[Atypical preeclampsia: case report]. / Preeclampsia atípica. Reporte de un caso.

BACKGROUND: Preeclampsia that occurs at < 20 weeks of gestation is rare and has been usually reported with molar or hydropic degeneration of the placenta and antiphospholipid syndrome. CASE REPORT: To describe the clinical presentation of atypical preeclampsia of a patient of 37 years old at her first gestation who developed this entity at 18.5 weeks of gestation. She had history of pre-existing hypertension and infertility. This pregnancy was obtained through in vitro fertility. She reported a severe headache and was admitted to our hospital secondary to elevated blood pressure of 160/110 mm Hg. The laboratory evaluation revealed platelet count 51,000, alanine aminotransferase of 331 UI/L, aspartate aminotransferase of 285 UI/L, lactate dehydrogenase 421 UI/L and urinalysis with +2 proteinuria, soluble fms-like tyrosine kinase-1/placental growth factor ratio 895.5. The diagnosis of chronic hypertension and superimposed preeclampsia and incomplete HELLP syndrome was supported. After termination of pregnancy, the patient improved rapidly. She was discharged home on postoperative day 7 with a blood pressure of 120/70 mm Hg with normal laboratory. CONCLUSIONS: Clinicians should consider the diagnosis of preeclampsia and HELLP syndrome before 20 weeks of gestation in women presenting with clinical or laboratory abnormalities consistent with this disease.

[Progression of gestational hypertension to preeclampsia]. / Evolución de hipertensión gestacional a preeclampsia.

BACKGROUND: 15 to 25% of patients with gestational hypertension progress to preeclampsia. OBJECTIVE: To determine the number of patients with gestational hypertension who developed preeclampsia. MATERIALS AND METHODS: Observational prospective comparative and longitudinal study realized between november 2010 to december 2012. We included pregnant patients diagnosed with mild gestational hypertension who were followed during pregnancy to observe the progression to preeclampsia. We compared the clinical features of each group among those who developed and not the disease. RESULTS: We included a total of 146 patients, of whom 36 (25%, IC 95% 17.7-31.7%) progress to preeclampsia. In this group 3 (8%) developed mild preeclampsia and 33 (92%) severe preeclampsia, of which 8 (24%) account HELLP syndrome. The remaining 110 patients (75%), did not develop preeclampsia. From 12 (8%) patients with gestational age < to 28 weeks, 7 (58%) developed preeclampsia, 46 (31%) patients between 28-33 weeks, 12 (26%) evolved into preeclampsia, 39 (27%) patients between 34-36 weeks, 11 (28%) progressed to preeclampsia and finally 49 (34%) with pregnancy > 37 weeks, 6 (12%) developed to preeclampsia. When comparing these groups we found that a lower gestational age was more frequent the progression to preeclampsia (p < 0.004). The onset of gestational hypertension before 28 weeks was significantly associated with the progression of preeclampsia (OR 5.1 IC 95% 1.5-17.2). The weight of infants and gestational age was lower in children of women who developed the disease in comparison that those who did not (p < 0.001). There were no significance differences between both groups in relation with body mass index, maternal age, parity and antecedent of preeclampsia. CONCLUSIONS: The progression of gestational hypertension into preeclampsia appreciated in one of each four patients. The progression of gestational hypertension in preeclampsia was more common in preterm pregnancy. Most of the patients developed the severe form of the disease.

Analysis of polymorphisms and haplotypes in genes associated with vascular tone, hypertension and oxidative stress in Mexican-Mestizo women with severe preeclampsia.

