High-risk pregnancy and its relationship with the neurodevelopment and behavior of 2-year-old children.

High-risk pregnancies elevate maternal stress, impacting offspring neurodevelopment and behavior. This study, involving 112 participants, aimed to compare perceived stress, neurodevelopment, and behavior in high-risk and low-risk pregnancies. Two groups, high-risk and low-risk, were assessed during pregnancy for stress using hair cortisol and psychological analysis. At 24 months post-birth, their children's neurodevelopment and behavior were evaluated. Results revealed higher perceived stress and pregnancy-related concerns in high-risk pregnancies, contrasting with low-risk pregnancies. Offspring from high-risk pregnancies displayed elevated internalizing behavior scores, while low-risk pregnancies showed higher externalizing behavior scores. Additionally, women in low-risk pregnancies exhibited increased cortisol concentrations 24 months post-delivery. These findings underscore the necessity for early stress detection and prevention programs during pregnancy, particularly in high-risk cases, to enhance maternal and infant health.

[Cognitive-behavioral therapy as a damper of the negative psychological effects of confinement by COVID-19 on pregnant women.] / La terapia cognitiva-conductual como amortiguadora de los efectos psicológicos negativos del confinamiento por la COVID-19 en mujeres embarazadas.

OBJECTIVE: The pandemic caused by COVID-19, at a psychological level, can cause an increase in levels of stress and anxiety due to the fear of contagion and its consequences. Pregnant women are especially vulnerable to these psychological consequences. Thus, the objective of this study was to verify the efficacy of a cognitive-behavioral stress control program in reducing psychological stress and increasing resilience in pregnant women, which ended at the begining of the confinement due to COVID-19 in Spain. METHODS: The study included 22 pregnant women who were randomly divided into two groups: the experimental group (GT) consisted of 11 participants and the control group (GC) also consisted of 11 participants. Participants were recruited from the Hospital Universitario Clínico San Cecilio in the province of Granada (Spain), where the weekly cognitive behavioral intervention was also carried out, which was implemented between January 22 and March 11, 2020. They used the assessment instruments: Pregnancy Distress Questionnaire (PDQ), Perceived Stress Scale (EEP-14), Inventory of Vulnerability to Stress (IVE) and Connor Davidson Resilience Scale (CD-RISC). A mixed ANOVA of repeated measures 2*2 was performed, with the variable between groups having two levels (CG and GT), and the within-subject having two time periods (pre and post). RESULTS: The repeated measures ANOVA analysis showed group*time interaction effects between the therapy group and the control group and the CD-RISC scores (F1,20=10.658; p<0.02). Intrasubject differences in CD-RISC scores were found in the (GT) (t=-2.529; p<0.05), with a moderate effect size. CONCLUSIONS: It can be affirmed that cognitive behavioral intervention in pregnant women, administrated prior to confinement in Spain and during the COVID-19 pandemic, has resulted in increased levels of resilience in this population.

OBJETIVO: La pandemia provocada por la COVID-19, a nivel psicológico, puede producir un aumento en los niveles de estrés y ansiedad por el miedo al contagio y sus consecuencias. Un grupo especialmente vulnerable a dichas consecuencias psicológicas es el de mujeres embarazadas. Así, el objetivo de este estudio fue comprobar la eficacia de un programa de control del estrés, de carácter cognitivo-conductual, en la reducción de estrés psicológico y el aumento de la resiliencia en mujeres embarazadas, que finalizó en el momento de la instauración del confinamiento por la COVID-19 en España. METODOS: El estudio quedó constituido por veintidós mujeres embarazadas que fueron divididas en dos grupos de forma aleatoria: once constituyeron el grupo experimental (GT) y once el grupo control (GC). Las participantes fueron reclutadas del Hospital Universitario Clínico San Cecilio de la provincia de Granada (España), donde también se llevó a cabo la intervención cognitivo-conductual de carácter semanal, que se implementó entre el 22 de enero y el 11 de marzo de 2020. Se emplearon los siguientes instrumentos de evaluación: Cuestionario de Preocupaciones Prenatales (PDQ), Escala de Estrés Percibido (EEP-14), Inventario de Vulnerabilidad al Estrés (IVE) y Escala de Resiliencia de Connor y Davidson (CD-RISC). Se realizó un ANOVA mixto de medidas repetidas 2*2, teniendo la variable entre grupos dos niveles (GC y GT), y la variable intrasujeto dos momentos temporales (pre y post). RESULTADOS: El análisis ANOVA de medidas repetidas mostró efectos de interacción grupo*tiempo entre los grupos de terapia y control y las puntuaciones del CD-RISC (F1,20=10,658; p<0,02). Se encontraron en el grupo de terapia diferencias intrasujeto en las puntuaciones del CD-RISC (t=-2,529; p<0,05), con un tamaño del efecto medio. CONCLUSIONES: Se puede afirmar que la intervención cognitivo-conductual en mujeres embarazadas, impartida de manera previa al confinamiento en España y durante la pandemia provocada por la COVID-19, ha provocado un incremento de los niveles de resiliencia en dicha población.

