Logical model of reception and risk classification for women with pre-eclampsia and eclampsia

OBJECTIVE

To describe the validation of the Logical Model of Reception and Risk Classification for women with pre-eclampsia/eclampsia in a high-risk maternity hospital.

METHOD

Evaluative research with a quantitative approach. The elaboration and validation of the Logical Model were systematized in stages related to the scope review, preparation of the document guided by the Donabedian model and validation by 12 stakeholders, aiming at the assessment of the Content Validation Index.

RESULTS

The problem that gave rise to the intervention was elaborated, supporting the construction of the Logical Model. Agreement was reached on 24 items, reaching a Content Validation Index of 0.99. Stakeholders included contributions regarding correlations between elements of the structure and process.

CONCLUSION

The document achieved high content validity and could contribute to decision-making by managers in the Reception and Risk Classification sectors for women with pre-eclampsia and/or eclampsia.

Social representations of pregnant women about high-risk pregnancy: repercussions for prenatal care

OBJECTIVE

To analyze the Social Representations of pregnant women about high-risk pregnancy and its repercussions for prenatal care.

METHOD

Qualitative study, based on the procedural aspect of the Theory of Social Representations, carried out with 62 high-risk prenatal pregnant women at a High Complexity Maternity, in Belém, PA, Brazil. Data from semi-structured interviews were processed by the software Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires.

RESULTS

Four categories emerged, in which three dimensions of the Theory composing the genesis of Social Representations are considered: the affective dimension, the biological dimension and the sociocultural dimension.

CONCLUSION

Affects, negative feelings, and adaptations were revealed, with high-risk pregnancy being represented as an unusual and uncomfortable event, influenced by common sense and science, communication means, and dialogues with health professionals, with family support being considered of paramount importance. and prenatal care a propitious moment for establishing bonds with the health professional, seen as essential for their adherence to the care offered.

Perinatal Outcomes in Women with Chronic Kidney Diseases

OBJECTIVE

 To assess maternal and neonatal outcomes in women with chronic kidney disease (CKD) at a referral center for high-risk pregnancy.

METHODS

 A retrospective cohort of pregnant women with CKD was followed at the Women's Hospital of Universidade Estadual de Campinas, Brazil, between 2012 and 2020. Variables related to disease etiology, treatment duration, sociodemographic variables, lifestyle, other associated diseases, obstetric history, and perinatal outcomes were assessed. The causes of CKD were grouped into 10 subgroups. Subsequently, we divided the sample according to gestational age at childbirth, as preterm and term births, comparing maternal and neonatal outcomes, and baseline characteristics as well as outcomes among such groups.

RESULTS

 A total of 84 pregnancies were included, in 67 women with CKD. Among them, six pregnancies evolved to fetal death, five to miscarriage, and one was a twin pregnancy. We further analyzed 72 single pregnancies with live births; the mean gestational age at birth was 35 weeks and 3 days, with a mean birth weight of 2,444 g. Around half of the sample (51.39%) presented previous hypertension, and 27.7% developed preeclampsia. Among the preterm births, we observed a higher frequency of hypertensive syndromes, longer maternal intensive care unit (ICU) stay in the postpartum period, higher incidence of admission to the neonatal ICU, higher neonatal death, lower 5-minute Apgar score, and lower birth weight.

CONCLUSION

 This study demonstrates increased adverse outcomes among pregnancies complicated by CKD and expands the knowledge on obstetric care among such women in an attempt to reduce maternal risks and identify factors related to prematurity in this population.

Natriuria and calciuria levels in preeclampsia: a cross-sectional study

CONTEXT AND OBJECTIVE

Sodium excretion abnormalities in preeclampsia have been studied in relation to several factors. The objective of this study was to compare natriuria (mEq/24 h) and calciuria levels (mg/24 h) in preeclamptic patients.

DESIGN AND SETTING

An analytical cross-sectional study with a control group was conducted in the obstetric center and the high-risk pregnancy outpatient clinic at a university hospital in southern Brazil, and in a primary healthcare unit in the same city, including pregnant women with mild preeclampsia, severe preeclampsia or chronic hypertension, and women with normal pregnancies (14 patients in each group).

