Contribuição para Livros Internacionais com Arbitragem Científica de Drª. Sofia Santareno
Durante o Internato Complementar de Cirurgia Plástica contribuiu em 2019 para o livro Critical Care Obstetrics: A clinical Guide, dos editores Carlos Montufar, Jorge Hidalgo e Alfredo F. Gei, Springer, com a elaboração do capíutulo:
“Burn management in pregnancy” p editado dois trabalhos científico em revistas internacionais com arbitragem científica.
Burn management in pregnancy
Santareno S, D’Almeida A.
Objective: After reading this chapter, you will be able to dominate the emergent assessment of a pregnant burn patient (based on gestational age, extent of total body surface area of burn (TBSAB) and presence of inhalation injury or other traumas); you will also be able to take decisions regarding the need for airway intubation, fluid resuscitation, urgent cesarean and/or continuous monitoring with delay of delivery.
Methods and materials: Evidence-data available and published until 31st October 2019.
Results: TBSAB is positively associated with maternal death. Fetal survival depends on maternal survival. When TBSAB is above 55%, maternal survival declines; inhalation injury further exacerbates maternal-perinatal risk. There is a relationship between gestational age and TBSAB with maternal and fetal survival. The second factor associated with worse outcome is the carbon monoxide poisoning. The best way to acutely manage a pregnant burn patient is through the ABCDE principles, taking in attention some special considerations in inhalation, electrical and chemical injuries.
Conclusions: Thought the role of the obstetric expert is as secondary consultant, each should be aware of the recommended guidelines for the management of the burn pregnant patient. If the TBSAB is above 20%, fluid resuscitation should be taken in consideration based on the Parkland formula, with an increase of at least 30% before the delivery; this percentage should be recalculated after. If gestational age is 24 weeks or higher and TBSAB is more than 55%, urgent cesarean delivery is advisable. Several other details including positioning of the pregnant patient, thromboembolic and infectious prophylaxis, monitorization of both mother and fetus, systemic/topical antibiotics and early debridement should be taken in consideration. We also advise about electrical and chemical burn management in these patients.
Keywords: burn management and pregnancy, burn and pregnant