Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis on sexuality and inflammatory bowel disease. / Documento de posicionamiento. Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa sobre sexualidad y enfermedad inflamatoria intestinal.

It is widely acknowledged that inflammatory bowel disease (IBD) is associated with a high prevalence of sexual dysfunction (SD). However, there is a notable paucity of specific literature in this field. This lack of information impacts various aspects, including the understanding and comprehensive care of SD in the context of IBD. Furthermore, patients themselves express a lack of necessary attention in this area within the treatment of their disease, thus creating an unmet need in terms of their well-being. The aim of this position statement by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) is to provide a review on the most relevant aspects and potential areas of improvement in the detection, assessment, and management of SD in patients with IBD and to integrate the approach to sexual health into our clinical practice. Recommendations are established based on available scientific evidence and expert opinion. The development of these recommendations by GETECCU has been carried out through a collaborative multidisciplinary approach involving gastroenterologists, gynecologists, urologists, surgeons, nurses, psychologists, sexologists, and, of course, patients with IBD.

The Effect of Online Supervised Exercise throughout Pregnancy on the Prevention of Gestational Diabetes in Healthy Pregnant Women during COVID-19 Pandemic: A Randomized Clinical Trial.

(1) Background: to examine the effect of an online supervised exercise program during pregnancy on the prevention of GDM, and on maternal and childbirth outcomes. (2) Methods: we conducted a randomized clinical trial (NCT04563065) in 260 pregnant women without obstetric contraindications who were randomized into two study groups: intervention group (IG, N = 130) or control group (CG, N = 130). An online supervised exercise program was conducted from 8-10 to 38-39 weeks of pregnancy. (3) Results: no significant differences were found at baseline in maternal characteristics; nevertheless, certain outcomes showed a favorable trend towards the IG. A lower number and percentage of GDM cases were found in the IG compared to the CG (N = 5/4.9% vs. N = 17/16.8%, p = 0.006). Similarly, fewer cases of excessive maternal weight gain (N = 12/11.8% vs. N = 31/30.7%, p = 0.001) were found in the IG, and a lower percentage of instrumental deliveries (N = 8/11.3% vs. N = 13/15.1%) and c-sections (N = 7/9.9% vs. N = 20/23.3%, p = 0.046). (4) Conclusions: an online supervised exercise program can be a preventative tool for GDM in healthy pregnant women.

Exercise throughout Pregnancy Prevents Excessive Maternal Weight Gain during the COVID-19 Pandemic: A Randomized Clinical Trial.

The purpose of this study was to examine the effects of a virtual exercise program throughout pregnancy during the COVID-19 pandemic on maternal weight gain. A randomized clinical trial (NCT NCT04563065) was performed. In total, 300 pregnant individuals were assessed for eligibility, and a total of 157 were randomized, of which 79 were in the control group (CG), and 78 were in the intervention group (IG). Those in the intervention group participated in a virtual supervised exercise program throughout pregnancy, 3 days per week. Fewer pregnant participants exceeded the weight gain recommendations in the IG group than in the CG (n = 4/5.9% vs. n = 31/43.1%, p = 0.001). Weight gain during pregnancy was lower in the IG than in the CG (9.96 ± 3.27 kg vs. 12.48 ± 4.87 kg, p = 0.001). Analysis of subgroups based on pre-pregnancy body mass index, showed significant differences in excessive maternal weight gain between study groups in normal-weight (IG, n = 0/0% vs. CG, n = 10/25%, p = 0.001) and those with overweight (IG, n = 2/18% vs. CG, n = 12/60%, p = 0.025). A virtual supervised exercise program throughout pregnancy could be a clinical tool to manage maternal weight gain during the COVID-19 pandemic by controlling excessive gain.

Multiple-parameter screening and prevention of preeclampsia: evaluation of a protocol implemented at Hospital Universitario Puerta de Hierro / Cribado multiparamétrico y prevención de la preeclampsia. Evaluación del protocolo implantado en el Hospital Universitario Puerta de Hierro

Objective: To evaluate the implementation in our center of a preeclampsia risk screening protocol in a low-risk population combined with preventive treatment (aspirin, 100 mg/d) by evaluating the variation in the incidence of preeclampsia. To validate the analysis tool and its predictive strength. Material and methods: We studied 310 patients divided into 2 groups: 138 controls (TR) and 172 patients who had undergone screening and received preventive treatment (CI). We collected demographic data, gestational age at consultation, obstetric history, reproductive method, risk factors for preeclampsia (hypertension, diabetes, BMI, kidney disease, and coagulopathy), use of aspirin as preventive therapy, and data on the outcome of pregnancy (hypertension, proteinuria, diagnosis of preeclampsia, and complications). In the CI group, we also recorded the risk of preeclampsia. This was calculated retrospectively in the TR group. Results: The protocol had 80% sensitivity and 98.4% specificity. The incidence of preeclampsia was 3.62% in the TR group and 0.58% in the CI group (p=0.053), with an OR of 0.155 (0.017-1.34). Among patients with a high risk, 66.7% developed preeclampsia in the TR group and 9.1% in the CI group (p=0.027), with an OR of 0.05 (0.04-0.57) and a number needed to treat of 1.74. Conclusions: The high sensitivity and specificity of the analytical tool make it adequate for screening. The protocol reduces the incidence of preeclampsia in high-risk patients, even if that difference was not significant at the level of the study population

