ABSTRACT
OBJECTIVES: Quality control of ultrasonography markers is necessary to ensure greater efficacy of prenatal aneuploidy screening. The aim of this study was to assess the quality of the crown-rump length (CRL) and nuchal translucence (NT) measurement accuracy by the laboratory according to quality indicators. METHODS: Retrospective observational study on 4,908 single-foetus pregnant women who underwent prenatal aneuploidy screening in the first trimester of pregnancy. Euploid foetuses with CRL between 45 and 84 mm were included, while those with NT≥3.5 mm were excluded. CRL measurement was considered to be accurate if the median multiples of the median (MoM) for pregnancy-associated plasma protein A (PAPP-A) was between 0.90 and 1.10. Fifteen sonographers participated in the study, six of whom comprised the control group. Systematic error for a sonographer was considered when CRL measurement was greater than ±2 mm with respect to the control group. Quality for NT was assured by means of the WHIRI method and each sonographer cumulative sum control chart (CUSUM). RESULTS: For CRL accuracy, five sonographers underestimated the measurements, while another four overestimated them, with no statistical differences. For smaller sized foetuses, all sonographers met the established specifications. Regarding NT control, three sonographers did not meet the quality criteria for the median MoM. All sonographers met the specifications for the logarithmic standard deviation of the NT MoM levels. Thirteen sonographers met the CUSUM specifications. CONCLUSIONS: Evaluation of a quality control of ultrasonography parameters by laboratory professionals is necessary to avoid under- or overestimation tendencies for CRL and NT measurements. CUSUM is a useful tool for the immediate correction of errors in NT measurements.
ABSTRACT
Objetivo: presentación de un caso recurrente de una patología fetal poco frecuente y revisión de posibles etiologías de la misma. Material y métodos: estudio descriptivo de caso único de hemorragia fetal intracraneal no asociada a prematuridad con recurrencia en siguiente gestación. Resultados: presentamos el caso de una gestante cuya sospecha se estableció en la semana 27 de gestación mediante control ecográfico seriado y con antecedente de feto con hemorragia fetal intracraneal de IV grado. Presentamos igualmente la evolución de ambos hijos ya que decidió continuar con la gestación. Conclusiones: La hemorragia fetal intracraneal es una entidad cuya incidencia es desconocida y cuya etiología generalmente no se conoce. Además la recurrencia es muy improbable. Con un mayor conocimiento de las etiologías probables sería posible una mejor prevención y asesoramiento a los progenitores
Objective: Report on a recurrent case relating to a rare fetal pathology and review of its etiologies. Material and methods: a descriptive study of a case of intracranial fetal hemorrhage not associated with prematurity and with recurrence in the following gestation. Results: we report the case of a pregnant woman, in which we suspected a recurrence of fetal intracranial hemorrhage at week 27 of gestation by means of serial ultrasound monitoring, and with a history of fetus with intracranial IV grade fetal hemorrhage. We also present the evolution of both children, since the parents decided to continue with the pregnancy. Conclusions: Intracranial fetal hemorrhage is an unknown entity and of which etiology is not generally known. In addition, recurrence is very unlikely. With a greater knowledge of probable etiologies, prevention and advice to parents would be better
Subject(s)
Humans , Female , Pregnancy , Adult , Cerebral Hemorrhage/diagnostic imaging , Cerebral Ventricles/diagnostic imaging , Hydrocephalus/diagnostic imaging , Prenatal Diagnosis/methods , Ultrasonography, Prenatal/methods , Risk Factors , Genetic Counseling/methodsABSTRACT
