Search

Objective: To examine whether a history of hysteroscopic adhesiolysis (HA)‐treated intrauterine adhesions (IUAs) was associated with an increased risk of adverse obstetrical outcomes in subsequent pregnancies. Design: Retrospective cohort study. Setting: A tertiary‐care hospital in Shanghai, China. Population: A cohort of 114 142 pregnant women who were issued an antenatal card and received routine antenatal care in Shanghai First Maternity and Infant Hospital, between January 2016 and October 2021. Methods: From the cohort of 114 142 pregnant women, each woman with a history of HA‐treated IUA prior to the current pregnancy (n = 780) was matched with four women without a history of IUAs (n = 3010) using propensity score matching. The matching variables were maternal age and parity, mode of conception, pre‐pregnancy body mass index and prior history of abortion. Main outcome measures: Pregnancy complications, placental abnormalities, postpartum haemorrhage and adverse birth outcomes. Results: Compared with women with no history of IUAs, women with a history of HA‐treated IUAs were at higher risk of pre‐eclampsia (RR 1.69, 95% CI 1.23–2.33), placenta accreta spectrum (RR 4.72, 95% CI 3.9–5.73), placenta praevia (RR 4.23, 95% CI 2.85–6.30), postpartum haemorrhage (RR 2.86, 95% CI 1.94–4.23), preterm premature rupture of membranes (RR 3.02, 95% CI 1.97–4.64) and iatrogenic preterm birth (RR 2.86, 95% CI 2.14–3.81). Those women were also more likely to receive cervical cerclage (RR 5.63, 95% CI 3.95–8.02) during pregnancy and haemostatic therapies after delivery (RR 2.17, 95% CI 1.75–2.69). Moreover, we observed that the RRs of those adverse obstetrical outcomes increased with the increasing number of hysteroscopic surgeries. Conclusions: This study found that a history of HA‐treated IUAs, especially a history of repeated HAs, was associated with an increased risk of adverse obstetrical outcomes. [ABSTRACT FROM AUTHOR]

Intra-amniotic infection (IAI), also known as chorioamnionitis, is a major cause of maternal and neonatal infection that occurs during pregnancy, labor and delivery, or in the postpartum period. Conditions such as meconium-stained amniotic fluid (MSAF) and premature rupture of membranes (PROMs) are recognized risk factors for amniotic fluid infection. This study identifies the microbial patterns in the amniotic fluid of women with PROMs and MSAF to determine the presence and types of bacterial growth. It also identifies trends in antibiotic use through descriptive statistics. Conducted as a descriptive observational study with prospective data collection, this research included maternal patients with PROMs lasting more than 12 h and those with MSAF, along with their infants. Of 30 cultured amniotic fluid samples, bacterial growth was observed in 13 cases, with Escherichia coli being the most prevalent (40%). Infants born with PROMs accompanied by MSAF were 5.5 days, significantly longer than those born with PROMs alone (3.19 days) or MSAF alone (3.91 days), with a significant difference between groups (p = 0.003). In addition, Escherichia coli isolates in this study are resistant to ceftriaxone, a third-generation cephalosporin antibiotic. Understanding these microbial patterns is critical for guiding clinical decisions, particularly in managing the risk of infection in pregnant women with PROMs and MSAF and ensuring better outcomes for both mothers and newborns. [ABSTRACT FROM AUTHOR]

Background: Chorioamnionitis is recognized as a major consequence of preterm premature rupture of membranes (PPROM), and a frequent cause of neonatal morbidity and mortality. The association between fetal heart rate (FHR) and chorioamnionitis remains unclear. Objectives: The aim of this study was to evaluate the dynamics of FHR in a PPROM population at the approach of delivery according to the presence or absence of chorioamnionitis. Materials & methods: 120 pregnant women with PPROM between 26 and 34 weeks' gestation were enrolled in this multicenter prospective unblinded study. All participants were fully informed of the study's objectives. 39 of the 120 patients were included in the analysis of FHR recordings. The analysis consisted of extracting features from computerized FHR analysis (cFHR) and fetal heart rate variability analysis (FHRV) in the temporal, frequency and nonlinear domains. Then, each set of features was analyzed separately using the multiple factor analysis, where three groups were defined as the feature set for days 0, -1 and -2 prior to birth. The distances between the global projection and the projections for each day were computed and used in the ROC analysis to distinguish chorioamnionitis from non-chorioamnionitis group. Results: The results showed that there were significant differences in certain features between populations with and without chorioamnionitis. The distinction between the two populations reached an area under the curve (AUC) of only 37% [34–40] for cFHR features and 63% [59–66] for time-domain FHRV features when comparing all stages of chorioamnionitis to non-chorioamnionitis subjects. When only stage 3 chorioamnionitis was compared to non-chorioamnionitis patients, the AUC reached 90% [88–93] for nonlinear-domain and 84% [82–87] for time-domain FHRV features, whereas it was limited to 71% [68–74] using cFHR features. Conclusion: The present study suggests that the HRV features are more reliable for diagnosing chorioamnionitis than cFHR, and that the assessment of features dynamics over several days is an interesting tool for detecting chorioamnionitis. Further study should be carried out on a larger sample to confirm these findings, improve the diagnostic performance of chorioamnionitis and help clinicians decide on delivery criteria. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess whether a partial term prelabor rupture of membranes (partial TPROM) had an impact on the spontaneous onset of labor compared to complete TPROM. Methods: We performed a retrospective study in a French level III maternity hospital. We included all singleton cephalic pregnancies presenting with prelabor rupture of membranes ≥37 weeks gestational age. Patients with a partial TPROM (P group) were compared to patients with a complete TPROM (C group). Induction of labor was performed following expectative management of 24–48 h, and antibiotic prophylaxis was started 12 h after rupture. Our main outcome measure was the rate of patients who had spontaneous labor 24 h following prelabor rupture. Results: Overall, 389 women were included in the study, 148 in the P group, 241 in the C group. The proportion of women who went into spontaneous labor in the 24 h following TPROM was significantly lower in the P group (45% vs 64%, P < 0.001). A partial TPROM was a predictive factor for absence of labor at 24 h following rupture (adjusted odds ratio: 0.44 [0.29–0.68]). There were more cases of induction of labor (50% vs 20%, P < 0.001) and antibiotic prophylaxis (91% vs 73%, P < 0.001) in the P group. However, obstetrical and neonatal outcomes were comparable between the two groups. Conclusion: Compared to complete TPROM, partial TPROM is associated with a lower probability of spontaneous labor in the 24 h following rupture. The persistence of a residual membrane has been identified as a risk factor for delaying labor beyond 24 h. Synopsis: The onset of labor within the first 24 h of rupture was less frequent if the prelabor rupture of membranes was incomplete. [ABSTRACT FROM AUTHOR]

Women with uterine myomas have increased rates of preterm delivery; however, data on other adverse pregnancy events conflict, and myomectomy does not appear to confer benefit. There is a prevailing opinion by gynecologists, much of it based on expert opinion or anecdotal evidence, that myomas are detrimental to pregnancy. Newer data challenge much of this dogma, but incorrect assumptions remain. Although not impeccable, multiple data address the correlation between myomas and reproduction, and some emerging evidence addresses surgical removal of these myomas and subsequent outcomes. A thorough literature search was performed, and the amassed data were analyzed to answer some of our most important queries about the role that myomas play in pregnancy and delivery. Uterine leiomyomas ultimately decrease in size during late pregnancy and postpartum. Spontaneous abortion rates are similar in women with and without leiomyomas. The data addressing leiomyoma effects on preterm prelabor rupture of membranes, placental abruption, cesarean delivery, and postpartum hemorrhage rates are conflicting, but the best evidence does not show a significant correlation compared with women without myomas. Preterm delivery rates are elevated in women with leiomyomas. Myomectomy does not decrease preterm deliveries and may increase this risk. Women with myomectomies have increased elective cesarean delivery rates and more blood loss at delivery compared with women with leiomyomas in situ. [ABSTRACT FROM AUTHOR]

There are multiple risk factors for preterm birth (PTB), one of the most important of which is mood disorders during pregnancy. We aimed to comprehensively investigate the association of both total mental health concerns and ten specific psychiatric symptoms with PTB risk. A cohort study was performed consisting of 25,175 pregnant women who participated in Women and Children's Hospital of Chongqing Medical University between 2020 and 2022. The Symptom Checklist 90 (SCL-90) was utilized to assess the psychiatric symptoms. Multivariable or multinomial logistic regression was applied to investigate mental health concerns associated with risk of PTB or its different clinical sub-categories, respectively. Sensitivity analyses were further performed to validate the results. 8336 women who met the inclusion criteria were included; of these, 547 (6.6 %) had preterm deliveries, and 2542 (30.5 %) had mental health concerns. Compared with women with healthy minds, women with total mental health concerns had a 29.0 % higher risk of overall PTB (OR = 1.28, 95%CI = 1.07–1.54), medical-induced PTB (OR = 1.49, 95%CI = 1.05–2.13) and spontaneous PTB with premature rupture of membranes (OR = 1.33, 95%CI = 1.01–1.74). As to the specific psychological symptoms, hostility pregnant women had a 55.0 % higher risk of PTB (OR = 1.55, 95%CI = 1.14–2.11). Similar results were observed in most of the sensitivity analyses. This is a single-center study, thus the extrapolation of the results may be limited. Pregnant women with mental health symptoms, especially hostility, have an increased risk of PTB. The findings underscore that integrating mental health services into routine maternal care may be a strategy to prevent PTB. • Few studies have comprehensively evaluated psychiatric symptoms with preterm birth risk • We investigated both total mental health concerns and ten specific symptoms with risk of preterm birth and its different clinical sub-categories • Women with total mental health concerns had a 29 % higher risk of preterm birth • For the specific symptoms, hostility pregnant women had a 55 % higher risk of preterm birth • The results highlight that integrating mental health services into routine maternal care may be a strategy to prevent preterm birth [ABSTRACT FROM AUTHOR]

To evaluate population characteristics and obstetric complications after abdominal myomectomy vs. laparoscopic myomectomy. Retrospective cohort study. A total of 13,868 and 338 pregnancies after abdominal or laparoscopic myomectomy, respectively. Obstetrics outcomes following abdominal and laparoscopic myomectomy were collected. Obstetric outcomes after abdominal or laparoscopic myomectomies were collected using hospital discharges from 2004 to 2014 inclusively, and adjusted using multiple and binomial logistic regression in different models for age, obesity, chronic hypertension, and pregestational diabetes mellitus. Pregnancy, delivery, and neonatal outcomes were analyzed. Abdominal myomectomy were characterized by younger patients, lower rates of Caucasian, chronic hypertension, pregestational diabetes, active smoking, illicit drug use, and higher rates of previous cesarean delivery, and multiple gestations when compared with laparoscopic myomectomy. Pregnant women with laparoscopic myomectomy had decreased rates of pregnancy-induced hypertension (adjusted risk ratios [aRR], 0.12; 95% confidence intervals [CI], 0.006–0.24]), gestational hypertension (aRR, 0.24; 95% CI, 0.08–0.76), pre-eclampsia (aRR, 0.18; 95% CI, 0.07–0.48), and pre-eclampsia or eclampsia superimposed on chronic hypertension (aRR, 0.03; 95% CI, 0.005–0.3), gestational diabetes mellitus (aRR, 0.14; 95% CI, 0.06–0.34), preterm premature rupture of membranes (aRR, 0.14; 95% CI, 0.02–0.96), preterm delivery (aRR, 0.36; 95% CI, 0.23–0.55), and cesarean delivery (aRR, 0.01; 95% CI, 0.007–0.01) and small for gestational age (aRR, 0.15; 95% CI, 0.005–0.04), compared with abdominal myomectomy group. Laparoscopic myomectomy group had a higher rate of spontaneous (aRR, 35.57; 95% CI, 22.53–62.66), and operative vaginal delivery (aRR, 10.2; 95% CI, 8.3–12.56), uterine rupture (aRR, 6.1; 95% CI, 3.2–11.63), postpartum hemorrhage (aRR, 3.54; 95% CI, 2.62–4.8), hysterectomy (aRR, 7.74; 95% CI, 5.27–11.4), transfusion (aRR, 3.34; 95% CI, 2.54–4.4), pulmonary embolism (aRR, 7.44; 95% CI, 2.44–22.71), disseminated intravascular coagulation (aRR, 2.77; 95% CI, 1.47–5.21), maternal infection (aRR, 1.66; 95% CI, 1.1–2.5), death (aRR, 2.04; 95% CI, 1.31–3.2), and intrauterine fetal death (aRR, 2.99; 95% CI, 1.72–5.2) compared with the abdominal myomectomy group. Women who had a previous abdominal myomectomy have underlying risk factors for hypertension disorders of pregnancy and gestational diabetes. Women who underwent laparoscopic myomectomies have higher risks of bleeding, uterine rupture, resultant complications, and death, and should be monitored as high-risk patients, like abdominal myomectomies. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily impacting women of childbearing age. While pregnancy and hormonal stress can trigger SLE flare-ups, the effects of assisted reproductive therapies (ARTs) on SLE patients are not well defined. We conducted a search of PubMed/Medline, Embase, and CENTRAL until March 20, 2024, to find observational studies assessing the prevalence of SLE flares and pregnancy outcomes following ARTs. Our analysis included random-effects meta-analysis and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for evaluating evidence quality. Five studies involving 237 SLE women who underwent ARTs were eligible. The meta-analysis indicated a prevalence of SLE flares at 17% (95% CI: 10–25%) with moderate-quality evidence. The pooled prevalence of arthritis flares was 7% (95% CI: 0–25%) with low-quality evidence. Successful pregnancy rates were 58% (95% CI: 43–72%), and live birth rates were 96% (95% CI: 83–100%), both with low-quality evidence. Moderate-quality evidence showed pregnancy complications, including preterm premature rupture of membranes (PPROM) at 8% (95% CI: 3–16%), miscarriages at 2% (95% CI: 0–9%), intrauterine fetal demise (IUFD) at 4% (95% CI: 0–11%), and preeclampsia at 7% (95% CI: 1–17%). Low-quality evidence showed preterm labor at 10% (95% CI: 0–32%) and ovarian hyperstimulation syndrome (OHSS) at 2% (95% CI: 0–11%). SLE flares, as well as pregnancy complications such as IUFD, miscarriage, PPROM, and preeclampsia in ART recipients, are equivalent to those in spontaneous conception. This indicates that ART is relatively safe for SLE patients with meticulous pregnancy planning. Key Points • Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily impacting women of childbearing age. • Pregnancy in women with SLE poses elevated maternal and fetal risks compared to healthy women. • SLE flares and pregnancy complications while receiving ART are equivalent to those in spontaneous conception and ART is relatively safe for SLE patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes. Methods: We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A total of 137,303 multiple pregnancies were analyzed; 130,542 (95%) were non-obese, while 6761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. Subsequently, chi-square tests and binary logistic regression analyses were conducted to assess the association between obesity and multiple gestation in the context of obstetric complications. Results: There was a statistically significant increase in the prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd's ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.77–2.02), gestational hypertension (aOR = 1.84, CI = 1.65–2.05), preeclampsia (aOR = 1.68, CI = 1.55–1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR = 1.86, CI = 1.58–2.20), gestational diabetes mellitus (aOR = 2.65, CI = 2.44–2.87), and placenta previa (aOR = 0.57, CI = 0.39–0.85). They were more likely to have preterm premature rupture of membranes (aOR = 1.19, CI = 1.06–1.34), chorioamnionitis (aOR = 1.24, CI = 1.03–1.51), caesarean deliveries (aOR = 1.28, CI = 1.18–1.38), wound complications (aOR = 1.65, CI = 1.31–2.08), and transfusions (aOR = 0.77, CI = 0.67–0.89). They were less likely to have small for gestational age neonates (aOR = 0.88, CI = 0.79–0.97), though more likely to have neonates with congenital anomalies (aOR = 1.56, CI = 1.16–2.10). Conclusion: Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, when analyzed in a large population, obesity in multiple gestation increases the risk of maternal, delivery, and neonatal complications. [ABSTRACT FROM AUTHOR]

Objective: There are conflicting data on whether fetoscopic laser photocoagulation (FLP) of placental anastomoses for the treatment of twin‐to‐twin transfusion syndrome (TTTS) is associated with lower rates of overall survival. The objective of this study was to characterize twin survival and associated morbidity according to the gestational age at which FLP was performed. Methods: This was a secondary analysis of data collected prospectively on patients with a monochorionic diamniotic (MCDA) twin pregnancy who underwent FLP for TTTS at two centers between January 2011 and December 2022. Patients were divided into six groups according to gestational age at the time of FLP: < 18 weeks, 18 + 0 to 19 + 6 weeks, 20 + 0 to 21 + 6 weeks, 22 + 0 to 23 + 6 weeks, 24 + 0 to 25 + 6 weeks and ≥ 26 weeks. Demographic characteristics, sonographic characteristics of TTTS and operative characteristics were compared across the gestational age epochs. Outcomes, including overall survival, preterm delivery (PTD), preterm prelabor rupture of membranes (PPROM), intrauterine fetal demise (IUFD) and neonatal demise (NND), were also compared across gestational age epochs. Multivariate analysis was performed by fitting logistic regression models for these outcomes. Kaplan–Meier curves were constructed to compare the interval from PPROM to delivery between gestational age epochs. Results: There were 768 patients that met the inclusion criteria. The rate of dual twin survival was 61.3% for cases in which FLP was performed before 18 weeks, compared with 78.0%–86.7% when FLP was performed at ≥ 18 weeks' gestation. This appears to be driven by an increased rate of donor IUFD following FLP performed before 18 weeks (28.0%) compared with ≥ 18 weeks (9.3–14.1%). Rates of recipient IUFD and NND and donor NND were similar regardless of gestational age at FLP. The rate of PPROM was higher for FLP conducted at earlier gestational ages, ranging from 45.6% for FLP before 18 weeks to 11.9% for FLP performed at 24 + 0 to 25 + 6 weeks' gestation. However, gestational age at delivery was similar across gestational age epochs, with a median of 31.7 weeks. On multivariate analysis, donor twin loss was associated with FLP before 18 weeks, even after adjusting for selective fetal growth restriction, Quintero stage and other covariates. PPROM and PTD were also associated with FLP performed before 18 weeks after adjusting for cervical length, placental location, trocar size, laser energy and amnioinfusion. Conclusions: FLP performed at earlier gestational ages is associated with lower overall survival, which is driven by the increased risk of donor IUFD, as opposed to differences in the rate of PPROM or PTD. Parental counseling regarding twin survival should account for the gestational age at which patients present with TTTS. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective To examine the effect of underweight maternal body mass index (BMI) on pregnancy complications and neonatal outcomes. Design Cohort study. Setting Tertiary academic center. Patients A total of 16 361 mothers who delivered a singleton between 2015-2021 with either a BMI <18.5 kg/m2 (n = 732) or normal BMI (18.5 ≥ BMI <23 or 25 kg/m2, n = 15 629) at the initial prenatal visit or within 6 months of the initial visit. Main Outcome Measures Birthweight, gestational age, neonatal intensive care unit admission, preterm birth, and fetal death; obstetrical complications including preeclampsia/eclampsia, premature rupture of membranes, preterm premature rupture of membranes, and postpartum hemorrhage. Results Underweight women were younger and less likely to have private insurance (P <.01 for both) than normal-weight women. Approximately 23% of infants born to underweight mothers were small