A woman with a monochorionic diamniotic twin pregnancy was referred to our Centre due to a discrepancy in size between the foetuses. She was 17 weeks’ pregnant when the diagnosis of selective IUGR type 2 was made and the laser ablation of the placental anastomoses was performed. During the fetoscopy, we identified an arterio-venous anastomosis with bidirectional flow, which is atypical in this type of anastomoses (unidirectionals) and could represent a sign of ominous prognosis for the restricted twin.

Twin-to-twin transfusion syndrome (TTTS) is thought to result from an unbalanced exchange of blood through inter-twin vascular anastomoses. Laser photocoagulation of communicating vessels has been used to prevent the development of the syndrome. Some authors have proposed that vessels crossing the membrane are “suspicious” to participate in the development of the syndrome and the laser photocoagulation of these vessels would reverse the syndrome. We present two cases of TTTS where the communicating vessels did not cross the dividing membrane, which were successfully treated with laser.

Introduction. Fetal obstructive uropathy can be treated early in pregnancy by intrauterine vesicoamniotic shunting, immediately after diagnosis by ultrasound, in specific cases with a favorable prognosis in renal function using fetal urine beta-2 microglobulin. Objective: To determine the changes of beta-2 microglobulin in consecutive samples of fetal urine in 48 – 72 hour-intervals in fetuses with obstructive uropathy at 16 weeks of gestation. Methods: We designed a descriptive and longitudinal study, including 15 pregnant women whose fetuses were diagnosed with obstructive uropathy without chromosomal abnormalities, performing vesicocentesis for urinary biometry. Results: Beta-2 microglobulin values were higher than 4 mg/dL in the first vesicocentesis of all 15 cases and decreased to less than 4 mg/dL in 7 cases (46.6%) after the second vesicocentesis. In all cases when beta-2 microg...

The introduction of ultrasound and the visualization of the fetus during pregnancy began a revolution that allowed to diagnose in fetal life the problems that only came to be known in the newborn; at the same time, the recognition of the fetus as a patient. The incorporation of Fetal Medicine allows us to offer many parents more precise information and advice on fetal problems, and in some cases to offer hope for serious problems through treatments within the uterus that, in the last 20 years, have saved the life of thousands of fetuses that were born and are now adults.

Determination of chorionicity and amnionicity by ultrasound is the most important step in the management of multiple pregnancies. This diagnosis should be done in the first trimester of pregnancy not only because less difficulty but because it constitutes the beginning of various steps in the control of these types of pregnancies. It is highly recommended that professionals dealing with this kind of study have the knowledge to assess correctly and promptly chorionicity and amnionicity in multiple pregnancies.

Determination of the chorionicity and amnionicity by ultrasound is the most important step in the management of the multiple pregnancies. This diagnosis should be done in the first trimestre of the pregnancy, not only because of a less difficult process but also because it constitutes the beginning of several steps to follow in the control of these types of pregnancies. All this makes highly necessary that professionals dealing with this kind of ultrasounds have the right knowledge to assess correctly and promptly the chorionicity and amnionicity in multiple pregnancies.

A pregnant woman with monochorionic twins was referred to our Centre due to discrepancy in size between the twins. She was 17 weeks pregnant when we made the diagnosis of selective IUGR type 2 and we decided to perform a fetoscopic Laser ablation of the placental anastomoses. During the fetoscopy, we identified an arterio-venous anastomosis with bidirectional flux that is completely atypical in these anastomoses, never reported before, thus representing a sign of bad prognosis for the small twin.

Introduction and objectives. Fetal obstructive uropathy can be treated early in pregnancy by intrauterine vesicoamnioticshunting, immediately after being diagnosed by ultrasound, in specific cases with a favorable prognosis in renal function usingfetal urinary beta-2 microglobuline. The main objective of the study was to determine the changes of beta-2 microglobulinein consecutive samples of fetal urine in 48 – 72 hour-intervals in fetuses with obstructive uropathy at 16 weeks of gestation.Methods. We performed a descriptive and longitudinal study, including 15 pregnant women whose fetuses were diagnosedwith obstructive uropathy and without chromosomal abnormalities, performing vesicocentesis for urinary biometry.

