Perinatal risk factors and Apgar score ≤ 3 in first minute of life in a referral tertiary obstetric and neonatal hospital.

This study aimed to identify the maternal, labour and newborn risk factors associated with an Apgar score of ≤3 in the first minute of life. This was a cross-sectional evaluation from an internal database information system in a tertiary referral obstetric and neonatal centre. Newborns with gestational age ≥24 weeks and birth weight ≥500 g with a registered Apgar score in the first minute of life were included. A total of 4475 newborns had an Apgar score >3 and 154 newborns had an Apgar score ≤3 in the first minute of life. A multivariate analysis revealed that eclampsia (OR = 31.53), twin pregnancy (OR = 7.06), analgesia (OR = 1.97), prematurity (OR = 2.00) and caesarean section (OR = 2.06) were risk factors for an Apgar score ≤3 in the first minute of life. Identification of these risk factors indicates prompt assistance during prenatal and labour care to prevent neonatal hypoxia and low Apgar scores, identifying newborns that may need resuscitation procedures.Impact StatementWhat is already known on this subject? Adequate prenatal care and proper labour management are the main factors that reduce the risk of complications at birth. The Apgar score at the first minute of life reflects conditions during labour but it is not a parameter that indicates resuscitation procedures. Previous studies have reported the association Apgar score at five minutes of life with the neonatal outcome.What the results of this study add? This study identifies risk factors associated with an Apgar score ≤3 in the first minute of life in a tertiary referral hospital. Eclampsia was the greatest independent risk factor, increasing by 31 times the risk of having an Apgar score ≤3 in the first minute of life.What the implications are of these findings for clinical practice and/or further research? Identification of these risk factors, especially prompt treatment antenataly and during labour for hypertensive pregnant women, can prevent neonatal hypoxia and reduce the number of newborns that may need resuscitation procedures.

[Transient central diabetes insipidus associated with pregnancy. Case report and bibliography review]. / Diabetes insípida central transitoria asociada a embarazo. Reporte de caso y revisión de bibliografía.

The case of a patient affected by transient diabetes insipidus associated with pregnancy, in the context of eclampsia, which was presented during seizures and identified by polyuria important, as well as changes in the urinary density occurs, and improving after nasal administration of desmopressin, which confirmed the diagnosis and treatment served completely by sending the picture without any sequel.

Se presenta el caso de una paciente afectada por una diabetes insípida central transitoria asociada al embarazo, en el contexto de una eclampsia, la cual se presentó durante las crisis convulsivas, identificándose por poliuria importante, así como alteraciones de la densidad urinaria, y mejorando tras la administración de desmopresina nasal, lo cual con-firmó el diagnóstico y sirvió de tratamiento, remitiendo totalmente el cuadro sin secuela alguna.

Blood pressure in adolescent patients with pre-eclampsia and eclampsia.

OBJECTIVE: To compare variables among adolescent and adult patients diagnosed with severe pre-eclampsia or eclampsia. METHODS: The present cross-sectional study enrolled patients with severe pre-eclampsia or eclampsia treated at an intensive care unit in Neiva, Colombia, between January 1 and November 30, 2014. Patients were stratified using age (younger than 20 years [adolescents] and aged at least 20 years [adults]) and patient variables were compared between groups. Maternal age, pregnancy duration at delivery, eclampsia, blood pressure, severe hypertension, maternal organ damage, HELLP syndrome, obstetric hemorrhage, laboratory findings, need for blood transfusion and fetal data were analyzed by group. RESULTS: There were 171 patients enrolled; 154 (90.1%) with severe pre-eclampsia and 17 (9.9%) with eclampsia. There were 46 (26.9%) adolescent patients and 125 (73.1%) adults, and 13 (28.3%) and 4 (3.2%) patients had eclampsia in the adolescent and adult groups, respectively (P=0.001). The systolic (P=0.081), diastolic (P=0.174), and mean (P=0.102) blood pressure did not differ significantly between the groups but were higher in the adult group. The incidence of severe hypertension was significantly higher among adult patients (P=0.037). CONCLUSION: The blood pressure used in defining pre-eclampsia and eclampsia should differ for adolescent patients in comparison with the rest of the population.

