Tromboprofilaxis precoz y evolución en embarazadas con COVID-19 / Early thromboprophylaxis and evolution in pregnant women with COVID-19

Introducción: en marzo del año 2020 se declara Pandemia, por la aparición de un nuevo Coronavirus, el SARS-CoV2 (COVID-19). Las mujeres embarazadas presentan un riesgo mayor de presentar procesos tromboembólicos, por lo que se recomienda utilizar de manera profiláctica heparina, para prevención de procesos tromboembólicos durante la infección por SARS-CoV2. Objetivo: Describir la evolución de las embarazadas con infección por SARS-CoV2 con la utilización de heparina de bajo peso molecular, Enoxaparina, ajustada al peso de manera precoz. Metodología: estudio descriptivo prospectivo, observacional, de corte transversal. Resultados: en la evolución de 30 mujeres embarazadas con infección por SARS-CoV2, las edades más frecuentes corresponden a 31 a 35 años, mayor número de infectadas en el segundo trimestre del embarazo, el índice de masa corporal predominante en rango de sobrepeso y obesidad, la dosis de enoxaparina utilizada fue de 40 mg/día, ya que se ajustó al peso de la embarazada, las comorbilidades más frecuentes correspondieron al sobrepeso y obesidad, enfermedad hipertensiva del embarazo y diabetes gestacional, la sintomatología resultó muy variada, debido a las distintas variantes del virus, con más frecuencia la rinorrea, congestión nasal, tos, anosmia, disgeusia, cefalea, fiebre y dificultad respiratoria, y la mayoría de las embarazadas no estaban vacunadas. Conclusiones: ninguna de las 30 embarazadas que recibieron heparina de bajo peso molecular (Enoxapina), ajustada al peso, y de manera precoz, con infección por SARS.CoV2, falleció, ni requirió internación en Unidad de Terapia Intensiva. Una embarazada, fue internada por disnea moderada y saturación de oxígeno menor a 95%. Las restantes embarazadas tuvieron buena evolución en su domicilio, sin ninguna complicación

Introduction: in March 2020, a Pandemic was declared, due to the appearance of a new Coronavirus, SARS-CoV2 (COVID-19). Pregnant women have a higher risk of presenting thromboembolic processes, so it is recommended to use heparin prophylactically, to prevent thromboembolic processes during SARS-CoV2 infection. Objective: to describe the evolution of pregnant women with SARS-CoV2 infection with the early use of Enoxaparin, adjusted to the weight of low molecular weight heparin. Methodology: prospective, observational, cross-sectional descriptive study. Results: in the evolution of 30 pregnant women with SARS-CoV2 infection, the most frequent ages correspond to 31 to 35 years, the highest number of infected in the second trimester of pregnancy, the predominant body mass index in the range of overweight and obesity. , the dose of enoxaparin used was 40 mg/day, since it was adjusted to the weight of the pregnant woman, the most frequent comorbidities were overweight and obesity, hypertensive disease of pregnancy and gestational diabetes, the symptoms were highly varied, due to the different variants of the virus, more frequently rhinorrhea, nasal congestion, cough, anosmia, dysgeusia, headache, fever and respiratory distress, and most of the pregnant women were not vaccinated. Conclusions: none of the 30 pregnant women who received low molecular weight heparin (Enoxapine), adjusted for weight, and early, with SARS.CoV2 infection, died or required admission to the Intensive Care Unit. A pregnant woman was hospitalized due to moderate dyspnea and oxygen saturation less than 95%. The remaining pregnant women had a good evolution at home, without any complications

Risk factors for seroconversion of HIV among children exposed in the State of Santa Catarina, 2007-2017 / Fatores de risco para a soroconversão de crianças expostas ao HIV no Estado de Santa Catarina, 2007-2017

Abstract Objectives: to estimate the proportion of seroconversion cases among infants exposed to HIV and verify the risk factors associated. Methods: this was a historical cohort study conducted in the State of Santa Catarina between 2007 and 2017. The data were obtained from the Notifable Diseases Information System (SINAN - Portuguese acronym) that records HIV-infected pregnant women and HIV-exposed infants. The public health service monitored the infants from birth to 18 months of age to determine whether HIV seroconversion occurred. Results: a total of 5,554 HIV-infected pregnant women were included in the study (mean age 26.7±6.5 years). They were predominantly white, with poor education level, and were diagnosed with HIV until the 2nd trimester of pregnancy. A total of 4,559 records of HIV-exposed infants were screened, of which 130 cases (2.9%) of seroconversion were confrmed. Non-use of antiretroviral drugs during pregnancy (OR=9.31, CI95%=5.97-14.52; p<0.001) and breastfeeding (OR=3.10, CI95%=1.34-7.20; p=0.008) were independent risk factors for seroconversion. Conclusions: these data demonstrate gaps in prenatal care, regarding adherence to treatment and monitoring of HIV-infected mothers, resulting in new cases of HIV among children, which could be avoided.

