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Coronavirus disease-2019 (COVID-19) related to Coronavirus-2 (SARS-CoV-2) is a worldwide health concern. Despite the majority of patients will evolve asymptomatic or mild-moderate upper respiratory tract infections, 20% will develop severe disease. Based on current pathogenetic knowledge, a severe COVID-19 form is mainly a hyperinflammatory, immune-mediated disorder, triggered by a viral infection. Due to their particular immunological features, pregnant women are supposed to be particularly susceptible to complicate by intracellular infections as well as immunological disturbances. As an example, immune-thrombosis has been identified as a common immune-mediated and pathogenic phenomenon both in COVID-19, in obstetric diseases and in COVID-19 pregnant women. According to extensive published clinical data, is rationale to expect an interference with the normal development of pregnancy in selected SARS-CoV-2-infected cases, mainly during third trimester. This manuscript provides insights of research to elucidate the potential harmful responses to SARS-CoV-2 and /or other coronavirus infections, as well as bidirectional interactions between COVID-19 and pregnancy to improve their respective management.

Preeclampsia is caused by placental impairment with increased expression of sFlt-1 (soluble fms-like tyrosine kinase 1) and decreased PlGF (placental growth factor); it has been associated with cardiovascular morbidity and mortality later in life, but the underlying mechanism remains unknown. The aim of this study was to determine whether sFlt-1 and PlGF levels during preeclampsia are associated to long-term cardiovascular risk. We prospectively recruited 43 women with previous preeclampsia and 21 controls with uncomplicated pregnancies. Cardiovascular risk assessment ≈12 years later included maternal hemodynamic, cardiac function and structure, biomarker analysis, and carotid-intima thickness evaluation. Women with previous preeclampsia had higher prevalence of hypertensive disorders and dyslipidemia than controls. In addition, they had worse global longitudinal strain, thicker left ventricular septal and posterior walls, more myocardial mass and increased carotid intima-media thickness compared with controls. PlGF during pregnancy correlated positively with high-density lipoprotein ( r =0.341; P =0.006), and negatively with global longitudinal strain ( r =−0.581; P r =−0.251; P =0.045), and mean arterial blood pressure ( r =−0.252; P =0.045), when adjusted by study group. sFlt correlated negatively with high-density lipoprotein ( r =−0.372; P =0.002) and apolipoprotein A-1 ( r =−0.257; P =0.040), and positively with carotid intima-media thickness ( r =0.269; P =0.032) and left ventricular posterior wall thickness ( r =0.368; P =0.003). The antiangiogenic state present in preeclampsia is related to greater prevalence of cardiovascular risk factors ≈12 years after delivery. The knowledge of altered angiogenic factors may help detect women with a higher risk for premature cardiovascular disease, who will require earlier follow-up after delivery.

Background: Preeclampsia (PE) and intrauterine growth restriction (IUGR) are major causes of maternal and perinatal morbidity and mortality. Previous studies have shown that intervention with low-dose aspirin resulted in a reduction in the occurrence of preterm PE. However, no data are currently available on the effect of low-molecular-weight heparin (LMWH) for the prevention of pregnancy complications in women enrolled at first trimester screening. Objective: We aimed to assess the effectiveness of LMWH in the prevention of PE, IUGR, fetal death, and abruptio placentae in women classified as high risk based on their medical history and in women selected by first trimester screening of PE. Study ­Design: This was a multicenter, randomized, open-label, parallel controlled trial in women without thrombophilia between 6.0 and 15.6 weeks of gestation. Inclusion criteria were severe PE or IUGR before 34 weeks of gestation and/or abruptio placentae or unexplained intrauterine death in a previous pregnancy; uterine artery mean pulsatility index Doppler >95th percentile and/or positive first trimester screening for PE. Pregnant women were randomly assigned to receive no intervention or LMWH until the 36th week of gestation. The primary composite outcome consisted of 1 or more of the following: development of PE, IUGR, abruptio placentae, and intrauterine fetal death. Results: A total of 278 pregnant women were randomly allocated to receive LMWH (n = 134) or no intervention (n = 144). Overall, 115 (41%) women experienced placental insufficiency complications, with no significant differences between the 2 arms: 50/144 (34.7%) in the LMWH arm and 43/134 (32%) in the control arm (p = 0.64, OR: 1.13, 95% CI: 0.68–1.85). Conclusion: LMWH did not reduce the incidence of placenta-mediated complications either in women with previous adverse obstetric history without thrombophilia or in women selected by first trimester screening for PE. Based on these results, we cannot recommend the use of LMWH alone in women at risk of placental complications.

Background Congenital heart disease (CHD) is the most prevalent congenital malformation affecting 1 in 100 newborns. While advances in early diagnosis and postnatal management have increased survival in CHD children, worrying long-term outcomes, particularly neurodevelopmental disability, have emerged as a key prognostic factor in the counseling of these pregnancies. Methods Eligible participants are women presenting at 20 to Discussion The results of NEURO-HEART study will provide the most comprehensive knowledge until date of children’s neurologic prognosis in CHD and will have the potential for developing future clinical decisive tools and improving preventive strategies in CHD. Trial registration NCT02996630, on 4th December 2016 (retrospectively registered).

