Fetal Growth Restriction (FGR) is an abnormal growth associated with adverse prognosis in the short, medium and long term. Etiological factors may be acting synergistically and therefore the use of multiple parameters is useful in diagnosis. The detection, monitoring and management depend on knowledge of the new terminology and parameters for identification that is related to clinical presentation and progression in relation to gestational age and from its etiology. We describe the typical presentations of early and late FGR and the need to differentiate the normal constitutionally small (NCS).

Objective. To know the indicators of placental insufficiency in term and post - term gestation with normal fetal growth and adverse outcome in the National Maternal Perinatal Institute during the year 2017. Materials and methods. A correlational, descriptive, cross-sectional and retrospective study was performed in 37-42 weeks' pregnant women with normal umbilical Doppler and normal fetal growth. We investigated the association between eight indicators and six adverse outcomes for placental insufficiency.

Existen entidades internacionales líderes y referentes en evaluación fetal que discrepan en los valores de referencia Doppler usados para Arteria Umbilical.

Las bajas tasas de detección de restricción de crecimiento intrauterino (RCIU) se explican en parte porque no hay un consenso en anteponer la edad gestacional real en el informe ecográfico. Muy pocos lo hacen y la mayoría sólo informa dando una edad por el promedio biométrico. Tampoco es rutina determinar e informar el percentil del peso estimado fetal.

El presente documento resulta del análisis del ejercicio de la ultrasonografía obstétrica en el Perú y como un aporte para el ordenamiento que repercuta favorablemente en la calidad de las evaluaciones y en la salud materno perinatal considerando, adoptando y adaptando normativas y lineamientos internacionales de entidades referentes en ecografía obstétrica y medicina fetal. Según consta en la Guía clínica de Ultrasonografía en el embarazo del 2016, diversas sociedades referentes han  adoptado la siguiente terminología uniforme para tres tipos de exámenes ecográficos según nivel de complejidad: Estandar, Limitada y Especializada. Algunas de tipo “especializada”, como las ecografías de tamizaje “Genética y Morfológica” no significa que deba ser realizada necesariamente por un médico especialista o subespecialista; sino que quien la realice deba tener la comp...

Background. Acute placental uterine vascular insufficiency is a cause of adverse fetal outcome in fetuses with failure to reach their growth potential and are born at an appropriate weight for gestational age. Clinical case. A 24-year-old patient, 37 weeks gestational age, went to the National Maternal Perinatal Institute of Lima, Peru, for reporting little vaginal bleeding. In the clinical evaluation, a BP of 90/60 mmHg, uterine height 32 cm, fetal heartbeat was found in 152. At ultrasound evaluation, a fetus of 2902 grams (34 Hadlock percentile) was reported 1 hour after admission, a Profile Fetal biophysicist 6/8 due to decreased body movements, 11cm amniotic fluid index, grade III posterior fundic placenta, Middle Cerebral Artery Doppler of the 1.18, umbilical artery Doppler of the 0.56, ductus venosus Doppler 0.26 and Aortic Isthmus with absent diastole. The contraction stress test ...

La debilidad técnica y en la comprensión hemodinámica genera evaluaciones Doppler de baja calidad con persistencia de desenlaces adversos, altos costos, vigilancia o tratamiento innecesarios y limitado avance del conocimiento fisiopatológico. La investigación y práctica clínica relacionadas al Doppler materno fetal muestran impacto poco significativo, discrepancias e incluso incongruencias; si bien un porcentaje de esto se genera por la no uniformidad en la terminología diagnóstica, las tablas de referencia y el manejo, otro porcentaje se explica por la baja calidad en la evaluación Doppler. Las recomendaciones ya establecidas para la calidad Doppler pueden representarse en una herramienta que permita mejorarla y evaluarla objetivamente. Esto podría no solo disminuir los desenlaces adversos sino que tornaría a las investigaciones más uniformes y con evidencias más sólidas....

Objectives. To identify late intrauterine growth restricted newborns (IUGR) with normal umbilical artery Doppler and assess the antepartum diagnostic value of a multi parameter algorithm. Material and methods. Analytic, observational, retrospective study and elaboration plus preliminary assessment of a diagnostic tool. 96 non anomalous newborns between 35 and 41 weeks of gestational age were randomly selected. 23 small for gestational age (SGE) according to local growth classification method, 13 borderline adequate for gestational age (AGE)(inside the 200 g over tenth percentile ) and 60 AEG over the 25 percentil. Using a pre established operative definition 22 IUGR (cases) and 74 non IUGR (controls ) were detected. For Statistical analysis we used Epidat 3,1 to calculate values for simple diagnostic Tests. Results. 22 from 96 (23% ) newborns were classified as IUGR; 16 from 23 (69,5 %) ...

  Presenting the case of a primigravida patient with no risk factors to which it is detected congenital heart disease muscular type VSD is performed which is confirmed by neonatal echocardiography at birth.

