Comprehensive analysis of current epidemiology, clinical features and prognostic factors of puerperal endometritis: A retrospective cohort analysis.

Background: Puerperal endometritis has not been recently investigated. We aimed to describe the current dimension of the endometritis in the context of other causes of puerperal fever and investigate the microbiology and need for curettage in these patients. Methods: A retrospective cohort study was conducted based on a prospectively maintained database of patients with puerperal fever, (2014-2020) in which cases fulfilling criteria for endometritis were selected for further analysis. Description of clinical and microbiological features was performed and determination of the factors related with puerperal curettage requirement were studied using univariate and multivariate analysis through binary logistic regression. Results: From 428 patients with puerperal fever, endometritis was the main cause of puerperal fever (233 patients, 52.7 %). Curettage was required in 96 of them (41.2 %). Culture of endometrial samples were performed in 62 (64.5 %), of which 32 (51.6 %) yielded bacterial growth. Escherichia coli was the most common microorganism in curettage cultures (46.9 %). Multivariate analysis identified the following predictive factors for curettage: the presence of pattern compatible with retained products of conception (RPOC) in transvaginal ultrasonography (odds ratio [OR]: 17.6 [95 % confidence interval [CI]: 8.4-36.6]; P-value < 0.0001), fever during the first 14 days after delivery (OR:5.1; [95 % CI: 1.57-16.5]; P-value 0.007), abdominal pain (OR: 2.9; [95 % CI: 1.36-6.1]; P-value 0.012) and malodorous lochia (OR:3.5; [95 % CI: 1.25-9.9]; P-value 0.017). Scheduled cesarean delivery was protective (OR: 0.11 [95 % CI 0.01-1.2]; P-value 0.08). Conclusions: Endometritis is still the main cause of puerperal fever. Women requiring curettage typically presented with abdominal pain and foul-smelling lochia, an ultrasound image compatible with RPOC and fever in the first 14 days postpartum. Curettage culture is useful for the microbiological affiliation mostly yielding gram-negative enteric flora.

The role of the T-cell mediated immune response to Cytomegalovirus infection in intrauterine transmission.

INTRODUCTION: Prognostic markers for fetal transmission of Cytomegalovirus (CMV) infection during pregnancy are poorly understood. Maternal CMV-specific T-cell responses may help prevent fetal transmission and thus, we set out to assess whether this may be the case in pregnant women who develop a primary CMV infection. METHODS: A multicenter prospective study was carried out at 8 hospitals in Spain, from January 2017 to April 2020. Blood samples were collected from pregnant women at the time the primary CMV infection was diagnosed to assess the T-cell response. Quantitative analysis of interferon producing specific CMV-CD8+/CD4+ cells was performed by intracellular cytokine flow cytometry. RESULTS: In this study, 135 pregnant women with a suspected CMV infection were evaluated, 60 of whom had a primary CMV infection and samples available. Of these, 24 mothers transmitted the infection to the fetus and 36 did not. No association was found between the presence of specific CD4 or CD8 responses against CMV at the time maternal infection was diagnosed and the risk of fetal transmission. There was no transmission among women with an undetectable CMV viral load in blood at diagnosis. CONCLUSIONS: In this cohort of pregnant women with a primary CMV infection, no association was found between the presence of a CMV T-cell response at the time of maternal infection and the risk of intrauterine transmission. A detectable CMV viral load in the maternal blood at diagnosis of the primary maternal infection may represent a relevant biomarker associated with fetal transmission.

SARS-CoV-2 in pregnancy: characteristics and outcomes of hospitalized and non-hospitalized women due to COVID-19.

