Delivery in breech presentation: Perinatal outcome and neurodevelopmental evaluation at 18 months of life.

OBJECTIVES: To compare maternal and perinatal outcomes, including neurodevelopmental results at 18 months of life, between term breech and cephalic deliveries. STUDY DESIGN: In this longitudinal retrospective study of mothers seen at the Maternity and Paediatric University Hospital of the Canary Islands delivery unit from November 1, 2011, to October 31, 2012, we compared maternal and perinatal outcomes associated with breech or cephalic presentation of the foetus. A second analysis was performed to compare breech births, differentiating between whether a vaginal delivery attempt was made or if caesarean section (C-section) without labour had been directly scheduled. The psychomotor development of children 18 months after birth was assessed using the Haizea-Llevant scale. RESULTS: A total of 130 breech deliveries were matched with 130 cephalic deliveries. No perinatal mortality occurred in either group. The C-section percentage was greater in the breech presentation group compared with the cephalic delivery group (72.3 % vs. 14.6 %; p < 0.001). Children in the breech presentation had a threefold increased risk for Apgar scores <7 at 1 min (OR 3.2; 95 % CI: 1.2-8.4; p = 0.016) compared with cephalic presentation. These differences disappeared 5 min after birth. No differences were observed in moderate to severe neonatal morbidity between the breech and cephalic presentation groups. There were no differences between groups in neurodevelopmental outcomes. Of 130 pregnancies with breech presentation, 79 (60.8 %) made a vaginal delivery attempt, and 51 (39.2 %) were planned C-sections. Women who attempted vaginal breech delivery were younger and had a history of previous pregnancy. Apgar scores <7 at 1 min were more frequent in the vaginal delivery attempt group (27.9 % vs. 5.9 %; p = 0.002). A high percentage of type III resuscitation (36.5 % vs. 14.3 %; p = 0.007) and Neonatology admission (22.8 % vs. 5.9 %; p = 0.013) was observed in the vaginal delivery attempt group. Except for Apgar scores <7 at 1 min, none of these associations was significant after adjusting for nulliparity and maternal age. The mode of delivery was not associated with moderate to severe perinatal outcomes. CONCLUSION: The implementation of a specific protocol for selecting pregnant women with breech presentation as candidates for vaginal delivery achieved perinatal outcomes similar to births in cephalic presentation.

A propósito de un caso: trombosis yugular interna espontánea en gestante sometida a tratamiento de fertilidad / On the subject of a case: Spontaneous internal jugular thrombosis in pregnant women undergoing fertility treatment

La trombosis venosa yugular interna constituye una causa poco común de trombosis venosa profunda. Existen factores de riesgo como el embarazo y la inducción de la ovulación con gonadotropinas en pacientes sometidas a tratamientos de fertilidad, normalmente asociada a síndrome de hiperestimulación ovárica. Se describe el caso de una paciente de 35 años con antecedentes personales de endometriosis. Quedó gestante tras un único ciclo de fecundación in vitro con semen de donante por pareja homosexual. Desarrolló un síndrome de hiperestimulación ovárica severo que requirió culdocentesis evacuadora, evolucionando favorablemente. En la semana 9+6 comienza con dolor y edema en cara lateral derecha cervical, diagnosticándose mediante ecografía doppler de trombo a nivel de la vena yugular derecha y tercio proximal de subclavia ipsilateral. Se instauró tratamiento con heparina de bajo peso molecular con monitorización de los niveles de factor anti-Xa y realizándose un seguimiento multidisciplinar seriado. Se finalizó el embarazo en semana 37+2 mediante estimulación produciéndose un parto eutócico. Tras el parto la paciente deberá mantener el tratamiento con heparina de bajo peso molecular recomendándose un estudio de trombofilia. Si bien el embarazo, puerperio y el tratamiento hormonal están descritos como factores predisponentes para eventos trombóticos, es poco frecuente que sean la única causa. No obstante, si tras un tratamiento hormonal la paciente desarrolla un síndrome de hiperestimulación ovárica se debe mantener la tromboprofilaxis hasta la semana 12 de gestación. Ante la presencia de trombosis durante el embarazo después de una estimulación ovárica, sobre todo si la localización de la misma es atípica, sería recomendable realizar una evaluación de trombofilia (AU)

