Current medical guidelines consider pregnant women with COVID-19 to be a high-risk group. Since physiological gestation downregulates the immunological response to maintain "maternal-fetal tolerance", SARS-CoV-2 infection may constitute a potentially threatening condition to both the mother and the fetus. To establish the immune profile in pregnant COVID-19+ patients, a cross-sectional study was conducted.
View Article and Find Full Text PDFBackground: COVID-19 disease is the leading cause of maternal death in Mexico. The data published to date indicate that pregnancy favors severe forms of the disease.
Objective: To describe the clinical, obstetric and perinatal characteristics of pregnant women with COVID-19 disease treated at the UMAE "Luis Castelazo Ayala" of the Instituto Mexicano del Seguro Social.
Introduction: In patients with COVID-19, olfactory dysfunction and anosmia have been reported, which in pregnant women occur in up to 24.2 %.
Objective: To know the frequency at which pregnant women with SARS-CoV-2 infection have olfactory dysfunction.
Objective: To compare the Doppler ultrasound parameters of the uterine and brachial arteries, between healthy pregnant women and pregnant women with preeclampsia.
Methods: 102 pregnant women were studied in the third trimester, group I 83 healthy women and group II 19 patients with severe preeclampsia. All of them underwent Doppler ultrasound of the uterine arteries, measuring the pulsatility index (PI) and determining the presence of proto-diastolic notch.
Congenital neck masses are associated with high perinatal mortality and morbidity secondary to airway obstruction due to a mass effect of the tumor with subsequent neonatal asphyxia and/or neonatal death. Currently, the only technique designed to establish a secure neonatal airway is the ex utero intrapartum treatment (EXIT) procedure, which involves neonatal tracheal intubation while fetal oxygenation is maintained by the uteroplacental circulation in a partial fetal delivery under maternal general anesthesia. We present a case with a giant cervical teratoma and huge displacement and compression of the fetal trachea that was treated successfully at 35 weeks of gestation with a novel fetoscopic procedure to ensure extrauterine tracheal permeability by means of a fetal endoscopic tracheal intubation (FETI) before delivery.
View Article and Find Full Text PDFBackground: In animal models of congenital diaphragmatic hernia (CDH), tracheal occlusion (TO) has induced maturation of both airway spaces and vascular structures. Airway and vascular response to TO are assumed to occur in parallel. This study aims to describe and measure the relationship between airway and vascular maturation induced by TO.
View Article and Find Full Text PDFObjective: To explore the potential value of intrapulmonary artery Doppler velocimetry in predicting neonatal morbidity in fetuses with left-sided congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO).
Methods: Observed/expected lung-to-head ratio (O/E-LHR), and intrapulmonary Doppler pulsatility index and peak early-diastolic reversed flow were evaluated within 24 h before FETO in a consecutive cohort of 51 fetuses with left-sided CDH at between 24 and 33 weeks' gestation. Lung Doppler parameters were converted into Z-scores and defined as abnormal if the pulsatility index had a Z-score of > 1.
Objective: To evaluate the accuracy of ten equations based on ultrasound parameters for estimating fetal weight (FW).
Study Design: A cross-sectional study was performed in 250 healthy women with normal singleton pregnancies between 34 and 41 weeks of gestation. FW estimations calculated according to ten different equations were compared against birth weight (BW) which was determined within 72 h after FW estimation.
Aim: To report the experience of the intrauterine treatment of monochorionic biamnotic (MC/BA) twin pregnancies complicated with twin-to-twin transfusion syndrome (TTTS) applying laser ablation of the placental vascular anastomoses (LAPVA).
Material And Methods: During 18 months period 35 MC/BA twin pregnancies were treated. TTTS was diagnosed based on the discrepancies in amniotic fluid and bladder size between both twins.
Objective: To analyze social and economic factors affecting the implementation of a fetal surgery program in a developing country.
