Fetal Bladder Rupture as a Complication of Adjunctive Therapy in Severe Maternal SARS-CoV-2 Pneumonia.

INTRODUCTION: A case of spontaneous fetal bladder rupture occurring in a woman with SARS-CoV-2 pneumonia receiving invasive ventilatory support is reported. CASE: A 33-year-old woman was admitted at 30.6 weeks' gestation with the diagnosis of severe pneumonia due to COVID-19. The patient required invasive mechanical ventilation on day 2. Propofol, fentanyl, midazolam, and dexmedetomidine were administered for sedation, pain relief, and to improve patient-ventilator interaction. A bedside ultrasound on day 3 revealed fetal megacystis. Follow-up scan two days later showed urinary ascites and a collapsed bladder. The diagnosis of fetal bladder rupture was confirmed postpartum. Bladder repair was performed on day 5, with an uneventful recovery. DISCUSSION: Transplacental transfer of opioids during invasive ventilatory support in pregnancy may cause acute fetal bladder atony leading to severe urine retention and, potentially, bladder rupture. This can be a serious complication of adjunctive therapy in women with severe SARS-CoV-2 pneumonia.

Hospitalisation in high-risk pregnancy patients: is prenatal attachment affected?

Objective: To compare prenatal attachment in women hospitalised due to high-risk pregnancy with prenatal attachment in non-hospitalised patients. To describe the impact of social support, socio-demographic factors and the nature of the pregnancy on prenatal attachment, anxiety and depression. Study Design: An exploratory, cross-sectional and descriptive study utilising the Maternal Antenatal Attachment Scale, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The sample comprised 80 hospitalised and 88 non-hospitalised patients. Result: No difference in prenatal attachment was found between the two groups. The hospitalised group presented higher levels of depressive symptomatology and anxiety. Social support had a significant effect on the hospitalised group, improving attachment quality. Conclusion: Incorporation of members of the patient's support network may help to improve quality of prenatal attachment during hospitalisation. Detection and treatment of anxiety and/or depression in hospitalised patients is recommended given their impact on the mental health of mother and baby.

Inhibición de marcapasos unipolares por miopotenciales / Inhibition of unipolar pacemakers by myopotentials

Se estudiaron 23 pacientes (con edad promedio 62 años) con marcapaso (MP) VVI, unipolar, sometidos a un ejercicio isométrico de sus pectorales. Se analizó incidencia y duración de la inhibición MP, síntomas y fuerza requerida para la inhibición. La contracción muscular se determinó con electromiograma integrado, expresándose en Unidad de Fuerza Mantenida (UFM), definida como la tensión de 52 libras mantenidas durante 1 segundo. 21 (91%) tuvieron inhibición MP, de duración entre 0.4 y 6.8 segundos. 83% de los pacientes requirieron 5 ó más UFM para inhibir el MP. Sólo 1 paciente tuvo mareos. Se concluye que la inhibición por miopotenciales, en pacientes con MP VVI unipolares, es altamente frecuente, especialmente si la contracción muscular es de duración y magnitud suficientes, y que, la inhibición producida, en general, es transitoria y asintomática