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Introduction: Pregnant women with a body mass index (BMI) ≥40 kg/m2 are at an increased risk of requiring planned‐ and unplanned cesarean deliveries (CD). The aim of this systematic review is to compare outcomes in women with BMI ≥ 40 kg/m2 based on planned and actual mode of birth. Material and Methods: Five databases were searched for English and French‐language publications until February 2019, and all studies reporting on delivery outcomes in women with BMI ≥ 40 kg/m2, stratified by planned and actual mode of birth, were included. Risk‐of‐bias was assessed using the Newcastle‐Ottawa Scale. Relative risks (RR) and 95% confidence intervals were calculated using random‐effects meta‐analysis. Results: Ten observational studies were included. Anticipated vaginal birth vs planned CD (5 studies, n = 2216) was associated with higher risk for postpartum hemorrhage (13.0% vs 4.1%, P <.001, numbers needed to harm (NNH = 11), I2 = 0%) but lower risk for wound complications (7.6% vs 14.5%, P <.001, numbers needed to treat (NNT = 15), I2 = 58.3%). Planned trial of labor vs repeat CD (3 studies, n = 4144) was associated with higher risk for uterine dehiscence (0.94% vs 0.42%, P =.04, NNH = 200, I2 = 0%), endometritis (5.1% vs 2.2%, P <.001, NNH = 35, I2 = 0%), prolonged hospitalization (one study, 30.3% vs 26.0%, P =.003, NNH = 23), low five‐minute Apgar scores (4.9% vs 1.7%, RR 2.95 (2.03, 4.28), NNH = 30, I2 = 0%) and birth trauma (1.1% vs 0.2%, P <.001, NNH = 111, I2 = 0%). Successful vaginal birth vs intrapartum CD (n = 3625) was associated with lower risk of postpartum hemorrhage (15.1% vs 70%, P <.001, NNT = 2, I2 = 0%), wound complications (one study, 0% vs 4.4%, P =.007, NNT = 23), prolonged hospitalization (one study, 1.9% vs 6.7%, 0.04, NNT = 21) and low five‐minute Apgar scores (one study, 1.0% vs 5.6%, P =.03, NNT = 22), but more birth trauma (5.9% vs 0.6%, P =.005, NNH = 19, I2 = 0%). Compared groups had dissimilar demographic characteristics. Although studies scored 6‐7/9 on risk‐of‐bias assessment, they were at high‐risk for confounding by indication. Conclusions: Evidence from observational studies suggests clinical equipoise regarding the optimal mode of delivery in women with BMI ≥ 40 kg/m2 and no prior CD. This question is best answered by a randomized trial. Based on an unplanned subgroup analysis, for women with BMI ≥ 40 kg/m2 and prior CD, repeat CD may be associated with better clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: As thromboembolism (TE) continues to be one of the principal causes of death in obstetrical patients and as the postpartum period is associated with the highest risk for TE, we sought to determine the risk factors associated with TE following cesarean section (CS). Methods: A retrospective analysis of patients who had CS at a large tertiary referral center was conducted. Patients were identified through hospital medical records and were contacted approximately 1 year following their CS. Medical records and a questionnaire were used to identify features that were potentially associated with TE. Univariate analysis was used to determine the risk associated with these characteristics. Results: A total of 2206 patients had a CS, of which 1377 (62%) participated. Of the respondents, 137 patients received heparin (94% received a prophylactic dose, 6% received a therapeutic dose) and the remainder, 1233 patients, did not receive heparin. Seven patients (0.5%) developed a TE and 86% developed a TE within 7 days of CS. The odds ratio (OR) for TE for women with hypertension prior to pregnancy compared to patients who did not receive anticoagulation was 21.28 [95% confidence interval (CI) 4.64-90.13] and for patients who had varicose veins with superficial thrombophlebitis when compared to patients who had received heparin postpartum was 21.01 (95% CI 1.55-288.24). Discussion: Hypertension and the presence of varicose veins were associated with TE following CS. Larger cohort analyses are required to confirm these associations so that risk scores incorporating these characteristics may accurately predict the occurrence of TE. [ABSTRACT FROM AUTHOR]

Introduction: Pregnant women with a body mass index (BMI) ≥40 kg/m 2 are at an increased risk of requiring planned- and unplanned cesarean deliveries (CD). The aim of this systematic review is to compare outcomes in women with BMI ≥ 40 kg/m 2 based on planned and actual mode of birth., Material and Methods: Five databases were searched for English and French-language publications until February 2019, and all studies reporting on delivery outcomes in women with BMI ≥ 40 kg/m 2 , stratified by planned and actual mode of birth, were included. Risk-of-bias was assessed using the Newcastle-Ottawa Scale. Relative risks (RR) and 95% confidence intervals were calculated using random-effects meta-analysis., Results: Ten observational studies were included. Anticipated vaginal birth vs planned CD (5 studies, n = 2216) was associated with higher risk for postpartum hemorrhage (13.0% vs 4.1%, P < .001, numbers needed to harm (NNH = 11), I 2  = 0%) but lower risk for wound complications (7.6% vs 14.5%, P < .001, numbers needed to treat (NNT = 15), I 2  = 58.3%). Planned trial of labor vs repeat CD (3 studies, n = 4144) was associated with higher risk for uterine dehiscence (0.94% vs 0.42%, P = .04, NNH = 200, I 2  = 0%), endometritis (5.1% vs 2.2%, P < .001, NNH = 35, I 2  = 0%), prolonged hospitalization (one study, 30.3% vs 26.0%, P = .003, NNH = 23), low five-minute Apgar scores (4.9% vs 1.7%, RR 2.95 (2.03, 4.28), NNH = 30, I 2  = 0%) and birth trauma (1.1% vs 0.2%, P < .001, NNH = 111, I 2  = 0%). Successful vaginal birth vs intrapartum CD (n = 3625) was associated with lower risk of postpartum hemorrhage (15.1% vs 70%, P < .001, NNT = 2, I 2  = 0%), wound complications (one study, 0% vs 4.4%, P = .007, NNT = 23), prolonged hospitalization (one study, 1.9% vs 6.7%, 0.04, NNT = 21) and low five-minute Apgar scores (one study, 1.0% vs 5.6%, P = .03, NNT = 22), but more birth trauma (5.9% vs 0.6%, P = .005, NNH = 19, I 2  = 0%). Compared groups had dissimilar demographic characteristics. Although studies scored 6-7/9 on risk-of-bias assessment, they were at high-risk for confounding by indication., Conclusions: Evidence from observational studies suggests clinical equipoise regarding the optimal mode of delivery in women with BMI ≥ 40 kg/m 2 and no prior CD. This question is best answered by a randomized trial. Based on an unplanned subgroup analysis, for women with BMI ≥ 40 kg/m 2 and prior CD, repeat CD may be associated with better clinical outcomes., (© 2020 Nordic Federation of Societies of Obstetrics and Gynecology.)

