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ilustraciones, gráficas, tablas Objective: To estimate the security and effectivity of the reduction or retirement of antihypertensive medication in pregnant women with chronic hypertension. Methods: Randomized controlled trials that compared management with antihypertensive drugs vs. no antihypertensive, discontinuation of the drug, placebo, or other interventions were included. We searched CENTRAL, MEDLINE, LILACS, and ClinicalTrials. We also hand-searched conference proceedings (ACOG, FIGO, RCOG, FECOLSOG) and reference lists of retrieved studies. Two review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We resolved disagreements through consensus. We used the GRADE approach to assess the quality of evidence. Results: The search did not find any controlled clinical trial evaluating the reduction or withdrawal of antihypertensive therapy. When antihypertensive management was compared with placebo or no antihypertensive, we found that antihypertensive treatment was associated with reduction of probability of developing severe hypertension in pregnant women with chronic hypertension (OR 0,43 95% CI 0.26 to 0.70 ) and increased probability of adverse effects associated to antihypertensive management (aOR 8.52; 95% CI 1.05 to 69). We did not found differences in the probability of developing superimposed pre-eclampsia, preterm birth, placental abruption, small for gestational age, pregnancy loss, neonatal death, admission to the neonatal intensive care unit or low APGAR at birth. We did not found differences in gestational age at birth. Quality of the evidence was very low due to the presence of serious risk of bias, limitations in the applicability of results and the confidence interval. Conclusion: Very low-quality evidence suggest that probably antihypertensive therapy reduces the incidence of severe hypertension in pregnant women with chronic hypertension when compared with placebo or no antihypertensive. Objetivo: Estimar la seguridad y efectividad de la reducción o retiro de la medicación antihipertensiva en mujeres embarazadas con hipertensión crónica. Métodos: Se incluyeron ensayos controlados aleatorios que compararon el tratamiento con fármacos antihipertensivos versus ningún antihipertensivo, suspensión del fármaco, placebo u otras intervenciones. Se realizaron búsquedas en CENTRAL, MEDLINE, LILACS y ClinicalTrials. También se realizaron búsquedas manuales en las actas de congresos (ACOG, FIGO, RCOG, FECOLSOG). Dos autores de la revisión evaluaron de forma independiente los ensayos para su inclusión, extrajeron los datos y evaluaron el riesgo de sesgo. Los desacuerdos fueron resultos por consenso. Utilizamos el enfoque GRADE para evaluar la calidad de la evidencia. Resultados: La búsqueda no encontró ningún ensayo clínico controlado que evaluara la reducción o el retiro de la terapia antihipertensiva. Cuando se comparó el tratamiento antihipertensivo con placebo o ningún antihipertensivo, encontramos que el tratamiento antihipertensivo se asoció con una reducción de la probabilidad de desarrollar hipertensión grave en mujeres embarazadas con hipertensión crónica (OR 0,43; IC del 95%: 0,26 a 0,70) y una mayor probabilidad de efectos adversos. asociado al tratamiento antihipertensivo (ORa 8,52; IC del 95%: 1,05 a 69). No encontramos diferencias en la probabilidad de desarrollar preeclampsia superpuesta, parto prematuro, desprendimiento de placenta, pequeño para la edad gestacional, pérdida del embarazo, muerte neonatal, ingreso en la unidad de cuidados intensivos neonatales o APGAR bajo al nacer. No encontramos diferencias en la edad gestacional al nacer. La calidad de la evidencia fue muy baja debido a la presencia de un riesgo grave de sesgo, las limitaciones en la aplicabilidad de los resultados y el intervalo de confianza. Conclusión: La evidencia de muy baja calidad sugiere que probablemente la terapia antihipertensiva reduce la incidencia de hipertensión severa en mujeres embarazadas con hipertensión crónica en comparación con placebo o ningún antihipertensivo. (Texto tomado de la fuente). Texto en inglés Revisión sistemática con meta-análisis Especialidades Médicas Especialista en Obstetricia y Ginecología Methods Criteria for including studies in this review Randomized controlled trials or non-randomized controlled trials, published, unpublished and ongoing. Types of participants Pregnant women with a diagnosis of chronic hypertensive vascular disease defined as: systolic blood pressure greater than 130 mm Hg or diastolic pressure greater than 80 mm Hg (2,3) on at least two occasions 4 hours apart, before pregnancy or before 20 weeks of pregnancy (4). Type of intervention Withdrawal of antihypertensive drugs defined as abrupt suspension of drug use, de-staging of the drug until the withdrawal is complete, or decrease in current drug dose (16); versus: 1. Continue usual antihypertensive therapy with one or more medications of the type: alpha 2 agonists, calcium antagonists, alpha and beta blockers, alpha adrenergic antagonists, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, vasodilators, and diuretics. 