RESUMO
Resumen Objetivo Describir las anomalías asociadas y las repercusiones perinatales de la persistencia de la vena cava superior izquierda en el feto y revisar la bibliografía. Materiales y métodos Estudio descriptivo, transversal y retrospectivo efectuado de enero de 2009 a diciembre 2012 en la Unidad de Diagnóstico Prenatal del Departamento de Obstetricia y Ginecología del Hospital Universitario Miguel Servet de Zaragoza, España. El estudio incluyó a todos los fetos con diagnóstico prenatal de persistencia de la vena cava superior izquierda establecido durante los controles gestacionales ecográficos. Resultados Se diagnosticaron 21 casos de persistencia de la vena cava superior izquierda entre las 20 y 35 semanas de embarazo. El 29% de los casos se detectó en la ecografía de las 20 semanas; 9 casos (43%) tuvieron anomalías cardiacas o extracardiacas asociadas y en 2 casos (10%) se encontró, además, trisomía 21, ambos con anomalías cardiacas asociadas. En 4 casos (19%) no hubo vena cava superior derecha. En los casos aislados la evolución fue favorable. Conclusiones Puesto que la persistencia de la vena cava superior izquierda se asocia, frecuentemente, con anomalías cardiacas y extracardiacas está justificada la ecografía morfológica fetal detallada y una ecocardiografía con posterior seguimiento antenatal. Si es aislada, la evolución obstétrica y el pronóstico perinatal serán favorables, como ha sucedido en los casos de persistencia de la vena cava superior izquierda aislados, con ausencia de vena cava superior derecha.
Abstract Objective To describe the associated anomalies and perinatal results in fetuses diagnosed with persistence of the left superior vena cava and to conduct a review of the literature. Materials and methods A descriptive, cross-sectional, retrospective study conducted between January 2009 and December 2012 in the Prenatal Diagnostic Unit of the Obstetrics and Gynecology Department at the Miguel Servet University Hospital in Zaragoza, Spain. The study included all fetuses with prenatal diagnosis of persistence of the left superior vena cava performed during gestational ultrasound controls in that period. Results 21 cases of persistence of the left superior vena cava were diagnosed between 20 and 35 weeks. Only 29% of the cases were detected on ultrasound at 20 weeks. 9 cases (43%) had associated cardiac or extracardiac anomalies and two cases (10%) associated trisomy 21, both with associated cardiac anomalies. In 4 cases (19%) there was an absence of right superior vena cava. In isolated cases, the evolution was favorable. Conclusions The presence of persistence of the left superior vena cava is frequently associated with cardiac and extracardiac abnormalities, so in the case of diagnosis, detailed fetal morphological ultrasound and echocardiogram are justified with subsequent antenatal follow-up. In the case of being isolated, it has an obstetric evolution and a favorable perinatal prognosis, results that were also presented in isolated persistence of the left superior vena cava cases with absence of right superior vena cava.
RESUMO
La anomalía más frecuente de la vena cava inferior es su interrupción. En estos casos, el drenaje al corazón se realizará por la vena ácigos y menos frecuentemente por la vena hemiácigos. Se considera un marcador ecográfico prenatal de isomerismos y/o cardiopatías por lo que su hallazgo obliga a descartarlos realizando una ecografía detallada del corazón y del situs fetal. Además, probablemente sea de las anomalías venosas que más implicaciones clínicas pueden tener en la edad adulta por su asociación a trombosis venosa profunda y es útil conocer la anatomía para posibles futuros procedimientos quirúrgicos o cateterismos cardiacos. Por lo tanto, es interesante realizar el diagnóstico prenatal, aunque se presente de forma aislada, siendo su diagnóstico ecográfico sencillo si somos sistemáticos en la práctica de la ecografía morfológica. El signo característico ecográfico es el de «doble vaso¼ o «doble burbuja¼ en un corte axial abdominal o torácico. Presentamos los esquemas ecográficos de diagnóstico de los dos tipos de drenaje principales de la interrupción de la vena cava inferior para poder realizar el correcto diagnóstico prenatal. Para ello tomamos de referencia dos casos clínicos que no presentan cardiopatías ni isomerismos asociados.
