Impaired hypoglycaemia awareness in early pregnancy increases risk of severe hypoglycaemia in the mid-long term postpartum irrespective of breastfeeding status in women with type 1 diabetes.

INTRODUCTION: Information regarding the postpartum period in women with type 1 diabetes (T1D) is scarce. We aim to evaluate the relation of impaired hypoglycaemia awareness (IAH) in early pregnancy and breastfeeding status (its presence and duration) with severe postpartum hypoglycaemia (SH). MATERIALS AND METHODS: Retrospective cohort study of women with T1D followed during pregnancy between 2012 and 2019. Data on SH were recorded before and during pregnancy. IAH was evaluated at the first antenatal visit. Data on breastfeeding and the long-term postpartum period were collected by questionnaire and from medical records. RESULTS: A total of 89 women with T1D were included with a median follow-up after pregnancy of 19.2 [8.7-30.5] months. Twenty-eight (32%) women had IAH at the first antenatal visit. At discharge, 74 (83%) started breastfeeding during a median of 8 [4.4-15] months. A total of 18 (22%) women experienced ≥1 SH during postpartum. The incidence of SH significantly increased from pregestational to the gestational and post-partum period (0.09, 0.15 and 0.25 episodes/patient-year, respectively). Postpartum SH rates were comparable in breastfeeding and non-breastfeeding women (21.4% vs. 25%, respectively, p>0.05). Clarke test score at the first antenatal visit was associated with postpartum SH (for each 1-point increase: OR 1.53; 95% CI, 1.06-2.21) adjusted for confounders. No other diabetes and pregnancy-related variables were identified as predictors of SH in this period. CONCLUSIONS: SH are common in the long-term postpartum period independently of breastfeeding. Assessing IAH in early pregnancy could identify those at an increased risk of SH in the postpartum period.

Pre-pregnancy overweight and obesity prevalence and relation to maternal and perinatal outcomes.

OBJECTIVE: To identify the prevalence of pre-pregnancy overweight/obesity in pregnant women and its relationship with socio-demographic factors and to describe the maternal and perinatal outcomes in a Barcelona hospital (Spain). METHOD: A descriptive cross-association study, with retrospective data collection, was performed Barcelona Hospital. The data of 5447 pregnant women who delivered at >=23 weeks of gestation were included. Body Mass Index (BMI) data were categorised into World Health Organization classifications. p values <.05 (two-tailed) were considered significant. Logistic regression models were performed. RESULTS: The prevalence of pre-pregnancy obesity was 8.4% and 18.9% for overweight. Gestational diabetes was more frequent in pre-pregnancy overweight/obesity (OR 1.92: 95% CI 1.54-2.40 and OR 3.34: 95% CI 2.57-4.33), as were preeclampsia (OR 2.08: 95% CI 1.55-2.79 and OR 3.35: 95% CI 2.38-4.71), induction of labour (OR 1.19: 95% CI 1.02-1.38 and OR 1.94: 95% CI 1.57-2.10), caesarean section (OR 1.41: 95% CI 1.21-1.65 and OR 2.68: 95% CI 2.18-3.29), prematurity (OR 1.28: 95% CI 1-1.65 and OR 1.79: 95% CI 1.32-2.44) and macrosomia (OR 1.87: 95% CI 1.43-2.46 and OR 2.03: 95% CI 1.40-2.93). CONCLUSIONS: One in four pregnant women had pre-pregnancy overweight or obesity. This study shows the relationship between pre-pregnancy overweight or obesity with adverse maternal and perinatal outcomes.

Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial.

BACKGROUND: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. OBJECTIVE: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. METHODS: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire-Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. RESULTS: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI -0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks-minutes per week vs 1386 metabolic equivalents of tasks-minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. CONCLUSIONS: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872.