The internal jugular vein thrombosis is an uncommon cause of deep vein thrombosis. There are risk factors such as pregnancy and ovulation induction with gonadotropins in patients undergoing fertility treatments, typically associated with ovarian hyperstimulation syndrome. The case of a patient of 35 years with a history of endometriosis is described. She was pregnant after a single cycle of IVF with donor sperm by homosexual couples. He developed severe ovarian hyperstimulation syndrome requiring evacuadora culdocentesis, evolving favorably. In week 9 + 6 begins with pain and swelling in right lateral cervical, diagnosed by Doppler ultrasound thrombus at the level of the right jugular vein and proximal third of ipsilateral subclavian. Treatment was established with low molecular weight heparin with monitoring the levels of anti-factor Xa and performing a serial multidisciplinary follow. Pregnancy ended in week 37 + 2 producing a vaginal delivery. After delivery the patient should continue treatment with low molecular weight heparin and is recommended a study of thrombophilia. While pregnancy, postpartum and hormone treatment are described as predisposing factors for thrombotic events, it is rare that they are the only cause. However, if after hormone treatment, the patient develops ovarian hyperstimulation syndrome thromboprophylaxis should be maintained until the 12th week of gestation. In the presence of thrombosis during pregnancy after ovarian stimulation, especially if the location of it is atypical, it would be advisable to make an assessment of thrombophilia (AU)

Impacto de la implementación del test combinado para el cribado de trisomía 21 en Gran Canaria. Experiencia de los tres primeros años / Impact of the first three years of the introduction of the combined test for trisomy 21 screening in Gran Canaria

Objetivo: Valorar la evolución de la tasa de detección prenatal de trisomía 21 tras la introducción de un programa de cribado de primer trimestre.Material y métodos: Estudio descriptivo, retrospectivo, con los resultados de 12.530 cribados de primer trimestre realizados en gestantes de población general. El punto de corte para la prueba invasiva fue 1/300.Resultados: Durante el estudio se diagnosticaron72 casos de trisomía 21: 75% prenatales y 25% posnatales. El 72,2% de los recién nacidos con trisomía 21 no tenían cribado de primer trimestre y el 27,8% fueron falsos negativos del cribado. El 4,06% de los cribados fueron positivos, por lo que se optó por la realización de una prueba invasiva en el 74,4% de esas pacientes. Los resultados de los 12.530 cribados fueron: tasa de detección 73,9%; tasa de falsos negativos 0,04%; valor predictivo positivo 3,3%; valor predictivo negativo 99,9%, y tasa de falsos positivos 3,9%. La tasa de pruebas invasivas en el período de estudio fue del 13,9%, con una tasa de pérdidas gestacionales del 0,7%. La introducción del cribado de primer trimestre ha supuesto elevar la tasa de detección del 45 al 75%.Conclusiones: El cribado de aneuploidías en el primer trimestre es un método válido para establecer el riesgo de trisomía 21 en las gestantes de nuestro medio, lo que mejora la tasa de detección prenatal obtenida sólo con la edad materna y permite, además, la detección temprana de aneuploidías y malformaciones fetales (AU)

Objective: To review the results of combined screening for trisomy 21 and the changes in our evolution in detection rates. Material and methods: Descriptive and retrospective study with results of the 12530 first-trimester aneuploidy screening in pregnant females from the general population. The cut-off for invasive test recommendations was 1/300.Results: During the study 72 cases of trisomy 21 were diagnosed: 75% prenatal and 25% postnatal. A total of 72.2% of the new-borns with trisomy 21 were not screened in the first trimester and 27.8% were false negatives in the screening. There were 4.06% positives in the screening. A total of 74.4% of patients who screened positively opted for a karyotype study. The results of the 12530 screenings were: detection rate 73.9%, false negative 0.04%, positive predictive value 3.3% and negative 99.9%, and 3.9% of false positives. Invasive tests rate was approximately 13.9%, with a gestational loss rate of 0.7%. The introduction of the first-trimester screening has resulted in an increase in detection rates from 45% to 75%.Conclusions: First trimester screening is a valid method to establish risk of trisomy 21 in pregnant women in our population; it improves on the prenatal detection rate of trisomy 21 obtained solely considering maternal age. It also enables aneuploidy and foetal malformations to be detected early and decreases the number of invasive tests (AU)

Surveillance and risk factors on hysterectomy wound infection rate in Gran Canaria, Spain.

OBJECTIVES: Surveillance programs for nosocomial infection control may find out opportunities for improvement. The aim of this study was to determine the incidence of surgical site infection and their potential risk factors after hysterectomy in a tertiary hospital in Gran Canaria, Spain. STUDY DESIGN: Prospective study on patients undergoing abdominal or vaginal hysterectomy between 1st June 2000 and 31st December 2004. Surgical site infection incidence rates were calculated according to procedure, and National Nosocomial Infection Surveillance (NNIS) system risk categories. We also reviewed antimicrobial prophylaxis use and morbidity. To determine associate risk factors a multivariate analysis was performed. RESULTS: A total of 1540 women were surveyed; neoplasm (30.5%), obesity (24.3%), and diabetes (16.2%) grouped the main morbidity. About 81 cases (5.2%) met criteria for postoperative surgical site infection (6.0% for abdominal procedure and 3.1% for vaginal procedure). Most patients (86.4%) had adequate antimicrobial prophylaxis, but inadequacy was more frequent by vaginal (17.6%) than abdominal procedure (12.0%) (p=0.005). NNIS high-risk patients had significantly higher infection rates than did low-risk patients (p=0.01). The most common causative organism isolated was Escherichia coli (17.5%). Multivariate analysis showed obesity, inadequate antimicrobial prophylaxis, and abdominal procedure as the main risk factors. CONCLUSION: Rate of surgical site infection is high. Enhanced and multidisciplinary efforts are needed.

