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Resumen Fundamento y objetivo Estudiar la epidemiologia, manifestaciones clinicas, diagnostico, tratamiento, seguimiento y resultados perinatales de la sifilis durante el embarazo. Pacientes y metodo Estudio retrospectivo de 94 gestantes con sifilis cuya gestacion y parto se controlaron en un Servicio de Obstetricia desde 2002 a 2010 entre un total de 85.806 partos de gestantes sin sifilis en el mismo periodo. Resultados La prevalencia de sifilis en el embarazo fue de 0,11%. La mayoria de las gestantes eran de procedencia extranjera y el tipo de sifilis mas prevalente fue la latente tardia. Realizaron el tratamiento correcto solo 57 pacientes, a pesar de la adecuada prescripcion medica. En 31 gestantes se comprobaron complicaciones maternas durante el embarazo y en 16 casos hubo complicaciones fetales. En los neonatos se diagnosticaron 4 casos de sifilis congenita, 3 de ellos con meningitis sifilitica, cuyas madres no habian realizado el tratamiento de forma correcta. Conclusiones La realizacion obligatoria de una serologia de sifilis en el primer trimestre de embarazo permite diagnosticar muchos casos de sifilis latente tardia. Tras la deteccion precoz de las gestantes infectadas se debe asegurar la correcta realizacion del tratamiento para prevenir la transmision vertical.

Oxidative stress is present in pregnancy complications. However, it is unknown if early maternal antioxidant status could influence later development of complications. The use of assisted reproduction techniques (ART) is rising due to the delay of first pregnancy and there is scarce information on its influence on oxidative balance. Objective To assess the possible relationship between maternal plasma antioxidant status in first trimester of gestation with later development of pregnancy complications, evaluating the influence of ART and nutrition. Methods Plasma from 98 healthy pregnant women was obtained at week 10, nutrition questionnaires filled and women were followed until delivery. We evaluated biomarkers of oxidative damage (carbonyls, malondialdehyde-MDA), antioxidants (thiols, reduced glutathione, phenolic compounds, catalase and superoxide dismutase activities) by spectrophotometry/fluorimetry and melatonin (ELISA). Antioxidant status score (Antiox-S) was calculated as the computation of antioxidants. Diet-antioxidants relationship was evaluated through multiple correspondence analysis. Results Melatonin and carbonyls exhibited a negative correlation. No difference in oxidative damage was found between groups, but Antiox-S was significantly lower in women who developed complications. No differences in oxidative damage or Antiox-S were found between ART and no-ART pregnancies. High consumption of foods of vegetable origin cluster with high plasma levels of phenolic compounds and with high Antiox-S. Conclusions In early normal gestation, low plasma antioxidant status, assessed through a global score, associates with later development of pregnancy complications. Larger population studies could help to determine the value of Antiox-S as predictive tool and the relevance of nutrition on maternal antioxidant status

Resumen El himen imperforado se presenta en aproximadamente una de cada 2.000 mujeres. Es la causa congenita mas comun de obstruccion del flujo genital y, por lo general, no suele presentar sintomas hasta la pubertad. Presentamos el caso de una adolescente de 13 anos que acudio a nuestro servicio de urgencias refiriendo dolor abdominal y metrorragia. La exploracion fisica revelo un himen integro y abombado por el que empezaba a drenar sangre oscura. La ecografia transabdominal era sugestiva de hematocolpos y hematometra. La paciente recibio tratamiento quirurgico y la evolucion postoperatoria fue favorable.

Resumen El teratoma sacroccocigeo (TSC) es el tumor neonatal mas frecuente. Un 15% de estos tumores son de predominio quistico. Aunque el pronostico de las formas quisticas es mucho mas favorable que el de las formas solidas, se asocian tambien a un aumento de la morbilidad y mortalidad perinatal debido al gran volumen tumoral que pueden alcanzar aumentando el riesgo de prematuridad y de compresion de visceras pelvicas. En caso de compresion de la via urinaria por un TSC de predominio quistico la puncion y drenaje ecoguiados percutaneos parecen ser una tecnica segura que permite resolver la obstruccion, disminuir el riesgo de prematuridad y de distocia durante el parto. Presentamos un caso clinico en el que realizo puncion y drenaje percutaneo guiado por ecografia de un teratoma sacrococcigeo con afectacion de la via urinaria que evoluciono favorablemente.

La acromegalia es el exceso de secreción de hormona de crecimiento (HC). Esta alteración está relacionada con esterilidad y con complicaciones maternas durante el embarazo por aumento de la secreción de la HC. Presentamos el caso de una gestante diagnosticada de acromegalia persistente a pesar de haber sido operada vía transesfenoidal y tratada con cabergolina. Durante la gestación, la paciente no presentó complicaciones metabólicas ni tensionales, observándose un progresivo descenso de los niveles del factor de crecimiento insulínico-1 (IGF-I). El feto tuvo un crecimiento acorde con la amenorrea hasta la semana 31 en la que hizo una restricción del crecimiento con oligoamnios y alteración en el doppler en la semana 37. Se finalizó la gestación realizando una cesárea naciendo un recién nacido de 2400 gramos sin complicaciones neonatales. Aunque el curso del embarazo de las gestantes con acromegalia transcurre generalmente sin complicaciones, presentamos el primer caso descrito de un crecimiento intrauterino retardado en una paciente con acromegalia.

