Reflexiones sobre la conducta obstétrica en la embarazada con feto anencefálico / Reflections about the obstetric attitude towards anencephalic fetuses

Pregnancy of an anencephalic fetus generates deep thoughts about its diagnosis, treatment and management of maternal risk, having in mind the irreversibility of the fetal situation. At the present moment, there are no guidelines for labor care in these cases, probably because in most developed countries in which abortion is legal, these pregnancies are interrupted earlier. In Chile, where abortion is illegal we must deal with these situations at the end of the pregnancy period. Of 35,682 labors attended at our hospital, 14 were anencephalic fetuses. In 50 percent of these a cesarean section was done and in one, a hysterectomy was required due to uterine inertia.

Defectos de pared anterior del abdomen: diagnóstico prenatal y seguimiento / Anterior abdominal wall defects: prenatal diagnosis and monitoring

Abdominal wall defects are ranking in the 4th place of congenital malformations. The most frequent ones are gastroschisis and omphalocele, which show a high perinatal mortality. Over the last 30 years, world incidence has grown. The national incidence and prevalence of these defects should be determined. Objective: The analysis of trends in clinical characteristics of these defects referred to a national centre and treated in Santiago, Chile, between March 2003 and August 2006. Method: 7 cases of omphalocele and 7 cases of gastroschisis were analysed. We studied associated risk factors, prenatal management and postnatal follow-up. Results: The average maternal age in gastroschisis was 18 and 28.4 in omphalocele. Five patients with gastroschisis were primigravida. None of the patients had a history of drugs, alcohol or tobacco intake. Six of seven of omphalocele cases we associated with other malformations, three of them were multiple malformations Cantrell type. None of the cases of gastroschisis showed any associated malformations. In six cases of omphalocele and in one case of gastroschisis fetal karyotyping was studied. Six cordocentesis and one amniocentesis were performed. Results were one Trisomy 18 (omphalocele) and six normal kariotype. In three cases of omphalocele, the babies were delivered with elective cesarean section. In three cases of omphalocele and all cases of gastroschisis, urgent Cesarean section had to be performed. There was one vaginal delivery with a stillborn (Trisomy 18). Among the gastroschisis cases and three of the omphalocele cases, four children were born prematurely. The average weight of the newborns with gastroschisis was 2.365 gr., and 2.770 gr., in omphalocele cases. The distribution by sex in gastroschisis was 6 females: 1 male, in cases of omphalocele it was 4 females: 3 males. Of all 14 cases, two died during the first hours, and one was a stillborn. In the first...

Los defectos de la pared anterior del abdomen se ubican en 4° lugar de las malformaciones congénitas, siendo los más frecuentes la gastrosquisisy el onfalocele que presentan una alta mortalidad perinatal. En los últimos 30 años se reporta un aumento de la incidencia a nivel mundial. Es importante determinar la incidencia y prevalencia nacional de estos defectos. Objetivos: Analizar tendencias en las características clínicas de los defectos de pared anterior del abdomen, derivados a un centro de referencia nacional (Centro de Referencia Perinatal Oriente, CERPO), y atendidos en su red en Santiago, Chile, entre Marzo 2003 y Agosto 2006. Método: Se analizan todos los casos encontrados en el periodo. Se trata de 7 onfaloceles y 7 gastrosquisis, factores de riesgo asociados, evolución prenatal y seguimiento postnatal. Resultados: Media de edad materna 18 años en gastrosquisis y 28.4 años en onfaloceles. Cinco de 7 pacientes con gastrosquisis eran primigestas. Ninguna paciente tiene antecedentes de consumo de drogas, alcohol ni tabaco. Malformaciones asociadas en 6 de 7onfaloceles, de las cuales 3 de 7 eran malformaciones múltiples tipo Cantrell. Ninguna gastrosquisis presentó malformaciones asociadas. Se realizaron siete cordocentesis y una amniocentesis a 6 onfaloceles y a 1 gastrosquisis resultando 1 trisomia 18 (onfalocele) y 6 cariogramas normales. Nacieron por cesárea programada 3 de 7 onfaloceles y por cesárea de urgencia 3 de 7 onfaloceles y 7 de 7 gastrosquisis. Un parto vaginal por óbito (trisomía 18). Edad gestacional al parto: 4 de 7 gastrosquisis nacieron de pretérmino: y 3 de 6 onfaloceles. Peso promedio de recién nacidos vivos con gastrosquisis:2.365 g, onfaloceles: 2.770 g. Distribución por sexo en gastrosquisis 6 femeninos / 1 masculino, en onfalocele 4 femeninos / 3 masculinos. Tres de 14 fallecieron en las primeras horas de vida o nacieron muertos. En los primeros tres meses de vida fallecieron 3 de 6 onfaloceles y 1 de...