Impact of the COVID-19 pandemic on maternal anxiety during pregnancy: A prevalence study / Impacto de la pandemia por COVID-19 en la ansiedad materna durante el embarazo: Un estudio de prevalencia

Aim: To assess the impact of the coronavirus SARS-CoV-2 pandemic on the level of anxiety in low-risk pregnant women. Material and method: Epidemiological, descriptive, prevalence study. A total of 74 patients who underwent low risk antenatal controls during the state of alarm because of COVID-19, were included. They filled in the Hamilton Anxiety Rating Scale and a specific document about the pandemic. Clinical histories and different variables of clinical interest were reviewed and compiled, respectively. Results: Mean age was 34.05 years with average amenorrhoea of 28.17 weeks. A total of 77% of the sample presented symptoms and signs compatible with anxiety. Of these, 44.6% and 32.4% presented minor and major anxiety, respectively. Concern over the time of the birth and postpartum and fear of being at greater risk because of possible infection was present in 95.9% and 94.6% of the sample, respectively. A total of 93.2% of the sample was afraid of intrauterine virus transmission; 94.5% admitted fear over the neonatal consequences of infection. Conclusions: The pregnant women assessed had three times more anxiety during the COVID-19 pandemic. This incidence is independent of most study variables.(AU)

Objetivo: Evaluar el impacto de la pandemia del coronavirus SARS-CoV-2 en el nivel de ansiedad en mujeres embarazadas de bajo riesgo. Material y método: Estudio epidemiológico, descriptivo, de prevalencia. Se incluyeron un total de 74 pacientes que se sometieron a controles prenatales de bajo riesgo durante el estado de alarma por COVID-19. Completaron la escala de calificación de ansiedad de Hamilton y un documento específico sobre la pandemia. Se revisaron y recopilaron historias clínicas y diferentes variables de interés clínico, respectivamente. Resultados: La edad promedio fue de 34,05 años con amenorrea promedio de 28,17 semanas. El 77% de la muestra presentó síntomas y signos compatibles con la ansiedad. De estos, el 44,6 y el 32,4% presentaron ansiedad menor y mayor, respectivamente. La preocupación por el momento del parto y el puerperio y el temor de presentar mayor riesgo por una posible infección estuvieron presentes en el 95,9 y 94,6% de la muestra, respectivamente. El 93,2% de la muestra temía una posible transmisión del virus intrauterino; el 94,5% admitió tener miedo a las consecuencias neonatales tras una posible infección. Conclusiones: Las embarazadas evaluadas tenían tres veces más ansiedad durante la pandemia de COVID-19. Esta incidencia es independiente de la mayoría de las variables de estudio.(AU)

Impact of the COVID-19 pandemic on maternal anxiety during pregnancy: A prevalence study.

Aim: To assess the impact of the coronavirus SARS-CoV-2 pandemic on the level of anxiety in low-risk pregnant women. Material and method: Epidemiological, descriptive, prevalence study. A total of 74 patients who underwent low risk antenatal controls during the state of alarm because of COVID-19, were included. They filled in the Hamilton Anxiety Rating Scale and a specific document about the pandemic. Clinical histories and different variables of clinical interest were reviewed and compiled, respectively. Results: Mean age was 34.05 years with average amenorrhoea of 28.17 weeks. A total of 77% of the sample presented symptoms and signs compatible with anxiety. Of these, 44.6% and 32.4% presented minor and major anxiety, respectively. Concern over the time of the birth and postpartum and fear of being at greater risk because of possible infection was present in 95.9% and 94.6% of the sample, respectively. A total of 93.2% of the sample was afraid of intrauterine virus transmission; 94.5% admitted fear over the neonatal consequences of infection. Conclusions: The pregnant women assessed had three times more anxiety during the COVID-19 pandemic. This incidence is independent of most study variables.

Objetivo: Evaluar el impacto de la pandemia del coronavirus SARS-CoV-2 en el nivel de ansiedad en mujeres embarazadas de bajo riesgo. Material y método: Estudio epidemiológico, descriptivo, de prevalencia. Se incluyeron un total de 74 pacientes que se sometieron a controles prenatales de bajo riesgo durante el estado de alarma por COVID-19. Completaron la escala de calificación de ansiedad de Hamilton y un documento específico sobre la pandemia. Se revisaron y recopilaron historias clínicas y diferentes variables de interés clínico, respectivamente. Resultados: La edad promedio fue de 34,05 años con amenorrea promedio de 28,17 semanas. El 77% de la muestra presentó síntomas y signos compatibles con la ansiedad. De estos, el 44,6 y el 32,4% presentaron ansiedad menor y mayor, respectivamente. La preocupación por el momento del parto y el puerperio y el temor de presentar mayor riesgo por una posible infección estuvieron presentes en el 95,9 y 94,6% de la muestra, respectivamente. El 93,2% de la muestra temía una posible transmisión del virus intrauterino; el 94,5% admitió tener miedo a las consecuencias neonatales tras una posible infección. Conclusiones: Las embarazadas evaluadas tenían tres veces más ansiedad durante la pandemia de COVID-19. Esta incidencia es independiente de la mayoría de las variables de estudio.

