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Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgoedt3
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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgoedt3
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Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo43
, , , , , , , , , , , , , , , , In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention – Vigilant Prenatal Care – Timely Delivery (Parturition) – Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo43
, , , , , , , , , , , , , , , , In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention – Vigilant Prenatal Care – Timely Delivery (Parturition) – Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management.
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Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(9):878-883
, , , , It is a challenge to consider preeclampsia (PE) diagnosis and management in low and middle-income settings, where it represents a major public health concern. The placenta is the underlying cause of disease, and the plasma concentrations of proangiogenic and antiangiogenic factors released by the placenta can reflect the risks of disease progression. Antiangiogenic proteins, such as soluble fms-like tyrosine kinase 1 (sFlt-1), and proangiogenic, like placental growth factors (PlGF), are directly and inversely correlated with the disease onset, respectively.
Narrative review on the use of biomarkers (sFlt-1 to PlGF ratio) with a suggested guidance protocol.
Key considerations on the use of biomarkers: the sFlt-1/PlGF ratio is mainly relevant to rule out PE between 20 and 36 6/7 weeks in cases of suspected PE; however, it should not replace the routine exams for the diagnosis of PE. The sFlt-1/PlGF ratio should not be performed after confirmed PE diagnosis (only in research settings). In women with suspected PE, sFlt-1/PlGF ratio < 38 can rule out the diagnosis of PE for 1 week (VPN = 99.3) and up to 4 weeks (VPN= 94.3); sFlt-1/PlGF ratio > 38 does not confirm the diagnosis of PE; however, it can assist clinical management. In cases of severe hypertension and/or symptoms (imminent eclampsia), hospitalization is imperative, regardless of the result of the sFlt-1/PlGF ratio.
The use of biomarkers can help support clinical decisions on the management of suspected PE cases, especially to rule out PE diagnosis, thus avoiding unnecessary interventions, especially hospitalizations and elective prematurity
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(9):878-883
, , , , It is a challenge to consider preeclampsia (PE) diagnosis and management in low and middle-income settings, where it represents a major public health concern. The placenta is the underlying cause of disease, and the plasma concentrations of proangiogenic and antiangiogenic factors released by the placenta can reflect the risks of disease progression. Antiangiogenic proteins, such as soluble fms-like tyrosine kinase 1 (sFlt-1), and proangiogenic, like placental growth factors (PlGF), are directly and inversely correlated with the disease onset, respectively.
Narrative review on the use of biomarkers (sFlt-1 to PlGF ratio) with a suggested guidance protocol.
Key considerations on the use of biomarkers: the sFlt-1/PlGF ratio is mainly relevant to rule out PE between 20 and 36 6/7 weeks in cases of suspected PE; however, it should not replace the routine exams for the diagnosis of PE. The sFlt-1/PlGF ratio should not be performed after confirmed PE diagnosis (only in research settings). In women with suspected PE, sFlt-1/PlGF ratio < 38 can rule out the diagnosis of PE for 1 week (VPN = 99.3) and up to 4 weeks (VPN= 94.3); sFlt-1/PlGF ratio > 38 does not confirm the diagnosis of PE; however, it can assist clinical management. In cases of severe hypertension and/or symptoms (imminent eclampsia), hospitalization is imperative, regardless of the result of the sFlt-1/PlGF ratio.
The use of biomarkers can help support clinical decisions on the management of suspected PE cases, especially to rule out PE diagnosis, thus avoiding unnecessary interventions, especially hospitalizations and elective prematurity
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):669-675
, , , , , , , Preeclampsia (PE) is a pregnancy-specific syndrome characterized by abnormal levels of cytokines and angiogenic factors, playing a role in the disease development. The present study evaluated whether immunological markers are associated with the gestational age and with the disease severity in preeclamptic women.
Ninety-five women who developed PE were stratified for gestational age as preterm PE (< 37 weeks) and term PE (≥ 37 weeks of gestation) and compared for disease severity as well as plasma concentration of angiogenic factors and cytokines. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor (VEGF), Fms-like soluble tyrosine kinase (sFlt-1) and soluble endoglin (sEng), as well as the cytokines, tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10), were determined by enzyme-linked immunosorbent assay (ELISA).
The comparison between preeclamptic groups showed a higher percentage of severe cases in preterm PE (82.1%) than in term PE (35.9%). Similarly, the concentrations of TNF-α, sFlt-1, and sEng, as well as TNF-α/IL-10 and sFlt-1/PlGF ratios were significantly higher in the preterm PE group. In contrast, concentrations of PlGF, VEGF, and IL-10 were significantly lower in women with preterm PE. Negative correlations between TNF-α and IL-10 (r = 0.5232) and between PlGF and sFlt1 (r = 0.4158) were detected in the preterm PE.
In pregnant women with preterm PE, there is an imbalance between immunological markers, with the predominance of anti-angiogenic factors and TNF-α, associated with adverse maternal clinical outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):669-675
, , , , , , , Preeclampsia (PE) is a pregnancy-specific syndrome characterized by abnormal levels of cytokines and angiogenic factors, playing a role in the disease development. The present study evaluated whether immunological markers are associated with the gestational age and with the disease severity in preeclamptic women.
