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Background There is increasing interest in the development of newborn screening tests to identify children at risk of fetal alcohol spectrum disorder (FASD) in order to provide these children with early intervention. Phosphatidylethanol (PEth) has emerged as a potential universal newborn screening candidate. Methods The aim of this report was to present the results of a study designed to compare PEth levels in 1,140 postpartum women and their newborn infants in Montevideo, Uruguay, and Sao Paulo, Brazil. Self-report alcohol use during pregnancy data was collected, along with both maternal and newborn dried blood spot samples for PEth analysis. Results The average age and parity of the women in the sample were 26 years of age and 2.3 pregnancies. For the Uruguay sample (n = 611), 45.8% of postpartum women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 43.6 ng/ml. In contrast, 86.8% of the newborns had PEth levels ≥ 8 ng/ml, with a mean positive PEth of 77.4 ng/ml. For the Brazil sample (n = 529), 33.2% of women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 31 ng/ml. In contrast, 76.9% of the Brazil newborns had PEth levels ≥ 8 ng/ml and 43.9% with a mean positive PEth of 61.1 ng/ml. PEth levels were significantly higher in newborns compared with their postpartum mothers in both the Uruguay and Brazil samples. Self-reported third-trimester alcohol was 6% in the Uruguay sample and 9.1% in the Brazil sample compared with positive maternal PEth levels in 45.8% and 33.2%, respectively. Conclusions Clinicians may want to consider newborn PEth screening in high-risk populations where prenatal alcohol use is common. The mechanism underlying significantly higher PEth levels in newborns compared with their mothers is not known.

Hypertensive syndromes in pregnancy, such as hemorrhagic and infectious conditions, are largely responsible for most maternal deaths in the world. It is estimated that chronic hypertension (CH) in pregnancy complicates about 6–8% of pregnancies, which can be aggravated when overlapping preeclampsia (PE) in 13–40% of cases. Differentiated prenatal care is a big step toward achieving efficient preventive and therapeutic aspects. Special attention should be paid to weight gain, uterine height, edema, and correct BP measurement, since such measures may lead to suspicion of complications in this group of patients. Hypertensive patients should have their routine of individualized consultations.

Objective To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique. Methods Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019. Results Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and pre-eclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method. Conclusion The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%. Resumo Objetivo Descrever a experiência clínica com a técnica de B-Lynch no manejo da hemorragia pós-parto e os fatores relacionados à indicação da técnica bem como apresentar as taxas de sucesso da aplicação da técnica de B-lynch. Métodos Estudo observacional, retrospectivo, de corte transversal e analítico. Os dados foram obtidos por estudo de prontuário. A população do estudo foi constituída de pacientes submetidas à sutura hemostática com a técnica de B-Lynch, sendo incluídas 104 pacientes dentro do período de 01 de janeiro de 2005 a 31 de dezembro de 2019. Resultados Do total de 104 pacientes, 82,7% não apresentaram qualquer complicação. A transfusão de sangue e a internação na UTI foram as complicações mais prevalentes, com 13,5% e 15,4%, respectivamente. Apenas 1% teve infecção puerperal e do sítio cirúrgico. Os fatores mais relacionados com a aplicação da técnica foram a presença de cesárea anterior (30,8%), uso de ocitocina (16,3%) e pré-eclâmpsia (11,6%). A histerectomia puerperal foi realizada em 4,8% das pacientes por falha do método. Conclusão A experiência clínica com a técnica de B-Lynch foi satisfatória, pois apresentou poucas complicações, com excelentes resultados no controle hemorrágico. A cesárea anterior, o uso de ocitocina e a pré-eclâmpsia se destacaram como fatores relacionados à indicação da aplicação da técnica. A taxa de sucesso avaliada foi de 95,2%.

The present report describes the case of a 31-year-old primigravida, with dichorionic twins at 31 weeks. She presented with history of myalgia, jaundice, and abdominal discomfort. No flu-like symptoms as fever or cough. She was not aware of exposure to COVID-19. Normal blood pressure and O2 saturation. Laboratory tests showed platelet count of 218,000 mm3, alanine aminotransferase (ALT) 558 IU and serum creatinine 2.3 mg/dl. Doppler ultrasound in one twin was compatible with brain sparing. Partial hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome was the hypothesis, and a cesarean section was performed. On day 2, the white-cell count reached 33,730, with decreased consciousness and mild respiratory distress. Tomography revealed both lungs with ground-glass opacities. Swab for COVID-19 polymerase chain reaction (PCR) was positive. Thrombocytopenia in patients with COVID-19 appears to be multifactorial, similar to what occurs in preeclampsia and HELLP syndrome. We assume that the synergism of these pathophysiological mechanisms could accelerate the compromise of maternal conditions and could be a warning to the obstetric practice.

Pre-eclampsia (PE) is a severe disorder that affects up to 8% of all pregnancies and represents an important cause of maternal and perinatal morbidity and mortality. The screening of the disease is a subject of studies, but the complexity and uncertainties regarding its etiology make this objective a difficult task. In addition, the costs related to screening protocols, the heterogeneity of the most affected populations and the lack of highly effective prevention methods reduce the potential of current available algorithms for screening. Thus, the National Specialized Commission of Hypertension in Pregnancy of the Brazilian Association of Gynecology and Obstetrics Federation (Febrasgo, in the Portuguese acronym) (NSC Hypertension in Pregnancy of the Febrasgo) considers that there are no screening algorithms to be implemented in the country to date and advocates that Aspirin and calcium should be widely used.

Introduction Progressive proteinuria and glomerulosclerosis characterize chronic allograft nephropathy. Podocytes are fundamental cells for maintaining the functionality of glomerular filtration barrier. Failure to achieve this task due to reduced podocyte number and 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. Objective To evaluate podocyturia and others renal parameters as functional markers in pregnant women with kidney grafts. Methods In this cross-sectional and prospective study, 43 pregnant women with kidney grafts had their Mid-stream urine samples collected to determine proteinuria, including retinol-binding protein (enzyme immunoassay using monoclonalantibodies), albumin/creatinine ratio (immunoturbidimetry), protein/creatinine ratio (the alkaline picrate colorimetric method), and podocyturia (indirect immunofluorescence). Results 43 women who got pregnant after renal transplantation were included. Podocyturia was not significantly correlated with other renal function markers. A gradual increase was observed in the following parameters during pregnancy and puerperium: serum creatinine levels (P Conclusion Proteinuria, urinary protein/creatinine ratio, and retinol-binding protein levels were elevated in patients with preeclampsia. Proteinuria (or more specifically, urinary protein/creatinine ratio) and albumin/creatinine ratio has also used as a marker of CKD progression. We observed that urinary podocyte excretion occurs in pregnant women with kidney transplant. Using these markers to assess renal function during pregnancy may be clinically useful for early diagnosis and follow-up of glomerular injury, eventually preeclampsia. It may be also associated to its severity or activity.

