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La pandemia del coronavirus 19 (COVID-19) y las medidas instauradas para su control significaron la interrupción de la atención prenatal, con potencial riesgo en la salud materna y fetal. Por otro lado, la atención prenatal convencional presencial implicaría exposición y riesgo de infección en pacientes y proveedores de salud. El Instituto Nacional Materno Perinatal (INMP) ha incorporado la teleconsulta como parte de un nuevo modelo de atención prenatal mixto, cuyo objetivo es disminuir las citas presenciales y, por tanto, el contacto y riesgo de transmisión viral. El paquete de atención prenatal incluye actividades esenciales para atender gestantes en edades gestacionales específicas con mayor impacto en los desenlaces perinatales y maternos. Este nuevo modelo podría generalizarse a nivel nacional y ser parte de la solución a las disparidades de atención en el Perú, mediante políticas del uso de la telemedicina en la atención prenatal que faciliten su implementación, así como su sostenibilidad después de la pandemia de COVID-19. The coronavirus 19 (COVID-19) pandemic and the measures implemented for its control meant the interruption of prenatal care, with potential risk to maternal and fetal health. However, conventional in-person prenatal care would imply exposure and risk of infection in patients and health care providers. The Instituto Nacional Materno Perinatal (INMP) has incorporated teleconsultation as part of a new model of mixed prenatal care, which aims to reduce in-person appointments and, therefore, the contact and risk of viral transmission. The prenatal care package performs essential activities to care for pregnant women of specific gestational ages with a greater impact on perinatal and maternal outcomes. This new model could be generalized nationally and be part of the solution to the disparities of healthcare in Peru, through policies for the use of telemedicine in prenatal care that fa e its implementation, as well as its sustainability after the COVID-19 pandemic.

Placental chorioangioma is a non-trophoblastic benign tumor of rare presentation. It may be associated with complications of pregnancy when larger than 4 cm. We present the case of a pregnant adolescent with 25 weeks of gestation referred for prenatal management of a giant placental chorangioma that complicated pregnancy with hydramnios and severe fetal anemia. Fetoscopic laser ablation of the main nutrient vessel of the tumor was performed for the first time in Peru, which reversed complications and improved fetal prognosis. El corioangioma placentario es una tumoración benigna no trofoblástica de muy rara presentación. Se asocia a complicaciones del embarazo cuando tiene dimensiones mayores a 4 cm. Se presenta el caso de una gestante adolescente de 25 semanas referida a nuestro servicio para manejo prenatal de un corioangioma placentario gigante que complicó el embarazo con polihidramnios y anemia fetal severa. Se realizó por primera vez en el Perú la ablación láser del vaso nutricio principal de la tumoración por fetoscopia, lo que logró revertir las complicaciones y mejorar el pronóstico fetal.

El corioangioma placentario es una tumoración benigna no trofoblástica de muy rara presentación. Se asocia a complicaciones del embarazo cuando tiene dimensiones mayores a 4 cm. Se presenta el caso de una gestante adolescente de 25 semanas referida a nuestro servicio para manejo prenatal de un corioangioma placentario gigante que complicó el embarazo con polihidramnios y anemia fetal severa. Se realizó por primera vez en el Perú la ablación láser del vaso nutricio principal de la tumoración por fetoscopia, lo que logró revertir las complicaciones y mejorar el pronóstico fetal. Placental chorioangioma is a non-trophoblastic benign tumor of rare presentation. It may be associated with complications of pregnancy when larger than 4 cm. We present the case of a pregnant adolescent with 25 weeks of gestation referred for prenatal management of a giant placental chorangioma that complicated pregnancy with hydramnios and severe fetal anemia. Fetoscopic laser ablation of the main nutrient vessel of the tumor was performed for the first time in Peru, which reversed complications and improved fetal prognosis.

El teratoma sacrococcígeo es una enfermedad rara en el feto, pero con alta mortalidad perinatal debido al secuestro de flujo sanguíneo y consiguiente desarrollo de anemia fetal severa. Presentamos el caso de una gestante de 27 semanas referida a nuestro servicio para manejo prenatal de un feto con teratoma sacrococcígeo gigante, que desarrolló anemia fetal severa y fue sometido a una transfusión intrauterina intravascular, la cual pudo prolongar el embarazo y mejorar los resultados perinatales. Sacrococcygeal teratoma is a rare fetal disease but with high perinatal mortality due to sequestration of blood flow and consequent development of severe fetal anemia. We present the case of a 27 weeks pregnant woman referred to our service for prenatal management of a fetus with giant sacrococcygeal teratoma and severe anemia and who was subjected to intrauterine intravascular transfusion that could permit prolongation of the pregnancy and improve perinatal results.

