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Vasa praevia rupture in velamentous insertion of the umbilical cord: The importance of prenatal diagnosis
Rotura de vasa previa en una inserción velamentosa de cordón umbilical. Importancia del diagnóstico prenatal
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Pérez Rodríguez, E. de Frutos Moneo, S. Nieto Llanos, J. Clemente Pollán" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.J." "apellidos" => "Pérez Rodríguez" "email" => array:1 [ 0 => "maryjo.pe.ro@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "de Frutos Moneo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Nieto Llanos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Clemente Pollán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rotura de vasa previa en una inserción velamentosa de cordón umbilical. Importancia del diagnóstico prenatal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 772 "Ancho" => 983 "Tamanyo" => 139623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Microscopic view of the placenta.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vasa praevia is said to occur when the foetal blood vessels traverse the membranes over the cervix, below the presenting part.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are two variants: type 1, which results from velamentous insertion of the umbilical cord, and type 2, which occurs when foetal vessels run between the lobes of a bilobed or succenturiate-lobed placenta.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Its incidence is approximately 1 in every 2500 pregnancies.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Spontaneous or artificial rupture of the membranes leads to a tearing of the foetal blood vessels, frequently giving rise to rapid foetal exsanguination<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and high perinatal mortality.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case history</span><p id="par0010" class="elsevierStylePara elsevierViewall">A healthy expectant mother, aged 28, attended the accident and emergency department in week 38 of pregnancy with premature rupture of membranes. The pregnancy had been controlled, with negative blood tests, except for rubella, to which she was immune. In the ultrasound scan performed in week 20 an anomaly compatible with club foot was diagnosed in the right foot. The next ultrasound scan, performed in week 36, did not find any other different anomalies.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Examination of the patient on arrival at the hospital detected the presence of vaginal blood clots. The foetal heart rate in the cardiotocographic recording and the ultrasound examination was 90 beats per minute. A Caesarean section was immediately performed for suspected placental abruption. The infant, a boy, was born floppy and markedly pale, with no respiratory effort and no heartbeat. Orotracheal intubation and intermittent positive pressure ventilation were performed. Since no response was detected, cardiac massage was initiated and a first dose of adrenaline was immediately administered. It was repeated a further five times. After 20<span class="elsevierStyleHsp" style=""></span>min, in view of the lack of response, resuscitation manoeuvres were discontinued. The pH of the umbilical artery was 6.88.</p><p id="par0020" class="elsevierStylePara elsevierViewall">An anatomical and pathological examination of the foetus, placenta and adnexa was carried out. The conclusion was that it was a male foetus, weighing 2270<span class="elsevierStyleHsp" style=""></span>g, with a right club foot. In the placenta a recent haemorrhage was observed in the chorioamniotic membranes, with no signs of inflammation. The histological section of the vascular structures showed that it was a case of velamentous insertion of the umbilical cord (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Few obstetric tragedies are as unexpected as vasa praevia rupture. Its incidence is 1 in every 2500 pregnancies,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> though this is probably an underestimate, as it is a problem that tends to go undiagnosed.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In the period before the widespread use of ultrasound, diagnosis could be made during vaginal examination with a speculum or by direct palpation of the vessels during delivery. Foetal mortality ranged between 58% and 73%.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It currently stands at around 33%; there are very few obstetric conditions with so high a rate of foetal mortality that do not entail any risk for the mother.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> When the membranes are ruptured, tearing of the foetal vessels occurs and a small amount of vaginal bleeding appears, the significance of which is commonly underestimated.