Objectives: The aim of this study was to evaluate the relationships between brain injury biomarkers in intrauterine growth-restricted (IUGR) infants (S100B and neuron-specific enolase (NSE)) and neurodevelopment at 2 years of age. Methods: This prospective case-control study was a cooperative effort among Spanish Maternal and Child Health Network (Retic SAMID) hospitals. At inclusion, biometry for estimated fetal weight and feto-placental Doppler variables were measured for each infant. Maternal venous blood and fetal umbilical arterial blood samples were collected at the time of delivery and neural injury markers S100B and NSE concentrations were measured. Neurodevelopment was evaluated at 2 years of age using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III). Results: Fifty six pregnancies were included. Thirty-one infants were classified as IUGR and 25 as non-IUGR. Neurodevelopmental evaluation at 2 years of age indicated that there were no between-group differences for any of the tests. For all patients in both groups, we found statistically significant inverse relationships between the concentrations of NSE in the cord blood and the results of the cognitive test (r = -271, p = .042), fine motor subtest (r = -280, p = .036), and social-emotional test (r = -349, p = .015). We also found statistically significant differences between the concentrations of S100B in the cord blood and the results of the cognitive test (r = -306, p = .022) and expressive communication subtest (r = -304, p = .023). For the IUGR group, we found a significant inverse relationship between the concentrations of S100B in the maternal serum and the results of adaptive behavior test (p < .05). In the non-IUGR group, we found statistically significant inverse relationships between the concentration of NSE in the cord blood and the results of the fine motor subtest (r = -446, p = .025) and social-emotional test (r = -489, p = .021). The difference between the concentration of S100B in the cord blood and the language composite score was also statistically significant (p = .038). Conclusions: At 2 years of age, the concentrations of NSE and S100B were higher in the non-IUGR and IUGR groups with the worst scores for some areas of neurodevelopmental evaluation. The value of these biomarkers for prognostic neurodevelopmental use requires further investigation for both non-IUGR and IUGR infants.

The integrity of the fetal amnion-chorion is an imperative for the preservation of a normal pregnancy in the human. The diagnosis of the status of the fetal membranes has traditionally been reduced to either intact or ruptured. In the last decades, evidence has accumulated demonstrating that this clinical approach may well be an over simplification. Practically, all maternal organs experienced physiologic or eventually pathologic changes during the length of the gestational period. We propose that the fetal membranes are also significantly impacted by those changes. The accurate, specific, simplified and low-cost diagnosis of the status of the fetal membranes is of critical importance for the assessment of risk to the pregnancy followed by efficient and prompt treatment. The presence of placental alpha macroglobulin-1 in the vagina specifically indicates a disruption in the integrity of the fetal membranes and may indirectly mean increased risk for preterm birth. Further research to properly characterize this marker and its importance in the care of pregnant woman at risk for preterm birth is strongly recommended.

Noncommunicable diseases (NCDs) are responsible for 36 million deaths every year. Of this death toll, nearly 80% (29 million) occur in low- and median-income countries. More than 9 million deaths attributed to NCDs occur in people under 60 years of age. National economies are suffering considerable losses due to premature death or disability to work resulting from heart disease, stroke, and diabetes. The knowledge that in utero and in early childhood certain processes can affect the risk of developing NCDs provides an opportunity to enforce interventions during this critical time, when they may have the greatest effect. Using appropriate protocols, the health-care provider can educate mothers about the risks of certain nutritional and environmental exposures and integrate health promotion on the agenda, as part of the social and economic development. All this could motivate a substantial reduction in the risk of NCDs. Current and future health challenges demand new and changing competencies that should form the basis for education, training, and workforce planning. The International Federation of Gynaecology and Obstetrics (FIGO) is aware of that responsibility and has joined hands with other agencies and organizations that make a considerable effort in providing appropriate prenatal care programs to prevent and treat most of the common preconditioning factors, especially in low-income countries.

Objectives To describe the outcome of patients with twin-to-twin transfusion syndrome and cervical length ≤ 25 mm, treated with laser and an Arabin cervical pessary. Methods Retrospective analysis of a consecutive series of all cases with severe twin-to-twin transfusion syndrome who underwent laser surgery: a group with cervical length above 25 mm (group A) and two groups who had a cervical length of 25 mm or less prior to the procedure. The first 8 cases (group B) were managed expectantly and the next 8 cases had a cervical pessary inserted immediately after laser surgery (group C). Gestational age at birth was the primary outcome. The secondary outcome was a composite one encompassing severe neonatal morbidity. Results The median gestational age at laser surgery was 20 weeks in all groups but the median gestational age at delivery was significantly higher in group C versus B (28 vs 32 weeks, p = 0.01). Severe neonatal morbidity was present in 18% in group C and 70% in group B (p

Resumen Fundamento y objetivo El embarazo es un factor de riesgo independiente para presentar una forma clinica grave de gripe. Multiples organismos nacionales e internacionales incluyen en sus recomendaciones oficiales la administracion de vacunacion antigripal a gestantes. El objetivo de este trabajo fue estimar las coberturas de vacunacion antigripal en una muestra amplia de mujeres atendidas por parto en un hospital de tercer nivel y conocer los conocimientos y practicas de los obstetras en relacion con la indicacion de la vacuna. Metodos Estudio descriptivo transversal mediante 2 encuestas: una administrada a las puerperas atendidas por parto entre diciembre de 2007 y febrero de 2008, y otra dirigida a los obstetras que trabajaban en este hospital o en centros de atencion primaria del area de referencia. Resultados La cobertura vacunal en las puerperas del estudio fue de un 4,1%. El 80,5% de las mujeres no presentaba comorbilidad asociada. La cobertura vacunal en el grupo con comorbilidad fue del 3,3%. El profesional que recomendo mas frecuentemente la vacuna fue la comadrona (28,9%) y la enfermera (18,4%). Entre los obstetras, solo el 20% conocia la indicacion de la vacunacion antigripal en gestantes durante el primer trimestre, y el 65,1%, en el segundo o tercer trimestre. Solo el 7% manifesto prescribir la vacuna en el primer trimestre y un 20,9%, en el segundo o tercer trimestre. Conclusiones La cobertura vacunal en las gestantes de nuestro estudio es muy baja. Los obstetras encuestados presentaron un bajo nivel de conocimiento de las recomendaciones vigentes, en especial la de la inmunizacion durante el primer trimestre del embarazo, y muy pocos la prescriben.

