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1.
Rev. bras. ginecol. obstet ; 43(7): 545-559, July 2021. tab, graf
Article in English | LILACS | ID: biblio-1347249

ABSTRACT

Abstract Fetal growth restriction (FGR) occurswhen the fetus does not reach its intrauterine potential for growth and development as a result of compromise in placental function. It is a condition that affects 5 to 10% of pregnancies and is the second most common cause of perinatal morbidity and mortality. Children born with FGR are at risk of impaired neurological and cognitive development and cardiovascular or endocrine diseases in adulthood. The purpose of the present revision is to perform a literature search for evidence on the detection and assessment by ultrasound of brain injury linked to FGR during fetal life. Using a systematic approach and quantitative evaluation as study methodology, we reviewed ultrasound studies of the fetal brain structure of growth-restricted fetuses with objective quality measures. A total of eight studies were identified. High quality studies were identified for measurement of brain volumes; corpus callosum; brain fissure depth measurements, and cavum septi pellucidi width measurement. A low-quality study was available for transverse cerebellar diameter measurement in FGR. Further prospective randomized studies are needed to understand the changes that occur in the brain of fetuseswith restricted growth, as well as their correlation with the changes in cognitive development observed.


Resumo A restrição do crescimento fetal (RCF) ocorre quando umfeto não consegue atingir seu potencial de crescimento intrauterino, na maioria das vezes por compromisso da função placentária. É uma condição que afeta de 5 a 10% das gravidezes e é a segunda causa mais comum de morbidade e mortalidade perinatal. Crianças nascidas com RCF incorrem em maior risco de atraso no desenvolvimento neurológico e cognitivo, bem como de doenças cardiovasculares e/ou endócrinas, na idade adulta. O objetivo desta revisão foi o de pesquisar na literatura evidência sobre o diagnóstico pré-natal por ecografia de lesões cerebrais relacionadas com a RCF. Utilizando uma abordagem sistemática, avaliamos de forma quantitativa a metodologia dos oito estudos que preencheram os critérios de inclusão e foram, assim, incluídos nesta revisão. Foram identificados estudos de alta qualidade para a medição dos volumes cerebrais;medição do corpo caloso; medição da profundidade das incisuras cerebrais emedição do cavum do septo pelúcido. Os autores identificaram um estudo de qualidade inferior sobre a medição transversal do diâmetro transcerebelar em fetos com RCF. Mais estudos prospectivos randomizados são necessários para perceber quais as alterações que ocorrem no cerébro dos fetos com restrição do seu crescimento, bem como, a sua correlação com as alterações do desenvolvimento cognitivo observadas.


Subject(s)
Humans , Female , Pregnancy , Child , Adult , Placenta , Ultrasonography, Prenatal , Brain/diagnostic imaging , Biometry , Gestational Age , Fetal Growth Retardation/diagnostic imaging , Fetus
2.
Rev. bras. ginecol. obstet ; 42(5): 289-296, May 2020. graf
Article in English | LILACS | ID: biblio-1137828

ABSTRACT

Abstract Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.


Resumo O crescimento intrauterino restrito (CIUR) está associado a um prognóstico perinatal adverso, com maior risco de óbito intrauterino e neonatal, bem como de paralisia cerebral. Assim, sua detecção e a determinação de sua gravidade por novos parâmetros Dopplervelocimétricos, como o istmo aórtico (IAo), são de fundamental importância na prática obstétrica. O IAo é um segmento vascular que representa um ponto de comunicação entre os sistemas circulatórios fetais esquerdo e direito. É considerado um shunt arterial funcional, capaz de refletir a relação entre as impedâncias dos circuitos cerebral e sistêmico, e foi proposto como uma ferramenta para detecção do status do equilíbrio hemodinâmico e do prognóstico de fetos com CIUR. Na presente revisão, observou-se que, em fetos saudáveis, o fluxo predominante no IAo é sempre anterógrado; mas em fetos com CIUR a deterioração do estágio de insuficiência placentária acarreta reduções progressivas no fluxo ístmico até este apresentar sentido predominantemente retrógrado e levar a uma drástica redução no aporte de oxigênio ao sistema nervoso central. Quanto mais alterado estiver o fluxo no IAo, maior a chance de haver alteração na Dopplervelocimetria de outros vasos; e as alterações no Doppler do IAo parecem preceder outros indicadores de hipoxemia severa. Embora o fluxo retrógrado no IAo pareça se correlacionar com maior risco de alteração no desenvolvimento neurológico a longo prazo, ainda não está claro o seu papel na predição de morbimortalidade perinatal. O Doppler do IAo parece ser um parâmetro promissor no manejo do CIUR; entretanto, mais estudos são necessários para avaliar seu emprego na prática clínica.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Aorta, Thoracic/diagnostic imaging , Ultrasonography, Prenatal , Fetal Growth Retardation/diagnostic imaging , Fetus/diagnostic imaging , Aorta, Thoracic/physiopathology , Blood Flow Velocity , Ultrasonography, Doppler , Fetal Growth Retardation/physiopathology , Fetus/blood supply
4.
Medisan ; 24(1)ene.-feb. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1091164

