Feasibility and Accuracy of Early Fetal Echocardiography Performed at 13+0-13+6 Weeks in a Population with Low and High Body Mass Index: a Prospective Study.

PURPOSE: The earlier the detection and diagnosis of congenital heart diseases (CHD), the greater the clinical benefit; however, early fetal cardiac examination can be a challenge. The aim of our study is to demonstrate that the fetal cardiac examination at 13+0-13+6 weeks can be as adequately assessed as the examination performed at 16 weeks in patients with low and high body mass index (BMI). METHODS: The study was a prospective observational cohort study. One hundred pregnant women at low risk of congenital heart anomalies were divided into two groups: 49 women with low BMI (<25) and 51 women with high BMI (≥ 25). A complete fetal cardiac scan was performed on each patient at 13+0-13+6 weeks, via the transvaginal and transabdominal approaches, and at 16 weeks by the transabdominal approach. RESULTS: The examination at 13+0-13+6 weeks was adequately assessed in at least one of the two routes in 97 patients, as opposed to 87 patients at 16 weeks. A significantly higher adequate assessment rate was obtained at 13+0-13+6 weeks than at 16 weeks (p=0.017). The transvaginal approach showed the best resolution of the three examinations in 42% of women with BMI ≥35. No CHD were overlooked. CONCLUSIONS: Early fetal echocardiography is feasible and accurate at 13+0-13+6 weeks. Within patients with high BMI, early fetal echocardiography may be performed two weeks in advance, since it allows visualization of the fetal heart through the transvaginal route with a higher resolution in a large number of women, which is not feasible at 16 weeks.

Carcinoma mioepitelial de mama / Myoepithelial carcinoma of the breast

El carcinoma mioepitelial de mama (o mioepitelioma maligno) es un tumor poco frecuente compuesto exclusivamente por células mioepiteliales malignas. Su diagnóstico supone un reto, y viene dado por los hallazgos anatomopatológicos apoyados por las técnicas de inmunohistoquímica. Presentamos un caso clínico y revisión bibliográfica

Myoepithelial carcinoma of the breast (or malignant myoepithelioma) is a rare tumor composed exclusively of malignant myoepithelial cells. Its diagnosis is a challenge and is reached through pathological findings supported by immunohistochemical techniques. We present a case report and a review of the literature

Enfermedad de Paget pigmentada de la mama / Pigmented mammary Paget disease

La enfermedad de Paget pigmentada de la mama es una variante clinicopatológica infrecuente de la enfermedad de Paget, la cual debe incluirse en el diagnóstico diferencial de las lesiones pigmentadas del pezón. Se presenta el caso de una mujer de 49 años que consulta al presentar una mácula pigmentada en el pezón derecho de 9 meses de evolución; y cuyo estudio histológico e inmunohistoquímico permitió diagnosticar una Enfermedad de Paget que se acompaña de una hiperplasia melanocitaria atípica, diferenciándola de un melanoma maligno

Pigmented mammary Paget disease is an uncommon clinicopathological variant of Paget's disease, which should be included in the differential diagnosis of pigmented lesions on the nipple. We present the case of a 49-year-old woman with a 9-month-old pigmented lesión on her right nipple. The histological and immunohistochemical study allowed the diagnosis of a Paget's disease with intense atypical melanocytic hyperplasia, differentiating it from a malignant melanoma

Angiosarcoma de mama radioinducido / Radiotherapy-induced angiosarcoma of the breast

El angiosarcoma radioinducido de mama tras tratamiento quirúrgico conservador y radioterapia complementaria en una paciente con cáncer de mama es una entidad poco frecuente, de difícil diagnóstico y mal pronóstico. Se presenta el caso de una mujer de 71 años, con antecedentes personales de carcinoma ductal infiltrante de mama izquierda, a la que se practicó tumorectomía y linfadenectomía axilar (pT1cpN0M0), y recibió tratamiento adyuvante con radioterapia y hormonoterapia. 77 meses después del tratamiento, la paciente consultó al presentar una lesión cutánea en la mama izquierda. Tras valoración clínica, radiológica e histológica y con el diagnóstico de angiosarcoma de mama, se practicó mastectomía izquierda. Posteriormente no recibió tratamiento complementario

