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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

Introduction and hypothesis: This study reports the long-term anatomic and subjective outcomes following sacrocolpopexy based on mesh weight and provides device-specific data. Method(s): This cohort study compared ultra-lightweight (<= 20 g/m2) with lightweight mesh (>= 25 g/m2). The primary outcome was composite failure defined as at least one of >= stage 2 apical prolapse, anterior or posterior vaginal wall beyond hymen, complaint of bulge or retreatment. Effect measure estimates were calculated as the incidence rate ratio of composite failure comparing the use of ultra-light with lightweight mesh. Crude and adjusted incidence rate ratios (IRRs) were obtained using uni- and multivariable Poisson regression models. Result(s): Of 358 women who met inclusion criteria, 220 (61%) agreed to attend for review; 95 (43%) had ultra-lightweight mesh and 125 (57%) had lightweight mesh including UpsylonTM. Median follow-up for ultra-light and lightweight mesh was 36 (IQR 22-42) and 63 (IQR 48-87) months, respectively (p < 0.001). Accounting for differences in follow-up time, there was no significant difference in composite failure between ultra-light and lightweight mesh groups (IRR 1.47, 95% CI 0.83-2.52, p = 0.15). This persisted after adjustment for age, body mass index, parity, smoking and presence of advanced prolapse prior to surgery (IRR 1.52, 95% CI 0.94-2.47, p = 0.087). Mesh exposure for both groups was mostly asymptomatic, and the rate was 7% for the ultra-light group and 8% in the lightweight group. Overall, repeat surgery for recurrent apical prolapse and mesh exposure occurred in 4% and 2%, respectively. Conclusion(s): Ultra-lightweight mesh appears to have similar incidence rate of failure compared to lightweight mesh. UpsylonTM mesh has a similar low rate of recurrent apical prolapse and mesh exposure.Copyright © 2022, The International Urogynecological Association.

Objective:To compare the effect of comorbidities on the phenotype and outcomes of preeclampsia. Method(s): A matched retrospective cohort study of women delivering at a tertiary maternity center following a diagnosis of preeclampsia. We collected data on signs and symptoms, biochemical markers, and maternal and perinatal outcomes. Result(s):We studied 474 women; 158 women with and 316 without comorbidities. Compared to women without comorbidities, women with comorbidities delivered earlier. They suffered fewer maternal but more neonatal complications. Conclusion(s): Women with comorbidities receive earlier intervention than women without comorbidities, which may lead to fewer maternal complications but worse neonatal outcomes.Copyright © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Background The COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternity care with documented impacts on perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne has endured one of the longest and most stringent lockdowns in globally. This paper presents the protocol for a multicentre study to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic. Methods Multicentre observational study analysing monthly deidentified maternal and newborn outcomes from births >20 weeks at all 12 public maternity services in Melbourne. Data will be merged centrally to analyse outcomes and create run charts according to established methods for detecting non-random signals' in healthcare. Perinatal outcomes will include weekly rates of total births, stillbirths, preterm births, neonatal intensive care admissions, low Apgar scores and fetal growth restriction. Maternal outcomes will include weekly rates of: induced labour, caesarean section, births before arrival to hospital, postpartum haemorrhage, length of stay, general anaesthesia for caesarean birth, influenza and COVID-19 vaccination status, and gestation at first antenatal visit. A prepandemic median for all outcomes will be calculated for the period of January 2018 to March 2020. A significant shift is defined as >=6 consecutive weeks, all above or below the prepandemic median. Additional statistical analyses such as regression, time series and survival analyses will be performed for an in-depth examination of maternal and perinatal outcomes of interests. Ethics and dissemination Ethics approval for the collaborative maternity and newborn dashboard project has been obtained from the Austin Health (HREC/64722/Austin-2020) and Mercy Health (ref. 2020-031). Trial registration number ACTRN12620000878976; Pre-results.Copyright ©

