Influência do controle metabólico materno nos resultados da cardiotocografia anteparto e sua relação com o prognóstico perinatal, nas gestações complicadas pelo diabete
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Data
2002
Autores
Mascaro, Moacyr Sanches [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A CTG anteparto é o teste mais utilizado para avaliar o bem-estar fetal, nas gestações complicadas pelo diabete, e seus resultados têm sido relacionados à qualidade do controle metabólico materno e ao prognóstico perinatal. Objetivos - Relacionar a qualidade do controle metabólico com os resultados da cardiotocografia (CTG) anteparto e avaliar sua capacidade preditiva no prognóstico perinatal de gestações associadas ao diabete. Sujeitos e Método - Estudo retrospectivo de 125 gestantes, portadoras de diabete gestacional ou clínico, no qual se relacionou a última CTG anteparto (intervalo máximo de 48 horas) à qualidade do controle metabólico materno e aos resultados perinatais. A qualidade do controle metabólico foi definida pela média glicêmica do dia do exame (MGd) e da gestação (MG) e pelo comportamento da requisição de insulina (R/insulina). Para os resultados perinatais foram analisados os índices de Apgar de 1º e 5º minutos, a classificação peso/idade gestacional, o tempo de internação, a necessidade de cuidados de UTI e a ocorrência de óbito neonatal (ONN) precoce. A capacidade diagnóstica da CTG anteparto foi avaliada pelos índices de sensibilidade (SENS), especificidade (ESP) e valor preditivo positivo (VPP) e negativo (VPN). Resultados - A MGd adequada (<120 mg/dL) evidenciou 2,9% dos resultados de CTG anteparto alterados e a inadequada ( 120 mg/dL), 26,1% (p<0,005). A MG mantida inadequada na gestação se relacionou a 13,7% de CTG anteparto alterada e a adequada, a apenas 2,7% (p<0,005). O comportamento da requisição de insulina não interferiu nos resultados da CTG anteparto. E, do mesmo modo, os índices de Apgar de 1º e 5º minutos, a necessidade de cuidados de UTI e a ocorrência de ONN não dependeram do último traçado da CTG anteparto...
The antepartum non-stress test (NST) is the most commonly used test to evaluate fetal well-being in pregnancies complicated by diabetes; its results being related to the quality of maternal metabolic control and perinatal prognosis. Objectives - To relate the quality of metabolic control to the results of the NST and to evaluate the predictive capacity for the perinatal prognosis of pregnancies associated with diabetes. Patients and Methods - This is a retrospective study of 125 pregnant women with gestational or clinical diabetes in which the last NST (maximum interval of 48 h) was related to the quality of maternal metabolic control and perinatal results. Quality of metabolic control was defined by the glycemic mean on the test day (GMd), glycemic mean during pregnancy (GM), and behavior of insulin requirement (Insulin/R). For the perinatal results, the following were evaluated: the 1st and 5th min Apgar scores; the gestational weight/age classification; the length of hospitalization; the use of neonatal ICU; and the occurrence of early neonatal death (END). Diagnostic capacity of the NST in relation to the perinatal results was evaluated by sensitivity and specificity values, positive predictive value (PPV), and negative predictive value (NPV). Results - The adequate GM (<120mg/dL) on the test day showed that 2.9% of the NST results were abnormal; the inadequate GM ( 120mg/dL) 26.1% (p<0.005). The maintained inadequate GM during pregnancy was related to 13.7% of abnormal NST; the adequate to only 2.7% (p<0.005). Insulin requirement behavior did not interfere with the NST. In addition, the 1st and 5th min Apgar scores, use of ICU, and occurrence of neonatal death did not depend on the last NST result. This test influenced the length of newborn (NB) hospitalization: the normal, 46.4% were discharged up to the 3rd day after birth ...(Complete abstract, click electronic access below)
The antepartum non-stress test (NST) is the most commonly used test to evaluate fetal well-being in pregnancies complicated by diabetes; its results being related to the quality of maternal metabolic control and perinatal prognosis. Objectives - To relate the quality of metabolic control to the results of the NST and to evaluate the predictive capacity for the perinatal prognosis of pregnancies associated with diabetes. Patients and Methods - This is a retrospective study of 125 pregnant women with gestational or clinical diabetes in which the last NST (maximum interval of 48 h) was related to the quality of maternal metabolic control and perinatal results. Quality of metabolic control was defined by the glycemic mean on the test day (GMd), glycemic mean during pregnancy (GM), and behavior of insulin requirement (Insulin/R). For the perinatal results, the following were evaluated: the 1st and 5th min Apgar scores; the gestational weight/age classification; the length of hospitalization; the use of neonatal ICU; and the occurrence of early neonatal death (END). Diagnostic capacity of the NST in relation to the perinatal results was evaluated by sensitivity and specificity values, positive predictive value (PPV), and negative predictive value (NPV). Results - The adequate GM (<120mg/dL) on the test day showed that 2.9% of the NST results were abnormal; the inadequate GM ( 120mg/dL) 26.1% (p<0.005). The maintained inadequate GM during pregnancy was related to 13.7% of abnormal NST; the adequate to only 2.7% (p<0.005). Insulin requirement behavior did not interfere with the NST. In addition, the 1st and 5th min Apgar scores, use of ICU, and occurrence of neonatal death did not depend on the last NST result. This test influenced the length of newborn (NB) hospitalization: the normal, 46.4% were discharged up to the 3rd day after birth ...(Complete abstract, click electronic access below)
Descrição
Palavras-chave
Diabetes na gravidez, Pregnancy - diabetes
Como citar
MASCARO, Moacyr Sanches. Influência do controle metabólico materno nos resultados da cardiotocografia anteparto e sua relação com o prognóstico perinatal, nas gestações complicadas pelo diabete. 2002. 66 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2002.