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Background and Objectives: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy. Secondarily, we assessed the associated complications in order to identify potential risk factors that could be used to select women at higher risk of adverse outcomes that could benefit from an early diagnosis and improved monitoring. Materials and Methods: We made a selection of all the women who consulted in the Emergency Department of the Hospital QuirónSalud in Malaga on 2015 presenting with first trimester metrorrhagia. We refer to first trimester metrorrhagia as that which occurs until week 12+6. Once these pregnant women were identified, we studied several variables not related to the gestation and some others associated with it and its natural course. Results: The average age of the patients assessed was 34.1. Associated gestational complications were metrorrhagia in the second trimester (6.3%), threatened preterm labour (7.4%), preeclampsia (2.5%), gestational diabetes (7.4%), late abortion (1.2%) and early postpartum hemorrhage (1.8%). We sought associations to assess possible risk factors, establishing an increased maternal age as an aggravating factor for the development of complications. We also studied gestational complications finding a higher prevalence of them in older women, such as prematurity (33.11 vs 34.48 years), gestational diabetes (33.11 vs 36.06 years) and preeclampsia (33.25 vs 35 years). Conclusions: Maternal age is a risk factor for first-trimester spontaneous miscarriage and for the development of complications of pregnancy. It is crucial to perform a correct screening of different pathologies throughout the pregnancy to anticipate potential complications.

BACKGROUND: The purpose of this study is to report on the validation process of the Spanish version of a questionnaire that explores health science students’ attitudes towards women’s childbirth experiences. This questionnaire could help inform education programs to enhance the quality of woman-professional interactions, and to improve women’s experiences of childbirth. \ud \ud METHODS: A standardised procedure for the development and validation of the questionnaire included: item development and psychometric pre-validation, Cronbach’s Alpha and split-half coefficients calculation, test–retest and item-total correlation for the reliability analysis. Content validity was undertaken by Delphi method with sixteen panelists over two rounds. We determined the factor structure and refined and validated the questionnaire according to the responses of a cohort of 160 students using principal components factor analysis with varimax rotation. \ud \ud RESULTS: A 52-items questionnaire CAVE-st: (acronym for cuestionario de actitudes sobre vivencias y experiencias en el parto) was developed and validated. The questionnaire had a high construct validity, with a Cronbach´s alpha > 0.92. The intraclass correlations (0.80) indicated adequate test–retest reliability. The results of the exploratory factor analysis revealed fourteen latent components that explained more than the 70% of the observed total variance.\ud \ud CONCLUSIONS: The Spanish version of the questionnaire CAVE-st has been developed and validated. Its psychometrics indicate that it is a valid and reliable tool to assess health sciences students’ attitude towards women´s childbirth experience. Further work to translate and adapt the instrument in other cultures and languages will be undertaken.

Objectives The main objective of the present study was to evaluate what educational needs were being neglected in current perinatal educational program in the University of Malaga. Methods We performed a cross-sectional study using the Students’ questionnaire on attitudes towards childbirth (CAVE-st) in a sample of 378 students who were finishing their undergraduate or postgraduate academic perinatal program, including medical and nursing students. Results The Cronbach’s alpha reliability coefficient was 0.895. The mean score of CAVE-st in the sample was 200.34 (DT 21.0). The scores were below the median value in more than 53% of the students, especially in medical students. Female students scored systematically higher in the overall scale and its subscales, even after adjusting for study groups. On the other hand, the students with children scored significantly lower in the subscale that explored their attitudes towards unexpected results. A huge margin for improvement was recognizable in those subscales related with childbirth medicalization, respect to women decisions, and health-care prioritization. Conclusions Students’ attitude towards childbirth need to be improved as a means to improve women’s childbirth experience and prevent birth-related trauma. The current undergraduate and postgraduate training in perinatal care lacks a comprehensive and biopsychosocial perspective that would improve the quality of clinical practice during childbirth.

(1) Background: Little is known about the effects of SARS-CoV-2 on the placenta, and whether the maternal inflammatory response is transmitted vertically. This research aims to provide information about the effects of SARS-CoV-2 infection on maternal and fetal immunity. (2) Methods: We have studied placental changes and humoral and cellular immunity in maternal and umbilical cord blood (UCB) samples from a group of pregnant women delivering after the diagnosis of SARS-CoV-2 infection during pregnancy. IgG and IgM SARS-CoV-2 antibodies, Interleukin 1b (IL1b), Interleukin 6 (IL6), and gamma-Interferon (IFN-γ), have been studied in the UCB samples. Lymphocyte subsets were studied according to CD3, CD8, CD4, CD34, and invariant natural Killer T cells (iNKT) markers. We used in situ hybridization techniques for the detection of viral RNA in placentas. (3) Results: During the study period, 79 pregnant women and their corresponding newborns were recruited. The main gestational age at the time of delivery was 39.1 weeks (SD 1.3). We did not find traces of the SARS-CoV-2 virus RNA in any of the analyzed placental samples. Detectable concentrations of IgG anti-SARS-CoV-2 antibodies, IL1b, IL6, and IFN-γ, in UCB were found in all cases, but IgM antibodies anti-ARS-CoV-2 were systematically undetectable. We found significant correlations between fetal CD3+ mononuclear cells and UCB IgG concentrations. We also found significant correlations between UCB IgG concentrations and fetal CD3+/CD4+, as well as CD3+/CD8+ T cells subsets. We also discovered that fetal CD3+/CD8+ cell counts were significantly higher in those cases with placental infarctions. (4) Conclusion: we have not verified the placental transfer of SARS-CoV-2. However, we have discovered that a significant immune response is being transmitted to the fetus in cases of SARS-CoV-2 maternal infection. Partial funding for open access charge: Universidad de Málaga. This research was funded by Ferring COVID-19 Investigational Grant Placental injury and immune reaction transmitted to the neonates in cases of SARS-CoV-2 infections during pregnancy. Study on placental and blood cord samples. The APC was funded by University of Málaga. Funding institutions did not participate in the design, recruitment, analysis, or interpretation of the results.

