Revista Brasileira de Ginecologia e Obstetrícia (Apr 2006)
Estudo do sonograma do ducto venoso em fetos com centralização hemodinâmica: avaliação de repercussões perinatais Study of ductus venosus in fetuses with brain sparing reflex: evaluation of perinatal outcomes
Abstract
OBJETIVO: avaliar a associação da relação sístole ventricular/atrial (S/A) do ducto venoso (DV) com resultados perinatais em fetos prematuros com centralização de fluxo à dopplervelocimetria. MÉTODOS: o estudo foi delineado como um estudo observacional, transversal, com os dados colhidos de forma prospectiva. A relação S/A do DV foi estudada em 41 fetos centralizados com idade gestacional (IG) entre 25 e 33ª semana completa, no período de novembro de 2002 a julho de 2005. Os recém-nascidos foram acompanhados até o 28º dia pós-parto na UTI da Clínica Perinatal Laranjeiras, buscando-se complicações neonatais. A população de estudo foi dividida em dois grupos a partir do resultado do DV. Foram incluídos no grupo normal os fetos com relação S/A menor ou igual a 3,6 e no grupo alterado aqueles com valores de S/A maiores que 3,6. A comparação entre os grupos foi realizada com os testes estatísticos de Mann-Whitney, chi2 e exato de Fisher. Todos os resultados foram considerados estatisticamente significativos se p3,6). Não houve diferença significativa entre os grupos quanto à IG ao nascimento e Apgar PURPOSE: to evaluate the relationship between S/A ratio in ductus venosus (DV) and perinatal outcomes in fetuses with brain sparing reflex. METHODS: the study was designed as an observational, sectional study with prospectively collected data. Forty-one fetuses with brain sparing reflex and gestational age between 25 and 33 weeks were studied between November 2002 and July 2005. The newborns were observed during the neonatal period in the intensive care unit of "Clínica Perinatal Laranjeiras" in order to find adverse outcomes. The study population was divided into two groups according to DV assessment. In the normal group all the fetuses with S/A ratio values of 3.6 or less were included, and in the abnormal group the fetuses with values of S/A ratio greater than 3.6. The statistical analysis was performed by the Mann-Whitney U-test, chi2 test and Fisher exact test. The results were considered significant when p3.6). There was no statistically signicant difference between the groups according to gestational age at delivery and Apgar <7. The only significant association was between abnormal DV S/A ratio and neonatal death (p=0.049; Fisher's exact test). No statistically significant association was observed for the other studied variables. CONCLUSIONS: our results suggest that abnormal DV blood flow detected by Doppler examination is not associated with adverse perinatal outcomes, except for neonatal mortality. This association may be considered statistically borderline (p=0.049). Excluding fetuses with birth weight less than 400 g, there was no other association between DV and neonatal mortality. The abnormal DV S/A ratio was not associated, in our study, with perinatal mortality in viable preterm fetuses.
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