Risk factors Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(1):34-40
DOI 10.1590/S0100-72032007000100006
PURPOSE: to determine the cesarean section (CS) rate in Campinas (SP) and to identify its risk factors. METHODS: a cross-sectional study that analyzed data obtained from Live Birth Certificates in 2001. The dependent variable was the type of delivery and the independent variables were: mothers’ characteristics and those related to their pregnancies, deliveries and to newborns. The assessment of the association among variables was performed through the chi2 test, and crude and adjusted odds ratio (OR) values were calculated. RESULTS: the CS rate was 54.9%. The chances of having CS increased 1.9 times for women from 20-34 years old (adjOR-1.9; 95% CI:1.7-2.1); 3.7 times for those over 35 years old (adjOR-3.8; 95% CI:3.2-4.5); 1.5 times for those who studied from 8-11 years (adjOR-1.5; 95% CI:1.4-1.6); 2.5 times for those who studied more than 11 years (adjOR-2.6; 95% CI:2.2-2.9); 1.3 times for those who were married (adjOR-1.3; 95 % CI:1.2-1.4); 1.6 times for those who had jobs (adjOR-1.6; 95% CI:1.5-1.8); 1.2 times for who had good living conditions (adjOR-1.2; 95% CI:1.0-1.3); 2.2 times for primiparous (adjOR-2.2; 95% CI:1.9-2.5), 1.6 times for multiparous (adjOR-1.6; 95% CI:1.4-1.9) and 2.7 times in twin gestations (adjOR-2.7; 95% CI:1.9-3.9). The women who had inadequate prenatal care were protected for CS (adjOR-0.6; 95% CI:0.5-0.7). CONCLUSION: the chance of having CS was greater among women with better socio-economic conditions, with adequate prenatal care, for primiparous, for multiparous and in twin gestations, suggesting that the basis for indication of cesarean sections were not restricted to clinical factors but influenced by non-medical reasons.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(1):34-40
DOI 10.1590/S0100-72032007000100006
PURPOSE: to determine the cesarean section (CS) rate in Campinas (SP) and to identify its risk factors. METHODS: a cross-sectional study that analyzed data obtained from Live Birth Certificates in 2001. The dependent variable was the type of delivery and the independent variables were: mothers’ characteristics and those related to their pregnancies, deliveries and to newborns. The assessment of the association among variables was performed through the chi2 test, and crude and adjusted odds ratio (OR) values were calculated. RESULTS: the CS rate was 54.9%. The chances of having CS increased 1.9 times for women from 20-34 years old (adjOR-1.9; 95% CI:1.7-2.1); 3.7 times for those over 35 years old (adjOR-3.8; 95% CI:3.2-4.5); 1.5 times for those who studied from 8-11 years (adjOR-1.5; 95% CI:1.4-1.6); 2.5 times for those who studied more than 11 years (adjOR-2.6; 95% CI:2.2-2.9); 1.3 times for those who were married (adjOR-1.3; 95 % CI:1.2-1.4); 1.6 times for those who had jobs (adjOR-1.6; 95% CI:1.5-1.8); 1.2 times for who had good living conditions (adjOR-1.2; 95% CI:1.0-1.3); 2.2 times for primiparous (adjOR-2.2; 95% CI:1.9-2.5), 1.6 times for multiparous (adjOR-1.6; 95% CI:1.4-1.9) and 2.7 times in twin gestations (adjOR-2.7; 95% CI:1.9-3.9). The women who had inadequate prenatal care were protected for CS (adjOR-0.6; 95% CI:0.5-0.7). CONCLUSION: the chance of having CS was greater among women with better socio-economic conditions, with adequate prenatal care, for primiparous, for multiparous and in twin gestations, suggesting that the basis for indication of cesarean sections were not restricted to clinical factors but influenced by non-medical reasons.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):285-291
DOI 10.1590/S0100-72032006000500004
PURPOSE: to identify risk factors for cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) types among women with CIN, and to compare with HPV types among patients with normal cervix. METHODS: a total of 228 patients were studied, of whom 132 with CIN (cases) and 96 with normal cervix (controls). In the two groups consisting of women selected among outpatients attended in the same hospital, living near the place of the research, mean ages were similar (34.0±8.3 years) and there was a predominance of married women. Possible risk factors for CIN were investigated with the application of a questionnaire surveying age, marital status, level of schooling, age at first coitus, number of pregnancies, number of sexual partners, method of used contraception, reference of previously sexually transmitted diseases (STDs) and smoking habits, with a comparison between