[Non-immunologic hydrops. Report of 2 cases]. / Hidrops no inmunológico. Informe de dos casos.

UNLABELLED: Non immune hydrops is an uncommon entity, it is observed in one per 2,000 to 3,500 alive birth. It can be idiopathic or secondary to different pathologies, the most important examples are: congenital malformations, cromosompathies or viral infections. OBJECTIVE: To show our therapeutic and diagnostic experience in two cases of non immune hydrops. STUDY DESIGN: To present a case of spontaneous reversion of non immune hydrops secondary to parvovirus B 19 infection and other case secondary to congenital cardiopathy. RESULTS: We found spontaneous reversion of a case of non immune hydrops due to a parvovirus B 19 infection and infant was normal but the infant with congenital cardiopathy died ten minutes after birth. CONCLUSIONS: Two of the most important causes of non immune hydrops are cardiopathies and infections, specially parvovirus which is responsible of poor perinatal outcome but there is a remote possibility of spontaneous reversion because it is important to make a specific diagnose and to make the expected management.

[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.

[Predictive value of fetal pulmonary maturity tests in pregnancy of diabetic mothers]. / Valor predictivo de las pruebas de madurez pulmonar fetal en la paciente diabética embarazada.

Respiratory distress syndrome is a common morbidity in a infants of diabetic mother however there is a controversy in the literature about apparition of lung maturity in this infants. However this reports have not got a control group. Lung maturity tests were prospectively studied, obtained by amniocentesis at 37 weeks of gestation, in 47 patients: twenty diabetics (studied group) and 27 healthy pregnant women (control group). All the pregnancies were solved by cesarean section. The values of lung maturity tests were related to presence of respiratory morbidity in neonates (respiratory distress syndrome: RDS). Five of 49 infants had some kind of respiratory morbidity. The incidence of RDS was 10.2%. Four of 5 infants with RDS belonged to the diabetic group, which gives us an incidence of 20% versus only one of the 29 healthy infants (3.7%). This difference is statistically significant, p < 0.0001. Four infants had false positive lung maturity tests (Od, L/S), three of them (two with severe metabolic meladjustment) occurred in the study group, with alteration of L/S ratio (3/20 = 15%). There was no false positive in PG (specificity 100%) in both group. The 3 lung maturity tests had a specificity of a hundred per cent in the control group). This study shows that the presence of PG in amniotic fluid of diabetic pregnant women confirms maturity with a very low risk to develop RDS. Finally, when the metabolic control of the diabetic is not appropriate, the L/S ratio may give false positive results in 15% of cases, which is quite important.