Resumo Objetivos: estimar a proporção de soroconversão da criança exposta ao HIV e verificar os fatores de risco associados, no período de 2007-2017 em Santa Catarina. Métodos: o delineamento utilizado foi de coorte histórica e os dados obtidos no Sistema de Informação de Agravos de Notificação (SINAN) que registra as gestantes infectadas e as crianças expostas ao HIV. As crianças foram acompanhadas pelo serviço de saúde desde o nascimento até o 18º mês de vida, para determinar a ocorrência de soroconversão pelo HIV. Resultados: foram identificadas 5.554 gestantes infectadas pelo HIV com média de idade de 26,7±6,5 anos, predomínio da raça branca, baixa escolaridade e que receberam o diagnóstico para o HIV até o 2º trimestre gestacional. Foram incluídas 4.559 fichas de crianças expostas ao HIV, das quais 130 casos (2,9%) de soroconversão foram confrmados. O não uso de antirretroviral durante a gestação (OR=9,31, IC95%=5,97-14,52; p<0,001) e aleitamento materno (OR=3,10, IC95%=1,34-7,20; p=0,008) foram fatores de risco independentes para a soroconversão. Conclusões: esses dados demonstram lacunas na assistência pré-natal, quanto a adesão ao tratamento e acompanhamento de mães infectadas pelo HIV, resultando em casos novos de HIV entre crianças, que poderiam ser evitados.

The Effect of an educational Intervention on Anxiety of Pregnant Women: A Quasi-Experimental Study / El efecto de una intervención educativa sobre la ansiedad de las mujeres embarazadas: Un estudio cuasi experimental / O efeito de uma intervenção educativa na ansiedade de gestantes: um estudo quase experimental

Objective. The aim of study is the effect of educational intervention on anxiety of pregnant women. Methods. This quasi-experimental study is done on the pregnant women referring to family physician's offices in Gerash City, Iran. 62 women were selected and divided into 2 groups (control and intervention). In intervention group the anxiety reduction training classes were held as a group discussion in 4 weekly 90-minute sessions. Control group received routine care. The anxiety assessment completed by two groups before and after the educational intervention. The measurement instruments included a demographic information questionnaire and the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17). Results. Comparison of the mean scores of different dimensions of pregnancy anxiety in the pre-intervention and post-intervention stages in the intervention group using paired t-test indicated a statistically significant difference in the dimensions Fear of childbirth, Fear of giving birth to a physically or mentally disabled child, Fear of mood swings and Fear of changes in marital relations (p < 0.05) in comparison with control group. Conclusion. Holding pregnancy-training classes using group discussion method is a good strategy to reduce anxiety in pregnant women. Therefore, it is recommended that this educational strategy classes be used with mothers from the second trimester of pregnancy in urban family physician centers or those referred to a nearby clinic.

Objetivo. Evaluar el efecto de una intervención educativa sobre la ansiedad de las mujeres embarazadas. Métodos. Estudio cuasi-experimental realizado con la participación de mujeres embarazadas que acuden a las consultas de los médicos de familia en la ciudad de Gerash, Irán. Se seleccionaron 62 mujeres y se dividieron en 2 grupos (control e intervención). En el grupo de intervención, las clases de entrenamiento para la reducción de la ansiedad se impartieron en forma de debate grupal en 4 sesiones semanales de 90 minutos. El grupo de control recibió atención rutinaria. Los dos grupos completaron la evaluación de la ansiedad antes y después de la intervención educativa. Los instrumentos de medición incluían un cuestionario de información sociodemográfica y la forma corta del Cuestionario de Ansiedad Relacionada con el Embarazo (PRAQ-17). Resultados. La comparación de las puntuaciones medias de las distintas dimensiones de la ansiedad durante el embarazo en las etapas previa y posterior a la intervención en el grupo de estudio indicó una diferencia estadísticamente significativa en las dimensiones Miedo al parto, Miedo a dar a luz a un niño discapacitado física o mentalmente, Miedo a los cambios de humor, y Miedo a los cambios en las relaciones conyugales (p < 0.05), en comparación con el grupo de control. Conclusión. La realización de clases de formación durante el embarazo utilizando el método de discusión en grupo es una buena estrategia para reducir la ansiedad en las mujeres embarazadas. Por lo tanto, se recomienda que esta estrategia educativa se emplee con las madres desde el segundo trimestre del embarazo en los centros de medicina de familia o a aquellas que sean derivadas a la consulta externa.

