Embarazo en paciente parapléjica con trombofilia
Ejemplo de trabajo de un equipo interdisciplinario
Palabras clave:
EMBARAZO, COMPLICACIONES DEL EMBARAZO, PARAPLEJIA, TROMBOFILIA
Resumen
La paraplejia es una de las entidades más devastadoras que puede presentar una persona, determinando a lo largo de su evolución múltiples complicaciones. Su alta incidencia, así como el incremento de las pacientes rehabilitadas, hacen del embarazo en la paciente con injuria medular en fase crónica un hecho cada vez menos inusual. Describiremos el caso de una paciente embarazada parapléjica en la que se diagnostica trombofilia combinada, congénita y adquirida. Poco se ha descripto en la literatura sobre los cambios en la salud sexual y reproductiva de las pacientes con esta discapacidad, lo que retardó aún más el diagnóstico de una trombofilia como coadyuvante en la pérdida de sus embarazos. Esta paciente –excepcional en nuestro medio– constituyó un verdadero desafío para todo el equipo médico tratante, donde el trabajo interdisciplinario permitió culminar con éxito su gravidez.
Citas
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(2) Jackson AB, Wadley V. A multicenter study of women’s self-reported reproductive health after spinal cord injury. Arch Phys Med Rehabil 1999; 80: 1420-8.
(3) Greenspoon JS, Paul RH. Paraplegia and quadriplegia: special considerations during pregnancy and labor and delivery. Am J Obstet Gynecol 1986; 155: 738-41.
(4) Baker ER, Cardenas DD. Pregnancy in spinal cord injured woman. Arch Phys Med Rehabil 1996; 77: 501-7.
(5) American College of Obstetricians and Gynecologists. ACOG Committee Opinion: Number 275, September 2002. Obstetric management of patients with spinal cord injuries. Obstet Gynecol 2002; 100: 625-7.
(6) Pereira L. Obstetric management of the patient with spinal cord injury. Obstet Gynecol Survey 2003; 58(10): 678-86.
(7) Poppas A, Shroff SG, Korcarz CE, Hibbard JU, Berger DS, Lindheimer MD, et al. Serial assessment of the cardiovascular system in normal pregnancy. Role of arterial compliance and pulsatile arterial load. Circulation 1997; 95: 2407-15.
(8) Romero Ganuza F, Mazaira Álvarez J. El paciente con lesión medular en el medio extrahospitalario. Aten Primaria 2001; 27: 127-36.
(9) Katz VL, Thorp JM, Cefalo RC. Epidural analgesia and autonomic hyperreflexia: a case report. Am J Obstet Gynecol 1990; 162: 471-2.
(10) Maehama T, Izena H, Kanazawa K. Management of autonomic hyperreflexia with magnesium sulfate during labor in a woman with spinal cord injury. Am J Obstet Gynecol 2000; 183: 492-3.
(11) Jones NA, Jones SD. Management of life-threatening autonomic hyper-reflexia using magnesium sulphate in a patient with a high spinal cord injury in the intensive care unit. Br J Anaesth 2002; 88(3): 434-8.
(12) Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001; 7(2): 342-7.
(13) Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Arch Intern Med 2000; 160(5): 678-82.
(14) Lucas MJ, Cunningham FG. Infecciones de vías urinarias durante el embarazo. Clín Obstet Ginecol 1993; 36(4): 807-18.
(15) Andriole VT, Patterson TF. Epidemiology, natural history, and management of urinary tract infections in pregnancy. Med Clin North Am 1991; 75: 359-73.
(16) Gilstrap LC. Infecciones del tracto urinario en el embarazo. In: Gleicher Medicina clínica en Obstetricia. Buenos Aires: Panamericana, 1991: 728-32.
(17) Bint AJ, Hill D. Bacteriuria of pregnancy–an update on significance, diagnosis and management. J Antimicrob Chemo-ther 1994; 33 Suppl A: 93-7.
(18) Green D. Diagnosis, prevalence, and manegement of thromboembolism in patients with spinal cord injury. J Spinal Cord Med 2003; 26(4) 329-34.
(19) Bryan T, Oshiro D, Branch. W. Maternal hemostasis: coagulation problems of pregnancy. In: Loscalzo J, Schafer A, ed. Thrombosis and hemorrhage. Philadelphia: Lippincott Williams and Wilkins, 1998; 46: 1005-25.
(20) David M. Venous thromboembolism during pregnancy and post partum. In: Leclerc J, ed. Venous thromboembolic disorders. Philadelphia: Lea & Febiger, 1991: 346–65.
(21) Sevrini I. Cambios fisiológicos en la hemostasis durante el embarazo normal. Congreso Uruguayo de Hematología, 8. Montevideo, 2000.
(22) Bonnar J, Green R, Norris L. Perinatal aspects of inherited thrombophilia. Semin Thromb haemost 1999; 25(5): 481-5.
(23) Amiram E. Thrombophilia, thrombosis and pregnancy. Thromb Haemost 2001; 86: 104-11.
(24) Gerhardt A, Scharf RE, Beckmann MW, Struve S, Bender HG, Pillny M, et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and puerperium. N Engl J Med 2000; 342 (6): 374-80.
(25) Brenner B, Hoffman R, Blumenfeld Z, Weiner Z, Younis JS. Gestacional outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin. Thromb Haemost 2000; 83(5): 693-7.
(26) Otero A, Pou Ferrari R, Pons E, Lens D, De Lisa E, Dellepiane M. Trombofilia y pérdida recurrente de embarazo. Rev Med Urug 2004; 20: 106-13.
(27) Lens D, Otero AM, Brugnini A, Henry S, Trías N, Díaz A. Prevalence of factor V Leiden, prothrombin 20210A and the thermolabile MTHFR in the uruguayan population. Thromb Haemost 2001; 86 (Suppl): 668.
(28) Pabinger J, Vormittag R. Thrombophilia and pregnacy outcomes. J Intern Societ Thromb Haemost 2005; 3: 1603-10.
(29) Sztenc S. Hyperhomocysteinemia and pregnacy copmplications. Ginekol Pol 2004; 75(4): 317-25.
(30) Carrizo C. MTHFR y pérdida recurrente de embarazo. Simposio: Trombofilia y embarazo. Montevideo, 22 junio 2005. (en prensa).
(31) Marietta, Facchinetti F, Sgarbi L, Simoni L, Bertesi M, Torelli G, Volpe A. Elevated plasma levels of factor VIII in women with early recurrent miscarriage. J Thromb Haemost 2003; 1(12): 2536-9.
(32) Dossenbach-Glaninger A, van Trotsenburg M, Krugluger W, Dossenbach MR, Oberkanins C, Huber J, et al. Elevated coagulation factor VIII and the risk for recurrent early pregnancy loss. Thromb Haemost 2004; 91(4): 694-9.
(33) Consenso Uruguayo sobre SAF del Embarazo, 8 de Agosto de 2002. Elaboración preliminar y coordinación: Dr. Enrique Pons, Dra. Ana María Otero, Dr. Ricardo Pou. Publicación laboratorio Aventis. pag. 1 -20.
(34) Hirsh J, MD. Antihrombotic Therapy during Pregnancy. Guidelines for Antithrombotic Therapy Fifth Edition 2005: 90-4.
(35) Yarkony GM, Heinemann AW. Pressure ulcers. In: Stover SL, DeLisa JA, Whiteneck G, ed. Spinal cord injury: clinical outcomes from the Model Systems. Gaithersburg: Aspen, 1995: 100-19.
(36) Yarkony GM, Chen D. Rehabilitation of patients with spinal cord injuries. In: Braddom RL, Buschbacher RM, ed. Physical Medicine and Rehabilitation. Philadelphia: Saunders, 1996: 1149-79.
(37) Kulkarni S, Morgan OS. Pregnancy outcome in paraplegic women. West Indian Med J 1992; 41(3): 99-100.
(38) Rageth JC, Wanner M, Iljazovic S, Heinzl S. Pregnancy, labor and the puerperium in paraplegic. Geburtshilfe Frauenheilkd 1986; 46 (8):536-40.
(39) Arias F. Crecimiento intrauterino retardado. In: Guía práctica para el embarazo y el parto de alto riesgo. 2ª ed. Barcelona:. Mosby-Doyma, 1995: 307-25.
(40) Fescina RH, Ucieda FJ, Cordano MC, Nieto F, Tenzer SM, López R. Ultrasonic patterns of intrauterine fetal growth in a Latin American country. Early human Dev 1982; 6: 239.
(41) Fescina R, Schwarcz R, Díaz, AG. Vigilancia del crecimiento fetal. Manual de autoinstrucción. Montevideo: Centro Latinoamericano de Perinatología y Desarrollo Humano, s.f. (Publicación Científica, n° 1261).
(42) Cordano M, Compte E, Bessis R, Papiernik E. Longitudinal follow-up of 100 patients at risk of intrauterine growth retardation: comparison of diagnosis in two periods. J Perinat Med 1988; 16(1): 61-6.
