Calidad en Doppler materno fetal: Propuesta de una Escala Objetiva Modificada de calidad y auditoría

Abstract

The technical and hemodynamic understanding weakness generates low-quality Doppler evaluations with persistence of adverse outcomes, high costs, unnecessary surveillance or treatment and limited advancement of pathophysiological knowledge.

Research and clinical practice related to maternal-fetal Doppler show little significant impact, discrepancies and even inconsistencies; Although a percentage of this is generated by the non-uniformity in diagnostic terminology, reference tables and management, another percentage is explained by the low quality of the Doppler evaluation.

The recommendations already established for Doppler quality can be represented in a tool that allows it to be improved and objectively evaluated. This could not only reduce adverse outcomes but also make research more uniform and with more solid evidence.

The quality of the Doppler indices measurements depends on the evaluation and measurement techniques, obtaining an optimal spectrum and its recording in basal conditions and free of confounding or intervening factors; failure in one or more of these generates falsely abnormal or falsely normal measurements leading to unnecessary management or loss of opportunity to avoid adverse outcomes.

We propose a modified scale with objective quality-audit parameters for incorporation into routine clinical practice. It evaluates 10 criteria: 1) Anatomical site, 2) Magnification, 3) Image clarity, 4) Insonation angle, 5) Scan speed, 6) PRF and Baseline, 7) Sample volume, 8) Confounding factor, 9) Adequate filter and 10) Reliability.