Revista Chilena de Obstetricia y Ginecología (Jan 2005)
RELACIÓN ENTRE DOPPLER DE LA ARTERIA UMBILICAL, INVASIÓN MICROBIANA DE LA CAVIDAD AMNIÓTICA, FUNISITIS Y RESULTADO ADVERSO NEONATAL EN LA ROTURA PREMATURA DE MEMBRANAS DE PRETÉRMINO
Abstract
Objetivo: Evaluar la utilidad del Doppler de la arteria umbilical (AU) para predecir invasión microbiana de la cavidad amniótica (IMCA), funisitis y resultado adverso neonatal (RA) en pacientes con rotura prematura de membranas de pretérmino (RPMPT). Métodos: Se estudian 80 embarazadas entre 24 y 34 semanas de gestación con diagnóstico de rotura prematura de membranas. Se excluyeron embarazadas con condiciones materno-fetales severas que pudiesen alterar el resultado perinatal. Todas tuvieron ultrasonografía para biometría fetal y Doppler de la arteria umbilical dentro de una semana del nacimiento y microbiología de líquido amniótico. Se creó una variable compuesta que incluyó morbilidad neonatal severa, secuelas o muerte neonatal. Las pacientes recibieron antibióticos, esteroides y manejo expectante hasta las 35 semanas. IMCA se definió por el cultivo positivo del líquido amniótico; funisitis por la presencia de leucocitos polimorfonucleares en la pared de los vasos umbilicales o gelatina de Warthon. Se usaron análisis de curva ROC y tablas de contingencia para el cálculo estadístico. Resultados: Se incluyeron 68 pacientes. El RA compuesto se presentó en 19,4%. Los fetos que desarrollaron RA tuvieron relación S/D de AU, significativamente más alta que los fetos con resultado bueno (RB) (65,6±30,9 vs 30,0±20,4 p41 tuvieron significativo más alto riesgo de RA que fetos con percentil Objective: To evaluate the usefulness of Doppler velocimetry of umbilical artery in the prediction of microbial invasion of the amniotic cavity (MIAC), funisitis and adverse neonatal outcome in patients with preterm PROM. Methods: 80 patients with preterm PROM between 24 and 34 weeks were invited to participate in this study. Exclusion criteria were fetal and maternal conditions that may influence perinatal outcome. All patients underwent obstetrical ultrasound, biophysical profile and Doppler velocimetry of the umbilical artery (UA) systole/diastole (S/D) measurements within 1 week of delivery. An amniocentesis was performed at admission for amniotic fluid microbiological assessment. MIAC was defined as the presence of a positive amniotic fluid culture. Patients received antibiotics, steroids and were managed expectantly until 35 weeks. A composite variable including severe neonatal morbidity, sequelae or death was created. Funisitis was diagnosed in the presence of polymorphonuclear leukocyte infiltration into the umbilical vessel walls or Wharton jelly. Statistics were performed using ROC curve analysis and contingency tables. Results: 68 patients were included. Composite neonatal morbidity was present in 19.4%. Fetuses that subsequently developed adverse neonatal outcome had a significantly higher mean UA S/D percentile for gestational age than fetuses without subsequent adverse neonatal outcome (65.6±30.9 vs 30.0±20.4; p41 had a significantly higher risk of adverse outcome than fetuses with percentile < 41 (odds ratio: 15.7; 95% CI 2.73-118; p<0.001) with a sensitivity: 85%, false-positive rate: 56%, specificity: 74%, and false-negative: 5%). Conclusions: Among patients with preterm PROM, umbilical artery Doppler velocimetry was significantly associated with adverse neonatal outcome, but it was not related to microbial invasion of the amniotic cavity or funisitis