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.

BACKGROUND: Empathy in the patient-provider relationship is associated with important outcomes in healthcare practice. Our aim was to translate and validate Warmometer, a visual tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese. DESIGN AND SETTING: Cross-sectional study conducted at an antenatal clinic of a public university hospital in São Paulo, Brazil. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted. It was tested for reliability and validity among 32 pregnant women, between June 2015 and January 2016. To assess construct validity, it was correlated with the Consultation and Relational Empathy (CARE) scale (gold standard for patient-provider relationships) and the Interpersonal Reactivity Index (IRI). RESULTS: The translated version of Warmometer had good face and content validity, low intra-observer reproducibility (intraclass correlation coefficient, ICC: 0.224; 95% confidence interval, CI -0.589 to 0.621;P = 0.242) and high inter-observer reproducibility (ICC: 0.952; 95% CI 0.902 to 0.977; P < 0.001). There was a strong correlation between Warmometer and CARE (r = 0.632) and a weak correlation between Warmometer and IRI (r = 0.105). CONCLUSIONS: Warmometer was translated, culturally adapted and validated for use in Brazilian Portuguese. The translated version is a reliable tool for assessing the degree of empathy perceived by the patient in a patient-provider relationship.

We report the case of a 20-year-old patient, primigravida, with twin monochorionic pregnancy, with a weight gain of 6 kg in one week and increased blood pressure. During the ultrasound diagnostic investigation, placental edema and hydrops were identified in both fetuses, which, in association with maternal anasarca and pressure control, constitute the triad for mirror syndrome, also known as triple edema. In addition to being hydropic, one of the twins was an acardiac fetus, which is a rare combination of events. Gestation was terminated at 22 weeks and five days because of high maternal risk. The patient progressed with clinical and laboratory improvement. Our study is relevant in that it documents an extremely rare case and discusses relevant aspects of the symptoms and diagnosis of mirror syndrome. It also systematically reviews the condition.

Pregnancy is a cardiometabolic and renal stress test for women, primarily when associated with hypertension syndrome, which can have deleterious effects in the long term. We undertook this study to make a long-term evaluation on these women.A retrospective cohort study was conducted to investigate voluntary women who had pregnancy-induced hypertension syndrome versus normal pregnancy.We evaluated a total of 85 women, divided in case (n = 25) and control (n = 60) groups, by clinical, anthropometric and epidemiological profiles, general, metabolic and renal tests, and risk stratification for cardiovascular disease (CVD) and chronic kidney disease (CKD).The case group showed a higher incidence of hypertension (P = .003), shorter period between its diagnosis and end of pregnancy (P .001) and lower age at diagnosis (P = .033); higher weight (P .001), body mass index (BMI) (P .001), waist-to-height ratio (p = .001) and abdominal circumference (P .001); higher fat percentage (P = .004) and weight to lose (P .001) as measured by bioimpedance; lower estimate glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (P = .021), greater difference between estimated vascular age and real age (P = .008) according to Framingham Risk Score (2008) and higher frequency of metabolic syndrome (P .001).Women who had pregnancy-induced hypertension syndrome were found with a higher incidence of obesity, metabolic syndrome and hypertension, earlier onset of hypertension, higher estimated vascular age and lower eGFR. These findings reinforce the importance of investigating the history of hypertension syndrome in pregnancy, which should be considered an indicator to be followed long term after childbirth.

Objective To evaluate whether the presence of maternal blood pressure reduces the risks of morbidity, perinatal mortality and morbidity at 24 months of age in very low birth weight infants (VLBWIs) compared with a control group. Methods A retrospective, observational, case-control study. Total 49 VLBWIs were allocated to the study group, called the maternal arterial hypertension group (AHG), and matched with 44 in the control group (CG). The infants were assessed during hospitalization and at 12 and 24 months corrected age at a specialized clinic. For the assessment of growth, the World Health Organization (WHO) Anthro software (Geneva, 2006) was used, and for the psychomotor assessment, the Denver II test was used. Results In relation to the antenatal variables, the infants of the AHG had more centralized circulation assessed by Doppler, received more corticosteroids and magnesium sulfate, and were born by cesarean section more frequently. In terms of the postnatal and in-hospital outcomes, the AHG had a higher gestational age at birth (30.7 versus 29.6 weeks) and a lower frequency of 5-minute Apgar scores of less than 7 (26.5% versus 52.3%). The CG had a higher rate of pulmonary dysplasia (30.2% versus 8.3%). There were no differences in terms of hospital mortality, complications, somatic growth and functional problems at 24 months of corrected age. Conclusion The presence of maternal hypertension, especially preeclampsia, was not a protective factor against morbidity, mortality and evolution in VLBWIs aged up to 24 months. Therefore, the clinical practice should be focused on prolonging the pregnancy for as long as possible in these conditions as well. Resumo Objetivo Avaliar se a presença de hipertensão arterial materna reduz os riscos de morbidade, mortalidade perinatal e morbidade aos 24 meses de idade em recém-nascidos de muito baixo peso (RNMBPs) em relação a um grupo controle. Métodos Estudo retrospectivo, observacional, caso controle. Foram alocados 49 RNMBPs no grupo de estudo, chamado de grupo com hipertensão arterial materna (GHA), e 44 no grupo controle (GC), avaliados durante a internação hospitalar e aos 12 e 24 meses de idade corrigida em ambulatório especializado. Para avaliação do crescimento, foi adotado o programa WHO Anthro, e o teste de desenvolvimento de Denver II para a avaliação psicomotora. Resultados Em relação às variáveis antenatais, fetos do GHA apresentaram mais centralização da circulação avaliada pelo Doppler, receberam mais corticosteroides e sulfato de magnésio, além de terem nascido mais por cesáreas. Quanto aos desfechos pós-natais e durante a internação, o GHA teve idade gestacional de nascimento maior (30,7 × 29,6 semanas) e menor frequência de boletim de Apgar no quinto minuto inferior a 7 (26,5% x 52,3%). Entre as complicações avaliadas, o GC teve maior frequência de displasia pulmonar (30,2 × 8,3%). Não houve diferenças em relação à mortalidade hospitalar, ao crescimento somático e às complicações funcionais aos 24 meses de idade corrigida. Conclusão A presença de hipertensão arterial materna, em especial a pré-eclâmpsia, não foi fator de proteção quanto à morbidade, mortalidade e evolução até os 24 meses de idade em RNMBPs. Desta forma, a prática clínica deve ser voltada para garantir o maior prolongamento possível da gestação também nestas condições.

