Comparison of preeclampsia and fetal growth restriction screenings at first trimester in a high-risk population.

AIM: To compare the sensitivity and specificity of screening for preeclampsia and FGR including maternal characteristics, mean arterial blood pressure and uterine artery pulsatility index and the combined screening, which adds biochemical markers, such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), in a sample of high risk population for hypertensive disorders. METHODS: This is a prospective study with 527 singleton pregnancies at 11-14 weeks of gestation. Maternal characteristics, biochemical and biophysical markers were studied to determine the development of preeclampsia and FGR by using receiver operating characteristic curves. RESULTS: For preeclampsia, screening, including sociodemographic data plus biophysical markers, had a sensitivity and specificity of 70.3% (CI% 64.3-75.2) and 93.8% (CI% 90.9-96.8), respectively. Combined screening, which includes sociodemographic data, biophysical (mean blood pressure and uterine artery pulsatility index) and biochemical markers (PlGF and PAPP-A), increased sensitivity and specificity up to 85.5% (CI% 80.2-90.3) and 96.3% (CI% 91.4-98.9), respectively. For FGR, sociodemographic data plus biophysical markers had a sensitivity and specificity of 57.8% (CI% 50.1-63.4) and 80.1% (CI% 74.3-85.9), respectively. Combined screening increased sensitivity and specificity up to 67.2% (CI% 52.1-71.3) and 82.7% (CI% 75.2-90.1), respectively. CONCLUSION: Combined screening for preeclampsia and FGR at 11 to 14 weeks of gestation, which includes maternal characteristics, mean blood pressure, uterine artery pulsatility index, PAPP-A and PlGF, has higher sensitivity and specificity than other screening options. Therefore, considering all these variables during screening is recommended for a superior opportunity of identifying pregnant women in risk for preeclampsia and FGR, especially in a high-risk population.

Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension.

The purpose of this study is to compare the levels of maternal serum pregnancy-associated plasma protein-A at the first trimester in pregnancies complicated by impaired placental diseases, such as preeclampsia (PE), intrauterine fetal growth restriction (IUGR), and gestational hypertension (GH), with those in pregnancies without the development of any of these outcomes to expand the knowledge of how this protein behaves in the different impaired placental diseases. This current work is an observational study based on a prospective cohort. Pregnancy-associated plasma protein-A was measured in 422 patients who had completed maternal-perinatal outcomes. Comparisons of pregnancy characteristics and the biomarker between outcome groups (PE, IUGR, gestational hypertension, and not impaired placental outcomes) were analyzed. PAPP-A MoM in the IUGR (0.8 IQR: 0.6-0.9) and GH groups (0.5 IQR: 0.3-1.4) compared to the PE group (1.06 IQR: 0.66-1.52) was significantly lower (p < 0.005). Pregnant women who developed early-onset PE (1.11 IQR 1.08-1.18) presented significant differences with the IUGR group (0.83 IQR: 0.59-0.98; p = 0.002) and those who developed preterm-PE (1.19 IQR: 0.66-1.58; p = 0.045). The results demonstrate that the levels of PAPP-A at first trimester in the sample of women who developed PE, and specially term-PE, were higher than those in women who developed GH or IUGR. The GH group had the lowest PAPP-A values in this sample of pregnant women. Research in a population with a high prevalence of preeclampsia is still lacking and deserves more extended studies to define if these patients could have different rates of PAPP-A.

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries?

OBJECTIVE: To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2nd or 3rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation. METHODS: This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2nd and 3rd trimesters, and it was considered to improve when it decreased below the 95th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) were calculated. RESULTS: A total of 72 participants with a mean UtA-PI > 95th percentile at the 1st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2nd and 3rd trimesters of gestation, although it was not statistically significant (p = 0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31-1.89), but between the 1st and 2nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21-0.99) and it was statistically significant. CONCLUSION: The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.

