Multidisciplinary management of idiopathic intracranial hypertension in pregnancy: case series and narrative review

Abstract Idiopathic intracranial hypertension (IIH) is a neurological condition characterized by raised intracranial pressure of unknown etiology with normal cerebrospinal fluid (CSF) composition and no brain lesions. It occurs in pregnant patients at approximately the same frequency as in general population, but obstetric and anesthetic management of the pregnancy and labor remains controversial. In this article we provide a multidisciplinary review of the main aspects of IIH in pregnancy including treatment options, mode of delivery and anesthetic techniques. Additionally, we report three cases of pregnant women diagnosed with IIH between 2012 and 2019 in our institution.

Preeclampsia de presentación grave asociada a hígado graso agudo del embarazo / Severe preeclampsia associated with acute fatty liver of pregnancy / Pré-eclâmpsia grave associada a fígado gorduroso agudo da gravidez

La preeclampsia se puede asociar a una patología poco frecuente como es el hígado graso agudo del embarazo. Se reporta el caso clínico de una paciente de 35 años, tercigesta, cursando embarazo gemelar que presenta preeclampsia con elementos de gravedad, asociada a hígado graso agudo del embarazo. Se realiza diagnóstico y tratamiento precoz de ambas patologías, presentando buena evolución materno-fetal.

Preeclampsia can be associated with acute fatty liver of pregnancy, a rare disease. This report describes the case of a 35-year-old patient, gravida 3, pregnant with twins, who presented with severe pre-eclampsia associated with acute fatty liver of pregnancy. Early diagnosis and treatment of both pathologies was performed, resulting in good maternal-fetal evolution.

A pré-eclâmpsia pode estar associada a uma patologia rara, como o fígado gorduroso agudo da gravidez. Neste relato, apresentamos uma paciente de 35 anos, terciária, em gestação gemelar, apresentando pré-eclâmpsia grave, associada a esteatose hepática aguda na gestação. É realizado diagnóstico e tratamento precoces de ambas as patologias, apresentando boa evolução materno-fetal.

Nefrolitiasis en la paciente gestante: revisión de la literatura / Renal lithiasis in pregnant patient: a literary review

Resumen La litiasis renal en la paciente gestante es una condición relativamente infrecuente; sin embargo, es la causa más común de dolor no obstétrico durante el embarazo. En el periodo de gestación se producen diversos cambios anatomofisiológicos en el tracto urinario, como la dilatación de los cálices renales, la pelvis renal y los uréteres por causa del efecto que ejerce la progesterona sobre el músculo liso uretral, y la compresión de los uréteres por el útero grávido. Estas modificaciones conducen a un aumento del flujo plasmático renal y de la tasa de filtrado glomerular, ocasionando hiperuricosuria e hipercalciuria. Del mismo modo, durante el embarazo también se produce un aumento de la secreción de inhibidores de cálculos, por lo cual la prevalencia de la formación de cálculos durante el embarazo es similar a la de las mujeres no embarazadas. El bajo índice de sospecha por parte del médico tratante puede entorpecer el diagnóstico y el tratamiento de esta patología, que también son limitados en la gestación debido a los potenciales riesgos teratogénicos. Se realiza una revisión narrativa de la literatura partiendo de la evidencia científica disponible en las diferentes bases de datos y de esta manera se pretende instruir al médico en los aspectos clave de dicho tema.

Abstract Renal lithiasis in pregnant women is a relatively rare condition. However, it is the most common cause of non-obstetric pain during pregnancy. During the gestation period, various anatomical-physiological changes occur in the urinary tract. These changes include dilation of the renal calyces, renal pelvis, and ureters due to the effect of progesterone on urethral smooth muscle and compression of the ureters by the gravid uterus. These modifications lead to an increase in renal plasma flow and glomerular filtration rate, thus causing hyperuricosuria and hypercalciuria. Similarly, during pregnancy there is also an increase in the secretion of stone inhibitors, therefore, the prevalence of stone formation during pregnancy is similar to non-pregnant women. The low index of suspicion on the part of the treating physician can hinder the diagnosis and treatment of this pathology, which is also limited in pregnancy due to teratogenic risks. A narrative review of the literature is carried out based on the scientific evidence available in the different databases and in this way it is intended to instruct the doctor in the key aspects of said topic.

Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease / Desfechos maternos e fetais da gravidez na doença renal crônica: desafios diagnósticos, vigilância e tratamento em todo o espectro da doença renal

Abstract Pregnancy requires several physiological adaptations from the maternal organism, including modifications in the glomerular filtration rate and renal excretion of several products. Chronic kidney disease (CKD) can negatively affect these modifications and consequently is associated with several adverse maternal and fetal adverse outcomes (gestational hypertension, progression of renal disease, pre-eclampsia, fetal growth restriction, and preterm delivery). A multidisciplinary vigilance of these pregnancies is essential in order to avoid and/or control the harmful effects associated with this pathology. Dialysis and transplantation can decrease the risks of maternal and fetal complications, nonetheless, the rates of complications remain high comparing with a normal pregnancy. Several recent developments in this area have improved quality and efficacy of treatment of pregnant women with CKD. This article summarizes the most recent literature about CKD and pregnancy.

Resumo A gravidez requer várias adaptações fisiológicas do organismo materno, incluindo modificações na taxa de filtração glomerular e na excreção renal de vários produtos. A doença renal crônica (DRC) pode afetar negativamente essas modificações e, consequentemente, está associada a vários desfechos adversos maternos e fetais (hipertensão gestacional, progressão da doença renal, pré-eclâmpsia, restrição do crescimento fetal e parto prematuro). A vigilância multidisciplinar dessas gestações é fundamental para evitar e/ou controlar os efeitos deletérios associados a essa patologia. A diálise e o transplante podem diminuir os riscos de complicações maternas e fetais, no entanto, as taxas de complicações permanecem altas em comparação com uma gravidez normal. Vários desenvolvimentos recentes nesta área melhoraram a qualidade e a eficácia do tratamento de mulheres grávidas com DRC. Este artigo resume a literatura mais recente sobre DRC e gravidez.

Transmediastinal gunshot wound in a pregnant patient with stable hemodynamics

Abstract Transmediastinal gunshot wounds (TGWs) may lead to life-threatening injuries of vital organs such as large vessels, the esophagus, and lungs. Although they are not commonly encountered in pregnant women, additional caution should be given to these patients. Physical examination for the diagnosis and the choice of treatment modality contain controversial points in hemodynamically stable patients, and resuscitation has excessive importance due to physiological changes in pregnancy. We present a hemodynamically stable 26-week pregnant woman brought to the emergency department for TGW. She had a 1-cm diameter of bullet entrance hole on the right anterior 4th intercostal space, 2 cm lateral to the sternum, and a 3-cm diameter exit hole on the right posterior 12th intercostal space on the midscapular line.With our conservative approach, she had an uncomplicated pregnancy period, and gave birth to a healthy baby at term.

Recomendaciones de expertos para el tratamiento biológico en pacientes con psoriasis / Expert recommendations for biological treatment in patients with psoriasis

Resumen En los últimos años, la introducción de diversos medicamentos biológicos para el tratamiento de la psoriasis ha aumentado considerablemente el arsenal terapéutico del médico, con lo cual se ha logrado un fuerte impacto positivo en el control de la enfermedad. Con el fin de proveer de las mejores recomendaciones para el uso de estos biológicos en los pacientes afectados de psoriasis, el grupo mexicano de expertos en psoriasis PSOMEX ha formulado recomendaciones para mejorar la comprensión y el posicionamiento terapéutico de este tipo de medicamentos.

Abstract In recent years, the introduction of a series of biological drugs for the treatment of psoriasis has considerably increased the therapeutic armamentarium of doctors, and thus a strongly positive impact on the control of this condition has been achieved. With the purpose to provide the best recommendations for the use of these biological agents in patients with psoriasis, the Mexican group of psoriasis experts, PSOMEX, has developed recommendations in order to improve the understanding and therapeutic positioning of this type of medications.

Depresión perinatal: detección, diagnóstico y estrategias de tratamiento / Perinatal depression: a review on diagnosis and treatment strategies

Para las mujeres, experimentar cambios emocionales durante el embarazo y hasta un año posterior al parto puede ser parte del proceso de adaptación a los cambios fisiológicos y emocionales de esta nueva etapa, siendo por lo general manejable por ellas mismas. Diferente es el desarrollo de síntomas depresivos durante este período perinatal que comprende el embarazo y hasta doce meses posterior al parto. La depresión perinatal constituye un trastorno de alta prevalencia que puede tener efectos negativos tanto para la salud de la madre, del hijo y de otros miembros de la familia.

