[Usefulness of stress-free test in preeclampsia]. / Utilidad de la prueba sin estrés en la preeclampsia.

INTRODUCTION: Poor perinatal outcome in patients with preeclampsia has been reported. This significant risk reinforces the importance of fetal evaluation. OBJECTIVE: The purpose of this study was to evaluate the utility of the nonstress test (NST) in preeclampsia. STUDY DESIGN: Criteria for inclusion in this report comprised pregnancies complicated by preeclampsia of longer than 28 weeks of gestation delivered 24 hours of final NST. The study population were divided into mild and severe preeclampsia. Each of the latter two groups was further subdivided into three subgroups by gestational age at 28-31, 32-34 and > 35 weeks. Measurements of adverse perinatal outcome included meconium staining, oligohydramnios, five-minute Apgar score less than 7 beyond 34 weeks of gestational age, intrauterine growth retardation, and perinatal death. RESULTS: A total of 250 patients with preeclampsia were analyzed, among these 147 with mild and 103 with severe disease. There were no stillbirths. Sensitivity of the NST was low ranged from 39% (mild preeclampsia) to 63% (severe disease). Its positive predictive value was equally low (66 and 45%) respectively. Specificity was quite high in both groups (89 and 64%). Its negative predictive value was 73% for mild disease and 78% for severe preeclampsia. CONCLUSION: The NST is an important test in antepartum care but based on its low sensitivity should not be considered as a stand alone test.

[Maternal morbidity and mortality in HELLP Syndrome]. / Morbimortalidad materna en síndrome de HELLP.

OBJECTIVE: To describe the maternal morbidity and mortality in pregnancies complicated by HELLP Syndrome. STUDY DESIGN: This is a descriptive and prospective study of women with HELLP Syndrome managed at our center from January 1998 through March 2000. Patients are grouped into 3-class system of Mississippi classification. RESULTS: 170 cases were analysed, 156 (92%), ocurred ante partum and 14 (8%) postpartum; 15 cases (9%) developed at < 27 weeks, 112 (66%) between 28 to 36 weeks of gestational age and 43 (25%) at term. Maternal morbidity included acute renal failure (13.5%), abruptio placentae (6.6%), pneumonia (3%), subcapsular liver hematoma (2.3%), pulmonary edema (2.3%), diseminated intravascular coagulopathy (1.7%) and cerebral hemorrhage (1.2%). Maternal mortality was 4.7% (8 patients), 7 deaths ocurred in patients with class I disease and only one with class II HELLP Syndrome. 6 maternal deaths (75%) were associated to eclampsia. Up to 85% of the maternal morbidity and mortality developed with class I disease (platelet nadir < 50,000 mm3. CONCLUSIONS: There is a progressive rise in maternal morbidity and mortality as the pregnancy moves from class III to class I HELLP Syndrome. 75% of maternal mortality was associated with eclampsia. Early diagnosis of this syndrome could improve maternal prognosis and outcome.

[Plasma concentration of biochemical markers in pre-eclampsia-eclampsia and its association with the severity of the disease]. / Concentración plasmática de indicadores bioquímicos en la preeclampsia-eclampsia y su asociación con la severidad de la patología.

UNLABELLED: It has been demonstrated that the concentrations of molecules related to endothelial cell dysfunction, coagulation and vasoconstriction are altered in preeclamptic patients, but they have not been evaluated in their relationship with the severity of preeclampsia. OBJECTIVE: To determine the relationship between the plasmatic concentrations of fibronectin ED1+, antithrombin III, prostacyclin and thromboxane, and the severity of preeclampsia. METHODS: Peripheral blood was collected from 215 women in the third trimester of pregnancy, admitted to the Luis Castelazo Ayala Gynecology and Obstetrics Hospital with mild preeclampsia (n = 103), severe preeclampsia (n = 71), HELLP syndrome (n = 25) or eclampsia (n = 16). Plasma aliquots were stored at -70 degrees C until analysis. Fibronectin ED1+ was measured by ELISA; antithrombin III activity was determined using an automated amidolytic technique, and the concentrations of the stable metabolites 6-keto-prostagiandin F1a and thromboxane B2 were measured by RIA. Statistical analysis included ANOVA and logistic regression. RESULTS: Maternal age was similar in all participants. Prematurity and low birth weight were present in the patients with severe preeclampsia, HELLP and eclampsia. The values for fibronectin were similar among the 4 groups of patients. Antithrombin III activity was significantly lower in the patients with HELLP. In patients with severe preeclampsia and HELLP syndrome, prostacyclin (Pc) and thromboxane (Tbx) concentrations were significantly higher, and the Pc/Tbx ratio was lower than in patients with mild preeclampsia. Those patients who had the highest thromboxane levels and the lowest Pc/Tbx ratio had a higher chance to develop severe preeclampsia or HELLP (5 times), as well as to have premature babies (12 times) than patients with mild preeclampsia. CONCLUSIONS: Our study demonstrates relationships among antithrombin III activity, prostacyclin and thromboxane concentrations, and the severity of preeclampsia. These compounds were significantly more altered in patients with HELLP syndrome, probably due to a higher organic and vascular dysfunction. Plasma determination of these compounds may be valuable as a tool in the screening of preeclampsia, and as an indicator of severity of the disease.

