Bienvenido Puerto - Academia.edu (original) (raw)
Papers by Bienvenido Puerto
The Ultrasound Review of Obstetrics & Gynecology, 2002
ABSTRACT During the past decade, an increasing number of reports concerning the diagnosis of most... more ABSTRACT During the past decade, an increasing number of reports concerning the diagnosis of most major congenital heart defects (CHDs) using early fetal echocardiography (before the 18th week of gestation) have been reported in both low- and high-risk populations for CHD. The finding of increased nuchal translucency seems to be the strongest predictor of CHD during the first trimester. Although some malformations are detected as early as 11 weeks' gestation, the optimal gestational age to perform the early scan is at least 13 weeks' gestation. Transvaginal ultrasound is the preferred approach, although most authors agree that results can be improved if transabdominal ultrasound is also incorporated. The further application of color Doppler enhances visualization. The sensitivity and specificity for the detection of CHD are of an acceptable level, compared with mid-gestational echocardiography. CHDs diagnosed early in pregnancy tend to be more complex than those detected later, with a higher incidence of associated structural malformations, chromosomal abnormalities and spontaneous abortions. The neonate follow-up or postmortem examination in the case of termination of pregnancy is essential to assess the actual role of early fetal echocardiography.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2003
To describe the time sequence of changes in cardiac function in intrauterine growth restriction. ... more To describe the time sequence of changes in cardiac function in intrauterine growth restriction. This was a prospective longitudinal study on 22 singleton pregnancies with growth-restricted fetuses. Pulsatility indices of fetal arterial and venous Doppler waveforms, systolic peak velocity in the aorta and pulmonary artery, right and left ventricular shortening fraction and atrioventricular flow E/A ratio were assessed at each monitoring session. Logistic regression was used for modeling the probability of abnormality of a variable in relation to the time interval before delivery. Trends over time were analyzed by Mann-Withney U-test. Umbilical artery pulsatility index was the first variable to become abnormal, followed by the middle cerebral artery, right diastolic indices (right E/A, ductus venosus), right systolic indices and, finally, both diastolic and systolic left cardiac indices. We have found an earlier and more pronounced right than left and diastolic than systolic fetal cardiac function deterioration in growth restricted fetuses monitored longitudinally.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1993
The maternal and perinatal outcome of seven gravidas receiving 2.2-2.5 mg/kg per day of indometha... more The maternal and perinatal outcome of seven gravidas receiving 2.2-2.5 mg/kg per day of indomethacin for polyhydramnios are reported. Such therapy was started between 26 and 33 weeks of gestational age (mean, 30.4 weeks) and lasted for 20.1 days (range, 2-37 days). Median of amniotic fluid index ranged from 47 at the start of therapy (range, 32-53) to 15 (range, 2-50) when indomethacin was ended. Interval between the end of the therapy and the delivery ranged from 0 to 45 days (mean, 15 days). On average, pregnancies were prolonged by 5.1 weeks (range, 2-8 weeks). The newborn weight was 2678 g on average (range, 620-3700 g). Oligohydramnios was seen in two instances; one patient developed constriction of the fetal ductus arteriosus, which returned to normality after indomethacin suppression; one newborn in which other causes of neonatal bleeding could be excluded, developed a disseminated intravascular coagulation and died 15 h after birth. Finally, one mother presented an acute renal failure immediately after indomethacin administration; this patient completely recovered after indomethacin withdrawal. Thus, the benefit of pregnancy prolongation should be balanced against the increased risks for the newborn, mainly fetal ductus arteriosus constriction and possible bleeding disorders. A causal relationship of indomethacin administration to the latter complication warrants further investigation.
Ultrasound in Obstetrics and Gynecology, 2005
Conclusions: About a third of severe non chromosomic fetal malformations diagnosed by ultrasound ... more Conclusions: About a third of severe non chromosomic fetal malformations diagnosed by ultrasound examination may be detected at the 11 + 0 to 13 + 6 week scan.
Ultrasound in Obstetrics and Gynecology, 2003
On the ''4 optimal chamber view'', we propose to check 4 key points: pulmonary inferior veins att... more On the ''4 optimal chamber view'', we propose to check 4 key points: pulmonary inferior veins attaching the heart to lungs, in a strict axial plane; 4 chambers, mobile, balanced and concordant with a normal offset of the AV valves on the crux of the heart. We also describe the difficulties and the possible traps of the 4 chamber view. We justify each key-point by the pathology it helps diagnose.