ABSTRACT

Introducción: La ecografía Doppler de las arterias uterinas es una técnica propuesta para predecir el riesgo de preeclampsia, retardo del crecimiento intrauterino y otras alteraciones perinatales adversas. Objetivos: Determinar la frecuencia de gestantes con alteración en las arterias uterinas durante el primer trimestre e identificar la presencia de preeclampsia/eclampsia, así como sus principales características clínicas. Métodos: Se efectuó un estudio descriptivo y longitudinal de 168 gestantes en el primer trimestre de embarazo, pertenecientes al municipio de Tercer Frente en Santiago de Cuba, evaluadas en una pesquisa de Genética realizada en el Policlínico Docente Cruce de los Baños, de abril a noviembre de 2018. A todas se les realizó ecografía Doppler para calcular el índice de pulsatilidad de las arterias uterinas. Resultados: En la casuística, 16 pacientes presentaron alterado el índice de pulsatilidad y, de ellas, solo en 3 se desarrolló preeclampsia, para 18,7 %; la edad promedio en estas últimas fue de 29 años y 2 eran nulíparas (66,6 %). Respecto al índice de pulsatilidad, el promedio fue de 2,5. Conclusiones: Se mantuvo un estrecho seguimiento, hasta el parto, de las pacientes con resultados patológicos, y se destacó la importancia de estudiar el índice de pulsatilidad de las arterias uterinas durante el primer trimestre del embarazo, sobre todo en las nulíparas.


Introduction: The Doppler echography of the uterine arteries is a technique suggested to predict the risk of pre-eclampsia, the intrauterine growth retardation and other adverse perinatal disorders. Objectives: To determine the frequency of pregnant women with disorder in the uterine arteries during the first trimester and to identify the pre-eclampsia/eclampsia presence, as well as their main clinical characteristics. Methods: A descriptive and longitudinal study of 168 pregnant women in the first trimester of pregnancy, belonging to the Tercer Frente municipality in Santiago de Cuba was carried out, they were evaluated by investigation of Genetics in Cruce de los Baños Teaching Polyclinic from April to November, 2018. To determine the pulsatility index of the uterine arteries, a Doppler echography was carried out. Results: In the case material 16 patients presented this parameter altered and just 3 pregnant women presented pre-eclampsia, for 18.7 %; the average age of these last ones was of 29 years and 2 were nonparous (66.6 %). Regarding the pulsatility index, the average was of 2.5. Conclusions: There was a close follow up of the patients with pathological results, until the childbirth, and the importance of studying the pulsatility index of the uterine arteries in the first trimester of the pregnancy, mainly in the nonparous, was emphasized.


Subject(s)
Pre-Eclampsia/diagnostic imaging , Pulsatile Flow , Ultrasonography, Doppler , Eclampsia/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging , Pregnancy
5.
Rev. chil. obstet. ginecol. (En línea) ; 84(5): 393-398, oct. 2019. tab
Article in Spanish | LILACS | ID: biblio-1058166

ABSTRACT

RESUMEN La enfermedad renal crónica (ERC) se observa en aproximadamente el 4% de las mujeres en edad fértil, pero el embarazo suele ser infrecuente en este grupo de pacientes, principalmente en aquellas con enfermedad renal crónica terminal (ERCT), reportándose entre el 1% al 7%. Los efectos de la enfermedad renal y su tratamiento pueden, a su vez, afectar el embarazo, incluido el desarrollo del feto, teniendo alta frecuencia las complicaciones perinatales. Es una patología que durante la gestación tiene una alta morbimortalidad para el binomio, por lo cual la cooperación interdisciplinaria intensiva de nefrólogos y obstetras es imprescindible para el manejo exitoso de la embarazada en esta condición. Se presenta el caso de una paciente con diagnóstico de ERCT antes de la concepción, manejo de su patología y seguimiento hasta la finalización del embarazo.


SUMMARY Introduction and objectives: The climacteric symptoms together with genital prolapse in the aging woman, affects the sexual function and the health related quality of life. The objective of this study was to describe sexual function and health related quality of life in climacteric women with genital prolapse according to sociodemographic and clinical characteristics. Methods: Descriptive cross-sectional design, on a consecutive sample of 45 climacteric women enrolled in two Family Health Centers of the Ñuble region, were selected all those between 42 and 60 years of age, with a clinical or ultrasound diagnosis of genital prolapse, with active sexual life the last 6 months and without hormone replacement therapy. To evaluate sexual function the Index of Feminine Sexual Function was applied and for the health related quality of life the Menopause Rating Scale was applied. Descriptive statistics were used, and to analyze the difference between the variables, the Chi-square and Fisher's Exact test were applied. In all cases a level of significance was considered p <0.05. The data was analyzed with the statistical software SPSS v. 23. Results: A statistically significant difference was observed between schooling and sexual function (p = 0.005) and type of delivery and health related quality of life (p = 0.034). Conclusions: The educational level could be considered as a protective factor of sexual function.


