Resultados obstétricos y neonatales relacionados con la hidratación intraparto en mujeres atendidas de parto de bajo riesgo / Obstetric and neonatal results associated with intrapartum hydration for women with low-risk labour

Objetivo: determinar la influencia de la hidratación intraparto en los resultados obstétricos y neonatales en mujeres nulíparas atendidas por parto de bajo riesgo.Métodos: se realizó un estudio observacional prospectivo en el Hospital Universitario Puerta de Hierro Majadahonda (Madrid, España). Se incluyeron mujeres nulíparas con gestación única atendidas por parto de bajo riesgo. Se recogieron variables maternas (sociodemográficas, clínicas al ingreso, intraparto y en el puerperio inmediato, resultados obstétricos) y neonatales (datos al nacimiento, a las 24 y 48 horas). Se realizó análisis descriptivo y univariante con los test estadísticos correspondientes. Se valoró la influencia de la hidratación en los resultados obstétricos y neonatales estableciendo un punto de corte en la hidratación recibida intraparto (mediana volumen total administrado por hora: 300 mL/h).Resultados: se incluyeron 148 mujeres. Edad media (DE) 32 (4,4) años, edad gestacional media (DE) 39 (1,4) semanas. Al ingreso, la dilatación media fue de 2 cm. Parto inducido en 65,5% (n= 97). Los resultados obstétricos y neonatales fueron más favorables en las mujeres que recibieron un volumen mayor(> 300 mL/h), con diferencias significativas en la duración total del parto (mediana 526 vs. 735 min; p< 0,001), incidencia de parto por cesárea (14,3% frente 18,7%), fiebre (5,5% frente a 7,7%), incidencia de pérdida de peso neonatal superior al 7% a las 48 horas (28,6% frente a 39,8%), lactancia materna (94,6% frente a 82,4%).Conclusiones: la administración de un mayor volumen de líquidos a mujeres nulíparas durante el parto de bajo riesgo se asoció con mejores resultados obstétricos y neonatales.(AU)

Objective: to determine the influence of intrapartum hydration on obstetric and neonatal results in nulliparous women during low-risk labour.Methods: an observational prospective study was conducted at the Hospital Universitario Puerta de Hierro Majadahonda (Madrid, Spain). The study included nulliparous women with single pregnancy and low-risk labour. Maternal variables were collected (sociodemographic, clinical signs at admission, intrapartum and immediately post-partum, obstetric results) as well as neonatal variables (data at birth, at 24 and 48 hours). Descriptive and univariate analysis was conducted with the relevant statistic tests. The influence of hydration was assessed in obstetric and neonatal results, determining a cut-off point for the hydration received intrapartum (median total volume administered per hour: 300 mL/h).Results: the study included 148 women, with a mean age (SD) of 32 (4.4) years, and a mean gestational age (SD) of 39 (1.4) weeks. At admission, mean dilation was of 2 cm. There was induced labour in 65.5% of cases (n= 97). Obstetric and neonatal results were more favourable in those women who received a higher volume (≥ 300 mL/h), with significant differences in the total duration of labour (median 526 vs. 735 min; p< 0.001), incidence of Caesarean births (14.3% vs. 18.7%), fever (5.5% vs. 7.7%), incidence of neonatal weight loss >7% at 48 hours (28.6% vs. 39.8%), breastfeeding (94.6% vs. 82.4%).Conclusions: administration of a higher volume of fluids to nulliparous women during low-risk labour was associated with better obstetric and neonatal results.(AU)

Efficacy of "optimal hydration" during labor: HYDRATA study protocol for a randomized clinical trial.

There is a lack of consensus in the international scientific community with respect to the most suitable hydration strategies when attending nulliparous women during low-risk births. This paper describes the protocol for a randomized controlled trial to compare two hydration strategies and their influence on maternal and neonatal morbidity. The study population consists of nulliparous women admitted to the obstetrics department of a University Hospital. The women are being randomized into two groups: the "optimal hydration" group, which will be guaranteed 300 ml/hr liquids (crystalloids and bottled mineral water) with a minimum diuresis of 35 ml/hr; and the "variability in hydration" group, which will receive intravenous (alternating normal saline, Ringer's lactate solution, glucose, or Voluven®) and clear (bottled mineral water or isotonic drinks [Aquarius®]) liquids, without any established perfusion rate, and without established minimum diuresis. Outcomes for mothers include duration of labor, cesarean section, fever, and dehydration. Outcomes for newborns are respiratory distress, hypoglycemia, hyponatremia, jaundice, weight loss over 48 hr, and breastfeeding difficulties. Analysis will be per-protocol. Administering optimal hydration may improve health and safety for mothers and their newborn and reduce maternal and neonatal morbidity. The study is registered at www.clinicaltrials.gov. The project received funding by the Ministry of Health of Spain and is approved by the Research Ethics Committee.

Cessation of breastfeeding in association with oxytocin administration and type of birth. A prospective cohort study.

BACKGROUND: Some studies have suggested an association between synthetic oxytocin administration and type of birth with the initiation and consolidation of breastfeeding. AIM: This study aimed to test whether oxytocin administration and type of birth are associated with cessation of exclusive breastfeeding at different periods. A second objective was to investigate whether the administered oxytocin dose is associated with cessation of exclusive breastfeeding. METHODS: We conducted a prospective cohort study (n=529) in a tertiary hospital. Only full-term singleton pregnancies were included. Four groups were established based on the type of birth (vaginal or cesarean) and the intrapartum administration of oxytocin. Follow-up was performed to evaluate the consolidation of exclusive breastfeeding at 1, 3 and 6months. FINDINGS: During follow-up, the proportion of exclusive breastfeeding decreased in all groups. After adjusting for confounding variables, the group with cesarean birth without oxytocin (planned cesarean birth) had the highest risk of cessation of exclusive breastfeeding (odds ratio [95% confidence interval], 2.51 [1.53-4.12]). No association was found between the oxytocin dose administered during birth and puerperium period and the cessation of exclusive breastfeeding. CONCLUSION: Planned cesarean birth without oxytocin is associated with the cessation of exclusive breastfeeding at 1, 3 and 6months of life. It would be desirable to limit elective cesarean births to essentials as well as to give maximum support to encourage breastfeeding in this group of women. The dose of oxytocin given during birth and puerperium period is not associated with cessation of exclusive breastfeeding.

Desprendimiento prematuro de placenta normoinsertada por mutación heterocigota en el gen de la protrombina / Placental abruption associated with heterozygous prothrombin gene mutation

El desprendimiento prematuro de placenta se define como la separación parcial o completa de una placenta normalmente insertada antes del inicio del parto. Esto se produce en un 0,4-1% de las gestaciones. Esta patología se asocia a una elevada morbimortalidad materno-fetal. Existen distintos factores de riesgo asociados con el desprendimiento prematuro de placenta. Entre estos factores se encuentran: trastornos hipertensivos del embarazo, antecedentes de desprendimiento placentario o cesárea, diabetes, multiparidad, sobredistensión uterina (gestación múltiple o polihidramnios), rotura prematura de membranas, traumatismos abdominales, consumo de tóxicos y trombofilias. En un elevado número de casos la causa del desprendimiento es desconocida. El diagnóstico se basa fundamentalmente en las manifestaciones clínicas. El empleo de la ecografía tiene una utilidad muy limitada para el diagnóstico debido a su baja sensibilidad. La actitud va a estar condicionada por el estado materno y fetal, el grado de desprendimiento placentario y la edad gestacional en el momento del diagnóstico. Se presenta un caso clínico de un desprendimiento prematuro de placenta normoinsertada asociado a coagulación intravascular diseminada, útero de Couvelaire y atonía uterina debido a la mutación 620210 A heterocigota en el gen de la protrombina