Objetivo. Avaliar o efeito de uma intervenção educativa sobre a ansiedade em gestantes. Métodos. Estudo quase experimental realizado com a participação de gestantes atendidas em consultórios médicos de família na cidade de Gerash, Irã. 62 mulheres foram selecionadas e divididas em 2 grupos (controle e intervenção). No grupo de intervenção, as aulas de treinamento de redução de ansiedade foram ministradas como uma discussão em grupo e em 4 sessões semanais de 90 minutos. O grupo de controle recebeu cuidados de rotina. Ambos os grupos completaram a avaliação da ansiedade antes e após a intervenção educativa. Os instrumentos de medida incluíram um questionário de informações sociodemográficas e a versão curta do Questionário de Ansiedade Relacionada à Gravidez (PRAQ-17). Resultados. A comparação das pontuações médias das diferentes dimensões da ansiedade durante a gravidez nas etapas antes e após a intervenção no grupo de estudo indicou diferença estatisticamente significativa nas dimensões; medo do parto, medo de dar à luz um filho com deficiência física ou mental, medo de mudanças de humor e medo de mudanças nas relações conjugais (p < 0,05), em comparação com o grupo de controle. Conclusão. A realização de aulas de capacitação durante a gravidez utilizando o método de discussão em grupo é uma boa estratégia para reduzir a ansiedade em gestantes. Portanto, recomenda-se que essa estratégia educativa seja utilizada com mães a partir do segundo trimestre de gestação em centros de medicina de família ou com aquelas que são encaminhadas ao ambulatório.

Accuracy of mid-trimester ultrasound scan in foetal gender determination at the University College Hospital, Ibadan Nigeria

Objectives: This study aimed to determine the accuracy of prenatal sonographic gender determination during foetal anomaly ultrasound and the overall sensitivity pattern in our institution.Materials and Methods: A cross-sectional study of 520 consenting pregnant women who presented for foetal anomaly scans within a one-year period in our institution. The diagnostic accuracy of gender determination during the anomaly and delayed scans were determined by comparing the sonographic gender with the birth gender and calculating sensitivity, specificity, positive predictive value and negative predictive value. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, frequencies, Mc-Nemar chi-square test were used at 5% level of significance. Results: The mean maternal age was 31.51 ±5.02years. Of the 520 consenting pregnant women studied, 16(6.0%) women were having twin gestation. Four hundred and ninety-seven (92.7%) genders were determined during foetal anomaly scan. The accuracy of the ultrasonography (US) examination performed by the resident doctors was 98.02% while the accuracy of the scan performed by the consultant radiologists was 100%. Overall, the accuracy of the gender determination on ultrasound was 98.69%. The general specificity and sensitivity of the US were 98.71 % and 98.68% respectively while the positive and negative predictive value were 99.01 % and 98.29% respectively. Conclusion: The accuracy of ultrasound examination in detecting foetal gender during foetal anomaly ultrasound is high with equally high predictive values and therefore it is recommended as a mandatory variable during anomaly scans. There is need for continuous training of resident doctors or operators in lower cadre to improve their competency in foetal gender determination.

Associations between plasma n-3 polyunsaturated fatty acids and gestational diabetes mellitus in the second trimester / 中华预防医学杂志

Objective: To examine the associations between plasma n-3 polyunsaturated fatty acids (PUFAs) in the second trimester and gestational diabetes mellitus (GDM) among Chinese pregnant women. Methods: Based on data from the Tongji-Shuangliu Birth Cohort enrolled from 2017 to 2019 in the Shuangliu Maternal and Child Health Hospital, it conducted a case-control study among 269 GDM cases who were diagnosed by 75 g oral glucose tolerance test, and 538 non-GDM controls matched at a 1∶2 ratio on maternal age and gestational weeks. The age range of the 807 women was 18-40 years. Fasting plasma n-3 PUFAs were determined by gas chromatography-mass spectrometry in the second trimester (24-28 weeks). Participants were categorized into quartiles (Q1-Q4) of plasma n-3 PUFAs based on distributions in the control group. Conditional logistic regression models were applied to estimate the associations between plasma n-3 PUFAs and GDM. Results: The median (interquartile) relative concentrations of plasma n-3 PUFA C22∶5n-3 was significantly lower in women with GDM 0.87 (0.72, 1.07) compared with women without GDM 0.94 (0.75, 1.19)(P=0.001). Plasma n-3 PUFA C22∶5n-3 was inversely associated with GDM, with an OR (95%CI) of 0.75 (0.62-0.90) for each SD increase of relative concentration. Compared with the Q1 group, the OR values and 95%CIs of Q2, Q3, and Q4 groups were 0.97 (0.62-1.51), 0.72 (0.45-1.15), and 0.54 (0.32-0.90), respectively (Ptrend<0.05). However, there were no significant associations of C18∶3n-3, C20∶5n-3, C22∶6n-3, and total n-3 PUFAs with GDM. Conclusion: Plasma n-3 PUFA C22∶5n-3 was inversely associated with GDM during the second trimester.

