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BACKGROUND: A striking number of national and subnational governments that previously allowed legal abortion in cases of severe fetal anomaly have passed new legislation to explicitly remove these allowances. However, we know little about the maternal health implications of such restrictions. OBJECTIVE: This study aimed to examine the health outcomes of pregnant individuals in El Salvador whose fetuses were diagnosed with a fatal congenital malformation and who were legally required to carry these nonviable pregnancies to term under the nation's absolute abortion ban. STUDY DESIGN: We reviewed the charts of all 239 pregnancies with fetuses classified as having 1 of 18 congenital malformations typically considered to be incompatible with extrauterine life that were evaluated at the National Women's Hospital in El Salvador between January 1, 2013 and December 31, 2018. Because regional healthcare providers who identify pregnancy complications in El Salvador are instructed to refer those patients to the National Women's Hospital, our analysis captured the total population of lethal fetal malformations treated by the national public health system. We documented pregnant patients' socioeconomic characteristics, pregnancy-related complications, and the medical procedures used to mitigate complications. RESULTS: Individuals who were required to carry pregnancies with severe fetal malformations to term (or until preterm labor began naturally) experienced high rates of maternal morbidity. More than half (54.9%) of pregnancies experienced at least 1 serious pregnancy-related health complication, whereas 47.9% underwent a physically-invasive medical procedure to manage complications, including cesarean deliveries, decompression amniocenteses, fetal head decompressions, and, in 1 case, a full hysterectomy. A total of 9% of patients opted to discontinue care after receiving the diagnosis of fatal fetal malformation. We also found striking variation in how physicians managed pregnancies with fatal fetal malformations, suggesting that different interpretations of the law lead to inequities in individual-level patient care. CONCLUSION: Laws prohibiting abortions in cases of severe fetal malformation can increase risks to pregnant patients by requiring clinicians to subject healthy patients to a course of treatment that generates morbidity.

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Os vírus são microrganismos comumente associados as doenças e infectam todos os seres vivos. Atuam de forma direta e indireta levando a pressão seletiva, com papel significativo e ainda em exploração no planeta. As fissuras orofaciais são anomalias congênitas de etiologia complexa e multifatorial, sendo as infecções virais durante a gestação um dos possíveis fatores etiológicos. A história da humanidade frente aos vírus e fissuras orofaciais de forma isolada é vasta, remontando a períodos antes de Cristo, seja por meio de leis para o controle de pragas e/ou por lendas de míticas criaturas deificadas e/ou demonizadas, cuja criação está fundamentada na Teoria Alegórica do surgimento das mitologias, demonstrando assim o interesse do ser humano e sua curiosidade em inovação e explicação destes assuntos. Considerando a relevância histórica, bem como a possível relação etiológica destes dois elementos, uma revisão da literatura foi realizada para apresentar a história mitológica e científica dos vírus e fissuras orofaciais, de forma isolada e associadas para fins de comparação. Para isso, foram utilizadas as bases PubMed/Medline, SciElo, LILACS e Portal Periódicos (CAPES) com os descritores: Virus, Anomalias/Anomalies, Virus and Anomalias/Virus and Anomalies, A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalies and Myths, Vampires and Virus/Vampiros and Virus. Enquanto o histórico mitológico é cheio de teorias contraditórias, o histórico cientifico acadêmico se revela coerente, porém resistente as novas áreas de atuação, não ponderando novas possibilidades e limitando a exploração científica, que só pôde ser alcançada nos séculos atuais. Quanto a associação, a linha de pesquisa relacionando vírus e fissuras orofaciais não possui nem meio século de existência, propiciando um grande campo a ser explorado e na mesma medida limitando os benefícios em prevenção que poderiam ser obtidos através destes estudos.

