RESUMO
OBJECTIVE: To describe characteristics, outcomes and clinical presentations for hypertensive disease of pregnancy (HDP) in patients admitted to three ICUs in Argentina. METHODS: Case-series multicenter study. RESULTS: There were 184 patients with HDP. Mean age 26 ± 8; 90% did not present comorbidity; APACHEII 9[6-14]; SOFA24 2[1-4]; ICU-LOS 3[2-6] days and hospital-LOS 8[5-12] days. Gestational age 34 ± 5 weeks; 46% (85) nulliparous and 71% received routine prenatal care. Maternal mortality 3.3% (6) - 50% attributed to intracranial hemorrhage (ICH). Neonatal mortality 13.6%. Diagnostic categories: eclampsia (64; 35%), severe preeclampsia (60; 32.6%), HELLP (33; 17.9%), eclampsia-HELLP (18; 9.8%) and other (chronic/gestational-hypertension) (9: 4.7%). Severe hypertension in 46%, multiple organ dysfunction in 23%, acute respiratory distress in 8.7% and acute renal failure in 8%. Variables independently associated with eclampsia: maternal age (OR 1.07 [1.02-1.13], gestational age (OR 1.14 [1.04-1.24]) and nulliparity (OR 2.40 [1.19-4.85]). CONCLUSIONS: Although patients were young and the majority received appropriate prenatal care, they spent considerable time in hospital and presented severe morbidity. Maternal mortality was 3.3% and in half of these cases it was attributed to ICH. Eclampsia and severe preeclampsia represented two thirds of the diagnostic categories. Variables independently associated with eclampsia were maternal and gestational ages and nulliparity.
Assuntos
Cuidados Críticos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/terapia , Adulto , Argentina , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/fisiopatologia , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Actualmente se pueden esperar cifras mundiales de preeclampsia de 143 667 casos y 431 000 de gestosis grave, muertes maternas mundiales de 20 000 pacientes y hasta 86 000 muertes perinatales. Esta afección es responsable de complicar entre el 2 y el 8 por ciento de los embarazos. En países desarrollados, la eclampsia es rara y afecta alrededor de 1 por cada 2 000 partos, mientras que en los países en vías de desarrollo esta cifra varía desde 1 en 100 hasta 1 en 1700. La hipertensión inducida por el embarazo es un factor mayor en la morbilidad y mortalidad materna y perinatal. Aunque esta enfermedad es relativamente común, su etiopatogenia es desconocida. Nuevas evidencias epidemiológicas, experimentales y clínicas en personas no embarazadas y en embarazadas, indican que el calcio puede desempeñar un rol importante en la regulación de la presión arterial. Son muchos los autores que señalan la importancia de suministrar el calcio durante el embarazo como elemento preventivo de la hipertensión arterial
Nowadays, it is possible to expect world figures of pre-eclampsia of 143 667 cases and 431 000 severe gestosis, global mother deaths of 20 000 patients and up to 86 000 perinatal deaths. This affection accounts for the complication between the 2 and the 8 percent of pregnancies. In developed countries, the pre-eclampsia is a rare entity and involves about 1 per each 2 000 labors, whereas in the developing ones, this figure fluctuates from 1 in 100 up to 1 in 1700. The high blood pressure induced by pregnancy is a major factor in the mother and perinatal morbidity and mortality. Although this disease is relatively common, its pathogenesis is unknown. New epidemiologic, experimental and clinical evidences in pregnant and non pregnant persons, suggest that calcium may play a significant role in the regulation of the blood pressure. Many authors emphasize on the significance of to supply calcium during the pregnancy as a preventive element of the high blood pressure