OBJETIVO: Analisar se a ingestão de acetilsalicílico (ASA) modifica o índice médio de pulsatilidade das artérias uterinas (UtA-PI) no 2° ou 3° trimestre em uma coorte de gestantes com média anormal de UtA-PI entre 11 e 14 semanas. MéTODOS: Este é um estudo de coorte retrospectivo. Gravidezes únicas com média anormal de UtA-PI entre 11 e 14 semanas foram estudadas. As participantes foram divididas em 3 grupos: 1) Se a participante não tomou ASA durante a gravidez, 2) Se a participante tomou AAS antes das 14 semanas e 3) Se a participante tomou ASA após 14 semanas. A média do UtA-PI foi avaliada nos 2° e 3° trimestres e considerou-se que melhorava quando diminuía < 95° percentil. Foram calculados a razão de prevalência (RP) e o número necessário para tratar (NNT). RESULTADOS: Foram avaliadas 72 participantes com média de UtA-PI > 95° percentil no 1° trimestre de gravidez. Das 18 participantes que tomaram ASA, 8 participantes começaram antes de 14 semanas e 10 depois. Um total de 33,3% desses participantes melhoraram a média de UtA-PI nos 2° e 3° trimestres, embora não tenha sido estatisticamente significante (p = 0,154). A razão de prevalência foi de 0,95 (intervalo de confiança [IC95%]: 0,31­1,89), mas entre os 1° e o 2° trimestres, a RP foi de 0,92 (IC95%: 0,21­0,99) e foi estatisticamente significativa. CONCLUSãO: O presente trabalho demonstra uma modificação da média de UtA-PI em participantes que faziam uso de ASA em comparação com aqueles que não faziam. É importante verificar se o ASA pode modificar os limites normais das artérias uterinas porque isso pode ter um impacto na vigilância.

First trimester placental growth factor in maternal blood and placenta related disorders.

OBJECTIVE: To describe and compare the placental growth factor levels at first trimester in patients that developed preeclampsia, gestational hypertension, IUGR and in those patients without impaired placentation diseases. METHODS: Observational study based on a prospective cohort of 422 pregnant women. PlGF values were compared between the different groups (preeclampsia, intrauterine growth restriction (IUGR), gestational hypertension or normal group-patients without impaired placentation diseases). RESULTS: The 85.3% (n = 360, 95% CI = 81.9-88.7) had a normal pregnancy, 7.6% (n = 32, 95% CI = 5.1-10.1) had preeclampsia, 3.8% (n = 16, 95% CI = 2.0-5.6) had IUGR and 3.3% (n = 14, 95% CI = 1.6-5.0) had gestational hypertension. The median level of PlGF for preeclampsia (0.76) and IUGR (0.75) were lower than gestational hypertension (0.82) and normal group (1.02). The groups of preeclampsia >34 weeks (0.76), preeclampsia <37 weeks (0.73), and preeclampsia ≥37 weeks (0.77), were significantly lower than the normal group. The sensitivity and specificity of PlGF for impaired placentation diseases is 65% and 64.9%, respectively. CONCLUSION: It was found in this study that PlGF has significantly lower levels in gestational hypertension than normal pregnancies, in concordance with the other impaired placentation diseases. Additionally, a better comparison of the PlGF values was obtained when separating early onset of preeclampsia <37 weeks and late-onset of preeclampsia 37≥ weeks of gestations.

Behavior of the Genetic Markers at Screening during the First Trimester of Pregnancy in Euploid Fetuses.

OBJECTIVE: This study aims to describe the behavior of chromosomopathy screenings in euploid fetuses. METHODS: This is a prospective descriptive study with 566 patients at 11 to 14 weeks of gestation. The associations between ultrasound scans and serological variables were studied. For the quantitative variables we used the Spearman test; for the qualitative with quantitative variables the of Mann-Whitney U-test; and for qualitative variables, the X2 test was applied. Significance was set at p ≤ 0.05. RESULTS: We have found that gestational age has correlation with ductus venosus, nuchal translucency, free fraction of ß subunit of human chorionic gonadotropin, pregnancy-associated plasma protein-A and placental growth factor; there is also a correlation between history of miscarriages and nasal bone. Furthermore, we correlated body mass index with nuchal translucency, free fraction of ß subunit of human chorionic gonadotropin, and pregnancy-associated plasma protein-A. Maternal age was associated with free fraction of ß subunit of human chorionic gonadotropin and pregnancy-associated plasma protein-A. CONCLUSION: Our study demonstrates for the first time the behavior of the biochemical and ultrasonographic markers of chromosomopathy screenings during the first trimester in euploid fetuses in Colombia. Our information is consistent with international reference values. Moreover, we have shown the correlation of different variables with maternal characteristics to determine the variables that could help with development of a screening process during the first trimester with high detection rates.

