Evaluación del crecimiento fetal por ultrasonografía; relación con los resultados neonatales inmediatos
Resumen
El crecimiento fetal humano es un proceso muy
complejo que se determina en el tiempo y en donde
interactúan factores intrínsecos y extrínsecos. Un
buen diagnostico ecografico del crecimiento fetal humano
es importante, ya que el presente y futuro del
recién nacido esta íntimamente ligado a esta etapa
de la vida. Uno de los riesgos bien conocidos es la
restricción del crecimiento intrauterino que llega al
10% en poblaciones de riesgos y se observa en un
5% en la población general. Para poder detectarlo,
debemos estudiar todo el entorno fetal, a la madre,
medir (biometrías)las distintas partes anatómicas del
feto. Las anormalidades en el crecimiento y desarrollo
fetal, es conocido por su bajo peso al nacer, mayor
morbilidad y mortalidad. Tienen mayor deterioro
de su calidad de vida futura. Objetivo: conocer la
concordancia entre la edad gestacional por la fecha
de la última menstruación y la ecografía. Determinar
el porcentaje de pacientes que presentan diferencias
en 1 - 2 y 3 semanas entre la fecha de última regla y
el examen ecografico de primero, segundo y tercer
trimestre, estos resultados a su vez relacionar con el
test de Capurro. Determinar la frecuencia de diferencias
Material y método: El estudio es descriptivo
temporalmente prospectivo de casos consecutivos en
una población de 161 mujeres grávidas con feto único
que asistieron al Centro Materno Infantil de Hospital
de Clínicas para su evaluación ecográfica, sumaron
322 observaciones, con los criterios de inclusión preestablecidos
durante los años 2002 al 2004, luego se
relacionó con los resultados neonatales inmediatos
para valorar las patologías detectadas y contribuir
al manejo oportuno y adecuado. Muestreo no probabilístico
de casos consecutivos. Resultados: En
el primer trimestre de la gestación la concordancia
entre la clínica, el examen ecografico y el test de Capurro
fue de 88 y 86% para diferencias de 1 semana.
91 y 92% si la diferencias llegan a 2 semanas. En
el segundo trimestre, los hallazgos de concordancia
entre la clínica y la ecografía, este a vez con el test
de Capurro fue de 84 y 73%. En cambio llegó a 92
y 93% si la diferencia eran 2 semanas. Para un nivel
de confianza del 90% El crecimiento fetal observado
por trimestres mostró variaciones de incrementos
de casos del p 3 y p10. Conclusiones: Los recién
nacidos, 81% adecuados para la edad gestacional,
observación igual al prenatal. 13% pequeños para la
edad gestacional. 6% grandes o macrosomicos.
Estas anormalidades se asociaron a morbilidades del
15.5%(n=25) que requirió el ingreso a terapia intensiva.
Palabras clave
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Facultad de Ciencias Médicas. Universidad Nacional de Asunción
