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Objetivo:Determinar la relación entre APGAR al minuto y la presencia de oligohidramnios en gestantes a término atendidas en el Hospital Niño Jesús de Barranquilla durante el período 2018 a 2019. Materiales y métodos:Estudio descriptivo, trasversal, retrospectivo, tipo serie de casos. Se incluyeron 203 mujeres embarazadas que fueron atendidas en el Hospital Niño Jesús, con embarazo a término y diagnostico ultrasonográfico de oligohidramnios (ILA menor o igual a 5 cm),durante los años 2018 y 2019. Se relacionaron variables sociodemográficas y gineco obstétricas con el resultado del APGAR y del ILA y se compararon los resultados utilizando Chi2 y prueba de Fisher. Resultados:El promedio de edad de las participantes fuede 23,6 años (DE+/-: 5,7); 48,8% provenían de municipios del departamento del Atlántico y 18,2% de Venezuela; 48,3% tenían un ILA de 4 a 4,9 y 8,4% tuvieron APGAR al minuto menor a 7; 4,9% tuvieron productos con bajo peso al nacer; 15,3% de los que tuvieron ILA de 1 a 3 tuvieron APGAR menor de 7, frente a 5,6% de los que tuvieron ILA de 4 a 5 (Chi2: 5,13; p: 0,024). Así mismo, 40% de las que tuvieron bajo peso al nacer presentaron APGAR <7 en contraste con 6,7% de las que tuvieron productos con peso normal(Fisher: 0,005). Conclusión: Se encontró una relación directamente proporcional entre el valor del ILA y los resultados del APGAR al minuto, y esta relación debe analizarse mediante un estudio de casos y controles. De igual forma se dedujo que el nivel inferior más seguro de líquido amniótico con el que se pueden presentar menos resultados perinatales adversos como la asfixia perinatal es con un ILA igual o mayor de 4 cm.

Objective: To determine the relationship between minute APGAR and the presence of oligohydramnios in full-term pregnant women attended at the Niño Jesús Hospital in Barranquilla during the period 2018 to 2019. Materials and methods: Descriptive, cross-sectional, retrospective study, case series type. 203 pregnant women who were treated at the Niño Jesús Hospital, with term pregnancy and ultrasound diagnosis of oligohydramnios (ILA less than or equal to 5 cm), during the years 2018 and 2019 were included. Sociodemographic and gyneco-obstetric variables were related to the APGAR and ILA and results were compared using Chi2 and Fisher's test. Results: The average age of the participants was 23.6 years (SD +/-: 5.7); 48.8% came from municipalities in the Atlántico department and 18.2% from Venezuela; 48.3% had an ILA of 4 to 4.9 and 8.4% had APGAR at one minute less than 7; 4.9% had products with low birth weight; 15.3% of those with ILA from 1 to 3 had APGAR less than 7, compared to 5.6% of those with ILA from 4 to 5 (Chi2: 5.13; p: 0.024). Likewise, 40% of those with low birth weight had APGAR <7 in contrast to 6.7% of those with normal-weight products (Fisher: 0.005). Conclusion: A directly proportional relationship was found between theILA value and the APGAR results per minute, and this relationship should be analyzed through a case-control study.Similarly, it was deduced that the safest lower level of amniotic fluid with which less adverse perinatal results can occur, such as perinatal asphyxia, is with an ILA equal to or greater than 4 cm

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BACKGROUND: Oligohydramnios is a condition of abnormally low amniotic fluid volume that has been associated with poor pregnancy outcomes. To date, the prevalence of this condition and its outcomes has not been well described in low and low-middle income countries (LMIC) where ultrasound use to diagnose this condition in pregnancy is limited. As part of a prospective trial of ultrasound at antenatal care in LMICs, we sought to evaluate the incidence of and the adverse maternal, fetal and neonatal outcomes associated with oligohydramnios. METHODS: We included data in this report from all pregnant women in community settings in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo (DRC) who received a third trimester ultrasound as part of the First Look Study, a randomized trial to assess the value of ultrasound at antenatal care. Using these data, we conducted a planned secondary analysis to compare pregnancy outcomes of women with to those without oligohydramnios. Oligohydramnios was defined as measurement of an Amniotic Fluid Index less than 5 cm in at least one ultrasound in the third trimester. The outcomes assessed included maternal morbidity and fetal and neonatal mortality, preterm birth and low-birthweight. We used pairwise site comparisons with Tukey-Kramer adjustment and multivariable logistic models using general estimating equations to account for the correlation of outcomes within cluster. RESULTS: Of 12,940 women enrolled in the clusters in Guatemala, Pakistan, Zambia and the DRC in the First Look Study who had a third trimester ultrasound examination, 87 women were diagnosed with oligohydramnios, equivalent to 0.7% of those studied. Prevalence of detected oligohydramnios varied among study sites; from the lowest of 0.2% in Zambia and the DRC to the highest of 1.5% in Pakistan. Women diagnosed with oligohydramnios had higher rates of hemorrhage, fetal malposition, and cesarean delivery than women without oligohydramnios. We also found unfavorable fetal and neonatal outcomes associated with oligohydramnios including stillbirths (OR 5.16, 95%CI 2.07, 12.85), neonatal deaths < 28 days (OR 3.18, 95% CI 1.18, 8.57), low birth weight (OR 2.10, 95% CI 1.44, 3.07) and preterm births (OR 2.73, 95%CI 1.76, 4.23). The mean birth weight was 162 g less (95% CI -288.6, - 35.9) with oligohydramnios. CONCLUSIONS: Oligohydramnos was associated with worse neonatal, fetal and maternal outcomes in LMIC. Further research is needed to assess effective interventions to diagnose and ultimately to reduce poor outcomes in these settings. TRIAL REGISTRATION: NCT01990625.

