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The aim of this prospective study was to describe demographic and clinical characteristics of neonates born to mothers with active or past Graves disease and to assess compliance since implementation of a new protocol in our center.We prospectively followed up neonates born to mothers with active or past Graves disease in a tertiary hospital in Spain between August 2019 and September 2021 according to our protocol. We reviewed maternal and neonatal history of these neonates, and we followed up newborns at risk of neonatal hyperthyroidism.Among 5808 births, 33 neonates were born to mothers with active or past Graves disease (0.57%). Six mothers (18.2%) had positive levels of thyroid-stimulating hormone receptor antibodies during pregnancy and five mothers (15.1%) between weeks 20 and 24 of pregnancy. Two of them had received definitive therapy for Graves disease before pregnancy. Two neonates (7.1%) were at high risk of neonatal hyperthyroidism and were followed-up until two months, without hyperthyroidism signs or abnormal thyroid hormone levels. Compliance of protocol during pregnancy was 84.9% and 75.8% at birth.Prevalence of Graves disease among pregnant women was 0.57%, with no cases of neonatal hyperthyroidism. Compliance of protocol was adequate during pregnancy (84.9%) and acceptable at birth (75.8%).

Pregnant women are particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In addition to unfavorable perinatal outcomes, there has been an increase in obstetric interventions. With this study, we aimed to clarify the reasons, using Robson's classification model, and risk factors for cesarean section (C-section) in SARS-CoV-2-infected mothers and their perinatal results. This was a prospective observational study that was carried out in 79 hospitals (Spanish Obstetric Emergency Group) with a cohort of 1704 SARS-CoV-2 PCR-positive pregnant women that were registered consecutively between 26 February and 5 November 2020. The data from 1248 pregnant women who delivered vaginally (vaginal + operative vaginal) was compared with those from 456 (26.8%) who underwent a C-section. C-section patients were older with higher rates of comorbidities, in vitro fertilization and multiple pregnancies (p < 0.05) compared with women who delivered vaginally. Moreover, C-section risk was associated with the presence of pneumonia (p < 0.001) and 41.1% of C-sections in patients with pneumonia were preterm (Robson's 10th category). However, delivery care was similar between asymptomatic and mild-moderate symptomatic patients (p = 0.228) and their predisposing factors to C-section were the presence of uterine scarring (due to a previous C-section) and the induction of labor or programmed C-section for unspecified obstetric reasons. On the other hand, higher rates of hemorrhagic events, hypertensive disorders and thrombotic events were observed in the C-section group (p < 0.001 for all three outcomes), as well as for ICU admission. These findings suggest that this type of delivery was associated with the mother's clinical conditions that required a rapid and early termination of pregnancy., This project was supported by public funds that were obtained in competitive calls: Grant COV20/00021 (EUR 43,000 from the Instituto de Salud Carlos III-Spanish Ministry of Health) and co-financed with Fondo Europeo de Desarrollo Regional (FEDER) funds.

Objective To evaluate the perinatal and maternal outcomes of pregnancies in SARS-CoV-2 infected women, comparing spontaneous and In Vitro Fertilization (IVF) pregnancies (with either own or donor oocytes). Design Multicentre, prospective, observational study. Setting 78 centres participating in the Spanish COVID19 Registry. Patients 1,347 SARS-CoV-2 positive pregnant women registered consecutively between February 26th and November 5th, 2020. Interventions Patient´s information was collected from their medical records, and multivariable regression analyses were performed, controlling for maternal age and the clinical presentation of infection. Main outcome measures Obstetrics and neonatal outcomes, pregnancy comorbidities, intensive care unit admission, mechanical ventilation need and medical conditions. Results The IVF group was composed of 74 (5.5%) women whereas the spontaneous group included 1,275 (94.5%) women. Operative delivery rate was high in all patients, especially in the IVF group, where C-section became the most frequent method of delivery (55.4%, compared to 26.1% of spontaneous). The reason for C-section was induction failure in 56.1% of IVF patients. IVF women had more gestational hypertensive disorders [16.2% vs 4.5% among spontaneous, adjusted Odds Ratio (aOR) 5.31, 95% Confidence Interval (CI) 2.45-10.93) irrespective of oocyte origin. The higher rate of ICU admittance observed in the IVF group (8.1% vs 2.4% spontaneous) was attributed to pre-eclampsia (aOR 11.82, 95% CI 5.25-25.87), not to the type of conception, Conclusions High rate of operative delivery has been observed in SARS-CoV-2 infected women, especially in IVF pregnancies; method of conception does not affect foetal or maternal outcomes, except for pre-eclampsia., CAPSULE: Method of conception does not affect foetal or maternal outcomes in SARS-CoV-2 infected women, except for pre-eclampsia.

Additional file 3. Patient Consent Form.

