Abruption Research Articles

Clinical characteristic and zero-fluoroscopy ablation outcomes of tachyarrhythmias in pregnant: a single center study

Abstract Background Although recommended avoid any intervention during gestation in cases of drug refractory of arrhythmias catheter ablation may be necessary in pregnant women. Purpose To present clinical characteristics and outcomes of zero-fluoroscopy catheter ablation during gestation. Methods This prospective, single center study included 84 cases of tachyarrhythmias during gestation. In 44 cases of drug refractory was performed catheter ablation without fluoroscopy (main group). We evaluated the further course of gestation and obstetric outcomes after ablation in comparison with pregnant with antiarrhythmic therapy of tachyarrhythmias (n=40, control group). Results Both groups were comparable by mean age of pregnant (28.2±4.2 vs. 27.3±3.9 years, p=0.093) and mean duration of gestation (24 ±3.4 vs. 23.8 ±3.2 weeks, p=0.123). New onset arrhythmia prevailed in both groups (64% vs. 55%, p=0,280). Supraventricular tachycardia was the most common arrhythmia during gestation (81,8% vs. 52,5%, p=0,005), which was followed by premature contraction (13,6% vs. 40%, p=0,007). Cases of ventricular tachycardia were rare (4,6% vs. 7,5%, p=0,665). Ablation was performed under the guidance of CARTO (45%) and Ensite Precision systems (55%) without using fluoroscopy in all cases. Acute procedural success of zero-fluoroscopy ablation was in 100% with mean procedural time 71±17 minutes without any complication. Outcomes: further course of gestation characterized by increased incidence of uterine contractile activity and placental abruption only in main group (4,54%, p=0.464 and 2.3%, p=642 respectively). There were no differences in the rate of other complication: uterine blood flow violation (15.9% vs 12.9%, p=0.234) and preeclampsia (4.55% vs 5%, p=0.237). Vaginal type of delivery was in the majority of cases in both groups (82% vs 83%, p=0.242). Neonatal outcomes characterized with normal range of fetal birth weight (median 3207,39±485,61 vs. 3312,3±234,1 grams, p=0.709) and 5 minute Apgar score (median 8,4±1,6 vs. 8,7±1,2, p=0.921). There was no incidence of maternal and fetal mortality. In 12 month, follow-up all there was no arrhythmia recurrence. Conclusions Zero-fluoroscopy ablation of tachyarrhythmias in pregnant is feasible and can be safety performed during gestation in cases of drug refractory with benign outcomes.

Preliminary Study of Air Pollution and Adverse Pregnancy Outcomes: A Mendelian Randomization Study

The chief aim of this research is to investigate the causality of air pollutants and adverse pregnancy outcomes. Two-sample Mendelian randomization was conducted, employing genetic variants connected with air pollution as instrumental variables. Sixteen adverse pregnancy outcomes were extracted as the main outcome measures from the genome-wide association study (GWAS). The inverse-variance weighted (IVW) method was conducted as the primary analysis method. This study found that there were causal association between NO2 and pre-eclampsia (weighted median: OR = 1.30, 95% CI = [1.03–1.64], p = 0.029) and between PM2.5 and placental abruption (IVW: OR = 10.94, 95% CI = [1.28–93.45], p = 0.029). There were potential causal relationships between NO2 and gestational hypertension (IVW: OR = 1.14, 95% CI = [0.99–1.30], p = 0.060); NO2 and placental abruption (IVW: OR = 1.97, 95% CI = [0.90–4.28], p = 0.089); NOx and fetal growth restriction (IVW: OR = 0.06, 95% CI = [0.99–1.12], p = 0.089); PM2.5 and slow fetal growth and fetal malnutrition (MR–Egger: OR = 54,240.95, 95% CI = [2.08–1,411,757,729.46], p = 0.059); PM10 and hyperemesis gravidarum (MR–Egger: OR = 0.12, 95% CI = [0.02–0.97], p = 0.086); PM10 and preterm birth (weighted median: OR = 1.60, 95% CI = [0.95–2.70], p = 0.075); and PM10 and spontaneous abortion (weighted median: OR = 1.60, 95% CI = [0.95–2.70], p = 0.075). There was no pleiotropy, but there was some heterogeneity. In conclusion, air pollution has a causal effect on several adverse pregnancy outcomes.

Extra-Hepatic Portal Venous Obstruction in Pregnant Women of South-Asian Descent: A Case Series

Liver diseases complicate approximately 3% of pregnancies worldwide, and require specialized care to ensure optimal pregnancy outcomes. Extra-hepatic portal venous obstruction (EHPVO), even though asymptomatic in a majority of the cases, has a higher risk of variceal bleeding in pregnancy and adverse pregnancy outcomes. In this series, we describe five cases of EHPVO presenting during pregnancy at our tertiary care hospital, their antenatal management, and delivery outcomes. In our case series on EHPVO in pregnancy, a majority of the women were diagnosed during childhood and adequately asymptomatic before pregnancy. Two women underwent Endoscopic band ligation for esophageal varices and one woman underwent splenectomy before pregnancy for disease control. One woman was Anti-nuclear antibody (ANA) positive and another was Anti-phospholipid antibody (APLA) positive, while the other three did not have pre-existing thrombotic tendencies. One patient required Endoscopic band ligation during pregnancy. Pregnancy complicated by hypertension was noted in two of the five women (40%). Four of the five women (80%) had thrombocytopenia requiring blood products during delivery. Two women underwent preterm vaginal delivery, and one woman underwent preterm Caesarean section because of placental abruption. Three women had a post-partum hemorrhage, which was effectively managed with uterotonics and blood products. All five women and their neonates were discharged in good health. Multi-disciplinary approach with standardized antenatal care can give positive pregnancy outcomes in women with EHPVO.

Diagnostic value of prenatal ultrasound screening and analysis of pregnancy outcomes in velamentous umbilical cord insertion

Objective: To explore diagnostic value of prenatal ultrasound screening in velamentous umbilical cord insertion (VCI) and its influence on perinatal outcomes, and to provide theoretical basis for clinical practice. Methods: Fifty-eight pregnant women diagnosed with VCI before or after delivery admitted to the First Affiliated Hospital of Xi'an Jiaotong University were selected from January 2012 to December 2022. The clinical features and perinatal outcomes of 45 women finally with VCI after delivery (VCI group) were retrospectively analyzed, and 225 women with normal umbilical cord attachment were selected as the control group during the same period. Results: (1) Among 58 women, 54 (93.1%, 54/58) were diagnosed with VCI by prenatal ultrasound screening, 4 patients (6.9%, 4/58) were missed; and 13 (22.4%, 13/58) were misdiagnosed. Finally, a total of 45 women were confirmed by postpartum placental examination, and 11 (24.4%,11/45) were combined with vasa previa. (2) There were no differences in age, number of pregnancies, and number of induced abortions between the two groups (all P>0.05). Compared with the control group, the rate of assisted reproductive technology [13.3% (6/45) vs 0.4% (1/225); P<0.01], and twin pregnancy rate [8.9% (4/45) vs 0.4% (1/225); P<0.01] in the VCI group were significant higher. (3) Compared with the control group, the rate of placenta previa, succenturiate placenta, vasa previa, postpartum hemorrhage, prenatal hemorrhage and postpartum intrauterine remainder in the VCI group were significant higher (all P<0.05); there was no significant difference in the incidence of placental abruption, premature rupture of membranes, fetal distress and single umbilical artery between the two groups (all P>0.05). The incidence of fetal structural abnormalities in the VCI group (4.4%, 2/45) was higher than that in the control group (1.3%, 3/225), but there was no significant difference between the two groups (P=0.195). (4) The cesarean section rate [75.0% (33/44) vs 45.1% (101/224); P<0.01], preterm birth rate [29.5% (13/44) vs 5.4% (12/224); P<0.01], rate of small for gestational age [20.5% (9/44) vs 5.4% (12/224); P<0.01] in the VCI group were significant higher. However, neonatal birth weight [(2 928±552) vs (3 353±498) g; P<0.01], and 1-minute Apgar score (median: 10 vs 10; P<0.01) in the VCI group were lower than those in the control group. Conclusions: Prenatal ultrasound screening is an important method to diagnose VCI. VCI is more prone to adverse pregnancy outcomes, such as postpartum hemorrhage, premature delivery, small for gestational age, et al. Its risk factors include twin pregnancy, assisted reproductive technology, placenta previa, and para-placenta.

Wunderlich syndrome in pregnancy: life threatening bleeding renal angiomyolipoma in first and third trimesters—two case reports and literature review

BackgroundRenal angiomyolipoma (AML) is a prevalent benign tumour of the kidney. However, Wunderlich syndrome, marked by retroperitoneal haemorrhage, remains a rare and critical complication of large AMLs. During pregnancy, AMLs demonstrate an accelerated growth pattern and pose an elevated risk of rupture, leading to massive retroperitoneal haemorrhage. This report presents two compelling cases of life-threatening bleeding AML during the first and third trimesters, shedding light on the urgent need for heightened awareness and management strategies in pregnant women with AML. These cases underscore the novel and crucial aspect of the increased vulnerability of AMLs in pregnancy, emphasizing the importance of timely diagnosis and intervention.Cases presentationThe first patient is a 37-year-old lady who presented at 27 weeks of gestation with foetal distress, abdominal pain and hypovolemic shock. Emergency Caesarean section was performed for possible abruptio placenta, and a large non-expanding retroperitoneal hematoma was found intra-operatively. Post-delivery computed tomography (CT) angiography assessment showed left perinephric hematoma from bleeding AML at the lower pole. She was hemodynamically unstable after CT and underwent an emergency nephrectomy. Post-operative recovery was uneventful. The second patient is a 30-year-old lady who presented with right abdominal pain at 11 weeks of gestation with hypotension and an actively bleeding ruptured AML found on the abdominal MRI. She underwent angioembolization at 12 weeks of pregnancy with a radiation shield to protect the foetus. She recovered well after the procedure and continued her pregnancy. Her baby was born healthy at term with no evidence of any congenital malformation.ConclusionsWhen dealing with renal angiomyolipoma during pregnancy, multidisciplinary team management is crucial for the best management care. Stable cases can be treated conservatively, while unstable cases may require angioembolization or nephrectomy. The management plan should prioritize the best outcomes for both the mother and foetus. During the first trimester, angioembolization is safe and effective in controlling bleeding. However, minimizing radiation exposure is crucial, especially during organogenesis. Tailored interventions are essential to optimize outcomes in this unique patient population.

Pregnancy-Associated Maternal Mortality Within One Year After Childbirth: Population-Based Cohort Study.

The objective of this study is to assess associations between pregnancy complications and pregnancy-associated maternal mortality (PAM) within 1 year after childbirth. Population-based cohort study. Norway, 1967-2020. 1 237 254 mothers with one or more singleton pregnancies registered in the Medical Birth Registry, 1967-2019 and followed in the Cause of Death Registry to 2020. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for maternal education, age, year of first childbirth and chronic medical conditions. PAM by lifetime history of pregnancy complications: placental abruption, preeclampsia, preterm birth, perinatal death, small for gestational age (< 2.5 percentile), gestational diabetes and gestational hypertension. Crude OR for PAM was 4.24 (95% CI 3.53-5.10), if complications occurred in the last pregnancy, whereas 2.52 (2.08-3.06) if complications occurred in the first pregnancy, compared to mothers without complications in any pregnancy. Adjusted ORs for PAM when complications occurred in the last pregnancy were, for placental abruption 3.75 (1.20-11.72), preeclampsia: 4.42 (3.17-6.15), preterm birth: 4.32 (3.25-5.75), perinatal death: 24.18 (16.66-35.08), small for gestational age: 2.90 (1.85-4.54), gestational diabetes: 1.43 (0.63-3.25) and pregnancy hypertension: 2.05 (1.12-3.74) compared to mothers without complications. The OR for PAM increased slightly by increasing the number of complicated pregnancies but the trend was stronger for increasing number of complications in the last pregnancy (e.g., during 1999-2019: one complication; 4.14 [2.79-6.13], two complications; 11.50 [6.81-19.43]). Complications in the last pregnancy were more strongly associated with PAM than those in the first pregnancy.

Association of abruptio placentae with hypertension in pregnancy: Analysis of risk factors in Nigerian women

AbstractObjectiveThe incidence of abruptio placentae complicating hypertensive diseases of pregnancy is high in Nigerian referral hospitals. We conducted a retrospective case‐control study to identify the socio‐demographic, behavioural, and clinical risk factors associated with abruptio placentae in women with hypertensive diseases of pregnancy.MethodsThe 41 cases of hypertensive diseases complicated by abruptio placentae identified in the records of the University of Benin Teaching Hospital over 2 years (January 2021–December 2022) were compared with 208 women (controls) who had hypertensive diseases without developing abruptio placentae. Multiple regression analysis was used to develop maximum likelihood estimates of the adjusted odds ratios and 95% confidence intervals to predict the likelihood of the association between the exposure factors and the risk of abruptio placentae.ResultsHigh blood pressure levels at presentation, when managed, can decrease the odds for abruptio placentae by 9% OR 0.91, CI:0.83–0.9, but smoking and alcohol intake were not significantly associated with abruptio placentae. A higher haemoglobin concentration decreased the likelihood of abruptio placentae by 60% OR 0.40, (CI 0.24– 0.68), while higher birth weight babies minimally decreased the odds for abruptio placentae, OR 1.01 (CI 0.08–12.49).ConclusionWe conclude that abruptio placentae is most likely to complicate hypertensive diseases of pregnancy in Nigerian women when there are concurrent pregnancy anaemia and low birth weight babies, while higher blood pressure levels at presentation, when promptly managed, can reduce the risk of abruptio placentae. Efforts to address the concurrent management of anaemia associated with hypertensive diseases in pregnancy will most likely reduce the incidence of abruptio placentae in this population.

Study Effect of Esomeprazole on the Treatment of Preeclampsia in Pregnant Women: A Double-Blind Clinical Trial Study

Background: Preeclampsia is one of the most serious complications of pregnancy, leading to various maternal and fetal complications. Objectives: This study aimed to determine the effect of oral esomeprazole in the treatment of preeclampsia in pregnant mothers. Methods: In this double-blind clinical trial, we compared oral esomeprazole with a placebo. The study population included 120 pregnant women with preeclampsia (60 in the esomeprazole 40 mg group and 60 in the placebo group) who were referred to Ba'ath Hospital in Sanandaj in 2023. Patient care and follow-up were conducted from the time of diagnosis of preeclampsia and inclusion in the study groups until delivery and the final condition of the baby. The outcomes investigated included prolongation of pregnancy and maternal, fetal, and neonatal outcomes. Results: The average delivery time in the esomeprazole group was 37.3 ± 1.2 weeks, compared to 37.5 ± 1.7 weeks in the placebo group, with no statistically significant difference (P = 0.75). The frequency of maternal outcomes, such as eclampsia, pulmonary edema, hemolysis, placental abruption, renal failure, hepatic hematoma, ascites, thromboembolism, and maternal death, was not statistically different between the esomeprazole and placebo groups, and no severe complications were observed in either group. Similarly, fetal outcomes, including intrauterine growth restriction (IUGR) and changes in fetal heart rate patterns, did not significantly differ between groups, with no instances of fetal or neonatal death observed. Additionally, neonatal outcomes, such as Apgar scores below 7, NICU admissions, mechanical ventilation, and other severe neonatal complications, were not significantly different between the two groups (P &gt; 0.05). Although the esomeprazole group showed a lower frequency of adverse maternal, fetal, and neonatal outcomes compared to the placebo group, these differences were not statistically significant. Conclusions: The frequency of adverse maternal, fetal, and neonatal outcomes was lower in the esomeprazole group than in the placebo group for most variables, but the differences were not statistically significant. Therefore, it cannot be concluded with certainty that esomeprazole is ineffective in preventing or controlling preeclampsia.

Two Concurrent Cases of NAIT in Pregnant Sisters

Abstract Neonatal alloimmune thrombocytopenia (NAIT) is caused by maternal antibodies directed against fetal platelet antigens inherited from the father. Approximately 80% of cases of NAIT are attributed to antibodies against human platelet antigen (HPA)-1a and less commonly to antibodies against HPA-5b. We present two cases of possible NAIT attributed to anti-HPA-5b that were identified in sisters requiring concurrent management. Patient #1 is a 32-year-old G9P4044 woman with one pregnancy complicated by intrauterine growth retardation and partial placental abruption, another pregnancy complicated by fetal anomaly (intracerebral hemorrhage) status post termination of pregnancy at 23 weeks’ gestation and three miscarriages (one with chromosomal abnormality). The patient is homozygous for HPA-1a and HPA-5a, and the partner is homozygous for HPA-5b. HPA-5b antibodies and HLA antibodies were identified in the patient’s serum. Deemed at high risk for subsequent NAIT, she was started on intravenous immunoglobulin twice weekly and steroids during her second trimester until delivery. The patient underwent weekly fetal sonograms during pregnancy which were normal. The patient’s platelet counts were stable. The patient refused caesarean delivery. At 38 weeks’ gestation, the patient gave birth to a healthy female via normal spontaneous vaginal delivery. HPA-5b negative platelets were procured from our blood supplier, but neither the mother nor neonate required transfusion. The neonate showed no signs of bleeding and had normal platelet counts. Ultrasound imaging of the head was unremarkable. The patient and neonate were discharged home. Patient #2 is a 33-year-old G13P6156 woman with a prior pregnancy complicated by stillbirth at 32 weeks’ gestation. Considering her personal and family history, HPA testing was performed and HPA-5b antibodies were identified in the patient’s serum. The patient’s partner is heterozygous for HPA-5b. Crossmatched platelets were procured from our blood supplier. The patient refused caesarean delivery. The patient gave birth at 37 weeks’ gestation to a healthy male via normal spontaneous vaginal delivery. The fetus had mild thrombocytopenia (107 x 103/uL), with no bleeding or bruising identified. Neither the mother nor neonate required transfusion. The patient and neonate were discharged home. Ultrasound imaging of the head was unremarkable, and his thrombocytopenia resolved. While some studies postulate that anti-HPA-5b identification may be coincidental rather contributory to the disease process, these cases re-emphasize the importance of obtaining pregnancy, neonatal and family history to best risk stratify patients and determine management from both the clinical and transfusion medicine perspectives. If transfusion is needed, transfusion options include HPA negative platelets, crossmatched platelets and random donor platelets depending on clinical urgency and platelet availability.

Comprehensive Management of Pelvic Trauma in Pregnant Patients

Pelvic fractures occur frequently due to traffic accidents and high-energy. Pregnant women are susceptible to trauma, with one in 12 pregnancies complicated by such incidents, making trauma the leading cause of non-obstetric maternal deaths during pregnancy. Pelvic fractures during pregnancy pose significant risks, potentially leading to adverse pregnancy outcomes such as preterm delivery, placental abruption, fetal distress, and even maternal or fetal death. The physiological changes that occur during pregnancy, including increased blood volume and altered cardiovascular dynamics, further complicate the management of pelvic trauma in pregnant patients. Prompt and appropriate management of pelvic trauma in pregnant patients is essential to optimize outcomes for both the mother and the fetus. Initial evaluation and stabilization of the mother take precedence, with close attention to airway, breathing, and circulation. Diagnostic imaging, including pelvic X-rays and, when feasible, body CT or MRI, aids in assessing the extent of pelvic injury and identifying associated injuries. Definitive treatment of pelvic fractures may involve a combination of surgical fixation, bed rest, traction, and pelvic slings, depending on the severity of the injury. The timing and approach to delivery in pregnant patients with pelvic fractures require careful consideration, with vaginal delivery being a viable option in many cases, provided that the pelvic architecture remains intact. Conclussions: The management of pelvic trauma in pregnant patients requires a multidisciplinary approach and careful consideration of maternal and fetal well-being. Further research is needed to establish clear treatment guidelines and preventive strategies to reduce the incidence of pelvic fractures during pregnancy and improve outcomes for both mother and fetus.

Unexpected early pregnancy during myomectomy followed by successful term delivery: A case report

Background: Leiomyoma, also known as uterine fibroid, is a non-malignant tumor originating from the uterus’s smooth muscles. It is the most common benign tumor in the female genital tract, exhibiting varying size and form that can distort the uterus’s shape. Uterine fibroids affect 2.7–10.7% of pregnant women and can lead to increased risks during pregnancy, such as miscarriage, placental abruption, preterm labor, and fetal malpresentation. Myomectomy is a surgical intervention for uterine fibroids, but it has drawbacks, including hemorrhage, fever, infection, ureter ligation, adhesive disorders, and unplanned hysterectomy. Case Presentation: In this case report, we present a 32-yr-old woman with a large leiomyoma who underwent laparotomy myomectomy due to abdominal pain and heavy menstrual bleeding. 4 wk after the myomectomy, she was referred to the Obstetric Clinic of Ayatollah Taleghani hospital, Tehran, Iran complaining of delayed menstruation. Her beta-human chorionic gonadotropin test was positive. Ultrasound revealed a fetus with an estimated gestational age of 6 wk and 4 days. The pregnancy continued with no complications. At 38 wk of gestation, she underwent a cesarean section and delivered a healthy newborn. Conclusion: This case report supports previous publications that have demonstrated the safety of myomectomy during pregnancy. Key words: Leiomyoma, Pregnancy, Uterine myomectomy.

Early intervention prevented intrauterine fetus death due to placental abruption in woman with JAK2V617F mutation-positive essential thrombocythemia.

Early intervention prevented intrauterine fetus death due to placental abruption in woman with JAK2V617F mutation-positive essential thrombocythemia.

Kidney Cortical Necrosis after Placental Abruption

Kidney Cortical Necrosis after Placental Abruption

Atypical Abruptio Placentae with AKI: Interventional Dilemma

Atypical Abruptio Placentae with AKI: Interventional Dilemma

Adverse pregnancy outcomes for women with endometriosis: a systematic review and meta-analysis.

This study aimed at assessing the adverse outcomes of pregnancy in women with endometriosis. The Cochrane, Embase and PubMed databases were searched for identifying the required studies published before June 2019. Meta-analyses of relative risk (RR) were performed under the random-effects model to estimate the risk of selected adverse outcomes of pregnancy in females with endometriosis. Twenty-eight studies (53,141 women with and 2,355,923 women without endometriosis data) were selected for meta-analysis. Endometriosis bearing females had a significantly higher risk placenta previa (RR 3.92 [95% CI 2.48-6.20]), miscarriage (RR 1.31 [95% CI 1.06-1.61), gestational hypertension (RR 1.30 [95% CI 1.02-1.65]), cesarean section (RR 1.48 [95% CI 1.33-1.65]) and preeclampsia (RR 1.18 [95% CI 1.09-1.28]). The incidence of placental abruption was not statistically significant between the groups (RR 3.62 [95% CI [0.99-13.28]). Women suffering from endometriosis are at higher risks of miscarriage, preterm birth, gestational hypertension, placenta previa, cesarean section, and preeclampsia.

A UTERINE RUPTURE NOT TO OVERLOOK IN THE CONTEXT OF RETROPLACENTAL HEMATOMA

Objective: To report a rare case of uterine rupture in the context of a Couvelaire uterus in a patient with no history of uterine surgery or manipulation and to discuss the clinical challenges and management strategies for such cases. Case Summary: A 34-year-old multiparous woman presented at 34 weeks gestation with intrauterine fetal death (IUFD) and preeclampsia. Despite an unremarkable history with no prior cesarean deliveries or intrauterine interventions, she developed sudden hemodynamic instability and was diagnosed with uterine rupture during an emergency laparotomy. Intraoperatively, a large posterior uterine rupture was identified and repaired. Postoperatively, the patient experienced uterine atony and significant hemorrhage, necessitating additional surgical interventions including Tsirulnikov ligation and the B-Lynch uterine compression technique. The patient recovered well following intensive care management. Discussion: Uterine rupture in an unscarred uterus is an exceedingly rare event, particularly in the absence of classic risk factors. This case occurred in the context of a Couvelaire uterus, where extensive intramyometrial hemorrhage due to placental abruption may have weakened the uterine wall. The nonspecific clinical presentation, including the absence of abdominal pain or vaginal bleeding, poses diagnostic challenges. Immediate surgical intervention is crucial, especially in low-resource settings where advanced treatment options may be limited. This case underscores the importance of maintaining a high index of suspicion for uterine rupture, even in patients without typical risk factors, and highlights the need for adaptable management strategies. Conclusion: Uterine rupture should be considered in the differential diagnosis of acute abdomen in pregnancy, regardless of the patients obstetric history. Early recognition, prompt surgical management, and flexible treatment strategies are essential for optimizing outcomes in such rare but potentially life-threatening situations. Further studies are needed to improve understanding and management of this rare complication.

The Association Between Maternal ABO Blood Group and the Occurrence of Spontaneous Preterm Birth: A Retrospective Population-Based Cohort Study.

There is limited and inconsistent evidence that imply a relationship between ABO blood types and rate of preterm birth (PTB). We aim to examine the association between maternal ABO blood group and PTB rate. A retrospective-study conducted at a university teaching institution on data collected between 2013 and 2019. Women who delivered a viable neonate at ≥ 24 weeks without major malformations were included. Indicated PTBs were excluded. PTB and early PTB were defined as deliveries that occurred < 37 and < 34 weeks respectively. PTB was further divided into 3 subgroups according to etiology: membranes rupture, intact membranes, and placental abruption regardless of membranes' status. The primary outcome was spontaneous PTB rate. Of 19,301 women included, PTB and early PTB rates were 7.3% (1,418/19,301) and 2.3% (440/19,301) respectively. Rates of PTB in blood groups A, B, O, and AB, were 7.3%, 6.9%, 7.5%, and 7.5% respectively (p = 0.68). There was no significant difference according to etiology. Rates of early PTB were also comparable (p = 0.63). After adjustment for demographic and obstetric variables, blood type was associated with increased placental abruption rate among women who had early PTB (p = 0.038). Placental abruption rate was significantly higher in group A (22.5%) compared to group B (14.1%), (adjusted p = 0.04) and group O (14.0%), (adjusted p = 0.01). The rate in group AB was 17.1%, (adjusted p = 0.85). In conclusion, no association was found between a particular blood group and PTB rate. Women with group A, admitted in early PTB, had an increased risk that the underlying etiology was placental abruption.

Evaluation of outcomes and risk factors for recurrent preeclampsia in a subsequent pregnancy.

The aim was to evaluate the pregnancy outcomes and identify risk factors for recurrent preeclampsia (PE). Retrospective analysis of patients discharged with PE between January 1, 2010, and January 1, 2023, from two tertiary referral hospitals. They were classified into recurrent and non-recurrent groups based on the presence of PE in subsequent pregnancies. Among 519 women who had a subsequent pregnancy after a history of PE, 153 developed recurrent PE while 366 did not. The recurrent cases included 81 preterm PE, of which 41 were early-onset PE (EOPE). Recurrent PE correlated significantly with prior EOPE, HELLP syndrome, placental abruption, and stillbirth, as well as with current chronic hypertension (CH) and type 2 diabetes. The recurrent group showed a 5.8-fold higher risk of preterm birth (PTB) compared to the non-recurrent group (50.7% vs. 8.7%). Notably, 58.1% of the PTBs in the non-recurrent group were spontaneous. Logistic regression identified previous EOPE (aOR: 4.22 [95% CI: 2.50-7.13]) and current CH (aOR: 1.86 [95% CI: 1.09-3.18]) as independent contributors for recurrent PE. Furthermore, recurrent preterm PE shared the same risk factors: previous EOPE (aOR: 5.27 [95% CI: 2.82-9.85]) and current CH (aOR: 2.99 [95% CI: 1.57-5.71]). The morbidity of CH in subsequent pregnancy peaked at 31.9% when women with a history of EOPE delivered within three years. Previous EOPE and current CH were sequentially crucial risk factors for the development of PE and preterm PE during the next pregnancy. This may clarify risk stratification in prenatal management for women with a history of PE.

Trends in Postpartum Hemorrhage Prevalence and Comorbidity Burden: Insights from the ENACT Network Aggregated Electronic Health Record Data.

The goal of this study was to assess trends in postpartum hemorrhage (PPH), its risk factors, and maternal comorbidity burden in the United States using aggregate data from the Evolve to Next-Gen Accrual to Clinical Trials (ENACT) network. This federated network employs interactive querying of electronic health record data repositories in academic medical centers nationwide. We conducted repeated annual cross-sectional analyses to evaluate PPH occurrence and comorbidities across various ethnoracial and sociodemographic groups, starting with a large cohort of 1,287,675 unique delivery hospitalizations collected from 22 ENACT sites between 2005 and 2022. During this time, there was a statistically significant increasing trend in the prevalence of PPH, rising from 5,634 to 10,504 PPH per 100,000 deliveries (P trend <0.001). Our findings revealed a continuous upward trend in PPH rates that remained consistent among women with ≥ 1 comorbid conditions (P trend <0.001) and those with ≥ 1 maternal risk factor (P trend <0.001). This result aligns with prior studies and extends beyond the time periods previously reported. Overall, Native Hawaiian or Other Pacific Islander women had the highest PPH prevalence (~ 13%), followed by Asian (9.8%), American Indian or Alaska Native (8.9%), multirace (8.6%), Black or African American (8.4%) and White (7.4%) women. The top PPH risk factor identified was placenta previa or accreta, while the top comorbidity was antepartum hemorrhage / placental abruption. The most common cause of PPH, namely uterine atony, was prevalent in ENACT data. Our analysis highlights significant ethnoracial disparities and underscores the need for targeted preventative interventions.

Uterine Leiomyomas and Reproduction.

There is a prevailing opinion by gynecologists, much of it based on expert opinion or anecdotal evidence, that myomas are detrimental to pregnancy. Newer data challenge much of this dogma, but incorrect assumptions remain. Although not impeccable, multiple data address the correlation between myomas and reproduction, and some emerging evidence addresses surgical removal of these myomas and subsequent outcomes. A thorough literature search was performed, and the amassed data were analyzed to answer some of our most important queries about the role that myomas play in pregnancy and delivery. Uterine leiomyomas ultimately decrease in size during late pregnancy and postpartum. Spontaneous abortion rates are similar in women with and without leiomyomas. The data addressing leiomyoma effects on preterm prelabor rupture of membranes, placental abruption, cesarean delivery, and postpartum hemorrhage rates are conflicting, but the best evidence does not show a significant correlation compared with women without myomas. Preterm delivery rates are elevated in women with leiomyomas. Myomectomy does not decrease preterm deliveries and may increase this risk. Women with myomectomies have increased elective cesarean delivery rates and more blood loss at delivery compared with women with leiomyomas in situ.