hypertension Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2009;31(5):254-261
DOI 10.1590/S0100-72032009000500009
It is believed that estrogen deficiency, lipid profile alterations, body weight gain, and sedentary lifestyle are strongly associated with the increased incidence of arterial hypertension in postmenopausal women. In an attempting to reduce the incidence of arterial hypertension in this population, a variety of approaches has been used, but the results are conflicting and the changing in lifestyle has been proposed and an important preventive action to control the arterial hypertension and associated risk factors in this women age - mainly practice of physical exercise. Continuous exercise has been used as an important approach in management cardiovascular disease and endocrine-metabolic disorders. Continuous exercise prescription is characterized by, at least, 30 minutes of moderate-intensity physical activity (60 to 70% of maximum heart rate), three days of the week. Intermittent exercise is characterized by low intensity exercise periods, alternating with high-intensity exercise periods, ranging of 50 to 85% of the maximum heart rate, during ten minutes. Intermittent exercise has been employed as training program in weight loss therapy and personal training because previous studies have shown similar metabolic adaptations and aerobic capacity after continuous or intermittent exercise. This review focused on the relevance of continuous and intermittent exercise on the blood pressure control, discussion of the data found in experimental model of menopause and in women and the relationship between incidence of arterial hypertension and its genesis in postmenopausal women.
Summary
Rev Bras Ginecol Obstet. 2009;31(5):254-261
DOI 10.1590/S0100-72032009000500009
It is believed that estrogen deficiency, lipid profile alterations, body weight gain, and sedentary lifestyle are strongly associated with the increased incidence of arterial hypertension in postmenopausal women. In an attempting to reduce the incidence of arterial hypertension in this population, a variety of approaches has been used, but the results are conflicting and the changing in lifestyle has been proposed and an important preventive action to control the arterial hypertension and associated risk factors in this women age - mainly practice of physical exercise. Continuous exercise has been used as an important approach in management cardiovascular disease and endocrine-metabolic disorders. Continuous exercise prescription is characterized by, at least, 30 minutes of moderate-intensity physical activity (60 to 70% of maximum heart rate), three days of the week. Intermittent exercise is characterized by low intensity exercise periods, alternating with high-intensity exercise periods, ranging of 50 to 85% of the maximum heart rate, during ten minutes. Intermittent exercise has been employed as training program in weight loss therapy and personal training because previous studies have shown similar metabolic adaptations and aerobic capacity after continuous or intermittent exercise. This review focused on the relevance of continuous and intermittent exercise on the blood pressure control, discussion of the data found in experimental model of menopause and in women and the relationship between incidence of arterial hypertension and its genesis in postmenopausal women.
Summary
Rev Bras Ginecol Obstet. 2009;31(1):10-16
DOI 10.1590/S0100-72032009000100003
PURPOSE: to determine the prevalence of histopathological changes, in human placentas, related to hypertensive syndromes. METHODS: a transversal study that compares histopathological changes identified in 43 placentae from hypertensive pregnant women (HypPr), with the ones from 33 placentae from normotensive pregnant women (NorPr). The weight, volume and macroscopic and microscopic occurrence of infarctions, clots, hematomas, atherosis (partial obliteration, thickness of layers and presence of blood vessels hyalinization) and Tenney-Parker changes (absent, discreet and prominent), as well as the locating of infarctions and clots (central, peripheral or the association of both) have been analyzed. The χ2 and t Student tests have been used for the statistical analysis, as well as medians, standard deviations and ratios. It has been considered as significant, p<0.05. RESULTS: the macroscopic study of HypPr placentae have presented lower weight (461.1 versus 572.1 g) and volume (437.4 versus 542.0 cm³), higher infarction (51.2 versus 45.5%; p<0.05: OR=1.15) and clots (51.2 versus 15.1%; p<0.05; OR=5.4) ratios, as compared to the NorPr's. In the HypPr and NorPr, microscopic clots have occurred in 83.7 versus 45.5% (p<0.05; OR=4.3), respectively. Atherosis and Tenney-Parker changes have been statistically associated to the hypertensive syndromes (p<0.05). CONCLUSIONS: the obtained data allow us to associate lower placentary weight and volume, higher ratio of macro and microscopic infarction, clots, atherosis and Tenney-Parker changes to placentae of gestations occurring with hypertensive syndromes.