Síndrome de encefalopatía posterior reversible, eclampsia y síndrome de hellp / Reversible posterior encephalopathy syndrome, eclampsia and hellp syndrome

Resumen El síndrome de encefalopatía posterior reversible (PRES) es una entidad caracterizada por alteraciones clínicas y radiológicas debidas a un desbalance en la regulación de los vasos sanguíneos cerebrales. En la paciente obstétrica, el síndrome es más frecuente en la eclampsia y el síndrome de hemólisis, enzimas hepáticas elevadas y trombocitopenia (HELLP). Objetivo Caracterizar el PRES a nivel fisiopatológico, clínico, diagnóstico y terapéutico en la eclampsia y el síndrome de HELLP. Metodología Búsqueda bibliográfica con los términos MESH "Posterior Leukoencephalopathy Syndrome", "Pregnancy", "HELLP syndrome", "Eclampsia". Resultados La eclampsia es una de las condiciones más asociadas al PRES, las pacientes son primigestas, el curso clínico y los hallazgos imagenológicos son menos graves, el tratamiento debe enfocarse en la causa desencadenante, en este contexto debe optarse por desembarazar, administrar fármacos para manejar la hipertensión y las convulsiones. La literatura de PRES y HELLP se limita a series y reportes de caso. Las características propias de la fisiopatogenia del síndrome de HELLP pueden exagerar la respuesta vascular e incrementar el riesgo de sangrado lo que podría predisponer a un curso clínico más agresivo. El pronóstico del PRES en la paciente obstétrica es bueno, no se ha reportado riesgo de recurrencias en esta población. Conclusión Se necesitan estudios con un mayor seguimiento y número de pacientes que permitan aclarar las discordancias existentes. El conocimiento y manejo precoz del PRES contribuiría a la reducción de la morbimortalidad materna y las secuelas neurológicas a largo plazo.

ABSTRACT Posterior reversible encephalopathy syndrome (PRES) is an entity characterized by clinical and radiological manifestations due to an imbalance in cerebral blood vessels. In the obstetric patient, this syndrome is more frequent in eclampsia and hemolysis, elevated liver enzymes and thrombocytopenia (HELLP) syndrome. Aim To characterize PRES at physiopathological, clinical, diagnostic and therapeutic context in eclampsia and HELLP syndrome. Methodology Bibliographic search with the MESH terms "Posterior Leukoencephalopathy Syndrome", "Pregnancy", "HELLP Syndrome", "Eclampsia". Results Eclampsia is one of the most associated conditions with PRES, patients are primigravida, clinical course and imaging findings are less severe. The treatment should focus on the triggering cause, so emergent delivery and drugs to manage hypertension and seizures must be chosen. The literature on PRES and HELLP is limited to series and case reports. The characteristics of the pathophysiology of HELLP syndrome may exaggerate vascular response and increase the risk of bleeding, which may predispose to a more aggressive clinical course. Prognosis of PRES in the obstetric patient is good, there is not risk of recurrences reported in this population. Conclusion Studies with a greater follow-up and number of patients would clarify the existing discordances. Knowledge and early management of PRES would contribute to the reduction of maternal morbidity and mortality and long-term neurological sequelae.

Preeclampsia - eclampsia: factor de riesgo para síndrome metabólico / Preeclampsia-eclampsia: risk factor for metabolic syndrome

La historia de Preeclampsia-Eclampsia ha sido documentada como factor de riesgo para SM. Objetivo: evaluar la relación entre el antecedente del Síndrome Preeclampsia-Eclampsia y el diagnóstico del SM actual. Método: Un estudio de casos, descriptivo y retrospectivo de pacientes mayores de 35 años, con historia de Preeclampsia ­ Eclampsia por lo menos 20 años antes. Procedimiento: Recolección de datos en las consultas y hospitalización del Hospital Hernández, Los Magallanes, Caracas, Venezuela entre los meses de septiembre a noviembre del 2012, y se evaluó el 100% de las mujeres atendidas en la consulta creada para ese fin. A estas pacientes se les realizó una historia médica integral y se evaluaron los criterios diagnósticos del SM. Tratamiento estadístico: Las variables se registraron en una hoja de recolección de datos y se vaciaron en una base de datos Excel 2010. Se evaluaron desde el punto de vista descriptivo, las variables numéricas fueron tratadas con promedios y medidas de tendencia central y las cualitativas con proporciones y/o porcentaje. Las comparaciones intergrupales se realizaron a través de la prueba de chi cuadrado modificado para el tamaño de la muestra(AU)