Background: Universal screening has been proposed as a strategy to identify asymptomatic individuals infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and mitigate transmission. Aim(s): To investigate the rate of positive tests among pregnant women in Melbourne, Australia. Method(s): We performed a cross-sectional prevalence study at three maternity hospitals (one tertiary referral hospital and two secondary maternities) in Melbourne, Australia. SARS-CoV-2 testing was offered to all pregnant women attending face-to-face antenatal visits and to those attending the hospital with symptoms of possible coronavirus disease, between 6th and 19th of May 2020. Testing was performed by multiplex-tandem polymerase chain reaction (PCR) on combined oropharyngeal and nasopharyngeal swabs. The primary outcome was the proportion of positive SARS-CoV-2 tests. Finding(s): SARS-CoV-2 testing was performed in 350 women, of whom 19 had symptoms of possible COVID-19. The median maternal age was 32 years (IQR 28-35 years), and the median gestational age at testing was 33 weeks and four days (IQR 28 weeks to 36 weeks and two days). All 350 tests returned negative results (p = 0%, 95% CI 0-1.0%). Conclusion(s): In a two-week period of low disease prevalence, the rate of asymptomatic coronavirus infection among pregnant women in Australia during the study period was negligible, reflecting low levels of community transmission.Copyright © 2020 Australian College of Midwives

Objective: We previously reported a reduction in preterm birth rates during mitigation measures for COVID-19 in Melbourne. In order to understand the mechanisms behind this phenomenon, here we investigate the characteristics of women who delivered preterm during COVID-19 mitigation measures as compared to women who delivered the year before. Study Design: In this cohort study, we studied women who delivered preterm (< 37 weeks) and conceived between November 2019 and February 2020 (mitigation measures exposed cohort) versus November 2018 and February 2019 (non-exposed cohort). We compared maternal characteristics, pregnancy complications, antenatal interventions and indications for delivery. Comparisons were made by calculating odds ratios and mean difference with 95% confidence intervals as well as by using Chi square test and independent samples t-test. Result(s): There were 252/3129 of women who delivered < 37 weeks in the mitigation cohort, versus 298/3154 in the non-exposed cohort. Here, we report 150 women of each group. No difference was observed in the mean maternal age, mean BMI or median parity (Table 1). Spontaneous preterm birth rates without preterm prelabour rupture of membranes (PPROM) were lower in the lockdown cohort (6% vs 19%, p< 0.001), while PPROM occurred more often (55% vs 34%, p< 0.001). No difference was observed in rates of hypertension related complications (20% vs 14%), and antihypertensive requirements or highest blood pressures were comparable (table 2). Rates of antepartum haemorrhage, mean birth weight centile (44th percentile in both cohorts), short cervical length, suspected fetal growth restriction or abnormal fetal monitoring (abnormal dopplers, AFI or CTG) were comparable. Conclusion(s): The reduction in preterm birth during COVID-19 lockdown was driven by a decrease in spontaneous preterm birth without PPROM. This reduction in preterm birth was not associated with increase in severity of pregnancy complications, while for all re

Objective: Maternal obesity is a major challenge to safe obstetric practice with higher rates of intrapartum complications, failed induction of labour (IOL) and emergency caesarean delivery (CD). We investigated the impact of obesity on labour outcomes and interventions. Study Design: Class III obese (BMI >40 Kg/m2) and normal BMI (<25 Kg/m2) patients who delivered from 2015-2018 were matched (1:1) based on age, gestational age, parity, onset of labour, and birth weight. Patients with previous CD, IOL < 37 weeks, maternal age <18 years or stillbirth were excluded. The primary outcome was CD. Secondary outcomes were instrumental delivery, cervical dilation at decision for CD, dilation rate prior to decision for CD for labour progress, oxytocin augmentation, and intrapartum interventions (epidural analgesia, fetal scalp electrode (FSE), intrauterine pressure catheter (IUPC), fetal scalp lactate, terbutaline use). Result(s): Of 600 matched patients, 50% were primigravidae (PG). Half of both PG and multigravidae groups underwent IOL. CD rate was higher for obese (oBMI) patients (19.3%) than the normal BMI (nBMI) cohort (13.3%, RR 1.45, CI 1.00-2.09, p = 0.049). Instrumental deliveries occurred less in oBMI (16.7%) than with nBMI (24.0%, RR 0.89, CI 0.50-0.96, p = 0.027). Median cervical dilation at CD was lower for oBMI (4 cm) than nBMI (6 cm), even when comparing only CD for poor progress (5 cm vs 7 cm). Rate of dilation prior to CD for poor progress was lower in oBMI (0.04cm/hr) than nBMI (0.16cm/hr). In CD patients, oxytocin was used less often for oBMI (75.8% vs 85.0%, RR 0.89, CI 0.73-1.08, p = 0.253) but with a higher mean total dose (12.3 IU vs 11.9 IU). Rates of intrapartum intervention were higher for oBMI, particularly FSE (72.7% vs 22.7%, RR 3.21, CI 2.52-3.99, p < 0.001) and IUPC (55% vs 0%, p < 0.001). Conclusion(s): Obesity increased the risk of CD, and CD for poor progress occurred at a lower cervical dilation in the obese cohort, with a slower rate of di

