Predictores de Preeclampsia
Predictores de Preeclampsia
Predictores de Preeclampsia
La preeclampsia (PE) es un síndrome sistémico que se desarrolla durante la segunda mitad del
embarazo. Se caracteriza por hipertensión acompañada de proteinuria o de disfunción de órganos
maternos.
Hipertensión Proteinuria
Brosens I, Pijnenborg R, Vercruysse L, Romero R. The "Great Obstetrical Syndromes" are associated with disorders of deep placentation. Am J Obstet Gynecol 2011; 204: 193-201.
PATOGÉNESIS
Brosens I, Pijnenborg R, Vercruysse L, Romero R. The "Great Obstetrical Syndromes" are associated with disorders of deep placentation. Am J Obstet Gynecol 2011; 204: 193-201.
MÉTODO DE CRIBADO DE LA FMF
Wright D, Akolekar R, Syngelaki A, Poon LC, Nicolaides KH. A competing risks model in early screening for preeclampsia. Fetal Diagn Ther 2012; 32: 171-8.
CARACTERÍSTICAS MATERNAS
E HISTORIA CLÍNICA
Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J Obstet Gynecol 2015; 213: 62.e1-10
PRESIÓN ARTERIAL MEDIA (PAM)
Media de la
presión arterial
durante un
ciclo cardiaco
PAM= 2/3
presión
diastólica + 1/3
presión
sistólica.
Tayyar A, Krithinakis K, Wright A, Wright D, Nicolaides KH. Mean arterial pressure at 12, 22, 32 and 36 weeks' gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 573-9
MEDICIÓN DEL ÍNDICE DE
PULSATILIDAD DE LAS ARTERIAS
UTERINAS (IPUT)
1.Tayyar A, Guerra L, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility index in the three trimesters of pregnancy: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45: 689-97.
2.O'Gorman N, Tampakoudis G, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility index at 12, 22, 32 and 36 weeks' gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 565-72.
FACTOR DE CRECIMIENTO
PLACENTARIO (PLGF)
Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, Schisterman EF, Thadhani R, Sachs BP, Epstein FH, Sibai BM, Sukhatme VP, Karumanchi SA. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 2004; 350: 672-83
Tsiakkas A, Duvdevani N, Wright A, Wright D, Nicolaides KH. Serum placental growth factor in the three trimesters of pregnancy: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45: 591-8.
Tsiakkas A, Cazacu R, Wright A, Wright D, Nicolaides KH. Maternal serum placental growth factor at 12, 22, 32 and 36 weeks' gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 472-7.
FORMA SOLUBLE DE LA
TIROSINA CINASA 1 (SFIT-1)
sFLT-1 es un factor
antiangiogénico que
parece tener un papel
principal en la patogénesis
de la PE. La administración
de sFLT-1 exógena en ratas
durante el embarazo
induce hipertensión,
proteinuria y endoteliosis
glomerular.
1.
Maynard SE, Min JY, Merchan J, Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, Libermann TA, Morgan JP, Sellke FW, Stillman IE, Epstein FH, Sukhatme VP, Karumanchi SA. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to
endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 2003; 111: 649-58.Tsiakkas A, Mendez O, Wright A, Wright D, Nicolaides KH. Maternal serum soluble fms-like tyrosine kinase-1 at 12, 22, 32 and 36 weeks' gestation in
screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 478-83Tsiakkas A, Duvdevani N, Wright A, Wright D, Nicolaides KH. Serum soluble fms-like tyrosine kinase-1 in the three trimesters of pregnancy: effects of maternal characteristics and
medical history. Ultrasound Obstet Gynecol 2015; 45: 584-90.
PROTEINA-A ASOCIADA
AL EMBARAZO (PAPP-A)
Wright A, Guerra L, Pellegrino M, Wright D, Nicolaides KH. Maternal serum PAPP-A and free β-hCG at 12, 22 and 32 weeks' gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 762-7.
RENDIMIENTO DEL CRIBADO
Performance of screening
11-13 weeks
20-24 weeks
30-33 weeks
35-37 weeks
CRIBADO A LAS 11-13 SEMANAS
O’Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation. Am J Obstet Gynecol 2016;214:103.e1-103.e12.
National Collaborating Centre for Women’s and Children’s Health (UK). Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. London: RCOG Press, 2010.
MÉTODO TRADICIONAL
Identificación del grupo de alto riesgo Recomienda el uso de aspirina en mujeres con
basándose en las características maternas antecedente de PE en 2 o más embarazos, o en
e historia clínica. las que han padecido PE y el parto ha ocurrido
antes de las 34 semanas.
Este método identifica tan sólo un 40% de Este método identifica un 5% de los casos de PE
los casos de PE pretérmino y un 35% de PE pretérmino y un 2% de PE a término.
a término.
Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122: 1122-31.
O’ Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, Carbone IF, Dutemeyer V, Fiolna M, Frick A, Karagiotis N, Mastrodima S, de Paco Matallana C, Papaioannou G, Pazos A, Plasencia W, Nicolaides KH. Multicenter screening for
preeclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison to NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol 2017; 49: 756-60.
CRIBADO A LAS 20-24 SEMANAS
Gallo DM, Wright D, Casanova C, Campanero M, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 19–24 weeks’ gestation. Am J Obstet Gynecol 2016; 214:
619-e1.