For women it is natural to experience changes in mood and feelings during pregnancy and after twelve months after childbirth, these shifting moods are often manageable by themselves, it differs with depressive symptoms that appear during these period. Perinatal depression constitutes a high prevalence disorder that might have a negative effect not only in the mother, but the child and other familiy members.

Beneficios del mindfulness en mujeres embarazadas / Benefits of mindfulness in pregnant women

Este trabajo tiene el propósito de revisar el efecto de las intervenciones basadas en mindfulness sobre la salud mental perinatal. Se efectuó una búsqueda de la literatura publicada hasta septiembre 2019 en la base de datos Web of Science (WOS). Teniendo en cuenta los criterios de inclusión y exclusión y después de leer el título y abstracts de los artículos encontrados, se han seleccionado 26 de ellos, de los que se han escogido solo ocho por tratarse de ensayos controlados y aleatorizados (RCTs) que estudian datos de ansiedad, depresión, estrés percibido y mindfulness pre y post-intervención y con datos de seguimiento. Los resultados encontrados muestran que las intervenciones basadas en mindfulness (IBMs) son más eficaces que la asistencia sanitaria habitual (TAU) para la mujer embarazada a la hora de reducir la sintomatología depresiva, ansiosa y estrés percibido e incrementar sus niveles de mindfulness post-intervención. Para futuras investigaciones se consideraría interesante realizar el seguimiento de estas variables en el posparto e incluir otras como la calidad del vínculo madre-bebé, la adherencia a la lactancia materna y el desarrollo evolutivo del recién nacido.

This article is intended to review the effect of mindfulness-based interventions on perinatal mental health. A search of the literature published until September 2019 in the Web of Science (WOS) database was carried out. Taking into account the inclusion and exclusion criteria and after reading the title and abstracts of the articles found, 26 of them have been selected. Finally we only analyzed randomized controlled trials (RCTs) that show data on anxiety, depression, perceived stress and mindfulness before and after intervention and with follow-up data. The results found show that mindfulness-based interventions (IBMs) are more effective than the usual healthcare (TAU) that pregnant women receive for the reduction of depressive, anxious and perceived stress symptoms as well as increasing their post-intervention mindfulness levels. For future research, a postpartum follow-up would be considered interesting taking into account variables such as the quality of the mother-baby attachment, adherence to breastfeeding and the evolutionary development of the newborn.

Hígado graso agudo del embarazo en una gestante peruana: a propósito de un caso / Acute fatty liver of pregnancy in a Peruvian pregnant woman: a case report

RESUMEN El hígado graso agudo del embarazo es una rara enfermedad de la gestación que se presenta con mayor preponderancia durante el tercer trimestre. Su etiología es desconocida, pero se evidencia un depósito micro vesicular de grasa a nivel del hepatocito. Tiene una mortalidad materno-fetal hasta un 20% debido a que el único tratamiento es terminar la gestación. Se reporta el caso de una gestante de 28 años de edad, con 36 semanas de embarazo, que acude con cuadro clínico de dolor abdominal asociado a malestar general, náuseas y vómitos. Los exámenes de laboratorio mostraron alteración del perfil hepático, falla renal y coagulopatía. La ecografía abdominal mostró infiltración hepática grasa. Se brindó manejo de soporte y regulación de trastornos hemodinámicos. El manejo final fue intervención de cesárea por emergencia debido a complicación de óbito fetal. La paciente fue dada de alta con mejoría de cuadro clínico y de las alteraciones de laboratorio.

ABSTRACT Acute fatty liver of pregnancy is a rare disease of pregnancy that occurs with greater preponderance during the third trimester. Its etiology is unknown, but there is evidence of a micro vesicular fat deposit in the hepatocyte. It has a maternal-fetal mortality up to 20% because the only treatment is to end gestation. We present a case of a 28-year-old pregnant woman, with 36 weeks of pregnancy, who had abdominal pain associated with general malaise, nausea and vomiting. Laboratory tests showed liver profile alteration, renal failure and coagulopathy. Abdominal ultrasound showed fatty liver infiltration. Support management and correction of hemodynamic disorders were provided. The final management was emergency caesarean section to avoid fetal death as a dreaded complication. The patient was discharged with improvement of clinical symptoms and laboratory alterations.