Objective: It has been suggested that lockdown during the COVID-19 pandemic decreased prematurity rates. We investigated the impact of lockdown on obstetric outcomes. Study Design: We performed a cohort study on women who gave birth at three maternity hospitals in metropolitan Melbourne, Australia, between Jan 1st, 2019 and Sept 16th, 2020. Data were extracted from the common birth registry of the three maternities. The second lockdown started July 8th, 2020 and required people to stay at home, with limited exemptions. We performed interrupted time-series analysis to compare the monthly rates of preterm birth before 34 weeks prior to and after July 2020. We also compared the group of women who delivered between July and September 2020 to the group of women who delivered during the same period in 2019. Result(s): A total 15,394 women gave birth. Interrupted time-series analysis demonstrated a significantly lower monthly rate of deliveries before 34 weeks of gestational age after July 2020 (Figure 1; p = 0.001). There were 2,207 deliveries between July to Sept. 2019 and 1,870 deliveries between July to Sept. 2020. Baseline characteristics were comparable, except for a significantly difference in twins (1.5% in 2020 versus 2.6% in 2019, p = 0.012). After excluding women with pregnancies complicated by major fetal abnormalities or stillbirth, the risk of preterm delivery before 34 weeks was much lower in patients who delivered between July and September 2020 (2.1% versus 3.3%, RR 0.64, 95% CI 0.44 to 0.94, p = 0.022) (Table 1). Similar patterns were observed for iatrogenic and spontaneous preterm birth at different gestational ages. The effect persisted after logistic regression adjustment for multiple pregnancies (adjusted OR 0.65, 95% CI 0.46 to 0.96, p = 0.028). The decrease in prematurity was not at the cost of an increase in stillbirth or undetected small for gestational age neonates. Conclusion(s): Strict lockdown has a strong impact on iatrogenic and spontaneous

OBJECTIVE: To investigate the effect of restriction measures implemented to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during the coronavirus disease 2019 (COVID-19) pandemic on pregnancy duration and outcome. METHOD(S): A before-and-after study was conducted with cohort sampling in three maternity hospitals in Melbourne, Australia, including women who were pregnant when restriction measures were in place during the COVID-19 pandemic (estimated conception date between 1 November 2019 and 29 February 2020) and women who were pregnant before the restrictions (estimated conception date between 1 November 2018 and 28 February 2019). The primary outcome was delivery before 34weeks' gestation or stillbirth. The main secondary outcome was a composite of adverse perinatal outcomes. Pregnancy outcomes were compared between women exposed to restriction measures and unexposed controls using the chi-square test and modified Poisson regression models, and duration of pregnancy was compared between the groups using survival analysis. RESULT(S): In total, 3150 women who were exposed to restriction measures during pregnancy and 3175 unexposed controls were included. Preterm birth before 34weeks or stillbirth occurred in 95 (3.0%) exposed pregnancies and in 130 (4.1%) controls (risk ratio (RR), 0.74 (95%CI, 0.57-0.96); P=0.021). Preterm birth before 34weeks occurred in 2.4% of women in the exposed group and in 3.4% of women in the control group (RR, 0.71 (95%CI, 0.53-0.95); P=0.022), without evidence of an increase in the rate of stillbirth in the exposed group (0.7% vs 0.9%; RR, 0.83 (95%CI, 0.48-1.44); P=0.515). Competing-risks regression analysis showed that the effect of the restriction measures on spontaneous preterm birth was stronger and started earlier (subdistribution hazard ratio (HR), 0.81 (95%CI, 0.64-1.03); P=0.087) than the effect on medically indicated preterm birth (subdistribution HR, 0.89 (95%CI, 0.70-1.12); P=0.305). The eff

Questions continue to be raised regarding the benefit of genetic assessment of embryos prior to transfer in IVF, specifically with regards to preimplantation genetic testing for aneuploidy (PGT-A). To evaluate and quantify these concerns, we appraised the most recent (2012-2019) randomized controlled trials on the topic. Only two of these six studies listed cumulative live birth rates per started cycle, with both eliciting a statistically non-significant result. This article describes the concern that a focus on results from the first embryo transfer compared to cumulative outcomes falsely construes PGT-A as having superior outcomes, whilst its true benefit is not confirmed, and it cannot actually improve the true pregnancy outcome of an embryo pool.Copyright © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved.

