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To evaluate the obstetric management and neonatal outcomes in twin pregnancies with delayed delivery of the second twin, including follow-up.This study is a review of four cases of delayed delivery of the second twin in our hospital from 2009 to 2012. The obstetric management of the cases from the expulsion of the first twin to the delivery of the second twin is analyzed. The neonatal outcomes including follow-up for 2 years were reviewed.The first twins were delivered between 15 and 25 weeks (average 21 weeks) and the second twins were delivered between 25 and 31 weeks (average 27 weeks). One first twin (25 %) survived, while three (75 %) second twins survived. Two out of the three second twins delivered after 28 weeks were in satisfactory condition.The delayed delivery of the second twins which occurred in the third trimester is associated with favorable outcome, however, the risks should not be ignored.

A 17-year-old nulligravida woman presented to the emergency department complaining of a six months’ history of severe dysmenorrhea. The patient underwent a laparoscopic excision of a right ovarian endometrioma in another hospital one year ago, 24 months after menarche at 14 years of age. Transvaginal ultrasonography, magnetic resonance imaging, hysteroscopy as well as laparo- scopy revealed a unicornuate uterus with a noncommunicating right rudimentary horn, a dilated right fallopian tube and a novel 40 mm right ovarian endometrioma. An excision of the right fallopian tube, the rudimentary horn and the endometrioma was performed. Since endometriosis may be originated by retrograde menstruation, an obstructive mullerian malformation should be ruled out at the diagnosis of endometriosis, particularly in adolescents. It may lead clinicians to provide an initial definitive treatment for avoidingrapid recurrent endometriosis.

Resumen Objetivo Revisar la evolucion y las opciones terapeuticas en las gestaciones con diagnostico intrauterino de taquicardia fetal. Materiales y metodos Estudio observacional retrospectivo en 23 pacientes con diagnostico de taquicardia fetal y seguimiento gestacional en el Servicio de Obstetricia del Hospital Universitario La Fe de Valencia entre los anos 2002 y 2010. Los datos de las gestaciones incluidas en el estudio fueron recogidos mediante revision de las historias clinicas de las pacientes. Resultados La edad gestacional media de deteccion de la taquicardia fetal fue 30,2 semanas. De los 23 fetos, 18 (78,26%) presentaron taquicardia supraventricular, 2 (8,69%) flutter auricular y 3 (13,04%) taquicardia no filiada. Seis fetos desarrollaron hidrops (26,08%). En 13 casos (56,52%) se prescribio inicialmente tratamiento con digoxina en monoterapia, en uno (4,34%) con digoxina y amiodarona, en 2 (8,69%) con digoxina y flecainida y en otro (4,34%) unicamente con flecainida, debiendo modificarse el tratamiento inicial en 15 casos (65,21%). La taquicardia fue revertida en 9 fetos. Finalizaron mediante parto vaginal 11 gestaciones (47,82%), mientras que en las 12 restantes se realizo cesarea (52,17%). Conclusion Nuestros resultados apoyan la evidencia actual, considerando que una proporcion significativa de taquicardias fetales pueden ser tratadas exitosamente mediante administracion transplacentaria de antiarritmicos, siendo la digoxina el farmaco de primera eleccion. Con el tratamiento y el seguimiento adecuados el pronostico fetal de esta afeccion es favorable, resolviendose el ritmo cardiaco anormal en un alto porcentaje de casos durante la gestacion.

Objective To investigate the effect of antiangiogenic treatment on experimental endometriotic lesion nerve fibers. Design Heterologous mouse model of endometriosis. Setting University Institute IVI, University Hospital La Fe. Animal(s) Ovariectomized nude mice (n = 16) receiving human endometrial fragments from oocyte donors (n = 4). Intervention(s) Endometrium fragments stuck in the peritoneum of 5-week-old female nude mice treated with vehicle (n = 8) and antiangiogenic agent cabergoline (n = 8; Cb 2, 0.05 mg/kg/day) for 14 days. Main Outcome Measure(s) Immunofluorescence analysis of von-Willebrand factor (vWF) and vascular smooth muscle cells (αSMA) for evaluating the number of immature blood vessels (IBV) and microvascular density (MVD); immunochemical analysis of protein-gene product 9.5 (PGP 9.5) to assess nerve fibers density (NFD), and blue toluidine staining to confirm presence of mast cells and macrophages in endometriotic lesions. Result(s) All the results were quantified by morphometric techniques. The IBV, NFD, and number of macrophages and mast cells were statistically significantly decreased in the Cb2-treated group when compared with controls. Conclusion(s) Antiangiogenic treatment statistically significantly diminishes new blood vessel formation after macrophage, mast cell, and nerve fiber reduction, providing a rationale to test antiangiogenic agents as a novel therapeutic approach to severe pelvic pain associated with human peritoneal endometriosis.

