Perinatal outcomes with isolated oligohydramnios at term pregnancy.

AIMS: To compare the outcomes of term gestations with oligohydramnios in the absence of other underlying disorders and term gestations with normal amniotic fluid. METHODS: A retrospective analysis of obstetric outcomes in 27,708 term pregnancies. We compared three groups: labor induced because of oligohydramnios, spontaneous onset of labor with normal amniotic fluid, and labor induced because of late term pregnancy with normal amniotic fluid. We excluded pregnancies with maternal or fetal diseases or disorders potentially related with amniotic fluid alterations. The main outcome measures were mode of delivery, neonatal birth weight, umbilical artery blood pH, Apgar scores and neonatal discharge status. RESULTS: Compared to spontaneous labor, induction of labor because of oligohydramnios was associated with a higher risk of cesarean delivery and small size of the fetus for gestational age (SGA). Compared to induction because of late term pregnancy there were no significant differences in neonatal, although neonates had a higher risk of being SGA. CONCLUSION: The only perinatal outcome for which the risk was higher in term pregnancies with isolated oligohydramnios was SGA. The systematic induction of labor in these pregnancies should be questioned.

Perinatal outcomes in singleton pregnancies with a single umbilical artery.

OBJECTIVE: To analyze perinatal outcomes in singleton pregnancies with a single umbilical artery (SUA) as an isolated finding with no other underlying disorders. METHODS: This retrospective observational study compared a group of pregnancies with SUA (n = 127) and a group with a normal 3-vessel umbilical cord (n = 27 752). The study variables comprised maternal and obstetric characteristics and perinatal outcomes. RESULTS: The frequency of SUA was 0.45%. Pregnancies with SUA ended more frequently with cesarean delivery, and had a higher risk that the indication for cesarean delivery was non-reassuring fetal heart rate (NRFHR). Neonates in the SUA group had a lower weight for gestational age, and a higher risk of low umbilical cord blood pH. CONCLUSION: Obstetricians should monitor fetal growth closely in pregnancies with SUA, and be alert to NRFHR during labor and delivery.

Tratamiento laparoscópico del quiste dermoide de ovario. Factores asociados a la rotura intraoperatoria, trascendencia clínica y resultados / Laparoscopic treatment of ovarian dermoid cyst. Factors associated with intraoperative spillage, clinical importance, and results

Objetivo. Analizar las peculiaridades quirúrgicas asociadas al tratamiento por vía laparoscópica del quiste dermoide ovárico. Se estudian, igualmente, los factores asociados a la rotura intraoperatoria del quiste y su trascendencia clínica. Material y métodos. Se realizó un estudio retrospectivo de 131 quistes dermoides intervenidos por vía laparoscópica en el Hospital Universitario Virgen de las Nieves desde enero de 2000 hasta diciembre de 2008. Resultados. La edad media de las pacientes fue de 32,4 años. El tamaño medio del quiste fue de 63,8mm. En el 62,6% de los casos se pudo realizar cirugía conservadora (quistectomía). Sólo 2 pacientes precisaron reintervención por problemas hemorrágicos. La estancia media fue de 1,6 días. La rotura intraoperatoria del quiste ocurrió con más frecuencia cuando se practicó quistectomía. No hubo ningún caso de peritonitis. Conclusiones. La laparoscopia es la técnica de elección en el tratamiento quirúrgico del quiste dermoide de ovario. Las complicaciones son mínimas y la recuperación rápida. Si se produce la rotura intraoperatoria del quiste no suele tener trascendencia clínica alguna (AU)

Objective. To analyze the surgical characteristics of laparoscopic treatment of dermoid cyst and the factors associated with intraoperative spillage and its clinical importance. Material and methods. A retrospective research was performed of 131 dermoid cysts treated by laparoscopy at the Virgen de las Nieves University Hospital from January 2000 to December 2008. Results. The mean age of the patients was 32.4 years. The mean size of the cysts was 63.8mm. In 62.6% of the patients, conservative surgery (cystectomy) was feasible. Only two patients needed reintervention due to bleeding complications. The mean length of hospital stay was 1.6 days. Intraoperative spillage was more common when cystectomy was performed. There were no cases of peritonitis. Conclusions. Laparoscopic surgery is the first treatment option in the management of ovarian dermoid cysts. There are few complications and healing is rapid. Spillage is usually clinically unimportant (AU)

Analysis of secondary ultrasound markers in the first trimester before chorionic villus sampling.