Clinical effect of fetal reduction by intracranial and intrathoracic KCl injection / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the feasibility and effectiveness of fetal reduction by transabdominal intracranial KCl injection for multifetal pregnancies in the early second trimester.@*METHODS@#The data of 363 patients who underwent transabdominal fetal reduction in the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2019 were analyzed retrospectively. According to the location of fetal reduction, they were divided into two groups: Intracranial injection group (n=196) and intrathoracic injection group (n=167). The process of fetal reduction and pregnancy outcome of the two groups were compared.@*RESULTS@#There was no significant difference between the two groups in the average age and the proportion of type of infertility before assisted reproductive technology, conception method, indication for fetal reduction, starting number of fetuses, reduced number of fetuses, and finishing number of fetuses (P>0.05). There was no significant difference between the two groups in the proportion of the number of puncture ≥ 2 times (12.1% vs. 8.6%, P=0.249) and the incidence of replacing puncture site (10.7% vs. 6.4%, P=0.161). The next day after fetal reduction, color Doppler ultrasound was rechecked. In the intracranial injection group and intrathoracic injection group, the incidence of fetal heartbeat recovery [3.6% (8/224) vs. 1.1% (2/187), P=0.188], the volumes of KCl used [(2.6±1.0) mL vs. (2.8±1.1) mL, P=0.079], and the abortion rate within 4 weeks after fetal reduction (1.0% vs. 0.6%, P=0.654) were of no significant difference. In addition, there was no significant difference in the total abortion rate after fetal reduction, premature delivery rate, cesarean section rate, delivery gestational week and neonatal birth weight between the two groups (P>0.05).@*CONCLUSION@#Intracranial KCl injection can be an effective alternative to intrathoracic KCl injection for multifetal pregancy reduction.

Application of genomic copy number variation detection technology in prenatal diagnosis of 7617 pregnant women with serological screening abnormalities during the second trimester of pregnancy / 中华医学遗传学杂志

OBJECTIVE@#To analyze the genomic variation characteristics of fetal with abnormal serological screening, and to further explore the value of copy number variation (CNV) detection technology in prenatal diagnosis of fetal with abnormal serological screening.@*METHODS@#7617 singleton pregnant women who underwent amniocentesis for prenatal diagnosis solely due to abnormal Down's serological screening were selected. According to the results of serological screening, the patients were divided into high risk group, borderline risk group and single abnormal multiple of median (MOM) group. CMA and CNV-Seq were used to detect the copy number variation of amniotic fluid cell genomic DNA and combined with amniotic fluid cell karyotype analysis for prenatal diagnosis. Outpatient revisit combined with telephone inquiry was used for postnatal follow-up.@*RESULTS@#Among 7617 amniotic fluid samples, aneuploidy was detected in 138cases (1.81%) by CMA and CNV-Seq, 9 cases of aneuploid chimerism were detected by amniotic fluid cell karyotype analysis, and 203 cases of fetus carrying pathogenic and likely pathogenic CNV (P/LP CNV) were detected, the variant of uncertain significance (VUS) was detected in 437 cases (5.7%), the overall abnormal detection rate was 10.33%. The detection rate of aneuploidy by CMA and CNV-Seq in three group were 123 cases (2.9%), 13 cases (1.3%) and 2 cases (0.4%), respectively,and showing no significant difference (χ 2=7.469, P=0.024). The detection rate of pathogenic and likely pathogenic CNV in three group were 163cases (2.6%); 24 cases (2.6%) and 16 cases (3.3%), respectively, and showing no significant difference (χ 2=0.764, P=0.682). The CMA reported 2.9% (108/3729)P/LP CNV, and CNV-seq reported 2.4% (95/3888)P/LP CNV, both tests showed similar detective capabilities (χ 2=1.504, P=0.22).The most popular P/LP CNV in this cohort were Xp22.31 microdeletion, 16p13.11 microduplication /microdeletion, 22q11.21 microduplication /microdeletion. In fetuses with P/LP CNV CNV, 59 fetuses were terminated pregnancy, and 32 of 112 fetuses born had abnormal clinical manifestations. Non-medically necessary termination of pregnancy occurred in 11 fetuses carrying VUS CNV, 322 fetuses carrying VUS CNV were born, 4 of them presented abnormal clinical manifestations.@*CONCLUSION@#Compared with the traditional chromosome karyotype, CMA and CNV-Seq can improve the detection rate of pathogenic and likely pathogenic CNV. CMA and CNV-seq can be used for first tier diagnosis of pregnant women in the general population with abnormal Down's serological screening.

