Management of foetal hyperthyroidism in a mother with autoimmune hypothyroidism: A case report.

Foetal hyperthyroidism is mediated by transplacental passage of thyroid stimulating antibodies (TSAbs) and affects mothers with autoimmune (AI) thyroid disease. We report a case of a 33-year-old woman with a history of AI hypothyroidism and raised TSI after 2 stillbirths with suspect foetal hyperthyroidism. At 20.5 gestational weeks (GW) of her third pregnancy, foetal tachycardia and goitre were detected. TSI levels were 30.9mUI/mL. Methimazole (MMI) was started and adjusted based on ultrasound signs (foetal heart rate and thyroid gland vascularisation). The neonate was born at 35GW and cord blood revealed decreased TSH and normal free T4. MMI was started in the neonate at 2 days of life due to the appearance of asymptomatic hyperthyroidism. This case illustrates a rare recurrence of foetal hyperthyroidism in a mother with AI hypothyroidism. Pregestational thyroidectomy, TSAbs determination, early ultrasound diagnosis and foetal therapy helped us to improve obstetric outcomes.

Correlation of Prenatal and Postnatal Diagnosis in Umbilical-Portal-Systemic Venous Shunts.

INTRODUCTION: Umbilical-portal-systemic venous shunts (UPSVS) are rare anomalies in the development of the fetal venous system. There are several postnatal and prenatal classifications of hepatic venous anomalies but the link between them is missing. We aimed to review the prenatal to postnatal diagnosis correlation in UPSVS at our center. METHODS: It is a retrospective study of patients diagnosed with UPSVS between 2019 and 2021 at our institution. Demographic, obstetric, genetic, and neonatal data were reviewed with special focus on prenatal and postnatal ultrasounds. RESULTS: A total of seven patients were diagnosed with UPSVS at a median of 24 (20-34) weeks of gestational age. All patients were male and 62% were Caucasian. None of the patients had chromosomopathies or cardiac anomalies. One patient had renal ectopia, another one had a single umbilical artery, and a third one suffered from intrauterine growth retardation. An umbilico-systemic shunt (USS) was found in two patients and a ductus venosus-systemic shunt (DVSS) in the rest. Patients with USS were diagnosed postnatally with intrahepatic portosystemic shunts. One of the DVSS patients was transferred to another hospital and the other four had normal postnatal cardiac ultrasounds, with normal abdominal ultrasounds in two patients and lack of postnatally abdominal control in the other two. All babies were found to be doing well at a median follow-up of 1 month (0-24). CONCLUSION: There is a knowledge gap in the natural history of UPSVS between fetal and neonatal life. Building bridges between prenatal and postnatal research is mandatory in order to understand these rare anomalies.

The influence of obesity and diet quality on fetal growth and perinatal outcome / Influencia de la obesidad y la calidad de la dieta en el crecimiento fetal y resultados perinatales

Background: maternal obesity is associated with an increase of both maternal and fetal complications as macrosomia.Aim:to assess the quality of diet in a cohort of pregnant women in terms of Mediterranean diet (MD) adherence and to examine the association between diet quality, obesity, weight gain and fetal growth and perinatal complications. Methods: Mediterranean Diet Adherence Screener (MEDAS) was applied to assess diet quality in 542 pregnant women. Fetal biometric measurements at third-trimester ultrasound were collected and perinatal outcomes were recorded. Results: only 35 % of pregnant women presented a good quality of diet, in terms of adherence to MD. Diet quality significantly increased with lower values of body mass index (BMI) and higher maternal age. Higher BMI was significantly associated with a higher abdominal circumference and estimated fetal weight at the third trimester, a higher risk of hypertension disorder, induction of labor and a higher birthweight. A statistically significant association between diet quality and ultranosographic measures or perinatal outcome was not found. However, a higher weight gain across gestation was significantly associated with a higher risk of gestational diabetes, a higher gestational age at delivery and a higher birthweight. Conclusion: most of our pregnant women did not showed a great diet quality, but there was no evidence that diet quality affected pregnancy complications. On the contrary, pre-pregnancy BMI was related to fetal and neonatal growth and obstetric outcomes, similarly to weight gain across gestation. (AU)

