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Exposure to adverse childhood experiences (ACEs) is a significant predictor for physical and mental health problems later in life, especially during the perinatal period. Prenatal common mental disorders (PCMDs) are well-established as a risk for obstetric interventions but knowledge on combined effects of multiple psychosocial risk factors is sparse. We aim to examine a comprehensive model of ACEs and PCMDs as risk factors for poor delivery and neonatal outcomes. With structural equation modeling, we examined direct and indirect pathways between psychosocial risk and delivery and neonatal outcomes in a prospective cohort from pregnancy to birth in Iceland. Exposure to ACEs increased risk of PCMDs [β = 0.538, p <.001, CI: 0.195–1.154] and preterm delivery [β = 0.768, p <.05, CI: 0.279–1.007)]. An indirect association was found between ACEs and increased risk of non-spontaneous delivery [β = 0.054, p <.05, CI: 0.004–0.152], mediated by PCMDs. Identical findings were observed for ACEs subcategories. ACEs are strong predictors for mental health problems during pregnancy. Both ACEs and PCMDs diagnosis are associated with operative delivery interventions and neonatal outcomes. Findings underscore the importance of identifying high-risk women and interventions aimed at decreasing psychosocial risk during the prenatal period. • Point 1: Exposure to ACE is a strong predictor for CMD's diagnosis during the antenatal period. • Point 2 : Exposure to ACE and prenatal CMD's increases risk of adverse delivery and neonatal outcomes. • Point 3: Results underscore the need for interventions aimed at decreasing PCMD and identifying high risk women. [ABSTRACT FROM AUTHOR]

Introduction: To delineate obstetric complications and neonatal outcomes by maternal age in singleton pregnancies with previous caesarean section (CS).Methods: A retrospective study involved 7715 singleton gestations with previous CS was conducted in a single centre. Statistical methods were used to describe and analyse the incidence of various complications and adverse outcomes classified by maternal ages. After selecting the reference group (30-34 years), multivariate logistic-binomial regression model was used to investigate the outcomes using SPSS.Results: From 2013 to 2017, the proportion of advanced maternal age (AMA, ≥35 years) women with a history of CS increased yearly, especially in the 35-39 years age group. AMA women accounted for 39.4% of all pregnancies and has a high incidence of in vitro fertilization(IVF), progesterone therapy in early pregnancy, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), placenta previa, premature rupture of membranes (PROM) and postpartum haemorrhage (PPH). Compared to the 30-34 years group, the risks of PIH, GDM, placenta previa, PROM and PPH increased in AMA pregnancies. Very advanced age (≥40 years) may be associated with placenta accreta while young mothers (20-24 years) have a higher prevalence of premature birth. Vaginal bleeding during pregnancy is a risk factor for maternal complications, maternal and neonatal morbidity.Discussion: AMA is associated with increased risk of PIH, GDM, placenta previa, PROM and PPH. Vaginal bleeding may be a predictor during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Bariatric surgery (BS) is known to reduce several obesity-related complications during pregnancy, but there is concern that it may increase the risk of maternal-fetal morbidity because of the malabsorption. This study aimed to investigate the impact of restrictive BS on several pregnancy outcomes in comparison with different grades of obesity.Materials and Methods: A single-center retrospective case-control study. All primiparous singleton pregnant women who underwent BS between the previous 1-5 years or with body mass index (BMI) ≥ 30 kg/m2 delivering in our center were included. Obstetric and perinatal outcomes were analyzed and compared between the two groups.Results: Overall, 90 women were included: 30 underwent BS and 60 were obese. The mean pre-pregnancy BMI was 31.0 ± 4.2 kg/m2 in the BS group and 38.1 ± 4.3 kg/m2 in the control group (p < 0.001). The obese group experienced higher rate of fetal macrosomia (25% vs 6.7%; p = 0.049), gestational hypertension (23.3% vs 3.3%; p = 0.04), preeclampsia (23.3% vs 0%; p = 0.04), gestational diabetes (33.3% vs 6.7%; p = 0.01), and cesarean section (68.3% vs 20%; p < 0.0001). The BS group showed higher frequency of small for gestational age (SGA) (46.7% vs 18.3%; p = 0.006), late preterm delivery (PTD) (33.3% vs 10%; p = 0.009), cholestasis (13.3% vs 1.7%; p = 0.049). Breastfeeding ≥ 6 months was higher among BS mothers (36.7% vs 11.7%; p = 0.007).Conclusions: Our findings support the positive impact of BS on several obstetric outcomes, at the expense of a higher frequency of SGA and PTD. BS mothers more frequently achieved the recommended goal of breastfeeding for 6 months compared to obese women. [ABSTRACT FROM AUTHOR]

