Hypertension in pregnancy: The current state of the art | Revista Portuguesa de Cardiologia (English edition)

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There have been numerous studies aimed at clarifying the variable presentation and systemic nature of pre-eclampsia (PE) and other hypertensive disorders of pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> However, there is some disagreement in the literature concerning antihypertensive treatment in pregnant women at risk, particularly the pharmacology, efficacy and safety of the available drugs, the best methods for identifying high-risk groups, and prediction and prevention of complications.Forty per cent of pregnant women who develop eclampsia do not present hypertension or proteinuria in the previous week. This highlights the need for preventive measures.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Hypertensive syndromes are also a cause of perinatal morbidity and mortality, mainly from intrauterine growth restriction due to utero-placental insufficiency and complications related to prematurity.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Even mild hypertension is associated with greater risk for prematurity and newborns who are small for gestational age.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Although much is known of the pathophysiology of PE, its etiology is still unclear. Increased blood pressure (BP) in PE can be considered a compensatory mechanism for reduced maternal–fetal blood flow.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Several studies have suggested a possible role for the nitric oxide synthase gene and the HLA system in the genesis of PE, which would fit within a wider picture of maternal immune responses to the trophoblast that lead to defective placentation, activation of the inflammatory cascade and endothelial dysfunction.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>There is agreement that a hypertensive emergency must be treated, but the best drug to use, and the importance for the health of both mother and fetus of maintenance antihypertensive therapy and treatment of non-severe hypertension, are less clear.Objective and methodsThe aim of this review was to summarize current knowledge on the diagnosis, pathophysiology, prediction, prevention and treatment of hypertension in pregnancy, focusing on the most recent studies on pathophysiology, prevention, identification of high-risk groups, and antihypertensive therapy in cases of severe hypertension, and analyzing the evidence on the efficacy and safety of the available drugs.Guidelines on hypertension in pregnancy were reviewed, particularly those of the Society of Obstetricians and Gynaecologists of Canada, the British Columbia Reproductive Care Program, the National Institute for Health and Clinical Excellence (UK), and the World Health Organization. The Medline, PubMed and Cochrane Library databanks were searched for the most recent evidence, using the search terms eclampsia, pre-eclampsia, hypertension/pregnancy, pre-eclampsia/prevention, gestational hypertension, and hypertensive disorders of pregnancy. The concepts explored were diagnosis, assessment, classification, prediction (using clinical or laboratory markers), prevention, prognosis and treatment.Diagnosis and classificationClassification of the hypertensive syndromes of pregnancy is based on the two main manifestations of PE: hypertension and proteinuria, and so rigorous measurement of BP and proteinuria is of particular importance.According to the guidelines of the Canadian and British Hypertension Societies, BP in a pregnant woman should be measured as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•The patient should be seated at 45° with the arm at the level of the chest;</li><li class="elsevierStyleListItem" id="lsti0010">•An appropriate-sized cuff should be used;</li><li class="elsevierStyleListItem" id="lsti0015">•A manual sphygmomanometer should be used. Automated devices tend to underestimate systolic and diastolic pressure by 5–15mmHg in pregnancy. The suitability of such devices for women with suspected or confirmed PE has only been tested in a small number of models and their use should be limited to assessment of BP variation in low-risk patients.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> In high-risk cases a mercury sphygmomanometer is indicated;</li><li class="elsevierStyleListItem" id="lsti0020">•Phase 5 Korotkoff sounds should be used to indicate diastolic BP<a class="elsevierStyleCrossRef" href="#bib0055">11</a>;</li><li class="elsevierStyleListItem" id="lsti0025">•Ambulatory BP monitoring in normotensive or mildly hypertensive pregnant women has not been assessed in randomized clinical trials, and its value in terms of maternal and fetal outcomes is unknown.<a class="elsevierStyleCrossRef" href="#bib0060">12</a></li></ul>Gestational hypertension is defined as systolic BP≥140mmHg and/or diastolic BP≥90mmHg on at least two occasions after the 20th week of pregnancy in a previously normotensive woman. The interval between BP measurements should be a minimum of 4–6hours and a maximum of seven days.Diastolic BP is a better predictor of adverse pregnancy outcomes than systolic BP; a diastolic BP of 90mmHg is the level above which perinatal morbidity is increased in non-proteinuric hypertension.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Severe hypertension is defined as systolic BP≥160mmHg or diastolic BP≥110mmHg and measurement should be repeated after 15min to confirm the diagnosis. These cutoffs were selected on the basis of evidence of a significantly increased risk of stroke in pregnant women with BP above these levels.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>The recommendations for measurement of proteinuria are as follows:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030">•All pregnant women should be assessed for proteinuria;</li><li class="elsevierStyleListItem" id="lsti0035">•When the suspicion of pre-eclampsia is low, a urine test strip may be used. If this gives a negative or inconclusive result, a more reliable test (24-hour urine protein/creatinine ratio) is recommended if the degree of suspicion is high.</li></ul>A diagnosis of proteinuria is suggested by a score of 2+ on the test strip and confirmed by levels over 0.3g/dl in 24-hour urine or a ratio of protein (in mg) to creatinine (in mmol) of over 30 in a urine sample. However, it is important to bear in mind that target-organ damage in PE can occur in the absence of significant proteinuria. Of pregnant women who develop pre-eclampsia, 20% only present hypertension in the week before the first seizure, 10% only present proteinuria, and 10% present neither.<a class="elsevierStyleCrossRef" href="#bib0075">15</a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the classification of hypertensive disorders of pregnancy proposed by the Canadian Hypertension Society and validated by the International Society for the Study of Hypertension in Pregnancy.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>A simplified classification is found in the International Classification of Diseases (ICD) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>PathophysiologyDespite being a major cause of maternal and fetal morbidity and mortality, the mechanisms responsible for the pathogenesis of pregnancy-induced hypertension (PIH) have not yet been fully elucidated. Studies during the past decade suggest that the initiating event is reduced utero-placental perfusion as a result of abnormal invasion of spiral arterioles by the extravillous cytotrophoblast and consequent reduction of blood flow to the intervillous space. The resulting placental ischemia would lead to widespread activation/dysfunction of the maternal vascular endothelium, which results in enhanced formation of endothelin and thromboxane, increased vascular sensitivity to angiotensin II, and decreased formation of nitric oxide and prostacyclin. The oxidative stress and systemic vasospasm associated with endothelial dysfunction would lend support to the model of target-organ damage outlined.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> A study by Gilbert et al. corroborates this theory by providing evidence linking placental ischemia/hypoxia and the production of molecules such as tumor necrosis factor-α, angiotensin II type 1 receptor antibodies, interleukin-6, and a variety of antiangiogenic substances, leading to widespread dysfunction of the maternal vascular endothelium, production of vasoconstrictors such as endothelin, thromboxane and angiotensin II, and reactive oxygen species (ROS), and decreased formation of vasodilators.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> These endothelial abnormalities cause hypertension by impairing natriuresis, increasing total peripheral resistance and glomerular endotheliosis. The authors stress the need for further studies to clarify the link between placental ischemia and maternal cardiovascular alterations in order to develop effective preventive therapies.Stennet et al. add further elements to the equation, suggesting that cytokines and ROS released by the placenta may increase vascular permeability, cross the blood–brain barrier, and affect sympathetic tone and the neuronal control mechanisms of BP.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> New data have also been furnished by Furuya et al., who suggest that the failure of trophoblasts to sufficiently invade the placental bed only partially explains PIH, and that other factors include (i) the inappropriate secretion into the maternal circulation of proinflammatory substances such as endoglin and the soluble form of vascular endothelial growth factor (VEGF) receptor-1 (an endogenous inhibitor of the angiogenic protein VEGF); (ii) direct damage to the endothelium by shear stress of uteroplacental blood flow; and (iii) microfocal fetal–placental hypoxia of unknown cause.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> The two-stage model – poor placentation in the early gestational period (stage I) and maternal systemic endothelial dysfunction in the later period (stage II) – is thus partially called into question; the authors suggest that impaired placental vasculogenesis does not in itself explain the clinical spectrum of pre-eclampsia.A 2009 study in the Journal of Experimental Medicine assessing the association between intrauterine growth restriction in pregnant women with hypertension and angiotensin II type 1 receptor autoantibodies suggested that these autoantibodies have direct harmful effects on fetal development by inducing apoptosis of placental and trophoblast cells.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Shah et al. corroborated these findings, adding that vascular endothelial growth factor and reduced placental growth factor (through increases in soluble tyrosine kinase-1, an antiangiogenic protein) may play a role in the development of proteinuria and other renal injury-mediated manifestations in pre-eclampsia.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>A study by Wang et al. added to the controversy by suggesting that the endothelial dysfunction seen in PE is not directly linked to fetal growth restriction associated with abnormal umbilical artery flow. Maternal plasma from pregnancies with umbilical placental vascular disease did not affect endothelial cell expression of nitric oxide synthase in vitro, which led the authors to suggest that the placental vascular pathology may be the primary event and that reduced uteroplacental circulation is secondary.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> This finding prompted further studies. Aardema et al. also raised the possibility that other factors besides defective placentation are implicated in the pathophysiology of PIH and PE. Their study sets out to test the hypothesis that PIH and PE with an early onset and poor pregnancy outcome is associated with defective placentation (inadequate spiral arteriole dilatation and subsequent reduced uteroplacental perfusion), whereas PIH and PE with normal pregnancy outcome is not. They measured the uterine artery pulsatility index (uteroplacental resistance to blood flow) by Doppler ultrasound and found that it was significantly higher in pregnancies with complicated PE but was normal in women who developed PIH/PE, but had a good pregnancy outcome. This indicates that only cases with poor outcomes are associated with defective placentation and supports the concept of heterogeneous causes of hypertensive disorders of pregnancy.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>This concept was strongly supported by Cross, who suggested that PE can be initiated by at least three independent mechanisms: pre-existing maternal hypertension that is exacerbated by pregnancy, elevated levels of angiotensin II in the maternal circulation by placental over-production of renin (placental renin-angiotensin system), and primary placental pathology, which prevents the placenta from contributing to the normal cardiovascular adaptations of pregnancy. Identification of genetic risk factors will thus only be possible when the disease has been separated into different subtypes according to the etiological mechanisms involved.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>Genetic study may have an important role in the future; mutations in the angiotensinogen gene are known to be associated with greater predisposition to PIH.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Predicting pre-eclampsiaA good test for predicting PE should be simple, rapid, non-invasive, inexpensive and easy to apply. The results should be reliable and reproducible, with high sensitivity and specificity. Ideally, it should provide an opportunity for early preventive therapy.The ability to predict PE within a reasonable time from symptom onset has improved somewhat in the last decade. However, these improvements have not been significant, and the search continues for the best way to predict this complication of pregnancy.Various risk markers for PE are known, including personal or family history of PIH or PE, pre-existing hypertension, older maternal age in the first pregnancy, maternal obesity,<a class="elsevierStyleCrossRef" href="#bib0125">25</a> and history of renal disease and/or thrombophilia (due to factor V Leiden heterozygosity, antiphospholipid syndrome, or prothrombin gene mutations).