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Various risk factors have been identified for the presence of vasa praevia, including in vitro fertilisation,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> bilobed or succenturiate-lobed placenta<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and multiple pregnancies.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> On the other hand, velamentous insertion of the cord is associated with an increase in the incidence of certain foetal anomalies, such as renal malformations, spina bifida, ventricular septal defect, single umbilical artery and an increase in obstetric complications, including miscarriage, prematurity and low birth weight.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> We have not found cases in the literature of vasa praevia associated with club foot, as occurred in our patient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Dougall and Baird<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> describe five modes of presentation: vessel rupture at amniotomy, vessel rupture before rupture of membranes, vessel rupture after rupture of membranes, vessel compression, and vessels palpable on vaginal examination.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The most frequent presentation is the first. Given that the blood volume of a term neonate is about 250<span class="elsevierStyleHsp" style=""></span>mL, a haemorrhage of around 50–60<span class="elsevierStyleHsp" style=""></span>mL (20–25% of the total) can lead to shock and death.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Vaginal bleeding appearing at amniotomy should raise suspicions of the presence of vasa praevia.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Compression of foetal blood vessels by presentation is manifested as decelerations and bradycardia in the cardiotocographic recording<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–15</span></a> and can lead to asphyxia and foetal death in 50–60% of cases.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> The aetiology of irregularities in foetal heart rate varies, but the presence of vasa praevia must be taken into account in differential diagnosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The first diagnosis of vasa praevia using ultrasonography was made in 1987.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In later years, improvements in the resolution of ultrasound images and the addition of Doppler colour made it easier to identify the point of insertion of the umbilical cord. Sepúlveda et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> report that they were able to identify the placental cord insertion site in 99% of cases and that the exploration was not particularly time-consuming. Other authors report a sensitivity of 62.5% in antenatal detection of velamentous insertion of the cord, with a positive predictive value of 100% and a negative predictive value of 99.6%.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">According to Lee et al., vasa praevia can be identified from the second trimester of pregnancy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Nevertheless, given that some cases of vasa praevia resolve themselves spontaneously at the end of the pregnancy, they consider it reasonable to confirm the diagnosis in the third trimester, when its detection has the greatest impact on treatment.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The treatment consists of performing a Caesarean section in week 35 of pregnancy or even earlier, if the lung maturity of the foetus has been documented. Immediate neonatal resuscitation must be aggressive and a rapid restitution of blood volume must be carried out. Some authors propose hospitalising the expectant mother in the 32nd week of pregnancy, administering corticosteroids to accelerate the lung maturation of the foetus and performing an urgent Caesarean section in the event of premature rupture of membranes before the 35th week. When an antenatal diagnosis is made, there are no associated malformations and an elective Caesarean is performed, the survival rate of newborns is close to 100%.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Velamentous insertion of the umbilical cord is an obstetric complication that can have fatal consequences for the foetus. Its antenatal diagnosis is straightforward and enables effective preventive and therapeutic measures to be taken. We believe that this anomaly should be investigated by ultrasound in all pregnancies, or at least in those where risk factors for the condition exist.