The REBECGA brazilian registry of pregnancy and heart disease: rationale and design

BACKGROUND: Maternal mortality rates in Brazil remain above the goals established by the United Nations Sustainable Development Goals. Heart disease is estimated to affect 4% of all pregnancies and remains by itself the main indirect obstetric cause of maternal death. In the last decades, a significant improvement in the prognosis of heart diseases has made pregnancy possible in women with heart disease and provided better maternal and fetal outcomes. OBJECTIVES: To establish a multicenter Brazilian Registry of pregnant women with heart disease; to study the causes of immediate and late maternal mortality; and to assess the prevalence of heart disease in the country's macro-regions. METHODS: This is an observational study, with retrospective and prospective stages, of the clinical and obstetric progression of pregnant women with heart disease. These women consecutively received care during pregnancy and will be followed up for up to a year after delivery at public and private hospitals with infrastructure for the execution of this project, a principal investigator, and approval by Ethics and Research Committees. RESULTS: Our results will be presented after data collection and statistical analysis, aiming to demonstrate immediate and late maternal mortality rates, as well as the prevalence of heart disease in the country and its cardiovascular and obstetric complications during pregnancy. CONCLUSIONS: REBECGA will be the Brazilian Registry of heart disease and pregnancy and it will contribute to planning preventive measures, raising financial resources for the improvement of high-risk prenatal care, and reducing immediate and late maternal mortality due to heart disease.

Preeclampsia y enfermedad cardiovascular: un enfoque integral para detectar las fases subclínicas de complicaciones obstétricas y cardiovasculares / Preeclampsia and cardiovascular disease: an integrated approach to detect the subclinical stages of obstetrical and cardiovascular complications

Desde 1995 hasta la fecha la asociación entre patologías derivadas los embarazos hipertensivos y las enfermedades cardiovasculares ha generado un gran volumen de potentes evidencias epidemiológicas y clínicas. Los propósitos de esta revisión son varios. Mostrar la consistencia y magnitud de la evidencia científica. Integrar los riesgos/enfermedades cardiovasculares y los problemas obstétricos a través de la disfunción endotelial. Preconizar el seguimiento postparto de la hipertensa embarazada, como una ventana de oportunidad para beneficiar la salud de las mujeres y sus hijos. Incluir la historia obstétrica como factor de riesgo de enfermedad coronaria. Proponer cuestionarios adaptables a las prácticas locales para facilitar la pronta incorporación de los índices de riesgo obstétrico y cardiovascular en dos etapas de la vida de una mujer. Ha llegado el momento para que los equipos obstétricos, cardiológicos y las pacientes jueguen un rol en la prevención de los riesgos y enfermedades cardiovasculares.

From 1995 onwards the association between hypertensive pregnancies and cardiovascular disease has generated a great volume of epidemiologic and clinical evidence. The purposes of this review are several. To demonstrate the consistence and weight of the scientific evidence. To integrate cardiovascular risks/diseases and obstetric complications through the link of endothelial dysfunction. To advocate postpartum follow-up after a hypertensive pregnancy as a window of opportunity to benefit the health of mothers and offsprings. To include the obstetrical history as a risk factor for coronary disease. To propose questionnaires adaptable to local practices to incorporate cardiovascular and obstetrical indexes in two stages of a woman's lifetime. The time has come for obstetrical teams, cardiologists and patients to play a preventive role regarding cardiovascular risks and diseases.

