hypertension Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2005;27(6):316-322
DOI 10.1590/S0100-72032005000600005
PURPOSE: to evaluate the relationship between renal transplantation and pregnancy through the analysis of clinical and obstetric intercurrent events and perinatal outcomes. METHODS: a retrospective series of 39 cases of pregnancy in 37 women with renal transplantation from January 1997 to December 2003 was evaluated. A control group consisted of 66 pregnant women with no previous clinical pathologies. This group received prenatal care and these patients delivered during 2002 and 2003. Preeclampsia, premature rupture of membranes, premature delivery, and intrauterine growth restriction were used to compare these variables. Demographic characteristics of these groups were related to the mean age at conception, ethnic characteristics and obstetric past. Regarding renal transplantation the type of donator and used immunosuppressive drugs were evaluated. The studied clinical variables were chronic hypertension, anemia and urinary tract infection. The interval between the surgery and conception, occurrence of dysfunction, rejection and loss of the allograft were characteristcs related to the allograft. Obstetric variables were related to the type of delivery, incidence of preeclampsia and premature rupture of membranes. Perinatal outcomes were premature delivery and intrauterine growth restriction and these results were compared with renal function. The used statistical methods were the chi2 and Fisher's exact tests. The significance level was fixed always as less than or equal to 0.05 (5%). RESULTS: the mean age at conception was 27 years. The live donator was the most frequent among the patients. Among the immunosuppressive drugs, cyclosporine was the most used. Chronic hypertension occurred in 82% of the cases, anemia in 77% and urinary tract infection in 38.5%. The incidence of renal dysfunction was 47.4% and preeclampsia was the main cause. The loss of the renal transplantation occurred in 10.2%. Delivery by cesarean section was performed in 53.8% of the patients, and the main causes were hypertensive syndromes. Preeclampsia occurred in 28.2%. Among the perinatal outcomes, premature delivery occurred in 46.1% of the cases, with a significant relation to creatinine level greater than or equal to 1.5 mg/dL at the start of prenatal care. Another observed intercurrent event was intrauterine growth restriction, which occurred in 41.0%, and here we found no relation between this event and creatinine levels. CONCLUSIONS: young patients constituted the study group. Chronic hypertension, anemia and urinary tract infection were very common. Renal dysfunction was frequent and must be investigated during prenatal care. There were four cases of loss of the transplant due to clinical or obstetric causes. Cesarean delivery had the highest incidence, but vaginal delivery should be the first choice in these cases. Preeclampsia occurred very frequently and this complication should be considered as a high risk. Preterm delivery and intrauterine growth restriction were the main perinatal complications. Premature deliveries before 37 weeks of gestation were related to allograft function.
Summary
Rev Bras Ginecol Obstet. 2005;27(6):316-322
DOI 10.1590/S0100-72032005000600005
PURPOSE: to evaluate the relationship between renal transplantation and pregnancy through the analysis of clinical and obstetric intercurrent events and perinatal outcomes. METHODS: a retrospective series of 39 cases of pregnancy in 37 women with renal transplantation from January 1997 to December 2003 was evaluated. A control group consisted of 66 pregnant women with no previous clinical pathologies. This group received prenatal care and these patients delivered during 2002 and 2003. Preeclampsia, premature rupture of membranes, premature delivery, and intrauterine growth restriction were used to compare these variables. Demographic characteristics of these groups were related to the mean age at conception, ethnic characteristics and obstetric past. Regarding renal transplantation the type of donator and used immunosuppressive drugs were evaluated. The studied clinical variables were chronic hypertension, anemia and urinary tract infection. The interval between the surgery and conception, occurrence of dysfunction, rejection and loss of the allograft were characteristcs related to the allograft. Obstetric variables were related to the type of delivery, incidence of preeclampsia and premature rupture of membranes. Perinatal outcomes were premature delivery and intrauterine growth restriction and these results were compared with renal function. The used statistical methods were the chi2 and Fisher's exact tests. The significance level was fixed always as less than or equal to 0.05 (5%). RESULTS: the mean age at conception was 27 years. The live donator was the most frequent among the patients. Among the immunosuppressive drugs, cyclosporine was the most used. Chronic hypertension occurred in 82% of the cases, anemia in 77% and urinary tract infection