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The incidence of cesarean section is dramatically increasing worldwide, whereas the training opportunities for obstetrician/gynecologists to manage complex cesarean section appear to be decreasing. This may be attributed to changing working hours directives and the increasing use of laparoscopy for gynecological surgical procedures, including in gynecological oncology. Various situations can create surgical difficulties during a cesarean section; however, two of the most frequent are complications from previous cesarean (myometrial defects, with or without placental intrusion and peritoneal adhesions) and the high risk of postpartum hemorrhage (uterine overdistension, abnormal placentation, uterine fibroids). Careful surgical dissection, with safe mobilization of the bladder and exposure of the anterior and lateral surfaces of the uterus, are pivotal steps for resolving the technical difficulties inherent in performing a complex cesarean section. We propose a standardized surgical protocol for women at risk of complex cesarean, including the antenatal identification of increased surgical risk, paramedian access to the pelvis, bladder dissection and mobilization, and the selection of a bleeding control strategy, considering uterine anatomy and the arterial pedicles involved in blood loss, which should be tailored to the individual case. We propose preoperative surgical planning to include consideration of the most common situations encountered during a complex cesarean, which facilitates anticipating an appropriate response for common possible scenarios, and can be adapted for low‐, middle‐, and high‐resource settings. This protocol also highlights the importance of self‐evaluation, continuous learning, and improvement activities within surgical teams. [ABSTRACT FROM AUTHOR]

The puerperium refers to the 6–8 weeks following delivery, and is a dynamic period in which maternal anatomy and physiology are restored to their prepregnant state. Postpartum complications can be divided into non-obstetric and obstetric. The latter are the topic of this article and can be further classified as infectious, thrombotic, hemorrhagic or cesarean-related. Transvaginal US is often the initial modality in the evaluation of puerperal disorders. CT is probably the most valuable imaging technique when life-threatening conditions are suspected. Pelvic MRI is being increasingly used in cases of inconclusive findings or if further characterization is needed, especially in the setting of postsurgical complications or placental disorders. Diagnostic and interventional radiologists play a pivotal role in the evaluation and management of a variety of puerperal complications. Many of these conditions pose a diagnostic challenge, as imaging findings often overlap with normal postpartum changes, so keeping in mind the patient's clinical information is key. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum (PAS) is one of the most dangerous pregnancy-related conditions. This study aims to conduct a systematic review of current research on the ultrasound scoring systems used in PAS patients with a comprehensive summarization of researches and comparison of prenatal ultrasound scoring in evaluating postpartum outcomes. Methods: This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from four databases (PubMed, Cochrane Library, Embase and Web of Science) up to December 2023. Original studies involving women diagnosed with PAS using ultrasound scoring for diagnosis or outcome evaluation were screened based on predefined inclusion and exclusion criteria. The primary outcome was the diagnostic performance of ultrasound scoring systems and their effectiveness in predicting labor outcomes. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was utilized to assess the study quality. The study has been registered on the PROSPERO website with the registration number CRD42024507311. Results: Sixteen studies met the inclusion criteria. 3930 patients were included in the review, with 1693 participants in the control group. Included studies had a high risk of bias in patient selection, with a low risk in flow and timing and reference standards. Existing studies have reported several indicators that can be included in ultrasound scoring systems and tested their effectiveness in diagnosis and severity evaluation. The pool sensitivity, specificity, and area under the curve (AUC) of ultrasound scoring system in diagnosing PAS were 0.89 (95% confidence interval [CI]: 0.82–0.94), 0.85(95%CI: 0.80–0.90) and 0.93 (95%CI:0.91–0.95). Ultrasound scores are associated with PAS outcomes including intraoperative haemorrhage, postpartum haemorrhage, hysterectomy, length of hospital stay, and neonatal prognosis. Limitation is that the existing studies are wide-ranging but have low replication and association. Conclusion: Ultrasound scoring systems play a role in the prenatal diagnosis, management, and prediction of postnatal complications in PAS. Nevertheless, additional research is required to further evaluate the performance between different scoring systems to develop a unified consensus. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality is among the main indicators of health in nations. Identifying the causes of maternal mortality is crucial in designing preventive interventions. Therefore, this study aimed to evaluate the causes of maternal mortality during 8 years. Methods: This descriptive-analytical study was conducted on the archived cases of maternal mortality in the Forensic Medicine Department of the Khorasan Razavi Province between March 2013 and March 2022, but as no data was available for the first two years, maternal mortality data for 8 years was evaluated. Demographic characteristics, midwifery data, pregnancy care method, pregnancy care and delivery agent, insurance type, and confirmed cause of death were compared between the first and last five-year periods of the study. Results: Overall, 250 cases of maternal mortality were identified in the study period. The prevalence of indirect and unrelated causes of maternal mortality was significantly higher in the last four-year period compared to the first four-year period (p < 0.001). The most common direct causes of maternal mortality in both periods were postpartum hemorrhage, eclampsia and gestational hypertension complications; and postpartum infection. Coronavirus disease 2019 (COVID-19) was the most common cause of maternal mortality in the last four-year period but the other common indirect causes of maternal mortality (cardiovascular disease and pulmonary embolism) were similar between the two periods. The most common unrelated cause of maternal mortality was accidents. Conclusions: Postpartum maternal mortality was higher than intrapartum period. Bleeding was still the main cause of maternal mortality. Despite the progress in prenatal care, it is necessary to improve intrapartum and postpartum quality of care. [ABSTRACT FROM AUTHOR]

Aim: This study examined the relationship between postpartum hair loss and psychological symptoms. Methods: This questionnaire‐based, cross‐sectional study included postpartum women who had delivered at two facilities and completed the questionnaire 10–18 months after delivery. Study protocols were sent by mail in two parts. Baseline characteristics and information regarding the pregnancy, delivery, childcare, and postpartum hair loss were obtained via a questionnaire. Psychological symptoms were assessed via the Whooley Questions, Generalized Anxiety Disorder 2‐item, and Edinburgh Postnatal Depression Scale. Participants were divided into two groups based on psychological symptoms. Multivariate analyses were performed. Results: In total, 331 responses were analyzed. Women with very much hair loss felt significantly more anxious than those with no postpartum hair loss, as reported on the Generalized Anxiety Disorder 2‐item anxiety subscale (odds ratio: 4.47). Multiple logistic regression analysis revealed that primiparity, greater amount of postpartum hair loss, and higher Athens Insomnia Scale scores were predictors of Generalized Anxiety Disorder 2‐item anxiety. Adjusted odds ratio of having anxiety among those with very much postpartum hair loss was 4.58 (95% confidence interval, 1.18–17.74) compared to those with no postpartum hair loss. Conclusions: A greater amount of postpartum hair loss was independently associated with postpartum anxiety on the Generalized Anxiety Disorder 2‐item. [ABSTRACT FROM AUTHOR]