Introducción: el laboratorio de citogenética del Instituto de Investigaciones en Salud (INISA) de la Universidad de Costa Rica estableció un Servicio de Dosimetría Biológica en enero del 2020 utilizando biomarcadores citogenéticos de exposición a radiaciones ionizantes. Es el primero de su tipo en la región centroamericana. Objetivo: establecer un servicio de dosimetría biológica para Costa Rica, elaborando una curva de calibración dosis-efecto para rayos gamma. Metodología: para la realización de la curva de calibración se irradiaron muestras de sangre periférica in vitro con rayos gamma de dos voluntarios, uno femenino y otro masculino, en 11 puntos de dosis en el rango de 0 a 5 Gy. Se cultivó la sangre acorde a los protocolos internacionales durante 48 horas y se registraron las aberraciones inducidas. Los programas Dose Estimate V5.2 y R versión 4.03 se utilizaron para el cálculo de los coeficientes de la curva de calibración que correlaciona la frecuencia de cromosomas dicéntricos con la dosis. Resultados: los coeficientes de la curva son α: 0.02737±0.00658, ß: 0,05938±0,00450 y C: 0.00129±0.00084. Estos coeficientes tienen valores similares a los reportados internacionalmente. La curva se validó calculando dos dosis incógnitas, en la primera incógnita la dosis suministrada fue de 1,5 Gy y la dosis estimada fue 1,47 Gy y en la segunda la dosis suministrada fue de 4 Gy y la dosis estimada fue 3,616 Gy, para ambos casos no existen diferencias estadísticamente significativas entre las dosis suministradas y las estimadas. Conclusiones: actualmente El Servicio de Dosimetría Biológica del INISA puede estimar dosis absorbida en personas que se sospecha de una sobre exposición a rayos gamma en personal ocupacionalmente expuesto o personas involucradas en un accidente radiológico.

Purpose: To test the performance of different algorithms that can be used in inter-laboratory comparisons based on dicentric chromosome analysis, and to evaluate the impact of considering a priori values different to calculate individual laboratory performance based on the ionizing radiation dose estimation. - Methods: Mean and standard deviation estimations in inter-laboratory comparisons are tested on simulated data and data from previously published inter-laboratory comparisons using three robust algorithms, Algorithm A, Algorithm B and Q/Hampel, all programmed in R-project language and implemented in a Shiny application. The simulated data were generated assuming three different probabilities to contaminate inter-laboratory comparisons samples with atypical dose values. Comparison between different algorithms was also done using published exercises where blood samples were irradiated at 0 and 0.7 Gy that represent a challenge for the assessment of an inter-laboratory comparison. - Results: The best performance was obtained with the Q/Hampel algorithm for the estimation of the dose mean and with the Algorithm B for the estimation of the dose standard deviation under the conditions tested in the simulations. The Q/Hampel algorithm showed the best performance when non-irradiated samples were evaluated and there was a high proportion of identical values. The presence identical values cause the Algorithm B to fail. Real examples illustrating the need to consider standard deviation priors, and the need to use algorithms resistant to a high proportion of identical values are presented. - Conclusions: Q/Hampel algorithm is a serious candidate to estimate the dose mean in the inter-laboratory comparisons, and to estimate both parameters when the proportion of identical values equals or higher than the half of the results. When the proportion of identical values is less than the half of the results, the Algorithm B should be considered as a candidate to estimate the standard deviation in the inter-laboratory comparisons withsmall number of laboratories. We remark that special attention is needed to establish prior definitions of standard deviation in the assessment of inter-laboratory dicentric assay comparisons.

Background: The objective of our study was to evaluate a new technique for emergency cerclage performed in a cohort of patients with cervical incompetence in the second trimester of pregnancy. Design: Prospective observational study in Regional university hospital. Population: Twenty-four pregnant women at 15 to 24 weeks gestation with cervical dilatation and bursa prolapseMethods: Depending on the clinical condition of the patient, a new emergency cerclage was performed with a technical consisting of a first cerclage in a purse-string and a second occlusive cerclage located inferiorly to the first one. The technique ended with the performance of a cervical cleisis, depending on the presence or absence of prolapse of the vaginal bag. This procedure is called the Three-Step Procedure for Emergency Cerclage (TSEC). Outcome measure: The latency period to deliveryResults: Latency from procedure to delivery, pregnancy duration, infant birth weight, rate of premature amniorrhexis. The mean latency from procedure to delivery was 14 weeks + 6 days, the mean weight of the newborns was 2550 g, and the mean age at delivery was 35 weeks. The neonatal survival rate was 95.8%. The rate of premature amniorrhexis Conclusion: The excellent results obtained with the TSEC procedure in terms of the latency from procedure to delivery, gestational age at delivery, birth weight, and few reported complications, highlight the importance of collecting new data on this promising novel procedure.

This study analyses, in children born in twin births, the relationship between reading, writing and arithmetic learning, on the one hand, and type of delivery, on the other, controlling for the effect of interaction and/or confusion of third variables (maternal age at delivery, gestational age, fetal position, birthweight, 1-min Apgar score). In the planned retrospective cohort design, the exposed cohort consisted of children born by caesarean section, and the non-exposed cohort was comprised of children born vaginally. One hundred and twenty-four children born of twin births were evaluated during their first year of primary school: K-BIT tests were used to measure intelligence; the Evalúa-1 battery was used to assess reading, writing, and arithmetic ability; and the children's clinical histories were analysed for obstetric and neonatal variables. After applying binary logistic regressions for each dependent variable, it was found that caesarean delivery in twin births appeared as a possible independent risk factor for specific learning disabilities (LDs) in reading, writing, and arithmetic. Based on these results, further research using larger samples and at more advanced ages is required in order to analyse the influence of obstetric and neonatal variables on the processes underlying specific LDs.