OBJECTIVE: To evaluate detection and false-positive rates of the ultrasound markers-nasal bone (NB), ductus venosus (DV) flow and tricuspid regurgitation (TR)-during the first trimester in a population at high genetic risk, and to study the influence of a two-stage screening policy alter previous combined screening on the rate of invasive procedures. METHODS: A total of 333 chorionic villus samples were obtained in singleton pregnancies. Before biopsy, the ultrasound markers-NB, DV, and TR-were assessed, although the findings were not used to recalculate the previously determined risk for Down syndrome. RESULTS: Detection and false-positive rates for Down syndrome were 63.2% and 3.4% for NB, 65% and 3.1% for DV, and 50% and 2.1% for TR. All three markers were normal in 30% [84/277, 95% confidence interval (CI) 25%-36%] of chorionic villus sampling (CVS) cases performed for abnormal findings at the first trimester genetic screen, with 0% (0/20, 95% CI 0%-17%) false-negative rate for Down syndrome. CONCLUSION: Assessment of secondary ultrasound markers is feasible in clinical practice and their use could reduce the number of unnecessary invasive procedures by 30%.

Predicción de anemia fetal por isoinmunización tras transfusiones intrauterinas. Revisión de los casos tratados en nuestra unidad / Prediction of fetal anemia in red blood cell alloimmunization after intrauterine transfusions. Review of the cases treated in our unit

Objetivo. Evaluar las transfusiones de sangre intrauterinas realizadas en fetos con anemia por isoinmunización a Rh en nuestra unidad y la sensibilidad del estudio con Doppler de la arteria cerebral media para predecir anemia fetal tras la primera transfusión. Material y métodos. Se realizaron 53 transfusiones de sangre intrauterinas en 15 pacientes afectados por isoinmunización a Rh. Se analizan las características de los casos y la capacidad del estudio Doppler de la arteria cerebral media como factor predictivo de anemia fetal. Resultados. La tasa de detección de anemia fetal de la velocidad sistólica pico de la arteria cerebral media fue del 85% tras la primera transfusión y del 72% tras la segunda y sucesivas, no se detectaron falsos positivos de la prueba en nuestra serie. Conclusiones. La valoración Doppler de la arteria cerebral media como predictor de anemia fetal presenta menor tasa de detección tras sucesivas transfusiones sanguíneas (AU)

Objetive. Evaluate the intrauterine blood transfusions performed in fetuses with anemia due to red blood cell alloimmunization in our unit and the detection rate of the middle cerebral artery Doppler to predict anemia after the first transfusion. Material and methods. Ee performed 53 intrauterine blood transfusions in 15 patients with red blood cell alloimmunization. We analyze the characteristics of the cases and the value of the middle cerebral artery Doppler to predict fetal anemia. Results. The detection rate of fetal anemia with the peak systolic velocity Doppler in the middle cerebral artery was 85% after the first transfusion and 72% after the second or more. There were no false positive results of the test in our series. Conclusions. Doppler evaluation of the middle cerebral artery as predictor of fetal anemia has a lower detection rate after consecutive transfusions (AU)

Comparación de la efectividad de la pulsioximetría y el electrocardiograma fetal en las situaciones de riesgo de pérdida de bienestar fetal / Comparison of the effectiveness of fetal pulse oximetry and fetal electrocardiogram in intrapartum risk of loss of fetal well- being

