{"id":64131,"date":"2021-09-21T09:05:53","date_gmt":"2021-09-21T07:05:53","guid":{"rendered":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/?p=64131"},"modified":"2021-09-20T11:19:24","modified_gmt":"2021-09-20T09:19:24","slug":"preeclampsia-y-sindrome-de-hellp-a-proposito-de-un-caso-atencion-de-la-matrona-en-primaria","status":"publish","type":"post","link":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/preeclampsia-y-sindrome-de-hellp-a-proposito-de-un-caso-atencion-de-la-matrona-en-primaria\/","title":{"rendered":"Preeclampsia y s\u00edndrome de HELLP a prop\u00f3sito de un caso. Atenci\u00f3n de la matrona en primaria"},"content":{"rendered":"

Preeclampsia y s\u00edndrome de HELLP a prop\u00f3sito de un caso. Atenci\u00f3n de la matrona en primaria<\/strong><\/p>\n

Autora principal: Isabel Guerrero Guzm\u00e1n<\/p>\n

XVI; n\u00ba 18; 912<\/p>\n

Preeclampsia and HELLP syndrome on a case. Midwife care in primary<\/strong><\/p>\n

Fecha de recepci\u00f3n: 17\/08\/2021<\/p>\n

Fecha de aceptaci\u00f3n: 17\/09\/2021<\/p>\n

Incluido en Revista Electr\u00f3nica de PortalesMedicos.com Volumen XVI. N\u00famero 18 \u2013\u00a0 Segunda quincena de Septiembre de 2021 – P\u00e1gina inicial: Vol. XVI; n\u00ba 18; 912<\/p>\n

Autoras:<\/strong><\/p>\n

Isabel Guerrero Guzm\u00e1n, Carmen Corrales Lobato, Alba Luc\u00eda Galindo Galindo.<\/p>\n

INTRODUCCI\u00d3N<\/p>\n

Los estados hipertensivos del embarazo (EHE) siguen siendo uno de los problemas obst\u00e9tricos m\u00e1s importantes por resolver. Presentan una prevalencia del 2% al 8% de las gestantes y el diagn\u00f3stico y el tratamiento precoces son de gran importancia tanto para la mujer gestante como para el feto.<\/p>\n

Se establece un diagn\u00f3stico de hipertensi\u00f3n en el embarazo cuando en dos o m\u00e1s determinaciones separadas por 6 horas la paciente presenta una tensi\u00f3n arterial sist\u00f3lica ( TAS) \u2265 140 mmHg y\/o una tensi\u00f3n arterial diast\u00f3lica (TAD) \u2265 90 mmHg.<\/p>\n

Palabras clave: Matrona,diagn\u00f3stico,preeclampsia,s\u00edndrome de HELLP,hipertensi\u00f3n.<\/p>\n

INTRODUCTION<\/p>\n

Hypertensive states of pregnancy (EHE) remain one of the most important obstetric problems to be solved. They have a prevalence of 2% to 8% of pregnant women and early diagnosis and treatment are of great importance for both the pregnant woman and the foetus. A diagnosis of hypertension in pregnancy is established when in two or more determinations separated by 6 hours the patient has a systolic blood pressure ( TAS) 140 mmHg and\/or a diastolic blood pressure (TAD) 90 mmHg.<\/p>\n

Keywords: Midwife , diagnosis, preeclampsia, HELLP syndrome, hypertension.<\/p>\n

CLASIFICACI\u00d3N<\/p>\n

Aunque existen m\u00faltiples clasificaciones, son cuatro las de utilizaci\u00f3n m\u00e1s difundida. De ellas, se propone seguir los conceptos b\u00e1sicos de la del \u00abPrograma Nacional para Educaci\u00f3n en Hipertensi\u00f3n\u00bb del Instituto Nacional de Coraz\u00f3n, Pulm\u00f3n y Sangre, en colaboraci\u00f3n con el Colegio Americano de Obstetras y Ginec\u00f3logos (ACOG).<\/p>\n

