Pulmão e gravidez

Pregnancy and lungs

 

Inês A C Gonçalves Marcos¹

 

Resumo

A patologia respiratória é relativamente frequente durante a gravidez. Um terço das grávidas sofrem exacerbação da asma. O tromboembolismo pulmonar é cerca de 5 vezes mais frequente na gravidez. As pneumonias bacterianas, virais e fúngicas são mal toleradas pela grávida, provocando significativa morbilidade materno-fetal, insuficiência respiratória, baixo peso ao nascer ou prematuridade. A tuberculose, se não for tratada, pode aumentar em 4 vezes a mortalidade materna e em 9 vezes o parto pré-termo. A gravidez está contra-indicada em mulheres com fibrose quística e função pulmonar grave. Apesar dos progressos terapêuticos, a hipertensão pulmonar continua a estar associada a valores superiores a 30% de morbilidade e mortalidade materno-fetal. Aproximadamente 1 em 1000-1500 gravidezes é complicada por neoplasia maligna materna. O cancro do pulmão nas grávidas coloca desafios terapêuticos importantes devido às elevadas taxas de mortalidade.

Palavras-chave: Pulmão, gravidez, alterações fisiológicas, complicações pulmonares.

 

Abstract

Respiratory pathology can be relatively frequent during pregnancy. One third of pregnant woman may experience worsening of their asthma condition. Pulmonary tromboembolism is 5 times more frequent in pregnancy. Bacterial, viral and fungal pneumonias are baddly tolerated during pregnancy, provoking mother-foetal morbidity, respiratory insufficiency, low born-weight or prematurity. Non-treated tuberculosis may increase maternal mortality and preterm birth by 4 and 9 times respectively. Pregnancy is counter-indicated in women with cystic fibrosis and severe pulmonary function. Despite therapeutic progresses already made, pulmonary hypertension is associated to over 30% of mother-foetal morbidity and mortality. Approximately 1 in 1,000-1,500 pregnancies is affected by mother cancer. High rates of lung cancer morbility in women bring new and important challenges to therapy.

Key-words: Pregnancy, lung, physiological changes, pulmonary complications.

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

Bibliografia

1. Soubra SH, Guntupalli KK. Critical illness in pregnancy: An overview. Crit Care Med 2005; 33(10 suppl):S248-55.        [ Links ]

2. Bhatia P, Bhatia K. Pregnancy and the lungs. Postgrad Med J 2000; 76:683-9.

3. Yeomans ER, Gilstrap III C. Physiologic Changes in pregnancy and their impact on critical care. Crit Care Med 2005; 33(10 suppl):S256-8.

4. Cunningham F, Gant N, Leveno K, Gilstrap L, Hauth J, Wenstrom K. Section XII: Medical and Surgical complications in pregnancy. Williams Obstetrics 21 St edition 2001; 1224-44.

5. K Spiropoulos, Prodromaki E, Tsapanos V. Effect of Body Position on PaO2 and PaCO2 during pregnancy. Gynecologic and Obstetric Investigation 2004; 58(1).

6. Sat Sharma. Pulmonary disease and pregnancy. www.emedicine.com/med/topic3252.htm. Updated: 2004.

7. Wise RA, Polito AJ, Krishnan V. Respiratory physiologic changes in pregnancy. Immunol Allergy Clin North Am 2006; 26(1):1-12.

8. K Spiropoulos, E. Prodromaki, V Tsapanos. Effect of body position on PaO2 and PaCO2 during pregnancy. Gynecologic and Obstetric Investigation 2004; 58(1).

9. Bier A, Virchow JC. Pneumological Disease in Pregnancy. MMW Fortschr Med 2005; 147(16):32-3.

10. E. Murphy, P.G. Gibson, R. Smith and V.L. Clifton. Asthma during pregnancy: mechanisms and treatment implication. Eur Respir Journ 2005; 25:731-750.

11. National Asthma Education and Prevention Program Asthma Pregnancy. Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment. Update 2004

12. Murphy VE, Clifton VL, Gibson PG. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes. Thorax 2006; 61:169-76.

13. Brum G. Gravidez-complicações pulmonares. 39.º Curso de Pneumologia para pós-graduados. Patologia respiratória na mulher, que diferenças? Clínica de Pneumologia. FML/HSM. 30 Março a 1 de Abril de 2006; 145-51.