• The possibility of vertical transmission of SARS-CoV-2 is still debated. • Evidence of SARS-CoV-2 vertical transmission in a twin-pregnant woman. • The viral genome was found in the umbilical cord blood of both twins. • Placental histologic examination confirmed indirect signs of viral infection. SARS-CoV-2 has affected millions of people around the world in recent years. Among susceptible patients, pregnant women seem to be prone to serious complications. The possibility of SARS-CoV-2 vertical transmission represents one of the most debated topics in the literature, providing inconclusive results. We present a case of a confirmed vertical transmission in a monochorial diamniotic twin pregnancy complicated by a selective intrauterine growth restriction and gestational diabetes mellitus. The analysis of different biological specimens identifies the presence of the SARS-CoV-2 genome in the umbilical cord blood of both twins, and the placental histologic examination confirmed indirect signs of viral infection, supporting the hypothesis that a transplacental infection can occur. Despite the devastating impact that SARS-CoV-2 has worldwide, neonatal infections have been infrequently reported, but they can occur under certain biologic conditions. Deep knowledge of the biological mechanisms underlying the risk of SARS-CoV-2 vertical transmission might be useful to understand the pathophysiological bases and the possible long-term implication of a mother-to-child vertical transmission. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the oncologic and obstetric outcomes of patients with low-risk cervical cancer who underwent conization and lymphatic evaluation to preserve fertility.Methods: Data were collected retrospectively from September 2013 to February 2021. Eligibility criteria included Women with cervical cancer (aged <45 years) who underwent fertility preservation treatment, [stage IA1 with positive lymphovascular space invasion (LVSI), stage IA2, or stage IB1 (≤2 cm) with less <10 mm cervical stromal invasion, according to the International Federaltion of Gynecology and Obstetrics (FIGO) 2018 staging system] aged ≤45 years who wished to preserve their fertility were included in this study. All patients were treated with cervical conization(s) and laparoscopic lymph node evaluation [pelvic lymphadenectomy and/or sentinel lymph node (SLN) mapping]. Oncologic and obstetric outcomes were evaluated.Results: Overall, 31 patients met the inclusion criteria; 15 (48.3%) women were nulliparous. There were 8 IA1LVSI+ (25.8%), 11 IA2 (35.4%) and 12 IB1 (31.7%) tumours, according to 2018 FIGO stage classification. Most patients had squamous cell carcinoma (77.4%). Lymphovascular space involvement was found in thirteen patients (41.9%). Reconization was performed in 17 (54.8%) patients, of which 6(35.2%) were done due to compromised margins, 4(23.5%) for margins under than 3 mm, 3(17.6%) for unreported or coagulated margins and 4(23.5%) because previous conization was done in another institution and we could not obtain the paraffin blocks for pathology review. Twenty patients had MRI and eleven CT scan. Nine (30%) patients had a complete bilateral pelvic lymph node dissection, 9 (26.6%) had SLN mapping with pelvic lymphadenectomy, and 13 (43.3%) had SLN mapping alone after bilateral SLN identification at surgery. After a median follow-up of 41.4 months (range 2-90 months), no recurrences have been detected. In terms of obstetrial outcome, 11 patients attempted pregnancy and 9 became pregnant. First-trimester miscarriage occurred in one patient. Five patients delivered at term by caesarean section, one of them requiring hysterectomy at the time of delivery. Pathology did not show residual disease. Two patients had a vaginal delivery at 38 weeks. One pregnancy is still ongoing.Conclusion: Cervical conization with lymph node assessment by SLN mapping/lymphadenectomy is an oncologic safe procedure in patients with low-risk cervical cancer. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether preimplantation genetic testing (PGT) increases the risk of adverse obstetric and neonatal outcomes.Design: Systematic review and meta-analysis.Setting: Not applicable.Patient(s): Pregnancies achieved after PGT or in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).Intervention(s): Systematic search of databases until December 2020 with cross-checking of references from relevant articles in English.Main Outcome Measure(s): Obstetric and neonatal outcomes after PGT and IVF/ICSI, including mean birth weight, low birth weight, very low birth weight (VLBW), mean gestational age at birth, preterm birth, very preterm birth, birth defects, intrauterine growth retardation (IUGR), sex ratio, cesarean section, hypertensive disorders of pregnancy, gestational diabetes mellitus, placenta disorder (placenta previa, placenta abruption, placenta accreta), and preterm premature rupture of membranes.Result(s): Ultimately, a total of 785,445 participants were enrolled in this meta-analysis, and these participants were divided into a PGT group (n = 54,294) and an IVF/ICSI group (n = 731,151). The PGT pregnancies had lower rates of low birth weight (risk ratio [RR] 0.85, 95% confidence interval [CI] 0.75 to 0.98), VLBW (RR 0.52, 95% CI 0.33 to 0.81), and very preterm births (RR 0.55, 95% CI 0.42 to 0.70) than those of IVF/ICSI pregnancies. However, the PGT group had a higher rate of the obstetric outcome of hypertensive disorders of pregnancy (RR 1.30, 95% CI 1.08 to 1.57). The PGT did not increase the risk of other adverse obstetric and neonatal outcomes, such as those associated with mean birth weight, mean gestational age at birth, birth defects, IUGR, sex ratio, cesarean section, gestational diabetes mellitus, placental disorder (placenta previa, placenta abruption, placenta accreta), or preterm premature rupture of membranes. We performed subgroup analysis with only blastocyst biopsies and found that PGT with blastocyst biopsies was associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.95). The PGT with blastocyst biopsies did not increase the risk of other adverse obstetric and neonatal outcomes. Additionally, we performed subgroup analysis with only frozen-thawed embryo transfer cycles, and we found that PGT pregnancies were associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.97), a lower rate of cesarean birth (RR 0.90, 95% CI 0.82 to 0.99), a higher rate of preterm birth (RR 1.10, 95% CI 1.02 to 1.18), and a higher rate of IUGR (RR 1.21, 95% CI 1.06 to 1.38) than those of IVF/ICSI pregnancies. The PGT with frozen-thawed embryo transfer did not increase the risk of other adverse obstetric and neonatal outcomes.Conclusion(s): The pooled analysis suggested that PGT did not increase the risk of adverse obstetric outcomes. The association between PGT and a higher risk of IUGR requires further investigation. [ABSTRACT FROM AUTHOR]

Do women of racial minorities aged 40 years or older have similar reproductive and obstetric outcomes as white women undergoing IVF? A retrospective cohort study conducted at a single academic university-affiliated centre. The study population included women aged 40 years or older undergoing their first IVF cycle with fresh cleavage-stage embryo transfer stratified by racial minority status: minority (black or Asian) versus white. Clinical intrauterine pregnancy and live birth rate were the primary outcomes. Preterm delivery (<37 weeks) and small for gestational age were the secondary outcomes. Odds ratios with 95% confidence intervals were estimated. P < 0.05 was considered to be statistically significant. A total of 2050 cycles in women over the age of 40 years were analysed, 561 (27.4%) of which were undertaken by minority women and 1489 (72.6%) by white women. Minority women were 30% less likely to achieve a pregnancy compared with their white (non-Hispanic) counterparts (adjusted OR 0.68, CI 0.54 to 0.87). Once pregnant, however, the odds of live birth were similar (adjusted OR 1.23, CI 0.91 to 1.67). Minority women were significantly more likely to have lower gestational ages at time of delivery (38.5 versus 39.2 weeks, P = 0.009) and were more likely to have extreme preterm birth delivery 24–28 weeks (5.5 versus 1.0%, P = 0.021). Minority women of advanced reproductive age are less likely to achieve a pregnancy compared with white (non-Hispanic) women. Once pregnancy is achieved, however, live birth rates are similar albeit with minority women experiencing higher rates of preterm delivery. [ABSTRACT FROM AUTHOR]

