Objectives: To review twin-twin transfusion syndrome (TTTS) comparative results by techniques used in regards to diagnosis, treatment, survival and complications, as well as current management of this complication in Peru. Methods: Articles published in specialized bibliographic sources were revised, and experience in Peru and Chile on management of this syndrome was analyzed. Results: TTTS is an uncommon complication of monochorionic twin pregnancy with major repercussion on the health of both fetuses. Treatment of choice of severe cases (Quintero I-IV) is fetoscopic laser photocoagulation of superficial and deep anastomoses at 18-26 weeks of pregnancy. About 140 cases per year occur in Peru and implementation of this technique is necessary. Conclusions: Elective treatment of severe cases of TTTS is fetoscopic laser photocoagulation of superficial and deep anastomoses between 18-26 week...

In recent decades there has been a special interest in studying the fetus, which has originated important progress in research for different medical specialties, based mainly on the development of fetal ultrasound application in diagnosis of fetal complications. In addition, there has been progress in technology for fetal genetic study from material directly obtained from the fetus or from maternal circulation, and interventions that improve pre- and post-natal prognosis. This progress encompasses a new multidisciplinary medical specialty that considers the fetus as an individual patient in the context of the mother-fetus relationship, establishing prophylactic treatments, medical therapies directly applied to the fetus or through the mother, interventions guided by ultrasonography, (limited) open surgery and fetoscopy, with reasonable advantages compared to conventional treatments. This...

We do a brief presentation on the parameters for preterm labor diagnosis, including uterine dynamics, uterine cérvix modifications and ultrasound findings.

Objective: To evaluate the use of methotexate (MTX) in the treatment of non-complicated ectopic pregnancy. design: Observational prospective study. Setting: Instituto Latinoamericano de Salud Reproductiva. Participants: Women with non complicated ectopic pregnancy. Interventions: Between 1998 and 2005, 21 cases had ultrasound diagnosis of less than 30 mm adnexal tumor, absence of embryo activity, absence of clinical and/or ultrasound evidence of internal hemorrage and chorionic gonadotropin beta sub unit (hCG-β) less than 3000 mUI/mL. Three women had only 1 uterine tube; one of them received MTX in 2 occasions. Treatment consisted in a single dose of MTX 1mg/kg IV or PO. Follow-up consisted in weekly-β and ultrasonographic assessment (including Doppler color study). Informed consent was applied. Main outcome measures: Ectopic pregnancy resolution. Results: Nineteen cases (95,2%) showed...

Objectives: To determine Doppler fetal pulmonary arterial trunk acceleration/deceleration times (AT/DT) in relation with gestational age, and if there would be a value of such index that would indicate pulmonary maturity with acceptable predictability. Design: Prospective and descriptive study.Setting: Instituto Latinoamericano de Salud Reproductiva, Lima, Peru, a teaching institution. Participants: Healthy women with single pregnancy. Methods: During 2007 and 2008, 79 pregnant women with 26 to 39 weeks healthy singleton pregnancies were studied. AT and DT mean values were measured in the fetal pulmonary arterial trunk using Doppler ultrasound and related to gestational age (GA). Results had statistical analysis to determine a cut value for pulmonary maturity, considering fetuses over 37 weeks have pulmonary maturity and none of the newborns studied had respiratory distress. Main outcome...

Objectives: To determine whether volumetric ultrasonography (3D, static and dynamic) provides better information than conventional ultrasound (2D) in the assessment of pregnancy before 7 weeks of amenorrhea. Design: Clinical series of cases study. Setting: Instituto Latinoamericano de Salud Reproductiva – ILSAR. Participants: Pregnant women within the fifth and seventh weeks of pregnancy. Interventions: An endovaginal ultrasound was performed to 30 pregnant women between the fifth and seventh weeks of amenorrhea with a GE Volusson Expert 730 using multifrequency endocavitary transductor (3.7-9.3 MHZ), 75% maximum potency in function ‘Early Pregnancy’ without harmonics; test duration was 5-15 minutes. Once the chorionic sac was localized its content was assessed for the yolk sac and the embryo, first using 2D and then static 3D and dynamic 3D (4D). Main outcome measures: Identifica...

