Resultados maternos y fetales en mujeres embarazadas con enfermedad renal crónica basada en la tasa de filtración glomerular / Maternal And Fetal Outcomes In Pregnant Women With Chronic Kidney Disease Based On Glomerular Filtration Rate

Introducción: el embarazo causa adaptaciones en el riñón, tanto en anatomía como en función, para mantener el entorno extracelular, hemodinámico y hormonal. Sin embargo, estos pueden no llevarse a cabo de manera completamente óptima en presencia de enfermedad renal. El objetivo era estudiar la relación entre la enfermedad renal y los resultados maternos de fetal durante el embarazo, asociado con un rechazo por paciente y/o en relación con el tratamiento especializado. Material y métodos: estudio observacional y retrospectivo en una serie de casos, revisando 134 archivos de pacientes embarazadas con cierto grado de enfermedad renal antes del embarazo. Los resultados maternos registrados fueron: enfermedad hipertensiva durante el embarazo, deterioro renal agudo, necesidad de terapia de sustitución renal y en productos: prematuridad, restricción del crecimiento intrauterino, muerte fetal y aborto espontáneo. Resultados: Resultados maternos: tasa media de filtración glomerular (GFR) de 58.23 ml/min, aumento de peso de 7 kg; La preeclampsia fue diagnosticada en 92 mujeres (55 severas). 46 pacientes mostraron lesión renal aguda, 40 se resolvieron conservativamente; 1 requirió diálisis peritoneal y 15 hemodiálisis (con una decisión retrasada un promedio de un mes por rechazo por paciente y/o pariente). La resolución del embarazo fue por cesárea en 111 pacientes; Nacieron 116 productos antes de las 37 semanas de gestación, con un peso promedio de 1910 g, 94 mostraron restricción del crecimiento intrauterino. Conclusión: la enfermedad renal influyó directamente en el mayor número de resultados adversos maternos y fetales cuando se rechazó la atención médica especializada. Existe una correlación entre el ligero estado de Davison con los estados I, II y IIIA de Kdigo en el análisis de correspondencia

Introduction: Pregnancy causes adaptations in the kidney, both in anatomy and function, to maintain the extracellular, hemodynamic and hormonal environment. However, these may not be carried out completely optimally in the presence of kidney disease. The objective was to study the relation between kidney disease and maternal-fetal outcomes during pregnancy, associated with a rejection by patient and/or relative to specialized treatment. Material and Methods: Observational, retrospective study in a series of cases, reviewing 134 files of pregnant patients with some degree of kidney disease prior to pregnancy. Maternal outcomes recorded were: hypertensive disease during pregnancy, acute renal deterioration, need for renal substitution therapy, and in products: prematurity, restriction of intrauterine growth, fetal death and miscarriage. Results: Maternal outcomes: mean glomerular filtration rate (GFR) of 58.23ml/min, weight gain of 7 kg; preeclampsia was diagnosed in 92 women (55 severe). 46 patients showed acute renal lesion, 40 were conservatively resolved; 1 required peritoneal dialysis and 15 hemodialysis (with decision delayed an average of one month by rejection by patient and/or relative). Resolution of pregnancy was by cesarean in 111 patients; 116 products were born before 37 weeks of gestation, with average weight of 1910 g, 94 showed restriction of intrauterine growth. Conclusion: Kidney disease directly influenced the greater number of adverse maternal and fetal outcomes when specialized medical care was rejected. There is a correlation between slight Davison state with states I, II and IIIa of KDIGO in correspondence analysis.

Estudio piloto de los factores de riesgo en la preeclampsia / Pilot study of risk factors in pre-eclampsia

La preeclampsia es una patología que surge de forma desconocida comprometiendo el estado de salud del binomio materno ­ neonatal, provocando daño multiorgánico. La característica principal es la relación con múltiples factores de riesgo tales como la hipertensión en familiares de primer grado, obesidad, alimentación, falta de controles obstétricos durante la gestación, entre otros; Objetivo: Validar el cuestionario diseñado para evaluar los factores que influyen en preclamsia, Determinar los factores de riesgo que influyen en su incidencia. Materiales y métodos: Se aplico una metodología cuanti cualitativa, corte transversal, exploratorio; la validación se efectuó a través del juicio de expertos, utilizando dos tipos de instrumentos uno para cada tipo de investigación, se valoran por separado, en el plan piloto se utiliza parte de la muestra seleccionada para la investigación macro. En el caso de la cualitativa se utiliza una técnica de entrevista a saturación, con una investigación de tipo fenomenológica, organizada por categorías. Resultados: El instrumento cuantitativo obtiene un puntaje 93% de confiabilidad, con un alfa de crombach de 0,7, el instrumento cualitativo 95%, dentro de los factores de riesgo se distingue los trastornos hipertensivos del embarazo, se asocia con un espectro de gravedad que va desde la hipertensión leve inducida por el embarazo hasta la eclampsia. Conclusión: Durante el estudio piloto se obtiene los datos con rapidez y efectividad, no existen conflictos en su comprensión, su confiabilidad garantiza el trabajo científico, la validación de instrumentos justifica el proceso, de inicio resultó conflictivo por la ausencia de instrumentos para medir los factores que influyen en esta patología, se encuentran los valores causales y en especial en las vivencias de cada uno de los actores e involucrados, La preeclampsia es un fenómeno frecuente cuya patología conlleva graves complicaciones para la madre y el feto con este tipos de estudio se aporta a su control y erradicación(AU)

