High-risk Obstetric Unit Research Articles

Clinical Validation of the sFlt-1:PlGF Ratio as a Biomarker for Preeclampsia Diagnosis in a High-Risk Obstetrics Unit.

Preeclampsia is a multisystem disorder defined by new onset of hypertension with proteinuria after 20 weeks gestation. In part due to dysregulation of pro-angiogenic factors (e.g., placental growth factor [PlGF]) and anti-angiogenic factors (e.g., soluble fms-like tyrosine kinase 1 [sFlt-1]), preeclampsia results in decreased placental perfusion. An increased sFlt-1:PlGF ratio is associated with increased risk of preeclampsia. In this study, we evaluated sFlt-1:PlGF cutoffs and evaluated the clinical performance of sFlt-1:PlGF for predicting preeclampsia. sFlt-1:PlGF results from 130 pregnant females with clinical suspicion of preeclampsia were used to evaluate the diagnostic accuracy of different sFlt-1:PlGF cutoffs and to compare the clinical performance of sFlt-1:PlGF to traditional preeclampsia markers (proteinuria and hypertension). Serum sFlt-1 and PlGF were measured using Elecsys immunoassays (Roche Diagnostics) and preeclampsia diagnosis was verified by expert chart review. A sFlt-1:PlGF cutoff of >38 yielded the greatest diagnostic accuracy of 90.8% (95% CI, 85.8%-95.7%). Using a cutoff of >38, sFlt-1:PlGF exhibited a greater diagnostic accuracy than traditionally used parameters such as new or worsening proteinuria or hypertension (71.9% and 68.6%, respectively). sFlt-1:PlGF >38 exhibited a negative predictive value (NPV) of 96.4% for rule-out of preeclampsia within 7 days, and a positive predictive value (PPV) of 84.8% for predicting preeclampsia within 28 days. Our study shows the superior clinical performance of sFlt-1:PlGF over hypertension and proteinuria alone to predict preeclampsia at a high-risk obstetrical unit.

A three-year audit of pregnancy outcomes in women with pulmonary hypertension admitted to the high-risk obstetric unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa.

The aim of this study was to describe the profile and outcomes of pregnancies in women with pulmonary hypertension in South Africa. A retrospective study was undertaken at a state-subsidised hospital. Data were analysed using SPSS. Descriptive statistics were used to summarise categorical variables. Central tendency and dispersion of data were measured using means and standard deviations for normally distributed variables and medians and interquartile ranges for skewed variables. A p-value less than 0.05 was considered statistically significant. Of a cohort of 185 women, 86.3% had pulmonary hypertension secondary to left heart disease. The median age of the cohort was 28 years (interquartile range 23-33) with 37.8% being HIV infected and 59% having mild pulmonary hypertension. Frequencies of deaths, intensive care unit admissions and cardiac failure events increased with increasing severity of pulmonary hypertension (p < 0.001). Women with more severe pulmonary hypertension had higher rates of preterm births (p < 0.001). Adverse pregnancy outcomes were concentrated in women with moderate-to-severe pulmonary hypertension.

Analytical Performance and Quality Indicators of Fully Automated Immunoassays for sFlt-1 and PlGF.

The ratio of the antiangiogenic factor, soluble fms-like tyrosine kinase 1 (sFlt-1), to the proangiogenic factor, placental growth factor (PlGF), is associated with increased risk of preeclampsia. Here, we describe an analytical evaluation of the Elecsys sFlt-1 and PlGF assays at the first North American site in which they were clinically implemented. The analytical evaluation included short- and long-term imprecision, method comparison, accuracy, linearity, sample stability, limit of quantification verification, and measurement uncertainty. Quality indicators were also evaluated, including turnaround time and repeat test frequency. Short-term (13-day) and long-term (12-month) imprecision for sFlt-1 and PlGF were <4% CV. Method comparison (n = 40) between Roche cobas e602 and e411 exhibited r > 0.99 and bias <10%. sFlt-1/PlGF ratio rule-out cutoffs (≤33 and ≤38) and rule-in cutoffs (>38, >85, and >110) exhibited negative percent agreement and positive percent agreement of 100%, respectively (n = 40). During the first 12 months, 257 orders were placed, repeat test frequency was 17.5%, mean time between repeat orders was 23 days, and 72.0% of results were reported within 2 h from sample receipt when quality control was run continuously. We describe analytical performance parameters and quality indicators of the Elecsys sFlt-1 and PlGF assays, which was the first North American clinical laboratory site to implement these assays in support of the institution's high-risk obstetrical unit.

