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Resumen Objetivo Analizar las peculiaridades quirurgicas asociadas al tratamiento por via laparoscopica del quiste dermoide ovarico. Se estudian, igualmente, los factores asociados a la rotura intraoperatoria del quiste y su trascendencia clinica. Material y metodos Se realizo un estudio retrospectivo de 131 quistes dermoides intervenidos por via laparoscopica en el Hospital Universitario Virgen de las Nieves desde enero de 2000 hasta diciembre de 2008. Resultados La edad media de las pacientes fue de 32,4 anos. El tamano medio del quiste fue de 63,8 mm. En el 62,6% de los casos se pudo realizar cirugia conservadora (quistectomia). Solo 2 pacientes precisaron reintervencion por problemas hemorragicos. La estancia media fue de 1,6 dias. La rotura intraoperatoria del quiste ocurrio con mas frecuencia cuando se practico quistectomia. No hubo ningun caso de peritonitis. Conclusiones La laparoscopia es la tecnica de eleccion en el tratamiento quirurgico del quiste dermoide de ovario. Las complicaciones son minimas y la recuperacion rapida. Si se produce la rotura intraoperatoria del quiste no suele tener trascendencia clinica alguna.

Objetive: Evaluate the intrauterine blood transfusions performed in fetuses with anemia due to red blood cell alloimmunization in our unit and the detection rate of the middle cerebral artery Doppler to predict anemia after the first transfusion. Material and methods: We performed 53 intrauterine blood transfusions in 15 patients with red blood cell alloimmunization. We analyze the characteristics of the cases and the value of the middle cerebral artery Doppler to predict fetal anemia. Results: The detection rate of fetal anemia with the peak systolic velocity Doppler in the middle cerebral artery was 85% after the first transfusion and 72% after the second or more. There were no false positive results of the test in our series.

Resumen Objetivo Evaluar la eficacia de la pulsioximetria y el electrocardiograma fetal en la conduccion del parto con registro de frecuencia cardiaca fetal compatible con riesgo de perdida del bienestar fetal (RPBF). Sujetos y metodos Se trataba de un estudio experimental aleatorizado abierto con dos brazos; en uno se aplico la tecnica de la pulsioximetria y en el otro la tecnica STAN®. En cada grupo se incluyo a 40 gestantes con feto unico, gestacion a termino, en presentacion cefalica y registro cardiotocografico (RCTG) compatible con RPBF. Se analizaron las variables: tasa total de cesareas, indicaciones basadas en el RPBF y las repercusiones en el equilibrio acido-base neonatal. Resultados No se han obtenido diferencias significativas en cuanto a la tasa de cesareas (el 47,5 frente al 40%; p = 0,33) ni a la indicacion por RPBF (el 32,5 frente al 37,5%; p = 0,41). Tampoco en los resultados neonatales. Conclusiones La utilizacion de la pulsioximetria y STAN®21, como metodos auxiliares del RCTG; no han demostrado ser superiores en lo que se refiere a descenso de la tasa de cesareas o mejoria del bienestar fetal.

Resumen Objetivo Evaluar los resultados obtenidos en el tratamiento de gestaciones monocoriales biamnioticas complicadas con sindrome de transfusion feto-fetal (STFF) grave o crecimiento intrauterino retardado (CIR) selectivo mediante la fotocoagulacion laser de las anastomosis vasculares placentarias. Material y metodos Se realizo esa terapia en 22 gestaciones, 17 por STFF severo y 5 por CIR selectivo. Se analizan la gravedad de los casos antes de la cirugia, las complicaciones obstetricas y la supervivencia fetal. Resultados Hubo 17 casos de STFF grave; en 15 (88%) de ellos sobrevivio al menos uno de los gemelos. En los 5 casos por CIR selectivo, el feto con crecimiento normal vivio en 3 casos, incluido uno donde el feto con CIR tambien vivio. Conclusiones Los resultados muestran la implementacion exitosa de la cirugia laser endoscopica en una de las unidades de referencia de medicina fetal de Espana tras un entrenamiento apropiado del operador.

Objective: To analyze perinatal outcomes in singleton pregnancies with a single umbilical artery (SUA) as an isolated finding with no other underlying disorders.Methods: This retrospective observational study compared a group of pregnancies with SUA (n = 127) and a group with a normal 3-vessel umbilical cord (n = 27 752). The study variables comprised maternal and obstetric characteristics and perinatal outcomes.Results: The frequency of SUA was 0.45%. Pregnancies with SUA ended more frequently with cesarean delivery, and had a higher risk that the indication for cesarean delivery was non-reassuring fetal heart rate (NRFHR). Neonates in the SUA group had a lower weight for gestational age, and a higher risk of low umbilical cord blood pH.Conclusion: Obstetricians should monitor fetal growth closely in pregnancies with SUA, and be alert to NRFHR during labor and delivery.

Aims:To compare the outcomes of term gestations with oligohydramnios in the absence of other underlying disorders and term gestations with normal amniotic fluid.Methods:A retrospective analysis of obstetric outcomes in 27,708 term pregnancies. We compared three groups: labor induced because of oligohydramnios, spontaneous onset of labor with normal amniotic fluid, and labor induced because of late term pregnancy with normal amniotic fluid. We excluded pregnancies with maternal or fetal diseases or disorders potentially related with amniotic fluid alterations. The main outcome measures were mode of delivery, neonatal birth weight, umbilical artery blood pH, Apgar scores and neonatal discharge status.Results:Compared to spontaneous labor, induction of labor because of oligohydramnios was associated with a higher risk of cesarean delivery and small size of the fetus for gestational age (SGA). Compared to induction because of late term pregnancy there were no significant differences in neonatal, although neonates had a higher risk of being SGA.Conclusion:The only perinatal outcome for which the risk was higher in term pregnancies with isolated oligohydramnios was SGA. The systematic induction of labor in these pregnancies should be questioned.

Objective To evaluate detection and false-positive rates of the ultrasound markers—nasal bone (NB), ductus venosus (DV) flow and tricuspid regurgitation (TR)—during the first trimester in a population at high genetic risk, and to study the influence of a two-stage screening policy alter previous combined screening on the rate of invasive procedures. Methods A total of 333 chorionic villus samples were obtained in singleton pregnancies. Before biopsy, the ultrasound markers—NB, DV, and TR—were assessed, although the findings were not used to recalculate the previously determined risk for Down syndrome. Results Detection and false-positive rates for Down syndrome were 63.2% and 3.4% for NB, 65% and 3.1% for DV, and 50% and 2.1% for TR. All three markers were normal in 30% [84/277, 95% confidence interval (CI) 25%–36%] of chorionic villus sampling (CVS) cases performed for abnormal findings at the first trimester genetic screen, with 0% (0/20, 95% CI 0%–17%) false-negative rate for Down syndrome. Conclusion Assessment of secondary ultrasound markers is feasible in clinical practice and their use could reduce the number of unnecessary invasive procedures by 30%. Copyright © 2010 John Wiley & Sons, Ltd.