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Soluble fms-like tyrosine kinase 1 (sFlt-1) is an anti-angiogenic factor released in higher amounts by preeclamptic placentas and it has been implicated in the endothelial dysfunction observed in the disease. In this study we evaluated if circulating sFlt-1/PlGF ratio is useful to predict adverse outcomes in women with early-onset preeclampsia. This is a cohort study of 88 preeclamptic women with singleton pregnancies at ⩽35weeks of gestation. According to definitions used, adverse outcomes occurred in 46.5% (N=43) of the patients. The median sFlt1/PlGF ratio (25th-75th centile) for all patients evaluated was of 42.26 (13.1-226.1). The median sFlt-1/PlGF ratio among women who had any adverse outcome (N=43) versus no adverse outcomes (N=45) was of 227.6 (80.3-346.1) versus 14.4 (3.35-30.0), (P

Introduction Preeclampsia (PE) is an important cause to maternal and perinatal morbimortality. The usage of acetylsalicylic acid (ASA) and Calcium (Ca) has been recommended to risk patients’ groups as preventive measures. Amongst the preeclampsia developing risk groups there are primiparous patients. However, we verified that this kind of intervention has been barely done in Sao Paulo and it seems not to be changed despite the consistent evidence to recommend its usage. Objectives Evaluate the ASA and Ca prescription frequency to primiparous patients. Methodology A comparative and retrospective study between two groups of primiparous patients was conducted. Firstly, all primiparous patients who have developed preeclampsia between January and May of 2016 and whose child-birth happened in Hospital Maternidade Vila Nova Cachoeirinha (HMEC) in Sao Paulo were identified through records evaluation and prenatal care portfolio. After that, a control group of primiparous patients who did not present any pathology during the gestation period was chosen and they were paired accordingly to their maternal age and gestational age at the child-birth. Results From that 23 primiparous pregnant woman with preeclampsia, 17.4% took ASA; 8.7% took Ca. Amongst the primiparous who did not develop preeclampsia, 2% took ASA; 12.2% took Ca and 2% took both medications (Table 1). There were no significant differences among the groups (p = 0.094). Conclusion Despite the consistent evidences for the usage of ASA and Ca, apparently the primary care in Sao Paulo city did not widely incorporate the recommendation of preventive measures to PE among high-risk patients. It is possible to assume that this behavior standard is similar among patients with other risk factors. Considering the strategic matter of prenatal care, that observation can be taken as a first step in order to enlarge this analysis and guide public policies to increase the usage of ASA and Ca in PE-risk patients. The authors thank the support FAPESP 2014.00213/7.

Introduction Know the additional risks associated with hypertensive disorders in pregnancy, such as the use of licit and illicit substances, may contribute to the adoption of strategies that minimize adverse outcomes. Objective Estabilish the prevelence of the use of harmful substances such as alcohol, tobacco and ilicit drugs in pregnant women in relation to healthy pregnant women. Methodology A transversal study has been conducted in the prenatal and maternity of the Hospital Guilherme Alvaro from April to June 2016. 61 patients were selected, 34 from the study group and 27 from de control group. Among the patients in the study group, are included pregnant or postpartum women with hypertensive disorders, according NHBPEP 2000. In the control group, are included only pregnant or postpartum women without previous comorbidity, which gave birth to one healthy live newborn, vaginal delivery. It was applied two questionnaires, ASSIST, screening test of involvement with alcohol, tobacco and illicit substances, developed by WHO, useful for health professionals to identify the use and dependence on psychoactive substances, evaluated through a score, the answer ranges from 0 to 4 points, and the sum can range from 0 to 20, it is considered casual use 0 to 3, 4 suggestive of abuse 4–15 and suggestive of addiction 16–20. And another that evaluates epidemiological woman information, current and obstetric pregnancy as well as age, color, living city, number of consultations prenatal, site of consultations, among others. The data were passed to the Excel program and analyzed quantitatively, to compare Study and Control groups on the ASSIST score related to each psychoactive drug, we used the Student’s T Test for unrelated samples. It was considered significant samples where p Results The obtained results, shown below, do not allow to say that the groups differ, although the sample size and the low frequency of drug use in the groups studied compromise the accuracy of information. In percentage, 80.32% of all pregnant women have proved any drugs. Among the groups, the Study 70.83% have used drugs and in the control group 81.48% have used drugs. Psychoactive drugs most used by pregnant women are: alcohol 77,0% and tobacco 42,6%. In the correlation between the use of each type of drug with additional information about pregnancy and previous pregnancies – The use of tobacco, the less prenatal consultations, higher the score, in the Study group – The use of marijuana, the number of children who died (fetal or neonatal previous) was higher in the Study group – The use of cocaine, the number of children who died (fetal or neonatal previous) was higher in the Study group – The use of sedatives, the number of prenatal consultations, the highest score in the Study group SUBSTANCE Study % Control % Total % P Tobacco Alcohol Marijuana Cocaine Amphetamine Inalants Sedatives Hallucinogens Opiates. Download : Download high-res image (180KB) Download : Download full-size image Conclusion Distribution ASSIST score among these drugs was more abuse and addiction to alcohol and tobacco in the Control group compared to the Study group. Although we saw that the Hypertensive group made greater use of cocaine, amphetamine and opioids than those of the Control group. The other comparisons were not significant and the larger sample can clear the results.

Introduction A systematic delivery approach in pregnant women diagnosed with preeclampsia could avoid risks to both mother and newborn. A study about these outcomes could guide this practice. Objectives Evaluate epidemiological characteristics and compare maternal and neonatal outcomes in gestations with and without preeclampsia. Methods Prospective study with 40 women was developed in Guilherme Alvaro Hospital- Santos/Sao Paulo/Brazil (December/2015–May/2016). Study group: 20 women with preeclampsia according to NHBPEP – National High Blood Pressure Education Program (2000), > 37 weeks. Control group: 20 pregnant women with single and live fetus, > 38 weeks, without comorbidities. Exclusion criteria for study group: twin pregnancy, fetal anomalies and gestational age under 37 weeks. Control group exclusion criteria: twin pregnancy, gestational age under 38 weeks, cesarean/ forceps/ induced vaginal delivery and comorbidities. Maternal variables: age, gestational age at delivery, previous pregnancy history, body mass index (BMI), comorbidities, length of hospital stay, intensive care unit admission, previous preeclampsia and delivery route. Neonatal variables: birth weight, adequacy weight for gestational age, Apgar score, meconium fluid at delivery, intensive care unit admission, acute respiratory distress syndrome, cardiopulmonary arrest, jaundice, oxygen therapy and intrahospital mortality. The statistical comparisons were made using Fisher’s exact test and Tukey multiple comparisons method. Data analysis was performed by calculating odds ratio adoption hypothesis and the rejection level of 0,05. Results Comparison between preeclampsia and normal pregnancies in maternal and neonatal outcomes (* = p 0 , 05 ): Download : Download high-res image (201KB) Download : Download full-size image Conclusions Preeclampsia is more often associated with maternal and neonatal adverse outcomes when compared to the healthy pregnancies. Women diagnosed with preeclampsia appears to be older, have higher body mass index, longer hospital stay (including intensive care unit) and have previous preeclampsia more often than those without this comorbidity. There is a lack of significance in comparing neonatal outcomes between the systematic delivery approach at 37 weeks and the control groups.

Introduction Preeclampsia is an expressive cause of maternal and neonatal morbidity and mortality, studying it contributes to guide approach strategies. Objectives Compare epidemiological characteristics, maternal and neonatal outcomes between preeclampsia and normal pregnancies with spontaneous vaginal delivery after 38 weeks. Methods Retrospective study with 124 women, through medical records review, was developed in Guilherme Alvaro Hospital- Santos/Sao Paulo/Brazil (July/2015–May/2016). Study group: 71 women with preeclampsia according to NHBPEP- National High Blood Pressure Education Program (2000) criteria, with single and live fetus, regardless of gestational age. Control group: 53 pregnant women with single and live fetus, after 38 weeks of gestation, without comorbidities. Exclusion criteria for study group: twin pregnancy and fetal anomalies. Exclusion criteria for control group: twin pregnancy, gestational age 38 weeks, cesarean/forceps/induced vaginal delivery, fetal anomalies and presence of comorbidities. Maternal variables: age, gestational age at admission, previous pregnancy history, body mass index and length of hospital stay. Neonatal variables: weight and adequacy weight for gestational age, height, Apgar score, intensive care unit admission, length of hospital stay and respiratory and non-respiratory complications. The study was approved by Guilherme Alvaro Hospital’s ethics and research committee. Statistical comparisons for categorical variables were made using Fisher’s exact test, and t-Student test for numerical variables. Data analysis was performed by calculating odds ratio adoption hypothesis and the rejection level of 0,05. Results Comparions between preeclampsia group and control group in maternal and neonatal outcomes (* = p 0,05): Download : Download high-res image (187KB) Download : Download full-size image Conclusions Preeclampsia is more often associated with maternal and neonatal adverse outcomes if compared to the normal pregnancies. Women diagnosed with preeclampsia appear to be older, have higher body mass index and longer hospital stay. The results show that newborns from the study group present lower weight and smaller height at birth, longer hospital stay (including in intensive care unit) and acute respiratory distress syndrome development.

Introduction Preeclampsia is associated with complications especially in severe forms. Recognize this condition can direct to adoption of different behaviors. Objectives Evaluate epidemiological characteristics and compare maternal and neonatal outcomes of mild and severe preeclampsia in pregnancies that results in delivery after 37 weeks of gestation. Methods Prospective study with 40 women was developed in Guilherme Alvaro Hospital-Santos/Brazil, during December/2015 and May/2016. Study group: 20 women with preeclampsia (13 mild and 7 severe), according to NHBPEP – National High Blood Pressure Education Program (2000) criteria and gestational age > 37 weeks. Control group: 20 pregnant women with single and live fetus, > 38 weeks, without comorbidities. Exclusion criteria for study group: twin pregnancy, fetal anomalies and gestational age under 37 weeks. Control group exclusion criteria: twin pregnancy, gestational age under 38 weeks, cesarean/forceps/induced vaginal delivery and comorbidities. Maternal variables: age, gestational age at delivery, previous pregnancy history, body mass index (BMI), comorbidities, length of hospital stay and intensive care unit (ICU) admission, previous preeclampsia and delivery route. Neonatal variables: birth weight, adequacy weight for gestational age, Apgar score, meconium fluid at delivery, intensive care unit admission, acute respiratory distress syndrome, cardiopulmonary arrest, jaundice, oxygen therapy and intrahospital mortality. The statistical comparisons were made using Fisher’s exact test and Tukey multiple comparisons method. The significance level was p 0,05. Results Comparison between the three groups in maternal and neonatal outcomes (* = p 0,05): Download : Download high-res image (199KB) Download : Download full-size image Conclusions The present study showed that the mild preeclampsia group has better results than the severe group in some variables. This first group had no need of mother ICU admission, their BMI is higher and was the group with more previous preeclampsia. The severe preeclampsia group has a significant level of arterial hypertension, stayed longer in the hospital and their newborn had presented more general complications. Data shows more favorable maternal and neonatal outcomes in the control group.

