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Background: Preeclampsia is the second leading cause of maternal death in Uganda. WHO recommends using magnesium sulphate (MgSO4) to prevent and treat preeclampsia with severe features (PEC) and eclampsia. MgSO4 is used to prevent eclampsia and treat women who experience an eclamptic convulsion to avoid severe maternal/infant illnesses and death. We set out to assess MgSO4 administration patterns in women with PEC or eclampsia and the immediate newborn outcomes of neonates. Methods: This was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study after receiving the loading dose of MgSO4 and then followed through labour and delivery to observe MgSO4 administration patterns and immediate newborn outcomes using Apgar and Thompson scores. SPSS version 23 was used to analyse data, and both bivariate and multivariate logistic regressions were used to determine factors associated with the low Apgar score at five minutes. Results: Overall, majority of the patients received more than one dose with 33.3% received a sixth dose of MgSO4. The majority, 84.8%, of the mothers delivered live babies, 31.0% babies had complications, and were admitted to the neonatal intensive care unit (NICU). NICU admissions were mostly due to respiratory distress21.4%, preterm delivery21.0%, and 5.5% died within seven days. Majority 93.3% of the newborns had an Apgar score of seven and above at five minutes, of the newborns who were Thompson scored, 70.4% scored between 1 to 10 which is mild HIE. Initiation of MgSO4 treatment within one hour from prescription (AOR = 0.49, CI: 0.01–1.94), 4-hourly timing of the first maintenance dose (AOR = 0.22, CI: 0.06–0.79) and having complete doses of MgSO4 treatment (AOR = 0.89, CI: 0.03–3.05) decreased the likelihood of having low Apgar scores at five minutes. Conclusions: Timely administration of the first maintenance dose of MgSO4 decreases the likelihood of low Apgar score at 5 min and NICU admission in newborns, and most NICU admissions were due to respiratory distress and preterm delivery. [ABSTRACT FROM AUTHOR]

Context Sugar alcohols (also called polyols) are regarded as a "healthy" sugar substitute. One of the possible reasons for their safe use in pregnant women is their natural origin and the presence of polyols in maternal and fetal samples during normal human gestation. But little is known about the association between circulating sugar alcohols levels and maternal metabolic disorders during pregnancy. Objective We aimed to detect the concentration of the polyols in participants with and without gestational diabetes mellitus (GDM), and to investigate the association between maternal serum levels of polyols and GDM, as well as newborn outcomes. Methods A nested population-based case–control study was conducted in 109 women with and without GDM. Maternal concentrations of serum erythritol, sorbitol, and xylitol in the fasting state were quantified using a time of flight mass spectrometry system. Result In women with GDM, serum concentrations of erythritol and sorbitol were higher, but serum concentrations of xylitol were lower than those in women without GDM. Per 1-SD increment of Box–Cox-transformed concentrations of erythritol and sorbitol were associated with the increased odds of GDM by 43% and 155% (95% CI 1.07-1.92 and 95% CI 1.77-3.69), while decreased odds were found for xylitol by 25% (95% CI 0.57-1.00). Additionally, per 1-SD increase of Box–Cox-transformed concentrations of serum sorbitol was associated with a 52% increased odds of large for gestational age newborns controlling for possible confounders (95% CI 1.00-2.30). Conclusion Maternal circulating sugar alcohols levels during pregnancy were significantly associated with GDM. These findings provide the potential roles of polyols on maternal metabolic health during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: This research sought to investigate the impact of COIVD 19 on the pregnancy outcome comparing that to the non-COVID pregnancies. Methods: This study undertook a retrospective comparative observational study design, among 68 randomly selected single tone pregnancy cases (34 RT-PCR diagnosed COVID positive and 34 RT-PCR diagnosed COVID negative) who were admitted in the selected hospital in their third trimester to attain medical care for delivery purpose. The study has been carried out between the period of March 2023 to October 2023 on the hospital records of patients admitted between July 2022 to February 2023. Data regarding maternal, fetal and neonatal outcomes have been inspected and compared among the COVID and non-COVID cases. Results: Only 14.7% of the COVID cases had mild symptoms, and rests were asymptomatic. In this study the adverse outcomes of the pregnancy were higher among COVID positive cases compared to non-COVID cases. Gestational age at delivery was significantly lower and hospital stay was significantly higher among COVID mothers (p<0.05). Prolonged labor, preterm delivery, ante-partum and post-partum complications, requirement of oxygen therapy and intensive care treatment were higher in proportion among COVID positive cases (p>0.05). Fetal distress, requirement of oxygen therapy and NICU, breathing difficulties found to be evident only among newborn of COVID positive cases (p>0.05). Conclusion: Maternal adverse outcomes were more common than the fetal outcomes when compared between COVID and non-COVID pregnancies. [ABSTRACT FROM AUTHOR]

Objective: This narrative review was performed to evaluate the correct timing of umbilical cord clamping for term infants. It was intended to determine any advantages or disadvantages from early or delayed cord clamping for newborns, infants or mothers. Methods: A systematic search on two databases was conducted using the PICO pattern to define a wide search. Out of 43 trials, 12 were included in this review. Three of the included studies are meta-analyses, nine are randomized controlled trials. Results: Early or delayed cord clamping was defined differently in all the included trials. However, there are many advantages from delayed cord clamping of at least > 60 s for newborns and infants up to 12 months of age. The trials showed no disadvantages for newborns or mothers from delayed cord clamping, except for a lightly increased risk of jaundice or the need for phototherapy. Conclusion: Delayed umbilical cord clamping for term infants should be performed. Further research is needed to improve knowledge on physiological timing of umbilical cord clamping in term infants, which also leads to the same advantages as delayed cord clamping. [ABSTRACT FROM AUTHOR]

ObjectiveThere has been a gradual increase in the prevalence of cesarean section deliveries and more healthcare professionals are considering the prophylactic use of corticosteroids before planned full-term cesarean sections. However, the association between dexamethasone administration before full-term cesarean delivery and short-term adverse neonatal outcomes is unclear. This study analyzed the disparities in short-term adverse neonatal effects in neonates born via full-term elective cesarean delivery with or without antenatal dexamethasone treatment.Study designThis single-center retrospective cohort study involved neonates aged 37–39 weeks. The primary neonatal outcomes included various short-term adverse events, including neonatal admission to the neonatal intensive care unit, neonatal access to the special care baby unit, transient neonatal respiratory distress, respiratory distress syndrome, and the requirement of intravenous antibiotics or ventilatory support. Multiple logistic regression analysis was used to assess the association between these outcomes and dexamethasone exposure while adjusting for covariates.ResultsOf the 543 neonates included in the study, 121 (22.2%) had been exposed to prenatal dexamethasone. When compared with the control group, the dexamethasone-exposed group exhibited significantly higher rates of transient neonatal respiratory distress, respiratory distress syndrome, administration of intravenous antibiotics, the need for ventilatory support, and longer duration of neonatal hospitalization (P

