Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO.

During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitis B, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated. Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines. The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines, and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6 months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36.

Vacunación en el embarazo. Documento de consenso del CAV-AEP y la SEGO / Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO

Durante el embarazo, los cambios fisiológicos en la respuesta inmunitaria favorecen que las gestantes sean más susceptibles a infecciones graves, tanto para ellas como para el feto, el recién nacido y el lactante. Todas las mujeres deberían entrar en el período reproductivo con su calendario vacunal correctamente cumplimentado, sobre todo en lo que respecta a enfermedades como tétanos, hepatitisB, sarampión, rubeola y varicela. Además de las vacunas recomendadas, en situaciones de riesgo las vacunas inactivadas podrían ser administradas en aquellas mujeres que no estuvieran correctamente inmunizadas con anterioridad, mientras que las atenuadas están contraindicadas.A pesar de que la vacunación durante el embarazo es una medida preventiva muy importante, y de las recomendaciones de autoridades sanitarias, sociedades científicas y profesionales sanitarios, las coberturas vacunales son claramente mejorables, especialmente en lo que respecta a gripe y COVID-19, por lo que todo profesional sanitario que atienda a la embarazada debe ser proactivo en aconsejarlas.La Asociación Española de Pediatría (AEP), a través de su Comité Asesor de Vacunas (CAV), y la Sociedad Española de Ginecología y Obstetricia (SEGO) recomiendan las siguientes vacunaciones durante la gestación: frente a gripe y COVID-19, en cualquier trimestre del embarazo, y durante el puerperio (hasta los 6meses) en aquellas que no hubieran sido vacunadas durante la gestación; frente a tosferina con Tdpa, entre las 27 y 36 semanas de gestación (el CAV-AEP da preferencia entre las 27 y 28 semanas); y frente al VRS con RSVPreF, entre las 24 y 36 semanas de gestación, de preferencia entre las 32 y 36 semanas. (AU)

During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitisB, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated.Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines.The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines (CAV), and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36. (AU)

Delivery in breech presentation: Perinatal outcome and neurodevelopmental evaluation at 18 months of life.

OBJECTIVES: To compare maternal and perinatal outcomes, including neurodevelopmental results at 18 months of life, between term breech and cephalic deliveries. STUDY DESIGN: In this longitudinal retrospective study of mothers seen at the Maternity and Paediatric University Hospital of the Canary Islands delivery unit from November 1, 2011, to October 31, 2012, we compared maternal and perinatal outcomes associated with breech or cephalic presentation of the foetus. A second analysis was performed to compare breech births, differentiating between whether a vaginal delivery attempt was made or if caesarean section (C-section) without labour had been directly scheduled. The psychomotor development of children 18 months after birth was assessed using the Haizea-Llevant scale. RESULTS: A total of 130 breech deliveries were matched with 130 cephalic deliveries. No perinatal mortality occurred in either group. The C-section percentage was greater in the breech presentation group compared with the cephalic delivery group (72.3 % vs. 14.6 %; p < 0.001). Children in the breech presentation had a threefold increased risk for Apgar scores <7 at 1 min (OR 3.2; 95 % CI: 1.2-8.4; p = 0.016) compared with cephalic presentation. These differences disappeared 5 min after birth. No differences were observed in moderate to severe neonatal morbidity between the breech and cephalic presentation groups. There were no differences between groups in neurodevelopmental outcomes. Of 130 pregnancies with breech presentation, 79 (60.8 %) made a vaginal delivery attempt, and 51 (39.2 %) were planned C-sections. Women who attempted vaginal breech delivery were younger and had a history of previous pregnancy. Apgar scores <7 at 1 min were more frequent in the vaginal delivery attempt group (27.9 % vs. 5.9 %; p = 0.002). A high percentage of type III resuscitation (36.5 % vs. 14.3 %; p = 0.007) and Neonatology admission (22.8 % vs. 5.9 %; p = 0.013) was observed in the vaginal delivery attempt group. Except for Apgar scores <7 at 1 min, none of these associations was significant after adjusting for nulliparity and maternal age. The mode of delivery was not associated with moderate to severe perinatal outcomes. CONCLUSION: The implementation of a specific protocol for selecting pregnant women with breech presentation as candidates for vaginal delivery achieved perinatal outcomes similar to births in cephalic presentation.