Introduction End stage renal disease usually disrupts normal gonadal function and leads to infertility. After successful renal transplantation, fertility improves within months and pregnancy occurs in approximately 12% of childbearing age women. Progressive proteinuria and glomerulosclerosis characterize chronic allograft nephropathy. Injury of parietal epithelial cells in glomeruli, the podocytes, is the initiating cause of many renal diseases, leading to proteinuria with possible progression to glomerulosclerosis. Podocytes must completely cover the filtration surface area with foot processes to maintain the glomerular filtration barrier. Failure to achieve this task due to reduced podocyte number, size, or function, or increased glomerular volume (quantitated by “podometric” methodology), results in progressive glomerular dysfunction, causing proteinuria and glomerulosclerosis and ultimately leading to end-stage kidney disease. Assessment of podocyturia and its correlation with other renal parameters could help with the diagnosis and definition of prognosis of the glomerulopathies, thus contributing to risk reduction. As during gestation there is a physiological increase in the glomerular filtration rate and reduction of serum creatinine, even mild elevations of the later can indicate renal function deficit. Objective To evaluate podocyturia and other renal parameters as functional markers in pregnant women. Methods 50 pregnant women with kidney grafts had their urine samples evaluated by indirect immunofluorescence for detection of podocyturia, as well as for dosages of albuminuria and retinol binding protein (urRBP). Results The mean age of the women was 28 years; 17 did not exhibit urinary podocytes and 22 had podocyturia in the 3rd trimester. Serum creatinine levels in the 3rd trimester and post childbirth were both increased compared to the 1st and 2nd trimesters (p Conclusion Levels of urinary podocyte, blood pressure and proteinuria were associated with worsening of kidney function during pregnancy. The proteinuria level in the 3rd trimester was higher when compared to the 1st and 2nd trimesters. There was a significantly greater excretion (P GRANT FAPESP 20140213-7.

Introduction Pre-eclampsia (PE) is one of the biggest causes for maternal mortality in the world. Identifying risk groups and using acetylsalicylic acid (AAS) and calcium (Ca) are pointed as important measures in the attempt to reduce maternal and fetal morbidity. Aim To assess, among patients with PE, the percentage of risk factors (RF) identifiable and to verify, among them, how many have used some prevention method. Methodology it were evaluated medical records and prenatal cards of all patients that have developed PE (n = 50) between January and May 2016. Also, a targeted questionnaire was applied to identify the RF and the use of some preventive medication for PE. It were considered RF: primiparity, previous PE history, chronic arterial hypertension, pre-existent kidney disease, thrombophilias, autoimmune diseases, multiple pregnancy, PE family history, diabetes mellitus, obesity and advanced maternal age. All patients have signed a free informed consent. Results The results are presented in the attached table. The vast majority of patients with PE (90%) had some RF identifiable during prenatal and a great part (86%) presented more than one. However, it was observed a small prescription rate of AAS and/or Ca in this population. Conclusion We have observed that among patients with PE, the RF presence is considerable. We also have observed a low prescription of AAS and Ca in this population. PE is a potentially fatal pathology and the interventions in an attempt to prevent its arising are few. We have verified that despite they exist, they are not used in the routine practice. Actions for making the assisting team more conscious shall be employed, as well as disseminating the scientific knowledge in a more comprehensive form. Download : Download high-res image (512KB) Download : Download full-size image

Introduction Preeclampsia (PE) and cardiovascular disease (CVD) have similar pathophysiological mechanisms and they also share some risk factors. The relationship between hypertensive disorders in pregnancy and CVD has not been totally elucidated; perhaps the metabolic stress and vascular injury may contribute to increase this future risk in such women. Objectives Investigate correlation between hypertensive disorders in pregnancy and incidence of postpartum CVD and metabolic syndrome. Methods Case-control study with a total of 65 women (45 normal pregnancy and 20 gestational hypertension). These volunteer patients were submitted to clinical, laboratorial and nutritional evaluation (bioimpedance BIODYNAMICS 310e, USA). The risk scores were estimated by using Findrisc Diabetes Risk Calculator (FDRC) and Framingham Risk Score ATP III (FRS-ATPIII); diagnosis of metabolic syndrome was based on the International Diabetes Federation (IDF) worldwide definition. Results Mean age of control group (CG) was 47.5 years and of gestational hypertension group (HG) was 43.8 years. The mean period postpartum that those patients were evaluated was 12.4 years in HG and 18.0 years in CG. Half of the HG had preeclampsia. Chronic hypertension (CH) was observed in 70% of HG and 24% of CG (p ⩽ 0.05). FDRC indicated high risk of diabetes over 10 years in 45% of HG and 21% of CG. Metabolic syndrome was present in 75% of HG and 26.6% in CG (p ⩽ 0.05). The mean body mass index (BMI) was 31.5 kg/m2 (obese) in HG and 26.5 kg/m2 (overweight) in CG. The body fat percentage detected by bioimpedance was similar, 38.5% in HG and 35.8% in CG. The FRS-ATPIII indicated low risk of CVD over 10 years in both groups. Conclusions The incidence of CH and metabolic syndrome appears to be increased in women who had hypertensive disorders in pregnancy, especially PE. A higher risk of developing diabetes over 10 years was also found in HG. The investigation of the history of hypertension during pregnancy may help preventing and early diagnosing those comorbidities. Fapesp n° 2014/00213-7

Introduction Thrombotic microangiopathy (TMA) represents a spectrum of disorders characterized by thrombosis that affect small arterial vessels. Pregnancy is a potential trigger to acute episodes of TMA, which in turn, although rare, are associated with high maternal and perinatal morbidity and mortality. In renal transplant (RT) setting, fertility is increased by restoration of renal function, meanwhile RT patients are more susceptible to gestational complications, such as TMA syndromes. Objectives The aim of this study was to report our experience with RT recipients who developed TMA in allograft during pregnancy. Methods We describe four cases of pregnant RT recipients with TMA diagnosed by allograft biopsy, due to acute allograft dysfunction, at Hospital do Rim between 2011 and 2015. Their clinical and laboratory data were collected and are highlighted here. Results At conception, the average age was 21 ± 4 years. Their obstetric history revealed previous abortions in two patients and one previous uncomplicated pregnancy in another patient. All patients had chronic hypertension before conception and one patient also had preexisting proteinuria greater than 0.5 g. At the time of the confirmation of pregnancy, 75% of the patients were being maintained on immunosuppressive therapy with prednisone, tacrolimus and azathioprine, while one patient was receiving prednisone, tacrolimus and everolimus. The mean interval time of RT to pregnancy was 25 (9–45) months and the average baseline creatinine was 1.1 (0.9–1.4). The TMA diagnosis was established in the 14th week of gestation on average, and it was associated with thrombocytopenia and microangiopathic hemolytic anemia in only one patient. Moreover, concomitant acute cellular rejection (AR) occurred in one patient, and superimposed urinary tract infection in another. Except for the patient who had AR, in all cases the calcineurin inhibitor was withdrawn. Three patients developed preeclampsia with HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome. The mean gestational term at delivery was 23 ± 2 weeks and these resulted in two abortions and two stillbirths. Over a 6 month follow-up period post pregnancy, there was one case of graft loss and all patients had increased proteinuria and creatinine levels – median creatinine = 4.3 (1.5–11); median proteinuria = 1.1 (0.6–1.9). Conclusions Since HELLP syndrome was very prevalent in these cases we suggest that the TMA diagnosis demands careful surveillance for gestational hypertension complications. Apart from the poor pregnancy outcomes, TMA in pregnant RT patients is associated with deterioration of graft function.

Introduction Association between antiphospholipid antibodies and poor gestational outcomes is recognized for decades. For the diagnosis of Catastrophic Antiphospholipid Syndrome (CAPS) is necessary high clinical suspicion and intensive care support is essential to save the patients in this really catastrophic disorder. Objectives Description of a case report and literature review of CAPS in gestation, looking updates in relation to the early diagnosis and appropriate management of these patients. Methods Case report of CAPS during pregnancy and literature review on Pubmed. Results Z.M.S.S, 33, G5P2, previously diagnosed with primary APS sought care at Hospital Sao Paulo on February 7, 2014, with a 34 weeks pregnancy, presenting hypertension, lower limb edema associated with laboratory findings of proteinuria and thrombocytopenia - Hellp syndrome class II (platelet 57.000). After pressure control, anticonvulsant therapy with magnesium sulfate, she was submitted to an emergency C/S with general anestesia, giving birth to a newborn female, weighing 2130 grams, Apgar 8/8. Evolved rapidly with coagulation disorder, severe epigastric pain radiating to the lower back, in association with sudden onset of pain in the left upper limb, having been referred to intensive care unit where she stayed until February 26. During research, we identified multiple vascular occlusion sites (hepatic microcirculation thrombosis, renal cortical and left brachial vein). The paciente underwent to immunosuppressive therapy with methylprednisolone, immunoglobulin and anticoagulation, with progressive improvement, and was home discharged on March 4, 2014 in good health. Catastrophic Antiphospholipid Syndrome (CAPS), also known as Asherson Syndrome, it’s a potentially fatal variant, that affects less than 1% of patients with antiphospholipid syndrome (APS). It was first described in 1992 by Asherson, is characterized by multiple vascular occlusive events, mainly affecting small vessels. Affects concomitantly different tissues, with progressive and rapid deterioration, leading to multiple organ failure and high mortality. Usually presents thrombocytopenia, hemolytic anemia associated with antiphospholipid antibodies in high titers. It may be the first manifestation of APS in a large percentage of cases. Among the triggers are infections, surgery, trauma, anticoagulation interruption and pregnancy. Clinical support is essential and includes removal of provocative factor, corticosteroid therapy, anticoagulation, intravenous immunoglobulin and plasmapheresis. Conclusion Although less than 1% of patients with APS develop this condition and despite all of the recommended therapies, this potentially fatal outcome (near 50%) shows their importance in modern medicine. Finally, we would like to thank the support of our Intensive Care Unit and Reumatology teams at UNIFESP.

