Recomendaciones prácticas sobre ejercicio físico durante el embarazo basadas en las principales guías de práctica clínica / Practical recommendations on physical exercise during pregnancy based on the main clinical practice guidelines

Las principales guías de actividad física/ejercicio durante el embarazo recomiendan que todas las mujeres embarazadas sin contraindicaciones médicas u obstétricas se mantengan activas físicamente durante la gestación, con el objetivo de conseguir beneficios para su salud y, al mismo tiempo, reducir la posibilidad de complicaciones durante el embarazo. El objetivo de este artículo fue extraer las recomendaciones prácticas sobre ejercicio físico durante el embarazo, de interés para el médico de atención primaria (AP), de las guías de práctica clínica de tres sociedades internacionales de obstetricia y ginecología de reconocido prestigio y gran influencia internacional en este tema, dos de ellas pioneras en la elaboración de este tipo de recomendaciones: el Colegio Americano de Obstetricia y Ginecología y la Sociedad Canadiense de Obstetricia y Ginecología; y el Real Colegio de Obstetras y Ginecólogos de Australia y Nueva Zelanda, junto con la publicada por la Sociedad Española de Ginecología y Obstetricia.(AU)

The main guidelines for physical activity/exercise during pregnancy recommend that all pregnant women without medical or obstetric contraindications remain physically active during pregnancy, in order to achieve health benefits and, at the same time, reduce the possibility of complications during pregnancy. The objective of this article was to extract the practical recommendations on physical exercise during pregnancy, of interest to the primary care physician, from the clinical practice guidelines of three international societies of Obstetrics and Gynecology of recognized prestige and great international influence on this subject, two of them pioneers in the elaboration of this type of recommendations: the American College of Obstetrics and Gynecology and the Society of Obstetricians and Gynaecologists of Canada; and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, together with the one published by the Spanish Society of Gynecology and Obstetrics.(AU)

[Practical recommendations on physical exercise during pregnancy based on the main clinical practice guidelines]. / Recomendaciones prácticas sobre ejercicio físico durante el embarazo basadas en las principales guías de práctica clínica.

The main guidelines for physical activity/exercise during pregnancy recommend that all pregnant women without medical or obstetric contraindications remain physically active during pregnancy, in order to achieve health benefits and, at the same time, reduce the possibility of complications during pregnancy. The objective of this article was to extract the practical recommendations on physical exercise during pregnancy, of interest to the primary care physician, from the clinical practice guidelines of three international societies of Obstetrics and Gynecology of recognized prestige and great international influence on this subject, two of them pioneers in the elaboration of this type of recommendations: the American College of Obstetrics and Gynecology and the Society of Obstetricians and Gynaecologists of Canada; and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, together with the one published by the Spanish Society of Gynecology and Obstetrics.

Walking Promotion in Pregnancy and Its Effects on Insomnia: Results of Walking_Preg Project (WPP) Clinical Trial.

Introduction: Insomnia is a frequent condition during pregnancy. The aim of this study was to assess if a walking promotion program from the 12th Gestational Week (GW) of pregnancy helps to prevent insomnia and improve the quality of sleep at third trimester. Materials and Methods: A prospective, randomized, and controlled trial was conducted with 270 pregnant women divided into 3 groups in parallel: maximum intervention group, I1 (pedometer and goal of 10,000 steps/day), minimum intervention group, I2 (pedometer without a goal), and control group (no intervention). All groups received recommendations about physical activity in pregnancy. A structured interview was performed at 13th, 20th, and 32nd GW, collecting pedometer mean steps/day, Athens Insomnia Scale (AIS), and Pittsburgh questionnaire (PSQI). Lineal regression models were conducted to determine the association between mean steps/day at 31st GW and AIS or PSQI score. Results: At 19th GW, groups I1 and I2 reached a mean of 6267 steps/day (SD = 3854) and 5835 steps/day (SD = 2741), respectively (p > 0.05). At 31st GW mean steps/day was lower for I2 (p < 0.001). Insomnia and poor sleep quality prevalence increased through pregnancy, but no differences between groups, within trimesters, were found (p > 0.05). Lineal regression showed no association between the average steps/day at third trimester of pregnancy and AIS and PSQI scores. Conclusions: Our walking promotion program based on pedometers did not help to prevent insomnia in the third trimester of pregnancy.