Perinatal outcomes in twin pregnancies: Association with fetal presentation and mode of delivery / Resultados perinatales en gestaciones gemelares en relación a la presentación de ambos fetos y a la vía del parto

Objective: To analyze perinatal outcomes in twin deliveries considering fetal presentation, delivery mode, and birth order. Material and methods: We performed a retrospective observational study of 639 women with twin pregnancies yielding 1278 newborns. The mode of delivery was chosen according to the presentation of the first twin and the mother's medical and obstetric history. Results: The pregnancy was dichorionic-diamniotic in 82.6% of cases, monochorionic-diamniotic in 14.6% of cases, and monochorionic-monoamniotic in 0.6% of cases. The overall rate of cesarean delivery was 20.7%. Of the 1278 newborns, 0.2% were admitted to the Neonatal Intensive Care Unit (NICU). Presentation at delivery was cephalic in 70.7% of first twins and only 49.9% of second twins. The rate of cesarean delivery was 28.5% for first twins in cephalic presentation and 85.8% for first twins in breech presentation. Analysis of perinatal outcomes for the first and second twins revealed no differences in newborns' weight, 5-minute Apgar score, arterial pH, rate of admission to the NICU, or perinatal mortality. Similarly, no differences were identified in perinatal outcomes according the presentation of both fetuses. Conclusions: There was no evidence of poorer perinatal outcomes related to order of birth, fetal presentation, or mode of delivery. Therefore, attempting vaginal delivery in a twin pregnancy is a reasonable approach

Objetivo: analizar los resultados perinatales en las gestaciones gemelares con respecto a su relación con la presentación y la vía del parto, atendiendo al orden de cada feto. Material y métodos: estudio observacional retrospectivo. Se incluyeron 639 mujeres con embarazos gemelares, con un total de 1278 recién nacidos. El tipo de parto se eligió de acuerdo con la presentación del primer gemelo y el historial médico y obstétrico de la madre. Resultados: el 82,6% fueron BC-BA, el 14,6% MC-BA y el 0,6% MC-MA. Hubo una tasa global de cesáreas del 20,7%. De 1278 recién nacidos, el 0,2% fue ingresado en la Unidad de Cuidados Intensivos Neonatales. El 70,7% de los primeros gemelos se encontraban en una presentación cefálica, lo que sólo ocurrió en un 49,9% de los segundos gemelos. La tasa de cesárea fue del 28,5% en los primeros gemelos con presentación cefálica y del 85,8% en los primeros gemelos con presentación de nalgas. En el análisis de los resultados perinatales (peso de los recién nacidos, la puntuación de Apgar a los 5 minutos, el pH arterial, la tasa de ingreso a la UCIN o la mortalidad perinatal) del primer o segundo gemelo no se encontraron diferencias así como tampoco las hubo en función de la presentación de ambos fetos. Conclusiones: no hubo diferencias estadísticamente significativas en los resultados perinatales atendiendo al orden de cada gemelo, a su presentación y a la vía del parto; por tanto, el intento de parto vaginal en gemelares es una opción razonable

Patología fetal grave relacionada con el parto / Severe fetal pathology related to childbirth

Introducción y objetivo: la encefalopatía hipóxico isquémica es una causa de encefalopatía neonatal. Aparece después del parto tras un episodio de asfixia con una incidencia global de encefalopatía hipóxico isquémica de 1,1 por cada 1.000 recién nacidos vivos. Otras complicaciones en el periodo perinatal son las fracturas y hemorragias intracraneales. El objetivo fue valorar las complicaciones graves del recién nacido en un hospital de tercer nivel, comparar los resultados con los obtenidos en el Benchmark de Obstetricia del 2005 y analizar la incidencia de encefalopatía hipóxico-isquémica. Material y métodos: estudio retrospectivo descriptivo durante el periodo 2007 a 2013. Se incluyeron todos los casos de encefalopatía hipóxico isquémica, traumatismo y hemorragia craneal y se determinó su incidencia anual y globalmente. Resultados: se analizó un total de 43.273 recién nacidos. La incidencia global de patología grave en nuestro centro fue del 0,6% del total de recién nacidos y 0,12% de los recién nacidos a término. Con respecto a la encefalopatía hipóxico isquémica, la tasa global fue de 1,34 por 1.000 y 0,93 por 1.000 en los recién nacidos a término. La incidencia de fractura craneal global fue de 25,4 por 100.000 y 12,8 por 100.000 recién nacidos a término. La incidencia de hemorragia intracraneal global fue de 51,9 por 10.000 en el total de recién nacidos y de 2,3 por 10.000 recién nacidos a término. Conclusiones: la incidencia de encefalopatía hipóxico isquémica encontrada fue similar a la publicada en la literatura, 0,93 por 1.000 recién nacidos y la incidencia de patología grave neonatal relacionada con el parto se encuentra por debajo de la estimada (AU)

