Hernán Muñoz S

Impétigo herpetiforme recurrente: manejo exitoso con ciclosporina

Impetigo Herpetiformis is a high-risk gestational skin disease that represents a risk for both the mother and offspring. Its management is based on multisystemic support and maternal steroid therapy. When these measures are insufficient to control the disease, the association of ciclosporine to the treatment has been proposed. We report a 24 yearold woman with a 16 weeks pregnancy, that presented with Impetigo Herpetiformis. The disease was refractory to the use of steroids, the patient had a metabolic decompensation and a dehydration with electrolyte imbalance. Therefore, treatment with ciclosporine was initiated and a rapid regression of the lesions was observed. Gestation was maintained, with a good perinatal outcome (Rev Med Chile 2005; 133: 1071-74). (Key Words: Adrenal cortex hormones; Cyclosporine; Impetigo)

Consenso salud materna para Chile en el nuevo milenio

Contexto: Chile presenta una tendencia secular hacia una sostenida mejoria en los principales indicadores materno-infantiles. Su situacion constituye una experiencia positiva a nivel de la region de Latino-America y el Caribe. Sin embargo, esta tendencia se ha estancado en los ultimos diez anos lo que produce una situacion inestable y preocupante desde el punto de vista de la salud publica materna. Esto motiva una reunion de expertos a nivel nacional e internacional para proponer estrategias para el alto nivel politico orientadas a alcanzar los Objetivos 4 y 5 del Milenio. Conclusion: Este documento de consenso sobre mortalidad materna, sugiere un enfrentamiento en dos ejes: primero, enfrentar la nueva realidad epidemiologica desde la etapa pre-concepcional, esto incluye considerar la alta prevalencia de obesidad, hipertension arterial, diabetes, hiperlipidemias e hipotiroidismo en la poblacion, y por otro lado reforzar la seguridad de la asistencia del embarazo, parto y puerperio en los lugares mas alejados y mas vulnerables del pais. Es necesario focalizar las intervenciones en los grupos de mayor riesgo vital (edades extremas de la vida fertil y portadoras de enfermedades medico-quirurgicas severas, que se reflejan en el aumento proporcional de las causas indirectas de muerte materna), reforzar las actividades de auditorias de mortalidad/near miss, asi como controlar el aumento alarmante de la tasa de partos por cesareas.

Proteína S libre en embarazadas normales: comparación entre dos métodos

Background: Pregnancy is a physiological hypercoagulable state with an increased incidence of thromboembolic phenomena. There is an increase in the concentrations of most clotting factors, a decrease in concentration of some of the natural anticoagulants and reduced fibrinolytic activity. Changes in PS levels have also been reported. Aim: To establish referral range values of functional PS and free PS antigen, during the second (2 nd T) and third trimester (3 rd T) of normal gestation. Patients and methods: Forty one normal pregnant women were included in our study, 20 during the 2 nd T (22-24 weeks) and 21 during the 3 rd T (29-38 weeks). Functional PS was measured by a clot based test and free PS antigen by ELISA. Results: Free PS Antigen was 65.8±18.3% during the 2 nd T and 62.3±16.5% during the 3 rd T. The figures for normal controls were 106±6.5%. Functional PS was 43.8±13.3 and 25.9±14.6% during the 2 nd T and 3 rd T, respectively. The figures for normal controls were 97±24% (p <0.001 compared with pregnant women). Free PS antigen did not change from the 2 nd to the 3 rd T (p=NS), however functional PS fell significantly from the 2 nd to the 3 rd T (p <0.001) and was significantly lower than free PS antigen in both trimesters (p <0.001). Conclusions: Pregnancy is associated to a decrease in PS. This abnormality is more pronounced for functional PS than free PS antigen and functional PS falls progressively during pregnancy. These assays should not be used to screen for PS deficiency during pregnancy because they could lead to a misdiagnosis (Rev Med Chile 2005; 133: 633-8). (Key Words: Pregnancy trimesters; Protein S; Protein S deficiency)

Consenso Latinoamericano sobre Resonancia Magnética Fetal

La ecografia es el metodo de estudio primario de las malformaciones fetales. Sin embargo, existen condiciones especiales y limitaciones que hacen de la resonancia magnetica el metodo util en estas circunstancias, proporcionando un gran detalle de la anatomia y patologia fetal. Es una tecnica que no utiliza radiaciones ionizantes, proporciona imagenes de alto contraste y obtiene imagenes de buena calidad de la mayoria de los organos fetales. Tambien puede proporcionar informacion util de la placenta, el cordon umbilical, el liquido amniotico y el utero. La utilizacion de esta tecnica, su desarrollo, avances y futuras proyecciones seran se presentan en este documento efectuado en la Reunion de Consenso Latinoamericano en Resonancia Magnetica en Obstetricia realizado el 14 y 15 de julio de 2012 en Santiago, Chile.

Evaluación de la Globulina transportadora de Hormonas Esteroidales (SHBG) durante el embarazo como factor predictor de pre-eclampsia y restricción del crecimiento intrauterino.

