Photoperiod during maternal pregnancy and lifetime depression in offspring.

Experimental studies indicate that perinatal light exposure has enduring effects on affective behaviors in rodents; however, insufficient research has explored this hypothesis in humans. We examined photoperiod (i.e., day length) metrics during maternal pregnancy in relation to lifetime depression in the longitudinal Nurses' Health Study (NHS) and NHS II. 160,723 participants reported birth date and birth state (used to derive daily photoperiod based on published mathematical equations), and clinician-diagnosed depression and antidepressant use throughout adulthood. Logistic regression was used to estimate odds ratios (OR) (and 95% confidence intervals [CI]) for depression (defined as clinician diagnosis and antidepressant use) across quintiles of two exposures during maternal pregnancy: 1) total photoperiod (total number of daylight hours) and 2) differences between minimum/maximum photoperiod; each trimester of pregnancy was examined separately. Total photoperiod during maternal pregnancy was not associated with depression overall or by trimester of pregnancy. However, larger differences between minimum/maximum photoperiod during maternal pregnancy were related to lower odds of depression (multivariable [MV]-adjusted OR: 0.86, 95% CI: 0.83, 0.90 comparing extreme quintiles of exposure; p-trend<0.0001); this association appeared specific to the second trimester of pregnancy (MV-adjusted p-trends = 0.03, <0.0001, and 0.3 across the three trimesters, respectively). In addition, birth at higher latitude (where larger differences in minimum/maximum photoperiod exist) was associated with a significant reduction in the lifetime risk of depression. These findings are consistent with an emerging hypothesis in which perinatal light exposure may influence risk of depression, and they might be understood through the conceptual framework of adaptive developmental plasticity.

Guía de la sistemática de la exploración ecográfica del 2º trimestre / Systematic guide to second-trimester ultrasound examination

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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)

Gestación ectópica del segundo trimestre / Second trimester ectopic pregnancy

La incidencia global del embarazo ectópico es del 1-2% de las gestaciones. Es infrecuente su diagnostico en el segundo trimestre, ya que por lo general los síntomas aparecen durante el primer trimestre. Presentamos el caso de una mujer que acude a urgencias con dolor en la fosa ilíaca de varios días de evolución y mediante la ecografía se le diagnostica embarazo tubárico derecho, con feto de biometría concordante con las 13 semanas de amenorrea de la paciente (AU)

The global incidence of ectopic pregnancy is around 1-2%. Its diagnosis is rare in the second trimester as symptoms usually appear during the first trimester. We present the case of a woman who was seen in the emergency room with a right lower quadrant pain of a few days duration. A transvaginal ultrasound confirmed an ectopic right pregnancy with a 13-week embryo (AU)

Safety of endoscopical procedures during pregnancy.

INTRODUCTION: Data on safety issues and therapeutic outcomes of endoscopy in pregnancy remains limited especially in the local context. The concerns are that of safety in sedation and radiation to the foetus, effects on the pregnancy, the need for special precautions on mother and foetus during the procedure and long-term foetal outcome. We report a case series on four pregnant women to address these concerns and outline their therapeutic approaches. METHODS: We reviewed four patients who underwent oral gastroduodenoscopy (OGD) or endoscopic retrograde cholangiopancreatography (ERCP) during their pregnancies. Lead aprons were used to shield the foetuses in all patients that underwent ERCP. Sedation was given when necessary, and an anaesthetist was employed in one case for close patient monitoring. Fluoroscopy was minimised and radiographs were taken only when essential. RESULTS: The mean patient age was 27.8 years (range 23-35 years). The mean gestation was 21.5 weeks (range 14-32 weeks), with two patients each being in their second and third trimesters. The indications for ERCP were cholangitis and pancreatitis (one), choledocholithiasis on ultrasonography (two), and that for OGD was persistent vomiting (one). Two patients underwent sphincterotomy and one had a biliary stent inserted. One patient was lost to follow-up. The other three had a full-term normal delivery and all babies were healthy at birth with good birth weight and normal Apgar scores. CONCLUSION: Our series showed that endoscopic procedures in pregnancy are safe for both mother and foetus. However, these procedures should be restricted to cases with definite. indications and radiation exposure should be minimised with additional safety precautions such as minimal radiation exposure and the use of lead shield when applicable.