2. Placebo. 3. Other interventions. Types of outcomes Primary Outcomes Maternal: Maternal death: Defined as the death of a woman due to direct or indirect obstetric causes during pregnancy or up to 42 days after its termination, regardless of the place in which it occurred or its duration (31). Severe preeclampsia: Defined as finding after week 20 of gestation up to 6 weeks postpartum of systolic blood pressure values greater than or equal to 160 mm Hg or diastolic blood pressure values greater than or equal to 110 mm Hg on two occasions separated by a short interval of time (5-15 minutes), or the finding of systolic blood pressure values greater than or equal to 140 mm Hg or diastolic blood pressure greater than or equal to 90 mm Hg on at least two occasions separated by four hours and associated with: thrombocytopenia (platelet count less than 100 x 109 / L); impaired liver function indicated by abnormal serum levels of liver enzymes (twice the higher level of reference); persistent severe pain in epigastrium or right upper quadrant not due to other diagnoses; renal failure (serum creatinine greater than 1.1 mg / dL or twice the baseline serum creatinine concentration in the absence of other kidney disease); pulmonary edema; recent-onset headache that does not respond to analgesic management and is not related to alternative diagnoses; hyperreflexia; visual disturbances such as photophobia, blurred vision, photopsia, scotomas, or blindness that are not related to alternative diagnoses (32); eclampsia defined as the sudden onset of focal or multifocal tonic-clonic seizures in the absence of other conditions that cause it such as epilepsy, cerebral ischemia or infarction, intracranial hemorrhage or use of medications; or HELLP syndrome defined as elevated lactic acid dehydrogenase (LDH) greater than or equal to 600 IU / L, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) greater than twice the upper limit of normality and platelets less than 100 x 109 / L (4). Admission to the Intensive Care Unit: defined as the requirement for care in intermediate or intensive care units (33). Adverse reactions: defined as adverse events caused by the withdrawal or use of antihypertensive medications, including palpitations, headache, joint pain, lower limb edema, orthostatic hypotension or rebound hypertension, in addition to changes in serum biochemistry, heart rate, pulse rate, kidney function, and left ventricular parameters (34). Fetal: Loss of pregnancy: Defined as abortion (death of the fruit of conception before week 20 or less than 500 g) or death (death of a fetus in utero after week 20 and greater than 500 g) (26). Neonatal Mortality: defined as those newborns who die before reaching 28 days of life (35). APGAR less than or equal to 5 at minute 5: defined by the Apgar scale that assesses the viability of a newborn according to five simple physio-anatomical parameters: muscle tone, respiratory effort, heart rate, reflexes and skin color, each parameter is assigned a score between 0 and 2 (36). Neonatal intensive care unit admission: defined as admission of a neonate to a neonatal intensive care unit for some neonatal condition that requires surveillance or monitoring (37). Among the causes of admission are: prematurity or birth weight less than 1500 g, gestational age less than 32 weeks, respiratory distress that requires ventilatory support (continuous positive pressure in the airway, mechanical ventilation), seizure syndrome; congenital abnormalities or inborn errors of metabolism, congenital heart disease or cardiac arrhythmias requiring cardiac management, hypoxic-ischemic encephalopathy, other conditions requiring neonatological consultation (severe hyperbilirubinemia, severe intrauterine growth restriction, birth weight between 1000 g 2000 g and gestational age between 32 and 36 weeks (38). Secondary outcomes Maternal Severe arterial hypertension: Defined as the finding of systolic blood pressure values greater than or equal to 160 mm Hg or diastolic blood pressure greater than or equal to 110 mm Hg on two occasions separated by a short time interval (minutes) (4). Gestational age at delivery: Defined as weeks from conception to the date of delivery. It will be calculated taking into account the gestational age reported in the first trimester ultrasound (up to week 13 6/7) or that of the subsequent trimesters if the first trimester is not provided. If the date of the last menstruation agrees with the gestational age obtained through the ultrasound of the first trimester or of the subsequent trimesters, it can be used (39). Hospitalization During Pregnancy: Defined as admission to a hospital during pregnancy (40) Renal compromise: Defined as serum creatinine greater than or equal to 1.1 mg / dL (4). Placental abruption: Defined as a process consisting of premature detachment of the placenta characterized by vaginal bleeding, uterine hypertonicity or unsatisfactory fetal status associated with direct visualization of retroplacental hemorrhage or hematoma (41). Fetal: Small for gestational age fetus: defined as a newborn