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Resumen OBJETIVO: Determinar la prevalencia de afecciones susceptibles de ser tratadas mediante un procedimiento intrauterino en una unidad de Medicina Materno Fetal de un hospital de tercer nivel del Occidente de México, en un periodo de nueve años. MATERIALES Y MÉTODOS: Estudio transversal y descriptivo, con revisión de los reportes de ultrasonidos obstétricos practicados en la Unidad de Medicina Materno Fetal del Hospital Civil de Guadalajara Dr. Juan I. Menchaca del 2013 al 2021, con selección de los casos de pacientes con diagnóstico de alguna afectación susceptible de ser intervenida de manera intrauterina. RESULTADOS: Durante el periodo de estudio se practicaron y registraron 103,721 ultrasonidos obstétricos, de éstos se integraron al estudio aquí publicado 257 pacientes con diagnóstico de alguna afectación susceptible de ser intervenida in útero. La prevalencia de afectaciones con posibilidad de ser intervenidas por vía intrauterina fue del 0.47% de la totalidad de pacientes valoradas. La media de edad de las pacientes fue de 24.6 años; 162 (63%) multigestas y 95 (37%) primigestas. Embarazos únicos 193 (75%) y 64 (25%) múltiples. Las semanas promedio de gestación al diagnóstico de la afectación fueron 25.6. CONCLUSIONES: En este ensayo se estimó una prevalencia de 0.47 padecimientos que pueden ser intervenidos in útero, dejando de lado muchas otros en los que los estudios no han demostrado beneficio de una cirugía fetal, ni los beneficios superan los riesgos, si se practica la cirugía de manera prenatal o posnatal.
Abstract OBJECTIVE: To determine the prevalence of conditions amenable to treatment by an intrauterine procedure in a Maternal-Fetal Medicine unit of a tertiary hospital in western Mexico over a nine-year period. MATERIALS AND METHODS: Cross-sectional and descriptive study, with review of obstetric ultrasound reports performed in the Maternal-Fetal Medicine Unit of the Civil Hospital of Guadalajara Dr. Juan I. Menchaca from 2013 to 2021, with selection of cases of patients diagnosed with any condition susceptible to intrauterine intervention. RESULTS: During the study period 103,721 obstetric ultrasounds were performed and recorded, of which 257 patients were included in the study published here with a diagnosis of a condition that could be treated in utero. The prevalence of conditions that could be treated in utero was 0.47% of all patients assessed. The mean age of the patients was 24.6 years; 162 (63%) were multigestational and 95 (37%) primigravid. Singleton pregnancies 193 (75%) and 64 (25%) multiple pregnancies. Mean weeks of gestation at diagnosis of involvement was 25.6. CONCLUSIONS: This trial estimated a prevalence of 0.47% of conditions that can be intervened in utero, leaving aside many others where studies have not demonstrated benefit of fetal surgery, nor do the benefits outweigh the risks, whether surgery is performed prenatally or postnatally.
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Introducción: Las cardiopatías congénitas son las anomalías más frecuentes y la principal causa de muerte infantil y neonatal. El diagnóstico prenatal mejora el resultado perinatal determinando el lugar de nacimiento y el nivel de cuidado neonata. La telemedicina mediante videoconferencia en tiempo real permite mejorar la precisión diagnóstica y planificar el nacimiento. Objetivo: Determinar el diagnóstico y manejo perinatal de fetos con sospecha de cardiopatía congénitas, evaluadas a través de telemedicina en tiempo real atendidas en CERPO en el periodo 2017-2022. Material y métodos: Estudio retrospectivo de las evaluaciones mediante telemedicina en tiempo real realizadas en CERPO entre los años 2017 a 2022. Se revisó el resultado perinatal y se compararon los diagnósticos pre y postnatales, extraídos de la base de datos CERPO y Unidad de Neonatología del Hospital Luis Tisné Brousse. Resultados: La correlación del diagnóstico de cardiopatía congénita mediante telemedicina es de un 81,8% y de 89,8% con el diagnostico posnatal. Conclusiones: La evaluación por medio de telemedicina permite mejorar la precisión diagnostica de la cardiopatía congénita en áreas con escaso acceso a operadores experimentados en evaluación cardiaca fetal. Esto minimiza el impacto económico y social asociado al manejo perinatal de un feto con cardiopatía congénita en nuestro país.
