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We deal with diagnosis and treatment of sexual hormone disruption. We also offer advice on contraceptive and reproductive methods to patients with high risk conditions, such as congenital heart disease or early menopause.
The Gynaecological Endocrinology Unit works with other units and specialists, such as: Cardiology (Congenital Heart Disease Unit), Paediatric Endocrinology, Assisted Reproduction and the Gynaecology and Obstetrics Ultrasound Unit. It also has sub-specialist and multi-disciplinary appointments, such as paediatric and adolescent gynaecology.
It deals with treatment of the following:
Our work here at the Diabetes and Pregnancy Unit is to monitor the pregnancies of women who are diabetic or who develop diabetes during their pregnancy. We offer coordinated care with endocrinologists and specialists in the management of the disease.
When someone suffers from diabetes, their body cannot properly process food and obtain energy from it, which leads to high levels of sugar (glucose) in the blood. High levels of glucose in the blood over long periods of time have been shown to cause damage to blood vessels, as a result of which the body’s organs can no longer function properly.
Having diabetes before pregnancy (pre-gestational diabetes) or developing diabetes during pregnancy (gestational diabetes) are two situations requiring specialist care.
The Diabetes and Pregnancy Unit consists of a multi-disciplinary team that includes endocrinologists, diabetes educators, obstetricians and midwives. We offer specialist educational information on diabetes and glucose-monitoring in mothers-to-be.
We attend to pregnant women with type 1 or type 2 diabetes and women who develop diabetes during pregnancy. We also work together to detect possible complications and improve the health of our female patients and their future babies.
Our Unit has taken part in several clinical studies and trials through the Spanish Diabetes and Pregnancy Group (GEDE) and launched a gestational diabetes screening programme.
The Unit is jointly coordinated by the endocrinology team (Dr Anna Casteras and Dr Olga Simó) and the obstetrics teams (Dr María Goya and Dr Mireia Vargas); in addition, we are also supported by specialist midwives and diabetes educators.
Training is also provided for other doctors, medical students at the Autonomous University of Barcelona and locums (fellowship).
At the Prenatal Diagnosis Unit (UPD) we detect the existence of congenital defects, disorders or malformations that the foetus may show as it develops, as early as possible. Depending on each case, and always on an individual basis, we advise families during the various stages of the pregnancy and help them to make decisions.
Up to 3% of newborns may have some kind of congenital anomaly or defect. These disorders may be structural or functional, familiar or sporadic, hereditary or not, and may occur in low risk as well as high risk pregnancies for various reasons:
In these cases, the pregnancy is monitored much more closely, so that the appearance of any anomaly is detected as soon as possible.
The following tools are used:
We tare active in all stages of the pregnancy:
We work very closely with the following units:
The Obstetrics Ultrasound Unit carries out all the necessary ultrasound scans on women and their future babies during pregnancy. Scans are most typically taken once per trimester during pregnancy, although there is no established number, as they are taken whenever they are considered necessary by the gynaecology professional.
The following ultrasound explorations are carried out during pregnancy:
First-trimester ultrasound: this is carried out between the first 11 and 13 weeks. This ultrasound, together with the previous blood analysis, is used for determining whether there is a risk of aneuploidy or early preeclampsia.
Aneuploidy is a complication that can cause birth defects in the foetus owing to an abnormal number of chromosomes in the blood. And early preeclampsia is a disease which, among other complications, can lead to premature births caused by high blood pressure.
Morphological ultrasound: this is carried out between the first 18 and 22 weeks. This ultrasound checks whether the foetus and all its organs are developing correctly and is used for ruling out malformations. In addition, here at the Vall d’Hebron we also carry out a vaginal exploration to measure the cervical length of the uterus and predict the risk of a premature birth; also a Doppler exploration, an ultrasound scan that enables us to see the blood flow of the mother’s uterine arteries and thereby assess the risk of preeclampsia.
Screening foetal echocardiography: this is carried out between the first 15 and 18 weeks. This ultrasound is only required for women at risk of foetal cardiopathy, a foetal-heart malformation.