Resumen Fundamento y objetivo tras los recientes brotes de rubeola descritos en poblacion inmigrante de Madrid, se ha querido conocer la proporcion de mujeres inmigrantes susceptibles a esta enfermedad en Cataluna. Pacientes y metodo se ha llevado a cabo un estudio de seroprevalencia en mujeres gestantes provenientes de paises de renta baja. Se recogio informacion demografica y sobre posibles factores predictivos de susceptibilidad. Resultados se incluyo en el estudio a 594 mujeres. La proporcion global de susceptibilidad a la rubeola fue del 11,7% (intervalo de confianza [IC] del 95%, 9,2–14,5%). La mayor prevalencia de susceptibles se observo en las mujeres de origen africano (17%; IC del 95%, 10,5–25,2%). La edad inferior a 25 anos fue un factor de riesgo asociado a la susceptibilidad a la rubeola (odds ratio ajustada=3,02; IC del 95%, 1,09–8,35). Conclusiones el porcentaje de susceptibilidad a la rubeola entre las gestantes provenientes de paises de renta baja supera en 10 veces la susceptibilidad de las mujeres en edad fertil autoctonas de Cataluna.

Resumen Objetivo Determinar si las pacientes con cesarea tienen un mayor numero de complicaciones que las de parto y describir el tipo de complicaciones observadas. Sujetos y metodos Se revisaron los expedientes de 1.017 pacientes que finalizaron su gestacion en el Hospital Materno-Infantil Vall d’Hebron durante el primer trimestre de 2007. Resultados Para una tasa de cesareas del 22%, la incidencia de complicaciones maternas fue del 18% y del 6% en los partos (riesgo relativo = [RR] 3,1; intervalo de confianza [IC] del 95%, 2,4-15.1). Las complicaciones mas frecuentes fueron la infeccion de herida (7,5%), la transfusion de sangre (5,3%) y la hemorragia (3,1%); la endomiometritis fue mas comun en el grupo de pacientes de parto (el 1,6 frente al 1,3%). Conclusiones La cesarea tiene un riesgo de complicaciones tempranas 3 veces mayor que el parto. La menor incidencia de endomiometritis poscesarea quiza es consecuencia de la profilaxis antibiotica, pero se requieren mas estudios para llegar a una conclusion al respecto.

PROBLEM Anti-beta(2)-Glicoprotein-1 antibodies (anti-beta(2)GPI-ab) have been related to recurrent miscarriage (RM) with conflicting results. The aim was to evaluate the role of anti-beta(2)-GPI-ab as unique biological marker in RM related to antiphospholipid (aPL). METHOD OF STUDY A cohort study that included 59 cases, divided in two groups, was designed: group 1 comprised 43 pregnant women with 'obstetric' antiphospholipid syndrome (APS) and group 2 included 16 cases with similar complaints but only having repeatedly anti-beta(2)-GPI-ab. Previous thrombosis and/or inherited thrombophilia were excluded. Lupus anticoagulant, anticardiolipin antibodies (aCA), anti-beta(2)-GPI-ab, and other autoantibodies were analyzed. Miscarriages, premature births, pre-eclampsia, live births, placental and systemic thromboses were studied. RESULTS No differences in previous obstetric complications were detected (P = 1.00-0.164). After the treatment, differences in number of obstetric complications were not seen (P = 1.00). Live births were similar in two groups (88.4% and 93.7%; P = 1.00). Placental thrombosis was equal in both groups, 93.3% versus 80% (P = 1.00). CONCLUSION These results suggest that anti-beta(2)-GPI-ab may be considered a biological marker for obstetric APS.

Kikuchi-Fujimoto disease (KFD) is a distinctive, benign type of necrotizing lymphadenitis. KFD is a rare entity, especially during pregnancy. Although first described in Japan, subsequently it has been reported in the West. We communicate herein a case of KFD in African women with bouts during pregnancy. Diagnosis was difficult because peripheral enlarged lymph nodes were absent and an extended differential diagnosis and adequate work-up was necessary. The patient suffered a miscarriage coinciding with a KFD bout. Further pregnancies were uneventful. Follow up showed that KFD evolved into a systemic lupus erythematosus-like syndrome.

Recent studies pointed to an intrinsically angiogenic imbalance in CHD in the maternal and foetal circulation suggestive of impaired placentation.To assess whether pregnant women with a CHD foetus are at greater risk of placenta-related complications.Perinatal results of women with a CDH foetus were compared with those of a non-selected population followed up at our centre. Multiple pregnancies and chromosomal abnormalities were excluded from the analysis.About 279 pregnancies with CHD foetuses were included. Mothers were classified in three groups according to the foetal cardiac defect: 104 (37.3%) atrioventricular defect, 102 (36.5%) conotruncal anomalies and 73 (26.2%) left-ventricular outflow tract obstruction. A significantly higher incidence of pre-eclampsia was observed in the CHD group compared with the normal population (5.7% versus 1.2% p 0.0001) [OR 5.96 (95% CI - 3.19-10.54)]. About 9.7% of foetuses with CHD had 3rd birth weight percentile compared with 3% for the normal population [OR 3.32 (95% CI - 2.39-4.56)]. A higher incidence of stillbirth was also observed in the CHD group compared with the normal population (2.5% versus 0.4%) [OR 9.45 (95% CI - 3.35-23.3)].Women carrying a foetus with CHD have a high risk of pre-eclampsia and intrauterine growth restriction. The relationship between CHD and placenta-related complications could be an encouraging topic for future research.

Introduction: Forty percent of Down syndrome (DS) fetuses have congenital heart defects (CHD). An abnormal angiogenic environment has been described in euploid fetuses with CHD. However, the underlying pathophysiologic pathway that contributes to CHD in DS remains unknown. The objective was to compare the expression of angiogenic factors and chronic hypoxia genes in heart tissue from DS and euploid fetuses with and without CHD. Methods: The gene expression profile was determined by real-time PCR quantification in heart tissue from 33 fetuses with DS, 23 euploid fetuses with CHD and 23 control fetuses. Results: Angiogenic factors mRNA expression was significantly increased in the DS group compared to the controls (soluble fms-like tyrosine kinase-1, 81%, p = 0.007; vascular endothelial growth factor A, 57%, p = 0.006, and placental growth factor, 32%, p = 0.0227). Significant increases in the transcript level of hypoxia-inducible factor-2α and heme oxygenase 1 were also observed in the DS group compared to the controls. The expression of angiogenic factors was similar in DS fetuses and CHD euploid fetuses with CHD. Conclusion: Abnormal angiogenesis was detected in the hearts of DS fetuses with and without CHD. Our results suggest that DS determines an intrinsically angiogenic impairment that may be present in the fetal heart.

Resumen Objetivo Evaluar el impacto que tiene en la estancia hospitalaria la utilizacion de la longitud cervical ecografica en pacientes ingresadas por amenaza de parto pretermino. Material y metodos Estudio prospectivo longitudinal que incluyo una muestra de pacientes ingresadas por amenaza de parto pretermino en 2 unidades de hospitalizacion. En la unidad 1 las pacientes fueron tratadas segun el protocolo habitual, basado en el indice de Bishop y la constatacion de la presencia de dinamica uterina en la monitorizacion. En la unidad 2 se modifico el protocolo de actuacion en funcion de la longitud cervical ecografica, optandose por el alta precoz en las pacientes con una longitud ecografica ≥ 25 mm. Se analizaron las caracteristicas de ambos grupos, la duracion media del ingreso y la tasa de parto antes de 7 dias, 34 y 37 semanas de gestacion en ambas unidades. Resultados Se incluyo en el estudio a un total de 138 pacientes. La tasa de parto antes de 7 dias, 34 y 37 semanas fue similar en las 2 unidades, asi como la incidencia de reingresos. Sin embargo, la estancia media hospitalaria se redujo significativamente en la unidad 2 (6,14 frente a 3,86 dias; p Conclusiones La introduccion de la longitud cervical ecografica en el manejo clinico de pacientes ingresadas por amenaza de parto pretermino puede hacer disminuir la estancia media hospitalaria sin aumentar la tasa de partos prematuros ni los reingresos hospitalarios.

Resumen Objetivo Evaluar la incidencia y la relevancia clinica del flujo diastolico intermitente en el Doppler de arteria umbilical en la gestacion monocorial. Metodos Estudio prospectivo que incluyo 3 grupos de gemelos monocoriales: grupo I, una cohorte de gemelos monocoriales controlados con ecografia cada 15 dias desde el primer trimestre (n = 80); grupo II, retardo de crecimiento intrauterino selectivo (n = 40), y grupo III, sindrome de transfusion fetofetal grave (n = 50). Se registro la presencia y persistencia en el tiempo de flujo diastolico ausente y/o revertido intermitente en el Doppler de arteria umbilical. Se examinaron las placentas, se registro la presencia de anastomosis arterioarteriales grandes (> 2 mm) y se calculo el reparto placentario. Los resultados perinatales se obtuvieron en todos los casos. Resultados Se observo flujo diastolico intermitente en el 5% (4/80) de los casos del grupo I, en el 45% (18/40) del grupo II y en el 2% (1/50) del grupo III (p Conclusiones El flujo diastolico intermitente debe considerarse como un signo caracteristico de los gemelos monocoriales, y parece ser la expresion de la existencia de anastomosis arterioarteriales grandes. Su incidencia esta significativamente aumentada en el contexto del retraso de crecimiento intrauterino selectivo, e indica un mal pronostico perinatal en esos casos.