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Resumen ANTECEDENTES: La enfermedad de Chagas es una zoonosis causada por Trypanosoma cruzi, un parásito endémico de América Latina. Los niños se infectan por el contacto con vectores o por trasmisión congénita. CASO CLINICO: Paciente indígena, de 32 años, procedente del área rural del occidente colombiano, analfabeta, con antecedente de 7 embarazos y 6 partos, el embarazo actual con 29.5 semanas determinadas por la ecografía del tercer trimestre, sin controles prenatales, con trabajo de parto pretérmino y oligohidramnios severo. El embarazo finalizó por cesárea, sin complicaciones y el nacimiento de una niña que pesó 1290 gramos. A los 50 días de vida cursó con inestabilidad hemodinámica, dificultad respiratoria, palidez mucocutánea y fiebre con diagnóstico de sepsis de origen indeterminado. Los estudios de extensión reportaron: parasitemia positiva por microhematocrito para Trypanosoma cruzi, con amastigotes en el líquido cefalorraquídeo. Diagnóstico: meningoencefalitis chagásica. CONCLUSIONES: La trasmisión vertical de la enfermedad de Chagas es baja; la trasmisión congénita es la responsable de la progresiva aparición de la enfermedad en zonas endémicas y no endémicas. En las embarazadas es importante la inclusión del tamizaje para infección por Trypanosoma cruzi, como parte del conjunto de pruebas de control prenatal.

Abstract BACKGROUND: Chagas disease is a zoonosis caused by Trypanosoma cruzi, a parasite endemic to Latin America. Children become infected by contact with vectors or by congenital transmission. CLINICAL CASE: Illiterate indigenous patient, 32 years old, from the rural area of western Colombia, with a history of 7 pregnancies and 6 deliveries, the current pregnancy with 29.5 weeks determined by the third trimester ultrasound, without prenatal controls, with preterm labor and severe oligohydramnios. The pregnancy ended by cesarean section, without complications and the birth of a girl who weighed 1290 g. At 50 days of life, he developed hemodynamic instability, respiratory distress, mucocutaneous pallor and fever with a diagnosis of sepsis of undetermined origin. Extension studies reported: positive microhematocrit parasitaemia for Trypanosoma cruzi, with amastigotes in the cerebrospinal fluid. Diagnosis: Chagasic meningoencephalitis. CONCLUSIONS: The vertical transmission of Chagas disease is low; congenital transmission is responsible for the progressive appearance of the disease in endemic and non-endemic areas. In pregnant women, it is important to include screening for Trypanosoma cruzi infection, as part of the prenatal control test suite.

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Resumen: La disgenesia tubular renal es una enfermedad adquirida o hereditaria autosómica recesiva. Se manifiesta durante la etapa fetal como oligoamnios por anuria fetal y en el recién nacido como anuria persistente, hipoplasia pulmonar, hipotensión severa refractaria y alteración de la osificación de los huesos craneales. Histológicamente es una alteración del desarrollo de los túbulos renales. Se expone un caso clínico de un recién nacido que presentó al nacer insuficiencia renal, múltiples dismorfias e hipoplasia pulmonar, falleciendo a los tres días de vida. La necropsia consigna el diagnóstico de disgenesia tubular renal.

Summary: Renal tubular dysgenesis is an acquired or inherited autosomal recessive disease. Before birth, it shows as oligohydramnios resulting from fetal anuria and after birth, it shows as persistent anuria, pulmonary hypoplasia, severe refractory hypotension and alteration of the ossification of the cranial bones. Histologically, it is an alteration of the development of the renal tubules. We hereby introduce a clinical case of a newborn who presented renal failure, multiple dysmorphia and pulmonary hypoplasia at birth, who died at 3 days of age and whose autopsy showed renal tubular dysgenesis.

Resumo: A disgenesia tubular renal é uma doença autossômica recessiva adquirida ou herdada. Manifesta-se durante o estágio fetal como oligoâmnio causado pela anúria fetal e no recém-nascido como anúria persistente, hipoplasia pulmonar, hipotensão grave refratária e alteração da ossificação dos ossos cranianos. Histologicamente, é uma alteração do desenvolvimento dos túbulos renais. Apresentamos um caso clínico de um recém-nascido que apresentou insuficiência renal, dismorfias múltiplas e hipoplasia pulmonar ao nascer, falecido aos 3 dias de vida e cuja autópsia estabelece o diagnóstico de disgenesia tubular renal.

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RESUMEN Fundamento: el oligohidramnios con frecuencia impide una gestación exitosa y es necesario buscar alternativas terapéuticas que minimicen los daños que causa al feto. Objetivo: caracterizar el uso de la hidroterapia materna endovenosa en el manejo del oligohidramnios. Métodos: se realizó un estudio observacional descriptivo de corte transversal. El universo quedó constituido por 1 272 gestantes con un tiempo de gestación ≥ 34 semanas que presentaban oligohidramnios divididas en dos grupos según el uso o no de la hidroterapia materna endovenosa. Se utilizó estadística descriptiva con distribución de frecuencias absolutas y relativas. Resultados: la media de índice de líquido amniótico al ingreso en el grupo uno fue de 3,9 cm y en el grupo dos de 4,1 cm, la cual ascendió en este último a 6,2 cm después del uso de la hidroterapia materna endovenosa. El 49,58 % de gestantes del grupo uno fueron cesáreas y 63,29 % del grupo dos tuvieron un parto eutócico. La indicación de cesárea por estado fetal intranquilizante se presentó en 182 grávidas del grupo uno y 139 gestantes del grupo dos. El bajo peso al nacer se presentó en 29 y 26 neonatos de las gestantes del grupo uno y dos respectivamente. Conclusiones: el uso de la hidroterapia materna endovenosa incrementó el promedio del índice de líquido amniótico. La mayoría de las pacientes hidratadas tuvieron un parto eutócico y fue menor la cantidad de gestantes con estado fetal intranquilizante y con complicaciones neonatales en ese grupo.