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres388681" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec367268" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres388680" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec367267" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case history" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-08-29" "fechaAceptado" => "2013-10-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec367268" "palabras" => array:3 [ 0 => "Vasa praevia" 1 => "Prenatal diagnosis" 2 => "Foetal bleeding" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec367267" "palabras" => array:3 [ 0 => "Vasa previa" 1 => "Diagnóstico prenatal" 2 => "Sangrado foetal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Vasa praevia is a rare condition in which the foetal blood vessels cross the foetal membranes of the lower segment of the uterus below the presenting part. It has a high foetal mortality due to foetal exsanguination resulting from foetal vessels tearing when the membranes rupture. Prenatal diagnosis can reduce or even prevent foetal mortality, but it requires a high level of suspicion. For this reason, pregnant women with risk factors of vasa praevia should be examined using transvaginal ultrasound in combination with colour Doppler, and if the diagnosis is made, elective delivery by caesarean and aggressive resuscitation of the new born is indicated.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La presencia de vasa previa es una afección poco frecuente en la que los vasos fetales atraviesan las membranas amnióticas por encima del cuello del útero y por debajo de la presentación foetal. Asocia una mortalidad elevada debida a la exanguinación foetal producida por el desgarro de los vasos fetales al romperse las membranas amnióticas. El diagnóstico prenatal puede disminuir significativamente la tasa de mortalidad, pero requiere un alto índice de sospecha. Por este motivo, aquellas mujeres embarazadas que presenten factores de riesgo de vasa previa deben ser exploradas con ecografía transvaginal y Doppler colour. Si se confirma el diagnóstico, está indicada la realización de una cesárea electiva y una enérgica reanimación del recién nacido. Presentamos el caso de un recién nacido que nace en parada cardiorrespiratoria que no revierte, pese a una enérgica reanimación, debido a la rotura de un vasa previa no diagnosticado.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez Rodríguez MJ, de Frutos Moneo E, Nieto Llanos S, Clemente Pollán J. Rotura de vasa previa en una inserción velamentosa de cordón umbilical. Importancia del diagnóstico prenatal. An Pediatr (Barc). 2014;81:393–395.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 772 "Ancho" => 983 "Tamanyo" => 139623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Microscopic view of the placenta.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 315 "Ancho" => 983 "Tamanyo" => 61532 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Macroscopic view of the placenta showing velamentous insertion of the umbilical cord.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa previa: the impacto f prenatal diagnosis on outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Oyelese" 1 => "V. Catanzarite" 2 => "F. Prefumo" 3 => "S. Lashley" 4 => "M. Schachter" 5 => "Y. Tovbin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.AOG.0000123245.48645.98" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2004" "volumen" => "103" "paginaInicial" => "937" "paginaFinal" => "942" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15121568" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Catanzarite" 1 => "C. Maida" 2 => "W. Thomas" 3 => "A. Mendoza" 4 => "I. Stanco" 5 => "K.M. Piacquadio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ultrasound Obstet Gynecol" "fecha" => "2001" "volumen" => "17" "paginaInicial" => "109" "paginaFinal" => "115" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa previa: an avoidable obstetric tragedy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.O. Oyelese" 1 => "M. Turner" 2 => "C.C. Lees" 3 => "C.S. Campbell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol Surv" "fecha" => "1999" "volumen" => "54" "paginaInicial" => "138" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9950006" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa previa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Pent" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "1979" "volumen" => "134" "paginaInicial" => "151" "paginaFinal" => "155" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/453241" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Velamentous insertion of the umbilical cord" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Kouyoumdijan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "1980" "volumen" => "56" "paginaInicial" => "737" "paginaFinal" => "742" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7443117" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa previa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.E. Torrey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "1952" "volumen" => "63" "paginaInicial" => "146" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14894510" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poor perinatal outcome associated with vasa previa: is it preventable? A report of three cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.Y. Fung" 1 => "T.K. Lau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1469-0705.1998.12060430.x" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Obstet Gynecol" "fecha" => "1998" "volumen" => "12" "paginaInicial" => "430" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9918093" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ruptured vasa previa in velamentous cord insertion placenta" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Jantarasaengaram" 1 => "C. Suthipintawong" 2 => "S. Kanchanawat" 3 => "K. Thanagumtorn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.jp.7211757" "Revista" => array:6 [ "tituloSerie" => "J Perinatol" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "457" "paginaFinal" => "459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17592490" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa praevia: another cause for concern in in vitro pregnancies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Burton" 1 => "D.M. Saunders" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Aust NZ J Obstet Gynaecol" "fecha" => "1988" "volumen" => "28" "paginaInicial" => "180" "paginaFinal" => "181" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa praevia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.M. Evans" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br Med J" "fecha" => "1952" "volumen" => "2" "paginaInicial" => "1243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/519394" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa praevia in twin pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.B.B. Whitehouse" 1 => "H.G. Kohler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Obstet Gynaecol Br Emp" "fecha" => "1960" "volumen" => "67" "paginaInicial" => "281" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13844429" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Velamentous insertion of the cord in early pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I.W. Monie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "1965" "volumen" => "93" "paginaInicial" => "276" "paginaFinal" => "281" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14336660" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa praevia – report of three cases and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Dougall" 1 => "C.H. Baird" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Obstet Gynaecol" "fecha" => "1987" "volumen" => "94" "paginaInicial" => "712" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3620417" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa previa: report of 3 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Naftolin" 1 => "S.D.R. Mishell Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "1965" "volumen" => "26" "paginaInicial" => "561" "paginaFinal" => "565" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5889776" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A nonhemorrhegic manifestation of vasa previa: a clinicopathologic case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.R. Cordero" 1 => "A.W. Helfgott" 2 => "H.J. Landy" 3 => "R.F. Reik" 4 => "C. Medina" 5 => "M.J. O'Sullivan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "1993" "volumen" => "82" "numero" => "4 Pt 2 Suppl." "paginaInicial" => "698" "paginaFinal" => "700" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8378018" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of vasa preiva with ultrasongraphy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Gianopoulos" 1 => "T. Carver" 2 => "P. Tomich" 3 => "R. Karlman" 4 => "K. Gadwood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "1987" "volumen" => "69" "numero" => "3 Pt 2" "paginaInicial" => "488" "paginaFinal" => "491" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3543773" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prenatal detection velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W. Sepulveda" 1 => "I. Rojas" 2 => "J.A. Robert" 3 => "C. Schnapp" 4 => "J.L. Lacalde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/uog.132" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Obstet Gynecol" "fecha" => "2003" "volumen" => "21" "paginaInicial" => "564" "paginaFinal" => "569" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12808673" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Velamenotuous cord insertion into the lower third of the uterus is associated with intrapartum fetal heart abnormalities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Hasegawa" 