OBJETIVO: Este estudo tem como objetivo descrever o comportamento do rastreamento de cromossomopatias em fetos euploides. MéTODOS: Trata-se de um estudo prospectivo descritivo com 566 pacientes, entre 11 e 14 semanas de gestação. A associação entre a ultrassonografia e as variáveis sorológicas foi estudada. Para as variáveis quantitativas foi utilizado o teste de Spearman; para as qualitativas com variáveis quantitativas foi utilizado o teste U de Mann-Whitney e para as variáveis qualitativas foi aplicado o teste X2. A significância foi fixada em p ≤ 0,05. RESULTADOS: Constatou-se que a idade gestacional tem correlação com o ducto venoso, translucência nucal, fração livre da subunidade ß da gonadotrofina coriônica humana, proteína plasmática A associada à gravidez e fator de crescimento placentário; há também correlação entre a história de abortos e o osso nasal. Além disso, correlacionamos o índice de massa corporal com translucência nucal, fração livre da subunidade ß da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. A idade materna foi relacionada com fração livre da subunidade ß da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. CONCLUSãO: Nosso estudo demonstra pela primeira vez o comportamento dos marcadores bioquímicos e ultrassonográficos de triagem de cromossomas durante o primeiro trimestre em fetos euploides na Colômbia. Nossa informação é consistente com a referência de valores internacionais. Além disso, mostram-se as relações das diferentes variáveis com as características maternas para determinar as variáveis capazes de ajudar no desenvolvimento de um processo de rastreamento durante o primeiro trimestre com alta taxa de detecção.

Uterine Artery Pulsatility Index as a Pre-eclampsia Predictor in the 3 Trimesters in Women with Singleton Pregnancies.

OBJECTIVE: To evaluate the mean uterine artery pulsatility index (UtAPI) in each trimester of pregnancy as a predictor of early or late pre-eclampsia (PE) in Colombian pregnant women. METHODS: The UtAPI was measured in singleton pregnancies in each trimester. Uterine artery pulsatility index as predictor of PE was evaluated by odds ratio (OR), receiver operating characteristic (ROC) curves, and Kaplan-Meier diagram. RESULTS: Analysis in the 1st and 3rd trimester showed that abnormal UtAPI was associated with early PE (OR: 5.99: 95% confidence interval [CI]: 1.64-21.13; and OR: 10.32; 95%CI: 2.75-42.49, respectively). Sensitivity and specificity were 71.4 and 79.6%, respectively, for developing PE (area under the curve [AUC]: 0.922). The Kaplan-Meier curve showed that a UtAPI of 0.76 (95%CI: 0.58-1.0) in the 1st trimester was associated with early PE, and a UtAPI of 0.73 (95%CI: 0.55-0.97) in the 3rd trimester was associated with late PE. CONCLUSION: Uterine arteries proved to be a useful predictor tool in the 1st and 3rd trimesters for early PE and in the 3rd trimester for late PE in a pregnant population with high prevalence of PE.

OBJETIVO: Avaliar o índice médio de pulsatilidade da artéria uterina (UtAPI) em cada trimestre da gravidez como preditor de pré-eclâmpsia (PE) precoce ou tardia em gestantes colombianas. MéTODOS: O UtAPI foi medido em gestações únicas em cada trimestre. O UtAPI como preditor de PE foi avaliado por odds ratio (OR), curvas receiver operating characteristic (ROC) e diagrama de Kaplan-Meier. RESULTADOS: A análise no 1° e 3° trimestres mostrou que um UtAPI anormal foi associado com PE inicial (OR: 5,99; intervalo de confiança [IC] 95%: 1,64­21,13; OR: 10,32; IC95%: 2,75­42,49, respectivamente). A sensibilidade e a especificidade foram de 71,4 e 79,6%, respectivamente, para o desenvolvimento de PE (area under the curve [AUC]: 0,922). A curva de Kaplan-Meier mostrou que um UtAPI de 0,76 (IC95%: 0,58­1,0) no 1° trimestre foi associado com PE precoce, e que um UtAPI de 0,73 (IC95%: 0,55­0,97) no 3° trimestre foi associado com PE tardia. CONCLUSãO: As artérias uterinas mostraram ser uma ferramenta preditora útil no 1° e 3° trimestres para PE inicial e no 3° trimestre para PE tardia em uma população de gestantes com alta prevalência de PE.

Perinatal outcomes associated with the diagnosis of gestational diabetes: Systematic review and meta-analysis.

