Obstetric Hemorrhage Research Articles

Long-term results of zero-fluoroscopy catheter ablation in pregnant patients with arrhythmias: a 2-year follow-up study

Abstract Funding Acknowledgements Type of funding sources: None. Background Incidences of rhythm disturbance in pregnant are commonly seen. Catheter ablation of arrhythmias has been shown to be effective and safe. Data on perinatal outcomes and results of zero-fluoroscopy catheter ablation in pregnant patients is limited. Purpose the aim of our study is to observe long-term results and perinatal outcomes in pregnant women with arrhythmias, treated by zero-fluoroscopy catheter ablation method. Methods There were 48 pregnant women, who underwent zero-fluoroscopy catheter ablation (Mean age of pregnant was 25.7±4.3 years, mean gestation age 24.1 ±3.2 weeks). Procedure-related complications, perinatal outcomes and arrhythmia recurrence were documented during 24 months follow-up. Results The most common arrhythmias were atrioventricular nodal reentrant tachycardia (n=21; 43.75%). This was followed by Wolff–Parkinson–White syndrome (n=15; 31.25%). Combination of accessory pathways with slow conduction ways were found in 3 cases (6.25%). In six cases were ablation due to frequent premature ventricular contraction (12.5%). Ventricular tachycardia was rare during pregnancy (n=3; 6.25%). Zero-fluoroscopy catheter ablation was performed under the guidance of CARTO (n=21; 43.75%) and Ensite Precision systems (n=27; 56.25%). The median procedural time was 71±15 minutes. Interventions were effective in all cases (100%). Procedural complication was in one patient (2.1%), who developed an ileofemoral thrombosis. Pregnancy course after ablation procedure was benign in all patients. Perinatal outcomes: spontaneus vaginal delivery was in the majority of cases (n=36; 75%). Twelve pregnancies (25%) were delivered by cesarean section due to obstetric indicators. Intrapartum hemorrhage was 335.2±228.92 ml. Two women had placental abraption and preeclampsia (4.2%). Maternal adverse cardiac events were none declared. There were 48 live births (in all cases). Fetal birth weight was 3324.7±684.4 grams, 5 minute Apgar was 8.4±1.3. There were no maternal and fetal mortality. At 24 months there were no arrhythmia recurrence. Conclusions Zero-fluoroscopy catheter ablation method is safe and effective in pregnant women with arrhythmias. Pregnancy course and outcomes after this procedure is bening in the majority of cases.

Association Between Surgeon Gender and Maternal Morbidity After Cesarean Delivery

The stereotype that men perform surgery better than women is ancient. Surgeons have long been mainly men, but in recent decades an inversion has begun; the number of women surgeons is increasing, especially in obstetrics and gynecology. Studies outside obstetrics suggest that postoperative morbidity and mortality may be lower after surgery by women. To evaluate the association between surgeons' gender and the risks of maternal morbidity and postpartum hemorrhage (PPH) after cesarean deliveries. This prospective cohort study was based on data from the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, a multicenter, randomized, placebo-controlled trial that took place from March 2018 through January 2020 (23 months). It aimed to investigate whether the administration of tranexamic acid plus a prophylactic uterotonic agent decreased PPH incidence after cesarean delivery compared with a uterotonic agent alone. Women having a cesarean delivery before or during labor at or after 34 weeks' gestation were recruited from 27 French maternity hospitals. Self-reported gender (man or woman), assessed by a questionnaire immediately after delivery. The primary end point was the incidence of a composite maternal morbidity variable, and the secondary end point was the incidence of PPH (the primary outcome of the TRAAP2 trial), defined by a calculated estimated blood loss exceeding 1000 mL or transfusion by day 2. Among 4244 women included, men surgeons performed 943 cesarean deliveries (22.2%) and women surgeons performed 3301 (77.8%). The rate of attending obstetricians was higher among men (441 of 929 [47.5%]) than women (687 of 3239 [21.2%]). The risk of maternal morbidity did not differ for men and women surgeons: 119 of 837 (14.2%) vs 476 of 2928 (16.3%) (adjusted risk ratio, 0.92 [95% CI, 0.77-1.13]). Interaction between surgeon gender and level of experience on the risk of maternal morbidity was not statistically significant. Similarly, the groups did not differ for PPH risk (adjusted risk ratio, 0.98 [95% CI, 0.85-1.13]). Risks of postoperative maternal morbidity and of PPH exceeding 1000 mL or requiring transfusion by day 2 did not differ by the surgeon's gender.

