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Impacto da obesidade nos desfechos obstétricos relacionados com o parto e puerpério
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A prevalência da obesidade tem vindo a aumentar nas mulheres em idade fértil, o que se reflete num aumento do número de grávidas obesas. A obesidade está frequentemente associada a comorbilidades como a diabetes mellitus e a doença hipertensiva, condições estas que contribuem para o aumento de complicações obstétricas. Contudo, a própria obesidade condiciona, por si só, um risco acrescido de desfechos obstétricos adversos.
Este trabalho tem como objetivo discutir o impacto da obesidade materna pré-gestacional isolada, isto é, na ausência de outras comorbilidades e/ou complicações obstétricas, nos desfechos obstétricos do parto e puerpério. Com este fim, foi realizada uma revisão narrativa com base na pesquisa de artigos na base de dados online Pubmed.
A obesidade é um fator de risco independente para diversos desfechos obstétricos. Uma grávida obesa apresenta um maior risco de prolongamento da gestação, consequente indução do trabalho de parto e maior falência da mesma. O primeiro período do trabalho de parto é mais prolongado em grávidas obesas. No entanto, mais estudos relativamente à duração do segundo período são necessários. Quanto à via de parto, a obesidade está independentemente associada a um maior risco de cesariana, principalmente emergente. Está, ainda, associada a uma maior probabilidade de macrossomia fetal, o qual contribui para um risco acrescido de distócia de ombros neste grupo de grávidas. A obesidade, por apresentar uma menor incidência de lacerações graus III e IV, parece ser um fator protetor do períneo. No pós-parto, o tromboembolismo venoso, a hemorragia pós-parto e a infeção da ferida cirúrgica são também mais frequentes nesta população.
Assim, e por se tratar de um fator de risco modificável, é fundamental atuar de forma preventiva na redução desta condição nas mulheres em idade fértil.
The prevalence of obesity in women of childbearing age has been rising, which is then reflecting in the rise of obese pregnant women. Obesity is often linked with comorbilities such as diabetes mellitus and hypertension, conditions that contribute to a higher risk of obstetric complications. However, obesity in itself contributes to an increased risk of adverse obstetric outcomes. The aim of this work is to discuss the impact of maternal pregestational obesity as an isolated link, i.e. in the absense of other comorbilities and/or obstetric complications, in the obstetric outcomes of labor, delivery and puerperium. For this purpose, a narrative review based on the research of articles in the online database Pubmed was conducted. Obesity constitutes an isolated risk factor for a series of obstetric outcomes. A pregnant woman who is obese suffers from a higher risk of extended gestation, of consequent necessity of labour induction and of failure of the induction. The first stage of labour is longer in pregnant women who are obese. However, more studies referring to the second stage of labour are needed. In concern to the delivery method, obesity is independently linked to a higher risk of cesarean section, and particularly in emergent settings. Moreover, obesity is linked to a higher probability of fetal macrosomia, which in itself contributes to a higher risk of fetal shoulder dystocia. On the other hand, obesity seems to be a protecting factor of the perineum, since the incidence of grade III and IV lacerations is lower in obese women. Postpartum complications, such as venous thromboembolism, postpartum hemorrhage and surgical wound infection, are also more frequent in this population. Therefore, and attending to the fact that obesity constitutes a modifiable risk factor, it is fundamental to act preventively in the reduction of this condition in women of childbearing age.
The prevalence of obesity in women of childbearing age has been rising, which is then reflecting in the rise of obese pregnant women. Obesity is often linked with comorbilities such as diabetes mellitus and hypertension, conditions that contribute to a higher risk of obstetric complications. However, obesity in itself contributes to an increased risk of adverse obstetric outcomes. The aim of this work is to discuss the impact of maternal pregestational obesity as an isolated link, i.e. in the absense of other comorbilities and/or obstetric complications, in the obstetric outcomes of labor, delivery and puerperium. For this purpose, a narrative review based on the research of articles in the online database Pubmed was conducted. Obesity constitutes an isolated risk factor for a series of obstetric outcomes. A pregnant woman who is obese suffers from a higher risk of extended gestation, of consequent necessity of labour induction and of failure of the induction. The first stage of labour is longer in pregnant women who are obese. However, more studies referring to the second stage of labour are needed. In concern to the delivery method, obesity is independently linked to a higher risk of cesarean section, and particularly in emergent settings. Moreover, obesity is linked to a higher probability of fetal macrosomia, which in itself contributes to a higher risk of fetal shoulder dystocia. On the other hand, obesity seems to be a protecting factor of the perineum, since the incidence of grade III and IV lacerations is lower in obese women. Postpartum complications, such as venous thromboembolism, postpartum hemorrhage and surgical wound infection, are also more frequent in this population. Therefore, and attending to the fact that obesity constitutes a modifiable risk factor, it is fundamental to act preventively in the reduction of this condition in women of childbearing age.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Obesidade Risco independente Trabalho de parto Parto Pós-parto Obstetrícia