Objectives

The purpose of this study was to estimate the prevalence of postpartum depression (PPD) and its relationship with life events (LE) and patterns for coping. We performed a cross-sectional study of 113 women, on the 10(th) day of puerperium, at the Obstetric Clinic of the São Paulo University Medical School. The study was based on the following: Pitt (1967) and Stein (1980) Scales, Beck Depression Inventory (1961), Holmes and Rahe Schedule of Recent Events (1967), Folkman and Lazarus Ways of Coping (1985) and questionnaire of social-demographic and obstetric data. Logistic regression was performed to calculate prevalence of PPD and its association with several risk factors. The significance level was defined at 5%. The prevalence of PPD was 15.9% (IC 9.7% to 24.0%). According to the multivariate analyses, the variables of coping with distancing, number of children and ethnic origin were significant. There were no association between PPD and LE. The depressed puerperal women have a low educational level, greater number of children and resort to inadequate coping strategies, such as distancing. This pattern of coping might be an etiological factor of the PPD as well as a reaction to their difficult life environment.

The present study establishes the probability of placenta previa at term depending on the relationship of the lower placental edge to the internal cervical os at 11-14 weeks.

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IntroductionPregnancy in women on dialysis is associated with a higher risk of adverse events, and the best care for this population remains to be established.MethodsIn this series, we aimed to identify factors associated with the risk of adverse fetal outcomes among 93 pregnancies in women on hemodialysis. Dialysis dose was initially assigned according to the presence of residual diuresis, body weight, and years on dialysis. Subsequent adjustments on dialysis dose were performed according to several parameters.ResultsThe overall successful delivery rate was 89.2%, with a dialysis regimen of 2.6 ± 0.7 h/d, 15.4 ± 4.0 h/wk, and mean weekly standard urea Kt/V of 3.3 ± 0.6. In the logistic models, preeclampsia, lupus, primigravida, and average midweek blood urea nitrogen (BUN) level were positively related to the risk of a composite outcome of perinatal death or extreme prematurity, whereas polyhydramnios was inversely related to it. In multivariable linear regression, preeclampsia, polyhydramnios, primigravida, average midweek BUN, and residual diuresis remained significantly and independently related to fetal weight, which is a surrogate marker of fetal outcome. An average midweek BUN of 35 mg/dl was the best value for discriminating the composite outcome, and BUN ≥35 mg/dl was associated with a significant difference in a Kaplan-Meier curve (P = 0.01).ConclusionOur results showed that a good fetal outcome could be reached and that preeclampsia, lupus, primigravida, residual diuresis, polyhydramnios, and hemodialysis dose were important variables associated with this outcome. In addition, we suggested that a midweek BUN <35 mg/dl might be used as a target for adjusting dialysis dose until hard data were generated.

RESUMO:As síndromes hipertensivas são as complicações mais freqüentes na gestação e constituem, no Brasil, a primeira causa de morte materna, principalmente quando se instalam nas suas formas graves, como a eclampsia e a síndrome hellp. São ainda responsáveis por altas taxas de mortalidade perinatal, prematuridade e restrição de crescimento fetal. Compreendem duas entidades distintas, a hipertensão arterial crônica e a pré-eclampsia. Eventualmente a pré-eclampsia pode instalar-se em uma gestante hipertensa crônica, quadro denominado pré-eclampsia superajuntada. A pré-eclampsia tem etiologia desconhecida. Sua fisiopatologia relaciona-se com diminuição da perfusão placentária conseqüente a falha na invasão do trofoblasto nas artérias espiraladas. Como conseqüência há alteração da função endotelial, ativação do processo inflamatório, queda dos níveis de prostaglandinas e aumento da ação do tromboxano resultando em aumento da reatividade vascular. A expansão do volume plasmático é menor ou inexistente com aumento do hematócrito, diminuição do fluxo plasmático renal e alteração do sistema de coagulação. O fluxo útero-placentário está diminuído levando ao quadro de insuficiência placentária. A pré-eclampsia se caracteriza pelo aparecimento de hipertensão, com proteinúria e ou edema; ocorre após a 20ª semana de gestação e é predominantemente patologia da primigesta. Também são fatores predisponentes as gestantes com hipertensão arterial, diabéticas, doenças autoimunes, doenças do parênquima renal e aquelas com aumento da massa placentária como a gestação múltipla, gestação molar. Não é possível a prevenção da pré-eclampsia pelo desconhecimento de sua etiologia, podendo ser utilizada com tal finalidade a aspirina em dose baixa nos casos de alto risco. Uma vez diagnosticada a doença, o objetivo do tratamento é a prevenção das complicações materno-fetais como o descolamento prematura da placenta, acidente vascular cerebral, edema agudo de pulmão, insuficiência renal e o agravamento do quadro clínico para pré-eclampsia grave, síndrome hellp e eclampsia; para o lado fetal o parto prematuro e o desconforto respiratório do recém-nascido. O sulfato de magnésio é a droga de escolha para o controle das convulsões eclâmpticas O melhor tratamento para pré-eclampsia continua sendo o pré-natal correto, o diagnóstico e tratamento clínico precoce e o adequado momento para a interrupção da gestação que é o tratamento definitivo.Descritores: Pré-eclâmpsia, Pré-eclampsia/terapia; Gravidez.

AIM:To describe the case profile of maternal death resulting from hypertensive disorders in pregnancy and to propose measures for its reduction. METHODS:The Committee on Maternal Mortality of São Paulo City has identified 609 cases of obstetric maternal death between 1995 and 1999 with an underreporting rate of 52.2% and a maternal mortality rate of 56.7/100,000 live births. Arterial hypertension was the main cause of maternal death, corresponding to 142 (23.3%) cases. RESULTS: Ninety-five (66.9%) of the deaths occurred during the puerperal period and 34 (23.9%) occurred during pregnancy. The time of death was not reported in 13 (9.2%) cases. Seizures were observed in 41 cases and magnesium sulfate was used in four of them. The causes of death were ruled to be cerebrovascular accident (44.4%), acute pulmonary edema (24.6%), and coagulopathies (14.1%). Cesarean section was performed in 85 (59.9%) cases and vaginal delivery in 15 (16.0%). CONCLUSION: Complications of arterial hypertension are responsible for the high rates of pregnancy-related maternal death in São Paulo City. Quality prenatal care and appropriate monitoring of the hypertensive pregnant patient during and after delivery are important measures for better control of this condition and are essential to reduce disorders in pregnancy.

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