Search

OBJECTIVE:  The aim of Placental Assessment in Response to Environmental Pollution Study (PARENTs) was to determine whether imaging of the placenta by novel multiparametric magnetic resonance imaging (MRI) techniques in early pregnancy could help predict adverse pregnancy outcomes (APOs) due to ischemic placental disease (IPD). Additionally, we sought to determine maternal characteristics and environmental risk factors that contribute to IPD and secondary APOs. STUDY DESIGN:  Potential patients in their first trimester of pregnancy, who agreed to MRI of the placenta and measures of assessment of environmental pollution, were recruited into PARENTs, a prospective population-based cohort study. Participants were seen at three study visits during pregnancy and again at their delivery from 2015 to 2019. We collected data from interviews, chart abstractions, and imaging. Maternal biospecimens (serum, plasma, and urine) at antepartum study visits and delivery specimens (placenta, cord, and maternal blood) were collected, processed, and stored. The primary outcome was a composite of IPD, which included any of the following: placental abruption, hypertensive disease of pregnancy, fetal growth restriction, or a newborn of small for gestational age. RESULTS:  In this pilot cohort, of the 190 patients who completed pregnancy to viable delivery, 50 (26%) developed IPD. Among demographic characteristics, having a history of prior IPD in multiparous women was associated with the development of IPD. In the multiple novel perfusion measurements taken of the in vivo placenta using MRI, decreased high placental blood flow (mL/100 g/min) in early pregnancy (between 14 and 16 weeks) was found to be significantly associated with the later development of IPD. CONCLUSION:  Successful recruitment of the PARENTs prospective cohort demonstrated the feasibility and acceptability of the use of MRI in human pregnancy to study the placenta in vivo and at the same time collect environmental exposure data. Analysis is ongoing and we hope these methods will assist researchers in the design of prospective imaging studies of pregnancy. KEY POINTS: · MRI was acceptable and feasible for the study of the human placenta in vivo.. · Functional imaging of the placenta by MRI showed a significant decrease in high placental blood flow.. · Measures of environmental exposures are further being analyzed to predict IPD..

• Grand multiparous women showed a significantly higher rate of postpartum hemorrhage only from parity eight. • Increasing parity is associated with an increased risk for obstetrical complications, such as PPH, placental abruption and LGA neonates, but with a decrease for some others obstetrical complications such as unplanned cesarean and preterm deliveries. • It seems that any additional delivery has an impact on obstetric outcomes, in a dose dependence matter. To assess the effect of each additional delivery among grand multiparous (GMP) women on maternal and neonatal outcomes. A multi-center retrospective cohort study that examined maternal and neonatal outcomes of GMP women (parity 5–10, analyzed separately for each parity level) compared to a reference group of multiparous women (parity 2–4). The study population included grand multiparous women with singleton gestation who delivered in one of four university-affiliated obstetrical centers in a single geographic area, between 2003 and 2021. We excluded nulliparous, those with parity > 10 (due to small sample sizes), women with previous cesarean deliveries (CDs), multifetal gestations, and out-of-hospital deliveries. The primary outcome of this study was postpartum hemorrhage (PPH, estimated blood loss exceeding 1000 ml, and/or requiring blood product transfusion, and/or a hemoglobin drop > 3 g/Dl). Secondary outcomes included unplanned cesarean deliveries, preterm delivery, along with other adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariable logistic regression. During the study period, 251,786 deliveries of 120,793 patients met the inclusion and exclusion criteria. Of those, 173,113 (69%) were of parity 2–4 (reference group), 27,894 (11%) were of parity five, 19,146 (8%) were of parity six, 13,115 (5%) were of parity seven, 8903 (4%) were of parity eight, 5802 (2%) were of parity nine and 3813 (2%) were of parity ten. GMP women exhibited significantly higher rates of PPH starting from parity eight. The adjusted odds ratios (aOR) were 1.19 (95 % CI: 1.06–1.34) for parity 8, 1.17 (95 % CI: 1.01–1.36) for parity 9, and 1.39 (95 % CI: 1.18–1.65) for parity 10. Additionally, they showed elevated rates of several maternal and neonatal outcomes, including placental abruption, large-for-gestational age (LGA) neonates, neonatal hypoglycemia, and neonatal seizures. Conversely, they exhibited decreased risk for other adverse maternal outcomes, including preterm deliveries, unplanned cesarean deliveries (CDs), vacuum-assisted delivery, and third- or fourth-degree perineal tears and small-for-gestational age (SGA) neonates. The associations with neonatal hypoglycemia, and neonatal seizure were correlated with the number of deliveries in a dose-dependent manner, demonstrating that each additional delivery was associated with an additional, significant impact on obstetrical complications. Our study demonstrates that parity 8–10 is associated with a significantly increased risk of PPH. Parity level > 5 correlated with increased odds of placental abruption, LGA neonates, neonatal hypoglycemia, and neonatal seizures. However, GMP women also demonstrated a reduced likelihood of certain adverse maternal outcomes, including unplanned cesarean, preterm deliveries, vacuum-assisted deliveries, SGA neonates, and severe perineal tears. These findings highlight the importance of tailored obstetrical care for GMP women to mitigate the elevated risks associated with higher parity. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality (MM) remains a real scourge that hits hardest in the poorest regions of the world, particularly those affected by conflict. However, despite this worrying reality, few studies have been conducted about MM ratio in the Democratic Republic of Congo (DRC). The study aimed to describe the trends as well as the epidemiological profile and causes of reported institutional maternal deaths between 2013 and 2022 in Eastern DRC. Methods: A retrospective descriptive study was conducted between March 2023 and August 2023 in eight Health Zones (HZ), five in South Kivu Province (Mwana, Minova, Miti-Murhesa, Kamituga and Idjwi) and three in North Kivu Province (Kirotshe, Karisimbi and Kayna) in the eastern region of the DRC. Our study covers 242 health facilities: 168 health centers (HC), 16 referral health centers (RHCs),50 referral hospitals (RH) and 8 general referral hospitals (GRHs). Data from registers and medical records of maternal deaths recorded in these zones from 2013–2022 were extracted along with information on the number of deliveries and live births. Sociodemographic, clinical parameters, blood and ultrasound tests and suspected causes of death between provinces were assessed. Results: In total, we obtained 177 files on deceased women. Of these, 143 (80.8%) were retained for the present study, including 75 in the 3 HZs of North Kivu and 68 in the 5 HZs of South Kivu. From 2013 to 2022, study sites experienced two significant drops in maternal mortality ratio (MMR) (in 2015 and 2018), and a spike in 2016–2017. Nonetheless, the combined MMR (across study sites) started and ended the 10-year study period at approximately the same level (53 and 57 deaths per 100,000 live births in 2013 and 2022 respectively). Overall, 62,6% of the deaths were reported from secondary hospital. Most deaths were of married women in their thirties (93.5%). Almost half (47.8%) had not completed four antenatal consultations. The main direct causes of death were, in decreasing order of frequency: post-partum haemorrhage (55.2%), uterine rupture (14.0), hypertensive disorders (8.4%), abortion (7.7%) puerperal infections (2.8%) and placental abruption (0.7%). When comparing among provinces, reported abortion-related maternal mortality (14.1% vs 0%) was more frequent in North Kivu than in South Kivu. Conclusion: This study imperatively highlights the need for targeted interventions to reduce maternal mortality. By emphasizing the crucial importance of antenatal consultations, intrapartum/immediate post-partum care and quality of care, significant progress can be made in guaranteeing maternal health and reducing many avoidable deaths. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of the present study was to determine the risk factors for patients with pre‐eclampsia (PE) with severe features to develop hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and to design a prediction score model that incorporates these risk factors.A retrospective cohort study was conducted at a tertiary university‐affiliated medical center between 2011 and 2019. The study population comprised patients diagnosed with PE with severe features, divided into two groups: those with HELLP syndrome (study group) and those without (control group). A logistic regression was employed to identify independent predictors of HELLP syndrome. A predictive model for the occurrence of HELLP syndrome in the context of PE with severe features was developed using a receiver operating characteristic curve analysis.Overall, 445 patients were included, of whom 69 patients were in the study group and 376 in the control group. A multivariate logistic analysis regression showed that maternal age <40 (OR = 2.28, 95% CI: 1.13–5.33, P = 0.045), nulliparity (OR = 2.22, 95% CI: 1.14–4.88, P = 0.042), mild hypertension (OR = 2.31, 95% CI: 1.54–4.82, P = 0.019), epigastric pain (OR = 3.41, 95% CI: 1.92–7.23, P < 0.001) and placental abruption (OR = 6.38, 95% CI: 1.29–35.61, P < 0.001) were independent risk factors for HELLP syndrome. A prediction score model reached a predictive performance with an area under the curve of 0.765 (95% CI: 0.709–0.821).This study identified several key risk factors for developing HELLP syndrome among patients with PE with severe features and determined that a prediction score model has the potential to aid clinicians in identifying high risk patients. [ABSTRACT FROM AUTHOR]

Purpose: PCOS and endometriosis are independent risk factors for perinatal outcomes. Little research has evaluated the concomitant effects of these conditions, nor have studies been conducted on a population database. We sought to identify the pregnancy, delivery, and neonatal outcomes in women with polycystic ovary syndrome (PCOS) and endometriosis vs. PCOS without endometriosis. Methods: A retrospective population-based cohort study was performed extracting data using ICD-9 codes from the HCUP-NIS Database from 2004 to 2014. Endometriosis in women with PCOS represented the study group (n = 163), and the remaining PCOS, non-endometriosis patients constituted the reference group (n = 14,719). Subjects were included once per delivery. Demographics were compared using chi-squared tests. Confounding effects in pregnancy outcomes were controlled using binary logistic regression analysis. Results: Concomitant endometriosis and PCOS patients were more likely to be white (88.5% vs.71.0%, p < 0.001), with BMI < 30 kg/m2 (87.1% vs.77.8%, p < 0.004) and from lower income quartiles (27.1% vs.17.1%, p < 0.017) when compared to PCOS without endometriosis. Comparing pregnancy complication rates, placental abruption (p < 0.018, aOR 3.01, 95% CI 1.21–7.50), Cesarean section (p < 0.003, aOR 1.75, 95% CI 1.21–2.53), deep venous thromboses (p < 0.002, aOR 74.31, 95% CI 4.57–1209.21), and venous thromboembolic events (p < 0.031, aOR 10.40, 95% CI 1.24–87.37), were increased in the study group compared to the reference group. Conclusion: Women with PCOS and endometriosis were more likely to be white, of lower socioeconomic status, lean, and experience abruptio-placenta, cesarean deliveries, and venous thromboembolisms. Since little was previously known about the combined outcomes of PCOS and endometriosis, it is difficult to counsel patients on risks. Our findings can help clinicians manage pregnant PCOS patients with endometriosis to minimize complications such as abruptio placenta and VTE. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence and sociodemographic and clinical risk factors associated with birth asphyxia and the immediate neonatal outcomes of birth asphyxia in Nigeria. Design: Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme. Setting: Fifty‐four consenting referral‐level hospitals (48 public and six private) across the six geopolitical zones of Nigeria. Population: Women (and their babies) who were admitted for delivery in the facilities between 1 September 2019 and 31 August 2020. Methods: Data were extracted and analysed on prevalence and sociodemographic and clinical factors associated with birth asphyxia and the immediate perinatal outcomes. Multilevel logistic regression modelling was used to ascertain the factors associated with birth asphyxia. Main outcome measures: Incidence, case fatality rate and factors associated with birth asphyxia. Results: Of the available data, 65 383 (91.1%) women and 67 602 (90.9%) babies had complete data and were included in the analysis. The incidence of birth asphyxia was 3.0% (2027/67 602) and the case fatality rate was 16.8% (339/2022). The risk factors for birth asphyxia were uterine rupture, pre‐eclampsia/eclampsia, abruptio placentae/placenta praevia, birth trauma, fetal distress and congenital anomaly. The following factors were independently associated with a risk of birth asphyxia: maternal age, woman's education level, husband's occupation, parity, antenatal care, referral status, cadre of health professional present at the birth, sex of the newborn, birthweight and mode of birth. Common adverse neonatal outcomes included: admission to a special care baby unit (SCBU), 88.4%; early neonatal death, 14.2%; neonatal sepsis, 4.5%; and respiratory distress, 4.4%. Conclusions: The incidence of reported birth asphyxia in the participating facilities was low, with around one in six or seven babies with birth asphyxia dying. Factors associated with birth asphyxia included sociodemographic and clinical considerations, underscoring a need for a comprehensive approach focused on the empowerment of women and ensuring access to quality antenatal, intrapartum and postnatal care. [ABSTRACT FROM AUTHOR]

Objective: To construct algorithms with a sequential decision analysis pathway for monitoring of the fetal heart rate and managing fetal heart rate bradycardia, late decelerations and tachycardia during labour. Population: Low‐risk pregnant women in labour with singleton cephalic term pregnancies. Setting: Institutional births in low‐ and middle‐income countries. Search strategy: We sought relevant published clinical algorithms, guidelines and randomised trials/reviews by searching the Cochrane Library, PubMed and Google on the terms: "fetal AND heart AND rate AND algorithm AND (labour OR intrapartum)", up to March 2020. Case scenarios: The two scenarios included were fetal heart rate bradycardia or late decelerations (potentially related to uterine rupture, placental abruption, cord prolapse, maternal hypotension, uterine hyperstimulation or unexplained) and fetal heart rate tachycardia (potentially related to maternal hyperthermia, infection, dehydration or unexplained). The algorithms provide pathways for definition, assessment, diagnosis, interventions to correct the abnormalities and ongoing monitoring leading to mode of birth, and linking to other algorithms in the series. Conclusions: The algorithms provide a framework for monitoring and managing fetal heart rate bradycardia, late decelerations and tachycardia during labour. We emphasise the inherent diagnostic inaccuracy of fetal heart rate monitoring, the tendency to over‐diagnose fetal compromise, the need to consider fetal heart rate information in the context of other clinical features and the need to engage in informed, shared, family‐centred decision‐making. We note the need for further research on methods of fetal assessment during labour including clinical fetal arousal testing and the rapid biophysical profile test. Decision analysis algorithms for fetal bradycardia, late decelerations and tachycardia highlight diagnostic limitations. Decision analysis algorithms for fetal bradycardia, late decelerations and tachycardia highlight diagnostic limitations. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for developing early postpartum hemorrhage (PPH) and to examine whether risk factors vary according to severity and mode of delivery. Methods: A population‐based cohort study was conducted in which all deliveries at a tertiary medical center were included. Risk factors for developing early PPH were compared based on the severity of bleeding as well as the mode of delivery. Multiple logistic regression models were used to control for confounders. Results: Among 322 497 deliveries included in the analysis, early PPH complicated 1811 (0.56%) of all deliveries. Among all cases of early PPH, 505 deliveries (28%) were complicated with severe PPH. Using a logistic regression model, in vitro fertilization (IVF) pregnancy, previous cesarean delivery (CD), pre‐eclampsia, placental abruption, and uterine rupture were independently associated only with severe early PPH, while non‐progressive second stage of labor, induction of labor, and large for gestational age were independently associated with both severe and mild early PPH. When applying an additional logistic regression model, whereas IVF pregnancy, pre‐eclampsia, and large for gestational age were independently associated with early PPH among vaginal deliveries only, placenta previa was independently associated with early PPH among CD only. Conclusions: Independent risk factors for developing severe PPH solely include IVF pregnancy, previous CD, pre‐eclampsia, placental abruption, and uterine rupture. IVF pregnancy, pre‐eclampsia, and large for gestational age are independent risk factors for early PPH following vaginal delivery, while placenta previa is independently associated with early PPH after CD only. Due to the recognition of the importance of both the provider and institutional planning and preparation for PPH, the study's results should be viewed within the scope of its retrospective cohort design. Synopsis: We found that risk factors for early PPH differ significantly according to its severity as well as the mode of delivery. [ABSTRACT FROM AUTHOR]

Objective: To determine the cutoff of intertwin delivery intervals (IDIs) as a predictor for neonatal acidemia. Method: This retrospective cohort study was conducted at a single tertiary care center. Women attempting vaginal delivery of twins between 2010 and 2019 and who reached the second stage of labor were included. The cutoff point for prolonged IDI was established using a receiver operating characteristic (ROC) curve and Youden's J statistic. Maternal and neonatal outcomes were compared between short and prolonged IDI cohorts. Results: A total of 461 women were included in the study. A cutoff time of 10 min was found to be the best predictor for neonatal acidemia (arterial cord pH ≤ 7.1), with a sensitivity of 90% and a specificity of 59%. Second twins delivered more than 10 min after the first twin were more likely to be acidemic and to have a 5‐min Apgar score of 7 or less (13.5% vs 3.3%, P = 0.01, and 8.4% vs 3.2%, P = 0.02, respectively). An IDI of more than 10 min was also associated with increased rate of cesarean delivery and placental abruption (13.5% vs 0.8%, P < 0.001, and 3.4% vs 0.8%, P = 0.047, respectively). No other adverse maternal or neonatal outcomes were statistically significant between cohorts. Conclusion: An IDI of more than 10 min is associated with a higher risk for neonatal academia, with a low 5‐min Apgar score, and higher cesarean delivery and placental abruption rates. These findings provide insights that are valuable when counseling and managing twin pregnancies attempting vaginal delivery. Interventions aimed at shortening the IDI should be considered to prevent adverse neonatal outcomes. Synopsis: A 10‐min IDI cutoff is the best predictor for neonatal acidemia in twin deliveries, with implications for cesarean delivery and placental abruption risks. [ABSTRACT FROM AUTHOR]