in 38.5%. The incidence of renal dysfunction was 47.4% and preeclampsia was the main cause. The loss of the renal transplantation occurred in 10.2%. Delivery by cesarean section was performed in 53.8% of the patients, and the main causes were hypertensive syndromes. Preeclampsia occurred in 28.2%. Among the perinatal outcomes, premature delivery occurred in 46.1% of the cases, with a significant relation to creatinine level greater than or equal to 1.5 mg/dL at the start of prenatal care. Another observed intercurrent event was intrauterine growth restriction, which occurred in 41.0%, and here we found no relation between this event and creatinine levels. CONCLUSIONS: young patients constituted the study group. Chronic hypertension, anemia and urinary tract infection were very common. Renal dysfunction was frequent and must be investigated during prenatal care. There were four cases of loss of the transplant due to clinical or obstetric causes. Cesarean delivery had the highest incidence, but vaginal delivery should be the first choice in these cases. Preeclampsia occurred very frequently and this complication should be considered as a high risk. Preterm delivery and intrauterine growth restriction were the main perinatal complications. Premature deliveries before 37 weeks of gestation were related to allograft function.
Summary
Rev Bras Ginecol Obstet. 2000;22(1):13-17
DOI 10.1590/S0100-72032000000100003
Purpose: to determine magnesium sulfate effectiveness to prevent eclamptic seizures in pregnant women diagnosed with preeclampsia. Methods: a case-control study involving 489 pregnant patients admitted to the Hospital de Clínicas de Porto Alegre (HCPA) with the diagnosis of hypertension between January 1990 and January 1997. The patients were divided into two groups: those who received magnesium sulfate (Group I) and those who did not (Group II). All patients were treated according to the hospital's standard protocol for the treatment of hypertensive pregnant women. The following variables were assessed: maternal age, race, number of seizures, number of seizures in patients receiving magnesium sulfate, period of magnesium sulfate administration, before and after delivery, maternal mortality, need of ICU care, need of mechanical ventilation and length of hospital stay after delivery. Data were assessed with Epi-Info 6.0 statistical package, using multivariate analysis. The main outcome measure was magnesium sulfate use. Results: no differences were found between the two groups in terms of maternal age, race or gestational age. Women who received magnesium sulfate had a higher mean systolic and diastolic blood pressure. Women in the intervention group had a longer hospital stay and a greater need of ICU care. Need of mechanical ventilation and maternal mortality were similar in the two groups. Twenty-two out of 353 women had one or more seizures before admission to the hospital. Six women (27.3%) had one or two additional seizures after magnesium sulfate administration. No subjects had three or more seizures after receiving magnesium sulfate. Conclusion: the results show that eclamptic seizures can be prevented by routine prophylactic magnesium sulfate administration.
Summary
Rev Bras Ginecol Obstet. 2000;22(1):13-17
DOI 10.1590/S0100-72032000000100003
Purpose: to determine magnesium sulfate effectiveness to prevent eclamptic seizures in pregnant women diagnosed with preeclampsia. Methods: a case-control study involving 489 pregnant patients admitted to the Hospital de Clínicas de Porto Alegre (HCPA) with the diagnosis of hypertension between January 1990 and January 1997. The patients were divided into two groups: those who received magnesium sulfate (Group I) and those who did not (Group II). All patients were treated according to the hospital's standard protocol for the treatment of hypertensive pregnant women. The following variables were assessed: maternal age, race, number of seizures, number of seizures in patients receiving magnesium sulfate, period of magnesium sulfate administration, before and after delivery, maternal mortality, need of ICU care, need of mechanical ventilation and length of hospital stay after delivery. Data were assessed with Epi-Info 6.0 statistical package, using multivariate analysis. The main outcome measure was magnesium sulfate use. Results: no differences were found between the two groups in terms of maternal age, race or gestational age. Women who received magnesium sulfate had a higher mean systolic and diastolic blood pressure. Women in the intervention group had a longer hospital stay and a greater need of ICU care. Need of mechanical ventilation and maternal mortality were similar in the two groups. Twenty-two out of 353 women had one or more seizures before admission to the hospital. Six women (27.3%) had one or two additional seizures after magnesium sulfate administration. No subjects had three or more seizures after receiving magnesium sulfate. Conclusion: the results show that eclamptic seizures can be prevented by routine prophylactic magnesium sulfate administration.