CRIBADO A LAS 30-34 SEMANAS
Tsiakkas A, Saiid Y, Wright A, Wright D, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 30–34 weeks’ gestation. Am J Obstet Gynecol 2016;
215: 87.e1-87.e17.
CRIBADO A LAS 35-37 SEMANAS
Andrietti S, Silva M, Wright A, Wright D, Nicolaides KH. Competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 35-37 weeks' gestation. Ultrasound Obstet Gynecol
2016; 48: 72-9.
ESTRATIFICACIÓN DEL MANEJO DEL
EMBARAZO
SEMANAS 11-13 DE GESTACIÓN
Mediante la combinación de
factores maternos, PAM, IPUT y 10% 75% 90%
PLGF
• Grupo de alto riesgo
Riesgo de PE < 37 sem ≥1 en 100
• Grupo de bajo riesgo
Riesgo de PE < 37 sem <1 en 100) ↓ riesgo 60-75%
SEMANAS 20-24 DE GESTACIÓN
Mediante la combinación de
1% <20% >90% >80%
factores maternos, PAM, IPUT, 95%
PLGF y sFLT-1
TA
Grupo de alto riesgo: EGO
A) A la población general
B) a quienes tengan antecedente personal de preeclampsia
C) en pacientes con factores de riesgo: raza negra, obesidad, diabetes e hipertensión
¿EN QUÉ MOMENTO SE REALIZA EL TAMIZAJE PARA PE SEGÚN
LA FMF?
• A) 40-50%
• B) 60-75%
• C) 80-95%
• D) 25-35%
BIBLIOGRAFÍA
Wright D, Akolekar R, Syngelaki A, Poon LC, Nicolaides KH. A competing risks model in early screening for preeclampsia. Fetal
Diagn Ther 2012; 32: 171-8.
Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal
characteristics and medical history. Am J Obstet Gynecol 2015; 213: 62.e1-10
Tayyar A, Krithinakis K, Wright A, Wright D, Nicolaides KH. Mean arterial pressure at 12, 22, 32 and 36 weeks' gestation in screening
for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 573-9
Tayyar A, Guerra L, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility index in the three trimesters of pregnancy: effects
of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45: 689-97.
O'Gorman N, Tampakoudis G, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility index at 12, 22, 32 and 36 weeks'
gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 565-72.
Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, Schisterman EF, Thadhani R, Sachs BP, Epstein FH, Sibai BM, Sukhatme
VP, Karumanchi SA. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 2004; 350: 672-83
Tsiakkas A, Duvdevani N, Wright A, Wright D, Nicolaides KH. Serum placental growth factor in the three trimesters of pregnancy:
effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45: 591-8.
Tsiakkas A, Cazacu R, Wright A, Wright D, Nicolaides KH. Maternal serum placental growth factor at 12, 22, 32 and 36 weeks'
gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 472-7.
Maynard SE, Min JY, Merchan J, Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, Libermann TA, Morgan JP, Sellke FW, Stillman
IE, Epstein FH, Sukhatme VP, Karumanchi SA. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to
endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 2003; 111: 649-58.
Tsiakkas A, Mendez O, Wright A, Wright D, Nicolaides KH. Maternal serum soluble fms-like tyrosine kinase-1 at 12, 22, 32 and 36
weeks' gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 478-83
Wright A, Guerra L, Pellegrino M, Wright D, Nicolaides KH. Maternal serum PAPP-A and free β-hCG at 12, 22 and 32 weeks'
gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016; 47: 762-7.
O’Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, Nicolaides KH. Competing risks model in screening for
preeclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation. Am J Obstet Gynecol 2016;214:103.e1-103.e12.
National Collaborating Centre for Women’s and Children’s Health (UK). Hypertension in pregnancy: the management of
hypertensive disorders during pregnancy. London: RCOG Press, 2010.
Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in
Pregnancy. Obstet Gynecol 2013; 122: 1122-31.
O’ Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, Carbone IF, Dutemeyer V, Fiolna M, Frick A, Karagiotis N,
Mastrodima S, de Paco Matallana C, Papaioannou G, Pazos A, Plasencia W, Nicolaides KH. Multicenter screening for preeclampsia
by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison to NICE guidelines and ACOG recommendations.
Ultrasound Obstet Gynecol 2017; 49: 756-60.
Gallo DM, Wright D, Casanova C, Campanero M, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal
factors and biomarkers at 19–24 weeks’ gestation. Am J Obstet Gynecol 2016; 214: 619-e1.
Tsiakkas A, Saiid Y, Wright A, Wright D, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal factors
and biomarkers at 30–34 weeks’ gestation. Am J Obstet Gynecol 2016; 215: 87.e1-87.e17.
Andrietti S, Silva M, Wright A, Wright D, Nicolaides KH. Competing-risks model in screening for pre-eclampsia by maternal factors
and biomarkers at 35-37 weeks' gestation. Ultrasound Obstet Gynecol 2016; 48: 72-9.
Brosens I, Pijnenborg R, Vercruysse L, Romero R. The "Great Obstetrical Syndromes" are associated with disorders of deep
placentation. Am J Obstet Gynecol 2011; 204: 193-201.
Kypros H. Nicolaides, MD; Manoel Sarno, MD; Alan Wright, PhD. (2020). Ophthalmic artery Doppler in the prediction of
preeclampsia. merican Journal of Obstetrics & Gynecology, ., 1.