<a class="elsevierStyleCrossRef" href="#bib0130">26</a> However, none of these risk factors has sufficient positive predictive value to be used in isolation.Recent research has raised the possibility that reasonable risk prediction can be achieved by measuring serum levels of substances involved in the pathogenesis of the disease or by assessing uterine artery flow by Doppler ultrasound.A study by Boulanger et al. stressed the need for rapid and reliable methods for quantifying levels of antiangiogenic proteins such as soluble tyrosine kinase-1 and endoglin produced in excess by the placenta before the clinical manifestations of PE appear.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Baweja et al. demonstrated that measuring urinary albumin using high-performance liquid chromatography gives a significantly more reliable urinary albumin/creatinine ratio than conventional methods. According to the authors, a ratio of >35.5mg/mmol predicted pre-eclampsia well before the onset of clinical manifestations.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>Various studies on uterine artery Doppler imaging, specifically estimation of indices of flow resistance (including the uterine artery pulsatility index) and notching in the pulsed Doppler spectrum, have suggested that this may be an effective way of predicting PE.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> Cnossen et al. reported more accurate prediction by this technique when performed in the second trimester, as well as the ability to predict intrauterine growth restriction (although with less predictive value).<a class="elsevierStyleCrossRef" href="#bib0150">30</a> Papageorghiou and Roberts confirmed these findings, adding that uterine artery Doppler screening can identify women in whom biochemical markers should be measured.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> Despite the enthusiasm with which these studies have been met, Doppler uterine artery analysis is unable in isolation to predict PE risk, as it identifies only 40–60% of those who subsequently develop PE and 20% of those who develop fetal growth restriction.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> However, when combined with assessment in the first trimester of serum markers associated with the pathophysiology of PE, particularly placental protein 13, placental growth factor, VEGF and soluble tyrosine kinase-1, it may predict up to 90% of cases of severe preeclampsia for a false positive rate of 9%.<a class="elsevierStyleCrossRef" href="#bib0165">33</a>Despite the lack of randomized trials showing the benefit of ambulatory blood pressure monitoring (ABPM) in predicting PE, some authors recommend serial BP measurement by this method, based on various observational studies and small trials. A study published in Arquivos Brasileiros de Cardiologia concluded that certain data from ABPM can predict PIH, particularly diastolic pressure load during wakefulness, diastolic and systolic pressure load during sleep, and pressure variability and maximum diastolic pressure during sleep. Specifically a maximum diastolic arterial pressure on ABPM during sleep of ≥64mmHg presented an odds ratio of 6 for PIH with a sensitivity of 80% and a specificity of 60%.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>A few years ago the World Health Organization began a large prospective observational study to assess the value of measuring levels of two antiangiogenic substances (soluble endoglin and soluble tyrosine kinase-1) and one angiogenic substance (placental growth factor) for predicting PE. The aim is to discover whether reversing the angiogenic imbalance in PE by adding exogenous angiogenic factors can be achieved in practice, thereby correcting the syndrome.In the absence of a test that can predict PE in isolation, multivariate models have been developed, although as yet with little success. Notable among them is the model recently developed by von Dadelszen et al. and which is currently at an advanced stage of investigation. The fullPIERS model was developed in a prospective multicenter study in women who were admitted to tertiary obstetric centers with PE or who developed PE after admission and was first published in January 2011. The model predicted adverse maternal outcomes (mortality or other serious complications of PE) occurring within the first 48hours after eligibility with a high degree of reliability and performed well up to seven days after eligibility, and brings new hope of identifying women at increased risk of adverse outcomes up to seven days before complications arise, so that aggressive preventive and therapeutic measures can be taken.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> Further details of the model are due to be released shortly.Prevention and treatmentThere has been extensive research into the prevention of PE, although current guidelines focus mainly on preventing its complications. Non-severe PIH may have an adaptive function; neonatal morbidity is lower, and neurological development is better, in small for gestational age babies with mildly hypertensive as opposed to normotensive mothers.Several studies have assessed the preventive value of various therapies, including inhibition of placental phosphodiesterase-5 to reverse the placental vasoconstriction that produces the ischemia/hypoxia of PE,<a class="elsevierStyleCrossRef" href="#bib0180">36</a> while low-dose aspirin (75–100mg) is accepted as a preventive measure in high-risk women (with PIH, gestational diabetes or previous PE).<a class="elsevierStyleCrossRef" href="#bib0185">37</a> The dose should be determined on the basis of platelet function testing.<a class="elsevierStyleCrossRef" href="#bib0190">38</a> Some antihypertensive agents also inhibit platelet activation in primary hypertension and their benefits in PIH therefore go beyond simply reducing BP.Calcium supplementation is beneficial in cases of low calcium intake and in pregnancies at high risk for early complications. Supplementation with antioxidants (vitamins C and E), zinc, melatonin, coenzyme Q10, omega-3 fatty acids and protein has not shown benefits and is not currently recommended.Antihypertensive therapy does not prevent PE or its complications, although it reduces by almost half the incidence of severe hypertension in women with mild to moderate hypertension. It cannot be recommended specifically for the prevention of PE until it has been demonstrated that reducing maternal BP is not outweighed by negative fetal outcomes.Severe hypertension (BP>160/110mmHg) should be treated in order to decrease maternal morbidity and mortality. Most women with severe hypertension in pregnancy will have PE, and most of those will have had normal BP in the recent past. Such marked BP elevations are considered urgencies. Labetalol, nifedipine and hydralazine are recommended for the treatment of severe PIH, aiming to reduce BP to <160/110mmHg. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> lists the main drugs used in severe PIH and their doses. Sodium nitroprusside should only be used as a last resort if all other measures have failed to obtain BP<160/110mmHg.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Treatment of non-severe hypertension (BP 140–159/90–109mmHg) aims to achieve values of 130–155/80–105mmHg (or 130–139/80–89mmHg in women with renal or cardiovascular comorbidities). Initial treatment should be with methyldopa, labetalol, other beta-blockers such as metoprolol, pindolol or propanolol (atenolol is not recommended since unlike the other beta-blockers mentioned, it is associated for unknown reasons with intrauterine growth retardation), or oral dihydropyridine calcium channel blockers (preferably slow- or intermediate-release nifedipine). Angiotensin receptor blockers and angiotensin-converting enzyme inhibitors are contraindicated due to their toxicity, particularly nephrotoxicity. Thiazide diuretics used after the first trimester are not associated with adverse maternal or fetal outcomes, but neither do they prevent PE or severe hypertension. <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> lists the main drugs used in the treatment of non-severe PIH and their doses.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Treatment of non-severe hypertension is the subject of debate because of potential harmful effects on fetal development. Two meta-analyses on this subject found a significant association between treatment-induced decreases in maternal mean arterial pressure and prematurity and small for gestational age infants,<a class="elsevierStyleCrossRefs" href="#bib0195">39,40</a> reinforcing the idea that antihypertensive therapy in itself does not reduce maternal morbidity in PE or eclampsia.ConclusionPregnancy-induced hypertension is still a little-understood entity, despite the enormous impact of its complications on maternal and fetal outcomes. There is consensus that antihypertensive therapy is essential in cases of severe hypertension, but there is disagreement concerning non-severe cases due to the risk of adverse fetal outcomes. Recent advances in our understanding of the pathophysiology of PE have raised expectations that effective methods to predict the condition and its complications will be developed, based on specific markers of endothelial dysfunction and/or antiangiogenic proteins, the detection and quantification of which, complemented by Doppler assessment of uterine artery flow, will help with timely identification of subgroups of pregnant women at risk of developing complications. It will then be possible to apply preventive measures such as low-dose aspirin and calcium supplementation, plan the optimum timing for delivery, potentially reverse antiangiogenic status using exogenous angiogenic substances, and use antihypertensive therapy appropriately, with greater confidence and with less risk for both mother and fetus.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres176224" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec164594" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres176225" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec164593" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objective and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Diagnosis and classification" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Pathophysiology" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Predicting pre-eclampsia" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Prevention and treatment" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-04-14" "fechaAceptado" => "2012-01-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec164594" "palabras" => array:5 [ 0 => "Pregnancy-induced hypertension" 1 => "Pre-eclampsia" 2 => "Prediction" 3 => "Pathophysiology" 4 => "Antihypertensive therapy" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec164593" "palabras" => array:5 [ 0 => "Hipertensão gestacional" 1 => "Pré-eclampsia" 2 => "Predição" 3 => "Fisiopatologia" 4 => "Terapêutica anti-hipertensora" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Hypertension complicates 6–8% of pregnancies and includes the following four conditions: hypertension preceding pregnancy or documented before the 20th week of gestation; pre-eclampsia (PE)/eclampsia; chronic hypertension with superimposed pre-eclampsia; and gestational hypertension. The latter is defined as a significant rise in blood pressure after the 20th week of pregnancy in previously normotensive women, to over 140/90mmHg. When blood pressure remains above 160/110mmHg, it is considered severe. PE is defined as the presence of proteinuria (≥300mg/24hours) in pregnant women with hypertension. The hypertensive syndromes of pregnancy are among the leading causes of maternal and fetal morbidity and mortality and anti-hypertensive treatment is part of the therapeutic arsenal used to prevent serious complications. Although the role of utero-placental insufficiency due to deficient migration of trophoblasts to the spiral arteries is universally accepted, the pathophysiology of PE remains largely unknown and is the subject of debate. No effective ways of predicting or preventing PE have been found, which highlights the need for further research in this field. This review aims primarily to evaluate recent advances in our understanding of the pathophysiology of gestational hypertension and especially PE, and new ways of predicting PE. Additionally, we present a brief review on the diagnosis, prevention and treatment of PE." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "A Hipertensão Arterial (HTA) na gravidez complica 6 a 8% das gestações e inclui 4 principais formas de apresentação: HTA crónica, que antecede a gravidez ou é documentada antes das 20 semanas de gestação, pré-eclampsia (PE)/eclampsia, HTA crónica com PE sobreposta e HTA gestacional. A HTA gestacional define-se como uma elevação significativa da pressão arterial após as 20 semanas de gestação em gestantes previamente normotensas, atingindo valores superiores a 140/90mmHg. Quando os valores de pressão arterial se mantêm acima de 160/110mmHg de forma sustentada, é considerada grave. A pré-eclampsia (PE) define-se pela presença de proteinúria (≥300mg/24horas) em gestante com HTA. As síndromes hipertensivas da gravidez encontram-se entre as principais causas de morbimortalidade materno-fetal, sendo que a terapêutica anti-hipertensora faz parte do arsenal terapêutico utilizado na prevenção das suas graves complicações. Apesar do papel da insuficiência útero-placentária por deficiente migração dos trofoblastos para as artérias espiraladas ser universalmente aceite, a fisiopatologia da PE permanece ainda parcialmente uma incógnita e reúne alguma controvérsia. Historicamente, não são conhecidas formas suficientemente eficazes de predição e prevenção da PE, pelo que a investigação nesta área assume particular importância. Esta revisão visa primariamente avaliar os avanços científicos mais recentes nas áreas da fisiopatologia da HTA gestacional e, em particular, da PE e das novas formas de predição desta patologia. Concomitantemente, apresentamos informação sumária recente acerca do diagnóstico, prevenção e tratamento anti-hipertensor na PE." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Barra, S. Hipertensão Arterial na Grávida: o actual estado da arte. Rev Port Cardiol 2012. doi:10.1016/j.repc.2012.04.006" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Classification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Definition \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A – Pre-existing hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diastolic hypertension that predates pregnancy or is diagnosed before 20 weeks’ gestation. It may be associated with proteinuria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– Essential —-→ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primary \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– Secondary —-→ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Secondary to such conditions as renal disease, pheochromocytoma and Cushing syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B – Gestational hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diastolic hypertension develops after 20 weeks’ gestation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 – Without proteinuria —-→ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protein excretion in 24-hour urine collection is <0.3g/d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">a – Without adverse conditions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">b – With adverse conditions —-→ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Convulsions (eclampsia); very high diastolic pressure (>110mmHg); thrombocytopenia; oliguria; pulmonary edema; elevated liver enzyme levels; severe nausea, frontal headache, visual disturbances, abdominal pain in right upper quadrant; suspected abruptio placentae; HELLP syndrome; intrauterine growth retardation, oligohydramnios, or absent or reversed umbilical artery end diastolic flow \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 – With proteinuria —-→ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protein excretion in 24-hour urine collection is ≥0.3g/d (corresponds to “pre-eclampsia”) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">a – Without adverse conditions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">b – With adverse conditions —-→ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Same conditions as in B1b; protein excretion >3g/d in 24-hour urine collection, especially with hypoalbuminemia (albumin level<18g/l) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C – Pre-existing hypertension+superimposed gestational hypertension with proteinuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-existing hypertension (as defined in A) associated with further worsening of blood pressure and protein excretion ≥3g/d after 20 weeks’ gestation. Corresponds to “chronic hypertension with superimposed pre-eclampsia” \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D – Unclassifiable antenatally \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension with or without systemic manifestations if blood pressure was first recorded after 20 weeks’ gestation. Reassessment is necessary at or after 42d post partum. The condition should be reclassified as gestational hypertension with or without proteinuria or as pre-existing hypertension depending on whether the hypertension has resolved \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268805.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Classification of hypertensive disorders of pregnancy proposed by the Canadian Hypertension Society." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-existing essential hypertension complicating pregnancy, childbirth and the puerperium \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-existing hypertensive disorder with superimposed proteinuria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gestational (pregnancy-induced) edema and proteinuria without hypertension \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gestational (pregnancy-induced) hypertension without significant proteinuria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gestational (pregnancy-induced) hypertension with significant proteinuria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O14.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe pre-eclampsia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eclampsia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unspecified maternal hypertension \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268806.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Hypertensive disorders in pregnancy: International Classification of Diseases (ICD) classification." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Agent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Dosage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Labetalol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Start with 20mg IV, repeat 20–80mg IV every 30min; or 1–2mg/min (max. 300mg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">May cause neonatal bradycardia; typical contraindications for beta-blockers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nifedipine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5–10mg capsule orally every 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermediate-release tablets may also be used \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydralazine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Start with 5mg IV; repeat 5–10mg IV every 30min, or 0.5–10mg/hour IV (max. 20mg IV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">May increase the risk of maternal hypotension \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268807.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Drugs recommended for treatment of severe pregnancy-induced hypertension." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Agent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Dosage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Methyldopa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">250–500mg orally 2–4 times daily (max. 2g/d) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No need for a loading dose \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Labetalol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100–400mg orally 2–3 times daily (max. 1200mg/d) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Typical contraindications for beta-blockers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nifedipine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermediate-release capsules: 10–20mg orally 2–3 times daily (max. 180mg/d; slow-release capsules: 20–60mg orally once daily (max. 120mg/d) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rapid-release capsules are contraindicated due to the risk of fetal hypotension \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268804.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Drugs recommended for treatment of non-severe pregnancy-induced hypertension (BP 140–159/90–109mmHg)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The sixth report of the confidential enquiries into maternal deaths in the United Kingdom" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Why mothers die 2000–2002" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2004" "editorial" => "RCOG Press" "editorialLocalizacion" => "London" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.M. Roberts" 1 => "G. Pearson" 2 => "J. Cutler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.HYP.0000054981.03589.E9" "Revista" => array:6 [ "tituloSerie" => "Hypertension" "fecha" => "2003" "volumen" => "41" "paginaInicial" => "437" "paginaFinal" => "445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12623940" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of preeclampsia and eclampsia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "ACOG" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "ACOG Pract Bull" "fecha" => "2002" "volumen" => "33" "paginaInicial" => "1" "paginaFinal" => "14" "itemHostRev" => array:3 [ "pii" => "S0145212609001611" "estado" => "S300" "issn" => "01452126" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertension in pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.G. Solomon" 1 => "E.W. Seely" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ecl.2005.09.003" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Metab Clin North Am" "fecha" => "2006" "volumen" => "35" "paginaInicial" => "157" "paginaFinal" => "171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16310647" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "National High Blood Pressure Education Program" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "2000" "volumen" => "183" "paginaInicial" => "S1" "paginaFinal" => "S22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10944363" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores de riesgo y resultados perinatales en la preeclampsia severa: um estudio caso control" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Barreto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Hosp Matern Infant Ramon Sarda" "fecha" => "2003" "volumen" => "22" "paginaInicial" => "116" "paginaFinal" => "120" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neonatal outcome in hypertensive disorders of pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Ferrazzani" 1 => "R. Luciano" 2 => "S. Garofalo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.earlhumdev.2011.03.005" "Revista" => array:6 [ "tituloSerie" => "Early Hum Dev" "fecha" => "2011" "volumen" => "87" "paginaInicial" => "445" "paginaFinal" => "449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21497462" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disfunción endotelial en la preeclampsia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.P. Romero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Fac Med" "fecha" => "2003" "volumen" => "64" "paginaInicial" => "43" "paginaFinal" => "54" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "British Hypertension Society guidelines for hypertension management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.E. Ramsay" 1 => "B. Williams" 2 => "G.D. Johnston" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "1999" "volumen" => "319" "paginaInicial" => "630" "paginaFinal" => "635" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10473485" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An accurate automated blood pressure device for use in pregnancy and pre-eclampsia: the Microlife 3BTO-A" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Reinders" 1 => "A.C. Cuckson" 2 => "J.T. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1471-0528.2005.00617.x" "Revista" => array:6 [ "tituloSerie" => "BJOG" "fecha" => "2005" "volumen" => "112" "paginaInicial" => "915" "paginaFinal" => "920" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15957992" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lack of reproducibility in pregnancy of Korotkoff phase IV as measured by mercury sphygmomanometry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Shennan" 1 => "M. Gupta" 2 => "A. Halligan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1996" "volumen" => "347" "paginaInicial" => "139" "paginaFinal" => "142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8544546" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ambulatory versus conventional methods for monitoring blood pressure during pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Bergel" 1 => "G. Carroli" 2 => "F. Althabe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2002" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertension in pregnancy: which method of blood pressure measurement is most predictive of outcome?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Peek" 1 => "A. Shennan" 2 => "A. Halligan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0029-7844(96)00350-X" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "1996" "volumen" => "88" "paginaInicial" => "1030" "paginaFinal" => "1033" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8942848" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.N. Martin Jr." 1 => "B.D. Thigpen" 2 => "R.C. Moore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.AOG.0000151116.84113.56" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2005" "volumen" => "105" "paginaInicial" => "246" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15684147" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eclampsia in the United Kingdom" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Douglas" 1 => "W. Redman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "1994" "volumen" => "309" "paginaInicial" => "1395" "paginaFinal" => "1400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7819845" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology of pregnancy-induced hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.P. Granger" 1 => "B.T. Alexander" 2 => "W.A. Bennett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Hypertens" "fecha" => "2001" "volumen" => "14" "numero" => "6 Pt 2" "paginaInicial" => "178S" "paginaFinal" => "185S" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11411754" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology of hypertension during preeclampsia: linking placental ischemia with endothelial dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.S. Gilbert" 1 => "M.J. Ryan" 2 => "B.B. LaMarca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/ajpheart.01113.2007" "Revista" => array:6 [ "tituloSerie" => "Am J Physiol Heart Circ Physiol" "fecha" => "2008" "volumen" => "294" "paginaInicial" => "H541" "paginaFinal" => "H550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18055511" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurovascular mechanisms of hypertension in pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.K. Stennett" 1 => "R.A. Khalil" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Neurovasc Res" "fecha" => "2006" "volumen" => "3" "paginaInicial" => "131" "paginaFinal" => "148" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16719796" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology of placentation abnormalities in pregnancy-induced hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Furuya" 1 => "J. Ishida" 2 => "I. Aoki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Vasc Health Risk Manage" "fecha" => "2008" "volumen" => "4" "paginaInicial" => "1301" "paginaFinal" => "1313" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The detrimental role of angiotensin receptor agonistic autoantibodies in intrauterine growth restriction seen in preeclampsia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.A. Irani" 1 => "Yujin Zhang" 2 => "S.C. Blackwell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1084/jem.20090872" "Revista" => array:6 [ "tituloSerie" => "J Exp Med" "fecha" => "2009" "volumen" => "206" "paginaInicial" => "2809" "paginaFinal" => "2822" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19887397" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preeclampsia: new insights" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.M. Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MNH.0b013e3280d942e9" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Nephrol Hypertens" "fecha" => "2007" "volumen" => "16" "paginaInicial" => "213" "paginaFinal" => "220" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17420664" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal plasma from pregnant women with umbilical placental vascular disease does not affect endothelial cell mRNA expression of nitric oxide synthase" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "X. Wang" 1 => "N. Athayde" 2 => "B. Trudinger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Soc Gynecol Invest" "fecha" => "2004" "volumen" => "11" "paginaInicial" => "149" "paginaFinal" => "153" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Second trimester Doppler ultrasound screening of the uterine arteries differentiates between subsequent normal and poor outcomes of hypertensive pregnancy: two different pathophysiological entities?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.W. Aardema" 1 => "M.C. Saro" 2 => "M. Lander" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Sci (Lond)" "fecha" => "2004" "volumen" => "106" "paginaInicial" => "377" "paginaFinal" => "382" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The genetics of pre-eclampsia: a feto-placental or maternal problem?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.C. Cross" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Genet" "fecha" => "2003" "volumen" => "64" "paginaInicial" => "96" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12859402" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Associations of maternal obesity with blood pressure and the risks of gestational hypertensive disorders. The Generation R Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Gaillard" 1 => "E.A. Steegers" 2 => "A. Hofman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/HJH.0b013e328345500c" "Revista" => array:6 [ "tituloSerie" => "J Hypertens" "fecha" => "2011" "volumen" => "29" "paginaInicial" => "937" "paginaFinal" => "944" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21430559" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pre-eclampsia screening in first and second trimester" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Kang" 1 => "H. Struben" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1024/0040-5930.65.11.663" "Revista" => array:6 [ "tituloSerie" => "Ther Umsch" "fecha" => "2008" "volumen" => "65" "paginaInicial" => "663" "paginaFinal" => "666" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18979429" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New insights in the pathophysiology of preeclampsia and potential therapeutic implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Boulanger" 1 => "M. Flamant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nephro.2007.07.001" "Revista" => array:6 [ "tituloSerie" => "Nephrol Ther" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "437" "paginaFinal" => "448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18047998" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin:creatinine ratio using high-performance liquid chromatography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Baweja" 1 => "A. Kent" 2 => "R. Masterson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1471-0528.2011.02960.x" "Revista" => array:2 [ "tituloSerie" => "BJOG" "fecha" => "2011" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of pre-eclampsia by uterine artery Doppler imaging: relationship to gestational age at delivery and small-for-gestational age" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Fetal Medicine Foundation Second-Trimester Screening Group" "etal" => false "autores" => array:5 [ 0 => "C.K. Yu" 1 => "O. Khouri" 2 => "N. Onwudiwe" 3 => "Y. Spiliopoulos" 4 => "K.H. Nicolaides" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/uog.5252" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Obstet Gynecol" "fecha" => "2008" "volumen" => "31" "paginaInicial" => "310" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18241089" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.S. Cnossen" 1 => "R.K. Morris" 2 => "G. ter Riet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/cmaj.070430" "Revista" => array:6 [ "tituloSerie" => "CMAJ" "fecha" => "2008" "volumen" => "178" "paginaInicial" => "701" "paginaFinal" => "711" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18332385" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uterine artery Doppler screening for adverse pregnancy outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.T. Papageorghiou" 1 => "N. Roberts" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Opin Obstet Gynecol" "fecha" => "2005" "volumen" => "17" "paginaInicial" => "584" "paginaFinal" => "590" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16258339" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Second-trimester uterine artery Doppler screening in unselected populations: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.T. Papageorghiou" 1 => "C.K. Yu" 2 => "S. Cicero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/jmf.12.2.78.88" "Revista" => array:6 [ "tituloSerie" => "J Matern Fetal Neonatal Med" "fecha" => "2002" "volumen" => "12" "paginaInicial" => "78" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12420836" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First trimester screening for preeclampsia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.T. Papageorghiou" 1 => "S. Campbell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/GCO.0b013e328010beda" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Obstet Gynecol" "fecha" => "2006" "volumen" => "18" "paginaInicial" => "594" "paginaFinal" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17099328" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictive factors for pregnancy hypertension in primiparous adolescents: analysis of prenatal care, ABPM and microalbuminuria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Carvalho" 1 => "H. Campos" 2 => "Z. Bruno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2006" "volumen" => "87" "paginaInicial" => "487" "paginaFinal" => "495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17128319" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Peter von Dadelszen" 1 => "Beth Payne" 2 => "Jing Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(10)61351-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2011" "volumen" => "377" "paginaInicial" => "219" "paginaFinal" => "227" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21185591" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypothesis: selective phosphodiesterase-5 inhibition improves outcome in preeclampsia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.W. Downing" 1 => "R. Ramasubramanian" 2 => "R.F. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mehy.2004.03.042" "Revista" => array:6 [ "tituloSerie" => "Med Hypotheses" "fecha" => "2004" "volumen" => "63" "paginaInicial" => "1057" "paginaFinal" => "1064" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15504576" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Bujold" 1 => "S. Roberge" 2 => "Y. Lacasse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AOG.0b013e3181e9322a" "Revista" => array:7 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2010" "volumen" => "116" "numero" => "2 Pt 1" "paginaInicial" => "402" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20664402" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is testing for aspirin response worthwhile in high-risk pregnancy?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Rey" 1 => "G.E. Rivard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Eur J Obstet Gynecol Reprod Biol" "fecha" => "2011" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: an updated metaregression analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Von Dadelszen" 1 => "L.A. Magee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JOGC" "fecha" => "2002" "volumen" => "24" "paginaInicial" => "941" "paginaFinal" => "945" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12464992" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Von Dadelszen" 1 => "M.P. Ornstein" 2 => "S.B. Bull" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2000" "volumen" => "355" "paginaInicial" => "87" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10675164" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003100000006/v1_201305151732/S2174204912000803/v1_201305151732/en/main.assets" "Apartado" => array:4 [ "identificador" => "9924" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003100000006/v1_201305151732/S2174204912000803/v1_201305151732/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912000803?idApp=UINPBA00004E"]

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Hypertension in pregnancy: The current state of the art

Hipertensão Arterial na Grávida: o actual estado da arte

Sérgio Barra

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sergioncbarra@gmail.com

Corresponding author.

, Maria do Carmo Cachulo, Rui Providência, António Leitão-Marques

Centro Hospitalar de Coimbra, Coimbra, Portugal

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The hypertensive syndromes of pregnancy are the leading cause of maternal and fetal morbidity and mortality in the developed world&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> occurring in around 8&#37; of pregnancies&#46; There have been numerous studies aimed at clarifying the variable presentation and systemic nature of pre-eclampsia &#40;PE&#41; and other hypertensive disorders of pregnancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; there is some disagreement in the literature concerning antihypertensive treatment in pregnant women at risk&#44; particularly the pharmacology&#44; efficacy and safety of the available drugs&#44; the best methods for identifying high-risk groups&#44; and prediction and prevention of complications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Forty per cent of pregnant women who develop eclampsia do not present hypertension or proteinuria in the previous week&#46; This highlights the need for preventive measures&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Hypertensive syndromes are also a cause of perinatal morbidity and mortality&#44; mainly from intrauterine growth restriction due to utero-placental insufficiency and complications related to prematurity&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Even mild hypertension is associated with greater risk for prematurity and newborns who are small for gestational age&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although much is known of the pathophysiology of PE&#44; its etiology is still unclear&#46; Increased blood pressure &#40;BP&#41; in PE can be considered a compensatory mechanism for reduced maternal&#8211;fetal blood flow&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Several studies have suggested a possible role for the nitric oxide synthase gene and the HLA system in the genesis of PE&#44; which would fit within a wider picture of maternal immune responses to the trophoblast that lead to defective placentation&#44; activation of the inflammatory cascade and endothelial dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There is agreement that a hypertensive emergency must be treated&#44; but the best drug to use&#44; and the importance for the health of both mother and fetus of maintenance antihypertensive therapy and treatment of non-severe hypertension&#44; are less clear&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Objective and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this review was to summarize current knowledge on the diagnosis&#44; pathophysiology&#44; prediction&#44; prevention and treatment of hypertension in pregnancy&#44; focusing on the most recent studies on pathophysiology&#44; prevention&#44; identification of high-risk groups&#44; and antihypertensive therapy in cases of severe hypertension&#44; and analyzing the evidence on the efficacy and safety of the available drugs&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Guidelines on hypertension in pregnancy were reviewed&#44; particularly those of the Society of Obstetricians and Gynaecologists of Canada&#44; the British Columbia Reproductive Care Program&#44; the National Institute for Health and Clinical Excellence &#40;UK&#41;&#44; and the World Health Organization&#46; The Medline&#44; PubMed and Cochrane Library databanks were searched for the most recent evidence&#44; using the search terms <span class="elsevierStyleItalic">eclampsia</span>&#44; <span class="elsevierStyleItalic">pre-eclampsia</span>&#44; <span class="elsevierStyleItalic">hypertension&#47;pregnancy</span>&#44; <span class="elsevierStyleItalic">pre-eclampsia&#47;prevention</span>&#44; <span class="elsevierStyleItalic">gestational hypertension</span>&#44; and <span class="elsevierStyleItalic">hypertensive disorders of pregnancy</span>&#46; The concepts explored were diagnosis&#44; assessment&#44; classification&#44; prediction &#40;using clinical or laboratory markers&#41;&#44; prevention&#44; prognosis and treatment&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis and classification</span><p id="par0040" class="elsevierStylePara elsevierViewall">Classification of the hypertensive syndromes of pregnancy is based on the two main manifestations of PE&#58; hypertension and proteinuria&#44; and so rigorous measurement of BP and proteinuria is of particular