ABSTRACT Objective: To assess the predictive value for adverse neonatal outcome of Doppler ultrasound, angiogenic factors and multi-parametric risk-score models in women with early-onset severe preeclampsia. Design: Prospective cohort study. Setting: Maternity units in two Spanish hospitals. Population: Women with diagnosis of early-onset severe pre-eclampsia. Methods: A multi-parametric risk score model, Doppler ultrasound, and levels of angiogenic factors were measured at admission. The predictive value for adverse neonatal outcome was calculated. Main outcome measures: Composite of adverse neonatal outcome. Results: Of 63 women with early-onset severe preeclampsia, 18 (28.6%) presented an adverse neonatal outcome. PlGF showed the best discrimination between neonatal outcomes among angiogenic factors. Good predictive values for the prediction of neonatal complications were found with the combination of PREP-L score with advanced Doppler (AUC ROC 0.9 95% CI 0.82-0.98]) and with PlGF levels (AUC ROC 0.91 [95% CI 0.84-0.98]). Conclusions:  The combination of maternal risk scoring (PREP-L score) with angiogenic factors or fetal Doppler ultrasound at the time of diagnosis of early-onset preeclampsia with severe features performs well in predicting adverse neonatal outcome. Keywords: Angiogenic factors; Early-onset severe preeclampsia; Hypertension in pregnancy; Neonatal adverse outcome; Doppler ultrasound; Placental growth factor; Soluble fms-like tyrosine kinase 1.

Objective: To evaluate the performance of INTERGROWTH-21st and World Health Organization (WHO) fetal growth charts to identify small-for-gestational-age (SGA) and fetal growth restriction (FGR) neonates as well as their specific risks for adverse neonatal outcomes. Design: Multicenter cross-sectional study. Setting: Ten maternity units across four Latin American countries, 2016-2018. Population: 67,968 singleton live births. Methods: According to each standard, the neonates were classified as SGA and FGR (birthweight <10th and <3rd centiles, respectively). Main Outcomes Measures: The relative risk (RR) and diagnostic performance for the occurrence of a low Apgar score and low ponderal index were calculated for each standard. Results: The WHO charts identified more neonates as SGA than IG-21st (13.9% vs. 7%, respectively). 6.9% babies were considered SGA only by the WHO chart. Compared to normally grown babies, neonates classified as FGRs by both standards had the highest RR for a low Apgar (RR: 5.57; 95% CI: 3.99–7.78), followed by those SGA by both curves (RR: 3.27; 95% CI: 2.52–4.24), while SGAs identified by WHO alone did not have an additional risk (RR: 0.87; 95% CI: 0.55–1.39). Furthermore, the diagnostic odds ratio for a low Apgar was higher when INTERGROWTH-21st was used than when SGA and FGR were defined by WHO charts. Conclusions: In a large population of singleton deliveries from Latin America, the WHO fetal growth charts seem to identify significantly more SGA neonates than the INTERGROWTH-21st charts, but the diagnostic performance of the latter for low Apgar score and low ponderal index is better.

Background: Maternal levels of angiogenic factors are promising prognostic parameters in patients with suspected preeclampsia, but in women with confirmed preeclampsia this performance has been less explored. Objective: To assess in women with early-onset severe preeclampsia whether longitudinal changes in angiogenic factors improve the prediction of adverse outcome. Study design: A cohort was created of consecutive women admitted for early-onset severe preeclampsia with no indication for immediate delivery. Levels of placental growth factor [PlGF], soluble fms-like tyrosine kinase [sFlt-1] and sFlt-1/PlGF ratio were measured at admission and before delivery; and average daily change was calculated. The association of longitudinal changes of angiogenic factors with maternal complications and with the time interval to delivery was evaluated by logistic and Cox regression. Results: Sixty-three women were analyzed, of which 23 (36.5%) had a complication. Longitudinal changes of sFlt-1 were more pronounce in complicated pregnancies (median: 1079.5 vs. 343.7 pg/mL/day; p=0.04). On the multivariate analysis, the baseline model (clinical risk score and sFlt-1 at admission) explained a 6.6% of the uncertainty for complication (R2-Naegelkerke). The addition of sFlt-1 longitudinal changes improved this performance to 23.2% (p=0.004). The median time from admission to delivery was 3 days (95% confidence interval: 1.9-4.05) in those in the highest quartile of sFlt-1 longitudinal changes vs. 10 days (95% confidence interval: 8.1-11.9) in the remaining women (Log-rank test p<0.001). Conclusions: Longitudinal changes in sFlt-1 maternal levels from admission for confirmed early-onset severe preeclampsia add to baseline characteristics in the prediction of maternal complications.

Objective: We aimed to describe mode of delivery and perinatal results among COVID-19 confirmed infected women. Design: Prospective cohort of consecutive pregnant women with confirmed SARS-CoV-2 infection, and comparison of perinatal outcome with expected values on an historical cohort. Setting: A tertiary referral center in Barcelona, Spain. Population: Pregnant women with SARS-CoV-2 confirmed infection. Methods: SARS-CoV-2 infected women managed under a standard protocol who delivered during the period March 13th - April 25th, were evaluated. Data on baseline maternal characteristics, COVID-19 disease parameters, clinical management, mode of delivery, and perinatal outcome were collected. Relevant perinatal data were compared with the expected values observed in an historical control of our center. Main Outcome and Measure: Rate of vaginal delivery among COVID-19 pregnancies. Secondary outcomes were maternal or neonatal complications, and vertical transmission of SARS-CoV-2. Results: A total of 21 women with COVID-19 delivered at our center during the study period: 42.9% had moderate or severe respiratory infection. 14 out of 21 (66.7%) delivered vaginally. Three out of 7 caesarean sections were maternal indicated because of maternal worsening secondary to COVID infection. Preterm delivery occurred in 4 cases (19%), half of them related to COVID-19. There were no differences between the observed and the expected perinatal outcomes. Conclusions: In the absence of severe maternal complications, vaginal delivery among pregnant women with COVID-19 infection is a safe option, both for the mother and the baby, with similar perinatal outcomes than expected in a non-infected cohort and with no evidence of vertical transmission.