Obstetric Conditions Research Articles

Multi-omics-based mapping of decidualization resistance in patients with a history of severe preeclampsia.

Endometrial decidualization resistance (DR) is implicated in various gynecological and obstetric conditions. Here, using a multi-omic strategy, we unraveled the cellular and molecular characteristics of DR in patients who have suffered severe preeclampsia (sPE). Morphological analysis unveiled significant glandular anatomical abnormalities, confirmed histologically and quantified by the digitization of hematoxylin and eosin-stained tissue sections. Single-cell RNA sequencing (scRNA-seq) of endometrial samples from patients with sPE (n = 11) and controls (n = 12) revealed sPE-associated shifts in cell composition, manifesting as a stromal mosaic state characterized by proliferative stromal cells (MMP11 and SFRP4) alongside IGFBP1+ decidualized cells, with concurrent epithelial mosaicism and a dearth of epithelial-stromal transition associated with decidualization. Cell-cell communication network mapping underscored aberrant crosstalk among specific cell types, implicating crucial pathways such as endoglin, WNT and SPP1. Spatial transcriptomics in a replication cohort validated DR-associated features. Laser capture microdissection/mass spectrometry in a second replication cohort corroborated several scRNA-seq findings, notably the absence of stromal to epithelial transition at a pathway level, indicating a disrupted response to steroid hormones, particularly estrogens. These insights shed light on potential molecular mechanisms underpinning DR pathogenesis in the context of sPE.

The Role of Maternal Blood Elabela Levels in the Prediction of Placenta Previa and Accreta

IntroductionPlacenta previa and Placenta Accreta Spectrum are life-threatening obstetric conditions that are challenging to diagnose accurately. Currently, there is no biochemical parameter available for their diagnosis. The aim of our study is to investigate the potential of Elabela as a laboratory marker that could predict placenta previa and placenta accreta, both of which can lead to severe, life-threatening complications for the mother. MethodsIn this study, which was conducted prospectively in two tertiary centers between 2020 and 2022, Elabela levels were examined in patient groups with placental insertion and invasion anomalies. SPSS program was used for comparative statistical analysis between groups. ResultsOf the 67 analyzed patients, 32 were in the control group, 12 were in the previa group, and 23 were in the accreta group. There was no statistically significant difference between the groups regarding age, BMI, number of curettages, presence of previous cesarean section, and smoking status. The Elabela level was measured at 135.6 ± 72.1 in the control group, 988.3 ± 925.5 in the previa group, and 376 ± 364.6 in the accreta group, with a statistically significant difference between the groups. The cut-off value of Elabela levels in the previa group was determined to be 304, with a sensitivity of 83.30% and a specificity of 83.60% (AUC = 0.909). In the accreta group, the cut-off value was 195.5, with a sensitivity of 60.90% and a specificity of 61.40% (AUC = 0.658). DiscussionBy showing that the prediction of placenta previa and placenta acreata can be made with a biochemical parameter in our study, young researchers will focus more on this subject and thus make many contributions to science.

Navigating obstetric enigma: Placenta accreta spectrum masquerading as gestational trophoblastic neoplasia.

Placenta accreta spectrum (PAS) represents a complex obstetric condition characterised by the abnormal invasion of anchoring villi and trophoblast into the myometrium. This case report explores two instances where the diagnosis of PAS was overlooked during antenatal care leading to significant complications during conservative management. Both patients presented with heavy menstrual bleeding and raised beta human chorionic gonadotrophin (β-hCG), mimicking gestational trophoblastic disease. The report delves into the clinical presentations, diagnostic challenges, and outcomes of two cases, shedding light on the importance of effective communication and follow-up in the management of PAS.

