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We report our postpartum haemorrhage protocol focussing on the use of Bakri Balloon, describing its placement and affixing method, effectiveness rates, risk factors that might contribute to Bakri Balloon's failure and complications associated. We designed a retrospective study including 147 cases where a Bakri Balloon was necessary to control the postpartum uterine bleeding to assess the efficacy and to determine which clinical, obstetric or delivery variables could be associated with successful treatment. Failed treatment was defined when surgery or any other technique was needed after a Bakri Balloon placement in order to control uterine bleeding. For statistical analysis, we developed a descriptive analysis and a univariate logistic regression study.IMPACT STATEMENT

Introduction: The placenta aging has been related with intrauterine fetal growth, low maternal age, Caucasian, multiparity, hypertensive states and smoking habit. Grannum P. classification is the most used for its assessment. The association between grade III placenta (G3P) and ex-smoking or smokeexposed pregnants has not been studied Main outcome: To asses if smoking, being an ex-smoker or a passive-smoker is a risk factor for developing grade III placenta, as well as if there is a smoking-free period of time to avoid the effect of smoking over placenta Material and methods: A retrospective case-control study of single pregnancies followed-up at the Obstetric Ultrasound Unit between January 2013 and January 2014. Placental grading according to Grannum classification was stablished through abdominal approach between 34-36 weeks of gestation and two groups were established: grade III placenta and grade I-II placenta (G1-2P) Maternal and paternal characteristics, type of delivery and perinatal outcomes were collected Results: Baseline characteristics were similar between the two groups. In G3P the incidence of hypertensive disease of pregnancy was higher(p=0,0107). The percentage was similar for premature birth, 1st and 5th minute Apgar, type of delivery and cesarean due to risk of loss of fetal wellbeing. A lower neonatal weight was found in G3P, at the same median days at delivery, with a mean difference of 148,156(p=0,008313. Regarding weight percentile, it was found a p35 in G3P and a p47,5 in G1- 2P(p=0,08235) 15% of the total pregnant were smokers. In G3P group it was found a higher frequency of smokers and ex-smokers since 1st trimester of pregnancy (p=0.0001), as well as pregnant non-smokers with an smoking partner(p=0,0001). There was an strong evidence for association between pregnant smokers and smoking partners(p=0,0001). No difference was found regarding to neonatal weight comparing smokers, ex-smokers and ex-smokers since 1st trimester of pregnancy. The length of pregnancy was lower between G3P pregnant smokers compared to G1-2P pregnant smokers, with a mean difference of 8 days (p=0,00091) Conclusions: There is a strong evidence for association between smoking during pregnancy, quitting smoking at the beginning of the pregnancy or being a passive smoker with development of G3P Some pregnant smokers don`t develop premature aging of placenta, it could be due to either other parameters or a later aging (data were collected between 34-36 weeks). The association between quitting smoking at the beginning of the pregnancy and not having a smoking partner reduces the risk of developing G3P

Las gestaciones gemelares alcanzar el término de la gestación de manera más precoz que las gestaciones únicas, a las 37-38 semanas. Una vez sobrepasada esta edad gestacional, el riesgo de morbimortalidad materno-fetal se incrementa. Éste y otros motivos, como complicaciones materno-fetales o rotura prematura de membrana, pueden obligar a finalizar la gestación de manera programada. Para ello en las gestaciones únicas se han utilizado históricamente prostaglandinas o métodos mecánicos. La evidencia de estos métodos en las gestaciones gemelares es limitada debido a su menor incidencia. En muchos centros no se realizan partos vaginales en gestaciones múltiples y optan por realizar una cesárea de forma programada. El objetivo de este estudio es demostrar que el dispositivo de liberación vaginal de dinoprostona (Propess) es efectivo a la hora de iniciar trabajo de parto en aquellas gestacione gemelares en las que está indicado (al menos el primer gemelo en cefálica más allá de las 32 semanas de gestación, ambos gemelos en cefálica si la edad gestacional es < 32 semanas, bienestar fetal, ausencia de contraindicaciones maternas) y analizar su seguridad en este tipo de embarazos.

Hay un aumento de la población mayor de 65 años que por mejoras en la calidad asistencial, da un estilo de vida más activo. El motivo que más demanda ocasiona son los traumatismos, representando la quinta causa de muerte de la población anciana. Las caídas son la causa más común de las lesiones, dando lugar a TCE, motivo principal de la mortalidad en ancianos. Los ancianos generan más demanda al servicio sanitario y con estancias más prolongadas consumiendo más recursos asistenciales. El objetivo es estudiar el tipo de lesión y la localización de los traumatismos en personas mayores de 65 años que han acudido al servicio de urgencias del Hospital de Barbastro.