Neurodevelopment of high and low-risk pregnancy babies at 6 months of age.

OBJECTIVE: to compare neurodevelopment differences between babies born from low-risk pregnancies and babies born from high-risk pregnancies. STUDY DESIGN: Longitudinal design SETTING: Spain PARTICIPANTS: A total of 91 women participated in the study, divided into two groups: 49 women in the low-risk pregnancy group and 42 women in the high-risk group. MEASUREMENT AND FINDINGS: The average amount of cortisol in pregnant mothers' hair was determined in both groups. Following their birth, the babies' neurodevelopment was evaluated using the Bayley-III instrument at 6 months of age and a new sample of cortisol was obtained from both the baby and the mother. The results showed that pregnancy risk group could predict cognitive, fine motor, gross motor and general motor neurodevelopment. KEY CONCLUSIONS: These results seem to show that an appropriate treatment tailored to the needs of individualised pregnancies may favor babies' neurodevelopment, including that of babies born from high-risk pregnancies. IMPLICATIONS FOR RESEARCH: It is essential to take special care of pregnant women no matter their medical condition and offer them the best medical care available.

Piometra por Streptococcus agalactiae tras parto vaginal eutócico. Presentación de un caso y revisión de la literatura / Streptococcus agalactiae pyometra following eutocic vaginal delivery. Case presentation and review of the literature

Objetivo: analizar un caso clínico de piometra por Streptococcus agalactiae tras parto vaginal. Revisar los factores de riesgo, el diagnóstico y el tratamiento de esta entidad. Materiales y métodos: se presenta el caso de una puérpera de 35 años con cuatro partos anteriores y parto vaginal diez días antes, quien consulta por sangrado genital abundante al Hospital Universitario San Cecilio de Granada (España) que realiza la atención obstétrico-ginecológica de la población sur de Granada y es centro de referencia de los Hospitales Básicos del Área Sanitaria Sur de la provincia. La ecografía transvaginal muestra cavidad uterina ocupada por contenido heterogéneo. Se practica legrado obteniéndose abundante material purulento, se hace diagnóstico de piometra y se instaura tratamiento antibiótico de amplio espectro. Cultivo positivo para Streptococcus agalactiae. Posteriormente presenta recidiva que precisa drenajes y tratamiento antibiótico intravenoso con clindamicina e imipenem, con buena evolución. Se realiza una búsqueda bibliográfica en las bases de datos: Pubmed, Cochrane y UpToDate utilizando los términos de búsqueda piometra posparto, endometritis posparto, Streptococcus agalactiae. Resultados: se encontraron 833 artículos en las bases de datos, de los cuales se seleccionaron 40 sobre casos de piometra o endometritis posparto en humanos incluyendo finalmente 14 artículos, 3 correspondieron a casos clínicos y 11 a revisiones del tema. Conclusiones: la aparición de piometra tras un parto vaginal eutócico es poco frecuente en humanos, pero debe considerarse como posible entidad etiológica en casos de fiebre puerperal con factores de riesgo asociados. El diagnóstico se basa en una buena exploración clínica y ecográfica, y se debe instaurar de forma precoz un tratamiento antibiótico de amplio espectro y realizar drenaje del mismo