whose weight is less than the 10th percentile for gestational age (42). Preterm delivery: Defined as delivery before 37 weeks of gestation (43). Hypoxic / Ischemic Encephalopathy: defined as the presence of neurological dysfunction in the form of neonatal encephalopathy, associated with depression of the level of consciousness, respiratory depression, alteration of muscle tone and seizures, associated with suggestive findings on brain MRI (44). Search methods for identification of studies Electronic searches A comprehensive search was conducted to identify as many relevant studies as possible in the electronic databases. A combination of controlled vocabulary was used (MeSH, Emtree terms, Health Sciences, and descriptors (DeCS). The following electronic databases were searched: - Cochrane Central Register of Controlled Trials (CENTRAL). - MEDLINE, PubMed - EMBASE Ovid - LILACS (Health Sciences of Latin America and the Caribbean). Search for other resources The following resources were sought for additional studies: • International Clinical Trials Registry Platform (ICTRP) https://apps.who.int/trialsearch/AdvSearch.aspx • Gray literature: a search was carried out in the information system for gray literature in Europe “OpenGrey”. Manual search Abstracts of the following conferences were hand searched: - International Federation of Gynecology and Obstetrics (FIGO) (www.figo.org). - American College of Obstetricians and Gynecologists (ACOG) (www.acog.org). - Royal College of Obstetricians and Gynecologists (RCOG) (www.rcog.org.uk). - Colombian Federation of Obstetrics and Gynecology. (https://www.fecolsog.org/) Data extraction and analysis The following methods were used when the reports were identified: Study selection Two reviewers independently assessed the inclusion of all potential studies that were identified as a result of the search strategy. Relevance and adherence to the inclusion criteria were evaluated. If studies did not meet the inclusion criteria, they were not included and the reasons for exclusion were wrote. Any disagreement was resolved through discussion or, if necessary, a third reviewer was consulted. Data extraction and management A form for data extraction was designed. For chosen studies, two reviewers extracted data using the agreed form. Discrepancies were resolved through discussion or, if necessary, a third reviewer was consulted. The data was entered into the RevMan 2019 software and verified for accuracy. When the information on any of the previous points was not clear, an attempt was made to contact the authors and editors of the original studies and the journals where they were published to provide more details. Assessment of risk of bias in included studies The risk of bias from randomized clinical trials was assessed using the criteria described in RoB 2.0 bias assessment tool (45). Any disagreement was resolved by discussion or involving a third reviewer. RoB 2.0 risk assessment of biases Assessment of the quality of evidence using the GRADE system The quality of evidence was evaluated using the GRADE system as specified in the GRADE manual so as to assess the quality of evidence related to the outcomes of the main comparison. Antihypertensive withdrawal was defined as abrupt discontinuation of drug use, de-escalation of the drug until complete withdrawal or tapering of the drug dose compared to continuing established antihypertensive therapy, Placebo and Other interventions. A summary of the effect of the intervention and of the quality measurement for each of the next outcomes was developed using the GRADE system (Annexed tables 1 and 2). Measurement of treatment effect Dichotomous data The results were reported as a probability ratio (OR) with a 95% confidence interval (CI). Continuous data The mean difference (MD) was used if the results are measured in the same way within the included studies and the standardized mean difference (SMD) was used to combine trials measuring the same outcome, but with different methods. Assessment of missing data An intention-to-treat analysis was performed, that is, an attempt was made to include all participants assigned to each analysis group and all participants who were analyzed in the group to which they were assigned, regardless of whether or not they received the assigned intervention. The impact of including studies with high levels of missing data in the overall evaluation of treatment effects was explored using a sensitivity analysis. Assessment of heterogeneity Statistical heterogeneity was assessed using I2 values and Chi square test values. Heterogeneity was considered substantial if the I2 statistical value was greater than 40% or if there was a low p-value (less than 0.10) in the Chi-square test. Assessment of reporting bias Publication bias was assessed when ten or more studies were retrieved through the evaluation of the asymmetry of the funnel plot and the formal tests. For continuous variables, the test proposed by Egger was used (46), and for dichotomous results the test proposed by Harbord was used (47). Subgroup analysis and investigation of heterogeneity We explored the following potential sources of heterogeneity where it was considered that the effect size may have changed based on their results using subgroup analysis. 