Intense inflammatory response and an anti-angiogenic state have been implicated in the pathogenesis of preeclampsia. Here, we investigated this hypothesis evaluating the serum concentrations of CXCL10/IP-10, sFlt-1, and PlGF in women with early-onset preeclampsia. CXCL10/IP-10 was measured by Cytometric Bead Array. sFlt-1 and PlGF were measured by automated electrochemiluminescence immunoassay. The median serum concentration of CXCL10/IP-10 was 109.5pg/mL in preeclamptic women, as compared with 52.28pg/mL in the controls (P=0.0028). The mean serum level of sFlt-1 was 13,636pg/mL in preeclamptic women, as compared with 2020pg/mL in the controls (P0.0001). PlGF levels were significantly lower in women with preeclampsia.

Objective To evaluate morbidity and mortality, during the first 24 months of postconceptual age, of children with very low birth weight, whose mothers were diagnosed with gestational hypertensive disorders and compare them with very low birth weight children from otherwise etiologies. Methods Retrospective cohort study, which included preterm children, with birth weight lower than 1.500 g, born at the Hospital Sao Paulo of the Federal University of Sao Paulo, between 2.004 and 2.007, whose mothers received prenatal care and obstetrical assistance during hospital stay, and were followed up until 24 months of corrected age. Resulsts 93 Patients were selected, including 49 children whose mothers were diagnosed with hypertension and 44 without such disease. Seven (14.3%) children from the group of hypertensive mothers died before hospital discharge. Among the 42 survivors, 14 (33.3%) were not followed up (no follow-up group) and 28 (66.7%) were eligible for analysis. Among the 44 children without the hypertensive history, 12 (27.2%) died before discharge. Among the 32 remaining, 11 (34.4%) were not followed up (no follow-up group) and 21 (65.6%) were assessed. There was no significant statistical difference in the hospital mortality rates of both groups and the overall mortality was 20.4%. The number of deaths was higher among children with birth weight lower than 1000 g ( p p = 0,015) and magnesium sulfate ( p p p p = 0.011), lower gestational age at birth ( p = 0.044) and bronchopulmonary dysplasia ( p = 0.007) were all more prevalent in the no maternal hypertension group. The remaining variables showed no statistically significant differences between the two groups. At 24 months of corrected age, there were no statistically significant differences for all variables. Conclusion We have identified a high prevalence of perinatal complications in our whole sample. Preterm delivery remains a major and complex health problem, accounting for most of neonatal morbidity and mortality, not to mention the high prevalence of sequels among survivors, no matter its cause. The authors thank FAPESP (Process 2014/00213-7) for its support in the execution of this work.

Introduction Trophoblast cell invasion is one of key steps for successful pregnancy, which is controlled by several factors including cytokines that activate intracellular signaling cascades including the Janus kinase / signal transducer and activator of transcription (JAK-STAT) system. Objectives We aimed to analyze the effect of cytokines on STAT1 expression and trophoblast cell functions. Methods Immortalized HTR-8/SVneo cells were treated with interleukin-6 (IL-6) IL-11, granulocyte macrophage colony-stimulating factor (GM-CSF), leukemia inhibitory factor (LIF) and oncostatin M (OSM). STAT1 phosphorylation (tyr-701) was analyzed by Western blotting and immunofluorescence staining. Simultaneously, cells were incubated with 50 μ M Fludarabine (specific STAT1 inhibitor) or small interfering RNA (siRNA) to inhibit the expression of STAT1 and followed by cytokine stimulation. STAT1 DNA-binding activity, cell viability and invasion were analyzed by DNA-binding, MTS and Matrigel invasion assays. Results Western blot analysis and immunofluorescence staining of STAT1 phosphorylation revealed that OSM induced phosphorylation of STAT-1 stronger than LIF in HTR-8/SVneo. IL-6, IL-11 and GM-CSF had no effect on STAT1 activation. STAT1 phosphorylation was inhibited by STAT1 siRNA and Fludarabine. STAT1 inhibition reduced STAT1 DNA binding activity and OSM could not rescue this effect. OSM stimulated HTR-8/SVneo cell viability and invasion, whereas STAT1 inhibition decreased trophoblast cell invasion. This reduction could not be prevented by OSM. Conclusions These findings demonstrate that the OSM-STAT1 axis plays an important role in trophoblastic cells and STAT1 activation may induce a variety of cell functions

Introduction Preeclampsia (PE) is a multifactor disease responsible for enormous amount of maternal and perinatal mortality worldwide. The growing knowledge about the disease has highlighted several biomarkers that may act in synergistic ways in the pathogenesis of PE, mainly the anti-angiogenic factor sFlt-1. Recently, some authors have demonstrated the involvement of the angiogenic microRNA-210 (miR-210) in the development of PE. Objective Our aims for this study were to re-evaluate the expression of sFlt-1 and miR-210 by preeclamptic placentas and determine any correlation between these two biomarkers. Methods Placentas were collected from normal and preeclamptic patients ( n = 11 in each group). These tissue samples were flash-frozen in liquid nitrogen within half an hour of placental delivery. Total RNA was extracted using the acid guanidinium thiocyanate–phenol–chloroform extraction technique and their concentrations were determined using spectrophotometer. qRT-PCR was performed for the quantitation of Flt1, sFlt13, sFlt14 and miR-210. Results The mRNA expression of sFlt-1 and miR-210 in PE and controls were respectively (14.70–1.047) and (2.737–1.125). We also identified a strong correlation between sFlt-1 and miR-210 ( R 2 = 0.7967, p Conclusion Our results confirm previous observations regarding the increased mRNA expressions of sFlt-1 and miRNA-210 by preeclamptic placentas and highlight the dysregulation of the angiogenic process in the pathogenesis of PE.

Background Women regain fertility a few time after renal transplantation. However, viability of pregnancy and maternal complications are still unclear. Methods Retrospective study of pregnancies in kidney transplanted patients between 2004 and 2014, followed up 12 months after delivery. Each pregnancy was considered an event. Results There were 53 pregnancies in 36 patients. Mean age was 28 ± 5 years. Pregnancy occurred 4.4 ± 3.0 years post-transplant. Immunosuppression before conception was tacrolimus, azathioprine, and prednisone in 74% of the cases. There were 15% miscarriages in the 1st trimester and 8% in 2nd trimester. In 41% of the cases, it was necessary to induce labor. From all births, 22% were premature and 17% very premature. There were 5% stillbirths and 5% of neonatal deaths. De novo proteinuria occurred in 60%, urinary tract infection in 23%, preeclampsia in 11%, acute rejection in 6%, and graft loss in 2% of the cases. It was observed a significant increase in creatinine at preconception comparing to 3rd trimester and follow-up (1.17 vs. 1.46 vs. 1.59 mg/dL, p Conclusion Although the sample is limited, the number of miscarriages was higher than in the general population, with high rates of maternal complications. Sustained increase of creatinine suggests increased risk of graft loss in long-term.

Introduction Acute fatty liver of pregnancy is defined by the infiltration of microvesicles of fat in hepatocytes and mitochondrial dysfunction, that occurs usually in the third trimester of pregnancy. It is very rare, occurring in 1: 700-1: 20,000 pregnant women, more often in multiple pregnancies. It is described mortality rates greater than 85% if there is no early recognition and prompt interruption of pregnancy. The main differential diagnosis is HELLP syndrome, since there is a large overlap of clinical signs and symptoms of these diseases. Treatment consists in maternal-fetal support until the resolution of pregnancy. Most patients reverse the symptoms and laboratory abnormalities less than one month after delivery. However, there is a risk of recurrence in subsequent pregnancies. Case report A 26 years old patient, Gravida 2 Para 1, with a 33w pregnancy, was hospital admitted due to fever, myalgia, vomiting and severe prostration for the last week. Physical examination revealed jaundice, dehydration, lower limbs edema, fever and tachycardia. Initial lab tests revealed mild leukocytosis, slightly elevated inflammatory markers, impaired renal function, increased bilirubin levels – due to direct bilirubin, substantially elevated aminotransferases, low albumin and enlarged IRN – context that supported the hypothesis of hepatic failure in pregnancy – acute fatty liver of pregnancy. Patient presented clinical worsening of liver and renal function + coagulopathy, and after maternal compensation opted for delivery – C/S. Intensive care and transfusional therapy were necessary to reverse the maternal morbidity context. Progressive improvement in the postpartum period was noted, and the patient was home discharged on day 17th, referred to family planning program – which she did not attend. Six months later, patient appears “de novo” to prenatal care, Gravida 3 Para 2, with a 18w pregnancy, raising the discussion on maternal risk. Possibility of termination of pregnancy was considered, but remained the choice for close follow up with strict control and maintenance of pregnancy. At 38 weeks, an elective C/S delivery was scheduled due iterativity and gestational thrombocytopenia. A healthy male newborn, 2360g Apgar score 9/10 who was discharged along with the mother on day 3. Discussion Although the outcome of last pregnancy has been favorable, it could have been dramatic. Hepatic disease poses a huge risk, what reinforces the importance of family planning counseling and contraceptive protocols – especially for long-acting reversible contraception – in women with potentially life-threatening conditions in order to reduce maternal mortality and finally achieve the Millennium Development Goal 5.