La enfermedad de Steinert es una enfermedad genética que se hereda con un patrón autosómico dominante, resultado de la expansión de la repetición de trinucleótidos CTG gen en el cromosoma 19, que codifica una proteína quinasa. Es una forma grave de distrofia muscular caracterizada por debilidad generalizada y degeneración muscular. El debut puede ocurrir en cualquier momento desde el nacimiento hasta la edad madura. Las complicaciones durante el embarazo son el aborto espontáneo, parto prematuro, el hidram-nios, atonía uterina posparto, distocias intraparto y accidentes anestésicos. Presentamos el caso de una gestante de 37 años, asintomática con una anamnesis familiar sin patología de interés. Fue diagnosticada de diabetes gestacional y polihidramnios inespecífico en la semana 30 de embarazo. Acudió a nuestro centro en semana 35 de gestación por dinámica uterina y metrorragia. Se realizó una cesárea extrayéndose un feto masculino, con graves dificultades respiratorias y miotonía generalizada. Posteriormente, el neonato fue diagnosticado de enfermedad congénita de Steinert. El análisis genético de la madre reveló que ella padecía la misma enfermedad. El diagnóstico de enfermedad congénita de Steinert es muy difícil, sobretodo cuando los padres no son conscientes de la enfermedad. Nuestro objetivo es enfatizar en la importancia de una buena anamnesis y los marcadores que se pueden encontrar por ultrasonidos, como hidramnios, reducción del tono fetal y los movimientos activos, artrogriposis, micrognatia, que nos puede proporcionar al menos una sospecha prenatal.

Objetivos: Analizar el diagnóstico ecográfico, la evolución y el tratamiento de los tumores cardiacos fetales diagnosticados en el Hospital La Paz de Madrid, entre los años 1995 y 2010. Método: Se realizó un estudio retrospectivo descriptivo recogiendo los principales datos ecográficos, de la historia clínica materna, neonatal y pediátrica. Resultados: En el periodo de estudio se diagnosticaron ecográficamente 28 tumores cardiacos fetales, 21 casos fueron catalogados como rabdomiomas. Once de ellos tuvieron una regresión prácticamente completa, con ocho casos diagnosticados hasta el momento de esclerosis tuberosa. Hubo 2 muertes intraútero, 1 interrupción legal del embarazo y 4 diagnósticos ecográficos de rabdomiomas, no se confirmaron al nacimiento. Se diagnosticaron prenatalmente dos fibromas; de ellos una gestante optó por la interrupción legal del embarazo y en el otro caso se produjo la muerte neonatal. Dos neonatos fueron sometidos a cirugía con una resección completa del tumor, con resultado anatomopatológico de heman-gioma capilar en uno y teratoma en el otro. En un caso se realizó una biopsia que confirmó la presencia de un hemangiopericitoma auricular que se redujo posteriormente con quimioterapia. Conclusiones: Los tumores cardiacos son una patología poco frecuente. La mayor parte de ellos son rabdomiomas, cuya sin-tomatología y evolución depende de su localización. Estos suelen regresar espontáneamente, pero pueden asociarse al diagnóstico de esclerosis tuberosa, lo que empeora su pronóstico. Aims: To analize the diagnosis, clinical course and management of fetal cardiac tumors diagnosed at La Paz Hospital (Madrid) between 1995 and 2010. Methods: We performed a retrospective descriptive study collecting the main ultrasound dates of the maternal, newborn and pediatric history. Results: During the study period, 28 fetal cardiac tumors were dignosed. Rhabdomyomas were diagnosed in 21 fetuses; 11 rhabdom-yomas returned almost completely. Eight of them were diagnosed of tuberous sclerosis up to the moment. Other two cases died in utero. One pregnant decided to be practised a miscarriage and four rhabdomyomas which were diagnosed by ultrasound, were not found in the newborns. Two fibroms were diagnosed by ultrasound; one of the pregnant woman decided to be practised a miscarriage and the other fetus died when he was born. Two newborns were operated, with the pathological anatomy result of a hemangioma and a teratoma. A biopsy was made that confirmed the presence of an atrial hemangiopericitoma which was treated by quimiotherapy. Conclusion: Fetal cardiac tumors are a rare disease. Most of them are rhabdomyomas which syntomatology and clinical course depend on its location. They usually regret spontaneously, but they can be associated with tuberous sclerosis, and this aggravates their prognosis.

