ABSTRACT
Fetal thyroid disease is rare, and the disease is mostly contextualized in the setting of a treated maternal thyroid disease. The presentation of thyroid disease in the fetus of a euthyroid mother is unusual. This paper presents the case of a 21-week pregnant woman with an incidental finding from a detailed anatomy ultrasound and evaluates available diagnostic and therapeutic management options. There is no consensus with sufficient evidence given the unusual presentation of this type of pathology. In most cases, the evidence is in the etiology of a mother with previous thyroid pathology that modifies the fetal outcome. Hence, it is important to describe cases to accumulate and, at some point, sufficient evidence of different treatments, with the intention of improving the quality of the recommendations. The management of fetal euthyroid goiter is a complex challenge. Most specialists manage the information on a case-by-case basis, with the same general goals as in patients with other thyroid pathologies.
ABSTRACT
OBJECTIVE: To establish the prevalence of congenital malformations diagnosed in Maternal-Fetal Medicine Unit of Hospital de San José, Bogotá-Colombia and comparing them to national and international reports. MATERIALS AND METHODS: Retrospective, descriptive observational where the quantification of all malformed fetuses diagnosed in Maternal-Fetal Medicine Unit from June 2010 to June 2013 was performed. RESULTS: 236 malformed fetuses, a total of 11,914 births, for a prevalence of 1.98% were included at a mean gestational age at diagnosis of 26.7 weeks (SD 7.1 weeks). The most common congenital malformations were at the level of Central Nervous System (CNS) 88 (37%) in total and within them, the most prevalent was ventriculomegaly 16 (7%). Of the 236 malformed fetuses, 165 fetuses (70.2%) had only one affected system 29 (12.3%) 2 compromised systems and 42 (17.5%) over 3 affected systems. Karyotyping was offered to all antenatal patients, however, accepted only 63 (26.7%), and 39 (62%) with normal results and the other aneuploidies were found, having Trisomy 21 as the most common. It was possible to establish a concordance of 86% between the antenatal and postnatal diagnosis. The perinatal mortality found in this study was 34.7%, mainly in fetuses with congenital diaphragmatic hernia 16 cases (88.8%), fetal non-immune hydrops 8 cases (80%), cardiovascular abnormalities 31 cases (46.2%) genitourinary and 13 cases (24%), and fetuses with CNS malformations such as sequence acranea-anencefalia, holoprosencephaly and encephalocele mortality occurred in 100%. CONCLUSION: In this study the prevalence of congenital anomalies was found comparable to that reported at local and global levels, which were diagnosed and adequately characterized by more than two-thirds by obstetrical ultrasound performed by trained personnel in prenatal diagnosis. Perinatal morbidity and mortality remain high thoracic, cardiovascular, renal and non-immune hydrops congenital anomalies.
Subject(s)
Congenital Abnormalities/epidemiology , Perinatal Mortality , Prenatal Diagnosis/methods , Ultrasonography, Prenatal/methods , Colombia/epidemiology , Congenital Abnormalities/diagnosis , Female , Humans , Karyotyping , Pregnancy , Prevalence , Retrospective StudiesABSTRACT
Introducción: el embarazo ectópico en la cicatriz uterina se presenta en 1:1.800 a 1:2.216 embarazos y representa 6,1% de los embarazos ectópicos en pacientes con antecedente de cesárea.Objetivo: revisar el manejo y el diagnóstico del embarazo ectópico en la cicatriz uterina a partir del caso de una paciente con esta patología. Presentación del caso: una paciente de 24 años con antecedente de cesárea, asistió a consulta en el Hospital Universitario de Santander con dolor en el hemiabdomen inferior. A partir de estos síntomas, se le realizó ecografía y Doppler interpretados como de alta probabilidad de embarazo ectópico en la cicatriz uterina. Posteriormente, se inició terapia con metotrexato combinado con ácido folínico. Finalmente, se hizo control con evolución favorable de la paciente. Discusión: el embarazo ectópico en la cicatriz uterina es una complicación a largo plazo de la cesárea. Su diagnóstico debe ser considerado en toda mujer con antecedente de cesárea que consulte por hemorragia en la primera mitad del embarazo antes de la décima semana de gestación. En estos casos, el diagnóstico ecográfico inicial puede ser difícil pero se puede llegar a un diagnóstico certero con ecografías repetidas. Por otra parte, el tratamiento puede ser médico o quirúrgico y depende básicamente del tiempo de gestación en que se haga el diagnóstico.
Introduction: ectopic pregnancy in the uterine scar occurs in 1:1,800 to 1:2,216 of pregnancies and accounts for 6.1% of ectopic pregnancies in the group of patients having had prior cesarean section. Objective: in order to review the management and diagnosis of this condition, the case of a patient having an ectopic pregnancy in the uterine scar is presented. Case presentation: a 24-year-old patient having had a previous cesarean section consulted the Santander teaching hospital suffering from lower abdominal pain. Doppler ultrasound suggested a high probability of ectopic pregnancy in the uterine scar. Methotrexate and folinic acid therapy was thus begun. Controls were made with favorable results. Discussion: ectopic pregnancy in the uterine scar is a long-term complication of cesarean section; it is a diagnosis which should be considered in any female having a history of previous cesarean consulting for hemorrhage during the first half of pregnancy before 10 weeks' gestation. Initial ultrasound diagnosis can be difficult; however, diagnosis can be made with repeated scans. Treatment may be medical or surgical and will mainly depend on the gestation time when diagnosis is made.
