RESUMO
Massive fetomaternal hemorrhage (FMH) can cause devastating pregnancy outcomes. Perinatal prognosis may be improved by intrauterine transfusion, but the appropriate management for these pregnancies remains unclear. To determine the recurrence risk of FMH after intrauterine transfusion, we performed a systematic review of all case reports/series of patients with proven FMH treated with intrauterine transfusion and who had subsequent follow-up of at least 72 h until delivery. This revealed 13 cases, with 1 additional case from our institution. Ten patients (71.4%) had a second episode of FMH requiring a second intrauterine transfusion. Five patients (35.7%) required at least 3 intrauterine transfusions. The time interval between intrauterine transfusions was progressively reduced. The gestational age at the onset of signs/symptoms was 26.6 ± 2.1 weeks, and gestational age at delivery was 34.2 ± 4.2 weeks. Two cases of fetal demise (14.3%) and no neonatal deaths were recorded. Limited postnatal follow-up on 8 neonates was normal. The mean neonatal hemoglobin and transfusion rates were 13.2 ± 5.7 g/dL and 33.3%, respectively. Close fetal monitoring, likely daily, is necessary to recognize FMH recurrence. Several transfusions may be necessary once FMH is diagnosed if pregnancy is allowed to continue > 72 h.
Assuntos
Transfusão de Sangue Intrauterina , Transfusão Feto-Materna/terapia , Adulto , Transfusão de Sangue Intrauterina/efeitos adversos , Feminino , Morte Fetal , Monitorização Fetal , Transfusão Feto-Materna/diagnóstico , Transfusão Feto-Materna/fisiopatologia , Idade Gestacional , Humanos , Nascido Vivo , Gravidez , Recidiva , Retratamento , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Domestic violence is a serious, complex, public health problem, which is more common than many physicians realize. Although certain characteristics may be associated with the victim and perpetrator, they have limited value in identification or prediction of partner violence. Any woman may be a victim and any man, a perpetrator; therefore, universal screening for partner abuse is encouraged. The medical and psychological consequences of domestic violence are often of tragic proportion, for both the woman and her children. Unfortunately, unless asked directly and in a supportive fashion, many women will remain silent and continue to be victimized.