The most frequent anomaly of the inferior vena cava is its interruption. In these cases, drains into the heart by the azygos vein and less frequently by the hemiazygos vein. It is considered a prenatal ultrasound marker of isomerisms and/or heart disease, therefore, its finding requires to discard them by performing a detailed ultrasound of the fetal heart and situs. Probably it is one of the venous anomalies with more clinical implications in adulthood due to their association with deep venous thrombosis, and it is useful to know the anatomy for possible future surgical or cardiac catheterization procedures. Therefore, it is interesting to perform the prenatal diagnosis, although isolated. In this sense, the ultrasound diagnosis of the interruption is simple if we are systematic in the practice of morphological ultrasound. The characteristic ultrasound sign of the aforementioned interruption is the "double vessel" or "double bubble" in an axial abdominal or thoracic section. We present the ultrasound diagnosis diagrams of the two main types of drainage of the inferior vena cava interruption in order to perform the correct prenatal diagnosis. For these purposes, we refer two cases with no heart diseases or isomerisms associated.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Veia Cava Inferior/anormalidades , Veia Cava Inferior/diagnóstico por imagem , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: To evaluate the success rate and reliability of fetal sex determination in first trimester between 11-13+ 6 weeks and make a comparative study with other studies. MATERIAL AND METHODS: A cohort study was performed. 2314 first trimester pregnancy ultrasounds were examined. For fetal sex estimation, the method of a sagittal section and the relation between the angle formed by the genital tubercle and spinal column was used. RESULTS: Diagnosis of fetal sex was issued in 1986 cases with 90.1% success rate. In 328 cases (14.2%) no gender assignment was achieved. A directly proportional relationship between success rate in fetal sex diagnosis and crown-rump length (CRL) (p < 0.001) was described; with CRL over 65 mm, the prediction of fetal sex is above 95% and from 77 mm is close to 100%. With CRL < 51 mm, the success rate is less than 80% in both sexes. CONCLUSION: The simplest and best performing technique is the relation between the angle formed by the genital tubercle and spinal column. Success rate below 60 mm is less than 90% overall, so it would have to be wary of establishing the fetal sex, especially if it involves a decision as to avoid an invasive test.
Assuntos
Análise para Determinação do Sexo/métodos , Ultrassonografia Pré-Natal , Estudos de Coortes , Feminino , Humanos , Masculino , Gravidez , Primeiro Trimestre da Gravidez , Estudos ProspectivosRESUMO
We report the case of a 22-year-old primiparous, admitted to our hospital with a 2-week history of vulvar edema that had evolved within 24 hours to the point of stopping urine flow and hindering ambulation. The only remarkable finding in relation with the edema was hypoalbuminemia for no apparent cause. The correction of hypoalbuminemia and the establishment of diuretic treatment, with the drainage of the edema allowed for a complete resolution of the edema.
Assuntos
Edema/etiologia , Hipoalbuminemia/complicações , Complicações na Gravidez , Doenças da Vulva/etiologia , Albuminas/administração & dosagem , Albuminas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Anticoagulantes/uso terapêutico , Cesárea , Edema/tratamento farmacológico , Enoxaparina/uso terapêutico , Exsudatos e Transudatos , Feminino , Ruptura Prematura de Membranas Fetais , Furosemida/uso terapêutico , Humanos , Hipoalbuminemia/tratamento farmacológico , Hipoproteinemia/complicações , Infusões Intravenosas , Limitação da Mobilidade , Prednisona/uso terapêutico , Gravidez , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Transtornos Urinários/etiologia , Doenças da Vulva/tratamento farmacológico , Adulto JovemRESUMO
Split hand-foot malformation is a rare disorder inherited in an autosomal dominant pattern with variable expression. Inour case, it was detected early by ultrasound in the twelfth week of gestation. The sonographic findings were bilateral split hands and feet. No other alterations were observed in the rest of the systematic assessment of the foetal anatomy. The pathological findings were consistent with the sonographic diagnosis. Prenatal diagnosis by corionic villus sampling was performed and voluntary termination of gestation decided.
Assuntos
Deformidades Congênitas dos Membros/diagnóstico por imagem , Ultrassonografia Pré-Natal , Feminino , Idade Gestacional , Humanos , Gravidez , Primeiro Trimestre da GravidezRESUMO
BACKGROUND: Right aortic arch is the most common abnormality of the aortic arch, excluding aberrant right subclavian artery. Its importance lies in its association with genetic syndromes, another important congenital heart defects, and that may cause clinical symptons from vascular rings. OBJECTIVE: Was to describe the prenatal clinical presentation, the correlation with postnatal findings and postnatal development of the fetus. METHODS: Observational retrospective analysis of 18 cases of right aortic arch diagnosed prenatally between the years 2005-2011. RESULTS: 5 pregnancies were interrupted because of ultrasound findings associated with poor prognosis. In 13 cases were term infants, with a good correlation between prenatal and postnatal findings, and the prognosis was excellent in cases in which the prenatal diagnosis of right aortic arch was isolated. CONCLUSIONS: In our experience, right aortic arch is a rare condition, but it can be associated with important congenital heart defects (heart disease or vascular rings) and/or other morphological anomalies in the fetus, in which case it should be ruled out chromosomal or genetic syndrome. If prenatally is considered an isolated finding, after careful ultrasound assessment by obstetricians and pediatric cardiologists, it is likely that evolution will be favorable postnatally.