ABSTRACT Background: oligohydramnio frequently blocks a successful pregnancy and it is necessary to found therapeutics options that reduce its damages over the fetus. Objective: to characterize the use of maternal intravenous hydration on the management of oligohydramnio. Methods: an observational descriptive cross-sectional study was carried out. The universe was constituted by 1 272 pregnant women with gestational age ≥ 34 weeks who suffered from oligohydramnio. They were divided into 2 groups depending on the use or not of maternal intravenous hydration. A descriptive statistic with absolute and relative frequencies was used. Results: the average of amniotic liquid index at the admission was 3.9 cm in group 1 and 4.1 cm in group 2, in which it increased until 6.2 cm after maternal intravenous hydration. 49.58 % of women in group 1 were cesarean and 63.29 % of women in group 2 have a eutocic labor. Fetal distress was the indication of cesarean in 182 and 139 pregnant women of group 1 and 2 respectively. 29 and 26 newborn of group 1 and 2 respectively have low birth weight. Conclusions: maternal intravenous hydration increases the average of amniotic liquid index. The majority of hydrated maternal women have a eutocic labor, newborn complications were less in that group too.

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OBJECTIVE: To identify prenatal, perinatal, and postnatal risk factors for dialysis within the first year of life in children with autosomal recessive polycystic kidney disease (ARPKD) as a basis for parental counseling after prenatal and perinatal diagnosis. STUDY DESIGN: A dataset comprising 385 patients from the ARegPKD international registry study was analyzed for potential risk markers for dialysis during the first year of life. RESULTS: Thirty-six out of 385 children (9.4%) commenced dialysis in the first year of life. According to multivariable Cox regression analysis, the presence of oligohydramnios or anhydramnios, prenatal kidney enlargement, a low Apgar score, and the need for postnatal breathing support were independently associated with an increased hazard ratio for requiring dialysis within the first year of life. The increased risk associated with Apgar score and perinatal assisted breathing was time-dependent and vanished after 5 and 8 months of life, respectively. The predicted probabilities for early dialysis varied from 1.5% (95% CI, 0.5%-4.1%) for patients with ARPKD with no prenatal sonographic abnormalities to 32.3% (95% CI, 22.2%-44.5%) in cases of documented oligohydramnios or anhydramnios, renal cysts, and enlarged kidneys. CONCLUSIONS: This study, which identified risk factors associated with onset of dialysis in ARPKD in the first year of life, may be helpful in prenatal parental counseling in cases of suspected ARPKD.

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BACKGROUND: Therapy with inhaled nitric oxide (iNO) is effective in the management of pulmonary hypertension and severe hypoxemia. However, these benefits have not been demonstrated in preterm infants (<34 weeks). The objective of this report is to present the experience of eight cases of preterm neonates with respiratory distress syndrome (RDS) and refractory hypoxemia, with oligohydramnios history. METHODS: We evaluated the clinical feature of 8 preterm neonates with severe hypoxemia who had maternal antecedents of oligoamnios, mainly due to premature rupture of membranes. They were treated with conventional management, with poor clinical response. Therefore, these neonates were treated with iNO, as a rescue strategy. iNO has been used with a dosage of 5 - 10 ppm. An echocardiogram was performed to determine the presence of structural malformations or persistent ductus arteriosus. RESULTS: All the infants showed improvement in oxygenation. The neonates had signs of low flow pulmonary, confirmed by echocardiogram. Five preterm infants survived without complications associated with the therapy. Two died from pulmonary bleeding secondary to ductus arteriosus and another for pneumothorax. CONCLUSION: iNO therapy can be useful in a subgroup of preterm infants with a high risk of death secondary to hypoxemia. Although this report is based on a small number of cases, it follows the directions of other studies that suggest that iNO therapy can benefit preterm neonates, particularly those exposed to oligohydramnios.

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Introducción: La rotura prematura ovular (RPO) antes de la viabilidad fetal consiste en una complicación obstétrica de baja incidencia, pero de alta morbimortalidad perinatal asociada. Estudios sugieren que el volumen de líquido amniótico (LA) es un factor importante a considerar. El objetivo de este trabajo es evaluar si en RPO ≤24 semanas, un bolsillo vertical máximo (BVM) <2cm al diagnóstico es un factor de riesgo para aparición de morbimortalidad fetal y neonatal. Métodos: Estudio de cohorte longitudinal retrospectivo de 94 pacientes con RPO ≤24 semanas ingresadas a un hospital terciario para manejo expectante entre los años 2005 y 2014. Embarazo gemelar o malformaciones congénitas fueron criterios de exclusión. Se obtuvieron y compararon 2 grupos según BVM al ingreso (BVM ≥ 2 cm y BVM < a 2 cms) y se comparó la edad gestacional (EG) al momento de la RPO y al parto, la latencia desde la RPO al parto, la presencia de corioamnionitis clínica, el número de óbitos fetales, muerte neonatal precoz (primeros 7 días de vida), tardía (entre los 7 y 28 días) y sobrevida global. Resultados: El 58 por ciento de las pacientes presentó un BVM <2 cm al ingreso, el cual se asoció a menor latencia al parto (p:0,01), menor EG al parto (p:0,02), más óbito fetal (p:0,04), mayor muerte neonatal precoz y tardía (p:0,02 y 0,01 respectivamente) además de menor sobrevida global (p:0,01). Conclusiones: La medición de BVM <2 cm al ingreso en pacientes con RPO ≤24 semanas, es un factor de mal pronóstico y debe ser considerado en el manejo clínico de estas pacientes.(AU)

