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Sépsis puerperal vs Embolia de Líquido Amniótico: Reflexão Acerca de um Caso Clínico
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Abstract(s)
A sépsis materna e a embolia de líquido amniótico são das principais causas globais de
mortalidade materna.
A sépsis materna, que engloba a sépsis puerperal, é uma disfunção orgânica que ocorre
em resposta a uma infeção durante a gravidez, parto, puerpério ou após aborto. Os seus
sinais e sintomas são inicialmente ténues, podendo ser mascarados pelas alterações
adaptativas da gravidez e do puerpério. O diagnóstico é clínico e o tratamento implica
um reconhecimento precoce com terapêutica antibiótica, associados a tratamento de
suporte.
Uma embolia de líquido amniótico, é uma síndrome rara que ocorre quando líquido
amniótico entra na circulação pulmonar materna resultando num colapso materno
súbito, com hipotensão, hipoxia e coagulopatia. É necessário um elevado nível de
suspeição para realizar o diagnóstico, sendo este clínico e o seu tratamento é
inteiramente de suporte.
Caso Clínico: Doente do sexo feminino, primigesta, recorreu ao Serviço de Urgência às
40 semanas e dois dias de gestação, por sensação de contratilidade uterina. Teve um
parto distócico e um pós-parto atípico, com instabilidade hemodinâmica marcada, com
hipotensão, trombocitopenia, parâmetros inflamatórios aumentados, etc. Sépsis e
embolia de líquido amniótico foram duas hipóteses diagnósticas consideradas. A doente
foi transferida para o Serviço de Medicina Intensiva onde lhe foi prestado tratamento de
suporte, com transfusão de componentes sanguíneos, administração de antibioterapia
empírica, oxigeno e fluidoterapia, entre outros, tendo alta sem complicações.
Após análise, conclui-se que o diagnóstico mais adequado para o caso será sépsis
puerperal, sendo que o outcome positivo resultou de uma atuação multidisciplinar,
rápida e eficaz de acordo com os achados.
Maternal sepsis and amniotic fluid embolism are among the leading global causes of maternal mortality. Maternal sepsis, which includes puerperal sepsis, is an organ dysfunction that occurs in response to an infection during pregnancy, labour, the puerperium or after miscarriage. Its signs and symptoms are initially tenuous and can be masked by the adaptive changes of pregnancy and the puerperium. Diagnosis is clinical and treatment involves early recognition, antibiotic therapy and supportive treatment. Amniotic fluid embolism is a rare syndrome that occurs when amniotic fluid enters the maternal pulmonary circulation, resulting in sudden maternal collapse with hypotension, hypoxia and coagulopathy. It requires a high level of suspicion for diagnosis, which is clinical, and its treatment is entirely supportive. Clinical Case: Female patient, primigravida, who came to the Emergency Department at 40 weeks and two days gestation due to uterine contraction sensation. She had a dystocic labour and atypical postpartum, with marked haemodynamic instability, hypotension, thrombocytopenia, increased inflammatory parameters, etc. Sepsis and amniotic fluid embolism were two diagnostic hypotheses considered. The patient was transferred to the Intensive Care Unit where she was given supportive treatment, with blood component transfusions, empirical antibiotherapy, oxygen and fluid therapy, among others, and was discharged without complications. After analysis, it was concluded that the most appropriate diagnosis for the case was puerperal sepsis, and that the positive outcome was the result of multidisciplinary action that was swift and effective according to the findings.
Maternal sepsis and amniotic fluid embolism are among the leading global causes of maternal mortality. Maternal sepsis, which includes puerperal sepsis, is an organ dysfunction that occurs in response to an infection during pregnancy, labour, the puerperium or after miscarriage. Its signs and symptoms are initially tenuous and can be masked by the adaptive changes of pregnancy and the puerperium. Diagnosis is clinical and treatment involves early recognition, antibiotic therapy and supportive treatment. Amniotic fluid embolism is a rare syndrome that occurs when amniotic fluid enters the maternal pulmonary circulation, resulting in sudden maternal collapse with hypotension, hypoxia and coagulopathy. It requires a high level of suspicion for diagnosis, which is clinical, and its treatment is entirely supportive. Clinical Case: Female patient, primigravida, who came to the Emergency Department at 40 weeks and two days gestation due to uterine contraction sensation. She had a dystocic labour and atypical postpartum, with marked haemodynamic instability, hypotension, thrombocytopenia, increased inflammatory parameters, etc. Sepsis and amniotic fluid embolism were two diagnostic hypotheses considered. The patient was transferred to the Intensive Care Unit where she was given supportive treatment, with blood component transfusions, empirical antibiotherapy, oxygen and fluid therapy, among others, and was discharged without complications. After analysis, it was concluded that the most appropriate diagnosis for the case was puerperal sepsis, and that the positive outcome was the result of multidisciplinary action that was swift and effective according to the findings.
Description
Keywords
Embolia de Líquido Amniótico Infeção Pós-Parto Mortalidade Materna Sépsis Materna Sépsis Puerperal