Avaliação da função endotelial e da perfusão uterina em gestantes com fatores de risco para pré-eclâmpsia

Abstract

Introduction: Pre-eclampsia (PE) is a specific disease of human pregnancy, associated with high rate of perinatal mortality. In order to predict the onset of this syndrome, clinical tests which evaluate early phenomena of PEs pathophysiology might be of great value in the care of pregnant women considered at high risk for the developming PE. The use of Uterine artery Dopplerfluxometry (UtA-PI), for the assessment of trophoblastic perfusion, associated with Flow-mediated Dilation (FMD) of brachial artery, in order to evaluate endothelial function, could represent an interesting association of biophysical tests to predict PE. Objectives: to assess, in patients with high risk for PE development, the behavior of placental perfusion and endothelial function in two distinct periods of pregnancy, in a group of patients who actually developed PE and in a group of patients who remained normotensive. Also, it is intended to evaluate the predictive capacity of these methods for the prediction of PE, in its early form (appearance before 34 weeks of gestation) and late form (appearance after 34 weeks of gestation). Patients and methods: From high risk prenatal service of our institution, a total of 118 patients classified as high risk for PE development were recruited, being 91 considered for final analysis. The results of the UtA-PI and FMD test were obtained between 16 and 19+0 +6 and 24+0 and+6 27 weeks of gestation. Results: Between 16+0 to 19+6 weeks and 24+0 to 27+6 weeks, a higher value of the UtA-PI was found among patients with subsequent development of PE. In relation to the results of FMD, there was no difference between the two studied groups between 16+0 to 19+6, however, patients with PE development showed lower values between 24+0 and 27+6. The use of UtA-PI in any of the studied periods proved good accuracy rates in predicting PE, particularly in its early form. The use of FMD between 24+0 and 27+6 also showed good values of PE prediction, similar between clinical forms of presentation. The association between the two tests proved to be superior if compared to the isolated use of anyone to the prediction tests, in early and late forms. Conclusions: Poor placentation is an early event in the pathophysiology of PE, and can be identified in the first half of pregnancy, before the impairment of endothelial function. The association between the UtA-PI and FMD represents an interesting prediction strategy, with important clinical repercussions.