Role of cervical cerclage and prolonged antibiotic therapy with azithromycin in patients with previous perinatal loss amnionitis.

In the group of 35 patients with cerclage, intermediate fetal mortality was reduced from 37.1% to 0 (p < 0.001); late fetal mortality rate from 8.5% to 2.8% (p = 0.606); prematurity from 65.7% to 5.7% (p < 0.001); newborn underweight from 11.4% to 5.7% (p = 0.671); newborns with very low weight from 34.2% to 0 (p < 0.001) and the abortion rate from 8.5% to 0 ( p < 0.001). In the group of 19 patients without buckling, intermediate fetal mortality was reduced from 26.3% to 10.5% (p = 402); late fetal mortality from 63.1% to 0 (p < 0.001); prematurity 78.9% to 31.5% (p < 0.009); the newborn of low weight from 31.5% to 10.5% (p = 0.234); newborns with very low weight from 68.4% to 15.7% (p < 0.003) and the abortion rate from 36.8 to 0 (p < 0.001). In conclusion, we believe the results of this study demonstrate the effectiveness of therapeutic and prophylactic cervical cerclage associated with prolonged antibiotic therapy.

PP113. NT-Pro-BNP: A predictor of adverse maternal outcomes in hypertensive gestational syndromes?

INTRODUCTION: BNP (brain-type natriuretic peptide) is released by cardiomyocytes, as a pro-hormone, in response to parietal stress augmentation and systemic endothelial dysfunction, and then Pro-BNP is cleaved into: NT-Pro-BNP and BNP fragment in 1:1 ratio. BNP is considered an important component of the adaptative mechanism that helps to reduce the load on the myocardium, through systemic vasodilatation, reduction in venous return and reduction in vascular volume. Hypertensive Gestational Syndromes (HGS) are considered to share those mechanisms, but the role of NT-Pro-BNP to evaluate maternal outcomes, is not well defined. OBJECTIVES: Evaluate the correlation between NT-Pro-BNP: in Normotensive Pregnant Women (NPW) and HGS with established markers of adverse maternal outcomes in HGS. METHODS: We performed a transversal case-control study to analyze NT-Pro-BNP in 68 patients with HGS vs 80 NPW admitted at a private hospital, and to evaluate its correlation with established clinical and blood markers of maternal outcomes at hospital admission. Patients with renal chronic failure, previous cardiac disease and mola were excluded. We used the Pearson and Kendall correlation test for quantitative variables and the non-parametrical Mann-Whitney test for qualitative variables. RESULTS: The average maternal age was: NPW 33.2 years, HGS 33.8 years; average gestational age at delivery: NPW 38.5 weeks, HGS 35.3 weeks; first pregnancy: NPW 36%, HGS 56%; birth average weight: NPW 3351.6g, HGS 2615.5g; media NT-Pro-BNP: NPW 59.7pg/ml, HGS 704.8pg/ml. None of the NPW had high levels of NT-Pro-BNP. In the HGS group: 57% had preeclampsia, 10% HELLP, 25% gestational hypertension and 8% chronic hypertension. In the HGS media values for: proteinuria 1.5g/24h, glutamic-oxalacetic transaminase 86 UI/L, platelets 231,688/mm(3), glutamic-pyruvic transaminase 100 UI/L, uric acid 48mg/dl, hematocrit 33%, alkaline phosphatase 152 UI/L, lactic dehydrogenase 284 UI/L. In the HGS the following significant correlations were found: for NT-Pro-BNP relation to: proteinuria (0.34 p=0.001), glutamic-oxalacetic transaminase (0.375 p=0.001), platelets (-0.353 p=0.001), glutamic-pyruvic transaminase (0.317 p=0.001), uric acid (0.398 p=0.001), hematocrit (-0.183 p=0.048), gestational age at delivery (-0.29 p=0.002), birth average weight (-0.23 p=0.018), cardiac failure ( p=0.001), number of used anti-hypertensive drugs (0.367 p=0.004), lactic dehydrogenase (0.65 p=0.001). The media NT-Pro-BNP was: 936pg/ml in preeclampsia , 1909pg/ml in HELLP, 150pg/ml in gestational hypertension and 107pg/ml in chronic hypertension. The highest NT-Pro-BNP level was 12,386pg/ml in a patient with systolic dysfunction (LVEF: 35%) associated with preeclampsia. After delivery, 13% HGS women had persistent hypertension post-partum, and this did not correlate with the level of NT-Pro-BNP at hospital admission. CONCLUSION: NT-Pro-BNP significantly correlates with established markers of adverse maternal outcomes in HGS, probing to be useful in routine maternal evaluation in this setting.

Uric acid levels: a useful index of the severity of preeclampsia and perinatal prognosis.

Maximum serum uric acid (SUA) levels during the third trimester of pregnancy were selected in 215 hypertensive pregnant women: 100 with mild preeclampsia (PE), 25 with severe PE, 70 with essential hypertension (EH) and 20 with EH with superimposed PE (EH + PE). The increase in SUA levels was statistically significant in women with severe PE (6.22 mg% +/- 1.30 mg%) and with EH + PE (6.09 mg% +/- 1.53 mg%) when compared with values in mild PE and EH women (4.85 mg% +/- 1.34 mg% and 4.95 mg% +/- 1.22 mg%, respectively). A significant decrease in average gestational age at delivery and a greater percentage of small-for-gestational age newborns were observed in women with severe PE and EH + PE, compared with patients with mild PE and EH. No correlation within the groups was found between SUA levels and fetal weight. To conclude, the determination of SUA concentration for the clinical screening of a pregnancy complicated by hypertension is an easy and inexpensive method for the prediction of perinatal results associated with severe PE.