Introduction: Congenital heart disease is the most common anomaly and the leading cause of infant and neonatal death. Prenatal diagnosis improves perinatal outcomes by choosing the right place of birth and level of neonatal care. Telemedicine by videoconferencing in real-time allows for improved diagnostic accuracy and birth planning. Objective: To determine the diagnosis and perinatal management of fetuses with suspected congenital heart disease, evaluated by telemedicine at CERPO in the period 2017-2022. Material and Methods: Retrospective study of evaluations via real-time videoconferencing performed at CERPO between 2017-2022. The perinatal outcome was reviewed, and pre and postnatal diagnoses were compared. The data was extracted from the CERPO database and the Neonatology Unit of the Luis Tisné Brousse Hospital. Results: The correlation of congenital heart disease diagnosis by telemedicine was 81.8% and 89.8% with postnatal diagnosis. Conclusions: Telemedicine assessment improves the diagnostic accuracy of congenital heart disease in areas with poor access to an experienced fetal cardiac specialist. This minimizes the economic and social impact associated with our countrys perinatal management of a fetus with congenital heart disease.
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Humans , Prenatal Diagnosis/methods , Telemedicine/methods , Heart Defects, Congenital/diagnosis , Congenital Abnormalities/diagnosis , Echocardiography , Retrospective Studies , Videoconferencing , Heart Defects, Congenital/therapyABSTRACT
Background: Congenital anomalies are responsible for a of 14.2% of perinatal mortality in India. This study focuses on incidence of structural fetal abnormalities detected during 1st and 2nd trimester sonography. Aim of this study was to evaluate the need for targeted fetal scans.Methods: This study is an observational study conducted at Gujarat fetal medicine Centre, Ahmedabad, Gujarat, super specialty antenatal radiology centre where exclusively antenatal USGs and prenatal procedures are performed. All pregnant female coming for 1st and 2nd trimester USG were included. All fetal abnormalities in form of soft markers and structural abnormality were included.Results: Out of 2122 total ANC scans, 183 cases (8.6%) had structural abnormality and 235 cases (11%) had significant soft markers. 1185 cases (55.84%) came in late 2nd trimester for TIFFA scan and 468 (22%) were seen in 1st trimester scan. The incidence of fetal anomaly in this study was higher than general population as it is an exclusively fetal medicine centre and majority of patients were diagnosed with anomaly in late 2nd trimester.Conclusions: There is immense need for early diagnosis and timely intervention before 20 weeks in case of prenatal detection of fetal abnormality.
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Background: The objective of our study is to check the incidence of various congenital fetal anomalies in antenatal period by ultrasonography in a subset of population.Methods: This cross sectional study was conducted in the department of Radiology, Bolan Medical Complex Hospital Quetta from November 2017 to October 2018. Total of 1323 second and third trimester pregnancies were analyzed for a period of one year. 34 fetal anomalies were detected making the prevalence of 2.5%. Information obtained from history, clinical examination and Ultrasound examination were recorded. The data was analyzed in SPSS 20.These patients were also interviewed for folic acid supplementation and consanguineous marriage.Results: 1323 patients were examined with congenital abnormalities detected in 34 fetuses. Among 34 fetuses, 20 were male and 14 were female fetuses. Out of 34, mother of 24 fetuses verified that they did not take folic acid supplementation. Consanguineous marriage recognized as the important risk factor as found in 22 congenital abnormal fetus. CNS anomalies were the most commonly occurring anomalies with prevalence of (0.9%) followed by gastrointestinal tract anomalies (0.3%) and Urinary tract anomalies (0.3%).Conclusions: The fetus prognosis largely depends on early detection of its any congenital anomaly on antenatal ultrasound as they can result in abortions, still births and other fetal defects. So antenatal ultrasound is very important and safe method for early detection and management of fetal anomalies.
