Joe Luiz Vieira Garcia Novo

Maternal and fetal outcome in women with hypertensive disorders of pregnancy: the impact of prenatal care

Background: Hypertensive disorders of pregnancy (HDP) are the most important cause of maternal and fetal death and pregnancy complications in Latin America and the Caribbean. Objectives: The objective of this study was to characterize the epidemiological profile of women with HDP admitted to a Brazilian tertiary reference hospital, and to evaluate maternal and fetal outcome in each HDP and the impact of prenatal care on the maternal and fetal outcome. Methods: HDP in 1501 women were classified according to usual definitions as chronic hypertension (n = 564), pre-eclampsia (n = 579), eclampsia (n = 74) and pre-eclampsia/eclampsia superimposed on chronic hypertension (n = 284). Adverse maternal and fetal outcomes registered as maternal death and near miss and fetal outcomes documented as stillbirth, neonatal death and newborn respiratory complications were compiled. Prenatal care was classified as complete (⩾6 visits), incomplete (<6 visits) or not done. Results: Women with eclampsia were younger (15 years), 68% were on their first pregnancy, had higher blood pressure, higher mortality and greater number of near miss cases and their children had lower birth weight, higher intra-uterus and neonatal mortality, and more respiratory distress. Women with pre-eclampsia/eclampsia superimposed on chronic hypertension and their fetuses had intermediate outcome and those with chronic hypertension and pre-eclampsia the better outcome among those with HDP. Women who had incomplete prenatal care or prenatal not done had progressive higher mortality rates and greater frequency of near miss cases, and their children had higher mortality rates. Conclusion: In a tertiary reference hospital, eclampsia and chronic hypertension superimposed on pre-eclampsia are associated with a worst outcome for mothers and fetuses, whereas complete prenatal care is associated with a better maternal and fetal outcome in HDP.

Mortalidade materna por eclâmpsia

OBJECTIVE: to assess the factors associated with maternal mortality resulting from eclampsia. METHODS: a retrospective cohort study reviewing the medical records of deliveries carried out at the Sorocaba Hospital Compound (between January 1995 and December 2005). The variables included were: year of delivery, social and demographic characteristics of mother, personal, family and obstetric history, characteristics of the pregnancy, delivery and puer-perium, the kind care given, the evolution of the case, and the conditions for release from hospital. The statistical analysis involved the use of Fisher s exact test, the Pearson correlation and Poisson s multiple regression. RESULTS: 35 973 deliveries were registered, 179 of which involved cases of eclampsia, 52 of them with serious complications, twenty-three resulting in a longer stay in intensive care and eight in death. The incidence of eclampsia decreased over the period (from 0.90% to 0.37%; r= -0.746;p= 0.008), although the proportion of cases with serious complications remained unchanged (0.25% compared with 0.17%, r= - 0.45; p=0.162). The proportion of patients who died was larger among non-white patients (RR=9.10; CI95%= 1.83-45.23; p= 0.007) and lower among those treated with magnesium sulfate (RR=0.08; CI95%= 0.02-0.35; p= 0.001). CONCLUSIONS: the incidence of eclampsia among deliveries performed at the Sorocaba Hospital Compound decreased, although the disease still represents a significant cause of maternal death in the region. This study shows that it is essential that early diagnostic measures and treatment of preeclampsia and eclampsia be perfected by the health care system.

Análise de procedimentos assistenciais ao parto normal em primíparas

Introducao: A tireoidite de Hashimoto e o tipo de hipotireoidismo primario adquirido de causa auto-imune mais comum em regiao nao-carente de iodo. Ja o carcinoma papilifero de tireoide e o tipo mais comum de câncer de tireoide diferenciado na infância. Embora exista controversia na literatura quanto a associacao entre Carcinoma Papilifero de Tireoide (CPT) e Tireoidite de Hashimoto (TH), varios estudos detectaram incidencia aumentada deste tipo de câncer em pacientes com TH. Objetivos: relatar o caso de uma paciente pediatrica com TH que desenvolveu CPT. Metodologia: revisao de dados obtidos e analisados do prontuario medico e pesquisa bibliografica. Relato de caso: L. P, nascida em 25/07/1999, sexo feminino, foi encaminhada ao ambulatorio de endocrinologia infantil da Policlinica Municipal de Sorocaba aos 9 anos de idade, devido ao desenvolvimento precoce de caracteristicas sexuais secundarias, com aparecimento de pelos pubianos e de telarca ha 1 ano. Ao exame fisico, constatou-se desenvolvimento puberal segundo a classificacao de Tanner, M3 P3 e tireoide palpavel. Atraves de exames laboratoriais, foi diagnosticada com tireoidite de Hashimoto. Apos 2 anos de tratamento, constatou-se aumento de tireoide em USG, diagnosticado como nodulo benigno em PAAF. No entanto, apos 5 anos de seguimento, foi observada a presenca de nodulo maligno, identificado como carcinoma papilifero da tireoide. Paciente foi submetida a tireoidectomia total com esvaziamento paratraqueal, devido as metastases em linfonodos. Apos a cirurgia a paciente evoluiu bem, sem intercorrencias e sem evidencias de metastases funcionantes de carcinoma diferenciado de tireoide. Conclusao: E importante que os profissionais de saude fiquem atentos a possibilidade de associacao do CPT com a TH, quando houver mudanca no padrao ultrassonografico com a presenca de linfoadenopatia cervical significativa.

Bussâmara Neme – In Memoriam

Introducao: A doenca musculo-olho-cerebro (MEB) [MIM: 253280], forma rara de distrofia muscular congenita, possui padrao de heranca autossomico re- cessivo com associacao a mutacoes no gene POMGnT1 e quadro clinico com grande heterogeneidade genetica. Objetivo: Relatar o caso de uma paciente com diagnostico de MEB por meio do exoma; Metodos: As informacoes foram obtidas por meio de entrevista com o paciente, registro fotografico de exames e revisao da literatura; Relato: Lactente de 1 ano e 6 meses encaminhada para avaliacao genetica por hipotonia muscular e achados de malformacao do sistema nervoso desde a ultrassonografia de 38 semanas de gestacao, que exibiu dilatacao dos ventriculos cerebrais. Parto cesareo sem intercorrrencias com APGAR 7 e 8 de 1’ e 5’ respectivamente, succao eficiente, mas tonus diminuido. TC de crânio, evidenciou ectasia do sistema ventricular com dilatacao do terceiro ventriculo e sinais de permeacao liquorica transependimaria. RM de encefalo, mostrou displasia cortical cerebelar e/ou hipoplasia ponto cerebelar. Apresentava miopia e, no mapeamento de retina, rarefacao pigmentar difusa e implantacao obliqua do disco optico com atrofia papilar. Ao exame fisico: cilios longos, nistagmo, palato alto e hipotonia generalizada. Possuia atraso do desenvolvimento neuropsicomotor. Nos exames subsidiarios: elevacao de CPK, CPKMb e LDH; sorologia STORCH com IgG positivo para rubeola e citomegalovirus; cariotipo 46,XX [20]; teste de triagem neonatal normal. O exoma, escolhido em vez de biopsia muscular, identificou duas variantes do gene POMGNT1, c.1268C>T e c.880-1G>A, ambas deleterias, permitindo diagnostico da doenca. Conclusao: Diante do quadro clinico heterogeneo, ressalta-se a relevância do exoma abreviando o tempo de diagnostico e reduzindo o estresse dos multiplos exames subsidiarios realizados por pacientes com esse fim.