Resumen Se presenta el caso de una paciente que a los 10 dias de un parto eutocico ingresa por un cuadro febril, anemia y distension abdominal. En la ecografia se detecta una gran cantidad de liquido libre. La laparotomia exploradora muestra un abundante liquido purulento y la trompa derecha engrosada. La anatomia patologica informa de la presencia de bacilos tuberculosos. Se administra tratamiento antituberculoso. La evolucion de la madre y el feto es favorable. Se exponen las dificultades en el diagnostico de la tuberculosis en estas pacientes.

Spontaneous preterm birth (SPB) is the leading cause of perinatal morbidity and mortality. In twins, the rate of preterm birth is higher than in singletons; interventions to prevent preterm birth are needed in this high-risk population.We sought to test whether a cervical pessary reduces the preterm birth rate in twin pregnancies with sonographic short cervix.A prospective, open-label, multicenter, randomized clinical trial was conducted in 5 hospitals in Spain. The ethics committees of all participating hospitals approved the protocol. The trial was registered as ClinicalTrials.gov, number NCT01242410. Eligible women were scanned in Spain. The primary outcome was SPB34 weeks of gestation. Neonatal morbidity and mortality were also evaluated.Cervical length was measured in 2287 women; 137 pregnant women with a sonographic cervical length ≤25 mm (of 154 detected with a short cervix) were randomly assigned to receive a cervical pessary or expectant management (1:1 ratio). SPB34 weeks of gestation was significantly less frequent in the pessary group than in the expectant management group (11/68 [16.2%] vs 26/66 [39.4%]; relative risk, 0.41; 95% confidence interval, 0.22-0.76). Pessary use was associated with a significant reduction in the rate of birthweight2500 g (P = .01). No significant differences were observed in composite neonatal morbidity outcome (8/136 [5.9%] vs 12/130 [9.1%]; relative risk, 0.64; 95% confidence interval, 0.27-1.50) or neonatal mortality (none) between the groups. No serious adverse effects associated with the use of a cervical pessary were observed.The insertion of a cervical pessary was associated with a significant reduction in the SPB rate. We propose the use of a cervical pessary for preventing preterm birth in twin pregnancies of mothers with a short cervix.

Sacrococcygeal teratoma tumors are more frequent in infants alive. It is characterized by its benign histology in the majority of the cases diagnosed prenatally; it is necessary to follow narrow to prevent neonatal complications that can lead to urinary tract complications and fecal, high-output heart failure, hydrops and, in extreme cases, the death of the fetus.Primigravidae 30 years old, with gestation twins, bicorial, biamniotic in the first trimester of pregnancy to one of the twins is diagnosed sacrococcygeus teratoma giant, with favorable monitoring in the maternal-fetal Medicine Unit of the University Hospital of La Paz in Madrid, and with postnatal resection surgery successful. We review the diagnostic procedures and treatment of this tumor in unique and twin gestations.

Introduction The Elecsys® immunoassay soluble fms-like tyrosine kinase (sFlt-1)/placental growth factor (PlGF) ratio is a CE-IVD-approved diagnostic and predictive aid for preeclampsia. Reference ranges for Elecsys® sFlt-1, PlGF and the sFlt-1/PlGF ratio were generated for normal singleton pregnancies [1,2]. Ranges in normal multiple pregnancies may be different [3,4]. Objectives To establish reference ranges for the Elecsys® immunoassay sFlt-1/PlGF ratio in normal multiple pregnancies. Methods We analyzed sFlt-1/PlGF ratio, sFlt-1 and PlGF data from three studies in women with normal multiple pregnancies (without preeclampsia/eclampsia/HELLP syndrome/IUGR). The Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia Study (PROGNOSIS) derived and validated an sFlt-1/PlGF ratio cut-off of 38 to rule out preeclampsia within 1 week in women with suspicion of preeclampsia (24 w + 0 d–36 w + 6 d; 25 normal multiple pregnancies) [5]. The Study of Early Preeclampsia in Spain (STEPS) evaluated the sFlt-1/PlGF ratio as a predictive marker for early-onset preeclampsia (11/20/24/28 w gestation; 729 women [188 normal multiple pregnancies] at risk of the syndrome) [6]. A multicenter case-control study (10 w + 0 d–delivery; 234 women with preeclampsia/915 normal pregnancies including 30 multiple pregnancies) examined the sFlt-1/PlGF ratio as a preeclampsia diagnostic aid [1]. Results Median sFlt-1/PlGF ratio, sFlt-1 and PlGF values in normal multiple pregnancies were generated (6 gestational age windows). Median sFlt-1/PlGF ratios were: 30.6 (10 w + 0 d–14 w+ 6d); 6.39 (15 w + 0 d–19 w + 6 d); 3.84 (20 w + 0d–23 w + 6 d); 3.81 (24 w + 0 d–28 w + 6 d); 22.2 (29 w + 0 d–33 w + 6 d); 47.1 (34 w + 0 d–36 w + 6 d). These values were not different to the median sFlt-1/PlGF ratios in singleton pregnancies up to gestational age 28 w + 6 d; from 29 w + 0 d–36 w + 6 d, the median sFlt-1/PlGF ratios were higher for multiple pregnancies (although the sample size was small here). Compared with singleton pregnancies, median sFlt-1 values were higher for multiple pregnancies, and median PlGF values were higher in multiple pregnancies until 28 w + 6 d, and then lower. Conclusion Reference ranges for the sFlt-1/PlGF ratio, sFlt-1 and PlGF in multiple pregnancies were different to singleton pregnancies; from 29 w + 0 d, the median sFlt-1/PlGF ratio was higher in multiple pregnancies. The Elecsys® immunoassay sFlt-1/PlGF ratio, sFlt-1 and PlGF reference ranges (median [5th–95th percentile]) in normal multiple pregnancies, compared with singleton pregnancies. Download : Download high-res image (671KB) Download : Download full-size image

