Predicció de complicacions maternes i fetals en pacients amb Pre-eclàmpsia

PE is classified as the third cause of global maternal deaths and it is also associated with increased perinatal morbidity and mortality, For all these conditions, an accurate identification of those patients at highest risk of complications remains a goal for modern obstetrics in developed countries. This would lead to a more appropriate management of these high-risk patients with a more intensive strategy and the possibility of home monitoring for those patients with a low-risk of complications. Third-trimester abnormal uterine artery Doppler has been related to worse perinatal outcomes among patients both with and without pregnancy complications. Furthermore, in PE clinical severity has been directly related to the extension of placental ischemia: the larger the ischemia, the more severe the clinical manifestations and the poorer the perinatal outcome. However, the role of uterine artery Doppler evaluation in the identification of pregnancy at risk of maternal or foetal morbidity with early-onset PE has not been investigated. In that context, our first article evaluated the performance of Uterine Doppler in the prognostic assessment of adverse outcomes. Our second article further explored the performance of Uterine Doppler in early-PE. Moreover, the excess in anti-angiogenic factors produced by the placenta may cause damage to the vasculature and distal orga. Karumanchi et al. showed that excess sFlt-1 would mediate the multiple symptoms of PE. Parallel, circulating PlGF levels are much lower in those patients who would develop PE than in normal pregnancies. The concentration of circulating PlGF begins to decrease 9 to 11 weeks before the onset of pre-eclampsia, with substantial reductions during the 5 weeks before the onset of hypertension or proteinuria. In that context, placental growth factor (PlGF) has emerged as a potential tool to be included in diagnostic and prognostic algorithms. This pro-angiogenic marker seems to be a more sensitive and precise predictor of PE than any other single biomarker, as it reflects placental function. Low concentrations of PlGF may reflect poor placentation and thus a response to oxidative stress in the placenta, which are mainly present in early PE. However, this excellent profile of PlGF as a marker of early PE may limit its clinical applicability for prognostic assessment if a high number of women already have very low levels at the onset of PE. The median of PlGF was of 12 pg/mL in women with either early onset or preterm PE. According to our results: 1- Uterine Doppler was the best predictive parameter for perinatal outcomes in pregnancies with PE and it was even more effective than classical clinical parameters 2- Uterine Doppler should be incorporated in the management strategy of PE at the clinical onset of the disease 3- Early-onset preeclamptic patients with impaired uterine Doppler are at higher risk of maternal and neonatal complications. 4- Uterine Doppler may help in the prognostic evaluation of early-PE and should be incorporated in the management strategy at its clinical onset 5- Very low PlGF is a highly prevalent finding in early onset PE leading to its low specificity and low positive predictive value 6- The predictive role of a low PlGF level in predicting maternal complications in very early PE is limite

Predicció de complicacions maternes i fetals en pacients amb Pre-eclàmpsia

[eng] PE is classified as the third cause of global maternal deaths and it is also associated with increased perinatal morbidity and mortality, For all these conditions, an accurate identification of those patients at highest risk of complications remains a goal for modern obstetrics in developed countries. This would lead to a more appropriate management of these high-risk patients with a more intensive strategy and the possibility of home monitoring for those patients with a low-risk of complications. Third-trimester abnormal uterine artery Doppler has been related to worse perinatal outcomes among patients both with and without pregnancy complications. Furthermore, in PE clinical severity has been directly related to the extension of placental ischemia: the larger the ischemia, the more severe the clinical manifestations and the poorer the perinatal outcome. However, the role of uterine artery Doppler evaluation in the identification of pregnancy at risk of maternal or foetal morbidity with early-onset PE has not been investigated. In that context, our first article evaluated the performance of Uterine Doppler in the prognostic assessment of adverse outcomes. Our second article further explored the performance of Uterine Doppler in early-PE. Moreover, the excess in anti-angiogenic factors produced by the placenta may cause damage to the vasculature and distal orga. Karumanchi et al. showed that excess sFlt-1 would mediate the multiple symptoms of PE. Parallel, circulating PlGF levels are much lower in those patients who would develop PE than in normal pregnancies. The concentration of circulating PlGF begins to decrease 9 to 11 weeks before the onset of pre-eclampsia, with substantial reductions during the 5 weeks before the onset of hypertension or proteinuria. In that context, placental growth factor (PlGF) has emerged as a potential tool to be included in diagnostic and prognostic algorithms. This pro-angiogenic marker seems to be a more sensitive and precise predictor of PE than any other single biomarker, as it reflects placental function. Low concentrations of PlGF may reflect poor placentation and thus a response to oxidative stress in the placenta, which are mainly present in early PE. However, this excellent profile of PlGF as a marker of early PE may limit its clinical applicability for prognostic assessment if a high number of women already have very low levels at the onset of PE. The median of PlGF was of 12 pg/mL in women with either early onset or preterm PE. According to our results: 1- Uterine Doppler was the best predictive parameter for perinatal outcomes in pregnancies with PE and it was even more effective than classical clinical parameters 2- Uterine Doppler should be incorporated in the management strategy of PE at the clinical onset of the disease 3- Early-onset preeclamptic patients with impaired uterine Doppler are at higher risk of maternal and neonatal complications. 4- Uterine Doppler may help in the prognostic evaluation of early-PE and should be incorporated in the management strategy at its clinical onset 5- Very low PlGF is a highly prevalent finding in early onset PE leading to its low specificity and low positive predictive value 6- The predictive role of a low PlGF level in predicting maternal complications in very early PE is limite

Eating disorders during gestation: Implications for mother's health, fetal outcomes, and epigenetic changes

Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period

Recomanacions per a la detecció precoç i el maneig de les dones embarassades afectades per la verola del mico (Monkeypox) i dels nadons

Embarassades; Verola del mico; RecomanacionsEmbarazadas; Viruela del mono; RecomendacionesPregnant; Monkeypox; RecommendationsAquest document conté informació sobre la verola del mico i la seva detecció i procediment en dones embarassades

Protocol d'atenció i acompanyament al naixement a Catalunya

Acompanyament al naixement; Voluntats de la dona; Atenció al nadóBirth support; Women's wills; Newborn careAcompañamiento en el nacimiento; Voluntades de la mujer; Atención al recién nacidoL’Organització Mundial de la Salut, l’any 2018 va proposar una sèrie d’actuacions per a l’atenció al moment del part, que tenen per lema ‘Atenció per a una experiència positiva en el naixement’. En aquest document s’actualitza el ‘Protocol del part, puerperi i atenció al nadó’, document elaborat pel Departament de Salut, publicat l’any 2003 i actualitzat l’any 2019 com a ‘Protocol d’atenció i acompanyament al naixement’, seguint les recomanacions de l’OMS, així com totes aquelles basades en l’evidència científica, amb el màxim respecte a les opinions i voluntats de les dones gestants i amb l’objectiu d’ajudar-les a elles i a les seves famílies a tenir una experiència positiva en el part. Les activitats de promoció de la salut i prevenció de la malaltia són l’eix vertebrador d’aquest protocol i de tots els que es coordinen des del Servei de Salut Maternoinfantil de la Sub-direcció de Promoció de la Salut de l’Agència de Salut Pública de Catalunya del Departament de Salut. En aquest sentit, cal ressaltar la seva relació amb el Protocol del seguiment de l’embaràs a Catalunya (3a. edició) que es va presentar el 2018, amb el qual comparteix principis i enfocament. El protocol s’estructura en tres capítols en relació a les etapes (prepart, part i puerperi), recollint en el tercer, l’atenció la nadó. Cada capítol té diversos apartats en les activitats a realitzar, la informació a donar i el registre, entre d’altres. Es recull, després, la bibliografia i una sèrie de annexos amb eines pràctiques

Predicció de complicacions maternes i fetals en pacients amb Pre-eclàmpsia

PE is classified as the third cause of global maternal deaths and it is also associated with increased perinatal morbidity and mortality, For all these conditions, an accurate identification of those patients at highest risk of complications remains a goal for modern obstetrics in developed countries. This would lead to a more appropriate management of these high-risk patients with a more intensive strategy and the possibility of home monitoring for those patients with a low-risk of complications. Third-trimester abnormal uterine artery Doppler has been related to worse perinatal outcomes among patients both with and without pregnancy complications. Furthermore, in PE clinical severity has been directly related to the extension of placental ischemia: the larger the ischemia, the more severe the clinical manifestations and the poorer the perinatal outcome. However, the role of uterine artery Doppler evaluation in the identification of pregnancy at risk of maternal or foetal morbidity with early-onset PE has not been investigated. In that context, our first article evaluated the performance of Uterine Doppler in the prognostic assessment of adverse outcomes. Our second article further explored the performance of Uterine Doppler in early-PE. Moreover, the excess in anti-angiogenic factors produced by the placenta may cause damage to the vasculature and distal orga. Karumanchi et al. showed that excess sFlt-1 would mediate the multiple symptoms of PE. Parallel, circulating PlGF levels are much lower in those patients who would develop PE than in normal pregnancies. The concentration of circulating PlGF begins to decrease 9 to 11 weeks before the onset of pre-eclampsia, with substantial reductions during the 5 weeks before the onset of hypertension or proteinuria. In that context, placental growth factor (PlGF) has emerged as a potential tool to be included in diagnostic and prognostic algorithms. This pro-angiogenic marker seems to be a more sensitive and precise predictor of PE than any other single biomarker, as it reflects placental function. Low concentrations of PlGF may reflect poor placentation and thus a response to oxidative stress in the placenta, which are mainly present in early PE. However, this excellent profile of PlGF as a marker of early PE may limit its clinical applicability for prognostic assessment if a high number of women already have very low levels at the onset of PE. The median of PlGF was of 12 pg/mL in women with either early onset or preterm PE. According to our results: 1- Uterine Doppler was the best predictive parameter for perinatal outcomes in pregnancies with PE and it was even more effective than classical clinical parameters 2- Uterine Doppler should be incorporated in the management strategy of PE at the clinical onset of the disease 3- Early-onset preeclamptic patients with impaired uterine Doppler are at higher risk of maternal and neonatal complications. 4- Uterine Doppler may help in the prognostic evaluation of early-PE and should be incorporated in the management strategy at its clinical onset 5- Very low PlGF is a highly prevalent finding in early onset PE leading to its low specificity and low positive predictive value 6- The predictive role of a low PlGF level in predicting maternal complications in very early PE is limite

Protocol d'atenció i acompanyament al naixement a Catalunya

Acompanyament al naixement; Voluntats de la dona; Atenció al nadóBirth support; Women's wills; Newborn careAcompañamiento en el nacimiento; Voluntades de la mujer; Atención al recién nacidoL’Organització Mundial de la Salut, l’any 2018 va proposar una sèrie d’actuacions per a l’atenció al moment del part, que tenen per lema ‘Atenció per a una experiència positiva en el naixement’. En aquest document s’actualitza el ‘Protocol del part, puerperi i atenció al nadó’, document elaborat pel Departament de Salut, publicat l’any 2003 i actualitzat l’any 2019 com a ‘Protocol d’atenció i acompanyament al naixement’, seguint les recomanacions de l’OMS, així com totes aquelles basades en l’evidència científica, amb el màxim respecte a les opinions i voluntats de les dones gestants i amb l’objectiu d’ajudar-les a elles i a les seves famílies a tenir una experiència positiva en el part. Les activitats de promoció de la salut i prevenció de la malaltia són l’eix vertebrador d’aquest protocol i de tots els que es coordinen des del Servei de Salut Maternoinfantil de la Sub-direcció de Promoció de la Salut de l’Agència de Salut Pública de Catalunya del Departament de Salut. En aquest sentit, cal ressaltar la seva relació amb el Protocol del seguiment de l’embaràs a Catalunya (3a. edició) que es va presentar el 2018, amb el qual comparteix principis i enfocament. El protocol s’estructura en tres capítols en relació a les etapes (prepart, part i puerperi), recollint en el tercer, l’atenció la nadó. Cada capítol té diversos apartats en les activitats a realitzar, la informació a donar i el registre, entre d’altres. Es recull, després, la bibliografia i una sèrie de annexos amb eines pràctiques