Objective: The study was aimed at comparing intrapartum and postpartum outcomes between pregnant patients with and without antenatal COVID‐19 infection using aggregated, deidentified electronic health record (EHR) data. Design and Setting: This retrospective cohort study included data from over 80 health care organizations within the TriNetX Analytics Research Network. Population: Individuals admitted for delivery from Jan 2020 to May 2023 were studied. Methods: We studied individuals with ICD‐10 codes for delivery, COVID‐19 diagnosis, and primary outcomes. We compared the incidence of adverse intrapartum and 30‐day postpartum outcomes in those with and without antenatal COVID‐19. Main Outcome Measures: The main outcomes compared were obstetric, cardiovascular, neurovascular, and respiratory outcomes within 30 days postpartum. Results: Twenty‐six thousand nine hundred seventy‐four of 369,923 (7%) birthing parents with a delivery encounter had an antenatal COVID‐19 diagnosis. Compared to matched controls, having COVID‐19 was associated with an increased risk of postpartum hemorrhage (RR—1.24 (CI—1.16–1.33)), gestational hypertension (RR—1.27 (CI—1.27–1.34)), preeclampsia (RR—1.25 (CI—1.18–1.32)), eclampsia (RR—1.66 (CI—1.29–2.32)), preterm labor (RR—1.21 (CI—1.21–1.34)), cerebral infarction (RR—1.74 (CI—1.04–2.90)), cardiomyopathy (RR—2.08 (CI—1.30–3.32)), heart failure (RR—1.55 (CI—1.04–2.31)), sepsis (RR—2.21 (CI—1.54–3.19)), DVT (RR—2.32 (CI—1.45–3.71)), and pulmonary embolism (RR—2.68 (CI—1.74–2.90)). Conclusion: Individuals with antenatal COVID‐19 were more likely to have intrapartum and postpartum obstetric, cardiovascular, neurovascular, and respiratory complications. This data will inform risk stratification and screening for prenatal care providers. [ABSTRACT FROM AUTHOR]

Background Aims Materials and methods Results Conclusions Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews or case series exist examining peripartum outcomes with bridging anticoagulation.Review of peripartum and postpartum anticoagulation management, with a focus on postpartum complications.Design: case series, single centre. Setting: Royal Brisbane and Women's Hospital, Australia between 1 January, 2000, and 1 August, 2022. Population: all pregnant women with mechanical heart valves (any type) who birthed. Main outcome measures: intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and maternal death.There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded.Women with mechanical heart valves who undergo bridging anticoagulation are associated with significant maternal morbidity. Most postpartum haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data are required to inform evidence‐based guidelines for postpartum anticoagulation management. [ABSTRACT FROM AUTHOR]

Background: Postpartum complications stand for significant challenges in maternal morbidity and mortality along with neonatal development. Antioxidants, a key contributor to preventing postpartum complications such as labor exhaustion, healing lacerations on external genital organs, restoring vigor and vitality, supporting the involution process, and helping in the preparation and secretion of breast milk by preventing oxidative damage, have emerged as potential therapeutic agents to alleviate these complications by neutralizing free radicals, reactive oxygen species (ROS) and reactive nitrogen species (RNS). The nourishment of blood (hematopoiesis) and high energy, the improvement of physique, and the holistic wellness of the mother are essential during the postpartum period. In Sri Lankan traditional medicine, a formula named "Kayam hodda" (KH) is the main and most important formula given at the onset of the delivery and during the entire postpartum period. The composition of the KH is different from the provincial vise in Sri Lanka. Aim: Therefore, the present study was carried out to evaluate the antioxidant capacity of ethanolic extracts of the different KH formulas related to nine provinces in Sri Lanka. Materials and Methods: The antioxidant capacity of the KH formulas was estimated using a stable radical, 1, 1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS). Results: In the DPPH assay, the Western province formula of KH (WPF) extract exhibited the highest antioxidant capacity [44.38 ± 0.4% (44.38 mean; 0.70SD; 0.40SE)], while the Northern province formula (NPF) of KH recorded the lowest (7.43 ± 0.73%). In the ABTS assay, WPF possesses the highest [60.47 ± 1.39 (60.47 mean; 2.41SD; 1.39SE)]. DPPH IC50 of aqueous extract of WPF is 21.95. Conclusion and clinical significance: This study directs future research on the antioxidant activity of individual ingredients and the benefits of antioxidant activity as a therapeutic strategy to overcome postpartum complications associated with harming radicals to restore the health of the puerperal woman through the preclinical and clinical studies proving the efficacy and safety of KH supplementation during the postpartum period. Moreover, this could be develop as a user-friendly nutraceutical by analyzing and finalizing the required dose, and frequency adjuvants, aiming to restore health with better postpartum care. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac disease is a leading cause of maternal morbidity and mortality during pregnancy. Effective management strategies are crucial for improving outcomes in this high-risk population. Aim: This study aimed to evaluate the outcomes of pregnant women with cardiac disease managed at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, to refine treatment protocols. Methods: A prospective cohort study was conducted over one year, enrolling 35 pregnant women with either congenital or acquired heart diseases. Participants underwent regular monitoring with echocardiography, and data were collected on maternal and perinatal outcomes, including delivery methods and postpartum complications. Results: The study highlights significant maternal and perinatal complications in pregnant women with cardiac disease, with anemia (31.4%) and preterm birth (25.7%) as prevalent issues. The findings underscore the need for careful monitoring and management tailored to the severity of cardiac dysfunction to improve outcomes for both mothers and newborns. Conclusion: Effective cardiac and obstetric management in a tertiary care setting allowed for predominantly vaginal deliveries and highlighted the importance of echocardiography in monitoring. Recommendation: Tailored antibiotic prophylaxis and comprehensive postpartum contraceptive counseling should be integrated into care protocols for pregnant women with cardiac disease. [ABSTRACT FROM AUTHOR]

