Diagnóstico de embarazo
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Diagnóstico de embarazo
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Diagnóstico de embarazo
- 1. Diagnóstico de embarazo MIP Vega Obeso Erika Gabriela Ginecología y obstetricia Julio 2017
- 3. Clasificación Cambios fisiológicos e inespecíficos Presunción Cambios físicos y laboratoriales Probabilidad Identificación de frecuencia cardiaca fetal Certeza
- 4. Diagnóstico de presunción Gastrointestinal Piel Mamas Urinario Generales • Náusea • Vómito • Perversiones del gusto • Cloasma • Linea morena abdominal • Aumento de volumen • Pigmentación de areola • Sensibilidad • Red venosa colateral • Areola secundaria • Calostro • Polaquiuria • Tenesmo • Mareo • Lipotimias • Somnolencia • Fatigabilidad • Irritabilidad
- 5. Diagnóstico de probabilidad Signos clínicos Inmunológicos
- 6. Diagnóstico de probabilidad: signos en útero • Reblandecimiento del istmo por lo que se alcanza la pared anterior y posterior del útero • 6-8 semana Hegar I • Reblandecimiento que permite alcanzar el fondo de saco anterior y maniobra abdominal • 10-12 semanaHegar II • Aumento de flexibilidad del cuerpo del útero sobre el cérvix, aumento de anteflexión o retroflexión • 7-8 semana McDonald
- 7. Diagnóstico de probabilidad: signos en útero • Asimetria uterina a nivel del cuerno uterino por implantaciónPiskacek • Pérdida de la forma piriforme del útero a esférico o globoso, cuerpo reblandecido, aplanamiento de fondo vaginal Noble budin • Contracciones palpables indoloras en intervalos irregulares, sin cambios cervicales. • 2do trimestre Contracciones de Braston Hicks
- 8. Diagnóstico de probabilidad: signos en cérvix/vagina • Reblandecimiento del cuello uterino • 4 semanaGoodell • Coloración violácea de paredes vaginales • 8-10 semanaChadwick • Pulso palpable en fondo de saco Osiander
- 9. Signos de probabilidad: prueba hCG Detección de hCG en sangre y orina Hormona glucoproteica con alto contenido en carbohidratos Heterodimero formado por 2 subunidades a y B. • Idéntica a LH, FSH y TSH. • Impide la involución del cuerpo amarillo en las primeras 6 semanas.
- 10. Pruebas de probabilidad: prueba hCG Sérica 7-8 día postfecundación Méximo 8-12 semanas Orina 20 día posfecundación 20-50 mUI/ml
- 11. Pruebas de probabilidad: prueba hCG • Detectan niveles 5-10 mUI/ ml • Más rápidasCualitativas • Detectan niveles 1-2 mUI/ml • Alta sensibilidadCuantitativas • Niveles se 20-50 mUI/ml • Baja sensibilidadOrina
- 12. Signos de probabilidad: pruebas hCG inmunológicas Radioinmuno- ensayo Ensayo inmunoradio- receptor Ensayo inmunoradio- radioreceptor Ensayo inmunoabsor- bente ligado a enzima (ELISA) Ensayo inmunoabsor- bente ligado a enzima (ELISA) Fluoroinmuno ensayo Sensibilidad 5 mIU/ml 150 mIU/ml 1,500 mUI/ml 25 mUI/ml 25 mUI/ml 1 mIU/ml Tiempo 4 horas 30 minutos 2 minutos 80 minutos 80 minutos 2-3 horas Positividad 10-18 semanas 18-22 días 25-28 días 14-17 días 14-17 días 14-17 días Edad gestacional 3-4 semanas 4 semanas 5 semanas 3.5 semanas 3.5 semanas 4 semanas hCG es producida en mujeres no embarazadas, posmenopausicas (110 pg/ml) o premenopausicas (10 pg/ml), pero se encuentran por debajo del nivel de sensibilidad de las pruebas (1 mUI/ml)
- 13. Signos de probabilidad: pruebas hCG Falso positivo •0.01-2% •5 posibilidades • Exposición a animales usados para producir Ac •Posmenopausica • Ingesta exógena de hCG • Embarazo molar • Cáncer Falso negativo • Niveles por debajo del rango de sensibilidad • Aborto • Retraso en la ovulación o implantación
- 14. Signos de probabilidad: pruebas progesterona • Método adjunto • Evaluación de embarazos anormales • Se utiliza como pronóstico del embarazo 97.5 % sensibilidad con niveles > 25 pg/ml para embarazo viable Niveles <5 pg/ml 100% sensibilidad para embarazos no viables
- 15. Signos de probabilidad: factor temprano de embarazo Inicia a detectarse durante las primeras 36-48 horas de la concepción Pico máximo en el 1er trimestre Casi indetectable al termino del embarazo No se encuentra 24 horas después del parto
- 16. Signos de certeza Ultrasonido • Saco gestacional • 4-5 semana • Saco vitelino • 5-6 semana • Placa embrionaria • 6-7 semana Detección de frecuencia cardiaca fetal • US: 6-7 semanas • Doppler: 10-12 semanas • Pinar: 17-18 semanas Detección de movimientos fetales por el médico
- 17. Bibliografía • Medscape: http://emedicine.medscape.com/article/262591- overview#a3 • Hoffman L. Barbara. Williams. Obstetricia, McGraw-Hill, 2014, 2da. Edición. • Lori A Bastian, MD, MPH, Haywood L Brown, MD. Clinical manifestations and diagnosis of early pregnancy. Up to date.
