Fetal cardiac remodeling in twin pregnancy conceived by assisted reproductive technology.

OBJECTIVE: Recent data suggest that singleton fetuses conceived by assisted reproductive technology (ART) present cardiovascular remodeling that may persist postnatally. Twin pregnancies are more frequent in the ART population and are associated with increased adverse perinatal outcomes, such as hypertensive disorders, gestational diabetes and preterm birth. However, it is unknown whether cardiac remodeling is also present in twin pregnancies conceived by ART. Our aim was to assess the presence of fetal cardiac remodeling and dysfunction in twin pregnancies conceived by ART as compared with those conceived spontaneously (SC). METHODS: This was a prospective cohort study including 50 dichorionic twin fetuses conceived by ART and 50 SC twin fetuses. The study protocol included collection of baseline/perinatal data and a fetal ultrasound examination at 28-30 weeks' gestation, including assessment of estimated fetal weight, fetoplacental Doppler and fetal echocardiography. Measurements of atrial area, atrial/heart ratio, ventricular sphericity index, free wall thickness, mitral and tricuspid annular plane systolic excursions, and systolic and early diastolic peak velocities were assessed. Multilevel analyses were used to compare perinatal and ultrasonographic parameters. Comparisons of echocardiographic variables were adjusted for parental age, paternal body mass index and incidence of pre-eclampsia. RESULTS: Compared with SC twins, ART twin fetuses showed significant cardiac changes, predominantly affecting the right heart, such as dilated atria (right atrial/heart area: 15.7 ± 3.1 vs 18.4 ± 3.2, P < 0.001), more globular ventricles (right ventricular sphericity index: 1.57 ± 0.25 vs 1.41 ± 0.23, P = 0.001) and thicker myocardial walls (septal wall thickness: 2.57 ± 0.45 mm vs 2.84 ± 0.41 mm, P = 0.034) together with reduced longitudinal motion (tricuspid annular plane systolic excursion: 6.36 ± 0.89 mm vs 5.18 ± 0.93 mm, P < 0.001). CONCLUSIONS: ART twin fetuses present signs of cardiac remodeling and dysfunction. These changes are similar to those observed in ART singletons and reinforce the concept of fetal cardiac programing in ART. These results open opportunities for early detection and intervention in infants conceived by ART. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

[An infection study of total parenteral nutrition catheters for Y-site drug administration]. / Estudio de la infección de catéteres de nutrición parenteral total al administrar fármacos en "Y".

When faced with the frequent use of parenteral nutrition (TPN) and the multiple problems which the maintenance of venous pathways presents, we initiated this study to try and show that the use of TPN catheters for the perfusion of drugs in "Y", does ot increase the incidence of infection. 70 patients subjected to TPN were studied, divided into 3 groups: I: TPN with exclusive use catheter (23 patients). II: TPN with a catheter through which antibiotic medication is administered in "Y" (22 patients). III: TPN with a catheter through which non-antibiotic medication is administered in "Y" (25 patients). Despite there being no extra manipulation in group I, when applying Cramer's "Y" we did not find any significant differences between the three groups as to incidence of infection. When relating the variables of infection and number of manipulations by means of chi-squared, we did not find significant differences either. There is no increase in the incidence of infection with the increase of manipulation. When we relate the variables of infection and number of days of treatment with TPN by chi-squared, we did not find significant differences either. There were no more infections of the catheters with more days of treatment. Neither did we find significant differences with respect to the number of manipulations, according to the calculation done by the Student T-rest, between groups II and III. Therefore, we have reached the conclusion that although the use of TPN for the administration of other drugs should not be used indiscriminately, it is absolutely valid for concrete cases, with a difficulty of multiple venolysis, as long as the drugs that shall be administered are stable with TPN and as a long as the norms form the correct administration and the aseptic techniques are observed.