Avaliação da Saúde Fetal – suporte decisional

Datado pela regra de CESDI (UK). Programa escrito por DJR Hutchon copyright. Requer Internet Explorer 4.0 ou superior (ou equivalente) para os cálculos. Compatível com o ano 2000. Se o perfil sorológico ou a translucência nucal não forem avaliáveis, (ou menor que 1 mm) deixe em branco. Somente válido para calculus de risco para Down para CCN de 38 – 84 e  DPB 28 a 50mm. Estes calculus assumem que a medida da TN e do CCN foram adquiridos usando os mesmos protocolos da Fetal Medicine Foundation, e para medida do DBP como descrito por Benacerraf et al (1987). Usando a fórmula de risco para Down de Hecht and Hook.  Instruções para uso OFFLINE . . . HOME PAGE

CCN usando a formula de Smith et al REFERENCES  Forma da data usado: UK, isto é dd/mm/aaaa (4 digitos para o ano)

Identificação do Paciente (opcional) Data de nascimento (obrigatório)
DUM  De certeza?  Sim - - - Duração do ciclo menstrual  O “default” é 28 dias
Data da ultra-sonografia  Translucência Nucal em  mm. MoM=LR= Screening sorológico para S. Down  1:
CCN mm or DPB mm (entre com somente um ou outro) Equivalente a semanas + dias
Osso Nasal identificado com 11-14 semanas y/n  (deixe em branco se não pesquisado)
Risco pela idade para S.Down (SD) no nascimento  1: Risco Integral para S. Down no nascimento 1:
Risco pela idade para SD na data da US  1: Risco integral para SD na data da US  1: (incluindo Osso Nasal se fornecido)
DPP pela DUM  pela US  42 semanas em 
Melhor DPP em 
Parto Electivo desaconselhável antes de  14% de risco antes desta data.
Trisomia 18 risk entre 9-14s = 1 em  entre 15-20s = 1 em  à termo = 1 em
Trisomia 13 risk entre 9-14s = 1 em  entre 15-20s = 1 em  à termo = 1 em
Idade Gestacional pelo US na data  é s +  dias.

OPINIÃO DO ESPECIALISTA
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Limites do normal para o escore Z é -1.645 to +1.645. Esta calculadora pe de uso educacional. Ela possui limites de acurácia satisfatórios, mas nenhuma responsibilidade pela acurácia deve ser atribuída ao autor. Os calculus assumem que não há correlação entre ausência do osso nasal e outros fatores de risco para Síndrome de Down utilizados nesta calculadora. (by David J R Hutchon BSc, MB, ChB, FRCOG Consultant Obstetrician, Memorial Hospital, Darlington, England)

Esta página foi escrita originalmente em inglês pelo Dr. Hutchon  ( www.hutchon.net/GrowthdownUKhookBPDnasal.htm )

REFERÊNCIAS:
1. Smith GCS, Smith MFS, McNay MB and Flemming JEE First-trimester growth and the risk of low birth weight New England Journal of Medicine 1998;339:1817-22

2. Kurmanavicius J, Wright EM, Royston P, Zimmermann R, Huch R, Huch A, Wisser J. Fetal ultrasound Biometry: 1. Head reference values. British Journal of Obstetrics and Gynaecology. 1999 106:126-135
3. Kurmanavicius J, Wright EM, Royston P, Zimmermann R, Huch R, Huch A, Wisser J. Fetal ultrasound Biometry: 2. Abdomen and femur length reference values. British Journal of Obstetrics and Gynaecology. 1999 106:136-143

4. Moore T R and Cayle J E. The amniotic fluid index in normal human pregnancy. American Journal of Obstetrics and Gynecology 1990;162:1168-73
5. Cuckle H S, & Schmi I Calculating correct Down's syndrome risks. British Journal of Obstetrics and Gynaecology 1999;106:371-372
6. Wald N J, Watt H C, & Hackshaw A K. Integrated screening for Down's Syndrome based on tests performed during the first and second trimester The New England Journal of Medicine 1999;341(7):461-467
7. Pandya P P, Johnson S, Malligianis P, and Nicolaides K H. First Trimester fetal nuchal translucency and screening for chromosomal abnormalities. Ultrasound and early pregnancy Chapter 7
8. Snijders R J M, Holzgreve W, Cuckle H and Nicolaides K H. Maternal age-specific risks for trisomies at 9-14 weeks gestation. Prenatal Diagnosis (1994) 13:543-552 For the purposes of the calculator I have assumed a uniform loss of pregnancies with trisomy 13 and 18 as a result to miscarriage between 9 and 14 weeks and 15 and 20 weeks.
9. Snijders R J M, Sundberg K, Holzgreve W, Henry G, and Nocolaides K H. Maternal age- and gestation specific risk for trisomy 21. Ultrasound in Obstetrics and Gynaecology 1999;13:167-170
10. Zosmer N, Souter V L, Chan C S Y, Huggon I C and Nicolaides K H. Early diagnosis of major cardiac defects in chromosomally normal fetuses with increased nuchal translucency. Brtish Journal of Obstetrics and Gynaecology 1999;106:829-833
11. Madar J, Richmond S & Hey E. surfactant deficient respiratory distress after elective delivery at 'term'. Northern Region Maternity Survey Meeting 1999. Accepted for publication in Acta Paediatrica
12. Hyett J A, Noble P L, Snijders R J M, Montenegro N, & Nicolaides K H. Fetal heart rate in trisomy 21 and other chromosomal abnormalities at 10 - 14 weeks of gestation. Ultrasound Obstet Gynecol 7 (1996) 239-244
13. Hecht C A & Hook EB the imprecision in rates of Down syndrome. (1994) Prenatal Diag 14:729-738
14. Larsen T, Nguyen T H, Greisen G, Engholm G & Moller H. does discrepancy between gestational age determined by biparietal diameter and last menstrual period sometimes signify early intrauterine groath retardation? BJOG 2000,107(2) 235-244
15. Gardosi & Francis A. Early pregnancy predictors of preterm birth: the role of a prolonged menstruation-conception interval. BJOG 2000,107(2),228-237
16. Stiller R J, Lieberson D, Herzlinger R, Siddiqui D, Laifer S A, & Whetham J C G. The association of increased nuchal translucency and spinal muscular atrophy type 1. Prenatal Diagnosis 1999;19:587-589
17. Locatelli A, Piccoli M G, Vergani P, Mariani E, Ghidini A, Mariani S, Pezzullo J. Critical appraisal of the use of nuchal thickness measurements for the predicition of Down syndrome. Am J Obstet Gynecol 2000;182:192-197 The authors point out that caution should be used in the use of the proposed liklihood ratios until other markers such as serum tests are proved to be independent of each other.
18. Nicholaides K H, Snijders R J M, and Cuckle H S Correct estimation of parameters for ultrasound nuchal translucency screening. Prenatal Diagnosis 1998 18;511-523
19. Benacerraf BR, Gelman R, Frigoletto Jr FD Sonographic identification of second-trimester fetuses with Down's syndrome. 1987;317:1371-1376
20. Altman D G and Chitty L S. New cahrts for ultrasound dating of pregnancy Ultrasound Obstet Gynecol 10 (1997) 174 - 191
21. Cicero S et al Absence of nasal bone in fetuses with trisomy 21 at 11 to 14 weeks of gestation: an observational study.(2001) The Lancet 358;1665-1667 I am grateful to Professor Howard Cuckle for information on the Gaussian LR equation for a single variable.
DOWN SYNDROME AGE RISK CALCULATION
This risk assumes no previous affected pregnancy. A previous affected pregnancy increases the risk further, to about 1 in 200 at age 30 and 1 in 25 at age 45. The maternal age specific incidence of trisomy 21 at birth is 54% lower than at 9-14 weeks of gestation. NT measurements in the second trimester should be carrried out in the transverse plane using the technique of Benacerraf et al. BPD measured from outer to inner edge of skull.

LINKS

Retornar para a calculadora
Go to OBGYN.net for paper on proposal for valid customised charts generation
Northern Region O&G Trainees website
Go to Fetal weight calculator