Jorge Hasbún

Three-Dimensional power doppler sonography in the prenatal diagnosis of a true knot of the umbilical cord : Value and limitations

The purpose of this study was to examine the value of 3‐dimensional power Doppler sonography in the prenatal diagnosis of a true knot of the umbilical cord.

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.

Actualización en el diagnóstico y manejo del daño hepático agudo grave en el embarazo

Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy (dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severe liver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acute hepatitis caused by medications or virus is the most severe disease. Its clinical presentation may be hyper-acute with neurological involvement and severe coagulation disorders. It has a high mortality and patients should be transplanted. Fulminant hepatic failure caused by acetaminophen overdose can be managed with n-acetyl cysteine. Because of the high fetal mortality rate, the gestational age at diagnosis is crucial.Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy (dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severe liver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acute hepatitis caused by medications or virus is the most severe disease. Its clinical presentation may be hyper-acute with neurological involvement and severe coagulation disorders. It has a high mortality and patients should be transplanted. Fulminant hepatic failure caused by acetaminophen overdose can be managed with n-acetyl cysteine. Because of the high fetal mortality rate, the gestational age at diagnosis is crucial.

Contents Vol. 33, 2013

R. Achiron, Tel Hashomer N.S. Adzick, Philadelphia, Pa. L. Allan, London A.A. Baschat, Baltimore, Md. K.J. Blakemore, Baltimore, Md. T.-H. Bui, Stockholm F.A. Chervenak, New York, N.Y. T. Chiba, Tokyo R. Chmait, Los Angeles, Calif. F. Crispi, Barcelona J.E. De Lia, Milwaukee, Wisc. J.A. Deprest, Leuven G.C. Di Renzo, Perugia J.W. Dudenhausen, Berlin N.M. Fisk, Brisbane, Qld. A.W. Flake, Philadelphia, Pa. U. Gembruch, Bonn M.R. Harrison, San Francisco, Calif. J.C. Hobbins, Denver, Colo. L.K. Hornberger, San Francisco, Calif. E.R.M. Jauniaux, London M.P. Johnson, Philadelphia, Pa. C. Jorgensen, Copenhagen J.-M. Jouannic, Paris P.M. Kyle, London O. Lapaire, Basel S. Lipitz, Tel-Hashomer G. Malinger, Holon G. Mari, Detroit, Mich. M. Martinez-Ferro, Buenos Aires K.J. Moise, Houston, Tex. F. Molina, Granada K.H. Nicolaides, London D. Oepkes, Leiden L. Otaño, Buenos Aires Z. Papp, Budapest R.A. Quintero, Miami, Fla. G. Ryan, Toronto J. Rychik, Philadelphia, Pa. H. Sago, Tokyo W. Sepulveda, Santiago P. Stone, Auckland D.V. Surbek, Bern B.J. Trudinger, Westmead, N.S.W. J.M.G. van Vugt, Amsterdam Y. Ville, Paris Clinical Advances and Basic Research

P12.13: Ultrasound reference ranges for fetal nasal bone in a Chilean population and its role as screening test for chromosomal abnormalities at 22–25 weeks of gestation

Objectives: The osteochondrodysplasias, or skeletal dysplasias are a genetically heterogeneous group. In the 2006 revision of the International Nosology and Classification of Genetic Skeletal Disorders, 372 different conditions were listed in 37 groups defined by such molecular, biochemical, and/or radiographic criteria. Many of them can present in the prenatal period as demonstrated by ultrasound. We report the prenatal diagnosis of skeletal dysplasias in three centers over 5 years period. Methods: Over 21,000 scans in three centers of prenatal diagnosis were made for suspect of skeletal displasya or routinary scan during 2004–08 period. In the most of cases the invasive prenatal diagnosis (chorionic villus sampling/amniocentesis) was performed and the final diagnosis was sought on the basis of fetopathological examination, radiographic studies and molecular testing. Results: A total of 70 antenatal skeletal dysplasias were diagnosed. Follow-up was in all cases, also if the parents decided to stop the pregnancy. The mean gestational age at US diagnosis was 24 wks (12–35 wks). The lethal skeletal dysplasias were diagnosed in the second trimester, instead the diagnosis of limb reduction was possible in the first trimester. Were diagnosed 31 cases of skeletal dysplasia (44,2%), 24 cases of limb reduction (34,2%), arthrogryposis 5 cases (7,1%), amniotic band lesion 5 cases, unexplained skeletal 5 cases (without diagnosis), dysplasia/limb defect 5 cases. A correct antenatal diagnosis was made in 55 cases (78,5%). Conclusion: A specific prenatal diagnosis is not possible in 20/30% of the cases. The diagnosis on the basis of specific pathology is made in a large period of the pregnancy (12–35wks). For an immediate management, assessment of prognosis (95%) is of more value by US plus molecular diagnosis. The definitive diagnosis is made postnatally based on clinical, radiographic, CT criteria and molecular analysis.

OP14.02: Uterine artery Doppler during the first and second trimester as screening for early‐onset preeclampsia

Objective: To evaluate the performance of screening for preeclampsia (PET) in women who had both first and second trimester uterine artery (UtA) Doppler. Methods: This longitudinal study involved 3090 asymptomatic pregnant women who had UtA pulsatility index (PI) routinely at 11–14 and 20–25 weeks gestation. Demographic characteristics was also recorded contemporary. Multiple regression analysis was used to evaluate which of the maternal variables and Doppler findings were significant predictors of early-onset PET. Receiveroperating characteristics curves were used to evaluate the value as screening of different combined predictive models. Results: There were 93 (3.0%) women who later developed PET, including 30 women who delivered before 34 weeks gestation (early PET). Early and late PET differed substantially in their UtA PI findings during the first and second trimester of pregnancy. Multiple regression analysis showed that increased body mass index, previous PET, UtA PI at 11–14 and 20–25 weeks gestation, and the change in UtA resistance between the first and second trimester were significantly associated with the appearance of early PET. The detection rate of early PET for a 10% false positive rate in screening by maternal characteristics and first trimester UtA PI only and by a combination with a ratio between both UtA Dopplers was 50% and 82%, respectively. However, second trimester UtA PI alone was able to detect about 90% of women who subsequently developed early cases. Conclusion: This study has confirmed that the severe the PET the lower the magnitude of change in uterine artery dilatation between the first and second trimester of pregnancy. In addition, although the best methods to predict early PET is still the second trimester uterine artery Doppler, a combination between maternal findings, UtA Doppler at 11–14 weeks gestation and the ratio of changes between both trimesters should be also a good screening test for early PET. Supported by Fondecyt No 1090245