Hallazgos ecocardiográficos en el embarazo y posparto tardío en mujeres mexicanas sanas / Echocardiographical findings in pregnancy and late postpartum of healthy mexicans women´s

Resumen: OBJETIVO: Evaluar y comparar la adaptación cardiovascular materna mediante variables antropométricas y parámetros hemodinámicos con ecocardiografía Doppler en mujeres mexicanas sanas, con embarazo único. MATERIALES Y MÉTODOS: Estudio prospectivo, observacional, longitudinal, efectuado de enero de 2014 a enero de 2017 en mujeres que cursaban el segundo y tercer trimestres del embarazo. A los 6 meses posparto se practicaron ecosonogramas obstétricos y registros ecocardiográficos Doppler a todas las pacientes del estudio. Cada paciente fue su propio control. Se aplicó el análisis estadístico con SPSS Windows v17, ANOVA para comparar los 3 grupos, con valor significativo de p < 0.05, y correlación no paramétrica de Pearson. RESULTADOS: Se estudiaron 30 embarazadas con edad promedio de 22.5 ± 3.1 años. Las semanas de embarazo se corroboraron con ultrasonido obstétrico. En el ecocardiograma transtorácico se observaron cambios significativos entre el segundo trimestre y los 6 meses posparto: el ventrículo izquierdo en diástole (cm), 4.5 ± 2.5 vs 4.2 ± 3.3, p < 0.01. El volumen diastólico final del ventrículo izquierdo (mL) fue de 93 ± 14.8 vs 78 ± 17.8 (p < 0.05), el volumen latido (mL): 99.5 ± 15.7 vs 86 ± 11.8 (p < 0.01). Las resistencias vasculares sistémicas (dinas/seg/cm-5), 870 ± 108 vs 1262 ± 176 (p < 0.01). Del segundo al tercer trimestres y posnatal hubo incrementos en la aurícula izquierda (cm): 3.1 ± 4.6, 3.3 ± 4.4, 2.9 ± 4.3 (p < 0.001), gasto cardiaco (L/m): 6.8 ± 0.4, 7.0 ± 0.4, 4.7 ± 0.4 (p < 0.001). CONCLUSIONES: El embarazo es un estado de sobrecarga transitoria de volumen con importantes efectos orgánicos y funcionales, sobre todo en el segundo trimestre.

Abstract: OBJECTIVE: The aim of this prospective, observational and longitudinal study, was to evaluate and to compare the maternal adaptation through changes on anthropometric and Doppler echocardiographic parameters in Mexican normal pregnancy with single product. MATERIALS AND METHODS: Prospective, observational, longitudinal study, from January 2014 to January 2017. Obstetric ecosonograms and echocardiographic Doppler studies were performed on 2nd and 3rd trimester and six months postpartum. Each patient was her own control. The data were analyzed using SPSS Windows 17, ANOVA for compared the 3 groups with P value < 0.05 was considered significant, as well as a non-parametric correlation of Pearson. RESULTS: There were thirty pregnant with a mean age 22.5 ± 3.1 years-old, between 2nd and 3rd trimester, with obstetrics ultrasound were corroborated gestational age. With transthoracic echocardiography, we found significant changes between 2nd trimester and 6 month post-partum, among the main, the left ventricle (LV) in diastole (cm), 4.5 ± 2.5 versus 4.2 ± 2.3 (p < 0.01), end diastolic left ventricle volume (mL) 93 ± 14.8, vs 78 ± 17.8 (p < 0.05). Stroke volume (mL) 99.5 ± 15.7 vs 86 ± 11.8 (p < 0.01). Systemic vascular resistance (dyne/sec/cm5 ) 870 ± 108 vs 1,262 ± 176 (p < 0.001). From, 2nd and 3rd trimester and postpartum, left atrial diameter (cm), 3.1 ± 4.4, 3.3 ± 4.4, 2.9 ± 4.3 (p < 0.001). Cardiac output (L/m), 6.8 ± 0.4, 7.0 ± 0.4, 4.7 ± 0.4 (p < 0.001). CONCLUSION: Pregnancy is a transitory overload condition with important organic and functional effects mainly in the second trimester.

