Obstetric Center Research Articles

Impact of pregnancy termination law reforms in Ireland on pregnancy termination rates in the setting of fetal congenital heart disease: A trend analysis.

Prior to 2019, termination of pregnancy (TOP) was unlawful in Ireland. We sought to examine the impact of legislative change on TOP for major congenital heart disease (CHD) and its effect on parental decision-making regarding the options of complex surgery, TOP, or palliative perinatal care. This was a trend analysis of second-trimester TOP for major CHD before and after the law reforms relating to pregnancy termination in Ireland. Retrospective data were collected on pregnancies complicated by major CHD at the largest tertiary referral obstetric center in Ireland from January 2017 to December 2023. Suspected CHD cases were referred to a dedicated fetal medicine/cardiology service. Major CHD was defined as an expected requirement for cardiac intervention in the first year of life. Genetic testing was performed where required, counseling was offered, and individualized care plans were developed. In a consecutive unselected cohort, 269 of 60 871 screened pregnancies fulfilled criteria for a diagnosis of major CHD. Major CHD was an isolated abnormality in 55% (147/269) of cases, while an extracardiac diagnosis was identified in 45% (162/269). TOP was chosen in 21% (16/76) of cases prior to legislative change and in 20% (39/193) of cases after legislative change (P = 0.158). The TOP rate was 8% (13/147) in isolated CHD cases, compared with 34% (42/122) in the setting of additional abnormalities (structural or genetic). We observed no difference in the rate of TOP for major CHD before and after TOP law reforms in Ireland on the grounds of fetal abnormality.

Infrared thermographic assessment of cutaneous temperature changes during labour epidural analgesia initiation: An observational pilot study

BackgroundInadequate labour epidural analgesia within 30––45 min of insertion is typically considered primary epidural failure and deemed unsuccessful. Early prediction of analgesic success would have clinical benefit, enabling corrective interventions. Sympathectomy accompanying a successful epidural block can cause foot temperature changes. We sought to evaluate the relationship between foot temperature changes and successful epidural, defined as adequate analgesia in 45 min of epidural administration. For the purpose of this study, we defined primary epidural failure as inadequate analgesia within 45 min of administration. MethodsFollowing ethical committee approval, this observational study was conducted in a tertiary level obstetric centre between January 2021 and March 2024. Patients attending for induction of labour were included; with labour epidural analgesia comprised the epidural study group and without acted as a control group. A FlirT540 infrared thermography camera was used to take bilateral foot images every 5 min for 30 min. Images were taken following epidural administration in the epidural group and at any convenient time once in established labour in the control group. We studied temperature changes over time in the epidural and control groups and compared the temperature changes in patients with successful and failed epidurals. ResultsThirty eight patients were included in the epidural group and eleven in the control group. 29 patients (76.3 %) had successful analgesia and 9 patients (23.7 %) had primary epidural failure. Patients with successful analgesia had a statistically significant rise in temperature after 10 min. The maximum rate of rise was between 5 and 15 min and was 0.5 (0.1)°C per minute on both sides. Primary epidural failure was associated with minimal temperature changes, while all patients who had a 2 °C rise in hallux temperature at 10 min had successful analgesia. ConclusionsSympathetic blockade associated with a successful analgesic epidural block produces cutaneous temperature elevation at the plantar surface of the hallux. These can be detected within ten minutes of instituting an epidural and have a potential role in guiding timely troubleshooting of an epidural.

Predicting vaginal delivery after labor induction using machine learning: Development of a multivariable prediction model.