Additional file 2: Table S1. List of hospitals included in the study (n = 45); and Table S2. STROBE Statement—checklist of items that should be included in reports of observational studies.

The COVID-19 pandemic has raised questions about the possible cross immunity resulting from common vaccination programs and SARS-CoV-2 infection. Therefore, the Spanish Obstetric Emergency group performed a multicenter prospective study on the vaccination status of Influenza and Tdap (diphtheria, tetanus and pertussis vaccine boost administered in adulthood) in consecutive cases of SARS-CoV-2 infection in a pregnancy cohort, in order to assess its possible association with the clinical presentation and severity of symptoms of SARS-CoV-2 infection, as well as to determine the factors that may affect vaccination adherence. A total of 1150 SARS-CoV-2 positive pregnant women from 78 Spanish hospitals were analyzed: 183 had not received either vaccine, 23 had been vaccinated for Influenza only, 529 for Tdap only and 415 received both vaccines. No association was observed between the vaccination status and the clinical presentation of SARS-CoV-2 infection and/or the severity of symptoms. However, a lower adherence to the administration of both vaccines was observed in the Latin-American subgroup. Based on the results above, we reinforce the importance of maternal vaccination programs in the actual pandemic. Health education campaigns should be specially targeted to groups less likely to participate in these programs, as well as for a future SARS-CoV-2 vaccination campaign., This research was supported by public funds obtained in competitive calls: Grant COV20/ 00021 from the Instituto de Salud Carlos III-Spanish Ministry of Health, and co-financed with Fondo Europeo de Desarrollo Regional (FEDER) funds

Introducción: Los residentes de Ginecología aprenden a realizar procedimientos quirúrgicos,tales como la conización cervical directamente en pacientes reales. El nivel de habilidad técnica influye en los resultados, aumentando los riesgos obstétricos posteriores de las pacientes si el profesional tiene poca experiencia. Este proyecto tiene como objetivo el diseño y la evaluación de un simulador seguro, útil y reproducible para el entrenamiento en conización cervical con asa diatérmica. Material y métodos: Para la construcción del simulador se ha utilizado material accesible en cualquier hospital docente, empleando productos cárnicos para reproducir el cuello uterino. Para la evaluación del mismo se ha diseñado una encuesta de satisfacción cumplimentada por 16 profesionales que valoraron el simulador, realizando posteriormente un análisis descriptivo de los resultados. Resultados: Durante la primera fase del proyecto se detallaron los pasos para la construcción del simulador de conización cervical. La segunda fase o evaluación del simulador mostró que la mayoría de profesionales valoran los primeros conos realizados por residentes como de mala calidad, dificultando la interpretación de la pieza quirúrgica por parte del patólogo. El 100% de los encuestados afirmó que utilizaría el simulador en su hospital de referencia y lo valoraron como «sencillo, útil, seguro, reproducible y adecuado para docencia». Conclusión: El simulador construido propone un método docente para la enseñanza a residentes de la técnica de conización cervical con asa diatérmica, siendo fácilmente reproducible y posibilitando en un futuro, tras su validación, el diseño de programas de entrenamiento, Introduction: Gynaecology residents learn how to perform surgical procedures such as cervicalconization directly on real patients. Their skills level determines the outcomes, with an increasein the subsequent obstetric risks of the patients if the physician is not experienced. This projectincludes the design and evaluation of a safe, useful and reproducible surgical simulator for loopelectrosurgical conisation technique training. Materials and methods: Affordable and available material in any teaching hospital was used inthe construction of the simulator. The human cervix was simulated using a sausage model.In order to evaluate the project, a satisfaction survey was designed and completed by 16professionals. A subsequent descriptive analysis of the results was performed.Results: During the first stage of the project, the different steps of the simulator’s constructionwere detailed. The second, or evaluation stage, showed that most professionals rated thefirst cones of resident doctors as poor in quality, making them difficult to be interpreted by apathologist. All the respondents stated that they would use the simulator in their hospital, andrated it as ‘‘simple, safe, useful, reproducible and suitable for teaching’’.Conclusions: The developed simulator proposes a method for teaching residents skills in loopelectrosurgical cervical conisation, being easily reproducible and allowing, after future valida-tion, the design of training programs for residents

