Vázquez-Rodríguez JG, Chiñas-Velázquez S

Language: Spanish
References: 21
Page: 435-442
PDF size: 90.45 Kb.

ABSTRACT

Background: Preeclampsia-eclampsia is a hypertensive disease of pregnancy with systemic complications. Studies regarding ultrasonographic characteristics of biliary gallbladder are limited. We undertook this study to determine the ultrasonographic biliary gallbladder characteristics in patients with preeclampsia-eclampsia.
Methods: This was a case series comprised of 115 women studied who were diagnosed with preeclampsia-eclampsia during pregnancy or the postpartum period. In all patients an ultrasonographic biliary gallbladder exam was carried out. Statistical analysis was performed with ANOVA test using SPSS software.
Results: We included 93 pregnant (80.9 %) and 22 women in the immediate postpartum period (19.1 %). Maternal age was 27.2 ± 5.7 years, parity was 1.9 ± 1.2, pregnancy age was 32.6 ± 4.1 weeks, epigastric pain was present in 23 patients (20 %), and two patients (1.7 %) had history of inflammatory gallbladder disease. The main diagnosis was uncomplicated severe preeclampsia (73 %), complicated severe preeclampsia was found in 20 %, eclampsia in 5.2 % and recurrent severe preeclampsia was present in 1.7 %. According to the ultrasonographic findings we established five groups as follows: wall edema (62 cases), normal appearance (45 cases), lithiasis (5 cases), undetermined (2 cases) and gallbladder polyp (1 case). The gallbladder size was similar in all cases (length 72 ± 9.8 mm, transverse 27.3 ± 6.6 mm). Regarding gallbladder wall thickness, we found a mean 6.2 ± 3 mm in the edema group, 2.1 ± 0.2 mm in the normal appearance group, 3 ± 1 mm in the lithiasis group and 2 mm in the gallbladder polyp group. The gallbladder content was anechoic in 102 patients (88.7 %), with biliary sludge in 11 women (9.6 %) and undetermined in 2 cases (1.7 %).
Conclusion: The most frequent ultrasonographic biliary gallbladder characteristics in patients with preeclampsia-eclampsia were reduced biliary gallbladder, thick walls secondary to edema, “double border” appearance and anechoic content.

REFERENCES

1. 1. Williams DJ, de Swiet D. The pathophysiology of pre-eclampsia. Int Care Med 1997;23:620-629.

2. 2. Pijnenborg R, Anthony J, Davey DA, Ress A, Tiltman A, Vercruysse L, Van Assche A. Placental bed spiral arteries in the hypertensive disorders of pregnancy. Br J Obstet Gynaecol 1996;98:648-655.

3. 3. Roberts JM, Taylor RN, Musci TJ, Rodgers GM, Hubel CA, McLaughlin MK. Preeclampsia: an endothelial cell disorder. Am J Obstet Gynaecol 1989;161:1200-1204.

4. 4. Sibai B, Dekker G. Pre-eclampsia. Lancet 2005;365:785-799.

5. 5. Bolt RJ. Fisiopatología de las enfermedades vesiculares. En: Sodeman WA, Sodeman TM, eds. Fisiopatología Clínica. Mecanismos de Producción de los Síntomas. 6ª ed. México: Nueva Editorial Interamericana;1986. pp. 987-999.

6. 6. Romero-Torres R. Tratado de Cirugía. Tomo II. México: Nueva Editorial Interamericana;1988. pp. 820-822.

7. 7. Pérez-Ramírez M, Pérez-Ramírez P, Hartman-Guilllarte A. Enfermedad litiásica biliar en pacientes embarazadas. Estudio ecográfico. Rev Cub Obstet Ginecol 2001;27:124-128.

8. 8. Palacios M. Valoración ultrasonográfica de la vesícula biliar en la embarazada. Ginecol Obstet 2002;48:1-4.

9. 9. Fiorelli-Rodríguez S, Alfaro-Rodríguez HJ. Complicaciones médicas del embarazo. México: McGraw-Hill Interamericana;1996. pp. 70-80.

10. 10. Various. Hypertension in Pregnancy. American College of Obstetricians and Gynecologists. Technical Bulletin No. 219. Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1996;53:175-183.

11. 11. Norma Técnica-Médica para el manejo de la preeclampsia-eclampsia en los tres niveles de atención del IMSS. México: IMSS;1995.

12. 12. Larson R, Farber B. Elementary Statistics: Picturing the Word. 2nd ed. Upper Saddle River, NJ: Prentice Hall;2003.

13. 13. Vázquez-Rodríguez JG. Efecto de nimodipina intravenosa como tercer antihipertensivo en el tratamiento de las pacientes con preeclampsia severa. Nefrol Mex 2006;27:4-10.

14. 14. Sibai BM, McCubbin JH, Anderson CD, et. al. Eclampsia I. Observations from 67 recents cases. Obstet Gynecol 1981;58:609-613.

15. 15. Díaz de León-Ponce MA, Briones-Garduño JC, Meneses-Calderón J, et. al. Microangiopatía trombótica y hemólisis intravascular en hipertensión por embarazo. La mentira del síndrome de HELLP. Cir Ciruj 2006;74:211-215.

16. 16. Suresh MS. The high-risk obstetric patient. HELLP Syndrome: an anesthesiologist’s perspective. Anesth Clin North Am 1998;16:331-347.

17. 17. Villar MA, Sibai BM. Eclampsia. Obstet Gynecol Clin North Am 1988;15:355-377.

18. 18. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis elevated liver enzymes and low platelets (HELLP Syndrome). Am J Obstet Gynecol 1993;169:1000-1006.

19. 19. Knuppel RA, Drukker JE. High-risk pregnancy: a team approach. Philadelphia: WB Saunders;1986. pp. 362-382.

20. 20. Briones-Garduño JC, Díaz de León-Ponce MA, Castañón, GJA, Briones VCG. Presión coloidosmótica (PCO) en el embarazo normal y puerperio fisiológico. Rev Asoc Mex Med Crit Ter Int 1997;11:45-47.

21. 21. Briones-Garduño JC, Díaz de León-Ponce MA, Gómez Bravo-Topete E, et. al. Medición de la fuga capilar en la preeclampsia-eclampsia. Cir Ciruj 2000;68:194-197.