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UTILIDAD DE LOS NIVELES DE ALFA FETOPROTEINA Y DE GONADOTROFINA CORIONICA HUMANA DURANTE EL SEGUNDO TRIMESTRE DEL EMBARAZO

UTILIDAD DE LOS NIVELES DE ALFA FETOPROTEINA Y DE GONADOTROFINA CORIONICA HUMANA DURANTE EL SEGUNDO TRIMESTRE DEL EMBARAZO

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Los embarazos que cursan con una elevación de la alfa fetoproteína sérica materna y de la gonadotrofina coriónica humana sérica materna sin causa aparente presentan un riesgo más alto de complicaciones gestacionales (restricción del crecimiento intrauterino, muerte fetal intrauterina, preeclampsia) como consecuencia de la insuficiencia placentaria.
Autor:
Georgios Androutsopoulos
Columnista Experta de SIIC

Institución:
University of Patras Medical School


Artículos publicados por Georgios Androutsopoulos
Recepción del artículo
20 de Agosto, 2011
Aprobación
1 de Septiembre, 2011
Primera edición
5 de Marzo, 2012
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Los niveles maternos de alfa fetoproteína (AFP) y gonadotrofina coriónica humana (hCG) durante el segundo trimestre del embarazo se han asociado con mal pronóstico fetal en ausencia de aneuploidías o defectos del tubo neural. Se presume que la concentración de AFP en el suero materno por encima de 2.5 MoM en el segundo trimestre representa una alteración de la placentación y se asocia con mayor riesgo de complicaciones en la fase final de la gestación (pérdida fetal tardía, hipertensión gestacional, preeclampsia, restricción de crecimiento intrauterino, parto prematuro y sufrimiento fetal). Los niveles maternos de hCG mayores de 2.5 MoM en el segundo trimestre se relacionan con las mismas complicaciones tardías. La elevación combinada de los dos parámetros sugiere una forma más compleja de enfermedad placentaria y se asocian en forma más acentuada con pérdida fetal tardía, hipertensión gestacional, preeclampsia, restricción de crecimiento intrauterino, parto prematuro y sufrimiento fetal. La sola determinación de la AFP, la hCG o ambas no permite detectar a todas las embarazadas con alto riesgo de complicaciones gestacionales. Las pruebas multiparamétricas de la función placentaria en el segundo trimestre (niveles maternos de AFP y hCG, ecografía Doppler de arterias uterinas, morfología placentaria) permite identificar a las mujeres con un incremento del riesgo de insuficiencia placentaria grave y complicaciones del embarazo.

Palabras clave
marcadores séricos maternos, AFP, hCG, mal pronóstico gestacional


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Abstract
Mid-trimester maternal serum AFP and hCG associated with adverse pregnancy outcomes in the absence of aneuploidy or neural tube defects.

Mid-trimester maternal serum AFP levels > 2.5 MoM are thought to reflect a defect in placentation and associated with an increased risk for complications in later pregnancy including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.

Mid-trimester maternal serum hCG > 2.5 MoM associated with an increased risk for complications in later pregnancy including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.

Combined mid-trimester elevation in maternal serum AFP and hCG levels suggest a more complex type of placental pathology. They have stronger association with complications in later pregnancy including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.

Mid-trimester maternal serum AFP and/or hCG levels alone cannot detect all pregnant women with increased risk to develop pregnancy complications. Multiparameter testing of placental function in mid-trimester (maternal serum AFP and hCG screening, uterine artery Doppler and placental morphology) may allow us to identify women with increased risk to develop severe placental insufficiency and pregnancy complications.

Key words
maternal serum markers, AFP, hCG, adverse pregnancy outcome


Full text
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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Diagnóstico por Laboratorio, Obstetricia y Ginecología
Relacionadas: Bioquímica, Medicina Familiar, Medicina Reproductiva