Introduction: The potential risks related to drug exposure during pregnancy represent a vast chapter in modern obstetrics and data regarding the safety of antihypertensive drugs during pregnancy are relatively scarce. Case report: A 37-year-old patient discovered her fifth pregnancy at our hospital after 26 weeks and 4 days of gestation. She reported a history of hypertension and was currently being treated with Losartan. Hospitalization was recommended for the patient and further evaluation of fetal vitality was performed. On the fourth day an ultrasound was performed, resulting in a severe oligohydramnios, fetal centralization and abnormal ductus venosus. After 36 hours, the newborn died. Pathologic evaluation: At autopsy, the skullcap had large fontanels and deficient ossification. The kidneys were slightly enlarged. A microscopic examination detected underdevelopment of the tubules and the presence of some dilated lumens. Immunohistochemical detection of epithelial membrane antigen was positive. Immunoreactivity of CD 15 was also assayed to characterize the proximal tubules, and lumen collapse was observed in some regions. Discussion: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARAs) are among the most widely prescribed drugs for hypertension. They are often used by hypertensive women who are considering become pregnant. While their fetal toxicity in the second or third trimesters has been documented, their teratogenic effect during the first trimester has only recently been demonstrated. Conclusion: Constant awareness by physicians and patients should be encouraged, particularly in regard to the prescription of antihypertensive drugs in women of childbearing age who are or intend to become pregnant.

Objective To assess correlations between maternal serum levels of pro- and anti-angiogenic factors with uterine perfusion in women with early- compared with late-onset preeclampsia, and in healthy pregnant women. Design Case-control study. Setting Antenatal care clinic located within a hospital (Sao Bernardo do Campo, Brazil). Population We enrolled 54 preeclamptic and 54 healthy control women who were coming for routine ultrasound at 28–36 weeks' gestation. Methods All participants had uterine artery and umbilical Doppler studies and a blood sample to assess maternal serum levels of soluble fms-like tyrosine kinase-1, soluble endoglin, adiponectin and plasminogen activator inhibitor-1. All angiogenic factors were measured using enzyme-linked immunosorbent assay. Main outcome measures Levels of pro- and anti-angiogenic factors in maternal serum, and uterine artery Doppler findings. Results Concentrations of soluble fms-like tyrosine kinase-1 and soluble endoglin were significantly higher in preeclamptic than control women (p

Introduction Hypertension in pregnancy, especially preeclampsia (PE), may result in maternal and perinatal complications and the best form of treatment is the interruption of gestation through the safest method for the mother and baby. In Brazil, there are high rates of Cesarean (CS) among patients with PE. Would it be possible to change these routines to reduce risks and costs associated with the actual patterns of care? Objective To assess the type of delivery in patients with PE in a public maternity in Sao Paulo (Brazil) and propose changes in this pattern. Methodology Retrospective Cohort of 117 patients with PE treated in a reference center (MEVNC) in 2016 and 2017. Maternal variables were assessed and related to childbirth and perinatal period. Baseline characteristics and labor and delivery characteristics according to PE early and late were analyzed. Results The average maternal age was 29.0 years, 51.3 being nulliparous and the BMI average was 29.1. Mild PE was present in 85.0%. The overall cesarean rate was 32.0%. Among patients with early PE the rate was 72.0% while in patients with late PE the rate was 77.0%. The reasons for CS were maternal risk in 30.7% and fetal risk in 22.7%. Discussion The overall rate of CS of the institution being on average, 34%. However in patients with PE CS rates are very high. Our results contrast with the literature, when compared with different places. Two aspects could be considered: insecurity related to maternal prognosis and the difficulties of assessing fetal well-being. Two interventions could be tested to modify this pattern: the adoption of the model PIERS for maternal care and fetal monitoring for fetal scalp samples for pH and lactate evaluation. In this way, the introduction of these alternatives could innovate the current standard of clinical practice.

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

Purpose This study estimates the prevalence of common mental disorders and the proportion and potential determinants of detection among adolescents attending prenatal care. Methods We recruited 930 consecutive adolescents admitted for obstetric care, of which 457 participants had attended the hospital's prenatal care unit. Common mental disorders were assessed using the Composite International Diagnostic Interview (version 2.1). A detailed review of prenatal care records was used to identify detection of psychiatric disorders by prenatal healthcare professionals. Results A total of 103 adolescents (22.5%) had some mental disorder but only one-fifth of them had had their psychiatric disorder detected during prenatal care. The most frequent diagnosis using the Composite International Diagnostic Interview (version 2.1) was depression (13.5% or 62), but only 21% had been detected. Alcohol and drug dependence were the least common mental disorders (2.4%), but they were the most commonly detected (45.5%). Physical chronic condition increased the likelihood of detecting psychiatric disorder. Conclusion Mental health is not yet recognized as an integral component of practice in prenatal care. Given the potential effect of antenatal psychiatric morbidity on maternal and child outcomes, especially among adolescents, practice needs to be changed and prenatal care professionals trained in the recognition and basic treatment of common mental disorders.

Pré-eclâmpsia é uma síndrome sistêmica caracterizada por intenso estado inflamatório e antiangiogênico. A fisiopatologia da pré-clâmpsia envolve alterações no processo de invasão trofoblástica, com consequente inadequado suprimento sanguíneo uterino e estresse oxidativo do tecido placentário. As alterações placentárias decorrentes desse processo levam à maior produção de sFlt-1, um receptor solúvel para as moléculas de VEGF e PlGF. O sFlt-1 impede com que VEGF e PlGF realizem suas funções na homeostase endotelial, culminando com disfunção dessas células. De uma maneira geral, os processos inflamatórios, de disfunção endotelial e estresse oxidativo estão interligados e agem de maneira sinérgica. Trabalhos recentes têm demonstrado que elevações nas concentrações séricas de sFlt-1 ocorrem 5 a 6 semanas antes das manifestações clínicas da pré-eclâmpsia. Concomitantemente, observa-se queda nas concentrações séricas de PlGF. Sendo assim, as dosagens séricas de sFlt-1 e PlGF têm sido sugeridas para o diagnóstico precoce de pré-eclâmpsia. Ademais, os conhecimentos adquiridos a respeito dos fatores antiangiogênicos proporcionam ainda a possibilidade de novas linhas de pesquisa sobre possíveis terapias para a pré-eclâmpsia. Neste artigo, foram revisados os aspectos inflamatórios e antiangiogênicos envolvidos na fisiopatologia da pré-eclâmpsia. Por fim, foram correlacionados esses aspectos com o risco elevado para doenças cardiovasculares apresentado por essas pacientes ao longo de suas vidas.

