Amniotic fluid index accuracy in mid-trimester.

OBJECTIVE: The aim of this trial was to evaluate the correlation between amniotic fluid index (AFI) and the real amniotic volume in mid-trimester pregnancies. METHODS: Eight women with mid-trimester anhydramnios pregnancies were included. Patients gave their informed consent. Those with premature rupture of membranes were excluded. Amnioinfusion was performed by instilling up to 400 ml of saline solution in 100 ml aliquots. With the patient in supine position, the AFI was determined by the sum of measurements of the deepest vertical pools in each of the 4 quadrants of the maternal uterus, evaluating the AFI after every 100 ml of infused solution. Statistical analysis was performed by analysis of variance, determination coefficient, linear correlation and t test. RESULTS: We realized 29 AFI measurements after amnioinfusions of 100, 200, 300 and 400 ml of saline solution. The AFI ranges that corresponded to the infused volume were: after 100 ml = 5-11 cm (median 6.5 cm); after 200 ml = 9-12.7 cm (median 10.3 cm); after 300 ml = 10-17 cm (median 13.5 cm), and after 400 ml = 12-16 cm (median 15 cm). The correlation between the AFI and the volume infused was r = 0.81 (p < 0.0001), the variance was r(2) = 0.65, suggesting that 65% of the variation in AFI measurements is directly accounted for by the amniotic fluid volume and 35% of the AFI measurements is accounted for by factors other than amniotic volume. CONCLUSIONS: We obtained a strong correlation between AFI and amnioinfusion volume (median of 6.5, 10.3, 13.5 and 15 cm after amniotic infusion of 100, 200, 300 and 400 ml of saline solution, respectively). The variance (0.65) suggests that 35% of AFI measurements is accounted for by factors other than amniotic fluid volume.

[Prenatal diagnosis of polycystic kidneys and Mullerian duplication. A case report]. / Diagnóstico prenatal de riñones poliquísticos y duplicación mulleriana. Reporte de un caso.

Polycystic kidney disease is a common genetic cause of chronic kidney disease, characterized by the formation of multiple cysts in the kidneys and other organs, occurs in 1 in 20,000 live births. 30 to 50% of affected newborns die shortly after birth because of respiratory and renal insufficiency. This study reports the case of a newborn with polycystic kidney disease diagnosed by obstetric ultrasound at 26 weeks of gestation and kidneys anhidramnios due to increased volume and appearance "in sponge." Neonato a primigravida 19 years of age. At 26 weeks you will be detected in a routine obstetric evaluation that measures were in line for somatométricas fetal gestational age, and anhidramnios increase in renal mass and bilateral thorax narrow. The pregnancy ended in a cesarean section at 37 weeks with a newborn of 3140 g, women who died within minutes after birth. We requested an autopsy because of the need for genetic counseling. The findings were: enlarged kidneys with microcystic dilatation of collecting duct and in the renal cortex and medulla, liver fibrosis and Müllerian duplication with double uterine cavity. It is a rare association between polycystic kidney disease and Müllerian duplication, liver fibrosis confirmed by autopsy and has not been documented previously.

[Relation between fresh plasma administration and morbidity in patients with HELLP syndrome]. / Relación entre la administración de plasma fresco y morbilidad en pacientes con síndrome HELLP.

INTRODUCTION: HELLP syndrome is a complication of severe preeclampsia; its incidence goes from 0.1 to 0.6% of pregnancies, and causes complications in 4% of patients. OBJECTIVE: To evaluate frozen fresh plasma administration to prevent pregnancy complications in patients with HELLP syndrome. PATIENTS AND METHODS: Retrospective, comparative and non-randomized study. Patients with HELLP syndrome were divided in two groups: first one (n=23) was treated with fresh frozen plasma (10 mL/kg/day), and second one (n=29) with dexamethasone. Complications, dialysis requirement, hospital stay, and mortality were compared (chi2 test was used). RESULTS: Group 1 (n=23) had nine patients with HELLP syndrome type I, and 14 with type II. Group 2 (n=29) had 20 cases with HELLP syndrome type I, and nine with type II. Most frequent complication in group 1 was acute renal failure (22%), and hospital stay was 4.5 days. Group 2 had 13 patients with acute renal failure, three with pulmonary edema, one with cerebral edema, one with hepatic fracture, and one with placenta detachment. Hospital stay was from 8 to 30 days (p < 0.002). There were no maternal deaths in both groups. CONCLUSIONS: Fresh frozen plasma meaningfully reduces (43%) complications, hospital stay, and hemodialysis requirement (45%) in patients with HELLP syndrome.

[Prenatal diagnosis of pentalogy of Cantrell associated to bilateral cleft lip. A case report]. / Diagnóstico prenatal de la pentalogía de Cantrell concomitante con labio hendido bilateral. Reporte de un caso.

The pentalogy of Cantrell is a rare congenital syndrome characterized by deficiency of the anterior diaphragm and defects of abdominal wall, the pericardium, the lower sternum, as well as congenital intracardiac abnormalities. It has usually a poor prognosis, but most cases have had incomplete variants of this syndrome, so it is important to make a prenatal diagnosis to determine the size of the wall defect and to establish a multidisciplinary management. Less than 90 cases have been reported in the world literature. There are no casuistic or even treatment criteria in Latin America. A case of a newborn in whom was suspected this pentalogy associated to bilateral cleft lip by an ultrasound examination at 25 week of gestation is described. We also comment on diagnostic aspects, as well as anatomopathological, therapeutic, and prognostic characteristics.

[Incidence some congenital defects in Monterrey, Mexico]. / Estimación de la tasa de incidencia de algunos defectos congénitos en Monterrey, México.

OBJECTIVE: In Mexico, the congenital defects (CD) in newborns represent the third cause of infant morbi-mortality. Incidence rates/1000 reported for our country vary from 8.15 (Puebla) to 32.90 (Distrito Federal). The aim of this study was to estimate the incidence of some CD in Monterrey, Mexico. METHOD: A transversal, prospective, descriptive, and observational study was carried out at the Hospital de Ginecologia y Obstetricia No. 23, IMSS during January 1995 to December 1999. The external CD were analyzed according to World Health Organization (WHO) and classified according to their topography distribution. RESULTS: A total incidence of 9.89 [(1309/132,369)* 1000)] was detected. The more frequent CD were: the nervous system (2.33), the chromosomal (1.67), osteomuscular (1.67) of face and neck (1.18), and reproductive system (0.81). The less frequent CD were: the digestive system (0.43), diverse syndromes (0.38), and skin (0.29). CONCLUSION: Even though the global incidence of DC observed in this study is into the rank informed in the national and international literature. Because of this incidence has a great variability, we considered important to homogenize diagnosis criteria for each DC. With this results it will be possible to carry out comparative cross-sectional studies to determine if they are similar or different and then, by association studies to establish its possible etiological factors.