OBJECTIVE: Several studies have reported the association of genes related to vascular tone, hypertension, oxidative stress and preeclampsia. We investigated the possible association among three polymorphisms in eNOS (as well their haplotypes): one of MTHFR, one of GSTP1 and one of AGT, with severe preeclampsia in Mexican-Mestizo women. METHODS: Two hundred thirty women with severe preeclampsia and 350 control subjects were genotyped; for rs2070744 and rs1799983 of eNOS, rs1801133 of MTHFR, rs1695 of GSTP1 and rs699 of AGT we used real-time PCR allelic discrimination and for VNTR of eNOS, PCR. Allele frequency differences were assessed by χ(2). Logistic regression was used to test for associations and for haplotype frequencies using Haploview 4.2. RESULTS: Genotypic and allelic distribution of the polymorphisms was similar between cases and controls; likewise, haplotype frequencies of the three polymorphisms of eNOS did not differ significantly. CONCLUSIONS: To our knowledge, this is the first time that these polymorphisms have been analyzed together and exclusively in women with severe preeclampsia. However, we did not find an association between polymorphisms of eNOS, MTHFR, GSTP1 and AGT with severe preeclampsia in our population. Additionally, we observed differences in the distribution of the alleles and genotypes of these polymorphisms in our population in comparison to those described in other ethnic groups.

Analysis of polymorphisms in interleukin-10, interleukin-6, and interleukin-1 receptor antagonist in Mexican-Mestizo women with pre-eclampsia.

Due to the fact that studies seeking associations of polymorphisms in regulatory regions of cytokine genes with pre-eclampsia (PE) have not always been consistent in different population analyses, the aim of this study was to investigate the possible association between rs1800896 of interleukin-10 (IL-10), rs1800795 of interleukin-6 (IL-6), and the variable number of tandem repeats (VNTR) in intron 2 of interleukin-1 receptor antagonist (IL-1Ra), as well as gene-gene interactions between these three polymorphisms with the presence of PE in Mexican-Mestizo women and one Amerindian population from México (Maya). A case-control study was performed where 411 pre-eclamptic cases and 613 controls were genotyped. For the rs1800896 of IL-10 and rs1800795 of IL-6, we used real-time polymerase chain reaction (PCR) allelic discrimination and for the VNTR of IL-1Ra, PCR. Allele frequency differences were assessed by Chi-squared test; logistic regression was used to test for associations; a gene-gene interaction was conducted. Genotypic and allelic distribution of the polymorphisms was similar in our population. The estimated of the gene-gene interaction between the polymorphisms did not differ significantly. However, we observed important differences in the distribution of the alleles and genotypes of the three polymorphisms analyzed between Mestiza-Mexicanas and Maya-Mestizo women. In conclusion, we did not find an association between polymorphisms in IL-10, IL-6, and IL-1Ra and PE in Mexican-Mestizo and Maya-Mestizo women. To our knowledge, this is the first time that these three polymorphisms were analyzed together with gene-gene interaction in women with PE.

Changes in circulating concentrations of soluble fms-like tyrosine kinase-1 and placental growth factor measured by automated electrochemiluminescence immunoassays methods are predictors of preeclampsia.

OBJECTIVE: Preeclampsia is characterized by an imbalance in angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). We herein assessed whether these factors measured by a newly developed automated electrochemiluminescence immunoassay are associated with risk to develop preeclampsia. METHODS: We performed a nested case-control study within a cohort of 230 women with singleton pregnancies. The study included all 37 women who eventually developed preeclampsia and 29 normotensive controls. Serum samples were collected at 4-week intervals (from weeks 20th to 36th). sFlt-1 and PlGF were measured using a commercial automated immunoassay (Elecsys). RESULTS: Women destined to develop preeclampsia had lower PlGF levels and higher sFlt-1 levels and sFlt-1/PlGF ratio than women with normal pregnancies. These changes became significant at 20 weeks in women destined to develop early preeclampsia (<34 weeks, P  ≤  0.003), and at 24-28 weeks in women who later developed preeclampsia (P  ≤  0.024). The risk for developing preeclampsia was higher among women with PlGF concentration values in the lowest quartile or with sFlt-1 levels and sFlt-1/PlGF ratio in the highest quartile of the control distribution. The odds ratios were higher and appeared earlier in women destined to develop early preeclampsia than in women who presented preeclampsia later. The sFlt-1/PlGF ratio was more tightly associated with risk of preterm or term preeclampsia than either angiogenic factor alone. CONCLUSION: Changes in circulating concentrations of PlGF, sFlt-1, and in the sFlt-1/PlGF ratio precede the onset of preeclampsia. The risk profile of circulating angiogenic factors for developing preeclampsia distinctly evolves depending on whether this condition is manifested at preterm or term.