Oxidative stress has been increasingly postulated as a major contributor to endothelial dysfunction in preeclampsia (PE), although evidence supporting this hypothesis remains inconsistent. This study aimed to analyze in depth the potential role of oxidative stress as a mechanism underlying endothelial damage in PE and the pregnant woman's susceptibility to the disease. To this end, indicative markers of lipoperoxidation and protein oxidation and changes in antioxidant defense systems were measured in blood samples from 53 women with PE and 30 healthy pregnant controls. Results, analyzed in relation to disease severity, showed PE women, compared with women with normal pregnancy, to have: (1) significantly enhanced antioxidant enzyme SOD and GPx activities in erythrocytes; (2) similar plasma alpha-tocopherol levels and significantly increased alpha-tocopherol/lipids in both mild and severe PE; (3) significantly decreased plasma vitamin C and protein thiol levels; (4) similar erythrocyte glutathione content, total plasma antioxidant capacity, and whole plasma oxidizability values; (5) significantly elevated plasma total lipid hydroperoxides, the major initial reaction products of lipid peroxidation, in severe PE; (6) no intracellular or extracellular increases in any of the secondary end-products of lipid peroxidation, malondialdehyde or lipoperoxides; (7) similar oxidative damage to proteins quantified by plasma carbonyl levels, immunoblot analysis, and advanced oxidation protein products assessment; and (8) significantly elevated and severity-related soluble vascular cell adhesion molecule-1 serum levels reflecting endothelial dysfunction. No correlations were found among plasma levels of circulating adhesion molecules with regard to lipid and protein oxidation markers. Globally, these data reflect mild oxidative stress in blood of preeclamptic women, as oxidative processes seem to be counteracted by the physiologic activation of antioxidant enzymes and by the high plasma vitamin E levels that would prevent further oxidative damage. These results do not permit us to conclude that oxidative stress might be a pathogenetically relevant process causally contributing to the disease.

Resumen Introduccion La infeccion por el virus de la hepatitis C (VHC) es un importante problema de salud publica por su elevada incidencia, el curso progresivo de la enfermedad y su asociacion con el carcinoma hepatico. La transmision nosocomial del VHC ha sido objeto de debate en nuestro medio. Este riesgo depende de la prevalencia de la infeccion en la poblacion atendida y en el personal sanitario, de los procedimientos realizados y de la adecuacion de las medidas de prevencion. Objetivo Determinar la prevalencia de la infeccion en las pacientes atendidas por un parto o intervenidas ginecologicamente en un hospital de tercer nivel, como parte de un estudio mas amplio dirigido a estimar el riesgo de transmision nosocomial del VHC. Material y metodos Se incluyeron en el estudio 1.649 pacientes atendidas en estos servicios entre octubre de 1999 y mayo de 2001. Antes de la intervencion, se realizo una encuesta epidemiologica sobre antecedentes y factores de riesgo de infeccion por VHC y una extraccion sanguinea para el estudio serologico (tecnicas de ELISA III y confirmacion por RIBA III). Resultados La prevalencia global de infeccion por el VHC fue del 0,97% (intervalo de confianza [IC] del 95%, 0,56–1,57), con cifras superiores en ginecologia (1,75%; IC del 95%, 0,96–2,92) que en obstetricia (0,24%; IC del 95%, 0,03–0,84) (p = 0,004). La edad fue la variable mas asociada a la presencia de infeccion. El 75% de los casos desconocian la presencia de la infeccion. Conclusion La prevalencia de infeccion por VHC en las pacientes intervenidas en los servicios de ginecologia y obstetricia en nuestro centro es similar a la de la poblacion general. Se ha observado un infradiagnostico importante de esta infeccion en la poblacion atendida.

Resumen Objetivo Obtener curvas de normalidad de la longitud cervical uterina en poblacion espanola, en gestacion unica y gemelar. Sujetos y metodos Gestantes derivadas a nuestro centro para control ecografico rutinario entre las 12 y 36 semanas. Se realizaron 285 ecografias transvaginales en gestaciones unicas y 281 en multiples. Se calculo la media y los percentiles 5 y 95 de la longitud cervical para cada semana de gestacion, y se obtuvieron las curvas de normalidad. Resultados La longitud cervical media disminuyo de forma progresiva durante el embarazo. Tanto en gestaciones unicas como multiples, el percentil 5 al inicio del segundo trimestre se situo en 25 mm. Sin embargo, en el tercer trimestre se observo una disminucion muy marcada especialmente en gestaciones multiples, que llego a ser de 15 mm en gestaciones unicas e inferior a 10 mm en multiples. Conclusiones Nuestros resultados aportan puntos de corte para la evaluacion de la utilizacion clinica o en investigacion de la longitud cervical ecografica. Las diferencias observadas en gestacion unica y multiple justifican la utilizacion de curvas diferenciadas.

Objectives To evaluate the susceptibility to oxidation of low density lipoprotein (LDL) in women with a history of pre-eclampsia. Design A case–control study. Setting The departments of obstetrics and gynaecology at two university teaching hospitals. Population Women delivering one to three years before enrolment, 35 who were diagnosed with severe pre-eclampsia and 35 controls matched for age, body mass index (BMI), smoking and parity. Methods Plasma samples were analysed for total cholesterol, high density lipoprotein (HDL) cholesterol, LDL cholesterol, triglycerides and lipoprotein A. The in vitro susceptibility to oxidation of LDL was measured and expressed in minutes (lag time). Results are expressed as mean and standard deviation. Main outcome measures Serum lipid profile and in vitro susceptibility to oxidation of LDL. Results Mean LDL cholesterol (116 [37] vs 98 [20] mg/dL, P < 0.05) and trygliceride (112 [56] vs 78 [38] mg/dL, P < 0.05) levels were significantly higher in the groups of women who had pre-eclampsia compared with controls. The rest of the measured lipid parameters were similar between the two study groups. The susceptibility to oxidation of LDL was also significantly higher in the pre-eclampsia group (lag time: 37.9 [8.4] vs 44.8 [9.1] minutes, P < 0.01). Conclusion Women with a history of pre-eclampsia have significant differences in lipid parameters and an increased susceptibility to lipoprotein oxidation when compared with women who had a normal pregnancy one to three years after delivery.

