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Papers by Paulino Gracia

Ginecología y obstetricia de México, 2017

Hypertension in …, 2009

Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has be... more Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has been done to identify unique screening tests that would predict the risk of developing preeclampsia before the classic symptoms appear. The possible use of a screening test with high predictive accuracy in patients with high-risk or low-risk of preeclampsia remains to be investigated. At present, the search for additional tests continues. There is growing interest in the use of combinations of tests. Effective primary prevention is not possible because the causes are still unknown, but to identify and to modify susceptible risk factors might decrease the frequency of preeclampsia. A community guideline improves the screening and early detection of preeclampsia, and uniforms the referral thresholds and assessment procedures. Secondary prevention with calcium supplementation and aspirin administration during pregnancy are beneficial in low calcium intake women and in the patient at a very high risk of developing severe early onset disease. Lifestyle choices, dietary nutritional measures (antioxidant as vitamin C, vitamin E, lycopene, selenium, zinc, magnesium and the mitochondrial antioxidants nicotine, coenzyme Q 10 and melatonin; and other dietary nutritional measures as low dietary salt, omega 3 fatty acids, folic acid, garlic, nutritional advice, protein and energy supplementation, isocaloric balanced protein and protein and energy restriction for obese women) and others drugs; have not shown benefits or there is insufficient evidence to recommend clinical use. Proper antenatal care and timed delivery are of utmost importance in tertiary prevention.

Journal of Maternal-fetal & Neonatal Medicine, Nov 27, 2014

Abstract This was a systematic review of randomized controlled trials comparing anticonvulsants w... more Abstract This was a systematic review of randomized controlled trials comparing anticonvulsants with placebo or no anticonvulsant for prevention (a) of eclampsia in women with severe preeclampsia diagnosed during the postpartum period or diagnosed before delivery but without previous treatment and (b) prevention of seizures recurrence in women with eclampsia postpartum. We did not find study with full inclusion criteria. However, a total of two randomised controlled trials meet inclusion criteria as subgroup analysis; one for severe preeclampsia diagnosed during the postpartum period and one for eclampsia postpartum. For severe preeclampsia diagnosed during postpartum, there was no clear difference between the groups reporting eclampsia (relative risk: 0.54, 95% confidence interval: 0.16-1.80). For seizure recurrence, magnesium sulfate was superior to diazepam, but there was no significant difference compared with phenytoin. No conclusion can be drawn on the role of magnesium sulfate post partum as established in antepartum pre-eclampsia/eclampsia management because of lack of powered randomised controlled trials.

European Journal of Obstetrics & Gynecology and Reproductive Biology, Mar 1, 2003

Background: Timing of delivery is difficult to judge in preeclampsia. Objective: To compare the d... more Background: Timing of delivery is difficult to judge in preeclampsia. Objective: To compare the differences of maternal and perinatal outcome of patients with severe preeclampsia and essential hypertension with superimposed preeclampsia, with expectant management at 24–34 ...

Obstetrical & Gynecological Survey, Mar 1, 2014

ABSTRACT Preeclampsia occurs in ∼2% to 12% of all pregnancies, and early severe preeclampsia acco... more ABSTRACT Preeclampsia occurs in ∼2% to 12% of all pregnancies, and early severe preeclampsia accounts for ∼25% of all cases. The only known treatment for preeclampsia is delivery, yet an early preterm delivery increases the risk for adverse neonatal outcomes. This randomized, multicenter, parallel, open-label clinical trial was undertaken to determine whether expectant management of severe preeclampsia at less than 34 weeks’ gestation results in better perinatal outcomes compared with prompt delivery (PD) after steroid administration. Pregnant women with severe hypertensive disorders at 28 to 33 weeks’ gestation were randomly allocated to the PD or expectant management (EXM) group. Prompt delivery patients received glucocorticoid therapy followed by delivery in 24 to 72 hours. Patients in the EXM group were treated with glucocorticoid therapy followed by delivery only for specific maternal/fetal indications or reaching 34 weeks’ gestation. The primary outcome was perinatal mortality (fetal and neonatal death). Secondary outcomes were composite neonatal morbidities, neonatal birth data, and maternal morbidities and death. Of 267 women, the final cohort included 131 patients (138 births) in the EXM group and 133 (137 births) in the PD group. The 2 groups did not differ significantly in baseline characteristics. Reasons for delivery in the EXM group were uncontrollable blood pressure (40.4%), fetal compromise (29%), persistent symptoms (28.2%), reaching 34 weeks’ gestation (26.0%), and maternal complications (21.3%). Perinatal mortality rates were 9.4% in the PD group and 8.7% in the EXM group, not a significant difference. Composite neonatal morbidities were 56.4% in the PD group and 55.6% in the EXP group (relative risk, 1.01; 95% confidence interval, 0.81–1.26; P = 0.89). The PD group had lower birth weights at delivery (1543 ± 438 vs 1659 ± 509 g), but the EXM group had more small-for-gestational age infants (13 [9.4%] vs 30 [21.7%]; P = 0.005) and abruptio placentae (2 [1.5%] vs 10 [7.6%]; P = 0.01). Rates of total neonatal morbidity and mortality stratified by gestational age at randomization were 85% (63/75), 66.3% (65/98), and 36.2% (37/102), respectively, for 28 to 29 weeks, 30 to 31 weeks, and 32 to 33 weeks, with no significant differences between the PD and EXM groups. The average pregnancy prolongation in the EXM group was 10.3 ± 8 days compared with 2.2 ± 0.8 days in the PD group (P = 0.0001). No maternal deaths occurred. Oral antihypertensive medications to maintain blood pressure at less than 160/110 mm Hg were used in 61 women (46.5%) in the EXM group. No significant differences in perinatal mortality were noted between women with or without oral antihypertensive medications (7 [11.48%] vs 5 [7.14%]; P = 0.29). The incidence of severe hypertension was 41% and 38.6% in these 2 groups, respectively (P = 0.81). Five women in each oral antihypertensive group had abruptio placentae. Higher maternal morbidity (37.7% vs 14.3%; P = 0.02) was found in the EXM group receiving oral antihypertensive medications. The only curative treatment for severe preeclampsia is delivery of the fetus. At very early preterm, the consequences of neonatal prematurity must be weighed against potential maternal morbidity by prolonging gestation. The most important factors for improved neonatal outcome are gestational age on presentation, use of corticosteroids, and providing intensive neonatal care. Severe preeclampsia before 34 weeks should be managed with PD after corticoid administration.

International journal of gynaecology and obstetrics, Feb 11, 2004

To identify independent predictors of successful labor induction with oral or vaginal misoprostol... more To identify independent predictors of successful labor induction with oral or vaginal misoprostol METHODS: Women enrolled in four previous randomized trials involving oral or vaginal misoprostol for cervical ripening and labor induction were included in the present study, with dosing 25-50 g every 4-6 hours vaginally (n ϭ 574) or 50 g

Ginecología y obstetricia de México, Dec 12, 2018

Rev. peru. ginecol. obstet. (En línea), 2020

Revista Médica de Panamá - ISSN 2412-642X, 2019

Authorea

Background: The optimal duration of magnesium administration postpartum for prevention of eclamps... more Background: The optimal duration of magnesium administration postpartum for prevention of eclampsia has not yet been established. Objective: To investigate the effect of early discontinuation of postpartum magnesium on the rates of postpartum eclampsia when compared to continuation for 24-hour postpartum. Search Strategy: Searches were performed using keywords related to "preeclampsia" and "magnesium sulfate" from inception of database until March 2019. Selection Criteria: Randomized controlled trials of women with preeclampsia receiving magnesium prior to delivery randomized to early discontinuation of magnesium postpartum. The control group was 24-hours of magnesium postpartum. Data Collection and Analysis: The primary outcome was the rate of postpartum eclampsia. Main Results: Eight RCTs with 2,183 women were included with five different magnesium administration time-frames. Eclampsia rates were not different between the two groups (5/1,088 (0.5%) after early discontinuation, versus 2/1,095 (0.2%) in the 24-hour group; RR 2.25, 95% CI 0.5-9.9, I2=0%, 8 studies, 2,183 participants). A number needed to treat was calculated; 370 women would need to receive 24-hours of magnesium postpartum to prevent one episode of postpartum eclampsia. The early discontinuation group had a significant decrease in time to ambulation and breastfeeding. Conclusions: Compared to continuation of magnesium for 24 hours postpartum, early magnesium discontinuation postpartum does not significantly increase the rate of postpartum eclampsia. The largest proportion of women did not receive magnesium postpartum after receiving at least 8 grams intrapartum, thus it is reasonable to consider discontinuation of magnesium postpartum if a woman has received similar adequate dose prior to delivery.

