Obstetric Conditions Research Articles

Placenta-on-a-Chip as an In Vitro Approach to Evaluate the Physiological and Structural Characteristics of the Human Placental Barrier upon Drug Exposure: A Systematic Review.

Quantification of fetal drug exposure remains challenging since sampling from the placenta or fetus during pregnancy is too invasive. Currently existing in vivo (e.g., cord blood sampling) and ex vivo (e.g., placenta perfusion) models have inherent limitations. A placenta-on-a-chip model is a promising alternative. A systematic search was performed in PubMed on 2 February 2023, and Embase on 14 March 2023. Studies were included where placenta-on-a-chip was used to investigate placental physiology, placenta in different obstetric conditions, and/or fetal exposure to maternally administered drugs. Seventeen articles were included that used comparable approaches but different microfluidic devices and/or different cultured maternal and fetal cell lines. Of these studies, four quantified glucose transfer, four studies evaluated drug transport, three studies investigated nanoparticles, one study analyzed bacterial infection and five studies investigated preeclampsia. It was demonstrated that placenta-on-a-chip has the capacity to recapitulate the key characteristics of the human placental barrier. We aimed to identify knowledge gaps and provide the first steps towards an overview of current protocols for developing a placenta-on-a-chip, that facilitates comparison of results from different studies. Although models differ, they offer a promising approach for in vitro human placental and fetal drug studies under healthy and pathological conditions.

Characterization of Pathogenic Microflora Causing Suppurative Septic Postpartum Complications: a Retrospective Cohort Study

Background. Suppurative septic postpartum complications occupy a leading position in the structure of causes of maternal mortality. Information about the characteristics of pathogenic microflora in various forms of complications and analysis of its resistance to antibacterial drugs determine the choice of rational therapy for this pathology.Objectives — to characterize the isolated pathogenic microflora in obstetric patients with suppurative septic postpartum complications.Methods. A retrospective cohort study was conducted at the Department of Obstetrics and Gynecology No. 2 of the Omsk State Medical University and the Department of Gynecology of the Omsk Regional Clinical Hospital. The study included 123 cesarean section patients treated from January 2013 to December 2022 who were divided into three groups: Group A — uncomplicated course of postpartum endometritis, n = 55; Group B — complicated forms of postpartum endometritis, n = 48: B1 — local complications (suture failure following cesarean section; parametritis) n = 29; B2 — pelvic peritonitis, n = 19; Group C — septic complications following critical obstetric conditions, n = 20. The pathogenic microflora of uterine and abdominal cavities was examined; the extent of contamination with a pathogen and sensitivity to antibacterial drugs were determined. The isolated microorganisms were identified using a MicroTax bacteriological analyzer (Austria), Vitek2 Compact (France) and routine methods; a disk diffusion method was employed to determine the sensitivity of microorganisms to antibacterial drugs. Calculations were performed using licensed Microsoft Office Excel 2013 and Statistica 10 programs (StatSoft Inc., USA). Nonparametric nominal data were compared using Pearson’s chi-squared test with p-value determination.Results. The pathogenic microflora was dominated by S. epidermidis, E. faecalis, E. coli, and E. faecium. In 2018–2022, a statistically significant decrease was observed in the isolation rate of S. epidermidis (p = 0.016), E. faecalis (p < 0.001), and E. faecium (p = 0.05). The highest resistance was exhibited by bacteria to the following antibiotics: S. epidermidis — cephalosporins (30.16%); E. faecalis — fluoroquinolones (33.33%); E. coli — cephalosporins (65.91%) and β-lactamase-resistant penicillins (40.91%); E. faecium — aminopenicillins (64.10%) and fluoroquinolones (50.0%); А. baumannii — fluoroquinolones, cephalosporins, carbapenems (100%), and aminoglycosides (84.2%). A contamination assessment revealed a high titer of isolated microorganisms in 60.53% of cases. We found a statistically significantly higher isolation rate of S. еpidermidis (p < 0.001), E. faecium (p = 0.01), and A. baumannii (p = 0.02) in the setting of pelvic peritonitis as compared to uncomplicated endometritis. In the case of suppurative septic complications due to critical obstetric conditions, the isolation rate was higher for S. еpidermidis (p <0.001), E. coli (p = 0.04), E. faecium (p = 0.005), A. baumannii (р<0.001), and K. рneumoniae (p = 0.04).Conclusion. The antibiotic resistance of pathogenic microorganisms calls for the development of new organ system support technologies and the use of methods capable of sorbing microorganisms and their toxins in the area of inflammation.

