Atosiban versus ritodrine as tocolytics in external cephalic version.

OBJECTIVE: To assess the efficacy of atosiban versus ritodrine as tocolytics in external cephalic version (ECV). MATERIALS AND METHODS: A prospective comparative trial was carried out in a tertiary hospital. 430 women with singleton breech pregnancies ≥36 weeks were recruited for ECV, 215 with ritodrine and 215 with atosiban as tocolytic agents. The efficacy, complications and perinatal outcomes were compared between both groups. The associations between variables were analyzed using the chi-square test (χ2) (qualitative), Student's t test (quantitative, parametric) or Mann-Whitney test (nonparametric). Statistical significance was established as p < .05. RESULTS: The overall ECV success rate was 47.9% (206/430), 46.0% in the atosiban group (99/215) and 49.8% in the ritodrine group (107/215). This difference showed no statistical significance (p = .440). A higher rate of uterine contractions after the maneuver was observed in the atosiban group (34.4 versus 22.8%; p = .008), but without clinical relevance. Perinatal outcomes were similar in both groups, with no significant differences. CONCLUSION: Atosiban and ritodrine showed similar efficacy as tocolytic agents in ECV, with no differences in complications and perinatal outcomes between these two agents.

SARS-CoV-2 infection in early first-trimester miscarriages: a prospective observational study.

RESEARCH QUESTION: Is there an association between SARS-CoV-2 infection and first-trimester miscarriage? DESIGN: This multicentre prospective study included a cohort of women with first-trimester miscarriages registered consecutively by seven Spanish hospitals where universal PCR screening for SARS-CoV-2 infection was implemented with both miscarriages and deliveries. The incidence of SARS-CoV-2 infection among women with first-trimester miscarriages was compared with the rate registered in women on admission to the delivery ward within the same time frame using a mixed-effects Poisson regression analysis, considering 'hospital' as random effect. The characteristics of SARS-CoV-2 positive and negative patients who miscarried were compared through two-sided univariable analyses. RESULTS: A total of 301 miscarriages were registered, 11 (3.7%) to SARS-CoV-2 infected and 290 to non-infected women. In the same time frame as the miscarriages, 1936 deliveries were registered, 44 [2.3%] of them were SARS-CoV-2 infected. No differences in terms of SARS-CoV-2 infection incidence were observed between infected miscarriages and infected deliveries (P = 0.233). Regarding the differences observed between miscarriages in SARS-CoV-2 positive and negative women, more inevitable miscarriages occurred in the group of infected women (36.4% versus 16.5% in non-infected women; P = 0.004), and there was greater surgical management of miscarriages (27.3% versus 8.2% in non-infected women; P = 0.036), probably in line with the greater number of inevitable miscarriages observed in this group. CONCLUSIONS: No association between SARS-CoV-2 infection and risk of first-trimester miscarriage was observed; however, the type of miscarriage seems to differ between SARS-CoV-2 positive and negative women, with inevitable miscarriage being more frequent among infected women.

Piometra secundario a estenosis cervical en una adolescente / Pyometra secondary to cervical stenosis in an adolescent

INTRODUCCIÓN: El piometra es una afección infrecuente, pero grave, que en general se diagnostica en mujeres posmenopáusicas. En adolescentes es sumamente raro, y si se acompaña de amenorrea primaria hay que tener en mente las anomalías congénitas. CASO CLÍNICO: Adolescente de 13 años, sin antecedentes personales de interés salvo amenorrea primaria, que acude con abdomen agudo y es intervenida por una peritonitis difusa causada por un piometra secundario a disgenesia (estenosis) cervical congénita. Se realizó dilatación cervical y se dejó una sonda vesical intrauterina para prevenir la reestenosis. CONCLUSIONES: Un diagnóstico precoz y un tratamiento conservador con dilatación cervical y colocación temporal de un catéter urinario son esenciales para un manejo seguro y efectivo de la estenosis cervical en adolescentes.

INTRODUCTION: Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. In adolescents it is extremely rare; if accompanied by primary amenorrhea, consider congenital abnormalities. CASE REPORT: A 13-year-old adolescent, with no relevant personal history except primary amenorrhea, who presented with an acute abdomen and was operated on for diffuse peritonitis caused by pyometra secondary to congenital cervical dysgenesis (stenosis). Cervical dilation was performed and a urinary catheter was temporarily placed inside the uterus to prevent restenosis. CONLUSIONS: An early diagnosis and conservative treatment with cervical dilation and temporary placement of a urinary catheter are essential for the safe and effective management of cervical stenosis in adolescents.

Intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid.

OBJECTIVE: To determine the intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid (MSAF). STUDY DESIGN: In a retrospective cohort study of all singleton deliveries over a period of one year (2015) in a tertiary hospital, we compared different degrees of MSAF (yellow, green and thick) to clear amniotic fluids, and analysed in each group maternal, intrapartum and neonatal variables as well as umbilical cord blood gas analysis. RESULTS: Of the 3590 deliveries included, 503 (14%) had MSAF. The incidence of MSAF rises with gestational age at delivery, reaching 20.7% in gestations above 41 weeks compared to 4.3% below 37 weeks. As the amniotic fluid staining progresses we found a higher proportion of intrapartum fevers (p < 0.001), pathological fetal heart rate patterns (p < 0.05), operative vaginal deliveries and cesarean sections (p < 0.001), as well as the need for advanced neonatal resuscitation (p < 0.001). There was also a correlation between MSAF and low Apgar scores at five minutes (p < 0.001) and fetal-neonatal mortality (p < 0.001) but there was not a higher proportion of neonatal intensive care admissions (p > 0.05). We have observed a similar distribution of umbilical artery pH ranges in all groups (p > 0.05). CONCLUSIONS: MSAF was associated with an increase in the rate of pathological fetal heart rate patterns, intrapartum fevers, operative vaginal and cesarean section deliveries, need for neonatal resuscitation, low Apgar scores and higher fetal-neonatal mortality. Moreover, we found that the risks increase as the staining and consistency of the amniotic fluid evolves so it should alert the obstetrician and paediatrician to the potential adverse outcomes.