METHOD

Natriuria was measured using an ion-selective electrode in an automated clinical chemistry analyzer (Hitache 917, Roche). All the patients collected 24-hour urine, at home or at the hospital, for analysis of proteins, creatinine, calcium, sodium and uric acid. Quantitative variables with asymmetrical distribution were described using the median, minimum and maximum, and were compared using the Kruskal-Wallis test. The results were logarithmically transformed, with one-way analysis of variance (ANOVA) by ranks and then the post-hoc Tukey test, and were analyzed by means of the Spearman correlation and receiver operating characteristic (ROC) curve. The significance level used was 0.05.

RESULTS

There were significant differences between the groups in comparing severe preeclampsia with chronic hypertension and severe preeclampsia with controls (P < 0.0001 for both measurements).

CONCLUSION

Natriuria levels may be lower in preeclampsia when associated with calciuria. Natriuria assessment is an additional test for differential diagnosis of hypertensive diseases in pregnancy, but is a poor predictor when used alone.

Anti-Toxoplasma gondii antibodies in pregnant women and their newborn infants in the region of São José do Rio Preto, São Paulo, Brazil

CONTEXT AND OBJECTIVE

Toxoplasmosis transmission during pregnancy can cause severe sequelae in fetuses and newborns. Maternal antibodies may be indicators of risk or immunity. The aim here was to evaluate seropositivity for anti-Toxoplasma gondii (anti-T. gondii) immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies and IgG avidity in pregnant women and their newborn infants.

DESIGN AND SETTING

Cross-sectional study in a high-risk pregnancy outpatient clinic.

METHODS

Serum samples from pregnant women (n = 87) and their respective newborns (n = 87) were evaluated for anti-T. gondii antibodies using indirect immunofluorescence (IIF) (IgM and IgG), enzyme-linked immunosorbent assay (ELISA) (IgG) and an avidity test.

RESULTS

Anti-T. gondii antibodies were identified in 64.4% of the serum samples from the mothers and their infants (56/87). Except for two maternal serum samples (2.3%), all others were negative for anti-T. gondii IgM antibodies, using IIF. The results showed that 92.9% of the pregnant women had high IgG avidity indexes (> 30%) and four samples had avidity indexes between 16 and 30%. Two women in the third trimester of pregnancy were positive for anti-T. gondii IgM antibodies; their babies had avidity indexes between 16 and 30%. The avidity indexes of serum from the other 83 newborns were similar to the results from their mothers.

CONCLUSIONS

The results showed that 2% of the pregnant women were at risk of T. gondii transmission during the gestational period. These data seem to reflect the real situation of gestational toxoplasmosis in the northwestern region of the state of São Paulo.

Does sodium nitroprusside kill babies? A systematic review

OBJECTIVE

To determine whether sodium nitroprusside causes fetal death in pregnancies complicated with hypertension.

DATA SOURCES

Medical Literature Analysis and Retrieval System Online (MEDLINE; 1996 to 2003), Excerpta Medica (EMBASE; 1970 to 2003), Web of Science/Institute for Scientific Information (ISI; 1945 to 2003), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS; 1982 to 2003) and the Cochrane Library.

REVIEW METHODS

The medical subject headings used were "nitroprusside and pregnancy", "hypertension or eclampsia or preeclampsia" and "nitroprusside and pregnancy and hypertensive emergencies". The search was limited to humans and female gender, in all fields, publication types, languages and subsets. Articles were also identified by reviewing the references of articles and textbooks on hypertension and pregnancy.

RESULTS

The search located nine studies. The sum of all the publications yielded a total of 22 patients and 24 exposed fetuses (two pairs of twins). There were no randomized clinical trials and no prospective cohorts. All of the studies were observational in nature.

CONCLUSIONS

At present, there is insufficient evidence for definitive conclusions about any direct association between sodium nitroprusside use and fetal demise.