BACKGROUND: There is little evidence about how novel coronavirus (SARS-CoV-2) affects pregnant women and their newborns. Comparisons with other members of the coronavirus family responsible for severe acute respiratory syndrome (SARS) have been done to predict maternal and neonatal outcomes; however, more information is required to establish clinical patterns, disease evolution and pregnancy prognosis in this group of patients. METHODS: This paper is reporting a series of 91 women diagnosed with SARS-CoV-2 infection during pregnancy and puerperium. The analysis showed that 40 patients developed pneumonia, bilateral in most cases, with a 46.2% rate of hospitalization and 4 patients requiring intensive care unit (ICU) admission. In confront with previous publications, we have found a higher rate of coronavirus disease (COVID-19) severe forms, even when compared to non-pregnant women with the same baseline characteristics. We have analyzed the demographic characteristics, pregnancy-related conditions and presenting symptoms to identify features that could determine which patients will need hospitalization because of COVID-19 (Group 1-G1) and those who not (Group 2-G2). We have found that obesity and Latin-American origin behave as risk factors: OR: 4.3; 95% CI: 1.4-13.2, and OR: 2.6; 95% CI: 1.1 - 6.2, respectively. Among the 23 patients that delivered with active SARS-CoV-2, the overall rate of cesarean section (CS) and preterm birth were 52.2% and 34.8%, respectively, but we observed that the rate of CS was even higher in G1 compared to G2: 81.8% versus 25%, p = .012. However, prematurity was equally distributed in both groups and only one preterm delivery was determined by poor maternal condition. There were no deaths among the patients neither their newborns. CONCLUSION: In conclusion, the results of our cohort reveal that SARSC-CoV-2 infection may not behave as mild as suggested during pregnancy, especially when factors as obesity or Latin-American origin are present. No evidence of late vertical transmission was noticed but prematurity and high CS rate were common findings, although it is difficult to establish any causality between these conditions and COVID-19. Further evidence is required to establish if pregnancy itself can lead to severe forms of COVID-19 disease and whether risk factors for the general population are applicable to obstetric patients. Until larger studies are available, pregnant women should be monitored carefully to anticipate severe complications.

Incidence and clinical profiles of COVID-19 pneumonia in pregnant women: A single-centre cohort study from Spain.

BACKGROUND: Information regarding the incidence and characteristics of COVID-19 pneumonia amongst pregnant women is scarce. METHODS: Single-centre experience with 32 pregnant women diagnosed with COVID-19 between March 5 to April 5, 2020 at Madrid, Spain. FINDINGS: COVID-19 pneumonia was diagnosed in 61·5% (32/52) women. Only 18·7% (6/32) had some underlying condition (mostly asthma). Supplemental oxygen therapy was required in 18 patients (56·3%), with high-flow requirements in six (18·7%). Eight patients (25·0%) fulfilled the criteria for acute distress respiratory syndrome. Invasive mechanical ventilation was required in two patients (6·2%). Tocilizumab was administered in five patients (15·6%). Delivery was precipitated due to COVID-19 in three women (9·4%). All the newborns had a favourable outcome, with no cases of neonatal SARS-CoV-2 transmission. Severe cases of pneumonia requiring supplemental oxygen were more likely to exhibit bilateral alveolar or interstitial infiltrates on chest X-ray (55·6% vs. 0·0%; P-value = 0·003) and serum C-reactive protein (CRP) levels >10 mg/dL (33·0% vs. 0·0%; P-value = 0·05) at admission than those with no oxygen requirements. INTERPRETATION: Pregnant women with COVID-19 have a high risk of developing pneumonia, with a severe course in more than half of cases. The presence of bilateral kung infiltrates and elevated serum CRP at admission may identify women at-risk of severe COVID-19 pneumonia. FUNDING: Instituto de Salud Carlos III (COV20/00,181), Spanish Ministry of Science and Innovation.

Prevention and treatment of fetal cytomegalovirus infection with cytomegalovirus hyperimmune globulin: a multicenter study in Madrid.

