Protocols - Hemorio

INITIAL ATTENDANCE TO PREGNANT WOMEN:
1. Clinical History: obtain information on renal disease, hypertension, smoking, drugs and allergies.
2. Obstetric History: number of deliveries and abortions, gestational age when it happened, newborn
weight, types of labors and complications during gestational period or abortions.
3. Hemoglobin Electrophoresis of the father –to guide about fetus disease.
4. Labs exams: complete blood exam, reticulocyte, ferritine, bilrrubins, TGO, TGP, LDH, phosphatase
alkaline, glucose, urea, creatinine, uric acid, serology for hepatitis A,B,C, HIV, HTLV1, CMV, measles,
toxoplasmosis, VDRL; T. Coombs, fecal parasitology, PPD, SAE and urine culture. Repeat at the end of
1º, 2º and 3º quarters.
5. Ultrasound and Doppler.
6. Evaluation of fetal vitality
Note: To evaluate maternal nutrition and hydration and to monitor BP, pulse oximetry,, gain of weight,
fundus of uterus, uterine colon exam.
TRANSFUSION:
The efficacy of prophylactic transfusion is not supported by controlled papers. The indications are:
- Toxemia
- Gemellary Pregnancy
- Previous peri-natal mortality
- Septicemia / Bacteremy
- Acute Renal Insufficiency
- Acute Thoracic Syndrome
- Pre-surgical procedure
- Severe Anemia: 20% below hematocrits from baseline value or hemoglobin below 6g/dl.
RETARDED INTRA-UTERUS GROWTH (RIUG):
- More frequent in SS, less in SC e Sβ + .
- Implicated factors:
(1) hypoxia: reduction of O2 from placental blood with inappropriate release to the fetus.
(2) malnutrition - there is inappropriate transport of substances through placental membrane (maternal
anemia, frequently episodes of vase-occulsion leading to hypotension).
(3) early placental detached - area reduced of placenta switch
(4) previous placenta - with repeated bleeding it will become necrosis areas.
(5) toxemia
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