Utilidad de la evaluación USG Doppler de las arterias uterinas entre las semanas 11 y 13+6 y su aplicación en las calculadoras de riesgo para predecir preeclampsia
Resumen
Introducción. La preeclampsia es la primera causa de muerte materna directa en Colombia y la segunda a nivel mundial. El desarrollo de estrategias de predicción y prevención puede disminuir las complicaciones y secuelas ocasionadas por dicha enfermedad. El Doppler de arterias uterinas entre las semanas 11 y 13+6 como prueba independiente o en combinación con factores maternos o pruebas bioquímicas permite tasas de detección de preeclampsia temprana ≥ 90% a partir de la implementación de distintos cribados. La validez de dicha prueba diagnóstica presenta una sensibilidad del 47.8% y especificidad del 92.1% para la detección de preeclampsia temprana; con una sensibilidad del 26.4% y especificidad del 93.4% para predecir preeclampsia en cualquier etapa. División de los temas tratados. En esta revisión de tema se aborda la utilidad de esta medición, se habla de la realización de la técnica en cuestión y, por último, se revisan las herramientas estandarizadas que están disponibles en la actualidad junto con su accesibilidad y precisión. Conclusiones. La evidencia empírica que respalda la validez de las herramientas disponibles hoy en día para el tamizaje de preeclampsia a través de la evaluación por ultrasonografía Doppler de las arterias uterinas es significativa. Al ser Colombia un país que presenta una prevalencia alta de preeclampsia, conocer la utilidad de esta medición favorece una vigilancia temprana y oportuna, lo que disminuye los posibles desenlaces desfavorables para las maternas.
Referencias bibliográficas
Lakshmy S, Ziyaulla T, Rose N. The need for implementation of first trimester screening for preeclampsia and fetal growth restriction in low resource settings. J Matern-Fetal Neo M [Internet]. 2020;34(24):4082-9. doi: https://doi.org/10.1080/14767058.2019.1704246
Instituto Nacional de Salud; Boletín Epidemiológico Semanal [Internet]. Semana Epidemiológica 23.. 2019. Recuperado a partir de: https://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2019%20Bolet%C3%ADn%20epidemiol%C3%B3gico%20semana%2023.pdf
El-Sayed AAF. Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements. Taiwan J Obstet Gynecol [Internet]. 2017;56(5):593-8. doi: https://doi.org/10.1016/j.tjog.2017.08.004
Sotiriadis A, Hernandez‐Andrade E, da Silva Costa F, Ghi T, Glanc P, Khalil A, et al. ISUOG Practice Guidelines: Role of ultrasound in screening for and follow‐up of pre‐eclampsia. Ultrasound Obstet Gynecol. [Internet]. 2019;53(1):7-22. doi: https://doi.org/10.1002/uog.20105
Campbell S, Griffin DR, Pearce JM, Diaz-Recasens J, Cohen-Overbeek TE, Willson K, et al. New doppler technique for assessing uteroplacental blood flow. Lancet [Internet]. 1983;321(8326):675-677. doi: https://doi.org/10.1016/s0140-6736(83)91970-0
Acolet D, Springett A, Golightly S. Perinatal Mortality 2006 [Internet]. Confidential Enquiry into Maternal and Child Health; 2008. Recuperado a partir de: https://www.oaa-anaes.ac.uk/assets/_managed/editor/File/Reports/2006_Perinatal_mortality.pdf
Farré MT, Borrell A, Ravenau W, Azulay M, Cararach V, Fortuny A. Estudio Doppler de las arterias uterinas: predicción de complicaciones perinatales. Prog Obstet Ginecol [Internet]. 2001;44(12):537-43. doi: https://doi.org/10.1016/S0304-5013(01)75714-7
Papageorghiou A, Yu CKH, Bindra R, Pandis G, Nicolaides KH. Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol. 2001;18(5):441-9. doi: https://doi.org/10.1046/j.0960-7692.2001.00572.x
Martin AM, Bindra R, Curcio P, Cicero S, Nicolaides KH. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation. Ultrasound Obstet Gynecol [Internet]. 2001;18(6):583-6. doi: https://doi.org/10.1046/j.0960-7692.2001.00594.x
Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganathan B, Illanes SE, et al. First‐trimester uterine artery Doppler and adverse pregnancy outcome: A meta‐analysis involving 55 974 women. Ultrasound Obstet Gynecol [Internet]. 2014;43(5): 500-7. doi: https://doi.org/10.1002/uog.13275
von Dadelszen P, Payne B, Li J, Ansermino JM, Pipkin F, Côté AM, et al. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet [Internet]. 2011;377(9761):219-27. doi: https://doi.org/10.1016/S0140-6736(10)61351-7
Chaiworapongsa T, Chaemsaithong P, Yeo L, Romero R. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat Rev Nephrol [Internet]. 2014;10:466-80. doi: https://doi.org/10.1038/nrneph.2014.102
Orabona R, Donzelli C, Falchetti M, Santoro A, Valcamonico A, Frusca T. Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia. Ultrasound Obstet Gynecol [Internet]. 2016;47(5):580-5. doi: https://doi.org/10.1002/uog.15799
Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, et al. Prevention of Preeclampsia and Intrauterine Growth Restriction with Aspirin Started in Early Pregnancy: A Meta-Analysis. Obstet Gynecol [Internet]. 2010;116(2p1):402-14. doi: https://doi.org/10.1097/aog.0b013e3181e9322a
Dugoff L, Lynch AM, Cioffi-Ragan D, Hobbins JC, Schultz LK, Malone FD, et al. First trimester uterine artery Doppler abnormalities predict subsequent intrauterine growth restriction. Am J Obstet [Internet]. 2005;193(3):1208-12. doi: https://doi.org/10.1016/j.ajog.2005.06.054
Plasencia W, Barber M, Álvarez E, Segura J, Valle L, Garcia-Hernandez J. Comparative Study of Transabdominal and Transvaginal Uterine Artery Doppler Pulsatility Indices at 11-13 + 6 Weeks. Hypertens Pregnancy. 2011;30(4):414-20. doi: https://doi.org/10.3109/10641955.2010.506232
Cortés-Yepes H. Doppler de arterias uterinas en el primer trimestre del embarazo para la detección de los trastornos hipertensivos asociados con el embarazo: estudio de cohorte. Bogotá (Colombia) 2007-2008. Rev Colomb Obstet Ginecol. [Internet]. 2009;60(4):328-33. doi: https://doi.org/10.18597/rcog.315
Khalil A, Nicolaides KH. How to record uterine artery Doppler in the first trimester. Ultrasound Obstet Gynecol [Internet]. 2013;42:478-9. doi: https://doi.org/10.1002/uog.12366
Witlin AG, Saade GR, Mattar F, Sibai BM. Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks' gestation. Am J Obstet [Internet]. 2000;182(3):607-11. doi: https://doi.org/10.1067/mob.2000.104224
Demers ME, Dubé S, Bourdages M, Gasse C, Boutin A, Girard M et al. Comparative Study of Abdominal Versus Transvaginal Ultrasound for Uterine Artery Doppler Velocimetry at 11 to 13 Weeks. J Ultrasound Med [Internet]. 2018;37(7):1771-6. doi: https://doi.org/10.1002/jum.14530
Tayyar A, Guerra L, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility index in the three trimesters of pregnancy: Effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol [Internet]. 2015;45(6):689-97. doi: https://doi.org/10.1002/uog.14789
Rivas M, González X, Guevara H. Valores de referencia del índice de pulsatilidad de la arteria uterina durante el embarazo. Rev Obstet Ginecol Venez [Internet]. 2016;76(3):225-31. Recuperado a partir de: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0048-77322016000400002&lng=es
Ferreira AEGMT, Mauad Filho F, Abreu PSG, Mauad FM, Araujo Júnior E, Martins WP. Reproducibility of first- and second-trimester uterine artery pulsatility index measured by transvaginal and transabdominal ultrasound. Ultrasound Obstet Gynecol [Internet]. 2015;46(5):546-52. doi: https://doi.org/10.1002/uog.14762
Peixoto A, Rodrigues Da Cunha Caldas T, Tonni G, Almeida Morelli P, Santos L, Martins W, et al. Reference range for uterine artery Doppler pulsatility index using transvaginal ultrasound at 20-24w6d of gestation in a low-risk Brazilian population. J Turk Ger Gynecol Assoc. 2016;17:16-20. doi: https://doi.org/10.5152/jtgga.2016.16192