the studied groups. Samples were collected for oncologic colpocytology and HPV search through polymerase chain reaction (PCR), using MY09/MY11 primers; then colposcopic and histopathological examinations were performed. For statistical analysis of the association between risk factors and CIN, odds ratio with 95% confidence interval and chi2 and Fisher tests were used at a significance level of 0.05. The logistic regression method with the significance expressed by the p value with maximum likelihood was also applied. RESULTS: the following variables remained in the logistic regression model: HPV infection of high oncogenic risk (OR=12.32; CI 95%: 3.79-40.08), reference of previous STDs (OR=8.23; CI 95%: 2.82-24.04), early age at first coitus (OR=4.00; CI 95%: 1.70-9.39) and smoking habit (OR=3.94; CI 95%: 1.73-8.98). PCR was positive in 48.5 and 14.6% in the case and control groups, respectively. CONCLUSIONS: the main risk factor for CIN was oncogenic HPV infection, with types 16, 18, 33, 35, 51, 52, 58, and 83. Among patients with a high-degree lesion, there was a predominance of HPV-16 or type 16 variant. In patients with normal cervix oncogenic, HPV types 51, 58, and 51 variant were also identified.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):285-291
DOI 10.1590/S0100-72032006000500004
PURPOSE: to identify risk factors for cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) types among women with CIN, and to compare with HPV types among patients with normal cervix. METHODS: a total of 228 patients were studied, of whom 132 with CIN (cases) and 96 with normal cervix (controls). In the two groups consisting of women selected among outpatients attended in the same hospital, living near the place of the research, mean ages were similar (34.0±8.3 years) and there was a predominance of married women. Possible risk factors for CIN were investigated with the application of a questionnaire surveying age, marital status, level of schooling, age at first coitus, number of pregnancies, number of sexual partners, method of used contraception, reference of previously sexually transmitted diseases (STDs) and smoking habits, with a comparison between the studied groups. Samples were collected for oncologic colpocytology and HPV search through polymerase chain reaction (PCR), using MY09/MY11 primers; then colposcopic and histopathological examinations were performed. For statistical analysis of the association between risk factors and CIN, odds ratio with 95% confidence interval and chi2 and Fisher tests were used at a significance level of 0.05. The logistic regression method with the significance expressed by the p value with maximum likelihood was also applied. RESULTS: the following variables remained in the logistic regression model: HPV infection of high oncogenic risk (OR=12.32; CI 95%: 3.79-40.08), reference of previous STDs (OR=8.23; CI 95%: 2.82-24.04), early age at first coitus (OR=4.00; CI 95%: 1.70-9.39) and smoking habit (OR=3.94; CI 95%: 1.73-8.98). PCR was positive in 48.5 and 14.6% in the case and control groups, respectively. CONCLUSIONS: the main risk factor for CIN was oncogenic HPV infection, with types 16, 18, 33, 35, 51, 52, 58, and 83. Among patients with a high-degree lesion, there was a predominance of HPV-16 or type 16 variant. In patients with normal cervix oncogenic, HPV types 51, 58, and 51 variant were also identified.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):278-284
DOI 10.1590/S0100-72032006000500003
PURPOSE: to analyze race, parity and presence of the progesterone receptor polymorphism, named PROGINS, as factors related to uterine leiomyoma occurrence in Brazilian women. METHODS: we carried out a case-control study, composed of 122 patients with the diagnosis of uterine fibroid and 125 women without the disease. After recording the clinical data, we collected biological material for DNA extraction, polymerase chain reaction and agarose gel electrophoresis in order to identify the presence of PROGINS polymorphism. Statistical analysis was performed using the non-parametric Mann-Whitney test or the chi2 test, depending on the studied variable. The risk for the occurrence of the disease was calculated by the logistic regression model, providing the odds ratio (OR). The adopted significance level was 5% (p<0.05) and the confidence interval was 95% (95% CI). RESULTS: we observed a higher prevalence of "non-white"women - mulatto and black - (50 vs 22.4%) and nulliparas (23.8 vs 11.2%) in the cases, while the progesterone receptor genotype was more often PROGINS positive - heterozygous or mutant homozygous - among the controls (21.6 vs 10.7%). The OR indicated an elevated risk for leiomyoma related to the "non-white"race (OR=3.46; 95% CI: 2.0-6.0) and the nulliparity (OR=3.30; 95% CI: 1.9-5.6), with reduction in the presence of PROGINS-positive genotypes (OR=0.43; 95% CI: 0.2-0.9). CONCLUSIONS: the "non-white"race and nulliparity were considered risk factors for the occurrence of uterine fibroid in the studied population, while PROGINS polymorphism showed to be a protective factor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(5):278-284
DOI 10.1590/S0100-72032006000500003
PURPOSE: to analyze race, parity and presence of the progesterone receptor polymorphism, named PROGINS, as factors related to uterine leiomyoma occurrence in Brazilian women. METHODS: we carried out a case-control study, composed of 122 patients with the diagnosis of uterine fibroid and 125 women without the disease. After recording the clinical data, we collected biological material for DNA extraction, polymerase chain reaction and agarose gel electrophoresis in order to identify the presence of PROGINS polymorphism. Statistical analysis was performed using the non-parametric Mann-Whitney test or the chi2 test, depending on the studied variable. The risk for the occurrence of the disease was calculated by the logistic regression model, providing the odds ratio (OR). The adopted significance level was 5% (p<0.05) and the confidence interval was 95% (95% CI). RESULTS: we observed a higher prevalence of "non-white"women - mulatto and black - (50 vs 22.4%) and nulliparas (23.8 vs 11.2%) in the cases, while the progesterone receptor genotype was more often PROGINS positive - heterozygous or mutant homozygous - among the controls (21.6 vs 10.7%). The OR indicated an elevated risk for leiomyoma related to the "non-white"race (OR=3.46; 95% CI: 2.0-6.0) and the nulliparity (OR=3.30; 95% CI: 1.9-5.6), with reduction in the presence of PROGINS-positive genotypes (OR=0.43; 95% CI: 0.2-0.9). CONCLUSIONS: the "non-white"race and nulliparity were considered risk factors for the occurrence of uterine fibroid in the studied population, while PROGINS polymorphism showed to be a protective factor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(3):171-178
DOI 10.1590/S0100-72032006000300006
PURPOSE: postpartum anxiety (PPA) is highly prevalent and has important consequences on mother and newborn. The aim of the present study was to estimate the prevalence of PPA and its risk factors, in a sample of women attending a private setting. METHODS: a cross-sectional study was performed with 299 women, at a routine gynecological visit, from August 2000 to May 2003. The Spielberger State-Trait Anxiety Inventory (STAIT) and a questionnaire with sociodemographic data and obstetric data were used. Inclusion criteria were: women with no past or present history of depression, psychiatric treatment, alcohol or drug abuse and whose children were alive. The prevalences of PPA-trace and PPA-state, that evaluate characteristics of personality and transitory anxiety, respectively, were estimated with 95% confiance intervals (CI). Odds ratios and 95% CI were used to examine the association between PPA and exposure variables. Hypothesis testing was done by the chi2 test or chi2 test for linear trend, when categories were ordered. A p value < 0.05 was considered to be statistically significant. RESULTS: the prevalences of PPA-state and PPA-trace were 44.8% (CI 95%: 39.1 - 50.7) and 46.1% (CI 95%: 40.4 - 52.0, respectively). Formal agreement between scales was moderate (kappa = 0.55; p<0.001). By univariate analysis, lower mother income and presence of newborn complications were associated with PPA-state and PPA-trace. Lower maternal age and greater number of alive children were associated with PPA-trace and PPA-state, respectively. By multivariate analysis, PPA-trace and PPA-state were associated with higher mother income (OR:0.39; IC 95%: 0.21 - 0.74, p=0,005; OR:0.46; IC 95%: 0.24 - 0.87, p=0.02) and presence of complications in newborns (OR:2.15; IC 95%: 1.02 - 4.54, p=0.04) (OR:2.47; IC 95%: 1.16 - 5.25, p=0.02), respectively. PPA-trace was associated with greater maternal age (OR:0.34; IC 95%: 0.13 - 0.88, p=0.008), while PPA-state was associated with greater number of alive children (OR:1.82; IC 95%: 1.01 - 3.29, p=0.04). CONCLUSIONS: PPA was highly prevalent in this sample of women attending a private setting. Higher mother income and greater maternal age decrease the risk of AP, while presence of complications in newborns and greater number of alive children increase the risk.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(3):171-178