Placental lesions attributed to shallow implantation, excess extravillous trophoblast and decidual hypoxia: Correlation with maternal vascular malperfusion and related obstetric conditions

IntroductionMaternal vascular malperfusion (MVM) is one of four main patterns of placental injury defined by the Amsterdam consensus statement and is associated with adverse fetal and maternal outcomes. Laminar decidual necrosis (DLN), extravillous trophoblast islands (ETIs), placental septa (PS), and basal plate multinucleate implantation-type trophoblasts (MNTs) are lesions attributed to decidual hypoxia, excess trophoblast, and shallow implantation, but are not included in the current MVM diagnostic criteria. We aimed to investigate the relationship between these lesions and MVM. MethodsA case-control model was used to evaluate for DLN, ETIs, PS, and MNTs. Placentas with MVM on pathologic examination (defined as ≥2 related lesions) constituted the case group, and maternal age- and GPA-status-matched placentas with less than 2 lesions constituted the control group. MVM-related obstetric morbidities were recorded, including hypertension, preeclampsia, and diabetes. These were correlated with the lesions of interest. Results200 placentas were reviewed: 100 MVM cases and 100 controls. MNTs and PS showed significant enrichment in the MVM group (p < .05). Furthermore, larger foci of MNTs (>2 mm linear extent) were significantly associated with chronic or gestational hypertension (OR = 4.10; p < .05) and preeclampsia (OR = 8.14; p < .05). DLN extent correlated with placental infarction, but DLN and ETIs (including size and number) lacked association with MVM-related clinical conditions. DiscussionAs a marker of abnormally shallow placentation and related maternal morbidities, MNT merits inclusion within the MVM pathologic spectrum. Consistent reporting of MNTs >2 mm in size is recommended, as these lesions correlate with other MVM lesions and MVM-predisposing morbidities. Other lesions, particularly DLN and ETI, lacked such association questioning their diagnostic utility.

Risk Factors Associated With Intrauterine Growth Restriction: A Case-Control Study.

Background Intrauterine growth restriction (IUGR) is a disorder in which the fetus fails to reach its genetic development potential and is considered to be present when the weight at birth is less than the 10th percentile; as a result, it is at risk of increased postnatal morbidity and mortality. Every year, approximately 24% of newborns worldwide are determined to have IUGR. The objective of the present study was to identify various sociodemographic, medical, and obstetric risk factors associated with IUGR. Methodology A case-control study was conducted from January 2020 to December 2022. Fifty-four cases and 54 controls were included in the study. Postnatal women with neonates having birth weight below the 10th percentile for gestational age (GA) were recruited as cases in the study.Control cases were postnatal women with neonatal birth weight appropriate for (GA).Detailed history with respect to socio-demographic, medical, and obstetric parameters was noted and compared. Results Among the sociodemographic factors, only socioeconomic status showed significant statistical differences with the age group of 21 to 25 years showing maximum (51.9%) IUGR cases. Among the maternal risk factors, anemia (29.6%) and hypertensive disorders of pregnancy (22.2%) were marked as significant risk factors for IUGR. There was no significant difference in the distribution of past medical and obstetric histories between the two research groups. Conclusion Due to the poor living conditions, low literacy rates, and general lack of knowledge, low socioeconomic level increases the risk of IUGR. This leads to nutritional deficiencies andinsufficient growth environment which results inanemia and hypertensive disorders of pregnancy which arepotentrisk factors for IUGR. IUGR may be caused by maternal risk factors as well as past medical and obstetric conditions. However, for the risk factor of IUGR, the birth weight at the time of delivery could be taken into consideration as well.

Clinical chorioamnionitis: where do we stand now?