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ABSTRACT BACKGROUND: The prevalence of congenital abnormalities in general populations is approximately 3-5%. One of the most important applications of obstetric ultrasound is in detection of fetal structural defects. OBJECTIVE: To assess fetal structural anomalies diagnosed using ultrasound in the three trimesters of pregnancy. DESIGN AND SETTING: Retrospective cohort study at the Mário Palmério University Hospital of the University of Uberaba (Universidade de Uberaba, UNIUBE), from March 2014 to December 2016. METHODS: Ultrasound data at gestational weeks 11-13 + 6, 20-24 and 32-36 were recorded to identify fetal anomalies in each trimester and in the postnatal period. The primary outcome measurements were sensitivity, specificity, positive predictive value and negative predictive value for detection of fetal anomalies and their prevalence. RESULTS: The prevalence of anomalies detected using ultrasound was 2.95% in the prenatal period and 7.24% in the postnatal period. The fetal anomalies most frequently diagnosed using ultrasound in the three trimesters were genitourinary tract anomalies, with a prevalence of 27.8%. Cardiac anomalies were diagnosed more often in the postnatal period, accounting for 51.0% of all cases. High specificity, negative predictive value and accuracy of ultrasound were observed in all three trimesters of pregnancy. CONCLUSION: Ultrasound is safe and has utility for detecting fetal anomalies that are associated with high rates of morbidity and mortality. However, the low sensitivity of ultrasound for detecting fetal anomalies in unselected populations limits its utility for providing reassurance to examiners and to pregnant women with normal results.
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Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Congenital Abnormalities/diagnostic imaging , Ultrasonography, Prenatal/methods , Fetal Diseases/diagnostic imaging , Fetus/abnormalities , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Pregnancy Trimester, First , Congenital Abnormalities/epidemiology , Brazil/epidemiology , Prevalence , Retrospective Studies , Fetus/diagnostic imagingABSTRACT
Introduction: In today’s world, infertility is one of themajor emerging health issues which effects about 8-9% ofreproductive age group. Infertility due to certain male factorsand complete tubal obstruction may require interventionalprocedure. Increased risk of adverse perinatal outcomes areassociated with ART. Study objctive was to asses perinataloutcome in pregnant women conceived with inventionaltechniques.Material and Methods: A Retrospective study was done attertiary care hospital from January 2018 to June 2018. anddata was collected. The maternal and fetal condition werenoted as per records.Results: Women > 40 years of age had 11.53% of intrauterinedeath, 65.38% requires NICU admission, 11.53% requiresventilator support and 7.69% had neonatal death.Study alsorevealed foetal complications like intra uterine death (pvalue=0.0004), fetal anomalies, IUGR (P value=0.0003)which were atleast four times more in ART group than inspontaneous conception.Study also revealed that out of 167new born in ART group,there were 28.74% having verylow birth weight,19.76% were having low birth weight and51.50% had adequate weight, i.e around half of them werehaving weight less than 2 kgs as compared to spontaneouspregnancy group were only 5.71% i.e 6 babies were born lessthan 2 kg weight(P value < .0001 highly significant).Conclusion: Maternal age was significantly associatedwith perinatal and obstetrical complications. To improvematernal and perinatal outcomes, pre-existing diseases likehypertension, anaemia, diabetes mellitus and hypothyroidismshould be treated before conception. Overall aim should beto minimize iatrogenic preterm birth for minor ailments,close supervision of such women can add few more weeks topregnancy thus improving neonatal outcome.
