PREDICCIÓN DE PREECLAMPSIA EN PACIENTES CON INDICE DE PULSATILIDAD AUMENTADA ENTRE 11-14 SEMANAS DE GESTACIÓN, HOSPITAL IESS LOS CEIBOS DE GUAYAQUIL, SEPTIEMBRE 2018-FEBRERO 2019

Abstract

Summary: Doppler ultrasound is currently the most widely used technique derived from ultrasound in centers specialized in maternal-fetal surveillance, its contribution to perinatal morbidity and mortality in fetuses with chronic hypoxia, in the identification of cases with severe anemia, in the characterization of the severity of the fetal-fetal transfusion syndrome and the identification of women at risk of developing preeclampsia has allowed the development of treatment and prevention strategies that have changed obstetric medical practice. Uterine artery ultrasound Doppler is a non-invasive method that assesses the resistance of the vessels that feed the placenta. Under normal conditions there is an increase in the speed of blood flow and a decrease in the resistance to this flow in the uterine arteries, and this reflects the adequate transformation of the spiral arteries. In contrast, in abnormal conditions such as hypertensive disorders of pregnancy, the Doppler of the uterine arteries shows an increase in resistance to flow. Currently, most studies to predict preeclampsia in the first trimester of gestation consider the combination of maternal medical history, uterine artery Doppler, and serum biochemical markers as the triad for the early diagnosis of hypertensive 10 disorders in pregnant women. . Preeclampsia is a pathology defined as the appearance of new hypertension (pregnancy-induced hypertension) from 20 weeks of gestation, in a previously normotensive woman, associated with new proteinuria (> 0.3 g / 24 hours) . It is frequently associated with other accompanying signs such as edema of the upper and lower limbs and elevated pressure (> 140/90 mmHg). A population of 240 patients was selected, of whom 20 were excluded due to the diagnosis of chronic hypertensive disorder, 60 patients were excluded from the study because their gestational age was not in the range of 11 to 14 weeks, 10 patients were excluded because they already had treatment for hypertension. Thus, 150 participants who met all the inclusion criteria were considered for the study. Of which 110 presented hypertensive disorders of pregnancy and 40 did not present the pathology. Most of the patients are between 19 and 34 years old (58%), the most frequent marital status was married (50%) and the secondary education level was the most frequent (60%). The employment situation of the patients was 54.7% for those patients who do work and 45.3% for those who do not have a job. The origin both urban and rural was distributed with 42% and 58% respectively. The highest percentage of patients did not smoke (86.7%). The highest percentage of patients was multiparous (61.3%). In relation to BMI, the highest percentage of the population was between 19 to 25 (57.3%), then a BMI> 25 with a percentage of 33.3% and <19 with a percentage of 0.7%. Regarding the ethnicity of the pregnant women, an interesting result was obtained, indicating the mestizo woman as the most frequent with a percentage of 68% followed by the black race with 26.7%. In those insulin-dependent diabetic patients, 65.3% use insulin and 34.7% do not use it. The gestational age with the highest frequency in having an increased pulsatility index of the uterine arteries, were those patients with week 14 of gestation with 57.3%, followed by those pregnant women with 13 weeks of gestation who presented 28.7%.