Efectividad de una intervención digital compleja en los hábitos alimentarios de gestantes con obesidad preconcepcional / Effectiveness of a complex digital intervention on eating habits in pregnant women with pre-pregnancy obesity

Objetivo: Evaluar la efectividad de una intervención digital compleja, en gestantes con obesidad, con la provisión de consejos sobre hábitos alimentarios y el soporte virtual de una matrona a través de una app, respecto a los hábitos alimentarios, así como analizar el grado de satisfacción global con la intervención digital. Métodos: Se realizó un ensayo clínico paralelo aleatorizado con dos brazos 1:1 con grupo intervención (GI) y grupo control (GC). Se incluyeron 150 gestantes con obesidad preconcepcional. Ambos grupos recibieron el control prenatal habitual. La intervención en el GI fue el uso de una pulsera de actividad y la recepción de consejos sobre hábitos alimentarios mediante una app, y el soporte virtual de una matrona. Se utilizó el «Cuestionario de hábitos alimentarios para pacientes con sobrepeso y obesidad» en una escala Likert de 1 a 5. Las pruebas estadísticas fueron bilaterales y se evaluaron a un nivel α de 0,05. Los análisis se realizaron con SPSS v. 25 y SAS v. 9.4.Resultados: Se analizaron 110 (73,3 % del total) mujeres. En el GI la puntuación media de los hábitos alimentarios fue mayor que en el GC (3,49 ± 0,36 vs. 3,35 ± 0,41; p= 0,056), pero no se observaron diferencias estadísticamente significativas. En el GI, la puntuación media del consumo del tipo de alimentos fue mayor que en el GC (3,49 ± 0,78 vs. 3,18 ± 0,71; p= 0,019). El grado de satisfacción global fue de 4,76 ± 0,6 puntos de media. Conclusiones: El uso de una intervención digital compleja fue efectivo en la mejora del consumo del tipo de alimentos respecto a las gestantes que solo recibieron el control prenatal habitual. (AU)

Objective: To assess the effectiveness of a complex digital health intervention, in pregnant women with obesity, by means of an app for advice eating habits and a virtual midwife’s support, regarding their eating habits, and also to analyze the global satisfaction with digital intervention.Methods: A parallel randomized clinical trial with two arms 1:1 with intervention group (IG) and control group (CG) was conducted. 150 pregnant women with pre-pregnancy obesity were included. Both groups received usual prenatal care. The intervention, in the IG, was delivered with smartband and an app providing advice about eating habits and with a virtual midwife to support women. The validated «Questionnaire of eating habits for patients with overweight and obesity» was administrated and measured using a 1-to-5-point Likert scale. Statistical tests were two-sided and evaluated at an α level of 0.05. Analyzes were performed with SPSS v. 25 and SAS v. 9.4.Results: 110 (73.3% of the total) women were analyzed. In the IG, the mean score for eating habits was higher than in the CG (3.49 ± 0.36 versus 3.35 ± 0.41; p=0.056), but no statistically significant differences were observed. In the IG, the mean score for the intake of the type of food was higher than in the CG (3.49 ± 0.78 versus 3.18 ± 0.71; p=0.019). The mean of global satisfaction was 4.76 ± 0.6 points. Conclusions: The use of a complex digital intervention was effective in improving the intake of the type of food compared to pregnant women who only received usual prenatal care. (AU)

Pre-pregnancy overweight and obesity prevalence and relation to maternal and perinatal outcomes.

