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Objective: To study induction of labor (IOL) at 39 weeks compared with expectant management among women undergoing labor after cesarean section (LAC) with no prior vaginal delivery. Methods: A retrospective cohort study including all women undergoing LAC with no prior vaginal delivery, between March 2011 and January 2021. We allocated the study cohort into two groups: IOL at 390/7 to 396/7 and all LACs at ≥400/7 weeks of gestation. The primary outcome was a composite of adverse neonatal outcome. The secondary outcome was a composite of adverse maternal outcome. Results: Overall, 1022 women met inclusion criteria, of whom 89 (8.7%) had IOL at 390/7–396/7 weeks and 933 (91.3%) had LAC at ≥400/7 weeks. The composite neonatal outcome rate was comparable between groups (0.186). There were three uterine ruptures (3.4%) in the IOL group and 11 (1.2%) in the LAC at ≥40 weeks group (P = 0.115). The rate of the composite maternal outcomes occurrence was higher in the IOL group (18.0% vs. 10.1%, P = 0.022). Conclusion: IOL at 39 weeks among women undergoing LAC with no prior vaginal delivery is not associated with improved neonatal outcomes when compared with expectant management but may be associated with a higher rate of adverse maternal outcomes. SynopsisThe contents of this page will be used as part of issue TOC only. It will not be published as part of main article. Induction of labor after cesarean section without prior vaginal delivery at 39 weeks does not compromise neonatal outcomes but increases adverse maternal outcomes rate. [ABSTRACT FROM AUTHOR]

Introduction: Safe motherhood ensures safe pregnancy and childbirth. One of the noteworthy causes of maternal morbidity and mortality is the complications arising from prolonged or obstructed labour. World Health Organization recommends the use of partograph to significantly reduce the maternal mortality crisis. This study aimed to evaluate the effectiveness of a novel partograph in terms of maternal and perinatal outcomes along with its utility. Materials and Methods: A total of 400 intranatal women were selected in a non-randomized control trial to evaluate the effectiveness of novel partograph on selected maternal and perinatal outcomes. Subjects in experimental group (n=200) received care with newly developed partograph whereas subjects in control group (n=200) received standard care. Effectiveness was determined at a significance level of α ≤ 0.05. Utility of the novel partograph was determined as perceived by nurses. Results: There was significant reduction in the duration of the 1st and 2nd stage of labour (P=0.023 and 0.006 respectively) and number of vaginal examinations performed during labour (P=0.017) among mothers in the experimental group. Significant improvement in the Apgar score (P=0.005) was also observed among the infants of mothers in experimental group. Novel partograph was considered as of having extreme utility by 71% nurses. Conclusion: Study concluded that subjects monitored by the partograph experienced improved maternal and perinatal outcomes. It was found to be having extreme utility. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality following a caesarean section (CS) is 50-fold higher in Africa compared to high-income countries (HIC), and strongly associated with peripartum haemorrhage. Blood transfusion (BT) may be lifesaving and the identification of associated preoperative factors may improve outcomes, especially in resource-limited settings. Methods: We conducted a prospective, multicentre cross-sectional study of all consecutive patients undergoing CS at three government-funded hospitals in KwaZulu-Natal. The primary outcome variable was the prevalence of BT. Multivariable binary logistic regression analysis was used to identify factors independently associated with BT. We hypothesised that there would be a higher prevalence of BT, but similar associated factors, compared to in HIC. Results: We recruited 1 533 patients between January and May 2021. Most patients presented for urgent or emergency CS (72.4%; 1 104/1 524). Human immunodeficiency virus (HIV) infection (38.6%) and hypertensive disorders of pregnancy (23.4%) were the most common comorbidities. In total, 71 patients received a BT, a prevalence of 4.6% (95% confidence interval [CI] 3.6–5.7%). The prevalence of preoperative anaemia was 36.7% (558/1 520; 95% CI 34.3–39.1%), while 6% (92/1 533; 95% CI 4.8–7.2%) of patients had bleeding during or after CS (BDACS). Factors independently associated with BT were ‘major bleeding risk’ (a composite of placenta praevia, abruptio placentae and antepartum haemorrhage) (adjusted odds ratio [aOR] 5.34; 95% CI 2.11–13.52%); preoperative anaemia both mild (2.39; 1.10–5.22%) and moderate/severe (28.37; 12.39–64.97%); platelet count < 100 000 cells/ mm3 (5.02; 1.41–17.83%), previous CS (two or more) (2.52; 1.21–5.25%) and BDACS > 1 500 ml (27.86; 6.72–115.54%). Conclusion: We confirmed that there was a higher prevalence of BT in the hospitals studied than in HIC. Major bleeding risks and BDACS should be identified early to allow appropriate perioperative planning and mobilisation of blood resources. Antenatal anaemia is a preventable and treatable condition. Therefore, earlier diagnosis and treatment should be prioritised. We also showed that even moderate thrombocytopaenia may be associated with BT. [ABSTRACT FROM AUTHOR]

The ABO blood group type has been considered an independent risk factor in pregnancy-related complications leading to significant morbidity and mortality in pregnant mothers and neonates. Aim: To study the relationship between maternal ABO blood group and Rh typing with maternal and perinatal outcomes. Materials and methods: Prospective Observational study was carried out for 24 months from November among 1000 pregnant women attending outpatient for ABO blood group and Rh typing with maternal and perinatal outcome. Results: Among 1000 subjects, 43.5 % belonged to blood group O, followed by 30 % in blood group B. 20.7 % had blood group A, and 5.8 % had AB blood group. In the present study, 95.4 % had Rh+ve, and 4.6 % had Rh-ve typing. The incidence of preterm labour was high at 6.3 % in the O+ve blood group, followed by 1.8 % in the AB +ve, 0.6 % in the A+ve and 0.3 % in the B+ve blood group. A statistically significant association was found between blood grouping and preeclampsia with high incidence among the A+ve blood group. A statistically significant association was found between blood grouping and imminent eclampsia with high incidence among the AB+ve blood group. There was a statistically significant association found between blood grouping and intrauterine death. Conclusion: The findings in the present study will help clinicians to identify the patients at risk of developing adverse pregnancy outcomes like preeclampsia and imminent eclampsia; hence, the timely intervention will help to improve maternal and perinatal outcome and also helps to reduce the complications of preeclampsia and imminent eclampsia. [ABSTRACT FROM AUTHOR]

Introduction: The concurrent influence of Gestational diabetes mellitus (GDM) and hypothyroidism on the incidence of hypothyroidism in GDM is not yet clearly reported. Thyroid dysfunction has been associated with adverse obstetric outcomes. However, less is known regarding subclinical hypothyroidism and its relationship to pregnancy complications. Methods: This prospective study was conducted with a total of 300 antenatal patients with GDM according to DIPSI criteria after 24 weeks and above were subjected to thyroid function tests. Patients with normal FT3, normal FT4 and S.TSH between 3.0mIU/L -10.0 mIU/L were diagnosed as Subclinical hypothyroidism and S. TSH more than 10.0mIU/L were diagnosed as Overt hypothyroidism. These patients were followed up and both maternal-fetal outcomes were observed in GDM patients with and without hypothyroidism. Results: In the study, 14% of GDM women developed hypothyroidism, all of which were subclinical. When compared to GDM women, patients with combined endocrinopathy were more prone for Hypertensive Disorders (HD) in pregnancy. Other foetal outcomes, such as preterm delivery (P= 0.384), RDS (P= 0.465), sepsis (P= 0.366), and jaundice in newborns (P= 0.193), and maternal outcomes included anemia (P= 0.720), abruptio placenta (0%), mode of delivery (P= 0.9), and oligohydramnios were not statistically significant. Conclusion: The incidence of hypothyroidism in GDM patients was only 14%. The incidence of HD in Pregnancy was more in combined endocrinopathy (26.19%) compared to GDM (13.57%) (P=0.035). This indicates the increased incidence of HD in Pregnancy, which emphasizes the importance of overseeing pregnancy as HD in Pregnancy may result in significant maternal-neonatal complications. [ABSTRACT FROM AUTHOR]

