Aim of the study To describe prenatal stress and state anxiety levels in pregnant women living in Spain during the lockdown of the first wave of COVID-19 and its relation with obstetric factors, perception of health care, and concerns about the socio-sanitary situation. Methods The present study is an observational, correlational, and cross-sectional quantitative study. The participants in the study were pregnant women recruited through non-probabilistic convenience and snowball sampling during the lockdown. A web link was provided to an online questionnaire designed for this research, which collected socio-demographic and obstetric variables, perceptions of health care received during the pandemic and preoccupations associated with COVID-19. It also included the Prenatal Stress Questionnaire (PDQ) and the State Anxiety Inventory (STAI-S). Results Based on the responses of 695 pregnant women, the results showed a mean of 16.98 (SD = 25.20) of prenatal stress and elevated levels of anxiety (M = 25.20/SD = 11.07) in the first wave of the pandemic. Risk factors for prenatal stress and anxiety were the level of preoccupation associated with COVID-19 and previous mental health issues. A specific risk factor for anxiety was having more than one child and a protective factor were perceiving accessibility and availability of health care, with clear and consistent pregnancy care and follow-up protocols. Conclusions The lockdown period for COVID-19 was a stressful experience for pregnant women, highlighting the need to address their psychological well-being through clear and coherent protocols in terms of maternal-foetal health control and follow-up.

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Experience with inline intermittent hemodiafiltration as renal replacement therapy in critically ill patients Background: In critical patients with acute renal failure, intermittent diffusive renal replacement techniques cause hemodynamic problems due to their high depurative efficiency. This situation is avoided using continuous low efficiency therapies, which are expensive, prevent patient mobilization and add hemorrhagic risk due to systemic anticoagulation. Intermittent and prolonged hemodiafiltration (HDF) has the depurative benefits of diffusion, plus the positive attributes of convection in a less expensive therapy. Aim: To report our experience with intermittent and prolonged on-line HDF in critically ill patients. Patients and Methods: During 2016, HDF therapies performed on critical patients with indication of renal replacement therapy were characterized. The hemodynamic profile was evaluated (doses of noradrenaline, blood pressure, heart rate and perfusion parameters). Results: Fifty-one therapies were performed in 25 critical patients, aged 58 ± 11 years (28% women), with an APACHE II score of 22.1 ±10. The average time of the therapies was 4.15 hours (range 3-8 hours), the replacement volume was 75 ± 18 mL/kg/h and ultrafiltration rate was 226 ± 207 mL/h. The mean initial, maximum and final noradrenaline doses were 0.07 ± 0.1, 0.13 ±0.18 and 0.09 ±0.16 μg/kg/min respectively. No differences between patients with low, medium and high doses of noradrenaline or dose increases during therapy, were observed. The greatest decrease in mean arterial pressure was 15.3% and the maximum increase in heart rate was 12.8%. Anticoagulation was not required in 88% of therapies. Conclusions: High-volume intermittent or prolonged HDF is an effective therapy in critical patients, with good hemodynamic tolerability, lower costs and avoidance of systemic anticoagulation risks.

Objetivo: Describir los niveles de estrés prenatal y ansiedad estado en mujeres gestantes residentes en España durante el confinamiento generado por la primera ola del COVID-19, y su asociación con los factores obstétricos, percepción de la atención sanitaria y preocupación provocada por la situación sociosanitaria. Método: Estudio cuantitativo observacional, correlacional y de corte transversal. La población de estudio fueron mujeres gestantes confinadas, reclutadas a través de muestreo no probabilístico por conveniencia y de bola de nieve. Se difundió un enlace web de acceso a un cuestionario online diseñado para la investigación, que recogía variables sociodemográficas, obstétricas, sobre la percepción de la atención sanitaria recibida durante la pandemia y preocupaciones asociadas al COVID-19. Se incluyó también el Cuestionario de Preocupaciones Prenatales (PDQ) y el Inventario de Ansiedad Estado (STAI-S). Resultados: Basados en las respuestas de 695 mujeres gestantes, los resultados indican que durante la primera ola de la pandemia se observó un nivel medio de estrés prenatal de 16,98 (DS=25,20) y un nivel elevado de ansiedad (M=25,20/DS=11,07). Factores de riesgo determinante del estrés prenatal y ansiedad fueron el nivel de preocupación asociada al COVID-19 y tener antecedentes de salud mental. Un factor de riesgo específico para la ansiedad fue tener más de un hijo/a y un factor protector fue percibir accesibilidad y disponibilidad de la atención sanitaria. Conclusiones: El periodo de confinamiento por COVID-19 significó un estrés adicional para las mujeres gestantes, poniendo en evidencia la necesidad de atender el bienestar psicológico de dicha población a través de protocolos claros y coherentes en cuanto a control y seguimiento de la salud materno-fetal.