OBJECTIVES: to evaluate the structural and functional heart abnormalities in women with mitral regurgitation during pregnancy. INTRODUCTION: Women with mitral regurgitation progress well during pregnancy. However, the effects on the heart of the association between pregnancy and mitral regurgitation are not well established. METHODS: This is a case-control, longitudinal prospective study. Echocardiograms were performed in 18 women with mitral regurgitation at the 12th and 36th week of pregnancy and on the 45th day of the puerperium. Twelve age-matched healthy and pregnant women were included as controls and underwent the same evaluation as the study group. RESULTS: Compared with controls, women with mitral regurgitation presented increased left cardiac chambers in all evaluations. Increasing left atrium during pregnancy occurred only in the mitral regurgitation group. At the end of the puerperium, women with mitral regurgitation showed persistent enlargement of the left atrium compared with the beginning of pregnancy (5.0 ± 1.1 cm vs 4.6 ± 0.9 cm; p<0.05). Reduced left ventricular relative wall thickness (0.13 ± 0.02 vs 0.16 ± 0.02; p<0.05) and an increased peak of afterload (278 ± 55 g/cm² vs 207 ± 28 g/cm²;p<0.05) was still observed on the 45th day after delivery in the mitral regurgitation group compared with controls. CONCLUSIONS: Pregnancy causes unfavorable structural alterations in women with mitral regurgitation that are associated with an aggravation of the hemodynamic overload.

Objetivo: definir os preditores clínicos e histopatológicos mais eficientes da evolução da mola hidatiforme completa (MHC) para tumor trofoblástico gestacional (TTG). Métodos: estudo prospectivo clínico e histopatológico de todas as portadoras de MHC, atendidas entre 1990 e 1998 no Hospital das Clínicas de Botucatu -- UNESP. A avaliação clínica pré-esvaziamento molar classificou a gravidez molar em: MHC de alto risco e MHC de baixo risco. Foram analisados os preditores clínicos para TTG, estabelecidos por Goldstein et al.¹ e por outros autores2--10. A avaliação histopatológica incluiu a determinação do diagnóstico de MHC, segundo os critérios de Szulman e Surti11, e o reconhecimento dos fatores de risco para TTG, de Ayhan et al.8. Os preditores clínicos e histopatológicos foram correlacionados com o desenvolvimento de TTG pós-molar. Resultados: em 65 portadoras de MHC, cistos do ovário maiores que 6 cm e tamanho uterino maior que 16 cm foram os preditores clínicos mais eficientes de TTG. A proliferação trofoblástica, a atipia nuclear, a necrose/hemorragia, a maturação trofoblástica e a relação cito/sinciciotrofoblasto não foram preditores significativos para TTG. A correlação entre preditor clínico e histopatológico para o desenvolvimento de TTG não foi possível porque nenhum parâmetro histopatológico foi significativo. Conclusões: mais estudos são necessários para avaliar possíveis preditores de persistência (TTG) e sua aplicação no contexto clínico das MHC. Enquanto isso, a determinação seriada de hCG sérico permanece o único indicador prognóstico seguro para TTG pós-MHC.

Purpose: to determine the most efficient clinical and histopathological predictors of complete hydatidiform mole (CHM) after gestational trophoblastic tumors (GTT). Methods: a prospective clinical and histopathological study was performed on all patients with CHM treated at the University Hospital of Botucatu between 1990 and 1998. Preevacuation clinical evaluation allowed the classification of molar pregnancy into high risk and low risk CHM. The author analyzed the clinical predictors of GTT established by Goldstein et al.¹ and by other authors2--10. The histopathological evaluation included the confirmation of CHM diagnosis based on the criteria by Szulman and Surti11 and the understanding of risk factors for GTT by Ayhan et al.8. The clinical and histopathological predictors were correlated with the postmolar GTT. Results: ovarian cysts larger than 6 cm and uterus size larger than 16 cm were the most efficient clinical predictors of GTT in 65 patients with CHM. Trophoblastic proliferation, nuclear atypia, necrosis/hemorrhage, trophoblastic maturation, and the ratio cytotrophoblast to syncytiotrophoblast were not significant predictors of GTT. The correlation between the clinical and histopathological predictors for the development of GTT was not possible, as no histopathological parameter was significant. Conclusion: additional investigations could evaluate other predictors for persistent disease, and its usefulness in a clinical context. The sequential determination of plasmatic beta-hCG remains the only safe predictor for persistent disease.