Background: Racial/ethnic disparities are evident in adverse maternal health outcomes, but they are shifting due to interventions, initiatives, changing demographics, and the prevalence of preexisting conditions. This study examined the current racial/ethnic disparities in adverse maternal outcomes. Materials and Methods: In a cross-sectional study, the International Classification of Diseases-10 codes for the principal diagnosis and secondary diagnoses were retrieved from the National Inpatient Sample database (2016–2018). A weighted multiple logistic regression model assessed disparities in seven adverse maternal outcomes, including preterm labor, gestational hypertension (GHTN) and diabetes, premature rupture of membranes (PRM), infection of the amniotic cavity (INFAC), placental abruption, and postpartum hemorrhage (PPH). A weighted linear regression model assessed disparities in a composite variable of maternal outcomes. A maternal-specific comorbidity index assessed risk adjustment, and other clinical, sociodemographic, and hospital factors were considered. Results: A total of 2,211,345 pregnancies were included. Preterm labor, GHTN, and placental abruption had the highest raw rate among Black women compared to all races. After adjusting for control variables in the regression analysis, these adverse outcomes also showed the highest odds ratio (OR) among Black women compared to White women (the reference group). Gestational diabetes, PRM, and INFAC had the highest raw rate among Asians/Pacific Islanders (PIs). After adjusting for control variables, these adverse outcomes also showed the highest OR among Asians/PIs compared to White women. The OR for PPH was the highest for Native Americans compared to White women. Furthermore, results of the composite outcome variable indicated that all minority groups experienced the overall poorer maternal outcome than White women. Conclusions: Overall, all four minority women had higher raw rates and also odds of experiencing the studied adverse outcomes than White women. Existing efforts should be strengthened to continue reducing racial/ethnic disparities in adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Background/Aim: The number of recurrent cesareans is increasing worldwide, but the optimal timing for delivery in women who have had previous cesareans is controversial. The aim of this study is to determine the optimal timing of elective cesarean delivery in women with a history of four or more cesarean sections (CSs). Methods: This retrospective cohort study was conducted in a tertiary hospital; 195 patients with a history of four or more CSs were grouped according to their gestation weeks on operation day and analyzed in terms of demographic features and clinical data as well as maternal and neonatal outcomes. Gestation weeks were grouped as 37-38 weeks and 39 weeks. Logistic regression analysis was used to determine the effect of independent variables on maternal and fetal outcomes. Results: Of the 195 patients, 118 had CS between 37-38 weeks and 77 at 39 weeks. Clinical and demographic characteristics were similar among groups. The overall maternal complication did not differ between the groups (16.1% vs 16.9%, P = 0.885). The 1st and 5th minute APGAR scores were significantly lower in the 37-386 weeks group (P = 0.013 and P = 0.04, respectively). Logistic regression analysis found that neonatal 5th minute APGAR score was associated with a model including maternal age, number of previous CS, anesthesia type, gestational week at delivery, and neonatal birth weight. Conclusion: Timing CS at 39 weeks in patients with a history of four or more CSs was found not to worsen maternal outcomes. Additionally, planning at 39 weeks could improve newborn outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Oligohydraminos, often due to impaired placental function, has been associated with an increased risk of caeserean delivery for fetal distress, low Apgar score, post maturity and high perinatal morbidity and mortality. Material and methodology: The prospective Longitudinal study was carried out over the period of two years in the Department of Obstetrics and Gynaecology of Rural Medical College, Loni. 170 pregnant women in 3 trimester of pregnancy, presenting clinically as oligohydramnios with AFI less than 5cm and intact membranes; were included in the study. All cases were evaluated on indoor basis. Results: In the present study, Eight babies were admitted in NICU for further management, five babies gestational age >37 weeks and associated with asymmetrical IUGR they were kept in NICU for birth asphyxia (apgar<7 at birth) and birth weight was <2kg. all were delivered by caesarean section Conclusion: All cases of Oligohydramnios rise suspicion about perinatal outcome. Unessessary Intervation in the form of Induction of Labour can result into increased operated intervention. [ABSTRACT FROM AUTHOR]

Introduction: Code red cesarean delivery (CD) is performed in the presence of an impending danger to maternal or fetal life. The indications, times, and procedures in this setting remain ambiguous. The aim of this study was to evaluate in a cohort of code red CD the impact of the level of care of Obstetric Units, indications, and decision to delivery interval CD on maternal and perinatal outcomes., Methods: This was a multicenter retrospective study conducted at four maternal units (two level-2 University Hospitals and two level-1 Community Hospitals) on a cohort of women who underwent code red CD between 2018 and 2021. An independent team of experts performed retrospective audits to assess the appropriateness of indications., Results: A cohort of 168 code red CDs were included. The most frequent indications were severely abnormal fetal heart rate patterns (41.7 %) and sentinel events (38.1 %). Decision to delivery interval (DDI) was similar between different level of care (20.7 vs 21.4 min, p = 0.66) and didn't affect adverse perinatal outcome. Rates of appropriate indications were higher in the level-2 than level-1 hospitals (80.2 % vs 65 %, p = 0.036), with worse adverse perinatal outcome in the former than the latter (43.4 % vs 21.1 %, p = 0.002).At multivariate analysis, worse perinatal outcomes were independently associated with indications for code red CD (P = 0.01) and level-2 units (P = 0.005)., Conclusions: Level-1 hospitals guarantee a promptness of response comparable to that of level-2 centers in dealing with emergency in CD, however with lower rates of appropriate indications. Indications for code red CD but not DDI are associated with worse perinatal outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Vaginal delivery can cause genital tract trauma and lacerations of different severity. This study aims to establish if routinary use of Ritgen's maneuver decreases the prevalence and severity of perineal lacerations compared to the traditional manual perineal protection (MPP)., Methods: This prospective case-control study was conducted in the labor ward of Fondazione Policlinico A. Gemelli, Rome, Italy. One hundred sixteen women who met inclusion criteria were included. The study group (n=58) consisted of women who were assisted using the Ritgen maneuver, whereas the women who gave birth immediately afterward were selected as the control group (n=58). All information was retrieved through electronic medical records., Results: In all, 22% women of the study group reported no perineal lacerations compared with 5% of the control group (p=0.007). Regarding the degree of lacerations, the study group exhibited more first-degree lacerations and fewer second-degree lacerations, while the control group exhibited the opposite trend. Among women who received epidural analgesia, 24% of the study group did not experience perineal lacerations, compared to 4.5% of the control (OR=0.15; 95% CI: 0.03-0.72; p=0.008). Similarly, 23.4% of cases in the study group with oxytocin-enhanced labor, experienced no perineal trauma while none in the control group had no perineal trauma in cases of oxytocin augmentation (p=0.005)., Conclusions: Our results suggest that using Ritgen's maneuver in childbirth care may reduce the incidence and severity of perineal lacerations, even in the presence of known risk factors for perineal lacerations such as oxytocin augmentation and epidural analgesia., Competing Interests: The authors have completed and submitted the ICMJE Form for disclosure of Potential Conflicts of Interest and none was reported., (© 2024 Salusest S. et al.)

