Obstetrical complications and outcome in patients with endometriosis

Objective of the Review: To study the impact of endometriosis on the course and outcomes of pregnancy; to propose methods for prevention of obstetrics complications in pregnant women with endometriosis. Key Points. Pregnant women with endometriosis are at a high risk of miscarriage, preterm delivery, preeclampsia, placental disorders, intranatal and postnatal bleeding, still birth, high rates of caesarean section; and at a risk of acute complications from endometriosis, e.g., spontaneous hemoperitoneum. Endometriosis is associated with progesterone resistivity, impaired endometrium receptivity; therefore, prescription of progesterone to pregnant women with endometriosis can be a key to prevention of not only miscarriages and preterm delivery, but also of preeclampsia and placental disorders. Folic acid has favourable effect for placenta formation. Low doses (75–150 mg/day) of acetylsalicylic acid prevent placentation disorders. Conclusion. In order to prevent impaired implantation, placentation, cytotrophoblastic invasion, and uteroplacental perfusion with a high risk of obstetric complications, pregnant women with endometriosis should take progesterone, folic and acetylsalicylic acids. Keywords: endometriosis, obstetric complications, pregnancy follow-up

Objective. To analyze a data base, including systematic reviews and clinical trials, devoted to the obstetric complications in pregnant women with gestational diabetes mellitus, who conceived after assisted reproductive technologies. Pubmed, Google Scoolar, Crossref, and e-library databases from 2012 to 2022 were searched for keywords: gestational diabetes, assisted reproductive technology, obstetric complications, preeclampsia, placental insufficiency, preterm delivery, and placental abruption. The review demonstrated a high risk of obstetric and perinatal complications in pregnant women with gestational diabetes mellitus after assisted reproductive technologies.

Safety of influenza vaccines in pregnant women

Background. It has been established that pregnancy after assisted reproductive technologies (ART) is significantly more often accompanied by the development of gestational diabetes mellitus (GDM), but the effect of GDM on the development of obstetric and perinatal complications of pregnancy after ART has not been studied enough to date. Objective. To determine the features of the course of pregnancy, delivery and perinatal outcomes in women with pregnancy after the use of ART and complicated by GDM. Materials and methods. An observational single-center retrospective cohort continuous study was conducted, the main group (n=41) consisted of patients with pregnancy resulting from the use of ART complicated by GDM. The comparison group (n=35) included patients with pregnancy resulting from ART without GDM. The analysis of somatic and gynecological anamnesis, reproductive function was carried out, as well as perinatal complications and pregnancy outcomes in the observation groups were analyzed. Results. Patients with pregnancy after ART and complicated by GDM were significantly more likely than patients after ART without GDM to be overweight and obese (BMI=30.3 (26.0÷32.3) kg/m2 versus BMI=26.1 (24.3÷30.0) kg/m2; OR 4.96; 1.47—16.92; p=0.007), diseases of the cardiovascular system (OR 3.84; 1.23—11.96; p=0.003), hypothyroidism (OR 5.53; 1.42—21.29; p=0.008) and chronic diseases of the urinary system (OR 4.96; 1.47—16.92; p=0.007). The risk factors for the development of GDM in patients after ART include prolonged use of progesterone preparations after 22 weeks (OR 14.097; 4.71—42.21; p<0.001), use of IVF/ICSI programs (OR 2.751; 1.038—7.29; p=0.039). Pregnancy resulting from ART and proceeding against the background of GDM significantly more often than pregnancy after ART without GDM was complicated by the development of moderate (OR 1.083; 1.11—77.52; p=0.04) and severe preeclampsia (OR 1.038; 1.08—69.52; p=0.04), the formation of fetal macrosomia (OR 6.05; 1.24—29.541; p=0.023) and the development of postpartum hemorrhage (OR 9.27; 1.11—75, 21; p=0.016). Conclusion. There is some synergy regarding the impact of GDM and the use of ART methods on the course of pregnancy, delivery and perinatal outcomes in patients with infertility. Timely detection of clinical and anamnestic risk factors, early diagnosis of GDM, and correction of carbohydrate metabolism disorders will help prevent and reduce the incidence of obstetric and perinatal complications in patients after the use of ART programs.

Diabetes and Pregnancy

Objetivo: Determinar el riesgo de complicaciones obstétricas en gestantes trabajadoras atendidas en la Maternidad “Dr. Armando Castillo Plaza” de Maracaibo, estado Zulia. Métodos: Investigación comparativa, con diseño no experimental y transeccional, que incluyó 100 gestantes trabajadoras (casos) y 100 no trabajadoras (controles); evaluándoseles el riesgo de presentar complicaciones obstétricas como preeclampsia, prematuridad, bajo peso al nacer y malformaciones congénitas. Resultados: Prevalecieron trabajadoras de los servicios y vendedores de comercio y mercado (31%) y ocupaciones elementales (20%), contratadas (74%), con antigüedad entre 2-5 años (56%), trabajo en bipedestación (62%), alta-media demanda física o mental (73% y 57%, respectivamente), alta demanda laboral (51%), alta satisfacción laboral (68%), y expuestas a riesgos ergonómicos como esfuerzo físico pesado (51,8%). Se encontró que 44% de las pacientes presentaron alguna complicación obstétrica, aunque en las trabajadoras hubo mayor número de complicaciones que en las no trabajadoras, la presencia de cualquier complicación fue similar y no mostró diferencias significativas (41% vs. 47%, respectivamente; OR [IC95%]= 0,783 [0,447 – 1,371]; p> 0,05). Aunque no constituyó un factor de riesgo, sólo el parto pretérmino predominó en las gestantes trabajadoras, aunque no re (10% vs. 1%; OR [IC95%]= 0,090 [0,011 - 0,724]; p= 0,009); mientras que la presencia de preeclampsia ocurrió mayormente en las no trabajadoras (8% vs. 16%, respectivamente; OR [IC95%]= 2,191 [0,892 – 5,381]; p> 0,005), representando el no tener la condición laboral un factor protector para no presentar preeclampsia, aunque no significativo. Conclusión: La condición laboral no genera mayor riesgo de presentar complicaciones en las gestantes.

The effect of infertility and assisted reproduction on first-trimester placental and fetal development

Definition of bleeding events in studies evaluating prophylactic antithrombotic therapy in pregnant women: A systematic review and a proposal from the ISTH SSC

The aim of our study is to assess the development of obstetric and perinatal complications in obese pregnant women with non-alcoholic steatohepatitis (NASH) depending on changes in blood lipid spectrum and body mass index (BMI). Materials and methods. We examined 98 pregnant women with non-alcoholic fatty liver disease (NAFLD) at the stage of NASH in combination with obesity. The control group consisted of 30 healthy pregnant women. All pregnant women with NAFLD and abdominal obesity were divided into 3 groups depending on BMI: Group I – 26 pregnant women with BMI 25.0–29.9 kg/m², Group II – 48 pregnant women with BMI 30.0–34.9 kg/m2, Group III – 24 pregnant women with BMI 35.0–39.9 kg/m2. Correlations of obstetric complications depending on changes in lipid metabolism and BMI were determined. Results. The analysis of obstetric complications revealed 3.4 times higher risk of early miscarriage in group I, 5.6 times – in group II, 7.5 times – in group III compared the control group (P < 0.05); early gestosis occurred 1.9 times more often in group I, 2.5 times – in group II, 3.3 times – in group III as compared to that in pregnant women of the control group (P < 0.05); the threat of premature birth was found 3.4 times more frequently in group I, 5.6 times – in group II, 7.5 times – in group III as compared with the control group (P < 0.05). Group I patients developed placental dysfunction with a frequency of 2.3 times, group II – of 4.0 times, and group III – of 6.3 times greater than pregnant women of the control group (P < 0.05), and moderate preeclampsia was diagnosed in overweight pregnant women, as well as in women with grade I and grade II–III obesity 2.3 times, 4.7 times and 5.6 times as often, respectively, as in the control group (P < 0.05). Correlation analysis showed correlations between lipid metabolism indicators and an increase in BMI. Conclusions. Obese pregnant women with NAFLD at the stage of NASH were found to have significantly more frequent obstetric and perinatal complications as well as lipid profile abnormalities correlating with increased BMI, which may be due to the presence of NASH and functional liver failure.

Obstetrical outcome in women with endometriosis including spontaneous hemoperitoneum and bowel perforation: a systematic review

BackgroundEssential thrombocythemia (ET) is a chronic myeloproliferative neoplasm characterized by persistently elevated platelet count without a clear secondary cause. Although most patients with ET are between 55 and 60 years of age, it has been estimated that 20% of women with ET are diagnosed during reproductive ages. Miscarriage is the most frequent complication of ET that has been hypothesized to be caused by microcirculatory disturbances and placental microinfarction. Furthermore, pregnant patients with ET are at increased risk of other pregnancy complications such as preterm delivery and intrauterine growth restriction.MethodsThis study was planned to evaluate pregnancy outcomes and predictors of obstetric complications in pregnant women with essential thrombocythemia (ET). The data of 21 patients with ET were analyzed retrospectively between 2016 and 2020. Age, parity, history of miscarriage, presence of Janus kinase 2 (JAK2) mutation, history of thrombotic events, treatment of thrombocytosis during pregnancy, and obstetrical outcomes including miscarriage were compared.ResultsPatients with ET had a significantly higher rate of history of two or more previous miscarriages. Miscarriage and obstetric complications in pregnant women with ET were found to be significantly higher than in the control group. Patients with ET with obstetric complications or miscarriage more frequently had a platelet count of >1000 × 103/μL. Acetylsalicylic acid (ASA) prevented miscarriages, but not obstetric complications, in patients with ET.ConclusionET increases miscarriage and obstetric complications in pregnancy. Treatment with ASA may reduce pregnancy losses, but not obstetric complications.

Study question Are there differences in the vaginal microbiome of pregnant women who had a spontaneous pregnancy compared to those who required IVF? Summary answer The composition of the vaginal microbiome at 12 week's gestation is different in women who achieve the pregnancy spontaneously or by IVF. What is known already The vaginal microbiome plays an important role in women's reproductive health, finding associations between different microbiome patterns and the presence of infertility and embryo implantation failure in IVF. Additionally, recent studies show a correlation between obstetrics and perinatal outcomes and the composition of vaginal microbiota in pregnant women, as well as an increased risk of obstetrics complications in pregnant women after IVF. Study design, size, duration Observational, prospective and multicentre study. A total of 64 women were enrolled between January 2020 and June 2021. Spontaneous pregnancies n = 30; and IVF pregnancies n = 34. Participants/materials, setting, methods Vaginal swabs were obtained by speculum exam at 12 weeks of gestation in two public hospitals and a fertility private clinic in Spain, to evaluate the differences in vaginal microbiome between both cohorts. The microbiome composition was analyzed by sequencing the V3-V4 region of the 16S rRNA on the Illumina MiSeq platform. Main results and the role of chance There were no significant differences in socio-demographic characteristics between groups, except for an expected higher maternal age in the IVF cohort. Lactobacillus was the most prevalent genus in both groups. When we compared the beta diversity of vaginal microbial by cohort a significant difference was obtained (p = 0.001). Gardenella, Neisseria, Prevotella and Staphyloccocus were significantly enriched in the IVF group (p = 0.01). A further evaluation of the four most abundant Lactobacillus species showed that Lactobacillus iners was dominant in IVF pregnancies (15.2%) compared to spontaneous (9.8%) (p = 0.002). On the other hand, Lactobacillus gasseri showed a lower abundance in vaginal microbiome from women belonged to IVF (9.2%) vs spontaneous pregnant group (13.8%) (p = 0.005). These findings allowed us to create a model to identify a microbial signature. This model is able to discriminate between IVF and spontaneous pregnancies. Limitations, reasons for caution The main limitation of our study is the small sample size. Larger studies are needed to corroborate our findings and their relationship with important aspects such as obstetric and perinatal complications. Wider implications of the findings The microbiome composition is different between both cohorts. The microbiome found in our IVF cohort has been also associated with obstetric complications as preterm delivery in previous studies. This suggest that the microbiome composition could be a plausible etiology for a higher risk of adverse pregnancy outcomes in IVF patients. Trial registration number Not applicable

