RESUMO
In the first case, the AA and glucose were infused through a perinatal port system into the umbilical vein at 30 weeks' gestation due to severe IUGR. The patient received daily hyperbaric oxygenation (HBO, 100% O2 ) with 1.4 atmospheres absolute for 50 min for 7 days. At 31+4 weeks' gestation, the patient gave birth spontaneously to a newborn weighing 1378 g, pH 7.33, APGAR score 4/6/intubation. In follow-up examinations at 5 years of age, the boy was doing well without any neurological disturbance or developmental delay. In the second case, the patient presented at 25/5 weeks' gestation suffering from severe IUGR received HBO and maternal AA infusions. The cardiotocography was monitored continuously during HBO treatment. The short-time variations improved during HBO from 2.9 to 9 msec. The patient developed pathologic CTG and uterine contractions 1 day later and gave birth to a hypotrophic newborn weighing 420 g. After initial adequate stabilization, the extremely preterm newborn unfortunately died 6 days later. Fetal nutrition combined with HBO is technically possible and may allow the prolongation of the pregnancy. Fetal-specific amino-acid composition would facilitate the treatment options of IUGR fetuses and extremely preterm newborn.
Assuntos
Aminoácidos/uso terapêutico , Retardo do Crescimento Fetal/terapia , Glucose/uso terapêutico , Oxigenoterapia Hiperbárica/métodos , Insuficiência Placentária/terapia , Adulto , Aminoácidos/administração & dosagem , Feminino , Retardo do Crescimento Fetal/tratamento farmacológico , Retardo do Crescimento Fetal/patologia , Glucose/administração & dosagem , Humanos , Insuficiência Placentária/tratamento farmacológico , Insuficiência Placentária/patologia , GravidezAssuntos
Nascimento Prematuro/prevenção & controle , Feminino , Humanos , Concentração de Íons de Hidrogênio , Gravidez , Complicações Infecciosas na Gravidez , Nascimento Prematuro/economia , Nascimento Prematuro/etiologia , Vagina/química , Vaginose Bacteriana/complicações , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/tratamento farmacológicoRESUMO
The aim is to present a document, which is based on current evidence and serves as a guideline for use in clinical practice. The following questions are addressed: Is the use of antenatal corticosteroids (ACS) an effective therapy? Who are the candidates for antenatal corticosteroid therapy? Is there benefit after 34 weeks' gestation? When is the optimal time to treat? Which are the optimal steroids; what is the ideal dose and route of administration? Are there any contraindications to the administration of ACS? Are antenatal corticosteroids indicated in women with premature rupture of membranes (PROM)? Is the use of ACS recommended in pregnancies complicated by maternal diabetes mellitus? Should the treatment with corticosteroids be repeated?