for gestational age and 15% were low birth weight vs 13.5% and 9% of infants of normal-weight mothers, respectively (P <.01 for both). These differences remained significant after adjusting for potential confounders. In adjusted logistic regression models, underweight women had a decreased risk of premature rupture of membranes and postpartum hemorrhage compared to normal-weight women. Conclusion Underweight BMI during pregnancy is associated with an increased risk of small for gestational age and low birth weight infants and a decreased risk of premature rupture of membranes and postpartum hemorrhage. These findings suggest underweight BMI during pregnancy increases the risk of adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy induces a hypercoagulable state, characterized by increased coagulation factors and decreased anticoagulants, alongside ongoing fibrinolysis marked by elevated D-dimer (DD) levels. Reference values for DD in pregnancy often exceed the non-pregnant cutoff due to these changes. Elevated DD levels are common in late pregnancy and may correlate with complications such as gestational diabetes, hypertension, and preterm delivery, particularly in cases of preterm premature rupture of membranes (PPROM). This study investigates the association between DD levels, the duration from PPROM diagnosis to delivery, and neonatal outcomes.This retrospective study was conducted at the Department of Perinatology, Etlik City Hospital, Ankara, Turkey, from October 2022 to May 2023. Eighty patients with PPROM between 24 and 36 weeks of gestation were included. Routine blood tests and coagulation parameters, including DD, were monitored every other day for 2 weeks. Patients were classified into two subgroups based on whether labor occurred within 7 days of PPROM diagnosis. Statistical analyses included the Mann–Whitney U test, Student’s t test, Chi-square test, Friedman test, Durbin–Conover test, generalized estimating equations (GEE), and ROC analysis.Gestational age at admission was significantly lower in patients who delivered later than 7 days post-PPROM. Significant differences were observed in ultrasonographic measurements, with larger fetal parameters in the early delivery group. Higher DD levels at the third follow-up correlated with shorter durations to delivery (p = 0.021). Longitudinal analysis showed significant fluctuations in DD levels over time, particularly near delivery. The GEE analysis demonstrated a strong inverse relationship between DD levels and time to delivery (p = 0.004), supported by ROC analysis (AUROC = 0.811).Elevated DD levels are associated with shorter durations from PPROM diagnosis to delivery, indicating their potential utility in predicting labor onset. Monitoring DD levels may help in clinical decision-making for managing PPROM, including planning neonatal care and timing of interventions.Methods: Pregnancy induces a hypercoagulable state, characterized by increased coagulation factors and decreased anticoagulants, alongside ongoing fibrinolysis marked by elevated D-dimer (DD) levels. Reference values for DD in pregnancy often exceed the non-pregnant cutoff due to these changes. Elevated DD levels are common in late pregnancy and may correlate with complications such as gestational diabetes, hypertension, and preterm delivery, particularly in cases of preterm premature rupture of membranes (PPROM). This study investigates the association between DD levels, the duration from PPROM diagnosis to delivery, and neonatal outcomes.This retrospective study was conducted at the Department of Perinatology, Etlik City Hospital, Ankara, Turkey, from October 2022 to May 2023. Eighty patients with PPROM between 24 and 36 weeks of gestation were included. Routine blood tests and coagulation parameters, including DD, were monitored every other day for 2 weeks. Patients were classified into two subgroups based on whether labor occurred within 7 days of PPROM diagnosis. Statistical analyses included the Mann–Whitney U test, Student’s t test, Chi-square test, Friedman test, Durbin–Conover test, generalized estimating equations (GEE), and ROC analysis.Gestational age at admission was significantly lower in patients who delivered later than 7 days post-PPROM. Significant differences were observed in ultrasonographic measurements, with larger fetal parameters in the early delivery group. Higher DD levels at the third follow-up correlated with shorter durations to delivery (p = 0.021). Longitudinal analysis showed significant fluctuations in DD levels over time, particularly near delivery. The GEE analysis demonstrated a strong inverse relationship between DD levels and time to delivery (p = 0.004), supported by ROC analysis (AUROC = 0.811).Elevated DD levels are associated with shorter durations from PPROM diagnosis to delivery, indicating their potential utility in predicting labor onset. Monitoring DD levels may help in clinical decision-making for managing PPROM, including planning neonatal care and timing of interventions.Results: Pregnancy induces a hypercoagulable state, characterized by increased coagulation factors and decreased anticoagulants, alongside ongoing fibrinolysis marked by elevated D-dimer (DD) levels. Reference values for DD in pregnancy often exceed the non-pregnant cutoff due to these changes. Elevated DD levels are common