anomalias fetais graves. O algoritmo usado no rastreio da pré-eclâmpsia combina características maternas, e marcadores biofísicos e bioquímicos. Definiu-se alto risco como risco de pré-eclâmpsia precoce (antes das 34 semanas) ≥ 1:50, tendo sido recomendada aspirina em baixa dose (150 mg à noite) desde o rastreio até às 36 semanas. Resultados Das 1.272 participantes, a maioria era caucasiana (1.051; 82,6%) e multípara (658; 51,7%). Cinquenta grávidas (3,9%) foram consideradas de alto risco para pré-eclâmpsia e todas iniciaram aspirina em baixa dose, com boa adesão (96%). Pré-eclampsia precoce foi diagnosticada em 3 grávidas (0,24%), e no total foram diagnosticados 25 casos de pré-eclâmpsia (2,02%), comparativamente com 28 (0,75%) casos de pré-eclampsia precoces (p = 0,0099) e 98 (2,62%) casos totais de préeclâmpsia (p = 0,2904) observados antes da implementação do rastreio. Verificou-se uma menor incidência de pré-eclâmpsia precoce e total após introdução do rastreio universal e uso profilático de aspirina. A redução da pré-eclâmpsia precoce foi estatisticamente significativa. Conclusão A associação de um modelo de rastreio combinado no primeiro trimestre com o uso profilático de aspirina é aparentemente eficaz na redução do risco de préeclâmpsia precoce.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/diagnosis , Pre-Eclampsia/prevention & control , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , Mass Screening , Pregnancy, High-Risk , Pregnancy Trimester, First , Pregnancy Outcome , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Aspirin/administration & dosage , Incidence , Prospective Studies , Risk Factors
8.
Rev. bras. ginecol. obstet ; 41(5): 318-332, May 2019. tab, graf
Article in English | LILACS | ID: biblio-1013611

ABSTRACT

Abstract 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


Resumo 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 préeclâmpsia também é considerada na ausência de proteinúria se houver lesão de órgãoalvo. 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.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/prevention & control , Prenatal Care , Practice Guidelines as Topic
9.
Femina ; 47(5): 258-273, 20190531. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1046517

ABSTRACT

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)


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/diagnosis , Pre-Eclampsia/etiology , Pre-Eclampsia/prevention & control , Hypertension, Pregnancy-Induced , Eclampsia , Hypertension , Pregnancy Complications , Proteinuria , Seizures , Practice Patterns, Physicians' , Antihypertensive Agents/therapeutic use
10.
Rev. cuba. obstet. ginecol ; 45(1): 14-24, ene.-mar. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1093619

ABSTRACT

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)


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/diagnosis , Pre-Eclampsia/prevention & control , Longitudinal Studies , Critical Care/methods , Postpartum Period , Eclampsia/diagnosis
11.
Braz. j. med. biol. res ; 52(6): e8273, 2019. tab, graf
Article in English | LILACS | ID: biblio-1001536

ABSTRACT

Excessive pro-inflammatory cytokines result in adverse pregnancy outcomes, including preeclampsia-like phenotypes, and fetal growth restriction. Anti-inflammation might be an effective therapy. The aim of this research was to investigate whether Uncaria rhynchophylla alkaloid extract (URE), a highly safe anti-inflammation constituent of the herb, can inhibit inflammation and improve clinical characteristics of preeclampsia in a lipopolysaccharide (LPS)-induced preeclampsia rat model. The rat model was established by daily administration of LPS (1 μg/kg body weight per day) from gestational day (GD) 14 to 19. Different doses of URE (35, 70, and 140 mg/kg body weight per day) were administered from GD 14 to GD 19. The effects of URE on proteinuria, maternal hypertension, pregnancy outcomes, as well as pro-inflammatory cytokines levels in serum and placenta were measured. High-dose URE (HURE) treatment decreased LPS-induced mean 24-h proteinuria and systolic blood pressure, and increased fetal weight, placental weight, and the number of live pups (P<0.05). Moreover, increased serum and placental levels of interleukin (IL)-6, IL-1β, tumor necrosis factor-α, and interferon-γ in the LPS-treated group were obviously inhibited after HURE administration (P<0.01). URE improved preeclampsia symptoms and mitigated inflammatory responses in the LPS-induced preeclampsia rat model, which suggests that the anti-inflammation effect of URE might be an alternative therapy for preeclampsia.


