Our unit is completely comprehensive in Ruber International Hospital since its maternity opening in 1990 with daily consultation mornings and afternoons, exclusively in the hospital; it has an all-encompassing care to women from the adolescence.
Our vocation is to prepare us continuously to offer the latest and cross-checked in our speciality.It is formed by highly qualified specialists in the different fields or our expertise development, we are focused in:
Obstetrics of pregnancy, normal delivery and high-risk pregnancy care.
Fetal medicine, covering Prenatal diagnosis of genetic and morphologic disorders. High resolution 3-D and 4D ultrasound.
Gynaecology:Prevention and diagnosis of benign and malignant pathology of feminine genital apparatus and breast; minimally invasive gynaecologic surgery, including laparoscopy and hysteroscopy. Genital prolapse surgery; HPV detection and cervix cancer prevention.
Assisted reproduction and sterility: treatment and study of sterility, assisted reproduction techniques.
For further knowledge, including detailed information on the surgical procedures, go to personal webpage to Dr. Ordenes.
In our consultation, we offer a comprehensive service to all the patients who are considered as obstetrical high-risked, bringing the human and technological support as well as the necessary infrastructure to reach the best materno-fetal results. Accordingly, we have a professional team with a wide experience in this obstetric field and the support of other involved specialities as neonatal and adults ICU.
The high-risk pregnancy is when the fetus mother and/or newborn has a greater possibility to be diseased o die, or to develop permanent damages before and/or after delivery.It stands for a 20% of all pregnancies, and it occurs more frequently to women under 20 or aged than 35.
The follow-up is carried out individually with serial controls matching during the pregnancy depending on each patient’s pathology, and including weight control and vital signs, ultrasounds and Doppler study according to each visit schedule and making periodic analysis. In Ruber International Hospital, we have all the medical and surgical specialities to be used in special situations during gestation.
THE FETUS AS PATIENT
The 6% of newborns, approximately, shows a congenital anomaly. The 2% to 4% of them correspond to major anomalies, determining the perinatal morbidity and mortality increases.
The experts’ team of our fetal medicine unit has the most innovative technology of high resolution ultrasounds and last generation to perform anatomical complete studies, fetal physiopathology, prenatal diagnosis, therapy and fetal health research.
The fetal medicine is multidisciplinary, and although we follow great part upon the activity, we are supported by genetic sub-specialists in neonatology, paediatric and cardiological surgery, paediatric radiology, specialized anaesthesiology and infirmary.
FETAL MEDICINE AND PRENATAL DIAGNOSIS
Performed by a medical team specialized in the most innovative technical available resources to the early detection of the pathology in normal course gestation and in high-risk pregnancy, customized in each case the examinations’ type and frequency.
Fist quarterly ultrasound (12-14 weeks):It allows to observe the fetal viability, to date the gestation and to analyses different ultrasound contouring of chromosomal diseases (nuchal scan, nose bone, ductus venous flow, tricuspid insufficiency, etc.). Risk rate calculation combined with chromosomal diseases through the PRISCA software (mother’s age + nuchal scan + mother’s blood analysis)
Second quarterly morphological ultrasound (19-22 weeks):Full study of the fetal anatomy and physiology.Including ultrasound (fetal heart study) and neurosonography (fetal brain study). Study with Doppler pressing the uterus arteries as pre-eclampsia screening or restrictive intrauterus growth.
Third quarterly ultrasound (32-34 weeks):To monitor the fetal well-being: Detailed fetal biometry (growth analysis and estimate fetal weight), fetal biophysical profile (placenta status, amniotic fluid and fetal activity assessment). Mother-fetus’sColor Doppler study and pressed at a central level and peripheral by ultrasounds, as well as the fetus presentation of a view of the birth canal.
Chromosomal, biochemical, immunological or infectious abnormalities determination by:
Genetic amniocentesis (amniotic fluid obtaining in week 15-16). This test allows having the chromosomic anomalies result within 3-4 weeks. If also the technique FISH (molecular genetic technique) is applied for the most usual hormosomes (Down Syndrome, trysomies 18, 13 and X and Y sexual chromosomes), this term is reduced to 24-48 hours.
Chorionic villus sampling (CVS) biopsy (placenta sample obtaining in week 11-12 for the karyotyping study)
Cordocentesis. (fetal blood obtained from the 19-20 week for the karyotype study or to perform blood transfusions)
Advice and monitoring of high-risk gestations. Sometimes, serious complications complications can arise (hypertension, diabetes, delayed growth, scarce amniotic fluid… ) forcing to do more periodic controls of the fetal well-being.
Congenital cardiopathies affect 9 of 1000 live newborns full-term.Therefore are considered the most common severe congenital anomalies.