OBJECTIVES: To investigate the effect of restriction measures during the COVID-19 pandemic on pregnancy duration and outcomes. METHOD(S): We conducted a before and after study with cohort sampling in three maternity hospitals in Melbourne, Australia, including women who were pregnant during the COVID-19 pandemic restriction measures (estimated conception between 1 November 2019 and 29 February 2020) and women who were pregnant before the restrictions (estimated conception between 1 November 2018 and 28 February 2019). The primary outcome was delivery before 34weeks' gestation or stillbirth. The main secondary outcome was a composite of adverse perinatal outcomes. Pregnancy outcomes were compared between the groups using chi-squared tests and modified Poisson regression models, and pregnancy duration was compared between the groups using and survival analysis. RESULT(S): There were 3150 exposed women and 3175 women in the control group. Preterm birth before 34weeks' gestation or stillbirth occurred in 95 (3.0%) of the pregnancies during restrictions and 130 (4.1%) in the control group (Risk ratio (RR) 0.74, 95% CI 0.57 to 0.96, p = 0.021). The effect was stronger in women with a previous preterm birth (RR 0.42, 95% CI 0.21 to 0.82, p = 0.008). The composite adverse perinatal outcome was less frequent in the exposed group (2.1% versus 2.9%, RR 0.73, 95% CI 0.54 to 0.99, p = 0.042 in all women and 4.5% versus 8.4%, RR 0.54, 95% CI 0.25 to 1.18, p = 0.116 in women with a previous preterm birth). CONCLUSION(S): Restrictions to mitigate COVID-19 transmission were associated with reduced rates of preterm birth before 34weeks. This effect was not associated with increased stillbirth rates and was stronger in women with previous preterm delivery. This article is protected by copyright. All rights reserved.

Background: Little evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care. Method(s): We analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation). Finding(s): Between Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0.72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0.50 for high-risk care models), number of stillbirths (1% vs 1%, p=0.79; 2% vs 2%, p=0.70), or

Background: The diagnostic criteria for preeclampsia have evolved from the traditional definition of de novo hypertension and proteinuria to a broader definition of hypertension with evidence of end-organ dysfunction. Although this change is endorsed by various societies such as the International Society for the Study of Hypertension in Pregnancy and the American College of Obstetricians and Gynecologists, there remains controversy with regard to the implementation of broader definitions and the most appropriate definition of end-organ dysfunction. Objective(s): This study aimed to assess the impact of different diagnostic criteria for preeclampsia on rates of disease diagnosis, disease severity, and adverse outcomes and to identify associations between each component of the different diagnostic criteria and adverse pregnancy outcomes. Study Design: We performed a retrospective cohort study of singleton pregnancies at Monash Health between January 1, 2016 and July 31, 2018. Within this population, all cases of gestational hypertension and preeclampsia were reclassified according to the International Society for the Study of Hypertension in Pregnancy 2001, American College of Obstetricians and Gynecologists 2018, and International Society for the Study of Hypertension in Pregnancy 2018 criteria. Differences in incidence of preeclampsia and maternal and perinatal outcomes were compared between the International Society for the Study of Hypertension in Pregnancy 2001 group and the extra cases identified by American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018. Outcomes assessed included biochemical markers of preeclampsia, a composite of adverse maternal outcomes, and a composite of adverse perinatal outcomes. Multiple logistic regression analysis was also performed to assess each component of the American College of Obstetricians and Gynecologists 2018 and International Society for the Study