[Clinical guideline. Preeclampsia-eclampsia]. / Guía de práctica clínica. Preeclampsia-eclampsia.

Preeclampsia remains a major cause of worldwide pregnancy related maternal and neonatal mortality and morbidity, it accounts for more than 50,000 maternal deaths each year. The World Health Organization estimates that at least one woman dies every 7 minutes from a complication of preeclampsia. It is the main cause of maternal death in Mexico and Latin America. Standarized assessment and surveillance of women with preeclampsia is associated with reduced maternal risk. Standarized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of preeclampsia-eclampsia. The working group selected clinical practice guidelines found in the Cochrane Library, Medline and PubMed. The results were expressed as levels of evidences and grade of recommendation. Evidence suggests, that treatment of severe hypertension, seizures prophylaxis with magnesium sulfate, and management by experienced health-care professionals will improve maternal, fetal and neonatal outcomes. Treatment remains supportive with pregnancy termination being the only definitive cure.

[The two leading hypothesis regarding the molecular mechanisms and etiology of preeclampsia, and the Mexican experience in the world context]. / Estado actual de la preeclampsia en México: de lo epidemiológico a sus mecanismos moleculares.

Preeclampsia (PE) is one of the most severe complications of pregnancy. PE is responsible for the highest rates of morbidity and mortality for both pregnant women and the neonate. In this review, we first address general aspects of PE and its diagnosis, along with some epidemiological aspects of this disease in the mexican population, in particular the experience from the Instituto Mexicano del Seguro Social. Even though over the last 20 years a great deal of evidence has accumulated regarding PE's pathophysiology, an exact mechanism to explain its etiology has not been established. This review aims to cover the status of two of the most important hypotheses in the etiology of PE: the immunological and the placental ischemia hypotheses. Recent data suggest that Natural Killer cells (NK) play a major role in the decidual spiral arteriole remodeling and in normal placental development. In genetic studies, KIR receptors present in NK cells have been involved in the susceptibility for the disease. In this review, we discuss data of our group regarding the presence of NK cells in the decidua, at the end of pregnancy and the genotypes of KIR receptors in normal and preeclamptic Mexican population. PE is characterized by abnormal placentation and hypoxia with an increase of anti-angiogenic factors; the Hypoxia-inducible factor 1-alfa (HIF1-alfa) is over expressed in PE. In this review, we also included some of our results concerning the polymorphisms and regulation of HIF in preeclamptic women.

[Pregnancy in patients with renal transplantation: maternal and fetal morbidity]. / Embarazo en pacientes con trasplante renal: morbilidad materna y fetal.

BACKGROUND: Preeclampsia is a multisystemic syndrome with unknown etiology and characterized by abnormal vascular placentation response. Patients with renal transplantation restore them fertility 10 months after the intervention. OBJECTIVE: To evaluate incidence of preeclampsia and maternal-perinatal outcome in patients with renal transplantation. PATIENTS AND METHODS: Comparative, observational and retrospective study performed in pregnant patients with renal transplantation, from December 1999 to April 2008 at Perinatology of Hypertensive Diseases Department of the Unidad Medica de Alta Especialidad de Ginecoobstetricia Luis Castelazo Ayala, IMSS. Davison' guide, descriptive statistic, and Fischer exact test were used. RESULTS: Thirty patients were analyzed, 27 cases satisfy Davison's recommended guidelines, and the rest did not achieve these criteria (p = 0.001). Preeclampsia occurred in 15 cases (50%), preterm delivery in 15 (50%), and fetal growth restriction in 6 (20%). Among the 11 patients with previous chronic hypertension, 8 developed superimposed preeclampsia (72%), and 9 had delivery before 37 weeks of gestation (82%). Malfunction of renal transplantation, before pregnancy, was associated with maternal and perinatal poor outcome (p = 0.006). There were no maternal deaths, but one perinatal (3%) CONCLUSIONS: Successful pregnancy is possible in patients with renal transplantation, however there is a high risk of preeclampsia, infection, and fetal growth restriction. Patients with renal transplantation must fulfill Davison's pre-pregnancy guidelines.

