PP091. Prematurity and hypertensive disorders in pregnancy. A major public health problem.

INTRODUCTION: Around the world each year 10% to 15% of direct maternal deaths are associated with hypertensive disorders in pregnancy. Not only it can be devastating and life threatening for the mothers but also for the babies. Risks for the baby include poor growth and prematurity [1]. In low and middle income countries many public hospitals have limited access to neonatal intensive care, and so the mortality and morbidity is likely to be considerably higher than in settings where such facilities are available. Thus, the approach to the problem preeclampsia should include issues related to prematurity and its impact, since many of these babies develop definitive complications, constituting a major public health problem with social and economic repercussions. OBJECTIVES: To evaluate the prevalence of preterm births in a public hospital health of the city of São Paulo, checking its main causal conditions, focusing in particular on the importance of hypertensive disorders in its determinism. METHODS: This was a retrospective study of a consecutive series of preterm infants, defined as gestational age less than 37 weeks born at Maternity School Vila Nova Cachoeirinha, situated at the north of Sao Paulo City, in the period from 01/04 to 31/12/2011. The study population was classified according to three main groups of causal factors: spontaneous labor, premature rupture of membranes and elective preterm delivery. In this group was evaluated the specific participation of hypertensive disorders. RESULTS: The number of live births during the study period was 5302 babies. Among these 433 had gestational age less than 37 weeks, corresponding to a prematurity rate of 8.16%. Of all infants, 385 cases were included in the analysis. Regarding the causes of the onset of preterm labor found that 140 cases (36.4%) presented with spontaneous labor, 128 cases (33.2%) had premature rupture of membranes and 117 (30.4%) cases were born as a result of elective preterm delivery. In the latter group 88 cases (75.2%) had complications related to hypertensive disorders. Regarding the general population of premature infants, hypertension accounted for 22.8% of cases. CONCLUSION: We conclude that among the various obstetric problems, hypertensive disorders represent an important impact on preterm birth in our setting, considering that our institution is a reference to this type of care across the city of São Paulo. This knowledge is a fundamental tool to support the adoption of interventions that can detect groups at risk for hypertension in pregnancy, the promotion of follow-up to intercept severe cases and provide an efficient network of maternity care that may have neonatal intensive care units. This set of measures is essential to minimize the impact of this serious problem.

PP163. Are we using magnesium sulphate excessively for preeclamptic patients?

INTRODUCTION: There is now evidence that magnesium sulfate can prevent and control eclamptic seizures. For women with pre-eclampsia, magnesium sulfate reduces by more than one half the risk of eclampsia. After Magpie Trial [1] our clinical practice has been modified in terms of more liberal use of MgSO4, but the evidence regarding the benefit-to-risk ratio of MgSO4 prophylaxis in mild preeclampsia remains uncertain [2]. Thus we consider important to evaluate whether there are specific characteristics between patients who received the medicine that might signal risk and justify our decisions. OBJECTIVES: To identify in a group of hypertensive patients who used magnesium sulfate, clinical and/or laboratory characteristics that can be defined as specific risk factors and be useful to base clinical decisions. METHODS: The study was conducted at the Maternity School of Vila Nova Cachoeirinha, a public institution located in the north of the city of São Paulo (Baazil) between 01/07 and 31/12/2011. This is a retrospective study of a series of 103 pregnant women with hypertensive disorders, defined according to NHBPEP. We excluded patients admitted in labor. Patients were assigned into two groups according to the use of MgSO4. We compared clinical and laboratory characteristics between the two groups. RESULTS: Of 103 patients included, 31 (30.1%) received MgSO4. Among the outcomes analyzed, there were significant differences in the group that received MgSO4 in terms of blood pressure equal to or greater than 110mmHg, clinical symptoms (eg headache and visual disturbance) and at least some evidence of organ dysfunction (hepatic, renal, haematologic, or central nervous system) (Table 1). Table 1. Variables associated with theuse of magnesium sulfate. CONCLUSION: We can say that in our institution over the years was an increase in the use of magnesium sulfate. Our results support the hypothesis that about one in three patients treated at this institution receive the medication. Although our protocol admits that the decision may be based on subjective criteria, we identified some objective characteristics that supported their application, and that these criteria do not differ from the classic recommendations. We can also conclude that in our clinical experience we do not have identified a clear justification for support the routinely use of magnesium sulphate for all women with preeclampsia.

