Fetal cardiac dysfunction in pregnancies affected by intrahepatic cholestasis of pregnancy: A cohort study.

AIM: To analyze the presence of fetal myocardial dysfunction in intrahepatic cholestasis of pregnancy (ICP) at diagnosis. METHODS: This prospective cohort study included 49 pregnant participants with ICP at diagnosis and 49 nonaffected controls from a single public hospital. ICP was diagnosed based on clinical symptoms after excluding other causes of pruritus and presence of autoimmune diseases. Total bile acids were not obtained in this cohort. ICP pregnancies were assessed with a functional echocardiography at diagnosis including PR-interval, isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) for electrical, systolic, and diastolic function, respectively. Controls were assessed at recruitment. Perinatal outcomes were obtained from delivery books. The main outcome was the presence of PR-interval prolongation or first-degree fetal heart block, and echographic signs of diastolic and systolic dysfunction. RESULTS: Compared to controls, ICP were above upper limit in conjugated bilirubin (2.0% vs. 20.4%; p = 0.008), aspartate aminotransferase (2.0% vs. 24.5%; p = 0.002), and alanine aminotransferase (4.1% vs. 28.6%; p = 0.002). ICP was associated with a higher PR-interval (130 ± 12 ms vs. 121 ± 6 ms; p < 0.0001) with five first-degree fetal heart blocks. IRT was significantly higher in ICP (42 ± 6 ms vs. 37 ± 5 ms; p = 0.0001), with no differences in ICT and ET. PR-interval trend was only positively correlated with IRT in ICP pregnancies (p = 0.04 and p = 0.34, in ICP and controls, respectively). CONCLUSIONS: Our study demonstrates that fetuses affected by maternal ICP are associated with electrical and diastolic myocardial dysfunction. More studies focused on antenatal and postnatal functional echocardiography are necessary to validate our results and consider these markers in the clinical management of ICP pregnancies.

Aspiración manual endouterina (AMEU): Revisión de la literatura y estudio de serie de casos / Manual vacuum aspiration (MVA): a literature review and a case series study

Introducción y objetivo El aborto es la pérdida del producto de la concepción antes de la viabilidad fetal y se considera la principal complicación del embarazo. El objetivo de nuestro trabajo es evaluar los resultados iniciales y en mediano plazo del manejo con Aspiración Manual Endouterina (AMEU) del aborto en el primer trimestre. Métodos Análisis estadístico de serie de casos de 53 pacientes sometidas a AMEU en el Hospital Carlos Van Buren, Valparaíso desde noviembre 2017 a junio 2018 por aborto del primer trimestre. El diagnóstico fue clínico y mediante ultrasonografía. Se efectuó un cuestionario de satisfacción posterior al procedimiento. Resultados Se analizaron 53 pacientes, cuya edad promedio es de 29 años, 19 nulíparas, 34 multíparas, con edad gestacional promedio de 8 semanas. Se analizaron 53 biopsias de contenido intrauterino que resultaron en 53 abortos, de éstos 39 retenidos y 14 incompletos. Se registró un 3% de complicaciones (1 caso de perforación uterina que sólo requirió manejo médico y 1 caso de evacuación incompleta). El cuestionario reveló en una mayoría, el alivio de los síntomas y satisfacción en relación al procedimiento. Conclusión La AMEU es una buena alternativa en el manejo del aborto debido a menores costos, baja tasa de complicaciones y alta eficacia. Los centros que disponen de diversas alternativas para el manejo del aborto deben asegurarse de que la mujer participe activamente en la elección en cuanto a su resolución.

