Quadruple pregnancy after post-IVF/ICSI transfer of blastocysts / Embarazo cuádruple tras la transferencia de blastocistos tras FIV/ICSI

Clinical case of a quadruple pregnancy (monochorionic diamniotic and dichorionic diamniotic) after the transfer of two blastocysts generated by intracytoplasmic sperm injection (ICSI). This is the case of a 29-year-old woman patient with transfer of two blastocysts after long cultivation of 6 embryos generated by ICSI and vitrified on day +3. This revealed quadruple clinical pregnancy (monochorionic diamniotic and dichorionic diamniotic) of 56 days of evolution by transvaginal ultrasound. The couple decided to undergo a selective embryonic reduction of the monochorionic diamniotic pregnancy after receiving information about the risks arising from it. After that embryonic reduction the uncomplicated pregnancy continued until 36 weeks of gestation, achieving reproductive success with the birth of two babies alive and healthy

Caso clínico de un embarazo cuádruple (monocoriónico biamniótico y dicoriónico biamniótico) después de la transferencia de dos blastocistos generados tras la inyección intracitoplasmática de espermatozoides (ICSI). Se trata de una mujer de 29 años a la que se le transfieren dos embriones en estado de blastocistos después del cultivo largo de 6 embriones ICSI vitrificados en día +3. Tras confirmar embarazo clínico cuádruple a los 56 días de evolución mediante ecografía transvaginal, la pareja decide someterse a una reducción embrionaria selectiva de la gestación monocorial biamiótica después de recibir la información de los riesgos derivadas de la misma. Después de dicha actuación el embarazo sigue su curso natural, sin complicaciones hasta la semana 36 con el resultado de dos recién nacidos vivos y sanos

Quadruple pregnancy after post-IVF/ICSI transfer of blastocysts.

Clinical case of a quadruple pregnancy (monochorionic diamniotic and dichorionic diamniotic) after the transfer of two blastocysts generated by intracytoplasmic sperm injection (ICSI). This is the case of a 29-year-old woman patient with transfer of two blastocysts after long cultivation of 6 embryos generated by ICSI and vitrified on day +3. This revealed quadruple clinical pregnancy (monochorionic diamniotic and dichorionic diamniotic) of 56 days of evolution by transvaginal ultrasound. The couple decided to undergo a selective embryonic reduction of the monochorionic diamniotic pregnancy after receiving information about the risks arising from it. After that embryonic reduction the uncomplicated pregnancy continued until 36 weeks of gestation, achieving reproductive success with the birth of two babies alive and healthy.

Maternal underweight and perinatal outcomes: a restrospective cohort study / Infrapeso materno y resultados perinatales: estudio de cohortes retrospectivo.

Introduction: Some studies have linked maternal underweight with adverse perinatal outcomes such as spontaneous abortion, abruptio placentae, small for gestational age newborn, intrauterine growth retardation and preterm birth. Objective: To determine the influence of maternal underweight in the onset of labor, route of delivery, birth weight, Apgar score and preterm birth. Methods: Retrospective cohort study. We included pregnant women from the Hospital Universitario de Puerto Real. Period of study: 2002-2011. Study group: underweight at the beginning of gestation (BMI < 18.5 kg/m2). Control group: pregnant women with normal body mass index (BMI) at the beginning of gestation (18.5-24.9 kg/m2). The risk (OR) of induction of labor, cesarean section, small for gestational age newborn, macrosomia, 5' Apgar score < 7, and preterm birth was calculated. Results: The prevalence of underweight was 2.5% versus 58.9% of pregnant women who had a normal BMI. We found no significant differences in the rate of induction of labor, fetal macrosomia, Apgar at 5' < 7 or preterm delivery. Maternal underweight was associated with a decreased risk of caesarean section (adjusted OR 0.45, 95% CI 0.22 to 0.89) and an increased risk of small for gestational age newborn (adjusted OR 1.74; 95% CI 1.05 to 2.90). Conclusions: Maternal underweight at the start of pregnancy is associated with a lower risk of caesarean section and a greater risk of small for gestational age newborns (birth weight < P10).

