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It is a challenge to consider preeclampsia (PE) diagnosis and management in low and middle-income settings, where it represents a major public health concern. The placenta is the underlying cause of disease, and the plasma concentrations of proangiogenic and antiangiogenic factors released by the placenta can reflect the risks of disease progression. Antiangiogenic proteins, such as soluble fms-like tyrosine kinase 1 (sFlt-1), and proangiogenic, like placental growth factors (PlGF), are directly and inversely correlated with the disease onset, respectively. Narrative review on the use of biomarkers (sFlt-1 to PlGF ratio) with a suggested guidance protocol. Key considerations on the use of biomarkers: the sFlt-1/PlGF ratio is mainly relevant to rule out PE between 20 and 36 6/7 weeks in cases of suspected PE; however, it should not replace the routine exams for the diagnosis of PE. The sFlt-1/PlGF ratio should not be performed after confirmed PE diagnosis (only in research settings). In women with suspected PE, sFlt-1/PlGF ratio 38 can rule out the diagnosis of PE for 1 week (VPN = 99.3) and up to 4 weeks (VPN= 94.3); sFlt-1/PlGF ratio 38 does not confirm the diagnosis of PE; however, it can assist clinical management. In cases of severe hypertension and/or symptoms (imminent eclampsia), hospitalization is imperative, regardless of the result of the sFlt-1/PlGF ratio. The use of biomarkers can help support clinical decisions on the management of suspected PE cases, especially to rule out PE diagnosis, thus avoiding unnecessary interventions, especially hospitalizations and elective prematurity. É um desafio considerar o diagnóstico e o tratamento da pré-eclâmpsia (PE) em locais de baixa e média renda, onde a doença representa um grande problema de saúde pública. A placenta é a causa subjacente da doença, e as concentrações plasmáticas de fatores pró-angiogênicos e antiangiogênicos liberados pela placenta podem refletir os riscos de progressão da doença. Proteínas antiangiogênicas, como a tirosina quinase fms solúvel tipo 1 (sFlt-1), e pró-angiogênicas, como o fator de crescimento placentário (PlGF), estão direta e inversamente correlacionados com o início da doença, respectivamente. MéTODOS: Revisão narrativa sobre o uso de biomarcadores (razão sFlt-1/PlGF) com sugestão de protocolo de orientação para uso clínico. Principais considerações sobre o uso de biomarcadores: a razão sFlt-1/PlGF é principalmente relevante para descartar PE entre 20 e 36 6/7 semanas em casos de suspeita de PE; entretanto, não deve substituir os exames de rotina para o diagnóstico de PE. A relação sFlt-1/PlGF não deve ser realizada após a confirmação do diagnóstico de PE (apenas em ambientes de pesquisa). Em mulheres com suspeita de PE, a razão sFlt-1/PlGF 38 pode descartar o diagnóstico de PE por 1 semana (VPN = 99,3) e até 4 semanas (VPN = 94,3); A relação sFlt-1/PlGF 38 pode auxiliar no manejo clínico. Em casos de hipertensão grave e/ou sintomas (eclâmpsia iminente), a hospitalização é imprescindível, independentemente do resultado da relação sFlt-1/PlGF. CONCLUSãO: O uso de biomarcadores pode auxiliar na tomada de decisões clínicas no manejo de casos suspeitos de PE, principalmente para afastar o diagnóstico da doença, evitando intervenções desnecessárias, tais como internações e prematuridade iatrogênica.

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.

