Placental levels of essential and non-essential trace element in relation to neonatal weight in Northwestern Spain: application of generalized additive models.

Adequate gestational progression depends to a great extent on placental development, which can modify maternal and neonatal outcomes. Any environmental toxicant, including metals, with the capacity to affect the placenta can alter the development of the pregnancy and its outcome. The objective of this study was to correlate the placenta levels of 14 essential and non-essential elements with neonatal weight. We examined relationships between placental concentrations of arsenic, cadmium, cobalt, copper, mercury, lithium, manganese, molybdenum, nickel, lead, rubidium, selenium, strontium, and zinc from 79 low obstetric risk pregnant women in Ourense (Northwestern Spain, 42°20'12.1″N 7°51.844'O) with neonatal weight. We tested associations between placental metal concentrations and neonatal weight by conducting multivariable linear regressions using generalized linear models (GLM) and generalized additive models (GAM). While placental Co (p = 0.03) and Sr (p = 0.048) concentrations were associated with higher neonatal weight, concentrations of Li (p = 0.027), Mo (p = 0.049), and Se (p = 0.02) in the placenta were associated with lower newborn weight. Our findings suggest that the concentration of some metals in the placenta may affect fetal growth.

Prediction of insulin therapy in women with gestational diabetes: a systematic review and meta-analysis of observational studies.

OBJECTIVES: To identify antenatal risk factors that may predict the need for insulin treatment upon diagnosis of gestational diabetes (GDM), that is, to identify the specific characteristics of women diagnosed with GDM who did not achieve good glycemic control through lifestyle modifications. METHODS: We performed a comprehensive literature search in PubMed, Science Direct, Ebsco, and Scielo for studies evaluating the associations between antenatal factors and the need for insulin treatment published until January 28th, 2021. Random-effects models were used to estimate risk ratios and their 95% confidence interval. The quality of studies was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to estimate outcomes, and effects reported as risk ratio and their 95% confidence interval. The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews. RESULTS: Eighteen observational studies were selected, reporting 14,951 women with GDM of whom 5,371 received insulin treatment. There were statistically significant associations between the need for insulin treatment and BMI ≥ 30 (RR:2.2; 95%CI: 1.44-3.41), family history of type 2 diabetes mellitus (RR:1.74; 95%CI: 1.56-1.93), prior personal history of GDM (RR:2.10; 95%CI: 1.56-2.82), glycated hemoglobin value at GDM diagnosis (RR:2.12; 95%CI: 1.77-2.54), and basal glycemia obtained in the diagnostic curve (RR: 1.2; 95%CI: 1.12-1.28). Nulliparity and maternal age were not determinants factor. There was moderate-to-high heterogeneity among the included studies. CONCLUSIONS: the strong causal association between BMI ≥ 30, family history of type 2 diabetes mellitus, prior history of GDM and glycosylated hemoglobin with the need for insulin treatment was revealed.

Determination of organic pollutants in meconium and its relationship with fetal growth. Case control study in Northwestern Spain.

OBJECTIVES: Antenatal exposure to organic pollutants is a leading public health problem. Meconium is a unique matrix to perform prenatal studies because it enables us to retrospectively evaluate fetal exposure accumulated during the second and third trimester. The aim of the present study was to evaluate associations between organic pollutant levels in meconium and birth weight in NW Spain. METHODS: In this study, we quantify the concentrations of 50 organic pollutants together with the total values of the most important chemical groups in meconium using gas chromatography coupled to tandem mass spectrometry. RESULTS: Organochlorine pesticides, polychlorinated biphenyls and polybrominated diphenyl ethers were detected with the highest levels in meconium from small for gestational age newborns. It was estimated that several congeners were statistically significant (p<0.05). However, organophosphorus pesticides attained higher concentrations in newborns with an appropriate weight. CONCLUSIONS: The occurrence of transplacental transfer can be confirmed. Prenatal exposure to organic pollutants was associated with a decrease in birth weight and, therefore, organic pollutants could have an impact on fetal growth. Nevertheless, these results need validation in larger sample sized studies.

Association between placenta concentrations polybrominated and polychlorinated biphenyls and gestational diabetes mellitus: a case-control study in northwestern Spain.