Introduction: Previable premature rupture of membranes (pPROM) is a low-incidence obstetric complication associated with high perinatal morbidity and mortality. Studies suggest that the volume of amniotic fluid (AL) is an important factor to consider. The aim of this study is to evaluate if in RPO ≤24 weeks, a maximum vertical pocket (MVP) <2 cm to the diagnostic is a risk factor for fetal and neonatal morbidity and mortality. Objectives: Evaluate fetal and neonatal morbidity and mortality according to amniotic fluid (AL) Maximum Vertical Pocket (MVP) ≥ or

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El desprendimiento crónico de placenta se caracteriza por la aparición de un sangrado venoso crónico intra o retroplacentario que produce la separación paulatina de la misma. Es poco frecuente y se puede presentar en pacientes sin factores de riesgo. La imagen ecográfica plantea diagnóstico diferencial con la corioamnionitis. El pronóstico fetal es malo especialmente si se asocia con oligoamnios. Se presentan cuatro casos caracterizados por imagen ecográfica característica, retraso del crecimiento fetal, alteración del Doppler, y confirmación anatomopatológica.

Chronic placental abruption is due to intra or retroplacental insidious bleeding that causes progressive separation from the uterine wall. It is a rare condition and can occur in low risk patients. Chronic abruption imaging poses differential diagnosis with infectious TORCH chorioamnionitis. Fetal prognosis is ominous especially in the presence of oligohydramnios. We present four cases with a common ultrasound appearance, fetal growth restriction, Doppler abnormalities and pathological confirmation.

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Abstract Purpose The amniotic fluid volume (AFV) is known as a predictor for the wellness of a fetus. We aimed to investigate whether N-terminal pro-brain natriuretic peptide (NTproBNP) levels reflect AFV abnormalities in otherwise normal fetuses. Methods We recruited 24 women with isolated oligohydramnios, 23 women with isolated polyhydramnios, and 36 women with normal AFV at a tertiary referral center. NT-proBNP levels in umbilical venous samples and the individual characteristics of the three groups were compared. One-way ANOVA and Kruskal-Wallis analysis of variance were used for multi-group comparisons of continuous variables. When a significant difference was detected, the Scheffe test was performed as a post-hoc analysis. Proportions were compared using the Chi-square (2) test. Results Maternal age, body mass indices, weight gained in pregnancy and NT-proBNP levels were similar among the three groups. Apgar scores at 1 and 5 minutes significantly correlated with NT-proBNP levels in all newborns (Spearman's r = 0.23 ; p = 0.03 and Spearman's r = 0.24; p = 0.02, respectively). The umbilical venous NTproBNP levels did not differ between newborns who needed mechanical ventilation and those who didn't (p = 0.595). Conclusions NT-proBNP is a biomolecule that may provide insights into the pathogenesis of fetal circulatory problems and subsequent renal failure. Further investigations are warranted.

Resumo Objetivo Investigar se os níveis de peptídeo natriurético pró-cerebral N-terminal (NTproBNP) refletem anormalidades no volume de líquido amniótico (VLA) em fetos normais. Métodos Reunimos 24 mulheres com oligoidrâmnios isolados, 23 com poli-hidrâmnios isolados, e 36 com VLA normal em um centro de referência. Comparamos os níveis de NT-proBNP em amostras venosas umbilicais e características individuais em três grupos. Usamos análise de variância simples (One-way ANOVA) e a análise de variação Kruskal-Wallis para comparação de variáveis contínuas em múltiplos grupos. Quando identificada uma diferença significativa, o teste de Scheffe foi aplicado como uma análise post-hoc. Comparamos proporções usando o teste Qui-quadrado (2). Resultados Idade fértil, índice de massa corporal, ganho de peso na gestação e níveis de NT-proBNP foram similares nos três grupos. Apgar em 1 e 5 minutos correlacionaram significativamente com os níveis de NT-proBNP em todos os recém-nascidos (Spearman's r = 0,23; p = 0,03 e Spearman's r = 0,24; p = 0,02, respectivamente). Os níves de NT-proBNP venoso umbilical não se distinguiram entre os recém-nascidos que precisaram de ventilação mecânica e aqueles que não precisaram (p = 0,595). Conclusões NT-proBNP é um candidato biomolecular que pode contribuir na patogênese de problemas circulatórios fetais e subsequente insuficiência renal. São necessárias futuras investigações.

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Feto-fetal transfusion syndrome is a pathological process unique to diamniotic monochorionic pregnancies. It is the consequence of an unbalanced fetal blood flow through communicating vessels within a shared placenta. When it occurs, a polyuric, hypervolemic recipient twin co-exists with a hypovolemic oliguric donor. The presence of polyhydramnios or oligohydramnios is considered a poor prognostic indicator, whereas normal amniotic fluid volumes indicate a lack of clinically significant twintwin transfusion. In addition, the spontaneous normalization of amniotic fluid volume is usually seen as a favorable prognostic sign. Here, however, we present a case of feto-fetal transfusion in a 31 year-old primigravida at 19 week, in which the spontaneous normalization of amniotic fluid volume in the recipient twin preceded the death of the donor.

