Doppler da Artéria Pulmonar Fetal e QuantusFLM na Avaliação da Maturidade Pulmonar: Uma Revisão Sistemática
Fetal Pulmonary Artery Doppler and QuantusFLM for the Assessment of Fetal Lung Maturity: A Systematic Review
DOI:
https://doi.org/10.22258/hgh.v10i3.438Resumo
Objetivo: Avaliar as evidências disponíveis sobre o desempenho diagnóstico do índice Doppler da artéria pulmonar fetal, particularmente da relação tempo de aceleração/tempo de ejeção (TA/TE), em comparação com o QuantusFLM®, para a estimativa da maturidade pulmonar fetal e a predição de morbidade respiratória neonatal. Métodos: Foi realizada uma revisão sistemática de estudos observacionais publicados entre 2019 e 2025 nas bases de dados eletrônicas internacionais MEDLINE/PubMed e Scopus. Foram incluídos estudos que avaliaram métodos ultrassonográficos não invasivos de maturidade pulmonar fetal e relataram desfechos respiratórios neonatais. O processo de seleção foi realizado por meio da plataforma Rayyan, e o risco de viés foi avaliado utilizando as Study Quality Assessment Tools do National Heart, Lung, and Blood Institute (NHLBI). Devido à heterogeneidade clínica e metodológica dos estudos incluídos, não foi realizada metanálise. Os resultados foram integrados por meio de uma síntese qualitativa e narrativa, comparando as características dos testes diagnósticos, os parâmetros avaliados e seu desempenho na predição da maturidade pulmonar e da morbidade respiratória neonatal. Resultados: Foram incluídos 14 estudos observacionais, com tamanhos amostrais variando de 40 a 790 gestações. Os índices Doppler da artéria pulmonar fetal apresentaram associação consistente com o desenvolvimento da síndrome do desconforto respiratório neonatal, destacando-se a relação TA/TE, com sensibilidades entre 71,4% e 94,8% e especificidades entre 79,7% e 96,2%. O QuantusFLM® demonstrou elevado desempenho diagnóstico, especialmente devido ao seu alto valor preditivo negativo, superior a 89% na maioria dos estudos. Métodos emergentes, como a avaliação da microvasculatura pulmonar fetal por meio do Doppler MV-Flow, apresentaram resultados promissores. A maioria dos estudos apresentou risco de viés moderado. Conclusão: Os métodos ultrassonográficos não invasivos, particularmente o QuantusFLM® e os índices Doppler da artéria pulmonar fetal, apresentam utilidade clínica para a estimativa da maturidade pulmonar fetal e a predição de morbidade respiratória neonatal, com potencial para complementar os critérios tradicionais baseados na idade gestacional.Downloads
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