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<p><b>INTRODUCTION</b>Assisted reproductive techniques (ARTs) result in a deficient luteal phase, requiring the administration of intramuscular, intravaginal or oral exogenous progesterone. Dydrogesterone, an oral retroprogesterone with good bioavailability, has been used in assisted reproductive cycles with outcomes that are comparable to those of vaginal or intramuscular progesterone. However, there are limited reviews on its use for luteal phase support in ARTs, in terms of pregnancy outcomes and associated fetal anomalies. This study aimed to review the live birth rates and associated fetal anomalies of women who were given dydrogesterone for luteal phase support in assisted reproductive cycles at a tertiary hospital in Singapore.</p><p><b>METHODS</b>This retrospective descriptive study included 1,050 women who underwent in vitro fertilisation/intracytoplasmic sperm injection at the Centre for Assisted Reproduction of Singapore General Hospital between 2000 and 2011. The women were given dydrogesterone for luteal phase support. The main outcome measures were rates of pregnancy, live birth, miscarriage and fetal anomalies.</p><p><b>RESULTS</b>The pregnancy and live birth rates were 34.7% and 27.7%, respectively. Among those who achieved pregnancy, 17.0% miscarried, 0.8% had ectopic pregnancies and 0.3% had molar pregnancies. Fetal anomalies were detected in 1.9% of pregnancies, all of which were terminated by choice.</p><p><b>CONCLUSION</b>Since the outcomes of dydrogesterone are comparable to those of intramuscular and vaginal progesterone, it is a reasonable option to provide luteal phase support for women who are uncomfortable with injections or vaginal insertions. Randomised controlled studies are needed to determine the optimal dosage of dydrogesterone for luteal phase support in ARTs.</p>
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The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. The Zika virus is transmitted by Aedes mosquitoes and by sexual relations. It has been found in humans blood, saliva, urine, semen, amniotic fluid. Zika infection lasts only a few days, and signs and symptoms present in only about 20% of people are typically mild. The Zika virus has been considered a teratogen that causes microcephaly and other serious brain anomalies as it may invade fetal nerve cells and disrupt brain development. It has also been related to Guillian-Barré syndrome and to an autoimmune syndrome called acute disseminated encephalomyelitis, or ADEM. A review is done on the Zika virus transmission, perinatal problems and prevention in women of reproductive age, during pregnancy and labor, and fertility treatments, as well as strategic preventive considerations implemented in Peru.
El virus zika se ha extendido rápidamente en las Américas desde su identificación en Brasil a principios de 2015. El virus es transmitido por los mosquitos Aedes y por relaciones sexuales. Se le encuentra en el ser humano en sangre, saliva, orina, semen y líquido amniótico. La infección por zika dura solo unos días, y los signos y síntomas presentes en solo 20% de personas son por lo general leves. El virus zika ha sido considerado como un teratógeno que causa microcefalia y otras anomalías graves del cerebro, porque parece invadir las células nerviosas fetales y perturbar el desarrollo del cerebro. También se le ha relacionado al síndrome de Guillian-Barré y a un síndrome autoinmune llamado encefalomielitis diseminada aguda o ADEM. Se presenta una revisión sobre el virus zika, la transmisión del virus, los problemas perinatales y su prevención tanto en mujeres en edad reproductiva, en el embarazo y parto, así como en tratamientos de infertilidad, y las estrategias preventivas implementadas en el Perú.
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Amniotic fluid plays an important role in fetal development and growth. Amniotic fluid volume should be maintained adequately throughout gestational periods. Polyhydramnios is a relatively common obstetrical problem, but is associated with poor perinatal outcome both in mother and fetus. For the proper management of polyhydramnios, it is important to find out accurate causes, but it is not easy even if obstetricians perform thorough prenatal assessments. It is also important to understand the regulation of amniotic fluid volume. Based on these backgrounds, this article will briefly review mechanisms of the regulation of amniotic fluid, and will also review diagnosis, etiologies, managements and prognosis of polyhydramnios.