Background: Birth tears are common after vaginal birth with a prevalence of up to 85%, especially in vaginal-assisted births. Because birth trauma can cause physical and psychological short-term and long-term maternal morbidity, it is essential to improve maternal outcomes at birth., Objective: This study aimed to evaluate the effect of a perineal protection device on the rate of spontaneous birth tears in the posterior compartment in vacuum-assisted births and the feasibility and safety of the device., Study Design: In a prospective, randomized controlled interventional trial from July 2020 to October 2022, we evaluated the application of a perineal protection device in vacuum-assisted vaginal births in a tertiary care center. A total of 1998 patients were asked to participate, and 1574 patients with singletons at ≥36 weeks of gestation gave their informed consent before birth. Ultimately, 209 were included according to a power calculation, performed in advance, with a statistical power of 80% and a significance level of 5% for an expected reduction in the rate of the primary composite outcome of 20%. The primary composite outcome was the rate of low-grade perineal and/or vaginal tears in the posterior compartment. Secondary outcomes were the rate of high-grade perineal tears and episiotomies, the feasibility of the device, and its safety for the mother and child. Descriptive statistics and a logistic regression analysis were performed in an intention-to-treat, a per-protocol, and an as-treated analysis, using SPSS, version 29.0.0.0, and R. A P value of <.05 was considered statistically significant., Results: Of the 1574 patients, 249 (15.8%) had an indication for vacuum-assisted vaginal birth, and 217 (13.8%) of those were randomized. An addition 8 patients (0.5%) were excluded because the birth ended without vacuum assistance. Of the remaining 209 patients, 105 formed the intervention group (application of the device), whereas 104 formed the control group (without application of the device). No differences in primary and secondary outcomes were found in the intention-to-treat and per-protocol analysis. In the intention-to-treat analysis, 79 patients (75.2%) in the intervention group and 73 patients (70.2%) in the control group (P=.4) met the primary endpoint. In the per-protocol analysis, the primary composite outcome was seen 53 patients (77.9%) in the intervention group and in 73 patients (70.2%) in the control group (P=.27). For the as-treated analysis, 68 of the 105 patients (65%) remained in the intervention group after exclusion of 37 (35%) patients with failed application of the device. Consequently, 141 formed the control group. In the as-treated analysis, there was also no difference in the primary composite outcome between the 2 groups (53 patients [77.9%] in the intervention group and 99 patients [70.2%] in the control group). However, within the secondary outcomes, we found a significantly lower rate of mediolateral episiotomies in the intervention group (29% vs 45%; P=.034). No adverse outcomes for the mother and child were seen. In one-third of cases, the device was difficult to place correctly and/or to keep correctly in place., Conclusion: The perineal protection device was not able to reduce the primary composite outcome of the study among women who gave birth by vacuum assistance. Although this was not the primary end point, a lower rate of mediolateral episiotomies was observed when the device was used correctly. As a limitation, difficulties with the application of the device occurred in 33% of cases. Nevertheless, no adverse events in association with the device were observed for either mother or child in our cohort., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The COVID-19 pandemic caused widespread changes in healthcare delivery, particularly affecting vulnerable populations such as pregnant adolescents. These patients faced additional challenges, including developmental and gestational changes, stress from isolation, and altered healthcare access, which may have impacted the incidence and prevalence of maternal and neonatal complications. This study aims to compare maternal and neonatal outcomes in adolescent pregnancies before and during the pandemic, focusing on how shifts in healthcare delivery influenced these outcomes., Methodology: A retrospective cohort study was conducted, including 340 adolescent pregnant patients who received prenatal care at a tertiary care institution. Patients were divided into two groups: pre-pandemic ( n  = 209) and pandemic ( n  = 131). Maternal data, including pre-BMI and gestational weight gain (GWG), were collected to evaluate maternal and neonatal outcomes. Statistical analysis was performed using chi-square tests, Fisher's exact tests, and odds ratio (OR) calculations., Results: The pandemic group showed a statistically significant increase in cesarean deliveries ( p  = 0.002; OR = 1.99) and cervicovaginitis, particularly caused by Ureaplasma spp. Conversely, the pre-pandemic group had higher rates of psychoactive substance use, maternal urinary tract infections, and neonatal transient tachypnea. In the pandemic group, overweight pre-gestational BMI and cervicovaginitis were more prevalent in patients with adequate GWG, while inadequate GWG was associated with an increased risk of urinary tract infection (UTI). A significant association between pre-gestational overweight/obesity and excessive GWG was also observed ( p  < 0.05)., Conclusion: The COVID-19 pandemic altered both healthcare delivery and maternal and neonatal outcomes in adolescent pregnancies. Changes in healthcare access, isolation, and shifts in medical management during the pandemic resulted in higher cesarean rates and infection rates among pregnant adolescents. These findings underscore the need for adaptable, resilient healthcare systems capable of maintaining comprehensive care even in the face of global crises. Further studies are needed to explore long-term effects on adolescent maternal and neonatal health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Grobeisen-Duque, Villavicencio-Carrisoza, Mora-Vargas, Arteaga-Lopez, Martinez-Salazar, Rosas-Balan, Leon-Juarez, Flores-Herrera, Zaga-Clavellina, Aguilera-Arreola and Helguera-Repetto.)

OBJECTIVE: To describe the method of reducing morbidity and mortality among women with morbidly adherent placenta who ended up in hysterectomy. METHODOLOGY: This retrospective descriptive case series study included twenty pregnant women with morbidly adherent placenta who needed hysterectomy and managed by team approach at Gynae unit I, Liaquat University of Medical and Health Sciences hospital Hyderabad from January 2019 to February 2020. Data was collected with respect to age, parity, gestational age, booking status, number of previous caesarean section, clinical presentation, time of diagnosis and maternal outcomes. Analysis was through SPSS program version 21. Frequency, percentages, means ± standard deviation was calculated for various variables. RESULTS: The frequency of morbidly adherent placenta (MAP) was found in 1 in 308 births. The mean age was 29.55±4.62years. The mean parity and gestational age was3.1±1.58 and 33.2±5.02 weeks respectively. All had one or more than one previous cesarean section with 90% had associated placenta previa. Half of the cases presented with ante partum hemorrhage, and had placenta accrete. Emergency surgery was required in 65% of the cases. Hypovolemic shock (45%), bladder injury (20%) was observed as main complications. Mean blood loss was 1.72±0.75 liters; mean blood transfusion of 3.6±1.31 units with mean hospital stay of 7.70±4.47 days, there was 1mortality (5%) in the study. CONCLUSION: Preoperative confirmed diagnosis, anticipation of high-volume blood transfusion, early recourse to hysterectomy by senior obstetrician, adapting team approach are methods of reducing morbidity and mortality in MAP.

HIGHLIGHT 1. As the incidence of placenta accreta is increasing which seems to parallel the increasing cesarean delivery rate, advance planning should be made for the management of delivery. 2. Maternal outcome of placenta accreta cases in a national hospital was reported based on the surgical technique performed. 3. No significant results of maternal outcome undergoing conservative surgery and conventional hysterectomy in managing accreta cases in the national hospital. ABSTRACT Objectives: To report maternal outcome based on surgical technique on the management of accreta. The study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2017 to January 2018. Case Report: There were 1609 cases of pregnant women delivered during the study period. From these, the prevalence of previous caesarean section was 73 cases, including 20 cases of accreta. Total maternal mortality for 1 year in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was 11, and accreta contributed 3 cases. We reported 20 cases of accreta in pregnancy The maternal outcomes, including bladder injury, duration of operation, intraoperative bleeding, length of hospitalization, and mortality, were evaluated. From 20 cases, 8 patients had one previous caesarean history, 11 had second previous caesarean section, while 2 patient had third previous caesarean section history. Of women with placenta accreta, about 7 patients (35%) had delivery in fullterm pregnancies, while 13 (65%) had delivery in preterm pregnancy. Surgical technique in accreta management mostly was hysterectomy to override bleeding complication along the delivery. From 20 cases, 16 caesarean sections were followed-up with hysterectomy. Four cases were with conservative management. From all the hysterectomy performed, four were complicated with bladder injury. The mean intraoperative bleeding was 600 - 5500 cc of blood, while the mean of post-operative transfusion was 1000 -3000 cc. There were 2 maternal deaths in this study. Thirteen patients were admitted to the ICU after the procedure. Conclusion: Accreta increases morbidity due to massive bleeding. It is important to have algorithm for managing abnormal implantation of the placenta. Our cases revealed no significant results of maternal outcome between conservative surgery and conventional hysterectomy in managing accreta cases in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Background & aim: Novel coronavirusease 2019 (Covid-19) started in China and caused unexplained pneumonia. The risk of adverse pregnancy outcomes increase in respiratory viral infection during pregnancy. This systematic review was performed to investigate the maternal and neonatal outcomes in pregnant women infected with Covid-19.Methods: In this systematic review, the international databases (PubMed, Cochrane Library, Web of Science, Scopus, Embase, PsycINFO, Google scholar) as well as national databases (SID and Magiran) were searched to find out the articles published from 1 September 2020 to 30 April 2021 regarding maternal and neonatal outcomes in pregnant women infected with Covid-19. Keywords were selected based on Mesh (“Pregnancy”, “Gravidity”, “Delivery”, “Infant”, “Newborn”, “Neonate”, “Outcome”, “Complication”, “Abortion”, “Obstetric Labor, Premature”, “Cesarean Section”, “Fetal Death”, “Infant, Premature”, “Coronavirus Infection”, “COVIDK19”). The full texts of articles were reviewed by two independent reviewers and the relevant data was extracted.Results: 20 studies including 78 pregnant women entered in this review. All women were at third trimester of pregnancy except 2 cases who were less than 28 weeks. The most prevalent clinical symptoms were fever, cough and sore throat. The most common maternal outcomes were intrauterine distress, rupture of membranes and preterm delivery. Most infants delivered by cesarean section. The most common neonatal complications were prematurity, small for gestational age, fetal distress, low birth weight and bacterial pneumonia.Conclusion: In this systematic review, we found some evidence to suggest that COVID-19 pneumonia causes negative maternal and neonatal outcomes in pregnant women infected with Covid-19.