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

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

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

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

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

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

Risk Prediction of Cardiovascular Complications in Pregnant Women With Heart Disease / Predição de Risco de Complicações Cardiovasculares em Gestantes Portadoras de Cardiopatia

Abstract Background: Heart disease in pregnancy is the leading cause of non- obstetric maternal death. Few Brazilian studies have assessed the impact of heart disease during pregnancy. Objective: To determine the risk factors associated with cardiovascular and neonatal complications. Methods: We evaluated 132 pregnant women with heart disease at a High-Risk Pregnancy outpatient clinic, from January 2005 to July 2010. Variables that could influence the maternal-fetal outcome were selected: age, parity, smoking, etiology and severity of the disease, previous cardiac complications, cyanosis, New York Heart Association (NYHA) functional class > II, left ventricular dysfunction/obstruction, arrhythmia, drug treatment change, time of prenatal care beginning and number of prenatal visits. The maternal-fetal risk index, Cardiac Disease in Pregnancy (CARPREG), was retrospectively calculated at the beginning of prenatal care, and patients were stratified in its three risk categories. Results: Rheumatic heart disease was the most prevalent (62.12%). The most frequent complications were heart failure (11.36%) and arrhythmias (6.82%). Factors associated with cardiovascular complications on multivariate analysis were: drug treatment change (p = 0.009), previous cardiac complications (p = 0.013) and NYHA class III on the first prenatal visit (p = 0.041). The cardiovascular complication rates were 15.22% in CARPREG 0, 16.42% in CARPREG 1, and 42.11% in CARPREG > 1, differing from those estimated by the original index: 5%, 27% and 75%, respectively. This sample had 26.36% of prematurity. Conclusion: The cardiovascular complication risk factors in this population were drug treatment change, previous cardiac complications and NYHA class III at the beginning of prenatal care. The CARPREG index used in this sample composed mainly of patients with rheumatic heart disease overestimated the number of events in pregnant women classified as CARPREG 1 and > 1, and underestimated it in low-risk patients (CARPREG 0).

Resumo Fundamento: Cardiopatia na gravidez é a primeira causa de morte materna não obstétrica. Poucos estudos brasileiros avaliaram o impacto da cardiopatia na gestação. Objetivo: Determinar os fatores de risco associados às complicações cardiovasculares e neonatais. Métodos: Foram avaliadas 132 gestantes cardiopatas, acompanhadas em um Setor de Gestação de Alto Risco, de janeiro de 2005 a julho de 2010. Foram selecionadas variáveis que poderiam influenciar no desfecho materno/fetal: idade, paridade, tabagismo, etiologia, gravidade da cardiopatia, complicações cardíacas prévias, cianose, classe funcional New York Heart Association (NYHA) > II, disfunção/obstrução do ventrículo esquerdo, arritmia, mudança de tratamento, início e número de consultas de pré-natal. Foi calculado, retrospectivamente, o índice de risco materno-fetal de acordo com o Cardiac Disease in Pregnancy (CARPREG) no início do pré-natal. As pacientes foram estratificadas nas três categorias de risco do CARPREG. Resultados: A cardiopatia reumática foi a cardiopatia mais prevalente (62,12%). As complicações mais frequentes foram descompensação cardíaca (11,36%) e arritmias (6,82%). Fatores associados às complicações cardiovasculares na análise multivariada foram mudança do tratamento (p = 0,009), complicações cardíacas prévias (p = 0,013) e classe funcional III NYHA na primeira consulta pré-natal (p = 0,041). O porcentual de complicação cardiovascular foi 15,22% no grupo CARPREG 0; 16,42% no CARPREG 1; e 42,11% no CARPREG >1 − diferentemente do estimado pelo índice original: 5%, 27% e 75%, respectivamente. Na amostra, tivermos 26,36% de prematuridade. Conclusão: Os fatores de risco para complicação cardiovascular nessa população foram a mudança de tratamento, as complicações cardíacas prévias e a classe funcional III NYHA no início do acompanhamento pré-natal. O índice CARPREG, nesta amostra, composta principalmente por pacientes com cardiopatia reumática, superestimou o número de eventos em gestantes classificadas como CARPREG 1 e > 1, e subestimou o risco em pacientes de baixo risco (CARPREG 0).

Hypertension, pregnancy and weather: is seasonality involved? / Hipertensão, gestação e clima: a sazonalidade contribui?

