Uterine Cervical Length Measurement to Reduce Length of Stay in Patients Admitted for Threatened Preterm Labor: A Randomized Trial.

Objective: To study whether knowledge of cervical length (CL) is useful in reducing the length of hospital stay in women admitted because of threatened preterm labor.

Methods: We performed a single-center, parallel, randomized trial at the Hospital Clínic of Barcelona. Inclusion criteria were single pregnancy, gestational age (GA) between 24+0 and 35+6 weeks, Bishop score <6, no parturition within 24-48 h after admission, and no clinical signs of chorioamnionitis, vaginal bleeding, or nonreassuring fetal status.

First-trimester Down syndrome screening in renal-transplanted pregnant women: a model for adjusting the false-positives rates.

Objective: This study aimed to develop a model to adjust the increased β-hCG levels observed in renal-transplanted women, leading to increased false-positive rates in Down syndrome screening.

Methods: Detailed data from 11 renal-transplanted and a nested-cohort of 70 pregnant women, matched by age, parity and gestational age were retrieved from our hospital records. Patient's age, multiples of the median (MoM) values for freeβ-hCG, pregnancy-associated plasma protein-A, nuchal translucency, and creatinine concentration and clearance were noted.

PP106. Risk of long term renal graft loss after pregnancy in renal transplant recipients immunosuppressed with calcineurin inhibitors.

Introduction: Intron long-term graft function are uncertain. Although there have been a large number of successful pregnancies in renal graft recipients, the effects of pregnancy and type of immunosuppressant drugs.

Objectives: To analyze (1) the impact of pregnancy on the long term renal function and graft survival of kidney transplant recipients (KTx), and (2) the impact og the pregnancy in (KTx) immunosupressed with calcineurin inhibitors (CNI).

[Preventing the risk of postpartum depression and premature childbirth by a psychosomatic approach: a randomized multicenter study].

Background And Objective: Randomized studies to assess postnatal depression and preterm childbirth are rarely in conjunction; the 2 problems are treated separately regardless of their common risk factors. The main objective of this study was to evaluate the effects of a prenatal program based on a psychosomatic approach on the risk of postpartum depression (PPD) and preterm childbirth.

Subjects And Method: Controlled clinical trial, randomized and multicenter study.

Previable rupture of membranes: effect of amniotic fluid on pregnancy outcome.

Objective: To evaluate pregnancy outcome and the role of the amount of amniotic fluid (AF) in the prognosis of extremely preterm (<24 weeks) premature rupture of membranes (EPPROM).

Study Design: Women with EPPROM and on-going pregnancy after 1 week of expectant management were included.

Exclusion Criteria: fetal anomalies, termination of pregnancy and spontaneous recovery of AF within the first week.

[Neonatal screening of hemoglobinopathies and G6PD deficiency in Catalonia (Spain). Molecular study of sickle cell disease associated with alpha thalassemia and G6PD deficiency].

Background And Objective: The prevalence of hemoglobinopathies and glucose-6-phosphate dehidrogenase (G6PD) deficiency in the Catalan neonatal population is increasing due to immigration. Coinheritance of more than a single RBC genetic defect is becoming more frequent and diagnostic pitfalls are also increasing. We intended to demonstrate the need to perform an early diagnosis of sickle cell disease (SCD) by means of neonatal screening, to establish the prevalence of SCD associated with alpha thalassemia and G6PD deficiency and to identify genotypes associated with sickle cell disease and G6PD deficiency.

Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe.

Background: The EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System (EUPHRATES) is a set of five linked projects, the first component of which was a survey of policies for management of the third stage of labour and immediate management of postpartum haemorrhage following vaginal birth in Europe.

Objectives: The objectives were to ascertain and compare policies for management of the third stage of labour and immediate management of postpartum haemorrhage in maternity units in Europe following vaginal birth.

Design: Survey of policies.

Clinical approach to intestinal maturation in neonates prenatally exposed to alcohol.

Aim: The need for a non-invasive diagnosis of the effects of ethanol in utero on the development of the intestine in humans led us to look for a serum marker of the structural integrity of the intestine. We propose apolipoprotein A-IV (apoA-IV) as a possible candidate. In humans this protein is synthesized only by intestinal mucosa, it is expressed in the enterocyte of the foetus from 20 weeks of gestation, and it is released to the blood stream after synthesis.

The use of a variable cut-off value of cervical length in women admitted for preterm labor before and after 32 weeks.

Objective: To determine whether the optimal cut-off value to predict low risk of preterm delivery in women admitted for preterm labor should be adjusted for gestational age.

Methods: A cohort of 333 women with singleton pregnancies admitted with preterm labor and intact membranes between 24 and < 36 weeks' gestation was studied. The women were categorized according to prematurity into one of two groups: those admitted at < 32 weeks (Group 1, very preterm) and those admitted at >or= 32 weeks (Group 2, preterm).

Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome.

Objective: To describe sequential changes in uterine artery waveform between the first and second trimesters of gestation and to analyze their association with the subsequent risk of hypertensive disorders and fetal growth restriction (IUGR).

Methods: Sequential uterine artery Doppler recordings were obtained in a final cohort of 870 singleton pregnancies over two gestational age intervals: 11-14 weeks and 19-22 weeks. The left and right uterine arteries were examined by color and pulsed Doppler and the mean pulsatility index (PI) as well as the presence of a bilateral protodiastolic notch were recorded during both intervals.

[Neonatal screening of hemoglobinopathies and glucose-6-phosphate dehydrogenase in Catalonia. Pilot study in anonymous not related population].

Background And Objective: This was a preliminary study on the prevalence of the HbS gene, associated with sickle cell disease, other hemoglobinopathies and G6PD deficiency of immigrant and non-immigrant population of Catalonia.

Patients And Method: A total of 3,189 blood samples from the Catalan Neonatal Screening Program for Metabolic Diseases (CNSPMD) including 1,620 from immigrant population were screened for haemoglobinopathies and G6PD deficiency. For screening of hemoglobinopathies the high performance liquid chromatography (HPLC) method was used and for the screening of G6PD deficiency, we used the fluorescent spot test as described by ICSH.

Nifedipine versus ritodrine for suppression of preterm labor. Comparison of their efficacy and secondary effects.

Objectives: To compare the efficacy of nifedipine and ritodrine in prolonging pregnancy beyond 48 h, 1 week and 36.0 weeks and to evaluate maternal side effects and adverse perinatal outcome.

Study Design: Non-blinded, randomized controlled trial.

Efficacy of two regimens of misoprostol for early second-trimester pregnancy termination.

Objective: To compare the efficacy of a combined regimen of misoprostol with vaginal misoprostol for early 2nd-trimester pregnancy termination.

Methods: This is a prospective study that includes 79 pregnant women who requested legal termination of 2nd-trimester pregnancy between 13 and 22 weeks. Two regimens of misoprostol were used.

First-trimester screening for trisomy 21 in twin pregnancy: does the addition of biochemistry make an improvement?

Objective: To evaluate the effectiveness of the addition of first-trimester biochemistry to fetal nuchal translucency (NT) measurement in the Combined Test when screening for trisomy 21 in twin pregnancies.

Methods: Maternal serum free beta-hCG and PAPP-A were determined at 8 to 12 weeks and fetal NT was measured at 11 to 14 weeks. The individual risks were estimated for each of the fetuses using both NT screening alone and the Combined Test.

Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population.

Objectives: To establish reference values for the first-trimester uterine artery (UtA) pulsatility index (PI) and to investigate the role of UtA Doppler in the early prediction of hypertensive disorders and their associated complications in an unselected Mediterranean population.

Methods: A prospective study including 1091 consecutive singleton pregnancies undergoing routine early ultrasound screening at 11-14 weeks of gestation was performed. The left and right UtA were examined by color and pulsed Doppler transvaginally.

Prenatal diagnosis and management of fetal xerocytosis associated with ascites.

Objectives: To discuss the prenatal diagnosis and management of fetal xerocytosis associated with ascites.

Case Report: A 29-year-old woman with hereditary xerocytosis was found to present a fetus with severe ascites on the 20-week scan. Cordocentesis showed mild anemia and blood transfusion was discarded.

Doppler assessment of fetal aortic isthmus blood flow in two different sonographic planes during the second half of gestation.

Objective: To compare the reliability of Doppler blood flow measurements of the fetal aortic isthmus (AoI) according to whether the sampling plane is obtained from the traditional longitudinal aortic arch (LAA) view or the more recently described three vessels and trachea (3VT) view of the fetal upper mediastinum.