CONTEXT AND OBJECTIVE: Preeclampsia and neural tube defects can be prevented during pregnancy. Today, there is level I evidence showing that calcium supplementation during pregnancy may prevent preeclampsia and that use of folic acid may prevent neural tube defects. The aim here was to evaluate the proportion of patients undergoing prenatal follow-up who had received a prescription for calcium and/or folic acid supplementation, and their adherence to the use of these two substances. DESIGN AND SETTING: Cross-sectional study at two hospitals in the Greater São Paulo region, Brazil (Faculdade de Medicina da Fundação ABC, Santo André, and "Dr. Mário de Moraes Altenfelder Silva" Municipal Teaching and Maternity Hospital, Vila Nova Cachoeirinha). METHODS: Early primigravidae, late primigravidae and pregnant women with chronic hypertension, diabetes mellitus or kidney disease who had already had their first prenatal consultation were included. RESULTS: Out of 250 pregnant women interviewed, 10.40% had received a prescription for calcium supplementation and 80.76% of them reported taking it in tablet form. Regarding folic acid, 48% of the women said that they had received a prescription for this and 64.16% reported that they had started to use it during the periconceptional period. CONCLUSIONS: Calcium supplementation and periconceptional use of folic acid seem not to be prescribed routinely by physicians. This should motivate the implementation of educational programs for obstetricians on the use of interventions based on the best available evidence.

The clinical spectrum of preeclampsia (PE) ranges from mild hypertension to severe vasospasm associated with convulsions and multiple organ damage. The biological factors that determine the progression of PE to eclampsia (E) are unknown. Endothelial cell activation seems related to an impaired maternal immune response. The production of cytokines, IL-10 and TGF-beta1, is apparently suppressed, and altered IL-2/IL-10 and TNF-alpha/IL-10 ratios have been reported in preeclamptic cases. The relationship between PE and cytokine gene polymorphism has been studied, but there are few studies that include eclamptic patients. This study aimed at investigating whether polymorphisms in genes, TNF-alpha promoter (-308 GA), IL6 promoter (-174 GC), IFN-gamma intron 1 (+874 AT), IL10 promoters (-1082 AG), (-819 CT) and (-592 CA) and TGF-beta1 codon 10 (+869 TC) and codon 25 (+915 GC) are associated with E and/or PE. Genotyping was carried out in 266 Mulatto women from the northeastern region of Brazil who were referred to a single maternity hospital: 92 with PE, 73 with E and 101 normotensive controls. The chi(2) or Fisher's exact tests were used to compare genotype frequencies. Among the six single-nucleotide polymorphisms (SNPs) studied, we found no difference in genotype frequencies between the groups. There was a higher frequency of IFN-gamma (+874 A) in eclamptic patients in comparison with that in controls. (70.3 vs. 57.8%, respectively; P=0.02). There were no other significant differences in allelic frequencies between eclamptic, preeclamptic and control groups We found no independent association between any single SNP and PE or E risk in this population of Mulatto women from the northeastern region of Brazil.

Objectives To evaluate the potential benefit of nasal continuous positive airway pressure (CPAP) administration in pregnant women recognized to have hypertension early in pregnancy. Methods This is a randomized study comparing the addition of nasal CPAP treatment to standard prenatal care to standard prenatal care alone in hypertensive women treated with alpha-methyl dopa during early pregnancy. Pregnant women with hypertension were recruited by their obstetricians and completed baseline sleep questionnaires and visual analogue scales on snoring and sleepiness. Subjects were then randomized to receive either CPAP with standard prenatal care (treatment group) or standard prenatal care alone (control group) with routine obstetric follow-up. Nocturnal polysomnography was performed in all patients randomized to the treatment group for initial CPAP titration. Periodic assessment of blood pressure control and CPAP compliance was performed by the same specialist at each scheduled follow-up visit. Results In the control group ( n =9), a progressive rise in blood pressure with a corresponding increase in alpha-methyl dopa doses was observed, beginning at the sixth month of pregnancy. There was also an increase in the number of non-scheduled post-natal visits during the first postpartum month. Pre-eclampsia occurred in one subject; the remaining eight patients had normal pregnancies and infant deliveries. In the treatment group ( n =7), blood pressure was noted to decrease significantly as compared to the control group with associated decreases in doses of antihypertensive medications at six months of gestation. All treated patients experienced uncomplicated pregnancies and delivered infants with higher APGAR scores at one minute post-delivery compared to those of controls. Conclusion In pregnant women with hypertension and chronic snoring, nasal CPAP use during the first eight weeks of pregnancy combined with standard prenatal care is associated with better blood pressure control and improved pregnancy outcomes.

To establish normative data for ophthalmic artery Doppler parameters throughout a healthy pregnancy, to investigate the possible correlation between these Doppler measurements and gestational age, and to test intraobserver variability.A prospective cross-sectional study was performed to assess various Doppler parameters in 276 healthy women between 20 and 39 weeks of gestation. The following measurements were obtained: pulsatility and resistance indices (PI, RI), peak systolic velocity (PSV), peak diastolic velocity (PDV), end diastolic flow velocity (EDFV), and peak ratio (PR). Quantile regression was used to estimate reference values throughout pregnancy and P0.05 was considered significant. The intraclass correlation coefficient (Intra-CC) was used to calculate intraobserver variability.The 5th and 95th prediction intervals for each gestational age are presented. No significant correlation was detected between Doppler indices and gestational age. Intra-CC was excellent (0.996).Reference values were generated for ophthalmic artery Doppler measurements, and they did not vary significantly during healthy pregnancy.

