New birthweight charts according to parity and type of delivery for the Spanish population.

OBJECTIVE: Birthweight by gestational age charts enable fetal growth to be evaluated in a specific population. Given that maternal profile and obstetric practice have undergone a remarkable change over the past few decades in Spain, this paper presents new Spanish reference percentile charts stratified by gender, parity and type of delivery. They have been prepared with data from the 2010-2014 period of the Spanish Birth Statistics Bulletin. METHODS: Reference charts have been prepared using the LMS method, corresponding to 1,428,769 single, live births born to Spanish mothers. Percentile values and mean birth weight are compared among newborns according to gender, parity and type of delivery. RESULTS: Newborns to primiparous mothers show significantly lower birthweight than those born to multiparous mothers (p<0.036). Caesarean section was associated with a substantially lower birthweight in preterm births (p<0.048), and with a substantially higher birthweight for full-term deliveries (p<0.030). Prevalence of small for gestational age is significantly higher in newborns born by Caesarean section, both in primiparous (p<0.08) and multiparous mothers (p<0.027) and, conversely, the prevalence of large for gestational age among full-term births is again greater both in primiparous (p<0.035) and in multiparous mothers (p<0.007). CONCLUSIONS: Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth.

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003-2012).

BACKGROUND: There is growing evidence of the impact of the current European economic crisis on health. In Spain, since 2008, there have been increasing levels of impoverishment and inequality, and important cuts in social services. AIM: The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain. METHOD: Trends in underweight at birth were examined between 2003 and 2012. Underweight at birth is defined as a singleton, term neonatal weight lesser than -2 SD from the median weight at birth for each sex estimated by the WHO Standard Growth Reference. Using data from the Statistical Bulletin of Childbirth, 2 933 485 live births born to Spanish mothers have been analysed. Descriptive analysis, seasonal decomposition analysis and crude and adjusted logistic regression including individual maternal and foetal variables as well as exogenous economic indicators have been performed. RESULTS AND CONCLUSIONS: Results demonstrate a significant increase in the prevalence of underweight at birth from 2008. All maternal-foetal categories were affected, including those showing the lowest prevalence before the crisis. In the full adjusted logistic regression, year-on-year GDP per capita remains predictive on underweight at birth risk. Previous trends in maternal socio-demographic profiles and a direct impact of the crisis are discussed to explain the trends described.

Histoplasma capsulatum and Pneumocystis spp. co-infection in wild bats from Argentina, French Guyana, and Mexico.

BACKGROUND: Histoplasma capsulatum and Pneumocystis organisms cause host infections primarily affecting the lung tissue. H. capsulatum is endemic in the United States of America and Latin American countries. In special environments, H. capsulatum is commonly associated with bat and bird droppings. Pneumocystis-host specificity has been primarily studied in laboratory animals, and its ability to be harboured by wild animals remains as an important issue for understanding the spread of this pathogen in nature. Bats infected with H. capsulatum or Pneumocystis spp. have been found, with this mammal serving as a probable reservoir and disperser; however, the co-infection of bats with both of these microorganisms has never been explored. To evaluate the impact of H. capsulatum and Pneumocystis spp. infections in this flying mammal, 21 bat lungs from Argentina (AR), 13 from French Guyana (FG), and 88 from Mexico (MX) were screened using nested-PCR of the fragments, employing the Hcp100 locus for H. capsulatum and the mtLSUrRNA and mtSSUrRNA loci for Pneumocystis organisms. RESULTS: Of the 122 bats studied, 98 revealed H. capsulatum infections in which 55 of these bats exhibited this infection alone. In addition, 51 bats revealed Pneumocystis spp. infection of which eight bats exhibited a Pneumocystis infection alone. A total of 43 bats (eight from AR, one from FG, and 34 from MX) were found co-infected with both fungi, representing a co-infection rate of 35.2% (95% CI = 26.8-43.6%). CONCLUSION: The data highlights the H. capsulatum and Pneumocystis spp.co-infection in bat population's suggesting interplay with this wild host.

