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BackgroundInduction of labour (IDP) is the artificial initiation of labour with the goal of achieving a vaginal delivery. IDP is one of the most frequently performed obstetric procedures in the world. Recent data indicate a highly variable percentage of induction depending on the country.MethodsA descriptive study was carried out on different aspects that are part of the ITP process through a survey prepared according to the Delphi method distributed among the 37 participating hospitals from June to October 2021.ResultsThe mean induction rate was 30.6%. The average rate of caesarean sections was 21.4%. 75% of the centers had a rate higher than 20% and only in 1 center was it lower than 15%. In 11 centers they were not available to use misoprostol and in 4 centers they did not have oxytocin as PDI. Mechanical methods were available in 23 hospitals. In 16 centers they had a double Cook balloon; in 5 they used a Foley catheter and in 2 hospitals they used both devices. In 4 hospitals they used mechanical methods simultaneously with prostaglandins. In all but 5 centers, continuous monitoring was performed in low-risk pregnancies, at least for the first hour. In these 5 centers, windows of 20 minutes were carried out from the start of the induction

We thank K. Shashok for translating the original manuscript into English., Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). A review of the available literature on fetal heart rate (FHR) monitoring in preterm fetuses shows that studies are scarce, and the evidence thus far is unclear. The lack of reference standards for CTG patterns in preterm fetuses can lead to misinterpretation of the changes observed in electronic fetal monitoring (EFM). The aims of this narrative review were to summarize the most relevant concepts in the field of CTG interpretation in preterm fetuses, and to provide a practical approach that can be useful in clinical practice. Materials and Methods: A MEDLINE search was carried out, and the published articles thus identified were reviewed. Results: Compared to term fetuses, preterm fetuses have a slightly higher baseline FHR. Heart rate is faster in more immature fetuses, and variability is lower and increases in more mature fetuses. Transitory, low-amplitude decelerations are more frequent during the second trimester. Transitory increases in FHR are less frequent and become more frequent and increase in amplitude as gestational age increases. Conclusions: The main characteristics of FHR tracings changes as gestation proceeds, and it is of fundamental importance to be aware of these changes in order to correctly interpret CTG patterns in preterm fetuses.

Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study.&nbsp, Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9, range 17–34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson’s coefficient −0.128 (p &lt, 0.05). Conclusions: In the period 2000–2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.

Alloscardovia omnicolens is a recently-reported microorganism with unknown pathogenic implications. It has been isolated in various clinical localizations but not in the endocervix. We isolated A. omnicolens in an endocervical sample from a 31-yr-old patient with preterm premature rupture of membranes (PPROM) in week 33+3 of pregnancy. The main risk of PPROM is prematurity and the possibility of developing infectious chorioamnionitis, which can be lethal for the mother and newborn. This is the first report of an association between A. omnicolens and PPROM, although its pathogenic role has not yet been elucidated.

The placental acretism defined as the abnormal insertion of chorionic villi in the myometrium is one of the main causes of maternal mortality The key of the progress in the maternal foetal results is the prenatal diagnostic which is based fundamentally on the ultrasound scan to perform a multidisciplinary programming of the treatment conservative or surgical We present a case study of a pregnant woman in which conservative treatment was performed initially with embolization of hypogastric arteries leaving the placenta in situ after delivery but that days later the patient needed hysterectomy for sepsis due to necrosis tissue placenta

The aim of infusion of a sterile solution into the uterine cavity during labor is to increase the volume or the dilution of the amniotic fluid. This measure can be used prophylactically or therapeutically depending on the aim of infusion. There is as yet no broad consensus on the precise indications for amnioinfusion, particularly regarding prophylactic amnioinfusion for oligohydramnios. This review aims to shed light on this issue and concludes that additional, well-designed studies are needed to provide data that can help clinicians choose the most appropriate procedure.

Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including criteria for the diagnosis of UTI and asymptomatic bacteriuria in pregnancy are clarified; IAP in preterm labour and premature rupture of membranes, and the management of the newborn in relation to GBS carrier status of the mother are also revised. These recommendations are only addressed to the prevention of GBS early neonatal infection, are not effective against late neonatal infection.

Resumen La tasa de parto vaginal instrumental esta disminuyendo en todos los paises desarrollados a costa de un aumento generalizado de la tasa de cesareas. El parto operatorio vaginal fallido es una situacion indeseada por los obstetras, que puede conllevar en algunas ocasiones un aumento de la morbilidad materno-fetal y en casos extremos un aumento de la mortalidad fetal. Estos riesgos pueden minimizarse o evitarse mediante una evaluacion individualizada de cada gestante, feto y situacion clinica, aplicando los protocolos recomendados por las sociedades cientificas para la realizacion de un parto instrumental y abandonando la via vaginal en el momento adecuado, sin prolongar el numero de intentos o sin aumentar la intensidad de la traccion realizada. La experiencia en parto operatorio vaginal es imprescindible, debiendose abandonar dicho procedimiento ante la inseguridad del obstetra.

