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Termos semelhantes:
Gestação Múltipla.
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A notícia de uma gestação múltipla ou gestação gemelar traz um misto de ansiedade e felicidade para a família, mas é necessário ter em mente que há um longo caminho que deve ser percorrido para que essa alegria seja plena.
Nas últimas décadas observou-se um aumento dos casos visto que, por questões afetivas, pessoais, profissionais ou financeiras, a maternidade tem sido adiada levando a necessidade de técnicas de reprodução assistida que são responsáveis por 25% das gestações gemelares.
Sabe-se que quando comparadas as gestações únicas teremos mais complicações maternas como anemia, hipertensão arterial, pré-eclâmpsia, diabetes gestacional, tromboembolismo e também complicações fetais como abortamentos , malformações , restrição de crescimento fetal e principalmente a prematuridade .
Exatamente por isso que é de extrema importância que o acompanhamento no pré-natal de alto risco englobe consultas com intervalo de 3 semanas até 30 semanas, após a cada 15 dias e a partir de 34 semanas seja semanal. O acompanhamento também será individualizado de acordo com o tipo de gestação.
Quando falamos da origem da gestação gemelar precisamos conhecer alguns termos como zigoto, córion e âmnion que ajudarão o obstetra a entender sobre os riscos de cada gestação, além de responder as perguntas frequentes da família sobre a probabilidade de os bebês serem do mesmo sexo, serem idênticos ou não, e também em conjunto programar o acompanhamento mais adequado.
O zigoto é o nome dado ao óvulo fecundado. Na gestação monozigótica pode ocorrer quando o ovário libera um óvulo que será fecundado por um espermatozoide, formando um único zigoto que irá se dividir carregando a mesma carga genética, ou seja os gêmeos idênticos.
Por outro lado, o ovário pode liberar mais de um óvulo e cada um ser fecundado por um espermatozoide, formando então vários zigotos. Estes são chamados dizigóticos e serão geneticamente diferentes podendo ou não ser do mesmo sexo. É o que mostra a figura 1.
Porém, mais importante que avaliar se a gestação é monozigótica , dizigotica ou polizigotica é classificar quanto ao número de placentas e bolsas.
Usamos o prefixo Córion quando nos referimos a placenta e âmnion quando estamos falando do número de bolsas amnióticas (ou bolsa das águas – que é a bolsa de liquido que envolve o bebê). A corionicidade, ou seja se os bebês tem a mesma placenta ou não é um dos parâmetros para avaliar os riscos de complicações da gestação gemelar.
Nas gestações dizigóticas ( dois óvulos fecundados por espermatozoides diferentes) obrigatoriamente teremos duas placentas e duas bolsas. Serão dois bebês diferentes em carga genética podendo ser ou não do mesmo sexo.
Nas gestações monozigóticas (um óvulo fecundado por um espermatozoide e este óvulo fecundado se divide) teremos bebês com carga genética igual e obrigatoriamente do mesmo sexo.
As monozigóticas quanto ao número de placentas e bolsas podem apresentar-se de diversas formas, conforme ilustra a figura 2.
Uma placenta e uma bolsa (Monozigótica – Monocoriônica – Monoamniótica)
Uma placenta e duas bolsas (Monozigótica – Monocorionica – diamniotica)
Duas placentas e duas bolsas (Monozigótica-dicorionica –diamniotica)
Essa diferenciação é feita através da realização de ultrassonografia entre 6 a 9 semanas de gestação e é de extrema importância pois o principal fator de risco para as gestações múltiplas é a corionicidade. A prematuridade é a principal complicação, ocorrendo em mais da metade das gestações gemelares principalmente nas monocorionicas. Outra complicação importante que pode atingir até 10% das gestações gemelares com apenas uma placenta e duas bolsas é a síndrome da transfusão feto fetal que ocorre quando não há uma distribuição equilibrada do fluxo placentário entre os fetos devido a anastomoses (ligações dos vasos) placentárias.
Para diagnosticar essas alterações, avaliar o desenvolvimento fetal, diagnosticar as restrições de crescimento fetais e avaliar o bem-estar fetal os exames de imagem são indispensáveis. As ecografias são mensais e nas monocorionicas a cada duas semanas.
Quanto a via de parto também existem critérios que devem ser avaliados . O parto vaginal é possível nas dicoriônicas por volta de 38 semanas, porém é preciso avaliar o peso dos fetos, a posição, a quantidade de líquido amniotico e a diferença de peso entre os fetos. É necessário equipe experiente, analgesia e sala para emergências disponível. Nas monocorionicas os partos costumam acontecer mais cedo por volta de 36 semanas nas diamnioticas e 34 semanas nas monoamnióticas.
Por todas estas questões é importante que as gestações gemelares sejam acompanhadas em pré natal de alto risco e por equipe multidisciplinar a fim de que seja possamos diagnosticar e quando possível prever e prevenir as complicações para que apesar dos riscos tenhamos um desfecho saudável e feliz para todos os envolvidos.
