Increased adherence to ACOG diagnostic guidelines for HDP following a workshop in Bolivia, a LMIC.

OBJECTIVES: Hypertensive disorders of pregnancy (HDP) exert a heavy mortality burden in low- to middle-income countries (LMIC). ACOG revised HDP diagnostic guidelines to improve identifying pregnancies at greatest risk but whether they are used in LMIC is unknown. STUDY DESIGN: We held a workshop to review ACOG guidelines in La Paz, Bolivia (BO) and then reviewed prenatal, labor and delivery records for all HDP diagnoses and twice as many controls at its three largest delivery sites during the year before and the nine months after a workshop (n = 1376 cases, 2851 controls during the two periods). MAIN OUTCOME MEASURES: HDP diagnoses, maternal, and infant characteristics. RESULTS: Bolivian and ACOG criteria identified similar frequencies of gestational hypertension (GH) or eclampsia, but preeclampsia with severe features (sPE) was under- and preeclampsia without severe features (PE) over-reported during both periods. Increases occurred after the workshop in testing for proteinuria and the detection of abnormal laboratory values and severe hypertension in HDP women. Any adverse maternal outcome occurred more frequently after the workshop in women with BO PE or sPE diagnoses who met ACOG sPE criteria. CONCLUSIONS: Utilization of ACOG guidelines increased following the workshop and improved identification of PE or sPE pregnancies with adverse maternal outcomes. Continued use of a CLAP perinatal form recognizing HELLP as the only kind of sPE resulted in under-reporting of sPE. FUNDING: NIH TW010797, HD088590, HL138181.

Is Maternal Cardiovascular Performance Impaired in Altitude-Associated Fetal Growth Restriction?

Mundo, William, Lilian Toledo-Jaldin, Alexandrea Heath-Freudenthal, Jaime Huayacho, Litzi Lazo-Vega, Alison Larrea-Alvarado, Valquiria Miranda-Garrido, Rodrigo Mizutani, Lorna G. Moore, Any Moreno-Aramayo, Richard Gomez, Patricio Gutierrez, and Colleen G. Julian. Is maternal cardiovascular performance impaired in altitude-associated fetal growth restriction? High Alt Med Biol. 23:352-360, 2022. Introduction: The incidence of fetal growth restriction (FGR) is elevated in high-altitude resident populations. This study aims to determine whether maternal central hemodynamics during the last trimester of pregnancy are altered in high-altitude FGR. Methods: In this cross-sectional study of maternal-infant pairs (FGR, n = 27; controls, n = 26) residing in La Paz, Bolivia, maternal heart rate, cardiac output (CO), stroke volume, and systemic vascular resistance (SVR) were assessed using continuous-wave Doppler ultrasound. Transabdominal Doppler ultrasound was used for uterine artery (UtA) resistance indices and fetal measures. Maternal venous soluble fms-like tyrosine kinase-1 (sFlt1) levels were measured. Results: FGR pregnancies had reduced CO, elevated SVR and UtA resistance, fetal brain sparing, and increased maternal sFlt1 versus controls. Maternal SVR was positively associated with UtA resistance and inversely associated with middle cerebral artery resistance and birth weight. Maternal sFlt1 was greater in FGR than controls and positively associated with UtA pulsatility index. Women with elevated sFlt1 levels also tended to have lower CO and higher SVR. Conclusion: Noninvasive assessment of maternal cardiovascular function may be an additional method for detecting high-risk pregnancies at high altitudes, thereby informing the need for increased surveillance and appropriate allocation of resources to minimize adverse outcomes.

ACOG and local diagnostic criteria for hypertensive disorders of pregnancy (HDP) in La Paz-El Alto, Bolivia: A retrospective case-control study.

Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal death in low- to middle-income countries (LMIC). The American College of Obstetricians and Gynecologists (ACOG) updated diagnostic guidelines to align signs and symptoms with those associated with maternal death. We performed an observational study to ask whether ACOG guidelines were employed and associated with adverse outcomes in La Paz-El Alto, Bolivia, an LMIC. Methods: Medical records for all HDP discharge diagnoses (n = 734) and twice as many controls (n = 1647) were reviewed for one year at the three largest delivery sites. For the 690 cases and 1548 controls meeting inclusion criteria (singleton, 18-45 maternal age, local residence), health history, blood pressures, symptoms, lab tests, HDP diagnoses (i.e., gestational hypertension [GH]; preeclampsia [PE]; haemolysis, low platelets, high liver enzymes [HELLP] syndrome, eclampsia), and adverse outcomes were recorded. Bolivian diagnoses were compared to ACOG guidelines using accuracy analysis and associated with adverse outcomes by logistic regression. Findings: Both systems agreed with respect to eclampsia, but only 27% of all Bolivian HDP diagnoses met ACOG criteria. HDP increased adverse maternal- or perinatal-outcome risks for both systems, but ACOG guidelines enabled more pre-delivery diagnoses, graded maternal-risk assessment, and targeting of HDP terminating in maternal death. Interpretation: Bolivia diagnoses agreed with ACOG guidelines concerning end-stage disease (eclampsia) but not the other HDP due mainly to ACOG's recognition of a broader range of severe features. ACOG guidelines can aid in identifying pregnancies at greatest risk in LMICs, where most maternal and perinatal deaths occur. Funding: NIH TW010797, HD088590, HL138181, UL1 TR002535.