Resumen La hemocromatosis neonatal (HN) es una enfermedad hepatica grave neonatal con alta tasa de mortalidad y recurrencia. Se postula un origen aloinmunitario, resultado de la presencia de un anticuerpo materno aun por determinar que interfiera con el metabolismo ferrico fetal. En esta teoria se basa el tratamiento materno con inmunoglobulinas por via intravenosa en gestaciones sucesivas. Describimos el caso de una paciente con un hijo anterior diagnosticado y fallecido por HN, que tratamos en la siguiente gestacion con inmunoglobulinas por via intravenosa. Es el primer caso descrito en Espana y demuestra el exito de la terapia, tal como describe la literatura cientifica.

There have been discrepancies in reports of total cholesterol and low density lipoprotein (LDL)-cholesterol levels in patients with acute porphyria. Some studies have found that acute porphyria patients have increased levels while others do not. The aim of this study has been to evaluate the lipid profile in a series of patients with acute porphyria, in order to help clarify these differences. Serum lipoprotein levels were studied in 30 patients (25 women and five men; age:38+/-10 years) with asymptomatic acute porphyria. Controls were 30 healthy volunteers matched for age and gender. For 13 patients and 15 controls, lipoprotein lipase and hepatic lipase activities were determined. Patients exhibited increased levels of total-cholesterol, LDL-cholesterol, high density lipoprotein (HDL)-cholesterol and apolipoprotein (apo)-A1 compared with controls (P4 mmol/l in 15 patients (50%). Levels of total triglycerides, very low density lipoprotein (VLDL)-triglycerides, VLDL-cholesterol, apo-B and lipoprotein(a) were similar in patients and controls. The hepatic lipase activity tended to be lower in patients than controls (33.8+/-17.7 vs. 50.4+/-23.0 pkat/ml; P=0.05). In conclusion, in patients with asymptomatic acute porphyria an increase of total and LDL-cholesterol was found. The cardiovascular risk conferred by this factor may be attenuated by increased HDL-cholesterol and apo-A1.

Fundamento y objetivo En las mujeres con sindrome de ovario poliquistico (SOP) es frecuente que haya factores de riesgo que predispongan a tener enfermedad cardiovascular. Se sabe que la hiperhomocisteinemia es un factor de riesgo independiente para esta enfermedad. El objetivo del presente estudio ha sido conocer si las mujeres jovenes con SOP presentan concentraciones elevadas de homocisteina, y su possible relacion con las de folato y vitamina B12. Pacientes y metodo Se selecciono a 39 mujeres con SOP, con una edad media (desviacion estandar [DE]) de 28,9 (5,8) anos, y 39 mujeres sanas de edad similar, y en todas ellas se evaluaron: tabaquismo, ciclos menstruales, grado de hirsutismo, indice de masa corporal, presencia de sindrome metabolico y concentraciones de homocisteina, lipidos, glucosa, creatinina, folato, vitamina B12, folitropina (FSH), lutropina (LH) y androstendiona. Resultados Los ciclos menstruales, el grado de hirsutismo, los valores de androstendiona y LH y la relacion LH/FSH eran mas elevados, como se esperaba, en las pacientes con SOP. Ademas, las pacientes presentaban valores mas elevados de homocisteina (media [DE] de 9,1 [2,1] frente a 6,4 [1,8] μmol/l; p 110 mg/dl) (el 23 frente al 2,5%; p = 0,01) y unos valores mas bajos de folato (media [DE] de 7,6 [3,7] frente a 10,2 [3,6] ng/ml; p = 0,02). En una regression lineal multiple, se comprobo una asociacion negativa entre las concentraciones de homocisteina y las de folato (r2 = 0,05; p = 0,02). Conclusiones La homocisteinemia es mas elevada en las mujeres con SOP y se asocia negativamente a las concentraciones de folato.

