RELATIONSHIP BETWEEN CLINICAL, PLACENTARY, OBSTETRIC AND NEONATAL ASPECTS AND INTRAUTERINE GROWTH IN HIGH RISK PREGNANCIES

Salge, Ana Karina Marques; Silva, Renata Calciolari Rossi e; Guimarães, Janaína Valadares; Ramalho, Wilzianne Silva; Abdalla, Douglas Reis; Abdalla, George Kemil

doi:10.1590/0104-07072017005520015

Brasil

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Original Article • Texto contexto - enferm. 26 (02) • 2017 • https://doi.org/10.1590/0104-07072017005520015 linkcopy

RELATIONSHIP BETWEEN CLINICAL, PLACENTARY, OBSTETRIC AND NEONATAL ASPECTS AND INTRAUTERINE GROWTH IN HIGH RISK PREGNANCIES

RELACIÓN ENTRE LOS ASPECTOS CLÍNICOS PLACENTARIOS, OBSTÉTRICOS Y NEONATALES Y EL CRECIMIENTO INTRAUTERINO EN LA GESTACIÓN DE ALTO RIESGO

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to analyze clinical, placental and obstetric aspects of women with and without high-risk pregnancy, and their relationship with intrauterine growth deviations and neonatal aspects.

Method: this is a cross-sectional descriptive study. Data collection was based on an analysis of the medical records of women with and without high-risk pregnancy and newborns, and anatomopathological characterization of the placenta.

Results: 265 placentas were analyzed, 130 (49.06%) women with high-risk pregnancy and newborns with intrauterine growth deviations. A higher occurrence of placental changes was found in high-risk pregnancy and uterine growth deviations in comparison to cases without high-risk pregnancy (p≤0.001). High-risk pregnancies with intrauterine growth deviations were associated with placental changes (p≤0.001). Intrauterine growth deviations was related to birth weight in cases of high-risk pregnancy compared to normal gestation (p=0.014).

Conclusion: a higher occurrence of placental anatomopathological changes was found in maternal and fetal surfaces in cases of high-risk pregnancy and intrauterine growth deviations.

DESCRIPTORS: Fetal growth retardation; High risk pregnancy; Neonatology; Placenta; Newborn.

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Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[TFN1] *χ² test, followed by the Yates' correction test.

Placental anatomopathological changes	High-risk pregnancy and intrauterine growth deviations			p*
	Yes	No	Total
Maternal surface
Yes	27	62	89	p<0.05
No	4	31	35	p<0.05
Total	31	93	124
Fetal surface
Yes	27	59	86	p<0.05
No	2	28	30	p<0.05
Total	29	87	116

Macroscopic anatomopathological changes	Maternal surface n (%)	Fetal surface n (%)	Maternal surfasse vs Fetal surface
Calciphylaxis	75 (57.7)*	18 (13.84)†	p<0.0001
Fibrin	31 (23.84)*	102 (78.5)†	p<0.0001
Infarction	1 (0.76)	1 (0.76)
Detachment Area/abruption site	1 (0.76)	-
Fibrosis	3 (2.3)	-
Bruising	-	3 (2.3)
Total changes	111 (85.4)	124 (95.4)
No changes	19 (14.6)	6 (4.6)

Neonatal factors related to intrauterine growth deviation	Normal pregnancy n (%)*	High-risk pregnancy n (%)*	Odds Ratio (95%CI) ^†	p
Cephalic perimeter (<32 and >38 centimeters)	10 (8.0)	25 (23.8)	0.34 (0.15-0.73)	0.006
Thoracic perimeter (<30 and >36 centimeters)	19 (16.4)	34 (35.4)	0.46 (0.25-0.86)	0.017
Abdominal perimeter (<28 and >34 centimeters)	11 (8.8)	24 (22.6)	0.39 (0.18-0.84)	0.021
NB weight (<2.500 and >4.000 grams)	11 (8.8)	29 (28.7)	0.31 (0.15-0.65)	0.002
Apgar at 1 (<8 points)	30 (28.6)	45 (52.9)	0.54 (0.31-0.93)	0.030
Apgar at 5 (<8 points)	3 (2.2)	4 (3.2)	0.72 (0.16-3.2)	0.718

NB Classification	n (%)
Small for gestational age	20 (15.39)
Large for gestational age	7 (5.38)
Appropriate for gestational age	94 (72.31)
Birth weight not available	9 (6.92)
Total	130 (100)

Gestational age vs birth weight	High-risk pregnancy (with placental change)	Normal pregnancy (without placental change)	p*
Small for gestational age	26	06	<0.05
Appropriate for gestational age	58	54	0.4583
Large for gestational age	20	-	<0.05

Maternal factors related to intrauterine growth deviation	n (%)
Maternal age ≤ 18 years and ≥36 years	26 (20.00)
Gestational age < 37 weeks and > 41 weeks and 6 days	29 (22.30)
Maternal Diseases
Preeclampsia	34 (26.15)
Eclampsia	3 (2.31)
Chronic hypertension	18 (13.85)
Gestational hypertension	11 (08.46)
HELLP syndrome	1 (0.77)
Gestational diabetes	43 (33.07)
Diabetes Mellitus I	15 (11.54)
Diabetes Mellitus II	5 (3.85)