Summary
Rev Bras Ginecol Obstet. 2009;31(1):10-16
DOI 10.1590/S0100-72032009000100003
PURPOSE: to determine the prevalence of histopathological changes, in human placentas, related to hypertensive syndromes. METHODS: a transversal study that compares histopathological changes identified in 43 placentae from hypertensive pregnant women (HypPr), with the ones from 33 placentae from normotensive pregnant women (NorPr). The weight, volume and macroscopic and microscopic occurrence of infarctions, clots, hematomas, atherosis (partial obliteration, thickness of layers and presence of blood vessels hyalinization) and Tenney-Parker changes (absent, discreet and prominent), as well as the locating of infarctions and clots (central, peripheral or the association of both) have been analyzed. The χ2 and t Student tests have been used for the statistical analysis, as well as medians, standard deviations and ratios. It has been considered as significant, p<0.05. RESULTS: the macroscopic study of HypPr placentae have presented lower weight (461.1 versus 572.1 g) and volume (437.4 versus 542.0 cm³), higher infarction (51.2 versus 45.5%; p<0.05: OR=1.15) and clots (51.2 versus 15.1%; p<0.05; OR=5.4) ratios, as compared to the NorPr's. In the HypPr and NorPr, microscopic clots have occurred in 83.7 versus 45.5% (p<0.05; OR=4.3), respectively. Atherosis and Tenney-Parker changes have been statistically associated to the hypertensive syndromes (p<0.05). CONCLUSIONS: the obtained data allow us to associate lower placentary weight and volume, higher ratio of macro and microscopic infarction, clots, atherosis and Tenney-Parker changes to placentae of gestations occurring with hypertensive syndromes.
Summary
Rev Bras Ginecol Obstet. 1998;20(1):7-11
DOI 10.1590/S0100-72031998000100002
With the purpose of identifying the causes of maternal deaths, this study evaluated all cases of deaths of 10 to 49-years-old women which occurred in Recife, Pernambuco, Brazil, during 1992 and 1993. The data were obtained from 1013 death certificates and were complemented by medical and anesthetia records forms, nursing reports, necropsies and also interviews with physicians who took care of the women, or with their relatives. The main basic causes of maternal deaths identified were arterial hypertension (23.8%), infections (19.0%), abortion (11.9%), hemorrhage (9.5%), pulmonary embolism (4.8%) and anaesthetic accident (2.4%). About 70% of maternal deaths in Recife in the studied period were due to directo obstetrical causes.
Summary
Rev Bras Ginecol Obstet. 1998;20(1):7-11
DOI 10.1590/S0100-72031998000100002
With the purpose of identifying the causes of maternal deaths, this study evaluated all cases of deaths of 10 to 49-years-old women which occurred in Recife, Pernambuco, Brazil, during 1992 and 1993. The data were obtained from 1013 death certificates and were complemented by medical and anesthetia records forms, nursing reports, necropsies and also interviews with physicians who took care of the women, or with their relatives. The main basic causes of maternal deaths identified were arterial hypertension (23.8%), infections (19.0%), abortion (11.9%), hemorrhage (9.5%), pulmonary embolism (4.8%) and anaesthetic accident (2.4%). About 70% of maternal deaths in Recife in the studied period were due to directo obstetrical causes.
Summary
Rev Bras Ginecol Obstet. 1998;20(2):71-75
DOI 10.1590/S0100-72031998000200003
Fetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.
