Hernia diafragmática congénita / Congenital diaphragmatic hernia

The congenital diaphragmatic hernia (CDH) is a congenital defect of the formation and /or closure of the diaphragm that permits the herniation of abdominal contents into the thorax. It occurs when the diaphragmatic muscle fails to close during the prenatal development, and the contain of the abdomen migrate into the chest through this hole. When the abdominal organs are in the chest, there is limited room for the lungs to grow. This prevents the lungs for developing normally, resulting in pulmonary hypoplasia (or underdeveloped lungs). This can cause reduced blood flow to the lungs and pulmonary hypertension, as well as gastrointestinal reflux, feeding disorders and developmental delays. CDH can occur on the left side, right side or, very rarely, on both sides, and it can be life-threatening. The etiology is usually unknown. The incidence of CDH may be as high as 1 in 2000 to 1 in 5000 newborns alive. The sex relationship male/female is 1:1.8. Because of associated persistent pulmonary hypertension of the newborn and pulmonary hypoplasia, medical therapy in patients with CDH is directed toward optimizing oxygenation while avoiding definitive therapy. No time for repair of CDH is ideal, but it is suggested that the opportunity is 24-48 hours after birth to achieve pulmonary development. The key to survival lies in prompt diagnosis and treatment. Over the past two decades antenatal diagnosis rates have increased the knowledge of the pathophysiology of CDH and has become better understand with advances in clinical care including prenatal surgery, with a reported mortality of almost 35 % in live-born patients and a higher mortality when in utero deaths are conected. All these considerations are described in the article, with special reference to pre and post-natal treatment, complications management, diagnosis and prognosis

Síndrome de Banda Amniótica / Amniotic Band Syndrome

Amniotic band sequence or syndrome, is the term applied to a wide range of congenital anomalies, as a group of congenital birth defects caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero. Before the baby was born, the body parts shows signs of arm, fingers, etc, that were caught and estrangled. Amniotic band syndrome can cause a number of different birth defects depending on which body part(s) is affected. Amniotic band sequence (ABS) is a rare condition caused by strands of the amniotic sac that separate and entrangle digits, limbs or other parts of the fetus. This constriction can cause a variety of problems depending on where the strands are located and how trightly they are wrapped. ABS can cause a broad spectrum of anomalies ranging from simple band constrictions to major craniofacialand visceral defects. This causes deformations, malformation and disruption, that results in incapacity or death. The aims of the present report, were to present a review of the literature concerning with this pathology, describing the clinical characteristics, etiology, diagnosis and prognosis, in order to improve the efficacy of the prenatal management

Elastografía: una nueva herramienta en obstetricia / ELASTOGRAPHY: A NEW TOOL IN OBSTETRICS

Elastography is a new method which is innovating its use in obstetrics. Elastography has been employed in different fields as a complement of the bidimensional sonography and has been widely studied. However, guidelines for the employement of elastography of the uterine cervix are not available at present. The limitations consist in that there is not a reference of the normel tissue, and of the pathological elasticity of the preterm labor delivery, and besides it is necessary in some types of elastographies an external force which is dependant operator for which the performance of elastographies with cut waves or quantitatives seems to be the most promising method for the evaluation of the elasticity of the cervix. The present utility, current status and future challenges are well docummented in the article. The diagnostic accuracy of cervical elastography in predicting labor induction success is reviewed. The wave elastography of placenta for in vivo quantation of placental elasticity is also considered.

Ultrasonografía tridimensional en el diagnóstico precoz de malformaciones fetales / Three dimensional ultrasonography in the early diagnosis of fetal anomalies

Observación de características morfológicas fetales por examen ultrasonográfico tridimensional en pacientes embarazadas con ecografía bidimensional anormal actual o con antecedentes de malformación congénita