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Objective Our objective was to determine whether maternal blood angiogenic factors in suspected-small-for-gestational-age (sSGA) fetuses can predict critical adverse perinatal outcomes (CAPO) and improve risk assessment. Methods Women with singleton pregnancies diagnosed with sSGA, between 24 and 35 6/7 weeks' gestation, were included. Clinical and sonographic comprehensive evaluations were performed at enrolment. Plasma angiogenic factors, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), were obtained at diagnosis. In parallel, three attending maternal-fetal-medicine specialists predicted the risk (1–5 scale) of these pregnancies to develop CAPO, based on the clinical presentation. CAPOs were defined as prolonged neonatal intensive care unit hospitalization, fetal or neonatal death, and major neonatal morbidity. Statistical analysis included sensitivity, specificity, positive and negative predictive values, and receiver-operating characteristic (ROC) curve analyses. Results Of the 79 cases included, 32 were complicated by CAPO (40.5%). In SGA fetuses with CAPO, the sFlt-1/PlGF ratio was higher (p < 0.001) and PlGF was lower (p < 0.001) as compared with uncomplicated pregnancies. The areas under the ROC curves for specialists were 0.913, 0.824, and 0.811 and for PlGF and sFlt-1/PlGF ratio 0.926 and 0.900, respectively. CAPO was more common in pregnancies with absent end-diastolic flow or reversed end-diastolic flow (AEDF or REDF) in the umbilical artery upon enrolment (91.6%). Yet, 65.6% of cases involving CAPO occurred in patients without AEDF or REDF, and 66.6% of these cases were not identified by one or more of the experts. The sFlt-1/PlGF ratio identified 92.9% of the experts' errors in this group and 100% of the errors in cases with AEDF or REDF. Conclusion Among sSGA pregnancies prior to 36 weeks' gestation, angiogenic factors testing can identify most cases later complicated with CAPO. Our data demonstrate for the first time that these markers can reduce clinician judgment errors. Incorporation of these measures into decision-making algorithms could potentially improve management, outcomes, and even health care costs. Key Points Angiogenic factors at diagnosis of sSGA can be used to predict CAPO. The sFlt-1/PlGF ratio can flag sSGA pregnancies at increased risk. The sFlt-1/PlGF ratio at admission of sSGA adds to clinical assessment. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the presence of brain sparing in fetal growth restricted (FGR) fetuses involves elevation of the cerebral injury biomarker S100B in maternal circulation. Methods: We included 63 women with suspected small for gestational age (SGA) fetuses between 24 and 35 +6/7 weeks of gestation. Maternal plasma angiogenic factors measurements and sonographic evaluation were performed at recruitment. Next, we subdivided our SGA cohort into three groups: SGA fetuses, FGR fetuses without brain‐sparing, and FGR fetuses with brain‐sparing (FGR‐BS). Serum S100B concentration was calculated as S100B µg/L, S100B MoM, and the ratio S100B/ estimated fetal weight (EFW). We also report one case of S100B concentration surge in maternal serum following the diagnosis of fetal intraventricular hemorrhage (IVH). Results: The FGR‐BS group had higher maternal S100B µg/L (p < 0.01, p < 0.05, respectively), S100B MoM (p < 0.001, p < 0.001, respectively), and S100B/EFW (p < 0.001, p < 0.01, respectively), compared to the SGA and FGR groups. In the case report, maternal serum S100B concentrations were 0.0346 µg/L before, and 0.0874 µg/L after IVH occurrence. Conclusions: S100B concentration in maternal serum increased in pregnancies complicated by FGR and brain sparing. These results may substantiate in‐utero cerebral injury and may explain the adverse neurocognitive outcomes reported for this group. Key points: What is already known about this topic? S100B, a neural injury marker, can be detected in maternal circulation during pregnancy. Fetuses that suffered from fetal growth restriction (FGR) with brain sparing have higher rates of neurodevelopmental abnormalities. However, it is still unclear whether the brain‐sparing effect signifies cerebral pathology occurring during pregnancy What does this study add? Our data demonstrate that S100B concentration in maternal circulation increases in pregnancies complicated by FGR with brain sparing, thus supporting the hypothesis that brain sparing, measured at the time of FGR diagnosis, may be linked to in‐utero cerebral injury [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To compare perinatal outcomes in subsequent pregnancies following second‐trimester abortions, stratified by the method of abortion.A