Induction of labor, often used for pregnancy termination, has globally rising rates, especially in high-income countries where pregnant women present with more comorbidities. Consequently, concerns on a potential rise in cesarean section (CS) rates after induction of labor (IOL) demand for improved counseling on delivery mode within this context. We aim to develop a prognostic model for predicting vaginal delivery after labor induction using computational learning. Secondary aims include elaborating a prognostic model for CS due to abnormal fetal heart rate and labor dystocia, and evaluation of these models' feature importance, using maternal clinical predictors at IOL admission. The best performing model was assessed in an independent validation data using the area under the receiver operating curve (AUROC). Internal model validation was performed using 10-fold cross-validation. Feature importance was calculated using SHAP (SHapley Additive exPlanation) values to interpret the importance of influential features. Our main outcome measures were mode of delivery after induction of labor, dichotomized as vaginal or cesarean delivery and CS indications, dichotomized as abnormal fetal heart rate and labor dystocia. Our sample comprised singleton term pregnant women (n = 2434) referred for IOL to a tertiary Obstetrics center between January 2018 and December 2021. Prediction of vaginal delivery obtained good discrimination in the independent validation data (AUROC = 0.794, 95% CI 0.783-0.805), showing high positive and negative predictive values (PPV and NPV) of 0.752 and 0.793, respectively, high specificity (0.910) and sensitivity (0.766). The CS model showed an AUROC of 0.590 (95% CI 0.565-0.615) and high specificity (0.893). Sensitivity, PPV and NVP values were 0.665, 0.617, and 0.7, respectively. Labor features associated with vaginal delivery were by order of importance: Bishop score, number of previous term deliveries, maternal height, interpregnancy time interval, and previous eutocic delivery. This prognostic model produced a 0.794 AUROC for predicting vaginal delivery. This, coupled with knowing the features influencing this outcome, may aid providers in assessing an individual's risk of CS after IOL and provide personalized counseling.

Navigation literacy of primary health care personnel (using the example of the heads of medical and obstetric centers in Orenburg region)

Objective. To assess navigation literacy of primary health care personnel (using the example of the heads of medical and obstetric centers in Orenburg region). Materials and methods. Navigation literacy of primary health care personnel was assessed among all heads of medical and obstetric centers in Orenburg region (n = 58). For this purpose, a single-stage continuous online survey was conducted using a combined questionnaire developed by the Central Research Institute for Healthcare Organization and Informatization of the Ministry of Heath of the Russian Federation. Results. The level of navigation literacy among the heads of the medical and obstetric centers of Orenburg region in 65.7 % of cases was excellent and sufficient. In the list of navigation skills, the heads of the medical and obstetric centers noted difficulties in the implementation of: issues of medical insurance (48.3 %), legal aspects of medical care and protection of patients' rights (27.5-48.3 %), healthcare reform (36.2 %). It was found out that from 63.7 % to 91.4 % of the heads of the medical and obstetric centers are aware of the ongoing state measures in the field of public health. The majority of the respondents (60.0 %) noted that they search for necessary information for professional purposes using digital tools. However, every third respondent (32.7 %) mentioned the difficulties in finding it on legislative issues, interpreting the quality and safety of food products according to their product labeling (27.6 %), solving problems related to mental health and well-being (18.9 %). These data demonstrate the need to improve navigation literacy of medical and obstetric centers managers in the digital environment. Conclusions. The modern multilevel and multicomponent healthcare system is associated with the need to improve the navigation literacy of medical personnel. The data obtained determined the main directions for improving navigation literacy of the heads of medical and obstetric centers.

Risk factors for relaparotomy after cesarean delivery.

To identify and analyze risk factors associated with relaparotomy following cesarean delivery (CD), focusing on obstetric and surgical parameters. Retrospective case-control study conducted at a high-volume tertiary obstetric center. We reviewed all women who underwent CD between 2013 and 2023. Patients who required a relaparotomy, defined as the reopening of the fascia, were included in the study group. Patient data were systematically reviewed to identify potential risk factors contributing to the need for post-CD relaparotomy, compared with a control group that did not undergo a relaparotomy. Out of 11 465 women underwent CD, 59 (0.5%) required relaparotomy. Using a multivariate model for independent risk factors, we found the following to be associated with relaparotomy: emergency CD (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI] 1.78-5.38, P < 0.01), placenta previa (aOR 4.66, 95% CI 1.54-14.11, P < 0.01), and multiple gestation as indications for the CD (aOR 4.61, 95% CI 2.10-10.12, P < 0.01); estimated intraoperative blood loss of more than 1 L (aOR 5.98, 95% CI 2.79-12.80, P < 0.01); and intraoperative adhesions (aOR 7.12, 95% CI 4.06-12.48, P < 0.01). Our study underscores the multifactorial nature of relaparotomy after CD, emphasizing the significance of considering a broad array of risk factors. By identifying and understanding these factors, clinicians can optimize patient care and potentially reduce morbidity, particularly the need for subsequent surgical interventions.