Revisión y evaluación de categorias del sistema bi - rads en lesiones mamarias sometidas a biopsia en pacientes del hospital materno infantil durante las gestiones 2013-2014 / Review and assesment of bi - rads system in breast lesions went under biopsy, carried out in patients of h.m.i. hospital within the periods of 2013-2014

INTRODUCCION: el Cáncer de mama se ha convertido en los últimos años en una enfermedad de salud pública, Una de las estrategias importantes de control es la prevención siendo el Sistema BIRADS una herramienta de screening importante. OBJETIVO: revisar y evaluar las categorías del Sistema BI - RADS en lesiones mamarias sometidas a biopsia en pacientes del Hospital Materno-Infantil durante las gestiones 2013-2014. MATERIAL Y METODOS: se obtuvieron resultados imagenológicos diversos mediante el sistema BIRADS y resultado histopatológico de lesiones estudiadas por biopsia, se aplicó el programa OpenEpi y la evaluación de prueba diagnóstica o de screening para cada categoría. RESULTADOS: en el estudio se encontró que: BI-RADS 3, la sensibilidad (S) 24.3% y especificidad (E) 100% con VPP de 100% y VPN de 6.66%. BIRADS 4 A la S de 61.54%, y E 94.87%, con VPP 80%, y VPN 88.1%. BI-RADS 4B mostro una S de 50%, y E de 94.87% con VPP de 60%, y VPN de 92.5%. El BI-RADS 4C tiene una S de 83.33 % y E 94.87%, su VPP es 71.43% y el VPN 97.37%. El BIRADS 5 mostro S 87.5% y E 94.87% con un correspondiente VPP de 77.78% y VPN de 97.37%. CONCLUSION: los informes imagenológicos reportados mediante el sistema BIRADS han probado ser pruebas confiables en la detección de pacientes con neoplasias malignas. Finalmente, se debe tener una especial atención a las pacientes con informes BI-RADS 3 con el fin de descartar una patología maligna.

INTRODUCTION: breast Cancer is a disease of public health, its prevalence is greater than the uterine carcinoma and mortality poses a risk to be faced. One important coping strategies is prevention, this is where the BIRADS system plays an important role. OBJECTIVE: identify, review and assess the categorization of BI - RADS system and biopsied breast lesions in patients of H.M.I. 2013 - 2014. MATERIAL AND METHODS: diagnosis test. Imaging results were obtained, either ultrasound, or ecomamograficos mammographic system by BlRADS result of histopathological lesions studied by biopsy. OpenEpi program and evaluation of diagnostic test or screening for each category was applied. RESULTS: the study found: BI-RADS 3, the sensitivity was 24.3% and 100% specificity with a PPV of 100% and NPV of 6.66%. BIRADS 4th sensitivity was 61.54% and specificity 94.87%, with a PPV 80% and NPV 88.1%. The BI-RADS 4B showed a sensitivity of 50% and a specificity of 94.87% with a PPV of 60% and a NPV of 92.5%. The BI-RADS 4c has a sensitivity of 83.33% and specificity 94.87%, the PPV is 71.43% and 97.37% VPN. The BIRADS 5 showed a sensitivity 87.5% and specificity 94.87% with a corresponding PPV of 77.78% and NPV of 97.37%. CONCLUSION: imaging reports reported by BI-RADS system have proven reliable in the detection of patients with malignancies and as a source to determine the healthy patients or with benign findings. Finally it should have special attention to patients with imaging reports BI-RADS 3 in order to rule out malignancy.

Actinomicosis Abdomino - Pélvica / Abdomino - Pelvic Actinomycosis

OBJETIVO: Informar caso de actinomicosis peri-ovárica, que se interviene de urgencia como abdomen agudo quirúrgico. CASO CLÍNICO: Reporte de caso clínico de adolescente de 16 años de edad con dolor abdominal intenso, datos de irritación peritoneal, además de la presencia de masa abdominal palpable en fosa iliaca izquierda, sometida a laparotomía exploratoria. RESULTADO DE ESTUDIO HISTOPATOLÓGICO: Actinomicosis peri ovárica. CONCLUSIONES: La actinomicosis abdomino ­ pélvica constituye una entidad de difícil diagnóstico, con una presentación clínica no habitual en las enfermedades pélvicas, sino que se presenta en forma de masas abcesificadas abdomino pélvicas pseudo tumorales, causando afectación grave del área intestinal más próxima, con resultado habitual de resección y exéresis.

OBJETIVE: To report the case ofperi - ovarian actinomycosis, which involved emergency and surgical acute abdomen. CASE: Report clinical case of 16-year -old with severe abdominal pain, peritoneal irritation, besides the presence of palpable abdominal mass in the left iliac fossa, subjected to exploratory laparotomy with resection of the same. RESULT: Histopathological report concludes peri ovarian actinomycosis. CONCLUSIONS: Abdominal actinomycosis - is an entity pelvic disease is difficult to diagnose , with an unusual clinical presentation in pelvic inflammatory disease, but in the form of abdominal and pelvic masses abcesificadas pseudotumoral, causing severe intestinal involvement nearest area with usual result of resection and excision.