La dona gestant durant la pandèmia de la covid-19: perpetuant el biaix de gènere? / No disponible

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Protocolo de interrupción de embarazo. Nuestra experiencia en el Instituto Dexeus / Protocol of pregnancy termination. Our experience at Institute Dexeus

Introducción. En el año 2004, en nuestro centro creamosun equipo especializado en el manejo de las interrupcionesvoluntarias y legalizadas de embarazo (ILE), con elobjetivo de actualizar los protocolos de actuación y así mejorarel resultado de los mismos.Material y métodos. Revisamos los casos de ILE que sehan realizado en el período 2004 - mayo 2009. Las diferentespautas médicas consideradas han sido: misoprostol (pauta1), dilatador osmótico + misoprostol (pauta 2),mifepristone 36 h antes + dilatador osmótico + misoprostol(pauta 3, actual y protocolizada desde el año 2006).Resultados. Hemos revisado un total de 134 casos deILE. La edad gestacional media es de 17 semanas de amenorrea(rango 11-22). Un total de 72 pacientes son nulíparas(50,8 %), 23 con antecedente de una o varias cesáreasanteriores (17 %). El tratamiento administrado es el siguiente:123 (91,8 %) casos de tratamiento médico, 8(5,9 %) casos de dilatación y legrado evacuador electivo, 1(0,8 %) caso de histerotomía tras fallo de tratamiento médico,2 (1,5 %) casos de legrado evacuador tras fallo detratamiento médico. El tratamiento médico se administrósegún 3 diferentes pautas: pauta 1: 11 pacientes (8,2 %);pauta 2: 40 pacientes (29,9 %); pauta 3: 75 pacientes(55,9 %). El tratamiento médico fue efectivo en 123/126pacientes (97,7 %). El tiempo medio global desde el iniciodel misoprostol hasta la expulsión fetal fue de 7,0 h (± 4,3)(10,8 h [± 4,3] en la pauta 1, 8,6 h [± 5,5] en la pauta 2 y5,6 h [± 2,7] en la pauta 3). Se demuestra una diferenciaestadísticamente significativa entre la pauta 3 y las otraspautas (p < 0.001). Conclusiones. La creación de un equipo especializadoen los procesos de ILE nos ha permitido un manejo más correcto.El protocolo actual nos parece seguro y efectivo(AU)

Introduction. In 2004 we created a new team focusedon the management of pregnancy terminations (PT). Theaim of this team was to update the clinical protocols inorder to improve the outcome. We have reviewed the PTsperformed from 2004 onwards and then compared the resultsusing different treatments.Material and methods. PT performed in our unit between2004 and 2009. The different medical dosing protocolsused were: misoprostol (dosing protocol 1), osmoticdilators + misoprostol (dosing protocol 2), mifepritone 36hours before + osmotic dilators + misoprostol (dosingprotocol 3).Results. We have reviewed 134 cases of PT. 72 patientswere nuliparous (50.8%), 23 with antecedentsof one or more previous caesarean section (17%).The treatments used were: 123 (91.8%) medical treatment,8 (5.9%) elective dilatation and evacuation (Dand E), 1 (0.8%) histerotomy after failure of medicaltreatment, 2 (1.5%) D and E after failure of medical treatment.Medical treatment was administrated through3 different dosing protocols: Dosing protocol 1: 11 patients(8,2%); Dosing protocol 2: 40 patients (29.9%);Dosing protocol 3: 75 patients (55.9%). The medicaltreatment was successful in 123/126 patients (97.7%).The average time required for the procedure was 7 ±4.3 h (10.8 ± 4.3 hours with the dosing protocol 1, 8.6± 5.5 h with the dosing protocol 2 and 5.6 h ± 2.7 h forthe dosing protocol 3). There is a significant statisticaldifference between dosing protocol 3 and the otherones (p < 0.001). Conclusions. The fact of having a specific team focusedon PTs permits a better management of the cases. Ourcurrent protocol seems safe and effective(AU)

Papel de los marcadores bioquimicos y ecograficos de aneuploid¨ªa en la predicci¨®n de resultado perinatal adverso / Role of biochemical and sonographic aneuploidy markers in the prediction of adverse perinatal outcome