14. Freitas MG, Amaral Marques R, Ponce P. Asma brônquica. Manual de Terapêutica Médica 1. Lidel Edições Técnicas, Lda. 2002; 45-54.

15. Bates SM, Ginsberg JS. How we manage venous thromboembolism during pregnancy. Blood 2002; 100(10):3470-8.

16. Scarsbrook AF, Evans AL, Owen AR, Gleeson FV. Diagnosis of suspected venous thromboembolic disease in pregnancy. Clin Radiol 2006; 61:1-12.

17. Lisa M, Kathry LB, Susan M. MSc. Sex and gender issues and venous thromboembolism. Clin Chest Med 2004; 25:281-97.

18. Stone S, Morris TA. Pulmonary embolism during and after pregnancy. Crit Care Med 2005; 33(10 suppl):S294-9.

19. Monteiro JT. Tromboembolismo pulmonar: Aspectos particulares. 39.º Curso de Pneumologia para pós-graduados. Patologia respiratória na mulher, que diferenças? Clínica de Pneumologia. FML/HSM. Lisboa, 2006; 115-7.

20. Nolan TE, Smith RP, Devoe LD: Maternal plasma D-dimer levels in normal and complicated pregnancy. Obstet Gynecol 1993; 81:235-8.

21. Tan LK, Swiet M. Management of thromboembolic disease in pregnancy. Ann Acad Med Singapore 2002; 31:311-9.

22. Palmer EL, Scott JA, Strauss HW. Practical Nuclear Medicine. Philadelphia: WB Saunders; 1992.

23. Goldhaber SZ. Pulmonary Embolism. Medical Progress. 339(2):93-104.

24. Trukhacheva E, Scharff M, Gardner M, Lakkis N. Massive pulmonary embolism in pregnancy treated with tissue plasminogen activator. Obstet Gynecol 2005; 106 (5 Pt 2):1156-8.

25. Moore J, Baldisseri MR. Amniotic fluid embolism. Crit Care Med 2005; 33(10 suppl):S279-84.

26. Marie BM, Arroliga AC, Emery S. Exacerbation of underlying pulmonary disease in pregnancy. Crit Care Med 2005; 33(10 suppl):S313-1.

27. Martins Correia J. Hipertensão Pulmonar. In: Maria João Marques Gomes, R Sotto-Mayor (eds): Tratado de Pneumologia. Vol II. SPP. pp. 1599-626.

28. Bendayan D, Hold M, Oron G, Sagie A, Eidelman L, Shitrit D, Kramer MR. Pregnancy outcome in patients with pulmonary arterial hypertension Receiving prostacyclin therapy. Obstetrics and Gynecology 2005; 106(5).

29. Mendes AC. Doenças vasculares do pulmão. 39.º Curso de Pneumologia para pós-graduados. Patologia respiratória na mulher, que diferenças? Clínica de Pneumologia. FML/HSM. Lisboa, 2006; 115-7.

30. Elliot CA, Stewart P, Webster VJ, Mills GH, Hutchinson SP, Howarth ES, Bu’lock FA, Lawson RA, Armstrong IJ, Kiely DG. The use of iloprost in early pregnancy in patients with pulmonary arterial hypertension. Eur Respir Journ 2005; 26:168-73.

31. Carro-Jiménez EJ, Lopez JE. Primary pulmonary hypertension and pregnancy. Bol Assoc Med PR 97(4):328-33. 32. Bildirici I, Shumway JB. Intravenous and Inhaled Epoprostenol for primary pulmonary hypertension during pregnancy and delivery. Obstetrics and Gynecology 2004; 103(5).

33. Weiss BM, Hess OM. Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives. Eur Heart J 2000; 21(2):104-15.

34. Geohas C, McLaughlin VV. Successful Management of Pregnancy in a Patient with Eisenmerger Syndrome With Epoprostenol. Chest 2003; 124:1170-3.

35. Barst RJ, Rubin LJ, Long WA, Rich S, et al. A comparison of continuous intravenous Epoprostenol with conventional therapy for primary pulmonary hypertension. N Eng J Med 1996; 334: 22-301.

36. Cole DE, Taylor TL, McCullough DM, Shoff CT, Derdak S. Acute respiratory distress syndrome in pregnancy. Crit Care Med 2005; 33(10 suppl):S269-76.

