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Purpose After living with the COVID-19 pandemic for more than 2 years, the impact of lockdown measures on preterm birth rates is inconsistent according to data from different countries. In this study, rates of preterm-born infants during the time of COVID-19-related lockdowns were analyzed in a tertiary perinatal center at Munich University, Germany. Methods We analyzed the number of preterm births, infants, and stillbirths before 37 weeks of gestation during the German COVID-19 lockdown period compared to the same time periods in the years 2018 and 2019 combined. Additionally, we expanded the analysis to Pre- and Post-Lockdown Periods in 2020 compared to the respective control periods in the years 2018 and 2019. Results Our database shows a reduction in the rate of preterm infants during the COVID-19 lockdown period (18.6%) compared to the combined control periods in 2018 and 2019 (23.2%, p = 0.027). This was mainly based on a reduced rate of preterm multiples during the lockdown period (12.8% vs. 28.9%, p = 0.003) followed by a reversed effect showing a threefold rise in multiple births after the lockdown. In singletons, the rate of preterm births was not reduced during the lockdown. The rate of stillbirths was not affected by the lockdown measures as compared to the control period (0.9% vs. 0.7%, p = 0.750). Conclusion During the COVID-19 pandemic lockdown period, we found a reduced rate of preterm-born infants compared to a combined control period in the years 2018 and 2019 in our large tertiary University Center in Germany. Due to the predominant reduction in preterm multiples, we postulate that less physical activity might have led to the protective effect by lockdown measures.

Purpose: To assess the percentage of missed developmental dysplasia of the hip, which escape the German criteria for newborn hip high-risk screening, we analyzed our data gained from the general neonatal sonographic hip screening performed at our department. The aim of the study was to determine the number of potentially belatedly treated developmental dysplasia of the hip. Methods: The data from 1145 standardized newborn hip ultrasound examinations according to the Graf technique were analyzed retrospectively comparing findings for general neonatal sonographic hip screening and high-risk screening subgroups. Results: We diagnosed developmental dysplasia of the hip in 18 of the 1145 newborns via ultrasound. A total of 10 out of 18 developmental dysplasia of the hip would have been missed by high-risk screening, which corresponds to a proportion of 55.6% false-negative results. The sensitivity of high-risk screening was only 44.4% and specificity, 78.3%. The positive predictive value was 3.2%. Family history as a screening criterion yielded false-negative results in 77.8% and false-positive results in 16.8%. In all, 83.3% of the children who were born with developmental dysplasia of the hip but not from breech position as a risk factor were false negative. The clinical examination was false negative in 88.9% and false positive in 0.6%. Conclusion: High-risk screening detected less than every second developmental dysplasia of the hip, rendering the first month as the most effective treatment window unavailable for inapparent dysplastic hips, potentially resulting in the need for more invasive treatment. Due to the high sensitivity of ultrasound in the detection of developmental dysplasia of the hip, we recommend to replace the current German high-risk screening guidelines with a general newborn screening for all neonates using Graf ultrasound in the first week of life. Level of evidence: Level II.

Fetal growth restriction is strongly associated with impaired placentation and abnormal uteroplacental blood flow. Nitric oxide donors such as pentaerythritol tetranitrate are strong vasodilators and protect the endothelium. Recently, we demonstrated in a randomized controlled pilot study a 38% relative risk reduction for the development of fetal growth restriction or perinatal death following administration of pentaerythritol tetranitrate to pregnant women at risk, identified by impaired uterine perfusion at midgestation. Results of this monocenter study prompted the hypothesis that pentaerythritol tetranitrate might have an effect in pregnancies with compromised placental function as a secondary prophylaxis.This study aimed to test the hypothesis that the nitric oxide donor pentaerythritol tetranitrate reduces fetal growth restriction and perinatal death in pregnant women with impaired placental perfusion at midgestation in a multicenter trial.In this multicenter, randomized, double-blind, placebo-controlled trial, 2 parallel groups of pregnant women presenting with a mean uterine artery pulsatility index95th percentile at 19+0 to 22+6 weeks of gestation were randomized to 50-mg Pentalong or placebo twice daily. Participants were assigned to high- or low-risk groups according to their medical history before randomization was performed block-wise with a fixed block length stratified by center and risk group. The primary efficacy endpoint was the composite outcome of perinatal death or development of fetal growth restriction. Secondary endpoints were neonatal and maternal outcome parameters.Between August 2017 and March 2020, 317 participants were included in the study and 307 were analyzed. The cumulative incidence of the primary outcome was 41.1% in the pentaerythritol tetranitrate group and 45.5% in the placebo group (unadjusted relative risk, 0.90; 95% confidence interval, 0.69-1.17; adjusted relative risk, 0.90; 95% confidence interval, 0.69-1.17; P=.43). Secondary outcomes such as preterm birth (unadjusted relative risk, 0.73; 95% confidence interval, 0.56-0.94; adjusted relative risk, 0.73; 95% confidence interval, 0.56-0.94; P=.01) and pregnancy-induced hypertension (unadjusted relative risk, 0.65; 95% confidence interval, 0.46-0.93; adjusted relative risk, 0.65; 95% confidence interval, 0.46-0.92; P=0.01) were reduced.Our study failed to show an impact of pentaerythritol tetranitrate on the development of fetal growth restriction and perinatal death in pregnant women with impaired uterine perfusion at midgestation. Pentaerythritol tetranitrate significantly reduced secondary outcome parameters such as the incidence of preterm birth and pregnancy-induced hypertension in these pregnancies.

Primary Epstein-Barr-Virus (EBV)-associated pulmonary lymphoepithelioma-like carcinoma (LELC) is an aggressive rare cancer. Higher incidences have been observed in Asian sub-populations. Multimodal treatment paradigms have emerged as promising novel strategies in the management of advanced NSCLC. In this report, we describe the case of a 34-year-old female patient of Asian origin with a post-partum initial diagnosis of pulmonary LELC. Multimodal treatment with chemoimmunotherapy and hypofractionated irradiation to the primary tumour and main metastatic sites led to a favourable response demonstrating that radiotherapy may potentially augment anti-tumour immunity. To the best of our knowledge, this is the first case report on this novel therapy strategy of multi-site hypofractionated radiotherapy and chemoimmunotherapy for metastatic pulmonary EBV-associated LELC.

Background Different areas of disparities remain a concern in developing countries like Nepal regarding the utilization of maternal, neonatal and child health services like disparities in education, income, administrative regions, ethnic groups, province-level etc. In order to support equitable outcomes for Maternal, Neonatal and Child Health (MNCH) and to scale-up quality services, an Investment case was launched by developmental partners in the Asia-Pacific region. Investment Case (IC) at the local level aims to develop a coherent plan with local level development plans, which is equitable and responsive to the bottlenecks and the local needs. The study aims to identify the factors affecting equitable access to maternal health services in Nepal. Methods The study focuses on the impact of the intervention package developed by applying the investment case (IC) approach in maternal and child health services in Nepal introduced in 2011. Complex sample analysis was carried out to adjust the weight of the sample. Cross tabulation with Confidence Interval (CI) was used to generate weighted disaggregated data. Difference in Difference (DiD) analysis was carried out using a linear regression model. Finally, multivariate linear regression was carried out to figure out the effect of the intervention. Results Based on the data, the improvements before and after the intervention were calculated in both the intervention and comparison districts; no variables showed a significant association. Changes were similar for intervention and comparison areas: four antenatal care seeking (DiD=-4.8, p = 0.547 CI= -0.041-0.022), Skill Birth Attendance (SBA) delivery (DiD = 6.6, p = 0.325, CI= -0.010-0.039). Multivariable regression analysis also did not reveal any significant improvement in aggregate outcomes. The intervention did not play a significant role in any variables, i.e., four antenatal care seeking (p-value 0.062), SBA delivery (p-value 0.939). Conclusion The IC approach is itself a successful approach in most of the developing countries. After the implementation of IC, some of the MNCH indicators like ANC, SBA delivery have shown improvements in the intervention as well as comparison districts but have not shown significant with the intervention.

To evaluate delayed interval deliveries in multiple gestations in regard of delayed interval and neonatal survival and to provide a protocol. Data of multiple pregnancies with delayed interval delivery at a tertiary maternity unit between 2002 and 2017 were collected. Contraindications for evaluation of a delay of the delivery of the remaining child were: severe maternal blood loss, poor maternal general condition, preeclampsia, placental abruption, fetal distress, serious congenital malformations of the remaining child, chorioamnionitis, and premature rupture of membranes of the second fetus. A total of 14 cases was included in this retrospective monocentric analysis. The cohort comprised nine twin and five triplet pregnancies. Mean gestational age at delivery of the first fetus was 21 + 6 and 26 + 0 of the retained fetus, respectively. The earliest delivery of the first fetus was at 15 + 2 weeks. The mean interval of the delay was 29.3 days (2–82 days). Mortality of the first fetuses was 53.3%, while it was 17.6% for the retained fetuses. Maternal outcome was good in general: two cases of major blood loss occurred with the necessity of a blood transfusion. Delayed interval delivery is a reasonable approach in cases of an imminent preterm birth in multiple gestations which can be performed with a good fetal outcome and limited maternal risks. The situation when this procedure may be an option always comes unexpected. Therefore, the team of perinatologists should keep it in mind as one potential therapeutic approach. In addition, a standard protocol for the procedure should be established in the perinatal center.

Antepartal MR pelvimetry is used to assess the viability of vaginal breech delivery. We evaluated the reliability of MR pelvimetric measurements as well as incidental findings noted by different clinicians and assessed potential reference values. In this monocentric study, the radiologic database was searched for obstetric MR pelvimetries with singleton breech pregnancies between 1999 and 2016. 99 consecutive MR pelvimetries were included. A structured, independent review was performed by six observers with three clinical experience levels (attending, fellow, junior resident from the departments of radiology and obstetrics). Image analysis entailed the quantitative assessment of conjugata vera (CV) and diameter transversalis (DT), image quality and incidental findings. Obstetric data was retrieved from the obstetric database for reference value assessment. Interobserver agreement was strong throughout (mean intraclass correlation coefficient range: 0.889 - 0.968). The individual measuring biases ranged between 0 - 2 mm, and the average limits of agreement were ± 3 mm. Regarding the mode of delivery, the recommended cesarean section (rCS) group showed significantly smaller CV measurements (CV: 11.37 ± 0.73, p-value 0.0001) than any other delivery group. No statistical difference in CV between the vaginal delivery and unplanned cesarean section groups was found (p-value 0.902). DT measurements only showed a significant difference between rCS and elective cesarean section (p-value 0.039). 134 incidental findings were noted. Strong interobserver agreement irrespective of the reader's experience level supports MR pelvimetry as a reliable method for identifying women with fetopelvic disproportion in breech presentation. For a comprehensive appraisal of incidental findings, radiologic expertise is vital. · MR pelvimetry is a reliable method irrespective of the reader's experience level.. · Conjugata vera measurements aid in the prepartal viability assessment of vaginal breech delivery.. · Incidental findings are relatively common..· von Bismarck A, Ertl-Wagner B, Stöcklein S et al. MR Pelvimetry for Breech Presentation at Term- Interobserver Reliability, Incidental Findings and Reference Values. Fortschr Röntgenstr 2019; 191: 424 - 432. Antepartale MR-Pelvimetrie wird genutzt, um die Durchführbarkeit von vaginalen Beckenendlagengeburten einzuschätzen. Evaluiert wurden die Reliabilität von MR-pelvimetrischen Messungen sowie Nebenbefunde durch verschiedene Kliniker; zudem wurden potenzielle Referenzwerte erwogen. In dieser monozentrischen Studie wurde die radiologische Datenbank nach MR-Pelvimetrien von Schwangeren mit Fetus in Beckenendlage zwischen 1999 und 2016 durchsucht. 99 konsekutive Pelvimetrien wurden inkludiert. Eine strukturierte, unabhängige Auswertung erfolgte durch sechs Untersucher mit drei klinischen Erfahrungsstufen (Oberarzt, Facharzt, Assistenzarzt aus je der radiologischen sowie geburtshilflichen Abteilung). Die Sequenzen wurden bezüglich der quantitativen Erfassung von Conjugata vera (CV) und Diameter transversalis (DT), Bildqualität und Nebenbefunde analysiert. Für die Untersuchung der Referenzwerte wurden geburtshilfliche Daten aus der passenden Datenbank erhoben. Die Interobserver-Übereinstimmung war durchgehend stark (Reichweite der durchschnittlichen Intraklassen-Korrelationskoeffizienten: 0,889 – 0,968). Individuelle Messfehler rangierten zwischen 0 und 2 mm, durchschnittliche Übereinstimmungsgrenzen waren ± 3 mm. In Bezug auf den Geburtsmodus wies die Gruppe „Kaiserschnitt empfohlen” (rCS) signifikant kleinere CV-Messungen auf (CV: 11,37 ± 0,73, p-Wert 0,0001) als alle anderen Gruppen. Es wurde kein statistischer Unterschied in CV zwischen den Gruppen „vaginale Geburt” und „ungeplanter Kaiserschnitt” gefunden (p-Wert 0,902). Die DT-Messungen zeigten nur einen signifikanten Unterschied zwischen rCS und „elektiver Kaiserschnitt” (p-Wert 0,039). 134 Nebenbefunde wurden erfasst. Eine starke Interobserver-Übereinstimmung unabhängig von der Erfahrungsstufe des Auswerters bestätigt die MR-Pelvimetrie als eine verlässliche Methode, um ein fetopelvines Missverhältnis bei Schwangeren mit Fetus in Beckenendlage zu identifizieren. Für eine vollständige Erfassung der Nebenbefunde ist eine radiologische Expertise unabdingbar. · MR-Pelvimetrie ist eine verlässliche Methode unabhängig von der Erfahrungsstufe des Auswerters.. · Conjugata-vera-Messungen helfen in präpartaler Einschätzung zur Durchführbarkeit einer vaginalen Beckenendlagengeburt.. · Zufallsbefunde kommen relativ häufig vor..

Background Maternal pre-conception obesity is a strong risk factor for childhood overweight. However, prenatal mechanisms and their effects in susceptible gestational periods that contribute to this risk are not well understood. We aimed to assess the impact of late-pregnancy dysglycemia in obese pregnancies with negative testing for gestational diabetes mellitus (GDM) on long-term mother–child outcomes. Methods and findings The prospective cohort study Programming of Enhanced Adiposity Risk in Childhood–Early Screening (PEACHES) (n = 1,671) enrolled obese and normal weight mothers from August 2010 to December 2015 with trimester-specific data on glucose metabolism including GDM status at the end of the second trimester and maternal glycated hemoglobin (HbA1c) at delivery as a marker for late-pregnancy dysglycemia (HbA1c ≥ 5.7% [39 mmol/mol]). We assessed offspring short- and long-term outcomes up to 4 years, and maternal glucose metabolism 3.5 years postpartum. Multivariable linear and log-binomial regression with effects presented as mean increments (Δ) or relative risks (RRs) with 95% confidence intervals (CIs) were used to examine the association between late-pregnancy dysglycemia and outcomes. Linear mixed-effects models were used to study the longitudinal development of offspring body mass index (BMI) z-scores. The contribution of late-pregnancy dysglycemia to the association between maternal pre-conception obesity and offspring BMI was estimated using mediation analysis. In all, 898 mother–child pairs were included in this unplanned interim analysis. Among obese mothers with negative testing for GDM (n = 448), those with late-pregnancy dysglycemia (n = 135, 30.1%) had higher proportions of excessive total gestational weight gain (GWG), excessive third-trimester GWG, and offspring with large-for-gestational-age birth weight than those without. Besides higher birth weight (Δ 192 g, 95% CI 100–284) and cord-blood C-peptide concentration (Δ 0.10 ng/ml, 95% CI 0.02–0.17), offspring of these women had greater weight gain during early childhood (Δ BMI z-score per year 0.18, 95% CI 0.06–0.30, n = 262) and higher BMI z-score at 4 years (Δ 0.58, 95% CI 0.18–0.99, n = 43) than offspring of the obese, GDM-negative mothers with normal HbA1c values at delivery. Late-pregnancy dysglycemia in GDM-negative mothers accounted for about one-quarter of the association of maternal obesity with offspring BMI at age 4 years (n = 151). In contrast, childhood BMI z-scores were not affected by a diagnosis of GDM in obese pregnancies (GDM-positive: 0.58, 95% CI 0.36–0.79, versus GDM-negative: 0.62, 95% CI 0.44–0.79). One mechanism triggering late-pregnancy dysglycemia in obese, GDM-negative mothers was related to excessive third-trimester weight gain (RR 1.72, 95% CI 1.12–2.65). Furthermore, in the maternal population, we found a 4-fold (RR 4.01, 95% CI 1.97–8.17) increased risk of future prediabetes or diabetes if obese, GDM-negative women had a high versus normal HbA1c at delivery (absolute risk: 43.2% versus 10.5%). There is a potential for misclassification bias as the predominantly used GDM test procedure changed over the enrollment period. Further studies are required to validate the findings and elucidate the possible third-trimester factors contributing to future mother–child health status. Conclusions Findings from this interim analysis suggest that offspring of obese mothers treated because of a diagnosis of GDM appeared to have a better BMI outcome in childhood than those of obese mothers who—following negative GDM testing—remained untreated in the last trimester and developed dysglycemia. Late-pregnancy dysglycemia related to uncontrolled weight gain may contribute to the development of child overweight and maternal diabetes. Our data suggest that negative GDM testing in obese pregnancies is not an “all-clear signal” and should not lead to reduced attention and risk awareness of physicians and obese women. Effective strategies are needed to maintain third-trimester glycemic and weight gain control among otherwise healthy obese pregnant women., Regina Ensenauer and colleagues study the relationship between perinatal dysglycemia in obese mothers and later BMI in their children., Author summary Why was this study done? Pre-conception obesity is associated with an increased risk of pregnancy complications and adverse long-term health outcomes for the mother and her child. Obese pregnant women can develop impairments in glucose metabolism in late pregnancy despite prior negative testing for gestational diabetes mellitus (GDM). Yet, to date, guidelines on obesity in pregnancy and GDM have focused only on early glucose screening rather than targeting factors relevant to the last trimester of pregnancy. To evaluate whether recommendations on management of obese pregnancies require optimization, additional evidence is needed on the consequences of late-pregnancy dysglycemia for long-term childhood and maternal outcomes. What did the researchers do and find? We performed an interim analysis of 898 obese and normal weight mothers and their offspring from the Programming of Enhanced Adiposity Risk in Childhood–Early Screening (PEACHES) cohort study (total n = 1,671) that recruited pregnant women in Germany from 2010 to 2015. Late-pregnancy dysglycemia predisposed the offspring of obese, GDM-negative mothers to higher weight gain in early childhood and a higher body mass index at age 4 years. Children of obese mothers treated because of a diagnosis of GDM appeared to have a better weight outcome than those of obese mothers who remained untreated following a negative GDM test and developed late-pregnancy dysglycemia. Obese, GDM-negative women with late-pregnancy dysglycemia also had a 4-fold higher risk of prediabetes or diabetes several years after delivery compared to those with normal glucometabolic status in late pregnancy. What do these findings mean? We suggest that a negative GDM test at the end of the second trimester should not be understood as an “all-clear signal” and should not result in reduced attention of caregivers and a false sense of security in the mothers. Guidelines to manage and maintain third-trimester glycemic and weight gain control are needed for “high risk” obese women. Further analyses and studies should validate the findings and investigate the possible role of third-trimester factors for future mother–child health.

