Hermógenes Chaves Netto

Changes in Ophthalmic Artery Doppler Indices in Hypertensive Disorders During Pregnancy

To compare the ophthalmic artery Doppler indices observed in women with singleton pregnancies complicated by hypertension and to correlate the indices observed in hypertensive pregnant women with those observed in healthy pregnant women.

Doppler Velocimetry of the Ophthalmic Artery Reproducibility of Blood Flow Velocity Measurements

The aim of this study was to investigate the interobserver reliability for measuring ophthalmic artery Doppler indices.

Uso do Verapamil em Gestantes Hipertensas Crônicas: análise do Fluxo das Artérias Uterinas e Umbilical

Objetivo: este trabalho, utilizando verapamil, um bloqueador dos canais lentos de calcio, constituiu ensaio clinico randomizado, duplo-cego e placebo controlado, e objetivou procurar variacao do fluxo uteroplacentario e fetoplacentario durante uso oral cronico do farmaco em gestantes com hipertensao cronica leve para moderada. Metodos: 123 pacientes divididas em dois grupos: grupo estudo (n = 61), submetidas a 240 mg/dia de verapamil, e grupo controle (n = 62), submetidas ao placebo. As pacientes randomizadas em grupos de quatro utilizaram a medicacao ou placebo durante trinta dias. Um exame do fluxo das arterias uterinas e da arteria umbilical pela dopplervelocimetria foi registrado. Pelo calculo da media e desvio padrao, foram comparados os valores dos indices de resistencia (IR) e pulsatilidade (IP) e da relacao sistole/diastole (A/B) das arterias em estudo apos administracao dos comprimidos. Resultados: o grupo verapamil apresentou os seguintes valores medios para as arterias uterinas: IR = 0,82 (0,28), IP de 1,06 (0,12) e A/B de 2,42 (0,51). O grupo placebo mostrou: IR de 0,75 (0,35), IP de 1,00 (0,18) e A/B de 2,30 (0,38). Quando analisada a arteria umbilical, os valores foram para o grupo verapamil: IR = 0,73 (0,12), IP = 1,04 (0,13) e A/B = 2,94 (0,32). No grupo placebo, IR = 0,70 (0,14), IP = 1,03 (0,07) e A/B = 3,02 (0,78). A analise estatistica das diferencas das medias por meio da razao F mostrou nao haver diferenca entre os dois grupos avaliados. Conclusao: este trabalho referenda o uso do verapamil entre gestantes com hipertensao cronica (leve para moderada), pois nao oferece prejuizos no fluxo uteroplacentario e fetoplacentario.

PP082. Ophthalmic artery doppler for identification of severe preeclampsia in pregnancies complicated by hypertension

