INTRODUCCIÓN La cirugía del suelo pélvico está en boga debido al envejecimiento de la población y al creciente interés en mejorar la calidad de vida. Así mismo las técnicas quirúrgicas han aumentado su complejidad para disminuir los efectos adversos en los pacientes. La vía vaginal permite tiempos quirúrgicos menores, una recuperación más rápida y menos complicaciones que la abdominal. Pero el uso de la laparoscopia acorta la recuperación y disminuye las tasas de rechazo de las prótesis. Una de las limitaciones de la laparoscopia sigue siendo que la intervención se alarga siendo una de las mayores dificultades técnicas para el cirujano la sutura al promontorio para fijar la malla. OBJETIVOS Verificar la factibilidad de inserción y cuantificar la resistencia a la tensión de los arpones de PEEK en el promontorio sacro para facilitar la sutura de la malla al promontorio en la sacropexia por laparoscopia. RESULTADOS El arpón, igual que el hilo, resiste durante 30 segundos tracciones a 1N, a 5N y a 10N. Los arpones resisten una fuerza máxima a la tracción 21Newton, el hilo de 32N. El arpón falla debido al propio mecanismo de sujeción en un 6% y el hilo en un 22%. El arpón se desinserta debido a la rotura del ligamento en un 64%, mientras que el hilo en un 22%. Respeto el porcentaje de fallos del conjunto ligamento-malla- arpón/hilo los resultados son de 92% de los casos del arpón y 56% de los hilos fallan. Según la localización del arpón, las cuatro posiciones son igual de seguras en cuanto a resistencia a la tracción. CONCLUSIÓN Es factible insertar los nuevos arpones de PEEK en el promontorio sacro. Éstos resisten a la tracción que puede ejercer la presión intraabdominal máxima. La estructura más débil es el ligamento. El hilo resiste más fuerza que el arpón aunque éste último presenta resultados óptimos de factibilidad quirúrgica. El punto de anclaje, según nuestro estudio, se puede realizar indistintamente en las cuatro localizaciones probadas.

Objetivos: Conocer el procedimiento de la episiotomía en el marco de la Estrategia de Atención al Parto Normal, su adecuación a la práctica clínica y la relación con distintos factores de tipo clínico y contextual que puedan influir en su práctica, así como estudiar la variabilidad existente entre los profesionales atendiendo a criterios de conocimiento y formación. Metodología: Estudio descriptivo, transversal y analítico, con un enfoque de investigación cuantitativa, de la actividad obstétrica durante el proceso de 12.093 partos (años 2011-2012) en el Hospital Clínico Universitario Virgen de la Arrixaca (Murcia). Entre los profesionales sanitarios se repartió un cuestionario auto administrado de elaboración propia. El tratamiento de los datos se realizó con el paquete estadístico SPSS 19.0. Resultados: La adecuación de la práctica clínica a las recomendaciones de la Estrategia de atención al parto normal, presenta una tendencia a disminuir las siguientes prácticas: el rasurado perineal, el uso de enemas y el número de cesáreas urgentes. Así mismo, se observa una tendencia a aumentar: el acompañamiento al parto tanto en dilatación como al expulsivo, la monitorización continua, la libre elección de postura por la mujer, la ingesta de líquidos intraparto, el número de partos vaginales tras cesárea y el número de mujeres con epidural. Manteniéndose sin variación el resto de variables estudiadas (realización de amniotomía y partos instrumentados). El porcentaje global de episiotomías fue del 50%. Las variables clínicas que presentan una asociación significativa, aumentando la probabilidad de la misma son: primiparidad (RR=2,98), edad gestacional > 41 semanas de gestación (RR=1,2), inicio del parto estimulado o inducido (RR= 1,33), uso de analgesia epidural (RR=1,95), uso de oxitocina (RR=1,58), posición de litotomía durante la etapa de expulsión fetal (RR=6,4) y parto instrumentado (RR=1,84). Por otra parte, edad materna ≥35 años (RR=0,85) y peso del RN < 2500gr. (RR=0,8), se asocian con una menor incidencia de episiotomía. Las variables contextuales que están relacionadas con el uso de la episiotomía son el acompañamiento al parto (RR=1,31) y el turno de día (1,12). Entre los profesionales que han participado en el estudio, se han observado diferencias en cuanto a la necesidad de formación y a la percepción de sus conocimientos como suficientes. Según su experiencia clínica, no se relaciona la episiotomía con los desgarros perineales de II-IV grado, especialmente entre el colectivo médico. Se evidencia una amplia variabilidad en la práctica clínica del procedimiento, incluida en los márgenes de seguridad de la técnica. Esta variabilidad obedece a la formación de los profesionales. Se evidencia una necesidad de actualización de conocimientos sobre anatomía del suelo pélvico en mujeres. Conclusiones: Las recomendaciones de la Estrategia no se siguen en su totalidad en el Hospital Universitario, por lo que será necesario revisar las políticas de reducción de procedimientos desaconsejados por el Ministerio, ya que los futuros profesionales se están formando en un medio que no es acorde, en su totalidad, con sus directrices. La episiotomía no es un procedimiento aislado e independiente del resto de las prácticas obstétricas, sino que está relacionado con otras variables clínicas, como la posición adoptada durante el expulsivo, uso de analgesia epidural, instrumentación del parto, etc. y de contexto, acompañamiento al parto y turno de día, que incrementan la posibilidad de tener que realizarla. Se le debe permitir a la mujer poder decidir sobre su proceso de parto tras haber recibido una información adecuada sobre la repercusión de determinadas prácticas obstétricas. El establecimiento de una política de episiotomía selectiva debe ir acompañada de un refuerzo en formación en materia de criterios de indicación clínica, reparación de desgarros y protección perineal. / Objectives: The main objective of this goal is to know the procedure of the episiotomy within the framework of the Strategy Normal Birth Care, its relevance to clinical practice and the relationship with different clinical and contextual factors which can influence in its practice, just like studying the existing variability among professionals attending to criteria of knowledge and training. Methodology: This has been a descriptive, transversal and analytical study of the obstetrical activity in 12,093 childbirths which took place between 2011 and 2012 in the Clinical University Hospital Virgen de la Arrixaca (Murcia). A self-administered survey was given to the health professionals. The processing of data was performed with SPSS 19.0. Results: The clinical appropriateness of the recommendations of the Strategy normal birth care practice presents a tendency to decrease in the following practices: perineal shaving, the use of enemas and the number of emergency caesareans. Likewise, some practices have also had a tendency to increase: the accompaniment in childbirth and the second stage of labour, continuous monitoring, free choice of women position, intrapartum fluid intake, and the number of vaginal births after caesarean and the number of women with epidural. There has not been any variation in the remaining studied variables (amniotomy and performing instrumental births). The global percentage of episiotomies was 50%. The clinical variables with a significant positive association, increasing its probability were: primipary (RR=2.98), gestational age > 41 weeks of pregnancy (RR=1.2), stimulated or induced labour (RR=1.33), use of epidural analgesia (RR=1.95), use of oxytocin (RR=1.58), lithotomy position during the second stage of labour (RR=6.4) and instrumented childbirth (RR=1.84). On the other hand, maternal age ≥ 35 years old (RR=0.85) and newborn weight < 2500 gr. (RR=0.8) were associated with a lower incidence of episiotomy. Contextual variables which are related to the use of episiotomy are the accompanying childbirth (RR = 1.31) and the day shift (1.12). Among the professionals who participated in the study, some differences have been observed as far as the need for training and the perception of knowledge is concerned as sufficient. According to its clinical experience, the episiotomy is not related to the 2nd - 4th degree perineal tears, especially among the medical community. A wide variability in the clinical practice of procedure can be evidenced, included in the safety margins of the technique. This variability is due to the training of professionals. A need to update knowledge on pelvic floor anatomy is evidenced. Conclusions: The recommendations of the Strategy are not followed entirely in the university hospital, so it will be necessary to review the reduction policies of procedure advised against by the Ministry, considering that future professionals are being trained in an environment that is not appropriate with this guideline. The episiotomy is neither an isolated procedure nor independent of the rest of the obstetrical practices, but it is linked to other clinical variables, such as the position adopted during the second stage of labour, the use of epidural analgesia, childbirth instrumentation, and so on. And in context, accompanying childbirth and the day shift which increase the possibility of being carried out. A woman must be allowed to decide about her childbirth plan after receiving suitable information about the repercussions of certain obstetric practices. The establishment of a policy of selective episiotomy should be accompanied by reinforcement in training about clinical indication criteria, repair of tears and perineal protection.