in late pregnancy and may correlate with complications such as gestational diabetes, hypertension, and preterm delivery, particularly in cases of preterm premature rupture of membranes (PPROM). This study investigates the association between DD levels, the duration from PPROM diagnosis to delivery, and neonatal outcomes.This retrospective study was conducted at the Department of Perinatology, Etlik City Hospital, Ankara, Turkey, from October 2022 to May 2023. Eighty patients with PPROM between 24 and 36 weeks of gestation were included. Routine blood tests and coagulation parameters, including DD, were monitored every other day for 2 weeks. Patients were classified into two subgroups based on whether labor occurred within 7 days of PPROM diagnosis. Statistical analyses included the Mann–Whitney U test, Student’s t test, Chi-square test, Friedman test, Durbin–Conover test, generalized estimating equations (GEE), and ROC analysis.Gestational age at admission was significantly lower in patients who delivered later than 7 days post-PPROM. Significant differences were observed in ultrasonographic measurements, with larger fetal parameters in the early delivery group. Higher DD levels at the third follow-up correlated with shorter durations to delivery (p = 0.021). Longitudinal analysis showed significant fluctuations in DD levels over time, particularly near delivery. The GEE analysis demonstrated a strong inverse relationship between DD levels and time to delivery (p = 0.004), supported by ROC analysis (AUROC = 0.811).Elevated DD levels are associated with shorter durations from PPROM diagnosis to delivery, indicating their potential utility in predicting labor onset. Monitoring DD levels may help in clinical decision-making for managing PPROM, including planning neonatal care and timing of interventions.Conclusions: Pregnancy induces a hypercoagulable state, characterized by increased coagulation factors and decreased anticoagulants, alongside ongoing fibrinolysis marked by elevated D-dimer (DD) levels. Reference values for DD in pregnancy often exceed the non-pregnant cutoff due to these changes. Elevated DD levels are common in late pregnancy and may correlate with complications such as gestational diabetes, hypertension, and preterm delivery, particularly in cases of preterm premature rupture of membranes (PPROM). This study investigates the association between DD levels, the duration from PPROM diagnosis to delivery, and neonatal outcomes.This retrospective study was conducted at the Department of Perinatology, Etlik City Hospital, Ankara, Turkey, from October 2022 to May 2023. Eighty patients with PPROM between 24 and 36 weeks of gestation were included. Routine blood tests and coagulation parameters, including DD, were monitored every other day for 2 weeks. Patients were classified into two subgroups based on whether labor occurred within 7 days of PPROM diagnosis. Statistical analyses included the Mann–Whitney U test, Student’s t test, Chi-square test, Friedman test, Durbin–Conover test, generalized estimating equations (GEE), and ROC analysis.Gestational age at admission was significantly lower in patients who delivered later than 7 days post-PPROM. Significant differences were observed in ultrasonographic measurements, with larger fetal parameters in the early delivery group. Higher DD levels at the third follow-up correlated with shorter durations to delivery (p = 0.021). Longitudinal analysis showed significant fluctuations in DD levels over time, particularly near delivery. The GEE analysis demonstrated a strong inverse relationship between DD levels and time to delivery (p = 0.004), supported by ROC analysis (AUROC = 0.811).Elevated DD levels are associated with shorter durations from PPROM diagnosis to delivery, indicating their potential utility in predicting labor onset. Monitoring DD levels may help in clinical decision-making for managing PPROM, including planning neonatal care and timing of interventions. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of first-trimester COVID-19 infection on the perinatal and obstetric outcomes following in vitro fertilization-frozen embryo transfer.This retrospective study was conducted at a university-affiliated IVF center. The infection group included women who contracted SARS-CoV-2 during the first trimester following frozen embryo transfer in China’s initial pandemic wave that occurred from 7 December 2022 to 7 January 2023. The control group consisted of pregnant women from the pre-pandemic period, considering the widespread incidence of the disease among the Chinese population during such a large outbreak. The primary outcome was perinatal and obstetric parameters.A total of 346 pregnant women who tested positive for COVID-19 during the first trimester were included in the analysis, while the control group comprised 705 uninfected women (pre-COVID-19 controls). Perinatal outcomes, such as preterm birth, low birthweight, birthweight Z scores, macrosomia, small for gestational age, large for gestational age, and congenital malformations, showed no significant differences between the infected and control groups in both the unadjusted and confounder-adjusted logistic regression models. Additionally, there were no significant differences between the groups concerning obstetric complications, including gestational