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O papel da fluxometria da artéria oftálmica no rastreio e diagnóstico da pré-eclâmpsia
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A prevalência das doenças hipertensivas na gravidez, onde se inclui a pré-eclâmpsia, tem vindo a aumentar nas últimas décadas, afetando cerca de 10% das gestações mundiais. A pré-eclâmpsia é uma das formas mais graves de apresentação de hipertensão arterial durante a gravidez. Caracteriza-se por HTA acompanhada de proteinúria de novo ou de lesão de órgão alvo, geralmente após as 20 semanas de gestação. Em 2005, segundo o The World Health Report, a pré-eclâmpsia e a eclâmpsia foram classificadas como as complicações da gravidez e do parto com maior taxa de mortalidade por número de casos. Assim, o seu rastreio, diagnóstico e prevenção são objetivos importantes a atingir. Atualmente, para a prevenção da pré-eclâmpsia precoce e dos seus desfechos está recomendado o uso precoce de baixa dosagem de aspirina até às 36 semanas de gestação. Esta recomendação é direcionada a grávidas identificadas precocemente, antes das 14 semanas, como tendo maior risco para a expressão precoce (antes das 37 semanas) dessa complicação. Um dos modelos de avaliação desse risco utiliza como preditores características anamnésicas, informações físicas maternas, o índice de pulsatilidade das artérias uterinas (obtido por meio de ultrassonografia doppler/fluxometria) e doseamentos de substâncias bioquímicas no soro materno – Placental Growth Factor (PlGF) e/ou Pregnancy Associated Plasma Protein-A (PAPP-A). Nalgumas populações, não há acessibilidade aos doseamentos bioquímicos. Este trabalho tem como objetivo a realização de uma revisão narrativa acerca do uso da fluxometria de um outro vaso periférico, a artéria oftálmica materna, como preditor alternativo de pré-eclâmpsia para populações com acesso a equipamentos ultrassonográficos de uso corrente em obstetrícia, muitos deles portáteis. Caso se mantenha ou eleve a performance dos algoritmos preditores já conhecidos, o seu uso poderá ser especialmente útil em locais com acesso laboratorial limitado, como em populações remotas, onde a morbimortalidade desta patologia é maior.
The prevalence of hypertensive diseases in pregnancy, including preeclampsia (PE), has been increasing in the past decades, affecting around 10% of gestations worldwide. PE is one of the most severe presentations of arterial hypertension during pregnancy. It is characterized by high blood pressure plus de novo proteinuria and/or target organ lesion, generally after 20 weeks of gestation. In 2005, according to The World Health Report, PE and eclampsia were classified as the pregnancy and labour complications with the highest mortality rate, per number of cases. Therefore, its screening, diagnosis and prevention are important goals to achieve. Currently, it is recommended early treatment with low dose aspirin until 36 weeks of gestation for the prevention of early PE and their outcomes. This recommendation is targeted to timely identified pregnancies, before 14 weeks, as the group with the highest risk of early expression (before 37 weeks) of this complication. One of the risk stratification models uses as predictors the maternal anamnesic characteristics and physical information, the uterine arteries pulsatility index (acquired through doppler ultrasound/fluxometry) and the measurement of biochemical substances in the maternal blood - Placental Growth Factor (PlGF) and/or Pregnancy Associated Plasma Protein-A (PAPP-A). In some populations, there is no access to these biochemical measurements. This paper has the objective of conducting a narrative review on the use of fluxometry of another peripheral vessel, the maternal ophthalmic artery, as an alternative predictor of PE in populations with access to ultrasound equipment commonly used in Obstetrics, many of those being portable. In case it retains or surpasses the performance of the already known predictive algorithms, its use can be especially useful in areas with limited access to laboratory analysis, such as remote populations, where the morbimortality of this condition is higher.
The prevalence of hypertensive diseases in pregnancy, including preeclampsia (PE), has been increasing in the past decades, affecting around 10% of gestations worldwide. PE is one of the most severe presentations of arterial hypertension during pregnancy. It is characterized by high blood pressure plus de novo proteinuria and/or target organ lesion, generally after 20 weeks of gestation. In 2005, according to The World Health Report, PE and eclampsia were classified as the pregnancy and labour complications with the highest mortality rate, per number of cases. Therefore, its screening, diagnosis and prevention are important goals to achieve. Currently, it is recommended early treatment with low dose aspirin until 36 weeks of gestation for the prevention of early PE and their outcomes. This recommendation is targeted to timely identified pregnancies, before 14 weeks, as the group with the highest risk of early expression (before 37 weeks) of this complication. One of the risk stratification models uses as predictors the maternal anamnesic characteristics and physical information, the uterine arteries pulsatility index (acquired through doppler ultrasound/fluxometry) and the measurement of biochemical substances in the maternal blood - Placental Growth Factor (PlGF) and/or Pregnancy Associated Plasma Protein-A (PAPP-A). In some populations, there is no access to these biochemical measurements. This paper has the objective of conducting a narrative review on the use of fluxometry of another peripheral vessel, the maternal ophthalmic artery, as an alternative predictor of PE in populations with access to ultrasound equipment commonly used in Obstetrics, many of those being portable. In case it retains or surpasses the performance of the already known predictive algorithms, its use can be especially useful in areas with limited access to laboratory analysis, such as remote populations, where the morbimortality of this condition is higher.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Pré-eclâmpsia Fluxometria Artéria oftálmica Rastreio Diagnóstico Obstetrícia