Valor predictivo del estudio Doppler uteroplacentario después de la semana 26 para el desarrollo de complicaciones perinatales en gestantes de alto riesgo

Santiago, C.; Manzanares, S.; Díaz, F.; Montoya, F.

doi:10.1016/S0210-573X(02)77163-3

Información del artículo

Resumen

Bibliografía

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Estadísticas

Resumen

Objective

Evaluar el valor predictivo del patrónanormal de velocimetría Doppler en el territorio ute-roplacentario realizado después de la semana 26 engestantes de alto riesgo para el desarrollo de complicaciones perinatales relacionadas con el desarrollo dela placenta.

Material y método

Estudio prospectivo realizadoen 85 embarazos de alto riesgo durante un período de18 meses. Mediante Doppler color se estudió la ondade velocidad de flujo de ambas arterias uterinas y arteria umbilical entre las semanas 26 y 34 de gestación. El estudio Doppler se consideró anormal si elíndice de pulsatilidad para los casos estudiados se encontraba por encima del percentil 95 para la edad gestacional o si existían muescas en una o ambas arteriasuterinas. Se determinó la incidencia de preeclampsia,muerte fetal intraútero, retraso de crecimiento intrauterino, parto prematuro espontáneo (< 34 semanas) uoligoamnios, y la capacidad del Doppler para predecirestas complicaciones.

Resultados

Un total de 42 gestantes presentó unpatrón Doppler uteroplacentario patológico mientrasque los 43 casos restantes presentaron un patrón normal. Treinta y seis de las 42 gestantes con Dopplerpatológico (85,6%) desarrollaron alguna de las complicaciones estudiadas mientras que sólo lo hicieronocho de las 43 gestantes con Doppler normal (18,6%)(p < 0,001).

Conclusión

El estudio Doppler uteroplacentario secomporta como un fuerte predictor de complicacionesperinatales estudiadas en gestantes de alto riesgo.

Summary

Objective

To evaluate the predictive value of abnormal Doppler velocimetry trace of the uterine placenta from the 26th week in gestants at high risk of developing perinatal complications related to placental development.

Material and method

A prospective study carried out on 85 high risk pregnancies over a period of 18 months. Using Doppler colour the speed of the flow wave of both uterine arteries and the umbilical artery were studied from weeks 26-34 of the gestation. The Doppler study was considered to be abnormal if the pulsatility index of the vessels studied was found to be below the 95th percentile for the gestational age, or if there were grooves in one or both of the uterine arteries. The incidence of pre-eclampsia, intra-uterine foetal death, intra-uterine growth retardation, spontaneous pre-term labour (< 34 weeks), and oligo-am-nios were determined. Also the Doppler capacity for predicting these complications. Results:42 gestants had a pathological Doppler utero-placentary trace, whilst the remaining 43 had a normal trace. Of the 42 gestants with altered Doppler, 36 (85.6%) developed some of the complications studied, whilst only 8 of the 43 gestants with normal Doppler (18.6%) had any (P < 0.001).

Conclusion

Uterine-placentary Doppler study is a good predictor of the perinatal complications studied in high risk pregnancy.

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Bibliografía

[1.]

I.A. Brisens, W.B. Robertson, H.G. Dixon.

The role of the spiral arteries in the pathogenesis of preeclampsia.

Obstet Gy-necol Annu, 1 (1972), pp. 177-191

[2.]

R. Pijnenborg, G. Dixon, W.B. Robertson, I. Brosens.

Trophoblast invasion of human decidua from 8 to 18 weeks of pregnancy.

Placenta, 1 (1980), pp. 3-19

Medline

[3.]

B.G. Sheppard, J. Bonnar.

An ultrastructural study of utero-placental spiral arteries in hypertensive and normotensive pregnancy and fetal growth retardation.

Br J Obstet Gynae-col, 88 (1981), pp. 695-705

[4.]

F. De Wolf, W.B. Robertson, I. Brosens.

Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small for gestational age infants.

Br J Obstet Gynaecol, 83 (1986), pp. 1049-1055

[5.]

C.M. Salafia, C.A. Vogel, A.M. Vintzileos, K.F. Bantham, J. Pez-zullo, L. Silberman.

Placental pathologic findings in pre-term birth.

Am J Obstet Gynecol, 165 (1991), pp. 934-938

Medline

[6.]

F. Arias, L. Rodríguez, S.C. Rayne, F.T. Kraus.

Maternal placental vasculopathy and infection: Two distinct subgroups among patients with preterm labor and preterm ruptured membranes.

Am J Obstet Gynecol, 168 (1993), pp. 585-591

Medline

[7.]

S.L. Adamson, R.J. Morrow, P.A. Bascom, L.Y. Mo, J.W. Ritchie.

Effect of placental resistance, arterial diameter, and blood pressure on the uterine arterial velocity waveform: a computer modeling approach.

Ultrasound Med Biol, 15 (1989), pp. 437-442

Medline

[8.]

W.B. Giles, B.J. Trudinger, P.J. Baird.

Fetal umbilical artery flow velocimetry waveforms and placental resistance: pathologic correlation.