• The diagnosis of fetal growth restriction (FGR) due to uteroplacental insufficiency improves perinatal outcome. • Using angiogenic markers to diagnose small for gestational age fetuses can enhance the current diagnostic FGR consensus. • Further studies are needed to integrate angiogenic markers into ultrasound parameters currently used for FGR diagnosis. The identification of fetal growth restriction (FGR) due to uteroplacental insufficiency is important to improve perinatal outcomes. To distinguish FGR from small for gestational age (SGA), FGR consensus definition is currently based on biometry and/or additional biophysical parameters. This study aims to verify if this definition might be modified by including circulating angiogenic factors. This historical cohort study included singleton pregnancies with SGA fetuses after 20 weeks. All patients underwent detailed ultrasound and measurements of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) at first assessment. ISUOG criteria for FGR were applied. Total PlGF was calculated using free PlGF, sFlt-1 and a receptor pharmacology model, and multiple of the median (MoM) values for sFlt-1, free PlGF, total PlGF and sFlt-1/PlGF ratio were calculated to adjust for gestational age. 72 pregnancies with SGA were first evaluated at median (IQR) of 28+5 (26+2 –31+3) weeks' gestation, and 51 fetuses (70.8 %) satisfied the FGR consensus definition. Pregnancies with FGR showed significantly lower levels of free and total PlGF MoM (0.12, 95 % IQR: 0.07–0.36 vs 0.32, 95 % IQR: 0.20–0.53, p = 0.008) and 0.26, 95 % CI: 0.16–0.55 vs 0.43, 95 % IQR: 0.23–0.53, p = 0.028) respectively; and higher sFlt-1 MoM (4.62, 95 % IQR: 1.80–7.30 vs 1.74, 95 % IQR:1.11–3.61, p = 0.014) than pregnancies not classified as FGR. Free and total PlGF MoM correlated significantly with gestational age at delivery (r = 0.776, p < 0.001 and r = 0.707, p < 0.001, respectively). sFlt-1 MoM and sFlt-1/PlGF ratio MoM also correlated with gestational age at delivery (r = -0.681, p < 0.001 and r = -0.823, p < 0.001). Six cases identified as FGR at first ultrasound were not confirmed at birth showing significantly higher levels of free PlGF MoM (0.77, 95 % IQR: 0.27–3.07 vs 0.17, 95 % IQR: 0.08–0.43, p = 0.022). These findings show that total as well as free PlGF levels are lower in pregnancies affected with placental growth restriction. Angiogenic biomarkers might improve the differentiation between placental growth restriction and constitutional smallness. Further studies are needed to determine how to integrate them into the current definitions of FGR. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relative importance of ethnicity and socioeconomic deprivation in determining the likelihood and prevalence of placentally derived composite of adverse pregnancy outcomes (CAPO) and composite of severe adverse pregnancy outcomes (CAPO‐S). Methods: This was a single‐center retrospective cohort study of data obtained in a tertiary maternity unit. Data regarding ethnicity and socioeconomic deprivation (as measured with indices of multiple deprivation) were collected for 13 165 singleton pregnancies screened routinely in the first trimester for pre‐eclampsia using the Fetal Medicine Foundation combined risk‐assessment algorithm. CAPO was defined as the presence of one or more interrelated outcomes associated with placental dysfunction, namely, hypertensive disorders of pregnancy, preterm birth, birth weight ≤ 10th centile and stillbirth. CAPO‐S was defined as the presence of one or more of the following: hypertensive disorders of pregnancy at < 37 + 0 weeks, preterm birth at < 34 + 0 weeks, birth weight ≤ 5th centile and stillbirth at < 37 + 0 weeks. Results: The prevalence of CAPO was 16.3% in white women, 29.3% in black women and 29.3% in South Asian women. However, half (51.7%) of all CAPO cases occurred in white women. There was a strong interaction between ethnicity and socioeconomic deprivation, with a correlation coefficient of −0.223. Both ethnicity and socioeconomic deprivation influenced the prevalence of CAPO and CAPO‐S, with the contribution of ethnicity being the strongest. Conclusions: Black and Asian ethnicity, as well as socioeconomic deprivation, influence the prevalence of placenta‐mediated adverse pregnancy outcomes. Despite this, most adverse pregnancy outcomes occur in white women, who represent the majority of the population and are also affected by socioeconomic deprivation. For these reasons, inclusion of socioeconomic deprivation should be considered in early pregnancy risk assessment for placenta‐mediated CAPO. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. This article's abstract has been translated into Spanish and Chinese. Follow the links from the abstract to view the translations. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Journal of General Medical Research is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective Methods Results Conclusion This study aimed to clarify the maternal and neonatal outcomes based on the presence or absence of a Couvelaire uterus with placental abruption.This single‐center retrospective study was conducted at a tertiary perinatal center in Japan, including patients diagnosed with acute placental abruption who delivered live births via cesarean section between 2016 and 2023. Patients were divided into two groups based on the presence or absence of a Couvelaire uterus during surgery: the Couvelaire and normal uterus groups. Maternal and neonatal outcomes were assessed.This study included 76 patients: 24 in the Couvelaire group and 52 in the normal uterus group. No patients underwent hysterectomies. The Couvelaire group had significantly higher intraoperative blood loss (median 1152 vs 948 g, P = 0.010), blood transfusion rates (58% vs 31%, P = 0.022), fibrinogen administration rates (38% vs 13%, P = 0.038), intensive care unit/high care unit admission rates (29% vs 7.7%, P = 0.013), and disseminated intravascular coagulation complication rates (25% vs 7.7%, P = 0.038). There were no differences in birth weight, gestational age (median 2387 vs 2065 g, P = 0.082), Apgar score <4 at 5 min (4.2% vs 3.9%, P = 0.95), umbilical artery blood pH <7.1 (25% vs 22%, P = 0.82), and neonatal death (4.2% vs 1.9%, P = 0.57).A Couvelaire uterus indicated adverse maternal outcomes but not neonatal ones. Its presence necessitates preparation for blood transfusions and/or intensive patient follow‐up. [ABSTRACT FROM AUTHOR]

This article addresses the issue of maternal mortality rates and the need for evidence-based interventions to address this global concern. It emphasizes that most maternal deaths occur in low- and middle-income countries, with hypertensive disorders of pregnancy and delivery complications being major contributors. The article also highlights the impact of factors such as obesity, ethnicity, and socioeconomic disparities on maternal mortality rates. It discusses the increase in maternal mortality during the COVID-19 pandemic and the need for comprehensive interventions and healthcare approaches to reduce maternal mortality. The text provides various interventions and strategies aimed at reducing maternal mortality rates, including addressing specific risk factors, medical and social interventions, access to healthcare facilities, and proper postpartum care. It emphasizes the importance of ongoing comprehensive interventions that are adaptable to diverse populations and tailored to individual and community needs. The article also emphasizes the importance of accurate statistics and a deeper understanding of contributing factors in preventing maternal deaths. The document provides a list of references related to maternal mortality and morbidity, including studies from various countries and regions. It also includes a list of research articles and publications related to maternal and neonatal health, covering topics such as prevention and treatment of conditions, access to care, and the impact of COVID-19. The article references three different sources related to severe maternal morbidity and the prevention of maternal mortality, providing valuable information for library patrons conducting research on these topics. [Extracted from the article]

Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusion Mental health disorders in pregnant women have been related to unfavorable obstetric and neonatal outcomes. Obsessive‐compulsive disorder (OCD) significantly distresses mothers and affects the maternal–infant bond.The present meta‐analysis and systematic review aimed to assess the association of maternal OCD with adverse feto‐maternal outcomes.A systematic search was undertaken in the five databases—Cochrane, Embase, ProQuest, Web of Science, and PubMed—on September 5, 2023.Studies that included pregnant women with OCD in whom the feto‐maternal outcomes were reported were included in the systematic review.Two pass screening (“title‐abstract screening” followed by “full‐text review”), and data extraction by two authors independently using the Nested‐Knowledge Auto living semi‐automated systematic review platform was carried out. The decision for selected studies was reviewed by a third author. Of the 360 studies identified, eight were included for the meta‐analysis. Meta‐analysis was conducted using R software.Of the 24 maternal and neonatal adverse outcomes assessed, 11 were found to be associated with maternal OCD, notably pre‐eclampsia (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.19–1.57), antepartum hemorrhage or placental abruption (OR 1.32, 95% CI 1.13–1.54), postpartum hemporrhage (OR 1.19, 95% CI 1.08–1.31), cesarean section delivery (OR 1.32, 95% CI 1.23–1.41), emergency cesarean section (OR 1.22, 95% CI 1.15–1.30), preterm birth (OR 1.41, 95% CI 1.21–1.64), low birth weight (OR 1.41, 95% CI 1.28–1.54), low Apgar score at 5 min (OR 2.37, 95% CI 1.32–4.27), neonatal hypoglycemia (OR 1.37, 95% CI 1.23–1.53), neonatal respiratory distress (OR 1.77, 95% CI 1.44–2.16), and major congenital malformations (OR 1.37, 95% CI 1.08–1.74).OCD in pregnant women might be associated with multiple adverse feto‐maternal outcomes. [ABSTRACT FROM AUTHOR]

Furcate cord insertion refers to the separation of umbilical vessels before reaching the placenta, where the branching vessels normally attach at the edge of the placental parenchyma or near the placental membranes. This is an extremely rare abnormal umbilical cord insertion. This paper reported a case of a furcate cord insertion, where the rupture of exposed umbilical vessels led to intrauterine fetal death at full term. Through literature review, we analyzed the prenatal ultrasound characteristics and pregnancy outcomes of furcate cord insertions, with the aim to improve detection rates and reduce the risk of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

The article presents a case study of a newborn admitted to a small community medical center with complications following delivery. Topics include the mother's prenatal challenges and the diagnosis of placental abruption, the newborn's critical condition with evidence of meconium aspiration and respiratory distress, and the delayed response in care that led to the eventual need for intubation and transport to a more advanced facility.

Purpose: To develop a new cost-effective marker named creatinine–fibrinogen ratio (CFR) for the prediction of composite adverse outcomes (CAO) in placental abruption cases. Methods: A total of 109 placental abruption patients (30 with adverse outcomes, 79 without adverse outcomes) were enrolled in this retrospective cohort study. Patients with at least one of the features listed below were included in the abruption with CAO group: requirement of blood product transfusion (erythrocyte suspension, fresh frozen plasma, pooled thrombocyte, thrombocyte apheresis), development of acute kidney injury or disseminated intravascular coagulation, and need for intensive care unit. Laboratory parameters and CFR values at admission to the hospital were compared between the two groups. Results: Higher creatinine and lower fibrinogen levels were found in the CAO group (p = 0.007 and p < 0.001 respectively). The CFR value of the CAO group was significantly higher (p < 0.001). In the ROC curve analysis performed to investigate the value of CFR in CAO prediction, the area under the curve (AUC) was calculated as 0,802 (95% CI 0.709–0.895, 77% sensitivity, 65% specificity). Conclusion: CFR seems to be a practical marker for the prediction of CAOs in pregnant women with ablatio placenta. [ABSTRACT FROM AUTHOR]

Introduction Materials and Methods Results Conclusions Antithrombin (AT) deficiency is a rare but highly thrombogenic inherited thrombophilia. Its association with adverse pregnancy outcomes (APO) is undefined. There is limited guidance on managing AT deficiency in pregnancy. Some significant issues remain controversial, including risk assessment for prophylactic anticoagulation, anticoagulant therapy, and monitoring. Our goal was to examine if the antepartum management of patients with AT deficiency affected their pregnancy outcomes.This retrospective, single‐center observational study included pregnant women with inherited AT deficiency in Peking Union Medical College Hospital between 2013 and 2024.Seventeen pregnancies in 6 women with AT deficiency were identified. A total of 7 pregnancies received adjusted‐dose low‐molecular‐weight heparin (LMWH) and were monitored by anti‐Xa level, AT activity, and D‐dimer. There were 5 live births (all received LMWH), 7 second‐trimester abortions (1 received LMWH), and 5 early pregnancy losses (1 received LMWH). There were 5 abruptio placentae events (3 received LMWH) and 7 thrombotic events (2 received LMWH).AT deficiency is at least an important partial factor contributing to APO. It is suggested to make a full assessment of AT patients both for venous thrombus embolism and APO risk. We observed a high prevalence of heparin resistance and a positive correlation between adequate anticoagulation and pregnancy outcome based on tight monitoring with anti‐Xa level and timely adjustment of the LMWH dosage. [ABSTRACT FROM AUTHOR]

Objective: To evaluate risk for adverse obstetric outcomes associated with the coronavirus disease 2019 (COVID‐19) pandemic period and with COVID‐19 diagnoses. Design: Serial cross‐sectional study. Setting: A national sample of US delivery hospitalisations before (1/2016 to 2/2020) and during the first 10 months of (3/2020 to 12/2020) the COVID‐19 pandemic. Population: All 2016–2020 US delivery hospitalisations in the National Inpatient Sample. Methods: Delivery hospitalisations were identified and stratified into pre‐pandemic and pandemic periods and the likelihood of adverse obstetric outcomes was compared using logistic regression models with adjusted odds ratios (aOR) with 95% confidence intervals (CI) as measures of association. Risk for adverse outcomes was also analysed specifically for 2020 deliveries with a COVID‐19 diagnosis. Main Outcome Measure: Adverse maternal outcomes including respiratory complications and cardiac morbidity. Results: Of an estimated 18.2 million deliveries, 2.9 million occurred during the pandemic. The proportion of delivery hospitalisations with a COVID‐19 diagnosis increased from 0.1% in March 2020 to 3.1% in December. Comparing the pandemic period to the pre‐pandemic period, there were higher adjusted odds of transfusion (aOR 1.12, 95% CI 1.05–1.19), a respiratory complication composite (aOR 1.37, 95% CI 1.29–1.46), cardiac severe maternal morbidity (aOR 1.30, 95% 1.20–1.39), postpartum haemorrhage (aOR 1.19, 95% CI 1.15–1.24), placental abruption/antepartum haemorrhage (OR 1.04, 95% CI 1.00–1.08), and hypertensive disorders of pregnancy (OR 1.23, 95% CI 1.21–1.26). These associations were similar to unadjusted analysis. Risk for these outcomes during the pandemic period was significantly higher in the presence of a COVID‐19 diagnosis. Conclusions: In a national estimate of delivery hospitalisations, the odds of cardiac and respiratory outcomes were higher in 2020 compared with 2016–2019. COVID‐19 diagnoses were specifically associated with a range of serious complications. [ABSTRACT FROM AUTHOR]

Severe cases of hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome requiring plasma exchange or dialysis should be differentiated from other thrombotic microangiopathy (TMA) and treated appropriately. To evaluate the prevalence and clinical characteristics of such cases in Japan, a questionnaire‐based survey was conducted among obstetricians who are members of the Perinatal Research Network Group in Japan. There were a total of 335 cases of HELLP syndrome over a 3‐year period in the 48 facilities that responded to the survey. Four patients required plasma exchange or dialysis, of which two were diagnosed with atypical hemolytic uremic syndrome and two with TMA secondary to systemic lupus erythematosus. Although such severe HELLP syndrome is rare, identifying the clinical features and making accurate differential diagnosis are critical for optimal clinical outcomes for mothers and neonates. [ABSTRACT FROM AUTHOR]