Background Although pregnancy is frequently associated with mental states of happiness, hope and well-being, some physical and psychological changes can contribute to increased sleep disturbances and worsened sleep quality. Sleep quality has been linked to negative emotions, anxiety and depression. The main objective of this paper was to systematically review the impact of sleep during pregnancy on maternal mood, studying the association between objective and subjective measures of sleep quality and perinatal depression. Methods We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which included studies published between January 2008 and April 2019, and met the following criteria: (i) studies on pregnant women assessing the effects of sleep quality variables on perinatal mood disorders, (ii) studies published in English and (iii) full paper published in a peer-reviewed scientific journal with full-text format available. Results A total of 36 studies published in the last decade met the inclusion criteria for qualitative review and eight of them were suitable for meta-analysis. Both confirmed the negative effects of poor sleep on perinatal mood. However, qualitative analysis showed that unrepresentative samples and low participation rates falling below 80% biased some of the studies. The standard random-effects meta-analysis showed a pooled size effect [ln odds ratio (OR) 1.49 (95% confidence interval [CI] 1.19, 1.79)] for perinatal depression in cases of poor prenatal sleep quality, although heterogeneity was moderate to high [Q 16.05, P ≤ 0.025, H2 2.45 (95% CI 1.01, 13.70)]. Conclusion Poor sleep quality was associated with perinatal mood disturbances. The assessment of sleep quality along the pregnancy could be advisable with a view to offering preventative or therapeutic interventions when necessary.

Resumen La incorporacion precoz del enfermo al que se ha realizado una angioplastia con stent a su vida habitual, por ausencia de impedimentos propios de la tecnica, ha permitido incluir mas pronto a estos pacientes en la fase II de la rehabilitacion cardiaca. Aunque la rehabilitacion del paciente coronario sigue para todos los pacientes unas pautas generales que pretenden abordar desde un punto de vista de prevencion secundaria la aterosclerosis coronaria, las circunstancias de cada enfermo, entre las que se incluye la tecnica con que ha sido revascularizado, determinan aspectos individuales de la rehabilitacion del enfermo con cardiopatia isquemica. El ejercicio fisico continuado (entrenamiento fisico) produce, por si mismo, grandes beneficios cardiovasculares para la prevencion cardiovascular primaria y secundaria. En pacientes con infarto disminuye la mortalidad y mejora la capacidad funcional, la funcion ventricular y el remodelado ventricular, y hay esperanzas de que pueda mejorar la circulacion colateral. Tambien mejora la funcion endotelial y estimula la circulacion de celulas madre. Se ha demostrado que el entrenamiento fisico tras revascularizacion percutanea disminuye el numero de eventos y que en pacientes con angina estable el entrenamiento fisico produce menos eventos que la revascularizacion percutanea.

Resumen La incorporacion precoz del enfermo al que se ha realizado una angioplastia con stent a su vida habitual, por ausencia de impedimentos propios de la tecnica, ha permitido incluir mas pronto a estos pacientes en la fase II de la rehabilitacion cardiaca. Aunque la rehabilitacion del paciente coronario sigue para todos los pacientes unas pautas generales que pretenden abordar desde un punto de vista de prevencion secundaria la aterosclerosis coronaria, las circunstancias de cada enfermo, entre las que se incluye la tecnica con que ha sido revascularizado, determinan aspectos individuales de la rehabilitacion del enfermo con cardiopatia isquemica. El ejercicio fisico continuado (entrenamiento fisico) produce, por si mismo, grandes beneficios cardiovasculares para la prevencion cardiovascular primaria y secundaria. En pacientes con infarto disminuye la mortalidad y mejora la capacidad funcional, la funcion ventricular y el remodelado ventricular, y hay esperanzas de que pueda mejorar la circulacion colateral. Tambien mejora la funcion endotelial y estimula la circulacion de celulas madre. Se ha demostrado que el entrenamiento fisico tras revascularizacion percutanea disminuye el numero de eventos y que en pacientes con angina estable el entrenamiento fisico produce menos eventos que la revascularizacion percutanea.

Background Testosterone replacement treatment as part of gender reassignment therapy has repercussions on the final pathological result of the hysterectomies that are performed. The objective of this review is to analyze the surgical pieces of hysterectomies performed on FTM patients (female-to-male) and to describe possible changes related to testosterone. There are few studies and with a low number of patients where this possible repercussion is addressed. Methods A retrospective study was carried out, which included 117 patients between the ages of 21 and 56, operated on between 2010 and 2019, with at least an average duration of treatment of 5 years before gender reassignment surgery. Main outcome measure were changes in follicle stimulating hormone (FSH), luteinizin hormone (LH), testosterone (TST) and estradiol in blood, both preoperatively and postoperatively. Also the differente types of endometrium and ovaries found in histerectomy pieces. Results the pathological study revealed that 95 (80.3%) cases showed an atrophic endometrium, 7 (6%) cases an endometrium with secretory-type changes, and 15 (13.7%) cases with weakly proliferating endometrium. Conclusions Our data revealed that the most frequent histology after chronic administration of parenteral testosterone was such compatible with atrophic endometrium, coinciding with what has been published in the literature up to now. More long-term studies on the effects of parenteral testosterone are still needed.

We thank K. Shashok for translating the original manuscript into English., Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). A review of the available literature on fetal heart rate (FHR) monitoring in preterm fetuses shows that studies are scarce, and the evidence thus far is unclear. The lack of reference standards for CTG patterns in preterm fetuses can lead to misinterpretation of the changes observed in electronic fetal monitoring (EFM). The aims of this narrative review were to summarize the most relevant concepts in the field of CTG interpretation in preterm fetuses, and to provide a practical approach that can be useful in clinical practice. Materials and Methods: A MEDLINE search was carried out, and the published articles thus identified were reviewed. Results: Compared to term fetuses, preterm fetuses have a slightly higher baseline FHR. Heart rate is faster in more immature fetuses, and variability is lower and increases in more mature fetuses. Transitory, low-amplitude decelerations are more frequent during the second trimester. Transitory increases in FHR are less frequent and become more frequent and increase in amplitude as gestational age increases. Conclusions: The main characteristics of FHR tracings changes as gestation proceeds, and it is of fundamental importance to be aware of these changes in order to correctly interpret CTG patterns in preterm fetuses.

