Epistaxis grave durante el embarazo, resistente al tratamiento: reporte de un caso y revisión bibliográfica / Refractory severe epistaxis during pregnancy: a case report and a literature review

RESUMEN

Resumen ANTECEDENTES La epistaxis durante el embarazo, aparte de ser una urgencia, tiene una prevalencia tres veces superior a la de la población general. Se controla con medidas conservadoras, aunque a veces deben indicarse tratamientos que implican intervenciones quirúrgicas. CASO CLÍNICO Paciente de 37 años, con embarazo de 37 semanas, que acudió a Urgencias por epistaxis, sin reacción a las técnicas conservadoras (taponamiento nasal de diversa índole), que provocó anemia progresiva y requirió ligadura de la arteria esfenopalatina para detener el sangrado. Enseguida se llevó a cabo la cesárea, indicada por rotura prematura de membranas e imposibilidad de realizar la maniobra de Valsalva; nació un varón con Apgar 9-10-10. La paciente continuó con alteraciones en la anatomía de los senos paranasales debido a la intervención quirúrgica y en seguimiento en consulta de Otorrinolaringología. CONCLUSIONES: La epistaxis, aunque es un evento frecuente durante el embarazo, puede afectar a la madre y su hijo; por tanto, es importante conocer los tratamientos disponibles al respecto, notificar los nuevos casos y el tratamiento para aumentar el conocimiento de esta alteración infrecuente pero grave.

ABSTRACT

Abstract BACKGROUND: Epistaxis is a frequent emergency, which prevalence during pregnancy is three times higher than the general female population. It is usually managed with conservative measures, but sometimes more aggressive treatments like surgery may be required. Due to the limited bibliography currently available, new cases and their management should be recorded in order to assess outcomes. CASE REPORT A 37-week-old pregnant woman went to the Emergency Department with an epistaxis that did not stop despite the use of conservative techniques. As a result of progressive anemization a sphenopalatine artery ligation was required to stop the bleeding. A cesarean section was performed for premature rupture of membranes and the impossibility of Valsalva maneuver. A male infant was born with APGAR test results of 9-10-10. During follow up the patient presented changes in the anatomy of her paranasal sinuses caused by the sphenopalatine artery ligation and is being followed up by Ear-Nose-Throat specialist. CONCLUSION: Epistaxis during pregnancy rarely leads to maternal and/or fetal involvement; it is therefore essential to know all treatments available as well to record new cases and their management to increase knowledge about this uncommon but severe pathology.