Maria Rita de Souza Mesquita

O leito placentário no descolamento prematuro da placenta

PURPOSE: to analyze the histopathological patterns of the placental bed arteries in pregnancies complicated by abruptio placentae (AP) and compare them with the normal vascular histology of the placental bed. METHODS: placental bed biopsy was performed in 23 pregnant women with a diagnosis of abruptio placentae associated with high blood pressure (G/HBP) disorders, with gestational age of 28 weeks or more, submitted to cesarean section. The control group (CG) consisted of 30 patients without disease, submitted to cesarean section for obstetric reasons. The selected histological variables were: unaltered pattern, physiological changes, medial layer disorganization, hyperplastic changes, acute necrosis and atherosis. RESULTS: in patients with AP associated with HBP there was a significant predominance of medial layer disorganization and hyperplastic changes, compared to CG, while physiological changes in spiral arteries were statistically more common in CG. Findings of acute necrosis and atherosis were observed in a low number of G/HBP, with no statistical significance. CONCLUSIONS: in pregnant women with AP associated with HBP the predominant vascular histological findings were medial layer disorganization and hyperplastic changes. The presence of histopathological features was significantly higher in G/HBP, with prevalence of medial layer disorganization. Normal histological pattern, i.e., physiological changes, were more prevalent in CG.

Service Creation Environment For IN CS1

The main focus of this paper is on IN service creation, test and validation aspects. It reflects the results of the design and development of a Service Creation Tool and a Service Test and Validation platform undertaken by CET/Telecom Portugal within the scope of RACE project R2076 - BOOST. The Service Creation Tool (SCT) is based upon a Meta-CASE tool, that is a generic CASE tool, which was specifically configured for the manipulation of the IN services entities at the IN Conceptual Model Global Functional Plane, that is, the SIBs (Service Independent Building Blocks), SSDs (Service Support Data) for each SIB and CID (Call Instance Data) which supports each execution instance of a service. The SCT supports the creation of new services using all the standard SIBs defined by CCITT in the IN-CS1 documents, plus the ETSI defined SlBs. Some of the standardised SIBs were modified in order to improve their functionality, which was considered very poor for the creation of useful services. An example of this is the SDM (Service Data Management) SIB. The logical and data aspects of the service developed using the SCT are syntactically validated. The final output of the SCT is a generic description of the service using a high-level intermediate language. Using compilation techniques, this mediation language is converted into the target service execution environment language, the so-called Service Logic Program (SLP), which consists of the SIB chains information and respective data templates. The SLID resulting from the service design process can be tested and validated through its execution on a Simulation Environment (SE), before it is passed to the Service Management System (SMS). The SMS is implemented in a TMN Operations System platform which comprises OS-S, OS-N and OS-NE functions. The SE is based on a distributed model of the IN Distributed Functional Plane and Global Functional Plane architectures. This model is implemented using the ANSAware distributed computing platform, and the IN entities (Functional Entity Actions, Information Flows and SIBs) are modelled in terms of ANSA computational objects (capsules) and operations. The resulting service creation tool and service simulation, test and validation platform are used as an SCE for the IN-CS1 experiment being developed by Telecom Portugal/CET and which will undertake the first field trials at the beginning of 1994.

PP148. Is there podocyturia in pregnant women with chronic hypertension? (Preliminary results).

later age of her reproductive cycle has be a phenomenon around the world. Epidemiology data show frequent increase of clinical complications in direct proportion in advanced age motherhood, hypertensive disturbances being more prevalent. Objectives: Analyse the prevalence of hypertensive syndromes in pre-determined age groups at Hospital Guilherme Alvaro in Santos, Sao Paulo, Brazil showing the different segments in each one. Methods: From data collected in the outpatient department of Hospital Guilherme Alvaro of High Risk Pre-natal between 04/06/2008 and 30/05/2011, a prevalence transversal study was carried out where data were obtained from 628 patients aged between 16 and 46 years. Procedures of homogeny analysts were set out, always collecting data such as age and disorder for high risk gestation. According to age, patients were divided into groups: precocious (up to 19 years old), middle age (between 20 and 34) and late pregnancies (over 35). Results: In the precocious pregnancies, clinical illnesses/ no hypertension (31%) were observed in first place, 25% (8) twin pregnancy in second place, 19% (6) showed hypertensive disturbances. Concerning pregnancies between 20 and 34 years old, 36% (144 patients) showed hypertensive syndromes, 23% (92 patients) showed endocrine disturbances, 22% (90 patients) showed clinical illnesses/no hypertension, and 9% twin pregnancy. Regarding late pregnancies, the most frequent disturbance was isolated hypertensive syndromes: 44% (88 patients) in first place, only endocrine disturbances, 24% (47 patients) in second place followed by association between hypertensive syndromes and endocrinopathy with 13% (26 patients). Conclusion: About precocious pregnancies, greater prevalence showed clinical illnesses/no hypertension, whereas middle age and late pregnancies showed greater hypertensive syndrome prevalence, results, which are compatible with other studies, have been observed that due to advance of age, hypertensive syndromes aremore frequent. For late pregnancies, the prevalence of clinical illnesses/no hypertension was a lower percentage regarding the other two groups: precocious pregnancies (31% = 10 women), middle age pregnancies (22% = 90 women), and late pregnancies (2% = 7 women). Considering the fact that the occurrence of pregnancy is more and more late in life, it can be concluded that the professionals must be prepared to attend pregnancies on women with hypertensive disturbances and their eventual complications.