Background: Intimate partner violence (IPV) is common worldwide. However, the health effects of exposure to IPV during pregnancy are significantly more severe. We investigated the relationship between exposure to IPV during pregnancy and the risk of preterm and low birthweight births among women in Ghana's northern region. Methods: We recruited 402 postnatal women aged 15–49 years from five selected public health facilities in the Tamale Metropolis of the northern region of Ghana. Using Kobo Collect, information on a wide range of factors, including exposure to IPV during the last pregnancy and pregnancy outcomes, was collected electronically. Multiple logistic regression analyses were conducted in Stata to determine the associations between prenatal exposure to IPV and binary measures of gestational age at birth and birthweight. Results: Overall, 35.1% (95% CI: 30.5, 39.9) of the respondents experienced IPV during their recent pregnancy; 6.7% (95% CI: 4.6, 9.6) experienced physical IPV; and 34.8% (95% CI: 30.3, 39.6) experienced psychological IPV. The prevalence of preterm and low birthweight deliveries was 18.9% (95% CI: 15.4, 23.1) and 9.0% (95% CI: 6.5, 12.2), respectively. Prenatal exposure to IPV was linked to poor newborn outcomes by multivariable binary regression models. Women who suffered IPV during their last pregnancy were three times more likely to deliver low birthweight babies (AOR = 3.12: 95% CI: 1.42, 6.84). Exposed women were also about twice as likely to deliver prematurely, although this association was not statistically significant (AOR = 1.81; 95% CI: 0.97, 3.38). Conclusion: Exposure to IPV during pregnancy increases a woman's risk of delivering prematurely and having a low birthweight baby. IPV screening should be a regular part of ANC, so that pregnant women who are experiencing IPV can be monitored and supported to avoid adverse outcomes for their babies.

Background and objectives: Research on in utero opioid exposure impacts has focused on Neonatal Opioid Withdrawal Syndrome (NOWS). However, possible impacts on fetal growth and newborn wellbeing have emerged, with inconsistencies likely driven by methodological issues. Our goal was to compare birth outcomes between newborns with prenatal opioid exposure and a matched control group. Methods: Participants were identified via manual review of electronic medical records of all deliveries over five years within a regional health system (6 delivery hospitals across 2 states). From over 18,000 births, 300 with prenatal opioid exposure and 300 control newborns matched on exposure, medical, and background factors were included. Additional factors were statistically controlled. Outcomes included pregnancy/delivery complications, newborn size, and newborn health complications. Results: Compared to biochemically verified controls, exposed newborns had higher rates of fetal growth restriction, weighed less, had decreased length and head circumference, and had higher rates of respiratory distress, sepsis, and jaundice. No significant differences in gestational length, Apgar scores, or neonatal hypoglycemia were found. Adjusted regression analyses revealed that compared to controls, those exposed had an average 150 g decrease in birth weight, a two-fold increased risk for IUGR (OR = 2.09), a nearly three-fold (OR = 2.80) increased risk for jaundice, a more than seven-fold (OR = 7.40) increased risk for respiratory distress, and a thirty-fold (OR = 30.47) increased risk for sepsis. Conclusions: Results suggest significant pregnancy and newborn outcomes beyond NOWS following pregnancy opioid use, informing clinical screening and treatment decisions to enhance health and wellbeing in pregnancy, during the neonatal period, and beyond. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe sociodemographic variations in client preference for birthplace and relationships to perinatal health outcomes. Methods: Descriptive data analysis (raw number, percentages, and means) showed that preference for birthplace varied across racial and ethnic categories as well as sociodemographic categories including educational status, body mass index, payer status, marital status, and gravidity. A subsample of medically low-risk childbearing people, qualified for birth center admission in labor, was analyzed to assess variations in maternal and newborn outcomes by site of first admission in labor. Results: While overall clinical outcomes exceeded national benchmarks across all places of admission in the sample, disparities were noted including higher cesarean birth rates among Black and Hispanic people. This variation was larger within the population of people who preferred to be admitted to the hospital in labor in the absence of medical indication. Conclusion: This study supports that the birth center model provides safe delivery care across the intersections of US sociodemographics. Findings from this study highlight the importance of increased access and choice in place of birth for improving health equity, including decreasing cesarean birth and increasing breastfeeding initiation. [ABSTRACT FROM AUTHOR]