Actualización del tratamiento de la insuficiencia venosa en la gestación / An update on the treatment of venous insufficiency in pregnancy

La insuficiencia venosa crónica es una situación patológica de larga duración derivada de alteraciones anatómicas o funcionales del sistema venoso que tiene como consecuencia la aparición de síntomas y signos físicos que afectan a una gran parte de la población y, debido a la propia fisiología del embarazo, especialmente a las gestantes. Los escasos estudios publicados sobre el uso de los tratamientos farmacológicos de la insuficiencia venosa en este grupo de la población dificultan en ocasiones el manejo de esta patología en la práctica clínica habitual. En este artículo realizamos una revisión de las últimas actualizaciones en el tratamiento de esta patología durante el embarazo, existiendo numerosas recomendaciones generales y algunas farmacológicas que podemos ofrecer con seguridad a la paciente embarazada

Chronic venous insufficiency is a long-term pathological condition resulting from anatomical or functional alterations of the venous system. This leads to the appearance of symptoms and physical signs that affect a large part of the population and particularly pregnant women, due to the physiology of pregnancy. The few published studies on the use of pharmacological treatments of venous insufficiency in this group of the population, often makes the management of this condition difficult in routine clinical practice. A review is presented in this article, with all the latest updates in the treatment of this condition during pregnancy. There are numerous general, and some pharmacological, recommendations, that we can safely offer the pregnant patient

[An update on the treatment of venous insufficiency in pregnancy]. / Actualización del tratamiento de la insuficiencia venosa en la gestación.

Chronic venous insufficiency is a long-term pathological condition resulting from anatomical or functional alterations of the venous system. This leads to the appearance of symptoms and physical signs that affect a large part of the population and particularly pregnant women, due to the physiology of pregnancy. The few published studies on the use of pharmacological treatments of venous insufficiency in this group of the population, often makes the management of this condition difficult in routine clinical practice. A review is presented in this article, with all the latest updates in the treatment of this condition during pregnancy. There are numerous general, and some pharmacological, recommendations, that we can safely offer the pregnant patient.

Displasia mesenquimal de placenta: revisión sistemática / Placental mesenchymal dysplasia: systematic review

Resumen OBJETIVOS: Describir las características clínicas y las repercusiones perinatales de la displasia mesenquimal de placenta. MÉTODO: Revisión sistemática de la bibliografía disponible en las bases PubMed, EMBASE y Scopus en donde se buscaron los términos "displasia mesenquimal de placenta" y "pseudomola parcial". Criterios de inclusión: artículos de casos o series que contuvieran los apartados de diagnóstico histológico confirmado y reporte de al menos 75% de los datos clínicos establecidos. Como ejemplo se comunica un caso clínico de los autores. RESULTADOS: Se encontraron 202 artículos, casi todos de casos clínicos o series de casos. Se descartaron los duplicados y los que no cumplieron los criterios de inclusión; finalmente la serie quedó formada por 88 publicaciones con 104 casos clínicos. CONCLUSIONES: La displasia mesenquimal de placenta es una anomalía poco conocida, infradiagnosticada y poco publicada. En la ecografía simula una mola parcial, casi siempre con un cariotipo fetal diploide y altas concentraciones de alfafetoproteína. Es frecuente su asociación con prematurez, rotura prematura de membranas, retraso del crecimiento intrauterino, malformaciones fetales, síndrome de Beckwith-Wiedemann y muerte perinatal.

Abstract OBJECTIVES: To describe the clinical characteristics and perinatal outcomes of placental mesenchymal dysplasia. MATERIALS AND METHODS: Systematic review of the medical literature under the terms "placental mesenchymal dysplasia", "partial pseudomole". Inclusion criteria for the review were: confirmed histological diagnosis and presence of at least 75% of established clinical data. The systematic review was performed by searching for cases or series published in PubMed, EMBASE, Scopus databases. We present 1 clinical case of our institution. RESULTS: A total of 202 articles were found, most of them corresponding to clinical cases or case series. Duplicates were discarded and those that did not meet inclusion criteria were excluded. Finally, the series consisted of 88 publications with 104 clinical cases. CONCLUSIONS: Placental mesenchymal dysplasia is a poorly understood, underdiagnosed, and poorly published clinical entity. Placental mesenchymal dysplasia echocardiography simulates a partial spring, but usually presents a diploid fetal karyotype and elevated levels of alpha-fetoprotein. It is frequently associated with prematurity, premature rupture of membranes, intrauterine growth retardation, fetal malformations, Beckwith-Wiedemann syndrome and perinatal death.