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 7, 2016

To compare differences in blood pressure levels between patients with severe post-partum pre-ecla... more To compare differences in blood pressure levels between patients with severe post-partum pre-eclampsia using ibuprofen or acetaminophen. A randomized controlled trial was made in women with severe pre-eclampsia or superimposed pre-eclampsia after vaginal birth. The patient was randomly selected to receive either 400 mg of ibuprofen every 8 hours or 1 g of acetaminophen every 6 hours during the post-partum. The primary variable was systolic hypertension ≥ 150 mmHg and/or diastolic hypertension ≥ 100 mmHg after the first 24 hours post-partum. Secondary variables were the arterial blood pressure readings at 24, 48, 72, and 96 hours post-partum and maternal complications. 113 patients were studied: 56 in the acetaminophen group and 57 in the ibuprofen group. With regard to the primary variable significantly more cases there was in the ibuprofen group (36/57; 63.1%) that in the acetaminophen group, (16/56; 28.6%). Severe hypertension (≥ 160/110 mmHg) was not significantly different betwe...

Journal of Maternal-fetal & Neonatal Medicine, Oct 31, 2013

ABSTRACT Abstract Objective: To determine the maternal and neonatal efficacy and safety with furo... more ABSTRACT Abstract Objective: To determine the maternal and neonatal efficacy and safety with furosemide, amlodipine or aspirin in women with mild/moderate chronic hypertension during pregnancy. Methods: A pilot clinical trial was performed in a tertiary teaching hospital in Panama. Pregnant patients with mild/moderate chronic hypertension at ≤ 20 weeks of gestation were invited to take part in the study. Mild/moderate chronic hypertension was defined as a pregnancy with systolic blood pressure of 140-159 mm Hg or diastolic blood pressure of 90-109 mm Hg. Women in the furosemide group received 20 mg of furosemide oral each day, those in the amlodipine group received 5 mg of amlodipine oral each day and those in the aspirin group received 75 mg of orally-administered acetylsalicylic acid each day. Results: We enrolled 63 patients during the study period, 21 women were randomised to each group (aspirin, amlodipine and furosemide). We found no difference in maternal complications, pre-term births, mean birth weight or in the proportion of small for gestational age infants among treatment groups. Severe hypertension and aggregate pre-eclampsia were similar among treatment groups. Conclusion: This pilot trial demonstrates that both furosemide and amlodipine might have the same effect during pregnancy. However, a large clinical trial is necessary to prove this.

Revista Peruana de Ginecología y Obstetricia

La preeclampsia es un trastorno hipertensivo multisistémico que se presentadespués de las 20 sema... more La preeclampsia es un trastorno hipertensivo multisistémico que se presentadespués de las 20 semanas de gestación en 5% a 15% de gestantes y es causa decomplicaciones que pueden afectar órganos importantes y hasta provocar la muertedurante la gestación o en el posparto. Incluye la preeclampsia severa, eclampsiay síndrome HELLP (hemolysis, elevation of liver enzymes, low platelets, por sus siglasen inglés). Se comunica tres casos de desprendimiento de retina que ocurrieron endos pacientes con preeclampsia severa y una con eclampsia, todas con hemorragiay alteración visual en el posparto que requirieron tratamiento farmacológico. Eldesprendimiento de retina es un síntoma asociado a la preeclampsia y eclampsiaque puede ser investigado por fundoscopia ocular para determinar si es factible sutratamiento conservador o farmacológico.

