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Aims Methods Results Conclusions To identify a subgroup of mothers at high risk of preterm delivery, defined by empirical classes of multimorbidity and recurrence across three consecutive births.The data were extracted from the perinatal data collection (PDC) of all inpatient live births (n = 435 912) occurring in the Australian state of Queensland between January 2009 and December 2015. Within this data, a total of 7714 primiparous mothers delivered three consecutive singleton live births (total births = 23 142), and comprise the sample for all analyses.The LCA indicated a four‐class solution fit the data best at each time point, including (i) a ‘normative’ or healthy class with little morbidity (including >80% of the sample at each birth); (ii) a preterm, high morbidity class (<2% of the sample); (ii) a delivery morbidity class (4–8% of the sample); and (iii) preterm, low morbidity class (5–6% of the sample). Each group exhibited unique and consistent associations with maternal and pregnancy‐related factors across births. After accounting for these factors, the high morbidity class and preterm, low morbidity class strongly predicted these same classes across consecutive births, and from birth 1 to birth 3 (second‐order transition).A small but highly morbid class of neonatal deliveries emerged, exhibiting strong continuity across consecutive births (odds ratios >10), independent of a range of maternal and pregnancy‐related factors. This group of women, if subject to further investigation, could provide valuable insight into the aetiology of prematurity and associated morbidity, perhaps providing information to improve birth outcomes among all women. [ABSTRACT FROM AUTHOR]

Objectives: The timing of planned repeat cesarean delivery (CD) is debateful in clinical practice. Planned repeat CD is typically scheduled before the spontaneous onset of labor to minimize the risk of uterine rupture during labor and the associated risk for fetal compromise. This timing should be balanced with the potential risk of delivering an infant who could benefit from additional maturation in utero. We aim to study the influence of gestational age at the time of repeat CD on maternal and fetal complications. Study design: A population-based retrospective cohort study including all term singleton third CDs (≥ 37 weeks of gestation), between February-2020 and January-2022 at a tertiary medical center was conducted. Maternal and neonatal adverse outcomes were compared by gestational age at the time of the CD. A logistic regression models were constructed to adjust for confounders. Results: The study population included624 third CDs. Among them, two study groups were defined: 199 were at 37 + 0 to 37 + 6 weeks of gestation, and 44 were at ≥ 39 weeks of gestation at the time of delivery. 381 were at 38 + 0 to 38 + 6 weeks. Since our routine practice is to schedule elective CD at 38 + 0 to 38 + 6 weeks of gestation, we defined this group as the comparison group. In a multivariate analysis, both study groups were associated with significantly higher rates of emergent CDs after adjusting for maternal age, parity, ethnicity, premature rapture of membranes, spontaneous onset of labor and birthweight. After adjusting also for emergent CDs, CDs at 37 + 0 to 37 + 6 weeks of gestation were significantly associated with maternal and neonatal length of stay exceeding 4 days. Additionally, CDs at 37 + 0 to 37 + 6 weeks of gestation were also associated with composite of adverse neonatal and maternal outcomes. Conclusions: Our study demonstrated that scheduling third CD at 38 + 0 to 38 + 6 weeks is associated with reduced risk of emergent CD, as well as beneficial maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Premature infants may be at risk for lower effortful control, and subsequent lower academic achievement, peer competence, and emotional and physical wellness throughout the lifespan. However, because prematurity is related to obstetrical and neonatal complications, it is unclear what may drive the effect. Effortful control also has a strong heritable component; therefore, environmental factors during pregnancy and the neonatal period may interact with genetic factors to predict effortful control development. In this study, we aimed to dissect the influences of genetics, prematurity, and neonatal and obstetrical complications on the development of effortful control from 12 months to 10 years using a twin cohort. This study used data from the Arizona Twin Project, an ongoing longitudinal study of approximately 350 pairs of twins. Twins were primarily Hispanic/Latinx (23.8%–27.1%) and non-Hispanic/Latinx White (53.2%–57.8%), and families ranged in socioeconomic status with around one third falling below or near the poverty line. Of the twins, 62.6% were born prematurely. Effortful control was assessed via parent report at six waves. There was not a significant relationship between gestational age and effortful control regardless of whether obstetrical and neonatal complications were controlled for. Biometric twin modeling revealed that the attentional focusing subdomain of effortful control was highly heritable. Gestational age did not moderate genetic and environmental estimates. Our findings help inform the risk assessment of prematurity and provide evidence for the differing etiology of each subdomain of effortful control and the strong role of genetics in effortful control development. Public Significance Statement: This study advances the current understanding of the development of effortful control. There was no compelling evidence that premature birth was a risk factor for lower effortful control. Further, although effortful control is heritable, particularly the attentional focusing subdomain of effortful control, the genetic and environmental estimates for effortful control were not influenced by obstetrical and neonatal complications. [ABSTRACT FROM AUTHOR]

Aim: Gestational diabetes (GD) is a global health concern with significant implications for maternal and neonatal outcomes. This study investigates the association between early GD (eGD) diagnosis (<24 weeks), pharmacotherapy requirements and adverse neonatal outcomes. Materials and Methods: A cohort of 369 pregnant women underwent a 75‐g oral glucose tolerance test. Maternal variables, pharmacotherapy prescriptions and neonatal outcomes were analysed employing t‐tests, χ2 tests, and logistic regression. A p <.05 was considered significant. Results: Early GD increased the odds of neonatal hypoglycaemia [odds ratio (OR): 18.57, p =.013] and respiratory distress syndrome (OR: 4.75, p =.034). Nutritional therapy prescription by an accredited nutritionist was the most common treatment in women diagnosed after 24 weeks, but those with eGD required more frequently specialized nutritional consulting + metformin to achieve glycaemic control (p =.027). eGD was associated with a higher requirement of nutritional therapy prescription + metformin (OR: 2.26, 95% confidence interval: 1.25‐4.09, p =.007) and with maternal hyperglycaemia during the post‐partum period at 2 h of the oral glucose tolerance test (OR: 1.03, 95% confidence interval: 1.02‐1.13, p =.024). Conclusion: Timely diagnosis and personalized treatment of GD are desirable because an earlier presentation is related to a higher risk of adverse neonatal and maternal outcomes. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to analyze maternal morbidity in the second stage of labor in a manner that approximates clinical choice. Study Design The study design comprises secondary analysis of the Consortium for Safe Labor, which included 228,688 deliveries at 19 hospitals between 2002 and 2008. We included the 107,675 women who were undergoing a trial of labor without a prior uterine scar or history of substance abuse, who reached the second stage, with a liveborn, nonanomalous, vertex, singleton, at term of at least 2,500 g. Maternal complications included postpartum fever, hemorrhage, blood transfusion, thrombosis, intensive care unit (ICU) admission, hysterectomy, and death. For maternal complications, we simulated the clinical choice by comparing operative vaginal or cesarean deliveries to continued expectant management at every hour in the second stage. For neonatal complications, we modeled the risk of severe neonatal complication by second stage duration for spontaneous vaginal deliveries only, adjusting for maternal demographics, comorbidities, and delivery hospital. Severe neonatal complications included death, asphyxia, hypoxic-ischemic encephalopathy (HIE), seizure, sepsis with prolonged stay, need for mechanical ventilation, and 5-minute Apgar score <4. Results Maternal morbidity was higher with operative vaginal/cesarean delivery versus continued expectant management for every hour in the second stage, a difference that was statistically significant at hour 2 (18.4 vs. 14.7%; p <0.01). Overall, 951 (0.88%) deliveries were complicated by a severe neonatal complication. A second stage over 4 hours was associated with an adjusted odds of severe neonatal complication of 2.10 (95% confidence interval [CI]: 1.32–3.34) as compared with women who delivered in the first hour. Conclusion There is a trade-off between maternal and neonatal morbidity in the second stage of labor. Serious neonatal complications rise throughout, however, there is no time at which maternal morbidity is improved with a cesarean or operative vaginal delivery. Strategies are needed to identify neonates at highest risk of complication for targeted intervention. Key Points Severe neonatal complications increase with every hour in the second stage. Shortening the second stage is associated with higher maternal complications at every hour. There is a trade-off between maternal and neonatal morbidity in the second stage. [ABSTRACT FROM AUTHOR]

