[Risk factors of prematurity. A case control study]. / Factores de riesgo para la prematurez. Estudio de casos y controles.

BACKGROUND: Prematurity is the most frequent cause of perinatal morbidity and mortality, and is responsible with 75% of neonantal deaths not related to congenital defects. OBJECTIVE: The aim of this study was to know risk factors that influence premature delivery in a third level attention in a Gyneco-Obstetric Unit. MATERIAL AND METHODS: In a case-control study, was conducted an interview with 300 mothers who had their delivery at 28 and 36 gestational weeks in group of cases and 600 mothers from 37 to 41 weeks in controls, who assisted for attention from April to September 2011. RESULTS: The factors associated eighth higher risk for prematurity were: maternal age above 35 years was more frequent in cases (14.6%), previous placenta occurred more frequent in cases (9.3%), Infectious disease were highly present in cases such as: urinary tract infection (46%). But association of 2 or more factors such as premature rupture of membranes and cervicovaginitis, were more frequent significantly in study group (76%). CONCLUSIONS: The prematurity risk factor more freqeunt were: infectouse disease in study group. A deficient prenatal attention can be increased in order to prevent premature delivery. When 2 or more factors associated in a gestation the risk also increase, and should increase the following and medical attention to reduce premature risk.

Doppler ultrasound evaluation in preeclampsia.

BACKGROUND: Worldwide preeclampsia (PE) is the leading cause of maternal death and affects 5 to 8% of pregnant women. PE is characterized by elevated blood pressure and proteinuria. Doppler Ultrasound (US) evaluation has been considered a useful method for prediction of PE; however, there is no complete data about the most frequently altered US parameters in the pathology. The aim of this study was to evaluate the uterine, umbilical, and the middle cerebral arteries using Doppler US parameters [resistance index (RI), pulsatility index (PI), notch (N), systolic peak (SP) and their combinations] in pregnant women, in order to make a global evaluation of hemodynamic repercussion caused by the established PE. RESULTS: A total of 102 pregnant Mexican women (65 PE women and 37 normotensive women) were recruited in a cases and controls study. Blood velocity waveforms from uterine, umbilical, and middle cerebral arteries, in pregnancies from 24 to 37 weeks of gestation were recorded by trans-abdominal examination with a Toshiba Ultrasound Power Vision 6000 SSA-370A, with a 3.5 MHz convex transducer. Abnormal general Doppler US profile showed a positive association with PE [odds ratio (OR) = 2.93, 95% confidence interval (CI) = 1.2 - 7.3, P = 0.021)], and a specificity and predictive positive value of 89.2% and 88.6%, respectively. Other parameters like N presence, RI and PI of umbilical artery, as well as the PI of middle cerebral artery, showed differences between groups (P values < 0.05). CONCLUSION: General Doppler US result, as well as N from uterine vessel, RI from umbilical artery, and PI from umbilical and middle cerebral arteries in their individual form, may be considered as tools to determine hemodynamic repercussion caused by PE.

Diagnóstico prenatal de cierre prematuro del foramen oval e hidrops fetal / Prenatal diagnosis of foramen ovale premature closure and hydrops fetalis

A case of premature closure of foramen ovale (PCFO) is presented. The patient was sent to the Fetal Maternal Unit after 30 weeks of gestation due to hydrops fetalis. A Doppler ultrasound performed after 34 weeks of gestation showed no interatrial flow and led to the confirmation of PCFO, associated to pleural effusion and ascitis. No evidence of hydrops, pleural effusion, ascitis, cardiac failure, cardiac defects nor chromosomal abnormalities were present in the newborn baby. Since prenatal diagnosis of PCFO is a life threatening condition, detection improves fetal and neonatal life expectancy (AU)

Se reporta el cierre prematuro de foramen oval (CPFO) en un embarazo de 30 semanas de gestación, enviado con hidrops fetal a Unidad de Medicina Materno Fetal. A las 34 semanas se evaluó con Ultrasonido Doppler y se observó falta de flujo entre aurículas, confirmando el CPFO, presencia de derrame pleural y ascitis. Después del nacimiento, al neonato se le descartó la presencia de hidrops, derrame o ascitis, insuficiencia cardiaca, defectos cardiacos o cromosomopatía, y egresó sano. El CPFO pone en riesgo la vida. Cuando es detectado prenatalmente mejora la expectativa de vida fetal y neonatal (AU)

[Prenatal diagnosis of choledochal cyst]. / Quiste de colédoco detectado prenatalmente.

The choledocal cyst is a defect of the biliary extrahepatic route, the incidence is 1 in 100-150,000 newborns. This paper reports the case of a female newborn with choledocal cyst detected prenatally, from a 32-year-old mother, 2nd term pregnancy, who was diagnosed in the routine obstetric ultrasound as an abdominal fetal cyst. An anatomic obstetric ultrasound confirmed the diagnosis that was defined of a probable hepatic origin. Newborn was delivered at 39 weeks by caesarean section, with weight of 3,980 g and Apgar score 9-9 in conventional time. Newborn presented a maxim bilirubin level of 16 mg, controlled with phototherapy; the hepatic function was normal. Ultrasound showed a choledocal cyst which measured 50 x 49 x 48 mm, with dilatation of the hepatic common conduct, the gall bladder was normal. The abdominal scan reported a cystic mass in the middle abdominal region of 44 x 53 x 52 mm confirming a choledocal cyst. The diagnosis was confirmed after surgery. Patient had a satisfactory post-surgical evolution.

