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INTRODUCTION: The aim of this study is to report our clinical experience in the management of pregnant women infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during the first thirty days of the Coronavirus disease (COVID-19) pandemic MATERIAL AND METHODS: We reviewed clinical data from the first 60 pregnant women with COVID-19 whose care was managed at Puerta de Hierro University Hospital, Madrid, Spain from March 14(th) to April 14(th) , 2020 Demographic data, clinical findings, laboratory test results, imaging findings, treatment received, and outcomes were collected An analysis of variance (Kruskal-Wallis test) was performed to compare the medians of laboratory parameters Fisher's exact test was used to evaluate categorical variables A correspondence analysis was used to explore associations between variables RESULTS: A total of 60 pregnant women were diagnosed with COVID-19 The most common symptoms were fever and cough (75 5%, each) followed by dyspnea (37 8%) Forty-one patients (68 6%) required hospital admission (18 due to disease worsening and 23 for delivery) of whom 21 patients (35%) underwent pharmacological treatment, including hydroxychloroquine, antivirals, antibiotics and tocilizumab No renal or cardiac failures or maternal deaths were reported Lymphopenia (50%), thrombocytopenia (25%), and elevated C-reactive protein (CRP) (59%) were observed in the early stages of the disease Median CRP, D-dimer and the neutrophil/lymphocyte ratio were elevated High CRP and D-dimer levels were the parameters most frequently associated with severe pneumonia The Neutrophil/lymphocyte ratio was found to be the most sensitive marker for disease improvement (relative risk: 6 65;95% CI: 4 1-5 9) During the study period, 18 of the women (78%) delivered vaginally All newborns tested negative for SARS-CoV-2 and none of them were infected during breastfeeding No SARS-CoV-2 was detected in placental tissue CONCLUSIONS: Most of the pregnant COVID-19 positive patients had a favorable clinical course However, one-third of them developed pneumonia, of whom 5% presented a critical clinical status CRP and D-dimer levels positively correlated with severe pneumonia and the neutrophil/lymphocyte ratio decreased as the patients improved clinically Seventy-eight percent of patients had a vaginal delivery No vertical or horizontal transmissions were diagnosed in the neonates during labor or breastfeeding

Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis.Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008-2016).In the 2017-2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation).These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications.

Research question Is there an association between SARS-CoV-2 infection and first-trimester miscarriage? Design This multicentre prospective study included a cohort of women with first-trimester miscarriages registered consecutively by seven Spanish hospitals where universal PCR screening for SARS-CoV-2 infection was implemented with both miscarriages and deliveries. The incidence of SARS-CoV-2 infection among women with first-trimester miscarriages was compared with the rate registered in women on admission to the delivery ward within the same time frame using a mixed-effects Poisson regression analysis, considering ‘hospital’ as random effect. The characteristics of SARS-CoV-2 positive and negative patients who miscarried were compared through two-sided univariable analyses. Results A total of 301 miscarriages were registered, 11 (3.7%) to SARS-CoV-2 infected and 290 to non-infected women. In the same time frame as the miscarriages 1936, deliveries were registered, 44 [2.3%] of them were SARS-CoV-2 infected. No differences in terms of SARS-CoV-2 infection incidence were observed between infected miscarriages and infected deliveries (P = 0.233). Regarding the differences observed between miscarriages in SARS-CoV-2 positive and negative women, more inevitable miscarriages occurred in the group of infected women (36.4% versus 16.5% in non-infected women; P = 0.004), and there was greater surgical management of miscarriages (27.3% versus 8.2% in non-infected women; P = 0.036), probably in line with the greater number of inevitable miscarriages observed in this group. Conclusions No association between SARS-CoV-2 infection and risk of first-trimester miscarriage was observed; however, the type of miscarriage seems to differ between SARS-CoV-2 positive and negative women, with inevitable miscarriage being more frequent among infected women.

Objective To evaluate the perinatal and maternal outcomes of pregnancies in SARS-CoV-2 infected women, comparing spontaneous and In Vitro Fertilization (IVF) pregnancies (with either own or donor oocytes). Design Multicentre, prospective, observational study. Setting 78 centres participating in the Spanish COVID19 Registry. Patients 1,347 SARS-CoV-2 positive pregnant women registered consecutively between February 26th and November 5th, 2020. Interventions Patient´s information was collected from their medical records, and multivariable regression analyses were performed, controlling for maternal age and the clinical presentation of infection. Main outcome measures Obstetrics and neonatal outcomes, pregnancy comorbidities, intensive care unit admission, mechanical ventilation need and medical conditions. Results The IVF group was composed of 74 (5.5%) women whereas the spontaneous group included 1,275 (94.5%) women. Operative delivery rate was high in all patients, especially in the IVF group, where C-section became the most frequent method of delivery (55.4%, compared to 26.1% of spontaneous). The reason for C-section was induction failure in 56.1% of IVF patients. IVF women had more gestational hypertensive disorders [16.2% vs 4.5% among spontaneous, adjusted Odds Ratio (aOR) 5.31, 95% Confidence Interval (CI) 2.45-10.93) irrespective of oocyte origin. The higher rate of ICU admittance observed in the IVF group (8.1% vs 2.4% spontaneous) was attributed to pre-eclampsia (aOR 11.82, 95% CI 5.25-25.87), not to the type of conception, Conclusions High rate of operative delivery has been observed in SARS-CoV-2 infected women, especially in IVF pregnancies; method of conception does not affect foetal or maternal outcomes, except for pre-eclampsia., CAPSULE: Method of conception does not affect foetal or maternal outcomes in SARS-CoV-2 infected women, except for pre-eclampsia.

The COVID-19 pandemic has raised questions about the possible cross immunity resulting from common vaccination programs and SARS-CoV-2 infection. Therefore, the Spanish Obstetric Emergency group performed a multicenter prospective study on the vaccination status of Influenza and Tdap (diphtheria, tetanus and pertussis vaccine boost administered in adulthood) in consecutive cases of SARS-CoV-2 infection in a pregnancy cohort, in order to assess its possible association with the clinical presentation and severity of symptoms of SARS-CoV-2 infection, as well as to determine the factors that may affect vaccination adherence. A total of 1150 SARS-CoV-2 positive pregnant women from 78 Spanish hospitals were analyzed: 183 had not received either vaccine, 23 had been vaccinated for Influenza only, 529 for Tdap only and 415 received both vaccines. No association was observed between the vaccination status and the clinical presentation of SARS-CoV-2 infection and/or the severity of symptoms. However, a lower adherence to the administration of both vaccines was observed in the Latin-American subgroup. Based on the results above, we reinforce the importance of maternal vaccination programs in the actual pandemic. Health education campaigns should be specially targeted to groups less likely to participate in these programs, as well as for a future SARS-CoV-2 vaccination campaign., This research was supported by public funds obtained in competitive calls: Grant COV20/ 00021 from the Instituto de Salud Carlos III-Spanish Ministry of Health, and co-financed with Fondo Europeo de Desarrollo Regional (FEDER) funds

Shoulder dystocia (SD) training is recommended by diverse international healthcare organizations; however, it is not so in Spain, and there is no specific programmes. The objective of the study was to evaluate the level of knowledge and attitudes towards resolving a SD among a large sample of spanish obstetricians and midwives.A multi-professional team carried out simulation-based training courses. Descriptive observational study where mean, standard deviation, minimum and maximum or median and interquartile intervals according to the distribution will be used for continuous variables. For the discrete variables, the number and the corresponding percentages will be reported.Between December 2015 and 2019, the team carried out 17 editions of SD workshop and 904 active professionals were trained in labour wards in different parts of Spain. The results showed that 64.8% of the professionals had learned to solve shoulder dystocia through books and/or 58.4% theoretical classes. 60.4% (380) of the respondents had not received any type of training in simulation in obstetrics. 87.1% (415/476) of the students had not felt prepared to face a SD when they finished the residency At the time of answering this survey, 61.8% (358) did not feel prepared to solve a SD.Training in Shoulder Dystocia in Spain is mainly theoretical and a high number of professionals recognize that they are not sufficiently prepared to face it with guarantees.El entrenamiento en distocia de hombros (DH) está recomendado por numerosas sociedades médicas internacionales y, sin embargo, en España, no existen programas específicos de entrenamiento. El objetivo de este estudio fue evaluar el nivel de conocimiento y habilidades prácticas para resolver una distocia de hombros de un amplio número de matronas y ginecólogos españoles que habían realizado un curso basado en simulación.El equipo multiprofesional de simulación obstétrica realizo talleres basados en simulación para la resolución de la DH. Estudio descriptivo observacional donde para las variables continuas se utilizará media, desviación estándar, mínimo y máximo o mediana e intervalos intercuartiles de acuerdo con la distribución. Para las variables discretas se reportarán el número y los porcentajes correspondientes.Entre diciembre de 2015 y 2019, el equipo llevo a cabo 17 ediciones del taller de DH y formo a 904 profesionales de diferentes partes de España. Los resultados mostraron que Un 64,8% de los profesionales había aprendido a solucionar la distocia de hombros a través de libros y/o un 58,4% clases teóricas. El 60,4% (380) de los encuestados, no había recibido ningún tipo de formación en simulación en obstetricia. Un 87,1% (415/476) de los alumnos no se había sentido preparado para enfrentarse a una DH cuando terminó la residencia En el momento de contestar esta encuesta, un 61,8% (358) no se sentía preparado para resolver una DH.La formación en distocia de hombros en España es principalmente teórica y un alto numero de profesionales reconoce que no están suficientemente preparados para afrontarla con garantías.

Background The first reports of the Chinese experience in the management of newborns of mothers with SARS-CoV 2 infection did not recommend mother-baby contact or breastfeeding. At present, the most important International Societies, such as WHO and UNICEF, promote breastfeeding and mother-baby contact as long as adequate measures to control COVID-19 infection are followed. In cases where maternal general health conditions impede direct breastfeeding or in cases of separation between mother and baby, health organizations encourage and support expressing milk and safely providing it to the infants. Methods A series of 22 case studies of newborns to mothers with COVID-19 infection from March 14th to April 14th, 2020 was conducted. Mothers and newborns were followed for a median period of 1.8 consecutive months. Results Out of 22 mothers, 20 (90.9%) chose to breastfeed their babies during hospital admission. Timely initiation and skin to skin contact at delivery room was performed in 54.5 and 59.1%, respectively. Eighty two percent of newborns to mothers with COVID-19 were fed with breast milk after 1 month, decreasing to 77% at 1.8 months. Six of 22 (37.5%) mothers with COVID-19 required transitory complementary feeding until exclusive breastfeeding was achieved. During follow-up period, there were no major complications, and no neonates were infected during breastfeeding. Conclusions Our experience shows that breastfeeding in newborns of mothers with COVID-19 is safe with the adequate infection control measures to avoid mother-baby contagion. Supplementing feeding with pasteurized donor human milk or infant formula may be effective, until exclusive breastfeeding is achieved.

This cohort study estimates associations between mode of delivery (vaginal vs cesarean delivery) and maternal and neonatal birth outcomes among SARS-CoV-2–infected women giving birth in Spain.

To compare the effectiveness of a cervical pessary and vaginal progesterone to prevent spontaneous preterm births in pregnant women with cervical lengths 25 mm or less as measured by transvaginal ultrasonography.This was a multicenter, open-label, randomized, noninferiority trial. Women with singleton pregnancies and a short cervix (25 mm or less) measured transvaginally at the second-trimester ultrasonogram were invited to participate. They were computer-randomized (one to one) into cervical pessary placement or treatment with vaginal progesterone (200 mg/24 hours). The primary outcome was spontaneous preterm delivery before 34 weeks of gestation. The noninferiority margin was set at 4% with a 0.025 one-sided α level and a statistical power of 80%. That is, if the 95% CI upper bound exceeded 4%, the pessary could not be deemed noninferior. A sample size of 254 women was required to show noninferiority of the pessary to progesterone.The trial was conducted from August 2012 to April 2016 with the participation of 27 Spanish hospitals. A total of 254 patients were enrolled and 246 included in the intention-to-treat analysis. Demographic and baseline characteristics were similar across groups. The rate of spontaneous delivery before 34 weeks of gestation was 14% (n=18/127) in the pessary group and 14% (n=17/119) in the progesterone group with a risk difference of -0.11% (95% CI -8.85% to 8.62%; P=.99), that is, noninferiority was not shown for the pessary. The incidence of increased vaginal discharge (87% vs 71%, P=.002) and discomfort (27% vs 3%, P.001) was significantly higher in the pessary group.A cervical pessary was not noninferior to vaginal progesterone for preventing spontaneous birth before 34 weeks of gestation in pregnant women with short cervixes.EU Clinical Trials Register, 2012-000241-13; ClinicalTrials.gov, NCT01643980.