Objective: To analyze a clinical case of rarely ocurring pyometra associated to Streptococcus agalactiae, after vaginal delivery and to review risk factors, diagnosis and treatment. Materials and methods: Case seen at the San Cecilio University Hospital in Granada (Spain), which provides obstetric and gynecological services to the population of southern Granada and is a referral center for the primary care hospitals of the southern provincial health district. The patient is a 35 year-old woman, parity 4, who assisted to the hospital, ten days ten days after eutocic vaginal delivery, with a clinical picture consistent with pyometra. On transvaginal ultrasound, the uterine cavity appeared occupied by heterogeneous content. Dilatation and curettage were performed with retrieval of abundant purulent material, and treatment with broad-spectrum antibiotics was instituted. The culture was positive for Streptococcus agalactiae. Pyometra reappeared at a later date, requiring drainage and intravenous treatment with clyndamicin and imipenem, with a good outcome. A literature search was conducted in the Pubmed, Cochrane and UpToDate databases using the terms pyometra, post-partum, endometritis, Streptococcus agalactiae. Results: Of 833 articles found in the databases, 40 with cases of pyometra or postpartum endometritis in humans were selected. Of these, 14 articles were finally selected, including 3 that described clinical cases and 11 topic reviews. Conclusions: The occurrence of pyometra after eutocic vaginal delivery is rare in humans, but must be considered as a potential etiology in cases of post-partum fever with associated risk factors. The diagnosis is based on good clinical and ultrasound examination, and the condition requires early treatment with broad-spectrum antibiotics and drainage

Analysis of perinatal mortality in newborn infants with a birth weight of less than 1000 grams in Hospital San Cecilio in Granada (Spain) over the 1991-2010 period.

INTRODUCTION: Perinatal mortality has significantly decreased over the last decades. Low birth weight and prematurity are amongst the strongest predictors of neonatal death. The main objective is to analyze the evolution of perinatal mortality and its causes in newborn infants with a birth weight of less than 1000 grams over the last 20 years (1991-2010). POPULATION AND METHODS: Observational, descriptive, longitudinal and ecological study. A total of 264 infants weighing less than 1000 g out of a total of 56 024 births during the study period. Different specific perinatal mortality rates by weight were calculated. The Spearman's Rho correlation coefficient was applied to assess the relationship between mortality rates and years of study, and ANOVA and Mann-Whitney test were used to compare five-year periods and ten-year periods, respectively. RESULTS: There were 131 perinatal deaths, 82 stillbirths and 49 early neonatal deaths; 64.1% of them occurred before 27 weeks of gestation. Only the fetal mortality rate was statistically significant, although perinatal mortality showed a downward trend, without reaching significance. The main immediate causes of death were extreme prematurity, intrauterine hypoxia and infection. The underlying causes related to death in this group of newborn infants were infection caused by premature rupture of membranes, maternal hypertension, uncontrollable preterm labor and twin pregnancy. CONCLUSIONS: The reduction in mortality rates in this group of newborn infants is undergoing a slowdown.

Analysis of perinatal mortality in newborn infants with a birth weight of less than 1000 grams in Hospital San Cecilio in Granada (Spain) over the 1991-2010 period / Análisis de la mortalidad perinatal en nacidos con peso menor de 1000 gramos en el Hospital San Cecilio de Granada (España) durante el período 1991-2010

Introduction. Perinatal mortality has significantly decreased over the last decades. Low birth weight and prematurity are amongst the strongest predictors of neonatal death. The main objective is to analyze the evolution of perinatal mortality and its causes in newborn infants with a birth weight of less than 1000 grams over the last 20 years (1991-2010). Population and Methods. Observational, descriptive, longitudinal and ecological study. A total of 264 infants weighing less than 1000 g out of a total of 56 024 births during the study period. Different specific perinatal mortality rates by weight were calculated. The Spearman's Rho correlation coefficient was applied to assess the relationship between mortality rates and years of study, and ANOVA and Mann-Whitney test were used to compare five-year periods and ten-year periods, respectively. Results. There were 131 perinatal deaths, 82 stillbirths and 49 early neonatal deaths; 64.1% of them occurred before 27 weeks of gestation. Only the fetal mortality rate was statistically significant, although perinatal mortality showed a downward trend, without reaching significance. The main immediate causes of death were extreme prematurity, intrauterine hypoxia and infection. The underlying causes related to death in this group of newborn infants were infection caused by premature rupture of membranes, maternal hypertension, uncontrollable preterm labor and twin pregnancy. Conclusions. The reduction in mortality rates in this group of newborn infants is undergoing a slowdown.

