Comparing Infection Profiles of Expectant Mothers with COVID-19 and Impacts on Maternal and Perinatal Outcomes between the First Two Waves of the Pandemic.

During 2020, Coronavirus Disease-19 (COVID-19) incidence fluctuated in two clear waves across the spring and autumn periods. This study was designed to compare the maternal and perinatal clinical outcomes in obstetrics patients with COVID-19 between the two waves of infection in Spain. We conducted an observational, analytical, ambispective cohort study with longitudinal follow-up of mothers with confirmed SARV-CoV-2 infection from different hospitals in our country between March-November 2020. We recruited 1295 pregnant women with SARS-CoV2 infection from 78 hospitals, 846 (65.3%) of whom were diagnosed during the first wave and 449 (34.7%) during the second wave. Our results show that patients developing COVID-19 during the first wave had more symptoms at triage, early in pregnancy with greater rates of COVID-19-related maternal morbidity; caesarean section and preterm birth in the first wave. We register two cases of maternal mortality and only during the first wave. Maternal morbidity events showed a strong link to perinatal mortality events in the first wave compared to the second wave, in which maternal morbidity was more associated with pneumonia. Likewise, maternal morbidity showed a strong correlation with perinatal morbidity events in both waves. We describe the differences between the patients' profiles and management between the two waves and related to maternal and perinatal outcomes. Differences were also observed in the management of pregnant women with COVID-19. Thus, there were fewer caesarean sections, and maternal and perinatal morbidity events were reduced in the second wave, while the impacts of respiratory symptoms and their severity, including a greater need for maternal treatment, were greater in this last period. Identifying the impact that changes in the profile as well as in the treatment have on maternal-perinatal morbidity and mortality will help improve the well-being of our patients and their newborns.

Factors Associated with Failure of Bakri Balloon Tamponade for the Management of Postpartum Haemorrhage. Case Series Study and Systematic Review.

BACKGROUND: Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Bakri balloon tamponade (BBT) is recommended when PPH does not respond to medical treatment. Nowadays few published studies have performed a multivariate analysis to determine the variables independently associated with BBT failure. METHODS: Our study purpose was to determine the variables independently associated with BBT failure: first, in a large single-centre cohort study between 2010 and 2020, and second, in a systematic literature review using Medline and the Cochrane Library. Maternal and perinatal variables, PPH characteristics, technique-related variables and complications were recorded in the case series study, comparing between successful and failed BBT patients. Study characteristic and variables significantly associated with BBT failure were recorded in the systematic review. All studies used a logistic regression test. RESULTS: The case series included 123 patients. The profile of these patients were primiparous, with vaginal delivery and a full-term new-born. BBT was successful in 81.3% of cases. Five studies were included in the systematic review, providing data from 551 patients. BBT was successful in 79.5% of cases. CONCLUSIONS: Maternal age, caesarean delivery, ≥7 red blood cells units (RBCU) transfused and curettage before BBT insertion, history of caesarean section, pre-pregnancy obesity, anteriorly placed placenta, placenta accreta, caesarean delivery, estimated blood loss before insertion of BBT, long operation duration, and coagulopathy were independent factors for BBT failure.

[Ultrasound scan of the fetal thymus]. / Evaluación ecográfica del timo fetal.

There is an increased interest nowadays on ultrasound analysis of the fetal thymus. Abnormal fetal thymic growth have been associated with DiGeorge syndrome, conotruncal cardiac malformations, chromosomal abnormalities and adverse outcome in different perinatal conditions as intrauterine growth restriction, preterm birth and others. Different methodologies that measure the fetal thymus by ultrasound have been published, however there is not a consensus of which one is the most useful. Our aim is to describe these methodologies and discuss their clinical applications.

[Perinatal outcome after prenatal diagnosis of intra-abdominal umbilical vein varix]. / Resultados perinatales luego del diagnóstico ecográfico prenatal de variz de la vena umbilical intraabdominal.

BACKGROUND: Increased number of cardiovascular disorders diagnosed prenatally is not a consequence of a spontaneous growing, but of the advance in echographic techniques, specifically, high-resolution echography, color Doppler, a higher knowledge and systematization in exploring fetal anatomy. OBJECTIVE: To describe the sonographic findings and perinatal outcomes in cases with prenatal ultrasound diagnosis of intraabdominal umbilical vein varix (UVV). METHODS: Retrospective study of cases with prenatal ultrasound diagnosis of UVV. The diagnosis is performed at the level of the abdominal circumference when the diameter of the vessel is above the established parameters for a certain gestational age. Variables concerning maternal-fetal features, ultrasound findings and perinatal outcomes of affected cases are described. RESULTS: During the period August 2008 to August 2012 14 cases of intra-abdominal UVV were diagnosed in our center with a mean gestational age at diagnosis of 29 weeks. Of the 14 cases, 35% had associated anomalies, mostly cardiovascular anomalies. No chromosomal defects were detected. Perinatal outcomes in newborns were favorable, with mean gestational age at delivery of 38 weeks. Only one case of monochorionic-monoamniotic twin pregnancy required preterm elective termination secondary to a twin to twin transfusion syndrome. CONCLUSION: Prenatal diagnosis of intra-abdominal UVV should be followed by further studies given its possible association with other anomalies, chromosomal defects and cases of stillbirth. However, isolated cases of UVV, representing a majority, often evolve favorably with few complications.

