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EL PARTO PRETERMINO: HERRAMIENTAS PREDICTIVAS Y PREVENTIVAS EN LA PRACTICA CLINICA

(especial para SIIC © Derechos reservados)
La utilización de la medición cuantitativa de la fibronectina fetal y de la longitud cervical, junto con los factores de riesgo clínicos, permiten predecir de manera precisa el parto pretérmino en mujeres tanto sintomáticas como asintomáticas.
Autor:
Andrew H Shennan
Columnista Experto de SIIC

Institución:
Kings College London


Artículos publicados por Andrew H Shennan
Coautores
Alexandra Ridout* Georgia Ross** 
Médica, Kings College London, Londres, Reino Unido*
University of Newcastle, Callaghan, Australia**
Recepción del artículo
5 de Mayo, 2016
Aprobación
15 de Julio, 2016
Primera edición
22 de Marzo, 2017
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
A pesar de los avances en la atención prenatal y en la comprensión de la fisiopatología del cuadro como un todo, el parto pretérmino es un fenómeno que continúa provocando un impacto significativo global. Continúa como la causa principal de morbilidad y mortalidad perinatal en todo el mundo y su prevalencia está en aumento. No solamente conlleva un costo social significativo, sino que el parto pretérmino produce una carga económica importante para el sistema de salud. Cada vez más, hay datos que indican que el parto pretérmino es un síndrome multifactorial, más que una condición única y nosotros documentamos un gran número de avances en las herramientas predictivas y preventivas en la práctica clínica. Uno de estos avances más recientes es la capacidad de la fibronectina fetal cuantitativa para predecir un parto pretérmino espontáneo tanto en mujeres de alto riesgo como de bajo riesgo. La investigación continúa hacia el uso potencial de la fibronectina fetal cuantitativa en sinergia con la medición de la longitud cervical por ecografía transvaginal para mejorar la precisión predictiva. Los avances están dirigidos a que los clínicos puedan predecir el riesgo en el lugar de atención. Las investigaciones continúan con la evaluación del cerclaje cervical, la progesterona y el pesario de Arabin como intervenciones profilácticas para las mujeres en riesgo de parto pretérmino, con pruebas crecientes para su papel potencial. Las exploraciones ulteriores con terapia reactiva para el parto pretérmino inminente alteran nuestro enfoque clínico y probablemente mejoren los desenlaces clínicos. Esta revisión analizará algunos de los avances recientes observados en esta área apasionante.

Palabras clave
predicción, parto pretérmino, fibronectina fetal cuantitativa, longitud cervical, prevención


Artículo completo

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Abstract
Despite advances in both neonatal care and our understanding of the pathophysiology of the condition as a whole, preterm birth is a phenomenon that continues to have significant impact globally. It remains the leading cause of perinatal morbidity and mortality worldwide, and the prevalence is increasing. Not only does it carry significant social cost, preterm birth places huge economic burden on the healthcare system. It is increasingly recognised that preterm birth is a multifactorial syndrome, rather than a single condition and we have seen a number of exciting advances in predictive and preventative tools for clinical practice. The ability of quantitative fetal fibronectin to predict spontaneous preterm birth in both high and low risk women has been one of these recent promising developments. Exploration continues into the potential for quantitative fetal fibronectin to be used in synergy with transvaginal ultrasound measurement of cervical length to improve predictive accuracy. Developments focus on enabling clinicians to predict risk at the point of care. Research continues to explore cervical cerclage, progesterone and the Arabin pessary as prophylactic interventions for women at risk of preterm birth, with increasing evidence for their potential role. Latest exploration of reactive management for imminent preterm birth is altering our clinical approach and is likely to improve outcomes. This review article will discuss some of the recent developments we have seen in this exciting area.

Key words
preterm birth, prediction, quantitative fetal fibronectin, cervical length, prevention


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

Especialidades
Principal: Obstetricia y Ginecología, Pediatría
Relacionadas: Atención Primaria, Cirugía, Diagnóstico por Imágenes, Diagnóstico por Laboratorio, Farmacología, Medicina Familiar, Medicina Interna, Salud Pública



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Andrew H Shennan, SE1 7EH, Westminster Bridge Road, Londres, Reino Unido
Bibliografía del artículo
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