Birth Complications Research Articles

Profil Maternal pada Kasus Kematian Neonatus di Rumah Sakit Umum Daerah (RSUD) Ciawi

In 2013, 4.6 million babies died worldwide before their first birthday, with 50% dying on the first day and nearly 75% within the first week. Most stillbirths and premature newborn deaths are attributable to birth complications that are preventable. The maternal profile in neonatal mortality cases plays an important role in understanding the factors that contribute to this high mortality rate. This cross-sectional study aims to determine the maternal profile of neonatal death cases at Ciawi Hospital, which were selected according to the criteria by total sampling based on medical record data from January 1, 2020, to December 31, 2020. The variables utilized in this study include maternal factors such as gestational age, type of delivery, twin pregnancy, presentation of pregnancy, medical condition of the mother, and obstetric problems. The data is presented in a descriptive format. Among the 58 respondents, the average age was 30.26 years, with a higher prevalence of preterm births (55.2%). The most frequently encountered medical condition in the maternal profile of neonatal deaths at Ciawi General Hospital is chronic hypertension. Conversely, the most common obstetric problems are premature rupture of membranes and oligohydramnios. Efforts to address medical issues in mothers can contribute to the reduction of neonatal mortality cases.
 

Antibiotic Treatment During Pregnancy and the First Six Months Postpartum - a Secondary Analysis of the "Healthy Living in Pregnancy" (GeliS) Study.

Antibiotic therapies for the treatment of bacterial infections pose a particular challenge during pregnancy and breastfeeding. For Germany, there is hardly any information on the frequency of antibiotic use during this phase. Our analysis uses data from the "Healthy Living in Pregnancy" (GeliS) study to describe antibiotic treatments during pregnancy and in the first six months after birth (postpartum), and to compare their use with existing recommendations. This is a retrospective secondary analysis of the GeliS study. In the cluster randomized lifestyle intervention study, detailed information on antibiotic therapies during pregnancy and postpartum was collected using surveys. Chi-square tests and generalized estimating equations were used for evaluation. Of the 1636 women included in the analysis, 21% reported antibiotic treatment at least once during pregnancy (14%) or in the first six months postpartum (7%). During pregnancy, the antibiotic therapies of women increased from 1.7% in the first trimester to 6.5% in the third trimester. Common reasons for treatment were urinary tract infections (7.3% of women), ear, nose, throat (ENT) infections (3.6%), and birth complications (2.6%). The information on the prescribed preparations corresponded to the current recommendations. A significant increase in the frequency of treatment with antibiotics was observed in the lifestyle intervention group (p<0.001), in participants without a partner (p<0.001), and in women who breastfed their children (p=0.005) or gave birth by caesarean section (p=0.003) or prematurely (p=0.012). Other socioeconomic or lifestyle factors were not significant. Approximately one in five women receives at least one antibiotic treatment during pregnancy and breastfeeding that meets current treatment recommendations. Treatment with antibiotics is more common in premature births, caesarean sections, and breastfeeding women.

Effect of Video-assisted Teaching on Knowledge and Practice of Preterm Care Bundle amongst Mothers of Preterm Babies

Abstract Background: Preterm is defined as all births before the completion of 37 weeks of gestation. The complications of preterm birth are the largest direct cause of neonatal deaths, responsible for 35% of the world’s 3.1 million deaths per year. Aims: The aims of the study were to assess the effect of video-assisted teaching on knowledge and practice of preterm care bundle amongst mothers of preterm babies. Methods: Pre-experimental one-group pre-test–post-test design with purposive sampling was used to collect data from 30 samples admitted in level I neonatal intensive care unit of a tertiary care hospital in Kerala. The pre-test was done using a structured knowledge questionnaire and observational practice checklist, followed by video-assisted teaching on the preterm care bundle and reinforced with a demonstration of skills. Post-test was done on the 5th day. Results: In the pre-test, 21 (70%) of the samples had inadequate knowledge and 17 (56.67%) had inadequate practice, while in post-test, 29 (96.67%) had adequate knowledge and 30 (100%) had adequate practice on preterm care bundle. The calculated paired t-test value on pre- and post-test knowledge score was 29.24 and calculated paired t-test value on pre- and post-test practice score was 56.63, which was higher than the table value (t29 = 2.04, P &lt; 0.05). There was a significant positive correlation (r = 0.771, P &lt; 0.001) between knowledge and practice of preterm care bundle. There was a significant association (P &lt; 0.05) between pre-test level of knowledge on preterm care bundle with selected socio-demographic and clinical data variables such as area of residence and a highly significant association (P &lt; 0.001) between pre-test level of knowledge on preterm care bundle with parity. There was a significant association (P &lt; 0.05) between pre-test level of practice on preterm care bundle with selected socio-demographic and clinical data variables such as education, area of residence and a highly significant association (P &lt; 0.001) between pre-test level of practice on preterm care bundle with parity. During the study, an investigator found that video-assisted teaching was effective in improving knowledge and practice of preterm care bundle amongst mothers of preterm babies. Conclusion: Therefore, video-assisted teaching is an effective method for improving the knowledge and practice amongst mothers of preterm babies as a supportive measure in the NICUs.