To examine the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women during the confinement due to the COVID-19 outbreak in Spain.Between 15 April and 14 May 2020, a multicentre cross-sectional survey was performed to study depression, anxiety and resilience in a sample of Spanish pregnant women during the lockdown set up by the Government in response to COVID-19 pandemic outbreak. We designed an anonymous online self-administered questionnaire (https://bit.ly/34RRpq1) that included the Spanish validated versions of the Edinburgh Postpartum Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) and the Connor-Davidson Resilience 10-items Scale (CD-RISC-10).A total of 514 pregnant women completed the survey. 72.8% had been confined40 days and 27.2% between 41 and 60 days. 182 (35.4%) participants scored over 10, with 21.3% scoring over 13 (75th Percentile) in depressive symptoms rates. We found high trait and anxiety scores, with 223 (43.4%) and 227 (44.2%) pregnant women scoring over the trait and state mean scores. Neither depression, anxiety or resilience levels showed any significant correlation with the length of confinement. We found low CD-RISC-10 scores.We found a high prevalence of depression and anxiety symptoms during the quarantine, although we did not find an increased prevalence of psychological distress according to length of home confinement. Resilience correlated negatively with depression and anxiety.

Background Gestational diabetes that is not properly controlled with diet has been commonly treated with insulin. In recent years, several studies have published that metformin can lead to, at least, similar obstetrical and perinatal outcomes as insulin. Nevertheless, not all clinical guidelines endorse its use, and clinical practice is heterogeneous. Objective This study aimed to test whether metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes that is not properly controlled with lifestyle changes. Study Design The metformin for gestational diabetes study was a multicenter, open-label, parallel arms, randomized clinical trial performed at 2 hospitals in Malaga (Spain), enrolling women with gestational diabetes who needed pharmacologic treatment. Women at the age of 18 to 45 years, in the second or third trimesters of pregnancy, were randomized to receive metformin or insulin (detemir or aspart). The main outcomes were (1) glycemic control (mean glycemia, preprandial and postprandial) and hypoglycemic episodes and (2) obstetrical and perinatal outcomes and complications (hypertensive disorders, type of labor, prematurity, macrosomia, large for gestational age, neonatal care unit admissions, respiratory distress syndrome, hypoglycemia, jaundice). Outcomes were analyzed on an intention-to-treat basis. Results Between October 2016 and June 2019, 200 women were randomized, 100 to the insulin-treated group and 100 to the metformin-treated group. Mean fasting and postprandial glycemia did not differ between groups, but postprandial glycemia was significantly better after lunch or dinner in the metformin-treated-group. Hypoglycemic episodes were significantly more common in the insulin-treated group (55.9% vs 17.7% on metformin; odds ratio, 6.118; 95% confidence interval, 3.134–11.944; P=.000). Women treated with metformin gained less weight from the enrollment to the prepartum visit (36–37 gestational weeks) (1.35±3.21 vs 3.87±3.50 kg; P=.000). Labor inductions (45.7% [metformin] vs 62.5% [insulin]; odds ratio, 0.506; 95% confidence interval, 0.283–0.903; P=.029) and cesarean deliveries (27.6% [metformin] vs 52.6% [insulin]; odds ratio, 0.345; 95% confidence interval, 0.187–0.625; P=.001) were significantly lower in the metformin-treated group. Mean birthweight, macrosomia, and large for gestational age and babies’ complications were not different between treatment groups. The lower cesarean delivery rate for women treated with metformin was not associated with macrosomia, large or small for gestational age, or other complications of pregnancy. Conclusion Metformin treatment was associated with a better postprandial glycemic control than insulin for some meals, a lower risk of hypoglycemic episodes, less maternal weight gain, and a low rate of failure as an isolated treatment. Most obstetrical and perinatal outcomes were similar between groups.

BACKGROUND: The purpose of this study is to report on the validation process of the Spanish version of a questionnaire that explores health science students’ attitudes towards women’s childbirth experiences. This questionnaire could help inform education programs to enhance the quality of woman-professional interactions, and to improve women’s experiences of childbirth. METHODS: A standardised procedure for the development and validation of the questionnaire included: item development and psychometric pre-validation, Cronbach’s Alpha and split-half coefficients calculation, test–retest and item-total correlation for the reliability analysis. Content validity was undertaken by Delphi method with sixteen panelists over two rounds. We determined the factor structure and refined and validated the questionnaire according to the responses of a cohort of 160 students using principal components factor analysis with varimax rotation. RESULTS: A 52-items questionnaire CAVE-st: (acronym for cuestionario de actitudes sobre vivencias y experiencias en el parto) was developed and validated. The questionnaire had a high construct validity, with a Cronbach´s alpha > 0.92. The intraclass correlations (0.80) indicated adequate test–retest reliability. The results of the exploratory factor analysis revealed fourteen latent components that explained more than the 70% of the observed total variance.CONCLUSIONS: The Spanish version of the questionnaire CAVE-st has been developed and validated. Its psychometrics indicate that it is a valid and reliable tool to assess health sciences students’ attitude towards women´s childbirth experience. Further work to translate and adapt the instrument in other cultures and languages will be undertaken.

We analysed the association between the concentration of four toxic elements (As, Cd, Hg and Pb) and diverse reproductive outcomes in a cohort of 194 women with fertility disorders undergoing IVF in a public hospital. Concentration in hair specimens was explored as biomarker of exposure during the three months prior to oocyte retrieval. The proportion of negative results, especially regarding pregnancy and birth outcomes, is remarkable. However, we found that the probability of mature oocytes was inversely associated with the concentration of Hg in hair (RR = 0.81, 95% CI: 0.70-0.95) and directly associated with that of Pb (RR = 1.18, 95% CI: 1.03–1.35). These findings provide insights for future research on the links between heavy metal concentrations and IVF outcomes.

