Doppler de arterias uterinas en la semana 20. ¿Cuál es el mejor parámetro para la predicción de preeclampsia?

Información del artículo

Resumen

Objetivo

Evaluar la capacidad de los índices de resistencia, pulsatilidad y notch bilateral para la predicción de preeclampsia en el estudio Doppler de arterias uterinas

Material y métodos

Estudio prospectivo a 319 gestantes en la semana 20. Se midieron manualmente los índices de resistencia y pulsatilidad medios para ambas arterias uterinas y se valoró subjetivamente la presencia de notch bilateral

Resultados

Aplicando los P-75, P-90 y P-95 para los índices de resistencia y de pulsatilidad, se obtienen los mismos resultados para ambos en la predicción de preeclampsia: sensibilidad de 72,7, 54,5 y 45,4%, respectivamente; especificidad de 73,7, 89,9 y 95,4% para índice de resistencia y de 73,05, 91,2 y 96,1% para índice de pulsatilidad. Si se utiliza el notch bilateral, sus resultados son similares a los índices de impedancia al P-95

Conclusiones

Es preciso utilizar un parámetro objetivo de medida, y no existen diferencias entre escoger el índice de resistencia o el de pulsatilidad. Aunque la evaluación del notch bilateral es subjetiva, debe valorarse como variable independiente

Palabras Clave:

Doppler de arterias uterinas

Preeclampsia

Índice resistencia

Índice pulsatilidad

Notch bilateral

Abstract

Objective

To evaluate the capacity of the resistance index, pulsatility index and bilateral notches to predict preeclampsia in uterine artery Doppler study

Material and methods

We performed a prospective study of 319 pregnant women at 20 weeks. The mean resistance and pulsatility indexes for both uterine arteries were measured manually and the presence of bilateral notches was evaluated subjectively

Results

P-75, P-90 and P-95 cut-off levels were applied to the resistance and pulsatility indexes and the same results were obtained for both in the prediction of preeclampsia. Sensitivity was 72.7%, 54.5% and 45.4%, respectively. Specificity was 73.7%, 89.9% and 95.4% for the resistance index and 73.05%, 91.2% and 96.1% for the pulsatility index. For bilateral notches the results were similar to impedance at P-95.

Conclusions

Use of an objective measurement is important; no differences were found between the resistance and pulsatility indexes. Although evaluation of bilateral notches is subjective, it is useful as an independent variable

Key Words:

Uterine artery Doppler

Preeclampsia

Resistance index

Pulsatility index

Bilateral notches

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Bibliografía

[1.]

S. Campbell, J. Díaz-Recasens, D.R. Griffin, T.E. Cohen-Overbeek, J.M. Pearce, K. Willson, et al.

New Doppler technique for assessing uteroplacental blood inflow.

Lancet, 1 (1983), pp. 675-677

Medline

[2.]

B.J. Trudinger, W.B. Giles, C.M. Cook.

Uteroplacental blood flow velocity-time waveforms in normal and complicated pregnancy.

Br J Obstet Gynaecol, 92 (1985), pp. 39-45

Medline

[3.]

A. Fleischer, H. Schulman, G. Farmakides, L. Bracero, L. Grunfeld, B. Rochelson, et al.

Uterine artery Doppler velocimetry in pregnant women with hypertension.

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

Medline

[4.]

S. Bower, S. Vyas, S. Campbell, K.H. Nicolaides.

Color Doppler imaging of the uterine artery in pregnancy: normal ranges of impedance to blood flow, mean velocity and volume of flow.

Ultrasound Obstet Gynecol, 2 (1992), pp. 261-265

http://dx.doi.org/10.1046/j.1469-0705.1992.02040261.x | Medline

[5.]

S. Bower, J. Kingdom, S. Campbell.

Objective and subjective assesment of abnormal uterine artery Doppler flow velocity waveforms.

Ultrasound Obstet Gynecol, 12 (1998), pp. 260-264

http://dx.doi.org/10.1046/j.1469-0705.1998.12040260.x | Medline

[6.]

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

[7.]

S. Bower, K. Schuchter, S. Campbell.

Doppler ultrasound screening as part of routine antenatal scanning: prediction of preeclampsia and intrauterine growth retardation.

Br J Obstet Gynaecol, 100 (1993), pp. 989-994

Medline

[8.]

G. Albaiges, H. Missfelder-Lobo, C. Lees, M. Parra, K.H. Nicolaides.

One-stage screening for pregnancy complications by color doppler assessment of the uterine arteries at 23 weeks’ gestation.

Obstet Gynecol, 96 (2000), pp. 559-564

Medline

[9.]

A.T. Papageorghiou, C.K.N. Yu, R. Bindra, G. Pandis, K.H. Nicolaides.

Multicenter screening for preeclampsia and fetal growth restriction by transvaginal uterine artery doppler at 23 weeks of gestation.

Ultrasound Obstet Ginecol, 18 (2001), pp. 441-449

[10.]