Follow-up ultrasound: these ultrasounds are always carried out when required by the Department or an external referral. They may be used for assessing risks such as:
The Obstetrics Ultrasound Unit, as a cross-disciplinary service, is taking part in several studies with competitive public funding, led by our Department's specialists in our Prematurity Prevention, Placental Insufficiency, Foetal Medicine and Placenta Accreta Units. It recently joined the Cesarean Scar Pregnancy (CSP) Registry.
In addition to providing multidisciplinary care for patients of all ages who suffer this condition, the objectives of Vall d’Hebron Hospital’s Hereditary Angioedema Unit include teaching and research in this field.
The Hereditary Angioedema Unit (UAEH) of Vall d’Hebron University Hospital’s Allergology Department has been treating patients with this disorder for more than 25 years.
UAEH outpatients are treated by allergology specialists in a multidisciplinary manner in the Outpatient Clinic in the Old Nursing School and in the Children’s and Women’s Hospital, ensuring transference and continuity of care from childhood through to adulthood for this genetic, lifelong condition.
The Unit is made up of popular, immunologists, geneticists, gynaecologists, maxillofacial surgeons, pharmacists and nurses, who are responsible for:
Depending on the type of care to be given to patients with diagnosed hereditary angioedema and their profile, they should be treated by the following divisions and/or units:
The specialists who work in the adult and paediatric allergology sections are responsible for treating patients aged 16 and under in the Children’s Hospital areas and subsequently facilitating their transfer and continuity of care with monitoring to the adult care departments in the Old Nursing School and the Allergology Day Hospital in the General Hospital.
The Hereditary Angioedema Unit (UAEH) offers an outpatient service to monitor patients with this disease: the Outpatient Clinic on the second floor of the Old Nursing School. Also, as it is a multidisciplinary unit, and depending on the type of patient (child, adult, pregnant woman), it provides care in a number of departments and units in the Children’s and Women’s Hospital, the General Hospital and A&E.
The nursing team specialises in education and specific care for patients with this disease.
Emergency care is provided at the Children’s Hospital for patients up to the age of 16 and at the General Hospital from the age of 17. The professionals who work in the A&Es have been trained to recognise the symptoms of this disease and to quickly provide its specific treatment.
When a patient needs a complex dental or maxillofacial procedure they will be assessed by the hospital’s maxillofacial surgeons and their operation will be organised with the suitable prophylaxis.
The Obstetrics, Foetal Medicine and Anaesthesia Departments have created a Working Unit for High-Risk Pregnancies for women with hereditary angioedema with the aim of monitoring the well-being of mother and child during pregnancy and of providing care during the delivery and postpartum period in accordance with a protocol specific to their type of hereditary angioedema and clinical situation. Care is also provided for high-risk postpartum cases.
In parallel to these services, there is also a reproductive counselling clinic for women with hereditary angioedema. The clinic is part of the Hereditary Angioedema Unit, and is that provided in conjunction with Gynaecology in the Outpatient Clinics of the Children’s and Women’s Hospital.
In this clinic an allergist and a gynaecologist combine their expertise to determine, in accordance with the patient’s clinical situation and type of hereditary angioedema, the possible effects of their having children. Their mission is to provide information and advice in relation to family planning and the reproductive possibilities of the patients living with this disease.
Paediatric oncological surgery is the branch of paediatric surgery that is dedicated to the surgical treatment of paediatric oncological and haematological diseases and their complications. It is one of the basic pillars for the treatment of solid paediatric tumours.
These are illnesses that, due to their severity, complexity, and rareness, must be centralised in hospitals that are equipped with experienced multidisciplinary teams and the technology and medical experience necessary. The evolution of this unit has often gone hand-in-hand with the surgical advances achieved in solid organ transplants, which has allowed it to develop advanced techniques that now make enormously difficult cases operable. In addition, it frequently requires collaboration from other highly complex paediatric specialities (heart surgery, neurosurgery, spinal surgery, plastic surgery, etc.).
Vall d’Hebron is the hospital that offers the most oncology services in Catalonia, and it is a member of the European Reference Networks (ERNs) for Paediatric Oncology “PaedCan” and Rare Haematological Diseases “EuroBloodNet”. It is also accredited by JACIE for paediatric haematopoietic stem cell transplants.
Paediatric tumours are complex and rare. Treating them in reference centres such as Vall d’Hebron offers the maximum chances of success. The Oncology Surgery Unit is a highly specialised reference unit that works in collaboration with the Paediatric Oncohaematology Department and other related departments, to offer the patient the best possible quality of care. We boast medical, surgical, and central departments that are highly specialised in oncological care and that ensure a comprehensive vision of the process. They incorporate all of the preventative, diagnostic, therapeutic, and monitoring aspects that these patients require, including personalised therapies and the use of genomic platforms. The hospital has some of the latest technological advances at its disposal, which allows us to offer everything from minimally invasive and robotic surgery to combined treatments using interventional radiology and complex multidisciplinary interventions. The position of Vall d’Hebron Hospital as a national reference centre for paediatric solid organ transplants allows for comprehensive care in cases where transplants are the only treatment or part of the treatment (especially in liver and kidney tumours) to cure the illness.
The Unit also provides the surgical treatments necessary for benign and malignant paediatric haematological diseases and haematopoietic stem cell transplants, such as fertility preservation techniques and the removal of the spleen in some types of anaemia.
We also participate in VHIR’s Translational Research in Cancer in Children and Teenagers Group as a fundamental part of the team, which works closely with clinical care, mostly through the Programme for Personalised Medicine in Paediatric Cancer. We also collaborate with other national and international research centres, along with several international collaborative groups for solid paediatric tumours. This allows us to remain at the forefront of surgical treatment for paediatric oncohaematology patients.
Either as a unit or individually, we participate in and/or are accredited by, via external audits, the following national and international networks, which guarantee that patients can access our unit from any point within the Spanish or European healthcare system:
ERN (European Reference Networks)
Reference Centres, Services and Units (RCSU)
The Unit treats all kinds of benign and malignant tumours, both visceral and of the soft tissue (thoracic and abdominal), with the exception of tumours of the central nervous system, the locomotor apparatus, and the heart, which are operated on by other surgical departments at our centre. We cover the age range from the prenatal period to adolescence, and even treat young adults (for some types of tumours).
We treat, among others, the following solid tumours:
Among the soft-tissue sarcomas, the following are included: retroperitoneal tumours, sarcomas of the biliary tract, gynaecological sarcomas, etc. We are a reference centre in Spain for the treatment of all kinds of paediatric sarcomas, and we are part of the EpSSG Surgical Subcommittee.
In bone sarcomas, we treat tumours of the thoracic wall, even when the vertebrae and medullary canal are affected (in collaboration with the Spine Unit) and/or the case requires complex thoracic reconstruction.
Regarding haematological diseases, we would especially like to mention:
Lastly, the Oncology Surgery Unit coordinates and takes part in Vall d’Hebron Hospital Paediatric Vascular Anomalies Committee, which meets once a month. This committee is comprised of dermatologists, plastic surgeons, paediatric surgeons, radiologists, pathologists, interventional radiologists, oncologists, and paediatricians. Its objective is to diagnose and treat the most complex cases of anomalies and both cutaneous and visceral vascular tumours.
Paediatric surgery is the only medical speciality exclusively dedicated to diagnosis, treatment, and post-operative care for problems which occur during the life stage between the foetal period and adolescence and which need to be treated surgically. The surgical pathologies, physiology, doctor-patient relationship, and needs of the paediatric patient are very different from those of an adult. Due to the complexity of the pathologies treated and the special needs of the paediatric patient, this type of surgery is usually restricted to tertiary centres.
Thanks to the wide range of pathologies we treat, the paediatric surgeons here receive training on how to carry out procedures in almost all surgical areas. Working closely with obstetricians, the paediatric surgeons participate in detecting and treating pathologies that are diagnosed in utero, providing prenatal medical advice to families, and even carrying out surgeries on foetuses or during labour.
The specialists in paediatric surgery receive specific training on how to correct congenital abdominal, thoracic, and urological defects, some of which can potentially be fatal. We also provide care for patients who are multiple trauma victims and those who need surgical treatment for solid tumours. We are also the specialists who treat the urological and gynaecological problems that occur in this age range.
VHUH’s Paediatric Surgery Department is the reference centre in Catalonia for the surgical treatment of most problems in paediatric patients, and in some procedures, it is the reference centre for the entire country, covering all areas of paediatric surgery (from organ transplants to foetal surgery, and every sub-speciality in between).
In order to offer the best quality of care possible, the Department is organised into surgical sub-specialities: Neonatal Surgery, Oncological Surgery, Digestive Surgery, Thoracic Surgery, Hepatobiliopancreatic Surgery, and Urology. This innovative structure allows us to obtain a high level of specialisation and competence in each area of paediatric surgery. General surgery tasks (those corresponding to major outpatient surgery and emergency surgery) are shared among all members of the team.
Our Department was the first in the country to use foetal surgery techniques and it is part of a multidisciplinary foetal medicine programme. We are committed to performing highly complex surgery, such as oncological surgery and reconstructive urological surgery, also using minimally invasive surgery, even in newborns, and we are pioneers in foetal surgery. We also have a minimally invasive surgery simulation laboratory. Within these minimally invasive techniques, we have carried out robotic surgery since 2009; we were the first paediatric hospital in the country with a robotic surgery programme that was applied to every area of paediatric surgery.
We were also the first Paediatric Surgery Department in Spain to carry out a paediatric kidney transplant (1981) and paediatric liver transplant (1985), and we also did the first reduced-sized liver transplant (1987) and the first split liver transplant (1992). We continue to be directly involved with both transplant programmes, which have among the highest volumes of patients and the best results in the country.
In the year 2012, our Paediatric Surgery Department received the Certificate of Hospital Accreditation for Specialist Training in Paediatric Surgery, an acknowledgement from the European Board of Paediatric Surgeons that is backed by the UEMS, distinguishing it as a centre of excellence in training paediatric surgeons. We also actively participate in national and international programmes and have various RCSU (Department of Health Reference Centres, Services and Units) and ERN (European Reference Networks) accreditations.
For more than 20 years now, we have maintained several well-known lines of research in experimental paediatric surgery (and also more specifically, in foetal surgery) at the Vall d'Hebron Research Institute (VHIR). In 2015, we created the “Bioengineering, Cell Therapy and Surgery in Congenital Anomalies” group, which is currently carrying out research on the prenatal treatment of spina bifida and congenital diaphragmatic hernias. In addition, among other projects, we have carried out research projects on amniotic band syndrome, gastroschisis, oesophageal atresia, and cleft lip/palate.
As regards clinical research, our Department is constantly carrying out research activities and boasts numerous national and international publications. One noteworthy example is the first multi-centre randomised study on treating parapneumonic empyema. It compares video-assisted thoracoscopy to drainage and the use of fibrinolytics and was published in the journal Pediatrics in 2014. Another two examples are our intestinal lengthening techniques and the treatment of congenital portosystemic shunts (Abernathy malformation).
At the same time, we collaborate with other research teams, especially in the field of paediatric oncology, and we also participate in collaborative studies and international multi-centre studies.
The Unit is made up of a team of specialist paediatricians, paediatric nursing staff, paediatric resident doctors working in shifts during their training, nursing assistants, paediatric nursing residents, porters, administrative and cleaning staff who share work and experiences for the sole purpose of offering the best care to the boys and girls in the Unit. We are experts in emergency care for children with complex diseases (patients with solid-organ or bone-marrow transplants, immunosuppressed patients, etc.,) in synergy with the other units in our centre. We are also part of the Paediatrics Department, offering comprehensive care to children who are poorly.
Our Paediatric Emergency Unit attends to patients up to the age of 16, except for children with chronic diseases requiring very specific treatment who may be attended to by our Unit even when they are over this age limit.
Besides making visits to assess children's emergency medical or surgical pathology, and appointments for patients who require clinical monitoring after our consultation, we also have an Observation ward for admitting patients who require hospitalisation.
Thanks to the coordination between the Nursing, Paediatric Emergency, Traumatology, Anaesthesiology, Radiology and Paediatric ICU teams and many other professionals, we are a benchmark centre in AITP (Initial Care for Paediatric Trauma).
When it comes to teaching, the Unit trains resident doctors (MIR) in Paediatrics and Family Medicine, as well as resident nurses in Paediatric Nursing. The Unit also plays a key role in training undergraduate Medical and Nursing students, as well practical training placements for nursing assistants. We take part in numerous continuous-teaching and training activities within and without the Hospital (advanced paediatrics life-support courses and AITP, joint courses with Primary Care, internal Hospital courses, sessions with several Units and Services, care simulations on children with multiple trauma and children in a critical condition, etc.).
As for research, we are part of the Spanish Society of Paediatric Emergency Medicine (SEUP) and its research network (RiSEUP), and we take part in numerous multi-centre projects and clinical trials.
The Paediatric Hospitalisation and Hospital Paediatrics Unit was recently created. It represents a considerable evolution in the care of paediatric patients admitted into the Maternity and Children's Hospital, replacing the former General Paediatrics Unit, in order to adapt to current care requirements.
This Unit plays a very important role in the overall, comprehensive care of paediatric patients. The paediatricians of this unit are responsible for the care of a large majority of acute paediatric illnesses, maintaining a close relationship with the other medical and surgical subspecialities, and aim to become leaders in treating patients who are difficult to diagnose or who have a complex pathology, as part of their care and teaching activities concerning paediatric hospitalism.
The Unit undertakes training activities that are crucial for paediatric residents and their specific areas in their first year of residency (such as obligatory rotation) and it is then especially interesting for those doctors who are about to finish their residency, as it allows them and their tutors to know how much theoretical, practical and communicative knowledge they have acquired, so that this can be complemented where necessary.
The members of this unit carry out a wide variety of external consultations: clinical follow-up of admitted patients who need care in Hospital Paediatrics before being transferred to Primary Paediatric Care, visits to difficult-to-diagnose or imprecisely diagnosed outpatients, patients with "brief, unexplained resolved episodes", Social Paediatrics, vascular anomalies, endocrinological alterations.
Unit paediatricians are lecturers at the UAB's Faculty of Medicine, responsible for teaching theoretical and practical paediatrics to future doctors.
In terms of scientific research, the Paediatric Hospitalisation Unit is becoming more and more active in carrying out research work based on care and clinical-testing activities.
Portfolio of Services
Education and Training
Training programme for paediatric residents by means of their 4-month obligatory rotation during their first year, and optional rotations in their fourth year of residency. Resident doctors undertake a theoretical and practical programme in order to obtain basic knowledge of Hospital Paediatrics.
There are weekly clinical sessions run by the Unit and periodic joint sessions with other paediatric units in the hospital.
Research
Research studies into paediatric illnesses in hospitals (infectious, respiratory, coagulation, etc.) and a variety of clinical tests.
The Institute for Diagnostic Imaging uses the most advanced techniques, and contributes to generalising the application of this type of diagnostics to improve care and the quality of image-based explorations and diagnoses.
The Institute for Diagnostic Imaging (IDI) is a state-owned company that is affiliated with Catsalut, and has one of its centres at the Vall d'Hebron Hospital. IDI manages, administers and executes image diagnostic services and nuclear medicine services.
At our hospital, we conduct explorations using: magnetic resonance imaging, computed tomography, nuclear medicine, PET-CT, angiography, ultrasound, mammography, densitometry, conventional radiology, and orthopantomography, among others. This centre is also charged with helping with technological innovation projects, developing research and promoting teaching, thus contributing to scientific and social progress.
IDI and Vall d'Hebron are committed to innovation. In this context, we have PET-CT equipment that allows us to analyse molecular aspects of diseases such as cancer and neurological or cardiovascular disorders. This equipment, which can carry out between 4,000 and 5,000 tests a year, also offers the possibility of introducing new radiopharmaceuticals that improve the management of diseases with a specific molecular profile.
General Hospital
Traumatology Unit
Maternity and Children's Hospital
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