BACKGROUND With increasing significance of developmental programming effects associated with placental dysfunction, more investigations are devoted to improving the characterization and understanding of placental signatures in health and disease. The placenta is a transitory but dynamic organ adapting to the shifting demands of fetal development and available resources of the maternal supply throughout pregnancy. Trophoblasts (cytotrophoblasts, syncytiotrophoblasts, and extravillous trophoblasts) are placental-specific cell types responsible for the main placental exchanges and adaptations. Transcriptomic studies with single-cell resolution have led to advances in understanding the placenta's role in health and disease. These studies, however, often show discrepancies in characterization of the different placental cell types. OBJECTIVE AND RATIONALE We aim to review the knowledge regarding placental structure and function gained from the use of single-cell RNA sequencing (scRNAseq), followed by comparing cell-type-specific genes, highlighting their similarities and differences. Moreover, we intend to identify consensus marker genes for the various trophoblast cell types across studies. Finally, we will discuss the contributions and potential applications of scRNAseq in studying pregnancy-related diseases. SEARCH METHODS We conducted a comprehensive systematic literature review to identify different cell types and their functions at the human maternal–fetal interface, focusing on all original scRNAseq studies on placentas published before March 2023 and published reviews (total of 28 studies identified) using PubMed search. Our approach involved curating cell types and subtypes that had previously been defined using scRNAseq and comparing the genes used as markers or identified as potential new markers. Next, we reanalyzed expression matrices from the six available scRNAseq raw datasets with cell annotations (four from first trimester and two at term), using Wilcoxon rank-sum tests to compare gene expression among studies and annotate trophoblast cell markers in both first trimester and term placentas. Furthermore, we integrated scRNAseq raw data available from 18 healthy first trimester and nine term placentas, and performed clustering and differential gene expression analysis. We further compared markers obtained with the analysis of annotated and raw datasets with the literature to obtain a common signature gene list for major placental cell types. OUTCOMES Variations in the sampling site, gestational age, fetal sex, and subsequent sequencing and analysis methods were observed between the studies. Although their proportions varied, the three trophoblast types were consistently identified across all scRNAseq studies, unlike other non-trophoblast cell types. Notably, no marker genes were shared by all studies for any of the investigated cell types. Moreover, most of the newly defined markers in one study were not observed in other studies. These discrepancies were confirmed by our analysis on trophoblast cell types, where hundreds of potential marker genes were identified in each study but with little overlap across studies. From 35 461 and 23 378 cells of high quality in the first trimester and term placentas, respectively, we obtained major placental cell types, including perivascular cells that previously had not been identified in the first trimester. Importantly, our meta-analysis provides marker genes for major placental cell types based on our extensive curation. WIDER IMPLICATIONS This review and meta-analysis emphasizes the need for establishing a consensus for annotating placental cell types from scRNAseq data. The marker genes identified here can be deployed for defining human placental cell types, thereby facilitating and improving the reproducibility of trophoblast cell annotation. [ABSTRACT FROM AUTHOR]

Objective: The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The study objective was to examine the effects of gestational LD on obstetrical and neonatal outcomes. Methods: Using the Healthcare Cost & Utilization Project National (Nationwide) Inpatient Sample from the United States, we conducted a retrospective cohort study of pregnant patients admitted to the hospital between 2016 and 2019. The exposed group consisted of pregnant patients with gestational LD infection (International Classification of Diseases, Tenth Revision [ICD‐10] code A692x), while the comparison group consisted of pregnant patients without gestational LD. Descriptive statistics and multivariate logistic regression models, adjusted for baseline maternal characteristics, were used to determine the associations between gestational LD and obstetrical and neonatal outcomes. Results: The cohort included 2 943 575 women, 226 of whom were diagnosed with LD during pregnancy. The incidence of LD was 7.67 per 100 000 pregnancy admissions. The incidence of gestational LD was stable over the study period. Pregnant patients with LD were more likely white, older, to have private health insurance, and to belong to a higher income quartile. Gestational LD was associated with an increased risk of placental abruption (adjusted odds ratio [aOR], 3.45 [95% confidence interval (CI), 1.53–7.80]) and preterm birth (aOR, 1.58 [95% CI, 1.03–2.42]). Conclusion: Gestational LD is associated with a higher risk of placental abruption and preterm birth. Pregnancies complicated by LD, while associated with a higher risk of certain adverse outcomes, can be followed in most healthcare settings. Synopsis: Lyme disease in pregnancy is associated with an increased risk of placental abruption and preterm birth. [ABSTRACT FROM AUTHOR]

Introduction: Pregnant women with a fibrinogen level <2 g/L represent a high‐risk group that is associated with severe postpartum hemorrhage and other complications. Women who would qualify for fibrinogen therapy are not yet identified. Material and methods: A population‐based cross‐sectional study was conducted using the UK Obstetric Surveillance System between November 2017 and October 2018 in any UK hospital with a consultant‐led maternity unit. Any woman pregnant or immediately postpartum with a fibrinogen <2 g/L was included. Our aims were to determine the incidence of fibrinogen <2 g/L in pregnancy, and to describe its causes, management and outcomes. Results: Over the study period 124 women with fibrinogen <2 g/L were identified (1.7 per 10 000 maternities; 95% confidence interval 1.4–2.0 per 10 000 maternities). Less than 5% of cases of low fibrinogen were due to preexisting inherited dysfibrinogenemia or hypofibrinogenemia. Sixty percent of cases were due to postpartum hemorrhage caused by placental abruption, atony, or trauma. Amniotic fluid embolism and placental causes other than abruption (previa, accreta, retention) were associated with the highest estimated blood loss (median 4400 mL) and lowest levels of fibrinogen. Mortality was high with two maternal deaths due to massive postpartum hemorrhage, 27 stillbirths, and two neonatal deaths. Conclusions: Fibrinogen <2 g/L often, but not exclusively, affected women with postpartum hemorrhage due to placental abruption, atony, or trauma. Other more rare and catastrophic obstetrical events such as amniotic fluid embolism and placenta accreta also led to low levels of fibrinogen. Maternal and perinatal mortality was extremely high in our cohort. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the clinical characteristics and serious medical and psychosocial complications of pregnant and postpartum adolescent patients at a pediatric emergency department (PED). Materials and Methods: Demographic and clinical data of all pregnant and postpartum adolescents who presented to the PED of a single tertiary referral hospital between January 2020 and January 2023 were collected and documented retrospectively. Results: Twenty-seven patients with a mean age of 16.7 ± 0.8 years were included in the study. The main presenting complaints were abdominal pain (n = 9), suspicion of pregnancy (n = 5), cough, seizure, and vomiting (3 patients each). Potentially life-threatening medical complications included stroke (n = 3), placental abruption (n = 1), and carbon monoxide intoxication (n = 1). Sexual assault (n = 4), physical assault (n = 2), recurrent pregnancies (n = 5), and suicide attempts (n = 4) were serious psychological and social complications in our patient group. Conclusion: Pregnant and post-partum adolescents may present to PED with serious lifethreatening complications, and permanent sequelae may occur. In addition to sexual and physical violence, various psychological problems are comorbid conditions. These patients should be managed with a multidisciplinary biopsychosocial approach, and these issues considered in their acute treatment and follow-up at emergency departments. [ABSTRACT FROM AUTHOR]

• Urinary PlGF is a tight reference of serum PlGF. • Urinary PlGF is the best predictor of prenatal cerebral vasodilatation. • Reliability of urinary sFlt-1 values are relative to serum creatinine concentration. To evaluate the correlation between maternal serum and urinary soluble Fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) levels and to assess their potential value in preeclampsia and fetal growth restriction. This case-control longitudinal prospective study was performed in 49 singleton pregnant women, divided into two clinical groups, low risk pregnancy (n = 23) and pregnancy complicated by preeclampsia (n = 26). Maternal serum and urinary sFlt-1 and PlGF levels were quantified by electrochemiluminescence. Every patient underwent an ultrasound for fetal biometry. Doppler assessment was done when estimated fetal weight was under the 10th centile. ROC curves were used to evaluate the predictive capability of serum and urinary angiogenic biomarkers and their ratios on preeclampsia. Linear regression was used to compare the values of serum and urinary sFlt-1 and PlGF and their ratios. Urine biomarkers were positively associated with their serum values, being the best associated urinary PlGF (R2 = 0.73), which also showed the highest predictive capability of preeclampsia of urine biomarkers (AUC 0.866). The predictive capability of urinary sFlt-1 was much lower (AUC 0.640), but increased when adjusting by serum creatinine, a more precise parameter (AUC 0.863). Urinary PlGF could be a lesser invasive alternative to circulating biomarkers to monitor pregnancies complicated with preeclampsia that need repeated controls of their pregnancy complication. Urinary sFlt-1 values need adjustment by serum creatinine to be reliable. [ABSTRACT FROM AUTHOR]

