Hemorrhage Disorders Research Articles

A novel virtual simulation training improves providers’ knowledge and confidence to manage obstetric emergencies

Maternal mortality in the United States (US) is rising and many deaths are preventable. We sought to determine the efficacy of virtual simulation training to optimize management of obstetric emergencies within low and moderate volume delivery hospitals that are disproportionately affected by adverse maternal outcomes. The educational platform was designed and deployed within urban non-teaching and rural hospitals, with low and moderate delivery volumes, in the US during the COVID-19 pandemic. Self-paced, interactive, online didactics on postpartum hemorrhage and hypertensive disorders of pregnancy were followed by two, 2-hour live virtual simulation trainings and debriefings. In this innovative simulation modality, participants verbalized actions to their co-participants and the simulation faculty as scenarios evolved with images, vitals and videos displayed on a PowerPoint. Participants completed multiple-choice questionnaires and confidence and attitude surveys prior to, immediately after and 3-months post-training. The multiple-choice questions were evidence-based using information from published guidelines and were validated by local experts. Paired t-tests were performed to asses for changes in knowledge and confidence. From December 2021 to March 2022, four hospitals received training (Table 1). Participants (n=22) were comprised of nurses (59%), certified nurse midwives (14%) and attending physicians (23%) in Obstetrics, Family Practice or Anesthesiology. The survey response rate was 59%. The mean difference in knowledge and confidence scores significantly improved immediately post-training compared to baseline (P < 0.05 for all, Table 2). This improvement was maintained 3 months following the training. Participants reported their preferred training format was hybrid (43%), virtual (35.7%) or in-person (21.4%). Virtual obstetric simulation is feasible and improves knowledge and confidence, which can be retained over time. This educational modality is sustainable, scalable and an accessible format to enhance education and training.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Incidence & factors influencing maternal near miss events in tertiary hospitals of Maharashtra, India.

Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future. This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals. The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively. The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.

Exploring the anti-inflammatory potential of Colocasia esculenta root extract in in-vitro and in-vivo models of inflammation

Ethnopharmacological relevanceColocasia esculenta (CE) (L.) Schott is an annual herbaceous tropical plant from the family of Araceae which has been traditionally used for the healing of various ailments such as asthma, arthritis, internal hemorrhage, diarrhea, and neurological disorders. The plant is reported to have potential anti-microbial, anti-fungal, antimetastatic, anti-hepatotoxic, and anti-lipid peroxidative activities. Aim of the studyThe present study is designed to explore the potential anti-inflammatory property of Colocasia esculenta methanolic root extract (CEMRE) on carrageenan-induced rat paw edema and lipopolysaccharide (LPS) stimulated RAW264.7 cells. Materials and methodsCarrageenan-induced rat paw edema model was used to investigate the in vivo anti-inflammatory action of CEMRE. Adult male Wistar rats (180–220 g; n = 6) were pre-treated with CEMRE (100, 200, and 400 mg/kg BW) orally before 1 h of injection of 1% carrageenan. Indomethacin (10 mg/kg BW) was given orally as the standard drug. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), nitric oxide (NO), prostaglandinE2 (PGE2), and cytokines levels were measured. Liquid chromatography-mass spectrometry (LC-MS) was done to identify the phytoconstituents present in CEMRE. The inhibitory activity of CEMRE was investigated against cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) in in vitro assessment of LPS-stimulated RAW264.7 cells. The RAW 264.7 cells were pre-treated with Indomethacin (5 μM and 10 μM) and CEMRE (17 μg/ml and 34 μg/ml) followed by induction of LPS (1 μg/ml) for 24 h. Docking analyses were also performed to explore the interaction of important phytoconstituents (Sinapic acid, Acetylsalicylic acid, L-fucose, Salicylic acid, Quinic acid, Zingerone, and Gingerol) of CEMRE with COX-2 and iNOS. ResultsPre-treatment with CEMRE (400 mg/kg) could inhibit the paw inflammation significantly which was elevated due to carrageenan induction. The inhibition is comparable to that of the standard drug Indomethacin. The concentration of serum AST, ALT, ALP, NO, PGE2 and cytokines were also considerably lowered in the CEMRE-treated group as compared to the carrageenan-induced group. CEMRE (34 μg/ml) inhibited the LPS-stimulated relative expression of mRNA of COX-2 and iNOS and significantly reduced the expression of nitric oxide and prostaglandin E2. Docking analyses revealed promising interaction with low binding energies between Sinapic acid with both the target proteins COX-2 and iNOS. ConclusionCollectively, our results suggested that CEMRE exhibited effective anti-inflammatory actions on carrageenan-induced rat paw edema and LPS-treated RAW 264.7 cells by reducing the in vivo paw edema inhibition, inhibiting the serum NO, PGE2, cytokines and also reduced the in vitro production of NO, PGE2 along with expressions of mRNA COX-2 and iNOS. Molecular docking demonstrated good binding affinities among the target proteins and ligand Sinapic acid. Thus the bioactive compound from CE need to be isolated and purified.

Using Whole Exome Sequencing to Identify the Pathogenic Variant of F7 C.681+1 G>t As a Potential Cause of Severe Bleeding Clinic Presentation in a Newborn Baby

Ching-Tien Peng1, 2, 3 Chien-Yu Lin4 Yin-Ting Chen1 1.Division of Pediatric Hematology & Oncology, China Medical University Children's Hospital, Taichung, 40447, Taiwan 2.Department of Biotechnology, Asia University, Taichung, 40447, Taiwan 3.Divisions of Pediatrics, China Medical University Hsinchu Hospital, Zhubei City, Hsinchu County, 30272, Taiwan. 4.Divisions of Laboratory Medicine, China Medical University Hsinchu Hospital, Zhubei City, Hsinchu County, 30272, Taiwan. Objective: The clinical manifestations of Factor VII deficiency vary, most cases remain asymptomatic or mild, and cases with severe clinical presentation are rarely reported. It is a rare hereditary hemorrhagic disorder passed on through autosomal recessive inheritance. We present a 2-day-old male infant with large cephalohematoma and intracranial hemorrhage, who was diagnosed using whole exome sequencing with Factor VII deficiency. Materials and Methods: Whole exome sequencing and Sanger sequencing were used to verify related variants. Other routine blood coagulation and factor activity tests were conducted by Divisions of Laboratory Medicine, China Medical University Hospital, Taiwan. Results: A 2-day-old male newborn was identified to develop left intracranial hemorrhage with unknown causes. The laboratory coagulation factor test results indicated a prolonged prothrombin time and normal activated partial thromboplastin time. The test results for Fibrinogen (279.9 mg/dL) and Factor activity analysis, included Factor VIII (85.6%), Factor V (49.3%), Factor VII (<1.0%), Factor IX (81.3%), and Factor X (42.7%). The results for VWF activity and antigen are normal. Subsequently, whole exome sequencing was used to conduct genetic tests, which revealed the homozygote mutation at F7 c.681+1 G>T (NM_000131). Further variant tests on the family members suggested that the father, mother, and older sister had heterozygote mutation at the same site. Conclusions: We used next-generation sequencing, which uses array-based sequencing to process reactions in parallel and enables the simultaneous investigation of multiple genes at a manageable cost, to identify the variants. While there is still little research on whether there is a relationship between different gene mutations and clinical presentations. The sequencing results revealed homozygote mutation at F7 c.681+1 G>T (NM_000131). The pathogenicity level was indicated to be "Highly pathogenic" in the ClinVar archive. Studies have reported the association of such mutation with severe hemorrhage disorders. Therefore, the present study offers critical empirical insights in that it applies to clinical practice in a clinical setting and identifies a pathogenic variant. We will present the hypothesis mechanism at the ASH meetings.

Red blood cell transfusion is associated with an increased risk of splanchnic vein thrombosis in patients with cirrhosis.

Haemorrhage and coagulation disorders are common complications in cirrhotic patients, which cause blood products transfusion, and mounting evidence suggested that red blood cells (RBCs) were associated with pathologic thrombosis and RBC transfusion increased the risk of venous thromboembolism (VTE). The aim of the study was to investigate the association of RBC transfusion with splanchnic vein thrombosis (SVT) in cirrhotic patients. We retrospectively reviewed patients with cirrhosis admitted in the Hunan Provincial People's Hospital between January 2010 and September 2020. Demographic data, the development of SVT, blood transfusion product type and RBC transfusion dose were collected. Multivariate logistic regression analyses and propensity matching analysis (PSM) were performed to identify the association between RBC transfusion and development of SVT. A total of 4479 patients with cirrhosis were enrolled in the study. SVT occurred in 48 (12.4%) cirrhotic patients in RBC transfusion group, and 233 (5.7%) cirrhotic patients in non-RBC transfusion group. RBC transfusion was significantly associated with an increased risk of SVT (unadjusted odds ratio [OR] 2.345, 95% confidence interval [CI] 1.686-3.262, p < 0.001). Notably, this association remained robust after PSM, and the volume of RBC transfusion was associated with SVT in a dose-dependent manner. This study suggested that RBC transfusion was associated with an increased risk of SVT in cirrhotic patients. High quality clinical study will be needed to further validate the association between RBC transfusion and SVT.

Updated Stroke Gene Panels: Rapid evolution of knowledge on monogenic causes of stroke

This article updates our previous Stroke Gene Panels (SGP) from 2017. Online Mendelian Inheritance in Man and PubMed were searched. We divided detected genes into two SGP groups, SGP1: genes reported in at least one person with stroke and associated with one or more clinical subgroups: large artery atherosclerotic, large artery non-atherosclerotic (tortuosity, dolichoectasia, aneurysm, non-atherosclerotic dissection or occlusion), cerebral small vessel diseases, cardio-embolic (arrhythmia, heart defect, cardiomyopathy), coagulation dysfunctions (venous thrombosis, arterial thrombosis, bleeding tendency), intracerebral hemorrhage, vascular malformations (cavernoma, arteriovenous malformations) and metabolism disorders; and SGP2: genes related to diseases that may predispose to stroke. We identified 168 SGP1 genes, 70 of these were validated for clinical practice. We also detected 72 SGP2 genes. Nine genes were removed because of conflicting evidence. The number of genes increased from 168 to 240 during 4.5-years, reflecting a dynamic evolution and the need for regular updates for research and clinical use.

Pamiparib Induces Neurodevelopmental Defects and Cerebral Haemorrhage in Zebrafish Embryos via Inhibiting Notch Signalling.

Pamiparib is a poly ADP-ribose polymerase (PARP) inhibitor used in clinical studies, which can penetrate the blood-brain barrier efficiently. At present, there are few studies on its effect on vertebrate neurodevelopment. In this study, we exposed zebrafish embryos to 1, 2 and 3µM of Pamiparib from 6 to 72h post-fertilisation (hpf). Results showed that pamiparib can specifically induce cerebral haemorrhage, brain atrophy and movement disorders in fish larvae. In addition, pamiparib exposure leads to downregulation of acetylcholinesterase (AChE) and adenosine triphosphate (ATPase) activities, and upregulation of oxidative stress which then leads to apoptosis and disrupts the gene expression involved in the neurodevelopment, neurotransmitter pathways and Parkinson's disease (PD) like symptoms. Meanwhile, astaxanthin can partially rescue neurodevelopmental defects by downregulating oxidative stress. After exposure to pamiparib, the Notch signalling is downregulated, and the use of an activator of Notch signalling can partially rescue neurodevelopmental toxicity. Therefore, our research indicates that pamiparib may induce zebrafish neurotoxicity by downregulating Notch signalling and provides a reference for the potential neurotoxicity of pamiparib during embryonic development.

Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients

Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients

Analysis of treatment for 360 critically ill pregnant and parturient women in intensive care unit

To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics. The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized. A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation II (APACHE II) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360). The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.

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Incidence and causes of severe maternal outcomes in Somaliland using the sub-Saharan Africa maternal near-miss criteria: A prospective cross-sectional study in a national referral hospital.

To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland. A prospective cross-sectional study was conducted from April 15, 2019 to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data were collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions, and ratios. The MNM ratios were 56 (SSA criteria) and 13 (WHO criteria) per 1000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric hemorrhage (13%), pregnancy-related infection (10%), and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum hemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after 3h. There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for healthcare providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.

Deliveries Among Patients Aged 11-19 Years and Risk for Adverse Pregnancy Outcomes.

To characterize delivery hospitalization trends of patients aged 11-19 years and associated comorbidities and outcomes. For this repeated cross-sectional analysis, deliveries to patients aged 11-54 years were identified in the 2000-2018 National Inpatient Sample. Temporal trends in deliveries to patients aged 11-14 years and 15-19 years were analyzed using joinpoint regression to estimate average annual percent change with 95% CIs. The association of deliveries among patients aged 11-19 years with other comorbid conditions was analyzed. The relationship between delivery among patients aged 11-19 years and adverse maternal outcomes was analyzed with unadjusted and adjusted logistic regression models, with unadjusted and adjusted odds ratios (aORs) as measures of effect. An estimated 73,198,153 delivery hospitalizations from 2000 to 2018 were included, of which 88,363 were to patients aged 11-14 years and 6,359,331 were to patients aged 15-19 years. The proportion of delivery hospitalizations among patients aged 11-14 years decreased from 2.1 to 0.4 per 1,000 from 2000 to 2018 (average annual percent change -7.8%, 95% CI -8.5% to -7.2%). Deliveries to patients aged 15-19 years decreased from 2000 to 2018, from 11.5% to 4.8% of all deliveries (average annual percent change -4.9%, 95% CI -5.6% to -4.3%). For deliveries among patients aged 11-19 years, rates of obesity, mental health conditions, substance use disorder, asthma, and pregestational and gestational diabetes all significantly increased over the study period. From 2000 to 2018, rates of severe maternal morbidity (average annual percent change 2.4%, 95% CI 1.6-3.1%), postpartum hemorrhage (average annual percent change 2.4%, 95% CI 1.4-3.4%), cesarean delivery (average annual percent change 1.3%, 95% CI 0.9-1.7%), and hypertensive disorders of pregnancy (average annual percent change 3.3%, 95% CI 2.8-3.8%) all increased significantly among deliveries to patients aged 11-19 years. Compared with deliveries to patients aged 20-54 years, deliveries to patients aged 11-14 years were associated with increased risk for severe maternal morbidity (aOR 1.73, 95% CI 1.49-2.00), hypertensive disorders of pregnancy (aOR 1.79, 95% CI 1.71-1.88), and postpartum hemorrhage (aOR 1.37, 95% CI 1.27-1.49). Deliveries among patients aged 11-19 years have decreased, but both comorbidity and risk for adverse outcomes increased among this age group.

Need of ICU in Obstetrical Complications

To elaborate on the role of the Intensive Care Unit (ICU) in Obstetric patients, their clinical properties, interventions, and the research results. Study Design: A Case-control study is performed to get the medical history of obstetric patients admitted to Hospital from 2018 to 2021. Location of Study: Aziz Bhatti Shaheed hospital, Gujrat, Pakistan. Results: From the patients admitted to Hospital, 87% out of 195 were kept on Ventilator. At the postnatal stage, there were no significant death rates were observed. Most of the admitted patients were 34-year-old, maximally survive for 53 days and minimally for one day only. Out of the total population admitted to hospital, 61% are with organ failure. The significant death rate of those patients is ~26%. Patients with gastrointestinal complications have the highest death rate. Haematological affected patients have a large number ~29%. Conclusion: In case of haemorrhage, hypertensive, sepsis, and infectious disorders, primary screening of patients is required before there is a need for ICU. The outcome of high-risk pregnant women is improved by increasing their alertness and stabilizing their condition before intervention is offered. Maternal morbidity could be reduced by improving the quality of care provided before and after being admitted to the ICU.

Postpartum-specific Vital Sign Reference Ranges

(Obstet Gynecol. 2021;137:295–304. doi: 10.1097/AOG.0000000000004239) Though the majority of maternal deaths occur in the postpartum period (57% in the United States), compared with the antenatal and intrapartum periods, the postpartum period doesn’t receive as much focus. Abnormal vital signs such as venous thromboembolism, hemorrhage, sepsis, and gestational hypertensive disorders are the leading cause of death during the postpartum period. Little data exists for postpartum vital signs. This study aims to estimate maternal postpartum vital sign ranges.

Predictors and causes of in-hospital maternal deaths within 120 h of admission at a tertiary hospital in South-Western, Nigeria: A retrospective cohort study.

An efficient, comprehensive emergency obstetrics care (CEMOC) can considerably reduce the burden of maternal mortality (MM) in Nigeria. Information about the risk of maternal death within 120 h of admission can reflect the quality of CEMOC offered. This study aims to determine the predictors and causes of maternal death within 120 h of admission at the Lagos University Teaching Hospital, LUTH, Lagos South-Western, Nigeria. We conducted a retrospective cohort study amongst consecutive maternal deaths at a hospital in South-Western Nigeria, from 1 January 2007 to 31 December 2017, using data from patients' medical records. We compared participants that died within 120 h to participants that survived beyond 120 h. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate the factors affecting survival within 120 h of admission. Stata version 16 statistical software (StatCorp USA) was used for analysis. Of the 430 maternal deaths, 326 had complete records. The mean age of the deceased was 30.7± (5.9) years and median time to death was 24 (5-96) h. Two hundred and sixty-eight (82.2%) women out of 326 died within 120 h of admission. Almost all maternal deaths from uterine rupture (95.2%) and most deaths from obstetric haemorrhage (87.3%), induced miscarriage (88.9%), sepsis (82.9%) and hypertensive disorders of pregnancy (77.9%) occurred within 120 h of admission. Admission to the intensive care unit (P = 0.007), cadre of admitting doctor (P < 0.001), cause of death (P = 0.036) and mode of delivery (P = 0.012) were independent predictors of hazard of death within 120 h. The majority (82.2%) of maternal deaths occurred within 120 h of admission. Investment in the prevention and acute management of uterine rupture, obstetric haemorrhage, sepsis and hypertensive disorders of pregnancy can help to reduce MM within 120 h in our environment.

Management of Psychiatric Disorders during the Perinatal Period.

Management of Psychiatric Disorders during the Perinatal Period.

Effects of different frozen embryo transfer regimens on abnormalities of fetal weight: a systematic review and meta-analysis.

Reported increases in maternal and perinatal morbidity (including macrosomia, large for gestational age (LGA), cesarean section, hemorrhage and hypertensive disorders of pregnancy) following frozen embryo transfer (FET) cycles may be associated with the lack of a corpus luteum seen in programmed FET. Given the growing number of studies comparing outcomes between natural FET and programmed FET cycles, a meta-analysis would prove useful to detect the presence of abnormalities in fetal birth weight in patients undergoing natural and programmed FET cycles. The aim of this study was to provide a systematic review and meta-analysis of the effects of natural versus programmed methods of endometrial preparation for FET cycles on fetal weight and the risks of LGA and macrosomia. A literature search using MEDLINE, SCOPUS, EMBASE and clinicaltrials.gov was conducted for published research comparing neonatal outcomes in natural FET and programmed FET cycles. Primary outcomes of interest were fetal weight, macrosomia and LGA. Studies were included if the following criteria were met: study contained cohorts of NFET and programmed FET with outcome data of birth weight, large for gestational data and/or macrosomia. The data are presented as average weight and odds ratio (OR) with 95% confidence interval (CI) with fixed- or random-effects meta-analysis between cohorts of NFET and programmed FET cycles. Bias was assessed using Newcastle-Ottawa quality assessment scale for the 14 included studies. Multiple subgroup analyses were performed to assess for effect of the true natural cycle (defined as no ovulation trigger medication use) and the day of embryo transfer on fetal weight parameters compared with programmed cycle FET. A total of 879 studies were identified, with 15 meeting inclusion the criteria. The studies varied with respect to country of origin, definition of natural cycle FET and type of progesterone supplementation used. The included studies had similar gestational ages at the time of birth. Programmed FET cycles resulted in a higher fetal weight compared with natural FET cycles (mean difference 47.38 gp = 0.04). Programmed FET cycles were also at higher risk for macrosomia (OR 1.15, 95% CI 1.06-1.26) and LGA (OR 1.10, 95% CI 1.02-1.19) compared with natural FET cycles. Subgroup analyses demonstrated that programmed FET cycles resulted in a higher fetal weight compared with true natural FET (mean difference 62.18 gp = 0.0001) cycles. Cleavage stage embryo transfers had an increased risk of LGA (OR 1.27, 95% CI 1.00-1.62) and an increased risk of macrosomia (OR 1.25, 95% CI 1.08-1.44) in programmed FET cycles compared with natural FET cycles. Blastocyst transfer in programmed FET cycles resulted in no difference in risk of macrosomia but an increased risk of LGA (OR 1.13, 95% CI 1.06-1.21) compared with natural FET cycles. Programmed endometrial preparation for FET cycles had a significant effect, causing increased fetal birth weight and increased risks of LGA and macrosomia. The numbers of studies in the subgroup analyses were too low to determine reliable results. Further prospective randomized trials are needed to determine whether the changes seen in the observational trials are indeed accurate.

Maternal morbidity of adolescent pregnant women

Background: In Mexico, it is estimated that the adolescent population represents 29% of the population of childbearing age. The present study aimed to analyze the obstetric results of 3310 adolescent pregnant women attended in a third level hospital. Material and methods: All records of pregnant women aged 19 years or less up to the date of admission were analyzed at the Mónica Pretelini Saenz Maternal Perinatal Hospital during the period from January 2018 to June 2020, with the following variables: age, pregnancy, resolution obstetric, severe preeclampsia, preeclampsia and gestational hypertension. Results: A total of 13874 pregnant women were attended, of which 3310 (24%) patients were adolescents. The overall frequency of obstetric complications was 21%, including obstetric hemorrhage (13%) and hypertensive disorders of pregnancy (8%). Regarding postpartum obstetric hemorrhage events, classified according to the Advanced Trauma Life Support shock scale, they were categorized as Grade 1 – 338 cases, Grade II – 76 cases, Grade III – 11 cases and Grade IV – 1 case. Hypertensive disorders of pregnancy highlight preeclampsia as the most frequent with a total of 97 cases, followed by 89 cases of severe preeclampsia, 58 cases of gestational hypertension, 14 cases of chronic hypertension and 3 cases of chronic hypertension with preeclampsia. Conclusions: The main complications found in the Mexican pregnant adolescent population were obstetric hemorrhage, which was more frequent in the population aged 15 to 19 years, and hypertensive disorders, which occurred more frequently in the population aged 9 to 14 years.

Postpartum-specific Vital Sign Reference Ranges

(Obstet Gynecol. 2021;137:295–304. doi: 10.1097/AOG.0000000000004239. PMID: 33417320) The majority of maternal deaths occur in the postpartum period (57% in the United States), compared with the antenatal and intrapartum periods. However, maternal deaths in the postpartum period have not been studied as extensively as the antenatal and intrapartum periods. Venous thromboembolism, hemorrhage, sepsis, and gestational hypertensive disorders are the leading causes of death during postpartum. Little data exists describing normal postpartum vital signs. This study aimed to estimate maternal postpartum vital sign ranges.

Younger age at intracranial aneurysms rupture among patients with opioid use disorders

BackgroundAssociation between opioid abuse and intracranial aneurysms rupture has been suggested in recent studies. However, these observations are limited to single center studies and could be benefited from validation in larger cohorts. Hence, we aimed to study the association between age at aneurysmal subarachnoid hemorrhage (aSAH) and opioid use disorders (OUD) using a large, national database. MethodsThis study was conducted using the 2016 and 2017 National Inpatient Sample (NIS) with ICD-10 codes. Cohorts were categorized as “Non-users”, “OUD”, and “Multi-drug users”. Linear regression models were used to examine the association between OUD and multi-drug users with age at aneurysm rupture, and multiple logistic regression models were used for the association between in-hospital mortality and drug abuse. ResultsA total of 17,391 patients with aSAH were captured in the 2016 and 2017 NIS database. Out of these patients, 235 (1.4%) were included in the OUD group and 59 (0.3%) in the multi-drug users’ group. Adjusted linear regression showed an unstandardized coefficient (UC) = −12.3 [95%CI = −14.4/−10.1, p < 0.001] for OUD patients and an UC = −16.8 [95%CI = −21.1/−12.5, p < 0.001] for multi-drug users, compared to non-users. The risk of in-hospital mortality was significantly increased in drug user, OR = 1.47 [95%CI: 1.1–2.01, p = 0.017] for OUD patients, and OR = 2.35 [95%CI: 1.35–4.11, p = 0.003] for multi-drug users. ConclusionsThis is the first national study to examine the association between age at intracranial aneurysms rupture and opioid abuse. aSAH patients with history of OUD were 12 years younger compared to non-users, when OUD was combined with other drugs, the age at aneurysms rupture was 17 years younger. Further elucidation regarding the mechanisms by which opioids triggers aneurysms rupture and predispose to worsen outcomes following aSAH is required, as well as appropriate prevention, and management strategies for aSAH patients with OUD.