Implementing a Cardiovascular Screening Tool for High-Risk Pregnant Women in a Hospital Setting

ObjectiveTo implement a cardiovascular screening tool in a hospital unit for high-risk pregnant women to determine if additional testing and specialty consultation were indicated. DesignQuality improvement project. SettingHigh-risk obstetrics unit of a U.S. Midwest 127-bed specialty hospital. ParticipantsWomen ages 19 years and older who were admitted to the high-risk obstetric care unit during February and March of 2020; staff registered nurses assigned to the women completed the screening tool upon women’s admission to the unit. InterventionNursing implementation of a cardiovascular screening tool in women hospitalized on a high-risk unit. The Iowa Model of Evidence-Based Care was used for implementation to recruit staff, guide the intervention of the screening tool, and collect and analyze the data. ResultsIn a 2-month period of time, the cardiovascular screening tool was completed for 31 women. Four of the 31 women screened positive, indicating the need for clinicians to consider further testing and/or specialty consultation. The intervention identified pregnant women requiring additional interventions including testing and/or specialty consultation, which may not have occurred without the screening triggering such need. ConclusionFurther research is needed to validate if routine screening of pregnant women using a cardiovascular screening tool will improve long-term outcomes for pregnant women.

Increasing Prophylactic Medication Administration for Venous Thromboembolism in a High-Risk Obstetric Unit

On starting an enterprise-wide quality initiative to achieve a greater than 95% administration rate of prophylaxis medication for venous thromboembolism (VTE), our obstetric service was alarmed to learn of the scope of patient refusals and missed medication events with our robust VTE safety bundle. VTE is a leading cause of maternal mortality and morbidity yet is amenable to uncomplicated prevention strategies. An interprofessional workgroup developed interventions that could be implemented to swiftly affect patient and nurse compliance with medication administration.

Retro cervical tunneling to ensure correct placement for robotic-assisted transabdominal cerclage

To demonstrate the step-by-step surgical technique of robotic-assisted transabdominal cerclage, highlighting a new posterior compartment approach. Stepwise explanation of a surgical technique using surgical video. The procedure was performed at the Obstetrics and Gynecology Department, Hospital Vall d'Hebron in Barcelona, Spain, a tertiary medical center. The local institutional review board considers that case reports are exempt from research approval. A 26-year-old non-pregnant patient, with a history of cervical incompetence, three second-trimester losses, and vaginal cerclage failure during her previous pregnancy. Robotic-assisted transabdominal cerclage placement was performed. An 8-mm, 30° scope; monopolar scissors; and Maryland bipolar graspers were used. A uterine manipulator was used for better exposure. First, a bladder flap was created, and the uterine vessels were identified and skeletonized. Next, a window between the uterine vessels and the uterine cervix at the level of the cervical-isthmic junction was created bilaterally. At the posterior compartment, the dissection of the root of the uterosacral ligaments was carefully performed. A retrocervical pocket was created with monopolar scissors and sharp dissection. The procedure was finished with the Mersilene tape placement. First, the tape was passed through the window created in the right broad ligament, with a posterior-to-anterior direction, the retro cervical pocket, and finally through the left broad ligament. The knot was placed anteriorly and reperitonization was performed. In addition to this operation, robotic-assisted transabdominal cerclage was successfully performed in another six patients with good surgical and obstetrics outcomes. Intraoperative technique to ensure successful robot-assisted abdominal cerclage placement. The patient became pregnant six months following the robotic-assisted transabdominal cerclage. Her pregnancy was closely followed up at the High-Risk Obstetric Unit, and she had no complications during pregnancy. An elective cesarean section was performed at 36 weeks with a healthy newborn baby that was discharged with the mother three days after delivery. The development of a retro cervical pocket during robotic-assisted transabdominal cerclage can be performed safely and effectively. It may help prevent displacement of the Mersilene tape during endoscopic knotting.