Preeclampsia is a pathology that arises in an unknown way, compromising the health status of the maternal-neonatal binomial, causing multi-organ damage. The main characteristic is the relationship with multiple risk factors such as hypertension in first degree relatives, obesity, diet, lack of obstetric controls during pregnancy, among others; Objective: to validate the questionnaire designed to evaluate the factors that influence preeclampsia, to determine the risk factors that influence its incidence. Materials and methods: A quantitative, qualitative, cross-sectional, exploratory methodology was applied; The validation was carried out through the judgment of experts, using two types of instruments, one for each type of research, they are valued separately, in the pilot plan part of the selected sample is used for the macro research. In the case of qualitative, a saturation interview technique is used, with a phenomenological type investigation, organized by categories. Results: The quantitative instrument obtains a 93% reliability score, with a crombach alpha of 0.7, the qualitative instrument 95%, within the risk factors distinguishes hypertensive disorders of pregnancy, it is associated with a spectrum of severity ranging from mild pregnancy-induced hypertension to eclampsia. Conclusion: During the pilot study the data is obtained quickly and effectively, there are no conflicts in its understanding, its reliability guarantees scientific work, the validation of instruments justifies the process, initially it was conflictive due to the absence of instruments to measure the factors that influence this pathology, are the causal values ​​and especially in the experiences of each of the actors and involved, Preeclampsia is a frequent phenomenon whose pathology entails serious complications for the mother and the fetus with this type of study is provided to its control and eradication(AU)

Expression of endothelin-1 and Ki-67 in normotensive and severe preeclamptic placentas / Expresión de endotelina-1 y Ki-67 en placentas normotensas y preeclampsia severa

SUMMARY: Severe preeclampsia (HELLP syndrome) is a life-threatening pregnancy complication, usually a severe form of preeclampsia. In this study, we aimed to examine histopathologic changes and Endothelin-1 and KI-67 expression levels by immunohistochemical methods in severe preeclamptic placentas. Severe preeclampsia and obstetric characteristics and biochemical and hematological characteristics of healthy subjects were compared. Placenta sections were stained with hematoxylin-eosin for histopathological examination. In the histopathological examination of severe preeclamptic placenta, degeneration in synaptic and cytotrophoblastic cells, increase in insidious knots, fibrinoid necrosis, degeneration in endothelial cells, calcification and hyaline villous stains were observed. In the severe preeclampsia group, Ki-67 expression increased in decidua cells and inflammatory cells, while endothelial cells in the vessel wall and inflammatory cells in the villus and intervillous spaces increased. It is thought that angiogenetic and cellular proliferation is induced in a co-ordinated manner and significantly influences fetal development.

RESUMEN: La preeclampsia severa (síndrome de HELLP) es una complicación del embarazo potencialmente mortal, generalmente una forma grave de preeclampsia. En este estudio, nuestro objetivo fue examinar los cambios histopatológicos y los niveles de expresión de Endotelina-1 y Ki-67 mediante métodos inmunohistoquímicos en placentas preeclámpsicas graves. Se compararon la preeclampsia grave y las características obstétricas, además de las características bioquímicas y hematológicas de pacientes sanas. Las secciones de placenta se tiñeron con hematoxilina-eosina para examen histopatológico. En el examen histopatológico de placenta preeclampsia severa, se observó la degeneración en células sinápticas y citotrofoblásticas, un aumento de nudos insidiosos, necrosis fibrinoide, degeneración en las células endoteliales,calcificación y manchas vellosas hialinas. En el grupo de preeclampsia grave, la expresión de Ki-67 aumentó en células deciduas y células inflamatorias, mientras que las células endoteliales en la pared del vaso, y las células inflamatorias en las vellosidades y los espacios intervellosos aumentaron. Se cree que la proliferación angiogenética y celular se induce de forma coordinada y que influye significativamente en el desarrollo fetal.