Reporting of Perinatal Outcomes in Probiotic Randomized Controlled Trials. A Systematic Review and Meta-Analysis.

The use of probiotic microorganisms in clinical practice has increased in recent years and a significant number of pregnant women are regular consumers of these products. However, probiotics might modulate the immune system, and whether or not this modulation is beneficial for perinatal outcomes is unclear. We performed a systematic review and meta-analysis to evaluate the reporting of perinatal outcomes in randomized controlled trials including women supplemented with probiotic microorganisms during pregnancy. We also analyzed the effects that the administration of probiotic microorganisms exerts on perinatal outcomes. In the review, 46 papers were included and 25 were meta-analyzed. Reporting of perinatal outcomes was highly inconsistent across the studies. Only birth weight, cesarean section, and weeks of gestation were reported in more than 50% of the studies. Random effects meta-analysis results showed that the administration of probiotic microorganisms during pregnancy did not have any a positive or negative impact on the perinatal outcomes evaluated. Subgroup analysis results at the strain level were not significantly different from main analysis results. The administration of probiotic microorganisms does not appear to influence perinatal outcomes. Nonetheless, future probiotic studies conducted in pregnant women should report probiotic strains and perinatal outcomes in order to shed light upon probiotics' effects on pregnancy outcomes.

Seroprevalence and epidemiology of hepatitis B and C viruses in pregnant women in Spain. Risk factors for vertical transmission.

BACKGROUND & AIM: Worldwide, measures are being implemented to eradicate hepatitis B (HBV) and C (HCV) viruses, which can be transmitted from the mother during childbirth. This study aims to determine the prevalence of HBV and HCV in pregnant women in Spain, focusing on country of origin, epidemiological factors and risk of vertical transmission (VT). METHODOLOGY: Multicentre open-cohort study performed during 2015. HBV prevalence was determined in 21870 pregnant women and HCV prevalence in 7659 pregnant women. Epidemiological and risk factors for VT were analysed in positive women and differences between HBV and HCV cases were studied. RESULTS: HBV prevalence was 0.42% (91/21870) and HCV prevalence was 0.26% (20/7659). Of the women with HBV, 65.7% (44/67) were migrants. The HBV transmission route to the mother was unknown in 40.3% of cases (27/67) and VT in 31.3% (21/67). Among risk factors for VT, 67.7% (42/62) of the women had viraemia and 14.5% (9/62) tested HBeAg-positive. All of the neonates born to HBV-positive mothers received immunoprophylaxis, and none contracted infection by VT. In 80% (16/20) of the women with HCV, the transmission route was parenteral, and nine were intravenous drug users. Viraemia was present in 40% (8/20) of the women and 10% (2/20) were HIV-coinfected. No children were infected. Women with HCV were less likely than women with HBV to breastfeed their child (65% vs. 86%). CONCLUSIONS: The prevalences obtained in our study of pregnant women are lower than those previously documented for the general population. Among the women with HBV, the majority were migrants and had a maternal family history of infection, while among those with HCV, the most common factor was intravenous drug use. Despite the risk factors observed for VT, none of the children were infected. Proper immunoprophylaxis is essential to prevent VT in children born to HBV-positive women.

Psychological distress and resilience of mothers and fathers with respect to the neurobehavioral performance of small-for-gestational-age newborns.

BACKGROUND: The existence of psychological distress (PD) during pregnancy is well established. Nevertheless, few studies have analyzed the PD and resilience of mothers and fathers during high-risk pregnancy. This study analyzes the differences between parents' PD and resilience and the relation between them and the neurobehavioral performance of their SGA newborns. METHODS: This prospective study compares two groups of parents and newborns: case group (52 parents and 26 SGA fetuses) and comparison group (68 parents and 34 appropriate-for-gestational-age, AGA, fetuses). In each group, the parents were evaluated during the last trimester of pregnancy, to obtain standardized measures of depression, stress, anxiety, and resilience. At 40 ± 1 weeks corrected gestational age, psychologists evaluated the state of neonatal neuromaturity achieved. RESULTS: Multivariate analysis of variance showed, in gender comparisons, that mothers obtained higher scores than fathers for psychological distress but lower ones for resilience. Similar differences were obtained in the comparison of parents' distress to intrauterine growth by SGA vs. AGA newborns. Mothers of SGA newborns were more distressed than the other groups. However, there were no differences between the fathers of SGA vs. AGA newborns. Regarding neurobehavioral performance, the profiles of SGA newborns reflected a lower degree of maturity than those of AGA newborns. Hierarchical regression analyses showed that high stress and low resilience among mothers partially predict low neurobehavioral performance in SGA newborns. CONCLUSIONS: These findings indicate that mothers of SGA newborns may need psychological support to relieve stress and improve their resilience. Furthermore, attention should be paid to the neurobehavioral performance of their babies in case early attention is needed.

Cistitis intersticial y embarazo / Interstitial cystitis and pregnancy

La etiopatogenia multifactorial de la cistitis intersticial hace que las modificaciones que se producen durante el embarazo puedan desenmascarar un cuadro de cistitis intersticial o producir el agravamiento del mismo (AU)

The multifactorial etiopathogenesis of interstitial cystitis causes changes that occur during pregnancy to unmask an interstitial cystitis or to worsen it (AU)

Perinatal outcomes with isolated oligohydramnios at term pregnancy.

AIMS: To compare the outcomes of term gestations with oligohydramnios in the absence of other underlying disorders and term gestations with normal amniotic fluid. METHODS: A retrospective analysis of obstetric outcomes in 27,708 term pregnancies. We compared three groups: labor induced because of oligohydramnios, spontaneous onset of labor with normal amniotic fluid, and labor induced because of late term pregnancy with normal amniotic fluid. We excluded pregnancies with maternal or fetal diseases or disorders potentially related with amniotic fluid alterations. The main outcome measures were mode of delivery, neonatal birth weight, umbilical artery blood pH, Apgar scores and neonatal discharge status. RESULTS: Compared to spontaneous labor, induction of labor because of oligohydramnios was associated with a higher risk of cesarean delivery and small size of the fetus for gestational age (SGA). Compared to induction because of late term pregnancy there were no significant differences in neonatal, although neonates had a higher risk of being SGA. CONCLUSION: The only perinatal outcome for which the risk was higher in term pregnancies with isolated oligohydramnios was SGA. The systematic induction of labor in these pregnancies should be questioned.

Perinatal outcomes in singleton pregnancies with a single umbilical artery.

OBJECTIVE: To analyze perinatal outcomes in singleton pregnancies with a single umbilical artery (SUA) as an isolated finding with no other underlying disorders. METHODS: This retrospective observational study compared a group of pregnancies with SUA (n = 127) and a group with a normal 3-vessel umbilical cord (n = 27 752). The study variables comprised maternal and obstetric characteristics and perinatal outcomes. RESULTS: The frequency of SUA was 0.45%. Pregnancies with SUA ended more frequently with cesarean delivery, and had a higher risk that the indication for cesarean delivery was non-reassuring fetal heart rate (NRFHR). Neonates in the SUA group had a lower weight for gestational age, and a higher risk of low umbilical cord blood pH. CONCLUSION: Obstetricians should monitor fetal growth closely in pregnancies with SUA, and be alert to NRFHR during labor and delivery.

