Analyze the epidemiology of affected women with cases of hypertensive disorders (SH), severe maternal morbidity (SMM) and near-miss (NM).
Prospective longitudinal/descriptive study ...(June/2013-May/2014-Guilherme Álvaro Hospital/Santos-Brazil), included women with at least one criteria recommended by the authors (Santos criteria) derived from the definition of MMG and NM (admitted to ICU) of the World Health Organization (2009), Waterstone et al. (2001), Mantel et al. (1998), seeking to homogenize/facilitate this definition according to clinical/laboratory/ management, using hospital records and interviews with women, describing the epidemiology/outcomes/economic status and quality of prenatal care.
We identified 54 women (46 MMG, NM 07 and 01 maternal death from sepsis). Reasons (/1000 births):MMG 33.63 and NM 5.11. White women (48.8%), above 35 years old (38.8%), 70% overweight/obese (82.5% associated with SH), and were often poor, incomplete secondary education, 41.5% multiparous, with previous preeclampsia (PE), 29.5% eclampsia and 8% fetal death , when prenatal consultation 57.64% were less than six with difficult access (35%). 88.8% SH: 36 chronic hypertension and superimposed PE (63.8%) and one with eclampsia, 22% severe PE, mainly contributing to NM, 54.1% and were not counseled on signs/symptoms of severity. The prevalent mode of delivery was cesarean section (79.54%), prematurity (69%), 03 cases of hysterectomy and 07 stillbirths. Of live births: 24.1% small for gestational age, 08 ICU admissions,05 neonatal deaths.
Santos’ criteria (adapted from the WHO, Waterstone et al. and Mantel et al. criteria)ClinicalSever chronic hypertension (BPD ⩾ 110), Severe preeclampsia superimposed (BP ⩾160×110mmHg) Severe preeclampsia: Proteinuria >2g/24h, Creatinine >1.2mg/dL, Platelets <100.000Acute pulmonary edema, epigastric pain, eclampsia, HELLP syndrome, Severe hemorrhage (blood loss >1500mL), severe sepsis, uterine rupture, pulmonary edemaAcute cyanosis, gasping, cerebral vascular accidentRespiratory rate > 40ipm or < 6ipm, shock, coagulation disordersTotal paralysis, coma ⩾12h, jaundice with preeclampsiaCardiopulmonary arrest, thyrotoxic crisis, endometritisCongestive cardiac insufficiency, urine output less than 400mL/24h, refractory to hydration, furosemide or dopamineLaboratoryOxygen saturation <90% for ⩾60min, PaO2/FiO2 <200mmHgCreatinine ⩾300mmol/L or ⩾3.5mg/dL Bilirubin >100mmol/L or >6.0mg/dLpH <7.1, lactate >5, ketoacidosis and glucose in urineAcute thrombocytopenia (<50,000 platelets)ManagementContinued use of vasoactive drugsHysterectomy for postpartum hemorrhage or infectionHypovolemia and need of volume replacement with crystalloid and/or blood transfusionIntubation and ventilation for ⩾60min not related to anesthesiaDialysis for acute renal failureIntubation and ventilation for ⩾60min not related to anesthesia Anesthetic accident: severe hypotension after-blockade and failed intubation
Among women with severe maternal morbidity, the prevalence of hypertension, over 35 years old, poor nutritional status/low income, and prenatal care making us suggest that this population must rely on qualified contraceptive programs/preconception/prenatal guidance and knowing this group may indicate timely interventions can help guide strategies to reduce maternal mortality rates.
L. Maruoka: None. M. Imad: None. L. Leme: None. N. da Silva: None. S. Sashida: None. V. Alonso Neto: None. V. Marçal: None. J. Garcia: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.
144-POS Diaz Cunha David, Maria Luisa; Rahe, Paula Seba; Pires de Campos, Veridiana Andrade ...