Objetivos: construir a curva de regressão do b-hCG pós-mola hidatiforme completa (MHC) com remissão espontânea e comparar com a curva de regressão pós-MHC com tumor trofoblástico gestacional (TTG). Análise comparativa da curva de regressão do b-hCG das portadoras de MHC, acompanhadas no Serviço, com a curva de regressão observada por outros autores1-3. Métodos: foi realizada avaliação clínica e laboratorial (dosagem sérica de b-hCG), na admissão e no segmento pós-molar, de todas as pacientes com MHC, atendidas entre 1990 e 1998 no Hospital das Clínicas de Botucatu - Unesp. O resultado da determinação seriada do b-hCG foi analisado em curvas log de regressão. A evolução da curva de regressão do b-hCG foi analisada e comparada em MHC com remissão espontânea e MHC com TTG numa curva log de regressão, com intervalo de confiança de 95%. A curva log de regressão do grupo de remissão espontânea foi comparada com curvas consideradas padrão1,2. Foram construídas curvas log individuais de todas as pacientes e classificadas de acordo com os quatro tipos de curva (I, II, III e IV), propostos para o seguimento pós-molar³. Resultados: 61 pacientes com MHC tiveram seguimento pós-molar completo, 50 (82%) apresentaram remissão espontânea e 11 (18%) desenvolveram TTG. No grupo de pacientes com MHC e remissão espontânea, o tempo para alcançar a normalização dos níveis do b-hCG, após o esvaziamento molar, foi até 20 semanas. As pacientes que desenvolveram TTG apresentaram desvio precoce da curva de regressão normal do b-hCG, 4 a 6 semanas após o esvaziamento molar. Nestas pacientes, a quimioterapia foi introduzida em média na 9ª semana pós-esvaziamento molar. Conclusões: a curva de regressão do b-hCG pós-MHC com remissão espontânea apresentou declínio log exponencial, semelhante ao observado por outros autores1,2, e diferente das MHC com TTG. Foram identificados três tipos de curvas de regressão do b-hCG, semelhantes aos de Goldstein³, I, II e IV, e outros dois tipos diferentes de regressão do b-hCG: V (regressão normal) e VI (regressão anormal).

Purpose: to construct a b-human chorionic gonadotropin (b-hCG) regression curve following complete hydatidiform mole (CHM) of patients with spontaneous remission, and then compare it to that of CHM patients with gestational trophoblastic tumor (GTT). Also, to compare the b-hCG regression curve of CHM patients followed-up at the Service to the regression curve of other authors1-3. Methods: clinical and laboratory evaluations (serum determinations of b-hCG) were performed on admission and during post-molar follow-up of CHM patients treated at the University Hospital of Botucatu between 1990 and 1998. The result of the serial b-hCG determinations was analyzed using log regression curves. The evolution of the b-hCG regression curve was analyzed and compared between cases of CHM with spontaneous remission and with GTT using a log regression curve, with 95% confidence interval. The log regression curve of the spontaneous remission group was compared to those of other authors1,2. Individual log curves for each patient were constructed and classified according to the four curve types (I, II, III, and IV) proposed by Goldstein³ for post-molar follow-up. Results: sixty-one patients received complete post-molar follow-up, 50 (82%) showing spontaneous remission and 11 (18%) developing GTT. In the group of patients with CHM and spontaneous remission, the time to return to normal b-hCG levels after mole emptying was 20 weeks. The patients who developed GTT showed early deviation from normal b-hCG regression curve 4 to 6 weeks after mole emptying. These patients received chemotherapy normally starting during the 9th post-mole emptying week. Conclusions: the regression curve of post-CHM b-hCG in patients with spontaneous remission showed a log-exponential decline similar to that observed by other authors1,2, but different from that of CHM patients who developed GTT. Three types of b-hCG regression curves similar to Goldstein's³, I, II, and IV, were identified, as well as two other different types: V (normal regression) and VI (abnormal regression).

A síndrome HELLP é uma complicação grave da pré-eclâmpsia que determina aumento de morbidade e mortalidade maternas e perinatais. São descritos dois casos de recorrência dessa síndrome, sendo que em um deles ocorreu morte materna. Este trabalho alerta para o risco aumentado de síndrome HELLP na gestação seguinte.

HELLP syndrome is a severe complication of preeclampsia that increases maternal and perinatal morbidity and mortality. Two cases of recurrent HELLP syndrome are described, maternal death occurring in one of the cases. This study is a warning about the increased risk of HELLP syndrome in the next pregnancy.