[Perinatal outcome after prenatal diagnosis of intra-abdominal umbilical vein varix]. / Resultados perinatales luego del diagnóstico ecográfico prenatal de variz de la vena umbilical intra-abdominal.

BACKGROUND: Progress in echographic techniques, particularly, high-resolution echography and color Doppler, as well the higher deep on knowledge and systematization in fetal anatomy exploration, are the main responsible of the increased number of cardiovascular anomalies diagnosed prenatally. OBJECTIVE: To describe the sonographic findings and perinatal outcomes in cases with prenatal ultrasound diagnosis of intra-abdominal umbilical vein varix. MATERIAL AND METHODS: A descriptive and retrospective study of cases with prenatal ultrasound diagnosis of umbilical vein varix. The diagnosis is performed at the level of the abdominal circumference when the diameter of the vessel is above the established parameters for a certain gestational age. Variables concerning maternal-fetal features, ultrasound findings and perinatal outcomes of affected cases are described. RESULTS: From August 2008 to August 2012 14 cases of intraabdominal umbilical vein varix were diagnosed in our center with a mean gestational age at diagnosis of 29 weeks. Of the 14 cases, 35% had associated anomalies, mostly cardiovascular anomalies. No chromosomal defects were detected. Perinatal outcomes in newborns were favorable, with mean gestational age at delivery of 38 weeks. Only one case of monochorionic-monoamniotic twin pregnancy required preterm elective termination secondary to a twin-to-twin transfusion syndrome. CONCLUSION: Prenatal diagnosis of intra-abdominal umbilical vein varix should be followed by further studies given its possible association with other anomalies, chromosomal defects and cases of stillbirth. However, isolated cases of umbilical vein varix, representing a majority, often evolve favorably with few complications.

Visualización ecográfica y diagnóstico prenatal del arco aórtico derecho / Prenatal ultrasound-guided visualisation and diagnosis of right aortic arch

Presentamos un caso de diagnóstico prenatal de arco aórtico derecho (AAD) aislado y se describe el manejo diagnóstico-clínico de esta entidad. En la exploración ecográfica fetal de una gestante de 20 semanas se detectó un AAD sin otras malformaciones asociadas. Mediante un corte axial del tórax fetal a nivel del plano de tres-vasos-tráquea, se comprobó el trayecto anómalo del arco aórtico, a la derecha de la tráquea. El AAD es una entidad rara (prevalencia del 0,1%) y sus variantes pueden condicionar sintomatología compresiva y estar relacionadas con anomalías cardíacas (hasta 90%) y/o con la microdeleción 22q11 (hasta 46%). El corte ecográfico de tres-vasos-tráquea es fundamental para su diagnóstico prenatal y tras su detección está indicada una evaluación exhaustiva del corazón fetal, distinguir sus variantes y/o un estudio cromosómico-genético específico. En presencia de otras anomalías el pronóstico es pobre; los casos aislados suelen tener una evolución postnatal oligo o asintomática(AU)

We report a case of prenatally diagnosed isolated right aortic arch (RAA) and describe the procedure for its ultrasound-guided diagnosis and clinical management. The ultrasound scan of a 20-week-old fetus revealed an isolated RAA. The diagnosis was achieved using the 3 vessels and trachea view, in which the aortic arch was visualized to the right side of the trachea. RAA is a rare finding (incidence, 0.1%) and its variants may cause compressive symptoms and be associated with congenital heart defects (up to 90%) and/or 22q11 microdeletion (up to 46%). The 3 vessels and trachea view is essential for the prenatal diagnosis of RAA. Detection of this condition must be considered an indication for fetal echocardiography, to distinguish its variants, and a genetic study is also recommended. Isolated RAA is usually asymptomatic, although the outcome of RAA associated with other abnormalities is uncertain(AU)

[Diagnosis of isolated fetal aberrant right subclavian artery]. / Diagnóstico de arteria subclavia derecha aberrante prenatal aislada.