1. Definition of chronic arterial hypertension. Chronic arterial hypertension defined as SBP greater than or equal to 130 and DBP greater than or equal to 80 vs. defined as SBP greater than or equal to 140 and DBP greater than or equal to 90. 2. Subgroup of type of antihypertensive. alpha 2 agonists, calcium antagonists, alpha blockers, beta blockers, alpha adrenergic antagonists, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, vasodilators, and diuretics. 3. Etiology of hypertension. Primary hypertension vs. secondary hypertension. Data analysis Statistical analysis was performed using RevMan 2019, a fixed-effect meta-analysis was used to pool the data when it was reasonable to assume that the studies estimated the same underlying treatment effect, that is, when the studies examined the same intervention, and the populations and study methods were sufficiently similar. When there was sufficient clinical heterogeneity to have expected underlying treatment effects differed between studies or substantial statistical heterogeneity, a random effects meta-analysis was performed. The average effect of the random effects was assessed as the average range of possible treatment effects and the clinical implications of treatment effects that differed between trials was discussed. If the average effect was not clinically significant, the trials were not combined. If random effects analysis was used, the results were presented as the mean treatment effect and 95% confidence intervals and I2 estimates. Sensitivity analysis A sensitivity analysis was performed by type of studies and based on other aspects of the review that may had have an effect on the results, a sensitivity analysis was also performed to explore the inclusion of the effects of fixed or random effects analysis for the results with statistical heterogeneity.

Introducción. El quiloperitoneo consiste en la presencia de fluido linfático en la cavidad intraabdominal, complicación poco descrita en el embarazo y cuyas repercusiones no están bien establecidas. Reporte de caso. Se presenta el caso de una mujer gestante con embarazo de 36,5 semanas, sin comorbilidades, hospitalizada por presentar cifras tensionales elevadas asociadas a síntomas de encefalopatía hipertensiva y bradicardia fetal sostenida; se le practicó una cesárea urgente en la cual se evidenció corioperitoneo incidental. La tomografía computarizada abdominal de control no demostró alteraciones. Discusión. Se descartaron las principales causas del quiloperitoneo, las cuales son neoplasia maligna y trauma. Se consideró que se trataba de un quiloperitoneo espontáneo posiblemente relacionado con la congestión pélvica propia del embarazo, por vasodilatación secundaria al influjo hormonal, aumento de la presión intraabdominal y contribución del volumen ascítico por la preeclampsia, que genera ruptura traumática de los vasos linfáticos. Conclusión. La ascitis quilosa es una entidad poco frecuente que puede verse asociada con el embarazo. Es fundamental el criterio acertado del ginecoobstetra para determinar tempranamente la etiología.

Aim To compare the sensitivity and specificity of screening for preeclampsia and FGR including maternal characteristics, mean arterial blood pressure and uterine artery pulsatility index and the combined screening, which adds biochemical markers, such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), in a sample of high risk population for hypertensive disorders. Methods This is a prospective study with 527 singleton pregnancies at 11-14 weeks of gestation. Maternal characteristics, biochemical and biophysical markers were studied to determine the development of preeclampsia and FGR by using receiver operating characteristic curves. Results For preeclampsia, screening, including sociodemographic data plus biophysical markers, had a sensitivity and specificity of 70.3% (CI% 64.3-75.2) and 93.8% (CI% 90.9-96.8), respectively. Combined screening, which includes sociodemographic data, biophysical (mean blood pressure and uterine artery pulsatility index) and biochemical markers (PlGF and PAPP-A), increased sensitivity and specificity up to 85.5% (CI% 80.2-90.3) and 96.3% (CI% 91.4-98.9), respectively. For FGR, sociodemographic data plus biophysical markers had a sensitivity and specificity of 57.8% (CI% 50.1-63.4) and 80.1% (CI% 74.3-85.9), respectively. Combined screening increased sensitivity and specificity up to 67.2% (CI% 52.1-71.3) and 82.7% (CI% 75.2-90.1), respectively. Conclusion Combined screening for preeclampsia and FGR at 11 to 14 weeks of gestation, which includes maternal characteristics, mean blood pressure, uterine artery pulsatility index, PAPP-A and PlGF, has higher sensitivity and specificity than other screening options. Therefore, considering all these variables during screening is recommended for a superior opportunity of identifying pregnant women in risk for preeclampsia and FGR, especially in a high-risk population.