Objective: To compare associations between individual antidepressants and newborn outcomes. Design: Retrospective cohort study. Setting: Deliveries in a large, US medical system. Population: Women who received at least one antidepressant prescription 3 months prior to conception through delivery. Methods: Eligible women had maternal characteristics and newborn outcomes extracted from medical record data. Exposure was defined by the timing of the prescription during pregnancy. Main outcome measures: Newborn outcomes (any adaptation syndrome, neonatal intensive care unit (NICU) admission) were analyzed for each antidepressant and compared using standard statistics and multivariable regression compared to exposure to bupropion. Odds of outcomes based on timing of exposure were also explored. Results: A total of 3,694 women were analyzed. Rates of any adaptation syndrome (p < 0.001), NICU admission (p < 0.001), and transient tachypnea of newborn (TTN) (p = 0.006) were significantly different between drugs. Infants exposed to duloxetine had the highest rates of NICU admissions (39.6%) and adaptation syndromes (15.1%). Venlafaxine‐exposed infants had the highest rates of TTN (18.2%). Controlling for maternal age, race, insurance, and gestational age at delivery, early pregnancy antidepressant exposure was associated with adaptation syndrome and NICU admission for both duloxetine (adjusted odds ratio (aOR) 2.31 [95% Confidence Interval (CI) 1.11–4.80] and aOR 2.47 [95% CI 1.40–4.34], respectively) and escitalopram (aOR 1.72 [95% CI 1.09–2.70] and aOR 1.64 [95% CI 1.21–2.22], respectively). Exposure in the third trimester was associated with any adaptation syndrome for citalopram, duloxetine, escitalopram, fluoxetine, sertraline, and venlafaxine and NICU admission for bupropion, citalopram, duloxetine, escitalopram, and fluoxetine. Conclusion: Duloxetine and escitalopram appear to have the strongest associations with any adaptation syndrome and NICU admission whereas bupropion and sertraline tended to have among the lowest risks of these outcomes. These results can help providers and patients discuss choice of individual antidepressant drugs during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin D deficiency occurs during pregnancy all over the world because of lifestyle modifications, less sun exposure, sunscreen application and reduced amount of vitamin D in diet. At present, there are very limited number of studies regarding the prevalence of vitamin D deficiency during pregnancy and its effects in the newborns in the North Eastern region of India. Aim: To estimate serum vitamin D levels in pregnant women and newborn and correlation between maternal and newborn hypovitaminosis D. The study also assess the association of maternal vitamin D levels with the outcomes of early neonatal period. Materials and Methods: A prospective cohort study was conducted in Assam Medical College and Hospital (AMCH), Dibrugarh, Assam, India, in the Obstetrics and Gynaecology Department over a period of one year (1st July 2019 to 30th June 2020). Seventy pregnant women attending antenatal ward, labour room of AMCH were recruited. The 25-hydroxy vitamin D level was assessed in the maternal and cord blood. Delivery details and foetal parameters were recorded. Primary outcome was to assess the correlation between maternal and cord blood vitamin D level and secondary outcome was to assess the association of maternal vitamin D level with demographic characteristics, economic and obstetrical characteristics, newborn characteristics and perinatal outcome. Analysis of Variance (ANOVA), chi-square test and Fischer’sexact test, Pearson’s correlation coefficient (r) were used for statistical analysis. Results: Out of 70 participants, majority of the pregnant women (61.43%) were vitamin D deficient, 22.86% were vitamin D insufficient and 15.71% had sufficient vitamin D levels. Maternal vitamin D level was significantly associated with maternal age (p=0.0043) and socio-economic status (p=0.0417). There was a significant positive association between the vitamin D level of the mother with the birth weight (p

Introduction: Treatment with ulipristal acetate effectively controls excessive bleeding due to uterine fibroids and reduces their size. Uterine fibroid size reduction is expected to improve the results of the myomectomy and the reproductive prospects of the patient. Methods: Retrospective and descriptive analysis of a series of 53 patients who achieved pregnancy after being treated for symptomatic uterine fibroids. The primary endpoints were pregnancy and birth outcomes in women with symptomatic uterine fibroids that conceived following at least one course of therapy with ulipristal acetate 5 mg/day. The secondary endpoints were time until pregnancy, reasons for ulipristal acetate treatment, number of treatment courses completed, hemorrhagic control achievement, hemoglobin levels, fibroid FIGO classification, largest fibroid diameter, and type of myomectomy (if any). Results: Fifty-five pregnancies were registered in 53 patients following ulipristal acetate therapy (43 live births, 9 miscarriages, and 3 ongoing pregnancies). Half of the patients became pregnant without interval surgery. Bleeding control was achieved in 96% of the cases. A significant increase (p < 0.001) in hemoglobin levels and a reduction (p < 0.001) in uterine fibroid size was observed after treatment. No malformations were reported among newborns after ulipristal acetate therapy. Conclusion: So far, this is the largest case series reporting both pregnancy and birth outcomes following ulipristal acetate therapy for uterine fibroids. Our data support favorable outcomes after therapy for this population subset. [ABSTRACT FROM AUTHOR]

Abstract Background Neonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions. This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service utilization factors. Methods We investigated maternal health utilization factors using health facility delivery and at least four Antenatal Care (ANC) visits; and newborn health outcomes using newborn death and low birth weight (LBW). We used data from a household cross-sectional survey that was conducted in 2015 in Kamuli, Pallisa and Kibuku districts. We interviewed 1946 women who had delivered in the last 12 months. The four interrelated (Endogenous) outcomes were ANC attendance, health facility delivery, newborn death, and LBW. We performed analysis using a structural equation modeling technique. Results A history of newborn death (aOR = 12.64, 95% CI 5.31–30.10) and birth of a LBW baby (aOR = 3.51, 95% CI 1.48–8.37) were directly related to increased odds of newborn death. Factors that reduced the odds of LBW as a mediating factor for newborn death were ANC fourth time attendance (aOR = 0.62, 95% CI 0.45–0.85), having post-primary level education (aOR = 0.68, 95% CI 0.46–0.98) compared to none and being gravida three (aOR = 0.49, 95% CI 0.26–0.94) compared to being gravida one. Mother’s age group, 20–24 (aOR = 0.24, 95% CI 0.08–0.75) and 25–29 years (aOR = 0.20, 95% CI 0.05–0.86) compared to 15–19 years was also associated with reduced odds of LBW. Additionally, ANC visits during the first trimester (aOR = 2.04, 95% CI 1.79–2.34), and village health teams (VHTs) visits while pregnant (aOR = 1.14, 95% CI 1.01–1.30) were associated with increased odds of at least four ANC visits, which is a mediating factor for health facility delivery, LBW and newborn death. Surprisingly, newborn death was not significantly different between health facility and community deliveries. Conclusions Attending ANC at least four times was a mediating factor for reduced newborn death and low birth weight. Interventions in maternal health and newborn health should focus on factors that increase ANC fourth time attendance and those that reduce LBW especially in resource-limited settings. Targeting women with high-risk pregnancies is also crucial for reducing newborn deaths.