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications , Renal Dialysis , Renal Insufficiency, Chronic , Ultrasonography , Peritoneal Dialysis , Fetal Growth Retardation/diagnostic imaging
6.
Rev. bras. ginecol. obstet ; 41(7): 454-462, July 2019. tab
Article in English | LILACS | ID: biblio-1020601

ABSTRACT

Abstract Fetal growth restriction (FGR) diagnosis is often made by fetal biometric ultrasound measurements orDoppler evaluation, but most babies are only diagnosed after birth, using the birth weight as a proxy for intrauterine development. The higher risks of neurodevelopmental delay, metabolic syndrome, and cardiovascular illness associated with FGR impose a shift on the focus during pregnancy. New methodological approaches, like metabolomics, can provide novel biomarkers for intrauterine fetal development. Recent evidence on metabolites involved with fetal growth and weight show a consistent role played by lipids (especially fatty acids), amino acids, vitamin D and folic acid. Fetal energy source andmetabolism, structural functions, and nervous system functioning need further evaluations in different populations. In the near future, the establishment of a core set of outcomes for FGR studies may improve the identification of the role of each metabolite in its development. Thus, we will concretely progress with the perspective of a translational capacity of metabolomics for this condition.


Resumo O diagnóstico da restrição do crescimento fetal (RCF) é frequentemente feito por medidas biométricas ultrassonográficas ou por avaliação pela Dopplervelocimetria, mas, na maioria dos casos, o diagnóstico é apenas pós-natal, usando o peso ao nascimento como um marcador para o desenvolvimento intrauterino. Riscos maiores de atraso do neurodesenvolvimento, síndrome metabólica e doenças cardiovasculares associadas com a RCF impõem uma mudança no foco durante a gestação. Novas abordagens metodológicas, como a metabolômica, podem fornecer novos biomarcadores para o desenvolvimento fetal intrauterino. As evidências recentes sobre os metabolitos envolvidos com o crescimento e peso fetalmostram um papel consistente desempenhado pelos lipídios (especialmente os ácidos graxos), aminoácidos, vitamina


Subject(s)
Humans , Female , Pregnancy , Prenatal Diagnosis , Fetal Growth Retardation/diagnosis , Infant, Small for Gestational Age/growth & development , Ultrasonography, Prenatal , Metabolomics , Fetal Growth Retardation/diagnostic imaging
7.
Rev. cuba. obstet. ginecol ; 45(1): 37-47, ene.-mar. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093621

ABSTRACT

Introducción: La restricción del crecimiento intrauterino se refiere a la incapacidad del feto para alcanzar su potencial genético de crecimiento biológicamente determinado. Las herramientas proporcionadas por el ultrasonido colocadas en manos en manos diestras, constituyen la piedra angular para el diagnóstico de restricción del crecimiento en la que la biometría fetal es clave. Objetivo: Determinar la efectividad de los indicadores antropométricos para el diagnóstico de la restricción del crecimiento intrauterino. Métodos: Se realizó un estudio prospectivo en el período comprendido desde octubre de 2012 hasta octubre de 2014 en gestantes con embarazos simples y de peso adecuado, en el área de salud Chiqui Gómez Lubián de Santa Clara. Se construyeron curvas de Receiver Operating Characteristic de indicadores antropométricos para la predicción de la restricción de crecimiento intrauterino. Resultados: El indicador circunferencia cefálica/circunferencia abdominal mostró mayor área bajo la curva ROC en ambos trimestres, con valores más elevados en el tercer trimestre. Conclusiones: La efectividad de los indicadores estudiados para la predicción de la restricción del crecimiento intrauterino solo fue comprobada en el tercer trimestre(AU)


Introduction: Intrauterine growth restriction refers to the inability of the fetus to reach the biologically determined growth potential. The ultrasound tool is the cornerstone for the diagnosis of growth restriction in which fetal biometry is crucial. Objective: To determine the effectiveness of anthropometric indicators for the diagnosis of intrauterine growth restriction. Methods: A prospective study was conducted from October 2012 to October 2014 in pregnant women with simple pregnancies and adequate weight, at Chiqui Gómez Lubián health area in Santa Clara. Receiver Operating Characteristic (ROC) curves of anthropometric indicators were constructed for the prediction of intrauterine growth restriction. Results: The cephalic circumference / abdominal circumference indicator showed greater area under ROC curve in both quarters, with higher values in the third quarter. Conclusions: The effectiveness of the indicators studied for the prediction of intrauterine growth restriction was only verified in the third quarter(AU)


Subject(s)
Humans , Female , Pregnancy , Anthropometry/methods , Fetal Growth Retardation/diagnostic imaging , Prospective Studies
9.
Rev. bras. ginecol. obstet ; 40(5): 287-293, May 2018. tab, graf
Article in English | LILACS | ID: biblio-958986

ABSTRACT

Abstract Objective To perform a comprehensive review of the current evidence on the role of uterine artery Doppler, isolated or in combination with other markers, in screening for preeclampsia (PE) and fetal growth restriction (FGR) in the general population. The review included recently published large cohort studies and randomized trials. Methods A search of the literature was conducted usingMedline, PubMed, MeSH and ScienceDirect. Combinations of the search terms "preeclampsia," "screening," "prediction," "Doppler," "Doppler velocimetry," "fetal growth restriction," "small for gestational age" and "uterine artery" were used. Articles in English (excluding reviews) reporting the use of uterine artery Doppler in screening for PE and FGR were included. Results Thirty articles were included. As a single predictor, uterine artery Doppler detects less than 50% of the cases of PE and no more than 40% of the pregnancies affected by FGR. Logistic regression-based models that allow calculation of individual risk based on the combination of multiple markers, in turn, is able to detect ~ 75% of the cases of preterm PE and 55% of the pregnancies resulting in small for gestational age infants. Conclusion The use of uterine artery Doppler as a single predictive test for PE and FGR has poor accuracy. However, its combined use in predictive models is promising, being more accurate in detecting preterm PE than FGR.


