Describe the perinatal outcome of pregnancies affected by hypertensive disorders classified as severe maternal morbidity (SMM) and near-miss (NM).
Longitudinal prospective study/descriptive ...(June/2013-May/2014 - Guilherme Álvaro Hospital, Santos-Brazil), included women with hypertensive disorders by definition (NHBPEP-2000) and at least one of the criteria recommended by the authors (Santos criteria) derived from the definition of MMG and NM (admission ICU) of the World Health Organization (2009), Waterstone et al. (2001), Mantel et al. (1998), followed by records and interview in which maternal status variables were evaluated: economic status/quality of prenatal/instruction on clinical signs of severity in hypertensive pregnant women/type of delivery. Perinatal variables: vitality at birth (live births and stillbirths) in the amount of births, Apgar/Gestational age at delivery, weight less than adequate (SGA), admission in NICU/death neonatal.
Forty-two cases of hypertensive disorders, with prevalence of low education, low income; average maternal age of 31.05 years and 23.8% of women above 35 years. Coverage of antenatal care in most of the women was inadequate; they were not warned of danger signals for preeclampsia. 47.61% had superimposed preeclampsia, and 19.04% isolated preeclampsia; 2 cases of eclampsia and 1 HELLP syndrome. 71.42% of deliveries were by cesarean section, with seven cases of stillbirth.
Live births%Results of perinatal variables of live birthsTotal of live births35100SGA822.95th min Apgar score <7514.2Neonatal ICU1337.1Neonatal death514.3Preterm birth2160
Hypertensive pregnant women presenting with criteria for severe maternal morbidity and near miss develop adverse perinatal outcomes, predominantly with preterm delivery and associated complications such as with frequent admissions to the intensive care unit and inadequate birth weight. Superimposed preeclampsia was associated with all cases of fetal death. Continuing this line of research will broaden the information on the perinatal outcomes in these women.
M. Imad: None. L. Maruoka: None. L. Leme: None. N. da Silva: None. S. Sashida: None. V. Alonso Neto: None. J. Garcia: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.
150-POS Imad, Malek Mounir; Maruoka, Lívia Yumi; de Sena Leme, Lucas ...
Pregnancy hypertension,
01/2015, Letnik:
5, Številka:
1
Journal Article
Objectives Describe the perinatal outcome of pregnancies affected by hypertensive disorders classified as severe maternal morbidity (SMM) and near-miss (NM). Methods Longitudinal prospective ...study/descriptive (June/2013-May/2014 - Guilherme Álvaro Hospital, Santos-Brazil), included women with hypertensive disorders by definition (NHBPEP-2000) and at least one of the criteria recommended by the authors (Santos criteria) derived from the definition of MMG and NM (admission ICU) of the World Health Organization (2009), Waterstone et al. (2001), Mantel et al. (1998), followed by records and interview in which maternal status variables were evaluated: economic status/quality of prenatal/instruction on clinical signs of severity in hypertensive pregnant women/type of delivery. Perinatal variables: vitality at birth (live births and stillbirths) in the amount of births, Apgar/Gestational age at delivery, weight less than adequate (SGA), admission in NICU/death neonatal. Results Forty-two cases of hypertensive disorders, with prevalence of low education, low income; average maternal age of 31.05 years and 23.8% of women above 35 years. Coverage of antenatal care in most of the women was inadequate; they were not warned of danger signals for preeclampsia. 47.61% had superimposed preeclampsia, and 19.04% isolated preeclampsia; 2 cases of eclampsia and 1 HELLP syndrome. 71.42% of deliveries were by cesarean section, with seven cases of stillbirth. Live births % Results of perinatal variables of live births Total of live births 35 100 SGA 8 22.9 5th min Apgar score < 7 5 14.2 Neonatal ICU 13 37.1 Neonatal death 5 14.3 Preterm birth 21 60 Conclusions Hypertensive pregnant women presenting with criteria for severe maternal morbidity and near miss develop adverse perinatal outcomes, predominantly with preterm delivery and associated complications such as with frequent admissions to the intensive care unit and inadequate birth weight. Superimposed preeclampsia was associated with all cases of fetal death. Continuing this line of research will broaden the information on the perinatal outcomes in these women. Disclosures M. Imad: None. L. Maruoka: None. L. Leme: None. N. da Silva: None. S. Sashida: None. V. Alonso Neto: None. J. Garcia: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.