Improving the management of high-risk pregnancies with the use of the Robson classification / Melhorando a gestão da gravidez de alto risco com o uso da classificação de Robson

Abstract Objective To analyze the rates of cesarean delivery longitudinally in a university hospital using the Robson classification. Methods Data related to births performed between 2014 and 2018 and recorded in the Maternal and Neonatal Health Information System (Sistema de Informações em Saúde Materna e Neonatal, SISMATER, in Portuguese) were analyzed using the Robson classification. As an aid, we used articles published in the last five years that approach the same topic in other Brazilian maternity hospitals; they were retrieved from the LILACS, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library databases. Results There was little variation in the total rate of cesarean sections in the period; however, the profile of each group changed over the years. It was possible to verify a significant reduction in the participation of groups of pregnant women with lower risk and an increase in high-risk pregnancies, attributable to the decrease in beds in the institution, with a greater transfer of patients. In addition, there was a reduction in cesarean sections among the lower-risk groups,while the rate among the higher-risk groups remained stable. Conclusion The use of the Robson classification to stratify cesarean deliveries contributes to a better analysis of the indications for cesarean delivery, enabling the establishment of strategies to reduce the rates, generating a positive impact on hospital management and quality of care.

Resumo Objetivo Analisar longitudinalmente as taxas de parto cesáreo em um hospital universitário usando a classificação de Robson. Métodos Foram analisados, por meio da classificação de Robson, dados relacionados a partos realizados entre 2014 e 2018 e armazenados no Sistema de Informações em Saúde Materna e Neonatal (Sismater). Para auxílio, foram utilizados artigos publicados nos últimos cinco anos que abordavam o mesmo tema em outras maternidades Resultados A taxa total de cesárea variou pouco no período; no entanto, alterou-se o perfil de cada grupo ao longo dos anos. Foi possível constatar redução significativa da participação de grupos de contendo gestantes de risco habitual e aumento das gestações de alto risco, atribuíveis à diminuição de leitos na instituição, com maior transferência de pacientes. Além disso, houve uma redução na taxa de cesáreas nos grupos de mais baixo risco, enquanto a taxa dos grupos de risco mais elevado se manteve estável. Conclusão A utilização da classificação de Robson para estratificar os partos cesáreos contribui para uma análise melhor das indicações do parto cesáreo, o que permite o estabelecimento de estratégias para a redução das taxas, gerando um impacto positivo na gestão hospitalar e na qualidade assistencial.

(Dis)continuation of care of the pre-term newborn at the border / (Des)continuidad del cuidado al recién nacido prematuro en una región de frontera / (Des)continuidade do cuidado ao recém-nascido pré-termo em região de fronteira

ABSTRACT Objectives: to understand how continuation of care for the preterm newborn in the health care network at the border. Methods: the Grounded Theory was the methodological framework. Data were collected through 17 semi-structured interviews between July 2016 and March 2017. Results: "Describing the structure and functioning of the Child Nutrition Center" represents the context; "Experiencing and signifying premature birth" are the causal conditions; "Identifying conditions that intervene in the process of continuation of care for the preterm newborn" are the intervening conditions; "Ensuring continuation of care for the preterm newborn" are strategies; "Identifying (dis)continuation of care flows for the preterm newborn at the border" are the study's consequences and phenomenon. Final Considerations: there is a need to plan referral and counter-referral flows of the preterm newborn and the commitment of public health managers to ensure continuation of care.

RESUMEN Objetivos: comprender cómo ocurre la continuidad del cuidado al recién nacido prematuro en la red de atención de salud en una región de frontera. Métodos: la Teoría Fundamentada en los Datos fue el referencial metodológico. Los datos fueron recolectados por medio de 17 entrevistas semiestructuradas, entre julio 2016 y marzo 2017. Resultados: Describiendo la estructura y el funcionamiento del Centro de Nutrición Infantil representa el contexto; Experimentando y significando el nacimiento prematuro son las condiciones causales; Identificando condiciones que intervienen en el proceso de continuidad del cuidado del recién nacido prematuro son las condiciones intervinientes; Asegurando la continuidad del cuidado al recién nacido prematuro son las estrategias; Identificando flujos de (des)continuidad del cuidado al recién nacido prematuro en una región de frontera son las consecuencias e, igualmente, el fenómeno del estudio. Consideraciones Finales: se identifica la necesidad de planificar flujos de referencia y contrarreferencia del recién nacido prematuro y el compromiso de los gestores en salud pública para garantizar la continuidad del cuidado.