Pregnancy hypertension,
01/2015, Letnik:
5, Številka:
1
Journal Article
Objectives Compare the maternal and perinatal outcomes of vaginal parturition among pregnant women with chronic arterial hypertension (CAH) and normotensive pregnant women. Methods A transversal, ...retrospective and comparative study was performed involving 31 pregnant women with CAH that were accepted on the Hospital Guilherme Álvaro’s Prenatal Service for Expecting Women with Hypertension or Nephropathies in Santos-SP/Brazil (January 2012–December 2013) and that had obstetric resolution by vaginal delivery. For the control group were selected pregnant women without hypertension or any other comorbidities who have had obstetric resolution by vaginal delivery subsequently to the pathological pregnant women. To compare the groups the Student’s t test and Fisher’s exact test were used. Results The groups differ with regard to the following variables: age (hypertensives, in average, 7.6 years older; p < 0.05), gestational age at moment of delivery (hypertensives, in average, has its births 2 weeks before the control group; p < 0.05), maternal hospitalization days (hypertensives require, in average, 3 more days of hospitalization; p < 0.05), type of delivery (induced in 74.2% of the hypertensive pregnant women and spontaneous in 80% of the pregnant women on the control group; p < 0.05), and presence of meconium amniotic fluid at delivery (0.0% in hypertensive pregnant women, 22.6% on control group; p < 0.05). There was no significant difference ( p > 0.05) when compared the variables APGAR on 1′ and 5′, maternal complications, perinatal complications, birth weight and need for Neonatal Intensive Care Unit hospitalization. Conclusions In order to reduce the high rate of cesarean sections in chronic hypertensive women, strategies could be adopted to encourage vaginal delivery in these pregnant women, considering that on the study, maternal and perinatal outcomes were favorable. Despite the small sample in this study, there were no adverse maternal and perinatal outcomes that contraindicate vaginal delivery in patients with chronic arterial hypertension. Disclosures M. David: None. P. Rahe: None. V. de Campos: None. M. da Silva: None. F. Marques: None. K. Dom Bosco: None. J. Del Sant: None. J. Garcia: None. M. Paltronieri: None. M. Saito: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.
Compare the maternal and perinatal outcomes of vaginal parturition among pregnant women with chronic arterial hypertension (CAH) and normotensive pregnant women.
A transversal, retrospective and ...comparative study was performed involving 31 pregnant women with CAH that were accepted on the Hospital Guilherme Álvaro’s Prenatal Service for Expecting Women with Hypertension or Nephropathies in Santos-SP/Brazil (January 2012–December 2013) and that had obstetric resolution by vaginal delivery. For the control group were selected pregnant women without hypertension or any other comorbidities who have had obstetric resolution by vaginal delivery subsequently to the pathological pregnant women. To compare the groups the Student’s t test and Fisher’s exact test were used.
The groups differ with regard to the following variables: age (hypertensives, in average, 7.6 years older; p<0.05), gestational age at moment of delivery (hypertensives, in average, has its births 2 weeks before the control group; p<0.05), maternal hospitalization days (hypertensives require, in average, 3 more days of hospitalization; p<0.05), type of delivery (induced in 74.2% of the hypertensive pregnant women and spontaneous in 80% of the pregnant women on the control group; p<0.05), and presence of meconium amniotic fluid at delivery (0.0% in hypertensive pregnant women, 22.6% on control group; p<0.05). There was no significant difference (p>0.05) when compared the variables APGAR on 1′ and 5′, maternal complications, perinatal complications, birth weight and need for Neonatal Intensive Care Unit hospitalization.
In order to reduce the high rate of cesarean sections in chronic hypertensive women, strategies could be adopted to encourage vaginal delivery in these pregnant women, considering that on the study, maternal and perinatal outcomes were favorable. Despite the small sample in this study, there were no adverse maternal and perinatal outcomes that contraindicate vaginal delivery in patients with chronic arterial hypertension.
M. David: None. P. Rahe: None. V. de Campos: None. M. da Silva: None. F. Marques: None. K. Dom Bosco: None. J. Del Sant: None. J. Garcia: None. M. Paltronieri: None. M. Saito: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.
Comparison between two electronic methods of antepartum fetal assessment in hypertensive pregnant women.