Introduction Assessment of proteinuria is essential to diagnose preeclampsia; it can be detected in spot urine sample or 24-hour urine collection. It has been shown that urine protein to creatinine (P/C) ratio seems to be highly predictive for detection of proteinuria in preeclampsia (PE). Objectives Evaluation of P/C ratio in normal pregnancy, and pregnant women with chronic hypertension (CH) and with PE. Methods P/C ratio was measured in 24 normal pregnant women, 14 with PE and 97 with CH. Proteinuria was detected by automated pyrogallol method and creatininuria by alkaline picrate method. Results Mean age of control group was 26 years, of PE group, 26 years and of CH group 34 years. P/C ratio was undetected in the control group, it was elevated in 5.2% of the CH group and in 100% of the PE group, also confirmed with 24-hour urine collection. Serum creatinine was elevated in 19.6% of the CH group and 42.8% of the PE group. Conclusions P/C ratio may be a good predictor of PE and it could be used as an alternative test to detect proteinuria in pregnant women, because it is faster and it is not influenced by serum creatinine concentration. Proteinuria should be evaluated during the prenatal care of CH women allowing early detection of incipient nephropathy. Fapesp n° 2014/00213-7. Renal evaluation in preeclampsia group. Download : Download high-res image (159KB) Download : Download full-size image

Introduction Glomerular filtration rate (GFR) increases during pregnancy and some incipient nephropathies may appear after this period, especially when gestational hypertension (GH) is present. Objectives Renal evaluation in women over 10 years after pregnancy. Methods Total of 30 volunteer patients whose last childbirth was 10–20years ago. Renal parameters assessed were: urinary excretion of retinol-binding protein (RBP), urine protein/creatinine ratio (PCR), Urine albumin/creatinine ratio (ACR), serum creatinine, serum C cystatin, vitamin D (25OHD), serum uric acid, vascular endothelial growth factor (VEGF), estimated GFR (eGFR) based on Modification of Diet in Renal Disease (MDRD) Study and the Chronic Kidney Disease Epidemiology Collaboration equation – CKD-EPI Creatinine, 2009 (CKD-EPI crea), CKD-EPI Cystatin C, 2012 (CKD-EPI cys) and CKD-EPI Creatinine-Cystatin C, 2012 (CKD-EPI crea-cys) equations. Results The average age was 45.5years old, 56.6% were afro descendant, and mean time after last labor was 13.7years. Approximately 6.6% had type 2 diabetes and 30.3% had chronic hypertension (CH) after pregnancy (among them 90% had GH). Mean body mass index (BMI) was 29.1kg/m 2 (overweight), although all patients with CAH were obese. Mean value of cystatin C was 1.45mg/L (elevated in 20%), RBP 0.30mg/L (high level in only one case), PCR 0.02g/g, ACR 6.91mg/g creatinine (high level in only one case), 25OHD 24.34ng/mL (deficiency in 33.3%), serum uric acid 4.50mg/dL (high level in only one case), serum creatinine 0.73mg/dL (normal level in all cases), VEGF 312.04pg/mL (high level in two cases). Mean clearance of creatinine using MDRD was 93.5mL/min/1.73m 2 , CKD-EPI crea 101.7mL/min/1.73m 2 , CKD-EPI cys 49.0mL/min/1.73m 2 and CKD-EPI crea-cys 68.3mL/min/1.73m 2 (about 30% less when compared with the equations without cystatin C, then 26.6% had eGFR 2 ). None of the patients had ever been assisted by a nephrologist. Conclusions Obesity, CH, 25OHD deficiency, high levels of serum cystatin C and low eGFR may appear years after pregnancy, especially if GH was present. Women who had GH should have long-term follow up with nephrologist to have a more complete and regular renal evaluation. The eGFR by combined creatinine-cystatin C equation seems to be better than other formulas and it could be useful to detect early chronic kidney disease. Fapesp n° 2014/00213-7

Introduction After caring of some patients with liver disorders in pregnancy we decided to review the main differential diagnosis of preeclampsia (PE) and liver disease. Objectives A quick review of the liver diseases related to pregnancy. Methods 2 case reports and a Pubmed review in recent years of the main differential diagnosis of PE. Results : Case 1: Pregnant 33 weeks gestation due to fever, myalgia, heartburn, vomiting, edema, jaundice (J), normal blood pressure (BP) and the following abnormal laboratory tests: leukocytosis, C-reactive protein, direct bilirubin (3.5 mg/dL), alanine aminotransferase (ALT) (643U/L), aspartate aminotransferase (AST) (421U/L), creatinin (C) (1.4 mg/dL), urea, coagulopathy and hypoglycemia (54 mg/dL). After 3 days, evolves with renal and hepatic insufficiency and underwent cesarean section (CS) and it was necessary treatment for atonia uterine. The patient received fresh frozen plasma, cryoprecipitate, packed red blood cels and intensive care (IC). Both, patient and newborn, home discharged in good health. Case 2: Pregnant 30 weeks of gestation complaining of itching and dark urine beginning 2 months earlier. Admitted at the hospital with J, elevation of ALT, AST, bilirubin, C and proteinuria. After 48 h of corticosteroids the patient was submitted to CS and had worsened renal and hepatic function. Liver biopsy was performed. HELLP syndrome The association of hemolysis, low platelet counts (PLTs) and elevated liver enzyme levels (LEL) is known by HELLP syndrome (SD). Occurs in about 0.5–0.9% of all pregnancies and complicates 10–20% of cases with severe PE, but some have the SD without hypertension. In 70% occurs in ante partum, in the third trimester. The symptoms are nausea, vomiting, epigastric and right upper quadrant abdominal pain. The pathogenesis is still a mystery; the association with PE supports the theory of deficient trophoblastic invasion causing inflammation and endothelial dysfunction. The treatment is delivery and IC. Acute fatty liver of pregnancy Acute fatty liver of pregnancy (AFLP) is a rare condition characterized by microvesicular steatosis associated with mitochondrial dysfunction that occurs mostly in the third trimester. Nausea, malaise, abdominal pain, J, fever, pruritus, hypertension, headache, coagulopathy, ascites, hypoglycemia and rarely encephalopathy are the symptoms. Effective treatment depends on how earlier is the resolution of pregnancy and IC. The patient generally improves from hepatic and renal failure and recovery in most cases within a few days. Intrahepatic cholestasis of pregnancy Intrahepatic cholestasis of pregnancy (ICP) is a dysfunction, mostly in the third trimester, of bile acid (BA) transport across the canalicular membrane that results in systemic accumulation of BA with intense pruritus. The pathogenesis is unknown but involves a genetic hypersensitivity to estrogen (E) or E metabolites. ICP has a benign prognosis to women but a higher risk of the fetus. The treatment is with symptomatic relief for the mother, supervision of the fetus, ursodeoxycholic acid and delivery. Conclusion The similar symptoms of hepatic diseases in gestation often lead to a retrospective diagnosis. However the resolution of pregnancy and an IC of patients with HELLP SD, AFLD and ICP generally is the main form of treatment. The first case diagnosis was AFLD and the result of the biopsy in the second case was ICP. Finally, we would like to thank the support of our Intensive Care Unit and Gastroenterology teams at UNIFESP.

Introduction Pre-eclampsia (PE) is a public health problem with possible fatal consequences for mother and fetus. Recent studies point that the regular consumption of chocolate and its metabolites could exert a beneficial cardiovascular effect, acting in the endothelial dysfunction and oxidative stress, important changes also observed in PE. Literature has been controversial regarding this issue but there are still many questions about the possible impact of these substances in the physiopathological process involved in PE. Aim To assess, in a convenience sample, the chocolate consumption profile in patients diagnosed with PE. Methodology A comparative and retrospective study was performed between two groups of primiparous patients. Initially were identified all patients that have developed pre-eclampsia between January and May 2016 (n = 49) whose birthing happened on Maternity Hospital Vila Nova Cachoeirinha (HMEC) at the city of Sao Paulo by means of medical records and prenatal cards. A control group (n = 48) of primiparous patients was formed that did not present pathologies during pregnancy, paired according to maternal age and birth gestational age. Through the questionnaire, it was evaluated the weekly chocolate consumption frequency in these patients. The following possibilities were considered: (a) less than once a week, (b) once a week, (c) twice a week and (d) more than 3 times a week. Results For all consumption ranges informed, meaningful differences among the groups were not detected (Table 1). Conclusion Despite some studies suggest the use of chocolate in pregnancy as a possible protective factor for PE development, the results obtained in the sample studied do not identify any correlation. However, it shall be considered the limitations of this study having in sight the sample size included and the difficulties to define accurately the quality of the food consumed. Additional studies are needed to understand the possible impact of chocolate consumption in the physiopathological process and consequential PE prevention. The authors thank the support of FAPESP 2014.00213/7.

Introduction Clinical forms of early and late preeclampsia have different physiopathological mechanisms. Their influence in the most adverse outcomes is related with as earlier the delivery occurs. Objectives Compare maternal and neonatal outcomes of preeclampsia according to gestational age and identify some maternal characteristics related in each group. Methods Retrospective study with 71 women, through medical records review, was developed in Guilherme Alvaro Hospital-Santos/Sao Paulo/Brazil (July/2015-April/2016). This study involved pregnant women diagnosed with preeclampsia according to NHBPEP – National High Blood Pressure Education Program (2000), with single and live fetus, regardless of gestational age. Patients were divided into three groups according to delivery gestational age: 20 for early group ( 37 weeks). Exclusion criteria: twin pregnancy and fetal anomalies. Maternal variables: age, gestational age at admission, previous pregnancy history, length of hospital stay, body mass index (BMI), chronic hypertension and diabetes mellitus. Neonatal variables: weight, adequacy of weight for gestational age, height, length of hospital stay, intensive care unit (ICU) admission, Apgar score and respiratory and non-respiratory complications. The study was approved by Guilherme Alvaro Hospital’s ethics and research committee. Statistical comparisons for categorical variables were made using Fisher’s exact test, and Tukey multiple comparisons method for numerical variables. The significance level was p Results A comparison between the three groups of preeclampsia according to maternal and neonatal outcomes (∗ = p Conclusions Preeclampsia delivery before 34 weeks is more often associated with maternal and neonatal adverse outcomes if compared to deliveries after this gestational age. Patients from early preeclampsia group stay longer in hospital and they are usually non-diabetic. Their newborns present lower weight, smaller height, lower Apgar scores at birth, longer hospital stay (including in ICU) and acute respiratory distress syndrome development. There is a lack of significance in associating maternal age, BMI and chronic hypertension with maternal and neonatal adverse outcomes.

Objectives There has been an increase in the number of pregnancies in renal transplant recipients. In recent years there has been a change from the option of immunosuppressive therapy in its patients. Unlike the previous standard of clinical care where cyclosporine was a common option, currently tacrolimus is the first choice in our group. However both options involve risks. Thus, our goal is a preliminary evaluation of maternal and perinatal outcomes of this new interaction. Methods Eighteen patients from January 2011 to December 2013 were evaluated as clinical, obstetrical and perinatal outcomes. All of them have used tacrolimus and azathioprine. Theirs results were compared with a cohort study (2001–2015) in our group where cyclosporine where the first choice. (Data from: Oliveira LG, Sass N et al. Pregnancy after renal transplantation. A five-yr single-center experience. Clin Transplant 2007;21:301–304). Results Tacrolimus group showed lower risk for chronic hypertension, preeclampsia, anemia and urinary infection, but with an increased rate of diabetes. Among perinatal outcomes, it had a higher risk of prematurity and small for gestational age babies (Table 1). Conclusions Considering the limitations of this preliminary analysis, it would not be possible to consider tacrolimus as a protective factor for the occurrence of hypertensive complications considering that its common adverse effects are nephrotoxicity and hypertension. However a higher incidence of diabetes was apparently confirmed. It should be considered that the rates of adverse outcomes are still higher than those observed in the general population, regardless of the type of immunosuppressive therapy. Further analyzes are needed seeking the best pattern to follow these patients to reduce maternal and perinatal risks. Support: FAPESP. Processo: 2014/00213-7. Disclosures N. Sass: None. J.L. Sato: None. T.A. Facca: None. V.A. Gomes: None. H.T. Silva Junior: None. M.R. Mesquita: None. H.A. Korkes: None. L.G. Oliveira: None.