Enablers and barriers for enteral feeding with mother`s own milk in preterm very low birth weight infants in a tertiary care neonatal intensive care unit.

The management of lactation in preterm mothers is a real challenge for Neonatal Intensive Care Unit (NICU) care, providers. The study aimed to evaluate the enablers and barriers for enteral feeding with mothers` own milk (MOM) in preterm very low birth weight (VLBW) infants in a tertiary care neonatal unit. This prospective observational study took place at a tertiary level NICU of a high-risk obstetric unit in a private hospital. All VLBW infants and mothers were incorporated into the study. Data on enablers and barriers were gathered from mother-baby dyads at the time of birth, at the end of the 7th day, and then weekly till the discharge of the baby from the unit. We studied 87 mother-baby dyads. Mean (SD) maternal age, gestation age and birth weight were 29.3 (4.7) years, 30.8 (2.0) weeks, and 1196 (196) grams respectively. We categorized our data into 2 groups based on outcome estimates done during the entire hospital stay or pre-discharge (48 hours before the discharge). On comparison of perinatal and post-natal factors, the enablers were maternal dwelling from the rural locality, number of milk expression son day 1 after the birth, number of night expressions in the first week postnatally, and MOM volume till day 3, day 7, and 2 weeks postnatally. The enablers of MOM in the pre-discharge group were the number of expressions in the first 3 days, the number of night expressions in week 1, mother`s visit, and the number of maternal visits on day 1 to NICU and MOM volume expressed from day 1 until the second week after birth. The main barriers for MOM (48 hours pre-discharge) were extremely low birth weight (ELBW) and intrauterine growth-restricted infants (IUGR). ELBW infants and IUGR infants are susceptible to low MOM feeding. The total of milk expressions in the first 3 days, number of night expressions in the first week, maternal visits on day 1 and the average MOM amount in the first 2 weeks are enablers for MOM feeding.

Pharmacist interventions in high-risk obstetric inpatient unit: a medication safety issue.

The aim of this study was to report number, type and severity of prescribing errors and pharmacist interventions in high-risk pregnant and postpartum women. A prospective cross-sectional, observational study. A high-risk obstetric inpatient unit of a Women's Hospital in Brazil. About 1826 electronic prescriptions for 549 women in the high-risk obstetrics inpatient unit were included. When the pharmacist detected potential prescribing errors, interventions were suggested. Prescriptions were evaluated by clinical pharmacist to identify the type, frequency and severity of prescribing errors and rate of clinical pharmacist intervention acceptance in a high-risk obstetric inpatient. A total of 1826 prescriptions were reviewed with 128 errors (7.0%). The most frequent errors were drug interaction (43.8%), incorrect frequency (21.5%) and improper dose (13.1%). One-hundred and sixty-eight interventions were made by pharmacists, 98.8% of which were accepted by prescribers. Higher maternal age (OR 1.0 (95%CI 1.0-1.1)), higher number of prescribed medications (OR 1.2 (95%CI 1.1-1.3)), obstetric conditions (OR 2.2 (95%CI 1.4-3.3)) and non-breastfeeding postpartum women (OR 3.9 (95% CI 2.5-6.1)) were the independent factors associated with prescribing errors identified through multivariate analysis. The most common prescription errors related to drug interactions, incorrect frequency and higher number of prescribed medications. The rate of pharmacist acceptance intervention was high.