Summary
Rev Bras Ginecol Obstet. 1998;20(2):71-75
DOI 10.1590/S0100-72031998000200003
Fetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):165-167
DOI 10.1590/S0100-72031998000300008
HELLP syndrome is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Two cases of recurrent HELLP syndrome are described, maternal death occurring in one of the cases. This study is a warning about the increased risk of HELLP syndrome in the next pregnancy.
Summary
Rev Bras Ginecol Obstet. 1998;20(3):165-167
DOI 10.1590/S0100-72031998000300008
HELLP syndrome is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Two cases of recurrent HELLP syndrome are described, maternal death occurring in one of the cases. This study is a warning about the increased risk of HELLP syndrome in the next pregnancy.
Summary
Rev Bras Ginecol Obstet. 2005;27(3):137-142
DOI 10.1590/S0100-72032005000300007
PURPOSE: to evaluate if there is any difference between Doppler indexes in the middle cerebral artery in two different sites of insonation in healthy patients and in patients with diseases. METHODS: a random prospective survey, in the period from June 2003 to March 2004 that analyzed the Doppler indexes of 100 patients: patient group (n = 50) included patients admitted to Clemente Farias University Hospital, which is part of UNIMONTES-MG, havinfg as inclusion criteria: to be in the 28th to 34th gestational week, diagnosis of chronic arterial hypertension, pre-eclampsia, intrauterine growth restriction. As control group, 50 healthy pregnant patients between the 28th and the 34th week, originary from SEMESP's clinic. The Doppler variables were the resistance index (RI), the pulsatility index (PI) and the relation systole/diastole (SD). All three Doppler indexes were assessed at two different sites of the cerebral artery: the first measurement in the diencephalons region, soon after the beginning of the middle cerebral artery and the second on a distal location in the telencephalon. The median Doppler indexes in the patient group in the first and second measurements were 1.55 and 1.69 for the PI, 0.77 and 0.79 for RI and 4.29 and 4.86 for SD, respectively. In the control group, the values were 1.73 and 1.86 for the PI; 0.83 and 0.79 for RI and 5.83 and 5.46 for SD. There were no differences between sites with a p value of 0.38, 0.29 and 0.39 for PI, RI and SD, respectively. In 15t fetuses with centralization (brain sparing effects), in the diencephalon the median indexes were 1.02 for PI, 0.63 for RI and 2.68 for SD. In the epencephalon the median indexes were 0.95 for IP, 0.62 for RI and 2.44 for SD. There were no differences between sites, with a p value of 0.53 for PI; 0.56 for IR and 0.31 for SD. The Doppler index site of assessment in the middle cerebral arteries does not interfere with the results.
Summary
Rev Bras Ginecol Obstet. 2005;27(3):137-142
DOI 10.1590/S0100-72032005000300007
PURPOSE: to evaluate if there is any difference between Doppler indexes in the middle cerebral artery in two different sites of insonation in healthy patients and in patients with diseases. METHODS: a random prospective survey, in the period from June 2003 to March 2004 that analyzed the Doppler indexes of 100 patients: patient group (n = 50) included patients admitted to Clemente Farias University Hospital, which is part of UNIMONTES-MG, havinfg as inclusion criteria: to be in the 28th to 34th gestational week, diagnosis of chronic arterial hypertension, pre-eclampsia, intrauterine growth restriction. As control group, 50 healthy pregnant patients between the 28th and the 34th week, originary from SEMESP's clinic. The Doppler variables were the resistance index (RI), the pulsatility index (PI) and the relation systole/diastole (SD). All three Doppler indexes were assessed at two different sites of the cerebral artery: the first measurement in the diencephalons region, soon after the beginning of the middle cerebral artery and the second on a distal location in the telencephalon. The median Doppler indexes in the patient group in the first and second measurements were 1.55 and 1.69 for the PI, 0.77 and 0.79 for RI and 4.29 and 4.86 for SD, respectively. In the control group, the values were 1.73 and 1.86 for the PI; 0.83 and 0.79 for RI and 5.83 and 5.46 for SD. There were no differences between sites with a p value of 0.38, 0.29 and 0.39 for PI, RI and SD, respectively. In 15t fetuses with centralization (brain sparing effects), in the diencephalon the median indexes were 1.02 for PI, 0.63 for RI and 2.68 for SD. In the epencephalon the median indexes were 0.95 for IP, 0.62 for RI and 2.44 for SD. There were no differences between sites, with a p value of 0.53 for PI; 0.56 for IR and 0.31 for SD. The Doppler index site of assessment in the middle cerebral arteries does not interfere with the results.