Objective: To assess adverse perinatal outcomes and caesarean section of low-risk women receiving elective induction of labour at 41 weeks or expectant management until 42 weeks according to their preferred and actual management strategy. Design: Multicentre prospective cohort study alongside RCT. Setting: 90 midwifery practices and 12 hospitals in the Netherlands. Population: 3642 low-risk women with uncomplicated singleton late-term pregnancy. Main outcome measures: Composite adverse outcome (perinatal death, Apgar score 5′ < 7, NICU admission, meconium aspiration syndrome), composite severe adverse perinatal outcome (all above with Apgar score 5′ < 4 instead of < 7) and caesarean section. Results: From 2012–2016, 3642 women out of 6088 eligible women for the INDEX RCT, participated in the cohort study for observational data collection (induction of labour n = 372; expectant management n = 2174; unknown preference/management strategy n = 1096).Adverse perinatal outcome occurred in 1.1 % (4/372) in the induction group versus 1.9 % (42/2174) in the expectant group (adjRR 0.56; 95 %CI: 0.17–1.79), with severe adverse perinatal outcome occurring in 0.3 % (1/372) versus 1.0 % (22/2174), respectively (adjRR 0.39; 95 % CI: 0.05–2.88). There were no stillbirths among all 3642 women; one neonatal death occurred in the unknown preference/management group. Caesarean section rates were 10.5 % (39/372) after induction and 8.9 % (193/2174) after expectant management (adjRR 1.32; 95 % CI: 0.95–1.84).A higher incidence of adverse perinatal outcome was observed in nulliparous compared to multiparous women. Nulliparous 1.8 % (3/170) in the induction group versus 2.6 % (30/1134) in the expectant management group (adjRR 0.58; 95 % CI 0.14–2.41), multiparous 0.5 % (1/201) versus 1.1 % (11/1039) (adjRR 0.54; 95 % CI 0.07–24.19). One maternal death due to amniotic fluid embolism occurred after elective induction at 41 weeks + 6 days. Conclusion: In this cohort study among low-risk women receiving the policy of their preference in late-term pregnancy, a non-significant difference was found between induction of labour at 41 weeks and expectant management until 42 weeks in absolute risks of composite adverse (1.1 % versus 1.9 %) and severe adverse (0.3 % versus 1.0 %) perinatal outcome. The risks in this cohort study were lower than in the trial setting. There were no stillbirths among all 3642 women. Caesarean section rates were comparable.

Background: In recent years a trend towards childbearing at older maternal age is evident. Most of the current literature investigated the association between advanced maternal age and neonatal outcome at term. We aimed to study the outcomes of the mother and the neonate among preterm births of women of advanced maternal age. Methods: This retrospective study between 2009 to 2017, comprised 494 singleton preterm births between 24 and 34 weeks gestation, of which 116 (23%) were of 35 years old or older (advanced maternal age) and 378 (77%) were of younger women. The medical records were reviewed and the outcomes of the mother and the neonate were compared between advanced maternal age (≥35 years) and younger women. Results: The rate of severe intra-ventricular hemorrhage (IVH) and of composite adverse neonatal outcome was lower among advanced maternal age women compared to younger women (p = 0.02 and p = 0.05 respectively). In multivariate regression analysis, composite adverse neonatal outcome was found to be independently inversely associated only with advanced maternal age (adjusted odds ratio (aOR) 0.45 95% confidence interval (CI) 0.23–0.86). Conclusions: Advanced maternal age was not found to be a risk factor for adverse neonatal outcome among preterm births before 34 weeks, and might be a protective factor from early neonatal complications.

Background: Alport syndrome is a rare inherited disorder affecting the glomerular basement membrane, manifested by hematuria and proteinuria that is commonly associated with ocular and hearing defects. There is limited information about the maternal and fetal outcomes of Alport syndrome in pregnancy.Case Presentation: We describe a smooth course of pregnancy, a good maternal outcome, and a good fetal outcome in three consecutive pregnancies for a 35-year-old Mediterranean woman with Alport syndrome over a 10-year duration. Although there was a nephrotic range of progressive proteinuria in all her pregnancies, there was a prompt drop in proteinuria within 2 weeks of her deliveries. She has constantly shown a normal serum creatinine level and a normal serum protein level in all her pregnancies. Apart from a single episode of asymptomatic hypertension in her second pregnancy at 34 weeks of gestation that returned to a normal range immediately after delivery, she was normotensive antenatally and postnatally. She gave birth by cesarean section to three healthy newborns.Conclusions: A normal prepregnancy creatinine level and a mild range of proteinuria in a patient with normotension, who is not on any medication, are associated with good maternal and fetal outcomes. Furthermore, successful pregnancy that is followed by a normal renal function test might suggest a favorable outcome for any future pregnancy. [ABSTRACT FROM AUTHOR]

Pregnancy-induced hypertension (PIH) is one of the main causes of maternal mortality. Many first- and second-line drugs are available to treat the condition. Labetalol lowers blood pressure by blocking both α and β adrenergic receptors. It preserves uteroplacental blood flow efficiently. A systemic review was carried out to find the efficacy and safety of labetalol in the treatment of PIH. Three thousand twenty-six studies were retrieved in 20 years. Finally, 28 studies were selected after applying the review criteria. Twenty-three studies detected that labetalol had superior or similar action compared to other drugs in controlling hypertension in patients with preeclampsia and eclampsia. The systematic review concluded that labetalol is a safe, effective, first-choice of drug with few side effects in treating PIH. [ABSTRACT FROM AUTHOR]

Objective: Rising caesarean delivery (CD) rates throughout the world are accompanied with high rates of severe maternal complications. The aim of the present study was to analyze the outcome of trial of labor after caesarean section (TOLAC) in a Western population and identify factors associated with the success of vaginal birth after caesarean section (VBAC). Material and Methods: A retrospective study was performed at two large obstetric departments in Germany from 2008 to 2018. Women with singleton pregnancies, a history of only one previous CD with a low transverse incision, a viable fetus in cephalic presentation, and gestational age >32 weeks were included in the study. The characteristics and outcome of successful VBAC and failed TOLAC were compared. A subgroup analysis addressed gestational age, interpregnancy interval, fetal macrosomia, body mass index, and maternal age. Results: Of 1,546 patients, 62.3% achieved VBAC while 37.7% had a secondary CD. Independent factors associated with the success of TOLAC were a history of vaginal birth in previous pregnancies (p<0.001) and the use of oxytocin (p<0.001), whereas preterm birth between gestational week 32 and 37 signified a higher risk of failed TOLAC (p=0.04). The success of VBAC did not differ significantly for patients older than 40 years of age, those with a shorter interpregnancy interval than 12 months, and fetal macrosomia with birth weight exceeding 4000 grams. Maternal and neonatal outcomes were poorer in women with failed TOLAC. Conclusion: Nearly two thirds of women with a history of CD achieve VBAC in Germany. Previous vaginal birth and the augmentation of labor with oxytocin are positively associated with the achievement of VBAC and no major perinatal complications. The decision to have a TOLAC should be encouraged in the majority of patients. Further studies are needed to evaluate the feasibility of TOLAC in preterm delivery. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate the effect of ureteral catheter use during surgery on the outcomes of obstetric and urinary complications in patients with placenta accreta spectrum (PAS) and placenta previa. Methods: The patients who were followed up at Meram Medical Faculty Hospital of Necmettin Erbakan University between January 2016 and November 2021 and diagnosed with PAS and placenta previa were included. Patients who underwent emergency and planned surgery were grouped as those with or without an intraoperative ureteral catheter. The primary outcome was determined as the rate of urinary system damage among these groups. The number of blood transfusions, preoperative and postoperative hemoglobin values and hemoglobin changes, length of hospitalization, patients who underwent uterine-sparing surgery or hysterectomy, urinary tract injury, and wound infection were compared regarding the use of catheters. Results: A total of 122 patients were included in the study. While an intraoperative ureteral catheter was placed in 56 (45.01%) patients, it was not used in 66 (54.09%) patients. Bladder injuries were determined in 31 (55.4%) patients with a catheter and 13 (19.7%) patients without a catheter, and no other urinary system injuries were found. The incidence of bladder injury was statistically significantly higher in the group with a catheter (p=0.001). The number of transfused erythrocyte suspensions, the hemoglobin change according to the preoperative hemoglobin level, and the mean duration of hospitalization in patients with a catheter were statistically significantly greater than the group without a catheter (p=0.001). Conclusion: Ureteral catheterization did not reduce urinary damage in patients with PAS and placenta previa who underwent uterine-sparing surgery and hysterectomy. However, we believe that the insertion of a catheter increases the possibility of diagnosing intraoperative damage. [ABSTRACT FROM AUTHOR]