Resumen Objetivo Evaluar los resultados perinatales en los primeros 50 casos de transfusion feto-fetal (TFF) tratados en Espana con coagulacion fetoscopica laser de anastomosis placentarias Sujetos y metodos Estudio prospectivo con 50 casos de TFF grave tratadas con laser. Se evaluo la supervivencia y la evolucion neonatales, las complicaciones obstetricas, y la tasa de lesion neurologica neonatal (28 dias) Resultados La edad gestacional media de tratamiento fue de 19,8 semanas (rango: 16,6–25,8). La supervivencia neonatal global fue del 72% (72/100), con un 86% (43/50) de casos con, al menos, un superviviente. Ocurrio rotura prematura de membranas en 9 pacientes (18%), tres de ellas (6%) precoces (menos de 32 semanas). La edad gestacional media de parto fue de 31,8 semanas (rango: 26,0-38,2), con un 94% (47/50) por encima de las 28 semanas. El peso medio fue de 1.840 g (rango: 640-3.390) para receptores y 1.415 g (rango: 390-2.250) en donantes. Se observo algun grado de lesion neurologica en el 5,5% (4/72) de los supervivientes Conclusion Los resultados presentados se situan en el rango alto de lo previamente reportado por otros grupos. La coagulacion fetoscopica laser permite ofrecer una alternativa terapeutica a una proporcion importante de casos de TFF grave

Resumen Objetivo Estudiar el valor de la leucocitosis, fiebre materna y la taquicardia fetal en el diagnostico de una infeccion amniotica Sujetos y Metodos Un total de 113 gestantes con amenaza de parto prematuro a las que se les practicaron una amniocentesis y un cultivo de liquido amniotico. Al ingreso se tomo la temperatura axilar, se realizo un hemograma y se realizo un registro cardiotocografico. Se relaciono la presencia de un cultivo de liquido amniotico positivo con la fiebre (≥ 37,8 °C), la taquicardia fetal (≥ 160 lat/min) y la leucocitosis materna (> 15.000 leucocitos/ml) Resultados Trece de las gestantes (11,5%) presentaron una infeccion amniotica; 26 mujeres (23%) tuvieron una leucocitosis, cinco de ellas tenian un cultivo de liquido amniotico positivo (p = 0,1); 5 gestantes tuvieron fiebre, dos de ellas con un cultivo de liquido amniotico positivo (p = 0,1); 26 gestantes presentaron una taquicardia fetal (23%), ocho de las cuales tuvieron un cultivo de liquido amniotico positivo (p = 0,001). La sensibilidad de la taquicardia fetal para detectar una infeccion amniotica fue del 61,5% y la especificidad del 82% Conclusion La taquicardia fetal fue el unico parametro clinico que se asocio significativamente a la infeccion amniotica, aunque su valor predictivo positivo fue bajo

Resumen Objetivo Evaluar la correlacion entre la velocidad maxima sistolica de la arteria cerebral media y el grado de anemia, asi como su potencial capacidad predictiva del grado de anemia fetal intertransfusional en tres pacientes con isoinmunizacion Rh Material y metodo Se describen tres casos de anemia fetal por isoinmunizacion Rh tratados con transfusion sanguinea intrautero. El seguimiento intertransfusional y la decision de realizar unanueva cordocentesis se hizo segun el protocolo clasico basado en la presencia de signos ecograficos de hidrops o la estimacion del grado de hemolisis postransfusion. De forma paralela, se midio con eco-Doppler la velocidad maxima de la arteria cerebral media (VmaxACM) pre y postransfusion, asi como entre las transfusiones Resultados Se realizaron un total de 11 cordocentesis con transfusion sanguinea. La medicion de la V max ACM se correlaciono con el grado de anemia, existiendo una correlacion inversa entre ambos parametros. La sensibilidad dela V max ACM para detectar anemia moderada y grave fue del 100%. En nuestros casos la inclusion de la medicion de la V max ACM en los protocolos clinicos podria haber evitado tres cordocentesis Conclusiones Nuestros resultados preliminares sugieren la utilidad del estudio Doppler de la V max ACM para el control del grado de anemia fetal entre transfusiones en los casos de anemia hemolitica por isoinmunizacion Rh

OBJECTIVE: This study analyzed the relationship between birth weight and perinatal outcome among women with gestational diabetes mellitus. STUDY DESIGN: The relationship between perinatal outcome and birth weight was analyzed for 821 pregnancies of women with gestational diabetes mellitus attended in a tertiary hospital and receiving intensive metabolic therapy (normocaloric diet, self-monitoring of blood glucose level and individually tailored insulin regimen when needed). The Mantel-Haenszel test was used to adjust for preterm delivery. RESULTS: Seven percent of neonates were small for gestational age, 85% were appropriate for gestational age, and 8% were large for gestational age. After adjustment for preterm delivery the rates of adverse fetal outcome, low 1-minute Apgar score, and hypoglycemia were greater among small for gestational age neonates than among appropriate and large for gestational age infants (odds ratios 3.08, 2.51, and 3.17, respectively). CONCLUSION: Among women with gestational diabetes mellitus who are receiving intensive therapy, perinatal outcome is worse for small for gestational age neonates than for appropriate and large for gestational age neonates. (Am J Obstet Gynecol 1998;179:481-5.)