Objectives To characterize the profile of pregnant women with hypertensive syndromes classified as severe maternal morbidity (SMM) and near-miss (NM). Methods Longitudinal prospective descriptive ...study conducted at Guilherme Álvaro Hospital, Santos/SP-Brazil (June/2013–May/2014). Women during pregnancy, childbirth or postpartum period, showed some hypertensive syndrome (NHBPEP-2000) and were classified as MMG/NM were studied according of criteria Santos, classification adapted by the authors from the definitions of Waterstone et al. (2001) Mantel et al. (1998) and World Health Organization (2009), in which, NM were patients admitted to ICU, followed by records and interview in which maternal status variables were evaluated: age, body mass index (BMI), average diastolic blood pressure (DBP) at admission. Results There are 49 patients with Hypertensive Syndromes with defining criteria and MMG/NM, according to clinical, laboratory and data management, 19 were older than 35 years (38.7%); aged between 20 and 35 corresponded to 59.1% of the sample (29 patients); Mean BMI of 38.0. The mean DBP at admission was 87.8 mmHg, 13 patients (26.0%) of them had chronic hypertension (CH). Of the 23 patients who had pre-eclampsia (PE) superimposed, seven (14.2%) did not associate with other complication, 14 (28.5%) were associated with severe PE, one with eclampsia, while another associated to the HELLP syndrome. Six patients were admitted to ICU and all were diagnosed with severe PE; three (5.5%) had HELLP syndrome; and two had eclampsia. Table 1 . Distribution of hypertensive disorders according to the criteria of severe maternal morbidity. PE CH Superimposed PE Severe PE Eclampsia HELLP SD N + − − − − − 1 + − − + − − 10 − − + − − − 7 − − + + − − 14 − − + + + − 1 − − + − + + 1 + − − + + + 1 − + − − − − 13 − − − − − + 1 Conclusions Considering the maternal age most affected and prevalence of obese pregnant, realizes the importance of pre-conception advice for this group. Also, recognize that the diagnosis of pre-eclampsia is more common among women affected by near-miss/severe maternal morbidity justifying skilled care for pregnant women with this disorder. Disclosures N. da Silva: None. L. Maruoka: None. M. Imad: None. L. Leme: None. S. Sashida: None. V. Alonso Neto: None. J. Sato: None. N. Miyashita: None. M. Mesquita: None. R. de Morais: None. E. de Souza: None. F. Sousa: None.
To characterize the profile of pregnant women with hypertensive syndromes classified as severe maternal morbidity (SMM) and near-miss (NM).
Longitudinal prospective descriptive study conducted at ...Guilherme Álvaro Hospital, Santos/SP-Brazil (June/2013–May/2014). Women during pregnancy, childbirth or postpartum period, showed some hypertensive syndrome (NHBPEP-2000) and were classified as MMG/NM were studied according of criteria Santos, classification adapted by the authors from the definitions of Waterstone et al. (2001) Mantel et al. (1998) and World Health Organization (2009), in which, NM were patients admitted to ICU, followed by records and interview in which maternal status variables were evaluated: age, body mass index (BMI), average diastolic blood pressure (DBP) at admission.
There are 49 patients with Hypertensive Syndromes with defining criteria and MMG/NM, according to clinical, laboratory and data management, 19 were older than 35years (38.7%); aged between 20 and 35 corresponded to 59.1% of the sample (29 patients); Mean BMI of 38.0. The mean DBP at admission was 87.8mmHg, 13 patients (26.0%) of them had chronic hypertension (CH). Of the 23 patients who had pre-eclampsia (PE) superimposed, seven (14.2%) did not associate with other complication, 14 (28.5%) were associated with severe PE, one with eclampsia, while another associated to the HELLP syndrome. Six patients were admitted to ICU and all were diagnosed with severe PE; three (5.5%) had HELLP syndrome; and two had eclampsia.
Table 1. Distribution of hypertensive disorders according to the criteria of severe maternal morbidity.PECHSuperimposed PESevere PEEclampsiaHELLP SDN+−−−−−1+−−+−−10−−+−−−7−−++−−14−−+++−1−−+−++1+−−+++1−+−−−−13−−−−−+1
Considering the maternal age most affected and prevalence of obese pregnant, realizes the importance of pre-conception advice for this group. Also, recognize that the diagnosis of pre-eclampsia is more common among women affected by near-miss/severe maternal morbidity justifying skilled care for pregnant women with this disorder.
N. da Silva: None. L. Maruoka: None. M. Imad: None. L. Leme: None. S. Sashida: None. V. Alonso Neto: None. J. Sato: None. N. Miyashita: None. M. Mesquita: None. R. de Morais: None. E. de Souza: None. F. Sousa: None.
156-POS Maruoka, Lívia Yumi; Imad, Malek Mounir; de Sena Leme, Lucas ...
Pregnancy hypertension,
01/2015, Letnik:
5, Številka:
1
Journal Article
Objectives Analyze the epidemiology of affected women with cases of hypertensive disorders (SH), severe maternal morbidity (SMM) and near-miss (NM). Methods 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. Results 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) Clinical Sever chronic hypertension (BPD ⩾ 110), Severe preeclampsia superimposed (BP ⩾160 × 110 mmHg) Severe preeclampsia: Proteinuria >2 g/24 h, Creatinine >1.2 mg/dL, Platelets <100.000 Acute pulmonary edema, epigastric pain, eclampsia, HELLP syndrome, Severe hemorrhage (blood loss >1500 mL), severe sepsis, uterine rupture, pulmonary edema Acute cyanosis, gasping, cerebral vascular accident Respiratory rate > 40 ipm or < 6 ipm, shock, coagulation disorders Total paralysis, coma ⩾12 h, jaundice with preeclampsia Cardiopulmonary arrest, thyrotoxic crisis, endometritis Congestive cardiac insufficiency, urine output less than 400 mL/24 h, refractory to hydration, furosemide or dopamine Laboratory Oxygen saturation <90% for ⩾60 min, PaO2 /FiO2 <200 mmHg Creatinine ⩾300 mmol/L or ⩾3.5 mg/dL Bilirubin >100 mmol/L or >6.0 mg/dL pH <7.1, lactate >5, ketoacidosis and glucose in urine Acute thrombocytopenia (<50,000 platelets) Management Continued use of vasoactive drugs Hysterectomy for postpartum hemorrhage or infection Hypovolemia and need of volume replacement with crystalloid and/or blood transfusion Intubation and ventilation for ⩾60 min not related to anesthesia Dialysis for acute renal failure Intubation and ventilation for ⩾60 min not related to anesthesia Anesthetic accident: severe hypotension after-blockade and failed intubation Conclusions 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. Disclosures 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.
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.
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