Resumo Objetivo Realizar revisão da literatura científica acerca do uso do Doppler das artérias uterinas, de forma isolada ou em combinação com outros marcadores, no rastreamento para pré-eclâmpsia (PE) e restrição do crescimento fetal (RCF) na população geral. A revisão incluiu estudos de coorte e ensaios clínicos randomizados recentemente publicados. Métodos Realizou-se uma pesquisa da literatura nas bases de dados Medline, PubMed, MeSH e ScienceDirect. Diferentes combinações dos termos "preeclampsia," "screening," "prediction," "Doppler," "Doppler velocimetry," "fetal growth restriction," "small for gestational age" e "uterine artery" foram utilizadas. Artigos eminglês, (excluindo-se artigos de revisão) em que o Doppler das artérias uterinas é reportado como ferramenta no rastreamento para PE e RCF foram incluídos. Resultados Trinta artigos foram incluídos. Como teste preditivo isolado, o Doppler das artérias uterinas tem sensibilidade inferior a 50% na detecção de casos de PE e inferior a 40% para identificação de gestações afetadas por RCF. Modelos matemáticos preditivos baseados em equações de regressão logística que permitem o cálculo de risco individual, por sua vez, são mais promissores, permitindo a detecção de 75% dos casos de PE pré-termo, e 55% das gestações que resultarão emparto de recém-nascidos pequenos para a idade gestacional. Conclusão O uso do Doppler das artérias uterinas tem baixa acurácia na identificação de gestações afetadas por PE e RCF. No entanto, seu uso combinado com outros marcadores é mais promissor, apresentando maior acurácia para detecção de PE do que para RCF.


Subject(s)
Humans , Female , Pre-Eclampsia/diagnostic imaging , Ultrasonography, Prenatal , Ultrasonography, Doppler , Uterine Artery/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging
10.
Coronel Oviedo; s.n; 5 ed; Dic. 2018. 51 p.
Thesis in Spanish | LILACS, BDNPAR | ID: biblio-999854

ABSTRACT

Introducción: Se considera restricción de crecimiento intrauterino al crecimiento fetal menor que el esperado para la edad gestacional. Asociado con un aumento de 6-10 veces de riesgo de muerte perinatal. Cada año nacen en el mundo más de 20 millones de niños con peso inferior a 2.500 gramos; de ellos, más del 96 % en países en desarrollo, lo cual demuestra que esta situación se asocia a condiciones socioeconómicas de pobreza. La prevalencia en Latinoamérica oscila entre el 10 a 17% de los nacidos vivos. Objetivo: Caracterizar a las embarazadas con restricción del crecimiento intrauterino en el Servicio de Ginecología y Obstetricia del Hospital Central del Instituto de Previsión Social, del año 2017. Materiales y métodos: Estudio observacional descriptivo de corte transversal. Fueron incluidas todas las embarazadas con restricción de crecimiento intrauterino que acudieron al Servicio de Ginecología y Obstetricia del Hospital Central de Instituto de Previsión Social del año 2017. Resultados: Fueron 42 embarazadas con restricción de crecimiento intrauterino. Con rango etario de 20 a 42 años, la mediana de 28 años, el 54,76% casadas, el 84,10% proceden del área urbana, y el 52,38% con estudio superior, la mitad eran multigestas, nulíparas sin antecedentes de aborto previo, el 59,62% realizaron más de 5 controles prenatales. El antecedente patológico materno más frecuente fue anemia en el 66,67%. En su mayoría con un índice de masa corporal normal, y moderada ganancia de peso materno durante el embarazo. El 81,25% son de tipo asimétrico, con diámetro biparietal y circunferencia abdominal disminuidos. Conclusión: Este estudio realizado en un centro de referencia nacional de cuarto nivel, similar a resultados de trabajos anteriores, aporta datos actuales sobre las características de las embarazadas con restricción de crecimiento intrauterino.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Fetal Growth Retardation/epidemiology , Paraguay/epidemiology , Parity , Pre-Eclampsia/epidemiology , Prenatal Care , Socioeconomic Factors , Urinary Tract Infections/epidemiology , Body Weight , Body Mass Index , Nutritional Status , Cross-Sectional Studies , Risk Factors , Ultrasonography, Prenatal , Gestational Age , Diabetes, Gestational/epidemiology , Marital Status , Age Distribution , Substance-Related Disorders/epidemiology , Educational Status , Fetal Growth Retardation/classification , Fetal Growth Retardation/diagnostic imaging , Anemia/epidemiology
11.
Rev. chil. obstet. ginecol. (En línea) ; 83(4): 408-414, 2018. graf, ilus
Article in Spanish | LILACS | ID: biblio-978113

