Avaliação da prevalência de anemia pós-parto e fatores associados em uma maternidade terciária do estado do Piauí / Prevalence of postpartum anemia and associated factors in a tertiary maternity hospital of the state of Piaui

Este trabalho avaliou a prevalência de anemia puerperal por meio das dosagens de hemoglobina (Hb) e hematócrito (Ht) numa maternidade pública terciária do estado do Piauí e os fatores de risco associados à presença de anemia. No total, 198 puérperas internadas na maternidade foram submetidas a entrevista e análise do prontuário e do cartão pré-natal. Foram feitas coletas de amostra de sangue venoso periférico antes do parto, 24 horas após o parto vaginal e 48 horas após o parto cesariano. A prevalência de anemia pós-parto encontrada na maternidade estudada foi de 27,27%. A presença de anemia pré-parto e gemelaridade e o ganho de peso foram os fatores de risco significativamente associados à anemia pós-parto.(AU)

This study evaluated the prevalence of puerperal anemia using hemoglobin (Hb) and hematocrit (Ht) measurements in a public tertiary maternity hospital in the state of Piauí and the risk factors associated with the presence of anemia. In total, 198 puerperal women admitted to the maternity hospital were interviewed, analyzed the medical record and the prenatal card. A peripheral venous blood sample was collected before delivery, 24 hours after vaginal delivery and 48 hours after cesarean delivery. The prevalence of postpartum anemia found in the maternity studied was 27.27%. The presence of pre-delivery anemia, twinning and weight gain were the risk factors significantly associated with postpartum anemia.(AU)

Primigravida with Bernard-Soulier Syndrome: a case report.

BACKGROUND: Bernard-Soulier Syndrome is a rare congenital bleeding disorder, mainly inherited in an autosomal recessive pattern. It is characterized by a genetic defect on one of the four genes encoding the subunits of the transmembrane protein complex GPIb-V-IX, physiologically expressed only in platelets. The exact phenotype varies widely from individual to individual depending on the particular mutation presented. Currently, there is no consensus about ideal management of affected pregnant women, in face of the scarcity of cases. CASE PRESENTATION: We report on a 28-year-old Black Brazilian primigravida who was referred to our maternity hospital, a tertiary care center, for decision about the most adequate mode of delivery. She was admitted with a platelet count of 43.000 plt/µL, and hemoglobin of 13.6 g/dL. Platelet transfusion was regarded as a necessary prophylactic measure prior to delivery. Ten units of random donor platelets were administered on the course of three days, after which the patient was submitted to an elective cesarean section delivery under general anesthesia at 40 weeks of gestational age. A healthy male baby with a normal birthweight of 3.615 kg was delivered. After the delivery, the mother's state continued being assessed daily, with special attention taken to lochia and surgical wound healing. At one week postpartum, a complete blood count revealed a platelet count of 41.000 plt/µL, and hemoglobin of 13.3 g/dL. As there were no signs of neither evident nor occult hemorrhage, and surgical wound was healing accordingly, the patient was discharged, after being oriented about bleeding preventive measures. CONCLUSION: The peripartum period is regarded as the most crucial moment of pregnancy in women with Bernard-Soulier Syndrome, hence the importance of a judiciously planned mode of delivery, and of careful prophylaxis against bleeding beforehand. Furthermore, absence of complications during the peripartum period does not predict how the woman will do subsequently. Strict vigilance is warranted at least until six weeks postpartum, due to the virtual risk of secondary postpartum hemorrhage.

Oxidative stress and immunological alteration in women with preeclampsia.