Ultrasound in Obstetrics and Gynecology, 2003
We describe a case of early prenatal diagnosis of a major congenital heart anomaly and trisomy 18... more We describe a case of early prenatal diagnosis of a major congenital heart anomaly and trisomy 18 in a low-risk pregnant woman. Nuchal translucency (NT) measurement at 13 weeks' gestation was 1.2 mm and Doppler evaluation of the ductus venosus detected a persistent reversed flow during atrial contraction. This finding prompted us to perform fetal echocardiography which showed hypoplastic left heart syndrome. Karyotyping following chorionic villus sampling diagnosed trisomy 18. Review of the recent literature suggests that the finding of an abnormal ductus venosus Doppler pattern in the late first trimester of pregnancy may be an early sign of either congenital cardiac or chromosomal abnormality, even in the presence of normal NT screening.
Ultrasound in Obstetrics and Gynecology, 2001
Purpose: To evaluate the efficiency of transvaginal ultrasound in the early diagnosis of ovarian ... more Purpose: To evaluate the efficiency of transvaginal ultrasound in the early diagnosis of ovarian cancer. Methods: Screening transvaginal ultrasound has been annually performed during the last 2 years in asymptomatic women without familial history of ovarian cancer. When abnormalities were detected, the procedure was repeated after 4-6 weeks. If the findings disappeared, the study was repeated after 1 year. If the abnormality persisted, study was complemented with tumor markers, computed tomography and laparoscopic surgery. The findings were compared with a control group of women in whom ovarian transvaginal ultrasonography was formally indicated. Results: A total of 26007 transvaginal ultrasound were performed: 8813 (33.8%) belonged to the screening group and 17194 (66.2%) to the control group. In 14 patients of the screening group, a malignant tumor was diagnosed and histologically confirmed. The mean age of these patients was 45 years old (SD 12). Eleven of these tumors were stage I (seven Ia, and four Ic), two stage IIIc and one was a metastatic melanoma in both ovaries. Six lesions were borderline tumors (five serous and one mucinous). In the control group, 27 ovarian cancers were diagnosed in patients with a mean age of 48 years (SD 17). In this group, 11 tumors were in stage I, and six were borderline. Conclusions: Although consensus about the benefits of using transvaginal ultrasound as a screening procedure is not conclusive, our data reveals that tumors detected in patients screened with transvaginal ultrasound are in earlier stages when compared with those diagnosed in the control group. No differences were found in age and number of borderline tumors between both groups. Additional studies are needed to support this preliminary findings.
Ultrasound in Obstetrics and Gynecology, 2002
Background: The aim of the study was to assess prospectively the evolution of multiple clinical p... more Background: The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy. Method: A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied.
Journal of assisted reproduction and genetics, 2000
Our purpose was to determine prospectively, using receiver-operating characteristic (ROC) analysi... more Our purpose was to determine prospectively, using receiver-operating characteristic (ROC) analysis, whether the ovarian reserve test with hMG could improve the predictive value of a woman's age and basal levels of follicle stimulating hormone (FSH), E2, and inhibin or any combination of them regarding ovarian response and pregnancy rate in IVF treatment following pituitary desensitization. The hMG test was performed within 3 months of IVF treatment in 80 women undergoing the first cycle of IVF and consisted of 2 ampoules of hMG daily for 5 days starting on cycle days 2 to 3. Hormone and ultrasound evaluation was performed on cycle days 2 to 3 and 7 to 8. The mean age and basal FSH levels were significantly higher in the canceled (n = 28) than in the control (n = 52) group, whereas the basal inhibin level was significantly higher in the latter. Regarding ovarian response, the combination FSH plus inhibin had the better diagnostic accuracy (predictive value of 70%) among basal var...
Ultrasound in Obstetrics and Gynecology, 2007
18 ± 3.4%. PPROM (37%) occurred prior to 32 weeks in 2/16 cases. In all but two cases the balloon... more 18 ± 3.4%. PPROM (37%) occurred prior to 32 weeks in 2/16 cases. In all but two cases the balloon could be removed electively at 34.2 ± 1 weeks. Mean GA at birth was 35.4 ± 2 weeks; 44% of fetuses survived (7/16), which fell to 30% (3/10) when cases undergoing FETO beyond 30 weeks were considered. Conclusions: In our experience survival after FETO decreases with GA at balloon insertion. Gestational age at birth and PPROM rates are no different from those reported in cases occluded earlier. Based on experimental data and available clinical experience we would restrict late FETO to fetuses with larger lung sizes (O/E LHR > 25%, who are currently not eligible) or to cases presenting late in gestation.
