Maternal mortality due to arterial hypertension in São Paulo City (1995-1999)

Donkin psychosis

Donkin psychoses are eclamptic psychoses without seizures. As symptomatic psychoses resulting from cerebral endothelial damage, they may explain the lucid intervals that sometimes occur between eclampsia and the eruption of psychosis. They have the same features as eclamptic psychoses, with onset during pregnancy or the early puerperium, especially in first-time mothers, a short duration and full recovery in most. The clinical picture is usually delirium, but mania is also seen, and some patients have retrograde amnesia or other cognitive defects. Donkin psychosis should be considered in the differential diagnosis of childbearing psychoses, and collaborative research is needed to clarify their differences.

Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

OBJECTIVES

To evaluate the incidence of and risk factors for hypertensive disorders in a cohort of HIV-infected pregnant women.

METHODS

Hypertensive disorders (HD) including preeclampsia/eclampsia (PE/E) and pregnancy induced hypertension, and risk factors were evaluated in a cohort of HIV-infected pregnant women from Latin America and the Caribbean enrolled between 2002 and 2009. Only pregnant women enrolled for the first time in the study and delivered at ≥20 weeks gestation were analyzed.

RESULTS

HD were diagnosed in 73 (4.8%, 95% CI: 3.8%-6.0%) of 1513 patients; 35 (47.9%) had PE/E. HD was significantly increased among women with a gestational age-adjusted body mass index (gBMI) ≥25 kg/m(2) (OR = 3.1; 95% CI: 1.9-5.0), hemoglobin (Hg) ≥11 g/dL at delivery (OR = 2.1; 95% CI: 1.2-3.6) and age ≥35 years (OR = 1.8; 95% CI: 1.1-3.2). PE/E was increased among women with a gBMI ≥25 kg/m(2) (OR = 3.0; 95% CI: 1.5-6.0) and Hg ≥11 g/dL at delivery (OR = 2.8; 95% CI: 1.2-6.5). A previous history of PE/E increased the risk of PE/E 6.7 fold (95% CI: 1.8-25.5). HAART before conception was associated with PE/E (OR = 2.3; 95% CI: 1.1-4.9).

CONCLUSIONS

HIV-infected women, with a previous history of PE/E, a gBMI ≥25 kg/m(2), Hg at delivery ≥11 g/dL and in use of HAART before conception are at an increased risk of developing PE/E during pregnancy.

Assessment of endothelial function by flow-mediated dilation of the brachial artery in adolescents with a history of preeclampsia or a normotensive pregnancy

Objectives: to determine the prevalence of endothelial dysfunction and its association with a history of mild and severe preeclampsia in adolescents. Methods: a cross-sectional study was carried out at the MEAC-UFC with 103 primiparous adolescents postpartum. The assessment of endothelial function was performed by way of flow-mediated dilatation of the brachial artery. Variables (age, body mass index, gestational age at delivery, systolic and diastolic blood pressure and flow-mediated dilation) were compared between groups. p<0.05 was considered to be statistically significant. Results: twenty-four (23.3%) patients had preeclampsia (PE): 11 mild and 13 severe. The overall prevalence of endothelial dysfunction was 23.3% (21.5% of patients with normotensive pregnancies and 29.2% of the PE patients: 18.2% of those with mild PE and 38.5% of those with severe PE). The figures were statistically significant for systolic blood pressure, p=0.007. Conclusions: patients with a history of PE have higher systolic blood pressure than patients with a history of normotensive pregnancy, but did not have more endothelial dysfunction.

