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Volume 58 • Número 6 • Novembro/Dezembro 2012 • ISSN 0104-4230 • ISSN 1806-9282 (On-line)
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ARTIGOS ORIGINAIS _____________Qualidade da informação da internet disponível para pacientes em páginas em português ___________________________________________________________645 Acesso a informações de saúde na internet: uma questão de saúde pública? ______650 Maus-tratos contra a criança e o adolescente no Estado de São Paulo, 2009_______659 Obesidade e hipertensão arterial em escolares de Santa Cruz do Sul – RS, Brasil ___666 Bone mineral density in postmenopausal women with and without breast cancer ___673 Prevalence and factors associated with thoracic alterations in infants born prematurely __________________________________________________679 Análise espacial de óbitos por acidentes de trânsito, antes e após a Lei Seca, nas microrregiões do estado de São Paulo ___________________________________685 Sobrevida e complicações em idosos com doenças neurológicas em nutrição enteral ______________________________________________________691 Infliximab reduces cardiac output in rheumatoid arthritis patients without heart failure ______________________________________________________698 Análise dos resultados maternos e fetais dos procedimentos invasivos genéticos fetais: um estudo exploratório em Hospital Universitário _______________703 Frequência dos tipos de cefaleia no centro de atendimento terciário do Hospital das Clínicas da Universidade Federal de Minas Gerais __________________709
ARTIGO DE REVISÃO ______________Influência das variáveis nutricionais e da obesidade sobre a saúde e o metabolismo __714 EDITORIAL
Conclusão: como exibir a cereja do bolo 633 PONTO DE VISTA
Os paradoxos da medicina contemporânea 634 IMAGEM EM MEDICINAObstrução duodenal maligna: tratamento
endoscópico paliativo utilizando prótese metálica autoexpansível 636 Gossypiboma 638
DIRETRIZES EM FOCO Hérnia de disco cervical no adulto: tratamento cirúrgico 639 ACREDITAÇÃOAtualização em perda auditiva: diagnóstico radiológico 644
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At the bedside
What are the recommendations for pregnant
and lactating women undergoing endoscopic procedures?
Quais as recomendações para gestantes e nutris
que serão submetidas a procedimentos endoscópicos?
Jarbas Faraco Maldonado
a, Elias Jirjoss Ilias
baService of Endoscopy, Hospital Sírio Libanes, São Paulo, SP, Brazil bBrazilian College of Surgeons, São Paulo, SP, Brazil
A RT I C L E I N F O
Article history:
Received 30 January 2013 Accepted 30 January 2013
* Corresponding author at: Rua Prof. Enéas de Siqueira Neto, 340, Jardim Imbuías, Sta. Cecília, São Paulo, SP, 04829‑900, Brazil
E‑mail:eliasilias@hotmail.com (E.J. Ilias)
The American Society for Gastrointestinal Endoscopy (ASGE) published, in the first issue of its journal in 2012, the recommendations for pregnant and lactating women undergoing endoscopic procedures such as upper endo scopy, colonoscopy, and endoscopic retrograde cholangio pancreato‑ graphy (ERCP).1
This guideline intends to be an educational tool to provide information that can help endoscopy physicians to give medical care to these patients. These guidelines are not rules, should not be interpreted as a legal standard of care, and should not encourage or discourage any endoscopic procedure.
Recommendations for pregnant women
• An endoscopy should only be performed during pregnancy
when there is strong indication; whenever possible, it should be postponed until the second trimester.
• An obstetrician should monitor the patient, in order
to assist in the management of the pregnancy, including the determination of the degree of maternal‑fetal monitoring.
• Meperidine should be the agent of choice for endoscopic
procedures that involve moderate sedation, followed by smaller doses of midazolam as needed.
• Deep sedation, when necessary, should be performed by an
anesthesiologist.
• ERCP is generally safe during pregnancy; however, measures
are recommended to minimize exposure of the fetus and pregnant woman to radiation.
• When the use of electrocautery is necessary, the bipolar
type should be chosen. If monopolar cautery is used, a grounding pad must be used to minimize the flow of electric current through the amniotic fluid.
• Near the end of pregnancy, the patient should be placed in
REV ASSOC MED BRAS. 2013;59(2):102-103
103
• The choice of antibiotics, when necessary, should be
consider factors specific to the patient and stage of fetal development. Although many antibiotics can be safely used during pregnancy, some are safe only at certain stages of fetal development. However, others are contraindicated in all stages of gestation (quinolones, streptomycin, tetracycline).
Recommendations for lactating women
• Breastfeeding should be maintained after maternal
administration of fentanyl.
• Children should not be breastfed for at least 4 hours after
maternal administration of midazolam.
• Breastfeeding should be maintained after maternal
administration of propofol, as soon as the mother recovers from sedation.
• Quinolones and sulfonamides should be avoided.
• Penicillins, cephalosporins, tetracyclines, and erythromycin
are compatible with breastfeeding.
These recommendations are important, as they aim to minimize possible damage to the fetus, to the mother, and to the newborn when an endoscopic procedure is necessary in pregnant or lactating women.
R E F E R E N C E
1. ASGE Standard of Practice Committee, Shergill AK, Ben‑
Menachem T, Chandrasekhara V, Chathadi K, Decker GA, et al.