Introducción: la obesidad materna se asocia con un aumento de complicaciones maternas y fetales, como la macrosomía.Objetivo:evaluar la calidad de la dieta en una cohorte de mujeres embarazadas en términos de adherencia a la dieta mediterránea (DM) y examinar la asociación entre la calidad de la dieta, la obesidad, el aumento de peso y el crecimiento fetal y las complicaciones perinatales. Métodos: se aplicó el Mediterranean Diet Adherence Screener (MEDAS) para evaluar la calidad de la dieta en 542 mujeres embarazadas. Se recogieron las medidas biométricas fetales en la ecografía del tercer trimestre y se registraron los resultados perinatales. Resultados: solo el 35 % de las gestantes presentó una buena calidad de alimentación en términos de adherencia a la DM. La calidad de la dieta aumentó significativamente con valores más bajos de índice de masa corporal (IMC) y mayor edad materna. Un IMC más alto se asoció significativamente con una mayor circunferencia abdominal y peso fetal estimado en el tercer trimestre, un mayor riesgo de trastorno hipertensivo, inducción del parto y mayor peso al nacer. No se encontró una asociación estadísticamente significativa entre la calidad de la dieta y las medidas ecográficas o el resultado perinatal. Sin embargo, un mayor aumento de peso durante la gestación se asoció significativamente con un mayor riesgo de diabetes gestacional, mayor edad gestacional al momento del parto y mayor peso al nacer. Conclusiones: la mayoría de nuestras gestantes no mostró una buena calidad de la dieta, pero no hubo evidencia de que la calidad de la dieta afectara las complicaciones del embarazo. Por el contrario, el IMC pregestacional se relacionó con el crecimiento fetal y neonatal y los resultados obstétricos, de manera similar al aumento de peso durante la gestación. (AU)

The influence of obesity and diet quality on fetal growth and perinatal outcome.

Introduction: .Background: maternal obesity is associated with an increase of both maternal and fetal complications as macrosomia. Aim: to assess the quality of diet in a cohort of pregnant women in terms of Mediterranean diet (MD) adherence and to examine the association between diet quality, obesity, weight gain and fetal growth and perinatal complications. Methods: Mediterranean Diet Adherence Screener (MEDAS) was applied to assess diet quality in 542 pregnant women. Fetal biometric measurements at third-trimester ultrasound were collected and perinatal outcomes were recorded. Results: only 35 % of pregnant women presented a good quality of diet, in terms of adherence to MD. Diet quality significantly increased with lower values of body mass index (BMI) and higher maternal age. Higher BMI was significantly associated with a higher abdominal circumference and estimated fetal weight at the third trimester, a higher risk of hypertension disorder, induction of labor and a higher birthweight. A statistically significant association between diet quality and ultranosographic measures or perinatal outcome was not found. However, a higher weight gain across gestation was significantly associated with a higher risk of gestational diabetes, a higher gestational age at delivery and a higher birthweight. Conclusion: most of our pregnant women did not showed a great diet quality, but there was no evidence that diet quality affected pregnancy complications. On the contrary, pre-pregnancy BMI was related to fetal and neonatal growth and obstetric outcomes, similarly to weight gain across gestation.

Introducción: Introducción: la obesidad materna se asocia con un aumento de complicaciones maternas y fetales, como la macrosomía. Objetivo: evaluar la calidad de la dieta en una cohorte de mujeres embarazadas en términos de adherencia a la dieta mediterránea (DM) y examinar la asociación entre la calidad de la dieta, la obesidad, el aumento de peso y el crecimiento fetal y las complicaciones perinatales. Métodos: se aplicó el Mediterranean Diet Adherence Screener (MEDAS) para evaluar la calidad de la dieta en 542 mujeres embarazadas. Se recogieron las medidas biométricas fetales en la ecografía del tercer trimestre y se registraron los resultados perinatales. Resultados: solo el 35 % de las gestantes presentó una buena calidad de alimentación en términos de adherencia a la DM. La calidad de la dieta aumentó significativamente con valores más bajos de índice de masa corporal (IMC) y mayor edad materna. Un IMC más alto se asoció significativamente con una mayor circunferencia abdominal y peso fetal estimado en el tercer trimestre, un mayor riesgo de trastorno hipertensivo, inducción del parto y mayor peso al nacer. No se encontró una asociación estadísticamente significativa entre la calidad de la dieta y las medidas ecográficas o el resultado perinatal. Sin embargo, un mayor aumento de peso durante la gestación se asoció significativamente con un mayor riesgo de diabetes gestacional, mayor edad gestacional al momento del parto y mayor peso al nacer. Conclusiones: la mayoría de nuestras gestantes no mostró una buena calidad de la dieta, pero no hubo evidencia de que la calidad de la dieta afectara las complicaciones del embarazo. Por el contrario, el IMC pregestacional se relacionó con el crecimiento fetal y neonatal y los resultados obstétricos, de manera similar al aumento de peso durante la gestación.

Validación de los criterios ecográficos IOTA en la práctica clínica con marcadores tumorales y patología / Validation of IOTA simple ultrasound rules in clinical practice with tumor markers and pathology / Validation of IOTA simple ultrasound rules in clinical practice with tumor markers and pathology

RESUMEN Objetivos . Correlacionar la ecografía prequirúrgica de las masas anexiales aplicando los criterios IOTA y el diagnóstico anatomopatológico tras intervención quirúrgica. Valorar la utilidad de los marcadores tumorales bioquímicos. Método . Estudio observacional prospectivo en 102 pacientes con diagnóstico ecográfico de tumoración anexial, intervenidas quirúrgicamente entre enero 2017 y febrero 2020. El análisis estadístico se realizó con SPSS 17.0. Las variables categóricas se analizaron mediante pruebas de Fisher y chi-cuadrado, las variables cuantitativas mediante prueba t-student. La concordancia entre la valoración de la ecografía transvaginal mediante criterios IOTA y el resultado anatomopatológico, se estudió con el coeficiente de contingencia y el índice kappa. Resultados . Según criterios IOTA, se clasificó como benignas a 48% de las tumoraciones, como malignas 24,5%, y 27,5% resultaron no clasificables. La anatomía patológica confirmó que 68,1% de las benignas y 72,8% de las malignas fueron correctamente filiadas por la ecografía. La concordancia entre la ecografía transvaginal prequirúrgica y la anatomía patológica fue significativa, con coeficiente de contingencia 0,58, índice kappa 0,47, p <0,05 y con sensibilidad 94,1% y especificidad 92,1%. Los valores de la proteína epididimal humana 4 (HE4) y el antígeno del cáncer 125 (CA 125) tuvieron correlación con la anatomía patológica, también con significación estadística, siendo mayor en las pacientes menopáusicas. Conclusiones . Los criterios IOTA discriminaron de forma satisfactoria las masas benignas de las malignas. La proteína HE4 resultó mejor marcador bioquímico que el CA125.

ABSTRACT Objectives: To determine correlation between preoperative ultrasound evaluation of adnexal masses applying IOTA simple rules and pathology diagnosis. To assess usefulness of biochemical tumor markers in these cases. Methods: A prospective study was performed between January 2017 and February 2020. Patients with suspected ovarian pathology were evaluated using IOTA ultrasound rules and designated as benign or malignant. Findings were correlated with histopathological findings. Collected data was statistically analyzed using the chi-square test and kappa statistical method. Results: During this period, 102 women were eligible for the study. According to IOTA ultrasound criteria, 48% of the adnexal masses were classified as benign, 24.5% malignant and 27.5% were not classifiable. Pathology confirmed 68.1% of benign and 72.8% of malignant tumors were correctly classified by ultrasound. Statistically, the agreement between pre-surgical transvaginal ultrasound and pathology result was significant with contingency coefficient 0.58 and Kappa index 0.47, both with p <0.05 significance. The sensitivity for detection of malignancy with IOTA simple rules was 94.1% and specificity 92.1%. As for biochemical tumor markers, human epididymal protein 4 (HE4) and cancer antigen 125 (CA 125) values had statistically significant correlation with pathology results. Conclusions: IOTA simple rules may be used in clinical practice for diagnosis of ovarian tumors. Human epididymis 4 appeared a better diagnostic tool than CA 125 in discrimination of malignant adnexal masses.

Correlación entre el diagnóstico ecográfico prenatal y posnatal en casos de hidronefrosis fetal / Correlation between prenatal and postnatal ultrasound diagnosis of fetal hydronephrosis

