Distancia anogenital y otras medidas antropométricas en la mujer

Resumo

Anogenital distance (AGD) is an anthropometric measure that has great potential as a marker of prenatal development and is related to health in humans. It presents sexual dimorphism in placental mammals and is determined by intrauterine hormonal influence, especially during the “male programming window” (weeks 8-14 of gestation). There is evidence that intrauterine exposure to stressful events, endocrine disruptors, drugs and other toxins can impact the development of AGD and reproductive health in adulthood. Furthermore, AGD is considered to remain stable during adulthood. Objectives of this thesis: 1) to carry out a review of the clinical applications and nomenclatures related to AGD, 2) to evaluate whether changes occur in AGD during pregnancy and 3) to study if there is a relationship between AGD and the frequency of intrapartum episiotomy and the method of finalisation of delivery. Material and method: a bibliographic review has been carried out on the available evidence in relation to AGD in humans, clinical applications and nomenclatures. In addition, a prospective observational study was carried out on 214 pregnant women. Measurements of AGD (AGDAC: anus-clitoris; AGDAF: anus-fork), weight and body mass index (BMI) were obtained in each trimester. The relationship between AGD, the method of finalisation of delivery, the frequency of episiotomy and the influence of maternal physical activity on childbirth were studied. Results: the development of AGD could be modified by intrauterine exposure to substances act as endocrine disruptors during the MPV of pregnancy. A shortened or elongated AGD has been related to different pathologies of the reproductive system. Furthermore, this distance receives different nomenclatures depending on the context of study: anogenital distance, perineal body, genital hiatus, etc. It was found that the AGDAC progressively lengthened during pregnancy (first trimester (T1): 87.69 ± 13.14 mm; third trimester (T3): 91.95 ± 13.25 mm; p< 0.001), while the DAGAF did not undergo significant changes (T1: 28.37 ± 6.94 mm; T3: 28.94 ± 6.7 mm). Finally, when adjusting to BMI, none of the measures showed a statistically significant change in the different quarters. Furthermore, the results of the study carried out suggest that AGDAF values in T1 below 25.89 mm could indicate the need to perform an episiotomy (S 72% and E 50.5%) and AGDAC values in T3 below 89.75 mm could indicate the need to perform an intrapartum episiotomy (S 92.3%, E 67.7% and NPV 94%). A correlation has been found between AGDAF and AGDAC in T3 and the frequency of eutocic delivery. The AGDAC in T3, adjusted to maternal weight, parity and weight of the newborn, with values below 89.4 mm, could indicate the need for an instrumental delivery (AUC 0.75, S 62.5%, E 78, 2% and NPV 80%). Our study confirms that instrumental delivery is correlated with a higher frequency of episiotomy. We have found no relationship between maternal physical activity and episiotomy or type of delivery. Conclusion: Our findings show that AGD has important implications for clinical practice and future research. In the clinic, the measurement of AGD could provide precision to diagnoses related to the reproductive system, although it would be advisable to unify the nomenclature related to this measurement. Furthermore, the results suggest that neither AGDAF nor AGDAC change during pregnancy. Furthermore, AGDAF would allow obtaining a significant measurement at any time during gestation without the need to take BMI into account and could be used as a biomarker of intrauterine fetal hormonal exposure. Finally, AGDAF in T1 and AGDAC in T3 adjusted for maternal weight, parity and fetal weight could moderately discriminate the presence of episiotomy and AGDAF and AGDAC in T3 could moderately discriminate the presence of instrumental vaginal delivery.