Objectives Gestational trophoblastic disease (GTD) involves a spectrum of abnormal proliferations arising from the placental villous trophoblast. Although the incidence is low, a biomarker with short serum half-life would be a major clinical advance to monitor surgical and medical treatment reducing the socioeconomic burden of multiple control visits as well as patient's anxiety. Placental growth hormone (hGH-V) plays an important role in the regulation of normal placental growth and has shown angiogenic effects. We aimed to determine by immunohistochemistry (IHC) whether hGH-V is expressed in GTD and whether it can be detected in the patient's blood for potential monitoring of surgical or medical treatment procedures. Methods Tissue and sera were collected from women undergoing treatment for GTD in a tertiary care university hospital. We evaluated partial and complete hydatidiform moles, invasive moles and choriocarcinoma, n=16. Trophoblast specimens were examined by a newly developed IHC set-up for hGH-V in addition to gross morphologic and histopathological examination. Serum samples were analyzed by a highly sensitive hGH-V specific immunoassay. Results hGH-V was localized in all entities of GTD to the syncytiotrophoblast by immunohistochemistry. Serum hGH-V was detected for the first time in GTD and was present in a high percentage of all analyzed entities. Conclusions hGH-V can be detected in all entities of GTD by IHC as well as by serum analysis and may therefore serve as a novel biomarker for the disease. Its clinical utility in diagnosis of GTD and monitoring surgical or medical treatment needs to be determined in further studies.