Fetal echocardiography is the anatomical study and the fetal cardiovascular system functionality, allowing the intrauterine diagnosis of almost all cardiopathies.What will let to improve the cardiopathy prognosis in some cases and to apply an early treatment for the newborn. In other cases, as rhythm disorders, the treatment is performed before delivery, resulting in improved prognosis and survival.
TRIDIMENSIONAL ULTRASOUND (3D) AND REAL TIME (4D)
Most modern ultrasound probes allow observing in three dimensions and in real time baby expressions, body movements and the fetal behaviour in their fetal environment before various stimuli.
It is also very important, according to diverse experts, in comprehension and the explanation of certain fetal anomalies.
Who is advisable to ask to a genetic adviser’s consultation:
Family background of congenital malformations, hereditary diseases, chromosomal abnormalities or developmental impairment.
The occurrence of 2 or more previous abortions or newborns earlier, malformed or dead.
Exposure to potential teratogenic factors (toxicities, radiation, etc.)
Our nit offers the feasibility f a genetic study to parents before a new pregnancy, therefore the risk of having a malformed child can be estimated, and whether or not to make a subsequent amniocentesis.
Sterility and assisted reproduction
Amelia Villa Milla
Rosina Gay Fernández –Vegue
The laboratory is equipped with the latest technology, constantly renewed ensuring the success of our treatments. Embryologists and geneticians work in this unit with the common protocols and the support and warranty of the General Services of Ruber International Hospital.
Gynaecologic endocrinology:Study and treatment of patients with anovulation, irregular cycles, dysmenorrhea, etc. in any reproductive life stage.
Assisted reproduction techniques.
All the techniques are performed with a customized complete follow up and so close as the patient requires it.
Study infertile couple :
It covers the comprehensive assessment of the couple. A detailed study of each case will be carried out, including anamnesis, examination, ultrasound, analytic study and complementary techniques (hysteroscopy, laparoscopy) if the team regards it necessary.
Study of Repeated miscarriages:
It embraces: detailed anamnesis, and complementary tests request of both members of the couple, and customized treatment.
It consists of various drug’s administrations to achieve a proper follicular maturation and then, ovulation.Ultrasound controls could be necessary to monitoring the treatment just about specifying the precise day of ovulation.
Artificial insemination with conjugal sperm:
It is a technique comprising two phases:A first one with follicular ovarian stimulation with drugs and once considered reached the follicular maturity, then, the second phase is performed, consisting of the introduction of a seminal sample through an intrauterine cannula (in consultation and without anaesthesia) with the prior capacitated spermatozoon in the laboratory.
It would be for cases of sterility with an unknown origin (in which, having done a complete study, there is no etiological factor diagnosed) or in cases of a slight masculine factors. And also for particular cases of feminine factor diagnosis, as ovulatory dysfunctions, cervical factors, tubal unilaterals, or in cases of mild endometriosis.
Artificial insemination with donor sperm:
It would be appropriate in cases of couples with azoospermia diagnosis who, after the corresponding evaluation, they cannot obtain sperm from testicles or epididymis, in those cases where the couple with genetic diseases could transfer them to their descendants, or in cases of women without partner.
It would be used the same procedure as in previous section but using an anonymous donor sperm, from the sperm bank, observing all the legal issues.
In vitro fertilisation:
It is complex technique based in 4 stages:
Ovarian stimulation: During approximately 10 days a hormonal treatment will be administered to the patient to achieve a maturing of multiple follicles simultaneously. In this stage, ultrasound monitoring will be performed in consultation in order to determine the treatment and evolution reaction.
Ovarian puncture: Process required to ovocytes extraction. It is performed under ultrasound monitoring, under anaesthesia, and its duration is 15 minutes approximately.
In vitro fertilisation:Process performed by the biologist in laboratory, whereby previously extracted ovocytes are connected with spermatozoa.
Embryo transfer: Insertion in the uterus of obtained in laboratory embryos, under ultrasound monitoring, without anaesthesia. Normally, one or two embryos are transferred, freezing the remaining if the couple wish so.
It is the most complicated option of In vitro fertilization, comprising the injection of a unique spermatozoon into the ovum by a biologist for fertilizing them; the rest of the treatment is equal to in vitro fertilization.
Pre-implantation genetic diagnosis:
Technique to examine through the biopsy of embryo, embryos genetically harvested through an in vitro fertilization program and hence, to detect possible chromosomal or genetic anomalies before to transfer the embryos to the woman. Once the biopsy is performed, the not carrier of chromosomal disorders embryos and susceptible to be transferred, can be chosen.
It would be ideal for carriers patients of genetic or chromosomal diseases, or in cases where there is a implantation failure or in couples with repeated miscarriages without any other etiologic filiated cause.