(43) Enfermedades y anormalidades de las membranas ovulares. In: Cunnigham FG, Mac Donald P. Williams Obstetricia 20 ed. Buenos Aires: Médica Panamericana, 1998: 617-20.
(44) Cross LL, Meythaler JM, Tuel SM, Cross AL. Pregnancy, labor and delivery post spinal cord injury. Paraplegia 1992; 30(12): 890-902.
(2) Jackson AB, Wadley V. A multicenter study of women’s self-reported reproductive health after spinal cord injury. Arch Phys Med Rehabil 1999; 80: 1420-8.
(3) Greenspoon JS, Paul RH. Paraplegia and quadriplegia: special considerations during pregnancy and labor and delivery. Am J Obstet Gynecol 1986; 155: 738-41.
(4) Baker ER, Cardenas DD. Pregnancy in spinal cord injured woman. Arch Phys Med Rehabil 1996; 77: 501-7.
(5) American College of Obstetricians and Gynecologists. ACOG Committee Opinion: Number 275, September 2002. Obstetric management of patients with spinal cord injuries. Obstet Gynecol 2002; 100: 625-7.
(6) Pereira L. Obstetric management of the patient with spinal cord injury. Obstet Gynecol Survey 2003; 58(10): 678-86.
(7) Poppas A, Shroff SG, Korcarz CE, Hibbard JU, Berger DS, Lindheimer MD, et al. Serial assessment of the cardiovascular system in normal pregnancy. Role of arterial compliance and pulsatile arterial load. Circulation 1997; 95: 2407-15.
(8) Romero Ganuza F, Mazaira Álvarez J. El paciente con lesión medular en el medio extrahospitalario. Aten Primaria 2001; 27: 127-36.
(9) Katz VL, Thorp JM, Cefalo RC. Epidural analgesia and autonomic hyperreflexia: a case report. Am J Obstet Gynecol 1990; 162: 471-2.
(10) Maehama T, Izena H, Kanazawa K. Management of autonomic hyperreflexia with magnesium sulfate during labor in a woman with spinal cord injury. Am J Obstet Gynecol 2000; 183: 492-3.
(11) Jones NA, Jones SD. Management of life-threatening autonomic hyper-reflexia using magnesium sulphate in a patient with a high spinal cord injury in the intensive care unit. Br J Anaesth 2002; 88(3): 434-8.
(12) Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001; 7(2): 342-7.
(13) Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Arch Intern Med 2000; 160(5): 678-82.
(14) Lucas MJ, Cunningham FG. Infecciones de vías urinarias durante el embarazo. Clín Obstet Ginecol 1993; 36(4): 807-18.
(15) Andriole VT, Patterson TF. Epidemiology, natural history, and management of urinary tract infections in pregnancy. Med Clin North Am 1991; 75: 359-73.
(16) Gilstrap LC. Infecciones del tracto urinario en el embarazo. In: Gleicher Medicina clínica en Obstetricia. Buenos Aires: Panamericana, 1991: 728-32.
(17) Bint AJ, Hill D. Bacteriuria of pregnancy–an update on significance, diagnosis and management. J Antimicrob Chemo-ther 1994; 33 Suppl A: 93-7.
(18) Green D. Diagnosis, prevalence, and manegement of thromboembolism in patients with spinal cord injury. J Spinal Cord Med 2003; 26(4) 329-34.
(19) Bryan T, Oshiro D, Branch. W. Maternal hemostasis: coagulation problems of pregnancy. In: Loscalzo J, Schafer A, ed. Thrombosis and hemorrhage. Philadelphia: Lippincott Williams and Wilkins, 1998; 46: 1005-25.
(20) David M. Venous thromboembolism during pregnancy and post partum. In: Leclerc J, ed. Venous thromboembolic disorders. Philadelphia: Lea & Febiger, 1991: 346–65.
(21) Sevrini I. Cambios fisiológicos en la hemostasis durante el embarazo normal. Congreso Uruguayo de Hematología, 8. Montevideo, 2000.
(22) Bonnar J, Green R, Norris L. Perinatal aspects of inherited thrombophilia. Semin Thromb haemost 1999; 25(5): 481-5.
(23) Amiram E. Thrombophilia, thrombosis and pregnancy. Thromb Haemost 2001; 86: 104-11.
(24) Gerhardt A, Scharf RE, Beckmann MW, Struve S, Bender HG, Pillny M, et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and puerperium. N Engl J Med 2000; 342 (6): 374-80.
(25) Brenner B, Hoffman R, Blumenfeld Z, Weiner Z, Younis JS. Gestacional outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin. Thromb Haemost 2000; 83(5): 693-7.
