Prenatal diagnosis of Greig Cephalopolysyndactyly Syndrome. When to suspect it.

Greig Cephalopolysyndactyly Syndrome (GCPS) is a very rare multiple congenital anomaly with an estimated incidence of 1-9:1,000,000 in newborns with principal findings of macrocephaly, ocular hypertelorism, and polysyndactyly (preaxial or mixed preaxial and postaxial). Very few cases of prenatal diagnoses have been reported. The postnatal diagnosis is based on clinical findings and family background. GLI3, the only gene associated with this anomaly, is altered in more than 75% of cases. Deletions over 1 Mb and involving other genes yield severe clinical cases, which are known collectively as Greig Cephalopolysyndactyly-contiguous gene Syndrome. We report a case in which, despite early polydactyly findings on week 16, the diagnosis was established during the third trimester of pregnancy due to the late presentation of other anomalies corresponding to this syndrome.

Maternal Thinness and Obesity and Customized Fetal Weight Charts.

OBJECTIVE: The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC(18.5-25)) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. MATERIAL AND METHODS: Data from 20,331 infants were used to construct CC and from 11,604 for CC(18.5-25), after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance. RESULTS: The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGAonly by CC(18.5-25) than in LGAonly by CC. In SGAonly by CC(18.5-25), neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGAonly by CC. Adverse outcomes rate was higher in LGAonly by CC(18.5-25) than in LGAonly by CC (21.6%; OR = 1.61, [1.34-193]) vs. (13.5%; OR = 0.84, [0.66-1.07]), and in SGA only by CC(18.5-25) than in SGAonly by CC (9.6%; OR = 1.62, [1.25-2.10] vs. 6.3%; OR = 1.18, [0.85-1.66]). CONCLUSION: The use of CC(18.5-25) allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.

Rotational forceps: a retrospective study evaluating anatomical and functional consequences for the pelvic floor.

INTRODUCTION AND HYPOTHESIS: The use of Kielland's rotational forceps is considered to involve greater technical difficulty and may be associated with a higher rate of pelvic floor trauma. Our main objective was to evaluate the association between avulsion of the levator muscle and rotational and non-rotational forceps. METHODS: This was an observational study carried out at a tertiary hospital that recruited singleton cephalic vaginally primiparous women with previous Kielland's forceps delivery between March 2012 and May 2017. Patients were retrieved from a local database, contacted consecutively and blinded to all clinical data. Power calculations determined a sample of n = 160 patients. All women underwent a urogynecological interview, clinical examination and 4D translabial ultrasound (TLUS). The 4D TLUS volumes were stored and analyzed offline by an experienced ultrasound examiner who was blinded to all clinical data. RESULTS: A total of 165 patients were available for analysis. Rotational forceps accounted for 27.3% (45 out of 165) of the study sample. Avulsion was present in 41.8% (69 out of 165) of all forceps deliveries. On multivariate analysis, rotational forceps was associated with avulsion, with an adjusted odds ratio (OR) of 2.57 (CI 95% 1.20-5.62, p = 0.016). Body mass index at the beginning of gestation was found to be a protective factor, with an adjusted OR of 0.918 (CI 95% 0.847-0.986, p = 0.025). CONCLUSION: Rotational forceps is associated with a higher avulsion rate than non-rotational forceps, with an adjusted OR of over 2.5. Obstetricians need to consider the potential long-term consequences of performing a rotational forceps for mothers.

Gestational Age-Specific Reference Ranges for the sFlt-1/PlGF Immunoassay Ratio in Twin Pregnancies.

