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Federación Mexicana de Ginecología y Obstetricia, A.C.

2015, Número 05

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Ginecol Obstet Mex 2015; 83 (05)


Tamiz prenatal de aneuploidías en el primer trimestre: auditoría a un centro de medicina fetal con laboratorio especializado en México

Oviedo-Cruz H, Hernández-Paredes J, Vanessa Ruíz-Ramírez A

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


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.


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