Revista Peruana de Ginecología y Obstetricia

Objetivo. Describir los métodos usados para predecir preeclampsia y cómo prevenirla usando ácido ... more Objetivo. Describir los métodos usados para predecir preeclampsia y cómo prevenirla usando ácido acetilsalicílico (aspirina) a dosis bajas de acuerdo con las recomendaciones de las principales organizaciones de ginecología y obstetricia. Metodología. Se realizaron búsquedas en PubMed y Cochrane Library desde el 1 de enero de 2020 al 1 de mayo de 2022, con los términos “pre-eclampsia”, “trastornos hipertensivos en el embarazo” e “hipertensión y embarazo”. Nos enfocamos en los análisis y recomendaciones de las más reconocidas organizaciones internacionales de ginecología y obstetricia, independiente del idioma original. Resultados. Para la predicción de preeclampsia se usan dos estrategias que pretenden encontrar la población con más riesgo: 1) basada en hallazgos clínicos de riesgo por condiciones antes del embarazo o propias del embarazo, y 2) un algoritmo de múltiples factores que incluye hallazgos clínicos, presión arterial, biomarcador y Doppler de arteria uterina. Usando ambas e...

Pregnant women with chronic hypertension have increased worldwide and with it more maternal and p... more Pregnant women with chronic hypertension have increased worldwide and with it more maternal and perinatal complications such as hypertensive crisis, preeclampsia, placental abruption, growth restriction, prematurity, perinatal mortality. In addition to correct diagnosis and strict follow-up during the pregnancy, antihypertensive drugs have been controversially used. An adequate randomized controlled study recently published shows the benefit of antihypertensives. The antihypertensive drug used seems to be the explanation why previous studies were not conclusive in denoting benefits. The drugs that have shown benefits are beta-blockers (labetalol), calcium channel blockers (nifedipine, amlodipine) and with minimal effectiveness methyldopa.

Revista Peruana de Ginecología y Obstetricia, 2020

Objetivo. Buscar toda la información y evidencia disponible sobre el SARS-CoV-2 -que surgió en es... more Objetivo. Buscar toda la información y evidencia disponible sobre el SARS-CoV-2 -que surgió en estos primeros 4 meses de 2020- y el embarazo. Metodología. Revisión sistemática en las bases de datos PubMed y Google Scholar, hasta el 25 de abril de 2020. Se buscó artículos publicados relacionados con mujeres embarazadas infectadas con SARS-CoV-2. No hubo restricción de idioma. La búsqueda se extendió a las referencias de los artículos encontrados. Resultados. La enfermedad COVID-19 en mujeres embarazadas se caracteriza porque más del 90% de las pacientes evoluciona en forma leve, 2% requiere ingresar a las unidades de cuidados intensivos. Una muerte materna ha sido reportada. La prematuridad es alrededor de 25%, con predominio de recién nacidos prematuros tardíos; aproximadamente el 9% se complica con rotura prematura de membranas; la mortalidad perinatal es baja o similar a la de la población general y no se ha demostrado la transmisión vertical. Conclusiones. Los ginecólogos obstetr...

Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has be... more Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has been done to identify unique screening tests that would predict the risk of developing preeclampsia before the classic symptoms appear. The possible use of a screening test with high predictive accuracy in patients with high-risk or low-risk of preeclampsia remains to be investigated. At present, the search for additional tests continues. There is growing interest in the use of combinations of tests. Effective primary prevention is not possible because the causes are still unknown, but to identify and to modify susceptible risk factors might decrease the frequency of preeclampsia. A community guideline improves the screening and early detection of preeclampsia, and uniforms the referral thresholds and assessment procedures. Secondary prevention with calcium supplementation and aspirin administration during pregnancy are beneficial in low calcium intake women and in the patient at a very hi...

