Dopplervelocimetria de artérias uterinas e síndrome antifosfolípide
Palabras clave:
dopplerfluxometria, síndrome antifosfolipídica, restrição de crescimento intra-uterino, pré-eclâmpsiaResumen
A síndrome antifosfolípide é uma condição clínica caracterizada pela presença de auto-anticorpos associada a complicações graves. Pode ocorrer trombose vascular, óbito fetal, aborto recorrente, parto prematuro, pré-eclâmpsia grave ou insuficiência placentária. O diagnóstico é feito a partir da identificação dos anticorpos antifosfolípides, principalmente do anticorpo anticardiolipina e do anticoagulante lúpico no soro materno, em associação com antecedente tromboembólico. A síndrome antifosfolípide é classificada em primária, quando ocorre isoladamente, e secundária, quando se associa a outras doenças. A dopplervelocimetria de artérias uterinas vem sendo exaustivamente estudada na tentativa de identificar as pacientes de risco para desenvolver complicações obstétricas tardias. A realização entre 18 e 24 semanas de gestação é a mais utilizada, já que é nessa fase da gestação que ocorre a segunda onda trofoblástica, diminuindo a resistência do fluxo placentário. Alguns estudos têm sugerido que as medidas dos índices de pulsatilidade, de resistência e relação A/B, associadas com a incisura diastólica, podem predizer o desenvolvimento de restrição de crescimento intra-uterino e pré-eclâmpsia. A dopplervelocimetria de artérias uterinas é um recurso diagnóstico que pode auxiliar no rastreamento da síndrome antifosfolípide, uma vez que permite identificar a placentação anormal.
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Wilson AW, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette J, et ai. lnternational consensus statement on preliminary classification criteria for definitite antiphospholipid syndrome (Report of an lnternational Workshop-Sapporo-Japon). Arthritis Rheumatism. 1999; 42(7):1309-11
Lockshin MD, Qamar T, Levy RA. Anticardiolipin and related antibodies: thrombosis and fetal death. ln: Scott JS, Bird HA, editors. Pregnancy, autoimmunity and conective tissue disorders. 5th ed. Oxford: Oxford University Press; 1990. p.185-211.
Triplett DA. Obstetrical complications associated with antiphospholipid antibodies. ln: Coulam CB, Faulk WP, Mclntyre JA, editors. lmmunological obstetrics. London: Norton Medical Books; 1992. p.377-403.
Wesney GE, Harris EN. Catastrophic antiphospholipid syndrome in the intensive care unit. Crit Care Clin. 2002; 18:(4)805-17.
Asherson RA, Cervera R, Piette JC, Shoenfeld Y, Espinosa G, Petri MA, et ai. Catastrophic antiphospholipid syndrome: clues to the pathogenesis from a series of 80 patients. Medicine. 2001; 80(6):355-77.
Miret C, Cervera R, Reverter JC, Garcia-Carrasco M, Ramos M, Molla M, et ai. Antiphospholipid syndrome without antiphospholipid antibodies at the time of the thrombotic event: transient "seronegative" antiphospholipid syndrome1 Clin Exp lmmunol. 1997; 15(5):541-4.
Mclntyre JA, Wagenknecht DR, Faulk WP. Antiphospholipid antibodies: discovery, definitions, detection and disease. Prog Lipid Res. 2003; 42(3):176-237.
Requena-Silla Y, Rosenfield CG, Miller LC. Anticardiolipin antibodies and Down syndrome: a case series. J Pediatr Hematol Oncol. 2002; 24(7): 575-78.9.
Gharavi AE, Wilson WA. Antiphospholipid antibodies. ln: Wallace DJ, Hahn BH, editors. Dubois' Lupus Erythematosus. 5th ed. New York: Williams & Wilkins; 1996. p.471-91.
Wasserman A, Neisser A, Bruck C, Triplett DA. Obstetrical complications associated with antiphospholipid antibodies. ln: lmmunological obstetrics. London: Norton Medical Books; 1992. p.378.
Castro AR, Morril WE, Shaw WA, Gale DC, Park MM, Peregrino-Ferreira LA, et ai. Use of synthetic cardiolipin and lecitin in D antigen used by the venerai disease research laboratory test for serodiagnosis of syphilis. Clin Diagn Lab lmmunol. 2000; 7(4):658-61.
Moore JE, Mohr CF. Biologically false positive serologic tests for syphilis; type, incidence and cause. JAMA. 1952; 150:467-73.
Hughes GR. Thrombosis, abortion, cerebral disease and lupus anticoagulant. Br Med J. 1983; 287(6399): 1088-9.
Garcia-Gonzales E. Anticuerpos antifosfolipídicos, anticuerpos anticardiolipina, anticoagulante lúpico. lCuál es su importancia? Perinatol Reprod Hum. 1991; 5(8):134.
