Preeclampsia*

Ramos, José Geraldo Lopes; Sass, Nelson; Costa, Sérgio Hofmeister Martins

doi:10.1055/s-0037-1604471

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 39 (09) • Sept 2017 • https://doi.org/10.1055/s-0037-1604471 copy

Preeclampsia^* * This review is part of the Series, Guidelines and Recommendations of the Federação Brasileira das Associações de Ginecologia e Obstetrícia - FEBRASGO, and was prepared by the National Specialized Commission for the Hypertension in Pregnancy.

Pré-eclâmpsia^* * This review is part of the Series, Guidelines and Recommendations of the Federação Brasileira das Associações de Ginecologia e Obstetrícia - FEBRASGO, and was prepared by the National Specialized Commission for the Hypertension in Pregnancy.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most important clinical disease in Brazilian pregnant women, may have its incidence reduced with prevention through the use of calcium and aspirin in pregnant women at risk. Previously, it was a disease that presented with hypertension with proteinuria, but it has now been classified with new clinical parameters besides proteinuria. Morbidity and mortality should be reduced in a continental country such as Brazil using protocols for the early treatment of complications by calculating severe outcomes in preeclampsia. The early treatment of acute hypertension, use of magnesium sulfate and early hospitalization in cases of preeclampsia are concepts to pursue the reduction of our pregnant women’s mortality.

Keywords:
pregnancy arterial hypertension; preeclampsia; HELLP syndrome; high risk pregnancy; pregnancy complications

Affected organic system	Adverse conditions	Severe complications indicating termination of pregnancy
Central nervous system	Headache;visual symptoms	Eclampsia; PRES; cortical blindness; Retinal detachment; Glasgow scale < 13; TIA; stroke; RND.
Cardiorespiratory	Chest pain; dyspnea;saturation O₂< 97%	Severe uncontrolled hypertension (for a 12-hour period despite maximum doses of hypotensive agents); SO₂< 90%, need for O₂> 50% for > 1 hour, intubation, support with vasoactive drugs; pulmonary edema; myocardial ischemia or infarction.
Hematological	Leukocytosis;thrombocytopenia;high INR PTT	Platelets < 50.000/dL;* need for transfusion of any blood product.
Renal	Elevated creatinine and uric acid	ARF (creatinine > 1.5 mg/dL without previous renal disease);need for dialysis (without previous CRF).
Hepatic	Nausea; vomiting epigastralgia;URQ pain; SGOT; SGTP; LDH; elevated bilirubin; low plasma albumin	Hepatic impairment (INR > 2 in absence of DIC or use of warfarin); hepatic hematoma with or without rupture.
Fetoplacental	Non-reactive CTG; Oligohydramnios; IUGR;Doppler of umbilical artery with absent or reversed diastolic flow	PA; reversed a-wave in ductus venous; fetal death.

Classification
1. Chronic hypertension
2. Gestational hypertension
3. Preeclampsia with or without overlapping chronic hypertension
4. White coat hypertension

Risk factors	Risks
Strong evidence
Prestimoniário	2.4 (2.1–2.7, 95%CI)
Diabetes mellitus	RR: 2–3 and higher if decompensated DM
Twin pregnancy	RR: 3 (2–4.2, 95%CI)
Sister with PE	RR: 3.3 (1.5–7.5, 95%CI)
Sister, mother or grandmother with eclampsia	Respectively 37%, 26% and 16% of PE
Chronic SAH	25% of developing PE overlap
PE in previous pregnancy	25% of PE recurrence
Fetal hydrops (non-immune)	RR: 10
Molar pregnancy	RR: 10
New paternity	Similar risk to first pregnancy
APS	Increases risk
Medium or weak evidence
BMI ≥ 25.8	RR: 2.3–2.7
Maternal age > 40 years	RR: 3–4
Use of contraceptive barrier method	Increased risk
Longer duration of sexual activity	Decreased risk
Prior abortion < 10 weeks with the same father	Decreased risk
Excessive weight gain	Increased risk
Artificial insemination	Increased risk
‘Risk man’ (previous partner had PE)	RR: 1.8 (1.2–2.6)
Pregnant woman born with low birth weight	Increases the risk
Bleeding in 1st trimester	Increases the risk

Affected system	Disorder
Cardiovascular	Severe SAH, pulmonary edema, pulmonary embolism, vascular accidents
Renal	Oliguria, ARF
Hematological	Hemolysis, thrombocytopenia, DIC
Neurological	Eclampsia, cerebral edema, stroke, PRES
Ophthalmologic	Amaurosis, retinal hemorrhages, exudates, papilledema
Hepatic	Dysfunction, ischemia, hematoma, capsular rupture
Placental	Ischemia, thrombosis, PA, fetal hypoperfusion

Suspected diagnosis	Initial evaluation	Follow-up
Proteinuria/creatininuria ratio or proteinuria in reagent tape	Pulse oximetryHemogramCreatininePlateletsSerum glutamic oxaloacetic transaminase or lactate dehydrogenase	PlateletsSerum glutamic oxaloacetic transaminase or lactate dehydrogenase

Maternal	Fetal
HELLP syndrome	Fetal growth below percentile 5
Eclampsia	Repeated late fetal decelerations on cardiotocography
Pulmonary edema or O₂ saturation < 94%	Vein Doppler with pathological a-wave
BP without control despite medications	Fetal death
Serum creatinine > 1.5 mg/dL or oliguria (< 500 mL/ mL/24 hours)	Suspected PA, ROM or onset of labor
Suspected PA, ROM or onset of labor

	Exam	Parameter
HemolysisPeripheral blood smear(schistocytosis, anisocytosis, echinocytosis, poikilocytosis)	Bilirubin	> 1.2 mg/dL
	Lactate dehydrogenase	> 600 U/L
Hepatic impairment	Serum glutamic oxaloacetic transaminase	> 70 U/L
Thrombocytopenia	Platelets	< 100,000/mm³

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence José Geraldo Lopes Ramos, MD, Professor, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Santa Cecília, Porto Alegre, RS, Brazil (e-mail: ramosjg@terra.com.br).

Brasil

Brasil

Preeclampsia* * This review is part of the Series, Guidelines and Recommendations of the Federação Brasileira das Associações de Ginecologia e Obstetrícia - FEBRASGO, and was prepared by the National Specialized Commission for the Hypertension in Pregnancy.

Pré-eclâmpsia* * This review is part of the Series, Guidelines and Recommendations of the Federação Brasileira das Associações de Ginecologia e Obstetrícia - FEBRASGO, and was prepared by the National Specialized Commission for the Hypertension in Pregnancy.

Abstract

Preeclampsia^* * This review is part of the Series, Guidelines and Recommendations of the Federação Brasileira das Associações de Ginecologia e Obstetrícia - FEBRASGO, and was prepared by the National Specialized Commission for the Hypertension in Pregnancy.

Pré-eclâmpsia^* * This review is part of the Series, Guidelines and Recommendations of the Federação Brasileira das Associações de Ginecologia e Obstetrícia - FEBRASGO, and was prepared by the National Specialized Commission for the Hypertension in Pregnancy.