Assuntos
Síndromes do Arco Aórtico/diagnóstico por imagem , Resultado da Gravidez , Ultrassonografia Pré-Natal/métodos , Adulto , Síndromes do Arco Aórtico/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Prognóstico , Estudos Retrospectivos , Adulto JovemRESUMO
La catarata congénita (CC) es una patología poco frecuente en nuestro medio frente a los países en desarrollo donde constituye la etiología más frecuente de ceguera infantil. La prevención de deterioro visual debido a esta patología es parte del programa de la OMS cuyo objetivo es la eliminación de ceguera evitable en el año 2020. Presentamos el caso de una gestante en la que el diagnóstico prenatal se realizó en la ecografía morfológica. Si somos capaces de realizar este diagnóstico podremos evitar el deterioro precoz de la función visual del recién nacido. Así, la identificación de ambos cristalinos debe de formar parte de las estructuras a reconocer de forma obligada en la ecografía morfológica.
Congenital cataract is a rare disease in our environment opposite developing countries where it is the most frequent etiology of childhood blindness. Prevention of visual impairment due to this pathology is a part of the WHO programme whose objective is the elimination of avoidable blindness by the year 2020. We present the case of a pregnant woman that prenatal diagnosis was made on mid- trimester ultrasound. If we are able to perform this diagnosis, we will be able to prevent early deterioration of visual function of the newborn. Thus, identification of both crystalline should be part of the structures to recognize in the mid- trimester ultrasound.
Assuntos
Humanos , Adulto , Feminino , Gravidez , Catarata/congênito , Catarata , Ultrassonografia Pré-Natal , Diagnóstico DiferencialRESUMO
La rotura espontánea en útero bicorne gestante es un accidente poco frecuente y difícil de diagnosticar. La prevalencia de malformaciones uterinas congénitas entre las mujeres fértiles está documentada entre 1-2 por ciento de la población; de éstas, el útero bicorne varía entre un 25 a 37 por ciento. Generalmente la rotura de la pared uterina sucede en el segundo trimestre, presentándose como intenso dolor abdominal a consecuencia de la hemorragia intraperitoneal. Presentamos caso clínico de una paciente gestante de 19 semanas con útero bicorne en el que se produjo una rotura uterina asociada a acretismo placentario. La placenta acreta y el útero bicorne son 2 entidades muy poco frecuentes pero que pueden asociarse. Como tratamiento se realizó una hemihisterectomía izquierda con una evolución satisfactoria.
The sudden rupture in bicornuate pregnant uterus is an uncommon and difficult-to-diagnose occurrence. The prevalence of congenital uterine malformations amongst fertile women is documented for 1-2 percent of the population; of these, bicornuate uterus varies from 25 to 37 percent. The rupture of the uterine wall happens generally in the second trimester, accompanied by an intense abdominal pain as a result of the intraperitoneal hemorrhage. We report a case of a 19 weeks pregnancy with an uterine rupture in a bicornuate uterus associated with a placental accretism. Both placental accretism and bicornuate uterus are uncommon but can be related. A left-side hemihysterectomy was applied leading to a satisfactory evolution.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Complicações na Gravidez , Placenta Acreta/patologia , Ruptura Uterina/cirurgia , Ruptura Uterina/etiologia , Útero/anormalidades , Dor Abdominal/etiologia , Segundo Trimestre da Gravidez , Ruptura EspontâneaRESUMO
Human papillomavirus (HPV) infection is the main aethiological factor in the development of squamous cervical neoplasia. Nowadays molecular hybridization is the most adequated method to detect HPV. Study is based on the HPV assay by means of mixed hybridization and capture of specific sequences of viral DNA. Detection of HPV by hybridization and capture is a very useful technique in patients with non-definitive cytologies of viral action, but that display high clinical suspect for such a infection. The cervical cancer screening increases its sensibility and specificity by a combined study of cytology and hibridization. The highest benefit is for those cases classified initially as ASCUS, in which the HPV results point out a more accurate diagnosis and guide subsequent adequate therapy. The results show that for normal cytology up to 87.1% was negative for virus, in the ASCUS group a 56.76% was positive for HPV, in the 32 LSIL cases a 43.8% was negative for HPV, while only a 33% of the HSIL II was negative, finally there were no negative cases for HSIL III, finding an 11.1% for low risk and low plus high risk, and a 77.8% for high risk alone. In spite of the clear relationship between cytology and HPV determination, one must be careful in establishing the treatment for the cases that displayed high risk HPV with cytology within normal limits or ASCUS. We consider these patients as high risk ones thus being suitable for a more strict follow up, keeping more aggressive procedures for the cases with cytologic manifestations.