Viruses are microorganisms commonly associated with diseases that infect all living beings, they act directly and indirectly leading to selective pressure, their role on the planet is significant and still under exploration. Orofacial clefts are congenital anomalies that have a complex multifactorial etiology, with viral infections during pregnancy being one of the possible etiological factors. The history of humanity in the face of viruses and orofacial clefts in isolation is vast, dating back to periods before Christ, whether through laws for pest control and/or legends of mythical deified and/or demonized creatures, whose creation is fundamentalized in the Allegorical Theory of the emergence of mythologies, thus demonstrating the interest of human beings and their curiosity in innovation and explanation of these subjects. Considering the historical relevance, as well as the possible etiology relationship of these two elements, we carried out a literature review to present the mythological and scientific history of viruses and orofacial clefts, isolated and associated for comparison purposes. For this intent, the bases PubMed/Medline, SciElo, LILACS and Portal Periódicos (CAPES) were selected with the descriptors: A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalies and Myths, Vampires and Virus/Vampiros and Virus. While the mythological history is full of contradictory theories, the academic, scientific history proves to be consistent, but resistant to new areas of action, not considering new possibilities and limiting scientific exploration, which can only be achieved in the present centuries. As for the association, the line of research relating viruses and orofacial clefts does not even have half a century of existence, providing a large field to be explored and at the same time limiting the benefits of prevention that could be obtained through these studies.

Los virus son microorganismos comúnmente asociados a enfermedades que infectan a todos los seres vivos, actúan directa e indirectamente provocando presión selectiva, su papel en el planeta es significativo y aún en exploración. Las hendiduras orofaciales son anomalías congénitas que tienen una compleja etiología multifactorial, siendo las infecciones virales durante el embarazo uno de los posibles factores etiológicos. La historia de la humanidad frente a los virus y las hendiduras orofaciales de forma aislada es vasta, remontándose a períodos anteriores a Cristo, ya sea a través de leyes para el control de plagas y/o leyendas de criaturas míticas deificadas y/o demonizadas, cuya creación se fundamentaliza en la Teoría Alegórica del surgimiento de las mitologías, demostrando así el interés del ser humano y su curiosidad en la innovación y explicación de estos temas. Considerando la relevancia histórica, así como la posible relación etiológica de estos dos elementos, realizamos una revisión bibliográfica para presentar la historia mitológica y científica de los virus y las hendiduras orofaciales, aislados y asociados para fines de comparación. Para ello, se seleccionaron las bases PubMed/Medline, SciElo, LILACS y Portal Periódicos (CAPES) con los descriptores: A History of viruses/História dos vírus, Virus and History/História and Virus, Virus and Myth/Virus and Mito, Anomalias and Mitos/Anomalías y Mitos, Vampiros and Virus/Vampiros y Virus. Mientras que la historia mitológica está llena de teorías contradictorias, la historia académica, científica, se muestra coherente, pero resistente a nuevos campos de actuación, no considerando nuevas posibilidades y limitando la exploración científica, que sólo puede alcanzarse en los siglos actuales. En cuanto a la asociación, la línea de investigación que relaciona virus y hendiduras orofaciales no tiene ni medio siglo de existencia, proporcionando un gran campo a ser explorado y al mismo tiempo limitando los beneficios de prevención que podrían ser obtenidos a través de estos estudios.

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Background: Fetal malformations are diagnosed prenatally in nearly 3% of pregnancies, and ∼1.2% are major malformations. After prenatal diagnosis, it is imperative to consider families' values and to support their decision-making process. Prenatal palliative care is a growing field mainly based on family conferences. The prenatal care setting is unique and differs from postnatal and adult care. There are no descriptions of family conferences in prenatal palliative care. The descriptions of themes that emerge from the prenatal care conference charts may guide professionals in this delicate task, and help determine the causes of suffering and identify family values before the birth of the infant. Aim: To perform a content analysis of medical records of family conferences and to describe the main themes observed during prenatal palliative care follow-up after the diagnosis of a life-limiting fetal condition. Design: This is a retrospective study of medical records of family conferences from a perinatal palliative care group, the GAI group, between May 2015 and September 2016. Setting/Participants: Families with estimated perinatal mortality >50% and eligibility for follow-up at our tertiary fetal medicine center were enrolled. We included women who participated in at least one family conference with the GAI group and who had given birth at the clinic or delivered at another center and returned for the postnatal family conference. Results: Fifty women met the inclusion criteria. Five main themes and 18 categories emerged from the charts and are described in detail. A model of follow-up in prenatal palliative care is proposed based on the themes and categories identified. Conclusions: This analysis may guide health professionals who seek to better identify family needs and values and organize follow-up during prenatal palliative care.