Fetal surgery, or better called maternal-fetal, because drugs and surgical techniques are administered to the fetus through the mother, therefore, share risks, began more than 40 years ago. In 2016, on the subject of a symposium on the relevance of fetal medicine in Peru, published in this journal, we affirmed: "These advances make up a new multidisciplinary medical specialty, which considers the fetus as an individual patient and in the relationship with its mother. , establishing prophylactic treatments, direct medical therapy or through the mother, interventions guided by ultrasound, open and fetoscopic surgeries, with advantages to conventional treatments. This reality obliges us to review ethical and legal aspects related to the unborn, to changes both in the organization of health services, and in the pre and postgraduate curricula of new professionals ". We added: "Currently, in o...

Background: Nuchal cystic hygroma is the most frequently identified marker of chromosomal anomalies during first trimester screening. Objective: To determine the association of the nuchal cystic hygroma with chromosomal anomalies diagnosed with karyotyping done between the first and second trimesters of pregnancy. Design: Retrospective study. Setting: Instituto Latinoamericano de Salud Reproductiva (ILSAR), Lima, Peru. Patients. Fetuses with nuchal cystic hygroma. Methods: The data were obtained from the ILSAR database between August 2007 and May 2018, the cases diagnosed by ultrasound from week 11 to 13.6. Nuchal cystic hygroma was defined as the presence of septated liquid content in the nuchal axial section with a thickness above the 95th percentile value for increased nuchal translucency value for the crown-rump length. The karyotype was obtained between the first and second trimeste...

In a prospective study of patients without evidence of infection, which were cesarean, postoperative infectious morbidity was assessed. In a group ampicillin he was given 8.8 days, in a second group ampicillin was used in the perioperative and a third group received no antibiotic. Postoperative infectious complications (endometritis, wound infection, urinary tract infection, pelviperitonitis) were significantly less frequent in patients in whom preoperative antibiotic prophylaxis was used in the other 2 groups. Ampicillin resistance of germs grow observed was achieved. Therefore, in our hospital we would recommend the preoperative use of ampicillin or not use any prophylactic antibiotic in cesareada woman, because of side effects and disadvantages and dangers of indiscriminate use of ampicillin.

The purpose of this communication is to review the importance of fetal maturity determination by non-invasive procedures using ultrasound Doppler velocimetry and grayscale. The authors emphasize the importance of precisely specifying fetal lung maturity when deciding to terminate pregnancy for various indications in order to avoid consequences of prematurity including newborn’s respiratory distress syndrome (RDS) due to absence of lung surfactant that could lead even to death. The authors coincide that a multiparameter diagnosis of gestational age calculation starts from a first ultrasound study between 5 and 10 weeks, assessment of lung vascular impedance by Doppler accompanied by intestinal maturity, degree of cerebral corticalization, presence of nuclei ossification, current biometric fetal age and estimation of weight. They conclude emphasizing that in doubt and presence of a healt...

INVASIVE PROCEDURES IN OBSTETRICS

The first fetal procedures considered as surgical interventions were performed by Liley in 1961, and consisted in whole blood transfusions to fetuses with anemia due to Rh isoimmunization. In 1974, the first diagnostic fetoscopy was performed at the University of Yale, USA. In a historic milestone in 1981, Harrison performed the first drainage in a case of fetal megacystis caused by urethral valve at the University of California. Using ultrasound guidance, he placed a catheter from the bladder to the amniotic cavity. Thus, he is recognized as the "father of fetal surgery". In 1982, fetal surgery specialists from five countries led by Harrison published the first rules governing this new field of medicine. Later, European collaborative groups reviewed the applications of fetal surgery, and ethical and safety standards to be prioritized in centers offering these techniques. In 2011, Americ...

The objective of this study is to determine the resistance index (RI) of the umbilical artery and of the fetal mediam cerebral artery in normal subjects during the second half of pregnancy. It was carried out a longitudinal prospective study of pregnancies without complications from the 20th week through the end of pregnancy. In 125 selected pregnants the resistance index was evaluated in the umbilical artery in area free of the umbilical cord, in absence of breathing movements and with normal heart rhythm, making the reading in wave of uniform flow so that they have similar values in the different calculations. The median cerebral artery was evaluated under the same technical conditions. The evaluations of the resistance index was carried out using the software of the team LOGIO 500 MD/MR 3 of GE. The results show that the RIs of the umbilical artery and the median cerebral artery decre...