OBJECTIVE: Establish reference ranges for the Elecsys® soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) immunoassay ratio in twin pregnancies. METHODS: Data analyzed were from 3 prospective studies: Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia (PE) (PROGNOSIS), Study of Early-onset PE in Spain (STEPS), and a multicenter case-control study. Median, 5th, and 95th percentiles for sFlt-1, PlGF, and the sFlt-1/PlGF ratios were determined for normal twin pregnancies for 7 gestational windows and compared with the previous data for singleton pregnancies. RESULTS: The reference range analysis included 269 women with normal twin pregnancies. Before 29 weeks' gestation, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios did not differ between twin and singleton pregnancies. From 29 weeks' gestation to delivery, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios were substantially higher in twin versus singleton pregnancies. sFlt-1 values were higher in women with twin pregnancies across all gestational windows. PlGF values were similar or higher in twin versus singleton pregnancies; PlGF concentrations increased from 10 weeks + 0 days to 28 weeks + 6 days' gestation. CONCLUSIONS: Reference ranges for the sFlt-1/PlGF ratio are similar in women with twin and singleton pregnancies until 29 weeks' gestation but appear higher in twin pregnancies thereafter.

Evaluation of the effectiveness of transcutaneous nerve stimulation during labor in breech presentation: a case series.

Objective: To analyze the effectiveness of pain relief with transcutaneous electrical nerve stimulation (TENS) dispositive during labor in breech vaginal delivery and also to describe its tolerance and satisfaction.Design: A randomized, double-blind, and placebo-controlled trial was conducted.Setting: Labor room of Complejo Hospitalario Universitario Insular-Materno Infantil (Spain).Participants: Ten women who met the inclusion criteria of the clinical trial and also had a fetus breech presentation were randomly assigned to three groups.Interventions: A portable TENS, Cefar Rehab 2pro®, unit was used to apply the experimental intervention, with different doses in the three groups in women during labor. The device intensity (amplitude) was individually adjusted to each participant's maximum sensory level. The pain was evaluated with visual analog scale (VAS). COMFORTS scale was used to measure women's satisfaction.Results: A significant association of VAS was detected depending on the type of TENS over time. Active TENS2 was the only group that obtained an improvement with clinically significant results. In connection with women satisfaction, active TENS2 group was also the group that presented higher values.Conclusions: We can recommend the use of TENS dispositive to relieve pain during labor, also in those women with breech presentation.

First-trimester cystic posterior fossa: reference ranges, associated findings, and pregnancy outcomes.

OBJECTIVE: To report reference ranges for fetal cerebral posterior fossa measurements and to describe the sonographic findings, karyotype results, and pregnancy outcomes in fetuses presenting with cystic posterior fossa (CPF) in the first trimester of pregnancy. METHODS: Two groups of patients undergoing first-trimester sonographic screening at 11-13 weeks' gestation were studied. The first (control group) consisted of 253 consecutive fetuses with normal posterior fossa, in which the brainstem (BS), fourth ventricle, cisterna magna, and BS-occipital bone (BS-OB) diameter were prospectively measured and the BS/BS-OB diameter ratio was calculated. The second (study group) consisted of 14 fetuses in which a CPF was detected. Information on sonographic findings, prenatal karyotype results, and pregnancy outcomes was obtained by reviewing ultrasound reports and medical records. The results from the two groups were then compared. RESULTS: In the control group, the size of all posterior fossa structures increased and the BS/BS-OB diameter ratio slightly decreased as the pregnancy progressed. In the study group, the BS diameter did not differ significantly from the measurements obtained in the control group. However, the BS-OB diameter and the fourth ventricle were significantly larger (p < .05 and p < .001, respectively) in the study group than in the control group. Additionally, the cisterna magna was not identified in 13 of the 14 fetuses (93%) in the study group, in comparison to zero out of the 253 fetuses in the control group (p < .001). Finally, the BS/BS-OB diameter ratio was significantly smaller in the study group when compared with the control group (p < .05). Regarding pregnancy outcomes, 12 of the 14 (86%) affected pregnancies underwent elective termination (n = 11) or ended in an early intrauterine demise (n = 1) due to the associated chromosomal abnormalities or structural defects. The two fetuses with isolated CPF had a normal second-trimester scan and resulted in the delivery of healthy newborn infants. CONCLUSIONS: The detection of a CPF in the first trimester is associated with a high rate of chromosomal and structural defects. By using normative data, early sonographic screening and detection of mildly and moderately abnormal cases is possible. Fetuses with isolated CPF require further study with a detailed second-trimester scan. This is essential in order to differentiate cases with poor and good perinatal outcomes. Finally, our data also demonstrate that the main sonographic tool when screening for CPF in the first trimester is the assessment of the fourth ventricle, which is significantly larger in abnormal cases as the result of the wide communication between the fourth ventricle and the cisterna magna.