Ginecología y obstetricia de México, 2017

Hypertension in …, 2009

Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has be... more Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has been done to identify unique screening tests that would predict the risk of developing preeclampsia before the classic symptoms appear. The possible use of a screening test with high predictive accuracy in patients with high-risk or low-risk of preeclampsia remains to be investigated. At present, the search for additional tests continues. There is growing interest in the use of combinations of tests. Effective primary prevention is not possible because the causes are still unknown, but to identify and to modify susceptible risk factors might decrease the frequency of preeclampsia. A community guideline improves the screening and early detection of preeclampsia, and uniforms the referral thresholds and assessment procedures. Secondary prevention with calcium supplementation and aspirin administration during pregnancy are beneficial in low calcium intake women and in the patient at a very high risk of developing severe early onset disease. Lifestyle choices, dietary nutritional measures (antioxidant as vitamin C, vitamin E, lycopene, selenium, zinc, magnesium and the mitochondrial antioxidants nicotine, coenzyme Q 10 and melatonin; and other dietary nutritional measures as low dietary salt, omega 3 fatty acids, folic acid, garlic, nutritional advice, protein and energy supplementation, isocaloric balanced protein and protein and energy restriction for obese women) and others drugs; have not shown benefits or there is insufficient evidence to recommend clinical use. Proper antenatal care and timed delivery are of utmost importance in tertiary prevention.

Journal of Maternal-fetal & Neonatal Medicine, Nov 27, 2014

Abstract This was a systematic review of randomized controlled trials comparing anticonvulsants w... more Abstract This was a systematic review of randomized controlled trials comparing anticonvulsants with placebo or no anticonvulsant for prevention (a) of eclampsia in women with severe preeclampsia diagnosed during the postpartum period or diagnosed before delivery but without previous treatment and (b) prevention of seizures recurrence in women with eclampsia postpartum. We did not find study with full inclusion criteria. However, a total of two randomised controlled trials meet inclusion criteria as subgroup analysis; one for severe preeclampsia diagnosed during the postpartum period and one for eclampsia postpartum. For severe preeclampsia diagnosed during postpartum, there was no clear difference between the groups reporting eclampsia (relative risk: 0.54, 95% confidence interval: 0.16-1.80). For seizure recurrence, magnesium sulfate was superior to diazepam, but there was no significant difference compared with phenytoin. No conclusion can be drawn on the role of magnesium sulfate post partum as established in antepartum pre-eclampsia/eclampsia management because of lack of powered randomised controlled trials.

European Journal of Obstetrics & Gynecology and Reproductive Biology, Mar 1, 2003

Background: Timing of delivery is difficult to judge in preeclampsia. Objective: To compare the d... more Background: Timing of delivery is difficult to judge in preeclampsia. Objective: To compare the differences of maternal and perinatal outcome of patients with severe preeclampsia and essential hypertension with superimposed preeclampsia, with expectant management at 24–34 ...

