Excessive prenatal supplementation of iodine and fetal goiter: report of two cases using three-dimensional ultrasound and magnetic resonance imaging / Suplementação pré-natal excessiva de iodo e bócio fetal: Relato de dois casos utilizando ultrassonografia tridimensional e ressonância magnética

Abstract Fetal thyroid complications in pregnancy are uncommon, and are commonly related to the passage of substances through the placenta. The excessive iodine intake during the pregnancy is a well-known mechanism of fetal thyroid enlargement or goiter, and invasive procedures have been proposed for the treatment of fetal thyroid pathologies. In the present report, we demonstrate two cases from different centers of prenatal diagnosis of fetal thyroid enlargement and/or goiter in three fetuses (one pair of twins, wherein both fetuses were affected, and one singleton pregnancy). The anamnesis revealed the ingestion of iodine by the patients, prescribed from inadequate vitamin supplementation. In both cases, the cessation of iodine supplement intake resulted in a marked reduction of the volume of the fetal thyroid glands, demonstrating that conservative treatmentmay be an option in those cases. Also, clinicians must be aware that patients may be exposed to harmful dosages or substances during pregnancy.

Resumo As complicações fetais da tireoide na gravidez são incomuns e são comumente relacionadas à passagem de substâncias pela placenta. A ingestão excessiva de iodo durante a gravidez é um mecanismo bem conhecido de aumento da tireoide ou bócio fetal, e procedimentos invasivos foram propostos para o tratamento de patologias da tireoide fetal. No presente relato de caso, demonstramos dois casos de diferentes centros de diagnóstico pré-natal de aumento da tireoide fetal e/ou bócio em três fetos (um par de gêmeos, em que ambos os fetos foram afetados, e uma gravidez única). A anamnese revelou a ingestão de iodo pelos pacientes prescrita por suplementação inadequada de vitaminas. Nos dois casos, a interrupção da ingestão de suplemento de iodo resultou em uma redução acentuada do volume das glândulas tireoides fetais, demonstrando que o tratamento conservador pode ser uma opção nestes casos. Além disso, os médicos devem estar cientes de que as pacientes podem ser expostas a doses ou substâncias nocivas durante a gravidez.

Effect of Obesity on Gestational and Perinatal Outcomes / Efeito da obesidade sobre os resultados gestacionais e perinatais

Abstract Purpose To assess the impact of pre-pregnancy obesity (body mass index [BMI] ≥30 kg/m2) on the gestational and perinatal outcomes. Methods Retrospective cohort study of 731 pregnant women with a BMI ≥30 kg/m2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m2 and 24.9 kg/m2. Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Student's t tests for the continuous variables, and the chi-squared (χ2) test, or Fisher's exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mother's BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant. Results Obesity was associated with older age [OR 9.8 (7.8-12.2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8-8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1-9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1-3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3-3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4-2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury. Conclusion We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.

Resumo Objetivo Avaliar o impacto da obesidade pré-gestacional (índice de massa corpórea [IMC] ≥30 kg/m2) sobre os resultados gestacionais e perinatais. Métodos Estudo transversal retrospectivo, com 731 gestantes que apresentaram IMC ≥ 30 kg/m2 na primeira consulta de pré-natal, comparando-as a 3.161 gestantes com IMC entre 18,5 kg/m2 e 24,9 kg/m2. Foram avaliadas variáveis maternas e neonatais. A análise estatística baseou-se nas características demográficas das gestantes (obesas e com peso normal), e foi realizada com estatísticas descritivas seguidas de testes t de Student independentes bicaudais para variáveis contínuas, e teste de qui-quadrado (χ2) ou exato de Fisher para as variáveis categóricas. Foi realizada uma regressão linear múltipla do peso do recém-nascido sobre o IMC materno, ajustado por idade materna, síndromes hiperglicêmicas, síndromes hipertensivas hipertensivas e operações cesarianas, a fim de analisar a relação entre essas variáveis. Todas as análises foram realizadas com o uso de R (R Foundation for Statistical Computing, Viena, Áustria) para Windows, versão 3.1.0. Um valor de p < 0,05 foi considerado estatisticamente significante. Resultados A obesidade associou-se à idade materna [OR 9,8 (7,8-12,2); p < 0,01], distúrbios hiperglicêmicos [OR 6.5 (4,8-8,9); p < 0,01], distúrbios hipertensivos (RP: 7,6 [6,1-9,5]; p < 0,01), maior taxa de operação cesariana [OR 2,5 (2,1-3,0); p < 0,01], macrossomia fetal [OR 2,9 (2,3-3,6); p < 0,01] e baixo pH na artéria umbilical [OR 2,1 (1,4-2,9); p < 0,01]. Não foi observada associação com tempo de trabalho de parto, sangramento durante o trabalho de parto, índice de Apgar no 1° e 5° minutos, idade gestacional, natimortalidade e mortalidade neonatal precoce, malformações congênitas e tocotraumatismo materno e fetal. Conclusões O estudo mostrou que a obesidade pré-gestacional associou-se com idade materna mais elevada, distúrbios hiperglicêmicos e hipertensivos, taxas mais altas de operação cesariana, macrossomia e acidose fetal.

