Placenta accreta spectrum disorders in the first trimester: a systematic review.

Placenta accreta spectrum (PAS) disorders involve an abnormality in the implantation of the placenta, being rarely diagnosed in the first trimester. To conduct a systematic review of the risk factors, clinical and imaging features, and outcomes of histopathologically confirmed cases of PAS disorders in the first trimester of pregnancy. Different databases including PubMed, MEDLINE Complete, Scopus, Web of Science, EMBASE, SciELO, LILACS, and Ovid were reviewed up to November 2018. 55 patients with a definitive histopathological diagnosis were reported. About 18 had a history of prior curettage and 47 of previous caesarean deliveries (CD). About 74.54% presented with miscarriage and ultrasound signs of caesarean scar pregnancy (CSP) were reported in 22.49%. Temporal sequence of diagnostic studies could be determined in 52 women, and, among these, PAS disorders were defined through imaging techniques in 11 (21.15%) while surgical findings unveiled them in 15 (28.84%). Nonetheless, in half of the cases, the diagnosis was concluded only on histopathological samples. PAS disorders in the first trimester of pregnancy are rarely diagnosed through imaging techniques and lead to hysterectomy in most cases. Ultrasound training to detect PAS disorders in women with risk factors is crucial for early diagnosis and prevention of adverse outcomes.

Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women.

An epidemic of Zika virus (ZIKV) infection began in Colombia in October 2015. Previous studies have identified a cause-effect relationship between fetal exposure to the ZIKV and the development of microcephaly and other central nervous system (CNS) anomalies with variable degrees of neurodevelopmental delay. Less is known about the neurodevelopmental outcome of infants without CNS anomalies born to symptomatic ZIKV RT-PCR-positive women. We aimed to compare the neurodevelopmental outcome of these infants to a control group of infants without CNS anomalies born to asymptomatic ZIKV RT-PCR negative women who did not seroconvert during pregnancy. Participating infants were categorized according to ZIKV maternal exposure. Women with symptomatology suggestive of ZIKV infection and a positive RT-PCR for ZIKV were categorized as ZIKV-exposed. Maternal controls (ZIKV unexposed) from the same geographic area were subsequently captured during the tail end of the epidemic through a partner project, the ZIKAlliance, whose aim was to determine the prevalence of ZIKV in pregnant women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). The ZIKV-exposed women were found to be older, had less subsidized health care, had a higher percentage of women in middle-class socioeconomic strata, had higher technical and university education, were less likely to be living with a partner, and had higher rates of pregnancy comorbidity and premature births than ZIKV unexposed women. Compared to infants born to ZIKV unexposed women (unexposed), infants born to ZIKV exposed women (exposed) were of lower gestational age and required more speech and occupational therapy services. No differences between groups were observed in the proportion of cut-off scores <70 on the Bayley-III Scale at 12, 18, and 24 months for motor, language, and cognitive domains. When a cut-off of <85 was used, a higher percentage of motor and cognitive impairment was observed in unexposed infants at 12 and 24 months CA, respectively. Median and IQR score on the Bayley-III scale showed higher scores in favor of exposed infants for motor development at 12 and 18 months CA, language at 12 months, and cognitive domain at 12, 18, and 24 months. The adjusted median and IQR compound score of the difference between exposed and unexposed was higher in favor of exposed infants at 12 to 24 months CA for motor (3.8 [95% CI 1.0 to 6.7]) and cognitive domains (10.6 [95% CI 7.3 to 13.9]). We observed no differences in the language domain (1.9 [95% CI -1.2 to 5.0]). We conclude that infants with no evidence of microcephaly or other CNS anomalies born to ZIKV-exposed women had normal neurodevelopment up to 24 months of CA, supporting an all-or-nothing effect with maternal ZIKV exposure. Long-term follow-up to evaluate school performance is required. Clinical Trial Registration: www.clinicaltrials.gov, NCT02943304.

Fetal central nervous system anomalies according to RT-PCR and trimester of maternal infection with Zika virus: A prospective cohort study.