Intraamniotic infection is an infection resulting in the inflammation of any combination of the amniotic fluid, the placenta, the fetus itself, the fetal membranes, umbilical cord, or the decidua. In the past, an infection of the amnion and chorion or both was dubbed chorioamnionitis. In 2015, a proposal was made by an expert panel that, instead of clinical chorioamnionitis, the name intrauterine inflammation or infection or both be used, abbreviated as Triple I or simply IAI. However, the abbreviation IAI did not gain popularity, and this article uses the term chorioamnionitis. Chorioamnionitis may arise prior to, during, or following labor. It can present as a chronic, subacute, or acute infection. Its clinical presentation is generally referred to as acute chorioamnionitis. The treatment of chorioamnionitis varies widely across the world due to different bacterial causes and the absence of sufficient evidence to support a specific treatment regimen. There are limited randomized controlled trials that have evaluated the superiority of antibiotic regimens for treating amniotic infections during labor. This lack of evidence-based treatment suggests that the current choice of antibiotics is based on limitations in existing research, rather than absolute science. Chorioamnionitis cannot be cured by antibiotic therapy alone without delivery, and therefore it is necessary to make a decision according to the guidelines for induction of labor or acceleration of delivery. When a diagnosis is suspected or established, it is therefore necessary to apply broad-spectrum antibiotics according to the protocol used by each country, and to continue with them until delivery. A commonly recommended first-line treatment for chorioamnionitis is a simple regimen consisting of amoxicillin or ampicillin and once-daily gentamicin. Available information is not sufficient to indicate the best antimicrobial regimen to treat this obstetric condition. However, the evidence that is currently available suggests that patients with clinical chorioamnionitis, primarily women with a gestational age of 34 weeks or more and those in labor, should receive treatment with this regime. However, antibiotic preferences may vary based on local policy, clinician experience and knowledge, bacterial reasons for the infection, antimicrobial resistance patterns, maternal allergies, and drug availability.

Rudimentary horn pregnancy, a differential diagnosis of an intraabdominal pregnancy: a case report

BackgroundRudimentary horn pregnancy is a rare life-threatening obstetric condition with clinical and sonographic presentation resembling that of an abdominal pregnancy. Preoperative diagnosis of advanced rudimentary horn pregnancy is difficult and cases are often identified incidentally during laparotomy for a presumed abdominal pregnancy.Case presentationWe report a case of a 29-year-old African woman, gravida 2 para 1 at 28 weeks of gestation complaining of epigastric pain for 7 days with no other associated gastrointestinal or genitourinary symptoms. On examination, she had normal vital signs and an enlarged abdomen sized at 33 cm with unremarkable fetal lie and presentation. She had normal laboratory blood results with an ultrasound revealing an abdominal pregnancy of 28 weeks. The informed decision for conservative management was planned after informing of the benefit and risks of early termination versus conservative management, however, with worsening symptoms an emergency laparotomy had to be performed in which a left unruptured rudimentary horn pregnancy with a viable fetus was identified incidentally and delivery of the fetus followed by surgical excision of the horn was done. The postoperative period was uneventful, and the patient was discharged home with her newborn.ConclusionRudimentary horn pregnancy is very rare and often indistinguishable from an abdominal pregnancy in advanced gestation age. First trimester ultrasound is by far the only noninvasive sensitive diagnostic modality for rudimentary horn pregnancy. Laparotomy with horn excision remains the standard of care for advanced rudimentary horn pregnancy.

Measurement of maternal morbidity during postpartum with the WHO-WOICE tools in Morocco

BackgroundMaternal morbidity refers to any health problems or complications experienced by a woman during pregnancy, childbirth, or the postpartum period. Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although, measurement of maternel morbidity remains underdeveloped. We aimed to evaluate the prevalence of non-severe maternal morbidities (including overall health, domestic and sexual violence, functionality, and mental health) in women during postpartum care and further analyze factors associated with compromised mental functioning and clinical health by administration of the WHO’s WOICE 2.0 instrument.MethodsA cross-sectional study was conducted at 10 Health centers in Marrakech, Morocco with WOICE questionnaire included three sections: the first with maternal and obstetric history, sociodemographic data, risk and environment factors, violence and sexual health; the second considers functionality and disability, general symptoms and mental health; and the third includes data on physical and laboratory tests. This paper presents descriptive data on the distribution of functioning status among postpartum women.ResultsA total of 253 women averaging 30 years of age participated. For self-reported health status of women, more than 40% reported good health, and just 9.09% of women had a health condition reported by the attending physician. Among postpartum women with clinical diagnoses, 16.34% had direct (obstetric) conditions and 15.56% indirect (medical) problems. When screening for factors in the expanded morbidity definition, about 20.95% reported exposure to violence. Anxiety was identified in 29.24% of cases, and depression in 17.78%. Looking into gestational results, just 14.6% delivered by cesarean section and 15.02% had preterm birth. We found also that 97% reported “good baby health” in the postpartum evaluation, with 92% of exclusive breastfeeding.ConclusionConsidering these results, improving the quality of care for women requires a multi-faceted approach, including increased research, better access to care, and improved education and resources for women and healthcare providers.

Outcomes of Evidence-Based Stratification of Placenta Accreta Spectrum (PAS) Disorders for Team-Based Management [ID: 1375468

INTRODUCTION: Placenta accreta spectrum (PAS) is characterized by placental invasion and adherence to underlying uterine myometrium resulting in significant maternal morbidity and mortality. Despite knowledge that greater placental depth results in worse outcomes, many centers approach PAS with a single uniform management protocol. We aimed to undercover the effect of surgical planning stratification by antenatal suspicion of placental depth. METHODS: This study was a preimplementation and postimplementation of analysis of PAS surgical stratification by suspected depth of placental invasion, accreta (less invasion) or increta/percreta (greater invasion), from 2019 to 2022. Depth of placenta invasion was determined by ultrasonography and/or magnetic resonance imaging. As a control, 4-year (2015–2018) preimplementation group was used to assess the effect of the protocol. This protocol included utilization of a hybrid operating room, uniform uterine artery embolization, as well as staffing by advanced pelvic surgeons. Patient demographics and clinically relevant outcomes were obtained from electronic medical records. Exclusion criteria included pregnancy less than 20 weeks of gestation, fetal demise, and multifetal gestation. RESULTS: During the 8-year time period, a total of 93 patients were managed by our PAS team. Forty-six patients were in the preimplementation period, of which 17 (37%) were suspected increta/percreta. During the postimplementation period, 24 of 53 (45%) cases were suspected increta/percreta. In cases of placenta accreta, no significant differences were noted in blood loss, blood transfusion rates, or operative time. When analyzing outcomes of the suspected increta/percreta cohort, our protocol was associated with lower blood loss (2,500 versus 1,500 mL, P=.008), lower blood transfusion rates (88% versus 54%, P=.03), and longer operative time (240 versus 384 minutes, P=.009). Final pathology confirmed increta/percreta suspicion in 23 of the 24 cases (96%). CONCLUSION: A protocol for the management of PAS cases by antenatally suspected degree of placenta invasion is not only feasible but results in optimal outcomes for patients with the most complex obstetric conditions.

A PROSPECTIVE CLINICAL STUDY ON PREGNANCY WITH ABRUPTIO PLACENTAE IN WOMEN ATTENDING A TERTIARY CARE CENTRE OF CENTRAL INDIA

Background- Placental abruption is a relatively rare but serious complication of pregnancy and placed the well-being of both mother and fetus at risk. Placental abruption is also called abruptio placentae. The estimated incidence is around 1% of all pregnancies. Despite being a relatively rare occurrence, placental abruption needs urgent intervention. Most placental abruptions happen before 37 weeks of pregnancy. Maternal morbidity and neonatal mortality are primarily caused by placental abruption. Despite the fact that blood transfusions are available, maternal deaths are nonetheless uncommon and higher than the overall maternal mortality rate. Preterm birth, low birth weight, perinatal hypoxia, stillbirth, and neonatal mortality are all neonatal consequences. Even with better prenatal care and monitoring methods, the rate of placental abruption has been rising in several nations. The present study Material and Method- is a prospective study done in the Department of Obstetrics and Gynecology, M.G.M Medical College and M.Y Hospital, Indore, over a period of 1 year from March 2021 to February 2022.. All cases are admitted in Department of Obstetrics and Gynaecology, M.G.M Medical College and M.Y Hospital, Indore. The study will include prospective cases for 1 year from ethics committee Inclusion Criteria- 1. All cases of concealed and revealed abruption with gestational age &gt; 28 weeks till term. 2. All abruption with clinical symptoms of sudden onset abdominal pain, vaginal bleeding and uterine tenderness 3. All patients of abruptio placentae diagnosed on USG ndings. Exclusion Criteria- 1. All patients who come with the history of Ante partum hemorrhage but are having local (vaginal/cervical)causes excluded. 2. All patients referred to the hospital for the management of post-partum complications. 3. All other causes of APH like placenta previa and other extra placental causes. Result- Majority of the study population were booked multigravida in the age group of 26-30 years of low socioeconomic status with B+ blood group with anemia and gestational hypertension as risk factors.Most of them underwent LSCS with Shock and sepsis as complications 80% study participants had live and healthy baby. 20% had perinatal death. 47.9% of the babies were low birth weight and 25% required resuscitation Without a doubt, abruptio placent Conclusion- ae is a potentially serious obstetric condition that has the potential to threaten mother health and wellbeing, foetal viability, neonatal mortality, and morbidity. We found that important risk factors for abruptio placenta are multiparty, unbooked status, living in a rural area, maternal anaemia, and hypertension and also it is independent risk factor for perinatal mortality. From the present study we conclude that to prevent and lessen the severity of the situation early intervention, prompt delivery, and strengthening of safe motherhood services, particularly in remote regions will be helpful.

