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Thèse de Doctorat
DOI
https://doi.org/10.11606/T.5.2021.tde-05042022-161235
Document
Auteur
Nom complet
Walkyria Sampaio Andrade
Adresse Mail
Unité de l'USP
Domain de Connaissance
Date de Soutenance
Editeur
São Paulo, 2021
Directeur
Jury
Brizot, Maria de Lourdes (Président)
Carvalho, Mário Henrique Burlacchini de
Liao, Adolfo Wenjaw
Marcolin, Alessandra Cristina
Titre en portugais
Gastrosquise fetal: predição de gastrosquise complexa com uso de parâmetros ultrassonográficos
Mots-clés en portugais
Atresia intestinal
Dilatação intestinal
Estenose intestinal
Gastrosquise complexa
Gastrosquise fetal
Marcadores ultrassonográficos
Necrose intestinal
Perfuração intestinal
Resumé en portugais
Objetivo: Investigar os marcadores ultrassonográficos (USG) preditivos de gastrosquise complexa (GC), mortalidade e morbidade em fetos com gastrosquise. Materiais e métodos: Em um primeiro momento, foi realizada análise retrospectiva incluindo 186 gestações de fetos com gastrosquise isolada que apresentavam avaliação USG durante a gestação. Oito marcadores USG foram analisados para as predições e associações com os resultados adversos. A associação de marcadores USG preditivos de GC foi também investigada. No segundo momento, foram analisados, retrospectivamente, os dados de medidas de AIIA de 174 fetos com gastrosquise isolada obtidos nos períodos de 20-22 e 30-32 semanas de gestação. A distribuição das medidas da AIIA foi determinada e o melhor ponto de corte para prever gastrosquise complexa foi selecionado usando curvas de características de operação do receptor (ROC). A área sob a curva ROC (AUC), taxa de detecção (DR), taxa de falso-positivo (FPR), valor preditivo positivo (VPP) e valor preditivo negativo (VPN) foi determinada. Resultados: Os resultados da análise do primeiro momento demonstram que a dilatação da alça intestinal extra-abdominal (AIEA), dilatação da alça intestinal intraabdominal (AIIA) e polidrâmnio foram preditivos de GC. AIEA entre 25 e 28 semanas apresentou sensibilidade de 64%, especificidade de 89%, VPP de 56,2% e VPN de 91,8%. As predições da AIIA foram: sensibilidade = 26,7%, especificidade = 96,7%, VPP = 61,5% e VPN = 86,8%. As razões de chances para GC na presença de 1 e 2 marcadores ultrassonográficos, em comparação com a ausência de um marcador, foram 18,3 (IC de 95%, 3,83- 87,64) e 73,3 (IC de 95%, 6,14-876), respectivamente. A população do segundo estudo incluiu 39 (22,4%) casos de gastrosquise complexa e 135 (77,6%) casos de gastrosquise simples, sendo eles 79 casos do Brasil e 95 do Reino Unido. Na predição de gastrosquise complexa, a AUC no período de 20-22 semanas de gestação foi de 0,742 (IC de 95%, 0,628-0,856) e o respectivo valor para o período entre 30-32 semanas foi de 0,820 (IC de 95%, 0,729-0,910). Usando ponto de corte para AIIA de 7 mm entre 20-22 semanas, DR, FPR, VPP e VPN para gastrosquise complexa; foram 61,5%, 6,7%, 72,7% e 89,4%, respectivamente; e, usando ponto de corte de 14 mm entre 30-32 semanas, os respectivos valores foram 64,9%, 5,9%, 75,0% e 90,7%. Conclusão: Foram estabelecidos os marcadores ultrassonográficos preditivos de GC. A combinação desses marcadores aumenta a probabilidade de GC. A medida da AIIA entre 20-22 ou 30-32 semanas de gestação é útil na predição de gastrosquise complexa
Titre en anglais
Fetal gastroschisis: prediction of complex gastroschisis using ultrasound markers
Mots-clés en anglais
Bowel atresia
Bowel dilatation
Bowel necrosis
Bowel perforation
Bowel stenosis
Complex gastroschisis
Fetal gastroschisis
Prenatal ultrasound markers
Resumé en anglais
Objective: To investigate the ultrasound (US) markers predictive of complex gastroschisis (CG), mortality, and morbidity in fetuses with gastroschisis. Materials and methods: At the first analysis, a retrospective cohort study of 186 pregnancies with isolated fetal gastroschisis that had at least one US during the pregnancy. Eight US markers were analysed for prediction and associations with adverse outcomes. The association of US markers predictive of CG were also investigated. At the second moment, were retrospectively analysed the intra-abdominal bowel measurement of 174 singleton pregnancies with isolated fetal gastroschisis, resulting in live birth and with available in the period of 20-22 and 30-32weeks gestation. The intraabdominal bowel dilation (IABD) was measured as the greatest transverse diameter of the most dilated intra-abdominal bowel segment, by an operator blinded to postnatal outcome. The distribution of IABD measurements in those with complex and those with simple gastroschisis was determined and the best cut-off value to predict complex gastroschisis was selected using receiver operating characteristics (ROC) curves. The area under the ROC curve (AUC), detection rate (DR), false-positive rate (FPR), positive predictive value (PPV) and negative predictive value (NPV) were determined. Results: The findings of the analysis at the first moment, demonstrate that, extra-abdominal bowel dilatation (EABD), intra-abdominal bowel dilatation (IABD), and polyhydramnios were predictive of CG. EABD between 25 and 28 weeks had a sensitivity of 64%, a specificity of 89%, a positive predictive value (PPV) of 56.2%, and negative predictive value (NPV) of 91.8%. The predictions of IABD were sensitivity = 26.7%, specificity = 96.7%, PPV = 61.5%, and NPV = 86.8%. The odds ratios for CG in the presence of 1 and 2 US markers, compared with the absence of a US marker, were 18.3 (95% CI, 3.8387.64) and 73.3 (95% CI, 6.14876), respectively. When looking for the prediction of CG using only the IABD, the study population included 39 (22.4%) cases of complex and 135 (77.6%) cases of simple gastroschisis. In the prediction of complex gastroschisis, the AUC at 2022 weeks gestation was 0.742 (95%CI, 0.628- 0.856) and the respective value for 3032weeks was 0.820 (95%CI, 0.729- 0.910). At the IABD cut-off of 7mm at 2022weeks, DR, FPR, PPV and NPV for complex gastroschisis were 61.5%, 6.7%, 72.7% and 89.4%, respectively, and at IABD cut-off of 14mm at 30-32 weeks, the respective values were 64.9%, 5.9%, 75.0% and 90.7%. Conclusion: US markers predictive of CG were established. The combination of these markers increases the probability of CG. Measurement of IABD at 20-22 or at 30-32 weeks gestation is useful in the prediction of complex gastroschisis
 
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Date de Publication
2022-04-07
 
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