INTRODUCTION: Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Data about the management of CMV infection in pregnant women are scarce, and treatment options are very limited. The aim of the study is to investigate the effectiveness of cytomegalovirus hyperimmune globulin (CMV-HIG) for the prevention and treatment of congenital CMV (cCMV) infection. MATERIALS AND METHODS: A retrospective observational study was conducted in three tertiary hospitals in Madrid. In the period 2009-2015, CMV-HIG (Cytotect® CP Biotest, Biotest) treatment was offered to all pregnant women with primary CMV infection and/or detection of CMV-DNA in amniotic fluid in participating centers. Women were divided into prevention and treatment groups (PG and TG, respectively). Those with primary CMV infection who had not undergone amniocentesis comprised the PG and received monthly CMV-HIG (100 UI/kg). If CMV-DNA was subsequently detected in amniotic fluid, one extra dose of CMV-HIG (200 UI/kg) was given 4 weeks after the last dose. Those women were considered to be part of the PG group despite detection of CMV-DNA in amniotic fluid. In the case of a negative result in CMV-DNA detection in amniotic fluid or if amniocentesis was not performed, monthly HIG was given up to the end of the pregnancy. RESULTS: Thirty-six pregnant women were included. Median gestational age at birth was 39 weeks (interquartile range: 38-40) and two children (5.5%) were premature (born at 28 and 34 weeks' gestation). Amniocentesis was performed in 30/36 (83.4%) pregnancies and CMV PCR was positive in 21 of them (70%). One fetus with a positive PCR in amniotic fluid that received one dose of HIG after amniocentesis presented a negative CMV-PCR in urine at birth, and was asymptomatic at 12 months of age. Twenty-four children were infected at birth, and 16/21 (76.2%) presented no sequelae at 12 months, while two (9.5%) had a mild unilateral hearing loss and three (14.3%) severe hearing loss or neurological sequelae. Seventeen women were included in the PG and 19 in the TG. In the PG 7/17 (41%) fetuses were infected, one pregnancy was terminated due to abnormalities in cordocentesis and one showed a mild hearing loss at 12 months of age. In the TG, 18/19 children (95%) were diagnosed with cCMV, while the remaining neonate had negative urine CMV at birth. Eight out of the 19 fetuses (42.1%) showed CMV related abnormalities in the fetal US before HIG treatment. Complete clinical assessment in the neonatal period and at 12 months of age was available in 16 and 15 children, respectively. At birth 50% were symptomatic and at 12 months of age, 4/15 (26.7%) showed a hearing loss and 3/15 (20%) neurologic impairment. Fetuses with abnormalities in ultrasonography before HIG presented a high risk of sequelae (odds ratios: 60; 95%CI: 3-1185; p = .007). DISCUSSION: Prophylactic HIG administration in pregnant women after CMV primary infection seems not to reduce significantly the rate of congenital infection, but is safe and it could have a favorable effect on the symptoms and sequelae of infected fetuses. The risk of long-term sequelae in fetuses without US abnormalities before HIG is low, so it could be an option in infected fetuses with normal imaging. On the other hand, the risk of sequelae among infected fetuses with abnormalities in fetal ultrasonography before HIG despite treatment is high.

Hydroxychloroquine in obstetrics: New outlooks for therapy / La hidroxicloroquina en obstetricia. Nuevas perspectivas terapeuticas

Hydroxychloroquine is an antimalarial drug that is used to treat autoimmune diseases. It is safe in pregnancy and compatible with breastfeeding. Hydroxychloroquine is the drug of choice in pregnant women in need of treatment. Recently, it has proven useful for the treatment of refractory antiphospholipid syndrome and prevention of recurrence of congenital heart block in anti Ro/La-positive pregnant women. Two large prospective studies that will confirm the usefulness of this drug currently under way

La hidroxicloroquina es una droga antimalárica utilizada en enfermedades autoinmunes, segura en la gestación y en la lactancia, siendo la terapia de elección de mujeres gestantes que precisen tratamiento. Recientemente se ha visto su utilidad en el tratamiento del síndrome antifosfolipido refractario y en la prevención de la recurrencia del bloqueo cardiaco congénito en gestantes con anticuerpos antiRo/antiLa positivos. Están en marcha dos estudios prospectivos que confirmarán esta alternativa terapéutica

Vigilancia de infección de herida quirúrgica poscesárea en un hospital general / Surgical site infection surveillance by caesarean section in a general hospital

Las infecciones relacionadas con la asistencia sanitaria suponen un problema de salud pública que justifica su prevención y vigilancia. La reducción de las estancias hospitalarias posquirúrgicas que se ha producido en los últimos años incrementa la posibilidad de que la infección se produzca después del alta hospitalaria. Objetivos: conocer y analizar las tasas de incidencia de infección de localización quirúrgica poscesárea con seguimiento posalta en el periodo 2013-2015. Describir su evolución a lo largo de los tres años. Material y métodos: selección de información quirúrgica en historias clínicas, introducción de datos al sistema de vigilancia de infecciones relacionadas con la asistencia sanitaria (VIRAS-Madrid) y vigilancia posalta los 30 días posintervención mediante consulta al sistema informático hospitalario y atención primaria mediante el visor HORUS. Resultados: se estudiaron 1.353 cesáreas. La incidencia de infección de localización quirúrgica fue 1,55% (1,92% en 2013, 1,52% en 2014 y 1,26% en 2015). La estancia media poscirugía fue de 4,4 días (índice de confianza 95%: 3,6; 5,2). El 95,24% de las infecciones se detectó después del alta hospitalaria y de ellas, el 52,38% a través de las consultas de atención primaria. La tasa de incidencia estratificada por índice de riesgo aumenta a medida que se incrementa este índice, aunque no se encuentran diferencias estadísticamente significativas. Conclusiones: la vigilancia posalta juega un papel fundamental en la detección de las infecciones relacionadas con la asistencia sanitaria puesto que gran parte de ellas se producen tras el alta. La vigilancia en continuidad asistencial mediante el seguimiento posterior al alta permite obtener una tasa de infección más ajustada a la realidad