Mola hidatidiforme completa con preeclampsia e hipertiroidismo: presentación clásica / Complete hydatidiform mole with preeclampsia and hyperthyroidism: classic presentation

Introducción: La enfermedad trofoblástica gestacional es un espectro de enfermedades de la placenta, existiendo entre ellas algunas con potencial de invasión y metástasis, dentro de las cuales se incluye la mola invasiva, coriocarcinoma, tumores del sitio de inserción de la placenta y mola hidatidiforme. Esta última a su vez se divide en mola completa y parcial, diferenciándose en histopatología, morfología, cariotipo, malignización y comportamiento clínico, que es el punto al cual nos referiremos en este caso. Caso clínico: mujer de 46 años ingresa por hemoptisis, metrorragia, disnea a pequeños esfuerzos, ortopnea y disnea paroxística nocturna, asociado a hipertensión, taquicardia, masa hipogástrica firme e inmóvil y edema de extremidades. Se realiza ecografía abdominal compatible con MH y bhCG elevada. Evoluciona con crisis hipertensivas, insuficiencia cardiaca congestiva y tirotoxicosis. Inicia trabajo de parto expulsando 665 grs de mola, presentando posteriormente a legrado uterino anemia severa y shock hipovolémico, requiriendo transfusiones y drogas vasoactivas. Se recupera progresivamente con posterior control al alta de bhCG indetectable a los 6 meses. Discusión: Es infrecuenta en la actualidad la presentación clínica clásica de la mola hidatidiforme completa debido al diagnóstico y control precoz del embarazo asociado al uso masivo de la ecografía. Sin embargo es relevante tener un alto grado de sospecha de esta patología debido a sus graves consecuencias, y así realizar una derivación y manejo precoz.

Background: Gestational trophoblastic disease is a spectrum of diseases of the placenta, existing some with potential for invasion and metastasis, among which include invasive mole, choriocarcinoma, tumors of the insertion site of the placenta and hydatidiform mole. The last one is divided into complete and partial mole, differing in histopathology, morphology, karyotype, and clinical malignant behavior, witch is the point we refer to in this case. Case report: 46 year old woman admitted for hemoptysis, metrorrhagia, dyspnea on slight exertion, orthopnea and paroxysmal nocturnal dyspnea associated with hypertension, tachycardia, firm and immovable hypogastric mass and limb edema. Abdominal ultrasound compatible with MH and high BhCG is performed. Evolve with hypertensive crisis, congestive heart failure and thyrotoxicosis. Labor starts driving out 665 grams of mole, after the curettage present hypovolemic shock and severe anemia requiring transfusions and vasoactive drugs. It gradually recovers further control the discharge of BhCG undetectable at 6 months. Discussion: It is currently infrequent classical clinical presentation of complete hydatidiform mole due to early diagnosis and management of pregnancy associated with the widespread use of ultrasound. However it is important to have a high degree of suspicion of this disease because of its serious consequences, and thus make a referral and early management.

Choroidal changes in pre-eclampsia during pregnancy and the postpartum period: comparison with healthy pregnancy / Alterações da coroide na pré-eclâmpsia durante a gravidez e período pós-parto: comparação com a gravidez saudável

ABSTRACT Purpose: To investigate subfoveal choroidal thickness (SFCT) in patients with pre-eclampsia using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: A sample of 73 pregnant women was studied over 28 weeks of gestation. The sample was divided into two groups: one comprising pre-eclamptic pregnant women (n=32), and the other comprising healthy pregnant women (n=41). The SFCT was determined for all patients using EDI-OCT during pregnancy and at the third month of the postpartum period. Results: The SFCTs in pre-eclamptic pregnant women were 351.97 ± 22.44 and 332.28 ± 20.32 µm during the pregnancy and postpartum periods (p<0.001), respectively, whereas these values in healthy pregnant women were 389.73 ± 49.64 and 329.78 ± 22.36 µm (p<0.001), respectively. During pregnancy SFCT in pre-eclamptic pregnant women was significantly thinner than that in healthy pregnant women (p<0.001). However, there was no statistically significant difference during the postpartum period (p=0.623). Conclusions: The results suggest that SFCT is significantly decreased in pre-eclamptic pregnant women than in healthy pregnant women, despite no statistically significant difference in SFCT existing between the groups during the postpartum period.

RESUMO Objetivo: Investigar espessura subfoveal coroidal (SFCT) em pacientes com pré-eclâmpsia usando imagens de tomografia de coerência óptica de profundidade otimizada (EDI-OCT). Método: Uma amostra de 73 mulheres grávidas foi estudado ao longo de 28 semanas de gestação. A amostra foi dividida em dois grupos: um com mulheres grávidas com pré-eclâmpsia (n=32), o outro com as mulheres grávidas saudáveis (n=41). SFCT foi determinada em todos os pacientes utilizando EDI-OCT durante a gravidez e no terceiro mês do período pós-parto. Resultados: Os SFCTs em gestantes com pré-eclâmpsia foram 351,97 ± 22,44 µm e 332,28 ± 20,32 µm durante o período de gravidez e pós-parto (p<0,001), respectivamente. Estes valores em mulheres grávidas saudáveis foram 389,73 ± 49,64 µm e 329,78 ± 22,36 µm (p<0,001), respectivamente. Durante a gravidez o SFCT foi significantemente mais fino em mulheres com pré-eclâmpsia quando comparado com as mulheres saudáveis (p<0,001). No entanto, não houve diferença estatisticamente significante no período pós-parto (p=0,623). Conclusões: Os resultados sugerem que SFCT é significativamente mais fino em gestantes com pré-eclâmpsia do que nas mulheres grávidas saudáveis, apesar de não haver diferença estatisticamente significativa na SFCT entre os grupos durante o período pós-parto.