Objective: During the past three decades, applying IVF for infertility treatment PCOS women has increased significantly, and the landscape of treatment strategies has changed dramatically. However, early review of IVF on PCOS have insufficiently accounted for efficacy and safety of the technic. With abundant studies in recent years, there is a need to reconcile these new data.Material and Methods: To compare reproductive and obstetric outcomes of IVF between women with and without PCOS, a meta-analysis of 95 studies involving more than 21289 PCOS patients and 43036 controls was performed.Results: Despite longer stimulation duration (WMD = 0.34 day, 95 % CI: 0.09, 0.59) and lower dose of Gn required (WMD = -361.3 IU, 95 % CI: -442.3, -280.4), more oocytes (WMD = 3.67, 95 % CI: 3.14-4.21) and matured oocytes (WMD = 2.16, 95 % CI: 1.52-2.80) per cycle were obtained from PCOS women. There were no statistically significant differences for cleavage, high-grade embryo and implantation rate. Although similar pregnancy and live birth rates per cycle were achieved in PCOS and non-PCOS women after IVF, women with PCOS still suffered from significantly increased risks of miscarriage (OR = 1.44, 95 % CI: 1.20-1.72), biochemical pregnancy loss (OR = 1.89, 95 % CI: 1.48-2.41), and OHSS (OR = 3.58, 95 % CI: 2.86-4.48), in addition to lower fertilization rate (OR = 0.79, 95 % CI: 0.71-0.88). Adverse obstetric outcomes including ectopics pregnancy and multiple pregnancies are comparable between two groups. The overall cycle cancellation rate was significantly higher among PCOS women with OR of 2.55 (95 % CI: 1.67-3.89), and concern over OHSS or hyper-response constitute the main cause. Similar results were also observed after stratified analysis.Conclusions: Our results support the effectiveness of IVF for infertility treatment among PCOS patients. However, options to minimize adverse outcomes regarding to lower fertilization, miscarriage, biochemical pregnancy loss and OHSS are required. Further studies elucidating detailed mechanism underlying these adverse outcomes could be of great importance to improve the experience of IVF treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine whether intracytoplasmic sperm injection (ICSI) is associated with improved outcomes compared with conventional in vitro fertilization (IVF) for patients with nonsevere male factor infertility.Design: Retrospective cohort.Setting: University-affiliated reproductive endocrinology unit.Patient(s): Couples who received their first-cycle embryo transfer without severe oligoasthenozoospermia (OA) between January 2012 and December 2016 were included in this study.Intervention(s): Six subgroup analyses were performed according to the proposed indications for the use of ICSI as follows: non-male factor infertility, advanced maternal age (≥38 years), unexplained infertility, low oocyte yield (≤6), mild OA, and moderate OA.Main Outcome Measure(s): Live birth rates and selected perinatal outcomes.Result(s): ICSI resulted in live birth rates similar to those achieved with IVF (41.68% vs. 44.31%). There were no significant differences in the incidences of gestational diabetes mellitus, hypertension disorder of pregnancy, placental previa, postpartum hemorrhage, cesarean delivery, fetal macrosomia, small for gestational age, large for gestational age, neonatal intensive care unit (NICU) admission, and congenital anomalies between the two groups. Subgroup analyses showed that ICSI resulted in a lower rate of NICU admission in couples with moderate OA.Conclusion(s): Our results suggested that routine use of ICSI for all causes of infertility did not result in better pregnancy and perinatal outcomes compared with conventional IVF in the first cycle. ICSI might be associated with a lower risk of NICU admission when used in couples with moderate OA. Large prospective studies are required to validate our current findings. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcome of preserving the ascending uterine artery in a modified fertility-sparing abdominal radical trachelectomy and understand whether preserving uterine arteries during abdominal radical trachelectomy is helpful for patients.Methods: From September 2005 to September 2019, 31 early uterine cervical cancer patients who underwent modified fertility-sparing abdominal radical trachelectomy were enrolled in this study, and were followed up in our cancer center. Computed tomography (CT) of the abdomen and pelvis was advised as the initial investigation to evaluate the ascending uterine artery in 11 patients. The major outcomes were recurrence, mortality, CT results and obstetric outcomes.Results: During the median follow-up of 56 months, two recurrences were recorded. Among 11 patients who underwent CT, none of them showed uterine arteries occlusion. Fifteen patients attempted to conceive, and 5 pregnancies were achieved in 5 patients. Hence, the pregnancy rate among patients who attempted to conceive was 33.3 %. There was only one artificial first-trimester abortion. Three pregnancies resulted in live births, and two of them got full-term births.Conclusions: The modified fertility-sparing abdominal radical trachelectomy in preserving uterine arteries is effective, and it is recommended that surgeon should retain the uterine artery as much as possible during operation. [ABSTRACT FROM AUTHOR]

To evaluate pre-existing comorbidities, obstetric risk factors and adverse obstetric and neonatal outcomes in pregnancies conceived by oocyte donation, compared with naturally conceived pregnancies or by conventional IVF/intracytoplasmic sperm injection (IVF/ICSI). This retrospective single-centre contemporary cohort study reviewed data from singleton deliveries at the University Hospital of Careggi, Florence, from 2009 to 2017. Maternal and perinatal outcomes were analysed. The study included 25,851 pregnancies and newborns: 276 (1.1%) children were conceived after oocyte donation, 925 (3.6%) after IVF/ICSI and 24,650 (95.4%) after natural conception. Women in the oocyte donation group were significantly older compared with IVF/ICSI and natural conception groups (P < 0.0001) and had a higher prevalence of chronic hypertension compared with the natural conception group (P = 0.0090). They were administered anticoagulant medications more frequently during pregnancy. The incidence of gestational hypertension was significantly higher than in natural conception (aOR 3.6) and IVF/ICSI pregnancies (aOR 2.7). The incidence of Caesarean section in oocyte donation pregnancies was higher than in natural conception and IVF/ICSI groups (aOR 3.4 and 2.3, respectively). An 11-fold increased risk of post-partum haemorrhage (PPH) was found in oocyte donation versus natural conception and an almost four-fold increased risk was found in oocyte donation versus IVF/ICSI; prematurity and low birthweight were more frequent after oocyte donation versus natural conception (aOR 2.4 and 1.8, respectively). Patients undergoing oocyte donation represent a group with increased comorbidities and risk factors for adverse obstetric outcomes. Oocyte donation seems to be independently associated with gestational hypertension and PPH. Pregnancies after oocyte donation warrant clinical surveillance with proper screening and, possibly, preventive strategies. [ABSTRACT FROM AUTHOR]

We investigated the role of pregnancy planning in improving glycemic control and its potential impact on the overall pregnancy outcomes, obstetric outcomes, and perinatal well-being in women with pregestational diabetes mellitus (PGDM). A retrospective observational cohort study was conducted, including all pregnant women with PGDM treated in our center 2012 and 2018. Among 425 participants, 26.6 % had planned pregnancies. The lowest rate of pregnancy planning was observed in women with type 2 diabetes mellitus (6.5 %). Women with planned pregnancies had lower BMI. Both pregestational HbA1c levels (6.66 % vs. 7.61 %, p < 0.001) and HbA1c levels at the first prenatal visit (6.39 % vs. 7.24 %, p < 0.001) were significantly lower in the planned pregnancy group. These differences persisted until the end of pregnancy (6.09 % vs. 6.47 %, p = 0.006). Although better glycemic control was associated with a non-significant decrease in fetuses with birth weight over 4000 g (18.1 % vs. 22.1 %) and 4500 g (3.0 % vs. 4.2 %), we did not find significant effects on other morbidity events, maternal outcomes, or the cesarean section rate. Pregnancy planning in PGDM women improved glycemic control and HbA1c levels. Limited impact on obstetric and perinatal outcomes suggests scope for other focused interventions to optimize maternal and fetal health. [ABSTRACT FROM AUTHOR]

