CONDUITA MEDICALĂ ÎN PIERDERILE REPRODUCTIVE

Abstract

Introducere. Avorturile spontane, sarcinile stagnate și decesul in utero se referă la pierderile reproductive. Etiopatogenia este multifactorială și necesită conduită medico-socială complexă. Scopul. Analiza conduitei cazurilor clinice diagnosticate cu pierderi reproductive. Material și metode. Au fost cercetate 174 paciente internate în Institutul Mamei și Copilului. Datele clinice și paraclinice au fost colectate din fișele medicale. Rezultate. Vârsta pacientelor a fost 21-34 ani în 103/59.2%. În 57/32.8% femeile au avut ≥35 ani; în 14/8.0% ≥41 ani, ultima fiind asociată cu aberații cromozomiale și malformații fetale. Pacientele s-au adresat cu acuze la dureri, eliminări sangvinolente. Stabilit: avort spontan precoce (87/50.0%), avort spontan tardiv complet (27/15.5%) și incomplet (26/15.0%), sarcini stagnate (30/17.2%), anembrionie (4/2.3%). Din anamneză: pierderi reproductive precoce au declarat 27/15.5% paciente; avorturi habituale- 11/6.3%, fiind apreciate trombofilii con genitale, infertilitate; sarcina stagnată- 14/8.0%. Pacientele au menționat semne de depresie. Volumul hemoragiei preponderent ≤300 ml (133 /76.4%). Fiecare a treia femeie a manifestat anemie; în 37/21.2% apreciată leucocitoza. Vacuum aspirația cavității uterine efectuată în 126/72.4%; anestezia generală practicată în 132/75.9%. Pacientele au urmat tratament uterotonic, spasmolitic. Externarea la a treia zi; recomandat examen ecografic, contracepție, consultul psihologului. Concluzie. Pierderile reproductive constituie o problemă și necesită abordare medico-socială, vizite de follow-up și stabilirea unui plan preconcepțional.

Background. Spontaneous abortions, miscarriages and intrauterine deaths refer to reproductive losses. Etiopatho genesis is multifactorial and requires a complex medical and social approach. Objective of the study. The analysis of the clinical management of cases diagnosed with reproductive losses. Material and methods. A total of 174 patients with reproductive losses, admitted and treated at the Institute of Mother and Child, were studied. Clinical and paraclinical data were collected from medical records. Re sults. The age of the patients ranged from 21 to 34 years in 103 cases (59.2%). In 57 cases (32.8%), the women were aged ≥35 years; in 14 cases (8.0%) they were ≥41 years, the latter being associated with chromosomal aberrations and fetal malformations. The patients came in with complaints of pain and bleeding. Diagnoses established included early spontaneous abortion (87/50.0%), complete late spontaneous abortion (27/15.5%), incomplete late spontaneous abortion (26/15.0%), miscarriages (30/17.2%), and anembryonic (4/2.3%). From the anamnesis: early reproductive losses were reported by 27 patients (15.5%); repeated miscarriages by 11 patients (6.3%), with congenital thrombophilia and infertility noted; miscarriages by 14 patients (8.0%). The patients reported signs of depression. The amount of hemorrhage was predominantly ≤300 ml (133/76.4%). Every third woman presented anemia; in 37 cases (21.2%) leukocytosis was noted. Vacuum aspiration of the uterine cavity was performed in 126 cases (72.4%); gen eral anesthesia was used in 132 cases (75.9%). Patients received uterotonic and antispasmodic treatment. They were being discharged on the third day; ultrasound examination, contraception, and psychologist consultation were advised. Conclusion. Reproductive losses constitute a significant issue and require a medical-social approach, follow-up visits and a preconception plan.