Prolapso uterino na gestação: relato de caso / Uterine prolapse during pregnancy: a case report

O prolapso de órgão pélvico é um evento raro durante a gestação, cuja conduta obstétrica deve ser individualizada e sempre direcionada para evitar complicações na gestação. O relato de caso é de uma mulher de 25 anos de idade, no segundo trimestre de sua segunda gestação, que apresentou prolapso de grau 4. Na ultrassonografia obstétrica, verificou-se feto em bom desenvolvimento e líquido amniótico normal. A conduta adotada foi a utilização do pessário vaginal e recomendação de repouso com acompanhamento até a resolução da gestação. Houve três episódios de queda acidental do pessário, que foi reintroduzido pela própria paciente, sem complicações, permanecendo até próximo ao momento do parto cesáreo. O prolapso desapareceu e não houve recidiva no pós-parto. Esta publicação é relevante por evidenciar que, seguindo as condutas recomendadas pela literatura para a presente condição ginecológica, se pode reduzir intercorrências obstétricas e viabilizar o parto do neonato.(AU)

Pelvic organ prolapse is a rare event during pregnancy, and obstetric management must be individualized and always aimed at avoiding complications in pregnancy. The case report is of a 25-year-old woman in the second trimester of her second pregnancy presented grade 4 prolapse. The obstetric ultrasound revealed good fetal development and normal amniotic fluid. The course of action implemented was the use of a vaginal pessary and recommendation of rest with monitoring up to pregnancy resolution. There were three episodes of accidental fall of the pessary, which was reintroduced by the patient herself without complications and was removed only when cesarean delivery was near. The prolapse disappeared and there was no recurrence during the postpartum period. This publication is relevant because it shows that by following the procedures recommended in the literature for this gynecological condition, it is possible to reduce obstetric complications and enable the delivery of the newborn.(AU)

Gravidez heterotópica espontânea: implicações de um diagnóstico tardio / Spontaneous heterotopic pregnancy: implications of a late diagnosis

A gestação heterotópica é uma entidade rara, principalmente se resultante de concepção natural. O diagnóstico é ultrassonográfico, porém a gestação intrauterina concomitante contribui para a dificuldade propedêutica. Neste relato de caso, a detecção foi tardia, a ultrassonografia não identificou a gestação heterotópica e apenas durante a avaliação intraoperatória, por meio de uma cirurgia de emergência devido a choque hemorrágico, houve o reconhecimento. A suspeita de uma gestação heterotópica deve ser sempre aventada quando sinais clínicos típicos (sangramento, dor abdominal) estão presentes, mesmo na ausência de fatores de risco ou imagens anômalas na ecografia. Assim, uma intervenção precoce menos invasiva pode ser realizada, reduzindo a morbimortalidade materna e do feto intrauterino. Este relato de caso destaca uma situação incomum dentro dessa patologia rara: diagnóstico tardio, apenas no segundo trimestre de gestação, sem evidência prévia ultrassonográfica, certificada apenas durante o intraoperatório. O manejo cirúrgico preciso permitiu a manutenção da gravidez intrauterina.(AU)

Heterotopic pregnancy is a rare entity, especially if it is resulted from natural conception. The diagnosis is ultrasonographic, but the concomitant intrauterine pregnancy contributes to the propaedeutic difficulty. In this case report, the detection was late, the ultrasonography did not identify heterotopic pregnancy and, only during intraoperative evaluation through emergency surgery, exploratory laparotomy, there was recognition. The suspicion of a heterotopic pregnancy should always be raised when typical clinical signs (bleeding, abdominal pain) are present, even in absentia of risk factors or anomalous images on ultrasound. Thus, a less invasive early intervention can be performed, reducing maternal and intrauterine fetus morbimortality. This case report highlights an unusual situation within this rare pathology: late diagnosis, only in the second trimester of pregnancy, without previous ultrasound evidence, certified only during the intraoperative period. Precise surgical management allowed the maintenance of intrauterine pregnancy.(AU)

Colestasis intrahepática del embarazo: forma de presentación temprana y relación con la infección por el virus de la hepatitis C: reporte de casos / Intrahepatic cholestasis of pregnancy: early presentation and relationship with infection by the hepatitis C virus: case reports / Colestase intra-hepática da gravidez: forma de apresentação precoce e sua relação com a infecção por vírus da hepatite C: relato de casos

Se describe los casos de tres pacientes a quien se les realiza diagnóstico de colestasis intrahepática del embarazo (CIE) de aparición temprana. En dos de ellos el diagnóstico se relacionó con infección por el virus de la hepatitis C (VHC). Reconocer que esta enfermedad puede presentarse de manera temprana en el embarazo y su relación con la infección por el VHC es fundamental para hacer un diagnóstico oportuno de ambas enfermedades y tomar las conductas terapéuticas adecuadas, mejorando así el pronóstico materno y fetal.

It is of great importance to acknowledge that this disease can occur early in pregnancy and that its relationship with HCV infection is a key point for a prompt diagnosis, allowing taking timely appropriate therapeutic decisions, aimed at improving the fetal prognosis.

Descrevemos os casos de três pacientes com diagnóstico de colestase intra-hepática da gravidez de início precoce. Em dois deles o diagnóstico estava relacionado à infecção pelo vírus da hepatite C (VHC). Reconhecer que esta doença pode se manifestar precocemente na gravidez e sua relação com a infecção pelo VHC é fundamental para fazer um diagnóstico oportuno de ambas as doenças e assumir condutas terapêuticas adequadas, melhorando assim o prognóstico materno e fetal.