COVID-19 has resulted in unprecedented changes to maternity care across Australia. This study aims to analyse trends in maternity consultations and the uptake of telehealth in Victoria and New South Wales (NSW) since the first restrictions to reduce COVID-19 transmission were implemented. From March 2020 to April 2021, a higher proportion of antenatal care consultations was delivered via telehealth in Victoria compared to NSW (13.8% vs 7.4%, P < 0.0001). Uptake of telehealth and a shift from in-person care has been a major contributor to maintaining pregnancy care during pandemic restrictions. However, further research is required to understand women's perspectives and health outcomes.Copyright © 2021 Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Objective: Induction of labor (IOL) is one of the most common obstetric interventions, with cervical ripening required for half of all inductions. Randomized clinical trials comparing balloon catheters and vaginal prostaglandins are generally underpowered for safety outcomes. We aim to compare effectiveness and safety by re-analyzing individual participant data from numerous trials comparing these two methods of cervical ripening. Study Design: Raw data was sought from eligible RCTs comparing balloon catheters and vaginal prostaglandins (PGE1 and/or PGE2). The primary outcomes were caesarean section (CS) and its indications (i.e., fetal compromise or failure to progress), a composite of adverse perinatal outcome (Apgar < 7 at 5 min, arterial umbilical cord pH < 7.1, admission to NICU, seizures, severe respiratory compromise, infection, neonatal death, or stillbirth), and a composite of adverse maternal outcome (admission to ICU, infection, severe postpartum hemorrhage, or death). The analysis followed intention-to-treat and considered clustering within trials. Result(s): We identified 13 eligible RCTs of which data was available from eight (3772 participants) with the data from three PROBAAT combined (PROBAAT 1+M+P). IOL with balloon catheters and vaginal prostaglandins did not have significantly different rates of CS (RR 1.09, 95% CI 0.97-1.22). However, balloon catheters were associated with significantly higher rates of CS for failure to progress (RR 1.23, 95% CI 1.01-1.51; Figure 1). CS for fetal compromise occurred less often, although the difference was not statistically significant (RR 0.85, 95% CI 0.66-1.09). Balloon catheters were associated with reduced composite adverse perinatal outcomes (Figure 2) compared to vaginal prostaglandins (RR 0.80, 95% CI 0.67-0.97). There were no differences noted for composite adverse maternal outcomes between the two methods (RR 1.00, 95% CI 0.86-1.16). Conclusion(s): For cervical ripening in IOL, balloon catheters and vagi

Objective: To analyse the published literature in reproductive endocrinology and infertility (REI) to examine the transparency and the use of reproducible research practices of the scientific literature and to identify possible avenues for improvement. Design(s): Meta-epidemiologic study. We examined the first 20 consecutive full-text original articles presenting primary data from five REI-specific journals for 2013 and for 2018, and eligible REI articles published in 2013-2018 in five high-impact general journals. Eligible articles were required to be full-text original articles, presenting primary data. Setting(s): Not applicable. Patient(s): Not applicable. Intervention(s): Not applicable. Main Outcome Measure(s): Each article was assessed for study type, trial registration, protocol and raw data availability, funding and conflict of interest declarations, inclusion in subsequent systematic reviews and/or meta-analyses, sample size, and whether the work claimed to be novel or replication. Sample sizes and citation counts also were obtained. Result(s): A total of 222 articles were deemed eligible; 98 from REI journals published in 2013, 90 from REI journals published in 2018, and 34 from high-impact journals. There were 37 studies registered, 15 contained a protocol, and two stated actively that they were willing to share data. Most studies provided a statement about funding and conflicts of interest. Two articles explicitly described themselves as replications. All randomized controlled trial published in REI journals were registered prospectively; many meta-analyses were not registered. High-impact journal articles had a greater median sample size and more citations and were more likely to be registered, to have a protocol, and to claim novelty explicitly when compared with REI 2013 and 2018 articles. Conclusion(s): Research in REI can be improved in prospective registration, routine availability of protocols, wider sharing of raw data whenever feasible, and mor

Objective: To determine the proportion of major fetal structural abnormalities that can be detected before 11 gestational weeks. Method(s): We conducted a retrospective study of individual patient files at a tertiary provider of obstetric and gynecological ultrasound in Melbourne, Australia. All women who had a pre-cell-free DNA ultrasound with a crown-rump length of less than 45 mm and had one or more ultrasounds at a later gestation were included in the analysis. The primary outcome was the incidence of a fetal structural abnormality. Result(s): A total of 3333 cases were included in the final analysis. Overall, 316 fetuses (9.5%) had a structural abnormality detected at any point throughout gestation, of which 86 were major structural abnormalities (2.6%). Sixteen fetal abnormalities were detected before 11 weeks of gestation, including 15 major abnormalities (17.4% of the major anomalies). All major fetal abnormalities detected before 11 gestational weeks were confirmed at later ultrasound examinations or the pregnancy did not continue (in four cases due to termination of pregnancy and in one case spontaneous miscarriage before first trimester morphology ultrasound). Conclusion(s): Detection of fetal abnormalities is possible before 11 weeks of gestation. Early suspicion is more likely in cases of major structural abnormalities.Copyright © 2021 John Wiley & Sons Ltd.

