ABSTRACT
Abstract Objective To provide a survey of relevant literature on umbilical artery Doppler ultrasound use in clinical practice, technical considerations and limitations, and future perspectives. Methods Literature searches were conducted in PubMed and Medline, restricted to articles written in English. Additionally, the references of all analyzed studies were searched to obtain necessary information. Results The use of this technique as a routine surveillance method is only recommended for high-risk pregnancies with impaired placentation. Meta-analyses of randomized trials have established that obstetric management guided by umbilical artery Doppler findings can improve perinatal mortality and morbidity. The values of the indices of Umbilical artery Doppler decrease with advancing gestational age; however, a lack of consensus on reference ranges prevails. Conclusion Important clinical decisions are based on the information obtained with umbilical artery Doppler ultrasound. Future efforts in research are imperative to overcome the current limitations of the technique.
Resumo Objetivo Compilar informação relevante proveniente da literatura atual sobre a ultrassonografia Doppler das artérias umbilicais (AUs) na prática clínica, considerações e limitações técnicas e perspectivas futuras. Métodos A pesquisa bibliográfica foi realizada nos bancos de dados PubMed e Medline e restringiu-se a artigos escritos na língua inglesa. Recorreu-se também à bibliografia dos artigos selecionados, quando necessário, para obter informação relevante. Resultados A utilização desta técnica como método de vigilância de rotina está apenas recomendada emgravidezes de alto risco comdisfunção placentar.Metanálises de estudos randomizados mostraram que o seguimento obstétrico baseado nos achados do Doppler da artéria umbilical pode melhorar a mortalidade e a morbilidade perinatal. É consensual que os valores dos índices Doppler da AU decrescem com o avanço da idade gestacional. No entanto, há ainda muita incerteza quanto aos valores de referência. Conclusão As informações obtidas através da AU Doppler US são a base para muitas decisões clínicas importantes. Trabalhos de investigação nesta área são essenciais para tentar colmatar atuais limitações da técnica.
Subject(s)
Humans , Female , Pregnancy , Placenta , Placental Insufficiency , Umbilical Arteries , Ultrasonography, Doppler, ColorABSTRACT
Resumen: ANTECEDENTES: La ruptura de una variz útero-ovárica durante el embarazo es un evento poco frecuente, pero con importantes implicaciones en la morbilidad y mortalidad materna y neonatal. Puede acontecer en cualquier momento del embarazo, aunque su frecuencia se incrementa en el tercer trimestre y durante el parto. CASO CLÍNICO: Paciente de 32 años, con 39 semanas de embarazo, en control prenatal, sin contratiempos, que acudió al servicio de Urgencias debido a un dolor abdominal generalizado e intenso, de dos horas de evolución. A la exploración física se encontraron: hipotensión, taquicardia y anemia moderada; hemoglobina de 8.9 g/dL y hematócrito de 35%. La evaluación fetal reportó: taquicardia y posterior bradicardia. Se decidió finalizar el embarazo por cesárea urgente, donde se objetivó hemoperitoneo de aproximadamente 1 L y sangrado activo procedente de la ruptura de un vaso en la parte posterior de la pared uterina que se suturó con puntos dobles. El desenlace materno y neonatal fue favorable. CONCLUSIONES: La rotura de las várices útero-ováricas puede originarse por hemoperitoneo masivo y resultar en consecuencias graves para la madre y el feto. La sospecha diagnóstica y la laparotomía de urgencia son decisivas para cohibir el sangrado y lograr un desenlace materno y fetal satisfactorios.
Abstract: BACKGROUND: The rupture of an utero-ovarian varicose vein during pregnancy is an infrequent event but it can have important implications for maternal and neonatal morbidity and mortality. It can occur at any time during pregnancy, although its frequency is increased in the third trimester and during labor. CLINICAL CASE: A single gestation of 39 weeks, with regular monitoring without incidents, who went to the emergency department for intense and generalized abdominal pain of two hours of evolution. The patient presented hypotension and tachycardia and moderate anemia with a hemoglobin of 8.9 g/dL and a hematocrit of 35%. Fetal monitoring showed fetal tachycardia with decreased variability and subsequent bradycardia. It was decided to end the pregnancy by an urgent caesarean section where a hemoperitoneum of approximately 1 liter was observed. As well, and active bleeding resulting from the rupture of a posterior uterine wall vein was noted and controlled with hemostatic sutures. The maternal and neonatal results were favorable. CONCLUSIONS: Spontaneous rupture of utero-ovarian varicose veins can be the cause of massive hemoperitoneum and can maternal and fetal serious consequences. A promptly suspected diagnosis and an urgent laparotomy are vital to restrain bleeding and achieve a good maternal and fetal result.
