Assuntos
Humanos , Feminino , Gravidez , Oligo-Hidrâmnio/etiologia , Oligo-Hidrâmnio/tratamento farmacológico , Oligo-Hidrâmnio/diagnóstico por imagem , Poli-Hidrâmnios/etiologia , Poli-Hidrâmnios/tratamento farmacológico , Poli-Hidrâmnios/diagnóstico por imagem , Líquido Amniótico/diagnóstico por imagem , Drenagem , Ultrassonografia/métodosRESUMO
BACKGROUND: Therapy with inhaled nitric oxide (iNO) is effective in the management of pulmonary hypertension and severe hypoxemia. However, these benefits have not been demonstrated in preterm infants (<34 weeks). The objective of this report is to present the experience of eight cases of preterm neonates with respiratory distress syndrome (RDS) and refractory hypoxemia, with oligohydramnios history. METHODS: We evaluated the clinical feature of 8 preterm neonates with severe hypoxemia who had maternal antecedents of oligoamnios, mainly due to premature rupture of membranes. They were treated with conventional management, with poor clinical response. Therefore, these neonates were treated with iNO, as a rescue strategy. iNO has been used with a dosage of 5 - 10 ppm. An echocardiogram was performed to determine the presence of structural malformations or persistent ductus arteriosus. RESULTS: All the infants showed improvement in oxygenation. The neonates had signs of low flow pulmonary, confirmed by echocardiogram. Five preterm infants survived without complications associated with the therapy. Two died from pulmonary bleeding secondary to ductus arteriosus and another for pneumothorax. CONCLUSION: iNO therapy can be useful in a subgroup of preterm infants with a high risk of death secondary to hypoxemia. Although this report is based on a small number of cases, it follows the directions of other studies that suggest that iNO therapy can benefit preterm neonates, particularly those exposed to oligohydramnios.
Assuntos
Hipóxia/tratamento farmacológico , Recém-Nascido Prematuro , Óxido Nítrico/administração & dosagem , Oligo-Hidrâmnio/tratamento farmacológico , Administração por Inalação , Feminino , Humanos , Hipóxia/diagnóstico por imagem , Hipóxia/etiologia , Recém-Nascido , Masculino , Oligo-Hidrâmnio/diagnóstico por imagem , GravidezRESUMO
O uso do trastuzumabe, anticorpo antimonoclonal contra o receptor do fator de crescimento epidérmico HER-2, tem sido utilizado no tratamento do carcinoma mamário de pacientes que superexpressam esta proteína. Relatos de casos divergem quanto à presença ou ausência de efeitos adversos na gravidez. Quando presentes, os mais encontrados no feto foram: oligo ou anidrâmnio, insuficiência renal, síndrome de angústia respiratória e óbito fetal/neonatal. Esta revisão discutiu as vias etiopatológicas possíveis deste fármaco em causar tais efeitos e sugeriu uma propedêutica de seguimento dessas pacientes.
The use of trastuzumab, a monoclonal antibody against human epidermal growth factor receptor type 2, has been a useful therapy in the treatment of breast cancer patients that overexpress such protein. Published case reports with different results regarding the presence or absence of adverse effects in pregnancy are shown. If present, the most reported ones were: oligo or anydramnios, renal insufficiency, respiratory distress syndrome, and fetal/neonatal death. This review discussed the ethiopathologic pathways of this drug in causing such effects and suggested a follow-up protocol for these patients.
Assuntos
Feminino , Gravidez , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Neoplasias da Mama/tratamento farmacológico , Oligo-Hidrâmnio/tratamento farmacológico , /uso terapêutico , Desenvolvimento FetalRESUMO
Premature amnion rupture occurs in about 5%-7% of normal pregnancies. Early and prolonged decreased amount of amniotic fluid determines deformities and impairment of fetal lung development. We report a case of a 35 year old mother with severe oligohydramnios since 25 weeks gestation, secondary to premature rupture of membranes. A male baby was born a 31 weeks with unmanageable asphyxia dying eleven hours later. Pathologic findings revealed a Potter phenotype including severe lung hypoplasia. The fall in intrauterine volume affects, through diverse mechanisms lung growth and maturation. The duration and severity of oligohydramnios are important elements in predicting the risk of pulmonary hypoplasia and neonatal morbidity.