Estreptococos do grupo B (EGB) na gestação

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Cesárea

Que bicho é esse?*

Group B streptococci (GBS), Streptococcus agalactiae ou Estrepto B.

É uma bactéria muito comum. Ocorre naturalmente em muitas pessoas, desde bebês a idosos, e normalmente não causa danos ou sintomas. 
Carregar o EGB (também chamado de colonização EGB ou carregador EGB) é uma atividade perfeitamente normal – uma em cada três pessoas desenvolvem EGB no intestino, e nas mulheres, muitas vezes, é também encontrado na vagina.
A hora que é importante saber se você carrega o EGB é durante a gestação.
A colonização da vagina e/ou reto ocorre em 15 a 40% (média 30%) das gestantes são portadoras.

EGB não é DST!


Nas gestantes portadoras estima-se que em 40% a 70% (média 50%) das vezes o feto pode acabar sendo também colonizado (antes ou depois do parto), sem que isso represente necessariamente infecção/doença. A contaminação pode ser intra-uterina (via ascendente a partir da vagina colonizada), pela aspiração de líquido amniótico contaminado ou durante a passagem pelo canal de parto (esta última forma leva geralmente a colonização cutânea ou da mucosa).

Amamentação NÃO transmite EGB!

Como o EGB pode atravessar as membranas ovulares íntegras, a colonização por este agente não é indicação para a operação cesariana, que não deve ser encarada como alternativa, apesar de não estar descrita a transmissão deste agente durante a cirurgia.

Quais os problemas que o EGB pode causar?

Na mãe: infecção urinária (cistite, pielonefrite) e uterina (corioamnionite, endometrite) infecção pós-parto de feridas (abdome ou períneo), sepse, meningite.

O EGB ocorre em bebês quando medidas preventivas não são tomadas.

No bebê: há dois tipos de infecção neonatal por EGB, a precoce e a tardia. A precoce (80% dos casos) acontece na primeira semana de vida, usualmente nas primeiras 6 – 12 horas, e freqüentemente está associada com complicações maternas obstétricas predisponentes, pois está diretamente relacionada à ascensão do patógeno da vagina e colo uterino de mulheres colonizadas.
Caracteriza-se por sepse, desconforto respiratório, apnéia, pneumonia e, menos freqüentemente, meningite.
A tardia acontece entre 7 e 90 dias do parto, sendo que cerca de 50% é de origem hospitalar; também podem adquirir na comunidade e de mães colonizadas. A meningite ocorre em 1/3 dos casos, comparada a 5% na doença precoce. Ainda pode ocorrer celulite, osteomielite, artrite séptica. Seqüelas em longo prazo de ambas as doenças inclui: deficiência visual ou auditiva, dificuldades de aprendizado ou retardo mental grave.
O uso intravenoso (IV) de antibiótico é a intervenção profilática (preventiva) recomendada.
A maioria se recupera plenamente, mas cerca de 10% dos bebês infectados com o EGB morrem e os sobreviventes podem ter grave deficiência física ou mental. A menos que você faça um teste designado para encontrá-lo, é improvável saber se você carrega o EGB ou não, porque não existem sintomas da colonização EGB.
Felizmente, estas infecções são relativamente raras – aproximadamente um em cada 1000 nascidos.

Como faço para descobrir se estou carregando o EGB? 
Você pode descobrir através de um teste, feito com amostras colhidas na vagina e reto. 
Estes testes não são rotineiros, mas, quando são feitos, são mais comumente realizados entre a 35ª e 37ª semanas de gestação. 
O melhor teste de detecção da EGB é chamado ECM (Enriched Culture Medium) e está disponível na rede privada e em alguns hospitais.
 Este teste usa amostras vaginais e rectais para detectar a bactéria e é altamente eficaz para saber se você está carregando o EGB por aproximadamente 5-6 semanas.
 O resultado positivo é altamente confiável e significa que você está carregando o EGB. 
Infelizmente um resultado negativo desse teste não é tão confiável – até 50% das mulheres que carregam o EGB quando a amostra é retirada terão um falso resultado negativo. 
O EGB pode ir e vir, mas o teste ECM feito em 35 – 37 semanas de gravidez é altamente eficaz para detectar a bactéria ao nascimento.
Se eu tiver um resultado positivo com uma amostra EGB o que devo fazer? 
Se você estiver carregando o EGB, deverá tomar antibióticos intravenosos durante o parto para minimizar o risco de infecção por EGB em seu bebê. 
Mais de 80% de infecções EGB em recém-nascidos poderiam ser evitadas se as mulheres tivessem feito o teste durante a gravidez e quando encontrado o EGB ou outros fatores de risco reconhecidos, tivessem recebido antibióticos intravenosos na hora do trabalho de parto. 
Os outros reconhecidos fatores de risco são:
  • A mãe já teve um bebê infectado com EGB – o risco aumenta em 10 vezes
  • A mãe carrega EGB nesta gravidez ou o EGB foi encontrada na urina em algum momento durante a gravidez – o risco aumenta em 4 vezes
     
Se for encontrado o EGB na sua urina, a qualquer momento durante a sua gravidez, então há a infecção e esta deve ser tratada rapidamente com antibióticos por via oral. 

É também um indício de que você deve receber antibióticos intravenosos quando estiver em trabalho de parto.

Dar antibióticos para as mulheres que apenas carregam o EGB não é eficaz para prevenir a infecção pelo EGB em bebê

Mais informações: http://www.gbss.org.uk/
Este artigo pertence ao http://gestavida.blogspot.com/
Plágio é crime e está previsto no artigo 184 do Código Penal.

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