Existen diferentes modelos para la provisión de servicios de atención al parto y distintos factores relacionados con la organización de los servicios en los que se atiende a las mujeres. En esta tesis se exploran los resultados de la atención al parto en Cataluña, y se comparan los resultados de 64 hospitales en base al tipo de financiación y también al volumen de partos anuales que se atiende en cada centro hospitalario. En este trabajo también se evalúa el impacto de una política sanitaria para implantar un modelo de atención al parto normal, basado en un concepto fisiológico y que promueve un uso racional de los recursos sanitarios disponibles. Para contextualizar el trabajo se ha realizado una exploración de diferentes modelos de atención en varios países industrializados, se han buscado los indicadores más utilizados en Europa, para la evaluación de este tipo de atención, y se han elaborado indicadores específicos y adecuados al contexto catalán. Para la exploración de los diferentes modelos de atención y de los indicadores para la evaluación más utilizados en Europa se ha realizado una revisión crítica de la bibliografía y de diferentes bases de datos. Además se han realizado entrevistas con expertos. Para la comparación de los resultados se han extraído los diagnósticos y procedimientos relacionados del Conjunto Mínimo Básico de Datos (CMBD) registrados en el Servei Català de la Salut. Además, se han agrupado los hospitales según el tipo de financiación y según el volumen de partos atendidos y se han comparado los resultados de todos los partos únicos de entre 37 a 42 semanas de gestación. Las conclusiones más relevantes son que el tipo de financiación y el volumen de partos atendidos en los hospitales tienen un efecto significativo en las intervenciones obstétricas investigadas en Cataluña. Por otra parte, la realización de episiotomía ha descendido de forma significativa y la incidencia de lesiones perineales graves se ha mantenido por debajo del 1% en todos los hospitales de Cataluña. / There are different models of maternity care and also other factors related to the organisation of services in which women are attended to. In this thesis the results of delivery of birth care in Catalonia are investigated, and the outcomes of 64 hospitals are compared according to the type of financing and volume of births attended to in each hospital. This thesis also evaluates the impact of the undertaken maternity care policy for the implementation of the normal childbirth model of care and to promote a rational use of the existing health care resources. For the contextualization of this work, some models of care in different industrialized countries are explored, and also it has been identified the most widely used indicators for the assessment of maternity care in Europe. Then specific and appropriate indicators for the Catalan context have been developed. To get information on different models of care and to know what indicators are used in the European context, it has been conducted a critical review of literature, an exploration on several database and also interviews with experts. A number of selected diagnoses and procedures have been obtained from the Minimum Basic Data Set (MBDS) recorded in the Catalan Health Service for the comparison of outcomes. Hospitals have been grouped by type of financing and by the volume of births attended to. All singleton births between 37 to 42 weeks of pregnancy have been included on the analysis. The most relevant conclusions are the type of funding and the volume of births in hospital have a significant effect on the obstetric interventions investigated in Catalonia. Also episiotomy has decreased significantly, and the incidence of severe perineal trauma has remained below 1% in all hospitals in Catalonia.

