Subjective well-being, happiness, and environmental health factors related to women planning a pregnancy or pregnant, using mobile health intervention.

Objectives: To compare the environmental health results in women trying to get pregnant or pregnant using a mobile health application (Green Page) through healthcare professionals or self-completed by women, and to explore the relationship between the subjective well-being of these women with their lifestyles and environmental factors. Methods: A descriptive study with mixed methods was conducted in 2018. A mobile health survey was used in two phases. Phase 1 was a cross-sectional study through professionals (n = 1100) followed by phase 2, a convenience sampling through women's self-reporting (n = 3425). A personalized report was downloadable with health recommendations for the well-being of the mother and child. Results: Of the 3205 participants (mean age = 33 years, SD = 0.2 years), 1840 were planning a pregnancy and 1365 were pregnant. One in five pregnant women had a low level of happiness. Globally, subjective well-being and happiness were found to be negatively associated with lack of contact with nature, sedentary lifestyle, excess weight, environmental exposure, and older age in pregnancy. Precisely 45%, 60%, and 14% of women were exposed to tobacco, alcohol, and illegal drugs, respectively. The women self-reported levels of risk factors higher than when the tool was used by or through professionals. Conclusions: The use of mobile health interventions focused on environmental health during planning or pregnancy periods could help improve the quality of healthcare and foster greater involvement of women in their self-care process, thus promoting empowerment, healthier environments, and lifestyles. Ensuring equity of access and data protection are global challenges to be addressed.

Early Effect of 0.005% Estriol Vaginal Gel on Symptoms and Signs of Vulvovaginal Atrophy.

OBJECTIVES: This study aims to assess the effect of ultralow dose 0.005% estriol vaginal gel in women with genitourinary syndrome of menopause (GSM). METHODS: In this prospective and multicenter single-arm study, efficacy was assessed by the evaluation of the epithelial maturation value (MV), vaginal pH, symptoms and signs of vulvovaginal atrophy. Tolerability, acceptability, and the effect on intimate relationships were also evaluated. RESULTS: We included 35 postmenopausal women with moderate-to-severe vaginal dryness. The most bothering symptom reported was vaginal dryness. The mean increase in the MV after 7 and 14 days of treatment were 22.1 (P < 0.001) and 39.9 (P < 0.001) points, with an increase in the superficial cells of 17.7 percentage points (pp) (95% confidence interval [CI], 7.9-27.4; P < 0.001) and 41.4 pp (95% CI, 28.2-54.6; P < 0.001) observed at the timepoints. Additionally, the pH decreased by 0.6 ± 0.7 (mean ± SD) at 7 days (P < 0.0001) and by 1.1± 0.8 at 14 days (P < 0.0001) from a baseline mean value of 6.3 ± 0.8. The severity of vaginal dryness (range, 0 [none] to 3 [severe]) was significantly reduced by a mean of 1.4 points (P < 0.0001) at 7 days and 2 points (P < 0.0001) at 14 days. CONCLUSIONS: Ultralow dose 0.005% estriol vaginal gel produced a rapid improvement of most relevant symptoms and signs of GSM. This clinically meaningful response was observed from the initial days of treatment, confirming a fast onset and a progressive action.

An Integrative Screening Tool of Alcohol Exposure During Early Pregnancy: Combining of the CDT Biomarker with Green Page Questionnaire.

AIMS: In current clinical practice, prenatal alcohol exposure is usually assessed by interviewing the pregnant woman by applying questionnaires. An alternative method for detecting alcohol use is to measure the biomarker carbohydrate-deficient transferrin (CDT). However, few studies measure CDT during pregnancy. This study examines the utility of CDT biomarker in the screening of alcohol exposure during early pregnancy. METHODS: A cohort of 91, first-trimester pregnant women assigned to a public reference maternity hospital, was screened using the Green Page (GP) questionnaire, an environmental exposure tool. CDT levels and other biomarkers of alcohol use were measured and compared with questionnaire data. RESULTS: About 70% of the mothers in the study consumed alcohol during early pregnancy and 22% met high-risk criteria for prenatal exposure to alcohol. CDT measurement showed a statistically significant area under the receiver operating characteristic curve with a value of 0.70. For a value of 0.95% of CDT, a specificity of 93% was observed. The most significant predictors of CDT were the number of binge drinking episodes, women's body mass index and European white race. CONCLUSION: Pregnant women with a CDT value >0.95% would be good candidates for the performance of the GP questionnaire during early pregnancy in order to detect potential high-risk pregnancy due to alcohol exposure.