Exposure to persistent organic pollutants begins in uterine life. The study was conducted to evaluate associations between gestational diabetes mellitus and the presence of persistent organic pollutants in placenta samples. They were derived from a birth cohort study in Ourense (NW Spain). Selective pressurized liquid extraction methodologies were used to determine targeted persistent organic pollutants in placenta samples. Cleanup of extracts was performed by solid-phase extraction using EZ-POP cartridges and detection by gas chromatography coupled to tandem mass spectrometry. Statistical calculations were performed by comparing the values obtained in the case and control groups. Statistical significance was considered as p < 0.050. Results: The concentrations of several congeners of polybrominated diphenyl ethers (PBDE) and polychlorinated biphenyls (PCB) presented lower levels in the placentas of expectant mothers with gestational diabetes mellitus when comparing them to the control cohort. This difference was statistically significant. It was revealed that this association was independent of obesity, age, parity, amenorrhoea at birth, or a family history of diabetes mellitus. To the best of our knowledge, this paper reported an inverse relationship between PBDE and PCB levels in placenta and gestational diabetes mellitus for the first time. We believe this may open a door to future studies in this field.

Prenatal exposure to organic pollutants in northwestern Spain using non-invasive matrices (placenta and meconium).

Human exposure to environmental organic pollutants (OPs) begins in the uterine life period by trans-placental transfer. Epidemiological studies have consistently demonstrated the vulnerability of human fetuses and infants to the effects of OPs because of their rapid growth and organ development, cell differentiation, and immaturity of metabolism. The aim of the present study was to evaluate the prenatal exposure to OPs characterized by different physicochemical properties using non-invasive biological samples (meconium and placenta). A total of 88 placenta and 53 meconium samples were collected in Ourense, a city located in northwestern Spain, at the delivery and after birth from mothers and their infants from the University Hospital of Ourense, respectively. Selective pressurized liquid extraction (SPLE) methodologies were used to determine the targeted OPs in the selected biological samples. Cleanup of extracts was performed by solid-phase extraction (SPE) using EZ-POP cartridges and detection by gas chromatography (GC) coupled to tandem mass spectrometry (QqQ-MS/MS). The targeted OPs were detected with the following mean level total concentration order polycyclic aromatic hydrocarbons (PAHs) > organophosphorus pesticides (OPPs) > non-dioxin like polychlorinated biphenyls (NDLPCBs) > pyrethroids (PYRs) > polybrominated diphenyl ethers (PBDEs) > dioxin like polychlorinated biphenyls (DLPCBs) > organochlorine pesticides (OCPs) for placenta and ΣNDLPCBs > ΣPAHs > ΣOCPs > ΣPYRs > ΣOPPs > ΣDLPCBs > ΣPBDEs for meconium, respectively. Significant correlations (p < .050) between the socio-demographic characteristics of the selected population (mother's parity, age, weight increase during pregnancy, place of living and smoking habits) and log transformed concentration of some of the targeted OPs (OCPs, PBDEs, PYRs, OPPs and PAHs) were detected. The results obtained shown the complementary information given by both biological samples selected. Nevertheless, additional research will be needed to gain an understanding of the trans-placental transfer of OPs, to choose the best biological matrix to evaluate the prenatal exposure to OPs in a correct way and to know their health implications.

Desenlaces maternos y neonatales relacionados con edad materna avanzada / Maternal and neonatal outcomes in advanced maternal age

Resumen OBJETIVO: Describir los desenlaces maternos y perinatales en embarazadas de edad avanzada. MATERIALES Y MÉTODOS: Estudio de dos cohortes, prospectivo y retrospectivo efectuado con base en la información de expedientes clínicos de pacientes atendidas en el Complexo Hospitalario Universitario de Ourense entre 2017 y 2018. Se establecieron dos cohortes: la cohorte A con edad mayor o igual a 40 años y la cohorte B con edad menor de 40 años. Se realizaron pruebas paramétricas y no paramétricas para determinar la asociación potencial entre las variables de estudio (χ2, t de Student, U de Mann-Whitney). RESULTADOS: Las pacientes de la cohorte A (n = 207) tuvieron significación estadística: índice de masa corporal mayor al inicio del embarazo (p = 0.028), mayor cantidad de embarazos previos (p = 0.001), a expensas de mayor cantidad de abortos (p < 0.001), estados hipertensivos del embarazo (p = 0.03), prematurez (p = 0.009), retraso en el crecimiento intrauterino (p = 0.006), macrosomía fetal (p = 0.04), inducciones (p < 0.001), cesáreas programadas o intraparto y hemorragia posparto (p = 0.001). No se encontraron diferencias en la paridad, amenorrea al parto, diabetes pregestacional-gestacional, peso fetal medio, Apgar, pH de la arteria umbilical y cantidad de recién nacidos con requerimiento de ingreso a la unidad de Neonatología. CONCLUSIONES: La edad materna avanzada es un factor de riesgo importante de morbilidad materna y perinatal. La mayor tasa de complicaciones descritas refleja la importancia del control exhaustivo del embarazo y vigilancia periparto minuciosa.

