{"id":38357,"date":"2022-04-27T23:58:34","date_gmt":"2022-04-27T21:58:34","guid":{"rendered":"https:\/\/www.icarectg.com\/7-o-caso-28-04-22\/"},"modified":"2022-04-27T23:58:34","modified_gmt":"2022-04-27T21:58:34","slug":"7-o-caso-28-04-22","status":"publish","type":"post","link":"https:\/\/www.icarectg.com\/pt-pt\/7-o-caso-28-04-22\/","title":{"rendered":"7.\u00ba CASO (28\/04\/22)"},"content":{"rendered":"

Hoje trazemos um caso de uma paciente em indu\u00e7\u00e3o por pr\u00e9-ecl\u00e2mpsia leve e que recebe tratamento com prostaglandinas e sulfato de magn\u00e9sio. Falaremos de como estes f\u00e1rmacos podem afetar e como avaliar as altera\u00e7\u00f5es de variabilidade. <\/p>\n

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[URIS id=”36348″]<\/p>\n

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Foi realizada uma cesariana urgente por SPBF. Nasce um rec\u00e9m-nascido do sexo masculino com g, APGAR e pHa 7,02\/PHv 7,06. EBa -9,4, EBv -9,9. <\/p>\n

COMENT\u00c1RIO<\/strong> (podem ver o v\u00eddeo completo no Instagram): <\/span><\/h3>\n

1.\u00ba tramo do RCTG<\/strong>: FCFb congruente para a idade gestacional. Variabilidade reduzida. Cycling. RUPI (introduzimos o conceito de RUPI). Taquissistolia. <\/p>\n

O Edwin pediu-nos que ponder\u00e1ssemos uma situa\u00e7\u00e3o hipot\u00e9tica na qual estiv\u00e9ssemos os dois num gin\u00e1sio e ele tivesse um colapso pulmonar parcial e eu n\u00e3o. Como \u00e9 que ambos nos adaptar\u00edamos ao stress hip\u00f3xico? N\u00e3o, pois n\u00e3o? <\/p>\n

–> A pr\u00e9-ecl\u00e2mpsia \u00e9 uma situa\u00e7\u00e3o semelhante no que diz respeito \u00e0 placenta. Devido \u00e0 afeta\u00e7\u00e3o ao n\u00edvel dos villi e devido a dep\u00f3sitos de fibrina, trombose e outras altera\u00e7\u00f5es, a fun\u00e7\u00e3o placent\u00e1ria est\u00e1 reduzida. Os beb\u00e9s que a pade\u00e7am mostrar\u00e3o mais cedo altera\u00e7\u00f5es com desacelera\u00e7\u00f5es tipo quimiorrecetor e RUPI. <\/p>\n

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2.\u00ba tramo do RCTG: <\/strong>FCFb est\u00e1vel e mantida. Aqui podemos observar cycling. Din\u00e2mica uterina frequente. <\/p>\n

Chama a aten\u00e7\u00e3o o facto de haver taquicardia materna de forma mantida.<\/p>\n

–> Numa pr\u00e9-ecl\u00e2mpsia com taquicardia materna, em que \u00e9 que ter\u00edamos de pensar.<\/p>\n

*Falamos das altera\u00e7\u00f5es no RCTG quando h\u00e1 um DPPNI: Se for um descolamento total, veremos uma bradicardia. Mas se houver um descolamento parcial (20-40%), veremos desacelera\u00e7\u00f5es tipo quimiorrecetor e aus\u00eancia de cycling. No per\u00edodo antenatal, \u00e9 necess\u00e1rio que se tenha descolado 50% da placenta para que se vejam altera\u00e7\u00f5es no Doppler ou no RCTG, mas durante o trabalho de parto acrescenta-se que, ao haver contra\u00e7\u00f5es, h\u00e1 limita\u00e7\u00e3o brusca da entrada de oxig\u00e9nio. <\/p>\n

3.\u00ba tramo do RCTG: <\/strong>Administra-se, ao princ\u00edpio, 1\/2 ampola de Dolantina. TV: 1 cm de dilata\u00e7\u00e3o. Persiste linha basal est\u00e1vel e variabilidade reduzida. H\u00e1 aus\u00eancia de cycling. <\/p>\n

Efeito da Dolantina (Meperidina, Petidina) ou Sulfato de magn\u00e9sio: Diminuem a variabilidade SEM fazer desaparecer o cycling.<\/p>\n

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A partir daqui, mant\u00e9m a diminui\u00e7\u00e3o de variabilidade e observa-se progressivamente o aparecimento de desacelera\u00e7\u00f5es tipo quimiorrecetor, com aus\u00eancia de cycling.<\/p>\n

–> Neste ponto, dever\u00edamos continuar a ter cycling, apesar de estar sob medica\u00e7\u00e3o. Perante a perda de cycling e desacelera\u00e7\u00f5es tipo quimiorrecetor, dever\u00edamos ponderar patologia. N\u00e3o estamos perante um caso de fase descompensada de uma hipoxia progressiva. Tamb\u00e9m n\u00e3o sugere uma infe\u00e7\u00e3o. O que nos resta pensar numa paciente com pr\u00e9-ecl\u00e2mpsia \u00e9 que tem uma reserva placent\u00e1ria reduzida e RUPI, sem poder descartar que tenha havido um descolamento parcial de placenta (n\u00e3o nos informaram que houvesse cl\u00ednica sugestiva). 30% dos beb\u00e9s que t\u00eam redu\u00e7\u00e3o de variabilidade de forma mantida t\u00eam acidose metab\u00f3lica. <\/p>\n

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Comentamos que se trata de “mild acidosis”. Com pH arterial e venoso muito pr\u00f3ximo. E excesso de bases elevado. <\/p>\n

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Acabamos por falar do programa de TV ingl\u00eas “I’m a celebrity get me out of here” –> Edwin fala que, quando h\u00e1 desaparecimento de cycling, redu\u00e7\u00e3o de variabilidade e desacelera\u00e7\u00f5es tipo quimiorrecetor, “get me out of here”. Devem ser um alarme. <\/p>\n

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 <\/p>\n","protected":false},"excerpt":{"rendered":"

Hoje trazemos um caso de uma paciente em indu\u00e7\u00e3o por pr\u00e9-ecl\u00e2mpsia leve e que recebe tratamento com prostaglandinas e sulfato de magn\u00e9sio. Falaremos de como estes f\u00e1rmacos podem afetar e como avaliar as altera\u00e7\u00f5es de variabilidade.  <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[47],"tags":[],"class_list":["post-38357","post","type-post","status-publish","format-standard","hentry","category-teactg"],"yoast_head":"\n7.\u00ba CASO (28\/04\/22) - icareCTG<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.icarectg.com\/pt-pt\/7-o-caso-28-04-22\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"7.\u00ba CASO (28\/04\/22) - icareCTG\" \/>\n<meta property=\"og:description\" content=\"Hoje trazemos um caso de uma paciente em indu\u00e7\u00e3o por pr\u00e9-ecl\u00e2mpsia leve e que recebe tratamento com prostaglandinas e sulfato de magn\u00e9sio. 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