Pregnancy, childbirth and neonatal outcomes of women with rare inherited coagulation disorders

Background We aimed to describe the characteristics and the pregnancy outcomes of women with rare inherited coagulation factor disorders managed at a tertiary obstetric-haematology unit in the United Kingdom. Methods A retrospective service evaluation was conducted using routinely collected medical records. Descriptive analyses were applied to investigate pregnancy, childbirth and neonatal management and outcomes. Results Overall, 20 patients with rare inherited coagulation disorders were included who birthed 30 live infants from 29 pregnancies. Regarding maternal bleeding outcomes, 3% experienced antepartum haemorrhage, 38% of pregnancies experienced primary post-partum haemorrhage, and none experienced secondary post-partum haemorrhage. Five (17%) neonates had cranial ultrasound scans for imaging to investigate for a neonatal haemorrhage, which were all normal. Conclusions Although women with rare inherited coagulation disorders may be more susceptible to complications in pregnancy, within this cohort there was no evidence that the condition led to increased morbidity or mortality when best practices were observed.

Handling obstetric emergencies: Paramedic, health informatics, and nursing interventions in prehospital care

Background: Maternal mortality rates in the UK have shown only a statistically insignificant decline, highlighting the need for urgent action. Obstetric emergencies remain a critical concern, contributing significantly to maternal mortality. The MBRRACE report underscores the challenges associated with direct and indirect causes of maternal death, particularly emphasizing conditions such as sepsis and hemorrhage. Aim: This article aims to explore paramedic and nursing interventions in managing obstetric emergencies during prehospital care, emphasizing the critical nature of timely and effective treatment. Methods: A comprehensive review of the existing literature was conducted, focusing on the management of obstetric emergencies, particularly sepsis and hemorrhage. Clinical guidelines were analyzed, highlighting key interventions and outcomes related to maternal care. Results: The findings reveal that obstetric emergencies, including sepsis and significant hemorrhage, require immediate and coordinated care from paramedics and nursing staff. Key interventions include early recognition, implementation of the sepsis-3-hour bundle, and effective communication within multidisciplinary teams. Conclusion: Enhancing the knowledge and preparedness of paramedic and nursing teams in managing obstetric emergencies is crucial in reducing maternal morbidity and mortality. Further research and continuous training are necessary to ensure that healthcare providers can respond effectively to these critical situations.

VARYING CLINICAL PRESENTATIONS OF CESAREAN SCAR ECTOPIC IN TERTIARY CARE CENTRE

Introduction: Cesarean scar pregnancy [CSP] is the implantation of gestational sac within the myometrium of prior caesarean surgery scar. The incidence of caesarean scar ectopic is 1 in 2000 normal pregnancies. CSP possess great risk for maternal haemorrhage, placenta accreta spectrum and uterine rupture. Women with caesarean scar ectopic usually present early. Pain and bleeding are common. However 40% of women are asymptomatic. Diagnosis is made by routine USG examination. Rarely early rupture can lead to abdominal pregnancy. To study various Aims And Objectives: clinical presentations, management, outcome of 3 caesarean scar pregnancies at a tertiary care centre. Materials And Methods: Retrospective study done in Department of Obstetrics and Gynaecology at Government Hospital Guntur from June 2021- June 2022. Sample size -3 Results: Out of 3 cases Ÿ One was presented with bleeding p/v as ?incomplete abortion Ÿ Other 2 cases were presented with pain abdomen with ?unruptured tubal ectopic Procedure: Ÿ Exploratory laparotomy with scar ectopic excision and repair Ÿ Exploratory laparotomy followed by sub total hysterectomy Conclusion: Cesarean scar ectopic is a rare and potentially life threatening ectopic pregnancy. Diagnosis of CSP could be done by comprehensive history taking and examination. Ultrasound is the main modality to identify. Early diagnosis and intervention is very important to decrease morbidity and mortality of Cesarean Scar Ectopic

Case report -Cesarean scar ectopic pregnancy

Cesarean scar ectopic pregnancy is one of the rarest of all ectopic pregnancy increase in number of cesarean section leads to increase in number of cesarean scar ectopic pregnancy. Early diagnosis and prompt management help in reducing mortality and morbidity occuring due to scar ectopic pregnancy. We are reporting a rare case of cesarean scar ectopic pregnancy G5P3L3D1 with period of gestation 7 weeks 3 days with previous all 4 deliveries by cesarean section. Cesarean scar ectopic pregnancy are life threatening as they pose a great risk of maternal hemorrhage as the patient vital are the stable patient managed medically with injection Methotrexate.