historic cohort study was conducted in a single tertiary hospital, including women who had second‐trimester abortions between 12+0 and 24+0 weeks and subsequent documented pregnancies within 3–60 months. Data were collected from hospitalization and perinatal databases. Composite outcome variables were constructed, and multivariable logistic regression was used to analyze associations, adjusting for confounders.Among 771 women meeting the inclusion criteria, 83% had surgical abortions and 17% had medical abortions. Medical abortion was associated with a higher incidence of placenta‐associated pregnancy complications compared with surgical abortion. No significant differences were found in other perinatal outcomes.The study highlights the potential influence of the abortion method on subsequent pregnancy outcomes, particularly regarding placenta‐associated complications. This underscores the importance of considering the method of second‐trimester abortion in counseling women regarding potential risks to subsequent pregnancies. Adverse outcomes in subsequent pregnancies following second‐trimester abortion were associated with the medical method of abortion, warranting further research and careful counseling in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate fetal gender and its influences on neonatal outcomes, taking into consideration the available tools for the assessment of fetal well-being. Methods: We conducted a retrospective study comparing maternal, fetal and neonatal outcomes according to fetal gender, in women carrying a singleton gestation. A multivariate analysis was performed for the prediction of adverse neonatal outcomes according to fetal gender, after adjustment for gestational age, maternal age and fetal weight. Results: A total of 682 pregnancies were included in the study, of them 56% (n = 383) were carrying a male fetus and 44% (n = 299) a females fetus. Male gender was associated with a significant higher rate of abnormal fetal heart tracing patterns during the first (67.7% versus 55.1,p = 0.001) and the second stage (77.6 versus 67.7,p = 0.01) of labor. Male gender was also significantly associated with lower Apgar scores at 1' (19.1% versus 10.7%,p < 0.01), as well as lower pH values (7.18 ± 0.15 versus 7.23 ± 0.18,p < 0.001), and significant differences in cord blood components (PCO2, PO2) compared with female fetuses. In the multivariate analysis, male gender was found to be significantly associated with first (OR 1.76, 95% CI 1.28–2.43,p = 0.001) and second stage (OR 1.73, 95% CI 1.20–2.50,p < 0.01) pathological fetal heart tracing patterns, pH < 7.1, and for Apgar scores at 1'< 7. Conclusions: The present study confirms the general trend of a lower clinical performance of male neonates compared with females. In addition, the relation between fetal heart rate patterns during all stages of labor and fetal gender showed an independent association between male fetal gender and abnormal fetal heart monitoring during labor. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether obesity during pregnancy poses a risk for subsequent maternal long-term cardiovascular morbidity, after controlling for diabetes and hypertensive disorders.Study Design: Data were analyzed from consecutive pregnant women who delivered between 1988 and 1999, and were followed-up until 2010. Long-term cardiovascular morbidity was compared among women with and without obesity in pregnancy (maternal pre-pregnancy body mass index (BMI) of 30 kg/m(2) or more). Kaplan-Meier survival curves were used to compare cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for long-term cardiovascular hospitalizations.Results: During the study period 46 688 women met the inclusion criteria, 1221 (2.6%) had a BMI ≥30 kg/m(2). During a follow-up period of more than 10 years, patients with obesity had higher rates of simple cardiovascular events and total number of cardiovascular hospitalizations. These complications tended to occur at a shorter interval (mean 4871 days ± 950 versus 5060 days ± 1140; p = 0.001). In a Cox proportional hazards model that adjusted for diabetes mellitus, preeclampsia and maternal age, obesity was independently associated with cardiovascular hospitalizations (adjusted HR 2.6, 95% CI 2.0-3.4).Conclusion: Obesity during pregnancy is an independent risk factor for long-term cardiovascular morbidity, and these complications tend to occur earlier. Pregnancy should be considered as a window of opportunity to predict future health problems and as an opportunity to promote women's health. Obese parturients might benefit from cardiovascular risk screening that could lead to early detection and secondary prevention of cardiovascular morbidity. [ABSTRACT FROM AUTHOR]