Delivery in breech presentation: Perinatal outcome and neurodevelopmental evaluation at 18 months of life.

OBJECTIVES: To compare maternal and perinatal outcomes, including neurodevelopmental results at 18 months of life, between term breech and cephalic deliveries. STUDY DESIGN: In this longitudinal retrospective study of mothers seen at the Maternity and Paediatric University Hospital of the Canary Islands delivery unit from November 1, 2011, to October 31, 2012, we compared maternal and perinatal outcomes associated with breech or cephalic presentation of the foetus. A second analysis was performed to compare breech births, differentiating between whether a vaginal delivery attempt was made or if caesarean section (C-section) without labour had been directly scheduled. The psychomotor development of children 18 months after birth was assessed using the Haizea-Llevant scale. RESULTS: A total of 130 breech deliveries were matched with 130 cephalic deliveries. No perinatal mortality occurred in either group. The C-section percentage was greater in the breech presentation group compared with the cephalic delivery group (72.3 % vs. 14.6 %; p < 0.001). Children in the breech presentation had a threefold increased risk for Apgar scores <7 at 1 min (OR 3.2; 95 % CI: 1.2-8.4; p = 0.016) compared with cephalic presentation. These differences disappeared 5 min after birth. No differences were observed in moderate to severe neonatal morbidity between the breech and cephalic presentation groups. There were no differences between groups in neurodevelopmental outcomes. Of 130 pregnancies with breech presentation, 79 (60.8 %) made a vaginal delivery attempt, and 51 (39.2 %) were planned C-sections. Women who attempted vaginal breech delivery were younger and had a history of previous pregnancy. Apgar scores <7 at 1 min were more frequent in the vaginal delivery attempt group (27.9 % vs. 5.9 %; p = 0.002). A high percentage of type III resuscitation (36.5 % vs. 14.3 %; p = 0.007) and Neonatology admission (22.8 % vs. 5.9 %; p = 0.013) was observed in the vaginal delivery attempt group. Except for Apgar scores <7 at 1 min, none of these associations was significant after adjusting for nulliparity and maternal age. The mode of delivery was not associated with moderate to severe perinatal outcomes. CONCLUSION: The implementation of a specific protocol for selecting pregnant women with breech presentation as candidates for vaginal delivery achieved perinatal outcomes similar to births in cephalic presentation.

The solitary median maxillary central incisor (SMMCI) syndrome: Associations, prenatal diagnosis, and outcomes.

Solitary median maxillary central incisor (SMMCI) syndrome is a complex disorder consisting of multiple, developmental defects involving midline structures of the head, which includes the cranial bones, the maxilla, and its container dentition (specifically the central incisor tooth germ), together with other midline structures of the body. SMMCI may appear as an isolated trait or in association with other midline developmental anomalies. We describe the case of a patient with SMMCI. He presented with a solitary median maxillary incisor, short stature, corpus callosum anomalies and a microform of holoprosencephaly (HPE), diabetes insipidus, and neurodevelopmental delay. The diagnosis was performed postnatally based on clinical features, radiological imaging, and a comprehensive genetic study. SMMCI can be diagnosed during the prenatal or neonatal periods or during infancy. Evaluation of the superior maxillary bone is important for prenatal diagnosis. Direct evaluation through bidimensional ultrasound or the use of multiplanar ultrasound or tridimensional reconstruction should be performed in cases of brain or face malformations. Early diagnosis can contribute to improved prenatal assessment and postnatal management.

Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial.

BACKGROUND: Pain during labour is one of the most intense pain that women may experience in their lifetime. There are several non-pharmacological analgesic methods to relieve pain during labour, among them transcutaneous electrical nerve stimulation (TENS). TENS is a low-frequency electrotherapy technique, analgesic type, generally used in musculoskeletal pathology, but it has also come to be used as an alternative treatment during labour. The purpose of this study is to investigate the pain-relieving effect of a TENS application during labour and to find out the most effective dose. METHODS: This study is a randomized, double-blind, placebo-controlled trial. TENS therapy was initiated at the beginning of the active phase of labour. Participants were randomly assigned to three groups (21 per group: two active TENS and one placebo). Active TENS 1 intervention consisted in a constant frequency of 100-Hz, 100-µs, active TENS 2 intervention consisted in a varying high-frequency (80-100 Hz), 350 µs, and in a placebo group, participants were connected to the TENS unit without electrical stimulation. TENS was applied with two self-adhesive electrodes placed parallel to the spinal cord (T10-L1 and S2-S4 levels). The primary outcome was pain intensity (0-10 cm) measured on a visual analogue scale (VAS) at several stages (at baseline and at 10 and 30 min later). Secondary outcomes included women's satisfaction (via the Care in Obstetrics: Measure for Testing Satisfaction scale). RESULTS: Sixty-three women participated. Regarding baseline characteristics, no differences were found among the three groups. The active TENS 2 group obtained an improvement with clinically significant VAS results (- 2.9, 95% confidence interval - 4.1 to - 1.6, p <  0.001). Regarding satisfaction, the results also revealed better results in the active TENS than in the placebo group. CONCLUSIONS: TENS with high frequencies modified in time as well as high pulse width are effective for relieving labour pain, and they are well considered by pregnant participants. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03137251 . Registered on 2 May 2017.

[Endocrine disruptors and hypospadias in Gran Canaria island (2012-2015)]. / Disruptores endocrinos e hipospadias en Gran Canaria (2012-2015).

OBJECTIVE: Hypospadias represents the most frequent male congenital malformation in children, with a prevalence of 1 in 200-300 new born or 4-6 in 1000 male new born. Genetic and environmental factors play a strong role on developing this virilization defect acting as endocrinal disruptors (ED). The objective of the present study was to evaluate the environmental factors that may have influenced the development oh hypospadias in children treated at the Maternal and Child University Hospital od Las Palmas of Gran Canaria Island during the years 2012-2015. METHODS: The present study represents a retrospective analysis of patients treated for hypospadias in the Maternal-Paediatric University Hospital of Las Palmas of Gran Canaria during 4 years (2012 -2015) by the use of medical records and telephone survey to families' patients. To perform the statistical analysis of the data, the SPSS program was used in version 15.0. The level of statistical significance was established for an error α = 0.05. The chi-square test and Fisher's correction were applied if necessary to test the associations between the qualitative variables. RESULTS: From 2012 to 2015, 128 patients were treated; we could only follow 116 patients. If we analyse patients' distribution throught those years we can resume that 33% of them were treated in 2012, 23% in 2013, 24% in 2014 and 20% in 2015. We analyse the study background of both parents: 45.5% of mothers had primary studies, 37.5% had secundary studies, 15.2% had university studies and 1.8% were students; 54.3% of fathers had primary studies, 32.4% had secundary studies and 13.3% had university studies. We did not found any statistically significant diference between the place of residence and the study background both in mothers (p=0,262) and fathers (p=0,052). Within all the patients followed, 78 had a clinical history of exposition to ED as a direct family background. CONCLUSIONS: The chronical exposure to ED, very frequent in our society, is a very important risk factor in the development of urologic pathologies as hypospadias; for this reason, awareness measures and prevention in social areas and workplace must be carried out to avoid unnecessary exposures.

