Effect of Milking Maneuver in Preterm Infants: A Randomized Controlled Trial.

OBJECTIVE: To assess the short and medium-term effects of milking maneuver (MM) compared with early cord clamping for infants born before 37 weeks of pregnancy. MATERIAL AND METHODS: 138 infants between 24+0 and 36+6 weeks of gestation were allocated to MM or early cord clamping. Primary outcomes were the requirement of red blood cell transfusions or phototherapy. RESULTS: Initial hemoglobin was significantly higher in the MM group by 1.675 g/dL (p < 0.05) and initial hematocrit by 5.36% (p < 0.05), but no differences in the need of transfusion during the first 30 days after delivery were found (RR 0.8; 95% CI 0.22-2.85). Peak serum bilirubin was similar in both groups (11,097 ± 3.21 vs. 11,247 ± 3.56 mg/dL, p = 0.837). Phototherapy requirements were higher in the MM group (RR 1.62; 95% CI 1.1-2.38). No differences regarding the need of oral iron supplementation, platelet transfusion, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, meconium aspiration syndrome, use of surfactant, days of oxygen supplementation, need of vasopressors, length of stay in the neonatal intensive care unit, or postpartum hemorrhage were found. CONCLUSION: MM does not reduce the need for red blood cell transfusions and increases phototherapy requirements in preterm infants.

Delivery after external cephalic version, is there an increased rate of cesarian section?

BACKGROUND: The aim of this study was to compare the obstetric outcomes after successful external cephalic version (cases) with a group of pregnant women with a spontaneous cephalic fetal position at delivery (controls). METHODS: Retrospective review of the cohort of study was performed at the University Hospital of Getafe (Madrid, Spain) between January 2012 and January 2013. SAMPLE POPULATION: 1516 patients (48 cases; 1468 controls). We compared the type of delivery in pregnant women after ECV performed successfully (cases) with spontaneous cephalic presentations (controls). Pregnancies with vaginal delivery contraindicated, elective cesarean section (CS) justified by maternal disease, multiple pregnancies, or pregnancies below 37 weeks were excluded. Maternal age, BMI, parity, gestational age at delivery, and onset of labor (spontaneous or induced) were controlled. RESULTS: Prevalence of CS and operative delivery in both groups. Women who underwent a successful ECV had a significantly higher CS rate compared with the women of the control group (12/48 [25%] vs. 202/1468 [13.76%]; P=0.028). There was no difference in the rate of operative delivery (6/48 [12.5%] vs. 177/1468 [12.05%] P=0.92). CONCLUSIONS: Deliveries following a successful ECV are associated with an increased CS rate compared with deliveries of fetuses with spontaneous cephalic presentations.

Relación entre el intervalo de nacimiento entre gemelos y el pH de cordón umbilical: ¿existe asociación entre la acidosis del primer gemelo y el segundo? / Relationship between the birth interval between twins and umbilical cord pH: is there an association between acidosis of the first twin and the second?

OBJETIVOS: Determinar si el intervalo de nacimiento vía vaginal entre gemelos, se relaciona con un descenso de pH arterial/venoso de cordón umbilical del segundo gemelo respecto al primero, y establecer si el pH acidótico del primer gemelo predice la acidosis del segundo. MÉTODO: Estudio de cohortes retrospectivo en 77 pares de gemelos realizado en el Hospital de Getafe, España, en el periodo 2008-2013. Se relacionó el tiempo transcurrido entre el nacimiento de los gemelos con el resultado del pH de cordón y el exceso de bases. Estudiamos la correlación entre el tiempo transcurrido entre ambos nacimientos y la diferencia entre los valores de pH del primer y segundo gemelo, y la correlación con la diferencia de exceso de base. RESULTADOS: Hubo correlación lineal significativa entre el tiempo transcurrido entre el nacimiento de los gemelos y la diferencia de pH venoso del segundo gemelo respecto del primero (R=0,560; p=0,0001), así como con el pH arterial (R=0,502; p=0,0001). El pH <7,20 del primer gemelo se asoció con acidosis en el cordón del 2° gemelo (<7,20, p=0,000; <7,15, p=0,0001; <7,10, p=0,0001; <7,05, p=0,001; <7,00, p=0,0001). CONCLUSIONES: El pH del segundo gemelo siempre fue igual o menor que el del primer gemelo, hubo una correlación lineal entre el intervalo de nacimiento entre gemelos y el descenso del pH venoso y arterial del segundo gemelo respecto al primero. El pH acidótico del primer gemelo predice la acidosis del segundo.

