Cirugía fetoscópica en síndrome de banda amniótica: comunicación del primer caso exitoso en el Perú con correlación posnatal a los 6 y 12 meses de vida

El síndrome de banda amniótica (SBA) o complejo de disrupción de banda amniótica es aquella malformación congénita que ocurre como consecuencia de bridas amnióticas de etiología heterogénea, patogénesis que involucra una serie de manifestaciones clínicas fetales, tales como constricción, amputación y múltiples defectos craneofaciales, viscerales y de la pared del cuerpo. La prevalencia estimada de SBA oscila entre 1:15,000 y 1:1,200 nacidos vivos. Afecta a ambos sexos por igual. El diagnóstico prenatal puede sospecharse tan pronto como el primer trimestre tardío, cuando las imágenes por ultrasonido detectan anillos de constricción, amputaciones de extremidades y/o defectos craneofaciales. La terapia prenatal puede ofrecer una alternativa de tratamiento con la liberación de anillos de constricción bajo fetoscopia en aquellos fetos que se verían beneficiados con el procedimiento.

Amniotic band syndrome (ABS) or amniotic band disruption complex is a congenital malformation that occurs because of amniotic flanges of heterogeneous etiology, a pathogenesis that involves a series of fetal clinical manifestations, such as constriction, amputation, and multiple craniofacial, visceral and wall defects. The estimated prevalence of ABS ranges from 1:15.000 to 1:1.200 liveborn. It affects both sexes equally. Prenatal diagnosis may be suspected as early as the late first trimester when ultrasound imaging detects constriction rings, limb amputations and/or craniofacial defects. Prenatal therapy may offer an alternative treatment with release of constriction rings through fetoscopy in those fetuses that would benefit from the procedure.

Manejo del embarazo gemelar monocoriónico monoamniótico: revisión de la literatura y reporte de caso

A propósito de la presentación de un caso de embarazo gemelar monocoriónico monoamniótico, se revisó la literatura sobre su diagnóstico y manejo mediante búsqueda electrónica en la base de datos de Medline, OVID, Cochrane y PubMed entre los años 1966 y 2019. Las palabras clave utilizadas en la indagación fueron: embarazo, gemelos, monoamniótico, enredamiento de cordones. Existe un riesgo alto de muerte fetal súbita en gemelos monoamnióticos causado por el enredamiento de los cordones umbilicales, por lo que el diagnóstico oportuno de la corionicidad y amnionicidad en el embarazo gemelar mediante ecografía puede dar la pauta para una vigilancia fetal estrecha y mejorar así el resultado obstétrico.

In view of the presentation of a case of monochorionic monoamniotic twin pregnancy, the literature on its diagnosis and management was reviewed by electronic search in the Medline, OVID, Cochrane, and PubMed databases between 1966 and 2019. The key words used in the inquiry were: pregnancy, twins, monoamniotic, cord entanglement. There is a high risk of sudden fetal death in monoamniotic twins caused by entanglement of the umbilical cords, so timely diagnosis of chorionicity and amnionicity in twin pregnancy by ultrasonography may provide guidance for close fetal surveillance and thus improve obstetric outcome.

The impact of the COVID-19 pandemic on depression and stress levels in pregnant women: a national survey during the COVID-19 pandemic in Mexico.

BACKGROUND: COVID-19 outbreak has been associated with a wide variety of psychiatric manifestations such as panic, anxiety, and depression. We aim to assess the impact of the COVID - 19 pandemic on the levels of stress and depression of pregnant women in Mexico. METHODS: A cross-sectional web survey was carried out in pregnant women in 10 states of the Mexican Republic during the COVID-19 pandemic among public and private hospitals. The perception of stress was assessed using the Perceived Stress Scale, while depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale. RESULTS: A total of 549 surveys were applied, of which 96.1% (n = 503) were included in the data analysis. The mean participant's age was 28.1 years old. The mean perceived stress scale score was 24. 33.2% (n = 167) of participants had a score equal to 27 points or more and were considered highly stressed. The mean depression score was 9. A total of 17.5% (n = 88) participants had more than 14 points on the Edinburgh's depression scale, and were considered depressed. Stress levels were higher at later gestational ages (p = .008). CONCLUSIONS: COVID-19 pandemic has caused mental health issues in pregnant women reflected by high perceived stress levels and depression.

