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Background Fetal smallness affects 10% of pregnancies. Small fetuses are at a higher risk of adverse outcomes. Their management using estimated fetal weight and feto-maternal Doppler has a high sensitivity for adverse outcomes; however, more than 60% of fetuses are electively delivered at 37 to 38 weeks. On the other hand, classification using angiogenic factors seems to have a lower false-positive rate. Here, we present a protocol for the Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) trial, which compares the use of angiogenic factors and Doppler to manage small fetuses at term. Objective The primary objective is to demonstrate that classification based on angiogenic factors is not inferior to estimated fetal weight and Doppler at detecting fetuses at risk of adverse perinatal outcomes. Methods This is a multicenter, open-label, randomized controlled trial conducted in 20 hospitals across Spain. A total of 1030 singleton pregnancies with an estimated fetal weight ≤10th percentile at 36+0 to 37+6 weeks+days will be recruited and randomly allocated to either the control or the intervention group. In the control group, standard Doppler-based management will be used. In the intervention group, cases with a soluble fms-like tyrosine kinase to placental growth factor ratio ≥38 will be classified as having fetal growth restriction; otherwise, they will be classified as being small for gestational age. In both arms, the fetal growth restriction group will be delivered at ≥37 weeks and the small for gestational age group at ≥40 weeks. We will assess differences between the groups by calculating the relative risk, the absolute difference between incidences, and their 95% CIs. Results Recruitment for this study started on September 28, 2020. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences in early 2023. Conclusions The angiogenic factor–based protocol may reduce the number of pregnancies classified as having fetal growth restriction without worsening perinatal outcomes. Moreover, reducing the number of unnecessary labor inductions would reduce costs and the risks derived from possible iatrogenic complications. Additionally, fewer inductions would lower the rate of early-term neonates, thus improving neonatal outcomes and potentially reducing long-term infant morbidities. Trial Registration ClinicalTrials.gov NCT04502823; https://clinicaltrials.gov/ct2/show/NCT04502823 International Registered Report Identifier (IRRID) DERR1-10.2196/37452

Background: maternal obesity is associated with an increase of both maternal and fetal complications as macrosomia. Aim: to assess the quality of diet in a cohort of pregnant women in terms of Mediterranean diet (MD) adherence and to examine the association between diet quality, obesity, weight gain and fetal growth and perinatal complications. Methods: Mediterranean Diet Adherence Screener (MEDAS) was applied to assess diet quality in 542 pregnant women. Fetal biometric measurements at third-trimester ultrasound were collected and perinatal outcomes were recorded. Results: only 35 % of pregnant women presented a good quality of diet, in terms of adherence to MD. Diet quality significantly increased with lower values of body mass index (BMI) and higher maternal age. Higher BMI was significantly associated with a higher abdominal circumference and estimated fetal weight at the third trimester, a higher risk of hypertension disorder, induction of labor and a higher birthweight. A statistically significant association between diet quality and ultranosographic measures or perinatal outcome was not found. However, a higher weight gain across gestation was significantly associated with a higher risk of gestational diabetes, a higher gestational age at delivery and a higher birthweight. Conclusion: most of our pregnant women did not showed a great diet quality, but there was no evidence that diet quality affected pregnancy complications. On the contrary, pre-pregnancy BMI was related to fetal and neonatal growth and obstetric outcomes, similarly to weight gain across gestation.Introducción: la obesidad materna se asocia con un aumento de complicaciones maternas y fetales, como la macrosomía. Objetivo: evaluar la calidad de la dieta en una cohorte de mujeres embarazadas en términos de adherencia a la dieta mediterránea (DM) y examinar la asociación entre la calidad de la dieta, la obesidad, el aumento de peso y el crecimiento fetal y las complicaciones perinatales. Métodos: se aplicó el Mediterranean Diet Adherence Screener (MEDAS) para evaluar la calidad de la dieta en 542 mujeres embarazadas. Se recogieron las medidas biométricas fetales en la ecografía del tercer trimestre y se registraron los resultados perinatales. Resultados: solo el 35 % de las gestantes presentó una buena calidad de alimentación en términos de adherencia a la DM. La calidad de la dieta aumentó significativamente con valores más bajos de índice de masa corporal (IMC) y mayor edad materna. Un IMC más alto se asoció significativamente con una mayor circunferencia abdominal y peso fetal estimado en el tercer trimestre, un mayor riesgo de trastorno hipertensivo, inducción del parto y mayor peso al nacer. No se encontró una asociación estadísticamente significativa entre la calidad de la dieta y las medidas ecográficas o el resultado perinatal. Sin embargo, un mayor aumento de peso durante la gestación se asoció significativamente con un mayor riesgo de diabetes gestacional, mayor edad gestacional al momento del parto y mayor peso al nacer. Conclusiones: la mayoría de nuestras gestantes no mostró una buena calidad de la dieta, pero no hubo evidencia de que la calidad de la dieta afectara las complicaciones del embarazo. Por el contrario, el IMC pregestacional se relacionó con el crecimiento fetal y neonatal y los resultados obstétricos, de manera similar al aumento de peso durante la gestación.

