Parâmetros fisiológicos e morbidade materna severa na pielonefrite aguda
DOI:
https://doi.org/10.24220/2318-0897v33a2025e8008Palavras-chave:
Unidades de terapia intensiva, Saúde materna, Near miss, Complicações na gravidez, Sinais vitais, PielonefriteResumo
Objetivo
Avaliar parâmetros vitais relacionados à morbidade materna grave decorrente de pielonefrite aguda, enquanto estratégia para melhoria de assistência obstétrica.
Métodos
Estudo transversal e retrospectivo de casos hospitalares de pielonefrite aguda alocados em melhora em enfermaria ou admissão em Unidade de Terapia Intensiva (UTI), de janeiro de 2014 a dezembro de 2018. Dados vitais dos casos foram comparados sob médias e parâmetros pré-estabelecidos como alterados de sistemas de alerta descritos em literatura, com significância estatística quando p<0,05. Foram calculados Odds Ratio (OR) e respectivos intervalos de confiança 95% (IC 95%) para examinar o efeito das variáveis sobre admissão em UTI.
Resultados
Estudou-se 335 casos, sem óbitos registrados e com 5,9% (n=20) de admissão em UTI; estas foram mais jovens (22,0±4,8 vs. 24,6±5,3 anos; p=0,022) e mais frequentemente primigestas (55% vs. 9,8%; p<0,001). Frequência cardíaca (FC), saturação periférica de oxigênio (SpO2) e frequência respiratória (FR) apresentaram diferença significativa sob as médias entre os grupos; classificados como alterados, foram os parâmetros mais prevalentes no grupo UTI. Observou-se maior associação de admissão em UTI com FC ≥100bpm (OR=30,5, IC 95% 8,6–108,1),
pressão arterial diastólica (PAD) <50mmHg (OR=16,4, IC 95% 5,3–50,0) e FR ≥22mrpm (OR=13,4, IC 95% 4,8–37,3). Casos com intervenções críticas em UTI contabilizaram 65% (n=13) de ventilação mecânica, 40% (n=08) de uso de vasopressores e 25% (n=05) de hemoterapia.
Conclusão
Alterações em FC, FR e SpO2 estiveram presentes em maior frequência nos casos com admissão em UTI e os critérios de FC≥100bpm, PAD<50mmHg e FR≥22mrpm apresentaram maior associação para este desfecho.
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Referências
Chou D, Tunçalp Ö, Firoz T, Barreix M, Filippi V, von Dadelszen P, et al. Constructing maternal morbidity
- towards a standard tool to measure and monitor maternal health beyond mortality. BMC Pregnancy
Childbirth. 2016;16:45.
World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO
near-miss approach for maternal health. Geneva: WHO; 2011.
Say L, Souza JP, Pattinson RC, WHO working group on Maternal Mortality and Morbidity classifications.
Maternal near miss-towards a standard tool for monitoring quality of maternal health care. Best Pract Res
Clin Obstet Gynaecol. 2009;23(3):287-96.
Jolley JA, Kim S, Wing DA. Acute pyelonephritis and associated complications during pregnancy in 2006 in
US hospitals. J Matern Fetal Neonatal Med. 2012;25(12):2494-8.
Snyder CC, Barton JR, Habli M, Sibai BM. Severe sepsis and septic shock in pregnancy: indications for
delivery and maternal and perinatal outcomes. J Matern Fetal Neonatal Med. 2013;26(5):503-6.
Society for Maternal-Fetal Medicine. Plante LA, Pacheco LD, Louis JM. SMFM Consult Series #47: Sepsis
during pregnancy and the puerperium. Am J Obstet Gynecol. 2019;220(4):B2-B10.
World Health Organization: Statement on Maternal Sepsis. Geneva: WHO, 2017.
Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. 2012;120(3):689-706.
Padilla C, Palanisamy A. Managing Maternal Sepsis: Early Warning Criteria to ECMO. Clin Obstet Gynecol.
;60(2):418-24.
Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: a systematic
review. Intensive Care Med. 2010;36(9):1465-74.
The Confidential Enquiry into Maternal and Child Health. Saving Mothers’ Lives: reviewing maternal
deaths to make motherhood safer - 2003-2005. The Seventh Report on Confidential Enquiries into
Maternal Deaths in the United Kingdom. London: CEMACH.
Zuckerwise LC, Lipkind HS. Maternal early warning systems-Towards reducing preventable maternal
mortality and severe maternal morbidity through improved clinical surveillance and responsiveness. Semin
Perinatol. 2017;41(3):161-5.
