Antepartum Period Research Articles

Correlation between antenatal and postnatal coiling index and its role in prediction of perinatal outcome: A prospective cohort study

Background: The umbilical cord has pivotal role in the development, well-being, and survival of fetus and is vulnerable to kinking, torsion, and compression affecting perinatal outcome adversely. Aims and Objectives: This study was aimed to correlate the umbilical cord index measured antenatally using ultrasonography with that of the umbilical cord index measured postnatally and the association of this index with adverse fetal outcomes. Materials and Methods: This prospective cohort study was conducted on 124 antenatal cases of age group 18–35 years with term gestation with singleton pregnancy that attendant the outpatients department and indoor of Department of Obstetrics and Gynecology, Nehru Hospital B.R.D. Medical College, Gorakhpur over a period of 1 year (2019–2020). After detailed history, examination, and required antenatal care investigations, Ultrasonographic examination was done and antenatal umbilical coiling index (UCI) was calculated. The cases were followed up till delivery and postnatal UCI was also calculated and fetomaternal outcome was noted. Statistical analysis: Appropriate tests were applied where ever necessary. Results: The mean age was 25.71±4.30 years. The risk of preeclampsia, fetal growth restriction, oligohydramnios was significantly high with antenatal and postnatal hypocoiling (P<0.001) whereas the risk of gestational diabetes mellitus was significantly associated with antenatal and postnatal hypercoiling. The risk of low birth weight, preterm, low APGAR, neonatal intensive care unit admission and perinatal mortality were significantly high with postnatal hypocoiling (P<0.0001). Conclusion: The present study concludes that abnormal UCI was associated with adverse perinatal outcomes. Quantification of degree of abnormal coiling in antepartum period is important.

A systematic review of Perinatal Antibiotic Stewardship - where we are, where to go?

The perinatal period is associated with high antibiotic exposure, which raises concerns about antimicrobial resistance (AMR) and future health impacts. The aim of this comprehensive systematic review, including publications from 2000 to 2022, is to describe the current evidence and state of antimicrobial stewardship (AMS) in the perinatal period and to identify gaps in knowledge for future research. The review included 36 studies from the Americas, Europe, Asia and Australia, involving a total of 64,798 pregnant women and 84,137 newborns. 33 out of 36 studies reported reduced antibiotic use, suggesting the potential to reduce antibiotic exposure. There is a lack of studies in the antepartum and intrapartum periods, of comprehensive AMS strategies across the entire perinatal period, and from low- and middle-income countries with a high burden of maternal and neonatal morbidity and mortality. Future research should include prospective, adequately powered studies including safety endpoints, clinical outcomes and AMR reports.

Trend, clinical characteristics, and pregnancy outcomes of pregnancy associated venous thromboembolism: a retrospective analysis of nearly 10 years

Background Pregnancy-associated venous thromboembolism (PA-VTE) seriously threatens maternal health. We aimed to investigate the clinical characteristics, risk factors, treatments, and pregnancy outcomes to better prevent and treat PA-VTE. Methods PA-VTE patients were selected from 171,898 women who were registered in the Department of Obstetrics of Fujian Maternity and Child Health Hospital from January 2014 to August 2023 and delivered to calculate the incidence. Clinical data were collected to retrospectively analyze the clinical characteristics, risk factors, treatments, and pregnancy outcomes of PA-VTE. Descriptive statistical analysis was used. Results There were 122 cases of PA-VTE with an incidence of 0.71 per 1000 pregnancies; the incidence showed an upward trend and peaked in 2022 (1.24‰). Pregnant women accounted for 28.69% (35/122), the onset were 5–39+6 weeks and incidence increased with the increase of trimester, reaching the highest level in puerperium with 87 cases (71.31%). VTE was mainly found in the lower extremities (112/122); a few were found in cranial venous sinus (4/122), pelvic vein (1/122), and pulmonary embolism (PE) in five cases. 78.68% (96/122) had clinical manifestations. By Royal College of Obstetricians and Gynaecologists (RCOG) risk assessment scale, 45.71% (16/35) of antepartum patients had risk score ≥3 with a maximum of 9, distributed in eight cases in the first trimester, four cases in the second trimester, and four cases in the third trimester. Patients with risk score <3 all occurred in the second and third trimester. Primary risk factors included advanced maternal age (AMA), thrombophilia. All patients received anticoagulant therapy, and seven patients were placed inferior vena cava (IVC) filter in antepartum period. Except one case of abortion in PPROM, the rest continued pregnancy to 29+1 to 40 weeks, only one case of postpartum hemorrhage and one case of severe neonatal asphyxia. The onset time in puerperium was three hours to 28 days after delivery; 62.07% (54/87) patients were scored ≥2. The main risk factors included elective cesarean section, AMA, and preterm birth. Anticoagulant therapy was given after diagnosis; two cases were placed with IVC filter, one case was placed with left iliac vein stent and thrombolysis. Conclusions The incidence of PA-VTE showed an increasing trend over the past decade, predominantly occurring postpartum. Main risk factors included AMA, thrombophilia, preterm birth, and elective cesarean section. Higher risk scores correlated with earlier onset. Early risk assessment, appropriate prophylaxis, and standardized anticoagulation therapy resulted in favorable maternal and fetal outcomes, with temporary IVC filter placement being beneficial in selected cases.

Association of Subcapsular Liver Hematoma With Preeclampsia, Eclampsia, or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome.

To describe the presentation, outcomes, and management strategies for cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. This was a case series of individuals with subcapsular liver hematoma managed at a single level IV center over a 10-year period, from 2013 to 2024. Presenting signs and symptoms, laboratory findings, time of onset, management strategies, acute perinatal and maternal outcomes, and long-term outcomes such as subsequent pregnancies were reviewed in the medical record and recorded. Data were summarized using descriptive statistics, with results reported as means, standard deviations, and ranges. Categorical variables were summarized as counts and percentages. There were 13 cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, and HELLP syndrome between 2013 and 2024. In 10 of the 13 pregnancies (76.9%), delivery was preterm. The most common presenting symptoms were epigastric or right upper quadrant pain (53.8%), followed by abdominal distention (38.5%). Diagnosis of subcapsular liver hematoma was made in the antepartum period for six patients and was made in the postpartum for seven patients. The diagnosis was confirmed in all cases by computed tomography. Conservative management with close hemodynamic monitoring and transfusion of blood and blood products was sufficient in 11 (84.6%) patients; two patients underwent surgical exploration. The mean duration of hospital stay was 10 days (range 2-21 days). Maternal complications included pleural effusions, acute kidney injury, and pulmonary edema. There were no maternal deaths. There were four stillbirths and no neonatal deaths. Four people had five subsequent pregnancies; delivery was preterm in all five pregnancies, two pregnancies were complicated by subsequent HELLP syndrome, and one patient developed recurrent subcapsular liver hematoma. Subcapsular liver hematoma is a rare complication of preeclampsia, eclampsia, and HELLP syndrome that is associated with substantial maternal and perinatal morbidities. Conservative management with hemodynamic monitoring and transfusion of blood and blood products was sufficient for management in the majority of cases. All subsequent pregnancies resulted in preterm births.

Pneumonia Vaccines: Indications for Use and Current Safety Data in Pregnancy.

Streptococcus pneumoniae is a leading cause of pneumonia, meningitis, and invasive pneumococcal disease among adults in the United States, with higher rates of disease occurring among individuals with chronic medical and immunocompromising conditions. Pregnant individuals, especially those with co-morbid conditions, are also at increased risk of infection due to S. pneumoniae due to physiologic and immunologic changes in pregnancy. Vaccination against pneumococcus is recommended for adults living with HIV aged 19-49, congenital or acquired immunodeficiency, asplenia, chronic renal failure, sickle cell disease, alcohol abuse, cerebrospinal fluid leaks, congestive heart failure and cardiomyopathies, chronic lung disease, chronic liver disease, and diabetes mellitus. During pregnancy, the American College of Obstetricians and Gynecologists (ACOG) recommends vaccination against S. pneumoniae for individuals meeting criteria for immunization outside of pregnancy. Pneumococcal vaccine uptake has been low. There are no data available for vaccine uptake in pregnancy, but we suspect it is lower than non-pregnant populations. Low uptake of immunization rates in pregnancy is likely multifactorial and includes general vaccine hesitancy among pregnant individuals, cost, access to care, and supply shortages. While data in support of pneumococcal vaccines during pregnancy are limited, sufficient evidence exists to support the safety and efficacy of vaccination in the antepartum period. Pregnancy provides an opportunity to continuously engage individuals in care, allowing obstetricians and gynecologists to establish rapport, work to reduce vaccine hesitancy, and to provide pneumococcal immunization to those who are eligible. Medical indications for pneumococcal vaccination will increasingly apply to pregnant persons as the population acquires co-morbidities and there is a need for improved education among obstetricians on the topic of antenatal pneumococcal vaccination.

Evaluation Of Maternal And Fetal Findings In Patients With Pemphigoid Gestationis.

To evaluate the maternal and fetal outcomes of 12 pregnant women diagnosed with pemphigoid gestationis, in conjunction with a review of the literature. A retrospective review was conducted on the medical records of 12 patients diagnosed with pemphigoid gestationis who presented between January 2014 and January 2024. Twelve pregnant patients with pemphigoid gestationis were included in the study. The disease manifested during the first pregnancy in six patients. Mean maternal age was 30 years, mean gestational age at delivery was 33 weeks, and mean birth weight was 2146 g. Neonatal lesions were identified in two neonates. Intrauterine growth restriction, starting at an average of 33 weeks of gestation, was observed in four patients. Oligohydramnios was noted in two patients, hypertension in one patient, placental abruption in one patient, and gestational diabetes mellitus in one patient. During pregnancy, five patients were treated with oral steroids, six patients with intravenous steroids, and nine patients with topical steroids. Neonatal intensive care unit admission occurred in six neonates, and maternal intensive care unit admission was required for one patient. Patients with pemphigoid gestationis are at significant risk for severe maternal morbidity and adverse fetal outcomes in both the antepartum and postpartum periods. Early diagnosis of vesiculobullous lesions and close monitoring as high-risk pregnancies through a multidisciplinary approach are recommended.

Assesment of anxiety and depression in pregnant women in home care management

This study aims to identify factors associated with depressive and anxious symptomatology in pregnant women hospitalized during the antepartum period in home care management (Hospitalisation à domicile). This is a quantitative, single-center, observational, and descriptive study that included all French-speaking women hospitalized in the HAD of AP-HP between September 2022 and February 2023. Anxious and depressive symptoms were assessed using the self-administered HADS (Hospital Anxiety and Depression Scale) questionnaire. Analyses were conducted according to two distinct groups, comparing patients with an anxiety or depression scores below 8 on the HADS to those with a score of 8 or above (the threshold set on the questionnaire corresponding to intermediate symptomatology). A second questionnaire created for the study detailed maternal history, pregnancy experience, and lifestyle. A total of sixty-four women were included from September 20, 2022, to February 15, 2023. Eighteen women (28%) evaluated had anxious symptomatology and thirteen women (20%) had depressive symptomatology. Factors significantly associated with anxiety were poor pregnancy experience (p = 0.04), the need for psychological follow-up during pregnancy (p<0,01), country of birth (p = 0.022), as well as psychiatric history such as previous consultations with a mental health specialist (p = 0.015) and previous psychotropic treatment (p = 0.028). Additionally, a history of violence (respectively, p = 0.034 and p<0.01) and the women's belief that a consultation with a psychologist would benefit them were also associated with anxious and depressive symptomatology (respectively, p<0,01 and p <0.01) Conclusion: Our results highlight the importance and necessity of enhancing the screening and prevention of various mental disorders during pregnancy. It would be interesting to implement organized screening for anxiety, similar to depression, in pregnant women hospitalized at home and for the entire obstetric population.

Postnatal glycaemic outcomes in women with high-risk gestational diabetes: Identifying key predictors for early intervention.

Women with gestational diabetes (GDM) have increased lifetime risk of developing diabetes. We aim todetermine the factors contributing to poor adherence of the postpartum oral glucose tolerance test (OGTT) and identify key predictors to postpartum dysglycaemia in our Asian cohort. We conducted a retrospective cohort study of women with high-risk GDM (n = 561). High-risk women with GDM were defined as (1) women with diabetic-range glucose excursions on an antepartum OGTT, (2) women diagnosed GDM on early OGTT and (3) women requiring ≥20 units of insulin during antepartum period. We use logistic regression predictive models to associate maternal variables with postpartum OGTT attendance and glucose tolerance status postnatally. Between March 2020 to March 2024, 58.7% (n = 329) of women returned for postpartum OGTT. Predictors for attendance of postpartum OGTT were Chinese ethnicity (odds ratio [OR] 2.11, 95% confidence interval [CI] [1.14-3.89]), pre-pregnancy body mass index (BMI) (OR 0.95 [95% CI 0.90-0.99]), first GDM (OR 2.34 [95% CI 1.39-3.96]) and 2-h glucose threshold on antepartum OGTT (OR 0.87 [95% CI 0.76-0.99]). Ethnicity influences postnatal dysglycaemia outcomes in our cohort. Chinese women, compared to women of Malay ethnicity, had a 4.5-odds of persistent postpartum dysglycaemia. An antenatal HbA1c of ≥5.7% and an elevated 2-h post-OGTT glucose value significantly predict postpartum dysglycaemia independent of ethnicity. Ethnicity-specific prediction models integrating antepartum OGTT and HbA1c predict postpartum dysglycaemia in a multiethnic Southeast Asian cohort. Using these predictive models, we could identify high-risk patients for early intervention.

Daily versus Twice Daily Nifedipine for Blood Pressure Control in Pregnancy and Postpartum.

The objective of this study was to compare 60mg daily (QD) extended released (XR) nifedipine to 30mg twice daily (BID) for blood pressure (BP) control antepartum and postpartum. This is a retrospective chart review conducted at the Mount Sinai Health System. Patients admitted from 1/1/2015-4/30/2021, diagnosed with a hypertensive disorder of pregnancy, who received nifedipine XR 30mg BID or 60mg QD for intrapartum or postpartum BP control were included. Primary outcome was need for up titration (i.e., need for increase in nifedipine dose or addition of another anti-hypertensive) after reaching one of the study doses (30mg BID or 60mg QD). Patients were excluded if they had preexisting renal disease or were already on oral anti-hypertensives. In a 1:1 ratio between single and twice daily dosing groups, the sample size needed to detect a 20% difference in up-titration rate to achieve 0.80 power is 97 patients per group, for a total of 194 patients. This is based on a Pearson Chi-square test with a significance level of 0.05. 237 patients were included, 139 (59%) received 30 mg BID and 98 (41 %) 60 mg QD. There was no statistically significant difference in the need for increase in nifedipine dose or addition of another oral anti-hypertensive agent between those receiving 30mg BID versus 60mg QD (33.8% vs 35.7%; aOR (95% CI): 0.90 (0.50-1.60); p=0.71). There was no difference in need for emergency hypertensive treatment after reaching study dose (p=0.19) or readmission for BP control between groups (p>0.99). These findings suggest that BID dosing does not confer better blood pressure control in the antepartum or postpartum periods. Thus, daily dosing is reasonable and may be preferable for patient convenience and compliance.

Maternal and Fetal Outcome in Pregnancy with diabetes mellitus: Study in a district hospital, Jamalpur, Bangladesh

Cardiac disease is an important cause of maternal mortality and morbidity in antepartum and postpartum period. Objectives of our study was to determine maternal and fetal outcome in pregnant women in Bangladesh.This was a cross-sectional analytical study was conducted in the department of Obstretics &amp; Gynecology in 250 bedded General Hospital, Jamalpur, Bangladesh during the period from January 2018 to in December 2018. The aim of this study was to find out the maternal and fetal outcome of the pregnancies complicated by pre-gestational and gestational diabetes mellitus. In this study, a total of 225 patients were selected using purposive sampling technique. There were three groups of pre-gestational diabetic, gestational diabetic and non-diabetic control, designated as Group A, Group B, Group C accordingly; and each consists of 75 patients. Information collected from all pregnant women (After 28 weeks of gestation) with diagnosed GDM and Pre-GDM and symptoms signs suggestive of GDM and Pre-GDM later confirmed by relevant investigation (FBS, 2h PPBS &amp; HbA1C) using a questionnaire made for recoding all relevant parameters under study, after proper counseling and taking written consent of the patient or her legal guardian admitted during the study period in obstetric ward in Rangpur Medical College &amp; Hospital, Rangpur. Results: History of GDM was significantly more common among patients with pre-GDM (38%) and GDM (18%) compared to controls. History of abortion, IUFD and congenital anomaly were significantly higher among pre-GDM mothers than GDM mothers and controls (p&lt;0.05). History of deliveries with macrosomia and still birth was distributed similarly across the groups (p&gt;0.05). Pre–GDM and GDM patients had significantly higher number of patients with HbA1C &gt;6.5% than controls. Mean FBS and PPBS was significantly higher in pre-GDM &amp; GDM patients than control (p&lt;0.05). APGAR score was &lt;7 in significantly higher number of pre–GDM and GDM babies than controls (p &lt;0.05). Mean Weight of the babies was significantly lower among pre–GDM patients than GDM patients (p &lt;0.05). Among pre–GDM patients and GDM patient’s cases of birth asphyxia, Hypoglycemia, hyperbilirubinemia and congenital anomalies were significantly higher than controls (p&lt; 0.05). Conclusion: Interventions such as preconception care for women with pre-gestational diabetes, screening for early diagnosis, patient education, multidisciplinary approach and good metabolic control maintained throughout the pregnancy is the key to successful fetomaternal outcome.

Hospital Discharge Codes and Overestimating Severe Maternal Morbidity During Delivery Hospitalization

(Obstet Gynecol. 2024;143(4):582–584. doi: 10.1097/AOG.0000000000005537) Administrative data play a crucial role in understanding severe maternal morbidity (SMM) events, yet their interpretation heavily relies on coding quality. Overestimation of SMM during birth hospitalizations might occur due to International Classification of Diseases, Tenth Revision (ICD-10) codes being carried forward from predelivery events. This study aimed to describe SMM distribution across the antepartum, birth, and postpartum periods and to assess the potential false discovery rate of SMM events, hypothesizing that some events are subject to carry-forward coding. Following IRB approval and data-use agreements, a shared, deidentified database was created using the PCORnet Common Data Model at the University of North Carolina and Duke University.

Does Timing of Diagnosis of Hypertensive Disorders of Pregnancy Impact Blood Pressure Resolution?

Hypertensive disorders of pregnancy (HDP) can be diagnosed prior to labor, during labor, or postpartum. We evaluated whether the timing of HDP diagnosis impacts postpartum blood pressure (BP) outcomes. Secondary analysis of 384 patients with HDP from a trial evaluating furosemide use on BP outcomes. The timing of HDP diagnosis was categorized into diagnosis in the antepartum period, prior to labor versus diagnosis peripartum (during labor or first day of postpartum). Outcomes included time to resolution of hypertension and persistent hypertension 7 days' postpartum. Logistic and Cox regression models were used. Patients diagnosed in the peripartum period had a shorter median time to postpartum BP resolution after adjusting for severity of HDP, mode of delivery, and furosemide use (5.5 vs. 6.5 days, adjusted hazard ratio: 1.18, 95% confidence interval [1.11-1.25]). Patients diagnosed with HDP in the peripartum period experience a faster BP resolution than those diagnosed in the antepartum period. · HDP can be diagnosed before and during labor and postpartum.. · The timing of HDP diagnosis may have different implications for postpartum BP outcomes.. · Patients diagnosed with HDP in the peripartum period experienced a 24-hour shorter time to BP resolution.. · Timing of HDP diagnosis may provide an added window of opportunity to augment existing modalities of managing postpartum hypertension and related cardiovascular disease complications..

Markers of Maternal Bone and Renal Toxicity Through 50 Weeks Postpartum: IMPAACT 2010 (VESTED) Trial.

Safety data from randomized trials of antiretrovirals in pregnancy are scarce. We evaluated maternal bone and renal data from the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 trial, which compared the safety and efficacy of 3 antiretroviral therapy regimens started in pregnancy: dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF), dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF), and efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF). A subset of participants underwent dual-energy X-ray absorptiometry scans at postpartum week 50 only. Maternal bone mineral density (BMD) Z-scores were compared between arms. Maternal creatinine was measured at enrolment and periodically through week 50 postpartum, and by-arm differences in average weekly change in estimated creatinine clearance were compared. Six hundred forty-three participants were randomized to DTG + FTC/TAF (N = 217) or DTG + FTC/TDF (N = 215) or EFV/FTC/TDF (N = 211). Median age = 27 years (IQR 23, 32), median CD4 count = 466 cells/mm3 (IQR 308, 624); 564 (88%) women enrolled in Africa and 479 (74%) breastfed. Week 50 postpartum dual-energy X-ray absorptiometry results from 154 women were included in the analysis. Hip and spine BMD was on average higher in women in the DTG + FTC/TAF and lower in the DTG + FTC/TDF and EFV/FTC/TDF arms, but no significant differences in BMD Z-scores were observed between treatment groups. The weekly rate of change in estimated creatinine clearance differed among treatment groups during the antepartum period, but not over the full study follow-up. Markers of bone and renal toxicity did not differ significantly through week 50 postpartum among women randomized to start DTG + FTC/TAF or DTG + FTC/TDF or EFV/FTC/TDF in pregnancy.

Beyond the womb: pontine hemorrhage’s impact on maternal and fetal outcomes: a case report from Nepal

Introduction: Strokes cause 37% of cardiovascular-related deaths in women, with 40% during delivery and 50% postpartum. Pontine hemorrhage, a rare cerebrovascular disease, can occur during pregnancy and postpartum, requiring complex diagnosis and management. Case presentation: A 33-year-old primipara female presented with headache, vomiting, and altered consciousness at 15 weeks and 5 days gestation. She had no history of head trauma, involuntary urine passage, cough, shortness of breath, palpitation, or per vaginal bleeding. Psychiatric and neurology consultations were conducted to address her symptoms. Discussion: Pontine hemorrhage is a rare condition affecting pregnant women, causing mild symptoms like vertigo, ataxia, and dysphagia. Our patient underwent an initial blood investigation with imaging of her brain (CT and MRI) to establish the diagnosis of pontine hemorrhage. It is believed to be caused by hormonal fluctuations, but studies have not proven it. Stroke during pregnancy is rare, with only 10% occurring during the antepartum period. Diagnosis requires a multidisciplinary approach with history, clinical examination, and radiological imaging like CT and MRI. Treatment involved antiplatelet therapy, which ensured favorable maternal and fetal outcomes for our patient. Conclusion: In summary, this case demonstrates the rare incidence of pontine hemorrhage during pregnancy. It highlights the diagnostic challenges and successful treatment with antiplatelet therapy, emphasizing the necessity for a comprehensive approach to ensure favorable maternal and fetal outcomes.

A systematic review and meta-analysis of the globally reported International Classification of Diseases to Perinatal Mortality (ICD-PM).

Accurate recording and identification of perinatal mortality causes are crucial to reducing the global burden of perinatal mortality through targeted interventions. However, existing studies on the International Classifications of Diseases to Perinatal Mortality (ICD-PM) are limited by inconsistent results and variations by gestational age. Thus, this review aims to synthesize and document updated data on the causes of death using the ICD-PM classification. Electronic databases such as the PubMed via MEDLINE, SCOPUS, Web of Sciences, EMBASE, Cochrane Library, and PROSPERO were searched to retrieve studies published from 2016 to February 2024. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies, and heterogeneity between the studies was assessed using I2 statistics. ICD-PM coded reported data were extracted to Microsoft Excel, and aggregate data of frequencies and percentages were reported. Out of the 23 included studies, 48,596 perinatal mortalities were reported, and approximately 96% (46,816 deaths) were classified according to the ICD-PM. The pooled rate of stillbirths in high-income countries was 23/1,000 births; in low-income countries, it was found to be approximately twice as in high-income countries. Regarding the category of deaths, 25,563 (54.6%) deaths were recorded in the antepartum period, and more than half, 14,887 (58.2%), were classified under unspecified causes (A6). Moreover, 6,148 (13.7%) and 14,835 (31.7%) deaths were coded with intrapartum and neonatal period causes, respectively. The leading causes of perinatal mortality during the intrapartum were acute intrapartum events (I3) 3,712 (57.8%). Furthermore, neonatal death was caused by low birth weight and prematurity (N9) 4,091 (27.6%), congenital malformations, and chromosomal abnormalities (N1) 2,512(16.9%). Congenital malformations, and chromosomal abnormalities contribute to 1 in every 10 perinatal deaths and 1 in every 4 neonatal deaths. Other specified antepartum disorders are responsible for over half of antepartum deaths, while acute intrapartum events are the leading cause of intrapartum deaths, with a significant proportion remaining unexplained. Maternal complications related to the placenta, membranes, cord, labor, and delivery play a significant role in antepartum and intrapartum deaths. Targeted interventions and improved monitoring of high-risk pregnancies are crucial to reducing perinatal mortality rates. Further investigation is needed to enhance understanding and address unexplained perinatal deaths. [https://clinicaltrials.gov/], identifier [CRD4202452549].

Long-term sequelae and management following obstetric sepsis

The long-term consequences of obstetric sepsis have been a growing area of concern requiring attention. This narrative review summarizes the existing literature on the long-term sequelae of sepsis, with a focus on the antepartum and postpartum periods. In this article, we discuss risk factors for and epidemiology of post-sepsis syndrome (PSS) and related long-term medical conditions. We include recommendations for screening for PSS and management strategies involving multidisciplinary teams. PSS and other long-term medical and psychological sequelae of sepsis impact individuals and their communities greatly, including the obstetric population. There is a need for improved identification, management, and coordination of care for long-term complications of sepsis. Gaps in the literature for future study include identifying specific needs of the obstetric population in the weeks, months, and years following a sepsis event.

Deep learning with information fusion and model interpretation for long-term prenatal fetal heart rate data

Long-term fetal heart rate (FHR) monitoring during the antepartum period, increasingly popularized by electronic FHR monitoring, represents a growing approach in FHR monitoring. This kind of continuous monitoring, in contrast to the short-term one, collects an extended period of fetal heart data. This offers a more comprehensive understanding of fetus’s conditions. However, the interpretation of long-term antenatal fetal heart monitoring is still in its early stages, lacking corresponding clinical standards. Furthermore, the substantial amount of data generated by continuous monitoring imposes a significant burden on clinical work when analyzed manually. To address above challenges, this study develops an automatic analysis system named LARA (Long-term Antepartum Risk Analysis system) for continuous FHR monitoring, combining deep learning and information fusion methods. LARA’s core is a well-established convolutional neural network (CNN) model. It processes long-term FHR data as input and generates a Risk Distribution Map (RDM) and Risk Index (RI) as the analysis results. We evaluate LARA on inner test dataset, the performance metrics are as follows: AUC 0.872, accuracy 0.816, specificity 0.811, sensitivity 0.806, precision 0.271, and F1 score 0.415. In our study, we observe that long-term FHR monitoring data with higher RI is more likely to result in adverse outcomes (p = 0.0021). In conclusion, this study introduces LARA, the first automated analysis system for long-term FHR monitoring, initiating the further explorations into its clinical value in the future.

Intravenous ferric carboxymaltose versus oral ferrous sulphate for the treatment of moderate to severe postpartum anaemia in Nigerian women (IVON-PP): protocol for an open-label randomised controlled type 1 hybrid effectiveness-implementation trial

IntroductionPostpartum anaemia is often caused by iron deficiency with onset during the antepartum period and can be exacerbated by excessive blood loss at birth. Its prevalence is estimated as 50–80%...

Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in Nigeria.

While research involving pregnant women with HIV has largely focused on the antepartum and intrapartum periods, few studies in Nigeria have examined the clinical outcomes of these women postpartum. This study aimed to evaluate antiretroviral therapy retention, adherence, and viral suppression among postpartum women in Nigeria. This retrospective clinical data analysis included women with a delivery record at the antenatal HIV clinic at Jos University Teaching Hospital between 2013 and 2017. Descriptive statistics quantified proportions retained, adherent (≥95% medication possession ratio), and virally suppressed up to 24 months postpartum. Among 1535 included women, 1497 met the triple antiretroviral therapy eligibility criteria. At 24 months, 1342 (89.6%) women remained in care, 51 (3.4%) reported transferring, and 104 (7.0%) were lost to follow-up. The proportion of patients with ≥95% medication possession ratio decreased from 79.0% to 69.1% over the 24 months. Viral suppression among those with results was 88.7% at 24 months, but <62% of those retained had viral load results at each time point. In multiple logistic regression, predictors of loss to follow-up included having a more recent HIV diagnosis, higher gravidity, fewer antenatal care visits, and a non-hospital delivery. Predictors of viral non-suppression included poorer adherence, unsuppressed/missing baseline viral load, lower baseline CD4+ T-cell count, and higher gravidity. Loss to follow-up rates were lower and antiretroviral therapy adherence rates similar among postpartum women at our study hospital compared with other sub-Saharan countries. Longer follow-up time and inclusion of multiple facilities for a nationally representative sample would be beneficial in future studies.

Treatment with chemotherapy plus brentuximab vedotin in anaplastic large cell lymphoma and pregnancy: A case report

Introduction: Brentuximab vedotin (BV) is a CD-30 directed antibody and microtubule inhibitor conjugate indicated for the treatment of multiple types of lymphoma, including anaplastic large cell lymphoma (ALCL). Consensus-based guidelines recommend BV with cyclophosphamide, doxorubicin, and prednisone (CHP) as first-line treatment in a patient with ALCL. Alternative treatment options for ALCL can be limited due to patient-specific factors. Lymphomas account for approximately 11% of cancers in pregnancy. Brentuximab vedotin has not been studied in pregnancy; therefore, making the use of an antibody drug conjugate in this patient the first documented use in pregnancy. Case Report: A 26-year-old female was diagnosed with anaplastic large cell lymphoma at 14 weeks gestation. The patient has a past medical history of ALCL in 2004 at eight years old and a prior miscarriage. Consensus-based guidelines recommend BV with cyclophosphamide, doxorubicin, and prednisone (CHP) as first-line treatment in a patient with ALCL. Treatment with BV plus CHP was initiated at 15 weeks gestation for a total of 6 cycles during the antepartum period. At 33 weeks gestation, the patient delivered a 4-pound infant male without complications, birth defects, or health disparities. Two additional cycles of BV and CHP were administered during the postpartum period. Complete remission has been achieved in this patient. Conclusion: The outcomes in this case indicate the potential safety of BV in patients after the first trimester of pregnancy.