This article provides information on fetal growth restriction (FGR), a condition where a fetus does not reach its full growth potential due to a pathological factor. It discusses the classification of FGR based on gestational age at diagnosis and explores the causes and outcomes of pre- and periviable FGR. The article emphasizes the importance of genetic counseling and testing in cases of FGR and provides information on the prevalence of genetic anomalies, structural defects, and congenital infections in these cases. It also discusses the incidence and outcome of placental insufficiency as a cause of FGR. The article highlights the varying frequency of hypertensive disorders of pregnancy (HDP) in pre- and periviable FGR and their impact on maternal and fetal/neonatal health. It concludes by discussing the management of pre- and periviable FGR, including the consideration of termination of pregnancy in certain cases and the determination of the mode of delivery for fetuses alive at birth. [Extracted from the article]

Maternal obesity results in increased placental oxidative stress, antioxidant production, and fatty acid mishandling. It also leads to placental leukocyte infiltration and proinflammatory response in some studies. Maternal obesity is linked to increased fetal circulating inflammatory markers and decreased immune response to pathogens. There are also programmed changes related to oxidative damage and hepatic steatosis in the offspring of obese mothers, with males appearing more affected. Promising data show increased physical activity, decreased sedentary time, and serine supplementation during pregnancy were able to correct placental and offspring oxidative stress damage induced by maternal obesity during pregnancy. The obesity epidemic has led to a growing body of research investigating the consequences of maternal obesity on pregnancy and offspring health. The placenta, traditionally viewed as a passive intermediary between mother and fetus, is known to play a critical role in modulating the intrauterine environment and fetal development, and we now know that maternal obesity leads to increased inflammation, oxidative stress, and altered placental function. Here, we review recent research exploring the involvement of inflammation and oxidative stress as mechanisms impacting the placenta and fetus during obese pregnancy. Understanding them is crucial for informing strategies that can mitigate the adverse health effects of maternal obesity on offspring development and disease risk. [ABSTRACT FROM AUTHOR]

Aims: Intrahepatic cholestasis of pregnancy (ICP) stands as the predominant liver disorder affecting pregnant women, with a prevalence ranging from 0.2% to 15.6%. While ICP is known to heighten the chances of perinatal mortality and morbidity, its pathogenesis remains elusive, and therapeutic options are limited. The objective of this study was to explore the characteristic lipid signature in placentas collected from normal pregnancies and those with mild and severe intrahepatic cholestasis of pregnancy. This research aims to clarify the pathogenesis and identify lipid biomarker for ICP through LC-MS/MS based lipidomic analysis. Methods and materials: Placenta samples were collected from 30 normal pregnancy women and 30 mild and severe ICP women respectively. Women with normal pregnancy and ICP were recruit from April 2021 to July 2022 in Chengdu, China. And LC-MS/MS based lipidomic analysis was used to explore the characteristic placental lipids in mild and severe ICP. Results: Fourty-four lipids were differentially expressed both in mild and severe ICP placenta. The pathway analysis revealed these lipids are mainly enriched in glycerophospholipid metabolism and autophagy pathway. Weighted correlation network analysis (WGCNA) identified the correlation network module of lipids highly related to ICP. Using multiple logistic regression analysis, we identified three and four combined metabolites that had an area under receiver operating characteristic curves (AUC) ≥ 0.90. Conclusion: Our results systematically revealed the lipid signature in mild and severe ICP placenta. The results may provide new insight into the treatment and early prediction of ICP. [ABSTRACT FROM AUTHOR]

Introduction: Fetal heart rate variability (fHRV) is a tool used to investigate the functioning of the fetal autonomic nervous system. Despite the significance of preeclampsia, fHRV during the latent phase of labor has not been extensively studied. This study aimed to evaluate fetal cardiac autonomic activity by using linear and nonlinear indices of fHRV analysis in women diagnosed with preeclampsia without hypertensive treatment during gestation, compared to normotensive women during the latent phase of labor. Methods: A cross-sectional and exploratory study was conducted among pregnant women in the latent phase of labor, forming three study groups: normotensive or control (C, 38.8 ± 1.3 weeks of pregnancy, n = 22), preeclampsia with moderate features (P, 37.6 ± 1.4 weeks of pregnancy n = 10), and preeclampsia with severe features (SP, 36.9 ± 1.2 weeks of pregnancy, n = 12). None of the participants received anti-hypertensive treatment during their pregnancy. Linear and nonlinear features of beat-to-beat fHRV, including temporal, frequency, symbolic dynamics, and entropy measures, were analyzed to compare normotensive and preeclamptic groups. Results: Significantly lower values of multiscale entropy (MSE) and short-term complexity index (Ci ) were observed in the preeclamptic groups compared to the C group (p < 0.05). Additionally, higher values of SDNN (standard deviation of R-R intervals) and higher values of low-frequency power (LF) were found in the P group compared to the C group. Conclusion: Our findings indicate that changes in the complexity of fetal heart rate fluctuations may indicate possible disruptions in the autonomic nervous system of fetuses in groups affected by undiagnosed preeclampsia during pregnancy. Reduced complexity and shifts in fetal autonomic cardiac activity could be associated with preeclampsia’s pathophysiological mechanisms during the latent phase of labor. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the clinical risk factors of disseminated intravascular coagulation (DIC) in case of an abruptio placenta. The second objective was to evaluate the maternal and perinatal complications in the cases with DIC secondary to abruptio placenta. Material and Methods: This is a retrospective study conducted in pregnant women with a diagnosis of abruption at a tertiary maternity hospital. 237 patients confirmed with abruptio placenta were assigned into two groups: complicated with DIC (study group), and those who were not (control group). Results: 23 patients were included in the study group, and 214 patients were included in the control group. In the study group, 82.6% of the patients were admitted urgently from the emergency room with diagnosis of abruption, whereas the rate of the patients diagnosed in the emergency room was 49.1% in the control group (p=0.002). The rate of cases with a ≥50% detachment of the total placental mass was significantly higher in the DIC group (91.3% vs. 41.7%). Uterine atony, Couvelaire uterus, transfusion of blood products, intensive care unit admission were significantly higher in the DIC group. Intrauterine fetal demise, neonatal excess base deficit, neonatal intensive care unit admission were also significantly higher in the DIC group. Conclusion: The patients presenting with vaginal bleeding, fetal demise, those who have ≥50% of the placenta detached, and those who are diagnosed in emergency department have higher likelihood of being complicated with DIC. The patients with known risk factors for abruption and their neonates benefit from in-patient follow-up. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to reduce maternal death rates and contribute to the literature by evaluating maternal near-miss (MNM) profiles, the prevalence, treatment approach, outcomes, and prognostic factors. Material and Methods: A total of 217 MNM patients and 19 cases of maternal death were included in this study. The criteria of organ dysfunction, revised by the World Health Organization (WHO) in 2009, was accepted as the criterion for patients defined as MNM. According to WHO's criteria, the patients were classified in 4 groups. These groups were classified as hypertensive pregnancies, hemorrhagic diseases, placental abruption and disseminated intravascular coagulation and other systemic diseases, respectively. Results: The MNM incidence was 2.31 per 100 live births, and the maternal mortality incidence was 202.4 per 100,000 births. The mortality rate of patients transferred to our hospital because of insufficient intervention at another centre was found to be statistically significantly higher. A statistically significant difference was determined in the laboratory parameters between the MNM cases and patients with maternal mortality in Group 1, 2, and Group 3. The rate of blood and blood products transfusion given to MNM patients was statistically significantly higher in Group 3 than in Group 2. Conclusion: The laboratory parameters found to be significant in MNM and maternal mortality cases could have a negative effect on prognosis and could be of guidance in the prediction of mortality. For patients with an insufficient treatment at other centres, transport to suitable centres would reduce maternal mortality by enabling appropriate interventions. [ABSTRACT FROM AUTHOR]

Previous epidemiologic research has shown that phthalate exposure in pregnant women is related to adverse birth outcomes in a sex-specific manner. However, the biological mechanism of phthalate exposure that causes these birth outcomes remains poorly defined. In this research, we investigated the association between phthalate exposure and placental oxidative stress in a large population-based cohort study, aiming to initially explore the relationship between phthalate exposure and gene expression in placental oxidative stress in a sex-specific manner. Quantitative PCR was performed to measure the expression of placental inflammatory mRNAs (HO-1, HIF1α, and GRP78) in 2469 placentae. The multiple linear regression models were used to investigate the associations between mRNA and urinary phthalate monoesters. Phthalate metabolites monomethyl phthalate (MMP) and mono-n-butyl phthalate (MBP) were positively correlated with higher HIF1α expression in placentae of male fetuses (p <.05). Mono-benzyl phthalate (MBzP) increased the expression of HO-1, HIF1α, and GRP78 in placentae of male fetuses, and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) up-regulated the expression of HIF1α and GRP78. Additionally, mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) was negatively correlated with HO-1, HIF1α, and GRP78 in placentae of female fetuses. Maternal phthalate exposure was associated with oxidative stress variations in placental tissues. The associations were closer in the placentas of male fetuses than in that of female ones. The placenta oxidative stress is worth further investigation as a potential mediator of maternal exposure-induced disease risk in children. [ABSTRACT FROM AUTHOR]

Objectives: Women with chronic rheumatic disease (CRD) are at greater risk of foetal growth restriction than their healthy peers. T2*-weighted magnetic resonance imaging of placenta (T2*P-MRI) is superior to conventional ultrasonography in predicting birth weight and works as a proxy metabolic mirror of the placental function. We aimed to compare T2*P-MRI in pregnant women with CRD and healthy controls. In addition, we aimed to investigate the correlation between T2*P-MRI and birth weight. Methods: Using a General Electric (GE) 1.5 Tesla, we consecutively performed T2*-weighted placental MRI in 10 women with CRD and 18 healthy controls at gestational week (GW)24 and GW32. We prospectively collected clinical parameters during pregnancy including birth outcome and placental weight. Results: Women with CRD had significantly lower T2*P-MRI values at GW24 than healthy controls (median T2*(IQR) 92.1 ms (81.6; 122.4) versus 118.6 ms (105.1; 129.1), p = 0.03). T2*P-MRI values at GW24 showed a significant correlation with birth weight, as the T2*P-MRI value was reduced in all four pregnancies complicated by SGA at birth. Three out of four pregnancies complicated by SGA at birth remained undetected by routine antenatal ultrasound. Conclusion: This study demonstrates reduced T2*P-MRI values and a high proportion of SGA at birth in CRD pregnancies compared to controls, suggesting an increased risk of placental dysfunction in CRD pregnancies. T2*P-MRI may have the potential to focus clinical vigilance by identifying pregnancies at risk of SGA as early as GW24. Key Points • Placenta-related causes of foetal growth restriction in women with rheumatic disease remain to be investigated. • T2*P-MRI values at gestational week 24 predicted foetuses small for gestational age at birth. • T2*P-MRI may indicate pregnant women with chronic rheumatic disease (CRD) in need of treatment optimization. [ABSTRACT FROM AUTHOR]

Invasive group A streptococcal (iGAS) infection is a leading cause of maternal death. The increase in the number of patients with iGAS in Japan is markedly greater than before the coronavirus pandemic. We encountered a case of iGAS infection, on a remote island with restricted medical resources, in a third‐trimester pregnant woman, resulting in both maternal and fetal death. A 34‐year‐old woman was admitted via a local general hospital with a high fever. Intrauterine fetal death disseminated intravascular coagulation, and septic shock were confirmed. Broad‐spectrum antibiotics were started, and the patient was returned to the local general hospital. Eight hours after arrival, the patient died of circulatory and respiratory dysfunction complications. iGAS infections in remote areas may directly lead to life‐threatening conditions and should be treated as an emergency, comparable to the serious conditions of placental abruption or placenta previa. [ABSTRACT FROM AUTHOR]

Background: The association between endometriosis and the outcome of pregnancy is one of the interesting topics. Endometriosis-related pain is alleviated with pregnancy; however, it is known to cause adverse outcomes in pregnancy. The main cause is systemic chronic inflammation caused by higher levels of cytokines, growth factors, and angiogenesis factors. Objective: This study aimed to clarify the relationship between endometriosis, deep endometriosis, adenomyosis, surgical treatment, and poor maternal consequences. Materials and Methods: In this case-control study, data from 250 women who gave birth in Hazrat Rasoul Akram hospital, Tehran, Iran from February 2015 to December 2019 was extracted from the hospital information system in January 2020. Participants were divided into 2 groups: 125 women with endometriosis and 125 women without endometriosis. We looked at how endometriosis affected mothers and newborn babies. Data on pregnancy, delivery, and newborns of both groups was extracted. Results: The mean age of participants was 32.74 ± 4.10 and 31.7 ± 5.53 yr in endometriosis and control group, respectively. In terms of pregnancy complications, placenta previa, placenta accreta, placenta abruption, pre-eclampsia, gestational diabetes mellitus, and postpartum hemorrhage remarkably increased in the endometriosis group compared to the control group. Small for gestational age was significantly higher in rectal endometriosis than women without rectal endometriosis (p = 0.03). The neonatal intensive care unit admission rate was notably higher in infants of the endometriosis group compared to controls (40.7% vs. 24.8%, p = 0.009). Conclusion: Our findings showed women with endometriosis are at a higher risk for important adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) can lead to severe respiratory illness, rapid disease progression, and higher rates of intensive care unit admission in pregnant women. Infection during pregnancy is associated with an increased risk of preterm delivery, cesarean section, fetal dysfunction, preeclampsia, and perinatal death. Vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from pregnant women to their fetuses has also been observed. Although severe infections in neonates and infants are rare, newborns can experience serious consequences from COVID-19 due to their suboptimal humoral immune system protection. The amino acids in the structural proteins of SARS-CoV-2 are constantly mutating. Since around January 2023, COVID-19, caused by omicron-type SARS-CoV-2 variants, has been prevalent globally. These variants can evade the immune response triggered by traditional mRNA-based COVID-19 vaccines, such as BNT162b2. Therefore, vaccination with BNT162b2 XBB.1.5, which provides protection against omicron-type SARS-CoV-2 variants, is recommended. Methods: This retrospective cohort study included 148 pregnant women who received the BNT162b2 XBB.1.5 vaccine at 30 partner medical institutions from September 2023 to January 2024. We examined the titers of anti-spike glycoprotein SARS-CoV-2 immunoglobin G (IgG) and IgA in the blood and umbilical cord blood obtained from the participants using ELISA. Findings: Anti-spike glycoprotein SARS-CoV-2 IgG and IgA titers were highest in the blood and cord blood at late gestational age (28–34 weeks). No serious side effects or adverse events were observed in either the pregnant women or their newborns. Interpretation: Pregnant women who received the BNT162b2 XBB.1.5 vaccine during gestational weeks 28 to 34 had the highest titers of anti-omicron SARS-CoV-2 variant antibodies in their blood. Moreover, these antibodies were transferred to their umbilical cord blood. To validate our findings, large cohort clinical studies involving numerous pregnant women are warranted. Funding: This study was funded by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS) and Grants-in-Aid for Medical Research from the Japan Agency for Medical Research and Development (AMED). [ABSTRACT FROM AUTHOR]

Objective: Management of placenta accreta spectrum (PAS) with the placenta kept in situ aims to preserve fertility and minimize blood loss. However, this method is associated with a risk of coagulopathy and subsequent bleeding. The aim of this study was to evaluate the occurrence and pathophysiology of coagulopathy in cases of PAS managed conservatively. Methods: We reviewed our database for cases of PAS in which the placenta was kept in situ. In addition, we performed a systematic review of articles on PAS in which the placenta was left in situ and was complicated by coagulopathy. PubMed was searched for publications between 1980 and 2023. Our eligibility criteria included studies in which no additional interventions were performed other than keeping the placenta entirely in situ, and in which coagulopathy was reported. Results: After screening and selection of full‐text articles, 10 studies were included in the review. A review of our databases yielded a case series of PAS managed conservatively with the placenta kept in situ. When adding our case series to the results of our systematic review, a total of 87 cases were found to have been managed conservatively, with 28 cases of coagulopathy. Of these, the time at which coagulopathy developed was known in 11 cases. The median time at development of coagulopathy was 58 (interquartile range, 50–67) days postpartum. Conclusions: Our findings highlight that conservative management of PAS with the placenta in situ poses a risk of coagulopathy. Keeping the placenta in situ after delivery prolongs the risk factors that are integral to PAS. The pathophysiology behind coagulopathy is comparable with that of concealed placental abruption, due to the disrupted uteroplacental interface and the collection of blood in the placenta. Therefore, the presence of large placental lakes could be an indicator of developing coagulopathy. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Placental development is a complex process which sets the stage for normal fetal development. Any variation/disruption occurring during the initial stages of placental formation leads to placental malfunction causing increased maternal–fetal morbidity and mortality. The succenturiate lobe is a structural variation of the placenta that usually appears as a distinct lobe from the main placental mass. Succenturiate lobe is a rare placental anomaly, with high risk of fetal distress, hemorrhage, abruptio placentae and even fetal death because the vessels of this succenturiate lobe are vulnerable to both compression and laceration. Prenatal imaging diagnosis of this pathology improves the fetal prognosis through more careful surveillance and, in case of complications such as abruptio placentae, by shortening the time-to-decision making in favor of cesarean delivery. We present the case of a 27-year-old patient, without risk factors for placental abnormalities, diagnosed antenatally with succenturiate placenta, who presented at 34 weeks of pregnancy for abruptio placentae. [ABSTRACT FROM AUTHOR]

