Overview and anesthetic management of fetal vessel anomalies and umbilical cord emergencies.

Swansea criteria score in acute fatty liver of pregnancy.

Anesthetic Management of Cesarean Delivery Complicated by Ex Utero Intrapartum Treatment of the Fetus

Anesthetic management of cesarean delivery complicated by ex utero intrapartum treatment of the fetus.

Background: A prolonged pregnancy is a pregnancy between 41+ 0 weeks through 41+6 weeks of gestation. It is also known as late–term pregnancy measured from the first day of the last menstrual period. It is approximately 5 to 10 percent of all pregnancies. The pregnancy which continued beyond 42 weeks' gestation is called post term or post maturity pregnancy. It is about 1%. Postterm pregnancy is associated with higher risk of maternal and fetal complications such as emergency cesarean delivery, postpartum hemorrhage, birth canal injuries, macrosomia, meconium aspiration syndrome, and admission to neonatal intensive care unit (NICU). Objective: To determine the effects of induction of labor in late and post term pregnancies on mode of deliveries, to determine the risk of obstetrical and fetal complications in prolonged pregnancy in employed women, to compare the maternal and neonatal outcomes between induction of labor group and expectant management group, and to detect prenatal risk indicators of prolonged pregnancy in employed women. Subjects and Methods: Across sectional descriptive study of selected data included deliveries of late and post term pregnancies at Misurata Medical Center from the 1st of January to 30th of June 2018 where 188 patients were included in the study. Women with gestational age between 41+0 to 42+6 completed weeks and beyond were included in the study. A comparison between expectant management and induction of labor management was conducted to evaluate maternal, fetal and neonatal complications. Results: The rate of cesarean deliveries was a significantly higher for induction of labor (IOL) group (26%) compared with expectant management group (9.6%). Besides, the more frequent occurrence of all types of perineal lacerations and episiotomies (51% in IOL group vs 16% in expectant management group) in women with vaginal deliveries. The total number of deliveries was 2248, the full term deliveries were 1890 (84%), preterm deliveries were 170 (7.6%), late and post term deliveries were 174 and 14 (7.7% and 0.8%) respectively. Cesarean deliveries in women with prolonged pregnancies 33 patients (17.6%); 4.8% were elective LSCS due to previous uterine scar and prolonged pregnancies and 12.8% were emergency LSCS because of pathological cardio-tocography (CTG), failed IOL and maternal exhaustion. Postterm case, about 24% of cases had previous history of prolonged pregnancy, 20% with family history of prolonged pregnancy. 15% of cases were primigravida, 51.6% were between P1-P3, and 33% were more than P3. In present study, neonatal outcome 98.9% were normal Apgar and 1.06% were with low Apgar less than 7 at five minutes. Thirty six neonates (19%) were admitted to neonatal ICU, for observation and supportive management because of transient tachypnea 1-2 days after operative deliveries and discharge with good state.Regarding birth weights of neonates among women in IOL group and who had spontaneous onset labor (84%)ranging from2500 grams (g) - 4000 g, only(2.7%) were large infants more than 4000 g. Conclusion: Induction of labor in late and postterm pregnancies was associated with increasing the rate of cesarean delivery. However, other maternal and fetal parameters were not affected by IOL.

The rate of maternal and perinatal complications increases after 39 weeks' gestation in both unselected and complicated pregnancies. The aim of this study was to synthesize quantitatively the available evidence on the effect of elective induction of labor at 39 weeks on the risk of Cesarean section, and on maternal and perinatal outcomes. PubMed, US Registry of Clinical Trials, SCOPUS and CENTRAL databases were searched from inception to August 2018. Additionally, the references of retrieved articles were searched. Eligible studies were randomized controlled trials of singleton uncomplicated pregnancies in which participants were randomized between 39 + 0 and 39 + 6 gestational weeks to either induction of labor or expectant management. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. The overall quality of evidence was assessed according to the GRADE guideline. Primary outcomes included Cesarean section, maternal death and admission to the neonatal intensive care unit (NICU). Secondary outcomes included operative delivery, Grade-3/4 perineal laceration, postpartum hemorrhage, maternal infection, hypertensive disease of pregnancy, maternal thrombotic events, length of maternal hospital stay, neonatal death, need for neonatal respiratory support, cerebral palsy, length of stay in NICU and length of neonatal hospital stay. Pooled risk ratios (RRs) were calculated using random-effects models. The meta-analysis included five studies (7261 cases). Induction of labor was associated with a decreased risk for Cesarean section (moderate quality of evidence; RR 0.86 (95% CI, 0.78-0.94); I2 = 0.1%), maternal hypertension (moderate quality of evidence; RR 0.65 (95% CI, 0.57-0.75); I2 = 0%) and neonatal respiratory support (moderate quality of evidence; RR 0.73 (95% CI, 0.58-0.95); I2 = 0%). Neonates born after induction weighed, on average, 81 g (95% CI, 63-100 g) less than those born after expectant management. No significant effects were found for the other outcomes with the available data. The main limitation of our analysis was that the majority of data were derived from a single large study. A second limitation arose from the open-label design of the studies, which may theoretically have affected the readiness of the attending clinician to resort to Cesarean section. Elective induction of labor in uncomplicated singleton pregnancy at 39 weeks' gestation is not associated with maternal or perinatal complications and may reduce the need for Cesarean section, risk of hypertensive disease of pregnancy and need for neonatal respiratory support. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Are increased fetal movements during pregnancy a predictor of neonatal adverse outcomes?

Background and objective: There are no local investigation on the role of the abnormal umbilical cord on neonatal and maternal outcomes in this region. This study aimed to examine the association of umbilical cord abnormalities on neonatal and maternal outcomes in Iraqi Kurdistan. Methods: This is a cross-sectional study, the patients who attended the Duhok Obstetrics and Gynecology Teaching Hospital in Duhok city were examined between 1/11/2020 and 1/11/2021. The sample size is 500 women, inclusion criteria are age>18 years, acceptance to participate, gestational age >24 weeks and singleton pregnancy. The exclusion criteria are women who refused to participate, multiple pregnancy and stillbirth. Results: The mean age of the pregnant women was 29.0 (16 - 45 years old). The most prevalent maternal complications were placenta Previa (7.06%), Polyhydramnios (9.88%), and post-partum hemorrhage (7.06%). In this study the most common abnormalities of UC were abnormal diameter of UC (29.4%), decreased Wharton jelly content (15.5%) and short UC (11.9%).Most of the patients’ babies had normal weight (79.64%), (16.94%) had low birth weight and (3.43%) had very low birth weight. A percentage of the babies died either early neonatal (1.41%) or stillbirth (5.24%). The study found that the patients with abnormal diameter of UC cord were more likely to have babies with low birth weight (35.62% vs. 9.14%, P <0.0001) and were more likely to suffer from stillbirth (9.59% vs. 3.43%). Patients with short UC were more prone to have abruptio placenta (20.34% vs. 2.75%) and PROM (13.56% vs. 3.66%) ,and neonates with short UC were more likely to be LBW, VLBW and suffer from early neonatal death. Conclusion: This study showed that the patients with abnormal umbilical cord have significantly higher rates of adverse neonatal and maternal outcomes.

Fetal ultrasonographic screening has to include assessment of the umbilical cord for possible abnormalitiesthat can be: hypercoiled cord and nuchal cord, abnormal length and thickness of the cord, anomalies of the placental insertion site, vascular abnormalities and primary tumors of the cord. These conditions may be associated with fetal anomalies, chromosomal anomalies and intrauterine growth restriction. In our study we describe and analyze the ultrasound diagnosis and management of major umbilical cord abnormalities, considering the current knowledge on physiologic and pathologic aspects of each of them. A retrospective study was conducted in Universitary Emargency Hospital Bucharest over a 3-year period. We found 18 cases of single umbilical arteries, 6 cases of velamentous cord insertion, 3 of them associated with placental adherence abnormalities, partial placenta previa and one with vasa previa, 16 cases of more than 2 loops nuchal cord, 7 cases of true knot cord with 2 ultrasound undiagnosed cases, 5 true cord cysts and 3 cases of fetal intra-abdominal umbilical vein dilatation. A pregnancy with umbilical cord anomalies is more likely to be complicated with polyhydramnios, preterm delivery under 34 weeks, low birthweight, Caesarean delivery for fetal distress, perinatal death, admission to NICU and placental abnormalities compared with a pregnancy with a normal umbilical cord. We sustain that prenatal detection of umbilical cord abnormalities will decrease the number of emergent Caesarean sections and intrauterine fetal death. Safe fetal delivery, fetal echocardiography and karyotype analysis should be offered depending on risk associated to each umbilical cord abnormality. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities, whereas 3D/4D Doppler US of the fetal umbilical cord and abdominal vasculature allows a high accurate diagnosis of vascular abnormalities.

Study question The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes. Summary answer Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, obesity in multiple gestation increases risk of maternal, delivery, and neonatal complications. What is known already Obesity is a pandemic and multiple pregnancies are a known consequence of assisted reproductive technologies. Obese women (body mass index [BMI] >30kg/m2) are at higher risk of hypertensive disorders, gestational diabetes, fetal growth complications, stillbirth, preterm birth, labour complications, caesarean deliveries, wound infection, venous thromboembolism, and adverse neonatal outcomes. Multiple gestation is associated with greater obstetric risks, including miscarriage, preterm birth, gestational diabetes, hypertensive disorders, operative delivery, postpartum hemorrhage, congenital anomalies, and fetal growth restriction. The combined effects are not well-established. Study design, size, duration We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. We evaluated deliveries using the international classification of diseases [ICD], ninth edition, clinical modification codes for delivery-related discharge diagnosis and birth-related procedural diagnosis. All women with a diagnosis of multiple pregnancies were selected. They were subsequently divided based on the ICD-9 code for obesity. A total of 137,303 multiple pregnancies were analyzed. Participants/materials, setting, methods Within the 137,303 multiple pregnancies, 130,542 (95%) were non-obese, while 6,761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. We then compared baseline clinical and demographic characteristics between women with obesity to those without obesity using chi-squared tests. Subsequently, binary logistic regression analyses were conducted to explore comparisons between the obese and non-obese groups while adjusting for the potential confounding effects. Main results and the role of chance Over the 11-year study period, there was a statistically significant increase in prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd’s ratio [aOR]=1.89, 95% confidence interval [CI]=1.77-2.02), gestational hypertension (aOR=1.84, CI = 1.65-2.05), preeclampsia (aOR=1.68, CI = 1.55-1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR=1.86, CI = 1.58-2.20), gestational diabetes mellitus (aOR=2.65, CI = 2.44-2.87), and placenta previa (aOR=0.57, CI = 0.39-0.85). They were more likely to have preterm premature rupture of membranes (aOR=1.19, CI = 1.06-1.34), chorioamnionitis (aOR=1.24, CI = 1.03-1.51), caesarean sections (aOR=1.28, CI = 1.18-1.38), wound complications (aOR=1.65, CI = 1.31-2.08), and transfusions (aOR=0.77, CI = 0.67-0.89). They were less likely to have small for gestational age neonates (aOR=0.88, CI = 0.79-0.97), though more likely to have neonates with congenital anomalies (aOR=1.56, CI = 1.16-2.10). Conversely, for certain factors, the outcomes were similar between obese and non-obese women with multiple gestation including rates of eclampsia (p = 0.07), abruptio placenta (p = 0.82), hysterectomy (p = 0.36), postpartum hemorrhage (p = 0.08), maternal death (p = 0.98), maternal infection (p = 0.10), deep vein thrombosis (p = 0.17), pulmonary embolism (p = 0.75), venous thromboembolism (p = 0.15), disseminated intravascular coagulation (p = 0.85) and intrauterine fetal demise (p = 0.52). Limitations, reasons for caution The database is retrospective and relies on hospitals reporting elevated body mass index, which may not always be consistently recognized, potentially resulting in an underestimation of the total number of obese women. However, this only stands to support the increased risks detected in this study as being legitimate. Wider implications of the findings We addresses a significant gap in the literature by simultaneously exploring the impacts of multiple pregnancies and maternal obesity on obstetric complications. This can guide clinical practice, encouraging single embryo transfer in obese women undergoing in-vitro fertilization and tailored care for obese patients with multiple pregnancies, anticipating the associated risks. Trial registration number not applicable

