Higher Risk Of Cesarean Section Research Articles

Obstetrical and neonatal outcomes in patients with surgically repaired heart disease

BackgroundCongenital and acquired heart disease complicate 1-4% of pregnancies in the United States. Beyond the risks of the underlying maternal congenital heart disease, cardiac surgery and its sequelae, such as surgical scarring resulting in higher rates of arrhythmias and implanted valves altering anticoagulation status, have potential implications that could affect gestation and delivery. ObjectiveTo investigate whether history of maternal cardiac surgery is associated with adverse obstetrical or neonatal outcomes when compared to patients without a history of cardiac disease or surgery, considered “healthy controls”. Study DesignThis is a secondary analysis of retrospective cohort studies performed at a tertiary care facility in the United States comparing obstetrical outcomes in patients with a history of open cardiac surgery that delivered from January 2007 – December 2018 with healthy controls, that delivered from April 2020-July 2020. There were 74 pregnancies in 61 patients with a history of open cardiac surgery that were compared to pregnancies in healthy controls. Of the 74 pregnancies, 65 were successfully matched based on gestational age to controls at a 1:3 (case:control) ratio. The remainder of cases were matched at a 1:2 or 1:1 ratio; therefore, a total of 219 control pregnancies were included in the analysis. Our primary outcome was the incidence of hypertensive disorders of pregnancy, as well as cesarean section, in patients with a history of open cardiac surgery compared with healthy controls. Our secondary outcome was the incidence of low-birth-weight neonates in patients with a history of open cardiac surgery compared with healthy controls. ResultsPatients with a history of cardiac surgery were not more likely to have any hypertensive disorder diagnosed than healthy controls. Patients with a history of cardiac surgery were more likely to have an operative delivery (p<0.0001) but equally likely to have a cesarean section (p=0.528) when compared with healthy controls. Birthweight was not statistically different of 2655 grams ± 808 grams in neonates born to patients with a history of cardiac surgery vs. 2844 grams ± 830 grams born to healthy controls (p=.092). ConclusionsPatients with a history of cardiac surgery may not be at higher risk of hypertensive disorder diagnosis during pregnancy. Similarly, most patients with a history of cardiac surgery are also likely not at higher risk for cesarean section or low birthweight neonates.

Obesity in Pregnancy as a Risk Factor in Maternal and Child Health-A Retrospective Cohort Study.

The prevalence of overweight and obesity has risen dramatically in the last few years. This has led to an increase in both conditions in pregnant women. Obesity and overweight are associated with complications for both the mother and the newborn. The aim of this study is to determine the prevalence of obesity and its association with the risk of complications during pregnancy. Materials and Methods: We conducted a retrospective cohort study of pregnant women who delivered from 1 January 2012 to 31 December 2018. Results: A higher prevalence of obesity is observed in the group of women aged 35 or older. Women with a BMI > 25 present a higher risk of cesarean section (aOR 1.49, 95% CI: 1.37-1.61), preeclampsia (aOR 1.64, 95% CI: 1.19-2.26), high-risk pregnancy (aOR 2.34, 95% CI: 1.68-2.6), Apgar < 7 at one minute (aOR 1.53, 95% CI: 1.25-1.89) and macrosomia (aOR 2.08, 95% CI: 1.83-2.37). Maternal overweight and obesity are important determinants of the risk of complications for both the mother and the newborn.

SARS-CoV-2 infection during pregnancy and perinatal outcomes in Estonia in 2020 and 2021: A register-based study.