ABSTRACT

RESUMEN La restricción de crecimiento fetal (RCF) es el término con el que se define a aquellos fetos que no alcanzan el potencial de crecimiento intraútero esperado debido a factores genéticos o ambientales. Dentro de las causas de RCF asociadas a la placenta encontramos mosaicismo confinado a la misma, enfermedad isquémica placentaria y anomalías estructurales a este nivel. Se presenta el caso de una paciente de 32 años con diagnóstico de RCF que asocia múltiples quistes econegativos subamnióticos en la cara fetal de la placenta. Se finaliza la gestación en semana 34 mediante cesárea electiva por ausencia de diástole en el estudio Doppler de la arteria umbilical, evidenciando cinco quistes subamnióticos de 4 a 6 cm que alteran la superficie del amnios.


ABSTRACT Fetal growth restriction (FGR) is the term used to define those fetuses that do not reach the expected intrauterine growth potential due to genetic or environmental conditions. The causes of FGR associated with the placenta are confined placental mosaicism, placental ischemic disease and placental structural abnormalities. We report a case of a 32-year-old patient with a diagnosis of FGR associated with multiple subamniotic econegative cysts overlaying the fetal plate of the placenta. The gestation is ended in week 34 by elective cesarean section due to absence of diastolic flow in the umbil-ical artery, showing five subamniotic cysts from 4 to 6 cm that disrupt the surface of the amnion.


Subject(s)
Humans , Female , Pregnancy , Adult , Placenta Diseases/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging , Hemangioma/complications , Placenta Diseases/pathology , Pregnancy Complications , Prenatal Diagnosis , Diagnosis, Differential , Hematoma
12.
Rev. cuba. obstet. ginecol ; 43(4): 61-68, oct.-dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-901332

ABSTRACT

El síndrome de Wolf Hirschhorn, también conocido como monosomía del brazo corto del cromosoma 4 (4p) o síndrome 4p-, es una rara enfermedad genética descrita por primera vez en el año 1961 por los doctores Cooper y Hirschhorn. El objetivo del trabajo es presentar un caso clínico sobre el síndrome de Wolf-Hirschhorn, que es un trastorno genético raro y aún bastante desconocido que cursa con múltiples anomalías morfológicas congénitas, así como con un retraso neurológico e intelectual de grado variable. La prevalencia de este síndrome es extremadamente baja, teniendo en cuenta que la cifra puede estar infraestimada, dada las pérdidas gestacionales precoces y la dificultad en el diagnóstico prenatal. Reportamos el caso de una paciente con gestación gemelar bicorial biamniótica tras un ciclo de FIV-ICSI, en el que al segundo gemelo se diagnosticó un Síndrome de Wolf-Hirschhorn, luego del estudio por una discordancia de pesos estimados y crecimiento intrauterino restringido de este segundo feto. El patrón clásico de presentación clínica se caracteriza por el desarrollo de alteraciones craneofaciales importantes, retraso en el crecimiento normal tanto prenatal como posnatal y deficiencia mental e intelectual de grado variable. El diagnóstico prenatal debe ser realizado por expertos. Puede sospecharse por un crecimiento intrauterino restringido, ya que se da en 80-90 por ciento de los fetos con esta patología. Una vez diagnosticado, se recomienda el estudio genético de los padres, dado que hasta 15 por ciento de los progenitores pueden padecer un reordenamiento cromosómico equilibrado en el brazo corto del cromosoma 4(AU)


Wolf Hirschhorn syndrome, also known as monosomy of the short arm of chromosome 4 (4p) or 4p-syndrome, is a rare genetic disorder first described in 1961 by doctors Cooper and Hirschhorn. The prevalence of this syndrome is extremely low, taking into account that the figure may be underestimated given the early gestational losses and the difficulty in prenatal diagnosis. The objective of the study is to present a clinical case of Wolf-Hirschhorn syndrome, presenting with multiple congenital morphological anomalies, as well as a neurological and intellectual retardation of variable degree. We report the case of a patient with a bicorial biamniotic twin gestation after a cycle of IVF-ICSI. The second twin was diagnosed with a Wolf-Hirschhorn syndrome, after performing the corresponding study due to a discordance of estimated weights and restricted intrauterine growth of this second fetus. The development of important craniofacial alterations, delay of normal prenatal and postnatal growth, and mental and intellectual deficiency of variable degree characterize the classic clinical presentation. Experts must make prenatal diagnosis. Wolf-Hirschhorn syndrome can be suspected by a restricted intrauterine growth, as it occurs in 80-90 percent of fetuses with this pathology. Once diagnosed, the genetic study of the parents is recommended, since up to 15 percent of the parents can suffer a balanced chromosomal rearrangement in the short arm of chromosome 4(AU)


Subject(s)
Humans , Female , Pregnancy , Wolf-Hirschhorn Syndrome/epidemiology , Wolf-Hirschhorn Syndrome/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging
13.
Rev. chil. obstet. ginecol. (En línea) ; 82(3): 252-258, jun. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899902

ABSTRACT

El desprendimiento crónico de placenta se caracteriza por la aparición de un sangrado venoso crónico intra o retroplacentario que produce la separación paulatina de la misma. Es poco frecuente y se puede presentar en pacientes sin factores de riesgo. La imagen ecográfica plantea diagnóstico diferencial con la corioamnionitis. El pronóstico fetal es malo especialmente si se asocia con oligoamnios. Se presentan cuatro casos caracterizados por imagen ecográfica característica, retraso del crecimiento fetal, alteración del Doppler, y confirmación anatomopatológica.