Introducción. Evaluar la utilidad clínica de los marcadorestempranos de aneuploid¨ªa en la predicci¨®n de partopret¨¦rmino y bajo peso para la edad gestacional.Material y m¨¦todos. Estudio retrospectivo de 5.192gestaciones ¨²nicas sin alteraciones cromos¨®micas sometidasa cribado combinado de s¨ªndrome de Down entre las 11 y las13,6 semanas de gestaci¨®n (con determinaci¨®n de translucencianucal [TN], ¦Â-gonadotrofina cori¨®nica humana libre[¦Â-hCG] y prote¨ªna plasm¨¢tica-A asociada al embarazo[PAPP-A]), entre abril de 2004 y diciembre de 2007. Los marcadoresbioqu¨ªmicos se expresan en m¨²ltiplos de la mediana(MoM) ajustados seg¨²n longitud cr¨¢neo-caudal (crown-rumplength, CRL), peso materno, h¨¢bito tab¨¢quico y antecedentede diabetes materna. La asociaci¨®n entre los marcadores individualesy/o el ¨ªndice de riesgo combinado con la incidenciade parto pret¨¦rmino (< 37 semanas) y la incidencia debajo peso para la edad gestacional (BPEG) (peso fetal < 5opercentil para las curvas de peso de nuestra poblaci¨®n) seobserv¨® comparando la incidencia relativa en varios puntosde corte.Resultados. Obtuvimos un total de 143 gestaciones pordebajo del 5o percentil de peso (BPEG) frente a 5.049 gestacionespor encima de este punto de corte. Existe una asociaci¨®ninversa y estad¨ªsticamente significativa entre los valoresde ¦Â-hCG y PAPP-A y el BPEG. Con un valor de PAPP-Apor debajo del 3er percentil (0,407 MoM) la odds ratio paraBPEG fue de 2,63 y con un valor de ¦Â-hCG por debajo del3er percentil (0,296 MoM) fue de 3,38. El n¨²mero de gestacionesque finalizaron antes de las 37 semanas fue de 245.Existe una asociaci¨®n inversa y estad¨ªsticamente significativaentre los valores de PAPP-A y el parto pret¨¦rmino. Con un valor de PAPP-A por debajo del 3er percentil (0,401MoM) la odds ratio para parto pret¨¦rmino fue de 2,58.Conclusiones. Los niveles bajos de ¦Â-hCG y PAPP-A en (..) (AU)

Objective. To evaluate the clinical utility of earlyaneuploidy markers in the prediction of pre-term deliveryand low birth weight for gestational age.Material and methods. Retrospective study of 5,192singleton pregnancies with no chromosomal abnormalitiesthat had undergone combined screening for trisomy21 between 11 and 13.6 weeks of gestation (with determinationof nuchal translucency [TN], free ¦Â-human chorionicgonadotrophin [¦Â-hCG] and pregnancy-associatedplasma protein-A [PAPP-A]), from april 2004 to december2007. The biochemical markers are converted to multiplesof the expected normal median (MoM) for a pregnancy ofthe same gestational age and corrected for maternalweight, smoking status and maternal diabetes history.The association between the individual markersand/or the combined risk with the incidence of pre-termdelivery (< 37 weeks) and the incidence of low birthweight for gestational age (fetal weight under the 5thcentile for weight curves in our population) wasestablished comparing the relative incidence in severalcut-offs. Results. We obtained 143 gestations in the low birthweight for gestational age group (under the 5th centile)and 5,049 pregnancies with weight above that cut-off.There is a statistically significant inverse associationbetween maternal serum ¦Â-hCG and PAPP-A MoM andthe risk of low birth weight for gestational age. WhenPAPP-A is under the 3rd centile (0.407 MoM) the oddsratio for low birth weight for gestational age is 2.63 andwhen ¦Â-hCG is under the 3rd centile (0.296 MoM) theodds ratio is 3.38. The number of pregnancies that finishedbefore the 37th week was 245. There is a statisticallysignificant inverse association between PAPP-A levelsand pre-term delivery. When PAPP-A is under the 3rdcentile (0,401 MoM) the odds ratio for pre-term deliveryis 2.58. (..) (AU)

QF-PCR frente a cariotipo convencional en amniocentesis precoz. ¿Puede sustituirse una técnica por otra ante determinadas indicaciones? / Single QF-PCR as an alternative to traditional cytogenetic karyotyping in early amniocentesis