Background: The cesarean delivery (CD) rate has been increasing globally. Trial of labor after cesarean delivery (TOLAC) has been used as a key method for the reduction of the CD rate. Little is known, however, about the association between the second-stage duration of TOLAC and adverse maternal and neonatal outcomes. This study evaluated the association between perinatal outcomes and the duration of second-stage labor in women undergoing TOLAC.Methods: A 10-year retrospective cohort study was performed at the Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, between January 2010 and January 2020. Women undergoing TOLAC who reached the second stage of labor were included in this study. Duration of the second stage of labor was examined as a categorical variable (group I: <0.5 h, group II: 0.5-2 h and group III: ≥2 h) and as a continuous variable to evaluate the association with adverse perinatal outcomes by using multivariable regression models and a Cox proportional hazards regression model adjusting for potential confounders.Results: Of the 1,174 women who met the inclusion criteria, the median (interquartile range) length of the second stage was 0.5 h (0.3-0.9 h). Among them, 1,143 (97.4%) delivered vaginally and 31 underwent an unplanned CD. As the second-stage duration increased, operative vaginal delivery (OVD), CD, and postpartum hemorrhage (PPH) rates increased. Women in group III had higher risks of OVD (aOR = 11.34; 95% CI [5.06-25.41]), CD (aOR = 4.22; 95% CI [1.32-13.43]), and PPH (aOR = 2.43; 95% CI [1.31-4.50]) compared with group I. Correspondingly, blood loss and the oxytocin used to treat PPH increased significantly, while the postpartum hemoglobin reduced significantly in group III compared with group I. The incidence of uterine rupture, uterine atony, cervical laceration, red blood cell transfusion, and intensive care unit admission were similar in all three groups. Neonatal outcomes were not affected by the second-stage duration.Conclusions: Women undergoing TOLAC with second-stage duration of ≥2 h have higher odds of OVD, unplanned intrapartum CD, and PPH. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension (PAH). Methods: We searched PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang and QVIP for investigating the effects of general anesthesia (GA) and local anesthesia (LA) in pregnant patients with PAH. Results were expressed as weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Publication bias was assessed by the Begg's test. Results: Totally, 18 articles containing 628 LA and 481 GA patients were involved in our study. The postoperative blood oxygen saturation (WMD = − 4.040, 95%CI: − 5.505 to − 2.576) and maternal mortality rate (RR = 0.507, 95%CI: 0.300–0.858) were lower in LA group than those in GA group. The postoperative systolic blood pressure (WMD = 15.647, 95%CI: 13.294–18.000) and postoperative diastolic blood pressure (WMD = 6.758, 95%CI: 5.715–7.802) were high in LA group compared with those in GA group. The mechanical ventilation time (WMD = − 4.112, 95%CI: − 4.655 to − 3.569), ICU admission time (WMD = − 4.176, 95%CI: − 4.523 to − 3.828), length of stay (WMD = −7.289, 95%CI: −7.799–6.779) were shorter in LA group than those in GA group. All P values were < 0.05. Conclusions: LA is superior to GA in regards to the postoperative blood oxygen saturation, the postoperative systolic blood pressure, postoperative diastolic blood pressure, the mechanical ventilation time, ICU admission time, length of stay and the maternal mortality rate. Registration number: osf.io/juybq (https://osf.io/search/). [ABSTRACT FROM AUTHOR]

Background: Preterm premature rupture of the membranes (PPROM) is an important contributor to perinatal mortality and morbidity. Neonatal complications are related primarily to the gestational age at rupture of membranes. Objective: The aim of the present study was to improve the perinatal maternal and fetal/neonatal outcomes in cases with preterm premature rupture of membranes between 34 -37 weeks of gestations. Patients and methods: This prospective case control study included 82 women comprised 41 with PPROM (group I) and 41 without ROM as matched controls (group II). All women were presented to maternity unit of Obstetrics and Gynecology Department over 8 months period, at Zagazig University Hospitals. Results: In this study (73.2%) with PPROM were below the age of 30 years. Urinary tract infection was 17.1% versus 12.2 %, cervicitis 4.9% versus 0% in patients with PPROM versus controls respectively. Maternal outcome in this study was evaluated; there were 82.9% of patients with PPROM versus 95.1% discharged from hospital within 4 days after delivery with no bad outcomes. Good Apgar score was (68.3%) in patients with PPROM and 82.9% in control group. In PPROM group; 7 fetuses were diagnosed as fetal distress and only 2 (4.9%) cases had clinical chorioamnionitis. Regarding neonatal morbidity in patients with PPROM, the results showed that respiratory distress syndrome (RDS) was diagnosed in 4 neonates, 7 with tachypnea, 6 with jaundice, and 3 with sepsis and no case of perinatal mortality. Conclusion: With appropriate care, the maternal risks of expectant management after 34 weeks of gestation are generally accepted to be minimal and a clear neonatal advantage exists by reducing risks of neonatal respiratory problems, admission for neonatal intensive care, and cesarean section. [ABSTRACT FROM AUTHOR]

Objectives: Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution. Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity. Material and methods: Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (= 10 µmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity. Results: The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007). A higher rate of preeclampsia was found in the severe (BA = 40 µmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018). Conclusions: The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is the first cause of mortality due to non-obstetric causes in pregnant women. There is a limited knowledge on mechanisms of trauma in pregnancy. Therefore, this study was performed with aim to determine the frequency, type and outcomes of trauma in pregnancy period in patients referring to the major trauma center in Guilan. Methods: This retrospective cross-sectional study was conducted using the data registered in triage unit of Poursina Teaching center, Guilan from July 2017 when the Hospital Information System was being implemented for the first time. Using complete enumeration, all mothers with trauma histories until July 2018 (n=138) were entered into the study. They were then interviewed via telephone about the maternal and fetal outcomes after discharge, and 77 mothers answered. Data were analyzed using SPSS software (Version 21). Results:The mean of maternal age was 29.24±5.25 years and mean gestational age was 20.92±10.12 weeks. The most common mechanism of trauma was falling (35.5%) and then traffic accidents (31.9%), other mechanisms (sharp objects penetrating in the limbs, falling of the object on the person, dog bite, etc.) (21%), violence (10.9%) and self-immolation (0.7%). In terms of frequency, the most reported fetal outcomes were without outcome (87%), preterm birth (7.8%) and abortion (5.2%), respectively; the most common maternal outcomes were reported as uncomplicated (67.5%), bleeding (11.7%), bone fractures (11.7%), uterine contractions and cervical dilatation (9.1%). Conclusion: The most common type of trauma during pregnancy was falling. Preterm birth and abortion were the fetal outcomes and vaginal bleeding, bone fracture, uterine contraction, and cervical opening were dangerous maternal outcomes which are reported. Future programs should prioritize trauma prevention in pregnancy and follow-up of maternal outcomes after discharge from trauma center.

Background: Eclampsia is still a leading cause of maternal death second to postpartum hemorrhage in developing countries. It is also associated with poor perinatal outcome. Aims and Objective: The objective of this study was to find the incidence, maternal and perinatal outcome of patients admitted in a tertiary hospital, Pokhara with diagnosis of eclampsia. Materials and Methods: A descriptive cross sectional study was conducted in department of obstetrics and gynecology, MTH, Pokhara for duration of 1 year from 1st January 2020 to 30th December 2020. A total of 22 patients were enrolled in the study irrespective of timing of occurrence of fits, age, parity, gestational age and status of booking on admission. Results: During the study period the incidence of eclampsia at our center was 0.85% .Majority of the patients 17(77.27%) were primigravida and 16(72.68%) delivered at less than 37 weeks of gestation. Only 4 patients had her antenatal checkup done in MTH. According to timing of occurrence of fits Antepartum and postpartum eclampsia comprise 50% each with no cases of intrapartum eclampsia. Caesarean section was done in 17(77%) cases. Among the cases 10, (45.45%) patients required ICU admission and 6(27.27%) required ventilator support. HELLP, acute renal failures, PRES, PPH were causes of maternal morbidity. Three (13.63%) babies were born stillbirth. Sixteen (72.72%) babies were born preterm and 13(59.09%) had birth weight less than 2.5kg. Six (27.27%) babies needed NICU admission. Conclusion: Eclampsia continues to be one of the prime etiological factors for maternal and perinatal morbidity and mortality in developing countries like ours. This is mostly due to the delay in seeking and reaching the care. Regular antenatal checkup, early recognition, its prevention and proper management of eclamptic cases are vital to tackle this challenge.