Objective: The present study aimed at assessing the association between environmental temperature and the relative humidity of the air with frequency of hypertensive disorders of pregnancy. Methods: A prospective and retrospective, descriptive, ecological study was held at a teaching maternity in Recife, Brazil. Data from all 26.125 pregnant women admitted between 2000 and 2006 were analysed and 5.051 had the diagnosis of hypertensive disorder of pregnancy. The incidence percentages were calculated monthly per deliveries. Data on mean monthly temperature and relative humidity of the air were collected and monthly comparisons were conducted. February was chosen as the reference month due to its lowest incidence of the disease. The relative chance of hypertensive disorders of pregnancy for each other month was estimated by odds ratio and Pearson's correlation coefficient was used to calculate the relation between the incidence of hypertensive disorders of pregnancy and the mean monthly temperature and relative air humidity. Results: February presented the lowest mean monthly incidence (9.95%) and August the highest (21.54%). Pearson correlation coefficient revealed a higher incidence of hypertensive disorders of pregnancy in the cooler months (r= -0.26; p=0.046) and no significant effect of relative air humidity (r=0.20; p=0.128). Conclusion: The incidence of hypertensive disorders of pregnancy may be affected by variations in temperature, increasing during cooler periods. .

Objetivo: O objetivo do presente estudo foi avaliar a associação entre a temperatura e umidade relativa do ar e a incidência de síndromes hipertensivas gestacionais. Métodos: Um estudo ecológico, prospectivo e retrospectivo, foi conduzido em uma maternidade-escola, na cidade do Recife, Brasil. Dados de todas as 26.125 gestantes, admitidas entre os anos de 2000 e 2006, foram analisados e 5.051 mulheres tiveram o diagnóstico de síndrome hipertensiva gestacional no momento da admissão. A incidência percentual foi calculada mensalmente, por número de partos. Dados referentes à temperatura média mensal e umidade relativa do ar mensal foram coletados e comparações feitas mês a mês quanto à incidência da doença. O mês de fevereiro foi escolhido como mês de referência por conta da sua menor incidência. O risco relativo de síndrome hipertensiva gestacional para cada outro mês foi calculado por odds ratio e o coeficiente de correlação de Pearson foi utilizado para calcular a relação entre a incidência da doença e a média mensal de temperatura e umidade relativa do ar. Resultados: O mês de fevereiro apresentou a menor incidência mensal da doença (9,95%) e agosto, a maior (21,54%). O coeficiente de correlação de Pearson demonstrou maior incidência de síndromes hipertensivas gestacionais nos meses mais frios (r= -0,26; p=0,046), e nenhum efeito significativo da umidade relativa do ar (r=0,20; p=0,128). Conclusão: A incidência de síndromes hipertensivas gestacionais parece ser afetada por variações na temperatura, com menor incidência nos períodos mais frios. .

Uso de hierro en forma de medicamento en gestantes colombianas / Pregnant Colombian females' iron in take in drug form

Objetivo Caracterizar el consumo de hierro en forma de medicamento en un grupo de embarazadas colombianas. Metodología Estudio observacional descriptivo, se obtuvo información de mujeres en control prenatal y/o atención del parto en 4 ciudades de Colombia. Las fuentes de información fueron entrevistas a gestantes y registros de historia clínica. Resultados La muestra fue de 1 637 mujeres en 15 instituciones. A 1 396 mujeres (85,3 %) les recomendaron consumir hierro, recomendación realizada por médico al 85,3 % de ellas, el 86,8 % tuvo adherencia al tratamiento. Al 84,7 % el hierro fue suministrado por la empresa aseguradora de salud, el 11,9 % lo compró a sus expensas. El 90,0 % de gestantes anémicas y el 82,8 % de las no anémicas consumieron hierro en forma de medicamento, en conjunto, en el 37,2 % de las gestantes el consumo de suplencia de hierro fue pertinente (es decir, lo necesitaban, se les recomendó y lo consumieron o no le necesitaban, no se recomendó y/o no lo consumieron). Discusión Se recomienda y se consume hierro independientemente de presentar anemia. Se invita a reflexionar sobre la utilidad de los programas que promueven el consumo masivo de esta sustancia en forma de medicamento durante el embarazo, programas que parecen desconocer las causas fundamentales de los problemas nutricionales que aquejan a la población.