Objective.- To determine the value of the doppler ultrasonography like marker of severity in severe preeclampsia. Study method: It was carried out a prospective, longitudinal study, of cohorts, in 56 patients with clinical diagnosis of severe preec­lampsia that studied gestations between 26 and 38 weeks. Results.- IUGR was in 85,7% of cases, oligohydramnios in 36%. The uric acid on the average was of 7,23 ± 1.32 (range 5,5 at 9,5), proteinuria 1,78 ± 1,16 (range 0,11 at 4,91), pressure arterial stocking of 122,8 ± 6,73 (range 114 at 134). notch of the uterine artery was observed in 64%. likewise there were abnormalities of the flow in the umbilical artery and in the uterine artery in 64%, in the art. cerebral stocking 57% and in the Index Fetal Placental in 86%. There was death perinatal in 14%. Aterosis placental in 65%. Positive correlation among the growing levels of uri...

Objectives: To determine whether volumetric ultrasonography (3D, static and dynamic) provides better information than conventional ultrasound (2D) in the assessment of pregnancy before 7 weeks of amenorrhea. Design: Clinical series of cases study. Setting: Instituto Latinoamericano de Salud Reproductiva – ILSAR. Participants: Pregnant women within the fifth and seventh weeks of pregnancy. Interventions: An endovaginal ultrasound was performed to 30 pregnant women between the fifth and seventh weeks of amenorrhea with a GE Volusson Expert 730 using multifrequency endocavitary transductor (3.7-9.3 MHZ), 75% maximum potency in function ‘Early Pregnancy’ without harmonics; test duration was 5-15 minutes. Once the chorionic sac was localized its content was assessed for the yolk sac and the embryo, first using 2D and then static 3D and dynamic 3D (4D). Main outcome measures: Identifica...

INVASIVE PROCEDURES IN OBSTETRICS

Objectives: To determine Doppler fetal pulmonary arterial trunk acceleration/deceleration times (AT/DT) in relation with gestational age, and if there would be a value of such index that would indicate pulmonary maturity with acceptable predictability. Design: Prospective and descriptive study.Setting: Instituto Latinoamericano de Salud Reproductiva, Lima, Peru, a teaching institution. Participants: Healthy women with single pregnancy. Methods: During 2007 and 2008, 79 pregnant women with 26 to 39 weeks healthy singleton pregnancies were studied. AT and DT mean values were measured in the fetal pulmonary arterial trunk using Doppler ultrasound and related to gestational age (GA). Results had statistical analysis to determine a cut value for pulmonary maturity, considering fetuses over 37 weeks have pulmonary maturity and none of the newborns studied had respiratory distress. Main outcome...

In a prospective study of patients without evidence of infection, which were cesarean, postoperative infectious morbidity was assessed. In a group ampicillin he was given 8.8 days, in a second group ampicillin was used in the perioperative and a third group received no antibiotic. Postoperative infectious complications (endometritis, wound infection, urinary tract infection, pelviperitonitis) were significantly less frequent in patients in whom preoperative antibiotic prophylaxis was used in the other 2 groups. Ampicillin resistance of germs grow observed was achieved. Therefore, in our hospital we would recommend the preoperative use of ampicillin or not use any prophylactic antibiotic in cesareada woman, because of side effects and disadvantages and dangers of indiscriminate use of ampicillin.

Objective: To evaluate the use of methotexate (MTX) in the treatment of non-complicated ectopic pregnancy. design: Observational prospective study. Setting: Instituto Latinoamericano de Salud Reproductiva. Participants: Women with non complicated ectopic pregnancy. Interventions: Between 1998 and 2005, 21 cases had ultrasound diagnosis of less than 30 mm adnexal tumor, absence of embryo activity, absence of clinical and/or ultrasound evidence of internal hemorrage and chorionic gonadotropin beta sub unit (hCG-β) less than 3000 mUI/mL. Three women had only 1 uterine tube; one of them received MTX in 2 occasions. Treatment consisted in a single dose of MTX 1mg/kg IV or PO. Follow-up consisted in weekly-β and ultrasonographic assessment (including Doppler color study). Informed consent was applied. Main outcome measures: Ectopic pregnancy resolution. Results: Nineteen cases (95,2%) showed...

We do a brief presentation on the parameters for preterm labor diagnosis, including uterine dynamics, uterine cérvix modifications and ultrasound findings.