Healthcare-associated infections are a critical challenge to public health that justifies their prevention and surveillance. The reduction in hospital stay after surgery that has occurred in recent years increases the probability that the infection will occur after hospital discharge. Objectives: The objectives of this analysis were to analyze the incidence rates of post-cesarean surgical site infection with post-discharge surveillance between 2013 and 2015 and to describe their evolution over the three years. Methods: Selection of surgical information in medical records, data record at the surveillance system VIRAS-Madrid and post-discharge surveillance at 30 days after surgery by consulting the hospital electronic medical record and primary care using HORUS. Results: A total of 1353 cesareans were included in the study. The incidence of surgical site infection was 1.55% (1.92% in 2013, 1.52% in 2014 and 1.26% in 2015). The average length of hospital stay after surgery was 4.4 days, (95% CI: 3.6; 5.2). 95.24% of infections were detected after discharge and 52.38% of them through Primary Care consultations. Infection rate increases with increasing risk index score but there are no statistically significant differences. Conclusions: Post-discharge surveillance plays a fundamental role in the detection of healthcare-associated infections occurring after discharge. Post-discharge monitoring is useful to analyze the real trend of surgical site infection (AU)

Angiogenesis-Related Biomarkers (sFlt-1/PLGF) in the Prediction and Diagnosis of Placental Dysfunction: An Approach for Clinical Integration.

Placental dysfunction is involved in a group of obstetrical conditions including preeclampsia, intrauterine growth restriction, and placental abruption. Their timely and accurate recognition is often a challenge since diagnostic criteria are still based on nonspecific signs and symptoms. The discovering of the role of angiogenic-related factors (sFlt-1/PlGF) in the underlying pathophysiology of placental dysfunction, taking into account that angiogenesis-related biomarkers are not specific to any particular placental insufficiency-related disease, has marked an important step for improving their early diagnosis and prognosis assessment. However, sFlt-1/PlGF has not been yet established as a part of most guidelines. We will review the current evidence on the clinical utility of sFlt-1/PlGF and propose a new protocol for its clinical integration.

Recomendaciones para el diagnóstico, seguimiento y tratamiento de la embarazada y del niño con enfermedad de Chagas / Recommendations for the diagnosis, treatment and follow-up of the pregnant woman and child with Chagas disease

La enfermedad de Chagas en zonas no endémicas, como nuestro país, se adquiere fundamentalmente por transmisión vertical. La prevalencia de la enfermedad en embarazadas latinoamericanas oscila entre el 0,7 y el 54% en función del país de origen, la procedencia rural o la edad de la madre, situándose la tasa de transmisión vertical entre el 5 y el 6%. Se sabe que el tratamiento en fases precoces y en concreto en el niño < 15 años tiene altas tasas de curación y parece que el tratamiento de la embarazada tras el parto podría prevenir la transmisión en otros embarazos. Todo ello justificaría el diagnóstico y tratamiento precoz de esta entidad en ambos grupos. En este documento se exponen las recomendaciones actuales de diagnóstico y tratamiento de la enfermedad en el niño y la embarazada. Estas recomendaciones han sido elaboradas por un grupo de trabajo formado por especialistas en Enfermedades Infecciosas, Microbiología Clínica, Ginecología y Pediatría (AU)

Congenital transmission of Chagas disease now occurs in areas where the disease is non-endemic, and also from one generation to another. According to epidemiological data from Latin America, the prevalence of the disease in pregnant women is 0.7%-54%, and the prevalence of vertical transmission is around 5%-6%.Congenital T. cruzi infection is an acute infection in newborns that should be treated with anti-parasitic therapy. The treatment of pregnant women could also have an impact on the control of the disease. This article has been prepared following the recommendations suggested by a group of experts in Infectious Diseases, Microbiology, Gynaecology and Paediatrics (AU)

