OBJETIVO: Determinar los factores de riesgo asociados a preeclampsia leve en primigestas. METODOLOGÍA: En la investigación se realizó un estudio epidemiológico analítico retrospectivo de caso y control, con el fin de conocer los factores de riesgo para desarrollar pre eclampsia leve en primigestas. La investigación contó con una muestra de 280 pacientes (140 casos y 140 controles). El estudio se llevó a cabo en el Servicio de Ginecología y Obstetricia del Hospital Vitarte durante el período 2015. RESULTADOS: La edad materna menor de 22 años y la edad mayor de 32 años con un p valor p < 0,05 (p = 0,0008 y p= 0,04, respectivamente). La edad menor de 22 años tenía un OR mayor de 1 (OR: 3,428, IC: 1.236- 5.602). Por otro lado, edad mayor de 32 años obtuvo un OR mayor de 1 (OR: 3.563, IC: 1.368-5.931). Índice de masa corporal normal 18- 24 con la preeclampsia p < 0,05 (p = 0,004) tiene un OR menor de 1 (OR: 0,567, IC: 0,286 - 0,88), entendiéndose que el IMC normal es un factor protector estadísticamente significativo. El sobrepeso IMC> 25kg/m2 (p = 0,003) (OR=6,663, IC: 1,986 - 18,016). CONCLUSIONES: El presente estudio identificó a la edad, el índice de masa corporal > 25kg/m2, como factor de riesgo para pre eclampsia leve, aumentando de forma significativa el riesgo de pre eclampsia leve incidiendo más en primigestas menor de 22 años y mayor de 32 años en gestantes atendidas en el Hospital Vitarte.

Objetivo: Determinar si la preeclampsia como factor predisponente está asociado a hemorragia post parto inmediato en el Hospital Santa Rosa de Enero - Diciembre 2015. Diseño y método: estudio observacional, retrospectivo, analítico de casos y controles. La población estudiada fueron las gestantes con diagnóstico de hemorragia que fueron atendidas y hospitalizadas en el departamento de Ginecoobstetricia del Hospital Santa Rosa de enero - Diciembre 2015 que cumplen con los criterios de inclusión y exclusión. Para el estudio se utilizó una ficha de recolección de datos y se analizó a través del programa SPSS versión 22, se usó pruebas chi cuadrado (X2) para variables cualitativas y Odds Ratio para asociación de variables. Resultados: Se evaluaron 148 pacientes con diagnóstico de preeclampsia en pacientes que presentaron hemorragia post parto inmediato, de las cuales 72.3% presentaron preeclampsia y 27.7% no presentaron preeclampsia, encontrándose asociación OR 6.223 IC 95% (2.96 - 13.05)) estadísticamente significativo p=0.000. Se encontró que 74 (84.1%), pacientes con preeclampsia severa tuvieron hemorragia post parto inmediato y 33 (15.9%) pacientes con preeclampsia leve tuvieron hemorragia post parto inmediato. Se analizó la asociación de hemorragia post parto inmediato con cesárea y multiparidad de las pacientes con diagnóstico de preeclampsia encontrándose asociación significativa. Conclusión: La preeclampsia es un factor asociado a hemorragia post parto inmediato; los factores de riesgo estudiados y que se asociaron significativamente con hemorragia post parto fueron preeclampsia severa, cesárea y multiparidad.

Objetivo: Determinar la relación entre primipaternidad y desarrollo de preeclampsia en gestantes atendidas en el servicio de Gineco-Obstetricia del Hospital III Suarez Angamos entre octubre y diciembre del 2016. Finalidad: Demostrar el rol de la primipaternidad en la aparición de preeclampsia en gestantes con antecedente de por lo menos un parto previo. Métodos y materiales: Estudio observacional tipo analítico de caso-control, ingresaron 32 casos (gestante con preeclampsia y más de un parto previo) y 64 controles (gestante sin preeclampsia y más de un parto previo). Se revisaron las historias clínicas y los datos se anotaron en una ficha de recolección de datos. El análisis se realizó en el programa SPSS.21 con estadística descriptiva, elaboración de tablas de 2x2 y se calculó el OR e IC95% crudo y corregido con análisis de regresión logística binaria. Resultados: La frecuencia de hipertensión inducida por embarazo (HIE) fue 16.3%, mayormente preeclamsia leve (8.8%) y preeclampsia severa (4.3%), Los principales factores de riesgo fueron: preeclampsia previa (OR: 2.270; IC95%: 0.867-5.942) y primipaternidad (OR: 2.993 e IC95%: 1.244-7.197). En el análisis de regresión logística binaria la preeclampsia previa (ORa: 3.855; IC95%a: 1.220-12.187) y primipaternidad (ORa: 3.707; IC85%a: 1.401-9.804) Conclusiones y recomendaciones: Existe una alta frecuencia de HIE en el Hospital III Suárez Angamos, y los factores de riesgo preeclampsia previa y primipaternidad fueron confirmados para nuestra población como lo señala la literatura. Estos deben tenerse presentes en las estrategias de planificación y consejería pre-concepcional y realizar la vigilancia epidemiológica en las gestantes que las tengan.

