| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 527.16 KB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
A hemorragia feto-materna é uma condição rara que deriva de uma disrupção na barreira
materno-fetal e consequente entrada de sangue fetal na circulação materna. Existem vários
fatores que podem contribuir para a sua ocorrência, no entanto, na maioria dos casos ocorre
espontaneamente sem causa identificável. A sua sintomatologia é reduzida e inespecífica,
sendo a diminuição dos movimentos fetais o sintoma mais comum, o que torna o seu
diagnóstico uma tarefa desafiante. Os testes de diagnóstico atualmente existentes, apesar
de serem um grande auxílio não são completamente fidedignos e nem sempre estão
disponíveis nas instituições, o que dificuldade ainda mais a identificação destes casos. A
gestão da hemorragia feto-materna é, também, bastante difícil sendo necessário avaliar os
riscos e os benefícios das diferentes intervenções, como a cordocentese com transfusão
intrauterina ou a realização do parto. O prognóstico da hemorragia feto-materna depende
de vários fatores como o volume da hemorragia e a hemoglobina neonatal. Esta condição
pode levar a anemia neonatal, hidropsia fetal, prematuridade, repercussões ao nível do
neurodesenvolvimento e até mesmo morte.
Assim, esta dissertação tem por objetivo reunir conhecimento científico atual relativo às
diversas vertentes da hemorragia feto-materna. Para além disso, ao expor e analisar um
caso clínico real comparando-o com a literatura científica, procura-se exemplificar a
aplicação prática do conhecimento teórico.
A metodologia aplicada na realização desta dissertação tem por base pesquisa bibliográfica
entre janeiro e setembro de 2023 nas plataformas Pubmed e Google Scholar de artigos
escritos em inglês ou português e sem aplicação de restrições temporais ou de tipologia do
texto.
O caso clínico apresentado diz respeito a uma mulher de 40 anos, sem qualquer
intercorrência na presente gravidez, que se apresenta às 37+1 semanas de gestação no
serviço de urgência por diminuição dos movimentos fetais. É realizada uma
cardiotocografia fetal que revela um padrão pouco reativo e realizada uma cesariana urgente
por suspeita de sofrimento fetal. Nasce um recém-nascido com uma hemoglobina neonatal
de 3.4 g/dl e hematócrito de 11.6%, compatível com anemia neonatal. Foi realizada pesquisa
de hemoglobina fetal na circulação materna por High Performance Liquid Chromatography
que revelou 8.5% de hemoglobina fetal. Esta criança ficou com repercussões a nível do
neurodesenvolvimento apresentando-se em consulta de follow-up aos 7 meses com achados
compatíveis com lesão neurológica. Desta forma, é fulcral que os profissionais de saúde estejam familiarizados com esta
condição para que possam atuar de forma rápida e de acordo com a melhor evidência
científica. É, ainda, importante garantir que os teste de diagnostico estão disponíveis nas
instituições e que existem profissionais capacitados para a sua atempada e eficaz utilização.
O caso clínico apresentado é sobreponível a outros relatados na literatura científica, o que
acentua a necessidade de colaboração entre instituições e comparação de casos clínicos para
atingir melhores resultados em saúde, sendo benéfico a criação de uma base de dados
global.