Endometriosis is a multifactorial disease with pathophysiological factors not yet well known; it also presents a wide symptomatic range that makes us think about the need for multidisciplinary management. It is a chronic disease in which there is no definitive treatment, and is associated in a large majority of cases with psychological pathology. Connecting comorbidities and multimorbidities on a neurobiological, neuropsychological, and pathophysiological level could significantly contribute to their more successful prevention and treatment. In our study, resilience is analyzed as an adjunctive measure in the management of endometriosis. Methods: A multi-centre, cross-sectional study was performed to analyse resilience levels in a sample of Spanish women suffering from endometriosis. CDRIS-25, CDRIS-10, BDI, the STAI, and the SF-36 Health Questionnaire were used for assessments. A representative group of 202 women with endometriosis was recruited by consecutive sampling. Exploratory and confirmatory factor analyses were performed for both resilience scales. Results: Mean CDRIS-25 and CDRIS-10 scores were 69.58 (SD 15.1) and 29.37 (SD 7.2), respectively. Women with adenomyosis and without signs of deep endometriosis showed the lowest scores. The best predictive model included women’s age, years of endometriosis evolution, number of pregnancies, and history of fertility problems as the best predictive factors. Conclusions: Women build resilience as the number of years of evolution of the disease increases. Symptoms such as dyspareunia and continued abdominal pain were more prevalent among less resilient women.

We performed an observational descriptive study on 89 women who requested for emergency contraception (EC) at the emergency units of two hospitals, Virgen de la Victoria Hospital, and Regional University Hospital in Malaga between October 2016 and April 2017. Both hospitals are on the Andalusian Public Health System. We evaluated a group of socio-demographic variables and others related to the beliefs and the knowledge about EC and contraception in general, sexual behavior, Eysenck's Inventory of Attitudes to Sex (satisfaction and promiscuity factors), and State-Trait Anxiety Inventory (STAI). RESULTS: State anxiety scores were low in 10.8% of the participants, middle in 25.7% and high in the 63.5%. On the other hand, the scores for trait anxiety were low in 13.5%, middle in 39.2% and high in 47.3%. The demand for EC resulted in a stressful situation for women, especially for youngest women. Also, married women with children and a history of pregnancy terminations showed higher anxiety scores. Regarding sexual attitudes, the highest levels of anxiety (state and trait) were found in women with less knowledge about EC, and in those who reported less satisfaction with their sex life. Best fit regression models for anxiety levels included beliefs that ECs are abortive, sexual dissatisfaction and women's age as predictive variables for STAI scores. In conclusion, women who requested EC showed high scores in anxiety-state and -trait, with those of younger age presenting more intense emotions.

The study of sexuality requires a biopsychosocial approach that integrates the existence of strictly organic factors, which is key to the development of optimal sexual function, with the study of psychological, educational, biographical, and contextual variables that will constitute the basis for the system of relationship and social interaction of each person. This fact becomes even more relevant when assessing sexual relationships with a disorder clearly related to lifestyles such as obesity. In the following sections, we shall analyze the influence of obesity on female sexual function.

Objective The main objective of this research was to assess the potential influence of cultural factors on the anxiety levels of a multicultural sample of Spanish and Turkish pregnant women at the beginning of the pregnancy. Methods Between October and December 2017 a total of 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy in three different cities, Istanbul, Antalya and Malaga, were recruited for study. These women completed a questionnaire that included the Turkish or Spanish validated of the state-trait anxiety Inventory, and a series of questions related to health status, general mood, and sociodemographic variables. Results The mean value for State Anxiety was 47.1 [16–56] (SD 4.2), and mild, moderate and severe State Anxiety was observed in 56.8%, 14.7% and 20.5% of participants, respectively. Mean value for trait anxiety was 46.9 [34–89] (SD 4.6) and 31.4%, 19.7% and 20.2% of participants scored for mild, moderate and severe anxiety respectively. Anxiety scores were significantly higher among Turkish women. In the whole sample, religion, working status, pregnancy planning and perceived partner´s support predicted anxiety at first trimester of pregnancy. Social support and educational level were the most important predictive variables in the Spanish subgroup, while religion, the number of living children and the lack of husband´s support were among Turkish pregnant women. Conclusion Our results confirm the existence of a high prevalence of women´s anxiety at the beginning of the pregnancy and some differences between Turkish and Spanish pregnant women have been observed. We have confirmed that some cultural features like family structure (having more children and cohabitants), the Islamic religion or the lack of perceived partner´s support became the most important vulnerability elements.

Que el sobrepeso y la obesidad estan intimamente relacionados con la hipertension arterial (HTA) esencial es una realidad que nadie discute hoy dia, y que nos hace asociarlos facilmente como factores de riesgo de los trastornos hipertensivos que aparecen tambien durante el embarazo. Sin embargo, no son tantos los estudios publicados, y menos en nuestro pais, que apoyen esta teoria, hecho que ha llevado a Fernandez-Alba y cols. a realizar el estudio de cohortes retrospectivo cuyos resultados son publicados en este numero de la revista Nutricion Hospitalaria . El estudio se ha realizado sobre embarazadas de la poblacion andaluza en el que la prevalencia global de obesidad encontrada fue de un 10% mayor que la encontrada en la poblacion espanola segun Valdes y cols. en 2014 (2) y similar a la registrada en los Estados Unidos. Tanto como un 38,5% presentaba algun tipo de sobrepeso. El estudio se refiere a diez anos, incluyendo a las gestantes cuyo embarazo y parto fue atendido en su unidad y cuyo IMC habia sido registrado al inicio de la gestacion. Los autores ponen de manifiesto que tanto las gestantes obesas como aquellas que padecen sobrepeso tienen incrementado el riesgo de HTA, datos apoyados por los resultados de estudios previos recogidos por Fernandez-Alba y cols. (3), asi como en el metaanalisis publicado por Wang y cols. en 2013. Dicho metaanalisis encuentra una OR ajustada de 1,70 de preeclampsia en gestantes con sobrepeso y una OR ajustada de 2,93 en gestantes obesas (4).