Conley CL, Hartmann RC. A hemorragic disorder caused by circurculating anticoagulant in patients with disseminated lupus erythematosus. J Clin lnvest. 1952; 31:621-2.
Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antifosfolipid syndrome: a systematic review of the literature. Blood. 2003; 101(5):1827-32
Triplett DA, Brandt JT. Lupus anticoagulants: misnomer, parodox, riddle, epiphenomenon. Hematol Pathol. 1988; 2(3):121.
Kaneria MV, Vishwanathan C. A prelimary study of antiphospholipid antibodies in 50 cases of bad obstetric history. J Assoe Physicians lndia. 1999; 47(7) 665-7.
Cecatti JG, Aquino MMA, Tintori EM, Yela DA, Queiroz MLS. Anticorpos anticardiolipina entre gestantes com óbito fetal. RBGO. 2000; 22(2):101-6.
Carvalho ECC. Estudo comparativo da frequência de fatores trombogênicos entre mulheres com aborto espontâneo recorrente e mulheres férteis [tese). Campinas: Universidade Estadual de Campinas; 2001.
Albaiges G, Missfelder-Lobos H, Lees C, Parra M, Nicolaides KH. One-stage screening for pregnancy complications by color doppler assessment of the uterine arteries at 23 weeks' gestation. Obstet Gynecol. 2000; 96(4):559-64.
Martin AM, Bindra R, Curcio P, Cícero S, Nicolaides KH. Screening for pre-eclampsia and fetal grovvth restriction by uterine artery doppler at 11-14 weeks of gestation. Ultrasound Obstet Gynecol. 2001; 18(6):583.
Papageorghiou To MS, Yu AT, Nicolaides KH. Repeatibility of measurement of uterine artery pulsatility index using transvaginal color Doppler. Ultrasound Obstet Gynecol. 2001; 18(5):456-9.
Caruso A, De Carolis S, Ferrazini S, Valesi G, Caforio L, Mancuso S. Pregnancy outcome in relation to uterine artery flow velocity waveforms and clinicai characteristics in women with antiphospholipid syndrome. Obstet Gynecol. 1993; 82(6):970-7.
Harrington K, Goldfrad C, Carpenter RG, Campbell S. Transvaginal uterine and umbilical Doppler examination at 12-16 weeks and the subsequent development of PET and intrauterine growth retardation. Ultrasound Obstet Gynecol. 1997; 9(2):94-100.
Delle Chiaie L, Gramellini D, Piantelli G, Manotti C, Fieni S, Vadora E. Doppler velocimetry and thrombophilic screening at middle trimestre of gestation: Preliminary data. Eur J Obstet Gynecol Reprod Biol. 2001; 99(1):38-46.
Donohoe S, Geary M, Kingdom JC, Jauniaux E, Purdy G, Mackie IJ. Maternal cardiolipin, beta 2- glycoprotein-l and prothrombin antibody expression in high-risk pregnancies with bilateral abnormal uterine artery doppler waveforms. Ultrasound Obstet Gynecol. 1999; 13(5):317-22.
Venkat-Raman N, Backos M, Tcoh TG, Lo WTS, Regan L. Uterine artery Doppler in predicting preganancy outcome in women with antiphospholipid syndrome. Obstet Gynecol. 2001; 98(2):235-42.
Battaglia C, Sgarbi L, Salvatori M, Maxia N, Gallinelli A, Volpe A. lncreased anticardiolipin antibodies are positively related to the uterine artery pulsatility index in unexplained infertility. Hum Reprod. 1998; 13(12):3487-91.
Sauer 1, Reiste F, Heylw W, Funk A. Significance of detecting impaired uteroplacental perfusion for diagnosis of antiphospholipid antibody syndrome - a case report. Z Geburtshilfe Neonatol. 2000; 204(5):198-201.
Conz PA, Catalano C. Pathogenesis of pre-eclampsia. G ltal Nefrol. 2003; 20(1):15-22.
Hague WM, Dekker GA. Risk factors for thrombosis in pregnancy. Best Pract Res Clin Haematol. 2003; 16(2):197-21O.
Lockshin MD, Sammaritano LR, Schwartzman S. Validation of the Sapporo criteria for antifosfolipid syndrome. Arthritis Rheum. 2000; 43(2):440-3.
Liberati M, Rotmensch S, Zannolli P, Perrino S, Celentano C, Bellati U, et ai. Uterine artery Doppler velocimetry in pregnant women with lateral placentas. J Perinat Med. 1997; 25(2):133-8.
Benifla JL, Tchobroutsky C, Uzan M, Sultan Y, Weill BJ, Laumond-Barny S. Predictive value of uterine artery velocity waveforms in pregnancies complicated by systemic lupus erythematosus and the antiphospholipid syndrome. Fetal Diagn Ther. 1992; 7(3-4):195-202.