Abstract Background The increasing prevalence of gestational diabetes mellitus (GDM) is a major challenge, particularly in rural areas of China where control rates are suboptimal. This study aimed to evaluate the effectiveness of a GDM subsidy program in promoting GDM screening and management in these underserved regions. Methods This multicenter, randomized controlled trial (RCT) was conducted in obstetric clinics of six rural hospitals located in three provinces in China. Eligible participants were pregnant women in 24–28 weeks’ gestation, without overt diabetes, with a singleton pregnancy, access to a telephone, and provided informed consent. Participants were randomly assigned in a 1:1 ratio to either the intervention or control groups using an internet-based, computer-generated randomization system. The intervention group received subsidized care for GDM, which included screening, blood glucose retesting, and lifestyle management, with financial assistance provided to health care providers. In contrast, the control group received usual care. The primary outcomes of this study were the combined maternal and neonatal complications associated with GDM, as defined by the occurrence of at least one pre-defined complication in either the mother or newborn. The secondary outcomes included the GDM screening rate, rates of glucose retesting for pregnant women diagnosed with GDM, dietary patterns, physical activity levels, gestational weight gain, and antenatal visit frequency for exploratory purposes. Primary and secondary outcomes were obtained for all participants with and without GDM. Binary outcomes were analyzed by the generalized linear model with a link of logistic, and odds ratios (OR) with 95% confidence intervals (CIs) were reported. Count outcomes were analyzed by Poisson regression, and incidence rate ratios with 95% CIs were reported. Results A total of 3294 pregnant women were randomly assigned to either the intervention group (n = 1649) or the control group (n = 1645) between 15 September 2018 and 30 September 2019. The proportion of pregnant women in the intervention group who suffered from combined maternal and/or neonatal complications was lower than in the control group with adjusted OR = 0.86 (0.80 to 0.94, P = 0.001), and a more significant difference was observed in the GDM subgroup (adjusted OR = 0.66, 95% CI 0.47 to 0.95, P = 0.025). No predefined safety or adverse events of ketosis or ketoacidosis associated with GDM management were detected in this study. Both the intervention and control groups had high GDM screening rates (intervention: 97.2% [1602/1649]; control: 94.5% [1555/1645], P

Aims: Foetal male sex is associated with adverse perinatal outcomes. However, studies evaluating the impact of foetal sex on perinatal outcomes in women with gestational diabetes (GDM) are scarce. We studied whether male new-born sex is associated with neonatal outcomes, in women with GDM. Methods: This is a retrospective study based on the national Portuguese register of GDM. All women with live-born singleton pregnancies between 2012 and 2017 were eligible for study inclusion. Primary endpoints under analysis were neonatal hypoglycaemia, neonatal macrosomia, respiratory distress syndrome (RDS) and neonatal intensive care unit (NICU) admission. We excluded women with missing data on the primary endpoint. Pregnancy data and neonatal outcomes between female and male new-borns were compared. Multivariate logistic regression models were built. Results: We studied 10,768 new-borns in mothers with GDM, 5635 (52.3%) male, 438 (4.1%) had neonatal hypoglycaemia, 406 (3.8%) were macrosomic, 671 (6.2%) had RDS, and 671 (6.2%) needed NICU admission. Male new-borns were more frequently small or large for gestational age. No differences were observed on maternal age, body mass index, glycated haemoglobin, anti-hyperglycaemic treatment, pregnancy complications or gestational age at delivery. In the multivariate regression analysis, male sex was independently associated with neonatal hypoglycaemia [OR 1.26 (IC 95%: 1.04–1.54), p = 0.02], neonatal macrosomia [1.94 (1.56–2.41), p < 0.001], NICU admission [1.29 (1.07–1.56), p = 0.009], and RDS [1.35 (1.05–1.73, p = 0.02]. Conclusions: Male new-borns have an independent 26% higher risk of neonatal hypoglycaemia, 29% higher risk of NICU admission, 35% higher risk of RDS, and almost twofold higher risk of macrosomia, compared to female new-borns. [ABSTRACT FROM AUTHOR]

Objective: Grand multiparity and being a refugee have been adversely associated with perinatal and neonatal outcomes. In this study, we aimed to compare the pregnancy outcomes of both grand multiparous and refugee pregnant women aged 18–34 years. Methods: In this retrospective study, birth data, electronic records, and patient files of refugee women under 35 years of age were scanned. The participants were divided into three groups according to parity: Group I, primiparous; Group II, multiparous; and Group III, grand multiparous. After the patients were divided into groups, the sample groups were randomized into 74 people. The antenatal and neonatal outcomes of the pregnant women included in the groups were recorded. All groups were compared among themselves. Results: There was a significant difference between the groups in terms of age, gravida, and parity (p<0.05). The number of abortions was significant when Groups I and II were compared (p<0.004). Estimated blood loss volume (EBLV) was significantly higher in primiparous pregnancies compared with multiparous pregnancies (p=0.007). The amount of bleeding over 1000 cc was significantly higher in primiparas than in grand multiparas (p=0.039). Conclusion: This study found that grand multiparous refugee pregnancies had similar perinatal and neonatal complication rates to multiparous and nulliparous pregnancies and that grand multiparity alone was not a risk factor. The findings indicate that most of the complications associated with grand multiparity are associated with advanced age, low socioeconomic status, and inadequate antenatal care. [ABSTRACT FROM AUTHOR]

Introduction: The Apgar score, assessing newborns' health at birth, indicates adverse conditions and the need for medical attention. This study investigates its predictive value for neonatal outcomes. Material & Methods: This retrospective cohort study involved 207 neonates in Ilam city hospitals (2015-2016). It compared two groups: 69 neonates with Apgar scores <7 (exposed) and 138 with scores =7 (unexposed) at birth. Neonates were followed through the neonatal period, and outcomes were compared. Statistical analysis used SPSS Statistics software. Results: At the fifth minute, the exposed group had higher rates of resuscitation need (51% vs. 26.7%, p=0.01), re-admission (51% vs. 31.1%), and mortality (60% vs. 12.2%, p=0.03) compared to the unexposed group. Relative risks for the exposed group were 3.8 (resuscitation), 6.1 (NICU admission), 2.94 (re-admission), and 2.5 (mortality) at the first minute, and 2.9, 2.7, 2.3, and 19.9, respectively, at the fifth minute. Conclusion: Apgar scores <7 increase the risk of adverse neonatal outcomes including NICU admission, resuscitation, and higher mortality rates. The Apgar score serves as a valuable predictor of adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Aim: There has been limited research about the associations between pre‐eclampsia and neonatal complications in relation to gestational age. This register‐based study aimed to address that gap in our knowledge. Methods: We used Swedish Medical Birth Register to carry out a population‐based study on primiparas with singleton pregnancies from 1999 to 2017. Descriptive statistics and logistic regressions were used to study the associations between pre‐eclampsia and neonatal complications in different gestational ages. The data is presented as adjusted odds ratios (aORs) with 95% CI. Results: The study comprised 805 591 primiparas: 2.9% had mild to moderate pre‐eclampsia and 1.4% had severe pre‐eclampsia. Neonates born to women with pre‐eclampsia had increased risks of several complications compared to those born to mothers without pre‐eclampsia. After adjustment for confounding variables, the risk of being small for gestational age (aOR 5.3, CI: 5.1–5.5) and needing resuscitation (aOR 2.6, CI: 2.4–2.7) were increased. The risk of a low Apgar score and convulsions/hypoxic ischemic encephalopathy was increased at 32–41 weeks of gestation. Moreover, the overall risk of sepsis (aOR 1.9. CI: 1.8–2.1) and perinatal death (aOR 1.2, CI: 1.1–1.5) was also increased. Conclusion: Compared with infants of mothers without pre‐eclampsia, those exposed to pre‐eclampsia had higher risks of all the studied neonatal complications. [ABSTRACT FROM AUTHOR]

