Search

Objective: To assess the effect of a uterine niche resection on fertility and pregnancy outcomes. We compared these outcomes in women with and without infertility, as we hypothesized that in the group with infertility, the presence of the niche may contribute to the failure to conceive. The focus on reproductive and pregnancy outcomes as well as the differentiation in study populations is novel and has not been a topic of research up until now. Evidence Review: The databases PubMed, Embase, and Web of Science were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until July 19, 2021. Randomized controlled trials (RCTs), cohort studies, case-control studies, and case series with at least 10 women were included if they reported fertility and/or pregnancy outcomes after any type of niche surgery among women with infertility or without the diagnosis of infertility. The risk of bias and quality of the included studies were assessed using the Cochrane risk-of-bias tool, the Newcastle-Ottawa Scale, and a set of niche-specific criteria. The primary outcome was live birth rate. The secondary outcomes included pregnancy and miscarriage rates, occurrence of an ectopic pregnancy, uterine dehiscence, and other obstetric complications. A meta-analysis was performed for the outcomes live birth, pregnancy, and miscarriage rates. The proportion with corresponding 95% confidence interval (CI) was calculated for each individual study, stratified for type of surgery and fertility status. Results: A total of 3,825 records were identified, of which 21 articles were included (1 RCT, 1 case series, and 5 prospective and 14 retrospective cohort studies). The RCT compared a surgical intervention with expectant management, whereas the other studies had an observational design. Sixteen studies reported on fertility outcomes in women with infertility (n = 648), and 5 studies reported on fertility outcomes in women without a diagnosis of infertility (n = 237). The reported surgical procedures were hysteroscopic niche resection (HNR) (n = 14), vaginal niche resection (n = 7), laparoscopic niche resection (n = 7), and laparotomic niche resection (n = 2). The overall methodological quality of included studies was moderate to poor with a high risk of bias. The statistical heterogeneity among the included studies ranged between 0 and 88%. Overall, the effect of a niche resection on the live birth rate was lower in women without infertility than in women with infertility: 36% (95% CI, 26 %–46%) vs. 54% (95% CI, 44%–64%).The live birth rates per different operative technique showed similar trends: HNR, 52% (95% CI, 40%–64%) vs. 55% (95% CI, 38%–71%); laparoscopic niche resection, 36% (95% CI, 25%–48%) vs. 42% (95% CI, 30%–55%); and vaginal niche resection, 25% (95% CI, 9%–46%) vs. 60% (95% CI, 52%–67%). The only RCT performed showed a significantly higher pregnancy rate after HNR than that after expectant management (N = 61 women; relative risk, 2.41; 95% CI, 1.32–4.39) in women diagnosed with infertility. There were no significant differences in the pregnancy and miscarriage rates between the different populations. A cesarean scar pregnancy was reported in 0.97% of pregnancies. After a hysteroscopic approach, in 4 (2.8%) of 145 deliveries, a uterine dehiscence or rupture was reported. There was no uterine dehiscence described after the other niche interventions. Conclusion: On the basis of the current available data, it is not advised to perform a niche resection to improve fertility outcomes. Well-designed comparative studies are necessary to investigate whether there is a role for niche surgery in patients with regard to fertility outcomes.

Megan Pagan,1 Ann Marie Mercier,1 Dayna Whitcombe,1 Songthip T Ounpraseuth,2 Everett F Magann,1 Amy Phillips1 1Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; 2Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USACorrespondence: Everett F MagannDepartment of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street Slot #518, Little Rock, AR, 72205, USA, Tel +1-501-686-8345, Email efmagann@uams.eduObjective: The July effect represents the month when interns begin residency and residents advance with increased responsibility. This has not been well studied in Obstetrics and Gynecology residencies and no study has been conducted evaluating obstetric outcomes. The purpose of this study was to evaluate the July effect on obstetric outcomes. Women who delivered between July and September (quarter 1) were compared to those delivering between April and June (quarter 4).Methods: This retrospective cohort study compared outcomes of deliveries between quarter 1 and quarter 4 from 2017 to 2020. Outcomes evaluated were postpartum length of stay (LOS), postpartum readmission, wound complication, wound infection, blood transfusion, estimated blood loss, 3rd and 4th degree lacerations, 5 min APGAR scores, and cesarean delivery rates.Results: There were 3693 deliveries in quarter 1 and 3107 deliveries in quarter 4. There was a higher incidence Of wound infection during the April–June period (N = 21; 0.68%) compared to July–September (N = 10; 0.27%; p = 0.0135). Although LOS for both periods were the same, the average postpartum LOS during July–September was slightly longer than April–June (1.7 days; SD = 1.1 vs 1.6 days; SD = 1.2; p = 0.0026). All other pregnancy outcomes were similar between the two groups.Conclusion: Overall, the July effect is minimal on obstetric complications. However, LOS between July and September may differ because all residents are less experienced in quarter 1. Wound infection rates were higher in April–June, perhaps because new PGY-1s went from assisting to primary on cesarean surgeries starting in the 4th quarter of the year.Keywords: July effect, obstetrics, interns, obstetric outcomes, residents

Objectives: This study aimed to investigate whether a history of loop electrosurgical excision procedure (i.e., conisation) affects obstetric and neonatal outcomes. Methods: A retrospective cohort study was carried out in Västernorrland county, Sweden. 57 nulliparous women with singleton pregnancies and previous conisation were compared with 100 age-matched pregnant controls without history of conisation. Results: There was significantly lower gestational age by delivery (p = 0.036), however, the premature delivery rate was not different. Caesarean section was also less frequent (OR: 0.29, 95% CI: 0.081–1.04, p = 0.047) in the conisation group than those in the control group. There were no differences in neonatal outcomes. Conclusions: Previous conisation does not affect the risk of prematurity or cervical dilatation during the first stage of labour. Women with history of conisation had a lower rate of caesarean section, and lower gestational age by delivery.

Refugee women experience more negative pregnancy and neonatal outcomes, such as low birth weight and preterm birth. The aim of the present study was to compare the clinical characteristics and pregnancy and neonatal outcomes between Turkish citizens and Syrian refugees with high-risk pregnancies. This prospective cohort study was conducted between March and December 2020 in Sanliurfa, Turkey. The maternal characteristics and pregnancy and neonatal outcomes were compared between the two groups. In this study, a total of 302 high-risk pregnant women (233 Turkish citizens and 69 Syrian refugees) were included. Parity and pregnancy spacing shorter than 2 years were significantly higher in Syrian refugees. Age, previous abortion or miscarriage and rates of cesarean section (C/S) were significantly higher in Turkish citizens. The live birth (Turkish: 94.8% vs Syrian: 92.8%), preterm birth (Turkish: 10% vs Syrian: 9.4%), low birth weight (Turkish: 7.7% vs Syrian: 3.1%) rates and birth weight (g) (Turkish: 3097.5 ± 501.3 g; Syrian: 2980.2 ± 395.0 g) were not significantly different between Turkish citizens and Syrian refugees with high-risk pregnancy. Similar pregnancy and neonatal outcomes could be attributed to the Syrians receiving adequate and free maternity care, similar to the Turkish citizens.

This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. Patients were divided into two groups: symptomatic and asymptomatic. We found a significantly higher rate of leukocytosis (p < 0.00078) and lymphopenia (p < 0.0024) in symptomatic women compared with asymptomatic ones. Other laboratory parameters, such as CRP (p = 0.002), AST (p = 0.007), LDH (p = 0.0142), ferritin (p = 0.0036), and D-dimer (p = 0.00124), were also significantly more often increased in the group of symptomatic pregnant women. Overall, symptomatic pregnant women with SARS-CoV-2 infection at the delivery show more often altered laboratory parameters compared with asymptomatic ones; nevertheless, they have a slightly higher but non-significant rate of preterm delivery, cesarean section, as well as lower neonatal birth weight and Apgar score, compared with asymptomatic women.

Assessment of strength of evidence with regards to the association of diabetes with gynaecological/obstetric outcomes

Maternal mortality in the United States is a public health crisis of preventable deaths among young women. The role of echocardiography in the evaluation of pregnant women with cardiovascular symptoms or risk factors without known heart disease is unclear. We retrospectively examined the clinical characteristics of consecutive pregnant patients without established heart disease who underwent echocardiography and evaluated associations between abnormal exam findings and obstetric outcomes. Among low-risk women undergoing echocardiography during pregnancy, older age, higher parity and a history of chronic hypertension are associated with a higher likelihood of echocardiographic abnormalities, which in turn are associated with a higher likelihood of adverse obstetric outcomes including caesarean section and preterm delivery.

Objective: To determine the impact of endometrial thickness on live birth outcomes and obstetric complication rate after hormone-replaced frozen embryo transfer. Design: Retrospective cohort study. Setting: Large, urban, academic fertility center. Patient(s): All patients with a singleton live birth after single euploid embryo transfer (by array comparative genomic hybridization or next-generation sequencing) in a hormone-replaced frozen embryo transfer cycle between January 2017 and December 2018 were reviewed. Intervention(s): None. Main Outcome measure(s): The primary outcomes were birth weight and obstetric complication rate. Result(s): A total of 492 patients were included. The median endometrial thickness was 8.60 mm (range, 6.0–20.0). The median gestational age at live birth was 39.4 weeks with a median birth weight of 3,345.2 g. Endometrial thickness was significantly correlated with birth weight. When patients were dichotomized into groups (those with an endometrial thickness of 7 mm), neonates born from endometria with a thickness of

Objective Review the menstrual and obstetric outcomes among Asherman syndrome patients when stratified by disease severity. Design Retrospective cohort study. Setting A community teaching hospital affiliated with a large academic medical center. Patients A total of 355 Asherman syndrome patients stratified by March classification who underwent hysteroscopic adhesiolysis. Interventions Telephone survey, analyzed with multivariable analysis. Main Outcome Measures Return of menstruation. Pregnancy, miscarriage, and live birth rate. Results A total of 355 patients underwent hysteroscopic adhesiolysis. Of these, 150 (42.3%) patients completed the telephone survey with a mean follow-up of 2.21 years. Additionally, 40.7% had mild, 52.7% had moderate, and 6.6% had severe disease. Furthermore, 25.3% of patients reported amenorrhea at presentation, with mild disease patients having the highest rate of returning menstruation (93.8%) following treatment. The cumulative pregnancy rate was 81.9%, and the cumulative live birth rate was 51.2%, with no statistical differences identified by the classification group. Conclusion Asherman syndrome disease severity predicted returning menstruation but not pregnancy or live birth rate.