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BACKGROUND: Fetal malformations occur in 2% of gestations and are the fifth most common cause of neonatal death in the world. In many cases, fetal malformations result in neonatal death or long stay in intensive care facilities. Families that continue the pregnancy in such a situation need to make choices and cope with an overwhelming number of potential issues. Palliative care starting at the prenatal period is a growing field that allows the entire family to prepare for this difficult situation. OBJECTIVE: To perform a systematic review of published data on palliative care in the prenatal period. DESIGN: PubMed and the Cochrane Library were searched using the keywords ("perinatal" OR "prenatal" OR "fetal") AND "palliative care" and also ("perinatal" OR "prenatal" OR "fetal") AND "hospice." SETTING/SUBJECTS: Studies focusing on the long-term impact of prenatal palliative care published up to December 2015 were used. MEASUREMENTS: Quantitative and qualitative studies. RESULTS: In total, 541 studies were retrieved; 29 articles met the inclusion criteria. Studies were organized into different categories according to the design or main focus. The majority of studies retrieved were reflexives or presented a narrative proposal on palliative care started in the prenatal period (45%). Clinical studies comprised 17% of all articles found. No studies were found on the long-term impact of prenatal palliative care. CONCLUSIONS: Prenatal palliative care is a growing field and an important supportive care measure that can help grieving parents and families who do not want to or cannot interrupt their pregnancy. More studies should be carried out, specifically concerning long-term impact of prenatal palliative care. Guidelines and training of health professionals must be developed so that more families can benefit from this type of care.

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OBJECTIVES: To describe the antenatal fetal heart rate (FHR) parameters analyzed by computerizedcardiotocography (cCTG) in fetuses with gastroschisis and compare the FHR parameters with ultrasound gastrointestinal markers. METHODS: A retrospective analysis of antepartum cCTG records were conducted in 87 pregnant cases with fetal gastroschisis between 28and 36 weeks (plus 6 days). A comparative analysis of the median distribution of the following FHR parameters was performed: basal FHR, short-term variation (STV), FHR accelerations and decelerations, episodes of high and low variations, and variations in low and high episodes. FHR parameters and ultrasound gastrointestinal markers were also compared. RESULTS: The majority of FHR parameters did not present significant changes throughout gestation. An increased number of records with episodes of low variation (p = 0.019) and an increased number of accelerations >15 bpm (p = 0.001) were the only observed changes throughout gestation. Stomach herniation was significantly associated with a lower STV (p = 0.018) and a higher frequency of records with low episodes (p = 0.049). CONCLUSIONS: The cCTG analysis indicated that the FHR parameters in fetuses with gastroschisis presented different patterns from those observed in normal fetuses. Stomach herniation was associated with altered FHR patterns.

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OBJECTIVE: The aim of this study was to evaluate postnatal outcomes in fetuses with gastroschisis. METHODS: This is a retrospective study (2009-2013) of patients with gastroschisis at the Hospital São Paulo (Federal University of São Paulo, Brazil). RESULTS: A total of 44 infants with gastroschisis were examined. The mean maternal age was 21.1 years and mean gestational age at delivery was 36.1 weeks. Delivery occurred before 34 weeks in 13.6%, between 34 and 36 weeks and 6 d in 40.9%, and after 37 weeks in 45.5%. The mean birth weight was 2349 g, with 37.2% small-for-gestational age infants. The mean umbilical cord blood pH was 7.32. Bowel resection and delayed fascial closure was performed in 14.6% and 19.5%, respectively. The mean hospitalization time in the neonatal intensive care unit was 52.7 d. Neonatal infection was detected in 52.4%, with a positive blood culture; 77.3% of those cases were coagulase negative staphylococci. The overall rate of mortality was 25%; 18.2% before birth, 45.4% during the neonatal period, and 36.4% in infants. The main cause of postnatal death was septicemia (55.5%). CONCLUSIONS: Despite advances in perinatal care and surgical techniques, infants with gastroschisis still present high rates of complications and death.

