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Browsing OBS - Artigos publicados em revistas não indexadas by Author "Caeiro, AF"
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- Amniotic Fluid Embolism. Is a New Pregnancy Possible? Case Report.Publication . Caeiro, AF; Ramilo, I; Santos, AP; Ferreira, E; Batalha, IAmniotic fluid embolism (AFE) is a rare but potentially catastrophic clinical condition, characterized by a combination of signs and symptoms that reflect respiratory distress, cardiovascular collapse and disseminated intravascular coagulation (DIC). Its pathogenesis is still unclear. More recently, the traditional view of obstruction of pulmonary capillary vessels by amniotic fluid emboli as the main explanation for the etiology has been ruled out, and immunologic factors and the activation of the inflammatory cascade took on an important role. Amniotic fluid embolism has an unpredictable character, its diagnosis is exclusively clinical, and the treatment consists mainly of cardiovascular support and administration of blood products to correct the DIC. No diagnostic test is recommended until now, though multiple blood markers are currently being studied. The authors present a case report of a woman who had survived AFE in her previous pregnancy and had a subsequent pregnancy without recurrence, providing one more clinical testimony of the low risks for the pregnancy after AFE.
- Postpartum hysterectomy: 15-year reviewPublication . Ramilo, I; Caeiro, AF; Mendinhos, G; Santos, AP; Matos, FOverview and Aims: Postpartum Hysterectomy (PPH) is considered an obstetrical emergency. Profuse bleeding, the most common indication, may jeopardize the puerperal woman. If not controlled by conservative measures, it may require PPH. Its incidence varies between 0.13 to 5.38 per 1000 births. Women with underlying conditions such as placenta previa, fi- broleiomyomas or previous cesarean section (CS) are at increased risk. We evaluated the incidence of PPH, its indications, risk factors and complications. Material and Methods: Retrospective study of PPH conducted at a tertiary care hospital in 15 years (1997-2011). Results: We found 41 cases of PPH (0.6 per 1000 births). Twenty eight occurred after CS (1.34 /1000) and 13 followed vaginal deliveries (0.27/1000), resulting in an odds ratio of 4.94 (2.56 to 9.54, p < 0.001) for CS vs vaginal delivery. Sixteen patients had a previous uterine surgery (CS and/or curettage) and 8 were nulliparous. The most common indication was uterine atony in 18 cases (43.9 %), followed by unspecified hemorrhage in 8 (19.5 %), placenta accreta in 7 (17.1%) and uterine dehiscence/rupture in 4 (9.8%). In 30 cases it was performed a total hysterectomy, being subtotal in the remaining 11 cases. The main complications were the need for red blood cell transfusion (39), disseminated intravascular coagulation (8) and febrile syndrome (6); 21 postpartum women were admitted in Intensive Care Unit. There were no maternal deaths. Pathologic examination of uterus and placenta showed normal postpartum changes in 11 (26.8 %), placenta accreta in 12 (29.3 %), changes consistent with uterine atony in 8 (19.5 %), fibroleiomyomas in 5 (12.2%) and uterine rupture in 3 (7.3%). Conclusions: hysterectomy remains a required procedure in the treatment of postpartum bleeding resistant to conservative management, being uterine atony the most frequent indication with CS accounting for a five times higher risk than vaginal delivery.