Objective: to determine the effect of gestational weight gain and perinatal outcomes in obese women who underwent and did not undergo bariatric surgery. Material and methods: a retrospective observational cohort study was conducted. The gestational weight gain was classified as insufficient, adequate or excessive according to the guidelines of the United States Institute of Medicine: 4.99-9.07 kg for body mass index (BMI) > 30 kg/ m2. Weight gain was calculated as the difference between the weight at the first visit of the 1st trimester and the weight at the visit of the 3rd trimester. Outcomes examined included antepartum variables (gestational diabetes, gestational hypertension, preeclampsia, premature rupture of membranes, placenta previa, placental abruption, intrauterine growth retardation, chorioammionitis, spontaneous abortion), intrapartum variables (induced delivery, vaginal delivery, vacuum, forceps delivery, cesarean section, shoulder dystocia), postpartum variables (postpartum hemorrhage, need for postpartum transfusion, postpartum anemia, need for emergency care, maternal death, postpartum tear, postpartum thrombosis) and neonatal variables (preterm delivery, weight percentile > 90, weight percentile < 10, Apgar score < 7, malformations). Using the statistical package SPSS 22.0, a statistical analysis of the data was performed. Results: two hundred and fifty-six women were recruited; 38 (14.58 %) were pregnant after bariatric surgery and 218 (85.15 %) were pregnant women with obesity who had not been operated on. Of the pregnant women with obesity who had not been operated on, 119 (46.68 %) had grade 1 obesity (BMI 30-34.9), and 99 (38.67 %) had grade 2 and 3 obesity (BMI > 35). A global and subgroup analysis was performed. In the overall analysis, 78 (30.46 %) had insufficient gain, 117 (45.70 %) had adequate gain, and 61 (23.82 %) excessive gain. Overall, insufficient weight gain was associated with a lower probability of gestational hypertension (p < 0.015) and forceps delivery (p < 0.000) and large for gestational age newborn (p < 0.000). On the other hand, insufficient weight gain was associated with a higher probability of intrauterine growth retardation (p 0.044), peripartum infection (0.022), preterm delivery (0.006), and delivery < 35 weeks (p 0.016). Excessive weight gain was associated with a higher probability of gestational hypertension (p 0.025), induced labor (p 0.009), forceps delivery (p 0.011) and large for gestational age newborn (p 0.006). Pregnancies after bariatric surgery had fewer overall complications compared to the other groups. Conclusions: insufficient and excessive weight gain worsens perinatal outcomes. Adequate weight gain does not increase complications and produces some benefits. [ABSTRACT FROM AUTHOR]

• ART pregnancies are linked to adverse maternal and perinatal outcomes. • This is the first Canadian study showing this association in primiparous singletons. • The mechanisms underlying ART associated adverse outcomes requires further research. To evaluate the odds of developing adverse maternal and perinatal outcomes in primiparous singleton pregnancies conceived with assisted reproductive technology (ART) compared with pregnancies conceived without ART. A retrospective population-based cohort study using data from the British Columbia Perinatal Data Registry. The population included primiparous women with singleton live or stillbirths delivering at or after 20 weeks' gestation between April 1st 2008–March 31st, 2021. Women who conceived with ART were compared with those who conceived without ART. The main outcome measures were gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, neonatal intensive care unit admission, stillbirth, and 5-minute Apgar score. Adjusted odds ratios were calculated. The study population included 191,059 primiparous women: 183,819 conceived without ART, 7,240 conceived using ART. After controlling for age, body mass index, pre-gestational diabetes, and smoking status, singleton pregnancies conceived by ART had significantly higher odds of gestational diabetes (OR 1.18, 95 % confidence interval [CI] 1.10–1.26) and hypertensive disorders of pregnancy (OR 1.39, 95 % CI 1.29–1.51). There were also significantly increased odds of preterm birth (OR 1.35, 95 % CI 1.25–1.46), low birth weight (OR 1.35, 95 % CI 1.23–1.49), and neonatal intensive care unit admission (OR 1.21, 95 % CI 1.11–1.32). There was not a statistically significant difference in the odds of stillbirth (OR 1.06, 95 % CI 0.72–1.57) or 5-minute Apgar score < 7 (OR 1.10, 95 % CI 0.97–1.26). There is an increased odds of developing several adverse maternal or neonatal outcomes in primiparous singleton pregnancies conceived by ART including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and increased incidence of neonatal intensive care unit admissions. [ABSTRACT FROM AUTHOR]

Background: Maternal pre-gestational diabetes (PGDM), gestational diabetes mellitus (GDM), and overweight/obesity have been associated with increased risks of offspring neurodevelopmental conditions (NDCs) including autism, intellectual disability (ID), and attention deficit/hyperactivity disorder (ADHD). Less is known about whether and how obstetric and neonatal complications (e.g., preterm birth, neonatal asphyxia) could mediate these associations. Methods: In this Swedish register-based cohort study, we examined complications during pregnancy, delivery, and the neonatal period as potential mediators of the relationships between maternal metabolic conditions and offspring NDCs. We quantified the extent to which these obstetric and neonatal factors could mediate the associations of maternal metabolic conditions with offspring NDCs by applying parametric regression models for single mediation analyses and weighting-based methods for multiple mediation analyses under counterfactual frameworks. Results: The study sample included 2,352,969 singleton children born to 1,299,692 mothers from 1987–2010 who were followed up until December 31, 2016, of whom 135,832 children (5.8%) were diagnosed with at least one NDC. A substantial portion of the association between maternal PGDM and children's odds of NDCs could be explained by the combined group of obstetric and neonatal complications in the multiple mediation analysis. For instance, these complications explained 44.4% of the relationship between maternal PGDM and offspring ID risk. The proportion of the relationship between maternal overweight/obesity and children's risk of NDCs that could be explained by obstetric and neonatal complications was considerably smaller, ranging from 1.5 to 8.1%. Some complications considered on their own, including pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities, could explain at least 10% of the associations between maternal PGDM and offspring NDCs. Complications during the neonatal period showed a stronger joint mediating effect for the relationship between PGDM and offspring NDCs than those during pregnancy or delivery. Conclusions: Obstetric and neonatal complications could explain nearly half of the association between maternal PGDM and offspring risk of NDCs. The mediating effects were more pronounced for complications during the neonatal period and for specific complications such as pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities. Effective preventive strategies for offspring NDCs should holistically address both the primary metabolic issues related to PGDM and the wide array of potential complications, especially those in the neonatal period. [ABSTRACT FROM AUTHOR]

Introduction: Human Immunodeficiency Virus (HIV) has persisted as the world's leading infectious killer disease. Globally, around 19.3 million women in the reproductive age group are suffering from HIV, and most of these women are capable of transmitting this infection to their babies. Although pregnancy does not have an adverse effect on the natural history of HIV infection in women, Acquired Immunodeficiency Syndrome (AIDS) has become a leading cause of maternal and perinatal morbidity and mortality in some areas as the epidemic progresses. Aim: To assess the impact of HIV infection on maternal health, the risk of vertical transmission, and neonatal complications. Materials and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India between March 1, 2021, and August 31, 2022. The study population comprised all pregnant patients with a known positive HIV status or those diagnosed newly during routine antenatal screening at the antenatal Outpatient Department (OPD) and Prevention of Parent to Child Transmission of HIV (PPTCT) clinic, or attending obstetric emergency. After registering in the antenatal clinic, they underwent all routine investigations, including baseline CD4 count, husband's HIV status, screening for other sexually transmitted diseases, and initiation of Antiretroviral Therapy (ART). Maternal and perinatal outcomes, such as maternal complications, risk of vertical transmission, gestational age at birth, and birth weight of the baby, were assessed throughout the antenatal period and up to six weeks post-delivery. Data were entered into a Microsoft Excel datasheet and analysed using Statistical Packages for Social Sciences (SPSS) version 22.0 software. Categorical data were represented in the form of frequencies and proportions. Chi-square test was used for significance testing, with a p-value <0.05 considered statistically significant. Results: Out of a total of 15,087 deliveries during the study period, 55 were HIV-positive cases, with a prevalence of 0.36%. Both vaginal delivery and cesarean section showed almost similar vertical transmission rates in the newborns, i.e., 4 (14%) and 4 (17%), respectively. Opportunistic infection rates were significantly higher in mothers with lower CD4 counts (<200). Mothers receiving regular ART treatment showed a lower incidence of perinatal complications, such as neonatal sepsis, perinatal asphyxia, convulsions, or perinatal death, i.e., 6 (13.63%), compared to those not on treatment, 8 (72.72%) (p-value=0.005475). Higher rates of vertical transmission were observed in patients with significantly lower Cluster of Differentiation 4 (CD4) counts, 5 (71%) versus 3 (6.8%) (p-value=0.00001). Conclusion: Pregnancy outcomes in terms of maternal risks of infection, risk of vertical transmission, preterm births, foetal deaths, and neonatal complications can be significantly improved by early diagnosis and treatment of HIV infection. Proper antenatal care, early detection, initiation of antiretroviral drugs, and patient compliance with the multidrug regimen are the mainstay of feto-maternal well-being. [ABSTRACT FROM AUTHOR]