Introducción: algunos estudios han asociado el infrapeso materno con resultados perinatales adversos tales como aborto espontáneo, desprendimiento placentario, feto pequeño para edad gestacional, crecimiento intrauterino retardado y parto pretérmino. Objetivos: determinar si el infrapeso materno al inicio de la gestación influye sobre la forma de inicio y vía del parto, peso al nacer, índice de Apgar al minuto 5 y edad gestacional en el momento del parto. Métodos: estudio de cohortes retrospectivo en gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Grupo de estudio: infrapeso al inicio de la gestación (índice de masa corporal [IMC] < 18,5); grupo control: IMC normal al inicio de la gestación (18,5-24,9). Analizamos el riesgo (OR) de inducción de parto, cesárea, bajo peso al nacer, macrosomía, Apgar a los 5' < 7 y parto pretérmino. Resultados: la prevalencia de infrapeso fue del 2,5% frente al 58,9% de gestantes que presentaron un IMC normal. No encontramos diferencias significativas en la tasa de inducción de parto, macrosomía fetal, Apgar a los 5' < 7 ni parto pretérmino. El infrapeso materno se asoció a una disminución en el riesgo de cesárea (OR ajustada 0,45; IC 95% 0,22-0,89) y a un riesgo aumentado de presentar recién nacido pequeño para su edad gestacional (OR ajustada 1,74; IC 95% 1,05-2,90). Conclusiones: el infrapeso materno al inicio de la gestación se asocia a una menor probabilidad de que el parto finalice mediante la realización de una cesárea y a un mayor riesgo de que el recién nacido presente un peso al nacer por debajo del percentil 10.

Defectos de la pared abdominal: complejo OEIS complex. Afectación de uno de los gemelos en una gestación monocorial monoamniótica / Defects of the abdominal wall: OEIS complex. Affection of one of the twins in a monoamniotic monocorial gestation

Los defectos de la pared abdominal engloban un amplio grupo de patologías que pueden clasificarse en distintos tipos según sus características anatomopatológicas y patogenia. El complejo OEIS complex es una rara entidad compuesta por onfalocele, extrofia vesical, ano imperforado y defectos espinales, dando origen a las siglas en inglés (Omphalocele, bladder Exstrophy, Imperforateanu and Spinal defects) y asociándose también a ausencia de genitales externos, deformidad en la flexión de miembros, defectos en pie y arteria umbilical única. Su incidencia estimada es de 1/200.000 a 1/400.000 nacidos en gestaciones únicas, menor en gestaciones gemelares. Su etiología en la mayoría de las ocasiones es desconocida, esporádica y heterogénea, pudiendo asociarse a varios factores. Presentamos el caso de una mujer con gestación monocorial monoamniótica y afectación de uno de los gemelos por este defecto (complejo OEIS complex), presentando un segundo gemelo totalmente sano, lo que demuestra la falta de conocimiento en cuanto a la etiología de esta rara entidad y la improbable implicación de los factores genéticos (AU)

The abdominal wall defects encompass a variety of disorders that can be classified into different types according to their pathologic features and pathogenesis. The OEIS complex is a rare complex composed of omphalocele, bladder exstrophy , imperforate anus and spinal defects, giving rise to the acronym (Omphalocele, bladder Exstrophy, Imperforate anus and Spinal defects) and associating with the absence of external genitalia, flexion deformity member, standing defects, and single umbilical artery. Its incidence is estimated from 1/400,000 to 1/200,000 born in singleton pregnancies, lower in twin pregnancies. The etiology in most cases is unknown, sporadic and heterogeneous it may be associated with several factors. We report the case of a woman with monochorionic monoamniotic gestation and involvement of one of the twins for this defect (OEIS complex complex), presenting one second fully healthy twin, demonstrating the lack of knowledge regarding the etiology of this rare entity and the unlikely involvement of genetic factors (AU)

