Spontaneous prematurity in fetuses with congenital diaphragmatic hernia: a retrospective cohort study about prenatal predictive factors.

Autor: Barbosa BML; Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, FMUSP,, Universidade de São Paulo, São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255 Cerqueira Cesar, São Paulo, CEP: 05403-000, Brazil., Rodrigues AS; Estatística, Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, FMUSP, Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255 Cerqueira Cesar, São Paulo, CEP: 05403-000, Brazil., Carvalho MHB; Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, FMUSP,, Universidade de São Paulo, São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255 Cerqueira Cesar, São Paulo, CEP: 05403-000, Brazil., Bittar RE; Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, FMUSP,, Universidade de São Paulo, São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255 Cerqueira Cesar, São Paulo, CEP: 05403-000, Brazil., Francisco RPV; Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, FMUSP,, Universidade de São Paulo, São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255 Cerqueira Cesar, São Paulo, CEP: 05403-000, Brazil., Bernardes LS; Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, FMUSP,, Universidade de São Paulo, São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255 Cerqueira Cesar, São Paulo, CEP: 05403-000, Brazil. lisbernardes@usp.br.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2018 Jan 12; Vol. 18 (1), pp. 27. Date of Electronic Publication: 2018 Jan 12.
DOI: 10.1186/s12884-017-1652-6
Abstrakt: Background: To evaluate possible predictive factors of spontaneous prematurity in fetuses with congenital diaphragmatic hernia (CDH).
Methods: A retrospective cohort study was performed. Inclusion criteria were presence of CDH; absence of fetoscopy; absence of karyotype abnormality; maximum of one major malformation associated with diaphragmatic hernia; ultrasound monitoring at the Obstetrics Clinic of Clinicas Hospital at the University of São Paulo School of Medicine, from January 2001 to October 2014. The data were obtained through the electronic records and ultrasound system of our fetal medicine service. The following variables were analyzed: maternal age, primiparity, associated maternal diseases, smoking, previous spontaneous preterm birth, fetal malformation associated with hernia, polyhydramnios, fetal growth restriction, presence of intrathoracic liver, invasive procedures performed, side of hernia and observed-to- expected lung to head ratio (o/e LHR). On individual analysis, variables were assessed using the Chi-square test and the Mann-Whitney test. A multiple logistic regression model was applied to select variables independently influencing the prediction of preterm delivery. A ROC curve was constructed with the significant variable, identifying the values with best sensitivity and specificity to be suggested for use in clinical practice.
Results: Eighty fetuses were evaluated, of which, 21 (26.25%) were premature. O/e LHR was the only factor associated with prematurity (p = 0.020). The ROC curve showed 93% sensitivity with 48.4% specificity for the cutoff of 40%.
Conclusion: O/e LHR was the only predictor of prematurity in this sample.
Databáze: MEDLINE
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