Placenta Previa: Case Report

Placenta previa is a significant obstetric complication that occurs during pregnancy, characterized by abnormal implantation of the placenta in the lower uterine segment. Risk factors for having had a previous caesarean section, multiple pregnancies, advanced maternal age, or having a history of uterine surgery at higher risk, a history of previous uterine curettage, may increase the likelihood of placenta previa. woman aged 29 years G3P2A0 38 weeks pregnant came with complaints of fresh blood coming out of the birth canal since 3 hours before entering the hospital about half of the pads. Previous history to an obstetrician with malpositioned ultrasound results and a history of 2 previous deliveries by cesarean section. Physical examination, blood pressure 110/70, pulse 78 times/minute, respiration 18 times/minute, temperature 360C, there was no clinical anemia, obstetric examination of the height of the uterine fundus (TFU) 33 cm with an estimated fetal weight (TBJ) 3100 gr, FHR 152 times/minute regularly, positive His 1-2 times/10 minutes 10-15 seconds each. From vaginal positive spots, no active bleeding, vaginal touch was not done. Ultrasound of the fetus in cephalic presentation, positive FHB, EFW 3100 gr, placenta corpus posterior closing OUI grade 3 SDP 6 cm PAI score 2 positive hypoechoic zone, negative lacuna, KTG category 1. From investigations, Hb was 10.2 gr/dl. Ht 30%, leukocytes 12,950 uL, platelets 322,000 uL, bleeding time and clotting time within normal limits. management carried out strict vital signs monitoring, planned sectio caesaria cito and given premedication injection of ceftriaxone 2gr and 250cc PRC blood supply. Placenta previa is a complex obstetric condition that requires careful diagnosis, monitoring and management. Prompt recognition of the condition, close monitoring of maternal and fetal safety, and timely intervention, such as cesarean section when indicated, are critical to reducing the risks associated with placenta previa.

Pregnancy Outcomes and Maternal Characteristics in Women with Pregestational and Gestational Diabetes: A Population-Based Study in Spain, 2016-2022.

Background/Objectives: The objective of this study was to compare trends in the incidence of deliveries and in obstetric interventions and outcomes in women with and without type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM). Methods: This was an observational study using the Spanish National Hospital Discharge Database (2016-2022). Results: A total of 1,995,953 deliveries were recorded between 2016 and 2022 (6495 mothers with T1DM, 5449 with T2DM, and 124,172 with GDM). The incidence of T1DM and GDM increased over time, although it remained stable in women with T2DM. Women with T2DM were more likely to have obstetric comorbid conditions (72.93%) than women with GDM (63.04%), women with T1DM (59.62%), and women who did not have diabetes (45.3%). Pre-eclampsia, previous cesarean delivery, and arterial hypertension were the most prevalent conditions in all types of diabetes. The highest frequency of cesarean delivery was recorded for women with T1DM (55.04%), followed by women with T2DM (44.94%), and those with GDM (28.13%). The probability of cesarean delivery was 2.38, 1.79, and 1.19 times greater for T1DM, T2DM, and GDM, respectively, than for women who did not have diabetes. The adjusted rate for severe maternal morbidity was significantly higher for women with T1DM (RR 2.31; 95%CI 2.02-2.63) and T2DM (RR 1.58; 95%CI 1.34-1.87) than for women without diabetes. Conclusions: The incidence of deliveries in women with T2DM remained unchanged between 2016 and 2022; the incidence of deliveries increased in women with T1DM and GDM. The prevalence of comorbidity and obstetric factors increased over time in women with T1DM and GDM.

The Other Side of the Coin: Secondary Takotsubo Syndrome in Living Donor Liver Transplantation Reversul medaliei: sindrom Takotsubo secundar la donator înrudit pentru transplant hepatic

Abstract Introduction Takotsubo syndrome is an acute reversible heart failure syndrome, and its secondary form occurs in patients already hospitalized for another medical, surgical, obstetric, or psychiatric condition. Takotsubo syndrome is also a complication that occurs in liver transplant recipients. There is little data regarding the management and long-term treatment of these patients; major recommendations are based on expert opinion. Case Presentation We present a case of a 46-year-old female patient, with no significant past medical history, admitted for hepatectomy, being a living hepatic transplant donor for her sister. In the early postoperative period, she developed worsening dyspnea, alongside ECG changes, abnormal cardiac biomarkers, and a significant decrease of the left ventricle systolic function, with a typical “apical ballooning” aspect of the left ventricle determined by the wall motion abnormalities that extend beyond the territory of a single coronary artery. All the clinical and imagistic aspects are highly suggestive of Takotsubo syndrome. She further developed a low cardiac output state and cardiogenic shock, with a recovery of her clinical state days later, being under supportive care, with a later improvement of her symptoms and of the left ventricle systolic function on repeated transthoracic echocardiography. Conclusions Takotsubo syndrome may be a complication occurring in liver transplant recipients, with a rising number of cases published. Secondary Takotsubo syndrome occurring in a living liver donor is in itself a peculiarity due to the fact that such cases are not currently reported in literature. We report this case to raise awareness regarding this possible outcome in living donors for solid organ transplantation.

The Role of the Vaginal and Endometrial Microbiomes in Infertility and Their Impact on Pregnancy Outcomes in Light of Recent Literature.

The Human Microbiome Project (HMP), initiated in 2007, aimed to gather comprehensive knowledge to create a genetic and metabolic map of human-associated microorganisms and their contribution to physiological states and predisposition to certain diseases. Research has revealed that the human microbiome is highly diverse and exhibits significant interpersonal variability; consequently, its exact impact on health remains unclear. With the development of next-generation sequencing (NGS) technologies, the broad spectrum of microbial communities has been better characterized. The lower female genital tract, particularly the vagina, is colonized by various bacterial species, with Lactobacillus spp. predominating. The upper female genital tract, especially the uterus, was long considered sterile. However, recent studies have identified a distinct endometrial microbiome. A Lactobacillus-dominated microbiome of the female genital tract is associated with favorable reproductive outcomes, including higher success rates in natural conception and assisted reproductive technologies (ART). Conversely, microbial imbalances, or dysbiosis, marked by reduced Lactobacilli as well as an increased diversity and abundance of pathogenic species (e.g., Gardnerella vaginalis or Prevotella spp.), are linked to infertility, implantation failure, and pregnancy complications such as miscarriage and preterm birth. Dysbiosis can impair the vaginal or endometrial mucosal barrier and also trigger pro-inflammatory responses, disrupting essential reproductive processes like implantation. Despite growing evidence supporting the associations between the microbiome of the female genital tract and certain gynecological and obstetric conditions, clear microbial biomarkers have yet to be identified, and there is no consensus on the precise composition of a normal or healthy microbiome. The lack of standardized protocols and biomarkers limits the routine use of microbiome screening tests. Therefore, larger patient cohorts are needed to facilitate comparative studies and improve our understanding of the physiological microbiome profiles of the uterus and vagina, as well as how dysbiosis may influence clinical outcomes. Further research is required to refine diagnostic tools and develop personalized therapeutic strategies to improve fertility and pregnancy outcomes.

A simplified pre-conceptional laparoscopic cervical cerclage for cervical insufficiency: a retrospective study from a single center

BackgroundCervical insufficiency is a pathological condition in obstetrics in which the cervix fails to retain the fetus before uterine contractions or labor (painless cervical dilatation). Patients usually have fetal loss in the mid-trimester or spontaneous pre-term birth due to painless cervical dilation. For non-pregnant women with cervical insufficiency, prophylactic laparoscopic abdominal cerclage (LAC) has been reported to improve pregnancy outcomes, such as live birth, neonatal survival, and full-term delivery rate. Conventional LAC involves opening the vesicular space and separating the anterior broad ligament leaves. In our surgical procedure, these two steps were omitted.MethodsAn observational study was conducted retrospectively on patients who underwent a simplified pre-conceptional LAC between January 2015 and December 2022 at West China Second University Hospital, Sichuan University. Follow-ups for all the patients ended at the delivery of the fetus. Subsequently, clinical characteristics, perioperative data, and obstetric outcomes were recorded and analyzed.ResultsIn total, 108 patients were included in a pre-conception LAC group Mean operation time was 56.8 ± 22.8 min, and mean estimated blood loss was 21.4 ± 23.6 mL. Only one case of urinary retention was classified as a grade I postoperative complication, according to the Clavien–Dindo classification. No severe complications or sequelae were observed during the perioperative period. Obstetric outcomes from 98 patients were collected: three patients had miscarriages, and 95 had live births. Of the 95 live births, 4 were twins and 91 were singletons. Two patients had vaginal delivery, and 93 underwent Cesarean section; mean neonatal weight was 3310.2 ± 382.1 g.ConclusionA simplified pre-conceptional LAC is a simple, safe, and effective method for women with cervical insufficiency. Thus, it is worthy of promotion to assist women with cervical insufficiency in achieving improved obstetric outcomes. Vaginal delivery after LAC is possible once the tape is removed before labor.

Placental histopathological abnormalities in adverse obstetric outcomes: a retrospective cross-sectional study at Sultan Qaboos University Hospital

IntroductionPlacenta is a vital organ with highly specialized functions. According to the Perinatal Section of the Pediatric Pathology Society, placental histopathological abnormalities are typically categorized into maternal vascular hypoperfusion, fetal thrombotic vasculopathy, and inflammatory lesions. This study aims to assess the placental histopathological abnormality results in relation to adverse obstetric outcomes and to investigate whether specific placental abnormalities are associated with particular adverse outcomes.MethodsA retrospective cross-sectional study was conducted between January 2017 and January 2020 including all women who were admitted to Sultan Qaboos University Hospital with an adverse obstetric outcome who met the inclusion criteria, and whose placentas were sent for histopathological examination.ResultsA total of 191 women were included in the study. The most common adverse obstetric outcomes included preterm labor (25.1%), fetal growth restriction (FGR) (19.4%), preeclampsia and related complications (15%), placental abruption (14.1%), and chorioamnionitis (14%). 74% of women had abnormal placental findings. Among women with preterm labor, inflammatory lesions were present in 56.3% of cases (p = 0.006). Fetal thrombotic vasculopathy lesions were present in 13.5% of FGR cases (p = 0.037). In preeclampsia cases, maternal under perfusion lesions were present in 79% of cases (p = 0.013).ConclusionPlacental histopathological examination is an important tool for assessing perinatal outcomes. Correlating placental findings with specific obstetrical conditions and adverse outcomes provides valuable information that can assist obstetricians in developing appropriate management plans for future pregnancies.

Routing of patients in critical conditions in obstetrics

Routing of patients in critical conditions associated with pregnancy, childbirth, and the postpartum period is an extremely important aspect of organizing medical care for this group of patients. Ensuring the safety of medical evacuation and developing transportation routes, indications and contraindications for its implementation, and algorithms for providing medical care at the evacuation stage are an essential factor in the regionalization of perinatal care, allowing to improve outcomes for both the mother and the newborn.

Thermosensitive Injectable Dual Drug-Loaded Chitosan-Based Hydrogels for Treating Bacterial Endometritis.

Endometritis, a prevalent obstetric condition primarily caused by Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), significantly threatens the reproductive performance of female animals. In this study, thermosensitive injectable chitosan (CS)/β-glycerophosphate (β-GP) hydrogels loaded with berberine (BBR) and carvacrol (CAR) were prepared for endometritis treatment. In vitro, BBR/CAR-CS/β-GP hydrogels exhibited rapid gelation within 5 min at 37 °C, excellent injectability, and more than 90% degradation within 30 days under enzymatic action. The dual drug-loaded system also exhibited controlled release of BBR and CAR and demonstrated the antimicrobial activity against E. coli and S. aureus. In vivo, uterine injection of BBR/CAR-CS/β-GP hydrogels alleviated infection-induced injuries and reduced the bacterial load in infected uterine tissues. In summary, these findings highlight the potential of BBR/CAR-CS/β-GP hydrogels as innovative carriers for drug delivery targeting endometritis.

Usefulness of decision tree analysis of MRI features for diagnosis of placenta accreta spectrum in cases with placenta previa.

Placenta previa complicated by placenta accrete spectrum (PAS) is a life-threatening obstetrical condition; therefore, preoperative diagnosis of PAS is important to determine adequate management. Although several MRI features that suggest PAS has been reported, the diagnostic importance, as well as optimal use of each feature has not been fully evaluated. The occurrence of 11 PAS-related MRI features was investigated in MR images of 145 patients with placenta previa. The correlation between each MRI feature and pathological diagnosis of PAS was evaluated using univariate analysis. A decision tree model was constructed according to a random forest machine learning model of variable selection. Eight MRI features showed a significant correlation with PAS in univariate analysis. Among these features, placental/uterine bulge and myometrial thinning showed high odds ratios: 138.2 (95% CI: 12.7-1425.6) and 66.0 (95% CI: 18.01-237.1), respectively. A decision tree was constructed based on five selected MRI features: myometrial thinning, placental bulge, serosal hypervascularity, placental ischemic infarction/recess, and intraplacental T2 dark bands. The decision tree predicted the presence of PAS in the randomly assigned validation cohort with significance (p < 0.001). The sensitivity and the specificity of the decision tree for detecting PAS were 90.0% (95%CI: 53.2-98.9) and 95.5% (95%CI: 89.9-96.8), respectively. Among PAS-related MRI features, placental/uterine bulge and myometrial thinning showed high diagnostic values. In addition, the present decision tree model was shown to be effective in predicting the presence of PAS in cases with placenta previa.

Effect of Ksheerbasti and Uttara Basti on Endometrial Fibrosis Induced Infertility (Kshetra Dushti Janya Vandhyatva) - A Case Report

Infertility is a disease of male or female, defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Fibrous scaring of the uterine cavity not only decreases fertility (via impairing embryo implantation) but is also associated with an increased risk of miscarriage and other obstetric conditions. Here is a case study of a 30-years-old female patient residing in Jaipur who consulted in OPD of the National Institute of Ayurveda (NIA) Jaipur on 30-9-23 with the chief complaint of being unable to conceive since 5 years. Her diagnostic Laproscopy &amp; Hysteroscopic findings were suggestive of multiple subserosal fibroid &amp; fibrosed endometrium. Patient was treated with Ayurvedic regime for 5 cycle considered as a Kshetra Dusthi Janya Vandhyatva. The patient missed her period on 8-03-24 and did her urine pregnancy test on 19-3-24, which was found to be positive. From this case study, it is concluded that Ayurvedic intervention are effective in treating infertility due to Endometrial Fibrosis (Kshetra Dushti Janya Vandhyatva).

Influenza and COVID-19 vaccines in pregnancy: investigation on associated factors and HAPA theory

Abstract Background Infections caused by influenza and COVID-19 during pregnancy represent a current public health problem as there are multiple populations at risk of complications: pregnant women, fetus, and future unborn children. The anatomical and physiological remodulation characteristic of pregnancy is responsible for the high pathological burden related to respiratory infections. Co-administration of influenza and COVID-19 vaccines may be beneficial because these two respiratory viruses cocirculate during cold weather. The need to explore pregnant women’s attitudes toward co-administration of influenza and COVID-19 vaccines and to evaluate factors associated with vaccine decision-making led to the conduct of this study. Methods In Palermo, Italy, during the 2021-2022 influenza season, a cross-sectional study was conducted to evaluate pregnant women’s intention to adhere to co-administration of influenza and COVID-19 vaccines. The determinants of vaccination attitudes were investigated through the administration of a questionnaire. The Health Action Process Approach theory (HAPA) was adopted to explore the cognitive behavioral aspects. Results Overall, 120 pregnant women were enrolled; average age 32 years, 98.2% (n = 118) of Italian nationality and 25.2% (n = 30) with obstetric or pathological conditions of pregnancy at risk. Factors significantly associated with attitudes toward co-administration of influenza and COVID-19 vaccines among pregnant women were: high level of education (OR = 13.96; p &amp;lt; 0.001), expectations of a positive outcome (OR = 2.84; p &amp;lt; 0.001) and self-efficacy (OR = 3.1; p &amp;lt; 0.001). Conclusions Vaccines co-administration could represent an advantageous preventive practice to facilitate vaccination logistics and allow full adherence to vaccinations recommended to pregnant women. Effective strategies to promote co-administration of influenza and COVID-19 vaccines could be focused on counselling about the expectation of positive outcomes of vaccine co-administration. Key messages • The need to explore pregnant women’s attitudes toward co-administration of influenza and COVID-19 vaccines and to evaluate determinants of vaccine decision-making led to the conduct of this study. • Vaccines co-administration could represent an advantageous preventive practice to facilitate vaccination logistics and allow full adherence to vaccinations recommended to pregnant women.

Clinical features and outcomes of patients diagnosed with diabetic ketoacidosis (DKA) who were hospitalized for conditions outside of internal medicine

AimsTo assess the clinical features and outcomes of patients diagnosed with DKA who were hospitalized for conditions outside of internal medicine. MethodsRetrospective analysis of admissions for DKA in adult patients between 2005 and 2022 at a tertiary hospital in Israel. Patients with DKA were stratified into medical vs non-medical groups, the primary outcome was in-hospital mortality. Results429 patients were included in the study, 385 patients (89.7 %) were treated by an internal medicine team, while 44 patients (10.3 %) were hospitalized with surgical or obstetrical conditions. Patients in the non-internal medicine group were older (52 ± 18.9 vs 43.6 ± 20.4, p < 0.005) and had higher rates of diabetes complications such as chronic ischemic heart disease (20.5 % vs. 4.2 %, p < 0.0001) and chronic kidney disease (50 % vs. 3.4 %, p < 0.001). Glucose level on presentation was lower for non-internal medicine patients (398 ± 221 mg/dL vs 551 ± 180 mg/dL) and outcomes of mechanical ventilation and length of hospitalization were more severe (29.5 % vs. 6 %, p < 0.001 and 8.0 vs. 3.0, p < 0.001). Multivariate analysis demonstrated that composite outcome of in-hospital mortality, ICU admission and longer hospitalization was more likely in the non-internal medicine group (OR 3.99, CI 1.89–8.4, p < 0.001). ConclusionDKA is a universal pathology that concerns various medical fields. It is essential for every clinician to be familiar with this condition. Patients diagnosed with DKA who were hospitalized for conditions outside of internal medicine may be at high risk and may present with lower glycemic levels. Future research is needed to characterize the unique features of subgroups of patients with DKA.

Frequency of adverse perinatal outcomes in patients with pregnancy related acute renal (kidney) injury in a tertiary care hospital.

Pregnancy related acute kidney injury (Pr-AKI) is coupled with adverse feto-maternal outcomes. Adverse perinatal outcome comprising of still births, intrauterine growth retardation, neonatal deaths are indicators of severity of underlying obstetrical conditions ending on Pr-AKI. These perinatal outcomes can also serve as potential predictors for long term outcomes of Pr-AKI. Our study aimed to determine frequencies of adverse perinatal outcomes and to evaluate adverse perinatal outcome as predictor for persistent renal injury in patients with pregnancy induced acute renal injury (Pr-AKI). A descriptive case series including 100 women with Pr-AKI, was conducted in a tertiary care hospital of Peshawar from 1st August 2021 to 31st July 2022. Included patients were followed for three months period, from their date of delivery. Adverse perinatal outcome included stillbirths, and early neonatal deaths. The mean age of study sample was 29.20±6.40. The pre dominant etiology for Pr-AKI was primary postpartum hemorrhage, occurring in 52% women. Still births were seen in 48% cases, while early neonatal deaths were seen in 7% cases. Adverse perinatal outcome had statistically significant association with persistent renal failure (p-0.01). Other factors having statistically significant association with persistent renal injury (PRF) were multiparity and cesarean births. (p<0.05) Association of adverse perinatal outcome with persistent renal injury persisted on multivariate logistic regression. a OR 6.14; CI 1.15-32.29, p-0.033. Almost half of the cases with Pr-AKI have still births. Still birth in patients with Pr-AKI is associated with persistent renal injury at 12 weeks follow up period.

An Integral Assessment of Patient’s Condition in Postpartum Women with Critic Obstetric Complications

Introduction. Septic complications after critical obstetric conditions (COC) are a pressing problem in obstetrics. The aim of the study is to conduct an integral assessment of the severity of postpartum women with septic complications after COC.Materials and methods. We examined 39 postpartum women after COC (massive obstetric hemorrhage, severe preeclampsia). All patients were divided into 2 groups: the main group (n = 18) — with associated septic complications, the comparison group (n = 21) — without septic complications. The average age of the subjects was (29.80±6.48) years.Results. Obstetric bleeding was complicated by hemorrhagic shock in more than 75 % of patients in both groups. Premature detachment of a normally located placenta (PDNLP) was statistically significantly more often recorded in the main group (p = 0.04). All patients underwent total hysterectomy during childbirth or in the early postpartum period. Multiple organ failure syndrome (MODS) occurred in all women of the main group and in 17/21 (80.95 %) in the comparison group (p = 0.05). When assessing the condition of maternity hospitals using integral scales, a higher number of points were noted in the main group on the APACHE II scale (p = 0.02), SOFA (p = 0.001), NEWS2 (p &lt; 0.001). In the main group, septic complications developed on the 9 [4; 9] day after delivery.Conclusion. Risk factors for septic complications after COC are: MODS, renal failure, acute kidney injury, heart failure, respiratory distress syndrome, pneumonia. Maternity hospitals at risk of septic complications after COC initially show an increase in the number of points according to APACHE II, SOFA, NEWS2.

Cesarean hysterectomy in pregnancies complicated with placenta previa accreta: a retrospective hospital-based study

BackgroundPlacenta previa accreta (PPA) is a severe obstetric condition that can cause massive postpartum hemorrhage and transfusion. Cesarean hysterectomy is necessary in some severe cases of PPA to stop the life-threatening bleeding, but cesarean hysterectomy can be associated with significant surgical blood loss and major complications. The current study is conducted to investigate the potential risk factors of excessive blood loss during cesarean hysterectomy in women with PPA.MethodsThis is a retrospective study including singleton pregnancies after 28 weeks of gestation in women with placenta previa and pathologically confirmed placenta accreta spectrum who received hysterectomy during cesarean sections. A total of 199 women from January 2012 to August 2023 were included in this study and were divided into Group 1 (estimated surgical blood loss (EBL) ≤ 3500 mL, n = 103) and Group 2 (EBL > 3500 mL, n = 96). The primary outcome was defined as an EBL over 3500 mL. Baseline characteristics and surgical outcomes were compared between the two groups. A multivariate logistic regression model was applied to find potential risk factors of the primary outcome.ResultsMassive surgical blood loss was prevalent in our study group, with a median EBL of 3500 mL. The multivariate logistic analysis showed that emergency surgery (OR 2.18, 95% CI 1.08–4.41, p = 0.029), cervical invasion of the placenta (OR 2.70, 95% CI 1.43–5.10, p = 0.002), and intraoperative bladder injury (OR 5.18, 95% CI 2.02–13.28, p = 0.001) were all associated with the primary outcome. Bilateral internal iliac arteries balloon occlusion (OR 0.57, 95% CI 0.34–0.97) and abdominal aortic balloon occlusion (OR 0.33, 95% CI 0.19–0.56) were negatively associated with the primary outcome.ConclusionsEmergency surgery, cervical invasion of the placenta, and intraoperative bladder injury were potential risk factors for additional EBL during cesarean hysterectomy in women with PPA. Future prospective studies are needed to confirm the effect of intra-arterial balloon occlusion in cesarean hysterectomy of PPA.

Updated Role of Ultrasound for Predicting Pregnancy Outcome in First-Trimester Vaginal Bleeding

Abstract Backgrounds Vaginal bleeding during the first trimester is a common obstetric condition. Approximately 20-25% women in their first trimester complain of vaginal bleeding The vast variety of reasons of early pregnancy bleeding, the risk of miscarriage, and the worry of having any life-threatening etiology puts pregnant women with first trimester hemorrhage in a state of uncertainty, leading to anxiety Aim: To predict pregnancy outcome through sonographic findings of subchorionic hematoma, slow fetal heart rate and high resistance to subtrophoblastic circulation in women presenting with vaginal bleeding in first trimester. Patients &amp;Methods A prospective study was conducted during twenty- month period from September 2021 to April 2023 on 60 pregnant patients during 6-13 + 6dweeks of gestation with positive pregnancy test, complaining of vaginal bleeding. The study group was subdivided into group of non-viable pregnancy (16 cases) and threatened abortion group (44 cases). The group of threatened abortion was subdivided into group of patients who ended in second trimester miscarriage (6 patients) and termination of pregnancy (2 patients) and a group who continued pregnancy (36 patients). Pregnancies were followed up until the final outcome was known. Confirmation of completed pregnancy loss was done with examination of the abortus products that passed spontaneously or after uterine aspiration for non viable group. Antenatal and neonatal outcomes were obtained from hospital records for cases of threatened abortion continued pregnancy to labor. The relation between slow embryonic (fetal) heart rate, subchorionic hematoma and high resistance to subtrophoblastic circulation and fetal demise was recorded and statistically analyzed. Results Spotting was most common nature of bleeding per vagina 63.3% (38/60). Among 60 subjects who were included in the study, 44 patients (73.3%) were diagnosed by US as viable pregnancy and 16 patients (26.7%) were non-viable pregnancy. Among 44 cases of viable pregnancy in the first trimester, 6 (10.0%) ended in second trimester miscarriage, 2(3.3%) were subjected to pregnancy termination (aneuploidy) and 36 (60%) completed their pregnancies of which the live birth rate was 81.8% of which 28 patients had no perinatal complications, and others (22.2%) had problems of PROM, and preterm labor. The prevalence of subchorionic hematoma in threatened abortion group was 22.7% (n = 10) and there was association between the size of the subchorionic hematoma and first trimester miscarriage. There was a statistically significant differences in pregnancy outcomes between those with and without subchorionic hematoma. There is highly significant relation between incidence of abortion and the slowing FHR and high resistance to subtrophoblastic circulation where p-value &amp;lt;0.001 and respectively Conclusions First trimester bleeding could be a predicting factor for perinatal complications. Slow embryonic (or fetal) heart rate as well as increased resistance to subtrophoblastic circulation could be the earliest predictors for subsequent possible miscarriage. Large subchorionic hematoma may increase the risk of miscarriage in patients with vaginal bleeding and so early follow up by ultrasound is recommended a and this help the clinician to make the diagnosis of fetal demise quickly.

PLACENTA ACCRETA: IS PRIMARY ELECTIVE CAESAREAN SECTION A PREDISPOSING RISK FACTOR?

Background:Placenta accrete spectrum is a fatal obstetrical condition associated with serious feto-maternal morbidity and mortality. It is associated with a variety of risk factors including primary elective caesarean section. To determine the association of placentaaccreta spectrum with primary elective caesarean section.Materials &amp; Methods:This case-control study was conducted over two years (June 2022 to May 2024) at Sir Ganga Ram Hospital, Lahore, including 100 pregnant women with placenta previa. Demographic and obstetric details were noted in all patients and their caesarean section and postoperative management were done as per hospital policy. Intraoperatively type of placenta previa and type of placenta accreta spectrum was noted. Based on intraoperative findings 50 women with placenta previa, adherent placenta, and one or more previouscaesarean sections were enrolled in Group A (cases), while 50 women with placenta previa and previous caesarean sections were enrolled in Group B (controls). Maternal outcomes along with demographic and obstetric details were noted in preformed proforma and analyzed using SPSS. Results were considered statistically significant with a p-value less than 0.05.Results:The number of elective primary lower segment caesarean section (LSCS)werehigher in Group A (cases) 37(74%) than 27(54%) in Group B (controls) (P value= 0.037). Amongst women with placenta accreta spectrum in Group A (cases), the present study found placenta accreta in 64%, placenta increta in 22%, and placenta percreta in 14% of women. Conclusion:Elective primary caesarean section is associated with a higher risk of placenta accreta spectrum.