ABSTRACT
RESUMEN La restricción de crecimiento fetal (RCF) es el término con el que se define a aquellos fetos que no alcanzan el potencial de crecimiento intraútero esperado debido a factores genéticos o ambientales. Dentro de las causas de RCF asociadas a la placenta encontramos mosaicismo confinado a la misma, enfermedad isquémica placentaria y anomalías estructurales a este nivel. Se presenta el caso de una paciente de 32 años con diagnóstico de RCF que asocia múltiples quistes econegativos subamnióticos en la cara fetal de la placenta. Se finaliza la gestación en semana 34 mediante cesárea electiva por ausencia de diástole en el estudio Doppler de la arteria umbilical, evidenciando cinco quistes subamnióticos de 4 a 6 cm que alteran la superficie del amnios.
ABSTRACT Fetal growth restriction (FGR) is the term used to define those fetuses that do not reach the expected intrauterine growth potential due to genetic or environmental conditions. The causes of FGR associated with the placenta are confined placental mosaicism, placental ischemic disease and placental structural abnormalities. We report a case of a 32-year-old patient with a diagnosis of FGR associated with multiple subamniotic econegative cysts overlaying the fetal plate of the placenta. The gestation is ended in week 34 by elective cesarean section due to absence of diastolic flow in the umbil-ical artery, showing five subamniotic cysts from 4 to 6 cm that disrupt the surface of the amnion.
Subject(s)
Humans , Female , Pregnancy , Adult , Placenta Diseases/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging , Hemangioma/complications , Placenta Diseases/pathology , Pregnancy Complications , Prenatal Diagnosis , Diagnosis, Differential , HematomaABSTRACT
Fundamento y objetivo: El estudio de la frecuencia de los defectos congénitos (DC) requiere incluir interrupciones voluntarias del embarazo (IVE) por DC y evaluar los factores que influyen en aquella. Pacientes y método: Serie consecutiva de 517 recién nacidos (RN) y 202 IVE con DC en 38.191 nacimientos entre 1982-2009. Resultados: La frecuencia media de RN con DC es 13,54 y la de RN + IVE por DC de 18,73. Los DC aislados suponen el 61,12% en RN y el 52,17% en IVE. El 18,37% de los DC en RN y el 40,58% en IVE son sindrómicos. La media de edad gestacional en IVE es 17,92 semanas. La frecuencia global de anencefalia es 2,62 y 6,77 por 10.000, respectivamente, en RN y en RN + IVE. La de la espina bífida es 3,14 y 5,99 por 10.000, respectivamente. La frecuencia global de síndrome de Down es 10,74 por 10.000 RN y 22,14 por 10.000 RN + IVE. El porcentaje de madres extranjeras en nuestra maternidad alcanza el 35,9% en 2009. La media de edad materna asciende significativamente a lo largo del tiempo. Conclusiones: Observamos una disminución estadísticamente significativa de DC en RN, pero no en su concepción. No detectamos prevención primaria de anencefalia ni espina bífida. El descenso de síndrome de Down en RN no alcanza significación estadística. La diversidad étnica y la mayor edad materna pueden estar modificando la frecuencia. El 53% de los casos (RN + IVE) con DC del trienio 2007-2009 fueron IVE. Se precisa el estudio completo de IVE por DC para ofrecer consejo reproductivo (AU)
Background and objective: The study of congenital defects (CD) must include termination of pregnancy (TOP) for CD and evaluate risk factors that modify their frequency. Patients and methods: Consecutive series of 517 newborn and 202 TOP with CD among 38,191 childbirths, between 1982-2009 years. Results: The mean frequency for newborns with CD is 13.54 and for newborn and TOP with CD is 18.73. Single CD are 61.12% in newborns and 52.17% in TOP. The 18.37% of CD in newborn and 40.58% of TOP are syndromic. Mean gestational age for TOP is 17.92 weeks. Overall frequency of anencephaly is 2.62 for newborns and 6.77 for 10,000 for newborns and TOP. Spina bifida is 3.14 for 10,000 newborns and 5.99 for 10,000 newborns and TOP. Overall frequency of Down syndrome (DS) is 10.74 for 10,000 newborns and 22.14 for 10,000 newborns and TOP. The percentage of foreign mothers was 35.9% in 2009 and the mean maternal age significantly increased in this period. Conclusion: We observe a significant decrease of CD in newborns but not in their conception. We have not detected primary prevention for neural tube defects. The decrease in DS in newborns is not statistically relevant but ethnic diversity and maternal aging may be modifying the frequency. The 53% of CD were TOP in the period 2007-2009. It is mandatory a complete study for CD in TOP in order to offer serious reproductive counseling (AU)
Subject(s)
Humans , Congenital Abnormalities/epidemiology , Abortion, Therapeutic/statistics & numerical data , Anencephaly/epidemiology , Down Syndrome/epidemiology , Spinal Dysraphism/epidemiology , Primary Prevention/trends , Genetic CounselingABSTRACT