Expression of human chorionic gonadotropin (ßhCG) in pre-eclamptic placenta / Expresión de gonadotropina coriónica humana (ßhCG) en placenta preeclámptica

This study aimed to assess association between preeclampsia with trophoblast cells and serum level of b-human chorionic gonadotropin (ß-hCG). Were compared 20 patients with preeclampsia and 20 control patients with respect to demographics, hematological parameters and the presence of trophopblast in placental samples. Patchy necrosis with loss of microvilli and gross thinning of the syncytium with distorted microvilli were seen in terminal villi of placentae of women with pre-eclampsia Syncytial cells at the molecular level crossings, especially at the level of ßhCG in conjunction with the changes in the preeclampsia was made on the histopathological changes to clarify the villi.

El objetivo fue evaluar la asociación entre la preeclampsia con células trofoblásticas y concentración sérica de la gonadotropina coriónica humana b (ß-hCG). Se compararon 20 pacientes con preeclampsia y 20 pacientes de control con respecto a datos demográficos, parámetros hematológicos y la presencia de trofoblasto en muestras de placenta. Se observaron áreas dispersadas de necrosis, con pérdida de microvellosidades y adelgazamiento del sincitio con microvellosidades distorsionadas en las vellosidades terminales de placentas en mujeres con células sincitiales preeclámticas a nivel molecular, junto a altos niveles de ßhCG asociados a los cambios generados por la preeclampsia sobre los parámetros histopatológicos.

Útero bicorne y agenesia renal, asociado a preeclampsia: a propósito de un caso / Uterus bicornis and renal agenesis associated with preeclampsia: a case report

Las malformaciones müllerianas tienen una incidencia mundial de 0,1 % a 0,5 %, siendo en Venezuela de 0.02 %; se asocia de 37 % a 60 % con agenesia renal congénita. Se ha observado que la relación entre malformación mülleriana y agenesia renal aumentan la incidencia de trastornos hipertensivos del embarazo. Se presenta el caso de una paciente de 18 años, IIG, IP, con embarazo de 30 semanas más 2 días por FUR, con diagnóstico de útero bicorne y agenesia renal, quien ingresó con presión arterial elevada, durante su hospitalización presentó proteinuria y síntomas neurológicos. Se diagnosticó preeclampsia grave y se interrumpió el embarazo. La evolución de madre e hijo fue normal, la madre egresó a los tres días y el recién nacido al mes. No encontramos en la literatura venezolana casos similares, por lo que este constituye el primero reportado

Müllerian malformations have a global incidence of 0.1 % to 0.5 %, in Venezuela the incidence is close to 0.02 %; is associated in 37 % to 60% with congenital renal agenesis. It has been observed that the relationship between renal agenesis and Mullerian malformation increases the incidence of hypertensive disorders of pregnancy. We present a case of 18 years old patient of 18, IIG, IP, with a pregnancy of 30 weeks plus 2 days by LMP, diagnosed with bicornuate uterus and renal agenesis, who was admitted with high blood pressure, during hospitalization showed proteinuria and neurological symptoms. Severe preeclampsia was diagnosed and pregnancy termination performed. The mother and child outcome was satisfactory, the mother was discharged after three days and the baby a month. We did not found in the Venezuelan literature similar cases, so this is the first reported

Placental morphology in pre-eclampsia and eclampsia and the likely role of NK cells.

Background: Placenta has long been a neglected organ as far as its pathology is concerned. This study is an attempt to observe the morphological features of placentae both gross and microscopic in normal pregnancy, preeclampsia, and eclampsia. Materials and Methods: A total of 150 placentae were collected; of these, 50 belonged to normal pregnancy, 50 belonged to pre-eclamptic women, and 50 were from patients of eclampsia. Results: Placental trimmed weight was seen to be decreased in patients of preeclampsia and eclampsia. Placental infarcts were more commonly seen in the diseased group and they were more centrally located. Hypertrophy of the spiral arterioles was observed in the decidual portion found in placental disc and membranes. Distal villous hypoplasia was also frequently seen in the diseased group. Fetal membranes were thickened and showed infarcts in preeclampsia and eclampsia. Conclusions: Morphological features seen in eclamptic placentae were similar but exaggerated compared to preeclampsia. In conclusion, the pathological changes were found to be more severe and frequent in preeclampsia and eclampsia, but more so in eclamptic placentae as compared with placenta of normal pregnancy. CD56 immunomarker was also used to identify NK cells. They were found to be present only in the diseased group and were located in the decidual portion of the basal plate, implicating their role in the development of the disease.

Spectrum of changes in placenta in toxemia of pregnancy.