Abstract OBJECTIVE: To describe the maternal and perinatal results in pregnant women with advanced age. MATERIALS AND METHODS: A cohort study was conducted with prospective follow-up and retrospective data collection of the Clinical History of the University Hospital Complex of Ourense between 2017 and 2018. Two cohorts were established, cohort A with age greater than and equal to 40 years and the cohort B with age under 40 years. Parametric and non-parametric tests were performed to determine the potential association between the study variables (Chi-Square, Student's T, Mann-Whitney U). RESULTS: The cohort A patients (n = 207) presented with statistical significance: body mass index higher at the beginning of pregnancy (p = 0.028), higher number of previous pregnancies (p = 0.001), but at the expense of a higher number of abortions (p <0.001), hypertensive states of pregnancy (p = 0.03), prematurity (p = 0.009), intrauterine growth retardation (p = 0.006), fetal macrosomia (p = 0.04), inductions (p < 0.001), of both scheduled and intrapartum caesarean sections and postpartum hemorrhage (p = 0.001). No differences were found in parity, amenorrhea at delivery, pregestational / gestational diabetes, mean fetal weight, Apgar score, umbilical artery pH and number of newborns who required admission to the Neonatal Unit. CONCLUSIONS: Advanced maternal age is an important risk factor for maternal and perinatal morbidity. The higher rate of complications described reflects the importance of thorough pregnancy control and careful peripartum surveillance.

Importancia de los márgenes quirúrgicos afectados en la conización uterina cervical / Importance of surgical margins affected in cervical uterine conization

Resumen: OBJETIVO: Determinar la asociación entre los márgenes afectados con la persistencia-recurrencia de neoplasia intraepitelial cervical, persistencia del virus del papiloma humano y las reintervenciones. MATERIALES Y MÉTODOS: Estudio de casos y controles anidado en una cohorte retrospectiva del Complexo Hospitalario Universitario de Ourense (enero 2010-octubre 2017). Criterio de inclusión: mujeres con al menos una revisión postintervención. Criterios de exclusión: mujeres sin evidencia de displasia de alto grado en la pieza de conización y a las que no se dio seguimiento. Variables de estudio: edad, tabaquismo, preservativo, anticonceptivos orales, vacunación contra VPH, persistencia-recurrencia de NIC y de VPH y reintervención. Se realizaron pruebas paramétricas y no paramétricas entre las variables. RESULTADOS: La cohorte se integró con 248 mujeres, de éstas 81 (32.6%) tuvieron afectación de los márgenes quirúrgicos en la conización. La inmunosupresión, el tabaquismo y la anticoncepción oral fueron las asociaciones más frecuentes en los márgenes afectados. El uso de preservativo y la vacunación contra VPH fueron significativamente más frecuentes en los márgenes libres. Los márgenes afectados reportaron mayor persistencia de VPH (50 vs 23.9%; OR 3.17 (1.90-5.26), p < 0.001), enfermedad persistente-recurrente (47.2 vs 22.5%; OR 3.07 (1.84-5.12), p < 0.001) y reintervenciones (40.2 vs 15.4%; OR 3.679 (2.094-6.463), p < 0.028). El margen más afectado fue, en orden descendente, endocervical (55.6%), exocervical (25%) y ambos (19.4%). CONCLUSIONES: El margen afectado confiere un riesgo importante en la evolución de la infección por VPH y la recurrencia de la enfermedad.