Placental pathology in SARS-CoV-2-infected pregnancies seems rather unspecific. However, the identification of the placental lesions due to SARS-CoV-2 infection would be a significant advance in order to improve the management of these pregnancies and to identify the mechanisms involved in a possible vertical transmission. The pathological findings in placentas delivered from 198 SARS-CoV-2-positive pregnant women were investigated for the presence of lesions associated with placental SARS-CoV-2 infection. SARS-CoV-2 infection was investigated in placental tissues through immunohistochemistry, and positive cases were further confirmed by in situ hybridization. SARS-CoV-2 infection was also investigated by RT-PCR in 33 cases, including all the immunohistochemically positive cases. Nine cases were SARS-CoV-2-positive by immunohistochemistry, in situ hybridization, and RT-PCR. These placentas showed lesions characterized by villous trophoblast necrosis with intervillous space collapse and variable amounts of mixed intervillous inflammatory infiltrate and perivillous fibrinoid deposition. Such lesions ranged from focal to massively widespread in five cases, resulting in intrauterine fetal death. Two of the stillborn fetuses showed some evidence of SARS-CoV-2 positivity. The remaining 189 placentas did not show similar lesions. The strong association between trophoblastic damage and placenta SARS-CoV-2 infection suggests that this lesion is a specific marker of SARS-CoV-2 infection in placenta. Diffuse trophoblastic damage, massively affecting chorionic villous tissue, can result in fetal death associated with COVID-19 disease.

Objectives Doppler measurement of fetal middle cerebral artery peak systolic velocity (MCA-PSV) is used to screen fetuses at risk of developing fetal anemia. This screening tool has demonstrated to be accurate to estimate the likelihood of fetal anemia and it has been used in the management of fetuses at this risk. It is rare to find in the literature cases of increased MCA-PSV in the absence of fetal anemia. We present the case of an elevated MCA-PSV in the absence of common causes of fetal anemia. Case presentation A 30-year-old woman at 21 weeks of gestation was referred to our unit with a left fetal renal agenesis and single umbilical artery diagnosis. The patient had a poorly controlled type 1 Diabetes with a booking HbA1C of 9.1%. At 31 weeks of gestation, MCA-PSV was raised (>1.5 multiples of the median) in the absence of any cause of fetal anemia and discrepancy of ventricular size with normal fetal heart function were seen. In a subsequent scan, thick interventricular septum was seen and hypertrophic cardiomyopathy (HC) was suggested. Follow-up ultrasonography showed a persistent MCA-PSV in a large for gestation age (LGA) fetus with HC. Due to the prenatal diagnosis of persistent elevated MCA-PSV in LGA fetus with diagnoses of HC in a poorly controlled type 1 diabetic patient labor was induced after fetal lung maturation. Biventricular hypertrophic cardiomyopathy was detected after birth. Conclusions HC may be an explanation for increased MCA-PSV without fetal anemia.

