O desempenho da medida do índice de pulsatibilidade do ducto venoso na predição de desfechos gestacionais adversos

Abstract

Introduction: Alteration of the ductus venosus (DV), qualitatively or quantitatively, contributes to the adverse prognosis of pregnancy, such as the presence of structural abnormalities, genetic syndromes and fetal death. Objectives: To describe the distribution of ductus venosus pulsatibility index (PI-DV) and to verify the association of the measurement of the same with fetal death without apparent cause, presence of chromosomal changes in the fetus and / or newborn (NB) and with the presence of malformations in the fetus and / or RN. Methods: Cross - sectional, descriptive and analytical study. A total of 1047 cases of single pregnancies, which performed ultrasonography (USG) with the measurement of PI-DV, were enrolled between January 1, 2013 and December 31, 2015, with a known outcome of gestation. Receiver operator characteristic (ROC) curve was constructed to determine the performance of the test, to define the value for which the sensitivity of the test with false positive rate was verified and to perform a logistic regression analysis for each of the possible outcomes studied. Results: We had 1047 cases in the final sample of the study with the following outcomes: 17 fetal deaths, 11 before 24 weeks and 6 between 25 and 40 weeks, 19 fetuses with malformations identified by USG, of which 5 were heart diseases and 2 fetuses with Chromosome changes identified by the karyotype. We obtained the 95th percentile of the normal group, which was 1.35 (95% CI: 1.32-1.44). Discussion: The first trimester screening in the Maternidade Escola of the Federal University of Rio de Janeiro is done by the Astraia ® calculation, with data on maternal age, PI-DV measurement and NT measurement. We did not use biochemical markers (PAPP-A, βHCG-free) at high cost. In spite of only 2 confirmed cases of aneuploidies in our sample, our series had a significant association with the increase in PI-DV, following the results shown in the literature. We found similarity when we evaluated the 95th percentile of PI-DV, with other authors who also evaluated our population. Conclusions: The measurement of PI-DV in the sample studied was well associated with the occurrence of chromosomal alterations and did not present any association with the occurrence of fetal death and malformations.