A predição do crescimento intrauterino restrito a partir do doppler das artérias uterinas no primeiro trimestre da gestação

Abstract

Backgroud: Intrauterine growth restriction (IUGR) is obstetric complications at high risk of perinatal morbidity and mortality and long-term permanent damage. In this study, IUGR is defined by fetal weight below the 10th percentile for gestational age (GA). Objectives: To associate the value of the average PI of uterine (PIaUt) between 11-14 weeks of gestation, with the prediction of newborns with birth weight below the 10th percentile and 5 for gestational age and require interruption of pregnancy before 37 weeks. Methods: A retrospective, cross-sectional, observational study including 693 singleton pregnancies with evaluation of the PI of the uterine arteries in the first trimester from October 2010 to December 2013 in Maternidade Escola - UFRJ (ME-UFRJ). Outcomes were recorded in the medical records: infants with birth weight below the 10th percentile (IUGR10) and the 5th percentile (IUGR5); IUGR 10 with delivery before 37 weeks (IUGR<37) and IUGR 5 with delivery before 37 weeks (IUGR5<37). There was the distribution of PIaUt in groups and was built ROC (receiver operator characteristic) curve to determine the test performance and set the value of PIaUt corresponding to false positive rate of 10%. Results: 606 cases were considered normal with PIaUt 1.72; 87 cases had CIR10; and of these, 38 CIR5; 9 CIR10 <37 and 5 CIR5 <37, they had respectively PIaUt 2.02; 2.12; 2.05 and 2.00. The value of PIaUt found was 2.4 and was used as the cut off point for considering a high IP. The areas under the ROC curve (AUC) was 0.66; 0.72; 0.65 and 0.64 respectively for screening IUGR10; IUGR10<37; IUGR5 and IUGR5<37. Discussion: The patients in the sample started early prenatal care in an institution with robust clinical protocol, which removes possible selection biases, and yet, the observed prevalence of IUGR was higher than those found by other authors. The average was higher in the group that developed the outcome of interest. Cases of IUGR<37 showed 95% off due to the small number of cases in this subgroup. The performance of this test in predicting the IUGR was positive with AUC > 0.5 in all associations made, however, was not entirely satisfactory because there intersection PIaUt values in normal and pathological pregnancy, which reflects the low sensitivity of your individual use. However, the test is good for correctly classifying 80% to 90% of the sample from the PIaUt 2.4, with high specificity as 90% of normal pregnancies have value below 2.4. The benefit to be achieved with the early identification of risk pregnancies for the development of fetuses with IUGR is to establish clinical protocols to ensure the risk pregnancies, conducting proper fetal workup in the third trimester, to the clinical management appropriate and optimized perinatal outcomes. Conclusion: PIaUt in the first trimester of pregnancy was associated on a regular basis to predicting the IUGR.