Complicações obstétricas em gestações com feto portador de anomalia incompatível com a sobrevida neonatal

Abstract

Objective: To describe the most common obstetric complications encountered during periods of pregnancy, childbirth and puerperium, in pregnancies with fetuses that presented anomalies incompatible with life. Methods: This is a descriptive study, which assessed 78 medical charts of patients in the Prenatal Fetal Medicine Division of the Federal University of São Paulo; the women gave birth at the same institution, between 2000 and 2006. Results: The major obstetric complications identified were: variation in the volume of amniotic fluid (68%), miscarriage, pre-term labor and prolonged pregnancy were present in 6.4%, 55.1% and 3.8% of pregnancies, respectively; intrauterine fetal death, 17.9%, abruptio placenta occurred in 6.4% and hysterectomy in 2.6%. Conclusion: These results suggest that fetus with severe anomalies presented an increase of the risk for pregnancies, which demonstrates the need for expert evaluation in each case. Descriptors: Pregnancy complications; Pregnancy, high-risk; Congenital abnormalities; Genetic counseling RESUMO Objetivo: Descrever as complicações obstétricas mais comuns encontradas nos períodos gestacional, parto e puerpério imediato de gestantes com fetos portadores de anomalias incompatíveis com a vida. Métodos: Estudo descritivo, onde avaliou-se 78 prontuários de pacientes atendidas no pré-natal da Disciplina de Medicina Fetal da Universidade Federal de São Paulo que tiveram partos nessa mesma instituição, entre 2000 e 2006. Resultados: As principais complicações obstétricas identificadas foram:variação do volume de líquido amniótico em 68%; abortamento, parto pré-termo e a gravidez prolongada estiveram presentes em 6,4%, 55,1% e 3,8% das gestações, respectivamente; óbito fetal intra-uterino em 17,9%; descolamento prematuro da placenta ocorreu em 6,4% e histerectomia em 2,6%. Conclusão: Estes resultados sugerem aumento de risco materno em gestações com fetos portadores de anomalias graves, fato que demonstra necessidade de avaliação especializada caso a caso. Descritores: Complicações na gravidez; Gravidez de alto risco; Anomalias congênitas; Aconselhamento genético RESUMEN Objetivo: Describir las complicaciones obstétricas más comunes encontradas en los períodos de gestación, parto y puerperio inmediato de embarazadas con fetos portadores de anomalías incompatibles con la vida. Métodos: Se trata de un estudio descriptivo, que evaluó 78 fichas médicas de pacientes atendidos en el prenatal de la Disciplina de Medicina Fetal de la Universidad Federal de Sao Paulo que tuvieron partos en esa misma institución, entre 2000 y 2006. Resultados: Las principales complicaciones obstétricas identificadas fueron: variación del volumen de líquido amniótico en 68%; abortamiento, parto pre-término y embarazo prolongado estuvieron presentes en 6,4%, 55,1% y 3,8% de las gestaciones, respectivamente; muerte fetal intra-uterina en 17,9%; desprendimiento prematuro de la placenta ocurrió en 6,4% e histerectomía en 2,6%. Conclusión: Éstos resultados sugieren un aumento del riesgo materno en gest...

Association of gestational age with the option of pregnancy termination for fetal abnormalities incompatible with neonatal survival

“…This scenario is similar to those found in a study carried out in the same department, with data from women seen between 2000 to 2006, where the diagnosis of fetal anomaly incompatible with neonatal survival was made up to the 13 th week in only 17% of pregnancies. (9) …”

“…Lethal fetal diseases, also described as nonviable or incompatible with neonatal survival, invariably lead to intrauterine fetal death or death in the neonatal period, regardless of attempting supportive measures or treatment. (5,9) …”

Nas vias de interromper ou não a gestação: vivências de gestantes de fetos com anencefalia

“…Many women can find meaning in continuing pregnancy, even in the face of the fetus' unfeasibility, and must be respected in their desire to remain pregnant 8 . Some need to give a name and bury 24 .…”

“…Despite health complications, the decision to interrupt, in the case of E4, was complicated, since she did not want to interrupt the pregnancy due to the belief that the mother should not interfere in the fetal life time 24 :…”

Repercussões maternas do diagnóstico pré-natal de anomalia fetal

“…However, situations may occur where fetal diagnosis reveals fetus unviability. (2) A non-viable fetus is one which is incapable of surviving on its own outside the uterus as a result of either incomplete formation (immaturity) or deficiency (malformation), in which etiology is multiple, being influenced by genetic or environmental factors, or a combination of both. (3) The breaking news about fetal malformation has great emotional impact on a pregnant woman's and her family's lives.…”