DOI 10.1590/S0100-72032006000300006
PURPOSE: postpartum anxiety (PPA) is highly prevalent and has important consequences on mother and newborn. The aim of the present study was to estimate the prevalence of PPA and its risk factors, in a sample of women attending a private setting. METHODS: a cross-sectional study was performed with 299 women, at a routine gynecological visit, from August 2000 to May 2003. The Spielberger State-Trait Anxiety Inventory (STAIT) and a questionnaire with sociodemographic data and obstetric data were used. Inclusion criteria were: women with no past or present history of depression, psychiatric treatment, alcohol or drug abuse and whose children were alive. The prevalences of PPA-trace and PPA-state, that evaluate characteristics of personality and transitory anxiety, respectively, were estimated with 95% confiance intervals (CI). Odds ratios and 95% CI were used to examine the association between PPA and exposure variables. Hypothesis testing was done by the chi2 test or chi2 test for linear trend, when categories were ordered. A p value < 0.05 was considered to be statistically significant. RESULTS: the prevalences of PPA-state and PPA-trace were 44.8% (CI 95%: 39.1 - 50.7) and 46.1% (CI 95%: 40.4 - 52.0, respectively). Formal agreement between scales was moderate (kappa = 0.55; p<0.001). By univariate analysis, lower mother income and presence of newborn complications were associated with PPA-state and PPA-trace. Lower maternal age and greater number of alive children were associated with PPA-trace and PPA-state, respectively. By multivariate analysis, PPA-trace and PPA-state were associated with higher mother income (OR:0.39; IC 95%: 0.21 - 0.74, p=0,005; OR:0.46; IC 95%: 0.24 - 0.87, p=0.02) and presence of complications in newborns (OR:2.15; IC 95%: 1.02 - 4.54, p=0.04) (OR:2.47; IC 95%: 1.16 - 5.25, p=0.02), respectively. PPA-trace was associated with greater maternal age (OR:0.34; IC 95%: 0.13 - 0.88, p=0.008), while PPA-state was associated with greater number of alive children (OR:1.82; IC 95%: 1.01 - 3.29, p=0.04). CONCLUSIONS: PPA was highly prevalent in this sample of women attending a private setting. Higher mother income and greater maternal age decrease the risk of AP, while presence of complications in newborns and greater number of alive children increase the risk.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(1):3-9
DOI 10.1590/S0100-72032006000100002
PURPOSE: to build a curve of fundal height according to gestational age among low-risk pregnant women and to compare it with the official standards used in Brazil. METHODS: a prospective observational study was carried out. A sample of 227 low-risk pregnant women with gestational age from 13 to 39 weeks was followed-up in the prenatal care sector of two public health services from João Pessoa, PB. Women with a known gestational age, a single live fetus, without malformation, with no known maternal-fetal pathological condition that could possibly affect fetal growth, with a normal body weight, and non-smokers were included in the study. Their fundal height was measured in a standard way, after a previous ultrasound done to confirm the gestational age. The same investigator performed 1206 measurements and each woman had a mean of 5.3 measurements. Statistical tests were performed with a significance level of 5%. Tables and graphs of fundal height were built according to the gestational age with the 10th, 50th and 90th percentiles. RESULTS: the values of percentiles 10, 50 and 90 of fundal height in each gestational age allowed the construction of a pattern curve of fundal height by gestational age among low-risk pregnant women. A clear visual difference was observed between this new and the official fundal height curve. Statistical analyses showed significant differences between them from the 19th week on. CONCLUSION: the results suggest different normal fundal height and fetal growth patterns among low-risk pregnant women on prenatal assistance compared to the used standard curve, thus with different performances when used for diagnosing fetal growth deviations. Future studies should validate the current fundal height curve by gestational age in order to possibly use it as a reference pattern.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(1):3-9
