Publications by authors named "Ernesto González-Mesa"

30 Publications

  • Page 1 of 1

Cesarean Scar Ectopic Pregnancy-Case Series: Treatment Decision Algorithm and Success with Medical Treatment.

Medicina (Kaunas) 2021 Apr 8;57(4). Epub 2021 Apr 8.

FEA Obstetric and Gynecology Hospital Regional Materno Infantil, C.P.29011 Málaga, Spain.

: Cesarean scar ectopic pregnancies are a rare form of extrauterine pregnancies, yet their incidence has increased along with the rise in the number of cesarean deliveries. As with other ectopic pregnancies, cesarean scar ectopic pregnancies pose a greater risk for maternal hemorrhage and ultimately maternal mortality. : We present a series of clinical cases of cesarean scar ectopic pregnancy diagnosed by transvaginal ultrasonography. Each patient received an individualized treatment: the rate of success depended on the particular maternal condition in each case. Due to the low frequency of this entity, there are no clear protocols for its treatment and thus there are numerous options for treatment and follow-up: expectant management, medical therapy, surgical intervention, uterine artery embolization or a combined approach. Each method has different levels of success and is dependent on the surgeon's skill and patient presentation. A transvaginal ultrasound is necessary to obtain the fine details of the gestation sac and its relation to the scar and must be followed by a meticulous abdominal scan with a full bladder. : Herein, we present a rare pathological phenomenon whose frequency is on the rise, and for which transvaginal ultrasound and flow Doppler provide high diagnostic accuracy. Early diagnosis of cesarean scar ectopic pregnancies offers treatment options that may help avoid uterine rupture and bleeding, thus preserving the uterus and future fertility.
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http://dx.doi.org/10.3390/medicina57040362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068280PMC
April 2021

MeDiGes Study. Metformin versus insulin in gestational diabetes: Glycemic control, and obstetrical and perinatal outcomes. Randomized prospective trial.

Am J Obstet Gynecol 2021 Apr 19. Epub 2021 Apr 19.

Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga. IBIMA; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM).

Background: Gestational diabetes not properly controlled with diet has been commonly treated with insulin. In recent years several studies have published that metformin can lead to, at least, similar obstetrical and perinatal outcomes as insulin. Nevertheless, not all clinical guidelines endorse its use, and clinical practice is heterogeneous.

Objectives: The aim of this study was to test if metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes not properly controlled with lifestyle changes.

Study Design: The MeDiGes study was a multicenter, open-label, parallel arms, randomized clinical trial performed at two hospitals in Málaga (Spain), enrolling women with GDM who needed pharmacological treatment. Women aged 18-45 years, in the second or third trimesters of pregnancy, were randomized to receive metformin or insulin (Detemir and/or Aspart). The main outcomes were: 1. glycemic control (mean glycemia, pre-prandial and postprandial) and hypoglycemic episodes, and 2. obstetrical and perinatal outcomes and complications (hypertensive disorders, type of labor, prematurity, macrosomia, large for gestational age, neonatal care unit admissions, respiratory distress syndrome, hypoglycemia, jaundice). Outcomes were analyzed on an intention-to-treat basis.

Results: Between 2016-October and 2019-June 200 women were randomized, 100 to the insulin-treated group and 100 to the metformin-treated group. Mean fasting and postprandial glycemia did not differ between groups, but postprandial glycemia was significantly better after lunch and/or dinner in the metformin-treated-group. Hypoglycemic episodes were significantly more common in the insulin-treated group (55.9% vs 17.7% on metformin, OR 6.118, 95% CI 3.134-11.944, p 0.000). Women treated with metformin gained less weight from the enrollment to the prepartum visit (36-37 gestational weeks) (1.35±3.21 vs 3.87±3.50 Kg, p 0.000). Labor inductions (MET 45.7% vs INS 62.5%, OR 0.506, 95% CI 0.283-0.903, p 0.029) and cesarean deliveries (MET 27.6% vs INS 52.6%, OR 0.345, 95% CI 0.187-0.625, p 0.001) were significantly lower in the MET-group. Mean birth weight, macrosomia and large for gestational age were not different between treatment groups, as well as babies' complications. The lower cesarean delivery rate for women treated with metformin was not associated with macrosomia, large or small for gestational age, or other complications of pregnancy.

Conclusions: Metformin treatment was associated with a better postprandial glycemic control than insulin for some meals, a lower risk of hypoglycemic episodes, less maternal weight gain, and a low rate of failure as an isolated treatment. Most obstetrical and perinatal outcomes were similar between groups.
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http://dx.doi.org/10.1016/j.ajog.2021.04.229DOI Listing
April 2021

Resilience and psychological distress in pregnant women during quarantine due to the COVID-19 outbreak in Spain: a multicentre cross-sectional online survey.

J Psychosom Obstet Gynaecol 2021 Mar 18:1-8. Epub 2021 Mar 18.

Department of Obstetrics and Gynecology, Hospital Quiron Salud, Málaga, Spain.

Purpose: To examine the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women during the confinement due to the COVID-19 outbreak in Spain.

Materials And Methods: Between 15 April and 14 May 2020, a multicentre cross-sectional survey was performed to study depression, anxiety and resilience in a sample of Spanish pregnant women during the lockdown set up by the Government in response to COVID-19 pandemic outbreak. We designed an anonymous online self-administered questionnaire (https://bit.ly/34RRpq1) that included the Spanish validated versions of the Edinburgh Postpartum Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) and the Connor-Davidson Resilience 10-items Scale (CD-RISC-10).