Placental abruption defined as the complete or partial separation of a normally implanted placenta before delivery, occurs in 0.4-1%. It is one of the most significant causes of maternal and perinatal morbidity and mortality. The risk factor of abruption placentae are hypertension, prior caesarean delivery, previous abruption placentae, pregestational diabetes, high parity, polyhydramnion, multiple gestation, premature rupture of membranes, abdominal trauma, drug abuse and thrombophilia. The cause of placental abruption often remains unexplained. The diagnosis of placental abruption is clinical, based on characteristic signs and symptoms. Sonography is not sensitive for the detection of placental abruption. Prenatal and perinatal management depend on maternal and foetal condition, severity and gestational age. We report the case of placental abruption associated with disseminated intravascular coagulation, Couvelaire uterus and uterine atony. The patient was diagnosed with heterozygous prothrombin gene mutation 620210 A

Vía de parto tras una cesárea anterior / Labor after an anterior cesarean section

Objetivo: describir la vía de parto en mujeres con una cesárea anterior. En el caso de la cesárea electiva se describen las causas y en aquellas que intentaron parto vaginal, los factores relacionados con la tasa de éxito o fracaso del mismo. También se estudia la incidencia de complicaciones relacionadas. Material y métodos: estudio de cohortes retrospectivo y descriptivo que incluye a 638 mujeres con antecedente de una cesárea anterior y gestación a término cuya finalización del embarazo tuvo lugar en el Hospital Universitario Puerta de Hierro entre enero de 2012 y enero de 2015. Resultados: de las 638 mujeres seleccionadas, 352 deciden intentar parto vaginal (54,5%), mientras que las 286 restantes (45,5%) optan por una cesárea electiva programada. La tasa de éxito del PVDC es del 81,8%. Se registran porcentajes mayores de éxito en mujeres con partos vaginales previos y con inicio del trabajo de parto espontáneo. Las indicaciones de cesárea electiva más frecuentes son la cesárea anterior practicada hace menos de 18 meses y el no deseo de parto vaginal. Hubo 7 casos de rotura uterina. Conclusiones: dada la alta tasa de éxito de la vía de parto en mujeres con una cesárea anterior., se debe ofrecer este como primera opción siempre que no haya condiciones que la contraindiquen, así como informar a la mujer para que la elección se base en la evidencia científica, haciendo hincapié en los riesgos y beneficios tanto de la vía vaginal como de la repetición de la cesárea (AU)

Objective: Describe the delivery in women with a previous caesarean section. In the case of the caesarean section the causes are described, and in those who tried the vaginal delivery, some factors related to the success or failure rates of it are reflected. Also, the incidence of the related complications is studied. Material and Methods: Retrospective and descriptive study of cohorts that include women with previous caesarean section, which conclusion of the pregnancy was in the Puerta de Hierro University Hospital between January 2012 and January 2015. Results: 54,5% decide to try vaginal delivery, while the rest are programmed caesarean sections. The success rate for PVDC is 81,8%. Higher success percentages are registered in women with previous vaginal deliveries, and with the initial work of spontaneous delivery. The most frequent indications of iterative caesarean section are the caesarean sections practiced less than 18 months before, and the wish to not have a vaginal delivery. There were 7 cases of uterine rupture. Conclusions: Provided the high rate of success on vaginal birth after an anterior cesarean section it must be offered as a first option as long as there is not a condition that contraindicates it, as well as educating and informing the woman so the choice is based on a scientific evidence, and is ethic and fair with her and the sanitary service (AU)

Fibrosis retroperitoneal como diagnóstico diferencial de cáncer de ovario / Retroperitoneal fibrosis as a differential diagnosis of ovarian cancer

La fibrosis retroperitoneal es una enfermedad rara de etiología incierta en la que se produce una fibrosis que rodea a la aorta y/o las arterias iliacas además de a otras estructuras abdomino-pélvicas. Se presenta el caso clínico de una paciente que presenta clínica de pseudo masa pélvica con uropatía obstructiva. Se opera con sospecha diagnóstica de cáncer de ovario y durante la cirugía se objetiva una fibrosis que engloba todo el lado pelviano izquierdo. Se diagnostica de fibrosis retroperitoneal idiopática sin relación a IgG4 y se trata con corticoterapia (AU)