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Enviar correspondencia a:
G Androutsopoulos, University of Patras Medical School Department of Obstetrics and Gynaecology, 15343, Anaxagora 45, Ag. Paraskevi, Patras, Grecia
Bibliografía del artículo
1. Snijders RJ, Noble P, Sebire N, Souka A, Nicolaides KH. UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10-14 weeks of gestation. Fetal Medicine Foundation First Trimester Screening Group. Lancet 352(9125):343-346, 1998.
2. Morrow RJ, McNay MB, Whittle MJ. Ultrasound detection of neural tube defects in patients with elevated maternal serum alpha-fetoprotein. Obstet Gynecol 78(6):1055-1057, 1991.
3. Dugoff L. First- and second-trimester maternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gynecol 115(5):1052-1061, 2010.
4. Yaron Y, Cherry M, Kramer RL, O'Brien JE, Hallak M, Johnson MP, et al. Second-trimester maternal serum marker screening: maternal serum alpha-fetoprotein, beta-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome. Am J Obstet Gynecol 181(4):968-974, 1999.
5. Mizejewski GJ. Alpha-fetoprotein structure and function: relevance to isoforms, epitopes, and conformational variants. Exp Biol Med (Maywood) 226(5):377-408, 2001.
6. McLeod JF, Cooke NE. The vitamin D-binding protein, alpha-fetoprotein, albumin multigene family: detection of transcripts in multiple tissues. J Biol Chem 264(36):21760-21769, 1989.
7. Gitlin D, Boesman M. Serum alpha-fetoprotein, albumin, and gamma-G-globulin in the human conceptus. J Clin Invest 45(11):1826-1838, 1966.
8. Johnson PJ. The role of serum alpha-fetoprotein estimation in the diagnosis and management of hepatocellular carcinoma. Clin Liver Dis 5(1):145-159, 2001.
9. Mizejewski GJ. Physiology of alpha-fetoprotein as a biomarker for perinatal distress: relevance to adverse pregnancy outcome. Exp Biol Med (Maywood) 232(8):993-1004, 2007.
10. Gitlin D, Perricelli A, Gitlin GM. Synthesis of a-fetoprotein by liver, yolk sac, and gastrointestinal tract of the human conceptus. Cancer Res 32(5):979-982, 1972.
11. Jones EA, Clement-Jones M, James OF, Wilson DI. Differences between human and mouse alpha-fetoprotein expression during early development. J Anat 198(Pt 5):555-559, 2001.
12. Mizejewski GJ. Levels of alpha-fetoprotein during pregnancy and early infancy in normal and disease states. Obstet Gynecol Surv 58(12):804-826, 2003.
13. Los FJ, De Bruijn HW, van Beek Calkoen-Carpay T, Huisjes HJ. AFP transport across the fetal membranes in the human. Prenat Diagn 5(4):277-281, 1985.
14. Lau HL, Linkins SE. Alpha-fetoprotein. Am J Obstet Gynecol 124(5):533-554, 1976.
15. Lardinois R, Anagnostakis D, Ortiz MA, Delisle M. Human 1 -foetoglobulin during the last trimester of gestation. Clin Chim Acta 37:81-90, 1972.
16. Hung TH, Shau WY, Hsieh CC, Chiu TH, Hsu JJ, Hsieh TT. Risk factors for placenta accreta. Obstet Gynecol 93(4):545-550, 1999.
17. Zelop C, Nadel A, Frigoletto FD Jr, Pauker S, MacMillan M, Benacerraf BR. Placenta accreta/percreta/increta: a cause of elevated maternal serum alpha-fetoprotein. Obstet Gynecol 80(4):693-694, 1992.
18. Gagnon A, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA, et al. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 30(10):918-949, 2008.
19. Krause TG, Christens P, Wohlfahrt J, Lei U, Westergaard T, Nørgaard-Pedersen B, et al. Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome(1). Obstet Gynecol 97(2):277-282, 2001.
20. Dugoff L, Hobbins JC, Malone FD, Vidaver J, Sullivan L, Canick JA, et al. Quad screen as a predictor of adverse pregnancy outcome. Obstet Gynecol 106(2):260-267, 2005.
21. Chandra S, Scott H, Dodds L, Watts C, Blight C, Van Den Hof M. Unexplained elevated maternal serum alpha-fetoprotein and/or human chorionic gonadotropin and the risk of adverse outcomes. Am J Obstet Gynecol 189(3):775-781, 2003.
22. Berkeley AS, Killackey MA, Cederqvist LL. Elevated maternal serum alpha-fetoprotein levels associated with breakdown in fetal-maternal-placental barrier. Am J Obstet Gynecol 146(7):859-861, 1983.