Background: Toxemia of pregnancy is the leading cause of maternal mortality and is an important factor in fetal wastage. The incidence is high in developing countries with malnutrition, hypoproteinemia, and poor obstetric facilities. Objectives: The present study was undertaken to analyze placental changes in the preeclampsia-eclampsia syndrome with a view to assess the significance of villous abnormalities by histopathological methods because these changes serve as a guide to the duration and severity of disease. Gross abnormalities noted were the placental infarcts, retroplacental hematoma, and calcification. Results: The striking villous abnormalities observed in the study group were cytotrophoblastic proliferation (86%), thickening of the villous basement membranes (95.23%), increase in syncytial knots (90.4%), villous stromal fibrosis (92%), fibrinoid necrosis (97.82%), endarteritis obliterans (53.96%), decreased villous vascularity, and paucity of vasculosyncytial membranes (93.65%). Conclusions: The gross abnormalities and villous lesions in the preeclampsia (P < 0.001) and eclampsia syndrome (P < 0.05) were significant.

Mortalidad materna: tragedia prevenible ¿hemos avanzado? / Maternal mortality: avoidable tragedy have we advanced?

Conocer la incidencia de la mortalidad materna, factores relacionados, identificar causas y sugerir acciones pertinentes. Estudio descriptivo retrospectivo epidemiológico analítico de las muertes maternas sucedidas durante el período de 2005-2009. Se analizaron 16 historias de las cuales 12 fueron por causas directas y 4 indirectas con 11 878 nacidos vivos. Departamento de Obstetricia y Ginecología, Hospital "Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo. La razón promedio de mortalidad materna directa fue 100,18 por 100 000. Las principales causas de muerte: hemorragia (atonía uterina 48,34 por ciento y embarazo ectópico roto 28,57 por ciento), toxemia, y sepsis con 58,34 por ciento, 25 por ciento, y 16,66 por ciento respectivamente. Las cuatro muertes no obstétricas: hemorragia digestiva superior, falla multiorgánica, insuficiencia respiratoria aguda, neumonía. Predominaron procedentes del Estado Carabobo (66,66 por ciento) y de Falcón y Yaracuy (33,4 por ciento), residentes en barrios (33,33 por ciento), solteras y concubinas (83,33 por ciento), estudios secundaria 75 por ciento. Antecedente familiar determinante la hipertensión arterial (25 por ciento), antecedente personal hipertensión (16,67 por ciento), edad materna entre 20-34 años (75 por ciento) y sin control prenatal (50 por ciento). Destacaron las I gestas (50 por ciento), edad de embarazo 37-41 semanas (41,67 por ciento) y 21 semanas y menos 25 por ciento, muerte en estado puerperal (66,67 por ciento), el lapso de ingreso al hospital menos de 12 horas (41,67 por ciento) y menos de 6 horas (33 por ciento), la hora de muerte 41,67 por ciento entre 1-6 am. El 66,67 por ciento fueron casos referidos al hospital por complicaciones severas. Se realizó autopsia a 62,5 por ciento (10/16). La razón promedio muestra cifras altas con incremento destacado, volviendo a niveles superados en década anterior, además ha retornando como causal de primacía el factot hemorrágico, seguida de la toxemia..

To know the incidence of maternal mortality, related factors, identify causes and suggest appropriate action. Analytical epidemiological retrospective descriptive study of maternal deaths occurred during the period 2005-2009. A total of 16 records of which 12 were for direct and 4 indirect causes with 11 978 live births. Department of Obstetrics and Gynecology, Hospital Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo. The average rate of direct maternal mortality was 100.18 per 100 000. The leading causes of death: hemorrhage (uterine atony 48.34 percent and 28.57 percent ruptured ectopic pregnancy), toxemia, and sepsis with 58.34 percent, 25 percent, and 16.66 percent respectively. The four non-obstetric deaths: upper gastrointestinal bleeding, organ failure, acute respiratory failure, pneumonia. Predominated from Carabobo Estado (66.66 percent) and Falcon and Yaracuy (33.4 percent), residents in neighborhoods (33.33 percent), unmarried and concubines (83.33 percent), secondary studies 75 percent. Family antecedent hypertension (25 percent), personal antecedent hypertension (16.67 percent), maternal age between 20-34 years (75 percent) and no prenatal care (50 percent). In the obstetrical state I gravid I (50 percent), gestational age 37-41 weeks (41.67 percent) and 21 weeks and less 25 percent, death in puerperal state (66.67 percent), the interval between admission to hospital less than 12 hours (41.67 percent) and less than 6 hours (33 percent), time of death 41.67 percent between 1-6 am. The 66.67 percent cases were referred to hospital for severe complications. Autopsy was performed to 62.5 percent (10/16). The average rate increase showed high with outstanding, returning to levels exceeded in the previous decade, has also returned as causal primacy hemorrhagic factor, followed by toxemia, which indicates that we must redouble preventive strategies, efficient health sector and other components

Fisiopatologia da pré-eclâmpsia / Pathophysiology of preeclampsia

A pré-eclâmpsia é uma complicação da gravidez que ocorre no terceiro trimestre de gestação e é específica da gravidez humana. Ela é secundária a uma disfunção placentária, a qual é responsável pela liberação na circulação materna de diversas substâncias responsáveis por ativação e até lesão do endotélio materno, tendo como consequências hipertensão arterial, nefropatia glomerular e aumento da permeabilidade vascular. Trabalhos recentes têm permitido melhor compreensão da fisiopatologia desta patologia, com a esperança de desenvolver novos instrumentos de detecção e possíveis perspectivas terapêuticas. Este artigo ilustra os mecanismos fisiopatológicos da revascularização uterina defeituosa, da disfunção placentária e da disfunção endotelial que ocorrem no decurso da pré-eclâmpsia.

