Revealed versus concealed criteria for placental insufficiency in an unselected obstetric population in late pregnancy (RATIO37): randomised controlled trial study protocol.

INTRODUCTION: Fetal growth restriction (FGR) affects 5%-10% of all pregnancies, contributing to 30%-50% of stillbirths. Unfortunately, growth restriction often is not detected antenatally. The last weeks of pregnancy are critical for preventing stillbirth among babies with FGR because there is a pronounced increase in stillbirths among growth-restricted fetuses after 37 weeks of pregnancy. Here we present a protocol (V.1, 23 May 2016) for the RATIO37 trial, which evaluates an integrated strategy for accurately selecting at-risk fetuses for delivery at term. The protocol is based on the combination of fetal biometry and cerebroplacental ratio (CPR). The primary objective is to reduce stillbirth rates. The secondary aims are to detect low birth weights and adverse perinatal outcomes. METHODS AND ANALYSIS: The study is designed as multicentre (Spain, Chile, Mexico,Czech Republic and Israel), open-label, randomised trial with parallel groups. Singleton pregnancies will be invited to participate after routine second-trimester ultrasound scan (19+0-22+6 weeks of gestation), and participants will be randomly allocated to receive revealed or concealed CPR evaluation. Then, a routine ultrasound and Doppler scan will be performed at 36+0-37+6 weeks. Sociodemographic and clinical data will be collected at enrolment. Ultrasound and Doppler variables will be recorded at 36+0-37+6 weeks of pregnancy. Perinatal outcomes will be recorded after delivery. Univariate (with estimated effect size and its 95% CI) and multivariate (mixed-effects logistic regression) comparisons between groups will be performed. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the principles of Good Clinical Practice. This study was accepted by the Clinical Research Ethics Committee of Hospital Clinic Barcelona on 23May 2016. Subsequent approval by individual ethical committees and competent authorities was granted. The study results will be published in peer-reviewed journals and disseminated at international conferences

Cribado de parto prematuro con progesterona salival

Preterm birth is the most frequent cause of perinatal morbidity and mortality, especially before 34 weeks. Current screening methods include medical history of preterm delivery and ultrasound assessment of cervix length during the second trimester of pregnancy, which give a detection rate of approximately 65% with a false positive rate of 10%. Vaginal progesterone therapy has proved to reduce the risk of early preterm delivery by 50% in patient under risk. This might suggest that preterm pregnancies have lower levels of progesterone compared to term pregnancies. Although, the prediction of prematurity using biomarkers, including plasma progesterone, has been researched for several years, none of them have proved to be associated with preterm delivery. However, measuring salivary progesterone has already been suggested to be a potential biomarker associated with prematurity in pregnancies at high risk of preterm delivery. Saliva is a fluid that reflects only the free fraction of the biologically active steroidal hormone, and thus is more representative measure than the total plasma progesterone, which is the one usually measured in laboratories. For these reasons, the aim of our study is to evaluate whether the assessment of salivary progesterone can be used as a screening test for prediction of preterm delivery less than 34 weeks in pregnant women who attended at our Fetal Medicine Unit at 11-14 and 20-25 weeks of gestation

Episiotomía y disfunciones del piso pélvico femenino

Pelvic floor dysfunctions are highly prevalent in our population significantly affecting the quality of life of women. Pregnancy and childbirth are well recognized risk factors. It has recently become clear that pelvic floor trauma encompass more than perineal trauma or “what one could see in the delivery room.” The levator ani muscle may be affected at birth with the loss of the integral structure of the pelvic floor support, secondarily triggering the descent of the pelvic organs. The overdistension of the urogenital hiatus and anal sphincter injuries can also be consequences of a vaginal birth. An episiotomy is an intervention that seeks to facilitate the expulsion of the fetus expanding the perineum preventing tissue distension and perineal tear. However, this claim raised by its developer has no scientific basis. Today the restrictive practice of this procedure is recommended, given the potential complications that may arise when it is systematically performe. Despite this recommendation, there are no conclusive studies that explore the role that episiotomy has in obstetric pelvic floor trauma

Validación de criterios ecográficos IOTA (International Ovarian Tumor Analysis Group) para caracterizar masas anexiales y determinar riesgo de malignidad en un grupo de mujeres con sospecha de cáncer de ovario

Epithelial carcinoma of the ovary is a gynecological malignancy associated with high mortality rate due to diagnosis in advanced stages, which occurs in more than 75% of the cases. Recent strategies in reducing mortality have been studied, however screening tests have not demonstrated to help in the diagnosis at early stages. Subjective impression of the examiner using transvaginal ultrasound is considered the best method to discriminate between benign and malignant adnexal tumors. The International Ovarian Tumor Analysis Group (IOTA) based on ultrasound features of the adnexal masses, has developed robust rules and prediction models that can be used by different examiners in various clinical settings.In Chile during 2012, national guidelines about epithelial ovarian cancer were published, establishing referral and management criteria. Little mention about ultrasound exam was included: all “solid tumors or complex adnexal masses” are sonographic criteria to refer patients to gynecologic oncology units. Considering that many functional or benign pathologies can be classified as “complex tumors”, it is important to use validated prediction models to improve accuracy of ultrasonography and therefore optimize the referral to gynecological oncologists and avoid surgeries of misclassified adnexal pathologies

INDICADORES DE CALIDAD DE ASISTENCIA EN OBSTETRICIA

Se presenta una selección de indicadores de calidad de asistencia obstétrica, obtenidos a través de una acuciosa revisión internacional de los indicadores utilizados por organizaciones públicas, privadas y sin fines de lucro, que persiguen mejorar la práctica asistencial en maternidades. Se presenta la comparación de los estándares de dichos indicadores con los obtenidos en el Servicio de Maternidad del Hospital Clínico de la Universidad de Chile el año 2004, y la justificación de la selección de los mismos. Se deja esbozado el trabajo futuro mediante técnicas que permitan la mejoría de indicadores, a través de sistemas "por posibilidades de mejora" y/o "sistemas de monitorización

Guía y protocolos clínicos sobre atención de embarazadas y recién nacidos en crisis sanitaria coronavirus (junio 2020)

Este documento tiene como propósito aportar tanto al aislamiento físico en el combate preventivo por la infección por coronavirus, como a la mantención de la atención médica que asegure los cuidados de nuestras embarazadas. Esta guía clínica abordará una serie de aspectos relacionados con la sospecha, diagnóstico y manejo de la infección viral en el curso del embarazo, parto, puerperio, neonato y anestesia del parto. También entregará una propuesta que racionaliza el número de controles y ecografías en el embarazo, y los cuidados de desinfección de las salas de ecografías