Background: Pseudohypoparathyroidism (PHP) and related disorders newly referred to as inactivating PTH/PTHrP signaling disorders (iPPSD) are rare endocrine diseases. Many clinical features including obesity, neurocognitive impairment, brachydactyly, short stature, parathyroid hormone (PTH) resistance, and resistance to other hormones such as thyroid-stimulating hormone (TSH) have been well described, yet they refer mainly to the full development of the disease during late childhood and adulthood. Objective: A significant delay in diagnosis has been reported; therefore, our objective is to increase awareness on neonatal and early infancy presentation of the diseases. To do so, we analyzed a large cohort of iPPSD/PHP patients. Methods: We included 136 patients diagnosed with iPPSD/PHP. We retrospectively collected data on birth and investigated the rate of neonatal complications occurring in each iPPSD/PHP category within the first month of life. Results: Overall 36% of patients presented at least one neonatal complication, far more than the general population; when considering only the patients with iPPSD2/PHP1A, it reached 47% of the patients. Neonatal hypoglycemia and transient respiratory distress appeared significantly frequent in this latter group, ie, 10.5% and 18.4%, respectively. The presence of neonatal features was associated with earlier resistance to TSH (P < 0.001) and with the development of neurocognitive impairment (P = 0.02) or constipation (P = 0.04) later in life. Conclusion: Our findings suggest that iPPSD/PHP and especially iPPSD2/PHP1A newborns require specific care at birth because of an increased risk of neonatal complications. These complications may predict a more severe course of the disease; however, they are unspecific which likely explains the diagnostic delay. [ABSTRACT FROM AUTHOR]

Scrub typhus shows a high prevalence in South-East Asia. In pregnant females, it can cause both maternal and fetal adverse outcomes. We report a case series of two women with scrub typhus and their varied outcomes. A 25-year-old primigravida treated for scrub typhus at 23 weeks' gestation presented at 34 weeks with stage three fetal growth restriction (FGR). Caesarean delivery was performed. The neonate had biliary atresia. A 24-year-old primigravida at 31 weeks' gestation was referred from a local hospital due to scrub typhus induced multi-organ dysfunction. She had FGR stage 1 with oligohydramnios. Emergency caesarean delivery was performed in view of acute fetal bradycardia. There is an emerging need for research to reassess what is already known about scrub typhus in pregnancy and to develop techniques for its treatment inorder to achieve a positive maternal and neonatal outcome in these cases. [ABSTRACT FROM AUTHOR]

Introduction: One of the major problems of the fetus is the excretion of the contents of the fetal intestine in the amniotic fluid sac or the amniotic fluid stained with meconium. If the time of stained with meconium is long or if the meconium is thick, it leads to serious risks for the mother and the fetus. The present study was conducted with aim to investigate the prevalence of babies born with meconial stained amniotic fluid and the associated maternal and fetal complications. Methods: This cross-sectional study was conducted in a period of 6 months (Dec 2014 to June 2015) on 1383 women with a singleton pregnancy and a gestational age of more than 28 weeks who had referred to Omolbanian Hospital in Mashhad due to the onset of labor pains. The investigated information included: mother's age, gestational age, number of pregnancies, mode of delivery, amniotic fluid condition, baby's gender, baby's Apgar, ABG (arterial blood gas), birth weight and the need for baby resuscitation. Data analysis was done using SPSS statistical software (version 22) and t-test and chi-square statistical tests. P< 0.05 was considered statistically significant. Results: In the present study, out of 1383 cases of normal delivery, 114 cases had meconium-stained amniotic fluid (prevalence of 8.2%). The number of cesarean section was higher in the thick meconial group (26 cases (%43.3)) compared to thin meconial group (9 cases (16.7%)) (p=0.002). The amount of abnormal ABG was 10 cases (8.7%) in the meconial group, of which 6 cases (5.2%) were in the fetal distress group. The amount of abnormal ABG was 8%, which was significantly higher in the thick meconial group (p=0.002). First minute Apgar less than 7 was more in the thick meconial group (p=0.01) and 5th minute Apgar had no difference between the two groups. There were no cases of convulsions or death of infant in the two groups. Conclusion: In this study, the prevalence of amniotic fluid stained with meconium was 8.2%. Although the rate of cesarean delivery was higher in the thick meconial group, there was no significant difference in fetal distress in the thick and thin meconial groups. Considering the complications of cesarean section for the mother, natural delivery can be a choice method in these mothers and cesarean section is limited to cases of fetal distress or thick meconium far from delivery.

Introduction: Human Immunodeficiency Virus (HIV) has persisted as the world’s leading infectious killer disease. Globally, around 19.3 million women in the reproductive age group are suffering from HIV, and most of these women are capable of transmitting this infection to their babies. Although pregnancy does not have an adverse effect on the natural history of HIV infection in women, Acquired Immunodeficiency Syndrome (AIDS) has become a leading cause of maternal and perinatal morbidity and mortality in some areas as the epidemic progresses. Aim: To assess the impact of HIV infection on maternal health, the risk of vertical transmission, and neonatal complications. Materials and Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India between March 1, 2021, and August 31, 2022. The study population comprised all pregnant patients with a known positive HIV status or those diagnosed newly during routine antenatal screening at the antenatal Outpatient Department (OPD) and Prevention of Parent to Child Transmission of HIV (PPTCT) clinic, or attending obstetric emergency. After registering in the antenatal clinic, they underwent all routine investigations, including baseline CD4 count, husband’s HIV status, screening for other sexually transmitted diseases, and initiation of Antiretroviral Therapy (ART). Maternal and perinatal outcomes, such as maternal complications, risk of vertical transmission, gestational age at birth, and birth weight of the baby, were assessed throughout the antenatal period and up to six weeks post-delivery. Data were entered into a Microsoft Excel datasheet and analysed using Statistical Packages for Social Sciences (SPSS) version 22.0 software. Categorical data were represented in the form of frequencies and proportions. Chi-square test was used for significance testing, with a p-value

Aims: To compare the gestational age of neonates in utero exposed to benzodiazepines (BDZs) with nonexposed controls. Secondary objectives were birth weight, presence of congenital malformations, APGAR score and the need for >3 months (prolonged) maternal psychiatric care. Methods: A retrospective cohort study of women and neonates from 2013 to 2021 with univariate and multivariable analysis to study the associations between BDZ exposure and gestational age compared to nonexposed women with mental health problems. Results: We found that BDZ exposure was not associated with a lower gestational age. We found that women in the exposed group had an increased risk of psychiatric care (adjusted odds ratio 2.58 [95% confidence interval 1.71–3.91], P <.001). Conclusion: We found that in utero BDZ exposure was not associated with a significantly lower gestational age of the neonates and was associated with prolonged psychiatric care of their mothers. [ABSTRACT FROM AUTHOR]

Objectives: To explore the effect of abnormally elevated serum alanine aminotransferase (ALT) on pregnancy outcomes in patients with moderate and severe ovarian hyperstimulation syndrome (OHSS) at disease onset. Methods: This was a single‐center retrospective cohort study conducted between January 1, 2014 and October 31, 2021. A total of 3550 fresh in vitro fertilization/intracytoplasmic sperm injection embryo transfer cycles were included, using Golan's three‐degree, five‐level classification to diagnose patients with OHSS. According to the patient's ALT level after diagnosis of OHSS, 123 (3.46%) patients with moderate‐to‐severe OHSS were divided into two groups. A control group included 3427 (96.54%) non‐OHSS patients, and 91 (2.56%) abnormal ALT patients were matched with the control group for propensity scores. Results: There was no difference in baseline data between the abnormal ALT and matched control groups. The incidence of obstetric complications was significantly higher in the abnormal ALT group than in the matched control group (P < 0.05). After adjusting for confounding factors, the incidence of obstetric complications in the abnormal ALT group was still higher than that in the normal ALT group (P < 0.05). Conclusion: In patients with moderate and severe OHSS, higher ALT levels resulted in an increased risk of obstetric and neonatal complications. Synopsis: Abnormally elevated ALT in patients with moderate and severe OHSS during the pathogenesis of OHSS can result in an increased risk of obstetric complications. [ABSTRACT FROM AUTHOR]

Abstract Background Limited information is available about neonates’ critical conditions data quality. The study aim was to measure the agreement regarding presence of neonatal critical conditions between Medicaid Analytic eXtract claims data and Birth Certificate (BC) records. Methods Claims data files of neonates born between 1999–2010 and their mothers were linked to birth certificates in the states of Texas and Florida. In claims data, neonatal critical conditions were identified using medical encounter claims records within the first 30 days postpartum, while in birth certificates, the conditions were identified based on predetermined variables. We calculated the prevalence of cases within each data source that were identified by its comparator, in addition to calculating overall agreement and kappa statistics. Results The sample included 558,224 and 981,120 neonates in Florida and Texas, respectively. Kappa values show poor agreement ( 50%) and substantial (> 60%) agreement in Florida and Texas, respectively. claims data resulted in higher prevalences and capture of a larger proportion of cases than the BC, except for assisted ventilation. Conclusions Claims data and BC showed low agreement on neonatal critical conditions except for NICU admission. Each data source identified cases most of which the comparator failed to capture, with higher prevalences estimated within claims data except for assisted ventilation.