Frequency and genetic diversity of the MAT1 locus of Histoplasma capsulatum isolates in Mexico and Brazil.

The MAT1-1 and MAT1-2 idiomorphs associated with the MAT1 locus of Histoplasma capsulatum were identified by PCR. A total of 28 fungal isolates, 6 isolates from human clinical samples and 22 isolates from environmental (infected bat and contaminated soil) samples, were studied. Among the 14 isolates from Mexico, 71.4% (95% confidence interval [95% CI], 48.3% to 94.5%) were of the MAT1-2 genotype, whereas 100% of the isolates from Brazil were of the MAT1-1 genotype. Each MAT1 idiomorphic region was sequenced and aligned, using the sequences of the G-217B (+ mating type) and G-186AR (- mating type) strains as references. BLASTn analyses of the MAT1-1 and MAT1-2 sequences studied correlated with their respective + and - mating type genotypes. Trees were generated by the maximum likelihood (ML) method to search for similarity among isolates of each MAT1 idiomorph. All MAT1-1 isolates originated from Brazilian bats formed a well-defined group; three isolates from Mexico, the G-217B strain, and a subgroup encompassing all soil-derived isolates and two clinical isolates from Brazil formed a second group; last, one isolate (EH-696P) from a migratory bat captured in Mexico formed a third group of the MAT1-1 genotype. The MAT1-2 idiomorph formed two groups, one of which included two H. capsulatum isolates from infected bats that were closely related to the G-186AR strain. The other group was formed by two human isolates and six isolates from infected bats. Concatenated ML trees, with internal transcribed spacer 1 (ITS1) -5.8S-ITS2 and MAT1-1 or MAT1-2 sequences, support the relatedness of MAT1-1 or MAT1-2 isolates. H. capsulatum mating types were associated with the geographical origin of the isolates, and all isolates from Brazil correlated with their environmental sources.

[Congenital cystic adenomatoid malformation. Consequences of prenatal diagnosis]. / Enfermedad adenomatoidea quística pulmonar congénita. consecuencias de su diagnóstico prenatal.

BACKGROUND: Advances in technology and the specialized training of gynecologists in ultrasound have led to an increase in fetal diagnoses. Congenital cystic adenomatoid malformation (CCAM) is of particular interest because of its difficulty in predicting the disease evolution. OBJECTIVE: To review the cases of prenatal diagnosis of CCAM during the last five years in our hospital, and to analyze their evolution as a consequence of its diagnosis. PATIENTS AND METHODS: Retrospective study that reviewed the cases of CCAM between 2005 and 2010 treated in our hospital. We evaluated gestational age, type of CCAM and evolution in at least the first 12 months. RESULTS: Twenty-one cases were diagnosed (1 for every 2,660 deliveries in our hospital of reference), 3 of them with CCAM type 1 (14.3%), 8 with type 2 (38.1%) and 10 with type 3 (47.6%). Two patients proceeded with a medical interruption of pregnancy; in 11 patients lesions were stable, in eight they disappeared and one fetus suffered severe mediastinal shift with little healthy lung, and died during the first postpartum week. Four of eight cases in which the image disappeared were considered free of disease after birth. Of the 19 cases in which pregnancy was not interrupt, 15 had mediastinal shift and 6 did not; in five of them (83.3%), the image disappeared and only one remained stable. The lesion disappeared in only three cases of the 13 who had mediastinal shift (p < 0.01). Lobectomies were necessary in 8 of 19 cases, four are considered free of the disease and seven are still in follow-up. CONCLUSION: Congenital cystic adenomatoid malformation is a condition in which the council is extremely complex, but most cases evolved favorably. Severe complications such as hydrops are described in up to 25% of all CCAM.

Molecular detection of Histoplasma capsulatum in the lung of a free-ranging common noctule (Nyctalus noctula) from France using the Hcp100 gene.

