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Gravidez gemelar monocoriónica biamniótica : experiência do Hospital de Santa Maria nos últimos 5 anos
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Resumo(s)
Objetivo: Estudo retrospetivo observacional das gestações gemelares MCBA vigiadas no HSM-CHLN, entre 2011 e 2016.
Materiais e métodos: Foi realizada uma análise retrospetiva das gestações gemelares monocoriónicas biamnióticas, vigiadas na CMMF do HSM-CHLN, entre 2011 e 2016, relativamente à história obstétrica e da gestação, complicações da gravidez e desempenho neonatal imediato. Para se obterem estes dados foram pesquisadas as bases de dados da CMMF e unidade de Ecografia do HSM e, em seguida, analisados os processos clínicos referentes a 64 casos, tendo a informação sido compilada e tratada para fins estatísticos descritivos e posterior contextualização na literatura.
Resultados: A idade materna média foi de 32,45 anos. Quanto à frequência das complicações: aborto precoce-1,56%; aborto tardio-6,25%; morte fetal ≥ 1 feto após as 22 semanas: 4,69%; IMG ≥ 1 feto: 7,81%; PPT: 60,94%; anomalias fetais ≥ 1 feto: 9,38%; crescimento discordante: 23,44%; RCF ≥ 1 feto: 20,31%; STFF: 12,5%; TAPS-0%; TRAP-0%. O peso médio do 1º e 2º gémeo foi, respetivamente, 2016,42g e 2023,12g; 52,72% dos recém-nascidos apresentaram peso entre 1500-2500g; 17,43% <1500g, tendo havido necessidade de internamento na UCERN em 44,95% dos casos, uma taxa de nados mortos de 6,42% e de mortalidade global de 20,31%.
Conclusões: De uma maneira geral, a incidência de complicações na amostra estudada foi sobreponível à de outros estudos. Contudo, verificou-se uma maior mortalidade global, devido a um maior número de perdas fetais associadas às principais complicações. A gravidez MCBA deve ser entendida como uma gestação de alto risco, sendo indispensável a determinação da corionicidade de uma gestação gemelar tão cedo quanto possível, de forma a antever eventuais complicações e, se necessário, intervir atempadamente, de forma a diminuir o número de perdas fetais e melhorar o prognóstico dos sobreviventes.
Objective: The aim of this work is to do a retrospective observational study of MCBA twin pregnancies followed in HSM-CHLN, between 2011 and 2016. Material and Methods: A retrospective analysis of MCBA twin pregnancies, followed in the HSM-CHLN’s CMMF, between 2011 and 2016, was carried out, focusing on the obstetric and gestation history, pregnancy complications and immediate neonatal performance. To get this data it was necessary to search in the HSM’s CMMF and Ecografia databases. Sixty four clinic processes were analyzed and the information was treated and compiled in order to allow a descriptive statistical analysis and a posterior contextualization in the literature. Results: The medium maternal age was 32,45 years. In terms of complications’ frequency: early miscarriage-1,56%; late miscarriage-6,25%; fetal demise ≥ 1 fetus after 22 weeks: 4,69%; TOP ≥ 1 fetus: 7,81%; pre-term delivery: 60,94%; fetal anomalies ≥ 1 fetus: 9,38%; discordant growth: 23,44%; FGR ≥ 1 fetus: 20,31%; TTTS: 12,5%; TAPS-0%; TRAP-0%. The medium weight of the 1st and 2nd twin was, respectively, 2016,42g and 2023,12g; 52,72% of the newborns had a birth weight between 1500-2500g; 17,43% <1500g. There was necessity of internment in the UCERN in 44,95% of all cases, a stillbirth rate of 6,42% and a global mortality of 20,31%. Conclusions: Broadly, the incidence of complications in this sample was concordant to that of other studies. However, it was verifiable a superior global mortality, due to a larger number of fetal demises associated with the main complications. MCBA pregnancies should be faced as high risk gestations, what makes indispensable determining the chorionicity of a twin pregnancy as soon as possible, so that eventual complications can be foreseen and, if necessary, intervened timely, in order to diminish the number of fetal losses and improve the survivors’ prognostic.
Objective: The aim of this work is to do a retrospective observational study of MCBA twin pregnancies followed in HSM-CHLN, between 2011 and 2016. Material and Methods: A retrospective analysis of MCBA twin pregnancies, followed in the HSM-CHLN’s CMMF, between 2011 and 2016, was carried out, focusing on the obstetric and gestation history, pregnancy complications and immediate neonatal performance. To get this data it was necessary to search in the HSM’s CMMF and Ecografia databases. Sixty four clinic processes were analyzed and the information was treated and compiled in order to allow a descriptive statistical analysis and a posterior contextualization in the literature. Results: The medium maternal age was 32,45 years. In terms of complications’ frequency: early miscarriage-1,56%; late miscarriage-6,25%; fetal demise ≥ 1 fetus after 22 weeks: 4,69%; TOP ≥ 1 fetus: 7,81%; pre-term delivery: 60,94%; fetal anomalies ≥ 1 fetus: 9,38%; discordant growth: 23,44%; FGR ≥ 1 fetus: 20,31%; TTTS: 12,5%; TAPS-0%; TRAP-0%. The medium weight of the 1st and 2nd twin was, respectively, 2016,42g and 2023,12g; 52,72% of the newborns had a birth weight between 1500-2500g; 17,43% <1500g. There was necessity of internment in the UCERN in 44,95% of all cases, a stillbirth rate of 6,42% and a global mortality of 20,31%. Conclusions: Broadly, the incidence of complications in this sample was concordant to that of other studies. However, it was verifiable a superior global mortality, due to a larger number of fetal demises associated with the main complications. MCBA pregnancies should be faced as high risk gestations, what makes indispensable determining the chorionicity of a twin pregnancy as soon as possible, so that eventual complications can be foreseen and, if necessary, intervened timely, in order to diminish the number of fetal losses and improve the survivors’ prognostic.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Gemelar Monocoriónica Biamniótica Complicações Mortalidade Obstetrícia