Hallazgos ecocardiográficos en pacientes con preeclampsia en la Unidad de alta dependencia obstétrica en el Hospital Universitario de San José, 2012-2014 / Echographic findings in patients with pre-eclampsia see at the critical obstetrics unit of the San Jose Children's Teaching Hospital, 2012-2014

Objetivo: describir las alteraciones ecocardiográficas encontradas en pacientes con diagnóstico de preeclampsia severa.Materiales y métodos: estudio de corte transversal. Se describen los hallazgos ecocardiográficos en las pacientes con preeclampsia severa (PS), de acuerdo con los criterios del Congreso Americano de Obstetras y Ginecólogos, atendidas en un hospital universitario de referencia ubicado en Bogotá (Colombia), entre enero 1 de 2012 y junio 30 de 2014. Se excluyeron las pacientes con control adecuado de tensión arterial o con patología cardiaca estructural previa conocida. Se describen las variables sociodemográficas, clínicas y los hallazgos ecocardiográficos más frecuentes, globalmente y por momento de aparición. Se presentan los datos mediante estadística descriptiva.Resultados: se diagnosticaron 228 pacientes con PS. A 124 se les realizó ecocardiograma: en 8 de ellas el informe de ecocardiografía fue no concluyente. Se hallaron 78 pacientes (67 %) con alguna alteración. Los principales hallazgos fueron: hipertensión pulmonar leve, n = 34 (29 %); hipertrofia del ventrículo izquierdo, n = 32 (27 %); hipertensión pulmonar moderada, n = 21 (18 %); disfunción diastólica, n = 16 (13 %). Las pacientes con PS pretérmino (69 %) presentaron alteraciones ecocardiográficas más frecuentes que las pacientes a término (20 %) y que las que comenzaron con PS en el puerperio (11 %). La disfunción diastólica se presentó más en pacientes con preeclampsia que comenzó en el puerperio.Conclusiones: la prevalencia de alteraciones ecocardiográficas en PS es del 67 %, con mayor frecuencia de hipertensión pulmonar e hipertrofia ventricular izquierda. Se requieren más estudios que validen estos hallazgos regionalmente.

Objective: To describe echographic abnormalities found in patients diagnosed with severe preeclampsia.Materials and methods: Cross-sectional study describing ultrasound findings in patients with severe preeclampsia (SP) in accordance with the criteria of the American Congress of Obstetricians and Gynecologists. The patients were seen in a referral teaching hospital in Bogota (Colombia), between January 1, 2012 and June 30, 2014. Patients with adequate blood pressure control or with known pre-existing structural heart disease were excluded. Social, demographic and clinical variables are described, as well as the most frequent global echographic findings, also by time of onset. The data are presented using descriptive statistics.Results: Overall, 228 patients were diagnosed with SP. An echographic examination was performed in 124 and in 8 of them the echographic report was non-conclusive. Some form of abnormality was found in 78 patients (67 %). Mild pulmonary hypertension [n=34 (29 %)], left-ventricular hypertrophy [n=32 (27 %)], moderate pulmonary hy per tension [n=21 (18 %)] and diastolic dysfunction [n= 16 (13 %)] were the main findings observed. Echographic abnormalities were found more frequently in patients with pre-term SP (69 %) than in term patients (20 %) or those who developed SP during the post-partum period (11 %). Diastolic dysfunction was found to occur more frequently in patients who developed preeclampsia in the post-partum period.Conclusions: The prevalence of echographic abnormalities in SP is 67 %, the most frequent being pulmonary hypertension and left ventricular hypertrophy. More studies are needed in order to validate these findings regionally.

Characterization of Atypical Preeclampsia.

OBJECTIVE: To characterize patients with atypical preeclampsia (PE), in relation to socio-demographic characteristics, clinical presentation, maternal complications and perinatal outcome. MATERIALS AND METHODS: Between July 1, 2011 and November 30, 2013, a cohort was created of women attended at a Obstetric High-dependency Unit who met criteria for atypical PE: gestational hypertension with severe hypertension or symptoms or laboratory signs suggestive of microangiopathy/hemolysis; normotensive proteinuria with the presence of symptoms or laboratory signs suggestive of microangiopathy/hemolysis; presence of PE or eclampsia or HELLP syndrome appearing after 48 h postpartum, and, PE or eclampsia appearing before 20 weeks of pregnancy. RESULTS: A total of 200 women fulfilling criteria for atypical PE, were included: 61.5% corresponded to non-proteinuric gestational hypertension, 35.5% to normotensive proteinuria and 3% to PE/eclampsia in late postpartum. Criteria for severe maternal morbidity were present in 12% of the cases and there were no maternal deaths. There were 6 perinatal deaths. CONCLUSION: Atypical preeclampsia is a type of preeclampsia not fully recognized that is associated with maternal and neonatal morbidity, mainly related to smallness-for-gestational-age and low birth weight. Vasospasm symptoms are a key element to detect this condition.

Marcadores ecográficos de corioamnionitis e infección fetal in utero. Revisión de la literatura / Ultrasound markers for chorioamnionitis and in utero fetal infection: a literature review

Introducción: el diagnóstico de corioamnionitis se basa en criterios clínicos que no alcanzan una sensibilidad mayor al 60%, y que tienen poca utilidad para predecir el compromiso fetal. El ultrasonido surge como una alternativa útil en el diagnóstico. Al mejorar el diagnóstico con la búsqueda de marcadores ecográficos de infección fetal podemos impactar en la morbimortalidad perinatal al poder intervenir de forma temprana a las gestantes en riesgo de compromiso fetal, especialmente corioamnionitis con curso subclínico. El objetivo de esta revisión es conocer la evidencia que soporta la asociación entre los hallazgos ecográficos del ultrasonido y la presencia de corioamnionitis e infección fetal in utero. Materiales y métodos: se realizó una revisión de la literatura existente en las bases de datos medline, ovid, ebsco, ProQuest, lilacs, SciELO desde enero de 1985 hasta octubre de 2012. Se incluyeron los artículos de revisión e investigaciones originales.Resultados: en las gestantes con parto pretérmino y ruptura prematura de membranas ovulares el acortamiento cervical, la presencia de "sludge", el oligohidramnios y la involución del timo son los marcadores que han mostrado mayor asociación con infección amniótica.Conclusiones: el ultrasonido es una herramienta por considerar en el diagnóstico de infección materna y fetal in utero.

Introduction: A diagnosis of chorioamnionitis is based on clinical criteria which only manage 60% sensitivity and have little usefulness in predicting fetal compromise. Ultrasound emerges as a useful diagnostic alternative. An impact might be made on perinatal morbimortality by improving diagnosis through the search for echographic markers of fetal infection, thereby enabling early intervention in pregnant women at risk of fetal compromise, especially regarding subclinical chorioamnionitis. This review was aimed at providing evidence supporting an association between ultrasound’s echographic findings and the presence of chorioamnionitis in in utero (congenital) fetal infection.Materials and methods: A review of the existing literature was made in medline, ovid, ebsco, ProQuest, lilacs and scielo databases from January 1985 to October 2012. Original research and review articles were included. Results: Cervical length shortening, the presence of sludge, oligohydramnios and thymus involution are the markers which have been shown to have the greatest association with intra-amniotic infection.Conclusions: Ultrasound is a tool to be considered when diagnosing in utero maternal and fetal infection.