Chronic placental abruption is due to intra or retroplacental insidious bleeding that causes progressive separation from the uterine wall. It is a rare condition and can occur in low risk patients. Chronic abruption imaging poses differential diagnosis with infectious TORCH chorioamnionitis. Fetal prognosis is ominous especially in the presence of oligohydramnios. We present four cases with a common ultrasound appearance, fetal growth restriction, Doppler abnormalities and pathological confirmation.


Subject(s)
Humans , Female , Pregnancy , Adult , Oligohydramnios/diagnostic imaging , Abruptio Placentae/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging , Pregnancy Outcome , Ultrasonography, Prenatal
14.
Rev. bras. saúde matern. infant ; 16(supl.1): S7-S15, Nov. 2016. tab, graf
Article in English | LILACS | ID: biblio-830086

ABSTRACT

Abstract Objectives: to describe altered intrauterine ultrasound, analyze fetal head circumference (HC) growth and neonates' outcomes among presumed cases of congenital Zika syndrome in Brazil. Methods: 30 women were included in the study with suspected history of Zika virus (ZIKV) infection during pregnancy and fetal's brain altered on ultrasound diagnosis. Sociodemographic and obstetric characteristics, prenatal altered ultrasounds, HC and other perinatal outcomes have been described. The relation between HC and gestational age was analyzed by using random regression effects based on polynomials fractions. The Z test was calculated to determine an instant variant mean rate of the HC for each gestational age. Results: the mean gestational age of the ultrasound diagnosis was 33.3 + 4.7 weeks and HC at birth was 28.9 + 1.6 cm. The main altered brain ultrasound was microcephaly (96.7%). The analysis of the fetal head circumference showed an estimated increase of the average HC, as to gestational age, it did not occur in a linear form. The instant HC variation rate increased according to gestational age (p<0,001). Conclusions: Fetal's main morphological alteration was microcephaly, observing an increase in the head circumference according to gestational age in a non-linear form and the variation decreased with gestational age.


Resumo Objetivos: descrever alterações ultrassonográficas intraútero, analisar o crescimento da circunferência cefálica (CC) fetal e desfechos neonatais entre casos presumíveis de síndrome da Zika congênita no Brasil. Métodos: foram incluídas 30 mulheres com história sugestiva de infecção por Zikavirus (ZIKV) na gestação e diagnóstico ultrassonográfico de alteração cerebral fetal. Foram descritas as características sociodemográficas e obstétricas, alterações ultrassonográficas pré-natal, CC e os resultados perinatais. A relação entre a CC e a idade gestacional foi analisada utilizando-se modelos de regressão de efeitos aleatórios baseados em polinômios fracionais. O teste Z foi calculado para determinar a taxa de variação instantânea da CC média de cada idade gestacional. Resultados: a média da idade gestacional do diagnóstico ultrassonográfico foi de 33,3 + 4,7 semanas e da CC ao nascer foi de 28,9 + 1,6 cm. A principal alteração ultrassonográfica cerebral foi a microcefalia (96,7%). A análise da circunferência cefálica fetal demonstrou que o aumento da estimativa da CC média segundo a idade gestacional ocorreu de forma não linear. Observou-se ainda que a taxa de variação instantânea da CC aumentou segundo a idade gestacional (p<0,001). Conclusões: a principal alteração morfológica fetal foi a microcefalia, observando um crescimento da circunferência cefálica segundo a idade gestacional de forma não linear e que a variação diminui com a idade gestacional.


Subject(s)
Humans , Female , Pregnancy , Microcephaly/diagnostic imaging , Ultrasonography, Prenatal , Zika Virus Infection/diagnostic imaging , Arbovirus Infections , Brazil/epidemiology , Cephalometry , Fetal Growth Retardation/diagnostic imaging , Infectious Disease Transmission, Vertical , Pregnancy
15.
Clinics ; 71(6): 332-337, tab
Article in English | LILACS | ID: lil-787424

ABSTRACT

OBJECTIVES: To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries. METHODS: Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries. RESULTS: The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index. CONCLUSIONS: Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Fetal Growth Retardation/diagnostic imaging , Placental Circulation/physiology , Placenta/anatomy & histology , Fetal Weight , Gestational Age , Imaging, Three-Dimensional/methods , Organ Size , Placenta/blood supply , Placenta/diagnostic imaging , Ultrasonography, Doppler/methods
16.
Rev. chil. obstet. ginecol ; 81(2): 126-129, abr. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-780547