Riesgo de displasia del desarrollo de la cadera en pacientes sometidos a versión cefálica externa / Risk of developmental dysplasia of the hip in patients subjected to the external cephalic version

Introducción: La displasia del desarrollo de la cadera (DDC) engloba un espectro de anomalías que afecta a la maduración y desarrollo de la cadera. La presentación podálica es uno de los factores de riesgo asociado a esta patología y puede ser modificada en las últimas semanas de gestación mediante la versión cefálica externa (VCE). El objetivo de nuestro trabajo es determinar la incidencia de DDC en pacientes sometidos a una VCE exitosa, así como valorar la necesidad de incluir a estos niños (podálicos durante gran parte de la gestación) en el protocolo de cribado de DDC. Material y métodos: Estudio de cohortes prospectivo realizado en el Hospital Universitario de Vigo entre el 1 de enero y el 31 de diciembre del 2015. Participaron niños sometidos a VCE y niños podálicos no sometidos a VCE. A todos ellos se les realizó una ecografía de cadera para estudiar la incidencia de DDC en ambos grupos. Resultados: Se incluyeron un total de 122 pacientes. Se intentó realizar VCE en 67 (54,9%) siendo exitosa en 35 (52,2%). De los 122 niños: 14 fueron diagnosticados de DDC mediante ecografía. Tres (8,5%) de los niños con DDC nacieron en presentación cefálica tras VCE exitosa con exploración física de caderas normal al nacimiento. Conclusiones: La VCE reduce el riesgo de DDC con respecto a la presentación podálica pero de no incluir a los niños versionados con éxito en el protocolo de cribado de DDC, corremos el riesgo de no detectar precozmente esta patología (AU)

Introduction: Developmental dysplasia of the hip (DDH) refers to the spectrum of abnormalities of maturation and development of the hip. Breech presentation is associated with DDH. This risk factor can be modified by external cephalic version (ECV). The aim of this study is to evaluate the incidence of DDH in patients who successfully underwent ECV, as well as to evaluate need for these children (breech for a period during gestation) to be included in the DDH screening protocol. Material and methods: A prospective cohort study was conducted in the Hospital Universitario de Vigo from January 1, 2015 to December 31, 2015. It included children born in cephalic presentation after a successful ECV, as well as children born in breech presentation. They all were screened for DDH by ultrasound examination of the hip. Results: Out of a total of 122 newborns included in the study, ECV was attempted on 67 (54.9%), of which 35 (52.2%) were successful. Out of the 14 children diagnosed with DDH, 3 of those born in cephalic presentation after a successful ECV were found to be normal on physical examination. Conclusions: Successful ECV is associated with a lower incidence of DDH as regards breech presentation. However, these patients should be included in the DDH screening protocol for the early detection of this disorder (AU)

[Risk of developmental dysplasia of the hip in patients subjected to the external cephalic version]. / Riesgo de displasia del desarrollo de la cadera en pacientes sometidos a versión cefálica externa.

INTRODUCTION: Developmental dysplasia of the hip (DDH) refers to the spectrum of abnormalities of maturation and development of the hip. Breech presentation is associated with DDH. This risk factor can be modified by external cephalic version (ECV). The aim of this study is to evaluate the incidence of DDH in patients who successfully underwent ECV, as well as to evaluate need for these children (breech for a period during gestation) to be included in the DDH screening protocol. MATERIAL AND METHODS: A prospective cohort study was conducted in the Hospital Universitario de Vigo from January 1, 2015 to December 31, 2015. It included children born in cephalic presentation after a successful ECV, as well as children born in breech presentation. They all were screened for DDH by ultrasound examination of the hip. RESULTS: Out of a total of 122 newborns included in the study, ECV was attempted on 67 (54.9%), of which 35 (52.2%) were successful. Out of the 14 children diagnosed with DDH, 3 of those born in cephalic presentation after a successful ECV were found to be normal on physical examination. CONCLUSIONS: Successful ECV is associated with a lower incidence of DDH as regards breech presentation. However, these patients should be included in the DDH screening protocol for the early detection of this disorder.

Manejo de la hiponatremia asociada a trastornos hipertensivos del embarazo / Management of hyponatremia associated with hypertensive disorders of pregnancy

La hiponatremia severa es una complicación poco frecuente de los trastornos hipertensivos en la gestación. Actualmente existen pocos casos publicados en la literatura, sin embargo resulta fundamental tener en cuenta este trastorno ante una paciente con preeclampsia. Presentamos dos casos de hiponatremia asociada a trastornos hipertensivos en pacientes gestantes, en los que la clínica y la analítica mejoraron rápidamente tras realizar el diagnóstico e iniciar un tratamiento adecuado, con remisión completa tras el parto (AU)

Severe hyponatremia is a rare complication of hypertensive disorders in pregnancy. Few cases have been reported in the literature. However, it is important to consider this disorder in patients with preeclampsia. We present two cases of hyponatremia associated with hypertensive disorders in pregnant women. Rapid clinical and analytical improvement was observed after diagnosis and appropriate treatment with complete remission following delivery (AU)