Background: Obesity in Indian women had increased from 10.6% to 14.8% in India. Mothers who are overweight or obese during pregnancy and childbirth cause significant antenatal, intrapartum, postpartum and also neonatal complications. Aim and Objective: The present study aimed to explore various maternal and fetal outcomes influenced by maternal obesity. The objective was to find the effect of obesity on maternal and perinatal outcome among obese pregnant women compared to those of normal weight. Methods: The study was conducted in antenatal women attending antenatal outpatient department of of Obstetrics and Gynecology in a teriary care referral hospital in Mumbai. Results recorded in simple percentages. Results: Eighteen percent cases developed gestational diabetes mellitus during their antenatal period and 15% developed gestational hypertension. 44% patients underwent lower segment caesarean section. The need for induction of labour and caesarean section was found to be 37% which is significantly higher. Increased NICU admissions due to hypoglycemia or congenital malformations,prematurity was found to be on a higher side. Conclusions: It was clearly evident from the present study that maternal obesity had adverse maternal and fetal outcomes. Maternal obesity was strongly associated with antenatal complications like gestational diabetes mellitus, gestational hypertension, preeclampsia and increase in need for induction of labour and operative interference.

Abstract Background The American College of Obstetricians and Gynecologists (ACOG) introduced a new standard of care in 2014, extending the duration of the second stage of labor in order to reduce caesarean delivery (CD) rates and its severe complications. The aim of the present study is to evaluate success rates of trial of labor after caesarean section (TOLAC), as well as maternal and neonatal outcomes after the establishment of the recent guidelines. Methods A retrospective study was performed at two large departments in Germany from January 2008 to January 2018. Patients undergoing TOLAC were divided into two groups. Group I (958 patients) was constituted before the establishment of the current guidelines, and Group II (588 patients) after the establishment of the guidelines. A subgroup analysis was performed to compare neonatal outcomes after successful TOLAC and operative vaginal delivery with those after failed TOLAC and secondary CD. Results The success rate of vaginal births after cesarean section (VBAC) fell from 66.4% in Group I to 55.8% in Group II (p

Objectives: To report maternal and perinatal outcomes of hyperthyroidsm in pregnancy. Case Report: There were 3622 cases of delivering pregnant women during the period of the study. From this number, the prevalence of pregnant women with hyperthyroid was 0.2 %. We reported 9 cases of hyperthyroid in pregnancy. The number of pregnancy complication and outcome on pregnant women with hyperthyroidism were preterm labor (44%) and preeclampsia (22%), both were found in group of mother who did taking antihyperthyroid therapy. In those who did not take antihyperthyroid therapy 11% had spontaneous abortion and 11% had preterm delivery. Fetal complications were intrauterine growth restriction (11%) and intrauterine fetal death (23%), both of these complication were on the group who did not take antihyperthyroid. On the contrary, 44% babies were born with normal birthweight in group who took antihyperthyroid. Conclusion: There were differences noted between the group that took adequate treatment and the group that did not take antihyperthyroid. The incidence of intrauterine growth restriction and intrauterine fetal death were high in group that did not took antihyperthyroid therapy but the incidence of preterm delivery as the maternal complication was high in group that did take the antihyperthyroid therapy.

Gestational diabetes mellitus (GDM) during pregnancy is associated with health complications for both mother and infant, but patient numbers in the Waikato District Health Board region of New Zealand have not been well characterised. This study reviewed the full 2018 cohort of Waikato District Health Board hospital births (n = 4970) to report on GDM prevalence by ethnicity and age. The overall prevalence of GDM was 5.7% and is more likely to affect Asian, Pacific and Māori women as well as those of advanced maternal age. [ABSTRACT FROM AUTHOR]

Aim: This study aims to describe the clinical characteristics, maternal and neonatal outcome of pregnancies complicated with COVID-19 infection. Methods: This is a retrospective, single center, observational study conducted on all COVID-19 positive pregnant women who were admitted in our institution from 1st April 2020 to 30th November 2020. During the study period, a total of 201 pregnant and postpartum women with COVID-19 infection confirmed by RT-PCR test, regardless of their symptoms, were admitted and included in the study. Data were collected from hospital records about the demographic profile, clinical characteristics, maternal and neonatal outcomes. Results: The mean age was 26 years (SD = 5.21). Majority patients (71.6%) were asymptomatic and 22.3% had mild symptoms. Only 4 (1.99%) women had severe COVID pneumonia. Majority (75.62%) were admitted in 3rd trimester. Cesarean section rate in COVID-19 infected pregnant women was 53.8%, which was almost similar to 52.8% rate in COVID-19 negative pregnant population. Incidence of preterm birth was 11%. Most neonate were asymptomatic and only 2 of them tested positive on testing within 48 h of birth. Conclusion: There is no major effect of COVID-19 infection during pregnancy on maternal and neonatal outcome. The incidence of preterm birth and cesarean section is similar to COVID-19 negative pregnant population. [ABSTRACT FROM AUTHOR]

Background: Pregnancy and childbirth, especially in high-risk women, necessitate proper antenatal, intranatal, and immediate postpartum care. Early detection of complications and prompt referral to the higher level of care can reduce the associated adverse maternal outcomes. Aims and Objectives: The aim of the study was to evaluate the spectrum of pregnancy-related referrals to our hospitals and their outcomes. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, B.R.D Medical College, Gorakhpur, U.P, India, over a period of 1 year (October 2020-September 2021). All the referred cases of obstetric indications =28 weeks of gestation were analyzed for reasons of referral and their outcomes. Results: Obstetrics referral accounted for 31.15% of the total obstetrics admissions (1416/4545). The average age of study participants was 26.92 years and majority being primigravida. The major reasons for referring patient were hypertensive disorders of pregnancy (16.74%), previous cesarean section (12.78%), and severe anemia (7.70%). There were 70 maternal deaths leading to case fatality rate of 4.94% while 94.2% of patient were discharged healthy. Conclusion: Lack of knowledge, ignorance, and poor transport facilities are major contributors of poor pregnancy outcome. Timely and appropriate referral is crucial in improving maternal outcome. Improvement in the quality of Maternal Child Health care at Primary Health Centre, Community Health Centre level; regular training of health-care providers in emergency obstetrics care is required to curb unnecessary referrals and consequently in reducing fetomaternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia has an adverse effect on both mother and fetus, and may be life-threating condition. Lifestyle modification can improve the clinical presentation of preeclampsia. Methods: Aim of the current study was to examine the effect of lifestyle modification guidelines on improving mild preeclampsia. A Quasi-experimental design was adopted on a purposive sample of 80 pregnant women with mild preeclampsia at the antenatal outpatient unit in Port Said Maternity Hospital, they were assigned into two groups; the study group received lifestyle modification guidelines alongside the routine care and pharmacological management, while the control group received the routine care and pharmacological management. Two tools were used for data collection, Interviewing Questionnaire Sheet and Follow Up Assessment Sheet. Results: The findings showed that lifestyle modifications guidelines lowering the mean of systolic and diastolic blood pressure, gestational weight gain, and proteinuria. Also, reducing risk of delivery before 34 weeks of gestation by 10.0%, delivery from 34 to 36 weeks of gestation by 30.0%, altered liver function by 22.5%, altered kidney function by 15.0%, and cardiac symptoms by 17.5%. Conclusion: Lifestyle modification guidelines alongside with routine care and pharmacological treatment are effective method in modifying mild preeclampsia and its complications. [ABSTRACT FROM AUTHOR]

Abstract Background Associations between trajectories of systolic blood pressure (SBP) during pregnancy and pregnant outcomes remain unclear and disparate. Methods Data of 20,353 mothers without chronic hypertension and who delivered live singletons between January, 2014 and November, 2019, was extracted from Taicang register-based cohort. Based on SBP measured during 10 to 40 weeks of gestation, SBP trajectories were explored using latent class growth mixture model, and their associations with maternal and neonatal outcomes were assessed by logistic regression analyses. Results Six heterogeneous SBP trajectories were identified: low delayed-increasing (7.47%), low reverse-increasing (21.88%), low-stable (19.13%), medium-stable (21.64%), medium reverse-increasing (16.47%), and high stable (13.41%) trajectories. The high-stable trajectory had SBP around 125 mmHg in the 10th gestational week, and increased slightly onwards. When compared with the low-stable trajectory, the high-stable trajectory had maximally adjusted odds ratio (95% confidence interval) of 5.28 (2.76–10.10), 1.30 (1.13–1.50), 1.53 (1.12–2.08), 1.32 (1.06–1.65) and 1.64 (1.08–2.48) for gestational hypertension (GH), early-term delivery (ETD), preterm delivery (PTD), small for gestational age and low birth weight (LBW), respectively. Besides, the medium reverse-increasing trajectory showed significantly increased risk of GH and ETD, while the medium-stable trajectory had significantly elevated risk of ETD and PTD. Notably, SBP trajectories slightly but significantly improved risk discrimination of GH, ETD and LBW, over traditional risk factors. Conclusion Women with different SBP trajectories were at varied risk of adverse maternal and fetal outcomes. Meanwhile, our study suggested that BP monitoring during pregnancy is necessary, especially for women with high SBP in early pregnancy or upward trajectory.