ABSTRACT

El trombohematoma subcoriónico masivo o Mola de Breus, por ser éste el autor que lo describió por primera vez en abortos, es un hematoma subcorial de al menos 1 cm de grosor que ocupa al menos, el 50% de la superficie fetal. Suele asociar una alta morbimortalidad fetal y perinatal, en forma de abortos, retraso del crecimiento intrauterino, muerte intrauterina, desprendimiento de placenta normalmente inserta y recién nacidos de bajo peso, generalmente pretérminos. Esta entidad debe diferenciarse de otros procesos que pueden asentar bajo la placa corial, hacia la superficie fetal como: corioangioma, depósitos de fibrina y trombosis del espacio intervelloso. Se han intentado postular mecanismos que pudieran causar dicha circunstancia, sin que por el momento podamos definir factores de riesgo médicos que claramente predispongan a padecer esta entidad. El objetivo de describir estos dos casos clínicos diagnosticados en 2013 es resaltar que, gracias a la sospecha ecográfica de un trombohematoma subcoriónico masivo, podemos estudiar la pieza de placenta y membranas tras la finalización de la gestación, con lo que obtendríamos así la confirmación anátomo-patológica, de otra manera esta información podría perderse.


The massive subchorionictrombo hematoma or Breus's Mola, this was the author who first described it in miscarriages, is a subchorionic hematoma at least 1 cm in thickness which occupies at least 50% of the fetal surface. Usually associated with high fetal and perinatal morbidity and mortality, as miscarriages, intrau-terine growth retardation, stillbirth, placental abruption and low birth weight, preterm generally. This entity should be distinguished from other processes that can seat under the chorionic plate to the fetal surface as chorioangioma, fibrin deposition and thrombosis intervillous space. They have tried to apply mechanisms that could cause such a circumstance, but for now we don't define medical risk factors that predispose clearly suffer from this entity. In order to describe these two cases diagnosed in 2013 is to emphasize that thanks to the sonographic suspicion of a massive subchorionic trombohematoma, can study the piece of placenta and membranes after the end of pregnancy, so it would provide pathologic confirmation, otherwise this information could be lost.


Subject(s)
Humans , Female , Pregnancy , Adult , Placenta Diseases/diagnostic imaging , Thrombosis/diagnostic imaging , Hematoma/diagnostic imaging , Thrombosis/complications , Abortion, Spontaneous , Ultrasonography, Prenatal , Fetal Growth Retardation/etiology , Fetal Growth Retardation/diagnostic imaging , Hematoma/complications
17.
Rev. chil. obstet. ginecol ; 80(6): 493-502, dic. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-771638

ABSTRACT

ANTECEDENTES: La restricción del crecimiento intrauterino (RCIU) es una entidad de origen multifactorial que puede ser causada por una gran variedad de patologías a nivel materno, fetal o placentario, y que representa altas tasas de morbimortalidad materna y perinatal. Es importante realizar un diagnóstico certero de esta patología con el fin de llevar a cabo un enfoque de seguimiento y de manejo que pueda disminuir todas las complicaciones asociadas a la enfermedad. OBJETIVO: Realizar una revisión detallada y actualizada de la etiopatogenia, criterios diagnósticos, seguimiento con ecografía Doppler y manejo de la restricción del crecimiento intrauterino. MÉTODO: Se realizó una búsqueda de literatura publicada en inglés y español en bases de datos como PubMed/MEDLINE, Ovid, MDconsult utilizando las palabras clave: restricción del crecimiento intrauterino, feto pequeño para la edad gestacional, circulación fetal, ecografía Doppler, además de la búsqueda de estadísticas relacionadas con RCIU, de los resultados obtenidos se seleccionaron 61 artículos. La información obtenida fue clasificada y utilizada como soporte para la realización de esta revisión. RESULTADOS: Se presentan los estudios disponibles, las revisiones y artículos recomendados para la evaluación de pacientes con RCIU, adicionalmente aquellos que brindan nueva información con respecto al diagnóstico, evaluación de circulación fetal, seguimiento y manejo de esta entidad clínica. CONCLUSIÓN: La restricción del crecimiento intrauterino es una patología que presenta altas tasas de morbimortalidad perinatal. La identificación temprana de estos fetos y el seguimiento adecuado mediante la evalución Doppler permiten disminuir los resultados adversos y las secuelas a corto y largo plazo.


BACKGROUND: Intrauterine growth restriction has a multifactorial origin and can be caused by a variety of pathologies in the mother, fetus or placenta, representing high rates of maternal and perinatal morbidity and mortality. Therefore, it is important to accurately diagnose this condition in order to focus in the follow and management, which can reduce the complications associated with the disease. OBJECTIVE: To perform a detailed and up to date review of the etiology, diagnostic criteria, follow up with Doppler ultrasonography and management of intrauterine growth restriction. METHODS: A literature search was done in English and Spanish in databases such us PubMed/MEDLINE, Ovid, MDconsult using the following key words: intrauterine growth restriction, small for gestational age fetus, fetal circulation, Doppler ultrasonography. Also national statistics for intrauterine growth restriction were used, obtaining 61 documents. The information obtained was classified and used in the development of this review. RESULTS: The available studies are presented, and recommended revisions to the evaluation of patients with IUGR, additionally those that provide new information regarding the diagnosis, evaluation of fetal circulation, monitoring and management of this clinical entity. CONCLUSION: Intrauterine growth restriction is a pathology with a frequent diagnosis an represents high rates of perinatal morbidity and mortality. Early identification of these fetuses and adequate monitoring by Doppler evaluation allow reducing adverse outcomes and consequences in the short and long term.