importance&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">According to the guidelines of the Canadian and British Hypertension Societies&#44; BP in a pregnant woman should be measured as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">The patient should be seated at 45&#176; 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and its value in terms of maternal and fetal outcomes is unknown&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">Gestational hypertension is defined as systolic BP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>mmHg and&#47;or diastolic BP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg on at least two occasions after the 20th week of pregnancy in a previously normotensive woman&#46; The interval between BP measurements should be a minimum of 4&#8211;6<span class="elsevierStyleHsp" style=""></span>hours and a maximum of seven days&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Diastolic BP is a better predictor of adverse pregnancy outcomes than systolic BP&#59; 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a urine test strip may be used&#46; If this gives a negative or inconclusive result&#44; a more reliable test &#40;24-hour urine protein&#47;creatinine ratio&#41; is recommended if the degree of suspicion is high&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">A diagnosis of proteinuria is suggested by a score of 2&#43; on the test strip and confirmed by levels over 0&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;dl in 24-hour urine or a ratio of protein &#40;in mg&#41; to creatinine &#40;in mmol&#41; of over 30 in a urine sample&#46; However&#44; it is important to bear in mind that target-organ damage in PE can occur in the absence of significant proteinuria&#46; Of pregnant women who develop pre-eclampsia&#44; 20&#37; only present hypertension in the week before the first seizure&#44; 10&#37; only present proteinuria&#44; and 10&#37; present neither&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the classification of hypertensive disorders of pregnancy proposed by the Canadian Hypertension Society and validated by the International Society for the Study of Hypertension in Pregnancy&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">A simplified classification is found in the International Classification of Diseases &#40;ICD&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pathophysiology</span><p id="par0115" class="elsevierStylePara elsevierViewall">Despite being a major cause of maternal and fetal morbidity and mortality&#44; the mechanisms responsible for the pathogenesis of pregnancy-induced hypertension &#40;PIH&#41; have not yet been fully elucidated&#46; Studies during the past decade suggest that the initiating event is reduced utero-placental perfusion as a result of abnormal invasion of spiral arterioles by the extravillous cytotrophoblast and consequent reduction of blood flow to the intervillous space&#46; The resulting placental ischemia would lead to widespread activation&#47;dysfunction of the maternal vascular endothelium&#44; which results in enhanced formation of endothelin and thromboxane&#44; increased vascular sensitivity to angiotensin II&#44; and decreased formation of nitric oxide and prostacyclin&#46; The oxidative stress and systemic vasospasm associated with endothelial dysfunction would lend support to the model of target-organ damage outlined&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> A study by Gilbert et al&#46; corroborates this theory by providing evidence linking placental ischemia&#47;hypoxia and the production of molecules such as tumor necrosis factor-&#945;&#44; angiotensin II type 1 receptor antibodies&#44; interleukin-6&#44; and a variety of antiangiogenic substances&#44; leading to widespread dysfunction of the maternal vascular endothelium&#44; production of vasoconstrictors such as endothelin&#44; thromboxane and angiotensin II&#44; and reactive oxygen species &#40;ROS&#41;&#44; and decreased formation of vasodilators&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> These endothelial abnormalities cause hypertension by impairing natriuresis&#44; increasing total peripheral resistance and glomerular endotheliosis&#46; The authors stress the need for further studies to clarify the link between placental ischemia and maternal cardiovascular alterations in order to develop effective preventive therapies&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Stennet et al&#46; add further elements to the equation&#44; suggesting that cytokines and ROS released by the placenta may increase vascular permeability&#44; cross the blood&#8211;brain barrier&#44; and affect sympathetic tone and the neuronal control mechanisms of BP&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> New data have also been furnished by Furuya et al&#46;&#44; who suggest that the failure of trophoblasts to sufficiently invade the placental bed only partially explains PIH&#44; and that other factors include &#40;i&#41; the inappropriate secretion into the maternal circulation of proinflammatory substances such as endoglin and the soluble form of vascular endothelial growth factor &#40;VEGF&#41; receptor-1 &#40;an endogenous inhibitor of the angiogenic protein VEGF&#41;&#59; &#40;ii&#41; direct damage to the endothelium by shear stress of uteroplacental blood flow&#59; and &#40;iii&#41; microfocal fetal&#8211;placental hypoxia of unknown cause&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The two-stage model &#8211; poor placentation in the early gestational period &#40;stage I&#41; and maternal systemic endothelial dysfunction in the later period &#40;stage II&#41; &#8211; is thus partially called into question&#59; the authors suggest that impaired placental vasculogenesis does not in itself explain the clinical spectrum of pre-eclampsia&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A 2009 study in the <span class="elsevierStyleItalic">Journal of Experimental Medicine</span> assessing the association between intrauterine growth restriction in pregnant women with hypertension and angiotensin II type 1 receptor autoantibodies suggested that these autoantibodies have direct harmful effects on fetal development by inducing apoptosis of placental and trophoblast cells&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Shah et al&#46; corroborated these findings&#44; adding that vascular endothelial growth factor and reduced placental growth factor &#40;through increases in soluble tyrosine kinase-1&#44; an antiangiogenic protein&#41; may play a role in the development of proteinuria and other renal injury-mediated manifestations in pre-eclampsia&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">A study by Wang et al&#46; added to the controversy by suggesting that the endothelial dysfunction seen in PE is not directly linked to fetal growth restriction associated with abnormal umbilical artery flow&#46; Maternal plasma from pregnancies with umbilical placental vascular disease did not affect endothelial cell expression of nitric oxide synthase <span class="elsevierStyleItalic">in vitro</span>&#44; which led the authors to suggest that the placental vascular pathology may be the primary event and that reduced uteroplacental circulation is secondary&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> This finding prompted further studies&#46; Aardema et al&#46; also raised the possibility that other factors besides defective placentation are implicated in the pathophysiology of PIH and PE&#46; Their study sets out to test the hypothesis that PIH and PE with an early onset and poor pregnancy outcome is associated with defective placentation &#40;inadequate spiral arteriole dilatation and subsequent reduced uteroplacental perfusion&#41;&#44; whereas PIH and PE with normal pregnancy outcome is not&#46; They measured the uterine artery pulsatility index &#40;uteroplacental resistance to blood flow&#41; by Doppler ultrasound and found that it was significantly higher in pregnancies with complicated PE but was normal in women who developed PIH&#47;PE&#44; but had a good pregnancy outcome&#46; This indicates that only cases with poor outcomes are associated with defective placentation and supports the concept of heterogeneous causes of hypertensive disorders of pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">This concept was strongly supported by Cross&#44; who suggested that PE can be initiated by at least three independent mechanisms&#58; pre-existing maternal hypertension that is exacerbated by pregnancy&#44; elevated levels of angiotensin II in the maternal circulation by placental over-production of renin &#40;placental renin-angiotensin system&#41;&#44; and primary placental pathology&#44; which prevents the placenta from contributing to the normal cardiovascular adaptations of pregnancy&#46; Identification of genetic risk factors will thus only be possible when the disease has been separated into different subtypes according to the etiological mechanisms involved&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Genetic study may have an important role in the future&#59; mutations in the angiotensinogen gene are known to be associated with greater predisposition to PIH&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Predicting pre-eclampsia</span><p id="par0145" class="elsevierStylePara elsevierViewall">A good test for predicting PE should be simple&#44; rapid&#44; non-invasive&#44; inexpensive and easy to apply&#46; The results should be reliable and reproducible&#44; with high sensitivity and specificity&#46; Ideally&#44; it should provide an opportunity for early preventive therapy&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The ability to predict PE within a reasonable time from symptom onset has improved somewhat in the last decade&#46; However&#44; these improvements have not been significant&#44; and the search continues for the best way to predict this complication of pregnancy&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Various risk markers for PE are known&#44; including personal or family history of PIH or PE&#44; pre-existing hypertension&#44; older maternal age in the first pregnancy&#44; maternal obesity&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and history of renal disease and&#47;or thrombophilia &#40;due to factor V Leiden heterozygosity&#44; antiphospholipid syndrome&#44; or prothrombin gene mutations&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> However&#44; none of these risk factors has sufficient positive predictive value to be used in isolation&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Recent research has raised the possibility that reasonable risk prediction can be achieved by measuring serum levels of substances involved in the pathogenesis of the disease or by assessing uterine artery flow by Doppler ultrasound&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A study by Boulanger et al&#46; stressed the need for rapid and reliable methods for quantifying levels of antiangiogenic proteins such as soluble tyrosine kinase-1 and endoglin produced in excess by the placenta before the clinical manifestations of PE appear&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Baweja et al&#46; demonstrated that measuring urinary albumin using high-performance liquid chromatography gives a significantly more reliable urinary albumin&#47;creatinine ratio than conventional methods&#46; According to the authors&#44; a ratio of &#62;35&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;mmol predicted pre-eclampsia well before the onset of clinical manifestations&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Various studies on uterine artery Doppler imaging&#44; specifically estimation of indices of flow resistance &#40;including the uterine artery pulsatility index&#41; and notching in the pulsed Doppler spectrum&#44; have suggested that this may be an effective way of predicting PE&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Cnossen et al&#46; reported more accurate prediction by this technique when performed in the second trimester&#44; as well as the ability to predict intrauterine growth restriction &#40;although with less predictive value&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Papageorghiou and Roberts confirmed these findings&#44; adding that uterine artery Doppler screening can identify women in whom biochemical markers should be measured&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Despite the enthusiasm with which these studies have been met&#44; Doppler uterine artery analysis is unable in isolation to predict PE risk&#44; as it identifies only 40&#8211;60&#37; of those who subsequently develop PE and 20&#37; of those who develop fetal growth restriction&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> However&#44; when combined with assessment in the first trimester of serum markers associated with the pathophysiology of PE&#44; particularly placental protein 13&#44; placental growth factor&#44; VEGF and soluble tyrosine kinase-1&#44; it may predict up to 90&#37; of cases of severe preeclampsia for a false positive rate of 9&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Despite the lack of randomized trials showing the benefit of ambulatory blood pressure monitoring &#40;ABPM&#41; in predicting PE&#44; some authors recommend serial BP measurement by this method&#44; based on various observational studies and small trials&#46; A study published in <span class="elsevierStyleItalic">Arquivos Brasileiros de Cardiologia</span> concluded that certain data from ABPM can predict PIH&#44; particularly diastolic pressure load during wakefulness&#44; diastolic and systolic pressure load during sleep&#44; and pressure variability and maximum diastolic pressure during sleep&#46; Specifically a maximum diastolic arterial pressure on ABPM during sleep of &#8805;64<span class="elsevierStyleHsp" style=""></span>mmHg presented an odds ratio of 6 for PIH with a sensitivity of 80&#37; and a specificity of 60&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">A few years ago the World Health Organization began a large prospective observational study to assess the value of measuring levels of two antiangiogenic substances &#40;soluble endoglin and soluble tyrosine kinase-1&#41; and one angiogenic substance &#40;placental growth factor&#41; for predicting PE&#46; The aim is to discover whether reversing the angiogenic imbalance in PE by adding exogenous angiogenic factors can be achieved in practice&#44; thereby correcting the syndrome&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In the absence of a test that can predict PE in isolation&#44; multivariate models have been developed&#44; although as yet with little success&#46; Notable among them is the model recently developed by von Dadelszen et al&#46; and which is currently at an advanced stage of investigation&#46; The fullPIERS model was developed in a prospective multicenter study in women who were admitted to tertiary obstetric centers with PE or who developed PE after admission and was first published in January 2011&#46; The model predicted adverse maternal outcomes &#40;mortality or other serious complications of PE&#41; occurring within the first 48<span class="elsevierStyleHsp" style=""></span>hours after eligibility with a high degree of reliability and performed well up to seven days after eligibility&#44; and brings new hope of identifying women at increased risk of adverse outcomes up to seven days before complications arise&#44; so that aggressive preventive and therapeutic measures can be taken&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Further details of the model are due to be released shortly&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Prevention and treatment</span><p id="par0190" class="elsevierStylePara elsevierViewall">There has been extensive research into the prevention of PE&#44; although current guidelines focus mainly on preventing its complications&#46; Non-severe PIH may have an adaptive function&#59; neonatal morbidity is lower&#44; and neurological development is better&#44; in small for gestational age babies with mildly hypertensive as opposed to normotensive mothers&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Several studies have assessed the preventive value of various therapies&#44; including inhibition of placental phosphodiesterase-5 to reverse the placental vasoconstriction that produces the ischemia&#47;hypoxia of PE&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> while low-dose aspirin &#40;75&#8211;100<span class="elsevierStyleHsp" style=""></span>mg&#41; is accepted as a preventive measure in high-risk women &#40;with PIH&#44; gestational diabetes or previous PE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> The dose should be determined on the basis of platelet function testing&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Some antihypertensive agents also inhibit platelet activation in primary hypertension and their benefits in PIH therefore go beyond simply reducing BP&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Calcium supplementation is beneficial in cases of low calcium intake and in pregnancies at high risk for early complications&#46; Supplementation with antioxidants &#40;vitamins C and E&#41;&#44; zinc&#44; melatonin&#44; coenzyme Q10&#44; omega-3 fatty acids and protein has not shown benefits and is not currently recommended&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Antihypertensive therapy does not prevent PE or its complications&#44; although it reduces by almost half the incidence of severe hypertension in women with mild to moderate hypertension&#46; It cannot be recommended specifically for the prevention of PE until it has been demonstrated that reducing maternal BP is not outweighed by negative fetal outcomes&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Severe hypertension &#40;BP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>160&#47;110<span class="elsevierStyleHsp" style=""></span>mmHg&#41; should be treated in order to decrease maternal morbidity and mortality&#46; Most women with severe hypertension in pregnancy will have PE&#44; and most of those will have had normal BP in the recent past&#46; Such marked BP elevations are considered urgencies&#46; Labetalol&#44; nifedipine and hydralazine are recommended for the treatment of severe PIH&#44; aiming to reduce BP to &#60;160&#47;110<span class="elsevierStyleHsp" style=""></span>mmHg&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> lists the main drugs used in severe PIH and their doses&#46; Sodium nitroprusside should only be used as a last resort if all other measures have failed to obtain BP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>160&#47;110<span class="elsevierStyleHsp" style=""></span>mmHg&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">Treatment of non-severe hypertension &#40;BP 140&#8211;159&#47;90&#8211;109<span class="elsevierStyleHsp" style=""></span>mmHg&#41; aims to achieve values of 130&#8211;155&#47;80&#8211;105<span class="elsevierStyleHsp" style=""></span>mmHg &#40;or 130&#8211;139&#47;80&#8211;89<span class="elsevierStyleHsp" style=""></span>mmHg in women with renal or cardiovascular comorbidities&#41;&#46; Initial treatment should be with methyldopa&#44; labetalol&#44; other beta-blockers such as metoprolol&#44; pindolol or propanolol &#40;atenolol is not recommended since unlike the other beta-blockers mentioned&#44; it is associated for unknown reasons with intrauterine growth retardation&#41;&#44; or oral dihydropyridine calcium channel blockers &#40;preferably slow- or intermediate-release nifedipine&#41;&#46; Angiotensin receptor blockers and angiotensin-converting enzyme inhibitors are contraindicated due to their toxicity&#44; particularly nephrotoxicity&#46; Thiazide diuretics used after the first trimester are not associated with adverse maternal or fetal outcomes&#44; but neither do they prevent PE or severe hypertension&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> lists the main drugs used in the treatment of non-severe PIH and their doses&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">Treatment of non-severe hypertension is the subject of debate because of potential harmful effects on fetal development&#46; Two meta-analyses on this subject found a significant association between treatment-induced decreases in maternal mean arterial pressure and prematurity and small for gestational age infants&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;40</span></a> reinforcing the idea that antihypertensive therapy in itself does not reduce maternal morbidity in PE or eclampsia&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0225" class="elsevierStylePara elsevierViewall">Pregnancy-induced hypertension is still a little-understood entity&#44; despite the enormous impact of its complications on maternal and fetal outcomes&#46; There is consensus that antihypertensive therapy is essential in cases of severe hypertension&#44; but there is disagreement concerning non-severe cases due to the risk of adverse fetal outcomes&#46; Recent advances in our understanding of the pathophysiology of PE have raised expectations that effective methods to predict the condition and its complications will be developed&#44; based on specific markers of endothelial dysfunction and&#47;or antiangiogenic proteins&#44; the detection and quantification of which&#44; complemented by Doppler assessment of uterine artery flow&#44; will help with timely identification of subgroups of pregnant women at risk of developing complications&#46; It will then be possible to apply preventive measures such as low-dose aspirin and calcium supplementation&#44; plan the optimum timing for delivery&#44; potentially reverse antiangiogenic status using exogenous angiogenic substances&#44; and use antihypertensive therapy appropriately&#44; with greater confidence and with less risk for both mother and fetus&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Predicting pre-eclampsia"
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          "titulo" => "Prevention and treatment"
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            0 => "Pregnancy-induced hypertension"
            1 => "Pre-eclampsia"
            2 => "Prediction"
            3 => "Pathophysiology"
            4 => "Antihypertensive therapy"
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          "titulo" => "Palavras-chave"
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            0 => "Hipertens&#227;o gestacional"
            1 => "Pr&#233;-eclampsia"
            2 => "Predi&#231;&#227;o"
            3 => "Fisiopatologia"
            4 => "Terap&#234;utica anti-hipertensora"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypertension complicates 6&#8211;8&#37; of pregnancies and includes the following four conditions&#58; hypertension preceding pregnancy or documented before the 20th week of gestation&#59; pre-eclampsia &#40;PE&#41;&#47;eclampsia&#59; chronic hypertension with superimposed pre-eclampsia&#59; and gestational hypertension&#46; The latter is defined as a significant rise in blood pressure after the 20th week of pregnancy in previously normotensive women&#44; to over 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#46; When blood pressure remains above 160&#47;110<span class="elsevierStyleHsp" style=""></span>mmHg&#44; it is considered severe&#46; PE is defined as the presence of proteinuria &#40;&#8805;300<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>hours&#41; in pregnant women with hypertension&#46; The hypertensive syndromes of pregnancy are among the leading causes of maternal and fetal morbidity and mortality and anti-hypertensive treatment is part of the therapeutic arsenal used to prevent serious complications&#46; Although the role of utero-placental insufficiency due to deficient migration of trophoblasts to the spiral arteries is universally accepted&#44; the pathophysiology of PE remains largely unknown and is the subject of debate&#46; No effective ways of predicting or preventing PE have been found&#44; which highlights the need for further research in this field&#46; This review aims primarily to evaluate recent advances in our understanding of the pathophysiology of gestational hypertension and especially PE&#44; and new ways of predicting PE&#46; Additionally&#44; we present a brief review on the diagnosis&#44; prevention and treatment of PE&#46;</p>"
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      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A Hipertens&#227;o Arterial &#40;HTA&#41; na gravidez complica 6 a 8&#37; das gesta&#231;&#245;es e inclui 4 principais formas de apresenta&#231;&#227;o&#58; HTA cr&#243;nica&#44; que antecede a gravidez ou &#233; documentada antes das 20 semanas de gesta&#231;&#227;o&#44; pr&#233;-eclampsia &#40;PE&#41;&#47;eclampsia&#44; HTA cr&#243;nica com PE sobreposta e HTA gestacional&#46; A HTA gestacional define-se como uma eleva&#231;&#227;o significativa da press&#227;o arterial ap&#243;s as 20 semanas de gesta&#231;&#227;o em gestantes previamente normotensas&#44; atingindo valores superiores a 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Quando os valores de press&#227;o arterial se mant&#234;m acima de 160&#47;110<span class="elsevierStyleHsp" style=""></span>mmHg de forma sustentada&#44; &#233; considerada grave&#46; A pr&#233;-eclampsia &#40;PE&#41; define-se pela presen&#231;a de protein&#250;ria &#40;&#8805;300<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>horas&#41; em gestante com HTA&#46; As s&#237;ndromes hipertensivas da gravidez encontram-se entre as principais causas de morbimortalidade materno-fetal&#44; sendo que a terap&#234;utica anti-hipertensora faz parte do arsenal terap&#234;utico utilizado na preven&#231;&#227;o das suas graves complica&#231;&#245;es&#46; Apesar do papel da insufici&#234;ncia &#250;tero-placent&#225;ria por deficiente migra&#231;&#227;o dos trofoblastos para as art&#233;rias espiraladas ser universalmente aceite&#44; a fisiopatologia da PE permanece ainda parcialmente uma inc&#243;gnita e re&#250;ne alguma controv&#233;rsia&#46; Historicamente&#44; n&#227;o s&#227;o conhecidas formas suficientemente eficazes de predi&#231;&#227;o e preven&#231;&#227;o da PE&#44; pelo que a investiga&#231;&#227;o nesta &#225;rea assume particular import&#226;ncia&#46; Esta revis&#227;o visa primariamente avaliar os avan&#231;os cient&#237;ficos mais recentes nas &#225;reas da fisiopatologia da HTA gestacional e&#44; em particular&#44; da PE e das novas formas de predi&#231;&#227;o desta patologia&#46; Concomitantemente&#44; apresentamos informa&#231;&#227;o sum&#225;ria recente acerca do diagn&#243;stico&#44; preven&#231;&#227;o e tratamento anti-hipertensor na PE&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Barra&#44; S&#46; Hipertens&#227;o Arterial na Gr&#225;vida&#58; o actual estado da arte&#46; Rev Port Cardiol 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.repc.2012.04.006">doi&#58;10&#46;1016&#47;j&#46;repc&#46;2012&#46;04&#46;006</span></p>"
