Does exercise during pregnancy impact on maternal weight gain and fetal cardiac function? A randomized controlled trial.

OBJECTIVE: To evaluate the association between physical exercise during pregnancy and maternal gestational weight gain and fetal cardiac function. METHODS: This was a randomized controlled trial of women with a singleton pregnancy managed from the first trimester at the Hospital de Torrejón, Madrid, between November 2014 and June 2015. Women were randomized to either follow a supervised physical conditioning program, consisting of a 60-min session 3 days per week for the duration of pregnancy, or not attend any exercise program (controls). The primary outcome was maternal weight gain during pregnancy. Secondary outcomes included fetal cardiac function parameters evaluated at 20, 28 and 36 weeks' gestation, Cesarean section, preterm delivery, induction of labor and birth weight. A sample size of 45 in each group was planned to detect differences in maternal weight gain of at least 1 kg, with a power of > 80% and α of 0.05. RESULTS: During the study period, 120 women were randomized into the exercise (n = 75) and control (n = 45) groups. Following exclusions, the final cohort consisted of 42 women in the exercise group and 43 in the control group. Baseline characteristics (maternal age, prepregnancy body mass index, parity, conception by in-vitro fertilization, Caucasian ethnicity, physical exercise prior to pregnancy and smoker) were similar between the two groups. No differences were found between the groups in maternal weight at 20, 28, 36 and 38 weeks' gestation or in weight gain at 38 weeks. However, the proportion of women with weight loss ≥ 9 kg at 6 weeks postpartum was higher in the exercise compared with the control group (68.2% vs 42.8%; relative risk 1.593; P = 0.02). The ductus arteriosus pulsatility index (DA-PI) at 20 weeks (2.43 ± 0.40 vs 2.26 ± 0.33, P < 0.05) and the ejection fraction (EF) at 36 weeks (0.85 ± 0.13 vs 0.81 ± 0.11, P < 0.05) were higher in the exercise compared with the control group. All other evaluated fetal cardiac function parameters were similar between the two groups. CONCLUSIONS: Performing exercise during pregnancy is not associated with a reduction in maternal weight gain but increases weight loss at 6 weeks postpartum. Physical exercise during pregnancy is associated with increased fetal DA-PI at 20 weeks and EF at 36 weeks, which could reflect adaptive mechanisms. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Endometriosis abdominal. A propósito de 2 casos / Abdominal endometriosis. Report of two cases

La endometriosis abdominal es una entidad poco frecuente que suele plantear problemas diagnósticos. La presencia de una masa abdominal cíclicamente dolorosa en una mujer premenopáusica con antecedentes de cirugía abdominal previa por causa obstétrica o ginecológica es altamente sospechosa. El diagnóstico diferencial generalmente se realiza mediante las complicaciones posquirúrgicas más habituales, como hernias, granulomas de suturas, abscesos o incluso hematomas en los músculos rectos. El diagnóstico por imagen suele ser poco específico, por lo que se llega al diagnóstico final a través del análisis anatomopatológico de la pieza tras su escisión quirúrgica. A continuación se presentan 2 casos de endometriosis abdominal: uno es el caso de una mujer con antecedente de cesárea 3 años antes y el otro es el caso con de una mujer antecedente de extirpación de teratoma ovárico maduro 4 años antes (AU)

Abdominal endometriosis is a rare entity, which usually hampers diagnosis. The presence of a cyclically painful abdominal mass in women with a previous history of abdominal surgery for obstetric or gynecological causes is highly suggestive. The differential diagnosis should be made with the most common postsurgical complications such as abdominal hernia, suture granuloma, abscesses, and rectus muscle hematomas. Imaging diagnosis has low specificity, and the final diagnosis is reached by histopathological study of the surgical specimen. We report two cases of abdominal endometriosis; the first patient had a history of cesarean section 3 years previously and the second had a history of mature ovarian teratoma extirpated 4 years previously (AU)