T. Todros, E. Ferrazzi, D. Arduini, S. Bastonero, V. Bezzeccheri, M. Biolcati, et al.

Performance of Doppler ultrasonography as a screnning test in low risk pregnancies: results of a multicentric study.

J Ultrasound Med, 14 (1995), pp. 343-348

Medline

[11.]

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

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

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

Medline

[12.]

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

Uteroplacental Doppler flow velocity waveforms in the second trimester. A complex circulation.

Br J Obstet Gynaecol, 96 (1989), pp. 1040-1046

Medline

[13.]

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

[14.]

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

Doppler assesments of the uterine and uteroplacental circulation in the second trimester in pregnancies 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

[15.]

M.A. Coleman, L.M. McCowan, R.A. North.

Mid-trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high-risk women.

Ultrasound Obstet Gynecol, 15 (2000), pp. 7-12

http://dx.doi.org/10.1046/j.1469-0705.2000.00014.x | Medline

[16.]

F.Y. Chan, T.C. Pun, C. Lam, J. Khoo, C.P. Lee, Y.H. Lam.

Pregnancy sgrenning by uterine artery doppler velocimetry- which criterion performs best?.

Obstet Gynecol, 85 (1995), pp. 596-602

http://dx.doi.org/10.1016/0029-7844(95)00006-D | Medline

[17.]

W. Kurdi, S. Campbell, J. Aquilina, P. England, K. Harrington.

The role of color Doppler imaging of the uterine arteries at 20 weeks gestation in stratifying antenatal care.

Ultrasound Obstet Gynecol, 12 (1998), pp. 339-345

http://dx.doi.org/10.1046/j.1469-0705.1998.12050339.x | Medline

[18.]

K. Harrington, W. Kurdi, J. Aquilina, S. Campbell.

A prospective management study of slow-release aspirin in the palliation of utero-placental insufficiency predicted by uterine artery Doppler at 20 weeks.

Ultrasound Obstet Gynecol, 15 (2000), pp. 13-18

http://dx.doi.org/10.1046/j.1469-0705.2000.00002.x | Medline

[19.]

J. Aquilina, A. Barnett, O. Thompson, K. Harrington.

Comprehensive analysis of uterine artery flow velocity waveforms for the prediction of pre-eclampsia.

Ultrasound Obstet Gynecol, 16 (2000), pp. 163-170

http://dx.doi.org/10.1046/j.1469-0705.2000.00217.x | Medline

[20.]

G. Albaiges, H. Missfelder-Lobos, M. Parra, C. Lees, D. Cooper, K. Nicolaides.

Comparison of color Doppler uterine artery indices in a population at high risk for adverse outcome at 24 weeks’ gestation.

Ultrasound Obstet Gynecol, 21 (2003), pp. 170-173

http://dx.doi.org/10.1002/uog.30 | Medline

[21.]

T. Frusca, M. Soregaroli, A. Valcamonico, F. Guandalini, L. Danti.

Doppler velocimetry of the uterine arteries in nulliparous women.

Early Hum Dev, 48 (1997), pp. 177-185

Medline

[22.]

O. Irion, J. Massé, J.C. Forest, J.M. Moutquin.

Prediction of preeclampsia, low birthweight for gestation and prematurity by uterine artery blood flow velocity waveforms analysis in low risk nulliparous women.

Br J Obstet Gynaecol, 105 (1998), pp. 422-429

Medline

[23.]

H. Valensise, V. Bezzeccheri, G. Rizzo, A.L. Tranquilli, G.G. Garzatti, C. Romanini.

Doppler velocimetry of the uterine artery as a screening for gestational hypertension.

Ultrasound Obstet Gynecol, 3 (1993), pp. 18-22

http://dx.doi.org/10.1046/j.1469-0705.1993.03010018.x | Medline

[24.]

R.A. North, C. Ferrier, D. Long, K. Townend, P. Kincaid-Smith.

Uterine artery doppler flow velocity waveforms in the second trimester for the prediction of preeclampsia and fetal growth retardation.

Obstet Gynecol, 3 (1994), pp. 378-386

[25.]

A. Ohkuchi, H. Minakami, I. Sato, H. Mori, T. Nakano, M. Tateno.

Predicting the risk of pre-eclampsia and a small-for-gestational age infant by quantitative assessment of the diastolic notch in uterine artery flow velocity waveforms in unselected women.

Ultrasound Obstet Gynecol, 16 (2000), pp. 171-178

http://dx.doi.org/10.1046/j.1469-0705.2000.00192.x | Medline

[26.]

M. Uzan, F. Massoni, C. Ben Said, C.h. Largillière, L. Carbillon.

Newclasification for analysing uterine Doppler wafeforms during pregnancy: is it useful?.

Fetal Diagn Ther, 15 (2000), pp. 251-254

http://dx.doi.org/21016 | Medline

[27.]

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

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

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

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

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