OBJECTIVE: To identify the prevalence of pre-pregnancy overweight/obesity in pregnant women and its relationship with socio-demographic factors and to describe the maternal and perinatal outcomes in a Barcelona hospital (Spain). METHOD: A descriptive cross-association study, with retrospective data collection, was performed Barcelona Hospital. The data of 5447 pregnant women who delivered at >=23 weeks of gestation were included. Body Mass Index (BMI) data were categorised into World Health Organization classifications. p values <.05 (two-tailed) were considered significant. Logistic regression models were performed. RESULTS: The prevalence of pre-pregnancy obesity was 8.4% and 18.9% for overweight. Gestational diabetes was more frequent in pre-pregnancy overweight/obesity (OR 1.92: 95% CI 1.54-2.40 and OR 3.34: 95% CI 2.57-4.33), as were preeclampsia (OR 2.08: 95% CI 1.55-2.79 and OR 3.35: 95% CI 2.38-4.71), induction of labour (OR 1.19: 95% CI 1.02-1.38 and OR 1.94: 95% CI 1.57-2.10), caesarean section (OR 1.41: 95% CI 1.21-1.65 and OR 2.68: 95% CI 2.18-3.29), prematurity (OR 1.28: 95% CI 1-1.65 and OR 1.79: 95% CI 1.32-2.44) and macrosomia (OR 1.87: 95% CI 1.43-2.46 and OR 2.03: 95% CI 1.40-2.93). CONCLUSIONS: One in four pregnant women had pre-pregnancy overweight or obesity. This study shows the relationship between pre-pregnancy overweight or obesity with adverse maternal and perinatal outcomes.

Prepregnancy care in women with type 1 diabetes improves HbA1c and glucose variability without worsening hypoglycaemia time and awareness: Glycaemic variability during prepregnancy care.

AIMS: To evaluate the impact of a prepregnancy care (PPC) programme, beyond HbA1c, on hypoglycaemia awareness and glycaemic variability (GV). METHODS: Prospective pilot study. We selected women with Type 1 diabetes who initiated a PPC programme with normal hypoglycaemia awareness (n = 24). Hypoglycaemia awareness, hypoglycaemic events and GV derived from masked-continuous glucose monitoring were evaluated in the first visit and within 2 weeks after pregnancy confirmation. RESULTS: The duration was 16.5 ±â€¯13.0 months. HbA1c significantly decreased (-0.8 ±â€¯0.7; p < 0.001). The Clarke score increased (0[0-1] vs. 1[0-2] points, p = 0.164), 2 out of 24 were reclassified as having impaired awareness of hypoglycaemia and 2 presented severe hypoglycaemia. GV decreased: standard deviation (p = 0.008), coefficient of variation (p = 0.021), mean amplitude of glycaemic excursions (p = 0.007), average daily risk range (p < 0.001), J-index (p = 0.010), high blood glucose index (HBGI) (p = 0.004), continuous overall net glycaemic action (CONGA) (p = 0.018), mean of daily differences (p = 0.045) and glycaemic risk assessment diabetes equation (p = 0.012). Final HbA1c was associated with baseline J-index, CONGA and HBGI (ß = 0.535, ß = 0.466, ß = 0.534, respectively; p < 0.05). CONCLUSIONS: A PPC programme improved HbA1c as well as GV with no significant impact on hypoglycaemia awareness. Moreover, GV could help to identify women less likely to achieve glycaemic targets. Larger studies are needed to confirm these results.

Impaired awareness of hypoglycaemia: A new risk factor for adverse pregnancy outcomes in type 1 diabetes.

AIM: The aim of this study is to evaluate the impact of impaired awareness of hypoglycaemia (IAH) on metabolic control and pregnancy outcomes in women with type 1 diabetes. MATERIAL AND METHODS: This was a single-centre prospective cohort study of singleton pregnant women with type 1 diabetes. IAH was assessed at the first antenatal visit using Clarke's test (score ≥ 3). Data on metabolic control, hypoglycaemic events, and the lipid profile were collected from prior to pregnancy and in each trimester of gestation. Pregnancy outcomes were also recorded. RESULTS: A total of 77 patients with type 1 diabetes were included; 24 (31.2%) were classified as having IAH. Compared with the normal awareness of hypoglycaemia (NAH) group, the IAH group did not show differences in HbA1c , weight gain, insulin doses, or severe and nonsevere hypoglycaemia events throughout pregnancy. IAH was associated with higher triglyceride concentrations in the second trimester (IAH: 154.8 ± 61.1 mg/dL, NAH: 128.6 ± 31.2 mg/dL, P = .034) and an increased risk of neonatal respiratory distress (odds ratio [OR] 11.24; 95% CI, 1.01-124.9, P = .041) in adjusted models. Increased risk of pre-eclampsia was related to higher second trimester triglyceride concentrations (OR 1.028; 95% CI, 1.004-1.053, P = .023) adjusted for confounders. CONCLUSIONS: The IAH was associated with increased risk of neonatal respiratory distress and pre-eclampsia, despite showing no differences in metabolic control. Hypoglycaemia awareness in the first antenatal visit should be assessed to identify the subgroup of pregnant women with increased risk of complications.

