RESUMO
INTRODUCTION: Poor perinatal outcome in patients with preeclampsia has been reported. This significant risk reinforces the importance of fetal evaluation. OBJECTIVE: The purpose of this study was to evaluate the utility of the nonstress test (NST) in preeclampsia. STUDY DESIGN: Criteria for inclusion in this report comprised pregnancies complicated by preeclampsia of longer than 28 weeks of gestation delivered 24 hours of final NST. The study population were divided into mild and severe preeclampsia. Each of the latter two groups was further subdivided into three subgroups by gestational age at 28-31, 32-34 and > 35 weeks. Measurements of adverse perinatal outcome included meconium staining, oligohydramnios, five-minute Apgar score less than 7 beyond 34 weeks of gestational age, intrauterine growth retardation, and perinatal death. RESULTS: A total of 250 patients with preeclampsia were analyzed, among these 147 with mild and 103 with severe disease. There were no stillbirths. Sensitivity of the NST was low ranged from 39% (mild preeclampsia) to 63% (severe disease). Its positive predictive value was equally low (66 and 45%) respectively. Specificity was quite high in both groups (89 and 64%). Its negative predictive value was 73% for mild disease and 78% for severe preeclampsia. CONCLUSION: The NST is an important test in antepartum care but based on its low sensitivity should not be considered as a stand alone test.
Assuntos
Pré-Eclâmpsia/diagnóstico , Feminino , Humanos , Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To describe the maternal morbidity and mortality in pregnancies complicated by HELLP Syndrome. STUDY DESIGN: This is a descriptive and prospective study of women with HELLP Syndrome managed at our center from January 1998 through March 2000. Patients are grouped into 3-class system of Mississippi classification. RESULTS: 170 cases were analysed, 156 (92%), ocurred ante partum and 14 (8%) postpartum; 15 cases (9%) developed at < 27 weeks, 112 (66%) between 28 to 36 weeks of gestational age and 43 (25%) at term. Maternal morbidity included acute renal failure (13.5%), abruptio placentae (6.6%), pneumonia (3%), subcapsular liver hematoma (2.3%), pulmonary edema (2.3%), diseminated intravascular coagulopathy (1.7%) and cerebral hemorrhage (1.2%). Maternal mortality was 4.7% (8 patients), 7 deaths ocurred in patients with class I disease and only one with class II HELLP Syndrome. 6 maternal deaths (75%) were associated to eclampsia. Up to 85% of the maternal morbidity and mortality developed with class I disease (platelet nadir < 50,000 mm3. CONCLUSIONS: There is a progressive rise in maternal morbidity and mortality as the pregnancy moves from class III to class I HELLP Syndrome. 75% of maternal mortality was associated with eclampsia. Early diagnosis of this syndrome could improve maternal prognosis and outcome.
Assuntos
Síndrome HELLP/epidemiologia , Complicações Hematológicas na Gravidez/epidemiologia , Adulto , Eclampsia/complicações , Feminino , Síndrome HELLP/classificação , Síndrome HELLP/mortalidade , Humanos , Contagem de Plaquetas , Gravidez , Complicações Hematológicas na Gravidez/mortalidadeRESUMO
A case report is presented of one preeclamptic patient with rupture of a big right subcapsular hematoma of the liver which was misdiagnosed with cholecystitis. A cesarean delivery was performed, which resulted is stillbirth, with abruptio placentae of 50%. The emergent treatment of the liver rupture was the right hepatic artery ligation, the postoperative development was favorable. Long term follow-up using ultrasound and liver function values were performed for 14 months and showed that the lesion has regressed with a normal hepatic imaging.
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Carcinoma Hepatocelular/etiologia , Neoplasias Hepáticas/etiologia , Pré-Eclâmpsia/complicações , Adulto , Feminino , Humanos , Gravidez , Ruptura Espontânea , Fatores de TempoRESUMO
OBJECTIVE: To determine in multivariate analysis the clinical, social, and demographic factors for preeclampsia. STUDY DESIGN: A case-control study was designed. Three hundred patients were included, divided in two groups. 150 cases with criteria diagnosis for preeclampsia. 150 patients with normal pregnancy and deliveries. The main variables analyzed were age, schooling, marital status, employment, socioeconomic status, smoking and alcohol consumption, body mass index, familiar history of preeclampsia, history of preeclampsia in previous pregnancy, parity and type of pregnancy (single or multiple). STATISTICAL ANALYSIS: For comparison of cases and controls on categorical variables, odds ratios and 95% confidence intervals were calculated, and multiple logistic regression analyses. RESULTS: Multiple logistic regression analysis showed that history of preeclampsia in previous pregnancy has OR 23.7, 95% p < 0.001, familiar history of preeclampsia OR 1.62, p < 0.08, high body mass has OR 1.60. CONCLUSIONS: The knowledge of the most important risk factors in our population could be useful for the clinical to pre-detect the patient who will develop preeclampsia.
Assuntos
Pré-Eclâmpsia/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Análise Multivariada , Pré-Eclâmpsia/etiologia , Gravidez , Fatores de Risco , Fatores SocioeconômicosRESUMO
A total of 58 women with severe preeclampsia between 28-33 weeks of gestation were studied during the period from 1 October 1996 to 1 October 1997. Twenty-four women (42%) developed maternal or fetal indications necessitating early delivery within 48 hours, meanwhile the other 34 patients (58%) received expectant management. The average pregnancy prolongation period in the conservative management group was 6.4 days (range 3 to 18). The primary indications for delivery in this group were maternal indications 16 (47%), fetal compromise 13 (39%), 34 weeks of gestation 3 (8%), abruption placentae 1 (3%) and preterm labor 1 (3%). The mean birth weight and Apgar score at 5 minutes were 1520 +/- 310 g and 8, respectively. Expectant management was not associated with fetal death or maternal complications. The only neonatal death was related with sepsis and prematurity. The women in the early delivery group totaled two stillbirths and three neonatal deaths.