Agência Minas Gerais | Infecção por dengue pode causar complicações em grávidas e puérperas
A pior epidemia de dengue da história de Minas Gerais já apresenta mais de 500 mil casos prováveis da doença registrados em todo o estado. O cenário preocupante exige cuidados de toda a população, mas um público, em especial, necessita de ainda mais atenção: as gestantes e puérperas (mães que acabaram de dar à luz).
Dados epidemiológicos do Ministério da Saúde mostram que o número de casos de dengue em gestantes aumentou 345,2% nas seis primeiras semanas deste ano, na comparação com o mesmo período de 2023. No Hospital Júlia Kubitschek (HJK), que é referência municipal no atendimento a gestantes com dengue, chikungunya ou zika, quase cem pacientes grávidas foram atendidas com a suspeita ou confirmação da doença nos últimos 30 dias.
As alterações fisiológicas próprias da gravidez podem favorecer o surgimento de quadros ainda mais graves da doença, que incluem complicações hemorrágicas e acúmulo de líquido em determinados órgãos, como no pulmão, por exemplo.
“Os sinais de alerta da dengue na gestação surgem, geralmente, entre 24 e 48 horas após diminuição do quadro febril. Podem aparecer sintomas como dificuldades respiratórias e sangramento de mucosas. Nesses casos, é imprescindível que a paciente procure atendimento médico, mesmo que já tenha sido atendida anteriormente pelo quadro de dengue”, explica Pollyanna Freire Barbosa Lima, ginecologista obstetra da maternidade do HJK.
A maioria dos casos graves se dá pelo aumento da permeabilidade vascular (passagem de substâncias do sangue para os tecidos e vice-versa). A paciente pode entrar em choque quando uma grande quantidade de plasma (componente do sangue que transporta substâncias pelo corpo) é perdida por meio do extravasamento ou sangramento.
Assim como as gestantes, as puérperas também têm risco maior de complicação, principalmente nas duas primeiras semanas após o parto. “O corpo ainda entende que a mulher está gestando. Então, ela também pode apresentar as alterações que a grávida teria. As puérperas nos primeiros dias pós-parto precisam ficar atentas”, afirma Pollyanna.
Medicações
A ginecologista explica que gestantes que fazem uso de ácido acetilsalicílico (AAS) devem ter ainda mais cuidado. “Na gravidez, a mulher já não pode utilizar uma série de medicamentos e, com a dengue, essa restrição aumenta mais um pouco. Gestantes com dengue não podem utilizar anti-inflamatório e anticoagulante. Algumas medicações para dor e febre são liberadas para quem não possui alergias, a critério da avaliação médica. O uso do AAS, indicado para prevenção da pré-eclâmpsia, também deve ser avaliado pelo médico”, detalha a médica.
Prevenção
As gestantes não podem utilizar a vacina contra a dengue por ser um imunizante com agente atenuado (vírus vivo, porém, sem capacidade de produzir a doença). Então, a prevenção deve ser redobrada. “As mulheres grávidas devem usar repelentes aprovados pela Anvisa, à base de DEET ou icaridina. Também ajuda bastante utilizar roupas que cubram braços e pernas, a fim de reduzir a área exposta e a chance de picadas pelo mosquito Aedes aegypti”, orienta a ginecologista.
Atendimento cuidadoso
No fim de janeiro deste ano, a dona de casa Isabela Carvalho Barcelos, à época com 34 semanas de gestação, precisou procurar o atendimento da maternidade do Hospital Júlia Kubitschek, quando começou a apresentar os sintomas de dengue.
“Foi a primeira vez que tive. Senti, de início, muita dor de cabeça e nos olhos e o corpo quente. Quando fui ver, estava com febre e muita dor na musculatura do corpo. Foi aí que procurei a maternidade. Depois do primeiro atendimento, tive que fazer um acompanhamento na unidade para monitorar a quantidade de plaquetas, pois as minhas ficaram muito baixas. O atendimento foi excelente, olharam meus exames, pediram ultrassom para ver como estava o bebê, enfim, me acolheram muito bem. Não precisei ficar internada”, conta.
Referência
A Fundação Hospitalar do Estado de Minas Gerais (Fhemig) elaborou o Plano de Contingência de Enfrentamento à Dengue, que prevê a ativação de serviços de acordo com a situação epidêmica e a demanda do gestor municipal.
A maternidade do Hospital Júlia Kubitschek passou a ser referência no atendimento a gestantes suspeitas e confirmadas com dengue, chikungunya ou zika. O serviço de urgência funciona 24 horas.
A unidade tem expertise no atendimento epidêmico. Durante a pandemia de covid-19, foi referência no cuidado a gestantes suspeitas ou confirmadas com a doença.
O HJK conta com 23 leitos e 51 poltronas para hidratação oral e venosa, dedicados aos casos de arboviroses. Outras unidades da Fhemig estão dando suporte nesse atendimento, como o Hospital Eduardo de Menezes, referência no atendimento a doenças infectocontagiosas, o Hospital Cristiano Machado, em Sabará, e o Hospital Infantil João Paulo II.
O Plano de Contingência também inclui o Hospital Regional João Penido, em Juiz de Fora, que pode ser usado como retaguarda para o atendimento aos casos de dengue, conforme necessidade do gestor municipal.
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