[Circadian rhythm of blood pressure in patients with chronic hypertension and pregnancy]. / Ritmo circadiano de la presión arterial en pacientes con hipertensión crónica y embarazo.

BACKGROUND: Ambulatory blood pressure monitoring during 24 hours shows a blood pressure variability. The prevalence of chronic hypertension in pregnant women is 1-5%, so it is important to know the changes in blood pressure and cardiovascular risk and prevent complications to the mother and fetus. OBJECTIVE: To know the circadian rhythm of the blood pressure in the chronic hypertensive pregnant patients, through the ambulatory blood pressure monitoring. MATERIAL AND METHODS: A cross-sectional and descriptive study included chronic hypertensive pregnant patients, with > 20 weeks of gestation. Assessment of factors related to gynaecologic characteristics, according to the inclusion criteria underwent a washout period of two weeks and they were monitored with a Spacelabs 90207 monitor blood pressure. Quantitative variables by Student t test, one-way ANOVA and Pearson correlation were analysed. RESULTS: 16 chronic hypertensive pregnant patients were included, whose ambulatory blood pressure monitoring for the systolic blood pressure in 24 hours averaged 117.12 ± 5.85 mmHg; 24 hours diastolic blood pressure 71.31 ± 5.89 mmHg; daytime systolic blood pressure 120.18 ± 5.75 mmHg, nocturnal systolic blood pressure 110.31 ± 8.41 mmHg; daytime diastolic blood pressure 75.43 ± 7.32 mmHg, nocturnal diastolic blood pressure 64.25 ± 8.27 mmHg. Significant differences between daytime and night time were found. CONCLUSION: 56% of chronic hypertensive pregnant patients had no nocturnal reduction in systolic blood pressure and 43.75% had no nocturnal changes on diastolic blood pressure. The fact that 50% of patients were non-dippers force us to use long-action antihypertensive therapy and obtain control of the blood pressure for 24 hours.

[Pregnancy and tetralogy of Fallot with and without surgical correction]. / Embarazo y tetralogía de Fallot con y sin corrección quirúrgica.

BACKGROUND: Tetralogy of Fallot is the most common cyanotic congenital cardiac lesions. Although pregnancy in patients with corrected tetralogy of Fallot usually have a satisfactory outcome, there may have maternal cardiovascular complications. OBJECTIVE: To report our experience in monitoring and treatment of 16 pregnancies in 14 women with tetralogy of Fallot. PATIENTS AND METHOD: Prospective study performed in 16 pregnancies of 14 patients with tetralogy of Fallot, who attended the services of Cardiology and High Risk Pregnancy in the Hospital de Gineco-Obstetricia of the Centro Médico de Occidente (Mexico), from January 1997 to January 2010. Nine women had total surgical correction and five hadn't. All patients obtained complete study protocol and tests of fetal wellbeing. RESULTS: Hemoglobin and hematocrit were significantly higher in the group without surgical correction; this group also had lower oxygen saturation and right ventricular enlargement. Of the 16 pregnancies, five were resolved vaginally, the other by cesarean section. The cyanotic mothers had premature termination of pregnancy, lower birth weight and Apgar slightly deteriorated. There were no maternal or neonatal deaths, neither cardiac malformation in newborns. CONCLUSIONS: There are more risks for the binomial in patients with uncorrected tetralogy of Fallot and in those operated with significant residual lesions. A greater anatomical impact was significantly correlated with major hemoglobin and minor oxygen saturation, which are the most important risk factors for adverse fetal outcomes.

[Cardiovascular risk factors in climacteric]. / Factores de riesgo cardiovascular en el climaterio.