Objective To compare the risk of severe maternal morbidity (SMM) from the delivery admission to 42 days' postdischarge among persons with sickle cell disease (SCD) to those without SCD. Study Design This retrospective cohort study included deliveries ≥20 weeks' gestation at an urban safety net hospital in Atlanta, GA from 2011 to 2019. The exposure was SCD diagnosis. The outcome was a composite of SMM from the delivery admission to 42 days' postdischarge. SMM indicators as defined by the Centers for Disease Control and Prevention were identified using the International Classification of Diseases, Ninth and Tenth Revisions (ICD-9/10) codes; transfusion of blood products and sickle cell crisis were excluded. Results Of N = 17,354 delivery admissions, n = 92 (0.53%) had SCD. Persons with SCD versus without SCD had an increased risk of composite SMM (15.22 vs. 2.29%, p < 0.001), acute renal failure (6.52 vs. 0.71%, p < 0.001), acute respiratory distress syndrome (4.35 vs. 0.17%, p < 0.001), puerperal cerebrovascular disorders (3.26 vs. 0.10%, p < 0.001), sepsis (4.35 vs. 0.42%, p < 0.01), air and thrombotic embolism (5.43 vs. 0.10%, p < 0.001), and ventilation (2.17 vs. 0.09%, p < 0.01). Ultimately, those with SCD had an approximately 6-fold higher incidence risk ratio of SMM, which remained after adjustment for confounders (adjusted incidence risk ratio [aIRR]: 5.96, 95% confidence interval [CI]: 3.4–9.19, p < 0.001). Persons with SCD in active vaso-occlusive crisis at the delivery admission had an approximately 9-fold higher risk of SMM up to 42 days' postdischarge compared with those with SCD not in crisis at the delivery admission (incidence: 25.71 vs. 8.77%, p < 0.05; aIRR: 8.92, 95% CI: 4.5–10.04, p < 0.05). Among those with SCD, SMM at the delivery admission was primarily related to renal and cerebrovascular events, whereas most postpartum SMM was related to respiratory events or sepsis. Conclusion SCD is significantly associated with an increased risk of SMM during the delivery admission and through 42 days' postdischarge. Active crisis at delivery further increases the risk of SMM. Key Points Sickle cell disease was associated with an approximately 6-fold increased risk of SMM. Active vaso-occlusive crisis at delivery was associated with an approximately 9-fold increased risk of SMM. 48% of SMM events in persons with SCD occurred postpartum and were respiratory- or sepsis-related. [ABSTRACT FROM AUTHOR]

Background: Postpartum psychotic‐ or mood disorders are psychiatric emergencies associated with risk of suicide and infanticide. Except from case reports, there are only few descriptions of its treatment. Therefore, we aimed to describe the treatment of women admitted with postpartum psychotic‐ or mood disorder in Denmark with emphasis on the use of electroconvulsive therapy (ECT). Methods: We conducted a register‐based cohort study of all women with incident postpartum psychotic‐ or mood disorder (no prior diagnoses of psychotic‐ or mood disorder or treatment with ECT) requiring admission in the period from 2011 to 2018. For these patients, we described the treatment and the 6‐month readmission risk. Results: We identified 91 women with postpartum psychotic‐ or mood disorder with a median admission length of 27 days (interquartile range: 10–45). Of those, 19% received ECT with a median time from admission to first ECT of 10 days (interquartile range: 5–16). The median number of ECT sessions was eight (interquartile range: 7–12). In the 6 months following discharge, 90% of the women received some form of psychopharmacological treatment (62% antipsychotics, 56% antidepressants, 36% anxiolytics/sedatives, 19% lithium, and 9% mood stabilizing antiepileptics), and 31% were readmitted. Conclusion: Psychiatric admission for incident postpartum psychotic‐ or mood disorder is rare in Denmark. Among those admitted, ECT and psychopharmacological treatment is commonly used. The 6‐month readmission risk is high, warranting close follow‐up. The fact that there is no international consensus on the optimal treatment of postpartum psychotic‐ or mood disorder is problematic and calls for action. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Postnatal care exhibits the lowest coverage levels in the obstetric continuum of care. The highest rates of maternal and newborn morbidity and mortality occur within 24 h of birth. Assessment of women in this time period could improve the detection of postpartum complications and maternal outcomes. This study determined the patterns of maternal assessment and the factors associated with postpartum complications. Methods: This was a cross-sectional study involving observations of immediate postpartum care provided to women following uncomplicated vaginal births at three health facilities in Mpigi and Butambala districts (Uganda) from November 2020 to January 2021. Data were collected using an observation checklist and a data abstraction form for maternal and newborn social demographic data. The collected data were analyzed using Stata version 14.0. Maternal assessment patterns were summarized as frequencies, and the prevalence of postpartum complications was calculated. Logistic regression analysis was performed at both bivariate and multivariate levels to identify factors associated with developing postpartum complications among these women. Results: We observed 263 women receiving care at three health facilities in the immediate postpartum period. The level of maternal assessments was very low at 9/263 (3.4%), 29/263(11%) and 10(3.8%) within the first two hours, at three hours and at the fourth hour, respectively. The prevalence of postpartum complications was 37/263 (14.1%), with 67.6% experiencing postpartum hemorrhage (PPH), 13.5% having perineal tears, and 10.8% having cervical tears. Mothers who did not undergo a postpartum check in the first three hours (p = 0.001), those who were discharged after 24 h (p = 0.038), and those who were transferred to the postpartum ward after two hours (p = 0.001) were more likely to have developed postpartum complications. Conclusion: The maternal assessment patterns observed in the population were suboptimal. Women who were not assessed at the third hour and those transferred after two hours to the postnatal ward were more likely to have developed postpartum complications. [ABSTRACT FROM AUTHOR]