Feto-maternal hemorrhage is a rare condition that results from a disruption in the maternal-fetal barrier and subsequent entry of fetal blood into the maternal circulation. There are several factors that may contribute to its occurrence, however, in most cases, it occurs spontaneously without an identifiable cause. Its symptoms are reduced and nonspecific, with decreased fetal movements being the most common symptom, making its diagnosis a challenging task. Currently available diagnostic tests, although very helpful, are not entirely reliable and may not always be available in institutions, further complicating the identification of these cases. The management of feto-maternal hemorrhage is also quite difficult, requiring an assessment of the risks and benefits of different interventions, such as cordocentesis with intrauterine transfusion or performing delivery. The prognosis of feto-maternal hemorrhage depends on various factors such as the volume of hemorrhage and neonatal hemoglobin. This condition can lead to neonatal anemia, fetal hydrops, prematurity, neurodevelopmental repercussions, and even death. Thus, this dissertation aims to gather current scientific knowledge regarding the various aspects of feto-maternal hemorrhage. Additionally, by presenting and analyzing a real clinical case and comparing it with scientific literature, the aim is to illustrate the practical application of theoretical knowledge. The methodology applied in this dissertation is based on a bibliographic research conducted between January and September 2023 on the PubMed and Google Scholar platforms based, only, on articles written in English or Portuguese, with no use of temporal or text typology restrictions. The clinical case presented concerns a 40-year-old woman, with no complications in the current pregnancy, who presents at 37+1 weeks of gestation to the emergency department due to decreased fetal movements. A fetal cardiotocography is performed, revealing a mildly reactive pattern, and an urgent cesarean section is performed due to suspected fetal distress. A newborn is delivered with a neonatal hemoglobin of 3.4 g/dl and hematocrit of 11.6%, consistent with neonatal anemia. Fetal hemoglobin research in maternal circulation by High Performance Liquid Chromatography revealed 8.5% fetal hemoglobin. This child had neurodevelopmental repercussions, presenting at a follow-up consultation at 7 months with findings consistent with neurological injury. Therefore, it is crucial that healthcare professionals are familiar with this condition so they can act quickly and in accordance with the best scientific evidence. It is also important to ensure that diagnostic tests are available in institutions and that there are trained professionals for their timely and effective use. The clinical case presented is comparable to others reported in scientific literature, emphasizing the need for collaboration between institutions and comparison of clinical cases to achieve better health outcomes, making the creation of a global database beneficial.
Feto-maternal hemorrhage is a rare condition that results from a disruption in the maternal-fetal barrier and subsequent entry of fetal blood into the maternal circulation. There are several factors that may contribute to its occurrence, however, in most cases, it occurs spontaneously without an identifiable cause. Its symptoms are reduced and nonspecific, with decreased fetal movements being the most common symptom, making its diagnosis a challenging task. Currently available diagnostic tests, although very helpful, are not entirely reliable and may not always be available in institutions, further complicating the identification of these cases. The management of feto-maternal hemorrhage is also quite difficult, requiring an assessment of the risks and benefits of different interventions, such as cordocentesis with intrauterine transfusion or performing delivery. The prognosis of feto-maternal hemorrhage depends on various factors such as the volume of hemorrhage and neonatal hemoglobin. This condition can lead to neonatal anemia, fetal hydrops, prematurity, neurodevelopmental repercussions, and even death. Thus, this dissertation aims to gather current scientific knowledge regarding the various aspects of feto-maternal hemorrhage. Additionally, by presenting and analyzing a real clinical case and comparing it with scientific literature, the aim is to illustrate the practical application of theoretical knowledge. The methodology applied in this dissertation is based on a bibliographic research conducted between January and September 2023 on the PubMed and Google Scholar platforms based, only, on articles written in English or Portuguese, with no use of temporal or text typology restrictions. The clinical case presented concerns a 40-year-old woman, with no complications in the current pregnancy, who presents at 37+1 weeks of gestation to the emergency department due to decreased fetal movements. A fetal cardiotocography is performed, revealing a mildly reactive pattern, and an urgent cesarean section is performed due to suspected fetal distress. A newborn is delivered with a neonatal hemoglobin of 3.4 g/dl and hematocrit of 11.6%, consistent with neonatal anemia. Fetal hemoglobin research in maternal circulation by High Performance Liquid Chromatography revealed 8.5% fetal hemoglobin. This child had neurodevelopmental repercussions, presenting at a follow-up consultation at 7 months with findings consistent with neurological injury. Therefore, it is crucial that healthcare professionals are familiar with this condition so they can act quickly and in accordance with the best scientific evidence. It is also important to ensure that diagnostic tests are available in institutions and that there are trained professionals for their timely and effective use. The clinical case presented is comparable to others reported in scientific literature, emphasizing the need for collaboration between institutions and comparison of clinical cases to achieve better health outcomes, making the creation of a global database beneficial.
Description
Keywords
Anemia Fetal Citometria de Fluxo Hemorragia Feto-Materna Teste de Kleihauer-Betke Transfussão Feto-Materna