Obstetric Complications Research Articles

Cumulative live birth rate of a blastocyst versus cleavage stage embryo transfer policy during in vitro fertilisation in women with a good prognosis: multicentre randomised controlled trial

ObjectivesTo evaluate whether embryo transfers at blastocyst stage improve the cumulative live birth rate after oocyte retrieval, including both fresh and frozen-thawed transfers, and whether the risk of obstetric and...

Conservative management of an incarcerated uterus in a pregnant woman

Incarceration of a retroverted uterus is a rare, but harmful obstetric complication increasing foetal mortality and maternal morbidity if untreated. In this case report, a pregnant woman at 16+3 presented with urine retention. Assessment showed an incarcerated uterus due to retroversion. To facilitate mobilisation of the uterus, she performed the yoga position Downward facing dog and had a permanent catheter inserted for 48 hours. The procedure was successful. This case report addresses the diagnosis, management, and risk of an incarcerated retroverted uterus in pregnancy. We aim to raise awareness, facilitate early diagnosis, and promote the conservative treatment.

Psychological impact of Placenta Accreta Spectrum disorders (PAS) and risk of Post-Traumatic Stress Disorder (PTSD): A cross-sectional study

ObjectivePlacenta Accreta Spectrum disorders (PAS) are a group of obstetric complications with an increasing incidence. The high maternal and neonatal morbidity and mortality associated with PAS leads to concerns about the negative psychological impact, and even the risk of developing Post-Traumatic Stress Disorder (PTSD). The aim of this study was to assess the psychological impact of PAS diagnosis and intervention during pregnancy and postpartum and its potential association with PTSD.STUDY DESIGN: A cross-sectional study was conducted, including cases of PAS FIGO grade 2 and 3 treated at University Hospital Center São João, between 2010–2023. Only cases with histopathological confirmation after peripartum hysterectomy were included. Data were obtained from electronic medical records (Sclinic® and Obscare®). The impact of Event Scale – Revised (IES-R), a validated questionnaire, was applied, after surgery for PAS, to assess the psychological impact of PAS diagnosis and treatment. ResultsFourteen cases of PAS were identified. The mean maternal age was 36.8 years. Approximately 86 % of cases had antenatal suspicion. The mean gestational age at delivery was 34 weeks. Of the 14 women, only 11 responded to the request to participate in the study (7 interviewed in person and 4 remotely). Four women had IES-R scores indicative of high risk of PTSD (IES-R>33 points), one had an intermediate risk (IES-R between 24–32 points), and 6 fell into the low-risk category. The mean score was 22.4 points. The analysis of IES-R results by clusters showed higher scores in the intrusion category, which relates to intrusive and unwanted thoughts, images and memories. ConclusionGiven the high morbidity and mortality described in women with PAS, the risk of PTSD should be acknowledged, motivating early intervention to prevent the development of severe and potentially chronic symptoms. Supportive measures and psychiatric and/or psychological follow-up should be promptly implemented, ideally by multidisciplinary teams.

Impact of isolated fetal congenital heart disease on pregnancy and perinatal outcomes.

The aim of the present study was to evaluate the obstetric complications associated with isolated fetal congenital heart disease (CHD) by comparing pregnancies with and without this condition. In this retrospective matched comparative study at Siriraj Hospital, Thailand, we included 233 postnatally confirmed fetal CHD cases and 466 unaffected fetuses. Controls were selected at a 2:1 ratio, ensuring that they matched the cases in terms of maternal age, parity, and history of preterm deliveries. Fetal CHD was significantly associated with an increased risk of spontaneous preterm labor (30% vs 9.7%; adjusted odds ratio [aOR] 2.42; 95% confidence interval [CI]: 1.35-4.36; P = 0.003), delivery before 34 gestational weeks (11.6% vs 0.6%; aOR 12.33; 95% CI: 3.32-45.78; P < 0.001), and pre-eclampsia (11.6% vs 2.8%; aOR 2.19; 95% CI: 1.01-4.76; P = 0.047). Newborns with CHD were significantly more likely to be small for gestational age (10.7% vs 5.2%; aOR 2.09; 95% CI: 1.11-3.94; P = 0.022). Intriguingly, a prenatal diagnosis of CHD was associated with a reduced risk of preterm delivery in affected pregnancies (P = 0.002). Pregnancies affected by isolated fetal CHD demonstrated a higher propensity for several adverse outcomes. These findings underscore the importance of prenatal CHD detection and tailored perinatal care to potentially improve both pregnancy outcomes and neonatal health.