OBJETIVO: El hipospadias es la malformación congénita genital masculina más frecuente en niños, con una prevalencia de 1 cada 250 recién nacidos de sexo masculino. Se especula que pueden existir factores genéticos y/o medioambientales que predisponen a este defecto de virilización actuando como disruptores endocrinos (DE). El objetivo del presente estudio fue evaluar los factores medio ambientales que puedan haber influido en el desarrollo del hipospadias en los niños tratados en el Hospital Universitario Materno Infantil de Las Palmas de Gran Canarias en los años 2012-2015. METODOS: El presente estudio representa un análisis retrospectivo de los casos de hipospadias tratados en el Hospital Universitario Materno Infantil de Las Palmas de Gran Canaria entre el 2012 y el 2015, tras la revisión de las historias clínicas y la realización de una encuesta telefónica a los padres de los pacientes tratados. Para realizar el análisis estadístico de los datos, se utilizó el programa SPSS en la versión 15.0. El nivel de significación estadística se estableció para un error α=0.05. Se aplicó el test de chi cuadrado y la corrección de Fisher en caso de que fuera necesario para testar las asociaciones entre las variables cualitativas. RESULTADOS: Durante el periodo de estudio se trataron a 128 pacientes de los cuales se siguieron a 116. Si analizamos su distribución por años, el 33% de los pacientes fueron tratados en el año 2012, el 23% en el 2013, el 24% en el 2014 y el 20% en el 2015. En relación al nivel de estudio de la familia, el 45.5% de las madres tenían estudios primarios, el 37.5% estudios secundarios, el 15.2% estudios universitarios y el 1.8% eran estudiantes. En relación a los padres, el 54.3% tenían estudios primarios, el 32.4% estudios secundarios y el 13.3% estudios universitarios. No se encontraron diferencias estadísticamente significativas entre el municipio de residencia y el nivel de estudio de las madres (p=0,262) y de los padres (p=0,052). De los 116 pacientes analizados, 78 tenían antecedentes familiares directos con exposición a disruptores endocrinos. CONCLUSIONES: La exposición a agentes químicos nocivos y pesticidas, cada vez más habitual en nuestra sociedad, constituye un factor de riesgo para el padecimiento de enfermedades del tracto urológico inferior como el hipospadias, por lo que se deberían tomar medidas de concienciación y prevención en el ámbito social y laboral frente a la exposición a dichos agentes.

Fetal hydrometrocolpos and congenital imperforate hymen: Prenatal and postnatal imaging features.

Congenital imperforate hymen is probably the most common obstructive anomaly of the female reproductive tract. The accumulation of fluid in the genital tract leads to a distended uterus and vagina, causing hydrometrocolpos. Prenatal diagnosis of fetal hydrometrocolpos is uncommon, with only 22 cases reported in the literature and only a few cases of prenatal imaging of this condition available to date. The main ultrasound finding is a fetal pelvic mass posterior to the bladder and anterior to the rectum. We present the case of a 37-week female fetus with a fetal pelvic mass detected in a routine obstetric ultrasound examination, and the correlation between the prenatal and postnatal findings.

Corrigendum to "Prenatal Diagnosis of Cardiac Diverticulum with Pericardial Effusion in the First Trimester of Pregnancy with Resolution after Early Pericardiocentesis".

[This corrects the article DOI: 10.1155/2015/154690.].

Characterization of mothers at risk of delivery at the limit of viability and factors related to infant survival.