It has been documented that a history of Preeclampsia - Eclampsia is a risk factor for metabolic syndrome. Objective: To evaluate the relationship between a history of preeclampsiaeclampsia syndrome and diagnosis of the current metabolic syndrome. Method: A case study, descriptive and retrospective patients in women older than 35 years, with a history of preeclampsia - Eclampsia at least 20 years earlier. Procedure: a data collection was used in ambulatory and hospitalization area of the Hospital José Gregorio Hernández between the months of September to November 2012, and assessed 100% of women are addressed in the query created for that purpose. These patients had a comprehensive medical history and diagnostic criteria of MS were evaluated. Statistics: Variables were recorded on a sheet of data collection and emptied in a database Excel 2010 data. They were evaluated from the descriptive point of view, numeric variables were treated with averages and measures of central tendency and qualitative proportions and / or percentage. Intergroup comparisons were carried out by the modified chi-square test for sample size(AU)

[Profile dipper/non-dipper in patient with severe preeclampsia, eclampsia and HELLP syndrome during pregnancy and puerperium]. / Perfil dipper-no dipper en pacientes con preeclampsia severa, eclampsia y síndrome de Hellp durante el embarazo y puerperio.

BACKGROUND: Blood pressure (BP) has a circadian rhythm, decreases at night and increases in the morning (dipper), have been observed in patients with impaired in this profile, increased at night and lower in the morning (no dipper) have increased cardiovascular risk. Preeclampsia-eclampsia complicates about 7% of pregnancies, preeclampsia is known to reverse the normal circadian cycle of the BP. OBJECTIVE: To determine the profile dipper/non-dipper in patients with severe preeclampsia, eclampsia and HELLP syndrome patients in Intensive Care and Obstetrics Hospital Juárez of México. MATERIAL AND METHODS: 15 patients were reviewed, 10 with severe preeclampsia, 4 with HELLP syndrome and 1 eclampsia, systolic, diastolic, mean and pulse PA were analyzed during the day/night and pregnancy/postpartum. Using ratios pregnancy day/night pregnancy, puerperium day/night postpartum dipper/non-dipper profile is determined RESULTS: Maternal age 30 ± 6.34 years, 7 primiparous (46%) 8 multiparous (54%), pregnancy was 31.67 ± 4.59 weeks. In all but two results in the ratio of pulse pressure during pregnancy was not the result dipper raiser and did not change during the postpartum period. CONCLUSION: in all patients during pregnancy profile was observed no dipper no change during the postpartum period. The established treatment did not modify this result. So it is appropriate to establish strategies to change this behavior and try to get the patient to regain normal circadian BP rhythm.

Actualización sobre las bases fisiopatológicas de la preeclampsia / Updating on the pathophysiological bases of preeclampsia

A pesar de los avances en el conocimiento clinicoepidemiológico de la obesidad, la prevalencia de esta ha aumentado significativamente, y su prevención y tratamiento continúa siendo un reto para los profesionales de la salud. Actualmente se considera que el control del balance energético se basa en un sistema de retroalimentación, cuyo objetivo es mantener los depósitos energéticos estables, a fin de lograr, con la disminución de peso, importantes beneficios en términos de salud y calidad de vida. En el presente trabajo se exponen algunas consideraciones relacionadas con la etiopatogenia de la obesidad y la importancia de la reducción de peso en los pacientes obesos(AU)

In spite of the advances in the clinical and epidemiological knowledge on obesity, its prevalence has increased significantly, and its prevention and treatment continue to be a challenge for the health professionals. At present it is considered that the control of the energy balance is based on a feedback system which objective is to maintain the stable energy deposits, in order to achieve, with the decrease of weight, important benefits in terms of health and life quality. In this work, some considerations related to the etiopatogenicity of obesity and the importance of weight reduction in the obese patients are exposed(AU)

Use of magnesium sulfate for treatment of pre-eclampsia and eclampsia in Mexico.

