OBJETIVO: Analizar los factores predictores de eclampsia en pacientes con preeclampsia atendidas en el Hospital Nacional Docente Madre Niño “San Bartolomé” durante el periodo 2010 – 2014. MATERIAL Y MÉTODOS: Estudio observacional analítico de casos y controles, retrospectivo y de corte transversal, que incluyó a pacientes con preeclampsia conformadas en dos grupos: grupo casos, constituido por 31 pacientes preeclampticas con diagnóstico de eclampsia atendidas en el servicio de hospitalización del HONADOMANI “San Bartolomé” durante el periodo 2010-2014 y grupo control, constituido por 62 pacientes con preeclampsia sin diagnóstico de eclampsia, en relación 1:2 con respecto al grupo casos. Se utilizó la prueba Chi-cuadrado, para establecer asociación entre variables, el cual se consideró significativo cuando tenía un valor p< 0.05 y para el análisis del factor de riesgo se usó la prueba de Odd Ratio (OR), considerando riesgo cuando es mayor a 1. Mediante el análisis multivariado, se hallaron los factores predictores. RESULTADOS: Los factores personales de riesgo para eclampsia en pacientes con preeclampsia fueron la Hipertensión arterial antes de las 37 semanas de gestación (p=0.003, OR=4.25), el Índice de Masa Corporal de Sobrepeso-Obesidad (p=0.022, OR=2.82) y el antecedente de consumo de tabaco (p=0.043, OR=3.14). Entre los factores ginecológicos, el tener una sola pareja sexual fue una factor protector para eclampsia (p=0.032). Entre los factores obstétricos, el bajo peso al nacer fue un factor de riesgo para eclampsia (p=0.002, OR=4.35). Los factores clínicos de riesgo para eclampsia fueron el nivel de aspartato amino transferasa ≥ 44 UI (p=0.049, OR=3.53), el nivel de ácido úrico > 5.3 mg/dl (p=0.04, OR=3.25) y la bilirrubina total >= 1.2 mg/dl (p=0.045, OR=2.80). Mediante el análisis multivariado se obtuvo que los factores predictores para eclampsia fueron el bajo peso al nacer (OR= 11.695, p=0.002), y el nivel de Aspartato Aminotransferasa ≥ 44 UI/L (OR=6.945, p=0.046). CONCLUSIÓN: Los factores predictores de eclampsia en pacientes con preeclampsia atendidas en el Hospital Nacional Docente Madre Niño “San Bartolomé” durante el periodo 2010 – 2014 fueron el bajo peso al nacer y el nivel de aspartato amino transferasa.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology MMed(O&G) Johannesburg, April 2015 / Background Pre-eclampsia and its complications remain a significant cause of maternal and perinatal morbidity and mortality on a global level. There are few data regarding the maternal and fetal outcome of pre-eclampsia at term. Studies suggest that poor maternal outcome is more prevalent as one approaches term, while there are conflicting findings regarding the outcomes of the babies born to term pre-eclamptic patients. Objective To determine the prevalence of pre-eclampsia in term pregnancies at Rahima Moosa Mother and Child Hospital (RMMCH), a hospital that provides district and higher level referral services, and to assess the severity of maternal disease in pre-eclampsia at term, as well as fetal outcomes. Methods This was a prospective cross-sectional, descriptive study on women giving birth at term with pre-eclampsia. All women were followed up until delivery. The indication for and mode of delivery, maternal progress and complications, as well as fetal outcome, were recorded. Results Seventy-eight patients were entered into the study, giving a hospital prevalence rate of pre-eclampsia at term of 1.2%. The major maternal complications were those of severe hypertension (75.6%), eclampsia (9%), HELLP syndrome (3.8%), and pulmonary oedema (7.7%). There was one maternal death. Fifty-one patients (65%) delivered by caesarean section. Major fetal complications encountered were respiratory distress (7.5%) and birth asphyxia (3.7%). There was one neonatal death from meconium aspiration.

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Made available in DSpace on 2014-07-02T12:58:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O organismo materno sofre intensas adaptações para o desenvolvimento adequado do feto. Entretanto, essas adaptações podem ocorrer de forma inadequada e predispor ao desenvolvimento de patologias na gravidez. Dentre estas destaca-se a pré-eclâmpsia, decorrente da má-adaptação circulatória, na qual observa-se expansão volumétrica inadequada. A água corporal total (ACT) está estritamente relacionada com o volume plasmático e a bioimpedância (BIA), como técnica indireta de avaliação das medidas de água corporal, pode ser utilizada para avaliar a variação gravídica do mesmo. A BIA fornece diretamente valores de resistência e reactância que avaliam indiretamente a composição dos compartimentos corporais. Esta avaliação pode ser método eficaz na determinação do grau de comprometimento do organismo materno pelo processo da pré-eclâmpsia, visto que a avaliação dos níveis de ACT durante a gravidez pode fornecer informações sobre a qualidade dessa adaptação. O presente estudo foi proposto com o objetivo de analisar os parâmetros diretos (resistência e reactância) e indiretos (água corporal total, intra e extracelular) da BIA, em gestantes portadoras de pré-eclâmpsia, comparando-os com os resultados obtidos em pacientes normais. Os dados foram ajustados para as covariáveis idade gestacional, idade materna e índice de massa corporal prégestacional. Foram analisadas as covariancias (ANCOVA) e aplicado o teste de Tuckey e para as variáveis independentes sem influencia das covariaveis foi aplicado o teste T. O valor de significância adotado foi de 5%. Avaliou-se 51 gestantes controle (grupo C) e 65 gestantes com pre-eclâmpsia (grupo PE) do HC-FMB- UNESP. O grupo PE apresentou menores valores de R (448Ω v 542 Ω ), Rc (40Ω v 53 Ω) e AIC (49,45% v 51%) quando comparados com o grupo C. O grupo PE apresentou maiores valores de ACT (49% v 47%) , ACTcor (41,6% v 34%), AEC (50% v 47%). Conclui-se que existem diferenças entre os grupos tanto para os parâmetros diretos, como para os indiretos. Embora os segundos sejam melhores para ilustrarem os processos fisio-patológicos, auxiliando na compreensão dos mecanismos envolvidos na pré-eclâmpsia, os primeiros, de mais fácil obtenção, foram suficientes e podem ser úteis na atenção a mulheres com alto risco de pré-eclâmpsia. / The maternal body undergoes significant adaptations to ensure adequate fetal development. However, inadequate adaptations play a leading role in the development of obstetrics disorders. Among these, the most important is preeclampsia, which may result from circulatory maladaptation. Nonetheless, total body water is closely related to plasma volume and bioimpedance (BIA), as an indirect method to measure body water, may be useful for the assessment of variations in plasma volume during pregnancy. BIA directly measures resistance and reactance values, which indirectly evaluate body compartments. Thus, this technique may effectively determine the level of maternal body involvement in preeclampsia, given that the measurement of total body water during pregnancy can provide information about the quality of this adaptation. This study aimed at comparing resistance, reactance, total body water, intra- and extracellular water between primigravidas diagnosed with preeclampsia and normal primigravidas at the third trimester of gestation. Outcome variables between groups were compared by ANCOVA with gestational age, maternal age and pre-gestational body mass index considered as confounding variables. Independent outcome variables between groups were compared by the t test of Student at a significance level of 0.05. Fifty-one control pregnant women (group C) and 65 pregnant women with preeclampsia (group PE) from Botucatu Medical School Hospital were submitted to the bioimpedance test (BIA). Data collected included resistance and reactance, total body water (TBW), pregnancy-corrected body water (TBWcor), extracellular water (ECW) and intracellular water (ICW). When compared to controls, PE values of resistance (448Ω v 542 Ω ) and reactance (40Ω v 53 Ω) were smaller; TBW (49% v 47%), TBWcor (41,6% 34%), ECW (50% v 47%) were higher; and ICW (49,45% v 51 %) was smaller. In conclusion, PE showed smaller resistance, reactance and ICW values and higher TBW, PBWcor and ECW. It can be concluded there are differences among the groups as to the direct parameters and also as to the indirect ones. Although the second ones were the best to illustrate the physiopathological process, helping in understanding the involved mechanisms of preeclampsia, the first ones, obtained in an easier way were enough and can be useful for care of the women with preeclampsia.

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The term eclampsia is derived from the Greek eklampien meaning a flesh, and its etymology suggests the acute onset of the convulsions. On the surface, therefore, it would appear paradoxical to define any state as being one of "imminent eclampsia". However, although the aetiology is unknown, sufficient knowledge of the preceding history and manifestations of eclampsia has accumulated to justify such a specific term. In a subsequent chapter, these symptoms and signs will be assessed and discussed in detail. Where the net of antenatal care is widespread and where such services are accepted and utilized by all who are pregnant in a community, the incidence of severe toxania and eclampsia is minimal. Few obstetricians in highly developed, civilized areas are afforded the opportunities for studing and treating any large numbers of cases of imminent eclampaia

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Obstetrics & Gynaecology. Johannesburg, 2017. / Background and objectives Evidence supporting an association between HPV infection and pre-eclampsia has recently been published. Pre-eclampsia is a common, serious complication of pregnancy of complex aetiology that to date has not been fully described. Human papillomavirus (HPV) is a ubiquitous, DNA-virus with tropism for human mucosal commonly found in the female genital tract. Association between placental HPV infection and preterm labour and pregnancy loss has previously been described. This study tested the hypothesis that an association exists between HPV in the placenta or the cervix and clinical pre-eclampsia, or levels of its associated biomarkers, soluble fms-like tyrosine kinase (sFLT1) and placental growth factor (PlGF). Methods Women with pre-eclampsia were matched to healthy controls. All subjects were delivered by caesarean section, and cervical and placental samples were collected at the time of delivery. These samples were tested for HPV using a polymerase chain reaction (PCR) assay. Serum levels of soluble fms-like tyrosine kinase (sFLT1) and placental growth factor (PlGF) at the time of delivery were tested. Placental and cervical HPV was compared to the outcomes of clinical pre-eclampsia and serum sFLT1 and PlGF levels. Results and conclusion While clinically apparent disease was associated with increased levels of sFLT1 and decreased levels of PlGF, HPV was not detected in any of the placental specimens using the PCR assay. As a result, no association was found between placental HPV detection and clinically apparent pre-eclampsia or deranged serum levels of sFLT1 or PlGF. HPV was very common in cervical samples and showed a non-significant trend towards negative association with clinical pre-eclampsia and sFLT1, and a positive association with PlGF. This may be an effect of cervical HPV infection on the vascular endothelial growth factor (VEGF) signalling system that may explain its association with miscarriage. / LG2018

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Copies of author's previously published articles inserted. / Bibliography: leaves 160-173. / xi,173 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / A prospective, descriptive study of every case of eclampsia which occurred in the United Kingdom during 1992. Multiple logistic regression analyses were carried out to help assess which factors of the eclamptic episode were associated with poorer maternal and fetal outcomes. / Thesis (M.D.)--University of Adelaide, Dept. of Obstetrics and Gynaecology, 1996?