[Umbilical artery Doppler velocimetry and adverse perinatal outcome in severe pre-eclampsia]. / Velocimetría Doppler de la arteria umbilical y resultado perinatal adverso en preeclampsia severa.

BACKGROUND: Abnormal placentation is a main preeclampsia characteristic. Its cause is a maternal spiral veins trophoblastic invasion failure, which conditions vascular resistances raise and uterus-placental perfusion decrease. OBJECTIVE: To determine the relationship between umbilical artery Doppler waveform and adverse perinatal outcome in patients with severe preeclampsia. PATIENTS AND METHOD: A prospective, observational and transversal study was done to analyze patients between 27 to 33 weeks of gestation with expectant management of severe preeclampsia from January 2004 to January 2006. Umbilical artery velocimetry studies were performed at least once a week by means of pulsed Doppler equipment with a 3.5 MHz transducer. Only the results of the last Doppler examination performed within 7 days of delivery were considered in the correlation with perinatal outcomes. The indications for delivery were maternal or fetal (non reassuring nonstress test or biophysical profile < or = 4). An abnormal Doppler velocimetry was defined as pulsatility index being higher than percentile 95 for gestational age, or absent or reversed end diastolic velocity waveforms in umbilical artery. The statistical analysis was done with chi2 test and Student t test. RESULTS: There were included 43 patients in this study. Twenty-two (52%) had an abnormal Doppler umbilical artery pulsatility index and 21 (49%) obtained a normal umbilical artery waveform. In the first group 13 (59%) had a positive end diastolic velocities with elevated pulsatility index values, end diastolic velocities were absent in seven cases (32%) and reversed in two cases (9%). Neonates with abnormal pulsatility index had a lower birth weight (1,174 vs 1,728 g), lower Apgar score at 5 minutes, higher admission to the neonatal intensive care unit (86.4 vs 43%), and significant neonatal morbidity compared with those with normal velocimetry (p < 0.05). There were no perinatal deaths with normal umbilical Doppler waveform. There were six perinatal deaths in the abnormal Doppler velocimetry. Two cases occurred with positive end diastolic velocity (15%), two cases with absent end diastolic velocity (28%) and two deaths with reversed flow of the umbilical artery (100%). CONCLUSION: An abnormal Doppler umbilical artery waveform is associated with poor perinatal outcome and is a strong predictor of perinatal mortality.

Urinary prolactin as a reliable marker for preeclampsia, its severity, and the occurrence of adverse pregnancy outcomes.

CONTEXT: It has been proposed that preeclampsia may result from of an imbalance in angiogenic factors. Although prolactin (PRL) is mainly related to lactation, it is also involved in other biological functions, including angiogenesis. OBJECTIVE: Our objective was to determine the relationship among preeclampsia, serum and urinary PRL (uPRL) levels, and excretion of antiangiogenic PRL fragments in urine. STUDY DESIGN: Using a cross-sectional design, uPRL and serum PRL levels, and the presence of PRL isoforms were determined in 546 pregnant women: 207 healthy pregnant, 124 with gestational hypertension, 48 with mild preeclampsia, and 167 with severe preeclampsia (sPE). RESULTS: uPRL concentrations were significantly (P < 0.001) higher in preeclampsia (11.99 ng/mg creatinine) than in healthy pregnancy (0.20 ng/mg creatinine) and gestational hypertension (0.19 ng/mg creatinine), and were even higher in sPE compared with mild preeclampsia (21.20 vs. 2.77 ng/mg creatinine, respectively; P < 0.001). Antiangiogenic PRL fragments (14-16 kDa) were detected in 21.6% of urine samples from women with sPE but in none from other groups. Patients with hemolysis, elevated liver enzymes, low platelet count syndrome, and/or eclampsia, placental abruption, acute renal failure, and pulmonary edema exhibited highest uPRL concentrations (P < or = 0.028) and frequency of antiangiogenic PRL fragments in urine (P < or = 0.036). High-serum PRL levels were associated with sPE independently of gestational age, proteinuria, and prolactinuria (P = 0.032). CONCLUSIONS: Preeclampsia is characterized by increased uPRL excretion. uPRL concentrations and their isoforms appear to be suitable markers to assess the severity of preeclampsia and occurrence of adverse outcomes. PRL and and/or its isoforms might be involved in the pathophysiology of preeclampsia.