O que sabemos das alterações auditivas centrais em crianças expostas ao álcool na gestação? Revisão sistemática / What we know of the central auditory disorders in children exposed to alcohol during pregnancy? Systematic review

RESUMO Objetivo Identificar os efeitos da ingestão de álcool na gestação sobre o sistema nervoso auditivo central em relação aos seus possíveis diagnósticos, Síndrome Fetal do Álcool, Síndrome Fetal do Álcool Parcial, Distúrbios ao Nascimento Relacionados ao Álcool e Distúrbio do Neurodesenvolvimento Relacionado ao Álcool, sua extensão e o método de avaliação auditiva. Estratégia de pesquisa Busca sistemática e integrativa nas bases de dados PubMed, LILACS e SciELO, com os termos em português e inglês “síndrome fetal do álcool”, “desordens relacionadas ao uso do álcool” associadas a “audição”. Critérios de seleção Dos 123 resumos identificados, foram seis selecionados, publicados até maio de 2015. Análise dos dados Foram elencados tópicos a serem respondidos, caracterização da casuística; o diagnóstico decorrente da exposição fetal nas crianças; método de avaliação auditiva; e resultados descritos. Resultados Entre as avaliações comportamentais, foram utilizados os testes dicóticos verbais com sílabas e com sentenças e o teste fala com ruído. Entre os testes eletrofisiológicos, no Potencial Evocado Auditivo de Tronco Encefálico, foi detectada alteração de sincronia neural, e no Potencial Evocado Auditivo de Longa Latência – P300, valores de latência precoces. Conclusão Existem evidências de que as crianças e adultos jovens expostos ao álcool na gestação apresentam sinais de comprometimento do sistema nervoso auditivo central, mas não foi possível caracterizar essas alterações nos diferentes subtipos diagnósticos do espectro. As vias auditivas corticais foram as mais investigadas e o método eletrofisiológico o mais utilizado, com um resultado inesperado em dois deles, a latência precoce da N2 e da P300.

ABSTRACT Purpose To identify the effects of alcohol intake during pregnancy on the central auditory nervous system in relation to their possible diagnosis, Fetal Alcohol Syndrome, partial Fetal Alcohol Syndrome, Alcohol-Related Birth Defects and Alcohol-Related Neurodevelopmental Disorder, his extension and the hearing assessment method. Research strategy Systematic and integrative review searched the databases PubMed, LILACS and SciELO, with terms in Portuguese and English “fetal alcohol syndrome”, “alcohol-related disorders” associated with “hearing”. Selection criteria: We identified 123 abstracts, six were selected and published until May 2015. Data analysis Were listed topics to be answered, characterization of the sample; the diagnosis result of fetal exposure; method of hearing assessment and described results. Results Among the behavioral assessments, Verbal Dichotic Tests with syllables and sentences and Speech in Noise Test, were used. Among the electrophysiological tests, the Brainstem Auditory Evoked Potential was detected change neural synchrony, and Long-Latency Auditory Evoked Potential – P300, early latency values. Conclusion There is evidence that children exposed to alcohol in utero present central auditory nervous system involvement signals, but it was not possible to identify the influence of different subtypes and their losses. Cortical auditory pathways were the most investigated and the electrophysiological method as used with an unexpected result in two of them, early N2 and P300 latency.