Asistencia a la gestante con diabetes. Guía de práctica clínica actualizada en 2014 / Care of pregnancies complicated by diabetes. Clinical practice guidelines: 2014 update

La diabetes es una de las complicaciones metabólicas más frecuentes de la gestación y se asocia a un incremento del riesgo de morbimortalidad maternal y fetal, que pueden evitarse y/o reducirse con un adecuado control. En la diabetes pregestacional, la preparación específica previa a la gestación es indispensable para intentar conseguir un control glucémico lo más próximo a la normalidad, evaluar complicaciones y revisar las pautas de tratamientos farmacológicos. En el caso de la diabetes gestacional, el tratamiento de esta entidad ha demostrado disminuir la tasa de complicaciones maternas y perinatales, por lo que su diagnóstico está justificado. En relación con la estrategia diagnóstica, ante la falta de consenso y la controversia desatada tras la aparición de los nuevos criterios IADPSG, el grupo ha decidido mantener la misma estrategia diagnóstica en 2 pasos y con los mismos puntos de corte hasta disponer de datos sólidos que avalen la introducción de nuevos criterios

Diabetes is one of the most common metabolic complications of pregnancy, and is associated with an increased risk of maternal and foetal morbidity and mortality that can be prevented and/or reduced with adequate glycaemic control. In pre-gestational diabetes, specific preparation prior to the pregnancy is essential in order to achieve glycaemic control near to normal as possible and to evaluate complications and review pharmacologic treatment prescription. The treatment of gestational diabetes has been shown to decrease the rate of maternal and perinatal complications, thus its diagnosis is justified. As regards the diagnostic strategy and due to the lack of consensus and the controversy arising after the publication of the new International Association of the Diabetes and Pregnancy Study Groups (IADPSG), the group has decided to keep the same diagnostic strategy in two stages, and with the same cut-off points, until there are solid data available that support the introduction of new criteria

Postpartum metabolic control in a cohort of women with type 1 diabetes / Control metabólico posparto en una cohorte de mujeres con diabetes tipo 1

BACKGROUND AND OBJECTIVE: Pregnancy in women with type 1 diabetes (T1D) involves greater risks as compared to non-diabetic women, but less information is available about blood glucose and weight control after delivery. Our aim was to evaluate the postpartum metabolic profile (blood glucose and weight control) of women with T1D and the factors related to those metabolic outcomes. METHODS: A retrospective, observational study of 36 women with T1D during pregnancy and for up to one year after delivery. RESULTS: Fifty percent of patients attended a preconceptional planning program (PPP), and 44.4% of women were treated with continuous subcutaneous insulin infusion. Mean preconceptional HbA1c and body mass index (BMI) were 7.2 ± 1.2% and 23.8 ± 5.0 respectively. In the total cohort, blood glucose control significantly worsened one year after delivery (HbA1c: 7.2 ± 1.2 vs 7.6 ± 1.2%, P < 0.001). Lower preconceptional HbA1c values were found in patients who attended PPP (6.6 ± 0.5 vs. 7.8 ± 1.4%; P = 0.02), and were maintained for one year after delivery. No differences were found in body mass index (BMI) from the pregestational period to one year after delivery in any of two groups (No PPP 22.5 ± 4.6 vs 23.2 ± 4.8, P = 0.078; PPP 25.4 ± 3.4 vs 25.5 ± 3.4 kg/m2, P = 0.947). Preconceptional HbA1c was shown to be the most important determinant of metabolic control (beta = 0.962, p < 0.001) and weight one year after delivery (beta = 0.524, p = 0.025) and weight gain during pregnancy (beta = 0.633,p = 0.004). CONCLUSIONS: Pregnant women with T1D return to prepregnancy body weight one year after delivery, especially those with lower HbA1c levels and BMI before pregnancy. However, blood glucose control deteriorates after delivery, suggesting the need for changes in clinical practice after deliver