[Recommendations for the diagnosis, treatment and follow-up of the pregnant woman and child with Chagas disease. Sociedad Española de Infectología Pediátrica. Sociedad de Enfermedades Infecciosas y Microbiología Clínica. Sociedad Española de Ginecología y Obstetricia]. / Recomendaciones para el diagnóstico, seguimiento y tratamiento de la embarazada y del niño con enfermedad de Chagas.

Congenital transmission of Chagas disease now occurs in areas where the disease is non-endemic, and also from one generation to another. According to epidemiological data from Latin America, the prevalence of the disease in pregnant women is 0.7%-54%, and the prevalence of vertical transmission is around 5%-6%. Congenital T. cruzi infection is an acute infection in newborns that should be treated with anti-parasitic therapy. The treatment of pregnant women could also have an impact on the control of the disease. This article has been prepared following the recommendations suggested by a group of experts in Infectious Diseases, Microbiology, Gynaecology and Paediatrics.

Cesárea humanizada / Humanized cesarean sections

Objetivo. Demostrar la ausencia de efectos negativos a corto plazo en aquellas cesáreas en las que se realiza piel con piel, con o sin la entrada del acompañante, así como una mayor satisfacción de dichas gestantes. Material y método. Se diseñó una encuesta de satisfacción que debía ser cumplimentada por todas las madres a las que se les había realizado una cesárea. Se analizaron 300 encuestas. Resultado. El 98,2% de las mujeres que estuvieron acompañadas consideraron que esto les sirvió de apoyo. El 94,2% de las mujeres con una cesárea con acompañante tuvieron un puerperio normal, frente al 87,2% de cesáreas sin acompañante (p = 0,69). Conclusiones. Tanto el contacto piel con piel como la entrada del acompañante durante una cesárea son actuaciones sin efectos negativos sobre la madre o su recién nacido(AU)

Objective. To demonstrate the absence of short-term negative effects in cesarean sections followed by skin-to-skin contact, with or without the presence of a companion, and the greater satisfaction of these women. Material and method. A satisfaction survey was designed for use in all women who had undergone a cesarean section. A total of 300 questionnaires were analyzed. Results. Among women accompanied by companions, 98.2% considered this measure to be a source of support. The puerperium was normal in 94.2% of accompanied women versus 87.2% of those who were unaccompanied (p = 0.69). Conclusions. No negative effects on the mother or newborn are associated with either skin-to-skin contact after delivery or the presence of a companion during cesarean section(AU)

Puerperal curettage after cesarean section delivery.

OBJECTIVE: To analyze the clinical situations that leads us to carry out curettage after cesarean section, the ultrasound prior surgery, intraoperative, and pathological findings. METHODS: A retrospective study of all cases of postpartum curettage after cesarean section in a level 3 maternity unit. RESULTS: There were 42 curettages to women with cesarean sections (1.6% of all cesarean sections). The indications for curettage were: fever: 21, methrorraghia: 11, and residual trophoblastic tissue: 10. In the previous ultrasound, all indicated curettages for retained trophoblastic tissue showed it, and in a lower proportion those indicated for fever (66.6%) or methrorraghia (22.2%). A total of fourteen curettages (35%) were performed without suspect image of retained tissue, and in all cases the surgeon described to obtain small amount of tissue. From material submitted to pathologic evaluation trophoblastic tissue was found in 64.7%, and there were no differences as curettage indication. CONCLUSIONS: When the previous ultrasound do not showed retained tissue, the surgeon did not remove retained material. When extracted there were always in small amounts. Therefore, it could be concluded that after cesarean section the curettage should be indicated only in the presence of evident ultrasound image of retained products.

Noninvasive fetal sex determination in maternal plasma: a prospective feasibility study.