DOI 10.1590/S0100-72032006000100002
PURPOSE: to build a curve of fundal height according to gestational age among low-risk pregnant women and to compare it with the official standards used in Brazil. METHODS: a prospective observational study was carried out. A sample of 227 low-risk pregnant women with gestational age from 13 to 39 weeks was followed-up in the prenatal care sector of two public health services from João Pessoa, PB. Women with a known gestational age, a single live fetus, without malformation, with no known maternal-fetal pathological condition that could possibly affect fetal growth, with a normal body weight, and non-smokers were included in the study. Their fundal height was measured in a standard way, after a previous ultrasound done to confirm the gestational age. The same investigator performed 1206 measurements and each woman had a mean of 5.3 measurements. Statistical tests were performed with a significance level of 5%. Tables and graphs of fundal height were built according to the gestational age with the 10th, 50th and 90th percentiles. RESULTS: the values of percentiles 10, 50 and 90 of fundal height in each gestational age allowed the construction of a pattern curve of fundal height by gestational age among low-risk pregnant women. A clear visual difference was observed between this new and the official fundal height curve. Statistical analyses showed significant differences between them from the 19th week on. CONCLUSION: the results suggest different normal fundal height and fetal growth patterns among low-risk pregnant women on prenatal assistance compared to the used standard curve, thus with different performances when used for diagnosing fetal growth deviations. Future studies should validate the current fundal height curve by gestational age in order to possibly use it as a reference pattern.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):555-559
DOI 10.1590/S0100-72031999000900009
Purpose: high parity and/or young age at first sexual intercourse have been reported as risk factors for cervical cancer development. Actually, little research has been devoted to these risk factors. The aim of the present study was to analyze the parity and age at first sexual intercourse in women with invasive cervical cancer. Methods: we have retrospectively studied the age at first sexual intercourse and parity of 362 women with invasive cervical cancer diagnosed at the Outpatient Clinic of Oncological Gynecology of the "Faculdade de Medicina do Triângulo Mineiro" from 1978 to 1995. The cases were analyzed according to the date of diagnosis and divided into three groups: from 1978 to 1983 with 65 cases, from 1984 to 1989 with 127 cases and from 1990 to 1995 with 170 cases. Results: the results showed that high parity (4 or more births) diminished from the first to the third period (82, 67.3 and 63.8%, respectively) (p<0.02, chi² test). The first sexual intercourse before 18 years occurred respectively in 59.2, 54.5 and 55.5% of the patients (p, not significant). Conclusions: it was concluded that high parity seems to be related to invasive cervical cancer, although in recent years the parity decreased. The first sexual intercourse occurred before the age of 18 years in the patients of the three periods.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(9):555-559
DOI 10.1590/S0100-72031999000900009
Purpose: high parity and/or young age at first sexual intercourse have been reported as risk factors for cervical cancer development. Actually, little research has been devoted to these risk factors. The aim of the present study was to analyze the parity and age at first sexual intercourse in women with invasive cervical cancer. Methods: we have retrospectively studied the age at first sexual intercourse and parity of 362 women with invasive cervical cancer diagnosed at the Outpatient Clinic of Oncological Gynecology of the "Faculdade de Medicina do Triângulo Mineiro" from 1978 to 1995. The cases were analyzed according to the date of diagnosis and divided into three groups: from 1978 to 1983 with 65 cases, from 1984 to 1989 with 127 cases and from 1990 to 1995 with 170 cases. Results: the results showed that high parity (4 or more births) diminished from the first to the third period (82, 67.3 and 63.8%, respectively) (p<0.02, chi² test). The first sexual intercourse before 18 years occurred respectively in 59.2, 54.5 and 55.5% of the patients (p, not significant). Conclusions: it was concluded that high parity seems to be related to invasive cervical cancer, although in recent years the parity decreased. The first sexual intercourse occurred before the age of 18 years in the patients of the three periods.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):698-705