Multidrug Resistant Group B Streptococcus Isolates from Pregnant Women in Delta State, Nigeria.

&lt;b&gt;Background and Objective:&lt;/b&gt; Group B &lt;i&gt;Streptococci&lt;/i&gt; (GBS) are globally recognized as a major risk factor for neonatal infections and various obstetric complications. More so, biofilm formation has been suggested to be important for GBS pathogenesis. The aim of this study was to determine the prevalence and antibiotic susceptibility pattern of GBS among pregnant women and their capacity to form biofilm. &lt;b&gt;Materials and Methods:&lt;/b&gt; A total of 87 pregnant women at 34 to 37 weeks' gestation aged 17-45 years were recruited from 3 healthcare centres in Delta State, Nigeria. Cultures for the isolation of GBS were carried out using recto-vaginal swabs, according to standard microbiological methods. All strains isolated were used for susceptibility tests to various antibiotics as recommended by CLSI using the disk-diffusion method. &lt;b&gt;Results:&lt;/b&gt; The overall prevalence of GBS colonization among pregnant women was 43.6% (38/87). The &lt;u&gt;<&lt;/u&gt;30 age group had the highest rate of GBS colonization. Resistance to erythromycin and vancomycin was 48.2 and 66.4%, respectively. The fluoroquinolones had the lowest resistant rates with no isolate showing resistance to ofloxacin. Multidrug resistance (MDR) (&lt;u&gt;>&lt;/u&gt;3 drug classes) was detected in 73.7% (28/38) of the GBS isolates. All GBS isolated in this study were either strong, moderate or weak biofilm producers. However, most 28 (73.7%) were strong biofilm producers. Resistance of GBS isolates to erythromycin and vancomycin, drugs used for treating GBS infection was high. &lt;b&gt;Conclusion:&lt;/b&gt; This suggested the importance of testing antimicrobial susceptibilities in GBS colonized pregnant women in order to guide antibiotic therapy and minimize newborn infection and co-morbidity.

Expression of CD68 by macrophages and histopathology of the placenta in COVID-19: association with obstetric and neonatal complications

Introduction. COVID-19 causes direct and indirect placental damage through inflammatory monocytes/ macrophages, increasing the risk of infectious and inflammatory diseases in newborns.Aim. To analyze the expression of CD68 by macrophages and structural changes in the placenta, and to assess the risks of obstetric and neonatal complications in cases of moderate COVID-19 during the third trimester of pregnancy.Materials and methods. A histological examination was conducted on 33 placentas from women with moderate COVID-19 in the third trimester of pregnancy and 30 placentas from women not infected with SARS-CoV-2. Tissue sections were analyzed using an automated microscopy system for histological studies. CD68 expression on placental macrophages was studied using flow cytometry. Detection of SARS-CoV-2 RNA in placental tissue samples, as well as in nasopharyngeal swabs from newborns, was carried out by real-time reverse transcription polymerase chain reaction (RT-PCR).Results. An increase in the number of CD68-positive macrophages was observed in the placentas from women with COVID-19 (80.8 (78.2; 83.5) %; p&lt;0.0001) compared to samples from women not infected with SARS-CoV-2 (19.6 (17.2; 21.8) %). All placental samples and nasopharyngeal swabs from newborns of mothers with COVID-19 tested negative for SARS-CoV-2, indicating a low risk of vertical transmission. Histological analysis revealed signs of infectious involvement of both maternal and fetal placental parts, including focal deciduitis, villitis, and histiocytic intervillositis. Circulatory disorders were characterized by decidual vasculopathy, accelerated villous maturation, perivillous fibrin deposition, thrombosis, villous necrosis, and an increase in syncytial knots. A link was established between structural placental abnormalities and the development of chronic placental insufficiency (relative risk (RR)=2.33), preterm birth and premature rupture of membranes (RR=4.26), and fetal growth restriction. Newborns from mothers with COVID-19 exhibited complications such as cerebral ischemia and respiratory distress syndrome.Conclusion. Moderate COVID-19 in the third trimester of pregnancy can induce structural changes in the placenta, reflecting both compensatory-adaptive responses and inflammation driven by CD68-expressing macrophages. These alterations are associated with a high risk of obstetric and neonatal complications.