Objective Describing a group of pregnant Colombian females' iron intake, in drug form. Methodology This was an observational descriptive study; information was collected in 4 Colombian cities regarding pregnant females during antenatal control or when giving birth. Information sources consisted of interviews with pregnant women and their clinical records. Results The sample consisted of 1,637 female sat tending 15 institutions. An iron intake was recommended for1, 396 women (85.3 %); a doctor made such recommendation in 85.3 % of cases and adherence was 86.8 %. Health insurance was used by 84.7 % of the females for supplying iron; 11.9 % of them bought it themselves. Iron intake as medication for anemic pregnant females was 90.0 % and 82.8 % in non-anemic ones. Iron intake supply was appropriate in 37.2 % of the pregnant females (i.e. they needed it, someone recommended it for them and they consumed it, or they didn't need it, someone didn't recommend it to them and/or they did not take it). Discussion Iron intake was recommended and consumed regardless of anemia status. The results invite to think on the usefulness of programs promoting the mass intake of iron as a medication during pregnancy. Such programs seem to be unaware of the fundamental causes of people's nutritional problems.

Prinzmetal's angina in a pregnant woman: a case report

Acute myocardial infarction [MI] during pregnancy is rare and MI due to Prinzmetal's angina is much rarer. We present a 35-year-old, obese, multigravida, and pre-eclamptic woman, who developed acute anterior wall MI at the 30th week of gestation. On coronary angiography, the second obtuse marginal branch was totally occluded and the right coronary artery [RCA] was normal. Three days later, she had chest pain and ST elevation in the inferior leads. On second angiography, there was narrowing in the RCA, while the obtuse marginal branch was patent. We presume that this discrepancy between the first and second electrocardiograms and angiographic findings was due to Prinzmetal's angina

Caracterización de los factores de riesgo en gestantes con hipertensión gestacional y crónica en un área de salud / Characterization of the risk factors present in pregnant with chronic and gestational hypertension in a health area

INTRODUCCIÓN: los trastornos hipertensivos de la gestación constituyen una de las complicaciones más frecuentes que causan morbimortalidad materno-fetal, por lo que la reducción de su prevalencia e incidencia es una prioridad. Para enfrentar este reto se debe tener un enfoque médico integral en la atención preconcepcional y concepcional a la mujer, que condicione una mejor calidad de vida. OBJETIVO: describir la tendencia que han tenido estos trastornos en los últimos 4 años (2004-2007), y los factores de riesgo que con más frecuencia se presentaron. MÉTODOS: se diseñó un estudio observacional analítico transversal utilizando un universo de estudio de 25 gestantes con trastornos hipertensivos de la gestación del área de salud Dr Antonio Pulido Humarán. RESULTADOS: la hipertensión gestacional y la hipertensión arterial crónica tuvieron una tendencia ascendente en su prevalencia en el período 2004-2007. La obesidad, el tabaquismo, las inadecuadas condiciones socioeconómicas, la no suplementación de folatos, entre otras, constituyeron los factores de riesgo más frecuentes.

INTRODUCTION: pregnancy hypertensive disorders are one of the more frequent complications causing morbidity and mortality in mother-fetus, where decrease of its prevalence and incidence is a priority. To confront this challenge we must to have a integral medical approach on woman pre-conception and conception care to achieve a better quality of life.] OBJECTIVE: to describe trend of these disorders during past 4 years (2004-2007), and the more frequent risk factors. METHODS: authors designed a cross-sectional, analytical and descriptive study using a cohort of 25 pregnant with hypertensive disorders related to this condition from Dr Antonio Pulido Humarán health area. RESULTS: pregnancy hypertension and chronic high blood pressure had a rising trend in its prevalence during 2004-2007. Obesity, smoking, and the inappropriate socioeconomic conditions, the non folate-fortification among others, were the more frequent risk factors.

