Background To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. Methods We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. Main outcome measures: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. Results Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32–3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11–2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43–8.94, p <  0.001) was also observed in positive mothers. Conclusion This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients’ information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13–3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms.

Our aim was to evaluate the effect of 4-dimensional (4D) 18 F-FDG PET/CT in the detection of pulmonary lesions. Methods: Fifty-seven pulmonary lesions were prospectively assessed in 37 patients (26 men and 11 women) with a mean age of 66.3 y. Twenty-nine of these patients had a history of neoplasm. All patients underwent 3-dimensional (3D) total-body PET/CT and 4D thoracic PET/CT (synchronized with respiratory movement). Maximum standardized uptake value (SUVmax) was obtained for each lesion in both studies. For the 4D studies, we selected the SUVmax in the respiratory period with the highest uptake ("best bin") and the average value over all bins ("average gated"). SUVmax percentage difference between 3D and 4D PET/CT and the relationship of this value to the diameter and location of the lesions were calculated. Statistical parameters were calculated for 3D and 4D PET/CT. Results: Fifty-four of 57 lesions showed an increase of SUVmax in the 4D study with respect to the 3D study. The mean SUVmax was 3.1 in the 3D study. 4D PET/CT studies showed a mean SUVmax of 4.5 for the best-bin study and 3.9 for the average gated study. The percentage difference in mean SUVmax between 3D and 4D studies (best bin and averaged gated) was 72.9% and 48.8%, respectively. The smaller the lesion, the greater was the SUVmax percentage difference (P , 0.05). However, no statistical differences dependent on the location of the lesions were observed. Final diagnosis showed that 37 lesions were malignant. The sensitivity, specificity, positive predictive value, and negative predictive value were 37.8%, 95%, 93%, and 45%, respectively, for 3D studies and 70.3%, 70%, 81.2%, and 56%, respectively, for 4D best-bin studies. Conclusion: Characterization of malignant lung lesions was better with 4D PET/ CT than with standard PET/CT.

The purpose of this study was to assess the feasibility of selective pelvic PET/CT with retrograde bladder irrigation in evaluating pelvic pathologies. Methods: Thirty-eight patients (22 women and 16 men), with a mean age of 61 y (range, 41-81 y) and a neoplastic background (most of them of pelvic pathology), were assessed with PET/CT. The most prevalent findings were urothelial (14 cases), gynecologic (12 cases), and rectal (7 cases) cancers. All but 3 patients had undergone previous surgical procedures or radio-or chemotherapy. Twenty-two patients had suspected pelvic pathology on a previous diagnostic CT scan. All the patients underwent a standard PET/CT protocol (from head to upper thighs) 60 min after the intravenous injection of 370 MBq of 18 F-FDG. Additional delayed pelvic PET/CT images were acquired with a filled-bladder technique. Both series of images were assessed by 2 experienced observers. A lesion was classified as malignant if it showed a standardized uptake value greater than 2.5 or, in the case of subcentimetric lesions, any uptake greater than background activity that persisted or increased on delayed pelvic imaging. All lesions were evaluated histologically or by clinical follow-up. Results: Twenty-seven of 43 studies were categorized as pathologic using PET/CT. Nineteen studies showed abnormalities in the pelvis; the findings of 5 of these studies were false-positive. Ten studies showed pathologic 18 F-FDG uptake in the bladder wall; in 7 of these studies the uptake was found to be true-positive on histopathologic examination. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT in the pelvic assessment were 100%, 83%, 74%, 100%, and 76%, respectively. The retrograde filling reduced the interference with physiologic urinary accumulation of 18 F-FDG in patients with possible pelvic lesions; no false-negative results were documented. Conclusion: In 18 F-FDG PET studies, retrograde filling of the urinary bladder is recommended to assess bladder wall lesions and malignancies in other pelvic locations. Several investigators have considered 18 F-FDG PET of no utility in the detection of kidney, ureter, bladder, and prostate tumors (1-7). Because 18 F-FDG is not reabsorbed as glucose, the limitation of 18 F-FDG PET has been attributed to glomerular filtration and urinary excretion (8). Furthermore, high 18 F-FDG activity in the urinary bladder is especially a problem in the evaluation of gynecologic tumors.On the other hand, previous treatments or diagnostic procedures such as biopsy, radiotherapy, systemic chemotherapy, and intravesical agents (e.g., bacille CalmetteGuérin) can cause circumferential bladder wall thickening, mimicking bladder cancer (9). The pooled activity in the urinary bladder makes the evaluation of these bladder wall lesions difficult or even impossible.Several methods have been used in an attempt to palliate this situation, with controversial results. Some approaches based on the continuous or not continuous irrigation of ...