Preeclampsia : factores de riesgo de complicaciones en adultas embarazadas, estudio a realizar en el Hospital Universitario de Guayaquil período 2014-2015
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Medicina
Resumen
La Preeclampsia es la forma más común de hipertensión en el embarazo, se define como un episodio nuevo de elevación de presión arterial más un episodio nuevo de proteinuria.
Se presenta después de las 20 semanas de gestación, junto con un aumento de la presión arterial ≥140 y/o 90 mmHg, proteinuria ≥300 mg en orina de 24 horas y se resuelve dentro de las primeras 6 semanas posteriores al parto.
Factores hereditarios y adquiridos, familiares, ambientales, inmunológicos e individuales parecen interactuar de diversas maneras para que aparezca la Preeclampsia.
La preeclampsia es una de las complicaciones más frecuentes y graves del embarazo que se caracteriza por reducción de la perfusión sistémica, generada por el vasoespasmo y la activación de los sistemas de coagulación.
La fisiopatología de la preeclampsia implica factores maternos, placentarios y fetales, que determinan dos alteraciones fisiopatológicas fundamentales; una invasión anómala del trofoblasto y una disfunción endotelial secundaria, que explica la microangiopatía producida en la preeclampsia, con el riesgo latente de daño a órganos diana como el corazón, cerebro, riñón, hígado, placenta y sistema hematológico.
En una paciente clasificada, al inicio del embarazo, como de alto riesgo, el monitoreo clínico cercano permitirá reconocer la enfermedad en sus estadios más tempranos.
Como primer paso, la mejor estrategia es la detección temprana de cifras tensionales persistentemente anormales. La medición de una presión arterial de 140/90 o con leve elevación de las cifras (140/95) por primera vez en la mujer embarazada con más de 20 semanas, suele constituir el primer signo de sospecha.
El tratamiento de la preeclampsia leve si el embarazo se encuentra a término (Edad gestacional > 37 semanas), se recomienda la culminación del embarazo mediante Inducción del parto, si existen condiciones obstétricas adecuadas. Si el embarazo es pretérmino (< 37 semanas), habría que valorar previamente si la paciente se encuentra en trabajo de parto o no y el estado de las membranas. En la preeclampsia severa debido
a las altas tasas de morbilidad materna y perinatal se recomienda la culminación del embarazo si la enfermedad se desarrolla a partir de las 34 semanas de gestación.
El propósito de esta investigación es determinar en la Preeclampsia los factores de riesgo de complicaciones, en adultas embarazadas, realizado en el Hospital Universitario de Guayaquil. En el presente estudio investigativo se demuestra la incidencia de Preeclampsia en mujeres adultas en 115 casos en el periodo comprendido 2014 al 2015. La incidencia de esta patología en este grupo de pacientes que se atendieron en el Hospital Universitario de Guayaquil es del 41% de casos en las edades comprendidas de 18 a 24 años. Los antecedentes patológicos maternos como una preeclampsia anterior nos demuestra que es un factor predisponente ya que ésta se pueda desarrollar nuevamente con otro embarazo.
Preeclampsia is the most common form of hypertension in pregnancy is defined as a new episode of elevated blood pressure plus a new episode of proteinuria. It occurs after 20 weeks gestation, along with an increase in blood pressure ≥140 and / or 90 mmHg, proteinuria ≥300 mg in 24-hour urine and resolved within the first 6 weeks postpartum. Family hereditary and acquired factors, environmental, immunological and individual appear to interact in different ways to display the Preeclampsia. Preeclampsia is one of the most frequent and serious complication of pregnancy characterized by reduction of systemic perfusion generated by vasospasm and activation of coagulation systems. The pathophysiology of preeclampsia involves maternal and fetal factors, placental, which determine two fundamental pathophysiological changes; an abnormal trophoblast invasion and secondary endothelial dysfunction, which explains the microangiopathy produced in preeclampsia, with the latent risk of target organ damage such as heart, brain, kidney, liver, placenta and blood system. In a classified, early pregnancy, such as high-risk patients close clinical monitoring allow to recognize the disease in its early stages. As a first step, the best strategy is early detection of persistently abnormal blood pressure values. Measurement of a blood pressure of 140/90 or mild elevation figures (140/95) for the first time in pregnant women over 20 weeks, is generally the first sign of suspicion. Treatment of mild preeclampsia if the pregnancy is at term (gestational age> 37 weeks), the culmination of pregnancy is recommended by induction of labor, if there are adequate obstetric conditions. If pregnancy is preterm (<37 weeks), we should previously assess whether the patient is in labor or not and the state of the membranes. In severe preeclampsia due to high rates of maternal and perinatal morbidity termination of pregnancy it is recommended if the disease develops after 34 weeks of gestation. The purpose of this research is to determine the risk factors Preeclampsia complications in pregnant adults, conducted at the University Hospital of Guayaquil. In this research study the incidence of preeclampsia in adult women in 115 cases demonstrated in the period 2014 to 2015. The incidence of this disease in this group of patients who were treated at the Hospital Universitario de Guayaquil is 41% of cases ranging in age from 18 to 24 years. Maternal medical history as a previous preeclampsia shows that it is a predisposing factor since it can be developed again with another pregnancy
Preeclampsia is the most common form of hypertension in pregnancy is defined as a new episode of elevated blood pressure plus a new episode of proteinuria. It occurs after 20 weeks gestation, along with an increase in blood pressure ≥140 and / or 90 mmHg, proteinuria ≥300 mg in 24-hour urine and resolved within the first 6 weeks postpartum. Family hereditary and acquired factors, environmental, immunological and individual appear to interact in different ways to display the Preeclampsia. Preeclampsia is one of the most frequent and serious complication of pregnancy characterized by reduction of systemic perfusion generated by vasospasm and activation of coagulation systems. The pathophysiology of preeclampsia involves maternal and fetal factors, placental, which determine two fundamental pathophysiological changes; an abnormal trophoblast invasion and secondary endothelial dysfunction, which explains the microangiopathy produced in preeclampsia, with the latent risk of target organ damage such as heart, brain, kidney, liver, placenta and blood system. In a classified, early pregnancy, such as high-risk patients close clinical monitoring allow to recognize the disease in its early stages. As a first step, the best strategy is early detection of persistently abnormal blood pressure values. Measurement of a blood pressure of 140/90 or mild elevation figures (140/95) for the first time in pregnant women over 20 weeks, is generally the first sign of suspicion. Treatment of mild preeclampsia if the pregnancy is at term (gestational age> 37 weeks), the culmination of pregnancy is recommended by induction of labor, if there are adequate obstetric conditions. If pregnancy is preterm (<37 weeks), we should previously assess whether the patient is in labor or not and the state of the membranes. In severe preeclampsia due to high rates of maternal and perinatal morbidity termination of pregnancy it is recommended if the disease develops after 34 weeks of gestation. The purpose of this research is to determine the risk factors Preeclampsia complications in pregnant adults, conducted at the University Hospital of Guayaquil. In this research study the incidence of preeclampsia in adult women in 115 cases demonstrated in the period 2014 to 2015. The incidence of this disease in this group of patients who were treated at the Hospital Universitario de Guayaquil is 41% of cases ranging in age from 18 to 24 years. Maternal medical history as a previous preeclampsia shows that it is a predisposing factor since it can be developed again with another pregnancy
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Embarazo, Preeclampsia, Hipertensión inducida en el embarazo, Complicaciones del embarazo, Hospital Universitario de Guayaquil, Cantón Guayaquil, Ecuador, Factores de riesgo