INTRODUCTION: In October 2015, an epidemic of Zika began in Colombia's geographic areas with a high population of mosquitoes of the genus Aedes. We aimed to describe the fetal brain ultrasound findings in pregnant women with active symptoms or a history of symptoms suggestive of Zika virus (ZIKV) infection. MATERIAL AND METHODS: Eligible pregnant women were tested with reverse transcriptase-polymerase chain reaction (RT-PCR) for ZIKV and followed prospectively using detailed anatomic ultrasound and transvaginal neurosonography to detect structural anomalies of the fetal central nervous system (CNS). RESULTS: A total of 115 symptomatic women with a positive ZIKV RT-PCR and 55 with a negative ZIKV RT-PCR were enrolled in the study; CNS compromise of the fetus occurred in 22% and 17%, respectively (p = 0.255). Callosal dysgenesis (14.5%) was the most frequent anomaly of the CNS, followed by microcephaly (13.6%) and neuronal migration disorders (8.3%). When symptomatic ZIKV RT-PCR-positive women were categorized by trimester of infection, CNS anomalies were present in 40% of first-trimester infections, compared with 21% and 7% in second- and third-trimester infections (p = 0.002). CNS anomalies were also more severe in first-trimester-infected fetuses than in second- and third-trimester-infected fetuses. The high prevalence of CNS anomalies in fetuses of symptomatic ZIKV RT-PCR negative women suggests a high rate of false-negative cases and an even higher prevalence of CNS anomalies than observed in this study. CONCLUSIONS: The prevalence of fetal CNS anomalies was higher than previously reported in the literature for both symptomatic RT-PCR-positive and -negative pregnant women. Corpus callosum anomalies, microcephaly, neuronal migration disorders, and brain parenchymal hyperechogenicities were the most frequent CNS anomalies detected. In addition, CNS anomalies were more frequent and severe in infected fetuses during the first trimester of pregnancy than during the second or third trimester.

Placenta mórbidamente adherente asociada a malformaciones congénitas: reporte de caso / Morbidly adherent placenta associated with congenital malformations: a case report

INTRODUCCIÓN: Las alteraciones en la placentación son causa importante de morbilidad materna y neonatal y, en ocasiones, de mortalidad. La literatura científica menciona la posible asociación entre acretismo placentario y alteraciones en los parámetros bioquímicos para aneuploidía, sin descripciones de casos en que coincidan estos dos hallazgos. OBJETIVO: Este es un reporte de caso de una gestante con placenta percreta y producto con trisomía 13 REPORTE DE CASO: Gestante de 34 años, gesta 4 cesáreas 2, abortos 1, vivos 2, con embarazo de 20.4 semanas, sin antecedentes de importancia, con hallazgos en ecografía de iii nivel de alteraciones morfológicas en el sistema nervioso central, onfalocele, malformación cardiaca y deformidades en miembros. Con doppler de placenta que evidencia placenta mórbidamente adherida variedad percreta; hallazgos ecográficos confirmados con el estudio anatomopatológico. CONCLUSIONES: La trisomía 13 es una condición genética que debido a las múltiples malformaciones asociadas se considera incompatible con la vida, la placenta mórbidamente adherida se ha asociado con morbimortalidad neonatal y fetal, la no evidencia en la literatura de estas dos condiciones asociadas puede ser debido a la interrupción temprana de las gestaciones en las que se confirma el primer diagnóstico.

BACKGROUND: Alterations in placentation are an important cause of maternal and neonatal morbidity and, sometimes, deaths. The scientific literature mentions the possible association between placental accreta and alterations in the biochemical parameters for aneuploidy, without descriptions of cases in which these two findings coincide. OBJECTIVE: This is a case report of a pregnant woman with placenta percreta and trisomy 13, in which an ultrasound and pathological analysis were made. The use of keywords, in different databases, did not yield information that directly comply with these associations. CASE REPORT: A 34-year-old pregnant woman, G4C2A1V2 with a 20.4-week pregnancy, without significant medical records, with findings at III level ultrasound of morphological alterations of the central nervous system, omphalocele, cardiac malformation and limb deformities. Also, with placental Doppler that evidences morbidly adhered placenta variety percreta; ultrasound findings confirmed with the pathological study. CONCLUSION: The morbidly adhered placenta has been associated with neonatal and fetal mortality, in which some of the identified causes of fetal death are congenital anomalies. This way this case report allows for the first time to describe the association of placental accreta with aneuploidy, type trisomy 13, demonstrated by the morphological alterations of the pathological and karyotype study.

Caracterización ecográfica y anatomopatológica de pacientes con artrogriposis múltiple congénita. Serie de casos / Ultrasound and anatomopathological characterization of patients with multiple congenital arthrogryposes. Series of cases

Resumen OBJETIVO: Describir una serie de casos de artrogriposis múltiple congénita reportados en autopsias perinatales y correlacionarlos con los estudios de ultrasonografía prenatal. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo de una serie de casos de autopsias practicadas en el Departamento de Patología de un hospital de tercer nivel de atención entre septiembre de 2016 y abril de 2019. Parámetros de estudio: hallazgos anatomopatológicos de artrogriposis múltiple congénita, de fetos y recién nacidos. RESULTADOS: Se analizaron 8 casos con diagnóstico anatomopatológico de artrogriposis múltiple congénita, 6 de ellos con PCR positiva para Zika virus. Hallazgos ecográficos prenatales: alteración en la movilidad de las extremidades y en el sistema nervioso central (cuerpo calloso y cerebelo); el estudio anatomopatológico confirmó los hallazgos. Desenlaces perinatales: 7 de 8 casos fallecieron durante la primera hora de vida. CONCLUSIONES: Ante la sospecha o confirmación ecográfica de artrogriposis múltiple congénita debe descartarse la coexistencia de procesos infecciosos y valorar, por genética clínica, para descartar alteraciones asociadas.

