Clinical characteristics and risk factors for SARS-CoV-2 infection in pregnant women attending a third level reference center in Mexico City.

BACKGROUND: COVID-19 symptoms vary widely among pregnant women. We aimed to assess the most frequent symptoms amongst pregnant women with SARS-CoV-2 infection in a tertiary hospital in Mexico City. METHODS: A cross-sectional study of pregnant women attending the National Institute of Perinatology in Mexico City was performed. All women who attended the hospital, despite their symptoms, were tested for SARS-CoV-2. A multivariate-age-adjusted logistic regression was used to assess the association between the main outcome and each characteristic of the clinical history. RESULTS: A total of 1880 women were included in the data analysis. Among all women, 30.74% (n = 578) had a positive PCR for SARS-CoV-2 from which 2.7 (n = 50) were symptomatic. Symptoms associated with a positive PCR result were headache (p=.01), dyspnea (p=.043), and myalgia (p=.043). CONCLUSIONS: At universal screening for SARS-CoV-2, one-third of the population had a positive result, while those symptoms associated with a positive PCR were headache, dyspnea, and myalgia.

Tratamiento de la ruptura prematura de membranas pretérmino (24-33.6 semanas): evidencia científica reciente / Management of premature preterm rupture of membranes (24-33.6 weeks): Recent scientific evidence

Resumen OBJETIVO Ofrecer al clínico la evidencia científica más reciente en lo relativo a algunos aspectos de la atención de pacientes con ruptura prematura pretérmino de membranas que han generado debate, controversia y, en algunos momentos, opiniones divergentes que condicionan la toma de decisiones basadas en criterios con un débil rigor científico que se reflejan en morbilidad perinatal significativa. MÉTODO Búsqueda en PubMed, The Cochrane Library, OVID, Science Direct, Practice Guidelines Internacional Networks de artículos publicados en inglés entre los años 2014 a 2016 con las siguientes palabras clave (Mesh): Preterm premature rupture of membranes; diagnostic tests in premature rupture of preterm membranes; pulmonary maturity scheme; antibiotic therapy in premature rupture of preterm membranes; pulmonary maturity tests; fetal inflammatory response syndrome; fetal well-being tests; chorioamnionitis. Criterios de inclusión: revisiones sistemáticas, metanálisis y ensayos clínicos controlados con metodología de medicina basada en evidencias, con consistencia y claridad en las recomendaciones seleccionadas. RESULTADOS Se seleccionaron 70 artículos, entre estos 5 guías internacionales de práctica clínica y 45 artículos. Al final se excluyeron 20 artículos porque el diseño era de casos y controles, ensayos clínicos no controlados y sus recomendaciones no eran concluyentes porque su nivel de evidencia era bajo. CONCLUSIONES El uso racional de los diversos instrumentos de diagnóstico permite ser más eficaces y eficientes en la utilización de los recursos, y la identificación de fetos que podrían beneficiarse de una conducta expectante versus resolutiva y, viceversa. La comprensión y aplicación de lo aquí expuesto puede contribuir a disminuir la incidencia de desenlaces neonatales adversos asociados con procesos infecciosos directamente relacionados con la morbilidad y secuelas neurológicas a corto y mediano plazo. Se planteó el tratamiento de la ruptura prematura pretérmino de membranas en algoritmos aplicables en la práctica clínica.

Abstract OBJECTIVE To provide the clinician the most recent scientific evidence regarding some aspects of the management of patients with preterm premature rupture ofmembranes. Those aspects have generated debate, controversy and sometimes divergent opinions leading to medical decisions based on weak criteria and as consequence significant perinatal morbidity. METHOD We searched databases in PubMed, The Cochrane Library, OVID, Science Direct, Practice Guidelines International Networks from 2014 to 2016 with the following keywords: preterm premature rupture of membranes, diagnostic tests for preterm premature rupture of membranes, antenatal corticosteroids, antibiotic therapy in preterm premature rupture of membranes, fetal pulmonary maturity tests, fetal inflammatory response syndrome, fetal well-being tests, chorioamnionitis. RESULTS We extracted 70 studies, information was collected with emphasis on several controversial themes. Inclusion criteria were systematic reviews, meta-analysis and clinical controlled trials from 2014 to 2016, languages spanish or english, articles with evidence-based medicine methodology with strong recommendations. The final selection includes 5 international clinical practice guidelines and. 45 articles from 2014-2016. Articles which methodology consisted in case-control design, uncontrolled or unrandomized clinical trials or with level of evidence D were excluded. CONCLUSIONS The appropriate use of diagnostic tools will allow us to become more efficient in the use of resources, also allowing the identification of fetuses that would benefit from an expectant versus resolute management and vice versa. The review aims, among other things, to reduce the incidence of adverse neonatal outcomes associated with infectious processes, which are directly related to morbidity and neurological sequelae in short and mid-term. The management of PPROM is proposed in algorithms applicable in clinical practice.

[Early severe restriction of intrauterine growth: a therapeutic alternative]. / Restricción del crecimiento intrauterino grave de inicio temprano: una alternativa terapéutica.

It is presented the case of the second pregnancy of a 36 year-old patient with antecedent of preeclampsia that was solved, at full-term, with a Caesarean operation by means of which was obtained a healthy new born. The patient began her prenatal control at 29th week. Ultrasound made at her admittance showed a fetus with an approximated weight of 451 grams. The patient was hospitalized until completing protocol of study for restriction of severe fetal growth. At 34.5 weeks, an ultrasonographical control showed an alteration in venous duct; for that reason it was decided to interrupt pregnancy abdominally. There were no surgical complications and was obtained a phenotypically normal new born, male, weight of 820 grams and size of 33 cm, who was referred to the Instituto Nacional de Perinatologia. At 43.3 weeks he was discharged from hospital with a weight of 1,840 grams. At the present he's fed with fortified milk.