PP181. The role of the JAK–STAT pathways and SOCS in preeclampsia

decreases insulin sensitivity and is associated with obesity. Recent data indicates that subclinical endotoxemia is associated with inflammation in obese women in late pregnancy. Objectives: The objective of this study was to quantify circulating endotoxin across pregnancy in lean and obese women, and assess the relationship between endotoxin and markers of inflammation and insulin sensitivity. Methods: Endotoxin was measured in sterile maternal EDTA plasma samples from 24 lean pregnant women (BMI = 22.4 ± 1.9 kg/m) and 45 obese pregnant women (BMI= 32.6 ± 2.1 kg/m), and 6 non-pregnant women. Samples were collected at 10.5 ± 3.1, 21.3 ± 4.6 and 35.2 ± 2.1 weeks gestation. Endotoxin was quantified using the PyroGene Recombinant Factor C endotoxin detection assay from LONZA, inter-assay variability <10%. IL-6, myloperoxidase, uric acid, triglycerides, insulin and glucose were also measured. Statistical analysis was by repeated measures ANOVA and students t-test as appropriate. Correlation analysis was performed using Pearson product moment correlation coefficient. Statistical significance was accepted at p < 0.05. Results: Endotoxin was significantly increased in both lean (10.4 ± 5.3 EU/ml) and obese (9.1 ± 5.3 EU/ml) pregnant women compared to non-pregnant women (4.3 ± 2.6 EU/ml, p < 0.05). Endotoxin increased significantly across pregnancy in both lean and obese pregnant women (p < 0.001), but was not different between these groups (table). Endotoxin was not associated with adiposity, IL-6, myloperoxidase, uric acid, triglycerides or insulin sensitivity as assessed by homeostasis model of insulin resistance (HOMA). Data are mean ± SD. Repeatedmeasures ANOVA p<0.001.

PP045. Maternal mortality due to hypertension: A look at the puerperium

INTRODUCTION Maternal death is the death of a woman during pregnancy within 42days after delivery. It is one of the most serious violations of human rights of women, because it is a preventable tragedy in 92% of cases and occurs mainly in developing countries. Brazil, a country of continental dimensions has the challenge of reducing maternal deaths; one of the priority regions is Santos, a city in the state of São Paulo. It is felt that efforts are made to the adoption of care that can minimize risks during complicated pregnancy with hypertensive disorders, but not always this service is offered proportionally to postpartum. Perhaps the erroneous concept that the delivery is capable of quickly balancing the harm of maternal hypertensive disorders is implicated in reducing postpartum surveillance, exposing this group of women to undesirable outcomes. OBJECTIVES Analyze the percentage of postpartum maternal deaths until 42days after delivery for hypertensive disorders in Santos in the period of 1999-2009. METHODS Data were provided by the Ministry of Health of Brazil in www.datasus.gov.br (accessed February 2012). The number of maternal deaths was divided into maternal death in pregnancy, delivery and abortion and maternal death in puerperium up to 42, considering all causes of maternal death and identifying the proportion of deaths due to hypertensive syndromes. RESULTS According to the general causes of death, more women die during pregnancy, delivery and abortion (69.7%) than postpartum (30.3%) and hypertensive disorders account for 20% of these outcomes. Analyzing the proportion of deaths due to hypertensive disorders in each period, we observed that during pregnancy the disorder accounts for 16.5% of all causes, however, the percentage reaches 30.3% in the puerperium. CONCLUSION The increase of death in postpartum due to hypertensive syndromes, regarding all general causes, shows the necessary action to be done by the professional team to offer continuity care in and out of hospital in this period, considering that the challenges persist even after delivery.

P10 Maternal death in Brazil last ten years: late maternal mortality rises

Objective: This study was undertaken to determine maternal and perinatal outcomes after expectant management of severe preeclampsia between 24 and 33 weeks’ gestation. Study design: This was a retrospective analysis of outcome in patients with severe preeclampsia between January, 2005 and December, 2009. Thirtysix patients with severe preeclampsia geatational aged 24-33 weeks were studied. Corticosteroids were administered. Perinatal and maternal complications (a composite maternal morbidities including HELLP syndrome, pulmonary edema, eclampsia, and renal insufficiency) were analyzed. Results: Mean of gestational aged was 30.7 weeks. The days of pregnancy prolongation were 5 days (range 2-22). There were five perinatal deaths (13.88%), four cases in those managed at < 28 weeks and one case in those managed at 28-30 weeks. Cesarean section rate was 94.44%. Maternal morbidities developed in four cases, two pulmonary edema, one placental abruption and one HELLP syndrome. There was no maternal death. Conclusion: Expectant management of severe preeclampsia at 24 to 33 weeks is associated with good perinatal outcome with a minimal risk for the mother. However, it should be done in the tertiary care center with close maternal and fetal monitoring.