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text_shadow_blur=”0″ text_shadow_color=”” margin_top_medium=”” margin_right_medium=”” margin_bottom_medium=”” margin_left_medium=”” margin_top_small=”” margin_right_small=”” margin_bottom_small=”” margin_left_small=”” margin_top=”” margin_right=”” margin_bottom=”2px” margin_left=”” margin_top_mobile=”” margin_bottom_mobile=”” text_color=”#202020″ animated_text_color=”” highlight_color=”” style_type=”default” sep_color=”” link_color=”” link_hover_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Dra. Fernanda Torino[/fusion_title][fusion_title title_type=”text” rotation_effect=”bounceIn” display_time=”1200″ highlight_effect=”circle” loop_animation=”off” highlight_width=”9″ highlight_top_margin=”0″ before_text=”” rotation_text=”” highlight_text=”” after_text=”” title_link=”off” link_url=”” link_target=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” content_align_medium=”” content_align_small=”” content_align=”left” size=”6″ font_size=”” animated_font_size=”” fusion_font_family_title_font=”Poppins” fusion_font_variant_title_font=”700″ line_height=”” letter_spacing=”” text_shadow=”no” text_shadow_vertical=”” text_shadow_horizontal=”” text_shadow_blur=”0″ text_shadow_color=”” margin_top_medium=”” margin_right_medium=”” margin_bottom_medium=”” margin_left_medium=”” margin_top_small=”” margin_right_small=”” margin_bottom_small=”” margin_left_small=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” margin_top_mobile=”” margin_bottom_mobile=”” text_color=”#202020″ animated_text_color=”” highlight_color=”” style_type=”default” sep_color=”” link_color=”” link_hover_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Ginecologista e Obstetra, CRM: 19772, RQE: 11733[/fusion_title][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”10px” margin_left=”” font_size=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” line_height=”” letter_spacing=”” text_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Ginecologia e Obstetrícia | Pré-Natal de Alto Risco | Gestação de Alto Risco[/fusion_text][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”0px” margin_right=”” margin_bottom=”10px” margin_left=”” font_size=”15px” fusion_font_family_text_font=”Poppins” fusion_font_variant_text_font=”400italic” line_height=”” letter_spacing=”” text_color=”#7e858e” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]“Conhecemos as várias funções exercidas pelas mulheres, por isso é necessário que o cuidado englobe todos os aspectos da vida . Sendo múltipla não pode ser tratada como parte.”[/fusion_text][fusion_button link=”https://grupoelasbrasilia.com.br/fernandatorino/” text_transform=”” title=”” target=”_self” link_attributes=”” alignment_medium=”” alignment_small=”” alignment=”” modal=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” color=”default” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” type=”” bevel_color=”” border_width=”” border_radius=”” border_color=”” border_hover_color=”” size=”small” stretch=”default” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” icon=”fusion-prefix-fa-message-medical” icon_position=”left” icon_divider=”no” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]CONHEÇA A MÉDICA[/fusion_button][/fusion_builder_column_inner][/fusion_builder_row_inner][/fusion_builder_column][fusion_builder_column type=”1_6″ layout=”1_6″ align_self=”auto” content_layout=”column” align_content=”flex-start” valign_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” order_medium=”0″ order_small=”0″ hover_type=”none” border_color=”” border_style=”solid” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” filter_type=”regular” filter_hue=”0″ 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padding_top=”6%” admin_label=”Call to Action Agendamento” admin_toggled=”yes” background_image=”https://ml1ca8kph5lh.i.optimole.com/f8pwKbQ-zroGwOxF/w:auto/h:auto/q:auto/https://grupoelasbrasilia.com.br/wp-content/uploads/2021/05/cta-agende-sua-consulta.jpg” padding_bottom=”5%” padding_left=”0px” padding_right=”0px” background_color=”rgba(0,0,0,0.6)”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_2″ align_self=”center” content_layout=”column” align_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” order_medium=”0″ order_small=”0″ hover_type=”none” border_color=”” border_style=”solid” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”fade” animation_direction=”right” animation_speed=”1.0″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ padding_right=”” last=”true” border_position=”all” padding_right_small=”0px” first=”true”][fusion_title title_type=”text” rotation_effect=”bounceIn” display_time=”1200″ highlight_effect=”circle” loop_animation=”off” highlight_width=”9″ highlight_top_margin=”0″ before_text=”” rotation_text=”” highlight_text=”” after_text=”” content_align_medium=”” content_align_small=”center” content_align=”center” size=”2″ font_size=”” animated_font_size=”” line_height=”” letter_spacing=”” dimensions_medium=”” dimensions_small=”” text_color=”#dbc5a6″ animated_text_color=”” highlight_color=”” style_type=”default” sep_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” fusion_font_variant_title_font=”700″ fusion_font_family_title_font=”Open Sans” margin_bottom=”30px”]Agende sua consulta[/fusion_title][fusion_button link=”https://grupoelasbrasilia.com.br/contato/” text_transform=”” title=”” target=”_self” link_attributes=”” alignment_medium=”” alignment_small=”” alignment=”center” modal=”” color=”default” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” 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