RESTRICCION DEL CRECIMIENTO INTRAUTERINO

RESTRICCION DEL CRECIMIENTO INTRAUTERINO MONICA N. ANGULO CARVALLO RESIDENTE III GO USCO-HUN

[object Object],[object Object],ACOG Practice Bulletin, Intrauterine Growth Restriction. Number 12. Washington, DC: American College of Obstricians and Gynecologists; 2000. Enfoque RCIU

3651+/-461 4230 3950 3640 3350 3090 2900 2700 42 3615+/-435 4170 3900 3600 3320 3080 2940 2755 41 3533+/-424 4080 3800 3510 3250 3010 2880 2700 40 3408+/-410 3930 3660 3400 3130 2910 2770 2600 39 3255+/-422 3800 3510 3235 2980 2750 2600 2425 38 3014+/-445 3570 3280 3000 2730 2500 2330 2135 37 2722+/-453 3280 2980 2700 2440 2190 2020 1805 36 2444+/-444 2970 2700 2430 2180 1920 1740 1524 35 2122+/-449 2720 2450 2200 1950 1680 1510 1322 34 1994+/-430 2470 2220 1980 1730 1480 1340 1165 33 1802+/-425 2250 2000 1780 1550 1320 1194 1060 32 1609+/-351 2018 1803 1600 1390 1160 1050 920 31 1452+/-368 1840 1620 1430 1230 1031 920 800 30 1308+/-410 1630 1440 1280 1100 926 820 680 29 1180+/-409 1490 1280 1120 980 810 730 625 28 1063+/-393 1300 1147 1000 890 749 660 570 27 912+/-291 1100 1000 884 770 660 601 545 26 829+/-257 1000 890 800 700 630 580 500 25 755+/-362 900 790 700 625 560 531 500 24 702+/-412 800 690 620 560 520 500 450 23 623+/-313 780 650 575 512 470 440 390 22 x +/- DE P90 P75 P50 P25 P10 P5 P2 EG PROMEDIO Y DESVIACION STANDART (DE). PARTOS SIMPLES TOTALES. CHILE 1993 - 2000 DISTRIBUCION DE PESO AL NACER(G) SEGÚN EDAD GESTACIONAL. PERCENTILES OBSERVADOS (DATA CRUDA),

[object Object],[object Object],[object Object],Robert Resnik, MD. Intrauterine Growth Restriction. Obstet Gynecol 2002;99:490–6.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Enfoque RCIU GIANCARLO MARI and FARHAN HANIF. Intrauterine Growth Restriction: How to Manage and When to Deliver. CLINICAL OBSTETRICS AND GYNECOLOGY, Volume 50, Number 2, 497–509.

[object Object],[object Object],[object Object],[object Object],[object Object],Enfoque RCIU DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

TAMIZAJE Y DIAGNÓSTICO PRENATAL Enfoque RCIU

CAUSAS RCIU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Baschat A. A; Pathophysiologic of fetal growth restriction: Implications for diagnosis and surveillance; Obstetrical and Gynecological Survey, 59(8), 2004 Enfoque RCIU

DIAGNOSTICO ,[object Object],[object Object],[object Object],[object Object],[object Object],Enfoque RCIU

[object Object],[object Object],[object Object],[object Object],[object Object],Nyberg D. A. et al; Ultrasound assesment of abnormal fetal growth; Seminars in Perinatology, Vol 28, N1, February (2004): p 3 - 22 Enfoque RCIU

P < 10 CONSTITUCIONALMENTE PEQUEÑOS PEG Sin patología materna y doppler umbilical y ACM normal PATOLÓGICAMENTE PEQUEÑOS RCIU Patología materna Y Doppler anormal IUGR idiopática: Sin Patología materna y Doppler fetal anormal Enfoque RCIU

RCIU de causa conocida y RCIU Idiopática ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Enfoque RCIU INSUFICIENCIA PLACENTARIA: No es la causa del problema. Es consecuencia de un proceso de enfermedad que a menudo no se conoce. GIANCARLO MARI and FARHAN HANIF. Intrauterine Growth Restriction: How to Manage and When to Deliver. CLINICAL OBSTETRICS AND GYNECOLOGY, Volume 50, Number 2, 497–509.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Enfoque RCIU ,[object Object],DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334 MANEJO ETIOLOGICO

MANEJO ETIOLOGICO ,[object Object],[object Object],[object Object],[object Object],Enfoque RCIU DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

PRUEBAS VIGILANCIA FETAL ANTEPARTO Enfoque RCIU

Vigilancia fetal anteparto ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Enfoque RCIU DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

Doppler de la Arteria umbilical ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

Arterias umbilicales – IP normal Arterias umbilicales el índice alto de pulsatilidad IP muy alto de pulsatilidad velocidad diastólica final ausente reversión de frecuencias diastólicas finales

[object Object],[object Object],DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

Estudios bien definidos: DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334 ,[object Object],[object Object],( OR 0,78 , IC del 95%: 0,65-0,94). Partos por cesárea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Temprano Tardio D O P P L E R P B F Retraso en la maduración del control Fcf Retraso en la maduración de los estados de Comportamiento fetal Pérdida de la variabilidad Desaceleraciones tardías Disminución volumen LA Disminución actividad global Pérdida de los MR Pérdida de los MC Pérdida del tono Índice Doppler elevado Flujo diastólico reverso / ausente Línea de base aumentada Variabilidad disminuida Reactividad disminuida IR Elevada

NST (LEVEL 2 AND 3 EVIDENCE) ,[object Object],[object Object],[object Object],Enfoque RCIU DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

1859 neonatos sometidos a PBF RCIU: 22% (n = 410) PEG (peso al nacer <= P10). 28% (n = 517) Oligohidramnios: 6% (95% CI, de 4 a 8%) Oligohidramnios: 6% (95% CI, de 4 a 8%) Volumen de líquido amniótico (evidencia nivel 2 Y 3) Chauhan, Suneet P., Taylor, Michelle et al. Intrauterine Growth Restriction and Oligohydramnios among High-Risk Patients. American Journal of Perinatology. 24(4)April 2007.215-21 ,[object Object]

BPP (nivel evidencia 2, 3 y 4) ,[object Object],[object Object],Enfoque RCIU DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

HALLAZGOS OMINOS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Enfoque RCIU DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

Enfoque RCIU FCIU por biometría (P <10 ) (no malformaciones ni aneuploidías) Test primario: Doppler umbilical semanal tranquilizador Vigilancia contínua Parto >37 sem EG AU REDF AU AEDF < = 34 sem. > 34 sem. PBF dia Doppler AU 2/sem Esteroides Doppler venoso tranquilizador Parto cualquiera de los signos ominosos DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

VÍA DEL PARTO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Enfoque RCIU DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

[object Object],[object Object],[object Object],[object Object],Enfoque RCIU DEV MAULIK, Management of Fetal Growth Restriction: An Evidence-Based Approach. CLINICAL OBSTETRICS AND GYNECOLOGY. Volume 49, Number 2, 320–334

RESTRICCION DEL CRECIMIENTO INTRAUTERINO

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RESTRICCION DEL CRECIMIENTO INTRAUTERINO