Atypical decelerations: do they matter?

OBJECTIVE: To estimate the association between atypical variable decelerations and neonatal acidemia. METHOD: We conducted a one-year case-control study comparing the last thirty minutes before delivery of fetal heart rate tracings of 102 acidemic neonates (umbilical arterial cord gas pH ≤ 7.10) with 100 non-acidemic controls (umbilical arterial cord gas pH > 7.10). Incidence of atypical features and total number of decelerations, number of atypical decelerations, number of slow return decelerations and number of decelerations with loss of moderate variability during deceleration were extracted. We estimated the association between atypical features, neonatal acidemia and neonatal morbidity. RESULTS: Acidemic neonates showed a larger number of atypical decelerations (4 [0-12] vs. 3 [0-10]), "slow return" decelerations (4 [0-11] vs. 1 [0-10]) and decelerations with non-moderate variability (0[0-12] vs. 0 [0-6]) compared to non-acidemic controls. "Slow return" was significantly associated with an increased risk of acidemia at birth (OR 4.46; CI 95%: 2.18 - 9.15) "Slow return" was the most discriminating feature between groups with an AUC: 0.745. CONCLUSION: Certain atypical features, as "slow return" and loss of moderate variability within decelerations are associated with neonatal acidemia. "Slow return" could help in the gradation of acidemia risk levels, as an indicator of gravity.

Schwannoma benigno retroperitoneal gigante: diagnóstico incidental en paciente con masa pélvica sospechosa de cáncer de ovario / Benign giant retroperitoneal schwannoma: incidental diagnosis in a patient with pelvic mass mimicking ovarian cancer

Las tumoraciones del compartimento sacro son poco frecuentes (1:40.000 ingresos hospitalarios), siendo los tumores benignos más infrecuentes. Los schwannomas son tumores benignos compuestos por células de Schwann con crecimiento lento, permaneciendo las pacientes asintomáticas durante gran parte de su historia natural. Se expone el caso de una paciente de 82 años, sin antecedentes de interés, que presenta masa pélvica y marcadores tumorales negativos, con diagnóstico de sospecha radiológico de cáncer de ovario, filiada como schwannoma benigno retroperitoneal gigante tras estudio anatomopatológico definitivo. Tras tratamiento quirúrgico óptimo, la paciente se encuentra libre de enfermedad tras 5 años de seguimiento (AU)

Sacral tumors are rare (1:40,000 hospital admissions) and benign sacral tumors are even more uncommon. Schwannomas are slow-growing benign tumors composed of Schwann cells and remain asymptomatic for much of their natural history. We report the case of an 82-year-old woman with no relevant medical history and a pelvic mass and negative tumor markers. The presumptive radiological diagnosis was ovarian cancer but the definitive pathological diagnosis was benign giant retroperitoneal schwannoma. After successful surgical treatment, the patient is disease-free after 5 years of follow-up (AU)