Analyse the evidence provided regarding neonatal and obstetric complications derived from gestational diabetes. A systematic search of the scientific literature, PUBMED, ScienceDirect was carried out with various search strategies guaranteeing the completeness and reproducibility of the phases of the PRISMA guide. 13 studies were included, 10 simultaneously evaluated obstetric and neonatal complications, the rest (3) evaluated only neonatal complications. The prevalence of GDM (gestational diabetes mellitus) was 12.5% (65,852 of 527,351) Obstetric complications include: emergency caesarean section (OR 1.1 to 2.37), preeclampsia with an OR range of 1.1 to 2.96, and prematurity (OR 1.1 to 2.3). The most frequent neonatal complications are: macrosomia with an OR range of 1.2 to 5.2, with a prevalence of 10.3%; while hypoglycaemia is the one with the highest risk (OR 3.19-11.97), other complications include greater height for gestational age OR 1.3 to 3.43; perinatal asphyxia (OR 1.2-3.4); shoulder dystocia (OR 1.3-2.56); respiratory distress (OR 1.3-2) and hyperbilirubinemia (OR 1.02-1.39). No increased risk of perinatal death was found, the reported OR range is 0.7-0.8. Both obstetric and neonatal gestational diabetes complications are very prevalent and may require intensive care, being a highly relevant public health problem. Although an efficient screen for the early detection of gestational diabetes has been established, greater efforts are required to comply with it and to avoid these complications.

Objective: This study aims to predict perinatal death or severe sequelae in isolated small‐for‐gestational‐age fetuses, diagnosed at a periviable gestational age, based on ultrasound and Doppler parameters at diagnosis. Design: Observational study. Setting: A tertiary perinatal centre. Population A cohort of singleton non‐malformed fetuses suspected to be small for gestational age (estimated fetal weight, EFW, <10th centile) diagnosed at 22.0–25.6 weeks of gestation. The following parameters were recorded at diagnosis: severe smallness (<3rd centile); absent or reversed end‐diastolic velocity in umbilical artery; abnormal middle cerebral artery Doppler; abnormal cerebroplacental ratio; abnormal uterine artery Doppler; and absent or reversed end‐diastolic velocity in the ductus venosus. Methods: Logistic regression analysis. Main outcome measures: Predictive performance of EFW and Doppler parameters for short‐term adverse outcome of perinatal morbimortality and composite serious adverse outcomes (death, neurological impairment or severe bronchopulmonary dysplasia). Results: A total of 155 pregnancies were included. There were 13 (8.4%) intrauterine and 11 (7.7%) neonatal deaths. A short‐term adverse perinatal outcome occurred in 40 (25.8%) pregnancies. There were 31 (20%) cases of serious adverse outcomes. For the prediction of serious adverse outcomes, the combination of absent or reversed end‐diastolic velocity in the umbilical artery and impaired middle cerebral artery detected by Doppler evaluation achieved a detection rate of 87%, with a false‐positive rate of 14% (accuracy 86%). Conclusion: In periviable isolated small‐for‐gestational‐age fetuses, a Doppler evaluation of the umbilical and fetal brain circulation can accurately predict short‐term adverse perinatal complications and serious adverse outcomes. This article includes Author Insights, a video abstract available at: https://vimeo.com/bjogabstracts/authorinsights17181 [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes in pregnancy is increasing worldwide. Gestational diabetes mellitus (GDM) is a common pregnancy complication that affects both maternal and fetal outcomes. This study aimed to assess maternal and fetal outcomes in pregnant women with diabetes mellitus. Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynecology at a tertiary care hospital from February 2021 to July 2022. The study included 104 pregnant women with diabetes mellitus diagnosed in the 1st, 2nd, and 3rd trimester of pregnancy. Maternal and fetal outcomes were assessed, and data were analyzed using descriptive statistics. Results: The mean age of the women was 26.47±2.83 years, and the majority of women (62.50%) belonged to the age group of 26-30 years. Maternal complications observed were pre-eclampsia (24.03%), polyhydramnios (15.38%), and preterm delivery (9.62%). Most patients (54.81%) were on insulin treatment. The majority of deliveries (84.62%) were caesarean section, and live birth was observed in 79.81% of neonates. Neonatal complications included respiratory distress syndrome (12.50%) and hypoglycemia (8.65%). Conclusion: Pregnant women with diabetes mellitus are at increased risk of adverse maternal and fetal outcomes. Timely diagnosis and appropriate management can help to reduce these complications. Further studies are required to develop effective preventive strategies and interventions to improve the outcomes of pregnant women with diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: Limited information is available about neonates' critical conditions data quality. The study aim was to measure the agreement regarding presence of neonatal critical conditions between Medicaid Analytic eXtract claims data and Birth Certificate (BC) records. Methods: Claims data files of neonates born between 1999–2010 and their mothers were linked to birth certificates in the states of Texas and Florida. In claims data, neonatal critical conditions were identified using medical encounter claims records within the first 30 days postpartum, while in birth certificates, the conditions were identified based on predetermined variables. We calculated the prevalence of cases within each data source that were identified by its comparator, in addition to calculating overall agreement and kappa statistics. Results: The sample included 558,224 and 981,120 neonates in Florida and Texas, respectively. Kappa values show poor agreement (< 20%) for all critical conditions except neonatal intensive care unit (NICU) admission, which showed moderate (> 50%) and substantial (> 60%) agreement in Florida and Texas, respectively. claims data resulted in higher prevalences and capture of a larger proportion of cases than the BC, except for assisted ventilation. Conclusions: Claims data and BC showed low agreement on neonatal critical conditions except for NICU admission. Each data source identified cases most of which the comparator failed to capture, with higher prevalences estimated within claims data except for assisted ventilation. [ABSTRACT FROM AUTHOR]

BackgroundTo investigate the association between insufficient maternal gestational weight gain (GWG) during dietary treatment, and neonatal complications of small-for-gestational-age (SGA) infants born to mothers with Gestational diabetes mellitus (GDM).MethodsA retrospective case-control study was conducted, involving 1,651 infants born to mothers with GDM. The prevalence of a perinatal outcome and maternal GWG were compared among SGA, adequate- (AGA), and large-for-gestational-age (LGA); association with birth weight and GWG was identified using Pearson's correlation analysis; binary logistic regression was performed to determine the odds ratio (OR) associated with SGA.ResultsIn total, 343 SGA, 1025 AGA, and 283 LGA infants met inclusion criteria. The frequency of SGA infants who were siblings (41.7 vs. 4.3 vs. 1.9%) and composite of complications (19.2 vs. 12.0 vs. 11.7%) were higher in SGA infants than in those in AGA or LGA infants group (both P < 0.01). GWG and pre-partum BMI were lower among the SGA mothers with GDM group (11.7 ± 4.5 kg, 25.2 ± 3.1 kg/m2) than AGA (12.3 ± 4.6 kg, 26.3 ± 3.4 kg/m2) or LGA (14.0 ± 5.1 kg, 28.7 ± 3.9 kg/m2) mothers with GDM group. Binary logistic regression showed that siblings who were SGA (AOR 18.06, 95% CI [10.83–30.13]) and preeclampsia (AOR 3.12, 95% CI [1.34–7.30]) were associated with SGA, but not GWG below guidelines (P > 0.05). The risk of SGA (25.7 vs. 19.1 vs. 14.2%) and FGR (15.3 vs. 10.9 vs. 7.8%) was higher in GWG below guidelines group than those in GWG above and within guidelines group, the risk of low Apgar score (6.4 vs. 3.0 vs. 2.8%) was higher in GWG above guidelines group than that in GWG below and within guidelines group (P < 0.05).ConclusionOur findings demonstrated that GWG above and below guidelines, compared with GWG within guidelines, had a higher risk of adverse infant outcomes. Our findings also suggested that GWG below guidelines did not increase the risk for SGA, though SGA infants had more adverse outcomes among neonates born to mothers with GDM.