Br J Obstet Gynaecol, 92 (1985), pp. 31-38

Medline

[9.]

A. Fleisher, H. Schulman, G. Farmakides, L. Bracero, L. Grun-feld, B. Rochelson, et al.

Uterine artery Doppler velocimetry in pregnanct women with hypertension.

Am J Obstet Gynecol, 154 (1986), pp. 806-813

Medline

[10.]

J.R. Leiberman, I. Meizner, D. Fraser, Z. Meril, D. Yohay, M. Glezerman.

The association between increased mean arterial pressure and abnormal uterine artery resistance to blood flow during pregnancy.

Obstet Gynecol, 83 (1993), pp. 965-969

[11.]

P. Zimmermann, V. Eiriö, J. Koskinen, E. Kujansuu, T. Ranta.

Doppler assessment of the uterine and uteroplacental circulation in the second trimester in pregnacies at high risk for pre-eclampsia and/or intrauterine growth retardation: comparison and correlation between different Doppler parameters.

Ultrasound Obstet Gynecol, 9 (1997), pp. 330-338

http://dx.doi.org/10.1046/j.1469-0705.1997.09050330.x | Medline

[12.]

F.A. Strigini, G. Lencioni, G. De Luca, M. Lombardo, F. Bianchi, A.R. Genazzani.

Uterine artery velocimetry and spontaneous preterm delivery.

Obstet Gynecol, 85 (1995), pp. 374-377

http://dx.doi.org/10.1016/0029-7844(94)00420-I | Medline

[13.]

K. Harrington, D. Cooper, C. Lees, K. Hecher, S. Campbell.

Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of pre-eclampsia, placental abruption or delivery of a small-for-gestational-age baby.

Ultrasound Obstet Gynecol, 7 (1996), pp. 182-188

http://dx.doi.org/10.1046/j.1469-0705.1996.07030182.x | Medline

[14.]

S. Campbell, J.M.F. Pearce, G. Hackett, T. Cohen-Overbeek, C. Hernandez.

Qualitative assessment of uteroplacental blood-flow: early screening test for high-risk pregnancies.

Obs-tet Gynecol, 68 (1986), pp. 649-653

[15.]

H. Schulman, D. Winter, G. Farmakides, J. Ducey, E. Guzman, A. Coury, et al.

Pregnancy surveillance with Doppler velocimetry of uterine and umbilical arteries.

Am J Obstet Gyne-col, 160 (1989), pp. 192-196

[16.]

S.A. Steel, J.M. Pearce, P. McParland, GVP. Early Doppler ultrasound in prediction of hypertensive disorders of pregnancy. Chamberlain.

Lancet, 335 (1990), pp. 1548-1551

Medline

[17.]

S. Bewley, D. Cooper, S. Campbell.

Doppler investigation of uteroplacental blood flow resistance in the second trimester: a screening study for preeclampsia and intrauterine growth retardation.

Br J Obstet Gynaecol, 98 (1991), pp. 871-879

Medline

[18.]

S.L. Jacobson, R. Imhog, N. Manning, V. Mannion, D. Little, E. Rey, et al.

The value of Doppler assessment of the uteroplacental circulation in predicting preeclampsia or intrauterine growth retardation.

Am J Obstet Gynaecol, 162 (1990), pp. 110-114

[19.]

J.A. Davies, S. Gallivan, JAD. Spencer.

Randomized controlled trial of Doppler ultrasound screening of placental perfusion during pregnancy.

Lancet, 340 (1992), pp. 1299-1303

Medline

[20.]

S. Bower, S. Bewley, S. Campbell.

Improved prediction of preeclampsia by two stage screening of uterine arteries, using the early diastolic notch and color Doppler imaging.

Obstet Gynecol, 82 (1993), pp. 78-83

Medline

[21.]

T. Murakoshi, N. Sekizuka, K. Takakuwa, H. Yoshizawa, K. Tanaka.

Uterine and spiral artery flow velocity waveforms in pregnancy-induced hypertension and/or intrauterine growth retardation.

Ultrasound Obstet Gynecol, 7 (1996), pp. 122-128

http://dx.doi.org/10.1046/j.1469-0705.1996.07020122.x | Medline

[22.]

K. Harrington, C. Goldfrad, R.G. Carpenter, S. Campbell.

Transvaginal uterine and umbilical artery Doppler examination of 12-16 weeks and the subsequent development of pre-eclampsia and intrauterine growth retardation.

Ultrasound Obstet Gynecol, 9 (1997), pp. 94-100

http://dx.doi.org/10.1046/j.1469-0705.1997.09020094.x | Medline

[23.]

G.J. Mires, F.L.R. Williams, J. Leslie, P.W. Howie.

Assessment of uterine arterial notching as a screening test for adverse pregnancy outcome.

Am J Obstet Gynecol, 179 (1998), pp. 1317-1323

Medline

[24.]

K. Van Asselt, S. Gudmundsson, P. Lindqvist, K. Marsal.

Uterine and umbilical velocimetry in preeclampsia.

Acta Obstet Gynecol Scand, 77 (1998), pp. 614-619

Medline