RESUMO Objetivos: compreender como acontece a continuidade do cuidado ao recém-nascido pré-termo na rede de atenção à saúde na fronteira. Métodos: a Teoria Fundamentada nos Dados foi o referencial metodológico. Os dados foram coletados por meio de 17 entrevistas semiestruturadas, entre julho de 2016 e março de 2017. Resultados: "Descrevendo a estrutura e o funcionamento do Centro de Nutrição Infantil representa o contexto"; "Experienciando e significando o nascimento prematuro" são as condições causais; "Identificando condições que intervêm no processo de continuidade do cuidado ao recém-nascido pré-termo" são as condições intervenientes; "Assegurando a continuidade do cuidado ao recém-nascido pré-termo" são as estratégias; "Identificando fluxos de (des)continuidade do cuidado ao recém-nascido pré-termo em região de fronteira" são as consequências e o fenômeno do estudo. Considerações Finais: identifica-se a necessidade de planejar fluxos de referência e contrarreferência do recém-nascido pré-termo e o comprometimento dos gestores em saúde pública para garantir a continuidade do cuidado.

Dilatación endoscópica en paciente con acalasia durante el embarazo: reporte de caso y revisión de la literatura / Endoscopic dilatation in a patient with achalasia during pregnancy: case report and review of the literature

La acalasia en el embarazo es una condición infrecuente, pobremente conocida y su manejo no esta claramente definido. Las repercusiones sobre el estado nutricional de los pacientes con esta entidad son graves y en una gestante tienen implicaciones serias para el curso de la gestación, con riesgo elevado de restricción del crecimiento intrauterino, parto pretérmino e incluso pérdida fetal; existen síntomas que pueden confundirse con hiperémesis gravídica retrasando el diagnóstico. Dentro de las opciones terapéuticas está el manejo médico, endoscópico e intervenciones quirúrgicas; para decidir cual es tratamiento adecuado se debe tener en cuenta la severidad, edad gestacional y condicien clasificaci de teratogenicidad conocido siendo su uso bienestar del binomioones del paciente, dentro del espectro mencionado en el manejo se incluyen los calcioantagonistas y nitratos, estos con restricciones en el embarazo, además toxina botulínica, dilatación neumática endoscópica, miotomía laparoscópica de Heller y recientemente el POEM; estas últimas con riesgo elevado de complicaciones. En el embarazo existe poca evidencia en la literatura y alrededor de 40 casos reportados, algunos con complicaciones como perdida fetal y muerte materna. Presentamos nuestra experiencia en el Hospital Universitario San Ignacio, Bogotá, Colombia de una mujer de 26 años de edad con diagnóstico de acalasia tipo 2 de novo durante el primer trimestre de gestación, cuadro clínico de disfagia severa asociado a desnutrición, a quien el manejo oportuno con soporte nutricional enteral con sonda nasogástrica para lograr repleción del índice de masa corporal (IMC) y luego de esto manejo endoscópico con dilatación con balón. Permitió llevar con éxito a término la gestación sin efectos adversos sobre la madre o el feto, con evolución adecuada y tolerancia a vía oral sin disfagia. Consideramos que es importante el soporte nutricional previo a la toma de conducta con este tipo paciente, además que el manejo endoscópico con dilatación puede ser seguro y efectivo a mediano plazo para el manejo de acalasia en embarazo.

Achalasia in pregnancy is an infrequent, poorly understood condition and its treatment is not clearly defined. The repercussions on the patients nutritional status are serious and in a pregnant woman have serious implications for the course of gestation, with high risk of intrauterine growth restriction, preterm delivery and even fetal loss; there are symptoms that can be confused with hyperemesis gravidarum delaying the diagnosis. The therapeutic options are medical treatment, endoscopic and surgical interventions; to decide what is the best treatment, we should be taken into account the severity, gestational age and patient conditions. Within the spectrum mentioned in the management include calcium antagonists and nitrates, however these have restrictions in pregnancy, another options are botulinum toxin, endoscopic pneumatic dilation, laparoscopic Heller myotomy and recently POEM. In pregnancy there is a few evidence in the literature and in this moment there are about 40 reported cases, some with complications such as fetal loss and maternal death. We present our experience at the San Ignacio University Hospital in Bogotá, Colombia, with a 26-year-old woman with a novo diagnosis of achalasia type II during the first trimester of pregnancy, with a clinical history of severe dysphagia associated with malnutrition. She was management with enteral nutrition support with nasogastric tube to achieve repletion of the body mass index (BMI) and after that, she had a endoscopic management with Rigiflex balloon dilation. It allowed to successfully carry out pregnancy without adverse effects on the mother or the fetus, with adequate evolution and oral tolerance without dysphagia. We consider that nutritional support is important prior to taking a desicion with this type of patient, in addition that endoscopic management with balloon dilation can be safe and effective for the management of achalasia in pregnancy.