We aimed to evaluate the pregnancy characteristics and obstetric outcomes in patients after perforation of the uterus. Study design: A retrospective cohort study was conducted and included all patients who were diagnosed with uterine perforation and treated in a tertiary referral medical center between the years 1996 and 2018. Up to two deliveries after perforations were investigated. Results: During the study period, 51 women were diagnosed with uterine perforation during gynecological procedures, including intrauterine device (IUD) insertion. The mean age of patients at the time of diagnosis was 27.9 (±4.7) years. The majority, 76.5% (n = 39), experienced perforation during IUD insertion, and 23.5% (n = 12) of the patients experienced perforation during surgical procedures. Most of the patients were multiparous or grand multiparous, 45.8. % (n = 22) and 39.6% (n = 19) respectively. Anteflexed uterus was found in 86.4% of the patients (n = 38). Five patients (9.8%) had pelvic abscesses after the IUD insertion. A total of 50 patients had 71 deliveries subsequent to uterine perforation. One patient experienced intrauterine fetal death due to fetal malformations. One patient experienced uterine rupture. No other major obstetric complications were noted. Conclusions: Uterine perforation may be associated with adverse obstetric outcomes. The possibility of uterine rupture must be considered while managing the deliveries of patients after uterine perforation. Moreover, a larger cohort and further studies are needed to establish an association between uterine perforation and adverse outcomes of the subsequent deliveries.

Aim: The aim of this study was to identify and compare birthing complications in women originating from countries where they are at risk (may become victims) of FGM with those of Spanish women, all having given birth from 2012 to 2015 at the “Virgen de la Arrixaca” University Clinical Hospital in Murcia, Spain. Methods: A transversal, observational, quantitative study was carried out, retrospectively, comparing 245 sub-Saharan women originating from countries where FGM is practiced with 490 Spanish women, in terms of obstetric complications. Data collection was performed via electronic clinical records. Results: The sub-Saharan women presented higher rates of intrapartum and emergency caesareans, intense postpartum haemorrhages, concurrent episiotomies and tears (2nd and 3rd degree), failed inductions, and non-progressive labours, and a more severe risk of foetal distress when compared with Spanish women. Conclusions: The fact that the sub-Saharan women originating from countries where FGM is practiced presented a greater number of birthing complications than the Spanish women proves the need for Spanish healthcare professionals to receive training towards cultural competency acquisition, in order to provide a multidisciplinary approach, with standardized action protocols focused fundamentally on prevention.

Lumbar epidural is the gold standard for labour analgesia. Low concentrations of local anaesthetic are recommended. This network meta-analysis investigated whether further reducing the concentration of local anaesthetic can improve maternal and neonatal outcomes without compromising analgesia. We conducted a systematic search of relevant databases for randomised controlled trials comparing high (>0.1%), low (>0.08% to ≤0.1%) or ultra-low (≤0.08%) concentration local anaesthetic (bupivacaine or equivalent) for labour epidural. Outcomes included mode of delivery, duration of labour and maternal/neonatal outcomes. Bayesian network meta-analysis with random-effects modelling was used to calculate odds ratios or weighted mean differences and 95% credible intervals. A total of 32 studies met inclusion criteria (3665 women). The total dose of local anaesthetic received increased as the concentration increased; ultra-low compared with low (weighted mean difference −14.96 mg, 95% credible interval [−28.38 to −1.00]) and low compared with high groups (weighted mean difference −14.99 [−28.79 to −2.04]), though there was no difference in the number of rescue top-ups administered between the groups. Compared with high concentration, ultra-low concentration local anaesthetic was associated with increased likelihood of spontaneous vaginal delivery (OR 1.46 [1.18 to 1.86]), reduced motor block (Bromage score >0; OR 0.32 [0.18 to 0.54]) and reduced duration of second stage of labour (weighted mean difference −13.02 min [−21.54 to −4.77]). Compared with low, ultra-low concentration local anaesthetic had similar estimates for duration of second stage of labour (weighted mean difference −1.92 min [−14.35 to 10.20]); spontaneous vaginal delivery (OR 1.07 [0.75 to 1.56]; assisted vaginal delivery (OR 1.35 [0.75 to 2.26]); caesarean section (OR 0.76 [0.49 to 1.22]); pain (scale 1–100, weighted mean difference −5.44 [−16.75 to 5.93]); and maternal satisfaction. Although a lower risk of an Apgar score

Contexto, hipótesis y objetivos: El retraso del crecimiento intrauterino (RCIU) es el fracaso para alcanzar el potencial de crecimiento predeterminado genéticamente. Este estudio pretende comprobar si los fetos cuya curva de crecimiento está bajo el percentil 3 tienen peores resultados obstétricos y neonatales, evaluando los resultados y comparándolos con fetos cuyo crecimiento fue adecuado para su edad gestacional. Además, se han analizado los factores que pueden influir en obtener resultados desfavorables. Material y métodos: Estudio observacional, retrospectivo de cohortes. Llevado a cabo entre 2016 y 2020 en el Hospital de Manises en el que se incluyen 6840 casos válidos para el estudio, de los cuales diferenciamos dos grupos. De estos, 211 fueron gestaciones RCIU y 6629 presentaron crecimiento normal. Resultados: Encontramos algunas diferencias significativas. Tener RCIU es factor de riesgo de acabar en cesárea OR 1,22, IC95% [0,33%;1,93%] y de que el neonato ingrese en UCIN OR 2,15 IC95% [4,33%;14,58%]. Dentro del grupo RCIU se han encontrado factores de riesgo y protectores de resultados perinatales adversos. Ser multípara y la prolongación de tiempo de pujo actúan como factor protector de cesárea y un aumento de la edad gestacional y la inducción al parto actúan como factores de riesgo de cesárea. Encontramos una mayor proporción de ingresos en UCIN entre los neonatos nacidos por cesárea frente a los nacidos por vía vaginal. Conclusión: Tener RCIU tiene asociados resultados perinatales desfavorables que puede derivar en un aumento de la morbimortalidad por lo que es necesaria una especial atención en estos partos. Context, hypotheses, and objectives: Intrauterine Growth Restriction (IUGR) is the failure to reach the genetically predetermined growth potential. This study aims to verify whether fetuses whose growth curve is below the 3rd percentile have worse obstetric and neonatal outcomes, evaluating the results and comparing them with fetuses whose growth was adequate for their gestational age. In addition, the factors that can influence obtaining unfavorable results have been analyzed. Material and methods: Observational, retrospective cohort study. Carried out between 2016 and 2020 at the Manises Hospital, which included 6,840 cases for the study, of which we differentiated two groups. Of these, 211 were IUGR pregnancies and 6629 had normal growth. Results: We found some significant differences. Having IUGR is a risk factor for ending in cesarean section OR 1.22, 95% CI [0.33%;1.93%] and for the newborn to be admitted to the NICU OR 2.15 95% CI [4.33%;14, 58%]. Within the IUGR group, risk factors and protectors of adverse perinatal outcomes have been found. Being multiparous and the prolongation of pushing time act as a protective factor for cesarean section and an increase in gestational age and labor induction act as risk factors for cesarean section. We found a higher proportion of NICU admissions among neonates delivered by cesarean section versus those delivered vaginally. Conclusion: Having IUGR is associated with unfavorable perinatal outcomes that can lead to increased morbidity and mortality, which is why special attention is necessary in these deliveries. Medicina

Background: The prevalence of reaches up to 5% in women younger than 40 years. Therefore, the fertility preservation should be the goal of the clinical practice in women with desire of pregnancy and low-risk features. The aim of this study is to compare oncological and reproductive outcomes of different hormonal therapies in FST of EC. Methods: A retrospective single-center study recruiting patients with presumed FIGO STAGE IA endometrioid G1 EC from 2005 to 2020 was performed. We assessed outcomes for three different therapeutic options: GnRHa + LNG-IUD vs. MA + LNG-IUD vs. MA + LNG-IUD + MET. Results: In total, 75 patients were enrolled and followed up for a median of 45 months. Complete response (CR) was achieved in 75% of patients at 12 months. Although not statistically significant, we reported an increasing rate of CR from the regimen with GnRHa to the one with MA + MET (65% vs. 83%). We showed a statistically significant lower risk of recurrence in women treated with MA + LNG-IUD + MET, when compared to GnRHa + LNG-IUD regimen. The pregnancy rate was 74% and live birth rate was 42%, with no differences among regimens. Conclusions: FST is a safe and effective option in women who desire to preserve fertility.

Severe acute respiratory syndrome affects all groups of population including pregnant women. Currently, there are limited evidences to show an increased risk of infection or increased mortality among pregnant women than the general population. On the 13th of March 2020, Ethiopian government reported the first case of COVID-19. Since then, until the time of this research compilation, more than 40 pregnant women have been managed at Eka Kotebe General Hospital, which is the first COVID-19 designated center in the country. The aim of this case series is to do an in-depth case review of the first four cases of pregnant women who tested positive for COVID-19. Out of the four cases discussed in this series, there was one maternal death, and three out of the four newborns delivered tested positive for COVID-19.

