RESUMO
Resumen ANTECEDENTES: La cetoacidosis diabética y el estado hiperosmolar hiperglucémico son complicaciones agudas de la diabetes que se superponen en uno de cada cuatro casos, y cada una pone en peligro la vida de la madre y del feto. Existe poca información acerca del diagnóstico y tratamiento de las complicaciones agudas de la diabetes en el embarazo. OBJETIVO: Reportar el caso de una embarazada sin controles prenatales y sin antecedentes personales ni familiares de importancia que tuvo una crisis hiperglucémica mixta asociada con eclampsia y óbito. CASO CLÍNICO: Paciente primigesta, de 21 años, con 33 semanas de embarazo que ingresó al hospital debido a: náuseas, disnea y ausencia de movimientos fetales. Al ingreso se encontró somnolienta y con presión arterial elevada. Los exámenes de laboratorio se reportaron compatibles con cetoacidosis diabética y estado hiperosmolar hiperglucémico. A pesar del tratamiento, sobrevino la eclampsia. El embarazo finalizó mediante cesárea, con un recién nacido sin latidos cardiacos. La paciente evolucionó favorablemente con la atención multidisciplinaria. Fue dada de alta con valores de glucosa y presión arterial en límites normales. CONCLUSIÓN: Las crisis hiperglucémicas durante el embarazo se asocian con morbilidad y mortalidad materna y fetal, además de trastornos hipertensivos. El diagnóstico temprano de diabetes en los controles prenatales es fundamental para evitar este cuadro.
Abstract BACKGROUND: Diabetic ketoacidosis and hyperglycemic hyperosmolar state are acute complications of diabetes. These two overlap in one in four cases, and each endangers the life of the mother and the fetus. There is little information about the diagnosis and management of acute complications of diabetes in pregnancy. OBJECTIVE: To report the case of a pregnant woman without prenatal controls and without significant personal or family history who developed a mixed hyperglycemic crisis associated with eclampsia and death. CLINICAL CASE: 21-year-old primigravida admitted at 33 weeks' gestation due to nausea, dyspnea and absence of fetal movements. She was drowsy and had high blood pressure values. Laboratory tests were consistent with a mixed presentation of diabetic ketoacidosis and hyperosmolar hyperglycemic state. Despite treatment, the patient developed eclampsia. Cesarean delivery was performed, extracting a newborn without fetal heartbeat. The patient evolved favorably with multidisciplinary management. She was discharged with glucose and blood pressure values within normal limits. CONCLUSION: Hyperglycemic crises in pregnancy are associated with maternal-fetal morbidity and mortality and hypertensive disorders of pregnancy. Early diagnosis of diabetes in prenatal checkups is essential to avoid this condition.
RESUMO
OBJECTIVE: To describe the maternal clinical characteristics, maternal and perinatal outcomes in COVID-19-positive pregnant women. METHODS: Articles in all languages on the SARS-CoV-2 infection in pregnant women were sought from MEDLINE, EMBASE, Cochrane Library and LILACS; China National Knowledge Infrastructure Database (CNKI), Chinese Science and Technology Periodical Database (VIP) and Wan Fang Data between December 1, 2019 and April 27, 2020. Bulletins and national reports were also searched. RESULTS: From 12,168 retrieved articles, 143 were selected for full-text assessment; 33 for descriptive analyses, and 4 case-controls for meta-analysis. In 322 infected pregnant women, aged 20-45 years, the most frequent maternal comorbidity was obesity (24.2%). Forty-two (28.4%) were asymptomatic at admission. Cough (n = 148,59.7%) and fever (n = 147,59.3%) were the most prevalent symptoms. In the meta-analysis, fever (OR: 0.13,95% CI 0.05 to 0.36) and cough (0.26,95% CI 0.11 to 0.59) were lower in pregnant women with COVID-19 than non-pregnant women with COVID-19.195 (60.6%) delivered, and 125 (38.8%) remained pregnant during the study. Cesarean was reported in 99 (50.8%) women and vaginal delivery in 64 (32.8%). The main adverse obstetric outcome was premature birth (n = 37,18.9%). Thirty patients (10.3%) with COVID-19-related complications required intensive care, one (0.3%) died. SARS-CoV-2 was absent in breast milk, amniotic fluid, placenta or umbilical cord blood. CONCLUSIONS: The maternal clinical characteristics of COVID-19-positive pregnant include frequently fever and cough; however significantly less frequently than non-pregnant women with COVID-19. Iatrogenic preterm birth is the main adverse obstetric outcome. Current data does not support vertical transmission in the third trimester.