Background Sacrococcygeal teratoma is one of the most frequently prenatally diagnosed neoplasias. Obstetric ultrasound has a role in the diagnosis and management of these tumors during pregnancy. In this report, we describe a multidisciplinary approach in a case of a patient with sacrococcygeal teratomas and preterm delivery, as well as postnatal outcomes. Case presentation A 26-year-old Caucasian woman at 20.3 weeks of gestation with a normal gestational course and no relevant medical or surgical history was referred to our institution with a sacrococcygeal mass diagnosis. Magnetic resonance imaging confirmed the diagnosis of sacrococcygeal teratoma type I according to the Altman classification. Follow-up with ultrasound showed an increase in the size of the mass up to 190 × 150 mm, high Doppler flow, and severe polyhydramnios. At 35.1 weeks of gestation, the patient had premature rupture of membranes, and an emergency cesarean section was performed due to recurrent late decelerations detected by fetal heart rate monitoring. Afterward, surgery was performed successfully at 36 hours of life. Posterior controls revealed normal and healthy child growth. Conclusions This case report demonstrates the importance of a multidisciplinary approach to offer the best neonatal outcomes by performing early surgery, as well as the need for follow-up by ultrasound in order to minimize complications by assessing mass growth, Doppler flow, and amniotic fluid.

Presentamos una experiencia formativa innovadora con los estudiantes de la titulación deMaestro/a de Educación Primaria de la Facultad de Ciencias de la Educación de la Universidad de Almería.Se ha realizado en el marco de un Programa Socioeducativo en colegios públicos de un barrio marginal dela ciudad de Almería mediante la metodología de Aprendizaje-Servicio (ApS). Desde la Didáctica de lasCiencias Sociales queremos contribuir a una educación democrática mediante la participación ciudadana.Mostramos algunas valoraciones de nuestros estudiantes en este proceso de investigación-acción. Elbalance positivo de esta evaluación inicial nos motiva para seguir implicados en el desarrollo de proyectoscomo éste donde se vincula universidad, escuela y comunidad. This paper speaks about an innovative training experience with Pre-Service Primary Teacher atthe University of Almeria, Faculty of Education. Carried out in the framework of a social and educationalproject in public schools in a slum in the city of Almeria using service learning methodology. From theteaching of the social sciences our aim seeks to contribute to a democratic education through citizenparticipation. We show some evaluations carried out by our students in the process of action research. Thepositive results of this initial assessment motivates us to keep involved in the development of projects likethis, where University, school and community are linked.

Publicado como libro con título Educar para la Participación Ciudadana en la Enseñanza de las Ciencias Sociales, 2 volúmenes

Resumen basado en el de la publicación Se desarrollan las medidas contempladas en el Plan de Igualdad entre Hombres y Mujeres en la Educación para hacer cada vez más real y efectivo el derecho a la igualdad entre todos los seres humanos, para poner en valor la contribución de las mujeres al desarrollo de las sociedades, y para eliminar, desde nuestras competencias en educación, aquellos presupuestos, costumbres y prácticas que invisibilizan, minusvaloran o discriminan a las mujeres. Se sigue la estructura siguiente: biografías de mujeres, en las que se puede observar la pluralidad de experiencias femeninas, los diversos itinerarios vitales seguidos por las mujeres en diferentes momentos de la historia, a lo que se añaden una serie de propuestas de actividades, bibliografía y enlaces web. Andalucía Biblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 planta; 28014 Madrid; Tel. +34917748000; biblioteca@mecd.es ESP

Resumen de las autoras El tema de la inmigración, debido al interés social que despierta y la repercusión que tiene y tendrá en la realidad educativa de la provincia de Almería, es de obligado tratamiento en la formación inicial del profesorado. Es por ello, que las autoras se plantean abordar un trabajo interdisciplinar desde la Didáctica General y la Didáctica de las Ciencias Sociales, con el alumnado de primero y segundo curso de Magisterio de Primaria y segundo de Magisterio de Educación Musical sobre este tema. La experiencia se ha desarrollado en el marco de la Facultad de Humanidades y Ciencias de la Educación de esta Universidad durante el curso académico 2000-2001 y en la actualidad se sigue trabajando el tema. Andalucía ESP