• Accurate assessment of maternal pancreatic islet β-cell function and insulin sensitivity during pregnancy is of great importance to the health of pregnant women. • Several assessment indices are deemed unsuitable for pregnant women. • we present the progress in the application of simple indices to help clinicians better understand their potential application in assessing insulin secretion and insulin sensitivity in pregnant women. The prevalence of gestational diabetes mellitus (GDM) is increasing annually, which poses substantial harm to the health of both mothers and children. Therefore, selection of clinically applicable and easily detectable indicators in the assessment of maternal insulin secretory function and insulin sensitivity in pregnant women undoubtedly holds great importance in evaluating the risk of GDM, guiding the choice of GDM therapy modalities, and improving the ability to provide early warning of adverse pregnancy outcomes. Compared with the classic clamp technique, many simple indices are more suited for use among pregnant women due to the low frequency of blood sampling and simple administration involved. While indices derived from fasting blood glucose and fasting insulin levels are most readily available, they are unable to provide information on the ability of insulin to manage the glucose load during pregnancy. Although the indices derived from the insulin and glucose values at each time point of the oral glucose tolerance test can provide a more comprehensive picture of the insulin sensitivity and insulin secretory function of the body, their application is constrained by the complexity of the procedure and associated high costs. Concomitantly, the findings from different studies are influenced by a variety of confounding factors, such as the gestational age during testing, race, and detection method. Furthermore, insulin secretory function and insulin sensitivity in pregnant women differ from those in non-pregnant women in that they change significantly with prolonged pregnancy; hence, there is an urgent need to develop a pregnancy-specific reference range. This article reviews the progress in the application of simple indices to help clinicians better understand their potential application in detecting GDM. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationships between excisional treatment for high-grade cervical intra-epithelial neoplasia (CIN2+) and obstetric outcomes in terms of preterm delivery risk, premature rupture of membrane (PROM) and type of delivery, and between pre-term delivery and the type of excisional technique (radio frequency excision, laser conization).Methods: This was a retrospective study of the obstetric outcomes of 2316 women aged 25-45 years who underwent excisional treatment for CIN2+ at the Obstetric and Gynecological Clinic of Ospedale Maggiore della Carità in Novara and at the Obstetric and Gynecological Department of Ospedale Sant'Anna in Torino in the period 2005-2014 and were evaluated until April 2016, and 57,937 untreated women of the same age, from the same centers.Results: After treatment, 320 women had at least one pregnancy leading to delivery after a mean of 3.35 years. Treatment significantly increased the risk of preterm delivery. Compared with no treatment, the risk of preterm birth was higher in women who had undergone treatment (33.13% vs. 6.60%). Techniques removing or ablating more tissue, such as large loop excision of the transformation zone, were associated with worse outcomes (OR 2.96, 95% IC 1.72-5.10). Smoking habits significantly increase the risk of preterm delivery in the treated women (OR 2.82, 95% IC 1.61-4.9). The risk of premature rupture of the membranes (PROM) (40% vs. 23.22%), the risk of preterm PROM (pPROM) (13.13% vs. 2.71%) and dystocic births (18.75% vs 4.48%) were also significantly increased after treatment. Caesarean sections were less frequent among the treated women (15.94% vs. 32.41%).Conclusions: Our findings reveal a relationship between cervical excisional treatment and pre-term delivery, PROM, and the method of delivery. In order to minimise risk and guarantee the best obstetric outcome, patient treatment and follow-up should be personalised. [ABSTRACT FROM AUTHOR]

Background: The effect of accidental dural puncture during labor epidural analgesia on obstetric outcomes remains unexplored. In this retrospective cohort study, we tested the hypothesis that accidental dural puncture is associated with prolonged second stage of labor.Methods: Anesthetic and obstetric data from nulliparous parturients who suffered an accidental dural puncture at term labor (n=89) during the years 2006-2012 were compared with randomly selected parturients with uncomplicated epidural analgesia (n=232). The primary outcome was the proportion of parturients with prolonged second stage of labor: secondary outcomes were the proportion of instrumented and cesarean deliveries. Statistical analysis included student t-test for continuous variables, chi-square test for binary variables, and logistic regressions for associations between accidental dural puncture and outcomes.Results: Demographic and obstetric characteristics of parturients were comparable except for a non-significant increase in prolonged second stage of labor in the accidental dural puncture group (27% vs. 17%, P=0.06). After adjusting for known potential confounders, multivariate logistic regression analyses revealed a significant association between accidental dural puncture and prolonged second stage of labor (adjusted risk ratio [aRR] 1.99, 95% CI 1.04 to 3.82; P=0.037). This was not accompanied by an increase in instrumented (aRR 0.57, 95% CI 0.27 to 1.21; P=0.15) or cesarean delivery (aRR 1.83, 95% CI 0.89 to 3.77; P=0.10).Conclusion: Accidental dural puncture during labor analgesia was associated with prolonged second stage of labor in nulliparous parturients. Prospective studies are needed to assess the relationship between the quality of neuraxial block after accidental dural puncture and obstetric outcomes. [ABSTRACT FROM AUTHOR]

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

Objectives: The present study aimed to analyze the clinicopathologic features and treatment of uSTUMP in a single institution. In addition, we described the obstetric outcomes after uterine-preserving surgery for uSTUMP.Methods and Materials: A retrospective chart review was performed of patients diagnosed with uSTUMP between January 2000 and February 2018 at the Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center. We obtained data on the patients' demographics, treatment, therapeutic results, time to recurrence, disease-free and overall survival, and subsequent obstetric outcomes. The central pathology reviews were carried out by two pathologists specializing in gynecologic oncology.Result: A total of 19 patients diagnosed with uSTUMP were identified and included in the study. The mean age at diagnosis was 41 years (range 28-49 years). Frozen sections were performed in 11 patients including five patients during surgery. Nine of the 19 patients (47.4%) were treated by hysterectomy and 10 patients were initially treated by myomectomy. The mean follow-up period was 47 months (range 6-209 months). Two patients (10.5%; 2/19) experienced recurrence. Although not defined as recurrence in the present study criteria, one patient had a secondary diagnosis of atypical leiomyoma one year after the initial diagnosis of uSTUMP. Seven patients requested uterine-preserving treatment, five of whom wanted to become pregnant. Three of them (3/5; 60%) successfully delivered live birth to full term by Cesarean section without complications such as abortion, preterm delivery or uterine rupture, and tumor recurrence.Conclusions: The present study describes the clinicopathologic data of uSTUMP patients. Our results suggest a uSTUMP recurrence of 10.5%, comparable to previous reports. Although there is a possibility of malignant recurrence, fertility-preserving management is worth attempting because of relatively low affected age with careful close follow-up. [ABSTRACT FROM AUTHOR]

