Resultados maternos y fetales en pacientes con preeclampsia severa e hipotiroidismo primario. Estudio de casos y controles / Maternal and perinatal outcomes in patients with severe preeclampsia and primary hypothyroidism. Case and control study

Introducción: El hipotiroidismo primario tiene efectos adversos maternos y fetales que en el escenario de la preeclampsia severa (PS) su impacto sobre el binomio puede ser mayor. Objetivo: Comparar los resultados maternos y fetales en pacientes con PS e hipotiroidismo primario. Material y métodos: Se trató de un estudio de casos y controles en 58 pacientes embarazadas con PS admitidas en la Unidad de Cuidados Intensivos de una Unidad de Alta Especialidad de la Ciudad de México atendidas de enero del año 2018 a diciembre del 2021. El grupo de casos se formó con 29 pacientes con hipotiroidismo primario pregestacional y el grupo de controles con 29 enfermas pareadas por la edad con función tiroidea pregestacional normal. Se compararon sus datos generales y los resultados maternos y fetales. Se utilizó estadística descriptiva, prueba chi cuadrada y la prueba «t» de Student con el programa SPSS versión 20. Fue significativo el valor p<0,05. Resultados: No se encontraron diferencias en la edad (p=0,8292), paridad (p=1), presión arterial sistólica (p=0,7229) y diastólica (p=0,5498), operación cesárea (p=0,812), hemorragia intraparto (p=0,3558), técnica anestésica (p=0,5786), complicaciones obstétricas, estancia en la Unidad de Cuidados Intensivos (p=0,6181) y mortalidad. No hubo diferencias en los productos: embarazo único (p=0,912), edad gestacional (p=0,8901), peso (p=0,3338), calificación de Apgar minuto uno y cinco, prematuridad (p=0,8701), cuidados intensivos (p=0.0623), mortalidad in útero (n=4 vs n=4) y mortalidad al nacimiento (n=2 vs n=0). Conclusiones: Los resultados maternos y fetales fueron similares. Los casos con descontrol tiroideo no mostraron efectos clínicos adversos.(AU)

Introduction: Primary hypothyroidism has adverse effects on maternal and fetal outcomes. In the scenario of severe preeclampsia (SP), the impact on the binomial may be greater. Objective: To compare maternal and fetal outcomes in patients with SP and primary hypothyroidism. Material and methods: This was a case-control study in 58 pregnant patients with SP admitted to the Intensive Care Unit of a High Specialty Unit in Mexico City attended from January 2018 to December 2021. The case group was formed with 29 patients with pre-pregnancy primary hypothyroidism and the control group with 29 age-matched patients with normal pre-pregnancy thyroid function. Their overall data and maternal and fetal outcomes were compared. Descriptive statistics, chi-square test, and Student's t-test with the SPSS version 20 programme were used. A p-value<0.05 was significant. Results: No differences were found in age (p=.8292), parity (p=1), systolic (p=.7229) and diastolic (p=.5498) blood pressure, caesarean section (p=.812), intrapartum haemorrhage (p=.812), p=.3558), anaesthetic technique (p=.5786), obstetric complications, Intensive Care Unit stay (p=.6181), and mortality. There were no differences in the products: singleton pregnancy (p=.912), gestational age (p=.8901), weight (p=.3338), Apgar score minute one and five, prematurity (p=.8701), intensive care (p=.0623), in utero mortality (n=4 vs n=4), and mortality at birth (n=2 vs n=0). Conclusions: Maternal and fetal outcomes were similar. The cases with uncontrolled thyroid did not show adverse clinical effects.(AU)

Enfermedades tiroideas y embarazo en una unidad de cuidados intensivos. Experiencia 2014-2019 / Thyroid disease and pregnancy in an intensive care unit. Experience 2014-2019

Introducción: Las mujeres con enfermedad tiroidea y embarazo tienen alto riesgo de complicaciones graves. Los cuidados intensivos pueden mejorar los resultados. Objetivo: Conocer los resultados maternos y perinatales en pacientes con enfermedades tiroideas manejadas en la Unidad de Cuidados Intensivos (UCI). Material y métodos: Estudio transversal en 50 mujeres con enfermedades tiroideas y embarazo admitidas en la UCI entre los años 2014 y 2019. Se consultaron los expedientes clínicos para conocer sus características generales y los resultados maternos y perinatales. Análisis estadístico: estadística descriptiva, prueba t de Student. Resultados: Se identificaron dos grupos, pacientes con hipotiroidismo 66% (n=33) y con hipertiroidismo 34% (n=17). Cuando fueron admitidas a la UCI, el 33,33% (11 casos) tenían hipotiroidismo descontrolado y el 76,47% (13 casos) hipertiroidismo descontrolado, incluyendo un caso de tirotoxicosis. Las causas de admisión en el grupo con hipotiroidismo fueron preeclampsia (32%), tiroideopatía descontrolada (10%) e hipertensión crónica (8%), y en el grupo con hipertiroidismo fueron preeclampsia (10%), tiroideopatía descontrolada (10%) e hipertensión crónica (2%). Se encontraron diferencias en la edad gestacional (hipotiroidismo 31,07±7,47 vs. hipertiroidismo 24,52±9,42 semanas, p=0,015) y en el tiempo de la admisión al hospital hasta la interrupción gestacional (hipotiroidismo 2,30±1,45 vs. hipertiroidismo 12,97±3,39 días, p=0,033). Los recién nacidos hijos de pacientes con hipertiroidismo tuvieron edad gestacional más corta (p=0,015), bajo peso al nacer (p=0,011), elevada frecuencia de prematurez (30,76%), necesidad de cuidados intensivos (11,54%) y mayor mortalidad al nacimiento (11,54%). Conclusiones: Los resultados maternos y perinatales de las pacientes hipotiroideas fueron satisfactorios, no así en las enfermas con hipertiroidismo.(AU)

