[Management of refractory autoimmune thrombocytopenic purpura during pregnancy, Review of the literature and report of three cases]. / Manejo de la púrpura trombocotopénica autoinmune refractaria durante el embarazo. Revisión de la literatura e informe de tres casos.

The immune thrombocytopenic purpura (ITP) is an immunological disease associated with pregnancy; it is difficult to control when there is not an adequate response to the treatment mainly with prednisone (refractory). When this problem occurs there are other ways to treat it: monthly pulses of dexamethasone (oral or intravenously), administration of gamma globulin or anti D and occasionally to perform a splenectomy. Three cases of refractory ITP and pregnancy are presented using different treatment in each case: Case 1 hyperimmune gammaglobulin; case 2 platelets by transfusion and in case number 3 monthly dexamethasone oral pulses. In the case treated with hyperimmune gammaglobulin the maternal response was acceptable but neonatal demise occurred due to hemorrhage; in the treated with platelets transfusion, there were maternal and fetal deaths; the best results were obtained with the administration of dexamethasone monthly, in this way we were able to reach the term of the pregnancy with good results for mother and neonate. The importance of early diagnosis is imperative and initiating the adequate treatment that according to our results would be dexamethasone pulses; the use of hyperimmune gammaglobulin in restricted due to high cost, and the platelets transfusion would be indicated only in cases of severe thrombocythopenia, imminence of hemorrhage or if a surgical procedure has to be done. An extensive review of the literature is done.

[Determination by ultrasound of chorionicity in twin pregnancy]. / Determinación de corionicidad por ultrasonido en embarazo gemelar.

Twins, specially those of monochorionic and monoamniotic pregnancies, are exposed to many perinatal risks and complications. The objective of this study was to evaluate the usefulness of ultrasonographic determination of the chorionicity of human placental by counting the number of layers in amniotic membranes. Thirty-eight patients with twin pregnancies were studied prospectively. The ultrasonographic evaluation of membranes layers was made only once, between the weeks and 16 and 30 of pregnancy. When two layers were identified, the placentation was determined as monochorionic, and when four layers were seen, the diagnosis of bichorionic placentation was made. The type of chorionicity was confirmed by histologic study of the placenta. With ultrasound, the chorionicity was correctly determined in 36 out of 38 cases, for a total predictive value of 94.6%. The capacity for diagnosing bichorionic (4 layers) placentation was 100% (22/22) and 87.6% (14/16) for monochorionic (2 layers) placentation. The ultrasonographic evaluation of the amniotic membranes number is an efficient method to recognize the chorionicity of placenta and constitutes an useful and simple method giving important information in perinatal prognosis.

[Value of the amniotic fluid rate in premature membrane rupture: prognosis of infection]. / Utilidad del índice del líquido amniótico en la ruptura prematura de membranas: Pronóstico de infección.

The presence of oligohydramnios evaluated by accumulation or major pool technique in pre-term PMR is strongly correlated with maternal and perinatal infection. The objective of this study is to evaluate the usefulness of amniotic fluid volume rate (AFVR) in prediction of maternal and fetal-neonatal infection in patients with PMR before 37 weeks. Thirty patients with PMR were prospectively studied. AFVR was done in all the patients at the time of arrival and they were managed conservatively. None of them had utero-inhibitors and only antibiotics were used after chord clamping. In absence of intrauterine infection corticotherapy was allowed. The results of AFVR were correlated with maternal infection (chorioamnioitis) and perinatal (possible neonatal sepsis or neonatal sepsis). Twenty three out of 30 patients (76.6%) had a AFVR less than or equal to 5.0 cm. (Oligohydramnios) and seven (30.4%) showed a greater rate than 5.0 cm. The earliest pregnancy was 26.5 weeks and the greatest 34.4 weeks. Out of the total of patients 13 (43.3%) had chorioamnioitis and all correspond to the group with AFVI smaller or equal to 5.0 cm. In the group with oligohydramnios were 15 neonates (65.2%) with neonatal infection (six possible sepsis and nine neonatal sepsis). All neonates with positive cultures also corresponded to the group with smaller AFVR; the comparison among the cases with oligohydramnios with infection and the ones that had normal AFVR without infection has statistical significance (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)