Valor predictivo de la flujometría doppler de la arteria uterina en el crecimiento fetal
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2019
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Los procesos fisiopatológicos que afectan a la gestación aumentando la morbimortalidad perinatal y a largo plazo, producen una disminución del crecimiento fetal. Por lo tanto, predecir el desarrollo de esta alteración es una meta fundamental para el obstetra. La alteración de la flujometría doppler de la arteria uterina (AUt) al finalizar el primer trimestre de la gestación ha sido indicada como una herramienta pronóstica de déficit de crecimiento fetal. El presente trabajo tiene como objetivo determinar el valor del Doppler de la AUt en el primer trimestre para predecir restricción de crecimiento intrauterino en gestante con factores de alto riesgo obstétrico, en el Hospital Dr. Teodoro Maldonado Carbo en Guayaquil – Ecuador. La metodología de la investigación se realizó mediante un estudio observacional, descriptivo, transversal, no experimental en el que se incluyeron 82 gestantes con embarazo simple y con factores de alto riesgo obstétrico, atendidas en el hospital entre el 01-11-2017 al 30-06-2018, que consintieron su participación. Se excluyeron las que desearon abandonar la investigación, tuvieron un producto con defecto congénito o se perdieron durante el seguimiento. Los resultados del presente trabajo corresponden al 13,4% de los neonatos tuvo un déficit de crecimiento fetal, de estos el 18,18% tuvo restricción de crecimiento intrauterino y el resto fue pequeño para la edad gestacional. Entre los niños con déficit del crecimiento fetal existió un mayor número de alteraciones en la flujometría de la AUt que entre los que no la tenían (55% vs 45%; P 0,000). La sensibilidad fue del 87,32% (IC95% 76,80 – 93,69) y la especificidad del 99,16% (IC95% 67,85 – 100%) El área bajo la curva fue de 0,98 (IC95%: 0,893 – 1,00; P 0,000). El índice de Youden fue de 0,87. Se concluye entonces que la flujometría de AUt en el primer trimestre tiene un alto valor para predecir déficit del crecimiento fetal en gestantes de alto riesgo
The pathophysiological processes that affect pregnancy, increasing perinatal morbidity and mortality in the long term, produce a decrease in fetal growth. Therefore, predicting the development of this disorder is a fundamental goal for the obstetrician. The alteration of the Doppler flowmetry of the uterine artery (AUt) at the end of the first trimester of gestation has been indicated as a prognostic tool for fetal growth deficit. The objective of this study is to determine the UA Doppler value in the first trimester to predict intrauterine growth restriction in pregnant women with high obstetric risk factors, at the Dr. Teodoro Maldonado Carbo Hospital in Guayaquil, Ecuador. The research methodology was carried out by means of an observational, descriptive, cross-sectional, non-experimental study in which 82 pregnant women with simple pregnancy and high-risk obstetric factors were included, treated in the hospital between 01-11-2017 to 30- 06-2018, who consented to their participation. Those who wished to abandon the research, had a product with a congenital defect or were lost to follow-up were excluded. The results of the present work correspond to 13.4% of the neonates had a fetal growth deficit, of these 18.18% had intrauterine growth restriction and the rest was small for gestational age. Among children with fetal growth deficit, there was a greater number of alterations in AUt flowmetry than among those without it (55% vs 45%, P 0.000). The sensitivity was 87.32% (95% CI 76.80-93.69) and the specificity was 99.16% (95% CI 67.85-100%). The area under the curve was 0.98 (95% CI). : 0.893 - 1.00, P 0.000). The Youden index was 0.87. We conclude then that AUt flowmetry in the first trimester has a high value for predicting fetal growth deficit in high risk pregnant women.
The pathophysiological processes that affect pregnancy, increasing perinatal morbidity and mortality in the long term, produce a decrease in fetal growth. Therefore, predicting the development of this disorder is a fundamental goal for the obstetrician. The alteration of the Doppler flowmetry of the uterine artery (AUt) at the end of the first trimester of gestation has been indicated as a prognostic tool for fetal growth deficit. The objective of this study is to determine the UA Doppler value in the first trimester to predict intrauterine growth restriction in pregnant women with high obstetric risk factors, at the Dr. Teodoro Maldonado Carbo Hospital in Guayaquil, Ecuador. The research methodology was carried out by means of an observational, descriptive, cross-sectional, non-experimental study in which 82 pregnant women with simple pregnancy and high-risk obstetric factors were included, treated in the hospital between 01-11-2017 to 30- 06-2018, who consented to their participation. Those who wished to abandon the research, had a product with a congenital defect or were lost to follow-up were excluded. The results of the present work correspond to 13.4% of the neonates had a fetal growth deficit, of these 18.18% had intrauterine growth restriction and the rest was small for gestational age. Among children with fetal growth deficit, there was a greater number of alterations in AUt flowmetry than among those without it (55% vs 45%, P 0.000). The sensitivity was 87.32% (95% CI 76.80-93.69) and the specificity was 99.16% (95% CI 67.85-100%). The area under the curve was 0.98 (95% CI). : 0.893 - 1.00, P 0.000). The Youden index was 0.87. We conclude then that AUt flowmetry in the first trimester has a high value for predicting fetal growth deficit in high risk pregnant women.
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FLUJOMETRIA DOPPLER, ARTERIA UTERINA, CRECIMIENTO FETAL, EPIDEMIOLOGIA DESCRIPTIVA, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR