[Intrahepatic cholestasis of pregnancy: review]. / Colestasis intrahepática del embarazo: una revisión.

The etiology of intrahepatic cholestasis of pregnancy includes genetic and environmental factors. Bile acids elevation in maternal and fetal blood is the main fact of its physiopathology, causing maternal itching and high perinatal morbidity and mortality. High levels of maternal blood bile acids are diagnostic. Best treatment is ursodeoxycolic acid and clearly it produces amelioration of bile acid levels and itching, but it is uncertain if it reduces perinatal morbidity and mortality. As far as fetal death is one of sudden onset, probably due to acute hypoxia, tests to evaluate and predict fetal condition are useless. Pregnancy interruption at 36-37 gestation weeks is the best strategy for lowering fetal death incidence. The purpose of this work is to achieve an actualized literature review on this disease.

[Doppler speedometry of changed umbilical artery due to placentitis secondary to cytomegalovirus. Case report and literature review]. / Velocimetría Doppler de la arteria umbilical alterada por placentitis secundaria a citomegalovirus. Reporte de un caso y revisión bibliográfica.

Cytomegalovirus infection during pregnancy is associated with subtle and severe fetal disease including abortion or fetal death. Such complications depend on many factors including age of gestation at the moment of infection, and whether or not it is a primary maternal infection. A controversial point is if cytomegalovirus infection is capable of causing fetal growth restriction and fetal death due to placental insufficiency. In this article we report a case of fetal growth and umbilical artery Doppler velocimetry with a typical patron of intrauterine growth restriction due to placental insufficiency. We also made a review of medical literature about this topic.

[Placenta previa-accreta: a singular problem. A report of two cases and bibliographic review]. / Placenta previa acreta: un problema singular. Comunicación de dos casos y revisión de la bibliografía.

Placenta previa in women older than 34 years old with previous cesarean section has a high risk to develop placenta accreta/inccreta/perccreta. Such background is frequent nowadays, so placenta previa-accreta is a growing problem. This disease cause hypervascularity in the pelvic floor and increases the risk of placenta penetrating the bladder. For these peculiarities, the maternal morbidity and mortality are higher; besides, hysterectomy produces additional morbidity and mortality. For such reasons, experts explore at present other alternatives to be able to make a better maternal prognosis. In this article we report two cases with placenta previa-accreta, and make a review of medical literature about this topic.

[Differences and similarities of preeclampsia and gestational hypertension]. / Diferencias y similitudes de la preeclampsia y la hipertensión gestacional.

Current criteria regarding hypertension in pregnancy consider two distinct types: gestational hypertension (pure type) and preeclampsia-eclampsia syndrome, the latter with albuminuria as a mandatory clinical fact. However, reports of lasts years show that a 15 to 46% of cases classified as pure type gestational hypertension evolve to a preeclamptic state, underlying the possibility that both clinical conditions represent diferent stages of the same disease. On the other hand, albuminuria may not be present in severe cases of pregnancy-related hypertensive disorders such as HELLP syndrome or eclampsia. It follows that if albuminuria is not necessary to establish the most severe forms of the disease, must the non-albuminuric hypertensive-type still be considered as a diferent diagnosis? This report reviews the medical literature on the subject, stressing similarities and diferences of both conditions in order to reflect about the need to change the classification concepts pregnancy-related hypertensive entities.

Colestasis intrahepática del embarazo, un riesgo fetal impredecible: presentación de un caso y revisión de la literatura / Intrahepatic Cholestasis of pregnancy, an umpredictable fetal risk: a case report and liteature review

Se presenta un caso de colestasis intrahepática del embarazo (CIE) que tuvo muerte fetal unas horas después de un registro cardiotocográfico normal. Es una mujer de 35 años con el antecedente de dos embarazos que cursaron con dicha enfermedad y tuvieron un buen desenlace. En el último embarazo tuvo nuevamente un cuadro clínico y bioquímico característicos de CIE. La evolución cardiotocográfica y ecográfica del embarazo fueron normales, salvo por tratarse de un feto pequeño para la edad de crecimiento armónico. A las 35 4/7 semanas inició actividad uterina prodrómica y una prueba de registro basal fue reactiva. Ocho horas después la paciente regresó para revalorar su hospitalización y se demostró la existencia de un óbito fetal. El estudio genético del producto y la valoración histológica de la placenta, fueron normales. La colestasis materna revirtió unas semanas después del parto.