BACKGROUND Sex-Hormone Binding Globulin (SHBG) may be associated to Pre-eclampsia (PE) and Fetal Growth Restriction (RCIU). AIM To determine if maternal serum SHBG concentrations during the first and second trimesters are predictive biomarkers of Pre-eclampsia and RCIU. PATIENTS AND METHODS Prospective cohort study carried out in the Fetal Medicine Unit, Universidad de Chile Clinical Hospital between January, 2005 and December, 2006. Blood samples were obtained from unselected pregnant women during routine 11-14 week and 22-25 week ultrasound examinations, conforming two different study groups. Posteriorly, serum SHBG concentrations were determined in women who developed Pre-eclampsia, RCIU and their respective controls. RESULTS Fifty five patients were included in the 11-14 weeks group. Nine women that developed PE, 10 that developed RCIU and 36 controls were selected from this group. There were no significant differences in SHBG levels between patients with PE, RCIU or controls (324.7 (26.6), 336.8 (33.9) and 377.5 (24.3) nmol/L, respectively). Fifty four women were included in the 22-25 weeks group. Eight women who developed Pre-eclampsia, 15 who developed RCIU and 31 controls were selected. Again, there were no significant differences in SHBG levels between patients with PE, RCIU or controls (345.5 (151.1), 383.8 (143.4) and 345.5 nmol/l (151.1), respectively). CONCLUSIONS Maternal SHBG serum levels did not predict subsequent development of Pre-eclampsia and RCIU.Background: Sex-Hormone Binding Globulin (SHBG) may be associated to Pre-eclampsia (PE) and Fetal Growth Restriction (RCIU). Aim: To determine if maternal serum SHBG concentrations during the first and second trimesters are predictive biomarkers of Pre-eclampsia and RCIU. Patients and Methods: Prospective cohort study carried out in the Fetal Medicine Unit, Universidad de Chile Clinical Hospital between January, 2005 and December, 2006. Blood samples were obtained from unselectedpregnant women during routine 11-14 week and 22-25 week ultrasound examinations, conforming two different study groups. Posteriorly, serum SHBG concentrations were determined in women who developed Pre-eclampsia, RCIU and their respective controls. Results: Fifty five patients were included in the 11-14 weeks group. Nine women that developed PE, 10 that developed RCIU and 36 controls were selected from this group. There were no significant differences in SHBG levels between patients with PE, RCIU or controls (324.7 (26.6), 336.8 (33.9) and 377.5 (24.3) nmol/L, respectively). Fifty four women were included in the 22-25 weeks group. Eight women who developed Pre-eclampsia, 15 who developed RCIU and 31 controls were selected. Again, there were no significant differences in SHBG levels between patients with PE, RCIU or controls (345.5 (151.1), 383.8 (143.4) and 345.5 nmol/l (151.1), respectively). Conclusions: Maternal SHBG serum levels did not predict subsequent development of Pre-eclampsia and RCIU.

PREVALENCIA DE PROCEDIMIENTOS INVASIVOS EN UNA POBLACIÓN CHILENA USUARIA DE MÉTODOS DE CRIBADO Y DIAGNÓSTICO PRENATAL

RESUMENObjetivo: Evaluar la prevalencia del uso de procedimientos invasivos prenatales en una poblacion chilena con cribado y diagnostico de alteraciones morfologicas y/o cromosomicas. Metodo: Estudio descriptivo en 17.906 embarazadas entre junio de 2000 y octubre de 2006, a las cuales se les realizo cribado ecografico de aneuploidia y malformaciones congenitas durante el primer y segundo trimestre. Las pacientes fueron informadas y aconsejadas acerca de las implicancias de dichos procedimientos. Los procedimientos efectuados fueron la biopsia de vellosidades coriales (BVC), amniocentesis (AMCT) y cordocentesis. Se calculo la prevalencia y las indicaciones de dichos procedimientos. Resultados: Se realizaron 81 procedimientos invasivos (0,45%). Las BVC representaron un 43,3%, las AMCT el 37,0% y las cordocentesis un 19,7%. Las principales motivaciones para realizarse un estudio invasivo fueron malformaciones congenitas (48,1%) y aumento del riesgo de aneuploidia (40,7%). Los cariotipos alterados fueron 43,2% del total de los procedimientos, encontrandose 29% de trisomias 21, 46% de trisomias 18 y 13 y 20% de sindrome de Turner. Conclusion: La prevalencia de procedimientos invasivos fue 10 veces inferior a la descrita en paises donde el aborto es legal, y aproximadamente la mitad de ellos resultaron alterados. En nuestra poblacion utilizando una asesoria adecuada, la principal motivacion para realizarse un procedimiento invasivo fue el mejor manejo obstetrico del embarazo y, secundariamente, la posibilidad de contar con una mejor informacion sobre la salud del hijo no nacido.PALABRAS CLAVE: Procedimientos invasivos, amniocentesis, biopsia de vellosidades coriales, cordocentesisSUMMARYObjective: The purpose of this study was to evaluate the prevalence and indications of invasive procedures in a population without termina-tion of pregnancy. Method: This descriptive study was performed in pregnant women who had either assessment of risk for chromosomal abnormalities during the first and second trimester of pregnancy or detection of soft markers or structural defects at any gestational age from June 2000 to October 2006. The patients were counseled with regards their estimated risk, and were informed about invasive diag-nostic tests. The invasive testing offered were chorion villous sampling (CVS), amniocentesis (AMCT) and fetal blood sampling (FBS). The prevalence of invasive testing was calculated and its causes analyzed according to the type of screening test. Results: Ultrasound was

SÍNDROME DE RUBÉOLA CONGENITA: PRIMER CASO CLÍNICO EN CHILE POST PROGRAMA DE REVACUNACIÓN

Se presenta el primer caso clinico de sindrome de rubeola congenita en Chile, posterior al programa de revacunacion en 1999. Se describe el caso indice y se realiza una breve revision actualizada del tema.

ACTUALIZACIÓN EN EL DIAGNÓSTICO Y MANEJO DE ALTERACIONES HEMATOLÓGICAS DEL FETO

SUMMARY We present a literature review of most relevant fetal hematologic disorders, with special approach for the diagnosis and prenatal treatment.