RESUMO
OBJECTIVE: To investigate whether signs of placental underperfusion (PUP), defined as any maternal and/or fetal vascular pathology, confer an increased risk of neonatal morbidity in late-onset small-for-gestational-age (SGA) fetuses with normal umbilical artery (UA) Doppler indices. METHODS: A cohort of 126 SGA singleton fetuses with normal UA Doppler indices that were delivered after 34 weeks' gestation was studied. For each case, the placenta was evaluated histologically for signs of PUP using a hierarchical and standardized classification system. Neonatal morbidity was assessed according to the score calculated from the morbidity assessment index for newborns (MAIN), a validated outcome scale. The independent association between PUP and neonatal morbidity was evaluated using multivariable median regression analysis. RESULTS: In 84 (66.7%) placentae, 97 placental histological findings that qualified as signs of PUP were observed. These PUP cases had a significantly higher incidence of emergency Cesarean section for non-reassuring fetal status (44.1% vs 21.4%, respectively; P = 0.013) and neonatal metabolic acidosis at birth (33.3% vs 14.3%, respectively; P = 0.023), than did those without PUP. The median MAIN score differed significantly between those with PUP and those without (89 vs 0, respectively; P = 0.025). This difference remained significant after adjustment for potential confounders. The proportion of cases with scores indicative of mild to severe morbidity was also significantly higher in the PUP group (31% vs 14.3%, respectively; P = 0.043). CONCLUSION: In late-onset SGA fetuses with normal UA Doppler indices, signs of PUP imply a higher neonatal morbidity. These findings allow the phenotypic profiling of fetal growth restriction among the general population of late-onset SGA.
Assuntos
Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Insuficiência Placentária/patologia , Adulto , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Fatores de Risco , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagemRESUMO
Los autores presentan su experiencia en la insuficiencia renal aguda durante el periodo neonatal. Se resalta su relacion con la edad gestacional, mas frecuente cuanto menor es esta. Las causas fundamentales han sido en los preterminos aquellas que originan hipoxia (anoxia neonatal, neumopatias, apneas, etc.) y en los recien nacidos a terminos aquellas que originan hipovolemia, sobre todo la deshidratacion hipernatremica. Terapeuticamente, en una fase inicial se debe forzar la diuresis y posteriormente en aquellos casos en que no tiene lugar la crisis diuretica la practica de una dialisis peritoneal, la cual es mejor tolerada por los pretermino al presentar menores complicaciones