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Abordagem materno-fetal no acidente de viação e como prevenir as suas complicações
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O trauma na gravidez é um evento que pode levar a grande morbimortalidade. No início do século, existia uma grande taxa de mortalidade materna e fetal e, com a melhoria dos cuidados de saúde, houve uma redução da mesma, sendo que, inicialmente, as principais causas eram obstétricas e, hoje em dia, as não obstétricas prevalecem. Assim, é importante referir e explorar os acidentes de viação pois são a principal causa não obstétrica de trauma na gravidez. Na abordagem de uma situação de trauma, tem de se ter em conta as alterações fisiológicas inerentes à condição da gravidez para assim ter melhores resultados e não haver falha no diagnóstico. A abordagem deve ser centrada na grávida uma vez que a maior parte das causas de mortalidade fetal são maternas. O diagnóstico deve ser completo e preciso, com uma boa história clínica, exame objetivo, exames imagiológicos e cirurgia exploradora caso necessário. A intervenção pode ser médica ou mesmo cirúrgica dependendo de cada situação. Como possíveis complicações do trauma, são de realçar o descolamento da placenta, a rutura uterina e a hemorragia materno-fetal. Por ser um assunto comum e importante pela sua incidência, deve-se investir numa boa prevenção, que é maioritariamente feita pelo uso correcto e constante dos sistemas de segurança, nomeadamente pelo cinto de segurança e airbag. No entanto, os sistemas de segurança dos carros em geral não estão adaptados à condição da grávida, podendo provocar-lhe lesões. Assim, conclui-se que devem ser realizados mais estudos na tentativa de criar sistemas de segurança apropriados à grávida e consequentemente ao feto.
Trauma in pregnancy is an event that can lead to great morbidity and mortality. At the beginning of the century, there was a high rate of maternal and fetal mortality and, with the improvement of health care, there was a reduction of the same, initially the main causes were obstetrical and nowadays the non-obstetric ones prevail. Thus, it is important to mention and explore road accidents as they are the main non-obstetric cause of pregnancy trauma. When approaching a trauma situation, the physiological changes inherent in the pregnancy condition must be taken into account in order to obtain better results and not to fail to diagnose. The approach should be centered on the pregnant since most of the causes of fetal mortality are maternal. The diagnosis should be complete and accurate, with a good clinical history, objective examination, imaging and exploratory surgery if necessary. The intervention can be medical or even surgical depending on each situation. Possible complications of trauma include placental abruption, uterine rupture and maternal-fetal hemorrage. Because it is a common issue and important for its incidence, it is necessary to invest in a good prevention, which is mostly made by the correct and constant use of the safety systems, namely by the seat belt and airbag. However, car safety systems in general are not adapted to the condition of the pregnant woman and can cause injury. Thus, it is concluded that more studies should be carried out in an attempt to create safety systems appropriate to the pregnant woman and consequently to the fetus.
Trauma in pregnancy is an event that can lead to great morbidity and mortality. At the beginning of the century, there was a high rate of maternal and fetal mortality and, with the improvement of health care, there was a reduction of the same, initially the main causes were obstetrical and nowadays the non-obstetric ones prevail. Thus, it is important to mention and explore road accidents as they are the main non-obstetric cause of pregnancy trauma. When approaching a trauma situation, the physiological changes inherent in the pregnancy condition must be taken into account in order to obtain better results and not to fail to diagnose. The approach should be centered on the pregnant since most of the causes of fetal mortality are maternal. The diagnosis should be complete and accurate, with a good clinical history, objective examination, imaging and exploratory surgery if necessary. The intervention can be medical or even surgical depending on each situation. Possible complications of trauma include placental abruption, uterine rupture and maternal-fetal hemorrage. Because it is a common issue and important for its incidence, it is necessary to invest in a good prevention, which is mostly made by the correct and constant use of the safety systems, namely by the seat belt and airbag. However, car safety systems in general are not adapted to the condition of the pregnant woman and can cause injury. Thus, it is concluded that more studies should be carried out in an attempt to create safety systems appropriate to the pregnant woman and consequently to the fetus.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Trauma Gravidez Feto Acidentes de viação Cinto de segurança Obstetrícia