Supresión de la visita de tercer trimestre en embarazo de bajo riesgo en la pandemia de SARS-CoV-2 / Third trimester suppression in low-risk pregnancy in the SARS-CoV-2 pandemic

Resumen Objetivo: La pandemia de SARS-CoV-2 ha obligado a una reorganización de las visitas presenciales, y por ese motivo se han minimizado hasta el punto de reconsiderar la realización de la visita del tercer trimestre. Nuestro centro suprimió dicha visita obstétrica y obtuvo datos propios para comparar los resultados perinatales logrados con dicho manejo. Método: Se realizó un estudio de cohortes retrospectivo, en marzo de 2020, con una cohorte con visita presencial única en la semana 40 de gestación (122 gestantes) frente a una cohorte con seguimiento convencional con visita presencial en la semana 36 de gestación (162 gestantes). Se evaluaron la restricción del crecimiento fetal, la edad gestacional al nacimiento, el peso neonatal y las tasas de inducciones, partos eutócicos y cesáreas urgentes en trabajo de parto. Resultados: Se encontraron diferencias leves en la tasa de nuliparidad (p < 0,04), sin hallarlas en el resto de las variables maternas. No hubo diferencias entre las dos cohortes en los resultados neonatales. Conclusiones: No hay diferencias entre los resultados materno-fetales obtenidos en gestantes con seguimiento gestacional con restricción de la visita del tercer trimestre respecto del seguimiento tradicional, excepto en el diagnóstico de las alteraciones de la estática fetal al término de la gestación.

Abstract Objective: The SARS-CoV-2 pandemic has forced a reorganization of face-to-face visits, for this reason they have been minimized to the point of reconsidering the completion of the third trimester visit. Our center eliminated the performance of this obstetric visit and obtained its own data to compare the perinatal results obtained with such management. Method: A retrospective cohort study was carried out in March 2020, with a cohort with a single face-to-face visit at 40th week of gestation (122 pregnant women), versus a cohort with conventional follow-up with face-to-face visit at 36th week of gestation (162 pregnant women). The following were evaluated fetal growth restriction, gestational age at birth, neonatal weight, rate of inductions, of eutocic deliveries, and of urgent cesarean sections in labor. Results: Slight differences were found in the nulliparity rate (p < 0.04), without finding them in the rest of the maternal variables. There were no differences between the two cohorts in neonatal outcomes. Conclusions: There were no differences between the maternal-fetal results obtained in pregnant women with gestational follow-up with restriction of the third trimester visit compared to traditional follow-up, except in the diagnosis of alterations in fetal statics at the end of pregnancy.

New approach to the evaluation of perineal measurements to predict the likelihood of the need for an episiotomy.

INTRODUCTION AND HYPOTHESIS: Episiotomy is performed selectively during vaginal delivery. Among the maternal anthropometric factors for episiotomy, the length of the perineal body (pb) and genital hiatus (gh) defined as per the POP-Q system have been studied. The objective of our study was to compare two perineal measurements (defined as per the POP-Q system and the anogenital distance [AGD] concept) to determine which of these can predict the likelihood of an episiotomy being performed. METHODS: An observational prospective cohort study was designed. Anthropometric data (pb, gh, symphysis-coccyx distance, distance between ischial tuberosities, AGDaf [anus-fourchette], and AGDac [anus-clitoris]), duration of the second stage of labor, and neonatal biometric data were collected from 119 women included in this study. Statistical analysis was performed using Student's t test for unpaired data, Mann-Whitney, and Chi-squared tests. Receiver operating characteristic (ROC) curves were generated to compare AGDaf, AGDac, and "gh + pb" with the presence of episiotomy. RESULTS: A shorter "gh + pb" length and AGDac were risk factors for episiotomy. Compared with AGDac, gh + pb was a slightly better predictor in ROC curve analysis. Furthermore, a longer duration of second-stage labor was evident in the episiotomy group. CONCLUSIONS: This study introduces measures of AGD as risk factors for episiotomy. We propose that "gh + pb" length <77 mm and AGDac <93 mm may predict the likelihood of requiring episiotomy and may be useful for diminishing subjectivity in the decision to perform an episiotomy.

Comparability between adult female anogenital distance and perineal measurements standardized by POP-Q system (GH and PB).

AIMS: Anogenital distance (AGD) has been proposed as a marker of the prenatal hormonal milieu and potential environmental insults. The measures of the Pelvic Organ Prolapse-Questionnaire (POP-Q) system is being widely used in the evaluation of the perineum in women with POP pathologies. Genital hiatus (GH) and perineal body (PB) lengths have been related to both prolapse incidence and recurrence and for pessary treatment failure. The use of AGD in female human studies is now emerging and its comparability with other anthropometric measurements could be relevant. The aim of the study was to compare AGD and POP-Q system in adult females. METHODS: The study included 155 pregnant women in the first stage of labor. Perineal measurements were performed on women in the lithotomy position: AGD from the anus to the clitoris (AGDAC ); AGD from the anus to the fourchette (AGDAF ); GH from the external urethral meatus to the posterior midline hymen, and length of the PB from the posterior midline hymen to the mid-anal opening. Coefficients of variations (CV) were calculated. Intraclass correlation coefficients (ICC) and Bland-Altman graphs were used to compare both set of measurements. RESULTS: CV were below 15% for AGDAC and GH + PB, though higher for AGDAF and PB (20% and 17%, respectively). ICCs for each pair of measurements were above 80%, (excellent agreement between methods). Concordance between measurements was confirmed by Bland-Altman graphs. CONCLUSIONS: Comparable measurements were obtained using AGDs and POP-Q system. Further studies are needed to explore clinical and epidemiological implications of these findings.