Fetoscopia y fotocoagulación láser en el manejo del síndrome de transfusión feto fetal: serie de los primeros casos tratados en el Perú / Fetoscopy and laser photocoagulation in the treatment of twin-to-twin transfusion syndrome: series of cases treated in Peru

Twin-to-twin transfusion syndrome is a severe complication of twin monochorial pregnancies manifested with one hypovolemic fetus (donor) and another hypervolemic fetus (receiver). Perinatal mortality is about 90 to 100% if untreated. The accepted treatment is fetoscopy and selective laser photocoagulation of the placental shunts that connect both twins. Currently, this specialized procedure is only performed in our institution. We present the first cases of monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome that underwent laser photocoagulation and fetoscopy.

El síndrome de transfusión feto fetal es una complicación severa de los embarazos gemelares monocoriónicos, que fisiopatológicamente se manifiesta con un feto hipovolémico (donante) y un feto hipervolémico (receptor). Conlleva una mortalidad perinatal de 90 a 100% si no es tratado. El tratamiento aceptado es la fetoscopia y fotocoagulación láser selectiva de las anastomosis placentarias que conectan ambos gemelos, procedimiento especializado que se viene realizando solo en nuestra institución. Se presenta los primeros casos de gestación gemelar monocoriónica complicado con síndrome de transfusión feto fetal sometidos a fetoscopia y fotocoagulación laser.

Non-invasive prenatal diagnosis from the perspective of a low-resource country.

Current clinical practice in obstetrics has shifted the paradigm from a conventional prenatal approach based on invasive procedures, risking both fetus and mother, to non-invasive prenatal testing for some fetal conditions via the analysis of cell-free fetal DNA in maternal blood. In the past 15 years, much research has been devoted to refining the methodology for measuring cell-free fetal DNA in maternal circulation and to exploring clinical applications of this technology as a potential tool for prenatal diagnosis. Since the rapid spread around the world of prenatal diagnosis based on cell-free fetal DNA, it is time to start thinking how this cutting-edge technology might influence current practice of obstetrics in low-resource countries.

Manejo prenatal de la malformación adenomatoidea quística pulmonar, variedad macroquística: Reporte de los primeros casos tratados intraútero en el Perú y revisión de la literatura / Prenatal management of congenital cystic adenomatoid lung malformation, macrocystic type: Report of a series of cases treated in utero in Peru and review of the literature

Se reporta una serie de 3 casos con diagnóstico prenatal de malformación adenomatoide quística pulmonar variedad macroquística sometida a terapia intraútero con derivación tóraco-amniótica. Se muestra que esta intervención intrauterina altamente especializada puede ser realizada con éxito en nuestro país. Los tres casos sobrevivieron. Se presenta una revisión corta de esta patología y se propone un flujograma de manejo.

We report a series of three cases with prenatal diagnosis of congenital cystic adenomatoid malformation of the lung, macrocystic type, treated in utero with thoraco-amniotic shunting. This highly specialized intervention is feasible in our local setting. The three cases survived. A mini-review of this condition is presented and an algorithm of prenatal management is proposed.

Perinatal outcomes associated with subsequent pregnancy among adolescent mothers in Peru.

OBJECTIVE: To assess the perinatal outcomes of a subsequent pregnancy among adolescent mothers living in Peru. METHODS: A large hospital-based retrospective cohort study was conducted to evaluate singleton births during a 9-year period (2001-2009). The study population was divided into 3 groups: adolescents aged 15-19 years who had 1 previous parturition (n=2074), nulliparous adolescents (n=20721), and multiparous adults aged 20-29 years (n=23 129). RESULTS: No significant differences were found between multiparous adolescents and the 2 control groups with regard to preterm delivery, perinatal death, and 5-minute Apgar score below 7. Logistic regression analysis showed no significant differences in the rates of cesarean delivery or preterm birth before 34 or 37 weeks. After adjusting for confounding factors, low birth weight (LBW) and small for gestational age (SGA) were more likely to occur during a subsequent pregnancy among adolescent mothers than during the 1st pregnancy among nulliparous adolescents. The odds ratios were 1.38 (95% CI, 1.14-1.67) and 1.27 (95% CI, 1.02-1.56), respectively. CONCLUSION: Multiparous adolescents are more likely to experience LBW or SGA than are nulliparous adolescents. No significant differences in other perinatal outcomes were found among the 3 study groups.