OBJECTIVE: To determine the prevalence of teenage pregnancy and compare its obstetric and perinatal outcomes with those of non-teenage pregnancy. METHOD: This retrospective hospital-based case-control study was conducted in the Department of Obstetrics and Gynaecology in Hospital Tuanku Ja'afar Seremban. The study made use of the Malaysian National Obstetric Registry (NOR) records of teenage pregnant women aged 11-19 at Hospital Tuanku Ja'afar Seremban over a 12-month period between May 2015 and May 2016 (n=164). Socio-demographic profiles, obstetric outcomes, and perinatal outcomes were detailed for each pregnant woman. The results were compared to a control group of 169 pregnant women aged 20-30 who also delivered in hospital Tuanku Ja'afar Seremban during the same period. The aim of this study was to assess the obstetric outcomes of teenage pregnancy and to compare them with those of the control group. A chi-squared test was used to identify the statistical significance of the relationship between teenage pregnancy rates and obstetric outcomes. Results with p

Objectives: The primary aim of this study was to determine the prevalence of maternal hypovitaminosis D. The secondary aim was to determine the obstetric outcomes between a group of pregnant women with hypovitaminosis D and the normal control group at Chonprathan Hospital, Nonthaburi province of Thailand.Materials and Methods: This study was a cross-sectional study. A total of 77 subjects were consecutively enrolled in the study. The inclusion criteria were pregnant women who had received antenatal care and delivered at Chonprathan Hospital, Nonthaburi, Thailand. The exclusion criteria included women who had a liver disease, kidney disease, gastrointestinal absorption disease, pulmonary tuberculosis, hyperthyroid disease, and pregnant women who used drugs that have an effect on vitamin D. Vitamin D deficiency was defined as 25-hydroxyvitamin D (25-OHD) < 20 ng/mL, insufficiency as 25-OHD 20–29.9 ng/mL, and sufficiency as 25-OHD ≥ 30 ng/mL. Hypovitaminosis D refer to vitamin D deficiency plus vitamin D insufficiency. A data interview was performed and the results recorded in a case record form by the research team. Venous blood samples were collected for 25-OHD, parathyroid hormone (PTH), calcium, phosphate, alkaline phosphatase (ALP), albumin, and magnesium on the day of labor.Results: The mean level of 25-OHD was 25.2% ± 7.9 ng/mL. The prevalence of vitamin D deficiency was 22.1%, vitamin D insufficiency was 44.1%, and vitamin D sufficiency was 33.8%. There was an association between vitamin D level and serum albumin but no association with the other blood parameters statuses (correct calcium,PTH, phosphate, ALP, magnesium,hematocrit), age, pre-pregnancy body mass index, or obstetric complications.Conclusion: The prevalence of hypovitaminosis D was 66.2%, while vitamin D deficiency was 22.1%. There was no association between the vitamin D level and obstetric outcomes.

Mariko Jitsumori,1,* Shinya Matsuzaki,1,* Masayuki Endo,1 Takeya Hara,1 Takuji Tomimatsu,1 Satoko Matsuzaki,2 Tatsuya Miyake,1 Tsuyoshi Takiuchi,1 Aiko Kakigano,1 Kazuya Mimura,1 Eiji Kobayashi,1 Yutaka Ueda,1 Tadashi Kimura1 1Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan; 2Department of Obstetrics and Gynecology, Otemae Hospital, Osaka, Japan*These authors contributed equally to this workCorrespondence: Shinya Matsuzaki; Aiko KakiganoDepartment of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanTel +81-6-6879-3355Fax +81-6-6879-3359Email zacky@gyne.med.osaka-u.ac.jp; ai-kaki@gyne.med.osaka-u.ac.jpBackground: Uterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case–control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE.Methods: We retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).Results: We used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01).Conclusion: Our results suggest that previous UAE is a significant risk factor for PAS.Keywords: placenta accreta, placenta accreta spectrum, uterine artery embolization, postpartum hemorrhage, obstetric outcomes

Mariko Jitsumori,1,* Shinya Matsuzaki,1,* Masayuki Endo,1 Takeya Hara,1 Takuji Tomimatsu,1 Satoko Matsuzaki,2 Tatsuya Miyake,1 Tsuyoshi Takiuchi,1 Aiko Kakigano,1 Kazuya Mimura,1 Eiji Kobayashi,1 Yutaka Ueda,1 Tadashi Kimura1 1Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan; 2Department of Obstetrics and Gynecology, Otemae Hospital, Osaka, Japan*These authors contributed equally to this workCorrespondence: Shinya Matsuzaki; Aiko KakiganoDepartment of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanTel +81-6-6879-3355Fax +81-6-6879-3359Email zacky@gyne.med.osaka-u.ac.jp; ai-kaki@gyne.med.osaka-u.ac.jpBackground: Uterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case–control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE.Methods: We retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).Results: We used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01).Conclusion: Our results suggest that previous UAE is a significant risk factor for PAS.Keywords: placenta accreta, placenta accreta spectrum, uterine artery embolization, postpartum hemorrhage, obstetric outcomes

Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/34981750/ Objectives: Over 1.9 billion people worldwide are living in areas estimated to be iodine insufficient. Strategies for iodine supplementation include campaigns targeting vulnerable groups, such as women in pre-conception, pregnancy and lactation. Portuguese women of childbearing age and pregnant women were shown to be mildly-to-moderately iodine deficient. As a response, in 2013, the National Health Authority (NHA) issued a recommendation that all women considering pregnancy, pregnant or breastfeeding, take a daily supplement of 150-200 μg iodine. This study explored how the iodine supplementation recommendation has been fulfilled among pregnant and lactating women in Portugal, and whether the reported iodine supplements intake impacted on adverse obstetric and neonatal outcomes. Design and methods: Observational retrospective study on pregnant women who delivered or had a fetal loss in the Braga Hospital and had their pregnancies followed in Family Health Units. Results: The use of iodine supplements increased from 25% before the recommendation to 81% after the recommendation. This was mostly due to an increase in the use of supplements containing iodine only. Iodine supplementation was protective for the number of adverse obstetric outcomes (odds ratio (OR) = 0.791, P = 0.018) and for neonatal morbidities (OR = 0.528, P = 0.024) after controlling for relevant confounding variables. Conclusion: The recommendation seems to have succeeded in implementing iodine supplementation during pregnancy. National prospective studies are now needed to evaluate the impact of iodine supplementation on maternal thyroid homeostasis and offspring psychomotor development and on whether the time of the beginning of iodine supplementation (how early during preconception or pregnancy) is relevant to consider. This work has been funded by National funds, through the Foundation for Science and Technology (FCT) – project UIDB/50026/2020 and UIDP/50026/2020 and by the project NORTE-01-0145-FEDER-000039, supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). Funding agencies did not participate in any part of the research or in data or manuscript preparation info:eu-repo/semantics/publishedVersion

Background Myasthenia gravis is an autoimmune disease which can impact pregnancy. Methods Six databases were systematically searched for studies with at least five subjects reporting pregnancy outcomes for women with myasthenia gravis in pregnancy. Assessment of bias was performed for all included studies. Forty-eight cases from our own centre were also included in the analysis. Results In total, 32 publications met inclusion criteria for systematic review, for a total of 33 unique data sets including 48 cases from our institution. Outcome data was available for 824 pregnancies. Spontaneous vaginal delivery occurred in 56.3% of pregnancies. Overall risk of myasthenia gravis exacerbation was 33.8% with a 6.4% risk of myasthenic crisis in pregnancy and 8.2% postpartum. The incidence risk of transient neonatal myasthenia gravis was 13.0%. Conclusions The current systematic review provides the best estimates of risk currently available to aid in counselling women with myasthenia gravis in pregnancy.

Bariatric surgery (BS) is known to reduce several obesity-related complications during pregnancy, but there is concern that it may increase the risk of maternal-fetal morbidity because of the malabsorption. This study aimed to investigate the impact of restrictive BS on several pregnancy outcomes in comparison with different grades of obesity.A single-center retrospective case-control study. All primiparous singleton pregnant women who underwent BS between the previous 1-5 years or with body mass index (BMI) ≥ 30 kg/mOverall, 90 women were included: 30 underwent BS and 60 were obese. The mean pre-pregnancy BMI was 31.0 ± 4.2 kg/mOur findings support the positive impact of BS on several obstetric outcomes, at the expense of a higher frequency of SGA and PTD. BS mothers more frequently achieved the recommended goal of breastfeeding for 6 months compared to obese women.

The prevalence of chronic diseases during pregnancy and adverse maternal obstetric outcomes in Switzerland has been insufficiently studied. Data sources, which reliably capture these events, are scarce. We conducted a nationwide observational cross-sectional study (2012–2018) using data from the Swiss Hospital Medical Statistics (MS) dataset. To quantify the recording of chronic diseases and adverse maternal obstetric outcomes during delivery in hospitals or birthing centers (delivery hospitalization), we identified women who delivered a singleton live-born infant. We quantified the prevalence of 23 maternal chronic diseases (ICD-10-GM) and compared results to a nationwide Danish registry study. We further quantified the prevalence of adverse maternal obstetric outcomes (ICD-10-GM/CHOP) during the delivery hospitalization and compared the results to existing literature from Western Europe. We identified 577,220 delivery hospitalizations, of which 4.99% had a record for ≥1 diagnosis of a chronic disease (versus 15.49% in Denmark). Moreover, 13 of 23 chronic diseases seemed to be substantially under-recorded (8 of those were >10-fold more frequent in the Danish study). The prevalence of three of the chronic diseases was similar in the two studies. The prevalence of adverse maternal obstetric outcomes was comparable to other European countries. Our results suggest that chronic diseases are under-recorded during delivery hospitalizations in the MS dataset, which may be due to specific coding guidelines and aspects regarding whether a disease generates billable effort for a hospital. Adverse maternal obstetric outcomes seemed to be more completely captured.