Summary
Rev Bras Ginecol Obstet. 2005;27(9):548-553
DOI 10.1590/S0100-72032005000900008
PURPOSE: to study maternal mortality caused by hypertension during pregnancy, determining the mortality rate and the profile of those patients. METHODS: a retrospective study of maternal mortality caused by hypertension at the Maternidade Escola Assis Chateaubriand of the Universidade Federal do Ceará, from 1981 to 2003. General maternal mortality rate (MMR) and specific maternal mortality rate due to hypertension were evaluated, as well as these patients' epidemiological and clinical data. RESULTS: two hundred and ninety six cases of maternal death and 184,672 of live births were recorded, with a MMR of 160.28/100.000 live births. The most frequent cause of death was hypertension (41.2%); with 122 cases and an annual average of 5.3 deaths, and hypertension MMR of 60.10/100,000 live births. The women's age range varied from 13 to 42 years with an average of 26 years. Most of the patients came from the interior of the state. Deaths occurred predominantly in the first 24 hours after admission to the hospital (50.9%). Deaths were predominant in the first pregnancy (40.3%) and in women with 31 to 38 weeks gestational age (48.2%). Eclampsia occurred in 73 patients (64.1%) and was predominant along the gestational period (53.4%). There were 101 deaths in the puerperium. Cesarean section (62.3%) and general anesthesia (45.1%) prevailed. A high percentage of patients (61.4%) had no prenatal care. CONCLUSIONS: General MMR and hypertension MMR were high, the latter being the main cause of death in our maternity hospital.
Summary
Rev Bras Ginecol Obstet. 2005;27(9):548-553
DOI 10.1590/S0100-72032005000900008
PURPOSE: to study maternal mortality caused by hypertension during pregnancy, determining the mortality rate and the profile of those patients. METHODS: a retrospective study of maternal mortality caused by hypertension at the Maternidade Escola Assis Chateaubriand of the Universidade Federal do Ceará, from 1981 to 2003. General maternal mortality rate (MMR) and specific maternal mortality rate due to hypertension were evaluated, as well as these patients' epidemiological and clinical data. RESULTS: two hundred and ninety six cases of maternal death and 184,672 of live births were recorded, with a MMR of 160.28/100.000 live births. The most frequent cause of death was hypertension (41.2%); with 122 cases and an annual average of 5.3 deaths, and hypertension MMR of 60.10/100,000 live births. The women's age range varied from 13 to 42 years with an average of 26 years. Most of the patients came from the interior of the state. Deaths occurred predominantly in the first 24 hours after admission to the hospital (50.9%). Deaths were predominant in the first pregnancy (40.3%) and in women with 31 to 38 weeks gestational age (48.2%). Eclampsia occurred in 73 patients (64.1%) and was predominant along the gestational period (53.4%). There were 101 deaths in the puerperium. Cesarean section (62.3%) and general anesthesia (45.1%) prevailed. A high percentage of patients (61.4%) had no prenatal care. CONCLUSIONS: General MMR and hypertension MMR were high, the latter being the main cause of death in our maternity hospital.