To determine whether pregnancies with donated embryos are at a higher risk of complications than the pregnancies from autologous frozen-thawed embryo transfer (FET). Anonymous, multicenter, comparative, observational, retrospective, matched-cohort study. Six French assisted reproductive technique centers from 2003 to 2018. Seventy-three singleton pregnancies with donated embryos (exposed) and 136 singleton pregnancies after autologous FET (nonexposed) were matched at 7–8 weeks of gestation (pregnancy date, parity, and women's age) (2:1 ratio, respectively). In accordance with French practices, all women were <44 years old and donated embryos were discarded frozen embryos from other couples. Not applicable. Percentages of hypertensive disorders of pregnancy (HDPs) with donated embryos versus autologous FET. Groups were comparable (mean age: 34.5 years) and HDPs (24.6% vs. 11.9%) were significantly more frequent among the donated-embryo pregnancies, mostly in its severe forms (17.5% vs. 4.6%). In contrast, their respective isolated hypertension frequencies were comparable (7.0% vs. 7.3%). Multivariate analysis retained increased severe HDP risk with donated embryos (odds ratio 2.08 [95% confidence interval: 1.08–4.02]). No significant effect of endometrial preparation was observed. C-sections were more frequent for donated-embryo pregnancies (47.3% vs. 29.2%). Newborns from embryo donation or autologous FET were comparable for prematurity, birth weight and length, Apgar score, small for gestational age, large for gestational age, neonatal malformations, and sex ratio. Even for young women, the risk of severe HDP was 4 times higher for donated-embryo pregnancies than for autologous-FET pregnancies. The HDP risk must be acknowledged to inform donated-embryo recipients and provide careful pregnancy monitoring. [ABSTRACT FROM AUTHOR]

Difficulties in oral-feeding functions are at the basis of feeding disorders in the neonatal period, as they negatively affect the acquisition of the ability to feed in an independent way. Today, these disorders occur in 25.35% of newborns with normal psychophysical development and more than 35% of those with a developmental difficulty, such as premature birth or full-term birth with neonatal complications, such as foetal hypoxia or congenital syndromes. These difficulties are mainly characterised by impaired oropharyngeal sensory and motor functions, for which prompt and early intervention is required, since newborns depend on feeding for their survival, especially in the event of a premature birth because it is closely related to weight. Moreover, due to these conditions, the child is often fed through enteral feeding; if continued this leads to further alterations of these abilities, with hypersensitivity of the oral and perioral area, due to exposure to negative stimulus and non-use. In taking care of the child, therefore, the speech language pathologist represents an essential figure right from NIC (Neonatal Intensive Care), since, through early and targeted stimulations, they can simplify and speed up the development of oral skills that should develop autonomously, but due to the primary problem are not present or are lagging behind the physiological norm. [ABSTRACT FROM AUTHOR]

Background: The number of triplet pregnancies in the United States has increased significantly. Perinatal morbidity and mortality are higher in these pregnancies mainly due to higher preterm birth rates. Interventions to decrease the risk of preterm delivery in this population are needed. Evidence regarding cerclage placement in triplets is limited. We performed a population-based, retrospective cohort study to study the risk of preterm birth and neonatal outcomes after cerclage placement in triplet pregnancies. Methods: All U.S. triplet deliveries from 2006 to 2013 with risk factors for cervical insufficiency were selected, excluding cases with indicated preterm delivery. Cases were categorized according to cerclage placement status. The risk of preterm birth and adverse neonatal outcomes were calculated using propensity score analysis, generalized linear, and logistic regression models. Results: From ∼33 million deliveries, 43,000 were triplets, and 7308 fulfilled eligibility criteria. There was no difference in the gestational age at delivery between the cerclage and noncerclage groups, aOR (95% CI) = 1.0(0.9–1.0). The difference between the risk of preterm delivery at <34 weeks and <32 weeks was not statistically significant. The risk of the composite outcome of neonatal complications was higher in the cerclage compared to the noncerclage group, aOR (95% CI) = 1.5 (1.1–2.2). Conclusions: Cerclage placement in triplet pregnancies does not appear to decrease preterm birth rates and seems to increase the risk of neonatal complications. [ABSTRACT FROM AUTHOR]

Objectives To report the maternal and neonatal results of patients infected with COVID-19 in Panama. Methods The study is based on the analysis of pregnant women with COVID-19, in five hospitals in the Republic of Panama. The inclusion criteria were: patients with or without symptoms, positive RT-PCR for SARS-CoV-2 in the period from March 23 to 6 months after, whose births were attended in one of those five hospitals and who signed the consent. Data were obtained at the time of diagnosis of the infection and at the time of termination of pregnancy for the mother and newborn. Results Two hundred and fifty-three patients met the inclusion criteria. Most were diagnosed in the third trimester (89.3%). 10.3% of the patients presented in a severe form of COVID-19. The most frequent complication was pre-eclampsia and if we add gestational hypertension they represent 21.2%; most of the patients terminated the pregnancy by cesarean section (58%). 26.9% (95% CI 21.3–32.9%) of the births were premature, and perinatal mortality was 5.4% (95% CI 3.0–9.0%). There was a need for mechanical ventilation in 5.9% (95% CI 3.6–9.6%) of the cohort and there were four maternal deaths (1.6% – 95% CI 0.6–4.0%). Conclusions This study of pregnant women infected with COVID-19 and diagnosed with RT-PCR shows serious maternal complications such as high admission to the ICU, need for mechanical ventilation and one death in every 64 infected. Frequent obstetric complications such as hypertension, premature rupture of membranes, high rate of prematurity, and perinatal lethality were also seen. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess the procedure-to-delivery interval (PDI), the obstetric complications, and the early neonatal outcome in patients that did or did not receive glucocorticosteroids (GCSs) before third-trimester amniocentesis (TTA). A retrospectively analysis of 445 TTA procedures divided into two groups based on the administration (study group = 220 patients) or not (control group = 225 patients) of GCSs before TTA. The PDI was calculated for all patients. Obstetric and neonatal outcomes were compared between the groups. The rate of procedure-associated complications was similar between the groups. The mean PDI was 47.2 ± 16.8 days. The overall incidence of preterm birth was 11.7%; 9% delivered between 34 and 37 weeks and 2.7% between 28 and 34 weeks. Only nine patients (2%) delivered within seven days following TTA. The incidence of respiratory distress syndrome in the study and control groups was 1.8% and 1.3%, p =.71, respectively. There were no significant differences in other neonatal outcomes in term and preterm deliveries between the study and control groups. In the present study, the administration of glucocorticoids prior to TTA did not reduce the rates of neonatal complications, which was similar in both groups and not higher than the general population. [ABSTRACT FROM AUTHOR]

Diabetes during pregnancy is more and more frequent worldwide because of the rising incidence of its known risk factors, such as high body mass index, sedentary lifestyle, and hypercaloric diets. It can be either a preexisting condition, or it can be first diagnosed during pregnancy, usually between the 24th and the 28th week of gestation, when it receives the name of gestational diabetes mellitus. Both preexisting diabetes mellitus and gestational diabetes mellitus may have severe maternal and newborn consequences, especially if there is insufficient control of the maternal glycemic levels and progression of diabetes complications, such as microvascular disease and nephropathy. Infants of diabetic mothers may experience excessive birth weight or, on the contrary, low birth weight, trauma at birth, cardiomyopathy, respiratory distress syndrome, hypoglycemia, hypocalcemia, jaundice, or polycythemia. This study’s aim is to gather and synthesize available information about maternal diabetes and its impact on fetal development and newborn outcome.

Abstract Background Severe valvular heart disease, especially stenosis, is a contraindication for conception according to the World Health Organization. This is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine predictors of maternal cardiac, obstetric and neonatal complications in pregnant women with severe valve disease. Methods This is an observational retrospective cohort study of all pregnant women with severe heart valvulopathy who gave birth between 2010 and 2017. Results We included 60 pregnancies in 54 women. Cardiac complications occurred during 37 pregnancies (61%). In multivariate analysis, parity (aOR =2.41, 95% CI[1.12–5.16]), revelation of valvulopathy during pregnancy (aOR = 6.34; 95% CI[1.26–31.77]), severe mitral stenosis (aOR = 6.98, 95% CI[1.14–41.05],) and systolic pulmonary arterial pressure (aOR =1.08, 95% CI[1.01–1.14]) were associated with cardiac complications. Obstetrical complications were noted during 19 pregnancies (31.8%). These complications were associated with nulliparity (aOR = 5.22; 95% CI[1.15–23.6]), multiple valve disease (aOR = 5.26, 95% CI[1.19–23.2]), systolic pulmonary arterial pressure (aOR =1.04, 95% CI[1.002–1.09]), and treatment with vitamin K antagonists (aOR = 8.71, 95% CI[1.98–38.2]). Neonatal complications were noted in 39.3% of newborns (n = 61) and these were associated with occurrence of obstetric complications (aOR = 16.47, 95% CI[3.2–84.3]) and revelation of valvulopathy during pregnancy (aOR = 7.33, 95% CI[1.4–36.1]). Conclusions Revelation of valvular heart disease during pregnancy is a predictor of not only cardiac but also neonatal complications. Valvular heart disease screening during pre-conceptional counseling is thus crucial.