Hipertensi\u00f3n cr\u00f3nica<\/p>\n

Es una hipertensi\u00f3n que se detecta antes del embarazo o antes de la semana 20 del mismo.<\/p>\n

Hipertensi\u00f3n arterial gestacional<\/p>\n

Hipertensi\u00f3n sin proteinuria que aparece m\u00e1s all\u00e1 de las 20 semanas de gestaci\u00f3n en una mujer gestante que previamente era normotensa.<\/p>\n

Preeclampsia-Eclampsia.<\/p>\n

Se define como el hallazgo despu\u00e9s de la semana 20 de embarazo (salvo enfermedad trofobl\u00e1stica o hidrops) de hipertensi\u00f3n, acompa\u00f1ada por proteinuria (\u2265300 mg\/24h), edema o ambos.<\/p>\n

Eclampsia<\/p>\n

Es la ocurrencia de convulsiones en una paciente con preeclampsia que no pueden ser atribuidas a otras causas.<\/p>\n

Hipertensi\u00f3n cr\u00f3nica con Preeclampsia sobrea\u00f1adida.<\/p>\n

Se define como tal el aumento de la tensi\u00f3n arterial previa de al menos 30 mmHg la sist\u00f3lica o 15 mmHg la diast\u00f3lica, o 20 mmHg la media, junto con aparici\u00f3n de proteinuria o edema generalizado.<\/p>\n

CLASSIFICATION<\/p>\n

Although there are multiple classifications, four are the most widely used. Of these, it is proposed to follow the basic concepts of the \u00abNational Program for Hypertension Education\u00bb of the National Institute of Heart, Lung and Blood, in collaboration with the American College of Obstetricians and Gynecologists (ACOG).<\/p>\n

Chronic hypertension<\/p>\n

Is hypertension that is detected before pregnancy or before the 20th week of pregnancy.<\/p>\n

Gestational arterial hypertension<\/p>\n

Hypertension without proteinuria that appears beyond the 20 weeks of gestation in a pregnant woman who previously was normotensive.<\/p>\n

Preeclampsia-Eclampsia.<\/p>\n

It is defined as the finding after the 20th week of pregnancy (except trophoblastic disease or hydrops) of hypertension, accompanied by proteinuria ( 300 mg\/24h), edema or both.<\/p>\n

Eclampsia<\/p>\n

Is the occurrence of seizures in a patient with preeclampsia that cannot be attributed to other causes.<\/p>\n

Chronic hypertension with added preeclampsia.<\/p>\n

This is defined as an increase in previous blood pressure of at least 30 mmHg systolic or 15 mmHg diastolic, or 20 mmHg mean, along with the appearance of proteinuria or generalized edema.<\/p>\n

HELLP SYNDROME<\/p>\n

Is a complication of preeclampsia and eclampsia symptoms characterized by the presence of hemolysis, elevation of liver enzymes, and plaquetopenia esencia de hem\u00f3lisis, elevaci\u00f3n de las enzimas hep\u00e1ticas y plaquetopenia<\/p>\n

CASO CLINICO:<\/strong><\/p>\n

Se presenta un caso de preeclampsia grave y s\u00edndrome de HELLP en una gestante, detectado por la matrona de atenci\u00f3n primaria en una consulta de seguimiento del embarazo, que presentaba edemas generalizados.<\/p>\n

Ante esta situaci\u00f3n, se realiz\u00f3 de inmediato una exploraci\u00f3n en la que se hall\u00f3 hipertensi\u00f3n y edemas, por lo que se deriv\u00f3 urgentemente a la gestante al hospital para un estudio m\u00e1s exhaustivo.<\/p>\n

Se diagnostica de preeclamspsia grave, ante mal pron\u00f3stico, se realiza ces\u00e1rea urgente con resultados maternofetales satisfactorios.<\/p>\n