Obstetrical & Gynecological Survey, Mar 1, 2014

ABSTRACT Preeclampsia occurs in ∼2% to 12% of all pregnancies, and early severe preeclampsia acco... more ABSTRACT Preeclampsia occurs in ∼2% to 12% of all pregnancies, and early severe preeclampsia accounts for ∼25% of all cases. The only known treatment for preeclampsia is delivery, yet an early preterm delivery increases the risk for adverse neonatal outcomes. This randomized, multicenter, parallel, open-label clinical trial was undertaken to determine whether expectant management of severe preeclampsia at less than 34 weeks’ gestation results in better perinatal outcomes compared with prompt delivery (PD) after steroid administration. Pregnant women with severe hypertensive disorders at 28 to 33 weeks’ gestation were randomly allocated to the PD or expectant management (EXM) group. Prompt delivery patients received glucocorticoid therapy followed by delivery in 24 to 72 hours. Patients in the EXM group were treated with glucocorticoid therapy followed by delivery only for specific maternal/fetal indications or reaching 34 weeks’ gestation. The primary outcome was perinatal mortality (fetal and neonatal death). Secondary outcomes were composite neonatal morbidities, neonatal birth data, and maternal morbidities and death. Of 267 women, the final cohort included 131 patients (138 births) in the EXM group and 133 (137 births) in the PD group. The 2 groups did not differ significantly in baseline characteristics. Reasons for delivery in the EXM group were uncontrollable blood pressure (40.4%), fetal compromise (29%), persistent symptoms (28.2%), reaching 34 weeks’ gestation (26.0%), and maternal complications (21.3%). Perinatal mortality rates were 9.4% in the PD group and 8.7% in the EXM group, not a significant difference. Composite neonatal morbidities were 56.4% in the PD group and 55.6% in the EXP group (relative risk, 1.01; 95% confidence interval, 0.81–1.26; P = 0.89). The PD group had lower birth weights at delivery (1543 ± 438 vs 1659 ± 509 g), but the EXM group had more small-for-gestational age infants (13 [9.4%] vs 30 [21.7%]; P = 0.005) and abruptio placentae (2 [1.5%] vs 10 [7.6%]; P = 0.01). Rates of total neonatal morbidity and mortality stratified by gestational age at randomization were 85% (63/75), 66.3% (65/98), and 36.2% (37/102), respectively, for 28 to 29 weeks, 30 to 31 weeks, and 32 to 33 weeks, with no significant differences between the PD and EXM groups. The average pregnancy prolongation in the EXM group was 10.3 ± 8 days compared with 2.2 ± 0.8 days in the PD group (P = 0.0001). No maternal deaths occurred. Oral antihypertensive medications to maintain blood pressure at less than 160/110 mm Hg were used in 61 women (46.5%) in the EXM group. No significant differences in perinatal mortality were noted between women with or without oral antihypertensive medications (7 [11.48%] vs 5 [7.14%]; P = 0.29). The incidence of severe hypertension was 41% and 38.6% in these 2 groups, respectively (P = 0.81). Five women in each oral antihypertensive group had abruptio placentae. Higher maternal morbidity (37.7% vs 14.3%; P = 0.02) was found in the EXM group receiving oral antihypertensive medications. The only curative treatment for severe preeclampsia is delivery of the fetus. At very early preterm, the consequences of neonatal prematurity must be weighed against potential maternal morbidity by prolonging gestation. The most important factors for improved neonatal outcome are gestational age on presentation, use of corticosteroids, and providing intensive neonatal care. Severe preeclampsia before 34 weeks should be managed with PD after corticoid administration.

International journal of gynaecology and obstetrics, Feb 11, 2004

To identify independent predictors of successful labor induction with oral or vaginal misoprostol... more To identify independent predictors of successful labor induction with oral or vaginal misoprostol METHODS: Women enrolled in four previous randomized trials involving oral or vaginal misoprostol for cervical ripening and labor induction were included in the present study, with dosing 25-50 g every 4-6 hours vaginally (n ϭ 574) or 50 g

Ginecología y obstetricia de México, Dec 12, 2018

Rev. peru. ginecol. obstet. (En línea), 2020

Revista Médica de Panamá - ISSN 2412-642X, 2019

Authorea

Background: The optimal duration of magnesium administration postpartum for prevention of eclamps... more Background: The optimal duration of magnesium administration postpartum for prevention of eclampsia has not yet been established. Objective: To investigate the effect of early discontinuation of postpartum magnesium on the rates of postpartum eclampsia when compared to continuation for 24-hour postpartum. Search Strategy: Searches were performed using keywords related to "preeclampsia" and "magnesium sulfate" from inception of database until March 2019. Selection Criteria: Randomized controlled trials of women with preeclampsia receiving magnesium prior to delivery randomized to early discontinuation of magnesium postpartum. The control group was 24-hours of magnesium postpartum. Data Collection and Analysis: The primary outcome was the rate of postpartum eclampsia. Main Results: Eight RCTs with 2,183 women were included with five different magnesium administration time-frames. Eclampsia rates were not different between the two groups (5/1,088 (0.5%) after early discontinuation, versus 2/1,095 (0.2%) in the 24-hour group; RR 2.25, 95% CI 0.5-9.9, I2=0%, 8 studies, 2,183 participants). A number needed to treat was calculated; 370 women would need to receive 24-hours of magnesium postpartum to prevent one episode of postpartum eclampsia. The early discontinuation group had a significant decrease in time to ambulation and breastfeeding. Conclusions: Compared to continuation of magnesium for 24 hours postpartum, early magnesium discontinuation postpartum does not significantly increase the rate of postpartum eclampsia. The largest proportion of women did not receive magnesium postpartum after receiving at least 8 grams intrapartum, thus it is reasonable to consider discontinuation of magnesium postpartum if a woman has received similar adequate dose prior to delivery.