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La Displasia tanatofórica es probablemente la displasia letal más común. Ocurre en aproximadamente en 0,69 por cada 10.000 nacimientos. Su etiología es posiblemente autosómica dominante y resulta de mutaciones nuevas del factor de crecimiento del receptor de los fibroblastos. La patogenia es debida a desorganización del cartílago de crecimiento con persistencia de tejido símil parenquimatoso. Es una condrodisplasia congénita letal caracterizada por el acortamiento de los miembros, hipoplasia torácica, cráneo en hoja de trébol, pliegue simiesco, fémur acortado, estrechamiento torácico, frente prominente, polo cefálico con dimensiones aumentadas aún sin ventriculomegalia y redundancia de las partes blandas.Ademásestá asociado a polihidramnios en un 70 %. Las anomalías asociadas son hidrocefalia, anomalías renales, defecto del tabique auricular, válvula tricúspide anómala, ano imperforado y sinóstosis radio cubital. Se presenta la experiencia de un caso de displasia tanatofórica que se ha podido diagnosticar con la ecografía prenatal.

Thanatophoric dysplasia is probably the most common lethal dysplasia. It occurs in about 0.69 of 10,000 births. Its etiologyis dominantand autosomal probabilly dueto new mutations from growth factor receptor fibroblasts. The pathogenesis is dueto disorganization of the growth cartilage with persistente of parenchymal like tissue. It´s a lethal congenital chondrodysplasia characterized by short limbs, thoracichypoplasia, skull cloverleaf, simiancrease, shortened femur, thoracic narrowing, prominent forehead, cephalic pole with increased dimension seven without ventriculomegaly, redundancy of the soft tissues. Also polyhydramniosis associated with in 70% of cases. The associated anomalies are hydrocephalus, kidney abnormalities, atrial septal defect, abnormal tricuspidvalve, imperforateanus which radioulnarsynostosis. The present a case with thanatophoric dysplasia which has been diagnosed with prenatal ultrasound.

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RESUMEN La sirenomelia constituye una anomalía congénita rara. Su incidencia es de 1:60.000 nacidos vivos. Es causada por un defecto vascular disruptivo y caracterizado por la fusión de las extremidades inferiores, asociados a anomalías cardiacas, renales, de pared abdominal y torácica, vértebras inferiores, tubo digestivo inferiores, genitales y de las arterias umbilicales. Se presenta la experiencia de un caso de sirenomelia que se ha podido diagnosticar con la ecografia prenatal.

ABSTRACT Sirenomelia is a very rare congenic anomaly. Being its incidence of approximately 1:60.000 live born, caused by a vascular disruptive defect, characterized by the fusion of lower limbs, associated to cardiac, renal, abdominal wall, and thoracic anomalies; also characterized by inferior vertebrae, inferior digestive tract, genital and umbilical artery anomalies A case of sirenomelia has been diagnosed thanks to prenatal echography.

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O presente estudo teve por objetivo conhecer as vivências de luto de mulheres que interromperam a gestação sob autorização judicial, devido à malformação fetal incompatível com a vida. Participaram do estudo dez mulheres atendidas no Setor de Medicina Fetal do Hospital das Clínicas de Botucatu. Para coleta dos dados foi realizada entrevista semiestruturada quarenta dias após a interrupção. As entrevistas foram audiogravadas, transcritas na íntegra e tiveram os dados analisados na perspectiva da análise temática de conteúdo. Os resultados revelaram que as mães buscaram explicações e significados para a perda, sendo muito frequentes respostas religiosas e autoculpabilizantes. Os relatos marcaram sentimentos de tristeza, saudade e sensação de vazio pela perda do filho, revelando também a necessidade das mães de manterem-se ligadas a ele. As mães estavam e continuaram vinculadas aos seus filhos e a interrupção da gestação, embora tenha sido uma escolha para minimizar a dor de uma perda inevitável, não as poupou de vivências de grande sofrimento. O estudo traz subsídios para a discussão e planejamento de abordagens e cuidados com a saúde de mulheres que interrompem a gestação por malformação fetal letal, mediante autorização judicial.