993: Adverse pregnancy outcomes with glyburide vs insulin among patients with gestational diabetes established by the International Association of Diabetes and Pregnancy Study Group (IADPSG)

To address whether maternal use of glyburide is associated with greater incidence of adverse neonatal and maternal outcomes among patients with gestational diabetes mellitus (GDM) established by the International Association of Diabetes and Pregnancy Study Group (IADPSG) compared to insulin use. We prospectively followed a cohort of women with GDM, diagnosed with criteria established by IADPSG, who attended a High Risk Obstetrical Unit and Comprehensive Diabetic educational Program (Sweet Success). Initially all the patients were started on an American Diabetic Association diet and exercise program. Glyburide or insulin treatment was added if necessary to maintain fasting glucose and 1 hour postprandial glucose values of less than 90 mg per deciliter and 130 mg per deciliter respectively. During the study period, a total of 394 patients required glyburide or insulin treatment for control of the GDM. Among these patients, 171 of them were on glyburide while 223 of them were on insulin at time of delivery. Both the glyburide and insulin user groups have similar body mass index of >30 (30.17 + 7.43 versus 31.89 + 9.03) as well as rate of nulliparous patients (22.8 %versus 25.5%). Comparison of adverse neonatal and maternal outcomes between the 2 groups was shown in the table. Newborns of women treated with glyburide were not at increased risk for macrosomia (P = .077), hypoglycemia (P = .068), neonatal intensive care unit admission (P= 0.9291), fetal demise (P = 1.00), and preterm birth (P = 0.871), compared with those treated with insulin. There was also no difference in the incidence of preeclampsia/gestational hypertension (P = 0.2289) or primary cesarean delivery (P = 0.950) among the women treated with glyburide or insulin. Among patients with GDM diagnosed with criteria established by IADPSG, maternal glyburide use does not increase the incidence of macrosomia or hypoglycemia when compared with maternal insulin use. Overall pregnancies treated with glyburide are not at higher risk for adverse neonatal and maternal outcomes than those pregnancies treated with insulin.

Segurança na prescrição de medicamentos durante o ciclo gravídico-puerperal em unidade de internação obstétrica de alto risco

Introdução: Os erros de prescrição são erros de medicação. A prevenção destes erros é um importante instrumento para a segurança das pacientes. Objetivos: Avaliar a frequência, os tipos, a gravidade dos erros de prescrição e a aceitação das intervenções farmacêuticas. Métodos: Estudo transversal, prospectivo e observacional, em unidade de internação obstétrica de alto risco, entre setembro de 2014 e março de 2015. As variáveis foram tipo de erro, significância clínica do erro de prescrição, classe terapêutica, medicamentos potencialmente perigosos envolvidos com erros, impacto e aceitação das intervenções. Resultados: Foram analisadas 1826 prescrições para 549 pacientes e identificados 130 erros (7,0%) de 101 pacientes (18,4%). Os erros mais frequentes foram interações medicamentosas (43,8%), frequência (21,5%), e dose incorreta (13,1%). O maior número de medicamentos em uma única prescrição foi o principal fator de risco relacionado aos erros (p&lt;0.0001). Quanto à significância clínica do erro, 56,9% foram significantes e 43,1% foram sérios. Os medicamentos mais envolvidos nos erros foram metoclopramida e ranitidina. Apenas 0,4% dos erros estavam relacionados com medicamentos potencialmente perigosos. Foram realizadas 168 intervenções e 98,8% foram aceitas pelos prescritores. Os medicamentos envolvidos em erros sérios foram da classe terapêutica aparelho digestivo e metabolismo (p&lt;0,0001), puérperas não lactantes apresentaram mais erros sérios (p&lt;0,0001) devido à interação envolvendo a cabergolina com metoclopramida/bromoprida. Conclusões: Os principais tipos de erros de prescrição foram interações medicamentosas, frequência e dose incorretas. A taxa de aceitação das intervenções foi elevada contribuindo para prevenção de erros e reduzindo riscos da terapia medicamentosa.