Shoulder dystocia (SD) training is recommended by diverse international healthcare organizations; however, it is not so in Spain, and there is no specific programmes. The objective of the study was to evaluate the level of knowledge and attitudes towards resolving a SD among a large sample of spanish obstetricians and midwives.A multi-professional team carried out simulation-based training courses. Descriptive observational study where mean, standard deviation, minimum and maximum or median and interquartile intervals according to the distribution will be used for continuous variables. For the discrete variables, the number and the corresponding percentages will be reported.Between December 2015 and 2019, the team carried out 17 editions of SD workshop and 904 active professionals were trained in labour wards in different parts of Spain. The results showed that 64.8% of the professionals had learned to solve shoulder dystocia through books and/or 58.4% theoretical classes. 60.4% (380) of the respondents had not received any type of training in simulation in obstetrics. 87.1% (415/476) of the students had not felt prepared to face a SD when they finished the residency At the time of answering this survey, 61.8% (358) did not feel prepared to solve a SD.Training in Shoulder Dystocia in Spain is mainly theoretical and a high number of professionals recognize that they are not sufficiently prepared to face it with guarantees.El entrenamiento en distocia de hombros (DH) está recomendado por numerosas sociedades médicas internacionales y, sin embargo, en España, no existen programas específicos de entrenamiento. El objetivo de este estudio fue evaluar el nivel de conocimiento y habilidades prácticas para resolver una distocia de hombros de un amplio número de matronas y ginecólogos españoles que habían realizado un curso basado en simulación.El equipo multiprofesional de simulación obstétrica realizo talleres basados en simulación para la resolución de la DH. Estudio descriptivo observacional donde para las variables continuas se utilizará media, desviación estándar, mínimo y máximo o mediana e intervalos intercuartiles de acuerdo con la distribución. Para las variables discretas se reportarán el número y los porcentajes correspondientes.Entre diciembre de 2015 y 2019, el equipo llevo a cabo 17 ediciones del taller de DH y formo a 904 profesionales de diferentes partes de España. Los resultados mostraron que Un 64,8% de los profesionales había aprendido a solucionar la distocia de hombros a través de libros y/o un 58,4% clases teóricas. El 60,4% (380) de los encuestados, no había recibido ningún tipo de formación en simulación en obstetricia. Un 87,1% (415/476) de los alumnos no se había sentido preparado para enfrentarse a una DH cuando terminó la residencia En el momento de contestar esta encuesta, un 61,8% (358) no se sentía preparado para resolver una DH.La formación en distocia de hombros en España es principalmente teórica y un alto numero de profesionales reconoce que no están suficientemente preparados para afrontarla con garantías.

The Spanish registry of Covid-19 in Spanish pregnant women, made up of 100 centers, is created in response to the need to know the morbidity that Covid-19 generates in pregnant women and their newborns, to know the real incidence of the disease in this population group and to establish and monitor the package of measures to improve their care. The aim of this paper was the creation of a registry of pregnant women with Covid-19 infection in order to establish the interventions and measures necessary to improve the care of these patients during hospital admission.To prepare the registry, the main researcher of each center collected weekly / biweekly the number of total pregnant women screened, as well as the total number of positive and negative, sending these data to the responsible researchers so that it could be available in real time of the percentage of infected asymptomatic pregnant population and the evolution by weeks in the centers of each participating province. The data were analyzed using the linear regression test and the Mantel test.As of May 31The Spanish epidemiological registry allows us to know the incidence of infection in pregnant women attended in the Spanish delivery centers, as well as the weekly and / or fortnightly evolution of the same, observing a significant decrease in the proportion of positive pregnant women over the total of screenings throughout this period, with an average of 6.5% in early April 2020 to an average of 0.93% positive in late May 2020.El registro español de Covid-19 en embarazadas españolas, integrado por 100 centros, surge en respuesta a la necesidad de conocer la morbilidad que la Covid-19 genera en las gestantes y sus recién nacidos, de conocer la incidencia real de la enfermedad en este grupo poblacional y de establecer y monitorizar el paquete de medidas para mejorar su atención. El objetivo de este estudio fue la creación de un registro de gestantes con infección por Covid-19 con la finalidad de establecer y monitorizar las intervenciones y medidas necesarias para mejorar la atención de estas pacientes durante el ingreso hospitalario.Para la elaboración del registro, el investigador principal de cada centro recogió con carácter semanal/quincenal el número de gestantes totales cribadas, así como el total de positivas y negativas, remitiendo a los investigadores responsables estos datos de manera que se pudiera disponer a tiempo real del porcentaje de población gestante asintomática infectada y de la evolución por semanas en los centros de cada provincia participante. Los datos fueron analizados mediante el Test de regresión lineal y test de Mantel.A día 31 de mayo de 2020, se realizaron en estos hospitales 16.308 test de cribado, en los cuales 338 gestantes resultaron positivas, lo que se traduce en que un 2,07% (Intervalo de Confianza del 95%: 1,86-2,30) de las gestantes asintomáticas que atendimos en nuestros centros eran portadoras del virus y podían desarrollar la enfermedad en días posteriores.El registro epidemiológico español permite conocer la incidencia de infección en gestantes atendidas en los paritorios españoles, así como la evolución semanal y/o quincenal de la misma, observándose un descenso significativo de la proporción de gestantes positivas sobre el total de cribadas a lo largo de este periodo, con una media del 6,5% a principios de abril de 2020 hasta una media del 0,93% de positivas a finales de mayo de 2020.