The association between Patau's syndrome and multiple pregnancy is extremely rare. This paper reports three cases with different obstetric treatment. CASE 1: Dichorionic diamniotic twin pregnancy with a fetus affected by trisomy 13 diagnosed at 16 weeks of gestation. The pregnancy was managed conservatively resulting in the delivery of twins at 38 weeks. The structurally normal twin was male survived without sequelae, but the female fetus with trisomy 13 died shortly after delivery. CASE 2: Dichorionic diamniotic twin pregnancy. At 14 weeks of pregnancy, one of the fetus affected by trisomy 13 showed an early intrauterine growth restriction and a cystic hygroma. At 16 weeks of pregnancy the abnormal twin died spontaneously. Avaginal delivery occurred at 38 weeks being born a healthy male. CASE 3: Dichorionic diamniotic twin pregnancy. The trisomy 13 fetus had been diagnosed at 17 weeks of pregnancy and showed a cardiopathy. At 32 weeks of gestation a selective fetal reduction was performed. Vaginal delivery occurred at 35 weeks and a healthy newborn was born.Patau's syndrome has an unfortunate fetal and neonatal outcome. It is important an early diagnosis to establish the best strategy to minimize the risk of the healthy twin.

During the last ten years multiple pregnancies have been increased as a result of assisted reproduction techniques, increases of even 470% are published. Multiple pregnancies are related to a higher risk of maternal and neonatal morbidity and mortality, as well as to increased use of health resources.To review the fetal and perinatal early complications in triple pregnancies.An observational and retrospective study of triple pregnancies followed up at the Obstetrics Department of La Paz University Hospital, Madrid, Spain, from January 2000 until May 2011.We reviewed the medical records of 147 triplets. The prevalence of triplets was 1 in 640 deliveries (0.15%). Among all, 79% were achieved using assisted reproductive techniques, 73% were obtained by means of in vitro fertilization. Regarding the pregnancy zigosity we found: 85% trichorionic triamniotic, 10% bichorionic triamniotic and 5% monochorionic tramniotic. Out of 402 fetuses, 35 (9%) had the following complications: 19(5%) growth retardation or oligohydramnios, nine (2%) intrauterine death, three (0.74%) postnatal death due to suspected chorioamnionitis, three (0.74%) major malformations and one case (0.24%) of twin to twin transfusion. The average duration of gestation was 33 weeks: 8% were born before 28 weeks of gestation, 30% between 28 and 32 weeks and 62% after 32 weeks. The mean birth weight was 1,906 +/- 400 g. In 29 cases (7%) arterial pH was less than 7.20. Any type of resuscitation was required by 60% of newborns and 47% were admitted to the intensive care unit. There were no significant differences in neonatal early outcomes among the first, second and third newborn.The risk of neonatal mortality and morbidity seems to be higher in triple pregnancies. Adverse neonatal outcomes are related to the high rate of severe prematurity.

To evaluate the incidence and characteristics of maternal complications in triple pregnancies. An additional objective was to study the relation between assisted reproductive techniques and maternal complications.Retrospective study on 147 triplets assisted at the Gynecology and Obstetrics department of La Paz University Hospital between 2000 and 2010. We analyzed the incidence of maternal complications and their relation to assisted reproductive techniques.One triplet was observed every 711 pregnancies. The most frequent maternal complications were spontaneous preterm labor (56%), premature rupture of membranes (28.9%), anemia (24.4%) and preeclampsia (20.4%). Triplets conceived by assisted reproductive techniques were significantly more likely to develop spontaneous preterm labor than spontaneous pregnancies (60% vs. 40%, respectively; p = 0.045).Triplets have a very high risk of maternal complications such as preeclampsia. Moreover, the presence of spontaneous preterm labor is more frequent in triplets conceived by assisted reproductive techniques than in those spontaneously conceived.

happens in the womb when the death of one of the twins, it is necessary to consider the factors that influence the perinatal outcome of surviving fetus.To review the outcome of twin pregnancies complicated by single fetal intrauterine death and how it can increase morbidity to its co-twin and its mother.A retrospective analysis of the fifty one twin pregnancies complicated by single fetal intrauterine death in the second or third trimester in our centre from December 1999 to December 2010.Of the total amount of 1996 twin pregnancies attended in our centre, 51 were complicated by single fetal intrauterine death (2.5%). In 68.7% of the cases we found several maternal complications, such as 12.2% of preeclampsia and 12% of coagulopathies. As for the dead foetus, there was a 47% of malformations, a 19.6% of intrauterine fetal growth restriction and there was a 9.8% of cases complicated by twin-twin transfusion syndrome. In the group of the surviving co-twin, 9.8% developed intrauterine growth restriction, 9.8% oligohydramnios and 9.8% Doppler alterations. There was a high risk of prematurity with 43.1% of the births under 34 weeks and 13.7% under 30 weeks of pregnancy. The percentage of caesarean was 64.7%. There was 3 cases of co-twin died intra-uterus, and one more died postpartum. A 10% of the newborns had some kind of neurological disability.It seems that surviving co-twin prognosis is mainly compromised by prematurity and its consequences. There should be more prospective research to inform decision-making and evaluate and control the potential maternal and fetal risks.