Histoplasma capsulatum is a dimorphic fungus that is widely distributed in the tropical or subtropical areas of the world and infects several mammalian hosts, mainly bats. Infective propagules grow in bat and bird droppings. A specific molecular marker, a highly sensitive fragment of a co-activator protein-coding gene (Hcp100), was used to detect H. capsulatum in lung samples of wild and captive bats from France using a nested polymerase chain reaction. To determine whether bats in France are potential carriers of H. capsulatum, 83 bats were sampled from two regions in France. Sixty-one specimens belonging to the Pteropus rodricensis (n = 45) and Rousettus aegyptiacus (n = 16) species were collected from a zoologic park (La Palmyre, western France). Twenty-two specimens were recovered from the Natural History Museum (Bourges) including the species Plecotus austriacus (n = 1), Pipistrellus pipistrellus (n = 3), and Nyctalus noctula (n = 18). From the lung DNA samples of 83 dead bats, only one sample of an N. noctula bat from Bourges amplified the H. capsulatum Hcp100 marker. The amplified product was sequenced and revealed a high similarity to the G217B H. capsulatum reference strain sequence that was deposited in the GenBank database. This finding suggests that H. capsulatum is an environmental pathogen in France that may infect bats.

Labor management and mode of delivery among migrant and Spanish women: does the variability reflect differences in obstetric decisions according to ethnic origin?

Based on previous findings showing both better birth outcomes in migrant than in Spanish women and different rates of medical intervention according to mother's origin, we hypothesize that mode of delivery decisions to solve similar problems differ according to ethnic origin. Ethnic differences for maternal characteristics, medical intervention, and mode of delivery were evaluated in 16,589 births from a Maternity Hospital in Madrid (Spain). Multinomial logistic regression analysis was used to evaluate the effect of mother's ethnic origin on the mode of delivery, adjusting for mother's age, parity, gestational age, birth weight, and epidural anesthesia. Compared with the Spanish mothers, the risk of having a Caesarean section is significantly higher in Latin Americans and significantly lower for the Chinese. Both low birth weight and macrosomic deliveries are at higher risk for Caesarean section. The interventionist system characterizing Spain is being extended to all ethnic groups and, at the same time, different medical interventions are applied to similar problems depending on women's ethnic origin. Obstetric interventions might be contributing to the increasing trend of low birth weight and late preterm/early full term deliveries (37-38 weeks) observed in Spain. Behavioral and cultural values of the women and of the health care providers may contribute to systematic differences in labor management and mode of delivery.

Characterizing Pneumocystis in the lungs of bats: understanding Pneumocystis evolution and the spread of Pneumocystis organisms in mammal populations.

Bats belong to a wide variety of species and occupy diversified habitats, from cities to the countryside. Their different diets (i.e., nectarivore, frugivore, insectivore, hematophage) lead Chiroptera to colonize a range of ecological niches. These flying mammals exert an undisputable impact on both ecosystems and circulation of pathogens that they harbor. Pneumocystis species are recognized as major opportunistic fungal pathogens which cause life-threatening pneumonia in severely immunocompromised or weakened mammals. Pneumocystis consists of a heterogeneous group of highly adapted host-specific fungal parasites that colonize a wide range of mammalian hosts. In the present study, 216 lungs of 19 bat species, sampled from diverse biotopes in the New and Old Worlds, were examined. Each bat species may be harboring a specific Pneumocystis species. We report 32.9% of Pneumocystis carriage in wild bats (41.9% in Microchiroptera). Ecological and behavioral factors (elevation, crowding, migration) seemed to influence the Pneumocystis carriage. This study suggests that Pneumocystis-host association may yield much information on Pneumocystis transmission, phylogeny, and biology in mammals. Moreover, the link between genetic variability of Pneumocystis isolated from populations of the same bat species and their geographic area could be exploited in terms of phylogeography.

[Anti-D isoimmunization severe in a twin pregnancy. Case report]. / Isoinmunización grave anti-D en una gestación gemelar. Caso clínico.

