Predikcia preeklampsie v prvom trimestri – pilotná štúdia


Authors: M. Dugátová 1;  J. Luha 2;  E. Korňanová 1;  M. Borovský 1
Authors‘ workplace: First Department of Gynecology and Obstetrics, Comenius University and University Hospital, Bratislava, Slovakia 1;  Institute of Medical Biology, Genetics and Clinical Genetics, School of Medicine, Comenius University, Bratislava, Slovakia 2
Published in: Čes. Gynek.2019, 84, č. 4 s. 276-282
Category:

Overview

Cieľ štúdie: Cieľom štúdie bolo zhodnotiť možnosti predikcie preeklampsie v prvom trimestri v rizikových graviditách.

Typ štúdie: Prospektívna štúdia.

Názov a sídlo pracoviska: I. gynekologicko-pôrodnícka klinika Lekárskej fakulty Univerzity Komenského, Univerzitná nemocnica v Bratislave.

Metodika: Štúdia zahŕňala 77 žien, ktoré boli vyšetrené v prvom trimestri medzi 11+0 a 13+6 gestačným týždňom od 1. 6. 2016 do 1. 6. 2017. Pacientky porodili do 31. 2. 2018. Štúdia bola schválená etickou komisiou a všetky pacientky podpísali informovaný súhlas. Do štúdie sme zahrnuli pacientky, ktoré mali minimálne jeden rizikový faktor pre vznik preeklampsie. Bolo realizované ultrazvukové vyšetrenie v prvom trimestri, zmerali sme pulzatívny index uterinnej artérie a tlak. Údaje o PAPP-A proteíne sme získali zo skríningového krvného testu. Tieto parametre boli použité na predikciu preeklampsie. Potom sme vyrátali senzitivitu a špecificitu. Preeklampsiu sme hodnotili podľa diagnostických kritérií American College Obstetricians and Gynecologists z roku 2013. V poslednej časti sme porovnali perinatálne výsledky u pacientok s preeklampsiou a kontrolnou skupinou. Štatistická analýza bola realizovaná IBM SPSS Statistics 25 Software. Rizikové faktory sme vyhodnotili pomocou Fisherovho exaktného testu a odds ratio. Mannov-Whitneyov test a one way analysis of variance boli použité na zistenie signifikantnosti prediktorov.

Výsledky: Pacientky, ktoré otehotneli po asistovanej reprodukcii, mali signifikantne vyššiu pravdepodobnosť vzniku preeklampsie (odds ratio = 7,7; p = 0,028). Takisto pacientky s viacplodovým tehotenstvom mali vyššie riziko vzniku preeklampsie (odds ratio = 16,5; p = 0,031). Len stredný arteriálny tlak sa potvrdil ako signifikantný prediktor preeklampsie v 12. gestačnom týždni.

Záver: Stredný arteriálny tlak je jednoduchý a nízkonákladový prediktor, ktorý má ale nízku senzitivitu 66,6 % a špecificitu 49 %.

Klíčová slova:

preeklampsia – pregnancy-associated plasma (PAPP-A) proteín – stredný arteriálny tlak – dopplerovské vyšetrenie uterinných artérií – rizikové faktory – pulzatívny index


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Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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