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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. 2023;45(3):109-112
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Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(3):109-112
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Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1122-1125
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Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1122-1125
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Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(7):637-639
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(7):637-639
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Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):662-668
, , , , , To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution.
Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327).
After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%).
Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):662-668
, , , , , To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution.
Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327).
After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%).
Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(1):3-8
To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure.
A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019.
The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, andwefound no differencebetween total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age.
Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(1):3-8
To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure.
A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019.
The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, andwefound no differencebetween total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age.
Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.
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Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(5):1-2
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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