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.

The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.

BACKGROUND: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS: We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS: Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p <  0.001) was also observed in positive mothers. CONCLUSION: This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Obstetric Outcomes of SARS-CoV-2 Infection in Asymptomatic Pregnant Women.

Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13-3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms.

Impétigo herpetiforme durante la gestación con empeoramiento posparto / Impetigo herpetiform during pregnancy with postpartum worsening

El impétigo herpetiforme es una rara enfermedad asociada al embarazo, ocurre habitualmente en el tercer trimestre, con una elevada morbimortalidad maternofetal cuando no se establece el tratamiento adecuado y un control obstétrico estricto. En la mayoría de los casos desaparece en el periodo posnatal y recurre en las siguientes gestaciones de manera más precoz y agresiva. Se presenta el caso de una gestante diagnosticada en la semana 28 de impétigo herpetiforme con evolución en brotes a pesar del tratamiento corticoideo y con empeoramiento del cuadro en el puerperio, precisando la administración de corticoides, ciclosporina y adalimumab (AU)

Impetigo herpetiformis is a rare disease associated with pregnancy, mainly during the third trimester. Without adequate treatment or close maternal-obstetric monitoring, thisdisease carries high mortality. In most cases, the disease resolves in the postnatal period but is associated with an earlier and more aggressive recurrence in subsequent pregnancies. We describe the case of a woman diagnosed with impetigo herpetiformis at week 28 week of pregnancy. Despite corticosteroid therapy, she continued to have recurrences, with worsening in the postpartum period, requiring treatment with corticosteroids, cyclosporine, and adalimumab (AU)

Recuperación del parto vaginal de nalgas y versión cefálica externa / Reintroduction of vaginal breech delivery and external cephalic version

Objetivo. Se analizan retrospectivamente los resultados obstétricos y neonatales de la aplicación de un protocolo de parto vaginal de nalgas tras 10 años de su abandono. Métodos. Las pacientes eran derivadas a una unidad específica en la semana 36 donde se les ofrecía una versión cefálica externa. Si la presentación de nalgas persistía, eran seleccionadas para intento de parto vaginal si cumplían los siguientes criterios: a) peso fetal estimado 2.500-3.600g; b) nalgas puras o completas; c) cabeza fetal no hiperextendida, y d) pelvis clínicamente adecuada. El progreso del parto requería: a) primer estadio ≥1cm/h; b) segundo estadio 90 min para el descenso pasivo de las nalgas y una hora de pujos activos, y c) se estableció la disponibilidad de experto localizado. Resultados. Se encontró a 93 pacientes con presentación de nalgas única y viva tras la aplicación de la versión cefálica externa. En 69 (73,4%) se indicó una cesárea electiva, y 24 (26,6%) fueron candidatas para parto vaginal, 19 de las cuales lo lograron (20,1%). La tasa de cesáreas por esta indicación se redujo significativamente del 5,7% en 2009 a 2,02% (p<0,001). No se observó ningún resultado fetal adverso (muerte fetal, test de Apgar<7 en 5 min, pH de la arteria umbilical < 7 o traumatismos fetales). Conclusiones. El cumplimiento de los criterios anteparto e intraparto y la disponibilidad de expertos localizados hacen posible un parto vaginal seguro. La aplicación combinada de versión e intento de parto vaginal reduce la tasa de cesáreas por presentación de nalgas(AU)

Objective: To review the obstetric and neonatal outcomes of the application of an updated vaginal breech delivery protocol 10 years after this practice had been discontinued. Methods: Breech presentations were referred to a dedicated breech unit at 36 weeks where the external cephalic version was offered. If breech presentation persisted, the patients were selected to undergo attempted vaginal delivery if the following criteria were met: a) estimated fetal weight of 2.500-3.600 g; b) frank or complete breech presentation; c) absence of hyperextension of the fetal head; and d) a clinically adequate pelvis. Intrapartum criteria included: a) progression of labor of 1 cm/hour in the first hour; b) In the second stage, 90 minutes were allowed for adequate descent of the breech, and 1 hour of active pushing, and c) the availability of an on-call expert. Results: A total of 93 patients showed single live pregnancies in breech presentation after external cephalic version. Sixty-nine patients (73.4%) underwent elective prelabor cesarean delivery, and 24 (26.6%) progressed to attempted vaginal breech delivery, which was successful in 19 (20.1%). Cesarean indications for breech presentation were reduced from 5.7% in 2009 to 2.02% after the application of external cephalic version and vaginal breech delivery (P<.001). We observed no fetal deaths, no Apgar test at 5 minutes of less than 7, no umbilical artery pH of less than 7, and no fetal injuries. Conclusions: . When antepartum and intrapartum criteria are met, vaginal breech delivery is safe. The availability of an on-call expert allows vaginal breech delivery to be safely performed. The combination of external cephalic version and vaginal breech delivery decreases the cesarean rate for breech presentation(AU)

Abdomen agudo por rotura espontánea de un leiomioma uterino subseroso / Acute abdomen due to spontaneous rupture of subserosal uterine leiomyoma

Aunque el dolor pélvico y la metrorragia son las alteraciones más frecuentemente asociadas al mioma uterino, el hemoperitoneo agudo por rotura de leiomioma subseroso es un hecho excepcional apenas recogido en la literatura médica internacional. Este artículo describe uno de los pocos casos conocidos de abdomen agudo por rotura espontánea de leiomioma uterino subseroso que hemos tenido ocasión de tratar en el Servicio de Ginecología del Hospital Universitario Central de Asturias. La edad de la paciente, la paridad, el tamaño del mioma y ciertas malformaciones vasculares uterinas son considerados factores de riesgo para este cuadro tan insólito, pero además, en nuestro caso, determinadas peculiaridades histológicas del tumor parecen tener cierta relevancia

Although pelvic pain and metrorrhagia are the disorders that are most commonly associated with uterine leiomyoma, acute hemoperitoneum due to rupture of a subserosal leiomyoma is an exceptional event that has scarcely been reported in the international medical literature. This article describes one of the few known cases of acute abdomen caused by spontaneous rupture of a subserosal uterine leiomyoma, which was treated at the Department of Gynecology of the Hospital Universitario Central de Asturias (Spain). Risk factors for this unusual entity are considered to be the patient's age and parity, as well as the size of the myoma and certain uterine vascular malformations; however, in this specific case, some histological peculiarities of the tumor seem to be of relevance