Abstract: OBJECTIVE: To determine the association between affected margins with persistence-recurrence of cervical intraepithelial neoplasia, persistence of human papillomavirus and re-interventions. MATERIALS AND METHODS: Study of cases and controls nested in a retrospective cohort of the Complexo Hospitalario Universitario de Ourense (January 2010-October 2017). Inclusion criteria: women with at least one post-intervention check-up. Exclusion criteria: women without evidence of high-grade dysplasia in the conization piece and who were not followed up. Study variables: age, smoking, condom, oral contraceptives, HPV vaccination, persistence-recurrence of CIN and HPV, and re-operation. Parametric and non-parametric tests were performed among the variables. RESULTS: The cohort consisted of 248 women, 81 of whom (32.6%) had affected surgical margins on conization. Immunosuppression, smoking and oral contraception were the most frequent associations in affected margins. Condom use and HPV vaccination were significantly more frequent in free margins. Affected margins reported greater persistence of HPV (50 vs 23.9%; OR 3.17 (1.90-5.26), p < 0.001), persistent-recurrent disease (47.2 vs 22.5%; OR 3.07 (1.84-5.12), p < 0.001), and reinterventions (40.2 vs 15.4%; OR 3.679 (2.094-6.463), p < 0.028). The most affected margin was, in descending order, endocervical (55.6%), exocervical (25%) and both (19.4%). CONCLUSIONS: The affected margin confers a significant risk in the evolution of HPV infection and disease recurrence.

Gestational diabetes: maternal programming / Diabetes gestacional: programming materno

Background: Gestational diabetes has been identified as a long-term risk factor for the development of type 2 diabetes mellitus, chronic hypertension, metabolic syndrome, and cardiovascular disease. Objectives: Based on the current scientific evidence, our objective was to increase our knowledge of the importance of gestational diabetes in women's future health. Material and methods: Retrospective study by searching for original articles and systematic reviews published in the databases PubMed, EMBASE, ScienceDirect, and Cochrane Library between 1999 and 2018. The key words used for the search were as follows: "Gestational diabetes mellitus and long-term consequences", "previous gestational diabetes mellitus", "gestational diabetes after delivery", "postpartum followup of women with gestational diabetes", "history of gestational diabetes mellitus", "after gestational diabetes mellitus", and "gestational diabetes and postpartum risk". The highest levels of evidence were selected. Results: We found 472 articles on gestational diabetes and its long-term effects on the mother. The articles were reviewed, and those with the lowest level of scientific evidence and all duplicate references were ruled out. Conclusions: There is sufficient clinical evidence linking gestational diabetes with subsequent development of type 2 diabetes mellitus, chronic hypertension, metabolic syndrome, and cardiovascular disease. It is still not possible to determine from gestation which patients are most likely to have long-term complications. There is sufficient evidence that diabetes mellitus can be prevented. This is not the case for cardiovascular disease

Introducción: La diabetes gestacional se ha identificado como factor de riesgo a largo plazo para el desarrollo de diabetes mellitus tipo 2, hipertensión arterial crónica, síndrome metabólico y enfermedad cardiovascular. Objetivos: En base a la evidencia científica actual profundizar en el conocimiento de la transcendencia para la salud futura de la mujer que ha padecido una diabetes gestacional. Material y métodos: Estudio retrospectivo mediante la búsqueda de artículos originales y revisiones sistemáticas publicados en las bases de datos: PubMed, EMBASE, ScienceDirect y Biblioteca Cochrane entre los años 1999 y 2018. Se incluyeron, en los diferentes motores de búsqueda, las siguientes asociaciones de palabras clave: "Gestational diabetes mellitus and long-term consequences", "previous gestational diabetes mellitus", "Gestational diabetes after delivery" "postpartum followup of women with gestational diabetes", "History of gestational diabetes mellitus", "after gestatio-nal diabetes mellitus", "gestational diabetes and postpartum risk". Se seleccionaron los de mayor nivel de evidencia. Resultados: Se encontraron 472 artículos que relacionan la diabetes gestacional y sus efectos maternos a largo plazo, se procedió a su revisión y se descartaron los de menor nivel de evidencia científica y todas aquellas referencias duplicadas. Conclusiones: Existe suficiente evidencia clínica que relaciona la Diabetes gestacional con el desarrollo posterior de diabetes mellitus tipo 2, hipertensión arterial crónica, síndrome metabólico y enfermedad cardiovascular. Todavía no es posible determinar desde la gestación cuales son las pacientes con mayor probabilidad de complicaciones a largo plazo. Existe suficiente evidencia que la diabetes mellitus se puede prevenir, no así de las enfermedades cardiovasculares

