Alvaro Sepúlveda-Martínez

Prediction of early and late pre-eclampsia from maternal characteristics, uterine artery Doppler and markers of vasculogenesis during first trimester of pregnancy.

To develop a predictive model for pre‐eclampsia using clinical, biochemical and ultrasound markers during the first trimester of pregnancy.

Assessment of pregestational insulin resistance as a risk factor of preeclampsia.

Aim: To assess the impact that pregestational insulin resistance (PIR) has as a risk factor for preeclampsia (PE). Methods: Nested case-control study that included patients with PIR and a control group that was randomly selected from pregnancies admitted to the Fetal Medicine Unit between January 2005 and May 2011. Clinical and hemodynamic variables were analyzed by a multiple logistic regression analysis. Results: Of the 13,124 patients admitted during the study period, 119 had a diagnosis of PIR (0.9%). Patients with PIR were older and had a higher body mass index (BMI). PIR was also related to a significantly higher frequency of chronic hypertension (CrHT; 10.1 vs. 2.2%, p < 0.05) and hypothyroidism (5.0 vs. 1.6%, p < 0.05) than in the control group. Moreover, women with PIR were more likely to develop PE (8.4 vs. 4.2%, p < 0.05) and gestational diabetes mellitus (9.2 vs. 2.9%) than the control group. Multivariate analysis showed that maternal age, CrHT and altered uterine artery Doppler sonography during the first and second trimesters were good predictors of PE and that PIR was not. Conclusion: Although PIR correlates with PE, conditions related to the latter (CrHT, higher maternal age and increased BMI) may be predominant as risk factors for PE.

Is there a role for cervical assessment and uterine artery Doppler in the first trimester of pregnancy as a screening test for spontaneous preterm delivery

To evaluate the role of cervical length (CL) and uterine artery pulsatility index (UtA‐PI) at 11 + 0 to 13 + 6 weeks as predictors of spontaneous preterm delivery (sPTD) in a Chilean population.

Second-Trimester Anterior Cervical Angle in a Low-Risk Population as a Marker for Spontaneous Preterm Delivery

Objective: The aim of this article is to assess the use of the anterior cervical angle (ACA) as a predictor of spontaneous preterm delivery (sPTD) at 20+0-24+6 weeks of gestation in an unselected population. Methods: We conducted a nested case-control study that included 93 women who later delivered spontaneously <34 weeks of gestation and 225 controls. The ACA was assessed retrospectively on all selected images using ImageJ® software. The concordance correlation coefficient was determined for the assessment of interobserver variability. Continuous variables were adjusted by maternal characteristics and expressed as the z-score or multiples of the expected normal median (MoM) of the unaffected group. Logistic regression analysis was used to evaluate whether any maternal characteristics and ultrasound variables were significantly associated with sPTD <34 weeks. Results: ACA z-score values were significantly greater in women who later delivered <34 weeks compared to controls (ACA z-score = 1.32 ± 0.57 vs. -0.09 ± 0.35; p = 0.035). The best prediction of sPTD <34 weeks was provided by a model that combined cervical length (CL) MoM, ACA z-score and maternal characteristics. For a fixed false-positive rate of 10%, the detection rate for this model was 37.6%. Conclusion: A model combining maternal history, CL and ACA at 20+0-24+6 weeks of gestation can predict approximately 40% of the severe preterm births.

Morbilidad materna grave e ingreso a cuidado intensivo: Hospital Clínico Universidad de Chile (2006-2010)

Background: Maternal morbidity is a quality of care indicator. The frequency of severe maternal morbidity that requires an intensive care management has increased, due to an increase in maternal age. Aim: To describe the severe and acute maternal morbidity spectrum that requires an intensive care management in a University Hospital. Material and methods: Review of medical records of 89 pregnant women aged 29 years, admitted to an Intensive Care Unit (UCI) between 2006 and 2010. Results: Mean gestational age on admission was 32 weeks. The main comorbidities identified were chronic hypertension (13.5%), hypothyroidism (4.5%) and coagulopathies (6.7%). Severe preeclampsia, sepsis and obstetric hemorrhage were the main causes of admission. Length of stay ranged from 1 to 28 days. Seventy eight percent of patients were admitted in the immediate postnatal period. Mechanical ventilation was required in 24% of patients for a median of three days. The longer unit lengths of stay were observed in patients with preeclampsia and non-obstetric severe sepsis (pyelonephritis and pneumonia). Seven abortions and seven perinatal deaths were recorded. The latter were mainly secondary to severe preeclampsia/HELLP syndrome. Neonatal morbidity was related to prematurity (19% hyaline membrane, 18% persistent ductus and 4% cerebral hemorrhage). There were no maternal deaths. Conclusions: Preeclampsia and its complications were the main causes of maternal ICU admission. In this series, there were no maternal deaths and the perinatal survival rate was 92%.BACKGROUND Maternal morbidity is a quality of care indicator. The frequency of severe maternal morbidity that requires an intensive care management has increased, due to an increase in maternal age. AIM To describe the severe and acute maternal morbidity spectrum that requires an intensive care management in a University Hospital. MATERIAL AND METHODS Review of medical records of 89 pregnant women with a mean age of 29 years, admitted to an Intensive Care Unit (UCI) between 2006 and 2010. RESULTS Mean gestational age on admission was 32 weeks. The main comorbidities identified were chronic hypertension (13.5%), hypothyroidism (4.5%) and coagulopathies (6.7%). Severe preeclampsia, sepsis and obstetric hemorrhage were the main causes of admission. Length of stay ranged from 1 to 28 days. Seventy eight percent of patients were admitted in the immediate postnatal period. Mechanical ventilation was required in 24% of patients for a median of three days. The longer unit lengths of stay were observed in patients with preeclampsia and non-obstetric severe sepsis (pyelonephritis and pneumonia). Seven abortions and seven perinatal deaths were recorded. The latter were mainly secondary to severe preeclampsia/ HELLP syndrome. Neonatal morbidity was related to prematurity (19% hyaline membrane, 18% persistent ductus and 4% cerebral hemorrhage). There were no maternal deaths. CONCLUSIONS Preeclampsia and its complications were the main causes of maternal ICU admission. In this series, there were no maternal deaths and the perinatal survival rate was 92%.