Rotura hepática en gestante residente en gran altura y la utilidad del monitoreo hemodinámico con doppler transesofágico / Hepatic rupture in a pregnant woman resident at high altitude and the usefulness of hemodynamic monitoring with transesophageal Doppler

RESUMEN La rotura hepática es una complicación poco frecuente de la gestación que se asocia a preeclampsia y síndrome HELLP, aumentando la morbimortalidad materna. No hay reportados casos de esta patología en gestantes residentes en altura, a pesar de que se considera a la altura como un factor que influye en la gestación. En este artículo se reporta el caso de una gestante residente de la gran altura, la cual evidenció una rotura hepática con sangrado persistente, siendo reintervenida por cirugía de emergencia oportunamente gracias al monitoreo hemodinámico con doppler transesofágico.

ABSTRACT Hepatic rupture is a rare complication of pregnancy associated with preeclampsia and HELLP syndrome, thus increasing maternal morbidity and mortality. There are no reported cases of this condition in high-altitude dweller pregnant women, even though altitude is considered a factor that influences in pregnancy. In this article the case of a pregnant dweller at high altitude is reported, which revealed hepatic rupture with persistent bleeding, being reoperated by Emergency Surgery appropriately thanks to the hemodynamic monitoring with transesophageal Doppler

Oxigenoterapia a alto flujo con cánula nasal en el tratamiento de la falla respiratoria aguda hipoxémica en una paciente embarazada: reporte de un caso / High-flow nasal cannula in the treatment of acute hypoxemic respiratory failure in a pregnant patient: case report

RESUMEN Existe poca evidencia que avale el uso de ventilación mecánica no invasiva en falla respiratoria aguda hipoxémica. Sin embargo, considerando las complicaciones asociadas a la intubación endotraqueal, se intentó implementar ventilación mecánica no invasiva en una paciente de 24 años cursando 32 semanas de gestación, que ingresó a la unidad de cuidados intensivos con falla respiratoria aguda hipoxémica y sepsis a foco urinario. La falta de tolerancia a la ventilación mecánica no invasiva, nos indujo a utilizar un método alternativo con el fin de evitar la intubación endotraqueal. La implementación de terapia con oxígeno a alto flujo a través de cánula nasal permitió superar la situación, presentando a ésta técnica como una opción de tratamiento en pacientes obstétricas críticas, segura tanto para la madre como para el feto.

ABSTRACT Little evidence exists to support the use of noninvasive mechanical ventilation for acute hypoxemic respiratory failure. However, considering the complications associated with endotracheal intubation, we attempted to implement noninvasive mechanical ventilation in a 24-year-old patient who was 32 weeks pregnant and was admitted to the intensive care unit with acute hypoxemic respiratory failure and sepsis secondary to a urinary tract infection. Lack of tolerance to noninvasive mechanical ventilation led us to use an alternative method to avoid endotracheal intubation. The use of high-flow nasal cannula allowed to overcome this situation, wich supports this technique as a treatment option for critical obstetric patients that is safe for both the mother and fetus.

Systemic lupus erythematosus and pregnancy: A single-center observational study of 69 pregnancies / Lúpus eritematoso sistêmico e gravidez: estudo observacional em um único centro com 69 gestações

Abstract Objective To evaluate the effects of pregnancy in systemic lupus erythematosus (SLE) patients. Methods The present article is a retrospective cohort study. Datawere collected from medical records of pregnant women with SLE from January 2002 to December 2012 at Universidade Estadual de Campinas, in the city of Campinas, state of São Paulo, Brazil. Systemic lupus erythematosus and disease activity were defined according to the American College of Rheumatology and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria respectively. The means, standard deviations (SDs), percentages and correlations were performed using the SAS software, version 9.4 (SAS Institute Inc., Cary, NC, US). Results We obtained data from 69 pregnancies in 58 women. During pregnancy, a new flare was observed in 39.2% (n = 27). The manifestations were most common in patients with prior kidney disease, and mainly occurred during the third quarter and the puerperium. Renal activity occurred in 24.6% (n = 17), and serious activity, in 16% (n = 11). Of all deliveries, 75% (n = 48) were by cesarean section. Twomaternal deaths occurred (3%). Preterm birth was themain complication in the newborns. The abortion rate was 8.7%. Severe SLEDAI during pregnancy was associated with prematurity (100%) and perinatal death (54%). Conclusion Thematernal-fetal outcome is worse in SLE when thewomen experience a flare during pregnancy. The best maternal-fetal outcomes occur when the disease is in remission for at least 6 months before the pregnancy.