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 7, 2016

To compare differences in blood pressure levels between patients with severe post-partum pre-ecla... more To compare differences in blood pressure levels between patients with severe post-partum pre-eclampsia using ibuprofen or acetaminophen. A randomized controlled trial was made in women with severe pre-eclampsia or superimposed pre-eclampsia after vaginal birth. The patient was randomly selected to receive either 400 mg of ibuprofen every 8 hours or 1 g of acetaminophen every 6 hours during the post-partum. The primary variable was systolic hypertension ≥ 150 mmHg and/or diastolic hypertension ≥ 100 mmHg after the first 24 hours post-partum. Secondary variables were the arterial blood pressure readings at 24, 48, 72, and 96 hours post-partum and maternal complications. 113 patients were studied: 56 in the acetaminophen group and 57 in the ibuprofen group. With regard to the primary variable significantly more cases there was in the ibuprofen group (36/57; 63.1%) that in the acetaminophen group, (16/56; 28.6%). Severe hypertension (≥ 160/110 mmHg) was not significantly different betwe...

Journal of Maternal-fetal & Neonatal Medicine, Oct 31, 2013

ABSTRACT Abstract Objective: To determine the maternal and neonatal efficacy and safety with furo... more ABSTRACT Abstract Objective: To determine the maternal and neonatal efficacy and safety with furosemide, amlodipine or aspirin in women with mild/moderate chronic hypertension during pregnancy. Methods: A pilot clinical trial was performed in a tertiary teaching hospital in Panama. Pregnant patients with mild/moderate chronic hypertension at ≤ 20 weeks of gestation were invited to take part in the study. Mild/moderate chronic hypertension was defined as a pregnancy with systolic blood pressure of 140-159 mm Hg or diastolic blood pressure of 90-109 mm Hg. Women in the furosemide group received 20 mg of furosemide oral each day, those in the amlodipine group received 5 mg of amlodipine oral each day and those in the aspirin group received 75 mg of orally-administered acetylsalicylic acid each day. Results: We enrolled 63 patients during the study period, 21 women were randomised to each group (aspirin, amlodipine and furosemide). We found no difference in maternal complications, pre-term births, mean birth weight or in the proportion of small for gestational age infants among treatment groups. Severe hypertension and aggregate pre-eclampsia were similar among treatment groups. Conclusion: This pilot trial demonstrates that both furosemide and amlodipine might have the same effect during pregnancy. However, a large clinical trial is necessary to prove this.

Revista Peruana de Ginecología y Obstetricia

La preeclampsia es un trastorno hipertensivo multisistémico que se presentadespués de las 20 sema... more La preeclampsia es un trastorno hipertensivo multisistémico que se presentadespués de las 20 semanas de gestación en 5% a 15% de gestantes y es causa decomplicaciones que pueden afectar órganos importantes y hasta provocar la muertedurante la gestación o en el posparto. Incluye la preeclampsia severa, eclampsiay síndrome HELLP (hemolysis, elevation of liver enzymes, low platelets, por sus siglasen inglés). Se comunica tres casos de desprendimiento de retina que ocurrieron endos pacientes con preeclampsia severa y una con eclampsia, todas con hemorragiay alteración visual en el posparto que requirieron tratamiento farmacológico. Eldesprendimiento de retina es un síntoma asociado a la preeclampsia y eclampsiaque puede ser investigado por fundoscopia ocular para determinar si es factible sutratamiento conservador o farmacológico.