Introducción. La mortalidad perinatal ha disminuido sustancialmente en las últimas décadas. La prematuridad y el bajo peso al nacer son los factores predictivos más fuertemente asociados a esta mortalidad. El objetivo es analizar la evolución de la mortalidad perinatal en los nacidos con peso menor de 1000 g en los últimos 20 años (1991-2010) y sus causas. Población y métodos. Estudio observacional-descriptivo de tipo ecológico longitudinal, sobre 264 nacidos con peso menor de 1000 g de un total de 56 024 nacidos durante el período estudiado. Se calculan las diferentes tasas de mortalidad perinatal específicas por peso. Se aplica el coeficiente de correlación Rho de Spearman para evaluar la relación entre las tasas de mortalidad y los años de estudio, y las pruebas ANOVA y de Mann- Whitney para comparación de quinquenios y decenios, respectivamente. Resultados. Se han producido 131 muertes perinatales, 82 de ellas muertes fetales y 49 neonatales precoces. El 64,1% sucede antes de la semana de gestación 27. Sólo la tasa de mortalidad fetal presenta una disminución estadísticamente significativa, aunque la mortalidad perinatal presenta una tendencia al descenso, pero sin alcanzar la significación. Las principales causas inmediatas de óbito son la inmadurez extrema, la hipoxia intrauterina y la infección. Las causas fundamentales relacionadas con la muerte de este grupo de nacidos son la infección por rotura prematura de membranas, la hipertensión materna, la amenaza de parto pretérmino incontrolable y la gemelaridad. Conclusiones. La disminución de las tasas de mortalidad en este grupo de nacidos está sufriendo un enlentecimiento.

Analysis of perinatal mortality in newborn infants with a birth weight of less than 1000 grams in Hospital San Cecilio in Granada (Spain) over the 1991-2010 period / Análisis de la mortalidad perinatal en nacidos con peso menor de 1000 gramos en el Hospital San Cecilio de Granada (España) durante el período 1991-2010

Introduction. Perinatal mortality has significantly decreased over the last decades. Low birth weight and prematurity are amongst the strongest predictors of neonatal death. The main objective is to analyze the evolution of perinatal mortality and its causes in newborn infants with a birth weight of less than 1000 grams over the last 20 years (1991-2010). Population and Methods. Observational, descriptive, longitudinal and ecological study. A total of 264 infants weighing less than 1000 g out of a total of 56 024 births during the study period. Different specific perinatal mortality rates by weight were calculated. The Spearmans Rho correlation coefficient was applied to assess the relationship between mortality rates and years of study, and ANOVA and Mann-Whitney test were used to compare five-year periods and ten-year periods, respectively. Results. There were 131 perinatal deaths, 82 stillbirths and 49 early neonatal deaths; 64.1% of them occurred before 27 weeks of gestation. Only the fetal mortality rate was statistically significant, although perinatal mortality showed a downward trend, without reaching significance. The main immediate causes of death were extreme prematurity, intrauterine hypoxia and infection. The underlying causes related to death in this group of newborn infants were infection caused by premature rupture of membranes, maternal hypertension, uncontrollable preterm labor and twin pregnancy. Conclusions. The reduction in mortality rates in this group of newborn infants is undergoing a slowdown.(AU)

Introducción. La mortalidad perinatal ha disminuido sustancialmente en las últimas décadas. La prematuridad y el bajo peso al nacer son los factores predictivos más fuertemente asociados a esta mortalidad. El objetivo es analizar la evolución de la mortalidad perinatal en los nacidos con peso menor de 1000 g en los últimos 20 años (1991-2010) y sus causas. Población y métodos. Estudio observacional-descriptivo de tipo ecológico longitudinal, sobre 264 nacidos con peso menor de 1000 g de un total de 56 024 nacidos durante el período estudiado. Se calculan las diferentes tasas de mortalidad perinatal específicas por peso. Se aplica el coeficiente de correlación Rho de Spearman para evaluar la relación entre las tasas de mortalidad y los años de estudio, y las pruebas ANOVA y de Mann- Whitney para comparación de quinquenios y decenios, respectivamente. Resultados. Se han producido 131 muertes perinatales, 82 de ellas muertes fetales y 49 neonatales precoces. El 64,1% sucede antes de la semana de gestación 27. Sólo la tasa de mortalidad fetal presenta una disminución estadísticamente significativa, aunque la mortalidad perinatal presenta una tendencia al descenso, pero sin alcanzar la significación. Las principales causas inmediatas de óbito son la inmadurez extrema, la hipoxia intrauterina y la infección. Las causas fundamentales relacionadas con la muerte de este grupo de nacidos son la infección por rotura prematura de membranas, la hipertensión materna, la amenaza de parto pretérmino incontrolable y la gemelaridad. Conclusiones. La disminución de las tasas de mortalidad en este grupo de nacidos está sufriendo un enlentecimiento.(AU)