Improving Resident Comfort With Peripartum Cesarean Hysterectomy Through the Use of Low-Fidelity Simulation Models.

Introduction Cesarean hysterectomy is a relatively rarely performed, complex, life-saving procedure considered during post-partum hemorrhage and other obstetric complications. This multi-site study aimed at validating a low-cost, low-fidelity cesarean hysterectomy model to support resident proficiency and increase their confidence in performing this critical procedure. Materials and methods We developed a low-fidelity, anatomically representative model for cesarean hysterectomy simulation purposes. Obstetrics and Gynecology residents at two residency programs were offered a simulation experience using the model, with a performance assessment via two validated assessment tools. The clinical case involved a 38 y/o woman with a delivery complicated by postpartum hemorrhage who failed conservative therapy and required a peripartum hysterectomy. Participants included 26 residents, postgraduate year (PGY)1 through PGY4, at two midwestern university-based obstetrics and gynecology residency programs. Results The median resident scores on the Task Specific Checklist (TSC) and Global Rating Scale (GRS) correlated with increasing PGY levels. The combined TSC+GRS score was a median of 40 out of 49 total for the PGY4 class, while the PGY1 class had a median combined TSC+GRS score of 12 of 49. The PGY2 and -3 classes had TSC+GRS scores of 14 and 28, respectively. The simulation model was well-received with a median 4/5 rating for improving comfort level with cesarean hysterectomy and a median 4/5 rating for model realism. Conclusion This study validated a cost-effective, easily reproducible model that highlights the vital anatomy relevant to a cesarean hysterectomy. The model and simulation offer a way to introduce cesarean hysterectomies to residents while in training, particularly at sites that may not perform a substantial number of these procedures.

Sources of moral distress among obstetrician-gynecologists after Dobbs: A qualitative, multi-state study

Since the US Supreme Court's 2022 decision in Dobbs v Jackson Women's Health Organization, 18 states have enacted functional bans on abortion, yet little is known about how these laws contribute to workplace stress and its sequelae among clinicians. The purpose of this study was to characterize sources of moral distress—which occurs when a clinician knows the right course of clinical action but is barred from taking that action by external constraints—among obstetrician-gynecologists (OB-GYNs) in states with abortion bans. We conducted qualitative, semi-structured interviews with 54 OB-GYNs practicing in 13 of 14 states where abortion was illegal as of March 2023. Using a qualitative descriptive coding approach, we identified four types of clinical situations leading to moral distress: delaying treatment for patients with obstetric complications, conflict with other clinicians, denying care they would have provided locally prior to Dobbs, and restrictions on clinical counseling. These situations provoked feelings of anger, frustration, helplessness, and emotional exhaustion. Participants attributed moral distress to the cumulative toll of routinely being unable to provide evidence-based healthcare, in addition to the acute burden of managing obstetric emergencies in legal gray areas, which was relatively rarer. The findings demonstrate a previously unreported source of moral distress: the everyday chipping away of professional integrity that occurs when OB-GYNs cannot care for patients in the way that patients need. Next steps include developing institutional-level policies and programs to support clinicians and enable them to practice ethical medicine in abortion-restrictive policy environments.