En los fetos de sexo femenino, los quistes ováricos son las anomalías intraabdominales que se diagnostican con mayor frecuencia durante el embarazo. La mayoría son diagnosticados de forma incidental entre el segundo y el tercer trimestre de gestación como consecuencia de una exploración rutinaria ecográfica. Presentamos el caso de una gestación en la que se observaron prenatalmente quistes ováricos fetales bilaterales. El neonato requirió intervención quirúrgica a los 27 días de vida y en ella se comprobó que ambos ovarios se habían torsionado y autoamputado (AU)
Ovarian cysts are the most frequent intraabdominal anomalies in female fetuses. Most are diagnosed incidentally during the second or third trimester of pregnancy in routine ultrasound examinations. We present the case of a fetus who was prenatally diagnosed with bilateral cystic abdominal masses. The neonate needed surgery on the 27th day of life, revealing that these masses represented a hemorrhagic cyst arising from the ovaries, which had undergone torsion and auto-amputation (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Ovarian Cysts/diagnosis , Prenatal Diagnosis/methods , Prenatal Diagnosis , Ovarian Cysts/physiopathology , Ovarian Cysts , Prenatal Diagnosis/trends , Ovary/abnormalities , Ovary , Magnetic Resonance Imaging/methodsABSTRACT
BACKGROUND: Our objective was to evaluate the impact of antiretroviral therapy (ART) in the prevention of maternal-fetal HIV transmission in a population of HIV-infected pregnant women. PATIENTS AND METHOD: We studied prospectively all HIV-infected pregnant women attended in our hospital from January 1995 to December 2000. We offered treatment with zidovudine (ZDV) alone or in combination according to women's requirements. RESULTS: There were 98 mother-infant pairs and we studied 93 of them. The rate of vertical transmission was 1.4% when ART was started in pregnancy. Risk of HIV transmission was greater in mothers not being treated with ART during pregnancy (relative risk [RR]: 18; 95% confidence interval [CI]: 2.2-145.4), in mothers who only received ZDV at delivery and child vs those who received ART during pregnancy (RR: 16.4; 95% CI: 1.8-145.6) and in mothers who were active intravenous drug users (RR: 9.3; 95% CI: 2.2-38.5), with significant differences between vaginal delivery and caesarean section. CONCLUSIONS: We observed a substantial benefit from ART, especially in the group of HIV-infected pregnant women who started treatment during pregnancy. Preventive interventions are needed.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/prevention & control , HIV Infections/transmission , HIV-1 , Infectious Disease Transmission, Vertical/prevention & control , Zidovudine/therapeutic use , Adult , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious , Prospective Studies , Spain , Time FactorsABSTRACT
FUNDAMENTO: Evaluar el impacto de la terapia antirretroviral (TAR) en la prevención de la transmisión materno-fetal, en una población de gestantes infectadas por el virus de la inmunodeficiencia humana (VIH).PACIENTES Y MÉTODO: Se estudiaron prospectivamente todas las gestantes infectadas por el VIH atendidas en nuestro hospital desde enero de 1995 a diciembre de 2000. Se ofreció tratamiento con zidovudina (ZDV) en monoterapia o en combinación, según requerimientos de la gestante. RESULTADOS: Se obtuvieron 98 pares madre-niño de los cuales pudieron estudiarse 93. La tasa de transmisión vertical fue de 1,4 por ciento cuando la TAR se inició durante el embarazo. El riesgo de transmisión del VIH fue mayor en madres sin TAR durante el embarazo (riesgo relativo [RR] = 18, intervalo de confianza [IC] del 95 por ciento, 2,2-145,4), en madres que sólo recibieron ZDV en parto y niño frente a las que tomaron TAR durante el embarazo (RR = 16,4; IC del 95 por ciento, 1,8145,6) y en madres usuarias de drogas por vía parenteral activas (RR = 9,3; IC del 95 por ciento, 2,238,5), con diferencias significativas entre parto vaginal y cesárea. CONCLUSIONES: Se evidenció un notable beneficio de la TAR, sobre todo en el grupo de gestantes infectadas por el VIH que iniciaron el tratamiento durante el embarazo. Se constata la necesidad de medidas preventivas (AU)