Comparison of conventional cardiotocography tracing and transabdominal fetal ...electrocardiography with the use of the fetal monitor AN24 (Monica Healthcare), in women with gestational age ⩾34weeks, single fetus, with hypertensive disorders according to the criteria of NHBPEP-2000 at Guilherme Álvaro Hospital – Santos/SP – Brazil (Dec/2013–Jun/2014). The cardiotocography recorded the fetal heart rate by a Doppler transducer, dependent on correct identification of fetal positioning, the AN24 detected electrophysiological signals using electrodes arranged on the maternal abdomen. The tests were performed according to standard recommendation; variables evaluated: gestational age, number of pregnancies, parity, baseline, variability, body mass index (BMI), obesity, preservation of mobility adhesion, successful recording, Preparation time (<10″)/procedure (>20″), facility of captation/stability of signal in the group with BMI>30, agreement in diagnostic classification (ACOG Practice Bulletin 106, 2009).
Of the 10 tracings evaluated: 03 pregnant women with pre-eclampsia, 07 with chronic hypertensive (06 developed superimposed pre-eclampsia). The AN24 monitor preserved the mobility and made it easier to obtain the registration in women with BMI>30 with better adherence in this group once it dismissed the additional manipulation of the abdomen to obtain registration.Gestational age average (weeks)34.8Good capitation MONICA80%Number of pregnancies (average)4.4Good capitation cardiotocography50%Parity (average)2.5Preparation time MONICA (<10′)70%Base line fetal heart rate (average)134.6Time procedure MONICA (>20′)80%Variability (oscillation 6–25bpm)67%Preparation time cardiotocography (<10′)90%BMI (average)37.4Time procedure cardiotocography (>20′)90%Obesity60%Concordance in the classification100%In the group with BMI⩾30 (07 pregnancies), facility of captation/stability of signal was 85%, instead of when BMI⩽30 was 42%.
We have not identified any differences regarding the quality of analysis fetal vitality between the methods. The easy achievement/continuity of record by AN24 monitor in maternal obesity may indicate that this resource is particularly valuable for this group. Additional studies may increase the information for this research.
C. Geraldes: None. M. Saco: None. P. Coelho: None. G. Calestini: None. C. Cury: None. F. Fuentes: None. B. Zeiger: None. J. Garcia: None. S. de Toledo: None. R. Guidoni: None. M. Saito: None. F. Sousa: None. C. Mariani Neto: None.
Objectives Comparison between two electronic methods of antepartum fetal assessment in hypertensive pregnant women. Methods Comparison of conventional cardiotocography tracing and transabdominal ...fetal electrocardiography with the use of the fetal monitor AN24 (Monica Healthcare), in women with gestational age ⩾34 weeks, single fetus, with hypertensive disorders according to the criteria of NHBPEP-2000 at Guilherme Álvaro Hospital – Santos/SP – Brazil (Dec/2013–Jun/2014). The cardiotocography recorded the fetal heart rate by a Doppler transducer, dependent on correct identification of fetal positioning, the AN24 detected electrophysiological signals using electrodes arranged on the maternal abdomen. The tests were performed according to standard recommendation; variables evaluated: gestational age, number of pregnancies, parity, baseline, variability, body mass index (BMI), obesity, preservation of mobility adhesion, successful recording, Preparation time (<10″)/procedure (>20″), facility of captation/stability of signal in the group with BMI > 30, agreement in diagnostic classification (ACOG Practice Bulletin 106, 2009). Results Of the 10 tracings evaluated: 03 pregnant women with pre-eclampsia, 07 with chronic hypertensive (06 developed superimposed pre-eclampsia). The AN24 monitor preserved the mobility and made it easier to obtain the registration in women with BMI > 30 with better adherence in this group once it dismissed the additional manipulation of the abdomen to obtain registration. Gestational age average (weeks) 34.8 Good capitation MONICA 80% Number of pregnancies (average) 4.4 Good capitation cardiotocography 50% Parity (average) 2.5 Preparation time MONICA (<10′) 70% Base line fetal heart rate (average) 134.6 Time procedure MONICA (>20′) 80% Variability (oscillation 6–25 bpm) 67% Preparation time cardiotocography (<10′) 90% BMI (average) 37.4 Time procedure cardiotocography (>20′) 90% Obesity 60% Concordance in the classification 100% In the group with BMI ⩾ 30 (07 pregnancies), facility of captation/stability of signal was 85%, instead of when BMI ⩽ 30 was 42%. Conclusions We have not identified any differences regarding the quality of analysis fetal vitality between the methods. The easy achievement/continuity of record by AN24 monitor in maternal obesity may indicate that this resource is particularly valuable for this group. Additional studies may increase the information for this research. Disclosures C. Geraldes: None. M. Saco: None. P. Coelho: None. G. Calestini: None. C. Cury: None. F. Fuentes: None. B. Zeiger: None. J. Garcia: None. S. de Toledo: None. R. Guidoni: None. M. Saito: None. F. Sousa: None. C. Mariani Neto: None.