Implementing a clinical practice guideline to manage postpartum urinary retention.

Postpartum urinary retention is a common condition in obstetric units. A Clinical Practice Guideline was implemented in a high-risk obstetrical unit to decrease variance of clinical practice, rate of postpartum urinary retention, and number of urinary catheterizations and increase awareness of this common condition. Guideline implementation met the 4 aims, including a decreased rate of urinary retention.

Ketamine/propofol (ketofol) versus propofol/fentanyl for induction of general anesthesia in parturients with rheumatic valvular lesions undergoing elective cesarean section

In this study, we assumed that the addition of ketamine to propofol (ketofol) would maintain cardiac stability in parturients with valvular heart without any deleterious effect on the fetus, that is no respiratory depression for the baby and hence a better Apgar score. This open-label randomized study was carried out in the High-risk Obstetric Unit, Cairo University Hospitals, in collaboration with the Anesthesia Department. The study included full-term parturients, 36-38 weeks' gestational age, 25-40 years old with severe rheumatic valvular heart lesions (mitral stenosis, mitral regurge, aortic stenosis, aortic regurge) of functional class II or III according to the New York Heart Association Classification. At the time of induction, patients were allocated randomly to one of the two study groups: group K (n = 25) received intravenous ketamine 1 mg/kg combined with propofol 1 mg/kg. Group P (n = 25) received propofol 2 mg/kg and fentanyl 2 mg/kg. Mean arterial blood pressure (MAP), heart rate (HR), and central venous pressure were recorded at the following times:T1, T2, T3, T4, T5, and T6. Decrease in MAP was only significant in group P (P < 0.001 at T2 and T3). The magnitude decreases in MAP. The absolute value of MAP was significantly lower in group P after induction, intubation, and skin incision. The median decrease in MAP was significantly higher in group P after induction and intubation. HR increased significantly after induction of anesthesia and after endotracheal intubation in the two groups. It reverted to near baseline values thereafter. The magnitude decreases in HR. The absolute value of HR was significantly lower in group P after intubation and skin incision. Apgar scoring was significantly better (higher) in the ketofol group at 1 and 5 min. We can conclude that a combination of ketamine and propofol seems to be an appropriate choice for anesthesia of critically ill rheumatic cardiac parturients undergoing cesarean section. It proved to be effective and hemodynamically safe for such a critical situation.

Motivaciones para el embarazo adolescente

ObjectivesTo identify the motivations (beliefs, values) for adolescent pregnancy among girls aged less than 17 years old. MethodWe performed a phenomenological qualitative study with audio recording of in-depth interviews with 12 pregnant adolescents between March and September 2008. Purposive sampling of pregnant adolescents (14-16 years) in the high-risk obstetric unit of the Hospital of Jaen (Spain) was performed, using education, voluntariness of pregnancy, urban-rural setting of the family residence and family socioeconomic status as heterogeneity criteria. A content analysis was performed with coding, triangulation of categories, and extraction and verification of results. ResultsThe adolescent's sociocultural context was of considerable weight in sexual and reproductive decisions. Adolescents with unplanned pregnancies felt that their responsibility was relative, showing an attitude of acceptance and resignation, which later became a tendency to rationalize the events and claim that the child was wanted or even planned. Girls with a wanted pregnancy did not have a clear idea of the consequences of having a child. Previous ideas about pregnancy were mainly related to physical changes without taking into account other changes that occur during and after pregnancy. ConclusionsThe family context and socialization of girls are based on a traditional division of gender roles in which the traditional role of the female caregiver is strongly internalized. The reasons for teenage pregnancy are unclear; pregnant adolescents lacked a sense of self-determination and felt that their lives were determined by circumstances.