[Effect of post-abortion interpregnancy interval on obstetric and perinatal outcomes]. / Efecto del intervalo intergenésico postaborto en los resultados obstétricos y perinatales.

BACKGROUND: The interval between pregnancies is important because it allows the mother to recover after an obstetric event. OBJECTIVE: To evaluate if postabortion short interpregnancy intervals affect the obstetrics and perinatal outcome. MATERIAL AND METHODS: A cases and controls study was carried out. We studied 858 patients with a history of early pregnancy loss in the previous pregnancy, of which 286 were cases (interval postabortion < or = 6 months) and 572 controls (interval postabortion > 6 months). Abortion, preterm birth and perinatal outcomes: apgar < or = 7, morbidity, mortality, and weight of newborns were analyzed. RESULTS: The risk of abortion was similar in both groups (14.68% and 13.28%, for the cases and controls respectively (OR: 1.12; IC 95%: 0.75-1.69), and there were no differences in preterm birth (5.59% vs 8.21%; OR: 0.66; IC 95%: 0.37-1.19). Apgar was similar between the groups; there were not differences in the perinatal morbidity (RM: 0.77; IV 95%: 0.27-2.17; p = 0.8005), mortality (RM: 1.14; IC 95%: 0.33-3.94; p = 0.9145) and weight of the newborns between cases and control group. CONCLUSIONS: A short interpregnancy interval less than or equal to six months is not a risk factor for adverse obstetrical and perinatal outcome.

[Sociodemographic and obstetric factors associated with preterm birth]. / Factores sociodemográficos y obstétricos asociados con nacimiento pretérmino.

BACKGROUND: Preterm birth is the major cause of neonatal morbidity and mortality and is responsible for 75 to 90% of neonatal deaths unrelated to congenital malformations. OBJECTIVE: To evaluate preterm birth association with sociodemographic and obstetric risk factors. MATERIAL AND METHOD: A retrospective, comparative, longitudinal and observational study was carried out in which were analyzed all preterm births registries found in 2001-2006 period in the Civil Hospital of Culiacan, Sinaloa, México. As controls were selected at random the clinical registries of patients who presented term birth (n = 755). Were analyzed the association between preterm birth with sociodemographic factors (maternal age, socioeconomic level, tobacco use, alcoholism, begin intercourse age, number of sexual partners) and obstetric factors (transvaginal bleeding in the first half of pregnancy, previous preterm birth, post abortion and pregnancy at term interval, premature rupture of membranes, anemia and urinary infection). RESULTS: Significant differences were found between cases and controls about socioeconomic level (OR: 0.71; IC 95%: 0.5-0.9; p = 0.0191), vaginal bleeding in first half of pregnancy (OR: 31.06; IC 95%: 7.5-127.6; p < 0.05), previous preterm birth antecedent, (OR: 9.33; IC 95%: 2-59.1; p = 0.0006), pregnancy at term interval < or = one year (OR: 1.79; IC 95%: 1.2-2.5; p = 0.0021), premature rupture of membranes (OR: 9.24; IC 95%: 6.1-13.9; p < 0.05) and urinary infection (OR: 3.72; IC 95%: 2.1-6.4; p < 0.05). There were not association with the other factors analyzed. CONCLUSION: Preterm birth was significantly associated to socioeconomic level, transvaginal bleeding in first half of pregnancy, preterm birth previous, interpregnancy interval equal or less than one year, premature rupture of membranes and urinary infection.