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Objectives The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands. Study design National quasi-experimental study. Methods Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. Results A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]). Conclusions During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions.

Contains fulltext : 297092.pdf (Publisher’s version ) (Open Access), BACKGROUND: Women with multiple pregnancies are at risk for maternal complications such as preterm birth. Hazardous working conditions, such as physically demanding work and long and irregular working hours, might increase the risk of preterm birth. OBJECTIVE: This study primarily aimed to determine whether certain working conditions up to 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective was to evaluate whether the working conditions of Dutch women with multiple pregnancy have been adjusted to the guidelines of the Netherlands Society of Occupational Medicine. STUDY DESIGN: We performed a prospective cohort study alongside the ProTWIN trial, a multicenter randomized controlled trial that assessed whether cervical pessaries could effectively prevent preterm birth. Women with paid work of >8 hours per week completed questionnaires concerning general health and working conditions between 16 and 20 weeks of pregnancy. Univariable and multivariable logistic regression analyses were performed to identify work-related factors associated with preterm birth (32-36 weeks' gestation) and very preterm birth (<32 weeks' gestation). We analyzed a subgroup of participants who worked for more than half of the week (>28 hours). We calculated the proportion of women who reported work-related factors not in accordance with guidelines. RESULTS: We studied 383 women, of whom 168 (44%) had been randomized to pessary, 142 (37%) to care as usual, and 73 (19%) did not participate in the randomized part of the study. After adjusting for confounding variables, working >28 hours was associated with very preterm birth (n=33; 78%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.1), and irregular working times were associated with preterm birth (n=26, 17%) (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.1) and very preterm birth (n=10; 24%) (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-7.3). Within a subgroup o

Contains fulltext : 297084.pdf (Publisher’s version ) (Open Access), STUDY QUESTION: What are the long-term outcomes after allocation to use of gonadotrophins versus clomiphene citrate (CC) with or without IUI in women with normogonadotropic anovulation and clomiphene failure? SUMMARY ANSWER: About four in five women with normogonadotropic anovulation and CC failure had a live birth, with no evidence of a difference in pregnancy outcomes between the allocated groups. WHAT IS KNOWN ALREADY: CC has long been used as first line treatment for ovulation induction in women with normogonadotropic anovulation. Between 2009 and 2015, a two-by-two factorial multicentre randomized clinical trial in 666 women with normogonadotropic anovulation and six cycles of CC failure was performed (M-ovin trial). This study compared a switch to gonadotrophins with continued treatment with CC for another six cycles, with or without IUI within 8 months. Switching to gonadotrophins increased the chance of conception leading to live birth by 11% over continued treatment with CC after six failed ovulatory cycles, at a cost of €15 258 per additional live birth. The addition of IUI did not significantly increase live birth rates. STUDY DESIGN, SIZE, DURATION: In order to investigate the long-term outcomes of switching to gonadotrophins versus continuing treatment with CC, and undergoing IUI versus continuing with intercourse, we conducted a follow-up study. The study population comprised all women who participated in the M-ovin trial. PARTICIPANTS/MATERIALS, SETTING, METHODS: The participating women were asked to complete a web-based questionnaire. The primary outcome of this study was cumulative live birth. Secondary outcomes included clinical pregnancies, multiple pregnancies, miscarriage, stillbirth, ectopic pregnancy, fertility treatments, neonatal outcomes and pregnancy complications. MAIN RESULTS AND THE ROLE OF CHANCE: We approached 564 women (85%), of whom 374 (66%) responded (184 allocated to gonadotrophins; 190 to CC). After a median follow-up time of 8

Purpose: To estimate whether the city-specific lockdown in Shanghai induced by the COVID-19 pandemic affected preterm birth rates among uninfected pregnant women in different trimesters. Method(s): The population-based retrospective cohort study was conducted in the International Peace Maternity and Child Health Hospital (IPMCH) in Shanghai, China. Pregnant women without COVID-19 received perinatal healthcare during lockdown (from January 24, 2020 to March 24, 2020) and non-lockdown (from January 24, 2019 to March 24, 2019) period and giving birth to a live infant at IPMCH were enrolled. 1:1 propensity score matching and Inverse probability of treatment weighting were used to evaluate preterm birth (<37 weeks), very preterm birth (<34 weeks), preterm birth with premature rupture of membranes (PROM-PTB), spontaneous preterm birth with intact membranes (S-PTB), and medically induced preterm birth (MI-PTB) between two groups. Result(s): 8,270 pregnant women were in the lockdown group, and 9,815 were in the non-lockdown group. Pregnant women in second trimester during lockdown had a higher risk of PTB than those during the non-lockdown period [OR: 1.43 (CI 1.01-2.02), ARD: 1.7% (CI 0.04-3.4%), p = 0.045]. Furthermore, pregnant women in third trimester during lockdown had a higher risk of PROM-PTB than those during the non-lockdown period [OR: 1.64 (CI 1.09-2.47), ARD: 0.9% (CI 0.2-1.6%), p = 0.02]; no group differences were found related to rates of VPTB, S-PTB or MI-PTB. Conclusion(s): In this cohort study in China, we found that there was an increased risk in preterm birth for non-infected women in COVID-19 lockdown who were in their second trimester.© Copyright © 2021 Lin, Zhang, Chen, Jin, Lin, Pan, Dennis, Mol, Huang and Wu.