CLINICAL CASE:<\/p>\n

There is a case of severe preeclampsia and HELLP syndrome in a pregnant woman , detected by the primary care midwife in a follow-up consultation of the pregnancy, which presented generalized edema. Given this situation, an examination was immediately carried out in which hypertension and edema were found, so the pregnant woman was urgently referred to the hospital for a more thorough study. It is diagnosed with severe preeclamspsia, with poor prognosis, emergency caesarean section with satisfactory maternal fetal results.<\/p>\n

OBJETIVO<\/p>\n

Diagn\u00f3stico precoz de preeclampsia en gestantes a t\u00e9rminos, para conseguir unos resultados materno-fetales satisfactorios.<\/p>\n

OBJECTIVE<\/p>\n

Early diagnosis of preeclampsia in pregnant women in order to obtain satisfactory maternal- fetal results.<\/p>\n

MATERIAL Y M\u00c9TODO<\/p>\n

Estudio realizado a trav\u00e9s de un caso cl\u00ednico real entre la consulta de la matrona de atenci\u00f3n<\/p>\n

primaria y unidad de urgencias obst\u00e9tricas del hospital. MATERIAL AND METHOD<\/p>\n

Study conducted through a real clinical case between the consultation of the primary care midwife and the emergency obstetric unit of the hospital<\/p>\n

CASO CL\u00cdNICO<\/p>\n

Gestante primigesta de 38 semanas de gestaci\u00f3n que acude a la matrona de AP para consulta de seguimiento del embarazo, embarazo controlado, evoluci\u00f3n correcta, feto \u00fanico, anal\u00edticas dentro de la normalidad y controles ecogr\u00e1ficos normales.<\/p>\n

En tratamiento con \u00e1cido f\u00f3lico 400 \u00b5g\/d\u00eda, yodo 300\u00b5g\/d\u00eda y hierro 80 mg\/d\u00eda.<\/p>\n

Durante la exploraci\u00f3n, la matrona observa que la gestante presenta edemas generalizados(pies, piernas, cara y manos)<\/p>\n

Refiere cefaleas desde hace 4 d\u00edas.<\/p>\n

Aumento de peso de 3,5 kg respecto a la semana anterior. Realiza toma de constantes:<\/p>\n

TA 170\/ 100 y 150\/90 mmHg tras 5 minutos de reposo. Frecuencia card\u00edaca 100 lpm<\/p>\n

Temperatura: 37 \u00baC Saturaci\u00f3n de Oxigeno 98%<\/p>\n

Ante esta situaci\u00f3n la matrona deriva de manera urgente a la gestante al hospital de referencia<\/p>\n

CLINICAL CASE<\/p>\n

Original pregnant woman of 38 weeks of gestation who comes to the AP midwife for consultation of follow-up of pregnancy, controlled pregnancy, correct evolution, single fetus, blood tests within normal and normal ultrasound checks.<\/p>\n

In treatment with folic acid 400 \u00b5g\/day, iodine 300\u00b5g\/day and iron 80 mg\/day.<\/p>\n

During the examination, the midwife observes that the pregnant woman has generalized edema (feet, legs, face and hands)<\/p>\n

Refers headaches since 4 days.<\/p>\n

Weight gain of 3.5 kg compared to the previous week.<\/p>\n

It takes constants: TA 170\/ 100 and 150\/90 mmHg after 5 minutes of rest. Heart rate 100 lpm<\/p>\n

Temperature: 37 \u00baC<\/p>\n

Oxygen saturation 98%<\/p>\n

Given this situation, the midwife urgently refers the pregnant woman to the referral hospital.<\/p>\n

DIAGN\u00d3STICO<\/p>\n

Se establece el diagn\u00f3stico de preeclampsia grave. DIAGNOSIS<\/p>\n

Diagnosis of severe preeclampsia is established. ACTUACI\u00d3N DE LA MATRONA DE URGENCIAS OBST\u00c9TRICA<\/p>\n

Realiza las siguientes pruebas:<\/p>\n