Objectives Analyze the epidemiology of affected women with cases of hypertensive disorders (SH), severe maternal morbidity (SMM) and near-miss (NM). Methods Prospective longitudinal/descriptive study (June/2013-May/2014-Guilherme Alvaro Hospital/Santos-Brazil), included women with at least one criteria recommended by the authors (Santos criteria) derived from the definition of MMG and NM (admitted to ICU) of the World Health Organization (2009), Waterstone et al. (2001), Mantel et al. (1998), seeking to homogenize/facilitate this definition according to clinical/laboratory/ management, using hospital records and interviews with women, describing the epidemiology/outcomes/economic status and quality of prenatal care. Results We identified 54 women (46 MMG, NM 07 and 01 maternal death from sepsis). Reasons (/1000 births):MMG 33.63 and NM 5.11. White women (48.8%), above 35 years old (38.8%), 70% overweight/obese (82.5% associated with SH), and were often poor, incomplete secondary education, 41.5% multiparous, with previous preeclampsia (PE), 29.5% eclampsia and 8% fetal death , when prenatal consultation 57.64% were less than six with difficult access (35%). 88.8% SH: 36 chronic hypertension and superimposed PE (63.8%) and one with eclampsia, 22% severe PE, mainly contributing to NM, 54.1% and were not counseled on signs/symptoms of severity. The prevalent mode of delivery was cesarean section (79.54%), prematurity (69%), 03 cases of hysterectomy and 07 stillbirths. Of live births: 24.1% small for gestational age, 08 ICU admissions,05 neonatal deaths. Santos’ criteria (adapted from the WHO, Waterstone et al. and Mantel et al. criteria) Clinical Sever chronic hypertension (BPD ⩾ 110), Severe preeclampsia superimposed (BP ⩾160 × 110 mmHg) Severe preeclampsia: Proteinuria >2 g/24 h, Creatinine >1.2 mg/dL, Platelets Acute pulmonary edema, epigastric pain, eclampsia, HELLP syndrome, Severe hemorrhage (blood loss >1500 mL), severe sepsis, uterine rupture, pulmonary edema Acute cyanosis, gasping, cerebral vascular accident Respiratory rate > 40 ipm or Total paralysis, coma ⩾12 h, jaundice with preeclampsia Cardiopulmonary arrest, thyrotoxic crisis, endometritis Congestive cardiac insufficiency, urine output less than 400 mL/24 h, refractory to hydration, furosemide or dopamine Laboratory Oxygen saturation 2 /FiO 2 Creatinine ⩾300 mmol/L or ⩾3.5 mg/dL Bilirubin >100 mmol/L or >6.0 mg/dL pH 5, ketoacidosis and glucose in urine Acute thrombocytopenia ( Management Continued use of vasoactive drugs Hysterectomy for postpartum hemorrhage or infection Hypovolemia and need of volume replacement with crystalloid and/or blood transfusion Intubation and ventilation for ⩾60 min not related to anesthesia Dialysis for acute renal failure Intubation and ventilation for ⩾60 min not related to anesthesia Anesthetic accident: severe hypotension after-blockade and failed intubation Conclusions Among women with severe maternal morbidity, the prevalence of hypertension, over 35 years old, poor nutritional status/low income, and prenatal care making us suggest that this population must rely on qualified contraceptive programs/preconception/prenatal guidance and knowing this group may indicate timely interventions can help guide strategies to reduce maternal mortality rates. Disclosures L. Maruoka: None. M. Imad: None. L. Leme: None. N. da Silva: None. S. Sashida: None. V. Alonso Neto: None. V. Marcal: None. J. Garcia: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.

Objectives Medical school in Brazil lasts six years to permit the M.D. degree; the first four years are theoretical and the last two are internship. This study assessed the knowledge of students of medicine about preeclampsia. Methods Questionnaire applied to 362 undergraduate students from a private school medicine in the state of Sao Paulo/Brazil with fifteen multiple choice questions about preeclampsia and its renal involvement. Results Total of 362 students, with 315 from theoretical years [first year 17.1% (54/315), second 31.7% (100/315), third 23.8% (75/315) and fourth 27.3% (86/315)] and 147 from internship [fifth year 44.2% (65/147) and sixth 55.8% (82/147)]. In relation to correct answers, first year reached 20.2% (164/810), second 20.1% (302/1500), third 23.1% (260/1125), fourth 27.3% (352/1290), fifth year 25.7% (251/975) and sixth 34.5% (425/1230), the theoretical years totaled 22.8% (1078/4725) and the internship 30.6% (676/2205), all 362 students totaled 35.6% (1754/4930). The theoretical years had over 90% of error about reference value of proteinuria in preeclampsia and its definition, the fifth year, 90.8% (59/65) about diagnostic tests for HELLP syndrome and the sixth, 79.3% (65/82) about tests to assess renal function in prenatal. The next most frequent error in internship was the definition of preeclampsia and evaluation of renal failure, fifth year had 78.1% (203/260) of error and sixth, 74.4% (244/328). There was an increase of right answers of 7.1% from first to fourth year and 8.8% from fifth to the sixth. Conclusions The knowledge of undergraduate medical students about preeclampsia and its renal involvement is apparently scarce. The emphasis on teaching preeclampsia and its evolution is important to reduce its complications. Fapesp n°2014/00213-7. Table 1. Percentage of correct answers from undergraduate medical students about preeclampsia. First year Second year Third year Fourth year Fifth year Sixth year Proportion of correct answers 20.2% 20.1% 23.1% 27.3% 25.7% 34.5% Disclosures T.A. Facca: None. E.A. Fama: None. G. Annicchino: None. J. Vieira: None. J. Vasconcelos: None. R. Campos: None. M.G. Ierardi: None. M.S. Geraldo: None. M.B. Silva: None. B.R. Ortega: None. A.R. Sabino: None. G. Mastroianni-Kirsztajn: None. N. Sass: None.

Objectives Compare the maternal and perinatal outcomes of vaginal parturition among pregnant women with chronic arterial hypertension (CAH) and normotensive pregnant women. Methods A transversal, retrospective and comparative study was performed involving 31 pregnant women with CAH that were accepted on the Hospital Guilherme Alvaro’s Prenatal Service for Expecting Women with Hypertension or Nephropathies in Santos-SP/Brazil (January 2012–December 2013) and that had obstetric resolution by vaginal delivery. For the control group were selected pregnant women without hypertension or any other comorbidities who have had obstetric resolution by vaginal delivery subsequently to the pathological pregnant women. To compare the groups the Student’s t test and Fisher’s exact test were used. Results The groups differ with regard to the following variables: age (hypertensives, in average, 7.6 years older; p p p p p p > 0.05) when compared the variables APGAR on 1′ and 5′, maternal complications, perinatal complications, birth weight and need for Neonatal Intensive Care Unit hospitalization. Conclusions In order to reduce the high rate of cesarean sections in chronic hypertensive women, strategies could be adopted to encourage vaginal delivery in these pregnant women, considering that on the study, maternal and perinatal outcomes were favorable. Despite the small sample in this study, there were no adverse maternal and perinatal outcomes that contraindicate vaginal delivery in patients with chronic arterial hypertension. Disclosures M. David: None. P. Rahe: None. V. de Campos: None. M. da Silva: None. F. Marques: None. K. Dom Bosco: None. J. Del Sant: None. J. Garcia: None. M. Paltronieri: None. M. Saito: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.

Objectives Analyze epidemiological data and the relation with potential markers of lipotoxicity in pregnancies with and without preeclampsia in a reference hospital. Methods A case-control study, 110 blood samples were collected from (August 2011–2013) in the immediate postpartum and biological potential markers of lipotoxicity analyzed which can be related to preeclampsia. Inclusion for the study group followed the NHBPEP – 2000: systolic blood pressure (⩾140 mmHg) and/or diastolic blood pressure (>−90 mmHg) two times, associated to proteinuria/24 h ⩾2 g/dL or tape reagent ⩾1 cross. Inclusion for the control group: healthy women, vaginal birth, newborn term. Exclusion criteria for all postpartum women were: comorbidities such as collagen diseases, diabetes, smoking, gemelarity and fetal malformations. Data analyzed: maternal age, body mass index (BMI) [weight/(height)[2], high urine protein, HDL (high density lipoprotein), VLDL (very low-density lipoprotein), triglycerides, mode of delivery, maternal clinical outcome, gestational age, birth weight, Apgar newborn score at one and five minutes and admission to the neonatal Intensive Care Unity (ICU). For the numerical variables of the research we used the Student t test, the Pearson’s Qui-square test and Fisher’s exact test and categorical variables. Data analysis was performed by calculating odds ratio adoption hypothesis rejection level of 0.05. Results The total of 110 blood samples (55 from the study group and 55 from the control group). Comparing the results analyzed biological potential markers of lipotoxicity (∗p Variable Control Group Study Group Variable Control Group Study Group Maternal age (average/years) 25 30∗ Neonatal ICU admission 4% 9.1%∗ Cesarean section 42.6% 77.3%∗ VLDL (mg/dl) 29 35∗ Comorbidities 19.6% 77.3%∗ Triglyderides (mg/dl) 150 185∗ Gestation age 40 35∗ HDL (mg/dl) 65 57∗ Weight newborn average 3150g 2500g∗ High urine protein (mg) 185 500∗ BMI 27 33∗ Conclusions The present study shows that the potential markers of lipotoxicity are related to preeclampsia, and eventually may indicate likely prognostics associated with clinical expressions. Additional studies can clarify this correlation and these results might be useful to orientate the adoption of practices which are able to decrease maternal/fetal risks. Disclosures B. Zeiger: None. A. Bergamo: None. D. Vidal: None. F. Aires: None. D. Ferreira: None. M. Scarpelini: None. J. Garcia: None. H. Korkes: None. M. Paltronieri: None. S. de Toledo: None. W. Chaiwangyen: None. F. Sousa: None. N. Sass: None.