Resumen Objetivo Evaluar la eficacia de la pulsioximetria y el electrocardiograma fetal en la conduccion del parto con registro de frecuencia cardiaca fetal compatible con riesgo de perdida del bienestar fetal (RPBF). Sujetos y metodos Se trataba de un estudio experimental aleatorizado abierto con dos brazos; en uno se aplico la tecnica de la pulsioximetria y en el otro la tecnica STAN®. En cada grupo se incluyo a 40 gestantes con feto unico, gestacion a termino, en presentacion cefalica y registro cardiotocografico (RCTG) compatible con RPBF. Se analizaron las variables: tasa total de cesareas, indicaciones basadas en el RPBF y las repercusiones en el equilibrio acido-base neonatal. Resultados No se han obtenido diferencias significativas en cuanto a la tasa de cesareas (el 47,5 frente al 40%; p = 0,33) ni a la indicacion por RPBF (el 32,5 frente al 37,5%; p = 0,41). Tampoco en los resultados neonatales. Conclusiones La utilizacion de la pulsioximetria y STAN®21, como metodos auxiliares del RCTG; no han demostrado ser superiores en lo que se refiere a descenso de la tasa de cesareas o mejoria del bienestar fetal.

Resumen Objetivo La Sociedad Espanola de Obstetricia y Ginecologia (SEGO) establece como uno de sus objetivos el conocer la tasa de mortalidad materna en Espana durante el periodo 2010-2012 y sus principales causas Sujetos y metodo Con este fin, la SEGO constituye un grupo de trabajo que elabora una encuesta que se remite a los 191 jefes de Servicio de hospitales publicos y privados espanoles. El analisis de los datos se llevo a cabo de forma confidencial, al igual que los nombres de los centros de los que procedencia. Se llevo a cabo un procedimiento confidencial de los datos y su procedencia. Se cruzaron. Se analizan las causas obstetricas directas e indirectas los datos con los publicados por el Instituto Nacional de Estadistica (INE). Resultados Respondieron 45 hospitales (23,56%). La encuesta representa el 18,9% de los recien nacidos en Espana en ese periodo. La tasa de mortalidad materna (TMM) fue de 6,00/100.000 nacidos. Se considero una subestimacion del 48% de los datos registrados por el INE. Las causas obstetricas directas representaron el 37,5%, siendo la hemorragia postparto la mas importante. La causa obstetrica indirecta represento el 56,25%. El porcentaje de autopsias fue del 31%. Conclusiones La TMM fue de 6/100.000 nacidos. El porcentaje de subestimacion en las cifras oficiales se cifra en el 48%. La causa obstetrica directa represento el 37,5%, siendo la hemorragia posparto la mas frecuente. Se proponen medidas para mejorar esta informacion en nuestro pais.

Objective: To analyze perinatal outcomes in singleton pregnancies with a single umbilical artery (SUA) as an isolated finding with no other underlying disorders.Methods: This retrospective observational study compared a group of pregnancies with SUA (n = 127) and a group with a normal 3-vessel umbilical cord (n = 27 752). The study variables comprised maternal and obstetric characteristics and perinatal outcomes.Results: The frequency of SUA was 0.45%. Pregnancies with SUA ended more frequently with cesarean delivery, and had a higher risk that the indication for cesarean delivery was non-reassuring fetal heart rate (NRFHR). Neonates in the SUA group had a lower weight for gestational age, and a higher risk of low umbilical cord blood pH.Conclusion: Obstetricians should monitor fetal growth closely in pregnancies with SUA, and be alert to NRFHR during labor and delivery.

Aims:To compare the outcomes of term gestations with oligohydramnios in the absence of other underlying disorders and term gestations with normal amniotic fluid.Methods:A retrospective analysis of obstetric outcomes in 27,708 term pregnancies. We compared three groups: labor induced because of oligohydramnios, spontaneous onset of labor with normal amniotic fluid, and labor induced because of late term pregnancy with normal amniotic fluid. We excluded pregnancies with maternal or fetal diseases or disorders potentially related with amniotic fluid alterations. The main outcome measures were mode of delivery, neonatal birth weight, umbilical artery blood pH, Apgar scores and neonatal discharge status.Results:Compared to spontaneous labor, induction of labor because of oligohydramnios was associated with a higher risk of cesarean delivery and small size of the fetus for gestational age (SGA). Compared to induction because of late term pregnancy there were no significant differences in neonatal, although neonates had a higher risk of being SGA.Conclusion:The only perinatal outcome for which the risk was higher in term pregnancies with isolated oligohydramnios was SGA. The systematic induction of labor in these pregnancies should be questioned.

It has been a significant reduction in neonatal group B streptococcus (GBS) infection in Spain following the widespread application of intrapartum antibiotic prophylaxis. In 2010, new recommendations have been published by the CDC and this fact, together with the new knowledge and experience available, has driven to the participating scientific societies publishing these new recommendations. In these recommendations is advised to study all pregnant women at 35-37 gestation weeks` to determine if they are colonized by GBS and to administer intrapartum antibiotic prophylaxis (IAP) to all colonized mothers. Microbiological methods to identify pregnant GBS carriers are updated and intrapartrum antibiotic prophylaxis in preterm labour and premature rupture of membranes and the management of the newborn in relation to GBS carrier status of the mother are also revised.

Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including criteria for the diagnosis of UTI and asymptomatic bacteriuria in pregnancy are clarified; IAP in preterm labour and premature rupture of membranes, and the management of the newborn in relation to GBS carrier status of the mother are also revised. These recommendations are only addressed to the prevention of GBS early neonatal infection, are not effective against late neonatal infection.