[Magnetic resonance imaging of the liver in postpartum stable women with HELLP syndrome]. / Ressonância magnética hepática em puérperas estáveis com síndrome HELLP.

OBJECTIVES: To describe magnetic resonance (MR) findings in the liver of stable patients with HELLP syndrome in the puerpuerium. METHODS: A descriptive study was carried out from August 2005 to July 2006, involving a series of 40 postpartum patients admitted to an obstetric intensive therapy unit in IMIP (Instituto Materno Infantil Prof. Fernando Figueira) with diagnosis of HELLP syndrome (complete and partial). Complete HELLP syndrome was defined when all laboratory parameters were present and incomplete when one or more but not all laboratory findings were present. All patients had stable clinical conditions and were evaluated with magnetic resonance of the liver and the main findings were recorded. RESULTS: Average maternal age was 26.8 +/- 6.4 years and gestational age at delivery was 34 +/- 26.8 weeks. The MR imaging was performed between eight and 96 hours after diagnosis of HELLP syndrome (56 +/- 31 h). The most frequent findings were ascitis in 20% (n = 8), pleural effusion in 17.5% and hepatic steatosis in 7.5%. The periportal intensity signal was normal in all cases. Cases of liver infarction and sub-capsular or parenchymatous hematoma were not observed. CONCLUSION: Findings of magnetic resonance imaging of the liver in stable HELLP syndrome postpartum patients were few and unspecific. Severe liver injuries such as parenchymatous or sub-capsular hematoma, entailing life risk were not found. Results do not corroborate the use of magnetic resonance as routine examination for stable patients with HELLP syndrome.

Ressonância magnética hepática em puérperas estáveis com síndrome HELLP / Magnetic resonance imaging of the liver in postpartum stable women with HELLP syndrome

OBJETIVOS: Descrever os achados hepáticos na ressonância magnética em puérperas estáveis com síndrome HELLP. MÉTODOS: Realizou-se um estudo descritivo, do tipo série de casos, envolvendo 40 puérperas internadas na UTI obstétrica do Instituto Materno Infantil Prof. Fernando Figueira (IMIP), com diagnóstico de síndrome HELLP completa (presentes todas as alterações laboratoriais) e incompleta (uma ou mais alterações laboratoriais, porém sem todos os critérios diagnósticos) no período de agosto de 2005 a julho de 2006. RESULTADOS: A idade média foi de 26,8 ± 6,4 anos, com idade gestacional média no parto de 34 semanas. A ressonância magnética foi realizada entre oito e 96 horas depois do diagnóstico de síndrome HELLP (média de 56 + 31horas). O achado mais freqüente foi ascite em 20 por cento (n = 8), seguindo-se derrame pleural (17,5 por cento) e esteatose hepática (7,5 por cento). A intensidade de sinal periportal foi normal em todos os casos e não se observaram casos de isquemia/infarto hepático ou de hematoma parenquimatoso ou subcapsular. CONCLUSÃO: Os achados da ressonância magnética pós-parto em puérperas estáveis com síndrome HELLP foram inespecíficos e, na presente série, não foram encontradas lesões importantes como hematoma parenquimatoso ou subcapsular, representando risco de vida para a paciente. Os resultados encontrados não corroboram a utilização desse exame de rotina para o seguimento de pacientes com síndrome HELLP.

OBJECTIVES: To describe magnetic resonance (MR) findings in the liver of stable patients with HELLP syndrome in the puerpuerium. METHODS: A descriptive study was carried out from August 2005 to July 2006, involving a series of 40 postpartum patients admitted to an obstetric intensive therapy unit in IMIP (Instituto Materno Infantil Prof. Fernando Figueira) with diagnosis of HELLP syndrome (complete and partial). Complete HELLP syndrome was defined when all laboratory parameters were present and incomplete when one or more but not all laboratory findings were present. All patients had stable clinical conditions and were evaluated with magnetic resonance of the liver and the main findings were recorded. RESULTS: Average maternal age was 26.8 ± 6.4 years and gestational age at delivery was 34 ± 26.8 weeks. The MR imaging was performed between eight and 96 hours after diagnosis of HELLP syndrome (56 ± 31 h). The most frequent findings were ascitis in 20 percent (n = 8), pleural effusion in 17.5 percent and hepatic steatosis in 7.5 percent. The periportal intensity signal was normal in all cases. Cases of liver infarction and sub-capsular or parenchymatous hematoma were not observed. CONCLUSION: Findings of magnetic resonance imaging of the liver in stable HELLP syndrome postpartum patients were few and unspecific. Severe liver injuries such as parenchymatous or sub-capsular hematoma, entailing life risk were not found. Results do not corroborate the use of magnetic resonance as routine examination for stable patients with HELLP syndrome.

Impacto das malformações congênitas na mortalidade perinatal e neonatal em uma maternidade-escola do Recife / Impact of congenital malformations on perinatal and neonatal mortality in an university maternity hospital in Recife

OBJETIVOS: determinar a incidência de malformações congênitas em recém-nascidos assistidos em uma maternidade-escola de Recife e avaliar o impacto destas malformações na mortalidade perinatal e neonatal. MÉTODOS: realizou-se um estudo longitudinal durante os meses de setembro de 2004 a maio de 2005, analisando-se todos os partos assistidos no Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Determinou-se a freqüência e o tipo de malformações congênitas e foram calculados os coeficientes de mortalidade fetal, mortalidade perinatal, mortalidade neonatal precoce e tardia. RESULTADOS: a freqüência de malformações foi de 2,8 por cento (em 4043 nascimentos). O percentual de malformações entre os nativivos foi de 2,7 por cento, e entre os natimortos foi de 6,7 por cento. Dentre as malformações, as mais freqüentes foram as do sistema nervoso central (principalmente hidrocefalia e meningomielocele), as do sistema osteomuscular e as cardiopatias. Não houve associação entre malformações e sexo, porém a freqüência de prematuridade e baixo peso foi maior entre os casos de malformações. Constatou-se, entre os malformados, mortalidade neonatal precoce de 32,7 por cento e tardia de 10,6 por cento. Os casos de malformações representaram 6,7 por cento dos natimortos, 24,2 por cento das mortes neonatais precoces e 25,8 por cento do total de mortes neonatais. CONCLUSÕES: a freqüência de malformações correspondeu a 2,8 por cento dos nascimentos. As malformações representaram a segunda causa mais freqüente de mortes neonatais, depois da prematuridade.

OBJECTIVES: to determine the incidence of congenital malformations in newborns in a university maternity hospital in Recife and assess the impact of malformation in perinatal and neonatal mortality. METHODS: a longitudinal study was performed from September 2004 to May 2005 with all deliveries at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP analyzed. The type and incidence of congenital malformations were determined, and fetal mortality, perinatal mortality, early and late neonatal mortality coefficients were calculated. RESULTS: malformation incidence was of 2.8 percent (in 4.043 births). Malformation percentages among live births was of 2.7 percent and among stillbirths of 6.7 percent. The most frequent malformations involved the central nervous system (principally hydrocephaly and meningomyelocele), the skeletal and muscular system and cardiopathies. There was no association between malformation and gender, but prematurity and low birthweight were more frequent among the malformation cases. It was determined that among malformed infants early neonatal mortality was of 32.7 percent and late neonatal mortality was of 10.6 percent. Malformation cases were 6.7 percent of stillborn babies, 24.2 percent of early neonatal deaths and 25.8 percent the total of neonatal deaths. CONCLUSIONS: malformation incidence corresponded to 2.8 percent of the births. Malformation was the second more frequent neonatal death cause following prematurity.