Objectives Evaluate the role of placenta growth factor (PlGF) as a predictor of preeclampsia (PE). Methods Systematic review on Pubmed (february/2014) with descriptor: “(placenta growth factor OR plgf) AND pre-eclampsia/diagnosis”’. A total of 126 articles were found. Items with more than three years of publication, systematic reviews, not related to the topic after reading the abstract and unavailability of the article were excluded. Among the papers which were read in full, three were excluded because they did not use as a predictive factor PlGF, totaling 19 items for the final sample. Results Due to the heterogeneity of the articles found, four groups were defined sorted into 4 groups: Group 1 PlGF isolated Fifteen studies were conducted as a single measure of PlGF and found a decrease in patients with PE; Ten in the first half of pregnancy; five found with lower values when PE early; four found with severe lower PE values Group 2 Relation sFlt-1/PlGF Six studies determined the relationship sFlt-1/PlGF and had an increase in pregnant women with PE values in the second quarter Group 3 Combination of PlGF Doppler velocimetry of uterine arteries Of the eight articles that combined biochemical to biophysical methods, five showed improvement in sensitivity and specificity with the combination, four in the first quarter Group 4 Combination of several biomarkers Three studies investigated various biomarkers, two achieved combination of markers. While Myatt et al. (2012) found increased diagnostic capacity with the association, Myers et al. (2013) did not obtain the same result combining several biomarkers Conclusions It is suggested that PlGF is reduced in PE, alternating the values in the first half of pregnancy, especially early/severe PE. The sFlt-1/PlGF ratio is better in the second trimester of gestation (late when compared to isolated PlGF). Diagnostic ability of PlGF can be extended by associating other methods, especially biophysical. Standardized studies are needed, homogenizing the collection time, cut off values and a way of presentation of the results for the comparison be clear. Disclosures G. Calestini: None. B. Reis: None. D. Labre: None. F. Fuentes: None. F. Sousa: None. L. Wenzel: None. P. Coelho: None. W. Chanwangyen: None. S. Prieto: None. D. Prieto: None. U. Markert: None. N. Sass: None.

Objectives Identify maternal and perinatal outcome of vaginal childbirth in pregnant women with pre-eclampsia (PE). Methods Retrospective study involving 524 pregnant women with single and live fetus who gave birth at the Hospital Guilherme Alvaro – Santos/SP (January, 2012 to December, 2012) presenting at gestational age ⩾ 37 weeks. Selected: 12 for study group (pregnant with preeclampsia NHBPEP-2000) and 12 for the control group (normal pregnant women who delivered vaginally after the study group). Several maternal variables were analyzed: obstetric history, method of early labor, administration of magnesium sulfate and/or antihypertensive, complications during labor and delivery, postpartum, days of hospitalization and ICU admission. Also, perinatal variables: birth weight of the newborn, meconium or not amniotic fluid at delivery, Apgar score, therapeutic care, with respiratory complications, length of stay in hospital and ICU admission. To compare the groups in terms of numerical variables, we applied the Student t test for unrelated samples and, regarding categorical, we used the Fisher exact test. Results The results show that the experimental and control groups differ in the variables: age of the pregnant women, gestational age at birth and early labor (∗p Variable Study group Control group Variable Study group Control group Average maternal age (years) 29.6* 24.3 Perinatal complications 1-meconium aspiration 1-tocotraumatism 1-transient tachypnea Average gestational age (weeks) 38.5* 39.4 Weight of newborn > 2500 g > 2500 g Early labor Spontaneous Induced Apgar 1st and 5th minute Same average Same average Admission period 4–7/>7 days 4/4 1/1 Puerperium complications No No Parity 9 8 Therapeutic care to newborn No Inhaled oxygen Induction of delivery for maternal indication 10 4 Indications for hospitalization in the intensive care unit for newborns and mothers No No Administration of magnesium sulfate and antihypertensive No No ICU admission for mothers’ and newborns between 4 and 7 days 3 0 Meconium amniotic fluid 2 0 ICU admission for mothers’ and newborns between 8 and 14 days 1 0 Conclusions Despite this small sample in the study, there were no adverse maternal/perinatal outcomes that contraindicate vaginal delivery in patients with preeclampsia. It was demonstrated by maternal/perinatal variables that there were no statistically difference between the control and study groups. Additional studies with larger sample will collaborate to encourage the adoption of practices that can reduce maternal and fetal risks, without the utilization of systematic cesarean delivery, particularly in the group of pregnant women with pre-eclampsia. Disclosures L. Vidal: None. G. Gomes: None. M. Boarini: None. R. Horita: None. R. de Mendonca: None. T. Molina: None. T. Kanashiro: None. A. Menegazzo: None. S. de Toledo: None. N. Sass: None. R. Guidoni: None. F. Sousa: None.

Introduction There is now evidence that magnesium sulfate can prevent and control eclamptic seizures. For women with pre-eclampsia, magnesium sulfate reduces by more than one half the risk of eclampsia. After Magpie Trial [1] our clinical practice has been modified in terms of more liberal use of MgSO 4 , but the evidence regarding the benefit-to-risk ratio of MgSO 4 prophylaxis in mild preeclampsia remains uncertain [2]. Thus we consider important to evaluate whether there are specific characteristics between patients who received the medicine that might signal risk and justify our decisions. Objectives To identify in a group of hypertensive patients who used magnesium sulfate, clinical and/or laboratory characteristics that can be defined as specific risk factors and be useful to base clinical decisions. Methods The study was conducted at the Maternity School of Vila Nova Cachoeirinha, a public institution located in the north of the city of Sao Paulo (Baazil) between 01/07 and 31/12/2011. This is a retrospective study of a series of 103 pregnant women with hypertensive disorders, defined according to NHBPEP. We excluded patients admitted in labor. Patients were assigned into two groups according to the use of MgSO 4 . We compared clinical and laboratory characteristics between the two groups. Results Of 103 patients included, 31 (30.1%) received MgSO 4 . Among the outcomes analyzed, there were significant differences in the group that received MgSO 4 in terms of blood pressure equal to or greater than 110mmHg, clinical symptoms (eg headache and visual disturbance) and at least some evidence of organ dysfunction (hepatic, renal, haematologic, or central nervous system) (Table 1). Table 1. Variables associated with theuse of magnesium sulfate. DBP at admissionMgSO 4 NOMgSO 4 YESp〈0,001Less 90 mmHg16 (22,2%)01 ( 3,2%)90–11047 (65,3%)15 (48,4%)110 or more09 (12,5%)15 (48,4%)Clinic simptomsMgSO 4 NOMgSO 4 YESp〈0,002Yes15 (20,8%)16 (51,6%)No57 (79,2%)15 (48,4%)Organic disfunctionMgSO 4 NOMgSO 4 YESp〈0,001Yes02 ( 2,8%)07 (22,6%)No70 (97,2%)24 (77,4%) Conclusion We can say that in our institution over the years was an increase in the use of magnesium sulfate. Our results support the hypothesis that about one in three patients treated at this institution receive the medication. Although our protocol admits that the decision may be based on subjective criteria, we identified some objective characteristics that supported their application, and that these criteria do not differ from the classic recommendations. We can also conclude that in our clinical experience we do not have identified a clear justification for support the routinely use of magnesium sulphate for all women with preeclampsia.

Introduction Pre-eclampsia is responsible for a great number of maternal deaths in our country. Even in urban areas that, theoretically, has more access to information and more medical assistance possibilities, much more women have very severe cases that could be avoided. Many initiatives to reduce this problem include effective women participation in that item, making us to believe that actual information access would allow precocious detection of the problem, leading to reduction of the maternal and perinatal risks. Objectives To investigate a specific female population about how much they understand about the disease and its risks. Methods Using the social net Facebook®, a survey was developed for online use, where direct questions related to pre-eclampsia were made. The questions involved information about age, times of pregnancy, knowledge about pre-eclampsia and their risks. It was considered an inclusion criterion the women who decided to participate in the survey spontaneously, and their identity was preserved. This form was sent to 1000 women, and 120 fully answered the questions and they were put under analysis. Results The studied group had average age between 22 and 35 years. From the total, 107 (89.6%) had at least initiated high school, and the rest (11%) said that they had at least finished elementary school. From the analyzed data, it was found that 60 (50%) of the interviewed women, did not know anything about the subject. The rest said that they had some knowledge about the topic. From those, 14 (23%) had already heard about pre-eclampsia, but did not know what was it, 44 (73%) had a vaguely notion but did not know about the risks, and just 2 (4%) gave the entirely correct definition and knew about its implications. From all, 24 (20%) from the interviewed had at least once been pregnant, and 15 from those, had never heard about the pathology. Conclusion Despite of the impact that pre-eclampsia represents on mother and baby’s health, our results show that information in the studied group, is poor. The studied group has naturally more access to information, showing us that the situation is even more concerning. We believe that it is necessary to apply instruments that could redefine, in a greater way, the real information level to the female population in all levels of assistance. To enlarge the health politics, and increase its efficiency through informed women, seem to us, a fundamental strategy to qualify assistance and enhance maternal and prenatal safety. In an era that social nets had changed human behavior, why should not we use it as an efficient tool to promote life quality?

Introduction Preeclampsia (PE) is a major cause of maternal and perinatal mobility and mortality and its etiology is not yet completely understood. Recently studies have shown the association between increased expression of glycosaminoglycans (GAGs) in placental of women with PE and its physiopathology. Objectives Identify and quantify GAGs in placental of pregnant women in healthy pregnancy and PE. Methods Case-control study with 44 patients, control group (CG) n = 29 and n = 15 PE group. All patients were submitted to placental tissue resection (sample size of 5 × 5 cm with the umbilical cord insertion in the center). The tissue was conserved in acetone. The GAGs’ analysis consisted of centrifugation, proteolysis, precipitation, and electrophoresis Results Average age and gestational age in CG and PE were 27.33 years and 39.02 weeks and 24.17 and 36.90, respectively. In CG 68.96% (20/29) were Caucasian and 80.00% (12/15) in PE. We found in CG 34.48% (10/29) of primiparous and 40.00% (6/15) in PE. The average 24-hour proteinuria in PE was 554.28 g/24hs. The average birth weight was 3333.31 g in CG and 2972.66 in PE. The mean ± standard deviation of dermatan sulfate (DS), heparan sulfate (HS) and hyaluronic acid (HA) in CG and PE were: 0,100 μg/mg of tissue ±0,005 and 0,144 ±0,071; 0,077 ± 0,041 and 0,113 ± 0,061; 1,281 ± 1,857 and 3,076 ± 4,930. Conclusion GAGs are increased in PE when compared to normal pregnancy. The expression of HA and HS was twice higher in PE. More studies are needed to determine the correlation between GAGs and physiopathology of PE.