Ultrasound in Obstetrics and Gynecology, 2007
Progresos de Obstetricia y Ginecología, 2004
ABSTRACT Ectopic pregnancy in a previous cesarean section scar is the rarest of ectopic pregnancy... more ABSTRACT Ectopic pregnancy in a previous cesarean section scar is the rarest of ectopic pregnancy locations and is possibly one of the most dangerous because of the risk of uterine rupture and hemorrhage. Few reports on this type of ectopic pregnancy have been published and differential diagnosis may be difficult. Because the diagnostic criteria and prognosis are uncertain, consensus on the preferred treatment is lacking.
Donald School Journal of Ultrasound in Obstetrics & Gynecology, 2009
A female fetus of a dizygotic pregnancy presented with a retrovesical cystic mass at 16 weeks. Se... more A female fetus of a dizygotic pregnancy presented with a retrovesical cystic mass at 16 weeks. Severe and recurrent fetal ascitis developed at 25 weeks. Pre-eclampsia, probably due to mirror syndrome, precipitated fetal extraction, which led to severe prematurity complications and neonatal death. Necropsy showed: cloacal anomaly, anal atresia, ambiguous genitalia and bicornuate uterus.
Diagnóstico Prenatal, 2012
información del artículo Historia del artículo: Recibido el 12 de junio de 2012 Aceptado el 13 de... more información del artículo Historia del artículo: Recibido el 12 de junio de 2012 Aceptado el 13 de junio de 2012 On-line el 27 de julio de 2012 Palabras clave: Embarazo gemelar monocorial Síndrome de transfusión feto-fetal Secuencia anemia-policitemia Restricción de crecimiento intrauterino selectivo Malformación discordante r e s u m e n El embarazo gemelar monocorial (MC) se presenta en uno de cada 250 embarazos y representa una proporción significativa de morbi mortalidad perinatal en los embarazos gemelares y en general. El manejo óptimo de los MC se basa en 2 aspectos fundamentales: clasificación temprana de la corionicidad y seguimiento estricto. El diagnóstico diferencial de las complicaciones del MC sigue siendo todavía un reto para el especialista de medicina fetal. Esto se debe a la frecuente superposición de signos clínicos y a las relaciones complejas entre las potenciales complicaciones. La experiencia clínica demuestra que en la mayoría de los casos la clasificación y el manejo adecuado se pueden lograr mediante la aplicación sistemática de conceptos sencillos. Esta revisión proporciona una visión global que permite una compresión integral de los embarazos gemelares MC, sus posibles complicaciones y los conceptos claves que permiten un diagnóstico diferencial adecuado y un manejo específico. © 2012 Asociación Española de Diagnóstico Prenatal. Publicado por Elsevier España, S.L. Todos los derechos reservados.
Ultrasound in Obstetrics and Gynecology, 2001
ABSTRACT Introduction: Classification of hypertensive disorders of pregnancy is problematic due t... more ABSTRACT Introduction: Classification of hypertensive disorders of pregnancy is problematic due to variable clinical presentation and confusing terminology. Management is based on severity of clinical and laboratory criteria, which, unfortunately, do not select pregnancies that will be delivered because of maternal or fetal indication.Objective: To evaluate whether maternal uterine Doppler evaluation correlates with fetal Doppler study and maternal and perinatal results.Design: Twelve women with pregnancy-induced hypertension (ISSHP criteria) between 26 and 38 weeks of gestation were divided into two groups based on uterine Doppler examination (presence – group A, or absence – group B, of a bilateral protodiastolic uterine notch) at diagnosis.Results: There were seven patients in group A (four severe and three mild pre-eclampsia) and five patients in group B (one severe and one mild pre-eclampsia, two severe gestational hypertension, one Hellp syndrome). The mean gestational age at delivery (weeks gestation), the mean birth weight (grams) and the mean umbilical artery pH in groups A and B were, respectively, 31.1 vs. 36.1, 1256 vs. 2428, and 7.20 vs. 7.25. Doppler evaluation showed statistically significant higher pulsatility index of the right and left uterine artery, as well as in the umbilical artery, in group A vs. group B. Fetal vascular redistribution or a ductus venosus PI >1 were detected only in group A (5/7 and 3/7, respectively), whereas in none of the group B. Indication for delivery was always for fetal risk (four cases) or maternal risk (three cases) among group A, whereas for maternal indication was only in one case of the group B.Comments: We suggest that uterine Doppler examination at the time of diagnosis in patients with hypertensive disorders of pregnancy may help to identify pregnancies at serious maternal and fetal risks better than classical clinical and laboratory criteria.