OBJECTIVES: To determine plasma concentrations of malondialdehyde (MDA) and of inflammatory markers in women with preeclampsia. METHODS: A case-control study was conducted on 50 preeclamptic and 50 healthy pregnant women. The concentrations of MDA were determined by the method of thiobarbituric acid reactive substances. Markers of inflammation were determined by the multiplex method. RESULTS: The concentrations of MDA did not differ between groups (p > 0.05) and the preeclampsia group had significantly higher IL-6, IL-10, TNF-α and IL-6/IL-10 ratio, compared to those with normal pregnancy. CONCLUSIONS: The MDA is a nonspecific marker for oxidative stress in preeclampsia, and the gestantes with preeclampsia have immune dysfunction.

Enzyme activity of superoxide dismutase and zincemia in women with preeclampsia / La actividad de la enzima superóxido dismutasa y zincemia en mujeres con preeclampsia

Introduction: Preeclampsia is a complex syndrome of unknown aetiologic origin. It is characterized by the clinical triad of hypertension, edema and protenuria. Current concepts of the genesis of preeclampsia include endothelial dysfunction and oxidative stress. Objective: This study assessed the relationship between the activity of superoxide dismutase, the zincemia and the preeclampsia. Methods: A case-control study was carried out with 94 women, age between 17 and 44 years, which were divided in two groups: women with preeclampsia (n = 44) and control group women with normal pregnancy (n = 50). The activity of superoxide dismutase enzyme was determined according to Ransod kit. Zinc concentrations in plasma and erythrocytes were determined using the flame atomic absorption spectrophotometry technique, both determined before delivery and during puerperium. Student's t-test and the paired t-test were used for statistical analysis, and significance was established at p < 0.05. Results: The study revealed plasma hypozincemia more pronounced in women with severe preeclampsia (p < 0.05). This behavior was not observed in eryth-rocytes, whose concentrations remained stable, before delivery and puerperium in women with preeclampsia and normal pregnancy. The antioxidant activity of the enzyme superoxide dismutase was found elevated in women with and without preeclampsia (p>0.05), with significant reduction in activity in the postpartum period (p < 0.05) in both groups studied (p>0.05). Conclusions: This study shows there are alterations in biochemical parameters of zinc in women with preeclampsia. The activity of superoxide dismutase shows that this marker cannot be used to predict the evolution of the disease (AU)

Introducción: La preeclampsia es un síndrome de origen desconocido del punto de vista etiológico. Se caracteriza clínicamente por una tríada de síntomas: edema, hipertensión y proteinuria. Los conceptos actuales sobre la patogénesis de la preeclampsia incluyen la disfunción endotelial y el estrés oxidativo. Objetivo: En este estudio se evaluó la relación entre la actividad de la superóxido dismutasa, zincemia y preeclampsia. Métodos: Este estudio de casos y controles se llevó a cabo con 94 mujeres, con un rango de edad situado entre 17 y 44 años, los que fueron divididos en dos grupos: mujeres con preeclampsia (n = 44) y grupo control, las mujeres con embarazo normal (n = 50). La actividad de la superóxido dismutasa se llevó a cabo según el kit Ransod. Las concentraciones de zinc en plasma y los eritrocitos fue realizada según el metodo de espectrofotometría de absorción atómica de llama, ambos determinados antes del nacimiento y después del parto. La prueba de la t de Student y la prueba t pareada fue utilizada para el análisis estadístico (p < 0,05). Resultados: El estudio reveló hypozincemia en el plasma, con valores más altos en las mujeres con preeclampsia severa (p < 0,05). Esta situación no fue observada en los eritrocitos, cuya concentración se mantuvo estable antes del parto y en el puerperio, en las mujeres con preeclampsia y en las con embarazo normal. La actividad antioxidante de la superóxido dismutasa, se encontró elevada en las mujeres con y sin preeclampsia (p > 0,05), con una reducción significativa en la actividad en el periodo postparto (p < 0,05) en ambos grupos (p > 0,05). Conclusiones: Este estudio revelló que hay cambios en los parámetros bioquímicos de zinc en mujeres con preeclampsia. La actividad de la superóxido dismutasa se revelló que este marcador no se puede utilizar para predecir la progresión de la enfermedad (AU)