Made available in DSpace on 2021-06-25T12:40:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01. Added 1 bitstream(s) on 2021-07-15T14:36:35Z : No. of bitstreams: 1 S0100-72032021000100061.pdf: 351132 bytes, checksum: ec2e22a997ed83c899edfdc67368253f (MD5) Brazilian Federation of Gynecology and Obstetrics (FEBRASGO) 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. Univ Estadual Paulista, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil Univ Fed Uberlandia, Fac Med, Dept Obstet & Gynecol, Uberlandia, MG, Brazil Univ Sao Paulo, Fac Med, Dept Gynecol & Obstet, Ribeirao Preto, SP, Brazil Pontificia Univ Catolica Rio Grande do Sul, Gynecol & Obstet Training Ctr, Sch Med, Porto Alegre, RS, Brazil Ctr Univ Lusiada, Dept Tocoginecol, Santos, SP, Brazil Pontificia Univ Catolica Sao Paulo, Fac Med, Dept Obstet & Gynecol, Sorocaba, SP, Brazil Univ Fed Rio Grande do Sul, Fac Med, Dept Gynecol & Obstet, Porto Alegre, RS, Brazil Univ Estadual Campinas, Fac Med Sci, Dept Gynecol & Obstet, Campinas, SP, Brazil Univ Fed Minas Gerais, Fac Med, Dept Gynecol & Obstet, Belo Horizonte, MG, Brazil Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, SP, Brazil Univ Estadual Paulista, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP, Brazil

Objectives Eclampsia results in high morbidity and mortality, so it is important to identify clinical and laboratorial aspects that may be useful as potential markers to differentiate women at higher risk. Thus, we aim to identify, among women with preeclampsia, aspects that may increase the risk to develop eclampsia. Study design Retrospective cohort study. The records of patients delivered at Hospital Sao Lucas/PUCRS were reviewed retrospectively; 733 pregnant women with hypertension were analyzed; 329 had preeclampsia, and 45 eclampsia. Main outcome measures Serum uric acid levels and protein excretion in women that develop eclampsia. Results Patients with eclampsia had higher serum uric acid levels and protein excretion, systolic and diastolic blood pressure; were more likely to have cesarean section and had worst perinatal outcomes. The combination of uric acid above 5.9 mg/dL and protein/creatinine ratio over 4.9 had a striking association with eclampsia (p ≤ 0.001). The occurrence of HELLP syndrome was significantly different between groups, with a higher incidence among women who developed eclampsia (OR 6.5; 95%CI, 3.2–13.2; p Conclusion Our data suggest that the combination of high levels of maternal serum uric acid and proteinuria are strongly associated with the development of eclamptic crises.

INTRODUÇÃO: a prevalência de transtornos depressivos na população feminina de Porto Alegre é estimada em 14,5%. Não existem relatos sobre a prevalência de sintomas ou transtornos depressivos entre as prostitutas, população de risco para transtornos mentais. OBJETIVOS: quantificar a prevalência de sintomas depressivos em amostra de prostitutas de Porto Alegre e fatores associados. MATERIAL E MÉTODOS: uma amostra consecutiva e não aleatória de 97 mulheres entre 18 e 60 anos, cadastradas na Organização Não Governamental Núcleo de Estudos da Prostituição (NEP), de Porto Alegre, foi estudada. Após consentimento informado, as entrevistadas foram investigadas através do Inventário para depressão de Beck (BDI). O ponto de corte igual ou maior que 13 foi utilizado para detecção de sintomas depressivos. RESULTADOS: na amostra estudada, a idade média foi de 29,6 anos (dp 8,5 anos); 67% apresentaram sintomas depressivos (ponto de corte³ 13) com escore médio no BDI de 19,1 (dp 10,9); 24,7% da amostra apresentava sintomas leves; 40,2% sintomas moderados e 7,2% sintomas graves. Houve associação estatisticamente significativa entre a presença de sintomas depressivos e uso de álcool, história de doenças sexualmente transmissíveis e ausência de prática religiosa (p