Morbilidad y mortalidad a largo plazo en mujeres con antecedente de desprendimiento prematuro de placenta normoinserta / Long-term morbidity and mortality in women with a history of premature placental abruption normoinserta

Resumen OBJETIVOS: Analizar las consecuencias a largo plazo del desprendimiento prematuro de placenta normoinserta, principalmente la incidencia de enfermedad cardiovascular y secundariamente otras causas de morbilidad y mortalidad (diabetes, neoplasias o trastornos psiquiátricos). MATERIALES Y MÉTODOS: Estudio de casos y controles, con recolección retrospectiva de datos de pacientes embarazadas que acudieron al Complexo Hospitalario Universitario de Ourense entre 1996 y 2008. El criterio de inclusión en el grupo casos fue el antecedente de desprendimiento prematuro de placenta normoinserta. El grupo control lo integraron pacientes con parto anterior y posterior al grupo de casos y que no habían sufrido desprendimiento de placenta. Las historias clínicas se analizaron mediante la recolección de datos de la "gestación índice" y se realizó el seguimiento a largo plazo para establecer el diagnóstico de hipertensión arterial, diabetes mellitus, enfermedad cardiovascular, neoplasias o alteraciones psiquiátricas. Para el análisis estadístico se requirió el programa SPSS15.0. Se consideró estadísticamente significativo el valor de p < 0.05. RESULTADOS: Se estudiaron 198 mujeres: 66 en el grupo de casos y 132 en el grupo control. Durante el seguimiento (15.8 ± 3.58 años), la incidencia de diabetes mellitus y dislipidemia fue mayor en el grupo de casos, pero sin significación estadística. No se encontraron diferencias en la incidencia de hipertensión arterial, síndrome metabólico, enfermedad cardiovascular ni trastorno ansioso-depresivo. En el grupo de casos se encontró una alta tasa de enfermedad neoplásica. CONCLUSIONES: No existe relación entre desprendimiento prematuro de placenta y enfermedad cardiovascular. Se carece de una explicación que justifique la alta tasa de patología tumoral en este grupo de pacientes.

Abstract OBJECTIVE: To analyze if women with a history of premature placental abruption have a long-term increase in morbidity and mortality. MATERIALS AND METHODS: Case-control study with retrospective data collection of pregnant women from the Hospital University Complex of Ourense between 1996 and 2008. The criteria for inclusion in the case group were the history of placental abruption. The control group was constituted by the women with previous and subsequent delivery to the case group and who had not presented placental abruption. The clinical histories were analyzed with data collection of the index pregnancy and a long-term follow-up was carried out to detect the subsequent diagnosis of arterial hypertension, diabetes mellitus, cardiovascular disease, as well as neoplastic and psychiatric pathology. The statistical study was carried out using the SPSS15.0 computer program. Values of p < 0,05 were considered significant results. RESULTS: A total of 198 women were studied, of which 66 belong to the case group and 132 to the control group. In the follow-up period (15,8±3,58 years) the incidence of diabetes mellitus and dyslipidemia was higher in the case group, but without statistical significance. No differences were found in the incidence of hypertension, metabolic syndrome, cardiovascular disease or anxiety-depressive illness. In the case group, a high rate of oncological pathology was found. CONCLUSIONS: We found no relationship between the history of placental abruption and cardiovascular disease. We lack an explanation that justifies the high rate of tumor pathology in this group of women.

Hemorragia posparto secundaria o tardía / Secondary postpartum haemorrhage

Introducción: la hemorragia posparto secundaria puede estar asociada a entidades poco conocidas, pero con capacidad para incrementar la morbimortalidad materna, por lo cual es necesario su conocimiento con el fin de instaurar las medidas terapéuticas oportunas. Objetivo: conocer la incidencia de la hemorragia posparto secundaria (HPS), los factores de riesgo, así como la prevalencia de las principales entidades implicadas en esta patología. Material y métodos: estudio descriptivo, observacional y retrospectivo, mediante el análisis poblacional de las pacientes hospitalizadas con el diagnóstico de HPS, en el Complexo Hospitalario Universitario de Ourense, en el periodo comprendido entre 2004 y el 31 de marzo de 2014. El criterio de selección se realizó de acuerdo con la definición de la OMS de la HPS: 'sangrado uterino excesivo que ocurre entre las 24 horas y las 12 semanas posteriores al parto'. Resultados: la incidencia de HPS fue del 0,29%. Esta enfermedad se asocia con mayor frecuencia al antecedente de parto vaginal en el actual episodio. La causa más prevalente de HPS fue la retención de restos placentarios, la cual representó el 75,51% del total de casos. El tratamiento realizado con mayor frecuencia fue el legrado evacuador (77,55%). Hasta en el 14% de los casos se asocia con anemia severa que requiere transfusión sanguínea. Conclusiones: la principal causa de la HPS es la retención de restos placentarios. Existen otras causas menos frecuentes y menos conocidas, pero con un alto potencial de generar morbimortalidad (AU)