Background: Infertility is a growing global health issue, affecting millions of couples worldwide. Assisted Reproductive Technology (ART) has revolutionized infertility treatment, yet concerns remain regarding its impact on maternal and neonatal outcomes. Pregnancies conceived through ART may be associated with higher risks of complications such as hypertensive disorders, gestational diabetes mellitus (GDM), preterm birth, and neonatal intensive care unit (NICU) admissions compared to spontaneous conceptions (SC). Objective: This study aimed to compare the obstetric and perinatal outcomes of pregnancies conceived via ART with age-matched pregnancies conceived spontaneously in a tertiary care center in Eastern India. Materials and Methods: A prospective observational study was conducted at IMS and SUM Hospital, Bhubaneswar, India, over 18 months. A total of 286 pregnant women aged 21–40 years were included, with 221 conceiving spontaneously and 65 through ART (31 via intrauterine insemination [IUI] and 34 via in vitro fertilization/intracytoplasmic sperm injection [IVF/ICSI]). Data on maternal demographics, pregnancy complications, delivery outcomes, and neonatal health were analyzed using SPSS software. Statistical significance was set at p ≤ 0.05. Results: ART pregnancies were associated with significantly higher rates of maternal complications, including gestational hypertension (15.03% vs. 7.2%; p=0.01), GDM (1.74% vs. 0.9%; p=0.04), and preterm birth (21.67% vs. 12.1%; p=0.001). ART pregnancies also had a higher rate of cesarean section (16% vs. 8.2%; p=0.002) and NICU admissions (18.3% vs. 9.8%; p=0.002). Additionally, postpartum depression was more frequent in the ART group (5.3% vs. 2.1%; p=0.04). Conclusion: This study highlights the increased risk of maternal and neonatal complications in ART pregnancies compared to spontaneous conceptions. Enhanced prenatal surveillance, individualized care strategies, and psychological support are crucial for improving ART pregnancy outcomes. Further large-scale studies with long-term follow-ups are needed to understand the broader implications of ART on maternal and neonatal health.

Idiopathic mitral valve prolapse in pregnant women has a more severe duration, associated with higher incidence of various cardiovascular and obstetric complications, accompanied by a number of phenotypic and visceral abnormalities that can be inherited to the child, that demonstrates a higher overall clinical significance of mitral valve prolapse precisely for pregnancy. The deficiency of vitamins, micro- and macroelements in these patients negatively predetermines the course of pregnancy and requires additional compensation for their deficiency.The purpose of the study was to investigate the importance of electrolyte disturbances as predictors of development of obstetric and perinatal complications in pregnant women with mitral valve prolapse and cardiac rhythm disturbances and to evaluate the effectiveness of their correction by using preventive use of a balanced vitamin and mineral complex Emfetal.Materials and methods. The study included 98 pregnant women with idiopathic (primary) cardiac arrhythmia in the form of supraventricular or ventricular extrasystoles. 78 patients received detailed nutrition and physical activity recommendations and used a balanced vitamin-mineral complex Emfetal by 1 pill 2 times a day in two courses for 28 days in the gestation period of 15-16 and 28-29 weeks. The comparison group included 20 pregnant women with mitral valve prolapse and arrhythmia who did not receive vitaminelectrolyte treatment. The control group consisted of 20 healthy pregnant women.Results. The analysis of pregnancy and childbirth in the main group of women has shown that women with cardiovascular risk factors (mitral valve prolapse, heart rhythm disturbance) during pregnancy have significantly more complications than in the general population. The gestational process was more often complicated by miscarriage, the development of placenta dysfunction, anemia, preeclampsia, fetal growth retardation syndrome. The development of the above-mentioned complications of pregnancy could be facilitated by the low concentration of ionized micronutrients and some vitamins in blood plasma level of these patients as it should be needed for normal fetal and physiological pregnancy development. At the same time, a decrease in blood plasma levels of vitamin C, important ionized macro- and microelements such as magnesium, iodine, selenium, iron were detected in these pregnant women during the laboratory biochemical study. In this case, the presence of mitral valve prolapse complicated by cardiac arrhythmias in pregnant women is associated with relative hypomagnesaemia. It is the disturbance of the normal balance between the Mg2+ and K+ ions can serve as a marker not only for cardiac rhythm disturbances but also as a predictor of the development of other obstetric and perinatal complications in pregnant women with mitral valve prolapse. Using the balanced vitamin-mineral complex Emfetal in pregnant women with mitral valve prolapse and extrasystoles is accompanied by a significant decrease of the patients with arrhythmia (by 55.1 %) and daily number of extrasystoles based on the results of the Holter heart rate analysis.Conclusions. Pregnancy in women with cardiovascular risk factors, such as mitral valve prolapse and cardiac arrhythmias is often complicated by the development of placental dysfunction (60.0%), early miscarriage (30.0%), anemia (75.0%), preeclampsia (30.0%), fetal growth retardation syndrome (10.0%). Decrease in magnesium level below 0.62 ± 0.04 mmol/l while decreasing the normal serum Mg2+ / Ca2+ and Mg2+ / K+ ratio is associated as with the development of cardiac arrhythmias in the form of extrasystolic arrhythmia, as a high rate of pregnancy complications. Using of the balanced vitamin-mineral complex (emphetal), therapeutic and prophylactic measures contributes to a significant decrease in the daily amount of extrasystoles and the frequency of development of severe pregnancy complications.