Data from different countries show partly controversial impact of SARS-CoV-2 infection on pregnancy outcomes. A nationwide register-based study was conducted in Estonia to assess the impact of SARS-CoV-2 infection at any time during pregnancy on stillbirth, perinatal mortality, Apgar score at 5 minutes, cesarean section rates, rates of preterm birth and preeclampsia. Data on all newborns and their mothers were obtained from the Estonian Medical Birth Registry, and data on SARS-CoV-2 testing dates, test results and vaccination dates against SARS-CoV-2 from the Estonian Health Information System. Altogether, 26 211 births in 2020 and 2021 in Estonia were included. All analyses were performed per newborn. Odds ratios with 95% confidence intervals (CI) were analyzed for all outcomes, adjusted for mother's place of residence, body mass index, age of mother at delivery and hypertension and for all the aforementioned variables together with mother's vaccination status using data from 2021 when vaccinations against SARS-CoV-2 became available. For studying the effect of a positive SARS-CoV-2 test during pregnancy on preeclampsia, hypertension was omitted from the models to avoid overadjustment. SARS-CoV-2 infection during pregnancy was associated with an increased risk of stillbirth (adjusted odds ratio [aOR] 2.81; 95% CI 1.37-5.74) and perinatal mortality (aOR 2.34; 95% CI 1.20-4.56) but not with a lower Apgar score at 5 minutes, higher risk of cesarean section, preeclampsia or preterm birth. Vaccination slightly decreased the impact of SARS-CoV-2 infection during pregnancy on perinatal mortality. A positive SARS-CoV-2 test during pregnancy was associated with higher rates of stillbirth and perinatal mortality in Estonia but was not associated with change in preeclampsia, cesarean section or preterm birth rates.

Causes and consequences of fever in Amazonian pregnant women: A large retrospective study from French Guiana.

The aim of this study was to describe different causes and consequences of fever during pregnancy in Western French Guiana and along the Maroni River. A retrospective single-center study including all patients with a history of documented fever ≥ 38°C during pregnancy at the West French Guiana Hospital for 9 years. Postpartum fever and nosocomial infections were excluded. We focused on medical history and on clinical and biological findings. Causes were characterized as confirmed or uncertain and then classified as preventable or non-preventable. A total of 940 pregnant women who experienced at least one episode of fever were included and compared to 23,811 deliveries who occurred during the same period without documented fever. Among them, 43.7% (411/940) were in labor. About 3.7% (35/940) of febrile pregnant women had at least two episodes of fever, while 0.3% (3/940) had a coinfection at the time of diagnosis, resulting in a total of 978 febrile episodes. Among them, causes remained unknown or uncertain in 7.6% (75/978) and 0.9% (9/978) of cases, respectively. Among confirmed causes of fever throughout pregnancy (n = 483), the most common known cause was arbovirus infection (146/483, 30.2%), followed by urinary tract infection (134/483, 27.7%), chickenpox (27/483, 5.6%), and gastrointestinal (14/483, 2.9%) and pulmonary infections (10/483, 2%). Mothers with fever had a higher risk of cesarean section (19.8% vs 15.5%, aOR 1.3 [95% CI 1.14-1.6], stillbirth (5.5% versus 1.9%, aOR 2.7 [95% CI 2-3.7]), and preterm delivery < 34 weeks of gestation (7.2% vs 4.7%, aOR 1.5 [95% CI 1.2-2]. In the Amazon region, causes of fever are diverse and often associated with epidemic waves, notably arboviruses. This must be considered when exploring possible causes of fever during pregnancy in these localities, including fetal anomalies and/or fetal loss. Physicians should consider the epidemiological context and avoid generalizations. Given the impact of emergent agents such as arboviruses on pregnancy, particular attention must be paid to the epidemiological context. This study can also help clinicians when managing fever in pregnant travelers or in their partner after having visited exposed areas. In this context, fetal abnormalities and adverse obstetric outcomes should be explored accordingly.