Improved screening of retinopathy of prematurity (ROP): development of a target product profile (TPP) for resource-limited settings

BackgroundAs more preterm infants survive, complications of preterm birth, including retinopathy of prematurity (ROP), become more prevalent. ROP rates and blindness from ROP are higher in low-income and middle-income countries,...

Fathers and peripartum mental illness: the neglected parent?

Fathers also play an important role during pregnancy and the postpartum period, both for the partner and for the child. With changes in society and increasing early involvement in the care of infants, the father-child relationship has become increasingly more important in recent years. There is growing evidence that fathers can also suffer from mental illnesses during their partner's pregnancy and especially after the birth of achild. As the transition to the role of a father is amajor change in aman's life, the birth of achild can be alife event that contributes to afirst time mental illness or triggers anew episode of an already existing illness. For example, birth complications can also traumatize the attendant fathers and result in trauma sequelae. Peripartum anxiety disorders and depression probably affect approximately 5% of all men and can among other things have anegative impact on the development of exposed children. Specific screening or even treatment services for affected men are still very rare and little research has been performed. Much less is known about the prevalence, risk factors, and treatment of other mental illnesses in fathers, and there is still agreat need for research in this respect.

Changes in moderately low birthweight infant feeding, care, and health outcomes before compared to during the COVID-19 pandemic in Malawi.

The coronavirus disease 2019 (COVID-19) and the measures taken to minimise its spread have significantly impacted mother- and infant-related healthcare. We describe the changes in newborn feeding, lactation support, and growth outcomes before compared to during the COVID-19 pandemic among moderately low birthweight infants (LBW) (1.5 to <2.5kg) in Malawi. The data presented here are part of the Low Birthweight Infant Feeding Exploration (LIFE) study, a formative, multisite, mixed methods observational cohort study. In this analysis, we included infants born at two public hospitals in Lilongwe, Malawi between 18 October 2019 and 29 July 2020. We categorised births as "pre-COVID-19 period" (before 1 April 2020) and "during COVID-19 period" (on or after 2 April 2020) and used descriptive statistics and mixed effects models to examine differences in birth complications, lactation support, feeding, and growth outcomes between the two time periods. We included 300 infants and their mothers (n = 273) in the analysis. Most infants (n = 240) were born during the pre-COVID-19 period; 60 were born during the pandemic period. The latter group had a lower prevalence of uncomplicated births (35.8%) compared to pre-pandemic period group (16.7%) (P = 0.004). Fewer mothers reported early initiation of breastfeeding in the pandemic period (27.2%) compared to the pre-pandemic period (14.6%) (P = 0.053), along with significantly less breastfeeding support, particularly in view of discussion of proper latching (44.9% during COVID-19 vs 72.7% pre-COVID-19; P < 0.001) and physical support with positioning (14.3% vs 45.5% pre-COVID-19 P < 0.001). At 10 weeks of age, the prevalence of stunting was 51.0% pre-COVID-19 vs 45.1% during COVID-19 (P = 0.46), the prevalence of underweight was 22.5% pre-COVID-19 vs 30.4% during COVID-19 (P = 0.27), and the prevalence of wasting was 0% pre-COVID-19 vs 2.5% during COVID-19 (P = 0.27). Our findings highlight the continued need to optimise early initiation of breastfeeding and lactation support for infants during COVID-19 and future pandemics. More studies are needed to evaluate the long-term outcomes of moderately LBW born during the COVID-19 pandemic (including growth outcomes) and determine the impact of restrictive measures on access to lactation support and promotion of early initiation of breastfeeding.