Antecedentes: El embarazo de gemelos monocoriales tienen un mayor riesgo de mortalidad y morbilidad perinatal, que la gestación única y el embarazo gemelar bicorial. Objetivos: Estudiar la incidencia y el manejo de las complicaciones fetales propias de las gestaciones gemelares monocoriales biamnióticas. Métodos: Se realizó un análisis retrospectivo de 94 embarazos gemelares monocoriales biamnióticos, seguidos en las Consultas de Tocología de Alto Riesgo del Hospital Universitario La Paz de Madrid, entre 2008 y 2010. Resultados: Se recogieron 94 gestaciones monocoriales biamnióticas. Aparecieron complicaciones fetales en el 23,4% de las mismas: síndrome de transfusión feto-fetal en el 9,57% de los casos, retraso del crecimiento intrauterino selectivo en el 11,7 %, muerte fetal intrauterina en el 2,1%, y malformaciones fetales en el 7,4%. Conclusiones: Las gestaciones monocoriales biamnióticas son un tipo de embarazo gemelar de alto riesgo, asociado con más complicaciones fetales y muerte perinatal. Se recomienda un estrecho seguimiento ecográfico cada 2 semanas, desde la semana 16, para diagnosticar y tratar precozmente las complicaciones fetales. Background: The monochorionic twin pregnancy has a higher risk of perinatal mortality and morbidity, than the single gestation and the dichorionic twin gestation. Objectives: To detail the incidence and management of specific fetal complications of monochorionic diamniotic twin pregnancies. Methods: We performed a retrospective analysis of monochorionic diamniotic pregnancies followed in the High Risk Obstetrics Unit of the University Hospital La Paz, Madrid, between 2008-2010. Results: We collected 94 monochorionic diamniotic pregnancies. Fetal complications occurred in 23.4% of them: feto-fetal transfusion syndrome in 9.57% of cases, selective intrauterine growth retardation in 11.7%, stillbirth in 2.1%, and fetal malformations in 7.4%. Conclusions: Monochorionic diamniotic twin pregnancies are a high-risk type of twin pregnancy, associated with an increased risk of death and perinatal complications. Ultrasound monitoring is recommended for uncomplicated monochorionic pregnancies every 2 weeks from week 16, to detect and treat fetal complications.

The incidence of multiple pregnancies increased in the last two decades. Several studies seeking the incidence of pelvic floor pathology, particularly urinary incontinence and its risk factors, conclude that a previous cesarean and vaginal delivery even more, carry an increased risk for developing urinary and fecal incontinence, compared with patients nulligravida.To determine the different risk factors for urinary incontinence after a twin pregnancy.331 women from 20 to 50 years of age without symptoms prior to pregnancy were interviewed, attending antenatal care of twin pregnancy in the Hospital La Paz, Madrid. The interview included the ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form). We recorded maternal age, gestational age, parity, episiotomy, weights of both newborns, the need for urinary protectors and fecal or gas incontinence.The prevalence of urinary incontinence postpartum according ICIQ-SF0 was 23%; 20.4% in the caesarean group, 25.3% in the eutocic delivery group and 35.5% in the instrumental delivery group (p = 0.033). The prevalence of moderate to severe incontinence (ICIQ-SF6) was 14.8%; 12.3% in caesarean group, 14.5% in the eutocic delivery group and 32.3% in the instrumental delivery group (p = 0.005). The prevalence of fecal incontinence was 3.4%; 4.8% in eutocic delivery group, 1.9% in the caesarean group and 9.7% in the instrumental delivery group (p = 0.058).The risk of urinary incontinence after a twin pregnancy was higher among patients who had an instrumental delivery when compared with patients with eutocic delivery or cesarean section. The total fetal weight and maternal age did not appear as risk factors in our study. Any woman who had an instrumental delivery for twins should be followed up by a pelvic floor specialist.

Background Mullerian duct anomalies occur in 0.1% to 3% of women, and they are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Having a twin pregnancy in a patient with a bicornuate uterus (uterus bicornis unicollis) is rare, especially if it is a spontaneous conception. Case A 40-year-old primigravid woman conceived a twin dichorionic diamniotic pregnancy after three years of primary infertility. She was found on 3-D ultrasound examination to have a bicornuate uterus with one fetus in each horn The prenatal course was uncomplicated. At 38 weeks' gestation, twin babies were successfully delivered by elective bilateral low transverse Caesarean section. Conclusion Because the incidence of such pregnancies is very low, it remains unclear whether a twin pregnancy in a bicornuate uterus is better delivered vaginally or by elective Caesarean section.