Underreporting of cocaine and marijuana during the thrid trimester of gestation among pregnant adolescents

Objetive: The aim of this study is to check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair. Results: Hair analysis detected the use of cocaine and/or marijuana, 17 (1,7%) used only cocaine, and 3 (0,3%) used both drugs. None of the patients had reported the use of these substances in their interview with healthcare profissionals. Conclusion: Althougth the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drugs use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions com be implemented for the mothers as well as for their children. (AU)

Correlates of substance use during adolescent pregnancy in São Paulo, Brazil

Objetive: To investigate the association of cocaina and marijuana use during adolescent pregnancy in são paulo-sp, brazil with psychiatric disorders, social status and sexual history. method: one thousand pregnancy adolescents were assessed by using the composite international diagnostic interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in são paulo. Hair samples were collected for analysis. Results: the following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 year of agge, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disordes, post-traumatic stress disorder, and somatoform disorder. Conclusion: in earlt adolescence pregnancy, having 3 or more sexual partners in the life for this population os significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.(au) - en

Gravidez na adolescência: perfil sócio-demográfico e comportamental de uma população da periferia de São Paulo / Teenage pregnancy: socio-demographic and behavioral profile of a population on the outskirts of Sao Paulo

Com objetivo de identificar o perfil sócio-demográfico e comportamental de gestantes adolescentes, foram entrevistadas mil adolescentes, admitidas entre 24 de julho de 2001 e 27 de novembro de 2002, em um hospital municipal de são paulo, brasil, correspondendo a 24,3% das internações para resolução da gestação. setenta (7%) adolescentes foram admitidas para curetagem pós-abortamento e 930 (93%), para parturição, com idade média de 17+/- 1,5 anos. a maioria (72,4%) residia próximo ao hospital e 93% pertenciam às classes econômicas c, d e e. na época da parturição , 627 (67,3%) adolescentes não estudavam. apenas 23,7% das adolescentes faziam uso de método contraceptivo, 81,2% não tinham planejado a gestação e 80,1% eram primigestas. dos partos, 67,4% foram vaginais. dos bebês, 13,3% foram pré-termo e 15,9%, baixo peso. durante a gestação, o consumo referido de tabaco, de álcool e de drogas ilícitas foi, respectivamente de 17,3%, 2,8% e 1,7%. conclui-se que gravidez na adolescência é um fenômeno complexo, associado a fatores econômicos, educacionais e comportamentais, preciptando problemas decorrentes da maternidade precoce. o presente estudo fornece subsídios para políticas públicas de saúde, visando a prevenir a gravidez na adolescência

Teenage pregnancy: use of drugs in the third trimester and prevalence of psyquiatric disorders

Objetivo: Determinar, em adolescentes de baixa renda, a prevalência de transtornos psiquiátricos durante a gravidez, a prevalência de uso de cocaína e maconha no terceiro trimestre de gestação e descrever suas características sociodemográficas. Método: Mil adolescentes grávidas foram avaliadas por meio do Composite International Diagnostic Interview e de um questionário sociodemográfico e socioeconômico no centro obstétrico de um hospital público de São Paulo. Dessas, foi colhida amostra para análise de fios de cabelo. Resultados: Das mil pacientes entrevistadas, 53,6% tem baixa renda , 60,2% abandonaram a escola, 90,4% estão desempregadas e 92,5% são financeiramente dependentes, 6% usaram drogas durante o terceiro trimestre da gravidez (maconha: 4%, cocáina1,7%, ambos: 0,3%) e 27,6% tiveram ao menos um transtorno psiquiátrico. Os diagnósticos mais frequentes foram: depressão(12,9%), transtornos de estresse pós-traumático(10,0%) e ansiedade (5,6%). Discussão: Famílias desestruturadas, evasão escolar, desemprego e baixa capacitação profissional são fatores que contribuem para a manutenção desta situação socioeconômica desfavorável, cenário no qual são elementos importantes a alta prevalência de uso de cocaína e maconha no 3º trimestre de gravidez e de transtornos psiquiátricos.(AU)