[Perinatal outcome of pregnancies in advanced maternal age]. / Hallazgos perinatales de embarazos en edad materna avanzada.

BACKGROUND: Traditionally an advanced maternal age have been associated with a higher risk of unfavorable perinatal results. OBJECTIVE: to know the perinatal outcomes in women giving birth at age 40 or older during a year in a concentration hospital located at Monterrey, Nuevo León. PATIENTS AND METHODS: In a retrospective, cross-sectional, study. RESULTS: 163 women and 170 newborn were included. A newborn death (5.8 x 1000 RN) and no one maternal death was observed. The most frequent maternal associated disease was gestational diabetes (16%) followed by the hypertensive disorders (10%). The cesarean rate was 71.1% and the most frequent indication was previous cesarean. The most frequent hospitalization cause was early premature labour (4.2%). Premature membrane was observed in 11% of patients. The mean delivery time was at 38 weeks with a mean body weight of 3032 g. There were 5 newborn with congenital malformations (2.9%). 21 newborns were hospitalized (12%) and the most frequent indication was prematurity. CONCLUSION: Women giving birth at age 40 or older observed a higher gestational diabetes incidence followed by the pregnancy-induced hypertension. The cesarean delivery was the most frequent mode of delivery. We consider that the perinatal outcomes in this study were favorable for both mother and child.

[Pituitary tumor detected prenatally]. / Tumor hipofisiario detectado prenatalmente.

INTRODUCTION: Brain tumors are present in 2.9 per 100,000 newborn. Craniopharyngioma is a benign and slow growing brain tumor, frequently localized in the sellar and suprasellar region. There are few reports of pituitary tumor detected prenatally. CASE REPORT: We report a neonate with a craniopharyngioma detected prenatally as a pituitary tumor. In a 23 year old mother, second gestation, with no important history, was detected a sellar tumor at 31 gestation weeks, the obstetric ultrasound reported a suprasellar tumor of 2 per 3 cm diameter. Pregnancy ended in a vaginal delivery at 39 weeks, and obtained a 3.9 kg female, with cephalic diameter of 37.5 cm, the Apgar score was 8-9 at 1st and 5th minutes. In early neonatal period was scanned and confirmed a 3.2/2.3/2.9 cm suprasellar tumor with calcium deposits. The Paediatric Oncology department suggested a surgery and was realized a craniotomy at 3rd week of age. The surgery allowed to obtain 30% of the tumor and confirmed by histology craniopharyngioma. Patient had favourable evolution and was discharged at 3 months of age. CONCLUSIONS: We report a neonate in who was detected by prenatal ultrasound the presence of a suprasellar solid tumor, scan and magnetic resonance images in neonatal period defined its size and location and a craniopharyngioma was confirmed by histology. Patient had a satisfactory postsurgical evolution and was discharged at 3 months of age.

[Perinatal mortality in multiple pregnancies]. / Mortalidad perinatal en embarazos múltiples.

BACKGROUND: The incidence of multiple pregnancies has increased over the last decade and hence the hospital stay and perinatal morbidity and mortality. OBJECTIVE: to know the perinatal mortality rate of multiple pregnancies treated in a regional hospital. MATERIAL AND METHODS: Retrospective study conducted from the hospital records of deaths that occurred from January 2002 to December 2007 at the Hospital Regional de Especialidades No. 23 IMSS, Monterrey, Nuevo Leon, Mexico. RESULTS: during the study period (six years) were 122,822 births and 95 were multiple pregnancies (0.77/1000 births): 81 (85%) of triplets, 11 (11%) of quadruplets, two of quintillizos and one sextillizos with a total of 303 newborns. 26% (25/95) of multiple pregnancies had one or more deaths. The perinatal mortality rate was 165/1000 births (50/303) compared with that of pregnancies with one fetus in the same period 14.5/1000 births (p<0.0001). 20.9% (17/81) of triplet pregnancies and 54.5% (6/11) of the four had one or more deaths (p<0.02), with a perinatal mortality rate of 131/1000 births (32/243) and 295/1000 births (13/44) (p<0.006), respectively. Only 2/10 (20%) of newborns in two pregnancies quintillizos died and 3/6 (50%) of a pregnancy sextillizos. There was no difference in the proportion of sexes, but in the average weight of newborns: the weight of the triplets was alive vs dead vs 1659 g 713 g (p<0.0001) and the quadruplets from 750 g vs 1341 g (p<0.0007), respectively. CONCLUSIONS: 26% of multiple pregnancies had one or more deaths and 15% of the neonates died (165/1000 births). Multiple pregnancies were complicated with one or more deaths at 20% of triplets, 54% of quadruplets and 100% of quintillizos. The perinatal mortality rate of pregnancies with multiple fetuses 3 and 4 was No. 131/1000 and No. 295/1000, respectively.