[Perinatal results of the patients assessed by fetal hypomotility]. / Resultado perinatal de las pacientes evaluadas por hipomotilidad fetal.

OBJECTIVE: To describe the perinatal outcome of those patients that come to emergency room because of diminished fetal movements. PATIENTS AND METHOD: This is a case series in which we evaluated the patients who were attended at the Maternal Fetal Medicine Department from January 2002 to December 2003. All patients with prenatal control in the institution whatever the basic pathology were enrolled in the study. They were evaluated following the institution protocol. All data was obtained from maternal and neonatal files. RESULTS: A total of 240 patients with mean age of 27 +/- 7 (SD) years were evaluated in the study. Ninety of them (37%) were primiparous, 66 (27%) secundiparous, and 44 (18%) coursed the third pregnancy. Mean gestational age when they were evaluated for diminished fetal movements was 37.1 +/- 2.5 (SD) weeks. After the evaluation, 195 (81%) patients resulted with a reactive non-stress test, 42 (17%) had a non-reactive stress test with a positive vibroacoustic stimulation test, no patients were found with a non-reactive non-stress test and a negative vibroacoustic stimulation test. In two patients (< 1%) the register showed ominous pattern. In these two preterm cases pregnancy was interrupted. Mean gestational age at birth was 39.1 (+/- 1.7) weeks, and 223 (92.91%) born at term. From the two intervened cases, one had intrauterine growth restriction and the other asphyxia with intraventricular hemorrhage as a consequence. CONCLUSIONS: Hypomotility is one manifestation of the loss of fetal well-being and cannot be ignored because there are some cases in which intervention is needed. A great number of patients without a real risk of asphyxia and with a good perinatal outcome must be evaluated, so we have to look for another mechanism of evaluation for these patients. A clinimetric method could be an intermediary step between clinic and electronic surveillance.

[Doppler ultrasound to detect Rh: a systematic review]. / Ultrasonido doppler para detección rh: una revisión sistemática.

BACKGROUND: Red cell alloimmunization is an important cause of perinatal morbidlity and mortality. Invasive procedures used to diagnose fetal anemia are associated with serious fetal and maternal complications. The development of noninvasive techniques as Doppler ultrasound can help us in the fetal anemia diagnosis. OBJECTIVES: To evaluate the effect of the Doppler ultrasound in prediction of fetal anemia caused by red cell alloimmunization. Strategy search: Relevant studies were identified by reviewing the registry of COCHRANE, and OVID, PROQUEST, MEDLINE and EMBASE data bases from 1966 to 2004. SELECTION CRITERIA: All prospective studies with clinically relevant results with comparison of Doppler ultrasound in fetal umbilical artery, fetal descendent aorta, middle cerebral fetal artery or esplecnic fetal artery with hemoglobin or fetal hematocrit. DATA COLLECTION AND ANALYSIS: Data were extracted from each report. The quality revision of the studies and the data compilation were made by the reviewers. MAIN RESULTS: Eighteen articles were included. Two studies reached the level of evidence 1 for diagnostic tests. The diagnostic tests had variations depending on the different cut-off of each study. Studies with level 1 of evidence reported detection of 100% for moderate to severe fetal anemia. CONCLUSIONS: Implementation of Doppler ultrasound for prediction of fetal anemia in complicated pregnancies with alloimmunization could reduce the number of invasive procedures and therefore its complications. The level of present evidence reveals to us that the studies do not fulfill the criteria of methodological quality.