Estudo dos principais fatores de risco maternos nas síndromes hipertensivas da gestação / Study on the major maternal risk factors in hypertensive syndromes

FUNDAMENTO: Os fatores de risco para as síndromes hipertensivas gestacionais (SHG) são vários e podem relacionar-se à região e etnia da população. No Estado de Goiás, são escassos os estudos sobre esse tema. OBJETIVO: Investigar os fatores de risco maternos para SHG. MÉTODOS: Utilizou-se um estudo caso-controle por meio da análise dos prontuários das parturientes da Maternidade do Hospital das Clínicas da Universidade Federal de Goiás (HC-UFG), em 2005. Os fatores de risco foram analisados pela análise de regressão logística e pelo teste exato de Fisher. RESULTADOS: Em 2005, houve 890 partos na Maternidade do HC-UFG, e 129 gestantes apresentaram diagnóstico de SHG (14,5 por cento). A análise multivariada identificou a obesidade como fator de risco tanto para hipertensão gestacional (HG) (OR: 17,636; IC 95 por cento: de 2,859 a 108,774) como para hipertensão arterial crônica superajuntada à pré-eclâmpsia (HCSPE) (OR: 27,307; IC 95 por cento: de 4,453 a 167,440). Primiparidade constituiu fator de risco para HG (OR: 5,435; IC 95 por cento: de 1,923 a 15,385). Idade acima de 30 anos foi fator de risco para HCSPE (OR: 5,218; IC 95 por cento: de 1,873 a 14,536) e fator de proteção para pré-eclâmpsia (PE) (OR: 0,035; IC 95 por cento: de 0,003 a 0,364). Raça não-branca representou risco independente para PE (OR: 13,158; IC 95 por cento: de 1,672 a 100,000) e PE prévia para HCSPE (OR: 4,757; IC 95 por cento: de 1,261 a 17,938). Das gestantes com hipertensão arterial crônica (HAC), 73,5 por cento desenvolveram HCSPE (p < 0,001). CONCLUSÃO: Os fatores obesidade, raça não-branca, PE prévia, idade acima de 30 anos e HAC identificados foram semelhantes à maioria dos achados da literatura.

BACKGROUND: There are several risk factors for hypertensive syndromes in pregnancy (HSP), and these can be related to regional and ethnic factors. Studies on this issue are scarce in the State of Goiás. OBJECTIVE: To investigate maternal risk factors for HSP. METHODS: Case-control study based on the analysis of medical records of parturients from the Maternity Service of Hospital das Clínicas da Universidade Federal de Goiás (HC-UFG) in 2005. Risk factors were analyzed using Logistic Regression Analysis and Fisher's Exact Test. RESULTS: In 2005, there were 890 deliveries in the Maternity Service of HC-UFG, and 129 pregnant women were diagnosed with HSP (14.5 percent). The multivariate analysis identified obesity as a risk factor both for gestational hypertension - GH (OR: 17.636; 95 percent CI: 2.859 to 108.774) and for preeclampsia superimposed on chronic hypertension - PESCH (OR: 27.307; 95 percent CI: 4.453 to 167.440). Primiparity was a risk factor for GH (OR: 5.435; 95 percent CI: 1.923 to 15.385). Age above 30 years was a risk factor for PESCH (OR: 5.218; 95 percent CI: 1.873 to 14.536) and a protective factor against preeclampsia - PE (OR: 0.035; 95 percent CI: 0.003 to 0.364). Non-white race was an independent risk for PE (OR: 13.158; 95 percent CI: 1.672 to 100.000) and previous PE for PESCH (OR: 4.757; 95 percent CI: 1.261 to 17.938). Of the pregnant women with chronic hypertension (CH), 73.5 percent developed PESCH (p < 0.001). CONCLUSION: The factors identified - obesity, non-white race, previous PE, age above 30 years and CH, were similar to those found in the majority of studies in the literature.