Resumen Introducción. El quiloperitoneo consiste en la presencia de fluido linfático en la cavidad intraabdominal, complicación poco descrita en el embarazo y cuyas repercusiones no están bien establecidas. Reporte de caso. Se presenta el caso de una mujer gestante con embarazo de 36,5 semanas, sin comorbilidades, hospitalizada por presentar cifras tensionales elevadas asociadas a síntomas de encefalopatía hipertensiva y bradicardia fetal sostenida; se le practicó una cesárea urgente en la cual se evidenció corioperitoneo incidental. La tomografía computarizada abdominal de control no demostró alteraciones. Discusión. Se descartaron las principales causas del quiloperitoneo, las cuales son neoplasia maligna y trauma. Se consideró que se trataba de un quiloperitoneo espontáneo posiblemente relacionado con la congestión pélvica propia del embarazo, por vasodilatación secundaria al influjo hormonal, aumento de la presión intraabdominal y contribución del volumen ascítico por la preeclampsia, que genera ruptura traumática de los vasos linfáticos. Conclusión. La ascitis quilosa es una entidad poco frecuente que puede verse asociada con el embarazo. Es fundamental el criterio acertado del ginecoobstetra para determinar tempranamente la etiología. Abstract Introduction: Chyloperitoneum consists of the presence of a lymphatic fluid in the intra-abdominal cavity, a complication little described during pregnancy, and whose repercussions are not well established. Case report: A pregnant woman with a pregnancy of 36.5 weeks, without comorbidities, is hospitalized in the context of high blood pressure levels associated with symptoms of hypertensive encephalopathy and sustained fetal bradycardia, leading to an emergent cesarean section where incidental chorioperitoneum was evidenced. Posterior abdominal CT control showed no alterations. Discussion: The main associated etiologies (malignancy and trauma) were ruled out. It is considered a presentation of spontaneous chyloperitoneum that could be related to the pelvic congestion of pregnancy due to: vasodilatation secondary to hormonal influence, increased intra-abdominal pressure and contribution of ascites due to preeclampsia, generating traumatic rupture of lymphatic vessels. Conclusion: Chylous ascites is a rare entity that can be associated with pregnancy. It is essential that gynecologist and obstetrician correctly approach these patients to determine the etiology early.

Objective: To describe the socioeconomic, demographic and obstetric profile of pregnant women with Gestational Hypertensive Syndrome. Methods: A descriptive and correlational study, conducted in Maternity School Assis Chateaubriand, with 120 pregnant women, through a questionnaire analyzed by descriptive and analytical statistics. Results: most women had chronic hypertension (60.83%). Regarding the socioeconomic and demographic profile, most pregnant women had a mean age of 30.9 ± 6.9 years, were Catholic, brown skin color, employed, in stable unions, complete high school education, and income of up to R$ 954.00. Regarding the obstetric profile, their Body Mass Index was up to 66, slightly elevated blood pressure, an average of five prenatal consultations, two pregnancies, one delivery and no abortions. Women with chronic hypertension were older (p = 0.0024), had lower gestational age (p = 0.0219) and a higher number of abortions (p = 0.0140). Conclusions: Pregnant women are overweight/obese, with a mean age of 30.9 years and are socially vulnerable. Pregnant women with chronic hypertension are older and have a higher number of abortions. RESUMEN Objetivo: Describir el perfil sociodemográfico y obstétrico de embarazadas con Síndrome Hipertensivo Gestacional. Métodos: Estudio descriptivo y correlacional, hecho en una unidad Escuela de maternidad Assis Chateaubriand, con 120 embarazadas, utilizando un cuestionario analizado por estadísticas descriptivas e inferenciales. Resultados: Prevalecieron las embarazadas con