Plasma volume expansion is an important component of a successful pregnancy. The failure of maternal plasma volume expansion has been implicated in adverse obstetric outcomes such as pre-eclampsia, fetal growth restriction, and preterm birth. Altered iron homeostasis and elevated maternal hemoglobin concentrations have also been associated with adverse pregnancy outcomes; limited data have suggested that these effects may be mediated by inadequate plasma volume expansion. In addition, it has been noted that pregnant, obese women, compared with lean subjects, have decreased plasma volume expansion along with impaired iron homeostasis and increased inflammation. Current estimates of plasma volume expansion are outdated and do not necessarily reflect contemporary obstetric populations. Moreover, the validation of clinically applicable methods of plasma volume determination as well as enhanced methodologies should be a priority. Further study is needed to characterize diminished plasma volume expansion during pregnancy and to understand the potential role of impaired iron homeostasis and inflammation in adverse obstetric outcomes, especially in obese women. [ABSTRACT FROM AUTHOR]

Preimplantation genetic diagnosis (PGD) may pose risks to pregnancy outcome owing to the invasiveness of the biopsy procedure. This study compares outcome of singleton and twin clinical pregnancies conceived after fresh embryo transfers of PGD ( n = 89) and matched intracytoplasmic sperm injection (ICSI) pregnancies ( n = 166). The study was carried out in a single university affiliated centre. Because of the paucity of available data, a literature-based meta-analysis of studies comparing neonatal outcome of PGD and ICSI pregnancies was also conducted. In the retrospective cohort study, obstetric and neonatal outcome were available in 67 PGD and 118 ICSI pregnancies. Perinatal outcomes were comparable between PGD and ICSI pregnancies. Meta-analysis revealed similar outcomes, except for higher rate of low birth weight (<2500 g) neonates in ICSI twin pregnancies (RR 0.86, 95% CI 0.74 to 1.0). Mean birth weight, gestational age at birth, pre-term deliveries (<37 weeks) and malformations were all comparable. In this cohort study and subsequent meta-analysis, no association was found between PGD conceived pregnancies and risks of adverse neonatal or obstetrical outcomes compared with ICSI pregnancies. Hence, blastomere biopsy for PGD does not seem to increase the risk for adverse perinatal outcome compared with ICSI pregnancies. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate whether pregnancies resulting from oocyte donation have a higher risk of preeclampsia compared with pregnancies after IVF using autologous oocytes. Propensity score matching on maternal age and parity was carried out on a one to one basis, and a total of 144 singleton pregnancies resulting in delivery beyond 22 gestational weeks, achieved by oocyte donation, were compared with 144 pregnancies achieved through IVF and intracytoplasmic sperm injection with the use of autologous oocytes. All pregnancies were achieved after fresh embryo transfer. Obstetric and neonatal outcomes were compared for each pregnancy. Singleton pregnancies after oocyte donation were associated with a significantly higher risk for preeclampsia (OR 2.4, CI 1.02 to 5.8; P = 0.046), as well as for pregnancy-induced hypertension (OR 5.3, CI 1.1 to 25.2; P = 0.036), and caesarean delivery (OR 2.3, CI 1.4 to 3.7; P = 0.001) compared with pregnancies using autologous oocytes. [ABSTRACT FROM AUTHOR]