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Introducción: el síndrome de transfusión feto fetal es una complicación mayor presente en el 10 a 15% de los embarazos monocorialesbiamnióticos, se conoce que parte de su fisiopatología corresponde a la presencia de anastomosis placentarias entre los dos fetos que conllevan a presentar una clínica aguda y de urgente intervención en presencia de anemia, restricción de crecimiento intrauterino, oliguria y oligohidramnios en el gemelo donante, mientras que el receptor se torna pletórico, poliúrico, presentando cardiomegalia, falla cardiaca congestiva y polihidramnios. Objetivo: presentar una revisión de tema acerca del síndrome de transfusión feto fetal, características clínicas, complicaciones y su tratamiento. Metodología: se utilizaron bases de datos como Pubmed y ScienceDirect para la búsqueda de la información, encontrándose 186 artículos de los cuales 41 fueron seleccionados según los criterios de inclusión. Resultados: se encontraron 41 artículos con información actualizada, se revisó su fisiopatología, clasificación y tratamiento, destacando el papel del sistema renina angiotensina aldosterona, la presencia de anastomosis placentarias, la implicación de los niveles de vasopresina y su actual tratamiento. Conclusiones: el síndrome de trasfusión feto fetal es una de las más severas complicaciones de las gestaciones monocoriales-biamnióticas con una alta tasa de morbimortalidad fetal y perinatal. Su patología es causada por desbalance de flujos entre las anastomosis placentarias, alteraciones en el eje renina angiotensina aldosterona, cambios en los niveles de vasopresina, entre otros factores. El tratamiento actual es la terapia de ablación láser de las anastomosis placentarias, con una sobrevida del 70% y una disminución de secuelas neurológicas. Se reitera la importancia de conocer esta patología para realizar un diagnóstico asertivo y un tratamiento inmediato, invitándose a investigarla.

Introduction: twin twin transfusion syndrome is one further complication in the 10-15% of all monochorionic-biamniotic pregnancies, it is known that part of its pathophysiology corresponds to the presence of placental anastomosis between two fetuses that lead to present an acute clinic and urgent intervention for anemia, restriction of intrauterine growth, oliguria and olgohydramnios in the donor twin, while the receiver becomes plethoric, polyuric, cardiomegaly, congestive heart failure and polyhydramnios appear. Objective: present a review about twin-twin transfusion syndrome, clinical features, complications and its treatment. Methodology: databases such as Pubmed and ScienceDirect were used to search for the information. Results: we found 41 articles with updated information, reviewing its pathophysiology, classification and treatment, highlighting the role of the renin angiotensin aldosterone system, the presence of placental anastomosis, the involvement of vasopressin levels and its present treatment. Conclusions: twin-twin transfusion syndrome is one of the most severe complications of the monochorionic-biamniotic pregnancies with a high rate of fetal and perinatal morbidity and mortality. It’s pathology is caused due to imbalance of flows between placental anastomoses, alterations in the axis renin angiotensin aldosterone, changes in the levels of vasopressin, among other factors. The current treatment is the therapy of laser ablation of placental anastomoses with a survival of 70% and a decrease of neurologic sequelae. We reiterate the importance of understanding this disease to make an assertive diagnosis and immediate treatment, inviting you to investigate it.

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BACKGROUND: Oligohydramnios is sometimes associated with poor perinatal outcome. Our aim was to determine the association of Doppler flowmetry with perinatal outcome in patients with oligohydramnios. METHODS: We carried out a prospective cross-sectional study that included 130 patients with pregnancy between 30 to 41 weeks of gestation; we compared the measurement of the resistance index in the umbilical artery by Doppler flowmetry and the measurement of amniotic fluid in patients with oligohydramnios. A follow-up of patients after birth was made, recording the Apgar score and whether they required special attention. The data were analyzed using descriptive statistics and we calculated the sensitivity, specificity, accuracy, and predictive values of the tests. RESULTS: Sensitivity, specificity and accuracy were obtained for oligohydramnios associated to perinatal death and for five-minute Apgar, with results of 100, 0, 50 % and 0, 0, 0 % respectively. The resistance index of umbilical artery related to perinatal death had sensitivity, specificity and accuracy of 100, 96 and 98 %, while in the Apgar were 0, 95 and 47.5 %, respectively. CONCLUSIONS: Doppler flowmetry of the umbilical artery showed a higher sensitivity, specificity and accuracy to diagnose perinatal death than the measurement of oligohydramnios and the Apgar score.

Introducción: el oligohidramnios en ocasiones se asocia a mala evolución perinatal. El objetivo fue determinar la asociación de la flujometría Doppler con la evolución perinatal en pacientes con oligohidramnios. Métodos: se realizó un estudio transversal en el que se analizaron 130 pacientes con embarazo de 30 a 41 semanas con oligohidramnios; se comparó la medición del índice de resistencia de la arteria umbilical por flujometría Doppler y la medición del líquido amniótico. Se hizo un seguimiento postnatal en el que se registró el Apgar y si los pacientes ameritaron cuidados especiales. Se utilizó estadística descriptiva y se calculó la sensibilidad, especificidad, exactitud y los valores predictivos de las pruebas. Resultados: para el oligohidramnios en muerte perinatal se obtuvo sensibilidad, especificidad y exactitud de 100, 0 y 50 %; y para Apgar de 0, 0 y 0 %, respectivamente. El índice de resistencia de la arteria umbilical referente a la muerte perinatal tuvo sensibilidad, especificidad y exactitud de 100, 96 y 98 %, en tanto que en el Apgar los valores fueron de 0, 95 y 47.5 %, respectivamente. Conclusiones: la flujometría Doppler de la arteria umbilical mostró mayor sensibilidad, especificidad y exactitud que la medición del oligohidramnios y la prueba de Apgar para diagnosticar muerte perinatal.