Objetivo: evaluar la implantación, en nuestro centro, de un protocolo de cribado del riesgo de preeclampsia en población de bajo riesgo obstétrico, combinado con tratamiento preventivo con 100 mg diarios de ácido-acetilsalicílico, mediante el análisis de la variación de la incidencia de preeclampsia. Validar la herramienta utilizada, analizando su capacidad predictiva. Material y métodos: se estudiaron 310 pacientes, distribuidas en dos grupos: 138 controles (TR) y 172 con cribado y tratamiento preventivo (CI). Se recogieron datos demográficos, edad gestacional en consulta, historia obstétrica, método reproductivo, factores de riesgo de preeclampsia (hipertensión, diabetes, IMC, nefropatía y coagulopatía), toma de ácido-acetilsalicílico de forma preventiva y datos del final de la gestación (hipertensión, proteinuria, diagnóstico de pree-clampsia y complicaciones). En el grupo CI se recogió el índice de riesgo, y en el grupo TR se calculó de forma retrospectiva. Resultados: la herramienta obtuvo una sensibilidad del 80% y una especificidad del 98,4%. La incidencia de preeclamp-sia resultó del 3,62% en el grupo TR frente al 0,58% en el grupo CI (p=0,053), con una OR de 0,155 [0,017-1,34]. Entre las pacientes con índice de alto riesgo, un 66,7% del grupo TR presentó preeclampsia, frente a un 9,1% del grupo CI (p=0,027), con OR 0,05 [0,04-0,57] y una NNT de 1,74. Conclusiones: la herramienta utilizada tiene elevada sensibilidad y especificidad, resultando útil como cribado. El protocolo implantado reduce la incidencia de preeclampsia en pacientes con índice de alto riesgo, aunque la variación a nivel poblacional no fue significativa

Detection of single umbilical artery in the first trimester ultrasound: its value as a marker of fetal malformation.

INTRODUCTION: The value of a single umbilical artery (SUA) in first trimester ultrasound is not well established. The aim of our study was to determinate the relevance of diagnosis of single umbilical artery in first trimester ultrasound as an early marker suggesting the presence of malformations or associated chromosomopathies. MATERIAL AND METHODS: Retrospective study of clinical cases of SUA diagnosed at the University Hospital Puerta de Hierro in Madrid (Spain) during the first trimester ultrasound between September 2008 and September 2012. RESULTS: Prevalence of SUA was 1.1% in single pregnancies and 3.3% in twin pregnancies. Sensitivity, specificity, false positive rate, and false negative rate for the finding in the first trimester were 84.2, 99.8, 0.2, and 15.7%, respectively. 17.6% of cases had associated malformations. With an ultrasound in the 16th week most of the cases with significant fetal malformation were diagnosed. DISCUSSION: SUA is a useful marker in the first trimester for fetal malformation pathology, as it will allow detecting a large number of cases with malformations before 20 weeks of gestation.

Neonatal neurological morbidity associated with uterine rupture.

AIMS: To compare neonatal neurological morbidity associated with uterine rupture with morbidity associated with a non-reassuring fetal status. METHODS: We conducted a retrospective cohort analysis. Twenty-one cases of term infants delivered after a symptomatic uterine rupture were analyzed and compared with a randomly selected group of 63 infants born after a non-reassuring fetal heart rate pattern. RESULTS: Prevalence of uterine rupture was 0.058%. Maternal factors and infant general data were similar in both groups. Infants delivered after a uterine rupture had lower Apgar scores at 1 and 5 min, lower umbilical blood pH, and required more advanced resuscitation than infants delivered after a non-reassuring fetal status. Prevalence of hypoxic-ischemic encephalopathy in the uterine rupture group was 33%, compared with 5% in the other group (P<0.01, relative risk 3.7). Four infants in the uterine rupture group (19%) had moderate or severe encephalopathy; all of them had also multisystem dysfunction and an adverse outcome. No infant in the non-reassuring fetal status group showed moderate or severe encephalopathy. CONCLUSIONS: Uterine rupture is a considerable sentinel event that involves a high rate of early and late neurological morbidity in the newborn infant.