- 作者：Edson Santos Ferreira Filho ; Tiago José ; De Oliveira Gomes ; Rodrigo Rocha Codarin ; Maria Rita De Figueiredo Lemos Bortolotto ; Fernanda Spadotto Baptista ; Marcelo Zugaib ; Rossana Pulcineli Vieira Francisco
- 刊名：Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
- 出版年：2016
- 出版时间：July 2016
- 年：2016
- 卷：6
- 期：3
- 页码：175-176
- 全文大小：47 K
Objective
Analyze the obstetric and perinatal outcomes in patients with severe pre-eclampsia before 34 weeks of gestation, according to the presence of thrombophilias.
Methods
Cohort study, with pregnant women being followed in “Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo”, because of preeclampsy or other diseases, hospitalized from October 2009 to October 2014. Women diagnosed with preeclampsia were included if they had any of the following severity criteria: systolic blood pressure ⩾160 and/or diastolic ⩾110 mmHg confirmed on two measurements with an interval of at least two hours; proteinuria ⩾5 g/24 h; diuresis <400 mL/day; headache, epigastric pain and visual changes simultaneously; cyanosis and/or pulmonary edema; HELLP syndrome; or when superimposed on chronic hypertension. No kidney or heart disease patients were included; also, gestational trophoblastic disease, fetal malformations, severe manifestation after 34 weeks were not included. Patients already enrolled in the study in another pregnancy were excluded. In our service, all patients with severe preeclampsia before 34 weeks are followed in the postpartum period and laboratorially investigated for thrombophilias. The variables analyzed were: birth weight, gestational age on the day of delivery, type of birth, Apgar scores, blood pH in umbilical artery and the occurrence of fetal deaths. Student’s t and chi-square tests were used, according to the type of variable analyzed. This research was approved by the Research Ethics Committee of “Faculdade de Medicina da Universidade de São Paulo”.
Results
239 patients were initially selected for the study, 99 patients did not investigate thrombophilia because they missed follow-up appointments after delivery and 5 were excluded, totalizing 135 patients. Thirty-five (25.9%) patients had positive laboratory markers for thrombophilias. Delivery occurred at gestational age of 31.1 ± 4.0 weeks (N = 100) in patients with negative results for thrombophilias and 29.5 ± 4.1 weeks (N = 35) in patients with positive search for thrombophilias (p = 0.05). There was no difference in the type of birth (cesarean delivery: 88.0% without thrombophilias versus 85.7% with thrombophilias; p = 0.73). The children of mothers without thrombophilias were born weighing 1236.12 ± 604.15 g (N = 102), while the children of mothers with thrombophilias were born weighing1126.97 ± 638.97 g (N = 35) (p = 0.38). The frequency of newborns with Apgar scores below 7 in the first minute of life was similar between groups (42.9% versus 51.6%, p = 0.39); there was not enough sample for analysis of the fifth and tenth minute. Blood pH in umbilical artery was also similar between groups: 7.18 ± 0.11 (N = 52, negative search) versus 7.15 ± 0.18 (N = 16, positive research), p = 0.54. The frequency of blood pH in umbilical artery below 7.20 was also similar between groups (53.8% versus 43.8%, p = 0.48). There was no difference in the distribution of cases of fetal death between the groups with negative versus positive search for thrombophilias (10.8% versus 20.0%, p = 0.16).
Conclusion
The existence of positive laboratory markers for thrombophilias does not appear to affect, at least directly, obstetric and perinatal outcomes of severe preeclampsia cases diagnosed before 34 weeks of pregnancy.