Fetal anemia is a rare condition that can be potentially lethal to the fetus, unless timely diagnosis and management take place. Etiology varies from autoimmune (Rh isoimmunization) to infectious (parvovirus B19) disorders, hemoglobinopathies, fetal-maternal hemorrhage and complications of monochorionic pregnancies. Diagnosis may be by invasive (cordocentesis) or non-invasive (medial cerebral artery peak systolic velocity – MCA-PSV) methods, although the latter is preferred. Treatment consisting in intrauterine transfusion achieves a survival of up to 90% without neurological sequelae. This article reviews the definition, classification, etiology, diagnosis and updated management of fetal anemia.

Preterm birth is the final common pathway of a series of different physiopathological processes, so it is considered a syndrome. Spontaneous preterm birth represents two thirds of preterm deliveries. Prevention can be primary or secondary, and is basically focused on prediction, which is currently done by risk calculators that combine medical history, cervical length and fetal fibronectin. Vaginal progesterone reduces the rate of spontaneous preterm birth to 35-40%, if used from week 16 through week 34.

In fetal anemia hemoglobin (Hb) concentration is below 2 standard deviations or <0.84 MoM in relation to median Hb in the general population. Gold standard in diagnosis is measuring fetal Hb by percutaneous chordocentesis, but medial cerebral artery systolic velocity peak (MCA – SVP) would be the best test for non invasive diagnosis of fetal anemia. MCA – SVP levels equal or above 1.55 MoM for gestational age correlate with moderate to severe fetal anemia. It is important to emphasize that a trained operator is conditio sine qua non for the correct sampling of MCA - SVP. It is useful to remember that MCA- SVO measurement has a high 12% false positives increasing at 35 weeks and following blood transfusion.

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.

Selective intrauterine growth restriction is a rare complication of monochorionic gestation characterized by growth deficiency of one fetus, phenomenon due to asymmetric distribution of the placental territory; the influence of the vascular anastomosis determines the type of evolution in each case. Umbilical artery Doppler study of the restricted fetus determines the clinical status and possible outcome in order to minimize risk of intrauterine death and brain damage in both fetuses.

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.

We report a case of massive unilateral hydrothorax diagnosed in an 18-weeks-old fetus with a normal karyotype. The fetus was severely affected by hydrops and bradycardia since week 24. Initially, we performed pleurodesis, but the hydrothorax worsened and evolved into hydrops, so we proceeded to insert a transplacental thoracoamniotic shunt. Improvement was evident one week after the procedure, and the hydrothorax resolved during the remainder of the pregnancy. Following cesarean delivery at 37 weeks, the neonate required prolonged NICU stay. He was discharged after two months and remains stable until the present time.

OBJECTIVES. To determine the frequency of intrauterine fetal death in a IV level reference institute, in Lima, Peru, and sensitize medical personnel on its importance and to identify critical points in order to motivate related specific investigations. DESIGN. Retrospective study of clinical charts. SETTING. Instituto Especializado Materno Perinatal (IEMP), a teaching hospital. POPULATION. Cases of intrauterine fetal death. INTERVENTIONS. We reviewed clinical charts of all cases of intrauterine fetal death registered in the Statistical and Informatic Direction, Instituto Especializado Materno Perinatal, occurred between January 1 and December 31, 2003. Data were registered in the Historia Clinica Perinatal Base chart (CLAP/ OPS-OMS) and processed with Sistema Informatico Perinatal V.1.5 software. MAIN OUTCOME MEASURES. Frequency of intrauterine fetal death. RESULTS. There were 17 869 del...

Background: The absolute and relative risks associated with the trial of labour in women with previous cesarean section have led to an increase in the rate of caesarean sections, despite the evidence that demonstrates the safety and benefits of trial of labour. Objectives: To determine maternal and perinatal outcomes of pregnant women with prior cesarean section to whom trial of labor was indicated. Design: Cohorts, retrospective, analytical study. Setting: Fetal Medicine Unit, Instituto Nacional Materno Perinatal, Lima, Peru. Participants: Pregnant women with prior cesarean section and attended at their delivery. Interventions: We reviewed clinical records of 584 women with history of previous cesarean section who delivered at Instituto Nacional Materno Perinatal between January and December 2007. We excluded patients who did not meet inclusion criteria and reviewed outcomes of the rema...