ANTECEDENTES Y OBJETIVO: La gestación en mujeres con diabetes tipo 1 (T1D) conlleva mayor riesgo que en las mujeres sanas; sin embargo, existe menos información acerca del control glucémico y del peso tras la gestación. Nuestro objetivo ha sido evaluar el perfil metabólico posparto (control glucémico y peso) en mujeres con T1D y qué factores están relacionados con dichos resultados metabólicos. MÉTODOS: Estudio observacional retrospectivo de 36 mujeres con T1D durante el embarazo y hasta un año posparto. RESULTADOS: El 50% de las pacientes realizaron un programa de planificación pregestacional (PPP) y el 44,4% realizaban tratamiento con infusor subcutáneo de insulina. La HbA1c y el índice de masa corporal (IMC) fueron de 7,2 ± 1,2% y 23,8 ± 5,0 respectivamente. En la cohorte total se observó un empeoramiento significativo del control glucémico al año posparto (7,2 ± 1,2 vs 7,6 ± 1,2%, p < 0,001). Las pacientes que acudieron al PPP (6,6 ± 0,5 vs. 7,8 ± 1,4%; p = 0,02) presentaban una menor HbA1c pregestacional, y esto se mantuvo un año tras el parto. No se objetivaron diferencias en el índice de masa corporal (IMC) entre el periodo pregestacional y al año posparto en ninguno de los 2 grupos (no PPP 22,5 ± 4,6 vs 23,2 ± 4,8, p = 0,078; PPP 25,4 ± 3,4 vs 25,5 ± 3,4 kg/m2, p = 0,947). La HbA1c fue el mayor determinante del grado de control metabólico (beta = 0,962, p < 0,001) y del peso un año posparto (beta = 0,524 p = 0,025) y de la ganancia ponderal durante la gestación (beta = 0,633, p = 0,004). CONCLUSIONES: Las mujeres embarazadas con T1D recuperan el peso preconcepcional al año posparto, especialmente aquellas con menor HbA1c e IMC pregestación. Sin embargo, el control glucémico se deteriora tras el parto, sugiriendo que es necesario modificar nuestra práctica clínica en este periodo

Postpartum metabolic control in a cohort of women with type 1 diabetes.

BACKGROUND AND OBJECTIVE: Pregnancy in women with type 1 diabetes (T1D) involves greater risks as compared to non-diabetic women, but less information is available about blood glucose and weight control after delivery. Our aim was to evaluate the postpartum metabolic profile (blood glucose and weight control) of women with T1D and the factors related to those metabolic outcomes. METHODS: A retrospective, observational study of 36 women with T1D during pregnancy and for up to one year after delivery. RESULTS: Fifty percent of patients attended a preconceptional planning program (PPP), and 44.4% of women were treated with continuous subcutaneous insulin infusion. Mean preconceptional HbA1c and body mass index (BMI) were 7.2±1.2% and 23.8±5.0 respectively. In the total cohort, blood glucose control significantly worsened one year after delivery (HbA1c: 7.2±1.2 vs 7.6±1.2%, P<0.001). Lower preconceptional HbA1c values were found in patients who attended PPP (6.6±0.5 vs. 7.8±1.4%; P=0.02), and were maintained for one year after delivery. No differences were found in body mass index (BMI) from the pregestational period to one year after delivery in any of two groups (No PPP 22.5±4.6 vs 23.2±4.8, P=0.078; PPP 25.4±3.4 vs 25.5±3.4 kg/m(2), P=0.947). Preconceptional HbA1c was shown to be the most important determinant of metabolic control (ß=0.962, p<0.001) and weight one year after delivery (ß=0.524, p=0.025) and weight gain during pregnancy (ß=0.633, p=0.004). CONCLUSIONS: Pregnant women with T1D return to prepregnancy body weight one year after delivery, especially those with lower HbA1c levels and BMI before pregnancy. However, blood glucose control deteriorates after delivery, suggesting the need for changes in clinical practice after delivery.