Methods: Doppler blood flow measurements of pulsatility index (PI), resistance index (RI), peak systolic (PSV), end-diastolic (EDV) and time-averaged maximum (TAMXV) velocities were performed in the AoI of 40 fetuses between 24 and 36 weeks of gestation. All measurements were sampled in two different sonographic planes of the AoI: the LAA view, at a few millimeters beyond the origin of the left subclavian artery, and the 3VT view, just before the V-shaped junction of the aortic and ductal arches.

Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome.

Objective: To evaluate the inter- and intra-observer agreement of visual analysis of fetal heart rate tracing and to evaluate the bias introduced by knowledge of perinatal outcome in this interpretation.

Methods: One hundred tracings were independently analyzed by four observers. In a second study period, two observers re-analysed the 100 tracings in order to evaluate intra-observer agreement.

Umbilical artery Doppler and umbilical cord pH at birth in small-for-gestational-age fetuses: valid estimate of their relationship.

Objective: To evaluate the relationship between umbilical artery pulsatility index and the umbilical cord pH in small-for-gestational-age fetuses.

Methods: Data were collected from all pregnancies seen in our Fetal Surveillance Unit that underwent antenatal monitoring for being small-for-gestational-age beyond 24 weeks of pregnancy. A linear regression was used to analyse the effect of the umbilical artery pulsatility index (UAPI) and umbilical artery pH at birth, assessing interaction and controlling for clinically meaningful antenatal, Doppler, biophysical and perinatal variables.

Prenatal diagnosis of a right ventricular diverticulum complicated by pericardial effusion in the first trimester.

A ventricular diverticulum associated with a large pericardial effusion was diagnosed at 13 weeks of gestation. The pericardial effusion resolved spontaneously by 20 weeks and the diverticular size remained the same during pregnancy. In the postnatal period the neonate underwent surgical correction of both the diverticulum and associated ventricular and atrial septal defects.

Impact of ultrasound cervical length assessment on duration of hospital stay in the clinical management of threatened preterm labor.

Objective: To evaluate the impact of ultrasound cervical length measurement on duration of hospital stay in patients admitted for threatened preterm labor.

Study Design: This was a prospective, comparative study in 294 patients with threatened preterm labor in three hospitalization units (Units A, B and C). In the first phase of the study (observational), cervical length was measured by transvaginal ultrasound, but managing physicians were blinded to the results.

Reference ranges for umbilical and middle cerebral artery pulsatility index and cerebroplacental ratio in prolonged pregnancies.

Objective: To construct normal ranges for umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI) and cerebroplacental ratio (CPR) in prolonged pregnancies according to strict methodological criteria using polynomial regression analysis.

Methods: This was a retrospective, cross-sectional observational study involving 140 women, 10 women for each gestational day between 287 and 300 days of gestation. Fetal Doppler parameters were assessed to construct normal reference ranges for UA PI and MCA PI.

Middle cerebral artery Doppler indices at different sites: prediction of umbilical cord gases in prolonged pregnancies.

Objectives: To assess the value of middle cerebral artery Doppler indices obtained from different sampling sites in predicting umbilical cord gases at delivery in prolonged pregnancies.

Methods: This was a prospective study of consecutive pregnant women referred for prolonged-pregnancy surveillance. The predictive value of distal and proximal middle cerebral artery Doppler indices for cord blood gases was evaluated in women who delivered within 48 h of their last antenatal test using stepwise multiple regression.

First-trimester screening for trisomy 21 combining biochemistry and ultrasound at individually optimal gestational ages. An interventional study.

Objective: To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 21 in the general pregnant population using a new timing for the screening approach.

Methods: First-trimester maternal serum biochemical markers (pregnancy-associated plasma protein-A and free-beta hCG) were determined in maternal serum at 7 to 12 weeks. Fetal nuchal translucency and gestational age were assessed at the 10- to 14-week ultrasound scan.

Awareness of the use of folic acid to prevent neural tube defects in a Mediterranean area.

Objectives: The risk of neural tube defects (NTDs) is decreased in women who take folic acid during the periconceptional period. The main objective of our study was to evaluate the awareness of the need for folic acid supplementation and also the actual intake during the periconceptional period to prevent neural tube defects in a Mediterranean area.

Study Design: A retrospective study was performed from 1 July to 30 November 2000.