Ultrasound in Obstetrics and Gynecology, 1995
Ultrasound in Obstetrics and Gynecology, 2006
To establish reference ranges for blood flow velocity waveforms (FVW) of the fetal aortic isthmus... more To establish reference ranges for blood flow velocity waveforms (FVW) of the fetal aortic isthmus (AoI) during the second and third trimesters of pregnancy. This was a prospective cross-sectional observational study involving 458 uncomplicated singleton pregnancies between 19 and 37 weeks of gestation. Fetal AoI Doppler parameters were assessed in either the longitudinal aortic arch view or the three vessels and trachea view. Regression analysis was used to determine gestational-age-specific reference ranges and to construct nomograms for the following Doppler parameters: pulsatility index (PI), resistance index (RI) and peak systolic (PSV), end-diastolic (EDV) and time-averaged maximum (TAMXV) velocities. Intra- and interobserver reproducibility were evaluated by calculating intraclass correlation coefficients (ICCs) and limits of agreement. Reliable FVW in the AoI were obtained in all cases. Acceptable intra- and interobserver reproducibility was obtained. With advancing gestation, there was a significant increase in PSV, TAMXV and PI, whereas RI and EDV remained constant during the second half of pregnancy. No cases of absent or reversed flow during diastole were detected. Normal data of the fetal AoI blood FVW throughout the second and third trimesters of pregnancy are provided. The reported Doppler profiles may be of clinical use in the assessment of hemodynamically compromised growth-restricted fetuses.
Ultrasound in Obstetrics and Gynecology, 2003
Methods Data were collected from all singleton pregnancies seen in our Fetal Surveillance Unit wh... more Methods Data were collected from all singleton pregnancies seen in our Fetal Surveillance Unit who underwent antenatal monitoring for fetal growth restriction, nonreactive NST and arterial redistribution beyond 26 weeks of pregnancy. Patients were divided into four groups based on their CST and ductus venosus waveform results. Perinatal outcome was evaluated by means of four variables: the need for admission to the neonatal intensive care unit (NICU), need for neonatal intubation, an umbilical artery pH < 7.10 and significant neonatal morbidity. Outcome was compared among fetuses delivered within 3 days of their antenatal test. Logistic regression analysis was used to analyze the relation between predictive and outcome variables.
Ultrasound in Obstetrics and Gynecology, 2008
Oral poster abstracts OP20.09 The uteroplacental and fetal circulation in ongoing pregnancies wit... more Oral poster abstracts OP20.09 The uteroplacental and fetal circulation in ongoing pregnancies with known fetal malformations -correlation with maternal distress Objectives: To prospectively investigate the correlation between maternal distress after prenatal diagnosis of fetal malformations and the feto-maternal circulation. Methods: A cohort of women (group A, n = 30) carrying a fetus with a non-cardiac malformation underwent Doppler blood flow measurements and psychometric evaluation at fixed points from the time of diagnosis throughout pregnancy. The same protocol was used in controls (group B, n = 29) with presumably healthy fetuses. At 29-31 weeks gestational age (GA), mean uterine artery (UtA) pulsatility index (PI), umbilical artery (UA) PI, middle cerebral artery (MCA) PI, and ductus venosus (DV) PI for veins (PIV) were measured. MCA/UA PI ratio (MCA/UA) was calculated. Psychological distress was measured by Impact of Event Scale (IES) self-report questionnaire. IES subscores for intrusion, avoidance, and arousal were calculated. Results: There were no significant differences in GA or parity between the groups. Median maternal age was significantly lower in group A (31.0 yrs (19-40) vs. 33.0 (23-39), P = 0.034), but this was not correlated with either parity or any of the outcome measures. Doppler findings did not differ significantly between the groups except UtA PI (A: 0.63 ± 0.13 vs. B: 0.74 ± 0.15, P = 0.006). IES scores were significantly higher in group A (IESsum P = 0.003, intrusion P = 0.002, avoidance P < 0.001, arousal P = 0.015). In the overall group, the only correlation between Doppler results and psychometric scores was found between UA PI and avoidance (r = 0.281, P = 0.034). In group A there was a correlation between both MCA PI and MCA/UA, and IESsum (r =−0.456, P = 0.011;r=−0.380, P = 0.038), intrusion (r =−0.475, P = 0.008;r=−0.436, P = 0.016), and avoidance (r =−0.368, P = 0.045;r=−0.375, P = 0.041), respectively. Conclusions: In women carrying a fetus with known malformation there may be a correlation between maternal distress and the fetal cerebral circulation at 30 weeks of GA.
