EXIT procedure in twin pregnancy: a series of three cases from a single center.

BACKGROUND: Indications for the ex utero intrapartum therapy (EXIT) procedure have evolved and nowadays in addition to secure the airway, obtain vascular access, administer surfactant and other resuscitation medications, EXIT is used to resect cervical or thoracic masses, for extracorporeal membrane circulation (ECMO) cannulation, as well as to rescue maximum intra-thoracic space for ventilation of the remaining functional lung tissue or in cases in which resuscitation of the neonate may be compromised. EXIT procedure in twin pregnancy has been rarely reported and some doubts have been raised about its strategy and safety in such cases. METHODS: We reviewed the medical records of 3 twin pregnancy cases where the EXIT procedure have been performed in our center. RESULTS: The mean gestational age at EXIT procedure was 34 + 4 weeks. In two out the three EXIT procedures, the affected twin was delivered first. The average time on placental bypass was 9 minutes. There were no fetal or maternal complications related to the EXIT procedure. All newborns are currently doing well. CONCLUSION: In twin pregnancies, prenatal diagnosis combined with the EXIT procedure permits the formulation of a controlled delivery strategy to secure both newborns outcome. In those pregnancies, if intervention can be accomplished without compromise of the normal twin, EXIT can be considered. Our results support that EXIT procedure, if properly planned, safely provides a good outcome for both the fetuses as well as the mother.

[Clinical and biological characteristics of a group of 54 pregnant women with HELLP syndrome]. / Características clinicobiológicas de un grupo de 54 gestantes con síndrome HELLP.

BACKGROUND AND OBJECTIVE: The HELLP syndrome is a rare form of preeclampsia with a variable presentation with substantial maternal and perinatal morbidity and mortality. The aim of this study was to determine its clinical and biological characteristics in our hospital. PATIENTS AND METHOD: An observational study of all cases of confirmed HELLP syndrome from 1999 to 2002 was carried out. RESULTS: There were 54 cases of HELLP syndrome. Mean maternal age was 30.06 (16-41) years. 57.4% were primiparous. Mean gestational age at diagnosis of HELLP syndrome was 31.75 (20-41) weeks. Symptoms and signs were dominated by the digestive ones. Hypertension was observed in all cases. 77.8% pregnancies were delivered by caesarean section. Mean birth weight was 1674.52 g (150-3800 g). There were 12 perinatal deaths and one maternal death. CONCLUSIONS: HELLP syndrome is an uncommon but potentially serious complication of pregnancy which is associated with an increased risk of adverse maternal and fetal outcomes. Management should be multidisciplinary and based on strict control by maternal and fetal symptoms.

Diagnosis and management of fetal intrapericardial Morgagni diaphragmatic hernia with massive pericardial effussion.

Herniation of the liver into the fluid-filled pericardial sac resulting in a thoracic mass is a particularly rare form of Morgagni hernia (congenital diaphragmatic hernia of Morgagni). We report an early antenatal diagnosis of congenital diaphragmatic hernia of Morgagni with pericardium effussion at 21 weeks' gestation. Two pericardiocentesis were performed at 21 and 22 4/7 weeks' gestation because of recurrence of pericardial effussion. Regular ultrasound assessments showed progressive herniation of the liver to practically fill the right hemithorax. An ex utero intrapartum treatment procedure was performed at 37 weeks' gestation to rescue maximum intrathoracic space for ventilation of the remaining functional lung tissue and to establish an airway for postnatal support. After birth, the patient successfully underwent early correction of the hernia. Postoperative course was uneventful, and the newborn girl was discharged 18 days later without complications and is currently doing well.

Características clinicobiológicas de un grupo de 54 gestantes con síndrome HELLP / Clinical and biological characteristics of a group of 54 pregnant women with HELLP syndrome

FUNDAMENTO Y OBJETIVO: El síndrome HELLP es una forma rara de preeclampsia de presentación variable que asocia un incremento de la morbilidad y mortalidad materna y perinatal. El objetivo de este estudio fue determinar las características clínicas y biológicas de los casos asistidos en nuestro hospital. PACIENTES Y MÉTODO: Estudio observacional de todas las pacientes con síndrome HELLP atendidas en un solo centro entre 1999 y 2002. RESULTADOS: Hubo 54 casos de síndrome HELLP. La edad materna fue de 30,06 años (extremos, 16-41) y el 57,4 por ciento eran primíparas. La edad gestacional al diagnóstico fue de 31,75 semanas (extremos, 20-41). Los síntomas y signos fueron predominantemente digestivos. La presencia de hipertensión fue común en todos los casos. En el 77,8 por ciento de los casos fue necesario practicar una cesárea. El peso medio de los recién nacidos fue de 1.674,52 g (150-3.800 g). Hubo 12 muertes perinatales y una muerte materna. CONCLUSIONES: Este síndrome es una complicación rara pero potencialmente grave del embarazo que asocia un riesgo aumentado de problemas maternos y fetales. Por consiguiente, su manejo debe ser multidisciplinario y basado en un control estricto de la clínica materna y fetal (AU)