Management of maternal pulse and blood pressure abnormalities during labour and childbirth: evidence-based algorithms for intrapartum care decision support.

AIMS: To develop evidence-based clinical algorithms for assessment and management of abnormal maternal pulse and blood pressure during the intrapartum period. POPULATION: Low risk singleton, term, pregnant women in labour. SETTING: Institutional births in low- and middle-income countries. SEARCH STRATEGY: A review of the literature was performed to retrieve evidence-based guidelines, systematic reviews, and papers on maternal pulse and blood pressure during labour. We searched a number of international clinical guidelines and PubMed using the corresponding key terms in November 2018 and updated the search in May 2020. CASE SCENARIOS: Four common intrapartum case scenarios of abnormal pulse and blood pressure were identified for which algorithms were developed: hypertension, hypotension, tachycardia and bradycardia. Algorithms were constructed after reviewing guidelines and relevant papers, with input from a panel of experts. Thresholds for upper and lower limits of normal maternal pulse and blood pressure measurements are defined, evidence-based interventions for the initial management of abnormal parameters are described (resuscitation and monitoring) and guidance is provided on exploration of the potential causes for each case scenario, with links to pathways for their management. CONCLUSIONS: Evidence-based algorithms to support the identification, and management of deviations in pulse and blood pressure during intrapartum care have been developed for hypertension, hypotension, tachycardia and bradycardia. The algorithms focus on initial resuscitation and monitoring, with an exploration of causes and early identification of underlying maternal conditions. These algorithms will help provide a standardised approach to investigation and management of these abnormal parameters to guide clinical practice. TWEETABLE ABSTRACT: Algorithms for abnormal maternal pulse and blood pressure during labour allow standardised approach to early identification and management of complications.

Magnesium sulfate for 6 vs 24 hours post delivery in patients who received magnesium sulfate for less than 8 hours before birth: a randomized clinical trial.

BACKGROUND: To compare the benefits of magnesium sulfate for 24 h (h) postpartum versus 6 h postpartum in patients who received magnesium sulfate (Mg) for less than 8 h before birth. METHODS: A randomized, multicenter, open study was conducted between November 2013 and October 2016 in three teaching maternity hospitals in Panama. Pregnant women diagnosed with severe pre-eclampsia or pre-eclampsia with severe features at more than 20 weeks gestation were invited to participate. They were randomized to the following groups in a 1:1 ratio: A- continue Mg for 24 h after birth (control group); and B- receive Mg for 6 h after birth (experimental group). The primary endpoint and variable was seizure (eclampsia) in the first 72 h postpartum. RESULTS: During the study period, 284 patients agreed to participate in the study; 143 were randomized to receive Mg for 24 h postpartum and 141 to receive Mg for 6 h postpartum. There were no significant differences in the baseline characteristics of the two groups studied. There was no eclampsia in the entire population; therefore, there was no significant difference in the primary variable. Two secondary variables showed a significant difference: time to onset of ambulation, which was 14 h shorter (p = 0.0001) in the group that received 6 h of postpartum Mg, and time to initiation of breastfeeding, which was 11 h earlier (p = 0.0001) in the group that received 6 h of postpartum Mg. There were not significant differences between the groups with respect to total complications or any particular complication. There were no cases of maternal death. CONCLUSION: Maintaining Mg for 6 h postpartum is equally effective in preventing eclampsia as receiving Mg for 24 h postpartum in patients with severe pre-eclampsia who receive less than 8 h of Mg treatment before birth. The onset of maternal ambulation and initiation of breastfeeding are faster in patients who only receive Mg for 6 h postpartum. TRIAL REGISTRATION: The study was registered at clinical-trials.gov, number NCT02317146 . Date of registration: December 11, 2014. This study was registered at clinical trials after the beginning of recruitment of patients.

Embarazadas con lupus eritematoso sistémico en el hospital Clínico Regional de Concepción, Chile / Pregnant women with systemic lupus erythematosus in the Regional Clinical Hospital of Concepcion, Chile

Antecedentes: El lupus eritematoso sistémico (LES) afecta principalmente a mujeres en edad fértil. El embarazo en estas pacientes puede asociarse con múltiples complicaciones. Objetivo: Caracterizar a las embarazadas con LES durante 10 años en el Hospital Clínico Regional de Concepción. Métodos: Se realizó un estudio descriptivo retrospectivo que consistió en la revisión de fichas clínicas. Se analizaron las variables: edad, años de enfermedad desde el diagnóstico, historia obstétrica, presencia de reactivaciones, anticuerpos maternos y complicaciones materno-fetales. Resultados: Durante el periodo de estudio hubo 49 embarazos en 21 pacientes con LES. El 12,2 por ciento terminó en aborto, un 2 por ciento en óbitos, y un total de 43 nacidos vivos. La edad promedio de las pacientes al momento del diagnóstico de LES fue 24,5 años. El 67 por ciento fueron diagnosticadas antes de su primer embarazo. En el total de pacientes el 85,7 por ciento presentaron ANA positivo, 57,1 por ciento antiDNA positivo, 52,4 por ciento aRo positivo y 33,3 por ciento aLa positivo. En los caso de abortos, aRo y aLa se encontraban positivos en 66,7 por ciento. Las anticardiolipinas se encontraban alteradas en 33,3 por ciento de los abortos. Durante el embarazo el 32,6 por ciento tenía LES activo y 34,7 por ciento en el postparto. El 53,5 por ciento de los recién nacidos no tuvieron complicaciones. La complicación más frecuente fue la prematuridad con 55 por ciento. La mortalidad perinatal de la serie fue de 46,5/1000 nacidos vivos (2/43). No hubo muertes maternas. Conclusión: Es importante la educación respecto al embarazo en pacientes con LES. Debemos resaltar en promover que estas pacientes planifiquen el embarazo en periodo de inactividad, y con controles frecuentes para pesquisar precozmente cualquier complicación.

Background: The systemic lupus erythematosus (SLE) affects mainly fertile age women. Pregnancy in these patients can associate with multiple complications. Aims: To characterize the pregnant women with SLE during 10 years in the Hospital Clínico Regional de Concepción, Chile. Methods: We made a retrospective descriptive study which consisted in clinical files revision. The following variables were analyzed: age, years with disease since diagnose, obstetric history, history of reactivation, maternal antibodies and mother-fetus complications. Results: During the time of study there were 49 pregnancies on 21 patients with SLE; 12.2 percent ended in abortion, 2 percent in late fetal death giving a total of 43 living newborn. The average age of these patients at the moment of diagnose of LES was 24.5 years old; 67 percent were diagnosed before their first pregnancy. From the total of patients, 85.7 percent presented positive ANA, 57.1 percent positive antiDNA, positive aRo in 52.4 percent and positive aLa in 33.3 percent. In case of abortions, aRo and aLa were positive in 66.7 percent. Anticardiolipins were altered in 33.3 percent of abortions. During pregnancy 32.6 percent had active SLE, and 34.7 percent post-partum. Among the newborn, 53.5 percent did not have any complications. The most frequent complication was prematurity with a 55 percent. The perinatal mortality was 46.5/1000 lives births (2/43). There were no maternal deaths. Conclusion: It is important to educate about pregnancy in SLE patients. We must emphasize to promote in those patients a planned pregnancy in inactive period and with frequent controls for early diagnose of any complication.