Subject(s)
Animals , Female , Pregnancy , Rats , Pre-Eclampsia/prevention & control , Plant Extracts/administration & dosage , Uncaria/chemistry , Inflammation/prevention & control , Anti-Inflammatory Agents/administration & dosage , Pre-Eclampsia/chemically induced , Lipopolysaccharides , Cytokines/drug effects , Cytokines/blood , Disease Models, Animal
12.
Rev. cuba. obstet. ginecol ; 44(3): 1-8, jul.-set. 2018. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1093605

ABSTRACT

Introducción: La morbilidad materna extrema se define como una complicación grave que ocurre durante el embarazo, parto y puerperio que pone en riesgo la vida de la mujer o requiere de una atención inmediata con el fin de evitar la muerte; el cual constituye un problema de salud pública y factor responsable para la mortalidad materna. Objetivo: Caracterizar los casos de morbilidad materna extrema en las pacientes de un Hospital Materno Infantil en el período enero- diciembre 2016. Métodos: Se realizó el estudio en base de 221 casos de Morbilidad Materna Extrema, donde 113 de estos casos cumplieron con los criterios de MME establecidos por el SINAVE del 2016. La recolección de la información fue por medio indirecto con la utilización de expedientes clínicos y base de datos obtenida del Instituto Nacional de Epidemiologia (INE), con llenado de ficha complementaria. Se analizó diferentes caracteres y variables obstétricas que conllevaron a los casos de MME. Resultados: Según nuestra muestra, a Morbilidad Materna Extrema (MME) afectó a un total de 113 pacientes, con índice de mortalidad (MM) de 0.097 y relación MME/MM de 10.27. Estuvo relacionada con pacientes de 21-35 años de edad, nivel educativo medio, multiparidad, mínima cantidad de controles prenatales, gestaciones mayormente del tercer trimestre, la mayoría terminando en desembarazo por vía cesárea e ingreso a UCI. La causa principal de los casos de MME fue por trastornos hipertensivos durante el embarazo (76.11 por ciento). Conclusiones: La causa principal de los casos de MME son los trastornos hipertensivos durante la gestación, teniendo el mayor porcentaje antecedentes de hipertensión arterial antes del embarazo(AU)


Severe maternal morbidity is as a serious complication that occurs during pregnancy, childbirth and puerperium that puts the woman's life at risk or requires immediate attention in order to avoid death. This entity represents a public health problem and responsible factor for maternal mortality. We conducted a cross-section descriptive study from retrospective and indirect information compilation from San Lorenzo de Los Mina Hospital, Santo Domingo, Dominican Republic with the purpose of interpreting risk factors that lead to maternal near miss event (NME) cases from January to December 2016 according to sociodemographic and gynecological characteristics. The study population consisted of 221 pregnant women of whom only 113 met the specific inclusion criteria used in this study. The main cause of severe maternal morbidity in this study were hypertensive disorders. The majority of cases had pre-eclampsia, eclampsia was in second place and HELLP Syndrome in third place. The average age of the patients was 26.64 years and median age 27 years. The age group over 35 years had the highest incidence. The highest percentage of complications occurred during the third trimester of pregnancy with cesarean section completion with 71 cases. There were 11 deaths (9.73 percent) of the cases of severe maternal morbidity(AU)


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Pre-Eclampsia/prevention & control , Pregnancy Complications/epidemiology , Hypertension, Pregnancy-Induced/prevention & control , Hypertension, Pregnancy-Induced/epidemiology , Epidemiology, Descriptive , Cross-Sectional Studies , Dominican Republic
13.
Hosp. Aeronáut. Cent ; 13(2): 95-104, 2018. il tabl
Article in Spanish | LILACS, BINACIS | ID: biblio-1021165