Resultados perinatales en adolescentes nulíparas. Estudio de cohorte retrospectiva / Perinatal outcomes in nulliparous adolescents. A hospital-based retrospective cohort study

Objetivo. Explorar los resultados perinatales en gestantes adolescentes nulíparas comparado con gestantes nulíparas de 20-29 años de edad. Materiales y métodos. Estudio de cohorte histórica poblacional. La población fueron gestantes de 11-29 años de edad con parto único ≥ 24 semanas en el periodo 2008-2009. Se distinguió 2 cohortes: 1) cohorte de estudio: adolescentes nulíparas (n = 3.555), y 2) cohorte de adultas nulíparas de 20-29 (n = 7.040). Además del análisis bivariado, se realizó análisis de regresión logística para ajustar por las principales variables confusoras. Los resultados perinatales evaluados son: bajo peso al nacer, parto pretérmino, feto muerto anteparto, cesárea y puntaje Apgar menor de 7 a los 5 minutos. Resultados. El parto pretérmino < 37 semanas fue más frecuente entre adolescentes que en mujeres de 20-29 años (7,5 vs. 5,4% respectivamente, p < 0,001). No hubo diferencia en el número de recién nacidos con bajo peso al nacer < 2.500 g (6,8 vs. 5,8%, en adolescentes vs. adultas respectivamente, p = 0,05), en la tasa de parto pretérmino < 34 semanas (1,7 vs. 2,1%, en adolescentes vs. adultas respectivamente p = 0,17), ni < 28 semanas (0,4 vs. 0,3%, en adolescentes vs. adultas respectivamente p = 0,32). Tampoco hubo diferencia en el número de fetos muertos anteparto (0,7 vs. 1,0%, en adolescentes vs. adultas respectivamente p = 0,11) ni en el puntaje Apgar < 7 a los 5 minutos (0,4 vs. 0,4%, en adolescentes vs. adultas respectivamente p = 0,983). El análisis de regresión logística mostró diferencia significativa en el riesgo de parto pretérmino < 37 semanas (OR = 1,3, IC 95%: 1,1-1,6), pero no de bajo peso al nacer < 2.500 g (OR = 1,0, IC 95% 0,8-1.3). Conclusiones. El embarazo en adolescentes nulíparas se asoció a parto pretérmino < 37 semanas. Otros resultados perinatales adversos como: bajo peso al nacer, puntaje Apgar < 7 a los 5 minutos y feto muerto anteparto no estuvieron asociados con embarazo en adolescentes nulíparas (AU)

Objective. To analyse perinatal outcomes in nulliparous adolescents compared with nulliparous women aged 20-29 years. Material and methods. This large hospital-based retrospective cohort study included singleton births at ≥ 24 weeks to women younger than 30 years from 2008 to 2009. The There were two cohorts: a) a study cohort consisting of nulliparous adolescents aged 11 to 19 years (n = 3555), and b) a control cohort comprising nulliparous women aged 20-29 years (n = 7040). In addition to a bivariate analysis, logistic regression was performed to adjust for confounding variables. Perinatal outcomes included low birth weight, preterm delivery, antepartum foetal death, caesarean section, and Apgar score at five minutes < 7. Results. Preterm delivery < 37 weeks was more frequent among adolescents than among women aged 20–29 years (7.5% vs 5.4% respectively, p < 0.001). There was no difference in the number of neonates with low birthweight < 2500 g (6.8% vs 5.8% in adolescents vs adults, respectively, p = 0.05), the rate of preterm delivery < 34 weeks (1.7% vs 2.1% in adolescents vs adults, respectively, p = 0.17), or in preterm delivery < 28 weeks (0.4% vs 0.3% in adolescents vs. adults, respectively, p = 0.32). There were no differences in antepartum foetal deaths (0.7% vs 1.0% in adolescents vs adults, respectively, p = 0.11) or in Apgar score < 7 at 5 minutes (0.4% vs 0.4% in adolescents vs adults, respectively, p = 0.983). Logistic regression analysis showed a significant difference in the risk of preterm delivery < 37 weeks (OR = 1.3, 95% CI: 1.1-1.6), but not in low birthweight < 2500 g (OR = 1.0, 95% CI 0.8–1.3). Conclusions. Preterm delivery < 37 weeks was more frequent in nulliparous adolescents than in women aged 20-29 years. There was no association between pregnancy in nulliparous adolescents and other adverse perinatal outcomes such as low birth weight, low Apgar score and antepartum foetal death (AU)

La importancia de la ecografía a las 11+0 a 13+6 semanas de embarazo: actualización / Importance of ultrasound evaluation at 11+0 - 13+6 weeks of pregnancy: an update

La evaluación ecográfica del primer trimestre (11+0 a 13+6 semanas) constituye actualmente una de las herramientas fundamentales en el manejo de toda paciente obstétrica. Es el mejor ejemplo de tamizaje en Obstetricia por medio del cálculo de riesgo de anormalidades cromosómicas y, sumado a ciertas características obstétricas y clínicas, se constituye en un potencial predictor de riesgo de las principales complicaciones obstétricas. Es nuestro objetivo presentar en forma resumida y simplificada los avances en este importante tópico de Medicina Fetal, con la finalidad de que sea reafirmada y asumida por todos los responsables del cuidado de la salud materno-fetal, incluyendo los padres.

First trimester ultrasound scan (11+0 to 13+6 weeks) is currently one of the most important clinical tools in managing pregnant women and their fetuses. It represents the best example of screening in Obstetrics to assess risk for chromosomal abnormalities and combined with maternal and obstetrical characteristics could be a useful predictor of obstetrical complications. We aim to present comprehensive summary of this important topic in Fetal Medicine for people involved in providing maternal and perinatal care, i.e. obstetricians, midwives and parents.