OBJECTIVE: To compare perinatal outcomes in pregnant women diagnosed with gestational diabetes using the one-step and the two-step test. METHODS: Meta-analysis of observational studies pregnancies women with gestational diabetes from January 2014 to February 2019. The outcomes studied were induction of labor and delivery, preterm delivery, fetal macrosomia, neonatal hypoglycemia, hyperbilirubinemia, low birth weight, and admission to the neonatal intensive care unit. RESULTS: Eight studies were included with a population of 108,609 pregnancies. Statistical differences were obtained for fetal macrosomia RR0.9 (95%CI0.85-0.97; I20%) and neonatal hypoglycemia RR1.1 (95%CI1.01-1.40; I248.5%). CONCLUSION: Neonatal macrosomia appears to be less present when the one-step diagnostic test is used and neonatal hypoglycemia was lower with the two-step test. Register PROSPERO CRD42020215062.

Preventive measures to avoid vertical transmission in untreated pregnant women with HIV/AIDS.

The HIV/AIDS during pregnancy has high morbidity and mortality, without optimal prevention and treatment. The advanced stage cases are found in developing countries due to late detection, but, also in developed countries due to immigration; therefore, the professionals should know the management steps for these patients. The implementation of specific interventions can reduce vertical transmission incidence until 1%-8%. It is presented a case of a pregnant woman with AIDS detected during first hospitalisation, due to a ventilatory failure by opportunistic germs; at the delivery the specific interventions were implemented, being able to eliminate vertical transmission to the newborn. This article explains the four main aspects to be considered for reducing vertical transmission (detection of HIV, viral load levels-CD4 lymphocyte count, way and moment of childbirth and antiretroviral therapy) and shares experiences of the management of an advanced case, in order to help professionals to handle these cases and its complications.

Could Aspirin Treatment Modify the Assessment of the Uterine Arteries? / O tratamento com aspirina pode modificar a avaliação das artérias uterinas?

Abstract Objective To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2nd or 3rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation. Methods This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2nd and 3rd trimesters, and it was considered to improve when it decreased below the 95th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) werecalculated. Results A total of 72 participants with a mean UtA-PI>95th percentile at the 1st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2nd and 3rd trimesters of gestation, although it was not statistically significant (p=0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31-1.89), but between the 1st and 2nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21-0.99) and it was statistically significant. Conclusion The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.

Resumo Objetivo Analisar se a ingestão de acetilsalicílico (ASA) modifica o índice médio de pulsatilidade das artérias uterinas (UtA-PI) no 2° ou 3° trimestre em uma coorte de gestantes com média anormal de UtA-PI entre 11 e 14 semanas. Métodos Este é um estudo de coorte retrospectivo. Gravidezes únicas com média anormal de UtA-PI entre 11 e 14 semanas foram estudadas. As participantes foram divididas em 3 grupos: 1) Se a participante não tomou ASA durante a gravidez, 2) Se a participante tomou AAS antes das 14 semanas e 3) Se a participante tomou ASA após 14 semanas. A média do UtA-PI foi avaliada nos 2° e 3° trimestres e considerou-se que melhorava quando diminuía<95° percentil. Foram calculados a razão de prevalência (RP) e o número necessário para tratar (NNT). Resultados Foram avaliadas 72 participantes com média de UtA-PI>95° percentil no 1° trimestre de gravidez. Das 18 participantes que tomaram ASA, 8 participantes começaram antes de 14 semanas e 10 depois. Um total de 33,3% desses participantes melhoraram a média de UtA-PI nos 2° e 3° trimestres, embora não tenha sido estatisticamente significante (p=0,154). A razão de prevalência foi de 0,95 (intervalo de confiança [IC95%]: 0,31-1,89), mas entre os 1° e o 2° trimestres, a RP foi de 0,92 (IC95%: 0,21-0,99) e foi estatisticamente significativa. Conclusão O presente trabalho demonstra uma modificação da média de UtA-PI em participantes que faziam uso de ASA em comparação com aqueles que não faziam. É importante verificar se o ASA pode modificar os limites normais das artérias uterinas porque isso pode ter um impacto na vigilância.