OBJECTIVES: To determine the sociodemographic and clinical characteristics of mothers of infants at the limit of viability and to know the perinatal factors associated to infants' survival. METHOD: Single-center cohort study of mothers and newborns assisted in our tertiary care center (2004-2010). Demographic and perinatal variables were compared between mothers who gave birth ≤26 weeks GA and the general population. The association between perinatal factors and neonatal survival was studied by Cox regression analysis. RESULTS: Mothers of newborns ≤26 weeks (n = 136) had less education and pregnancy control. They had more frequently assisted reproductive technologies (ART) (5.2% versus 2.3%; p< 0.05), multiple gestations (16.6% versus 2.1%; p < 0.05), pregnancy complications and C-section (39.7% versus 13.4%; p < 0.001). After correcting for confounders, the perinatal factors independently associated with a variation in the risk of mortality were the administration of antenatal steroid [aHR (95%CI): 0.465 (0.254-0.853), p = 0.013], singleton pregnancy [aHR (95%CI): 0.482 (0.279-0.834), p = 0.009], infant's temperature on admission [aHR (95%CI): 0.642 (0.426-0.968), p = 0.035] and CRIB score [aHR (95%CI): 1.151 (1.058-1.251), p = 0.001]. CONCLUSIONS: Mothers of preterm infants at the limit of viability had more ART, multiple pregnancies, obstetrical complications and C-section. Infants' survival was independently associated to antenatal steroids, singleton pregnancy, temperature on admission and CRIB score.

End-of-Life Care and Survival without Major Brain Damage in Newborns at the Limit of Viability.

BACKGROUND: The probabilities of survival and survival without major brain damage (MBD) are low in newborns at the limit of viability. Survival without MBD constitutes a major concern for parents and professionals. OBJECTIVES: To know the probabilities of survival without MBD in newborns ≤26 weeks' gestational age (GA) relative to the total number of survivors, whether these probabilities vary with GA, and how end-of-life (EoL) decisions influence these results. METHODS: We included all live-inborn patients of 22-26 weeks' GA, without major congenital anomalies, born in collaborating centers of the Spanish SEN1500 Network (2004-2010). MBD was defined as the presence of severe intraventricular hemorrhage and/or periventricular leukomalacia. RESULTS: A total of 3,371 patients were born alive, 3,236 of whom were admitted to the neonatal intensive care unit (NICU). Survival without MBD was 44.4% among patients admitted to the NICU, increasing from 12.5% at 22 weeks to 57.9% at 26 weeks' GA. The proportion of survivors without MBD relative to the total number of survivors was 81.1%, and it was independent of GA. EoL decisions preceded one-third of all deaths and were more frequent among the most immature patients. CONCLUSIONS: The proportion of survivors without MBD, when referred to the total number of survivors, is relatively high and is independent of GA. EoL decisions after the occurrence of MBD seem to play an important role in this respect. These results support the attitude of "giving an opportunity" even to the most immature patients, if this is in accordance with the parents' wishes.

[SOCIODEMOGRAPHIC AND HEALTH CHARACTERISTICS ASSOCIATED WITH LOW BIRTH WEIGHT IN THE CANARY ISLANDS]. / CARACTERÍSTICAS SOCIODEMOGRÁFICAS Y SANITARIAS ASOCIADAS CON BAJO PESO AL NACER EN CANARIAS.