Objetivo. Evaluar la eficacia de la pulsioximetría y el electrocardiograma fetal en la conducción del parto con registro de frecuencia cardíaca fetal compatible con riesgo de pérdida del bienestar fetal (RPBF).Sujetos y métodosSe trataba de un estudio experimental aleatorizado abierto con dos brazos; en uno se aplicó la técnica de la pulsioximetría y en el otro la técnica STAN®. En cada grupo se incluyó a 40 gestantes con feto único, gestación a término, en presentación cefálica y registro cardiotocográfico (RCTG) compatible con RPBF. Se analizaron las variables: tasa total de cesáreas, indicaciones basadas en el RPBF y las repercusiones en el equilibrio ácido-base neonatal.ResultadosNo se han obtenido diferencias significativas en cuanto a la tasa de cesáreas (el 47,5 frente al 40%; p=0,33) ni a la indicación por RPBF (el 32,5 frente al 37,5%; p=0,41). Tampoco en los resultados neonatales.ConclusionesLa utilización de la pulsioximetría y STAN(R)21, como métodos auxiliares del RCTG; no han demostrado ser superiores en lo que se refiere a descenso de la tasa de cesáreas o mejoría del bienestar fetal (AU)

Objective. To evaluate the effectiveness of pulse oximetry and fetal electrocardiogram in the management of labor with fetal heart rate patterns associated with a risk of loss of fetal well-being.Subjects and methodsWe performed an open, randomized, experimental trial with two groups: pulse oximetry was used in one group and the STAN® technique was used in the other. Each group included 40 women with single, term pregnancies in cephalic presentation and fetal heart rate patterns associated with a risk of loss of fetal well-being. The overall cesarean section rate, indications of risk of fetal distress, and neonatal acid-base balance were evaluated.ResultsNo significant differences were found in the rate of cesarean section (47.5 vs 40%; P=.33), indications of risk of fetal distress (32.5 vs 37.5%; P=.41), or neonatal outcomes.ConclusionsThe use of pulse oximetry and STAN(R)21, as auxiliary methods to cardiotocographic recording, showed no superiority in reducing the cesarean section rate or improving neonatal outcomes (AU)

Implementación de la terapia láser endoscópica para las complicaciones de gestaciones gemelares monocoriales / Implementation of endoscopic laser therapy in complicated monochorionic twin pregnancies

Objetivo: Evaluar los resultados obtenidos en el tratamiento de gestaciones monocoriales biamnióticas complicadas con síndrome de transfusión feto-fetal (STFF) grave o crecimiento intrauterino retardado (CIR) selectivo mediante la fotocoagulación láser de las anastomosis vasculares placentarias. Material y métodos: Se realizó esa terapia en 22 gestaciones, 17 por STFF severo y 5 por CIR selectivo. Se analizan la gravedad de los casos antes de la cirugía, las complicaciones obstétricas y la supervivencia fetal. Resultados: Hubo 17 casos de STFF grave; en 15 (88%) de ellos sobrevivió al menos uno de los gemelos. En los 5 casos por CIR selectivo, el feto con crecimiento normal vivió en 3 casos, incluido uno donde el feto con CIR también vivió. Conclusiones: Los resultados muestran la implementación exitosa de la cirugía láser endoscópica en una de las unidades de referencia de medicina fetal de España tras un entrenamiento apropiado del operador (AU)

Objective: To evaluate the outcomes of monochorionic diamniotic (MCDA) twin pregnancies with severe twin-to-twin transfusion syndrome (TTTS) or selective fetal growth restriction (FGR) treated by endoscopic laser separation of placental vessels in our unit. Material and methods: Fetoscopic laser therapy was performed in 22 MCDA pregnancies, including 17 for severe TTTS, and five for selective FGR. Presurgical severity, obstetric complications, and fetal survival were analyzed. Results: In 15 of the 17 (88%) cases of severe TTTS, at least one twin survived. In the five cases of selective FGR, the fetus with normal growth survived in three cases, including one in which the growth restricted fetus also survived. Conclusions: The results demonstrate the successful implementation of endoscopic laser surgery in a fetal medicine center in Spain after appropriate training of the operator (AU)