hipertensión crónica (60,83%). En cuanto al perfil sociodemográfico, prevalecieron las embarazadas con promedio de edad de 30,9 años, católicas, pardas, con relación laboral, unión estable, nivel de escolarización medio e ingreso de hasta R$ 954,00. En cuanto al perfil obstétrico, eran embarazadas con Índice de Masa Corporal de hasta 66, presión arterial ligeramente alta, promedio de cinco consultas prenatales, dos embarazos, un parto y ningún aborto. Las mujeres con hipertensión crónica eran mayores (p=0,0024), tenían edad gestacional menor (p=0,0219) y mayor número de abortos (p=0,0140). Conclusiones: Las mujeres embarazadas presentan una edad media de 30 años, un nivel sociodemográfico bajo y sobrepeso/obesidad. Las mujeres embarazadas con hipertensión arterial crónica son mayores y tienen un mayor número de abortos. RESUMO Objetivo: Descrever o perfil socioeconômico, demográfico e obstétrico de gestantes com Síndrome Hipertensiva Gestacional. Métodos: Estudo descritivo e correlacional, realizado em unidade Maternidade Escola Assis Chateaubriand, com 120 gestantes, mediante questionário analisado por estatística descritiva e analítica. Resultados: Prevaleceram gestantes com hipertensão crônica (60,83%). Quanto ao perfil socioeconômico e demográfico, prevaleceram gestantes com idade média de 30,9 ± 6,9 anos, católicas, pardas, com vínculo empregatício, união estável, ensino médio completo e renda até R$ 954,00 reais. Quanto ao perfil obstétrico, eram gestantes com Índice de Massa Corporal até 66, pressão arterial levemente elevada, média de cinco consultas pré-natais, duas gestações, um parto e nenhum aborto. As mulheres com hipertensão crônica eram mais velhas (p=0,0024), tinham menor idade gestacional (p=0,0219) e maior número de abortos (p=0,0140). Conclusões: as gestantes apresentam sobrepeso/obesidade, idade média de 30,9 anos e vulnerabilidade social. As gestantes com hipertensão arterial crônica, são mais velhas e com maior número de abortos.

Resumen Objetivo: Determinar los factores que se asocian con los Trastornos Hipertensivos del Embarazo y la interacción entre ellos con el fin de establecer la dinámica de presentación clínica. Metodología: Estudio Observacional Analítico y Retrospectivo de tipo Casos y Controles con aplicación de Red de Probabilidad Neuronal Multicapa (RPNM). Se utilizó una muestra de 42 mujeres con Trastornos Hipertensivos del Embarazo y 80 mujeres sin THE. Se utilizó el programa SPSS 19® para el análisis descriptivo y aplicación de la RPNM. Para el análisis de casos y controles, se utilizó el programa Vassarstats©. Resultados: Se encontraron factores comunes para la preeclampsia y la hipertensión gestacional, menores de 21 años con mayor prevalencia de THE (p0.05), el sobrepeso con un (OR=5.9; (IC: 2.34-14.9) p=0.0001) y el estrés durante el embarazo (OR: 3.85 (IC: 1.63-9.08) p=0.01). Conclusión: Se evidencia la existencia de factores comunes tanto protectores como de riesgo y su interacción para presentar THE. Abstract Objective. To determine the factors that are associated with the hypertensive disorders of pregnancy and the interaction between them in order to establish the dynamics of clinical presentation. Methodology. Analytical and retrospective observational study of case-control type with application of network multilayer neural probability (RPNM). We used a sample of 42 women with hypertensive disorders of pregnancy and 80 women without HDP. The program SPSS 19 ® was used for the descriptive analysis and application of the RPNM. The program was used for the analysis of case-control Vassar stats©. Results. Common factors for pre-eclampsia and gestational hypertension, also found the younger age of 21 years with the highest prevalence of HDP (p0.05), envelope weight with a (OR=5.9; (IC: 2.34-14.9) p=0.0001) and stress during pregnancy (OR: 3.85) (IC: 1.63-9.08) p=0.01). Conclusion. Evidenced the existence of protective both common factors of risk and their interaction to present HDP.

