Immunophenotypic profile and increased risk of hospital admission for infection in infants born to female kidney transplant recipients.

Children born to female kidney recipients are exposed to immunosuppressive drugs during gestation. Little is known about their immune system at birth or in the long term. Twenty-eight children born to female kidney recipients and 40 full-term children born to healthy mothers were evaluated. T, B, NK, NKT, γδT cells were assessed by flow cytometry and functional evaluation of T and dendritic cells after in vitro activation was performed at birth and at 8 months of age. At birth, infants born to female kidney recipients showed lower numbers of CD4+ T, NKT and intense reduction of B cells (median cells/mm(3) , transplant: 153.7 X control: 512.4; p < 0.001). There was also a reduced percentage of activated CD8+ T and of CD4+ regulatory T cells. Activated memory and exhausted memory B cells showed higher percentages among children exposed to immunosuppressors when compared to control group. At 8 months, most immune alterations were no longer observed, but four children still had low numbers of some lymphocyte subsets at this age. Children born to female kidney recipients had 4.351 (95% CI: 1.026-15.225; p = 0.046) higher risk of hospital admission in the first months of life-some, with severe clinical manifestations-than those born to healthy women.

PIERS proteinuria: relationship with adverse maternal and perinatal outcome.

OBJECTIVE: To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes. METHODS: We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia. Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection. Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection. We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time). Models with AUC ≥ 0.70 were considered of interest. Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessments. RESULTS: More women were proteinuric by urinary dipstick (≥ 2+, 61.4%) than by spot urine Pr/Cr (≥ 30 g/mol, 50.4%) or 24-hour urine collection (≥ 0.3g/d, 34.7%). Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods. No single method was predictive of adverse perinatal outcome. CONCLUSION: The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia. Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events.

Ophthalmic artery Doppler as a measure of severe pre-eclampsia.

OBJECTIVE: To identify differences in orbital flow behavior in mild and severe pre-eclamptic women compared with healthy pregnant women, demonstrated by ophthalmic artery Doppler indexes. METHODS: Ophthalmic artery Doppler indexes of 20 mild and 20 severe pre-eclamptic women were compared with 51 healthy pregnant women. Right and left eye Doppler index means were evaluated and the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), end diastolic velocity (EDV), and peak ratio (PR) were calculated. RESULTS: Statistically significant differences were observed between PR, PSV, and EDV (P=0.0009, P=0.0020, P=0.0001) ophthalmic artery Doppler in a comparison of women with mild and severe pre-eclampsia. Statistically significant differences were seen between all Doppler indexes of the study group and healthy pregnant women. Ophthalmic PR, PSV, and EDV were significantly higher in severe pre-eclamptic cases but other index parameters did not show any difference. An elevation of diastolic and systolic flow occurred when pre-eclampsia became severe. CONCLUSION: Orbital vascular impedance reduction with orbital hyperperfusion was present in severe pre-eclamptic women compared with mild pre-eclamptic and healthy pregnant women. Ophthalmic Doppler is a novel parameter that may be useful in the diagnosis of severe pre-eclampsia.

1985 NHIS findings: nutrition knowledge and baseline data for the weight-loss objectives.

A nutrition objective for the nation is that, by 1990, 50 percent of the overweight population should have adopted weight regimens, balancing diet and physical activity. More than half of the overweight respondents in the 1985 National Health Interview Survey were trying to lose weight, and almost half of this group reported both increasing their physical activity and decreasing their intake of calories. Dietary restriction without exercise was the next most common weight-loss regimen, suggesting that educational efforts should emphasize the need to increase physical activity as part of appropriate weight-loss regimens. Attempts to lose weight were reported frequently among those of normal and lean weight as well as among those who were overweight, especially among women and the better educated. About one-fifth of already lean young women reported attempting weight loss, an indication that some inappropriate dieting is probably occurring, suggesting the need for caution in public health promotion of weight loss. Another 1990 objective is that 90 percent of adults should understand that eating fewer calories or increasing activity, or both, is essential to lose weight. More than 70 percent of adults in this survey were able to identify these as the two best ways to reduce weight, with greater proportions of the younger adults and the more highly educated being knowledgeable. The survey also provided data for an objective that targets some nutrition education and counseling as part of all routine health contacts with health professionals by 1990. Twenty-nine percent of all women and 22 percent of all men reported that eating proper foods was discussed sometimes or often in routine contacts.

