RESUMO
The relationship between focal segmental glomerulosclerosis (FSGS) and pregnancy is complex and not completely elucidated. Pregnancy in patients with FSGS poses a high risk for complications, possibly due to hemodynamic factors, imbalance between angiogenic and antiangiogenic factors, and hormonal conditioning. Although poor clinical outcomes associated with collapsing FSGS are common outside of pregnancy, the prognosis during pregnancy is not well documented. We report 3 patients who developed collapsing FSGS during pregnancy, 2 of whom had presumed underlying FSGS. Two patients underwent biopsy during pregnancy, and 1, during the puerperium. None of the 3 patients improved spontaneously after delivery, and 1 experienced a rapid deterioration in kidney function and proteinuria after delivery. Aggressive immunosuppressive therapy led to a full response in 1 case (without chronic lesions) and to partial responses in the remaining 2 cases. These cases suggest that collapsing lesions should be considered in patients with FSGS who develop a rapid increase in serum creatinine level or proteinuria during pregnancy and that these lesions may at least partially respond to treatment.
Assuntos
Glomerulosclerose Segmentar e Focal/diagnóstico , Imunossupressores/uso terapêutico , Glomérulos Renais/patologia , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Proteinúria/fisiopatologia , Adulto , Biópsia por Agulha , Creatinina/sangue , Progressão da Doença , Feminino , Idade Gestacional , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Humanos , Imuno-Histoquímica , Testes de Função Renal , Cuidado Pós-Natal , Gravidez , Complicações na Gravidez/tratamento farmacológico , Diagnóstico Pré-Natal/métodos , Proteinúria/tratamento farmacológico , Medição de Risco , Estudos de Amostragem , Adulto JovemRESUMO
OBJECTIVE: The objective of this study is to evaluate the actions taken by obstetricians when faced with postpartum hemorrhage (PPH). MATERIALS AND METHODS: A standardized open-ended survey was applied to 235 physicians at five hospitals and at an obstetrics and gynecology conference, inquiring about which actions are recommended in the initial stages of PPH. We calculated the frequency and confidence intervals of the actions mentioned and correlated the number of actions with the number of clinicians mentioning them using Spearman's rho test. RESULTS: Asking for help was mentioned by 45% of the respondents and 38% asked for vital signs. Only one-fifth of those surveyed asked for blood count, coagulation testing, arterial blood gas, or urinary catheter. Very few mentioned hypothermia prevention, oxygen administration, or blood transfusion. A total of 80% of those interviewed only mentioned 3 of the 16 recommended actions. CONCLUSION: Postpartum hemorrhage training should include instructions on initial steps in order to improve treatment comprehension and outcomes.