Introduction: With the spread of COVID‐19, certain population groups, including pregnant women, were more susceptible than others. This disease can lead to postpartum complications, including mental disorders, in mothers. Few studies have investigated the impact of mindfulness‐based interventions on mental health, and the most effective counseling approach to promote mental health has not been identified. Objective: This study aimed to determine the impact of online mindfulness‐based counseling on improving mental health among women with a history of COVID‐19 during pregnancy in Iran. Methods: The present study was a quasi‐experimental design conducted on 100 women with a history of coronavirus infection during pregnancy referred to the Mother's Clinic of Yahya Nejad and Ayatollah Rouhani Educational‐Treatment Hospital, affiliated with Babol University of Medical Sciences, Iran, via convenience sampling. The women were randomly assigned to the intervention (mindfulness‐based counseling) and control groups. The intervention group received eight 45‐min weekly mindfulness‐based counseling sessions over 8 weeks. Data were collected via a demographic information questionnaire and the Goldberg General Health Questionnaire before and after the intervention, which were completed by both groups. Independent t‐tests and analysis of covariances (ANCOVAs) were used to compare the outcomes of the two groups. Results: After controlling for confounding variables, the mean mental health scores before and after counseling were 29.42 ± 4.49 and 19.80 ± 3.88, respectively, in the intervention group and 26.26 ± 2.29 and 25.92 ± 2.15, respectively, in the control group. The mean mental health score in the intervention group was significantly lower than that in the control group (F = 266.7, p < 0.001). The mean scores for somatic symptoms (F = 89.30, p < 0.001), depression symptoms (F = 142.71, p < 0.001), anxiety and insomnia symptoms (F = 120.56, p < 0.001), and social dysfunction scores (F = 127.77, p < 0.001) were significantly different between the two groups after counseling. Conclusion: The findings indicated that online mindfulness‐based counseling positively affects mental health and its domains during the postpartum period. However, further randomized clinical trials are needed before a definitive conclusion can be drawn. Trial Registration: We were not allowed to register according to the law of our country. [ABSTRACT FROM AUTHOR]

Background: Cesarean hysterectomy is a dominant and effective approach during delivery in patients with placenta accreta spectrum (PAS). However, as hysterectomy results in a loss of fertility, conservative management is an alternative approach. However, management selection may be affected by a country's overall economic level. Thus the preferred treatment for PAS generates controversy in middle‐income countries. Objectives: We aimed to compare conservative management and cesarean hysterectomy for managing PAS in middle‐income countries. Search Strategy: China National Knowledge Infrastructure, Wanfang Med Online Databases, Cochrane Library, Ovid MEDLINE, PubMed, Web of Science, EMBASE, clinicaltrials.gov, and Scopus were searched from inception through to October 1, 2022. Selection Criteria: We included studies that evaluated at least one complication comparing conservative management and hysterectomy. All cases were diagnosed with PAS prenatally and intraoperatively. Data Collection and Analysis: The primary outcomes were blood loss, adjacent organ damage, and the incidence of hysterectomy. Descriptive analyses were conducted for studies that did not meet the meta‐analysis criteria. A fixed‐effects model was used for studies without heterogeneity and a random‐effects model was used for studies with statistical heterogeneity. Main Results: In all, 11 observational studies were included, with 975 and 625 patients who underwent conservative management and cesarean hysterectomy, respectively. Conservative management was significantly associated with decreased blood loss and lower risks of adjacent organ injury and hysterectomy. Conservative management significantly reduced blood transfusions, hospitalization duration, operative time, intensive care unit admission rates, and infections. There were no significant differences in the risks of coagulopathy, thromboembolism, or reoperation. Conclusion: Given short‐term complications and future fertility preferences for patients, conservative management appears to effectively manage PAS in middle‐income countries. Owing to low levels of evidence, high heterogeneity and insufficient long‐term follow‐up data, further detailed studies are warranted. Synopsis: In middle‐income countries, conservative treatment of placenta accreta spectrum seems to be a viable option for managing PAS in the short term. [ABSTRACT FROM AUTHOR]

Further study is needed to determine the safest mode of delivery and anesthetic management for parturients with ventriculoperitoneal shunts (VP). Prior recommendation for delivery in women with ventriculoperitoneal shunts was cesarean delivery. However, both vaginal delivery and neuraxial anesthesia have been shown to be safe in women with appropriately functioning VP shunts. We present a case series of parturients with VP shunt. Parturients with VP shunts were identified and VP shunt placement indications, neurologic symptoms during pregnancy, delivery mode, anesthetic type, and postpartum complications were reviewed. Forty patients were identified, and fifteen women with twenty deliveries were included. Two women experienced neurological symptoms during pregnancy and one required postpartum shunt revision for blurry vision and ataxia. There were ten cesarean deliveries and ten vaginal deliveries (eight normal spontaneous, one vacuum assisted, and one forceps assisted). Assisted vaginal deliveries were performed to decrease Valsalva including the patient with neurological symptoms related to shunt malfunction. Of the vaginal deliveries, six (60%) had epidural analgesia. Anesthesia for cesarean delivery included neuraxial anesthesia (n = 5) and general anesthesia (n = 5). In our cohort, women with VP shunt received neuraxial blockade without complication. Neuraxial techniques should be offered to women with appropriately functioning VP shunt. [ABSTRACT FROM AUTHOR]