Objective Data: The purpose of this study was to determine the effect of body mass index category on pregnancy outcomes., Study: Five databases (Medline, Embase, PubMed, www.clinicaltrials.gov, and Cochrane) were searched from inception until February 2019 for English or French publications that reported on pregnancy outcomes in women with body mass index ≥30 kg/m 2 . Reference lists of included articles were searched, and authors were contacted for missing data where necessary. Because no randomized trials were identified, we included single-center and population-based cohort studies that stratified pregnancy outcomes under the following body mass index categories: underweight, standard weight, overweight, and obese classes I-III, based on the World Health Organization international classification system., Study Appraisal and Synthesis Methods: Study quality was appraised with the use of the Newcastle-Ottawa Scale Quality Assessment Scale for cohort studies. Because significant heterogeneity was anticipated among studies, we used random-effects metaanalysis to arrive at pooled estimates and 95% confidence intervals for pregnancy outcomes in each body mass index category and relative risks in relation to women with a standard body mass index., Results: We identified 10,258 studies, of which 13 studies with a low risk-of-bias that described 3,722,477 pregnancies that were included in the metaanalysis. Most adverse pregnancy outcomes increased steadily with increasing body mass index category. Compared with women with body mass index 18.5-24.9 kg/m 2 , women with body mass index >40 kg/m 2 were at increased risk for gestational diabetes mellitus [17% vs 3.9%; relative risk, 4.6 [95% confidence interval, 3.6-5.9]), hypertensive disorders of pregnancy (15.9% vs 3.5%; relative risk, 4.6 [95% confidence interval, 3.4-6.0]), and cesarean delivery (47.7% vs 26.0%; relative risk, 1.86 [95% confidence interval, 1.75-1.97]). Babies were at increased risk for hypoglycemia (4.1% vs 1.4%; relative risk, 3.3 [95% confidence interval, 2.8-3.8]), macrosomia (12.9% vs 6.2%; relative risk, 2.6 [95% confidence interval, 1.4-4.7]), infection (2.8% vs 1.3%; relative risk, 2.3 [95% confidence interval, 1.6-3.3]), birth trauma (1.3% vs 0.9%; relative risk, 2.1 [95% confidence interval, 1.2-3.8]), respiratory distress (5.1% vs 2.7%; relative risk, 2.0 [95% confidence interval, 1.8-2.2]), death (1.4% vs 0.9%; relative risk, 1.8 [95% confidence interval, 1.2-2.9]), and neonatal intensive care unit admission (13.5% vs 9.5%; relative risk, 1.6 [95% confidence interval, 1.4-1.9])., Conclusion: There is a linear association between maternal body mass index and almost all adverse pregnancy outcomes. These risks, stratified by body mass index category as presented in this article, would facilitate counselling and encourage appropriate interventions to improve outcomes for mothers and babies., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To determine the frequency of Plasmodium (P.) vivax and P. falciparum in cases of acute febrile illness, and the haematological parameters in patients suffering with acute malaria., Study Design: An observational study., Place and Duration of Study: Baqai Medical University, Fatima Hospital Laboratory, Karachi, from January 2006 to December 2007., Methodology: Patients with acute febrile illness were evaluated. Complete blood count and malarial parasite were performed. Descriptive statistics of haematological parameters was computed. Mean and standard deviations (SD) were calculated; p-value was determined using test of proportions on SPSS., Results: Out of 3344 patients, 392 (11.72%) were proved as suffering from malaria with male to female ratio of 1.36. The age ranged from 1 month to 94 years. One hundred and seventy six (42.6%) had P. falciparum, 204 (52%) had P. vivax, and 21 (5.4%) had mixed infection. Haemoglobin varied from 1.10 g/dl -17.10 g/dl, (mean 9.83 + 3.09 g/dl). TLC ranged from 1.30 x 103/ul - 48.50 x 103/ul, (mean 6.80 + 5.15 x 103/ul. The platelet counts ranged from 10.0 x 103/ul - 850 x 103/ul, (mean 106 + 90.98 x 103/ul). Thrombocytopenia was observed in 70%, platelet count was significantly lower in patients with mixed infection as compared to patients with P. falciparum and P. vivax (p=.017)., Conclusion: The frequency of malaria was 11.72%. Thrombocytopenia was the most common finding. In none of the patients platelet counts dropped below the critical levels of 10 x 103/microl.