The Ultrasound Review of Obstetrics & Gynecology, 2002
ABSTRACT During the past decade, an increasing number of reports concerning the diagnosis of most... more ABSTRACT During the past decade, an increasing number of reports concerning the diagnosis of most major congenital heart defects (CHDs) using early fetal echocardiography (before the 18th week of gestation) have been reported in both low- and high-risk populations for CHD. The finding of increased nuchal translucency seems to be the strongest predictor of CHD during the first trimester. Although some malformations are detected as early as 11 weeks' gestation, the optimal gestational age to perform the early scan is at least 13 weeks' gestation. Transvaginal ultrasound is the preferred approach, although most authors agree that results can be improved if transabdominal ultrasound is also incorporated. The further application of color Doppler enhances visualization. The sensitivity and specificity for the detection of CHD are of an acceptable level, compared with mid-gestational echocardiography. CHDs diagnosed early in pregnancy tend to be more complex than those detected later, with a higher incidence of associated structural malformations, chromosomal abnormalities and spontaneous abortions. The neonate follow-up or postmortem examination in the case of termination of pregnancy is essential to assess the actual role of early fetal echocardiography.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2003
To describe the time sequence of changes in cardiac function in intrauterine growth restriction. ... more To describe the time sequence of changes in cardiac function in intrauterine growth restriction. This was a prospective longitudinal study on 22 singleton pregnancies with growth-restricted fetuses. Pulsatility indices of fetal arterial and venous Doppler waveforms, systolic peak velocity in the aorta and pulmonary artery, right and left ventricular shortening fraction and atrioventricular flow E/A ratio were assessed at each monitoring session. Logistic regression was used for modeling the probability of abnormality of a variable in relation to the time interval before delivery. Trends over time were analyzed by Mann-Withney U-test. Umbilical artery pulsatility index was the first variable to become abnormal, followed by the middle cerebral artery, right diastolic indices (right E/A, ductus venosus), right systolic indices and, finally, both diastolic and systolic left cardiac indices. We have found an earlier and more pronounced right than left and diastolic than systolic fetal cardiac function deterioration in growth restricted fetuses monitored longitudinally.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1993
The maternal and perinatal outcome of seven gravidas receiving 2.2-2.5 mg/kg per day of indometha... more The maternal and perinatal outcome of seven gravidas receiving 2.2-2.5 mg/kg per day of indomethacin for polyhydramnios are reported. Such therapy was started between 26 and 33 weeks of gestational age (mean, 30.4 weeks) and lasted for 20.1 days (range, 2-37 days). Median of amniotic fluid index ranged from 47 at the start of therapy (range, 32-53) to 15 (range, 2-50) when indomethacin was ended. Interval between the end of the therapy and the delivery ranged from 0 to 45 days (mean, 15 days). On average, pregnancies were prolonged by 5.1 weeks (range, 2-8 weeks). The newborn weight was 2678 g on average (range, 620-3700 g). Oligohydramnios was seen in two instances; one patient developed constriction of the fetal ductus arteriosus, which returned to normality after indomethacin suppression; one newborn in which other causes of neonatal bleeding could be excluded, developed a disseminated intravascular coagulation and died 15 h after birth. Finally, one mother presented an acute renal failure immediately after indomethacin administration; this patient completely recovered after indomethacin withdrawal. Thus, the benefit of pregnancy prolongation should be balanced against the increased risks for the newborn, mainly fetal ductus arteriosus constriction and possible bleeding disorders. A causal relationship of indomethacin administration to the latter complication warrants further investigation.
Ultrasound in Obstetrics and Gynecology, 2005
Conclusions: About a third of severe non chromosomic fetal malformations diagnosed by ultrasound ... more Conclusions: About a third of severe non chromosomic fetal malformations diagnosed by ultrasound examination may be detected at the 11 + 0 to 13 + 6 week scan.
Ultrasound in Obstetrics and Gynecology, 2003
On the ''4 optimal chamber view'', we propose to check 4 key points: pulmonary inferior veins att... more On the ''4 optimal chamber view'', we propose to check 4 key points: pulmonary inferior veins attaching the heart to lungs, in a strict axial plane; 4 chambers, mobile, balanced and concordant with a normal offset of the AV valves on the crux of the heart. We also describe the difficulties and the possible traps of the 4 chamber view. We justify each key-point by the pathology it helps diagnose.
