The iatrogenic risk of HIV vertical transmission, calculated in initial epidemiologic studies, seemed to counterindicate invasive prenatal diagnosis (PND) procedures. The implementation of highly active antiretroviral therapy (HAART) represented a turning point in PND management, owing to a rapid and effective reduction of maternal viral load (VL). In the present study, we identified cases of vertical transmission in HIV-infected pregnant women who did amniocentesis in the second trimester of pregnancy (n = 27), from 1996 to 2011. We divided our sample into Group A—women under HAART when submitted to amniocentesis (n = 20) and Group B—women without antiretroviral therapy before amniocentesis (n = 7). We had 1 case of vertical transmission in Group B. Preconceptional or early first trimester HIV serology is essential to avoid performing an amniocentesis without antiretroviral therapy or viral suppression. When there is an indication for amniocentesis in an HIV-infected pregnant woman, it should be done if the patient is on HAART and, if possible, when VL is undetectable. Nowadays, with combined first trimester screening test to select pregnancies with high risk of aneuploidies, advanced maternal age is a less frequent indication to perform PND invasive procedures, representing an outstanding gain in prenatal diagnosis of this population.

Summary:The fourth heart sound (S4) has been associated with vigorous atrial contraction. However, the presence of' S4 has not been previously correlated with quantitated left atrial filling fraction. In this study, the presence of an auscultatory S4 was compared with the Doppler echocardiographically quantitated left atrial filling fraction in 4 I consecutive patients in whom S4 was judged to be present or absent according to the consensus of cardiologists. Left atrial filling fraction in patients with S4 was 49% arid was significantly greater than 33% found in patient\ without S4 (p<0.005). Using atrial filling fraction of 35% as a dividing line, S4 had a sensitivity of 84% and a specificity of 75% for determining left atrial filling fraction L or <35%. Furthermore, of 25 patients with S4, 21 (84%) had atrial filling fraction 235%, and of 16 patients without S4, 12 (75%) had atrial filling fraction <35%. Thw, the presence or the absence of S4 is quantitatively related to the left atrial filling fraction and appears to predict atrial filling fraction 2 or < 35% reasonably well.

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