Resumo Objetivo Avaliar os efeitos da gravidez em pacientes com lúpus eritematoso sistêmico (LES). Métodos Estudo de coorte retrospectivo. Os dados foram coletados de prontuários de mulheres com LES que engravidaram de janeiro de 2002 a dezembro de 2012 na Universidade Estadual de Campinas, São Paulo, Brasil. Lúpus eritematoso sistêmico e atividade da doença foram definidos segundo o American College of Rheumatology e os critérios doÍndice deAtividadedaDoença de Lúpus Eritematoso (SLEDAI, nasigla eminglês), respectivamente. As médias, os desvios-padrão (DP), as porcentagens e as correlações foram realizados utilizando o software SAS, versão 9.4 (SAS Institute Inc., Cary, NC, US). Resultados Obtivemos dados de 69 gestações em58mulheres. Durante a gravidez, a reatividade da doença foi observada em 39.2% (n = 27). As manifestações mais comuns foram em pacientes com doença renal prévia, e ocorreram principalmente no terceiro trimestre e no puerpério. Atividade renal ocorreu em 24,6% (n = 17), e atividade grave, em 16% (n = 11). De todos os partos, 75% (n = 48) foram por cesariana. Dois óbitos maternos ocorreram (3%). A prematuridade foi a principal complicação nos recém-nascidos. A taxa de aborto foi de 8,7%. O índice SLEDAI grave durante a gestação foi associado à prematuridade (100%) e à morte perinatal (54%). Conclusão O resultado materno-fetal é pior no LES quando as mulheres sofrem crise de reativação durante a gravidez. Os melhores desfechos materno-fetais ocorrem quando a doença está em remissão por pelo menos 6 meses anteriores à gestação.

Espiritualidad y salud: problemas de salud durante el embarazo y el puerperio y sus consecuencias en las trayectorias de mujeres y niños (Salta, Argentina) / Spirituality and health: problems during pregnancy and postpartum and their consequences in women and children's life trajectories (Salta, Argentina)

RESUMEN Este trabajo aborda la relación entre salud y espiritualidad a través del análisis de la narrativa de padecimientos que ocurren durante el embarazo y el puerperio y afectan a mujeres y niños en comunidades rurales de Molinos (Valles Calchaquíes, Salta). Se basa en una investigación desarrollada entre 2009 y 2017, en el marco de la cual se realizaron 33 entrevistas semiestructuradas a mujeres cuidadoras de niños menores de seis años, y en la que se focalizó en el modo en que las entrevistadas presentaban las secuencias de eventos que rodeaban la emergencia de problemas de salud propios y de sus hijos, en las que se conjugan aspectos orgánicos, emocionales y espirituales tanto en su etiología como en su terapéutica. Tomamos como ejemplos de análisis el susto y sus variantes, la recaída y la matriz. Los sentidos otorgados a estos padecimientos ponen de relieve la dimensión espiritual que justifica la apelación a recursos médicos tradicionales. Nuestro enfoque busca trascender la perspectiva taxonómica y esencialista para dar cuenta de los aspectos procesuales involucrados en la experiencia de enfermar.

ABSTRACT This article addresses the relationship between health and spirituality through the analysis of narratives of illnesses that occur during pregnancy and postpartum and that affect women and children in rural communities of Molinos (Calchaquí Valleys, Salta). It is based on research carried out from 2009-2017, in which 33 semi-structured interviews were conducted with women caring for children under six years of age. We focused on the way in which the interviewed women presented the sequence of events surrounding the emergence of illnesses affecting their own health and that of their children, in which organic, emotional and spiritual aspects interact in both the etiology of the illness and its treatment. We analyze as an example susto [fright] and its variations, as well as recaida [relapse] and matriz [womb]. The meanings attributed to these illnesses stress the spiritual dimension involved that justifies the use of traditional medicine resources. Our approach seeks to go beyond a taxonomic and essentialist perspective to focus on aspects involved in the process of the experience of illness.

