Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study.

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients' information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

[Pelvic inflammatory disease due to Herlyn-Werner-Wunderlich syndrome]. / Enfermedad inflamatoria pélvica causada por el síndrome de Herlyn-Werner-Wunderlich.

BACKGROUND: Herlyn-Werner-Wunderlich syndrome is a congenital urogenital malformation that is associated with a uterus didelphys and a longitudinal vaginal septum, resulting in a blind hemivagina and ipsilateral renal agenesis. Clinical presentation is highly variable, delaying diagnosis and leading to important complications. CLINICAL CASE: We present the case of a 13-year-old female who was diagnosed with Herlyn-Werner-Wunderlich syndrome following an acute abdomen due to a right tubo-ovarian abscess. She had a vaginal septum giving rise to a right blind hemivagina. It was microperforated, causing intermittent genital bleeding. This hematocolpos was colonized by microorganisms that ascended to the pelvic cavity, causing right tuboovarian abscess. Nuclear magnetic resonance imaging provided theWernermost diagnostic information. We performed a vaginal septum resection, and both hemiuteros communicated with a single vagina, resulting in an asymptomatic patient. CONCLUSION: Herlyn-Werner-Wunderlich syndrome is a little known entity and can be presented atypically, resulting in diagnostic difficulty and treatment delay. It is important to be aware of this syndrome in order to avoid irreversible complications.

ANTECEDENTES: el síndrome de Herlyn-Werner-Wunderlich es una malformación urogenital congénita que asocia un útero didelfo con un tabique vaginal longitudinal que forma una hemivagina ciega y agenesia renal ipsilateral a ésta. La presentación clínica es muy variable, lo que retrasa el diagnóstico y provoca algunas complicaciones que pueden ser graves. Caso clínico: paciente femenina de 13 años de edad, con diagnóstico de síndrome de Herlyn-Werner-Wunderlich a raíz de un cuadro de abdomen agudo por un absceso tuboovárico derecho. El tabique vaginal formaba una hemivagina ciega derecha microperforada que provocaba sangrados genitales intermitentes. Este hematocolpos se colonizó con microorganismos y el ascenso de estos a la cavidad pélvica causó el absceso tuboovárico derecho. La resonancia magnética nuclear aportó mayor información para el diagnóstico. La resección del tabique vaginal comunicó los dos hemiúteros con una sola vagina y los síntomas desaparecieron. CONCLUSIÓN: el síndrome de Herlyn-Werner-Wunderlich es poco conocido y puede manifestarse de forma atípica, lo que dificulta el diagnóstico y retrasa el tratamiento. Para evitar complicaciones irreversibles es importante mantener una alta sospecha clínica.