ABSTRACT

Introducción: La detección de alteraciones en la circulación fetal y materna advierte sobre las alteraciones hemodinámicas que comienza a sufrir el feto. Si la edad gestacional garantiza la viabilidad fetal no se requiere prolongar la gestación, evitando complicaciones por hipoxia crónica. Sin embargo, en fetos con inmadurez pulmonar se esperan trastornos más severos por alteraciones en el sistema venoso fetal. En embarazos de alto riesgo, la ecografía fetal con Doppler es el método de elección debido a su alta sensibilidad que, además de ser no invasivo y accesible, permite la identificación de alteraciones que ponen en riesgo la vida del feto, ayudando al diagnóstico y monitoreo de las mismas. Su buen uso reduce el riesgo de muerte fetal en casos de alto riesgo. La evaluación de las arterias uterinas en el tamizaje de patologías del embarazo es de utilidad en preeclampsia, restricción de crecimiento intrauterino, desprendimiento de placenta y muerte fetal. El estudio de la morfología de onda de la arteria umbilical se utiliza ante sospecha de hipoxia, siendo el mejor indicador para interrupción de la gestación ante la presencia de anomalías, mientras que los cambios en la velocimetría de la arteria cerebral media son de utilidad en la evaluación de fetos con insuficiencia placentaria y anemia. El índice cerebro-placentario es el marcador más sensible para diagnosticar la redistribución cerebral como primer fenómeno adaptativo del feto ante la injuria. El estudio del sistema venoso fetal detecta estados más avanzados de hipoxia fetal, acompañados de acidemia e insuficiencia cardíaca. Objetivo: Describir aspectos a evaluar con EcoDoppler fetal para identificar alteraciones sugerentes de patología materno-fetal. Destacar su utilidad en embarazos de alto riesgo. Revisión de bibliografía actualizada. Materiales y Método: Para la localización de la bibliografía se utilizaron varias fuentes documentales, abarcando una búsqueda crítica en internet desde Google Académico, incluyendo artículos publicados a partir del año 2002, utilizando los descriptores: ecografía, ecoDoppler, embarazo, control prenatal, preeclampsia, restricción del crecimiento intrauterino. Se seleccionaron aquellos documentos que informasen sobre los aspectos físicos del ecoDoppler, aplicación del ecoDoppler en embarazos de alto riesgo y metodología del estudio


Introduction: The detection of alterations in the fetal and maternal circulation warns about the hemodynamic alterations that the fetus begins to suffer. If gestational age guarantees fetal viability, it is not necessary to prolong gestation, avoiding complications due to chronic hypoxia. However, in fetuses with pulmonary immaturity more severe disorders are expected due to alterations in the fetal venous system. In high-risk pregnancies, fetal ultrasound with Doppler is the method of choice due to its high sensitivity that, in addition to being non-invasive and accessible, allows the identification of alterations that put the life of the fetus at risk, aiding diagnosis and monitoring from the same. Its good use reduces the risk of fetal death in high-risk cases. The evaluation of the uterine arteries in the screening of pathologies of pregnancy is useful in preeclampsia, intrauterine growth restriction, placental abruption and fetal death. The study of the wave morphology of the umbilical artery is used when hypoxia is suspected, being the best indicator for interruption of gestation in the presence of anomalies, while changes in the velocimetry of the middle cerebral artery are useful in the evaluation of fetuses with placental insufficiency and anemia. The brain-placental index is the most sensitive marker to diagnose cerebral redistribution as the first adaptive phenomenon of the fetus before injury. The study of the fetal venous system detects more advanced stages of fetal hypoxia, accompanied by acidemia and heart failure. Objective: Describe aspects to be evaluated with Fetal EcoDoppler to identify alterations suggestive of maternal-fetal pathology. Highlight its usefulness in high risk pregnancies. Review of updated bibliography. Materials and Method:Several documentary sources were used to locate the bibliography, covering a critical search on the Internet from Google Scholar, including articles published since 2002, using the descriptors: ultrasound, ecoDoppler, pregnancy, prenatal control, preeclampsia, intrauterine growth restriction . We selected those documents that reported on the physical aspects of ecoDoppler, application of ecoDoppler in high-risk pregnancies and study methodology.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/prevention & control , Prenatal Care/trends , Ultrasonography/trends , Doppler Effect , Fetal Growth Retardation/prevention & control , Pregnancy/metabolism , Diagnostic Techniques, Obstetrical and Gynecological
15.
Rev. chil. obstet. ginecol. (En línea) ; 82(4): 438-446, oct. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899926