Objective: To explore obstetric and perinatal outcomes in singleton pregnancies occurring as a result of fresh and thawed frozen embryo transfer using anonymized Human Fertilisation and Embryology Authority data.Design: Retrospective cohort study.Setting: Not applicable.Patient(s): Singleton births after IVF/intracytoplasmic sperm injection cycles in the United Kingdom (1991-2011).Intervention(s): A total of 112,432 cycles (95,911 fresh and 16,521 frozen) were analyzed using multivariate logistic regression to explore associations between type of embryo transferred (frozen vs. fresh) and obstetric and perinatal outcomes. Relative risks (RRs) and their 99.5% confidence intervals (CIs) were calculated using Stata 14 MP, adjusting for potential confounders.Main Outcome Measure(s): Birth weight.Result(s): The adjusted RR (99.5% CI) of low birth weight [0.73 (0.66-0.80)] and very low birth weight [0.78 (0.63-0.96)] were all lower after frozen embryo transfer; however, RR of having a high birth weight baby was higher [1.64 (1.53-1.76)]. There was no difference in RR of preterm birth [0.96 (0.88-1.03)], very preterm birth [0.86 (0.70-1.05)], and congenital anomalies [0.86 (0.73-1.01)].Conclusion(s): The findings of low birth and very low birth weight after thawed frozen embryo transfer are consistent with the literature and provide reassurance regarding the outcome of pregnancies after frozen embryo transfers. However, they highlight the possibility of high birth weight in these babies. Because these results are based on observational data, further evidence from randomized, controlled trials is needed before elective cryopreservation of all embryos is practiced in preference to the current practice of transfer of fresh embryos. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is the major cause of perinatal mortality in the United States. In the past, pregnant women have been recommended to not exercise because of presumed risks of preterm birth. Physical activity has been theoretically related to preterm birth because it increases the release of catecholamines, especially norepinephrine, which might stimulate myometrial activity. Conversely, exercise may reduce the risk of preterm birth by other mechanisms such as decreased oxidative stress or improved placenta vascularization. Therefore, the safety of exercise regarding preterm birth and its effects on gestational age at delivery remain controversial.Objective: The objective of the study was to evaluate the effects of exercise during pregnancy on the risk of preterm birth.Data Sources: MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library were searched from the inception of each database to April 2016.Study Design: Selection criteria included only randomized clinical trials of pregnant women randomized before 23 weeks to an aerobic exercise regimen or not. Types of participants included women of normal weight with uncomplicated, singleton pregnancies without any obstetric contraindication to physical activity. The summary measures were reported as relative risk or as mean difference with 95% confidence intervals. The primary outcome was the incidence of preterm birth <37 weeks.Tabulation, Integration, and Results: Of the 2059 women included in the meta-analysis, 1022 (49.6%) were randomized to the exercise group and 1037 (50.4%) to the control group. Aerobic exercise lasted about 35-90 minutes 3-4 times per week. Women who were randomized to aerobic exercise had a similar incidence of preterm birth of <37 weeks (4.5% vs 4.4%; relative risk, 1.01, 95% confidence interval, 0.68-1.50) and a similar mean gestational age at delivery (mean difference, 0.05 week, 95% confidence interval, -0.07 to 0.17) compared with controls. Women in the exercise group had a significantly higher incidence of vaginal delivery (73.6% vs 67.5%; relative risk, 1.09, 95% confidence interval, 1.04-1.15) and a significantly lower incidence of cesarean delivery (17.9% vs 22%; relative risk, 0.82, 95% confidence interval, 0.69-0.97) compared with controls. The incidence of operative vaginal delivery (12.9% vs 16.5%; relative risk, 0.78, 95% confidence interval, 0.61-1.01) was similar in both groups. Women in the exercise group had a significantly lower incidence of gestational diabetes mellitus (2.9% vs 5.6%; relative risk, 0.51, 95% confidence interval, 0.31-0.82) and a significantly lower incidence of hypertensive disorders (1.0% vs 5.6%; relative risk, 0.21, 95% confidence interval, 0.09-0.45) compared with controls. No differences in low birthweight (5.2% vs 4.7%; relative risk, 1.11, 95% confidence interval, 0.72-1.73) and mean birthweight (mean difference, -10.46 g, 95% confidence interval, -47.10 to 26.21) between the exercise group and controls were found.Conclusion: Aerobic exercise for 35-90 minutes 3-4 times per week during pregnancy can be safely performed by normal-weight women with singleton, uncomplicated gestations because this is not associated with an increased risk of preterm birth or with a reduction in mean gestational age at delivery. Exercise was associated with a significantly higher incidence of vaginal delivery and a significantly lower incidence of cesarean delivery, with a significantly lower incidence of gestational diabetes mellitus and hypertensive disorders and therefore should be encouraged. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related anxiety (PrA) has attracted considerable research attention, but questions remain about its distinctiveness from conventional constructs and measures. In a high psychosocial risk, ethnically diverse sample, we examine the degree to which PrA is distinct from continuous and diagnostic measures of anxiety and worry in terms of longitudinal course, associations with psychosocial and perinatal risk, and prediction of postnatal mood disturbance.Methods: 345 women oversampled for prenatal anxiety and depression were selected from an urban obstetrics clinic serving a predominantly low-income, ethnically diverse population. PrA was assessed at 20 and 32 weeks gestation; anxiety and depression symptoms were assessed from questionnaire and from clinical interview at 20 and 32 weeks gestation and again at 2 and 6 months postnatally. Data relevant to psychosocial and obstetric risks were ascertained from interview, medical exam, and chart review.Results: Two distinct factors of PrA were identified, indexing specific concerns about the child's health and about the birth; these two PrA factors showed distinct longitudinal patterns in the prenatal period, and modest associations with general measures of anxiety and depression from questionnaire and clinical interview. PrA was also distinguished from conventional symptom measures in its associated features and prediction of birth weight and postnatal mood.Limitations: The sample was at high psychosocial risk and ethnically diverse; findings may not generalize to other samples.Conclusions: PrA can be distinguished from general measures of anxiety in pregnancy in terms of longitudinal course, associated features, and prediction to postnatal mood disturbance, and may warrant specific clinical attention. [ABSTRACT FROM AUTHOR]

Objective: To examine whether dichorionic twin pregnancies after assisted reproductive technology (ART) were at higher risk of adverse obstetric outcomes compared with those conceived naturally.Design: Meta-analysis.Setting: University-affiliated teaching hospital.Patient(s): Dichorionic twin pregnancies conceived with ART and naturally.Intervention(s): Studies comparing obstetric outcomes in dichorionic twin pregnancies conceived by ART and naturally were identified by searching PubMed, Google Scholar, Cochrane Libraries, and Chinese databases through July 2015 with no restrictions. Either a fixed-effects or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators.Main Outcome Measure(s): Maternal complications and adverse pregnancy outcomes.Result(s): Fifteen cohort studies involving 6,420 dichorionic twins after ART and 13,650 dichorionic twins conceived naturally were included. Most of maternal complications were similar in both groups, but placenta previa (relative risk [RR] = 2.99, 95% confidence interval [CI] 1.51-5.92; I(2) = 0) was significantly more common in the ART group. For neonatal outcomes, the ART group experienced higher risk of preterm birth (RR = 1.13, 95% CI 1.00-1.29; I(2) = 75%), very preterm birth (RR = 1.39, 95% CI 1.07-1.82; I(2) = 71%), low birth weight (RR = 1.11, 95% CI 1.00-1.23; I(2) = 61%), and congenital malformations (RR = 1.26, 95% CI 1.09-1.46; I(2) = 26%). In addition, the ART group had a higher proportion of elective cesarean sections (RR = 1.79, 95% CI 1.49-2.16; I(2) = 60%), but had a similar proportion for emergency cesarean sections. Relevant heterogeneity moderators have been identified by subgroup analysis. No evidence of publication bias was observed.Conclusion(s): The rates of placenta previa, elective cesarean section, preterm birth, very preterm birth, low birth weight, and congenital malformations were significantly higher in dichorionic twin pregnancies after ART. [ABSTRACT FROM AUTHOR]

Objective: this study aimed to examine how women's childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors. Design: a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records. Setting: data were recruited from antenatal health-care clinics in Halland, Sweden. Participants: a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42. Measurements: five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States. Findings: results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy. Key conclusions: this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth. [ABSTRACT FROM AUTHOR]

Background Continuity of midwife-led care is recommended in maternity care because of its various positive outcomes. In Japan, midwife-led care is receiving broad attention as well. In order to popularise midwifery care within the entire system of perinatal care in Japan, there is a need to show evidence that continuity of midwife care for women will bring about positive outcomes. Aim The objectives of this study were to compare the health outcomes of women and infants who received midwife-led care with obstetrician-led care in Japan. Methods This was an observational study using non-random purposive sampling with a survey questionnaire. Settings where midwife-led care and obstetrician-led care were chosen by purposive samples. Participants were low-risk women who received antenatal care and delivered a term-singleton-infant at the participating settings during the research period. Measurements were: Women-centred care pregnancy questionnaire, Stein's maternity blues questionnaire, and Edinburgh Postnatal Depression Scale. Findings Midwife-led care was perceived by women to be beneficial and had no adverse outcomes compared to obstetrician-led care. Main findings are: (1) Perception of Women-centred care was higher; (2) Less premature rupture of membranes, and the Apgar scores of the infants were similar; (3) Exclusively breast-feeding during hospitalisation and at one-month postpartum; (4) Stein's maternity blues scale scores was lower in women who received midwife-led care than those who received obstetrician-led care. Conclusions Continuity of midwife-led care was perceived by women to be beneficial and had no adverse outcomes. Therefore, midwife-led care in low-risk pregnancy could be applicable and recommended. [ABSTRACT FROM AUTHOR]

Highlights: [•] Inactivated influenza vaccination is recommended during pregnancy. [•] No increased risk of maternal obstetric outcomes after vaccination has been reported. [•] Two new studies confirm no increased risk of maternal outcomes after vaccination. [•] Findings should reassure women and providers about the safety of influenza vaccine. [Copyright &y& Elsevier]

Objectives: to audit clinical management of women with type III female genital mutilation (FGM) according to local guidelines. Secondary objectives were to describe the population that uses the service and compare obstetric outcomes of intrapartum deinfibulation and antenatal deinfibulation. Design: retrospective audit. Setting: a hospital midwifery-led FGM specialist service in Birmingham, UK. Participants: 253 women with type III FGM who gave birth between January 2008 and December 2009 Methods: retrospective case analysis using patient records. Main outcome measures: proportion of women managed according to locally agreed criteria for the management of FGM; obstetric outcomes including perineal tears, episiotomy rates, estimated blood loss, infant APGAR scores and indications for caesarean section. Findings: 91 (36%) women booked into antenatal care after 16 weeks gestation. Only 26 (10.3%) were managed fully according to guidelines. The area with poorest performance was child protection, where the presence of normal genitalia was documented in only 52 (38.8%) of medical notes following birth of a female infant. The majority of women (214, 84.6%) had been deinfibulated in a previous pregnancy. Of the 39 infibulated at booking, only 9 (23.1%) were deinfibulated antenatally, the rest opted for intrapartum deinfibulation. Women who had intrapartum deinfibulation had a higher average blood loss and more tears than those deinfibulated antenatally, although this was not statistically significant. Conclusions and implications for practice: alternative systems should be considered to improve documentation of child protection related information. Further research is needed to confirm or refute the adverse findings among those that delayed deinfibulation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproduction technology (ART) with spontaneously conceived (SC) twin pregnancies. Study design: A prospective cohort study compared all dichorionic twin pregnancies in nulliparous women following fresh in vitro fertilization/intra-cytoplasmic sperm injection (ICSI) or ICSI cycles at Royan Institute (n =320) with SC dichorionic twin pregnancies in nulliparous women at Arash Women''s hospital (n =170) from January 2008 to October 2010. These pregnancies were followed-up until hospital discharge following delivery. Obstetric and neonatal outcomes of SC and ART twin pregnancies were compared. Results: Multivariate analysis, adjusted for maternal age and body mass index, revealed that the obstetric outcomes were similar in both groups. However, the risks of very preterm birth [odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1–12.9], extremely low birth weight (OR 2.2, 95% CI 1.0–3.9), admission to a neonatal intensive care unit (OR 2.0, 95% CI 1.2–3.2) and perinatal mortality (OR 2.3, 95% CI 1.2–4.0) were higher in the ART group. Conclusions: The maternal outcomes of ART dichorionic twins were comparable with those of SC twins. However, despite the same obstetric management, the rates of very preterm birth, extremely low birth weight, admission to a neonatal intensive care unit and perinatal mortality were significantly higher in the ART group. [Copyright &y& Elsevier]

Abstract: Study Objective: To determine whether, when controlling for confounding factors, there was still an association of adolescence with adverse outcomes. Design: Retrospective case control study. Setting: Seven Bangkok Metropolitan Administration General Hospitals. Participants: Charts of all women aged 19 and younger (n = 1,354) having singleton live births in 2004, 2005, and 2006 were retrieved. For the adult group, 1,389 charts of mothers between the ages of 20 and 34 delivering singleton babies were selected using proportionate systematic random sampling. Maternal age was divided into 3 groups: 11–15, 16–19, and 20–34. Main Outcome Measures: Obstetric and perinatal outcomes. Results: After statistically controlling for known confounding factors, teenage pregnancy was associated with increased risks of anemia (11–15: AOR = 1.81, P < 0.001; 16–19: AOR = 1.48, P < 0.01), very preterm deliveries (11–15: AOR = 2.18, P < 0.05), very low birth weight babies (11–15: AOR = 6.98, P < 0.05; 16–19: AOR = 9.86, P < 0.01), newborn admission to Intensive Care Unit (11–15: AOR = 1.93, P < 0.01; 16–19: AOR = 2.10, P < 0.01), and postpartum complications (11–15: AOR = 3.33, P < 0.01). The rates of cesarean delivery (11–15: AOR 0.58, P < 0.01; 16–19: AOR = 0.57, P < 0.01), operative delivery (11–15: AOR = 0.49, P < 0.01), and oxytocin augmentation (16–19: AOR = 0.66, P < 0.01) were less frequent in younger mothers. Conclusion: Independent of known confounding factors, teenage pregnancy was associated with increased risks of adverse maternal and neonatal outcomes requiring clinical and outreach interventions from health care providers. [Copyright &y& Elsevier]

