SINDROME PREECLAMPSIA-ECLAMPSIA -CONTROVERSIAS-
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SINDROME PREECLAMPSIA-ECLAMPSIA
-CONTROVERSIAS-
Jornadas Tocoginecológicas SOGIUCentro Regional Trinidad
Setiembre 2014
Asist. Dra. María Eugenia Verde-Prof. Agdo. Dr. Fabián RodríguezClínica Ginecotocológica C
Facultad de MedicinaUniversidad de la Republica
PREECLAMPSIA CONTROVERSIAS
PREVENCIÓN DE PREECLAMPSIA Calcio
AAS a bajas dosis
DIAGNÓSTICO Índice Proteinuria/Creatininuria
INTERRUPCIÓN
DIAGNÓSTICO PRECOZDoppler de arterias uterinasTecnología “Omics”
SUPLEMENTO DE CALCIO
Almirante CY. Calcium supplementation during pregnancy in the prevention of EPH gestosis. Prenatal and Neonatal Medicine 1998;3 Suppl 1:24.
Hofmeyr G, Lawrie T, Atallah N, Duley L, Torloni R. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews. In: The Cochrane Library, Issue 7, 2009
Hypertension in Pregnancy. Task Force on Hypertension in Pregnancy. Report of the American College of Obstetricians and Gynecologists. Vol. 122, No. 5, November 2013
Calcium supplementation (≥ 1 g/day) is associated with a significant reduction in the risk of pre-eclampsia, particularly for women with low calcium diets. It also reduces preterm birth and the occurrence of the composite outcome 'maternal death or serious morbidity'. We considered these benefits to outweigh the increased risk of HELLP syndrome, which was small in absolute numbers. The World Health Organization recommends calcium 1.5 g to 2 g daily for pregnant women with low dietary calcium intake
PREVENCIÓN CON AAS
Rotchell et al.Results of the Barbados low dose aspirin study in pregnancy (BLASP): A population-based trial in a developing country with excess pre-eclampsia (PE) and perinatal mortality. 27th British Congress of Obstetrics & Gynaecology. 1995:31
Knight M, Duley L, Henderson-Smart J, King F. Antiplatelet agents for preventing and treating pre-eclampsia. Cochrane Database of Systematic Reviews. In: The Cochrane Library, Issue 7, 2009
Antiplatelet agents, in this review largely low dose aspirin, have small-moderate benefits when used for prevention of pre-eclampsia. Further information is required to assess which women are most likely to benefit, when treatment should be started, and dose
Hypertension in Pregnancy. Task Force on Hypertension in Pregnancy. Report of the American College of Obstetricians and Gynecologists. Vol. 122, No. 5, November 2013
DIAGNOSTICO DE PREECLAMPSIA
Jaschevatzky OE, et al. Protein/creatinine ratio in random urine specimens for quantitation of proteinuria in preeclampsia. Obstet Gynecol. 1990;75:604-6
Price C, Newall R, Boyd J. Use of Protein Creatinine Ratio Measurements on Random Urine Samples for Prediction of Significant Proteinuria. A systematic review. Clinical Chemistry. 2005;51(9):1577-86
Hypertension in Pregnancy. Task Force on Hypertension in Pregnancy. Report of the American College of Obstetricians and Gynecologists. Vol. 122, No. 5, November 2013
The protein/creatinine ratio on a random urine specimen provides evidence to "rule out" the presence of significant proteinuria as defined by a 24-h urine excretion measurement
INTERRUPCIÓN
Preeclampsia Leve37 semanas
Sin elementos severidad y con seguimiento de la salud materna o fetal
Preeclampsia Severa
Independientemente de la EG
≤34 semanas corticoterapia previo al nacimiento de ser posible
Hypertension in Pregnancy. Task Force on Hypertension in Pregnancy. Report of the American College of Obstetricians and Gynecologists. Vol. 122, No. 5, November 2013
DOPPLER ARTERIAS UTERINAS
Meads et al. Health Technol Assess 2008;12:1-270
PREDICCION DE PREECLAMPSIA
La predicción de la preeclampsia es factible aunque en la actualidad no existe un test único que reuna los criterios para ser considerado clínicamente útil
La velocimetría Doppler de las arterias uterinas tiene capacidad predictiva moderada/alta para la preeclampsia de inicio temprano
Los modelos predictivos multivariable tienen capacidad predictiva alta para la preeclampsia de inicio temprano
TEST PROMISORIOS
Podocituria
DNA fetal libre
Tecnología “omics”
MUCHAS GRACIAS