[Antiphospholipid syndrome and pregnancy]. / Sindrome antifosfolipídico asociado con embarazo.

OBJECTIVE: To assess the maternal and perinatal outcome of patients with antiphospholipid syndrome in pregnancy. PATIENTS AND METHOD: A descriptive and retrospective analysis of patients with antiphospholipid syndrome in pregnancy was made from January 2000 to June 2005. RESULTS: We analyzed 35 patients. Primary and secondary antiphospholipid syndrome occurred in 25 (71%) and 10 (29%) women, respectively. Nine cases were associated with systemic lupus erythematosus and one with scleroderma. Approximately, 48% of women had history of thrombosis, 23% recurrent pregnancy loss, and 15% early onset preeclampsia in previous pregnancies. Twenty-seven patients had positive anticardiolipin antibodies, 6 lupus anticoagulant, and 2 both of them. About 80% of the patients were delivered by cesarean section. There was one spontaneous embryo loss before seven weeks. Eleven (32%) patients had preeclampsia. There were no maternal deaths. All women began treatment since the first trimester of pregnancy. Twenty-three patients (66%) received heparin and low dose aspirin, 8 cases (22%) heparin, low dose aspirin and prednisone, for presenting systemic lupus erythematosus, and the remaining 4 cases (12%) were treated with prednisone and aspirin. Ninety four percent of the cases got a live newborn. There were two neonatal deaths secondary to extreme prematurity and associated with preeclampsia. There was one fetal death related to maternal lupus renal activity. Fifty-eight percent of the newborns were premature. Intrauterine growth restriction was present in 20% of the cases. CONCLUSIONS: Early treatment combined with close maternal-fetal surveillance was associated with a 90% chance of a live birth rate. However, prematurity, preeclampsia and intrauterine growth restriction were common.

[Usefulness of fetal biophysical profile in preterm rupture of membranes with treatment]. / Utilidad del perfil biofísico fetal en la rotura prematura de membranas pretérmino con tratamiento.

OBJECTIVE: To evaluate the usefulness of the fetal biophysical profile as a predictor of early neonatal infection in patients with preterm rupture of membranes in conservative management. PATIENTS AND METHODS: This is a validation study of a diagnostic test. Between November, 2001 and August, 2003, 75 patients with 27 to 33 weeks of gestation and preterm rupture of membranes in conservative management were studied. Daily, a fetal biophysical profile was applied to them. Statistical analysis was done with chi square test and with a 2 x 2 contingency table that compared the biophysical score of + 8 and < or = 6 versus the presence or absence of early neonatal infection. RESULTS: The biophysical score < or = 6 was associated with early neonatal infection (p < 0.05), with sensitivity, specificity, positive and negative predictive values of 80, 85, 64 and 85%, respectively (OR 9.73, 95% CI: 2.88-34.63; p = 0.0000164). CONCLUSIONS: The biophysical score < or = 6 was significantly associated with early neonatal infection.

[Microalbuminuria: early prognostic factor of preeclampsia?]. / Microalbuminuria: factor pronóstico temprano de preeclampsia?

UNLABELLED: Many markers have been proposed to identify the pregnant woman at risk to develop preeclampsia, without finding at the moment the gold standard. OBJECTIVE: The main purpose of the present study was to know if the detection of microalbuminuria in early stages of pregnancy is a good predictor of preeclampsia. METHODS AND MATERIAL: One hundred and two women (102) were studied. All of them had risk factors for preeclampsia with a pregnancy between 16 and 18 weeks, an evaluation of microalbuminuria was done through a clean-catch dipstick of the first miction of the day, excluding patients with urinary tract infections and nephropaty, > 20 mg/L was considered a positive value. Diagnosis data of preeclampsia were recopilated from the clinical chart of each patient after the pregnancy was resolved. RESULTS: Of the 102 patients, 53 had a negative microalbuminuria, 6 (11%) developed preeclampsia and 47 (88%) did not. Forty nine women had positive microalbuminuria and 23 (46.9%) of them developed preeclampsia and 26 (53%) did not. The sensitivity was 79%, specificity 63%, the positive predictive value was 46% and the negative predictive value was 88%. CONCLUSIONS: The detection of microalbuminuria in early stages of pregnancy could be a good predictor of preeclampsia, moreover it is a simple and feasible procedure to do by the obstetrician.

