Correlação entre doppler de artérias uterinas maternas, no segundo trimestre de gestação, e resultados obstétricos e perinatais, em gestantes de alto risco

Abstract

Objective: the present paper applies to the study of Doppler sonography of the uterine arteries, in the first half of the second trimester of pregnancy, as a screening method for gestational pathological outcomes in high risk pregnancies. Patients and Method: for this study, pregnant women with risk factors for developing preeclampsia and other pathological outcomes due to insufficient trophoblastic invasion were selected, between 12 and 18 weeks of gestation. Doppler sonography screening of the uterine arteries were performed, at those gestationalages, in 65 pregnant women, from February 2004 to November 2006, but two patients were excluded from the final analysis. The presence of bilateral notch in the uterine arteries was considered as a positive screening test. The patients were followed through pregnancy regardingobstetric and neonatal outcomes. Preterm birth before 34 weeks, severepreeclampsia, brain sparing or umbilical artery reversed end-diastolic flow, placental abruption, fetal death and late miscarriage represented severe adverse gestational outcomes. Results: thirty-nine patients of our study (61.9%) presented bilateral notch in uterine arteries at gestational ages between 12 and 18 weeks. Fourteen patients with bilateral notch developed severe adverse gestational outcomes. We have found a relative risk of 2.15 (CI 95% 0.80 5.79) in the bilateral notch group, concerning the development of severe adverse gestational outcomes.The sensibility of the test was 77.8%, negative predictive value of 83.3%, with a pvalue of 0.1. Conclusion: based on this study, we have concluded that Doppler examination of the uterine arteries in the first half of the second trimester of gestation, in a high risk group of pregnant women, is a sensitive screening method, with high negative predictive value, for prediction of severe adverse gestational outcomes due to insufficient trophoblastic invasion.