The impact of routine transvaginal ultrasound measurement of the cervical length on the prediction of preterm birth: A retrospective study in a tertiary hospital / O impacto da medição por rotina do comprimento cervical por ecografia transvaginal na predição de parto pré-termo: Um estudo retrospetivo num hospital terciário

Abstract Pretermbirth (PTB) is a major obstetric problem associated with high rates of neonatal morbidity and mortality. The prevalence of PTB has not changed in the last decade; thus, the establishment of a screening test and effective treatment are warranted. Transvaginal ultrasoundmeasurement of the cervical length (TUCL) has been proposed as an effective method to screen pregnant women at a higher risk of experiencing PTB. Objective To evaluate the applicability and usefulness of second-trimester TUCL to predict PTB in a cohort of Portuguese pregnant women. Methods Retrospective cross-sectional cohort study including all singleton pregnant women who performed their second-trimester ultrasound (between weeks 18 and 22þ6 days) from January 2013 to October 2017 at Centro Hospitalar Universitário São João. Results Our cohort included 4,481 women. The prevalence of spontaneous PTB was of 4.0%, with 0.7% occurring before the 34th week of gestation. The mean TUCL was of 33.8mm,and percentiles 3, 5 and 10 corresponded toTUCLs of 25.0mm, 27.0mmand 29.0mmrespectively. The multiple logistic regression analysis, including maternal age, previous PTB and cervical surgery showed a significant negative association between TUCL and PTB, with an odds ratio (OR) of 0.92 (95% confidence interval [95%CI]: 0.90-0.95; p<0.001). The use of a TUCL of 20mm is the best cut-off, when compared with the 25-mm cut-off, improving the prediction of risk. Conclusion The present study showed an inverse association between TUCL and PTB, and that the inclusion of other risk factors like maternal age, previous PTB and cervical surgery can improve the screening algorithm. Furthermore, it emphasizes that the TUCL cut-off that defines short cervix can differ according to the population.

Resumo O parto pré-termo (PPT) é uma grande complicação obstétrica que se associa a elevadas taxas de morbimortalidade neonatal. A sua prevalência não tem alterado na última década, sendo esencial determinar uma forma de rastreio e tratamento eficaz. A medição ecográfica transvaginal do comprimento cervical tem sido proposta como um método eficaz de rastreio das grávidas com risco aumentado de PPT. Objetivo Avaliar a aplicabilidade e utilidade da medição ecográfica transvaginal do comprimento cervical na previsão de PPT numa amostra de grávidas portuguesas. Método Estudo de coorte retrospectivo incluindo todas as grávidas com gestação unifetal que realizaram ecografia do 2° trimestre (de 18 a 22semanasþ6 dias) no Centro Hospitalar Universitário de São João entre janeiro de 2013 e outubro de 2017. Resultados A nossa amostra incluiu 4.481 mulheres. A prevalência de PPT espontâneo foi de 4,0%, sendo que 0,7% ocorreu antes das 34 semanas de gestação. A média do comprimento cervical por ecografia transvaginal foi 33,8mm, e os percentis 3, 5 e 10 da amostra corresponderam a comprimentos cervicais de 25,0mm, 27,0mm e 29,0mm, respetivamente. A regressão logística múltipla, que incluiu a idade materna, PPT anterior e antecedentes de conização, demonstrou uma associação estatisticamente significativa entre o comprimento cervical e o risco de PPT, com um risco relativo de 0,92 (intervalo de confiança de 95% [IC95%]: 0.90-0.95; p<0.001). A utilização de um valor de referência de comprimento cervical de 20mm, quando comparado com o valor de referência de 25 mm, melhora a previsão do risco de PPT. Conclusão Este estudo demostra uma associação entre o comprimento cervical avaliado por ecografia tranasvaginal e o risco de PPT, e salienta que a inclusão de outros fatores de risco, como idade materna, PPT anterior e antecedentes de conização podem melhorar o algoritmo de rastreio. Realça ainda que o valor de comprimento cervical utilizado para definir "colo curto" varia de acordo com a população em estudo.

Transmediastinal gunshot wound in a pregnant patient with stable hemodynamics

Abstract Transmediastinal gunshot wounds (TGWs) may lead to life-threatening injuries of vital organs such as large vessels, the esophagus, and lungs. Although they are not commonly encountered in pregnant women, additional caution should be given to these patients. Physical examination for the diagnosis and the choice of treatment modality contain controversial points in hemodynamically stable patients, and resuscitation has excessive importance due to physiological changes in pregnancy. We present a hemodynamically stable 26-week pregnant woman brought to the emergency department for TGW. She had a 1-cm diameter of bullet entrance hole on the right anterior 4th intercostal space, 2 cm lateral to the sternum, and a 3-cm diameter exit hole on the right posterior 12th intercostal space on the midscapular line.With our conservative approach, she had an uncomplicated pregnancy period, and gave birth to a healthy baby at term.

