Résumé
Relato de evolução de paciente com infecção por dengue associada com a gestação. A Dengue constitui-se em doença de grande incidência nos países tropicais. Sua ocorrência pode ser de difícil diagnóstico quando junto com a gravidez, pelas modificações que a gestação determina sobre vários parâmetros laboratoriais. Na maioria das vezes, não há intercorrências, apesar dos relatos da dengue com prematuridade e morte fetal. As manifestações da dengue são semelhantes em gestantes e não gestantes ; mas alto grau de suspeição clínica favorece seu diagnóstico precoce.
When dengue, an infection with increasing incidence among the tropical area, occurs in pregnancy it could provide difficult in diagnoses. V. P. C., 20 years old, between the 19th and 20th week of pregnancy, admitted to the hospital with high-grade fever for two days, associated with myalgia, arthralgia, retro-orbital pain, exanthema in anterior chest, and gingival bleeding. The score of platelets and hematometria exams were made and the serologic test detected IgM antibodies and the tourniquet test was negative. Warning signal was not observed. The patient did not show signs of gravity and was follow-up by medical care in the health center. The normal physiological changes in pregnancy could confuse the laboratory exams used at the follow up of pregnant. The treatment was based on control of temperature, hydration oral, and intravenous fluid replacement. Most pregnancies progressed with no complications, besides some works show that there is a relationship between infection and prematurity/fetal death. The clinical picture of dengue is similar in pregnancy and non-pregnancy. However, the high index of suspicion in patients can provides an early diagnosis.
Sujets)
Humains , Femelle , Grossesse , Adulte , Complications de la grossesse , Dengue/diagnostic , Diagnostic différentielRésumé
Paciente de 36 anos de idade evoluiu com atonia uterina, sendo submetida a histerectomiasubtotal e ligadura de artérias ilíacas internas. O pós-operatório cursou com choquehemorrágico grave, acidose, hipotermia e coagulopatia. Foi necessária a realizaçãode relaparotomia que mostrou 3 L de hemoperitônio e sangramento ativo no local dahisterectomia. O sangramento foi controlado por tamponamento intra-abdominal eoclusão abdominal temporária. Após controle das condições fisiológicas da paciente,realizou-se relaparotomia para remoção do tamponamento abdominal e laparorrafiadefinitiva.
A 36-year-old woman developed uterine atonia and was submitted to a subtotal hys-terectomy and bilateral internal iliac artery ligation. At Intensive Care Unit the patient presented with a major hemorrhage shock, acidosis, hypothermia, and coagulopathy. A relaparotomy showed 3 L of hemoperitoneum and active bleeding from the hysterectomy site, which was controlled by intra-abdominal packing and temporary abdominal closure. After improvement of the patientÆs physiology, a planned re-operative procedure was performed to remove the packs and definitive abdominal closure.