O doppler das artérias entre 11 a 14 semanas de gestação na predição de pré-eclâmpsia

Abstract

Background: Preeclampsia (PE) is still the leading cause of maternal and perinatal morbidity and mortality and generates high levels of unfavorable outcomes for the mother-infant pairbinomial.OBJECTIVES: Obtain the value of the average PI of the uterine arteries held between 11-14 weeks gestation which is associated with preeclampsia requiringdeliverybefore 34, 37 and 42 weeks gestation. Methods: Retrospective, cross-sectional, observational study including 786 singleton pregnancies with evaluation of the PI of the uterine arteries in the first quarter from October 2010 to December 2013 at the MaternidadeEscola - UFRJ (ME-UFRJ). The study outcome: patients who developed preeclampsia that required interruption before 34, 37 or 42 weeks of gestation.The distribution of medium pulsatilityindexof uterine arteries(PImUt) in groups was tracked and the receiver operator characteristic( ROC) was built to determine the performance of test and set the value of PImUt corresponding to false positive (FP) rate of 10% and 20%. RESULTS: In the sample 65 pacientsdeveloped PE (average PImUt 1.86) and 693 didn´t have this outcome (average PImUt 1.76). PE cases: 6 had PE <34 (average PImUt 2.32); and 14 patients developed PE <37 weeks (average PImUt 2.31). The areas under the ROC curve (AUC) was 0.80; 0.81; 0.56 respectively for PE <34, PE <37 and PE <42.DISCUSSION: The PImUt values of those who developed PE and normal group in our sampleare superimposed. However, the average and the confidence interval(IC) 95% are significantly higher in the clinical forms of PE that required interruption before 34 and 37 weeks gestation. These groups are the subject for early prediction to start prophylaxis and mitigate the need to interrupt for gestational age (IG) more advanced or even prevent the onset of disease. Cases of PE <34 showed IC95% wide due to the small number of cases in this subgroup. The performance of the test in predicting PE was positive with AUC> 0.5 in all associations made, however, was not satisfactory because of intersections inPImUt values in both normal and pathological pregnancy, which reflects the low sensitivity of its individual use. The value of 2.45 was PImUt corresponding to FP rate of 10% with a sensitivity of 50%; 42% and 15% for PE <34, <37 and <42 respectively. For PE <PE 34 and <37, there was excellent performance in terms of accuracy, specificity and AUC. Conclusion: The performance of the PImUt measurement is moderate for predicting PE that demand interruption before 34 and 37 weeks, and inneficientfor PE prediction that demand interruption before 42 weeks, with 2.45 and 2.20 medium PI representing 10% and 20% false positive respectively.