An estimated 7.7 million Venezuelans have fled a severe humanitarian crisis in their country, most (70%) to other middle-income host countries in the same Andean region. Migration-related exposures during periconception and other critical gestational periods can adversely impact maternal-perinatal outcomes. Emerging evidence suggests that Venezuelan refugee and migrant women (VRMW) who migrate to Andean host countries are at-risk for delivering preterm and low birthweight infants and for Cesarean-sections. However, relatively few studies have examined obstetrical complications that could contribute to these or other short- and longer-term health outcomes of VRMW and/or their offspring. Our exploratory study analyzed four recent years of national hospital discharge data (2018–2021) from Ecuador to compare the primary discharge diagnoses of VRMW (n = 29,005) and Ecuadorian nationals (n = 1,136,796) for ICD-10 O code obstetrical complications related to or aggravated by pregnancy, childbirth, or the puerperium. Our findings indicated that VRMW were hospitalized for 0.5 days longer than Ecuadorian reference group women and they had higher adjusted odds (aOR) for a primary discharge diagnosis for obstetrical complications including preeclampsia (aOR:1.62, 95% CI:1.55,1.69), preterm labor (aOR:1.20, 95% CI:1.11,1.31), premature rupture of membranes (aOR: 1.72, 95% CI:1.63,1.83), oligohydraminos (aOR:1.24, 95% CI:1.12,1.36), obstructed labor (aOR: 1.39, 95% CI:1.31,1.47), perineal lacerations/other obstetric trauma (aOR:1.76, 95% CI:1.63, 1.91), STIs (aOR:2.59, 95% CI:1.29,2.92), anemia (aOR:1.33, 95% CI:1.24,1.42), and ectopic pregnancy (aOR:1.16 95% CI:1.04,1.28). They had similar aOR for diagnosed gestational diabetes and spontaneous abortion (SAB) compared to the reference group but a reduced aOR for genitourinary infections (aOR:0.79, 95% CI:0.74,0.84) and early pregnancy hemorrhage not ending in SAB (aOR:0.43, 95% CI:0.36,0.51). Our findings underscore the vulnerability of VRMW for a number of potentially serious obstetrical complications with the potential to adversely impact the short- and longer-term health of mothers and their offspring. Future studies should collect more detailed information on the migration status, experiences, and exposures of MRMW that influence their risk for obstetrical complications. These are needed to expand our findings to better understand why they have excess risk for these and to inform social and public health policies, programs and targeted interventions aimed at reducing the risk of this vulnerable refugee and migrant group. [ABSTRACT FROM AUTHOR]

Objectives: Maternal mortality in the U.S. continues to increase, and the State of Georgia has one of the highest maternal mortality rates among the 50 states at 33.9 deaths per 100,000 live births, disproportionately affecting Black and rural populations. This study sought to ascertain knowledge of adults living in Georgia about proper pregnancy care behaviors and their ability to identify warning signs and symptoms (WSS) of life-threatening complications during pregnancy and up to 1-year postpartum. Methods: In 2022, using a cross-sectional study design, a questionnaire including items from validated instruments was distributed to adults residing in Georgia through social media and email. Questions were grouped into categories: total pregnancy knowledge, general pregnancy care behaviors, and pregnancy and postpartum WSS. Based on correct answer choices, scores were created for each of the four categories and compared by gender, age, education, race, and ethnicity using multiple linear regressions. Results: Participants (n = 588) ranged from 18 to 76 years old and were primarily female (80%). The vast majority (83.3%) failed to identify important pregnancy care behaviors. More than half of all participants were unable to recognize pregnancy and postpartum WSS of complications, 52% and 56% respectively. Male, Black, and Hispanic self-identified adults exhibited lower recognition of pregnancy care behaviors and WSS of pregnancy and postpartum complications, relative to other genders, races, and ethnic groups, respectively (p < 0.001). Conclusions: This research identified important gaps in maternal health knowledge among adults living in the State of Georgia, highlighting specific opportunities for intervention and offering evidence-based information that can help improve health literacy for better maternal outcomes. [ABSTRACT FROM AUTHOR]

Background: This study systematically reviewed the causes of child death across different age groups based on the International Classification of Diseases, 10th Revision (ICD-10) criteria. Methods: A comprehensive search was conducted in seven electronic databases and two search engines to identify all studies examining child mortality in any part of Iran or the entire country. Hand searching, gray literature, and bibliographies were also utilized. Data were synthesized descriptively and through meta-analysis. Results: A total of 35 studies were included, encompassing 58,519 death cases across various age groups. According to the ICD-10 classification, the most common causes of Neonatal Mortality Rates (NMR) were pregnancy, childbirth, and puerperium-related conditions (41.1%), congenital malformations (19.2%), and certain conditions originating in the perinatal period (14.5%). For Infant Mortality Rates (IMR), the leading causes were congenital malformations (44.0%), pregnancy, childbirth, and related conditions (14.5%), and respiratory and cardiovascular diseases (8.7%). In the age group of 28 days to 5 years, the primary causes of death were pregnancy, childbirth, and puerperium-related issues (27.5%), congenital malformations and chromosomal abnormalities (21.6%), and respiratory and cardiovascular disease (9.3%). For children aged 1 to 5 years, congenital malformations (29.1%), external causes (19.6%), and respiratory and cardiovascular disorders (7.2%) were the most significant causes of death. The meta-analysis revealed that immaturity [0.171 (PI: 0.032–0.561)] in infants aged 0–28 days, and congenital malformations in the age groups of 28 to 1 year [0.261 (PI: 0.166–0.385)] and 28 to 5 years [0.173 (PI: 0.078–0.342)] were the leading causes of death. Conclusions: The findings of this study provide valuable insights for priority-setting interventions aimed at reducing child mortality according to the prevalence rate of specific causes in different age groups. [ABSTRACT FROM AUTHOR]

Access to parenthood is not always easy, and various difficulties can sometimes emerge. Often underdiagnosed, these peri- and post-partum disorders have a major impact on the quality of early interactions. Prevention and fast care are fundamental. In Nancy, France, a mobile perinatal psychiatry team (EMPPer) was created in September 2021 with the aim of "reaching out" to these vulnerable populations with care access difficulties. A clinical case combining precariousness, migration, maternal psychopathological disorders, baby's psycho-affective and psychomotor development trouble is exposed. This article aims to present the multidisciplinary network intervention of EMPPer. [ABSTRACT FROM AUTHOR]