INTRODUCTION Hypertension is the most common disorder that occurs during pregnancy and one of the main causes of maternal mortality worldwide. Among the hypertensive disorders that affect pregnancy, preeclampsia (PE) is the major cause of maternal mortality, maternal morbidity, perinatal death, prematurity and intrauterine growth restriction. The acute cerebral complications in PE account for at least 75% of maternal death. Central nervous system hemodynamic modifications in PE are a controversial issue. Neurological involvement in PE-eclampsia syndrome fulfills the criteria of posterior reversible encephalopathy syndrome (PRES). The pathophysiology of PRES is still under investigation. Assessment of cerebral circulation is challenging. Noninvasive techniques, especially transcranial Doppler sonography, are becoming more widely used to evaluate cerebral flow. Ophthalmic artery Doppler is a noninvasive examination used to study central vascular flow that has been shown to be a promising method in the evaluation of pregnant women with hypertension. OBJECTIVES The aim of this study was to compare the ophthalmic artery Doppler indices observed in singleton pregnant women complicated by hypertension (study group) and to correlate the indices observed in hypertensive pregnant women with those observed in normal pregnant women (control group). METHODS Ophthalmic artery Doppler indices of 30 mild and 30 severe pre-eclamptic women and 30 pregnant women with chronic hypertension (CH) at 20-40weeks of gestational age (GA) were compared. The control group consisted of 289 healthy pregnant women. Resistance index (RI), pulsatility index (PI), and peak ratio (PR) were determined in the right eye. The mean and SD were calculated for each group. Analysis of variance (ANOVA) was used to compare Doppler indexes means between groups. As significant differences were determined by ANOVA analysis, each group was compared by the Tukey method. Receiver operating characteristics (ROC) curves were used to determine the predictive power of ophthalmic artery Doppler indexes for the identification of severe pre-eclamptic women. P<0.05 was considered statistically significant. RESULTS Significant differences were found between the values obtained for RI, PI, and PR in severe PE women compared to the other groups (study and control). The mean and SD for IR, IP and PR in mild PE, severe PE and CH groups were respectively 0.73 (±0.06), 1.63 (±0.35) and 0.65 (±0.10); 0.63 (±0.09), 1.13 (±0.31) and 0.89 (±0.12); 0.73 (±0.07), 1.66 (±0.49) and 0.66 (±0.14). The mean and SD for IR, IP and PR in normotensive pregnant women were 0.75 (±0.05), 1.88 (±0.43), 0.52 (±0.10). The optimal cut-off values for IR, IP and PR for the identification of severe pre-eclamptic women determined by roc curves was 0.657, 1.318, 0.784 (sensitivity and specificity were 0.633 and 0.919, 0.733 and 0.888, 0.833 and 0.974, respectively). The area under the ROC curve for IR was 0.787(95% CI: 0.68-0.89), for IP was 0.797 (95% CI: 0.69-0.90) and for PR was 0.886 (95% CI: 0.80-0.96). CONCLUSION Ophthalmic Doppler is a useful method in the identification of severe PE. PR was best ophthalmic Doppler index at discriminating between severe PE and pregnant women with mild PE or chronic hypertension as determined by roc curve.

Complicações perinatais em gestantes infectadas pelo vírus da imunodeficiência humana

OBJETIVOS: analisar as complicacoes perinatais em gestantes infectadas pelo HIV. METODOS: estudo do tipo coorte, realizado em centro perinatal terciario, no periodo de 1 de janeiro de 1996 a 31 de marco de 2003. Foram selecionadas para o estudo 7698 gestacoes, cujos criterios de inclusao foram: gestacao unica e idade gestacional superior a 22 semanas. A infeccao pelo HIV foi confirmada pelos testes ELISA e Western Blot. Estudou-se a associacao entre a presenca da infeccao pelo HIV e as seguintes variaveis: ruptura prematura de membranas, parto prematuro, muito baixo peso ao nascimento, infeccao puerperal, Apgar baixo no primeiro e quinto minutos, crescimento intra-uterino restrito (CIUR) e pequeno para a idade gestacional (PIG). RESULTADOS: do total de gestantes estudadas, 228 (2,96%) estavam infectadas pelo HIV. Os resultados dos testes estatisticos indicam que a infeccao pelo HIV nao e fator de risco para a ruptura prematura de membranas (RR = 0,48, p <0,01), parto prematuro (RR = 0,92, p = 0,01), muito baixo peso ao nascimento (RR = 0,69, p = 0,54), infeccao puerperal (RR = 0,00, p = 0,31), Apgar menor do que sete no primeiro minuto (RR = 0,81, p = 0,40) e no quinto minuto (RR = 0,36, p = 0.19). Entre as variaveis estudadas, a hipotese de homogeneidade das proporcoes foi rejeitada para crescimento intra-uterino restrito (RR = 5,27, p <0,01) e pequeno para a idade gestacional (RR = 1,73, p < 0,01). CONCLUSOES: a ocorrencia de complicacoes maternas e fetais em gestantes infectadas pelo HIV nao e diferente da observada em mulheres nao infectadas, com excecao CIUR e PIG.