Infección perinatal por Listeria monocytogenes durante el embarazo y el parto / Perinatal Listeria monocytogenes infection during pregnancy and labour

Objetivo: Conocer la prevalencia de la infección perinatal por Listeria monocytogenes (LM) en nuestro centro y describir los efectos en el embarazo y el parto.Material y métodos: Se analizaron 21 casos de infección perinatal por LM que acontecieron en el Hospital Universitario Materno Infantil de Canarias entre los años 1992 y 2004. Los casos fueron localizados a través del registro de hemocultivos del servicio de medicina preventiva del hospital. Todos los casos presentaron, en la gestante o en el recién nacido, hemocultivos positivos frente a LM. Se evaluaron diferentes variables: la incidencia de la infección por LM durante ese período, la edad y paridad de las gestantes, la sintomatología, los resultados de las pruebas complementarias, el tratamiento realizado, el tipo y la vía del parto, las alteraciones en el registro cardiotocográfico (RCTG), las características del líquido amniótico y el estado del recién nacido (RN). El análisis se realizó de todos los casos con hemocultivo positivo frente a LM; se recogieron los resultados generales y, posteriormente, se los dividió en 2 grupos: en elgrupo 1 se incluyó a las pacientes que presentaron un cuadro infeccioso en la gestación producto de la colonización por LM, diagnosticada por hemocultivo materno positivo, y en el grupo 2, a las gestantes que, con una gestación aparentemente normal, parieron un RN que presentó clínica de cuadro infeccioso y mostró hemocultivo positivo frente a LM.Resultados: La incidencia fue de 21 casos de infección diagnosticada por LM en 97.839 nacimientos (2,1 casos/10.000 nacimientos). Nueve gestantes fueron diagnosticadas de listeriosis por la presencia de clínica de cuadro infeccioso y hemocultivo materno positivo, y 12 neonatos fueron diagnosticados de listeriosis neonatal por la presencia de clínica de cuadro infeccioso y hemocultivo positivo. Seis (6/21) casos acabaron en aborto, 8 (8/21) casos en cesárea, 6 (6/21) partos fueron vaginales, 11 (11/21) RN fueron ingresados en la unidad de cuidados intensivos neonatales (UCIN), una (1/21) muerte se produjo durante el período neonatal, una gestación siguió en curso y 2 (2/21) RN sanos no requirieron ingreso (2/21)

Objective: To determine the prevalence of perinatal infection with Listeria monocytogenes in our center and to analyze the effects of this infection during pregnancy and labour. Material and methods: Twenty-one cases of L. monocytogenes infection occurring in the University Maternity Hospital of the Canary Islands (Spain)between 1992 and 2004 were analyzed. Cases were identified through the blood culture registry of the hospital’s Preventive Medicine Service. Cases were defined as a positive blood culture to L. monocytogenes in pregnant women and/or their newborns. The following variables were evaluated: the incidence of L. monocytogenes infection during this period, age and parity of the pregnant women, symptoms, results of complementary investigations, treatment, type and route of delivery, alterations in cardiotocographic recording, amniotic fluid characteristics, and perinatal outcomes. All cases with a positive blood culture to L. monocytogenes were analyzed. An overall analysis of the results was performed. Subsequently, the patients were divided into 2 groups: women with L. monocytogenes infection during pregnancy, diagnosed by positive maternal blood culture, and those with an apparently normal pregnancy whose neonates had a positive blood culture to L. monocytogenes.Results: The incidence was 21 cases of infection by L. monocytogenes diagnosed in our center out of 97,839 births (2.1 cases per 10,000 births). Nine women and 12 neonates were diagnosed with listeriosis on the basis of symptoms and a positive blood culture. Miscarriage occurred in 6 women (6/21), cesarian section was performed in 8 (8/21) and there were 6 vaginal deliveries (6/21). Eleven neonates (11/21) were admitted to the neonatal intensive care unit, one neonate died (1/21), one pregnancy was still in course, and two healthy neonates did not require admission to the neonatal intensive care unit (2/21)