Estudio comparativo de la morbimortalidad del producto gestacional en mujeres embarazadas con preeclampsia modera o severa / Comparative study of morbimortality of gestational product in pregnant women with mild or severe preeclampsia

INTRODUCCION: La preeclampsia es una enfermedad exclusiva de la gestación humana, que afecta a la embarazada produciendo una disfunción vascular. OBJETIVO: Comparar la morbimortalidad del producto gestacional en mujeres embarazadas con preeclampsia (PE) moderada o severa. PACIENTES Y METODO: Estudio de tipo no experimental, descriptivo, por causa-efecto, de carácter retrospectivo. La población estudiada correspondió a toda paciente que sufrió PE, subclasificada en dos grupos; pacientes con PE moderada y pacientes con PE severa. El estudio se realizó en la Clínica Hospital del Profesor en el período comprendido entre junio del año 2007 y junio del año 2008. Se analizaron variables clínicas del recién nacido y de la embarazada. Los resultados obtenidos fueron analizados por medio de las pruebas de comparación de medias poblacionales y comparación de proporciones poblacionales. RESULTADOS: De un total de 1680 embarazos registrados en la Clínica Hospital del Profesor, 42 fueron diagnosticados con síndrome hipertensivo del embarazo (SHE), correspondiendo a un 2,5 por ciento. 28 (66 por ciento) correspondieron a PE moderada, 13 (32 por ciento) correspondieron a PE severa. El retardo del crecimiento intrauterino (RCIU) presentó diferencia significativa con un p< 0,05. El sufrimiento fetal agudo (SFA) y la mortalidad fetal, no presentaron diferencia significativa con un p> 0,05. CONCLUSION: Si bien las diferencias clínicas para el diagnóstico de preeclampsia moderada y severa son claras, las complicaciones que pueden traer al producto de la gestación no presentan diferencia, salvo al analizar el RCIU.

INTRODUCTION: Preeclampsia is an exclusive disease of human gestation, that affects pregnant women producing vascular dysfunction. AIM: Compare the morbid-mortality of the gestational product in pregnant women with mild or severe preeclampsia (PE). PATIENT AND METHODS: Retrospective, descriptive, non experimental, cause-effect study. The studied subjects were women that suffered with PE, sub-classified in two groups, mild PE patients and severe PE patients. The study was made in the “Clínica Hospital del Profesor” from June 2007 to June 2008. Different clinical parameters from the newborn and the pregnant were analyzed. The results were analyzed by the comparison of population and population ratio tests. RESULTS: From a total of 1680 pregnant women registred in the “Clínica Hospital del Profesor”, 42 were diagnosed pregnancy-induced hypertension / gestational hypertension, which represents 2.5 percent of all pregnancies. 28 (66 percent) represents to a moderate PE, 13(32 percent) represents to a severe PE. Intrauterine growth restriction presented a significant difference with an p< 0,05. The acute fetal suffering and fetal mortality didn’t have a significant difference with an p> 0,05. CONCLUSION: Although the clinical differences for the diagnose of mild and severe PE are clear, the complications that may ocurre to the product of the pregnancy don’t present a significant difference, except for the intrauterine growth restriction, that presented a significant difference with an alpha = 0,05.

Morte materna por hipertensão no Estado de Santa Catarina / Maternal death rate related to hypertension in Santa Catarina State

Objetivo: Esse trabalho tem por objetivo avaliar o coeficiente de Morte Materna por hipertensão nos anos de 1996 a 2005 no estado de Santa Catarina. Métodos: Foi realizado um estudo descritivo retrospectivo. A fonte oficial relativa aos óbitos maternos estudados é o Sistema de Informações sobre Mortalidade, tendo sido utilizada as bases de óbitos de residentes em Santa Catarina no período de 1996 a 2005. O número de nascidos vivos foi obtido a partir da base de dados do Sistema de Informações sobre Nascidos Vivos. Calculou-se o Coeficiente de Mortalidade Materna geral e o relacionado a distúrbios hipertensivos e a porcentagem de óbitos relacionados aos distúrbios hipertensivos no total geral. Resultados: No período do estudo ocorreram 79 óbitos maternos relacionados à hipertensão. Esse número corresponde a 20 % do total de óbitos maternos ocorridos. O coeficiente de mortalidade materna geral no período do estudo foi de 43,3 por 100000 nascidos vivos e o de mortalidade materna relacionada à hipertensão foi de 8,6 por 100000 nascidos vivos. Conclusões: As mortes maternas por hipertensão ainda representam 20% das mortes maternas no estado. Sabe-se que as complicações da hipertensão gestacional são passíveis de prevenção com a ampliação da cobertura pré-natal, preparação do pessoal de assistência (incluindo atenção primária), diagnóstico precoce de pacientes de alto risco e um sistema de referência eficaz e rápido para centros de atenção terciária.

