RESUMEN
RESUMO O anquiloblefáro filiforme congênito é uma rara anomalia congênita, caracterizada por uma fusão palpebral, parcial ou completa, cuja incidência é de 4,4 por 100 mil recém-nascidos. Normalmente, o anquiloblefáro filiforme congênito constitui uma malformação solitária, de ocorrência esporádica, no entanto, pode estar associado a outras malformações. O pediatra possui papel imprescindível para observar as alterações clínicas do recém-nascido e dar orientação para o tratamento adequado. O objetivo deste estudo foi relatar o caso de recém-nascido de termo que teve diagnóstico precoce de anquiloblefáro filiforme congênito associado a outras malformações congênitas, tendo desfeito as aderências em procedimento cirúrgico oportuno, evitando-se a evolução para futuras complicações visuais do paciente.
ABSTRACT Ankyloblepharon filiforme adnatum is a rare congenital anomaly, characterized by partial or complete palpebral fusion, with an incidence of 4.4 per 100,000 newborns. Normally, ankyloblepharon filiforme adnatum constitutes a solitary malformation, with sporadic occurrence, however, it can be associated with other malformations. Pediatricians play an essential role in observing clinical changes in newborns and providing guidance on appropriate treatment. The this study aims to report the case of a full-term newborn who had an early diagnosis of ankyloblepharon filiforme adnatum associated with other congenital malformations.
Asunto(s)
Humanos , Femenino , Recién Nacido , Anomalías del Ojo/cirugía , Anomalías del Ojo/diagnóstico , Párpados/anomalías , Párpados/cirugía , Anomalías Congénitas/diagnóstico por imagen , Cesárea , Adherencias Tisulares , Ultrasonografía Prenatal , Labio Leporino , Fisura del Paladar , Sufrimiento Fetal/diagnóstico por imagenRESUMEN
Background: Diagnostic ultrasound has revolutionized obstetric practice. Doppler techniques provided in vivo studies of the fetus-placental and uterus-placental circulations, in an increasingly precise manner. The assessment of fetal well-being is essential in obstetric practice, however, in veterinary medicine, there is a deficit of ultrasound parameters related to fetal distress. The main of this research was to determine the hemodynamic characteristics and behavior, through Doppler ultrasonography, of maternal-fetal vessels during the final third of gestation in bitches with fetuses under stress, as well as correlating them with each other and with fetal distress. Materials, Methods & Results: An observational, prospective study was carried out, in which 30 healthy bitches were examined, during the last third of pregnancy, with fetuses under fetal distress. Fetuses were evaluated in 2 stages: (1st): 50-54 days and (2nd): 55-60 days of gestation. All fetuses were calmly assessed, one by one, and fetal heart rate (FHR) was measured 5 times, for at least 3 min, to identify and confirm fetal distress. At least 3 fetuses were evaluated in each bitch and each measurement was performed in triplicate, setting a hemodynamic mean for each value evaluated. The flow pattern in the middle cerebral artery (MCA), internal carotid artery (ICA) and umbilical artery (UA) was evaluated. The analyzed vessel was initially visualized in B mode, followed by evaluation by color and spectral Doppler. The variables observed were: peak systolic velocity (PSV), end diastolic velocity (EDV) and the resistivity (RI) and pulsatility (PI) index, as well as the systole/diastole ratio (S/D). The analysis of RI and PI of the umbilical artery showed a statistically significant difference between the mean values found for the times studied, increasing from time 1 to time 2. For middle cerebral and internal carotid arteries, PI, RI and the relationship systole/diastole (S/D), showed a statistically significant difference between the mean values found for the times studied, decreasing from time 1 to time 2. Discussion: Fetal heart rate (HR) findings are considered normal above 200 beats per minute (bpm), only if preceded by acceleration and deceleration. This fact confirms the presence of fetal stress, by this parameter, for the fetuses in the present study. Corroborating the picture of fetal distress, another study concluded that HR tends to increase up to 20 days before delivery, a fact that did not occur in the study in question, where animals in the same gestational period were evaluated. Recent research has concluded that an elevated umbilical artery PI at 28 weeks of gestation, in the absence of fetal growth restriction or prematurity, is associated with some adverse cognitive findings in 12-year-olds children. In the present study, a progressive increase in this index was observed throughout the final third of pregnancy. Although the pups were not monitored after birth, this data serves as a warning for veterinarians, and can be useful in the assessment and diagnosis of possible postnatal nervous alterations. Like what was found in the present study, a study reported that from the 4th week to birth, the PSV of the umbilical artery (UA) increased almost linearly, with high significance. For the middle cerebral arteries, the PI showed a statistically significant difference between the mean values found for the times studied, however, decreasing throughout the final third of pregnancy.
Asunto(s)
Animales , Femenino , Embarazo , Perros , Sufrimiento Fetal/veterinaria , Sufrimiento Fetal/diagnóstico por imagen , Monitorización Hemodinámica/veterinaria , Intercambio Materno-Fetal/fisiología , Ultrasonografía Doppler/veterinariaRESUMEN
The detection of fetal pathology is important for the care of puppies in the postnatal period. The objective of this study was to identify parameters of fetal distress by determining fetal heart rate and bowel movements, and also to detect early pathology by means of fetal biometry, which involves determination of the biparietal and abdominal diameters. Ultrasonographic examinations were carried out on 30 pregnant bitches of different breeds and ages at least three times, including examination at days 40-47, days 48-57, and days 58-62 after coitus, and subsequently every 12-14 h for 3 days before parturition. Fetuses that had biparietal:abdominal diameter ratios of < 2 at the second and third series of ultrasonography, or after birth were considered to have intrauterine growth retardation. The average weight of each litter was calculated and puppies that weighed < 20% of the average weight were also considered to have experienced intrauterine growth retardation. Intrauterine growth retardation occurred in 39.6% of the bitches studied. Fetuses were considered to be normal when heart rate, determined by a Doppler flowmeter was > 220 beats min-1; suffering from slight fetal distress when heart rate was between 180 and 220 beats min-1; suffering from severe fetal distress when heart rate was < 180 beats min-1. Some level of distress was observed in 33.0% of puppies. In 86.7% of bitches, bowel movements were observed in at least one puppy, and appeared to be correlated with fetal distress. Bowel movements were observed in all of the puppies that had severe fetal distress (heart rate < 180 beats min-1), whereas bowel movements were observed in only 40.0% of puppies with slight fetal distress (heart rate 180-200 beats min-1). In conclusion, ultrasonographic evaluation allowed identification of fetuses with intrauterine growth retardation, and bowel movements were a reliable indicator of fetal distress; these conditions are presumed to indicate a greater perinatal risk.
Asunto(s)
Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/embriología , Enfermedades Fetales/diagnóstico por imagen , Enfermedades Fetales/veterinaria , Ultrasonografía Prenatal/veterinaria , Animales , Biometría , Perros , Sufrimiento Fetal/diagnóstico por imagen , Sufrimiento Fetal/veterinaria , Retardo del Crecimiento Fetal/diagnóstico por imagen , Retardo del Crecimiento Fetal/veterinaria , Frecuencia Cardíaca Fetal , Intestinos/diagnóstico por imagen , Flujometría por Láser-DopplerRESUMEN
In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.