Notes de l'éditeur
- Serum pregnancy test — In clinical practice, the most sensitive method for detecting hCG in early pregnancy is a serum pregnancy test. Qualitative serum pregnancy tests typically detect hCG levels of 5 to 10 milli-int. units/mL, while a high-sensitivity, quantitative serum beta-hCG assay can measure hCG values as low as 1 to 2 milli-int. units/mL. By contrast, the urine pregnancy test is less sensitive, detecting hCG beginning at a level of 20 to 50 milli-int. units/mL. The median hCG concentration is higher in serum than in urine [17,40]; therefore, early in pregnancy, a serum pregnancy test may be positive while the urine pregnancy test is still negative. The only potential advantage of a qualitative serum pregnancy test over a quantitative test is that the qualitative test can usually be performed more rapidly [41]. The quantitative test procedure requires use of dedicated automated measurement equipment and may be processed only in a commercial or hospital-based laboratory. It takes about 15 minutes to complete a test, but because samples are typically processed in batches, it may take much longer to obtain a result.
- Falso positivo The five potential sources of positive hCG results outside of pregnancy are described below: Phantom hCG itemizedlist Caused by heterophilic antibodies that bind the capture and labeled antibodies together without hCG being present Antibody production results from exposure to animals used to produce antibodies used in assay Rule out with sensitive urine assay, as these antibodies do not cross into urine Pituitary hCG itemizedlist Stimulated by gonadotropin-releasing hormone; suppressed by gonadotropin-releasing hormone agonist and estrogen/progestin therapy Can be detected in postmenopausal women due to increased GnRH secretion (Snyder et al propose that postmenopausal women should have a higher cutoff for a negative hCG of 14 IU/L reference_ids_tool_tip reference_ids [12] ) Diagnosed by administering oral contraceptive pills, which should suppress hCG levels Exogenous administration of hCG itemizedlist Used by some centers to aid in weight loss by intramuscular or oral administration Repeat hCG assays should be negative if exogenous administration is discontinued for at least 24 hours Trophoblastic neoplasm - Consists of pregnancy, gestational trophoblastic neoplasia (GTN), and placental site trophoblastic tumors (PSTTs) itemizedlist Gestational trophoblastic neoplasia itemizedlist Quiescent - Constant, low levels of hCG without evidence of primary or metastatic malignancy; premalignant state; resistant to chemotherapy and surgery; follow with frequent hCG levels and if found to be rising, consider active gestational trophoblastic neoplasia Active - Invasive cytotrophoblasts produce hyperglycosylated hCG found only in early pregnancy and invasive gestational trophoblastic neoplasia; thus, hyperglycosylated hCG or invasive trophoblastic antigen can be measured to rule in active disease Placental site trophoblastic tumors - Diagnosed with low-level hCG in combination with intramyometrial lesions on imaging Nontrophoblastic neoplasm - Can be secreted by different cancers, (eg, testicular, bladder, uterine, lung, liver, pancreas, stomach)
- The early pregnancy factor (EPF) assay may be useful in the future. EPF is a poorly defined immunosuppressive protein that has been isolated in maternal serum shortly after conception and is the earliest available marker to indicate fertilization. It is detectable in the serum 36-48 hours after fertilization, peaks early in the first trimester, and is almost undetectable at term. EPF also appears within 48 hours of successful in vitro fertilization embryo transfers. EPF cannot be detected 24 hours after delivery or at the termination of an ectopic or intrauterine pregnancy. EPF is also undetectable in many ectopic pregnancies and spontaneous abortions, indicating that an inability to identify EPF during pregnancy heralds a poor prognosis. EPF has limited clinical applications at this time because the molecule is difficult to isolate. Detection of EPF currently relies on a complex and unwieldy assay termed the rosette inhibition test. EPF may play a more prominent role in the future as the diagnosis of conception prior to implantation elucidates new strategies for contraception, highly accurate dating, and advanced genetic studies.