ABSTRACT
Introdução: A hipertensão é uma das mais graves patologias gestacionais, levando a um aumento importante da morbimortalidade materna e perinatal. Este estudo teve como objetivo determinar a correlação entre o número de internações hospitalares em primigestas com distúrbios hipertensivos na gestação e variação sazonal. Métodos: Estudo prospectivo ecológico entre todas as primigestas com idade gestacional maior de 20 semanas que internaram no Centro Obstétrico do Hospital de Clínicas de Porto Alegre num período de 12 meses. A frequência de internações por distúrbios hipertensivos foi comparada nos diferentes meses e estações do ano e também em relação à temperatura média e mínima do dia da internação e da semana anterior. Resultados: Foram estudadas 1.327 primigestas com idade média de 20,7 anos e idade gestacional média de 38,6 semanas. Entre estas, 232 (17,5%) apresentaram alteração na pressão arterial, sendo que 9,7% apresentaram pré-eclâmpsia (PE) e 7,5% outros distúrbios hipertensivos da gestação. Não houve associação significativa entre a frequência de internações por distúrbios hipertensivos e a temperatura média ou mínima do dia ou da semana anterior à internação. Ao longo do ano, ocorreu variação significativa (p < 0,05) na frequência de internações por pré-eclâmpsia, sendo esta maior no mês de setembro (15,1% das internações), marcando a transição entre o inverno e primavera. Conclusão: As variações da temperatura têm influência no número de internações por hipertensão na gestação, sendo essa informação útil no planejamento do sistema de saúde e da disponibilidade de leitos hospitalares.
Introduction: Hypertension is one of the most severe pregnancy disorders, leading to a significant increase of maternal and perinatal morbidity and mortality. This study aimed to determine the correlation of the number of hospital admissions of primiparous women with hypertensive disorders and seasonal variation. Methods: A prospective ecologic study of all primiparous women who were admitted to the Obstetric Center of Hospital de Clínicas de Porto Alegre at 20 or more weeks of gestation in 12 months. The frequency of hospital admissions was compared in different months and seasons of the year and with regard to mean or minimum temperature of the day and the week before admission. Results: A total of 1,327 primiparous women were studied, with average age of 20.7 years and mean gestational age of 38.6 weeks. Of these, 232 (17.5%) had hypertensive disorders, 9.7% of which had pre-eclampsia and 7.5% others hypertensive disorders. We observed no differences between the number of admissions and mean or minimum temperature on the day of admission nor during the week before the diagnosis. There was a significant variation (p < 0.05) in the number of admissions for pre-eclampsia by month, with the highest frequency in September (15.1% of admissions), which marks a transition from winter to spring. Conclusions: Variations in temperature influence the number of hospital admissions for hypertensive disorders. This information is very important to plan public health services and availability of hospital beds
Subject(s)
Humans , Female , Pregnancy , Blood Pressure Determination , Pregnancy/physiology , Temperature , Pre-Eclampsia , Pregnancy Complications , SeasonsABSTRACT
BACKGROUND: A better understanding of the uterine and endometrial vascularization in intrauterine device (IUD)-induced side effects is clearly of paramount importance in terms of both physiological and pathophysiological changes and may permit assessment for future therapeutic treatments. The aim of the study was to quantify the subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects using power Doppler analysis as well as pulsatility index (PI) and resistance index (RI) in the exact midluteal phase 3 months after IUD insertion. There were 27 patients using the levonorgestrel-releasing intrauterine system and 25 patients using TCu 380A. STUDY DESIGN: This study has a prospective clinical trial design. RESULTS: There is an increased subendometrial blood flow in patients with severe dysmenorrhea and/or bleeding, after controlling for IUD type, age and parity. Moreover, the PI and RI were not different in such women. CONCLUSION: The results provide new data on the bleeding patterns related to these IUD types that may be relevant during contraception use. This method could be used as a prognostic factor to better evaluate women for the risk of developing dysmenorrhea and/or bleeding after IUD insertion.
Subject(s)
Intrauterine Devices, Copper/adverse effects , Intrauterine Devices, Medicated/adverse effects , Microvessels/physiopathology , Uterus/blood supply , Adult , Amenorrhea/etiology , Arteries/diagnostic imaging , Dysmenorrhea/diagnostic imaging , Dysmenorrhea/etiology , Dysmenorrhea/physiopathology , Female , Hemorheology , Humans , Menorrhagia/diagnostic imaging , Menorrhagia/etiology , Menorrhagia/physiopathology , Microvessels/diagnostic imaging , Pulsatile Flow , Regional Blood Flow , UltrasonographyABSTRACT
OBJECTIVE: To evaluate the effect of the levonorgestrel intrauterine system (LNG-IUS) and TCU 380A on the subendometrial vascularization and the uterine artery blood flow during the midluteal phase. DESIGN: Prospective clinical trial. SETTING: Teaching hospital. PATIENT(S): The trial included 27 patients who received the LNG-IUS compared with 25 patients who received the TCU 380A. INTERVENTION(S): The subendometrial blood flow was evaluated using power Doppler analysis, uterine artery pulsatility index (PI), and resistance index (RI) just before inserting the intrauterine device in the midluteal phase and 3 months after. MAIN OUTCOME MEASUREMENT(S): Power Doppler analysis, PI, RI, and endometrial thickness. RESULT(S): There were no significant differences in subendometrial vascularization between the groups. Pulsatility index and RI variability (before and after) increased and endometrial thickness reduced in LNG-IUS users. We used the multiple logistic regression model to examine the potential confounding bias (age and parity). The LNG-IUS was independently associated with increased PI. CONCLUSION(S): No subendometrial microvascularization difference was found between the groups. It is the first direct evidence that LNG-IUS reduced uterine artery blood flow, even after controlling for age and parity.
Subject(s)
Contraceptive Agents, Female/administration & dosage , Intrauterine Devices, Copper , Intrauterine Devices, Medicated , Levonorgestrel/administration & dosage , Uterus/blood supply , Adult , Age Factors , Arteries/diagnostic imaging , Arteries/drug effects , Female , Humans , Logistic Models , Luteal Phase , Microvessels/diagnostic imaging , Microvessels/drug effects , Odds Ratio , Parity , Pregnancy , Prospective Studies , Regional Blood Flow/drug effects , Ultrasonography, Doppler, Color , Ultrasonography, Doppler, PulsedABSTRACT
Os distúrbios hipertensivos da gestação são importante fator causal de morbimortalidade materna, fetal e neonatal. É inquestionável a necessidade de um diagnóstico preciso e simplificado para uso da emergência obstétrica. A fita reagente de imersão em urina (dipstick) é utilizada amplamente como método de detecção de proteína na urina. Este estudo tem como objetivo principal comparar os resultados do dipstick em amostra urinária ao resultado da proteinúria de 24 horas, considerado teste padrão-ouro na detecção de proteínas na urina...