ABSTRACT
This article describes three complicated cases in rheumatology and pregnancy. The first case elucidates the challenges in treating SLE in conjunction with pulmonary arterial hypertension, while the second case features an SLE-affected pregnancy with development of portal hypertension secondary to portal vein thrombosis related to APS. The third case is a pregnant woman with stable SLE who developed thrombotic microangiopathy caused by atypical haemolytic uraemic syndrome, and failed to improve despite multiple measures including biopsy and elective preterm delivery. There are grave and unique challenges for women with autoimmune disease, but adverse outcomes can sometimes be avoided with careful and multidisciplinary medical management. Pre-conception counselling with regard to medications and disease treatment should also include discussion of the advisability of pregnancy, which may be difficult for a patient, but present the best course for optimizing health outcomes.
Subject(s)
Lupus Erythematosus, Systemic/therapy , Pregnancy Complications, Cardiovascular/therapy , Pregnancy Complications, Hematologic/therapy , Adult , Atypical Hemolytic Uremic Syndrome/complications , Atypical Hemolytic Uremic Syndrome/therapy , Female , Humans , Hypertension, Portal/etiology , Hypertension, Portal/therapy , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Lupus Erythematosus, Systemic/complications , Portal Vein , Pregnancy , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Complications, Hematologic/etiology , Pregnancy Outcome , Thrombotic Microangiopathies/etiology , Thrombotic Microangiopathies/therapy , Venous Thrombosis/complications , Venous Thrombosis/therapy , Young AdultABSTRACT
Objetivos: Descrever as características do choque séptico em pediatria, seus critérios diagnósticos e tratamento atual. Métodos: Revisão da literatura publicada entre 2013 e 2018 no banco de dados PubMed e LILACS, utilizando as palavras-chave "Shock", "Septic", "Child" e "Infant". Resultados: O choque séptico é uma sepse com disfunção cardiovascular. Seu diagnóstico requer a suspeita ou a confirmação de uma infecção além de sinais de choque, que apresenta sinais de disfunção cardiovascular após a reposição de 40 ml/kg de volume cristaloide. O atendimento na primeira hora após o choque é crucial para um bom prognóstico, devendo seguir os passos: monitorização, oxigenação e via aérea, circulação, antibioticoterapia, drogas vasoativas e o encaminhamento do paciente para uma Unidade de Terapia Intensiva Pediátrica. Conclusão: Choque séptico é a uma das principais causas de morte em pediatria. Seu reconhecimento e tratamento adequado, feito de forma precoce, são cruciais para diminuir a chance de evolução para choque refratário e disfunção de múltiplos órgãos, condições de alta morbimortalidade.
Aims: To describe the characteristics of septic shock in pediatrics, diagnostic criteria and current treatment.Methods: Literature review between 2013 and 2018 in the PubMed and LILACS database, using the keywords "Shock", "Septic", "Child" and "Infant". Results: Septic shock is a sepsis with cardiovascular dysfunction. Its diagnosis requires the suspicion or confirmation of an infection in addition to signs of shock, which shows signs of cardiovascular dysfunction after the replacement of 40 ml / kg of crystalloid volume. The first hour after the shock is crucial for a good prognosis and should follow the steps: monitoring, oxygenation and airway, circulation, antibiotic therapy, vasoactive drugs and the referral of the patient to a Pediatric Intensive Care Unit. Conclusion: Septic shock is one of the leading causes of death in pediatrics. Its recognition and proper treatment early is crucial to decrease the chance of evolution to refractory shock and dysfunction of multiple organs, conditions of high morbidity and mortality.