Neonatal hypoglycemia is a known side effect of antenatal betamethasone (BMZ) given for fetal maturation. We sought to investigate if delayed cord clamping (DCC) has an impact on neonatal hypoglycemia induced by antenatal late preterm BMZ administration. Retrospective cohort study (January 2019–May 2019) of pregnancies undergoing delivery at 34–0/7 to 36–6/7 weeks at a single center included in two groups: DCC + BMZ and BMZ-only (no DCC). The primary outcome was the occurrence of neonatal hypoglycemia at the first hour after delivery. A total of 62/188, 32.98% (DCC + BMZ group) and 45/100, 45% (DCC-only group) infants presented with hypoglycemia at 1-h after birth (adjusted p =.06; OR 0.73, 95% CI 0.54–1.01). When stratified according to gestational age at delivery, DCC was associated with a 46% reduction in the occurrence of neonatal hypoglycemia among those born at 35–0/7 to 35–6/7 weeks (adjusted p =.033; OR 0.54, 95% CI 0.33–0.88) and 35% reduction among those born at 36–0/7 to 36–67 weeks (adjusted p =.046; OR 0.65, 95% CI 0.43–0.97). In our cohort, delayed cord clamping in infants receiving late preterm BMZ born between 35–0/7 and 36–6/7 weeks' gestation protects from early neonatal hypoglycemia. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic has affected all age groups globally including pregnant women and their neonates. The aim of the study was to understand outcomes in neonates of mothers with COVID-19 during the first and second waves of COVID-19 pandemic. A retrospective analysis of 2524 neonates born to SARS-CoV-2-infected mothers was conducted during the first wave (n = 1782) and second wave (n = 742) of the COVID-19 pandemic at five study sites of the PregCovid registry in Maharashtra, India. A significant difference was noted in preterm birth, which was higher in the second wave (15.0%, 111/742) compared to the first wave (7.8%, 139/1782) (P < 0.001). The proportion of neonates requiring NICU admission was significantly higher in the second wave (19.0%, 141/742) as compared to that in the first wave (14.8%, 264/1782) (P < 0.05). On comparing regional differences, significantly higher neonatal complications were reported from Mumbai metropolitan region (P < 0.05). During the second wave of COVID-19, birth asphyxia and prematurity were 3.8- and 2.1-fold higher respectively (P < 0.001). Neonatal resuscitation at birth was significantly higher in second wave (3.4%, 25/742 vs 1.8%, 32/1782) (P < 0.05). The prevalence of SARS-CoV-2 infection in neonates was comparable (4.2% vs 4.6%) with no significant difference between the two waves.Conclusion: Higher incidence of adverse outcomes in neonates born to SARS-CoV-2-infected mothers in the second wave of COVID-19 as compared to the first wave.Trial Registration: PregCovid study is registered with the Clinical Trial Registry of India (CTRI/2020/05/025423, Registered on 28/05/2020).What Is Known: • The second wave of COVID-19 was more lethal to pregnant women than the first wave. Newborns are at risk of developing complications.What Is New: • Birth asphyxia, prematurity, and neonatal resuscitation at birth were significantly higher in the second wave as compared to those in the first wave of the COVID-19 pandemic in India. [ABSTRACT FROM AUTHOR]

Despite many available treatments, infants born to preeclamptic mothers continue to pose a serious clinical problem. The present study focuses on the evaluation of infants born to preeclamptic mothers for the occurrence of early-onset complications and attempts to link the clinical status of such infants to the angiogenesis markers in maternal blood (sFlt-1, PlGF). The study included 77 newborns and their mothers diagnosed with preeclampsia. The infants were assessed for their perinatal outcomes, with an emphasis on adverse neonatal outcomes such us infections, RDS, PDA, NEC, IVH, ROP, or BPD during the hospitalization period. The cutoff point was established using the ROC curve for the occurrence of any adverse neonatal outcome and it was 204 for the sFlt-1/PlGF and 32 birth week with AOC 0.644 and 0.91, respectively. The newborns born to mothers with high ratios had longer hospitalization times and, generally, were more frequently diagnosed with any of the aforementioned adverse neonatal outcomes. Also, the neonates born prior to or at 32 wkGA with higher sFlt-1/PlGF ratios were statistically significantly more common to be diagnosed with any of the adverse neonatal outcomes compared to those with lower ratio born prior to or at 32 wkGA. The sFlt-1/PlGF ratio can be a useful tool in predicting short-term adverse neonatal outcomes. Infants born after a full 33 weeks gestation developed almost no severe neonatal complications. Appropriate screening and preventive healthcare for preeclampsia can contribute significantly to reducing the incidence of neonatal complications. [ABSTRACT FROM AUTHOR]

Background: It is clinically challenging to determine when to intervene in the prolonged second stage. Although individualized prediction of spontaneous vaginal delivery is crucial to avoid maternal and neonatal complications associated with operative deliveries, the approach has not been fully established., Objective: We aimed to evaluate the predictability of spontaneous vaginal delivery using the difference in angle of progression between pushing and rest, delta angle of progression, to establish a novel method to predict spontaneous vaginal delivery during the prolonged second stage in nulliparous women with epidural anesthesia., Study Design: We retrospectively analyzed deliveries of nulliparous women with epidural anesthesia between September 2018 and October 2023. Women were included if their delta angle of progression during the second stage was available. Operative deliveries were defined as the cases that required forceps, vacuum, and cesarean deliveries due to labor arrest. Women requiring operative deliveries due to fetal and maternal concerns, or women with fetal occiput posterior presentation were excluded. The second stage was stratified into the prolonged second stage, the period after 3 hours in the second stage, and the normal second stage, the period from the beginning until the third hour of the second stage. The association of the delta angle of the progression measured during each stage with spontaneous vaginal delivery and operative deliveries was investigated. Furthermore, the predictability of spontaneous vaginal delivery was evaluated by combining the delta and rest angle of progression., Results: A total of 129 women were eligible for analysis. The delta angle of progression measured during the prolonged second stage and normal second stage were significantly larger in women who achieved spontaneous vaginal delivery compared to operative deliveries (p<.001 and p<.05, respectively). During the prolonged second stage, a cutoff of 18.8 derived from the receiver operative characteristic curves in the context of the delta angle of progression predicted the possibility of spontaneous vaginal delivery (sensitivity, 81.8%; specificity, 60.0%; AUC, 0.76). Combining the rest angle of progression (>140) and delta angle of progression (>18.8) also provided quantitative prediction of spontaneous vaginal delivery (sensitivity, 86.7%; specificity, 70.0%; AUC, 0.80)., Conclusion: The delta angle of progression alone or in combination with the rest angle of progression can be used to predict spontaneous vaginal delivery in the second stage in nulliparous women with epidural anesthesia. Quantitative analysis of the effect of pushing using the delta angle of progression provides an objective guide to assist with an assessment of labor dystocia in the prolonged second stage on an individualized basis, which may optimize labor management in the prolonged second stage by reducing neonatal and maternal complications related to unnecessary operative deliveries and prolonged second stage of labor., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Hepatic Hemangioma in infants is a mass with good prognosis which can be followed by life threatening complications such as heart failure with high output, Kasabach-Merritt Syndrome and hydrops. In other cases with no fetal, maternal and placental causes for poly hydramnios, hepatic Hemangioma should be considered. In this report, a case of large infant's liver hemangioendothelioma complicated with mild polyhydramnios is presented that led to the improvement of infant by intervention and timely treatment.Case presentation: The patient was a 35 years old woman para 2 with one previous cesarean section. She referred with mild Poly hydramnios in 27th week of gestation. A 56×61 mm sized hypo echogenic & hetrogenic hepatic mass contained with micro calcification particles in the posterior right liver lobe was diagnosed for the fetus. At 36th week of gestation, planned cesarean was done. After urgent ultrasound, the baby was operated and resection of the tumor was performed. Pathological report showed hepatic hemangioendothelioma. The infant undergone ……. treatment due to the residue. During next follow up, baby was completely recovered and had normal growth & development.Conclusion: In the cases of diagnosis of poly hydramnios and echogenic mass probably with hepatic origin, then Hepatic Hemangioendothelioma may be considered for the infant. Clinical evaluation and early intervention if needed should be performed to prevent cardiovascular complication, and pregnancy termination should be performed to prevent infantile sever complication as soon as lung maturation. Urgent surveillance should be performed immediately after delivery. We should have needed preparation because this tumor is treatable in many cases.