Background. Postpartum haemorrhage (PPH) is a potentially life-threatening complication for women, and the leading cause of maternal mortality. Tranexamic acid (TXA) is an antifibrinolytic used worldwide to treat uterine haemorrhage and to reduce blood loss in general surgery. TXA may have effects on thrombin generation, platelet function and coagulation factors as a result of its inhibition on the plasmin. Methods. WOMAN ETAPlaT is a sub-study of the World Maternal Antifibrinolitic trial (WOMAN trial). All adult women clinically diagnosed with PPH after a vaginal delivery or caesarean section, are eligible for inclusion in the study. Blood samples will be collected at the baseline and 30 minutes after the first dose of study treatment is given. Platelet function will be evaluated in whole blood immediately after sampling with Multiplate® tests (ADPtest and TRAPtest). Thrombin generation, fibrinogen, D-dimer, and coagulation factors vW, V and VIII will be analysed using platelet poor plasma. Results. Recruitment to WOMAN ETAPlaT started on 04 November 2013 and closed on 13 January 2015, during this time 188 patients were recruited. The final participant follow-up was completed on 04 March 2015. This article introduces the statistical analysis plan for the study, without reference to unblinded data. Conclusion. The data from this study will provide evidence for the effect of TXA on thrombin generation, platelet function and coagulation factors in women with PPH. Trial registration: ClinicalTrials.gov Identifier: NCT00872469; ISRCTN76912190

Objective To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in maternal blood, correlation with immunohistochemistry and possible role as a marker for the course of EP. Design Women presenting in the outpatient or emergency department of a tertiary care university hospital with a positive pregnancy test and strong suspicion of EP by ultrasound and/or symptoms were eligible for the study (n = 70). Tissue specimens from the surgically treated patients (n = 50) were examined by histopathology as well as by a hGH-V specific immohistochemistry set-up. A highly sensitive hGH-V specific immunoassay was used to analyse serum samples collected before treatment, day 1 post surgery samples and serial samples for medical treatment. Result(s) In EP patients' sera hGH-V was shown to be measurable for the first time (n = 18). HGH-V however could not be detected in all patients' sera. HCG levels were significantly higher in the hGH-V serum positive group (p 0.001). HGH-V was localized to the syncytiotrophoblast in all specimens of EP examined by immunohistochemistry (n = 10) regardless of the detection in the patient's blood. Conclusion(s) Placental growth hormone (hGH-V) was shown to be present both in ectopic pregnancy patients' sera and tissue. It may serve as a biomarker for monitoring the course and treatment of EP.