Abstract OBJECTIVE: To describe a series of cases of multiple congenital arthrogryposes reported in fetal and newborn autopsies, performed in the pathology department of a high complexity hospital, between September 2016 and April 2019. MATERIALS AND METHODS: A retrospective descriptive study of a series of cases of autopsies, with anatomopathological findings of multiple congenital arthrogryposes, performed on fetuses and newborns, during the established time lapse. RESULTS: The analysis included 8 cases with an anatomopathological diagnose of multiple congenital arthrogryposes, six of them with PCR positive for ZIKA. Among the ultrasound reports, altered limb movement and abnormal central nervous system development (corpus callosum and cerebellum), were the main findings; which were confirmed by the anatomopathological study. Regarding perinatal results, 7/8 cases died during the first hour of life. CONCLUSION: In case of suspicion or confirmation of multiple congenital arthrogryposes by ultrasound, infectious processes should be ruled out; also, a clinical genetics consult should be sought to exclude associated alterations.

Accuracy of 2D ultrasound and Doppler ultrasound findings for the diagnosis of placenta accreta in pregnant women with risk factors / Exactitud de los hallazgos ecográficos 2D más ecografía doppler para el diagnóstico de acretismo placentario clínico en gestantes con factores de riesgo

ABSTRACT Objective: To determine the accuracy of 2D ultrasound and Doppler ultrasound for the diagnosis of placenta accreta in pregnant women with risk factors when compared to clinical diagnosis. Materials and methods: Study of diagnostic accuracy for the assessment of placenta accreta in high-risk patients who ended their pregnancy between 2014 and 2016 at Hospital Universitario de Santander. After obtaining their informed consent, 51 pregnant women over 18 years of age, more than 12 weeks of gestational age, low or anterior placenta or a history of uterine surgery were included. The diagnosis of a high probability of placenta accreta based on the presence of at least two ultrasound criteria and one Doppler criterion was compared with the gold standard of the visual finding during the cesarean section and of the surgical specimen in patients taken to hysterectomy, or during the clinical course in women with vaginal delivery. Sociodemographic and clinical variables are described, and the sensitivity and specificity, and positive or negative odds ratios are estimated. Results: The diagnosis of high probability of placenta accreta based on 2D Doppler Ultrasound has a high sensitivity of 88.2% (95% CI: 70.0-100) and specificity of 97.1% (95% CI: 89,9-100), with positive LR of 30.0 (95% CI: 4.3-208.5) and negative LR of 0.12 (95% CI: 0.03-0.45). Conclusions: The diagnosis of high probability of placenta accreta using non-invasive imaging provides valuable information regarding the presence and extent of placenta accreta in patients with known risk factors.

RESUMEN Objetivo: Establecer, en gestantes con factores de riesgo, la exactitud de la ecografía 2D más Doppler para hacer el diagnóstico de acretismo placentario al compararlo con el diagnóstico clínico. Materiales y métodos: Estudio de evaluación de la exactitud diagnóstica en gestantes de alto riesgo de placenta ácreta que terminaron el embarazo entre 2014 y 2016 en el Hospital Universitario de Santander. Previo consentimiento informado se incluyeron 51 gestantes mayores de 18 años, con más de 12 semanas de edad gestacional, con placenta baja o anterior, o antecedentes de cirugía uterina. Se comparó el diagnóstico de alta probabilidad de acretismo placentario dado por la presencia de, al menos, dos criterios en la ecografía 2D y uno en el Doppler, con un patrón de oro dado por el hallazgo visual durante la cesárea y la pieza quirúrgica en las que fueron llevadas a histerectomía, o la evolución clínica en las mujeres con parto vaginal. Se describen las variables sociodemográficas y clínicas, y se calcula la sensibilidad, especificidad y razón de probabilidades positiva y negativa. Resultados: El diagnóstico de alta probabilidad de acretismo placentario dado por ecografía 2D más Doppler tiene una sensibilidad del 88,2 % (IC 95 %: 70,0-100) y especificidad del 97,1 % (IC 95 %: 89,9- 100), LR positivo de 30,0 (IC 95 %: 4,3-208,5) y LR negativo de 0,12 (IC 95 %: 0,03-0,45). Conclusiones: El diagnóstico de alta probabilidad de acretismo placentario por imágenes diagnósticas no invasivas ofrece información valiosa sobre la presencia y extensión del acretismo placentario en pacientes con factores de riesgo conocidos Palabras clave: acretismo placentario, ultrasonografía doppler, técnicas de diagnóstico obstétrico y ginecológico.