Objective: To test the hypothesis that the risk of adverse obstetric or neonatal outcomes varies according to different phenotypes of polycystic ovary syndrome (PCOS), and to evaluate the clinical impact of the main features of PCOS. Design: Prospective controlled clinical study. Setting: Academic Departments of Obstetrics and Gynecology, and of Endocrinology, Italy. Patient(s): Ninety-seven pregnant women with PCOS and 73 healthy pregnant subjects were recruited as cases and controls, respectively. Intervention(s): Clinical, biochemical, and ultrasonographic evaluations. Main Outcome Measure(s): Obstetric and neonatal outcomes. Result(s): The relative risk (RR) for adverse obstetric or neonatal outcomes was increased (1.7, 95% confidence interval [CI] 1.12–2.96) in patients with PCOS and varied according to the PCOS phenotype (1.93, 95% CI 1.12–2.96; 2.23, 95% CI 1.21–3.15; 0.54, 95% CI 0.09–1.63, and 0.48, 95% CI 0.31–0.78 for full-blown, nonpolycystic ovaries [PCO], nonhyperandrogenic, and ovulatory phenotypes, respectively). The RRs were 1.57 (95% CI 0.85–2.52) and 0.48 (95% CI 0.31–0.78) for oligoanovulatory and ovulatory patients with PCOS, respectively. The risk for adverse obstetric or neonatal outcomes was affected significantly by ovarian dysfunction and biochemical hyperandrogenism, whereas no significant effect was detected for clinical hyperandrogenism and PCO. Conclusion(s): The increased risk for adverse obstetric and neonatal outcomes that was observed in patients with PCOS varies widely according to the different phenotypes and features of PCOS. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To estimate obstetrical complications at term after hysteroscopic metroplasty for septate uterus. Design: A retrospective comparative study (Canadian Task Force classification II-2). Setting: La Conception Hospital, Department of Obstetrics and Gynecology, Marseille, France. Patients and Interventions: Thirty-one women who had a term pregnancy from January 1996 through December 2004 after hysteroscopic metroplasty for septate uterus (group A) were studied retrospectively. A control group (group B) of 62 women was selected from the same database who had term pregnancies and no history of hysteroscopic metroplasty. Measurements and Main Results: Obstetric complications at term and neonatal outcomes after hysteroscopic metroplasty were compared between 2 groups. The rate of fetal malpresentation was significantly higher in group A versus group B (11/31 [35.5%] vs 0/62, p < .001). Mean birth weight was significantly lower in group A versus group B (2940g±52 vs 3266g±456, p =.002). The rate of caesarean section was significantly higher in group A versus group B (19/31 [61.3%] vs 4/62 [6.4%], p < .001). Conclusion: The results of this study suggest that patients with a previous hysteroscopic metroplasty for septate uterus are at increased risk for fetal malpresentation at term, low birth weight infants, and delivery by caesarean section and should therefore be informed of these risks before delivery. [Copyright &y& Elsevier]

• 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]

Objective: To study whether women conceiving after preimplantation genetic diagnosis (PGD) and their children have greater risks of adverse pregnancy and birth outcomes compared with children conceived spontaneously or after IVF with or without intracytoplasmic sperm injection (ICSI).Design: Historical cohort study.Setting: Not applicable.Patient(s): All deliveries following PGD treatment for single gene and sex-linked disorders or structural chromosomal aberrations (n = 126 deliveries/149 children), IVF/ICSI treatment (n = 30,418 deliveries/36,115 children), and spontaneous conception (n = 896,448 deliveries/909,624 children).Intervention(s): None.Main Outcome Measure(s): Adverse obstetric and neonatal outcomes, such as pre-eclampsia, preterm primary rupture of membranes, placenta previa, abruption of placenta, preterm birth, low birth weight, malformations, and neonatal admission.Result(s): Compared with spontaneously conceived pregnancies, PGD pregnancies were at significantly increased risk of placenta previa (adjusted odds ratio [ORa] 9.1; 95% confidence interval [95% CI] 3.4, 24.9), cesarean section (ORa 2.0; 95% CI 1.3, 2.9), preterm birth (ORa 1.6; 95% CI 1.0, 2.7), shorter gestation (mean difference -3.4 days; 95% CI -5.7, -1.1 days), and longer neonatal admission (mean difference 21 days; 95% CI 15, 28 days). The risks were comparable to that of pregnancies following IVF/ICSI. In subanalyses, adverse outcomes were only present in children conceived by PGD owing to parental monogenetic disorder and comparable to those of children born to parents with monogenic disorders conceiving without PGD, except for a higher risk of placenta previa.Conclusion(s): In this cohort study, the risk of adverse obstetric and neonatal outcomes was mainly related to the underlying parental condition rather than the PGD procedure. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of blastocyst-stage and cleavage-stage embryos generated through IVF. Design: Systematic review. Setting: University hospital. Patient(s): Singleton pregnancies resulting from ET at the blastocyst stage versus those at the cleavage stage. Intervention(s): Medline, EMBASE, Cochrane Central Register of Clinical Trials DARE, and CINAHL (1980–2013) were searched. Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using CASP scoring. Risk ratios and risk differences were calculated in Rev Man 5.1. Main Outcome Measure(s): Very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, congenital anomalies, perinatal mortality, preeclampsia, and placenta previa. Result(s): In vitro fertilization pregnancies occurring as a result of ET at the blastocyst stage were associated with a higher relative risk (RR; 95% confidence interval [CI]) of preterm (RR 1.27; 95% CI 1.22–1.31) and very preterm delivery (RR 1.22; 95% CI 1.10–1.35) in comparison with those resulting from the transfer of cleavage-stage embryos. The risk of growth restriction was lower in babies conceived through blastocyst transfer (RR 0.82; 95% CI 0.77–0.88). Conclusion(s): Data from observational studies show that ET at the blastocyst stage is associated with a higher risk of very preterm delivery. However, we were not able to adjust for confounders. Perinatal outcome data from existing randomized trials are needed to determine the safety of ET at the blastocyst stage compared with the cleavage stage. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of frozen thawed and fresh embryos generated through IVF. Design: Systematic review. Setting: Observational studies, comparing obstetric and perinatal outcomes in singleton pregnancies subsequent to frozen thawed ET versus fresh embryo transfer, were included from Medline, EMBASE, Cochrane Central Register of Clinical Trials, DARE, and CINAHL (1984–2012). Patient(s): Women undergoing IVF/intracytoplasmic sperm injection (ICSI). Intervention(s): Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using critical appraisal skills program scoring. Risk ratios and risk differences were calculated in Rev Man 5.1. Subgroup analysis was performed on matched cohort studies. Main Outcome Measure(s): Antepartum hemorrhage, very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, cesarean section, congenital anomalies, perinatal mortality, and admission to neonatal intensive care unit. Result(s): Eleven studies met the inclusion criteria. Singleton pregnancies after the transfer of frozen thawed embryos were associated with better perinatal outcomes compared with those after fresh IVF embryos. The relative risks (RR) and 95% confidence intervals (CI) of antepartum hemorrhage (RR = 0.67, 95% CI 0.55–0.81), preterm birth (RR = 0.84, 95% CI 0.78–0.90), small for gestational age (RR = 0.45, 95% CI 0.30–0.66), low birth weight (RR = 0.69, 95% CI 0.62–0.76), and perinatal mortality (RR = 0.68, 95% CI 0.48–0.96) were lower in women who received frozen embryos. Conclusion(s): Although fresh ET is the norm in IVF, results of this systematic review of observational studies suggest that pregnancies arising from the transfer of frozen thawed IVF embryos seem to have better obstetric and perinatal outcomes. [Copyright &y& Elsevier]