OBJECTIVE: To assess the effectiveness of ultrasound in the antenatal prediction of symptomatic congenital cytomegalovirus infection. STUDY DESIGN: The sonograms of 650 fetuses from mothers with primary cytomegalovirus infection were correlated to fetal/neonatal outcome. Infection status was disclosed by viral urine isolation at birth or CMV tissue inclusions at autopsy. Classification of symptomatic disease was based on postnatal clinical/laboratory findings or macroscopic evidence of tissue damage at autopsy. RESULTS: Ultrasound abnormalities were found in 51/600 (8.5%) mothers with primary infection and in 23/154 congenitally infected fetuses (14.9%). Symptomatic congenital infection resulted in 18/23 and 68/131 cases with or without abnormal sonographic findings, respectively. Positive predictive values of ultrasound versus symptomatic congenital infection was 35.3% relating to all fetuses/infants from mothers with primary infection and 78.3% relating to fetuses/infants with congenital infection. CONCLUSION: When fetal infection status is unknown, ultrasound abnormalities only predict symptomatic congenital infection in a third of cases.

OBJECTIVE: One major problem in counselling couples with a prenatal diagnosis of a correctable fetal anomaly is the ability to exclude associated malformations that may modify the prognosis. Our aim was to assess the precision of fetal sonography in identifying isolated malformations. METHODS: We retrospectively reviewed the prenatal and postnatal records of our center for cases with a prenatal diagnosis of an isolated fetal anomaly in the period 2002-2007. RESULTS: The antenatal diagnosis of an isolated malformation was made in 284 cases. In one of this cases the anomaly disappeared in utero. Of the remaining cases, the prenatal diagnosis was confirmed after birth in 251 (88.7%). In 8 fetuses (7 with a suspected coarctation of the aorta, 1 with ventricular septal defect) the prenatal diagnosis was not confirmed. In 24 fetuses (8.5%) additional malformations were detected at postnatal or post-mortem. In 16 of these cases the anomalies were mild or would not have changed the prognosis. In 8 cases (2.8%) severe anomalies were present (1 hypoplasia of the corpus callosum with ventriculomegaly, 1 tracheal agenesis, 3 cases with multiple anomalies, 1 Opitz Syndrome, 1 with CHARGE Syndrome, 1 COFS Syndrome). Two of these infants died. CONCLUSIONS: the prenatal diagnosis of an isolated fetal anomaly is highly reliable. However, the probability that additional malformations will go undetected albeit small remains tangible. In our experience, it was 2.8%.

Cerebellar malformation are increasingly diagnosed in utero. To assess the effectiveness of ultrasound and fetal magnetic resonance in the antenatal prediction of long term neurodevelopmental delay. STUDY DESIGN: We collected 105 cases of cerebellum malformation in the period 2000-2010 in Bologna and Bari University. Classification included cystic anomalies of posterior fossa and cerebellar hypoplasia. RESULTS: The greater group included Blake’s pouch cysts and mega cisterna magna cases (58/105). These cases seemed to have a good prognosis with a good outcome both in association with other anomalies and isolated. In cases of Dandy Walker malformation, vermis hypoplasia and cerebellum hypoplasia there were few survivors, so it was so difficult to outline some conclusion for child outcome. Despite great neuroimaging advances, in our study, ultrasound and MR reached a similar sensitivity (62-63%) for the diagnosis of posterior fossa anomalies, but the number of MR was lower compared with ultrasonography. CONCLUSION: Ultrasonography remains the screening method of choice for evaluation of cerebellum anatomy but probably MR imaging can improve some details expecially in the third trimester. Despite the data on Dandy Walker, vermis hypoplasia and cerebellum hypoplasia were conflicting and uncertain, for Blake and mega cisterna magna we can considered a rather good outcome.

