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Abordagem da grávida com hipertensão portal : a propósito de um caso clínico
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Resumo(s)
A gravidez em mulheres com diagnóstico de hipertensão portal não-cirrótica é um acontecimento pouco frequente, principalmente nos países de elevados recursos, uma vez que nestes as causas não cirróticas de hipertensão portal têm pouca expressão. Durante a gravidez, a pressão venosa portal aumenta, principalmente no segundo e terceiro trimestres, o que pode levar à maior expressão de complicações associadas à hipertensão portal, sendo a mais grave e potencialmente fatal a rutura de varizes gastroesofágicas. Por poder condicionar um aumento da morbilidade materna e perinatal ou até mesmo implicar consequências fatais para ambos, esta é uma situação clínica que constitui um desafio obstétrico, principalmente devido à falta de estudos e dados clínicos no que concerne à abordagem e desfechos da gravidez. Neste trabalho apresenta-se o caso clínico de uma grávida com o diagnóstico de hipertensão portal secundária a trombose da veia porta, com transformação cavernomatosa. A gravidez e o parto decorreram sem intercorrências, tendo a trombocitopenia sido a única complicação, a qual não teve impacto no outcome. O parto ocorreu no termo, por via vaginal, e o recém-nascido apresentava-se saudável e com um peso adequado à idade gestacional. Sendo esta uma situação clínica rara, a discussão do caso clínico motivou uma revisão da literatura acerca da gestão da gravidez em mulheres com hipertensão portal previamente diagnosticada, particularmente com hipertensão portal secundária a trombose da veia porta não associada a cirrose ou a malignidade, na tentativa de uniformizar a abordagem e acompanhamento destes casos e de compreender as suas particularidades obstétricas.
Pregnancy in women with a previous diagnosis of non-cirrhotic portal hypertension is an uncommon event, especially in high income countries where the non-cirrhotic causes of portal hypertension have reduced expression. During pregnancy, portal venous pressure increases, mainly during the second and third trimesters, which can lead to a greater expression of complications associated with portal hypertension, the most serious and potentially fatal including rupture of gastroesophageal varices. As it may lead to the increase of maternal and perinatal morbidity or even fatal consequences for both, this is a clinical situation that represents an obstetric challenge, mainly due to the lack of studies and clinical data regarding pregnancy approach and outcome. This work presents the clinical case of a pregnant woman, diagnosed with portal hypertension secondary to portal vein thrombosis, with cavernomatous transformation. Pregnancy and delivery were successful, thrombocytopenia was the only complication, with no negative impact on the outcome. The delivery was vaginal and occurred at term, and the newborn was healthy and had a birthweight appropriate for the gestational age. As this is an uncommon situation, the discussion of the clinical case led to a review of the literature on pregnancy management in women with previously diagnosed portal hypertension, particularly with portal hypertension secondary to portal vein thrombosis not associated with cirrhosis or malignancy, in an attempt to standardize the approach and follow-up of these cases and to understand their obstetric particularities.
Pregnancy in women with a previous diagnosis of non-cirrhotic portal hypertension is an uncommon event, especially in high income countries where the non-cirrhotic causes of portal hypertension have reduced expression. During pregnancy, portal venous pressure increases, mainly during the second and third trimesters, which can lead to a greater expression of complications associated with portal hypertension, the most serious and potentially fatal including rupture of gastroesophageal varices. As it may lead to the increase of maternal and perinatal morbidity or even fatal consequences for both, this is a clinical situation that represents an obstetric challenge, mainly due to the lack of studies and clinical data regarding pregnancy approach and outcome. This work presents the clinical case of a pregnant woman, diagnosed with portal hypertension secondary to portal vein thrombosis, with cavernomatous transformation. Pregnancy and delivery were successful, thrombocytopenia was the only complication, with no negative impact on the outcome. The delivery was vaginal and occurred at term, and the newborn was healthy and had a birthweight appropriate for the gestational age. As this is an uncommon situation, the discussion of the clinical case led to a review of the literature on pregnancy management in women with previously diagnosed portal hypertension, particularly with portal hypertension secondary to portal vein thrombosis not associated with cirrhosis or malignancy, in an attempt to standardize the approach and follow-up of these cases and to understand their obstetric particularities.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Trombose da veia porta Hipertensão portal Varizes gastroesofágicas Gravidez Obstetrícia