Letrozole co-treatment in an antagonist protocol for overweight women undergoing IVF treatment: a retrospective study

BackgroundOverweight women undergoing IVF treatment have lower success rates. Letrozole, an aromatase inhibitor, has been used as an adjunct for IVF treatment, but its specific effects in overweight women have not been investigated. This study was to explore the effects of letrozole co-treatment in an antagonist protocol for overweight infertile women undergoing IVF treatment.MethodsThis retrospective cohort study included overweight infertile women who underwent IVF/ICSI treatment and fresh embryo transfer (ET), with or without letrozole co-treatment in an antagonist protocol, from 2007 to 2021 at Shanghai Ninth People’s Hospital (Shanghai, China). A total of 704 overweight infertile women were included: 585 women were in the antagonist group, and 119 women were in the letrozole co-treatment group. The primary outcome was the live birth rate after fresh ET. Propensity score-based patient-matching was employed to balance the covariates between the groups. Multivariate logistic regression analysis was also performed to estimate odds ratio (OR) and 95% confidence interval (CI) for association of letrozole co-treatment and the live birth outcome.ResultsLetrozole co-treatment induced significant changes in hormonal profile on the trigger day. The letrozole group exhibited a decrease in the total number of follicles compared to the antagonist group, but a higher proportion of large follicles at oocyte retrieval (P < 0.05). The quantity and quality of embryos were comparable between the two groups (P > 0.05). The letrozole co-treatment group had a significantly higher live birth rate than the control group (38.7% vs. 22.6%, P = 0.026). With multivariate logistic regression analysis, letrozole co-treatment was associated with higher odds of live birth after adjusting for potential confounding factors (adjusted OR = 2.00, 95% CI = 1.17–3.39, P = 0.011). Letrozole presented no significant associations with obstetrical or neonatal complications (P > 0.05).ConclusionLetrozole co-treatment in an antagonist protocol may offer potential benefits for overweight infertile women undergoing IVF treatment. Further research is warranted to validate these findings and explore the broader implications for letrozole co-treatment.

Hormone-free versus FSH-primed infertility treatment of women with polycystic ovary syndrome using biphasic in vitro maturation: a randomized controlled trial

To compare oocyte maturation rates and pregnancy outcomes in women with polycystic ovary syndrome (PCOS) undergoing biphasic in vitro maturation (capacitation [CAPA]-IVM) with versus without follicle-stimulating hormone (FSH) priming. Randomized, controlled, assessor-blinded trial SUBJECTS: Women aged 18-37 years with PCOS and an indication for CAPA-IVM. Participants were randomized (1:1) to undergo CAPA-IVM with or without FSH priming. The FSH priming group had two days of FSH injections before oocyte pick-up; no FSH was given in the non-FSH group. After CAPA-IVM, day-5 embryos were vitrified for transfer in a subsequent cycle. The primary endpoint was number of matured oocytes. Secondary outcomes included rates of live birth, implantation, clinical pregnancy, ongoing pregnancy, pregnancy complications, obstetric and perinatal complications, and neonatal complications. The number [interquartile range] of matured oocytes did not differ significantly in the non-FSH versus FSH group (13 [9-18] vs. 14 [7-8]; absolute difference -1 [95% confidence interval (CI) -5, 4]); other oocyte and embryology outcomes did not differ between groups. Rates of ongoing pregnancy and live birth were both 38.3% in the non-FSH group and both 31.7% in the FSH group (risk ratio for both outcomes: 1.21, 95% CI 0.74-1.98). Maternal complications were infrequent and occurred at a similar rate in the two groups; there were no preterm deliveries before 32 weeks' gestation. These findings open the possibility of a new, hormone-free approach to infertility treatment of women with PCOS.