Objectives: To determine cervical length measured by transvaginal ultrasound between 22 and 24 weeks’ gestation in the prediction of spontaneous preterm birth. Design: Observational analytic cohort type study. Setting: Fetal Medicine Unit, Instituto Nacional Materno Perinatal, Lima, Peru. Participants: Pregnant women with single gestation. Interventions: Cervical length was measured by transvaginal ultrasound in 1 218 pregnant women during routine prenatal care, between 22 to 24 weeks of gestation, in a tertiary hospital center. Main outcome measures: Cervical length measured at 22-24 weeks of gestation and its correlation with spontaneous preterm delivery. Results: The incidence of spontaneous preterm delivery was 11,8%. Cervical  length was normally distributed. Mean (+/- SD) cervical length was 35,1 +/- 8,5 mm (range, 11-72 mm).  Cervical length, history of preterm delivery, multi...

  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.

Objetivos. Determinar la sensibilidad y especificidad del ultrasonido en la detección prenatal del acretismo placentario. Materiales y Métodos. Diseño: Estudio observacional analítico retrospectivo Lugar: Unidad de Medicina Fetal. Instituto Nacional Materno Perinatal. Lima-Perú. Participantes: Gestantes que acudieron a la Unidad entre el 02 de enero y el 31 de diciembre del 2012, para realización de ecografía obstétrica por sospecha de acretismo. Se revisaron las historias clínicas de 93 pacientes evaluadas mediante ecografía durante el segundo y tercer trimestre buscando signos de acretismo, comparando luego con los hallazgos durante el parto y la anatomía patológica. Resultados. La sensibilidad del diagnóstico ecográfico de acretismo placentario es de 90.9% y la especificidad de 99%. La edad gestacional al momento del diagnóstico ecográfico fue en el 50% de casos entre ...

In fetal anemia hemoglobin (Hb) concentration is below 2 standard deviations or <0.84 MoM in relation to median Hb in the general population. Gold standard in diagnosis is measuring fetal Hb by percutaneous chordocentesis, but medial cerebral artery systolic velocity peak (MCA – SVP) would be the best test for non invasive diagnosis of fetal anemia. MCA – SVP levels equal or above 1.55 MoM for gestational age correlate with moderate to severe fetal anemia. It is important to emphasize that a trained operator is conditio sine qua non for the correct sampling of MCA - SVP. It is useful to remember that MCA- SVO measurement has a high 12% false positives increasing at 35 weeks and following blood transfusion.

Background: The absolute and relative risks associated with the trial of labour in women with previous cesarean section have led to an increase in the rate of caesarean sections, despite the evidence that demonstrates the safety and benefits of trial of labour. Objectives: To determine maternal and perinatal outcomes of pregnant women with prior cesarean section to whom trial of labor was indicated. Design: Cohorts, retrospective, analytical study. Setting: Fetal Medicine Unit, Instituto Nacional Materno Perinatal, Lima, Peru. Participants: Pregnant women with prior cesarean section and attended at their delivery. Interventions: We reviewed clinical records of 584 women with history of previous cesarean section who delivered at Instituto Nacional Materno Perinatal between January and December 2007. We excluded patients who did not meet inclusion criteria and reviewed outcomes of the rema...