Background: Secondary postpartum hemorrhage may be associated with little known entities but with ability to increase maternal mortality and morbidity by which its knowledge is necessary in order to establish appropriate therapeutic measures. Objective: To determine the incidence of secondary postpartum hemorrhage (HPS), risk factors, and the prevalence of the main entities involved in this pathology. Material and methods: Descriptive and retrospective study using the population analysis of patients hospitalized with the diagnosis of HPS in the University Hospital Complex of Ourense, in the period between 2004 and March 31, 2014. Inclusion criteria was the WHO’s definition for HPS: 'excessive uterine bleeding from 24 hours to 12 weeks after childbirth'. Results: The incidence of HPS was 0.29%. This entity is more strongly associated with previous vaginal deliveries in the current episode. The most prevalent cause of HPS was retained placental remnants, representing 75.51% of all cases. The treatment most frequently performed was evacuator curettage (77.55%). Severe anemia is observed in 14% of the women requiring blood transfusion. Conclusions: The principal cause of the HPS is placental retention. There are other less common and less well-known causes but with a high potential for morbidity and mortality (AU)

[Risk factors of evolution of postpartum hemorrhage towards severe postpartum hemorrhage: A case-control study]. / Factores de riesgo de la evolución de la hemorragia posparto a hemorragia posparto severa: estudio de casos y controles.

OBJECTIVE: To describe the incidence and risk factors for evolution of postpartum haemorrhage towards severe. MATERIAL AND METHODS: Epidemiologic, observational, analytical, case-control study was done from total data of deliveries in Complexo Hospitalario de Ourénse between January 1st 2004 and June 30th 2014. Mann-Whitney U test was used to determine the differences between cases and controls. The statistical analyses were made with the informatic programs Spss 15.0 y Epidat 3.0. We considered statistical significance for p < 0.05. RESULTS: The initial size of the sample was 17,116 deliveries from which we selected 150 patients with the diagnosis of postpartum haemorrhage. The incidence for HPSe form all deliveries was 3.3% reaching 36% of the total of postpartum haemorrhages. 79.63% of HPSe showed symptoms withing the first 24h postpartum, but we found that 20.37% debuted as secondary postpartum haemorrhages. BMI ≥ 35, hypertensive gestational manifestations, labor's second phase ≥ 120 minutes and weight at birth > 4000 g presented statistical significance as risk factor for evolution to severe postpartum haemhorrage. The relative risk for evolution towards HPSe was 2.81 for instrumental delivery and 3.55 for cesarean section. The most prevalent etiology was uterine atony. CONCLUSION: The incidence of HPSe in our hospital is low, as well as secondary maternal mortality. The major risk factor for the appearance of the clinical symptoms is cesarean section, followed, in less proportion by instrumental delivery. It is possible for the HPSe to make its appearance delayed after delivery, usually secondary to infrequent and non well-known clinical presentations.

Encuesta perinatal de la Sociedad Gallega de Obstetricia y Ginecología 2010-2011 / Perinatal survey of the Galician Society of Obstetrics and Gynecology 2010-2011

Objetivo. Obtener y evaluar los datos de la asistencia perinatal en Galicia. Material y métodos. Estudio descriptivo, retrospectivo y multicéntrico. Se solicitó la colaboración de todos los centros sanitarios gallegos con asistencia al parto para la realización de la base de datos perinatales de los años 2010 y 2011. Resultados. Realizamos el estudio estadístico epidemiológico de 29.254 nacimientos acontecidos en nuestra comunidad en el bienio 2010-2011, lo cual representa el 67,2% del total de nacimientos de Galicia en ese periodo. Analizamos las siguientes variables: edad materna, estática fetal, amenorrea en el momento del parto, tipo de parto, indicaciones de cesáreas, y mortalidad perinatal y materna (AU)