Light microscopic observations on the reproductive tract of the male sand rat, Psammomys obesus.

The anatomy of the reproductive tract of the male sand rat, Psammomys obesus, was examined by light microscopy. Histologically, the reproductive tract is similar to other rodent species. Seminiferous tubules in the 1-month-old sand rat do not contain a tubular lumen but Sertoli cells, spermatogonia and spermatocytes are present. A full complement of germ cells is present in the seminiferous tubules by 2.5 months and spermatogenesis is well established. The interstitial space is not well defined until 2.5 months when cell types typical of most rodent species are observed. The epididymis is not noticeably segmented into lobules. An epididymal lumen is not observed until 2.5 months. Cauda epididymal sperm are not observed in the 1 or 2.5-month-old animals and cauda epididymal sperm counts from the 7.5 and 12.5-month-old animals are highly variable. The epididymis, proximal and middle regions of the vas deferens, seminal vesicles and prostate display morphological and histological characteristics similar to other rodent species. The distal end of the vas deferens is not expanded to form an ampulla.

Attempts to establish experimental Cyclospora cayetanensis infection in laboratory animals.

Attempts were made to develop an animal model for Cyclospora cayetanensis to identify a practical laboratory host for studying human cyclosporiasis. Oocysts collected from stool of infected humans in the United States, Haiti, Guatemala, Peru, and Nepal were held in potassium dichromate solution to allow development of sporozoites. The following animal types were inoculated: 9 strains of mice, including adult and neonatal immunocompetent and immune-deficient inbred and outbred strains, rats, sandrats, chickens, ducks, rabbits, jirds, hamsters, ferrets, pigs, dogs, owl monkeys, rhesus monkeys, and cynomolgus monkeys. Most animals were inoculated by gavage, although some of the primates were fed oocysts on food items. The animals were examined for signs of infection, particularly diarrhea, and stool samples were examined for 4-6 wk after inoculation. None of the animals developed patent infections or signs of infection. We conclude that none of the animals tested is susceptible to infection with C. cayetanensis.

[Prenatal corticoid therapy in hypertensive syndromes of pregnancies and its effects in maternal blood pressure]. / Corticoterapia pré-natal nas síndromes hipertensivas da gestação e seus efeitos na pressão arterial materna.

PURPOSE: To evaluate the behaviour of blood pressure among hypertensive pregnants during glucocorticoid therapy (LIGGINS scheme) in order to accelerate the maturity of fetal lung. METHODS: In a retrospective study, 27 pregnant with a story of hypertensive disorder, between 24 and 34 weeks, during glucocorticoid cycle were avaluated. For this matter, statistical analisis were performed using the means of systolic (SBP) and diastolic blood pressure during the therapy days, on the day before and on the day after. The results were statistically analyzed with F statistic test ( significant if p<005) RESULTS: There was no statistical variance in blood pressure levels, neither in SBP nor in DBP. There was no difficulty in clinical controls and no change in antihypertensive drugs related to glucocorticoid therapy. CONCLUSIONS: Our results show observe the safety of glucocorticoid therapy among pregnant women with hypertensive disorders related to the possible raising of the blood pressure levels.

Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial.

Preeclampsia is an important cause of maternal and perinatal morbidity and mortality. Previous studies have tested calcium supplementation and aspirin separately to reduce the incidence of preeclampsia but not the effects of combined supplementation. The objective of this study was to investigate the effectiveness of aspirin combined with calcium supplementation to prevent preeclampsia in women with chronic hypertension. A double-blind, placebo-controlled randomized clinical trial was carried out at the antenatal clinic of a large university hospital in São Paulo, SP, Brazil. A total of 49 women with chronic hypertension and abnormal uterine artery Doppler at 20-27 weeks gestation were randomly assigned to receive placebo (N = 26) or 100 mg aspirin plus 2 g calcium (N = 23) daily until delivery. The main outcome of this pilot study was development of superimposed preeclampsia. Secondary outcomes were fetal growth restriction and preterm birth. The rate of superimposed preeclampsia was 28.6% lower among women receiving aspirin plus calcium than in the placebo group (52.2 vs 73.1%, respectively, P=0.112). The rate of fetal growth restriction was reduced by 80.8% in the supplemented group (25 vs 4.8% in the placebo vs supplemented groups, respectively; P=0.073). The rate of preterm birth was 33.3% in both groups. The combined supplementation of aspirin and calcium starting at 20-27 weeks of gestation produced a nonsignificant decrease in the incidence of superimposed preeclampsia and fetal growth restriction in hypertensive women with abnormal uterine artery Doppler.