Ruído no alojamento conjunto: percepção das usuárias e dos profissionais de enfermagem

OBJETIVO: mensurar os níveis de ruído e levantar a percepção dos profissionais de enfermagem e usuárias de Alojamento Conjunto em uma maternidade de referência para gestação de alto risco em Curitiba-PR. MÉTODOS: estudo transversal, quantitativo, realizado em alojamento conjunto de um hospital público, no qual a percepção foi levantada por meio de entrevistas com 19 profissionais e 77 usuárias, e o ruído foi avaliado por meio de Medidor Integrador marca Bruel e Kjaer tipo 2230 calibrado na compensação "A". RESULTADOS: os níveis de ruído em todas as áreas do Alojamento Conjunto estão acima do recomendado pela literatura (35 a 45 dB(A) para ambiente hospitalar). Os valores mais expressivos foram de 67,7dB(A) no posto de enfermagem e 65,3 dB(A) na sala de visitas. Usuárias e profissionais de enfermagem estão expostos a fontes de ruído advindos do processo de trabalho da equipe de saúde, do comportamento dos usuários, dos funcionários e de ruído externo da maternidade. Estratégias para diminuir o ruído e melhorar a ambiência do AC estão voltadas para ações relacionadas ao processo de trabalho da equipe de saúde, a confortabilidade e a gestão. CONCLUSÃO: o ruído do Alojamento Conjunto está acima do preconizado. Profissionais de enfermagem percebem mais o ruído externo, enquanto as usuárias mais o ruído interno. Constatou-se que o ruído elevado interfere na ambiência do AC e afeta as atividades diárias dos profissionais e pacientes.

Risk factors for hypertensive disorders of pregnancy in southern Brazil

OBJECTIVE

The aim of the study was to identify the frequency of risk factors for hypertensive disorders in pregnancy in Southern Brazil.

METHODS

The study included 161 patients with hypertensive disorders and 169 control subjects matched by age and ethnicity. The frequency of the risk factors was compared by Fisher's exact test, chi-square and Student's t test. A multivariate logistic regression analysis assessed the independent role of clinical, social and demographic factors which were associated with occurrence of the hypertensive disease in pregnancy in the univariate analysis.

RESULTS

Patients enrolled in the study were predominantly Caucasian (73%) and the mean age was 29. In the multivariate analysis, the variables associated were: family history of preeclampsia (p = 0.001; OR = 3.88; 95% CI = 1.77-8.46), diabetes (p = 0.021; OR = 3.87; 95% CI = 1.22-12.27) and chronic hypertension (p = 0.002; OR = 7.05; 95% CI = 1.99-24.93).

CONCLUSION

The risk factors associated with hypertensive disorders in pregnancy appear to be similar to those reported in other countries. The knowledge of the risk factors could be helpful in a prenatal care.

Mortalidade materna no Brasil: o que mostra a produção científica nos últimos 30 anos?

O objetivo deste trabalho foi descrever o perfil epidemiológico e a tendência da mortalidade materna no Brasil, por meio de revisão de estudos sobre o tema. Foi realizada busca eletrônica de artigos científicos publicados entre 1980 e 2010, nas bases de dados LILACS e MEDLINE. Identificaram-se inicialmente 486 artigos. Após aplicação dos critérios de inclusão e exclusão restaram 50 artigos. A comparação dos dados mostrou queda da RMM de forma diferenciada nas regiões brasileiras. Os estudos sobre determinação do óbito materno apontaram desigualdades sociais relacionadas à cor da pele e escolaridade. O preenchimento incompleto da declaração de óbito e a subnotificação ainda persistem. Prevaleceram as causas obstétricas diretas, com predomínio das doenças hipertensivas. Quando analisada, a evitabilidade apontou falhas na assistência pré-natal e ao parto. Apesar de sua relevância, são poucos os artigos sobre mortalidade materna no Brasil. A RMM, embora em declínio, permanece em níveis elevados. Melhorias na qualidade da assistência pré-natal e ao parto são necessárias.

Health-related quality of life and blood pressure control in hypertensive patients with and without complications

INTRODUCTION

The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL) OBJECTIVE: This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications.

MATERIALS AND METHODS

Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 +/- 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher's Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into "with complications" (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and "without complications" (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics.

RESULTS

In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143+/-18/84+/-11 and 144+/-21/93+/-11 mm Hg for patients with and without complications, respectively) relative to phase 1 (128+/-17/75+/-13 and 128+/-15/83+/-11 mm Hg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the "with complications" group and from 78% to 50% in the "without complications" group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher's Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher's Questionnaire showed no differences in these scores.

CONCLUSION

Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL.