RESUMO
BACKGROUND: In obstetrical service it is frequent to find women with acute renal failure during second trimester of pregnancy. Main causes are related to hypertensive alterations, hemorrhage, sepsis, intrinsic renal disease and some rare disorders that produce high maternal morbidity and mortality. OBJECTIVE: [corrected] To evaluate changes of adrenal function in pregnancy as well as its associated repercussions in diabetic and preeclamsic patients. PATIENTS AND METHODS: Prospective study in 56 patients. Groups included women with normal pregnancy, patients with diabetes type 2, and women with preeclampsia. It was requested basic exams and samples from urine of 24 h for catecholamines determinations; as well as after two months of delivery. Catecholamines were measured with Bertler immune-fluorescent procedure. RESULTS: Levels of catecholamines has statistically significant difference in all groups of study during the gestation. There was high quantity in the group of patients that developed preeclampsia 4535.5 +/- 356.4 microg/24 h (p < 0.05), compared with 31.2 +/- 9.2 microg/24 h in normal pregnancy; however, those with diabetes has a trend to increas 45.6 +/- 3.7 microg/24 h, without statistical differences. Two months after pregnancy levels shown 17.1 +/- 4.9 microg/24 h in normal pregnancy group, with preeclampsia 17.2 +/- 8.7 microg/24 h, and mild permanent increase 33.8 +/- 4.7 microg/24 h in the group with diabetes (p = 0.537). CONCLUSIONS: An important catecholamines elevation is related with progress or severity of preeclampsia, and could be due to less adrenal injury associated with pregnancy, and contribute to renal failure. Longer studies are necessary to evaluate this approach in renal function.
Assuntos
Catecolaminas/urina , Pré-Eclâmpsia/urina , Gravidez em Diabéticas/urina , Adulto , Feminino , Humanos , Gravidez , Estudos ProspectivosRESUMO
BACKGROUND: Premature rupture of membranes is considered an obstetrical emergency since it has been associated with an increment of sepsis and maternal-fetal morbidity. For this reason, controversy exists among conservative and active management for the obstetrical resolution. OBJECTIVE: To determine if active management of premature rupture of membranes in pregnancy of 34 to 37 weeks diminishes the cesarean section incidence and the maternal-fetal morbidity. PATIENTS AND METHODS: Two groups of patients with pregnancy of 34 to 37 weeks and premature rupture of membranes were compared. Group I with active management was integrated by 42 cases that initiated inductoconduction at their admission to the hospital, and in group II, with 26 cases on the conservative management, medication was used to induce fetal pulmonary maturity and spontaneous delivery was expected. Descriptive statistics was carried out by means of the statistical package SPSS-10. RESULTS: The mean age of the patients was 27.2 +/- 5.8 years. Pregnancy resolution within the first 12 hours was 23.8% in group I and 11.5% in group II. Cesarean section in group I was made in 28.5% of the cases and in group II in 65.3% of them (p < 0.05). The most common indication for cesarean section in group I was stationary labor (16.5%) and in group II unfavorable cervical conditions (26.9%). Maternal and newborn hospital stay was greater in group II (p < 0.01). The most frequent maternal complication in both groups was decidual infection, with 4.7 and 15.3%, respectively. General maternal and neonatal morbidity was greater in group II. CONCLUSIONS: Conservative management of premature rupture of membranes, when pregnancy is equal or greater than 34 weeks, does not offer fetal benefits, increases the incidence of cesarean sections, the hospital stay and the cost of the medical attention.
Assuntos
Ruptura Prematura de Membranas Fetais/terapia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Terceiro Trimestre da GravidezRESUMO
Emergency obstetric hysterectomy is a procedure that potentially preserves the life and the postpartum bleeding is the direct cause of its indication, the hemorrhage postpartum happens in 1% of obstetric patients. This study was carried out to identify women with potential risk for this event and to prevent this obstetric problem. The most frequent indications for hysterectomy were identified, as well as the sociodemographic characteristic of the patients. The surgical procedure carried out was extra-fascial technique with type Richardson hysterectomy modified; the surgical pieces went to the pathology service, to obtain the histopathological diagnosis. 43 cases of obstetric hysterectomy, were analyzed; the characteristics of this group showed that bigger percentage of this event was more frequent in 31 to 35 years (39.5%), with pregnancies at term (51.1%) in third pregnancies(27.9%), nulliparas (60.4%), with first cesarean section (39.5%), without previous abortions (79.0%). The most frequent obstetric complications were uterine atony and placenta accreta. The cause for uterine atony could be interstitial edema, as well as myometrial hypertrophy, because such histopathological diagnoses were the most common. Odds ratio showed that a patient with cesarean section has 1.16 more probabilities of suffering hysterectomy than a woman with childbirth. This study describes the histological presence of interstitial edema and myometrial hypertrophy as possible causes of uterine atony in the histological study of surgical specimen. This could be related to no response of myometrial to the uterus-tonic effect of oxytocin. Obstetric uterine dysfunction has multifactorial cause. Patients with the characteristics described in this study should be considered as high risk.