Perinatal hemolytic disease occurs secondary to a hemolytic phenomenon of immune origin resulting in fetal or neonatal anemia. A 38-year-old pregnant woman was referred to the Department of high risk Obstetrics, Hospital Universitario La Paz Madrid because of presenting a dichorionic diamniotic twin pregnancy spontaneously, pre-pregnancy diabetes poorly controlled and severe alloinmunization anti-D. Her first pregnancy ended in a normal delivery at term; in the period of 4 years, she has three newborn with 36, 34 and 40 weeks respectively, who die with a week of life. After that, two intrauterine fetal death occur at 26 weeks of gestation. The patient who is RhD negative, suffers anti-D inmunization with a antibody titration of 1/1024 with 14 weeks of gestation. Twelve plasmapheresis, eight doses of anti-D inmunoglobulins and intrauterine transfusions has been the treatment received. A severe anemia is found during the ultrasound control of the middLe cerebral artery peak systolic velocity in both twins since the 16th week. It remains stable thanks to the treatment. Finally at the 28th week of gestation, pregnancy is terminated with a cesarean section. The twins are born alive and premature, but with good general state. The measurement of the middle cerebral artery peak systolic velocity predicts moderate-severe fetal anemia cases, which are the most important in the clinical management because of the need of active treatment or finish the pregnancy.

[Twin pregnancy with intrauterine death of one fetus: maternal and neonatal outcome of surviving fetus]. / Gestación gemelar con muerte intraútero de uno de los fetos: pronóstico materno y neonatal del feto superviviente.

BACKGROUND: 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. OBJECTIVE: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Relevant aspects of the Hcp100 molecular marker of Histoplasma capsulatum and its potential therapeutic use in histoplasmosis]. / Aspectos relevantes del marcador molecular Hcp100 de Histoplasma capsulatum y su potencial uso terapéutico en la histoplasmosis.

BACKGROUND: Fungal pathogens have developed strategies, involving genes expression that favors their persistence and multiplication in the host. The absence of molecules encoded by these genes could interfere with the growth and death of these fungi. In the past, a coactivator protein coding gene (Hcp100) of the fungus Histoplasma capsulatum was reported, which is overexpressed after 1h of contact between fungal yeast-cells and murine macrophages. The product of this gene, a protein of 100 kDa (Hcp100) of H. capsulatum, is probably a regulatory protein involved in the processes required for fungal adaptation and its survival in the intracellular hostile conditions of the macrophages. A 210-bp fragment of the Hcp100 marker has proved to be an excellent tool for H. capsulatum molecular detection in clinical samples. The potential use of this gene as a therapeutic target in Plasmodium falciparum has been explored through the inhibition of both, the gene and the protein p100 of the parasite, by blocking its growth. METHODS: Based on the above mentioned antecedents, we believe that the Hcp100 has an important role in the development and maintenance of the H. capsulatum yeast cells within macrophages. RESULTS AND CONCLUSIONS: To study the probable function of Hcp100 in the yeast-phase of this fungal pathogen is relevant to understand its activity and to propose it as a therapeutic target for histoplasmosis treatment.

Hemorragia fetomaterna masiva como causa de hidrops en gestación a término: reporte de caso y revisión de la literatura / Massive fetomaternal hemorrage cause hydrops in pregnancy at term: case report and literature revision

Objetivo: la hemorragia fetomaterna masiva es una complicación rara del embarazo, que puede causar anemia fetal severa y muerte fetal intrauterina. Se presenta un caso clínico con el objetivo de hacer una revisión de la fisiopatología del diagnóstico y del tratamiento Materiales y métodos: se presenta el caso clínico de una mujer en la semana 39 de embarazo, remitida al Hospital La Paz de Madrid, centro de referencia de atención materna y perinatal, por signos ecográficos de hidrops y de insuficiencia cardíaca derecha. El registro cardiotocográfico evidenció un patrón sinusoidal. La recién nacida presentó acidosis metabólica y anemia severa. El estudio anatomopatológico de la placenta fue sugestivo de anemia fetal crónica. El test de Kleihauer-Betke evidenció hemorragia fetomaterna de 90-100 ml. Se realizó una búsqueda bibliográfica en las bases de datos Medline vía Pubmed, EMBASE, LILACS y SciELO y la biblioteca Cochrane. Conclusión: el diagnóstico intrauterino es difícil, se debe sospechar cuando una mujer refiere reducción de movimientos fetales y cuando el registro cardiotocográfico muestra un patrón sinusoidal. En general, el estudio ecográfico es anodino, el Doppler de la arteria cerebral media puede ayudar en la identificación de los casos de anemia fetal, donde se evidencia un aumento del pico sistólico. Es importante la identificación precoz de los casos afectados para empezar un tratamiento sintomático de la anemia...