Ultrasound in Obstetrics and Gynecology, 2003
We describe a case of early prenatal diagnosis of a major congenital heart anomaly and trisomy 18... more We describe a case of early prenatal diagnosis of a major congenital heart anomaly and trisomy 18 in a low-risk pregnant woman. Nuchal translucency (NT) measurement at 13 weeks' gestation was 1.2 mm and Doppler evaluation of the ductus venosus detected a persistent reversed flow during atrial contraction. This finding prompted us to perform fetal echocardiography which showed hypoplastic left heart syndrome. Karyotyping following chorionic villus sampling diagnosed trisomy 18. Review of the recent literature suggests that the finding of an abnormal ductus venosus Doppler pattern in the late first trimester of pregnancy may be an early sign of either congenital cardiac or chromosomal abnormality, even in the presence of normal NT screening.
Ultrasound in Obstetrics and Gynecology, 2001
Purpose: To evaluate the efficiency of transvaginal ultrasound in the early diagnosis of ovarian ... more Purpose: To evaluate the efficiency of transvaginal ultrasound in the early diagnosis of ovarian cancer. Methods: Screening transvaginal ultrasound has been annually performed during the last 2 years in asymptomatic women without familial history of ovarian cancer. When abnormalities were detected, the procedure was repeated after 4-6 weeks. If the findings disappeared, the study was repeated after 1 year. If the abnormality persisted, study was complemented with tumor markers, computed tomography and laparoscopic surgery. The findings were compared with a control group of women in whom ovarian transvaginal ultrasonography was formally indicated. Results: A total of 26007 transvaginal ultrasound were performed: 8813 (33.8%) belonged to the screening group and 17194 (66.2%) to the control group. In 14 patients of the screening group, a malignant tumor was diagnosed and histologically confirmed. The mean age of these patients was 45 years old (SD 12). Eleven of these tumors were stage I (seven Ia, and four Ic), two stage IIIc and one was a metastatic melanoma in both ovaries. Six lesions were borderline tumors (five serous and one mucinous). In the control group, 27 ovarian cancers were diagnosed in patients with a mean age of 48 years (SD 17). In this group, 11 tumors were in stage I, and six were borderline. Conclusions: Although consensus about the benefits of using transvaginal ultrasound as a screening procedure is not conclusive, our data reveals that tumors detected in patients screened with transvaginal ultrasound are in earlier stages when compared with those diagnosed in the control group. No differences were found in age and number of borderline tumors between both groups. Additional studies are needed to support this preliminary findings.
Ultrasound in Obstetrics and Gynecology, 2002
Background: The aim of the study was to assess prospectively the evolution of multiple clinical p... more Background: The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy. Method: A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied.
Journal of assisted reproduction and genetics, 2000
Our purpose was to determine prospectively, using receiver-operating characteristic (ROC) analysi... more Our purpose was to determine prospectively, using receiver-operating characteristic (ROC) analysis, whether the ovarian reserve test with hMG could improve the predictive value of a woman's age and basal levels of follicle stimulating hormone (FSH), E2, and inhibin or any combination of them regarding ovarian response and pregnancy rate in IVF treatment following pituitary desensitization. The hMG test was performed within 3 months of IVF treatment in 80 women undergoing the first cycle of IVF and consisted of 2 ampoules of hMG daily for 5 days starting on cycle days 2 to 3. Hormone and ultrasound evaluation was performed on cycle days 2 to 3 and 7 to 8. The mean age and basal FSH levels were significantly higher in the canceled (n = 28) than in the control (n = 52) group, whereas the basal inhibin level was significantly higher in the latter. Regarding ovarian response, the combination FSH plus inhibin had the better diagnostic accuracy (predictive value of 70%) among basal var...
Ultrasound in Obstetrics and Gynecology, 2007
18 ± 3.4%. PPROM (37%) occurred prior to 32 weeks in 2/16 cases. In all but two cases the balloon... more 18 ± 3.4%. PPROM (37%) occurred prior to 32 weeks in 2/16 cases. In all but two cases the balloon could be removed electively at 34.2 ± 1 weeks. Mean GA at birth was 35.4 ± 2 weeks; 44% of fetuses survived (7/16), which fell to 30% (3/10) when cases undergoing FETO beyond 30 weeks were considered. Conclusions: In our experience survival after FETO decreases with GA at balloon insertion. Gestational age at birth and PPROM rates are no different from those reported in cases occluded earlier. Based on experimental data and available clinical experience we would restrict late FETO to fetuses with larger lung sizes (O/E LHR > 25%, who are currently not eligible) or to cases presenting late in gestation.