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.

Objetivo: Determinar la relación entre la violencia doméstica de la pareja y la preeclampsia en gestantes atendidas en el Hospital San Juan de Lurigancho enero – julio, 2015. Material y métodos: Estudio retrospectivo, analítico de casos y controles en 80 gestantes (40 gestantes con preeclampsia y 40 gestantes normotensas) atendidas en el Hospital San Juan de Lurigancho durante el periodo enero – julio, 2015. Con la finalidad de evaluar la presencia o ausencia de violencia doméstica de la pareja durante el embarazo. Los datos se recopilaron a través de la revisión de historias clínicas y un cuestionario válido para la violencia intrafamiliar durante el embarazo. En el análisis se aplicó estadísticas descriptivas, distribución de frecuencias y proporciones en las variables cualitativas. Para las variables cuantitativas se aplicó medidas de tendencia central, promedios y desviaciones estándar. Para las inferencias estadísticas se aplicó la prueba de Chi-Cuadrado en las variables cualitativas. Para la determinación de las relaciones se aplicó la razón de productos cruzados (OR) con sus intervalos de confianza al 95%, regresión logística binaria, regresión de Cox y Snell y se aplicó la prueba de Hosmer y Lemeshow para la validación del modelo, considerándose adecuado cuando el p > 0.05. Resultados: El promedio de edad de las gestantes preeclampticas (casos) fue 27.83 y 27.35 para las gestantes normotensas (controles). En ambos grupos, la educación secundaria completa fue mayoritaria, 72.5% en los casos y 57.5% en los controles. El 85% de los casos manifestaron ser amas de casa al igual que los controles, 72.5%. El 62.5% de los casos tienen una procedencia de nacimiento de la costa y el 40% de los controles procede de la sierra. En ambos grupos el estado civil conviviente fue mayoritario, 72.5% en los casos y el 80% en los controles. Asimismo el tiempo de cohabitación sexual con la pareja representó el 57.5% y el 92.5% para los casos y controles, respectivamente. La probabilidad de tener Preeclampsia cuando se presenta violencia física (OR: 2.1; IC95% 0.706-6.253) es más de dos veces y casi tres veces más cuando se presenta la violencia sexual (OR: 2.97; IC95% 0.966-9.155), p<0.05. Para la violencia psicológica, la probabilidad de sufrir preeclampsia en presencia de este factor es 1.11 veces más, p>0.05. En general, existe una probabilidad de 2.5 veces más en desarrollar Preeclampsia cuando se presenta la violencia (OR: 2.54; IC95% 0.895-7.202), p>0.05. Conclusiones: La violencia doméstica física y sexual de la pareja incrementa el riesgo de sufrir preeclampsia. No se obtuvieron datos estadísticamente significativos para la violencia psicológica y su relación con esta patología. En general, la violencia doméstica de la pareja constituye un factor de riesgo para desarrollar preeclampsia en las gestantes atendidas en el Hospital San Juan de Lurigancho en el periodo enero – julio 2015, aunque estos resultados no fueron estadísticamente significativos. PALABRAS CLAVES: Violencia infligida por la pareja, violencia durante el embarazo, preeclampsia. / --- Objective: To determine the relationship between domestic partner violence and preeclampsia in pregnant women treated at the Hospital San Juan de Lurigancho January to July 2015. Materials and methods: Retrospective, analytical case-control study of 80 pregnant women (40 pregnant women with preeclampsia and 40 normotensive pregnant) at the Hospital San Juan de Lurigancho for the period January-July 2015. In order to assess the presence or absence of domestic partner violence during pregnancy. Data were collected through review of medical records and valid for domestic violence during pregnancy questionnaire. In the analysis descriptive statistics, frequency distributions and proportions for qualitative variables applies. For quantitative variables measures of central tendency, means and standard deviations was applied. For the statistical inferences Chi-Square test is applied in the qualitative variables. To determine the relationship was applied the odds ratio (OR) with confidence intervals of 95%, binary logistic regression, Cox and Snell products and the HosmerLemeshow test was used to validate the model, considering suitable when the p> 0.05. Results: The mean age of preeclamptic pregnant women (cases) was 27.83 and 27.35 for normotensive pregnant women (controls). In both groups, the majority was completed secondary education, 72.5% in cases and 57.5% in controls. 85% of cases being housewives expressed as the controls, 72.5%. 62.5% of cases have a source of birth of the coast and 40% of controls comes from the mountains. In both groups the majority law marriage was 72.5% in cases and 80% in controls. Also the time of sexual cohabitation with the couple represented 57.5% and 92.5% for cases and controls, respectively. The chance of having preeclampsia when physical violence (OR: 2.1; 95% CI 0.706- 6.253) presented is more than twice and almost three times as sexual violence (OR: 2.97; 95% CI 0.966–9.155) is presented, p <0.05. For psychological violence, the likelihood of preeclampsia in the presence of this factor is 1.11 times, p> 0.05. In general, there is a probability of 2.5 times in preeclampsia when violence (OR: 2.54; 95% CI 0.895-7.202) is presented p> 0.05. Conclusions: Domestic physical and sexual partner violence increases the risk of preeclampsia. No statistically significant data for psychological violence and their relationship with this pathology were obtained. Usually, Domestic partner violence is a risk factor for preeclampsia in pregnant women treated at the Hospital San Juan de Lurigancho in the period January to July 2015, although these results were not statistically significant. KEYWORDS: Intimate partner violence, violence during pregnancy, preeclampsia.