Objective: massive fetomaternal hemorrhage is a rarely occurring complication during pregnancy which can cause severe fetal anemia and intrauterine fetal death. A clinical case is presented here to review the pertinent pathophysiology, diagnosis and treatment. Materials and methods: the case of a 39 weeks pregnant woman admitted to La Paz Hospital in Madrid is reported; this hospital is the center for perinatal and maternal attention. The patient was referred due to sonographic signs of hydrops and right heart failure. Cardiotocographic records showed a sinusoidal pattern. The newborn presented metabolic acidosis and severe anemia. Pathologic examination of the placenta was suggestive of chronic fetal anemia. The Kleihauer-Betke test revealed a 90-100 ml fetomaternal hemorrhage. A literature search was made in Medline via Pubmed, EMBASE, LILACS and SciELO and the Cochrane Library. Conclusion: intrauterine diagnosis is difficult; massive fetomaternal hemorrhage should be suspected when a woman refers to reduced fetal movements and when the record shows a sinusoidal pattern in cardiotocography. Ultrasound is usually bland and Doppler of the middle cerebral artery may help in identifying cases of fetal anemia, revealing an increased systolic peak. Such cases must be identified early on to start symptomatic treatment of anemia...

Hemorragia fetomaterna masiva con patrón cardiotocográfico sinusoidal: presentación de un caso y revisión de la literatura / Massive fetomaternal hemorrhage with cardiotocographic sinusoidal rhythm: a case presentation and literature review

Introducción: la transfusión fetomaterna masiva (TFM) es una entidad con una elevada morbilidad y mortalidad fetal, suele cursar con una disminución en la percepción de los movimientos fetales por parte de la madre, y la presencia de un patrón cardiotocográfico sinusoidal fetal, asociado a la anemia fetal. No obstante, ambas situaciones tienen muy baja especificidad. Se presenta un caso clínico con el objetivo de revisar la exactitud del patrón sinusoidal en el diagnóstico de anemia fetal. Materiales y metodos: se presenta el caso de una gestante de 36 semanas que fue atendida en el Hospital Universitario La Paz (complejo hospitalario de tercer nivel que forma parte del conjunto de hospitales públicos en España), en la que tras presentarse un patrón cardiotocográfico no tranquilizador, se realizó una inducción del parto en el que las pruebas habituales de bienestar fetal resultaron insuficientes para el diagnóstico de sufrimiento fetal. Tras un parto eutócico se comprobó la presencia de una anemia neonatal grave, comprobándose la presencia de un gran volumen de sangre fetal en la sangre materna mediante el test de Kleihauer Betke. Se hace una revisión de los artículos publicados en los últimos 10 años en las base de datos Medline vía PubMed, en español e inglés.Conclusión: la monitorización fetal intraparto podría ser útil en el diagnóstico de la hemorragia fetomaterna masiva, aunque se deben hacer estudios más amplios para determinar la exactitud diagnóstica...

Introduction: massive fetomaternal transfusion (MFT) is an entity having high fetal morbidity and mortality; it usually involves the mother’s reduced perception of fetal movements and the presence of a cardiotocographic fetal sinusoidal rhythm, associated with fetal anemia. However, both situations have very low specificity. A clinical case is presented here to arouse interest in reviewing the precision of the sinusoidal rhythm when diagnosing fetal anemia. Materials and methods: the case of a 36-weeks pregnant mother is presented; she attended La Paz teaching hospital (a third-level hospital forming part of the Spanish public hospital system). After presenting a non-reassuring cardiotocographic heart rate pattern, birth was induced in which the usual fetal wellbeing tests proved insufficient for diagnosing fetal suffering. The presence of serious neonatal anemia was shown following a eutocic delivery, the Kleihauer-Betke test proving the presence of a large volume of fetal blood in the mother’s blood. Articles published in both Spanish and English during the last 10 years in the Medline database were reviewed via PubMed. Conclusion: intradelivery fetal monitoring could be useful in diagnosing massive fetal-maternal hemorrhage, even though broader studies should be carried out for determining diagnostic precision...

[Role of middle cerebral artery Doppler in the management of Rhesus alloimmunization cases]. / Papel del Doppler en la arteria cerebral media en la atención de pacientes con isoinmunización Rhesus.

BACKGROUND: The most common cause of anemia remains fetal red cell alloimmunization. Although after the systematization of prophylactic anti-D gamma globulin decreased the number of cases, has not eliminated the problem. OBJECTIVES: To evaluate the role of the fetal middle cerebral artery peak systolic velocity in the management of fetus at risk for anemia due to Rh alloimmunization and analyze the effect in perinatal outcomes. MATERIAL AND METHOD: 68 pregnancies complicated by Rh alloimmunization, in La Paz Hospital (Madrid, Spain) since February 2006 until August 2009, with maternal antibody titers > or = 1:32, affected in previous pregnancies and/or anti-Kell isoimmunization. In every case it was measured the middle cerebral artery peak systolic velocity and the fetal hemoglobin concentration in blood obtained either by cordocentesis or at delivery. RESULTS: For the detection of moderate-severe fetal anemia, Doppler ultrasonography of the middle cerebral artery had a sensitivity of 80% (95% confidence interval: 59.8 to 100%), a specificity and positive predictive value of 100%, and a negative predictive value of 85.7% (95% confidence interval: 70.7 to 100%). The Pearson correlation coefficient between estimated hemoglobin and real hemoglobin was 0.71. The 22% (15/68) of the fetuses required at least one intrauterine transfusion making a total of 26. In 23% (6/26) of them appeared complications. The last middle cerebral artery peak systolic velocity measurement is associated with neonatal anemia and/or icterus (p < 0.01), anemia during the hospitalization (p < 0.05) and neonatal transfusion (p < 0.05). CONCLUSION: The measurement of the middle cerebral artery peak systolic velocity predicts moderate-severe fetal anemia cases, which are the most important in the clinical management because of the need of active treatment with intrauterine transfusion or induction labor.

Complicaciones obstétricas tras una traquelectomía radical: caso clinico y revisión de la literatura / Obstetric complications after a radical trachelectomy: case report and review of literature

Introducción: la traquelectomía radical (TR) es una técnica quirúrgica utilizada en estadios precoces del cáncer de cérvix en aquellas mujeres que desean conservar la capacidad reproductiva. Los embarazos posteriores a esta técnica quirúrgica pueden desencadenar complicaciones obstétricas. El presente artículo tiene como objetivo hacer una revisión de la literatura en relación al pronóstico obstétrico de estas pacientes. Metodología: en este estudio se presenta un caso clínico. Posteriormente, se realiza una búsqueda en las bases de datos MEDLInE, vía PubMed, y Cochrane con las palabras clave “cáncer de cérvix”, “traquelectomía radical”, “embarazo” y “complicaciones obstétricas”. Resultados: se evaluó un total de 17 artículos que comprendieron revisiones, artículos de opinión y casos clínicos. Conclusión: la preservación de la fertilidad en estadios precoces del cáncer de cérvix mediante la traquelectomía radical está adquiriendo cada vez mayor aceptación a medida que se publican más casos en la literatura. Los resultados obstétricos parecen ser cada vez más favorables aunque son más numerosas las complicaciones en comparación con la población general.

Introduction: radical trachelectomy (TR) is a surgical technique which is used in the early stages of cervical cancer in females wishing to conserve their reproductive ability. Pregnancies following this surgical technique having been applied could trigger obstetric complications. This article was thus aimed at reviewing the literature related to these patients’ obstetric prognosis. Methodology: a clinical case is presented. A literature search was made in MEDLInE databases, via PubMed and Cochrane, using the following key words: “cervical cancer”, “radical trachelectomy”, “pregnancy”, “obstetric complications”. Results: 17 articles were evaluated, covering review articles, articles expressing opinion and clinical cases. Conclusion: preserving fertility in early stages of cervical cancer by radical trachelectomy is increasingly acquiring more acceptance as more cases are published in the literature. Obstetric results seem to be becoming more favorable even though complications are becoming more numerous compared to incidence in the general population.