Los fibroadenomas son las lesiones mamarias mas frecuentes durante la adolescencia. Se habla de «fibroadenoma gigante» cuando alcanza un tamano mayor de 5cm o un peso superior a 500g. Su tratamiento consiste en la tumorectomia, siendo necesaria excepcionalmente la mastectomia. En ocasiones resulta complicada su diferenciacion histologica con el tumor filodes, lesion mamaria benigna muy recidivante que raramente evoluciona como maligna. Presentamos el caso de una paciente diagnosticada de fibroadenoma gigante a los 17 anos y sometida a cinco intervenciones por sucesivas recidivas tumorales, con resultado final de la realizacion de una mastectomia. En dos ocasiones la lesion fue catalogada como tumor filodes borderline. Consideramos de interes su presentacion por su excepcional evolucion y como ejemplo de la dificultad de las indicaciones quirurgicas en determinadas lesiones mamarias benignas de dificil diagnostico anatomopatologico.

Resumen Presentamos el seguimiento de un caso clinico de pentalogia de Cantrell detectado en la ecografia del primer trimestre. Se trata de una paciente de 33 anos, G2C1, sin antecedentes medicos de interes. Acude en su semana 13 + 2 para ecografia del primer trimestre. La ecografia se informo como feto unico con una longitud cefalo-nalga de 50,1 mm y una translucencia nucal de 7,5 mm. Se observa masa cardiopulmonar extracorporea, diagnosticandose de ectopia cordis, megavejiga, afectacion renal bilateral y pies zambos, etiquetandose al feto como portador de la pentologia de Cantrell. La paciente solicito interrupcion voluntaria del embarazo. La anatomia patologica describio feto con peso y talla adecuados a edad gestacional, que presentaba por la cara anterior extrofia visceral, identificandose tanto corazon como paquete intestinal y vejiga. Por tanto, el uso de la ecografia del primer trimestre no solo permite el diagnostico de la viabilidad fetal y la datacion de la edad gestacional, sino que hoy en dia permite tambien el diagnostico de patologia malfomativa estructural sin necesidad de esperar a la ecografia de la semana 20 para la toma de decisiones. Con este trabajo pretendemos describir la utilidad de la ecografia de primer trimestre en el diagnostico de patologia morfologica, tratando en nuestro caso la pentalogia de Cantrell.

Resumen El sindrome de Ehlers-Danlos (SED) es un grupo de enfermedades del tejido conectivo caracterizado principalmente por fragilidad tisular e hiperlaxitud articular. Es poco frecuente su asociacion con el embarazo y algunos tipos cursan con complicaciones severas maternas. Presentamos nuestra experiencia con una paciente de 35 anos afectada de SED tipo clasico, que presento un embarazo sin complicaciones, que alcanzo las 38 semanas y, un aborto espontaneo en el primer trimestre de una gestacion gemelar.

Twin reverse arterial perfusion (TRAP) sequence is a rare complication that occurs exclusively in monochorionic multiple gestations (Wong and Sepulveda 2005). It consists in a normal twin, who acts...

We present a case of a twin pregnancy in which one fetus developed a rapidly growing unilateral intrathoracic tumor. While a cystic adenomatoid malformation was suspected in the ultrasound scan, the magnetic resonance scan suggested a pulmonary blastoma or a bronchioalveolar carcinoma. Postnatal chest radiography and contrast-enhanced computed tomography of the affected newborn were performed, and it was ruled out the possibility of malignant origin. Finally, the anatomopathologic exam revealed the presence of a mesenchymal hamartoma in the chest wall. Nevertheless, parents refused any treatment for the newborn.

Arthrogryposis multiplex congenital is a rare condition defined as contractures in multiple joints at birth due to disorders starting in fetal life. Its etiology is associated with many different conditions and in many instances remains unknown. The final common pathway to all of them is decreased fetal movement (fetal akinesia) due to an abnormal intrauterine environment. Causes of decreased fetal movements may be neuropathic abnormalities, abnormalities of connective tissue or muscle, intrauterine vascular compromise, maternal diseases, and space limitations within the uterus. When the cause of arthrogryposis is space limitations in uterus, the most common etiology is oligohydramnios. The same can result from intrauterine tumours as fibroids, although to our knowledge there are only two papers reporting cases of fetal deformities related to uterine leiomyomas. We describe a well-documented exceptional case of arthrogryposis associated with the presence of a large uterine fibroid. It could illustrate the importance of a careful and appropriate assessment of uterine fibroids before and in the course of a pregnancy considering that they can cause both serious maternal and fetal complications.

La endometriosis ureteral es una infrecuente localizacion de endometriosis profunda, que puede condicionar una grave disminucion de la funcion renal de forma silenciosa. Se presenta el caso de una paciente con fibrosis peritoneal secundaria a endometriosis profunda, cuya inespecifica sintomatologia conllevo un retraso diagnostico, permitiendo el desarrollo de hidronefrosis. Es necesario descartar la presencia de endometriosis profunda en mujeres en edad fertil con hidronefrosis de etiologia desconocida.