OBJECTIVE: To determine whether sodium nitroprusside causes fetal death in pregnancies complicated with hypertension. DATA SOURCES: Medical Literature Analysis and Retrieval System Online (MEDLINE; 1996 to 2003), Excerpta Medica (EMBASE; 1970 to 2003), Web of Science/Institute for Scientific Information (ISI; 1945 to 2003), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS; 1982 to 2003) and the Cochrane Library. REVIEW METHODS: The medical subject headings used were "nitroprusside and pregnancy", "hypertension or eclampsia or preeclampsia" and "nitroprusside and pregnancy and hypertensive emergencies". The search was limited to humans and female gender, in all fields, publication types, languages and subsets. Articles were also identified by reviewing the references of articles and textbooks on hypertension and pregnancy. RESULTS: The search located nine studies. The sum of all the publications yielded a total of 22 patients and 24 exposed fetuses (two pairs of twins). There were no randomized clinical trials and no prospective cohorts. All of the studies were observational in nature. CONCLUSIONS: At present, there is insufficient evidence for definitive conclusions about any direct association between sodium nitroprusside use and fetal demise. OBJETIVOS: Resolver a questão: o nitroprussiato de sódio causa morte fetal em gestações complicadas por hipertensão? FONTES DE INFORMAÇÃO: Medical Literature Analysis and Retrival System Online, MEDLINE (1996 a 2003), Excerpta Medica, EMBASE (1970 to 2003), Web of Science - Institute for Scientific Information, ISI (1945 a 2003), Literatura Latino-Americana e do Caribe em Ciências da Saúde, LILACS (1982 a 2003) e a Cochrane Library. MÉTODO DE REVISÃO: Os descritores usados foram "nitroprussiato e gravidez", "hipertensão ou eclâmpsia ou pré-eclâmpsia", "nitroprussiato e gravidez e emergências hipertensivas" limitada a humanos e mulheres, em todos os campos, tipos de publicação, línguas e subgrupos. Foram também identificados artigos através das referências das publicações e de livros sobre hipertensão e gravidez. RESULTADOS: A revisão identificou nove publicações. A soma de todas elas descreveu um total de 22 mulheres e 24 fetos (duas gestações gemelares) expostos ao nitroprussiato. Não foram localizados ensaios clínicos randomizados ou coortes prospectivas. Todos os estudos eram do tipo descritivo. CONCLUSÕES: No momento, não existem evidências suficientes para se chegar à conclusão definitiva de que exista uma associação direta entre o uso de nitroprussiato de sódio e morte fetal.

Introducao: O acometimento renal em gestantes portadoras de hipertensao arterial cronica (HAC) nao e amplamente conhecido. Objetivos: 1- Descrever o perfil epidemiologico de pacientes com HAC; 2- Avaliar a ocorrencia de alteracoes urinarias e de funcao renal (por meio de determinacao serica de creatinina, cistatina C e ritmo de filtracao glomerular estimada - RFGe); 3- Avaliar o desfecho das gestacoes em HAC. Metodos: Foram submetidas a avaliacoes clinicas e laboratoriais 103 gestantes com HAC (pressao arterial acima de 140/90 mmHg, identificada previamente a gestacao ou ate a 20a semana). Resultados: As gestantes tinham 21-45 (media: 34) anos; 12,6% eram primigestas, 64,1% tiveram multiplas gestacoes. A relacao proteinuria/creatininuria em amostra isolada estava alterada em 5,2% casos (0-6,44 g/g), creatinina serica estava elevada em 19,6% e cistatina C em 14,7%. Na avaliacao das caracteristicas da gestacao em pacientes com HAC e seus recem-nascidos (RN) (vs. frequencias nos casos com CKD-EPI cistatina C < 60 ml/min/1,73 m2), observou-se: 20,5% (33,3%) de nascidos pre-termo < 37 sem, 17,5% (22,2%) de RN com peso < 2500 g e 17,5% (22,2%) de RN pequeno para a idade gestacional (PIG); sobreposicao de DHEG ocorreu em 24,7% (22,2%) dos casos. Conclusao: Alteracoes renais foram identificadas por proteinuria, creatinina e cistatina C sericas em 5,2%, 19,6 e 14,7% das gestantes. Os resultados sugerem que as formulas do CKD-EPI e MDRD tambem podem ter aplicabilidade nessa avaliacao em gestantes. Detectou-se alta frequencia de RN pre-termo ou com menos de 2500 g ao nascer ou PIG, assim como de sobreposicao de DHEG (24,7%) em gestantes com HAC.

Introduction The maternity mortality rate in the Santos lowlands region, priority region of Sao Paulo/Brazil, is higher when compared to regions in the state of Sao Paulo. The hypertensive disorders are implicated in approximately 20% of death. Severe preeclampsia (PE) is recognized as the frequent diagnosis associated with maternal and fetal ominous outcomes. The recognition of potential risk support antenatal intervention which could anticipate the installation of catastrophic results. Identifying the epidemiological profile of women who may present with this evolution can guide public health policies and actions of the professionals involved in caring for these women avoiding preformed concepts and contributing to the recognition of local reality situation. Objectives Identify the epidemiological profile of women affected by severe PE. Methods A descriptive study involving 46 pregnant women admitted to specialized hospital for high-risk pregnancy with the diagnosis of severe PE according to the criteria of NHBPEP (2000), as: blood pressure ⩾160/110 mmHg, proteinuria 2.0 g/24 h or +2 dipstick, serum creatinine >1.2 mg/dl (new onset), platelets 3 , microangiopathic hemolysis (increased lactate dehydrogenase), elevated alanine aminotransferase or aspartate aminotransferase, persistent headaches or other cerebral or visual disturbance, persistent epigastric pain or eclampsia in the period from January/2008 to November/2010. Results The average age of the pregnant women was 25.5 years (±6.5), 11 women were multiparous and nulliparous and 35 (76.1%), the average gestational age at admission was 34 4/7, developing to eclampsia and/or HELLP syndrome were 07 women (15.2%), admission often occurred before the installation of labor in (93.5%) had a previous diagnosis of chronic hypertension (30.4%) and in all cases magnesium sulfate administration with an average length of 32 h (±16.6 h). Conclusion The occurrence of severe PE was more common in nulliparous women at the age of 25 years, admitted in prematurity and not in preterm labor. The outcome of seizure and/or HELLP has a considerable impact. The association of chronic hypertension with severe PE is more than 1/4 of the cases. These data are equivalent to other areas of Brazil and may contribute to emphasize the practice of prenatal acting that can recognize and pre-comment possible adverse developments and attitudes aimed at intercepting the process.