PP043. Do women know what pre-eclampsia is? What is the level of knowledge of the disease in a small population connected to a social net?

INTRODUCTION: Pre-eclampsia is responsible for a great number of maternal deaths in our country. Even in urban areas that, theoretically, has more access to information and more medical assistance possibilities, much more women have very severe cases that could be avoided. Many initiatives to reduce this problem include effective women participation in that item, making us to believe that actual information access would allow precocious detection of the problem, leading to reduction of the maternal and perinatal risks. OBJECTIVES: To investigate a specific female population about how much they understand about the disease and its risks. METHODS: Using the social net Facebook®, a survey was developed for online use, where direct questions related to pre-eclampsia were made. The questions involved information about age, times of pregnancy, knowledge about pre-eclampsia and their risks. It was considered an inclusion criterion the women who decided to participate in the survey spontaneously, and their identity was preserved. This form was sent to 1000 women, and 120 fully answered the questions and they were put under analysis. RESULTS: The studied group had average age between 22 and 35years. From the total, 107 (89.6%) had at least initiated high school, and the rest (11%) said that they had at least finished elementary school. From the analyzed data, it was found that 60 (50%) of the interviewed women, did not know anything about the subject. The rest said that they had some knowledge about the topic. From those, 14 (23%) had already heard about pre-eclampsia, but did not know what was it, 44 (73%) had a vaguely notion but did not know about the risks, and just 2 (4%) gave the entirely correct definition and knew about its implications. From all, 24 (20%) from the interviewed had at least once been pregnant, and 15 from those, had never heard about the pathology. CONCLUSION: Despite of the impact that pre-eclampsia represents on mother and baby's health, our results show that information in the studied group, is poor. The studied group has naturally more access to information, showing us that the situation is even more concerning. We believe that it is necessary to apply instruments that could redefine, in a greater way, the real information level to the female population in all levels of assistance. To enlarge the health politics, and increase its efficiency through informed women, seem to us, a fundamental strategy to qualify assistance and enhance maternal and prenatal safety. In an era that social nets had changed human behavior, why should not we use it as an efficient tool to promote life quality?

PP123. Evaluation of glycosaminoglycans in placental of pregnant women with and without preeclampsia.

INTRODUCTION: Preeclampsia (PE) is a major cause of maternal and perinatal mobility and mortality and its etiology is not yet completely understood. Recently studies have shown the association between increased expression of glycosaminoglycans (GAGs) in placental of women with PE and its physiopathology. OBJECTIVES: Identify and quantify GAGs in placental of pregnant women in healthy pregnancy and PE. METHODS: Case-control study with 44 patients, control group (CG) n=29 and n=15 PE group. All patients were submitted to placental tissue resection (sample size of 5×5cm with the umbilical cord insertion in the center). The tissue was conserved in acetone. The GAGs' analysis consisted of centrifugation, proteolysis, precipitation, and electrophoresis RESULTS: Average age and gestational age in CG and PE were 27.33years and 39.02weeks and 24.17 and 36.90, respectively. In CG 68.96% (20/29) were Caucasian and 80.00% (12/15) in PE. We found in CG 34.48% (10/29) of primiparous and 40.00% (6/15) in PE. The average 24-hour proteinuria in PE was 554.28g/24hs. The average birth weight was 3333.31g in CG and 2972.66 in PE. The mean ± standard deviation of dermatan sulfate (DS), heparan sulfate (HS) and hyaluronic acid (HA) in CG and PE were: 0,100µg/mg of tissue ±0,005 and 0,144 ±0,071; 0,077±0,041 and 0,113±0,061; 1,281±1,857 and 3,076±4,930. CONCLUSION: GAGs are increased in PE when compared to normal pregnancy. The expression of HA and HS was twice higher in PE. More studies are needed to determine the correlation between GAGs and physiopathology of PE.