Introduction: Prenatal ultrasound detects fetal anomalies in 1% of pregnancies, about 20-30% of them are urogenital and among them 50% are fetal urinary tract dilatations (UTD). Objective: To establish the correlation between prenatal and postnatal hydronephrosis diagnosis, as well as to analyze the prognosis. Design, patients, interventions and main outcome measure: Retrospective observational study performed by the Prenatal Diagnosis Unit of Parc Taulí Hospital (Sabadell), which included 177 pregnant women with ultrasound diagnosis of UTD between January 2011 and December 2016. We performed a descriptive analysis of the most important ultrasound and perinatal variables. The main outcome measure was the degree of dilatation of UTD. Results: The prevalence of HNF was 1.17%; 82.8% were diagnosed in the second trimester ultrasound; 42.9% of fetal hydronephrosis cases were bilateral and, in 95.6%, the urogenital pathology was not associated with other malformations. Congenital heart disease was the most frequently associated prenatal anomaly (3.3%). Among 93 low-risk hydronephrosis cases diagnosed in the second trimester, 53.8% resolved spontaneously in the third trimester, 30.1% remained stable and 16.1% worsened. Of the 32 cases of moderate-severe UTD diagnosed in the second trimester, only 9.4% improved in the third trimester. Complementary examination was required in 46.9% of the neonates and 14.1% required surgical intervention. Conclusions: Most cases of fetal hydronephrosis were diagnosed by second trimester ultrasound. Mild UTD presents good prognosis as opposed to moderate-severe cases, which usually persist after birth.

Introducción. La ecografía prenatal permite detectar una anomalía significativa en 1% de los embarazos; de ellos, 20 a 30% son genitourinarias y 50% de estas son hidronefrosis fetales (HNF). Objetivo. Establecer una correlación entre el grado de hidronefrosis prenatal y posnatal, así como analizar las implicaciones pronósticas. Diseño, pacientes, intervenciones y variables principales. Estudio observacional retrospectivo realizado por la Unidad de Diagnóstico Prenatal del hospital Parc Taulí de Sabadell, que incluyó un total de 177 gestantes con diagnóstico ecográfico de HNF entre enero de 2011 y diciembre de 2016. Se realizó un análisis descriptivo de las variables ecográficas y perinatales más importantes. La principal variable de estudio fue el grado de dilatación de la HNF. Resultados. La prevalencia de HNF fue 1,17%. El 82,8% de los casos fue diagnosticado en la ecografía del 2º trimestre. En 42,9%, la afectación fue bilateral, y en 95,6% la malformación renal fue aislada. La cardiopatía fue la anomalía congénita asociada con más frecuencia (3,3%). De las 93 hidronefrosis de riesgo bajo diagnosticadas en el 2º trimestre, 53,8% se normalizaron en el 3er trimestre, 30,1% permanecieron estables y 16,1% progresaron. De los 32 casos de HNF moderadas-severas diagnosticadas en el 2º trimestre, solo 9,4% se normalizaron en el 3er trimestre. El 46,9% de los neonatos precisó exploraciones complementarias y 14,1% intervención quirúrgica. Conclusiones. Existe buena correlación de la HNF prenatal y posnatal. La HNF leve presenta buen pronóstico, mientras que la moderada-severa suele persistir posnatalmente.

Ovarian torsion and spontaneous ovarian hyperstimulation syndrome in a twin pregnancy: A case report.

INTRODUCTION: Ovarian hyperstimulation syndrome (OHSS) is extremely rare in spontaneous pregnancies. Spontaneous OHSS can result from glycoprotein hormones stimulating follicle-stimulating hormone receptors (FSHR). PRESENTATION OF CASE: We report a twin pregnancy in which ovarian torsion and hemoperitoneum complicating OHSS were treated with left adnexectomy and aspiration. The only trigger for spontaneous OHSS in this case was high levels of chorionic gonadotropin hormone. DISCUSSION: Multiple pregnancy, gestational trophoblastic disease, primary hypothyroidism, thyroid-stimulating hormone/gonadotropin-secreting adenomas, and mutations of the FSHR gene may trigger spontaneous OHSS. CONCLUSION: Spontaneous OHSS should be included in the differential diagnosis of acute abdomen in pregnant women; if spontaneous OHSS is diagnosed, the etiology should be determined in order to focus the treatment and avoid future complications.