Fatores preditivos de hipertensão gestacional em adolescentes primíparas: análise do pré-natal, da MAPA e da microalbuminúria / Predictive factors for pregnancy hypertension in primiparous adolescents: analysis of prenatal care, ABPM and microalbuminuria / Predictive factors for pregnancy hypertension in primiparous adolescents: analysis of prenatal care, ABPM and microalbuminuria

OBJETIVO: Quantificar a prevalência de HG em adolescentes primíparas; definir fatores de preditividade para a ocorrência de HG e sua repercussão nos recém-nascidos. MÉTODOS: Foram acompanhadas 29 adolescentes primíparas durante o pré-natal até a 12ª semana de puerpério, com idade média de dezesseis anos, do ambulatório do Serviço de Adolescentes da Maternidade Escola Assis Chateaubriand (MEAC) da Universidade Federal do Ceará (Fortaleza). As gestantes foram dividas em dois grupos; ou seja, nas que permaneceram normotensas (Grupo I) e naquelas que desenvolveram hipertensão gestacional -HG - (Grupo II). As variáveis investigadas na avaliação de valor de preditividade no desenvolvimento de HG foram valores antropométricos, aspectos socioeconômicos, o hábito de fumar, a hereditariedade para HAS (pai/mãe), os exames do pré-natal solicitados na primeira consulta do pré-natal e a microalbuminúria e a monitorização ambulatorial da pressão arterial (MAPA) na 28ª semana de gestação. As gestantes foram acompanhadas no parto e no puerpério tardio (12ª semana de puerpério). Os recém-nascidos das mães do nosso estudo foram avaliados ao nascer pelos índices de APGAR e de Capurro, peso, estatura e pela presença de hipóxia perinatal. RESULTADOS: A prevalência de HG foi de 51,7 por cento . A hereditariedade para HAS apresentou-se com o maior valor de preditividade para HG com odds ratio de 10,99. A pressão arterial diastólica maior ou igual a 70 mmHg, na idade média gestacional de 35 semanas, apresentou significância estatística como valor de preditividade para HG. Na MAPA encontramos valor de preditividade para HG: carga pressórica diastólica em vigília, carga pressórica sistólica e diastólica no sono noturno, variabilidade pressórica e pressão máxima diastólica no sono. Especificamente a pressão arterial diastólica (PAD) máxima na MAPA no período do sono noturno ³64 mmHg apresentou odds ratio de 6 para HG com sensibilidade de 80 por cento e especificidade de 60 por cento para o desenvolvimento de HG...

OBJECTIVE: To quantify PH prevalence in primiparous adolescents; define predictive factors for the occurrence of PH and its impact on newborns. METHODS: We followed 29 primiparous adolescents from the prenatal period through the 12th week of the puerperium, with a mean of sixteen years of age, served at the Outpatient Facility for Adolescents of Maternidade Escola Assis Chateaubriand (MEAC) of Universidade Federal do Ceará (Fortaleza, Brazil). The pregnant adolescents were divided into two groups, that is, those who remained normotensive (Group I) and those who developed PH (Group II). The variables investigated in the assessment of the value of predictability for the development of PH were anthropometric measures, socioeconomic aspects, smoking habit, inheritance for SAH (father/mother), prenatal tests requested in the first prenatal care visit in addition to microalbuminuria and ambulatory blood pressure monitoring (ABPM) in the 28th week of gestation. The pregnant adolescents were followed up at delivery and late puerperium (12th week after the puerperium). The newborns to the mothers included in our study were assessed at birth according to the Apgar score and the Capurro method, for weight, height and perinatal hypoxia. RESULTS: The prevalence of PH was 51.7 percent. Inheritance for SAH presented the highest predictive value for PH with an odds ratio of 10.99. Diastolic arterial pressure equal to or above 70 mmHg at the gestational age of 35 weeks was statistically significant as a predictive value for PH. At ABPM we found a predictive value for PH: diastolic pressure load during alertness, diastolic and systolic pressure load during night sleep, pressure variability and maximum diastolic pressure during sleep. Specifically a maximum diastolic arterial pressure (DAP) at ABPM during the period of night sleep ³64 mmHg presented an odds ratio of 6 for PH with a sensitivity of 80 percent and a specificity of 60 percent for the development of PH...

