Biomedical subjects

Bienvenido Puerto

Publications and source records attributed to Bienvenido Puerto.

7 recordsLinked to original sources

PubMed2007

False positives in the prenatal ultrasound screening of fetal structural anomalies.

OBJECTIVE: To describe the false-positive diagnoses of prenatal ultrasound screening of fetal structural anomalies. METHODS: Pregnancies with fetal structural anomalies either detected prenatally in our center or referred to us, were registered, evaluated, and followed-up prospectively by a multidisciplinary Congenital Defects Committee. After postnatal follow-up was completed, cases were assigned as true positives, false positives or false negatives and categorized by anatomical systems. Pregnancies referred with a nonconfirmed suspicion of anomaly were not included. The false-positive diagnoses were analyzed. RESULTS: From 1994 to 2004, 903 new registry entries of fetuses structurally abnormal at ultrasound with a complete follow-up were included in the Committee database. There were 76 false positives, accounting for 9.3% of all the prenatally established diagnoses. The urinary tract anomalies were the most frequent false-positive diagnoses found (n = 25; accounting for 8.7% of the urinary tract defects), but the genital anomalies showed the higher rate of no confirmation (n = 5; 15.2%). The specific anomalies most commonly not confirmed were renal pyelectasis (n = 9), cerebral ventriculomegaly (n = 9), abdominal cysts (n = 7) and short limbs (n = 7). CONCLUSION: Several prenatally diagnosed anomalies would benefit from prudent counseling, because they may be normal variants or transient findings.

Congenital Abnormalities↗

PubMed2006

Umbilical artery pulsatility index: reliability at different sampling sites.

OBJECTIVES: To analyse the inter-observer and inter-artery reliability of the umbilical artery (UA) pulsatility index (PI) at different sampling sites. METHODS: One hundred consecutive singleton pregnancies between 24 and 40 weeks were included. The PI was calculated by two independent operators from both umbilical arteries at the placental end, at a free-floating loop and at the perivesical segment. Reliability analyses were performed between observers and between arteries at each sampling site. RESULTS: The mean percentage of PI difference between arteries was 15.2, 14.5 and 22% at the placental end, free-loop and perivesical site, respectively. The Intraclass correlation coefficients at each site were 0.51, 0.59 and 0.67, respectively. Whereas about 20% of cases showed a percentage of PI difference between arteries greater than 20% at free-loop and placental end sites, and at the perivesical site this figure was 45%. CONCLUSIONS: The perivesical sampling site for UA PI calculation is more reliable than at a free-floating loop, albeit without significance, and is significantly more reliable than at the placental end of the umbilical cord. Since discordances in PI between both arteries are more pronounced at the perivesical site, it seems mandatory to evaluate both arteries in this segment.

Adult↗

PubMed2005

Successful selective termination at 17 weeks' gestation in monochorionic monoamniotic twin pregnancy affected by twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome.

OBJECTIVES: To report a successful selective feticide in a complicated monochorionic monoamniotic (MCMA) pregnancy. METHODS: A case of MCMA pregnancy with severe twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome was diagnosed at 16 weeks' gestation. A complete ultrasound and fetoscopic surveillance was performed, ruling out cord entanglement and, thus, precluding the necessity of transecting the cord. RESULTS: The selective feticide was successfully performed by bipolar coagulation of the umbilical cord of the abnormal fetus under ultrasound guidance. The survivor twin developed normally during the rest of the pregnancy and was born at term. At 6 months of age, the infant was healthy. CONCLUSION: Selective feticide in complicated monoamniotic pregnancies can be safely performed. Cord entanglement can be confidently excluded by both ultrasound and fetoscopy, thus making the systematic transection of the umbilical cord unnecessary.

Adult↗

PubMed2005

Umbilical artery Doppler and umbilical cord pH at birth in small-for-gestational-age fetuses: valid estimate of their relationship.

