Anemia grave no puerpério / Severe anemia in the puerperium

A anemia no puerpério é bastante prevalente, estando principalmente relacionada à ocorrência de anemia não corrigida durante a gestação e às hemorragias agudas durante o parto. Essas situações aumentam significativamente a probabilidade de anemia grave no período pós-parto, gerando manifestações orgânicas e psicológicas que trazem prejuízo ao binômio materno-fetal. A forma grave da doença é caracterizada laboratorialmente por hemoglobina < 7 g/dL e suas manifestações clínicas variam na dependência de diversos fatores. O objetivo do tratamento é corrigir a hipóxia tecidual, revertendo as alterações adaptativas relacionadas à carência de oxigênio. Enquanto o tratamento agressivo de perdas volêmicas agudas diminui a morbimortalidade por esses eventos, políticas restritivas de transfusão sanguínea em pacientes hemodinamicamente estáveis mostram-se benéficas. Se não houver indicação de transfusão, a reposição de ferro atuará na correção das principais etiologias, pelas vias endovenosa ou oral, na dependência de disponibilidade, custo e tolerância individual aos medicamentos disponíveis.(AU)

Anemia is quite prevalent in puerperium; in this population, the disease is mainly related to the occurrence of uncorrected anemia during pregnancy and to acute bleeding during childbirth. These situations significantly increase the likelihood of severe anemia in the postpartum period, generating organic and psychological manifestations that cause damage to the maternal-fetal binomial. The severe form of anemia is characterized by hemoglobin < 7 g/dL and its clinical manifestations vary depending on several factors. The goal of treatment is to correct tissue hypoxia, reversing adaptive changes related to oxygen deficiency. While the aggressive treatment of acute blood losses decreases the morbidity and mortality of these events, restrictive blood transfusion policies in hemodynamically stable patients are beneficial. If there is no indication for transfusion, iron replacement will act to correct the main etiologies, through the intravenous or oral routes, depending on availability, cost and individual tolerance to the available drugs.(AU)

Correlation of periodontal and microbiological evaluations, with serum levels of estradiol and progesterone, during different trimesters of gestation.

Our purpouse was to identify quantitatively and qualitatively the subgingival flora in different gestational trimesters, compared to non-pregnant women; evaluating the correlations between epidemiological characteristics, clinical diagnosis, microbiological findings and levels of estradiol and progesterone. 52 pregnant women divided into 3 groups, according to the gestational trimester and 15 non-pregnant patients, without hormonal contraceptives, were evaluated. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) were evaluated. Subgingival biofilm samples were processed by the qPCR technique and the serum levels of estradiol and progesterone quantified by chemiluminescence. Clinical diagnosis during gestation was correlated with the total bacterial count. A higher prevalence of Tannerella forsythia (Tf) was identified in first trimester of pregnancy and this periodontopathogen was correlated with the diagnosis of gingivitis among pregnant women. Porphyromonas gingivalis (Pg) showed a positive correlation with progesterone levels in the first trimester. High prevalence of periodontopathogens was noticed in this population. Clinical diagnosis in gestation was positively correlated with the total amount of bacteria, without influence of the hormonal levels or the epidemiological factors evaluated. The presence of Tf favored occurrence of gingivitis during pregnancy and the progesterone levels in the first trimester enhanced the growth of Pg.