Adecuación del cribado de diabetes mellitus en mujeres con antecedente de diabetes gestacional / Suitability of screening for diabetes mellitus in women with a history of gestational diabetes

Objetivo. Evaluar a largo plazo la adecuación del cribado de diabetes mellitus de tipo 2 en mujeres con diagnóstico previo de diabetes gestacional en Atención Primaria. El objetivo secundario fue determinar los factores clínicos que modifican la adecuación del cribado. Material y métodos. Estudio observacional de cohortes. Se seleccionó al total de pacientes con el diagnóstico de diabetes gestacional durante de los años 2000-2009 (n=470) en el Complexo Hospitalario Universitario de Ourense. Se procedió a la revisión de la historia clínica electrónica, valorando la existencia y el año de realización de la última glucemia basal. El tiempo medio de seguimiento fue de 12,9 años. Se consideró cribado adecuado la constancia en la historia clínica de una glucemia basal en los últimos 3 años. Se analizaron las siguientes variables: adecuación del cribado de diabetes mellitus de tipo 2, edad, índice de masa corporal, diabetes gestacional en más de una gestación, medio rural/urbano. Se realizó el análisis descriptivo de los datos. Para la determinación de las diferencias entre subgrupos se utilizó la prueba Chi2 y la prueba t de Student. Se consideró significación estadística p<0,05. Resultados. El control a largo plazo de estas pacientes fue muy irregular. Solo el 67,0% del grupo a estudio realizó cribado de diabetes mellitus de tipo 2. Ni la edad, ni el índice de masa corporal, ni el lugar de residencia, ni el año del diagnóstico modificaron el grado de seguimiento. Las pacientes con más de un episodio de diabetes gestacional presentaron un control glucémico posterior que alcanzó el 94,1%. Conclusión. La adecuación del cribado en nuestra área es muy irregular y altamente mejorable (AU)

Objective. To assess long-term suitability of screening for type 2 diabetes mellitus in women with a previous diagnosis of gestational diabetes in Primary Care. The secondary objectives were to determine if there were clinical factors that modified the usefulness of the screening. Material and methods. An observational cohort type study was performed, which included all patients with the diagnosis of gestational diabetes during the years 2000 to 2009 (n=470) in the University Hospital Complex of Ourense. The electronic medical records were reviewed to assess the existence of gestational diabetes and the year of the last fasting blood glucose. The mean follow-up time was 12.9 years. The screening for evidence of a fasting blood glucose in the last 3 years was considered adequate. The following variables were analysed: adequacy of screening for type 2 diabetes mellitus, age, body mass index, gestational diabetes in more than one gestation, and rural/urban environment. A descriptive analysis of the data was performed, using Chi2 and Student's t-test to determine differences between subgroups. Statistical significance was considered as P<.05 Results. The long-term monitoring of these patients was very irregular. Only 67.08% of the study group underwent diabetes mellitus type 2 screening. The level of follow-up was not associated with age, BMI, the place of residence, or the year of diagnosis. In patients with more than one episode of gestational diabetes, subsequent blood glucose control was achieved in 94.1%. Conclusion. The adequacy of the screening in our area is very irregular and highly improvable (AU)

[Suitability of screening for diabetes mellitus in women with a history of gestational diabetes]. / Adecuación del cribado de diabetes mellitus en mujeres con antecedente de diabetes gestacional.

OBJECTIVE: To assess long-term suitability of screening for type 2 diabetes mellitus in women with a previous diagnosis of gestational diabetes in Primary Care. The secondary objectives were to determine if there were clinical factors that modified the usefulness of the screening. MATERIAL AND METHODS: An observational cohort type study was performed, which included all patients with the diagnosis of gestational diabetes during the years 2000 to 2009 (n=470) in the University Hospital Complex of Ourense. The electronic medical records were reviewed to assess the existence of gestational diabetes and the year of the last fasting blood glucose. The mean follow-up time was 12.9 years. The screening for evidence of a fasting blood glucose in the last 3 years was considered adequate. The following variables were analysed: adequacy of screening for type 2 diabetes mellitus, age, body mass index, gestational diabetes in more than one gestation, and rural/urban environment. A descriptive analysis of the data was performed, using Chi2 and Student's t-test to determine differences between subgroups. Statistical significance was considered as P<.05 RESULTS: The long-term monitoring of these patients was very irregular. Only 67.08% of the study group underwent diabetes mellitus type 2 screening. The level of follow-up was not associated with age, BMI, the place of residence, or the year of diagnosis. In patients with more than one episode of gestational diabetes, subsequent blood glucose control was achieved in 94.1%. CONCLUSION: The adequacy of the screening in our area is very irregular and highly improvable.