ABSTRACT

INTRODUCCIÓN: El diagnóstico precoz de las complicaciones en preeclampsia, constituye uno de los retos principales en obstetricia que suelen determinar la instauración de medidas preventivas y terapéuticas, con el fin de cambiar su historia natural; por tal motivo se construyó una escala de factores de riesgo para predecir sus complicaciones. OBJETIVO: Determinar la precisión de la escala de factores de riesgo para complicaciones de preeclampsia como instrumento predictivo. MÉTODO: Se realizó un estudio prospectivo, longitudinal y analítico aplicando la escala en 60 pacientes que ingresaron con diagnóstico de preeclampsia al Hospital de ginecoobstetricia del Instituto Materno Infantil del Estado de México (HGO del IMIEM) utilizando la técnica de minería de datos de tipo supervisado a través de un árbol de decisión, en la que a partir de datos de un grupo de estudio con una escala previamente construida, se evaluó la eficiencia del instrumento mediante entrenamiento y prueba de red neuronal artificial así como determinación del área bajo la curva (ABC) Receiver operating characteristic curve (ROC). RESULTADOS: Los resultados del árbol de decisiones indican que la escala tiene una precisión del 93.3%, error estimado de 6.7%, con respecto a la evaluación de la red neuronal artificial se encontró que dicho instrumento, tiene una precisión del 100% sin presentar pronósticos in correctos. El cálculo del rendimiento diagnóstico de la escala con Curva ROC, registra que el área bajo la curva (ABC) es de 0.98. CONCLUSIONES: El uso de la escala de factores de riesgo para complicaciones de preeclampsia, constituye un buen instrumento para la predicción de complicaciones en preeclampsia.


INTRODUCTION: Early diagnosis of complications in preeclampsia, is one of the main challenges in obstetrics that can determine the establishment of preventive and therapeutic measures, in order to change its natural history, for that reason a scale of risk factors was constructed to predict their complications. OBJECTIVE: To determine the accuracy of the scale of risk factors for complications of preeclampsia as a predictive tool. METHOD: A prospective, longitudinal and analytical study using the scale in 60 patients admitted with a diagnosis of preeclampsia to HGO the IMIEM using the technique of data mining type supervised by a decision tree, in which from of scale data of a study group with a previously built instrument scale efficiency it was assessed by testing and training artificial neural network and determining the area under the curve (AUC) Receiver operating characteristic curve (ROC). RESULTS: The results of the decision tree indicate that the scale has an accuracy of 93.3%, estimated error of 6.7%. The evaluation of the artificial neural network shows that the instrument has an accuracy of 100%, without incorrect predictions. Calculating the diagnostic performance of ROC curve scale, records that the area under the curve (AUC) is 0.98. CONCLUSIONS: The use of the scale of risk factors for complications of preeclampsia, is an excellent tool for predicting preeclampsia complications.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/diagnosis , Risk Assessment/methods , Pre-Eclampsia/prevention & control , Prospective Studies , Risk Factors , ROC Curve , Longitudinal Studies , Sensitivity and Specificity , Mexico/epidemiology
16.
Rev. cuba. obstet. ginecol ; 43(3): 80-95, jul.-set. 2017. tab
Article in Spanish | LILACS, CUMED | ID: biblio-901315

ABSTRACT

Introducción: la preeclampsia en una afección que complica el embarazo y es responsable entre 10-15 por ciento de la mortalidad materna y perinatal. En Villa Clara, constituyen la primera causa de ingreso en los Servicios de Cuidados Maternos y perinatales. Objetivo: demostrar la efectividad y la seguridad de la aspirina y los suplementos de calcio en embarazadas con riesgo. Métodos: se realizó una investigación observacional, prospectiva en la consulta provincial de riesgo de preeclampsia del Hospital Universitario Ginecobstétrico Mariana Grajales, de Villa Clara, desde enero del 2014 hasta diciembre del 2015. Resultados: se comprobó que el uso de la aspirina y el calcio, a las dosis empleadas, resultaron ser efectivas en la disminución de la incidencia de preeclampsia y sus formas severas. Existieron beneficios mayores con las medidas preventivas empleadas, para algunos grupos específicos de riesgo como: hipertensión arterial crónica, obesidad, historia de preeclampsia previa y pacientes con ecografía Doppler alterada. No se observó un incremento de eventos adversos sobre la madre y el feto. Conclusiones: no se observó un incremento de eventos adversos sobre la madre y el neonato en las pacientes tratadas(AU)


Introduction: preeclampsia in a condition that complicates pregnancy and it is responsible for 10-15 percent of maternal and perinatal mortality. In Villa Clara, it constitutes the first cause of admission to the Maternal and Perinatal Care Services. Objective: demonstrate the effectiveness and safety of aspirin and calcium supplements in pregnant women at risk. Methods: an observational, prospective investigation was conducted in the provincial consultation for risk of preeclampsia at Mariana Grajales Gyneco-Obstetric University Hospital, in Villa Clara, from January 2014 to December 2015. Results: the use of aspirin and calcium, at the doses used, proved to be effective in reducing the incidence of preeclampsia and its severe forms. There were greater benefits with the preventive measures used, for some specific risk groups such as chronic hypertension, obesity, history of previous preeclampsia and patients with altered Doppler ultrasound. There was no increase in adverse events on the mother and the fetus. Conclusions: there was no increase in adverse events on the mother and the newborn in the treated patients(AU)