Sodium and Growth in Preterm Infants: A Review.

This article is intended to review the relationship between sodium homeostasis and growth, outline reasons why preterm infants may become sodium deficient, and share data from our group and others regarding the potential benefits of dietary sodium supplementation. Despite tremendous efforts over the past 20 years to optimize neonatal nutrition, postnatal growth failure in preterm infants remains a significant problem. Compelling associations have been identified between in-hospital growth failure and cardiometabolic and neurodevelopmental disorders, heightening the need to further identify the optimal nutritional needs of preterm infants. The impact of sodium deficiency may have on somatic growth is poorly studied and reported upon within the human literature. In contrast, animal studies dating back almost 100 years highlight the nutritional importance of dietary sodium. Sodium homeostasis during early postnatal life is understudied and underappreciated by neonatologists. Insufficient sodium intake during early life is likely a critical yet underappreciated contributor to growth failure. Total body sodium depletion may be an important risk factor driving complications of premature birth. Increased awareness of sodium homeostasis in preterm infants may improve outcomes in this population. Sodium intake recommendations are provided based on the interpretation of currently available literature.

Forceps Use in Rotational and Non-Rotational Vaginal Delivery

Forceps are a commonly used instrument for assisting vaginal delivery. Accepted indications include prolonged labour, suspected fetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of forceps-assisted birth have been extensively reported in observational studies, but randomized trial evidence is limited. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma. Second-stage caesarean section is associated with less fetal-neonatal trauma than forceps-assisted delivery but markedly reduces the chance of a subsequent vaginal birth. This review outlines the existing evidence on prevention, indications, and contraindications for forceps-assisted birth (non-rotational and rotational), short- and long-term complications for mother and baby, alternatives to use of forceps and how to manage an abandoned forceps-assisted birth. The essential components of informed consent are also discussed.

Neonatal Mortality Rate among Twin and Singleton Births with the Gestational Age of 34-37 Weeks: A Population-Based Study

Introduction: Twin pregnancy, compared to a singleton pregnancy, is associated with a higher risk of preterm birth and other neonatal complications. This study aimed to compare neonatal mortality rates and risk factors among births with the gestational age of 34 weeks - 37 weeks in twin and singleton pregnancies. Methods: The study design was cross-sectional and population-based. We extracted the data from the birth information registry in Iran. Mothers' and neonates' information was removed from the registry systems between 2018 and 2020. We used Statistical R software to compare neonatal mortality rate, demographic variables, and risk factors between two groups of twin and singleton neonates. Results: Out of 579,873 live births with a gestational age of 34 weeks - 37 weeks, 729 (1.4/1000) singleton and 54(0.77/1000) twins (one out of two) neonates died in the delivery room in the first hour of life. Of the neonates who left the delivery room alive, 3129 (4.9 per 1000) neonates had died (5.7/1000 singleton and 3.04/1000 twin). The neonatal mortality rate in hospitalized singleton neonates (1.85%) was higher than twin group (1.06%). After adjustment of other variables, the mortality rate in twin pregnancy was significantly lower than in singletons (p value &lt; 1/1000), with an odds ratio of 0.47 (CI: 0.39 - 0.55). Antenatal corticosteroid treatment in the twin group was significantly higher than in singletons. Conclusion: Twin neonatal mortality rate was lower than singletons in the neonates with gestational age 34 weeks - 37 weeks. Clinicians could consider these results for delivery timing in uncomplicated twin pregnancies. Antenatal corticosteroid therapy can be considered to reduce the mortality rate of late preterm neonates in resource-limited countries.

Brief Review Study on COVID-19 Risks for Complications in Preterm Birth and Protective Measures

Introduction: Conceptualized that pregnant women who are contracted COVID-19 face significantly higher risks for complications with regard to their health and well-being. Preterm birth is one of the complications observed, so there is a need to be agile and be able to discuss the multiple ways that would protect women. Purpose: This review study has the determination to bring out thoughtful, innovative, and insightful perceptions by analyzing literature studies on preterm birth due to COVID-19 and the multiple ways that would provide protective measures to women. Methodology: This is a review study of premature delivery due to COVID-19 and the manifold protective measures for women. The secondary data is collected from the literature search from various electronic databases such as PubMed, Google Scholar, and PubMed Central. Results: The study draws insights that advance the knowledge concerning preterm birth due to COVID-19 and the compounding ways that provide protective measures to women. Conclusion: This review study analyses the risks for complications to pregnant women contracting COVID specifically premature deliveries seen at an increased rate. For patient safety various measures have been studied systematically in multiple ways and has been applied in the healthcare system. Drawing insights from the literature, the review study frames various measures for patient safety that would help professionals have novel ideas to deal with these types of mishaps.

Primary Care Framework to Monitor Preterm Infants for Neurodevelopmental Outcomes in Early Childhood

To support decision-making in the primary care medical home, this clinical report links preterm birth and perinatal complications to early childhood developmental disability risks. It consolidates extensive contemporary outcome research from 2005 onward into an easy-to-use framework and stratifies prematurity and NICU experiences by degree of risk for developmental impairments. This framework informs and prioritizes point-of-care screening and surveillance strategies for pediatricians caring for children born preterm, guides additional assessment and referral for appropriate therapies, and offers opportunities for reassurance (when applicable) in office settings.

P-386 The impact of cross-border surrogacy practices on the welfare of children

Abstract Study question What are the clinical characteristics and medical outcomes of cross-border surrogacy (CBS) arrangements? Summary answer CBS practices commonly involve anonymously donated oocytes and multiple embryo transfers which can adversely impact the psychological and physical welfare of the children born. What is known already Intended parents may seek CBS when surrogacy in their home country is prohibited or when access is restricted to heterosexual couples, or when they cannot find a surrogate in their home country. Standards of clinical care can differ between the parents' home country and the CBS destination. Surrogacy is generally unregulated in CBS destinations, making it difficult to monitor clinical practices and the outcomes for the children born. In Australia, where this study is set, anonymous gamete donation and multiple embryo transfers for patients engaged in surrogacy is prohibited. The rate of twin surrogacy deliveries is 2.2%. Study design, size, duration This cross-sectional study collected data through an online, anonymous survey open between April and November 2021. Participants/materials, setting, methods A survey with predominantly fixed-choice questions was developed and informed by the authors’ prior research, the literature, and one author’s experience of surrogacy and surrogacy advocacy. Questions were refined through an iterative process involving consultation with parents through surrogacy. Australian parents through surrogacy were eligible to participate and the study was advertised to personal contacts, members of a surrogacy non-profit organisation and members of a surrogacy related Facebook group. Data were analysed descriptively. Main results and the role of chance One hundred and eight Australian parents through CBS completed the survey. Surrogacy was undertaken in twelve destinations, with approximately half of respondents completing surrogacy in the United States of America (34%, n = 37) or Canada (17%, n = 18). Almost all respondents reported the pregnancy was a result of an embryo transfer (92%, n = 98) and not artificial insemination (8%, n = 10). Of those reporting embryo transfer, 41% reported the transfer of multiple embryos (n = 40) and 79% reported the use of donor oocytes (n = 77). Of the respondents that used donor oocytes, almost half were from an anonymous donor (47%, n = 36) and all but one noted their intent to disclose the use of donor oocytes to their child (97%, n = 76). Pregnancy or birth complications were reported by 29% of respondents (n = 31). There were 12 twin births (11%), 22 preterm births (20%) and 24 births requiring neonatal intensive care (22%). The median time spent in the neonatal intensive care unit was 6 days (range 1-60). All but one twin birth arose from pregnancies resulting from a multiple embryo transfer and the majority were preterm (75%, n = 9) and required neonatal intensive care (59%, n = 7). Limitations, reasons for caution It is not known if those who completed the survey are representative of all parents through CBS. However, the respondents’ sociodemographic characteristics and motivations for surrogacy were similar to those in previously conducted studies, both within Australia and internationally. Wider implications of the findings The welfare of children born through surrogacy can be protected by addressing the barriers to undertaking surrogacy domestically and thereby reducing the number of people crossing borders, and by promoting identity release or known donation and single embryo transfer as best practice in surrogacy internationally. Trial registration number Not applicable

Early Postpartum Hospital Encounters among Patients with Genitourinary and Wound Infections during Hospitalization for Birth.

This study aimed to assess the associations between genitourinary and wound infections during the birth hospitalization and early postpartum hospital encounters, and to evaluate clinical risk factors for early postpartum hospital encounters among patients with genitourinary and wound infections during the birth hospitalization. We conducted a population-based cohort study of births in California during 2016 to 2018 and postpartum hospital encounters. We identified genitourinary and wound infections using diagnosis codes. Our main outcome was early postpartum hospital encounter, defined as a readmission or emergency department (ED) visit within 3 days after discharge from the birth hospitalization. We evaluated the association of genitourinary and wound infections (overall and subtypes) with early postpartum hospital encounter using logistic regression, adjusting for sociodemographic factors and comorbidities and stratified by mode of birth. We then evaluated factors associated with early postpartum hospital encounter among patients with genitourinary and wound infections. Among 1,217,803 birth hospitalizations, 5.5% were complicated by genitourinary and wound infections. Genitourinary or wound infection was associated with an early postpartum hospital encounter among patients with both vaginal births (2.2%; adjusted risk ratio [aRR[: 1.26; 95% confidence interval [CI]: 1.17-1.36) and cesarean births (3.2%; aRR: 1.23; 95% CI: 1.15-1.32). Patients with a cesarean birth and a major puerperal infection or wound infection had the highest risk of an early postpartum hospital encounter (6.4 and 4.3%, respectively). Among patients with genitourinary and wound infections during the birth hospitalization, factors associated with an early postpartum hospital encounter included severe maternal morbidity, major mental health condition, prolonged postpartum hospital stay, and, among cesarean births, postpartum hemorrhage (p-value < 0.05). Genitourinary and wound infections during hospitalization for birth may increase risk of a readmission or ED visit within the first few days after discharge, particularly among patients who have a cesarean birth and a major puerperal infection or wound infection. · In all, 5.5% of patients giving birth had a genitourinary or wound infection (GWI).. · A total of 2.7% of GWI patients had a hospital encounter within 3 days of discharge after birth.. · Major puerperal infection and wound infection had the highest risk of an early hospital encounter.. · Among GWI patients, several birth complications were associated with an early hospital encounter..

Exposures to ambient particulate matter are associated with reduced adult earnings potential

The societal costs of air pollution have historically been measured in terms of premature deaths (including the corresponding values of statistical lives lost), disability-adjusted life years, and medical costs. Emerging research, however, demonstrated potential impacts of air pollution on human capital formation. Extended contact with pollutants such as airborne particulate matter among young persons whose biological systems are still developing can result in pulmonary, neurobehavioral, and birth complications, hindering academic performance as well as skills and knowledge acquisition. Using a dataset that tracks 2014–2015 incomes for 96.2% of Americans born between 1979 and 1983, we assessed the association between childhood exposure to fine particulate matter (PM2.5) and adult earnings outcomes across U.S. Census tracts. After accounting for pertinent economic covariates and regional random effects, our regression models indicate that early-life exposure to PM2.5 is associated with lower predicted income percentiles by mid-adulthood; all else equal, children raised in high pollution tracts (at the 75th percentile of PM2.5) are estimated to have approximately a 0.51 decrease in income percentile relative to children raised in low pollution tracts (at the 25th percentile of PM2.5). For a person earning the median income, this difference corresponds to a $436 lower annual income (in 2015 USD). We estimate that 2014–2015 earnings for the 1978–1983 birth cohort would have been ∼$7.18 billion higher had their childhood exposure met U.S. air quality standards for PM2.5. Stratified models show that the relationship between PM2.5 and diminished earnings is more pronounced for low-income children and for children living in rural environments. These findings raise concerns about long-term environmental and economic justice for children living in areas with poor air quality where air pollution could act as a barrier to intergenerational class equity.

Process and costs for readiness to safely implement immediate kangaroo mother care: a mixed methods evaluation from the OMWaNA trial at five hospitals in Uganda

BackgroundPreterm birth complications result in > 1 million child deaths annually, mostly in low- and middle-income countries. A World Health Organisation (WHO)-led trial in hospitals with intensive care reported reduced mortality within 28 days among newborns weighing 1000–1799 g who received immediate kangaroo mother care (iKMC) compared to those who received standard care. Evidence is needed regarding the process and costs of implementing iKMC, particularly in non-intensive care settings.MethodsWe describe actions undertaken to implement iKMC, estimate financial and economic costs of essential resources and infrastructure improvements, and assess readiness for newborn care after these improvements at five Ugandan hospitals participating in the OMWaNA trial. We estimated costs from a health service provider perspective and explored cost drivers and cost variation across hospitals. We assessed readiness to deliver small and sick newborn care (WHO level-2) using a tool developed by Newborn Essential Solutions and Technologies and the United Nations Children’s Fund.ResultsFollowing the addition of space to accommodate beds for iKMC, floor space in the neonatal units ranged from 58 m2 to 212 m2. Costs of improvements were lowest at the national referral hospital (financial: $31,354; economic: $45,051; 2020 USD) and varied across the four smaller hospitals (financial: $68,330-$95,796; economic: $99,430-$113,881). In a standardised 20-bed neonatal unit offering a level of care comparable to the four smaller hospitals, the total financial cost could be in the range of $70,000 to $80,000 if an existing space could be repurposed or remodelled, or $95,000 if a new unit needed to be constructed. Even after improvements, the facility assessments demonstrated broad variability in laboratory and pharmacy capacity as well as the availability of essential equipment and supplies.ConclusionsThese five Ugandan hospitals required substantial resource inputs to allow safe implementation of iKMC. Before widespread scale-up of iKMC, the affordability and efficiency of this investment must be assessed, considering variation in costs across hospitals and levels of care. These findings should help inform planning and budgeting as well as decisions about if, where, and how to implement iKMC, particularly in settings where space, devices, and specialised staff for newborn care are unavailable.Trial registrationClinicalTrials.gov, NCT02811432. Registered: 23 June 2016.

Prevalence of complications associated with premature births in Khyber Pakhtunkhwa

Objectives: This cross-sectional study was executed in three districts of Khyber Pakhtunkhwa (Abbottabad, Peshawar and Charsada), from April 2021 to January 2023, to determine the complications associated with premature births. Methods: The study comprised 339 preterm infants, including 175 male and 164 female infants. All the demographic features of the mother for assessment of the potential risk factors for preterm births along with the initial fetal weights were recorded in the delivery room, and the complications of preterm births were also recorded. Results: Maternal demographic features revealed that a significant proportion of women (p&lt;0.05) pertained to age group of 30-40 years (42.18%), subsequently 20-30 years (31.56%), below 20 years (17.99%) and above 40 years (8.25%). A significant number of women who gave birth to premature babies (p&lt;0.05) were in their Multiparous phase (82.01%) and sixty-one women were in their Primiparous stage (17.99%). Most of the women were emaciated (p&lt;0.05) and had poor health status (59.58%), while, 12.38% had moderate health. It was evident from the findings that there was a non-significant correlation among the gestational groups (p≥0.05), in which a maximum number of patients were lying in very mature infants (56.63%), followed by moderately premature (28.90%) and extremely preterm (14.45%).

Programmed frozen embryo transfer cycles are associated with a higher risk of abnormal placental development: a retrospective cohort study of singleton live births.

Abnormal placental development can lead to adverse outcomes for both mother and fetus. The effect of different types of endometrium preparation regimens of frozen-thawed cycles on the placental development features associated with the perinatal outcomes remains unclear. Hence, we conducted a retrospective cohort study to assess the impact of specific endometrial preparation regimens on placenta-mediated pregnancy complications in singleton live births. A retrospective cohort study was conducted evaluating data of all singleton live births both conceived naturally or by in vitro fertilization (IVF) therapy from 2018 to 2020 at our hospital. Two exposed groups of frozen-thawed embryo transfer (FET) were created by the endometrium preparation regimen as the modified natural cycles (mNC) and the programmed cycles. The nonexposed group was the singleton pregnancies conceived naturally. The obstetrical and perinatal outcomes were compared among the three groups using multivariate analysis to adjust the results for determinants potentially associated with the abnormal placental development. A total of 2186 pregnant women with singleton live births were included in our final analysis and were divided into three groups as naturally conceived group (n=1334), mNC-FETs group (n=217) and programmed-FETs group(n=635). After adjusting for maternal age and parity, no significant difference was observed on the risk of placental disorders between mNC-FET cycles and natural conceived pregnancies (aOR 1.16; 95%CI 1.31-7.01), while programmed-FET cycles were associated with a higher occurrence of placental disorders (aOR 5.36; 95%CI 3.63-8.05). Using the mNC-FET group as a reference and adjusting for confounders such as maternal age, parity, endometrial thickness, and number of embryos transferred, we found that the main manifestation of abnormal placentation in programmed FET cycles was abnormal placental attachment, including placental adhesion and placenta increta (aOR 2.50, 95%CI 1.36-4.90). The dysfunction of placentation in programmed-FET cycles was independently associated with the type of infertility, the total dose of Femostone and thinner endometrium. Additionally, placental disorders in the programmed-FET group were associated with higher rate of preeclampsia, postpartum hemorrhage and Cesarean section. Our retrospective study revealed that the programmed-FET has a substantial impact on placental development, resulting in a higher incidence of preeclampsia, postpartum hemorrhage and Cesarean section. These findings have significant implications on clinical decision-making.

Successful Outcome of a Rare Complication of Vaginal Birth: A Case Report

Uterine inversion is a condition in which the interior surface of the relaxed uterus protrudes through the vaginal entrance. Its causes are divided into two categories: puerperal and non-puerperal, with puerperal uterine inversion being more common than non-puerperal uterine inversion. The most common variety is acute inversion, which occurs immediately or within 24 hours after delivery. Chronic Uterine Inversions (CUI) that occur more than four weeks after delivery are uncommon. In this study we discuss a case of a 30-year-old woman who came with the complaints of feeling of a mass in the vagina after her last confinement which was gradually coming down through the vagina and remain outside the introitus for 5 years. Based on clinical and sonographic evaluation, she was diagnosed with CUI and developed post partum haemorrhage. We adopted Haultain’s method for correction of CUI. Since, CUI as a painless vaginal mass in the delayed post-partum period is uncommon and hence documented.

Risk factors associated with third- and fourth-degree perineal lacerations in singleton vaginal deliveries: a comprehensive United States population analysis 2016-2020.

Perineal lacerations are a common complication of vaginal birth, affecting approximately 85 % of patients. Third-and fourth-degree perineal lacerations (3/4PL) remain a significant cause of physical and emotional distress. We aimed to perform an extensive assessment of potential risk factors for 3/4PL based on a comprehensive and current US population database. Retrospective population-based cohort analysis based on the US Centers for Disease Control and Prevention Natality Live Birth online database between 2016-2020. Baseline characteristics were compared between women with 3/4PL and without 3/4PL by using Pearson's Chi-squared test with statistical significance set at p<0.05. Bonferroni correction was used to account for multiple comparisons. Multivariable logistic regression was performed to evaluate the association between a variety of potential risk factors and the risk of 3/4P. Asians/Pacific Islanders had the highest risk of 3/4PL (2.6 %, aOR 1.74). Gestational hypertension and preeclampsia were associated with increased risk of 3/4PL (aOR1.28 and 1.34, respectively), as were both pre-gestational and gestational diabetes (aOR 1.28 and 1.46, respectively). Chorioamnionitis was associated almost double the risk (aOR 1.86). Birth weight was a major risk factor (aOR 7.42 for greater than 4,000 g), as was nulliparity (aOR 9.89). We identified several maternal, fetal, and pregnancy conditions that are associated with an increased risk for 3/4PL. As expected, nulliparity and increased birth weight were associated with the highest risk. Moreover, pregestational and gestational diabetes, hypertensive disorders of pregnancy, Asian/Pacific Islander race, and chorioamnionitis were identified as novel risk factors.

Emergency cerclage using double-level versus single-level suture in the management of cervical insufficiency (Cervical Occlusion double-level Stitch Application, COSA): study protocol for a multicentre, non-blinded, randomised controlled trial

IntroductionCervical insufficiency accounts for 15% of recurrent pregnancy losses between 16 and 28 weeks of gestation. The aim of the study is to verify the effectiveness of emergency double-level cerclage...