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A grávida em hemodiálise : abordagem e desfechos maternos, obstétricos e perinatais
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Abstract(s)
A gravidez no estádio G5 da doença renal crónica é um evento raro dada a elevada prevalência de infertilidade e disfunção sexual neste grupo de mulheres. O diagnóstico da gestação pode ser difícil e é geralmente tardio. Ao longo dos anos, os avanços na abordagem da grávida em hemodiálise, através da prescrição de hemodiálise intensiva e de um melhor controlo metabólico e hemodinâmico, permitiram diminuir a incidência de desfechos adversos nomeadamente parto pré-termo, polihidrâmnios e baixo peso ao nascer, reduzindo significativamente a mortalidade perinatal. O sucesso da gestação depende de um aconselhamento multidisciplinar pré-concecional para planeamento da gravidez, da prevenção e/ou controlo da patologia hipertensiva e do planeamento do parto, não descurando a importância do apoio psicológico destas mulheres na gravidez e pós-parto. Apesar do progresso positivo nos desfechos são necessários mais estudos que permitam a continuação desta melhoria nesta população.
Pregnancy with end-stage renal disease remains a rare event since the rates of infertility and sexual dysfunction are high. The diagnosis of pregnancy is difficult and often delayed in dialysis patients. The advances in the approach of pregnant women in dialysis with the use of intensive hemodialysis prescription and a better metabolic and hemodynamic control have led to a significant reduction in the incidence of adverse outcomes such as polyhydramnios, prematurity, low birth weight and perinatal mortality. Successful management depends on several factors: preconceptional multidisciplinary counseling, prevention and/or control of hypertensive disorders and appropriate planning of delivery. Moreover, psychological support is crucial during pregnancy and in the postpartum period. More data are needed in order to properly guide these women.
Pregnancy with end-stage renal disease remains a rare event since the rates of infertility and sexual dysfunction are high. The diagnosis of pregnancy is difficult and often delayed in dialysis patients. The advances in the approach of pregnant women in dialysis with the use of intensive hemodialysis prescription and a better metabolic and hemodynamic control have led to a significant reduction in the incidence of adverse outcomes such as polyhydramnios, prematurity, low birth weight and perinatal mortality. Successful management depends on several factors: preconceptional multidisciplinary counseling, prevention and/or control of hypertensive disorders and appropriate planning of delivery. Moreover, psychological support is crucial during pregnancy and in the postpartum period. More data are needed in order to properly guide these women.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Keywords
Doença renal crónica terminal Hemodiálise Gravidez Complicações maternas e fetais Obstetrícia