ABSTRACT Introduction and objective Miscarriage is the loss of the product of conception before fetal viability and it is considered the main complication of pregnancy. The main objective of our study is to evaluate initial and midterm reports using Manual Vacuum Aspiration (MVA) as management of first trimester miscarriage. Methods Statistic analysis of a case series of 53 patients submitted to MVA at Hospital Carlos Van Buren, Valparaíso since November 2017 until June 2018 with first trimester miscarriage. The diagnosis was clinical and ultrasonographic. A post procedure satisfaction questionnaire was carried out. Results Fifty-three patients were analyzed, with mean age of 29 years, 19 were nulliparous, 34 multiparous, mean gestational age of 8 weeks. Fifty-three intrauterine biopsies were analyzed, of which 53 were miscarriage, 39 retained sacs and 14 incomplete. We had 3% of complications (1 case of uterine perforation requiring only medical treatment and 1 case incomplete vacuum). The questionnaire revealed in a majority, the relief of symptoms and satisfaction with the procedure. Conclusion MVA is a good alternative in the management of miscarriage due to less costs, low rate of complications and high efficacy. The centres with various alternatives for miscarriage management must ensure that the women actively participates in the election of the resolution.

Endarterectomía carotídea con medición de presión de muñón, manejo hemodinámico y uso selectivo de shunt / Carotid Endarterectomy with routine carotid stump pressure measurement, intraoperative hemodynamic management and selective use of shunt

Resumen Introducción En la endarterectomía carotídea (EC) durante el clampeo, la perfusión cerebral se mantiene por circulación contralateral a través del Polígono de Willis, que se relaciona con la presión de muñón carotídeo (PM). Si ésta es menor a 50 mmHg existe riesgo de Accidente Cerebrovascular (ACV) por hipoperfusión y está indicado uso de shunt para asegurar suficiente circulación cerebral, pero también se puede elevar transitoriamente la presión arterial sistémica haciendo innecesario el uso de shunt. Objetivo Mostrar los resultados de EC con medición de PM para evaluar la perfusión cerebral del hemisferio clampeado con manejo hemodinámico intraoperatorio minimizando el uso de shunt. Material y Métodos Estudio retrospectivo de 73 pacientes sometidos a EC bajo anestesia general con medición de PM, manejo hemodinámico intraoperatorio y uso selectivo de shunt. Se analizaron variables demográficas, clínicas y morbimortalidad perioperatoria. Resultados 73 pacientes, edad promedio 71,1 años, 69,9% sintomáticos. En 54 pacientes la PM fue superior a 50 mmHg y no se usó shunt, en 19 la PM fue menor a 50 mmHg y con manejo hemodinámico intraoperatorio se elevó en 16 que no requirieron shunt. Sólo en 3 casos la PM no alcanzó los 50 mmHg y se usó un shunt de Pruitt-Inahara. Dos pacientes sintomáticos presentaron déficit neurológico central transitorio postoperatorio y 2 pacientes fallecieron por infarto cardíaco. Conclusión La EC con medición de PM y manejo hemodinámico minimizó el uso de shunt transitorio y fue un procedimiento seguro para tratar los pacientes con estenosis carotídea con indicación quirúrgica.

Introduction During carotid endarterectomy (CEA) clamping cerebral perfusion is maintained by contralateral circulation through the Circle of Willis and it is correlated to the stump pressure (SP). If it is below 50 mmHg there is risk of stroke due to hypoperfusion and a shunt must be used, but systemic blood pressure can be temporarily elevated making the use of shunt unnecessary. Aim Results of CEA with SP measurement to evaluate cerebral perfusion in cross-clamped hemisphere and hemodynamic intraoperative management reducing the use of shunt. Material and Methods Retrospective study of CEAs performed in 73 patients under general anaesthesia with SP measurement, hemodynamic management and selective use of shunt. Demographics, clinical and perioperative morbimortality variables were analized. Results 73 patients, average age 71.1 years, 69.9% symptomatic. In 54 patients SP was above 50 mmHg and shunt was not used, in 19 SP was below 50 mmHg, it was elevated through intraoperative hemodynamic management and shunt was not needed. In only 3 cases SP did not reach 50 mmHg and a Pruitt-Inahara shunt was used. Two patients presented postoperative transient central neurological deficit and 2 died due to myocardial infarction. Conclusion CEA with SP measurement and hemodynamic management reduced the use of carotid shunting and it was a safe procedure to treat patients with severe carotid stenosis who need surgical intervention.