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Fundamento: el oligohidramnios, es un diagnóstico que se incorporó al trabajo obstétrico en las últimas décadas, es causa importante de morbilidad fetal e incrementó el indicador de la operación cesárea, se sabe que el daño fetal será proporcional al tiempo de exposición del feto a las causas que lo provocan. Objetivo: determinar le repercusión del oligohidramnios en las embarazadas de riesgo. Método: se realizó un estudio descriptivo observacional prospectivo sobre el comportamiento del oligohidramnios, desde el año 2010 al 2012 en el Hospital Ginecobstétrico Docente Provincial Ana Betancourt de Mora de Camagüey. El universo estuvo constituido por las embarazadas diagnosticadas con oligohidramnios. Los datos se recolectaron por una encuesta acorde a los objetivos y propósitos de la investigación; los datos primarios se obtuvieron del libro de registro del departamento de imaginología y las historias clínicas. En el análisis estadístico se aplicó relación de variables y se realizó probabilidad estadística mediante el software Microsoft Word y Microsoft Excell para Windows 98. Resultados: por años aumentó el número de inducciones, prevaleció el parto eutócico con 2 454, de un total de 4 199 inducciones pero el parto distócico en este tipo de comienzo del parto fue de 1 745 para un 41, 5 %. La edad más frecuente fue entre 20 y 30 años, lo cual se corresponde con la edad con que paren con mayor incidencia las mujeres en el país, la cesárea primitiva fue la más frecuente en el estudio con 293 pacientes, la inducción como forma de comienzo del parto por ser portadoras de un oligohidramnios severo. Conclusiones: con los años se incrementó el número de inducciones por este diagnóstico, el oligohidramnios se presentó en la mayoría de las nulíparas, el tipo de parto que prevaleció fue el distócico por cesárea primitiva y el diagnóstico de mayor incidencia de estas, el estado fetal intranquilizante. En la morbilidad fetal se encontró el bajo peso al nacer, ya sea por prematuridad o por crecimiento intrauterino retardado.

Background: oligohydramnios, diagnosis added to the obstetric practice in the last decades, is an important cause of fetal mortality and has increased the indicator of Cesarean section. It is known that the fetal damage is proportional to the time of exposure of the fetus to the causes that provoke it. Objective: to determine the repercussions of the oligohydramnios in women with pregnancies of risk. Methods: a prospective, observational, descriptive study of the behaviour of the oligohydramnios was conducted from 2010 to 2012 at the Ana Betancourt de Mora Provincial Gynecological-Obstetric Teaching Hospital in Camagüey. The universe was composed of the pregnant women diagnosed with oligohydramnios. The data were collected by means of a survey, according to the objectives and purposes of the research; the primary data were obtained from the register of the Imagenology department and from the patients’ charts. In the statistical analysis a variables relation was applied and a statistical provability was found for which Microsoft Word and Microsoft Excell for Windows 98 were used. Results: over the years, the number of inductions increased and normal childbirths prevailed, being 2454 of a total of 4199 inductions. On the other hand, abnormal childbirths, in this type of beginning the labor, were 1745 for a 41, 5 %. The most frequent ages were between 20 and 30 years old, which tallies with the age that most women give birth with in the country. Classical Cesarean section was the most frequent in the study with 293 patients; induction was present as a way to start labor in women that presented severe oligohydramnios. Conclusions: over the years there was an increase of the number of inductions caused by this diagnosis. Oligohydramnios was present in most nulliparous women. The type of childbirth that prevailed was abnormal by classical Cesarean section. The diagnosis of greatest incidence was fetal distress. One of the causes of fetal mortality was low weight at birth, whether because of being born prematurely or because of intrauterine growth restriction.

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OBJETIVO: Determinar os desfechos maternos e perinatais em gestantes com o líquido amniótico diminuído segundo o índice de líquido amniótico (ILA). MÉTODOS: Realizou-se estudo de coorte com 176 pacientes admitidas na enfermaria de alto risco do Instituto de Medicina Integral Prof. Fernando Figueira (IMIP. O líquido amniótico foi mensurado pelo índice de líquido amniótico , sendo classificado como diminuído, quando entre 5,1 e 7,9 cm; oligohidrâmnio moderado, entre 3,1 e 5,0 cm; e grave, quando menor ou igual a 3,0 cm. Para se determinar a diferença entre os três grupos das variáveis categóricas estudadas, foram utilizados o teste de chi-quadrado e exato de Fisher, quando pertinentes, e, para as variáveis numéricas, utilizou-se o teste de Mann Whitney, em um nível de significância de 5%. RESULTADOS: As malformações fetais ocorreram mais frequentes quando o oligohidrâmnio foi grave, enquanto as síndromes hipertensivas foram associadas ao oligohidrâmnio moderado. Observou-se semelhança entre os três grupos em relação à rotura prematura das membranas e outras causas. O líquido amniótico reduzido foi encontrado com maior frequência quando a idade gestacional do diagnóstico foi ≥32ª semana. Em relação aos desfechos perinatais, a incidência de índice de Apgar <7 no 1ºe 5ºminuto do óbito perinatal, da icterícia neonatal e da hipoplasia pulmonar foi mais elevada na presença do oligohidrâmnio moderado a grave. CONCLUSÕES: As causas e os desfechos maternos e perinatais em gestantes com líquido amniótico reduzido varia em relação a sua classificação pelo ILA, estando o oligohidrâmnio grave associado aos desfechos perinatais adversos e às malformações fetais.