Inherited thrombophilia (IT) has been implicated as a potential causal factor of adverse pregnancy outcomes (APOs), including recurrent miscarriage with and without the presence of antiphospholipid syndrome (APS). The aim of this study was to assess the prevalence and impact of IT on fetal–maternal outcomes and thrombotic risk in women within the spectrum of obstetric APS. Three hundred and twenty-eight women with APS-related obstetric morbidity ever pregnant were included. Of these, 74 met the APS classification criteria, 169 were non-criteria (NC)-APS, and 85 were seronegative (SN)-APS. Patients with other autoimmune diseases were excluded. APOs included early pregnancy loss, fetal death, preeclampsia, abruptio placentae, and preterm birth. Successful pregnancy was defined as the achievement of a live newborn. A literature search was also performed. The mean age of the overall group was 33.9 ± 5.3 years, and the patients were followed up for 35 (11–79) months. During the study period, there were 1332 pregnancies. Nearly 14% of the patients had an associated IT. IT patients more frequently received the standard-of-care (SoC) therapy. The presence of IT was not associated with worse maternal–fetal outcomes in patients treated with SoC treatment. Overall, IT patients had a lower frequency of newborns without treatment, especially those without definite APS. In addition, IT did not increase the risk of thrombosis during pregnancy or the postpartum period. A detailed analysis of the literature review identified only four publications related to our study and did not show conclusive evidence of the impact of IT on patients with obstetric APS. The group of women with APS-related obstetric morbidity and IT who did not receive treatment, especially those without definite APS, had a worse prognosis in terms of a live birth. However, with SoC therapy, the prognosis is similar in those patients without IT. The association of IT with APS does not seem to predispose to the development of thrombosis during pregnancy and/or the postpartum period. [ABSTRACT FROM AUTHOR]

Home high-flow nasal cannula (HFNC) use in the neonatal field has become prevalent as a noninvasive respiratory support, but its application in home care remains rare. We report two cases in which a home HFNC was effective in managing extremely low-birth-weight infants with severe bronchopulmonary dysplasia (BPD). Case 1 was a male infant born at 22 weeks' gestation weighing 435 g. Case 2 was a female infant born at 23 weeks' gestation weighing 450 g. Both patients had mothers with chronic placental abruption or chorioamnionitis. They transitioned from invasive mechanical ventilation to nasal CPAP (nCPAP) at 45 days (case 1) and 50 days (case 2) old. Subsequently, at 324 days (case 1) and 90 days (case 2) old, they transitioned to a HFNC, demonstrating stable oxygenation and ventilation, but faced difficulty in removal. Considering the drawbacks of prolonged hospitalization, the patients were discharged using a home HFNC at 404 days (case 1) and 391 days (case 2) old. For case 1, the HFNC was set at 4 L/min of room air and 2 L/min of oxygen, whereas for case 2, it was set at 5 L/min of room air and 1 L/min of oxygen. These settings maintained an SpO2 above 90% and a pCO2 below 60 mmHg. An HFNC offers advantages over nCPAP owing to its lower invasiveness and reduced discomfort for long-term use. However, reports on the use of a home HFNC for BPD are scarce. In recent years, while premature infant mortality has decreased worldwide, the incidence of BPD has risen, necessitating preparedness for prolonged ventilation in preterm infants. Home ventilators represent a strategy to prevent extended hospitalization, and based on our cases, home HFNC for BPD appears safe and effective, making it potentially useful for managing preterm infants requiring prolonged respiratory support in the future. [ABSTRACT FROM AUTHOR]

Aim: To estimate the incidence of abruption in first births and recurrence in the subsequent birth in patients of a large US‐based integrated health care system. Methods: Retrospective population‐based cohort study of patients with first two consecutive singleton births using data from the Kaiser‐Permanente South California health care system who delivered over a period of 30 years (1991–2021), using longitudinally linked electronic health records. ICD‐9/ICD‐10 codes "641.20" and "O45.x" identified placental abruption. We calculated the incidence and rates of abruption in first and second pregnancies. We used logistic regression to estimate the adjusted odds ratios (aOR) for abruption in second pregnancies in patients with and without abruptions in their first pregnancies. Results: Of the 126 264 patients with first two consecutive singleton births over the period, 805 had abruptions in their first births, and 861 in their second births. Rates of abruption in first and second births were 0.63% and 0.68%, respectively. Twenty‐seven patients had abruptions in both first and second births. Rates of abruption in the second birth among individuals with and without previous placental abruption were 3.35% and 0.66%, respectively, giving an approximately five‐fold increased odds of abruption in a second pregnancy in individuals who had abruption in their first birth when compared with those who did not have placental abruption in their first birth (aOR: 4.95, 95% confidence interval: 3.35–7.31, p < 0.00001). Interpregnancy interval had no statistically significant association with recurrence. Conclusion: Abruption in a first birth is associated with an approximately five‐fold increased odds of abruption in a second birth. [ABSTRACT FROM AUTHOR]

New World mabuyine skinks are a diverse radiation of morphologically cryptic lizards with unique reproductive biologies. Recent studies examining population-level data (morphological, ecological, and genomic) have uncovered novel biodiversity and phenotypes, including the description of dozens of new species and insights into the evolution of their highly complex placental structures. Beyond the potential for this diverse group to serve as a model for the evolution of viviparity in lizards, much of the taxonomic diversity is concentrated in regions experiencing increasing environmental instability from climate and anthropogenic change. Consequently, a better understanding of genome structure and diversity will be an important tool in the adaptive management and conservation of this group. Skinks endemic to Caribbean islands are particularly vulnerable to global change with several species already considered likely extinct and several remaining species either endangered or threatened. Combining PacBio long-read sequencing, Hi-C, and RNAseq data, here we present the first genomic resources for this group by describing new chromosome-level reference genomes for the Puerto Rican Skink Spondylurus nitidus and the Culebra Skink S. culebrae. Results indicate two high quality genomes, both ∼1.4 Gb, assembled nearly telomere to telomere with complete mitochondrion assembly and annotation. [ABSTRACT FROM AUTHOR]

Introduction: The inaccuracy of late pregnancy dating is often discussed, and the impact on diagnosis of fetal growth restriction is a concern. However, the magnitude and direction of this effect has not previously been demonstrated. In this study, we aimed to investigate the effect of late pregnancy dating by head circumference on the detection of late onset growth restriction, compared to first trimester crown‐rump length dating. Material and methods: This was a cohort study of 14 013 pregnancies receiving obstetric care at a tertiary center over a three‐year period. Universal scans were performed at 12 weeks, including crown‐rump length; at 20 weeks including fetal biometry; and at 36 weeks, where biometry, umbilical artery doppler and cerebroplacental ratio were used to determine the incidence of fetal growth restriction according to the Delphi consensus. For the entire cohort, the gestational age was first calculated using T1 dating; and was then recalculated using head circumference at 20 weeks (T2 dating); and at 36 weeks (T3 dating). The incidence of fetal growth restriction following T2 and T3 dating was compared to T1 dating using four‐by‐four sensitivity tables. Results: When the cohort was redated from T1 to T2, the median gestation at delivery changed from 40 + 0 to 40 + 2 weeks (p < 0.001). When the cohort was redated from T1 to T3, the median gestation at delivery changed from 40 + 0 to 40 + 3 weeks (p < 0.001). T2 dating resulted in fetal growth restriction sensitivity of 80.2% with positive predictive value of 78.8% compared to T1 dating. T3 dating resulted in sensitivity of 8.6% and positive predictive value of 27.7%, respectively. The sensitivity of abnormal CPR remained high despite T2 and T3 redating; 98.0% and 89.4%, respectively. Conclusions: Although dating at 11–14 weeks is recommended, late pregnancy dating is sometimes inevitable, and this can prolong the estimated due date by an average of two to three days. One in five pregnancies which would be classified as growth restricted if the pregnancy was dated in the first trimester, will be reclassified as nongrowth restricted following dating at 20 weeks, whereas nine out of 10 pregnancies will be reclassified as non‐growth restricted with 36‐week dating. [ABSTRACT FROM AUTHOR]