OBJETIVO: comparar, macro e microscopicamente, cicatrizes uterinas pós-cesáreas, nas quais foram feitas suturas com pontos separados, contínuos e contínuos ancorados. MÉTODOS: utilizamos três coelhas ...prenhes, realizando parto cesáreo no 26º dia de prenhez, com três incisões em cada corno uterino. As histerorrafias foram realizadas com fio Vicryl® 00, com suturas distintas (pontos separados, sutura contínua e contínua ancorada). No 60º dia pós-parto, realizamos histerectomia total abdominal e anexectomia bilateral, para avaliação das cicatrizes cirúrgicas. Na macroscopia, avaliamos o grau de retração cicatricial (longitudinal e transversal), o depósito de fibrina, presença de aderências e integridade dos fios de sutura. Na microscopia, utilizamos coloração de hematoxilina-eosina, para contagem de vasos sangüíneos e fibroblastos, e a coloração do tricômio de Masson, para quantificação do colágeno. Para a análise comparativa das cicatrizes, utilizamos os testes de Friedman e exato de Fisher, adotando nível de significância de 5%. RESULTADOS: foram obtidas 18 cicatrizes, seis para cada tipo de sutura. Obtivemos as seguintes médias 0,5/0,4/0,5 (p=0,069) para os graus de retração longitudinal e 0,3/0,4/0,3 (p=0,143) para os graus de retração transversal, respectivamente para as suturas com pontos separados, contínuo e contínuo ancorado. Todas as suturas apresentaram depósito de fibrina regular, ausência de aderência e reabsorção integral dos fios. Na microscopia, apuramos a média de vasos sangüíneos (158,5/139,3/172,1; p=0,293), de fibroblastos (351,6/345,8/354,3; p=0,311) e da porcentagem de tecido colágeno (44,0/45,5/48,5; p=0,422), respectivamente para as suturas com pontos separados, contínuo e contínuo ancorado. CONCLUSÕES: a técnica de histerorrafia na cesárea de coelhas (pontos simples, sutura contínua e contínua ancorada) não determinou diferenças estatísticas significantes em relação aos parâmetros macroscópicos e microscópicos avaliados.PURPOSE: to compare macro and microscopically, surgical uterine sutures in female rabbits, after caesarean section utilizing separate, continuous and continuous anchored suture stitches. METHODS: three New Zealand female rabbits in their first pregnancy were used. The caesarean section was carried out at the 26th day of gestation and three incisions were performed in each uterus. The hysterorrhaphy was performed with a 00 Vicryl® thread, and a different suture technique was employed for each incision. Total hysterectomy and adnexectomy were done at the 60th day post-delivery with the preservation of eventual adhesions for the evaluation of the surgical scars. The extent of scar retraction, amount of fibrin deposit and the suture integrity were evaluated through macroscopy. For the evaluation through microscopy, hematoxylin eosin technique was used for cellular colorimetry, and Masson's trichrom to evidence collagen. The statistical non-parametric Friedman's test was employed for the matching hypothesis, and Fisher's exact test to verify the homogeneity of the techniques (level of significance: 5%). RESULTS: a total of 18 scars were obtained (six scars per suture). The following mean values were obtained for the longitudinal (0.5/0.4/0.5, p=0.069) and transversal retraction degrees (0.3/0.4/0.3, p=0.143) respectively for separate, continuous and continuous anchored suture techniques. All sutures presented regular fibrin deposit, no adhesions and integral absorption of the stitches. The mean value of the blood vessels (158.5/139.3/172.1; p=0.293), fibroblasts (351.6/345.8/354.3; p=0.311) and of collagen percentage (44.0/45.5/48.5; p=0.422) were calculated through microscopy, respectively for separate, continuous and continuous anchored suture techniques. CONCLUSIONS: the type of hysterorrhaphy technique of caesarean section in female rabbits did not generate any significant statistical difference in the macroscopic and microscopic parameters evaluated.
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