A critical review on obstetric follow-up of women affected by systemic lupus erythematosus / Uma revisão crítica sobre o acompanhamento obstétrico de mulheres com lúpus eritematoso sistêmico

Abstract Objective To review the existing recommendations on the prenatal care of women with systemic lupus erythematosus (SLE), based on currently available scientific evidence. Methods An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed), EMBASE and The Cochrane Library databases, using the medical subject headings (MeSH) terms "systemic lupus erythematosus" AND "high-risk pregnancy" OR "prenatal care." Studies published in English between 2007 and 2017 were included; experimental studies and case reports were excluded. In cases of disagreement regarding the inclusion of studies, a third senior researcher was consulted. Forty titles were initially identified; four duplicates were excluded. After reading the abstracts, 7 were further excluded and 29 were selected for a full-text evaluation. Results Systemic lupus erythematosus flares, preeclampsia, gestation loss, preterm birth, fetal growth restriction and neonatal lupus syndromes (mainly congenital heartblock) were the major complications described. The multidisciplinary team should adopt a specific monitoring, with particular therapeutic protocols. There are safe and effective drug options that should be prescribed for a good control of SLE activity. Conclusion Pregnant women with SLE present an increased risk for maternal complications, pregnancy loss and other adverse outcomes. The disease activity may worsen and, thereby, increase the risk of other maternal-fetal complications. Thus, maintaining an adequate control of disease activity and treating flares quickly should be a central goal during prenatal care.

Resumo Objetivo Revisar as recomendações existentes sobre o cuidado pré-natal às mulheres comlúpus eritematoso sistêmico (LES), combase emevidências científicas atualmente disponíveis. Métodos Revisão integrativa realizada por dois pesquisadores independentes, com base na literatura disponível nos bancos de dados MEDLINE (via PubMed), EMBASE e The Cochrane Library, usando os cabeçalhos de assuntos médicos, ou termos MeSH, "systemic lupus erythematosus" E "high-risk pregnancy" OU "prenatal care." Estudos publicados em inglês entre 2007 e 2017 foram incluídos; estudos experimentais e relatos de caso foram excluídos. Em caso de desacordo, umterceiro pesquisador sênior foi consultado. Quarenta títulos foram inicialmente identificados; quatro duplicatas foram excluídas. Após leitura dos resumos, mais 7 artigos foramexcluídos e 29 foram selecionados para uma avaliação de texto completo. Resultados Surtos de LES, pré-eclâmpsia, perda de gestação, parto prematuro, restrição de crescimento fetal e síndromes de lúpus neonatal foram as principais complicações descritas. A equipe multidisciplinar deve adotar um monitoramento específico, com protocolos terapêuticos apropriados. Há drogas seguras e eficazes que devem ser prescritas para um bom controle do LES. Conclusão Gestantes com LES apresentam risco aumentado de complicações maternas, perda de gravidez e outros desfechos adversos. A atividade da doença pode piorar e, assim, aumentar o risco de outras complicações. Assim, manter um controle adequado da atividade da doença e tratar rapidamente os surtos deve ser um objetivo central durante o pré-natal.

Cesación de tabaquismo en embarazo / Smoking cessation during pregnancy

In Chile, women of childbearing age and pregnant women have a high prevalence of smoking. Tobacco use during pregnancy has antenatal effects (e.g. spontaneous abortion, stillbirth) and is a risk factor for infant morbidity and mortality. All women of childbearing age should be encouraged to stop smoking, and women who are already pregnant should be continuously encouraged to stop smoking throughout their pregnancy, from the earliest possible moment to the postpartum period. We present a set of background information and recommendations for smoking cessation in pregnant women, based on international guidelines on this topic.

En Chile, las mujeres en edad fértil y las embarazadas presentan una alta prevalencia de tabaquismo. El consumo de tabaco durante el embarazo tiene efectos antenatales (por ejemplo, aborto espontáneo, mortinatalidad) y es un factor de riesgo de morbilidad y mortalidad infantil. Todas las mujeres en edad fértil deben ser alentadas a dejar de fumar, y las mujeres que ya están embarazadas deben ser alentadas a dejar de fumar continuamente durante todo el embarazo, desde el momento más precoz posible hasta el período posterior al parto. Se presenta un conjunto de antecedentes y recomendaciones para la cesación de tabaquismo en embarazadas, basadas en guías internacionales sobre este tema.