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Epilepsia e gravidez : revisão da casuística da consulta de medicina materno-fetal
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Introdução: A epilepsia afecta 0,5% da população e 0,3 a 0,7% das gravidezes ocorrem em mulheres com epilepsia, sendo o seu acompanhamento clínico um desafio. Com este estudo pretendemos comparar a experiência da nossa consulta de medicina materno-fetal com o descrito na literatura. Material e métodos: Foram analisadas retrospectivamente 56 gestações em 43 mulheres com epilepsia entre Março/2006 e Janeiro/2016. Para tal, foram recolhidos dados demográficos e dados relativos ao curso da doença e às complicações obstétricas e perinatais, através da consulta de processo clínicos. Resultados: Dezoito (32,14%) gravidezes foram planeadas, sendo que destas 100% estiveram sob monoterapia e 94,4% não tiveram exposição a valproato. Doze grávidas (21,4%) suspenderam a medicação durante a gravidez e 24 (42,9%) tiveram crises durante a gravidez, das quais 11 (45,8%) tinham tido crises nos 3 meses pré-concepção. Registámos 2 casos (3,6%) de HTA transitória da gravidez, 4 (7,1%) de hemorragia na gravidez e 3 (5,4%) no pós-parto, 5 (8,9%) partos pré-termo, 9 (20,5%) cesarianas, 11 recém-nascidos (25,0%) leves para a idade gestacional e 7 (15,9%) malformações: Síndrome de Arnold-Chiari; tetralogia de Fallot, hipertrofia biventricular ligeira, 2 pequenas comunicações interventriculares, 1 microcefalia e 1 retrognatismo. Conclusão: Este estudo reforça a importância do planeamento e acompanhamento clínico da gestação em mulheres com epilepsia. Apesar do número reduzido de gestações analisadas, a maioria dos resultados está de acordo com o descrito na literatura.
Introduction: Epilepsy affects 0.5% of the population and 0.3 to 0.7% of pregnancies occur in women with epilepsy, making their clinical follow-up a challenge. In this study we intend to compare the experience of our maternal-fetal medicine outpatient unit to that described in the literature. Methods: We retrospectively analysed 56 pregnancies in 43 women with epilepsy between March/2006 and January/2016. We collected demographic data and data related to the course of the disease and to obstetric and perinatal complications from medical records. Results: Eighteen (32.14%) pregnancies were planned, and of these 100% underwent monotherapy and 94.4% were not exposured to valproate. Twelve women (21.4%) discontinued medication during pregnancy and 24 (42.9%) had seizures during pregnancy, of which 11 (45.8%) had had seizures in the 3 months before conception. We documented 2 cases (3.6%) of transient hypertension of pregnancy, 4 (7.1%) of bleeding during pregnancy and 3 (5.4%) of postpartum hemorrhage, 5 (8.9%) preterm births, 9 (20.5%) cesarean sections, 11 infants (25.0%) small for gestational age and 7 (15.9%) malformations: Arnold-Chiari Syndrome; tetralogy of Fallot, mild biventricular hypertrophy, 2 small interventricular communication, 1 microcephaly and 1 retrognathism. Conclusion: This study reinforces the importance of planning and of close clinical surveillance of pregnancies in women with epilepsy. Despite the low number of pregnancies examined, most results are in accordance to literature reports.
Introduction: Epilepsy affects 0.5% of the population and 0.3 to 0.7% of pregnancies occur in women with epilepsy, making their clinical follow-up a challenge. In this study we intend to compare the experience of our maternal-fetal medicine outpatient unit to that described in the literature. Methods: We retrospectively analysed 56 pregnancies in 43 women with epilepsy between March/2006 and January/2016. We collected demographic data and data related to the course of the disease and to obstetric and perinatal complications from medical records. Results: Eighteen (32.14%) pregnancies were planned, and of these 100% underwent monotherapy and 94.4% were not exposured to valproate. Twelve women (21.4%) discontinued medication during pregnancy and 24 (42.9%) had seizures during pregnancy, of which 11 (45.8%) had had seizures in the 3 months before conception. We documented 2 cases (3.6%) of transient hypertension of pregnancy, 4 (7.1%) of bleeding during pregnancy and 3 (5.4%) of postpartum hemorrhage, 5 (8.9%) preterm births, 9 (20.5%) cesarean sections, 11 infants (25.0%) small for gestational age and 7 (15.9%) malformations: Arnold-Chiari Syndrome; tetralogy of Fallot, mild biventricular hypertrophy, 2 small interventricular communication, 1 microcephaly and 1 retrognathism. Conclusion: This study reinforces the importance of planning and of close clinical surveillance of pregnancies in women with epilepsy. Despite the low number of pregnancies examined, most results are in accordance to literature reports.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Epilepsia Gravidez Obstetrícia Ginecologia