DOI 10.1590/S0100-72032005001100011
One of the most important advances in the control of the spread of infection with type 1 human immunodeficiency virus (HIV-1) occurred within the context of vertical transmission (VT), with a reduction from levels of more than 40% to levels of less than 3%. Technological progress together with a better physiopathological understanding of this infection has permitted the determination of the situations and factors that increase the rates of perinatal transmission of the virus, indicating which interventions are most adequate for its control. The situations of higher risk for VT of HIV involve maternal, adnexal, obstetrical, fetal, viral, and postnatal factors. Among maternal factors, particularly important is viral load, the major indicator of the risk of this form of transmission. However, despite its relevance, viral load is not the only variable in this equation, with the following factors also playing important roles: use of illicit drugs, multiple sex partners and unprotected sex, malnutrition, smoking habit, advanced maternal disease, and lack af access or compliance with antiretroviral drugs. Among the adnexal factors are prolonged chorion-amniorrhexis, loss of placental integrity, and the expression of secondary receptors in placental tissue. Among the obstetrical factors, it should be remembered that invasive interventions in the fetus or amniotic chamber, internal cardiotocography, type of delivery, and contact of the fetus/newborn infant with maternal blood are also important elements to be controlled. Among the fetal factors are the expression of secondary HIV-1 receptors, genetic susceptibility, reduced cytotoxic T-lymphocyte function, and prematurity. Among the viral factors, mutations and syncytium-inducing strains are believed to be risk factors for VT. Finally, there are postnatal factors represented by an elevated viral load in maternal milk, a low antibody concentration in this fluid, clinical mastitis and nipple lesions, which can be grouped within the context of breast-feeding.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):698-705
DOI 10.1590/S0100-72032005001100011
One of the most important advances in the control of the spread of infection with type 1 human immunodeficiency virus (HIV-1) occurred within the context of vertical transmission (VT), with a reduction from levels of more than 40% to levels of less than 3%. Technological progress together with a better physiopathological understanding of this infection has permitted the determination of the situations and factors that increase the rates of perinatal transmission of the virus, indicating which interventions are most adequate for its control. The situations of higher risk for VT of HIV involve maternal, adnexal, obstetrical, fetal, viral, and postnatal factors. Among maternal factors, particularly important is viral load, the major indicator of the risk of this form of transmission. However, despite its relevance, viral load is not the only variable in this equation, with the following factors also playing important roles: use of illicit drugs, multiple sex partners and unprotected sex, malnutrition, smoking habit, advanced maternal disease, and lack af access or compliance with antiretroviral drugs. Among the adnexal factors are prolonged chorion-amniorrhexis, loss of placental integrity, and the expression of secondary receptors in placental tissue. Among the obstetrical factors, it should be remembered that invasive interventions in the fetus or amniotic chamber, internal cardiotocography, type of delivery, and contact of the fetus/newborn infant with maternal blood are also important elements to be controlled. Among the fetal factors are the expression of secondary HIV-1 receptors, genetic susceptibility, reduced cytotoxic T-lymphocyte function, and prematurity. Among the viral factors, mutations and syncytium-inducing strains are believed to be risk factors for VT. Finally, there are postnatal factors represented by an elevated viral load in maternal milk, a low antibody concentration in this fluid, clinical mastitis and nipple lesions, which can be grouped within the context of breast-feeding.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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.
