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>Revistas >Ginecología y Obstetricia de México >Año 2015, No. 05


Oviedo-Cruz H, Hernández-Paredes J, Vanessa Ruíz-Ramírez A
Tamiz prenatal de aneuploidías en el primer trimestre: auditoría a un centro de medicina fetal con laboratorio especializado en México
Ginecol Obstet Mex 2015; 83 (05)

Idioma: Español
Referencias bibliográficas: 40
Paginas: 259-276
Archivo PDF: 800.49 Kb.

[Texto completo - PDF]

RESUMEN

Antecedentes: el tamiz de aneuploidías, con los marcadores ecográficos y bioquímicos del primer trimestre, tiene un desempeño esperado si se cumplen los requisitos de idoneidad.
Objetivo: describir los marcadores del primer trimestre en México mediante la auditoría a un Centro de Medicina Fetal y Laboratorio.
Material y método: estudio descriptivo efectuado con el método de auditoría de los marcadores ecográficos y bioquímicos en embarazos a los que se realizaron pruebas de tamiz prenatal en el primer trimestre, entre las 11+1 y 14+1 semanas, de pacientes embarazadas que acudieron al Laboratorio del Centro Médico para Atención Fetal Especializada.
Resultados: en 17 meses se estudiaron 1020 embarazadas: 962 (94%) de feto único, 55 (5%) dobles y 3 (1%) triples. La mediana de la edad materna fue de 33.8 años (límites 16 y 52 años), 413 (40%) ≥ 35 años. Se estudiaron 1080 fetos con 1009 mediciones válidas de traslucencia nucal (30% en gabinetes externos), 54% ›p50; 7.3% ›p95 y 1.6% › p99. De 1555 sueros procesados en el laboratorio (f-β-hCG y PAPPA, Roche®) 641 (41%) se interpretaron en centros externos. En 914 sueros los MoM de f-β-hCG p50 = 0.72, 3.2% ›p95; de PAPP-A, p50 = 0.89, 9.0% ‹p5. Hubo 850 pruebas combinadas y 745 de ellas con un marcador adicional; la mediana del IP ducto venoso fue de 0.99 MoM. En 50 fetos (4.6%) resultó un riesgo ≥ 1 en 100; en 27 se realizaron procedimientos invasivos en el Centro, 19 cariotipos normales y 8 anormales a saber: 3 con trisomía 21 y 5 con diversas aneuploidías.
Conclusiones: se cumplen los requisitos de idoneidad para traslucencia, ducto venoso y prueba combinada; 1 de cada 3 procedimientos invasivos resulta con una aneuploidía; la tasa estimada de falsos positivos es de 3.9%. El laboratorio ajustará las medianas de los marcadores bioquímicos. Se ha iniciado una cohorte.


Palabras clave: diagnóstico prenatal, tamiz prenatal, síndrome de Down, aneuploidía, pruebas de tamiz en suero materno, proteína plasmática - A asociada al embarazo, subunidad beta de la gonadotropina coriónica humana, ultrasonografía prenatal, medición de la traslucencia nucal, embarazo del primer trimestre, México, tamiz en suero materno, tamiz del primer trimestre, trisomía 21, aneuploidías, traslucencia nucal, PAPP-A en suero, free β–hCG, free β-hCG, PAPP-A, tamiz combinado, tamiz de trisomía 21.


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>Revistas >Ginecología y Obstetricia de México >Año2015, No. 05
 

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