Diagnóstico prenatal de otocefalia. Importancia de la ecografía de primer trimestre en el diagnóstico de las dismorfias faciales / Prenatal diagnosis of otocephaly. Importance of first trimester ultrasound in the diagnosis of facial dysmorphia

La otocefalia es una malformación congénita rara y en la mayoría de casos letal, caracterizada por la presencia de agnatia, microstomia, aglosia y melotia. La mayoría de los casos reportados en la literatura corresponden a diagnósticos prenatales tardíos. Reportamos a continuación un caso de otocefalia diagnosticado en la exploración ecográfica de primer trimestre. La ecografía es la herramienta diagnóstica de elección desde el primer trimestre de la gestación, permitiendo un diagnóstico precoz de las malformaciones craneo-faciales y un mejor manejo prenatal (AU)

Otocephaly is a rare congenital facial dysmorphia with a poor prognosis, characterised by the presence of agnathia, microstomia, aglossia and melotia. Most of the cases reported until now are second and especially late third trimester diagnosis. We report a case of prenatal detection of otocephaly at the first trimester ultrasound scan: the case was diagnosed at 13 weeks’ gestation and confirmed at autopsy. Currently, first-trimester ultrasound allowed the detection of this and other malformations, obtaining an early suspected diagnosis and enabling to perform invasive diagnostic tests to obtain information necessary to convey to the patient (AU)

Diagnóstico ecográfico de la ventriculomegalia fetal. Seguimiento posnatal / Ultrasound diagnosis of fetal ventriculomegaly. Postnatal follow-up

Objetivos. Conocer la prevalencia de la ventriculomegalia fetal (VM). Estudiar la evolución de los casos diagnosticados prenatalmente y realizar el seguimiento neurológico de los nacidos vivos. Método. Estudio observacional de los casos de VM diagnosticados prenatalmente en nuestro servicio entre 2004 y 2012. Resultados. Diagnosticamos 61 casos de VM, siendo la prevalencia del 2,25 por 1.000. En 54 pacientes el diagnóstico se realizó en el segundo trimestre y en 7 pacientes durante el tercer trimestre. La bilateralidad se observó en el 91% de los casos. En el 79,4% de casos, la VM fue leve (10-12 mm) y en un 5,6% moderada (12-15 mm). Un 15% de los fetos mostraban una VM severa (> 15 mm) o hidrocefalia y en un 13% de los casos la VM evolucionó desfavorablemente durante la gestación. En 23 casos se diagnosticaron otras anomalías asociadas. Conclusiones. El pronóstico más favorable lo observamos cuando la afectación es leve, aislada y no progresiva (AU)

Objetives. To determine the prevalence of fetal ventriculomegaly and identify the neurological outcomes of newborns with a prenatal diagnosis. Method. Observational study of ventriculomegaly prenatally diagnosed by ultrasound in our department between 2004 and 2012. Results. We diagnosed 61 cases of ventriculomegaly. The prevalence rate was 2.25 per 1,000. Diagnosis was made during the second trimester in 54 patients and during the third trimester in 7. Bilateral ventriculomegaly was found in 91% of the fetuses. Ventriculomegaly was mild (10-12 mm) in 79.4% and moderate (12-15 mm) in 5.6%. Severe ventriculomegaly (>15 mm) or hydrocephalus was diagnosed in 15% of the fetuses. The clinical course during pregnancy was unfavorable in 13%. Associated anomalies were diagnosed in 23 cases. Conclusions. Mild, isolated and non-progressive ventriculomegaly has the best neurological prognosis (AU)

Enfermedad renal: urinoma. A propósito de un caso / Renal disease: urinoma. Apropos of a case

Objetivo. Ecografía permite diagnosticar y seguir el progreso de las uropatías obstructivas incluyendo la aparición de urinomas. Sujeto y métodos. Presentamos un caso de hidronefrosis diagnosticado en segundo trimestre con evolución posterior a urinoma. Resultados. Paciente de 21,4 semanas de gestación (SG) se realiza ecografía observándose hidronefrosis izquierda grado II. A las 27.5SG se observó una hidronefrosis izquierda con colección líquida de 40×50×30mm retroperitoneal izquierda peri-renal con distorsión de la morfología del riñón desplazado medialmente compatible con urinoma. Conclusiones. La aparición prenatal de un urinoma se asocia a afectación postnatal en diferente grado de la función del riñón afectado (AU)

Objective. Fetal ultrasound enables us to diagnose and follow the progress of obstructive uropathies including the occurrence of fetal urinomas. Subject and methods. We report a case of hydronephrosis diagnosed in the second trimester with evolution urinoma. Results. Patient at 21.4 weeks’ gestation showed in fetal ultrasound a left hydronephrosis grade II. At 27.5w showed a left hydronephrosis with a retroperitoneal fluid collection perirenal 40×50×30mm and distortion of the kidney morphology compatible with urinoma. Conclusions. the prenatal occurrence of an urinoma is often associated with the postnatal absence of function of the involved kidney (AU)