23. Perkes EA, Baim RS, Goodman KJ, Macri JN. Second-trimester placental changes associated with elevated maternal serum alpha-fetoprotein. Am J Obstet Gynecol 144(8):935-938, 1982.
24. Spong CY, Ghidini A, Walker CN, Ossandon M, Pezzullo JC. Elevated maternal serum midtrimester alpha-fetoprotein levels are associated with fetoplacental ischemia. Am J Obstet Gynecol 177(5):1085-1087, 1997.
25. Salafia CM, Pezzullo JC, Lopez-Zeno JA, Simmens S, Minior VK, Vintzileos AM. Placental pathologic features of preterm preeclampsia. Am J Obstet Gynecol 173(4):1097-1105, 1995.
26. Baschat AA, Harman CR, Farid G, Chodirker BN, Evans JA. Very low second-trimester maternal serum alpha-fetoprotein: Association with high birth weight. Obstet Gynecol 99(4):531-536, 2002.
27. Burton BK. Outcome of pregnancy in patients with unexplained elevated or low levels of maternal serum alpha-fetoprotein. Obstet Gynecol 72(5):709-713, 1988.
28. Kiran TS, Bethel J, Bhal PS. Correlation of abnormal second trimester maternal serum alpha-fetoprotein (MSAFP) levels and adverse pregnancy outcome. J Obstet Gynaecol 25(3):253-256, 2005.
29. Pierce JG, Parsons TF. Glycoprotein hormones: structure and function. Annu Rev Biochem 50:465-495, 1981.
30. Cole LA. Biological functions of hCG and hCG-related molecules. Reprod Biol Endocrinol 8:102, 2010.
31. Alfthan H, Schröder J, Fraser R, Koskimies A, Halila H, Stenman UH. Choriogonadotropin and its beta subunit separated by hydrophobic-interaction chromatography and quantified in serum during pregnancy by time-resolved immunofluorometric assays. Clin Chem 34(9):1758-1762, 1988.
32. Nakamura H, Makino K, Kochi M, Ushio Y, Kuratsu J. Evaluation of neoadjuvant therapy in patients with nongerminomatous malignant germ cell tumors. J Neurosurg Pediatr 7(4):431-438, 2011.
33. Berndt S, Blacher S, Perrier d'Hauterive S, Thiry M, Tsampalas M, Cruz A, et al. Chorionic gonadotropin stimulation of angiogenesis and pericyte recruitment. J Clin Endocrinol Metab 94(11):4567-4574, 2009.
34. Zygmunt M, Herr F, Keller-Schoenwetter S, Kunzi-Rapp K, M?nstedt K, Rao CV, et al. Characterization of human chorionic gonadotropin as a novel angiogenic factor. J Clin Endocrinol Metab 87(11):5290-5296, 2002.
35. Shi QJ, Lei ZM, Rao CV, Lin J. Novel role of human chorionic gonadotropin in differentiation of human cytotrophoblasts. Endocrinology 132(3):1387-1395, 1993.
36. Wan H, Versnel MA, Cheung WY, Leenen PJ, Khan NA, Benner R, et al. Chorionic gonadotropin can enhance innate immunity by stimulating macrophage function. J Leukoc Biol 82(4):926-933, 2007.
37. McGregor WG, Kuhn RW, Jaffe RB. Biologically active chorionic gonadotropin: synthesis by the human fetus. Science 220(4594):306-308, 1983.
38. Nisula BC, Blithe DL, Akar A, Lefort G, Wehmann RE. Metabolic fate of human choriogonadotropin. J Steroid Biochem 33(4B):733-737, 1989.
39. Lenton EA, Neal LM, Sulaiman R. Plasma concentrations of human chorionic gonadotropin from the time of implantation until the second week of pregnancy. Fertil Steril 37(6):773-778, 1982.
40. Gonen R, Perez R, David M, Dar H, Merksamer R, Sharf M. The association between unexplained second-trimester maternal serum hCG elevation and pregnancy complications. Obstet Gynecol 80(1):83-86, 1992.
41. Lepage N, Chitayat D, Kingdom J, Huang T. Association between second-trimester isolated high maternal serum human chorionic gonadotropin levels and obstetric complications in singleton and twin pregnancies. Am J Obstet Gynecol 188(5):1354-1359, 2003.
42. Morssink LP, de Wolf BT, Kornman LH, Beekhuis JR, van der Hall TP, Mantingh A. The relation between serum markers in the second trimester and placental pathology. A study on extremely small for gestational age fetuses. Br J Obstet Gynaecol 103(8):779-783, 1996.
43. Shenhav S, Gemer O, Sassoon E, Volodarsky M, Peled R, Segal S. Mid-trimester triple test levels in early and late onset severe pre-eclampsia. Prenat Diagn 22(7):579-582, 2002.
