José Luis Bartha

Use of intrapartum ultrasound in the prediction of complicated operative forceps delivery of fetuses in non-occiput posterior position.

To evaluate the hypothesis that intrapartum ultrasound (ITU) measurements, including the angle of progression (AOP), progression distance (PD) and head direction (HD), can predict complicated forceps delivery in non‐occiput posterior deliveries.

Nuevos criterios diagnósticos de diabetes mellitus gestacional a partir del estudio HAPO. ¿Son válidos en nuestro medio?

Servei d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, España CIBER Bioingenieria, Biomateriales y Nanotecnologı́a, Barcelona, España Departamento de Salud Pública, Historia de la Ciencia y Ginecologı́a, Universidad Miguel Hernández, Alicante, España CIBER en Epidemiologı́a y Salud Pública, Alicante, España Sección de Medicina Materno Fetal, Departamento de Obstetricia y Ginecologı́a, Hospital Universitario Puerta del Mar, Cádiz, España Servei de Diabetis, Endocrinologia i Nutrició, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España CIBER Fisiopatologia de la Obesidad y Nutrición, Girona, España

La episiotomía en España. Datos del año 2006

Resumen En una encuesta realizada por la Seccion de Medicina Perinatal de la SEGO, se ha podido comprobar que durante el ano 2006, la tasa de episiotomias en los partos eutocicos fue del 54,08% y en los partos instrumentales del 92,62%.

Nuevos criterios diagnósticos de diabetes mellitus gestacional a partir del estudio HAPO: ¿Son válidos en nuestro medio?

Rosa Corcoy a,b, , Blanca Lumbreras , José Luis Bartha e y Wifredo Ricart f,g Grupo Español de Diabetes y Embarazo a Servei d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, España b CIBER de Bioingenieria, Biomateriales y Nanotecnologı́a, España c Departamento de Salud Pública, Historia de la Ciencia y Ginecologı́a, Universidad Miguel Hernández, Alicante, España d CIBER de Epidemiologı́a y Salud Pública, España e Sección de Medicina Materno Fetal, Departamento de Obstetricia y Ginecologı́a, Hospital Universitario Puerta del Mar, Cádiz, España f Servei de Diabetis, Endocrinologia i Nutrició, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España g CIBER de Fisiopatologı́a de la Obesidad y Nutrición, España

The effect of customized growth charts on the identification of large for gestational age newborns

Objective: To determine the effect of using customized vs. standard population birthweight curves to define large for gestational age (LGA) infants. Methods: We analyzed data obtained from 2,097 singleton pregnancies using three different methods of classifying newborn birthweight: standard population curves, British or Spanish customized curves. We recorded maternal characteristics, proportion of LGA newborns when using each method, percentage of LGA according to one method but not for the others, and concordance between the different methods. Results: The proportion of LGA newborns according to Spanish customized curves was significantly lower than that calculated using either standard general population birthweight curves or British curves (p < 0.001). A third (33.9%) of the infants classified as LGA according to the general population method were adequate for gestational age (AGA) when the Spanish customized curves were used, and 18.5% of non-LGA were LGA according to customized curves (p < 0.001). Concordance between the different models high, but on excluding AGA the concordance coefficient was low (Cohen’s κ <0.4). Conclusions: The use of customized curves allows differentiation between constitutional LGA and cases of fetal overgrowth, leading to a decrease in the rate of both false-positives and negatives as well as the overall proportion of LGA babies.

The continuing enigma of the fetal echogenic intracardiac focus in prenatal ultrasound.

Purpose of review The present article aims to review recent literature about intracardiac echogenic foci (ICEFs), with special emphasis in potential causes, relationships with aneuploidy and cardiac function. Recent findings The presence of an ICEF may be considered as a soft marker that may be of interest only in high-risk populations for chromosomal abnormalities. In cases of isolated ICEF in euploid fetuses there is not evidence of an altered cardiac function and a detailed echocardiogram is not recommended as long as the second trimester scan is normal. Cases of fetal myocardial diffuse or multiple calcifications may be related to inflammatory and hypoxic changes in fetal heart, but the relationships between these conditions and isolated ICEF remain unclear. Summary The origin of ICEF remains unclear. It is considered a normal developmental variant, but either inflammatory or hypoxic processes could be involved in its appearance. In low-risk populations for aneuploidy, the presence of an ICEF is not an indication for invasive procedures. In high-risk populations this depends on the previous calculated risk. In euploid fetuses, cardiac function is not significantly altered but further studies in specific populations may be justified. Fetuses with diffuse myocardial calcification or multiple foci may need further investigations.

Nuevos criterios diagnósticos de diabetes mellitus gestacional a partir del estudio HAPO. ¿Son válidos en nuestro medio?☆☆Nota: El mismo artículo se publica simultáneamente en las revistas Avances en Diabetología, Endocrinología y Nutrición, Progresos de Obstetricia y Ginecología, y Gaceta Sanitaria, con el conocimiento y la aceptación de los respectivos editores.

Rosa Corcoy a,b, , Blanca Lumbreras , José Luis Bartha e y Wifredo Ricart f,g Grupo Español de Diabetes y Embarazo a Servei d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, España b CIBER de Bioingenieria, Biomateriales y Nanotecnologı́a, España c Departamento de Salud Pública, Historia de la Ciencia y Ginecologı́a, Universidad Miguel Hernández, Alicante, España d CIBER de Epidemiologı́a y Salud Pública, España e Sección de Medicina Materno Fetal, Departamento de Obstetricia y Ginecologı́a, Hospital Universitario Puerta del Mar, Cádiz, España f Servei de Diabetis, Endocrinologia i Nutrició, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España g CIBER de Fisiopatologı́a de la Obesidad y Nutrición, España

First and second trimester screening for large for gestational age infants.

Abstract Objectives: To find the best early predictor model for fetal growth and large for gestational age (LGA) infants considering clinical, ultrasonographic and biochemical variables. Method: In 2097 singleton pregnancies at first trimester, we evaluated maternal characteristics, PAPP-A and ß-HCG proteins, fetal nuchal translucency thickness and uterine artery pulsatility index (UtA-PI). At second trimester fetal ultrasound biometry and UtA-PI were then measured. The relationships between birth weight and LGA and maternal characteristics, first and second trimester variables, and all variables combined, were studied. The performance of screening was determined by receiver operating characteristic curves analysis. Results: Stepwise regression analysis showed that in the prediction of birthweight percentile there were significant contributions from all maternal factors, PAPP-A and Ut-A PI in the first trimester, and fetal biometric variables in the second trimester. Maternal charateristics combined with PAPP-A, β-hCG, fetal NT and uterine artery PI identified 30.2 % LGA (FPR 10%). The combined model reached a sensitivity of 41.2% (FPR 10%) and 56.2% (FPR 20%). Conclusions: Sensitivity of the screening for LGA improves significantly after addition of second trimester ultrasound measurements to first trimester variables and maternal characteristics.

Fetal cardiac biometry and function in HIV‐infected pregnant women exposed to HAART therapy

Previous studies have suggested that antiretroviral therapy in human immunodeficiency virus (HIV)‐infected pregnant women can cause alterations in cardiac structure and function in fetuses or children, although the results are not very clear. The aim of this study is to assess whether or not these alterations are present in the heart of fetuses of HIV‐infected pregnant women, undergoing treatment with highly active antiretroviral therapy (HAART).

Optimal Gestational Weight Gain for Women with Gestational Diabetes and Morbid Obesity

ObjectivesOur aim was to investigate the greatest gestational weight gain (GWG) without adverse pregnancy complications in women with gestational diabetes mellitus (GDM) and morbid obesity.MethodsAn observational retrospective study including 3284 patients with single pregnancies and GDM was completed. Of the patients, 131 (4.0%) were classified as having pre-pregnancy morbid obesity (BMIu2009≥u200935xa0kg/m2). Perinatal complications were compared among BMI groups. In the group with morbid obesity, GWG threshold values to predict outcomes were examined based on sensitivity and specificity values under the receiver operating characteristic curve.ResultsGWG was higher in mothers with morbid obesity and macrosomic neonates: 11.3 (4.4–15.7) versus 4.8 (1.5–8.2) kg (pu2009=u20090.033). The GWG and neonatal ponderal index were positively correlated (ru2009=u20090.305, pu2009=u20090.001). The GWG was 7.0 (2.9–11.6) kg in women with hypertensive disorder versus 4.5 (1.0–7.5) kg in normotensive women (pu2009=u20090.017). A GWG above 5xa0kg was a risk factor for macrosomia (87.8% sensitivity, 54.7% specificity) and hypertensive disorder (70.0% sensitivity, 48.4% specificity). GWG associations were maintained after controlling for glycemic control, maternal and gestational age, parity, smoking and neonatal sex.Conclusions for practiceA GWG below 5xa0kg is recommended for women with GDM and morbid obesity. In these women, adequate GWG may prevent macrosomia, fetal overgrowth and hypertensive disorder.