BackgroundHypertensive disorders of pregnancy (HDP) remain a major cause of maternal and perinatal morbidity and mortality globally. Quantifying the effects of HDP on complications during pregnancy is vital for enhancing risk prediction and improving pregnancy outcomes.MethodsThis study leveraged data from a cohort of 3652 women from a prior study investigating the prevalence of HDP at a tertiary maternity hospital in Kenya - between 1st January, 2018 and 31st December, 2019. Sociodemographic characteristics, pregnancy outcomes, and complications among women diagnosed with HDP compared with normotensive women were analysed. The maternal complications explored included acute renal injury, antepartum haemorrhage and postpartum haemorrhage. The perinatal complications included intrauterine foetal demise, intrauterine growth restriction, small-for-gestational-age neonates, preterm birth and low APGAR (7 or below). Log-binomial regression was used to estimate the risk ratios of maternal and perinatal complications between these groups. Both composite and individual complication analyses were done.ResultsThe rate of maternal complications within the study was 1.3% (46/3652), whereas perinatal complications occurred in 13.0% (474/3652). After adjusting for maternal age ≥ 35 years and caesarean delivery, women with HDP had 3.34 times the risk of maternal composite complications compared to normotensive women (adjusted risk ratio 3.34; 95% CI 1.81– 6.16). These complications included acute renal injury and postpartum haemorrhage. Furthermore, there was a significant association between HDP and composite perinatal complications (adjusted risk ratio 1.38; 95% CI 1.07– 1.77). Specifically, the risk of intrauterine foetal demise and intrauterine growth restriction was elevated among the HDP group compared to normotensive women.ConclusionHDP continues to pose a significant burden on pregnancy and childbirth in Kenya. A strong association between pregnancy complications and HDP has been demonstrated. Regionally adapted pregnancy surveillance and optimised management approaches for acute kidney injury, post partum haemorrhage and perinatal morbidity prevention are urgently needed.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-07941-1.

Pregnancy in patients with myelofibrosis: Mayo-Florence series of 24 pregnancies in 16 women.

Hypothyroidism is among the most prevalent endocrine disorders complicating pregnancy, leading to a broad range of adverse maternal and neonatal outcomes, especially when thyroid function is inadequately managed. Despite the significant disease burden in India, regional evidence on the impact of uncontrolled hypothyroidism on fetomaternal outcomes remains scarce. This prospective observational study evaluated the socio-demographic profile, maternal morbidities, neonatal outcomes, and influence of thyroid control status on pregnancy outcomes among hypothyroid pregnant women at a tertiary care center in Central India. Conducted in the Department of Obstetrics and Gynecology at Jaya Arogya (J.A.) Group of Hospitals, Gwalior, from May 2023 to April 2024, the study included 215 pregnant women diagnosed with hypothyroidism. Data on socio-demographic characteristics, obstetric history, treatment status, maternal complications, and neonatal outcomes were collected using a pretested semi-structured proforma. Participants were categorised into controlled and uncontrolled groups based on thyroid function status. Data were analyzed using IBM SPSS Statistics for Windows, V. 25.0 (IBM Corp., Armonk, NY, USA), with categorical variables expressed as frequencies and percentages and associations assessed using chi-squared tests. The mean age of participants was 26.62 ± 5.09 years. The most common maternal complications were anaemia (48%), postpartum haemorrhage (28%), and intrauterine growth restriction (IUGR) (24.6%), while low birth weight (43.7%), preterm birth (19.1%), and neonatal intensive care unit (NICU) admission (16.8%) were the predominant neonatal adverse outcomes. Uncontrolled hypothyroidism was significantly associated with higher rates of anaemia, IUGR, gestational diabetes mellitus, oligohydramnios, preterm birth, low birth weight, NICU admission, and postpartum haemorrhage (p < 0.05 for all). These findings highlight that uncontrolled hypothyroidism significantly increases maternal and neonatal morbidity, emphasizing the need for early detection, regular monitoring, and optimal treatment to improve fetomaternal outcomes, particularly in resource-limited settings.

Purpose: Marfan syndrome (MFS) is an autosomal dominant genetic disorder of the connective tissue associated with progressive dilation of the aorta and a potential risk for aortic dissection. Objective of this study was to review the successful management of one high-risk pregnancy to term complicated by MFS. Material and Methods: Authors consulted the most important scientific databases investigating the influence MFS on pregnancy, analyzing fetal and maternal complications, gestational age at the time of delivery, labor, the postpartal fetomaternal complications, and neonatal and maternal outcome. Results: Obstetric complications associated with MFS may also include preterm delivery, preterm prelabor rupture of the membranes, cervical incompetence, and postpartum hemorrhage. In pregnancies complicated by MFS, the most common fetal and neonatal complications are preterm birth, small for gestational age (SGA), respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), fetal demise, perinatal mortality, and neonatal mortality (up to one month of life). Conclusion: The control of most high risk pregnancies, as this one complicated by MFS, must be multidisciplinary. The present authors’ attempt was to review the important aspects of the evaluation and management of a successful outcome of a pregnancy complicated by MFS.

Background: Advanced maternal age (AMA) is increasingly common worldwide and is associated with a higher risk of adverse maternal and fetal outcomes. Understanding these risks is important for improving antenatal care and counseling. Objective: To assess the relationship between maternal age and pregnancy complications. Study Design: Case-control study. Setting: Department of Obstetrics &amp; Gynaecology, Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: From 01-10-2024 to 01-04-2025. Methods: A total of 74 pregnant women were included and categorized into two groups: advanced maternal age (≥35 years) and younger controls (18–34 years). Maternal and fetal complications were compared between the two groups, including cesarean section, gestational diabetes, preeclampsia, postpartum hemorrhage, anemia, preterm birth, and fetal distress. Statistical analysis was conducted using appropriate comparative tests, with p &lt; 0.05 as the significance threshold. Results: The mean age of the AMA group was 42.78 ± 3.98 years, compared with 26.14 ± 4.37 years in the control group. The AMA group showed significantly higher rates of cesarean delivery (64.9% vs. 29.7%; p = 0.002), gestational diabetes (37.8% vs. 16.2%; p = 0.03), preeclampsia (48.6% vs. 21.6%; p = 0.01), postpartum hemorrhage (29.7% vs. 10.8%; p = 0.04), preterm birth (24.3% vs. 5.4%; p = 0.02), and fetal distress (32.4% vs. 8.1%; p = 0.009). Conclusion: Advanced maternal age was associated with a significantly increased risk of major maternal and fetal complications, including cesarean section, postpartum hemorrhage, gestational diabetes, preeclampsia, preterm birth, and fetal distress. These findings highlight the importance of risk stratification and enhanced antenatal surveillance in older pregnant women.

Severe placental abruption: clinical definition and associations with maternal complications