El presente estudio titulado “La metodología 5S para mejorar la productividad en la gerencia regional de Agricultura, Chiclayo 2024” tuvo como principal objetivo analizar el nivel en que la metodología 5S mejora la productividad en la gerencia regional de Agricultura, Chiclayo 2024. La metodología del estudio tuvo un enfoque cuantitativo, de diseño no experimental y nivel descriptivo. La muestra estuvo conformada por el acervo documentario del área de almacén, y la técnica de recolección de datos fue la observación. Los resultados del estudio, permitieron conocer que existe un bajo nivel de eficiencia en la productividad de la gerencia, cuyos niveles fueron de 43% y 34% en eficacia, por tal razón, se adaptó la metodología 5S a modo de propuesta para que su aplicación pueda mejorar la situación problemática. La propuesta de esta metodología permitirá que se mejore la ...

La presente investigación tuvo como propósito determinar como la aplicación de un plan de abastecimiento y política de inventarios permitirá reducir los sobrestocks de almacén reduciendo costos en el área de abastecimiento en una empresa de servicios de limpieza. Basado en herramientas Lean se buscó un resultado adecuado para reducir costos logísticos de la empresa de servicios de limpiza. Con la información obtenida se tomó como punto de investigación el almacén de de insumos, materiales, EPP, administrativos y equipos de limpieza, el cual posee sobre stocks. Mediante el uso de la herramienta del ciclo DMAIC se consiguió proyectar mejoras aplicando los pasos definir, medir, analizar, mejorar y controlar. La información fue analizada con instrumentos de procesamiento como diagramas de procesos, Diagrama de Pareto, Diagrama de Ishikawa, Matriz de Kraljic, proyecciones de de...

Microcystic fetal lung tumors or masses such as the congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (SBP) are rare congenital pathologies, diagnosed by ultrasound during prenatal assessment, with a high mortality rate of 95% as a consequence of prenatal complications due to hydrops and postnatal death from pulmonary hypoplasia. Minimally invasive therapies using sclerosing agents are positioned among the low cost and highly effective techniques for such pathologies. Methodology: We conducted a prospective, randomized, blind clinical study in 17 pregnant women with diagnosis of fetal microcystic CCAM or hybrid lesion (CCAM + SBP), who were treated with betamethasone or polidocanol. Alternative therapy was employed in case of failure of the initial procedure. Results: In four (44.4%) of the nine cases treated with betamethasone, the alternative therapy ...

The amniotic band syndrome (ABS) is characterized by accumulation of fibrous tissue bands or strings that adhere to the fetus and may produce compression in different sites. Most cases present multiple congenital anomalies incompatible with life. A small group of fetuses have isolated constrictions of the limb that may cause severe limb dysfunction or limb amputation if not treated during pregnancy. This rare condition occurs in approximately 1:1 200 to 1:15 000 live births. The exact cause of ABS remains uncertain; however, theories of intrinsic, extrinsic and iatrogenic reasons have been proposed. The evolution of the limb affected by ABS is characterized by progression of distal edema due to venous obstruction, and intrauterine amputation of the limb from vascular insufficiency. Fetoscopic release of the amniotic bands through minimally invasive surgery techniques may allow life prese...

In the article “Placental insufficiency in term and post-term pregnancy with normal fetal growth and adverse outcome” in the Peruvian Journal of Maternal Perinatal Research 2017 6 (2): 31-36.

La pandemia del coronavirus 19 (COVID-19) y las medidas instauradas para su control significaron la interrupción de la atención prenatal, con potencial riesgo en la salud materna y fetal. Por otro lado, la atención prenatal convencional presencial implicaría exposición y riesgo de infección en pacientes y proveedores de salud. El Instituto Nacional Materno Perinatal (INMP) ha incorporado la teleconsulta como parte de un nuevo modelo de atención prenatal mixto, cuyo objetivo es disminuir las citas presenciales y, por tanto, el contacto y riesgo de transmisión viral. El paquete de atención prenatal incluye actividades esenciales para atender gestantes en edades gestacionales específicas con mayor impacto en los desenlaces perinatales y maternos. Este nuevo modelo podría generalizarse a nivel nacional y ser parte de la solución a las disparidades de atención en el Perú, median...

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.

Purpose: To examine the historical process for institutionalization of therapeutic abortion in Peru and to explain its current condition. Methodology: Review of bibliographic information available in the country regarding the process conducted by many institutions to have the Ministry of Health approve the National Guide for Therapeutic Abortion. Subsequently, the lead researcher met with 10 heads of the Gynecology and Obstetrics Service/Department from the same number of hospitals, from whom he requested information, as they have been regulating the provision of therapeutic abortion services by means of local Guides or Protocols for the last 5 years. Results: The formalization of the National Guide for the provision of therapeutic abortion services by the Ministry of Health has been a persistent endeavor of many institutions of civil society, but the 10 convened hospitals have already b...