Objective: The objective of this study was to provide a descriptive analysis of the clinical outcomes achieved in oocyte vitrification in cases where sperm was unavailable on oocyte retrieval day, and to identify predictors of oocyte survival.Methods: This retrospective cohort study used data from a university-affiliated reproductive medical center. There were 321 cycles in which some of, or all oocytes were vitrified owing to the unavailability of sperm between March 2009 and October 2017. A descriptive analysis of the clinical outcomes including both fresh embryo transfers and cryopreserved embryo transfers was provided. The ability of an individual parameter to forecast oocyte survival per thawing cycle was assessed by binary logistic regression analysis. The cumulative probability of live birth (CPLB) was estimated by using the Kaplan-Meier method according to the total number of oocytes thawed in consecutive procedures.Results: The average survival rate was 83.13%. High-quality embryo rate and blastocyst rate decreased significantly decreased significantly in vitrification oocyte group compared to fresh control oocytes. The comparison of sibling oocytes in part-oocyte-vitrified cycles shows fewer high-quality embryos developed in the vitrified group. The live birth rate per warmed-oocyte was 4.3%. Reasons for lack of sperm availability on oocyte retrieval day and serum cholesterol levels were found to be associated with oocyte survival rate in the present study. Kaplan-Meier analysis showed no significant difference in CPLB between patients ≤35 vs. >35 years.Conclusions: Oocyte vitrification is an indispensable and effective alternative when sperm are not available on oocyte retrieval day. The present study provided evidence that oocytes from infertile couples were more likely to suffer oocyte/embryo vitrification injury. Clinicians need to take this into account when advising patients in similar situations. Further studies will be necessary to clarify the correlation between serum metabolism parameters and human oocyte survival after vitrification.

Today, the issues of the pregnancy course in women with endometriosis and endometriosis impact on obstetric outcome remain unresolved and insufficiently studied.Research objective: to study the association between endometriosis and pregnancy complications, adverse obstetric outcomes.Materials and methods. A retrospective cohort study comparing the incidence of pregnancy complications and adverse obstetric outcomes in 478 women with endometriosis (main group) and 544 women without endometriosis (control group). Complications of pregnancy and unfavorable obstetric outcomes were assessed, such as spontaneous miscarriage, ectopic pregnancy, vomiting of pregnant women, premature birth, caesarean section, pathological attachment of the placenta, postpartum hemorrhage and small for gestational age fetuses.Results. The study showed that pregnant women with endometriosis have an increased risk of spontaneous miscarriages compared to the control group: 89/478 (19.07 ± 1.13%) versus 87/544 (14.93 ± 0.49%) respectively (p < 0.001), ectopic pregnancy: 12/478 (2.84 ± 0.47%) versus 5/544 (0.97 ± 0.36%) respectively (p < 0.001); vomiting of pregnant women: 86/478 (17.85 ± 1.09%) compared with 16/544 (3.15 ± 0.34%) respectively (p < 0.001); premature birth: 72/478 (15.5 ± 1.03%) versus 55/544 (10.17 ± 0.30%) respectively (p < 0.001); increased frequency of caesarean section: 99/478 (20.44 ± 1.24%) versus 87/544 (15.5 ± 0.73%) respectively (p < 0.001) and pathological attachment of the placenta: 19/478 (4.31 ± 0.59%) versus 8/544 (1.46 ± 0.30%) respectively (p < 0.001).There was no association between endometriosis and postpartum hemorrhage and small gestational age of the fetus.Conclusions. Pregnant women with endometriosis have an increased risk of spontaneous miscarriages, ectopic pregnancy, vomiting of pregnant women, premature birth, caesarean section, pathological attachment of the placenta. The association established in our study between endometriosis and complications of pregnancy, unfavorable obstetric results requires further research to clarify the mechanisms of the results obtained., На сегодня остаются до конца нерешенными и недостаточно изученными вопросы течения беременности у женщин с эндометриозом и влияния эндометриоза на акушерский результат.Цель исследования: изучить связь между эндометриозом и осложнениями беременности, неблагоприятными акушерскими результатами.Материалы и методы. Проведено ретроспективное когортное исследование, в котором сравнивали частоту осложнений беременности и неблагоприятных акушерских результатов у 478 женщин с эндометриозом (основная группа) и 544 женщин без эндометриоза (контрольная группа). В исследуемых группах оценивали осложнения беременности и неблагоприятные акушерские результаты, такие как самопроизвольный выкидыш, внематочная беременность, рвота беременных, преждевременные роды, кесарево сечение, патологическое прикрепление плаценты, послеродовые кровотечения и малый размер плода для гестационного возраста.Результаты. Проведенное исследование показало, что беременные с эндометриозом имеют повышенный риск самопроизвольных выкидышей по сравнению с контрольной группой: 89/478 (19,07 ± 1,13%) против 87/544 (14,93 ± 0,49%) соответственно (р < 0,001); внематочной беременности: 12/478 (2,84 ± 0,47%) против 5/544 (0,97 ± 0,36%) соответственно (р < 0,001); рвоты беременных: 86/478 (17,85 ± 1,09%) против 16/544 (3,15 ± 0,34%) соответственно (p < 0,001); преждевременных родов: 72/478 (15,5 ± 1,03%) против 55/544 (10,17 ± 0,30%) соответственно (р < 0,001); повышенную частоту кесарева сечения: 99/478 (20,44 ± 1,24%) против 87/544 (15,5 ± 0,73%) соответственно (р < 0,001) и патологического прикрепления плаценты: 19/478 (4,31 ± 0,59%) против 8/544 (1,46 ± 0,30%) соответственно (р < 0,001).Не выявлено связи между эндометриозом и послеродовыми кровотечениями, малым размером плода для гестационного возраста.Выводы. Беременные с эндометриозом имеют повышенный риск самопроизвольных выкидышей, внематочной беременности, рвоты беременных, преждевременных родов, кесарева сечения, патологического прикрепления плаценты. Установленная в исследовании взаимосвязь между эндометриозом и осложнениями беременности, неблагоприятными акушерскими результатами требует дальнейших исследований для выяснения механизмов полученных данных., На сьогодні залишаються остаточно нерозв’язаними й недостатньо вивченими питання перебігу вагітності в жінок з ендометріозом та впливу ендометріозу на акушерський результат.Мета дослідження: вивчити зв'язок між ендометріозом та ускладненнями вагітності, несприятливими акушерськими результатами.Матеріали та методи. Проведено ретроспективне когортне дослідження, у якому порівнювали частоту ускладнень вагітності й несприятливих акушерських результатів у 478 жінок з ендометріозом (основна група) і 544 жінок без ендометріозу (контрольна група). У досліджуваних групах оцінювали ускладнення вагітності й несприятливі акушерські результати, як-от: самовільний викидень, позаматкова вагітність, блювання вагітних, передчасні пологи, кесарів розтин, патологічне прикріплення плаценти, післяпологові кровотечі та малий розмір плода для гестаційного віку.Результати. Проведене дослідження показало, що вагітні з ендометріозом мають підвищений ризик самовільних викиднів порівняно з контрольною групою: 89/478 (19,07 ± 1,13%) проти 87/544 (14,93 ± 0,49%) відповідно (р < 0,001); позаматкової вагітності: 12/478 (2,84 ± 0,47%) проти 5/544 (0,97 ± 0,36%) відповідно (р < 0,001); блювання вагітних: 86/478 (17,85 ± 1,09%) проти 16/544 (3,15 ± 0,34%) відповідно (p < 0,001); передчасних пологів: 72/478 (15,5 ± 1,03%) проти 55/544 (10,17 ± 0,30%) відповідно (р < 0,001); підвищену частоту кесаревого розтину: 99/478 (20,44 ± 1,24%) проти 87/544 (15,5 ± 0,73%) відповідно (р < 0,001) та патологічного прикріплення плаценти: 19/478 (4,31 ± 0,59%) проти 8/544 (1,46 ± 0,30%) відповідно (р < 0,001).Не виявлено зв'язку між ендометріозом і післяпологовими кровотечами, малим розміром плода для гестаційного віку.Висновки. Вагітні з ендометріозом мають підвищений ризик самовільних викиднів, позаматкової вагітності, блювання вагітних, передчасних пологів, кесаревого розтину, патологічного прикріплення плаценти. Встановлений у дослідженні взаємозв'язок між ендометріозом та ускладненнями вагітності, несприятливими акушерськими результатами потребує подальших досліджень для з'ясування механізмів отриманих даних.

Today, the issues of the pregnancy course in women with endometriosis and endometriosis impact on obstetric outcome remain unresolved and insufficiently studied. Research objective:to study the association between endometriosis and pregnancy complications, adverse obstetric outcomes. Materials and methods.A retrospective cohort study comparing the incidence of pregnancy complications and adverse obstetric outcomes in 478 women with endometriosis (main group) and 544 women without endometriosis (control group). Complications of pregnancy and unfavorable obstetric outcomes were assessed, such as spontaneous miscarriage, ectopic pregnancy, vomiting of pregnant women, premature birth, caesarean section, pathological attachment of the placenta, postpartum hemorrhage and small for gestational age fetuses. Results.The study showed that pregnant women with endometriosis have an increased risk of spontaneous miscarriages compared to the control group: 89/478 (19.07 ± 1.13%) versus 87/544 (14.93 ± 0.49%) respectively (p < 0.001), ectopic pregnancy: 12/478 (2.84 ± 0.47%) versus 5/544 (0.97 ± 0.36%) respectively (p < 0.001); vomiting of pregnant women: 86/478 (17.85 ± 1.09%) compared with 16/544 (3.15 ± 0.34%) respectively (p < 0.001); premature birth: 72/478 (15.5 ± 1.03%) versus 55/544 (10.17 ± 0.30%) respectively (p < 0.001); increased frequency of caesarean section: 99/478 (20.44 ± 1.24%) versus 87/544 (15.5 ± 0.73%) respectively (p < 0.001) and pathological attachment of the placenta: 19/478 (4.31 ± 0.59%) versus 8/544 (1.46 ± 0.30%) respectively (p < 0.001). There was no association between endometriosis and postpartum hemorrhage and small gestational age of the fetus. Conclusions.Pregnant women with endometriosis have an increased risk of spontaneous miscarriages, ectopic pregnancy, vomiting of pregnant women, premature birth, caesarean section, pathological attachment of the placenta. The association established in our study between endometriosis and complications of pregnancy, unfavorable obstetric results requires further research to clarify the mechanisms of the results obtained.

