External cephalic version outcomes with tocolysis and sedation: A 10-year retrospective cohort study Javier Sánchez‐Romero, Rosa María Gallego‐Pozuelo, José Eliseo Blanco‐Carnero, Javier Herrera‐Giménez, Fernando Araico‐Rodríguez, Alberto Rafael Guijarro‐Campillo, Aníbal Nieto‐Díaz, Catalina de Paco‐Matallana International Journal of Gynecology and Obstetrics, 2026 Objective To evaluate the effectiveness and safety of external cephalic version (ECV) performed with tocolysis and sedation or spinal anesthesia, and to identify predictors of ECV success, complications, and delivery outcomes after successful ECV. Methods This 10‐year cohort study included 990 pregnant women with term non‐cephalic presentation at a tertiary hospital in Spain. Data were collected retrospectively (2014–2020) and prospectively (2020–2024). All ECVs followed a standardized protocol using ritodrine plus either propofol sedation or spinal anesthesia. Multivariable logistic regression identified predictors of ECV success and complications, and delivery outcomes were recorded. Results ECV was successful in 691/990 (69.8%). Factors associated with higher success included a deepest amniotic fluid pocket >30 mm (OR = 1.80; 95%CI 1.04–3.11) and transverse lie (OR = 3.60; 95%CI 1.74–7.45). Lower success was observed in nulliparous women (OR = 0.55; 95%CI 0.40–0.76) and those with BMI between 30 and 35, and >35 kg/m 2 (OR = 0.53 and 0.49 respectively). Complications occurred in 101/990 (10.2%), including 67/990 (6.7%) emergent cesarean sections. After successful ECV, 556/691 (80.5%) delivered vaginally. Conclusion In this high‐volume tertiary center, ECV performed with systematic tocolysis and sedation or spinal anesthesia achieved high success and low complication rates, supporting the safety and feasibility of this optimized protocol.
Placental dysregulation of mitochondrial morphology and dynamics as a hallmark of maternal age–related adaptation Juan M. Toledano, Maria Puche-Juarez, María Paz Carrillo, Javier Diaz-Castro, Javier Sanchez-Romero, Francisco Manuel Ocaña-Peinado, Catalina de Paco Matallana, Estefania Martín-Alavarez, Jorge Moreno-Fernandez, Julio J. Ochoa Life Sciences, 2026 Advanced maternal age (AMA), increasingly prevalent worldwide, is linked to obstetric risk even in clinically uncomplicated pregnancies. Mitochondria are essential for trophoblast metabolism and stress adaptation, and their alteration is associated with gestational pathologies. However, it remains unclear whether maternal age alone alters placental mitochondrial homeostasis. Human placentas from AMA and control pregnancies were analysed by transmission electron microscopy (TEM) to assess mitochondrial ultrastructure and mitochondria–endoplasmic reticulum contacts (MERCs). Western blotting was used to evaluate regulators of mitochondrial fusion, fission, and mitophagy. placentas from AMA pregnancies showed a significant increase in mitochondrial number in both syncytiotrophoblast and cytotrophoblast cells, with regional variation between maternal and foetal sides. Despite increased abundance, mitochondria were smaller (reduced area and perimeter), indicating a fragmented phenotype, while circularity was unchanged. MERCs exhibited decreased distance and increased ER coverage, suggesting enhanced stress signaling and fission. Western blotting revealed decreased MFN1 with increased OPA1 and DRP1 expression, whereas MFN2, FIS1, and DNM2 remained unchanged. Mitophagy markers were dysregulated, with reduced OPTN and BNIP3 but elevated FUNDC1. AMA is associated with fragmented and stress-adapted placental mitochondria, showing structural imbalance in dynamics and altered quality control even in the absence of clinical pathology. These features may reflect reduced placental capacity to buffer metabolic and stress challenges and contribute to increased vulnerability in pregnancies of older mothers, positioning mitochondria as a potential target for monitoring and improving outcomes in this population. • Placental mitochondria show increased abundance in both trophoblast populations. • Reduced mitochondrial size indicates a fragmented ultrastructure with no changes in circularity. • Tighter mitochondria–ER contacts in cytotrophoblasts suggest augmented stress signaling. • Imbalanced fusion–fission protein profile, with a shift towards fission, favours mitochondrial fragmentation. • Altered mitophagy receptor signaling reflects disrupted mitochondrial quality control.