Neonatal screening for prenatal alcohol exposure: Assessment of voluntary maternal participation in an open meconium screening program

Meconium fatty acid ethyl esters (FAEEs) are validated biomarkers of fetal alcohol exposure. Meconium FAEE testing can potentially be used as a screen by health-care professionals to identify neonates at-risk for Fetal Alcohol Spectrum Disorder, thereby permitting diagnostic follow-up of these children and early intervention in those who develop disabilities. The purpose of this study was to assess whether women would willingly partake in a screening program of this nature. This was determined by launching a pilot screening program for prenatal alcohol exposure in a high-risk obstetric unit previously shown to have a high prevalence of FAEE-positive meconium via anonymous meconium testing. The program involved voluntary testing of meconium for FAEEs and long-term developmental follow-up of positive cases through an existing public health program. The participation rate in the screening program was significantly lower than when testing was conducted anonymously (78% vs. 95%, respectively; p < 0.05), and the positivity rate was 3% in contrast to 30% observed under anonymous conditions (p < 0.001). These low rates suggest that the majority of mothers who consumed alcohol in pregnancy refused to participate. We conclude that despite the potential benefits of such screening programs, maternal unwillingness to consent, likely due to fear, embarrassment, and guilt, may limit the effectiveness of meconium testing for population-based open screening, highlighting the need for public education and social marketing efforts for such programs to be of benefit.

Reverse end-diastolic flow in a fetus with a rare liver malformation: a case report

IntroductionWe describe a case of early and persistent reverse end-diastolic flow in the middle cerebral artery in a fetus with severe ascites. These features are associated with a rare liver malformation known as ductal plate malformation.Case presentationA 28-year-old Caucasian woman was referred to our high-risk obstetric unit at 24 weeks' gestation for fetal ascites detected during a routine ultrasound examination. During her hospitalization we performed medical investigations, including a fetal paracentesis, to detect the etiology of fetal ascites. The cause of fetal ascites (then considered non-immune or idiopathic) was not evident, but a subsequent ultrasound examination at 27 weeks' gestation showed a reverse end-diastolic flow in the middle cerebral artery without any other Doppler abnormalities. A cesarean section was performed at 28 weeks' gestation because of the compromised fetal condition. An autopsy revealed a rare malformation of intrahepatic bile ducts known as ductal plate malformation.ConclusionPersistent reverse flow in the middle cerebral artery should be considered a marker of adverse pregnancy outcome. We recommend careful ultrasound monitoring in the presence of this ultrasonographic sign to exclude any other cause of increased intracranial pressure. To better understand the nature of these ultrasonographic signs, additional reports are deemed necessary. In fact in our case, as confirmed by histopathological examination, the fetal condition was extremely compromised due to failure of the fetal liver. Ductal plate malformation altered the liver structures causing hypoproteinemia and probably portal hypertension. These two conditions therefore explain the severe hydrops that compromised the fetal situation.

Rates of fetal alcohol exposure among newborns in a high-risk obstetric unit

Meconium fatty acid ethyl esters (FAEEs) are sensitive and specific biomarkers for prenatal alcohol exposure (PAE) in pregnancy. We recently reported a 2.5% rate of FAEE positive meconium in a general population sample of infants born in the region of Grey-Bruce, Ontario. Women in this region with high-risk pregnancies are transferred to a tertiary care facility in London, Ontario. The objective of this study was to determine, in a population-based sample, whether high-risk pregnancies are associated with an increased risk of in utero alcohol exposure. Grey-Bruce residents transferred to the high-risk obstetric unit of St. Joseph's Health Care in London, Ontario were identified and consented to this anonymous prevalence study. Meconium was collected and analyzed for FAEE using gas chromatography with mass spectrometry. The prevalence of FAEE positive meconium was compared with the population-based prevalence in the Grey-Bruce. Fifty meconium specimens were collected from August 1, 2006 to July 31, 2007. Fifteen (30%) specimens tested positive for FAEE. The results indicate that infants born in the high-risk obstetric unit had a 12-fold higher risk of screening positive for second and third trimester alcohol exposure compared with infants born in the general population of Grey-Bruce (relative risk = 12.04, 95% confidence interval = 6.40–22.65, P < .0001). These results suggest that the high-risk pregnancies should be screened for PAE and followed-up for potential diagnosis of fetal alcohol spectrum disorder.

