ABSTRACT
Pré-eclâmpsia, síndrome HELLP (hemólise, elevação de enzimas hepáticas e plaquetopenia) e fígado gorduroso agudo da gestação são as principais causas de microangiopatia trombótica e disfunção hepática grave durante a gestação, representando um spectrum do mesmo processo patológico. Relatou-se aqui o caso de uma gestante com 35 semanas internada em unidade de terapia intensiva no pós-operatório imediato de cesariana por morte fetal, com náuseas, vômitos e icterícia. Diagnosticaram-se pré-eclâmpsia pós-parto e fígado gorduroso agudo da gestação. Houve evolução tardia com hematoma subdural agudo e hemorragia intracerebral, sendo realizado tratamento neurocirúrgico. A paciente foi a óbito por anemia hemolítica refratária, com sangramento espontâneo em múltiplos órgãos. Pré-eclâmpsia, síndrome HELLP e fígado gorduroso agudo da gestação são processos patológicos que podem se sobrepor e se associar a complicações potencialmente fatais, como a hemorragia intracraniana aqui descrita. Sua detecção e diagnóstico precoces são fundamentais para a instituição de manejo adequado e sucesso do tratamento.
Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and evere liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The case of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure management and treatment success.
Subject(s)
Adult , Female , Humans , Pregnancy , Cerebral Hemorrhage/physiopathology , Hematoma, Subdural, Acute/physiopathology , Pregnancy Complications, Hematologic/physiopathology , Thrombotic Microangiopathies/physiopathology , Cesarean Section , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/surgery , Fetal Death , Fatty Liver/complications , Fatty Liver/physiopathology , HELLP Syndrome/physiopathology , Hematoma, Subdural, Acute/etiology , Hematoma, Subdural, Acute/surgery , Intensive Care Units , Pre-Eclampsia/physiopathology , Thrombotic Microangiopathies/etiologyABSTRACT
Si bien el púrpura trombocitopénico idiomático (PTI) es una patología poco frecuente, su importancia radica en que existe una alta morbimortalidad materno-fetal durante el embarazo, el parto y el puerperio. Es en el parto donde actualmente existe mayor controversia, con respecto a que vía es más recomendable, cesárea o vía vaginal. Nuestro propósito es acortar la brecha de la duda con respecto a ésta incógnita en base a la literatura disponible actualmente tanto a nivel nacional como internacional presentando una revisión bibliográfica sobre el PTI en el embarazo dando una pequeña reseña sobre la fisiopatología de ésta, diagnóstico y tratamiento, centrándonos en la controversia sobre que vía de parto es la más indicada. Se adoptó la estrategia de búsqueda desarrollada en la revisión electrónica de bases de datos, bajo criterios definidos que permitieron identificar los estudios con mejor evidencia posible. En nuestra búsqueda se encontraron 18 trabajos que cumplieran con nuestros criterios de búsqueda. En la literatura no encontramos un trabajo prospectivo randomizado con un buen grado de evidencia y fuerza que afirme una vía por sobre otra. Los trabajos encontrados corresponden a reportes de casos y guías de expertos que recomiendan un manejo por sobre otro. Podemos concluir que la vía del parto se definiría según condiciones obstétricas y no por el nivel de plaquetas fetales encontrados. Además, algunos de los procedimientos para determinar los niveles de plaquetas estarían relacionado a un mayor riesgo de morbimortalidad que la patología base.
Subject(s)
Female , Pregnancy , Adult , Humans , Pregnancy Complications, Hematologic/diagnosis , Pregnancy Complications, Hematologic/physiopathology , Pregnancy Complications, Hematologic/therapy , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/physiopathology , Purpura, Thrombocytopenic, Idiopathic/therapy , Cesarean Section , Evidence-Based Medicine , Platelet Count , Pregnancy Outcome , Delivery, ObstetricABSTRACT
Peak expiratory flow rates (PEFR) were measured in 60 pregnant women aged 20-28 years (average 24 yrs) height between 130-160 cm (average 154.5 cm), each month beginning from 3rd month of gestation and also 8-10 weeks postpartum using, Wright's Peak Flow Meter. The PEFR declined from 329.12 +/- 4.40 lpm in 3rd month to 286.22 +/- 3.81 lpm in 9th month of gestation and increased to 347.86 +/- 2.93 lpm in postpartal period. A similar, declining trend is also observed in other Indian studies. However, the values are lower than those observed in Europeans. Also no change in PEFR during pregnancy was observed in an European study. The PEFR in our study regressed at a rate of 6.68 lpm/month of gestation and 5.49 lpm/kg increase in weight throughout pregnancy. The correlation with forced vital capacity (FVC) and forced expiratory volume in first second (FEV1) is non-significant throughout pregnancy. The anaemic pregnant women showed lower PEFR when compared with PEFR of nonanaemic pregnant women, but showed a similar declining trend throughout pregnancy.
Subject(s)
Adult , Anemia/physiopathology , Body Height/physiology , Body Weight/physiology , Cohort Studies , Female , Forced Expiratory Volume/physiology , Humans , India , Peak Expiratory Flow Rate/physiology , Postpartum Period/physiology , Pregnancy/physiology , Pregnancy Complications, Hematologic/physiopathology , Regression Analysis , Vital Capacity/physiologyABSTRACT
Os autores pretendem fazer uma breve revisäo bibliográfica, visando a orientaçäo de médicos e estudantes sobre os aspectos fisiológicos e patológicos da anemia na gestaçäo