Preeclampsia is an important cause of maternal and perinatal morbidity and mortality. Previous studies have tested calcium supplementation and aspirin separately to reduce the incidence of preeclampsia but not the effects of combined supplementation. The objective of this study was to investigate the effectiveness of aspirin combined with calcium supplementation to prevent preeclampsia in women with chronic hypertension. A double-blind, placebo-controlled randomized clinical trial was carried out at the antenatal clinic of a large university hospital in São Paulo, SP, Brazil. A total of 49 women with chronic hypertension and abnormal uterine artery Doppler at 20-27 weeks gestation were randomly assigned to receive placebo (N = 26) or 100 mg aspirin plus 2 g calcium (N = 23) daily until delivery. The main outcome of this pilot study was development of superimposed preeclampsia. Secondary outcomes were fetal growth restriction and preterm birth. The rate of superimposed preeclampsia was 28.6% lower among women receiving aspirin plus calcium than in the placebo group (52.2 vs 73.1%, respectively, P=0.112). The rate of fetal growth restriction was reduced by 80.8% in the supplemented group (25 vs 4.8% in the placebo vs supplemented groups, respectively; P=0.073). The rate of preterm birth was 33.3% in both groups. The combined supplementation of aspirin and calcium starting at 20-27 weeks of gestation produced a nonsignificant decrease in the incidence of superimposed preeclampsia and fetal growth restriction in hypertensive women with abnormal uterine artery Doppler.

Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted.

OBJETIVO: Validar a escala de Torrington e Henderson na estratificação do risco cirúrgico da nossa população, fornecendo a quantificação do mesmo. Tipo de estudo: coorte prospectivo longitudinal. Duração do estudo: 30 meses. MÉTODOS: Foram avaliados 1162 pacientes no pré-operatório de cirurgia geral eletiva no Ambulatório de Risco Cirúrgico da Disciplina de Pneumologia da EPM/Unifesp. De acordo com a escala de Torrington e Henderson os pacientes foram classificados no período pré-operatório em portadores de baixo (n=785), moderado (n=317) e alto risco (n=60) para a ocorrência de complicações pulmonares e óbito, no período pós-operatório. No pós-operatório realizou-se avaliação clínica diária dos mesmos até alta hospitalar ou óbito verificando-se a ocorrência das seguintes complicações pulmonares neste período: infecção respiratória aguda (pneumonia ou traqueobronquite),atelectasia, insuficiência respiratória aguda, entubação orotraqueal ou ventilação mecânica por mais de 48 horas e broncoespasmo. RESULTADOS: Complicações pulmonares no pós-operatório ocorreram em 6,1% dos pacientes de baixo risco, 23,3% nos de moderado e 35% nos de alto risco (p < 0,05). O risco relativo de ocorrer complicações pulmonares foi de 3,8 vezes para os pacientes de moderado risco e de 5,7 vezes para os de alto risco em relação aos de baixo risco. A incidência de óbito de causa pulmonar no pós-operatório foi, respectivamente, de 1,7%, 6,3 e 11,7% entre os pacientes de baixo, moderado e de alto risco (p < 0,001). O risco relativo de óbito pulmonar foi de 3,7 vezes para os pacientes de moderado risco e de 6,9 vezes para aqueles de alto risco em relação aos de baixo risco. CONCLUSÃO: A escala de Torrington e Henderson é útil na estratificação do risco cirúrgico nesta população estudada .

PURPOSE: To validate the Torrington & Henderson preoperative risk assessment program in the population of surgical patients in an university hospital (Hospital São Paulo, UNIFESP, São Paulo, Brasil). MATERIAL AND METHODS: We evaluated 1162 patients who underwent to major thoracic, upper and under abdominal surgery using the Torrington & Henderson program. The patients were classified in low (785), moderate (317) and high risk (60). All patients were accompanied daily during the postoperative period by the same medical team which assessed the preoperative period, until discharged or died. RESULTS: The postoperative pulmonary complications were present in 6,1%, 23,3% and 35,0% in the low, moderate and high risk respectively. The relative risk to develop postoperative pulmonary complications was 3,8 higher in the patients with moderate risk and 5,7 higher in the patients with high risk. The mortality rate due to pulmonary complications was 1,7%, 6,3% and 11,7% respectively in the patients with low, moderate and high risk. The relative risk to the death was 3,7 higher in the patients with moderate risk and 6,9 in the high risk. CONCLUSION: We concluded that the Torrington & Henderson preoperative risk assessment program can identify in our population patients who will develop postoperative pulmonary complications.