Results: A total of 514 pregnant women completed the survey. 72.8% had been confined < 40 days and 27.2% between 41 and 60 days. 182 (35.4%) participants scored over 10, with 21.3% scoring over 13 (75th Percentile) in depressive symptoms rates. We found high trait and anxiety scores, with 223 (43.4%) and 227 (44.2%) pregnant women scoring over the trait and state mean scores. Neither depression, anxiety or resilience levels showed any significant correlation with the length of confinement. We found low CD-RISC-10 scores.

Conclusions: We found a high prevalence of depression and anxiety symptoms during the quarantine, although we did not find an increased prevalence of psychological distress according to length of home confinement. Resilience correlated negatively with depression and anxiety.
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http://dx.doi.org/10.1080/0167482X.2021.1896491DOI Listing
March 2021

Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth.

J Perinat Med 2021 May 15;49(4):485-495. Epub 2020 Dec 15.

IBIMA Research Group in Maternal-Fetal Medicine, Epigenetics, Women's Diseases and Reproductive Health, Malaga, Spain.

Objectives: The main objective of the present study was to evaluate what educational needs were being neglected in current perinatal educational program in the University of Malaga.

Methods: We performed a cross-sectional study using the Students' questionnaire on attitudes towards childbirth (CAVE-st) in a sample of 378 students who were finishing their undergraduate or postgraduate academic perinatal program, including medical and nursing students.

Results: The Cronbach's alpha reliability coefficient was 0.895. The mean score of CAVE-st in the sample was 200.34 (DT 21.0). The scores were below the median value in more than 53% of the students, especially in medical students. Female students scored systematically higher in the overall scale and its subscales, even after adjusting for study groups. On the other hand, the students with children scored significantly lower in the subscale that explored their attitudes towards unexpected results. A huge margin for improvement was recognizable in those subscales related with childbirth medicalization, respect to women decisions, and health-care prioritization.

Conclusions: Students' attitude towards childbirth need to be improved as a means to improve women's childbirth experience and prevent birth-related trauma. The current undergraduate and postgraduate training in perinatal care lacks a comprehensive and biopsychosocial perspective that would improve the quality of clinical practice during childbirth.
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http://dx.doi.org/10.1515/jpm-2020-0395DOI Listing
May 2021

Relationship of breast volume, obesity and central obesity with different prognostic factors of breast cancer.

Sci Rep 2021 Jan 21;11(1):1872. Epub 2021 Jan 21.

Department of Surgical Specialties, Biochemistry and Immunology, University Hospital of Malaga, Faculty of Medicine, University of Malaga, Málaga, Spain.

The objective of this study was to investigate whether the BC tumor biology in women with larger breast volume, in obese women and especially in women with central adiposity at the moment of diagnosis of BC is more aggressive than in those women without these characteristics. 347 pre- and postmenopausal women with a recent diagnosis of BC were analyzed. In all patients, anthropometric measurements at the time of diagnosis was collected. In 103 of them, the breast volume was measured by the Archimedes method. The Breast volume, BMI, WHR and the menopausal status were related to different well-known pathological prognostic factors for BC. At the time of diagnosis, 35.4% were obese (BMI > 30 kg/m), 60.2% had a WHR ≥ 0.85, 68.8% were postmenopausal and 44.7% had a breast volume considered "large" (> 600 cc). Between patients with a large breast volume, only a higher prevalence of ER (+) tumors was found (95.3% vs. 77.2%; p = 0.04) compared to those with small breast volumes. The obese BC patients showed significantly higher rates of large tumors (45.5% vs. 40.6%; p = 0.04), axillary invasion (53.6% vs. 38.8%; p = 0.04), undifferentiated tumors (38.2% vs. 23.2%) and unfavorable NPI (p = 0.04) than non-obese women. Those with WHR ≥ 0.85 presented higher postsurgical tumor stages (61.7% vs. 57.8%; p = 0.03), higher axillary invasion (39.9% vs. 36.0%; p = 0.004), more undifferentiated tumors (30.0% vs. 22.3%; p = 0.009), higher lymphovascular infiltration (6.5% vs. 1.6%; p = 0.02), and a higher NPI (3.6 ± 1.8 vs. 3.2 ± 1.8; p = 0.04). No statistically significant differences were found according to menopausal status. We conclude that obesity, but especially central obesity can be associated with a more aggressive tumour phenotype. No relation between breast volume and tumoral prognostic factors was found, except for a higher proportion of ER (+) tumor in women with higher breast volume.
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http://dx.doi.org/10.1038/s41598-021-81436-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820412PMC
January 2021

Comorbid anxiety and depression (CAD) at early stages of the pregnancy. A multicultural cross-sectional study.

J Affect Disord 2020 06 29;270:85-89. Epub 2020 Mar 29.

School of Medicine, University of Malaga, Spain.

Introduction: When anxiety and depression are comorbid (CAD), symptoms are more severe and the response to treatments is worse. Given the links between mood disorders and poor perinatal outcomes, CAD and its correlates deserve special clinical attention during pregnancy. The main objective of this study was to learn about the prevalence of comorbid anxiety and depression (CAD) in early stages of the pregnancy analyzing the relationship between CAD and cultural and sociodemographic factors.

Methods: We have studied a multicultural sample of 514 Turkish and Spanish pregnant women (264 in Málaga, 102 in Istambul and 148 in Antalya) recruited at the moment of their first pregnancy medical check-up between 10 and 12 weeks of pregnancy. These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg postnatal depression scale (EDS), the state and trait anxiety scale (STAI) and a series of questions related to health status, general mood, and sociodemographic variables.