Analysis of perinatal mortality in newborn infants with a birth weight of less than 1000 grams in Hospital San Cecilio in Granada (Spain) over the 1991-2010 period. / Analysis of perinatal mortality in newborn infants with a birth weight of less than 1000 grams in Hospital San Cecilio in Granada (Spain) over the 1991-2010 period.

INTRODUCTION: Perinatal mortality has significantly decreased over the last decades. Low birth weight and prematurity are amongst the strongest predictors of neonatal death. The main objective is to analyze the evolution of perinatal mortality and its causes in newborn infants with a birth weight of less than 1000 grams over the last 20 years (1991-2010). POPULATION AND METHODS: Observational, descriptive, longitudinal and ecological study. A total of 264 infants weighing less than 1000 g out of a total of 56 024 births during the study period. Different specific perinatal mortality rates by weight were calculated. The Spearmans Rho correlation coefficient was applied to assess the relationship between mortality rates and years of study, and ANOVA and Mann-Whitney test were used to compare five-year periods and ten-year periods, respectively. RESULTS: There were 131 perinatal deaths, 82 stillbirths and 49 early neonatal deaths; 64.1

of them occurred before 27 weeks of gestation. Only the fetal mortality rate was statistically significant, although perinatal mortality showed a downward trend, without reaching significance. The main immediate causes of death were extreme prematurity, intrauterine hypoxia and infection. The underlying causes related to death in this group of newborn infants were infection caused by premature rupture of membranes, maternal hypertension, uncontrollable preterm labor and twin pregnancy. CONCLUSIONS: The reduction in mortality rates in this group of newborn infants is undergoing a slowdown.

Eficacia de la tromboprofilaxis obstétrica / Efficacy of obstetrical tromboprophylaxis

Valorar la incidencia de enfermedad tromboembólica durante el embarazo, parto y puerperio en gestantes con riesgo y la efectividad de las tromboprofilaxis. Seguimiento de 2 727 gestantes con parto durante un año. Se realiza análisis descriptivo de nuestra población, de los factores de riesgo y de la duración de la tromboprofilaxis, analizando su relación con la incidencia de eventos tromboembólicos. Hospital Universitario San Cecilio de Granada, España. Nuestras gestantes tienen pocos factores de riesgo: cesárea, anemia posquirúrgica, tabaquismo, hipertensión inducida por el embarazo o previa, diabetes, cardiopatía y trombofilia, siendo la cesárea y la anemia los más frecuentes. La tromboprofilaxis postcesárea con nadroparina cálcica 0,4 diaria durante su hospitalización ha sido efectiva. No hubo ningún tromboembolismo. En nuestra población, con un adecuado control obstétrico y profilaxis con antiagregantes plaquetarios y/o heparinas de bajo peso molecular, se han evitado eventos tromboembólicos relacionados con el embarazo, parto puerperio.

Fractura subcapital de fémur secundaria a osteoporosis idiopática en el embarazo: a propósito de un caso / Subcapital fracture of the femur due to a idiopathic osteoporosis during pregnancy: a case report

Presentamos el caso de una paciente imposibilitada para la deambulación durante el puerperio, consecuencia de una fractura de fémur producida por una osteoporosis idiopática durante el embarazo. A los 11 meses del parto, la paciente presenta una evolución favorable con tratamiento médico con bifosfonatos y calcio.

We present the case of a mobility disabled person during puerperium as a consequence of a femur fracture due to an idiopathic osteoporosis during pregnancy. Eleven months after delivery, the patient's evolution was favourable with a medical treatment using bisphosphonates and calcium.