Analiza los resultados del test estresante en gestantes con y sin preeclampsia atendidas en el Instituto Nacional Materno Perinatal durante el primer semestre del año 2014. Es un estudio analítico de preeclampticas y controles, retrospectivo y de corte transversal, que tiene como muestra a 190 gestantes con resultados cardiotocográficos del test estresante divididas en dos grupos: pacientes con diagnóstico de preeclampsia (n=95) y pacientes sin preeclampsia (n=95). Para el análisis descriptivo o univariado de las variables cuantitativas se estima medias y desviación estándar y para las variables cualitativas se estimaron frecuencias y porcentajes. Para el análisis inferencial, se utiliza la prueba Chi-cuadrado, la cual se considera significativa cuando tenía un valor p<0.05. El 86% tiene diagnóstico de preeclampsia leve y el 14% de preeclampsia severa. Los hallazgos cardiotocográficos del test estresante en las gestantes con preeclampsia son: línea de base 110-160 lpm (98.9%), variabilidad mayor o igual a 1 (90.5%), aceleraciones presentes (85.3%), desaceleraciones variables (14.7%), desaceleraciones mayor o igual a 50% (13.7%) y contracciones uterinas menor a 5 (98.9%). En las gestantes sin preeclampsia, los hallazgos cardiotocográficos del test estresante son: línea de base 110-160 lpm (100%), variabilidad mayor o igual a 1 (97.9%), aceleraciones presentes (85.3%), desaceleraciones variables (8.4%), desaceleraciones mayor o igual a 50% (8.4%) y contracciones uterinas menor a 5 (100%). La ausencia de variabilidad estuvo relacionada a la presencia de preeclampsia (p=0.030). Además existe relación entre la conclusión dudosa e insatisfactoria y la presencia de preeclampsia (p=0.033). Se obtiene que la variabilidad y las conclusiones del test estresante en gestantes fueron diferentes para el grupo de gestantes con y sin preeclampsia; ya que la variabilidad ausente (p=0.030) y las conclusiones dudosas e insatisfactorias del test estresante (p=0.033) se relacionan significativamente con el diagnóstico de gestantes con preeclampsia.