Behavior of the Genetic Markers at Screening during the First Trimester of Pregnancy in Euploid Fetuses / Comportamento dos marcadores genéticos na triagem durante o primeiro trimestre de gravidez em fetos euploides

Abstract Objective This study aims to describe the behavior of chromosomopathy screenings in euploid fetuses. Methods This is a prospective descriptive study with 566 patients at 11 to 14 weeks of gestation. The associations between ultrasound scans and serological variables were studied. For the quantitative variables we used the Spearman test; for the qualitative with quantitative variables the of Mann-Whitney U-test; and for qualitative variables, the X2 test was applied. Significance was set at p ≤ 0.05. Results We have found that gestational age has correlation with ductus venosus, nuchal translucency, free fraction of β subunit of human chorionic gonadotropin, pregnancy-associated plasma protein-A and placental growth factor; there is also a correlation between history of miscarriages and nasal bone. Furthermore, we correlated body mass index with nuchal translucency, free fraction of β subunit of human chorionic gonadotropin, and pregnancy-associated plasma protein-A. Maternal age was associated with free fraction of β subunit of human chorionic gonadotropin and pregnancy-associated plasma protein-A. Conclusion Our study demonstrates for the first time the behavior of the biochemical and ultrasonographic markers of chromosomopathy screenings during the first trimester in euploid fetuses in Colombia. Our information is consistent with international reference values. Moreover, we have shown the correlation of different variables with maternal characteristics to determine the variables that could help with development of a screening process during the first trimester with high detection rates.

Resumo Objetivo Este estudo tem como objetivo descrever o comportamento do rastreamento de cromossomopatias em fetos euploides. Métodos Trata-se de um estudo prospectivo descritivo com 566 pacientes, entre 11 e 14 semanas de gestação. A associação entre a ultrassonografia e as variáveis sorológicas foi estudada. Para as variáveis quantitativas foi utilizado o teste de Spearman; para as qualitativas com variáveis quantitativas foi utilizado o teste U de Mann-Whitney e para as variáveis qualitativas foi aplicado o teste X2. A significância foi fixada em p ≤ 0,05. Resultados Constatou-se que a idade gestacional tem correlação com o ducto venoso, translucência nucal, fração livre da subunidade β da gonadotrofina coriônica humana, proteína plasmática A associada à gravidez e fator de crescimento placentário; há também correlação entre a história de abortos e o osso nasal. Além disso, correlacionamos o índice de massa corporal com translucência nucal, fração livre da subunidade β da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. A idade materna foi relacionada com fração livre da subunidade β da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. Conclusão Nosso estudo demonstra pela primeira vez o comportamento dos marcadores bioquímicos e ultrassonográficos de triagem de cromossomas durante o primeiro trimestre em fetos euploides na Colômbia. Nossa informação é consistente com a referência de valores internacionais. Além disso, mostram-se as relações das diferentes variáveis com as características maternas para determinar as variáveis capazes de ajudar no desenvolvimento de um processo de rastreamento durante o primeiro trimestre com alta taxa de detecção.

Uterine Artery Pulsatility Index as a Pre-eclampsia Predictor in the 3 Trimesters in Women with Singleton Pregnancies / Índice de pulsatilidade da artéria uterina como preditor de pré-eclâmpsia nos 3 trimestres em mulheres com gestações únicas

Abstract Objective To evaluate the mean uterine artery pulsatility index (UtAPI) in each trimester of pregnancy as a predictor of early or late pre-eclampsia (PE) in Colombian pregnant women. Methods The UtAPI was measured in singleton pregnancies in each trimester. Uterine artery pulsatility index as predictor of PE was evaluated by odds ratio (OR), receiver operating characteristic (ROC) curves, and Kaplan-Meier diagram. Results Analysis in the 1st and 3rd trimester showed that abnormal UtAPI was associated with early PE (OR: 5.99: 95% confidence interval [CI]: 1.64-21.13; and OR: 10.32; 95%CI: 2.75-42.49, respectively). Sensitivity and specificity were 71.4 and 79.6%, respectively, for developing PE (area under the curve [AUC]: 0.922). The Kaplan-Meier curve showed that a UtAPI of 0.76 (95%CI: 0.58-1.0) in the 1st trimester was associated with early PE, and a UtAPI of 0.73 (95%CI: 0.55-0.97) in the 3rd trimester was associated with late PE. Conclusion Uterine arteries proved to be a useful predictor tool in the 1st and 3rd trimesters for early PE and in the 3rd trimester for late PE in a pregnant population with high prevalence of PE.