A survey of obstetrical anesthesia health equity practices at academic centers in the United States (US)

BackgroundLimited research has explored obstetrical anesthesiologists' perceptions of healthcare disparities associated with labor and delivery. The objective of this study was to evaluate the perception of obstetrical anesthesia related healthcare disparities, drivers of disparities, and potential solutions. MethodsAn online survey was emailed to division leads at Accreditation Council for Graduate Medical Education (ACGME) accredited obstetrical anesthesiology programs in the United States. The survey included a mixture of yes/no, select all that apply, and free-text questions. Descriptive statistics were used to characterize variable distribution. Free text responses were categorized into themes by selective coding. Results149 surveys were delivered, 74 surveys were conducted (50 %), and 57 were completed entirely (38 %). Fifty-seven percent of participants reported perceived presence of obstetrical/obstetrical anesthesia related healthcare disparities. Most participants reported that they consider a patient's cultural preferences during clinical management, collect race/ethnicity data, implement specific practices to address disparities, and analyze outcome data by social determinants of health. The majority of participants reported using additional relevant practice features, including translator services, quality improvement practices, provider rounds, standardized protocols, and cultural competency or diversity training. Thematic analysis of free text responses into drivers of disparities mapped to 6 themes: language barriers, racism or bias, socioeconomics or social determinants of health, access or quality of care, patient-provider interactions or cultural sensitivity, and individual patient factors. ConclusionMost academic obstetrical anesthesia center division leads reported perceived presence of obstetric anesthesia related health care disparities. Efforts should be made to devise targeted solutions to this multifaceted, pervasive problem.

The Importance of Cited-1 and HIF-1α Immune Activity of Granulosa Cells in IVF Treatment

Aim: The aim of this study was to investigate the Cited-1 and HIF-1α immune activity in granulosa cells in follicular development in patients who underwent IVF for infertility. Materials and Methods: This study was conducted on 40 patients who were admitted to the assisted reproductive program with the complaint of infertility at the Gazi Yaşargil Training and Research Hospital Obstetrics and Gynecology Clinic IVF center between January 2022 and November 2022 and had primary or secondary infertility while starting the Ovum-Pick-Up (OPU) procedure. The fluid containing the granulosa cells was centrifuged at 3000 rpm for 10 min. The samples were fixed and processed for routine paraffine wax tissue embedding protocol. Sections were taken from paraffin blocks and immune stained with Cited-1 and HIF-1α. The preparations were examined under the microscope. Results: HIF-1α expression was positive in membrane of granulosa cells. The nuclei were apoptotic and pyknotic. Cited1 expression was positive in membrane of granulosa cells. the cells were pyknotic. Conclusion: The high level of HIF-1α immunopositivity and negative Cited1 immunoreactivity in the immunohistochemical staining after the granulosa cells around the oocytes collected from female patients admitted to the IVF clinic and diagnosed with infertility showed that granulosa cell viability may be important on oocyte quality.

Care pathways for reduced fetal movements: Acost-consequence analysis.

This study aimed to evaluate the costs and consequences of a new midwife-navigator-facilitated care pathway for reduced fetal movements. This study was conducted at a tertiary obstetric centre in Queensland, Australia and modelling occurred for this and smaller services. Two months of data from pre (n = 112 in 2019) and post (n = 141 in 2020) implementation of the care pathway were analysed with T-tests and logistic regression models to evaluate maternal and neonatal outcomes. A Markov model was built to estimate the costs and consequences of the intervention. Sensitivity analysis was conducted to test various scenarios including modelling for smaller centres. There were no statistically significant differences in clinical outcome between the intervention and usual care groups. Intervention patients spent one hour and eight minutes less time in hospital (P < 0.001). This resulted in a saving to the centre of AU$135 per patient (AU$159 083 annually). One-way sensitivity analysis suggested that cost savings would be found in all scenarios except for smaller units providing services for less than 1900 births per annum. To our knowledge, no other care pathway involving acute obstetric care has been economically evaluated to date. Our model based on real-world presentations for reduced fetal movements confirms that midwife-navigators may be an economically beneficial implementation strategy for dealing with common obstetric conditions.

Организационные аспекты мониторинга беременных в Тульской области.

In recent decades, there has been an increasing use of modern technologies and information systems in order to increase the accessibility, effectiveness and quality of medical care. The issue of organizing medical care using digital technologies in the Tula region is relevant. The purpose of the study is to determine the main organizational aspects of the work of the situational center of the Tula Regional Perinatal Center named after V. S. Gumilyovskaya for monitoring pregnant women. Materials and methods. The structure and mechanisms of operation of the situational center of the GUZ «TOPTS named after V. S. Gumilyovskaya» are analyzed. Research methods: empirical, analytical, descriptive. Results. The situation center inside the perinatal center represents a new direction, where the collection, visualization and processing of data from various services play a crucial role in optimizing and improving the level of medical care for pregnant women registered in the regional women’s clinics. One of the main pillars is such a division of the perinatal center as the obstetric remote consultation center. In addition to the ADCC, the situation center receives data on the state of the service from the regional information subsystem for monitoring maternity care in the Tula region (RISAR) and reports from the BARS-Web-Vaults information and analytical system. The main visualization tool obtained from all data sources used by the situation center is a component of the information and analytical system of the Situation Center of the Governor of the Tula Region interactive analytical panels with a graphical interface – dashboards. Conclusion. Creation of a situation center in the State Institution «TOPC named after. V. S. Gumilevskaya» is designed to increase the efficiency of the obstetrics and gynecology service in the region through the prism of modern technologies. The combination of modern technologies and medical knowledge in the situation center makes it a relevant tool for improving medical care for pregnant women and newborns, providing medical institutions with solutions based on advanced information technologies and data analytics. The introduction of a situation center made it possible to reduce the number of errors in routing pregnant women at the regional level.

A retrospective analysis of postpartum red blood cell transfusions at a tertiary care obstetric centre.

Postpartum anaemia is a prevalent health problem. We aimed to determine the compliance rate for red blood cell (RBC) transfusion indication among postpartum women in a single tertiary care centre in Quebec, Canada. Retrospective cohort study including all women ≥6 h postpartum who received ≥1 RBC transfusion during their delivery hospitalization between January 2005 and February 2022. We determined our centre's compliance rate by indication as compared to current society guidelines, all published after 2015 (Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis [NATA], Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG]). We then explored predictors of guideline non-compliance and described transfusion practices in our centre. A total of 171 women were included. Our centre's compliance rate was 79.5% (95% confidence interval [CI] 72.7-84.8). Predictors of guideline non-compliance were maternal medical comorbidity or abnormal placentation, both limited by large CIs (odds ratio [OR] 2.26, CI 1.02-4.94, p = 0.04; OR 4.00, CI 1.31-12.06, p = 0.01, respectively). Postpartum haemorrhage was diagnosed among 68% of the cohort, mostly due to uterine atony (73.3%). Mean baseline and nadir haemoglobin were 111 g/L (±18) and 62 g/L (±7.7), respectively. Multiple unit initial transfusion was found in a majority of patients (63.7%). Iron therapy was administered to 51.5% of women in-hospital and 81.9% received an oral iron prescription at discharge. There were no differences in primary or secondary outcomes subsequent to relevant guideline publication. Our centre's compliance rate for RBC transfusion indication meets current practice guidelines. Areas for improvement include single-unit initial transfusion protocols and adjuvant iron treatment. Antenatal optimization of haemoglobin and ferritin stores may limit postpartum transfusions.

Pregnancy outcomes in patients with systemic lupus erythematosus compared to a high-risk tertiary cohort andtostandard population from the Austrian birth registry.

Women with systemic lupus erythematosus (SLE) have a higher risk for fetal and maternal complications. We aimed to investigate maternal and fetal complications in pregnant women with SLE compared to a high-risk pregnancy cohort (HR) from a tertiary university center and a standard-risk general population (SR) from the Austrian Birth Registry. In this retrospective data analysis, we compared the incidence of fetal/neonatal and maternal complications of pregnancies and deliveries of women with SLE to age, body mass index and delivery date-matched high-risk pregnancies from the same department, a progressive tertiary obstetric center and to a group of women, who represent pregnancies with standard obstetric risk from the Austrian Birth Registry. One hundred women with SLE were compared to 300 women with high-risk pregnancies and 207 039 women with standard-risk pregnancies. The incidence of composite maternal complications (preeclampsia, Hemolysis, Elevated Liver enzymes and Low Platelets [HELLP] syndrome, pregnancy-related hypertension, gestational diabetes mellitus, maternal death, thromboembolic events) was significantly higher in the SLE as compared to the SR group (28% vs. 6.28% SLE vs. SR, p = 0.001). There was no difference between the SLE and the HR groups (28% vs. 29.6% SLE vs. HR group, p = 0.80). The incidence of composite fetal complications (preterm birth before 37 weeks of gestation, stillbirths, birthweight less than 2500 g, fetal growth restriction, large for gestational age, admission to neonatal intensive care unit, 5-min Apgar <7) was also higher in the SLE than in the SR group (55% vs. 25.54% SLE vs. SR p < 0.001) while the higher incidence of adverse fetal outcome was detected in the HR than in the SLE group (55% vs. 75% SLE vs. HR group, p = 0.0005). Although composite fetal risk is higher in the SLE group than in the general population, it is still significantly lower as compared to high-risk pregnant women at a tertiary obstetric center. Prepregnancy counseling of women with SLE should put fetal and maternal risk in perspective, not only in relation to healthy, low risk cohorts, but also compared to mixed HR populations.

Placental cord drainage impact on third stage of labor: a randomized controlled trial

BackgroundThe third stage of labor is a pivotal phase in obstetric care. Management may be physiological or active. Although the use of prophylactic placental cord drainage has been assessed in prior data, there is still no clear-cut evidence supporting its effectiveness in improving key obstetric outcomes. ObjectiveThe aim of the study was to investigate the impact of placental cord drainage during the third stage of labor on the amount of maternal bleeding, duration of the third stage, and incidence of postpartum hemorrhage. Study DesignA randomized controlled trial was conducted at a high-volume tertiary obstetric center between May 2021 and December 2022. A total of 212 pregnant women with a singleton uncomplicated pregnancy were randomly assigned to undergo placental cord drainage or standard care without drainage. The randomization was manual, using premarked cards drawn by the participants. The power calculation determined a sample size of 92 participants per group to achieve 80% power at a 5% significance level, aiming to detect 20% difference in bleeding amount between the groups. In practice, we included more than 100 women in each group. The primary outcome was the amount of bleeding during the third stage of labor, while secondary outcomes included the duration of the third stage and incidence of postpartum hemorrhage. After delivery, all participants received 10 units of oxytocin via intravenous drip, and delayed cord clamping was performed. In the study group, the maternal umbilical cord was then unclamped. Blood was allowed to drain into a plastic bag placed under the women's buttocks. If an episiotomy or perineal tear was observed, pressure packing was applied to reduce bleeding. The collected blood was measured in milliliters after placental expulsion. ResultsA total of 212 women were recruited of whom 104 underwent placental cord drainage and 108 received standard care without drainage. No significant differences were observed between the intervention and control groups in mean duration of the third stage of labor (10.56±6.12 vs 10.95±6.33 minutes, P=.65), incidence of postpartum hemorrhage (3.84% vs 7.41%, P=.38), or mean amount of bleeding during the third stage of labor (292±200 vs 300±242 mL, P=.79). Furthermore, there were no significant between-group differences in the mean amount of bleeding on separate analysis of nulliparous women (356±246 vs 330±240 mL, P=.68), multiparous women (265±171 vs 289±244 mL, P=.50), women who were not exposed to external oxytocin during labor (287±204 vs 317±250 mL, P=.59), and women who were exposed to external oxytocin (296±198 vs 289±238 mL, P=.39). ConclusionPlacental cord drainage during the third stage of labor showed no statistically significant impact on bleeding amount, third-stage length, or postpartum hemorrhage rate. The findings suggest that placental cord drainage may not offer additional benefits in preventing postpartum hemorrhage in women with uncomplicated pregnancies.

Causes and investigation of stillbirths in Brazil: A multicentre cross-sectional study in 10 referral maternity hospitals.

Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death. A cross-sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility. Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. "Intrauterine hypoxia and asphyxia" (ICD-10 P20) and "unspecific causes of death" (ICD-10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases. The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed.

Design, construction, and validation of obstetric risk classification systems to predict intensive care unit admission.

To develop and validate a support tool for healthcare providers, enabling them to make precise and critical decisions regarding intensive care unit (ICU) admissions for high-risk pregnant women, thus enhancing maternal outcomes. This retrospective study involves secondary data analysis of information gathered from 9550 pregnant women, who had severe maternal morbidity (any unexpected complication during labor and delivery that leads to substantial short-term or long-term health issues for the mother), collected between 2009 and 2010 from the Brazilian Network for Surveillance of Severe Maternal Morbidity, encompassing 27 obstetric reference centers in Brazil. Machine-learning models, including decision trees, Random Forest, Gradient Boosting Machine (GBM), and Extreme Gradient Boosting (XGBoost), were employed to create a risk prediction tool for ICU admission. Subsequently, sensitivity analysis was conducted to compare the accuracy, predictive power, sensitivity, and specificity of these models, with differences analyzed using the Wilcoxon test. The XGBoost algorithm demonstrated superior efficiency, achieving an accuracy rate of 85%, sensitivity of 42%, specificity of 97%, and an area under the receiver operating characteristic curve of 86.7%. Notably, the estimated prevalence of ICU utilization by the model (11.6%) differed from the prevalence of ICU use from the study (21.52%). The developed risk engine yielded positive results, emphasizing the need to optimize intensive care bed utilization and objectively identify high-risk pregnant women requiring these services. This approach promises to enhance the effective and efficient management of pregnant women, particularly in resource-constrained regions worldwide. By streamlining ICU admissions for high-risk cases, healthcare providers can better allocate critical resources, ultimately contributing to improved maternal health outcomes.

Postpartum neurological deficits following neuraxial intervention: a retrospective analysis in a tertiary obstetric centre (2021-2023)

Postpartum neurological deficits following neuraxial intervention: a retrospective analysis in a tertiary obstetric centre (2021-2023)

Perinatal outcomes in grand multiparous women stratified by parity- A large multicenter study

ObjectiveTo assess the effect of each additional delivery among grand multiparous (GMP) women on maternal and neonatal outcomes. MethodsA multi-center retrospective cohort study that examined maternal and neonatal outcomes of GMP women (parity 5–10, analyzed separately for each parity level) compared to a reference group of multiparous women (parity 2–4). The study population included grand multiparous women with singleton gestation who delivered in one of four university-affiliated obstetrical centers in a single geographic area, between 2003 and 2021. We excluded nulliparous, those with parity > 10 (due to small sample sizes), women with previous cesarean deliveries (CDs), multifetal gestations, and out-of-hospital deliveries. The primary outcome of this study was postpartum hemorrhage (PPH, estimated blood loss exceeding 1000 ml, and/or requiring blood product transfusion, and/or a hemoglobin drop > 3 g/Dl). Secondary outcomes included unplanned cesarean deliveries, preterm delivery, along with other adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariable logistic regression. ResultsDuring the study period, 251,786 deliveries of 120,793 patients met the inclusion and exclusion criteria. Of those, 173,113 (69%) were of parity 2–4 (reference group), 27,894 (11%) were of parity five, 19,146 (8%) were of parity six, 13,115 (5%) were of parity seven, 8903 (4%) were of parity eight, 5802 (2%) were of parity nine and 3813 (2%) were of parity ten.GMP women exhibited significantly higher rates of PPH starting from parity eight. The adjusted odds ratios (aOR) were 1.19 (95 % CI: 1.06–1.34) for parity 8, 1.17 (95 % CI: 1.01–1.36) for parity 9, and 1.39 (95 % CI: 1.18–1.65) for parity 10. Additionally, they showed elevated rates of several maternal and neonatal outcomes, including placental abruption, large-for-gestational age (LGA) neonates, neonatal hypoglycemia, and neonatal seizures. Conversely, they exhibited decreased risk for other adverse maternal outcomes, including preterm deliveries, unplanned cesarean deliveries (CDs), vacuum-assisted delivery, and third- or fourth-degree perineal tears and small-for-gestational age (SGA) neonates. The associations with neonatal hypoglycemia, and neonatal seizure were correlated with the number of deliveries in a dose-dependent manner, demonstrating that each additional delivery was associated with an additional, significant impact on obstetrical complications. ConclusionOur study demonstrates that parity 8–10 is associated with a significantly increased risk of PPH. Parity level > 5 correlated with increased odds of placental abruption, LGA neonates, neonatal hypoglycemia, and neonatal seizures. However, GMP women also demonstrated a reduced likelihood of certain adverse maternal outcomes, including unplanned cesarean, preterm deliveries, vacuum-assisted deliveries, SGA neonates, and severe perineal tears. These findings highlight the importance of tailored obstetrical care for GMP women to mitigate the elevated risks associated with higher parity.

Risk Factors of Cardiac Complications in Pregnant Women with Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a common inherited genetic cardiac disease during pregnancy. Studies of risk factors are of great significance for maternal and fetal outcomes. The aim of the study was to identify predictive risk factors for cardiac complications in pregnant women with HCM. One hundred patients with HCM who delivered at the Shanghai obstetrical cardiology intensive care center between January 2000 and December 2022 were retrospectively reviewed. A logistic regression model was used to identify independent risk factors for cardiac complications. Twenty-one cases were obstructive HCM (21%), 16 with cardiac function grade I and 5 with grade II; 79 cases were non-obstructive HCM (79%), 67 with cardiac function grade I, 11 with grade II, and 1 with grade III. Ninety-one cases had abnormal electrocardiogram (ECG) (91%), mainly with ST-T changes (77%). The average interventricular septum was 19.39 ± 6.13 mm by echocardiography (21.75 ± 5.86 mm for obstructive HCM and 18.73 ± 6.08 mm for non-obstructive HCM). The main cardiac complications were maternal death (n = 2, 2%), heart failure (n = 7, 7%), and sustained ventricular tachyarrhythmia (n = 1, 1%). Cardiac complications occur commonly during the third trimester and postpartum period. Three independent risk factors to predict cardiac complications in pregnant women with HCM were obstructive HCM (P = 0.036), New York Heart Association (NYHA) class ≥II (P = 0.022), and previous history of syncope (P = 0.037). HCM increases the risk of maternal death, heart failure, and malignant arrhythmia. More attention should be given to risk assessment and pregnancy management. Early detection of risk factors can reduce the incidence of maternal mortality and cardiac complications.

The Role of Hypertension for Maternal Outcomes of Women with HELLP Syndrome - a Retrospective Study from a Tertiary Obstetric Center.

HELLP syndrome is a serious disorder that can occur in pregnancy; it has many possible complications and is associated with adverse maternal outcome. Due to the lack of predictive parameters for HELLP syndrome, finding the right time for delivery is challenging. In contrast to preeclampsia, hypertension is not an essential part of the diagnosis; nevertheless, many women with HELLP syndrome are hypertensive. The role and possible implications of hypertension in HELLP syndrome are not fully understood. In this retrospective cohort study, we analyzed the maternal outcomes of 59 patients diagnosed with HELLP syndrome. The patients were divided into three groups according to their blood pressure levels during their stay in hospital. These three groups were compared in terms of patient characteristics and maternal outcomes. A combined endpoint for adverse maternal outcome was defined which included blood pressure and antihypertensive medication at discharge from hospital, severe postpartum anemia, and eclampsia. Women with hypertensive crises had an unfavorable outcome compared to women with lower blood pressure levels. Patients with higher blood pressure during pregnancy were more likely to be hypertensive at discharge and needed a combination of antihypertensive agents significantly more often. The risk of an adverse maternal outcome increased with the severity of hypertension. An increase in systolic blood pressure by 10mmHg raised the risk of an adverse outcome by 74% (95% CI: 1.22-2.66). Hypertension not only plays an important role in preeclampsia but also affects the outcomes of patients with HELLP syndrome. These patients need to be identified quickly and treated accordingly as they are at risk of cardiovascular impairment. Patients should be followed up closely after delivery to reduce cardiovascular morbidity.

Perspectives on sustainable practices in the use of nitrous oxide for labour analgesia: A patient and staff survey.

Climate change has emerged as the single biggest global health threat of the twenty-first century. Nitrous oxide accounts for the largest carbon footprint amongst our use of anaesthetic gas. It is a potent greenhouse gas possessing a global warming potential of approximately 265 times that of carbon dioxide. Despite recent curtailment of its use, it remains extensively employed as an analgesic for women in labour. Assessment of the opinions of post-natal women and staff on nitrous oxide use and to investigate whether knowledge of its environmental harm would influence their choice of labour analgesia. Postnatal women and healthcare staff were invited to participate in a survey of nitrous oxide use as a labour analgesic and knowledge of its effect of the environment. A single-centre study in a major obstetric tertiary referral centre in Ireland in 2021. To evaluate the awareness and perceptions of postnatal women and staff regarding the environmental impact of nitrous oxide and if it would affect their decision to use it in the future. One hundred postnatal women and 50 healthcare staff completed the survey. One hundred and six post-natal women were invited to complete the survey, resulting in a response rate of 94%. Knowledge of nitrous oxide's environmental impact was low. After receiving information, 46% of patients were more inclined to seek epidural or request it earlier (54%) to limit their nitrous oxide use, while 51% would choose an alternative analgesia to avoid nitrous oxide altogether. Overwhelmingly, 99% believed they had the right to know about these harmful effects when choosing an analgesic option. Patients should be informed of the environmental impact of nitrous oxide antenatally, empowering them to make informed decision on a climate friendly analgesic option if they wish.

First Successful Pregnancy After Lung Transplantation in Poland—Case Report

Lung transplantation is well-established treatment for patients with advanced lung dysfunction in cystic fibrosis (CF). Pregnancy in CF lung transplant recipients is feasible, although it still remains challenging for even professionals and demands a multidisciplinary approach. We report the case of pregnancy in a 22-year-old woman after lung transplantation (LTx) due to end-stage respiratory failure in the course of CF. The interval from transplant to conception was 2.5 years. In 2019, orthotopic LTx was performed and a 3-drug immunosuppressive scheme was used-tacrolimus, mycophenolate mofetil, and prednisolone. There were no complications in the postoperative course. In April 2022, the patient was confirmed pregnant. All fetotoxic or teratogenic drugs were discontinued. Throughout the whole pregnancy, the patient was regularly monitored in the transplant and obstetrics centers. Due to the vaginal bleeding and irregular contractions at the 33 weeks of pregnancy, the course of steroids was administered. At 38 weeks and 5 days of gestation, she presented premature rupture of membranes. The caesarean section was performed because of breech presentation of the fetus. A live, term daughter was born and according to the screening test she does not have CF. Currently, 12 months after the delivery, the mother's lung function is good. Getting pregnant and having a safe pregnancy after LTx is possible, but it requires a specialized and individual approach. The patient should be well informed about possible complications and risks including graft failure. The patient's attitude and her cooperation with doctors play a major role.