Results: We found a CAD prevalence rate of 26.9% and a significant higher prevalence rate among Turkish women (47.6%) when compared to Spanish participants (9.5%) (p<0.001). The multivariate analysis showed that the lack of someone who provided emotional support was the variable that best predicted CAD symptoms.

Conclusion: The CAD prevalence rate was high and significant differences were found depending on the geographic and cultural context.
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http://dx.doi.org/10.1016/j.jad.2020.03.086DOI Listing
June 2020

Type of delivery and reading, writing, and arithmetic learning in twin births.

Dev Psychobiol 2020 05 31;62(4):484-495. Epub 2019 Oct 31.

Área de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain.

This study analyses, in children born in twin births, the relationship between reading, writing and arithmetic learning, on the one hand, and type of delivery, on the other, controlling for the effect of interaction and/or confusion of third variables (maternal age at delivery, gestational age, fetal position, birthweight, 1-min Apgar score). In the planned retrospective cohort design, the exposed cohort consisted of children born by caesarean section, and the non-exposed cohort was comprised of children born vaginally. One hundred and twenty-four children born of twin births were evaluated during their first year of primary school: K-BIT tests were used to measure intelligence; the Evalúa-1 battery was used to assess reading, writing, and arithmetic ability; and the children's clinical histories were analysed for obstetric and neonatal variables. After applying binary logistic regressions for each dependent variable, it was found that caesarean delivery in twin births appeared as a possible independent risk factor for specific learning disabilities (LDs) in reading, writing, and arithmetic. Based on these results, further research using larger samples and at more advanced ages is required in order to analyse the influence of obstetric and neonatal variables on the processes underlying specific LDs.
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http://dx.doi.org/10.1002/dev.21932DOI Listing
May 2020

Poor sleep quality is associated with perinatal depression. A systematic review of last decade scientific literature and meta-analysis.

J Perinat Med 2019 Sep;47(7):689-703

Obstetrics and Gynecology at Malaga University Hospital, Málaga, Spain.

Background Although pregnancy is frequently associated with mental states of happiness, hope and well-being, some physical and psychological changes can contribute to increased sleep disturbances and worsened sleep quality. Sleep quality has been linked to negative emotions, anxiety and depression. The main objective of this paper was to systematically review the impact of sleep during pregnancy on maternal mood, studying the association between objective and subjective measures of sleep quality and perinatal depression. Methods We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which included studies published between January 2008 and April 2019, and met the following criteria: (i) studies on pregnant women assessing the effects of sleep quality variables on perinatal mood disorders, (ii) studies published in English and (iii) full paper published in a peer-reviewed scientific journal with full-text format available. Results A total of 36 studies published in the last decade met the inclusion criteria for qualitative review and eight of them were suitable for meta-analysis. Both confirmed the negative effects of poor sleep on perinatal mood. However, qualitative analysis showed that unrepresentative samples and low participation rates falling below 80% biased some of the studies. The standard random-effects meta-analysis showed a pooled size effect [ln odds ratio (OR) 1.49 (95% confidence interval [CI] 1.19, 1.79)] for perinatal depression in cases of poor prenatal sleep quality, although heterogeneity was moderate to high [Q 16.05, P ≤ 0.025, H2 2.45 (95% CI 1.01, 13.70)]. Conclusion Poor sleep quality was associated with perinatal mood disturbances. The assessment of sleep quality along the pregnancy could be advisable with a view to offering preventative or therapeutic interventions when necessary.
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http://dx.doi.org/10.1515/jpm-2019-0214DOI Listing
September 2019

Type of Delivery, Neuropsychological Development and Intelligence in Twin Births.

Front Psychol 2019 3;10:972. Epub 2019 May 3.

Facultad de Psicología, Universidad de Málaga, Málaga, Spain.

Based on a retrospective cohort design with 6-year-old children born in twin births, the relationship between verbal, non-verbal, global neuropsychological development, general intelligence and type of delivery has been studied. To this end, the possible effect of third gestational, obstetric and neonatal variables, such as maternal age at delivery, fetal presentation, gestational age, newborn weight and Apgar at minute one, was controlled. The exposed cohort includes children born by cesarean section, and the unexposed cohort is composed of children born vaginally with or without induction. A total of 124 children were evaluated in their 1st year of primary school using the Child Neuropsychological Maturity Questionnaire, Kaufman's Intelligence Test and the medical histories of the children collected after birth. By means of binary logistic regression analysis, it has been found that the type of delivery is presented as an independent risk factor for disorders in verbal, non-verbal and global development and for the general intellectual difficulties of children born of multiple births. These results suggest the need to analyze in future prospective studies with broader samples the relationship between different types of obstetric and perinatal variables of birth type and infant neuropsychological development and general intelligence, in order to prevent possible psychological alterations from birth.
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http://dx.doi.org/10.3389/fpsyg.2019.00972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509588PMC
May 2019

Correlates for state and trait anxiety in a multicultural sample of Turkish and Spanish women at first trimester of pregnancy.

J Affect Disord 2019 Apr 31;249:1-7. Epub 2019 Jan 31.

Obstetrics and Gynaecology Clinic, Sisli, Istanbul.

Objective: The main objective of this research was to assess the potential influence of cultural factors on the anxiety levels of a multicultural sample of Spanish and Turkish pregnant women at the beginning of the pregnancy.

Methods: Between October and December 2017 a total of 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy in three different cities, Istanbul, Antalya and Malaga, were recruited for study. These women completed a questionnaire that included the Turkish or Spanish validated of the state-trait anxiety Inventory, and a series of questions related to health status, general mood, and sociodemographic variables.

Results: The mean value for State Anxiety was 47.1 [16-56] (SD 4.2), and mild, moderate and severe State Anxiety was observed in 56.8%, 14.7% and 20.5% of participants, respectively. Mean value for trait anxiety was 46.9 [34-89] (SD 4.6) and 31.4%, 19.7% and 20.2% of participants scored for mild, moderate and severe anxiety respectively. Anxiety scores were significantly higher among Turkish women. In the whole sample, religion, working status, pregnancy planning and perceived partner´s support predicted anxiety at first trimester of pregnancy. Social support and educational level were the most important predictive variables in the Spanish subgroup, while religion, the number of living children and the lack of husband´s support were among Turkish pregnant women.

Conclusion: Our results confirm the existence of a high prevalence of women´s anxiety at the beginning of the pregnancy and some differences between Turkish and Spanish pregnant women have been observed. We have confirmed that some cultural features like family structure (having more children and cohabitants), the Islamic religion or the lack of perceived partner´s support became the most important vulnerability elements.
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http://dx.doi.org/10.1016/j.jad.2019.01.036DOI Listing
April 2019

[Obesity and hypertesion in pregnancy].

Nutr Hosp 2018 Jul 9;35(4):751-752. Epub 2018 Jul 9.

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http://dx.doi.org/10.20960/nh.2186DOI Listing
July 2018

Cultural factors influencing antenatal depression: A cross-sectional study in a cohort of Turkish and Spanish women at the beginning of the pregnancy.

J Affect Disord 2018 10 2;238:256-260. Epub 2018 Jun 2.

Obstetrics and Gynaecology Clinic Sisli Istanbul, Turkey.

Background: Depression is the most frequent mental disorder during pregnancy, and its prevalence is at least as high as that of postnatal depression. Differences between Western and Eastern countries may exist according to cultural and educational factors.

Objective: to determine the influence of social and cultural factors on the mood state of a multicultural sample of 514 Turkish and Spanish pregnant women at the beginning of the pregnancy.

Methods: Between October and December 2017 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy were recruited (264 in Málaga, 102 in Istanbul and 148 in Antalya). These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg Postnatal Depression Scale (EDS) and a series of questions related to health status, general mood, and sociodemographic variables.

Results: Turkish women scored significantly higher with a mean value of 12.1 (SD 4.2) against 7.6 (SD 4.3) of Spanish women. Coping strategies and matters of women´s concern were also different. A total of 9.1% of Spanish and 30% of Turkish scored over cut-off point of 13. We found differences in EDS scores regarding the type of work, working status, and educational level. Family structure and perceived support were identified as specific risk factors for antenatal depression (AD). The multivariate regression model showed that best predictor variables for EDS score in the global sample were the country of recruitment, the number of living children, the pregnancy planning and the perceived partner´s support.

Conclusions: Our results confirm the existence of important differences in AD prevalence between Turkish (30.0%) and Spanish (9.9%) pregnant women. Some sociocultural features like having more children, unplanned pregnancies, or perceiving poor support from the partner, become important vulnerability factors.
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http://dx.doi.org/10.1016/j.jad.2018.06.003DOI Listing
October 2018

Toxic elements in hair and in vitro fertilization outcomes: A prospective cohort study.

Reprod Toxicol 2018 04 10;77:43-52. Epub 2018 Feb 10.

Obstetrics and Gynaecology Research Group at Malaga Regional and University Hospital (IBIMA), Avda. Arroyo de los Ángeles, s/n, 29011 Málaga, Spain.

We analysed the association between the concentration of four toxic elements (As, Cd, Hg and Pb) and diverse reproductive outcomes in a cohort of 194 women with fertility disorders undergoing IVF in a public hospital. Concentration in hair specimens was explored as biomarker of exposure during the three months prior to oocyte retrieval. The proportion of negative results, especially regarding pregnancy and birth outcomes, is remarkable. However, we found that the probability of mature oocytes was inversely associated with the concentration of Hg in hair (RR = 0.81, 95% CI: 0.70-0.95) and directly associated with that of Pb (RR = 1.18, 95% CI: 1.03-1.35). These findings provide insights for future research on the links between heavy metal concentrations and IVF outcomes.
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http://dx.doi.org/10.1016/j.reprotox.2018.02.001DOI Listing
April 2018

Mood state at the beginning of the pregnancy and its influence on obstetric and perinatal outcomes.

J Psychosom Obstet Gynaecol 2019 Jun 24;40(2):106-113. Epub 2018 Jan 24.

a Obstetrics & Gynecology Department , Malaga University School of Medicine , Málaga , Spain.

We designed this study to ascertain the prevalence of depressive disorders and anxiety at the beginning of the pregnancy, studying possible associated factors and assessing the influence of mood disorders on perinatal outcomes. A representative sample of 191 pregnant women at first trimester of their pregnancies completed a questionnaire that included the Whooley´s questions, the Spanish version of the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory and a series of questions related to health status, general mood and sociodemographic variables. Later, we prospectively evaluated the influence of anxiety and depression on the perinatal and obstetric results in 145 of them. More than 20% of pregnant women presented high levels of anxiety. The mean values of the state and trait anxiety scores were 38.7 (SD 9.8) and 34.5 (SD 9.5). The mean BDI score was 5.97 (SD 4.9), with 9.5% of participants achieving scores compatible with depression, (61% mild in, 22.2% moderate, and 16.6% severe). BDI scores were significantly lower in women who became pregnant after assisted reproductive techniques. We observed an association between depression and trait anxiety scores with an infant's low birth weight. The multivariate analysis showed that the feeling of happiness at the beginning of pregnancy was the best predictor of foetal weight. The prevalence of emotional disorders in the first trimester of pregnancy is high, with more than 20% of pregnant women presenting high levels of anxiety, and more than 9.5% presenting depression. During the first trimester, depression and anxiety were associated with low birth weight.
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http://dx.doi.org/10.1080/0167482X.2018.1427726DOI Listing
June 2019

Anxiety and attitudes towards sex in women requesting emergency contraception.

J Psychosom Obstet Gynaecol 2019 Mar 9;40(1):75-81. Epub 2017 Nov 9.

b Obstetrics & Gynecology Department , Málaga University Hospital , Málaga , Spain.

We performed an observational descriptive study on 89 women who requested for emergency contraception (EC) at the emergency units of two hospitals, Virgen de la Victoria Hospital, and Regional University Hospital in Malaga between October 2016 and April 2017. Both hospitals are on the Andalusian Public Health System. We evaluated a group of socio-demographic variables and others related to the beliefs and the knowledge about EC and contraception in general, sexual behavior, Eysenck's Inventory of Attitudes to Sex (satisfaction and promiscuity factors), and State-Trait Anxiety Inventory (STAI). RESULTS: State anxiety scores were low in 10.8% of the participants, middle in 25.7% and high in the 63.5%. On the other hand, the scores for trait anxiety were low in 13.5%, middle in 39.2% and high in 47.3%. The demand for EC resulted in a stressful situation for women, especially for youngest women. Also, married women with children and a history of pregnancy terminations showed higher anxiety scores. Regarding sexual attitudes, the highest levels of anxiety (state and trait) were found in women with less knowledge about EC, and in those who reported less satisfaction with their sex life. Best fit regression models for anxiety levels included beliefs that ECs are abortive, sexual dissatisfaction and women's age as predictive variables for STAI scores. In conclusion, women who requested EC showed high scores in anxiety-state and -trait, with those of younger age presenting more intense emotions.
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http://dx.doi.org/10.1080/0167482X.2017.1398728DOI Listing
March 2019

Neurological complications after therapy for fetal-fetal transfusion syndrome: a systematic review of the outcomes at 24 months.

J Perinat Med 2018 Nov;46(9):991-997

Department of Obstetrics and Gyncecology, School of Medicine, Regional University Hospital, Málaga University, 32, Boulevard Louis Pasteur, 29010, Málaga, Spain.

Objective: The main objective of this study was to review the available scientific evidence about mid-term neurological outcomes in twins after laser therapy for twin-to-twin transfusion syndrome (TTTS).

Methods: A systematic review of studies on neurodevelopmental outcomes (cognition, motor development, communication skills and cerebral palsy) of twins after laser therapy for TTTS was conducted. Outcomes at 24 months of age and the use of validated scales for assessment were the selected criteria. Electronic and manual research identified 25 studies, and nine of them were eligible for the review.

Results: The global mean rate of neurological injury in twins treated with laser was 14.07%. The mean rate of cognitive impairment was 8.41%, 11.14% for motor delay, 16.5% for communication delay and 5.73% for cerebral palsy. These rates were higher than the results found in dichorionic twins, but lower than the results found in twins treated with amnio-reductions or conservative management.

Conclusion: Laser therapy is associated with a lower rate of neurological injury at 24 months of age compared to other therapeutic techniques. This tendency was also observed with specific incidences regarding cognition, motor skills and cerebral palsy.
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http://dx.doi.org/10.1515/jpm-2017-0217DOI Listing
November 2018

Temporal trends for pregnancy length in a hospital setting of Southern Spain.

J Obstet Gynaecol 2017 Jan 19;37(1):38-43. Epub 2016 Oct 19.

a Obstetrics & Gynecology Department , Malaga University School of Medicine , Malaga , Spain.

For centuries it has been considered that the due date for delivery in our species is 280 days after the onset of the last menstruation. However, in most cases this statement is not accurate. The main objective of this study was to determine the mean duration of pregnancy in our setting and whether it has experienced changes in recent years. A retrospective, population-based descriptive study was made of 102,169 deliveries assisted in Malaga University Hospital (Malaga, Andalusia, Spain) during the period 1998-2015. The mean gestational age at delivery was 269 days (SD 16 days), with a modal gestational age of 273 days. The mean duration of the singleton and multiple pregnancies was 271 days (SD 17 days) and 242 days (SD 20 days), respectively. A significant shortening of the duration of pregnancy was observed in the course of the study period.
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http://dx.doi.org/10.1080/01443615.2016.1205568DOI Listing
January 2017

The influence of obstetric variables on school achievement, intelligence and neuropsychological development in a sample of Spanish twins at the age of six: a retrospective study.

J Matern Fetal Neonatal Med 2016 6;29(10):1595-602. Epub 2015 Jul 6.

b Evolutionary and Educational Psychology Department , Malaga University School of Psychology , Málaga , Spain.

Objectives: The increasing number of multiple pregnancies in recent years has raised a particular concern about the problems associated to these pregnancies. It still remains unclear whether twin deliveries, as currently conceived, provide the same future health chances to both fetuses. In this regard, it is worth mentioning that the effects of obstetric and neonatal care beyond the perinatal period have not often been evaluated. The main objective of this research was to analyze the impact of obstetric and perinatal variables on postnatal neuropsychological development, intelligence and school achievement of twin children.

Methods: We conducted a cross-sectional and observational study on 62 pairs of 6-year-old twins, who were on their first year of primary education. All 124 children and their mother were individually assessed and perinatal clinical data were collected. A stratified multivariate analysis was performed using multiple linear regressions.

Results: The type of birth was the best predicting variable, so that the best results were achieved in children born in spontaneous vaginal deliveries. Comparatively, however, poorer scores were seen in males second twins born by the vaginal route in spatial structuring, non-verbal development and total development areas, especially in case of delivery before 37 weeks.

Conclusions: Our study confirms the impact of some obstetric variables on school achievement and psychological development of twins.
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http://dx.doi.org/10.3109/14767058.2015.1055724DOI Listing
December 2016

Exposure to tobacco, alcohol and drugs of abuse during pregnancy. A study of prevalence among pregnant women in Malaga (Spain).

Adicciones 2015 Jun 17;27(2):99-108. Epub 2015 Jun 17.

Departamento de Obstetricia y Ginecología. Universidad de Málaga. Hospital Regional Universitario de Málaga..

The prevalence of substance abuse in women who become pregnant is similar to that of the general population, resulting in a high fetal exposure rate during the most vulnerable period regarding neurodevelopment and organogenesis. The present study was intended to assess the level of prenatal exposure to tobacco, alcohol or illicit drugs in the city of Málaga (Spain). It was designed as a cross-sectional study, and based on the anonymous self-reports of participants. A total of 451 pregnant women were recruited in the first, second or third trimester. The prevalence in each of the quarters respectively was 21.2%, 18.5% and 13.3% for smoking, 40.7%, 23.1% and 17.1% for alcohol and 4.8%, 1.9% and 1.2% for cannabis. We also found that a higher educational level was associated with a lower consumption of tobacco (RR 0.659 [0.537-0.810] p<0.0001) and greater exposure to alcohol (RR 1.87 [1.30-2.69] p<0.0007). These results, particularly in regard to alcohol intake, are sufficiently alarming to alert obstetric care providers about the need to implement preventive measures.
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June 2015

Exposure to synthetic oxytocin during delivery and its effect on psychomotor development.

Dev Psychobiol 2015 Dec 23;57(8):908-20. Epub 2015 May 23.

Dpto Cirugía, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Málaga, Campus Universitario de Teatinos, s/n Málaga, 29071, Spain.

The main objective is to examine the influence of oxytocin administration during delivery on psychomotor development at age five years. This was a retrospective cohort study involving two groups: children of mothers exposed vs. not exposed to oxytocin during labor. Of the 7,465 newborns registered in our maternity service during 2006 we randomly selected an initial sample of 400 children. Of these, 146 children were assessed using the motor scale of the Battelle Developmental Inventory. Other predictor variables that could potentially act as confounders and/or interact with the main relationship were also examined. The data were subjected to bivariate analysis, estimates of measures of strength of association, stratified analysis and multivariate binary logistic regression. The results indicate that exposure to synthetic oxytocin during delivery is an independent risk factor for a delay in gross and fine motor development. This was the case after controlling for the variables duration of labor and sex of the newborn, none of which modified the effect of oxytocin on gross and fine motor development. However, sex of the newborn were shown to be confounding gross motor development. In light of these results, and with the aim of preventing possible psychomotor alterations, further studies are now needed to analyze the effect that the oxytocin dose and the duration of perfusion may have on children's subsequent development.
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http://dx.doi.org/10.1002/dev.21321DOI Listing
December 2015

Effects of oxytocin used during delivery on development: a retrospective cohort study.

J Clin Exp Neuropsychol 2014 11;36(7):680-90. Epub 2014 Jun 11.

a Department of Developmental and Educational Psychology, Faculty of Psychology , University of Málaga , Málaga , Spain.

Objective: The objective was to evaluate the potential influence of oxytocin administered during delivery on children's development at the age of 5.

Method: This study was designed as a retrospective cohort study where children from patients given synthetic oxytocin during delivery were considered as the exposed cohort and children from patients not given oxytocin as the nonexposed cohort. From a total of 7465 births attended at our maternity ward in 2006, an initial sample of 400 was randomly selected. A total of 148 children were evaluated using the Battelle Developmental Inventory. Potential confounding and adjustment factors were analyzed using stratified analysis and multivariate analysis (logistic regression).

Results: Oxytocin use did not significantly affect the overall risk of developmental delay in the study sample (relative risk, RR, 1.46; 95% confidence interval, CI [0.79-2.71]). The best fit regression model included twin delivery, type of delivery, and maternal age. In the group of vaginal noninstrumental deliveries, oxytocin administration increased the risk of poor Battelle Developmental Inventory outcome, particularly when maternal age was under 28 or over 35 years of age (odds ratio, OR, 67.14; 95% CI [5.46-824.86]). When delivery was instrumental or through cesarean section in mothers aged 28-35 years, oxytocin administration decreased the risk of developmental disorders (OR 0.16; 95% CI [0.04-0.66]).

Conclusion: Although oxytocin administration during delivery did not affect the overall risk of low Battelle Developmental Inventory scores in the study sample, some effects were seen according to maternal age and type of birth.
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http://dx.doi.org/10.1080/13803395.2014.926864DOI Listing
July 2015

Tubal ectopic pregnancy two years after laparoscopic supracervical hysterectomy.

BMC Womens Health 2014 May 24;14:69. Epub 2014 May 24.

Obstetrics and Gynecology Research Group, IBIMA, Málaga University, School of Medicine, Málaga University Hospital, Málaga, Spain.

Background: Ectopic pregnancy after hysterectomy is a very rare condition, but it must be kept in mind in women with history of hysterectomy who present with abdominal pain and ecographic adnexal heterogeneous images. Since first described by Wendeler in 1895, at least 67 ectopic pregnancies (tubal, ovarian and abdominal) have been described in patients subjected to prior hysterectomy.

Case Presentation: We describe the case of a 41-year-old white caucasian woman admitted to the emergency room due to abdominal pain for two days. The ultrasounds scan and the quantification of beta-HCG led to the diagnosis of tubal ectopic pregnancy, although she had been hysterectomized two years before. An emergency laparoscopy was performed for salpingectomy. The pathology report indicated trophoblastic tubal implantation and hematosalpinx.

Conclusions: Ectopic pregnancy is one of the conditions to be considered in the differential diagnosis of abdominal pain in women of child bearing potential, and the absence of the uterus does not rule out its diagnosis.
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http://dx.doi.org/10.1186/1472-6874-14-69DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4041893PMC
May 2014

Oxytocin administered during labor and breast-feeding: a retrospective cohort study.

J Matern Fetal Neonatal Med 2014 Oct 13;27(15):1598-603. Epub 2014 Jan 13.

Obstetric and Gynecology Research Group at Malaga Regional and University Hospital (IBIMA) , Málaga , Spain and.

Objective: The relationship between labor physiology and the onset of lactation leads to assess the potential correlation between oxytocin administration during labor and duration of breast-feeding.

Methods: This study was designed as a retrospective cohort study where patients given synthetic oxytocin during labor induction were considered as the exposed cohort, and patients not given oxytocin formed the non-exposed cohort. Four hundred of the 7465 children born at our maternity during 2006 were randomly selected. Information about breast-feeding was available for 316 of these children. Eventual confounding or adjustment factors were analyzed using stratified and multivariate analysis.

Results: Oxytocin was used for delivery of 189 (59.8%) newborns, multiplying the risk of bottle-feeding by 1.451 (95% CI 1.28-1.63). The best-fit regression model of oxytocin use effect on bottle-feeding included sex and gestational age of the newborn. The use of oxytocin also multiplies the risk of breast-feeding withdrawal at 3 months by 2.29 (95% CI 1.41-3.74). This effect is confounded by maternal age, being higher for mothers under 27 years.

Conclusion: Oxytocin administration during labor had some impact on both onset and duration of breast-feeding, particularly in mothers under 27 years of age and newborns delivered at term. Clinical Study registered at U.S.

Nih, Id: NCT01951040.
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http://dx.doi.org/10.3109/14767058.2013.871255DOI Listing
October 2014

Uterine rotation: a cause of intestinal obstruction.

Case Rep Obstet Gynecol 2013 23;2013:759250. Epub 2013 May 23.

Obstetrics and Gynecology Department, University Hospital Carlos Haya, Málaga, Spain ; Málaga Research Group in Obstetrics and Gynecology, Biomedical Research Institute of Málaga (IBIMA), Spain ; Servicio de Obstetricia y Ginecología, Hospital Materno Infantil, Arroyo de los Angeles Avenida s/n, 29006 Málaga, Spain.

Intestinal obstruction is an uncommon surgical emergency during pregnancy that affects seriously the prognosis of gestation. The underlying cause can be identified in the majority of cases and usually consists of adhesions secondary to previous abdominal or pelvic surgery, followed in order of frequency by intestinal volvuli. In recent years there have been no reports in which the gravid uterus has been the cause of intestinal obstruction. We report the case of a woman in week 33 + 4 of pregnancy who developed extrinsic compression of the colon secondary to uterine rotation and pelvic impaction of the head of the fetus.
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http://dx.doi.org/10.1155/2013/759250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676995PMC
June 2013

Maternal-fetal thyroid function at the time of birth and its relation with iodine intake.

Thyroid 2013 Dec 4;23(12):1619-26. Epub 2013 Sep 4.

1 Gynecology & Obstetrics Service, Riotinto Hospital, Huelva, Spain .

Background: The effects of moderate variations in dietary iodine intake on maternal and fetal thyroid function are poorly understood. Recent studies question the usefulness of neonatal screening of congenital hypothyroidism as a tool for monitoring iodine deficiency. We proposed to test the hypothesis of an association between iodine intake during the last trimester of pregnancy and fetal thyroid function at the time of birth.

Methods: The study was undertaken at term in 233 healthy pregnant women (29.7±5.6 years) and in their newborn. Inclusion of women in the study was done within the 24 hours before delivery.

Results: The median maternal urinary iodine concentration was 126.5 μg/L. The maternal free triiodothyronine (FT3), although not thyrotropin (TSH) and free thyroxine (FT4), correlated significantly with the urinary iodine concentration (r=0.17, p=0.013). The cord blood TSH, FT4, and FT3 correlated positively with the maternal urinary iodine concentration at the time of delivery (r=0.24, p=0.001; r=0.16, p=0.032; and r=0.24, p=0.003, respectively). The cord blood and heel blood TSH correlated positively with the amniotic fluid iodine concentration (r=0.21, p=0.015 and r=0.15, p=0.036). The cord blood TSH correlated positively with the cord blood FT4 (r=0.21, p=0.022) and FT3 (r=0.32, p=0.017). The maternal TSH correlated significantly with the cord blood TSH (r=0.22, p=0.014) and with the heel blood TSH (r=0.13, p=0.050).

Conclusions: The results of this study show the presence of a positive association of TSH-FT4 at the time of delivery, which may be modulated by the amount of iodine consumed by the mother during pregnancy.
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http://dx.doi.org/10.1089/thy.2013.0035DOI Listing
December 2013

Unfavorable course in pregnancy-associated thrombotic thrombocytopenic purpura necessitating a perimortem Cesarean section: a case report.

J Med Case Rep 2013 Apr 29;7:119. Epub 2013 Apr 29.

Obstetrics and Gynecology Department, Obstetrics and Gynecology Research Group, IBIMA, University Carlos Haya Hospital, Arroyo de Los Angeles Avenue, Málaga, 29011, Spain.