1 => "R. Matsouka" 2 => "K. Ichizuka" 3 => "A. Sekizawa" 4 => "A. Farina" 5 => "T. Okai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/uog.2645" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Obstet Gynecol" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "425" "paginaFinal" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16479618" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasa previa: prenatal diagnosis, natural evolution and clinical outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Lee" 1 => "V.L. Lee" 2 => "J.S. Kirk" 3 => "C.T. Sloan" 4 => "R.S. Smith" 5 => "C.H. Comstock" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2000" "volumen" => "95" "paginaInicial" => "572" "paginaFinal" => "576" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10725492" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Placenta previa, placenta accrete and vasa previa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Oyeles" 1 => "J.C. Smulina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.AOG.0000207559.15715.98" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2006" "volumen" => "107" "paginaInicial" => "927" "paginaFinal" => "941" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16582134" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008100000006/v1_201412100926/S2341287914001045/v1_201412100926/en/main.assets" "Apartado" => array:4 [ "identificador" => "26004" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008100000006/v1_201412100926/S2341287914001045/v1_201412100926/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287914001045?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 14 | 25 |
| 2024 October | 82 | 33 | 115 |
| 2024 September | 121 | 40 | 161 |
| 2024 August | 112 | 66 | 178 |
| 2024 July | 126 | 38 | 164 |
| 2024 June | 135 | 41 | 176 |
| 2024 May | 99 | 45 | 144 |
| 2024 April | 77 | 33 | 110 |
| 2024 March | 86 | 23 | 109 |
| 2024 February | 93 | 31 | 124 |
| 2024 January | 100 | 30 | 130 |
| 2023 December | 95 | 24 | 119 |
| 2023 November | 72 | 36 | 108 |
| 2023 October | 70 | 23 | 93 |
| 2023 September | 56 | 27 | 83 |
| 2023 August | 58 | 23 | 81 |
| 2023 July | 55 | 29 | 84 |
| 2023 June | 70 | 31 | 101 |
| 2023 May | 78 | 19 | 97 |
| 2023 April | 46 | 11 | 57 |
| 2023 March | 61 | 26 | 87 |
| 2023 February | 51 | 22 | 73 |
| 2023 January | 50 | 33 | 83 |
| 2022 December | 65 | 31 | 96 |
| 2022 November | 60 | 32 | 92 |
| 2022 October | 67 | 43 | 110 |
| 2022 September | 51 | 45 | 96 |
| 2022 August | 54 | 42 | 96 |
| 2022 July | 56 | 49 | 105 |
| 2022 June | 48 | 33 | 81 |
| 2022 May | 64 | 62 | 126 |
| 2022 April | 44 | 41 | 85 |
| 2022 March | 74 | 49 | 123 |
| 2022 February | 77 | 34 | 111 |
| 2022 January | 85 | 64 | 149 |
| 2021 December | 78 | 37 | 115 |
| 2021 November | 90 | 51 | 141 |
| 2021 October | 147 | 68 | 215 |
| 2021 September | 101 | 48 | 149 |
| 2021 August | 60 | 59 | 119 |
| 2021 July | 59 | 26 | 85 |
| 2021 June | 40 | 32 | 72 |
| 2021 May | 65 | 50 | 115 |
| 2021 April | 109 | 97 | 206 |
| 2021 March | 107 | 20 | 127 |
| 2021 February | 67 | 26 | 93 |
| 2021 January | 69 | 17 | 86 |
| 2020 December | 87 | 24 | 111 |
| 2020 November | 60 | 19 | 79 |
| 2020 October | 119 | 16 | 135 |
| 2020 September | 125 | 18 | 143 |
| 2020 August | 107 | 7 | 114 |
| 2020 July | 78 | 18 | 96 |
| 2020 June | 130 | 8 | 138 |
| 2020 May | 52 | 16 | 68 |
| 2020 April | 61 | 23 | 84 |
| 2020 March | 62 | 12 | 74 |
| 2020 February | 42 | 16 | 58 |
| 2020 January | 50 | 17 | 67 |
| 2019 December | 63 | 28 | 91 |
| 2019 November | 41 | 14 | 55 |
| 2019 October | 55 | 7 | 62 |
| 2019 September | 39 | 8 | 47 |
| 2019 August | 57 | 29 | 86 |
| 2019 July | 44 | 17 | 61 |
| 2019 June | 27 | 16 | 43 |
| 2019 May | 55 | 20 | 75 |
| 2019 April | 51 | 22 | 73 |
| 2019 March | 35 | 18 | 53 |
| 2019 February | 34 | 14 | 48 |
| 2019 January | 29 | 11 | 40 |
| 2018 December | 34 | 20 | 54 |
| 2018 November | 76 | 27 | 103 |
| 2018 October | 99 | 27 | 126 |
| 2018 September | 44 | 18 | 62 |
| 2018 August | 4 | 0 | 4 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 6 | 0 | 6 |
| 2018 May | 15 | 0 | 15 |
| 2018 April | 86 | 0 | 86 |
| 2018 March | 93 | 0 | 93 |
| 2018 February | 21 | 0 | 21 |
| 2018 January | 66 | 0 | 66 |
| 2017 December | 40 | 0 | 40 |
| 2017 November | 17 | 0 | 17 |
| 2017 October | 20 | 0 | 20 |
| 2017 September | 27 | 0 | 27 |
| 2017 August | 23 | 0 | 23 |
| 2017 July | 23 | 0 | 23 |
| 2017 June | 26 | 13 | 39 |
| 2017 May | 31 | 14 | 45 |
| 2017 April | 58 | 51 | 109 |
| 2017 March | 17 | 2 | 19 |
| 2017 February | 14 | 3 | 17 |
| 2017 January | 9 | 0 | 9 |
| 2016 December | 28 | 9 | 37 |
| 2016 November | 47 | 9 | 56 |
| 2016 October | 61 | 8 | 69 |
| 2016 September | 27 | 4 | 31 |
| 2016 August | 14 | 2 | 16 |
| 2016 July | 12 | 5 | 17 |
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