Colestase intra-hepática da gravidez: evidências científicas para escolha do tratamento / Intrahepatic cholestasis of pregnancy: scientific evidence for choice of treatment

A colestase intra-hepática da gravidez caracteriza-se pelo aparecimento de prurido generalizado no segundo ou terceiro trimestre gestacional e alterações dos ácidos biliares e das enzimas hepáticas. Sua etiologia não é totalmente conhecida, mas pode comprometer o prognóstico perinatal. Esta revisão teve como objetivo avaliar as principais opções terapêuticas desta intercorrência, com base nas melhores evidências científicas disponíveis. O tratamento dessa colestase permanece polêmico. Entre as opções medicamentosas, o uso do ácido ursodesoxicólico parece ser a melhor, favorecendo melhoria do prognóstico perinatal.(AU)

Intrahepatic cholestasis of pregnancy is characterized by the appearance of generalized pruritus in the second or third trimester with changes in bile acids and liver enzymes. Its etiology is not fully known but may impair the perinatal outcome. This review aimed to evaluate the main therapeutic options for this complication based on the best available scientific evidence. The treatment of this cholestasis remains controversial. Among the drug options the use of ursodeoxycholic acid appears to be the best choice to improve the perinatal outcome.(AU)

Conservative management of cervical pregnancy with embryonic heart activity by ultrasound-guided local injection: an eight case series.

OBJECTIVE: To evaluate the efficacy of conservative management of cervical pregnancy with embryonic heart activity by ultrasound-guided local injection. METHODS: Retrospective case series at University tertiary care Hospital. Eight patients diagnosed with cervical pregnancy with embryonic heart activity managed conservatively. The intervention was ultrasound-guided local injection of methotrexate (1 mg/kg) and potassium chloride (2 meq/mL). Measurements were occurrence of morbidity, necessity for further intervention, the initial titers of beta-hCG, interval of time in which the levels of beta-hCG became negative, period for regression of cervical pregnancy at ultrasound and future pregnancy. RESULTS: All patients were treated successfully. The initial levels of beta-hCG ranged from 3013 to 71199 mUI/mL. One case evaluated with infection. There was no need for additional intervention in our series study. The interval of time for the levels of beta-hCG becomes negative range from 2 to 12 weeks. The period for the regression of the cervical pregnancy at ultrasound range from 3 to 14 weeks. In two cases intrauterine pregnancies occurred after the treatment. CONCLUSION: Conservative management of cervical pregnancy with embryonic heart activity by ultrasound-guided injection is an effective treatment avoiding the need of further intervention.

Gravidez ectópica cervical com embrião vivo: o uso do metotrexato é eficiente? / Cervical ectopic pregnancy with alive embryo: the use of methotrexate is effective?

A gravidez ectópica cervical é tida como de localização excepcional, representando menos de 1% das implantações ectópicas. Embora rara, constitui patologia obstétrica de elevada gravidade. Sua letalidade, no passado, atingia índices assustadores. Estabelecido o diagnóstico, a conduta clássica era a histerectomia total, pois o sangramento intravaginal oriundo do canal cervical era frequentemente mortal, diante de tentativas de tratamento conservador por curetagem e/ou sutura local, sobretudo em nulíparas, desejosas de manter a fertilidade. Mais recentemente, tem sido proposto o uso do metotrexato por via local e/ou sistêmica, por vezes associado a técnicas de ligadura e embolização arterial, como forma de evitar a cirurgia mutiladora. Este trabalho teve como objetivo buscar evidências científicas na literatura que possam avaliar a eficácia do tratamento dessas pacientes utilizando o metotrexato.

The cervical ectopic pregnancy is considered of exceptional location, less than 1% of ectopic implantations. Although rare, is extremely serious obstetric pathology. Lethality in the past, reached frightening levels. After the diagnosis, the procedure was the classic radical hysterectomy, because the bleeding originated from intravaginal cervical canal was often fatal before the attempts of conservative treatment by curettage and/or suture, especially in nulliparous women desiring to maintain fertility. More recently, it has been suggested the use of methotrexate by local and/or systemic way, frequently associated with techniques of ligation and arterial embolization, in order to avoid mutilating surgery. This study aimed to look for evidence in the scientific literature to evaluate the effectiveness of treatment of these patients using methotrexate.