RESUMO
Pregnancy-associated hypertension is a health problem in Mexico due to its high frequency of morbidity and mortality in mother and fetus as well. Research in this area has been restrained by limitations upon epidemiologic information, unknown etiology and the somewhat easy resolution provided when pregnancy is interrupted. We have reviewed contributions made in our country and up-to-date management concepts.
Assuntos
Eclampsia , Pré-Eclâmpsia , Eclampsia/etiologia , Eclampsia/prevenção & controle , Eclampsia/terapia , Feminino , Humanos , Obstetrícia/métodos , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/terapia , GravidezRESUMO
The aetiology of pre-eclampsia-eclampsia remains largely unclarified, despite over 100 years of systematic study. The assumption that the triggering event is linear and amenable to reductionist techniques has characterized these efforts. The main purpose of this paper is to show that complexity and complicity characterize most pathophysiological processes in pre-eclampsia-eclampsia, a situation suggesting that similar mechanisms must exist at the origin of the disease. The unique configuration of the intervillous space and the intensity of energy transference through the fetomaternal interface offer many dysfunctional possibilities, even in clinically normal pregnancies. The most characteristic seem to be: the shedding and deportation of trophoblast, the fragmentation of villi, the escape of fetal blood, and events associated with trophoblast damage, degeneration and death. The pathogenic potential of these natural processes seems to depend on the association with amplifiers and permissive factors, which vary from person to person and from time to time. Thus, considering the convergence of multiple factors and the presence of nonlinearity in some of their interactions as a plausible working hypothesis, further exploration on this subject should adhere to the rules of this different reality. To find the best possible method of inquiry and to recognize its limitations will be the surest way to avoid failure.
Assuntos
Eclampsia/etiologia , Modelos Biológicos , Vilosidades Coriônicas/fisiopatologia , Eclampsia/genética , Eclampsia/fisiopatologia , Meio Ambiente , Feminino , Humanos , Modelos Lineares , Dinâmica não Linear , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/genética , Pré-Eclâmpsia/fisiopatologia , GravidezRESUMO
The study of the possible importance of the sex of the fetus on the frequency and clinical characteristics of 777 singleton pregnancies complicated by antepartum eclampsia showed that; (1) the male to female ratio for the total group was 1.23/1, (2) this figure was 1.27/1 in first pregnancies and 1.32/1 in patients less than 20 years old, (3) the ratio increased to 1.44/1 in women more than 30 years of age, and (4) in contrast, 169 postpartum eclampsia cases had a male to female ratio of 1.07/1. There were no statistically significant differences in the obstetric profiles, the main eclamptic symptoms or the fetomaternal mortality figures attributable to the sex of the fetus. However, since eclampsia is more severe in older women, the clinician may see more complications and maternal deaths associated with male fetuses because of their significantly higher ratio. In addition, these findings suggest that the presence of a male fetus with a hormonal and genetic code more different from the mother than with female offspring may be an accessory to the fundamental causes of this disease.
Assuntos
Eclampsia/epidemiologia , Razão de Masculinidade , Adulto , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Masculino , Idade Materna , Mortalidade Materna , México/epidemiologia , Gravidez , PrevalênciaRESUMO
The clinical analysis of 46 cases of abruptio placentae complicating eclampsia showed that, (1) the severity of the eclamptic symptoms influenced the extension of the placental separation, (2) older and multiparous women had more complications, larger placental separations and higher mortality, (3) there were ten maternal deaths due to the additive effects of various complications, (4) total perinatal mortality was 44.7% and it was 40.5% for fetuses above 1000 g, (5) optimum timing of delivery by cesarean operation offered slightly better prognosis, even in cases with antepartum fetal death, (6) the dominant factor for morbidity was the stage reached by the combined pathology before receiving qualified medical care, and (7) the wide variability of these cases suggested that the basis for the complete management should be a series of sound and individually tailored decisions to be carried out in a reasonably short time.
Assuntos
Descolamento Prematuro da Placenta/etiologia , Eclampsia/complicações , Mortalidade Infantil , Mortalidade Materna , Descolamento Prematuro da Placenta/mortalidade , Descolamento Prematuro da Placenta/terapia , Injúria Renal Aguda/complicações , Adolescente , Adulto , Cesárea/mortalidade , Coagulação Intravascular Disseminada/complicações , Eclampsia/mortalidade , Eclampsia/terapia , Feminino , Humanos , Recém-Nascido , Masculino , México , Paridade , Período Pós-Parto , Gravidez , Prognóstico , Fatores de TempoAssuntos
Síndrome Nefrótica/diagnóstico , Complicações na Gravidez/diagnóstico , Aborto Espontâneo/etiologia , Adolescente , Adulto , Nefropatias Diabéticas/diagnóstico , Feminino , Humanos , Síndrome Nefrótica/complicações , Gravidez , Complicações Hematológicas na Gravidez/etiologia , Complicações Infecciosas na Gravidez/etiologia , Gravidez em Diabéticas/complicações , Estudos RetrospectivosRESUMO
The statistical study of a large number of eclamptic patients (n = 704), divided into five successive 3-year periods, was undertaken at the Hospital de Gineco-Obstetricia No. 2 del Centro Médico Nacional in Mexico City in orders to detect significant changes in therapeutic results and/or in the basic character of the disease, as it occurs in a large referral medical complex. The following variables were studied: maternal and perinatal deaths, obstetric profile, main clinical data of the eclamptic episode, frequency of cesarean operation, timing of delivery after admission, main therapeutic changes, frequency of complications in survivors of ante- and intrapartum eclampsia, and cause of death with associated complications. The study showed (1) a continuous increment in the number of cases from the first to the last period, (2) averages for maternal age (24.9 +/- 0.45 years) and for previous parity (1.7 +/- 0.19) unlike those commonly accepted, (3) a significant progression in the severity of the disease in recent years, (4) a frequency of 22.9% of important complications in survivors of ante- and intrapartum eclampsia, and (5) a very limited overall influence of some therapeutic changes on the final outcome of complicated eclampsia, and (6) the impossibility of improving morbidity figures significantly during the 15 years of the study. It was concluded that prevention, early diagnosis, and timely simple medical care offer the only perspective for true medical progress in this particular problem.