Infrapeso materno y resultados perinatales: estudio de cohortes retrospectivo / Maternal underweight and perinatal outcomes: a restrospective cohort study

Introducción: algunos estudios han asociado el infrapeso materno con resultados perinatales adversos tales como aborto espontáneo, desprendimiento placentario, feto pequeño para edad gestacional, crecimiento intrauterino retardado y parto pretérmino. Objetivos: determinar si el infrapeso materno al inicio de la gestación influye sobre la forma de inicio y vía del parto, peso al nacer, índice de Apgar al minuto 5 y edad gestacional en el momento del parto. Métodos: estudio de cohortes retrospectivo en gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Grupo de estudio: infrapeso al inicio de la gestación (índice de masa corporal [IMC] < 18,5); grupo control: IMC normal al inicio de la gestación (18,5-24,9). Analizamos el riesgo (OR) de inducción de parto, cesárea, bajo peso al nacer, macrosomía, Apgar a los 5’ < 7 y parto pretérmino. Resultados: la prevalencia de infrapeso fue del 2,5% frente al 58,9% de gestantes que presentaron un IMC normal. No encontramos diferencias significativas en la tasa de inducción de parto, macrosomía fetal, Apgar a los 5’ < 7 ni parto pretérmino. El infrapeso materno se asoció a una disminución en el riesgo de cesárea (OR ajustada 0,45; IC 95% 0,22-0,89) y a un riesgo aumentado de presentar recién nacido pequeño para su edad gestacional (OR ajustada 1,74; IC 95% 1,05-2,90). Conclusiones: el infrapeso materno al inicio de la gestación se asocia a una menor probabilidad de que el parto finalice mediante la realización de una cesárea y a un mayor riesgo de que el recién nacido presente un peso al nacer por debajo del percentil 10 (AU)

Introduction: Some studies have linked maternal underweight with adverse perinatal outcomes such as spontaneous abortion, abruptio placentae, small for gestational age newborn, intrauterine growth retardation and preterm birth. Objective: To determine the influence of maternal underweight in the onset of labor, route of delivery, birth weight, Apgar score and preterm birth. Methods: Retrospective cohort study. We included pregnant women from the Hospital Universitario de Puerto Real. Period of study: 2002-2011. Study group: underweight at the beginning of gestation (BMI < 18.5 kg/m2). Control group: pregnant women with normal body mass index (BMI) at the beginning of gestation (18.5-24.9 kg/m2). The risk (OR) of induction of labor, cesarean section, small for gestational age newborn, macrosomia, 5’ Apgar score < 7, and preterm birth was calculated. Results: The prevalence of underweight was 2.5% versus 58.9% of pregnant women who had a normal BMI. We found no significant differences in the rate of induction of labor, fetal macrosomia, Apgar at 5’ < 7 or preterm delivery. Maternal underweight was associated with a decreased risk of caesarean section (adjusted OR 0.45, 95% CI 0.22 to 0.89) and an increased risk of small for gestational age newborn (adjusted OR 1.74; 95% CI 1.05 to 2.90). Conclusions: Maternal underweight at the start of pregnancy is associated with a lower risk of caesarean section and a greater risk of small for gestational age newborns (birth weight < P10) (AU)

Granular cell tumor in breast: a case report.

Granular cell tumor (GCT) is a rare neoplasm of the soft tissues, and <1% of all GCTs are malignant. It usually appears in the tongue and sometimes may affect the female breast. Initially, GCT was considered to be a myogenic lesion affecting female breast (myoblastoma). Actually, it is assumed as a tumor originating from perineural or putative Schwann cells of peripheral nerves or their precursors that grows in the lobular breast tissue, due to the immunohistochemical features. Here, we review the importance of differentiating between this tumor and malignant breast carcinoma. Mammographically, by ultrasound scan and clinically, this case appears to be a malignant tumor of the breast, but with a correct and precise diagnosis including histopathologic examination and immunohistochemical studies, it was correctly identified as a GCT. CASE DETAILS: We present a case of a 52-year-old premenopausal woman. This report is of interest because of patient's familial oncologic history and personal history of gynecologic cancer. This rare tumor of the breast and the special way to approach the tumor by local anesthesia makes it interesting to communicate. CONCLUSION: This is a case of interest because GCT located in the breast is very unusual and knowledge of GCT is required for the differential diagnosis with breast cancer.