Introduction and objective: Hypoxic ischaemic encephalopathy is a cause of neonatal encephalopathy. It appears postpartum after an episode of asfixia with an overall incidence of hypoxic ischaemic encephalopathy of 1.1 per 1,000 newborns. Other complications in the perinatal period are skull fractures and intracranial bleeding. The aim of this study was to assess the serious complications related to childbirth in a tertiary hospital, compare the results with those obtained in the 2005 Benchmark Obstetrics and analyze the incidence of hypoxic-ischemic encephalopathy. Material and methods: It is a retrospective descriptive study during the period 2007 to 2013. All cases of hypoxic ischaemic encephalopathy, cranial trauma and intracranial hemorrhage were included and annual and global incidence was determined for each. Results: A total of 43,273 newborns were included in the study. The overall incidence of severe neonatal pathology in our hospital was 0.6% of all newborns and 0.12% of those borned at term. Regarding hypoxic ischaemic encephalopathy, the overall rate was 1.34 per 1,000 newborns and 0.93 per 1,000 newborns at term. The overall incidence of skull fracture was 25.4 per 100,000 newborns and 12.8 per 100,000 newborns at term. The overall incidence of intracranial hemorrhage was 51.9 per 10,000 newborns and 2.3 per 10,000 newborns at term. Conclusions: The incidence of hypoxic ischaemic encephalopathy found was similar to that reported in the literature, 0.93 per 1,000 newborns and the incidence of severe neonatal pathology related to childbirth is below the estimated (AU)

Rotura espontánea de varices uterinas como causa de hemoperitoneo en la segunda mitad de la gestación / Spontaneous uterine rupture as a cause of hemoperitoneum in the second half of pregnancy

Introducción: el hemoperitoneo durante el embarazo, secundario a la rotura espontánea de varices uterinas, es una condición clínica infrecuente aunque potencialmente letal. La mortalidad materna puede llegar al 49%, aunque, con la rápida atención, ha descendido hasta un 3,4%; la mortalidad perinatal alcanza el 31%. La clínica es inespecífi ca, dolor abdominal y choque hipovolémico, asociado o no a sufrimiento fetal. La laparotomía exploradora es necesaria en estos casos, junto con la reposición de líquidos y sangre. Caso clínico: se presenta el caso de una septigesta de 44 años con edad gestacional de 28 semanas y cinco días, que presentaba dolor abdominal intenso e inestabilidad hemodinámica en la que se objetivó bradicardia fetal mantenida. Se indicó cesárea urgente ante sospecha de desprendimiento prematuro de placenta normoinserta, comprobándose importante hemoperitoneo procedente de dos grandes varices de la pared anterior del útero. Se realizó una histerectomía puerperal al no controlarse el sangrado con puntos de hemostasia (AU)

Background: The hemoperitoneum during pregnancy, secondary to spontaneous rupture of uterine varices, is an infrequent clinic condition but potentially lethal clinical condition. Maternal mortality can reach 49%, although with fast service, has fallen to 3.4%; perinatal mortality is 31%. Symptoms are nonspecifi c, abdominal pain and hypovolemic shock, which may be or not fetal distress. Exploratory laparotomy is necessary in these cases, with fl uid replacement and blood. Case report: We present the case of a 44 septigesta with a gestational age of 28 weeks and fi ve days, which had severe abdominal pain and hemodynamic instability that sustained fetal bradycardia was observed. Emergency cesarean section for suspected abruptio normoinserta placenta was realized and we found important hemoperitoneum from two large veins of the anterior wall of the uterus. Puerperal hysterectomy was performed because was not possible to control the bleeding with hemostasis stitches (AU)