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/prevention & control , Calcium, Dietary/therapeutic use , Aspirin/therapeutic use , Pre-Eclampsia/drug therapy , Prospective Studies
17.
Lima; Peru. Ministerio de Salud. Instituto Nacional de Salud; 2017. (Peru. Ministerio de Salud. Instituto Nacional de Salud).
Non-conventional in Spanish | LILACS, BIGG | ID: biblio-948832

ABSTRACT

Este documento abarca temas de prevención y tratamiento de preeclampsia y eclampsia.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/prevention & control , Prenatal Care/methods , Eclampsia/prevention & control , Pregnancy Complications/prevention & control , GRADE Approach
18.
Femina ; 44(2): 127-130, 20160630. ilus
Article in Portuguese | LILACS | ID: biblio-1050857

ABSTRACT

As desordens hipertensivas na gestação, em especial a pré-eclâmpsia (PE), são consideradas, nos países em desenvolvimento, a maior causa de morbimortalidade tanto materna quanto perinatal. Com objetivo de alcançar maior entendimento da fisiopatologia da PE e de evitar as manifestações clínicas desta doença e suas consequências, foram realizadas pesquisas relacionadas à suplementação de substâncias que atuariam na fisiopatologia, em especial examinando o uso do ácido acetilsalicílico (AAS). O uso de AAS em baixas doses em gestantes com alto risco de desenvolver PE quando iniciado na 16ª semana de gestação, ou mesmo antes, pode ser considerado importante avanço devido aos resultados observados em estudos relatando boa eficácia e redução do risco de morte perinatal, de restrição de crescimento intrauterino e de nascimento pré-termo.(AU)


Hypertensive disorders in pregnancy, particularly preeclampsia (PE), are considered a major cause of maternal and perinatal morbidity and mortality in developing countries. With the objetive of improving the knowledge about the pathophysiology of PE, and to avoid the clinical manifestations and consequences of this disease, several studies related with the supplementation of acetylsalicylic acid (AAS) on the PE pathophysiology have been performed. The use of low doses of AAS starting at or before week 16 can be considered an important advance in reducing the risk of perinatal death, intrauterine growth restriction and preterm birth.(AU)


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/physiopathology , Pre-Eclampsia/prevention & control , Aspirin/therapeutic use , Pregnancy, High-Risk/drug effects , Placentation/drug effects , Randomized Controlled Trials as Topic , Meta-Analysis as Topic , Efficacy , Obstetric Labor, Premature/prevention & control
19.
Colomb. med ; 46(4): 156-161, Oct.-Dec. 2015. ilus, tab
Article in English | LILACS | ID: lil-774948

ABSTRACT

Introduction: Preeclampsia is the main complication of pregnancy in developing countries. Calcium starting at 14 weeks of pregnancy is indicated to prevent the disease. Recent advances in prevention of preeclampsia endorse the addition of conjugated linoleic acid. Objective: To estimate the protective effect from calcium alone, compared to calcium plus conjugated linoleic acid in nulliparous women at risk of preeclampsia. Methods: A case-control design nested in the cohort of nulliparous women attending antenatal care from 2010 to 2014. The clinical histories of 387 cases of preeclampsia were compared with 1,054 normotensive controls. The exposure was prescriptions for calcium alone, the first period, or calcium plus conjugated linoleic acid, the second period, from 12 to 16 weeks of gestational age to labor. Confounding variables were controlled, allowing only nulliparous women into the study and stratifying by age, education and ethnic group. Results: The average age was 26.4 yrs old (range= 13-45), 85% from mixed ethnic backgrounds and with high school education. There were no differences between women who received calcium carbonate and those who did not (OR= 0.96; 95% CI= 0.73-1.27). The group of adolescents (13 to 18 yrs old) in the calcium plus conjugated linoleic acid was protected for preeclampsia (OR= 0.00; 95% CI= 0.00-0.44) independent of the confounder variables. Conclusions: 1. Calcium supplementation during pregnancy did not have preventive effects on preeclampsia. 2. Calcium plus Conjugated Linoleic acid provided to adolescents was observed to have preventive effect on Preeclampsia.