STUDY OBJECTIVES: To assess the performance of placental, fetal and cardiovascular markers in the prediction of adverse outcomes in women with suspected or confirmed preeclampsia. METHOD(S): In this prospective prognostic accuracy study, women with suspected or confirmed preeclampsia underwent a series of investigations to measure maternal hemodynamic indices, mean arterial pressure (MAP), augmentation index (AIx), ophthalmic artery peak ratio (PR), uterine artery pulsatility index (UTA-PI), fetal biometry and Doppler studies, soluble fms-like tyrosine kinase-1 (sFLT-1), and placental growth factor (PlGF). The performance of these markers in isolation or in combination, to predict adverse perinatal outcomes and adverse maternal outcomes was then assessed using receiver-operating characteristics (AUROC) analysis. RESULT(S): We included 126 women with suspected (n=31) or confirmed preeclampsia (n=95) with a median gestational age of recruitment of 33.9weeks (interquartile range 30.9-36.3). Adverse perinatal outcomes were associated with a higher median UTA-PI (1.3 vs 0.8, p<0.001), ophthalmic artery PR (0.8 vs 0.7, p=0.01), and umbilical artery PI (82.0 vs 68.5 percentile, p<0.01), and lower median estimated fetal weight (4.0 vs 43.0 percentile, p<0.001), abdominal circumference (4.0 vs 63.0 percentile, p<0.001), middle cerebral artery PI (28.0 vs 58.5 percentile, p<0.001), and cerebroplacental ratio (18.0 vs 46.5 percentile, p<0.001). Pregnancies with adverse perinatal outcomes also had a higher median sFLT-1 (8208.0pg/mL vs 4508.0pg/mL, p<0.001), lower PlGF (27.2pg/mL vs 76.3pg/mL, p<0.001) and a higher sFLT-1/PlGF ratio (445.4 vs 74.4, p<0.001). The best performing individual marker for predicting adverse perinatal outcomes was the sFLT-1/PlGF ratio (AUROC 0.87, 95% CI 0.81-0.93) followed by estimated fetal weight (AUROC 0.81, 95% CI 0.73-0.89). Adverse maternal outcomes were associated with a higher median sFLT-1 (7471.0pg/mL vs 5131.0pg/mL, p<0.001), sFLT-1/PlGF

One unique character of reproductive medicine is the involvement of multiple individuals. Apart from individual(s) who want to become parents, also the interests offspring that is created by reproductive medicine treatments should be considered. This unique character brings unique ethical challenges, as the principle 'Primum non nocere' should be applied on all involved, including the children born form fertility treatments. I will present a framework that involves three dimensions, the risks for the mother, risks for the offspring and consequences for society and the public system. First, treatment can be refused as there is uncertainty about the quality of life of the future offspring. I will argue that before the treatment is started, the new individual is not there and cannot claim any rights. The care provider has a responsibility towards the future individual, not only in terms of health, but also from a social perspective. If the future child going to live an abusive family, it might be better of not existing. Second, treatment can be refused because of an unhealthy lifestyle or a health risk for the future mother. Treatment might be refused because a mother has an underlying disease that could severely exacerbate during pregnancy, or because she smokes or is obese. I will argue that in these situations decisions should be made in the context of absolute health risks for the mother and the offspring, as well as success rates of treatments. I will demonstrate that the bar to refuse treatments based on these grounds is high and that in most cases risks are acceptable while success rates are sufficiently high to justify treatment. Third, the risks of treatments should be balanced against the expected success rates of treatments. Risks of treatment are more acceptable if the success rates are higher. This obviously does not count for risks that only occur if the treatment is successful, for example pregnancy risks or risks for the offspring. Finally, treatments w