The main gestational complications in pregnant women with a history of combined tubal-peritoneal and endocrine infertility are miscarriage, hypertensive and metabolic disorders. An adequate solution to the prevention of various obstetric complications became possible by developing methods of prognosis with using computer technology in clinics. Purpose - to develop an algorithm for predicting preterm birth, the development of isthmic and cervical insufficiency (ICI), gestational hypertension and gestational diabetes in pregnant women with a combined history of infertility. Materials and methods. The main groups: the Group 1 - 155 pregnant women who had a history of endocrine infertility; the Group 2 - 245 pregnant women who had a history of infertility of tubular-peritoneal genesis; the Group 3 - 83 pregnant women who had a history of combined infertility: tubular-peritoneal genesis with endocrine; the control Group 4 - 89 healthy pregnant women who did not have history of infertility. An algorithm for predicting the main gestational complications: hypertensive and metabolic disorders, miscarriage (ICI, preterm birth) was developed only in the most severe category of pregnant women (the Group 3). For the prediction of obstetric complications, the method of logistic regression was chosen, which allows to build a statistical model to predict the probability of occurrence of the event based on existing data. Results. With increasing age and in the presence of an obtuse cervical-uterine angle on ultrasound cervicometry, the risk of preterm birth dramatically increased. With increasing body mass index (BMI), increasing 17-OP, total testosterone, cortisol, the risk of preterm birth also increased. There was no significant increase in the risk of preterm birth with changes in dihydrotestosterone (DHT) and thyroid stimulating hormone (TSH). With increasing index of free testosterone (ІFТ), the risk of preterm birth, on the contrary, decreased. With increasing age and BMI, the risk of gestational hypertension dramatically increased. With the increase of 17-OP, total testosterone, cortisol, the risk of gestational hypertension also increased but the impact of these indicators was much less. There was no significant increase in the risk of gestational hypertension with changes in TSH, IFT. The presence of anemia and obtuse cervical angle of ultrasound cervicometry did not affect the risk of gestational hypertension. With increasing age, BMI and in the presence of an elevated glucose tolerance test (GTT), the risk of gestational diabetes dramatically increased. With increasing 17-OP, total testosterone, cortisol, TSH, the risk of gestational diabetes also increased. The risk of gestational diabetes, on the contrary, decreased with an increase in IFT. Conclusions. Our prediction algorithm (binary logistic regression model) allows to foresee the development of: preterm birth - in 73.43% (p=0.019938) pregnant women; ICI - in 91.30% (p=0.00004) pregnant women; gestational diabetes - in 80.43% (p=0.00004) pregnant women; gestational hypertension - in 82.61% (p=0.00322) pregnant women with combined infertility in history. The most informative clinical and laboratory predictive indicators (age, BMI, 17-OP, TSH, total testosterone, cortisol, GTT, cervical-uterine angle) were determined, which makes it possible to improve the management tactics of these pregnant women. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.