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Publicaciones 2010


Tamara Illescas M., Javier Pérez P. , Pilar Martínez-Ten , Belén Santacruz M. , Begoña Adiego B. , Esther Barrón A. Translucencia nucal aumentada y cariotipo normal. Rev Chil Obstet Ginecol 2010; 75(1): 3 - 8 .


ABSTRACT

Antecedentes: La exploración ecográfica entre las semanas 11 y 14 tiene un papel fundamental en el cribadode anomalías cromosómicas, siendo la medida de la translucencia nucal un método bien establecido y ampliamente aceptado para este fin.

Objetivo: Evaluar retrospectivamente la evolución de los fetos con translucencia nucal aumentada y cariotipo normal.

Método: Se recogieron los datos de 104 fetos con TN ≥percentil 95 (p95) entre las semanas 11 y 14, evaluados en nuestro centro. En los 61 que resultaron euploides, se estudió la incidencia de anomalías estructurales diagnosticadas tanto prenatalmente como tras el nacimiento, así como las pérdidas fetales anteparto. De estos fetos, nacieron sanos el 80% cuando la TN estaba entre p95 y 3,4 mm, el 50% con TN entre 3,5 y 4,4 mm, el 30% con TN entre 4,5 y 5,4 mm, y el 18% con TN ≥ 5,5 mm. Entre los 4 recién nacidos euploides con patología, hubo 3 con cardiopatía.

Conclusión: La presencia de TN aumentada entre las 11-14 semanas en fetos euploides se asocia a un incremento delriesgo de anomalías estructurales mayores, principalmente cardiacas. La prevalencia de malformacionesaumenta significativamente con TN >3,5 mm, y el pronóstico gestacional adverso empeora conforme aumentala medida de la TN.





Begoña Adiego Burgos, Pilar Martínez Ten, Javier Pérez Pedregosa, Alicia Crespo Rivera, Belén Santacruz Martín, Tamara Illescas Molina, Esther Barrón Azurmendi. Determinación del sexo fetal en el primer trimestre de la gestación: estudio prospectivo. Rev Chil Obstet Ginecol 2010; 75(2): 117 – 123.


ABSTRACT

Valorar la precisión de la determinación ecográfíca del sexo fetal entre las 11 y las 14 semanas en una cohorte no seleccionada de gestantes.

Métodos: Se realizó un estudio prospectivo transversal en una serie consecutiva de 636 gestaciones entre las 11 y 14 semanas, en gestantes que acudieron para el estudio ecográfico rutinario de primer trimestre. Se examinó la región genital del feto en un plano mediosagital, visualizando el “signo sagital” y la dirección en la que apunta el tubérculo genital (craneal en los varones, caudal en las mujeres) ambos indicadores del sexo fetal. La confirmación clínica del sexo fetal se obtuvo después del parto por confirmación telefónica, o por el cariotipo en casos con amniocentesis por indicaciones convencionales.

Resultados: Se consiguió asignar el sexo fetal correctamente en el 86,3% de los fetos. La precisión de la asignación ecográfica del sexo fetal fue mayor en varones que en mujeres (el 90,6% de los varones fueron asignados correctamente vs el 83,1% de las mujeres, p<0,05), y se incrementó con la edad gestacional desde un 72% entre las 11 y 11+6 semanas, un 92% entre las 12 y las 12+6 semanas, hasta un 95% entre las 13 y las 13+6 semanas.

Conclusión: La determinación ecográfíca del sexo fetal tiene una elevada tasa de precisión a partir de las 13 semanas, lo que sugiere que las pruebas invasivas para la exclusión de enfermedades ligadas al X podrían obviarse cuando se identifica un feto varón a esta edad gestacional. Sin embargo, en fetos identificados como mujeres esta decisión deberá posponerse hasta una edad gestacional más avanzada.




Manuel Recio Rodríguez, Vicente Martínez de Vega Fernández, Pilar Martínez-Ten, Javier Pérez Pedregosa, Daniel Martín Fernández-Mayoralas, Mar Jiménez de la Peña. RM fetal en las anomalías del SNC. Aspectos de interés para el obstetra. RAR - Volumen 74 - Número 4 – 2010.


ABSTRACT

La resonancia magnética (RM) fetal es una técnica de imagen en auge, útil en la valoración del cerebro y columna fetal. Ayuda a estudiar el desarrollo cerebral etal y se puede realizar un diagnóstico precoz de las anomalías congénitas. La imagen de RM muestra gran resolución de contraste y permite diferenciar mejor que la ecografía entre hallazgos normales y patológicos. Además, algunas malformaciones cerebrales o lesiones destructivas ocultas en la ecografía prenatal pueden ser detectadas por RM. Revisamos las indicaciones, utilidad, seguridad, aspectos técnicos de la RM fetal y la apariencia del desarrollo cerebral fetal, y evaluamos su contribución en el diagnóstico de las patologías de las diferentes regiones cerebrales y de la patología espinal fetal.





Pilar Martinez-Ten, MD, Begoña Adiego, MD, Javier Perez-Pedregosa, MD, Tamara Illescas, MD, Amy E. Wong, MD, Waldo Sepulveda, MD. First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View A 3-Dimensional Sonographic Study. J Ultrasound Med 2010; 29:1555–1561.


ABSTRACT

Objective. The purpose of this study was to evaluate a new sonographic technique for identifying the nasal bones using the retronasal triangle view, ie, the coronal plane at which the palate and frontal processes of the maxilla are simultaneously visualized.

Methods. Three-dimensional (3D) volumes were acquired from women undergoing first-trimester sonographic screening for aneuploidy by 2 accredited operators. Those data sets in which the fetal face was clearly identified were selected for offline analysis by 2 other observers who were unaware of the sonographic or clinical findings. The nasal bones were classified as both present, only 1 present (right or left), or absent according to the presence or absence of 2 small paired echogenic linear structures at the upper tip of the retronasal triangle as determined by 3D navigation in the coronal plane and compared to those findings obtained by 3D navigation in the sagittal plane. Additional 3D data sets involving a subset of 4 first-trimester fetuses with trisomy 21 and absent nasal bones were also analyzed retrospectively and included randomly in the study group.

Results. A total of 110 3D data sets were analyzed, of which 86% were obtained transabdominally and 14% transvaginally. The quality of nasal bone identification was classified subjectively by the observers as good in 67% of cases, fair in 29%, and poor in 4%. The nasal bones were classified as at least 1 present in 106 of the cases (96%) and absent in 4 (4%), with complete agreement between observers in both the sagittal and coronal planes (κ = 1). Discrimination between the right and left nasal bones was possible in 89% and 93% for observer A and in 96% and 96% for observer B by assessing the sagittal and coronal views, respectively (right nasal bone: κ = 0.90 [95% confidence interval (CI), 0.79–1]; left nasal bone: κ = 0.85 [95% CI, 0.60–0.99]). The nasal bones were not identified at the level of the retronasal triangle view in any of the fetuses with trisomy 21 and absent nasal bones.

Conclusions. This study shows that the nasal bones can be confidently identified as paired echogenic structures located at the upper tip of the retronasal triangle. This coronal view of the fetal face offers the possibility of screening for the presence or absence of the nasal bones in the first trimester, especially when the standard midsagittal views of the fetal face are suboptimal because of fetal or maternal factors. Because both nasal bones can be evaluated simultaneously in the coronal plane, the retronasal triangle view may be advantageous over the conventional midsagittal view assessment, in which only 1 of the 2 nasal bones is evaluated.





W. Sepulveda, A. E. Wong, P. Martinez-Ten and J. Perez-Pedregosa. Retronasal triangle: a sonographic landmark for the screening of cleft palate in the first trimestre. Ultrasound Obstet Gynecol 2010; 35: 7–13.


ABSTRACT

Objectives: To describe a new first-trimester sonographic landmark, the retronasal triangle, which may be useful in the early screening for cleft palate.

Methods: The retronasal triangle, i.e. the three echogenic lines formed by the two frontal processes of the maxilla and the palate visualized in the coronal view of the fetal face posterior to the nose, was evaluated prospectively in 100 consecutive normal fetuses at the time of routine first-trimester sonographic screening at 11 + 0 to 13 + 6 weeks’ gestation. In a separate study of five fetuses confirmed postnatally as having a cleft palate, ultrasound images, including multiplanar three-dimensional views, were analyzed retrospectively to review the retronasal triangle.

Results: None of the fetuses evaluated prospectively was affected by cleft lip and palate. During their first-trimester scan, the retronasal triangle could not be identified in only two fetuses. Reasons for suboptimal visualization of this area included early gestational age at scanning (11 weeks) and persistent posterior position of the fetal face. Of the five cases with postnatal diagnosis of cleft palate, an abnormal configuration of the retronasal triangle was documented in all cases on analysis of digitally stored three-dimensional volumes.

Conclusions: This study demonstrates the feasibility of incorporating evaluation of the retronasal triangle into the routine evaluation of the fetal anatomy at 11 + 0 to 13 + 6 weeks’ gestation. Because fetuses with cleft palate have an abnormal configuration of the retronasal triangle, focused examination of the midface, looking for this area at the time of the nuchal translucency scan, may facilitate the early detection of cleft palate in the first trimester.





C. Bermejo, P. Martínez-Ten, R. Cantarero, D. Diaz, J. Perez Pedregosa, E. Barrón, E. Labrador and L. Ruiz Lopez. Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol 2010; 35: 593–601.


ABSTRACT

Objectives: To demonstrate the value of three-dimensional (3D) ultrasound in the diagnosis of uterine malformations and its concordance with magnetic resonance imaging (MRI).

Methods: This study included 286 women diagnosed with uterine malformation by 3D ultrasound, having been referred to our clinics on suspicion of uterine malformation following clinical and/or conventional twodimensional ultrasound examination. With the exception of three with intact hymen, patients underwent both bimanual examination and speculoscopy before and/or after sonography. MRI was performed in 65 cases. We analyzed the diagnostic concordance between the techniques in the study of uterine malformations.

Results: Using 3D ultrasound we diagnosed: one case with uterine agenesis; 10 with unicornuate uterus, four of which also underwent MRI; six with didelphic uterus, one of which had MRI; 45 with bicornuate uterus, 12 of which had MRI; 125 with septate uterus (18 with two cervices), 42 of which had MRI (six with two cervices); 96 with arcuate uterus, three of which had MRI; and three with diethylstilbestrol (DES) iatrogenic uterine malformations, all of which had MRI. Among the 65 which underwent MRI, the diagnosis was: four cases with unicornuate uterus, 10 with bicornuate uterus (two with two cervices), 45 with septate uterus (five with two cervices), three with arcuate uterus and three with DES-related uterine malformations. The concordance between 3D ultrasound and MRI was very good (kappa index, 0.880 (95% CI, 0.769–0.993)). Discrepancies in diagnosis between the two techniques occurred in four cases. There was very good concordance in the diagnosis of associated findings (kappa index, 0.878 (95% CI, 0.775–0.980)), this analysis identifying differences in two cases.

Conclusions: There is a high degree of concordance between 3D ultrasound and MRI in the diagnosis of uterine malformations, the relationship between cavity and fundus being visualized equally well with both techniques. 3D ultrasound should be complemented by careful gynecological exploration in order to identify any alterations in the cervix.





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