Una biopsia corial que da en el clavo: síndrome de Nicolau en gestante / A chorionic biopsy with fortuitous results: Nícolau syndrome in pregnant women

Presentamos a una gestante de 40 años, en la semana 12+6. Al obtener riesgo alto en el cribado del primer trimestre, se procedió a la biopsia corial por vía abdominal. Cuando se introdujo el anestésico local, la paciente comenzó con un dolor punzante sobre la zona de inyección, cambiando inmediatamente de color a rojo vinoso. Tras consultar con dermatología, se diagnosticó de síndrome de Nicolau, un vasoespasmo agudo por la inyección intraarterial de anestésico, que lleva a necrosis del tegumento cutáneo subsidiario a este. Dada la escasa prevalencia de esta afección, consideramos necesario elaborar una revisión bibliográfica sobre este síndrome

We present a 40-year-old pregnant woman, at week 12 + 6. By getting high risk in the first three months period screening, we abdominally proceeded to chorionic villus sampling. When the local anesthetic was introduced, the patient began with a shooting pain on the injection site, changing into a wine-red colour. After consultating with dermatology, she was diagnosed with Nicolau syndrome, an acute vasospasm by intra-arterial injection of anesthetic, leading to necrosis of the skin integument that depends on this. Given the low prevalence of this condition, we consider necessary to develop a literature review on this syndrome

Encuesta SEGO. Predicción, diagnóstico y tratamiento de la preeclampsia en los hospitales españoles / SEGO survey. Prediction, diagnosis, and treatment of pre-eclampsia in Spanish hospitals

Objetivos: la preeclampsia es causa importante de morbilidad y mortalidad materna y perinatal. La identificación de gestantes con riesgo de preeclampsia, el correcto diagnóstico y la adecuada evaluación del pronóstico son fundamentales para la elección de la actitud clínica más adecuada en cada caso y lograr evitar así las complicaciones asociadas y la mortalidad por preeclampsia. En este sentido, en los últimos años se han desarrollado y estudiado numerosos biomarcadores que, bien por sí mismos o en combinación con otros parámetros, muestran resultados prometedores en la predicción y diagnóstico de preeclampsia, y cuya incorporación a la práctica clínica habitual supondrá un avance en el manejo clínico de las gestantes con preeclampsia. Material y métodos: desde la Sociedad Española de Ginecología y Obstetricia se envió vía internet una encuesta con 25 preguntas (3 de ellas casos clínicos) a 2.699 miembros de la secciones de Medicina Perinatal y Ecografía con el objetivo de revisar el estado actual de la predicción, diagnóstico y manejo clínico de la preeclampsia en nuestro país. Resultados: a la encuesta respondieron 476 profesionales (17,63%) y de sus respuestas se concluye que la práctica clínica entre los profesionales de los hospitales españoles se ajusta en la mayoría de los aspectos evaluados a las recomendaciones actuales y al estado del conocimiento. Cabe destacar la baja utilización de biomarcadores en el primer trimestre para identificar gestantes con riesgo de preeclampsia e indicar profilaxis así como en el segundo y tercer trimestre para establecer el pronóstico y optimizar la actitud terapéutica

Objectives: Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The correct diagnosis, prognosis, and identification of patients at high risk of pre-eclampsia are crucial for the optimal treatment and prevention of pre-eclampsia-associated complications and mortality. A large variety of prognostic and diagnostic biomarkers have been studied in the recent years either alone or in combination with other parameters, with promising results. The routine use of these biomarkers in clinical practice would help optimize the clinical approach to pre-eclampsia. Material and methods: The Spanish Society of Gynecology and Obstetrics forwarded an online 25-item questionnaire (of which 3 were clinical cases) to 2.699 members of the departments of perinatal medicine and ultrasound with the aim of revising how pre-eclampsia is predicted, diagnosed, and treated in Spain. Results: A total of 476 questionnaires (17.63%) were returned. The conclusion was that most aspects addressed in the questionnaire were approached in hospitals in Spain in accordance with official guidelines and the current state of knowledge. Of note is the rare use of biomarkers either during the first trimester of gestation in patients at risk of pre-eclampsia for the indication of prophylaxis, or during the second and third trimester for the prognosis and selection of the best therapeutic option

Second trimester angiotensing-converting enzyme and uterine artery Doppler as predictors of preeclampsia in a high-risk population.

OBJECTIVE: To investigate whether serum angiotensing-converting enzyme (ACE) and uterine artery Doppler (UAD) are useful markers as predictors of preeclampsia (PE) in a high-risk population. METHODS: Patients at risk of PE (n = 68) were subclassified as having PE (n = 8) or no PE (n = 60). Blood samples were obtained between 19 and 22 weeks of gestation. Doppler ultrasound of the uterine arteries was done at the time of blood sampling. Maternal serum ACE was determined through spectrophotometry assay (A15 Biosystem, ATOM, Barcelona, Spain). RESULTS: Comparing the group who presented PE with the one who was not developed it, we found significant differences for ACE (54.2 ± 21.2, 38.1 ± 12.3 U/L; p = 0.003); the pulsatility index (PI) (1.2 ± 0, 3.1 ± 0.3; p = 0.032) and resistance index (RI) (0.7 ± 0.1, 0.5 ± 0.1; p = 0.004). The AUC for ACE was 0.724, so we selected the cutoff of 36.5 U/L (sensitivity: 62.5% and specificity: 86.7%). The AUC for PI was 0.652 choosing a cutoff of 1.4 (sensitivity: 57.1% and specificity: 93.1%). The AUC for RI was 0.712 and the cutoff of 0.7 (sensitivity of 71.4% and specificity: 89.6%). The combination that allowed us to increase the diagnostic performance was the ACE+RI with Doppler study, increasing the AUC to 0.872. CONCLUSIONS: ACE, PI and RI as parameters of Doppler study were useful predictors of PE in the second trimester of gestation. The best combination to increase the diagnostic performance was ACE with the RI.