Introduction: Abnormal placental adhesion is often associated with severe life-threatening bleeding that requires peri-delivery emergency hysterectomy and can increase the risk of complications such as Disseminated intravascular coagulation, respiratory distress and renal failure for mother. This study was performed with aim to investigate the maternal and neonatal complications in patients with abnormal placental adhesion. Methods: This cross-sectional study was performed on 70 pregnant women with abnormal placental adhesion in the educational hospitals of Mashhad University of Medical Sciences in 2017-2018. Patients with abnormal placental adhesions who were diagnosed through Doppler or MRI and given a clinical diagnosis during cesarean section and then confirmed in pathology results entered the study. Data collection tool was a researcher-made checklist. Based on the pathology sample, the patients were divided into 3 groups of abnormal placental adhesions. Maternal and neonatal complications were evaluated for each group based on the amount and degree of adhesion. Qualitative data were reported as frequency and percentage. Chi-square test was used to compare their frequency distribution. One-way analysis of variance and Kruskal-Wallis tests were used to compare the means of quantitative variables. P

Introduction: Misoprostol is a synthetic prostaglandin E1 analogue widely used for cervical ripening and labour induction. However, misoprostol optimal dose required to induce labour is still controversial. Aim: To determine the efficacy and safety of 25 µg and 50 µg of intravaginal misoprostol for induction of labour at term and to evaluate maternal and neonatal complications. Materials and Methods: The present study was a prospective, randomised, double blind, single centre study carried out during March 2019 to December 2020. All the selected participants were randomised (1:1) to group 1 which received 25 µg of intravaginal misoprostol (n=70) and group 2 received 50 µg of intravaginal misoprostol (n=70). Based on the Bishop's score, misoprostol was chosen as labour inducing agent. Number of misoprostol doses, mode of delivery, vaginal delivery duration, maternal and neonatal complications was recorded. Statistical significance among study groups were analyzed by using Chi-square test. Conclusion: The efficacy and safety results of 25 µg intravaginal misoprostol were comparable with 50 µg of intravaginal misoprostol for labour induction. The advantages of 50 µg misoprostol were it favours the vaginal deliveries, lesser active induction time and decrease number of misoprostol doses required to induce labour. However, higher dose of misoprostol showed higher frequencies of both maternal and neonatal complications. [ABSTRACT FROM AUTHOR]

Objective  While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity. Study Design  Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t -tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression. Results  History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p  = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2–13.7; p  = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5–89.0, p  < 0.01), however, there was no difference for those born between 38 and 39 weeks. Conclusion  Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management. Key Points Steroids administered prior to scheduled cesarean lead to decreased neonatal respiratory morbidity. Steroid administration was not associated with increased adverse neonatal outcomes. Steroid administration was most beneficial between 37 and 38 weeks. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association of maternal and neonatal complications from COVID-19 severity. Study Design: Case-series. Setting: Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Peshawar Pakistan. Period: June 2020 to Dec 2020. Material & Methods: 50 pregnant patients with COVID-19 were included. Clinical information on COVID-19 exposures and information on maternal and neonatal complications were noted through a predesigned proforma. The Kendall's tau (t) test was applied between maternal complications and neonatal complications, COVID-19 severity (in mothers) & maternal/neonatal complications. Results: More women (52%) were asymptomatic in COVID-19 exposure. Mild symptoms with no shortness of breath were reported in 44% of women, whereas only 4% required ventilator support. 80% of women were in postpartum when they turned COVID-19 negative. In the majority (72%) of women, no maternal complications were noted. In 14% of them, oligohydramnios was reported. Preterm labor and PROM/PPROM were reported in 6% of mothers. Preterm birth was reported 10%, fetal, the APGAR score was 7-9 out of 10. In the majority of neonates (94%), no early death was reported. 42% of distress/meconium was 8%, intrauterine growth restriction (IUGR) was 6%, and stillbirth was 5%. In 82% of neonates were COVID-19 negative on PCR. A strong correlation existed between maternal complications and neonatal complications. However, a weak correlation was observed between COVID-19 severity (in mothers) and maternal & neonatal complications. Conclusion: Although maternal and neonatal complications were strongly linked to each other, these complications had a weak association with the presence of COVID-19. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To evaluate the association between HbA1c levels measured in the third trimester and the risk for large for gestational age (LGA) in neonates of mothers affected by gestational diabetes mellitus (GDM). Secondarily, we aimed to identify an ideal cut-off for increased risk of LGA amongst pregnant women with GDM. Materials and methods: Observational retrospective review of singleton pregnant women with GDM evaluated in a diabetes and pregnancy clinic of a tertiary and academic hospital. From January/2011 to December/2017, 1,085 pregnant women underwent evaluation due to GDM, of which 665 had an HbA1c test in the third trimester. A logistic regression model was performed to evaluate predictors of LGA. A receiver-operating-characteristic (ROC) curve was used to evaluate the predictive ability of third trimester HbA1c for LGA identification. Results: A total of 1,085 singleton pregnant women were evaluated during the study period, with a mean age of 32.9 ± 5.3 years. In the multivariate analysis, OGTT at 0 minutes (OR: 1.040; CI 95% 1.006-1.076, p = 0.022) and third trimester HbA1c (OR: 4.680; CI 95% 1.210-18.107, p = 0.025) were associated with LGA newborns. Using a ROC curve to evaluate the predictive ability of third trimester HbA1c for LGA identification, the optimal HbA1c cut-off point was 5.4% where the sensitivity was 77.4% and the specificity was 71.7% (AUC 0.782; p < 0.001). Conclusions: Few studies in the Mediterranean population have evaluated the role of HbA1c in predicting neonatal complications in women with GDM. A third trimester HbA1c > 5.4% was found to have good sensitivity and specificity for identifying the risk of LGA.

Introduction: Misoprostol is a synthetic prostaglandin E1 analogue widely used for cervical ripening and labour induction. However, optimal dose of misoprostol required to induce labour is still controversial. Aim: To determine the efficacy and safety of 25 μg and 50 μg of intravaginal misoprostol for induction of labour at term and to evaluate maternal and neonatal complications. Materials and Methods: The present study was a prospective, randomised, double blind, single centre study carried out during March 2019 to December 2020. The present study was conducted at Department of Obstetrics and Gynaecology, Maharaja Institute of Medical Sciences, Vijayanagaram, Andhra Pradesh, India. All the selected participants were randomised (1:1) to group 1 which received 25 μg of intravaginal misoprostol (n=70) and group 2 received 50 μg of intravaginal misoprostol (n=70). Based on the Bishop’s score, misoprostol was chosen as labour inducing agent. Number of misoprostol doses, mode of delivery, vaginal delivery duration, maternal and neonatal complications was recorded. Statistical significance among study groups were analysed by using Chi-square test. Results: Postdatism was most frequently reported indication in both the study groups (57.1% and 52.9%). A total of 14 and 4 participants in group 2 and group 1 received only single dose of misoprostol (p

Triplet pregnancies are rare events that affect approximately 93 in 100,000 deliveries in the world, especially due to the increased use of assisted reproductive techniques and older maternal age. Triplet pregnancies are associated with a higher risk of fetal and maternal morbidity and mortality compared to twins and singletons. Chorionicity has been proposed as a major determinant of perinatal and maternal outcomes in triplet pregnancies, although further evidence is needed to clarify the extent and real influence of this factor. Thus, the aim of this study was to conduct a systematic review of the literature and a meta-analysis of the maternal and perinatal outcomes of triplet pregnancies, evaluating how chorionicity may influence these results. A total of 46 studies with 43,653 triplet pregnancies and 128,145 live births were included. Among the main results of our study, we found a broad spectrum of fetal and maternal complications, especially in the group of monochorionic and dichorionic pregnancies. Risk of admission to NICU, respiratory distress, sepsis, necrotizing enterocolitis, perinatal and intrauterine mortality were all found to be higher in non-TCTA pregnancies than in TCTA pregnancies. To date, our meta-analysis includes the largest population sample and number of studies conducted in this field, evaluating a wide variety of outcome measures. The heterogeneity and retrospective design of the studies included in our research represent the main limitations of this review. More evidence is needed to fully assess outcome measures that could not be studied in this review due to scarcity of publications or insufficient sample size. [ABSTRACT FROM AUTHOR]