Introduction: Thrombotic thrombocytopenic purpura is a type of occlusive thrombotic microangiopathy that is not specific to pregnancy but occurs with an increased frequency during it. Prognosis of thrombotic thrombocytopenic purpura greatly depends on early diagnosis and treatment. As delivery does not generally cause resolution of thrombotic thrombocytopenic purpura, pregnancy termination is not initially considered, especially under 34 weeks, although it may be required under some conditions such as preeclampsia. Plasma therapy, including plasmapheresis, and steroids are used for treatment. In the event of an unfavorable course leading to cardiopulmonary arrest, effectiveness of cardiopulmonary resuscitation measures greatly depends on an early start of such measures. In pregnant patients, not only rapid implementation of these measures is required, but a decision should also be taken about the convenience of fetal delivery through a perimortem Cesarean section.

Case Presentation: We report the case of thrombotic thrombocytopenic purpura in a 30-year-old primigravida white woman in week 28 of pregnancy that had a rapidly deteriorating course leading to cardiopulmonary arrest and an emergency perimortem Cesarean section resulting in fetal survival but maternal death. The patient was asymptomatic at admission and such an unfavorable evolution was initially unexpected. Analytical findings were treated with fresh frozen plasma and methylprednisolone but they did not improve. Plasmapheresis was considered but cardiac arrest rapidly ensued.

Conclusions: Despite the low prevalence of thrombotic thrombocytopenic purpura, the finding in a pregnant woman of the triad consisting of anemia, thrombocytopenia, and neurological changes should guide clinical diagnosis, and should prompt measurement of the metalloprotease ADAMTS-13 in order to rule out or confirm diagnosis of thrombotic thrombocytopenic purpura and evaluate the best therapeutic option. If cardiopulmonary arrest occurs in a woman with a gestational age of more than 24 weeks, a perimortem Cesarean section is advised if the patient has not recovered her pulse after the first four minutes.
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http://dx.doi.org/10.1186/1752-1947-7-119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656795PMC
April 2013

Klippel-Trenaunay syndrome complicating pregnancy.

BMJ Case Rep 2012 Aug 1;2012. Epub 2012 Aug 1.

Department of Obstetrics and Gynecology, Carlos Haya University Hospital, Málag, Spain.

The Klippel-Trenaunay syndrome is a rare congenital disorder that affects one or more limbs. It is characterised by cutaneous vascular nevi, venous malformations and hypertrophy of soft tissues and bone. There are very few cases reported in pregnant women, so the level of uncertainty is high when it appears during gestation. It is a disease that increases obstetric risk and can exacerbate complications, mainly thromboembolic and haemorrhagic. We report below the case of a pregnant woman diagnosed with this syndrome and the multidisciplinary management held in our centre.
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http://dx.doi.org/10.1136/bcr-2012-006534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543845PMC
August 2012

Temporal trends of latency period and perinatal survival after very early preterm premature rupture of fetal membranes.

Arch Gynecol Obstet 2012 Aug 29;286(2):347-52. Epub 2012 Mar 29.

Obstetric Department, University Hospital Carlos Haya, Arroyo De Los Ángeles Av., 29011 Málaga, Spain.

Purpose: This paper shows temporal trends of latency period and perinatal survival after preterm premature rupture of membranes at or before 28 weeks (very early PPROM).

Methods: We have studied retrospectively medical records of all cases of very early PPROM attended in our Obstetric Department from January 1, 2000 to December 31, 2010.

Results: A total of 327 cases of very early PPROM were attended, representing 0.4 % of all deliveries, 3.68 % of all preterm births and 15 % of cases all of PPROM. The mean gestational age at delivery was 27 weeks (range 20-34). The mean duration of latency period for the total of 327 cases was 12.1 days (range 0-83, SD 13.3), with a clear trend to its increase from 2005 (p < 0.05). The mean duration of latency period was largest in 2010 (p < 0.05). For the whole period 2000-2010, perinatal deaths reached 30.6 % of all cases, with a clear trend to decrease as gestational age at diagnosis increased, and over the years of study. We have also found a high rate of obstetric complications and a high rate of cesarean deliveries.

Conclusions: The upward trend in the duration of latency period in all groups over the years of study and the encouraging perinatal survival observed, even in previable PPROM, are incentives to follow expectant/conservative management in these cases.
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http://dx.doi.org/10.1007/s00404-012-2299-1DOI Listing
August 2012

Incidence and costs of multifetal pregnancies in Andalusia (2000-2010).

Twin Res Hum Genet 2011 Oct;14(5):484-9

Obstetrics Department, General University Hospital, Carlos Haya, Málaga, Spain.

In the past 50 years the incidence of multiple pregnancies has increased dramatically due almost exclusively to two factors: delayed childbearing and assisted reproductive techniques. In this paper we analyze the variations in the incidence of multiple gestations in Andalusia, one of the biggest administrative regions in Spain, over the last decade. Assisted reproduction techniques are very often evaluated only in terms of implantation and pregnancy rates per cycle, ignoring everything related to complications of multiple births, prematurity or economic overload. The rate of twins in Andalusia has increased from 10.9 per thousand in 2000 to 16.2 per thousand in 2009. The rate of triplet births has also increased in recent years. After a decline in 2003, motivated by promulgation of the first Human Assisted Reproduction Law, there was an increase after a second law came into effect in 2006. Health care spending attributable to the excess of multiple pregnancies reported in the decade 2000-2010 may have been much higher than € 25 million.
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http://dx.doi.org/10.1375/twin.14.5.484DOI Listing
October 2011