DENGUE DURING PREGNANCY: ASSOCIATION WITH LOW BIRTH WEIGHT AND PREMATURITY

The aim of this study was to evaluate the effects of dengue virus infection during pregnancy and its correlation with low birth weight, prematurity, and asphyxia. A non-concurrent cohort study reveals the association of dengue during pregnancy with prematurity and low birth weight, when birth occurred during the maternal-fetal viremia period (p = 0.016 and p < 0.0001, respectively).

Impacto de la altura en el embarazo y en el producto de la gestación / Impact of high altitude on pregnancy and newborn parameters

Esta revisión describe los procesos asociados con mantener un embarazo en mujeres nacidas al nivel del mar que cursan su embarazo en la altura; en aquellas que viajan intermitentemente, o las que nacen y residen en la altura. La literatura examinada demuestra que la frecuencia de malformaciones congénitas es elevada en la altura; que las tasas de mortalidad fetal tardía, nacidos pequeños para su edad gestacional, y preeclampsia se encuentran incrementadas en la altura, asociadas a valores altos de hemoglobina materna (>14,5 g/dL). En conclusión, el embarazo en una mujer expuesta de forma aguda, intermitente o permanente a las grandes alturas, genera mayores riesgos en comparación con un embarazo desarrollado a nivel del mar.

This review describes adverse outcomes in pregnancy after brief, intermittent, or permanent residence at high altitudes. Review of literature shows that congenital malformations rates are higher at high altitudes. Additionally, rates of stillbirths, small size for gestational age, and preeclampsia are increased in populations living at high altitudes and are associated with high maternal hemoglobin levels (>14.5 g/dl). In conclusion, a pregnant woman exposed briefly, intermittently, or permanently to high altitudes results in increased risk of adverse outcomes when compared to pregnancies observed at sea level.

Conhecimento de mulheres com diabetes mellitus sobre cuidados pré-concepcionais e riscos materno-fetais / The knowledge of women with diabetes mellitus regarding preconception care and maternal-fetal risks / Conocimiento de mujeres con diabetes mellitus sobre cuidados preconcepcionales y riesgos materno-fetales

Objetivou-se descrever o perfil reprodutivo de mulheres com diabetes mellitus (DM) e verificar o nível de conhecimento destas quanto aos riscos maternos e fetais e os cuidados pré-concepcionais. Estudo exploratório, que contou com a participação de 106 mulheres, realizado no Centro Integrado de Hipertensão e Diabetes, de março a julho de 2009. As variáveis reprodutivas foram: número de gestações, partos e abortos e planejamento da gravidez. Os dados foram coletados por meio de entrevista que seguiu um formulário pré-estabelecido. O perfil reprodutivo de mulheres com DM mostrou-se permeado de riscos e repercussões reprodutivas negativas à saúde materna e fetal. Das 106 (100%) mulheres estudadas, 44 (41,5%) apresentaram conhecimento moderado sobre os cuidados pré-concepcionais e 58 (54,7%) conhecimento limitado sobre os riscos maternos e fetais. Faz-se necessário oferecer informações às mulheres a fim de promover o conhecimento sobre os riscos maternos e fetais e os cuidados pré-concepcionais.

The objective of this study was to describe the reproductive profile of women with diabetes mellitus (DM) and to identify their knowledge regarding maternal and fetal risks and preconception care. This exploratory study was performed at the Integrated Center for Hypertension and Diabetes, from March to July 2009, on a sample consisting of 106 women. The variables were: number of pregnancies, births and abortions, and planning the pregnancy. The data were collected through interviews that followed a preconceived form. The reproductive profile of women with DM proved to be permeated with risks and showed negative repercussions to maternal and fetal health. Of the 106 (100%) women studied, 44 (41.5%) demonstrated adequate knowledge regarding preconception care, while 58 (54.7%) had limited knowledge regarding maternal and fetal risks. It is necessary to provide information to women with diabetes to promote knowledge of maternal and fetal risks and preconceptional care.

Se objetivó describir el perfil reproductivo de mujeres con diabetes mellitus (DM) y verificar su nivel de conocimiento en cuanto a riesgos maternales y fetales, y cuidados preconcepcionales. Estudio exploratorio realizado con 106 mujeres, en el Centro Integrado de Hipertensión y Diabetes, de marzo a julio de 2009. Las variables reproductivas fueron: número de gestaciones, partos y abortos y planificación del embarazo. Los datos se recogieron mediante entrevista según formulario preestablecido. El perfil reproductivo de mujeres con DM se mostró expuesto a riesgos y repercusiones reproductivas negativas a la salud materna y fetal. De 106 (100%) mujeres estudiadas, 44 (41,5%) presentaron conocimiento limitado sobre riesgos maternales y fetales, y 58 (54,7%), con conocimiento limitado sobre riesgos maternos y fetales. Se hace necesario ofrecer información a las mujeres con el objeto de promover el conocimiento sobre riesgos maternales y fetales y sobre cuidados preconcepcionales.