The scope of this study was to investigate the grieving experiences of women who terminated pregnancies under judicial authorization, due to life-incompatible fetal malformation. Ten women attended in the Fetal Medicine Department of Botucatu Clinical Hospital participated in the study. Data collection was conducted by means of semi-structured interviews forty days after termination. The interviews were recorded and transcribed in full, with the data analyzed from the thematic content analysis perspective. The results revealed that the mothers sought explanations and meanings for the loss, with religious responses and self-blame being very frequent. The reports were marked by feelings of sadness, longing and sensations of emptiness due to the loss of the child, revealing the need of the mothers to dwell on the issue. The mothers were and continued to be linked to their children; the termination of the pregnancy, although being a choice to minimize the pain of an inevitable loss, did not spare the women from experiences of great suffering.>The study includes input for the discussion and planning of health approaches and care for women who terminate their pregnancy due to lethal fetal malformation, by means of judicial authorization.

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Com o objetivo de avaliar a toxicidade de diferentes concentrações das favas de Stryphnodendron fissuratum em vacas prenhes, as favas desta árvore foram moídas, misturadas à ração comercial e fornecidas a oito vacas nas doses totais de 6,5g/kg, 7,5g/kg, 9g/kg e 10g/kg. Os animais que receberam doses de 6,5g/kg pariram bezerros normais e aqueles que receberam 7,5g/kg pariram bezerros fracos que não sobreviveram. Doses de 9g/kg resultaram no nascimento de um bezerro imaturo e de outro bezerro com distiquíase, opacidade congênita das córneas e microftalmia. Ambas as vacas que ingeriram 10g/kg morreram, porém uma vaca abortou antes de morrer. Nas vacas que morreram, as lesões macroscópicas e histológicas do sistema digestivo e fígado foram semelhantes às descritas anteriormente na intoxicação por S. fissuratum. Nos bezerros e no feto abortado não foram observadas lesões macroscópicas ou histológicas significantes. A análise fitoquímica dos extratos metanólicos das favas de S. fissuratum revelou a presença de taninos hidrossolúveis, proantocianidinas, leucoantocianidinas e da saponina triterpénica β-amirina. Saponinas triterpénicas têm sido associadas com a toxicidade das favas de Stryphnodendron spp. e Enterolobium spp., que causam sinais clínicos semelhantes aos observados na intoxicação por S. fissuratum. Esta pesquisa confirmou a toxicidade das favas de S. fissuratum para bovinos, no entanto não foram confirmados os efeitos abortivos das mesmas, pois o aborto e as mortes neonatais observadas podem ser decorrentes dos efeitos tóxicos da planta nas mães. Novas pesquisas são necessárias para pesquisar se as favas da planta causam malformações semelhantes às observas em um dos bezerros nascidos vivos.

To evaluate the toxicity of different concentrations of pods of Stryphnodendron fissuratum to pregnant cows, the pods of this tree were grounded, mixed in a commercial food and given to eight pregnant cows in total doses of 6.5g/kg, 7.5g/kg, 9g/kg and 10g/kg. The animals that received doses of 6.5g/kg delivered normal calves and those that received 7.5g/kg delivered weak calves that did not survive. Doses of 9g/kg resulted in the birth of an immature calf and another with congenital bilateral distichiasis, corneal opacity, and microphthalmia. Both cows that ingested 10g/kg died, and one of these aborted before death. In the dead cows, the gross and histological lesions of the digestive system and liver were similar to those previously described in S. fissuratum poisoning. No significant lesions were observed in the calves and in the aborted fetus. The phytochemical analysis of methanol extracts from pods of S. fissuratum revealed the presence of soluble tannins, proanthocyanidins, leucoanthocyanidins and the triterpenoid saponin β-amyrin. Triterpenoid saponins had been associated with the toxicity of Stryphnodendron spp. and Enterolobium spp., which cause clinical signs similar to those observed in the poisoning by S. fissuratum. The results presented herein confirmed the toxicity of S. fissuratum to bovines. However, the abortive effects of this plant was not confirmed; thus because the abortion and neonatal deaths could be due to the toxicity of the pods to the cows. New research should be done to demonstrate if S. fissuratum is a cause of malformations similar to those observed in one of the calves born from the treated cows.

