Índice de pulsatilidad de la arteria uterina y parto pretérmino inminente en pacientes sintomáticas
Palabras clave:
Índice de Pulsatilidad, Arteria Uterina, Doppler, Predicción, Parto Pretérmino, Pulsatility Index, Uterine artery, Uterine Artery, Prediction, Preterm DeliveryResumen
Establecer la asociación entre el índice de pulsatilidad de la arteria uterina y parto pretérmino inminente en pacientes sintomáticas. Métodos: Se realizó un estudio de cohortes, prospectivo. Se seleccionaron mujeres con embarazos simples de 24 - 35 semanas, con amenaza de parto pretérmino y membranas íntegras. Antes del inicio de cualquier tratamiento, todas fueron sometidas a evaluación ecográfica doppler. La principal variable de estudio fue la frecuencia de parto inminente (en los 7 días siguientes a la evaluación). Se evaluaron las características generales y los valores del índice de pulsatilidad de la arteria uterina.
Resultados: Para el estudio se seleccionaron 481 pacientes. 119 participantes presentaron parto pretérmino inminente (grupo A) y 362 pacientes presentaron partos más allá de los 7 días (grupo B). Los índices de pulsatilidad de la arteria uterina en reposo (2,24 ± 0,51 comparado con 1,57 ± 0,36) y durante las contracciones (0,94 ± 0,21 comparado con 0,75 ± 0,12) fueron más altos en las pacientes del grupo A comparado con las del grupo B (p < 0,0001). Se observó que el índice de pulsatilidad en reposo tenía un área bajo la curva de 0,843 comparado con un área bajo la curva de 0,748 durante las contracciones uterinas (p < 0,05). La combinación de ambas mediciones presentó un valor bajo la curva significativamente superior (0,892) a ambas pruebas en forma individual (p < 0,05). Conclusión: El índice de pulsatilidad de la arteria uterina está asociado con el parto pretérmino inminente en pacientes sintomáticas
Descargas
Citas
Faneite P. Parto pre-término: impacto perinatal y la medicina genómica. Gac Med Caracas 2010; 118(4):292-304.
Faneite P, Rivera C, Amato R, Faneite J, Urdaneta E, Rodríguez F. Prematurez: resultados perinatales. Rev Obstet Ginecol Venez. 2006; 66(4):213-218.
Brown RN. Resolved threatened preterm labour: an opportunity for reducing future prematurity? BJOG. 2019; 126(7):906. doi: 10.1111/1471-0528.15660.
Cho GJ, Choi SJ, Lee KM, Han SW, Kim HY, Ahn KH, et al. Women with threatened preterm labour followed by term delivery have an increased risk of spontaneous preterm birth in subsequent pregnancies: a population-based cohort study. BJOG. 2019; 126(7):901-905. doi: 10.1111/1471-0528.15653.
Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, Deshpande AD, et al. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol. 2002; 100:94-100. doi: 10.1016/s0029-7844(02)02024-0.
Cho HJ, Roh HJ. Correlation between cervical lengths measured by transabdominal and transvaginal sonography for predicting preterm birth. J Ultrasound Med. 2016; 35(3):537-44. doi: 10.7863/ultra.15.03026.
Pantelis A, Sotiriadis A, Chatzistamatiou K, Pratilas G, Dinas K. Serum relaxin and cervical length for prediction of spontaneous preterm birth in second-trimester symptomatic women. Ultrasound Obstet Gynecol. 2018; 52(6):763-768. doi: 10.1002/uog.18972.
Reyna-Villasmil E, Mejia-Montilla J, Reyna-Villasmil N, Torres-Cepeda D, Santos-Bolívar J, Fernández-Ramírez A. Interleucina 6 cervicovaginal en la predicción de parto pretérmino. Rev Peru Ginecol Obst. 2016; 62(3):175-181.
Navathe R, Saccone G, Villani M, Knapp J, Cruz Y, Boelig R, et al. Decrease in the incidence of threatened preterm labor after implementation of transvaginal ultrasound cervical length universal screening. J Matern Fetal Neonatal Med. 2019; 32(11):1853-1858. doi: 10.1080/14767058.2017.1421166.
Prefumo F, Sebire NJ, Thilaganathan B. Decreased endovascular trophoblast invasion in first trimester pregnancies with high-resistance uterine artery Doppler indices. Hum Reprod. 2004; 19(1):206-9. doi: 10.1093/humrep/deh037.
Hafner E, Metzenbauer M, Höfinger D, Stonek F, Schuchter K, Waldhör T, et al. Comparison between three-dimensional placental volume at 12 weeks and uterine artery impedance/notching at 22 weeks in screening for pregnancy-induced hypertension, pre-eclampsia and fetal growth restriction in a low-risk population. Ultrasound Obstet Gynecol. 2006; 27(6):652-7. doi: 10.1002/uog.2641.