• The prevalence of prenatal ectopic kidney is quite low. • The most common locations of ectopic kidneys are the iliac fossa and lateral pelvic areas, respectively. • In ectopic kidney cases, both kidneys are equally affected in both genders. • Blood supply to ectopic kidneys is most commonly provided by the iliac artery and then the aorta. • The most common extraurinary anomalies accompanying prenatally diagnosed ectopic kidney are cardiac anomalies. To assess the characteristics, additional structural anomalies and postnatal urinary outcome of the cases diagnosed with fetal ectopic kidneys in the prenatal period. Cases having fetal ectopic kidneys, detected from a total of 14,617 pregnant women examined by routine detailed (Group 1) or indicated (Group 2) obstetric ultrasonography (USG) in a tertiary perinatology unit were analyzed. The prevalence of the cases, time of the diagnosis, sidedness of the affected kidney, anatomical location, origins of blood supply, additional urinary or extraurinary anomalies, and urinary complications during the postnatal follow-up period were investigated. We have detected 33 fetuses with ectopic kidneys in our cohort. The prevalence of fetal ectopic kidney was 0.22 %, with a median (min.-max.) diagnosis time of 21.3 (17.6–34) weeks. In the group in whom indicated USG was performed, the time of diagnosis was later compared to routine detailed USG (p = 0.04) group. There was no difference in terms of gender [male, (n = 14), female (n = 19), p = 0.38] and the sidedness of the ectopic kidneys (p = 0.38). The location of ectopic kidneys was most frequent in the iliac fossa (n = 20, 60.6 %) and in the lateral pelvic areas (n = 13, 39.3 %). The blood supply origin of ectopic kidneys was the common iliac artery in 22 (66.6 %), whereas the aorta in 11 cases (33.3 %). There was an additional urinary anomaly in 8 cases (24 %), an extraurinary structural anomaly, most commonly cardiac, and/or a soft marker for aneuploidy were presented in 16 cases (48 %). The most common urinary complication in the postpartum period was vesicoureteral reflux (n = 5). Ectopic kidney in the prenatal period is a rare structural anomaly that can equally affect both genders and both kidneys. Prenatal diagnosis is important for the diagnosis of additional anomalies and follow-up of postnatal complications. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Psychiatry is the property of Turk Psikiyatri Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Black birthing people are three to four times more likely to die from pregnancy-related causes than White birthing people. Objective: We aimed to better understand the pregnancy and postpartum experiences with health care, support, and maternal morbidity and mortality (MMM) of Black pregnant and parenting people living in neighborhoods with increased rates of MMM in Chicago, Illinois. Methods: This was a rapid qualitative analysis in Chicago, Illinois based on principles of community-based participa-tory research. Community partners recruited Black pregnant and parenting individuals living in neighborhoods with higher rates of MMM. Four focus groups from February 2021 to October 2021 were led by community health workers and covered pregnancy and postpartum experiences. Transcripts were deductively and inductively coded by paired-analyst teams and thematically analyzed. Results: This study included 31 participants from eight neighborhoods. Key themes related to pregnancy and the postpartum period included the: (1) a need for social and mental health support during and after pregnancy, (2) a preference for multiple sources of health information, (3) a need for strengthened connection with medical providers and health care systems, (4) a lack of clarity regarding MMM and the postpartum period, and (5) a difference in language between patients and health care providers. Conclusions: Further research and interventions are needed to evaluate how to best support pregnant and postpartum people, to implement patient-centered language when communicating about pregnancy and postpartum complications, and to demonstrate investment by health care workers in Black birthing people. Crucial to further research and interventions is communication with and input from communities most affected by MMM. [ABSTRACT FROM AUTHOR]

The article present a case study of a 30-year-old woman who experienced postpartum anxiety and intrusive thoughts following the birth of her first child. Topics discussed include the clinical presentation of postpartum psychiatric disorders; the differential diagnosis; and the management strategies, particularly focusing on postpartum obsessive-compulsive disorder and coexisting major depressive disorder.

Background: Postpartum readmission for preeclampsia is a difficult predicament for patients which creates financial, psychosocial, and physical stress. It is often a challenge to predict postpartum preeclampsia and therefore identify patients that may be at risk prior to discharge. This study aims to identify risk factors in patients that are at high risk for readmission due to preeclampsia. The identification of these risk factors may also lead to enhanced education and counseling prior to discharge. Methods: Researchers conducted a case–control study using a data set collected from 2015 to 2022 looking at obstetric readmissions within 6 weeks of delivery and then stratified these patients for preeclampsia diagnosis. A control set was created within the healthcare system's electronic medical record's search tools for patients diagnosed with preeclampsia who were not readmitted to the hospital. This study evaluates 78 patients who were readmitted with a diagnosis of preeclampsia and compared to 77 patients who were diagnosed with preeclampsia who were not readmitted. Again, the aim of this study was to investigate risk factors for readmission among patients with preeclampsia. Results: A multivariable logistic regression model was used to assess predictors which revealed that older age (OR 1.13, CI 1.03–1.24), no history of preeclampsia with or without severe features within pregnancy before delivery (OR 15.29, CI 5.56–41.98 and 13.58, CI 4.46–12.85), no aspirin use in pregnancy (OR 4.38, CI 2.02–9.48), and number of triage visits related to hypertension during prenatal care were all significant predictors for readmission due to preeclampsia. Conclusion: With these risk factors in mind, better counseling and preventative surveillance can be provided to patients. Future studies are needed to evaluate the effectiveness of predictive models developed using these found risk factors. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria. Design: Retrospective observational study. Setting: A total of 54 referral‐level hospitals across the six geopolitical regions of Nigeria. Population: Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020. Methods: Secondary analysis of routine maternity care data sets. Random‐effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour. Main outcome measures: Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis. Results: Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death. Conclusions: Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD), as a common condition occurring in women in the postnatal period, is underdiagnosed, seldom identified, and infrequently treated. Undiagnosed PPD can have negative consequences for overall quality‐of‐life outcomes in the mother, psychological growth of the infant, and bonding between the infant and its mother. However, early diagnosis and prompt treatment of PPD can lead to an improvement in postpartum maternal health and a healthier relationship between the mother and her infant. Additionally, early identification of risk factors in the prenatal and antenatal period can enable preventive treatment and ensure that the expectant or pregnant woman remains free of disease after giving birth. Therefore, we propose a protocol for the risk assessment, screening, diagnosis, assessment, and therapy of postnatal depression (RASDAT). The RASDAT protocol recommends assessment of risk factors for PPD in the perinatal period as well as early diagnosis and treatment in the early‐to‐mid postpartum period. It also recognizes, for the first time, insomnia and anxiety as important predictors, comorbidities, and poor prognostic factors in postpartum depression. Further studies are necessary to determine the feasibility and applicability of this novel tool, including costs of availing health facilities, burden on the health system, and knowledge, attitudes, and practices among physicians and clinical pharmacists regarding PPD and its resolution. Synopsis: Insomnia and anxiety are important comorbidities of postpartum depression. Risk assessment must be conducted in the prenatal and antenatal period for preventive treatment. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between the duration of transition from latent to active labor and various obstetric, maternal, fetal, and neonatal outcomes. Methods: A retrospective cohort study was conducted on term, singleton deliveries at Soroka University Medical Center from 2013 to 2018. Data were extracted from electronic medical records. The exposure variable was defined as prolonged transition, which was itself defined as the upper 10th centile of dilation duration from 4 to 6 cm. Clinical and demographic characteristics were compared using χ2 test. Multivariate logistic regression was used to estimate the contribution of a prolonged transition with each adverse outcome adjusting for potential confounders. Results: In all, 12 104 deliveries met the inclusion criteria. The mean ± standard deviation of duration of dilation from 4 to 6 cm was 03:07:58 ± 03:03:42 (hours:minutes:seconds). Progress curves varied significantly among patients with different obstetrical and demographic characteristics. Prolonged transition was significantly linked to an increased risk of cesarean delivery (adjusted odds raito 2.607, 95% confidence interval 2.171–3.130, area under the curve 0.689) and higher rates of maternal and neonatal morbidity. Conclusions: Patients experiencing transition phases exceeding the 90th centile faced an elevated risk of cesarean delivery and postpartum complications. Future studies should focus on interventions during the transition phase to improve pregnancy outcomes and enhance patient safety. Synopsis: Women whose transition from latent to active phase of labor exceeds the 90th centile have increased risk for cesarean delivery and maternal and neonatal complications. [ABSTRACT FROM AUTHOR]