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Female , Humans , Amniotic Fluid , Fetal Development , Fetus , Mothers , Polyhydramnios , PrognosisABSTRACT
Objective To investigate the applied value of abnormalities of fetus with oligohydramnios in mid-pregnancy by anmioinfusion. Methods Fifty women with oligohydramnios diagnosed by ultrasonograph were analysed retrospectively. During the procedure 60-300 ml saline solution at 37 ℃ were infused into the amniotic cavity,made prenatal diagnosis at the same time necessarily. And examined the women to know whether the fetal anomaly existed or not after the amnioinfusion by the ultrasound. Results There were 15 cases with fetal anomaly, 8 cases with genitotirinary anomaly(2 cases associated with multiple organs anomaly), 1 case with single umbilical artery, 4 cases with chromosomal abnormality (2 cases associated with fetal growth restriction), 2 cases with pulmonary hypolasia. There was no significant difference in dilivery outcome between others and 35 cases with normal pregnant women (P >0.05). Conclusion Transabdominal amnioinfusion has double function on beth diagnosis and therapy for the oligohydramnios in the mid-pregnancy.
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Objectives : To determine the effectiveness of ultrasound screening for fetal anomalies at different gestational ages and to define an appropriate cost for each ultrasound screening. Materials and methods: 470 pregnant women participated in our ultrasound screening programme from October 1st, 2002 to September 15th, 2003. 757 scans were appointed throughout the first, second and third trimesters, numbering 240,257 and 260 scans, respectively. The ultrasound cost were reduced to about 30% of the normal price (800 baht for 2-3 scans). Results : out of757 scans, 7 abnormal fetuses were found. All abnormalities were detected around 18-20 weeks of gestation No abnormalities were found at other gestational ages. The abnormalities included infantile polycystic kidney, cleft lip, trisomy 13,gastroschisis and 3 cases of echogenic foci of hearts. Using this reduced cost, these pregnant women were easily able to participate in this research Programme. Conclusion: In order to reduce perinatal morality and morbidity, ultrasound screening for fetal anomalies can be performed between 18-20 weeks gestation. If the fetus is found to be abnormal, proper management and care can be planned before delivery. An important obstacle is the high cost of having a scan performed. Therefore, a reduced cost should be considered to recruit more pregnant women to participate in this policy. A reasonable cost for each ultrasound was found to be 425 baht.
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A retrospective study was performed over a 5-year period (1990-94) to evaluate the effectiveness of prenatal ultrasonography in terms of sensitivity, specificity, and predictive values in detecting fetal anomalies by comparing prenatal ultrasonic results with anomalies found in neonates and the perinatal outcome of anomalous fetuses. Minor congenital anomalies as listed and defined in the Eurocat Register were excluded. From a total of 5544 singletons, 4819 had at least one ultrasound scan (87%), of which 3004 at low risk and 1815 (38%) at high risk for anomalies had routine screening (RS) and indicated scanning (IS), respectively. A total of 136 fetuses were structurally abnormal (2.82%, RS and IS: 0.77% and 6.23%) and 200 major anomalies (RS and IS: 37 and 163) were recorded. The overall sensitivity of the ultrasound test was 78.7% (RS and IS: 34.8% and 87.6%, P < 0.01) for abnormal fetuses and 58.0% (RS and IS: 29.7% and 64.4%, P < 0.01) for anomalies. The overall specificity was 99.9% and the positive and negative predictive values were 97.3% and 99.4%, respectively; these values did not differ significantly between the two groups. The sensitivity of ultrasound for the detection of abnormal fetuses before 24 weeks was 22.8% (RS and IS: 13.0% and 24.8%) which was associated with a 61% (25/41) termination rate (RS and IS: 25% and 75.9%, P < 0.01) and a 24.4% (10/41) postnatal survival rate (RS and IS: 41.7% and 17.2%). The overall survival rate following pre- and postnatal correction of anomalies was 44.9% (RS and IS: 60.9% and 41.6%). For the detection of fetal anomalies anatomic ultrasound scanning is necessary during pregnancy, irrespective of pregnancy condition. Early detection of fetal anomalies could offer the option of pregnancy termination.
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Female , Humans , Infant, Newborn , Pregnancy , Congenital Abnormalities/diagnostic imaging , Abortion, Induced , Retrospective Studies , Ultrasonography, PrenatalABSTRACT
No abstract available.