Perinatal outcomes of pregnancies resulting from assisted reproduction technology in SARS-CoV-2-infected women: a prospective observational study.

OBJECTIVE: To evaluate the perinatal and maternal outcomes of pregnancies in women infected with SARS-CoV-2, comparing spontaneous and in vitro fertilization (IVF) pregnancies (with either own or donor oocytes). DESIGN: Multicenter, prospective, observational study. SETTING: 78 centers participating in the Spanish COVID19 Registry. PATIENT(S): 1,347 pregnant women with SARS-CoV-2 positive results registered consecutively between February 26 and November 5, 2020. INTERVENTION(S): The patients' information was collected from their medical records, and multivariable regression analyses were performed, controlling for maternal age and the clinical presentation of the infection. MAIN OUTCOME MEASURE(S): Obstetrics and neonatal outcomes, pregnancy comorbidities, intensive care unit admission, mechanical ventilation need, and medical conditions. RESULT(S): The IVF group included 74 (5.5%) women whereas the spontaneous pregnancy group included 1,275 (94.5%) women. The operative delivery rate was high in all patients, especially in the IVF group, where cesarean section became the most frequent method of delivery (55.4%, compared with 26.1% of the spontaneous pregnancy group). The reason for cesarean section was induction failure in 56.1% of the IVF patients. IVF women had more gestational hypertensive disorders (16.2% vs. 4.5% among spontaneous pregnancy women, adjusted odds ratio [aOR] 5.31, 95% confidence interval [CI] 2.45-10.93) irrespective of oocyte origin. The higher rate of intensive care unit admittance observed in the IVF group (8.1% vs. 2.4% in the spontaneous pregnancy group) was attributed to preeclampsia (aOR 11.82, 95% CI 5.25-25.87), not to the type of conception. CONCLUSION(S): A high rate of operative delivery was observed in pregnant women infected with SARS-CoV-2, especially in those with IVF pregnancies; method of conception did not affect fetal or maternal outcomes, except for preeclampsia. CLINICAL TRIAL REGISTRATION NUMBER: NCT04558996.

Perinatal outcomes of pregnancies after homologous artificial insemination a comparison with spontaneous pregnancies / Resultados perinatales de embarazos tras inseminación artificial homóloga frente a embarazos espontáneos

Objective: To establish the association between ovarian stimulation followed by intrauterine insemination and the appearance of major congenital abnormalities and to study infertility as a risk factor. Materials and methods: We performed a retrospective single-center cohort study of 209 patients who gave birth at our center. The patients were classified into 3 groups: 44 patients who received treatment, 22 nontreated infertile women, and 143 nontreated fertile women. Results: Congenital malformation rates were higher in treated infertile women, as was the relative risk (RR) after comparison with nontreated patients taken as single group (RR, 2.81; 95%CI, 1.02-9.46). Nontreated infertile patients did not have an increased RR with respect to nontreated fertile women (RR, 0.88; 95%CI, 0.11-7.9). Logistic regression showed statistically significant differences when treated infertile patients were compared with all nontreated patients taken as a single group (p = 0.048), with a greater risk of major malformations observed in the first group; however, statistical significance was not reached when nontreated fertile women were used as a control group (p = 0.057). As for the remaining variables analyzed, statistical significance was only found for the risk of congenital malformations associated with a body mass index higher than the median (22). Conclusions: There is a statistically significant higher risk (p = 0.048) in infertile treated patients in relation to nontreated patients taken as a group. When treated patients were compared with nontreated fertile patients, the relative risk did not reach statistical significance, probably on account of the small sample size. Consequently, further studies with a larger sample size are needed

Objetivo: analizar la asociación entre la estimulación ovárica seguida de inseminación intrauterina y la aparición de malformaciones mayores, así como la infertilidad como factor de riesgo para malformaciones. Materiales y métodos: se trata de un estudio de cohortes retrospectivo unicéntrico en el que se incluyeron 209 gestantes con parto en este centro. Fueron clasificadas en tres grupos, 44 expuestas a estimulación ovárica e inseminación intrauterina, 22 estériles no expuestas a tratamiento y 143 sanas no expuestas. Resultados: las tasas de malformaciones fueron mayores en estériles expuestas, así como el riesgo relativo respecto a las no expuestas en conjunto [riesgo relativo 2,81; IC95% (1,02-9,46)]. Las pacientes estériles no expuestas no presentaron un aumento del riesgo relativo respecto a las sanas no expuestas [riesgo relativo 0,88; IC95% (0,11-7,9)]. La regresión logística mostró diferencias significativas al enfrentar a las estériles expuestas con los dos grupos no expuestos en conjunto (p = 0,048) con mayor riesgo de malformación mayor en las primeras pero no llegó a la significación si como grupo control se empleaban exclusivamente las pacientes sanas no expuestas (p = 0,057). Respecto al resto de variables estudiadas, únicamente fue significativo para el riesgo de malformaciones congénitas el índice de masa corporal mayor de la mediana (22). Conclusiones: existe un riesgo mayor con significación estadística (p = 0,048) en las expuestas respecto a las pacientes no expuestas en conjunto. Al enfrentar a las pacientes expuestas frente a las fértiles no expuestas, el riesgo no alcanzó significación estadística, probablemente por el escaso número muestral, lo que indica que son necesarios estudios con mayor número de pacientes