Introducción: La preeclampsia es la principal causa de mortalidad materna y bajo peso al nacer en países en vías de desarrollo. Empezar la suplementación de calcio en la semana 14 de gestación es indicada para prevenir la enfermedad. Recientes avances en prevención de preeclampsia han sugerido la suplementación de calcio y la combinación de calcio con ácido linoleico conjugado. Objetivo: Estimar el efecto protector de la suplementación de calcio (CC), comparado con la suplementación de calcio más ácido linoleico conjugado (CC+ALC) en mujeres embarazadas primigravidas con relación al desarrollo de preeclampsia. Métodos: Se realizó un estudio de casos y controles anidado en una cohorte retrospectiva de mujeres embarazadas primigravidas que asistieron al programa de control prenatal entre el año 2010 hasta el años 2014. La historia clínica de 387 casos de preeclampsia fueron comparadas con 1,054 controles en pacientes embarazadas primigestantes, normotensas. Las gestantes expuestas fueron consideradas como aquellas gestantes que recibieron solo calcio, en el primer periodo de evaluación, o calcio más ácido linoleico conjugado, segundo periodo de evaluación, desde las semanas 12 a la 16 del embarazo. Los posibles factores de confusión se controlaron admitiendo solo las primigestantes y estratificando, por edad, educación y grupo étnico de la paciente. Resultados: La edad promedio de las pacientes fue de 26.4 años (rango= 13-45), 85% con etnia mestiza y educación secundaria completa. La exposición a CC+ALC tuvo un efecto protector en las adolescentes (13 a 18 años) (OR= 0.00, IC 95%= 0.00-0.44; p= 0.005), mientras que la exposición a CC no modificó la incidencia de preeclampsia (OR= 0.96, IC 95%= 0.73-1.27; p= 0.82). Conclusiones: 1. La suplementación de solo calcio durante el embarazo no tuvo efecto preventivo para la preeclampsia, 2. La suplementación con calcio y ácido linoleico conjugado previno la aparición de preeclampsia en adolescentes.


Subject(s)
Adolescent , Adult , Female , Humans , Middle Aged , Pregnancy , Young Adult , Calcium Carbonate/therapeutic use , Linoleic Acid/therapeutic use , Pre-Eclampsia/prevention & control , Age Factors , Case-Control Studies , Cohort Studies , Drug Therapy, Combination , Parity , Pregnancy Trimester, Second
20.
Diagnóstico (Perú) ; 54(4): 193-198, oct.-dic. 2015. ilus, tab
Article in Spanish | LILACS, LIPECS | ID: lil-788689

ABSTRACT

Sin conocer aún el origen preciso de la preeclampsia, sabemos hoy que es un trastorno con fondo genético e inmunológico-inflamatorio que compromete el endotelio y, con alteraciones metabólicas y de estrés oxidativo, es definida como la presencia de hipertensión arterial con compromiso multiorgánico en una gestante. Produce serio compromiso materno y feto-neonatal y la posibilidad de secuelas metabólicas y cardiovasculares en el futuro para ambos. Sin medidas de prevención o terapéuticas efectivas, la preeclampsia debe ser sospechada por su historia obstétrica o familiar y por la sintomatología de compromiso orgánico, como cefalea, dolor en hipocondrio derecho, falta de crecimiento uterino, compromiso del bienestar fetal, entre otros. La terminación del embarazo será a las 37 semanas de preferencia y de acuerdo al estado materno y fetal. La atención del puerperio será preferente.


The origin of preeclampsia is not known but is considered a genetic-immuno-inflammatory disorder that compromises the endothelium along with metabolic alterations and oxidative stress. It is currently defined as presence of arterial hypertension and multiorganic involvement in a pregnant woman. Mother and the fetus-neonate are dangerously ill and are prone to metabolic and cardiovascular sequelae in the future. Preventive and therapeutic measures are not effective, but preeclampsia should be suspected considering obstetrical and familiar background and by organic symptomatology including headache, right upper abdominal pain, lack of uterine growth, fetal compromise and others. Pregnancy termination is recommended at 37 weeks of gestation and according to maternal and fetal wellbeing. Care in the puerperium should be preferential.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia , Pre-Eclampsia/diagnosis , Pre-Eclampsia/physiopathology , Pre-Eclampsia/prevention & control
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