OBJECTIVE: To establish a baseline of magnesium sulfate utilization prior to publication of the updated 2006 technical guidelines on pre-eclampsia and eclampsia in Mexico, and to examine barriers to treating pregnant women with magnesium sulfate as perceived by maternal health experts. METHODS: In collaboration with the Federal Ministry of Health, medical charts were reviewed for 87 maternal deaths due to hypertensive disorders that occurred in Mexico in 2005. Evidence was gathered on whether magnesium sulfate had been indicated or administered. In-depth interviews with experts were conducted to identify barriers to treatment utilization. RESULTS: Magnesium sulfate had been used in 37.5% of severe pre-eclampsia and 47.7% of eclampsia cases. Thematic analysis of expert interview data revealed 4 primary barriers to the implementation of evidence-based guidelines and use of magnesium sulfate: lack of knowledge of magnesium sulfate, lack of acceptance, drug-related barriers, and insufficient monitoring or supervision. It was found that magnesium sulfate was not the treatment used for Mexican women who died of pregnancy-related hypertensive disorders in public facilities, and there was suboptimal implementation of evidence-based practices and official guidelines. CONCLUSION: The results highlight barriers to magnesium sulfate use, which constitutes a significant gap in treating women with eclampsia in Mexico.

Hemodynamic evaluation and anti-hypertensive schemes used in puerperal women following pre-eclampsia.

Pre-eclampsia is still a very prevalent disease with critical hemodynamic changes. This study was evaluated the major anti-hypertensive schemes used at the Materno Perinatal Hospital "Monica Pretelini" (HMPMP) hospitalized at the Obstetric Intensive Care Unit (OICU) for at least seven days. In other group of patients we compared hemodynamic monitoring with Swan-Ganz catheter versus transthoracic electrical bioimpedance (TEB) and gasometric formulas. Statistical analysis was done using the Statistical Package for Social Science (SPSS) software, version 17. Amlodipine + temisartan + prazocin was the preferred anti-hypertensive drug combination used in our intensive care unit. Sodium nitroprusside is required in 25% of patients until reaching control. There was no statistically significant difference in cardiac output calculated with gasometric formulas compared to thermodilution with Swan-Ganz catheter. Calcium antagonists + angiotensin II receptor blocker (ARB) + α-blockers offer the best option to control hypertension in puerperal women that followed pre-eclampsia, but oral and IV drugs to control hypertension is required in 20% of cases, in a Mexican Intensive Care Unit specialized in obstetrical patients. Hemodynamic monitoring with gasometric formulas is still usefull in this set of patients, without discarding TEB with a correction factor due to the accumulated extravascular water in these patients.

[Role of uric acid in preeclampsia-eclampsia]. / Papel del ácido úrico en la preeclampsia-eclampsia.

Uric acid is a terminal metabolite of the degradation of nucleotides, which increases their blood levels in patients with preeclampsia-eclampsia, increasing its synthesis by damage and death of trophoblastic cells in proliferation and decreased urinary excretion due a lower glomerular filtration rate and increased absorption in the proximal tubule. Hyperuricemia (> 4.5 mg/dL) is the first biomarker of the clinical chemistry considered as an early evidence of disease (< or = 20 weeks gestation). Uric acid concentrations are not only a criterion for establishing the correct diagnosis and the differential with other hypertensive states, but an indication of termination of pregnancy, often by cesarean section. Hyperuricemia has also demonstrated its usefulness as a predictor of maternal and fetal complications and maternal sequelae of late postpartum. Several studies have demonstrated its influence on the genesis of preeclampsia-eclampsia, either alone or jointly with other known processes (metabolic syndrome, oxidative stress, inflammation cascade, angiogenesis) that have a proven role in perpetuating the endothelial damage and maternal vascular smooth muscle cells. Further research is needed in large-scale clinical and experimental studies that expand our knowledge about the usefulness of uric acid as a biomarker of preeclampsia-eclampsia to allow early prevention and reducing the prevalence.

Plasma colloid osmotic pressure, Briones index and ascites in preeclampsia-eclampsia.