Materials And Methods: During an 18-month period, 30 women with complicated monochorionic diamniotic twin pregnancies were evaluated. 27 women had twin-to-twin transfusion syndrome (TTTS), 2 women had a selective intrauterine growth restriction, and 1 a discordant twin pregnancy with 1 fetus with a severe open neural tube defect.
Pulmonary Doppler may play an important role in the prediction of survival and postnatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion (FETO). Spectral Doppler indexes such as pulsatility index and peak early diastolic reversed flow could help to refine the selection of fetuses that might benefit from fetal therapy. When combined with lung-to-head ratio (LHR), these Doppler indices allow to discriminate cases with moderate-to-high survival rates from fetuses with extremely low chances to survive after FETO.
View Article and Find Full Text PDFObjective: To assess the impact of lung perfusion by fractional moving blood volume (FMBV) for the prediction of survival in fetuses with congenital diaphragmatic hernia (CDH) treated with fetal endoscopic tracheal occlusion (FETO).
Study Design: Lung perfusion by FMBV (%) and the observed/expected lung-to-head ratio (o/e LHR) were evaluated 1 day before and 7-14 days after FETO in a cohort of 62 CDH fetuses, and their isolated and combined values to predict survival was assessed.
Results: Preoperative lung perfusion did not show association with survival.
Objective: To evaluate lung tissue perfusion in fetuses with congenital diaphragmatic hernia (CDH) and to explore the association of lung tissue perfusion with the lung area to head circumference ratio (LHR) and intrapulmonary artery pulsed Doppler.
Methods: Fetuses with isolated left CDH were evaluated and compared with a group of fetuses without CDH, which were sampled from our general population and matched by gestational age at inclusion. Lung tissue perfusion measured using fractional moving blood volume (FMBV), the observed to expected (O/E) LHR and pulsed Doppler of the proximal intrapulmonary artery were evaluated in the lung contralateral to the side of the hernia.
Objective: To evaluate the contribution of intrapulmonary artery Doppler in predicting the survival of fetuses with congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO).
Methods: A cohort of 41 fetuses (between 24 and 28 weeks of gestation) with CDH was treated with FETO. The observed/expected lung-to-head ratio (O/E-LHR), pulmonary artery pulsatility index (PI), peak early diastolic reversed flow (PEDRF) and peak systolic velocity (PSV) were evaluated before FETO, and their isolated and combined value to predict survival using multiple logistic regression and decision-tree analysis was assessed.
Objective: To assess the learning curve for the fetal lung area to head circumference ratio (LHR) calculation in fetuses with congenital diaphragmatic hernia (CDH).
Methods: Three trainees with the theoretical knowledge, but without prior experience in the LHR measurement, were selected. Each trainee and one experienced examiner measured the observed to expected (O/E)-LHR in the lung contralateral to the side of the hernia by two methods-manual tracing of lung borders and multiplication of the longest diameters-in a cohort of 95 consecutive CDH fetuses.
Objective: To analyze the impact of in utero tracheal occlusion (TO) on lung tissue blood perfusion, as measured by fractional moving blood volume (FMBV) and conventional spectral Doppler, in a rabbit model of congenital diaphragmatic hernia (CDH).
Methods: In 50 fetal rabbits, a left CDH was surgically created at 23 days of gestational age (GA). At 28 days of GA, the surviving CDH fetuses were randomly assigned to undergo either TO (CDH+TO group) or a sham operation (CDH group).
Introduction of Doppler ultrasound in obstetrical practice has changed both management and understanding of several diseases that put at risk women and them fetuses. To establish necessary basics and correctly apply this technique, this review will focus in physical principles, acquisition methods, consistency, and safety issues of Doppler ultrasound, in order to improve precision, accuracy and interpretation of this methodology.
View Article and Find Full Text PDFObjectives: To describe the association between the intrapulmonary circulation and the degree of lung growth in fetuses with congenital diaphragmatic hernia (CDH).
Methods: Thirty-six fetuses with isolated left CDH at 22-29 weeks of gestation were studied. Four groups were defined according to lung-to-head ratio (LHR), expressed as the ratio of observed to expected LHR for gestational age (O/E LHR).