BACKGROUND: Untreated microangiopathic hemolytic anemia in pregnancy is associated with adverse maternal and perinatal outcomes. Accurate diagnosis is challenging owing to nonspecific clinical features and pathologic findings. Timely initiation of appropriate management is essential to optimize maternal and perinatal outcomes. CASE: A 26-year-old primiparous woman presented at 20 weeks of gestation with new-onset microangiopathic hemolytic anemia on a background of poorly controlled type 1 diabetes. She received eculizumab for presumed atypical hemolytic uremic syndrome. At 24 weeks of gestation, she developed superimposed early-onset preeclampsia; she delivered at 27 weeks of gestation after continuing eculizumab. CONCLUSION(S): Eculizumab may prolong pregnancy in early-onset preeclampsia. Additional research is needed to assess short-term and long-term maternal and newborn outcomes.Copyright © 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Background: Competing risk models used for midpregnancy prediction of preterm pre-eclampsia have shown detection rates (DR) of 85%, at fixed false-positive rate (FPR) of 10%. The full algorithm used between 19+0 and 24+6 weeks includes maternal factors, mean arterial pressure (MAP), mean uterine artery pulsatility index (UtAPI), serum placental growth factor (PlGF) level in multiples of the median (MoM), and soluble Fms-like tyrosine kinase-1 (sFlt-1) level in MoM. Aim(s): To assess performance of the Fetal Medicine Foundation (FMF) algorithm at midpregnancy to screen for preterm (<37 weeks) pre-eclampsia. The outcome measured was preterm pre-eclampsia. Material(s) and Method(s): This is a prospective study including singleton pregnancies at 19-22 weeks gestation. Maternal bloods were collected and analysed using three different immunoassay platforms. Maternal characteristics, medical history, MAP, mean UtAPI, serum PlGF MoM and serum sFlt-1 MoM were used for risk assessment. DR and FPR were calculated, and receiver operating characteristic curves produced. Result(s): Five hundred and twelve patients were included. Incidence of preterm pre-eclampsia was 1.6%. Using predicted risk of pre-eclampsia of one in 60 or more and one in 100 or higher, as given by the FMF predictive algorithm, the combination with the best predictive performance for preterm pre-eclampsia included maternal factors, MAP, UtAPI and PlGF MoM, giving DRs of 100% and 100%, respectively, and FPRs of 9.3 for all platforms and 12.9-13.5, respectively. Addition of sFlt-1 to the algorithm did not appear to improve performance. sFlt-1 MoM and PlGF MoM values obtained on the different platforms performed very similarly. Conclusion(s): Second trimester combined screening for preterm pre-eclampsia by maternal history, MAP, mean UtAPI and PlGF MoM using the FMF algorithm performed very well in this patient population.Copyright © 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecolo

OBJECTIVES: The acrania-anencephaly sequence is a lethal condition with a high detection rate in experienced hands after 10weeks' gestation. However, earlier in gestation, many cases remain undetected. Different phenotypic appearances have been described and might help increase the detection rate in less experienced hands and also earlier in gestation. The purpose of this study was to assess interobserver reliability in classifying cases of the acrania-anencephaly sequence during first trimester in 6 different subtypes according to their ultrasound appearances. METHOD(S): This was a retrospective descriptive cohort study at 3 centers for fetal imaging. Each case was classified according to its phenotypic appearance by 2 independent operators as "bilobular," "cystic," "elongated," "irregular," "foreshortened," or "overhanging." Frequencies of each type are described, and interoperator agreement was assessed with the intraclass correlation coefficient. RESULT(S): From the 88 included cases, the frequencies of the different subtypes classified as overhanging, elongated, bilobular, cystic, foreshortened, and irregular were 31%, 25%, 19%, 11%, 8%, and 6%, respectively. The interoperator reliability was good, with an intraclass correlation coefficient of 0.903 (95% confidence interval, 0.853-0.937; P<.001). CONCLUSION(S): Using different subtypes may improve the detection of the acrania-anencephaly sequence. An accurate early diagnosis could lead to timely, less traumatic, and safer management of affected pregnancies.Copyright © 2020 by the American Institute of Ultrasound in Medicine.

BACKGROUND: Untreated microangiopathic hemolytic anemia in pregnancy is associated with adverse maternal and perinatal outcomes. Accurate diagnosis is challenging owing to nonspecific clinical features and pathologic findings. Timely initiation of appropriate management is essential to optimize maternal and perinatal outcomes. CASE: A 26-year-old primiparous woman presented at 20 weeks of gestation with new-onset microangiopathic hemolytic anemia on a background of poorly controlled type 1 diabetes. She received eculizumab for presumed atypical hemolytic uremic syndrome. At 24 weeks of gestation, she developed superimposed early-onset preeclampsia; she delivered at 27 weeks of gestation after continuing eculizumab. CONCLUSION(S): Eculizumab may prolong pregnancy in early-onset preeclampsia. Additional research is needed to assess short-term and long-term maternal and newborn outcomes.