3D Hysterosalpingo-contrast sonography: description of the technique and results / Histerosonosalpingografía con contraste 3D: descripción de la técnica y resultados

Objective: To describe the 3-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) technique and analyze our results with 2 contrast agents: SonoVue® and ExEm Foam®. Material and methods: Cross-sectional study of 160 infertility patients with unknown tubal patency. Results: Bilateral tubal patency was diagnosed in 102/153 (66.7%) patients. A similar proportion of bilateral occlusion was observed with both SonoVue® 5/87 (5.7%) and ExEm foam® 4/66 (6.1%) (p = 0.52). Intrauterine disease was suspected in 33/155 (21.3%) patients: 20% (18/90) with SonoVue® and 23.1% (15/65) with ExEm Foam® (p = 0.644). The visual analog scale (VAS) revealed mild pain (VAS ≤ 4: 86.4% [70/81] with SonoVue® vs. 86.8% [59/68]) with ExEm Foam® (p = 0.951). A pediatric nasogastric probe was easily used to cannulate the cervical os in 128/159 (80.5%) cases. The volume of ExEm foam® used was lower than that of SonoVue® (median: 3 cc vs.20 cc, p < 0.001). Conclusion: 3D-HyCoSy is a reliable, well-tolerated, and effortless tool for the sonographic assessment of sterility. The results were similar with both contrast agents (AU)

Objetivo: describir la técnica y analizar nuestros resultados con histerosonosalpingografía con contraste 3D (HyCoSy-3D) utilizando SonoVue® y Exem Foam®. Material y métodos: estudio retrospectivo de corte transversal en 160 pacientes estériles con permeabilidad tubárica desconocida. Resultados: l 66,7% (102/153) de las pacientes tuvo permeabilidad tubárica bilateral. El diagnóstico de obstrucción tubárica bilateral fue similar utilizando SonoVue® 5/87 (5,7%) y Exem Foam® 4/66 (6,1%), p = 0,52. Diagnosticamos patología intrauterina en 33/155 (21,3%) de las pacientes, 20% (18/90) con SonoVue® vs. 23,1% (15/65) p = 0,644. El dolor percibido resultó leve en la mayoría de los casos (escala visual analógica ≤ 4; 86,4% (70/81) SonoVue® vs. 86,8% (59/68), p = 0,951). La canalización cervical fue sencilla con sonda nasogástrica pediátrica en 128/159 (80,5%). Exem Foam® precisó un menor volumen instilado (mediana: 3 cc vs. 20 cc, p < 0,001). Conclusiones: la HyCoSy-3D es una prueba tolerable, sencilla y rentable para el estudio ecográfico en esterilidad. Ambos contrastes mostraron similares resultados (AU)

Prospective Study of Concordance Between Hysterosalpingo-Contrast Sonography and Hysteroscopy for Evaluation of the Uterine Cavity in Patients Undergoing Infertility Studies.

OBJECTIVES: The purpose of the study was to assess the accuracy of hysterosalpingo-contrast sonography (HyCoSy) for evaluation of the uterine cavity. METHODS: Hysterosalpingo-contrast sonography was compared with hysteroscopy for assessment of the uterine cavity. This work was a descriptive prospective study to assess the concordance between pathologic intrauterine findings using the Cohen κ coefficient. Ninety infertile patients from Puerta de Hierro University Hospital were included in the study. They underwent HyCoSy between June 2016 and April 2017. Fifteen of them had pathologic findings in the uterine cavity during HyCoSy and therefore underwent hysteroscopy. Clinical and sonographic findings were compared in those 15 patients by to evaluate the agreement between both techniques. RESULTS: In this study, intrauterine sonographic findings on HyCoSy and hysteroscopic features of the uterine cavity reached 100% concordance, with a κ coefficient of 1.000 and a 100% agreement rate. CONCLUSIONS: Hysterosalpingo-contrast sonography permits a very accurate evaluation of the uterine cavity, which could be of interest for infertile patients who might be examined for tubal patency.