Resumo Objetivo Avaliar o índice médio de pulsatilidade da artéria uterina (UtAPI) em cada trimestre da gravidez como preditor de pré-eclâmpsia (PE) precoce ou tardia em gestantes colombianas. Métodos O UtAPI foi medido em gestações únicas em cada trimestre. O UtAPI como preditor de PE foi avaliado por odds ratio (OR), curvas receiver operating characteristic (ROC) e diagrama de Kaplan-Meier. Resultados A análise no 1° e 3° trimestres mostrou que um UtAPI anormal foi associado com PE inicial (OR: 5,99; intervalo de confiança [IC] 95%: 1,64-21,13; OR: 10,32; IC95%: 2,75-42,49, respectivamente). A sensibilidade e a especificidade foram de 71,4 e 79,6%, respectivamente, para o desenvolvimento de PE (area under the curve [AUC]: 0,922). A curva de Kaplan-Meier mostrou que um UtAPI de 0,76 (IC95%: 0,58- 1,0) no 1° trimestre foi associado com PE precoce, e que um UtAPI de 0,73 (IC95%: 0,55-0,97) no 3° trimestre foi associado com PE tardia. Conclusão As artérias uterinas mostraram ser uma ferramenta preditora útil no 1° e 3° trimestres para PE inicial e no 3° trimestre para PE tardia em uma população de gestantes com alta prevalência de PE.

Infección por Listeria monocytogenes en una mujer gestante con lupus eritematoso sistémico y síndrome HELLP / Listeria monocytogenes infection in a pregnant woman with systemic lupus erythematosus and HELLP syndrome / Infeção por Listeria monocytogenes em uma mulher gestante com antecedente de lúpus eritromatoso sistemático e síndrome HELLP

La listeriosis es una enfermedad transmitida principalmente por alimentos contaminados con Listeria monocytogenes. Se presenta con mayor frecuencia en neonatos, mayores de 65 años, mujeres gestantes y pacientes inmunosuprimidos. La infección por L. monocytogenes durante la gestación se asocia a una importante morbimortalidad materno-fetal.Se reporta el caso de una mujer gestante de 29 años de edad con lupus eritematoso sistémico, a quien se le diagnosticó bacteriemia por L. monocytogenes. Durante la hospitalización, el cuadro clínico se complicó con hipertransaminasemia y, ante la presencia de trombocitopenia, se estableció el diagnóstico presuntivo de síndrome HELLP. El alto riesgo de morbimortalidad llevó a una finalización precoz de la gestación.La importancia de este trabajo clínico radica en presentar la dificultad en el diagnóstico y manejo en una paciente gestante de gran complejidad con una infección relativamente frecuente que puede pasar desapercibida.

Listeriosis is a disease mainly transmitted by food contaminated with bacteria called Listeria monocytogenes. It occurs more often in newborns, elder population, pregnant women and immunosuppressed patients. L. monocytogenes infection during pregnancy is associated to significant maternal mortality and morbidity. The case of a 29-year-old pregnant woman with history of Systemic Lupus Erythematosus is review. The said woman was diagnosed with bacteremia related to L. monocytogenes. During hospitalization, the patient experienced complications with hipertransaminasemia, which led to the presumptive diagnosis of HELLP in presence of thrombocytopenia. Given the high risk of mortality and morbidity, the pregnancy was terminated. The importance of the present clinical work lays in showing the difficulties embedded in diagnosing and handling a high-complexity pregnant patient presenting a frequent infection that would otherwise go undetected.

A listeriosis é uma doença transmitida principalmente por alimentos contaminados com Listeria monocytogenes. Apresentase com maior frequência em neonatos, maiores de 65 anos, mulheres gestantes e pacientes imunossuprimidos. Durante a gestação esta infeção associa-se a uma importante morbimortalidade materno-fetal. Foi reportado o caso de uma mulher gestante de 29 anos com antecedente de lúpus eritematoso sistémico, diagnosticada com bacteriemia por L. monocytogenes, na hospitalização teve complicações com hipertransaminasemia, foi estabelecido um diagnostico presuntivo de síndrome HELLP em presença de trombocitopenia. O alto risco de morbimortalidade levou a uma finalização precoce da gestação. A importância deste trabalho clínico radica em apresentar a dificuldade de diagnóstico e tratamento em pacientes gestantes de alta complexidade com infeção relativamente frequente, que pode passar desapercebida