Purpose of Review: Our review aims to compare and contrast Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2/COVID-19's impact on maternal and neonatal outcomes. We have made significant progress in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome prevention and treatment over the last few decades. Drawing on empirical evidence with past public health crises can offer valuable insights into dealing with current and future pandemics. Therefore, it is imperative to conduct a comparative analysis of the resemblances and disparities existing between Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2/COVID-19.This research endeavor represents a pioneering and all-encompassing examination, aiming to discern and comprehend the parallels and contrasts in the respective impacts of SARS-CoV-2 and Human Immunodeficiency Virus on pregnancy., Recent Findings: Based on the current evidence, there is no indication that pregnancy increases women's susceptibility to acquiring Human Immunodeficiency Virus or SARS-CoV-2. Nevertheless, the state of being pregnant was correlated with the worsening of diseases and their progression. Both Human Immunodeficiency Virus and SARS-CoV-2 pose increased risks of maternal mortality and several obstetric complications, including premature birth and pre-eclampsia. While the vertical transmission of Human Immunodeficiency Virus is well-established, a comprehensive understanding of the vertical transmission of SARS-CoV-2 remains elusive, emphasizing the need for further investigations. Initial data suggest low SARS-CoV-2 vertical transmission rates in the setting of proper preventative interventions and universal screening. A cesarean delivery could reduce the risk of mother-to-child transmission in Human Immunodeficiency Virus-infected women with high viral loads or poor adherence to antiretroviral therapy (ART). However, it did not offer additional protection for Human Immunodeficiency Virus-infected women who adhered to Adherence to Antiretroviral Therapy or those with COVID-19. Human Immunodeficiency Virus and SARS-CoV-2 were linked to neonatal complications such as stillbirth, low birth weight, and neonatal intensive care unit (ICU) admissions. The universal testing of both pregnant patients and neonates is an effective strategy to prevent the spread and complications of both Human Immunodeficiency Virus and SARS-CoV-2. Human Immunodeficiency Virus control largely relies on preventing vertical transmission and medications during pregnancy and postpartum, whereas safety behaviors and vaccines have proven effective in preventing SARS-CoV-2 vertical transmissions., Summary: This review aims to compare and contrast the impact of Human Immunodeficiency Virus and SARS-CoV-2 on pregnancy outcomes, vertical transmissions, delivery modalities, neonatal outcomes, and clinical management. SARS-CoV-2 and Human Immunodeficiency Virus were associated with significant obstetric-related complications, making close clinical monitoring and preparation essential. Integration of SARS-CoV-2/COVID-19 management with reproductive health services is crucial to ensuring maternal and neonatal outcomes. Our review is not only the first to establish a groundwork for the current state of knowledge and its clinical implications on this topic, but it also sheds new insights for future research directions.Comparing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2 in terms of their impact on maternal and neonatal outcomes provides valuable insights despite their differences. Leveraging Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome research can help understand SARS-CoV-2 effects on pregnancy. Both infections pose risks to pregnant individuals and their fetuses, leading to increased maternal mortality and complications. Identifying common patterns and risk factors can improve clinical management for pregnant individuals with SARS-CoV-2. While a direct observational study for this comparison may not be feasible, comparing with Human Immunodeficiency Virus offers an ethical and practical approach. However, specific studies on SARS-CoV-2 are still necessary to gather detailed data on maternal and fetal outcomes., Competing Interests: Conflict of Interest Dan Li, Dr. Yifan Chang, and Dr. Sten H. Vermund declared that they have no conflict of interest.

Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy and can lead to significant perinatal mortalities as well as long term risk of comorbidities for both mother and her offspring. This systematic review aimed to explore whether combined diet and exercise interventions are associated with improved glycemic control and/or improved maternal and newborn outcomes in women with GDM when compared to dietary interventions. A search on combined diet and exercise interventions during pregnancy in women with GDM was performed in 3 electronic databases: PubMed (NCBI), ScienceDierct, and the Cochrane Library. Evaluated outcomes were fasting blood glucose levels, postprandial blood glucose levels, glycated hemoglobin percentages, total weight gain during pregnancy, proportion of caesarean delivery, proportion of patients needing insulin, neonatal birth weight, proportion of macrosomia, neonatal hypoglycemia, and preterm birth. This systematic review identified eight randomized, controlled trials involving 592 pregnant women and 350 infants. The risk of bias of the included trials ranged from high to low. The combined diet and exercise interventions reduced fasting and postprandial blood glucose levels when compared to dietary interventions. No significant differences were reported in the selected trials regarding total weight gain during pregnancy, cesarean section, neonatal birth weight, macrosomia, neonatal hypoglycemia, and preterm birth between diet plus exercise and diet groups. The combination of diet and exercise interventions help to control postprandial blood glucose concentration in women diagnosed with GDM, but did not change either maternal or newborn outcomes. PROSPERO CRD42018109896. [ABSTRACT FROM AUTHOR]

The aim of the present work was to present the outcomes of the patients with Y-chromosome microdeletions treated by intracytoplasmic sperm injection (ICSI), either using fresh (TESE) or frozen-thawed (TESE-C) testicular sperm and ejaculated sperm (EJAC). The originality of this work resides in the comparisons between the different types of Y-microdeletions (AZFa, AZFb, and AZFc) and treatments, with detailed demographic, stimulation, embryological, clinical, and newborn (NB) outcomes. Of 125 patients with Y-microdeletions, 33 patients presented severe oligozoospermia (18 performed ICSI with ejaculated sperm) and 92 secretory azoospermia (65 went for TESE with 40 having successful sperm retrieval and performed ICSI). There were 51 TESE treatment cycles and 43 TESE-C treatment cycles, with a birth of 19 NB (2 in AZFa/TESE-C, 12 in AZFc/TESE, and 5 in AZFc/TESE-C). Of the 29 EJAC cycles, there was a birth of 8 NB (in AZFc). In TESE and EJAC cycles, there were no significant differences in embryological and clinical parameters. In TESE-C cycles, there was a significant lower oocyte maturity rate, embryo cleavage rate and mean number of embryos transferred in AZFb, and a higher mean number of oocytes and lower fertilization rate in AZFc. In conclusion, although patients with AZFc microdeletions presented a high testicular sperm recovery rate and acceptable clinical outcomes, cases with AZFa and AZFb microdeletions presented a poor prognosis. Due to the reported heredity of microdeletions, patients should be informed about the infertile consequences on NB and the possibility of using preimplantation genetic diagnosis for female sex selection.

The aim of the present work was to present the outcomes of the patients with Y‑chromosome microdeletions treated by intracytoplasmic sperm injection (ICSI), either using fresh (TESE) or frozen‑thawed (TESE‑C) testicular sperm and ejaculated sperm (EJAC). The originality of this work resides in the comparisons between the different types of Y‑microdeletions (AZFa, AZFb, and AZFc) and treatments, with detailed demographic, stimulation, embryological, clinical, and newborn (NB) outcomes. Of 125 patients with Y‑microdeletions, 33 patients presented severe oligozoospermia (18 performed ICSI with ejaculated sperm) and 92 secretory azoospermia (65 went for TESE with 40 having successful sperm retrieval and performed ICSI). There were 51 TESE treatment cycles and 43 TESE‑C treatment cycles, with a birth of 19 NB (2 in AZFa/TESE‑C, 12 in AZFc/TESE, and 5 in AZFc/TESE‑C). Of the 29 EJAC cycles, there was a birth of 8 NB (in AZFc). In TESE and EJAC cycles, there were no significant differences in embryological and clinical parameters. In TESE‑C cycles, there was a significant lower oocyte maturity rate, embryo cleavage rate and mean number of embryos transferred in AZFb, and a higher mean number of oocytes and lower fertilization rate in AZFc. In conclusion, although patients with AZFc microdeletions presented a high testicular sperm recovery rate and acceptable clinical outcomes, cases with AZFa and AZFb microdeletions presented a poor prognosis. Due to the reported heredity of microdeletions, patients should be informed about the infertile consequences on NB and the possibility of using preimplantation genetic diagnosis for female sex selection. [ABSTRACT FROM AUTHOR]

