RESUMO
In order to measure the umbilical resistance and pulsatility Doppler indexes 60 pregnant women with low risk pregnancies were studied in a descriptive, observational and prospective study carried out at the Hospital de Gineco-Pediatria numero 48 del Instituto Mexicano del Seguro Social. Umbilical Doppler measurements were done of the fetal umbilical cord from the week 30 at the 40 of gestation. We carried out a total of 337 measurements and 178 (52.8%) corresponded to the resistance index and 159 (47.2%) to the pulsatility index. The average of the resistance index was 0.64 with a range average (average plus two standard deviations was 0.48-0.79) and the pulsatility index had an average value of 0.94 with an average range of 0.58-1.30. The percentil values of the resistance index were 0.52, 0.66 and 0.79 respectively in the percentil 5, 50 and 95 whereas the percentil values of the pulsatility index were 0.64, 0.94 and 1.28 respectively in the percentil 5, 50 and 95. The analysis of variance with the Bonferroni test for multiple comparisons showed that our found indexes can be applied from the week 31 to the 40 of gestation. Our findings are in according to reported by other authors and it should be kept in mind that the concept of normality of the Doppler velocimetry indexes is strictly statistical and that only its judicious use will offer the benefit to our pregnant patients to obtain products under good conditions of health.
Assuntos
Fluxometria por Laser-Doppler , Ultrassonografia Pré-Natal , Análise de Variância , Intervalos de Confiança , Feminino , Idade Gestacional , Humanos , Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Fatores de RiscoRESUMO
In order to compare the maternal-fetal outcome in pregnant women of advanced age (bigger than 35 years old) with those smaller than 30 years. 268 pregnant women were studied that went for their control and attention of the childbirth, corresponding 134 patients of more than 35 years and 134 patients between 20-29 years (control group). Cases were excluded if presented confounding variables (smoking, obesity, multiparity and maternal illnesses associated to the pregnancy). Data of maternal-fetal morbimortality were written down both groups and they were analyzed by means of X2 test or Fisher exact test for assessing differences between the groups, P < 0.05 was considered statistically significant, with a power of 80%, with a delta of 12%. The only two variables that had statistical significant were the number of cesarean sections 66 (49.2%) in the group of older women against 43 (32%) in the control group (P < 0.01) and normal vaginal deliveries (45 cases in the study group and 80 cases in the control group (P < 0.001). The rest of the analyzed variables none had difference statistically significant between both groups and they are described next: Forceps delivery was documented in 6 patients of the older group and 4 of the control group; 7 abortions were observed in a group and 17 in the other group of patients; there were not maternal deaths in both groups. The premature rupture of membranes was presented in 22 cases of the study group and in 24 cases of the control group; 8 congenital anomalies were presented in women's of advanced age children and 2 in mother's of the group control children; admission to the unit of therapy intensive neonatal happened in 17 products of the study group and in 9 cases of the control group; there were 3 stillbirths in the women of advanced age and 1 stillbirth in the control group; 3 perinatal deaths were presented in the patients of advanced age and 2 cases in the control group, all these variables had a value of P greater than 0.05 (not significant). When controlling confounding variables that can influence in the increase of the maternal-fetal morbimortality, it was observed that the only two significant variables were smaller normal vaginal deliveries (P < 0.001) and higher number of cesarean sections (P < 0.01) in patients with advanced age, owing to most of them are subjected to cesarean section without evaluating the possibility to obtain the product by means of a childbirth, for what the indication of cesarean section should be revalued in advanced age multiparous pregnant and in case of not having factors of associated risk to attempt the birth for childbirth, reducing by this way the incidence of cesarean sections as well as the morbidity that this procedure may imply.