Gómez O, Martínez JM, Figueras F, Del Río M, Borobio V, Puerto B, et al. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound Obstet Gynecol [Internet]. 2005;26(5):490-4. doi: https://doi.org/10.1002/uog.1976
Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre‐eclampsia: A pragmatic guide for first‐trimester screening and prevention. Int J Gynecol Obstet [Internet]. 2019;145(S1):1-33. doi: https://doi.org/10.1002/ijgo.12802
O’Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol [Internet]. 2016;214(1):103.e1-12. doi: https://doi.org/10.1016/j.ajog.2015.08.034
O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, Wright A, et al. Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation. Ultrasound Obstet Gynecol [Internet]. 2017;49(6):751-755. doi: https://doi.org/10.1002/uog.17399
O'Gorman N, Wright D, Poon L, Rolnik D, Syngelaki A, de Alvarado M, et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: Comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol [Internet]. 2017;49(6):756-60. doi: https://doi.org/10.1002/uog.17455
ACOG. First-Trimester Risk Assessment for Early-Onset Preeclampsia. Committee opinion No. 638. Obstet Gynecol. 2015;126:e25-7. doi: https://doi.org/10.1097/aog.0000000000001049
National Collaborating Centre for Women's and Children's Health (UK). Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. London: RCOG Press; 2010 Aug. (NICE Clinical Guidelines, No. 107.) Recuperado a partir de: https://www.ncbi.nlm.nih.gov/books/NBK62652/
Akolekar R, Syngelaki A, Poon L, Wright D, Nicolaides K. Competing Risks Model in Early Screening for Preeclampsia by Biophysical and Biochemical Markers. Fetal Diagn Ther. 2013;33(1):8-15. doi: https://doi.org/10.1159/000341264
Rolnik DL, Wright D, Poon LCY, Syngelaki A, O'Gorman N, de Paco Matallana C, et al. ASPRE trial: Performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol [Internet]. 2017;50(4):492-5. doi: https://doi.org/10.1002/uog.18816
Skråstad R, Hov G, Blaas H, Romundstad P, Salvesen K. Risk assessment for preeclampsia in nulliparous women at 11-13 weeks gestational age: Prospective evaluation of two algorithms. BJOG [Internet]. 2015;122(13):1781-8. doi: https://doi.org/10.1111/1471-0528.13194
Lakovschek IC, Ulrich D, Jauk S, Csapo B, Kolovetsiou-Kreiner V, Mayer-Pickel K, et al. Risk assessment for preterm preeclampsia in first trimester: Comparison of three calculation algorithms. Eur J Obstet Gynecol [Internet]. 2018;231:241-7. doi: https://doi.org/10.1016/j.ejogrb.2018.11.006
Duley L. The Global Impact of Pre-eclampsia and Eclampsia. Semin Perinatol [Internet]. 2009;33(3):130-7. doi: https://doi.org/10.1053/j.semperi.2009.02.010
O'Gorman N, Nicolaides K, Poon L. The Use of Ultrasound and other Markers for Early Detection of Preeclampsia. Womens Health. 2016;12(2):199-207. doi: https://doi.org/10.2217/whe.15.95
Wright A, Wright D, Syngelaki A, Georgantis A, Nicolaides KH. Two-stage screening for preterm preeclampsia at 11-13 weeks’ gestation. Am J Obstet Gynecol [Internet]. 2019;220(2):197.e1-11. doi: https://doi.org/10.1016/j.ajog.2018.10.092
Tan MY, Syngelaki A, Poon LC, Rolnik DL, O'Gorman N, Delgado JL, et al. Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation. Ultrasound Obstet Gynecol [Internet]. 2018;52(2):186-195. doi: https://doi.org/10.1002/uog.19112
Ridding G, Schluter PJ, Hyett JA, McLennan AC. Uterine Artery Pulsatility Index Assessment at 11-13 Weeks' Gestation. Fetal Diagn Ther [Internet]. 2014;36:299-304. doi: https://doi.org/10.1159/000361021
Descargas
| Estadísticas de artículo | |
|---|---|
| Vistas de resúmenes | |
| Vistas de PDF | |
| Descargas de PDF | |
| Vistas de HTML | |
| Otras vistas | |
