Crecimiento intrauterino restringido tardío: optimización del diagnóstico y tratamiento

El crecimiento intrauterino restringido (CIR) constituye una entidad en la que el feto no alcanza su potencial intrínseco de crecimiento1. Si bien puede deberse a cromosomopatías (5-20%), infecciones congénitas (5-10%) o malformaciones (1-2%), el CIR en más de dos terceras partes de los casos es el resultado de un desajuste entre el aporte placentario y las necesidades nutricionales fetales2,3. Es el denominado CIR de causa placentaria (CIRp).El CIRp tardío (aquel diagnosticado a partir de la semana 32), afecta a un 3-5% de todos los embarazos4 y se asocia a un mayor riesgo de morbilidad perinatal y mortalidad, así como comorbilidades a largo plazo tanto a nivel de desarrollo neurológico, como cardiovascular o metabólico5. Su correcta identificación y evaluación son claves para un manejo adecuado, resultando además fundamental diferenciar a aquellos fetos constitucionalmente pequeños de los que realmente tienen un CIRp, ya que su evolución y pronóstico serán distintos. Para ello se han identificado una serie de marcadores prenatales ecográficos, como la estimación del peso fetal o la evaluación de la hemodinámica materno-fetal mediante el estudio Doppler. En el caso de los primeros, el estudio hemodinámico será normal y el pronóstico bueno, con una adecuada tolerancia al parto. En el de los segundos, el peso fetal estimado (PFE) se sitúa por debajo del percentil (p) 3 o bien, sin llegar a caer hasta percentiles tan bajos, aparecen alteraciones hemodinámicas y el pronóstico, aunque favorable, será algo peor, con aumento de la mortalidad intrauterina a partir de la semana 37-386, menor tolerancia al parto y peor evolución posnatal7..

Diagnostic accuracy of prenatal ultrasound in coarctation of aorta: systematic review and individual participant data meta‐analysis

Objective: To determine the diagnostic accuracy of prenatal ultrasound in detecting coarctation of the aorta (CoA). Methods: An individual participant data meta-analysis was performed to report on the strength of association and diagnostic accuracy of different ultrasound signs in detecting CoA prenatally. MEDLINE, EMBASE and CINAHL were searched for studies published between January 2000 and November 2021. Inclusion criteria were fetuses with suspected isolated CoA, defined as ventricular and/or great vessel disproportion with right dominance on ultrasound assessment. Individual participant-level data were obtained by two leading teams. PRISMA-IPD and PRISMA-DTA guidelines were used for extracting data, and the QUADAS-2 tool was used for assessing quality and applicability. The reference standard was CoA, defined as narrowing of the aortic arch, diagnosed after birth. The most commonly evaluated parameters on ultrasound, both in B-mode and on Doppler, constituted the index test. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and likelihood ratios were computed using the hierarchical summary receiver-operating-characteristics model. Results: The initial search yielded 72 studies, of which 25 met the inclusion criteria. Seventeen studies (640 fetuses) were included. On random-effects logistic regression analysis, tricuspid valve/mitral valve diameter ratio > 1.4 and > 1.6, aortic isthmus/arterial duct diameter ratio 1.4 (P = 0.048) and bidirectional flow at the foramen ovale (P = 0.012) were independently associated with CoA. Redundant foramen ovale was inversely associated with CoA (P = 0.037). Regarding diagnostic accuracy, tricuspid valve/mitral valve diameter ratio > 1.4 had a sensitivity of 72.6% (95% CI, 48.2-88.3%), specificity of 65.4% (95% CI, 46.9-80.2%) and DOR of 5.02 (95% CI, 1.82-13.9). The sensitivity and specificity values were, respectively, 75.0% (95% CI, 61.1-86.0%) and 39.7% (95% CI, 27.0-53.4%) for pulmonary artery/ascending aorta diameter ratio > 1.4, 47.8% (95% CI, 14.6-83.0%) and 87.6% (95% CI, 27.3-99.3%) for aortic isthmus diameter Z-score of < -2 in the sagittal view and 74.1% (95% CI, 58.0-85.6%) and 62.0% (95% CI, 41.6-78.9%) for aortic isthmus diameter Z-score of < -2 in the three-vessel-and-trachea view. Hypoplastic aortic arch had a sensitivity of 70.0% (95% CI, 42.0-88.6%), specificity of 91.3% (95% CI, 78.6-96.8%) and DOR of 24.9 (95% CI, 6.18-100). The diagnostic yield of prenatal ultrasound in detecting CoA did not change significantly when considering multiple categorical parameters. Five of the 11 evaluated continuous parameters were independently associated with CoA (all P < 0.001) but all had low-to-moderate diagnostic yield. Conclusions: Several prenatal ultrasound parameters are associated with an increased risk for postnatal CoA. However, diagnostic accuracy is only moderate, even when combinations of parameters are considered. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.Depto. de MedicinaDepto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEpubAPC financiada por la UC

Prediction of perinatal survival in early‐onset fetal growth restriction: role of placental growth factor

Objective To analyze the ability to predict perinatal survival and severe neonatal morbidity of cases with early-onset fetal growth restriction (eoFGR) using maternal variables, ultrasound parameters and angiogenic markers at the time of diagnosis. Methods This was a prospective observational study in a cohort of singleton pregnancies with a diagnosis of eoFGR (< 32 weeks of gestation). At diagnosis of eoFGR, complete assessment was performed, including ultrasound examination (anatomy, biometry and Doppler assessment) and maternal serum measurement of the angiogenic biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). Logistic regression models for the prediction of perinatal survival (in cases diagnosed at < 28 weeks) and severe neonatal morbidity (in all liveborn cases) were calculated. Results In total, 210 eoFGR cases were included, of which 185 (88.1%) survived perinatally. The median gestational age at diagnosis was 27 + 0 weeks. All cases diagnosed at ≥ 28 weeks survived. In cases diagnosed < 28 weeks, survivors (vs non-survivors) had a higher gestational age (26.1 vs 24.4 weeks), estimated fetal weight (EFW; 626 vs 384 g), cerebroplacental ratio (1.1 vs 0.9), PlGF (41 vs 18 pg/mL) and PlGF multiples of the median (MoM; 0.10 vs 0.06) and lower sFlt-1/PlGF ratio (129 vs 479) at the time of diagnosis (all P < 0.001). The best combination of two variables for predicting perinatal survival was provided by EFW and PlGF MoM (area under the receiver-operating-characteristics curve (AUC), 0.84 (95% CI, 0.75–0.92)). These were also the best variables for predicting severe neonatal morbidity (AUC, 0.73 (95% CI, 0.66–0.80)). Conclusions A model combining EFW and maternal serum PlGF predicts accurately perinatal survival in eoFGR cases diagnosed before 28 weeks of gestation. Prenatal prediction of severe neonatal morbidity in eoFGR cases is modest regardless of the model used. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology

Cardiovascular and renal health: Preeclampsia as a risk marker.

BACKGROUND Cardiovascular (CVD) and chronic kidney disease (CKD) in women have unique risk factors related to hormonal status and obstetric history that must be taken into account. Pregnancy complications, such as preeclampsia (PE), can reveal a subclinical predisposition for the development of future disease that may help identify women who could benefit from early CVD and CKD prevention strategies. MATERIALS AND METHODS Review of PE and its association with future development of CVD and CKD. RESULTS Multiple studies have established an association between PE and the development of ischemic heart disease, chronic hypertension, peripheral vascular disease, stroke and CKD. It has not been sufficiently clarified if this relation is a causal one or if it is mediated by common risk factors. Nevertheless, the presence of endothelial dysfunction and thrombotic microangiopathy during pregnancies complicated with PE makes us believe that PE may leave a long-term imprint. Early identification of women who have had a pregnancy complicated by PE becomes a window of opportunity to improve women's health through adequate follow-up and targeted preventive actions. Oxidative stress biomarkers and vascular ultrasound may play a key role in the early detection of this arterial damage. CONCLUSIONS The implementation of preventive multidisciplinary targeted strategies can help slow down CVD and CKD's natural history in women at risk through lifestyle modifications and adequate blood pressure control. Therefore, we propose a series of recommendations to guide the prediction and prevention of CVD and CKD throughout life of women with a history of PE.The present work has been funded by the Instituto de Salud Carlos III with the project “Cardiovascular health in women with a history of early preeclampsia” (grant PI19/01579), and by the Spanish Society of Cardiology, through a Grant for Translational Research Projects in Cardiology (grant TP18/0308).S

Prediction of perinatal survival in early‐onset fetal growth restriction: role of placental growth factor

Fondos FEDERObjective To analyze the ability to predict perinatal survival and severe neonatal morbidity of cases with early-onset fetal growth restriction (eoFGR) using maternal variables, ultrasound parameters and angiogenic markers at the time of diagnosis. Methods This was a prospective observational study in a cohort of singleton pregnancies with a diagnosis of eoFGR (< 32 weeks of gestation). At diagnosis of eoFGR, complete assessment was performed, including ultrasound examination (anatomy, biometry and Doppler assessment) and maternal serum measurement of the angiogenic biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). Logistic regression models for the prediction of perinatal survival (in cases diagnosed at < 28 weeks) and severe neonatal morbidity (in all liveborn cases) were calculated. Results In total, 210 eoFGR cases were included, of which 185 (88.1%) survived perinatally. The median gestational age at diagnosis was 27 + 0 weeks. All cases diagnosed at ≥ 28 weeks survived. In cases diagnosed < 28 weeks, survivors (vs non-survivors) had a higher gestational age (26.1 vs 24.4 weeks), estimated fetal weight (EFW; 626 vs 384 g), cerebroplacental ratio (1.1 vs 0.9), PlGF (41 vs 18 pg/mL) and PlGF multiples of the median (MoM; 0.10 vs 0.06) and lower sFlt-1/PlGF ratio (129 vs 479) at the time of diagnosis (all P < 0.001). The best combination of two variables for predicting perinatal survival was provided by EFW and PlGF MoM (area under the receiver-operating-characteristics curve (AUC), 0.84 (95% CI, 0.75–0.92)). These were also the best variables for predicting severe neonatal morbidity (AUC, 0.73 (95% CI, 0.66–0.80)). Conclusions A model combining EFW and maternal serum PlGF predicts accurately perinatal survival in eoFGR cases diagnosed before 28 weeks of gestation. Prenatal prediction of severe neonatal morbidity in eoFGR cases is modest regardless of the model used. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.European CommissionMinisterio de Economía, Industria y Competitividad (España)Instituto de Salud Carlos III (España)Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEpu

Seroprevalence analysis of SARS-CoV-2 in pregnant women along the first pandemic outbreak and perinatal outcome.

ObjectivesTo evaluate the progression of the seroprevalence of SARS-CoV-2 in the pregnant population of the south of Madrid during the first wave of the COVID-19 pandemic. Secondarily we aimed to evaluate maternal and perinatal outcomes.Study designRetrospective cohort study conducted at Hospital Universitario 12 de Octubre during weeks 10 to 19 of 2020, coinciding with the Spanish lockdown. We tested 769 serum samples obtained from routine serological testing during the first and third trimesters of pregnancy for specific IgG anti SARS-CoV-2 RBD and S proteins. RT-PCR tests were performed in suspected cases according to clinical practice. We compared maternal and perinatal outcomes in those with delivered pregnancies (n = 578) according to the presence or absence of specific IgG antibodies. Those with positive IgG were subdivided by the presence or absence of Covid-19 related symptoms at any time and the results of RT-PCR testing if performed. Therefore, we had 4 study groups: G1 (IgG negative), G2 (IgG positive, asymptomatic, RT-PCR testing negative or not done), G3 (IgG positive, symptomatic, RT-PCR testing negative or not done), and G4 (IgG positive, symptomatic, RT-PCR positive).ResultsSeropositivity increased from 0% to 21.4% (95% CI 11.8-31.0) during the study period, of which 27.9% had an asymptomatic course. Overall outcomes were favorable with a significant increased rate of preterm birth in G4 vs G1 (21.4% vs 6.7%) and cesarean/operative delivery (50% vs 26.9%). Asymptomatic and mild cases did not have differences regarding pregnancy course when compared to seronegative women. There were no documented cases of vertical or horizontal transmission.ConclusionSeroprevalence in pregnant women in southern Madrid went up to 21.4% of which 27.9% had an asymptomatic course. Overall perinatal results were favorable, especially in those asymptomatic

Prediction of postnatal circulation in pulmonary atresia/critical stenosis with intact ventricular septum: systematic review and external validation of models

ObjectiveA favorable postnatal prognosis in cases ofpulmonary atresia/critical stenosis with intact ventricu-lar septum (PA/CS-IVS) is generally equated with thepossibility of achieving biventricular (BV) repair. Identi-fication of fetuses that will have postnatal univentricular(UV) circulation is key for prenatal counseling, opti-mization of perinatal care and decision-making regardingfetal therapy. We aimed to evaluate the accuracy ofCorrespondence to:Dr C. Villala ́ın, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Avenida de C ́ordoba,Madrid 28041, Spain (e-mail: [email protected])Accepted: 23 January 2023published models for predicting postnatal circulation inPA/CS-IVS using a large internationally derived validationcohort.MethodsThis was a systematic review of publisheduni- and multiparametric models for the predictionof postnatal circulation based on echocardiographicfindings at between 20 and 28 weeks of gestation.Models were externally validated using data fromthe International Fetal Cardiac Intervention Registry.Sensitivity, specificity, predictive values, area underthe receiver-operating-characteristics curves (AUCs) andproportion of cases with truevspredicted outcome werecalculated.ResultsEleven published studies that reported prog-nostic parameters of postnatal circulation were iden-tified. Models varied widely in terms of the mainoutcome (UV (n=3), non-BV (n=3), BV (n=3),right-ventricle-dependent coronary circulation (n=1) ortricuspid valve size at birth (n=1)) and in terms ofthe included predictors (single parameters only (n=6),multiparametric score (n=4) or both (n=1)), and weredeveloped on small sample sizes (range, 15 – 38). Ninemodels were validated externally given the availability ofthe required parameters in the validation cohort. Tricus-pid valve diameterZ-score, tricuspid regurgitation, ratiosbetween right and left cardiac structures and the presence. Postnatal circulation in pulmonary atresia15of ventriculocoronary connections (VCC) were the mostcommonly evaluated parameters. Multiparametric mod-els including up to four variables (ratios between rightand left structures, right ventricular inflow duration, pres-ence of VCC and tricuspid regurgitation) had the bestperformance (AUC, 0.80 – 0.89). Overall, the risk of UVoutcome was underestimated and that of BV outcomewas overestimated by most models.ConclusionsCurrent prenatal models for the predictionof postnatal outcome in PA/CS-IVS are heterogeneous.Multiparametric models for predicting UV and non-BVcirculation perform well in identifying BV patients buthave low sensitivity, underestimating the rate of fetusesthat will ultimately have UV circulation. Until betterdiscrimination can be achieved, fetal interventions mayneed to be limited to only those cases in which non-BVpostnatal circulation is certain.Objetivo.Un pron ́ostico postnatal favorable en casos de atresia pulmonar/estenosis cr ́ıtica con tabique interventricularintacto (PA/CS-IVS, por sus siglas en ingl ́es) se equipara generalmente con la posibilidad de lograr una reparaci ́onbiventricular (BV). La identificaci ́on de los fetos que tendr ́an circulaci ́on univentricular (UV) postnatal es clave parael asesoramiento prenatal, la optimizaci ́on de los cuidados perinatales y la toma de decisiones relativas a la terapiafetal. El objetivo fue evaluar la precisi ́on de los modelos publicados para predecir la circulaci ́on postnatal en casos dePA/CS-IVS utilizando para ello una gran cohorte de validaci ́on estimada a partir de datos internacionales.M ́etodos.El estudio consisti ́oenunarevisi ́on sistem ́atica de los modelos uni- y multiparam ́etricos publicados para lapredicci ́on de la circulaci ́on postnatal basados en los hallazgos ecocardiogr ́aficos entre las semanas 20 y 28 de gestaci ́on.Los modelos se validaron externamente utilizando datos del Registro Internacional de Intervenciones Card ́ıacas Fetales.Se calcularon la sensibilidad, la especificidad, los valores predictivos, el ́area bajo las curvas (ABC) de caracter ́ısticasoperativas del receptor y la proporci ́on de casos con resultado verdadero frente a resultado pronosticado.Resultados.Se identificaron once estudios publicados en los que se hab ́ıan reportado par ́ametros pron ́osticos de lacirculaci ́on postnatal. Los modelos variaron ampliamente en cuanto al resultado principal (UV (n=3), no-BV (n=3), BV(n=3), la circulaci ́on coronaria dependiente del ventr ́ıculo derecho (n=1)oeltama ̃no de la v ́alvula tric ́uspide al nacer(n=1)) y en cuanto a los predictores incluidos (s ́olo par ́ametros ́unicos (n=6), puntuaci ́on multiparam ́etrica (n=4) oambos (n=1)), y se desarrollaron a partir de muestras peque ̃nas (rango, 15 – 38).Dada la disponibilidad de los par ́ametros requeridos en la cohorte de validaci ́on, se validaron externamente nuevemodelos. La puntuaci ́on est ́andar (Z) del di ́ametro de la v ́alvula tric ́uspide, la insuficiencia tricusp ́ıdea, los cocientesentre las estructuras card ́ıacas derecha e izquierda y la presencia de conexiones ventr ́ıculo-coronarias (CVC) fueronlos par ́ametros evaluados con mayor frecuencia. El mejor desempe ̃no (ABC, 0,80 – 0,89) correspondi ́o a los modelosmultiparam ́etricos que inclu ́ıan hasta cuatro variables (cocientes entre las estructuras derecha e izquierda, duraci ́on delinflujo ventricular derecho, presencia de CVC e insuficiencia tricusp ́ıdea). En general, en la mayor ́ıa de los modelos sesubestim ́o el riesgo del resultado UV y se sobreestim ́oeldelresultadoBV.Conclusiones.Los modelos prenatales actuales para la predicci ́on del resultado postnatal en la PA/CS-IVS sonheterog ́eneos. Los modelos multiparam ́etricos para predecir la circulaci ́on UV y no-BV funcionan bien para laidentificaci ́on de pacientes BV, pero tienen una sensibilidad baja, que subestima la tasa de fetos que finalmente tendr ́ancirculaci ́on UV. Hasta que se consiga una mejor forma para poder discriminar entre casos, puede ser necesario limitarlas intervenciones fetales ́unicamente a aquellos en los que est ́e asegurado que la circulaci ́on postnatal es no-BV.©2023 The Authors.Ultrasound in Obstetrics & Gynecologypublished by John Wiley &SYSTEMATIC REVIEWSons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.Depto. de MedicinaFac. de MedicinaTRUEpubAPC financiada por la UC

Frequent Alteration of Annexin A9 and A10 in HPV-Negative Head and Neck Squamous Cell Carcinomas: Correlation with the Histopathological Differentiation Grade

The annexin protein superfamily has been implicated in multiple physiological and pathological processes, including carcinogenesis. Altered expression of various annexins has frequently been observed and linked to the development and progression of various human malignancies. However, information is lacking on the expression and clinical significance of annexin A9 (ANXA9) and A10 (ANXA10) in head and neck squamous cell carcinomas (HNSCC). ANXA9 and ANXA10 expression was evaluated in a large cohort of 372 surgically treated HPV-negative HNSCC patients and correlated with the clinicopathologic parameters and disease outcomes. Down-regulation of ANXA9 expression was found in 42% of HNSCC tissue samples, compared to normal epithelia. ANXA9 expression in tumors was significantly associated with oropharyngeal location and histological differentiation grade (p &lt; 0.001). In marked contrast, ANXA10 expression was absent in normal epithelium, but variably detected in the cytoplasm of cancer cells. Positive ANXA10 expression was found in 64% of tumors, and was significantly associated with differentiation grade (p &lt; 0.001), being also more frequent in oropharyngeal tumors (p = 0.019). These results reveal that the expression of both ANXA9 and ANXA10 is frequently altered in HNSCC and associated to the tumor differentiation grade, suggesting that they could be implicated in the pathogenesis of these cancers

The use of antenatal corticosteroids for fetal maturation: Clinical practice guideline by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine foundation

This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the use of antenatal corticosteroids (ACS) for fetal maturation. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of ACS with the aim to increase the timely administration and avoid unnecessary or excessive use. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world and serves as a guideline for use in clinical practice

Acquisition of basic practical skills in Obstetrics and Gynecology

La necesaria formación práctica de los alumnos en el ámbito de la Obstetricia y Ginecología se desarrolla en las rotaciones que hacen por las diferentes estaciones de los servicios clínicos hospitalarios (consultas, quirófano, paritorio, plantas de hospitalización, urgencias). Esta inmersión clínica del alumno tiene como finalidad observar los procedimientos diagnósticos exploratorios y pautas terapéuticas más habituales en el campo de nuestra especialidad, tratándole de capacitar para “Saber hacer con competencia (rutinariamente y sin supervisión)” y, en la medida de lo posible, en “Haberlo practicado tuteladamente (bajo supervisión del tutor)”, las actividades o procedimientos más importantes de esta especialidad. Dentro de estos, los más básicos y a la vez más importantes son la anamnesis obstétrica, la anamnesis ginecológica, la exploración del aparato genital femenino, y la exploración mamaria. En los Hospitales Universitarios de la UCM estas rotaciones pueden realizarse tanto en el contexto de la asignatura de Obstetricia y Ginecología como en la de la Práctica Clínica I, ambas en el 4º año del Grado de Medicina. En la Unidad Docente del Hospital Universitario 12 de octubre se realizan dentro de la asignatura de Práctica Clínica I. Según el organigrama en vigor, la internalización de los alumnos en nuestro Servicio tiene lugar durante el primer cuatrimestre del curso, de forma coordinada con las rotaciones por la Unidad Médica y por la Unidad Quirúrgica, que también son en el mismo período, distribuyéndose para ello los alumnos en 4 grupos. Cada uno de ellos se compone de 24-25 alumnos, que permanecen internalizados en el Servicio durante 14-16 jornadas matutinas o vespertinas, distribuyéndose en 15 estaciones clínicas. A esto hay que añadir 2 jornadas de guardia en horario de 15 a 22 horas. A la hora de distribuir las rotaciones de los alumnos existían dos opciones: la primera, intentar que en el tiempo asignado los alumnos pudieran pasar por todas las estaciones clínicas, con el fin de que conocieran, aunque fuera de forma somera, la mayor parte de las actividades clínicas esenciales de nuestra especialidad. La segunda, renunciar a lo anterior y sortear entre los alumnos qué tres rotaciones harían cada uno, intentando con ello que tuvieran más continuidad en la rotación asignada y por tanto un mejor conocimiento de la actividad realizada en esa estación clínica. Aunque en un principio se optó por la primera fórmula, los propios alumnos solicitaron la segunda opción. El inconveniente de esta segunda fórmula es que la formación en las cuatro actividades o procedimientos antes citados por parte de todos los alumnos no está asegurada, siendo dependiente de en qué estaciones clínicas le corresponde a cada alumno rotar y pudiéndose dar el caso, por tanto, de que un alumno termine su rotación sin haber realizado un interrogatorio clínico a una paciente ginecológica u obstétrica. Esto además supone una dificultad añadida a la hora de afrontar el ECOE de 4º donde todos los alumnos matriculados en Práctica Clínica I tendrán que resolver un escenario clínico obstétrico o ginecológico interrogando a una paciente simulada. Para paliar este problema, y con el fin de asegurar que todos los alumnos reciben una formación básica en los aspectos esenciales de nuestra especialidad antes citados y también de facilitar su internalización, proponemos la realización de un taller o aula de habilidades de la siguiente manera: en jornada de tarde, los alumnos de cada uno de los 4 grupos y de forma previa a su entrada en el Servicio, serán convocados a esta aula de formación clínica donde se les enseñará las bases de la anamnesis en obstetricia y en ginecología, la exploración obstétrica, la ginecológica y la mamaria. Por tanto, se realizarán 4 sesiones, una por grupo. Para ello contaremos con la ayuda de alumnos de 5º y/o 6º que ya han superado la asignatura y que actuarán como formadores, bajo la supervisión del profesor, y nos apoyaremos en el material de simulación (maniquíes) para reproducir los 3 tipos de exploración antes citados. Y lógicamente mediremos el impacto de esta actividad con el fin de conocer hasta qué punto este taller capacita a los alumnos para desarrollar con soltura estas actividades.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaFALSEunpu