[Why pregnant women sleep poorly compared to non-pregnant women? Cross-sectional study]. / ¿Por qué duermen mal las mujeres embarazadas comparadas con las no gestantes? Estudio de corte transversal.

AIMS: To evaluate causes/reasons that fragment sleep related to physiological changes in the different trimesters of pregnancy and compare them with those of non-pregnant women. To identify some sleep disorders in pregnant women (PW) and to compare them with those in non-pregnant women (NPW). METHOD: A cross sectional study was performed. A specific questionnaire was designed for the data collection of the study, Oviedo Sleep Questionnaire, Epworth Sleepiness Scale and others were also used. All the full term expectant mothers who attended the Obstetrics Department were invited to participate; non-pregnant students from College and teaching staff were used as control group. The results were expressed in measures of frequency, percent, mean and standard deviations (SD). Differences were considered significant if p <0.05 for all tests. RESULTS: PW: 1st Trimester (T): n = 106, 2nd. T: n = 104, 3rd T: n = 110. CONTROL GROUP: n = 304 NPW. When comparing both groups we find: ME / MNE: Snoring: p = 0.001. Apnea: p = 0.89. In NPW, the following predominated: Restless legs syndrome: p = 0.01. Bruxism: p = 0.00. CONCLUSIONS: The PW reported more fragmented sleep due to almost all physiological causes, related to pregnancy, who were questioned, but the only sleep disorders found, by survey, were mainly respiratory disorders, nightmares and leg movements. In NPW, however, we found more sleep disorders such as insomnia, hypersomnia and restless legs syndrome, bruxism.

[COMPARISON OF DREAMS IN PREGNANT WOMEN AND NON-PREGNANT WOMEN]. / Comparación de las características de los sueños en mujeres embarazadas y en mujeres no gestantes.

Sleep disturbances are prevalent among, pregnant women, among them sleep is more fragmented during the third trimester, and could be associated with increased ability to remember dream's content. The aim of this study were to compare recall, and the contents of dreams during the three trimesters of pregnancy according to Gruen's Scale (Scale Subjective assessment scale of sleep and dreams), and to compare this with a non-pregnant women. An observational cross-sectional study was conducted during 50 months. After oral informed consent, a demographic survey and the Scale of dreams were offered and self-administered by parti-cipants. Assesses frequency of recall and other dreams characteristics. A total of 621 questionnaires were available for analysis, 320 pregnant and 301 non pregnant women. Pregnant women showed statistically significant decreased of recall, stirring, pleasant, erotic, strange, and vivid dreams compared with non pregnant women. Conclusions: non pregnant women have mayor recall of dreams and other characteristic in comparison with pregnant women. We did not find differences between the various trimesters.

[Sleep quality, depressive symptoms and other menopause things]. / Calidad de sueño, síntomas depresivos y las otras cosas de la menopausia.

Sleep disorders (insomnia, hypersomnia, parasomnias and breathing disturbances), hormonal changes and vasomotor symptoms are highly prevalent in peri and postmenopausal women. The aim of our study was to assess sleep quality, some sleep disturbances, depression and suffocation during postmenopausal. Data come from a cross-sectional study of 195 women, which was conducted at a University Hospital. Data related to sleep were assessed with the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Oviedo Sleep Questionnaire (OSQ) and Beck´s Inventory of Depression (BDIII). The hospital Ethical Committee granted their approval of this study. The mean PSQI score was 6.90½ 4.43. Up to 46.7% of participants had a PSQI > 5 (poor sleep quality). Snoring was reported by 13% of the patients (PSQI # 10 A). COS score was 17.57± 7. According to COS #1 all the subjects (100%) reported some degree of sleep dissatisfaction. Media of BDIII´s inventory of depression was 9.8 (½7.14), 41% of women reported depression. Correlation BDIII and PSQI was 0.00. We found that the level of dissatisfaction was elevated. One out of two women referred poor quality of sleep, requiring medical assistance. Poor sleep quality was associated with depression.

Women's preferences and mode of delivery in public and private hospitals: a prospective cohort study.

BACKGROUND: Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women's preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. METHODS: A prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women's preferences: a survey using a tailored questionnaire, and a discrete choice experiment. RESULTS: Only 8 and 6% of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40% ended their pregnancies by caesarean section in public and private hospitals, respectively. CONCLUSIONS: The preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35% caesarean sections are unlikely related to their preferences for mode of delivery.

Prenatal diagnosis of CHDs: a simple ultrasound prediction model to estimate the probability of the need for neonatal cardiac invasive therapy.

OBJECTIVES: To develop a prediction model based on echocardiographic findings to estimate the probability of the need for neonatal cardiac invasive therapy, including cardiac surgery or catheter-based therapy, in foetuses with CHD. METHODS: Retrospective cohort study: a prediction model was developed based on echocardiographic findings on the examination of the four-chamber, the three-vessel, and the three-vessel and tracheal views. We assessed performance using the area under the curve of the receiver operating characteristic. RESULTS: Among 291 patients with prenatal diagnosis of CHD and complete follow-up, 175 (60.1%) required neonatal cardiac invasive therapy. The variables "functionally single ventricle", "great artery reverse flow", and "congenital heart block" had a discrimination value of 100% and were excluded from the model. In univariate and multivariate analysis, "non-visualisation of a great vessel", "asymmetry of the great vessels", "visualisation of one atrioventricular valve", and "ventricular asymmetry" were significantly associated with the need for neonatal cardiac invasive therapy. The area under the receiver operating characteristic curve was 0.9324 (95% CI 0.92-0.97). CONCLUSIONS: A prediction model based on echocardiographic findings in foetuses with CHD, even without a definite diagnosis, allows an accurate estimation of the probability of requiring neonatal cardiac invasive therapy. This can modify patient care, especially in regions where a Foetal Medicine Specialist or a Paediatric Cardiologist is not available and referral may be extremely difficult due to social and economic barriers.

Feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta.

PURPOSE: To evaluate the feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta (PA). MATERIALS AND METHODS: Retrospective chart review was performed of 95 consecutive patients with prenatal suspicion of PA managed in a 10-year period with a strategy that included prophylactic bilateral uterine artery catheterization, delivery of the baby, uterine artery embolization if indicated, and subsequent surgery. Feasibility was defined as catheterization being possible to perform, technical success as embolization being possible when indicated and complete stasis of the vessels achieved, and clinical success as no maternal death or major blood loss. Median gestational age at delivery was 36 weeks (interquartile range, 24-39 wk). RESULTS: PA was confirmed in 79 patients (83%). Feasibility was 97% (92 of 95); in three cases (3%), acute early massive hemorrhage forced emergency delivery without catheterization. Embolization was performed in 83 of 92 patients (87%) to the extent of complete stasis; in the remaining nine, it was unnecessary because spontaneous placental detachment was visualized after fetal delivery (technical success rate, 100%). There were several complications, including bleeding requiring blood transfusion (49%) and bladder surgery (37%), but there were no major complications attributable to the endovascular procedures. There was one minor complication presumably related to embolization (transient paresthesia and decreased temperature of lower limb), with uneventful follow-up. Clinical success rate was 86%, with no maternal deaths, but 14% of patients received large-volume blood transfusion. CONCLUSIONS: Prophylactic uterine artery catheterization and embolization in the management of PA appeared to be feasible and safe in this consecutive series of patients.

[Advanced maternal age as a risk factor for adverse maternal and perinatal outcomes] / Edad materna avanzada como factor de riesgo de resultados adversos maternos y perinatales.

Introduction: A progressive increase in the age of women at first pregnancy is observed, a situation that has been associated with a greater risk of adverse maternal and perinatal effects. Objective: The aim of this study was to describe the characteristics and the maternal and perinatal outcomes of nulliparas of 40 years and older and compare them with those of nulliparas under 40. Study design: This was a retrospective cohort analysis of a database of pregnancy population who had attended their deliveries in a private university hospital. Results: An association was observed between maternal age ≥ 40 with the maternal compound adverse outcome (OR 1,3; 95% CI: 1,1-1,6), gestational diabetes (OR 3,6; 95% CI: 1,80-3,7), hypertensive disorders/preeclampsia (OR 2,2; 95% CI: 1,6-3,1) and postpartum hemorrhage (4,7; 95% CI: 1,2-16,3), with advanced maternal age persisting as an independent risk factor for the maternal compound adverse outcome (OR 1,3; 95% CI: 1,1 -1,6) and the perinatal compound adverse outcome (OR 1,40; 95% CI: 1,2-1,7) in the multivariate analysis. A higher rate of preterm birth was observed in the group of older nulliparas (OR 1,6; 95% CI: 1,3-2,0) with a higher requirement for admission to NICU for their newborns (OR 1,3; 95% CI: 1,0-1,8). Conclusions: Women with advanced maternal age constitute a high-risk population, whose attention and follow-up would require a differential approach aiming to improve maternal and perinatal outcomes.

Introducción: Se observa un progresivo aumento en la edad de las mujeres al primer embarazo, situación que se ha asociado con mayor riesgo de efectos maternos y perinatales adversos. Objetivo: Describir las características y los resultados maternos y perinatales de nulíparas de 40 años y mayores y compararlos con los de nulíparas menores de 40. Material y métodos: Cohorte retrospectiva de embarazos que atendieron su parto en un hospital privado universitario mediante revisión de registros. Diseño: Se observó asociación entre la edad materna ≥ 40 con el resultado adverso compuesto materno (OR 1.3; IC 95%: 1,1-1,6), DBT g (OR 3,6; IC 95%: 1,8-3,7), enfermedad hipertensiva/PE (OR 2,2; IC 95%: 1,6-3,1) y hemorragia postparto (4,7; IC 95%: 1,2-16.3), persistiendo la edad avanzada como factor de riesgo independiente para el resultado adverso compuesto materno (OR 1,3; IC 95%: 1,1-1,6) y perinatal (OR 1,4; IC 95%: 1,2-1,7) en el análisis multivariado. Se observó mayor tasa de parto pretérmino en el grupo de nulíparas añosas (OR 1,6; IC 95%: 1,3-2,0) con mayor requerimiento de ingreso a UCIN para sus recién nacidos (OR 1,3; IC 95%: 1,0-1,8). Conclusiones: Las mujeres con edad materna avanzada constituyen una población de alto riesgo, cuya atención y seguimiento requeriría un enfoque diferencial que tenga como objetivo mejorar los resultados maternos y perinatales.

Reviving forgotten techniques: Vaginal salpingectomy in public health system, a retrospective cohort study.

OBJECTIVE: To evaluate the viability of the vaginal route as an alternative to laparoscopy for patients seeking permanent surgical contraception. METHODS: We conducted a retrospective cohort study in 2021, dividing patients into two groups based on their preference: vaginal and laparoscopic salpingectomy. The statistical analysis was conducted using STATA, employing standard statistical methods based on the distribution of variables. RESULTS: The study included 64 patients, with 34 undergoing the vaginal approach and 30 the laparoscopic route. No statistically significant differences were observed in baseline characteristics or complications between the two groups. Both surgical methods were found to be feasible. The vaginal route demonstrated a significantly shorter mean surgical time (P < 0.001). The laparoscopic route exhibited significantly less intraoperative blood loss (P < 0.001) and fewer hospitalization hours (P = 0.008). Postoperative satisfaction and pain levels did not show statistically significant differences. CONCLUSION: Vaginal salpingectomy is a feasible technique with low complication rates, making it a potential option for gynecologists to offer their patients. We propose vaginal route inclusion in the training curriculum for gynecologic surgeons during the residency program, without any subspecialty requirements.

Foetal aortic valvuloplasty: experience of five cases.

OBJECTIVES: Foetal aortic valvuloplasty has been proposed as a strategy to improve left heart growth and function in foetuses with severe aortic stenosis at risk of progression to hypoplastic left heart syndrome. We report our experience with this intervention. METHODS AND RESULTS: Between 2005 and 2010, five foetuses with aortic stenosis and at risk of progression to hypoplastic left heart syndrome underwent ultrasound-guided percutaneous foetal aortic valvuloplasty. There were no associated maternal complications or foetal demise. In one case, the pregnancy was terminated a couple of weeks after the intervention, one foetus evolved to hypoplastic left heart syndrome, and three did not. CONCLUSIONS: Foetal aortic valvuloplasty seems to be a safe and feasible procedure. It has been reported that it has the potential to prevent progression to hypoplastic left heart syndrome in selected foetuses with severe aortic stenosis. Further investigation regarding physiological and clinical aspects of this disease both prenatally and postnatally will probably allow to improve therapeutic strategies and clinical outcome.

Cervical-length as a screening for spontaneous preterm birth in uncomplicated twins: one vs. serial measurements.

OBJECTIVE: While cervical length (CL) provides an effective screening tool for spontaneous preterm birth in singletons, the performance in twins is still controversial. Our aim was twofold. First, to compare the performance of a single CL measurement at mid-gestation (∼20 weeks) versus serial measurements as a predictor of spontaneous preterm birth < 34 weeks in uncomplicated twin pregnancies. Second, to describe the performance of a single CL at ∼24, ∼28 and ∼32 weeks. MATERIAL AND METHODS: cohort study of twins followed at Hospital Italiano de Buenos Aires from 2013 to 2017. Inclusion criteria were dichorionic or monochorionic diamniotic twins with CL measurement between 18 and 33 + 6 weeks with available data of the delivery. Exclusion criteria included any of the following complications: iatrogenic preterm delivery <34 weeks, cerclage, fetal growth restriction, fetal death, structural anomalies, polyhydramnios, twin-twin transfusion syndrome, selective fetal growth restriction, twin anemia-polycythemia sequence, and twin reversed arterial perfusion sequence. Spontaneous preterm birth was defined as spontaneous delivery < 34 weeks. Two different cutoffs were used to classify CL as short (positive screening) or normal (negative screening): (a) a fixed cutoff of 25 mm at any gestational age (GA). The screening was considered positive if any CL measurement was <25 mm; and (b) a GA adjusted cutoff to a 10% false positive rate (FPR). The 10% FPR for each GA was calculated and the screening was considered positive if any of the CL measurements were below this 10% FPR cutoff. We report sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio and area under the ROC curve. RESULTS: Among 777 twins followed in our Unit, 381 met exclusion criteria and 18 were excluded due to incomplete follow-up. We included 378 patients, 284 (75%) dichorionic and 94 (25%) monochorionic. The performance of one CL at 20 weeks showed a sensitivity ≤ 20% with an area under the ROC curve of 0.58 (95% CI, 0.45-0.70), while the performance of serial measurements showed a sensitivity of 58.8% (95% CI, 40.7-75.4) with an area under the ROC curve of 0.70 (95% CI, 0.61-0.79) (p < .001). The analyses of the performance of a single CL at ∼24, ∼28 and ∼32 weeks showed similar AUC than the serial measurements and, for a FPR = 10%, the performance of one measurement at 24 and 32 weeks showed a sensitivity of 30% (95% CI, 14.7-49.4) and 31.6% (95% CI, (12.6-56.6), while the measurement at 28 weeks showed a sensitivity of 48.3% (95% CI, (29.4-67.5). CONCLUSION: Serial measurements showed a better performance than a single one in mid-gestation. Moreover, among single measurements the CL in mid-gestation showed the poorest performance, while the 28 weeks assessment detected half of the preterm deliveries. However, all the strategies showed modest performances.

Performance of the cervical shortening for prediction of spontaneous preterm birth in uncomplicated twins.

OBJECTIVE: There is a lack of consensus about the management of twins with significant cervical length (CL) shortening, especially if CL is above 25 mm. Therefore, it is important to define "abnormal" CL change over time, and to compare the performance of different strategies. The aim of this study was twofold, to describe the performance of the cervical shortening and that of an integrated strategy that includes both the cervical shortening and a fixed CL cutoff <25 mm in any measurement as predictor of spontaneous PTB (sPTB) < 34 weeks in uncomplicated twin pregnancies. MATERIAL AND METHODS: Retrospective cohort study of twins followed in our Twins Clinic at Hospital Italiano de Buenos Aires from 2013 to 2017. Inclusion criteria were dichorionic or monochorionic diamniotic twins with CL measurement between 18 and 33 + 6 weeks with available data of the delivery. Exclusion criteria included any of the following complications: iatrogenic preterm delivery <34 weeks, cerclage, fetal growth restriction, fetal death, structural anomalies, polyhydramnios, twin-twin transfusion syndrome, selective fetal growth restriction, twin anemia-polycythemia sequence, and twin reversed arterial perfusion sequence. Spontaneous preterm birth was defined as spontaneous delivery <34 weeks. Cervical shortening was analyzed in the following periods: 20-24 weeks, 20-28 weeks, 24-28 weeks, 24-32 weeks and 28-32 weeks. Cervical changes were analyzed as velocity of shortening over time (mm/week) and as the ratio of shortening over time (%/week). ROC curves for each period were constructed and two different cutoffs were used to classify changes of the CL as positive or negative screening: a) the shortening of CL associated to the highest value of the Youden Index and b) fixing a 10% false positive rate (FPR). For the second objective, we analyzed an integrated strategy considering a fixed cutoff of 25 mm at any GA and/or a significant shortening. The screening was considered positive if any CL measurement was <25 mm at any GA or there was a shortening of the CL ≥ the cutoff obtained for each period. We report sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio and area under the ROC curve. RESULTS: We included 378 patients and 1417 measurements, 284 (75%) dichorionic and 94 (25%) monochorionic. Between 20 and 28 weeks, with a change in CL cutoff = 1.6 mm/week or 4.1%/week the detection rate was 54.2% (32.8-74.4%) and the specificity 80.5% (75.1-85.1%) and 83.5% (78.5-87.8%) respectively. In the integrated strategy, the detection rate was 65.7% (47.8-80.9%) and the specificity 69 (63.7-74). All the ROC curves of the periods studied showed an AUC < 0.7. In the group of patients that delivered preterm the initial mean CL was shorter than in the term group, 39 (±12) mm vs. 43 (± 7.7) mm (p = .02) and the most important change in CL was at 20-24 weeks both in the velocity and in the ratio of shortening over time. Conversely, patients that delivered at term showed a higher change in CL in the third trimester. CONCLUSION: The performance of all the strategies analyzed as a predictor of sPTB <34 weeks was moderate. The period 20-28 weeks detected half of the patients at risk with a FPR around 10-20% and the integrated strategy increased the sensitivity up to a detection of two thirds of the patients at risk but with a FPR of ∼30%. Future analyses need to explore other strategies to improve the performance and to really identify the patients at higher risk.

[Analysis of causes or reasons that fragment sleep and sleep disorder in pregnant and non-pregnant women] / Análisis de causas o motivos que fragmentan el sueño y los trastornos del sue-ño, en mujeres embarazadas y no embarazadas.

Introduction: During pregnancy, sleep undergoes important changes. The objective was to assess the causes or reasons that fragment sleep and sleep disorders in different women and trimesters of pregnancy, comparing them with those of non-pregnant women (NPW). Methods: Cross-sectional study. Anonymous surveys were used to evaluate reasons that fragment sleep and specific questionnaires to evaluate sleep disorders. Results: Pregnant Women (PW)= 320. 1st Trimester of pregnancy (T): n = 106, 2nd. T: n = 104, 3rd T: n = 110. MNE: n = 304. Most frequent reasons that fragmented sleep, statistically significant in PW and were: need to urinate, uncomfortable position, not being able to rotate in bed. As sleep disorders we find: nightmares 44 vs 4.9%; snoring with pauses: 31 vs 3%. Conclusion: We found that in the PW studied, most of the causes or reasons analyzed fragmented sleep; they had more sleep disorders such as nightmares, respiratory disorders and periodic leg movements, in that order, compared to the NPW who in turn, presented insomnia, excessive sleepiness and bruxism.

Introducción: Durante la gestación, el sueño sufre cambios importantes. El objetivo fue evaluar causas o motivos que fragmentan el sueño y los trastornos del sueño en diversas mujeres y trimestres de embarazo, comparándolos con los de las mujeres no embarazadas (MNE). Métodos: Estudio de corte transversal. Se utilizó encuestas anónimas, para evaluar motivos que fragmentan el sueño y cuestionarios específicos para evaluar trastornos del sueño. Resultados: Mujeres Embarazadas (ME)= 320. 1er Trimestre de embarazo (T): n = 106, 2do. T: n = 104, 3er T: n = 110. MNE: n = 304. Motivos más frecuentes que fragmentan el sueño, se presentó en ME y fueron: necesidad de orinar, posición incómoda, no poder rotar en la cama. Como trastornos del sueño encontramos: pesadillas 44 vs 4.9%; ronquidos con pausas: 31 vs 3%. Conclusión: En las mujeres embarazadas estudiadas, la mayoría de las causas o motivos analizados fragmentaron el sueño; tuvieron más desórdenes del sueño como pesadillas, trastornos respiratorios y movimientos periódicos de piernas, comparados con las no embarazadas; quienes a su vez, presentaron insomnio, somnolencia excesiva y bruxismo.

[Adaptation to Spanish and cross-cultural interpretation of the scale of lucidity and awareness in the subjects (Lucidity and Consciousness in Dreams scale)] / Adaptación al español e interpretación transcultural de la escala de lucidez y consciencia en los sueños (Lucidity and Consciousness in Dreams scale)

Introduction: It is called lucid dreaming, when the dreamer is aware that he is dreaming and can control the dream content. We lack Spanish-speaking tools that assess the presence of lucid dreams, so our objectives were to carry out the adaptation to Spanish and cross-cultural interpretation of the Lucidity and Consciousness in Dreams Scale (LuCID) and to evaluate the presence of lucid dreamers. Material and methods: Cross-sectional study, carried out by means of translation and retro-translation of the LuCID scale. The ethics committee approved it with number 3359. Results: 220 surveys, N = 216 were chosen. Age of subjects who completed: 18-76 (mean: 47) years. Women: n = 146 women. Countries: Argentina and Mexico were the ones that mostly participated. The mean and standard deviation of the analyzed subscales were: control: 2.82 / 1.1; introspection: 2.79 / 1.1; positive emotion: 2.66 / 1.3; dissociation: 2.62 / 1.3; memory: 2.51 / 1.1; thoughts: 2.44 / 1.3; realism: 2.34 / 1.2; negative emotion: 2.22 / 1.3. Of those surveyed, 56 individuals (24.5%) presented higher scores on the subscales for lucid dream diagnosis. Conclusion: The transcultural adaptation and interpretation of the lucidity and consciousness in dreams scale (LuCID) was carried out, which allowed us to detect almost a third of lucid dreamers. This scale should be validated in a select population of lucid dreamers for use.

Introducción: Se denomina sueños lúcidos, cuando el soñador es consciente de que esta soñando y puede controlar el contenido onírico. Carecemos de herramientas en habla hispana, que valoren la presencia de sueños lúcidos, por lo que nuestros objetivos fueron realizar la adaptación al español e interpretación transcultural de la escala Lucidity and Consciousness in Dreams Scale (LuCID) y evaluar la presencia de soñadores lúcidos en una población afines a las neurociencias. Material y métodos: Estudio de corte transversal, realizado mediante traducción y retro-traducción de la escala LuCID. El comité de ética, lo aprobó con el número 3359. Resultados: 220 encuestas, se eligieron N=216. Edad de sujetos que completaron: 18-76 (media:47) años. Mujeres: n=146 mujeres. Países: Argentina y México fueron los que mayoritariamente participaron. La media y desvío estándar de las subescalas analizadas fueron: control: 2.82/1.1; introspección: 2.79/1.1; emoción positiva: 2.66/1.3; disociación: 2.62/1.3; memoria: 2.51/1.1; pensamientos: 2.44/1.3; realismo: 2.34/1.2; emoción negativa: 2.22/1.3. De los encuetados, 56 individuos (24.5%), presentaron mayores puntajes en las subescalas para diagnóstico de sueño lúcidos. Conclusión: se realizó la adaptación e interpretación transcultural de la escala de lucidez y consciencia en los sueños (LuCID), que nos permitió detectar casi un tercio de soñadores lúcidos. Esta escala, deberá ser validada en población selecta de soñadores lúcidos para su uso.

Update on prenatal diagnosis and fetal surgery for myelomeningocele. / Actualización del diagnóstico prenatal y cirugía fetal del mielomeningocele.

A seminal study titled Management of Myelomeningocele Study, from 2011, demonstrated that prenatal myelomeningocele defect repaired before 26 weeks of gestation improved neurological outcomes; based on this study, fetal surgery was introduced as a standard of care alternative. Thus, prenatal myelomeningocele diagnosis within the therapeutic window became a mandatory goal; therefore, research efforts on screening strategies were intensified, especially in the first trimester. In addition, different fetal surgery techniques were developed to improve neurological outcomes and reduce maternal risks. The objective of this review is to provide an update on the advances in prenatal screening and diagnosis during the first and second trimesters, and in open and fetoscopic fetal surgery for myelomeningocele.

A partir del estudio seminal Management of Myelomeningocele Study en el año 2011, el cual demostró que la reparación prenatal del defecto del mielomeningocele antes de la semana 26 mejoraba los resultados neurológicos, la cirugía fetal fue incorporada dentro de las opciones de estándar de cuidado. Así, el diagnóstico prenatal del mielomeningocele dentro de la ventana terapéutica se convirtió en un objetivo obligatorio y, por ello, se intensificó la investigación de estrategias de tamizaje, sobre todo, en el primer trimestre. Además, se desarrollaron distintas técnicas de cirugía fetal para mejorar los resultados neurológicos y disminuir los riesgos maternos. El objetivo de la siguiente revisión es actualizar los avances en tamizaje y diagnóstico prenatal en el primer y segundo trimestre, y en cirugía fetal abierta y fetoscópica del mielomeningocele.

Decidual factors and vasoactive intestinal peptide guide monocytes to higher migration, efferocytosis and wound healing in term human pregnancy.

AIM: To explore the functional profile of circulating monocytes and decidual macrophages at term human pregnancy and their contribution to tissue repair upon stimulation ex vivo with decidual factors and the vasoactive intestinal peptide (VIP). METHODS: Peripheral blood monocytes were isolated from pregnant and non-pregnant volunteers and tested in vitro with decidual explants from term placenta and VIP. The effect of VIP on decidual explants and the effect of its conditioned media on monocytes or decidual macrophages isolated by magnetic beads was carried out by RT-qPCR and ELISA for cytokines expression and release. Migration assays were performed in transwell systems. Efferocytosis was assessed in monocytes or decidual macrophages with CFSE-labelled autologous apoptotic neutrophils and quantified by flow cytometry. Monocyte and decidual macrophages wound healing capacity was evaluated using human endometrial stromal cell monolayers. Immunohistochemistry was performed in serial tissue sections of different placentas. RESULTS: VIP is expressed in the villi as well as in trophoblast giant cells distributed within the decidua of term placenta. VIP induced the expression of antiinflmammatory markers and monocyte chemoattractant CCL2 and CCL3 in decidual tissues. Monocytes presented higher migration towards decidual explants than CD4 and CD8 cells. VIP-conditioned monocytes displayed an enhanced efferocytosis and wound healing capacity comparable to that of decidual macrophages. Moreover limited efferocytosis of pregnant women monocytes was restored by VIP-induced decidual factors. CONCLUSION: Results show the conditioning of monocytes by decidual factors and VIP to sustain processes required for tissue repair and homeostasis maintenance in term placenta.

Sleep quality and related factors in postmenopausal women.

Sleep disorders, resulting from hormonal changes and vasomotor symptoms, are common in both peri- and postmenopausal women. Poor sleep quality is associated with increased metabolic and cardiovascular risk, depression and a global impairment in health status. OBJECTIVES: Our study aimed to assess sleep quality in a sample of postmenopausal women and to identify the factors associated with poor sleep quality. It also considered the negative impact of sleep disorders such as insomnia, hypersomnia and breathing disturbances. SUBJECTS & METHODS: Data came from a cross-sectional study of 195 postmenopausal women conducted at the Italian Hospital of Buenos Aires, Argentina. Their sociodemographic, gynecological and clinical characteristics were recorded and sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Oviedo Sleep Questionnaire (Cuestionario Oviedo de Sueño, COS). RESULTS: The mean PSQI score was 6.90 ± 4.43. Sleep problems were common, with 46.7% of participants scoring over 5 on the PSQI. Snoring was reported by 13% of the patients (PSQI item 10 A). While 10% of the poor sleepers reported episodes of apnea during rest (PSQI item 10B), 7.1% reported leg spasm (PSQ I item 10C). The mean total COS score was 17.57 ± 7. According to COS item 1, all the subjects reported some dissatisfaction with the quality of their sleep. According to the COS, the prevalence of insomnia was 3.6% using ICD-10 criteria and 15.4% using DSM-IV criteria. The mean ESS score was 6.12 ± 4.09. CONCLUSION: Postmenopausal women are likely to complain of disturbed sleep. Almost half of the women in this survey said their sleep quality was impaired, and most of that group would benefit from medical attention.