Ninety-five women who developed PE were stratified for gestational age as preterm PE (< 37 weeks) and term PE (≥ 37 weeks of gestation) and compared for disease severity as well as plasma concentration of angiogenic factors and cytokines. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor (VEGF), Fms-like soluble tyrosine kinase (sFlt-1) and soluble endoglin (sEng), as well as the cytokines, tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10), were determined by enzyme-linked immunosorbent assay (ELISA).
The comparison between preeclamptic groups showed a higher percentage of severe cases in preterm PE (82.1%) than in term PE (35.9%). Similarly, the concentrations of TNF-α, sFlt-1, and sEng, as well as TNF-α/IL-10 and sFlt-1/PlGF ratios were significantly higher in the preterm PE group. In contrast, concentrations of PlGF, VEGF, and IL-10 were significantly lower in women with preterm PE. Negative correlations between TNF-α and IL-10 (r = 0.5232) and between PlGF and sFlt1 (r = 0.4158) were detected in the preterm PE.
In pregnant women with preterm PE, there is an imbalance between immunological markers, with the predominance of anti-angiogenic factors and TNF-α, associated with adverse maternal clinical outcomes.
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Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(1):61-65
, , , , , , , , , , , , Pre-eclampsia (PE) is a severe disorder that affects up to 8% of all pregnancies and represents an important cause of maternal and perinatal morbidity and mortality. The screening of the disease is a subject of studies, but the complexity and uncertainties regarding its etiology make this objective a difficult task. In addition, the costs related to screening protocols, the heterogeneity of the most affected populations and the lack of highly effective prevention methods reduce the potential of current available algorithms for screening. Thus, the National Specialized Commission of Hypertension in Pregnancy of the Brazilian Association of Gynecology and Obstetrics Federation (Febrasgo, in the Portuguese acronym) (NSC Hypertension in Pregnancy of the Febrasgo) considers that there are no screening algorithms to be implemented in the country to date and advocates that Aspirin and calcium should be widely used.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(1):61-65
, , , , , , , , , , , , Pre-eclampsia (PE) is a severe disorder that affects up to 8% of all pregnancies and represents an important cause of maternal and perinatal morbidity and mortality. The screening of the disease is a subject of studies, but the complexity and uncertainties regarding its etiology make this objective a difficult task. In addition, the costs related to screening protocols, the heterogeneity of the most affected populations and the lack of highly effective prevention methods reduce the potential of current available algorithms for screening. Thus, the National Specialized Commission of Hypertension in Pregnancy of the Brazilian Association of Gynecology and Obstetrics Federation (Febrasgo, in the Portuguese acronym) (NSC Hypertension in Pregnancy of the Febrasgo) considers that there are no screening algorithms to be implemented in the country to date and advocates that Aspirin and calcium should be widely used.
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):1-2
, Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):1-2
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Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):318-332
, Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):318-332
, Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(9):433-439
DOI 10.1590/S0100-72032009000900003
PURPOSE: the main goal of this study is to evaluate the emotional conditions among mothers of newborns with visible malformation (Group M) and mothers of eutrophic newborns (Group E) soon after birth. METHODS: twenty-two mothers from the Group M were matched by age and number of children to 22 mothers of the Group E. They were assessed through the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). The data were complemented by interviews and analyses of the medical files of both mother and child. RESULTS: the results have shown significant differences in the mean scores of the three subscales (trait anxiety, state anxiety, dysphoria/depression) between the two groups of mothers. In terms of clinical signs, there were a significantly larger percentage of mothers from Group M identified with depression and anxiety after the child's birth, and for both conditions when compared with mothers from Group E. Although the results may reflect characteristics of the maternal personality, the trait anxiety was significantly more evident in mothers of malformed children, especially due to the child's health condition, its referral to the ICU and his/her condition regarding their future life. CONCLUSION: the percentage of mothers with clinical depression and anxiety suggests the need for either individual or group support to attend the needs of the mothers and mitigate the adverse effects of stressors throughout the child's development. Support should also be provided during pregnancy, when the mothers currently receive the news about the malformation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(9):433-439
DOI 10.1590/S0100-72032009000900003
PURPOSE: the main goal of this study is to evaluate the emotional conditions among mothers of newborns with visible malformation (Group M) and mothers of eutrophic newborns (Group E) soon after birth. METHODS: twenty-two mothers from the Group M were matched by age and number of children to 22 mothers of the Group E. They were assessed through the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). The data were complemented by interviews and analyses of the medical files of both mother and child. RESULTS: the results have shown significant differences in the mean scores of the three subscales (trait anxiety, state anxiety, dysphoria/depression) between the two groups of mothers. In terms of clinical signs, there were a significantly larger percentage of mothers from Group M identified with depression and anxiety after the child's birth, and for both conditions when compared with mothers from Group E. Although the results may reflect characteristics of the maternal personality, the trait anxiety was significantly more evident in mothers of malformed children, especially due to the child's health condition, its referral to the ICU and his/her condition regarding their future life. CONCLUSION: the percentage of mothers with clinical depression and anxiety suggests the need for either individual or group support to attend the needs of the mothers and mitigate the adverse effects of stressors throughout the child's development. Support should also be provided during pregnancy, when the mothers currently receive the news about the malformation.