Summary
Rev Bras Ginecol Obstet. 2005;27(10):627-634
DOI 10.1590/S0100-72032005001000010
Arterial hypertension is one of the most frequent causes of maternal death. The most important types found in pregnancy are gestational hypertension, clinically defined by increased arterial pressure after the 20th week of pregnancy, and preeclampsia associated with proteinuria. In the initial phase, the disease is asymptomatic, but when not treated or when the pregnancy is not interrupted, it naturally progresses to serious forms such as eclampsia and HELLP syndrome. Eclampsia is defined by one or more generalized tonic-clonic seizures or coma in a pregnant woman with gestational hypertension or preeclampsia, and without neurological disease. It may occur during pregnancy, labor, and immediately after delivery. It is often preceded by signs and symptoms of imminent eclampsia (central nervous system, visual and gastric disorders). Its association with hemolysis, low platelet count, and hepatic dysfunction had already been reported in the literature of the 1950's. In 1982, Weinstein grouped these alterations as a syndrome under the acronym of HELLP, meaning hemolysis (H), elevated liver enzyme levels (EL), and low platelet (LP) count. The literature differs in relation to the parameter values that define the syndrome. Sibai et al. (1986) proposed a system of laboratory and biochemical diagnosis standards which has been adopted by the Brazilian Health Ministry. Clinical manifestations are sometimes imprecise; common complaints are epigastric pain, general malaise, loss of appetite, nausea, and vomiting. Early diagnosis is exclusively by laboratory tests and should be systematically investigated in women with serious preeclampsia/eclampsia or pain in the superior right abdominal quadrant. Differentiating HELLP syndrome from others with similar clinical or laboratory manifestations is not easy. Differential diagnosis is particularly difficult regarding diseases such as thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, or acute fatty liver of pregnancy, due to poor clinical history, and similar physiopathological aspects. An understanding of preeclampsia physiopathology, early diagnosis, and precise action at the right moment in situations complicated by eclampsia or HELLP syndrome, allows a better maternal and perinatal prognosis.
Summary
Rev Bras Ginecol Obstet. 2005;27(10):627-634
DOI 10.1590/S0100-72032005001000010
Arterial hypertension is one of the most frequent causes of maternal death. The most important types found in pregnancy are gestational hypertension, clinically defined by increased arterial pressure after the 20th week of pregnancy, and preeclampsia associated with proteinuria. In the initial phase, the disease is asymptomatic, but when not treated or when the pregnancy is not interrupted, it naturally progresses to serious forms such as eclampsia and HELLP syndrome. Eclampsia is defined by one or more generalized tonic-clonic seizures or coma in a pregnant woman with gestational hypertension or preeclampsia, and without neurological disease. It may occur during pregnancy, labor, and immediately after delivery. It is often preceded by signs and symptoms of imminent eclampsia (central nervous system, visual and gastric disorders). Its association with hemolysis, low platelet count, and hepatic dysfunction had already been reported in the literature of the 1950's. In 1982, Weinstein grouped these alterations as a syndrome under the acronym of HELLP, meaning hemolysis (H), elevated liver enzyme levels (EL), and low platelet (LP) count. The literature differs in relation to the parameter values that define the syndrome. Sibai et al. (1986) proposed a system of laboratory and biochemical diagnosis standards which has been adopted by the Brazilian Health Ministry. Clinical manifestations are sometimes imprecise; common complaints are epigastric pain, general malaise, loss of appetite, nausea, and vomiting. Early diagnosis is exclusively by laboratory tests and should be systematically investigated in women with serious preeclampsia/eclampsia or pain in the superior right abdominal quadrant. Differentiating HELLP syndrome from others with similar clinical or laboratory manifestations is not easy. Differential diagnosis is particularly difficult regarding diseases such as thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, or acute fatty liver of pregnancy, due to poor clinical history, and similar physiopathological aspects. An understanding of preeclampsia physiopathology, early diagnosis, and precise action at the right moment in situations complicated by eclampsia or HELLP syndrome, allows a better maternal and perinatal prognosis.