Introduction: Pregnant women with thyroid diseases have a high risk of severe complications. Intensive care may improve results. Objective: To determine maternal and perinatal outcomes in patients with thyroid diseases managed in the intensive care unit (ICU). Material and methods: Cross-sectional study in 50 pregnant women with thyroid diseases admitted into the ICU between the years 2014 and 2019. Clinical files were consulted for general characteristics, as well as maternal and perinatal outcomes. Statistical analysis: descriptive analysis, Student t test. Results: Two groups were identified: patients with hypothyroidism 66% (n=33) and with hyperthyroidism 34% (n=17). When admitted to ICU, 33.33% (11 cases) had uncontrolled hypothyroidism and 76.47% (13 cases) uncontrolled hyperthyroidism, including one case of thyrotoxicosis. The reasons for admission in the group with hypothyroidism were preeclampsia (32%), uncontrolled thyroid disease (10%), and chronic hypertension (8%). In the group with hyperthyroidism, it was preeclampsia (10%), uncontrolled thyroid disease (10%), and chronic hypertension (2%). Differences were found in gestational age (hypothyroidism 31.07±7.47 vs hyperthyroidism 24.52±9.42 weeks, P=.015), and in the time of hospital admission until termination of pregnancy (hypothyroidism 2.30±1.45 vs hyperthyroidism 12.97±3.39 days, P=.033). The children of patients with hyperthyroidism had lower gestational age (P=.015), lower birth weight (P=.011), higher frequency of prematurity (30.76%), need for intensive care (11.54%), and higher birth mortality (11.54%). Conclusions: Maternal and perinatal outcomes of patients with hypothyroidism were satisfactory, but not so in those with hyperthyroidism.(AU)

[Maternal complications in preeclamptic patients with hyperuricemia managed in Intensive Care Unit]. / Complicaciones maternas en pacientes con preeclampsia e hiperuricemia tratadas en la unidad de cuidados intensivos.

BACKGROUND: Hyperuricemia is a factor related to a higher frequency of complications in patients with preeclampsia. OBJECTIVES: To determine maternal complications in preeclamptic patients with hyperuricemia managed in the intensive care unit of a high-specialty hospital. MATERIAL AND METHODS: Cross-sectional study. Clinical files of 127 preeclamptic patients with criteria of severe disease were reviewed. Maternal complications were studied only in patients with hyperuricemia defined as a serum uric acid (UA) level > 4 mg/dL upon admission. Descriptive statistics were used. RESULTS: Frequency of patients with hyperuricemia was 88.1% (112 cases). Median value of UA was 6.6 ± 1.5 mg/dL (range 4.6-12.4), maternal age 28.1 ± 5.98 years, parity 2 and gestational age 32.9 ± 3.7 weeks. Cesarean section was performed in 98.21%. Frequency of maternal complications was 50% (56 cases): HELLP syndrome 40.1% (45 cases), acute renal injury 6.2% (7 cases), abruptio placentae 1 .7% (2 cases), hemorrhage due to uterine atony 0.8% (1 case) and acute pulmonary edema 0.8% (1 case). There were no cases of multiorgan failure syndrome and maternal mortality was 0%. None of the patients experienced worsening of their condition. CONCLUSIONS: There was an elevated frequency of patients with hyperuricemia and maternal complications. Reported complications were different from those reported in previous studies. All patients were successfully intervened with the administered medical treatment and may be a reflection of the beneficial effect of intensive care treatment.

[Frequency and maternal complications of the criteria of hemolysis in preeclamptic patients with HELLP syndrome treated in an intensive care unit]. / Frecuencia y complicaciones maternas de los criterios de hemólisis en pacientes con preeclampsia y síndrome de HELLP tratadas en una unidad de cuidados intensivos.

BACKGROUND: HELLP syndrome is an aggressive form of preeclampsia related with hemolysis and its complications. OBJECTIVE: To determine the frequency of the appearance of criteria of hemolysis and maternal complications in preeclamptic patients with HELLP syndrome treated in an intensive care unit. MATERIAL AND METHODS: We carried out a cross-sectional study in 50 preeclamptic women with HELLP syndrome admitted to intensive care unit to determine the presence of the following criteria of hemolysis: peripheral blood schistocytes, anemia (hemoglobin ≤ 10 g/dL), lactate dehydrogenase ≥ 600 U/L, indirect bilirubin ≥ 0.6 mg/dL and hemoglobinuria. We also studied maternal complications in patients with lactate dehydrogenase ≥ 600 U/L and positive for schistocytes. Descriptive (mean, median, range, standard deviation) and inferential (Student t test) statistics were used. RESULTS: Lactate dehydrogenase ≥ 600 U/L was found in 36%, indirect bilirubin 0.6 mg/dL in 20%, positive schistocytes in 16%, hemoglobinuria in 4% and anemia in 0%. Patients with lactate dehydrogenase ≥ 600 U/L had more clinical and laboratory deterioration as well as prolonged intensive care unit stay (p = 0.0025). Patients positive for schistocytes did not demonstrate adverse effects. CONCLUSION: Biochemical criteria of hemolysis were more frequent than schistocytes, hemoglobinuria and anemia. Patients with lactate dehydrogenase ≥ 600 U/L was alterations more serious than patients with positive schistocytes so its usefulness as a biomarker may be higher.