Birthweight in pregnant women with protein S deficiency treated with low-molecular-weight heparin: a retrospective cohort study.

OBJECTIVE: To determine the risk of small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) in pregnant women with protein S (PS) deficiency who received low-molecular-weight heparin (LMWH). METHODS: Retrospective cohort study of pregnant women seen from January 2002 to December 2011. The study cohort comprised a total of 328 patients with PS deficiency, who received prophylactic enoxaparin during pregnancy. The control cohort included 11 884 pregnant women without significant past medical history. The risk of SGA and IUGR was calculated as odds ratio. Multivariate regression analysis over the entire reference population was performed determining the risk of both SGA and IUGR by adjusting for maternal age, first delivery, maternal underweight status, pre-eclampsia, other treated thrombophilias or history of recurrent abortion. RESULTS: The SGA rates in the PS deficiency and control cohorts were 10.7% and 8.5%, respectively (p > 0.05). There was no increased risk of SGA (unadjusted OR = 1.28, 95% confidence interval [CI] 0.9-1.83; adjusted OR = 1.35, 95% CI 0.91-2.01). The IUGR rate was 2.7% in pregnant women with PS deficiency versus 4.1% in the control group (p > 0.05). Also, we did not find a significant risk of IUGR (OR = 0.66; 95% CI 0.34-1.28; adjusted OR = 0.843; 95% CI 0.42-1.70). CONCLUSIONS: In women with PS deficiency treated with LMWH, the risk of SGA and IUGR is similar to the one found in healthy pregnant women.

Sobrepeso y obesidad maternos como factores de riesgo independientes para que el parto finalice en cesárea.

Introducción: el sobrepeso y la obesidad se asocian a una mayor probabilidad de que el parto finalice en cesárea. Dado que dicho incremento del riesgo podría estar sesgado por variables de confusión como la diabetes o la hipertensión, en el presente trabajo pretendemos determinar si este riesgo persiste tras ser ajustado por numerosas variables de control.Objetivo: determinar si el sobrepeso y/o la obesidad son factores de riesgo independientes para que el parto finalice en cesárea.Métodos: estudio de cohortes retrospectivo. Se han incluido gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Se incluyeron dos grupos de estudio: sobrepeso al inicio de la gestación (IMC entre 25 y 29,9) y obesidad al inicio de la gestación (IMC ≥ 30). Grupo ontrol: IMC al inicio de la gestación normal (entre 18,5 y 24,9). El riesgo de cesárea fue analizado mediante un estudio de regresión logística múltiple incluyendo como covariables: edad materna, parto inducido, diabetes gestacional, diabetes pregestacional, macrosomía, hipertensión arterial, nuliparidad, cesárea anterior, parto pretérmino y parto postérmino.Resultados: de los 18.243 partos registrados, el IMC al inicio de la gestación constaba en 4.711 casos (25,8%). El 26,1% presentaban sobrepeso, el 12,4% obesidad y el 58,9% IMC normal. Sin ajustar por variables control, se asociaron a un incremento del riesgo de cesárea: sobrepeso (OR 1,48; IC95% 1,27-1,73); obesidad grado 1 (OR 2,09; IC95% 1,66-2,64); obesidad grado 2 (OR 3,23; IC95% 2,31-4,53); obesidad grado 3 (OR 2,57; IC95% 1,56-4,22). El riesgo aumentado se mantuvo significativo en el análisis multivariante: sobrepeso (OR 1,51; IC95% 1,24-1,84); obesidad (OR 2,15; IC95% 1,67-2,76).Conclusiones: encontramos una asociación significativa e independiente entre el sobrepeso/obesidad maternos y la finalización del parto mediante cesárea incluso ajustando por numerosas variables de control como: edad materna, nuliparidad, cesárea anterior, hipertensión, diabetes, peso al nacer y edad gestacional al parto.