Cribado de cromosomopatías fetales en España. Cambios hospitalarios en el periodo 2006–2011 / Screening of chromosomal abnormalities in Spain. Hospital changes in the period 2006–2011

Introducción: Hasta 2006, en España no existe una política uniforme para el cribado y diagnóstico prenatal de anomalías cromosómicas. La SEGO (Sociedad Española de Ginecología y Obstetricia) recomienda descartar la edad materna avanzada comoúnica indicación para realizar prueba invasiva y propone el test combinado del primer trimestre. Objetivo: Conocer el grado de implantación de las recomendaciones SEGO y los cambios en la práctica hospitalaria del cribado en España. Material y métodos: Encuesta a hospitales a la que respondieron 54 centros en 2007, que atendieron a 149.320 gestantes y 53 centros en 2011, que atendieron a 147.195 embarazadas. Los resultados se compararon mediante el test de McNemar. Resultados: En total, 26 centros hacían pruebas invasivas por edad materna avanzada en 2007 y 11 en 2011 (p = 0,01); 31 tenían disponible BVC en 2007 y 33 en 2011(p = 0,005); 42 tenían implantado el cribado del primer trimestre en 2007 y 50 en 2011 (p = ns); en 30 el único marcador era TN en 2007 y 36 en 2011 (p = ns); 26 desconocían el tipo de analizador empleado en 2007 y 17 en 2011 (p < 0,01); y en 34 el laboratorio calculaba el índice de riesgo en 2007 y en 36 en 2011 (p = ns). Conclusiones: El cribado combinado del primer trimestre está ampliamente extendido en los hospitales españoles, y la tendencia es a no considerar la edad materna como indicación para prueba invasiva, disponer de BVC, realizar prueba combinada, solo con TN como marcador ecográfico, desconocer el analizador utilizado y que el laboratorio calcule el índice de riesgo(AU)

Introduction: There was no uniform policy for prenatal screening and diagnosis of chromosomal abnormalities in Spain until 2006. The Spanish Society of Obstetrics and Gynaecology (SEGO) recommends rejecting advanced maternal age as the only indication for invasive procedure, and proposes the first trimester combined test. Objective: To determine the level of implementation of the SEGO recommendations and the changes in hospital screening practice in Spain. Methods: A total of 54 Hospitals, that had attended to 149,320 pregnant women, and 53 hospitals with147,195 pregnancies, responded to an e-mail survey, in the year 2007 and 2011, respectively. The McNemar test was used to compare the results. Results: A total 26 hospital centres performed invasive procedures for advanced maternal age only in 2007, and 11 in 2011 (P = .01); 31 had chorionic villus sampling (CVS) available in 2007, and 33 in 2011 (P=.005); in 42 implemented first trimester combined screening in 2007, and 50 in 2011 (p = ns); in 30 hospitals the only ultrasound marker was Nuchal translucency in 2007, and in 36 in 2011 (p = ns); 26 did not know the type of analyser used for determining biochemical markers in 2007, and 17 in 2011 (P<.01); and 34 the laboratory performed risk calculation in 2007 and 36 in 2011 (p = ns). Conclusion: First trimester combined screening test is widely available across Spanish hospitals, and most centres, do not consider advanced maternal age as the only indication for the invasive procedure, have CVS available, perform combined first trimester test only with nuchal translucency as an ultrasound marker, do not know the analyser used for measure biochemical markers, and that the laboratory provide risk calculations(AU)

Parto operatorio fallido / Failed operative vaginal delivery

La tasa de parto vaginal instrumental está disminuyendo en todos los países desarrollados a costa de un aumento generalizado de la tasa de cesáreas. El parto operatorio vaginal fallido es una situación indeseada por los obstetras, que puede conllevar en algunas ocasiones un aumento de la morbilidad materno-fetal y en casos extremos un aumento de la mortalidad fetal. Estos riesgos pueden minimizarse o evitarse mediante una evaluación individualizada de cada gestante, feto y situación clínica, aplicando los protocolos recomendados por las sociedades científicas para la realización de un parto instrumental y abandonando la vía vaginal en el momento adecuado, sin prolongar el número de intentos o sin aumentar la intensidad de la tracción realizada. La experiencia en parto operatorio vaginal es imprescindible, debiéndose abandonar dicho procedimiento ante la inseguridad del obstetra (AU)