Corioamnionitis histológica y morbimortalidad neonatal: aproximación al síndrome de respuesta inflamatoria fetal / Chorioamnionitis neonatal morbidity: approach to fetal inflammatory response syndrome

Antecedentes: El síndrome de respuesta inflamatoria fetal (SRIF) es una entidad relacionada con la presencia de inflamación intrauterina y suele asociarse a infección intraamniótica. Su consecuencia más grave es la lesión cerebral y posterior desarrollo de parálisis cerebral. Objetivo: Evaluar la relación entre el síndrome de respuesta inflamatoria fetal y el desarrollo de complicaciones neonatales. Método: Estudio descriptivo y retrospectivo, realizado en el Hospital Universitario La Paz de Madrid, buscando una aproximación al SRIF desde la corioamnionitis histológica/funiculitis. El grupo de estudio constituido por 35 gestaciones simples pretérmino recogidas durante el primer semestre de 2008 y en las que la anatomía patológica de la placenta y anexos ovulares demostró la presencia de una corioamnionitis histológica y/o funiculitis. Resultados: Siete casos (20 por ciento) presentaban clínica sospechosa de infección intraamniótica, si bien en 28 gestantes (80 por ciento) existían factores de riesgo asociados al síndrome de respuesta inflamatoria fetal. Mortalidad perinatal en el grupo estudiado fue de 11,4 por ciento (4 casos). Sólo en 2 pacientes (5,7 por ciento) se pudo relacionar la muerte con el SRIF. En 28 recién nacidos (80 por ciento) se encontró algún tipo de patología, siendo la misma inherente a dicho síndrome en 17 casos (48,6 por ciento), destacando sepsis neonatal (40 por ciento), leucomalacia periventricular (14,3 por ciento) y displasia broncopulmonar (5,7 por ciento). Conclusión: Se comprueba el alto riesgo neonatal del SRIF. El conocimiento de esta condición, abre una serie de controversias diagnósticas y terapéuticas que obliga a una reevaluación de los protocolos actuales de manejo de la amenaza de parto pretérmino y la rotura prematura de membranas de pretérmino.

Background: The fetal inflammatory response syndrome (FIRS) is an entity related to intrauterine inflammation which is commonly associated with intraamniotic infection. The most serious consequence is the neurologic damage and the subsequent development of cerebral palsy. Aims: To evaluate the relationship between the fetal inflammatory response syndrome and the development of neonatal complications. Method: Descriptive and retrospective study realized in "La Paz" University Hospital of Madrid, looking for an approximation to the FIRS from histologic chorioamnionitis/funisitis. Group of study constituted by 35 single preterm gestations collected during the first semester of 2008 and in which the pathologic anatomy study of the placenta and annexes showed the presence of histological corioamnionitis and / or funisitis. Results: Suspicious clinic was found in 7 cases (20 percent) but in 28 cases (80 percent) risk factors associated to FIRS were present. Perinatal mortality found was 11.4 percent (4 cases). Only in 2 cases (5.7 percent) the cause was relationated with FIRS. Pathology associated was found in 28 newborn (80 percent), being 17 cases (48.6 percent) pathology associated with the fetal inflammatory response syndrome, enhancing neonatal sepsis (40 percent), periventricular leukomalacia (14.3 percent), and bronchopulmonar dysplasia (5.7 percent). Conclusion: It is verified that FIRS enteals a high neonatal risk. The knowledge of this entity opens some diagnostic and therapeutic controversies. Current management protocols of preterm labor and preterm premature rupture of membranes should be revised.