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Com o objetivo de avaliar a toxicidade de diferentes concentrações das favas de Stryphnodendron fissuratum em vacas prenhes, as favas desta árvore foram moídas, misturadas à ração comercial e fornecidas a oito vacas nas doses totais de 6,5g/kg, 7,5g/kg, 9g/kg e 10g/kg. Os animais que receberam doses de 6,5g/kg pariram bezerros normais e aqueles que receberam 7,5g/kg pariram bezerros fracos que não sobreviveram. Doses de 9g/kg resultaram no nascimento de um bezerro imaturo e de outro bezerro com distiquíase, opacidade congênita das córneas e microftalmia. Ambas as vacas que ingeriram 10g/kg morreram, porém uma vaca abortou antes de morrer. Nas vacas que morreram, as lesões macroscópicas e histológicas do sistema digestivo e fígado foram semelhantes às descritas anteriormente na intoxicação por S. fissuratum. Nos bezerros e no feto abortado não foram observadas lesões macroscópicas ou histológicas significantes. A análise fitoquímica dos extratos metanólicos das favas de S. fissuratum revelou a presença de taninos hidrossolúveis, proantocianidinas, leucoantocianidinas e da saponina triterpénica β-amirina. Saponinas triterpénicas têm sido associadas com a toxicidade das favas de Stryphnodendron spp. e Enterolobium spp., que causam sinais clínicos semelhantes aos observados na intoxicação por S. fissuratum. Esta pesquisa confirmou a toxicidade das favas de S. fissuratum para bovinos, no entanto não foram confirmados os efeitos abortivos das mesmas, pois o aborto e as mortes neonatais observadas podem ser decorrentes dos efeitos tóxicos da planta nas mães. Novas pesquisas são necessárias para pesquisar se as favas da planta causam malformações semelhantes às observas em um dos bezerros nascidos vivos.(AU)

To evaluate the toxicity of different concentrations of pods of Stryphnodendron fissuratum to pregnant cows, the pods of this tree were grounded, mixed in a commercial food and given to eight pregnant cows in total doses of 6.5g/kg, 7.5g/kg, 9g/kg and 10g/kg. The animals that received doses of 6.5g/kg delivered normal calves and those that received 7.5g/kg delivered weak calves that did not survive. Doses of 9g/kg resulted in the birth of an immature calf and another with congenital bilateral distichiasis, corneal opacity, and microphthalmia. Both cows that ingested 10g/kg died, and one of these aborted before death. In the dead cows, the gross and histological lesions of the digestive system and liver were similar to those previously described in S. fissuratum poisoning. No significant lesions were observed in the calves and in the aborted fetus. The phytochemical analysis of methanol extracts from pods of S. fissuratum revealed the presence of soluble tannins, proanthocyanidins, leucoanthocyanidins and the triterpenoid saponin β-amyrin. Triterpenoid saponins had been associated with the toxicity of Stryphnodendron spp. and Enterolobium spp., which cause clinical signs similar to those observed in the poisoning by S. fissuratum. The results presented herein confirmed the toxicity of S. fissuratum to bovines. However, the abortive effects of this plant was not confirmed; thus because the abortion and neonatal deaths could be due to the toxicity of the pods to the cows. New research should be done to demonstrate if S. fissuratum is a cause of malformations similar to those observed in one of the calves born from the treated cows.(AU)

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Esta é uma revisão tradicional (narrativa) que teve como objetivo salientar a contribuição da ultrassonografia (USG) obstétrica entre a 11ª e a 14ª semana de gravidez, comumente denominada ultrassonografia morfológica de primeiro trimestre. Além do rastreamento de anomalias cromossômicas, a USG pode ser empregada neste período para: confirmação ou determinação da idade gestacional; avaliação da anatomia fetal; diagnóstico de malformações; rastreamento de anormalidades estruturais maiores e de síndromes gênicas; definição do prognóstico da gravidez; diagnóstico e caracterização das gestações múltiplas; e rastreamento da pré-eclampsia e da restrição de crescimento intrauterino. Foram incluídos os principais estudos sobre o tema publicados entre 1990 e 2010, pesquisados nas bibliotecas eletrônicas Cochrane e PubMed, e que podem ser incorporados nos níveis de evidência científica I a III.