diabetes mellitus, hypertensive disorders of pregnancy, placenta previa, preterm premature rupture of the membrane, and mode of delivery.The current study demonstrated that contracting COVID-19 during the first trimester did not adversely impact future obstetric and perinatal outcomes following in vitro fertilization-frozen embryo transfer. This data holds practical significance and offers essential insights for reproductive specialists and obstetricians advising expectant mothers.Methods: To investigate the impact of first-trimester COVID-19 infection on the perinatal and obstetric outcomes following in vitro fertilization-frozen embryo transfer.This retrospective study was conducted at a university-affiliated IVF center. The infection group included women who contracted SARS-CoV-2 during the first trimester following frozen embryo transfer in China’s initial pandemic wave that occurred from 7 December 2022 to 7 January 2023. The control group consisted of pregnant women from the pre-pandemic period, considering the widespread incidence of the disease among the Chinese population during such a large outbreak. The primary outcome was perinatal and obstetric parameters.A total of 346 pregnant women who tested positive for COVID-19 during the first trimester were included in the analysis, while the control group comprised 705 uninfected women (pre-COVID-19 controls). Perinatal outcomes, such as preterm birth, low birthweight, birthweight Z scores, macrosomia, small for gestational age, large for gestational age, and congenital malformations, showed no significant differences between the infected and control groups in both the unadjusted and confounder-adjusted logistic regression models. Additionally, there were no significant differences between the groups concerning obstetric complications, including gestational diabetes mellitus, hypertensive disorders of pregnancy, placenta previa, preterm premature rupture of the membrane, and mode of delivery.The current study demonstrated that contracting COVID-19 during the first trimester did not adversely impact future obstetric and perinatal outcomes following in vitro fertilization-frozen embryo transfer. This data holds practical significance and offers essential insights for reproductive specialists and obstetricians advising expectant mothers.Results: To investigate the impact of first-trimester COVID-19 infection on the perinatal and obstetric outcomes following in vitro fertilization-frozen embryo transfer.This retrospective study was conducted at a university-affiliated IVF center. The infection group included women who contracted SARS-CoV-2 during the first trimester following frozen embryo transfer in China’s initial pandemic wave that occurred from 7 December 2022 to 7 January 2023. The control group consisted of pregnant women from the pre-pandemic period, considering the widespread incidence of the disease among the Chinese population during such a large outbreak. The primary outcome was perinatal and obstetric parameters.A total of 346 pregnant women who tested positive for COVID-19 during the first trimester were included in the analysis, while the control group comprised 705 uninfected women (pre-COVID-19 controls). Perinatal outcomes, such as preterm birth, low birthweight, birthweight Z scores, macrosomia, small for gestational age, large for gestational age, and congenital malformations, showed no significant differences between the infected and control groups in both the unadjusted and confounder-adjusted logistic regression models. Additionally, there were no significant differences between the groups concerning obstetric complications, including gestational diabetes mellitus, hypertensive disorders of pregnancy, placenta previa, preterm premature rupture of the membrane, and mode of delivery.The current study demonstrated that contracting COVID-19 during the first trimester did not adversely impact future obstetric and perinatal outcomes following in vitro fertilization-frozen embryo transfer. This data holds practical significance and offers essential insights for reproductive specialists and obstetricians advising expectant mothers.Conclusion: To investigate the impact of first-trimester COVID-19 infection on the perinatal and obstetric outcomes following in vitro fertilization-frozen embryo transfer.This retrospective study was conducted at a university-affiliated IVF center. The infection group included women who contracted SARS-CoV-2 during the first trimester following frozen embryo transfer in China’s initial pandemic wave that occurred from 7 December 2022 to 7 January 2023. The control group consisted of pregnant women from the pre-pandemic period, considering the widespread incidence of the disease among the Chinese population during such a large outbreak. The primary outcome was perinatal and obstetric parameters.A total of 346 pregnant women who tested positive for COVID-19 during the first trimester were included in the analysis, while the control group comprised 705 uninfected women (pre-COVID-19 controls). Perinatal outcomes, such as preterm birth, low birthweight, birthweight Z scores, macrosomia, small for gestational age, large for gestational age, and congenital malformations, showed no significant differences between the infected and control groups in both the unadjusted and confounder-adjusted logistic regression models. Additionally, there were no significant differences between the groups concerning obstetric complications, including gestational diabetes mellitus, hypertensive disorders of pregnancy, placenta previa, preterm premature rupture of the membrane, and mode of delivery.The current study demonstrated that contracting COVID-19 during the first trimester did not adversely impact future obstetric and perinatal outcomes following in vitro fertilization-frozen embryo transfer. This data holds practical significance and offers essential insights for reproductive specialists and obstetricians advising expectant mothers. [ABSTRACT FROM AUTHOR]