Hemorragia posparto secundaria o tardía / Secondary postpartum haemorrhage

RESUMEN ANTECEDENTES: la hemorragia posparto, secundaria o tardía, es un tema que requiere estudiarse aún más; quizá no ha despertado el interés suficiente por su baja asociación con la mortalidad materna, pero sí alta morbilidad que puede determinar múltiples complicaciones y necesidad de hospitalización. OBJETIVO: con base en la evidencia científica disponible profundizar en el conocimiento de las diferentes condiciones que forman parte del concepto hemorragia posparto secundaria. METODOLOGÍA: estudio retrospectivo mediante la búsqueda de artículos originales y revisiones sistemáticas en: PubMed, EMBASE, ScienceDirect y Biblioteca Cochrane. Para todos los sitios se utilizaron las palabras clave: "secondary postpartum hemorrhage", "delayed postpartum hemorrhage". Se seleccionaron los artículos de mayor nivel de evidencia. CONCLUSIONES: a diferencia de lo que ocurre en la hemorragia posparto primaria, la hemorragia posparto tardía rara vez amenaza la vida de la mujer sin por ello dejar de afectarla seriamente, cuando así sucede suele deberse a padecimientos poco frecuentes y conocidos. En estos últimos es prioritario el diagnóstico temprano junto con el tratamiento multidisciplinario.

ABSTRACT BACKGROUND: Secondary or late postpartum hemorrhage is a disease poorly represented in the literature and research studies; probably due to low association with maternal mortality, but high morbidity it implies that can determine a number of complications as well as increased hospital admissions. OBJECTIVE: To deepen the knowledge of the different entities that are part of postpartum hemorrhage secondary concept based on the available scientific evidence. METHODOLOGY: Was a search for original articles and systematic reviews published in the databases: PubMed, EMBASE, Cochrane Library and ScienceDirect. Included in the different search engines, keywords: "secondary postpartum hemorrhage", "delayed postpartum hemorrhage". Greater level of evidence selected and collected information from 52 documents CONCLUSIONS: Unlike what happens in primary postpartum hemorrhage, postpartum hemorrhage late rarely life threatening women but sometimes it can seriously compromise when this occurs often due to rare diseases and little known. In the latter, early diagnosis is a priority with a multidisciplinary approach.

Factores clínicos y bioquímicos de riesgo de hipertensión arterial en mujeres con diagnóstico previo de estados hipertensivos del embarazo / Clinical and biochemical risk factors for hypertension in women with previous diagnosis of hypertensive states of pregnancy

Resumen: OBJETIVO: determinar la incidencia, a largo plazo, de hipertensión arterial en mujeres con diagnóstico previo de estados hipertensivos del embarazo e identificar los factores clínicos y bioquímicos gestacionales que incrementan el riesgo posterior de padecer hipertensión. MATERIALES Y MÉTODOS: estudio de casos y controles anidados en una cohorte. Se estudiaron las pacientes en quienes se estableció el diagnóstico de estados hipertensivos del embarazo entre 2000 y 2010. Grupo 1: mujeres con diagnóstico de estados hipertensivos del embarazo y posterior inicio de hipertensión arterial. Grupo 2: control de mujeres con diagnóstico de estados hipertensivos del embarazo que durante el tiempo de seguimiento no padecieron hipertensión arterial. Para determinar la potencial asociación entre las variables de estudio con la hipertensión arterial posterior se realizaron pruebas paramétricas y no paramétricas, y para detectar la relación o interacción entre las diferentes variables se estudiaron sus correlaciones. RESULTADOS: se registraron 121 pacientes con estados hipertensivos del embarazo. La incidencia posterior de hipertensión arterial fue de 41.3%. El tiempo promedio transcurrido hasta el diagnóstico de hipertensión arterial fue de 11.7 años (IC 95%: 10.6-12.9). El único factor de riesgo de hipertensión arterial posterior a la gestación índice fue la multiparidad. Ninguno de los demás parámetros estudiados tuvo significación estadística. CONCLUSIONES: los estados hipertensivos del embarazo son un factor de riesgo para el posterior desarrollo de hipertensión arterial. No es posible determinar, con base en los parámetros clínicos o bioquímicos gestacionales, cuáles presentarán una mayor incidencia de hipertensión futura. Todas las gestantes con esta patología deben ser informadas del riesgo hipertensivo a largo plazo.

Abstract: OBJECTIVE: To determine the incidence of long-term hypertension in women who were previously diagnosed of hypertensive pregnancy states. Secondarily identify clinical and biochemical gestational factors that increase the subsequent risk of hypertension. MATERIAL AND METHODS: Study of nested cases and controls in a cohort. Patients were selected who were diagnosed of "hypertensive pregnancy disorders" between 2000 and 2010 and two subgroups were differentiated: Group cases: women diagnosed with "hypertensive pregnancy disorders" and subsequent development of hypertension. - Control group: women with the diagnosis of "hypertensive pregnancy disorders" and who at the time of follow-up did not develop hypertension. The mean time elapsed until the diagnosis of hypertension was 11.79 years (95% CI: 10.6-12.90). Parametric and non-parametric tests were performed to determine the Potential association between the study variables with the later hypertension. In addition, to detect the relationship or interaction between the different variables, their correlations were studied. The influence of the different gestational variables on the subsequent occurrence of arterial hypertension as a function of the time parameter was obtained through the Kaplan Meier survival study and the COX models were applied for the categorical variables. RESULTS: We studied 121 patients diagnosed with "hypertensive pregnancy disorders". The subsequent incidence of hypertension was 41.32%. As a risk factor for posterior hypertension in gestation index, only multiparity was identified. None of the other parameters studied presented statistical significance. CONCLUSIONS: The hypertensive pregnancy disorders are a risk factor for the subsequent development of hypertension. It is not possible to determine, based on clinical or biochemical gestational parameters, which will present a higher incidence of future hypertension. All pregnant women with this pathology should be informed of the long-term hypertensive risk.