Background: Women with Extra hepatic portal vein obstruction (EHPVO) are mostly young and belong to Asian countries. In the Indian subcontinent, 20–30% variceal bleeds are caused by EHPVO. Hence pregnancy is a concern in such patients. The objective of this study is to observe the maternal and neonatal outcomes in women with EHPVO. Materials and Method: Extra hepatic portal vein obstruction was studied retrospectively in 28 pregnancies in 20 women from Jan 2011 to July 2018 at a tertiary hospital in South India and the pregnancy outcomes were observed during this period. Institutional Review Board approval obtained. Results: The mean age of the women was 24.3 years and the mean age of diagnosis was 18.5 years. Splenomegaly, thrombocytopenia and anaemia were seen in 22 (78.5%), 17 (60.7%) and 8 (28.5%) of pregnancies, respectively. Rate of abortions and preterm deliveries were 2 (7.1%,n=28) and 10 (35.7%,n=28). There was one stillbirth (3.6%) in the study group. EHPVO was diagnosed in 25 (89.3%) women prenatally in our series. During pregnancy only one woman had variceal bleed, which was managed conservatively. Blood and blood product transfusion was required in 7(25%) of women and there was no maternal mortality. Conclusion: Pregnancies in EHPVO have good maternal and neonatal outcomes, provided they are taken care of by a multidisciplinary approach in a tertiary care centre.

Background: We assessed risk factors, antenatal and intrapartum complications associated with early-onset Gestational diabetes mellitus (GDM) in comparison with late-onset GDM. Methods: This retrospective study included 161 GDM women having singleton pregnancies, without previous medical disorder and delivered at a tertiary care Hospital in Ha’il City, KSA from Dec 2020 till Jun 2021. Women diagnosed at < 24 weeks of pregnancy were grouped as early-onset GDM (n=71) and those diagnosed at ≥ 24 weeks as late-onset GDM (n=90). Both groups were matched for background variables. Chi-square and binary logistic regression analysis were applied with P-value significance at 0.05. Results: Past history of GDM, macrosomia and stillbirth were significant predictors for early-onset GDM (P value 0.000, 0.002 and 0.040 respectively). Regression analysis showed early-onset GDM significantly increases the risk for recurrent urinary tract infections (AOR 2.35), polyhydramnios (AOR 2.81), reduced fetal movements (AOR 2.13), intrauterine fetal demise (AOR 8.06), macrosomia (AOR 2.16), fetal birth trauma (2.58), low APGAR score at birth (AOR 8.06), and neonatal ICU admissions (AOR 2.65). Rate of preterm birth, hypertensive disorders, labor onset (natural vs. induced) and cesarean section and intrapartum maternal complications were same in both groups. Conclusion: Early-onset GDM significantly increases certain maternal (recurrent urinary tract infections, polyhydramnios and reduced fetal movements) and fetal complications (intrauterine fetal demise, macrosomia fetal birth trauma, low APGAR score at birth and neonatal ICU admissions). Most of these adverse pregnancy outcomes can be prevented through early registration and screening, close follow up, growth ultrasounds, and provision of efficient emergency and neonatal care services.

Oligohydramnios is the condition in which the liquor amni is reduced in amount to the extent of less than 200 ml at term. Sonographically, it is defined as when the maximum vertical pocket of liquor is < 2 cm or when amniotic fluid index is less than 5cm (<10th percentile). Oligohydramnios can be defined by an amniotic fluid index less than 5th percentile for gestational age or an amniotic fluid index <5.0 cm regardless of gestational age. Amniotic fluid volume decreases progressively during the last few weeks of pregnancy and during the postdate period, it is estimated that there is a 93 percent decline in amniotic fluid each week. The normal decline in the amniotic fluid volume has an impact on fetal movement in potentially compromised fetus. Ahn at al demonstrated a 3 to 5 fold increase ultrasonographically detected oligohydramnios in patient with complaints of decreased fetal movements. This relationship becomes extremely important in the postdate pregnancy, where changes of amniotic fluid volume can occur quickly. [ABSTRACT FROM AUTHOR]

The use of frozen embryo transfer in assisted reproductive technology (ART) has steadily increased since development in the early 1980's. While there are many benefits to delayed frozen embryo transfer, certain adverse perinatal outcomes are noted to be more common in these transfers when compared to fresh transfers, specifically hypertensive disorders of pregnancy. Frozen embryo transfers require coordination between the embryo's developmental stage and the endometrial environment and can occur in either ovulatory or programmed cycles. Though there is no consensus on the ideal method of endometrial preparation prior to frozen embryo transfer, emerging data suggests differences in maternal and neonatal outcomes, specifically increased rates of hypertensive disorders of pregnancy in programmed cycles. Other reported differences include an increased risk of cesarean delivery, placenta accreta, postpartum hemorrhage, low birthweight, preterm birth, post term delivery, macrosomia, large for gestational age, and premature rupture of membranes in programmed cycles. The mechanism by which these differences exist could reflect inherent differences in groups selected for each type of endometrial preparation, the role of super physiologic hormone environments in programmed cycles, or the unique contributions of the corpus luteum in ovulatory cycles that are not present in programmed cycles. Given that existing studies are largely retrospective and have several key limitations, further investigation is needed. Confirmation of these findings has implications for current practice patterns and could enhance understanding of the mechanisms behind important adverse perinatal outcomes in those pursuing assisted reproduction. [ABSTRACT FROM AUTHOR]

Background: Premature termination of pregnancy because of unmanageable maternal complications in hypertensive disorders of pregnancy (HDP) results in adverse neonatal outcome. Identification of biochemical derangements associated with maternal complications may help in the better medical management of the mother resulting in better neonatal outcomes. Method: Healthy pregnant women (C); pregnant women with gestational hypertension (GH), and preeclampsia (late [LP] and early [EP] onset) were studied. Maternal serum redox markers and adipokines were evaluated for their association with maternal complications. Results: Adiponectin levels were significantly raised in preeclampsia groups when compared with control and GH groups. Univariate and multivariate analysis confirmed that malondialdehyde (MDA) and total antioxidant status (TAS) were associated with eclampsia; adiponectin and TAS with HELLP syndrome; adiponectin, MDA and TAS with severe preeclampsia; and adiponectin with impaired renal function. Conclusion: We identified that increased serum adiponectin, MDA, and TAS were associated with adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to describe clinical characteristics and outcomes of pregnant women with COVID‐19 undergoing cesarean section, and evaluated the association of blood values at admission with severe COVID‐19 disease in this group of patients. Method: We retrospectively analyzed the clinical data of 110 patients infected with COVID‐19 who underwent cesarean section at Adana City Education and Research Hospital in Turkey. The COVID‐19 severity of the patients was classified as either severe or nonsevere disease according to World Health Organization of COVID‐19 clinical management guidance. We compared blood values, clinical characteristics, and outcomes between severe and nonsevere patients. Receiver operating characteristics (ROC) curves analyses and area under the ROC curve (AUC) value was calculated to evaluate the predictive value of blood parameters on the COVID‐19 severity. Results: Of the 110 women, 12 were severe cases. Severe patients had higher ferritin, neutrophil‐to‐lymphocyte ratio (NLR), lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate transaminase (AST), and procalcitonin levels on admission (p < 0.05). The ROC analysis demonstrated AUC of NLR, LDH, AST, ALT, ferritin, and procalcitonin was 0.757, 0.856, 0.840, 0.771, 0.821, and 0.698, respectively. The LDH had a maximum specificity (90.8%), with the cutoff value of 365. The O‐blood group was more likely to have severe illness than the non‐O‐blood group (relative risk: 3.6; 95% confidence interval; 1.2–10.4). Conclusion: This study shows that LDH values at admission are an early and powerful predictor of severe infection for pregnant women with COVID‐19 who will undergo a cesarean section. [ABSTRACT FROM AUTHOR]