Summary
Rev Bras Ginecol Obstet. 2000;22(5):287-292
DOI 10.1590/S0100-72032000000500006
Purpose: to evaluate the effects of hormone replacement therapy (HRT) on the systolic and diastolic blood pressure of postmenopausal women. Methods: a total of 166 users and 136 non-users of hormone replacement were evaluated retrospectively during a period of three years. All women were assisted at the Menopause Outpatient Clinic of CAISM -- Unicamp, where the variations of these parameters were evaluated at the end of each year in relation to the initial parameters. The data analysis was performed through Student's t test, Mann-Whitney test, and the Wilcoxon nonparametric test. Results: we observed that the systolic blood pressure of HRT users was statistically lower at the end of the third year of use, compared to the initial values (p = 0.01). There was no significant difference in the diastolic blood pressure between users and non-users. Conclusion: hormone replacement therapy did not produce changes in the parameters studied in women properly assisted during the use of HRT.
Summary
Rev Bras Ginecol Obstet. 2000;22(5):287-292
DOI 10.1590/S0100-72032000000500006
Purpose: to evaluate the effects of hormone replacement therapy (HRT) on the systolic and diastolic blood pressure of postmenopausal women. Methods: a total of 166 users and 136 non-users of hormone replacement were evaluated retrospectively during a period of three years. All women were assisted at the Menopause Outpatient Clinic of CAISM -- Unicamp, where the variations of these parameters were evaluated at the end of each year in relation to the initial parameters. The data analysis was performed through Student's t test, Mann-Whitney test, and the Wilcoxon nonparametric test. Results: we observed that the systolic blood pressure of HRT users was statistically lower at the end of the third year of use, compared to the initial values (p = 0.01). There was no significant difference in the diastolic blood pressure between users and non-users. Conclusion: hormone replacement therapy did not produce changes in the parameters studied in women properly assisted during the use of HRT.
Summary
Rev Bras Ginecol Obstet. 2003;25(10):739-744
DOI 10.1590/S0100-72032003001000007
PURPOSE: to verify the contribution of maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes as risk factors for cesarean section. METHODS: after approval by the Ethics in Research Committee of the "Maternidade Professor Monteiro de Morais" - Recife, PE - Brazil, for a case control study, the authors analyzed data from 3919 pregnant women, without two or more prior cesarean sections, who gave birth to alive newborns with gestational age equal to or more than 28 weeks, weighing at least 1,000 g, on cephalic presentation, from September 1, 1999 to August 31, 2000. The case group included women submitted to cesarean section and the control group included women submitted to vaginal delivery. With the data collected from obstetric and neonatal reports, the authors performed multivariate analysis by logistic regression to determine a mathematical equation that associates cesarean probability due to more than one independent variable acting as risk factor, determining odds ratio with a confidence interval of 95% (95% CI), for the variables: maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes. RESULTS: the chances for cesarean section significantly increased 8.3 times in twin pregnancy (OR = 8.3; 95% CI: 3.7-19.1), 3.4 in hypertensive syndrome (OR = 3.4; 95% CI: 2.9-4.0), 1.9 in primiparity (OR = 1.9; 95% CI: 1.8-2.0), 1.5 in maternal age over 34 years (OR = 1.5; 95% CI: 1.2-1.8), and 1.2 in the presence of premature rupture of membranes (OR = 1.2; 95 %CI: 1.0-1.4). CONCLUSIONS: the risk for cesarean section was greater in the presence of premature rupture of membranes, maternal age greater than 34 years, primiparity, hypertensive syndrome, and twin pregnancy.
