Autor: Dra Andrea Pereira Marcaccini | Publicado: 2012-06-13T17:32:00-07:00

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d &nbsp; &nbsp; O ideal é que toda mulher tenha completado o calendário vacinal antes
de engravidar. Vacinas produzidas com vírus atenuados (tríplice viral,varicela
e febre amarela), se possível e de preferência, devem ser aplicadas pelo menos
um mês antes do inicio da gravidez e não durante a gestação. A aplicação de
vacinas no primeiro trimestre de gravidez deve ser evitada sempre que possível.
A lactação, em geral, não contraindicada a vacinação (exceto a vacina para a
febre amarela, quando devem ser observadas as orientações do Ministério da
Saúde).&nbsp;

( &nbsp; &nbsp; ( 1)&nbsp;&nbsp;
Vacina viva atenuada : contraindicada em gestantes e/ou
imunossuprimidas.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp; Vacina inativada: não oferecem riscos teóricos para
gestantes e podem ser aplicadas em mulheres imunossuprimidas.

(&nbsp; &nbsp; &nbsp; (3)&nbsp;&nbsp;
Vacinação contra a
difteria,
o tétano e a coqueluche: a vacina tríplice bacteriana acelular do tipo adulto
(dTpa) é composta de apenas antígenos inativados, portanto, não há risco
teórico na administração durante a gravidez. Entretanto, por não ser consenso,
deve-se evitar, por enquanto, o uso rotineiro durante a gravidez. Para a
prevenção do tétano neonatal, deve-se, portanto, preferir a vacina dupla do
tipo adulto (dT). Na Falta da dT, esta pode ser susbstituida pela vacina
antitetânica(toxoide tetânico ou TT).



Esquemas de vacinação
para a prevenção do tétano neonatal:



a.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Em
gestantes previamente vacinadas com pelo menos três doses, comprovadas, de
vacina contendo o toxoide tetânico (dT,DTP,DTPa, TT), tendo recebido a ultima
dose há mais de cinco anos: aplicar uma dose da dT no segundo trimestre da
gravidez e uma dose de dTpa no pós-parto, seis meses(ou no mínimo dois meses)
depois da última dose de dT.

b.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Em
gestantes que receberam vacinação incompleta contra tétano: concluir o esquema
com uma ou duas doses de dT(estas, com intervalo de dois meses), a partir do
segundo trimestre de gravidez,e aplicar uma dose de dTpa no pós parto, seis
meses(ou no mínimo dois meses) depois da ultima dose de dT.

c.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Em
gestante cuja vacinação antitetânica anterior não for conhecida: aplicar duas
doses de dT a partir do quarto mês de gravidez, com intervalo de dois meses, e
uma dose de dTpa no pós-parto, seis meses(ou no mínimo dois meses) depois da
ultima dose de dT.





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<![endif]-->Vacina para febre
amarela: apesar de conter vírus atenuado e do risco teórico para o feto, a
vacina para a febre amarela pode ser indicado conforme observações em Vacinas
com risco teórico durante a gestação (veja abaixo). Nos locais em que a endêmica e os ricos de adquirir febre amarela superem os riscos de
eventos adversos graves pela vacina de febre amarela, esta deve ser aplicada
mesmo durante a gravidez. Devido ao relato de dois casos de encefalite com
lactantes de mulheres brasileiras vacinadas contra a febre amarela após o
parto, ambos com boa evolução, recomendam-se que mães amamentando lactantes com
até seis meses de vida só devem receber esta vacina se houver&nbsp; <!--[if gte mso 9]>
 
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<![endif]--><!--[if gte mso 10]>

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 mso-style-qformat:yes;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin-top:0cm;
 mso-para-margin-right:0cm;
 mso-para-margin-bottom:10.0pt;
 mso-para-margin-left:0cm;
 line-height:115%;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri","sans-serif";
 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-bidi-font-family:"Times New Roman";
 mso-bidi-theme-font:minor-bidi;
 mso-fareast-language:EN-US;}

<![endif]-->alto risco de
exposição ao vírus.
<!--[if !mso]>

v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}

<![endif]--><!--[if gte mso 9]>
 
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  0
  
  
  21
  
  
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  MicrosoftInternetExplorer4
  
   
   
   
   
   
   
   
   
   
   
   
  
<![endif]--><!--[if gte mso 9]>
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 <![endif]--><img align="left" alt="Canto dobrado: Vacinas recomendadas na gestação:
São aquelas não contraindicadas na gestação e que protegem de infecções de alto risco de complicações e óbitos para a gestante e/ou para feto: e quando é consenso que a vacina traz benefícios comprovados se aplica durante a gestação.

Vacinas containdicadas
São as vacinas que oferecem risco teórico para o feto(vacinas com vírus atenuado).

Vacinas recomendadas no puerpério
São aquelas que protegem a mãe não vacinada, ou sem infecção prévia, de infecções consideradas de alto risco para o lactente e que podem ser transmitidas para o bebê.

Vacinas a serem consideradas em situações de risco especiais:

Vacinas sem risco teórico: durantea gestação
 - são as vacinas inativadas. Tais vacinas não têm risco teórico para a gestante. A indicação deve ser considerada quando a situação epidemiológica colocar em risco a gestante.

Vacinas com risco teórico durante a gestação
- são aquelas contraindicadas, embora a prescrição possa ser feita quando o risco de infecção e das conseqüências do adoecimento. Este é o caso da vacinha para a febre amarela.
" height="852" hspace="12" src="file:///C:%5CUsers%5CNathalia%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_image001.gif" style="background-color: #f4cccc; color: black;" vspace="10" width="339" />