Retraso de crecimiento intrauterino severo: ¿es posible su cribado en el primer trimestre de gestación? / Severe intrauterine growth retardation: Is screening feasible in the first trimester of pregnancy?

Objetivo: Determinar si existe una relación entre los niveles plasmáticos de proteína A asociada a la gestación (PAPP-A) expresada en múltiplos de la mediana (MoM) con el retraso de crecimiento intrauterino (RCIU), independientemente de otros parámetros clínicos o ecográficos. Valorar si los valores de PAPP-A son capaces de predecir el riesgo de RCIU. Material y método: Estudio epidemiológico, observacional, analítico, tipo casos y controles, desarrollado entre enero de 2012 y septiembre de 2013 con pacientes del Complexo Hospitalario Universitario de Ourense. El tamaño muestral fue de 138 gestantes y sus respectivos recién nacidos. Para la determinación de las diferencias en las PAPP-A entre casos y controles se utilizó la prueba U de Mann-Whitney. Se realizó la representación gráfica mediante modelos GAM con respuesta gaussiana y binaria para conocer el comportamiento de los valores de la PAPP-A con respecto a los pesos de los recién nacidos y el riesgo de presentar un feto con RCIU respectivamente. Los valores de la PAPP-A fueron obtenidos de las muestras extraídas para el cribado combinado del primer trimestre entre la semana 11 + 3 y 13 + 5 de amenorrea. El estudio estadístico se realizó con el paquete SPSS 15.0 y Epidat 3.0. Se consideró significación estadística para una p < 0,05. Resultados: Los valores de PAPP-A expresados en MoM se comportan como un predictor independiente de retraso de crecimiento fetal, sin estar influidos por factores maternos o parámetros ecográficos fetales precoces. Un valor de PAPP-A (MoM) por debajo de 0,33 MoM puede predecir pesos fetales inferiores al percentil 3, para un intervalo de confianza al 95% (0,24-0,56). Un valor de PAPP-A (MoM) inferior a 0,4 MoM tiene un riesgo relativo de RCIU del 2,50; superior, incluso, al que presenta el consumo de tabaco en la gestación (RR: 1,7). Conclusiones: El cribado combinado de cromosomopatías fetales es actualmente una práctica habitual en la mayoría de los hospitales. A partir de los datos que este nos ofrece, es posible seleccionar a un grupo de pacientes con mayor riesgo de alteraciones de la placentación, sin que ello suponga un incremento del gasto sanitario, facilitando la optimización de los recursos materiales y humanos

Objective: To determine if there is a relationship between pregnancy-associated plasma protein-A (PAPP-A) levels, expressed in multiples of the median (MoM), and intrauterine growth retardation (IUGR) independently of other clinical or ultrasound parameters. To assess whether PAPP-A values are able to predict the risk of IUGR. Material and method: An epidemiological, observational, analytical, case-control study was conducted between January 2012 and September 2013 in patients attending the University Hospital Complex of Ourense. The sample consisted of 138 pregnant women and their respective newborns. Differences in PAPP-A between cases and controls were determined by the Mann-Whitney U test. Graphs were plotted using GAM models with Gaussian and binary response to determine the behavior of PAPP-A values with respect to birthweight and the risk of intrauterine growth restriction, respectively. PAPP-A values were obtained from samples taken for combined first trimester screening at weeks 11 + 3 and 13 + 5 of amenorrhea. The statistical analysis was conducted with the statistical package SPSS 15.0 and Epidat 3.0. Statistical significance was set at P < .05. Results: PAPP-A values, expressed as MoM, behaved as an independent predictor of IUGR, without being influenced by maternal factors or early fetal ultrasound parameters. A PAPP-A value (MoM) below 0.33 MoM predicted fetal weights below the 3rd percentile for a 95% confidence interval (0.24-0.56). A PAPP-A value (MoM) of less than 0.4 MoM had a relative risk of IUGR of 2.50, which was even higher than that posed by smoking during pregnancy (RR: 1,7). Conclusion: Combined screening of fetal chromosomal abnormalities is currently routine practice in most hospitals. The data provided by this screening can be used to select a group of patients at increased risk of alterations of placentation, without increasing health costs, thus facilitating the optimization of material and human resources

[Incidence and clinical risk factors for the development of diabetes mellitus in women with previous gestational diabetes]. / Incidencia y factores clínicos de riesgo de diabetes mellitus en mujeres con diabetes gestacional previa.