37. Fatimi S, Sheikh S, Khan SF. Student. Arterio-venous malformation of the lung in pregnancy with massive haemoptysis. IJTCVS 2005; 21:281-2

38. Ramsey PS, Ramin KD. Pneumonia in pregnancy. Obstet Gynecol Clin North Am 2001; 28.

39. Lim WS, Macfarlane JT; Colthorpe CL. Treatment of community-acquired lower respiratory tract infections during pregnancy. Am J Respir Med 2003; 2(3):221-33.

40. Munnur U, Boisblanc B, Suresh MS. Airway problems in pregnancy. Crit Care Med 2005; 33(10 supp):S259-67.

41. Ely JW, Jerome Y, Noelle B. Evaluation of Pregnant Womem Exposed to Respiratory Virus. American Family Physician. American Academy of Family Physicians. 2000.

42. Wheat LJ. Systemic Fungal Infection During Pregnancy. Case Study 2005A.

43. Aoki F, Sando Y, Tajima S, Imai K, Hosono T, Maeno T, Suga T, Sugano J, Shitara Y, Kurabayashi M. Invasive Pulmonary Aspergillosis in a Puerperant with Drug induced Agranulocytosis. Intern Med 2001; 40(11):1128-31.

44. Manique A. Tuberculose na Mulher – Aspectos particulares. 39.º Curso de Pneumologia para pós graduados. Patologia respiratória na mulher, que diferenças? Clínica de Pneumologia. FML/HSM. Lisboa 2006; 153-62.

45. World Health Organization. Stop Tuberculosis Guidelines for Social Mobilization. A Human Rights Approach to Tuberculosis. WHO/CDS/STB, 2001.

46. Good JTI, Davidson PT, et al. Tuberculosis in association with pregnancy. Am J Obstet Gynecol 1981; 140,492.

47. Arora VK, Gupta R. Tuberculosis and Pregnancy. Indian Journal of Tuberculosis 2003; 50,13.

48. Antunes F. Programa Nacional da Luta Contra a Tuberculose. Sistema de Vigilância. Ponto de situação epidemiológica e de desempenho. 2003; 1-12.

49. Administração de Saúde do Norte. Saúde na Região Norte. Centro regional de saúde pública do norte, Dezembro 2001. Medir para mudar. Tuberculose. Ministério da Saúde: 126-36.

50. Rieder, Hans L. Bases epidemiológicas do controlo da tuberculose. Direcção Geral de Saúde, 2001.

51. Manual de Pneumologia. 2002.Sociedade Brasileira PT. Pneumopatias na gestação: 371-8.

52. Telhada MF. Quimioterapia antituberculosa. Tratado de Pneumologia. In: Maria João Marques Gomes, R Sotto-Mayor (eds): Vol I. SPP 2003; 711-64.

53. Pestana E, Pina J. A Tuberculose em grupos epidemiológicos Particulares. Tuberculose na Viragem do Milénio. Lidel – Edicões Técnicas, Lda. pp. 501-503.

54. Toure NO, Dia Y, Diatta A, Ndiaye CM,Sah BA, Niang A, Fall N, Kane M, Mbaye F, Cisse A, Hane AA. Preliminary study of the association of tuberculosis and pregnancy: about 9 cases. Dakar Med 2004; 49(3):192-5.

55. Gomes MC, Freitas MG, Ponce P. Tuberculose pulmonar e extra pulmonar. Manual de Terapêutica Médica 1. Lidel – Edições Técnicas, Lda. 2002: 12-21.

56. World Health Organization information. TB is single biggest killer of young women. Press release WHO/40. 1998. 57. Treatment of tuberculosis: Guidelines for National Programme: WHO/CDS/TB 2003.313.Geneve: World Health Organization, 2003.

 

¹ Interna do 5.º ano de Pneumologia.

Orientador de Formação: Dr. João Valença Rodrigues, Assistente Graduado de Pneumologia.

Director do Serviço de Pneumologia: Dr. Renato Sotto-Mayor

Serviço de Pneumologia, Hospital de Santa Maria, Lisboa

 

Recebido para publicação/received for publication: 06.12.10

Aceite para publicação/accepted for publication: 06.12.19