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Classification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Definition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">A &#8211; Pre-existing hypertension</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diastolic hypertension that predates pregnancy or is diagnosed before 20 weeks&#8217; gestation&#46; It may be associated with proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8211; <span class="elsevierStyleItalic">Essential</span> &#8212;-&#8594;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8211; <span class="elsevierStyleItalic">Secondary</span> &#8212;-&#8594;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Secondary to such conditions as renal disease&#44; pheochromocytoma and Cushing syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">B &#8211; Gestational hypertension</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diastolic hypertension develops after 20 weeks&#8217; gestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 &#8211; <span class="elsevierStyleItalic">Without proteinuria</span> &#8212;-&#8594;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protein excretion in 24-hour urine collection is &#60;0&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>a &#8211; Without adverse conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>b &#8211; With adverse conditions &#8212;-&#8594;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Convulsions &#40;eclampsia&#41;&#59; very high diastolic pressure &#40;&#62;110<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#59; thrombocytopenia&#59; oliguria&#59; pulmonary edema&#59; elevated liver enzyme levels&#59; severe nausea&#44; frontal headache&#44; visual disturbances&#44; abdominal pain in right upper quadrant&#59; suspected abruptio placentae&#59; HELLP syndrome&#59; intrauterine growth retardation&#44; oligohydramnios&#44; or absent or reversed umbilical artery end diastolic flow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 &#8211; <span class="elsevierStyleItalic">With proteinuria</span> &#8212;-&#8594;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protein excretion in 24-hour urine collection is &#8805;0&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;d &#40;corresponds to &#8220;pre-eclampsia&#8221;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>a &#8211; Without adverse conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>b &#8211; With adverse conditions &#8212;-&#8594;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Same conditions as in B1b&#59; protein excretion &#62;3<span class="elsevierStyleHsp" style=""></span>g&#47;d in 24-hour urine collection&#44; especially with hypoalbuminemia &#40;albumin level<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>g&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">C &#8211; Pre-existing hypertension<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>superimposed gestational hypertension with proteinuria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre-existing hypertension &#40;as defined in A&#41; associated with further worsening of blood pressure and protein excretion &#8805;3<span class="elsevierStyleHsp" style=""></span>g&#47;d after 20 weeks&#8217; gestation&#46; Corresponds to &#8220;chronic hypertension with superimposed pre-eclampsia&#8221;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">D &#8211; Unclassifiable antenatally</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypertension with or without systemic manifestations if blood pressure was first recorded after 20 weeks&#8217; gestation&#46; Reassessment is necessary at or after 42<span class="elsevierStyleHsp" style=""></span>d post partum&#46; The condition should be reclassified as gestational hypertension with or without proteinuria or as pre-existing hypertension depending on whether the hypertension has resolved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Classification of hypertensive disorders of pregnancy proposed by the Canadian Hypertension Society&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre-existing essential hypertension complicating pregnancy&#44; childbirth and the puerperium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre-existing hypertensive disorder with superimposed proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gestational &#40;pregnancy-induced&#41; edema and proteinuria without hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gestational &#40;pregnancy-induced&#41; hypertension without significant proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gestational &#40;pregnancy-induced&#41; hypertension with significant proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe pre-eclampsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eclampsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unspecified maternal hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hypertensive disorders in pregnancy&#58; International Classification of Diseases &#40;ICD&#41; classification&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Agent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Dosage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Labetalol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Start with 20<span class="elsevierStyleHsp" style=""></span>mg IV&#44; repeat 20&#8211;80<span class="elsevierStyleHsp" style=""></span>mg IV every 30<span class="elsevierStyleHsp" style=""></span>min&#59; or 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mg&#47;min &#40;max&#46; 300<span class="elsevierStyleHsp" style=""></span>mg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">May cause neonatal bradycardia&#59; typical contraindications for beta-blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nifedipine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8211;10<span class="elsevierStyleHsp" style=""></span>mg capsule orally every 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intermediate-release tablets may also be used&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hydralazine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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              "identificador" => "bib0005"
              "etiqueta" => "1"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The sixth report of the confidential enquiries into maternal deaths in the United Kingdom"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Why mothers die 2000&#8211;2002"
                          ]
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                      "Libro" => array:3 [
                        "fecha" => "2004"
                        "editorial" => "RCOG Press"
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                      ]
                    ]
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                ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Roberts"
                            1 => "G&#46; Pearson"
                            2 => "J&#46; Cutler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.HYP.0000054981.03589.E9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2003"
                        "volumen" => "41"
                        "paginaInicial" => "437"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12623940"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and management of preeclampsia and eclampsia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "ACOG"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "ACOG Pract Bull"
                        "fecha" => "2002"
                        "volumen" => "33"
                        "paginaInicial" => "1"
                        "paginaFinal" => "14"
                        "itemHostRev" => array:3 [
                          "pii" => "S0145212609001611"
                          "estado" => "S300"
                          "issn" => "01452126"
                        ]
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                  ]
                ]
              ]
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              "etiqueta" => "4"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypertension in pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;G&#46; Solomon"
                            1 => "E&#46;W&#46; Seely"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ecl.2005.09.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocrinol Metab Clin North Am"
                        "fecha" => "2006"
                        "volumen" => "35"
                        "paginaInicial" => "157"
                        "paginaFinal" => "171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16310647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "National High Blood Pressure Education Program"
                          ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Obstet Gynecol"
                        "fecha" => "2000"
                        "volumen" => "183"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10944363"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factores de riesgo y resultados perinatales en la preeclampsia severa&#58; um estudio caso control"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Barreto"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Hosp Matern Infant Ramon Sarda"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "116"
                        "paginaFinal" => "120"
                      ]
                    ]
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              ]
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            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neonatal outcome in hypertensive disorders of pregnancy"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "S&#46; Ferrazzani"
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                            2 => "S&#46; Garofalo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.earlhumdev.2011.03.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Early Hum Dev"
                        "fecha" => "2011"
                        "volumen" => "87"
                        "paginaInicial" => "445"
                        "paginaFinal" => "449"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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            7 => array:3 [
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              "etiqueta" => "8"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;P&#46; Romero"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Fac Med"
                        "fecha" => "2003"
                        "volumen" => "64"
                        "paginaInicial" => "43"
                        "paginaFinal" => "54"
                      ]
                    ]
                  ]
                ]
              ]
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            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "British Hypertension Society guidelines for hypertension management"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;E&#46; Ramsay"
                            1 => "B&#46; Williams"
                            2 => "G&#46;D&#46; Johnston"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "1999"
                        "volumen" => "319"
                        "paginaInicial" => "630"
                        "paginaFinal" => "635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10473485"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An accurate automated blood pressure device for use in pregnancy and pre-eclampsia&#58; the Microlife 3BTO-A"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "A&#46;C&#46; Cuckson"
                            2 => "J&#46;T&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1471-0528.2005.00617.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJOG"
                        "fecha" => "2005"
                        "volumen" => "112"
                        "paginaInicial" => "915"
                        "paginaFinal" => "920"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15957992"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lack of reproducibility in pregnancy of Korotkoff phase IV as measured by mercury sphygmomanometry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "M&#46; Gupta"
                            2 => "A&#46; Halligan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1996"
                        "volumen" => "347"
                        "paginaInicial" => "139"
                        "paginaFinal" => "142"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8544546"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ambulatory versus conventional methods for monitoring blood pressure during pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Bergel"
                            1 => "G&#46; Carroli"
                            2 => "F&#46; Althabe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2002"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypertension in pregnancy&#58; which method of blood pressure measurement is most predictive of outcome&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "A&#46; Halligan"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0029-7844(96)00350-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "1996"
                        "volumen" => "88"
                        "paginaInicial" => "1030"
                        "paginaFinal" => "1033"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8942848"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke and severe preeclampsia and eclampsia&#58; a paradigm shift focusing on systolic blood pressure"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "R&#46;C&#46; Moore"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.AOG.0000151116.84113.56"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "2005"
                        "volumen" => "105"
                        "paginaInicial" => "246"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15684147"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eclampsia in the United Kingdom"
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                  "host" => array:1 [
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                        "tituloSerie" => "BMJ"
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                        "paginaFinal" => "1400"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7819845"
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            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology of pregnancy-induced hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Granger"
                            1 => "B&#46;T&#46; Alexander"
                            2 => "W&#46;A&#46; Bennett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Hypertens"
                        "fecha" => "2001"
                        "volumen" => "14"
                        "numero" => "6 Pt 2"
                        "paginaInicial" => "178S"
                        "paginaFinal" => "185S"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11411754"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology of hypertension during preeclampsia&#58; linking placental ischemia with endothelial dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Gilbert"
                            1 => "M&#46;J&#46; Ryan"
                            2 => "B&#46;B&#46; LaMarca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/ajpheart.01113.2007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Physiol Heart Circ Physiol"
                        "fecha" => "2008"
                        "volumen" => "294"
                        "paginaInicial" => "H541"