Sobrepeso y obesidad maternos como factores de riesgo independientes para que el parto finalice en cesárea / Maternal overweight and obesity as independent risk factors for cesarean delivery

Introducción: el sobrepeso y la obesidad se asocian a una mayor probabilidad de que el parto finalice en cesárea. Dado que dicho incremento del riesgo podría estar sesgado por variables de confusión como la diabetes o la hipertensión, en el presente trabajo pretendemos determinar si este riesgo persiste tras ser ajustado por numerosas variables de control. Objetivo: determinar si el sobrepeso y/o la obesidad son factores de riesgo independientes para que el parto finalice en cesárea. Métodos: estudio de cohortes retrospectivo. Se han incluido gestantes adscritas al Hospital Universitario de Puerto Real. Periodo de estudio: 2002-2011. Se incluyeron dos grupos de estudio: sobrepeso al inicio de la gestación (IMC entre 25 y 29,9) y obesidad al inicio de la gestación (IMC ≥ 30). Grupo control: IMC al inicio de la gestación normal (entre 18,5 y 24,9). El riesgo de cesárea fue analizado mediante un estudio de regresión logística múltiple incluyendo como covariables: edad materna, parto inducido, diabetes gestacional, diabetes pregestacional, macrosomía, hipertensión arterial, nuliparidad, cesárea anterior, parto pretérmino y parto postérmino. Resultados: de los 18.243 partos registrados, el IMC al inicio de la gestación constaba en 4.711 casos (25,8%). El 26,1% presentaban sobrepeso, el 12,4% obesidad y el 58,9% IMC normal. Sin ajustar por variables control, se asociaron a un incremento del riesgo de cesárea: sobrepeso (OR 1,48; IC95% 1,27-1,73); obesidad grado 1 (OR 2,09; IC95% 1,66-2,64); obesidad grado 2 (OR 3,23; IC95% 2,31-4,53); obesidad grado 3 (OR 2,57; IC95% 1,56-4,22). El riesgo aumentado se mantuvo significativo en el análisis multivariante: sobrepeso (OR 1,51; IC95% 1,24-1,84); obesidad (OR 2,15; IC95% 1,67-2,76). Conclusiones: encontramos una asociación significativa e independiente entre el sobrepeso/obesidad maternos y la finalización del parto mediante cesárea incluso ajustando por numerosas variables de control como: edad materna, nuliparidad, cesárea anterior, hipertensión, diabetes, peso al nacer y edad gestacional al parto (AU)

Introduction: Overweight and obesity both are associated with an increased risk of cesarean section. Since this increased risk could be biased by confounding variables such as diabetes or hypertension, in this study we aim to determine whether this risk persists after adjusting for numerous control variables. Objective: To determine if maternal overweight and/or obesity are independent risk factors to cesarean section. Methods: Retrospective cohort study. We included pregnant women from the University Hospital of Puerto Real. Period of study: 2002-2011. Two study groups were included: overweight at the beginning of the gestation (BMI between 25 and 29.9 kg/m2) and obesity at the beginning of the gestation (BMI ≥ 30 kg/m2). Control group: pregnant women with normal BMI at the beginning of the gestation (Between 18.5 and 24.9 kg/m2). Multiple logistic regression analysis was conducted in order to evaluate the risk of caesarean. The variables included in the model were maternal age, induced labor, diabetes (gestational and pregestational), macrosomia, arterial hypertension, nulliparous, previous caesarean section, preterm birth and post-term childbirth. Results: Initial BMI was registered in 4,711 cases (25.8%) of a total of 18,243 births. Of these, 26.1% were overweight; 12.4% obesity and 58.9% normal BMI. Without adjusting by control variables, both overweight and obesity are associated to an increase in the risk of caesarean section: overweight (OR 1.48; CI95% 1.27-1.73); type 1 obesity (OR 2.09; CI95% 1.66-2.64); type 2 obesity (OR 3.23; CI95% 2.31-4.53); type 3 obesity (OR 2.57; IC95% 1.56-4.22). The risk remained significantly increased in the multivariate analysis: overweight (OR 1.51; CI95% 1.24-1.84); obesity (OR 2.15; IC95% 1.67-2.76). Conclusions: In conclusion, a significant and independent association was found between maternal overweight/obesity and cesarean section, even including numerous control variables such as age, nulliparous, previous cesarean section, hypertension, diabetes, birth weight and gestational age at birth (AU)

