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SINDROME PREECLAMPSIA-ECLAMPSIA -CONTROVERSIAS-

Jornadas Tocoginecológicas SOGIU Centro Regional Trinidad Setiembre 2014. SINDROME PREECLAMPSIA-ECLAMPSIA -CONTROVERSIAS-. Asist . Dra. María Eugenia Verde-Prof. Agdo . Dr. Fabián Rodríguez Clínica Ginecotocológica C Facultad de Medicina Universidad de la Republica.

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SINDROME PREECLAMPSIA-ECLAMPSIA -CONTROVERSIAS-

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  1. Jornadas Tocoginecológicas SOGIU Centro Regional Trinidad Setiembre 2014 SINDROME PREECLAMPSIA-ECLAMPSIA-CONTROVERSIAS- Asist. Dra. María Eugenia Verde-Prof. Agdo. Dr. Fabián Rodríguez Clínica Ginecotocológica C Facultad de Medicina Universidad de la Republica

  2. PREECLAMPSIA CONTROVERSIAS • PREVENCIÓN DE PREECLAMPSIA Calcio AAS a bajas dosis • DIAGNÓSTICO Índice Proteinuria/Creatininuria • INTERRUPCIÓN • DIAGNÓSTICO PRECOZ Doppler de arterias uterinas Tecnología “Omics”

  3. SUPLEMENTO DE CALCIO • Almirante CY. Calciumsupplementationduringpregnancy in theprevention of EPH gestosis. Prenatal and Neonatal Medicine 1998;3 Suppl 1:24. • Hofmeyr G, Lawrie T, Atallah N, Duley L, Torloni R. Calciumsupplementationduringpregnancyforpreventinghypertensivedisorders and relatedproblems. Cochrane Database of SystematicReviews. 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

  4. PREVENCIÓN CON AAS • Rotchellet al.Results of the Barbados lowdoseaspirinstudy in pregnancy (BLASP): A population-based trial in a developing country withexcess pre-eclampsia (PE) and perinatal mortality. 27th British Congress of Obstetrics & Gynaecology. 1995:31 • Knight M, Duley L, Henderson-Smart J, King F. Antiplateletagentsforpreventing and treating pre-eclampsia. Cochrane Database of SystematicReviews. 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, November2013

  5. DIAGNOSTICO DE PREECLAMPSIA • JaschevatzkyOE, 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

  6. INTERRUPCIÓN • Preeclampsia Leve 37 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

  7. DOPPLER ARTERIAS UTERINAS Meads et al. Health Technol Assess 2008;12:1-270

  8. PREDICCION DE PREECLAMPSIA • La predicción de la preeclampsia esfactibleaunqueen la actualidad no existe un test únicoquereuna los criterios para serconsideradoclínicamenteútil • 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

  9. TEST PROMISORIOS • Podocituria • DNA fetal libre • Tecnología “omics”

  10. MUCHAS GRACIAS

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