Introduction: Placenta previa is a condition characterised by abnormal placental implantation and usually presented as painless vaginal bleeding in second or third trimester of pregnancy. Various studies have reported adverse outcomes in the cases of placenta previa. Aim: To find incidence, maternal and perinatal outcomes in placenta previa. Materials and Methods: This retrospective study was carried out during April-June 2021 at a Government Tertiary care centre in Maharashtra. Total 260 cases of placenta previa managed at the institute between 1st January 2017 to 31st December 2019 were included in study. Primary data from labour room and operation theatre was collected and detailed case papers were accessed from medical records section. Data was analysed using Microsoft Excel Windows 2013. Results: Incidence of placenta previa was 1.09%. Majority of cases were from age group of 26-30 years, booked, gravida 2-3, belonging to low socio-economic status and without any history of risk factors. In 81.15% cases Lower Segment Cesarean Section (LSCS) was required. Post Partem Haemorrhage (PPH) (32.30%) and need for blood transfusion (86.15%) were major complications. Maternal mortality in cases of placenta previa was 4.23%. In perinatal outcome, prematurity was reported 44.30% cases while 57.46% needed NICU admission. Perinatal mortality was 17.53%. Conclusion: There is need for regular Antenatal Care (ANC) check-up and timely referral to tertiary care obstetrical care centre with availability of Blood bank and NICU for better outcome. [ABSTRACT FROM AUTHOR]

Background: Cardiac disease in pregnancy is a major contributor to maternal mortality in high, middle and low-income countries. Availability of data on outcomes of pregnancy in women with heart disease is important for planning resources to reduce maternal mortality. Prospective data on outcomes and risk predictors of mortality in pregnant women with heart disease (PWWHD) from low- and middle-income countries are scarce.Methods: The Tamil Nadu Pregnancy and Heart Disease Registry (TNPHDR) is a prospective, multicentric and multidisciplinary registry of PWWHD from 29 participating sites including both public and private sectors, across the state of Tamil Nadu in India. The TNPHDR is aimed to provide data on incidence of maternal and fetal outcomes, adverse outcome predictors, applicability of the modified World Health Organization (mWHO) classification of maternal cardiovascular risk and the International risk scoring systems (ZAHARA and CARPREG I & II) in Indian population and identify possible gaps in the existing management of PWWHD. Pregnancy and heart teams will be formed in all participating sites. Baseline demographic, clinical, laboratory and imaging parameters, data on counselling received, antenatal triage and management, peripartum management and postpartum care will be collected from 2500 eligible participants as part of the TNPHDR. Participants will be followed up at one, three and six-months after delivery/termination of pregnancy to document study outcomes. Predictors of maternal and foetal outcome will be identified.Discussion: The TNPHDR will be the first representative registry from low- and middle-income countries aimed at providing crucial information on pregnancy outcomes and risk predictors in PWWHD. The results of TNPHDR could help to formulate steps for improved care and to generate a customised and practical guideline for managing pregnancy in women with heart disease in limited resource settings.Trial Registration: The TNPHDR is registered under Clinical Trials Registry-India ( CTRI/2020/01/022736 ). [ABSTRACT FROM AUTHOR]

Background: Globally, mobile health (mHealth) applications are known for their potential to improve healthcare providers' access to relevant and reliable health information. Besides, electronic decision support tools, such as the Safe Delivery mHealth Application (SDA), may help to reduce clinical errors and to ensure quality care at the point of service delivery. The current study investigated the use of the SDA and its relationship to basic emergency obstetric and newborn care (BEmONC) outcomes for the most frequent complications in Rwanda; post-partum haemorrhage (PPH) and newborn asphyxia.Methods: The study adopted a pre-post intervention design. A pre-intervention record review of BEmONC outcomes: Apgar score and PPH progressions, was conducted for 6 months' period (February 2019 - July 2019). The intervention took place in two district hospitals in Rwanda and entails the implementation of the SDA for 6 months (October 2019- March 2020), and included 54 nurses and midwives using the SDA to manage PPH and neonatal resuscitation. Six months' post-SDA intervention, the effect of the SDA on BEmONC outcomes was evaluated. The study included 327 participants (114 cases of PPH and 213 cases of neonatal complications). The analysis compared the outcome variables between the baseline and the endline data. Fisher's exact test was used to compare the proportions and test between-group differences and significance level set at p < 0.05.Results: Unstable newborn outcomes following neonatal resuscitation were recorded in 62% newborns cases at baseline and 28% newborns cases at endline, P-value = 0.000. Unstable maternal outcomes following PPH management were recorded in 19% maternal cases at baseline and 6% maternal cases at endline, P-value = 0.048. There was a significant association between the SDA intervention and newborns' and maternal' outcomes following neonatal resuscitation and PPH management, 6 months after baseline.Conclusion: The use of the SDA supported nurses and midwives in the management of PPH and neonatal resuscitation which may have contributed to improved maternal and neonatal outcomes during 6 months of the SDA intervention. The findings of this study are promising as they contribute to a broader knowledge about the effectiveness of SDA in low and middle income hospital settings. [ABSTRACT FROM AUTHOR]

Background: Despite maternal iron deficiency anemia being a worldwide medical complication, very few studies have been performed to evaluate the efficacy of iron supplementations for treating and preventing adverse pregnancy sequelae. This study attempts to show the impact of maternal iron deficiency anemia on the mother and the fetus and whether treatment can reverse the physiological and pathological effects of anemia on the mother as well as the fetus. Objective: To evaluate the effect of vascular adaptation and extent of compensatory changes in the fetus with the change in maternal hemoglobin (Hb) levels and to study maternal and perinatal outcomes after treatment of maternal iron deficiency anemia. Methodology: The present study was an observational prospective study conducted on 50 pregnant women in GMC, Srinagar from January 2016 to June 2017. The study population was divided into two groups-Group A-Patients with moderate anemia – Hb 7–9 g/dl and Group B-Patients with severe anemia – Hb <7 g/dl. Group A received parenteral iron preparation and Group B received blood transfusion or packed red blood cells until Hb exceeded 7 g/dL, then parenteral iron was used. Maternal Hb and color Doppler were performed before and after treatment of anemia. Results: There was a decrease in the umbilical artery resistivity index (RI) after treatment of maternal anemia in both the groups and the decrease was more in those who received blood transfusion. There was an improvement in middle cerebral artery RI in both the groups after treatment and the increase was statistically significant. The C/U ratio was normalized to >1.1 in both the study groups after treatment of anemia. Conclusion: Our data support the fact that maternal Hb content of <7 g/dl is strongly associated with marked fetal hemodynamic adaptation and must be treated with acute red cell transfusion. Moderate anemia (>7 g/dl) is not sufficient to trigger fetal blood flow redistribution and can be treated with parenteral iron. Close monitoring of the fetal umbilical and cerebral circulation by Doppler examination in anemic pregnancies allows the measurement of the amplitude of fetal vascular response, early assessment of fetal damage and helps in improving fetal outcome as well. [ABSTRACT FROM AUTHOR]

Background: There is a considerable debate about the management of myoma during cesarean section (CS). Recently, several studies indicated the safety and feasibility of undertaking myomectomy during CS. Objectives: To evaluate the safety, accessibility, and short-term morbidity of myomectomy for fibroids during cesarean section. Patients and methods: This was a randomized controlled trial that included 72 patients who were admitted to the Obstetrics & Gynecology Department, Menoufia University Hospital with uterine fibroids during pregnancy; who were randomly allocated equally into a group of cesarean myomectomy (CM; n=36) and another group of CS only (n=36). The operative events and the outcome were recorded and analyzed. Results: CM group showed a longer duration of surgery and longer hospital stay, higher amount of blood loss, and higher mean pain sores, with a highly statistically significant difference (p = 0.000). No cases in both groups required blood transfusion or ICU admission. No statistically significant differences were noted between both groups as regards the fetal outcome measures (p=0.583 & 0.601). Conclusion: CM is safe and applicable in selected cases without deleterious maternal complications. Special precautions ought to be paid during the procedure, particularly in the intramural type and with large fibroids. [ABSTRACT FROM AUTHOR]

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Background and objective: Orally disintegrating film is a solid dosage form made as an alternative for tablets for pediatric and geriatric patients who have difficulty in swallowing. These formulations are designed to dissolve in the mouth rapidly upon contact with saliva. This study aimed to prepare a thin oro-dispersible film base that can withstand handling in which a drug can be incorporated to provide a new dosage form. Methods: The solvent casting method was used to prepare the films, in which the ingredients were mixed, dissolved, and cast in a Petri dish. Then, they were left to dry in the oven overnight. Different concentrations of each of the two polymers alone and combined in different ratios were compared using different concentrations of plasticizer. Results: Successful, transparent films were prepared from gelatin and glycerin. A combination of 70% gelatin and 30% sodium carboxymethyl cellulose with glycerin formed an acceptable film having white color. The film forming capacity of sodium carboxymethyl cellulose alone was not good. All films were tearing and not well formed. All films that contain polyethylene glycol were brittle. Both superdisintegrants reduced the disintegration time for both films, but kyron was more effective than sodium starch glycolate. Conclusion: A successful oral film was prepared using different types of polymers, which is suitable for incorporating a potent drug to form a new dosage form that is easily portable and does not require water for swallowing.