Antenatal care visits during pregnancy and their effect on maternal and fetal outcomes in pre-eclamptic patients.

AIM: The frequency of antenatal care visits during pregnancy was examined to determine their effect on maternal and fetal outcomes in patients with pre-eclampsia. METHODS: This study included 150 pregnant women with pre-eclampsia who attended the Outpatient Clinic of the Obstetrics and Gynecology Department, Ismailia General Hospital. The women were interviewed and their antenatal care visits recorded. Blood pressure control, cardiotocography, ultrasonographic and Doppler evaluations and the administration of methyldopa were recorded. We calculated the distribution of women who attended an adequate versus an inadequate number of antenatal care visits, examined the characteristics of the groups using significance tests, computed the risk of poor maternal and fetal outcomes and created regression analysis models. We also calculated the incidence rate of poor maternal and fetal outcomes, odds ratios and 95% confidence intervals. RESULTS: Women who attended an inadequate number of antenatal care visits had a significantly higher risk of post-partum hemorrhage, eclampsia, and intensive care unit admission compared with women who attended an adequate number of visits. Women who attended an inadequate number of visits had a 12-fold risk of a poor maternal outcome, a 53-fold risk of a poor fetal outcome and a significantly higher risk of neonatal mortality in comparison to women who attended an adequate number of antenatal visits. CONCLUSIONS: The frequency of antenatal care visits during pregnancy has a significant effect on maternal and fetal outcomes in patients with pre-eclampsia.

Customized versus Population-Based Birth Weight References for Predicting Fetal and Neonatal Undernutrition.

OBJECTIVES: The aim of our study was to construct a model of customized birth weight curves based on a Spanish population and to compare the ability of this customized model to our population-based chart to predict a neonatal ponderal index (PI) <10th percentile. METHODS: We developed a model that can predict the 10th percentile for a fetus according to gestational age and gender as well as maternal weight, height, and age. We compared the ability of this customized model to that of our own population-based model to predict a neonatal PI <10th percentile. Data from a large database were used (32,854 live newborns, from 1993 through 2012). Only singleton pregnancies with a gestational age at delivery of 32-42 weeks were included. RESULTS: In the entire pregnant population, the customized method was superior to the population-based method for detecting newborns with a PI <10th percentile (sensitivity: 55 vs. 40.96%; specificity: 99.6 vs. 91.23%; positive predictive value: 11.49 vs. 9.55%, and negative predictive value: 98.84 vs. 98.55%, respectively). In pregnant women with a BMI >90th percentile, the sensitivity was 75%, compared to 50% in the population-based method. In pregnant women with a height >90th percentile, the sensitivity was almost as high as in the population-based method (61.53 vs. 33.33%). CONCLUSION: The customized birth weight curve is superior to the population-based method for the detection of newborns with a PI <10th percentile. This is especially the case in women in the higher scales of height and weight as well as in preterm babies.