Antecedentes: Se están usando diferentes tipos de suplementación nutricional durante la gestación, sin embargo, existen escasez de estudios que se centren en los resultados metabólicos de los mismos. Objetivos: Comprobar si mediante la suplementación se logra el control del impacto de los múltiples cambios metabólicos que conlleva una gestación múltiple, usando análisis comunes. Método: Comparamos tres diferentes grupos de pacientes entre la semana gestacional 25 y 27. Un grupo de 46 gestaciones únicas, un grupo de 38 gestaciones gemelares espontáneas y otro grupo de 32 gestaciones gemelares tras técnicas de reproducción asistida. Comparamos niveles de colesterol LDL, HDL, triglicéridos, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Resultados: Los niveles de triglicéridos fueron más altos en ambos grupos de gemelares (p

Fundamento La elevacion de las concentraciones de homocisteina plasmatica en las mujeres posmenopausicas se ha descrito en algunos estudios, aunque en otros no se ha objetivado. Creemos de interes conocer si en las mujeres espanolas se encuentran aumentados los valores de homocisteina tras la menopausia. Pacientes y metodo En 100 mujeres posmenopausicas (edad media [DE] 56 [6] anos) se determinaron las concentraciones de homocisteina, creatinina, acido folico, vitamina B12 y lipoproteinas. Los controles fueron 50 mujeres con menstruaciones periodicas (edad: 29 [6] anos), 50 varones con edad similar a las mujeres posmenopausicas y 50 varones con edad similar a las premenopausicas. Todos los sujetos del estudio se encontraban sanos. Resultados Las concentraciones de homocisteina fueron mas elevadas en las mujeres posmenopausicas que en las premenopausicas (8,6 [2,1]; intervalo de confianza [IC] del 95%, 8,2-9,1, frente a 7,7 [1,6]; IC del 95%, 7,2-8,1 μmol/l; p Conclusiones La concentracion de homocisteina aumenta en las mujeres posmenopausicas. Esto puede contribuir, junto con la existencia de hipercolesterolemia, a aumentar su riesgo cardiovascular.

La hemocromatosis neonatal es una enfermedad hepatica muy severa del recien nacido y se asocia a una alta mortalidad. Se cree que su etiologia es de tipo aloinmune, debido a la presencia de un anticuerpo materno hasta ahora desconocido que interfiere con el metabolismo ferrico del feto, llegando a producir gran morb i mortal idad. Basandonos en esta teoria, el tratamiento materno con inmunoglobulinas intravenosas en gestaciones sucesivas podria prevenir el desarrollo de un nuevo cuadro de hemocromatosis neonatal. Se describe el caso de una gestante con un hijo anterior diagnosticado y fallecido neonatalmente por hemocromatosis, a la que en el embarazo actual se le trato con inmunoglobulinas intravenosas consiguiendo un hijo sano y vivo. Es el primer caso descrito en Espana y demuestra el exito de esta terapia, tal como describe la literatura.

La principal causa de anemia fetal es la isoinmunización Rh por el desarrollo de anticuerpos frente al antí-geno D. La aloinmunización antiKell es una patología poco frecuente aunque puede producir un cuadro de anemia fetal muy grave. Su incidencia relativa ha aumentado en los últimos años debido al mayor número de transfusiones sanguíneas por disminución de la isoinmunización anti-D. Presentamos 26 casos de isoin-munización antiKell controlados en el Hospital La Paz de Madrid, durante los años 2003-2009 y una revisión de la literatura. The main cause of fetal anemia is red-cell alloimmunization. Kell alloinmunization is a rare disease, although it can produce severe fetal damages. The relative incidence of antiKell isoinmunization has increased last years due to the blood transfusions has grown also, and anti-D aloinmunization has decreased. We report twenty six cases of pregnant women with isoinmunization antikell controlled in La Paz Hospital, Madrid, between 2003-2009 and a review of the literature.

