RESUMO
Immune thrombocytopenia (ITP) is most common in women during their reproductive years. When a low platelet count occurs for the first time during pregnancy, the differential diagnosis includes pregnancy-specific conditions. Although ITP is the most common cause of thrombocytopenia early in pregnancy, pregnancy-related thrombocytopenia develops mainly in late gestation. As maternal and neonatal outcomes are usually favourable, ITP per se is not a contraindication for pregnancy. We report the case with a literature review of patient with ITP, whose diagnosis was established in early pregnancy. This condition was refractory to first-line treatments, such as high-dose steroids and intravenous immunoglobulin and other splenectomy-sparing approaches, as rituximab, having the control been reached on the third trimester after splenectomy. Although not effective in this case, we still believe that rituximab should be considered before surgery during pregnancy.
Assuntos
Complicações Hematológicas na Gravidez , Púrpura Trombocitopênica Idiopática , Rituximab , Humanos , Rituximab/uso terapêutico , Gravidez , Feminino , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/sangue , Adulto , Complicações Hematológicas na Gravidez/tratamento farmacológico , Complicações Hematológicas na Gravidez/sangue , Esplenectomia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêuticoRESUMO
Perinatal depression is an important indicator of mothers' mental health. Studies have been carried out to identify and characterize women at risk of such affective disorder. The aim of this study is to assess mothers' adherence to our perinatal depression screening and eventual follow-up by a multidisciplinary team, including mental health and obstetrics professionals. Ultimately, a risk profile for the uptake rate of referral was described to psychological support. Pregnant women from a maternity of a tertiary center with on-site assessment and treatment (n = 2163) were included in this study. The identification of women at risk for depression was based on a two-question screening and the EPDS scale. Demographic and obstetric data were obtained from medical records. The number of screening evaluations, the uptake referral rate and the compliance to treatment were analyzed. Logistic regression was used to predict a risk profile for adherence. Among 2163 enrolled in the protocol, 10.2% screened positive for depression. Of these, 51.8% accepted referral for mental health assistance. 74.9% were compliant to Psychology appointments and 74.1% to Psychiatry appointments. Women who had a previous history of depression were more likely to accept referral for mental health support. With this study, we were able to understand the behaviour of this population towards the screening protocol we offer. Women with a previous history of depression are more likely to accept mental health assistance.
Assuntos
Depressão Pós-Parto , Transtorno Depressivo , Feminino , Gravidez , Humanos , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/terapia , Saúde Mental , Programas de Rastreamento/métodos , Encaminhamento e Consulta , Depressão Pós-Parto/psicologiaRESUMO
As an X linked disorder, the presence of severe symptomatic haemophilia A is an extremely rare disorder in women. Therefore there are no high-level evidence-based guidelines when it comes to pregnancy. Although there have been advances in the fields of prenatal counselling and maternal-fetal care, the management of these gestations continues to embody a challenge for any medical team. We report the successful management of a pregnant woman with symptomatic haemophilia A, from pregnancy to the postpartum period. Our aim is to enhance knowledge on this topic, and further improve outcomes for these mothers and their offspring.
Assuntos
Hemofilia A , Feminino , Hemofilia A/diagnóstico , Hemofilia A/terapia , Humanos , Mães , Período Pós-Parto , Gravidez , Cuidado Pré-NatalRESUMO
Idiopathic thrombocytopenic purpura is a very rare disease, especially during pregnancy. It is characterised by low platelet count and predominantly muco-cutaneous bleeding. There are many forms to monitor and treat these patients. Here, we present a case of a pregnant woman, with idiopathic thrombocytopenic purpura, who was submitted to treatment only when the platelet count was below 10,000/µl, with human intravenous immunoglobulin. During the evolution of pregnancy, caesarean delivery and puerperium were favourable.