BACKGROUND: Gestational diabetes is considered a variant of diabetes mellitus as they share a common pathophysiological basis: insulin resistance in target and insufficient secretion of it by pancreatic p-cell bodies. Pregnancy is a unique physiological situation provides an opportunity to identify future risk of diabetes mellitus. OBJECTIVE: To determine the long-term incidence of diabetes mellitus in women who have previously been diagnosed with gestational diabetes and identifying clinical risk factors for developing the same. METHODS: nested case-control cohort study. 671 patients between 1996 and 2009 were diagnosed with gestational diabetes were selected. The incidence of diabetes mellitus was estimated and 2 subgroups were formed: Group A or cases: women who develop diabetes mellitus after diagnosis of gestational diabetes. Group B or control: random sample of 71 women with a history of gestational diabetes in the follow-up period remained normoglycemic. Both groups were studied up to 18 years postpartum. By studying Kaplan Meier survival of the influence of different gestational variables it was obtained in the later development of diabetes mellitus with time parameter and COX models for categorical variables were applied. Significant variables were studied by multivariate Cox analysis. In all analyzes the Hazard ratio was calculated with confidence intervals at 95%. RESULTS: The incidence of diabetes mellitus was 10.3% in patients with a history of gestational diabetes. They were identified as risk factors in the index pregnancy to later development of diabetes mellitus: greater than 35 and younger than 27 years maternal age, BMI greater than 30 kg/m2, hypertensive disorders of pregnancy, insulin therapy, poor metabolic control and more than a complicated pregnancy with gestational diabetes. CONCLUSIONS: Clinical factors have been identified in the pregnancy complicated by gestational diabetes that determine a higher probability of progression to diabetes mellitus in the medium and long term.

[Maternal serum 25-hydroxy vitamin D levels in the first trimester and adverse gestational outcomes]. / Concentraciones séricas maternas de 25-hidroxivitamina D en el primer trimestre y resultados adversos gestacionales.

BACKGROUND: Some disorders of pregnancy and newborn have been associated with vitamin D deficiency (25 (OH) D) in maternal serum. The pathophysiology of this relationship is unknown today. OBJECTIVE: The aim of this study was to determine whether serum levels of vitamin D at the beginning of pregnancy are associated with gestational diabetes, hypertensive disorders of pregnancy, preterm birth and fetal growth restriction. MATERIAL AND METHOD: We conducted a prospective cohort study in 370 pregnant women at low obstetric risk randomly selected in our area (latitude 42 ° 20'N). The level of 25-hydroxy vitamin D was determinate between 8 and 14 weeks of pregnancy. We studied the relationship between the status of vitamin D and gestational diabetes, preeclampsia, preterm birth, intrauterine growth restriction and small for gestational age. The statistic analysis was performed using SPSS 15.0 and 3.1 Epidat programs. RESULTS: The prevalence of vitamin D deficiency in pregnant women in this serie was 96.8%, 34.6% had severe deficiency. After adjusting for maternal and seasonal variables, we haven't found association between first trimester maternal serum vitamin D levels and pregnancy outcomes studied. CONCLUSIONS: The pregnancy outcome was independent of the first trimester maternal serum 25(OH)D status.

[Perinatal outcomes of twin pregnancies conceived through in vitro fertilization versus spontaneous]. / Resultados perinatales de las gestaciones gemelares concebidas mediante fecundación in vitro versus espontáneas.

OBJECTIVE: Determine maternal and fetal characteristics of in vitro fertilization twin pregnancies in comparison with spontaneous twin pregnancies. MATERIAL AND METHODS: Retrospective historical cohort study between 2011 and 2013. Statistical analysis was performed with SPSS 15.0 program and Epidat 3.0. A value of p<0.05 was considered statistically significant. RESULTS: 96 twin pregnancies met inclusive criteria with an incidence of 2.01%, of which 54.16% were spontaneous twin pregnancies and 45.83% in vitro fertilization twin pregnancies. Mean maternal age at delivery was higher in vitro fertilization twin pregnancies (p=0.004). The primigravidae were more frequent in vitro fertilization twin pregnancies group (p<0.001). Monochorionic pregnancies percentage was superior in spontaneous pregnancies (p=0.009). Amenorrhea at delivery was not a significant difference between cohorts (p=.9). Preterm rate was superior in spontaneous twin pregnancies group (p=0.003). However, "great preterm deliveries" were higher in in vitro fertilization twin pregnancies (p<0.001). Significant differences were not observed in fetal presentation at delivery, first-born child birth-weight or intrauterine growth retardation between the two groups. Nevertheless, the mean birth-weight of second-born spontaneously conceived twins was higher than second-born twins of the in vitro fertilization conceived group (p=0.027). Gestational pathology presented the same distribution in both cohorts. There was no significant difference in the mode of delivery between the two groups. Total perinatal mortality rate was 20,83%o and comprised 2 first born twins and 2 second born twins. Three of the stillbirths came from the spontaneous pregnancies group and one from the in vitro fertilization group. CONCLUSIONS: Perinatal death was secondary to stillbirths, which we found higher in spontaneously conceived twin pregnancies due to higher number of monochorionic pregnancies.

