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Restrição de crescimento fetal tardia : análise dos desfechos perinatais
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Restrição de crescimento fetal (RCF) define-se como uma situação em que o feto não atinge o seu potencial de crescimento, e pode ter várias etiologias. Relativamente à RCF por fatores placentários, existem dois subgrupos: RCF precoce e tardia, que se distinguem pela idade gestacional em que surgem, e pela forma de apresentação clínica e progressão. Esta investigação tem por objetivo analisar os desfechos perinatais das gestações complicadas por RCF tardia cuja vigilância foi feita de acordo com o protocolo instituído em 2019. Para este efeito foram avaliados os seguintes desfechos perinatais: a idade gestacional no parto, a indicação para parto pré-termo, o tipo de parto, o peso ao nascer, a presença de índice de Apgar <7 ao 5’ minuto de vida, necessidade de internamento em Unidade de Cuidados Intensivos Neonatais, retinopatia grave, hemorragia cerebral, sépsis e morte fetal. Foram incluídas 37 gestações complicadas por restrição de crescimento fetal tardia. A idade gestacional média no parto foi 37 semanas, tendo-se verificado um total de 6 partos pré-termo (16,2%). 64,9% dos partos foram distócicos, incluindo 6 cesarianas (16,2%) por estado fetal não tranquilizador. Foram admitidos em UCIN cerca de um terço dos recém-nascidos, e não se verificaram casos de morte fetal. Os desfechos neonatais observados foram: hemorragia cerebral, enterocolite necrotizante e sépsis. Não há, até à data, tratamento clínico eficaz para a RCF tardia. Assim, o estabelecimento de abordagens padrão para a vigilância e decisão sobre o momento do parto é fundamental no sentido de otimizar os cuidados de saúde prestados e melhorar os desfechos destas gestações.
Fetal growth restriction (FGR) is defined as a situation in which the fetus doesn’t reach its growth potential, and it may have multiple etiologies. Regarding FGR caused by placental factors, there are two subgroups: early-onset FGR and late-onset FGR, that differ on the gestational age at onset but also on their presentation and progression. This investigation aims to analyze the perinatal outcomes of the pregnancies complicated with late-onset FGR whose surveillance was made according to the criteria instituted in 2019. The assessed perinatal outcomes were gestational age at birth, preterm labour indication, type of delivery, birth weight, Apgar index below 7 at the 5th minute of life, the need to be admitted in the neonatal intensive care unit, and also individual neonatal outcomes such as severe retinopathy, cerebral hemorrhage, sepsis and fetal death. There were 37 pregnancies complicated with FGR included in this study. The mean gestational age at birth was 37 weeks, having verified a total of 6 preterm births (16,2%). 64,9% of labours were dystocic, including 6 cesarean deliveries for non reassuring fetal state (16,2%). One third of newborns were admitted to NICU, and there were no cases of fetal death. The individual outcomes were: cerebral hemorrhage, necrotizing enterocolitis and sepsis. Currently, no effective treatment has been developed, hence the importance of establishing approach patterns and surveillance protocols (particularly the decision concerning the timing of the delivery), in order to improve prenatal care and the outcomes of these pregnancies.
Fetal growth restriction (FGR) is defined as a situation in which the fetus doesn’t reach its growth potential, and it may have multiple etiologies. Regarding FGR caused by placental factors, there are two subgroups: early-onset FGR and late-onset FGR, that differ on the gestational age at onset but also on their presentation and progression. This investigation aims to analyze the perinatal outcomes of the pregnancies complicated with late-onset FGR whose surveillance was made according to the criteria instituted in 2019. The assessed perinatal outcomes were gestational age at birth, preterm labour indication, type of delivery, birth weight, Apgar index below 7 at the 5th minute of life, the need to be admitted in the neonatal intensive care unit, and also individual neonatal outcomes such as severe retinopathy, cerebral hemorrhage, sepsis and fetal death. There were 37 pregnancies complicated with FGR included in this study. The mean gestational age at birth was 37 weeks, having verified a total of 6 preterm births (16,2%). 64,9% of labours were dystocic, including 6 cesarean deliveries for non reassuring fetal state (16,2%). One third of newborns were admitted to NICU, and there were no cases of fetal death. The individual outcomes were: cerebral hemorrhage, necrotizing enterocolitis and sepsis. Currently, no effective treatment has been developed, hence the importance of establishing approach patterns and surveillance protocols (particularly the decision concerning the timing of the delivery), in order to improve prenatal care and the outcomes of these pregnancies.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Restrição de crescimento fetal Restrição de crescimento fetal tardia Desfechos perinatais