Nueva terapia con inmunoglobulinas en un caso de hemocromatosis neonatal / Immunoglobulin therapy for natal hemochromatosis

La hemocromatosis neonatal es una enfermedad hepática muy severa del recién nacido y se asocia a una alta mortalidad. Se cree que su etiología es de tipo aloinmune, debido a la presencia de un anticuerpo materno hasta ahora desconocido que interfiere con el metabolismo férrico del feto, llegando a producir gran morb i mortal ¡dad. Basándonos en esta teoría, el tratamiento materno con inmunoglobulinas intravenosas en gestaciones sucesivas podría 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 trató con inmunoglobulinas intravenosas consiguiendo un hijo sano y vivo. Es el primer caso descrito en España y demuestra el éxito de esta terapia, tal como describe la literatura.

Neonatal hemochromatosis is a severe neonatal liver disease with a high mortality and recurrence rate. It is supposed to be a gestational alloimmune disease because of the existence of maternal antibodies against fetal hepatic metabolism. On the basis of this hypothesis, the administration of intravenous immunoglobulin has been reported as a successful treatment during the following pregnancy. We describe the first case of this treatment in Spain which confirms the data available in the literature.

Cesárea corporal y miomectomía: indicaciones actuales / Classic cesarean section and myomectomy

Actualmente, tanto la realización de una cesárea corporal como la práctica de una miomectomía en el transcurso de una cesárea, suponen dos hechos muy infrecuentes. No obstante, en determinados casos, ambos procedimientos pueden ser necesarios. La cesárea corporal es una técnica quirúrgica poco menos que abandonada, si bien aún mantiene algunas indicaciones; y la exéresis de un mioma durante una cesárea está clásicamente contraindicada, salvo en circunstancias muy concretas. Sin embargo, hay que destacar que en los últimos años se está constatando un incremento significativo de ambos procedimientos, siendo las razones muy diversas (aumento de las gestaciones pretérmino que se finalizan por vía abdominal, incremento de la edad materna, mayores tasas de cesáreas, etc.). Se presenta el caso clínico de una gestante con un gran mioma localizado en segmento inferior uterino y en la que fue preciso llevar a cabo una cesárea corporal, seguida de una miomectomía.

Nowadays, it is very rare to perform both classic cesarean section or myomectomy during cesarean section. However, sometimes it is necessary to do them. The classic cesarean section is a very uncommon chirurgical technique, however, it still has some indications. The performance of a myomectomy during a cesárea section although it is to be avoided, it might be necessary under specific circumstances. However, it is necessary to emphasize that in recent years it is more and more frecuent to performe these chirurgical techniques, due to different reasons such as the increasing of preterm pregnancies that are finished by an abdominal delivery, the increasing of the age of pregnancy and higher cesarean rates. We present a case report of large myoma situated at the lower uterine segment. Classic caesarean section followed by myomectomy was performed to allow the delivery.

[Angiomyolipomas, tuberous sclerosis and pregnancy]. / Angiomiolipomas, esclerosis tuberosa y gestación.

Renal angiomyolipomas are uncommon tumours during pregnancy, but it's important to consider them in the differential diagnosis, for the increased risk of complications such as bleeding, specially during pregnancy. Their characteristics are different depending on if the tumour is associated or not with facomatosis. To show both possibilities, we describe two cases of pregnant women with angiomyolipomas: the first one presented with bleeding of the tumour (Wünderlich's syndrome), but surveillance without treatment was possible until 37th week of gestation, and embolization of the tumour was performed afterwards. The second patient had multiple well known angiomyolipomas, associated to tuberous sclerosis; even though she had required two previous embolizations, she had an uneventful pregnancy, without any episodes of bleeding. Both pregnancies ended successfully by means of a cesarean section. Since there are few papers available in the literature, there is not an agreement about therapeutic management when pregnant women present with bleeding angiomyolipomas (Wünderlich's syndrome). Treatment options include partial or total nephrectomy (with cesarean section simultaneously in patients at 28 weeks of gestation or later), transcateter selective arterial embolization (which can also be preventive), and sometimes, conservative management. If this last option is possible, there's still discussion about the risk of vaginal delivery compared with that of cesarean section, in terms of bleeding of the tumour.