Introduction Postpartum haemorrhage is an important cause of maternal morbidity and mortality, uterine atony being responsible for most of the cases. Hypertensive disorders are supposed to increase the possibility of such complications, mainly when complicated by “abruptio placentae”. The classical treatments for postpartum haemorrhage have been based on medications like oxytocin and misoprostol, but more recently a haemostatic uterine suture developed by Christopher B-Lynch has been indicated. Here, we describe our experience of performing such technique and investigate its results in patients complicated by hypertensive disorders. Objectives Reporting a series of cases of postpartum haemorrhage treated with the B-Lynch suture. Methods This is a descriptive study including 39 patients treated with the B-Lynch suture after postpartum haemorrhage related to uterine atony. The period evaluated was between January 2005 and February 2012. Intravascular oxytocin was routinely used in all cases, with doses changing from 20 to 60 IU. The suture material used was chromed catgut 1.0 mm. Results The mode of delivery was cesarean-section in all cases. Five patients (12.8%) had hypertensive disorder as additional complication and one of these patients had abruptio placentae followed by development of Couvelaire uterus. Overall, the B-Lynch technique helped to control haemorrhage in all cases evaluated. Conclusion We believe that the B-Lynch technique appears as an important procedure to be indicated in cases of postpartum haemorrhage. Therefore, we recommend that this technique should be tried to control such complications before deciding for other more aggressive procedures like hysterectomy. It seems that this treatment may be used in patients complicated by hypertensive disorders.

Introduction Preeclampsia (PE) is an important cause of glomerulopathy. Assessment of renal markers during pregnancy may have a predictive value for glomerular disease later in life. The early detection of PE may prevent the complications of this syndrome. Objectives Assess the glomerular involvement in PE and in normal pregnancy by evaluating renal markers such as podocyturia and proteinuria. Methods Case–control study with 39 pregnant women after 20 weeks of gestation (control group – CG with n =25 and PE with n =14), we assessed podocyturia (cytospin method) and proteinuria (albuminuria, urine protein:creatinine – PCR, urinary retinol protein – RBP and albumin/creatinine ratio – ACR). (Grant FAPESP 08/56338-1) Results Mean±standard deviation of age and mean gestational age of CG were 26.9±6.4years and 37.1±5.0weeks and of PE, 26.4±6.9 and 30.6±5.6, respectively ( p =0.001). No statistical differences were found between podocyturia in CG and PE although it was more frequent in this last group ( p =0.258). Podocyte cells and parietal epithelial cells were detected in the slides. Mean±standard deviation of urinary RBP ( p =0.017), albuminuria ( p =0.002) and UAC ratio ( p =0.006) of CG were 0.4±0.7mg/L, 7.3±6.9mg/L and 8.2±6.7mg/g and of PE, 2.0±4.4mg/L, 2267.4±2130.8mg/L ( p =0.002) and 3778.9±4296.6mg/g ( p =0.006), respectively. Mean value±standard deviation of urine PCR in PE was 6.7±6.1g/g ( p = Conclusion Urinary RBP, PCR, albuminuria and UAC ratio were elevated in PE in comparison to CG indicating its glomerular involvement but there was no correlation between those renal parameters and podocyturia. RPC and UAC ratios were good predictors of PE, but not podocyturia. Either podocyte cells as parietal epithelial cells were detected in the urine, these findings may indicate a non-invasive marker for renal disease activity but more studies are required to determine its role in PE.

Introduction Preeclampsia (PE) affects 5–8% of all pregnant women and can trigger a severe gestational hypertension framework and eventually develop into eclampsia and HELLP syndrome. Anticipating the damage would be important in order to establish procedures that can reduce adverse outcomes. For this reason, many researches are undertaken to identify ways to make a diagnosis of preeclampsia as early as possible. It has been highlighted in literature the study: the sFlt1 (soluble fms-like tyrosine kinase-1) has been implicated in the precocious diagnosis of pre eclampsia. The sFlt1 is an anti-angiogenic factor produced in response to oxidative stress derived from the deleterious effects of pre-eclampsia. Objectives The objective of the study was to evaluate the role of Soluble fms-like tyrosine kinase-1 in the diagnosis of preeclampsia. Methods This is a review conducted in the database PubMed and Lilacs. For this purpose, we used the following MeSH, “Vascular Endothelial Growth Factor Receptor-1” OR “FLT1 protein, human” AND “Pre-Eclampsia/diagnosis” in PubMed and “Pre-eclampsia” AND “SFLT1A” in Lilacs, resulting in 84 papers. After reading the abstracts of these studies, we selected the articles analyzed taking into consideration the criteria for inclusion and exclusion. We excluded publications that were not in the period under study (2008 to July 2011) and by study design. Including only case-control, cohort and prospective observational. For a critical analysis of the material, we used the following indicators: researcher, years, central theme, participants, study design and primary outcome. Results The final results of this study were composed of seven articles and are shown for each target outcome. These vary according to gestational age at which PE is installed and the marker studied (sFlt1 alone or its relation to PlGF – sFlt1/PIGF). Six studies showed greater levels of sFlt1 for the preeclampsia groups when compared to the control group. Significantly differences in antiangiogenic factors seric levels were not found among preeclamptic and eclamptic patients. When associated with another factor, like PIGF, a greater efficacy in the diagnosis of early preeclampsia is shown. Of the studies analyzed, only one (Lynch et al) showed no significant difference between the values of sFlt-1 in groups of early PE, late PE and control for gestational ages between 10 and 15 weeks. As for the relation sFlt-1/PIGF, five studies have considered it even better for PE diagnosis when compared to sFlt-1 isolated. Conclusion The dosage of sFlt1 may be a relevant resource for the early diagnosis of preeclampsia before the installation of target organ damage, especially if measured in the period between 12 and 28 weeks of gestational age. Whereas sFlt-1 manifests itself before the 20th week, that may be interesting clinical point of view since it is this phase that settles the most severe cases, when the adoption of care could prevent further risks. The relationship sFlt1/PIGF, was more appropriate than the measurement of sFlt1 alone. Additional studies are needed to: amplification of the number of women evaluated, establishing gestational age appropriate for study, serum standard and need to consider the relationship between sFlt1 and other factors pro and/or anti-angiogenic.

decreases insulin sensitivity and is associated with obesity. Recent data indicates that subclinical endotoxemia is associated with inflammation in obese women in late pregnancy. Objectives: The objective of this study was to quantify circulating endotoxin across pregnancy in lean and obese women, and assess the relationship between endotoxin and markers of inflammation and insulin sensitivity. Methods: Endotoxin was measured in sterile maternal EDTA plasma samples from 24 lean pregnant women (BMI = 22.4 ± 1.9 kg/m) and 45 obese pregnant women (BMI= 32.6 ± 2.1 kg/m), and 6 non-pregnant women. Samples were collected at 10.5 ± 3.1, 21.3 ± 4.6 and 35.2 ± 2.1 weeks gestation. Endotoxin was quantified using the PyroGene Recombinant Factor C endotoxin detection assay from LONZA, inter-assay variability