Placental chorioangioma is a non-trophoblastic benign tumor of rare presentation. It may be associated with complications of pregnancy when larger than 4 cm. We present the case of a pregnant adolescent with 25 weeks of gestation referred for prenatal management of a giant placental chorangioma that complicated pregnancy with hydramnios and severe fetal anemia. Fetoscopic laser ablation of the main nutrient vessel of the tumor was performed for the first time in Peru, which reversed complications and improved fetal prognosis.

Placental chorioangioma is a non-trophoblastic benign tumor of rare presentation. It may be associated with complications of pregnancy when larger than 4 cm. We present the case of a pregnant adolescent with 25 weeks of gestation referred for prenatal management of a giant placental chorangioma that complicated pregnancy with hydramnios and severe fetal anemia. Fetoscopic laser ablation of the main nutrient vessel of the tumor was performed for the first time in Peru, which reversed complications and improved fetal prognosis.

Objective. To determine the similarity or difference in femur length of normal fetuses compared to fetuses with Downsyndrome at the Maternal Perinatal Institute period 2011-2015. Methodology. It is a quantitative, retrospective, observational,descriptive and cross-sectional descriptive study. Our population was all fetuses of the National Perinatal Maternal Institutein the period 2011-2015, which had the measure of Femur Length and the complete database, which meet the criteria ofInclusion and Exclusion.

Schizencephaly is a pathology of unknown etiology characterized by clefts that communicate the subarachnoidal space with the lateral ventricles. Two types have been described since the first paper published in 1941: Type I schizencephaly (closedlip), where the edges of the cleft (lips) come into contact; Type II schizencephaly (openlip) presents cleft edges (lips) that are widely open and filled by cephalo-spinal fluid. The latter has a worse prognosis and may be diagnosed antenatally. We present the case of a fetus with prenatal ultrasonographic findings of Type 2 schizencephaly.

A case of a pregnant woman referred to our center at 27 weeks of gestational age for twin reversed arterial perfusion (TRAP) sequence is reported. Fetoscopy and bipolar coagulation of the umbilical cord of the acardiac twin was performed with successful outcome.

A case of a pregnant woman referred to our center at 27 weeks of gestational age for twin reversed arterial perfusion (TRAP) sequence is reported. Fetoscopy and bipolar coagulation of the umbilical cord of the acardiac twin was performed with successful outcome.

La esquizencefalia es una patología de etiología desconocida que se caracteriza ecográficamente por presentar hendiduras que comunican el espacio subaracnoideo con los ventrículos laterales. Desde la primera publicación en 1941, se describe dos tipos: la esquizencefalia tipo I (labio cerrado), en la cual los bordes de la hendidura (labios) entran en contacto; y la esquizencefalia tipo II (labio abierto), cuyos bordes (labios) están ampliamente separados por líquido cefalorraquídeo, que es de peor pronóstico y la única diagnosticable antenatalmente. Se presenta el caso de diagnóstico prenatal de un feto con hallazgos ultrasonográficos de esquizencefalia tipo 2.

A case of a pregnant woman referred to our center at 27 weeks of gestational age for twin reversed arterial perfusion (TRAP) sequence is reported. Fetoscopy and bipolar coagulation of the umbilical cord of the acardiac twin was performed with successful outcome.

Intrauterine growth restriction is defined as a fetus that does not reach its growth potential. The early (<32 weeks) and late (> 32 weeks) presentations have differential but not exclusive characteristics; in relation to the degree of placental obstructive compromise that affects the severity of the hemodynamic manifestations. For its diagnosis, follow-up and management, we have a multivessel Doppler evaluation, which provides information on the deterioration and the risk of intrauterine mortality, allowing to establish the opportune moment of birth. We present the report of a case of early-onset intrauterine growth restriction with severe Doppler alteration evaluated by our department and review the pathogenesis, clinical, and diagnostic approach and management of this condition.

Pfeiffer syndrome is an autosomic dominant disorder characterized by craniosynostosis, midface hypoplasia and syndactyly of the hands and feet. Three different phenotypes have been described, where type 2 is the most severe and the one amenable of prenatal diagnosis. We present the first clinical case reported at Instituto Nacional Materno Perinatal, Lima, Peru, of a fetus with suspicious ultrasound prenatal findings of this syndrome including cloverleaf-shaped skull, severe ventriculomegaly, frontal bossing, ocular proptosis and overlapped fingers, who was born by cesarean section and died at day eight due to progressive respiratory distress.

Pfeiffer syndrome is an autosomic dominant disorder characterized by craniosynostosis, midface hypoplasia and syndactyly of the hands and feet. Three different phenotypes have been described, where type 2 is the most severe and the one amenable of prenatal diagnosis. We present the first clinical case reported at Instituto Nacional Materno Perinatal, Lima, Peru, of a fetus with suspicious ultrasound prenatal findings of this syndrome including cloverleaf-shaped skull, severe ventriculomegaly, frontal bossing, ocular proptosis and overlapped fingers, who was born by cesarean section and died at day eight due to progressive respiratory distress.