PP146. Psychological assessment of renal transplant recipients during pregnancy.

INTRODUCTION: Although many centers have reported their experience on maternal and perinatal outcomes in renal transplant recipients. Very few information can be found about the psychological aspects that may rise for these patients during pregnancy. Considering the importance of the psychological concerns for this kind of patients, we have developed a protocol to better assist renal transplant recipients during pregnancy and here we show what we have learnt. OBJECTIVES: To understand how the maternal concerns are seen from renal transplant recipients in terms of psychological aspects. METHODS: Fifteen pregnant kidney transplanted women with an average age of 27.5years were included in the study. All patients have been investigated beyond the 20th week of pregnancy to delivery. The study is cross-sectional, qualitative, and participation is based on developed phenomenological method. Final data analysis will be done through thematic analysis and hermeneutics of meaning. The only exclusion criteria were the current presence of psychiatric disorders or use of drugs that could influence cognitive and emotional aspects during the psychological evaluation. RESULTS: During the last two years we have observed in these women that all of them are aware of the risks of pregnancy after transplantation. Qualitative aspects were: Pregnant with kidney transplantation show: in relation to pregnancy, the desire to be mothers, to give a son to her husband, to become a healthy person again; they believe that conception is God's will, they have fear of pregnancy, ambivalence of feelings (fear and happiness). In relation to the graft, they reported fear of baby malformations, fear and anguish of graft loss, still consider it worth the risk of having the baby, and some women name the graft, if it were another infant. In relation to delivery, state anxiety and anguish at the proximity of labor (fear of labor pain, anesthesia, cesarean section, vaginal delivery and the "psychic pain"). CONCLUSION: Pending the final results of this study, we still observed that these patients and their husbands require multidisciplinary monitoring since the beginning of pregnancy. Factors religious, cultural and psychic are involved in the desire to be mothers.

PP007. Effects of STAT1 suppression on ERK1/2 in trophoblastic cells.

INTRODUCTION: Migration and trophoblast invasion are controlled functionally along with the active participation of cytokines and growth factors. Two important intracellular signaling pathways are the Janus kinase/signal transducer and activator of transcription (JAK-STAT) and extracellular regulated kinase1/2 (ERK1/2). These pathways have been associated with the regulation of gene expression, cellular proliferation, differentiation, angiogenesis, embryo development and invasion in tumor and trophoblast cells. OBJECTIVES: The aim of our study is to characterize and analyze the regulation and crosstalks of STAT1 and ERK1/2 in trophoblast cells and the identification of activating cytokines. METHODS: The trophoblast derived cell line HTR-8/svneo and a choriocarcinoma cell line (JEG-3) were stimulated with interleukin-6 (IL-6), IL-11, granulocyte-macrophage colony-stimulating factor (GMC-SF), leukemia inhibitory factor (LIF) or oncostatine M (OSM). The the expression and phosphorylation of STAT1(tyr705) and ERK1/2 were analyzed by gel electrophoresis and Western blotting. Expression of STAT1 was inhibited by administration of 50µM fludarabine (2-fluoro-ara-AMP) for 2, 4, 8, 24, 48 or 72h or by using small interfering RNA (siRNA). The full activation of STAT1 was assessed by using an STAT1 DNA-binding assay. Finally, proliferation and invasion assays were performed (Grant Deutscher Akademischer Austausch Dienst A/10172477). RESULTS: LIF and OSM induce STAT1 and ERK1/2 phosphorylation in HTR-8 and JEG-3 cells. Fludarabine inhibits the so induced phosphorylation of STAT1 when administered 48 or 72h before stimulation. Simultaneously, ERK phosphorylation increases. In contrast, silencing of STAT1 by application of specific siRNA induces reduction of ERK1/2 phosphorylation. Fludarabine reduces STAT1 DNA-binding capacity. LIF and OSM increase proliferation. Silencing of STAT1 slightly decreases invasiveness of analyzed cells. CONCLUSION: STAT1 in trophoblast cells can be activated by placental cytokines. Suppression of STAT1 by fludarabine or siRNA influences activity of ERK1/2 which indicates a crosstalk between both pathways. Current studies will clarify the reason for the different effects on ERK1/2 in trophoblastic cells.