(26) Otero A, Pou Ferrari R, Pons E, Lens D, De Lisa E, Dellepiane M. Trombofilia y pérdida recurrente de embarazo. Rev Med Urug 2004; 20: 106-13.
(27) Lens D, Otero AM, Brugnini A, Henry S, Trías N, Díaz A. Prevalence of factor V Leiden, prothrombin 20210A and the thermolabile MTHFR in the uruguayan population. Thromb Haemost 2001; 86 (Suppl): 668.
(28) Pabinger J, Vormittag R. Thrombophilia and pregnacy outcomes. J Intern Societ Thromb Haemost 2005; 3: 1603-10.
(29) Sztenc S. Hyperhomocysteinemia and pregnacy copmplications. Ginekol Pol 2004; 75(4): 317-25.
(30) Carrizo C. MTHFR y pérdida recurrente de embarazo. Simposio: Trombofilia y embarazo. Montevideo, 22 junio 2005. (en prensa).
(31) Marietta, Facchinetti F, Sgarbi L, Simoni L, Bertesi M, Torelli G, Volpe A. Elevated plasma levels of factor VIII in women with early recurrent miscarriage. J Thromb Haemost 2003; 1(12): 2536-9.
(32) Dossenbach-Glaninger A, van Trotsenburg M, Krugluger W, Dossenbach MR, Oberkanins C, Huber J, et al. Elevated coagulation factor VIII and the risk for recurrent early pregnancy loss. Thromb Haemost 2004; 91(4): 694-9.
(33) Consenso Uruguayo sobre SAF del Embarazo, 8 de Agosto de 2002. Elaboración preliminar y coordinación: Dr. Enrique Pons, Dra. Ana María Otero, Dr. Ricardo Pou. Publicación laboratorio Aventis. pag. 1 -20.
(34) Hirsh J, MD. Antihrombotic Therapy during Pregnancy. Guidelines for Antithrombotic Therapy Fifth Edition 2005: 90-4.
(35) Yarkony GM, Heinemann AW. Pressure ulcers. In: Stover SL, DeLisa JA, Whiteneck G, ed. Spinal cord injury: clinical outcomes from the Model Systems. Gaithersburg: Aspen, 1995: 100-19.
(36) Yarkony GM, Chen D. Rehabilitation of patients with spinal cord injuries. In: Braddom RL, Buschbacher RM, ed. Physical Medicine and Rehabilitation. Philadelphia: Saunders, 1996: 1149-79.
(37) Kulkarni S, Morgan OS. Pregnancy outcome in paraplegic women. West Indian Med J 1992; 41(3): 99-100.
(38) Rageth JC, Wanner M, Iljazovic S, Heinzl S. Pregnancy, labor and the puerperium in paraplegic. Geburtshilfe Frauenheilkd 1986; 46 (8):536-40.
(39) Arias F. Crecimiento intrauterino retardado. In: Guía práctica para el embarazo y el parto de alto riesgo. 2ª ed. Barcelona:. Mosby-Doyma, 1995: 307-25.
(40) Fescina RH, Ucieda FJ, Cordano MC, Nieto F, Tenzer SM, López R. Ultrasonic patterns of intrauterine fetal growth in a Latin American country. Early human Dev 1982; 6: 239.
(41) Fescina R, Schwarcz R, Díaz, AG. Vigilancia del crecimiento fetal. Manual de autoinstrucción. Montevideo: Centro Latinoamericano de Perinatología y Desarrollo Humano, s.f. (Publicación Científica, n° 1261).
(42) Cordano M, Compte E, Bessis R, Papiernik E. Longitudinal follow-up of 100 patients at risk of intrauterine growth retardation: comparison of diagnosis in two periods. J Perinat Med 1988; 16(1): 61-6.
(43) Enfermedades y anormalidades de las membranas ovulares. In: Cunnigham FG, Mac Donald P. Williams Obstetricia 20 ed. Buenos Aires: Médica Panamericana, 1998: 617-20.
(44) Cross LL, Meythaler JM, Tuel SM, Cross AL. Pregnancy, labor and delivery post spinal cord injury. Paraplegia 1992; 30(12): 890-902.
Publicado
2008-06-30
Cómo citar
1.
Carrizo C, Sevrini I, Pérez N, Sosa L, Borrelli G, Cordano C. Embarazo en paciente parapléjica con trombofilia. Rev. Méd. Urug. [Internet]. 30 de junio de 2008 [citado 16 de mayo de 2024];24(2):133-9. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/584
Sección
Casos Clínicos
