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Resumen OBJETIVO: Primario: comparar las diferencias en la vía de nacimiento (cesárea, instrumentado o parto eutócico) entre embarazadas con IMC ≥ 25 y menor de 25. Secundario: comparar las diferentes complicaciones gestacionales y puerperales en embarazadas con IMC ≥ 25 y menor que éste. MATERIALES Y MÉTODOS: Estudio analítico, longitudinal, observacional, de cohortes y retrospectivo efectuado en pacientes atendidas entre diciembre de 2010 y diciembre de 2015 en el Hospital Clínico San Carlos, Madrid, España. Parámetros de estudio: concepción natural o asistida, diabetes gestacional, enfermedad hipertensiva e hipotiroidismo gestacionales, peso del feto y semanas de embarazo al momento de su finalización, inducción y sus causas, vía del parto y complicaciones puerperales. RESULTADOS: Se estudiaron 642 embarazadas con límites de edad de 13 y 45 años, con media de 32 años. El riesgo de cesárea fue 1.6 veces superior en embarazadas con IMC ≥ 25. Este grupo tuvo dos veces más diabetes gestacional y fetos macrosómicos y tres veces más hipertensión gestacional que las embarazadas con IMC normal. Las inducciones del parto y las complicaciones del puerperio tuvieron una tendencia mayor en IMC más elevados, sin diferencias estadísticamente significativas. CONCLUSIONES: Se encontró mayor incidencia de cesáreas, diabetes e hipertensión gestacional y fetos macrosómicos en las pacientes que iniciaron el embarazo con sobrepeso u obesidad en comparación con quienes tuvieron peso normal. Los desenlaces obtenidos justifican la importancia de una intervención en estos casos para recomendar hábitos nutricionales adecuados y estilo de vida activo que permitan alcanzar un peso saludable previo al embarazo.

Abstract OBJECTIVE: Primary: to compare the differences in the route of birth (cesarean section, instrumental or euthyroid delivery) between pregnant women with BMI ≥ 25 and less than 25. Secondary: to compare the different gestational and puerperal complications in pregnant women with BMI ≥ 25 and less than 25. MATERIALS AND METHODS: Analytical, longitudinal, observational, cohort and retrospective study performed in patients attended between December 2010 and December 2015 at the Hospital Clínico San Carlos, Madrid, Spain. Study parameters: natural or assisted conception, gestational diabetes, gestational hypertensive disease and hypothyroidism, fetal weight and weeks of pregnancy at termination, induction and its causes, route of delivery and puerperal complications. RESULTS: We studied 642 pregnant women with age limits of 13 and 45 years, mean 32 years. The risk of cesarean section was 1.6 times higher in pregnant women with BMI ≥ 25. This group had twice as many gestational diabetes and macrosomic fetuses and three times more gestational hypertension than pregnant women with normal BMI. Labor inductions and puerperium complications had a higher trend in higher BMIs, with no statistically significant differences. CONCLUSIONS: A higher incidence of cesarean section, diabetes, gestational hypertension and macrosomic fetuses was found in patients who started pregnancy overweight or obese compared to those with normal weight. The outcomes obtained justify the importance of an intervention in these cases to recommend adequate nutritional habits and an active lifestyle to achieve a healthy weight prior to pregnancy.

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RESUMEN La úlcera de Lipschütz es una entidad poco frecuente e infradiagnosticada. Se presenta el caso de una paciente de 24 años sin antecedente de contacto sexual que consultó por aparición súbita de úlceras vulvares dolorosas, en el contexto de un cuadro pseudogripal. Se discuten los principales diagnósticos diferenciales, dado que es una enfermedad no relacionada con enfermedades de transmisión sexual y poco reconocida por los profesionales de la salud, que precisa de manejo conservador.

ABSTRACT Lipschütz ulcer is a rare underdiagnosed entity. We present the case of a 24-year-old patient without history of sexual contact who consulted for sudden occurrence of painful vulvar ulcers, in the context of flu-like symptoms. The main differential diagnoses are discussed, as it is a disease unrelated to sexually transmitted diseases and little recognized by health professionals, which requires conservative management.

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RESUMEN CASO CLÍNICO: la encefalitis anti receptor N-metil D-aspartato (NMDAR) es un trastorno autoinmune con un amplio espectro de síntomas neuropsiquiátricos. Se presenta el caso de una mujer de 22 años con una encefalitis anti-NMDA que cursó con amnesia, crisis parciales complejas y alteraciones del comportamiento asociado a un teratoma ovárico. La evolución fue adecuada con cirugía e inmunosupresores. A los tres años se objetivó un teratoma contralateral, sin recidiva de encefalitis; que fue extirpado tras estimulación ovárica para criopreservación de ovocitos. CONCLUSIONES: el teratoma ovárico debe ser sospechado ante la presencia de una encefalitis atípica. Antes de realizar cirugías ováricas repetidas, debe valorarse la opción de vitrificación ovocitaria si los deseos genésicos de la mujer no están cumplidos.

ABSTRACT CLINICAL CASE: anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is an autoimmune disorder with a wide sprectrum of neuropsyquiatric symtoms. A case of a 22 years old woman with NMDAR encephalitis presenting with amnesia, focal complex seizures and behavior disturbances associated with an ovarian teratoma is reported. Three years after the first episode, a contralateral teratoma was observed, with no recurrence of the encephalitis; teratoma excision was performed, after controlled ovarian stimulation for oocyte cryopreservation. CONCLUSIONS: ovarian teratoma must be suspected when atypical encephalitis occurs. Before performing repetead ovarian surgeries, oocyte vitrificaction must be considered as a fertility-sparing option in women who have not completed their childbearing wishes.

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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.

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