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

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

SUPLEMENTO DE CALCIO  Almirante CY. Calcium supplementation during pregnancy in the prevention of EPH gestosis. Prenatal and Neonatal Medicine 1998;3 Suppl 1:24.  Hofmeyr G, Lawrie T, Atallah N, Duley L, Torloni R. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews. 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

PREVENCIÓN CON AAS  Rotchell et al.Results of the Barbados low dose aspirin study in pregnancy (BLASP): A population-based trial in a developing country with excess pre-eclampsia (PE) and perinatal mortality. 27th British Congress of Obstetrics & Gynaecology. 1995:31  Knight M, Duley L, Henderson-Smart J, King F. Antiplatelet agents for preventing and treating pre-eclampsia. Cochrane Database of Systematic Reviews. 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, November 2013

DIAGNOSTICO DE PREECLAMPSIA  Jaschevatzky OE, 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):  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

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

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

PREDICCION DE PREECLAMPSIA  La predicción de la preeclampsia es factible aunque en la actualidad no existe un test único que reuna los criterios para ser considerado clínicamente útil  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

TEST PROMISORIOS  Podocituria  DNA fetal libre  Tecnología “omics”