Funder: NIHR Cambridge Biomedical Research Centre, Aims: There is seasonal variation in the incidence of gestational diabetes (GDM) and delivery outcomes of affected patients. We assessed whether there was also evidence of temporal variation in maternal treatment requirements and early neonatal outcomes. Methods: We performed a retrospective analysis of women diagnosed with GDM (75 g oral glucose tolerance test, 0 h ≥ 5.1; 1 h ≥ 10.0; 2 h ≥ 8.5 mmol/L) in a UK tertiary obstetric centre (2015–2019) with a singleton infant. Data regarding demographic characteristics, total insulin requirements and neonatal outcomes were extracted from contemporaneous electronic medical records. Linear/logistic regression models using month of the year as a predictor of outcomes were used to assess annual variation. Results: In all, 791 women (50.6% receiving pharmacological treatment) and 790 neonates were included. The likelihood of requiring insulin treatment was highest in November (p < 0.05). The average total daily insulin dose was higher at peak (January) compared to average by 19 units/day (p < 0.05). There was no temporal variation in neonatal intensive care admission, or neonatal capillary blood glucose. However, rates of neonatal hypoglycaemia (defined as

Background: Evaluating the fertility and obstetric outcomes in women with rare rheumatic diseases is challenging as it needs to take into account various influencing factors. Aims and Objectives: The aim is to draft a structured case record form (CRF) for collating obstetric outcomes in rheumatic diseases Materials and Methods: Clinical CRFs were designed for inflammatory myositis, ANCA associated vasculitis, Takayasu arteritis and systemic sclerosis with the objectives in mind, taking into account disease characteristics, drugs administered, and the changes related to the pregnant state. The forms underwent four rounds of revision by two rheumatologists with trial runs on three patients each. The form was scrutinized for face validity, ambiguity and were designed to ease filling them in a busy outpatient setup. Results: The CRF forms for obstetric outcomes in patients were labelled as version 10.0, 11.0, 12.0, and 13.0 for myositis, AAV, TA, and SSc. Conclusion: Beginning with a well-designed CRF is the first step in collating proper data for research. This paper details the steps involved in the same for collating obstetric outcomes in tfour rare rheumatic illnesses.

The use of analgesia techniques for labor has become increasingly frequent, with neuraxial techniques being the most commonly used and most effective. Labor pain entails a number of physiological consequences that may be negative for the mother and fetus, and therefore must be treated. This literature review was performed through a search in the PubMed database, from July to November 2016, and included articles in English or Portuguese, published between 2011 and 2016 or anteriorly, if relevant to the topic. The techniques were divided into the following topics: induction (epidural, combined epidural-spinal, continuous spinal, and epidural with dural puncture) and maintenance of analgesia (continuous epidural infusion, patient-controlled epidural analgesia, and intermittent epidural bolus). Epidural analgesia does not alter the incidence of cesarean sections or fetal prognosis, and maternal request is a sufficient indication for its initiation. The combined technique has the advantage of a faster onset of analgesia; however, patients are subject to a higher incidence of pruritus resulting from the intrathecal administration of opioids. Patient-controlled analgesia seems to be an excellent technique, reducing the consumption of local anesthetics, the number of anesthesiologist interventions, and increasing maternal satisfaction. Resumo: O uso de técnicas de analgesia para o trabalho de parto tem se tornado cada vez mais frequente. As técnicas neuroaxiais são as mais comumente usadas e de maior eficácia. A dor do trabalho de parto traz uma série de consequências fisiológicas que podem ser negativas para a mãe e para o feto, e por isso deve ser tratada. Esta revisão de literatura foi feita na base de dados PubMed, de julho a novembro de 2016, e foram incluídos artigos em inglês ou português publicados entre 2011 e 2016, ou mais antigos que fossem relevantes ao tema. As técnicas foram divididas nos tópicos: indução (peridural, raquiperidural combinada, raquianestesia contínua e peridural com punção dural) e manutenção da analgesia (infusão peridural contínua, analgesia peridural controlada pela paciente e bolus peridural intermitente). A analgesia peridural não altera a incidência de cesarianas nem o prognóstico fetal, e o desejo materno é indicação suficiente para seu início. A técnica combinada apresenta como vantagem um início mais rápido da analgesia, entretanto as pacientes estão sujeitas a maior incidência de prurido decorrente da administração intratecal de opioides. A analgesia controlada pela paciente parece ser uma excelente técnica, diminui o consumo de anestésicos locais e o número de intervenções do anestesiologista e aumenta a satisfação materna. Keywords: Labor analgesia, Neuraxial analgesia, Obstetric outcomes, Palavras-chave: Analgesia de parto, Analgesia neuroaxial, Resultados obstétricos

Background Excessive gestational weight gain (GWG) leads to obstetric complications, maternal postpartum weight retention and an increased risk of offspring obesity. The GeliS study examines the effect of a lifestyle intervention during pregnancy on the proportion of women with excessive GWG and pregnancy and obstetric complications, as well as the long-term risk of maternal and infant obesity. Methods The GeliS study is a cluster-randomised multicentre controlled trial including 2286 women with a pre-pregnancy BMI between 18.5 and 40.0 kg/m2 recruited from gynaecological and midwifery practices prior to the end of the 12th week of gestation in five Bavarian regions. In the intervention regions, four lifestyle counselling sessions covering a balanced healthy diet, regular physical activity and self-monitoring of weight gain were performed by trained healthcare providers alongside routine pre- and postnatal practice visits. In the control regions, leaflets with general recommendations for a healthy lifestyle during pregnancy were provided. Results The intervention did not result in a significant reduction of women showing excessive GWG (adjusted OR 0.95, 95% CI 0.66–1.38, p = 0.789), with 45.1% and 45.7% of women in the intervention and control groups, respectively, gaining weight above the Institute of Medicine recommendations. Gestational diabetes mellitus was diagnosed in 10.8% and 11.1% of women in the intervention and control groups, respectively (p = 0.622). Mean birth weight and length were slightly lower in the intervention group (3313 ± 536 g vs. 3363 ± 498 g, p = 0.020; 51.1 ± 2.7 cm vs. 51.6 ± 2.5 cm, p = 0.001). Conclusion In the setting of routine prenatal care, lifestyle advice given by trained healthcare providers was not successful in limiting GWG and pregnancy complications. Nevertheless, the potential long-term effects of the intervention remain to be assessed. Trial registration NCT01958307, ClinicalTrials.gov, retrospectively registered October 9, 2013. Electronic supplementary material The online version of this article (10.1186/s12916-018-1235-z) contains supplementary material, which is available to authorized users.

Background Administration of gonadotropin-releasing hormone agonist (GnRH-a) in the luteal phase is commonly used for pituitary suppression during in vitro fertilisation (IVF). There is an ineluctable risk of inadvertent exposure of spontaneous pregnancy to GnRH-a. However, little is known about the pregnancy complications and repregnancy outcomes of the affected women and the neurodevelopmental outcomes of the GnRH-a-exposed children. Methods Retrospective analysis was used to determine obstetric and repregnancy outcomes after natural conception in 114 women who naturally conceived while receiving GnRH-a during their early pregnancy over the past 17 years. The GnRH-a-exposed children were evaluated to determine their neonatal characteristics and long-term neurodevelopmental outcomes. The outcomes were compared to those of relevant age-matched control groups. Results Sixty-five women had 66 live births. The neonatal health outcomes and the incidence of maternal complications were similar in the GnRH-a-exposed and control groups. Thirty-one GnRH-a-exposed children, aged 2–8 years, were available for investigation of neurodevelopment. Except for one case of autism spectrum disorder, the full-scale intelligence quotient score was within the normal range and similar to that of the control group. Most mothers with successful pregnancies and about one-third of the women who had spontaneous abortions were subsequently able to conceive naturally again. IVF is recommended for repregnancy in women who have experienced ectopic pregnancies. Conclusions Accidental exposure to GnRH-a in early pregnancy might be safe. Reproductive treatment suggestions for repregnancy should be made with consideration of the outcomes of the previously GnRH-a-exposed spontaneous pregnancy.

Background A rapid development in assisted reproductive technology (ART) has led to a surge in its popularity among target couples. However, elucidation on the molecular mechanism and effective solutions for a common problem posed by ART, namely transfer failure, is still lacking. The new therapeutic potential of cyclosporin A (CsA), a typical immunosuppressant widely used in the treatment of rejection after organ transplantation, in recurrent pregnancy loss (RPL) patients may inspire some novel transfer failure therapies in the future. To further explore the clinical effects of CsA, this study investigated whether its application can improve clinical pregnancy outcomes in patients with a history of unexplained transfer failure in frozen-thawed embryo transfer (FET) cycles. Methods Data from a retrospective cohort investigation (178 frozen-thawed embryo transfer cycles in 178 patients) were analysed using binary logistic regression to explore the relationship between CsA treatment and clinical pregnancy outcomes; the odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated as a measure of relevancy. Implantation rate was the main outcome measure. Results There was no difference in the fine adjusted OR (95 % CI) of the implantation rate [1.251 (0.739–2.120)], clinical pregnancy rate [1.634 (0.772–3.458)], chemical pregnancy rate [1.402 (0.285–6.909)], take-home baby rate [0.872 (0.423–1.798)], multiple births rate [0.840 (0.197–3.590)], preterm birth [1.668 (0.377–7.373)], abnormal birth weight [1.834 (0.533–6.307)] or sex ratio [0.956 (0.339–2.698)] between the CsA-treated group and control group. No birth defects were observed in the present study. Conclusions Although CsA does not affect infant characteristics, it has no beneficial effects on the clinical pregnancy outcomes in patients with a history of unexplained transfer failure in FET cycles.

Background Excisional procedures of cervical intraepithelial neoplasia (CIN) may increase the risk of preterm birth. It is unknown whether this increased risk is due to the excision procedure itself, to the underlying CIN, or to secondary risk factors that are associated with both preterm birth and CIN. The aim of this study is to assess the risk of spontaneous preterm birth in women with treated and untreated CIN and examine possible associations by making a distinction between the excised volume of cervical tissue and having cervical disease. Methods and findings This Dutch population-based observational cohort study identified women aged 29 to 41 years with CIN between 2005 and 2015 from the Dutch pathology registry (PALGA) and frequency matched them with a control group without any cervical abnormality based on age at and year of pathology outcome (i.e., CIN or normal cytology) and urbanization (, In a population-based study, Diede Loopik and colleagues investigate associations between cervical intraepithelial neoplasia and risk of preterm birth among Dutch women., Author summary Why was this study done? Women who are treated for a precancerous cervical lesion may have an increased risk of preterm birth. It is unknown whether this increased risk is due to the treatment itself, to the cervical disease, or to secondary risk factors that are associated with both preterm birth and cervical disease. What did the researchers do and find? We identified women with untreated and treated cervical disease and matched them with a control group through the Dutch pathology registry and compared their pregnancy outcomes through the Dutch perinatal database. The control group (29,907 pregnancies) showed a 4.8% proportion of preterm birth, which increased to 6.9% in the untreated cervical disease group (5,940 pregnancies), 9.5% in the treated cervical disease group (9,412 pregnancies), and 15.6% in the group with multiple treatments (505 pregnancies). After adjustment for 19 potential confounders for preterm birth, women with untreated cervical disease had a 1.4 times and women with treated cervical disease had a more than 2 times increased odds of preterm birth compared to the control group. Independent from cervical disease, a volume excised from the cervix of 0.5 cc or more was associated with an approximately 2 times greater odds of preterm birth. What do these findings mean? We observed a strong association between women with a 0.5 cc or more excised cervical tissue volume (through biopsy and/or treatment) and the odds of preterm birth, regardless of severity of cervical disease or secondary risk factors associated with both preterm birth and cervical disease. Our findings suggest that caution should be taken when performing multiple biopsies or treatment for CIN in women of reproductive age and that women with such a history may benefit from close surveillance during pregnancy.

Endometrial cancer is the most frequent gynecological malignancy, and, although epidemiologically it mainly affects advanced age women, it can also affect young patients who want children and who have not yet completed their procreative project. Fertility sparing treatments are the subject of many studies and research in continuous evolution, and represent a light of hope for young cancer patients who find themselves having to face an oncological path before fulfilling their desire for motherhood. The advances in molecular biology and the more precise clinical and prognostic classification of endometrial cancer based on the 2013 The Cancer Genome Atlas classification allow for the selection of patients who can be submitted to fertility sparing treatments with increasing oncological safety. It would also be possible to predict the response to hormonal treatment by investigating the state of the genes of the mismatch repair.

The benefits of exclusive breastfeeding are well known for both mother and baby. Despite this, rates of exclusive breastfeeding remain low. The present study aimed to determine the factors associated with the maintenance of this type of feeding after being discharged from the hospital after childbirth. A cross-sectional study was carried out with 1200 postpartum women in Spain. Sociodemographic, obstetric, and neonatal data were collected. Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were calculated. Early breastfeeding initiation was identified as a factor that favors breastfeeding after hospital discharge (aOR: 2.47; 95%CI: 1.77, 3.45). Other factors that favor breastfeeding after discharge included the woman feeling very supported by her partner during pregnancy, childbirth, and the puerperium (aOR: 2.54; 95%CI:1.30, 5.00) and having previously breastfed other children (aOR: 1.97; 95%CI: 1.40, 2.76). Among the factors that hindered exclusive breastfeeding after discharge were multiple or twin pregnancies (aOR: 0.31; 95%CI 0.12, 0.83), induction of labor (aOR: 0.73; 95%CI: 0.53, 0.99), admission of the newborn to the neonatal intensive care unit (NICU) (aOR: 0.31; 95%CI 0.19, 0.52), using epidural pain relief during labor (aOR: 0.41; 95%CI: 0.27, 0.64), or a preterm newborn (aOR: 0.38; 95%CI: 0.21, 0.69). For all these reasons, it is essential to promote certain practices such as the early start of breastfeeding or the induced onset of labor, among others, in order to promote the maintenance of exclusive breastfeeding beyond hospital discharge after childbirth.

Objective The present study is a systematic review of the literature to assess whether the presence of endometriosis determines or contributes to adverse obstetric outcomes. Data Sources The present work was carried out at the Hospital Israelita Albert Einstein, São Paulo, state of São Paulo, Brazil, in accordance to the PRISMA methodology for systematic reviews. A review of the literature was performed using PubMed, Web of Science and Scopus databases. The keywords used were: pregnancy outcome, pregnancy complications, obstetrical complications, obstetrics, obstetric outcomes and endometriosis. The survey was further completed by a manually executed review of cross-referenced articles, which was last performed on November 30, 2018. Selection of studies The survey disclosed a total of 2,468 articles, published from May 1946 to October 2017. A total of 18 studies were selected to be further classified according to their quality and relevance. Data Collection The Newcastle-Ottawa Quality Assessment Scale was used for classification. Five studies of greater impact and superior evidence quality and 13 studies of moderate evidence quality were selected. We analyzed the studies for the characteristics of their patients plus how endometriosis was diagnosed and their respective obstetric outcomes taking into account their statistical relevance. Data Synthesis Analyses of the higher impact and better quality studies have shown high incidence of preterm birth and placenta previa in patients with endometriosis. Conclusion Placenta previa and preterm birth are the most statistically significant outcomes related to endometriosis, as indicated by our systematic review. The present information is useful to alert obstetricians and patients about possible unfavorable obstetric outcomes. Resumo Objetivo Realizar uma revisão sistemática e crítica da literatura de modo a avaliar se a presença de endometriose determina desfechos obstétricos adversos na gestação. Fonte dos dados O presente estudo foi realizado no Hospital Israelita Albert Einstein, São Paulo, SP, Brasil, de acordo com a metodologia PRISMA para revisões sistemáticas. As bases de dados usadas para a revisão de literatura foram Pubmed, Web of Science e Scopus. As palavras-chave usadas foram: pregnancy outcome, pregnancy complications, obstetrical complications, obstetrics, obstetric outcomes e endometriosis. Uma revisão manual de artigos com referências cruzadas completou a pesquisa, que foi realizada pela última vez em 30 de novembro de 2018. Seleção dos estudos A pesquisa contou com o total de 2.468 artigos, publicados de maio de 1946 a outubro de 2017. Foram selecionados 18 estudos com base em sua relevância. Coleta de dados A metodologia Newcastle-Ottawa Quality Assessment Scale foi usada para selecionar 5 estudos cuja evidência era de melhor qualidade e 13 estudos de moderada qualidade de evidência. As características das populações dos estudos foram analisadas, assim como a doença endometriose foi diagnosticada e os respectivos desfechos obstétricos nas pacientes observando-se a relevância estatística dos estudos. Síntese dos dados A análise dos estudos de maior impacto e de melhor qualidade de evidência mostram que placenta prévia e ocorrência de nascimentos pré-termo são os desfechos obstétricos desfavoráveis de maior incidência em pacientes com endometriose. Conclusão Placenta prévia e nascimentos pré-termo são os desfechos obstétricos com maior significância estatística relacionados à endometriose. Esta informação é útil para alertar obstetras e pacientes com endometriose para possíveis desfechos obstétricos desfavoráveis.

RESUMEN : Introducción: Estudios previos han demostrado un mayor riesgo de complicaciones obstétricas y perinatales en gestaciones obtenidas mediante ovodonación. Objetivo: Evaluar el impacto de la ovodonación sobre los resultados obstétricos y perinatales, a través del análisis de dos parámetros: parto pretérmino y patología relacionada con el aumento de la resistencia de las arterias uterinas. Material y métodos: Se trata de un estudio de cohortes retrospectivo en el que se incluyeron mujeres con parto en el Hospital Universitario Marqués de Valdecilla (HUMV) entre enero de 2014 y diciembre de 2019. Estas mujeres se dividieron en tres grupos ; el primero compuesto por mujeres ≤ 38 años incluidas dentro del programa de ovodonación de la Unidad de Reproducción Asistida del HUMV, el segundo mujeres que concibieron tras un tratamiento de FIV-ICSI con óvulos autólogos y el tercero es un grupo control con gestantes por concepción espontánea. Resultados: El grupo de gestantes mediante ovodonación presentó un mayor riesgo de patología relacionada con el aumento de la resistencia de las arterias uterinas en comparación con el grupo de FIV-óvulos autólogos (RR=3’579 IC95%: 1’076-11’906) y con el grupo de gestaciones espontáneas (RR=3’841 IC95%: 1’152-12’812). No se ha encontrado una relación estadísticamente significativa entre el uso de óvulos donados y la incidencia de parto pretérmino, si bien los resultados parecen indicarnos una tendencia hacia un mayor riesgo de esta complicación con esta técnica. Conclusiones: La ovodonación se relaciona con un mayor riesgo de ciertas complicaciones obstétricas y perinatales en comparación con las gestaciones conseguidas tras FIV con óvulos autólogos y con las gestaciones espontáneas. La razón de esta asociación se desconoce, pero muy probablemente una de las causas sea inmunológica. ABSTRACT : Introduction: Previous studies have demonstrated a higher risk of maternal and perinatal complications in pregnancies after oocyte donation. Objective: Assess the impact of oocyte donation on obstetric and perinatal outcomes, through the analysis of two parameters: preterm birth and pathology associated with increased resistance to blood flow in the uterine arteries. Material and methods: This is a retrospective cohort study that includes women that gave birth in Hospital Universitario Marqués de Valdecilla (HUMV) from January 2014 to December 2019. These women were divided into three different groups: the first one is composed of women ≤38 years old included in the egg donation program of the assisted reproduction unit of HUMV, the second one of women that conceived after a IVF-ICSI treatment using autologous oocytes and the third one is a control group made up of women that conceived spontaneously. Results: The oocyte donation pregnancies group showed a greater risk of pathology associated with increased resistance to blood flow in the uterine arteries compared with the IVF-autologous oocytes group (RR=3’579 IC95%: 1’076-11’906) and with the spontaneous conception group (RR=3’841 IC95%: 1’152-12’812). No statistically significant relationship was observed between the use of donated oocytes and incidence of preterm birth, nonetheless the results seem to indicate a trend towards an increased risk of this complication when using the aforesaid technique. Conclusions: Oocyte donation is associated with an increased risk of certain obstetric and perinatal complications compared with pregnancies using IVF-autologous oocytes and with spontaneously conceived pregnancies. The reason behind this relationship is yet unknown, but one of the causes is probably immunologic. Grado en Medicina

Purpose To evaluate pregnancy rates, time to pregnancy (TTP) and obstetric outcomes in female childhood cancer survivors (CCSs) and to identify specific diagnosis- and treatment-related factors associated with these outcomes. Methods The study is part of the DCOG LATER-VEVO study, a nationwide multicenter cohort study evaluating fertility among long-term Dutch female CCSs. Data were collected by questionnaire. The current study included 1095 CCSs and 812 controls, consisting of sisters of CCSs and a random sample of women from the general population. Results Among the subgroup of women who ever had the desire to become pregnant, the chance of becoming pregnant was significantly lower for CCSs than controls (OR 0.5, 95%CI 0.4–0.8). Moreover, TTP was 1.1 times longer for CCSs compared to controls (p = 0.09) and was significantly longer in survivors of CNS and renal tumours. Overall, no differences were found between CCSs and controls regarding the probability of ever having had a miscarriage, still birth, or induced abortion. However, CCSs had a significantly increased risk of delivering preterm (OR 2.2, 95%CI 1.3–3.7) and delivering via caesarean section (OR 1.8, 95%CI 1.2–2.6). Treatment with lower abdominal/pelvic radiotherapy was strongly associated with several adverse obstetric outcomes. Conclusion CCSs are less likely to have ever been pregnant. Among those who do become pregnant, certain subgroups of CCSs are at increased risk of longer TTP. Moreover, as pregnant CCSs, especially those treated with lower abdominal/pelvic radiotherapy, are more likely to develop various adverse obstetric outcomes, appropriate obstetric care is highly advocated.

[EUS] In vitro ernalketa (IVE) ugalketa lagundurako teknika arrakastatsuena da gaur egun. Azken urteetan bere erabilera biderkatzearekin batera, teknika honen inguruko ikerketa gehiago argitaratu dira; hala nola, IVE-k konplikazio obstetrikoetan izan dezakeen eraginari buruzkoak. Konplikazio horien artean, errebisio honen aztergaia haurdunaldiko eritasun hipertentsiboa izan da; prebalentzia altuko eta prebentziorako aukerarik gabeko gaixotasuna. Orokorrean, haurdunaldi espontaneoekin alderatzerakoan IVE kasuetan arrisku altuagoa ikusi da, baita izozketa jasan duten enbrioiak freskoekin alderatzerakoan, eta batez ere, obodonazioak oozito autologo bidezko IVE-ekin alderatzerakoan. Hala ere, jakina da IVE ziklo guztiak ez direla alderagarriak eta kasu bakoitzak hainbat ezaugarri barne hartzen dituela, non paziente bakoitzaren ezaugarri zehatzek, IVE-rako erabili den prozedura zehatzarekin bat eginez, egoera bakoitza berezi bihurtzen duten. Beraz, ikerketa egoki baterako aldagaien parekatze zailaren aurrean, eta arrisku faktore moduan eragin dezaketen aldagaiak izanik (amaren adina, GMI, antzutasuna, antzutasun kausa, ziklo artifizialen erabilera…) ez da egokia IVE kasuetan eman den arrisku hori teknika berari leporatzea. Bitartean, ondorio nagusia IVE bidezko haurdunaldietan eritasun hipertentsiborako arriskua esanguratsua izan dela onartuz, IVE haurdunaldiak arrisku altuko haurdunalditzat hartu eta maneiatu beharko lirateke.

院内助産システムの安全性を探ることを目的とし、医学中央雑誌を用いて、「院内助産システム」また、「院内助産」、「助産師外来」「バースセンター」のキーワードで国内文献を検索した。ヒットした 8３1 件のうち、２01２ 年から 5 年間に絞り ２61 件、さらに原著論文に限定して85 件が抽出された。そのうち、運用基準、医師への移行(医療介入 )率の記載、分娩アウトカム指標の記述がある文献 11 件を分析対象とした。 助産師外来の記載があった文献は 5 件、院内助産は 10 件、助産師外来と院内助産の記載があった文献は 4 件であった。 助産師外来から非助産師外来への移行率は 4.0 〜 8.8% であり、非助産師外来のローリスクからハイリスク移行率 9.0% に比較して低率であった。また、院内助産における医師の医療介入率は9.6〜44.4％で、非院内助産における医療介入率41〜46.6%より低率であった。分娩アウトカムは児の体重と臍帯血 pH、会陰裂傷においては非院内助産と有意差がなかった。 院内助産システムの運用基準は、産婦人科診療ガイドラインを基本に、各施設で独自に選定対象基準を記載しており、助産師外来は、妊娠初期から中期まで医師が担当する協働の実態があった。助産師外来と院内助産の安全性が示唆される一方で、分娩の施設間で運用基準が異なるため、系統的なメタ分析を妨げているという課題が見えた。以上から院内助産システムの運用に関するガイドラインの検討と院内システムの標準化を進展することが早急の課題と考える。, This study was performed to verify the safety of midwife-managed delivery units in Japan based on a review of the domestic literature. We conducted a literature review using the Ichushi-Web (Japan Medical Abstracts Society) and searched the domestic literature with the keywords “midwife-managed delivery units system,” “midwife-managed delivery units,” “midwife-led examinations,” and “birth center.” A total of 8３1 articles were identified, of which ２61 papers were published between ２01２ and ２016, from which 85 were extracted as original articles. Eleven transcripts were analyzed by extracting the transfer rate from midwife-led examinations to obstetrician-led examinations, obstetric intervention of midwife-managed delivery units, neonatal and physiological outcomes, and safety. There were five studies with descriptions of midwife-led examinations, ten studies with descriptions of midwife-managed delivery units, and four describing both systems. The rate of transfer to obstetrician-led examinations was 4.0% – 8.8%, which was low compared to the high-risk transition rate of 9.0% for obstetric outpatients. The obstetric intervention rate in midwife-managed delivery units was 9.6% – 44.4%, which was lower than the obstetric intervention rate of 41% – 46.6% in deliveries managed by physicians. The neonatal and physiological outcomes were not significantly different according to the weight of the child, umbilical cord arterial blood pH, or perineal lacerations in the physician control group. The operation criteria of midwife-led examinations and midwife-managed delivery units are based on the Obstetrics and Gynecology Clinical Practice Guidelines, and many facilities have established their own criteria. In outpatient midwifery clinics, the doctor was in charge from early pregnancy to mid-term. This study suggested that midwife-led examinations and midwife-managed delivery units have good levels of safety. On the other hand, there were differences in operation standards among the facilities, which prevented more reliable meta-analysis of midwife-managed delivery units. To further disseminate midwife-managed delivery units, it is necessary to evaluate not only the outcome items but also operational criteria, and establish standards according to the environment, facilities, and personnel of each facility.

Introduction This study aimed to investigate the influence of obesity on pregnancy complications and neonatal outcomes in diabetic and nondiabetic women. Materials and Methods This retrospective case control study was conducted on 1193 pregnant women and their neonates at a tertiary level maternity hospital between March 2007 and 2011. The pregnant women were classified into 2 groups according to the presence of diabetes mellitus. Six hundred and seven patients with gestational diabetes or pregestational diabetes formed the diabetic group (study group) and 586 patients were in the nondiabetic group (control group). Demographic characteristics, body mass index, gestational weight gain, obstetric history, smoking status, type of delivery, gestational ages, pregnancy complications, neonatal outcomes were recorded for each patient. Multivariable logistic regression analysis was performed to evaluate the effect of obesity and diabetes on the pregnancy complications and neonatal outcomes. Results The mean age and pre-pregnancy body mass indices of women with diabetes mellitus were significantly higher than the control groupʼs (p Conclusion While obesity increases risk of developing a pregnancy complication, diabetes worsens neonatal outcomes.