This is a traditional (narrative) review with the objective of highlighting the contribution of obstetric ultrasonography (US) between the 11th and 14th week of pregnancy, commonly called first trimester anomaly scan. In addition to being used for the screening of chromosomal anomalies, US can be employed during this period to confirm or determine gestational age, evaluate fetal anatomy, diagnose malformations, screen major structural abnormalities and genetic syndromes, define the prognosis of pregnancy, diagnose and characterize multiple pregnancies, and screen preeclampsia and intrauterine growth restriction. The most important studies about this subject published between 1990 and 2010 in the Cochrane and PubMed libraries were included. The selected studies can be classified with scientific levels I to III.

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Antecedentes: La exploración ecográfica entre las semanas 11 y 14 tiene un papel fundamental en el cribado de anomalías cromosómicas, siendo la medida de la translucencia nucal un método bien establecido y ampliamente aceptado para este fin. Objetivo: Evaluar retrospectivamente la evolución de los fetos con translucencia nucal aumentada y cariotipo normal. Método: Se recogieron los datos de 104 fetos con TN >percentil 95 (p95) entre las semanas 11 y 14, evaluados en nuestro centro. En los 61 que resultaron eu-ploides, se estudió la incidencia de anomalías estructurales diagnosticadas tanto prenatalmente como tras el nacimiento, así como las pérdidas fetales anteparto. De estos fetos, nacieron sanos el 80 por ciento cuando la TN estaba entre p95 y 3,4 mm, el 50 por ciento con TN entre 3,5 y 4,4 mm, el 30 por ciento con TN entre 4,5 y 5,4 mm, y el 18 por ciento con TN > 5,5 mm. Entre los 4 recién nacidos euploides con patología, hubo 3 con cardiopatía. Conclusión: La presencia de TN aumentada entre las 11 -14 semanas en fetos euploides se asocia a un incremento del riesgo de anomalías estructurales mayores, principalmente cardiacas. La prevalencia de malformaciones aumenta significativamente con TN >3,5 mm, y el pronóstico gestacional adverso empeora conforme aumenta la medida de la TN.

Background: Ultrasound scan has a main role at the 11-14 weeks screening for chromosomal abnormalities. The measurement of nuchal translucency (NT) thickness is a widespread stablished method to achieve this target. Objective: To assess retrospectively the outcome of fetuses with increased nuchal translucency and normal karyotype. Method: Data were collected from 104 fetuses with NT > 95th percentile at 11 to 14 weeks of gestation, followed in our institution. The sixty one euploid fetuses were studied in order to determine the incidence of structural abnormalities, diagnosed either before or after delivery, as well as antenatal fetal loss. Among these fetuses, there were no malformations at birth in 80 percent for NT between the 95th percentile and 3.4 mm; 50 percent for NT between 3.5 and 4.4 mm; 30 percent for NT of 4.5-5.4 mm; and 18 percent for NT > 5.5 mm. There were 4 euploid newborns with some kind of structural defect at birth, 3 of them presented a cardiac malformation. Conclusion: The presence of increased NT at 11-14 weeks scan in euploid fetuses it's associated with a higher risk of major structural abnormalities, mainly cardiac ones. The prevalence of malformations is significantly increased for NT > 3.5 mm, and the adverse perinatal outcome is directly associated with the thickness of NT.

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Se describen dos casos de duplicación posterior congénita en cachorros. Esta malformación también conocida como Monocephalus dipygus, hace referencia a individuos dobles, caracterizados por tener cabeza y tórax fusionados en uno solo, duplicidad simétrica de pelvis y miembros posteriores. El primer caso, presentó cuatro miembros anteriores, cuatro miembros posteriores y palatosquisis. El segundo caso, presentó dos miembros anteriores y cuatro miembros posteriores. En general, ambos casos pueden ser relacionados como gemelos fusionados simétricos.

It is described two cases of congenital posterior duplication in puppies. This malformation also known as Monocephalus dipygus refers to individuals doubles, characterized by having the head and thorax fused into a single and symmetrical duplication of pelvis and hind limbs. The first case, showed four former members, four posterior members and palatosquisis. The second case, showed only two former members and four posterior members. In general, both cases can be related as twins symmetric fused.