PURPOSE: To prospectively validate a protocol for noninvasive fetal sex determination in maternal plasma and demonstrate its applicability to clinical practice. METHODS: Peripheral blood from 404 pregnant women undergoing prenatal invasive testing was collected from 6 to 23 weeks of gestation. Real-time PCR was performed for the SRY gene and multicopy DYS14 marker sequence located within the TSPY gene by the TaqMan minor groove binder probe assay as a first-line test. Owing to a false-positive result, amplification of repetitive motifs of the DAZ gene region was also tested as a second-line test performed in the last 232 patients enrolled in our series. A diagnostic algorithm was designed using a combination of these three markers. Fetal gender determined by noninvasive prenatal diagnosis (NIPD) was compared with that diagnosed by quantitative fluorescent PCR after invasive testing or ultrasound. RESULTS: A single false-positive result was obtained in the first 172 pregnancies. Reporting criteria were modified in the subsequent 232 pregnancies, giving an overall sensitivity and specificity of 100% (95% CI 99.8-100%) and 99.5% (95% CI 98.1-100%), respectively. Pregnancy outcome was obtained in all cases, including 221 male-bearing and 183 female-bearing pregnancies. CONCLUSION: NIPD for fetal sex determination in maternal plasma is highly accurate and clinically applicable if robust reporting criteria are applied.

Implantación de un sistema de gestión de riesgos en obstetricia: aprendiendo de los errores / Implementation of a patient safety program in obstetrics: learning from mistakes

Objetivos. Describir la implantación de un sistema de gestión de riesgos y presentar los resultados obtenidos en el primer año. Material y métodos. El sistema se implantó en todos los ingresos en el área de obstetricia e incluyó un registro de sucesos adversos (SA) y un sistema de notificaciones voluntarias (NV). Resultados. Un 9,26% de los ingresos en obstetricia presentan algún tipo de SA. Éstos son más frecuentes en el puerperio (6,61%) y en los ingresos con cesárea (16,04%) que en los partos instrumentales (10,63%) y en los partos eutócicos (7,40%). La mayoría de las NV hacen referencia a incidentes; un 72% generan mejora.Conclusiones. El sistema de gestión de riesgos en obstetricia permite elaborar estrategias encaminadas a mejorar la seguridad del paciente. En obstetricia es importante porque es una causa frecuente de ingreso, por los frecuentes problemas legales asociados a la práctica obstétrica y por los potenciales efectos sobre la madre y su hijo (AU)

Objective. To describe the implementation of a patient safety program in an obstetrics department and the results obtained. Material and methods. The program was applied in all women admitted to the labor and delivery unit. To detect adverse events, a patient safety indicator system that allows monitoring over time was designed and an anonymous event reporting tool was activated. Results. An adverse event occurred in 9.26% of hospitalized patients. Adverse events were more common in the puerperium (6.61%) and after cesarean delivery (16.04%) than in instrumental (10.63%) and vaginal delivery (7.40%). Most of the notifications concerned potential adverse events (near misses) and 72% led to improvements. Conclusions. Our program detects adverse events and allows improvement measures to be designed. In obstetrics, safety is of great importance because of the potential effects to mother and child. Furthermore, childbirth is a frequent cause of hospitalization and litigation in obstetrics is common (AU)

Osteoporosis transitoria de cadera y gestación / Transient osteoporosis of the hip and pregnancy

La osteoporosis transitoria de cadera es una entidad rara, de etiología desconocida. Afecta a varones de mediana edad y a mujeres en el tercer trimestre del embarazo. Se caracteriza por dolor inguinal agudo, progresivo e incapacitante sin antecedente de traumatismo.Las pruebas de laboratorio son normales, a excepción de la velocidad de sedimentación globular y los valores urinarios de hidroxiprolina, que pueden estar elevados. Los hallazgos radiológicos consisten en una desmineralización de la cabeza femoral, pero se manifiestan después de un periodo de ventana de 4-6 semanas. La resonancia magnética es la prueba más sensible y específica para su diagnóstico temprano, lo cual es importante para evitar potenciales complicaciones como fracturas patológicas.La resolución suele ser espontánea a los 6-8 meses, tanto clínica como radiológica. El tratamiento consiste en analgesia y descarga del miembro afectado. La calcitonina se utiliza como analgésico y parece disminuir la duración del proceso. Los bifosfonatos pueden también mejorar el pronóstico del mismo modo.Se describe un caso de osteoporosis transitoria de cadera bilateral en una gestante (AU)