                        "paginaFinal" => "H550"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18055511"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neurovascular mechanisms of hypertension in pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;K&#46; Stennett"
                            1 => "R&#46;A&#46; Khalil"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Neurovasc Res"
                        "fecha" => "2006"
                        "volumen" => "3"
                        "paginaInicial" => "131"
                        "paginaFinal" => "148"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16719796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology of placentation abnormalities in pregnancy-induced hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Furuya"
                            1 => "J&#46; Ishida"
                            2 => "I&#46; Aoki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Vasc Health Risk Manage"
                        "fecha" => "2008"
                        "volumen" => "4"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1313"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The detrimental role of angiotensin receptor agonistic autoantibodies in intrauterine growth restriction seen in preeclampsia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;A&#46; Irani"
                            1 => "Yujin Zhang"
                            2 => "S&#46;C&#46; Blackwell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1084/jem.20090872"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Exp Med"
                        "fecha" => "2009"
                        "volumen" => "206"
                        "paginaInicial" => "2809"
                        "paginaFinal" => "2822"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19887397"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preeclampsia&#58; new insights"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;M&#46; Shah"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MNH.0b013e3280d942e9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Nephrol Hypertens"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "paginaInicial" => "213"
                        "paginaFinal" => "220"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17420664"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal plasma from pregnant women with umbilical placental vascular disease does not affect endothelial cell mRNA expression of nitric oxide synthase"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "X&#46; Wang"
                            1 => "N&#46; Athayde"
                            2 => "B&#46; Trudinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Soc Gynecol Invest"
                        "fecha" => "2004"
                        "volumen" => "11"
                        "paginaInicial" => "149"
                        "paginaFinal" => "153"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second trimester Doppler ultrasound screening of the uterine arteries differentiates between subsequent normal and poor outcomes of hypertensive pregnancy&#58; two different pathophysiological entities&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;W&#46; Aardema"
                            1 => "M&#46;C&#46; Saro"
                            2 => "M&#46; Lander"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Sci &#40;Lond&#41;"
                        "fecha" => "2004"
                        "volumen" => "106"
                        "paginaInicial" => "377"
                        "paginaFinal" => "382"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The genetics of pre-eclampsia&#58; a feto-placental or maternal problem&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;C&#46; Cross"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Genet"
                        "fecha" => "2003"
                        "volumen" => "64"
                        "paginaInicial" => "96"
                        "paginaFinal" => "103"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12859402"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Associations of maternal obesity with blood pressure and the risks of gestational hypertensive disorders&#46; The Generation R Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Gaillard"
                            1 => "E&#46;A&#46; Steegers"
                            2 => "A&#46; Hofman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/HJH.0b013e328345500c"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hypertens"
                        "fecha" => "2011"
                        "volumen" => "29"
                        "paginaInicial" => "937"
                        "paginaFinal" => "944"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21430559"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pre-eclampsia screening in first and second trimester"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Kang"
                            1 => "H&#46; Struben"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1024/0040-5930.65.11.663"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ther Umsch"
                        "fecha" => "2008"
                        "volumen" => "65"
                        "paginaInicial" => "663"
                        "paginaFinal" => "666"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18979429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New insights in the pathophysiology of preeclampsia and potential therapeutic implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Boulanger"
                            1 => "M&#46; Flamant"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nephro.2007.07.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Ther"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "paginaInicial" => "437"
                        "paginaFinal" => "448"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18047998"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin&#58;creatinine ratio using high-performance liquid chromatography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Baweja"
                            1 => "A&#46; Kent"
                            2 => "R&#46; Masterson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1471-0528.2011.02960.x"
                      "Revista" => array:2 [
                        "tituloSerie" => "BJOG"
                        "fecha" => "2011"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of pre-eclampsia by uterine artery Doppler imaging&#58; relationship to gestational age at delivery and small-for-gestational age"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Fetal Medicine Foundation Second-Trimester Screening Group"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;K&#46; Yu"
                            1 => "O&#46; Khouri"
                            2 => "N&#46; Onwudiwe"
                            3 => "Y&#46; Spiliopoulos"
                            4 => "K&#46;H&#46; Nicolaides"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/uog.5252"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ultrasound Obstet Gynecol"
                        "fecha" => "2008"
                        "volumen" => "31"
                        "paginaInicial" => "310"
                        "paginaFinal" => "313"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18241089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction&#58; a systematic review and bivariable meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Cnossen"
                            1 => "R&#46;K&#46; Morris"
                            2 => "G&#46; ter Riet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1503/cmaj.070430"
                      "Revista" => array:6 [
                        "tituloSerie" => "CMAJ"
                        "fecha" => "2008"
                        "volumen" => "178"
                        "paginaInicial" => "701"
                        "paginaFinal" => "711"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18332385"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Uterine artery Doppler screening for adverse pregnancy outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;T&#46; Papageorghiou"
                            1 => "N&#46; Roberts"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Obstet Gynecol"
                        "fecha" => "2005"
                        "volumen" => "17"
                        "paginaInicial" => "584"
                        "paginaFinal" => "590"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16258339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second-trimester uterine artery Doppler screening in unselected populations&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;T&#46; Papageorghiou"
                            1 => "C&#46;K&#46; Yu"
                            2 => "S&#46; Cicero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/jmf.12.2.78.88"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Matern Fetal Neonatal Med"
                        "fecha" => "2002"
                        "volumen" => "12"
                        "paginaInicial" => "78"
                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12420836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "First trimester screening for preeclampsia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;T&#46; Papageorghiou"
                            1 => "S&#46; Campbell"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/GCO.0b013e328010beda"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Obstet Gynecol"
                        "fecha" => "2006"
                        "volumen" => "18"
                        "paginaInicial" => "594"
                        "paginaFinal" => "600"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17099328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive factors for pregnancy hypertension in primiparous adolescents&#58; analysis of prenatal care&#44; ABPM and microalbuminuria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Carvalho"
                            1 => "H&#46; Campos"
                            2 => "Z&#46; Bruno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2006"
                        "volumen" => "87"
                        "paginaInicial" => "487"
                        "paginaFinal" => "495"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17128319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of adverse maternal outcomes in pre-eclampsia&#58; development and validation of the fullPIERS model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Peter von Dadelszen"
                            1 => "Beth Payne"
                            2 => "Jing Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(10)61351-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2011"
                        "volumen" => "377"
                        "paginaInicial" => "219"
                        "paginaFinal" => "227"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21185591"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2012.01.016

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Year/Month	Html	Pdf	Total

2024 November	14	3	17
2024 October	83	49	132
2024 September	114	38	152
2024 August	74	39	113
2024 July	83	36	119
2024 June	68	40	108
2024 May	75	38	113
2024 April	76	29	105
2024 March	82	30	112
2024 February	76	33	109
2024 January	67	30	97
2023 December	57	31	88
2023 November	65	30	95
2023 October	92	26	118
2023 September	57	23	80
2023 August	78	20	98
2023 July	70	17	87
2023 June	67	18	85
2023 May	92	35	127
2023 April	51	3	54
2023 March	55	27	82
2023 February	64	26	90
2023 January	54	12	66
2022 December	64	26	90
2022 November	88	37	125
2022 October	72	24	96
2022 September	47	44	91
2022 August	49	37	86
2022 July	51	31	82
2022 June	34	31	65
2022 May	24	30	54
2022 April	55	29	84
2022 March	51	25	76
2022 February	55	33	88
2022 January	27	38	65
2021 December	21	26	47
2021 November	35	36	71
2021 October	50	40	90
2021 September	47	25	72
2021 August	42	39	81
2021 July	30	23	53
2021 June	26	21	47
2021 May	43	51	94
2021 April	46	59	105
2021 March	86	23	109
2021 February	82	19	101
2021 January	49	7	56
2020 December	53	8	61
2020 November	44	19	63
2020 October	23	20	43
2020 September	63	15	78
2020 August	37	9	46
2020 July	60	7	67
2020 June	66	17	83
2020 May	69	5	74
2020 April	84	28	112
2020 March	74	9	83
2020 February	100	26	126
2020 January	46	9	55
2019 December	38	7	45
2019 November	59	4	63
2019 October	45	7	52
2019 September	29	8	37
2019 August	37	9	46
2019 July	44	17	61
2019 June	26	10	36
2019 May	36	13	49
2019 April	33	17	50
2019 March	102	11	113
2019 February	94	13	107
2019 January	109	12	121
2018 December	101	15	116
2018 November	145	12	157
2018 October	253	18	271
2018 September	44	12	56
2018 August	54	29	83
2018 July	34	11	45
2018 June	73	8	81
2018 May	47	22	69
2018 April	121	14	135
2018 March	84	22	106
2018 February	45	15	60
2018 January	46	13	59
2017 December	63	13	76
2017 November	69	21	90
2017 October	53	20	73
2017 September	54	18	72
2017 August	57	17	74
2017 July	51	18	69
2017 June	56	23	79
2017 May	78	19	97
2017 April	72	13	85
2017 March	78	23	101
2017 February	72	17	89
2017 January	64	5	69
2016 December	53	23	76
2016 November	36	24	60
2016 October	74	28	102
2016 September	37	7	44
2016 August	37	3	40
2016 July	47	9	56
2016 June	35	15	50
2016 May	33	9	42
2016 April	250	3	253
2016 March	241	29	270
2016 February	285	47	332
2016 January	205	26	231
2015 December	195	30	225
2015 November	240	41	281
2015 October	267	34	301
2015 September	230	21	251
2015 August	169	18	187
2015 July	204	17	221
2015 June	161	16	177
2015 May	219	17	236
2015 April	204	27	231
2015 March	214	12	226
2015 February	174	11	185
2015 January	185	10	195
2014 December	185	16	201
2014 November	213	12	225
2014 October	316	28	344
2014 September	265	20	285
2014 August	193	18	211
2014 July	215	16	231
2014 June	165	17	182
2014 May	153	18	171
2014 April	142	15	157
2014 March	223	30	253
2014 February	199	29	228
2014 January	168	22	190
2013 December	161	26	187
2013 November	185	28	213
2013 October	140	23	163
2013 September	131	21	152
2013 August	127	39	166
2013 July	125	28	153
2013 June	108	21	129
2013 May	121	33	154
2013 April	121	38	159
2013 March	115	31	146
2013 February	112	30	142
2013 January	116	42	158
2012 December	91	21	112
2012 November	81	25	106
2012 October	54	23	77
2012 September	25	1	26

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