UNLABELLED: A case of a fetal isolated aberrant right subclavian artery (ARSA) diagnosis and discuss its clinical implications and the methodology used to assess the fetal right subclavian artery by transabdominal ultrasound in normal cases and those with ARSA is reported. CLINICAL CASE: A 35-year-old pregnant woman in her twentieth week of pregnancy was evaluated at our Fetal Medicine Unit. An isolated ARSA was detected by a transabdominal ultrasound scan of the fetus. The visualization of this anomaly was achieved through an axial view of the fetal thorax, at the level of the three vessels and trachea scanning plane. It was observed that the origin of ARSA from the aortic arch was close to the ductus arteriosus and it followed a retrotracheal course towards the right arm. The described methodology used to assess the right subclavian artery could be useful for prenatal diagnosis in cases of ARSA. Based on this protocol, further studies could be performed to evaluate the utility of ARSA as a sonographic marker for chromosomal abnormality and congenital heart disease. After the diagnosis of an isolated ARSA, the performance of a fetal karyotype test is still debatable.

Malformaciones esqueléticas: diagnóstico ecográfico y resultados perinatales / Skeletal malformations: ultrasound diagnosis and perinatal results

Introducción. la incidencia de las alteraciones del desarrollo de las estructuras osteocartilaginosas fetales es baja. Aunque su diagnóstico ecográfico es sencillo, especialmente en las osteocondrodisplasias letales, llegar a un diagnóstico etiológico es complicado. El objetivo del presente trabajo es presentar los hallazgos ecográficos y resultados perinatales de las malformaciones esqueléticas diagnosticadas en nuestro centro. Material y métodos. estudio descriptivo retrospectivo de serie de casos. Se incluyeron las malformaciones esqueléticas diagnosticadas prenatalmente en la Sección de Medicina Fetal del Hospital General Universitario Gregorio Marañón (noviembre de 2004-febrero de 2010). Los casos se clasificaron en defectos del esqueleto axial o radial, tanto focales aislados como cuadros generalizados de displasias óseas. Se analizaron la edad gestacional al diagnóstico, los defectos congénitos asociados y los resultados perinatales. Resultados. durante el período de estudio se registraron 56 casos. La edad gestacional media al diagnóstico fue de 23,7 semanas (rango 12-37; desviación estándar 7,25). Veintiséis (46,4%) se presentaron como malformación aislada; 14 (25%) asociadas a otras malformaciones, y 16 (28,6%) en el contexto de un síndrome polimalformativo. De los 29 (51,8%) casos en que se realizó estudio citogenético, en 10 (34,5%) se diagnóstico una cromosomopatía. En 40 casos (71,4%) el diagnóstico fue de anomalía focal del esqueleto radial; en 5 (8,9%), de anomalía del esqueleto axial, y en 14 (25%), de osteocondrodisplasia. Sólo en 11 casos se estableció un diagnóstico nosológico. La supervivencia en el período neonatal fue del 61,1% (33/54). Conclusiones. las malformaciones esqueléticas se asocian frecuentemente a otros defectos congénitos, de difícil diagnóstico etiológico y con una alta tasa de resultado perinatal adverso(AU)

Introduction. The incidence of disorders in the development of foetal bone and cartilage structures is low. Although ultrasound diagnosis is easy, especially in lethal skeletal dysplasias, to reach an aetiological diagnosis can be difficult. The aim of this study was to present the ultrasound findings and perinatal outcomes of skeletal malformations diagnosed in our centre. Material and methods. A retrospective descriptive study of case series. Skeletal malformations prenatally diagnosed in the Foetal Medicine Unit at the Gregorio Marañón General University Hospital (HGUGM) Madrid between November 2004 and February 2010 were included. Cases were classified as axial or radial skeletal defects, including isolated defects, as well as generalised skeletal dysplasias. Gestational age at diagnosis, presence of associated congenital defects and perinatal outcome were recorded. Results. A total of 56 cases were included during the study period. The mean gestational age at diagnosis was 23.7 weeks (range 11-36, standard deviation 7.25). Twenty-six (46.4%) occurred as an isolated malformation, 14 (25%) associated to other malformations, and 16 (28.6%) as a multiple malformation syndrome. Among the 29 (51.8%) cases in which a cytogenetic study was performed, 10 (34.5%) had a chromosomal abnormality. The diagnosis was a radial skeletal focal anomaly in 40 cases (71.4%); anomalies of the axial skeleton in 5 (8.9%); and osteochondrodysplasia in 14 (25%). A nosological diagnosis was established in only 11 cases. Neonatal survival was 61.1% (33/54). Conclusions. Skeletal malformations are often associated with other congenital defects. Aetiological diagnosis may be extremely difficult and the rate of adverse perinatal outcomes is high(AU)