RESUMENLa Restricción Selectiva del Crecimiento Intrauterino se produce en 10 a 19% de los gemelos monocoriónicos y se asocia con un aumento importante de la mortalidad y la morbilidad perinatal. La evolución clínica está dada en gran parte por la presencia de anastomosis vaculares y la distribución placentaria asimétrica. Se propuso una clasificación en tres tipos según el Doppler de la arteria umbilical del gemelo más pequeño, la que sé que se correlaciona con distintos comportamientos clínicos y características de la placenta, lo que ayuda en el asesoramiento y conducta obstétrica. Los del tipo I tienen un pronóstico favorable por el resultado perinatal satisfactorio por lo que se recomienda un seguimiento cercano por ecografía y Doppler. Los de tipo II tienen un mal pronóstico y el tipo III un pronóstico intermedio e impredecible. En estos dos últimos se puede realizar un manejo expectante hasta que se observe deterioro del feto pequeño, considerando la posibilidad de la coagulación con láser o la oclusión del cordón (feticidio selectivo). Ambas conductas aparentemente aumentan las posibilidades de supervivencia del feto de peso normal.Palabras claves: restricción selectiva del crecimiento intrauterino, diagnóstico, manejo, gemelos monocoriales, doppler, terapia fetal ABSTRACT Selective intrauterine growth restriction occurs in 10-19% of monochorionic twins and is associated with increased mortality important and perinatal morbidity. The clinical course is given largely by the presence of placental vascular anastomosis and asymmetric distribution. It classified into three types according to the proposed Doppler umbilical artery smaller twin, the one that correlates with different clinical behaviors and characteristics of the placenta, which helps in counseling and obstetric conduct. The type I have a favorable prognosis for satisfactory perinatal outcome so closely monitored by ultrasound and Doppler is recommended. The type II has a poor prognosis and type III intermediate and unpredictable prognosis. In these last two you can make an expectant management until deterioration of the small fetus is observed, considering laser coagulation or cord occlusion(selective feticide). Both behaviors appear to increase the chances of survival of the fetus of normal weight.
RESUMENLa medida de la Translucencia Nucal (TN) es un método ampliamente aceptado en el cribado de anomalías cromosómicas. Su técnica está bien descrita y estandarizada, refiriéndose como aumentada cuando la medida está por encima del percentil 95. Su combinación con la edad materna, hueso nasal y marcadores bioquímicos, pueden detectar aproximadamente el 90% de los fetos con Trisomía 21 y en forma aislada el 70% con una tasa de falsos positivos del 5%.Se han atribuido como causa de su aumento a la falla cardíaca, alteración en la composición de la matriz extracelular, hipoproteinemia fetal, congestión venosa en cabeza y cuello, fallo del drenaje linfático, infecciones congénitas o anemia fetal.Su aumento se ha asociado a abortos o muertes fetales, anomalías fetales mayores y entre ellas las cardíacas o bien Síndromes genéticos, asociado a infecciones, macrosomía e incluso retraso en el desarrollo, por lo que no solamente se circunscribe a las alteraciones cromosómicas. De ahí radica su importancia de conocer el manejo de estas pacientes, en especial si el cariotipo es normal.Palabras Clave: trasnlucencia nucal, cromosomopatías, ecografía semana 11 -13+6, cribado.
This case report illustrates the prenatal diagnosis of fetal hypothyroidism in a nulliparous 31-year-old woman with a history of four previous cesarean sections. She was presented with chronic renal failure of unknown etiology and had been on dialysis for 3 years along with a subclinical hypothyroidism. At 21.4 weeks of gestation, color Doppler revealed a fetus with symmetrical solid mass in the anterior cervical region with little vascularization compatible with fetal goiter. Aminotic fluid was also increased for gestational age. At 25 weeks of gestation, due to maternal respiratory distress, an amniodrainage was performed. From the same sample, thyroid-stimulating hormone (TSH) was determined yielding 1.3 mIU/mL and 0.1 ng/dL for free T4. At 27 weeks of gestation, membrane rupture occurred. Chorioamniotis was suspected and cesarean section was performed extracting a live 1060 gm female newborn. The newborn was 29 weeks of age by Capurro test and Apgar score was 7/08. On physical examination, a 2 to 3 cm symmetrical tumor was found in cervical region. Admitted to neonatal intensive care unit for mechanical respiratory support, four ampoules of T4 were given, achieving complete regression of thyroid gland size at 15 days of life. At 34 days of age, nosocomial infection, Klepsiella neumonie, was confirmed and death occurred at 40 days of life. Isolated fetal hypothyroidism is rare. Ultrasound evaluation allows the identification of compensatory growth of the thyroid, showing a hypoechoic solid image. In extreme cases, it may cause esophageal obstruction and polyhydramnios as well as cervical hyperextension and dystocia during labor. How to cite this article Ruoti Cosp M, Gruhn E, Ontano M, Calabrese E, Mendoza L. Fetal Hypothyroidism. Donald School J Ultrasound Obstet Gynecol 2016;10(3):326-329.
Evaluación ecográfica del ductus venoso fetal y sus aplicaciones Clínicas en la Obstetricia actual Ultrasound evaluation of the fetal venous ductus and its clinical applications in the current Obstetrics
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