Background Depression is the most frequent mental disorder during pregnancy, and its prevalence is at least as high as that of postnatal depression. Differences between Western and Eastern countries may exist according to cultural and educational factors. Objective to determine the influence of social and cultural factors on the mood state of a multicultural sample of 514 Turkish and Spanish pregnant women at the beginning of the pregnancy. Methods Between October and December 2017 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy were recruited (264 in Malaga, 102 in Istanbul and 148 in Antalya). These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg Postnatal Depression Scale (EDS) and a series of questions related to health status, general mood, and sociodemographic variables. Results Turkish women scored significantly higher with a mean value of 12.1 (SD 4.2) against 7.6 (SD 4.3) of Spanish women. Coping strategies and matters of women´s concern were also different. A total of 9.1% of Spanish and 30% of Turkish scored over cut-off point of 13. We found differences in EDS scores regarding the type of work, working status, and educational level. Family structure and perceived support were identified as specific risk factors for antenatal depression (AD). The multivariate regression model showed that best predictor variables for EDS score in the global sample were the country of recruitment, the number of living children, the pregnancy planning and the perceived partner´s support. Conclusions Our results confirm the existence of important differences in AD prevalence between Turkish (30.0%) and Spanish (9.9%) pregnant women. Some sociocultural features like having more children, unplanned pregnancies, or perceiving poor support from the partner, become important vulnerability factors.

The increasing number of multiple pregnancies in recent years has raised a particular concern about the problems associated to these pregnancies. It still remains unclear whether twin deliveries, as currently conceived, provide the same future health chances to both fetuses. In this regard, it is worth mentioning that the effects of obstetric and neonatal care beyond the perinatal period have not often been evaluated. The main objective of this research was to analyze the impact of obstetric and perinatal variables on postnatal neuropsychological development, intelligence and school achievement of twin children.We conducted a cross-sectional and observational study on 62 pairs of 6-year-old twins, who were on their first year of primary education. All 124 children and their mother were individually assessed and perinatal clinical data were collected. A stratified multivariate analysis was performed using multiple linear regressions.The type of birth was the best predicting variable, so that the best results were achieved in children born in spontaneous vaginal deliveries. Comparatively, however, poorer scores were seen in males second twins born by the vaginal route in spatial structuring, non-verbal development and total development areas, especially in case of delivery before 37 weeks.Our study confirms the impact of some obstetric variables on school achievement and psychological development of twins.

The main objective is to examine the influence of oxytocin administration during delivery on psychomotor development at age five years. This was a retrospective cohort study involving two groups: children of mothers exposed vs. not exposed to oxytocin during labor. Of the 7,465 newborns registered in our maternity service during 2006 we randomly selected an initial sample of 400 children. Of these, 146 children were assessed using the motor scale of the Battelle Developmental Inventory. Other predictor variables that could potentially act as confounders and/or interact with the main relationship were also examined. The data were subjected to bivariate analysis, estimates of measures of strength of association, stratified analysis and multivariate binary logistic regression. The results indicate that exposure to synthetic oxytocin during delivery is an independent risk factor for a delay in gross and fine motor development. This was the case after controlling for the variables duration of labor and sex of the newborn, none of which modified the effect of oxytocin on gross and fine motor development. However, sex of the newborn were shown to be confounding gross motor development. In light of these results, and with the aim of preventing possible psychomotor alterations, further studies are now needed to analyze the effect that the oxytocin dose and the duration of perfusion may have on children's subsequent development.

Aim: We designed this study to ascertain the prevalence of depressive disorders and anxiety at the beginning of the pregnancy, studying possible associated factors and assessing the influence of mood disorders on perinatal outcomes. Methods: A representative sample of 191 pregnant women at first trimester of their pregnancies completed a questionnaire that included the Whooley´s questions, the Spanish version of the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory and a series of questions related to health status, general mood and sociodemographic variables. Later, we prospectively evaluated the influence of anxiety and depression on the perinatal and obstetric results in 145 of them. Results: More than 20% of pregnant women presented high levels of anxiety. The mean values of the state and trait anxiety scores were 38.7 (SD 9.8) and 34.5 (SD 9.5). The mean BDI score was 5.97 (SD 4.9), with 9.5% of participants achieving scores compatible with depression, (61% mild in, 22.2% moderate, and 16.6% severe). BDI scores were significantly lower in women who became pregnant after assisted reproductive techniques. We observed an association between depression and trait anxiety scores with an infant's low birth weight. The multivariate analysis showed that the feeling of happiness at the beginning of pregnancy was the best predictor of foetal weight. Conclusion: The prevalence of emotional disorders in the first trimester of pregnancy is high, with more than 20% of pregnant women presenting high levels of anxiety, and more than 9.5% presenting depression. During the first trimester, depression and anxiety were associated with low birth weight.

El objetivo de este articulo es realizar un protocolo de manejo perinatal para aquellos fetos/neonatos nacidos en el limite de la viabilidad (por debajo de la semana de gestacion 256/7). Para ello se han revisado las principales publicaciones que hacen referencia a su asistencia en los ultimos anos. Partiendo de los resultados de morbimortalidad en nuestro hospital y en consenso con los neonatologos, hemos establecido un protocolo de manejo en nuestro centro. Proponemos un esquema en el que segun la edad gestacional y, en su defecto, el peso al nacimiento, establecemos cual debe ser el tipo de vigilancia fetal anteparto, necesidad de transporte neonatal, administracion de corticoides prenatales, via del parto y tipo de reanimacion al nacimiento. Todo ello se realiza en estrecha colaboracion con los neonatologos y haciendo participes a los progenitores en la toma de decisiones.

For centuries it has been considered that the due date for delivery in our species is 280 days after the onset of the last menstruation. However, in most cases this statement is not accurate. The main objective of this study was to determine the mean duration of pregnancy in our setting and whether it has experienced changes in recent years. A retrospective, population-based descriptive study was made of 102,169 deliveries assisted in Malaga University Hospital (Malaga, Andalusia, Spain) during the period 1998-2015. The mean gestational age at delivery was 269 days (SD 16 days), with a modal gestational age of 273 days. The mean duration of the singleton and multiple pregnancies was 271 days (SD 17 days) and 242 days (SD 20 days), respectively. A significant shortening of the duration of pregnancy was observed in the course of the study period.

