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Inicio Clínica e Investigación en Ginecología y Obstetricia Cribado con doppler de las arterias uterinas para la predicción de complicacion...
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Vol. 30. Núm. 6.
Páginas 178-184 (enero 2003)
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Vol. 30. Núm. 6.
Páginas 178-184 (enero 2003)
Acceso a texto completo
Cribado con doppler de las arterias uterinas para la predicción de complicaciones de la gestación
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J. Arenasa, J. Fernández-iñareaa, C. Rodríguez-mona, B. Dupláa, E. Díeza, A. González-garcíaa
a Servicio de Obstetricia y Ginecología. Hospital de Cabueñes. Gijón. Asturias. España
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Summary

The role of uterine artery Doppler in the prediction of pre-eclampsia and uterine growth retardation has been known since the middle of the 1980s, but as yet it does not have a definitive place in obstetric practice.

With the aim of assessing its value as a screening. test for these pathologies a prospective study of 319 pregnancies in an unselected population in the 20th week of pregnancy was made. The parameter of the impedance to flow was the mean resistance index for the two uterine arteries with different cut-off levels.The prevalence of pre-eclampsia was 3.44%, growth retardation 8.15%, and of premature birth 6.89%.

For a resistance index ≥ 0.59 (P-75) the following results are obtained:

1. Prediction of pre-eclampsia: sensitivity, 72.7%; specifity, 73.7%; predictive value of positive tests, 8.98%; predictive value of negative tests, 98.6%; odds ratio, 7.47 (1.74-36.51).

2. Prediction of foetal growth retardation: sensitivity, 46.15%; specificity, 73.72%; predictive value of positive tests, 13.48%; predictive value of negative tests, 93.1%; odds ratio, 2.40 (1.31-8.97).

3. Prediction of premature birth: sensitivity, 54.54%; specificity, 74.07%; predictive value of positive tests, 13.48%; predictive value of negative test, 95.65%; odds ratio, 3.42 (1.31-8.97).

Its routine use as a screening test is proposed, makinguse of the routine ultrasound scan at 20 weeks.

Resumen

El papel del Doppler de las arterias uterinas en la predicción de preeclampsia y crecimiento intrauterino restringido se conoce desde mediados de la década de 1980, pero aún no ha encontrado un lugar definitivo en la práctica obstétrica.

Con el propósito de evaluar su utilidad como prueba de cribado para estas patologías, se realizó un estudio prospectivo en una población no seleccionada de 319 gestantes en la semana 20. El parámetro de medida de la impedancia al flujo fue el índice de resistencia medio para las dos arterias uterinas utilizando diferentes niveles de corte. La prevalencia de preeclampsia fue del 3,44%, la de crecimiento intrauterino restringido del 8,15% y la de parto pretérmino del 6,89%.

Para un índice de resistencia ≥ 0,59 (percentil 75) se obtienen los siguientes resultados:

1. Predicción de preeclampsia: sensibilidad del 72,7%; especificidad del 73,7%; valor predictivo positivo (VPP) del 8,98%; valor predictivo negativo (VPN) del 98,6%, y odds ratio (OR) de 7,47 (intervalo de confianza [IC], 1,74-36,51).

2. Predicción de CIR: sensibilidad del 46,15%; especificidad del 73,72%; VPPdel 13,48%; VPN del 93,1%, y OR de 2,40 (IC del 95%, 0,99-5,81).

3. Predicción de parto pretérmino: sensibilidad del 54,54%; especificidad del 74,07%; VPP del 13,48%; VPN del 95,65%, y OR de 3,42 (IC de 95%, 1,31-8,97).

Se propone su uso habitual como prueba de cribado aprovechando la ecografía ordinaria protocolizada de la semana 20.

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Copyright © 2003. Elsevier España, S.L.. Todos los derechos reservados
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