ABSTRACT
Objetivo: Determinar si es factible visualizar marcadores de espina bífida abierta (EBA) en el primer trimestre, de forma sencilla, rápida y sin utilizar biometrías. Realizar biometría de diferentes estructuras en el cerebro posterior, determinando su evolución según la edad gestacional. Material y métodos: Estudio prospectivo de 362 gestantes. De febrero a diciembre de 2013. Con 11-13+6 semanas (LCR: 45-84mm). Exploración vaginal y abdominal. Plano sagital medio, dorso posterior, visualizándose los marcadores de referencia para la medida de la translucencia nucal (TN). Observación de 4 líneas ecogénicas paralelas en el cerebro posterior: 1.ª) Borde posterior hueso esfenoidal. 2.ª) Borde posterior tronco encéfalo-anterior IV ventrículo. 3.ª) Plexos coroideos IV ventrículo. 4.ª) Hueso occipital. Estas líneas delimitan 3 espacios econegativos de similar ecogenicidad: 1.°) Tronco encéfalo. 2.°) IV ventrículo. 3.°) Cisterna magna, obteniendo sus biometrías y ratio tronco encéfalo/tronco encéfalo-hueso occipital. Resultados: LCR medio 64,65 (rango: 46,97-84). Fue posible obtener plano sagital medio y visualizar 4 líneas-3 espacios y biometría en el 98,6%. Las biometrías son concordantes con la bibliografía, aumentan con la edad gestacional y son de espesor decreciente. El ratio se mantiene constante. Ningún feto, valorado en la ecografía de la semana 20 o al nacimiento, tenía EBA. Confirmamos la utilidad de obtener esta vista tras cerrar el estudio, en un caso en que identificamos solo 3 líneas-2 espacios y ello nos impulsó a dirigir nuestra atención hacia el raquis y diagnosticar una EBA a nivel lumbosacro. Conclusiones: Se precisan estudios, pero proponemos integrar la simple visualización de 4 líneas-3 espacios como cribado rutinario de EBA. Si es anormal o dudosa, procederían biometrías y examen cráneo-raquídeo más minucioso, sin olvidar la opción de una ecografía intermedia
Objective: To determine the feasibility of visualizing markers of open spina bifida (OSB) in the first trimester in a simple, fast manner without the use of biometrics. To conduct biometrics of the different structures of the hindbrain, establishing changes in these structures depending on gestational age. Material and methods: We conducted a prospective study in 362 pregnant women from February-December 2013. The women were at 11-13+6 weeks of pregnancy (crl: 45-84mm.). Vaginal and abdominal examinations were carried out. The fetus was viewed in mid-sagittal plane, rear back, with visualization of the reference markers for nuchal translucency (NT). View of 4 echogenic parallel lines in the hindbrain: 1st. Sphenoid bone rear ridge. 2nd Rear ridge of the anterior brainstem of the forth ventricle. 3rd Fourth ventricle choroid plexus. 4th Occipital bone. These lines delimit 3 echonegative spaces of similar echogenicity: 1st Brainstem. 2nd Forth ventricle. 3rd Cisterna magna. Their biometries and the brainstem/brainstem- occipital bone ratio were obtained. Results: The mean crl was 64.65mm (range 46.97-84). It was possible to obtain a mid-sagittal plane and visualize 4 lines-three spaces and a biometry in 98.6%. The biometrics were in agreement with those reported in the literature; they increased with gestational age and their thickness decreased. The ratio was constant. None of the fetuses evaluated in the 20th week ultrasonography and/or at birth had OSB. We confirm the usefulness of obtaining this view after finishing the study, in a case in which we only identified 3 lines-2 spaces, which prompted us to focus on the spine and diagnose OSB at a lumbosacral level. Conclusions: Further studies are required, but we suggest including simple visualization of 4 lines-3 spaces as a routine step in OSB screening. If this visualization is abnormal or questionable, biometrics and a more meticulous cranio-spinal examination should be carried out taking into account the option of ultrasonography
Subject(s)
Humans , Female , Pregnancy , Spina Bifida Cystica/diagnosis , Nuchal Translucency Measurement/methods , Prenatal Diagnosis/methods , Pregnancy Trimester, First , Mass Screening/methods , Prospective Studies , Ultrasonography, Prenatal/methodsABSTRACT
The eustachian valve, or valve of the inferior vena cava, is an embryogenic derivative of the right valve of the sinus venosus. Although it generally disappears during fetal life, its persistence may simulate symptoms of cardiac disease, particularly those associated with atrial tumors. We describe a case of prenatal diagnosis of a persistent, large and prominent eustachian valve with redundant tissue attached to the junction of the inferior vena cava and the right atrium. The neonate was asymptomatic and was healthy at 7 months of age at the time of writing. This is the first time that this finding has been diagnosed prenatally.