Retroperitoneal fibrosis is a rare condition, with an uncertain etiology, in which abdominal aorta, iliac arteries and other abdomino-pelvic organs get encased by fibrous tissue. We report a case of a 53 years old women who presents a pseudo-pelvic mass and an urinary tract obstruction. Suspecting ovarian cáncer, the patient goes under surgery in which fibrous tissue surrounding left pelvis is evidenced. Idiopatic retroperitoneal fibrosis not related to IgG4 is diagnosed, and the patient initiates treatment with corticoids (AU)

A Comparison of Factors Associated with Cessation of Exclusive Breastfeeding at 3 and 6 Months.

AIM: To analyze the association of labor and sociodemographic factors with cessation of exclusive breastfeeding (EBF) at 3 and 6 months of life. MATERIALS AND METHODS: A prospective cohort study (n = 529) was performed in a tertiary hospital with the Baby-Friendly Hospital Initiative (BFHI) award. Labor and sociodemographic factors were investigated. Single-term newborns were included. After 3 and 6 months, telephone calls were made to determine the type of lactation. Univariate analysis was performed with the chi-square test or Fisher's exact test. Multivariable logistic regression models were developed to determine risk factors associated with cessation of breastfeeding at 3 and 6 months. RESULTS: At 3 months, 523 participants (98.9%) were contacted, of whom 64.4% maintained EBF. Factors associated with cessation were pacifier use (odds ratio [OR] 3.49; 95% confidence interval [95% CI] 2.24-5.43), cesarean delivery (OR 4.49; 95% CI 2.96-6.83), no college degree (OR 2.01; 95% CI 1.35-3.01), and not attending breastfeeding support groups (OR 1.96; 95% CI 1.22-3.12). At 6 months, 512 participants (96.8%) were contacted, of whom 31.4% maintained EBF. Factors associated with cessation were reintegration into the workplace (OR 4.49; 95% CI 2.96-6.83), pacifier use (OR 3.49; 95% CI 2.24-5.43), and primiparity (OR 1.61; 95% CI 1.05-2.46). CONCLUSIONS: Several risk factors are associated with the premature cessation of EBF. There is a need to define strategies to correct modifiable factors and to promote protective factors with the aim of improving the success rate of EBF to reach the recommendations of the World Health Organization.

Rotura hepática espontánea en el embarazo / Spontaneous rupture of liver during pregnancy

La rotura hepática espontánea es una complicación poco habitual durante la gestación asociada a graves complicaciones. Presentamos un caso de rotura hepática espontánea y se realiza una revisión de la literatura (AU)

Liver rupture is a rare but potentially devastating complication of pregnancy. We report a case of spontaneous liver rupture and provide a review of the literature (AU)

Gestación heterotópica: dos casos con gestación intrauterina viable a término / Heterotopic pregnancy: two cases with viable intrauterine pregnancy at term

Se presentan dos casos de gestación heterotópica, el primero de ellos espontáneo y el segundo tras técnicas de fecundación in vitro. En ambos la gestación intrauterina evolucionó de forma favorable, con control gestacional normal y llegando a término, con el nacimiento de recién nacidos sanos. La gestación heterotópica se define como la presencia simultánea de gestación en dos lugares de implantación distintos, lo más frecuente una gestación intrauterina acompañada de otra ectópica. Se trata de una situación poco frecuente, con una incidencia de 1/8000 embarazos espontáneos según la bibliografía más reciente.

We report two cases of heterotopic pregnancy, the first one spontaneous and the second one after in vitro fertilization techniques. In both, the intrauterine gestation evolved favorably, normal pregnancy control and coming to terms with the birth of healthy newborns. Heterotopic pregnancy is defined as the simultaneous presence of gestation at two different locations, most often in utero accompanied by another ectopic pregnancy. This is a rare situation, with an incidence of spontaneous pregnancies 1/8000 according to the most recent literature.