Is birth weight associated with pregestational maternal BMI? BRISA Cohort, Ribeirão Preto, Brazil

Given the increase of women with excess weight or obesity and its possible effects on birth weight, the present study aimed to investigate the association between pregestational maternal body mass index (BMI) and birth weight in a birth cohort from Ribeirão Preto, SP, Brazil. This was a prospective study conducted on 1362 mother-child pairs involving singleton births. The women were evaluated using standardized questionnaires during the second trimester of pregnancy and at the time of childbirth. Information about the newborns was obtained from their medical records. The dependent variable was birth weight, categorized as low, adequate, or high. The independent variable was pregestational maternal BMI, categorized as malnutrition, adequate weight, overweight, and obesity. A multinomial regression model was used to estimate the crude and adjusted relative risk (RR) of low and high birth weight. A high frequency of pregestational excess weight (39.6%) was detected and found to be independently associated with high birth weight (RR=2.13, 95%CI: 1.19-3.80 for overweight and RR=3.34, 95%CI: 1.80-6.19 for obese pregnant women). There was no association between pregestational malnutrition and low birth weight (RR=1.70; 95%CI: 0.81-3.55). The present data showed a high rate of women with excess pregestational weight, supporting the hypothesis that pregestational BMI may contribute to high birth weight babies and indicating the need for actions aiming to prevent excessive weight in women at reproductive age.

Twin-twin transfusion syndrome - a University Hospital experience with intrauterine treatment / Síndrome da transfusão feto-fetal - experiência de um hospital universitário com tratamento intrauterino

ABSTRACT Introduction: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. Objectives: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. Methods: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero's staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. Results: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero's staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. Conclusion: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.

RESUMO Introdução: a síndrome de transfusão feto-fetal (STFF), definida pela combinação polidrâmnio-oligohidrâmnio, é a mais prevalente (5 a 35%) das anormalidades associadas às anastomoses vasculares placentárias e tem a maior letalidade (80 a 100%) se não tratada. A ablação a laser destes vasos por via fetoscópica com a técnica de Solomon é o tratamento de escolha atual para a interrupção das anastomoses vasculares. Objetivo: apresentar a experiência inicial do Serviço de Cirurgia Fetal do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) e comparar nossos resultados com os da literatura. Métodos: foram revisados os prontuários de todas as pacientes submetidas ao procedimento de ablação a laser, sendo analisados os dados referentes ao estadiamento de Quintero, à idade gestacional ao diagnóstico e ao procedimento, à posição placentária, à sobrevida imediata pós-procedimento e sobrevida após o período neonatal. Os dados foram então comparados com os mais recentes disponíveis na literatura. Resultados: dez casos de STFF foram analisados. Todos diagnosticados antes da 26a semana (mediana 20,79) e o intervalo diagnóstico-tratamento teve mediana de 9,5 dias. A distribuição pelo estadiamento de Quintero foi: três casos no estádio II, cinco casos no III e dois casos no IV. Em 50% das gestações pelo menos um dos fetos sobreviveu ao período neonatal. Conclusão: o tratamento da STFF no HC-UFPR impactou positivamente a sobrevida dos fetos acometidos. Entretanto, nossos resultados estão aquém dos reportados na literatura, possivelmente pelo demora no referenciamento das pacientes, com intervalo aumentado entre diagnóstico e tratamento.

Women's obstetric history and midtrimester cervical length measurements by 2d/3d and doppler ultrasound / História obstétrica e medida do comprimento do colo uterino de mulheres no segundo trimestre gestacional por ultrassonografia bi/tridimensional e Doppler

Abstract Objective The aim of the present study was to compare the obstetric history and both two- and tri-dimensional ultrasound parameters according to different cervical lengths. Methods The present cross-sectional study analyzed 248 midtrimester pregnant women according to cervical length and compared the data with the obstetric history and 2D/3D ultrasound parameters. Patients were divided into 3 groups according to cervical length: The Short Cervix group for cervical lengths ≥ 15mm and< 25mm(n= 68), the Very Short Cervix group for cervical lengths< 15mm (n = 18) and the Control group, composed of 162 pregnant women with uterine cervical lengths ≥ 25mm. Results When analyzing the obstetric history of only non-nulliparous patients, a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth was reported (p = 0.021). Cervical length and volume were positively correlated (Pearson coefficient = 0.587, p < 0.0001). The flow index (FI) parameter of cervical vascularization was significantly different between the Control and Very Short Cervix groups. However, after linear regression, in the presence of volume information, we found no association between the groups and FI. Uterine artery Doppler was also not related to cervical shortening. Conclusion The present study showed a significant association between the presence of a short cervix in the current pregnancy and at least one previous preterm birth. None of the vascularization indexes correlate with cervical length as an independent parameter. Uterine artery Doppler findings do not correlate with cervical length.