Background: The number of cases of coronavirus disease 19 (COVID-19) is rapidly increasing, including among pregnant patients. Current data are reassuring regarding the clinical course of COVID-19 among pregnant women and suggest the absence of vertical transmission. Caesarean sections (CS), however, were performed in almost all cases. This study aimed to assess the safety of vaginal birth in patients with COVID-19 and the risk of vertical transmission compared to patients undergoing CS. Methods: In this multicentre cohort study, we included all pregnant patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection close to delivery. Maternal and neonatal outcomes were recorded. Findings: 82 patients were included. 78 (95.1%) presented with mild to moderate symptoms at admission and 4 (4.9%) presented with severe symptoms. Patients with severe symptoms were delivered by pre-labour CS. Among the patients with mild to moderate symptoms, 41 (52.6%) had a vaginal birth and 37 (47.4%) underwent CS. Among patients with a CS, 9 (11%) patients developed severe adverse outcomes and 6 (7.3%) required mechanical ventilation. No maternal complications were noted among patients with a vaginal birth. Evidence of vertical transmission was not documented, but perinatal transmission was suspected in two new-borns, all delivered by CS. Interpretation: Maternal outcomes are generally good among COVID-19 patients infected close to delivery, with a minority of patients requiring intensive care management. Vaginal birth in pregnant women with mild to moderate COVID-19 symptoms seems safe. Though perinatal transmission cannot be excluded, delivery by CS does not seem to prevent it. Funding Statement: None. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The study was approved by the Ethics committee (Ref PI 55/20).

Achondroplasia is the most frequent nonlethal skeletal dysplasia, with a prevalence of 1 : 5000 to 1 : 40,000 live births, and it is caused by a fibroblast growth factor receptor alteration. The combination of achondroplasia and Klinefelter syndrome is extremely rare and just four reports have been published in the literature, which were all diagnosed postnatally. We report the fifth case described of this uncommon association and its prenatal diagnosis. In cases of prenatal diagnosis of achondroplasia with additional suspicious morphological abnormalities, an invasive test such as amniocentesis must be carried out to assess the karyotype normality.

espanolIntroduccion. La simulacion es un elemento que ya se utiliza de manera profusa en el entrenamiento de obstetras y gine- cologos. Permite entrenarse en situaciones complejas con seguridad para la paciente. Presentamos un programa piloto con la aplicacion de distintas tecnicas de simulacion al entrenamiento en ecografia obstetrica. Sujetos y metodos. Disenamos un programa con parte presencial y no presencial destinado a 12 medicos internos resi- dentes de ginecologia y obstetricia. La parte no presencial consistio en el acceso a unos documentos en una pagina web. La parte presencial consistio en tres talleres con una duracion total de cuatro horas: taller de ecografia en la semana 20 mediante realidad virtual, taller de tecnicas invasivas con simuladores de tareas y taller de habilidades comunicativas en dar malas noticias mediante paciente estandarizado. Se les paso a los alumnos una encuesta de satisfaccion anonima (con escala de 1 a 10) al final del programa. Resultados. El resultado de la experiencia de aprendizaje fue muy satisfactorio, como asi lo reflejaron los alumnos en la puntuacion media global del curso, que fue de 9,1. Conclusion. En este trabajo mostramos que la simulacion en el aprendizaje de la ecografia obstetrica ha sido satisfactoria para los residentes. EnglishIntroduction. Simulation is an useful tool widely used among obstetrician and gynaecologist, as it allows training in complex situations increasing patient’s safety. We are introducing a brand-new simulation program based on obstetric ultrasound. Subjects and methods. It is designed half face-to-face for 12 gynecology and obstetrics residents. The non presence part of the course was online, with access to several documents at a website. The on-site modality consisted of 3 workshops that lasted 4 hours in total: the 20th week ultrasound workshop implementing virtual reality, the invasive techniques course using mannequin simulation, and the development of bad news communicative skills with standardized patients workshop. All participants were required to fill an anonymous satisfaction survey (scale 1 to 10) at the end of the programme. Results. The learning experience was very satisfactory and the learners gave their inputs in the feedback survey. The final score was 9.1 over 10