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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

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

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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Clinical significance of mid-trimester maternal serum AFP and hCG and correlation with adverse pregnancy outcome

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


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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
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