Resumen Diversos trabajos publicados en ultimos anos apoyan que el uso del sulfato de magnesio como neuroprotector antenatal administrado ante la inminencia de un parto pretermino reduce el riesgo de padecer severas secuelas neurologicas en los recien nacidos. Guias clinicas de actuacion de diversos paises apoyan la instauracion de estos tratamientos neuroprotectores. En nuestro trabajo haremos una revision del problema, de la bibliografia al respecto y realizaremos una propuesta metodica de un protocolo de neuroproteccion dirigido a intentar reducir la morbilidad neurologica de los nacidos pretermino con una terapia que ya ha demostrado su efectividad. Al mismo tiempo, invitamos a diferentes hospitales a sumarse a nuestra propuesta aportando elementos de mejora y participando en estudios multicentricos que nos permitan evaluar en un tiempo razonable los resultados de esta actuacion cotejandolos con los publicados hasta ahora en la literatura.

In the past 50 years the incidence of multiple pregnancies has increased dramatically due almost exclusively to two factors: delayed childbearing and assisted reproductive techniques. In this paper we analyze the variations in the incidence of multiple gestations in Andalusia, one of the biggest administrative regions in Spain, over the last decade. Assisted reproduction techniques are very often evaluated only in terms of implantation and pregnancy rates per cycle, ignoring everything related to complications of multiple births, prematurity or economic overload. The rate of twins in Andalusia has increased from 10.9 per thousand in 2000 to 16.2 per thousand in 2009. The rate of triplet births has also increased in recent years. After a decline in 2003, motivated by promulgation of the first Human Assisted Reproduction Law, there was an increase after a second law came into effect in 2006. Health care spending attributable to the excess of multiple pregnancies reported in the decade 2000–2010 may have been much higher than €25 million.

Resumen Son extremadamente infrecuentes los tumores no neoplasicos que aparece durante el embarazo o el puerperio y originan complicaciones obstetricas, la mayor parte de las veces debido al tamano que pueden llegar a alcanzar. El hallazgo de una masa anexial es, en general, casual ya que las no complicadas producen escasa sintomatologia. El uso generalizado de la ecografia durante el embarazo y el puerperio permite su diagnostico. El manejo de un tumor anexial durante la gestacion o el puerperio debe ser individualizado, dependiendo de los sintomas de la paciente, la edad gestacional y el tamano y las caracteristicas de la tumoracion. El quiste folicular gigante solitario luteinizado del puerperio es una lesion poco frecuente del ovario que puede surgir en el embarazo y aumentar de tamano durante el puerperio hasta que es detectado. Presentamos el caso de un quiste folicular gigante luteinizado del puerperio diagnosticado en una paciente en la 6.a semana del puerperio. Realizamos asimismo una revision de las masas ovaricas no neoplasicas mas frecuentes.

The prevalence of substance abuse in women who become pregnant is similar to that of the general population, resulting in a high fetal exposure rate during the most vulnerable period regarding neurodevelopment and organogenesis. The present study was intended to assess the level of prenatal exposure to tobacco, alcohol or illicit drugs in the city of Málaga (Spain). It was designed as a cross-sectional study, and based on the anonymous self-reports of participants. A total of 451 pregnant women were recruited in the first, second or third trimester. The prevalence in each of the quarters respectively was 21.2%, 18.5% and 13.3% for smoking, 40.7%, 23.1% and 17.1% for alcohol and 4.8%, 1.9% and 1.2% for cannabis. We also found that a higher educational level was associated with a lower consumption of tobacco (RR 0.659 [0.537-0.810] plt;0.0001) and greater exposure to alcohol (RR 1.87 [1.30-2.69] plt;0.0007). These results, particularly in regard to alcohol intake, are sufficiently alarming to alert obstetric care providers about the need to implement preventive measures.La prevalencia de hábitos tóxicos en la población de mujeres que quedan embarazadas es similar a la de la población general, por lo que la exposición fetal a tóxicos es elevada en el período de mayor vulnerabilidad, sobre todo en relación al neurodesarrollo y la organogénesis. El presente estudio ha sido desarrollado para conocer el nivel de exposición prenatal a tabaco, alcohol u otras drogas en la ciudad de Málaga (España). El trabajo responde a un diseño observacional de corte transversal sobre el consumo de tóxicos durante el embarazo, y se basa en la autodeclaración de las gestantes mediante la cumplimentación de un cuestionario. Se reclutaron 451 gestantes de primer, segundo y tercer trimestre. La prevalencia de consumo en cada uno de los trimestres resultó ser respectivamente del 21.2%, 18.5% y 13.3% para el tabaco, 40.7%, 23.1% y 17.1% para el alcohol y del 4.8%, 1.9% y 1.2% para cannabis. En los tres trimestres, un mayor nivel de estudios se asoció a un menor consumo de tabaco (RR 0,659 [0.537-0.810] plt; 0.0001) y una mayor exposición al alcohol (RR 1.87 [1.30-2.69] plt; 0.0007). Los resultados obtenidos, sobre todo en relación al consumo de alcohol, son suficientemente llamativos como para alertar a los proveedores de atención obstétrica sobre la necesidad de poner en marcha medidas preventivas.

The prevalence of alcohol intake in women who become pregnant is similar to that found in the general population, especially in cases of unplanned pregnancies. Consequently, foetal exposure is high during the period of maximum vulnerability. The present study was carried out to determine the prenatal level of exposure to alcohol in Malaga, a Mediterranean region whose economy is based on the touristic sector (Costa del Sol). A cross-sectional, observational design was used to investigate the consumption of alcohol during pregnancy, based on a self-reporting questionnaire. A total of 451 women in the first, second or third trimesters of pregnancy were recruited. Consumption prevalences in each trimester were 40.7%, 25.5% and 17.1%. A higher educational level was associated with greater exposure to alcohol (risk ratio, 1.87 [1.30–2.69]). These results should alert the providers of obstetric care in touristic areas to the need for the adoption of adequate preventive measures.