We have an ovum donation program; it is an option with high rate of pregnancy success; it is suitable for cases with previous technical failures due to ovum bad quality as for aged patients or young patients with prior ovarian failure.
It is a simple technique. It requires few medications for our patient. Its performance is rather quick to its indication in the first consultation (3-4 weeks.)
Minimally Invasive Surgery
Along with the classic surgery, still necessary for some pathologies, we have developed the most modern techniques of endoscopic surgery and with limited-access surgeries minimally invasive as possible achieving the same results and allowing faster recoveries, less painful and hospitalizations of less than 24 hours in most of the cases. To perform it, it is necessary an experience in traditional surgery and in minimal invasive surgery and to have instrumental technical equipment and very specific optics.
It is the diagnosis technique for intrauterine pathology, comprising the endoscopic study in the uterus cavity. It also allows doing driven injury biopsy without any type of anaesthesia or sedation.It is essential for the current diagnosis in the abnormal uterine bleeding of non-hormonal cause. It is performed entirely outpatient.
It enables the surgical treatment without entry incisions sites (injuries) of pathology localization predominantly in the uterine cavity, such as myomas (myomectomy by hysteroscopy), endometrial polyps (polypectomy by hysteroscopy), intrauterine adhesions correction (adhesiolysis or Asherman’s Syndrome by hysteroscopy) and abnormalities as septum or partitions (partition separation or septum by hysteroscopy). Moreover, as a conservative treatment of abnormal uterine bleeding (endometric ablation by hysteroscopy) when there is no intrauterine pathology.
Laparoscopy is the surgical technique that allows the access to the abdominal cavity by small incisions (injuries) commonly not bigger than 5 or 10 mm. With the suitable instrumentation, we treat the mostly part of benign pathology and part of malign pathology of female genitalia.
Surgical treatment of endometriosis. Ovarian cyst resections, adhesions release, endometrium implant resection, infertility treatment related to endometriosis, are part of the procedures that we perform with the reliability based in a vast experience from several successful cases. It needs anaesthesia and usually hospitalization for less than 24 hours.
Hysterectomy by Laparoscopy. Involving the removal of the uterus by tiny incisions whenever we do not consider more appropriate to perform directly a Vaginal Hysterectomy.This extraction is normally vaginally, or removal of small pieces (morcellation).This technique achieves the same results as it used to have before, with large incisions, and with a faster recovery. It is necessary to do it with general anaesthesia and around 24-48 hours hospitalization.
Myomas removal (myomectomy) by Laparoscopy. It involves the benign tumors removal of the uterine wall preserving the Uterus and Ovaries through small incisions in the abdominal wall. The part is removed in smaller pieces (morcellation).It requires anaesthesia and hospitalization of 24 hours.
Ovary and Fallopian Tubes surgery. Solid or cysts ovary injuries removal, keeping ovaries, adnexectomy (ovary and tubes removal) where appropriate.
Surgical treatment of female infertility. Complementing Assisted Reproduction techniques, or as a treatment in cases of adhesions, some cases of tubes obstruction, endometriosis surgery, the fertile capacity can be restored in some cases without any more treatments.
Genital prolapse surgical treatment.
Urinary incontinence due to efforts surgery: With or without cystocele (prolapse of the urinary bladder due to the drop of vagina wall).Interposition technique of synthetic mesh requiring less hospitalization time than 24 hours and regional anaesthesia and/or sedation.
Uterine prolapse surgery, preserving uterus or with vaginal hysterectomy.
Vulva and perineum repair surgery in traumatic deliveries cases or morphologic disorders.Rectocele, perineum laceration.
Cervix cancer prevention
HPV.(Human Papilloma Virus), follow up detection and treatment, where necessary.
Cervicovaginal cytology: It is for the cells study from the cervix uteri to detect a viral infection presence and its effects in the cell morphology.
Colposcopy:It allows to detect injured rather suspicious areas in the cervix uteri of being affected by the HPV virus to monitor them and do a biopsy when necessary.
Cervix biopsy. To take a sample of the cervix uteri tissues to its deep analyses and to establish the affecting extent in applicable cases.
Cervical conization. Minimal surgery under local anesthesia and sedation and that solves –without neither damage to the uterus nor risking fertility- the mostly part of persisting injuries or highly hazarded due to HPV infection.
Surgical treatment of malign injuries from genitalia
Ovarian rumors, endometrium and uterus tumors, cervix uteri tumors.
Interoperative or delayed biopsy of breast injuries.
Sentinel lymph node.
Quadrantectomy and axillary lymphadenectomy.
Mastectomy and lymphadenectomy. Immediate axillary reconstruction.