INTRODUCTION Preeclampsia, a hypertensive disorder of pregnancy, affects 3% to 7% of women throughout the world. Preeclampsia is a leading cause of maternal and infant mortality worldwide, occurring primarily in nulliparous women. Despite extensive research over the past decade, the underlying pathophysiological mechanisms of the disease are largely unknown. A recent hypothesis has suggested that when a pregnancy is complicated by preeclampsia, it is the result of an inability of the maternal cardiovascular system to fully adapt to the physiologic challenge of pregnancy. This may result when there is an underlying and predisposing prepregnancy maternal cardiovascular state that leads to the pathophysiologic consequences of preeclampsia when pregnancy is superimposed. Despite evidence for familial predisposition and presumed multifactorial genetic inheritance, preeclampsia generally occurs in first pregnancies and does not recur when the interpregnancy interval is short. One explanation for these observations is that pregnancy itself modifies the maternal cardiovascular system in ways that persist postpartum and reduce the risk for preeclampsia recurrence, at least for a limited period of time. It has been demonstrated that the maternal cardiovascular system is remodeled during pregnancy, and these changes extend postpartum. The long lasting reduction in mean arterial pressure postpartum that pregnancy induces, and the cardiovascular remodeling that accounts for this, may allow for easier adaptation to volume expansion in subsequent pregnancies, even when the first pregnancy was complicated by preeclampsia. As the maternal cardiovascular system returns, over time, to the baseline condition, this protective effect diminishes. With this knowledge, we hypothesize that the length of time between pregnancies is negatively correlated to the likelihood of recurrence of preeclampsia, and more narrowly that the length of time between pregnancies is inversely associated with mean arterial pressure differences comparing pregnancies across all trimesters. METHODS This study was a retrospective chart review of existing medical records. We reviewed medical records of women who had been diagnosed with preeclampsia at Fletcher Allen Health Care, during their first advanced pregnancy between 1995 and 2014, who went on to have a subsequent pregnancy within that time period. We aimed to identify factors that could affect the blood pressure and risk of preeclampsia in women who were previously diagnosed, including previous medical history and demographic variables. We collected blood pressures from each pregnancy, across each trimester, marking the recurrence of preeclampsia and other complications. Mean antepartum mean arterial blood pressure, pulse pressure, and systolic and diastolic blood pressures were calculated and compared between pregnancies examining differences as a function of interpregnancy interval. RESULTS One hundred and seventy two subjects were identified for review. Overall, there was evidence of a significant association of interpregnancy interval (IPI) and the difference in mean arterial pressure (MAP) between pregnancies (p=0.04). The mean MAP of pregnancy decreased significantly between first and second pregnancies when the interpregnancy interval was <24 months (p=0.0018) and 24-48 months (p=0.0003), but the change was non-significant at interpregnancy intervals of >48 months (p=0.55). The mean MAP during the third trimester, specifically, decreased significantly between first and second pregnancies across all subject groups (IPI <24 months: p<0.0001; IPI 24-48 months: p<0.0001; IPI >48 months: p=0.03). Preeclampsia recurred in 39 of the second pregnancies. The recurrence rate of preeclampsia did not vary significantly with interpregnancy interval (p=0.21). DISCUSSION/CONCLUSIONS The interval between preeclamptic pregnancies and subsequent pregnancies has an influence on the MAP of the second pregnancy. There is good evidence of a temporal influence, in that the shorter interpregnancy intervals resulted in a greater reduction in MAP when compared to the longer interpregnancy interval. We believe that with additional research on interpregnancy intervals >48 months, there could be more a conclusive association identified between the rate of recurrence of preeclampsia and the length of interpregnancy interval.

Preeclampsia is a complex, baffling and unpredictable syndrome. The condition affects the lives of approximately one in every twenty pregnant women. Most cases are mild but some are serious enough to threaten the life of mother and baby. Medical research has yet to identify a cause, and the search for a cure continues. Delivery remains the only method of resolving this dangerous complication of pregnancy and may need to be effected before the foetus has become mature enough to avoid the risks associated with preterm birth. Women's experience of preeclampsia has received little attention in midwifery and obstetric literature. This hermeneutic phenomenological study has been designed to answer the question "What is women's experience with preeclampsia before 34 weeks of gestation?" Eight women who had experienced severe preeclampsia were interviewed. Their narratives are analyzed to uncover the meaning of the lived experience of preeclampsia from diagnosis to postpartum recovery. Three data chapters reveal some of the ways that preeclampsia reveals itself as the disease progresses. The findings of this study indicate that there are many atypical presentations of preeclampsia and that sometimes early "showing" goes unrecognized. The woman may in fact feel better as the disease progresses. Late diagnosis leaves the woman and her family shocked and may compromise foetal and maternal safety. Having preeclampsia changes the reality of pregnancy and early parenting for a woman. Emotional consequences are significant and include an increased risk of post-traumatic stress disorder. The unpredictable manner in which preeclampsia first "shows itself" is analyzed in the first data chapter and the following two chapters explore the way in which a woman's life may be thrown out of control by diagnosis and management of the disease. Paradoxically, women with severe preeclampsia often lose continuity of care with their midwife at a time when they most need the support of a familiar and trusted professional. Provision of continuity creates a challenge for the midwife when the woman's care is taken over by secondary services. Innovative ideas to enhance the safety and holistic quality of care for women with preeclampsia are discussed.