The objective was to evaluate the potential influence of oxytocin administered during delivery on children's development at the age of 5.This study was designed as a retrospective cohort study where children from patients given synthetic oxytocin during delivery were considered as the exposed cohort and children from patients not given oxytocin as the nonexposed cohort. From a total of 7465 births attended at our maternity ward in 2006, an initial sample of 400 was randomly selected. A total of 148 children were evaluated using the Battelle Developmental Inventory. Potential confounding and adjustment factors were analyzed using stratified analysis and multivariate analysis (logistic regression).Oxytocin use did not significantly affect the overall risk of developmental delay in the study sample (relative risk, RR, 1.46; 95% confidence interval, CI [0.79-2.71]). The best fit regression model included twin delivery, type of delivery, and maternal age. In the group of vaginal noninstrumental deliveries, oxytocin administration increased the risk of poor Battelle Developmental Inventory outcome, particularly when maternal age was under 28 or over 35 years of age (odds ratio, OR, 67.14; 95% CI [5.46-824.86]). When delivery was instrumental or through cesarean section in mothers aged 28-35 years, oxytocin administration decreased the risk of developmental disorders (OR 0.16; 95% CI [0.04-0.66]).Although oxytocin administration during delivery did not affect the overall risk of low Battelle Developmental Inventory scores in the study sample, some effects were seen according to maternal age and type of birth.

Case Reports; Journal Article; BACKGROUND Ectopic pregnancy after hysterectomy is a very rare condition, but it must be kept in mind in women with history of hysterectomy who present with abdominal pain and ecographic adnexal heterogeneous images. Since first described by Wendeler in 1895, at least 67 ectopic pregnancies (tubal, ovarian and abdominal) have been described in patients subjected to prior hysterectomy. CASE PRESENTATION We describe the case of a 41-year-old white caucasian woman admitted to the emergency room due to abdominal pain for two days. The ultrasounds scan and the quantification of beta-HCG led to the diagnosis of tubal ectopic pregnancy, although she had been hysterectomized two years before. An emergency laparoscopy was performed for salpingectomy. The pathology report indicated trophoblastic tubal implantation and hematosalpinx. CONCLUSIONS Ectopic pregnancy is one of the conditions to be considered in the differential diagnosis of abdominal pain in women of child bearing potential, and the absence of the uterus does not rule out its diagnosis. Yes

The relationship between labor physiology and the onset of lactation leads to assess the potential correlation between oxytocin administration during labor and duration of breast-feeding.This study was designed as a retrospective cohort study where patients given synthetic oxytocin during labor induction were considered as the exposed cohort, and patients not given oxytocin formed the non-exposed cohort. Four hundred of the 7465 children born at our maternity during 2006 were randomly selected. Information about breast-feeding was available for 316 of these children. Eventual confounding or adjustment factors were analyzed using stratified and multivariate analysis.Oxytocin was used for delivery of 189 (59.8%) newborns, multiplying the risk of bottle-feeding by 1.451 (95% CI 1.28-1.63). The best-fit regression model of oxytocin use effect on bottle-feeding included sex and gestational age of the newborn. The use of oxytocin also multiplies the risk of breast-feeding withdrawal at 3 months by 2.29 (95% CI 1.41-3.74). This effect is confounded by maternal age, being higher for mothers under 27 years.Oxytocin administration during labor had some impact on both onset and duration of breast-feeding, particularly in mothers under 27 years of age and newborns delivered at term. Clinical Study registered at U.S.NCT01951040.

The effects of moderate variations in dietary iodine intake on maternal and fetal thyroid function are poorly understood. Recent studies question the usefulness of neonatal screening of congenital hypothyroidism as a tool for monitoring iodine deficiency. We proposed to test the hypothesis of an association between iodine intake during the last trimester of pregnancy and fetal thyroid function at the time of birth.The study was undertaken at term in 233 healthy pregnant women (29.7±5.6 years) and in their newborn. Inclusion of women in the study was done within the 24 hours before delivery.The median maternal urinary iodine concentration was 126.5 μg/L. The maternal free triiodothyronine (FT3), although not thyrotropin (TSH) and free thyroxine (FT4), correlated significantly with the urinary iodine concentration (r=0.17, p=0.013). The cord blood TSH, FT4, and FT3 correlated positively with the maternal urinary iodine concentration at the time of delivery (r=0.24, p=0.001; r=0.16, p=0.032; and r=0.24, p=0.003, respectively). The cord blood and heel blood TSH correlated positively with the amniotic fluid iodine concentration (r=0.21, p=0.015 and r=0.15, p=0.036). The cord blood TSH correlated positively with the cord blood FT4 (r=0.21, p=0.022) and FT3 (r=0.32, p=0.017). The maternal TSH correlated significantly with the cord blood TSH (r=0.22, p=0.014) and with the heel blood TSH (r=0.13, p=0.050).The results of this study show the presence of a positive association of TSH-FT4 at the time of delivery, which may be modulated by the amount of iodine consumed by the mother during pregnancy.

Intestinal obstruction is an uncommon surgical emergency during pregnancy that affects seriously the prognosis of gestation. The underlying cause can be identified in the majority of cases and usually consists of adhesions secondary to previous abdominal or pelvic surgery, followed in order of frequency by intestinal volvuli. In recent years there have been no reports in which the gravid uterus has been the cause of intestinal obstruction. We report the case of a woman in week 33 + 4 of pregnancy who developed extrinsic compression of the colon secondary to uterine rotation and pelvic impaction of the head of the fetus.

This paper shows temporal trends of latency period and perinatal survival after preterm premature rupture of membranes at or before 28 weeks (very early PPROM).We have studied retrospectively medical records of all cases of very early PPROM attended in our Obstetric Department from January 1, 2000 to December 31, 2010.A total of 327 cases of very early PPROM were attended, representing 0.4 % of all deliveries, 3.68 % of all preterm births and 15 % of cases all of PPROM. The mean gestational age at delivery was 27 weeks (range 20-34). The mean duration of latency period for the total of 327 cases was 12.1 days (range 0-83, SD 13.3), with a clear trend to its increase from 2005 (p0.05). The mean duration of latency period was largest in 2010 (p0.05). For the whole period 2000-2010, perinatal deaths reached 30.6 % of all cases, with a clear trend to decrease as gestational age at diagnosis increased, and over the years of study. We have also found a high rate of obstetric complications and a high rate of cesarean deliveries.The upward trend in the duration of latency period in all groups over the years of study and the encouraging perinatal survival observed, even in previable PPROM, are incentives to follow expectant/conservative management in these cases.