Summary
Rev Bras Ginecol Obstet. 2003;25(10):739-744
DOI 10.1590/S0100-72032003001000007
PURPOSE: to verify the contribution of maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes as risk factors for cesarean section. METHODS: after approval by the Ethics in Research Committee of the "Maternidade Professor Monteiro de Morais" - Recife, PE - Brazil, for a case control study, the authors analyzed data from 3919 pregnant women, without two or more prior cesarean sections, who gave birth to alive newborns with gestational age equal to or more than 28 weeks, weighing at least 1,000 g, on cephalic presentation, from September 1, 1999 to August 31, 2000. The case group included women submitted to cesarean section and the control group included women submitted to vaginal delivery. With the data collected from obstetric and neonatal reports, the authors performed multivariate analysis by logistic regression to determine a mathematical equation that associates cesarean probability due to more than one independent variable acting as risk factor, determining odds ratio with a confidence interval of 95% (95% CI), for the variables: maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes. RESULTS: the chances for cesarean section significantly increased 8.3 times in twin pregnancy (OR = 8.3; 95% CI: 3.7-19.1), 3.4 in hypertensive syndrome (OR = 3.4; 95% CI: 2.9-4.0), 1.9 in primiparity (OR = 1.9; 95% CI: 1.8-2.0), 1.5 in maternal age over 34 years (OR = 1.5; 95% CI: 1.2-1.8), and 1.2 in the presence of premature rupture of membranes (OR = 1.2; 95 %CI: 1.0-1.4). CONCLUSIONS: the risk for cesarean section was greater in the presence of premature rupture of membranes, maternal age greater than 34 years, primiparity, hypertensive syndrome, and twin pregnancy.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):585-591
DOI 10.1590/S0100-72032003000800007
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.
Summary
Rev Bras Ginecol Obstet. 2003;25(8):585-591
DOI 10.1590/S0100-72032003000800007
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.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):431-436
DOI 10.1590/S0100-72032003000600008
PURPOSE: to analyze maternal death cases that occurred at the "Hospital de Clínicas de Porto Alegre", a reference university hospital for high-risk pregnancies in the state of Rio Grande do Sul, Brazil. METHODS: we carried out a retrospective study of medical records of 10- to 49-year-old women who died at the hospital between 1980 and 1999. Deaths related to pregnancy and puerperium were analyzed independently of the kind and duration of pregnancy. The causes were classified into direct obstetric, indirect obstetric and nonobstetric, according to their association with pregnancy, delivery and puerperium disorders. RESULTS: a total of 81 patients with a mean age of 28.5 years were studied. The maternal mortality rate was 109 per 100,000 live births. Direct obstetric causes made up 61.7% of deaths. Indirect causes made up 23.5% of deaths. Nonobstetric causes made up 15.0% of the total. Among direct obstetric causes, arterial hypertension (18.5%), post-cesarean infection (16%), and septic abortion (12.3%) were the most prevalent. The main maternal mortality events among indirect obstetric causes were cardiopathy (8.6%), acute fatty liver disease (3.5%), and systemic lupus erythematosus (2.5%). Among the nonobstetric causes, malignant neoplasia (7.4%) and AIDS (3.7%) were the most important. CONCLUSIONS: the prevailing causes of maternal death have not changed in the last two decades. The main cause is still hypertension. There is an expressive number of deaths related to cesarean section and infections. The high prevalence of direct obstetric causes shows the low maternal mortality prevention capacity of our health care system.