Niveles de proteína placentaria A asociada a la gestación: Predictor de macrosomía fetal en gestantes no diabéticas / Levels of pregnancy-associated plasma protein-A: A predictor of fetal macrosomia in non-diabetic women

Objetivos: Determinar si los niveles plasmáticos de proteína A asociada a la gestación (PAPP-A) expresada en múltiplos de la mediana (MoM) se pueden emplear para predecir la macrosomía fetal, independientemente de otros parámetros clínicos o ecográficos. Determinar el riesgo que puede presentar una gestante de tener un feto macrosómico en función de los valores de la PAPP-A. Material y métodos Estudio epidemiológico, observacional, analítico, tipo casos y controles, desarrollado entre junio de 2011 y julio de 2012 con pacientes del Complexo Hospitalario Universitario de Ourense. Resultados Los resultados del presente estudio apuntan a que los niveles maternos de PAPP-A (MoM) se asocian positivamente al peso fetal. Por cada punto que se incrementa la PAPP-A, aumenta 2,6 veces el riesgo de tener un recién nacido macrosómico. Conclusiones Los valores de PAPP-A expresados en MoM se comportan como un predictor independiente de macrosomía fetal, sin estar influidos por factores maternos o parámetros ecográficos fetales precoces. Un valor de PAPP-A (MoM) por encima de 1,89 puede predecir la macrosomía fetal con una especificidad superior al 80%.Los valores de PAPP-A (MoM) son capaces de discriminar entre un futuro recién nacido de peso normal y macrosómico en el 75% de los caso

Objectives: To determine whether plasma levels of pregnancy-associated plasma protein A (PAPP-A) expressed in multiples of the median (MoM) can be used to predict fetal macrosomia, independently of other clinical or ultrasound parameters, and to determine the risk of having a macrosomic fetus in pregnant women, based on PAPP-A values. Material and methods: An epidemiological, observational, analytical, case-control study was performed between June 2011 and July 2012 in patients at the the University Hospital of Ourense. Results: The results of this study suggest that maternal levels of PAPP-A (MoM) are positively associated with fetal weight. A 2.6-fold increment in the risk of having a macrosomic neonatewas found for each point-increase in PAPP-A. Conclusions: PAPP-A values expressed in MoM are an independent predictor of fetal macrosomy and are not influenced by maternal factors or early fetal ultrasound parameters. PAPP-A (MoM)values exceeding 1.89 can predict fetal macrosomia with a specificity of above 80%. In 75%of cases, PAPP-A (MoM) values discriminate between future neonates with normal weight and those with macrosomia

Síntomas y signos digestivos durante la gestación: náuseas y vómitos/hiperemesis gravídica / Gastrointestinal signs and symptoms during pregnacy: nausea and vomiting / hyperemesis gravidarum

Entre los simples vómitos gestacionales y la HG existe una multitud de cuadros con grados de intensidad intermedios, sin que se observen claras diferencias etiopatogénicas. Las náuseas y vómitos de la gestación (NVG) son una situación fisiológica frecuente en la embarazada. Suelen ser esporádicos, preferentemente matutinos, con capacidad de alterar la calidad de vida de la gestante pero sin repercusión en su estado metabólico. Cuando el cuadro se agrava presentando vómitos continuos e intensos que imposibilitan la correcta alimentación de la gestante nos encontramos ante una hiperemesis gravídica (HG), que puede llevar a un cuadro de deshidratación, deficiencias nutricionales y alteración metabólica, requiriendo en muchas ocasiones tratamiento hospitalario para corregir las alteraciones hidroelectrolíticas presentes y múltiples complicaciones tanto digestivas como neurológicas(AU)

Nausea and vomiting in pregnancy is a common physiological condition in pregnant women. It is usually sporadic, often in the morning, which can affect the quality of life of the pregnant woman without any change in her metabolic state. When the condition is aggravated, with continuous and intense vomiting which makes it impossible to follow a correct diet, we are faced with a hyperemesis gravidarum (HG) which can lead to dehydration, nutritional deficiencies and metabolic changes. On many occasions this may require hospital treatment to correct the water and electrolyte changes and the multiple digestive tract and neurological complications. There is a multitude of conditions between simple gestational vomiting and HG with intermediate levels of intensity, without any clear differences in pathological origin(AU)

Cáncer de endometrio en la premenopausia / Endometrial carcinoma in premenopausal women