Transient osteoporosis of the hip (TOH) is a rare disorder of unknown etiology, characterized by acute, progressive disabling pain in the hip without prior trauma. This disease is more common among middle-aged men and during the third trimester of pregnancy.Laboratory values are normal, except for erythrocyte sedimentation rate and urinary hydroxyproline levels, which can be elevated. Radiologic findings consist of demineralization of the femoral head, but are only apparent after a window of 4-6 weeks. Magnetic resonance imaging has been proven to be the most accurate test for an early diagnosis, which can be important to avoid potential complications such as pathological fractures.Both clinical and radiological signs of TOH usually resolve spontaneously at 6-8 months. Treatment consists of analgesics and restricted weight bearing of the affected limb. Calcitonin may be used as an analgesic and to shorten disease duration. Bisphosphonates are another alternative. We report a case of severe bilateral TOH in a pregnant woman (AU)

Epidermólisis ampollosa distrófica recesiva y gestación / Recessive dystrophic epidermolysis bullosa and pregnancy

La epidermólisis ampollosa distrófica recesiva noHallopeau-Siemens (EADR no-HS) es unaenfermedad hereditaria de la piel, infrecuente,caracterizada por una falta de adhesión cutánea quepuede involucrar también a mucosas, cuyo cursono se ve afectado por la gestación. Se debe ofrecerconsejo genético a las parejas que hayan tenido unniño con esta afección, ya que un 25% de los hijosde dichas parejas pueden tener la enfermedad. Sinembargo, en el caso de las pacientes, al tratarse deuna forma recesiva, el riesgo de tener un niñoafectado es menor de un 1%, recomendándose enestos casos el diagnóstico prenatal únicamente siexisten antecedentes familiares en su pareja oconsanguinidad o sospecha de consanguinidad(p. ej., ambas familias oriundas de una mismaregión geográfica). El parto por vía vaginal y lalactancia no están contraindicados, pero son difícilesy requieren una valoración individualizada y unoscuidados especiales (AU)

Recessive non-Hallopeau-Siemens dystrophicepidermolysis bullosa is a rare and severe inheritedskin disease characterized by increased skinfragility that can also involve the mucosa. Thisentity is not associated with pregnancycomplications. Genetic counselling must be offered,because the risk of recurrence in parents with anaffected child is 25%. However, becausetransmission is recessive, the risk of having affectedoffspring in individuals with the disease is lessthan 1%. Therefore prenatal diagnosis is onlyrequired if the partner has a familial history of thedisease or if there is consanguinity or suspectedconsanguinity (for example, if both families arefrom the same geographical area). Vaginal deliveryand breast feeding are not contraindicated, but aredifficult and require individual assessment andclose monitoring (AU)

Lesión urológica compleja y gestación. Técnica de Mitrofanoff / Complex urological damage and pregnancy. Mitrofanoff’s technique

Se expone el caso de una mujer primigesta, de 31 años, con lesión traumática uretral 10 años atrás, sometida a derivación urinaria de Mitrofanoff, consistente en la creación de una comunicación cateterizable de la vejiga con el exterior (generalmente se emplea el apéndice cecal). El control gestacional realizado fue el habitual, además de urocultivos mensuales, en los que se detectan infecciones del tracto urinario (ITU) de repetición resueltas con antibioticoterapia oral.En la semana 31 se produjo un prolapso de cordón que obligó a la realización de una cesárea urgente.A propósito de éste, presentamos los 14 casos publicados sobre gestación en pacientes con derivación urinaria de Mitrofanoff, circunstancia en la que se recomienda la cesárea programada como vía de finalización del embarazo (AU)

We report the case of a 31-year-old primigravida who had sustained irreversible urethral damage in a traffic accident 11 years previously. The lesion required the application of Mitrofanoff’s technique, consisting of the creation of a catheterizable urinary conduit from the urinary bladder to the abdominal wall (the cecal appendix is generally used). In addition to routine prenatal care, monthly urine cultures were performed, revealing recurrent urinary tract infections, which were resolved with oral antibiotics.At 31 weeks of pregnancy, emergency cesarean section was performed due to umbilical cord prolapse. We review the 14 cases published on pregnant women with Mitrofanoff’s technique, in whom elective cesarean section is the recommended form of delivery (AU)

Un caso especial de diabetes mellitus gestacional / A special case of gestacional diabetes mellitus

El caso que se presenta es el de una mujer joven, cuyo diagnóstico de diabetes monogénica por mutación del gen de la glucocinasa, en el tercer embarazo, planteó un cambio en la actitud terapéutica respecto a susgestaciones previas. Se hace, asimismo, un breve repaso de la literatura sobre las implicaciones obstétricas de las pacientes gestantes condiabetes mellitus MODY 2 (AU)

We report the case of a young woman who was diagnosed with monogenic diabetes caused by a glucokinase gene mutation during the third trimester of pregnancy,r equiring a change in treatment plan in comparison with her previous pregnancies. We also discuss the implications for obstetric management in patients with maturity onset diabetes of the young, type2 (MODY-2) (AU)

A special case of gestational diabetes mellitus.