Problematiche delle infezioni da Citomegalovirus in gravidanza Obiettivi: migliorare la sensibilità dell'ecografia nella diagnosi di infezione da CMV individuando un reperto ecografico cerebrale suggestivo di infezione fetale da Citomegalovirus a 20 settimane di gestazione. Metodi: tra febbraio 1989 e settembre 2009, 721 pazienti afferenti alla nostra Unità di Medicina Materno fetale per infezione primaria da CMV hanno eseguito amniocentesi e sono state sottoposte ad un esame neurosonografico transvaginale a 20-22 settimane di gestazione. Risultati: in 29 feti con infezione congenita sono state evidenziate anomalie ecografiche (17%), di cui in 22 casi a livello cerebrale. In 13 casi l'ecografia transvaginale ha permesso di identificare un alone ecogeno periventricolare a margini ben definiti ad un'epoca gestazionale media di 20.5 settimane (20-22 settimane). Di questi casi 12 pazienti hanno deciso di interrompere la gravidanza. L'unico neonato ha presentato alla nascita un'ipoacusia bilaterale. I riscontri autoptici ottenuti (7/12) hanno mostrato un'infezione citomegalica disseminata ed in 3 casi segni a livello cerebrale. Conclusioni: il limite ecografico della diagnosi di infezione fetale nei casi di infezione primaria da CMV è noto. In pazienti gravide alla 20 settimana di gestazione con infezione recente da Citomegalovirus, il riscontro di un alone ecogeno periventricolare risulta essere un precoce ed attendibile segno di infezione fetale e di possibile danno della sostanza bianca cerebrale. Occorrono però studi aggiuntivi per valutare la possibile manifestazione clinica di questa anomalia cerebrale nei neonati con infezione da CMV.

Obiettivo: descrivere le caratteristiche ecografiche e flussimetriche dei sarcoma uterini Materiali e Metodi: Dall'archivio anatomopatologico di due cliniche Universitarie sono state reclutate retrospettivamente tutte le pazienti con diagnosi anatomopatologica di sarcoma uterino. Tutte le cartelle cliniche, le immagini e i filmati digitalizzati sono stati analizzati e dati raccolti in un database. Risultati: Sono stati inclusi nello studio 49 casi, che comprendono 17 leiomiosarcoma, 14 sarcoma dello stroma endometriale e 18 carcinosarcoma. L'età media alla diagnosi è stata 62 anni (range 35-87). L'ottanta per cento delle pazienti erano in menopausa al momento della diagnosi. Circa la metà delle pazienti presentavano sanguinamento anomalo e il 20% dolore pelvico. La maggior parte delle lesioni sono apparse iso-ipoecogene, senza coni d’ombra (47/49;96%). Conclusioni: I sarcomi uterini sono un gruppo eterogeneo di tumori che presentano aspetti ecografici diversi anche in relazione all’istotipo. Conoscere le diverse caratteristiche può essere utile ai fini di una corretta diagnosi. Nel nostro studio l’assenza dei coni d’ombra risulta essere l’aspetto più significativo. / Objectives: To describe the gray-scale and Color-doppler sonographic features of uterine sarcomas. Methods: consecutive patients with a histological diagnosis of uterine sarcoma were retrospectively recruited from the databases of two gynecologic oncology Departments. The sonographic reports and the digital images were analysed. Results: Forty-nine cases were included in the study: 17 leiomyiosarcoma, 14 endometrial stromal sarcoma and 18 carcinosarcoma. Median age of the patient population was 62 years (range 35-87). Half of the cases presented abnormal uterine bleeding and 20% pelvic pain. 47/49 (96%) lesions appeared as iso-hypoechoic, without cones of shadow. Conclusions: Uterine sarcomas are a heterogeneous group of tumours showing a range of preoperative sonographic aspects depending on the histological subtype. Knowledge of the spectrum of sonographic findings might help in suspecting these malignant tumours at ultrasound. Opposite to the most common benign uterine mesenchimal tumors (leyomiomas), they never show cones of shadow.

Obiettivi: Valutare la prevalenza dei diversi genotipi di HPV in pazienti con diagnosi di CIN2/3 nella Regione Emilia-Romagna, la persistenza genotipo-specifica di HPV e l’espressione degli oncogeni virali E6/E7 nel follow-up post-trattamento come fattori di rischio di recidiva/persistenza o progressione di malattia; verificare l’applicabilità di nuovi test diagnostici biomolecolari nello screening del cervicocarcinoma. Metodi: Sono state incluse pazienti con citologia di screening anormale, sottoposte a trattamento escissionale (T0) per diagnosi di CIN2/3 su biopsia mirata. Al T0 e durante il follow-up a 6, 12, 18 e 24 mesi, oltre al Pap test e alla colposcopia, sono state effettuate la ricerca e la genotipizzazione dell'HPV DNA di 28 genotipi. In caso di positività al DNA dei 5 genotipi 16, 18, 31, 33 e/o 45, si è proceduto alla ricerca dell'HPV mRNA di E6/E7. Risultati preliminari: Il 95.8% delle 168 pazienti selezionate è risultato HPV DNA positivo al T0. Nel 60.9% dei casi le infezioni erano singole (prevalentemente da HPV 16 e 31), nel 39.1% erano multiple. L'HPV 16 è stato il genotipo maggiormente rilevato (57%). Il 94.3% (117/124) delle pazienti positive per i 5 genotipi di HPV DNA sono risultate mRNA positive. Abbiamo avuto un drop-out di 38/168 pazienti. A 18 mesi (95% delle pazienti) la persistenza dell'HPV DNA di qualsiasi genotipo era del 46%, quella dell'HPV DNA dei 5 genotipi era del 39%, con espressione di mRNA nel 21%. Abbiamo avuto recidiva di malattia (CIN2+) nel 10.8% (14/130) a 18 mesi. Il pap test era negativo in 4/14 casi, l'HPV DNA test era positivo in tutti i casi, l'mRNA test in 11/12 casi. Conclusioni: L'HR-HPV DNA test è più sensibile della citologia, l'mRNA test è più specifico nell'individuare una recidiva. I dati definitivi saranno disponibili al termine del follow-up programmato. / Objective. To evaluate the prevalence of several HPV genotypes in patients with CIN2/3 in Emilia-Romagna, the genotype-specific HPV DNA persistence and the expression of HPV oncogenes E6/E7 during follow-up after conisation, and their role in the prediction of residual disease; to verify the applicability of new molecular diagnostic tests in cervical cancer screening. Methods. Patients with abnormal screening citology treated by conisation (T0) for histologically confirmed CIN2/3 were included. At T0 and at 6, 12, 18 and 24 months of follow-up, in addition to the Pap smear and colposcopy, research and genotyping of HPV DNA of 28 types were performed. In case of positivity to the DNA of the 5 genotypes 16, 18, 31, 33 and/or 45, we proceeded to detect HPV E6/E7 mRNA. Preliminary results. The 95.8% of 168 selected patients were HPV DNA positive at T0. In 60.9% of cases the infections were single (mostly HPV 16 and 31), in 39.1% were multiple. HPV 16 was the most frequent genotype detected (57%). The 94.3% (117/124) of patients positive for 5 genotypes of HPV DNA were mRNA positive. Of the 168 patients 38 dropped out. At 18 months (95% of patients), the persistence of HPV DNA of any genotype was 46%, of HPV DNA of 5 genotypes was 39%, with mRNA expression in 21%. We found recurrent disease (CIN2 +) in 10.8% (14/130) at 18 months. Citology was negative in 4/14 cases, HPV DNA test was positive in all cases, mRNA testing in 11/12 cases. Conclusions: HR-HPV DNA test is more sensitive than cytology, mRNA testing is more specific in identifying a recurrence. Final data will be available after the follow-up planned.

