Sonographic Evaluation of Fetal Adrenal Gland in Gestational Diabetes: Relation to Fetal Growth and Maternal Biochemical Markers.

OBJECTIVES: To relate measurements and volume of the fetal adrenal gland in third trimester ultrasound in diabetic pregnancies (1) to birth weight; (2) to other sonographic markers of diabetic fetopathy (expected fetal weight, sectional area, and fractional volume in fetal limbs); and (3) to maternal biochemical markers of diabetes (HbA1c, leptin). METHODS: Fetal adrenal gland measurements were obtained between 32 and 34 weeks. The gland length, width, depth, and volume (by Virtual Organ Computer-Aided Analysis [VOCAL]) were measured for total gland and fetal zone. Fetal total and fat sectional area and fractional volume were obtained in arm and thigh. A maternal blood sample was obtained. Univariate and multivariate models were used to assess the associations. RESULTS: Thirty-nine diabetic pregnancies were included. Birth weight related significantly to total and fetal zone adrenal depth, and total adrenal volume in third trimester. Total adrenal length and corrected adrenal gland volume also showed a significant correlation to birth weight percentile in univariate and multivariate models. Total adrenal volume associated significantly to total and fat areas and volumes in fetal limbs. Both maternal leptin and HbA1c levels found a significant positive relation to fetal total adrenal volume and corrected adrenal gland volume. Total adrenal gland volume showed a significant association to maternal HbA1c level in multivariate model. CONCLUSIONS: An enlargement of the fetal adrenal gland may be observed in gestational diabetes, not only related to birth weight, but also to distinctive features of diabetic pregnancies, such as fat tissue fetal deposits or maternal biochemical markers.

Weight-related and analytical maternal factors in gestational diabetes to predict birth weight and cord markers of diabetic fetopathy.

OBJECTIVE: The objective was to determine the value of clinical and analytical maternal factors to predict birth weight and umbilical cord biochemical markers of diabetic fetopathy. METHODS: Prospective evaluation of gestational diabetes pregnancies (n = 50). Maternal weight-related clinical and analytical factors were collected during pregnancy. After birth, an umbilical cord sample was taken. RESULTS: Univariate linear regression analysis showed relationship between maternal weight, glycated hemoglobin (HbA1c) and insulin-like growth factor 1 (IGF1) with birth weight percentile. A significant association was found between maternal weight and cord insulin and C-peptide. Maternal HbA1c, leptin and insulin during pregnancy showed a positive linear association to cord leptin, insulin and C-peptide. In multivariate analysis models, final maternal BMI showed an independent positive association with cord C-peptide. CONCLUSIONS: Maternal weight-related and analytical parameters show diagnostic value to birth weight and cord markers.

Fetal limb soft tissue assessment for prediction of birth weight and umbilical cord blood analytes in gestational diabetes.

OBJECTIVE: To evaluate the value of third trimester ultrasound (estimated fetal weight, cheek-to-cheek diameter, sectional Wharton's jelly area, sectional areas and fractional volumes in extremities) to predict birth weight and cord biochemical markers at birth (leptin, insulin, c-peptide, IGF1, erythropoietin and ferritin) in diabetic pregnancies. METHOD: Prospective study in 49 patients with gestational diabetes. An ultrasound was performed between 32 and 34 weeks. Clinical data were collected, and a blood sample was obtained from cord after birth. ROC curve models were evaluated for 75(th) and 90(th) birth weight percentile. Univariate and multivariate models were used to assess the association between ultrasound and neonatal outcomes. RESULTS: Sectional areas and fractional volumes showed significant differences and highest AUC values for predicting birth weight. A significant association was found for extremities measurements with total birth weight and its percentile. The only marker which showed a significant association to estimated fetal weight was erythropoietin. Sectional areas and fractional volumes related to cord leptin, erythropoietin, insulin and c-peptide. CONCLUSION: Sectional areas and fractional volumes improve the predictive value of estimated fetal weight in diabetic pregnancies. They also show a predictive association to biochemical changes in cord (leptin, insulin and erythropoietin) related to increased adiposity and risk of fetal hypoxia. © 2015 John Wiley & Sons, Ltd.

Clinical value of maternal bile Acid quantification in intrahepatic cholestasis of pregnancy as an adverse perinatal outcome predictor.

AIMS: To evaluate the correlation between perinatal outcome and bile acid levels in intrahepatic cholestasis of pregnancy (ICP), and to evaluate variations in the mean bile acid level when stratifying by maternal and perinatal factors. A comparison between mild and severe ICP was made. METHODS: A prospective observational study was performed in pregnant patients who underwent blood tests for bile acids due to persistent pruritus. Based on bile acid levels, maternal and neonatal data were obtained and were compared between patients presenting with ICP and gestational pruritus (normal bile acid level). RESULTS: A total of 145 patients were included, 47 of whom were diagnosed as ICP (52 newborns) and 98 as gestational pruritus (102 newborns). The ICP group had a higher rate of NICU admission (14/42 vs. 6/98, p < 0.001) and global neonatal morbidity (13/42 vs. 9/98, p = 0.002), but these differences were no longer seen after adjusting for gestational age, singleton pregnancies and induction of labour. Patients presenting with severe ICP (maximum bile acids levels above 40 µmol/l) showed a higher rate of meconium-stained amniotic fluid (0/28 vs. 4/14, p = 0.009), NICU admission (9/34 vs. 11/17, p = 0.01) and neonatal global morbidity (5/32 vs. 8/17, p = 0.02). CONCLUSIONS: ICP patients have higher rates of adverse neonatal outcomes when compared to those with gestational pruritus. Some of this neonatal morbidity may be secondary to late spontaneous preterm deliveries, multiple gestation and a policy of elective induction of labour after 37 weeks of gestation. A comparison of outcomes among patients with mild and severe ICP shows that the severely affected group has higher rates of meconium-stained amniotic fluid and neonatal morbidity.