Complicaciones tardías de la terapia láser como tratamiento de la transfusión feto-fetal: caso clínico / Late complications of laser therapy as a treatment for feto-fetal transfusion: clinical case

Presentamos la descripción del diagnóstico y manejo de una secuencia anemia-policitemia (SAP) que se presenta como complicación de una terapia láser exitosa en un embarazo gemelar monocorial cursando una transfusión feto-fetal (TFF) severa. Describimos la manifestación de esta complicación tardía de la terapia láser de la TFF severa y realizamos una revisión de la literatura internacional al respecto. A pesar del éxito de la introducción de la terapia láser en cuanto a la sobrevida y secuelas neonatales, recientemente se han descrito una serie de complicaciones de presentación tempranas o tardías. Entre las tardías, destacan la muerte de uno o ambos gemelos, recidiva de la TFF, y aparición de una SAP. Varios autores han descrito que la SAP sería secundaria a la presencia, o persistencia, de comunicaciones vasculares extremadamente pequeñas de flujo lento, las cuales llevan a una discordancia en los niveles de hemoglobina entre ambos gemelos, sin diferencias en sus volúmenes sanguíneos.

We describe the diagnosis and management of twin anemia-polycythemia sequence (TAPS), which occurs as a late complication of successful laser therapy in twin monochorionic pregnancies developing severetwin to twin transfusion syndrome (TTTS). We offer a description of this late complication of laser therapy in this condition and a review of the related medical literature. Despite the successful introduction of laser therapy on the survival and neonatal sequelae, various early and late complications related to this procedure have been recently described. Among the late, stands out the death of one or both twins, recurrence of TTTS, and the appearance of TAPS. With regards TAPS, several authors have reported that it would be secondary to the presence, o persistence, of extremely small slow flow vascular communications, which lead to discre-pancies in the hemoglobin levéis between the twins, with no differences in blood volume.

Hemodiálisis y embarazo: aspectos técnicos / Hemodialysis and pregnancy: technical aspects

La hemodiálisis es el método de primera elección para sustituir la función renal en mujeres con insuficiencia renal crónica o aguda durante el embarazo o posparto. Las complicaciones perinatales son frecuentes, sin embargo, el conocimiento de la adecuación de la técnica en el tratamiento médico de las pacientes puede contribuir a la reducción de su presentación y mejorar los resultados perinatales. El objetivo de esta investigación fue revisar la técnica y prescripción médica de la hemodiálisis en la mujer durante el embarazo o posparto. Este tipo de enfermas debe atenderse en un centro de alta especialidad. Se recomienda la hemodiálisis intensa incrementando la frecuencia y duración de las sesiones, utilizar aparatos que manejan altos flujos de sangre y líquido de diálisis, filtros nuevos, microdosis de heparina y limitar la ultrafiltración para evitar cambios hemodinámicos, hidroelectrolíticos, metabólicos, hemorragia obstétrica o parto pretérmino. El objetivo es mantener un estado clínico satisfactorio y niveles sanguíneos maternos de nitrógeno de la urea ≤ 80 mg/dl y creatinina 5 a 7 mg/dl para favorecer el crecimiento y desarrollo fetales. El tratamiento farmacológico rutinario debe continuarse, ajustando el número de medicamentos y su dosis de manera individual. El conocimiento de la técnica de hemodiálisis y su prescripción pueden contribuir a lograr mejores resultados perinatales.

Hemodialysis is the gold standard for substitution of renal function in women with chronic or acute renal insufficiency during pregnancy or during the postpartum period. Perinatal complications are frequent. Recognition of appropriate techniques in medical treatment of patients will contribute to decrease its incidence and allow better perinatal results. We undertook this study to review the techniques and medical indications of hemodialysis in pregnant and postpartum patients. This condition requires care in a high-specialty medical center. We recommend incremental increases in intensity and frequency and duration of treatments, use of equipment to manage fluctuations in blood and dialysis fluids, new filters, microdose of heparin and limiting ultrafiltration to avoid hemodynamic, electrolytic, and metabolic alterations, obstetrical hemorrhage or premature delivery. The objective is to maintain a satisfactory clinical status and maternal blood, urea, nitrogen (BUN) levels =80 mg/dl and creatinine 5-7 mg/dl for opportune fetal development and birth. Routine pharmacological treatment should continually be individually adjusted as to number of medications and dosage. Recognition of hemodialysis techniques and indications will contribute to obtaining improved perinatal results.