PP098. Lipidic fingerprinting in women with early-onset preeclampsia: A first look.

INTRODUCTION: preeclampsia is characterized by intense inflammatory response and an anti-angiogenic state. Maternal obesity has been considered to have important impact on the genesis of preeclampsia as lipotoxicity leads to maternal endothelial dysfunction and chronic inflammation. Here we investigate the plasma lipid profile of preeclamptic women. OBJECTIVES: identify possible lipid biomarkers for preeclampsia. METHODS: this study included 8 pregnant women with early-onset preeclampsia (before 34weeks gestation) and 8 normal pregnant women. Each patient in the preeclampsia group was matched to a patient in the control group according to gestational age at the time of sample collection. All patients in the control group were followed until term and had normal outcomes. To investigate the lipid profile, lipids were extracted from plasma samples using the Bligh-Dyer protocol and the extracts were subjected to MALDI-TOF Mass Spectrometry. Data matrix was exported for partial least squares discriminant analysis. All the variables analysed were sorted by a score number named Variable Importance in the Projection. The major discriminant variables were selected and underwent to Mann-Whitney U test. RESULTS: a total of 1290 ions were initially identified during lipidomic assessment. Twelve m/z signals were highlighted as the most important lipids for the discrimination of patients with preeclampsia. The identification of these differential lipids was carried out through Lipid Database Search. The main classes identified were Glycerophosphocholines [GP01], Glycerophosphoserines [GP03], Glycerophosphoglycerols [GP04], Glycosyldiradylglycerols [GL05] and Glycerophosphates [GP10]. CONCLUSION: Our results suggest that some lipid species may be potential biomarkers for early-onset preeclampsia.

PP115. Relationship between angiogenic factors and preeclampsia: Preliminary results.

INTRODUCTION: The pathogenesis of preeclampsia (PE) is complex and involves many mechanisms, including impaired placental angiogenesis. Endoglin (Eng) promotes angiogenesis, but in its soluble form (sEng) it is antiangiogenic and adiponectin has pro-angiogenic and anti-inflammatory effects on the endothelium. The combined analysis of these factors seems to better reflect maternal vascular damage. OBJECTIVES: We aimed to evaluate adiponectin and soluble endoglin levels, to analyze adiponectin (+45) gene polymorphism and its relation with adiponectin serum levels in patients with PE. METHODS: This case-control study included 24 PE patients and 20 healthy pregnant women (C: control). Adiponectin and sEng serum levels were determined by ELISA. Polymorphism genotyping was obtained by PCR-RFLP. Data were analyzed by Mann-Whitney, Chi-square or Fisher's exact tests and significance was set at p<0.05. RESULTS: There were no differences in adiponectin levels between the groups (C×PE: 6772.4ng/mL×7763.2ng/mL, p=0.99), but women with PE had significantly higher sEng levels (23.45 ng/mL×3.35ng/mL, p<0.0001). Moreover, the ratio adiponectin/sEng was significantly lower in PE than in C women (325.02×2119.4, p<0.0001). There was no association between PE and the analyzed polymorphism, neither between adiponectin genotype/phenotype. CONCLUSION: Our findings confirm an association between PE and altered sEng levels. In addition, these results suggest that angiogenic mediators when analyzed together, can better reflect their involvement in the pathophysiology of PE. Financial support: FAPESP (09/54729-6 and 10/08082-8).

PP138. Human fetal malformations associated with the use of angiotensin II receptor antagonist.