INTRODUCTION AND OBJECTIVE: since 1976, the term low birth weight (LBW) has been applied to all infants weighing less than 2 500 g and it constitutes the most important factor affecting neonatal mortality, morbidity in childhood. The aim of this study is to identify associations between biological, socioeconomic and health factors and underweight newborns in the Canary Islands. MATERIALS AND METHODS: a cross-sectional epidemiological study was conducted, with the files belonging to pregnant women in 2011 and 2012 (n = 11.768) at the Hospital Universitario Insular Materno of Gran Canaria, which accounted for 66.3% of all births in the province for those years, excluding from the analysis the data pertaining to multiple births (393) (3.3%). The distribution and frequency of weight by sociodemographic characteristic were analyzed. Percentages were compared using the χ2 test, means with the t-test and medians with the Wilcoxon test for independent data. Those variables that were associated with low birth weight in the univariate analysis were entered into a logistic multidimensional analysis. RESULTS: the distribution of birth weight revealed an of excess underweight children (9.3%), of which (62.1%) were pretermature. Mothers of children with LBW are thinner, of a smaller size and BMI (< 18.5 kg/m2), and an average age of 31.5. It was also noted that there is an increase between the age of the mothers and low weight although the effect is not linear; in fact, the increases in the risk of LBW accelerate as age increases. When maternal BMI decreases, to approximately below 25, the risk of low birth weight increases linearly. The highest OR correspond to fetal intrauterine growth retardation (CIR) (OR = 6.3; 95% CI = 5.3, 7.4), hypertension/eclampsia (OR = 3.2; 95% CI = 2.1; 5.1), in gestations of less than 37 weeks (OR = 2.5; 95% CI = 2.0; 3.3) and the consumption of tobacco by the mother (OR = 1.9; 95% CI = 1.6, 2.3). CONCLUSIONS: smoking during pregnancy appears to be the most important mediating factor in IUGR mediating factor. An overweight or obese mother did not appear to constitute a risk factor for a child's low birth weight. Intrauterine growth restriction (IGR) is the variable health that most affects low weight and high blood pressure in the mother, also associated with fetal growth retardation. While it is true that lack of antenatal care cannot be considered as a causal factor of underweight babies, 47.1% of pregnant women in the Canaries had insufficient controls (< 3 controls) with an increase of said controls would make it possible to reduce the frequency of the low weight in newborns.

Introducción y objetivo: desde 1976, el término bajo peso al nacer (BPN) se aplica a todos los recién nacidos con un peso inferior a 2.500 g. y constituye el factor más importante que afecta a la mortalidad neonatal y a la morbilidad en la infancia. El objetivo de este trabajo es identificar las asociaciones entre los factores biológicos, socioeconómicos y sanitarios y el bajo peso en el recién nacido en las islas Canarias. Material y método: se realizó un estudio epidemiológico transversal, con los ficheros de las gestantes del 2011 y 2012 (n = 11,768) del Complejo Hospitalario Universitario Insular Materno de Gran Canaria, que representó el 66,3% de todos los partos de la provincia para esos años, excluyéndose del análisis los datos correspondientes a los embarazos múltiples (393) (3,3%). Se analizaron la distribución y la frecuencia del peso según características sociodemográficas; los porcentajes se compararon con el test de la 2, las medias con el t-test y las medianas con el test de Wilcoxon para datos independientes. Aquellas variables que mostraron asociación con el bajo peso en el análisis univariado fueron introducidas en un análisis logístico multidimensional. Resultados: en la distribución del peso al nacer se observó un exceso de niños con bajo peso (9,3%), de los cuales el 62,1% fueron pretérmino. Las madres de estos niños son más delgadas, de menor talla y tienen un IMC promedio de < 18,5 kg/m2, así como un promedio de edad de 31,5 años. Se observó igualmente que existe un incremento entre la edad de la madre y el bajo peso, aunque el efecto no es lineal; de hecho, los aumentos del riesgo de BPN se aceleran a medida que aumenta la edad. Cuando el IMC de la madre decrece, aproximadamente por debajo de 25, aumenta linealmente el riesgo de bajo peso. Las OR más elevadas corresponden al retraso fetal en el crecimiento intrauterino (CIR) (OR = 6,3; IC-95% = 5,3; 7,4), la hipertensión/eclampsia (OR = 3,2; IC-95% = 2,1; 5,1), la gestación menor de 37 semanas (OR = 2.,5; IC- 95% = 2,0; 3,3) y el consumo de tabaco de la madre (OR = 1,9; IC-95% = 1,6; 2,3). Conclusiones: el tabaquismo durante la gestación parece ser el factor mediador más importante para la restricción del crecimiento intrauterino. El sobrepeso u obesidad de la madre no parece que sean factores de riesgo para el bajo peso del niño. El crecimiento intrauterino restringido (CIR) es la variable sanitaria que más influye en el bajo peso, al igual que la hipertensión arterial de la madre, enfermedad asociada igualmente con el retraso en el crecimiento fetal. Aunque la falta de atención prenatal no puede considerarse como un factor causal del bajo peso, el 47,1% de las gestantes han tenido controles insuficientes (< de tres controles); con el aumento de los mismos se lograría reducir la frecuencia del bajo peso.