Ultrasound in Obstetrics and Gynecology, 2007
Progresos de Obstetricia y Ginecología, 2004
ABSTRACT Ectopic pregnancy in a previous cesarean section scar is the rarest of ectopic pregnancy... more ABSTRACT Ectopic pregnancy in a previous cesarean section scar is the rarest of ectopic pregnancy locations and is possibly one of the most dangerous because of the risk of uterine rupture and hemorrhage. Few reports on this type of ectopic pregnancy have been published and differential diagnosis may be difficult. Because the diagnostic criteria and prognosis are uncertain, consensus on the preferred treatment is lacking.
Donald School Journal of Ultrasound in Obstetrics & Gynecology, 2009
A female fetus of a dizygotic pregnancy presented with a retrovesical cystic mass at 16 weeks. Se... more A female fetus of a dizygotic pregnancy presented with a retrovesical cystic mass at 16 weeks. Severe and recurrent fetal ascitis developed at 25 weeks. Pre-eclampsia, probably due to mirror syndrome, precipitated fetal extraction, which led to severe prematurity complications and neonatal death. Necropsy showed: cloacal anomaly, anal atresia, ambiguous genitalia and bicornuate uterus.
Diagnóstico Prenatal, 2012
información del artículo Historia del artículo: Recibido el 12 de junio de 2012 Aceptado el 13 de... more información del artículo Historia del artículo: Recibido el 12 de junio de 2012 Aceptado el 13 de junio de 2012 On-line el 27 de julio de 2012 Palabras clave: Embarazo gemelar monocorial Síndrome de transfusión feto-fetal Secuencia anemia-policitemia Restricción de crecimiento intrauterino selectivo Malformación discordante r e s u m e n El embarazo gemelar monocorial (MC) se presenta en uno de cada 250 embarazos y representa una proporción significativa de morbi mortalidad perinatal en los embarazos gemelares y en general. El manejo óptimo de los MC se basa en 2 aspectos fundamentales: clasificación temprana de la corionicidad y seguimiento estricto. El diagnóstico diferencial de las complicaciones del MC sigue siendo todavía un reto para el especialista de medicina fetal. Esto se debe a la frecuente superposición de signos clínicos y a las relaciones complejas entre las potenciales complicaciones. La experiencia clínica demuestra que en la mayoría de los casos la clasificación y el manejo adecuado se pueden lograr mediante la aplicación sistemática de conceptos sencillos. Esta revisión proporciona una visión global que permite una compresión integral de los embarazos gemelares MC, sus posibles complicaciones y los conceptos claves que permiten un diagnóstico diferencial adecuado y un manejo específico. © 2012 Asociación Española de Diagnóstico Prenatal. Publicado por Elsevier España, S.L. Todos los derechos reservados.
Ultrasound in Obstetrics and Gynecology, 2001
ABSTRACT Introduction: Classification of hypertensive disorders of pregnancy is problematic due t... more ABSTRACT Introduction: Classification of hypertensive disorders of pregnancy is problematic due to variable clinical presentation and confusing terminology. Management is based on severity of clinical and laboratory criteria, which, unfortunately, do not select pregnancies that will be delivered because of maternal or fetal indication.Objective: To evaluate whether maternal uterine Doppler evaluation correlates with fetal Doppler study and maternal and perinatal results.Design: Twelve women with pregnancy-induced hypertension (ISSHP criteria) between 26 and 38 weeks of gestation were divided into two groups based on uterine Doppler examination (presence – group A, or absence – group B, of a bilateral protodiastolic uterine notch) at diagnosis.Results: There were seven patients in group A (four severe and three mild pre-eclampsia) and five patients in group B (one severe and one mild pre-eclampsia, two severe gestational hypertension, one Hellp syndrome). The mean gestational age at delivery (weeks gestation), the mean birth weight (grams) and the mean umbilical artery pH in groups A and B were, respectively, 31.1 vs. 36.1, 1256 vs. 2428, and 7.20 vs. 7.25. Doppler evaluation showed statistically significant higher pulsatility index of the right and left uterine artery, as well as in the umbilical artery, in group A vs. group B. Fetal vascular redistribution or a ductus venosus PI >1 were detected only in group A (5/7 and 3/7, respectively), whereas in none of the group B. Indication for delivery was always for fetal risk (four cases) or maternal risk (three cases) among group A, whereas for maternal indication was only in one case of the group B.Comments: We suggest that uterine Doppler examination at the time of diagnosis in patients with hypertensive disorders of pregnancy may help to identify pregnancies at serious maternal and fetal risks better than classical clinical and laboratory criteria.
