Metformin therapy in gestational diabetes (GD) has beneficial effects on insulin resistance and does not appear to be teratogenic; but the use effect in early pregnancy on pernatal morbility has not beenstudied. Objective: To assess that metformin therapy initiated early in pregnancy in obese women with GD reduces macrosomia and neonatl morbidity. Design: Department of Maternal Fetal Medicine, high specialty medical university, Social Security Mexican Institute. Participants: Patients with diagnosis of GD. Interventions: We examined the record of women with GD, 17 or less weeks of pregnancy and a body mass index equal or more than 30 when they started therapy. They were divided in two groups: metformin group (women treated only with metformin throughout pregnancy because they did not accept to use insulin, n = 34) and insulin group (women who received only insulin treatment, n = 40). Per...

Metformin therapy in gestational diabetes (GD) has beneficial effects on insulin resistance and does not appear to be teratogenic; but the use effect in early pregnancy on pernatal morbility has not beenstudied. Objective: To assess that metformin therapy initiated early in pregnancy in obese women with GD reduces macrosomia and neonatl morbidity. Design: Department of Maternal Fetal Medicine, high specialty medical university, Social Security Mexican Institute. Participants: Patients with diagnosis of GD. Interventions: We examined the record of women with GD, 17 or less weeks of pregnancy and a body mass index equal or more than 30 when they started therapy. They were divided in two groups: metformin group (women treated only with metformin throughout pregnancy because they did not accept to use insulin, n = 34) and insulin group (women who received only insulin treatment, n = 40). Per...

Myelomeningocele affects 17,8 in 100 000 newborns. It is one of the ten leading causes of death in children under the age of 10 in Mexico and it is associated with high cognitive, sensory and motor morbidity. Studies in animals and, later, the Management of Myelomeningocele Study (MOMS), showed that the repair of prenatal neural tube defects decreases the risk of hydrocephalus and improves motor function at the age of 30 months. Prenatal fetal surgery for myelomeningocele described in MOMS is performed through hysterotomy, and is associated to significant maternal and fetal morbidity. Thus, the therapeutic approach has evolved to fetoscopic techniques with less maternal and fetal complications and better perinatal results. In this section, we describe the different fetoscopic techniques, their evolution, advantages and disadvantages, and the challenges for fetal surgical techniques in th...