The purpose of this study was to correlate MR pelvimetric pelvic inlet measurements with mode of delivery and neonatal outcome in patients with suspected fetopelvic disproportion or breech presentation. For this retrospective monocentric study, 237 consecutive MR pelvimetry reports (1999–2016) of pregnant women due to either suspected fetopelvic disproportion, pelvic deformation after trauma, or persistent breech presentation were retrieved from the radiologic database and matched with corresponding information from the obstetric database. Of 223 included women, 95 (42.6%) underwent planned cesarean section (pCS) and 128 (57.4%) underwent a trial of vaginal labour (TOL), of whom 93 (72.7%) delivered vaginally. Vaginal delivery was successful in 45 out of 64 (70.3%) cephalic cases and in 48 out of 64 (75.0%) breech cases. We found statistically significant differences in conjugata vera obstetrica (CV) and diameter transversalis (DT) between the groups TOL and pCS (CV: 12.5 ± 1.0 vs 12.1 ± 1.2 cm, p value 0.001; DT: 13.3 ± 0.9 vs 12.7 ± 0.9 cm, p value

Background Intestinal parasitism in large urban cities is an ongoing public health challenge. Although most epidemiological studies were concentrating on children, there is an ongoing concern that adult vulnerable populations are prone to protozoal and helminthic pathogenic infestations. In pregnant women living in social inequality settings, this is particularly important as it may affect their overall health and that of their offspring. Methods We investigated the prevalence of intestinal parasitic infections in pregnant women in three districts of Bogota, the largest city in Colombia. We undertook a cross-sectional study including questionnaires on sociodemographic factors and living conditions, in addition to home visits. By examination of stool samples, we determined the prevalence of intestinal parasites, including protozoa and helminths that are pathogenic and of debated pathogenicity. The presence of microorganisms was detected by multiple approaches including direct smears, concentration techniques, double stool sampling and/or qPCR techniques. Five hundred and fifty pregnant women from low-income urban areas participated in this study by answering the questionnaire, with 331 providing in addition a stool sample, 98 of them providing two stool samples, and 48 of them being prospectively analyzed for the presence of protozoal and helminthic parasites with quantitative PCR. Results The findings revealed an overall 41.4% prevalence of intestinal parasites, with an unexpected 40.5% predominance of protozoa that are considered non-pathogenic and/or of debated pathogenicity, with Blastocystis hominis as the most prevalent parasite (25.1%). The low prevalence of pathogenic parasites was confirmed with all techniques. Double sampling and qPCR showed highest diagnostic capacity. Sociodemographic, pregnancy and living conditions analyses in women infected with any parasite revealed associations with civil status (higher parasites in married women or those living with someone, P Conclusions This is the first study focused on pregnant women in Bogota, the largest city in Colombia that estimates the prevalence and factors associated with intestinal parasitism in vulnerable populations living in conditions of poverty and social inequality. Although a low prevalence of pathogenic parasites was found in pregnant women, a high prevalence of parasites with disputed pathogenicity was revealed. In Bogota, the good quality of water for human consumption, open availability of broad-spectrum anti-parasitic drugs, better educational level and appropriate sanitary facilities play an important role in the prevention of pathogenic parasitic infections. However, the high prevalence of non-pathogenic parasites indicates that fecal-oral contamination continues in these communities. Accordingly, public health services should emphasize education campaigns to prevent these contamination routes, particularly in women belonging to minority groups, those without water sinks and who have not been dewormed recently. Additionally, public health services could take into account the findings that double stool sampling may increase diagnostic capacity in these populations, a cost-effective strategy in middle income countries like Colombia.

Background. Postpartum haemorrhage (PPH) is a leading cause of maternal death. Tranexamic acid (TXA) has the potential to reduce bleeding and a large randomized placebo controlled trial of its effect in women with PPH (The WOMAN trial) is underway. TXA might also affect coagulation factors and platelets. Objectives. To examine the effect of TXA on thrombin generation, platelet function, fibrinogen, D-dimer and coagulation factors in women with PPH. Methods. We will conduct a sub-study within the WOMAN trial. Women with clinically diagnosed primary PPH after vaginal or caesarean delivery are eligible for inclusion. Blood samples will be collected at baseline and 30 minutes after the first dose of study treatment. Using platelet poor plasma we will measure thrombin generation, fibrinogen, D-dimer, factor V and VIII, and Von Willebrand factor. Platelet function will be evaluated in whole blood using Multiplate® tests.Outcomes. The primary outcome is the effect of TXA on thrombin generation. Secondary outcomes include the effect of TXA on platelet function, fibrinogen, D-dimer and coagulation factors.