Introduction Around the world each year 10% to 15% of direct maternal deaths are associated with hypertensive disorders in pregnancy. Not only it can be devastating and life threatening for the mothers but also for the babies. Risks for the baby include poor growth and prematurity [1] . In low and middle income countries many public hospitals have limited access to neonatal intensive care, and so the mortality and morbidity is likely to be considerably higher than in settings where such facilities are available. Thus, the approach to the problem preeclampsia should include issues related to prematurity and its impact, since many of these babies develop definitive complications, constituting a major public health problem with social and economic repercussions. Objectives To evaluate the prevalence of preterm births in a public hospital health of the city of Sao Paulo, checking its main causal conditions, focusing in particular on the importance of hypertensive disorders in its determinism. Methods This was a retrospective study of a consecutive series of preterm infants, defined as gestational age less than 37 weeks born at Maternity School Vila Nova Cachoeirinha, situated at the north of Sao Paulo City, in the period from 01/04 to 31/12/2011. The study population was classified according to three main groups of causal factors: spontaneous labor, premature rupture of membranes and elective preterm delivery. In this group was evaluated the specific participation of hypertensive disorders. Results The number of live births during the study period was 5302 babies. Among these 433 had gestational age less than 37 weeks, corresponding to a prematurity rate of 8.16%. Of all infants, 385 cases were included in the analysis. Regarding the causes of the onset of preterm labor found that 140 cases (36.4%) presented with spontaneous labor, 128 cases (33.2%) had premature rupture of membranes and 117 (30.4%) cases were born as a result of elective preterm delivery. In the latter group 88 cases (75.2%) had complications related to hypertensive disorders. Regarding the general population of premature infants, hypertension accounted for 22.8% of cases. Conclusion We conclude that among the various obstetric problems, hypertensive disorders represent an important impact on preterm birth in our setting, considering that our institution is a reference to this type of care across the city of Sao Paulo. This knowledge is a fundamental tool to support the adoption of interventions that can detect groups at risk for hypertension in pregnancy, the promotion of follow-up to intercept severe cases and provide an efficient network of maternity care that may have neonatal intensive care units. This set of measures is essential to minimize the impact of this serious problem.

Objectives Evaluation of outpatients with glomerupathies who had pregnancy complicated by arterial hypertension. Methods Retrospective study with 52 women who started monitoring of glomerulonephritis during the period of 1989–2014 at outpatient clinics of UNIFESP, Sao Paulo/Brazil and who had pregnancy complicated by arterial hypertension. Results Women ranged from age 15 to 52 years old ± 7.83 (mean 30.67). A total of 88.5% (46/52) had a pregnancy with a hypertensive syndrome, 11.5% (6/52) eclampsia, 1.9% (1/52) HELLP syndrome, 75.0% (39/52) preeclampsia or pregnancy-induced hypertension. The other 11.5% (6/52) had previous kidney disease that had an acute exacerbation or was only manifested during pregnancy. The majority 86.5% (45/52) developed hypertension with proteinuria and/or hematuria after pregnancy; 7.7% (4/52) had clinical and laboratory remission after delivery, but later had progression to glomerulonephritis. About 7.7% (4/52) had late abortions, 30.8% (16/52) preterm birth, 7.7% (4/52) fetal death, and 3.8% (2/52) neonatal death. Renal biopsy was performed in 71.1% (37/52), renal transplant in 5.8% (3/52) and hemodialysis in 7.7% (4/52). The diagnoses were focal segmental glomerulonephritis in 13.5% (7/52), mild lesion 5.6% (3/52), membranoproliferative glomerulonephritis 13.5% (7/52), IgA nephropathy 5.6% (3/52), lupus nephritis 13.5% (7/52), other nephropathies 48.0% (25/52). Outpatient dropout was 43.4% (21/52). ambulatory discharge 3.8% (2/52) and 55.8% (29/52) kept follow up. Only 12.9% (4/31) of patients who kept follow up had worsening of renal function. Conclusions Women who had a pregnancy complicated with arterial hypertension, specially preeclampsia, may have a worse maternal and fetal/neonatal outcome and they may develop glomerulopathies in the long run. Monitoring by a nephrologist allows early diagnosis, preventing depletion of renal function. Table 1. Diagnoses during pregnancy in women under outpatient follow up for glomerulonephritis (%). % (n) of outpatients under monitoring for glomerulonephritis (n = 52) Eclampsia 11.5% (6) HELLP syndrome 1.9% (1) Preeclampsia/pregnancy-induced hypertensive 75% (39) Previous kidney disease 11.5% (6) Disclosures T.A. Facca: None. A.R. Sabino: None. J. Sato: None. E.A. Fama: None. G.S. Junior: None. G. Mastroianni-Kirsztajn: None. N. Sass: None.

Objectives Adipose tissue is responsible for triggering systemic inflammatory response and these changes may be involved in the pathophysiology of preeclampsia. To characterize the lipid profile in the placenta of patients with early-onset preeclampsia. Methods Samples were collected from placenta of 10 pregnant women with early-onset preeclampsia and 10 controls. Lipids were extracted using the Bligh-Dyer protocol and were analyzed by MALDI TOF–TOF mass spectrometry. Results The placental analysis of patients with preeclampsia revealed the main class glycerophosphoserines-GP03 (PS) as the most prevalent lipid, representing 56.28% of the total composition. Other main class found was macrolides/lactone polyketides-PK04 with 32.77%, both were increased in preeclamptic placentas when compared to the control group, PS (p Conclusions Placental tissues from patients with preeclampsia expressed different lipid profile when compared to normal pregnant women. These findings suggest that specific lipidic species may be more associated with risk of developing preeclampsia than others. Interestingly, some of the lipids identified here have important cell functions that may be involved in the pathophysiology of preeclampsia. Disclosures H.A. Korkes: None. N. Sass: None. A.F. Moron: None. N.O. Câmara: None. T. Bonetti: None. A.S. Cerdeira: None. I.D. Silva: None. L.G. De Oliveira: None.

Objectives Assessment of all maternal deaths and the proportion of maternal deaths related to International Disease Code (CID-10) O.10–O.16) reported by DATASUS (Brazilian Health Ministry) from 2003 to 2012. Methods Data were from http://www2.datasus.gov.br . (Accessed June 14, 2014): total live births, total MM, total MM due to hypertensive disorders. The MMR was calculated n[o] MM/n[o] live births per 100.000 and percentage of hypertensive disorders over total MM. Results Graphic 1 shows the MM rates and the proportion of hypertension in pregnancy (HP) in the total deaths. Disparities are detected among regions: North and Norwest have higher MMR (×25.0) and South the better MMR among all (×16,1). Conclusions MM in Brazil remains at worrying levels and with a trend of stagnation. The same can be supposed for the proportion of deaths related to hypertensive disorders. These problems are directly related to the quality of prenatal care and all health system. These indicators should guide public politics and expose the urgent needs for a task force to improve not only the quality of maternal care but also start a permanent auditing committee in order to provide an effective agenda until effective decline of these numbers. Support: FAPESP Process 2014/00213-7. Disclosures N. Sass: None. M.R. Silveira: None. L.G. Oliveira: None. T.A. Facca: None. J.L. Sato: None. H.A. Korkes: None. M.R. Mesquita: None.

Aims: To evaluate whether circulating angiogenic and anti-angiogenic factors may differentiate early-onset from late-onset preeclampsia. Methods: The study was conducted in 86 women with preeclampsia diagnosed in the third trimester of pregnancy. Preeclampsia was classified according to the onset of clinical manifestation in early-onset (before 34 weeks of gestation; n=31) or in late-onset (from 34 weeks of gestation on; n=55) preeclampsia. Serum was obtained from the patients in the moment of the diagnosis and assayed for placental growth factor (PlGF), vascular endothelial growth factor (VEGF), Endostatin, soluble Endoglin (sEng) and soluble form of vascular endothelial growth factor receptor (sVEGFR-1) determination by enzyme-linked immunosorbent assay. Results: Early-onset preeclampsia was characterized by significant lower levels of PlGF (median 38.3 vs 123.5 pg/mL) and VEGF (median 23.1 vs 35.3 pg/mL) in serum as well as by higher serum levels of Endostatin (median 33.9 vs 22.6 ng/mL), sEng (median 54.7 vs 42.1 pg/mL) and sVEGFR-1 (median 5211.0 vs 4657.6 pg/mL) compared with late-onset preeclampsia. Conclusions: In this study serum levels of angiogenic and antiangiogenic factors prove useful in differentiating early-onset from lateonset preeclampsia in the third trimester of pregnancy. Therefore, these findings suggest that angiogenic factors determination may indicate that earlyand late-onset preeclampsia have different pathophysiology.

Introduction The impact of preeclampsia (PE) of pregnancy is seen as a global concern. Despite their importance, PE does not have well-established causes. Several studies point to obesity as a predisposing factor for PE [1] . In a systematic review Duckitt and Harrington showed that in women with BMI ⩾ 30 the relative risk of developing PE is equal to 2.1 [2] . Bianco et al. demonstrated that the chance of patients with BMI ⩾ 35 developing PE is more than 4 times [3] . Furthermore, it is believed that the intracellular accumulation of triglycerides cause mitochondrial dysfunction, more electron transport and generation of ROS (Reactive Oxygen Species) [4] , causing a harmful effect on the endothelium. Objectives To compare the incidence of potential lipotoxicity markers among normal pregnant women and with pre-eclampsia. Methods A case–control study, including pregnant women from October 2011 to January 2012 at Hospital Guilherme Alvaro in Santos/Brazil. The study group consisted of 27 mothers with pre-eclampsia, according to the criteria of NHBPEP (2000) and the control group consisted of 27 mothers with normal pregnancy, who gave birth vaginally, at term without hypertension. The exclusion criteria were diagnosis of collagen diseases, smoking, diabetes, twin pregnancy and fetal malformations. Blood samples were collected immediately after delivery and the results were analyzed in conjunction with maternal data, according to the following variables: age, body mass index (BMI), serum cholesterol total and fractions, glucose, triglyceride and creative protein. Analysis of SF data was performed by calculating the odds ratio adopting an hypothesis rejection level of 0.05. Results The PE group had BMI > 30 (or), serum triglycerides > 150 (or) and LDL cholesterol > 100 (or) more frequently than normal mothers, and as regards statistical significance comparing the age of the women, glucose level, HDS cholesterol, there was no significant difference between the groups. Conclusion In pregnancy, lipotoxicity reduces the ability of trophoblastic invasion, causing maternal systemic endothelial and placental dysfunction causing alterations in metabolic functions. All such changes maintain a close relationship with the pathophysiology of PE. Monitoring pregestational period of obese patients or those with lipid disorders is part of the medical arsenal against PE by monitoring and advising on the best time to conceive.