Objectives Endothelial dysfunction is thought to be one of the mechanism involving in pre-eclampsia manifestation. Likewise, one of the inflammatory mediators involved in this process is interleukin (IL)-6, a mediator synthesized by mononuclear phagocytes, endothelial cells and fibroblasts in response to inflammatory stimuli. IL-6 has been described increased in women with pre-eclampsia. Thus, we aimed to investigate the association between endothelial dysfunction (by flow-mediated dilatation) and IL-6 levels in women with pre-eclampsia. Methods Following ethical approval, a written consent was obtained from 21 women diagnosed with pre-eclampsia. Endothelial function was evaluated by brachial artery flow-mediated dilatation. IL-6 was quantified using MagPlexTH-C - microspheres system, in maternal plasma. Pre-eclamptic groups was divided into altered (n = 9) and normal (n = 12) endothelial function, considering a cutoff point of 10%, below or above, respectively. The Mann–Whitney U-tests was carried out to compare the IL-6 values between pre-eclamptic groups. Correlations between the parameters were tested with a Spearman’s Rank correlation tests. The null hypothesis was rejected when p Results Higher levels of IL-6 was observed in altered flow-mediated dilatation test group in relation to normal endothelial group (median [IQR]): 4.34 pg/mL [3.38; 6.22] and 2.56 pg/mL [1.57; 3.67]; p = 0.028, respectively. When an analysis was made between flow-mediated dilatation levels and IL-6, a negative correlation was found (r = −0.514, p = 0.017). Conclusions As expected in patients with pre-eclampsia, a high inflammatory response showed a low flow-mediated dilatation. The significant correlation between a potential clinical prediction method and a well-known inflammatory cytokine support the importance of working not only with one potential biomarker to predict pre-eclampsia, but also, with a group of molecules and/or techniques, in order to increase the chance to diagnose the disease as early in pregnancy as possible – before signals and symptoms. Disclosures M.R. Hentschke: None. M.C. Vieira: None. E.V. da Cunha Filho: None. J. Guaragna: None. C.E. Poli de Figueiredo: None. B.E. Pinheiro da Costa: None.

FUNDAMENTO: A síndrome de pré-eclâmpsia se associa com a disfunção endotelial e o diagnóstico diferencial entre pré-eclâmpsia pura (PE) e sobreposta (PES) só pode ser feito após 12 semanas do parto. OBJETIVO: Comparar a avaliação da função endotelial através de dilatação mediada por fluxo de gestantes com pré-eclâmpsia pura e sobreposta. MÉTODOS: A dilatação mediada por fluxo da artéria braquial foi realizada utilizando as recomendações da International Brachial Artery Reactivity Task Force em gestantes com a Síndrome de Pré-eclâmpsia. Pré-eclâmpsia (n = 14) e pré-eclâmpsia sobreposta (n = 13) foram diagnosticadas no pós-parto segundo as definições do National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTADOS: A mediana da dilatação mediada por fluxo (DMF) na PES (6,0%; 1,9-10,3) foi reduzida em comparação com PE (13,6%; 4,4-17,1), uma disparidade aparentemente relevante, mas sem diferença estatisticamente significativa (p = 0,08). A DMF inferior a 10% foi detectada em 30,8% das PE e em 69,2% das PES (p = 0,057). Diferenças significativas não ocorreram na comparação entre a morfologia das artérias uterinas de PE e PES através do espectro do Doppler. CONCLUSÃO: A DMF da artéria braquial de pacientes com Síndrome de Pré-eclâmpsia não se mostrou ser um método capaz de diferenciar PE de PES. Entretanto, os dados sugerem que PES se associa com pior função endotelial em comparação a PE. BACKGROUND: The preeclampsia syndrome is associated with endothelial dysfunction and the differential diagnosis between pure preeclampsia (PE) and superimposed preeclampsia (SPE) can be only be attained 12 weeks after delivery. OBJECTIVE: To compare the assessment of endothelial function through flow-mediated dilatation in pregnant women with pure preeclampsia and superimposed preeclampsia. METHODS: The flow-mediated dilatation of the brachial artery was carried out according to the recommendations of the International Brachial Artery Reactivity Task Force in pregnant women with preeclampsia syndrome. PE (n=14) and SPE (n=13) were diagnosed in the postpartum period according to the definitions of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTS: The median of the flow-mediated dilatation (FMD) in SPE (6.0%; 1.9-10.3) was decreased in comparison with the PE (13.6%;4.4-17.1), an apparently relevant difference , but not statistically significant (p = 0.08). The FMD < 10% was detected in 30.8% of the PE cases and in 69.2% of the SPE cases (p = 0.057). Significant differences could not be detected in the morphology of the uterine arteries between the PE and SPE cases through the Doppler spectrum. CONCLUSION: The FMD of the brachial artery of patients with preeclampsia syndrome was not capable of differentiating between PE and SPE. However, the data suggest that SPE is associated with worse endothelial function I comparison to PE. FUNDAMENTO: El síndrome de preeclampsia se asocia con la disfunción endotelial y el diagnóstico diferencial entre preeclampsia pura (PE) y sobreagregada (PES) sólo puede realizarse 12 semanas después del parto. OBJETIVO: Comparar la evaluación de la función endotelial a través de dilatación mediada por flujo en gestantes con preeclampsia pura y sobreagregada. MÉTODOS: La dilatación mediada por flujo de la arteria braquial se realizó utilizando las recomendaciones de la International Brachial Artery Reactivity Task Force en gestantes con Síndrome de Preeclampsia. La Preeclampsia (n = 14) y preeclampsia sobreagregada (n = 13) fueron diagnosticadas en el posparto según las definiciones del National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTADOS: El promedio de la dilatación mediada por flujo (DMF) en la PES (6,0%; 1,9-10,3) fue reducido en comparación con la PE (13,6%; 4,4-17,1), una disparidad aparentemente relevante, pero sin diferencia estadísticamente significativa (p = 0,08). Una DMF inferior al 10% se detectó en el 30,8% de las PE y en el 69,2% de las PES (p = 0,057). No aparecieron diferencias significativas en la comparación entre la morfología de las arterias uterinas de PE y PES a través del espectro del Doppler. CONCLUSIÓN: La DMF de la arteria braquial de pacientes con Síndrome de Preeclampsia no demostró ser un método capaz de diferenciar PE de PES. No obstante, los datos sugieren que la PES se asocia a una peor función endotelial en comparación con la PE.