Objetivo: Comprobar si el sobrepeso y la obesidad materna son factores de riesgo de complicaciones pe-rinatales. Método: Estudio transversal de 1.223 gestantes nulíparas atendidas en el Hospital La Paz entre agosto 2007 y abril 2008. Las gestantes se dividieron en tres grupos según el índice de masa corporal (IMC) al inicio del embarazo: 482 con peso normal (IMC: 18,5-24,9 Kg/m²); 419 con sobrepeso (IMC: 25-29,9Kg/m²) y 322 con obesidad (IMC: >30Kg/m²). Se estudiaron las complicaciones obstétricas, semanas de gestación en el momento del parto, tipo de parto y peso fetal. Resultados: El riesgo de cesárea en las gestantes con sobrepeso fue casi el doble que el de las gestantes de peso normal (OR: 1,9; IC95% 1,4-2,5) Las gestantes obesas sufrieron el triple de cesáreas que las de peso normal (OR: 3,1; IC95% 2,8-4,3). El número de inducciones del parto fue mayor en las gestantes con sobrepeso (OR: 1,7; IC95% 1,4-1,9) y el doble en las obesas (OR: 2,0; IC95% 1,8-2,9) con respecto a las de peso normal. El riesgo de macrosomía fetal (>4.000 gramos) fue mayor en las gestantes con sobrepeso (OR: 1,5; IC95% 1,4-2,2) y en las obesas (OR: 1,9; IC95% 1,3-2,8) que en las de peso normal. En el análisis de regresión logística multivariante (ajusfando por edad, diabetes e hipertensión gestacionales) persistió la asociación entre sobrepeso y cesárea (OR: 2,1; IC95% 1,7-2,7) y entre obesidad y cesárea (OR: 3,0; IC95% 2,6-3,8). Conclusiones: El sobrepeso y la obesidad materna al inicio del embarazo están asociados con un aumento del número de cesáreas y de inducciones del parto. Este riesgo es mayor a medida que aumenta el IMC materno. Objective: The objective of this study is to determine if the maternal prepregnancy overweight and obesity are related to risk of cesarean delivery and other obstetrical complications. Methods: Transversal study of 1223 nulliparous women that delivered in our maternity between August 2007 and April 2008. Women were categorized by the body mass index (BMI): 482 normal weight (BMI: 18.5-24.9 Kg/m²), 419 overweight (BMI: 25-29.9 Kg/m²) and 322 obesity (BMI: >30 Kg/m²). Obstetrical complications, labor and its complications, and neonatal weight were studied. Results: Women who were overweight was nearly twice as likely to deliver by cesarean section as women with normal weight (OR: 1.8; 95%CI 1.4-2.9). Obese women experienced a three-fold increase in risk of cesarean section in comparison to normal weight women (OR: 3.02; 95%CI 2.6-4.5). Number of labor inductions was higher in overweight and obese group (OR: 1.6; 95%CI 1.3-1.9) and (OR: 2.1; 95%CI 1.7-2.9) respectively in comparison to control group. The highest risk of fetal macrosomia (weight >4000 g) was in the overweight (OR: 1.5; 95%CI 1.4-2.2) and obese women (OR: 1.9; 95%CI 1.3-2.8) compared with the normal weight women. In multivariate logistic regression analysis, the association persisted between obesity and cesarean delivery (OR 3.0; 95%CI 2.6-3.8) and among overweight and cesarean section (OR 2.1; 95%CI 1.7-2.7) after adjusting for variables such as age, diabetes and hypertension. Conclusions: Overweight or obesity prior to pregnancy are associated with an increased risk of cesarean delivery and labor inductions. This risk increases as the BMI increases.

Vaginal moisturizers are used for symptomatic relief of vulvovaginal atrophy (VVA) caused by estrogen deficiency. The quality of life of postmenopausal women can be negatively affected with these symptoms and it should not be underestimated. Current Guidelines advice on the regular use of long acting non-hormonal moisturizers as first-line therapies to alleviate symptoms, being dryness and dyspareunia the most frequent and bothersome. The efficacy of a polycarbophilic vaginal moisturizing gel (Ainara®) for relieving severe symptoms of VVA was evaluated in 32 postmenopausal women suffering from severe vaginal dryness or severe dyspareunia. Allwomen received 1g of the gel daily during 3 weeks and twiceweekly up to 12weeks. Symptomswere evaluated with a validated numeric scale (0 = absent, 1 =mild, 2 =moderate and 3= severe) at baseline and at after 3 and 12weeks of treatment. Significant change in the intensity of the symptoms was evaluated using Wilcoxon tests. The percentage of women that improved the symptoms was also calculated. After 3 weeks, 78% women improved vaginal dryness and 65% improved dyspareunia. After 12 weeks, 78% women improved vaginal dryness and 69% improved dyspareunia. The intensity of the vaginal dryness decreased from 2.8 to 1.6 (p

Existe una versión en castellano, con el título "Mi primer portfolio : 3-7 años : guía didáctica" Se pretende acercar al profesorado las posibilidades de utilización del Portfolio Europeo de Lenguas (PEL) en los primeros niveles de enseñanza (Educación Infantil y primer ciclo de Educación Primaria. Se presentan preguntas y actividades que le hacen reflexionar al niño o la niña sobre el papel que juega el colegio, sus familiares, amistades, o los personajes que conocen a través de los medios de comunicación y la posibilidades de aprender que les ofrecen las actividades cotidianas en casa, el colegio, en su tiempo de ocio, viajes, o con los objetos que les rodean, en suma, se pretende que aprendan de sus experiencias dentro y fuera del aula, que les lleven a percibir y entender la realidad plurilingüe y pluricultural en la que viven, con el fin de apoyar las estrategias básicas que facilitarán el desarrollo de un aprendizaje autónomo de lengua. ESP

Existe una versión en euskera, con el título "Nire lehen portfolioa : 3-7 urte : gida didaktikoa" Se pretende acercar al profesorado las posibilidades de utilización del Portfolio Europeo de Lenguas (PEL) en los primeros niveles de enseñanza (Educación Infantil y primer ciclo de Educación Primaria). Se presentan preguntas y actividades que le hacen reflexionar al niño o la niña sobre el papel que juega el colegio, sus familiares, amistades, o los personajes que conocen a través de los medios de comunicación y la posibilidades de aprender que les ofrecen las actividades cotidianas en casa, el colegio, en su tiempo de ocio, viajes, o con los objetos que les rodean, en suma, se pretende que aprendan de sus experiencias dentro y fuera del aula, que les lleven a percibir y entender la realidad plurilingüe y pluricultural en la que viven, con el fin de apoyar las estrategias básicas que facilitarán el desarrollo de un aprendizaje autónomo de lengua. ESP