PURPOSE: To determine maternal and perinatal outcomes in pregnant women with low amniotic fluid, according to the amniotic fluid index (AFI). METHODS: A cohort study conducted on 176 patients admitted to the high risk ward of Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), in Recife, Pernambuco, Brazil. Amniotic fluid was measured by the amniotic fluid index, and classified as low when between 5.1 and 7.9 cm, moderate oligohydramnios between 3.1 and 5.0 cm, and severe oligohydramnios when less than or equal to 3.0 cm. To determine the difference between the three groups of categorical variables studied the chi-square and Fisher exact tests were used, when applicable, and for the numerical variables the Mann-Whitney test was applied, with the level of significance set at 5%. RESULTS: Fetal malformation more frequently occurred when oligohydramnios was severe. Hypertensive disorders, however, were associated with moderate oligohydramnios. There was similarity between the three groups in relation to premature rupture of membranes and other causes. Low amniotic fluid was more frequently diagnosed when tested at the gestational age of 32 weeks or earlier. Regarding the perinatal outcomes, the incidence of Apgar score <7 in the 1st and 5th minutes, perinatal death, neonatal jaundice and pulmonary hypoplasia was higher when oligohydramnios was moderate to severe. CONCLUSIONS: Maternal and perinatal causes and outcomes in pregnant women with low amniotic fluid vary with respect to their AFI, severe oligohydramnios being associated with fetal malformation and other adverse perinatal outcomes.

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OBJETIVO: Avaliar o desempenho de uma curva de altura uterina (AU) quanto à capacidade de rastrear desvios do volume de líquido amniótico, utilizando uma curva brasileira de índice de líquido amniótico (ILA) como padrão-ouro. MÉTODOS: O presente estudo representa um corte transversal no qual foram incluídas 753 gestantes em acompanhamento pré-natal na rede pública de João Pessoa (PB) no período de março a outubro de 2006 e que tiveram um exame de ultrassonografia (US) de rotina agendado para depois da 26ª semana de idade gestacional. Foram excluídos os casos com diagnóstico de gestação gemelar, óbito fetal intrauterino e malformações fetais maiores. Além de informações sociodemográficas, foram coletados também os valores da AU medida de forma padronizada, os valores do peso fetal estimado, do ILA e a idade gestacional pelo exame de US. A capacidade da curva de AU em predizer os desvios do volume de líquido amniótico foi avaliada tendo uma curva brasileira de ILA em função da idade gestacional como padrão-ouro. Para isso, foram estimados a sensibilidade, especificidade e valores preditivos positivo e negativo para diferentes pontos de corte. RESULTADOS: A medida da AU identificou 10,5% das mulheres como AU baixa e possivelmente associada ao oligoâmnio, e 25,2% como AU alta e possivelmente associada ao polidrâmnio. Utilizando uma curva brasileira de referência para ILA, a AU foi capaz de predizer pobremente a ocorrência de oligoâmnio (sensibilidade variando entre 37 a 28%) e de forma razoável a ocorrência de polidrâmnio (sensibilidade variando entre 88 a 69%). CONCLUSÃO: A medida da altura uterina mostrou um desempenho ruim para predizer oligoâmnio e um desempenho razoável para predizer polidrâmnio. Sua utilização para essa finalidade só se justifica, portanto, em situações nas quais o exame ultrassonográfico não esteja fácil e rotineiramente disponível, a fim de ajudar na priorização dos casos que deveriam ter esse exame realizado.

PURPOSE: To evaluate the performance of a Brazilian reference curve of fundal height (FH) regarding its capacity of screening the deviations of volume of amniotic fluid using a Brazilian reference curve of amniotic fluid index (AFI) as gold standard. METHODS: This was a cross-sectional study evaluating 753 pregnant women receiving prenatal care at the public health services of João Pessoa (PB), from March to October 2006, who had a routine ultrasound exam scheduled for after 26 weeks of gestational age. Cases with diagnoses of twin pregnancy, intrauterine fetal death and major fetal malformations were excluded. Besides socio-demographic information, data regarding fundal height measured in a standard way, estimated fetal weight, AFI and gestational age at the time of the ultrasound exam were also collected. The capacity of the FH curve to predict deviations of the amniotic fluid volume was assessed using the Brazilian curve of AFI according to gestational age as the gold standard. For this purpose, sensitivity, specificity, positive and negative predictive values were estimated for different cut-off points. RESULTS: The measurement of FH identified 10.5% of women as having low FH possibly associated with oligohydramnios and 25.2% as having high FH possibly associated with polyhydramnios. Using a Brazilian reference curve of AFI, the FH was able to poorly predict the occurrence of oligohydramnios (sensitivity ranging from 37 to 28%) and to reasonably predict the occurrence of polyhydramnios (sensitivity ranging from 88 to 69%). CONCLUSIONS: The measurement of fundal height showed a poor performance for predicting oligohydramnios and a reasonable performance for predicting polyhydramnios. Its use for this purpose is then only supported in settings where the ultrasound exam is not easily or routinely available in order to help define priorities for cases that should have this exam performed.