Utilidad de la prueba sin estrés en la preeclampsia / Utility of nonstress test (NST) in preeclampsia

Introducción. La preeclampsia es una causa importante de morbimortalidad perinatal, por tanto, es necesario dentro del manejo integral una adecuada vigilancia fetal. Objetivo. Evaluar la utilidad de la prueba sin estrés (PSS) en pacientes con preeclampsia. Materiales y método. Se incluyeron embarazos de 28 semanas o más, complicados con preeclampsia, a los que se les efectuó una PSS 24 horas antes de la resolución de la gestación. La población estudiada se dividió en dos grupos: preeclampsia leve y severa, agrupándose cada uno de acuerdo a las semanas de gestación en 28 - 31, 32 - 34 y = 35. El resultado perinatal adverso fue definido por la presencia de líquido amniótico meconial, oligohidramnios, Apgar menor de 7 a los 5 minutos en gestaciones mayores de 34 semanas, restricción del crecimiento intrauterino y muerte perinatal. Resultados. Se analizaron 147 pacientes con preeclampsia leve y 103 con preeclampsia severa. No hubo ningún caso de óbito. La sensibilidad de la PSS fue baja, tanto para la forma leve (39 por ciento), como para la severa (63 por ciento). El valor predictivo positivo fue igualmente bajo (66 y 45 por ciento, respectivamente) en ambos grupos. La especificidad y el valor predictivo negativo fueron altos para el grupo de preeclampsia leve (89 y 73 por ciento) y severa (64 y 78 por ciento), respectivamente. Conclusiones. La PSS es una prueba preparto importante, sin embargo, debido a su baja sensibilidad no debe ser usada como única prueba de vigilancia fetal.

Morbimortalidad materna en síndrome de HELLP / Maternal morbidity and mortality in HELPP

Objetivo. Describir la morbimortalidad materna asociada a embarazos complicados con síndrome de HELLP. Diseño. Se realizó un estudio prospectivo, descriptivo del 01 de enero de 1998 al 31 de marzo de 2000 en pacientes con síndrome de HELLP que ingresaron a nuestro Hospital. La población estudiada se dividió en tres grupos de acuerdo con la clasificación de Mississippi. Resultados. Se analizaron 170 casos, de los cuales 156 (92 por ciento) ocurrieron anteparto y 14 (8 por ciento) posparto. En cuanto a la edad gestacional, 15 casos (9 por ciento) se presentaron antes de la semana 27 de gestación, 112 (66 por ciento) entre las semanas 28 a 36, y 43 (25 por ciento) al término del embarazo. Las principales complicaciones fueron insuficiencia renal (13.5 por ciento), desprendimiento prematuro de placenta normoinserta (6.6 por ciento), neumonía (3 por ciento), hematoma hepático (2.3 por ciento), edema pulmonar (2.3 por ciento), coagulación intravascular diseminada (1.7 por ciento) y hemorragia cerebral (1.2 por ciento). La mortalidad materna fue de 4.7 por ciento (ocho pacientes), de las cuales siete ocurrieron en la clase I y una en la clase II. Seis muertes (75 por ciento) se asociaron a eclampsia. Ochenta y cinco por ciento de la morbimortalidad materna se presentó en pacientes con cuenta plaquetaria < 50,000 mm3 (clase I). Conclusiones. Existe un incremento progresivo de la morbimortalidad materna conforme la cifra de plaquetas disminuye y pasa de la clase III a la clase I. Setenta y cinco por ciento de la mortalidad materna se asoció a eclampsia. El diagnóstico temprano puede mejorar el pronóstico y resultado materno de este síndrome.