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

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

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

Pregnancy induced hypertension in twin pregnancy.

OBJECTIVE: To compare the incidence, severity and pregnancy outcomes of pregnancy induced hypertension in twins and singleton gestations. MATERIAL AND METHOD: The cohort study enrolled 305 twins and 298 singleton gestations at Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand between January 1996 and December 2001. The rates of pregnancy induced hypertension and pregnancy outcomes were statistically analysed in both groups. P-value of< 0.05 was considered statistically significant. RESULTS: Pregnancy induced hypertension was found to at develop 18.36% in the twin gestations, compared with 5.03% in the singleton gestations (P < 0.05). Women with twin gestations had higher rates of pregnancy induced hypertension (RR 3.65, 95% CI 2.11-6.30, P<0.05) and occurred earlier than singleton gestations (35.86+/-2.50 VS 37.40+/-1.18 weeks, P<0.05). Twin gestations with pregnancy induced hypertension had significantly higher rate of cesarean delivery, low birthweight, NICU admission and perinatal death than singleton gestations with pregnancy induced hypertension (P< 0.05). Moreover the abruptio placenta, postpartum hemorrhage and perinatal mortality in twin gestations with pregnancy induced hypertension group were significantly higher than in normotensive group (P< 0.05). CONCLUSION: The incidence of pregnancy induced hypertension was significant higher and occurred earlier with greater adverse pregnancy outcomes among twin gestations than singleton gestations. Moreover, the rate of adverse maternal and perinatal outcomes in twin gestations with pregnancy induced hypertensive group was higher than in normotensive group.

Estudo dos fatores relacionados à determinação da via de parto em gestantes portadoras de cardiopatias / Obstetrical and clinical factors related to the mode of delivery in pregnant women with heart disease

Foram estudados 571 partos de mulheres cardiopatas (T) e seus subgrupos: arritmias (A), congênitas (CC) e adquiridas (CA), para avaliar o tipo de parto, os fatores clínicos e obstétricos relacionados à determinação da via de parto e suas complicações. Foi verificado que as taxas de cesárea foram elevadas (T=57,2 por cento, A=45,6 por cento, CC=64,2 por cento, CA=55,7 por cento), e estiveram relacionadas à presença de: cesárea anterior (T), intercorrências obstétricas (T, CC e CA), idade gestacional no parto menor que 37 semanas (T, CA), insuficiência cardíaca (T, CC), medicamentos cardiovasculares (T, A) e cardiopatia congênita (T). Complicações obstétricas foram mais freqüentes em partos vaginais e as clínicas em cesáreas / The mode of delivery was studied in 571 pregnancies in cardiac women (T) in order to establish the clinical and obstetrical factors related to the kind of delivery and their complications. The results showed that cesarean rates were high (total=57,2 per cent, arrhythmias A=45,6 per cent, congenital diseases CD=64,2 per cent, and acquired diseases AD=55,7% per cent and were related to: previous cesarean sections (T), obstetrical events (T, CD, AD), prematurity (T, AD), heart failure (T, AD), cardiovascular drugs (T, A) and congenital heart disease (T). Obstetrical complications were more frequent in vaginal birth and clinical complications in cesarean section...

Uterine artery resistance index above 95 percentile: prevalence and adverse perinatal outcome prediction in pregnancies complicated by hypertensive disorders.

