Should fetal growth be a matter of concern in isolated single umbilical artery? / Artéria umbilical única isolada e restrição do crescimento fetal

Objective: To examine birth weight in pregnancies with isolated single umbilical artery (ISUA). Methods: Case control study with retrospective review of 131 singleton pregnancies with isolated single umbilical artery diagnosed before birth. Control group consisted of 730 singleton pregnancies recruited prospectively, that had histological confirmation of a 3 vessels cord. Pregnancies were classified as uncomplicated or high-risk according to the presence of diseases that increase the risk of placental insufficiency during pregnancy. Mean birth weight and frequency of low birth weight (< 2.500 g), very low birth weight (< 1.500 g) and fetal growth restriction below the 5th and 10th centiles were compared between groups. Results: Mean birth weight difference between ISUA (n=131, 2840±701g) and control (n=730, 2.983 ± 671g) pregnancies was 143g (95% CI= 17-269; p=0.04) and birth weight below the 5thcentile was significantly more common in ISUA group [28/131 (21.4%) versus 99/730 (13.6%), p=0.02]. When only uncomplicated pregnancies were considered in both groups, no birth weight differences were observed. Amongst high-risk subgroups, birth weight below the 5th centile remained significantly more common in ISUA compared to control pregnancies [10/35 (28.6%) versus 53/377 (14.1%), p=0.04]. Conclusion: Isolated single umbilical artery does not increase the risk of fetal growth restriction in uncomplicated singleton pregnancies. .

Objetivo: Examinar a frequência de peso ao nascer abaixo dos percentis 5 e 10, em gestações únicas com artéria umbilical única isolada (AUUI), de acordo com a presença de complicações maternas. Métodos: Estudo caso-controle. De acordo com a presença de doenças maternas prévias à gestação, ou ocorrência de complicações obstétricas, as gestações foram classificadas em "não complicadas" ou de "alto risco". As frequências de peso ao nascer abaixo dos percentis 5 e 10 foram comparadas entre os subgrupos. Resultados: O peso ao nascer foi significativamente menor em gestações com AUUI (n=134, 2840 ± 701 g) quando comparado com o grupo controle (n= 730, 2983 ± 671 g, p= 0,04; média da diferença=143 g, IC 95% = 17-269). Em gestações de alto risco, peso ao nascer abaixo do 5º percentil foi significativamente mais frequente no subgrupo com AUUI [10/35 (28,6%) versus 53/377 (14,1%), p= 0,04; razão de chances= 2.45 (IC 95% = 1,11- 5,38)]; não foi observada diferença em relação ao peso abaixo do 10º percentil (p= 0,11). Em gestações não complicadas, não foram observadas diferenças na frequência de peso ao nascer abaixo do 5º e 10º percentis entre os subgrupos com AUUI e cordão com 3 vasos (p= 0,21). Conclusão: Em gestações de alto risco, a frequência de peso ao nascer abaixo do percentil 5 é significativamente aumentada. .

Incidencia y asociaciones de arteria umbilical única en recién nacidos: maternidad del Hospital Clínico de la Universidad de Chile, 1998-2010 / Incidence and associations of single umbilical artery in newborns: of Hospital Clínico de la Universidad de Chile maternity, 1998-2010, 1998-2010