Objective. To obtain and evaluate information on perinatal care in Galicia (Spain). Material and methods. We performed a descriptive, retrospective, multicenter study. All centers in Galicia involved in deliveries were requested to collaborate in the perinatal database for 2010 and 2011. Results. We performed a statistical, epidemiological study of 29,254 births in our region in the 2-year period from 2010 to 2011, representing 67.2% of all births in Galicia in this period. The following variables were analyzed: maternal age, fetal statics, amenorrhea at delivery, type of delivery, indications for cesarean section, and perinatal and maternal mortality (AU)

[Complete uterine ruptures]. / Roturas uterinas completas.

BACKGROUND: Uterine rupture is one of the most severe Obstetric complications by high morbidity and maternal and fetal mortality. OBJECTIVES: To review cases of uterine rupture occurred for the last five years. Release the incidence, the risk factors and maternal and fetal complications, both immediate and long term. METHODS: Retrospective cohort study including all patients who completed their gestation in the University Hospital Complex of Ourense (Spain) between 2008 and March 2013. Review all medical records of patients diagnosed with uterine rupture during this period. Statistical analysis was performed using the statistical package Epidat 3.0. RESULTS: We found an overall incidence of uterine rupture of 0.078 %. In patients with a previous cesarean delivery incidence rises to 0.31%. CONCLUSION: Uterine rupture is an uncommon but with high maternal fetal morbidity. The main risk factor is a trial of labor after a previous cesarean delivery.

Influencia de la gestación de bajo riesgo en la calidad de vida relacionada con la salud percibida por las gestantes / Influence of low-risk pregnancy on self-perceived health-related quality of life in pregnant women

Objetivos: Valorar la calidad de vida relacionada con la salud (CVRS) percibida por las gestantes de bajo riesgo en comparación con los valores poblacionales de referencia para mujeres del mismo grupo de edad; determinar si la gestación de bajo riesgo puede modificar la CVRS percibida; relacionar los «cambios fisiológicos de la gestación» con la pérdida de calidad de vida percibida; obtener valores de CVRS de referencia del cuestionario Medical Outcomes Study (MOS) 36-Item Short Form, o cuestionario SF-36, para gestantes del primer y tercer trimestres, dado que hasta la actualidad no hemos encontrado publicaciones españolas similares. Material y métodos: Encuesta transversal de prevalencia y comparación de 2 grupos independientes. Como instrumento de medición se utilizó el Medical Outcomes Study 36-Item Short Form (SF-36). Conclusiones: Las gestantes presentan una pérdida estadísticamente significativa de las dimensiones físicas cuando se comparan con los valores poblacionales de referencia para mujeres del mismo intervalo de edad; esta pérdida es más significativa al progresar la gestación, es decir, la progresión cronológica del embarazo normal puede alterar la percepción en la calidad de vida percibida por las gestantes, especialmente en el campo físico. No se observan alteraciones en las dimensiones relacionadas con la función emocional o social. Los síntomas propios de la gestación, como las náuseas y los vómitos, son capaces de alterar las funciones física y emocional

Objectives: The aims of the present study were four-fold: to assess health-related quality of life (QoL) perceived by women with low-risk pregnancies in comparison with reference population values for women in the same age group; to determine whether low risk pregnancy by itself can modify perceived QoL; to determine the association between the physiological changes of pregnancy and perceived loss of QoL; to obtain reference values for QoL from the questionnaire Medical Outcomes Study (MOS) 36-Item Short Form (SF-36) for expectant mothers in their first or third trimester, given that to date we have found no Spanish publications on the topic. Material and methods: We performed a cross-sectional survey of prevalence, with comparison of two independent groups. Measuring instrument: SF-36. Conclusions: The expectant mothers showed a statistically significant loss in physical dimensions in comparison with the reference population values for women in the same age group; this loss was more significant as the pregnancy progressed, that is, the chronological progression of a normal pregnancy is, by itself, able to alter the quality of life perceived by the pregnant women, especially in the physical domain. No changes in the dimensions related to social or emotional functions were observed. The typical symptoms of pregnancy such as nausea and vomiting are able to alter physical and emotional functions