Background: Small for gestational age (SGA) foetuses have an increased risk of adverse outcomes in the perinatal period and later life. Antenatal detection of these at-risk foetuses allows the opportunity to initiate surveillance and delivery. We aimed to explore the impact of antenatal detection on obstetric and perinatal outcomes. Method(s): This was a retrospective study of all singleton deliveries after 20 weeks' gestation at a large hospital maternity service over an 18-month period. Terminations of pregnancy and major foetal anomalies were excluded. An SGA neonate was defined as birthweight below the 10th percentile according to local birthweight reference ranges. Detected SGA was defined as sonographic estimated foetal weight or abdominal circumference below the 10th percentile at any gestational age after 24 weeks, or small or static symphysio-fundal height. Simple log binomial regression was used to compute the risk of adverse outcomes depending on size at birth and antenatal recognition of foetal smallness. Result(s): 13178 neonates were included. 1303 neonates (10.0%) were small for gestational age at birth. There was a trend towards increased risk of composite adverse perinatal outcome in undetected compared to detected SGA neonates, but the difference was not statistically significant (RR 1.19, 95% CI 0.72-1.95). However, detected SGA neonates were more likely to be delivered preterm (RR 4.55, 95% CI 3.27-6.34), and require admission to neonatal intensive care unit (RR 3.23, 95% CI 1.94-5.37). Conclusion(s): Antenatal detection of SGA neonates may improve perinatal outcomes but is also associated with higher probability of preterm delivery and neonatal admission.

Background: Women with a history of preeclampsia are at increased risk of cardiovascular morbidity and mortality. However, the underlying mechanisms of disease association, and the ideal method of monitoring this high-risk group, remains unclear. This review aims to determine whether women with a history of preeclampsia show clinical or subclinical cardiac changes when evaluated with an echocardiogram. Methods and Results: A systematic search of MEDLINE, EMBASE, and CINAHL databases was performed to identify studies that examined cardiac function in women with a history of preeclampsia, in comparison with those with normotensive pregnancies. In the 27 included studies, we found no significant differences between preeclampsia and nonpreeclampsia women with regard to left ventricular ejection fraction, isovolumetric relaxation time, or deceleration time. Women with a history of preeclampsia demonstrated a higher left ventricular mass index and relative wall thickness with a mean difference of 4.25 g/m2 (95% CI, 2.08, 6.42) and 0.03 (95% CI, 0.01, 0.05), respectively. In comparison with the nonpreeclampsia population, they also demonstrated a lower E/A and a higher E/e' ratio with a mean difference of -0.08 (95% CI, -0.15, -0.01) and 0.84 (95% CI, 0.41, 1.27), respectively. Conclusion(s): In comparison with women who had a normotensive pregnancy, women with a history of preeclampsia demonstrated a trend toward altered cardiac structure and function. Further studies with larger sample sizes and consistent echocardiogram reporting with the use of sensitive preclinical markers are required to assess the role of echocardiography in monitoring this high-risk population group.Copyright © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Background: Detection of small for gestational age (SGA) foetuses with risk factor screening and selective growth ultrasonography is the standard of care in Australia, but evidence regarding diagnostic accuracy is limited. We sought to identify pregnancies at risk of poor foetal growth, quantify the use of foetal growth ultrasonography and assess compliance with local screening guidelines for SGA foetuses. Method(s): This was a retrospective clinical audit of all singleton deliveries after 20 weeks' gestation at a large metropolitan maternity care centre, over 18 months. Terminations of pregnancy were excluded. An SGA neonate was defined by birthweight below the 10th percentile according to local reference ranges. Suspected SGA was defined as sonographic estimated foetal weight or abdominal circumference below the 10th percentile at any gestational age after 24 weeks, or small or static symphysis-fundal height. Result(s): 13384 singleton pregnancies were included. 10266 pregnancies (77.0%) had at least one risk factor for an SGA infant. Of these, 6650 (64.8%) underwent at least one foetal growth ultrasound after 24 weeks' gestation. 1330 infants (10.0%) were SGA at birth. Antenatal detection rate of SGA at birth was 39.6%, with a false positive rate of 10.2%. Conclusion(s): Three-quarters of pregnancies had risk factors for delivering an SGA infant, but growth ultrasonography may be underutilised. Overall, antenatal recognition of poor foetal growth is suboptimal using current screening protocols.