Summary
Rev Bras Ginecol Obstet. 2003;25(6):431-436
DOI 10.1590/S0100-72032003000600008
PURPOSE: to analyze maternal death cases that occurred at the "Hospital de Clínicas de Porto Alegre", a reference university hospital for high-risk pregnancies in the state of Rio Grande do Sul, Brazil. METHODS: we carried out a retrospective study of medical records of 10- to 49-year-old women who died at the hospital between 1980 and 1999. Deaths related to pregnancy and puerperium were analyzed independently of the kind and duration of pregnancy. The causes were classified into direct obstetric, indirect obstetric and nonobstetric, according to their association with pregnancy, delivery and puerperium disorders. RESULTS: a total of 81 patients with a mean age of 28.5 years were studied. The maternal mortality rate was 109 per 100,000 live births. Direct obstetric causes made up 61.7% of deaths. Indirect causes made up 23.5% of deaths. Nonobstetric causes made up 15.0% of the total. Among direct obstetric causes, arterial hypertension (18.5%), post-cesarean infection (16%), and septic abortion (12.3%) were the most prevalent. The main maternal mortality events among indirect obstetric causes were cardiopathy (8.6%), acute fatty liver disease (3.5%), and systemic lupus erythematosus (2.5%). Among the nonobstetric causes, malignant neoplasia (7.4%) and AIDS (3.7%) were the most important. CONCLUSIONS: the prevailing causes of maternal death have not changed in the last two decades. The main cause is still hypertension. There is an expressive number of deaths related to cesarean section and infections. The high prevalence of direct obstetric causes shows the low maternal mortality prevention capacity of our health care system.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):543-549
DOI 10.1590/S0100-72032000000900002
Purpose: to compare the efficiency between magnesium sulfate and phenytoin in the control of convulsions in patients with eclampsia and to evaluate the effects of magnesium sulfate and phenytoin on the maternal and perinatal prognosis in patients with eclampsia. Methods: this is a prospective, randomized and controlled study in which the results obtained with the use of anticonvulsive treatment in 77 women with eclampsia, treated with either magnesium sulfate or phenytoin, were analyzed comparatively. The drugs which were used in both therapeutic schemes were distributed in a one to one ratio, in randomly numbered boxes which presented similar characteristics. When a patient was admitted, a box was opened and its contents were given to the patient. Results: in the group whose patients were treated with magnesium sulfate, 19.5% had recurrent convulsions while in the group whose patients used phenytoin, 36.1% had new crises (p<0,05). The patients who were treated with magnesium sulfate showed a greater prevalence of postpartum hemorrhage (14,7%) than those to whom phenytoin was administered (2.7%) (p<0.05). In relation to the newborns, 17.0% of the group from mothers treated with magnesium sulfate presented respiratory distress as opposed to the group of newborns from mothers treated with phenytoin (11.8%), (p> 0,05). Conclusion: magnesium sulfate is shown to be more efficient than phenytoin in the control and the prevention of convulsions in patients with eclampsia. However, its utilization showed a higher prevalence of postpartum hemorrhage and respiratory distress. Phenytoin should be used in cases where the use of magnesium sulfate is contraindicated.
