Visualización de las 4 líneas-3 espacios para cribado de espina bífida abierta en primer trimestre / Visualization of 4 lines-3 spaces for first-trimester screening of open spina bifida

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

Anillo vascular completo: diagnóstico prenatal de doble arco aórtico / Complete vascular ring: Prenatal diagnosis of double aortic arch

No disponible

Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia: an individual patient data meta-analysis.

OBJECTIVE: To investigate the value of adding second-trimester uterine artery Doppler ultrasound to patient characteristics in the identification of nulliparous women at risk for pre-eclampsia. METHODS: For this individual patient data meta-analysis, studies published between January 1995 and December 2009 were identified in MEDLINE and EMBASE. Studies were eligible in which Doppler assessment of the uterine arteries had been performed among pregnant women and in which gestational age at ultrasound, Doppler ultrasound findings and data on the occurrence of pre-eclampsia were available. We invited corresponding authors to share their original datasets. Data were included of nulliparous women who had had a second-trimester uterine artery Doppler ultrasound examination. Shared data were checked for consistency, recoded to acquire uniformity and merged into a single dataset. We constructed random intercept logistic regression models for each of the patient and Doppler characteristics in isolation and for combinations. We compared goodness of fit, discrimination and calibration. RESULTS: We analyzed eight datasets, reporting on 6708 nulliparous women, of whom 302 (4.5%) developed pre-eclampsia. Doppler findings included higher, lower and mean pulsatility index (PI) and resistance index (RI) and any or bilateral notching. Of these, the best predictors were combinations of mean PI or RI and bilateral notching, with areas under the receiver-operating characteristics curve (AUC) of 0.75 (95% confidence interval (CI), 0.56-0.95) and 0.70 (95% CI, 0.66-0.74), respectively. Addition of Doppler findings to the patient characteristics blood pressure or body mass index (BMI) significantly improved discrimination. A model with blood pressure, PI and bilateral notching had an AUC of 0.85 (95% CI, 0.67-1.00). CONCLUSIONS: The addition of Doppler characteristics of mean PI or RI and bilateral notching to patient characteristics of blood pressure or BMI improves the identification of nulliparous women at risk for pre-eclampsia.

Factores relacionados con la vía de parto tras cesárea anterior / Factors related to delivery route after a previous cesarean section

Con el objetivo de evaluar la tasa de parto vaginal tras una cesárea anterior en nuestro medio se hizo un estudio retrospectivo mediante revisión de historias clínicas de las 258 gestantes con cesárea anterior que parieron en nuestro hospital entre 2005 y 2007. Se excluyó a las mujeres que tenían más de una cesárea, incisión uterina clásica o cualquier contraindicación absoluta para parto vaginal. El 59,3% tuvo parto vaginal; el 55% inició trabajo de parto espontáneo, en el 21,7% se indujo el parto y al 23,3% se le programó cesárea. De las variables estudiadas, las mayores tasas de parto vaginal se producen cuando el trabajo de parto se inició espontáneamente (78,87%), cuando el test de Bishop fue superior o igual a 6 (88,51%) y cuando existía el antecedente de parto vaginal previo (66,7%) o posterior (84,25%). En cuanto a la indicación de la cesárea anterior, las peores tasas de parto vaginal (42,2%) se obtienen cuando la indicación previa fue distocia (no progresión/desproporción). No se produjo ninguna rotura uterina en nuestra serie y no hubo un incremento de la morbimortalidad materna ni fetal, por lo que podemos concluir que el parto vaginal es posible en casi el 60% de las gestantes con cesárea anterior sin un incremento de la morbimortalidad maternofetal (AU)

The aimof this study was to evaluate the rate of vaginal birth after a previous cesarean in our population. A retrospective study was performed throug hare view of the clinical histories of the 258 women with a previous cesarean section that delivered in our hospital between 2005 and 2007. Women with more than one prior cesarean section, classical uterine incision or any absolute contraindication for vaginal delivery were excluded.Delivery was through the vaginal route in 59.3%. Fifty-five percent of the women began spontaneous delivery, 21.7%were induced and cesarean section was scheduled in 23.3%. Ofthe variables studied, the high estrates of vaginal birth were produced with spontaneous labor, when Bishop’s scorewas X6 (88.51%) and when there was a history of vaginal birth before a cesarean section (66.7%)or after a cesarean section (84.25%). The low estrates of vaginal delivery (42.2%)were obtained when the previous indication for cesarean sectionwas dystocia (no progression/disproportion). There were no case sof uterine rupture in ourstudy and maternal and fetal complications did not increase. In conclusion, vaginal birthisfeasible in almost 60%of women with a prior cesarean section and does not in crease fetaland maternal complications (AU)

[Holoprosencephaly. Role of magnetic resonance imaging in prenatal diagnosis]. / Holoprosencefalia. Papel de la resonancia magnética en el diagnóstico prenatal.

We presented a case affected of trisomía 13 and fetal malformations. Prenatal sonography and magnetic resonance imaging were performed. The fetus suffered semilobar holoprosencephaly, craniofacial malformations and tetralogy of Fallot. A review of sonographics and magnetic resonance findings is presented emphasizing the role of magnetic resonance as a complementary imaging technique when sonography has diagnostic limitations.

Holoprosencefalia. Papel de la resonancia magnética en el diagnóstico prenatal / Holoprosencephaly. Role of magnetic resonance imaging in prenatal diagnosis

Presentamos el caso de un feto malformado, con trisomía 13, estudiado prenatalmente con ecografía y resonancia magnética que padecía holoprosencefalia semilobar, malformaciones faciales y tetralogía de Fallot. Revisamos los hallazgos tanto ecográficos como de resonancia magnética y planteamos el papel de esta última como estudio complementario a la ecografía, cuando esta presenta limitaciones diagnósticas

We presented a case affected of trisomía 13 and fetal malformations. Prenatal sonography and magnetic resonance imaging were performed. The fetus suffered semilobar holoprosencephaly, craniofacial malformationsand tetralogy of Fallot. A review of sonographics and magnetic resonance findings is presented emphasizing the role of magnetic resonance as a complemmentary imaging technique when sonography has diagnostic limitations

Persistent and redundant eustachian valve simulating atrial tumor: prenatal diagnosis.

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.