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Abstract(s)
Introdução: A gravidez ectópica é uma condição em que o embrião se desenvolve fora do
útero. É uma possível emergência médica que requer atenção imediata, pois pode ser
potencialmente fatal para a gestante. A gravidez ectópica afeta cerca de 1% a 2% de todas as
gestações, e os fatores de risco incluem histórico de gravidez ectópica anterior, infertilidade,
uso de dispositivos intrauterinos (DIU), infeção pélvica, cirurgia anterior, entre outros. Os
critérios de diagnóstico incluem sinais e sintomas clínicos, como dor abdominal aguda e
hemorragia vaginal. A ultrassonografia transvaginal é o exame de imagem padrão para
estabelecer o diagnóstico. Além disso, o nível sanguíneo de ß-hCG (hormona gonadotrofina
coriónica humana) é utilizado para identificar e estratificar uma gravidez ectópica. O
tratamento da gravidez ectópica depende da gravidade da condição e pode basear-se numa
atitude expectante, médica e/ou cirurgia. A administração de metotrexato é a opção de
tratamento clássica para gravidezes ectópicas iniciais, estáveis e de baixo risco, enquanto a
cirurgia laparoscópica ou laparotómica é necessária em casos mais graves. Apesar de ser
uma entidade rara, esta condição tem o potencial de causar graves prejuízos na saúde da
mulher, quer pelas complicações associadas à patologia como pelos efeitos secundários
associados ao tratamento.
Objetivo: Efetuar uma revisão da literatura existente tendo por base um caso clínico de
Gravidez ectópica, com o objetivo de alargar o conhecimento existente acerca desta
condição. Dado tratar-se de uma situação incomum, o conhecimento na área pode ser
aprofundado e desta forma ambiciono que o trabalho em causa possa contribuir para um
melhor entendimento desta doença estabelecendo também uma ponte com o caso clínico
ocorrido no CHUCB.
Métodos: Análise de artigos publicados entre 2013 e 2023, na PubMed, Google Scholar e
SciElo em língua inglesa, portuguesa ou espanhola.
Desenvolvimento: A gravidez ectópica (GE) é uma condição de elevada complexidade
que acarreta grandes riscos para a saúde da mulher quer pela própria patologia como pelo
tratamento a que poderá ser sujeita. Com base na revisão da literatura, determina-se que a
grande maioria de implantações ectópicas são tubárias. A tríade de sintomas, imagem
ecográfica e nível de ß-hCG são responsáveis por determinar o diagnóstico e tratamento de
uma GE. A ultrassonografia transvaginal é o método padrão para a obtenção de uma
imagem. O tratamento pode ser uma gestão expectante, medicamentoso ou cirúrgico. Os
níveis de ß-hCG e sinais clínicos são os principais orientadores terapêuticos assim como as
preferências da paciente. O tratamento conservador pode ser admitido até níveis de ß-hCG
de 1500 mIU por mL. Medições inicias superiores sugerem a necessidade de um tratamento
medicamentoso, classicamente recorrendo a metotrexato sistémico, em protocolo de dose única ou de múltipla dose. Sinais e sintomas de instabilidade hemodinâmica ou rutura
implicam um tratamento cirúrgico recorrendo-se a uma cirurgia preservadora de órgão ou
uma salpingectomia.
Conclusão: Este estudo destaca a complexidade da gravidez ectópica, ressaltando a
importância do diagnóstico preciso, tratamento individualizado e uma abordagem
multidisciplinar para garantir o melhor desfecho para as pacientes. Será necessário no
futuro, especialmente a nível nacional, um estudo que permita avaliar os tratamentos
utilizados e a sua eficácia de forma a garantir a melhoria dos cuidados futuros prestados.