Reproducibility of first trimester three-dimensional placental measurements.

OBJECTIVE: The aim of this study was to assess intra and interobserver reproducibility of placental volume and vascularization during the first trimester of pregnancy studied by three dimensional ultrasonography and angio power Doppler. STUDY DESIGN: This is a prospective study in 69 singleton pregnancies. Once the bi-dimensional protocol study was carried out, we performed a 3D-US (three-dimensional ultrasonography) of the placenta by abdominal ultrasonography. The Virtual Organ Computer-Aided Analysis program was used to evaluate the placental volume (PV), the placental quotient (PQ: placental volume/crown-rump length) and the vascular indices (vascularization index VI, flow index FI and vascularization-flow index VFI). The intraobserver and interobserver variability were respectively expressed as an intraclass correlation coefficient (Intra-CC) and interclass correlation coefficient (inter-CC). RESULTS: Intraobserver correlation for PV was excellent with an Intra-CC of 0.97 while an Inter-CC of 0.71 demonstrated less agreement between observers. In the same way, PQ showed better intraobserver than interobserver correlation, with an Intra-CC of 0.97 and an inter-CC of 0.67. The analyzed vascular indices had both excellent intraobserver and interobserver correlation coefficients, with values of 0.98 and 0.96 for VI, 0.93 and 0.89 for FI and 0.97 and 0.95 for VFI, respectively. CONCLUSION: Our study demonstrate an excellent intra and inter-observer reproducibility for vascular indices and a good reproducibility of the evaluated Doppler indices with intra-CC higher than 0.90. PV and PQ were also reproducible most of all within the same observer. As a conclusion, first trimester tridimensional sonography is a reproducible tool for the systematic study of placental vascularization.

[Sonographic ovarian vascularization and volume in women with polycystic ovary syndrome treated with clomiphene citrate and metformin]. / Vascularización y volumen ovárico ecográfico en mujeres con síndrome de ovario poliquístico tratadas con citrato de clomifeno y metformina.

OBJECTIVE: To measure the vascularization and ovarian volume with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome with stimulated ovulation treatment, and to analyse the differences between the patients treated with clomiphen citrate versus clomiphen citrate and metformin. MATERIAL AND METHOD: Therty patients were studied. Twenty ovulation cycles were obtained with clomiphen citrate and 17 with clomiphen citrate plus merformin (added in case of obesity or hyperglucemy/hyperinsulinemia). Ovarian volumes and vascular indexes were studied with 3D-sonography and results were analysed by treatment. RESULTS: There were no statistical differences of ovarian volume by treatment along the cycles, although bigger volume were found in ovulatory cycles compared to non-ovulatory ones (20,36 versus 13,89 ml, p = 0,026). No statistical differences were also found concerning vascular indexes, neither by treatment nor by the obtention of ovulation in the cycle. CONCLUSIONS: Ovarian volume and vascular indexes measured with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome do not show differents values in patients treated with clomiphen citrate alone versus clomiphen citrate plus metformin.

[Reproducibility of the fetal nasal bone measurement by means of bidimensional and three-dimensional ecography during the second trimester of the pregnancy]. / Reproducibilidad de la medición del hueso nasal fetal mediante ecografía bidimensional y tridimensional durante el segundo trimestre del embarazo.

AIMS: The utility of the valuation-measurement of the nasal bone in the prognosis of chromosomopaties during the second trimester of the pregnancy is demonstrated. OBJECTIVE: To evaluate the repeatability of nasal bone measurement during second trimester with bidimensional and three-dimensional sonography. MATERIAL AND METHOD: Nasal bone was measured in 50 single pregnancies. First observer carried out two measures of nasal bone with bidimensional sonography, and 1 measure with three-dimensional sonography. Second observer carried out just one measure with bidimensional sonography (2D) and just another one with three-dimensional sonography (3D). We studied the intraobserver variability with 2D sonography, and the interobserver variability with 2D and 3D sonography. RESULTS: 2D-sonography: nasal bone measurement showed excellent intraobserver correlation with a correlation coefficient of 0,87 (CI 95%: 0,78-0,93) and a little means difference of 0,18 (SD: 0,74). Indeed, there was a good interobserver correlation with a correlation coefficient of 0,92 (CI 95%: 0,85-0,95), and a means difference of 0,14 (SD: 0,56). 3D-sonography: there was a acceptable interobserver correlation with correlation coefficient of 0,70 (CI 95%: 0,52-0,82). CONCLUSION: Nasal bone measurement is highly reproducible by means of bidimensional sonography while using three-dimensional sonography, the results are just acceptable.