BACKGROUND AND OBJECTIVE: The study of congenital defects (CD) must include termination of pregnancy (TOP) for CD and evaluate risk factors that modify their frequency. PATIENTS AND METHODS: Consecutive series of 517 newborn and 202 TOP with CD among 38,191 childbirths, between 1982-2009 years. RESULTS: The mean frequency for newborns with CD is 13.54 and for newborn and TOP with CD is 18.73. Single CD are 61.12% in newborns and 52.17% in TOP. The 18.37% of CD in newborn and 40.58% of TOP are syndromic. Mean gestational age for TOP is 17.92 weeks. Overall frequency of anencephaly is 2.62 for newborns and 6.77 for 10,000 for newborns and TOP. Spina bifida is 3.14 for 10,000 newborns and 5.99 for 10,000 newborns and TOP. Overall frequency of Down syndrome (DS) is 10.74 for 10,000 newborns and 22.14 for 10,000 newborns and TOP. The percentage of foreign mothers was 35.9% in 2009 and the mean maternal age significantly increased in this period. CONCLUSION: We observe a significant decrease of CD in newborns but not in their conception. We have not detected primary prevention for neural tube defects. The decrease in DS in newborns is not statistically relevant but ethnic diversity and maternal aging may be modifying the frequency. The 53% of CD were TOP in the period 2007-2009. It is mandatory a complete study for CD in TOP in order to offer serious reproductive counselling.
Subject(s)
Abortion, Eugenic/statistics & numerical data , Abortion, Induced/statistics & numerical data , Congenital Abnormalities/epidemiology , Prenatal Diagnosis , Anencephaly/epidemiology , Anencephaly/prevention & control , Birth Rate , Congenital Abnormalities/prevention & control , Down Syndrome/epidemiology , Down Syndrome/prevention & control , Emigrants and Immigrants/statistics & numerical data , Female , Gestational Age , Humans , Infant, Newborn , Male , Morbidity/trends , Neural Tube Defects/epidemiology , Neural Tube Defects/prevention & control , Pregnancy , Prenatal Diagnosis/trends , Risk Factors , Spain/epidemiologyABSTRACT
La listeriosis es una enfermedad poco común en la población general; sin embargo, tiene importancia en las gestantes y recién nacidos, por lo que se debería advertir a la gestantes de su existencia y sus posibles vías de transmisión (carnes poco cocinadas, quesos frescos, productos lácteos no pasteurizados o comidas preparadas). En España, la incidencia se estima en aproximadamente de 0,5 casos/millón habitantes/año. La incidencia en gestantes es mayor que la observada en la población general; se estima en aproximadamente 12/100.000 habitantes. Nosotros tuvimos una incidencia de 1,5 casos/1.000 habitantes, lo que constituye un incremento importante respecto a lo descrito en la literatura científica. En los años anteriores (2003 y 2004), tan sólo se había detectado 1 caso de listeriosis. No presenta manifestaciones clínicas específicas ni en la madre ni en el recién nacido. El clínico debe aumentar sus sospechas frente a la historia de prematuridad, aborto espontáneo y feto muerto. Es necesario pensar en ella ante una gestante con fiebre y amenaza de parto prematuro. El diagnóstico de certeza viene dado por el cultivo de líquido amniótico, líquido cefalorraquídeo o hemocultivos, por lo que en una gestante con fiebre de origen desconocido, con o sin amenaza de parto prematuro, está justificada la realización de amniocentesis o hemocultivos. El tratamiento de elección es la ampicilina asociada o no a gentamicina, a altas dosis y durante un período prolongado
Listeriosis is uncommon in the general population but is far more frequent in pregnant women and newborns. Consequently, expectant mothers should be warned about this disease and its possible routes of transmission (insufficiently cooked meats, fresh cheeses, unpasteurized milk, and prepared food). In Spain, the incidence of listeriosis is considered to be approximately 0.5 cases/million inhabitants/per year. In pregnant women this incidence is higher, being approximately 12 cases/100,000 inhabitants. We found an incidence of 1.5 cases per 1,000 inhabitants, which represents a substantial increase over that described in the literature. In previous years (2003 and 2004), only one single case of listeriosis was detected. This disease has no specific clinical manifestations in the mother or newborn. Clinicians should maintain a high index of suspicion and take careful note of a history of prematurity, spontaneous abortion and fetal demise. Listeriosis should be considered in pregnant women with fever and threatened premature delivery. Definitive diagnosis is given by culture of amniotic liquid, cerebrospinal fluid or blood culture; consequently, in women with fever of unknown origin, with or without threatened premature delivery, the performance of amniocentesis or blood culture is warranted. The treatment of choice is ampicillin alone or associated with gentamycin, at high doses and for prolonged periods