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Introducción: el diagnóstico de corioamnionitis se basa en criterios clínicos que no alcanzan una sensibilidad mayor al 60%, y que tienen poca utilidad para predecir el compromiso fetal. El ultrasonido surge como una alternativa útil en el diagnóstico. Al mejorar el diagnóstico con la búsqueda de marcadores ecográficos de infección fetal podemos impactar en la morbimortalidad perinatal al poder intervenir de forma temprana a las gestantes en riesgo de compromiso fetal, especialmente corioamnionitis con curso subclínico. El objetivo de esta revisión es conocer la evidencia que soporta la asociación entre los hallazgos ecográficos del ultrasonido y la presencia de corioamnionitis e infección fetal in utero. Materiales y métodos: se realizó una revisión de la literatura existente en las bases de datos medline, ovid, ebsco, ProQuest, lilacs, SciELO desde enero de 1985 hasta octubre de 2012. Se incluyeron los artículos de revisión e investigaciones originales.Resultados: en las gestantes con parto pretérmino y ruptura prematura de membranas ovulares el acortamiento cervical, la presencia de "sludge", el oligohidramnios y la involución del timo son los marcadores que han mostrado mayor asociación con infección amniótica.Conclusiones: el ultrasonido es una herramienta por considerar en el diagnóstico de infección materna y fetal in utero.

Introduction: A diagnosis of chorioamnionitis is based on clinical criteria which only manage 60% sensitivity and have little usefulness in predicting fetal compromise. Ultrasound emerges as a useful diagnostic alternative. An impact might be made on perinatal morbimortality by improving diagnosis through the search for echographic markers of fetal infection, thereby enabling early intervention in pregnant women at risk of fetal compromise, especially regarding subclinical chorioamnionitis. This review was aimed at providing evidence supporting an association between ultrasound’s echographic findings and the presence of chorioamnionitis in in utero (congenital) fetal infection.Materials and methods: A review of the existing literature was made in medline, ovid, ebsco, ProQuest, lilacs and scielo databases from January 1985 to October 2012. Original research and review articles were included. Results: Cervical length shortening, the presence of sludge, oligohydramnios and thymus involution are the markers which have been shown to have the greatest association with intra-amniotic infection.Conclusions: Ultrasound is a tool to be considered when diagnosing in utero maternal and fetal infection.

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Renal tubular dysgenesis (RTD) is a rare, lethal, autosomal recessive disorder characterized by non-differentiation of the renal proximal convoluted tubules, resulting in oligohydramnios. It is usually diagnosed in the second trimester of pregnancy, following the oligohydramnios sequence, pulmonary hypoplasia and hypocalvaria. The prognosis is poor, and death usually occurs in utero or within the first few days of life. The pathogenesis of RTD is associated with the perinatal use of drugs, such as angiotensin- converting enzyme inhibitors, angiotensin II receptor antagonists, and anti- inflammatory drugs, as well as with fetal transfusion syndrome, genetic mutations in the pathway of the renin-angiotensin system pathway, cocaine snorting, or other pathological mechanisms that reduce renal blood flow. Here, we report the autopsy of a neonate born to consanguineous parents at 38 weeks of gestation, with RTD, decreased amniotic fluid, oligohydramnios sequence, hypocalvaria, pulmonary hypoplasia, and ileocecal valve agenesis. To our knowledge, the latter has never been reported associated with RTD.

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El hallazgo de riñones fetales hiperecogénicos es un problema de gran preocupación médica y de ansiedad familiar, porque casi siempre traduce una enfermedad renal importante. Cuando la hiperecogenicidad se acompaña de oligohidramnios, la mayoría de las veces estamos enfrentando una enfermedad poliquística; cuando no existe oligohidramnios, el diagnóstico probable es difícil. El objetivo de este reporte es la presentación de un niño con enfermedad poliquística autosómico recesiva. En los exámenes realizados a la madre, durante el embarazo, se encontró hiperecogenia renal y oligohidramnios. Se describe la evolución clínica, ultrasonográfica y gammagráfica de su enfermedad. Se revisa brevemente la literatura con relación al tema(AU)

The finding of hyperechogenic fetal kidneys is a problem of a great medical concern and of family anxiety, because of almost always it expresses an important renal disease. When hyper-echogenicity is accompanied by oligohydramnios, usually we are facing a polycystic disease; where there are not oligohydramnios the potential diagnosis is difficult. The objective of present paper is the presentation of a child presenting with recessive autosomal polycystic disease. En examinations performed in the mother during pregnancy, it was found a renal hyperechogeny and oligohydramnios. The clinical evolution, ultrasonography and scintigraphy of its disease is described and a brief review of literature in relation to thus subject is reviewed(AU)

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El hallazgo de riñones fetales hiperecogénicos es un problema de gran preocupación médica y de ansiedad familiar, porque casi siempre traduce una enfermedad renal importante. Cuando la hiperecogenicidad se acompaña de oligohidramnios, la mayoría de las veces estamos enfrentando una enfermedad poliquística; cuando no existe oligohidramnios, el diagnóstico probable es difícil. El objetivo de este reporte es la presentación de un niño con enfermedad poliquística autosómico recesiva. En los exámenes realizados a la madre, durante el embarazo, se encontró hiperecogenia renal y oligohidramnios. Se describe la evolución clínica, ultrasonográfica y gammagráfica de su enfermedad. Se revisa brevemente la literatura con relación al tema

The finding of hyperechogenic fetal kidneys is a problem of a great medical concern and of family anxiety, because of almost always it expresses an important renal disease. When hyper-echogenicity is accompanied by oligohydramnios, usually we are facing a polycystic disease; where there are not oligohydramnios the potential diagnosis is difficult. The objective of present paper is the presentation of a child presenting with recessive autosomal polycystic disease. En examinations performed in the mother during pregnancy, it was found a renal hyperechogeny and oligohydramnios. The clinical evolution, ultrasonography and scintigraphy of its disease is described and a brief review of literature in relation to thus subject is reviewed