RESUMO
OBJECTIVES: The aim of this study was to asses the correlation of middle cerebral artery pulsatility index (MCA-PI) and perinatal outcomes in prolonged pregnancies. STUDY DESIGN: This was a prospective study of all consecutive pregnant women beyond 41 weeks' gestation attending for obstetric surveillance during a two years period. We evaluated the predictive value of MCA-PI lower than the 5th percentile (Assuntos
Sofrimento Fetal
, Mecônio
, Artéria Cerebral Média
, Gravidez Prolongada
, Fluxo Pulsátil
, Ultrassonografia Doppler/métodos
, Adulto
, Feminino
, Sofrimento Fetal/diagnóstico
, Sofrimento Fetal/etiologia
, Humanos
, Recém-Nascido
, Artéria Cerebral Média/diagnóstico por imagem
, Artéria Cerebral Média/fisiopatologia
, Valor Preditivo dos Testes
, Gravidez
, Resultado da Gravidez/epidemiologia
, Gravidez Prolongada/epidemiologia
, Gravidez Prolongada/fisiopatologia
, Espanha/epidemiologia
RESUMO
Objective. To examine the value of one-step uterine artery Doppler at 20 weeks of gestation in the prediction pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR). Methods. A prospective multicentre study that included all women with singleton pregnancies at 19-22 weeks of gestation (w). The mean pulsatility index (mPI) of both uterine arteries was calculated. Receiver-operating characteristics curves (ROC) were drawn to compare uterine artery Doppler and maternal risk factors for the prediction of early-onset PE and/or IUGR (before 32 w) and late-onset PE and/or IUGR. Results. 6,586 women were included in the study. Complete outcome data was recorded for 6,035 of these women (91.6%). PE developed in 75 (1.2%) and IUGR in 69 (1.1%) cases. Uterine Doppler mPI was 0.99 and the 90th centile was 1.40. For 10% false-positive rate, uterine Doppler mPI identified 70.6% of pregnancies that subsequently developed early-onset PE and 73.3% of pregnancies that developed early-onset IUGR. The test had a lower detection rate for the late-onset forms of the disease (23.5% for PE and 30% for IUGR). Maternal history has a low sensitivity in the detection of early-onset cases, although it is better at detecting late-onset PE. Conclusion. Uterine artery Doppler and maternal risk factors seem to select two different populations - early and late-onset PE which might suggest a different pathogenesis.