Objective: To evaluate the maternal death rate related to hypertension from 1996 to 2005 in Santa Catarina State. Methods: A retrospective descriptive study was made. The official source of maternal death is the Information System about Mortality. The database of deaths in Santa Catarina state from 1996 to 2005 was used. The number of born alive was gathered from the Information System about Born Alive databases. The general and hypertension maternal death rates are calculated along with the general death rate related to hypertension. Results: During the studied time 79 maternal deaths related to hypertension occurred. This number represents 20% of maternal deaths in the period. The general maternal death rate in the period was 43.3 by 100,000 born alive and the one related to hypertension was 8.6 by 100,000 born alive. Conclusions: Maternal deaths related to hypertension still represent 20% of maternal death in the state. It is known that the complications of gestational hypertension may be prevented by the broadening of prenatal coverage, training of personnel, early diagnosis of high risk patients and a quick and efficient reference system on the third health-attention level.

Enfermedad hipertensiva en la gestante: resultados de un servicio / Hypertensive disease in the pregnant woman: results of a service

La preeclampsia constituye una de las principales causas de mortalidad materna en el mundo. Se realizó un estudio retrospectivo, longitudinal y descriptivo en el Hospital Docente Ginecoobstétrico de Guanabacoa de los años 2004 y 2005, de todas las gestantes que ingresaron en la Sala de Cuidados Perinatales, clasificadas como hipertensas, y que tuvieron su parto en igual período. El grupo estudio correspondió a 71 pacientes. Se tomó como grupo control igual número de gestantes que tuvieron su parto en el mismo período, y que no eran hipertensas ni presentaron la enfermedad durante la gestación. Predominó la preeclampsia como entidad única o asociada a una hipertensión crónica. Entre los factores de riesgo fueron más frecuentes la nuliparidad con un 45,1 por ciento, el sobrepeso y la obesidad (22,5 y 25,4 por ciento respectivamente), lo cual resultó de gran significación estadística. Fue significativa la diferencia en el parto por cesárea (77,5 por ciento) en el grupo estudio, en relación con el parto transpelviano. También el bajo peso tuvo diferencias estadísticas significativas (21,1 por ciento). La morbilidad materna fue baja.

Preeclampsia is one of the main causes of maternal mortality in the world. A retrospective, longitudinal and descriptive study was conducted in the Gynecoobstetric Hospital of Guanabacoa in 2004 and 2005. All the expectants admitted in the Perinatal Care Ward that were classified as hypertensive and that delivered in the same period were studied. The study group was composed of 71 patients. The same number of pregnant women that gave birth during this period were included in the control group. They were not hypertensive and and they did not suffer from this disease during pregnancy. Preeclampsia predominated as a unique entity or associated with chronic hypertension.The most common risk factors were nuliparity with 45.1 percent, overweight and obesity (22.5 and 25.4 percent, respectively), which had a great statistical significance. In the study group, there was a remarkable difference between the cesarean delivery (77.5 percent) and the transpelvic delivery. Low weight also showed significant differences (21.1 pecent). Maternal mortality was low.

Cambios ultraestructurales del trofoblasto en los casos de hipoxia durante la preeclampsia / Ultraestructural changes of trophoblast in hipoxic cases during

Examinar la ultraestructura del sincitiotrofoblasto en placentas de embarazadas complicadas con preeclampsia con especial referencia al efecto de la hipoxia sobre la estructura fina del tejido. Diez placentas, a término, afectadas por preeclampsia, fueron tomadas inmediatamente después del parto por cesárea y de cada una de ellas tres biopsias de la superficie maternal se disecaron en sala de parto, en especímenes de 2 a 5 mm, y se fijaron por inmersión en glutaraldehido al 4 por ciento, pH 7,4,a 4 ºC. Posteriormente se dividieron en fragmentos de 1 mm y sumergidos en solución fresca fijadora por períodos variables de 2 a 72 horas seguidas por una fijación secundaria en tetraóxido de osmio al 1 por ciento en buffer fosfato 0,1 M durante 1 hora. Las muestras se procesaron siguiendo los procedimientos convencionales de a microscopia electrónica de transmisión para su observación. Laboratorio de microscopia electrónica del Ciadana, Facultad de Ciencias de la Salud, Maracay. Los hallazgos revelan proyecciones de la membrana plasmática del sincitio de diversas formas, que simulan desprenderse de la superficie. La membrana basal del sincitio se mostró engrosada. Mitocondrias en diversos grados de degeneración presentaron partículas electron densas en la matriz mitocondrial. Regiones apicales del citoplasma sincitial parecen desprenderse hacia el espacio intervelloso. Numerosas vacuolas intracitoplasmáticas y ampliaciones de las cisternas del retículo endoplásmico rugoso se destacan en el citoplasma. Interrupciones de la membrana sincitial y regiones citoplásmicas sin membrana plasmática se notaron. Fragmentos del sincitio desprendidos de la superficie del mismo sugieren ser los corpúsculos que dañan los endotelios de la unidad materna – feto – placentaria constituyendo uno de los estímulos para l mantenimiento de a patogénesis de a preeclampsia.