BACKGROUND: Capillary leak in preeclampsia-eclampsia (P-E) can be evaluated by calculating the plasma colloid osmotic pressure (COP) and the Briones index (BI). We undertook this study to report the values of plasma COP and BI in patients with P-E. We compared their correlation with ascites. METHODS: We studied 225 pregnant patients with P-E. We calculated plasma COP and BI as a total group and in three categories: 1) severe preeclampsia (SP) patients without HELLP syndrome, 2) SP patients with HELLP syndrome and 3) patients with eclampsia. We compared the correlation of both parameters as well as the correlation of each with ascites. Student's t test and Pearson correlation coefficient (r) were used for statistical analysis. RESULTS: Total COP was 20.14 +/- 2.52 mmHg. In 148 cases (65.78%) the results were normal (21.54 +/- 1.60 mmHg) and in 77 cases (34.22%) results were low (17.55 +/- 1.71 mmHg) (p = 0.058). There was no difference among the three categories (p >0.05). Total BI was 0.18 +/- 0.03, in 87 cases (38.67 %) it was normal (0.22 + 0.01) and in 138 cases (61.33 %) it was low (0.16 +/- 0.01) (p = 0.07). There were no differences among the three categories (p >0.05). We documented ascites of 627.27 +/- 85.21 ml in 11 patients (4.89%). The r of the COP vs. BI was 0.55, COP vs. ascites was -0.03 and BI vs. ascites was -0.43. CONCLUSIONS: We found low levels of COP in 34.22% and BI in 61.33% of patients. Both parameters had negative correlation with ascites.

Presión coloidosmótica plasmática, índice de Briones y ascitis en preeclampsia-eclampsia / Plasma colloid osmotic pressure, Briones index and ascites in preeclampsia-eclampsia

Introducción: La fuga capilar en la preeclampsia-eclampsia se puede evaluar calculando la presión coloidosmótica de las proteínas plasmáticas (PCO) y el índice de Briones. El objetivo de la presente investigación fue informar los valores de la PCO y del índice de Briones en preeclampsiaeclampsia, y comparar su correlación con ascitis. Material y métodos: Se estudiaron 225 pacientes gestantes con preeclampsia-eclampsia. Se calculó la PCO y el índice de Briones como grupo total y en tres categorías: a) preeclampsia severa sin síndrome HELLP, b) preeclampsia severa con síndrome HELLP y c) eclampsia. Se comparó la correlación de ambos parámetros entre sí y con la ascitis. Pruebas estadísticas: t de Student, coeficiente de correlación de Pearson (r). Resultados: La PCO total fue de 20.14 ± 2.52 mm Hg, en 148 casos (65.78 %) resultó normal (21.54 ± 1.60 mm Hg) y en 77 (34.22 %) fue baja (17.55 ± 1.71 mm Hg) (p = 0.058). No hubo diferencia entre las tres categorías (p > 0.05). El índice de Briones total fue de 0.18 ± 0.03, en 87 casos (38.67 %) resultó normal (0.22 ± 0.01) y en 138 (61.33 %) se encontró bajo (0.16 ± 0.01) (p = 0.07). No hubo diferencia entre las tres categorías (p > 0.05). Se documentó ascitis (627.27 ± 85.21 ml) en 11 pacientes (4.89 %). La r de la PCO versus índice de Briones fue de 0.55, PCO versus ascitis fue de −0.03 y del índice de Briones versus ascitis fue de −0.43. Conclusiones: Se encontraron valores bajos de la PCO en 34.22 % y del índice de Briones en 61.33 %. Ambos parámetros tuvieron correlación negativa con la ascitis.