Trata-se de uma pesquisa documental que analisou a produção brasileira da pós-graduação stricto sensu em enfermagem relacionada à hipertensão gestacional. Para tal, utilizou-se como fonte de pesquisa o Banco de Teses e Dissertações da Associação Brasileira de Enfermagem. Identificaram-se 14 estudos produzidos entre 1979-2008, cuja produção concentrou-se na região sudeste, entre 1996-2008. O processo analítico revelou a preocupação com a subjetividade das gestantes e com aspectos voltados à assistência de enfermagem. Mostrou, também, que a maioria dos estudos envolveu metodologia qualitativa e sob sustentação de teorias de enfermagem. A experiência vivida pelas gestantes hipertensas é marcada por sentimentos negativos, por problemas socioeconômicos e é influenciada pela forma de organização familiar. A cultura das gestantes hipertensas é desconsiderada e elas são assistidas em um contexto no qual a doença é prioridade. Conclui-se que, apesar de alguns avanços científicos, o tema não tem despertado o interesse merecido entre os enfermeiros que cursam pós-graduação. This documental study analyzed the Brazilian production of stricto sensu nursing graduate programs related to gestational hypertension. The data source used was the Brazilian Nursing Association Theses and Dissertations Database. The survey located 14 studies produced between 1979-2008, produced mainly in the Southeast region between 1996 and2008. The analytical process revealed a concern with the subjectivity of pregnant women and with aspects regarding nursing care. Furthermore, it showed that most studies used a qualitative methodology supported by nursing theories. The experience lived by pregnant women with hypertension is marked by negative feelings and socioeconomic problems, and is also affected by how the family is organized. The culture of pregnant women with hypertension is disregarded and they receive care in a context in which the disease is the priority. In conclusion, despite some scientific advancements, this topic has not raised the interest it deserves among nurses attending graduate study programs. Investigación documental que analizó la producción brasileña de posgrado stricto sensu en enfermería relacionada a hipertensión gestacional. Se utilizó como fuente el Banco de Tesis y Disertaciones de la Asociación Brasileña de Enfermería. Se identificaron 14 estudios realizados entre 1979-2008, con producción concentrada en la región sudeste, entre 1996-2008. El proceso analítico expuso la preocupación por la subjetividad de estas gestantes y con aspectos enfocados a la atención de enfermería. También mostró que la mayoría de los estudios involucró metodología cualitativa y sustentada por teorías de enfermería. La experiencia vivida por las gestantes hipertensas queda marcada por sentimientos negativos, por problemas socioeconómicos, e influenciada por la organización familiar. La cultura de las gestantes hipertensas no es considerada, son atendidas en un contexto donde la patología es prioritaria. Se concluye en que, a pesar de algunos avances científicos, el tema no ha despertado mayor interés entre los enfermeros cursando posgraduación.

Objective: To describe the epidemiological profile of women admitted to a tertiary hospital in Northeastern Brazil with Hypertensive Disorders of Pregnancy (HDP). Methods: A retrospective cross-sectional study was carried out at the Hospital Geral César Cals (César Cals General Hospital), a tertiary care center of the Sistema Único de Saúde – SUS (Brazil’s National Health System) in Fortaleza, Ceará, Brazil. The study included 1,865 pregnant women admitted with HDP from January 2006 to December 2013 regardless of age, education, marital status, place of birth, place of residence and outcome (discharge, death and ongoing pregnancy). Results: Pregnant women were predominantly aged 17-35 years (n=1484, 79.6%), mixed-race (n=1464, 78.5%), single (n= 775, 41.6%), housewives (n=1269, 68.0%), lived in Fortaleza (n=1198, 64.3%) and had complete elementary education (n=766, 41%). Overweight (n= 1408, 75.4%), first pregnancy (n=827, 44.3%) and multiparity (n=686, 36.7%) were the main risk factors for HDP. Regarding fetal status, 30.9% (n=576) were preterm. The main HDP complications were: HELLP syndrome (n=60, 3.2%), bleeding disorders (n=15, 0.8%) and acute respiratory failure (n=13, 0.6%). Conclusion: The pregnant women assessed presented risk factors for HDP, reinforcing the idea that the health status and the disease and health process are directly influenced by socioeconomic and demographic characteristics of the population. Objetivo: Describir el perfil epidemiológico de mujeres admitidas en un hospital terciario del Noreste de Brasil con Trastorno Hipertensivo del Embarazo (THE). Métodos: Estudio transversal retrospectivo realizado en el Hospital General César Cals que es un centro de cuidado terciario del Sistema Único de Salud - SUS (Sistema de Salud Nacional Brasileño) de Fortaleza, Ceará, Brasil. El estudio incluyó 1.865 mujeres embarazadas admitidas con THE entre enero de 2006 y diciembre de 2013 sin tener en cuenta la edad, la educación, el estado civil, el lugar de nacimiento, el domicilio y el resultado del embarazo (alta, muerte y en seguimiento). Resultados: Las mujeres embarazadas tenían predominantemente entre 17-35 años (n=1.484; 79,6%), mestizolas (n=1.464; 78,5%), solteras (n= 775; 41,6%), amas de casa (n=1.269; 68,0%), con domicilio en Fortaleza (n=1.198; 64,3%) y tenían educación básica completa (n=766; 41%). El sobrepeso (n= 1.408; 75,4%), el primer embarazo (n=827; 44,3%) y la multiparidad (n=686; 36,7%) fueron los principales factores de riesgo para THE. Respecto el estado del feto, el 30,9% (n=576) eran prematuros. Las principales complicaciones de la THE fueron: la síndrome HELLP (n=60; 3,2%), los disturbios de la pérdida de sangre (n=15; 0,8%) y la insuficiência respiratoria aguda (n=13; 0,6%). Conclusión: Las mujeres embarazadas evaluadas presentaron factores de riesgo para la THE lo que refuerza la idea que el estado de salud y el proceso de salud y enfermedad sufren directamente la influencia de las características socioeconómicas y demográficas de la población. Objetivo: Descrever o perfil epidemiológico das mulheres internadas em um hospital terciário do nordeste brasileiro com síndromes hipertensivas da gestação (SHG). Métodos: Realizou-se estudo transversal retrospectivo no Hospital Geral César Cals (HGCC), hospital terciário do Sistema Único de Saúde (SUS) em Fortaleza, Ceará, Brasil, com 1865 grávidas diagnosticadas com SHG internadas no período de janeiro de 2006 a dezembro de 2013, independente da idade, escolaridade, estado civil, nascimento, origem e desfecho (alta, morte e gravidez em andamento). Resultados: Houve predominância de mulheres na faixa etária entre 17-35 anos (n=1484, 79,6%), pardas (n=1464, 78,5%), solteiras (n= 775, 41,6%), donas-de-casa (n=1269, 68,0%), residentes em Fortaleza (n=1198, 64,3%) e com ensino fundamental completo (n=766, 41%). Excesso de peso (n= 1408, 75,4%), primeira gravidez (n=827, 44,3%) e multiparidade (n=686, 36,7%) foram os principais fatores de risco para SHG. Com relação ao estado do feto, 30,9% (n=576) eram prematuros. As principais complicações da SHG foram: síndrome HELLP (n=60, 3.2%), distúrbios hemorrágicos (n=15, 0,8%) e insuficiência respiratória aguda (n=13, 0,6%). Conclusão: As mulheres grávidas investigadas apresentaram fatores de risco para desenvolvimento da SHG, reforçando a idéia de que o nível de saúde e o processo de saúde e doença são diretamente influenciados por características demográficas e socioeconômicas da população.

Resumen Introducción: Los estados hipertensivos del embarazo son un conjunto de trastornos que acontecen en gestantes, siendo una de las principales causas de morbimortalidad materna y perinatal. Se clasifican en: hipertensión crónica, hipertensión gestacional, preeclampsia e hipertensión crónica con preclampsia sobreañadida. El adecuado control de la presión arterial es clave para su seguimiento. Objetivos: describir el perfil de los recién nacidos fruto de una gestación con estados hipertensivos y estudiar si existe relación con el tipo de alteración hipertensiva de la madre. Pacientes y Método: estudio de cohortes retrospectivo, que incluye a recién nacidos de gestantes con estados hipertensivos, seguidas en la unidad de hipertensión arterial, y que naciesen entre el 1 de enero de 2009 y el 31 de diciembre de 2015. Resultados: la muestra estuvo formada por 84 sujetos. La edad gestacional fue de 37,1 y el peso al nacer fue de 2.782,7 g. Las menores edades gestacionales y peso al nacer fueron en hijos de gestantes con preeclampsia o hipertensión crónica con preeclampsia sobreañadida (p