Background: Neonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions. This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service utilization factors.Methods: We investigated maternal health utilization factors using health facility delivery and at least four Antenatal Care (ANC) visits; and newborn health outcomes using newborn death and low birth weight (LBW). We used data from a household cross-sectional survey that was conducted in 2015 in Kamuli, Pallisa and Kibuku districts. We interviewed 1946 women who had delivered in the last 12 months. The four interrelated (Endogenous) outcomes were ANC attendance, health facility delivery, newborn death, and LBW. We performed analysis using a structural equation modeling technique.Results: A history of newborn death (aOR = 12.64, 95% CI 5.31-30.10) and birth of a LBW baby (aOR = 3.51, 95% CI 1.48-8.37) were directly related to increased odds of newborn death. Factors that reduced the odds of LBW as a mediating factor for newborn death were ANC fourth time attendance (aOR = 0.62, 95% CI 0.45-0.85), having post-primary level education (aOR = 0.68, 95% CI 0.46-0.98) compared to none and being gravida three (aOR = 0.49, 95% CI 0.26-0.94) compared to being gravida one. Mother's age group, 20-24 (aOR = 0.24, 95% CI 0.08-0.75) and 25-29 years (aOR = 0.20, 95% CI 0.05-0.86) compared to 15-19 years was also associated with reduced odds of LBW. Additionally, ANC visits during the first trimester (aOR = 2.04, 95% CI 1.79-2.34), and village health teams (VHTs) visits while pregnant (aOR = 1.14, 95% CI 1.01-1.30) were associated with increased odds of at least four ANC visits, which is a mediating factor for health facility delivery, LBW and newborn death. Surprisingly, newborn death was not significantly different between health facility and community deliveries.Conclusions: Attending ANC at least four times was a mediating factor for reduced newborn death and low birth weight. Interventions in maternal health and newborn health should focus on factors that increase ANC fourth time attendance and those that reduce LBW especially in resource-limited settings. Targeting women with high-risk pregnancies is also crucial for reducing newborn deaths. [ABSTRACT FROM AUTHOR]

Background Anemia and pregnancy-induced hypertension (PIH) are two significant high-risk conditions that can have a profound impact on maternal health during pregnancy. The scarcity of studies investigating the potential links and interactions between these two conditions adds to the gap in our understanding of their combined impact on pregnant women. This study aimed to assess the impact of PIH in conjunction with anemia and without anemia on pregnancy outcomes. Methods A prospective study was conducted among 150 primi pregnant women (third trimester of pregnancy) from a secondary-care hospital (Government General Headquarters Hospital, Cuddalore) in Tamil Nadu, India. The study population was selected using a purposive sampling technique. Data were collected using a structured questionnaire to assess sociodemographic characteristics, dietary patterns, and outcomes of pregnancy. Clinical parameters such as blood pressure were measured using a sphygmomanometer, and hemoglobin and urine tests for protein were obtained from the patient's medical records. Results The result showed that out of 150 primi pregnant women, 73 (49%) had PIH and 77 (51%) experienced both PIH and anemia. On comparing the outcomes, pregnant women with PIH accompanied by anemia exhibited developing preeclampsia (p<0.001), encountered maternal complications (p=0.034), delivered preterm babies (p=0.03), and gave birth to low-birth-weight babies (p<0.001), and their newborns admitted to the NICU (p=0.02). Additionally, pregnant women with both PIH and anemia demonstrated significantly higher levels of systolic blood pressure after delivery (p=0.009). Conclusion  The study calls for the immediate attention of healthcare providers for vigilant monitoring and addressing anemia in conjunction with PIH to improve maternal and neonatal outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Johnson et al.)

Background. The aim of this article is to present a rare clinical case of vasa praevia as well as to assess the relevance of the problem by reviewing the latest literature sources. Materials and methods. In this report we present a case of a 33-yearold woman diagnosed with vasa praevia at 33 weeks of pregnancy, after hospitalisation with preterm rupture of membranes following the delivery of a live healthy baby through a lower segment Caesarean section during 33rd week of gestation at Vilnius University Hospital Santariškių Clinics. We investigated all the documentation of the patient before and after delivery. Results and conclusions. Vasa praevia is a rather rare pathology which is likely to occur during pregnancy, may result in heavy bleeding and be particularly threatening to the fetus life. A timely diagnosis for these women is essential. The gold standard for vasa praevia diagnosis is the fetal ultrasound scan. Vasa praevia pathology is found during the routine second trimester ultrasound check-up. The selection of proper tactics applied during pregnancy care is essential. At the gestational age of 28–32, it is advisable to mature fetal lungs as well as the fetus condition should be investigated by a perinatologist. The mode of delivery is the C-section which tends to reduce the frequency of possible complications.

Objective: To explore the importance of administering influenza vaccine during pregnancy. Materials and Methods: An internet search for data, study and position papers was done. Medline and Pubmed were the frequently used search engines besides search for WHO and CDC position statements. The keywords used included, influenza vaccine, pregnancy, outcome, safety and trimesters. Results: Search provided studies that had been conducted in developing nations like Bangladesh as well as developed nations like Norway and England. The WHO and CDC status reports were also accessed and studied. Conclusion: Administration of influenza vaccine is recommended in any trimester of pregnancy, to protect the pregnant woman as well as the newborn child below the age of 6 months from the deleterious effects of influenza. The vaccine is safe and free from side effects. [ABSTRACT FROM AUTHOR]

Background. The aim of this article is to present a rare clinical case of vasa praevia as well as to assess the relevance of the problem by reviewing the latest literature sources. Materials and methods. In this report we present a case of a 33-yearold woman diagnosed with vasa praevia at 33 weeks of pregnancy, after hospitalisation with preterm rupture of membranes following the delivery of a live healthy baby through a lower segment Caesarean section during 33rd week of gestation at Vilnius University Hospital Santariškių Clinics. We investigated all the documentation of the patient before and after delivery. Results and conclusions. Vasa praevia is a rather rare pathology which is likely to occur during pregnancy, may result in heavy bleeding and be particularly threatening to the fetus life. A timely diagnosis for these women is essential. The gold standard for vasa praevia diagnosis is the fetal ultrasound scan. Vasa praevia pathology is found during the routine second trimester ultrasound check-up. The selection of proper tactics applied during pregnancy care is essential. At the gestational age of 28-32, it is advisable to mature fetal lungs as well as the fetus condition should be investigated by a perinatologist. The mode of delivery is the C-section which tends to reduce the frequency of possible complications. [ABSTRACT FROM AUTHOR]

Background Progress during early labour may impact subsequent labour trajectories. Women admitted to hospital in latent phase (<3 cm cervical dilation) labour have been shown to be at higher risk of obstetrical interventions. Methods We conducted a secondary analysis of data from a randomized controlled trial of 1247 healthy nulliparous women in spontaneous labour at term with a singleton fetus in cephalic presentation at seven hospitals in Southwestern British Columbia. We computed relative risks and their 95% confidence intervals to examine our primary outcome of cesarean section and secondary outcomes including obstetrical interventions and maternal and newborn outcomes according to women's perception of length of pre-hospital labour. Women were asked on admission to hospital how long they had been experiencing contractions prior to coming to hospital. Results Women indicating that they had been in labour for 24 hours or longer at the time of hospital admission were at elevated risk for cesarean birth, relative risk (RR) 1.40, (95% Confidence Intervals 1.15-1.72), admission with a cervical dilation of 3 cm or less, RR 1.21 (1.07-1.36), more obstetrical interventions including continuous electronic fetal monitoring RR 1.11 (1.03-1.20), augmentation of labour RR 1.33 (1.23-1.44), use of narcotic RR 1.21 (1.06-1.37) and epidural analgesia RR 1.18 (1.09-1.28). Adverse neonatal outcomes did not differ apart from a significant increase in meconium-stained amniotic fluid RR 1.60 (1.09-2.35). Conclusions A single question asked of women on presentation to hospital was an important predictor of cesarean birth and may have utility in identifying women who would benefit from close observation and more active management of labour. [ABSTRACT FROM AUTHOR]

Objective. To study mode of birth, perinatal health and death in children born to mothers with intellectual disability (ID) in Sweden. Design. Population-based register study. Setting. National registers; the National Patient Register linked to the Medical Birth Register. Sample. Children of first-time mothers with ID ( n = 326; classified in the International Classification of Diseases 8-10) were identified and compared with 340 624 children of first-time mothers without ID or any other psychiatric diagnosis between 1999 and 2007. Methods. Population-based data were extracted from the National Patient Register and the Medical Birth Register. Main outcome measures. Mode of birth, preterm birth, small for gestational age, Apgar score, stillbirth and perinatal death. Results. Children born to mothers with ID were more often stillborn (1.2 vs. 0.3%) or died perinatally (1.8 vs. 0.4%) than children born to mothers without ID. They had a higher proportion of cesarean section birth (24.5 vs. 17.7%) and preterm birth (12.2 vs. 6.1%), were small for gestational age (8.4 vs. 3.1%) and had lower Apgar scores (<7 points at five minutes; 3.7 vs 1.5%) compared with children born to mothers without ID. Logistic regression adjusted for maternal characteristics confirmed an increased risk of small for gestational age (odds ratio 2.25), stillbirth (odds ratio 4.53) and perinatal death (odds ratio 4.25) in children born to mothers with ID. Conclusions. Unborn and newborn children of mothers with ID should be considered a risk group, and their mothers may need better individual-based care and support. [ABSTRACT FROM AUTHOR]

Background: Violence against pregnant women is an increasing public health concern. The purpose of this study is to estimate the prevalence of violence during pregnancy, to identify characteristics associated and to assess the impact of violence on newborn outcomes. Methods: Prospective cohort study of 652 pregnant women attending primary care clinics in Southern Brazil, from June 2006 to September 2007. Women with gestational age ranging from 16th and 36th were enrolled and their exposure to violence and mental disorder was assessed. After the birth they were contacted by telephone when information on obstetric and neonatal outcomes was obtained. Results: Any violence during current pregnancy was reported by 18.3% [95% confidence interval (CI) 15.3–21.4%] participants, 15.0% (95% CI 12.3–17.8%) psychological violence, 6% (95% CI 4.2–7.8%) physical violence and 3% (0–0.5%) sexual violence. These women were more often of low income, did not work or study and had inadequate prenatal care and pregnancy weight gain. There was a statistically significant crude association between exposure to physical and psychological violence [relative risk (RR) 3.21 (1.51–6.80)]. After adjustment for family income, number of prenatal visits, length of gestation and gestational weight gain, the effect size decreased, but remained statistically significant (RR 2.18; 95% CI 1.16–4.08%). Conclusion: In disadvantaged settings in Brazil, violence in pregnancy is frequent; it is associated with inadequate maternal weight gain during pregnancy and prenatal care, and increases risk of low birth-weight. Thus, violence in pregnancy imposes a challenge to effective prenatal care delivery with potential benefits to the mother and her baby. [ABSTRACT FROM AUTHOR]

Maternal and child nutrition has been a critical component of health, sustainable development, and progress in low- and middle-income countries (LMIC). While a decrement in maternal mortality is an important indicator, simply surviving pregnancy and childbirth does not imply better maternal health. One of the fundamental obligations of nations under international human rights law is to enable women to endure pregnancy and delivery as an aspect of their enjoyment of reproductive and sexual health and rights and to live a dignified life. The aim of this study was to discover the correlation between the Maternal Observation and Motivation (MOM) program and m-Health support for maternal and newborn health. A comparative study was done among 196 pregnant mothers (study group—94; control group—102 mothers) with not less than 20 weeks of gestation. Maternal outcomes such as Hb and weight gain and newborn results such as birth weight and crown–heel length were obtained at baseline and at 28 and 36 weeks of gestation. Other secondary data collected were abortion, stillbirth, low birth weight, major congenital malformations, twin or triplet pregnancies, physical activity, and maternal well-being. The MOM intervention included initial face-to-face education, three in-person visits, and eight virtual health coaching sessions via WhatsApp. The baseline data on Hb of the mothers show that 31 (32.98%) vs. 27 (28.72%) mothers in the study and control group, respectively, had anemia, which improved to 27.66% and 14.98% among study group mothers at 28 and 36 weeks of gestation (p < 0.001). The weight gain (p < 0.001), level of physical activity (p < 0.001), and maternal well-being (p < 0.01) also had significant differences after the intervention. Even after controlling for potentially confounding variables, the maternal food practices regression model revealed that birth weight was directly correlated with the consumption of milk (p < 0.001), fruits (p < 0.01), and green vegetables (p < 0.05). As per the physical activity and maternal well-being regression model, the birth weight and crown–heel length were strongly related with the physical activity and maternal well-being of mothers at 36 weeks of gestation (p < 0.05). Combining the MOM intervention with standard antenatal care is a safe and effective way to improve maternal welfare while upholding pregnant mothers' human rights. [ABSTRACT FROM AUTHOR]