Prediction of cesarean delivery in class III obese nulliparous women: An externally validated model using machine learning.

class III obese women, are at a higher risk of cesarean section during labor, and cesarean section is responsible for increased maternal and neonatal morbidity in this population. the objective of this project was to develop a method with which to quantify cesarean section risk before labor. this is a multicentric retrospective cohort study conducted on 410 nulliparous class III obese pregnant women who attempted vaginal delivery in two French university hospitals. We developed two predictive algorithms (a logistic regression and a random forest models) and assessed performance levels and compared them. the logistic regression model found that only initial weight and labor induction were significant in the prediction of unplanned cesarean section. The probability forest was able to predict cesarean section probability using only two pre-labor characteristics: initial weight and labor induction. Its performances were higher and were calculated for a cut-point of 49.5% risk and the results were (with 95% confidence intervals): area under the curve 0.70 (0.62,0.78), accuracy 0.66 (0.58, 0.73), specificity 0.87 (0.77, 0.93), and sensitivity 0.44 (0.32, 0.55). this is an innovative and effective approach to predicting unplanned CS risk in this population and could play a role in the choice of a trial of labor versus planned cesarean section. Further studies are needed, especially a prospective clinical trial. French state funds "Plan Investissements d'Avenir" and Agence Nationale de la Recherche.

Prophylactic Administration of Tranexamic Acid Reduces Blood Products' Transfusion and Intensive Care Admission in Women Undergoing High-Risk Cesarean Sections.

Postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Tranexamic acid (TxA) has shown effectiveness in reducing PPH-related maternal bleeding events and deaths. We conducted a cohort study including parturient women at high risk of bleeding after undergoing a cesarean section (CS). Participants were divided into two groups: the treatment group received prophylactic 1-g TxA before surgery (n = 500), while the comparison group underwent CS without TxA treatment (n = 500). The primary outcome measured increased maternal blood loss following CS, defined as more than a 10% drop in hemoglobin concentration within 24 h post-CS and/or a drop of ≥2 g/dL in maternal hemoglobin concentration. Secondary outcomes included PPH indicators, ICU admission, hospital stay, TxA complications, and neonatal data. TxA administration significantly reduced hemoglobin decrease by more than 10%: there was a 35.4% decrease in the TxA group vs. a 59.4% decrease in the non-TxA group, p < 0.0001 and hemoglobin decreased by ≥2 g/dL (11.4% in the TxA group vs. 25.2% in non-TxA group, p < 0.0001), reduced packed red blood cell transfusion (p = 0.0174), and resulted in lower ICU admission rates (p = 0.034) and shorter hospitalization (p < 0.0001). Complication rates and neonatal outcomes did not differ significantly. In conclusion, prophylactic TxA administration during high-risk CS may effectively reduce blood loss, providing a potential intervention to improve maternal outcomes.

Application of glycemic qualification rate based on fingerstick glucose monitoring in women with gestational diabetes mellitus