Chorioamnionitis caused by Listeria monocytogenes: a case report of ultrasound features of fetal infection.

Maternal listeriosis is often associated with mild symptoms for the patient, but fetal infection can lead to severe adverse perinatal outcome. The most described antenatal symptoms are reduced fetal movements and an abnormal fetal heart rate trace. We present a case of fetal listeriosis suspected by ultrasound findings of fetal gastrointestinal compromise, neonatal diagnosis and outcome.

OC23.04: A risk model for pre-eclampsia based on maternal characteristics and uterine artery Doppler during the first trimester of pregnancy

for significant physiological and pathological variables affecting fetal growth were derived using backward stepwise multiple regression for singletons (Cust Singlechart). The same process was repeated including only twin births (1893 pairs) in the regression models and adjusting for chorionicity (cust Twinchart). The association between SGA <10th percentile defined using the twin versus singleton customized charts and IUFD were compared. Statistical analyses including OR, 95% confidence interval (CI), and screening accuracy using each chart was performed. Results: The derived coefficients for fetal growth for cust Twinchart are different from those for cust Singlechart; with lower constants and R2 (2744 and 279 in twins; versus 3244 and 416 in singletons, respectively). Among 3786 twin infants, IUFD was seen in 123 (3.2%). The numbers of pregnancies identified as SGA were: 972 (25.7%), and 371 (9.8%) by the cust Singlechart and cust Twinchart, respectively. The association between SGA and IUFD and screening efficiency using both customized charts are shown in the table. Conclusions: Customized charts designed specifically for twins are more efficient at identifying twin pregnancies at risk for IUFD compared with those derived using singleton birth data.

Perinatal outcome and placental apoptosis in patients with late‐onset pre‐eclampsia and abnormal uterine artery Doppler at diagnosis

To determine the rate of placental apoptosis and adverse perinatal outcome in patients with late‐onset pre‐eclampsia (PE) and abnormal uterine artery (UtA) Doppler at diagnosis.

Increased PR Interval in Fetuses of Patients with Intrahepatic Cholestasis of Pregnancy

Objective: To evaluate the fetal mechanical PR interval in fetuses from pregnancies with intrahepatic cholestasis of pregnancy (ICP). Methods: A case-control study was conducted in the Maternal-Fetal Medicine Unit at Hospital Carlos Van Buren between 2011 and 2013. Fetal echocardiography was performed in patients with ICP and normal pregnancies. Demographic and clinical characteristics were compared using the Mann-Whitney U test for continuous variables. A p value <0.05 was considered significant. Results: 51 patients with ICP were compared with 51 unaffected pregnancies. There were no significant differences in neither demographic nor clinical characteristics between the two groups. The fetal PR interval was significantly longer in the ICP group when compared to the control group (134.6 ± 12 vs. 121.4 ± 10 ms, p < 0.001). Moreover, four fetuses from the ICP group had a mechanical PR interval >150 ms, which is compatible with a first-degree atrioventricular block. Two fetuses were identified in the neonatal period and were transferred to pediatric cardiology for follow-up, with a normal mechanical PR after the first month of life. Conclusions: We demonstrated that the fetal cardiac conduction system is altered in fetuses of patients with ICP. Further research is necessary to determine whether this alteration is related to stillbirths seen in ICP.

Role of the glucose tolerance test as a predictor of preeclampsia.

Objective: To determine whether oral glucose tolerance tests (OGTT) play a role as predictors of preeclampsia (PET) in pregnant women. Methods: A retrospective case-control study was conducted in 2,002 singleton pregnancies that had a uterine artery (UtA) Doppler at 22-25 weeks and an OGTT. The UtA Doppler and OGTT were adjusted based on maternal characteristics, and the results were expressed as multiples of the expected normal median and compared between groups. Logistic regression analysis was used to determine whether maternal characteristics, OGTT, and UtA Doppler significantly contribute to the prediction of early- (<34 weeks), intermediate- (34-37 weeks), or late-onset (>37 weeks) PET. The performance of the screening was determined by ROC curves. Results: Women who developed PET were characterized by an older maternal age, an increased body mass index, and an altered UtA Doppler. The group with intermediate-onset PET was the only one associated with higher 2-hour OGTT levels compared to controls. Combined models were developed via logistic regression analysis using maternal characteristics, UtA Doppler, and OGTT to predict PET. These combined models were able to detect around 74, 42, and 21% of women who later developed early-, intermediate-, or late-onset PET, respectively, with only a 5% false-positive rate. Conclusions: This study shows that the combination of maternal characteristics, second-trimester UtA Doppler, and OGTT is a predictor of the development of PET in healthy pregnant women.