Análisis de la tasa de detección de fetos macrosómicos mediante ecografía / Analysis of detection rate of macrosomia fetal by ultrasound

Antecedentes: la macrosomía fetal es clínicamente relevante debido a que se asocia a un incremento significativo de la morbilidad materno-fetal. La ecografía es el estándar dorado para la estimación del peso fetal y la valoración de su crecimiento. Tiene una sensibilidad de 21,6 por ciento, por tanto la probabilidad de detectar ma-crosomía es baja para todas las fórmulas. El error entre el peso real y el estimado es 7,5-10 por ciento, y en el caso de RN macrosomas éste puede llegar al 15 por ciento. Objetivo: analizar las tasas de detección de fetos macroso-mas mediante biometría ultrasonográfica en la Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario San Cecilio, Granada, España. Método: estudio retrospectivo de casos-controles. Se analizaron gestaciones únicas a término, comparándo peso fetal estimado ecográfico con el peso del recién nacido (RN). Se incluyeron 200 casos (criterio de inclusión: peso del RN >4.000 g) y 100 controles (criterio de inclusión: peso del RN 3.000-4000 g). Resultados: la incidencia de macrosomas fue del 7,5 por ciento. El error medio en la estimación de peso fetal en los macrosomas fue de 577 g. El error medio en el grupo control fue 206,6 g, diferencia estadísticamente significativa (p<0,05). Conclusión: nuestros resultados muestran una tasa de error para la detección de macrosomía del 13,5 por ciento (577 g), algo inferior a la de diferentes publicaciones. Debemos ser cautos al decidir la interrupción del embarazo por esta causa.

Background: fetal macrosomia is clinically relevant due to its association with a significant increase in maternal-fetal morbidity. Ultrasonography is the gold-standard method to estimate fetal weight and growth assessment. It has a sensitivity of 21.6 percent, therefore the probability of detecting macrosomia is low for all ultrasonographycs formulas. The error between the estimated and actual weight is 7.5-10 percent, and in the case of macrosoma it can reach 15 percent. Objective: to analyze the detection rate of macrosomia fetal by ultrasound examination at our Unit of Obstetrics and Gynecology, Hospital Universitario San Cecilio, Granada, Spain. Methods: this is a retrospective study of cases and controls. We analyzed singleton pregnancies comparing estimated fetal weight with the weight of the newborn. It included 200 cases (inclusion criteria: newborn weight >4000 g) and 100 control (inclusion criteria: newborn weight 3000-4000 g). Results: the incidence of macrosomia was 7.5 percent. The mean error in estimating fetal weight in the macrosomia group was 577 g, while the mean error in the control group was 206.6 g, the difference mean error was statistically significant (p <0.05). Conclusion: our results show an error rate for detection of macrosomia of 13.5 percent (577 g), somewhat lower than those reported in different reviews. We must be cautious in deciding the termination of pregnancy by this cause.

Rubella outbreak amongst residential students in a military vocational school of Malaysia

An outbreak of rubella occurred amongst 303 newly recruited residential Form IV students in a military vocational training school in Malaysia. Of the 303 Form IV students, 77 gave a history of acute illness. Rubella specific IgM was detected in the sera of 46.5% (141/303) whereas rubella specific IgG was detected in 100% of all Form IV students. Sixty five students with no clinical history of acute illness during the outbreak period had detectable rubella IgM in their sera and rubella specific IgM was detected in the sera of all symptomatic students except one. Maculopapular rash was the commonest presenting clinical feature among students with acute rubella infection in this outbreak (97.4%) followed by fever (88.2%). The duration of rash ranged from one to nine days with a mean of 4.6 days. Of the 65 students that had both fever and rash, 56 (85.2%) students had maculopapular skin eruption on the same day as the date of onset of fever, six (9.2%) developed the rash a day after the onset of fever and three (4.6%) had the rash after two days of fever. The duration of fever ranged from one to eight days with a mean of 3.5 days. The duration of conjunctivitis ranged from one to four days with a mean of 2.3 days, and all those who developed conjunctivitis had mild eye-discharge without photophobia. The duration of arthralgia ranged from one to three days with a mean of 2.1 days. The commonest type of joints affected was knee joints (66.7%, 12/18), followed by elbow and shoulder joints (27.8%, 5/18) and wrist joints (5.6%, 1/18). A good clinical history of the temporal relationship between the occurrence of rash and fever during the outbreak could easily differentiate rubella illness from that of measles.