Background A population-based study to describe the impact of SARS-CoV-2 infection on pregnancy outcomes. Methods Prospective, population-based study including pregnant women consecutively attended at first/second trimester or at delivery at three hospitals in Barcelona, Spain. SARS-CoV-2 antibodies (IgG and IgM/IgA) were measured in all participants and nasopharyngeal RT-PCR was performed at delivery. The primary outcome was a composite of pregnancy complications in SARS-CoV-2 positive versus negative women: miscarriage, preeclampsia, preterm delivery, perinatal death, small-for-gestational age, neonatal admission. Secondary outcomes were components of the primary outcome plus abnormal fetal growth, malformation, intrapartum fetal distress. Outcomes were also compared between positive symptomatic and positive asymptomatic SARS-CoV-2 women. Results Of 2,225 pregnant women, 317 (14.2%) were positive for SARS-CoV-2 antibodies (n=314, 99.1%) and/or RT-PCR (n=36, 11.4%). Among positive women, 217 (68.5%) were asymptomatic, 93 (29.3%) had mild COVID-19 and 7 (2.2%) pneumonia, of which 3 required intensive care unit admission. In women with and without SARS-CoV-2 infection, the primary outcome occurred in 43 (13.6%) and 268 (14%), respectively [risk difference -0.4%, (95% CI: -4.1% to 4.1)]. As compared with non-infected women, women with symptomatic COVID-19 had increased rates of preterm delivery (7.2% vs. 16.9%, p=0.003) and intrapartum fetal distress (9.1% vs. 19.2%, p=0.004), while asymptomatic women had similar rates to non-infected cases. Among 143 fetuses from infected mothers, none had anti-SARS-CoV-2 IgM/IgA in cord blood. Conclusions The overall rate of pregnancy complications in women with SARS-CoV-2 infection was similar to non-infected women. However, symptomatic COVID-19 was associated with modest increases in preterm delivery and intrapartum fetal distress.

What are the novel findings of this work?This work demonstrates the accuracy of transvaginal ultrasound (TVS) for diagnosing deep endometriosis (DE) involving the uterosacral ligaments, torus uterinus or posterior vaginal fornix, as compared with laparoscopic findings, and describes in detail the TVS technique performed. What are the clinical implications of this work?TVS has high accuracy in the evaluation of DE involving the uterosacral ligaments, torus uterinus and posterior vaginal fornix during preoperative assessment of women with suspected endometriosis.

Introduction: Cytomegalovirus (CMV), is a major cause of childhood disabilities and consensus recommendations emphasize the importance of hygienic measures to reduce perinatal infection. Objective: To evaluate the level of awareness about CMV among health professionals and pregnant women. Methods: We submitted a 20-item online survey regarding CMV perinatal infection to all obstetricians and midwives in Catalonia (Spain) and a 7-item lay-version of the questionnaire to 700 pregnant women. Levels of knowledge were compared among groups. Results: Of the 1449 health professionals approached, 338 surveys were answered. 72% of professionals considered CMV a relevant problem. 47% of obstetricians and 28% of midwives (p=<0.001) routinely informed pregnant women, and less than half knew the risk of fetal transmission. We observed significant differences in knowledge between obstetricians and midwives concerning the risks of recurrent infections, risk of transmission, and risk of severe infection (60.7% vs 45.6%, p=0.006 and 50.6% vs 22.5% p=<0.001); and regarding maternal and neonatal symptoms, and newborn sequelae (23% vs. 8.8% p=<0.001). Of the 700 women approached, we obtained a response rate of 72%. Only 23% had previously heard about CMV; 22% identified transmission routes, and 15% preventive measures. Compared to women without risk factors for CMV infection women at greater risk had heard more about CMV [mothers of children <3 years: 36% vs. 20% p< 0.001; occupational exposure: 43% vs. 20% p=<0.001] and had received more information (mothers of children <3 years: 18% vs. 9.5% p=<0.001; occupational exposure: 23% vs. 9.3% p=0.001). Conclusions: Health care professionals have limited knowledge about CMV and may fail to enforce preventive measures. While pregnant women have limited awareness about CMV infection, they recognize the need for information. Health campaigns should be promoted to enhance awareness about this perinatal infection.