Radiotherapy-induced angiosarcoma of the breast after conservative surgical treatment and complementary radiotherapy in a patient with breast cancer is a rare condition, with both difficult diagnosis and poor prognosis. We present the case of a 71-year-old woman with a personal history of infiltrating ductal carcinoma of the left breast, who underwent tumorectomy and axillary lymphadenectomy (pT1cpN0M0), and received adjuvant treatment with radiotherapy and hormone therapy. 77 months after treatment, the patient consulted with a skin lesion on her left breast. After clinical, radiological and histological assessment and with the diagnosis of angiosarcoma of the breast, a mastectomy of her left breast was performed. The patient did not receive complementary treatment

Carcinoma de células acinares de mama / Primary acinic cell carcinoma of the breast

El carcinoma de células acinares primario de mama es un tumor raro que muestra similitudes con neoplasias de las glándulas salivales; y aunque pertenece al grupo de carcinomas de mama "triple negativos", su comportamiento biológico parece ser más favorable. Se presenta el caso de una mujer de 54 años, sin antecedentes oncoginecológicos, remitida a la consulta de patología mamaria para valoración por mamografía de screening que informa de BIRADS IV en mama derecha. A la exploración física, las mamas y axilas son normales a la inspección y a la palpación, tratándose de una lesión no palpable. El estudio citológico tras punción ecoguiada informa de sospecha de malignidad, motivo por el cual se practica biopsia excisional radioguiada que informa de la presencia de un carcinoma de células acinares de mama. Se realizó tratamiento quirúrgico conservador en mama-axila derecha y recibió radioterapia adyuvante. Tras 6 años del diagnóstico, se encuentra libre de enfermedad

Primary acinic cell carcinoma of the breast is a rare tumor that shows similarities with neoplasms of the salivary glands; and although it belongs to the group of "triple negative" breast cancer, its biological behavior seems to be more favorable. We present the case of a 54-year-old woman, with no gynecological cáncer history, referred to the mammary pathology office for evaluation after mammography screening that reports BIRADS IV in the right breast. On physical examination, the breasts and axillas are normal to inspection and palpation, being this the case of a non-palpable lesion. The cytological study after echoguided puncture reports suspicion of malignancy, which is why a radioguided excisional biopsy is performed, which shows the presence of an acinic cell carcinoma of the breast. Conservative surgical treatment is performed in the right breast-axilla, together adjuvant radiotherapy. 6 years after diagnosis, the patient is free of disease

Echographic features and perinatal outcomes in fetuses with congenital absence of ductus venosus.

INTRODUCTION: The purpose of this study was to describe the echographic features and perinatal outcomes of fetuses with absence of ductus venosus. MATERIAL AND METHODS: Retrospective review of 10 cases with absence of ductus venosus diagnosed by prenatal ultrasonography between January 2014 and February 2016 at a single referral center. Prenatal findings, umbilical shunting type, perinatal outcomes, and autopsy reports were reviewed. RESULTS: A total of 11 491 fetuses underwent a first- and second-trimester screening during the study period. Ten cases of absence of ductus venosus were diagnosed. All of the fetuses presented an extrahepatic shunt: three fetuses from the umbilical vein to the right atrium and the seven remaining fetuses from the umbilical vein to the inferior vena cava. Major structural defects and fetal effusions were detected in six fetuses. There were two cases of chromosomal abnormalities. Five patients underwent legal termination of pregnancy and five decided to carry to term. In two of these, the absence of ductus venosus anomaly was isolated and had a normal outcome. In the remaining three cases, a follow up of the children showed a variety of adverse outcomes. CONCLUSIONS: The absence of ductus venosus is associated with high rates of adverse perinatal outcomes. The prognosis for this group of anomalies depends on the additional findings with targeted ultrasound. This pathology should lead to a detailed anatomical study and affected fetuses should be closely monitored for signs of congestive heart failure.

Application of customized birth weight curves in the assessment of perinatal outcomes in infants of diabetic mothers.