Obiettivo: Valutare l’accuratezza reciproca dell’ecografia “esperta” e della risonanza magnetica nelle diagnosi prenatale delle anomalie congenite. Materiali e metodi: Sono stati retrospettivamente valutati tutti i casi di malformazioni fetali sottoposte a ecografia “esperta” e risonanza magnetica nel nostro Policlinico da Ottobre 2001 a Ottobre 2012. L’età gestazionale media all’ecografia e alla risonanza magnetica sono state rispettivamente di 28 e 30 settimane. La diagnosi ecografica è stata confrontata con la risonanza e quindi con la diagnosi postnatale. Risultati: sono stati selezionati 383 casi, con diagnosi ecografica o sospetta malformazione fetale “complessa” o anamnesi ostetrica positiva infezioni prenatali, valutati con ecografia “esperta”, risonanza magnetica e completi di follow up. La popolazione di studio include: 196 anomalie del sistema nervoso centrale (51,2%), 73 difetti toracici (19,1%), 20 anomalie dell’area viso-collo (5,2%), 29 malformazioni del tratto gastrointestinale (7,6%), 37 difetti genito-urinari (9,7%) e 28 casi con altra indicazione (7,3%). Una concordanza tra ecografia, risonanza e diagnosi postnatale è stata osservata in 289 casi (75,5%) ed è stata maggiore per le anomalie del sistema nervoso centrale 156/196 casi (79,6%) rispetto ai difetti congeniti degli altri distretti anatomici 133/187 (71,1%). La risonanza ha aggiunto importanti informazioni diagnostiche in 42 casi (11%): 21 anomalie del sistema nervoso centrale, 2 difetti dell’area viso collo, 7 malformazioni toraciche, 6 anomalie del tratto gastrointestinale, 5 dell’apparato genitourinario e 1 caso di sospetta emivertebra lombare. L’ecografia è stata più accurata della risonanza in 15 casi (3,9%). In 37 casi (9,7%) entrambe le tecniche hanno dato esito diverso rispetto agli accertamenti postnatali. Conclusioni: l’ecografia prenatale rimane a tutt’oggi la principale metodica di imaging fetale. In alcuni casi complessi e/o dubbi sia del sistema nervoso centrale sia degli altri distretti anatomici la risonanza può aggiungere informazioni rilevanti. / Objective: To evaluate the accuracy of fetal magnetic resonance (MRI) compared to 2D-3D ultrasound in the prenatal diagnosis of congenital anomalies. Materials and methods: We retrospectively evaluated all cases of fetal malformations underwent "expert" ultrasound and MRI in our Hospital from October 2001 to October 2012. The gestational age at ultrasound and magnetic resonance were respectively 28 and 30 weeks. The ultrasound diagnosis was compared with the MRI and then with the postnatal diagnosis. Results: 383 cases were selected, with a sonographic diagnosis or suspected fetal "complex" malformation or obstetric history of positive prenatal infections, evaluated with 2D-3D ultrasound, MRI and complete of follow-up. The study population included: 196 anomalies of the central nervous system (CNS) (51.2%), 73 thoracic defects (19.1%), 20 abnormalities of the face and the neck (5.2%), 29 malformations of the gastrointestinal tract (7.6%), 37 genitourinary defects (9.7%) and 28 cases with other indications (7.3%). An agreement between ultrasound, MRI and postnatal diagnosis was observed in 289 cases (75.5%) and was greater for the CNS anomalies, 156/196 cases (79.6%), compared with the others congenital defects, 133/187 cases (71.1%). The MRI has added important diagnostic information in 42 cases (11%): 21 CNS abnormalities, 2 facial and neck defects, 7 thoracic malformations, 6 gastrointestinal anomalies, 5 genitourinary defects and 1 case of suspected lumbar emivertebra. The ultrasound was more accurate than MRI in 15 cases (3.9%). In 37 cases (9.7%) both techniques were not correlated with postnatal findings. Conclusions: Prenatal ultrasound is still the primary fetal imaging modality. In some complex CNS and extra-CNS anomalies, particularly in late pregnancy, MRI can add relevant information.