OBJETIVES: To describe the epidemiological characteristics and obstetric and perinatal outcomes in pregnant women after 40 years. DESIGN: Descriptive Study retrospectivo.MATERIAL AND METHODS: The medical records of all births occurred in women 40 years or older treated at the IME of January 1, 2004 to November 30, 2004. Revised RESULTS: 18568 births were attended, of which 516 were women aged 40 or more, with an incidence of 2.78%. Two groups, the group of gilts (n = 46) and the group of multiparous (n = 470) was distinguished. 58.2% were between 40 and 42 years at birth. Both groups had similar characteristics in terms of average age, marital status, BMI and number of prenatal visits. The cesarean rate in the entire population was high (56.8%) and highest in nulliparous group (71.7%; p

Background: The finding of short femur (length below the 5th centile) at second trimester ultrasound examination is a diagnostic challenge. Classically, the short femur has been associated to chromosomal abnormalities and skeletal dysplasias. A few reports have been published on fetuses with isolated short femur outcomes. Objectives: To determine perinatal outcomes in the second-trimester fetuses with isolated short femur and to determine its association with fetal growth restriction. Design: Retrospective cohort study, also called historical or concurrent study. Setting: Fetal Medicine Unit, Instituto Nacional Materno Perinatal, Lima, Peru. Participants: Women with 16 to 28 weeks pregnancies. Interventions: The sample size was drawn from our 2006-2008 databases and consisted in 278 fetuses 16 to 28 weeks who had ultrasound examination. We categorized two groups: fetuses with isolated short femur (cases) and fetuses with normal femur length (controls). We excluded from analysis fetuses with abnormalities or multiple gestations. Tstudent bivariated analysis was done to compare continuous variables and categorical variables were analyzed by Fisher’s exact test. Main outcome measures: Association of fetal short femur with fetal and maternal complications. Results: Fetuses with isolated short femur showed significantly lower mean birth weight by 412,3 g (p=0,000). Odds ratio for growth restriction was 2,32 (95%CI: 1,03-5,23). Additionally we observed more cases of mothers developing preeclampsia (11,2% vs. 2,1%, p=0,001) and gestational hypertension (11,2% vs. 4,8%, p= 0,046). Also, fetuses with isolated short femur had more frequently 5 minute Apgar score

Systematic amniotomy in pregnant women with spontaneous labor is largely practiced in Peruvian and world hospitals with documented prevalence up to 77%. Little is known on benefits and harms resulting to both fetus and mother. We searched the medical literature in order to find solid evidence to support or reject this practice. We conclude that systematic amniotomy alters the physiological evolution of labor shortening it about 50 minutes average. However, this has no clinical significance on both fetus and mother. Conversely, routine practice may increase incidence of dysfunctional labor and five minutes less than seven Apgar score., La amniotomía de rutina o sistemática, practicada en gestantes con trabajo de parto de inicio espontáneo, se da en gran parte de hospitales del Perú y el mundo, documentándose su prevalencia hasta en 77%. Sin embargo, poco se conoce acerca de los beneficios y daños que puede ocasionar en el feto y en la madre. Se realizó una búsqueda de la literatura médica, con la finalidad de encontrar evidencia científica sólida que respalde o rechace esta práctica. Se llega a la conclusión que la amniotomía practicada sistemáticamente altera la evolución fisiológica del trabajo de parto, acortándolo hasta en 50 minutos en promedio; sin embargo, este acortamiento no tiene trascendencia clínica ni para el feto ni para la madre. Por el contrario, su práctica de rutina puede aumentar el número de partos disfuncionales y el puntaje Ápgar menor de siete a los cinco minutos.

First trimester ultrasound scan (11+0 to 13+6 weeks) is currently one of the most important clinical tools in managing pregnant women and their fetuses. It represents the best example of screening in Obstetrics to assess risk for chromosomal abnormalities and combined with maternal and obstetrical characteristics could be a useful predictor of obstetrical complications. We aim to present comprehensive summary of this important topic in Fetal Medicine for people involved in providing maternal and perinatal care, i.e. obstetricians, midwives and parents., La evaluación ecográfica del primer trimestre (11+0 a 13+6 semanas) constituye actualmente una de las herramientas fundamentales en el manejo de toda paciente obstétrica. Es el mejor ejemplo de tamizaje en Obstetricia por medio del cálculo de riesgo de anormalidades cromosómicas y, sumado a ciertas características obstétricas y clínicas, se constituye en un potencial predictor de riesgo de las principales complicaciones obstétricas. Es nuestro objetivo presentar en forma resumida y simplificada los avances en este importante tópico de Medicina Fetal, con la finalidad de que sea reafirmada y asumida por todos los responsables del cuidado de la salud materno-fetal, incluyendo los padres.