Prenatal Diagnosis of Cardiac Diverticulum with Pericardial Effusion in the First Trimester of Pregnancy with Resolution after Early Pericardiocentesis.

Cardiac diverticulum is a rare anomaly, which may present in association with pericardial effusion. Only few cases diagnosed during fetal life have been published and only in 12 cases pericardiocentesis was made with good postnatal outcomes in 83% of the cases. In the first trimester of pregnancy only 6 cases were reported. We described the largest series of cases published. We describe a case of cardiac diverticulum complicated with pericardial effusion during the first trimester of pregnancy and resolved by intrauterine pericardiocentesis at 17 weeks of pregnancy. We made a systematic review of the literature with the cases reported of cardiac diverticulum, management, and outcomes.

Customized weight curves for Spanish fetuses and newborns.

OBJECTIVES: To construct a model of customized birthweight curves for use in a Spanish population. MATERIALS AND METHODS: Data of 20 331 newborns were used to construct a customized birthweight model. Multiple regression analysis was performed with newborn weight as the dependent variable and gestational age (GA), sex and maternal (M) weight, height, parity and ethnic origin as the independent variables. Using the new model, 27,507 newborns were classified as adequate for GA (AGA), large for GA (LGA) or small for GA (SGA). The results were compared with those of other customized and non-customized models. RESULTS: The resulting formula for the calculation of optimal neonatal weight was: Optimum weight (g) = 3289.681 + 135.413*GA40-14.063*GA40(2)-0.838*GA40(3) + 113.889 (if multiparous) + 165.560 (if origin = Asia) + 161.550 (South America) + 67.927 (rest of Europe) +109.265 (North Africa) + 9.392*Maternal-Height + 4.856*Maternal-Weight-0.098*Maternal-Weight(2) + 0.001*Maternal-Weight(3) + 67.188*Sex + GA40*(6.890*Sex + 9.032 (If multiparous) +0.006*Maternal-Height(3) + 0.260*Maternal-Weight) + GA40(2) (-0.378*Maternal-Height - 0.008*Maternal-Height(2)) + GA40(3) (-0.032*Maternal-Height). Weight percentiles were obtained from standard data using optimum weight variation coefficient. Agreement between our customized model and other Spanish models was "good" (κ = 0.717 and κ = 0.736; p < 0.001). CONCLUSIONS: Our model is comparable to other Spanish models, but offers the advantage of being customized, updated and freely available on the web. The 30.6% of infants classified as SGA using our model would be considered as AGA following a non-customized model.

[Prevalence of obesity in pregnant women of Canary Islands, Spain]. / Prevalencia de obesidad en la población gestante de Gran Canaria.

BACKGROUND AND OBJECTIVE: Different epidemiological studies have shown that maternal excess of weight during pregnancy is associated with adverse outcomes of pregnancy, childbirth and morbidity of the neonate. Prevalence of obesity in a pregnant population of Canary Islands is reported here. SUBJECTS AND METHODS: The group studied was an integrated cohort of all the pregnant women being followed-up at the Materno-Infant University Hospital of the Canarias [Hospital Universitario Materno-Infantil de Canarias; HUMIC] and who concluded their gestation during the year 2008 (n=6693). BMI was measured at the beginning of the pregnancy. RESULTS: 25.0% of the sample of pregnant women were overweight and 17.1% were obese, increasing both with age and not influenced with the educational level. CONCLUSIONS: The prevalence of obesity and overweight among pregnant women from the Canary Islands is high. Among the values available from other European countries, only the UK reported values greater than our study sample.