Subject(s)
Humans , Female , Fetal Growth Retardation/etiology , Fetal Growth Retardation/diagnostic imaging , Gestational Age , Ultrasonography, Doppler , Fetal Growth Retardation/classification , Fetal Growth Retardation/therapy , Fetus/blood supply
19.
Indian J Pediatr ; 2009 May; 76(5): 485-488
Article in English | IMSEAR | ID: sea-142193

ABSTRACT

Objective. To explore the role of endothelin-1 (ET-1) and leptin in intrauterine growth restriction (IUGR) among preeclamptic and non-pre-eclamptic women. Methods. Forty three patients with a pregnancy complicated by IUGR, 23 cases with severe pre-eclampsia and 20 cases of non-pre-eclamptic were enrolled. Control group comprised 15 cases with uncomplicated pregnancy. Blood samples from umbilical artery and maternal venous blood were collected at the time of delivery for analysis of ET-1 and leptin levels. Mode of delivery, birth weight and Apgar score were also recorded. Results. The mean maternal and fetal ET-1 level was significantly higher in pregnancies complicated by IUGR than in control group. The mean maternal leptin level was significantly higher in pre-eclamptic patients when compared to nonpreeclamptic and control groups. Mean fetal leptin level was significantly lower in patients compared to control; however, when fetal leptin corrected to fetal weight, it was insignificantly different in the both groups. Conclusion. Maternal plasma ET-1 and leptin correlate with the degree of fetal growth restriction originating from deterioration of placental function. Maternal plasma leptin and ET-1 levels may reflect deterioration in fetal growth.


Subject(s)
Adult , Analysis of Variance , Biomarkers/blood , Birth Weight , Case-Control Studies , Chi-Square Distribution , Endothelin-1/blood , Endothelin-1/metabolism , Enzyme-Linked Immunosorbent Assay , Female , Fetal Growth Retardation/blood , Fetal Growth Retardation/diagnostic imaging , Gestational Age , Humans , Infant, Newborn , Leptin/blood , Leptin/metabolism , Linear Models , Maternal Age , Pre-Eclampsia/blood , Pre-Eclampsia/diagnostic imaging , Predictive Value of Tests , Pregnancy , Pregnancy Outcome , Prenatal Care/standards , Prenatal Care/trends , Probability , Reference Values , Sensitivity and Specificity , Severity of Illness Index , Ultrasonography, Prenatal , Young Adult
20.
PAFMJ-Pakistan Armed Forces Medical Journal. 2009; 59 (2): 149-153
in English | IMEMR | ID: emr-92288

ABSTRACT

To study the light microscopic structure of human placenta in ultrasonically determined cases of intrauterine growth retardation [IUGR]. A cross sectional comparative study. This study was carried out at military hospital Rawalpindi from Jan 2002 to June 2002. Ten placenta of normal and 30 placentae of known intrauterine growth retardation cases were used in this cross sectional comparative study. Placentae were weighed and cut along their maximum diameter into two halves after trimming the membranes. Three specimens were taken: one from the center [A], one from the peripheral margin [C] and one from midway between the two [B]. Specimens were further processed for paraffin sections, 5micro m thick sections were made on rotary microtome. Haematoxylin and eosin [H and E], periodic acid schiff [PAS] and Masson's trichrome stains were used. The morphology of villi was observed and syncytial knots and capillaries were counted. In comprehensive study of the gross observations of the 30 placentae of IUGR cases, it was noted that all [100%] had meconium staining with presence of marginal or retroplacental hemorrhages. Calcification was noted in 24 cases. In the control group mean number of capillaries in A, B and C regions were 114 +/- 14.56, 89 +/- 8.61 and 92 +/- 11.63 respectively. In the IUGR group mean number of capillaries in A, B and C regions were 127 +/- 6.12, 125 +/- 5.53, 122 +/- 7.16 respectively. The difference between mean number of capillaries per field in A, B and C region of control and IUGR group was significant [P<0.05]. Mean birth weight, placental weight, placental diameter and placental thickness in IUGR group was 2.7 +/- 0.200, 163 +/- 18.26, 12.8 +/- 1.18 and 1.46 +/- 0.104 respectively. Difference between placental weight diameter and thickness of normal and IUGR group was statistically significant [p<0.05]. In control group mean number of syncytial knots in A, B and C regions was 114 +/- 7.13, 93 +/- 8.44 and 93 +/- 6.80 respectively. IN IUGR group, the mean number of syncytial knots in A, B and C regions was 169 +/- 7.09, 169 +/- 8.93 and 165 +/- 44.36 respectively. These differences were statistically significant [P<0.05] In terminal villi, syncytial knots and capillaries of the IUGR cases were more in the central region as compared to in the peripheral region. The quantitative difference between syncytial knots and capillaries in IUGR and control group were statistically significant [p<0.05]


Subject(s)
Humans , Fetal Growth Retardation/diagnostic imaging , Chorionic Villi , Cross-Sectional Studies , Microscopy , Capillaries , Meconium , Calcinosis
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