We report the case of a young woman who was diagnosed with monogenic diabetes caused by a glucokinase gene mutation during the third trimester of pregnancy, requiring a change in treatment plan in comparison with her previous pregnancies. We also discuss the implications for obstetric management in patients with maturity onset diabetes of the young, type 2 (MODY-2).

Evaluación de la aplicación del protocolo de prevención de la sepsis neonatal precoz por estreptococo del grupo B en el Hospital “Doce de Octubre” de Madrid / Evaluation of the application of the protocol for prevention of early neonatal group B Streptococcal sepsis at Hospital Doce de Octubre in Madrid, Spain

Objetivo: Evaluar la aplicación del protocolo de profilaxis antibiótica intraparto (PAI) para la prevención de las enfermedades perinatales por estreptococo del grupo B (EGB) en el Hospital “Doce de Octubre” de Madrid. Métodos: Se realizó un estudio observacional, descriptivo y transversal que evaluó el cumplimiento de la PAI frente al EGB en un total de 425 partos atendidos en el Hospital “Doce de Octubre” durante un período de tiempo comprendido entre el 10 de febrero y el 10 de marzo de 2004, a través de tres indicadores: porcentaje de mujeres con cribado realizado, porcentaje de mujeres con indicación de profilaxis efectuada y porcentaje de mujeres que recibieron la PAI entre aquellas a las que se indicó según el protocolo.Resultados: Se practicó la prueba de cribado al 73,7% de mujeres (308) que lo requerían. Se reflejó el resultado del exudado en el informe de seguimiento de la gestación en el 58,7% de los casos (181) y en el 90,9% de los pacientes (280) en los informes de ingreso en el hospital. Se indicó la profilaxis en el 89,4% de los casos (84) que lo requerían. Se administró en el 95,2% de las mujeres en las que estaba indicada.Conclusiones: La monitorización del programa de prevención establecido en el hospital “Doce de Octubre” permite establecer unas propuestas de mejora en la aplicación del mismo. Las propuestas principales son: realización del exudado vaginorrectal de modo universal a todas las gestantes entre las semanas 35 y 37 de gestación; protocolizar en la historia clínica la constatación del resultado del exudado y la edad gestacional en que se realizó; si está indicada la quimioprofilaxis, iniciar siempre su administración de forma inmediata tras el ingreso

Objective: To evaluate the protocol for intrapartum antibiotic prophylaxis (IAP) for prevention of perinatal group B streptococcal (GBS) infection at Hospital Doce de Octubre in Madrid, Spain.Methods: The authors carried out a descriptive, cross-sectional, observational study to evaluate compliance with the IAP for the prevention of GBS infection in 425 births occurring at Hospital Doce de Octubre between February 10 and March 10, 2004, in terms of three indicators: percentage of women screened, percentage of women in whom prophylaxis was indicated and percentage of women who received IAP among those in whom prophylaxis was indicated according to the protocol.Results: The screening test was performed in 73.7% (308) of the women who requested it. The results of the analysis of the exudates were recorded in the pregnancy follow-up in 58.7% of the cases (181) and in the hospital admission records in 90.9% (280). Prophylaxis was indicated in 89.4% (84) of the cases in which it was requested, and was administered in 95.2% of the cases in which it was indicated.Conclusiones: The monitoring of the prevention program underway at Hospital Doce de Octubre makes it possible to stablish proposals for improving the application of said program. The major proposals are: analysis of the recto-vaginal exudates in all pregnant women between weeks 35 and 37 of gestation; application of a protocol for the inclusion of the results of the analysis of the exudates and the gestational age at which it was performed in the clinical record; if chemoprophylaxis is indicated, administration should always begin immediately after admission