Evolución a largo plazo de la ruptura hepática en la preeclampsia: informe de un caso / Long-term evolution of a liver repture in a preeclamptic patient: a case report

Se presenta un caso de una paciente preeclámptica con ruptura de un hematoma hepático de grandes dimensiones de lóbulo derecho, en donde el diagnóstico se retrasó por haberse confundido con una colecistitis; se efectuó cesárea, obteniéndose un producto de 1225 g, óbito y DPPNI de 50 por ciento, el procedimiento quirúrgico para la ruptura hepática fue el de la ligadura de la arteria hepática derecha, con buena evolución de la paciente. Se realizó el seguimiento del caso con ultrasonidos y pruebas de funcionamiento hepático con el fin de conocer la evolución clínica del hematoma y su tiempo de reabsorción o sus secuelas, y se observó que éste desapareció totalmente, se informó una imagen hepática normal a los 14 meses posteriores a la ruptura.

Factores de riesgo para preeclampsia: análisis multivariado / Risk factors for preeclampsia

El objetivo de este estudio fue conocer por medio de análisis multivariado, los factores sociodemográficos y clínicos que pueden ser predictores de la presentación de preeclampsia en nuestro medio. Material y métodos. Se realizó un diseño de casos y controles, aplicando un cuestionario a 300 pacientes, 150 que correspondieron al grupo de casos en el diagnóstico de preeclampsia, y 150 controles, sin preeclampsia y con embarazo y resolución del mismo de forma satisfactoria y sin complicaciones. Se analizaron las siguientes variables: edad, escolaridad, estado civil, ocupación, nivel socioeconómico, tabaquismo, alcoholismo, índice de masa corporal, antecedentes familiares de preeclampsia, antecedente de la paciente de preeclampsia en embarazos previos, tipo de embarazo (único o múltiple) y características obstétricas (gestas, paras y abortos). En el análisis estadístico se tomó como estimador de la medida de ocurrencia la razón de momios (RM) e intervalo de confianza al 95 por ciento (IC 95 por ciento), con prueba de x2 y T de students y el análisis multivariado a través del modelo de regresión logística. Resultados. El análisis multivariado mostró que las variables que mostraron mayor fuerza de asociación fueron: el antecedente de preeclampsia en embarazos previos con RM de 23.7 con p<0.0001, el antecedente familiar de preeclampsia con RM 1.6 y p< 0.08, el aumento en el índice de masa corporal tiene mayor riesgo de desarrollar preeclampsia con RM 1.6 y p<0.08, y a mayor número de gestas el riesgo disminuye con RM 0.43 y p<0.005. Conclusiones. El conocer los principales factores de riesgo para el desarrollo de preeclampsia puede ser importante para identificar tempranamente a las mujeres con alto riesgo y poder ofrecerles un diagnóstico oportuno y medidas terapeúticas que eviten las complicaciones mortales de esta patología y mejoren el resultado perinatal.

Manejo conservador en preeclampsia severa / Severe preeclampsia and its conservative management

Se analizan 58 pacientes con preeclampsia severa entre 28 y 33 semanas de gestación, del 1 de octubre de 1996 al 1 de octubre de 1997. No fueron candidatas a manejo conservador 24 pacientes (42 por ciento) y se interrumpió el embarazo a las 48 h de su ingreso, 34 casos (58 por ciento) recibieron manejo conservador. El tiempo promedio de prolongación del embarazo fue de 6.4 días (rango: 3 18). Las indicaciones de interrupción del embarazo fueron: maternas en 16 pacientes (47 por ciento), sufrimiento fetal en 13 (39 por ciento), 34 semanas de gestación 3 (8 por ciento), desprendimiento prematuro de placenta normoinserta en una (3 por ciento) y trabajo de parto en una (3 por ciento). El peso promedio al nacer fue de 1520 + 310 g y la media de Apgar a 5 min de 8. No hubo muertes fetales ni complicaciones maternas, sólo un caso de muerte neonatal por sepsis y prematurez. En las pacientes que no recibieron manejo conservador hubo dos óbitos y tres muertes neonatales.