OBJETIVOS: Determinate if the twin-to-twin vaginal delivery time interval, is related with a decline of the arterio-venous cord blood pH of the second twin regarding to the first twin, and to evaluate if the acidotic pH of first twin can predict the acidosis status of the second one. METHOD: A retrospective descriptive cohort study was performed at the Hospital of Getafe, Spain, in the period 2008-2013, with 77 pairs of twins that were registered and met the inclusion criteria. The twin-to-twin delivery time interval and the cord blood status results were registered. A statistical analysis was performed to study the relation of the twin-to-twin delivery time interval with the pH value differences between first and second twins, and with the base excess. RESULTS: A positive linear correlation between the twin-to-twin delivery time interval and the difference of venous pH of the second twin respect to the first one was found (R=0.560; p=0.0001), and also with the difference on arterial pH (R=0.502; p=0.0001). A pH value <7.20 of the first twin was associated with blood cord acidosis of the second twin (<7.20, p=0.000; <7.15, p=0.0001; <7.10, p=0.0001; <7.05, p=0,001; <7.00, p=0.0001). CONCLUSIONS: The second twin pH was equal to or less than the first twin pH in all cases. There is a linear relation between twin-to-twin delivery time interval and the decrease of the pH value of the second twin regarding to the first one. The acidosis of first twin could predict the acidosis status of the second twin.

Rotura uterina espontánea durante el segundo trimestre asociado a placenta pércreta. Caso clínico y revisión de la literatura / Spontaneous uterine rupture in the second trimester associated with placenta percreta: Case report and literature review

Caso de rotura uterina por placenta pércreta confirmado histológicamente a las 20 semanas de gestación y revisión bibliográfica de casos clínicos publicados de menos de 28 semanas (AU)

We report a case of histologically-confirmed uterine rupture due to placenta percreta at 20 weeks of gestation. We provide a review of case reports of this event occurring at less than 28 weeks of pregnancy (AU)

Metástasis mamaria de melanoma / Breast metastasis of melanoma

El melanoma es uno de los principales tumores que metastatizan en la mama. El problema es su diagnóstico, ya que no hay imágenes radiológicas específicas, por lo que el diagnóstico anatomopatológico es fundamental. Se comentan 2 casos clínicos donde la aparición de una lesión sospechosa de malignidad en la mama está precedida de un antecedente de melanoma. Se confirmó el diagnóstico de tumor metastásico en dichas lesiones mediante inmunohistoquímica y se descartó la cirugía. Ante la sospecha de una lesión metastásica en la mama, se debería realizar inmunohistoquímica mediante biopsia diferida o punción-aspiración con aguja fina, evitando así realizar una mastectomía en caso de confirmarse el diagnóstico

Melanoma is one of the main tumors metastasizing in the breast. Diagnosis is problematical since there are no specific radiological images and consequently histopathological diagnosis is essential. We report 2 cases in which the development of a breast lesion suspicious for malignancy was preceded by a melanoma. In both patients, the diagnosis of metastatic tumor was confirmed with immunohistochemical studies and surgery was avoided. When a metastatic breast lesion is suspected, immunohistochemical study with deferred or fine-needle aspiration should be performed. If the diagnosis is confirmed, mastectomy can be avoided