Brain injury and poor neurodevelopment have been consistently reported in infants and adults born before term. These changes occur, at least in part, prenatally and are associated with intra-amniotic inflammation. The pattern of brain changes has been partially documented by magnetic resonance imaging but not by neurosonography along with amniotic fluid brain injury biomarkers. This study aimed to evaluate the prenatal features of brain remodeling and injury in fetuses from patients with preterm labor with intact membranes or preterm premature rupture of membranes and to investigate the potential influence of intra-amniotic inflammation as a risk mediator. In this prospective cohort study, fetal brain remodeling and injury were evaluated using neurosonography and amniocentesis in singleton pregnant patients with preterm labor with intact membranes or preterm premature rupture of membranes between 24.0 and 34.0 weeks of gestation, with (n=41) and without (n=54) intra-amniotic inflammation. The controls for neurosonography were outpatient pregnant patients without preterm labor or preterm premature rupture of membranes matched 2:1 by gestational age at ultrasound. Amniotic fluid controls were patients with an amniocentesis performed for indications other than preterm labor or preterm premature rupture of membranes without brain or genetic defects whose amniotic fluid was collected in our biobank for research purposes matched by gestational age at amniocentesis. The group with intra-amniotic inflammation included those with intra-amniotic infection (microbial invasion of the amniotic cavity and intra-amniotic inflammation) and those with sterile inflammation. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture and/or positive 16S ribosomal RNA gene. Inflammation was defined by amniotic fluid interleukin 6 concentrations of >13.4 ng/mL in preterm labor and >1.43 ng/mL in preterm premature rupture of membranes. Neurosonography included the evaluation of brain structure biometric parameters and cortical development. Neuron-specific enolase, protein S100B, and glial fibrillary acidic protein were selected as amniotic fluid brain injury biomarkers. Data were adjusted for cephalic biometrics, fetal growth percentile, fetal sex, noncephalic presentation, and preterm premature rupture of membranes at admission. Fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes showed signs of brain remodeling and injury. First, they had a smaller cerebellum. Thus, in the intra-amniotic inflammation, non–intra-amniotic inflammation, and control groups, the transcerebellar diameter measurements were 32.7 mm (interquartile range, 29.8–37.6), 35.3 mm (interquartile range, 31.2–39.6), and 35.0 mm (interquartile range, 31.3–38.3), respectively (P =.019), and the vermian height measurements were 16.9 mm (interquartile range, 15.5–19.6), 17.2 mm (interquartile range, 16.0–18.9), and 17.1 mm (interquartile range, 15.7–19.0), respectively (P =.041). Second, they presented a lower corpus callosum area (0.72 mm2 [interquartile range, 0.59–0.81], 0.71 mm2 [interquartile range, 0.63–0.82], and 0.78 mm2 [interquartile range, 0.71–0.91], respectively; P =.006). Third, they showed delayed cortical maturation (the Sylvian fissure depth–to–biparietal diameter ratios were 0.14 [interquartile range, 0.12–0.16], 0.14 [interquartile range, 0.13–0.16], and 0.16 [interquartile range, 0.15–0.17], respectively [ P <.001], and the right parieto-occipital sulci depth ratios were 0.09 [interquartile range, 0.07–0.12], 0.11 [interquartile range, 0.09–0.14], and 0.11 [interquartile range, 0.09–0.14], respectively [ P =.012]). Finally, regarding amniotic fluid brain injury biomarkers, fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes had higher concentrations of neuron-specific enolase (11,804.6 pg/mL [interquartile range, 6213.4–21,098.8], 8397.7 pg/mL [interquartile range, 3682.1–17,398.3], and 2393.7 pg/mL [interquartile range, 1717.1–3209.3], respectively; P <.001), protein S100B (2030.6 pg/mL [interquartile range, 993.0–4883.5], 1070.3 pg/mL [interquartile range, 365.1–1463.2], and 74.8 pg/mL [interquartile range, 44.7–93.7], respectively; P <.001), and glial fibrillary acidic protein (1.01 ng/mL [interquartile range, 0.54–3.88], 0.965 ng/mL [interquartile range, 0.59–2.07], and 0.24 mg/mL [interquartile range, 0.20–0.28], respectively; P =.002). Fetuses with preterm labor with intact membranes or preterm premature rupture of membranes had prenatal signs of brain remodeling and injury at the time of clinical presentation. These changes were more pronounced in fetuses with intra-amniotic inflammation. [Display omitted] [ABSTRACT FROM AUTHOR]