RESUMO
OBJECTIVE: To describe the ultrasonographic characteristics of congenital porto-systemic venous shunts (CPSS) diagnosed during pregnancy, their outcomes, and their evolution. METHODS: Two independent researchers selected 493 review articles and case reports through the analysis of titles, abstracts, and full text. The PubMed and LILACS databases were searched. Through the application of filters according to the PRISMA protocol, only six articles were used in the research. The following information was collected, when available: gestational age at diagnosis, gender, birth weight, type of shunt, associated anomalies/complications and treatment/progression. RESULTS: The data were obtained from 27 cases, with 22 (82%) fetuses diagnosed with intra-hepatic CPSS and 5 (18%) with extra-hepatic CPSS. The median time of intrauterine diagnosis was 33 weeks. In 12 (57.1%) of the 21 pregnancies evaluated, delivery was preterm. The estimated fetal weight ranged from 1150 to 3760 g, with 4 (25%) cases at <3rd, 3 (18.75%) cases at <10th, 8 (50%) cases at <50th, and 1 (6.25%) case at >97th percentile for gestational age. The most frequent obstetric complication was fetal growth restriction, which occurred in nine (60%) cases. As for postnatal treatment, 19 (70.4%) cases were conservatively treated, and 8 (29.6%) cases required surgical intervention. CONCLUSION: The diagnosis of CPSS still represents a challenge during prenatal care. Its early identification aims to provide guidance to pregnant women and their families, as well as follow-up and anticipation of possible complications, in addition to the evaluation of the mode of delivery and postnatal follow-up, directing the short- and long-term prognosis.
Assuntos
Retardo do Crescimento Fetal , Diagnóstico Pré-Natal , Recém-Nascido , Gravidez , Humanos , Feminino , Idade GestacionalRESUMO
No início do século 20, as altas taxas de mortalidade materna e infantil estimularam o desenvolvimento de um modelo de atendimento pré-natal que mantivesse características parecidas até os dias atuais. Nesse modelo, haveria maior concentração de visitas durante o final do terceiro trimestre de gestação, devido às maiores taxas de complicações nas fases finais da gestação e à dificuldade de prever a ocorrência de resultados adversos durante o primeiro trimestre. Atualmente, a avaliação clínica durante o primeiro trimestre, com auxílio da ultrassonografia e marcadores bioquímicos, pode prever uma série de complicações que acometem a gestação, incluindo cromossomopatias, pré-eclâmpsia, restrição de crescimento fetal, anomalias fetais e trabalho de parto pré-termo.
At the beginning of the 20th century, the high rates of maternal and infant mortality stimulated the development of a model of prenatal care that maintained similar characteristics until the present day. In this model, there would be a greater concentration of visits during the end of the third trimester of pregnancy, due to the higher rates of complications in the final stages of pregnancy and the difficulty in predicting the occurrence of adverse outcomes during the first trimester. Currently, clinical evaluation during the first trimester, with the aid of ultrasound and biochemical markers, can predict a series of complications that affect pregnancy, including chromosomal disorders, preeclampsia, fetal growth restriction, fetal anomalies and preterm labor.
Assuntos
Humanos , Feminino , Gravidez , Pré-Eclâmpsia/diagnóstico por imagem , Ultrassonografia Pré-Natal , Aneuploidia , Trissomia/diagnóstico , Biomarcadores/química , Mortalidade Infantil , Mortalidade Materna , Medição de RiscoRESUMO
Objetivo: Averiguar e avaliar o déficit cognitivo, a mobilidade e as atividades da vida diária entre idosos institucionalizados e não institucionalizados. Métodos: Participaram desta pesquisa 34 idosos (17 institucionalizados e 17 não institucionalizados), os quais foram submetidos a uma ficha de avaliação, o Mini Exame do Estado Mental, para avaliar o estado cognitivo, o TIMED UP and GO TEST para avaliar a mobilidade e a Escala de Barthel para analisar as atividades da vida diária. Resultados: A média de idade dos idosos foi de 78,03 (± 9,72), sendo a dos idosos institucionalizados de 78,82 (± 10,93) e a média dos não institucionalizados 77,23 (± 8,59). Dentre os sujeitos entrevistados, tanto na instituição asilar como na comunidade, 58,83% e 52,94%, respectivamente eram do sexo feminino. Dos idosos não institucionalizados, 82,35% não apresentaram alteração no estado cognitivo, enquanto os institucionalizados, somente 29,41%, apresentam esta condição, sendo essa diferença estatisticamente significativa (p=0,002). Para a mobilidade, foi possível identificar que 88,24% dos idosos institucionalizados são independentes enquanto entre os não institucionalizados 70,59% apresentam essa condição, sendo essas diferenças não significativas (p=0,0210). Em relação às atividades da vida diária, somente um (01) idoso institucionalizado apresenta dependência, sendo a diferença entre os dois grupos não significativa (p=0,317). Conclusões: Neste estudo, tanto os idosos institucionalizados quanto os não institucionalizados apresentaram alto grau de independência para as atividades diárias, sendo que os entrevistados da instituição asilar possuem déficit cognitivo maior que os residentes na comunidade. Torna-se necessário, pois, repensar a estrutura asilar além de espaço acolhedor, mas como ambiente responsável para proteção e promoção da saúde dos idosos institucionalizados.
Objective: To assess and evaluate the cognitive, mobility and activities of daily living among elderly institutionalized and non-institutionalized. Methods: 34 subjects participated in this study (17 institutionalized and 17 noninstitutionalized), which underwent an evaluation form, the Mini-Mental State Examination to assess cognitive status, the TIMED UP and GO TEST to assess mobility and Barthel Index to analyze the activities of daily living. Results: The mean age of the elderly was 78.03 (± 9.72), and the institutionalized elderly 78.82 (± 10.93) and the average of the non-institutionalized 77.23 (± 8.59) . Among the interviewees, both the nursing home and in the community, 58.83% and 52.94%, respectively, were female. Of older noninstitutionalized 82.35% showed no change in cognitive state, while institutionalized, only 29.41% have this condition, and this difference was statistically significant (p = 0.002). For mobility, we found that 88.24% of the institutionalized elderly are independent while among non-institutionalized 70.59% have this condition, and these differences were not significant (p = 0.0210). In relation to activities of daily living only one (01) has institutionalized elderly dependency, being the difference between the two groups was not significant (p = 0.317). Conclusions: In this study, both the institutionalized elderly as non-institutionalized showed a high degree of independence in daily activities, and respondents from nursing home have greater cognitive deficits that residents in the community. It becomes necessary, therefore, to rethink the structure asylum besides cozy, but as responsible for environmental protection and promoting the health of institutionalized elderly.