Oxytocin is a hormone involved in the mechanism of breastfeeding, uterine contractions, and social relationships. Atosiban (competitive oxytocin antagonist) is one of the most commonly used tocolytics for the threat of preterm labor in Europe. The aim of this study is to determinate if the administration of atosiban has any influence in the type of feeding in the term newborn at discharge. The secondary objective is to verify its effectiveness for the prevention of preterm delivery and in the possibility of applying treatment to complete lung maturation.Retrospective cohort study carried out in a tertiary University Hospital distinguished by WHO-UNICEF as a Baby-Friendly Hospital Initiative. The analysis included 264 women exposed to atosiban during a period of 4 years. One hundred met inclusion criteria. Unexposed infants born right after and before the exposed ones were selected as the not exposed subgroup (n = 200).Among women treated with atosiban, 82% maintained exclusively breastfed (EBF), 8% had mixed breastfeeding, and 10% had formula feeding at discharge. In the nonexposed group, 82% maintained EBF, 9.5% had mixed breastfeeding, and 8.5% had formula feeding at discharge (p = 0.84). 97.5% of pregnant women treated with atosiban received corticosteroid for lung maturation, and 49.5% completed gestation with term newborns.There were no significant differences in the type of feeding at discharge between the atosiban group and the nonexposed group. In most cases, the administration of tocolytic therapy allowed to complete lung maturation.

Background: Pertussis immunization during pregnancy is recommended in many countries. Data from large randomized controlled trials are needed to assess the immunogenicity, reactogenicity and safety of this approach. Methods: This phase IV, observer-blind, randomized, placebo-controlled, multicenter trial assessed immunogenicity, transplacental transfer of maternal pertussis antibodies, reactogenicity and safety of a reduced-antigen-content diphtheria-tetanus-three-component acellular pertussis vaccine (Tdap) during pregnancy. Women received Tdap or placebo at 27–36 weeks’ gestation with crossover ≤ 72-hour-postpartum immunization. Immune responses were assessed before the pregnancy dose and 1 month after, and from the umbilical cord at delivery. Superiority (primary objective) was reached if the lower limits of the 95% confidence intervals (CIs) of the pertussis geometric mean concentration (GMC) ratios (Tdap/control) in cord blood were ≥ 1.5. Solicited and unsolicited adverse events (AEs) and pregnancy-/neonate-related AEs of interest were recorded. Results: 687 pregnant women were vaccinated (Tdap: N = 341 control: N = 346). Superiority of the pertussis immune response (maternally transferred pertussis antibodies in cord blood) was demonstrated by the GMC ratios (Tdap/control): 16.1 (95% CI: 13.5–19.2) for anti-filamentous hemagglutinin, 20.7 (15.9–26.9) for anti-pertactin and 8.5 (7.0–10.2) for anti-pertussis toxoid. Rates of pregnancy-/neonate-related AEs of interest, solicited general and unsolicited AEs were similar between groups. None of the serious AEs reported throughout the study were considered related to maternal Tdap vaccination. Conclusions: Tdap vaccination during pregnancy resulted in high levels of pertussis antibodies in cord blood, was well tolerated and had an acceptable safety profile. This supports the recommendation of Tdap vaccination during pregnancy to prevent early-infant pertussis disease. Clinical Trial Registration. ClinicalTrials.gov: NCT02377349., This work was supported by GlaxoSmithKline Biologicals S.A.

RESUMEN Se presentan dos casos de gestacion heterotopica, el primero de ellos espontaneo y el segundo tras tecnicas de fecundacion in vitro. En ambos la gestacion intrauterina evoluciono de forma favorable, con control gestacional normal y llegando a termino, con el nacimiento de recien nacidos sanos. La gestacion heterotopica se define como la presencia simultanea de gestacion en dos lugares de implantacion distintos, lo mas frecuente una gestacion intrauterina acompanada de otra ectopica. Se trata de una situacion poco frecuente, con una incidencia de 1/8000 embarazos espontaneos segun la bibliografia mas reciente.PALABRAS CLAVE: Gestacion ectopica, gestacion heterotopica, salpingectomia,fecundacion in vitro SUMMARY We report two cases of heterotopic pregnancy, the first one spontaneous and the second one after in vitro fertilization techniques. In both, the intrauterine gestation evolved favorably, normal pregnancy control and coming to terms with the birth of healthy newborns. Heterotopic pregnancy is defined as the simultaneous presence of gestation at two different locations, most often in utero accompanied by another ectopic preg-nancy. This is a rare situation, with an incidence of spontaneous pregnancies 1/8000 according to the most recent literature.KEY WORDS