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Performed three prenatal consultations. She referred gestational diabetes in previous pregnancies, hypertension and denied a family history of heart disease. Serology for HIV, VDLR, HBsAg and Toxoplasmosis Negatives. She presented altered glycemia during pregnancy but did not undergo treatment. Physical examCardiologic: cardiac auscultation with hyperphonectic, rude sounds, with systolic murmur 1 ± 6 + in left sternal border. Complementary examsCardiologic evaluation was requested for the newborn in the first hours of life due to cardiac auscultation.

Introdução: A asfixia perinatal é uma causa importante de mortalidade no período neonatal. Objetivo: O objetivo deste estudo é analisar as características clínico-epidemiológicas dos óbitos ocorridos por asfixia perinatal e comparar com outras causas de óbito no mesmo período. Material e método: Foi realizado um estudo transversal onde foram verificados todos os óbitos ocorridos no período neonatal nos anos de 2009 a 2015 em uma maternidade publica do sul do Brasil. Resultados: Dos 92 casos de óbito 80% eram prematuros e a principal causa de morte foi Insuficiência respiratória (29%). Por asfixia perinatal foram 18 casos (19,5%). Comparando o grupo cuja causa morte foi asfixia com o grupo que morreu por outras causas encontramos diferença no Apgar (p<0,001) e ausência de prematuros extremos (p<0,05). Não houve diferença entre idade no óbito, consultas de pré-natal, idade gestacional, tipo de parto, presença de malformações, uso de oxigênio e peso ao nascer. Conclusão: Portanto observou-se que a morte por asfixia perinatal ocorre na primeira semana de vida, não são prematuros extremos e tem um bom peso ao nascer e quando comparado ao outro grupo o índice de Apgar e ausência de prematuridade extrema mostraram correlação com a morte por asfixia.

Conjoined twins are a rare presentation with an estimated incidence of 1: 50000 pregnancies. They occur due to a random event, not related to heredity, maternal age or delivery conditions. This article is a case-report of a pair of female thoraco-omphalopagus conjoined twins, who were diagnosed during prenatal period through a morphological ultrasound. After a 24-week gestation period, the female newborns had a total weight of 1100g, and were born of a cesarean section. Both fetuses scored 3 in the Apgar scale in the first minute, getting down to a score of 1 in the fifth minute. Soon after birth, the newborns were referred to the Intensive Care Unit, where supportive measures were taken and transthoracic Doppler echocardiography was performed for diagnostic confirmation. The echocardiogram showed that there was only one heart for both newborns with a complex heart disease. In 75% of the cases of thoraco-omphalopagus conjoined twins, structural heart disfigurements are found in at least one of the fetuses. Besides, in approximately 80-90% of the cases, the cardiac abnormalities in the heart junction are far too complex, making it impossible to surgically separate the fetuses. This way, a structural and functional analysis of the heart is considerably more efficient post-birth, and it’s shown to be more accurately done through an echocardiography. This reveals that cardiac changes are a crucial factor in the fetal and postnatal evaluations of conjoined twins. Such procedures are a way of providing adequate medical recommendations, which may always be honest and based on scientific evidence.Descriptors: Diseases in Twins; Twins, Conjoined; Heart Diseases.ReferencesMcMahon CJ, Spencer R. Congenital heart defects in conjoined twins: outcome after surgical separation of thoracopagus. Pediatr Cardiol. 2006;27(1):1-12Rode H, Fieggen AG, Brown RA, Cywes S, Davies MRQ, Hewitson JP et al. Four decades of conjoined twins at Red Cross Children's Hospital--lessons learned. S Afr Med J. 2006; 96(9Pt2):931-40.Barth RA, Filly RA, Goldberg JD, Moore P, Silverman NH. Conjoined twins: prenatal diagnosis and assessment of associated malformations [published correction appears in Radiology 1991 Jan;178(1):287]. Radiology. 1990;177(1):201-7.Spencer R. Anatomic description of conjoined twins: a plea for standardized terminology. J Pediatr Surg. 1996;31(7):941-944.Andrews RE, Yates RW, Sullivan ID. The management of conjoined twins: Cardiology assessment. Semin Pediatr Surg. 2015;24(5):217-20.Andrews RE, McMahon CJ, Yates RW, et al. Echocardiographic assessment of conjoined twins. Heart. 2006;92(3):382-87.Lopes LM, Brizot ML, Schultz R, Liao AW, Krebs VLJ, Francisco RPV et al. Twenty-five years of fetal echocardiography in conjoined twins: lessons learned. J Am Soc Echocardiogr. 2013;26(5):530-538.Brooks R. Ian McEwan attacks church over right to die. Sunday may 18 2014. The Sunday Times  https://www.thetimes.co.uk/article/mcewan-attacks-church-over-right-to-die-gq8nwtbhqjb.Sih DA, Bimerew M, Modeste RRM. Coping strategies of mothers with preterm babies admitted in a public hospital in Cape Town. Curationis. 2019;42(1):e1-8.Albuquerque S, Pereira M, Fonseca A, Canavarro MC. Impacto familiar e ajustamento de pais de crianças com diagnóstico de anomalia congênita: influência dos determinantes da criança. Rev psiquiatr clín.  2012;39(4):136-41.Pereira PK, Lima LA, Legay LF, Santos JFC, Lovisi GM. Congenital malformation of the baby and risk of maternal mental disorders during the pregnancy-puerperal period: a systematic review. Cad Saúde Colet (Rio de Janeiro). 2011;19(1):2-10.

Ebsteins anomaly, in addition to being a rare congenital heart disease, is infrequently associated with Down’s syndrome. In this paper, it is described a case report of a newborn with this association, who presented with persistent cyanosis. The echocardiogram showed anomalous insertion of tricuspid valve leaflet with moderate valvar insufficiency, having a good outcome at the end of hospitalization. Ebstein’s anomaly is a cardiac modification related with the position and structure of the tricuspid valve and has high mortality in the neonatal period. The Down syndrome is a chromosomal alteration accompanied by major congenital changes, with a high prevalence of cardiac abnormalities. An association of Ebsteins anomaly with other syndromes, such as the one reported, and extracardiacs abnormalities is very uncommon and subject of few case reports. Therefore, giving the predisposition of patients with Down syndrome to develop cardiac problems, it must be emphasized that these patients should be systematically submitted to complete cardiac evaluation, with echocardiographic examination. Knowing their anatomical differences, hemodynamic variables and associated malformations are an imperative for a good management of its bearer, and, therefore, its longevity.