[Conservative management in severe pre-eclampsia]. / Manejo conservador en preeclampsia severa.

A total of 58 women with severe preeclampsia between 28-33 weeks of gestation were studied during the period from 1 October 1996 to 1 October 1997. Twenty-four women (42%) developed maternal or fetal indications necessitating early delivery within 48 hours, meanwhile the other 34 patients (58%) received expectant management. The average pregnancy prolongation period in the conservative management group was 6.4 days (range 3 to 18). The primary indications for delivery in this group were maternal indications 16 (47%), fetal compromise 13 (39%), 34 weeks of gestation 3 (8%), abruption placentae 1 (3%) and preterm labor 1 (3%). The mean birth weight and Apgar score at 5 minutes were 1520 +/- 310 g and 8, respectively. Expectant management was not associated with fetal death or maternal complications. The only neonatal death was related with sepsis and prematurity. The women in the early delivery group totaled two stillbirths and three neonatal deaths.

[The induction of fetal lung maturity in pre-eclampsia]. / Inducción de madurez pulmonar fetal en preeclampsia.

The consensus of the world literature shows that the prematurity is the first cause of perinatal morbidity and mortality. In this period several are the complications to short and long term that they can be presented, but seems be that it is the respiratory distress syndrome (RDS) the principal cause of this problems. This syndrome is frequent in the neonate of mothers with severe preeclampsia of early appearance in which exists the need of interruption the pregnancy. There are some articles, that show that preeclampsia by itself or the steroids given antenatally to the mother may accelerated the fetal lung maturity. The objective of the present study was analyze the behavior of the phospholipids responsible for the fetal lung maturity in amniotic fluid, with the administration of steroids to mothers with preeclampsia, and its correlation with the presentation of the RDS in the RDS in the newborn. 31 patients were included in the study, all of them with severe preeclampsia without complications, between 28 and 33 weeks of pregnancy. Twenty one patients received 12 mg of betametasone i.m. in 2 doses one each day (Group 1) and 10 patients who did not receive the steroid (Group 2). All the births were by cesarean section, amniocentesis was done during this procedure. The relation L/E > or = were observed in 81% of the patients of group 1. In the group 2 the relation L/E < or = 2 were observed in 80% of the cases. The RDS was present in 47% of the neonates in Group 1 and in 100% of the group that did not receive betametasone (p 0.004). The perinatal mortality (20%) was present only in the that did not receive betametasone. The findings of the present paper shows that the administration of betametasone in patients with severe preeclampsia accelerated the fetal lung maturity more the disease in consequence the frequency and severity of the RDS were less.

[Maternal mortality from eclampsia. A 5-year experience]. / Mortalidad materna por eclampsia. Cinco años de revisión.

UNLABELLED: Eclampsia is the most important cause of maternal mortality in our hospital. The main purpose of the present study was to define the main clinical, social and demographic profiles of the pregnant women at risk of fatality due to eclampsia. Of a total 71 maternal deaths that took place our hospital from January 1991 to December 1995, 37 cases were due to eclampsia, and they are the subject of the present analysis. RESULTS: The fatalities due to eclampsia represented 52.1% of the total mortality. The average age of these women were 26 years, 46% were primigravid and 20% were chronically hypertensive. Eclampsia was diagnosed at an average of 33 weeks gestation. The most important clinical signs were: severe headache, vomiting and convulsions. Systolic blood pressure on admission was 160 mm Hg with an average of 110 mm Hg for the diastolic figure. Proteinuria greater that 3 g/L was present in 45% of the cases. Signs of hemolysis, a platelet count below 100,000 mm3 and liver involvement with increased levels of amino-transferases. CONCLUSIONS: The pregnant women likely to die from eclampsia seems to be relatively older, multipara, with underlying chronic hypertension, with early onset of the clinical picture, and with multisystemic manifestations of the disease, mainly in the hematologic, hepatic and neurologic territories.

Caracteristicas electrocardiograficas en embarazo a termino y postparto.Correlacion con lipidos sericos. / Electrocardiographic characteristics in pregnancy at term and postpartum.Correlation with serum lipids

En el sindrome gravidico circulatorio se incluyen ciertas caracteristicas electrocardiograficas que no tienen significado patologico y cuyo origen es aun incierto.El objetivo del estudio es el conocer la incidencia de estas caracteristicas en 51 embarazadas sanas a termino; observar cuales de ellas persisten en el puerperio inmediato, a la semana y a las cuatro semanas, y tratar de correlacionar estos hallazgos con los niveles de lipidos sericos La mayoria de estas embarazadas tienen corazon con eje electrico dirigido a la izquierda que se torna a la derecha a las cuatro semanas de puerperio.La caracteristica electrocardiografica mas frecuente es el desnivel del segmento ST en derivaciones precordiales; sin embargo, no se considera exclusivo del embarazo ya que tambien se presenta en el puerperio. Con lo que respecta a otras caracteristicas su presencia es variable. Los niveles de lipidos son elevados durante el embarazo e inmediatamente despues del parto, descienden; la titulacion a las cuatro semanas no se llevo a cabo. No se encontro correlacion entre la incidencia de las caracteristicas electrocardiograficas y los niveles de lipidos sericos