Odontogenic Peri-Mandibular Cellulitis and Pregnancy about Five Cases at the Owendo University Hospital Center

Odontogenic perimandibular cellulitis are infections spreading into the celluloadipose tissues of the compartments of the perimandibular region. Promoted by taking non-steroidal anti-inflammatory drugs. They constitute an emergency for patients and especially pregnant women, because they are the cause of serious complications, which can endanger the maternal-fetal prognosis. To study the contributing factors, complications and management of odontogenic perimandibular cellulitis in pregnant women. Patients and method: This is a retrospective, descriptive and single-center study, focusing on patients hospitalized in the CMF Stomatology department from April 2022 to April 2024. The sources of information were the department registers and patient files. The study population, odontogenic cervico-facial cellulitis in pregnant women, included all patients with odontogenic perimandibular cellulitis during pregnancy; other locations were not included. The study parameters were age, history, contributing factors, maternal-fetal complication and treatment. Results: The study concerns five pregnant women. The average age was twenty-five years, two were carriers of HIV retrovirosis. They had all taken non-steroidal anti-inflammatory drugs, two were in the first trimester of pregnancy and three in the second trimester. All patients had diffuse perimandibular cellulitis, with cervical diffusion. Non-obstetric complications were dysphagia associated with odynophagia and obstetric complications were one threat of premature delivery. The treatment was medical-surgical. Conclusion: Odontogenic perimandibular cellulitis is more common in pregnant women in the second trimester of pregnancy. They are favored by taking non-steroidal anti-inflammatory drugs. The maternal-fetal complications found are dysphagia, odynophagia and a threat of premature delivery.

Mothers’ Psychological Trauma Experiences Associated With Preterm Pregnancy, Birth, and Care: A Qualitative Study

Background: Preterm birth trauma has become a growing concern in achieving the sustainable development goal targets for mental, maternal, and child health. Although obstetric and developmental complications associated with preterm birth have received a great deal of research attention over the years, subjective trauma experiences of mothers are often understudied. This qualitative study aims to fill this gap by adopting a phenomenological design to explore the traumatic experiences of mothers from pregnancy to care after childbirth of preterm babies in a low-resource economy. Results: The results of our Interpretative Phenomenological Analysis (IPA) revealed three superordinate and six subordinate themes: pregnancy-related (Primary pregnancy-related complications and secondary pregnancy-related factors), healthcare-related (Trauma from invasive procedures performed on babies and trauma from the poor physical health status of the babies at NICU), and parenting-related trauma (Initial shock and denial and feelings of inadequateness and helplessness in caring for their babies). Conclusions: The study shows the complex nature of the birth trauma experienced by mothers of preterm babies. The study recommends client-centered, culturally sensitive, and trauma-focused mental health support within the maternal health system.

Maternal Pathologies Associated with Admission to the Intensive Care Unit

Introduction: Maternal health is a global concern due to its significant impact on mothers and newborns. In developing countries, obstetric complications often lead to ICU admissions.Objective: To determine the prevalence of maternal pathologies associated with admission to the Intensive Care Unit (ICU) at the Instituto Ecuatoriano de Seguridad Social (IESS) in Manta, during the period from August 2022 to August 2023.Methods: A descriptive cross-sectional study was conducted with 13 patients admitted to the ICU for maternal pathologies. Variables analyzed included age, type of delivery, maternal pathology, and length of hospital stay.Results: Women aged 25 to 30 years represented 30.77% of ICU admissions. 76.92% of deliveries were by cesarean section. The main pathologies identified were severe preeclampsia (31.03%) and sepsis (20.69%). The duration of hospital stay ranged from three to five days in most cases.Conclusions: Adolescent women and those aged 25 to 30 are most likely to require intensive care. Severe preeclampsia and sepsis are the primary causes of ICU admission.

Safety of contrast-enhanced ultrasound using microbubbles in human pregnancy: A scoping review.

Successful placentation is crucial for fetal development and maintaining a healthy pregnancy. Placental insufficiency can cause a variety of obstetric complications. Despite the many efforts to enhance diagnosing placental insufficiency, no imaging technique has proven satisfactory. A promising imaging technique is contrast-enhanced ultrasound (CEUS) using microbubbles which has proven capable of (micro)vascular imaging. Its use for placental vascularization assessment in human pregnancies remains constrained by limited evidence and safety concerns. This scoping review aims to demonstrate the safety of CEUS used in human pregnancy in the published literature to date. A systematic search using PubMed, Medline, Embase, and Cochrane databases was performed. All studies where contrast-enhanced ultrasound was used in pregnant humans were included. Studies, where there was a planned termination of pregnancy, were excluded. To assess the safety of CEUS during pregnancy, relevant outcomes were divided into the following 3 categories; fetal outcome, maternal outcome, and pregnancy and neonatal outcomes. A total of 13 articles were included, in which 256 women underwent CEUS during pregnancy. No clinically significant maternal or fetal adverse events or negative pregnancy or neonatal outcomes associated with CEUS were described. Based on our findings, we consider expanding the knowledge of this promising diagnostic technique in future larger clinical studies to be safe and relevant.

Adenomyosis: An Update Concerning Diagnosis, Treatment, and Fertility.

This review article aims to summarize current tools used in the diagnosis of adenomyosis with relative pharmacological and surgical treatment and to clarify the relative association between adenomyosis and infertility, considering the importance of an accurate diagnosis of this heterogeneous disease. Among different reported concepts, direction invagination of gland cells from the basalis endometrium deep into the myometrium is the most widely accepted opinion on the development of adenomyosis. Adenomyosis has been increasingly identified in young women with pain, AUB, infertility, or no symptoms by using imaging techniques such as transvaginal ultrasound and magnetic resonance. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. However, there is no agreement on the definition and classification of adenomyotic lesions from both the histopathology and the imaging points of view, and diagnosis remains difficult and unclear. A standard, universally accepted classification system needs to be implemented to improve our understanding and inform precise diagnosis of the type of adenomyosis. This could be the key to designing RCT studies and evaluating the impact of adenomyosis on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome, given the high risk of miscarriage and obstetric complications.

Postpartum Hemorrhage: A Diagnostic and Therapeutic Challenge

Postpartum hemorrhage (PPH) is a common, potentially life-threatening obstetric complication and a leading cause of maternal mortality worldwide, accounting for over a quarter of maternal deaths. Effective treatment largely depends on early recognition of hemorrhage and prompt medical intervention. Aim of the study: The aim of this study was to present current knowledge about PPH, predict its occurrence, and implement appropriate treatment. Analyzing current information, understanding risk factors, and recognizing PPH can prevent many maternal deaths in the future. Materials and methods: A systematic review of scientific and medical literature from the PubMed and Google Scholar databases was conducted. Results: PPH remains a serious global mortality issue. In recent years, many studies have described the challenges in diagnosing and treating PPH. Innovative treatment concepts have been presented, and knowledge of various novel methods can provide clinicians with alternatives that can be applied as a last resort in hemorrhage cases that do not respond to conventional methods. Conclusions: Postpartum hemorrhage (PPH) is still a serious obstetric complication. Innovative approaches and research on diagnostic and therapeutic methods allow for the refinement of guidelines, the establishment of international protocols, and actions that lead to quicker diagnoses and more appropriate responses.

Urban-rural disparities and change in postnatal care use from 2016 to 2019 in Ethiopia: Multivariate decomposition analysis.

Postnatal care (PNC) is essential for early identification and management of life-threatening obstetric complications. Despite efforts by the Ethiopian government to improve maternal and child health service use, PNC service has remained low, and disparity across geographic locations is a major public health problem. This study aimed to investigate the change and contributing factors in PNC service use across geographical locations (rural-urban) and over time (2016 to 2019) in Ethiopia. We analyzed data on women who gave birth from the 2016 and 2019 Ethiopian Demographic and Health Surveys. A total of 6,413 weighted samples (4,308 in 2016 and 2,105 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine the change and identify factors that contributed to the change across geographical locations and over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. The prevalence of PNC use was higher among urban residents, and the urban-rural disparity reduced from 32.59% in 2016 to 19.08% in 2019. The difference in the composition of explanatory variables was the only statistically significant for the urban-rural disparity in PNC use in both surveys. Specifically, female household heads (4.51%), delivery at a health facility (83.45%), and birth order of two to three (5.53%) and four or more (-12.24%) in 2016 significantly contributed to the urban-rural gap. However, in 2019, middle wealth index (-14.66%), Muslim religion (3.84%), four or more antennal care contacts (18.29%), and delivery at a health facility (80.66%) significantly contributed to the urban-rural gap. PNC use increased from 16.61% in 2016 to 33.86% in 2019. About 60% of the explained change was due to the difference in the composition of explanatory variables. Particularly, urban residence (-5.79%), a rich wealth index (2.31%), Muslim (3.42%), and other (-2.76%) religions, having radio or television (1.49%), 1-3 (-1.13%), and 4 or more (11.09%) antenatal care contacts, and delivery at a health facility (47.98%) were statistically significant contributors to the observed change. The remaining 40% of the overall change was due to the difference in unknown behaviors (coefficient) of the population towards PNC. There was a significant change in PNC service use by residence location and over time in Ethiopia, with urban women in both surveys being more likely to use PNC service. The urban-rural disparity in PNC uptake was due to the difference in the composition of explanatory variables, whereas the change over time was due to the change in both the composition of explanatory variables and population behavior towards PNC. Increased antenatal care contacts and delivery at a health facility played a major role in explaining the gap in PNC services across residences and over time in Ethiopia, highlighting the importance of stepping up efforts to enhance their uptake in rural settings.

Adverse obstetric and neonatal outcomes associated with maternal schizophrenia-spectrum disorders and prenatal antipsychotic use: a meta-analysis of 37,214,330 pregnancy deliveries and propensity-score weighted population-based cohort study assessing confounder dependency of risk estimates.

Studies demonstrated increased obstetric and neonatal complications in women with schizophrenia-spectrum disorder (SSD), but most inadequately addressed confounders and rarely considered antipsychotic effects. We conducted a meta-analysis and a population-based cohort study evaluating associations of adverse obstetric/neonatal outcomes with SSD and prenatal antipsychotic use. In the meta-analysis, we searched four databases from inception to October-31-2023 and generated pooled risk estimates using random-effect models. In the cohort study, we identified women aged 15-50 years with SSD-diagnosis from electronic-heath-record database of public healthcare-services who delivered first/singleton children between 2003 and 2018 in Hong Kong. Propensity-score weighted regression-analyses incorporating important confounders including maternal pre-existing and gestational morbidities, substance/alcohol abuse, and psychotropic use, were performed to assess risk of adverse obstetric/neonatal outcomes in SSD-women versus non-SSD-women, and subsequently treated-SSD and untreated-SSD subgroups to disentangle effects of SSD from antipsychotic exposure. The meta-analysis (studies = 18, women = 37,214,330, including 42,926 SSD-women) found significant associations of SSD with 12 of 17 analyzed negative obstetric/neonatal outcomes (with pooled relative risk ranged:1.12-2.10), including placental complications, induced labor, Caesarean delivery, fetal distress, stillbirth, preterm birth, small-for-gestational-age, low birth weight, low APGAR scores, neonatal and post-neonatal deaths. However, the cohort study (466,358 women, including 804 SSD-women) revealed that elevated risk of most study outcomes in unadjusted-models were markedly-attenuated or became non-significant in propensity-score weighted adjusted-models, except index-delivery hospitalization ≥7 days (odds ratio [OR] = 1.76 [95% CI = 1.33-2.34]), preterm birth (OR = 1.48 [95% CI = 1.09-2.00]) and neonatal special-care admission (OR = 1.65 [95% CI = 1.35-2.01]). Apart from higher neonatal special-care admission in treated-SSD than untreated-SSD women (OR = 1.75 [95% CI = 1.23-2.52]), no significant between-group differences emerged in other outcomes. In sum, elevated risk of most obstetric/neonatal complications reported in SSD-women might largely be explained by maternal physical comorbidities, substance/alcohol use disorders and other confounders. Interventions targeting modifiable maternal risk factors should be incorporated in prenatal care for SSD-women to minimize avoidable adverse outcomes.

Severe Maternal Morbidity by Disability Status and Type in the United States

OBJECTIVE: To estimate the risk of severe maternal morbidity (SMM) among women with disabilities compared with those without disabilities in a nationally representative sample of U.S. delivery hospitalizations. METHODS: We conducted a retrospective cohort analysis using the 2016–2021 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. We identified delivery hospitalizations and disability status using International Classification of Diseases, Tenth Revision diagnosis codes. The primary outcome was SMM, which was determined using 21 indicators specified by the Centers for Disease Control and Prevention. We used Poisson regression to estimate unadjusted and adjusted relative risks (aRRs) and 95% CIs for the association between disability status and type with SMM outcomes. RESULTS: Among 4,331,457 delivery hospitalizations, 128,413 (3.0%) were to women with disabilities. Women with disabilities had significantly higher rates of SMM compared with those without disabilities (396/10,000 deliveries vs 177/10,000 deliveries). In fully adjusted models, women with disabilities had an aRR of 1.86 (95% CI, 1.80–1.91) for one or more SMM indicators. The risk of SMM varied by disability type, with the highest risks observed for women who had vision disabilities (aRR 3.02, 95% CI, 2.70–3.38) or had physical disabilities (aRR 2.44, 95% CI, 2.34–2.55). Women with disabilities had the highest risk for other medical complications (puerperal cerebrovascular disorders and sickle cell disease with crisis), followed by other obstetric complications, respiratory complications, cardiovascular complications, acute renal failure, sepsis, and bleeding complications compared with women without disabilities. CONCLUSION: Women with disabilities have a significantly higher risk of SMM during delivery compared with those without disabilities, with the magnitude of risk varying by disability type. Efforts to reduce SMM and maternal mortality in the United States must prioritize the unique needs of this population and ensure equitable, disability-competent care for all women.

Readmission Rates After Expedited Postpartum Discharge.

To characterize national trends in expedited postpartum discharge and, secondarily, to identify predictors of expedited postpartum discharge and assess whether expedited postpartum discharge was associated with postpartum readmissions within 60 days of delivery hospitalization discharge. Birth hospitalizations and subsequent 60-day postpartum readmissions were extracted from the 2016-2020 Nationwide Readmissions Database for this retrospective cohort study. Postpartum discharge was categorized as expedited (less than 2 days after vaginal birth or less than 3 days after cesarean birth), routine (2 days after vaginal birth or 3 days after cesarean birth), or prolonged (more than 2 days after vaginal birth or more than 3 days after cesarean birth). Trends in expedited discharge were assessed over the study period with joinpoint regression. Unadjusted and adjusted logistic regression models were performed to assess clinical, hospital, and demographic predictors of expedited postpartum discharge. Sixty-day postpartum readmission risk was calculated, and adjusted regression models were performed to evaluate the association between expedited postpartum discharge and readmission. Of 17.9 million birth hospitalizations, 32.9% had expedited postpartum discharge. The overall 60-day postpartum readmission rate after delivery hospitalization discharge was 1.7% for all patients, 1.4% for expedited postpartum discharge, 1.6% for routine discharge, and 3.3% for prolonged discharge. Rates of expedited postpartum increased from 29.1% in 2016 to 31.4% in 2019 and to 43.8% in 2020. This trend was not significant (average annual percent change: 9.9%, 95% CI, -1.6% to 23.7%), although rates of expedited discharge were significantly higher in 2020 than in 2016-2019 ( P <.01). Younger and older age, chronic comorbid conditions, mental health conditions, and obstetric complications (eg, transfusion, chorioamnionitis or endometritis) were associated with lower likelihood of expedited postpartum discharge. Expedited postpartum discharge was associated with 14% lower adjusted odds of 60-day postpartum readmission compared with routine discharge (adjusted odds ratio 0.86, 95% CI, 0.85-0.88). Rates of expedited postpartum discharge increased significantly in 2020 compared with 2016-2019 and were not associated with 60-day postpartum readmission. These findings suggest that broader use of expedited postpartum discharge has not resulted in increased risk of postpartum readmissions.