INTRODUCTION: antagonists of angiotensin II receptor (AAR) are commonly used for the treatment of chronic hypertension in the general population. Some of these pharmacological agents are losartan, candesartan, valsartan and tasosartan. Despite the good response achieved with these drugs in the control of hypertension, all medications that act directly on the renin-angiotensin system should be contraindicated during pregnancy. These drugs have been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure and death.Here we report a case of fetal malformations and death associated with the use of losartan. OBJECTIVES: describing the association of fetal malformations and the use of losartan during first and second trimester of pregnancy. METHODS: this is a case report involving a 37-year-old pregnant woman at 26 gestational weeks. This patient had history of chronic hypertension for more than five years that was being regularly treated with Losartan 50mg/day. After her first consultation losartan was promptly discontinued and substituted for methyldopa. However, scan evaluation demonstrated severe oligohydramnios associated with altered fetal biophysical profile and altered Doppler fluxometry (absent diastolic flow at umbilical arteries). Therefore, a cesarean-section was performed after corticoid administration for fetal lung maturation. At first moment some characteristic alterations as fetal limb contractures and craniofacial deformation were detected at the 1007g new-born. This baby went to death 36h after delivery due to severe lung hypoplasia. RESULTS: the autopsy examination revealed renal tubular dysgenesis associated with changes secondary to nephropathy, probably induced by drug (Fig. 1). Associated findings were underdevelopment of bones of the skull with large fontanelles, thymus atrophy and signs of perinatal hypoxia. CONCLUSION: the difficulty of attending basic health assistance was attributed to be associated with this case, as this patient did not have opportunity and sufficient information about the necessity of changing her medication during pregnancy. Apart from this situation, this case report brings good information about the association between antagonists of angiotensin II receptor and human fetal malformations.

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.

PP165. Treatment approaches for preeclampsia: A sample from a big city of a developing country.

INTRODUCTION: Preeclampsia is a major cause of maternal morbidity and mortality worldwide, mainly in developing countries. Here we show an example of how is the clinical condition of these patients when they are referred from first care units to a tertiary care teaching maternity in the city of São Paulo, Brazil. OBJECTIVES: To evaluate how has been the approach for preeclamptic women in a big city of Brazil, an example of developing country. METHODS: This is a retrospective study that evaluated 41 patients that were referred to our hospital from August 2010 to December 2011. In most of the cases patients were referred due to elevations in blood pressure. The diagnosis of preeclampsia was based on the ISSHP recommendations. The diagnosis of severe preeclampsia was based either on clinical symptoms and/or laboratory parameters. Fetal distress was defined when Doppler velocimetry assessment demonstrated abnormal parameters (centralization with abnormal diastolic blood flow at umbilical arteries). RESULTS: Severe preeclampsia was diagnosed in 26 cases (63.4%) and 34 patients were treated with magnesium sulfate (82.9%). One case of eclampsia (2.4%) and five cases of "Abruptio Placentae" (12.1%) were registered. Fetal distress was diagnosed at the moment of admission in 13 cases (31.7%) and two of these fetuses ended in stillbirth (4.8%). Neonatal death occurred in three cases (7.3%), mainly due to extreme preterm delivery. Other outcomes are reported in the following table. ICU: Intensive Care Unit. CONCLUSION: This is a good example of how has been the approach of preeclamptic women in a big city of Brazil. Our results suggest that a special concern about the moment of referring these patients to tertiary care units should be taken by doctors at first care units.

Renal evaluation in women with preeclampsia.

BACKGROUND/AIMS: Preeclampsia (PE) is a cause of glomerulopathy worldwide. Urinary retinol-binding protein (RBP) is a marker of proximal tubular dysfunction, albuminuria is an endothelial injury marker, urine protein:creatinine ratio (PCR) may have a predictive value for renal disease later in life, and, recently, podocyturia has been proposed as a sensitive tool in pregnancy, but it needs to be tested. The aim of this study was to evaluate renal involvement in PE and healthy pregnancy. METHODS: Case-control study with 39 pregnant women assessed after 20 weeks of gestation (25 in the control group, CG, and 14 in the PE group) by performing urinary tests. RESULTS: Mean (±SD) age and gestational age of the CG were 26.9 ± 6.4 years and 37.1 ± 5.0 weeks, and of the PE group 26.4 ± 6.9 years and 30.6 ± 5.6 weeks, respectively (p = 0.001). Mean (±SD) urinary RBP (p = 0.017), albuminuria (p = 0.002), and urinary albumin concentration (UAC) ratio (p = 0.006) of the CG were 0.4 ± 0.7 mg/l, 7.3 ± 6.9 mg/l, and 8.2 ± 6.7 mg/g and of the PE group 2.0 ± 4.4 mg/l, 2,267.4 ± 2,130.8 mg/l (p = 0.002), and 3,778.9 ± 4,296.6 mg/g (p = 0.006), respectively. Mean (±SD) urine PCR in the PE group was 6.7 ± 6.1 g/g (p < 0.001). No statistical differences were found between podocyturia in the CG and PE group (p = 0.258). CONCLUSIONS: Urinary RBP, PCR, albuminuria, and UAC ratio were elevated in the PE group in comparison to the CG. Podocyturia did not predict PE.