Uterine artery resistance index (UARI) was determined in a cohort of pregnant women complicated by a hypertensive disorder. The prevalence of the value above 95 percentile (UARI95) and its prediction of adverse perinatal outcomes were evaluated. Fifty-eight women were included in the study. The prevalence of UARI95 in this group of women was 27.6 per cent. The correlations between mean UARI95 and adverse perinatal outcomes were: 31.6 per cent sensitivity, 74.4 per cent specificity, with only 60.3 per cent accuracy. The mean UARI95 does not qualify as a reliable screening test for adverse perinatal outcomes in pregnancies complicated by hypertensive disorders.

Emerging insights into peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is relatively common in the Hospital Albert Schweitzer (HAS) district of Haiti. This investigation was carried out to expand epidemiologic data aiming at identifying risk factors for PPCM in this population. The HAS District PPCM Registry with 74 PPCM patients, enrolled from 1 February 2000 to 1 September 2002, served to identify the PPCM patients involved in this study. Thirty-seven non-PPCM Haitian mothers from the HAS district served as controls in the case-control study I and 32 non-PPCM Haitian mothers from the HAS district served as controls for the case-control study II. Following informed consent, patients and controls participated in clinical examination, echocardiography, epidemiologic questionnaire interviews, and immunohaematologic testing. Findings revealed: increased parity in PPCM vs control mothers (4.6 vs 3.3, p = 0.0252); 47% of the PPCM mothers had their initial diagnosis with the 5th or more pregnancy; increased number of patients with some hospital prenatal care in PPCM vs control mothers (42% vs 0%, p = 0.00001); and increased valley unit PPCM vs control mothers with no formal schooling (54% vs 24%, p = 0.0054). However, when hill-unit controls were included, there was no statistical difference in this category. Taking drinking-water from the river was found in 11% of the valley PPCM mothers vs 0% of the valley control mothers (p = 0.0509). Although the first 59 PPCM cases identified came from the valley units, recent identification of PPCM mothers in the hill unit indicates similar incidence of PPCM in mothers of remote hill area compared to the valley mothers--approximately 1 per 350 to 400 livebirths. Although the cause of PPCM and reasons for increased incidence in the HAS district of Haiti remain unknown, initial data present emerging insights and avenues to pursue in subsequent studies.

Factores epidemiológicos de la hipertensión en el embarazo / Epidemiological factors of hypertension during pregnancy

Se realizó un estudio de 64 pacientes con hipertensión arterial durante el embarazo en el año 1997, donde fueron analizados los principales factores epidemiológicos. La preeclampsia leve representó el 6,1 porciento del total de pacientes con hipertensión inducida por el embarazo (HIE). Del total de pacientes hipertensas hubo 61,1 porciento con factores de riesgo y de ellos, la obesidad ocupó el primer lugar (54,5 porciento). La mayoría de las pacientes con HIE fueron adolescentes (85,7) y el 64,9 porciento, nulíparas. Además se demostró que el 52,8 porciento de las HIE se diagnosticaron después de las 34 semanas

Enfermedad hipertensiva gravídica: consideraciones sobre su influencia en indicadores de morbimortalidad perinatal y materna durante 1997 / Gravidic hypertensive disease: considerations about its influence on the indexes of maternal and perinatal morbimortality during 1997

Se exponen los resultados de un trabajo realizado en las pacientes ingresadas y clasificadas como hipertensas durante el año 1997 en el Hospital Docente Ginecoobstétrico de Matanzas, que alcanzaron un total de 267 pacientes. De ellas, 3 313 eran no hipertensas, lo que arrojó una incidencia de 8,1 porciento de hipertensión gravídica.Se creó una base de datos que fue procesada posteriormente en el sistema Microstat, que permitió la aplicación del método de porcentaje, el método paramétrico del X2, donde £ 0,05 para percentil prefijado y las medias aritméticas. Las variables estudiadas permitieron demostrar por su significación estadística la influencia negativa de la hipertensión gravídica en nuestros indicadores de morbi-mortalidad