OBJECTIVE: To determine whether the use of customized curves (CC) allows better detection of large- (LGA) or small-for-gestational age (SGA) infants at risk of adverse perinatal morbidity than non-CC in women with diabetes mellitus (DM). MATERIAL AND METHODS: A model of CC was applied to all infants of diabetic mothers (IDM) who attended the Hospital Universitario Materno Infantil de Canarias between 2008 and 2011. We compared perinatal outcomes of IDM classified as LGA or SGA by non-CC versus CC. RESULTS: One of 4 LGA was appropriate for gestational age (AGA) by CC (false-positive rate: 25%) and 30% of SGA by CC were not identified by non-CC (false-negative rate). False-positive LGA and SGA showed similar perinatal outcomes to AGA infants. The rates of cesarean section, cephalopelvic disproportion, total fetal distress and shoulder dystocia were significantly higher in false-negative LGA than in AGA by CC (p < 0.004, p < 0.02, p < 0.04 and p < 0.04, respectively). Fetal distress was higher in false-negative SGA than in AGA by CC (p < 0.03). DISCUSSION: In pregnancies complicated by DM, the use of CC allowed more accurate identification of LGA and SGA infants at high risk of perinatal morbidity than non-CC.

Maternal obesity in early pregnancy and risk of adverse outcomes.

OBJECTIVES: To assess the role of the health consequences of maternal overweight and obesity at the start of pregnancy on gestational pathologies, delivery and newborn characteristics. METHODS: A cohort of pregnant women (n = 6.558) having delivered at the Maternal & Child University Hospital of Gran Canaria (HUMIGC) in 2008 has been studied. Outcomes were compared using multivariate analyses controlling for confounding variables. RESULTS: Compared to normoweight, overweight and obese women have greater risks of gestational diabetes mellitus (RR = 2.13 (95% CI: 1.52-2.98) and (RR = 2.85 (95% CI: 2.01-4.04), gestational hypertension (RR = 2.01 (95% CI: 1.27-3.19) and (RR = 4.79 (95% CI: 3.13-7.32) and preeclampsia (RR = 3.16 (95% CI: 1.12-8.91) and (RR = 8.80 (95% CI: 3.46-22.40). Obese women have also more frequently oligodramnios (RR = 2.02 (95% CI: 1.25-3.27), polyhydramnios. (RR = 1.76 (95% CI: 1.03-2.99), tearing (RR = 1.24 (95% CI: 1.05-1.46) and a lower risk of induced deliveries (RR = 0.83 (95% CI: 0.72-0.95). Both groups have more frequently caesarean section (RR = 1.36 (95% CI: 1.14-1.63) and (RR = 1.84 (95% CI: 1.53-2.22) and manual placenta extraction (RR = 1.65 (95% CI: 1.28-2.11) and (RR = 1.77 (95% CI: 1.35-2.33). Newborns from overweight and obese women have higher weight (p<0.001) and a greater risk of being macrosomic (RR = 2.00 (95% CI: 1.56-2.56) and (RR = 2.74 (95% CI: 2.12-3.54). Finally, neonates from obese mother have a higher risk of being admitted to special care units (RR = 1.34 (95% CI: 1.01-1.77). Apgar 1 min was significantly higher in newborns from normoweight mothers: 8.65 (95% CI: 8.62-8.69) than from overweight: 8.56 (95% CI: 8.50-8.61) or obese mothers: 8.48 (95% CI: 8.41-8.54). CONCLUSION: Obesity and overweight status at the beginning of pregnancy increase the adverse outcomes of the pregnancy. It is important to promote the normalization of bodyweight in those women who intend to get pregnant and to provide appropriate advice to the obese women of the risks of obesity at the start of the pregnancy.

Correction: Maternal Obesity in Early Pregnancy and Risk of Adverse Outcomes.

[This corrects the article DOI: 10.1371/journal.pone.0080410.].

The effect of customized growth charts on the identification of large for gestational age newborns.

OBJECTIVE: To determine the effect of using customized vs. standard population birthweight curves to define large for gestational age (LGA) infants. METHODS: We analyzed data obtained from 2,097 singleton pregnancies using three different methods of classifying newborn birthweight: standard population curves, British or Spanish customized curves. We recorded maternal characteristics, proportion of LGA newborns when using each method, percentage of LGA according to one method but not for the others, and concordance between the different methods. RESULTS: The proportion of LGA newborns according to Spanish customized curves was significantly lower than that calculated using either standard general population birthweight curves or British curves (p < 0.001). A third (33.9%) of the infants classified as LGA according to the general population method were adequate for gestational age (AGA) when the Spanish customized curves were used, and 18.5% of non-LGA were LGA according to customized curves (p < 0.001). Concordance between the different models high, but on excluding AGA the concordance coefficient was low (Cohen's κ <0.4). CONCLUSIONS: The use of customized curves allows differentiation between constitutional LGA and cases of fetal overgrowth, leading to a decrease in the rate of both false-positives and negatives as well as the overall proportion of LGA babies.

Transfusión intrauterina. Nuestra experiencia en el Hospital Universitario Materno Infantil de Canarias / Intrauterine transfusion. Experience in Canaries University Hospital Maternity Ward

Objetivo. evaluar los casos de transfusión intravascular intrauterina por anemia fetal realizados en la Unidad de Medicina Fetal del Hospital Universitario Materno Infantil de Canarias. Material y método. estudio descriptivo y prospectivo de los casos diagnosticados de anemia fetal y a los que posteriormente se sometió a transfusión intravascular intrauterina en el período comprendido entre mayo de 2007 y junio de 2009. Resultados. durante ese período se diagnosticaron 7 casos de anemia fetal: 4 de anemia fetal inmune y 3 no inmune. En 2 casos los padres no autorizaron la transfusión. Se realizaron un total de 8 transfusiones intravasculares a los 5 casos restantes, y a 2 de éstos se realizaron transfusiones de forma repetida. Conclusiones. la transfusión intravascular es el método de elección para el tratamiento de la anemia fetal en nuestro medio. Tras iniciarse en el año 2007 el uso de este tratamiento, se ha podido realizar en todos los casos en que se encontraba indicado(AU)

Objectives. to present intrauterine intravascular transfusions cases performed for fetal anaemia in Fetal Medicine Unit of Canaries University Hospital Maternity Ward. Material and method. prospective descriptive study of cases diagnosed of fetal anaemia that were treated with intrauterine transfusion from may 2007 to June 2009. Results. during this period seven cases of fetal anaemia were diagnosed. Four isoimmunization-anaemia and three of non-immune anaemia. Eight intrauterine transfusions were performed in five of cases (in two cases repeated transfusion was required). Two cases did not allow transfusion. Conclusion. blood transfusion through umbilical cord seems to be the best option for fetal anaemia treatment. After first intrauterine transfusion in 2007, all indicated cases were carried out(AU)

Comparative study of transabdominal and transvaginal uterine artery Doppler pulsatility indices at 11-13 + 6 weeks.

OBJECTIVE: The objective of this study was to compare two approaches to determine the uterine artery pulsatility index (PI) as a screening measure for preeclampsia. METHODS: Comparative analysis of the PI values obtained from transabdominal and transvaginal Doppler ultrasound in 351 women with singleton pregnancies who were examined between May and June 2009 during routine morphological study and risk calculation of chromosome anomalies at 11-13 + 6 weeks of gestation. RESULTS: The mean PI measured transabdominally was 1.83 [95% confidence interval (CI) 1.78-1.89], but when measured transvaginally it was 1.98 (95% CI 1.93-2.08) (p < 0.05). Transabdominal mean PI was observed to decrease as the crown-rump length (CRL) increased: 1.96 (95% CI 1.80-2.12) for CRL <60 mm and 1.71 (95% CI 1.56-1.87) for CRL ≥70 mm (p < 0.05). The transvaginally measured indices were 2.09 (95% CI 1.93-2.26) and 1.78 (95% CI 1.64-1.92), respectively, for the same CRL groups (p < 0.05). A weak correlation was found between the mean PI and the mean CRL using Spearman's rho correlation (-0.20 for abdominal measures and -0.21 for vaginal measures, p < 0.001). CONCLUSIONS: Transabdominal and transvaginal Doppler ultrasound measurements of the uterine artery PI were significantly different. The latter approach yielded significantly higher values than the first.

Role of ultrasound in the labor ward.

Intrapartum ultrasound is commonly used to evaluate fetal vitality, presentation and status as well as placental location. Health professionals are increasingly using intrapartum ultrasound for advanced applications that have not yet been shown to be effective by controlled research studies, using advanced ultrasound technologies such as bi-dimensional ultrasound, color ultrasound, pulsed Doppler ultrasound and three-dimensional ultrasound. This article reviews the current applications of intrapartum ultrasound and considers which advanced technologies can add to the standard of care in the delivery ward.

Prenatal diagnosis and tridimensional ultrasound features of bilateral femoral hypoplasia--unusual facies syndrome.

The femoral hypoplasia - unusual facies syndrome is a rare disorder, which was described first three decades ago. It is characterised by the occurrence of short femurs with certain associated alterations mainly affecting the face, of which micrognathia is the most frequently found. Although the etiology of this condition is unknown, clear relationship with maternal insulin-dependent diabetes has often been reported, which suggests some sort of inherited component. Nevertheless, most cases occur sporadically. This entity is usually diagnosed after birth because prenatal ultrasound detection is rather difficult. Here, we report a case of prospective detection. So far, such cases have been seldom described in the literature.

Neumotórax complicado en una gestante a término: tratamiento mediante cesárea y videotoracoscopia simultáneas / Complicated pneumothorax in a term pregnancy. Combined cesarean section and videothoracoscopy

El neumotórax espontáneo es infrecuente durante la gestación. La causa más frecuente está relacionada con la presencia de blebs o bullas en el vértice pulmonar. Los síntomas más comunes son el dolor pleurítico y la disnea y la radiografía de tórax confirma el diagnóstico. El tratamiento de elección es la colocación de un drenaje pleural y la cirugía debería considerarse en los casos de neumotórax recurrente o pérdidas aéreas persistentes. Los factores más controvertidos del tratamiento del neumotórax durante la gestación son el momento de la cirugía y la vía de finalización de la gestación. Presentamos el caso de una gestante que en su tercer trimestre gestacional presentó un neumotórax espontáneo con pérdidas aéreas persistentes y que fue tratada mediante una cesárea electiva y una videotoracoscopia en el mismo acto quirúrgico, de forma satisfactoria. Creemos que una alternativa válida para el tratamiento definitivo del neumotórax complicado en una gestante a término es la extracción fetal y la videotoracoscopia combinadas en el mismo acto quirúrgico a fin de evitar riesgos materno y fetales

Spontaneous pneumothorax rarely occurs during pregnancy. The most common cause is almost always related to the presence of apical blebs or bullae. The most frequent symptoms are chest pain and dyspnea and chest radiography usually confirms the diagnosis. The treatment of choice is insertion of a chest drain and surgery should be considered in recurrent pneumothorax or persistent air leaks. The most controversial issues in spontaneous pneumothorax during pregnancy are the timing of surgery and delivery route. We describe the case of a pregnant patient in the third trimester with spontaneous pneumothorax and persistent air leaks who was successfully treated with combined elective cesarean section and videothoracoscopy in the same intervention. We believe that combined fetal extraction and videothoracoscopy in the same intervention could be a valid alternative for the definitive treatment of complicated spontaneous pneumothorax in full term pregnancies in order to avoid risks to the mother and fetus (AU)

Macrosomía fetal. Resultados obstétricos y neonatales / Fetal macrosomia. Obstetric and neonatal outcomes

Objetivos: Se realizó un estudio retrospectivo, descriptivo y longitudinal de los partos de los recién nacidos (RN) que pesaron más de 3.999 g en el servicio de Obstetricia y Ginecología del Hospital Universitario Materno Infantil de Canarias, durante el período comprendido entre el 1 de enero de 1998 y el 31 de diciembre de 2002. Sujetos y métodos: Se recogieron los datos de las historias clínicas maternas y de los RN, y se procesaron estadísticamente un total de 2.037 casos cuyos RN pesaron 4.000 g o más. Posteriormente se evaluaron: la edad, la paridad, la edad gestacional, la afección durante la gestación, el inicio y la vía del parto, el sexo del RN, puntuación en la prueba de Apgar, el pH arterial, el traslado a la unidad de cuidados intensivos neonatales, la mortalidad fetal y neonatal, las complicaciones hemorrágicas y los traumatismos del canal del parto, y se compararon con el grupo control de RN de menos de 4.000 g en ese período. Resultados: La incidencia de macrosomía fue del 5,3%, el 79,4% entre los 17 y los 34 años de edad. El 54,4% de las pacientes eran multíparas. Un 74,6% de los partos fue a término, el 66,7% de inicio espontáneo y el 64,1% de finalización eutócica. La mayoría de los RN fueron varones, y un 67,3% tuvo buenos resultados perinatales. En el grupo de macrosomías hubo las siguientes complicaciones: el 74,07% presentó traumatismos del canal del parto; el 25,97%, afección gestacional; el 2,95%, complicaciones hemorrágicas, y el 2,061%, distocia de hombros. Conclusiones: En las tablas 1, 2, 3 y 4 se recogen los datos finales. En éstos, se evidencian diferencias estadísticamente significativas, con una p < 0,001, en los siguientes datos: edad mayor de 34 años en el momento del parto, multiparidad, gestación cronológicamente prolongada, sexo fetal varón, más posibilidades de inducción de parto, parto finalizado mediante cesárea, mayor tasa de ingresos de recién nacidos en la unidad de cuidados intensivos neonatales y mayor mortalidad perinatal ampliada