Globally, the rate of instrumental vaginal delivery is declining in all developed countries at the expense of a general increase in the rate of cesarean sections. Failed operative vaginal delivery is an undesirable situation for all obstetricians and can sometimes lead to increased maternal and fetal morbidity and, in extreme cases, to fetal mortality. These risks can be minimized or avoided through individualized assessment of each patient, fetus, and clinical situation by using the protocols recommended by scientific societies to perform instrumental delivery and abandoning the vaginal route at the appropriate moment without extending the number of attempts or increasing the intensity of the traction performed. Experience of vaginal surgery is essential, and the procedure should be abandoned whenever the obstetrician feels uncertain (AU)

Tratamiento conservador del cáncer de endometrio en una pareja estéril / Conservative treatment of endometrial cancer in an infertile couple

El tratamiento conservador del cáncer deendometrio (estadio I) es una opción terapéuticapara aquellas mujeres jóvenes que aún no hancumplido sus deseos genésicos. Aunque los datospublicados sobre los resultados de las técnicas dereproducción asistida (TRA) tras el manejoconservador del cáncer de endometrio son escasos,el pronóstico no parece empeorar con el uso deestas. A continuación, se describe el caso de unapaciente de 29 años, con esterilidad primaria,diagnosticada de cáncer de endometrio en estadioIA, tratada con altas dosis de progesterona oral, ytras el cual quedó embarazada mediante TRA (AU)

Successful conservative management for early-stagelow-grade endometrial cancer in young womenwishing to preserve fertility has been reported insmall series. Although few data are available on assisted reproductive technology (ART) outcomesafter conservative management of endometrialcarcinoma, ART does not seem to worsenprognosis. We report the case of a 29-year-oldwoman with a history of primary infertility, whowas diagnosed with a well-differentiatedendometrial adenocarcinoma (stage Ia), which wastreated with high doses of oral progesterone. Asuccessful pregnancy was achieved after ART (AU)

Síndrome metabólico en ginecología / Metabolic syndrome in gynecology

El síndrome metabólico (SM) se define por una constelación de múltiples factores de riesgo de enfermedad cardiovascular (ECV), entre los que se incluye la obesidad abdominal, la dislipemia aterogénica, la hipertensión y el aumento de la glucosa en ayunas. Este síndrome se considera como un importante problema de salud pública, ya que está asociado a un incremento de 5 veces en la prevalencia de diabetes tipo 2 y de 2-3 veces en la de ECV. La resistencia a la insulina, o disminución de la sensibilidad a la insulina en la captación y el metabolismo de la glucosa en los tejidos periféricos, tiene una gran importancia en el desarrollo del SM. En el campo de la ginecología y la obstetricia, hay varias entidades clínicas en las que puede existir resistencia a la insulina con hiperinsulinemia compensatoria y, por consiguiente, ser más frecuente la presencia del SM: síndrome de ovarios poliquísticos, hiperandrogenismo, posmenopausia, disfunción sexual femenina, riesgo de recurrencia de cáncer de mama, hiperglucemia gestacional e hipertensión inducida por el embarazo. En este trabajo, se revisa la implicación del SM en estos frecuentes cuadros de nuestra especialidad (AU)

Metabolic syndrome is defined by the constellation of multiple cardiovascular risk factors that include abdominal obesity, atherogenic dyslipidemia, hypertension and increased fasting glucose levels. This syndrome is an important public health problem, since it is associated with a 5-fold increase in the prevalence of diabetes type 2 and a 2-3-fold increase in that of cardiovascular disease. Insulin-resistance, or reduced insulin sensitivity in the uptake and metabolism of glucose in peripheral tissues, plays a major role in the development of metabolic syndrome. In obstetrics and gynecology, insulin resistance with compensatory hyperinsulinism can occur in several entities, in which the presence of metabolic syndrome is therefore more frequent. These entities include polycystic ovary syndrome, hyperandrogenism, postmenopausal status, female sexual dysfunction, risk of recurrence of breast cancer, gestational hyperglycemia and pregnancy-induced hypertension. In this review, the involvement of metabolic syndrome in these frequent gynecological and obstetric conditions is discussed (AU)