ANTECEDENTES: La presencia de 2 vasos en el cordón umbilical es una anomalía con incidencia de 1% de todos los recién nacidos. Se asocia frecuentemente con restricción del crecimiento intrauterino (RCIU), malformaciones estructurales mayores y cromosómicas y prematuridad. Constituye un factor de riesgo que aumenta la mortalidad fetal tardía y neonatal. OBJETIVOS: Establecer la prevalencia al nacimiento de arteria umbilical única (AUU), la magnitud de las asociaciones con malformaciones congénitas (MFC), RCIU, prematuridad y su influencia en la morbimortalidad neonatal. MÉTODO: Se usó la base de datos que el Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC) tiene en la maternidad del Hospital Clínico de la Universidad de Chile. Incluyó a todos los recién nacidos vivos (RN) y mortinatos con peso de nacimiento 500 gramos o más en el período mayo 1998 a junio 2010. Se comparó algunas variables demográficas entre los casos y sus controles. RESULTADOS: En 22.011 nacimientos ocurridos hubo 65 RN con AUU (0,3%), 9 eran mortinatos (13,8%), 88,9% de ellos presentaban RCIU. Eran prematuros 55,4% de los RN. El 60% de los casos de AUU estaban asociados a MFC mayores, destacando las del aparato genitourinario (35,3%) y las cardiovasculares (29,4%); 23,8% eran parte de un síndrome, donde dominaban latrisomía 13 y 18 (12 casos, 18,5%). De los RN vivos fallecieron 13 (23,2%), 8 (61,5%) presentaban RCIU. CONCLUSIÓN: La AUU es un factor de alto riesgo de asociación con RCIU, MFC mayores estructurales y/o cromosómicas, prematuridad y de un aumento de la morbimartalidad neonatal.

BACKGROUND: The presence of only two blood vessels in the cord blood is a congenital anomaly that has an incidence about 1% among all newborns. Frequently, it is associated with intrauterine growth restriction (IUGR), major congenital malformations (MCMF), chromosome anomalies and prematurity. It represents a risk factor that increases late foetal and neonatal mortality and morbidity. AIMS: To estímate the prevalence at birth of unique umbilical artery (UUA), to know its association with congenital anomalies, IUGR, prematurity and to evaluate its influence in neonatal morbidity and mortality. METHODS: We studied data registered in the Latin American Study of Congenital Malformations (ECLAMC) from the Maternity of the Clinical Hospital of University of Chile from May 1998 and June 2010. All newborns (alive and stillbirths) with a birth weigh >500 g were included. Demographic variables were compared between cases and controls. RESULTS: 65 newborns with UUA (0.3%) was found among the 22.011 births registered: 9 was stillbirths (13.8%), 88.9% of them had IUGR and 55.4% were premature. 60% of cases has another MCMF (35.3% of the genitourinary system and 29.4% involved the cardiovascular system). 23.8% of cases were part of a syndrome, 13 and 18 trisomy were the most common (12 cases, 18.5%). 13 newborns died (23.2%), 8 of them (61.5%) had IUGR. CONCLUSION: The presence of UUA in a foetus or newborn represents a high risk for IUGR, MCMF, chromosome anomalies, prematurity and increase of neonatal morbidity and mortality.

Doppler fetoplacentario en hipertensión gestacional y preeclampsia leve / The usefulness of fetal placental doppler ultrasound in gestational hypertension and mild preeclampsia

Introducción: la preeclampsia se presenta en 6% de los embarazos en Colombia y se asocia con una elevada tasa de morbimortalidad maternofetal. Con frecuencia los casos severos se acompañan de restricción del crecimiento intrauterino; en estos casos el doppler fetoplacentario es útil para determinar el pronóstico fetal, pero su valor en preeclampsia leve o hipertensión gestacional no está bien definido. Objetivos: determinar en estas dos circunstancias la frecuencia de alteraciones en el doppler de las arterias umbilical y cerebral media. Materiales y métodos: búsqueda de casos en la base datos de la unidad de medicina maternofetal del Hospital de San José, entre agosto de 2006 y febrero de 2008. Se definió como casos las pacientes con gestaciones > a 28 semanas con HTG o PL y fetos con perfil de crecimiento normal. Se consideraron y analizaron variables demográficas, resultados del doppler fetoplacentario y las complicaciones. Resultados: se identificaron 85 pacientes. El 17% presentó alteración del doppler de la AU y 7% de la ACM; en gestaciones < 32 semanas los hallazgos anormales son bajos (75% AU y 85% ACM normales). Conclusiones: la frecuencia de alteraciones en el Doppler de AU y ACM fue similar en el grupo de mujeres que presentaron complicaciones y aquellas con un desenlace normal.

