Enrique Calabrese’s research while affiliated with National University of Asuncion and other places

This case report illustrates the prenatal diagnosis of fetal hypothyroidism in a nulliparous 31-year-old woman with a history of four previous cesarean sections. She was presented with chronic renal failure of unknown etiology and had been on dialysis for 3 years along with a subclinical hypothyroidism. At 21.4 weeks of gestation, color Doppler revealed a fetus with symmetrical solid mass in the anterior cervical region with little vascularization compatible with fetal goiter. Aminotic fluid was also increased for gestational age. At 25 weeks of gestation, due to maternal respiratory distress, an amniodrainage was performed. From the same sample, thyroid-stimulating hormone (TSH) was determined yielding 1.3 mIU/mL and 0.1 ng/dL for free T4. At 27 weeks of gestation, membrane rupture occurred. Chorioamniotis was suspected and cesarean section was performed extracting a live 1060 gm female newborn. The newborn was 29 weeks of age by Capurro test and Apgar score was 7/08. On physical examination, a 2 to 3 cm symmetrical tumor was found in cervical region. Admitted to neonatal intensive care unit for mechanical respiratory support, four ampoules of T4 were given, achieving complete regression of thyroid gland size at 15 days of life. At 34 days of age, nosocomial infection, Klepsiella neumonie, was confirmed and death occurred at 40 days of life. Isolated fetal hypothyroidism is rare. Ultrasound evaluation allows the identification of compensatory growth of the thyroid, showing a hypoechoic solid image. In extreme cases, it may cause esophageal obstruction and polyhydramnios as well as cervical hyperextension and dystocia during labor. How to cite this article Ruoti Cosp M, Gruhn E, Ontano M, Calabrese E, Mendoza L. Fetal Hypothyroidism. Donald School J Ultrasound Obstet Gynecol 2016;10(3):326-329.

Illicit drug use and dependence is a serious social problem with high maternal and fetal morbidity. Supply increase and propitious social context allowed that the diffusion of the use of illicit toxic substances entails a growing incidence in pregnant women who use illicit drugs and an increase of newborns affected by the practices of their mothers. Risk evaluation is difficult when gestation is exposed to illicit drugs because the results could be biased by the concomitant consumption of others toxic substances or by psychological and socio-sanitary unfavorable factors. Though a specific pattern of congenital anomalies has not been defined, in general it is considered that drug abuse has an increased risk of anomalous outcomes in pregnancies. This risk is caused by an increase in the risk of congenital malformations due to the probable teratogenicity of some substances or the perinatal morbility affecting the fetal growth or normal pregnancy development. Although it has not been demonstrated effectively, there are also possible long-term repercussions in the learning capacity and behavior of the children exposed intra uterus. In conclusion, all pregnancies exposed to illicit drugs must be considered high risk pregnancies and measures should be taken so that the patients avoid these practices supported by a multidisciplinary team. Ideally, this team should start working before pregnancy implying the adoption of preventive measures such as information and public awareness of women in fertile age and support during pregnancy and maternal lactation.