Sensor augmented pump therapy in the management of type 1 diabetes complicated with Addison's disease prior to and during pregnancy / Tratamiento combinado con sistema bomba-sensor para el control de la diabetes de tipo 1 complicada con enfermedad de Addison antes del embarazo y durante este

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Obstetric and perinatal outcome in women with twin pregnancy and gestational diabetes.

OBJECTIVE: The aim of this study was to evaluate pregnancy complications and obstetric and perinatal outcomes in women with twin pregnancy and GDM. STUD DESIGN: An observational multicentre retrospective study was performed and 534 pregnant woman and 1068 twins infants allocated into two groups, 257 with GDM and 277 controls, were studied. MAIN OUTCOME MEASURES: Pregnant women characteristics, hypertensive complications, preterm delivery rate, mode of delivery and birthweight were analysed. RESULTS: Pregnant women with GDM were older (p < 0.001) and had higher body mass index (p < 0.001) than controls. GDM was associated with higher risk of prematurity in twin pregnancy (odds ratio 1.64, 95% confidence interval [1.14-2.32], p = 0.005). This association was based on the association with other pregnancy complications. Birthweight Z-scores were significantly higher in the GDM group (p = 0.02). The rate of macrosomia was higher in the GDM group (p = 0.002) and small for gestational age (SGA) babies were significantly less frequent (p = 0.03). GDM was an independent predictor of macrosomia (p = 0.006). CONCLUSION: The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.

Gestational age-specific cutoff levels of TDx-FLM II for the prediction of neonatal respiratory distress syndrome.

AIM: To construct a predictive model for respiratory distress syndrome (RDS) from gestational age (GA) at delivery and TDx-FLM II value. METHODS: Pregnant women who underwent an amniocentesis in which TDx-FLM II was determined were included in the study. A model for the occurrence of RDS was constructed by means of a logistic regression procedure from TDx-FLM II values and GA at delivery. RESULTS: The mean value of TDx-FLM II was 47.11 mg/g. The mean GA at delivery was 33.4 weeks. The incidence of RDS was 7.8% (18/231). The optimal cutoff of predicted risk for respiratory distress was found to be 8.8%, resulting in a sensitivity and specificity of 89 and 83%, respectively. CONCLUSIONS: The adjustment of the TDx-FLM II value for GA at delivery results in a significant improvement in the predictive capacity of the test for the occurrence of RDS. The use of GA-specific cutoff values may simplify clinical decisions.

La episiotomía en España. Datos del año 2006 / Episiotomy in Spain: Data from 2006

En una encuesta realizada por la Sección de Medicina Perinatal de la SEGO, se ha podido comprobar que durante el año 2006, la tasa de episiotomías en los partos eutócicos fue del 54,08% y en los partos instrumentales del 92,62%

A survey performed by the Perinatal Medicine Section of the Spanish Society of Obstetrics and Gynecology found that the rate of episiotomies was 54.08% in uneventful deliveries and was 92.62% in instrumental deliveries

Anticoncepción poscoital con levonorgestrel: estudio sociodemográfico / Levonorgestrel emergency contraception: results of a sociodemographic study

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