Introduction: In Colombia, around 6% of pregnant women will experience preeclampsia. It is associated with high maternal and fetal morbidity and mortality rates. Severe cases are frequently related to intrauterine growth restriction; placental and fetal Doppler has prognostic value in these cases, although, its usefulness in mild preeclampsia (MP) or gestational hypertension (GHT) is not yet well defined. Objectives: to determine the frequency of abnormal Doppler sonography of the umbilical artery (UA) and middle cerebral artery (MCA) in MP or GHT. Materials and methods: cases were searched for in the Maternal Fetal Unit databases at Hospital de San José between August 2006 and February 2008. Cases were defined as patients with > 28 week pregnancies complicated by GHT or MP with fetuses with a normal growth profile. Demographic variables, placental fetal Doppler evaluation results and complications were considered and analyzed. Results: 85 patients were identified. Seventeen percent (17 %) presented abnormal Doppler of the UA and 7% of the MCA; abnormal findings were low (normal UA in 75% and normal MCA in 85%) in < 32 week gestations. Conclusions: the frequency of abnormal Doppler results of the UA and MCA were similar in the group of women with complications and in those who had a normal pregnancy outcome.

Utilidad de la velocimetría Flujo Doppler en el manejo de fetos con sospecha de retardo del crecimiento intrauterino / Utility of Doppler flow velocimetry in the management of suspect fetuses of intrauterine growth restriction

Objetivo: el objetivo del presente trabajo fue el de determinar la eficacia del índice cerebro-placentario doppler en la predicción de la resultante neonatal en fetos con retraso del crecimiento intrauterino de más de 32 semanas de gestación. Diseño del estudio: se estudió de manera prospectiva en el hospital Enrique C. Sotomayor, Guayaquil – Ecuador, 50 pacientes con embarazos mayores de 32 semanas con riesgo de retraso del crecimiento intrauterino a quienes se les realizó un índice cerebro – placentario (relación del índice de resistencia de la cerebral media para el índice de resistencia de la arteria umbilical) con el fin de predecir resultante neonatal adversa (hipoglicemia neonatal, muerte, policitemia, ingreso a cuidados intensivos neonatales, etc.). También se analizaron rasgos demográficos maternos. Resultados: hubo un incremento en la morbilidad y mortalidad en los casos con un índice cerebro – placentario menor a 1. Todos los productos con una resultante perinatal adversa fueron pequeños para la edad gestacional. Usando un valor referencial corte de 1, el índice cerebro – placentario mostró una sensibilidad diagnóstica del 71.4 por ciento, una especificidad del 66.7 por ciento, un valor predictivo positivo de 83.3 por ciento, y valor predictivo negativo de 50 por ciento. Conclusiones: se concluye de acuerdo a los resultados anteriormente mencionados que el índice cerebro – placentario es una herramienta útil en la predicción de resultante neonatal adversa en fetos mayores del crecimiento intrauterino.

The objective of the present study is to evaluate the efficacy of the cerebroplacental rate in the prediction of neonatal outcome in growth retarded fetuses of more than 32 weeks of gestation. The study was prospective and realized at the Enrique C. Sotomayor hospital, Guayaquil – Ecuador. 50 patients with pregnancy > 32 weeks of gestation at risk of fetal growth restriction were performed a cerebral placental ratio (cerebral resistance index divided by the umbilical resistance index) in order to predict adverse neonatal outcome (neonatal hypoglycemia, neonatal death, admission to neonatal intensive care unit, etc.). We also analyzed maternal demographic characteristics. Results: there was a significant increment of morbi-mortality in cases with a cerebral placental ratio of less than I. All the neonates with adverse neonatal outcome were small for gestational age. Use a referential value of 1, the cerebral placental ratio demonstrated a diagnostic sensibility of 71.4 percent, a specificity of 66.7 percent, a positive predictive value of 83.3 percent and a negative predictive value of 50 percent. Conclusions: cerebral placental ratio is a useful tool in the management and identification of fetuses more than 32 weeks of gestation at risk for fetal growth restriction.