Objective: A longitudinal descriptive retrospective study was performed of neonates weighing more than 3,999 g born in the Obstetrics and Gynecology Service of the University Maternity Hospital of the Canary Islands (Spain) from January 1st, 1992 to December 31st, 2002. Subjects and methods: Data were taken from the medical records of mothers and newborn infants. Statistical analysis was performed of 2,037 newborns weighing 4,000 g or more. Subsequently, the following variables were analyzed: age at delivery, parity, gestational age, pregnancy-related conditions, onset and route of delivery, sex of the infant, Apgar score, fetal artery pH, intensive care unit admission, fetal and neonatal mortality, hemorrhagic complications, and birth canal trauma. These data were compared with those in a control group of infants weighing less than 4,000 g at birth and delivered in the same period. Results: The incidence of macrosomia was 5.3%. Most of the mothers (79.4%) were aged between 17 and 34 years old and 54.4% were multiparous. Three-quarters (74.6%) of deliveries were at term, with spontaneous onset in 66.7% and normal delivery in 64.1%. Most of the newborns were boys (67.3%) with good perinatal outcomes. In the macrosomic group, birth canal trauma was found in 74.07%, pregnancy-related conditions in 25.97%, hemorrhagic complications in 2.95%, and shoulder dystocia in 2.061%. Conclusions: In tables 1, 2, 3 and 4 are related the final data. Statistically significant differences with p less than 0.001 are demonstrated in the following data: older age of 34 years at the time of delivery, multiparity, gestation chronological prolonged, male fetal gender, delivery induction, rates of cesaran section, neonatal income in intensive care unit, and extended perinatal mortality

Manejo del asma grave en pacientes gestantes / Management of severe asthma in pregnant women

El asma es una de las afecciones crónicas más frecuentes en mujeres gestantes; normalmente, es una condición que con el tratamiento adecuado se controla bien durante el embarazo. Describimos el caso de una gestante en el tercer trimestre que presentó una crisis de broncospasmo que derivó en un estatus asmático que complicó seriamente su vida. Posteriormente, describimos las implicaciones y el manejo del asma grave en la mujer embarazada

Asthma is one of the most frequent chronic diseases in pregnant women. With appropriate treatment, this condition can normally be well controlled during pregnancy. We describe a woman in the third trimester of pregnancy who suffered an attack of bronchospasm leading to status asthmaticus, which jeopardized the patient's life. We describe the implications and management of severe asthma in pregnant women

Infección perinatal por Listeria monocytogenes durante el embarazo y el parto / Perinatal Listeria monocytogenes infection during pregnancy and labour