Novedades y controversias en relación con la preeclampsia/eclampsia / Novelties and controversies in relation to preeclampsia/eclampsia

Se analizaron los temas controversiales existentes en relación con la preeclampsia/eclampsia. Se comprobó que aunque la causa continúa siendo desconocida, el hallazgo del aumento de la tirosina quinasa 1 soluble similar al fibrina (SFLT-1) en pacientes con la misma sugiere que esta puede interferir con el proceso angiogénico de la placentación y desempeñar un papel patogénico. La hipertensión gestacional severa tiene mayor morbilidad perinatal que la preeclampsia leve. La aspirina tiene solo un efecto muy moderado ya que reduce la preeclampsia en el grupo de alto riesgo. El sulfato de magnesio es útil para prevenir las convulsiones eclámpticas en las pacientes con preeclampsia grave, pero su influencia sobre la progresión de la enfermedad no se ha demostrado. El síndrome HELLP puede presentarse en forma parcial (ELLP), al no comprobarse hemólisis. Estos casos presentan mejor evolución que los otros. Se observó que antes de las 34 sem, el tratamiento expectante por 48 h para administrar esteroides parece ser una buena opción.

Existing controversial topics in relation to preeclampsia/eclampsia were analyzed. It was shown that although the cause is still unknown, increased soluble fibrin-like tyrosine kinase (sFLT-1) in patients affected by this condition suggests that it can interfere with the angiogenic process of placentation and play a pathogenic role. Severe gestational hypertension exhibits higher perinatal morbidity than mild preeclampsia. Aspirin has just a very mild effect in reducing preeclampsia in the high risk group. Magnesium sulphate is useful for eclampsic convulsions in those patients with severe preeclampsia, but its impact on disease progression has not yet been demonstrated. HELLP syndrome may partially occur (ELLP) without proven hemolysis. These cases showed better evolution than the others. It was observed that before 34th week of pregnancy, the expectant treatment based on steroid administration for 48 hours seemed to be a good choice.

Espectro clínico de la preeclampsia: estudio comparativo de sus diversos grados de severidad / Clinical spectrum of preeclampsia: comparative study of different grades of severity

Objetivo: Comparar los resultados maternos y perinatales en embarazadas que cursaron con preeclampsia (PE) en sus diversas presentaciones en el período 2001 -2005. Material y Método: Estudio retrospectivo de 7.205 partos asistidos en la maternidad del Hospital Clínico de la Universidad de Chile. 204 mujeres presentaron PE/eclampsia, dividiéndose en 3 grupos: PE modera, severa y síndrome de HELLP. Se analizaron las variables clínicas y de laboratorio de la embarazada y del recién nacido. Se compararon estos resultados en los 3 grupos de estudio. Para variables continuas de distribución normal se empleó el análisis de varianza (ANOVA). Para variables categóricas se empleó la tabla de contingencia de Chi2 o la prueba exacta de Fisher. Resultados: 80 mujeres presentaron PE moderada (39,2 por ciento), 114 PE severa (55,8 por ciento) y 10 HELLP (4,9 por ciento). Se observaron diferencias significativas en la vía de parto, edad gestacional, peso del recién nacido, percentil, morbi-mortalidad neonatal, complicaciones maternas médico-quirúrgicas en los grupos de PE severa y HELLP comparados con las PE moderadas. La PE severa tuvo una mayor proteinuria que los otros dos grupos. Así mismo, se observaron también diferencias significativas en el grupo de síndrome de HELLP en los niveles de enzimas hepáticas, LDH y recuento plaquetario en comparación con el grupo de las PE moderadas y severas. Conclusión: La PE es una entidad clínica que puede presentarse en diversos grados de severidad, por lo que su correcta clasificación de acuerdo a criterios clínicos y de laboratorio, es clave para el tratamiento y pronóstico de las pacientes.

Some histochemical changes in the placentae of preeclampsia

The placenta has been implicated in the pathophysiology of preeclampsia. Preeclampsia is more common in multifetal gestations which have an increased placental mass compared to singleton pregnancies. Detecting the effects of preeclampsia on the availability of enzymes in the full term placenta. Two groups of placentae were taken from full term pregnant women immediately after labour, each consisting of ten placentae. The first group are placentae obtained from women having an uneventful pregnancy with no history of disease or complication [as a control group] while the second group consists of placentae obtained from women with a history of preeclampsia. The materials were obtained from Al-Batool and Al-Khansaa Teaching Hospitals in Mosul, between February and July [2006]. Significant histochemical changes were detected in the placentae of the second group when compared with those from the first group, such changes result from syncytial damage and destruction affecting the preeclamptic placentae, leading to the loss of alkaline phosphatase enzyme with an increase in the amount of the degenerating acid phosphatase enzyme