Background: In routine antenatal care, blood pressure is used as a screening tool for preeclampsia and its associated adverse outcomes. As such women with a blood pressure greater than 140/90 mm Hg undergo further investigation and closer follow-up, whereas those with lower blood pressures receive no additional care. In the nonpregnant setting, the American College of Cardiology now endorses lower hypertensive thresholds and it remains unclear whether these lower thresholds should also be considered in pregnancy. Objective(s): (1) To examine the association between lower blood pressure thresholds (as per the American College of Cardiology guidelines) and pregnancy outcomes and (2) to determine whether there is a continuous relationship between blood pressure and pregnancy outcomes and identify the point of a change at which blood pressure is associated with an increased risk of such outcomes. Study Design: This was a retrospective study of singleton pregnancies at Monash Health, Australia. Data were obtained with regards to maternal characteristics and blood pressure measurements at varying gestational ages. Blood pressures were then categorized as (1) mean arterial pressure and (2) normal, elevated, stage 1 and stage 2 hypertension, as per the American College of Cardiology guidelines. Multivariable regression analysis was performed to identify associations between blood pressure categories and pregnancy outcomes. Result(s): This study included 18,243 singleton pregnancies. We demonstrated a positive dose-response relationship between mean arterial pressure and the development of preeclampsia in later pregnancy. Across all gestational ages, the risk of preeclampsia was greater in those with "elevated blood pressure" and "stage 1 hypertension" in comparison with the normotensive group (adjusted risk ratio; 2.45, 95% confidence interval, 1.74-3.44 and adjusted risk ratio, 6.60; 95% confidence interval, 4.98-8.73 respectively, at 34-36 weeks' gestation). There was als

Intracranial hemorrhage and stroke are primary causes of maternal mortality in pregnancies affected by hypertensive disorders. As such antihypertensive therapy plays a crucial role in the management of severe hypertension. However, the target level to achieve the best outcome for both-mother and fetus-is still unclear. Moreover, given the lack of well-designed randomized controlled trials with standardized key outcomes, the current choice of antihypertensive medications depends rather on clinicians' preference. Furthermore, data on long-term outcomes of offspring is not available. Therefore, there is an urgent need for randomized trials comparing different anti-hypertensive options to address efficacy and safety questions.Copyright © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Objective: Ectopic pregnancy is a potentially life-threatening health problem that affects fertility and generates a significant economic burden. Optimal management, including when to choose methotrexate, and whether to do salpingectomy or salpingostomy, is still unclear. This study aimed to assess the quality and utility of research on ectopic pregnancy in the last three decades. Study design: We analyzed the quantity, quality and utility of the published literature, including 6,309 articles published over a 30-year period. We searched PubMed for studies on ectopic pregnancy, with subsequent analysis utilizing bibliometric network maps. Consolidated Standards of Reporting Trials (CONSORT) guidelines and a newly adapted checklist for usefulness of research were applied to assess randomized controlled trial (RCT) quality. Result(s): The initial search returned 14,727 articles, of which, after filters of publication date (1987/01/01 to 2017/12/31), species (Human) and language (English) were applied, 6,309 articles remained. The number of publications each year remained relatively stable, with a mean number of 280 articles published three decades ago versus 248 articles published on average in the last decade. The 7,733 human species articles published between 1987-2017 were written in 27 different languages, with 82 % in English. Publications in 14 selected high-impact journals accounted for 26.5 % (1,673/6,309) of all articles, with on average 54 publications per year across three decades. An increase in systematic reviews and meta-analyses (+1000 %), and case reports (+53 %) was seen between 1987-2017, while the percentage of RCTs (-25 %) decreased. The analyzed RCTs were of moderate quality, and few addressed the most important clinical questions. Conclusion(s): In the last three decades, both the number of articles on ectopic pregnancy and the number of articles in high-impact journals have remained stable. Despite these constant numbers, the quality of RCTs was

In this review, we discuss the recent literature regarding the prevention of preeclampsia and aim to answer common questions that arise in the routine antenatal care of pregnant women. Prescription of low-dose aspirin for high-risk patients has been shown to reduce the risk of preeclampsia (PE). A daily dose between 100 and 150 mg taken in the evening should be initiated prior to 16 weeks of gestation and can be continued until delivery. Calcium supplementation seems to be advantageous but currently it is only considered for patients with poor dietary intake and high risk for PE. Recent data about heparin are still conflicting, and therefore, heparin can currently not be recommended in the prevention of PE.