• ACOG and RCOG guidelines for postpartum venous thromboprophylaxis show notable differences. RCOG identifies parity ≥ 3, age ≥ 35, and smoking as VTE risk factors, while ACOG does not recognize them. • Why was this study conducted? • Considering the major discordances between societies' recommendations regarding postpartum Venous Thromboprophylaxis, we aimed to reveal these differences by comparing ACOG and RCOG guidelines recommendations and their real-time implications for our 1000 postpartum patients. • What are the key findings ? • The ACOG and RCOG guidelines' recommendations regarding venous thromboprophylaxis in postpartum women significantly differ. While parity ≥ 3, age ≥ 35, and smoking are considered risk factors for VTE according to RCOG, they are not considered risk factors according to ACOG. • What does this study add to what is already known? • Although the literature consensuses regarding the discordance between societies' guidelines regarding postpartum venous thromboprophylaxis, our study can be counted as a contribution to this knowledge, with a remarkable high number of patients within a detailed risk-factor-based evaluation. Venous thromboembolism is one of the most serious complications of the postpartum period, and international societies have various thromboprophylaxis guidelines for its prevention. This study compares postpartum venous thromboprophylaxis recommendations from the American College of Obstetrics and Gynecology (ACOG) and the Royal College of Obstetricians and Gynecologists (RCOG) with real-life clinical practices. Data analysis of 1000 postpartum women at a tertiary care center focused on patient demographics, venous thromboembolism risk factors, and clinical thromboprophylaxis practices. Patient-specific risk factors were compared between ACOG and RCOG guidelines, assessing Low-Molecular-Weight-Heparin dosages and durations. Guideline compliance, undertreatment/overtreatment rates, and the required number of prefilled Low-Molecular-Weight-Heparin syringes were evaluated. Significant discrepancies were observed between ACOG and RCOG guidelines, particularly in Low Molecular Weight Heparin dosages and durations. Consensus rates with clinical approaches were around 53%, with inconsistencies leaning towards undertreatment (RCOG) and overtreatment (ACOG). The number of required prefilled Low-Molecular-Weight-Heparin syringes was notably higher according to RCOG compared to ACOG guidelines. Postpartum Venous thromboembolism prophylaxis guidelines from American College of Obstetrics and Gynecology and Royal College of Obstetricians and Gynecologists exhibit substantial differences, leading to variations in clinical practice. Further research on the significance of Venous thromboembolism risk factors is essential for improving risk assessment tools and refining guideline recommendations for pregnancy-related Venous thromboembolism prevention. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería Neonatal is the property of Fundacion para la Salud Materno Infantil (FUNDASAMIN) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BackgroundSocial support is associated with decreased symptoms of postpartum mood and anxiety disorders (PMAD) in mothers of healthy infants, but less is known about social support and PMADs in mothers with preterm infants. The purpose of this study was to examine the relationship between social support and symptoms of PMADs reported by mothers in the months following hospital discharge of their preterm infant.MethodsMothers of infants less than 33 weeks gestational age were enrolled from neonatal intensive care units (NICU) at 6 sites. Mothers completed PMAD measures of depression, anxiety and post-traumatic stress approximately 3 months following their infant's discharge. Multivariable regression was used to evaluate relationships between social support and PMAD measures.ResultsOf 129 mothers, 1 in 5 reported clinically significant PMAD symptoms of: depression (24%), anxiety (19%), and post-traumatic stress (20%). Social support was strongly inversely associated with all 3 PMADs. Social support explained between 21% and 26% of the variance in depression, anxiety and post-traumatic stress symptoms.ConclusionIncreased social support may buffer PMAD symptoms in mothers of preterm infants after discharge. Research is needed to determine effective screening and interventions aimed at promoting social support for all parents during and following their infant's hospitalisation.

Background: New mothers and fathers are at risk of developing postnatal depressive problems. To understand how postnatal depressive symptoms unfold over time, analyses at the within-person level are necessary. Inspecting postnatal depressive problems at the symptom level provides a novel perspective, ultimately offering insight into which symptoms contribute to the elevation of other symptoms over time. Methods: Panel graphical vector-autoregression (GVAR) models were applied to analyze the within-person temporal and contemporaneous relations between depressive symptoms across the postnatal period in new mothers and fathers (at T1; Nmothers = 869, Nfathers = 579). Depressive symptoms were assessed at 6-, 12-, and 18-months postpartum, using the Edinburgh Postnatal Depression Scale. Results: The results revealed that for mothers, sadness was a key symptom predicting symptom increases in multiple other depressive symptoms and itself (autoregressive effect) over time. Furthermore, anxiousness and feeling scared predicted each other across the postnatal period in mothers. For fathers, the most central predicting symptom in the overall network of symptoms was being anxious, while self-blame and being overwhelmed had strong self-maintaining roles in the fathers' symptomatology, indicating that these could be key features in fathers experiencing postnatal depressive problems. The pattern of symptoms that mothers and fathers experienced within the same time window (contemporaneous associations), shared many of the same characteristics compared to the temporal structure. Conclusions: This study suggests that across the postnatal period, from 6- to 18-months postpartum, depressive symptoms in mothers and fathers contribute differently to the pattern of depressive problems, highlighting sadness as a key feature in maternal symptomatology and anxiousness components in paternal symptomatology. [ABSTRACT FROM AUTHOR]