The preeclampsia syndrome is associated with endothelial dysfunction and the differential diagnosis between pure preeclampsia (PE) and superimposed preeclampsia (SPE) can be only be attained 12 weeks after delivery.To compare the assessment of endothelial function through flow-mediated dilatation in pregnant women with pure preeclampsia and superimposed preeclampsia.The flow-mediated dilatation of the brachial artery was carried out according to the recommendations of the International Brachial Artery Reactivity Task Force in pregnant women with preeclampsia syndrome. PE (n=14) and SPE (n=13) were diagnosed in the postpartum period according to the definitions of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy.The median of the flow-mediated dilatation (FMD) in SPE (6.0%; 1.9-10.3) was decreased in comparison with the PE (13.6%;4.4-17.1), an apparently relevant difference , but not statistically significant (p = 0.08). The FMD10% was detected in 30.8% of the PE cases and in 69.2% of the SPE cases (p = 0.057). Significant differences could not be detected in the morphology of the uterine arteries between the PE and SPE cases through the Doppler spectrum.The FMD of the brachial artery of patients with preeclampsia syndrome was not capable of differentiating between PE and SPE. However, the data suggest that SPE is associated with worse endothelial function I comparison to PE.

arteri osus without clinical symptoms or haemody-namic repercussion. Association between ALS and pregnancy has rarely been described. Since 1977, 19 pregnancies in 16 women have been reported, including the present case (2 6). As foetal growth can be affected by mul-tiple factors, it is diffi cult to attribute this fi nding to the drug use. This is the fi rst report of association between riluzole use and cardiac malformation, although prevalence of cardiac malformations in the general population is considerable. Riluzole use during pregnancy is thought to be harmless, but foetal effects are unknown. It is catego-rized as a Class C drug by the Food and Drug Administration (FDA) (7). The only case of riluzole use throughout pregnancy reported a low birth weight of the newborn, but IURG was not consid-ered because of an uncertain gestational age (2). There has been another case in which riluzole was used until pregnancy diagnosis, at nine weeks GA, when the drug was discontinued (3). ALS seems not to cause obstetric complications. In advanced cases, respiratory complications have been described (4). This was not seen in our patient, whose neurological evaluation deteriorated as a normal progression. Also, uterine contractions seem not to be adversely affected by ALS (5). No clear evidence exists as to the better method of delivery. Besides incipient respiratory failure, caesarean delivery indication should follow obstetrics routine (6).