Revista Peruana de Ginecología y Obstetricia

Objetivo. Describir los métodos usados para predecir preeclampsia y cómo prevenirla usando ácido ... more Objetivo. Describir los métodos usados para predecir preeclampsia y cómo prevenirla usando ácido acetilsalicílico (aspirina) a dosis bajas de acuerdo con las recomendaciones de las principales organizaciones de ginecología y obstetricia. Metodología. Se realizaron búsquedas en PubMed y Cochrane Library desde el 1 de enero de 2020 al 1 de mayo de 2022, con los términos “pre-eclampsia”, “trastornos hipertensivos en el embarazo” e “hipertensión y embarazo”. Nos enfocamos en los análisis y recomendaciones de las más reconocidas organizaciones internacionales de ginecología y obstetricia, independiente del idioma original. Resultados. Para la predicción de preeclampsia se usan dos estrategias que pretenden encontrar la población con más riesgo: 1) basada en hallazgos clínicos de riesgo por condiciones antes del embarazo o propias del embarazo, y 2) un algoritmo de múltiples factores que incluye hallazgos clínicos, presión arterial, biomarcador y Doppler de arteria uterina. Usando ambas e...

Pregnant women with chronic hypertension have increased worldwide and with it more maternal and p... more Pregnant women with chronic hypertension have increased worldwide and with it more maternal and perinatal complications such as hypertensive crisis, preeclampsia, placental abruption, growth restriction, prematurity, perinatal mortality. In addition to correct diagnosis and strict follow-up during the pregnancy, antihypertensive drugs have been controversially used. An adequate randomized controlled study recently published shows the benefit of antihypertensives. The antihypertensive drug used seems to be the explanation why previous studies were not conclusive in denoting benefits. The drugs that have shown benefits are beta-blockers (labetalol), calcium channel blockers (nifedipine, amlodipine) and with minimal effectiveness methyldopa.

Revista Peruana de Ginecología y Obstetricia, 2020

Objetivo. Buscar toda la información y evidencia disponible sobre el SARS-CoV-2 -que surgió en es... more Objetivo. Buscar toda la información y evidencia disponible sobre el SARS-CoV-2 -que surgió en estos primeros 4 meses de 2020- y el embarazo. Metodología. Revisión sistemática en las bases de datos PubMed y Google Scholar, hasta el 25 de abril de 2020. Se buscó artículos publicados relacionados con mujeres embarazadas infectadas con SARS-CoV-2. No hubo restricción de idioma. La búsqueda se extendió a las referencias de los artículos encontrados. Resultados. La enfermedad COVID-19 en mujeres embarazadas se caracteriza porque más del 90% de las pacientes evoluciona en forma leve, 2% requiere ingresar a las unidades de cuidados intensivos. Una muerte materna ha sido reportada. La prematuridad es alrededor de 25%, con predominio de recién nacidos prematuros tardíos; aproximadamente el 9% se complica con rotura prematura de membranas; la mortalidad perinatal es baja o similar a la de la población general y no se ha demostrado la transmisión vertical. Conclusiones. Los ginecólogos obstetr...

Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has be... more Preeclampsia increases maternal and perinatal morbidity and mortality rates. Much research has been done to identify unique screening tests that would predict the risk of developing preeclampsia before the classic symptoms appear. The possible use of a screening test with high predictive accuracy in patients with high-risk or low-risk of preeclampsia remains to be investigated. At present, the search for additional tests continues. There is growing interest in the use of combinations of tests. Effective primary prevention is not possible because the causes are still unknown, but to identify and to modify susceptible risk factors might decrease the frequency of preeclampsia. A community guideline improves the screening and early detection of preeclampsia, and uniforms the referral thresholds and assessment procedures. Secondary prevention with calcium supplementation and aspirin administration during pregnancy are beneficial in low calcium intake women and in the patient at a very hi...