Key Points: Question: Among patients with increased risk of postpartum venous thromboembolism, does a more selective protocol for initiating postpartum enoxaparin, compared with a standard risk-stratified protocol, decrease wound complications without increasing patient risk of venous thromboembolism? Findings: In this retrospective observational study, a more selective protocol for chemoprophylaxis resulted in a decrease in heparin (enoxaparin) administration (16% vs 8%). The selective protocol for postpartum enoxaparin was associated with a decrease in wound hematoma (0.7% vs 0.3% in the selective protocol group; adjusted odds ratio, 0.38; 95% CI, 0.21-0.67) without evidence of increase in venous thromboembolism (0.1% vs 0.1% in the selective protocol group; adjusted odds ratio, 0.40; 95% CI, 0.12-1.36). Meaning: A more selective protocol for postpartum enoxaparin was associated with decreased rates of wound hematomas without evidence of increased rates of postpartum thromboembolic events. Importance: In 2016, our institution adopted a pregnancy-related venous thromboembolism (VTE) prophylaxis protocol based on American College of Obstetricians and Gynecologists guidelines that recommended postpartum heparin-based chemoprophylaxis (enoxaparin) based on a risk-stratified algorithm. In response to increased wound hematomas without significant reduction in VTE using this protocol, a more selective risk-stratified approach was adopted in 2021. Objective: To evaluate outcomes of the more selective risk-stratified approach to heparin-based obstetric thromboprophylaxis (enoxaparin) protocol. Design, Setting, and Participants: Retrospective observational study of 17 489 patients who delivered at a single tertiary care center in the southeast US between January 1, 2016, and December 31, 2018 (original protocol), and between December 1, 2021, and May 31, 2023 (more selective protocol). Patients receiving outpatient anticoagulation for active VTE or high VTE risk during pregnancy were excluded. Exposure: Standard risk-stratified and more selective postpartum VTE chemoprophylaxis protocols. Main Outcomes and Measures: The primary outcome was clinical diagnosis of wound hematoma up to 6 weeks pos tpartum. The secondary outcome was new diagnosis of VTE up to 6 weeks post partum. We compared baseline characteristics and outcomes between groups and estimated adjusted odds ratios with 95% CIs of primary and secondary outcomes using the original protocol group as reference. Results: Of 17 489 patients included in the analysis, 12 430 (71%) were in the original protocol group and 5029 (29%) were in the more selective group. Rates of chemoprophylaxis decreased from 16% (original protocol) to 8% (more selective protocol). Patients in the more selective group were more likely to be older, be married, and have obesity or other comorbidities (hypertension, diabetes, cardiac disease). Compared with the original protocol, the more selective protocol was associated with a decrease in any wound hematoma (0.7% vs 0.3%; adjusted odds ratio [aOR], 0.38; 95% CI, 0.21-0.67), specifically due to a lower rate of superficial wound hematomas (0.6% vs 0.3%; aOR, 0.43; 95% CI, 0.24-0.75). There was no significant increase in VTE or individual types of VTE (0.1% vs 0.1%; aOR, 0.40; 95% CI, 0.12-1.36). Conclusions and Relevance: A more selective risk-stratified approach to an enoxaparin thromboprophylaxis protocol for VTE was associated with decreased rates of wound hematomas without increased rates of postpartum VTE. This observational study assesses incidence of wound hematoma diagnoses up to 6 weeks post partum among obstetric patients who received thromboprophylaxis according to less selective vs more selective hospital chemoprophylaxis protocols. [ABSTRACT FROM AUTHOR]

Background: Biologic strain such as oxidative stress has been associated with short leukocyte telomere length (LTL), as well as with preeclampsia and spontaneous preterm birth, yet little is known about their relationships with each other. We investigated associations of postpartum maternal LTL with preeclampsia and spontaneous preterm birth. Methods: This pilot nested case control study included independent cohorts of pregnant people with singleton gestations from two academic institutions: Cohort 1 (hereafter referred to as Suburban) were enrolled prior to 20 weeks' gestation between 2012 and 2018; and Cohort 2 (hereafter referred to as Urban) were enrolled at delivery between 2000 and 2012. Spontaneous preterm birth or preeclampsia were the selected pregnancy complications and served as cases. Cases were compared with controls from each study cohort of uncomplicated term births. Blood was collected between postpartum day 1 and up to 6 months postpartum and samples were frozen, then simultaneously thawed for analysis. Postpartum LTL was the primary outcome, measured using quantitative polymerase chain reaction (PCR) and compared using linear multivariable regression models adjusting for maternal age. Secondary analyses were done stratified by mode of delivery and self-reported level of stress during pregnancy. Results: 156 people were included; 66 from the Suburban Cohort and 90 from the Urban Cohort. The Suburban Cohort was predominantly White, Hispanic, higher income and the Urban Cohort was predominantly Black, Haitian, and lower income. We found a trend towards shorter LTLs among people with preeclampsia in the Urban Cohort (6517 versus 6913 bp, p = 0.07), but not in the Suburban Cohort. There were no significant differences in LTLs among people with spontaneous preterm birth compared to term controls in the Suburban Cohort (6044 versus 6144 bp, p = 0.64) or in the Urban Cohort (6717 versus 6913, p = 0.37). No differences were noted by mode of delivery. When stratifying by stress levels in the Urban Cohort, preeclampsia was associated with shorter postpartum LTLs in people with moderate stress levels (p = 0.02). Conclusion: Our exploratory results compare postpartum maternal LTLs between cases with preeclampsia or spontaneous preterm birth and controls in two distinct cohorts. These pilot data contribute to emerging literature on LTLs in pregnancy. [ABSTRACT FROM AUTHOR]