Allotey J, Snell KI, Smuk M, Hooper R, Chan CL, Ahmed A, et al. Validation and development of models using clinical, biochemical and ultrasound markers for predicting pre-eclampsia: an individual participant data meta-analysis. Health Technol Assess. 2020; 24(72):1-252. doi: 10.3310/hta24720.
Adekanmi AJ, Roberts A, Akinmoladun JA, Adeyinka AO. Uterine and umbilical artery doppler in women with pre-eclampsia and their pregnancy outcomes. Niger Postgrad Med J. 2019; 26(2):106-112. doi: 10.4103/npmj.npmj_161_18.
Tahara M, Nakai Y, Yasui T, Nishimoto S, Nakano A, Matsumoto M, et al. Uterine artery flow velocity waveforms during uterine contractions: differences between oxytocin-induced contractions and spontaneous labor contractions. J Obstet Gynaecol Res. 2009; 35 (5):850-854. doi: 10.1111/j.1447-0756.2009.01064.x.
Ducros L, Bonnin P, Cholley BP, Vicaut E, Benayed M, Jacob D, et al. Increasing maternal blood pressure with ephedrine increases uterine artery blood flow velocity during uterine contraction. Anesthesiology. 2002; 96(3):612-6. doi: 10.1097/00000542-200203000-00017.
Olgan S, Celiloglu M. Contraction-based uterine artery Doppler velocimetry: novel approach for prediction of preterm birth in women with threatened preterm labor. Ultrasound Obstet Gynecol. 2016; 48(6):757-764. doi: 10.1002/uog.15871.
Ghosh G, Breborowicz A, Brazert M, Maczkiewicz M, Kobelski M, Dubiel M, et al. Evaluation of third trimester uterine artery flow velocity Índices in relationship to perinatal complications. J Matern Fetal Neonatal Med. 2006; 19(9):551-5. doi: 10.1080/14767050600852510.
Chilumula K, Saha PK, Muthyala T, Saha SC, Sundaram V, Suri V. Prognostic role of uterine artery Doppler in early- and late-onset preeclampsia with severe features. J Ultrasound. 2021; 24(3):303-310. doi: 10.1007/s40477-020-00524-0.
McNally R, Alqudah A, Obradovic D, McClements L. Elucidating the pathogenesis of pre-eclampsia using in vitro models of spiral uterine artery remodelling. Curr Hypertens Rep. 2017; 19(11):93. doi: 10.1007/s11906-017-0786-2.
Opichka MA, Rappelt MW, Gutterman DD, Grobe JL, McIntosh JJ. Vascular dysfunction in preeclampsia. Cells. 2021; 10(11):3055. doi: 10.3390/cells10113055.
Minissian MB, Kilpatrick S, Shufelt CL, Eastwood JA, Robbins W, Sharma KJ, et al. Vascular function and serum lipids in women with spontaneous preterm delivery and term controls. J Womens Health (Larchmt). 2019; 28(11):1522-1528. doi: 10.1089/jwh.2018.7427.
Jaiman S, Romero R, Pacora P, Erez O, Jung E, Tarca AL, et al. Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor. J Perinat Med. 2021; 49(4):412-430. doi: 10.1515/jpm-2020-0138.
Hong K, Kim SH, Cha DH, Park HJ. Defective uteroplacental vascular remodeling in preeclampsia: key molecular factors leading to long term cardiovascular disease. Int J Mol Sci. 2021; 22(20):11202. doi: 10.3390/ijms222011202.
Mecacci F, Avagliano L, Lisi F, Clemenza S, Serena C, Vannuccini S. Fetal growth restriction: Does an integrated maternal hemodynamic-placental model fit better? Reprod Sci. 2021; 28(9):2422-2435. doi: 10.1007/s43032-020-00393-2.
Agarwal N, Suneja A, Arora S, Tandon OP, Sircar S. Role of uterine artery velocimetry using color-flow Doppler and electromyography of uterus in prediction of preterm labor. J Obstet Gynaecol Res. 2004; 30(6):402-8. doi: 10.1111/j.1447-0756.2004.00222.x.
Brar HS, Medearis AL, DeVore GR, Platt LD. Maternal and fetal blood flow velocity waveforms in patients with preterm labor: prediction of successful tocolysis. Am J Obstet Gynecol. 1988; 159(4):947-50. doi: 10.1016/s0002-9378(88)80178-9.
Schulman H, Ducey J, Farmakides G, Guzman E, Winter D, Penny B, et al. Uterine artery Doppler velocimetry: the significance of divergent systolic/diastolic ratios. Am J Obstet Gynecol. 1987; 157:1539-42. doi: 10.1016/s0002-9378(87)80259-4.
Stoenescu M, Serbanescu MS, Dijmarescu AL, Manolea MM, Novac L, Tudor A, et al. Doppler uterine artery ultrasound in the second trimester of pregnancy to predict adverse pregnancy outcomes. Curr Health Sci J. 2021; 47(1):101-106. doi: 10.12865/CHSJ.47.01.16