Introduction antagonists of angiotensin II receptor (AAR) are commonly used for the treatment of chronic hypertension in the general population. Some of these pharmacological agents are losartan, candesartan, valsartan and tasosartan. Despite the good response achieved with these drugs in the control of hypertension, all medications that act directly on the renin-angiotensin system should be contraindicated during pregnancy. These drugs have been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure and death.Here we report a case of fetal malformations and death associated with the use of losartan. Objectives describing the association of fetal malformations and the use of losartan during first and second trimester of pregnancy. Methods this is a case report involving a 37-year-old pregnant woman at 26 gestational weeks. This patient had history of chronic hypertension for more than five years that was being regularly treated with Losartan 50mg/day. After her first consultation losartan was promptly discontinued and substituted for methyldopa. However, scan evaluation demonstrated severe oligohydramnios associated with altered fetal biophysical profile and altered Doppler fluxometry (absent diastolic flow at umbilical arteries). Therefore, a cesarean-section was performed after corticoid administration for fetal lung maturation. At first moment some characteristic alterations as fetal limb contractures and craniofacial deformation were detected at the 1007g new-born. This baby went to death 36h after delivery due to severe lung hypoplasia. Results the autopsy examination revealed renal tubular dysgenesis associated with changes secondary to nephropathy, probably induced by drug (Fig. 1). Associated findings were underdevelopment of bones of the skull with large fontanelles, thymus atrophy and signs of perinatal hypoxia. Conclusion the difficulty of attending basic health assistance was attributed to be associated with this case, as this patient did not have opportunity and sufficient information about the necessity of changing her medication during pregnancy. Apart from this situation, this case report brings good information about the association between antagonists of angiotensin II receptor and human fetal malformations.

later age of her reproductive cycle has be a phenomenon around the world. Epidemiology data show frequent increase of clinical complications in direct proportion in advanced age motherhood, hypertensive disturbances being more prevalent. Objectives: Analyse the prevalence of hypertensive syndromes in pre-determined age groups at Hospital Guilherme Alvaro in Santos, Sao Paulo, Brazil showing the different segments in each one. Methods: From data collected in the outpatient department of Hospital Guilherme Alvaro of High Risk Pre-natal between 04/06/2008 and 30/05/2011, a prevalence transversal study was carried out where data were obtained from 628 patients aged between 16 and 46 years. Procedures of homogeny analysts were set out, always collecting data such as age and disorder for high risk gestation. According to age, patients were divided into groups: precocious (up to 19 years old), middle age (between 20 and 34) and late pregnancies (over 35). Results: In the precocious pregnancies, clinical illnesses/ no hypertension (31%) were observed in first place, 25% (8) twin pregnancy in second place, 19% (6) showed hypertensive disturbances. Concerning pregnancies between 20 and 34 years old, 36% (144 patients) showed hypertensive syndromes, 23% (92 patients) showed endocrine disturbances, 22% (90 patients) showed clinical illnesses/no hypertension, and 9% twin pregnancy. Regarding late pregnancies, the most frequent disturbance was isolated hypertensive syndromes: 44% (88 patients) in first place, only endocrine disturbances, 24% (47 patients) in second place followed by association between hypertensive syndromes and endocrinopathy with 13% (26 patients). Conclusion: About precocious pregnancies, greater prevalence showed clinical illnesses/no hypertension, whereas middle age and late pregnancies showed greater hypertensive syndrome prevalence, results, which are compatible with other studies, have been observed that due to advance of age, hypertensive syndromes aremore frequent. For late pregnancies, the prevalence of clinical illnesses/no hypertension was a lower percentage regarding the other two groups: precocious pregnancies (31% = 10 women), middle age pregnancies (22% = 90 women), and late pregnancies (2% = 7 women). Considering the fact that the occurrence of pregnancy is more and more late in life, it can be concluded that the professionals must be prepared to attend pregnancies on women with hypertensive disturbances and their eventual complications.

Introduction Maternal death is the death of a woman during pregnancy within 42 days after delivery. It is one of the most serious violations of human rights of women, because it is a preventable tragedy in 92% of cases and occurs mainly in developing countries. Brazil, a country of continental dimensions has the challenge of reducing maternal deaths; one of the priority regions is Santos, a city in the state of Sao Paulo. It is felt that efforts are made to the adoption of care that can minimize risks during complicated pregnancy with hypertensive disorders, but not always this service is offered proportionally to postpartum. Perhaps the erroneous concept that the delivery is capable of quickly balancing the harm of maternal hypertensive disorders is implicated in reducing postpartum surveillance, exposing this group of women to undesirable outcomes. Objectives Analyze the percentage of postpartum maternal deaths until 42 days after delivery for hypertensive disorders in Santos in the period of 1999–2009. Methods Data were provided by the Ministry of Health of Brazil in www.datasus.gov.br (accessed February 2012). The number of maternal deaths was divided into maternal death in pregnancy, delivery and abortion and maternal death in puerperium up to 42, considering all causes of maternal death and identifying the proportion of deaths due to hypertensive syndromes. Results According to the general causes of death, more women die during pregnancy, delivery and abortion (69.7%) than postpartum (30.3%) and hypertensive disorders account for 20% of these outcomes. Analyzing the proportion of deaths due to hypertensive disorders in each period, we observed that during pregnancy the disorder accounts for 16.5% of all causes, however, the percentage reaches 30.3% in the puerperium. Conclusion The increase of death in postpartum due to hypertensive syndromes, regarding all general causes, shows the necessary action to be done by the professional team to offer continuity care in and out of hospital in this period, considering that the challenges persist even after delivery.

OBJETIVO: Avaliar a presença de podocitúria em gestantes hipertensas crônicas no terceiro trimestre da gestação e a associação com doença renal.MÉTODOS: Estudo observacional descritivo em uma amostra de conveniência de 38 gestantes hipertensas crônicas. Os podócitos foram marcados com técnica de imunofluorescência indireta com antipodocina e diamidino-fenilindol (DAPI). A contagem foi feita a partir de 30 campos analisados de forma aleatória, corrigida pela creatinina urinária (podócitos/mg de creatinina). Foram assumidos dois grupos: grupo GN (função glomerular normal), com até 100 podócitos, e grupo GP (provável glomerulopatia), com mais de 100 podócitos. A dosagem de creatinina foi realizada com uso da técnica do picrato alcalino. As variáveis de análise foram o índice de massa corpórea, a idade gestacional na coleta, a pressão arterial sistólica e a pressão arterial diastólica no momento da coleta. Para a análise dos dados, foi utilizado o programa SPSS - versão 16.0. (IBM - USA). Nas análises estatísticas, foi utilizado o teste do χ2, sendo consideradas diferenças significantes valores de p

A dopplervelocimetria colorida é uma modalidade do exame ultra-sonográfico que se expandiu rapidamente em todas as áreas da medicina, em virtude da sua riqueza de informações. A dopplervelocimetria colorida das artérias orbitais tem sido empregada no auxílio diagnóstico de doenças oftalmológicas, bem como para o estudo de doenças específicas como a pré-eclâmpsia. O objetivo deste estudo é descrever a anatomia normal da região orbital e detalhar a técnica de exame dopplervelocimétrico colorido, tendo em vista ser este um exame acessível e reprodutível. Acreditamos que surgirão novas aplicações deste método, que deverá ser inserido na prática diária do radiologista, visando à melhoria da qualidade do diagnóstico e seguimento das doenças oculares e sistêmicas.

OBJETIVO: Avaliar o valor prognóstico da proteinúria nas gestantes com síndromes hipertensivas nos desfechos maternos e perinatais. MÉTODOS: Estudo transversal retrospectivo de 334 gestantes com síndromes hipertensivas que pariram no Hospital São Paulo na disciplina de Obstetrícia da UNIFESP/EPM, no período de 1º de janeiro de 1999 a 31 de dezembro de 2002. RESULTADOS: Após a revisão dos prontuários, as pacientes foram divididas em quatro grupos: I sem proteinúria (n-203), II com proteinúria de 0,3 a 1g (n-39), III de 1 a 2g (n-45) e grupo IV de 2g ou mais (n-47). Na ausência da proteinúria houve um caso de descolamento prematuro da placenta. Com proteinúria observou-se desfechos maternos adversos, com a presença das complicações, proporcional à elevação da proteinúria, sendo a síndrome HELLP a mais freqüente com 30,5% (40/131) seguida da eclâmpsia com 3,8% (5/131), DPP 3,01% (4/131) e insuficiência renal 0,7% (1/131). Foi constatado um óbito materno nesse grupo, perfazendo-se o CMM de 763100.000/n.v. Em relação aos desfechos perinatais, no grupo sem proteinúria não houve elevação dos efeitos adversos. Na presença da proteinúria e a elevação dos seus níveis observou-se pior prognóstico perinatal com os seguintes indicadores: aumento da prematuridade (62,2% vs 11,5%), recém-nascidos com peso < 2500g (6,5% vs 1,5%), Apgar < 7 no 5º minuto (30,4% vs 3,5%), restrição de crescimento intra-útero (41,9% vs 6,5%), cuidados intensivos na unidade neonatal (59,8% vs 15,5%), natimortos (14,4% vs 1,4%), e óbitos neonatais (6,1% vs 0,98%). O coeficiente de mortalidade perinatal foi maior com proteinúria (175 vs 19,7) e, quando > 2g (297,8 vs 19,7). CONCLUSÕES: A presença da proteinúria e a elevação dos seus níveis, aumentaram as complicações maternas, principalmente a síndrome HELLP e eclâmpsia. Observou-se incidência de complicações perinatais com elevação significativamente maior da prematuridade, recém-nascidos com Apgar < 7, peso < 2500g, CIUR, natimortos e óbitos neonatais. AIM: The purpose of this study was to determine the role of proteinuria on pregnancy outcome in hypertensive syndrome with singleon pregnancies. METHODS: Transversal study with retrospective data of 334 pregnancies complicated by hypertensive syndromes who were delivered in the Department of Obstetrics of UNIFESP/EPM from January 1, 1999 to December 31, 2002. RESULTS: The patients were divided into four groups: (I) without proteinuria (n-203); (II) with proteinuria of 0.3 to 1.0g (n-39); (III) 1.0 to 2.0g (n-45); and (IV) 2.0g or more. Without proteinuria there was one case of placental abruption. The presence of proteinuria predicted adverse maternal outcome with increase of complications proportional to his elevation; among them, HELLP syndrome was the most frequent with 30.5% (40/131) followed by eclampsia with 3.8% (5/131), DPP 3.1% (4/131) and renal insufficiency with 0.7% (1/131). It was confirmed one maternal death in that group, when Maternal Mortality of 763/100.000nv was added up. As to the perinatal effects there was not increase of adverse effects without proteinuria. In the presence of proteinuria and its levels was observed the worst perinatal outcome with the elevation of the following indicatives: increase prematurety (62.2% vs 11.5%), newborn with weight < 2500g (6.5% vs 1.5%), newborn with Apgar < 7 in the 5th minute (30.4% vs 3.5%), concepts with growing restriction of intrauterine (41.9% vs 6.5%), newborn interned in the neonatal undid, (59.8% vs 15.5%) stillborn (14.4% vs 1.4%), neonatal deaths (6.1% vs 0.98%). The Perinatal Mortality was greater with proteinúria (175 vs 19,7) and, when = 2.0g (297.8 vs 19.6). CONCLUSIONS: The presence of proteinuria in the hipertensives syndromes during gestation and the elevation of their levels increase the risks of maternal complications, especially HELLP syndromes and eclampsia. Besides, it was observed a significative incidence of premature birth, newborn with Apgar < 7, weight < 2500g, IUGR, stillborn and neonatal deaths.

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.

Neonates born to renal transplanted women are exposed in utero to immunosuppressors and to antenatal conditions that may predispose the neonate to a high risk of prematurity and intrauterine growth retardation. These factors might interfere with the transfer of maternal IgG immunity. Total IgG levels and specific antibodies to measles, varicella, tetanus, Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (serotypes 4,6B,9V,14,18C,19F and 23F) were evaluated on maternal and cord blood samples of 23 sets of renal transplanted women and their newborns and 32 sets of healthy women-newborns at term. Total IgG levels were measured by nephelometry and specific antibodies, by ELISA. Renal transplanted mothers had lower median tetanus antibodies (0.67 IU/mL) than controls (1.53 IU/mL; p = 0.017). Neonates from renal transplanted mothers had lower median tetanus antibodies (0.95 IU/mL) than controls (1.97 IU/mL, p = 0.008). Antibodies to measles, varicella, Hib and the 7 serotypes of S. pneumoniae were similar between groups. Maternal antibodies were associated with an increase in neonatal antibodies for all antigens; gestational age was associated with an increase in Hib neonatal antibodies. Preeclampsia was associated with a decrease in neonatal total IgG and serotype 4 S. pneumoniae antibodies; chronic hypertension was associated with a decrease in neonatal serotype 6B S. pneumoniae antibodies. As neonates from transplanted women may be born with lower tetanus antibodies than controls, efforts should be made to keep maternal vaccines up-to-date. Clinical antenatal care with control of preeclampsia, chronic hypertension and prevention of premature delivery might also contribute to neonatal antibody levels to specific antigens at birth.

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.