Consumo y exposición al humo de tabaco en mujeres embarazadas de Ecuador / Smoking and exposure to tobacco smoke among pregnant women in Ecuador

OBJETIVOS: Determinar la frecuencia de tabaquismo y exposición ambiental al humo de tabaco en mujeres embarazadas de Ecuador y describir los perfiles sociodemográficos asociados con esos factores de riesgo perinatal. MÉTODOS: Estudio descriptivo transversal mediante una encuesta aplicada a mujeres de 18 a 46 años con más de 3 meses de embarazo que asistieron entre octubre de 2004 y septiembre de 2005 a sus consultas de seguimiento en siete servicios de maternidad de seis ciudades de Ecuador. Se analizaron los datos demográficos y de exposición medioambiental (variables independientes) y su relación con el hábito de fumar cigarrillos y la exposición ambiental al humo de tabaco. RESULTADOS: De las 746 mujeres analizadas, 53,3 por ciento había fumado ocasionalmente y 4,3 por ciento había fumado habitualmente; de estas, 75,0 por ciento había dejado de fumar antes o durante el embarazo. De las encuestadas, 12,9 por ciento estuvo expuesta con frecuencia o siempre al humo de tabaco en ambientes cerrados. Tener mayor educación (11 años o más) y un nivel socioeconómico medio o alto, ser caucásica y considerar aceptable que las mujeres de su comunidad fumen se asoció significativa y directamente con el hábito de fumar cigarrillos (P < 0,001). En general, 12,9 por ciento de las mujeres estuvo expuesta al humo de tabaco y esto se asoció significativamente con ser soltera y cohabitar con fumadores o trabajadores vinculados con la industria del tabaco (P < 0,001). CONCLUSIONES: Se deben diseñar e implementar medidas específicas dirigidas no solo a estimular el abandono de este hábito en las embarazadas, sino también a prevenir que las mujeres en edad reproductiva comiencen a fumar y controlar el entorno fumador en el hogar.

OBJECTIVES: To determine the frequency of smoking and second-hand smoke exposure among pregnant women in Ecuador and to describe the sociodemographic profiles associated with these perinatal risk factors. METHODS: A cross-sectional descriptive study using a survey of women 18-46 years of age who were more than three months pregnant and attended follow-up consultations in seven maternity clinics in six cities in Ecuador between October 2004 and September 2005. Demographics and environmental exposure (independent variables) data and their relationship to cigarette smoking and secondhand-smoke exposure were analyzed. RESULTS: Of the 746 women studied, 53.3 percent had smoked occasionally, and 4.3 percent, regularly; of these, 75 percent had quit smoking before or during pregnancy. Of the respondents, 12.9 percent were frequently or always exposed to secondhand smoke indoors. Having more education (11 or more years), being in the middle or upper socioeconomic classes, being Caucasian, and it being considered acceptable for women in the community to smoke were significantly and directly associated with cigarette smoking (P < 0.001). Overall, 12.9 percent of women were being exposed to secondhand smoke and this was significantly associated with being single and cohabiting with smokers or employees connected to the tobacco industry (P < 0.001). CONCLUSIONS: Specific measures must be designed and implemented to not only encourage smoking cessation during pregnancy, but also to prevent women of reproductive age from taking up smoking and to limit smoking in the home environment.