Objectives: To determine cervical length measured by transvaginal ultrasound between 22 and 24 weeks’ gestation in the prediction of spontaneous preterm birth. Design: Observational analytic cohort type study. Setting: Fetal Medicine Unit, Instituto Nacional Materno Perinatal, Lima, Peru. Participants: Pregnant women with single gestation. Interventions: Cervical length was measured by transvaginal ultrasound in 1 218 pregnant women during routine prenatal care, between 22 to 24 weeks of gestation, in a tertiary hospital center. Main outcome measures: Cervical length measured at 22-24 weeks of gestation and its correlation with spontaneous preterm delivery. Results: The incidence of spontaneous preterm delivery was 11,8%. Cervical  length was normally distributed. Mean (+/- SD) cervical length was 35,1 +/- 8,5 mm (range, 11-72 mm).  Cervical length, history of preterm delivery, multi...

OBJECTIVES. To determine the frequency of intrauterine fetal death in a IV level reference institute, in Lima, Peru, and sensitize medical personnel on its importance and to identify critical points in order to motivate related specific investigations. DESIGN. Retrospective study of clinical charts. SETTING. Instituto Especializado Materno Perinatal (IEMP), a teaching hospital. POPULATION. Cases of intrauterine fetal death. INTERVENTIONS. We reviewed clinical charts of all cases of intrauterine fetal death registered in the Statistical and Informatic Direction, Instituto Especializado Materno Perinatal, occurred between January 1 and December 31, 2003. Data were registered in the Historia Clinica Perinatal Base chart (CLAP/ OPS-OMS) and processed with Sistema Informatico Perinatal V.1.5 software. MAIN OUTCOME MEASURES. Frequency of intrauterine fetal death. RESULTS. There were 17 869 del...

  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.

Objetivos. Determinar la sensibilidad y especificidad del ultrasonido en la detección prenatal del acretismo placentario. Materiales y Métodos. Diseño: Estudio observacional analítico retrospectivo Lugar: Unidad de Medicina Fetal. Instituto Nacional Materno Perinatal. Lima-Perú. Participantes: Gestantes que acudieron a la Unidad entre el 02 de enero y el 31 de diciembre del 2012, para realización de ecografía obstétrica por sospecha de acretismo. Se revisaron las historias clínicas de 93 pacientes evaluadas mediante ecografía durante el segundo y tercer trimestre buscando signos de acretismo, comparando luego con los hallazgos durante el parto y la anatomía patológica. Resultados. La sensibilidad del diagnóstico ecográfico de acretismo placentario es de 90.9% y la especificidad de 99%. La edad gestacional al momento del diagnóstico ecográfico fue en el 50% de casos entre ...

Introducción: A través de los años, la macrosomía en recién nacidos se ha ligado a alta tasa de morbimortalidad materna -perinatal, siendo doble comparado con los recién nacidos no macrosómicos, existe incremento de peso al nacer con los años. En el INMP en el año 2016, 8.7% de todos los partos fueron macrosómicos por lo que se aborda el estudio. Objetivo: Determinar los resultados perinatales según vía de parto en los recién nacidos macrosómicos atendidos en el Instituto Nacional Materno Perinatal en el período enero – diciembre 2019. Materiales y Métodos: Estudio descriptivo comparativo, retrospectivo, transversal, con muestra censal de 430 historias clínicas. Las variables: resultados perinatales (Apgar, necesidad de hospitalización, complicaciones, peso del recién nacido) y vía de parto (parto vía vaginal, cesárea electiva, cesárea de...

Umbilical arteries (UA) resistance is assessed to detect growth restriction due to an inadequate placentation in small infants at risk of perinatal death and longterm incapacity. The umbilical artery pulsatility index (UA PI) must be compared with a statistically selected reference chart. Objective: To identify the pulsatility index (PI) reference curve whose critical value best matches our population data. Methods: The cohort was described in a previous study of 1 753 fetuses with 2 031 measurements of the PI of the uterine arteries and umbilical arteries with normal maternal-perinatal outcome. Results: PI UA had a significant negative correlation (r= -0.42) with gestational age (GA). The 95th percentile of our patients was significantly different from those published by Arduini, Acharya, Ciobanu, Baschat and Limay. Conclusion: The umbilical artery pulsatility index figures obtained con...