Objective: To evaluate obstetric outcomes in twin pregnancies of advanced maternal age (≥35 years). Materials and methods: A retrospective study involved 470 twin pregnancies in a single center from Sep. 1, 2012 to Mar. 31, 2015. Clinical characteristics and obstetric outcomes were recorded and compared among twin pregnancies who were classified as follows: age 20–29, 30–34, 35–39 and ≥40 years. Results: The incidence of gestational diabetes (age 20–29 years 15.8%; 30–34 years 24.3%; 35–39 years 30.4%; ≥40 years 57.1%; p = 0.004) and premature delivery (20–29 years 58.6%; 30–34 years 69.1%; 35–39 years 72.2%; ≥40 years 85.7%; p = 0.001) significantly increased with increasing age whereas spontaneous abortion (20–29 years 27.6%; 30–34 years 11.6%; 35–39 years 11.4%; ≥40 years 0.0%; p = 0.021) decreased in twin pregnancies of advanced maternal age. In addition, the rate of postpartum hemorrhage increased almost continuously by age and advanced maternal age was described as a risk factor for postpartum hemorrhage (age 35–39, adjusted OR 3.377; 95% confidence interval 1729–6.598; p

Objective: The purpose of this study was to investigate the relationship between pregnancy outcome in older pregnant women and the uterine artery and fetal hemodynamic parameters in the third trimester. Methods: Randomized selection of 100 patients in our hospital delivery and late pregnancy monitoring of uterine artery and fetal hemodynamics in patients. (1) There were compared and analyzed the hemodynamic parameters (PSV, EDV, RI, PI, S/D) of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 36 elderly patients with normal pregnancy outcome (≥35 years old, observation group) and 32 patients with normal age of normal pregnancy (

Background: The aim of this study was to compare the obstetric outcomes of twin pregnancies between Japanese women aged ≥ 40 years and their younger counterparts aged 25 - 29. Methods: This was a retrospective study of twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2016. Women aged 40 and older at delivery (n = 117) were compared with women aged 25 - 29 at delivery (n = 536). Results: Although the women ≥ 40 years old were more likely to have increased risks of HELLP (hemolytic, elevated liver enzymes and low platelet) syndrome and very low birth weight neonates, there were no measurable differences in obstetric outcomes such as hypertensive disorders, premature delivery and neonatal asphyxia between the two groups. Conclusion: Advanced maternal age did not seem to affect obstetric outcomes in twin pregnancies seriously. J Clin Med Res. 2017;9(10):860-863 doi: https://doi.org/10.14740/jocmr3148w

Prenatal physical activity (PA) was discussed to decrease the incidence of obstetric and neonatal complications. In this secondary cohort analysis of the cluster-randomized GeliS (&ldquo, healthy living in pregnancy&rdquo, ) trial, associations between prenatal PA and such outcomes were investigated. PA behavior was assessed twice, before or during the 12th week (baseline, T0) and after the 29th week of gestation (T1), using the self-reported Pregnancy Physical Activity Questionnaire. Obstetric and neonatal data were collected in the routine care setting. Data were available for 87.2% (n = 1994/2286) of participants. Significant differences between the offspring of women who adhered to PA recommendations at T1 and offspring of inactive women were found in birth weight (p = 0.030) but not in other anthropometric parameters. Sedentary behavior was inversely associated with birth weight at T1 (p = 0.026) and, at both time points, with an increase in the odds of low birth weight (T0: p = 0.004, T1: p = 0.005). Light-intensity PA at T0 marginally increased the odds of caesarean section (p = 0.032), but neither moderate-intensity nor vigorous-intensity activity modified the risk for caesarean delivery at any time point. The present analyses demonstrated associations between prenatal PA and some neonatal and obstetric outcomes.

Background: In April 2012 our institution chose to switch from a two- step criteria for Gestational Diabetes Mellitus (GDM) screening, to the International Association of Diabetes in Pregnancy Study Group (IADSPG) criteria. This shift led to an increased prevalence of GDM in our pregnant population. We designed a study in order to estimate the magnitude of the increase in GDM prevalence before and after the switch in screening strategy. As a secondary objective we wanted to evaluate if there was a significant difference between the two periods in the percentage of maternal and neonatal complications such as gestational hypertensive disorders (GHD), primary cesarean section (pCS), preterm birth, large for gestational age (LGA) newborns, macrosomia, shoulder dystocia, 5′ Apgar score less than to 7 at birth, neonatal intensive care unit (NICU) transfer and neonatal hypoglycemia. Methods: We selected retrospectively 3496 patients who delivered between January 2009 and December 2011 who were screened with the two-step criteria (group A), and compared them to 2555 patients who delivered between January 2013 and December 2014 and who were screened with IADPSG criteria (Group B). We checked patients' electronic files to establish GDM status, baseline characteristics (age, body mass index, nationality, parity) and the presence of maternal and neonatal complications. Results: GDM prevalence increased significantly from group A (3.4%; 95%CI 2.8-4.06%) to group B (16.28%; 95%CI 14.8 -17.7%). In group B there were significantly more non-Belgian and primiparous patients. There was no statistically significant difference in maternal and neonatal complications between the two groups, even after adjustment for nationality and parity. There was a non-significant reduction of the proportion of macrosomic and of LGA babies. Conclusions: In our population the introduction of IADPSG screening criteria has increased the prevalence of GDM without having a statistically significant impact on pregnancy outcomes., SCOPUS: ar.j, info:eu-repo/semantics/published

RESUMEN: Introducción: Las gestaciones tras FIV-ICSI se han relacionado con peores resultados obstétricos y perinatales en numerosos estudios. Objetivo: Estimar el efecto de las técnicas FIV-ICSI sobre la morbimortalidad materna y perinatal. Material y métodos: En este estudio de cohortes retrospectivo, los datos fueron recogidos de pacientes a quienes se les realizó un tratamiento de FIV-ICSI en la unidad de reproducción asistida del HUMV y de gestantes espontáneas entre enero de 2016 y diciembre de 2017. Resultados: El grupo de gestaciones tras FIV-ICSI mostró mayor riesgo de enfermedad hipertensiva del embarazo (RR 3,24; IC95% 1,66-6,47), diabetes gestacional (RR 2,12; IC95%, 1,04-4,34), CIR (RR 3,57; IC95%, 1,52-8,43), embarazo gemelar, parto pretérmino (RR 2,82; IC95%, 1,61-4,92), bajo peso al nacimiento y malformaciones congénitas (RR 1,85; IC95% 1,11-3,07). No se encontraron diferencias estadísticamente significativas para otras complicaciones. Conclusiones: Las gestaciones obtenidas tras FIV-ICSI están relacionadas con el aumento de la prevalencia de ciertas complicaciones obstétricas y peores resultados perinatales en comparación con gestaciones espontáneas. Se requieren más estudios para determinar la etiología exacta de estos resultados. ABSTRACT: Introduction: FIV-ICSI pregnancies have been associated with worse obstetric and perinatal outcomes in multiple studies. Material and methods: In this retrospective cohort study, data were collected from FIV-ICSI treatments in the assisted reproduction unit of HUMV and spontaneus pregnancies from January 2016 to December 2017. Results: The FIV-ICSI group showed higher risk of hyppertensive stages of pregnancy (RR 3,24; IC95% 1,66-6,47), gestational diabetes (RR 2,12; IC95%, 1,04-4,34), CIR (RR 3,57; IC95%, 1,52-8,43), twin pregnancy (RR 10,33; IC95%, 3,98-26,78), premature birth (RR 2,82; IC95%, 1,61-4,92), low birth weitgh and congenital malformations (RR 1,85; IC95% 1,11-3,07). No statistically significant differences were found for other complications. Conclusions: Pregnancies using FIV-ICSI are associated with an increased prevalence of certain obstetric complications and worse perinatal outcomes in comparation with espontaneous pregnancies. More studies are needed to determine the etiology of this results. Grado en Medicina

INTRODUCTION Fetal femur length below the expected value has been described as a marker of aneuploidy, skeletal dysplasia, intrauterine growth restriction and small-for-gestational-age neonate. The aim of this systematic review and meta-analysis was to evaluate the strength of association between isolated short femur length and intrauterine growth restriction or small-for-gestational-age, and perinatal adverse outcomes. MATERIAL AND METHODS PubMed, EMBASE and Medline were searched from the inception of each database to May 2018. Selection criteria included prospective and retrospective cohort studies of singleton pregnancies between 18 and 28 weeks of gestation, with sonographic finding of isolated short femur length, without any structural chromosomal abnormality. The meta-analysis was performed by computing odds ratios using both fixed and random-effects models. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. RESULTS Six studies including 3078 cases of isolated short femur length (study group) and 222 303 normal femur length (control group) were included. The prevalence of intrauterine growth restriction or small-for-gestational-age in the study group was 14.2%, compared with 5.2% in the control group (odds ratio of 4.04, 95% confidence interval 3.63-4.50). Isolated short femur length was associated with a higher incidence of low birthweight (study group: 22.10% vs control group: 8.57%, odds ratio 3.24, 95% confidence interval 2.34-4.48), Apgar

Potential risk of adverse obstetrical outcomes has been shown among breast cancer survivors. Therefore, the aim of this systematic review and meta-analysis was to evaluate the relationship between history of breast cancer (BC) and obstetrical outcomes. PubMed, EMBASE, and Medline were searched from the inception of each database to April 2019. Selection criteria included prospective and retrospective cohort studies of BC pregnant survivors. The meta-analysis was performed by computing odds ratios (ORs) using both fixed and random-effects models. Quality assessment of the included studies was performed using the Newcastle–Ottawa Scale and the review was registered with PROSPERO number CRD42019127716. Four studies, including 1466 cases of BC survivors and 6,912,485 controls, were included. Compared with controls, a higher incidence of obstetrical complication was found in women with history of BC. The incidence of preterm birth (PTB) in the study group was 11.05% compared with 7.79% in the control group (1.68, 95% confidence interval 1.43–1.99). Breast cancer history was also associated with low birth weight (LBW) (study group: 9.26% vs. control group: 5.54%, 1.88, CI 95% 1.55–2.27), cesarean section (CS) (study group: 19.76% vs. control group 10.81%, 1.78, CI 95% 1.39–2.27), intrauterine fetal death (IUFD) (study group: 0.004% vs. control group 0.36%, of 1.25 CI 95% 0.36–4.35), and fetal anomalies (study group: 5.8% vs. control group: 4.26%, 1.45 CI 95% 1.01–2.09). History of BC was associated with adverse obstetrical outcomes.