We report the case of a pregnant woman attended at our unit with 39 weeks of gestation carrying a fetus affected with left diaphragmatic hernia. An EXIT (ex-utero intrapartum treatment) procedure was carried out in order to reduce hypoxia and aerophagia commonly observed during neonatal intubation. We demonstrate the feasibility of this highly specialized procedure in our local setting, not only for diaphragmatic hernia but also for diseases affecting fetal airway. This procedure is currently a standard procedure in perinatal care of fetuses with diaphragmatic hernia at our hospital.

Twin-to-twin transfusion syndrome is a severe complication of twin monochorial pregnancies manifested with one hypovolemic fetus (donor) and another hypervolemic fetus (receiver). Perinatal mortality is about 90 to 100% if untreated. The accepted treatment is fetoscopy and selective laser photocoagulation of the placental shunts that connect both twins. Currently, this specialized procedure is only performed in our institution. We present the first cases of monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome that underwent laser photocoagulation and fetoscopy.

We report the first successful case of fetal surgery for spina bifida repair in Peru. A pregnant woman was referred to our center at 23 weeks’ gestation because of prenatal diagnosis of spina bifida. We formed a multidisciplinary international team with the goal of performing the first open intrauterine surgery in Peru. We performed a successful intrauterine surgery at 25 weeks of gestation and a healthy infant was born by cesarean section at 37 weeks of gestation. We demonstrated the feasibility of this complex intrauterine surgery in our local setting.

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.

We report a series of three cases with prenatal diagnosis of congenital cystic adenomatoid malformation of the lung, macrocystic type, treated in utero with thoraco-amniotic shunting. This highly specialized intervention is feasible in our local setting. The three cases survived. A mini-review of this condition is presented and an algorithm of prenatal management is proposed.

We report the first successful case of fetal surgery for spina bifida repair in Peru. A pregnant woman was referred to our center at 23 weeks of gestation because of prenatal diagnosis of spina bifida. A multidisciplinary team was formed with the goal of performing the first open intrauterine surgery in Peru. A successful intrauterine surgery was carried out at 25 weeks of gestation and a healthy infant was born by cesarean section at 37 weeks of gestation. We demonstrated the feasibility of this complex intrauterine surgery in our local setting.

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.

The discovery of cell free fetal DNA (cff-DNA) in maternal circulation has profoundly changed the clinical practice of Obstetrics and knocked down an old paradigm in prenatal diagnosis. Over the past five years screening for chromosomal abnormalities has moved from one with a high false positive rate into another more effective and at lower false positive rate. Undoubtedly, this test is the best effective screening tool in Obstetrics.

Objective: To compare gestational age assessed by Capurro test versus the gold standard, the first trimester ultrasound (10+0 to 14+2 weeks) in women with reliable last menstrual period. Design: Retrospective and correlation study. Setting: Instituto Nacional Materno Perinatal, Lima, Perú. Participants: Fetuses and the same once born. Methods: Ultrasound study was performed to 167 pregnant women at 10+0 to 14+2 weeks of gestation during the period 2005 through 2009; gestational age at birth of fetuses calculated by ultrasound was compared with gestational age by Capurro test. Main outcome measures: Comparison of medians of Wilcoxon test, interclass correlation coefficient, Lin’s coefficient concordance correlation, Bland & Altman’s graphic limits of agreement. Results: Mean gestational age assessed by Capurro test was 39 weeks versus 38 weeks determined by the crown rump length (Wil...

Existe un incremento en el número de embarazos de gestantes cada vez de mayor edad, el cual se debe a la postergación voluntaria de la maternidad por lograr un éxito profesional y económico en las mujeres de hoy, y por las cada vez más complejas y desarrolladas técnicas de fertilidad. El presente estudio busca determinar cuales son las complicaciones maternas y perinatales en las gestantes que logran embarazarse después de los 40 años y que acuden al Instituto Nacional Materno Perinatal de Lima durante Enero del 2004 a Diciembre del 2005. Se realizó un estudio, descriptivo, de corte transversal de casos y controles en el que se incluyen todas las gestantes que tienen su parto en el INMP desde el 1ro de enero del 2004 al 31 de diciembre del 2005, siendo los casos las mujeres de 40 a más años, y los controles las mujeres de 20 a 34 años. Además, se realizó un análisis descri...

The discovery of cell free fetal DNA (cff-DNA) in maternal circulation has profoundly changed the clinical practice of Obstetrics and knocked down an old paradigm in prenatal diagnosis. Over the past five years screening for chromosomal abnormalities has moved from one with a high false positive rate into another more effective and at lower false positive rate. Undoubtedly, this test is the best effective screening tool in Obstetrics.

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.

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.

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.

Objectives: Set the values for reference index pulsatilidad of artery uterine between 11-41 weeks of gestation in fetuses healthyin the maternal perinatal national institute in the period 2010 to 2016. Desing: Retrospective Cross-sectional descriptive study.Participants: Healthy fetuses. Main outcome measures: Reference ranges of the uterine artery pulsatility index.

Objective: To establish reference values of pulsatility index of the middle cerebral artery in healthy fetuses. Method: This is adescriptive, retrospective and cross-sectional study conducted at the National Maternal Perinatal Institute between 2014 and 2016.1865 women with a single pregnancy and low risk were registered between 20 and 40 weeks of gestation and were screened DopplerFetal middle cerebral artery.

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.