QFIntroducción.La técnica de quantitative fluorescentpolymerase chain reaction (QF-PCR) permite la detecciónprenatal de las principales aneuploidías (21, 18, 13, X e Y)con una gran fiabilidad, mayor rapidez y menor coste comparadocon las técnicas de citogenética clásica. El debateactual se centra en la posibilidad de sustituir el cariotipoconvencional por una técnica de QF-PCR aislada frente adeterminadas indicaciones.Objetivos. Primero, comparar la tasa de detección delas anomalías cromosómicas clínicamente relevantes mediantecariotipo convencional (gold standard) y QF-PCR paralos cromosomas 21, 18, 13, X e Y en las muestras prenatalesobtenidas mediante amniocentesis.Segundo, la estratificación del riesgo residual de no detectaranomalías cromosómicas clínicamente relevantes medianteQF-PCR de acuerdo a la indicación de la técnica.Material y métodos. Revisamos retrospectivamente loscariotipos prenatales realizados mediante amniocentesis ennuestro departamento durante el período enero de 2006 adiciembre de 2008. Las principales indicaciones de la técnicainvasiva son: edad materna avanzada (> 38 años), cribadocombinado o bioquímico de alto riesgo para síndrome deDown (SD) (> 1/270), anomalía fetal detectada en la ecografía,antecedentes familiares de cromosomopatía y ansiedad.Comparamos el resultado del cariotipo convencional con elteóricamente obtenido si hubiéramos realizado exclusivamenteuna técnica de QF-PCR. (..) (AU)

The rapid detection of aneuploidies byquantitative fluorescent polymerase chain reaction (QFIntroducción PCR) allows reliable prenatal diagnosis of commonaneuploidies (21, 18, 13, X and Y). Discussion has beenraised as to whether single QF-PCR could be an alternativeto traditional cytogenetic karyotyping for certain referralcategories.Objective. First, to determine the suitability of replacingfull karyotype analysis with QF-PCR for prenataldiagnosis in amniotic fluid samples obtained by amniocentesis.Second, to evaluate an indication-based classificationof cases at risk of missing clinically relevant chromosomaldisorders by QF-PCR. Methods. We reviewed all fetal karyotypes obtainedby amniocentesis done at our centre between January2006 and December 2008. We compared the cytogeneticfindings obtained through conventional karyotype withthose that would have been theoretically obtained usingQF-PCR. Outcome measures included (i) the proportionof prenatal samples with abnormal karyotypes thatwould not have been detected by QF-PCR, as a wholeand for each indication, and (ii) pregnancy outcome foreach chromosome abnormality that was predicted to beclinically significant or of uncertain significance andwould not have been detected by PCR. (..) (AU)

Early prenatal diagnosis of major cardiac anomalies in a high-risk population.

OBJECTIVE: To examine the accuracy of early fetal echocardiography performed in a high-risk population combining transvaginal and transabdominal routes. METHODS: A series of 330 high-risk pregnancies were screened by transvaginal and transabdominal scan at 12-17 weeks' gestation in a prospective multicentre trial in Spain between September 1999 and May 2001. A total of 334 fetal heart examinations were performed, including four twin pregnancies. Maternal age ranged from 17 to 46 years (mean 33 years with 36% of women over 34 years). The median gestational age at scan was 14.2 weeks (range 12-17 weeks). For each fetus, visualization of the four-chamber view, the origin of the great arteries, aortic and ductal arches and systemic venous return was attempted in a segmental approach. B-mode and colour/pulsed Doppler flow imaging were used in all cases. The duration of complete heart examination was less than 30 minutes. The examinations were performed by three experienced operators. Reliability was assessed by conventional transabdominal echocardiography at 20-22 weeks, by postnatal follow-up in the first three months of life, and/or by autopsy in cases of termination of pregnancy. RESULTS: The rate of successful visualization of the fetal heart was 94.6% (316/334). In 48 out of 334 (14.4%) fetuses the final diagnosis was abnormal. In 38 out of 48 (79.2%) cases with heart defects the diagnosis was suspected at early echocardiography. In the group with congenital heart defects, 27 cases had an abnormal karyotype (56.3%) and 31 cases showed extracardiac anomalies (64.6%). There were 10 false-negative cases at early scan. There were no false-positive diagnoses. CONCLUSIONS: This experience stresses the usefulness of early fetal echocardiography when performed by expert operators on fetuses specifically at risk for cardiac disease. The high rate of successful visualization of the fetal heart provides a reliable diagnosis of major cardiac defects at this early stage of pregnancy.

Uropatías obstructivas / Nephrourologic obstructive processes

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