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

No disponible

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

No disponible

Guía de práctica clínica de atención en el embarazo y puerperio / Clinical practice guide for pregnancy and puerperal care

El objetivo de esta guía es establecer un conjunto de recomendaciones basadas en la evidencia científica de mayor calidad disponible para mejorar la salud de las mujeres embarazadas y puérperas, así como la salud de los y las recién nacidos.

Prevención de la infección perinatal por estreptococo del grupo B. Recomendaciones españolas. Actualización 2012. Documento de consenso SEIMC/SEGO/SEN/SEQ/SEMFYC / Prevention of Neonatal Group B Sreptococcal Infection. Spanish Recommendations. Update 2012. SEIMC/SEGO/SEN/SEQ/SEMFYC Consensus Document

La infección por Streptococcus agalactiae, estreptococo grupo B (EGB), continúa siendo la causa más frecuente de sepsis neonatal de etiología bacteriana. En 2003, las Sociedades Españolas de Ginecología y Obstetricia, Neonatología, Enfermedades Infecciosas y Microbiología Clínica, Quimioterapia y Medicina Familiar y Comunitaria publicaron recomendaciones actualizadas para la prevención de la infección neonatal precoz por EGB. En ellas se recomendaba la identificación de gestantes portadoras de EGB mediante cultivo de muestra de exudado vaginorrectal realizado en las 35-37 semanas de gestación y la administración de profilaxis antibiótica intraparto (PAI) a todas las gestantes colonizadas. En estas nuevas recomendaciones se actualizan los métodos microbiológicos para realizar la identificación de portadoras de EGB y la técnica de sensibilidad a antibióticos; se revisan los antibióticos de primera línea que pueden usarse para PAI (penicilina, ampicilina, cefazolina) y sus alternativas (clindamicina y vancomicina); se clarifica el significado de la presencia de EGB en orina, incluyendo criterios para el diagnóstico de infección urinaria y bacteriuria asintomática por EGB en la embarazada; se define el uso de PAI en la amenaza de parto prematuro y rotura prematura de membranas, y se revisa el manejo del recién nacido en relación con el estado de portadora de EGB de la madre. Estas recomendaciones solo son válidas para la prevención de la infección neonatal precoz por EGB, y no son efectivas frente a la infección neonatal tardía. Tras la aplicación generalizada de la PAI, la incidencia de la sepsis neonatal precoz por EGB ha disminuido (..) (AU)

Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including (..) (AU)

[Prevention of Neonatal Group B Sreptococcal Infection. Spanish Recommendations. Update 2012. SEIMC/SEGO/SEN/SEQ/SEMFYC Consensus Document]. / Prevención de la infección perinatal por estreptococo del grupo B. Recomendaciones españolas. Actualización 2012. Documento de consenso SEIMC/SEGO/SEN/SEQ/SEMFYC.

Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including criteria for the diagnosis of UTI and asymptomatic bacteriuria in pregnancy are clarified; IAP in preterm labour and premature rupture of membranes, and the management of the newborn in relation to GBS carrier status of the mother are also revised. These recommendations are only addressed to the prevention of GBS early neonatal infection, are not effective against late neonatal infection.

[Prevention of perinatal group B Streptococcal disease. Updated Spanish recommendations 2012]. / Prevención de la infección perinatal por estreptococo del grupo B. Recomendaciones españolas revisadas 2012.

It has been a significant reduction in neonatal group B streptococcus (GBS) infection in Spain following the widespread application of intrapartum antibiotic prophylaxis. In 2010, new recommendations have been published by the CDC and this fact, together with the new knowledge and experience available, has driven to the participating scientific societies publishing these new recommendations. In these recommendations is advised to study all pregnant women at 35-37 gestation weeks` to determine if they are colonized by GBS and to administer intrapartum antibiotic prophylaxis (IAP) to all colonized mothers. Microbiological methods to identify pregnant GBS carriers are updated and intrapartrum antibiotic prophylaxis in preterm labour and premature rupture of membranes and the management of the newborn in relation to GBS carrier status of the mother are also revised.