BACKGROUND: Capillary leak in preeclampsia-eclampsia (P-E) can be evaluated by calculating the plasma colloid osmotic pressure (COP) and the Briones index (BI). We undertook this study to report the values of plasma COP and BI in patients with P-E. We compared their correlation with ascites. METHODS: We studied 225 pregnant patients with P-E. We calculated plasma COP and BI as a total group and in three categories: 1) severe preeclampsia (SP) patients without HELLP syndrome, 2) SP patients with HELLP syndrome and 3) patients with eclampsia. We compared the correlation of both parameters as well as the correlation of each with ascites. Student's t test and Pearson correlation coefficient (r) were used for statistical analysis. RESULTS: Total COP was 20.14 +/- 2.52 mmHg. In 148 cases (65.78%) the results were normal (21.54 +/- 1.60 mmHg) and in 77 cases (34.22%) results were low (17.55 +/- 1.71 mmHg) (p = 0.058). There was no difference among the three categories (p >0.05). Total BI was 0.18 +/- 0.03, in 87 cases (38.67 %) it was normal (0.22 + 0.01) and in 138 cases (61.33 %) it was low (0.16 +/- 0.01) (p = 0.07). There were no differences among the three categories (p >0.05). We documented ascites of 627.27 +/- 85.21 ml in 11 patients (4.89%). The r of the COP vs. BI was 0.55, COP vs. ascites was -0.03 and BI vs. ascites was -0.43. CONCLUSIONS: We found low levels of COP in 34.22% and BI in 61.33% of patients. Both parameters had negative correlation with ascites.

Cytokine gene polymorphisms in preeclampsia and eclampsia.

The clinical spectrum of preeclampsia (PE) ranges from mild hypertension to severe vasospasm associated with convulsions and multiple organ damage. The biological factors that determine the progression of PE to eclampsia (E) are unknown. Endothelial cell activation seems related to an impaired maternal immune response. The production of cytokines, IL-10 and TGF-beta1, is apparently suppressed, and altered IL-2/IL-10 and TNF-alpha/IL-10 ratios have been reported in preeclamptic cases. The relationship between PE and cytokine gene polymorphism has been studied, but there are few studies that include eclamptic patients. This study aimed at investigating whether polymorphisms in genes, TNF-alpha promoter (-308 G>A), IL6 promoter (-174 G>C), IFN-gamma intron 1 (+874 A>T), IL10 promoters (-1082 A>G), (-819 C>T) and (-592 C>A) and TGF-beta1 codon 10 (+869 T>C) and codon 25 (+915 G>C) are associated with E and/or PE. Genotyping was carried out in 266 Mulatto women from the northeastern region of Brazil who were referred to a single maternity hospital: 92 with PE, 73 with E and 101 normotensive controls. The chi(2) or Fisher's exact tests were used to compare genotype frequencies. Among the six single-nucleotide polymorphisms (SNPs) studied, we found no difference in genotype frequencies between the groups. There was a higher frequency of IFN-gamma (+874 A) in eclamptic patients in comparison with that in controls. (70.3 vs. 57.8%, respectively; P=0.02). There were no other significant differences in allelic frequencies between eclamptic, preeclamptic and control groups We found no independent association between any single SNP and PE or E risk in this population of Mulatto women from the northeastern region of Brazil.

Conducta anestésica en la embarazada hipertensa / The anesthetic management of the hypertensive pregnant

El principal objetivo de esta revisión es examinar el manejo anestésico de la embarazada con hipertensión arterial. Para tal fin, es necesario comenzar analizando dos aspectos fundamentales de este tipo de pacientes. En primer lugar, la clasificación de los estados hipertensivos del embarazo para poder distinguir entre hipertensión independiente de la gestación (hipertensión crónica) y la hipertensión producida por el embarazo (preeclampsia). Estas patologías son completamente distintas. Mientras que en la hipertensión crónica la enfermedad es la hipertensión, en la preeclampsia la hipertensión es solo un signo más de una enfermedad multisistémica. En segundo lugar, la fisiopatología de la preeclampsia. Actualmente se considera que el punto de partida de la enfermedad es el daño endotelial (de causa desconocida) que al afectar la mayoría de los órganos y sistemas es el responsable de las manifestaciones clínicas de la enfermedad. Teniendo en cuenta estos dos aspectos, se comenta el manejo anestésico. El autor considera que ni la hipertensión crónica ni la preeclampsia constituyen per se contraindicaciones para la anestesia regional central. El tema de la anestesia subaracnoidea debe ser considerado en función de las dosis y los fármacos empleados. Las contraindicaciones de la anestesia regional en la preeclampsia son las mismas que en las pacientes no hipertensas. (AU)

[Preeclampsia-eclampsia: a change in utero-placental microcirculation. Immunologic, histologic, and biochemical features]. / Preeclampsia-eclampsia: una alteración en la microcirculación útero-placentaria. Aspectos inmunológicos, histológicos y bioquímicos.

