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Vasa previa : abordagem e desfechos maternos e perinatais
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Introdução: Vasa previa é uma entidade caracterizada pela presença de vasos sanguíneos fetais desprotegidos da geleia de Wharton, que cobrem o orifício interno do colo. É uma entidade que, quando não é diagnosticada, está associada a elevada mortalidade perinatal. Esta doença pode ser letal, uma vez que, na rotura de membranas, espontânea ou de forma artificial, os vasos fetais desprotegidos estão em maior risco de rotura, podendo levar à morte por exsanguinação fetal. Sendo assim, o diagnóstico pré-natal e uma abordagem obstétrica adequada, com a realização de cesariana eletiva e maturação fetal se indicada, levaram à redução da mortlidade e morbilidade fetal. Objetivos: Este trabalho pretende avaliar a abordagem e desfechos maternos e perinatais das gestações complicadas por vasa previa no Hospital Santa Maria. Metodologia: Estudo observacional retrospetivo, com recurso à base de dados do internamento e Sistema Obscare de grávidas com o diagnóstico de vasa previa no Serviço de Obstetrícia do Hospital de Santa Maria, no período de 2011 a 2021. A análise estatística foi realizada através do Microsoft Office 365 Excel. Resultados: Neste estudo foram incluídas 10 grávidas, com média de idade de 35 anos. Os fatores de risco identificados foram placenta baixamente inserida, placenta prévia, placenta sucenturiada e inserção velamentosa do cordão umbilical. Os casos foram internados com posterior indução de maturação fetal com corticoterapia e realização de cesariana eletiva em média às 35 semanas. Não se verificou complicações maternas, nem se registaram casos de morte fetal. Conclusão: No presente estudo, as gestações complicadas por vasa previa, vigiadas no Hospital de Santa Maria, não apresentaram diferenças significativas no que diz respeito a fatores de risco, abordagem e desfechos, quando comparados com a literatura disponível à data.
Introduction: Vasa previa is an entity characterized by the presence of unprotected fetal blood vessels of Wharton’s jelly, which cover the internal os of the cervix. An entity that if undiagnosed is associated with a high perinatal mortality rate. This condition can be fatal, since, in spontaneous or artificial rupture of membranes, unprotected fetal vessels are at greater risk of rupture, which can lead to fetal death by exsanguination. Therefore, a prenatal diagnosis and a proper obstetric approach with elective cesarean section and fetal maturation led to a reduction in fetal mortality and morbidity. Objectives: This study aims to evaluate the approach and maternal and perinatal outcomes of pregnancies complicated by vasa previa at Hospital Santa Maria. Methodology: Retrospective observational study, based on the hospital database and the Obscare System of pregnant women diagnosed with vasa previa in the Obstetrics Service of HSM, from 2011 to 2021. Statistical analysis was performed using Microsoft Office 365 Excel software. Results: In this study, 10 women were included, with a mean age of 35 years old. The risk factors identified were low-lying placenta, placenta previa, succenturiated placenta and velamentous cord insertion. All cases were hospitalized with subsequent induction of fetal maturation and elective cesarean section at an average of 35 weeks. There weren’t identified maternal complication, nor were there any cases of fetal death. Conclusion: in the present study, pregnancies complicated by vasa previa monitored at Hospital de Santa Maria, did not show significant differences with regard to risk factors, approach and outcomes, when compared with the literature available at the time.
Introduction: Vasa previa is an entity characterized by the presence of unprotected fetal blood vessels of Wharton’s jelly, which cover the internal os of the cervix. An entity that if undiagnosed is associated with a high perinatal mortality rate. This condition can be fatal, since, in spontaneous or artificial rupture of membranes, unprotected fetal vessels are at greater risk of rupture, which can lead to fetal death by exsanguination. Therefore, a prenatal diagnosis and a proper obstetric approach with elective cesarean section and fetal maturation led to a reduction in fetal mortality and morbidity. Objectives: This study aims to evaluate the approach and maternal and perinatal outcomes of pregnancies complicated by vasa previa at Hospital Santa Maria. Methodology: Retrospective observational study, based on the hospital database and the Obscare System of pregnant women diagnosed with vasa previa in the Obstetrics Service of HSM, from 2011 to 2021. Statistical analysis was performed using Microsoft Office 365 Excel software. Results: In this study, 10 women were included, with a mean age of 35 years old. The risk factors identified were low-lying placenta, placenta previa, succenturiated placenta and velamentous cord insertion. All cases were hospitalized with subsequent induction of fetal maturation and elective cesarean section at an average of 35 weeks. There weren’t identified maternal complication, nor were there any cases of fetal death. Conclusion: in the present study, pregnancies complicated by vasa previa monitored at Hospital de Santa Maria, did not show significant differences with regard to risk factors, approach and outcomes, when compared with the literature available at the time.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Vasa previa Inserção velamentosa do cordão umbilical Anomalias placentárias Obstetrícia