Los nacimientos prematuros constituyen la principal causa de muerte neonatal, y aunque en algunos casos es inevitable que el niño nazca antes de tiempo, la prematurez es prevenible si se identifican tempranamente los factores que predisponen a la mamá a tener un parto en pretérmino.
Los nuevos mecanismos de prevención del parto prematuro fue uno de los temas centrales que se trataron en el 8º Congreso de Atención Primaria de la Salud, que organizó en Mendoza el MInisterio de Salud de la Provincia de Buenos Aires.
En ese marco, los expertos señalaron que actualmente, a través de un estudio sencillo y mínimamente invasivo entre las semanas 20 y 24 del embarazo, es posible conocer cuáles son las mujeres proclives a tener un parto en pretérmino.
Es así que la cervicometría o ecografía transvaginal es el estudio que ayuda a detectar la prematurez en más de la mitad de los casos, y en un 75 por ciento los que se consideran extremos, es decir, los nacimientos antes de la semana 28.
Los especialistas que expusieron en la conferencia “Nuevos mecanismos para la prevención del parto prematuro”, explicaron que la cervicometría endovaginal, consiste en un estudio por imágenes que mide la longitud del cuello uterino, ya que se sabe que entre las 22 y 24 semanas tiene una longitud media de 36 milímetros y que el riesgo de parto prematuro está inversamente relacionado con la longitud cervical.
El director de Atención Primaria de la Salud a cargo de la disertación, Luis Crovetto, explicó que “el acortamiento de la longitud del cuello de útero se asocia con un incremento de riesgo de parto prematuro espontáneo”, al tiempo que señaló que la cervicometría es un estudio que “ha ganado aceptación en la comunidad médica debido a que es mínimamente invasivo, con una tasa de detección que alcanza el 75 por ciento en los casos de prematurez extrema”.
“El riesgo de parto prematuro aumenta exponencialmente cuando la longitud del cuello de útero es inferior a 15 milímetros en embarazos únicos, y de 25 mm en embarazos múltiples”, detalló Crovetto. Y en ese sentido, indicó que el hospital provincial Gutiérrez de La Plata se abrió recientemente una unidad de diagnóstico fetal y prevención del parto prematuro para atender a estos casos a tiempo, a cargo de Mariano Núñez.
La importancia de la prevención
Crovetto señaló que “el desafío actual es tratar de identificar a aquellas pacientes que tienen más probabilidades de tener un parto prematuro y poder implementar en ellas intervenciones que disminuyan la tasa de prematurez. En ese sentido, explicó: “si el 85 por ciento de los partos prematuros se dan en mujeres sin factores de riesgo, quiere decir que la estrategia debe estar direccionada en gran parte a las embarazadas sanas”.
Una vez identificado al grupo de riesgo de parto prematuro, la administración de progesterona se presenta como una posibilidad para disminuir su ocurrencia, según señalaron los expertos en el Congreso. Se estima inclusive que reduce el riesgo de parto antes de la semana 34 en un 45 por ciento en las pacientes sin antecedentes de riesgo y en un 25 por ciento en las pacientes con antecedentes.
Las infecciones, la hipertensión, la diabetes, el consumo de tabaco, alcohol o drogas durante el embarazo, figuran entre las causas más frecuentes de parto prematuro, aunque hoy se sabe que contextos hostiles, en los que peligra la salud mental de la mamá por hechos de violencia de género, falta de atención y el estrés pueden también acortar los tiempos de embarazo.
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