Emissões otoacústicas em lactentes expostos a infecção intra-útero / Otoacoustic emissions in infants exposed to intrauterine infection

OBJETIVO: Analisar as Emissões Otoacústicas (EOA) em lactentes expostos à infecção intra-útero. MÉTODOS: Foi realizada a captação das EOA por transiente (EOAT) e das EOA produto de distorção (EOAPD) em 40 lactentes: 14 lactentes portadores e/ou expostos a algum tipo de infecção intra-útero (Grupo Estudo) e 26 lactentes sem intercorrências e sem indicadores de risco auditivo (Grupo Comparação). Os critérios de inclusão foram: Grupo Comparação: lactentes nascidos a termo, saudáveis e sem indicador de risco para alteração auditiva; Grupo Estudo: lactentes nascidos a termo, ou com idade gestacional corrigida entre 37 e 41 semanas na data de avaliação e portador ou exposto a algum tipo de infecção intra-útero. A análise estatística do conjunto de dados foi efetuada utilizando os testes estatísticos não paramétricos de Wilcoxon e Mann-Whitney, e a técnica de intervalo de confiança para média. RESULTADOS: Foram observados menores níveis de resposta e relação sinal/ruído das EOAT e EOAPD no Grupo Estudo em relação ao Grupo Comparação, com valores estaticamente significantes para as EOAPD em 8000 Hz e para EOAT em 1,5 Hz. CONCLUSÃO: A exposição à infecção intra-útero pode atenuar o nível de resposta das emissões otoacústicas no período neonatal.

PURPOSE: To analyze otoacoustic emissions (OAE) in infants exposed to intrauterine infection. METHODS: Transient OAE (TEOAE) and distortion product OAE (DPOAE) were performed in 40 infants: 14 with and/or exposed to some type of congenital infection (Study Group) and 26 without exposition and with no risk factors for hearing loss (Control Group). Inclusion criteria were: Control Group: healthy full-term infants, with no risk factors for hearing loss; Study Group: full-term infants or preterms with corrected gestational age between 37 and 41 weeks at the date of assessment, exposed to some type of intrauterine infection or with congenital infection. The statistical analysis of the data set was performed using the non-parametric tests of Wilcoxon and Mann-Whitney, and the technique of confidence interval for the mean. RESULTS: Lower levels of response and signal/noise ratio in TEOAE and DPOAE were observed in the Study Group, when compared to the Control Group, with significant statistical values for DPOAE in 8 kHz, and for TEOAE in 1.5 kHz. CONCLUSION: The exposure to intrauterine infections might attenuate the response level in OAE during the neonatal period.

Patologías maternas, su efecto sobre el feto y el recién nacido / Maternal diseases, their effect on the fetus and newborn

Este artículo pretende describir las patologías maternas que con frecuencia afectan al feto y al recién nacido. Se revisarán las patologías propias del embarazo, aquellas exacerbadas por éste, y enfermedades que por su fisiopatología, tienen un comportamiento interesante en el feto y el recién nacido. No es el objetivo de este artículo describir todas las patologías maternas que pueden afectar al feto y recién nacido, sino solamente las más frecuentes y relevantes. Es interesante destacar que muchas de las enfermedades a las cuales nos vamos a referir, pueden afectar al feto y al recién nacido, tanto en su crecimiento, como en la aparición de malformaciones, así como aumentando el riesgo de secuelas y mortalidad en éstos. Aquí radica la importancia de establecer un adecuado diagnóstico y manejo en los periodos previos al embarazo y prenatal con el fin de evitar estos riesgos.

The present artide will describe some of the maternal diseases that affects the newborn and the fetus, the diseases that were revised, are those that are present only during pregnancy, those exacerbated by pregnancy, and those that theír physiopathology is interestíng in how it's present in the fetus and newborn. It's not the objective of this artide to descríbe in extensive all of the disease that are related to pregnancy and affects the fetus and newborn. It's interesting to note that most of the maternal diseases that are treated in this artide, could affect the fetus and newborn, restricting their growth, increasing the risk of malformations, sequels and death. This is why it's important to realize an adequate diagnosis and management, previous to and during the pregnancy.

A Case of Fetal Congenital Mesoblastic Nephroma with Oligohydramnios

Although congenital renal tumors are rare, congenital mesoblastic nephroma (CMN) is the most common renal tumor in early infancy. It is non-metastatic, well differentiated, amenable to surgical removal, and carries a good prognosis. Polyhydramnios has been detected in most of the published cases of CMN. However, we experienced a rare case of fetal CMN associated with oligohydramnios. A 28-yr old woman at 34 weeks of gestation was referred to our hospital for oligohydramnios and a fetal abdominal mass. An ultrasonography revealed a huge, well-encapsulated mass arising from the right kidney. An emergency cesarean section was performed due to fetal distress. After birth, despite intensive neonatal care, the baby died because of renal failure, disseminated intravascular coagulopathy, pulmonary edema, together with other problems.