Desenlaces materno-fetales de los embarazos atendidos en el Hospital Universitario de Santander, Bucaramanga (Colombia), 2007-2011. Estudio de cohorte / Maternal and foetal outcomes in twin pregnancies seen at Hospital Universitario de Santander, Bucaramanga (Colombia), 2007-2011. A cohort study

Los embarazos gemelares implican mayor riesgo de complicaciones materno-fetales que los embarazos únicos, particularmente en los monocoriales. El objetivo del trabajo fue describir las características clínicas y los desenlaces materno-fetales, por tipo de placenta (monocorial o bicorial), de los embarazos gemelares atendidos en el Hospital Universitario de Santander (HUS), institución de tercer nivel de complejidad localizada en Bucaramanga (Colombia). Materiales y métodos: estudio descriptivo de cohorte, se incluyeron las pacientes que terminaron un embarazo gemelar entre 2007 y 2011 en el HUS, hospital general de referencia de la región centro-oriental del país. Muestreo consecutivo. Se evaluó la edad gestacional en la primera consulta al hospital, los hallazgos clínicos en la evaluación inicial, la terminación del parto y los resultados perinatales. Se hace análisis descriptivo por tipo de corionicidad. Resultados: se incluyeron un total de 248 gestantes con embarazo gemelar en el periodo de estudio. La mediana de la edad gestacional en la primera atención en el hospital en fue de 34 semanas. Al ingreso, 127 (51,2 %) pacientes se diagnosticaron con embarazo monocorial, pero solo en dos terceras partes coincidió el diagnóstico prenatal de corionicidad con el del posparto. Se diagnosticó RCIU con más frecuencia en embarazos monocoriales que en bicoriales (22,3 vs. 7,5 %), y el doppler se encontró alterado con mayor frecuencia en fetos de embarazo monocorial (7,8 vs. 1,1 %). Los neonatos > 24 semanas de edad gestacional de embarazo monocorial pesaron, en promedio, 109 g (IC 95 %: 34-184) menos que los bicoriales. Conclusiones: los resultados de este estudio sugieren un problema de salud pública en este grupo de pacientes, con inicio tardío de control prenatal, de remisión tardía a centros especializados y capacidad insuficiente para definir corionicidad. Se requiere plantear estrategias de atención que incluyan considerar los embarazos gemelares como alto riesgo y garantizar la atención oportuna y adecuada, orientada por una guía de cuidado diferencial para este grupo de gestantes...

Twin pregnancies, especially monochorionic placentations, are associated with a higher rate of maternal and foetal complications when compared to singleton pregnancies. The objective of this work was to describe the clinical characteristics and the maternal and foetal outcomes according to the type of placentation (monochorial or dichorial) of twin pregnancies delivered at Hospital Universitario de Santander (HUS), a level III institution located in Bucaramanga, Colombia. Materials and methods: Descriptive cohort study. The cohort consisted of patients delivered of a twin pregnancy between 2007 and 2011 at the HUS, a general referral hospital for the central-eastern region of the country. The assessment included gestational age at the time of initial presentation to the hospital, clinical findings during the initial assessment, delivery completion, and perinatal results. Descriptive analysis by chorionicity type. Results: A total of 248 women with a twin pregnancy during the study period were included. The mean gestational age on the first visit to the hospital was 34 weeks. On admission, 127 patients (51.2%) were diagnosed with a monochorionic pregnancy, but only in two thirds of the cases was the prenatal chorionicity diagnosis consistent with the post-partum finding. IUGR was diagnosed more frequently in monochorionic than in dichorionic pregnancies (22.3% v. 7.5%) and abnormal Doppler findings were more frequent in monochorionic foetuses (7.8% v. 1.1%). Neonates > 24 of gestational age in monochorionic pregnancies weigh in average 109 gr (IC 95%: 34-184) less than dichorionic twins. Conclusions: The results of this study suggest a public health problem in this group of patients who come late for their prenatal visits and are late referrals to specialized centres, when there is already a limited ability to determine chorionicity. There is a need to develop care strategies in which twin pregnancies are included as a high-risk condition, and to ensure timely and adequate care provision in accordance with differential care guidelines for this group of pregnant women...