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The congenital diaphragmatic hernia is one of the most common severe malformations, with a high mortality that has been maintained for the time. There have been numerous markers that predict postnatal survival, of which the LHR and the presence of intrathoracic liver are the most reliable. Materials and methods: A review of the tabs of patients carrying fetuses with diagnosed CHD in the HGGB’s Department of Echography, as well as records of entry, exit and neonatal mortality in the same hospital. Results: We found 20 cases of CHD with an incidence of 1:1.647 births. Two patients were discarded by incomplete data. The 77,7 percent were diagnosed leftists. A 50 percent presenting deformities partners, among which one was diagnosed as Sd. Pallister Killian. The presence of intrathoracic liver was found in 38,8 percent. The mortality was 66,6 percent. Patients with LHR <1 were 100 percent mortality. Patients with liver Intrathoracic had 71,4 percent of mortality. Conclusion: The HDC is a malformation of high perinatal mortality. The indicators used as predictors of survival were very effectively. Our results are comparable to current publications.

La hernia diafragmática congénita constituye una de las malformaciones severas más comunes, con una alta mortalidad que se ha mantenido durante el tiempo. Se han formulado numerosos marcadores predictores de sobrevida postnatal, de los cuales el LHR y la presencia de hígado intratorácico son los más confiables. Material y método: Se realizó una revisión de las fichas de pacientes portadoras de fetos con hernia diafragmática congénita diagnosticadas en el Departamento de Ecografía del HGGB, además de registros de ingreso, egreso y mortalidad de neonatología del mismo hospital. Resultado: Se encontraron 20 casos de hernia diafragmática congénita con una incidencia de 1:1.647 partos. Se descartaron 2 pacientes por data incompleta. El 77,7 por ciento fueron diagnosticadas izquierdas. Un 50 por ciento presentó malformaciones asociadas, entre las cuales una fue diagnosticada como síndrome Pallister Killian. La presencia de hígado intratorácico se encontró en el 38,8 por ciento. La mortalidad fue de 66,6 por ciento. Las pacientes con LHR<1 tuvieron 100 por ciento mortalidad. Las pacientes con hígado intratorácico tuvieron 71,4 por ciento de mortalidad. Conclusión: La hernia diafragmática congénita constituye una malformación de alta mortalidad perinatal. Los indicadores utilizados como predictores de sobrevida tuvieron una alta efectividad. Nuestros resultados son comparables a las publicaciones actuales.

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Os autores relatam um caso de diagnóstico pré-natal de síndrome de Meckel-Gruber em gestante de 12 anos de idade. A primeira ultra-sonografia, realizada na 32ª semana, identificou feto único portador de microcefalia, volumosa encefalocele na linha média da região occipital, lábio leporino completo bilateral e fenda palatina. Os rins encontravam-se de dimensões e ecotextura aumentadas, medindo cerca de 12 cm de comprimento, levando a importante aumento do volume abdominal. A genitália fetal não foi identificada, sendo visualizada pequena imagem cística na sua topografia.Em função da presença de oligodramnia, foi realizada ressonância magnética na 33ª semana, que confirmou os achados ultra-sonográficos e demonstrou uma lisencefalia. Na 34ª semana, a gestação evoluiu com amniorrexe prematura, sendo realizada cesariana, com retirada de natimorto, posteriormente encaminhado à necropsia. Polidactilia foi a única alteração presente não-identificada pelos métodos de imagem.

The authors report a case of antenatal ultrasound diagnosis of Meckel-Gruber syndrome in a 12-year-old pregnant girl. The first scan done at 32 weeks of gestation revealed a single fetus withmicrocephaly, large encephalocele in the occipital mid-line region, bilateral complete cleft lip, and cleft palate. The kidneys and their ecotexture were found to be enlarged, measuring about 12 cm in length, causing an important enlargement of the abdomen. The fetus' genitals were not identified, but a small cystic image was visualized in their topography. Due to the presence of oligohydramnios, a magnetic resonance was performed at 33 weeks of gestation,which confirmed the sonographic findings and demonstrated a lisencephaly. A premature rupture of membranes occurred at 34 weeks of gestation, upon which a caeserian section was performed, the stillborn baby removed and subsequently taken for a necropsy. Polydactyly was the only anomaly present which was not identified by the imaging methods used.

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