44. Liu DF, Dickerman LH, Redline RW. Pathologic findings in pregnancies with unexplained increases in midtrimester maternal serum human chorionic gonadotropin levels. Am J Clin Pathol 111(2):209-215, 1999.
45. Fox H. Effect of hypoxia on trophoblast in organ culture. A morphologic and autoradiographic study. Am J Obstet Gynecol 107(7):1058-1064, 1970.
46. Heinonen S, Ryynänen M, Kirkinen P, Saarikoski S. Velamentous umbilical cord insertion may be suspected from maternal serum alpha-fetoprotein and hCG. Br J Obstet Gynaecol 103(3):209-213., 1996
47. Morssink LP, Sikkema-Raddatz B, Beekhuis JR, De Wolf BT, Mantingh A. Placental mosaicism is associated with unexplained second-trimester elevation of MShCG levels, but not with elevation of MSAFP levels. Prenat Diagn 16(9):845-851, 1996.
48. Endres LK, Krotz S, Grobman WA. Isolated low second-trimester maternal serum beta-human chorionic gonadotropin is not associated with adverse pregnancy outcome. Am J Obstet Gynecol 189(3):755-757, 2003.
49. Chitayat D, Farrell SA, Huang T, Meier C, Wyatt PR, Summers AM. Double-positive maternal serum screening results for down syndrome and open neural tube defects: an indicator for fetal structural or chromosomal abnormalities and adverse obstetric outcomes. Am J Obstet Gynecol 187:758-763, 2002.
50. Huang T, Hoffman B, Meschino W, Kingdom J, Okun N. Prediction of adverse pregnancy outcomes by combinations of first and second trimester biochemistry markers used in the routine prenatal screening of Down syndrome. Prenat Diagn 30(5):471-477, 2010.
51. Alkazaleh F, Chaddha V, Viero S, Malik A, Anastasiades C, Sroka H, et al. Second-trimester prediction of severe placental complications in women with combined elevations in alpha-fetoprotein and human chorionic gonadotrophin. Am J Obstet Gynecol 194(3):821-82, 2006.
52. Gkogkos P, Androutsopoulos G, Vassilakos P, Panayiotakis G, Kourounis G, Decavalas G. Mid-trimester maternal serum AFP levels in predicting adverse pregnancy outcome. Clin Exp Obstet Gynecol 35(3):208-210, 2008.
53. Androutsopoulos G, Gkogkos P, Vassilakos P, Panayiotakis G, Decavalas G. Mid-trimester maternal serum hCG levels in predicting adverse pregnancy outcome. Clin Exp Obstet Gynecol 36(3):173-175, 2009.
54. Androutsopoulos G, Gkogkos P, Papadopoulos V, Adonakis G, Tsapanos V, Vassilakos P, et al. Mid-trimester maternal serum markers in predicting adverse pregnancy outcome. Clin Exp Obstet Gynecol 36(4):237-240, 2009.
55. Campbell S, Diaz-Recasens J, Griffin DR, Cohen-Overbeek TE, Pearce JM, Willson K, Teague MJ. New doppler technique for assessing uteroplacental blood flow. Lancet 1(8326 Pt 1):675-677, 1983.
56. Papageorghiou AT, Yu CK, Nicolaides KH. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 18(3):383-396, 2004.
57. Bower S, Schuchter K, Campbell S. Doppler ultrasound screening as part of routine antenatal scanning: prediction of pre-eclampsia and intrauterine growth retardation. Br J Obstet Gynaecol 100(11):989-994, 1993.
58. Toal M, Chaddha V, Windrim R, Kingdom J. Ultrasound detection of placental insufficiency in women with elevated second trimester serum alpha-fetoprotein or human chorionic gonadotropin. J Obstet Gynaecol Can 30(3):198-206, 2008.
59. Elsandabesee D, Srinivas M, Kodakkattil S. The clinical value of combining maternal serum screening and uterine artery Doppler in prediction of adverse pregnancy outcome. J Obstet Gynaecol 26(2):115-117, 2006.
60. Hershkovitz R, de Swiet M, Kingdom J. Mid-trimester placentation assessment in high-risk pregnancies using maternal serum screening and uterine artery Doppler. Hypertens Pregnancy 24(3):273-280, 2005.
61. Papageorghiou AT, Leslie K. Uterine artery Doppler in the prediction of adverse pregnancy outcome. Curr Opin Obstet Gynecol 19(2):103-109, 2007.

 
 
 
 
 
 
 
 
 
 
 
 
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