ABSTRACT
INTRODUCTION: The maternity mortality rate in the Santos lowlands region, priority region of São Paulo/Brazil, is higher when compared to regions in the state of São Paulo. The hypertensive disorders are implicated in approximately 20% of death. Severe preeclampsia (PE) is recognized as the frequent diagnosis associated with maternal and fetal ominous outcomes. The recognition of potential risk support antenatal intervention which could anticipate the installation of catastrophic results. Identifying the epidemiological profile of women who may present with this evolution can guide public health policies and actions of the professionals involved in caring for these women avoiding preformed concepts and contributing to the recognition of local reality situation. OBJECTIVES: Identify the epidemiological profile of women affected by severe PE. METHODS: A descriptive study involving 46 pregnant women admitted to specialized hospital for high-risk pregnancy with the diagnosis of severe PE according to the criteria of NHBPEP (2000), as: blood pressure ⩾160/110mmHg, proteinuria 2.0g/24h or +2 dipstick, serum creatinine >1.2mg/dl (new onset), platelets <100,000/mm(3), microangiopathic hemolysis (increased lactate dehydrogenase), elevated alanine aminotransferase or aspartate aminotransferase, persistent headaches or other cerebral or visual disturbance, persistent epigastric pain or eclampsia in the period from January/2008 to November/2010. RESULTS: The average age of the pregnant women was 25.5years (±6.5), 11 women were multiparous and nulliparous and 35 (76.1%), the average gestational age at admission was 34 4/7, developing to eclampsia and/or HELLP syndrome were 07 women (15.2%), admission often occurred before the installation of labor in (93.5%) had a previous diagnosis of chronic hypertension (30.4%) and in all cases magnesium sulfate administration with an average length of 32h (±16.6h). CONCLUSION: The occurrence of severe PE was more common in nulliparous women at the age of 25years, admitted in prematurity and not in preterm labor. The outcome of seizure and/or HELLP has a considerable impact. The association of chronic hypertension with severe PE is more than 1/4 of the cases. These data are equivalent to other areas of Brazil and may contribute to emphasize the practice of prenatal acting that can recognize and pre-comment possible adverse developments and attitudes aimed at intercepting the process.
ABSTRACT
INTRODUCTION: The hypertensive pregnancy disorders affect 7.5% of Brazilian women, being a major cause of maternal and perinatal morbidity and mortality, affecting 6-10% of primigravidae. They represent a significant cause of prematurity birth, with elective responsible for 20-30% of premature births, with higher incidence of neonatal morbidity due to high rates of complications in short and long term. OBJECTIVES: Identify the repercussions in a short time, on caused by elective obstetric parity decisions in women with hypertensive neonatals pregnancy syndromes. METHODS: Retrospective analysis of medical records of pregnant women admitted to Hospital Guilherme Álvaro, in the city of Santos/SP - Brazil, between Jan/2005 to Jan/2012. Calculations were performed for dichotomous variables and an epidemiological analysis with data obtained on pregnant women with hypertension with a single fetus, subjected to delivery before 37 weeks. Classification of Hypertensive Syndromes followed the criteria of the NHBPEP - 2000, after blood pressure measurements were calibrated following standard technique: Chronic hypertension (CH), Pre-eclampsia, superimposed pre-eclampsia and late gestational hypertension and multiple births were excluded, premature labor and fetal malformations, totaling 102 cases. RESULTS: Throughout the study, it was observed that 67.6% are appropriate for gestational age, birth weight 1500-2500grams (43.1%). Support in the neonatal were excluded ICU was necessary in the vast majority (75.7%), and length of stay exceeding 28 days in 29.3% of cases. The main indication was respiratory distress syndrome (63.6%) requiring intubation orotraquel and jaundice in 18.2% of premature infants was a common comorbidity (39.4%). Even with all the support in-hospital, the neonatal mortality was present in 8.1% of cases. The main indication of the resolution was for obstetric maternal complications (61.8%) where pre-eclampsia and preeclampsia superimposed were expressions which caused more frequent (42.2 and 40.2% respectively), showing the level of proteinuria between two -4.9g (32.1%). Gestational age at delivery was 32-34 weeks (43.1%), corticosteroid therapy was not performed (54.9%) and cesarean delivery was (94.1%). The most frequent age group was 20-34 years (53.9%), Caucasian (54.9%), primigravida (62.7%) and less than five prenatal visits (36.3%) were performed. CONCLUSION: The hypertensive pregnancy are risk factors for preterm elective delivery and is more frequent before 34 weeks, resulting in high perinatal morbidity and mortality, especially in cases of preeclampsia with severe clinical presentation and long hospital stays, with consequent costs and conducting excessive procedures in the neonate. Enable early referral to specialist services and consequent prenatal follow up, enables the adoption of early action, such as clinical support in a timely manner to facilitate the handling of cases which are still stable, optimizing the opportunity for administration of antenatal corticosteroids. It is necessary to review decisions about the mode of delivery in prematurity related to hypertension cases, with the aim of increasing the occurrence of vaginal deliveries.