Síndrome de dificultad respiratoria aguda por ácidos biliares en un recién nacido de término / Acute respiratory distress syndrome by biliary acids in a term newborns

Describimos las características clínicas de un recién nacido a término que presentó un síndrome de dificultad respiratoria aguda. Su madre cursó una colestasis intrahepática del embarazo. Por la severidad del cuadro se indicó asistencia respiratoria mecánica y se administró surfactante. Se descartaron procesos infecciosos. Por antecedentes maternos de colestasis intrahepática del embarazo se sugiere el diagnóstico de dificultad respiratoria aguda por ácidos biliares. Conclusión: Sugerimos tener en cuenta el diagnóstico de dificultad respiratoria aguda por ácidos biliares, en todo neonato a término, nacido de una madre con colestasis intrahepática del embarazo.

Non-invasive diagnosis of fetal anemia due to maternal red- cell alloimmunization

To determine the value of measurement of velocity of the middle cerebral artery [MCA] in the prediction of fetal anemia in alloimmunized pregnancies without ultrasound evidence of hydrops and to see if this could replace the invasive techniques in the diagnosis and management of this condition. In a prospective cohort study, 65 non-hydropic fetuses with red blood cell alloimmunization were evaluated with ultrasound and Doppler imaging. This study was carried out at Feto Maternal Medicine Unit at Women's Hospital, Hamad Medical Corporation, Doha, Qatar from January 2003 to December 2003. Middle cerebral artery-peak systolic velocity [PSV] was measured. We interfered only if there is a sign of fetal anemia as indicated by changes in blood velocity in MCA using the table designed by Giancarlo Mari or the fetus developed signs of hydrops fetalis. Immediately after delivery, the blood was taken from umbilical cord for full blood count, blood group, bilirubin and antibodies level. Results before first fetal blood sampling [FBS] or delivery were analyzed. Sixty-five patients met the inclusion criteria for the study and were managed. Sixty-three women were alloimmunized with rhesus [Rh]-D antibodies and 2 with anti-C. With the conventional management, all 65 patients undergone amniocentesis to determine bilirubin levels. However, with non-invasive management, 60 women were safely prevented from undergoing invasive testing or invasive procedures. Amniocentesis was performed for only one [1.54%] patient, despite having a normal MCV-PSV which was carried out solely due to the care provider was insisting on this procedure and the result was normal. Planning delivery based on MCA-PSV allowed us to deliver 97% [63/65] of these babies without any signs of severe anemia between 28-38 weeks. Two [3%] of the fetuses were diagnosed as severely anemic with MCA-PSV. In both cases, anemia was confirmed by FBS and intra uterine transfusion was carried out immediately to the test. Only 2 babies were diagnosed anemic after birth and underwent blood transfusion. Doppler evaluation of MCA-PSV is effective in the prediction of fetal anemia in red blood cell alloimmunization. Using this technique will reduce the number of invasive procedures needed with the added risks of these procedures with good fetal outcome

Infecciones en la mujer embarazada transmisibles al feto / Vertically transmissible infections to the fetus in the pregnant woman

La mujer embarazada está expuesta a contraer una variedad de infecciones, tanto bacterianas, como virales y parasitarias, muchas de las cuales implican un riesgo de afectar también al feto y recién nacido. La transmisión de infecciones de la madre al hijo (transmisión vertical) puede ocurrir tanto durante el embarazo como durante el parto y aún después del parto. Este artículo resume ciertas medidas preventivas de probada eficacia contra algunas de estas infecciones, como son la vacunación pre- embarazo contra rubéola, varicela, hepatitis B, difteria-tétanos; o contra influenza durante el embarazo, el estudio serológico de algunas infecciones que cuentan con medidas de prevención de transmisión al hijo (VIH, sífilis, hepatitis B en no vacunadas) y medidas generales para prevenir la toxoplasmosis. Además revisa con mayor detalle las siguientes infecciones: Streptococcus b hemolítico Grupo B, Listeria monocytogenes, Chlamydia trachomatis, herpes genital, varicela y parvovirus. Para cada una de éstas se indican algunos aspectos epidemiológicos, frecuencia y momento de la transmisión vertical, los riesgos para la madre y para el hijo, las medidas terapéuticas para la infección materna y en especial, las medidas preventivas de la transmisión vertical.