Resumo Objetivo O objetivo do presente estudo foi comparar a história obstétrica e os parâmetros bi- e tridimensionais ultrassonográficos de acordo com os diferentes comprimentos cervicais. Métodos O presente estudo transversal analisou 248 gestantes no segundo trimestre de acordo com o comprimento cervical e comparou os dados com a história obstétrica e os parâmetros ultrassonográficos 2D/3D. As pacientes foram divididas em 3 grupos de acordo com o comprimento do colo uterino: grupo Colo Curto para comprimentos cervicais ≥ 15mm e < 25mm (n = 68), grupo Colo Muito Curto para comprimentos cervicais < 15mm (n = 18) e grupo Controle, composto por 162 gestantes com comprimento cervical uterino ≥ 25 mm. Resultados Ao analisar a história obstétrica apenas de pacientes não nulíparas, foi relatadauma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior (p = 0,021). Comprimento e volume do colo uterino foram correlacionados positivamente (coeficiente de Pearson = 0,587, p < 0,0001). O parâmetro índice de fluxo (IF) da vascularização cervical foi significativamente diferente entre os grupos Controle e Colo Muito Curto. Entretanto, após regressão linear, na presença de informações de volume, não encontramos associação entre os grupos e o parâmetro IF. Também não foi encontrada relação entre o Doppler da artéria uterina e o encurtamento cervical. Conclusão O presente estudo mostrou uma associação significativa entre a presença de colo uterino curto na gravidez atual e pelo menos um episódio de parto prematuro anterior. Nenhum dos índices de vascularização se correlaciona com o comprimento cervical como parâmetro independente, assim como o Doppler da artéria uterina também não está relacionado ao comprimento do colo uterino.

Diagnóstico ecográfico prenatal de focomelia de los miembros superiores / Prenatal echographic diagnosis of phocomelia in the upper limbs

Se describe el caso clínico de una paciente de 28 años de edad, que a las 23,4 semanas de gravidez fue ingresada en el Hospital Ginecoobstétrico Docente Tamara Bunke Bider de Santiago de Cuba con el objetivo de interrumpir el embarazo, por sugerencia de los especialistas del Centro Provincial de Genética Médica, quienes habían detectado una malformación fetal (focomelia de los miembros superiores) en la ecografía del segundo trimestre. A la gestante se le realizó una histerotomía; al ser extraído el feto, se confirmó el diagnóstico ecográfico.

The case report of a 28 years patient is described, she was admitted to Tamara Bunke Bider Teaching Gynaecoobstetric Hospital in Santiago de Cuba at the 23.4 weeks of pregnancy with the objective of interrupting pregnancy, due to the specialists of the Provincial Center of Medical Genetics suggestion who had detected a fetal malformation (phocomelia of the upper limbs) in the echography of the second trimester. When the fetus was removed, a hysterectomy was carried out and the echographic diagnosis was confirmed.

Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore

INTRODUCTION@#Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore.@*METHODS@#Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission.@*RESULTS@#Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5).@*CONCLUSION@#The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.

Salud respiratoria y del sueño infantil tras una amniocentesis en el segundo trimestre / Child's respiratory and sleep health following mid-trimester amniocentesis

Objetivo. Investigar las tasas de trastornos respiratorios y del sueño en los niños cuyas madres se sometieron a una amniocentesis. Materiales y métodos. Se incluyó a niños cuyas madres se sometieron a una amniocentesis en el segundo trimestre (entre las 16 y las 20 semanas) y otros sin procedimiento invasivo (controles). Resultados. Se anallizó a 50 niños en el grupo de amniocentesis y a 47 controles. Hubo mayor incidencia de trastornos del sueño en el grupo de amniocentesis: 30 casos (60 %) frente a 11 controles (23,4 %) (p = 0,001). En el grupo de amniocentesis, 7 niños (14%) tenían asma; en el grupo de referencia, 1 niño (2,1 %) (p = 0,032).Conclusión. Podría haber una asociación entre la amniocentesis en el segundo trimestre, el asma y los trastornos del sueño en los niños. Se requieren estudios futuros y analizar los efectos a largo plazo de las pruebas invasivas.

Objective. The aim was to investigate the rates of respiratory and sleep disturbances in infants whose mothers experienced amniocentesis.Material and methods. Infants whose mothers have undergone midterm amniocentesis (between 16 and 20 weeks) and no invasive procedure (controls) were enrolled.Results. The study analyzed 50 infants whose mothers have undergone amniocentesis (amniocentesis group) and 47 controls. Amniocentesis group had higher incidence of sleep disturbances: 30 cases (60 %), compared with 11 controls (23.4 %) (P = 0.001). In the amniocentesis group there were 7 children (14 %) with asthma, while in the control group, asthma was confirmed in 1 child (2.1 %) (P = 0.032).Conclusion. Our data triggers the hypothesis that associations between midterm amniocentesis, child's asthma and sleep isturbances may exist. These preliminary results reveal the importance of further studies and the need for the analysis of long term effects of invasive testing.