Objetivo: Conocer la prevalencia de la infección perinatal por Listeria monocytogenes (LM) en nuestro centro y describir los efectos en el embarazo y el parto.Material y métodos: Se analizaron 21 casos de infección perinatal por LM que acontecieron en el Hospital Universitario Materno Infantil de Canarias entre los años 1992 y 2004. Los casos fueron localizados a través del registro de hemocultivos del servicio de medicina preventiva del hospital. Todos los casos presentaron, en la gestante o en el recién nacido, hemocultivos positivos frente a LM. Se evaluaron diferentes variables: la incidencia de la infección por LM durante ese período, la edad y paridad de las gestantes, la sintomatología, los resultados de las pruebas complementarias, el tratamiento realizado, el tipo y la vía del parto, las alteraciones en el registro cardiotocográfico (RCTG), las características del líquido amniótico y el estado del recién nacido (RN). El análisis se realizó de todos los casos con hemocultivo positivo frente a LM; se recogieron los resultados generales y, posteriormente, se los dividió en 2 grupos: en elgrupo 1 se incluyó a las pacientes que presentaron un cuadro infeccioso en la gestación producto de la colonización por LM, diagnosticada por hemocultivo materno positivo, y en el grupo 2, a las gestantes que, con una gestación aparentemente normal, parieron un RN que presentó clínica de cuadro infeccioso y mostró hemocultivo positivo frente a LM.Resultados: La incidencia fue de 21 casos de infección diagnosticada por LM en 97.839 nacimientos (2,1 casos/10.000 nacimientos). Nueve gestantes fueron diagnosticadas de listeriosis por la presencia de clínica de cuadro infeccioso y hemocultivo materno positivo, y 12 neonatos fueron diagnosticados de listeriosis neonatal por la presencia de clínica de cuadro infeccioso y hemocultivo positivo. Seis (6/21) casos acabaron en aborto, 8 (8/21) casos en cesárea, 6 (6/21) partos fueron vaginales, 11 (11/21) RN fueron ingresados en la unidad de cuidados intensivos neonatales (UCIN), una (1/21) muerte se produjo durante el período neonatal, una gestación siguió en curso y 2 (2/21) RN sanos no requirieron ingreso (2/21)

Objective: To determine the prevalence of perinatal infection with Listeria monocytogenes in our center and to analyze the effects of this infection during pregnancy and labour. Material and methods: Twenty-one cases of L. monocytogenes infection occurring in the University Maternity Hospital of the Canary Islands (Spain)between 1992 and 2004 were analyzed. Cases were identified through the blood culture registry of the hospital’s Preventive Medicine Service. Cases were defined as a positive blood culture to L. monocytogenes in pregnant women and/or their newborns. The following variables were evaluated: the incidence of L. monocytogenes infection during this period, age and parity of the pregnant women, symptoms, results of complementary investigations, treatment, type and route of delivery, alterations in cardiotocographic recording, amniotic fluid characteristics, and perinatal outcomes. All cases with a positive blood culture to L. monocytogenes were analyzed. An overall analysis of the results was performed. Subsequently, the patients were divided into 2 groups: women with L. monocytogenes infection during pregnancy, diagnosed by positive maternal blood culture, and those with an apparently normal pregnancy whose neonates had a positive blood culture to L. monocytogenes.Results: The incidence was 21 cases of infection by L. monocytogenes diagnosed in our center out of 97,839 births (2.1 cases per 10,000 births). Nine women and 12 neonates were diagnosed with listeriosis on the basis of symptoms and a positive blood culture. Miscarriage occurred in 6 women (6/21), cesarian section was performed in 8 (8/21) and there were 6 vaginal deliveries (6/21). Eleven neonates (11/21) were admitted to the neonatal intensive care unit, one neonate died (1/21), one pregnancy was still in course, and two healthy neonates did not require admission to the neonatal intensive care unit (2/21)

A rare cause of polyhydramnios: Neu-Laxova syndrome.

Neu-Laxova syndrome is a rare group of congenital malformations including intrauterine growth retardation (IUGR), microcephaly, central nervous system alterations, facial abnormalities, ichthyosis, limb abnormalities, generalized edema, polyhydramnios, and perinatal death. Thirty cases have been identified since the publication of the first two cases and only five of them had a prenatal diagnosis. The earliest diagnosis in a published case was at week 32 of gestation. This study illustrates that the detection of the syndrome during the second trimester of gestation is possible, with emphasis on the detection of the early appearance of polyhydramnios and the association of the syndrome with the Arabic ethnic group.

Retraso de crecimiento intrauterino precoz y severo junto con manifestación atípica de herpes gestacional / Early and severe intruterine growth restriction and atypical manifestations of herpes gestationis

El herpes gestationis (HG), o penfigoide gestacional (PG), es una rara pero grave enfermedad, que puede afectar al curso del embarazo y a su resultado perinatal. Se piensa que tiene una posible etiología inmunológica. Presenta una serie de características clínicas y anatomopatológicas específicas que se describen en este artículo

Pemphigoid gestationis, or herpes gestationis, is an uncommon and severe disease that can affect the course of pregnancy and perinatal outcome. Its etiology is thought to be autoimmune. The specific clinical and histological features are described