BACKGROUND: Ischemic heart disease is the second leading killer of women in Mexico, regardless of age group. The incidence of cardiovascular events increases after menopause, and depend on the prevalence and accumulation of risk factors. OBJECTIVE: To determine the prevalence of cardiovascular risk factors in a population of Mexican women who receive care in a menopause clinic. METHODS: Cross-sectional study included 308 women. Sociodemographic characteristics were collected, and background somatometric-family inherited cardiovascular risk factors, biochemical variables: blood glucose and lipid profile. Women were classified into two groups: pre-and postmenopause, the latter being subdivided according to time since menopause: less than three years and more than three years. RESULTS: Two hundred six (66.7%) women had inherited a positive family history. We identified 123 (39.9%) in premenopausal, mean age 46.4 +/- 3.2 years and 185 (60.1%) postmenopausal with a mean age of 50.5 +/- 3.2. We found no differences in blood pressure and blood glucose somatometric features. The levels of total cholesterol (TC) and cholesterol of low density lipoprotein (LDL-C) were significantly higher in the group of postmenopausal women. It was noted that total cholesterol and triglycerides increased with age regardless of hormonal status. Hypercholesterolemia was detected in 41.5% of premenopausal patients and in 51.4% of postmenopausal women. More than half of the population studied had three or more cardiovascular risk factors. CONCLUSIONS: There is a high prevalence of cardiovascular risk factors in Mexican women present from pre-menopause. The major modifiable: sedentary lifestyle, dyslipidaemia and overweight.

[Chronic high blood pressure in 110 pregnant women]. / Hipertensión arterial crónica en 110 mujeres embarazadas.

BACKGROUND: Hypertension is associated with increased maternal and fetal mortality and morbidity. While there is consensus that severe hypertension should be treated, antihypertensive treatment for mild chronic hypertension during pregnancy remains controversial. OBJECTIVE: To evaluate clinical course, and maternal and perinatal outcomes of pregnant women with mild chronic hypertension without other disease, under strict control of maternal hypertension (target dBP of 85-89 mmHg). PATIENTS AND METHODS: We conducted a prospective cohort study of 110 pregnant women with mild chronic hypertension without other disease; clinical course was classified in three groups: stable condition, exacerbation of hypertension and superimposed preeclampsia. We compare maternal and perinatal outcomes; statistical comparisons were performed by ANOVA test. Relative risk (RR) was calculated for adverse perinatal outcomes. RESULTS: Atotal of 110 women were included, mean maternal age was 33 +/- 5.8 years. There were 78 (71%) women with stable condition, 26 (24%) with exacerbation of hypertension and 6 (5%) with superimposed preeclampsia (PE). Women with superimposed PE and exacerbation of hypertension delivered earlier and had more small for gestational age (SGA) babies than women with stable condition and exacerbation. Delivery route was vaginal in 45 patients (40%) while 65 patients (60%) underwent cesarean section in order to avoid fetal distress. CONCLUSIONS: Results demonstrated that fetuses in the stable condition group (strict control) did not have worst outcomes than those in the other groups. This cohort study shows efficacy and safety of treating mild chronic hypertension during pregnancy.

[Pregnancy in patients with single ventricle, corrected and uncorrected]. / Embarazo en pacientes con ventrículo único, con y sin corrección quirúrgica.

We describe two cases of pregnancy in women with congenital heart disease, single ventricle. The first one underwent Fontan surgery at the age of 5 years due to a single ventricle of the left ventricular morphology. The second one, had uncorrected single ventricle. There were no maternal complications. Both deliveries were by cesarean section. Infants were premature, being delivered at 33 and 27 weeks, and weighing 1,250 and 625 g, respectively.

Triple prótesis valvular mecánica cardiaca y embarazo / Triple valvular, mechanical, cardiac prosthesis and pregnancy

Se presenta un caso poco usual de una mujer de 36 años, multigesta, portadora de triple protésis mecánica cardiaca, anticoagulada con cumarínicos, que evolucionó en su sexta gestación sin complicaciones cardiovasculares, obteniendo un recién nacido, con peso de 1,700 g. sin malformaciones. Se discuten los problemas de manejo, seguimiento y resolución del embarazo así como los factores que influyen en un resultado óptimo para el binomio materno-fetal