Introduction: A ectopic pregnancy is a condition in which the embryo develops outside the uterus. It is a potential medical emergency that requires immediate attention, as it can be potentially fatal for the pregnant woman. Ectopic pregnancy affects approximately 1% to 2% of all pregnancies, and risk factors include a history of previous ectopic pregnancy, infertility, intrauterine device (IUD) use, pelvic infection, previous surgery, among others. Diagnostic criteria include clinical signs such as acute abdominal pain and vaginal bleeding. Transvaginal ultrasound is the standard imaging test for diagnosis. Additionally, the blood level of ß-hCG (human chorionic gonadotropin hormone) is used to identify and stratify an ectopic pregnancy. The treatment of ectopic pregnancy depends on the severity of the condition and may involve expectant management, medication, and/or surgery. Methotrexate administration is the classic treatment option for early, stable, and low-risk ectopic pregnancies, while laparoscopic or open surgery is required in more severe cases. Despite being a rare entity, this condition has the potential to cause serious harm to women's health, both due to complications associated with the pathology and the side effects associated with treatment. Objective: Conduct a literature review based on a clinical case of Ectopic Pregnancy, aiming to expand the existing knowledge about this condition. Considering it is an uncommon situation, there is an opportunity to deepen understanding in this field. The goal is for the study to contribute to a better comprehension of this disease, establishing a connection with the clinical case that occurred at CHUCB. Method: A review of articles published between 2013 and 2023 was conducted using PubMed, Google Scholar, and SciELO. The search encompassed literature in English, Portuguese, or Spanish. Discussion: Ectopic Pregnancy (EP) is a highly complex condition that poses significant health risks for women, both due to the pathology itself and the potential treatments involved. Based on the literature review, the majority of ectopic implantations occur in the fallopian tubes. The triad of symptoms, ultrasound imaging, and ß-hCG levels are crucial for diagnosis and treatment decisions in EP. Transvaginal ultrasound is the standard method for obtaining imaging. Treatment options include expectant management, medication, or surgery. ß-hCG levels and clinical signs guide therapeutic choices, along with patient preferences. Conservative treatment may be considered for ß-hCG levels up to 1500 mIU/mL. Initial measurements higher than this suggests the need for medication, typically systemic methotrexate, in a single- or multi-dose protocol. Signs and symptoms of hemodynamic instability or rupture warrant surgical intervention, involving either organpreserving surgery or salpingectomy. Conclusion: This study underscores the complexity of ectopic pregnancy, emphasizing the significance of accurate diagnosis, individualized treatment, and a multidisciplinary approach to ensure the best outcome for patients. Future research, particularly at the national level, is essential to assess the treatments employed and their effectiveness, aiming to enhance future care provided.
Introduction: A ectopic pregnancy is a condition in which the embryo develops outside the uterus. It is a potential medical emergency that requires immediate attention, as it can be potentially fatal for the pregnant woman. Ectopic pregnancy affects approximately 1% to 2% of all pregnancies, and risk factors include a history of previous ectopic pregnancy, infertility, intrauterine device (IUD) use, pelvic infection, previous surgery, among others. Diagnostic criteria include clinical signs such as acute abdominal pain and vaginal bleeding. Transvaginal ultrasound is the standard imaging test for diagnosis. Additionally, the blood level of ß-hCG (human chorionic gonadotropin hormone) is used to identify and stratify an ectopic pregnancy. The treatment of ectopic pregnancy depends on the severity of the condition and may involve expectant management, medication, and/or surgery. Methotrexate administration is the classic treatment option for early, stable, and low-risk ectopic pregnancies, while laparoscopic or open surgery is required in more severe cases. Despite being a rare entity, this condition has the potential to cause serious harm to women's health, both due to complications associated with the pathology and the side effects associated with treatment. Objective: Conduct a literature review based on a clinical case of Ectopic Pregnancy, aiming to expand the existing knowledge about this condition. Considering it is an uncommon situation, there is an opportunity to deepen understanding in this field. The goal is for the study to contribute to a better comprehension of this disease, establishing a connection with the clinical case that occurred at CHUCB. Method: A review of articles published between 2013 and 2023 was conducted using PubMed, Google Scholar, and SciELO. The search encompassed literature in English, Portuguese, or Spanish. Discussion: Ectopic Pregnancy (EP) is a highly complex condition that poses significant health risks for women, both due to the pathology itself and the potential treatments involved. Based on the literature review, the majority of ectopic implantations occur in the fallopian tubes. The triad of symptoms, ultrasound imaging, and ß-hCG levels are crucial for diagnosis and treatment decisions in EP. Transvaginal ultrasound is the standard method for obtaining imaging. Treatment options include expectant management, medication, or surgery. ß-hCG levels and clinical signs guide therapeutic choices, along with patient preferences. Conservative treatment may be considered for ß-hCG levels up to 1500 mIU/mL. Initial measurements higher than this suggests the need for medication, typically systemic methotrexate, in a single- or multi-dose protocol. Signs and symptoms of hemodynamic instability or rupture warrant surgical intervention, involving either organpreserving surgery or salpingectomy. Conclusion: This study underscores the complexity of ectopic pregnancy, emphasizing the significance of accurate diagnosis, individualized treatment, and a multidisciplinary approach to ensure the best outcome for patients. Future research, particularly at the national level, is essential to assess the treatments employed and their effectiveness, aiming to enhance future care provided.
Description
Keywords
Gestão Diagnóstico Epidemiologia Gravidez Ectópica Tratamento