Background: Antenatal corticosteroids improve newborn outcomes for preterm infants. However, predicting which women presenting for threatened preterm labor will have preterm infants is inaccurate, and many women receive antenatal corticosteroids but then go on to deliver at term.Objective: This study aimed to compare the short-term outcomes of infants born at term to women who received betamethasone for threatened preterm labor with infants who were not exposed to betamethasone in utero.Study Design: We performed a retrospective cohort study of infants born at or after 37 weeks' gestational age to mothers diagnosed as having threatened preterm labor during pregnancy. The primary neonatal outcomes of interest included transient tachypnea of the newborn, neonatal intensive care unit admission, and small for gestational age and were evaluated for their association with betamethasone exposure while adjusting for covariates using multiple logistic regression.Results: Of 5330 women, 1459 women (27.5%) received betamethasone at a mean gestational age of 32.2±3.3 weeks. The mean age of women was 27±5.9 years and the mean gestational age at delivery was 38.9±1.1 weeks. Women receiving betamethasone had higher rates of maternal comorbidities (P<.001 for diabetes mellitus, asthma, and hypertensive disorder) and were more likely to self-identify as White (P=.022). Betamethasone-exposed neonates had increased rates of transient tachypnea of the newborn, neonatal intensive care unit admission, small for gestational age, hyperbilirubinemia, and hypoglycemia (all, P<.05). Controlling for maternal characteristics and gestational age at delivery, betamethasone exposure was not associated with a diagnosis of transient tachypnea of the newborn (adjusted odds ratio, 1.10; 95% confidence interval, 0.80-1.51), although it was associated with more neonatal intensive care unit admissions (adjusted odds ratio, 1.49; 95% confidence interval, 1.19-1.86) and higher odds of the baby being small for gestational age (adjusted odds ratio, 1.78; 95% confidence interval, 1.48-2.14).Conclusion: Compared with women evaluated for preterm labor who did not receive betamethasone, women receiving betamethasone had infants with higher rates of neonatal intensive care unit admission and small for gestational age. Although the benefits of betamethasone to infants born preterm are clear, there may be negative impacts for infants delivered at term. [ABSTRACT FROM AUTHOR]

• Hepatitis B association with maternal and neonatal complications remains unclear. • Three good quality studies revealed that hepatitis B can cause adverse outcomes. • Larger, more robust, well-designed prospective cohort studies are needed. The association between hepatitis B virus (HBV) infection and maternal, obstetric and newborn outcomes remains controversial, as previous studies have reported conflicting and inconsistent results on the matter. The aim was to investigate whether HBV infection increases the risk of maternal, obstetric and newborn complications. We conducted a systematic literature review, according to PRISMA statement guidelines. Studies were eligible for inclusion if they were observational cohort, case-control or cross-sectional studies, comparing maternal, obstetric or newborn complications in HBV-infected and uninfected pregnant women. PubMed was searched for published literature in English, with no date restrictions, using combinations of keywords. The titles and abstracts were independently screened for eligibility by three authors. Two authors assessed the quality of each included study and no meta-analysis was performed. We retrieved 275 records and included 15 papers. The methodological and statistical heterogeneity as well as a great variation on the types of maternal, obstetric and newborn complications studied did not allow quantitative analysis of results and conclusions about the level of evidence. Seven studies are of good quality, which makes their results more reliable. Three of them revealed that maternal HBV infection increased the risk of miscarriage, preterm birth, pregnancy-induced hypertension, fetal distress and macrosomia. These three studies were performed in China and the one with the largest number of participants only included women from rural areas. Larger, more robust, well-designed prospective cohort studies are needed. These must include adjusted estimates for confounding factors, such as other possible complications determinants, like the antenatal care quality. [ABSTRACT FROM AUTHOR]

As mothers age, the risk of adverse pregnancy outcomes may increase, but the results so far are controversial and several issues remain unknown, such as the impact of maternal weight on the effects associated with older age. In a prospective cohort of 912 Polish women with singleton pregnancies (recruited in 2015–2016), we assessed the pregnancy outcomes depending on the mother's age (18–24, 25–29, 30–34, 35–39, and ≥40 years). Women aged ≥35 years (vs. <35 years) were assessed in terms of body mass index (BMI). Multidimensional logistic regression was used to calculate the odds ratios (with 95% confidence intervals) of the pregnancy results. The risk profiles (using the Lowess method) were applied to determine the threshold risk. We found that both the youngest and the oldest group members displayed higher adjusted odds ratios of preeclampsia (PE), intrauterine growth restriction (IUGR), and preterm birth <37th week (U-shaped risk). In the remaining cases, the age ≥40 years, compared to the youngest age 18–24 years, was associated with a higher adjusted risk of gestational hypertension (GH) (AOR = 5.76, p = 0.034), gestational diabetes mellitus GDM-1 (AOR = 7.06, p = 0.016), cesarean section (AOR = 6.97, p <0.001), and low birth weight LBW (AOR = 15.73, p = 0.033) as well as macrosomia >4000 g (AOR = 8.95, p = 0.048). We found that older age ≥35 years (vs. <35 years) was associated with higher adjusted odds ratios of all the pregnancy outcomes investigated. In obese women, these adverse older age related results were found to be more intense in GH study, as well as (though weaker) in birth <37th week study, small-for-gestational age birth weight (SGA), LBW, large-for-gestational age birth weight (LGA), and macrosomia. In overweight women, these adverse older age related results were found to be more intense in preterm birth study, as well as (though weaker) in SGA and LBW. In underweight women, adverse pregnancy outcomes related to older age were more intense in a study of cesarean section. At the same time, underweight was associated with reversal of some negative effects of older age (we found lower odds ratios of GDM-1 diabetes). The maternal threshold age above which the risk of GH, PE, GDM, caesarean section, and preterm birth increased was 33–34 years (lower than the threshold of 35 years assumed in the literature), and the threshold risk of IUGR, LBW, SGA, LGA, and macrosomia was 36–37 years. Main conclusions: Older maternal age was associated with a higher chance of all kinds of obstetric complications. Older women should particularly avoid obesity and overweight. [ABSTRACT FROM AUTHOR]