This research investigated the development of a novel canine model to study preeclampsia. Normal canine placental development has morphologic and histologic similarities to the shallow trophoblast invasion occurring with preeclampsia in humans, which makes the dog a particularly good choice for modeling this disease and will be an improvement on existing animal models. Preeclampsia is a pregnancy-specific syndrome, occurring in mild (late onset) and severe (early onset) forms. Severe preeclampsia is a major cause of maternal, fetal, and neonatal morbidity and mortality worldwide. It affects 0.35-1.40% of human pregnancies. Despite intense investigation, the cause (and therefore the prevention or treatment) of shallow trophoblast invasion in preeclampsia remains largely unknown. In a normal human pregnancy, trophoblasts invade the endometrium and myometrium as well as the maternal blood vessels (hemochorial placentation). In preeclampsia, trophoblast invasion is shallow and vascular transformation incomplete. In contrast to the normal human placenta, trophoblasts within the canine placenta only invade to the level of the endothelial cells within the maternal blood vessels (endotheliochorial). In this way, normal canine placental development is similar to preeclampsia. The hypothesis of this research was that isolated canine trophoblasts will express similar proteins as human preeclamptic trophoblasts. The objectives of the research were to (1) isolate canine trophoblasts from fresh and cryogenically frozen placenta and (2) perform immunocytochemistry and immunohistochemistry on canine trophoblasts for proteins expressed in human preeclamptic trophoblasts. Cellular morphology was similar to that reported for trophoblasts. More than 97% of the cells cultured expressed cytokeratin-7. Although both matrix metalloproteinases (MMPs) were immunolocalized to the cytoplasm, MMP2 was found in large, coalescing granules, whereas MMP9 was more diffusely expressed throughout the cell. More cultured canine trophoblasts expressed MMP9 (54.7±3.4%) compared to MMP2 (40.3±1.8%) (p=0.02). Cryopreserving placental tissue prior to primary cell culture had no effect on cell proliferation (p=0.37). Relaxin, vascular endothelial growth factor, and tissue inhibitor of metalloproteinase 2 were positively expressed in primary canine trophoblasts. Immunohistochemical results revealed CK-7, MMP9, TIMP2 and relaxin was expressed in trophoblasts along the villous margin with MMP9, TIMP2 and relaxin extending towards the basement membrane. S100A4 was minimally expressed in the basement membrane. MMP2 was strongly expressed within the basement membrane. CK-7, MMP2, MMP9 & TIMP2 were all immunolocalized to the same cells in canine placental sections as previously described in human preeclamptic placental sections. These results have demonstrated the cellular similarities in protein expression between normal canine and human preeclamptic trophoblasts thereby confirming this model is suitable for further studies. / Graduation date: 2012

Endoglin is an auxiliary receptor for ligands of TGF-β receptor superfamily, present in endothelial cells and the placental syncytiotrophoblast. The expression of placental membrane endoglin (mEng) is further increased during preeclampsia, a pregnancy-specific hypertensive syndrome. We hypothesize that the soluble form of endoglin (sEng) released from the placenta leads to endothelial dysfunction and hypertension by disrupting normal BMP-9 signaling. We show that cell surface mEng inhibits TGF-β1, BMP-2, and BMP-7 induced Smad1,5,8 phosphorylation while potentiating BMP-9 induced signaling. sEng has been shown to be elevated in the sera of preeclamptic women and is postulated to interfere with endothelial cell function. We show that sEng binds to BMP-9 with a 2 nM affinity and can compete for its binding to endothelial cells, inhibiting downstream Smad1,5,8 phosphorylation. Our results suggest that sEng is contributing to endothelial dysfunction by dysregulating BMP-9 signaling.