PP019 The role of renal markers in women with and without preeclampsia: Evaluation of urinary excretion of podocytes and proteins.

INTRODUCTION: Preeclampsia (PE) is an important cause of glomerulopathy. Assessment of renal markers during pregnancy may have a predictive value for glomerular disease later in life. The early detection of PE may prevent the complications of this syndrome. OBJECTIVES: Assess the glomerular involvement in PE and in normal pregnancy by evaluating renal markers such as podocyturia and proteinuria. METHODS: Case-control study with 39 pregnant women after 20 weeks of gestation (control group - CG with n=25 and PE with n=14), we assessed podocyturia (cytospin method) and proteinuria (albuminuria, urine protein:creatinine - PCR, urinary retinol protein - RBP and albumin/creatinine ratio - ACR). (Grant FAPESP 08/56338-1) RESULTS: Mean±standard deviation of age and mean gestational age of CG were 26.9±6.4years and 37.1±5.0weeks and of PE, 26.4±6.9 and 30.6±5.6, respectively (p=0.001). No statistical differences were found between podocyturia in CG and PE although it was more frequent in this last group (p=0.258). Podocyte cells and parietal epithelial cells were detected in the slides. Mean±standard deviation of urinary RBP (p=0.017), albuminuria (p=0.002) and UAC ratio (p=0.006) of CG were 0.4±0.7mg/L, 7.3±6.9mg/L and 8.2±6.7mg/g and of PE, 2.0±4.4mg/L, 2267.4±2130.8mg/L (p=0.002) and 3778.9±4296.6mg/g (p=0.006), respectively. Mean value±standard deviation of urine PCR in PE was 6.7±6.1g/g (p=< 0.001). CONCLUSION: Urinary RBP, PCR, albuminuria and UAC ratio were elevated in PE in comparison to CG indicating its glomerular involvement but there was no correlation between those renal parameters and podocyturia. RPC and UAC ratios were good predictors of PE, but not podocyturia. Either podocyte cells as parietal epithelial cells were detected in the urine, these findings may indicate a non-invasive marker for renal disease activity but more studies are required to determine its role in PE.

PP022 The haemostatic suture (technique of B-Lynch) may be an alternative to control uterine hemorrhage associated with hypertensive disorders.

INTRODUCTION: Postpartum haemorrhage is an important cause of maternal morbidity and mortality, uterine atony being responsible for most of the cases. Hypertensive disorders are supposed to increase the possibility of such complications, mainly when complicated by "abruptio placentae". The classical treatments for postpartum haemorrhage have been based on medications like oxytocin and misoprostol, but more recently a haemostatic uterine suture developed by Christopher B-Lynch has been indicated. Here, we describe our experience of performing such technique and investigate its results in patients complicated by hypertensive disorders. OBJECTIVES: Reporting a series of cases of postpartum haemorrhage treated with the B-Lynch suture. METHODS: This is a descriptive study including 39 patients treated with the B-Lynch suture after postpartum haemorrhage related to uterine atony. The period evaluated was between January 2005 and February 2012. Intravascular oxytocin was routinely used in all cases, with doses changing from 20 to 60 IU. The suture material used was chromed catgut 1.0mm. RESULTS: The mode of delivery was cesarean-section in all cases. Five patients (12.8%) had hypertensive disorder as additional complication and one of these patients had abruptio placentae followed by development of Couvelaire uterus. Overall, the B-Lynch technique helped to control haemorrhage in all cases evaluated. CONCLUSION: We believe that the B-Lynch technique appears as an important procedure to be indicated in cases of postpartum haemorrhage. Therefore, we recommend that this technique should be tried to control such complications before deciding for other more aggressive procedures like hysterectomy. It seems that this treatment may be used in patients complicated by hypertensive disorders.