Previous studies have shown that planned home birth in low-risk pregnancies is a generally safe option. However nowadays, only 0.5 percent of deliveries have been at home in Spain. This study sought to understand the characteristics of planned home births with qualified healthcare professionals in low-risk pregnancies and their results on maternal and neonatal health in the Balearic Islands. The study followed a retrospective descriptive design to investigate planned home births from 1989 to 2019 ( n = 820). Sociodemographic data of women, healthcare professional intervention rates, and maternal/fetal morbidity/mortality results were collected. Statistical analysis of the results was performed using the IBM SPSS Version 25 software package. The results indicated that women with low-risk pregnancies who planned home births with a qualified midwife had a higher probability of spontaneous vaginal birth delivery and positive maternal health results. Furthermore, the risk of hospital transfer was low (10.7%) and the rate of prolonged breastfeeding (>1 year) was extremely high (99%). Moreover, the study showed that planned home births can be generally associated with fetal well-being. The conclusions and implications of this study are that planned home births in low-risk pregnancies attended by qualified midwives in the Balearic Islands achieve positive results in both maternal and newborn health, as well as low rates of obstetric intervention.

Background: Evidence suggests a strong association between nutrition during the first 1000 days (conception to 2 years of life) and cognitive development. Maternal docosahexaenoic acid (DHA) supplementation has been suggested to be linked with cognitive development of their offspring. DHA is a structural component of human brain and retina, and can be derived from marine algae, fatty fish and marine oils. Since Indian diets are largely devoid of such products, plasma DHA levels are low. We are testing the effect of pre- and post-natal DHA maternal supplementation in India on infant motor and mental development, anthropometry and morbidity patterns.Methods: DHANI is a double-blinded, parallel group, randomized, placebo controlled trial supplementing 957 pregnant women aged 18-35 years from ≤20 weeks gestation through 6 months postpartum with 400 mg/d algal-derived DHA or placebo. Data on the participant's socio-demographic profile, anthropometric measurements and dietary intake are being recorded at baseline. The mother-infant dyads are followed through age 12 months. The primary outcome variable is infant motor and mental development quotient at 12 months of age evaluated by Development Assessment Scale in Indian Infants (DASII). Secondary outcomes are gestational age, APGAR scores, and infant anthropometry. Biochemical indices (blood and breast-milk) from mother-child dyads are being collected to estimate changes in DHA levels in response to supplementation. All analyses will follow the intent-to-treat principle. Two-sample t test will be used to test unadjusted difference in mean DASII score between placebo and DHA group. Adjusted analyses will be performed using multiple linear regression.Discussion: Implications for maternal and child health and nutrition in India: DHANI is the first large pre- and post-natal maternal dietary supplementation trial in India. If the trial finds substantial benefit, it can serve as a learning to scale up the DHA intervention in the country.Trial Registration: The trial is retrospectively registered at clinicaltrials.gov ( NCT01580345 , NCT03072277 ) and ctri.nic.in ( CTRI/2013/04/003540 , CTRI/2017/08/009296 ). [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were evaluation of the association of reduced fetal movements (RFM) and small-for-gestational-age (SGA) birth at term and to explore if fetal and maternal outcomes are different with single vs repeated episodes of RFM and normal fetal assessment test results.Study Design: This was a retrospective cohort study of all singleton pregnancies referred for RFMs at a tertiary fetal medicine unit from January 2008 through September 2014. Ultrasound and Doppler indices were obtained from a computerized ultrasound database and pregnancy outcome was collected from hospital records.Results: Of the 21,944 women with a singleton pregnancy booked for maternity care during the study period, 1234 women (5.62%) reported RFMs >36+0 weeks. Of these, 1029 women (83.4%) reported a single episode of RFM and 205 (16.6%) had ≥2 presentations for RFM. Women with repeated RFMs had a significantly higher mean uterine artery pulsatility index in the second trimester. The prevalence of SGA baby at birth in women presenting with a single episode as compared to repeated episodes of RFM was 9.8% and 44.2%, respectively (odds ratio, 7.3; 95% confidence interval, 5.1-10.4; P < .05).Conclusion: Repeated episodes of RFMs at term are more likely to occur in women with high second-trimester uterine artery Doppler resistance indices and are strongly associated with the birth of SGA infants. Women presenting with repeated episodes of RFM should be treated as being at high risk of placental dysfunction irrespective of the results of prenatal ultrasound and Doppler assessment. [ABSTRACT FROM AUTHOR]

Objective: To compare demographic, embryologic, pregnancy, and newborn outcomes after intracytoplasmic sperm injection (ICSI) cycles with or without mature oocytes (metaphase II [MII]) showing visible aggregates of tubular smooth endoplasmic reticulum (aSERT) and to describe the ultrastructure of this dysmorphism. Design: Retrospective study. Setting: Private fertility center and university cell biology and genetics departments. Patient(s): There were 721 ICSI cycles, 520 carrying morphologically normal MII (control group) and 60 containing aSERT-MII (study group). Intervention(s): None. Main Outcome Measure(s): Embryologic and clinical and live birth outcomes, including malformations and ultrastructural characterization of aSERT-MII. Result(s): Compared with the control group there was a significant decrease in the fertilization, embryo cleavage, and blastocyst rates in the study group. The only child born after transfer of embryos derived from aSERT-MII presented a major cardiovascular malformation. Ultrastructurally, large aSERT were surrounded by abnormal-shaped mitochondria and clusters of small dense bodies formed by very small vesicles, and they had curvilinear dense tubules in the interior. The same pathology was observed in small peripheral aSERT. Conclusion(s): The presence of large aSERT, showing attainment of the periphery, demonstrated that the cytoplasm is pathologic. The compromised embryo development and implantation was associated with decreased clinical outcomes and newborn malformations. Therefore, oocytes with large aSERT should not be used for embryo transfer. [ABSTRACT FROM AUTHOR]