A carregar...
Publicação
Alteração dos movimentos fetais e CTG sem critérios de reatividade após ciclo de resgate de indução maturativa fetal : caso clínico
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 283.97 KB | Adobe PDF |
Orientador(es)
Resumo(s)
A corticoterapia está indicada para promover a indução da maturação fetal (IMF), particularmente pulmonar, nas situações de elevado risco de parto pré-termo, reduzindo a morbimortalidade neonatal. Como efeito colateral agudo, os corticosteróides podem induzir uma supressão transitória das frequências cardíaca e respiratória fetal, assim como dos movimentos fetais, resultando numa diminuição do perfil biofísico, habitualmente reversível até às 48h-72h.
Descreve-se o caso clínico de uma grávida de 26 anos, Gesta 2 Para 1 (G2P1), submetida a indução maturativa fetal às 24 semanas e 3 dias por encurtamento cervical progressivo (20 -> 11mm) sob terapêutica com progesterona vaginal. Posteriormente realizado ciclo de resgate às 32 semanas e 2 dias (11 -> 4mm), com consequente ausência de movimentos fetais, cardiotocografia (CTG) sem critérios de reatividade e perfil biofísico 6/10. Das ecografias seriadas realizadas, destaca-se o diagnóstico de polihidrâmnios transitório que se assumiu em contexto de ausência de movimento de deglutição do feto. Na ausência de medidas específicas/dirigidas, verificou-se progressiva normalização do padrão de movimentos fetais, perfil biofísico e volume de líquido amniótico (LA). Alta após 13 dias, com CTG normal. O trabalho de parto iniciou-se espontaneamente no termo, ocorrendo parto eutócico às 38 semanas e 0 dias. Recém-nascido (RN) do sexo masculino, com 2580g, índice de Apgar 9/10/10, aparentemente saudável.
As potenciais implicações positivas e negativas para o feto da administração pré-natal de corticosteróides motivaram a descrição deste caso clínico. É realizada a descrição e avaliação dos efeitos observados, e possíveis mecanismos subjacentes, assim como uma breve revisão dos benefícios e riscos do uso dos corticosteróides.
Corticosteroid therapy is indicated to promote the induction of fetal maturation (IMF), particularly pulmonary maturation, in situations of high risk of preterm delivery, reducing neonatal morbidity and mortality. As an acute side effect, corticosteroids can induce a transient suppression of fetal heart and respiratory rates, as well as fetal movements, resulting in a decrease in the biophysical profile, usually reversible up to 48h-72h. We describe the clinical case of a 26-year-old pregnant woman, gestation 2 delivery 1 (G2P1), who underwent fetal maturation induction at 24 weeks and 3 days due to progressive cervical shortening (20 -> 11mm) under therapy with vaginal progesterone. Subsequently, a rescue cycle was performed at 32 weeks and 2 days (11 -> 4mm), with consequent absence of fetal movements, cardiotocography (CTG) without reactivity criteria and biophysical profile 6/10. Of the serial ultrasound scans performed, the diagnosis of transient polyhydramnios stands out, which was assumed in the context of absence of fetal swallowing movement. In the absence of specific/directed measures, there was a progressive normalization of the pattern of fetal movements, biophysical profile and amniotic fluid (LA) volume. Discharge after 13 days, with normal CTG. Labor began spontaneously at term, with eutocic delivery occurring at 38 weeks and 0 days. Male newborn (RN)), weighing 2580g, Apgar score 9/10/10, apparently healthy. The potential positive and negative implications for the fetus of the prenatal administration of corticosteroids motivated the description of this clinical case. A description and evaluation of the observed effects and possible underlying mechanisms are performed, as well as a brief review of the benefits and risks of using corticosteroids.
Corticosteroid therapy is indicated to promote the induction of fetal maturation (IMF), particularly pulmonary maturation, in situations of high risk of preterm delivery, reducing neonatal morbidity and mortality. As an acute side effect, corticosteroids can induce a transient suppression of fetal heart and respiratory rates, as well as fetal movements, resulting in a decrease in the biophysical profile, usually reversible up to 48h-72h. We describe the clinical case of a 26-year-old pregnant woman, gestation 2 delivery 1 (G2P1), who underwent fetal maturation induction at 24 weeks and 3 days due to progressive cervical shortening (20 -> 11mm) under therapy with vaginal progesterone. Subsequently, a rescue cycle was performed at 32 weeks and 2 days (11 -> 4mm), with consequent absence of fetal movements, cardiotocography (CTG) without reactivity criteria and biophysical profile 6/10. Of the serial ultrasound scans performed, the diagnosis of transient polyhydramnios stands out, which was assumed in the context of absence of fetal swallowing movement. In the absence of specific/directed measures, there was a progressive normalization of the pattern of fetal movements, biophysical profile and amniotic fluid (LA) volume. Discharge after 13 days, with normal CTG. Labor began spontaneously at term, with eutocic delivery occurring at 38 weeks and 0 days. Male newborn (RN)), weighing 2580g, Apgar score 9/10/10, apparently healthy. The potential positive and negative implications for the fetus of the prenatal administration of corticosteroids motivated the description of this clinical case. A description and evaluation of the observed effects and possible underlying mechanisms are performed, as well as a brief review of the benefits and risks of using corticosteroids.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Indução maturativa fetal Corticosteróides Cardiotocografia (CTG) Movimentos fetais Perfil biofísico Obstetrícia