OBJECTIVE: To evaluate the relationship between umbilical artery pulsatility index and the umbilical cord pH in small-for-gestational-age fetuses. METHODS: Data were collected from all pregnancies seen in our Fetal Surveillance Unit that underwent antenatal monitoring for being small-for-gestational-age beyond 24 weeks of pregnancy. A linear regression was used to analyse the effect of the umbilical artery pulsatility index (UAPI) and umbilical artery pH at birth, assessing interaction and controlling for clinically meaningful antenatal, Doppler, biophysical and perinatal variables. RESULTS: A total of 117 pregnancies were included. According to the estimated model (which included all clinically significant confounders and statistically significant interactions), in cases with reactive cardiotography (CTG) a 1-unit increase in the UAPI resulted in a mean decrease of 0.021 (95% 0.05 to -0.005) units of umbilical artery pH at delivery. In the non-reactive CTG group a 1-unit increase in the UAPI resulted in a mean decrease of 0.02 (95% CI 0.059 to -0.019) units of umbilical artery pH at delivery. Finally, in fetuses with a pathological CTG a 1-unit increase in the UAPI resulted in a mean decrease of 0.149 (95% CI 0.107 to 0.19) units of umbilical artery pH at delivery. CONCLUSIONS: The crude effect between umbilical artery velocimetry on umbilical artery pH at birth has to be interpreted with caution, since an important part of this effect is related to other factors that confound and modify the relationship. After controlling for confounders, it was only in fetuses with pathological CTG that the effect remained statistically significant.

Adult↗

PubMed2003

Cardiac function monitoring of fetuses with growth restriction.

OBJECTIVE: To describe the time sequence of changes in cardiac function in intrauterine growth restriction. STUDY DESIGN: 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. RESULTS: 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. CONCLUSION: 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.

Adult↗

PubMed2003

Ultrasonography as a predictor of embryo implantation after in vitro fertilization: a controlled study.

OBJECTIVE: To investigate the predictive value of ultrasonographic parameters as prognostic indicators of implantation after IVF when measured on the day of embryo transfer. DESIGN: Comparative, observational study. SETTING: University teaching hospital. PATIENT(S): Two hundred eighty patients undergoing IVF. INTERVENTION(S): Ovarian stimulation, IVF. MAIN OUTCOME MEASURE(S): Variables related to patients' clinical characteristics, treatment characteristics, ovarian response, ovum retrieval, outcome of IVF and ICSI, embryo transfer, ultrasonographic and Doppler endometrial measurements, and uterine blood flow that have been proposed as potential predictive factors of implantation. All transvaginal ultrasonographic assessments were performed on the day of embryo transfer. RESULT(S): Among 240 patients finally evaluable, 67 (group 1) became pregnant after IVF, and 173 (group 2) failed to conceive. The 111 nonpregnant patients who had the same embryo score per replacement (group 3) as did patients in group 1 were selected for comparison purposes. The only significant differences between groups 1 and 3 were the type A endometrium and the absence of a protodiastolic notch in the uterine arteries, both of which were more frequently found in group 1. However, a considerable overlap existed between conception and nonconception cycles regarding both variables. CONCLUSION(S): Ultrasonographic parameters as predictors of implantation in assisted reproduction have a limited value in the clinical setting.

Adult↗

PubMedDate not supplied

Ultrasonographic diagnosis of Jarcho-Levin syndrome at 20 weeks' gestation in a fetus without previous family history.

Jarcho-Levin syndrome (JLS; spondylothoracic dysplasia) is a congenital disease characterized by multiple vertebral and rib malformations, causing a short trunk dwarfism commonly leading to respiratory insufficiency and death during the first years of life. We describe a case diagnosed during the second trimester routine ultrasound scan for screening of fetal anomalies without a previous family history. The fetus had a severe disorganization of the spine and ribs, skeletal kyphosis, with several hemivertebrae and a small thorax. All of the findings at postmortem examination confirmed the ultrasound features and were consistent with the JLS. To the best of our knowledge there is only one case reported in the literature of a prenatal diagnosis of the syndrome in a family with low risk for the condition.

Adult↗