Aims Animal models showed that angiogenesis is related to abnormal heart development. Our objectives were to ascertain whether a relationship exists between congenital heart defects (CHDs) and angiogenic/anti-angiogenic imbalance in maternal and foetal blood and study the expression of angiogenic factors in the foetal heart. Methods and results Maternal and cord blood placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) were compared in 65 cases of CHD and 204 normal controls. Angiogenic factor expression and markers of hypoxia were measured in heart tissue from 23 CHD foetuses and 8 controls. In the CHD group, compared with controls, plasma PlGF levels were significantly lower (367 ± 33 vs. 566 ± 26 pg/mL; P < 0.0001) and sFlt-1 significantly higher (2726 ± 450 vs. 1971 ± 130 pg/mL, P = 0.0438). Foetuses with CHD had higher cord plasma sFlt-1 (442 ± 76 vs. 274 ± 26 pg/mL; P = 0.0285) and sEng (6.76 ± 0.42 vs. 4.99 ± 0.49 ng/mL, P = 0.0041) levels. Expression of vascular endothelial growth factor (VEGF), sFlt-1, markers of chronic hypoxia, and antioxidant activity were significantly higher in heart tissue from CHD foetuses compared with normal hearts (VEGF, 1.59-fold; sFlt-1, 1.92-fold; hypoxia inducible factor (HIF)-2α, 1.45-fold; HO-1, 1.62-fold; SOD1, 1.31-fold). Conclusion An intrinsically angiogenic impairment exists in CHD that appears to be present in both the maternal and foetal circulation and foetal heart. Our data suggest that an imbalance of angiogenic-antiangiogenic factors is associated with developmental defects of the human heart.

Three-dimensional Ultrasound (3DUS) has grown quickly and constantly over the last fifteen years. However, some of its best clinical uses remain to be defined. The threedimensional Power Doppler (PD) is based on the ability to register the signal amplitude of the ultrasound wave, which allows us to depict most moving particles in a given Region of Interest (ROI). It is also based on the three-dimensional US principles, that permit the collection of signals from such particles in a given Volume of Interest (VOI) The inclusion of a time sequencing protocol or a Space-Time Image correlation (STIC) algorithm, developed and made available to last generation US machines, adds the additional possibility of following the signal evolution during a pre-established lap. At first, this promising tool was used to evaluate vascularisation and perfusion in a series of foetal organs, finding neither adequate accuracy nor repeatability. Nowadays, its use in Foetal Medicine is restricted to certain foetal conditions, although new research is on-going and further uses for this technology are being unveiled.

Premature rupture of membranes is a significant contributor to preterm birth with its associated short- and long-term complications. The absence of a standard approach to its management places a burden on the clinicians’ ability to promptly and accurately diagnose premature rupture of membranes. For the last half century, there have been no significant changes in the way premature ruptured membranes is diagnosed. With the advent of newer, amniotic fluid-specific, noninvasive, and accurate markers, there is an opportunity to update the diagnosis of premature rupture of membranes.

To describe the prevalence of congenital varicella syndrome (CVS) within the population of presumably infected pregnant women.From 1993 to 2006, all women who presented vesicular rash or a suspicious contact were referred and evaluated in a special unit at our center. Those with residual immunity or were serologically negative were precluded from this study. Positive IgM cases underwent monthly ultrasound scans (US), fetal blood (FB) sampling (including IgM anti VZV and virus culture). Amniotic fluid sample for PCR was added to the diagnosis of positive IgM cases after 1997.A total of 276, of the 566 consulted women, tested positive for IgM anti VZV. Seventeen (6%) were excluded because of an unadvised termination of pregnancy and seven (2.55%) miscarried. Only seven (2.7%) were considered highly likely to have a VZV fetal infection. One case showed positive IgM in FB but developed normally. Another fetus showed positive PCR and infection was confirmed post TOP. Four cases that underwent TOP and histochemistry confirmed no more cases. Complete post-natal follow-up was carried out. The asymptomatic infected child grew healthy until the completion of screening tests when it reached 5 years old.The fetal infection rate in this cohort was 0.8%, but the best expected prevalence of CVS, according to our findings, should be 0.39% among infected women. This data should be considered and used during parental counselling.

6 páginas Objective. Fetal goitrous hypothyroidism is a rare and potentially lethal condition. Consequently, itsearly diagnosis and treatment improve prognosis. Thyroid hormone measurement in either fetal serumor amniotic fluid implies important risks. Here we present a fetal goiter and the follow-up procedure,both done by the traditional method and by using 3-dimensional power Doppler (3DPD) imaging andvirtual organ computer-aided analysis (VOCAL). Methods.A single well-documented case of fetal goi-ter was followed weekly from 22 weeks until delivery. Amniocentesis for thyrotropin (TSH) and freethyroxine (T4) measurement as well as levothyroxine injections were performed at every control. Inaddition to amniocentesis, every control involved a sonographic evaluation, which included standardmeasurements of the gland and the capture of volume image sets in gray scale and 3DPD. Volume cal-culation of the gland was done using VOCAL software. Vascularization of the gland was evaluated bythe vascularization index (VI) included in the software. Results. With treatment, TSH levels decreasedprogressively until normalization. Free T4levels increased toward the end of gestation. Sonographicmeasurements of the gland volume to estimated fetal weight ratio decreased across treatment as lev-els of TSH did. The VI clearly depicted the vascular regression of the goiter, decreasing throughouttreatment in a consistent way until 24 hours before delivery. Conclusions.Gray scale and 3DPD eval-uations of the thyroid gland have been validated under similar circumstances and might be reliablecomplements to the invasive methods used in the management of this fetal condition. Key words:fetal hypothyroidism; goiter; 3-dimensional power Doppler sonography; 3-dimensional sonography;virtual organ computer-aided analysis.