Nair S, Spring A, Dockrell L, Mac Colgain S. Irish Maternal Early Warning Score. Ir J Med Sci. 2020;189(1):229-
Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Use of Maternal Early Warning Trigger tool
reduces maternal morbidity. Am J Obstet Gynecol. 2016;214(4):e1-527.e6.
O’Regan C, O’Malley EG, Power KA, Reynolds CME, Sheehan SR, Turner MJ. Development of a novel
bedside index for the early identification of severe maternal infection. Eur J Obstet Gynecol Reprod Biol.
;235:26-9.
Hill JB, Sheffield JS, McIntire DD, Wendel GD Jr. Acute pyelonephritis in pregnancy. Obstet Gynecol.
;105(1):18-23.
Friedman AM, Phipps MG, Raker CA, Anderson BL. Pyelonephritis during pregnancy as a marker for quality
of prenatal care. J Matern Fetal Neonatal Med. 2012;25(6):739-42.
Albright CM, Ali TN, Lopes V, Rouse DJ, Anderson BL. The Sepsis in Obstetrics Score: a model to identify
risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol. 2014;211(1):39.e1-8.
Carle C, Alexander P, Columb M, Johal J. Design and internal validation of an obstetric early warning
score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme
database. Anaesthesia. 2013;68(4):354-67.
Bowyer L, Robinson HL, Barrett H, Crozier TM, Giles M, Idel I, et al. SOMANZ guidelines for the investigation
and management sepsis in pregnancy. Aust N Z J Obstet Gynaecol. 2017;57(5):540-51.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International
Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
Mhyre JM, D’Oria R, Hameed AB, Lappen JR, Holley SL, Hunter SK, et al. The maternal early warning
criteria: a proposal from the national partnership for maternal safety. Obstet Gynecol. 2014;124(4):782-6.
Dotters-Katz SK, Grotegut CA, Heine RP. The effects of anemia on pregnancy outcome in patients with
pyelonephritis. Infect Dis Obstet Gynecol. 2013;2013:1-5.
Lepine S, Lawton B, Geller S, Abels P, MacDonald EJ. Severe maternal morbidity due to sepsis: The burden
and preventability of disease in New Zealand. Aust N Z J Obstet Gynaecol. 2018;58(6):648-53.
Galvão A, Braga AC, Gonçalves DR, Guimarães JM, Braga J. Sepsis during pregnancy or the postpartum
period. J Obstet Gynaecol. 2016;36(6):735-43.
Dawkins JC, Fletcher HM, Rattray CA, Reid M, Gordon-Strachan G. Acute pyelonephritis in pregnancy: a
retrospective descriptive hospital based-study. ISRN Obstet Gynecol. 2012;2012:1-6.
Kidson KM, Henderson WR, Hutcheon JA. Case Fatality and Adverse Outcomes Are Reduced in Pregnant
Women With Severe Sepsis or Septic Shock Compared With Age-Matched Comorbid-Matched
Nonpregnant Women. Crit Care Med. 2018;46(11):1775-82.
Ziesmann MT, Marshall JC. Multiple Organ Dysfunction: The Defining Syndrome of Sepsis. Surg Infect
(Larchmt). 2018;19(2):184-90.
McDonnold M, Friedman A, Raker C, Anderson B. Is postpartum pyelonephritis associated with the same
maternal morbidity as antepartum pyelonephritis? J Matern Fetal Neonatal Med. 2012;25(9):1709-11.
Sharma P, Thapa L. Acute pyelonephritis in pregnancy: a retrospective study. Aust N Z J Obstet Gynaecol.
;47(4):313-5.
DeYoung TH, Whittington JR, Ennen CS, Poole AT. Pyelonephritis in Pregnancy: Relationship of Fever and
Maternal Morbidity. AJP Rep. 2019;9(4):e366-e371.
ACOG Practice Bulletin No. 211: Critical Care in Pregnancy. Obstet Gynecol. 2019;133(5):e303-e319.
Bonet M, Nogueira Pileggi V, Rijken MJ, Coomarasamy A, Lissauer D, Souza JP, et al. Towards a consensus
definition of maternal sepsis: results of a systematic review and expert consultation. Reprod Health.
;14(1):67.
Burlinson CEG, Sirounis D, Walley KR, Chau A. Sepsis in pregnancy and the puerperium. Int J Obstet Anesth.
;36:96-107.
Millar LK, Cox SM. Urinary tract infections complicating pregnancy. Infect Dis Clin North Am. 1997;11(1):13-26.
Friedman AM, Campbell ML, Kline CR, Wiesner S, D’Alton ME, Shields LE. Implementing Obstetric Early
Warning Systems. AJP Rep. 2018;8(2):e79-e84.