Sífilis y embarazo: estudio de 94 casos / Syphilis and pregnancy: Study of 94 cases

Fundamento y objetivo: Estudiar la epidemiología, manifestaciones clínicas, diagnóstico, tratamiento, seguimiento y resultados perinatales de la sífilis durante el embarazo. Pacientes y método: Estudio retrospectivo de 94 gestantes con sífilis cuya gestación y parto se controlaron en un Servicio de Obstetricia desde 2002 a 2010 entre un total de 85.806 partos de gestantes sin sífilis en el mismo período. Resultados: La prevalencia de sífilis en el embarazo fue de 0,11%. La mayoría de las gestantes eran de procedencia extranjera y el tipo de sífilis más prevalente fue la latente tardía. Realizaron el tratamiento correcto solo 57 pacientes, a pesar de la adecuada prescripción médica. En 31 gestantes se comprobaron complicaciones maternas durante el embarazo y en 16 casos hubo complicaciones fetales. En los neonatos se diagnosticaron 4 casos de sífilis congénita, 3 de ellos con meningitis sifilítica, cuyas madres no habían realizado el tratamiento de forma correcta. Conclusiones: La realización obligatoria de una serología de sífilis en el primer trimestre de embarazo permite diagnosticar muchos casos de sífilis latente tardía. Tras la detección precoz de las gestantes infectadas se debe asegurar la correcta realización del tratamiento para prevenir la transmisión vertical (AU)

Background and objective: To study the epidemiology, diagnosis, treatment strategies and perinatal outcomes of gestational syphilis. Patients and method: We performed a retrospective study of 94 pregnant women with syphilis whose gestation and delivery were monitored in a Department of Obstetrics from 2002 to 2010 among a total of 85,806 births of women without syphilis in the same period. Results: The prevalence of gestational syphilis was 0.11%. Most of the women were foreign and the most prevalent type was late latent syphilis. Only 57 patients underwent right treatment despite adequate prescription. Maternal complications were confirmed in 31 pregnant women and 16 cases had fetal complications. We diagnosed 4 cases of neonatal syphilis, 3 of them with syphilitic meningitis, whose mothers had not completed the treatment correctly. Conclusions: The implementation of a mandatory syphilis serology in the pregnancy has enabled us to diagnose many cases of late latent syphilis. The successful completion of treatment must be ensured to prevent vertical transmission (AU)

Fetal magnetic resonance imaging and neurosonography in congenital neurological anomalies: supplementary diagnostic and postnatal prognostic value.

OBJECTIVE: To compare the diagnostic conclusions between fetal neurosonography and MRI in the cases of congenital neurological abnormalities, and with postnatal clinical and imaging evaluation, when available. METHODS: A retrospective study of 28 patients who underwent a fetal MRI study for suspected congenital neurological anomalies. The diagnoses obtained by neurosonography and MRI were collected and compared. Both of them were compared with the final diagnosis when available by necropsy or postnatal evaluation. Postnatal imaging tests were performed only when clinically indicated. RESULTS: The indications for the fetal MRI examination were: fetal ventriculomegaly, posterior fossa anomalies, suspected midline defects, small-for-gestational-age cephalic biometry and confirmed congenital CMV infection. There was a good degree of agreement beyond chance between both techniques (kappa test = 0.76). CONCLUSIONS: Both imaging modalities give a high-diagnostic performance with a good degree of agreement between them, when made by specialized staff. Fetal MRI is a valuable complementary tool to detailed neurosonography which allows an evaluation of the normal brain maturation from the second trimester. It also offers a higher diagnostic performance for some congenital abnormalities such as cortical development or acquired lesions.

[Syphilis and pregnancy: study of 94 cases]. / Sífilis y embarazo: estudio de 94 casos.

BACKGROUND AND OBJECTIVE: To study the epidemiology, diagnosis, treatment strategies and perinatal outcomes of gestational syphilis. PATIENTS AND METHOD: We performed a retrospective study of 94 pregnant women with syphilis whose gestation and delivery were monitored in a Department of Obstetrics from 2002 to 2010 among a total of 85,806 births of women without syphilis in the same period. RESULTS: The prevalence of gestational syphilis was 0.11%. Most of the women were foreign and the most prevalent type was late latent syphilis. Only 57 patients underwent right treatment despite adequate prescription. Maternal complications were confirmed in 31 pregnant women and 16 cases had fetal complications. We diagnosed 4 cases of neonatal syphilis, 3 of them with syphilitic meningitis, whose mothers had not completed the treatment correctly. CONCLUSIONS: The implementation of a mandatory syphilis serology in the pregnancy has enabled us to diagnose many cases of late latent syphilis. The successful completion of treatment must be ensured to prevent vertical transmission.

Successful delivery of a twin pregnancy in a bicornuate uterus (uterus bicornis unicollis) by bilateral Caesarean section.

BACKGROUND: Müllerian duct anomalies occur in 0.1% to 3% of women, and they are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Having a twin pregnancy in a patient with a bicornuate uterus (uterus bicornis unicollis) is rare, especially if it is a spontaneous conception. CASE: A 40-year-old primigravid woman conceived a twin dichorionic diamniotic pregnancy after three years of primary infertility. She was found on 3-D ultrasound examination to have a bicornuate uterus with one fetus in each horn The prenatal course was uncomplicated. At 38 weeks' gestation, twin babies were successfully delivered by elective bilateral low transverse Caesarean section. CONCLUSION: Because the incidence of such pregnancies is very low, it remains unclear whether a twin pregnancy in a bicornuate uterus is better delivered vaginally or by elective Caesarean section.