BACKGROUND: To know the alterations in the microcirculation of the placenta, umbilical cord, as well as the immune and hemorrheologic disorders in preeclampsia-eclampsia. MATERIAL AND METHODS: Two groups were conformed, 30 patients each, all of them with pregnancy of more than 24-week gestation. Group A included patients with preeclampsia-eclampsia and group B (control group) included women with normal pregnancy. In all patients determinations of levels of platelets, fibrinogen, antinuclear antibodies, IgG and IgM anticardiolipin, VDRL were made; clotting times were determined, and histopathologic analyses (placenta, umbilical cord and uterus-placenta membranes) were performed. RESULTS: Platelet levels in the group A were normal in 40% and low in 60%. In group B they were normal in 83.3% and low in 16.7%. with p < 0.05. In group A fibrinogen was normal in 10% and high in 90%; in the group B it was normal in 62.1% and high 37.9%, with p < 0.05. In group A prothrombin time (PT) was normal in 40% and high in 60%; in group B it was normal in 76.7% and low in 23.3%, with p < 0.05. in group TPT was normal in 36.7% and high in 62.1%, with p > 0.05. VDRL was negative in the 100% of the women of group A and positive in the 3.3% of the controls with p > 0.05. The antinuclear antibodies were positive in 6.7% in group A, and in 23.3% in group B, p < 0.05. IgG anticardiolipin antibodies were negatives in the 100% in both groups and IgM antibodies were negative in 96.7% in the group B and 3.3% in group A, p > 0.05. Analysis of histopathologic and immune changes did not show statistic significance when comparing both groups. CONCLUSIONS: Statistical and clinical significance was observed only in the hemorrheologic changes (PT, TPT, fibrinogen and platelets) and in the newborn weight.

Frotis de sangre periférica y alteración orgánica en la preeclampsia-eclampsia / Peripheral blood frotis and organic alteration in preeclampsia-eclampsia

Introducción: la preeclampsia-eclampsia tiene un sustrato fisiopatológico común que es la lesión del endotelio vascular, condicionante del desarrollo de microangiopatía trombótica-hemolítica, que propicia la alteración de órganos blanco, el frotis de sangre periférica es un estudio sencillo que apoya el diagnóstico y pronóstico de esta entidad. Objetivo: hacer una correlación clínico-patológico entre pacientes con preeclampsia-eclampsia, los hallazgos morfológicos del frotis de sangre periférica y el desarrollo de alteración orgánica. Material y pacientes: se diseñó un estudio piloto prospectivo, transversal y comparativo de pacientes que ingresaron a la Unidad de Cuidados Intensivos del Hospital con diagnóstico de preeclampsia-eclampsia durante un periodo comprendido de junio de 1999 a febrero del 2000, y fueron manejadas de acuerdo con el protocolo del propio hospital que incluyó la realización de un frotis de sangre periférica a su ingreso. El método consistió en hacer una revisión de los expedientes consignando las disfunciones documentadas de acuerdo con el criterio internacional y dividimos la población en dos grupos: grupo A = pacientes con frotis negativo y grupo B = pacientes con fro-tis positivo, se calculó razón de momios y se comparó cada grupo en cuanto a las principales variables valoradas mediante la prueba paramétrica t de Student y los resultados los expresamos en media, desviación estándar y porcentajes. Resultados: incluimos 77 pacientes: nueve (12 por ciento) con frotis negativo identificando una alteración orgánica (grupo A), 78 pacientes (88 por ciento) con frotis positivo documentando 56 disfunciones orgánicas (grupo B). La razón de momios de 34, destacando diferencias significativas en variables hematológicas y renales principalmente. Se concluye que de acuerdo con la medida de riesgo calculada, se estima que la probabilidad de que una paciente con preeclampsia-eclampsia desarrolle alteración orgánica, es 34 veces mayor cuando se asocia a un frotis de sangre periférica positivo, por lo que proponemos que esta prueba se realice a todas las pacientes con esta patología como una prueba predictiva de alteración orgánica que además resulta ser barata y fácil de hacer.