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  • The evaluation of serum electrolytes e g sodium

    2024-04-08

    The evaluation of serum electrolytes (e.g.: sodium, potassium, urea, creatinine, and uric acid), liver transaminases, blood counts (e.g. identification of thrombocytopenia, and bilirubin), 24-h urine (in order to monitor proteinuria), and heart rate and lung function of the mother should be performed continuously, and so should analysis of cardiotocography, fetal growth, amniotic fluid volume, and umbilical artery perfusion through Doppler ultrasound [3], [105]. Therefore, the importance of high quality prenatal care for pregnancy risk stratification into low- and high-risk groups. The introduction of oral anti-hypertensives (e.g.: methyldopa, hydralazine, β-blockers, and nifedipine) [105], [106] and gaba receptors low-dose acetylsalicylic gaba receptors (in high-risk pregnancies after the first trimester) [96] should be taken into account for the control of BP (BP <160×105mmHg, mean BP <125mmHg), for the reduction of heart attack risk in hypertensive emergencies (≥160×105mmHg), as well as for the increase in placental blood flow [22], [105]. In the imminence or signs of seizure, it is recommended to administer magnesium sulfate (MgSO4) [dose of 4g MgSO4, followed by infusion for 1g/h up to 24h after delivery] [17], [105], [107] and plasma expanders [105], [106]. Nonetheless, delivery is indicated in the presence of fetal distress, when BP is difficult to control and clinical parameters and eclampsia deteriorate, since PE resolves after the delivery of the fetus and the delivery of the placenta [105]. Furthermore, postpartum follow-up is essential for monitoring maternal blood pressure, and for the subsequent confirmation of the resolution of gestational hypertension or diagnosis of systemic hypertension in postpartum mothers, as well as for monitoring the risk of renal and cardiovascular diseases [2], [28], [105]. The literature highlights the increased risk for cardiovascular diseases (ex.: coronary death, myocardial infarction, fatal or non-fatal stroke, coronary insufficiency, angina pectoris, transient ischemic attack, intermittent claudication or congestive heart failure) among women with previous PE [108], [109], [110]. In these women, significant changes in blood pressure, fasting glucose, fasting insulin, high-sensitive C-reactive protein, triglycerides and cholesterol were observed about three months postpartum [108]. A research has shown that women diagnosed with isolated PE showed a doubled risk for major coronary events, compared with women without PE; and the risk may triple if PE is accompanied by newborns small for gestational age and/or preterm delivery, or become even larger than 4,7 times for women with recurrent PE, and with a risk of dying even 23% higher in relation to women without PE [110]. It should be noted that a meta-analysis indicates a relative risk of 3.70 for the diagnosis of hypertension after PE, compared to women who did not develop PE. As well as a risk of 2.60 for fatal ischemic heart disease, which can be almost eight times higher if PE develops before 37 weeks. It also stands out the relative increased risk for fatal and non-fatal stroke and venous thromboembolism in women who developed PE [111].
    Conclusion
    Compliance with ethical standards
    Ethical approval
    Author contributions Fernanda Rodrigues Helmo: ‘I declare that I participated in the project development, data collection, manuscript writing/editing and that I have seen and approved the final version. I have no conflicts of interest’. Angela Maria Moed Lopes: ‘I declare that I participated in the project development, data collection, manuscript writing and that I have seen and approved the final version. I have no conflicts of interest’. Anna Cecília Dias Maciel Carneiro: ‘I declare that I participated in the project development, data collection, manuscript writing and that I have seen and approved the final version. I have no conflicts of interest’. Carolina Guissoni Campos: ‘I declare that I participated in the project development, data collection, manuscript writing and that I have seen and approved the final version. I have no conflicts of interest’. Polyana Barbosa Silva: ‘I declare that I participated in the project development, data collection, manuscript writing and that I have seen and approved the final version. I have no conflicts of interest’. Maria Luíza Gonçalves dos Reis Monteiro: ‘I declare that I participated in the manuscript writing and that I have seen and approved the final version. I have no conflicts of interest’. Laura Penna Rocha: ‘I declare that I participated in the data collection and that I have seen and approved the final version. I have no conflicts of interest’. Marlene Antônia dos Reis: ‘I declare that I participated in the management and that I have seen and approved the final version. I have no conflicts of interest’. Renata Margarida Etchebehere: ‘I declare that I participated in the management and that I have seen and approved the final version. I have no conflicts of interest’. Juliana Reis Machado: ‘I declare that I participated in the management and that I have seen and approved the final version. I have no conflicts of interest’. Rosana Rosa Miranda Corrêa: ‘I declare that I participated in the project development, management and that I have seen and approved the final version. I have no conflicts of interest’.