Knowledge, Utilization, and Associated Factors of Nonpneumatic Antishock Garments for Management of Postpartum Hemorrhage among Maternity Ward Health Care Professionals in South Wollo Zone Health Facilities, Ethiopia, 2021: A Cross-Sectional Study Design.

In 2017, approximately, 810 women died every day from preventable causes related to pregnancy and childbirth around the world. Obstetric hemorrhage, specifically postpartum hemorrhage, is the leading cause of preventable maternal mortality in the world. New strategies and technologies are needed to reduce the global public health epidemic of maternal mortality. However, nonpneumatic antishock garments were recently introduced and incorporated into teaching curriculums as a management modality for postpartum hemorrhage in Ethiopia. Therefore, this study assessed the knowledge, utilization and associated factors of nonpneumatic antishock garment among maternity ward healthcare professionals in the selected South Wollo zone health facilities, North West Ethiopia. An institutional-based cross-sectional study design was conducted from February 1 to April 30, 2021. A consecutive sampling technique was employed to collect the data. A self-administered semistructured English version questionnaire was used to collect the data. EPI-Info and SPSS were used for data entry and analysis, respectively. Bivariable and multivariable logistic regression analyses were used to analyze the association of nonpneumatic antishock garment utilization with independent variables. A total of 244 maternity ward health care professionals participated. One hundred forty-six (59.8%) had a good knowledge of nonpneumatic antishock garments. About 110 (45.1%) of the participants have ever used it for the management of postpartum hemorrhage. Those having one nonpneumatic antishock garment (AOR = 2.7, 95% CI: 1.3, 5.5), two or more nonpneumatic antishock garments (AOR = 14.1, 5.7, 35.0), good knowledge (AOR = 5.2, 2.5, 10.7), and positive attitude (AOR = 2.5, 1.1, 5.7) and those who were receiving training (AOR = 2.2, 1.1, 4.4) at 95% CI were significantly associated with utilization of nonpneumatic antishock garments. The knowledge and utilization of nonpneumatic antishock garments for the management of postpartum hemorrhage were low. Those having more nonpneumatic antishock garments, good knowledge, and a positive attitude and those who received training were found to be significantly associated with nonpneumatic antishock garment utilization. The provision of training and availability of nonpneumatic antishock garments are the key actions to be taken to increase the utilization of nonpneumatic antishock garments.

Utilization of Nonpneumatic Antishock Garment and Associated Factors among Obstetric Care Providers in Public Hospitals of Sidama Region, Hawassa, Ethiopia, 2022.

Nonpneumatic antishock garment is one of the newly emerging technology advances that reduce blood loss which is caused by obstetric hemorrhage and help women survive during delays to get definitive care. Over 80% of maternal mortality due to hemorrhagic shock may have been prevented if a nonpneumatic antishock garment had been utilized by an obstetric care provider. However, to the current knowledge, the utilization of nonpneumatic antishock garments is low and even no single study was conducted in the study area. Hence, we found that it is necessary to assess the magnitude and factors affecting the utilization of antishock garments among obstetric care providers in public hospitals of the Sidama region, Ethiopia, 2022. A facility-based cross-sectional study design was employed among 403 obstetric care providers from June 15 to July 15, 2022. A two-stage sampling technique was applied; the data was collected by 5 trained BSc midwives using pretested and structured self-administered questionnaires. Data was entered into EpiData Manager version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 26 software. Bivariate and multivariable logistic regression analyses were used. A total of 394 (97.8%) health professionals participated in this study. Overall, 30.71% (95% CI: 26.4%, 35%) of the obstetric care providers had utilized nonpneumatic antishock garments for the management of postpartum hemorrhage. Training on the antishock garment (AOR = 4.183, 95% CI: 2.167, 8.075, p < 0.00), tertiary hospital (AOR = 0.355, 95% CI: 0.132, 0.952, p < 0.04), having protocol in the facility (AOR = 2.758, 95% CI: 1.269, 5.996), availability of NASG in the facility (AOR = 4.6, 95% CI: 1.603, 13.24), good knowledge (AOR = 2.506, 95% CI: 1.26, 4.984), and positive attitude (AOR = 2.381, 95% CI: 1.189, 4.766) were significantly associated factors. Conclusion and Recommendation. We found that less than one-third of the study participants have used the antishock garment in the management of postpartum hemorrhage in the current study. In addition to enhancing in-service and ongoing professional development training, it is preferable to insure the availability and accessibility of antishock in the facilities in order to close the knowledge and attitude gap among obstetric care providers.

Management of Hemorrhage During Cesarean Delivery in a Patient With Vascular Ehlers-Danlos Syndrome: A Case Report.

Parturients with vascular Ehlers-Danlos syndrome are at particular risk of hemorrhage, and there is little evidence to guide prevention or management of hemorrhage in these patients. We present the case of a patient with vascular Ehlers-Danlos syndrome who had a cesarean delivery complicated by an intraoperative hemorrhage. Administration of desmopressin and tranexamic acid appeared to be of marked benefit in achieving hemostasis. To the best of our knowledge, this is the first report of the use of desmopressin during major obstetric hemorrhage in vascular Ehlers-Danlos syndrome.

Pregnancy and birth complications associations with long-term adverse maternal mental health outcomes: a systematic review and meta-analysis protocol

Background: Existing studies have established an association between pregnancy, birth complications, and mental health in the first few weeks postpartum. However, there is no clear understanding of whether pregnancy and birth complications increase the risk of adverse maternal mental outcomes in the longer term. Research on maternal adverse mental health outcomes following pregnancy and birth complications beyond 12 months postpartum is scarce, and findings are inconsistent. Objective: This systematic review and meta-analysis will examine the available evidence on the association between pregnancy and birth complications and long-term adverse maternal mental health outcomes. Methods and analysis: We will include cohort, cross-sectional, and case-control studies in which a diagnosis of pregnancy and/or birth complication (preeclampsia, pregnancy loss, caesarean section, preterm birth, perineal laceration, neonatal intensive care unit admission, major obstetric haemorrhage, and birth injury/trauma) was reported and maternal mental disorders (depression, anxiety disorders, bipolar disorders, psychosis, and schizophrenia) after 12 months postpartum were the outcomes. A systematic search of PubMed, Embase, CINAHL, PsycINFO, and Web of Science will be conducted following a detailed search strategy until August 2022. Three authors will independently review titles and abstracts of all eligible studies, extract data using pre-defined standardised data extraction and assess the quality of each study using the Newcastle-Ottawa Scale. We will use random-effects meta-analysis for each exposure and outcome variable to calculate overall pooled estimates using the generic inverse variance method. This systematic review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Ethical consideration: The proposed systematic review and meta-analysis is based on published data; ethics approval is not required. The results will be presented at scientific meetings and publish in a peer-reviewed journal. PROSPERO registration: CRD42022359017

Association between epidural-related maternal fever and short-and long-term prognosis of parturients: A prospective observational study.

We aimed to explore the association between epidural-related maternal fever (ERMF) and prognosis of parturients. 159 parturients who underwent vaginal delivery under labor epidural analgesia (LEA) received noninvasive continuous core body temperature monitoring. 122 of them completed the 42-day postpartum follow-up. Parturients with body temperature ≥38°C during labor were categorized as the Fever group, while the others were categorized as the No-Fever group. Compared to No-Fever group, Fever group had a greater proportion of primiparas, greater gestational age of parturients, and longer third stage of labor. The cesarean section and forceps delivery rates, and the amount of intrapartum hemorrhage in Fever group were significantly higher. There were no significant between-group differences with respect to puerperal infection, and amniotic fluid turbidity degree, neither significant between-group difference at 42-days postpartum. We found that ERMF was associated with some short-term outcomes. However, it showed no relation with long-term prognosis of the parturients at 42-days postpartum.

Maternal Mortality in a Rural District of Pakistan and Contributing Factors.

Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality. A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence. The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants. The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services.

Pregnancy characteristics of patients with placenta acreta spectrum at Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar, Bali-Indonesia during January 2020 - January 2022

Introduction: Placenta accreta spectrum is a problem during delivery when the placenta is not completely separated from the uterus and is followed by massive obstetric bleeding and can cause postnatal morbidity and mortality. The purpose of this study was to describe the pregnancy characteristics of patients with placenta accreta spectrum at Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar, Bali-Indonesia during period 1 January 2020 - 1 January 2022. Methods: This study is a descriptive study that describes the basic sociodemographic characteristics, ligation procedures, ultrasonographic findings, and histopathology. Results: A total of 48 patients were sampled in this study, the highest proportion of pregnant women with placenta accreta spectrum with lacuna grade II (39.6%), loss of basal hypoechoic zone (64.6%), myometrial thickness &lt;1 mm (39.6%), anterior placenta location (81.3%), regular vesicouterine border (75%), no exophytic mass (97.9%), bridging vessels (68.8%), no feeding vessels (85.4%), loss of placental basal Doppler image (97.9%), no hypervascularity of the vesicouterine area (66.7%), no lacunae vascular turbulence (83.3%) and the highest PAI score with a value of less than 5.37 (56.3%). Conclusion: The spectrum of placenta accreta was found with grade II lacunae, loss of basal hypoechoic zone, myometrial thickness &lt;1 mm, anterior placenta location, regular vesicouterine border, no exophytic mass, no bridging vessels, no feeding vessels, loss of placental basal Doppler image, there was no hypervascularity in the vesicouterine area, no vascular lacunae turbulence and the highest PAI score with a value of less than 5.37.

Circulating microparticle proteins predict pregnancies complicated by placenta accreta spectrum

Placenta accreta spectrum (PAS) is characterized by abnormal attachment of the placenta to the uterus, and attempts at placental delivery can lead to catastrophic maternal hemorrhage and death. Multidisciplinary delivery planning can significantly improve outcomes; however, current diagnostics are lacking as approximately half of pregnancies with PAS are undiagnosed prior to delivery. This is a nested case–control study of 35 cases and 70 controls with the primary objective of identifying circulating microparticle (CMP) protein panels that identify pregnancies complicated by PAS. Size exclusion chromatography and liquid chromatography with tandem mass spectrometry were used for CMP protein isolation and identification, respectively. A two-step iterative workflow was used to establish putative panels. Using plasma sampled at a median of 26 weeks’ gestation, five CMP proteins distinguished PAS from controls with a mean area under the curve (AUC) of 0.83. For a separate sample taken at a median of 35 weeks’ gestation, the mean AUC was 0.78. In the second trimester, canonical pathway analyses demonstrate over-representation of processes related to iron homeostasis and erythropoietin signaling. In the third trimester, these analyses revealed abnormal immune function. CMP proteins classify PAS well prior to delivery and have potential to significantly reduce maternal morbidity and mortality.

Evaluating the Association Between Fibrinogen and Rotational Thromboelastometry and the Progression to Severe Obstetric Hemorrhage.

This study aims to investigate the ability of fibrinogen and rotational thromboelastometry (ROTEM) parameters measured at obstetric hemorrhage protocol initiation to predict severe hemorrhage. In this retrospective study we included patients whose hemorrhage was managed with an obstetric massive transfusion protocol. Fibrinogen and ROTEM parameters EXTEM clotting time (CT), clot formation time (CFT), alpha angle, A10, A20, lysis index 30 min after CT (LI30), FIBTEM A10, A20, were measured at initiation of the protocol with transfusion based on a predefined algorithm. Patients were grouped into either severe or nonsevere hemorrhage based on: peripartum fall in hemoglobin ≥4 g/dL, transfusion of ≥4 units of blood product, invasive procedures for hemorrhage control, intensive care unit admission, or death. Of the 155 patients included, 108 (70%) progressed to severe hemorrhage. Fibrinogen, EXTEM alpha angle, A10, A20, FIBTEM A10, A20 were significantly lower in the severe hemorrhage group while the CFT was significantly prolonged in the severe hemorrhage group. In univariate analysis, predicted progression to severe hemorrhage yielded areas under the receiver operating characteristic curve (95% confidence interval [CI]) of: fibrinogen: 0.683 (0.591-0.776), CFT: 0.671 (0.553, 0.789), EXTEM alpha angle: 0.690 (0.577-0.803), A10: 0.693 (0.570-0.815), A20: 0.678 (0.563-0.793), FIBTEM A10: 0.726 (0.605-0.847), and A20: 0.709 (0.594-0.824). In a multivariable model, fibrinogen was independently associated with severe hemorrhage (odds ratio [95% CI] = 1.037 [1.009-1.066]) for every 50 mg/dL decrease in fibrinogen drawn at obstetric hemorrhage massive transfusion protocol initiation. Both fibrinogen and ROTEM parameters measured at the initiation of an obstetric hemorrhage protocol are useful parameters for predicting severe hemorrhage.

Widespread adoption of AI risk models for maternal hemorrhage requires mitigation of bias

Accurate risk stratification for maternal hemorrhage could lead to improved outcomes. However, the performance of risk stratification tools across populations has not been extensively explored. Therefore, we aim to examine the fairness of machine learning methods for predicting the risk of maternal hemorrhage. A retrospective study was performed using the U.S. Consortium for Safe Labor (2002–2008) dataset. Severe maternal hemorrhage was defined based on receiving at least 1 unit of blood transfusion. The Random Forest algorithm was adopted to model a patient’s risk using eighty-six clinical variables. Model training was done using patients’ data from 2002 - 2006 and was tested on the following two years while excluding patients with missing transfusion records. The model evaluation was conducted using the area under the receiver operating characteristic (AUROC) and precision-recall curves(AUPRC). In addition, following the recommendations from the Aequitas fairness group, we assessed the bias using: (1) equality of opportunity criteria that aims to match errors in the hemorrhage predictions outcomes for the different subgroups, (2) positive predictive value rate that aims to evaluate whether the predicted outcome equally matches the observed outcome for all subgroups. Of the 142,137 births, 3.7% required at least 1 unit of blood transfusion. The model had good performance concerning AUROC (0.80) and AUPRC (0.11), representing a nearly three-fold improvement compared to the prior. However, when comparing the model performance and fairness metrics with respect to race (AUROC: W:.75, B:0.83, H:0.75, A:0.85, AUPRC: W:0.11 B:0.11, H:0.08, A:0.06), the model underperformed in minority populations compared to the white patients as the reference(Figure 1). The Widespread adoption of machine learning-based risk assessments requires careful evaluation of their performance across various sub-populations, choosing appropriate decision thresholds and developing methods for mitigating potential bias.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A prospective and observational study on maternal and fetal outcome in antepartum hemorrhage at a tertiary care hospital

Background: Antepartum hemorrhage (APH) in our country is a frequent problem due to various reasons. This event affects maternal physical and mental health, fetal health, family health, social impact, and countries burden at large. We have conducted the study to find out the precise effect on maternal and fetal health. Aims and Objectives: The aim of the study was to find out the socio-demographic variables of study population and analyze mother and fetal outcome and complications of antepartum bleeding in Obstetrics and Gynaecology department, Midnapore Medical College and Hospital. Materials and Methods: This prospective and observational study done for 1 ½ year (April 2021–September 2022), estimated sample size of 100 fulfilling study criteria. Data collected included maternal age, parity, gestational age, delivery pattern, complications after delivery, and fetal complications. Results: In the present study, 92% of patients were booked, maximum number of women presented at 34–36+6 weeks of gestation (34%) followed by 37–39+6 weeks of gestation (28%), mean age of population was 20–24 years, commoner in multipara (66%), stillbirth occurred in 14% of cases, 51% had associated risk factors, 21% suffered from postpartum hemorrhage, 70% of patients required blood transfusion, 91% delivered by cesarean section, zero maternal death, 67% were premature, and 81% were low birth weight. Conclusion: As most of the cases presented late, already complications had occurred. Thus, APH is known to be associated with maternal and fetal morbidity and mortality. Complications can be minimized by early detection and by proper and prompt management. Proper equipped obstetric and neonatal wards with multidepartmental management facilities can improve mother and perinatal well-being. Routine antenatal visits, timely cesarean sections, timely referral, and correction of anemia with good ICU and NICU facilities can lower the maternal and fetal mortality and morbidity.

Prevalence, Outcome, and Predictors of Placenta Migration among Pregnant Women with Placenta Praevia in Enugu Nigeria

Abstract Background: Placenta praevia is one of the leading causes of obstetric haemorrhages and a major contributor to maternal and fetal morbidity and mortality. Although low-lying placentae are common during routine midtrimester anomaly scans, the incidence of placenta praevia at term remains low, probably due to placenta migration. It is important to follow-up pregnant women with low-lying placentae to identify the few whose placenta will remain in the lower segment and hence at risk of major obstetric haemorrhage. Aim: The objectives of this study were to determine the prevalence, predictors, and pregnancy outcome of low-lying placenta diagnosed in the midtrimester. Materials and Methods: The study was a cohort study with longitudinal follow-up of 416 pregnant women from the University of Nigeria Teaching Hospital, Enugu State University Teaching Hospital, and Mother of Christ Specialist Hospital who had an ultrasound diagnosis of low-lying placentae between 16 weeks and 20 weeks of gestation. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22. P &lt; 0.05 was considered statistically significant. Results: The prevalence of low-lying placenta at 20, 24, 28, 32, and 36 weeks of gestation was 51%, 41.3%, 22.3%, 12.7%, and 10.5%, respectively. 87.3% of those with low-lying placenta had normally situated placenta at term. Previous caesarean section and male gender were significant predictors of placenta praevia at delivery (P &lt; 0.001 and P = 0.03, respectively). Conclusion: Despite the high prevalence of low-lying placenta before 20 weeks of gestation, only a few of these placentas remain low-lying at term. Previous caesarean section and male gender were significant predictors of placenta praevia at delivery. This study recommends a routine ultrasound scan in the second or third trimester for placenta localisation.

Place of death and associated factors among reviewed maternal deaths in Ethiopia: a generalised structural equation modelling

ObjectiveThe study aims to determine the magnitude and factors that affect maternal death in different settings.Design, setting and analysisA review of national maternal death surveillance data was conducted. The data...

CLINICAL PATHOGENETIC SUBSTANTIATION OF THE REGENERATIVE TREATMENT OF PARTURIENTS WHO SUFFERED FROM OBSTETRICAL HAEMORRHAGES

The publication is devoted to an urgent problem of modern obstetrics – the study of pathophysiological changes in the organism of parturients after obstetrical haemorrhages, improvement of restorative treatment, as well as reduction of complications in the puerperium and prevention of their occurrence. The aim of the study: to increase the effectiveness of restorative treatment of women in labor who suffered obstetric bleeding by studying the features of the clinical course, mechanisms of pathogenetic disorders, and their correction using ozone therapy. Materials and methods. A comprehensive clinical and laboratory examination of 150 women in labor was carried out, including 120 women (the main group) who suffered bleeding during childbirth and the early postpartum period. The control group consisted of 30 women with the physiological course of labor, childbirth and the early postpartum period. The state of lipid peroxidation (LPO) in parturient women was evaluated by the content of primary lipid products in the blood plasma – diene conjugates (DK) according to the method of B.V. Gavrilov (1983) and secondary molecular products – malondialdehyde (MDA) using the reaction with 2 thiobarbituric acid. The activity of the enzymatic link of the antioxidant system (AOS) was determined by the content of catalase in peripheral blood erythrocytes using the substrate hydrogen peroxide and glutathione peroxidase (GPO) using the P phenylenediamine substrate. The Spielberg–Hanin scale of state and trait anxiety was used to study the state of the psycho-emotional sphere in parturient women. Morphological examination of preparations of placentas and surgically removed uteri was carried out with staining of sections with hematoxylin and eosin, picrofuchsin according to Van Gieson. Results. Basic etiopathogenetic factors of the development of obstetric haemorrhages were examined, changes in the psychoemotional status of the patients were detected, haematological and metabolic indices, parameters of oxidation-antioxidation homeostasis and endogenic intoxication were studied, as well as morphofunctional disorders in placentas and uteruses. The efficacy of the restorative treatment of the parturients, who had moderate and massive haemorrhages during delivery, with the use of medical ozone in combined treatment versus traditional methods of treatment was studied. Conclusion. From the first day of the puerperium, free-radical lipid peroxidation increases, the activity of the enzymatic and non-enzymatic links of the antioxidant system increases, endogenous intoxication increases, and lactate and pyruvate levels increase. In the placentas of women in labor who suffered bleeding during labor, there is a violation of the synthesis of type IV collagen in the basal membranes of vessels and the phenomenon of endothelial dysfunction in the form of increased expression of endothelin by the endotheliocytes of the vessels of the decidual membrane (53.8 ± 2.9 µa) and the villous chorion (46.0 ± 2.6 μa). In the uterus, an increase in the expression of endothelin by endotheliocytes of the spiral arteries of the uterus (57.8 ± 8.56 µa) was detected, in combination with a violation of the synthesis of stromal collagen of type I and III and type IV in the basal membranes of vessels.