OBJECTIVE: To examine the effect of physical partner violence on pregnancy loss and unplanned pregnancy. DESIGN: Cross-sectional, self-reported questionnaire survey. SETTING: A maternity ward of a university hospital in Munich, Germany. SAMPLE: Women who gave birth within the previous seven days. METHODS: The effects of physical partner violence on pregnancy loss and unplanned pregnancy were estimated using descriptive statistics based on χ(2) tests, bivariate logistic regression and multivariate logistic regression. MAIN OUTCOME MEASURES: Physical partner violence was assessed using the Abuse Assessment Screen, information on pregnancy loss was derived from women's medical files and the assessment of pregnancy planning was based on women's self-reports. RESULTS: The survey had a response rate of 73%; 29% of the women experienced pregnancy loss, 13% reported that their last pregnancy was unplanned and 4% revealed physical violence by a current or previous partner. Physical partner violence was significantly associated with pregnancy loss (odds ratio 8.33, 95% confidence interval 2.01-34.59) and unplanned last pregnancy (odds ratio 5.03, 95% confidence interval 1.21-21.26), even after adjusting for other commonly known explanatory factors, such as number of children, women's age and women's and their partners' education level and employment, marital status, financial situation and support during pregnancy. CONCLUSIONS: Physical partner violence is an important factor in understanding pregnancy loss and unplanned pregnancy. Inquiring about the existence of intimate partner violence among these women might help to identify women in need of domestic violence services.

Background Health facility delivery is considered a critical strategy to improve maternal health. The Government of Nepal is promoting institutional delivery through different incentive programmes and the establishment of birthing centres. This study aimed to identify the socio-demographic, socio-cultural, and health service-related factors influencing institutional delivery uptake in rural areas of Chitwan district, where high rates of institutional deliveries co-exist with a significant proportion of home deliveries. Methods This community-based cross-sectional study was conducted in six rural Village Development Committees of Chitwan district, which are characterised by relatively low institutional delivery rates and the availability of birthing centres. The study area represents both hilly and plain areas of Chitwan. A total of 673 mothers who had given birth during a one-year-period were interviewed using a structured questionnaire. Univariate and multivariable logistic regression analysis using stepwise backward elimination was performed to identify key factors affecting institutional delivery. Results Adjusting for all other factors in the final model, advantaged caste/ethnicity [aOR: 1.98; 95% CI: 1.15-3.42], support for institutional delivery by the husband [aOR: 19.85; 95% CI: 8.53-46.21], the decision on place of delivery taken jointly by women and family members [aOR: 5.43; 95% CI: 2.91-10.16] or by family members alone [aOR: 4.61; 95% CI: 2.56-8.28], birth preparations [aOR: 1.75; 95% CI: 1.04-2.92], complications during the most recent pregnancy/delivery [aOR: 2.88; 95% CI: 1.67-4.98], a perception that skilled health workers are always available [aOR: 2.70; 95% CI: 1.20-6.07] and a birthing facility located within one hour’s travelling distance [aOR: 2.15; 95% CI: 1.26-3.69] significantly increased the likelihood of institutional delivery. On the other hand, not knowing about the adequacy of physical facilities significantly decreased the likelihood of institutional delivery [aOR: 0.14; 95% CI: 0.05-0.41]. Conclusion With multiple incentives present, the decision to deliver in a health facility is affected by a complex interplay of socio-demographic, socio-cultural, and health service-related factors. Family decision-making roles and a husband’s support for institutional delivery exert a particularly strong influence on the place of delivery, and this should be emphasized in the health policy as well as development and implementation of maternal health programmes in Nepal.