Introduction preeclampsia is characterized by intense inflammatory response and an anti-angiogenic state. Maternal obesity has been considered to have important impact on the genesis of preeclampsia as lipotoxicity leads to maternal endothelial dysfunction and chronic inflammation. Here we investigate the plasma lipid profile of preeclamptic women. Objectives identify possible lipid biomarkers for preeclampsia. Methods this study included 8 pregnant women with early-onset preeclampsia (before 34 weeks gestation) and 8 normal pregnant women. Each patient in the preeclampsia group was matched to a patient in the control group according to gestational age at the time of sample collection. All patients in the control group were followed until term and had normal outcomes. To investigate the lipid profile, lipids were extracted from plasma samples using the Bligh-Dyer protocol and the extracts were subjected to MALDI-TOF Mass Spectrometry. Data matrix was exported for partial least squares discriminant analysis. All the variables analysed were sorted by a score number named Variable Importance in the Projection. The major discriminant variables were selected and underwent to Mann–Whitney U test. Results a total of 1290 ions were initially identified during lipidomic assessment. Twelve m/z signals were highlighted as the most important lipids for the discrimination of patients with preeclampsia. The identification of these differential lipids was carried out through Lipid Database Search. The main classes identified were Glycerophosphocholines [GP01], Glycerophosphoserines [GP03], Glycerophosphoglycerols [GP04], Glycosyldiradylglycerols [GL05] and Glycerophosphates [GP10]. Conclusion Our results suggest that some lipid species may be potential biomarkers for early-onset preeclampsia.

Introduction The hypertensive pregnancy disorders affect 7.5% of Brazilian women, being a major cause of maternal and perinatal morbidity and mortality, affecting 6–10% of primigravidae. They represent a significant cause of prematurity birth, with elective responsible for 20–30% of premature births, with higher incidence of neonatal morbidity due to high rates of complications in short and long term. Objectives Identify the repercussions in a short time, on caused by elective obstetric parity decisions in women with hypertensive neonatals pregnancy syndromes. Methods Retrospective analysis of medical records of pregnant women admitted to Hospital Guilherme Alvaro, in the city of Santos/SP - Brazil, between Jan/2005 to Jan/2012. Calculations were performed for dichotomous variables and an epidemiological analysis with data obtained on pregnant women with hypertension with a single fetus, subjected to delivery before 37 weeks. Classification of Hypertensive Syndromes followed the criteria of the NHBPEP – 2000, after blood pressure measurements were calibrated following standard technique: Chronic hypertension (CH), Pre-eclampsia, superimposed pre-eclampsia and late gestational hypertension and multiple births were excluded, premature labor and fetal malformations, totaling 102 cases. Results Throughout the study, it was observed that 67.6% are appropriate for gestational age, birth weight 1500–2500 grams (43.1%). Support in the neonatal were excluded ICU was necessary in the vast majority (75.7%), and length of stay exceeding 28 days in 29.3% of cases. The main indication was respiratory distress syndrome (63.6%) requiring intubation orotraquel and jaundice in 18.2% of premature infants was a common comorbidity (39.4%). Even with all the support in-hospital, the neonatal mortality was present in 8.1% of cases. The main indication of the resolution was for obstetric maternal complications (61.8%) where pre-eclampsia and preeclampsia superimposed were expressions which caused more frequent (42.2 and 40.2% respectively), showing the level of proteinuria between two -4.9 g (32.1%). Gestational age at delivery was 32–34 weeks (43.1%), corticosteroid therapy was not performed (54.9%) and cesarean delivery was (94.1%). The most frequent age group was 20–34 years (53.9%), Caucasian (54.9%), primigravida (62.7%) and less than five prenatal visits (36.3%) were performed. Conclusion The hypertensive pregnancy are risk factors for preterm elective delivery and is more frequent before 34 weeks, resulting in high perinatal morbidity and mortality, especially in cases of preeclampsia with severe clinical presentation and long hospital stays, with consequent costs and conducting excessive procedures in the neonate. Enable early referral to specialist services and consequent prenatal follow up, enables the adoption of early action, such as clinical support in a timely manner to facilitate the handling of cases which are still stable, optimizing the opportunity for administration of antenatal corticosteroids. It is necessary to review decisions about the mode of delivery in prematurity related to hypertension cases, with the aim of increasing the occurrence of vaginal deliveries.

Introduction Progressive proteinuria and glomerulosclerosis characterize chronic allograft nephropathy. However, the causes are not fully elucidated. Injury of parietal epithelial cells in glomeruli, the podocytes, is the initiating cause of many renal diseases, leading to proteinuria with possible progression to glomerulosclerosis. Podocytes are highly specialized cells, with an important role in maintaining the glomerular filtration barrier and producing growth factor for mesangial cells and endothelial cells. With their foot processes they cover the glomerular basement membrane, and form slit diaphragms with neighboring podocytes. The potential role of podocytes in the failing transplanted kidney is unknown. Objectives To evaluate podocyturia as a functional marker in pregnant women with kidney grafts. Methods Twenty pregnant women with kidney grafts had their urine samples cytocentrifugated and evaluated by indirect immunofluorescence. The slide was incubated for 45’ at room temperature with fluorescein (FITC) anti-rabbit IgG secondary antibody (Sigma-Aldrich, EUA). Then Vectashield (mounting medium for fluorescence) with DAPI (4’6-diamino-2-fenilindol dihidrocloreto) were applied H-1200 (Vector laboratories, inc, USA). The podocytes and the total number of cells were counted in 15 fields photographed under 400x magnification with a digital camera coupled to an epifluorescence microscope DM1000 (Leica, Germany) connected to a computer. The results were expressed as podocyte/total cells (%) per area of higher cell concentration (hot spots) in the field of 400x detected by staining of nuclei and cytoplasm. (Grant FAPESP 08/56338-1). Results The mean age of the women was 26 years. The urinalysis was performed at the third trimester of gestation; 11 did not exhibit urinary podocytes and 9 had podocyturia. There was also a relationship between blood pressure levels, proteinuria and the excretion of podocytes. Conclusion Urinary podocyte number, blood pressure and proteinuria were associated. We observed that urinary podocyte excretion occurs in pregnant women with kidney transplant almost synchronously with higher systolic and diastolic blood pressure and higher mean levels of proteinuria. The detection of podocyturia in these women could be useful for early diagnosis and follow-up of glomerular injury, eventually preeclampsia. It may be also associated to its severity or activity, although additional studies are necessary to confirm these aspects.

Introduction Although many centers have reported their experience on maternal and perinatal outcomes in renal transplant recipients. Very few information can be found about the psychological aspects that may rise for these patients during pregnancy. Considering the importance of the psychological concerns for this kind of patients, we have developed a protocol to better assist renal transplant recipients during pregnancy and here we show what we have learnt. Objectives To understand how the maternal concerns are seen from renal transplant recipients in terms of psychological aspects. Methods Fifteen pregnant kidney transplanted women with an average age of 27.5 years were included in the study. All patients have been investigated beyond the 20th week of pregnancy to delivery. The study is cross-sectional, qualitative, and participation is based on developed phenomenological method. Final data analysis will be done through thematic analysis and hermeneutics of meaning. The only exclusion criteria were the current presence of psychiatric disorders or use of drugs that could influence cognitive and emotional aspects during the psychological evaluation. Results During the last two years we have observed in these women that all of them are aware of the risks of pregnancy after transplantation. Qualitative aspects were: Pregnant with kidney transplantation show: in relation to pregnancy, the desire to be mothers, to give a son to her husband, to become a healthy person again; they believe that conception is God’s will, they have fear of pregnancy, ambivalence of feelings (fear and happiness). In relation to the graft, they reported fear of baby malformations, fear and anguish of graft loss, still consider it worth the risk of having the baby, and some women name the graft, if it were another infant. In relation to delivery, state anxiety and anguish at the proximity of labor (fear of labor pain, anesthesia, cesarean section, vaginal delivery and the “psychic pain”). Conclusion Pending the final results of this study, we still observed that these patients and their husbands require multidisciplinary monitoring since the beginning of pregnancy. Factors religious, cultural and psychic are involved in the desire to be mothers.

The pathogenesis of preeclampsia (PE) is complex and involves many mechanisms, including impaired placental angiogenesis. Endoglin (Eng) promotes angiogenesis, but in its soluble form (sEng) it is antiangiogenic and adiponectin has pro-angiogenic and anti-inflammatory effects on the endothelium. The combined analysis of these factors seems to better reflect maternal vascular damage.We aimed to evaluate adiponectin and soluble endoglin levels, to analyze adiponectin (+45) gene polymorphism and its relation with adiponectin serum levels in patients with PE.This case-control study included 24 PE patients and 20 healthy pregnant women (C: control). Adiponectin and sEng serum levels were determined by ELISA. Polymorphism genotyping was obtained by PCR-RFLP. Data were analyzed by Mann-Whitney, Chi-square or Fisher's exact tests and significance was set at p0.05.There were no differences in adiponectin levels between the groups (C×PE: 6772.4ng/mL×7763.2ng/mL, p=0.99), but women with PE had significantly higher sEng levels (23.45 ng/mL×3.35ng/mL, p0.0001). Moreover, the ratio adiponectin/sEng was significantly lower in PE than in C women (325.02×2119.4, p0.0001). There was no association between PE and the analyzed polymorphism, neither between adiponectin genotype/phenotype.Our findings confirm an association between PE and altered sEng levels. In addition, these results suggest that angiogenic mediators when analyzed together, can better reflect their involvement in the pathophysiology of PE. Financial support: FAPESP (09/54729-6 and 10/08082-8).

and 0.4g/24h for PE and 2.9mg/dl and 4.8g/24h for PG. Podocyte cells were observed in all three groups, but there were only significant numbers in PG and PE. In PE group it was found almost three times the quantity detected in PG. Conclusions: Urinary podocyte excretion occurs in PE and PG besides other renal abnormalities; furthermore, it may contribute to the development of glomerulosclerosis. The detection of podocyturia in PE could be useful for preventing, diagnosing and following up the glomerular injury and it may also be correlated to its severity or activity, although additional studies are necessary to confirm these points. Apoio FAPESP 08/56338-1