Objective To explore the appropriate application of glycemic qualification rate (GQR) calculated by fingerstick blood glucose (BG) monitoring for patients with gestational diabetes mellitus (GDM) by analyzing the relationship between BG control and adverse pregnancy outcomes. Methods Fingerstick Blood Glucose data during the second and third trimester of singleton pregnant women diagnosed with GDM were collected. GQR which is defined as the percentage of fingerstick BG values reaching the targets of BG control in a period of time was calculated. Patients were divided into three groups according to tertiles (tertile 1, GQR <56.25%; tertile 2, GQR 56.25–75%; and tertile 3, GQR ≥75%). Pregnant outcomes were compared among the three groups. Univariate analysis and logistic regression were performed to analyze the potential relationship between GQR and pregnancy outcomes. Receiver operating characteristic (ROC) curves were calculated to determine the cutoff values. We also explored that whether twice or three times monitoring per day would be adequate for GQR calculation, so we brought in two or three glucose measuring times per day to explore the relationship between new GQR and adverse outcomes. Results A total of 311 patients diagnosed with GDM were analyzed. In univariate analysis, the incidences of cesarean section of tertile 1–3 groups were 61.4%, 58.7%, and 44.9%, respectively (p < .05). The incidences of neonatal hypoglycemia of tertiles 1–3 groups were 19.8%, 18.6%, and 8.7% (p < .05). The difference of composite outcomes was statistically significant (p = .001). After adjustment, the patients with worse BG control (lower GQR) had higher risk of cesarean section (tertile 1 – aOR = 2.029, 1.128–3.648), neonatal hypoglycemia (tertile 1: aOR = 2.498, 1.082–5.766) as well as composite outcomes. The ROC curve of GQR indicated the predictive value for neonatal hypoglycemia (area under the ROC curve (AUC) 0.612 (0.532–0.692)) and neonatal composite outcomes (AUC 0.593 (0.528–0.657)) with optimal cutoff values of 81.1% and 73.5%, respectively. We also explored that whether twice or three times monitoring per day would be adequate for GQR calculation. The result showed that GQR only calculated by FBG + 2hPG after lunch (2h AL) per day also had well relationship with cesarean section (tertile 1: OR = 2.412, 1.322–4.398), neonatal hypoglycemia (tertile 1: aOR = 4.497, 1.607–12.586), and neonatal composite outcomes (tertile 1: aOR = 1.959, 95% confidence interval (CI): 1.114–3.444, p = .020). Conclusions The GQR calculated by the easily applicable fingerstick BG is related to occurrence of cesarean section and neonatal hypoglycemia in GDM women. GQR ≥ 80% is recommended for better pregnancy outcomes. As for the number of points monitoring per day, GQR calculated by FBG + 2h AL was an optimal option for better pregnancy outcomes if mothers needed to simplify the process of monitoring.

Inducción del parto en gestaciones gemelares: estudio comparativo de oxitocina vs dinoprostona

IntroductionIn the last few years the number of twin gestations that reach term has increased. Although vaginal delivery route has proven to be a safe alternative to caesarean section when first foetus is in cephalic presentation, available evidence on induction methods applied to this type of pregnancies is limited. MethodsRetrospective observational study conducted in a tertiary hospital. Forty-four pregnant twins, with gestational age greater than 34weeks, and with the first twin in cephalic presentation, who underwent induction of labour, were included. Vaginal prostaglandins (dinoprostone) were used in 17 cases and intravenous oxytocin in 27 cases, indication was randomised according to daily clinical practice. Results of both groups were compared in terms of safety and efficacy. ResultsNo significant differences were found in the rate of caesarean section due to induction failure between oxytocin and prostaglandins (42.9% vs. 57.1%; P=.3). No differences were found either in terms of neonatal or maternal complications. Two pregnant women presented obstetric haemorrhage, the only maternal complication described, both in oxytocin group. Higher risk of caesarean section was found in women with BMI >30kg/m2 (P=.001) and pre-induction Bishop's index ≤6 (RR: 2.06) (P=.005). ConclusionsBoth vaginal prostaglandins and intravenous oxytocin are similar in efficacy, maternal and neonatal safety when used in twin gestations. Bishop's index ≤6 and BMI >30 are associated with higher probability of induction failure.

The combined effect of pre-pregnancy body mass index and gestational weight gain on the risk of pre-labour and intrapartum caesarean section-The ICE-MCH study.

Women who are obese before pregnancy have a higher risk of caesarean section than normal weight women. We investigated the combined effect of pre-pregnancy weight and gestational weight gain on pre-labour and intrapartum caesarean section risk. We collected data on 22,763 singleton, term, live deliveries in 2003-2014 from the Icelandic Maternal and Child Health Study (ICE-MCH), based on Icelandic registries. These were the Icelandic Medical Birth Registry and the Saga Maternal and Child Health Database. Pre-pregnancy body mass index was categorised into underweight, normal weight, overweight and obese. Gestational weight gain was classified according to the Institute of Medicine´s recommendation into below, within and above the recommended range. Logistic regression models, adjusted for maternal and gestational characteristics, were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the risk of caesarean section. Obese women had a higher risk of pre-labour (AOR 1.56, 95% CI 1.34-1.81) and intrapartum caesarean section (AOR 1.92, 95% CI 1.70-2.17) than normal weight women in all categories of gestational weight gain. Gestational weight gain above the recommended range, compared to within the range, increased the risk of intrapartum caesarean section among normal weight (AOR 1.46, 95% CI 1.23-1.73) and overweight women (AOR 1.291, 95% CI 1.04-1.60). Gestational weight gain below the recommended range, compared to within the range, increased the risk of pre-labour caesarean section (AOR 1.64, 95% CI 1.20-2.25), but only among overweight women. Women who are obese before pregnancy have a high risk of caesarean section regardless of gestational weight gain. However, women who are normal weight or overweight before pregnancy and gain weight above the recommended range during pregnancy may also have an increased risk of caesarean section.

The success of vaginal birth by use of trans-labial ultrasound plus vaginal examination and vaginal examination only in pregnant women with labor induction: a comparative study

BackgroundPredicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. Thus, this study aimed to compare the success rate of vaginal birth by using trans-labial ultrasound and vaginal examination, and vaginal examination only in pregnant women with labor induction.MethodsThis was a comparative study including 392 eligible pregnant women with labor induction attending to a teaching hospital affiliated with Iran University of Medical Sciences from April to October 2018 in Tehran, Iran. Women were randomly assigned to two groups; the trans-labial ultrasound plus vaginal examination (group A), and the vaginal examination only (group B). Women were included in the study if they satisfied the following criteria: singleton pregnancy, 37 to 42 weeks of gestational age, fetal head presentation, a living fetus with no abnormalities, uncomplicated pregnancy, and no previous cesarean section or any uterine surgery. We used a partograph for both groups to assess the fetal head position and the fetal head station. In group 1, the Angle of Progression (AoP) and Rotation Angle (RA) were also assessed. Finally, the success and progression of vaginal delivery in two groups were compared by predicting the duration of delivery and mode of delivery.ResultsThe findings showed that 8.68% of women in the trans-labial plus vaginal examination group delivered by cesarean section, while 6.13% in the vaginal examination only group delivered by cesarean section (P = 0.55). In women with cesarean section in positive fetal head stations, Angle of Progression (AoP) was significantly decreased ranging from 90 to 135 degrees compared to women who delivered vaginally (135–180 degrees; P < 0.001). In addition, the Rotation Angle (RA) was significantly decreased in women with cesarean section ranging from 0 to 30 degrees compared to women who delivered vaginally (60-90degrees; P < 0.001). Further analysis indicated that a higher risk of cesarean section was associated with vaginal examination only as compared to trans-labial ultrasound plus vaginal examination (HR: 8.65, P < 0.001).ConclusionAngle of Progression (AoP) and Rotation Angle (RA) indexes might be useful parameters to predict labor progression and successful vaginal delivery among women undergoing labor induction.

Perinatal outcomes associated with ICP in twin pregnancies were worse than singletons: an almost 5-year retrospective cohort study

BackgroundIntrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse perinatal outcomes leading to high perinatal morbidity and mortality. However, few studies have examined twin pregnancies complicated by ICP. To assess the perinatal outcomes of twin pregnancies with ICP, a retrospective cohort study was conducted.MethodsA total of 633 twin pregnancies and 1267 singleton pregnancies with ICP were included. In addition, a correlation study was performed on the matched total bile acid (TBA) levels from maternal serum, fetal umbilical venous blood, and amniotic fluid of 33 twin pregnancies from twin groups.ResultsWhen compared to singletons, twin pregnancies with ICP had a higher risk of cesarean section (CS) (96.4% vs. 76.1%), preterm birth (PTB) (82.6% vs. 19.7%), fetal distress (2.0% vs. 1.3%), and neonatal intensive care unit (NICU) admission (23.6% vs. 5.1%), which was significantly related to increasing TBA levels (P < 0.05). In twin pregnancies with TBA ≥100 μmol/L, the incidences of CS, PTB, fetal distress, neonatal asphyxia, and meconium-stained amniotic fluid were 94.4, 100, 11.1, 5.6, and 36.1%, respectively. Furthermore, the maximum maternal TBA levels were positively correlated with TBA levels in the amniotic fluid (r = 0.61, P < 0.05) and umbilical cord blood (r = 0.44, P < 0.05), and a similar correlation was found for maternal TBA levels at delivery. TBA levels in umbilical cord blood and amniotic fluid also had a significant and positive correlation (r = 0.52, P < 0.05).ConclusionsTwin pregnancies with ICP had a higher risk for adverse perinatal outcomes than singletons, which was associated with higher TBA levels. TBA can be transported through the placenta and is involved in uterus-placenta-fetal circulation.

Factors influencing the first thousand days of life

Abstract Background The first 1000 days are crucial for the health of the baby and the well-being of the mother-baby dyad, which forms a single complex organism with its co-metabolism expressed through sophisticated neurobiological, epigenetic and microbiome development mechanisms. This study aims to investigate how much social support can influence the path of pregnancy and motherhood. Methods The retrospective observational study was conducted on a sample of mothers enrolled through social networks who were administered a questionnaire from July to September 2021. The questionnaire consisted of 37 questions: 11 analyzed sociodemographic variables, 20 were on current / any previous pregnancies and breastfeeding, and 6 were used to calculate the Maternity Social Support Scale (MSSS-Webster et al.). STATA 14 was used for statistical analysis. Results Our sample consisted of 3447 women. 88.0% wanted the pregnancy, and 63.5% planned it. The average of the Maternity Social Support Scale (MSSS) was 23.91 points. A low MSSS score correlates with a higher risk of cessation of breastfeeding before 6 months of age, a higher risk of not having spontaneous labour, a higher risk of cesarean section and a higher risk of not having a spontaneous birth. On the other hand, a higher MSSS total score is a protective factor concerning breastfeeding duration, which is more likely to be longer-lasting (&amp;gt;6 months), to have spontaneous onset labour with a higher probability of spontaneous delivery. Conclusions The results showed that most of our sample have good friends who support them, can often count on their family, and receive help from their partner/husband. The outcomes of pregnancy, childbirth and motherhood are strongly influenced and conditioned by the social context in which they occur and the support the woman can receive. The presence or lack of this support can affect the health of newborns. Key messages • The first 1,000 days is a vulnerable phase in which parents, institutions and health professionals should create early interventions for the proper development and promotion of good health. • the outcomes of pregnancy, birth and motherhood are strongly influenced and conditioned by the social context, but especially by the presence or lack of support that can affect the health of newborns.

Gestational weight gain and mode of delivery by the class of obesity: A meta-analysis.

The association between gestational weight gain (GWG) and mode of delivery in females with different obesity classes is not clear. We conducted a meta-analysis to evaluate the association between GWG, categorized according to the 2009 Institute of Medicine (IOM) guidelines, and the risk of cesarean section (CS) or operative vaginal delivery (OVD) in females with different obesity classes. Eight studies were identified. The pooled odds ratios (ORs) (95% confidence interval [CI]) of CS for females with GWG above the recommendations were 1.27 (1.20-1.33) for obesity class I, 1.22 (1.20-1.23) for class II, and 1.17 (1.15-1.19) for class III. Also, the pooled ORs (95% CI) of OVD were 1.21 (1.005-1.46) for obesity class I, 1.12 (1.04-1.21) for class II, and 1.10 (1.001-1.22) for obesity class III. GWG below the recommendations was associated with lower risk of CS for females with obesity class I (OR 0.87, 95% CI 0.82-0.92), class II (OR 0.84, 95% CI 0.77-0.90), and class III (OR 0.86, 95% CI 0.79-0.93). Pregnant participants gaining weight above the 2009 IOM guidelines were at higher risk for CS and OVD regardless of obesity classes. Gaining weight below the guidelines was associated with a lower risk of CS among females in any obesity class.

Frequency of Cesarean Section in Patients with Previous One Scar

Objective: To determine the frequency of cesarean section in patients with previous one scar. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology, ATH, Abbottabad from 1st June 2020 to 30th November 2020. Methodology: One hundred and thirty pregnant women with previous one scar were included in the study. All participants were managed as per department protocol and frequency of cesarean section was noted. Results: The age range was from 18 to 35 years with mean age of 29.361±1.95 years, mean gestational age 38.592±1.26 weeks, mean parity 1.923±0.91 and mean weight was 70.776±4.20 kg. Cesarean section was seen in 25.4% patients. Conclusion: Prior scar women are at higher risk of caesarean section unless the type of delivery method. Keywords: Pregnancy, Previous one scar, Cesarean section

Association between Trimester-Specific Gestational Weight Gain Rate and Maternal and Neonatal Outcomes

Background: To investigate the associations of adjusting gestational weight gain rate (GWGr) with maternal and neonatal outcomes. Methods: We analyzed 6235 singleton pregnancies among women with normal pre-pregnancy body mass index at two medical centers in China during 2016~2018 to figure out whether pregnancy outcomes could be improved by adjusting GWGr timely when the first-trimester weight gain rate (GWGr-1) and/or the second-trimester weight gain rate (GWGr-2) were inappropriate. Results: When GWGr-1 was excessive, excessive GWGr during the second and third trimesters of pregnancy (late GWGr) was associated with a higher risk of cesarean section (CS), postpartum hemorrhage (PPH), obstructed and prolonged labor and large for gestational age (LGA), and inadequate late GWGr was associated with a lower prevalence of CS and hypertensive disorders of pregnancy (HDP). In pregnancies with inadequate GWGr-1, excessive late GWGr was related to a higher rate of CS, LGA and HDP. Among women with adequate GWGr-1, excessive GWGr in the third trimester (GWGr-3) was positively associated with CS, HDP, and obstruction and prolongation of labor if their GWGr-2 was excessive, and excessive GWGr-3 was associated with a higher risk of CS even though tFheir GWGr-2 was inadequate. Conclusions: Prompt control of GWGr, even during late pregnancy, was beneficial to improving pregnancy outcomes.

Valores extremos del IMC materno: factores determinantes de peores resultados obstétricos y perinatales

ObjectiveTo study the influence of maternal body mass index (BMI) at the beginning of pregnancy on obstetric-perinatal outcomes. Material and methodsObservational-ambispective study. We recruited 1407 patients with singleton gestations and deliveries of foetuses>24 weeks between 01/12/2017 and 31/07/2019. The sample was stratified according to their BMI following the WHO classification. Variables on pre-pregnancy, gestational disease, obstetric care, and maternal-perinatal outcomes were analysed and compared between the studied groups. The statistical program has been R Core Team 2020, version 3.6.3. P≤.05 was considered significant. ResultsClass II-III (BMI 35-39 and BMI≥40 respectively) obese women have a higher risk of chronic arterial hypertension (OR 53.54, 95% CI 18.21-229.02), gestational diabetes (OR 5.24, 95% CI 2.87-9.51) and preeclampsia (OR 2.38, 95% CI 0.95-5.51 with P=.049). The underweight women had more intrauterine growth restriction diagnoses (OR 3.09, 95% CI 1.46-6.17). Inductions of labour and caesarean sections increase as BMI increases (P=.006). Low weight patients also had a higher risk of caesarean section (OR 2.46, 95% CI 1.06-5.20). Neonatal admissions were more frequent in obese and underweight women (OR 2.68, 95% CI 1.39-5.00 and OR 2.56, 95% CI 1.10-5.44 respectively). Obese women had a higher risk of neonatal weight>4000g (OR 3.06, 95% CI 1.57-5.77) and low weight pregnant women had a higher risk of neonatal weight<2500g (OR 2.94, 95% CI 1.54-5.41). ConclusionExtreme values of maternal BMI at the beginning of gestation are determining factors for an adverse obstetric-perinatal outcome.

Impact of diabetes on the severity of COVID-19 infection in pregnant women - A single-center descriptive study

Background and aimsPregnant women have significant morbidity and mortality due to COVID-19 infection. Pregnancy and diabetes are known risk factors for severe COVID 19 infection. Understanding the interactions between COVID-19 and diabetes in pregnancy is crucial in developing appropriate therapeutic approaches. India, like many other countries, has a very high prevalence of diabetes and COVID-19 infected cases. Such studies are minimal worldwide and none from India to the best of our knowledge. Materials and methodsWe did a retrospective cross-sectional study. 856 COVID-19 infected pregnant women were included in the study. We estimated the impact of diabetes on the severity of COVID-19 infected pregnant women and compared the outcomes with the non-diabetic group. ResultsPrevalence of diabetes in pregnancy in the present study was 15.43%(n = 132/856). Prevalence of diabetes in non-severe infection was 14%(n = 115/818), severe infection was 44.73%(n = 17/38), and in maternal deaths was 75% (n = 6/8). The age-adjusted odds ratio for diabetes for severe infection was 4.492 (95% CI = 2.277–8.865, p < 0.001). COVID-19 infected pregnant women with diabetes were at higher risk for Cesarean section (78.3%) and ICU admission for newborns (14.81%) ConclusionDiabetes in pregnant women is strongly associated with the severity of COVID-19 infection. The prevalence of diabetes in pregnancy increases as the severity of COVID-19 infection increases. Diabetes is associated with more adverse outcomes in mothers and newborns. It is necessary to identify pregnant women with diabetes and prioritize them in public health interventions like vaccination.

Analysis of Delivery in Singleton Pregnancies Achieved by In Vitro Fertilization

BACKGROUND: Birth after IVF is increasingly observed in modern obstetrics, so knowledge of its features is of paramount importance for clinical practice. &#x0D; AIM: The purpose of our study was to compare IVF and spontaneous singleton pregnancies in terms of cesarean section rate, operative vaginal birth rate, induction of labor, manual removal of the placenta in vaginal births, severe PPH and need for blood transfusion after delivery.&#x0D; &#x0D; MATERIAL AND METHODS: We conducted a retrospective study at "Maichin Dom" University Hospital in Sofia, Bulgaria for the period from January 2013 to December 2017 and analyzed 402 singleton IVF pregnancies and compared them with 523 spontaneous singleton pregnancies &#x0D; &#x0D; RESULTS: We found a significantly higher rate of cesarean sections in IVF compared to spontaneous pregnancies [OR 1.73; 95% CI 1.4-2.14; p&lt;0.001]. Vaginal delivery after IVF is associated with a higher incidence of operative vaginal delivery than spontaneous pregnancies [OR 2.27; 95% CI 1.14 - 4.52; p=0.018]. No statistical differences in rates of labor induction and manual removal of the placenta between two groups were estimated (p&gt;0.05). Severe PPH and blood transfusions were three times higher in patients after IVF undergoing a cesarean section than in those with spontaneous singleton pregnancies [OR 3.0; 95% CI 1.11 - 8.11; p=0.018].&#x0D; &#x0D; CONCLUSION: IVF singleton pregnancies are associated with a higher risk of cesarean section as well as some obstetric complications. Obstetricians should treat these pregnancies with caution in order to reduce cesarean section rate and improve the outcome.

COVID19 PANDEMIC AND PREGNANCY

In a COVID19 pandemic, pregnant women become infected no more frequently than the general population. COVID19 in pregnant women is associated with a higher risk of caesarean section. Pregnant women with COVID19 who are obese, have high blood pressure, or a combination of two or more conditions are at risk for more severe disease and longer hospital stays.

Maternal outcomes and risk factors for COVID-19 severity among pregnant women

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.