Anti-beta(2)-Glicoprotein-1 antibodies (anti-beta(2)GPI-ab) have been related to recurrent miscarriage (RM) with conflicting results. The aim was to evaluate the role of anti-beta(2)-GPI-ab as unique biological marker in RM related to antiphospholipid (aPL).A cohort study that included 59 cases, divided in two groups, was designed: group 1 comprised 43 pregnant women with 'obstetric' antiphospholipid syndrome (APS) and group 2 included 16 cases with similar complaints but only having repeatedly anti-beta(2)-GPI-ab. Previous thrombosis and/or inherited thrombophilia were excluded. Lupus anticoagulant, anticardiolipin antibodies (aCA), anti-beta(2)-GPI-ab, and other autoantibodies were analyzed. Miscarriages, premature births, pre-eclampsia, live births, placental and systemic thromboses were studied.No differences in previous obstetric complications were detected (P = 1.00-0.164). After the treatment, differences in number of obstetric complications were not seen (P = 1.00). Live births were similar in two groups (88.4% and 93.7%; P = 1.00). Placental thrombosis was equal in both groups, 93.3% versus 80% (P = 1.00).These results suggest that anti-beta(2)-GPI-ab may be considered a biological marker for obstetric APS.

Abnormal lipid metabolism has been proposed as a pathogenic factor of preeclampsia, although whether it is a constant feature in all preeclamptic patients is unclear. We assessed whether plasma triglyceride (TG) levels can distinguish a subgroup of preeclamptic women with alterations in lipoprotein profile from those with normal lipid metabolism and can be used to identify 2 distinct pathogenic groups in preeclampsia. This prospective study included 34 women with preeclampsia and 23 healthy pregnant women. Preeclamptic women were further subclassified into normal-TG (250 mg/dL) and high-TG (or=250 mg/dL) groups on the basis of the 90th percentile in our population. Low-density lipoproteins (LDLs) were ultracentrifuged and were separated into 4 subfractions, and lipid distribution in the subfractions was analyzed in all study groups. Vascular cell adhesion molecule-1 was also measured as a marker of endothelial dysfunction. Sixteen women with preeclampsia had high TGs (47% vs 13% in control subjects, P.001). This subgroup showed a significant shift in lipid distribution, mainly, TGs, toward the small, dense LDL subfractions. However, preeclamptic patients in the normal-TG subgroup showed LDL subfraction lipid distribution similar to that of healthy pregnancies. Vascular cell adhesion molecule-1 levels were significantly elevated in preeclamptic patients in comparison with those in control subjects regardless of TG levels. The presence of a proatherogenic lipoprotein profile, previously described in preeclampsia, is characterized by increased small dense LDL and is exclusive to a subset of preeclamptic patients with high TG levels. These findings support the concept of heterogeneous pathogenic lines in preeclampsia and the use of subclassifications in pathophysiologic research on this condition.

To assess coagulation activation and endothelial cell injury in normotensive and pre-eclamptic pregnant women, a comparison was made of plasma levels of tissue factor, fibronectin, fibrinopeptide A and D-dimer. Samples were taken from 50 nonpregnant women, 40 normotensive pregnant women in the third trimester and 27 women with pre-eclampsia after diagnosis and before treatment. High levels of fibrinopeptide A and D-dimer were found in pre-eclamptic women. Moreover, the ratio fibrinopeptide A:D-dimer was much greater in the pre-eclampsia group than in normotensive pregnant women. The levels of fibronectin and tissue factor were also higher in the pre-eclampsia group. The increase of tissue factor levels suggests an alteration of the extrinsic coagulation pathway in pre-eclampsia. The increase of fibrinopeptide A:D-dimer ratio shows that the activation of coagulation is associated with a relative hypofibrinolysis in pre-eclampsia.

The objective of this article is to evaluate the plasma levels of coagulation and fibrinolysis parameters in the third trimester of gestation and 72 hr postdelivery. Antithrombin III (ATIII), thrombin-antithrombin III complexes (TAT), heparin cofactor II (HCII), protein C (PC), protein S (PS), tissue plasminogen activator (t-PA), D-dimer, and plasminogen activator inhibitors (PAI-1 and PAI-2) levels in uncomplicated pregnancies and in pregnancies complicated by intrauterine growth retardation (IUGR) have been determined. Normal pregnant women (n = 63) and women whose was complicated by IUGR (n = 10) formed the study population. Coagulation and fibrinolysis parameters were estimated using commercial tests. There were no differences in ATIII, HCII, and PS levels between normal and IUGR pregnancies. TAT, t-PA, and D-dimer levels were higher in IUGR pregnancy than in the uncomplicated pregnancy group. PAI-1 and PAI-2 were found depressed in IUGR pregnancy when compared with normal pregnancy. Changes in coagulation and fibrinolytic systems occur in plasma of women with pregnancies complicated by IUGR. The results suggest an activation of the coagulation system in pregnancies complicated by IUGR. Reduced PAI-2 and high TAT levels correlate with birth weight. In IUGR pregnancies a hypercoagulative state with hyperfibrinolytic compensatory mechanisms is suggested.