Ultrasound in Obstetrics and Gynecology, 1995
Ultrasound in Obstetrics and Gynecology, 2006
To establish reference ranges for blood flow velocity waveforms (FVW) of the fetal aortic isthmus... more To establish reference ranges for blood flow velocity waveforms (FVW) of the fetal aortic isthmus (AoI) during the second and third trimesters of pregnancy. This was a prospective cross-sectional observational study involving 458 uncomplicated singleton pregnancies between 19 and 37 weeks of gestation. Fetal AoI Doppler parameters were assessed in either the longitudinal aortic arch view or the three vessels and trachea view. Regression analysis was used to determine gestational-age-specific reference ranges and to construct nomograms for the following Doppler parameters: pulsatility index (PI), resistance index (RI) and peak systolic (PSV), end-diastolic (EDV) and time-averaged maximum (TAMXV) velocities. Intra- and interobserver reproducibility were evaluated by calculating intraclass correlation coefficients (ICCs) and limits of agreement. Reliable FVW in the AoI were obtained in all cases. Acceptable intra- and interobserver reproducibility was obtained. With advancing gestation, there was a significant increase in PSV, TAMXV and PI, whereas RI and EDV remained constant during the second half of pregnancy. No cases of absent or reversed flow during diastole were detected. Normal data of the fetal AoI blood FVW throughout the second and third trimesters of pregnancy are provided. The reported Doppler profiles may be of clinical use in the assessment of hemodynamically compromised growth-restricted fetuses.
Ultrasound in Obstetrics and Gynecology, 2003
Methods Data were collected from all singleton pregnancies seen in our Fetal Surveillance Unit wh... more Methods Data were collected from all singleton pregnancies seen in our Fetal Surveillance Unit who underwent antenatal monitoring for fetal growth restriction, nonreactive NST and arterial redistribution beyond 26 weeks of pregnancy. Patients were divided into four groups based on their CST and ductus venosus waveform results. Perinatal outcome was evaluated by means of four variables: the need for admission to the neonatal intensive care unit (NICU), need for neonatal intubation, an umbilical artery pH < 7.10 and significant neonatal morbidity. Outcome was compared among fetuses delivered within 3 days of their antenatal test. Logistic regression analysis was used to analyze the relation between predictive and outcome variables.
Ultrasound in Obstetrics and Gynecology, 2008
Oral poster abstracts OP20.09 The uteroplacental and fetal circulation in ongoing pregnancies wit... more Oral poster abstracts OP20.09 The uteroplacental and fetal circulation in ongoing pregnancies with known fetal malformations -correlation with maternal distress Objectives: To prospectively investigate the correlation between maternal distress after prenatal diagnosis of fetal malformations and the feto-maternal circulation. Methods: A cohort of women (group A, n = 30) carrying a fetus with a non-cardiac malformation underwent Doppler blood flow measurements and psychometric evaluation at fixed points from the time of diagnosis throughout pregnancy. The same protocol was used in controls (group B, n = 29) with presumably healthy fetuses. At 29-31 weeks gestational age (GA), mean uterine artery (UtA) pulsatility index (PI), umbilical artery (UA) PI, middle cerebral artery (MCA) PI, and ductus venosus (DV) PI for veins (PIV) were measured. MCA/UA PI ratio (MCA/UA) was calculated. Psychological distress was measured by Impact of Event Scale (IES) self-report questionnaire. IES subscores for intrusion, avoidance, and arousal were calculated. Results: There were no significant differences in GA or parity between the groups. Median maternal age was significantly lower in group A (31.0 yrs (19-40) vs. 33.0 (23-39), P = 0.034), but this was not correlated with either parity or any of the outcome measures. Doppler findings did not differ significantly between the groups except UtA PI (A: 0.63 ± 0.13 vs. B: 0.74 ± 0.15, P = 0.006). IES scores were significantly higher in group A (IESsum P = 0.003, intrusion P = 0.002, avoidance P < 0.001, arousal P = 0.015). In the overall group, the only correlation between Doppler results and psychometric scores was found between UA PI and avoidance (r = 0.281, P = 0.034). In group A there was a correlation between both MCA PI and MCA/UA, and IESsum (r =−0.456, P = 0.011;r=−0.380, P = 0.038), intrusion (r =−0.475, P = 0.008;r=−0.436, P = 0.016), and avoidance (r =−0.368, P = 0.045;r=−0.375, P = 0.041), respectively. Conclusions: In women carrying a fetus with known malformation there may be a correlation between maternal distress and the fetal cerebral circulation at 30 weeks of GA.