Summary
Rev Bras Ginecol Obstet. 2000;22(9):543-549
DOI 10.1590/S0100-72032000000900002
Purpose: to compare the efficiency between magnesium sulfate and phenytoin in the control of convulsions in patients with eclampsia and to evaluate the effects of magnesium sulfate and phenytoin on the maternal and perinatal prognosis in patients with eclampsia. Methods: this is a prospective, randomized and controlled study in which the results obtained with the use of anticonvulsive treatment in 77 women with eclampsia, treated with either magnesium sulfate or phenytoin, were analyzed comparatively. The drugs which were used in both therapeutic schemes were distributed in a one to one ratio, in randomly numbered boxes which presented similar characteristics. When a patient was admitted, a box was opened and its contents were given to the patient. Results: in the group whose patients were treated with magnesium sulfate, 19.5% had recurrent convulsions while in the group whose patients used phenytoin, 36.1% had new crises (p<0,05). The patients who were treated with magnesium sulfate showed a greater prevalence of postpartum hemorrhage (14,7%) than those to whom phenytoin was administered (2.7%) (p<0.05). In relation to the newborns, 17.0% of the group from mothers treated with magnesium sulfate presented respiratory distress as opposed to the group of newborns from mothers treated with phenytoin (11.8%), (p> 0,05). Conclusion: magnesium sulfate is shown to be more efficient than phenytoin in the control and the prevention of convulsions in patients with eclampsia. However, its utilization showed a higher prevalence of postpartum hemorrhage and respiratory distress. Phenytoin should be used in cases where the use of magnesium sulfate is contraindicated.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):103-107
DOI 10.1590/S0100-72032003000200005
PURPOSE: to study the causes and associated factors of fetal death. METHODS: epidemiological descriptive study, composed of 190 cases of fetal loss amongst 11,825 pregnant women that gave birth at the two only hospitals (Casa de Saúde Divino Espírito Santo and Hospital Nossa Senhora Auxiliadora) of Caratinga City, in the State of Minas Gerais, Brazil, in the period from January 1, 1995 to April 30, 2000. The variables were the number of pregnancies, the timing of the pregnant women at the time of hospitalization, the occurrence of fetal death in relation to delivery and the cause of fetal death. Since there were no comparative groups, tables, percentages and arithmetical means were applied, following the guidelines of the Course of Statistics, of the "Universidade Federal de São Paulo". RESULTS: among the 189 pregnant women with fetal death, 77 were primigravidal and 76 had already been pregnant 2 to 5 times. The gestational age in 113 women was from 20 to 37 weeks. In relation to parturition, the fetal loss occurred during the antepartum period in 164 of 190 dead fetuses. The most frequently noticed death causes were: abruptio placentae in 35 cases, fetal anomaly in 12 cases, and hypertension syndrome in 8 cases. Nervertheless, there was no explanation for the etiology of 117 cases of fetal death. CONCLUSION: stillbirth has frequently been observed among the primigravidae (40.74%), in preterm period (59.79%), and in the antepartum period (86.31%). Among fetal death causes, the most frequent was a abruptio placentae (18.42%), and in 61.57% of the cases the fetal death could not be explained.
Summary
Rev Bras Ginecol Obstet. 2003;25(2):103-107
DOI 10.1590/S0100-72032003000200005
PURPOSE: to study the causes and associated factors of fetal death. METHODS: epidemiological descriptive study, composed of 190 cases of fetal loss amongst 11,825 pregnant women that gave birth at the two only hospitals (Casa de Saúde Divino Espírito Santo and Hospital Nossa Senhora Auxiliadora) of Caratinga City, in the State of Minas Gerais, Brazil, in the period from January 1, 1995 to April 30, 2000. The variables were the number of pregnancies, the timing of the pregnant women at the time of hospitalization, the occurrence of fetal death in relation to delivery and the cause of fetal death. Since there were no comparative groups, tables, percentages and arithmetical means were applied, following the guidelines of the Course of Statistics, of the "Universidade Federal de São Paulo". RESULTS: among the 189 pregnant women with fetal death, 77 were primigravidal and 76 had already been pregnant 2 to 5 times. The gestational age in 113 women was from 20 to 37 weeks. In relation to parturition, the fetal loss occurred during the antepartum period in 164 of 190 dead fetuses. The most frequently noticed death causes were: abruptio placentae in 35 cases, fetal anomaly in 12 cases, and hypertension syndrome in 8 cases. Nervertheless, there was no explanation for the etiology of 117 cases of fetal death. CONCLUSION: stillbirth has frequently been observed among the primigravidae (40.74%), in preterm period (59.79%), and in the antepartum period (86.31%). Among fetal death causes, the most frequent was a abruptio placentae (18.42%), and in 61.57% of the cases the fetal death could not be explained.