Prevención de la infección perinatal por estreptococo del grupo B. Recomendaciones españolas revisadas 2012 / Prevention of perinatal group B Streptococcal disease. Updated Spanish recommendations 2012

Como consecuencia aplicación de la profilaxis antibiótica intraparto ha ocurrido una importante reducción de la infección neonatal por estreptococo grupo B en nuestro país. En 2010 se han publicado nuevas recomendaciones por los CDC y este hecho, junto con los nuevos conocimientos disponibles, ha llevado a las sociedades participantes a publicar estas nuevas recomendaciones. En ellas se mantiene el criterio de administrar profilaxis intraparto a todas las embarazadas colonizadas por EGB, se actualizan las técnicas de diagnostico de portadoras y se clarifica la actuación frente al parto prematuro y a los recién nacidos a riesgo de infectarse(AU)

It has been a significant reduction in neonatal group B streptococcus (GBS) infection in Spain following the widespread application of intrapartum antibiotic prophylaxis. In 2010, new recommendations have been published by the CDC and this fact, together with the new knowledge and experience available, has driven to the participating scientific societies publishing these new recommendations. In these recommendations is advised to study all pregnant women at 35-37 gestation weeks` to determine if they are colonized by GBS and to administer intrapartum antibiotic prophylaxis (IAP) to all colonized mothers. Microbiological methods to identify pregnant GBS carriers are updated and intrapartrum antibiotic prophylaxis in preterm labour and premature rupture of membranes and the management of the newborn in relation to GBS carrier status of the mother are also revised(AU)

Mola hidatiforme parcial en gestante de 17 semanas con preeclampsia / Partial hydatiform mole at 17 weeks’ gestation in a woman with preeclampsia

Objetivo. Presentar un caso de mola hidatiforme parcial (MHP) que comienza con un cuadro de preeclampsia a las 17 semanas de gestación, y revisar los datos relativos al diagnóstico y manejo de esta patología. Caso clínico. Paciente que ingresa por cuadro grave de preeclampsia. El estudio ecográfico y citogenético ponen de manifiesto una MHP. Se realiza evacuación uterina por vía abdominal y seguimiento posterior de la paciente hasta la resolución del proceso. Discusión. La MHP suele manifestarse por metrorragia del primer trimestre; no suelen identificarse anomalías fetales específicas aunque casi siempre existe un crecimiento fetal retardado. Raramente comienza con un cuadro de preeclampsia de aparición precoz, como en el caso que se presenta. Su diagnóstico prenatal se basa en la ecografía, determinaciones seriadas de HCG y cariotipo fetal, si bien el diagnóstico de certeza es histológico. Es considerada una enfermedad localizada que normalmente se resuelve con la evacuación uterina, sin embargo en algunos casos da lugar a una enfermedad trofoblástica persistente. Conclusión. El diagnostico de la MHP debe ser tenido en cuenta en los cuadros de preeclampsia que comienzan precozmente (AU)

Objectives. To report a case of partial hydatidiform mole presenting as preeclampsia at 17 weeks of gestation and to review the data on the diagnosis and management of this entity. Case Rrport. The patient was admitted for severe preeclampsia. Ultrasound and cytogenetic studies revealed a partial hydatiform mole. Abdominal uterine evacuation was performed and the patient was monitored until the process resolved. Discussion. Partial hydatiform mole usually manifests as first-trimester metrorrhagia. This entity is not generally associated with specific fetal anomalies, but retarded fetal growth is almost always present. These moles rarely present with a picture of early-onset preeclampsia, as in the present case. Diagnosis is based on ultrasound, human chorionic gonadotropin (HCG) measurements and fetal karyotype, although the definitive diagnosis is histological. Partial hydatiform mole is considered a localized disease that usually resolves with uterine evacuation. However, in some patients, there can be persistent trophoblastic disease. Conclusion. Diagnosis of partial hydatiform mole should be taken into account in patients with early onset preeclampsia (AU)