Neoadjuvant Chemotherapy Following Hyperthermic Intraperitoneal Chemotherapy in Platinum-Sensitive Recurrent Ovarian Cancer: A Retrospective Cohort Study Alberto Rafael Guijarro-Campillo, Alida González-Gil, Elena Gil-Gómez, Vicente Olivares-Ripoll, Javier Sánchez-Romero, Jerónimo Martínez, Aníbal Nieto, Pedro Antonio Cascales-Campos Cancers, 2026 Objective: This study aims to compare the efficacy of neoadjuvant chemotherapy (NACT) followed by secondary cytoreductive surgery (SCS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) versus SCS with HIPEC alone in patients with platinum-sensitive recurrent ovarian cancer. Methods: A retrospective analysis was conducted on patients treated at Hospital Clínico Universitario Virgen de la Arrixaca from January 2011 to December 2024. Two cohorts were analyzed: those receiving NACT prior to SCS and HIPEC, and those undergoing SCS with HIPEC without prior NACT. The primary endpoint was progression-free survival (PFS), while secondary endpoints included overall survival (OS), peritoneal progression-free survival, extraperitoneal progression-free survival, and safety. Results: A total of 86 patients were included in the study, with 39 in the NACT group and 47 in the non-NACT group. The non-NACT cohort exhibited a significantly longer PFS of 20 months compared to 12 months in the NACT group (p = 0.004). Median OS was also superior in the non-NACT group, at 88 months versus 34 months (p = 0.023). Patients in the NACT group experienced longer surgical durations, increased transfusion requirements, and a higher incidence of severe complications. Conclusions: The addition of NACT prior to SCS and HIPEC does not enhance survival outcomes for patients with platinum-sensitive recurrent ovarian cancer. In fact, those who underwent SCS with HIPEC alone demonstrated better PFS and OS, underscoring the importance of careful patient selection in optimizing treatment strategies.
Randomized clinical trial of the use of Propofol as a sedative agent versus spinal analgesia with bupivacaine in External Cephalic Version (PropoSpinECV): study protocol for a randomized clinical trial Javier Sánchez-Romero, Luis Falcón-Araña, José Eliseo Blanco-Carnero, Joaquín García-Ferreira, Javier Herrera-Giménez, Diego Fuentes-García, Fernando Araico-Rodríguez, Rosa María Gallego-Pozuelo, Aníbal Nieto-Díaz, Catalina de Paco-Matallana Trials, 2025 BACKGROUND: External Cephalic Version (ECV) is an effective procedure for modifying fetal position to achieve a cephalic presentation. ECV is usually performed with tocolysis and spinal anesthesia. Recently, propofol has been proposed as a sedative agent for ECV, showing promising results in observational studies. This clinical trial aims to compare the outcomes of ECV performed under tocolysis with either propofol or spinal anesthesia. METHODS: The PropoSpinECV randomized clinical trial is designed as a single-center, randomized, open-label trial. Participation will be offered to every pregnant woman with a non-cephalic presentation undergoing external cephalic version. Sedation with propofol and spinal analgesia with bupivacaine and fentanyl will be compared for ECV with a 1:1 allocation ratio. All procedures will be performed under tocolysis with ritodrine. The breech progression angle before ECV will be measured for all participants. The main outcome will be the ECV success rate. ECV complication rates and post-procedure pain will also be evaluated. DISCUSSION: The PropoSpinECV trial will thoroughly evaluate the efficacy of propofol in ECV. Additionally, this trial will investigate the role of the breech progression angle prior to ECV as a predictive variable for the success of the procedure. TRIAL REGISTRATION: The PropoSpinECV clinical trial is registered in the European Union Clinical Trial Database (EU CT number: 2024-510701-29-00) and in the ClinicalTrials.gov Database (NCT06449430) with the Clinical Trial Registry (2024-06-03).
Ultrasound Assessment of Breech Engagement: Breech Progression Angle and Prediction of External Cephalic Version Success Javier Sánchez-Romero, Rosa María Gallego-Pozuelo, Cristina Ortuño-Hernández, Ana Martínez-Zarco, Rocío Barroso-Linares, Fernando Araico-Rodríguez, José Eliseo Blanco-Carnero, Aníbal Nieto-Díaz, Catalina de Paco-Matallana Journal of Clinical Medicine, 2025 Objectives: To evaluate the role of breech progression angle (BPA), a novel transperineal ultrasound parameter, as a predictor of external cephalic version (ECV) success, and to compare BPA between breech and transverse lie presentations. Methods: This prospective exploratory study was nested within a randomized clinical trial (NCT06449430) at Virgen de la Arrixaca University Hospital, Murcia, Spain. Eligible participants were pregnant women ≥18 years with a singleton fetus in non-cephalic presentation at term, without contraindications to vaginal birth. BPA was measured transperineally following standardized methodology prior to ECV, performed under either spinal analgesia or propofol sedation. Logistic regression models adjusted for maternal and obstetric variables assessed the association between BPA and ECV success. Receiver operating characteristic (ROC) curves were generated to evaluate predictive accuracy. Results: A total of 117 women were included: 100 with breech and 17 with transverse lie presentations. Median BPA was significantly higher in breech compared with transverse lie (87.2° vs. 70.2°, p < 0.001). In the overall cohort, BPA was not significantly associated with ECV success (OR 0.97, 95% CI 0.94–1.00; p = 0.068). However, in breech presentations, BPA was independently associated with ECV success (adjusted OR 0.95, 95% CI 0.91–0.99; p = 0.015). The area under the ROC curve for BPA predicting ECV success in breech cases was 0.64 (95% CI 0.53–0.73). Predictive accuracy was poor for transverse lie (AUC 0.27, 95% CI 0.08–0.56). Conclusions: BPA measured by transperineal ultrasound does not provide clinically useful information for predicting the success of external cephalic version, either in breech or transverse lie.
Evaluation of maternal and neonatal complications in preeclamptic twin versus singleton pregnancies: a retrospective study Javier Sánchez-Romero, María Rodríguez-Contreras, Valeria Rolle, Romina Sol Liandro, Miriam Pertegal-Ruiz, María Muñoz-Contreras, José Eliseo Blanco-Carnero, Catalina De Paco Matallana Archives of Gynecology and Obstetrics, 2025 Purpose This study aims to compare maternal and neonatal outcomes in singleton and twin pregnancies complicated by preeclampsia, emphasizing differences between preterm and term deliveries. Methods This is a retrospective study conducted at "Virgen de la Arrixaca" University Hospital (Murcia, Spain), from 2009 to 2020. Maternal demographic data and maternal and neonatal outcomes were collected from hospital records. Pregnancies were stratified by delivery before and after 37 weeks of gestation. Results The study included 161 singleton pregnancies and 77 twin pregnancies, all complicated by preeclampsia. Preterm delivery rates (< 37 weeks) were significantly higher in twin compared to singletons (79.2% vs. 48.4%). The mean maternal hospital stay was longer in twins (9.0 days) than for singletons (7.6 days). Maternal complications occurred in 13.7% of singleton pregnancies and 28.6% of twin pregnancies (p = 0.006), with maternal hemorrhage more frequent in twins (22.1% vs. 9.3%; p = 0.007). Maternal complications were more common in twin pregnancies (OR = 3.13; 95%CI 1.38–7.10). Cesarean delivery (OR = 2.00; 95%CI 0.85–4.66) and BMI (OR = 0.96; 95%CI 0.90–1.03) were not associated with the maternal composite outcome. Neonatal complications occurred in 29.2% of singleton pregnancies and 30.0% of first twin and 27.3% of second twin (p = 0.890 and 0.790 respectively). Factors associated with neonatal complications included birthweight (OR 0.99; 95%CI 0.99–0.99) and delivery between 34 and 37 weeks of gestation (OR = 0.08; 95%CI 0.01–0.59) and delivery after 37 weeks of gestation (OR = 0.04; 95%CI 0.01–0.46). Conclusions Maternal complications were more frequent in twin pregnancies complicated by preeclampsia, while neoantal complications were more likely to occur in cases of preterm preeclampsia.
Vaginal Administration of Progesterone in Twin Gestation: Influence on Bone Turnover and Oxidative Stress María Puche-Juarez, Juan M. Toledano, Jorge Moreno-Fernandez, Javier Diaz-Castro, Javier Sánchez-Romero, María Mar Gil, Valeria Rolle, Aníbal Nieto-Díaz, Julio J. Ochoa, Catalina De Paco Matallana Antioxidants, 2025 Twin pregnancies, with higher incidences of preterm birth, are becoming more prevalent. Progesterone has shown effectiveness in the prevention of preterm labour, though other factors related to pregnancy and neonatal health may be affected by this hormone and have not been previously addressed. This study aims to evaluate the impact of progesterone administration on oxidative stress and bone turnover during twin gestation and investigate associations with some maternal/neonatal variables of interest. Women pregnant with twins were recruited in the “Virgen de la Arrixaca” University Hospital and randomly assigned to two groups: control (n = 49) and progesterone (n = 50). A total of 600 mg/day of progesterone was vaginally administered from 11 to 14 to 34 weeks of gestation. Blood samples were taken in the first (T1) and third trimester (T3), analyzing biomarkers related to oxidative stress and bone turnover. Most bone turnover and oxidative markers experiment with significant changes during gestation. Progesterone administration significantly increased (p < 0.05) the levels of osteocalcin in T3 and decreased (p < 0.05) the levels of sclerostin. Regarding oxidative stress, the progesterone group, unlike the control group, showed no significant increase in oxidative stress between T1 and T3. In conclusion, results show that progesterone administration could increase maternal bone formation and modulate oxidative stress.
Association of uterine fibroids with late miscarriage: multicenter cohort study A. Siargkas, M. del Mar Gil Mira, P. Chaveeva, C. de Paco Matallana, M. Impis Oglou, M. Muñoz‐Contreras, V. Kalev, L. Gonzalez‐Gea, I. Fernandez‐Buhigas, J. Sanchez‐Romero, I. Tsakiridis, T. Dagklis Ultrasound in Obstetrics and Gynecology, 2025
External cephalic version following prior cesarean delivery: A comparative cohort analysis Javier Sánchez‐Romero, Rosa María Gallego‐Pozuelo, Hajar Dahmouni‐Dahmouni, José Eliseo Blanco‐Carnero, Fernando Araico‐Rodríguez, Javier Herrera‐Giménez, Alberto Rafael Guijarro‐Campillo, Aníbal Nieto‐Díaz, Katy de Paco International Journal of Gynecology and Obstetrics, 2024
Sedation with Propofol plus Paracetamol in External Cephalic Version: An Observational Study Javier Sánchez-Romero, Jesús López-Pérez, Ana Belén Flores-Muñoz, María Josefa Méndez-Martínez, Fernando Araico-Rodríguez, Jaime Mendiola-Olivares, José Eliseo Blanco-Carnero, Luis Falcón-Araña, Aníbal Nieto-Díaz, María Luisa Sánchez-Ferrer Journal of Clinical Medicine, 2022
External cephalic version: Is it an effective and safe procedure? Javier Sánchez-Romero, Vanesa García-Soria, Fernando Araico-Rodríguez, Javier Herrera-Giménez, José E. Blanco-Carnero, Aníbal Nieto-Díaz, María Luisa Sánchez-Ferrer Journal of Visualized Experiments, 2020