Sagittal suture overlap in cephalopelvic disproportion: Blinded and non‐participant assessment

To determine the role of assessment of overlap of fetal skull bones (molding) in intrapartum prediction of cephalopelvic disproportion (CPD). Prospective cross-sectional study. South African high-risk obstetric unit that receives referrals from other facilities. Women of at least 37 weeks' gestation in the active phase of labor, with singleton vertex presentations and live fetuses, and without previous cesarean sections. The researcher was blinded to parity and previous clinical information on the women, and not involved in their obstetric care. The researcher performed clinical assessments, including estimation of level of head, cervical dilatation, head flexion, position, overlap of fetal skull bones, caput succedaneum and asynclitism. A single assessment was done on each woman. CPD, defined as cesarean section for poor progress in labor. The author examined 504 women, and CPD occurred in 113 (22.4%). In multivariate logistic regression analysis, sagittal suture overlap was independently associated with CPD. Other factors associated were maternal height, duration of labor, birth weight, and the interaction between caput succedaneum and cervical dilatation at the time of examination. Lambdoid suture overlap was not significantly associated with CPD, and could be determined in only 66.5% of examinations because of frequent head deflexion. Assessment of sagittal suture overlap, but not lambdoid suture overlap, is useful for prediction of CPD. Knowledge of sagittal suture overlap may assist in decisions on clinical management where there is poor progress in a trial of labor.

Acute respiratory failure during pregnancy: a case of nitrofurantoin-induced pneumonitis

The Case: A previously healthy 27-year-old woman bearing twins during her first pregnancy arrived at our hospital's high-risk obstetrical unit when labour threatened at 33 weeks' gestation. Her antenatal care had been standard and her pregnancy, until then, unremarkable. The results of her physical

El síndrome de la plaqueta pegajosa: serie de casos en gestantes en el hospital militar central y revisión de literatura

El síndrome de la plaqueta pegajosa es un desorden plaquetario autosómico dominante asociado con eventos tromboembólicos arteriales y venosos. Se caracteriza por hiperagregabilidad plaquetaria en plasma rico en adenosindifosfato y epinefrina. Clínicamente las pacientes pueden presentar angina de pecho, infarto agudo del miocardio, accidentes isquémicos transitorios, accidentes cerebrovasculares, trombosis retiniana, trombosis de arterias periféricas y trombosis venosas, frecuentemente recurrente bajo tratamiento anticoagulante oral. Se presentan cuatro casos de gestantes diagnosticadas y tratadas en la Unidad de Alto Riesgo Obstétrico del Hospital Militar Central, con pruebas diagnósticas para otros eventos hipercoagulables normales que sólo presentaban hiperagregación plaquetaria. Posteriormente se hace una revisión de la literatura.

Fetal evaluation for transport by ultrasound performed by air medical teams: A case series

The air medical team has limited options when evaluating the obstetrical patient and assessing fetal health during air transport to a high-risk obstetrical unit. Traditionally, physical examination and a Doppler stethoscope have been used to determine fetal heart rates and movement. However, with the advent of portable ultrasound technology, new information about the mother and child are available to the air medical crew. The Fetal Evaluation for Transport with Ultrasound (FETUS) is a screening examination that consists of an evaluation of the fetal heart rate, position, and movement and general condition of the placenta. The examination can be repeated in flight with no acoustic distortion from rotor noise. The additional information can be advantageous when transport decisions need to be made or when conditions do not allow Doppler stethoscope use.