El cáncer de endometrio es la neoplasia genital más frecuente. Su incidencia es mayor en pacientes de más de 50 años, estimándose que menos del 25% ocurre en la premenopausia. Realizamos un estudio retrospectivo descriptivo de los cánceres de endometrio en pacientes premenopáusicas diagnosticadas en nuestro Servicio, de cara a conocer sus características epidemiológicas, clínicas, diagnósticas y terapéuticas (AU)

Endometrial cancer is the most frequent genital neoplasm. The incidence of this tumor is higher in women aged more than 50 years old and less than 25% of cases occur in premenopausal women. To determine the epidemiological, clinical, diagnostic and therapeutic features of these tumors, we performed a retrospective, descriptive study of endometrial cancers in premenopausal women diagnosed in our service (AU)

Sangrado cíclico en foco endometriósico en cicatriz de cesárea / Cyclic bleeding in cesarean scar endometriotic focus

Presentamos el caso clínico de una paciente con endometriosis extragenital localizada a nivel cutáneo en la zona de cicatriz de intervención de cesárea. Tras el estudio de la paciente, no se encontraron lesiones endometriósicas activas a nivel genital (AU)

We present the clinical case of a female patient with extragenital endometriosis located on the cutaneous level in the area of a cesarean surgical scar. After the study of the patient, no active endometriotic lesions were found on the genital level (AU)

Gonococia diseminada y gestación / Disseminated gonococcal infection and pregnancy

Presentamos el caso clínico de una gestante del tercer trimestre con meningitis por Neisseria gonorrhoeae, entidad poco frecuente y de difícil diagnóstico. En nuestro caso sólo se pensó en esta entidad ante el resultado del cultivo de líquido cefalorraquídeo, si bien se había tratado como meningitis bacteriana de forma empírica. Realizamos una revisión de la literatura médica, encontrando pocos casos publicados de esta forma de gonococia diseminada en gestantes (AU)

We present the case of a woman in the third trimester of pregnancy with Neisseria gonorrhoeae meningitis, a highly infrequent entity that is difficult to diagnose. In our patient, we only considered this entity after learning the results of cerebrospinal fluid culture, although the patient had been treated empirically for bacterial meningitis. We review the literature on the topic, which contains few cases of disseminated gonococcal infection in pregnant women (AU)

Feto acardio en aborto gemelar / Acardiac fetus in intrauterine fetal demise in a twin pregnancy

Se trata de una entidad poco frecuente que complica las gestaciones múltiples, en mayor medida las gemelares univitelinas, aunque puede afectar también a las monocoriales dicigóticas, las triples e incluso a embarazos únicos. La presencia del feto acardio supone una sobrecarga para el gemelo donante que tiene que mantener la perfusión propia y la del gemelo parásito. Se presenta el caso clínico de una paciente con gestación gemelar (no controlada) con diagnóstico de muerte fetal intraútero de ambos gemelos, uno de ellos un feto acárido (AU)

Acardiac fetus is a rare entity that complicates multiple pregnancies. Occurrence is more frequent in monozygotic twin pregnancies but monochorionic dizygotic, triple and even singleton pregnancies may also be affected. The acardiac fetus acts as a parasite on the pump twin, which must provide a blood supply for the perfused fetus. We present the case of a patient with a twin pregnancy (without prenatal monitoring) with a diagnosis of intrauterine fetal demise in both twins, one of which was an acardiac fetus (AU)

Depresión en el posparto inmediato: factores de riesgo / Depression in the immediate postpartum: risk factors

El test Edinburgh Postnatal Depression Scale (EPDS) se puede emplear como método de cribado de la depresión posparto (DPP); al aplicarlo en el segundo-tercer día del puerperio presenta un alto valor predictivo positivo, con una sensibilidad del 80%. Las pacientes con EPDS positivo en el puerperio inmediato, deberían ser candidatas a una evaluación posterior cara al diagnóstico precoz de la DPP. Según nuestro trabajo, las mujeres del grupo de edad mayor de 35 años que finalizan su gestación mediante intervención de cesárea y cuyos hijos requieren ingreso en la unidad de neonatología son las que presentan mayor probabilidad de desarrollar una DPP, con un riesgo relativo 6 veces superior, por lo que estas pacientes deberían revaluarse en el puerperio tardío (AU)

The Edinburgh Postnatal Depression Scale (EPDS) can be used to screen for mothers with postnatal depression. The test is applied 3-4 days after delivery and has a high positive predictive value and a sensitivity of 80%. Patients with a positive EPDS score in the immediate postpartum should undergo subsequent evaluation to establish an early diagnosis of postnatal depression. In our study, the women most likely to develop postnatal depression were those aged more than 35 years who underwent cesarean section and whose infants required admission to the neonatal unit. These women had a relative risk 6 times higher than that of other women. Consequently, these patients should be reevaluated in the late postpartum period (AU)