A Case of Very Severe Anemia in Pregnancy Combined with Beta-Thalassemia Major and Pre-Eclampsia

OBJECTIVE: To investigate the clinical diagnosis, preventive antenatal screening and antenatal diagnosis, pregnancy management, timing and mode of delivery and postnatal management of β-thalassaemia in pregnancy combined. METHODS: Retrospective analysis of the medical history and treatment of a patient with β-thalassaemia in pregnancy combined with pregnancy outcome. RESULTS: The patient recovered well, had a normal temperature, the abdominal incision was removed at 7 d, the II/nail healed, the general obstetric condition was acceptable and she was discharged successfully. CONCLUSION: Anaemia is very common in pregnancy, but very severe anaemia in pregnancy is extremely rare and it is important to define the cause of anaemia. Thalassaemia is a group of inherited chronic haemolytic disorders caused by autosomal defects, which can be aggravated by pregnancy. Thalassaemia can be divided into α-, β-, γ-, δ-, δβ- and other categories, and for β-thalassaemia it can be divided into mild, moderate and severe, with both intermediate and severe patients presenting early with obvious anaemic symptoms and relying on long-term transfusion therapy. The majority of these patients die in childhood and are extremely rare in pregnancy. Thalassaemia in pregnancy can directly affect the outcome of pregnancy and cause many near and long-term complications in the newborn, and timely antenatal screening and prenatal diagnosis can detect the disease early. Active obstetric management and timing of pregnancy can also help to improve maternal and infant pregnancy outcomes.

Successful Reposition of an Incarcerated Gravid Uterus by Instrument: A Case Report and Literature Review

Incarcerated gravid uterus is a rare obstetric condition that contributes to pregnancy-related adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. An effective diagnosis of this condition is benefited from pelvic examination combined with imaging methods and based on suspected symptoms. We present a case of ultrasound-assisted instrument reposition of an incarcerated gravid uterus at mid-gestation and discuss its clinical characteristics, diagnosis, imaging features, and treatment. We believe that once manual reduction fails, the use of instruments will undoubtedly be a better choice.

Accelerating action to reduce anemia: Review of causes and risk factors and related data needs.

Anemia is a major public health concern. Young children, menstruating adolescent girls and women, and pregnant women are among the most vulnerable. Anemia is the consequence of a wide range of causes, including biological, socioeconomic, and ecological risk factors. Primary causes include: iron deficiency; inherited red blood cell disorders; infections, such as soil-transmitted helminthiasis, schistosomiasis, and malaria; gynecological and obstetric conditions; and other chronic diseases that lead to blood loss, decreased erythropoiesis, or destruction of erythrocytes. The most vulnerable population groups in low- and middle-income countries are often at the greatest risk to suffer from several of these causes simultaneously as low socioeconomic status is linked with an increased risk of anemia through multiple pathways. Targeted and effective action is needed to prevent anemia. Understanding the causes and risk factors of anemia for different population subgroups within a country guides the design and implementation of effective strategies to prevent and treat anemia. A coordinated approach across various expert groups and programs could make the best use of existing data or could help to determine when newer and more relevant data may need to be collected, especially in countries with a high anemia burden and limited information on the etiology of anemia.

Major Causes of Dystocia in Bovine: A Review

The inability of the cow to expel neonates through the birth canal from the uterus is called dystocia. There are several physical, physiological and hormonal changes take place to prepare the dam and fetus for parturition. It is one of the most important obstetrical conditions and requires immediate attention of obstetricians as it causes severe economic losses to dairy farmers. The causes of dystocia are generally classified as being maternal or fetal in origin. Maternal causes include feto-maternal disproportion, incomplete cervical dilation, uterine torsion, uterine inertia and hernia of gravid uterus, and fetal causes are fetal maldisposition, fetal oversize and fetal monstrosities. Dystocia negatively affects the productive and reproductive performance due to increased risk for uterine diseases. As one of the reproductive problems in cows, it is important to prevent and reduce the incidence of dystocia and awareness on the significance of dystocia should be enhanced, which necessitate presenting the current literature review on dystocia.

Caesarean Section Delivery Is Associated with Childhood Overweight and Obesity, Low Childbirth Weight and Postnatal Complications: A Cross-Sectional Study.

Background and Objectives: In the last decades, simultaneously increasing trends have been recorded for both caesarean section delivery and childhood overweight/obesity around the world, which are considered serious public health concerns, negatively affecting child health. Aim: The present study aims to investigate whether caesarean section is associated with the increased rates of childhood overweight/obesity, low childbirth anthropometric indices and postnatal complications in pre-school age. Materials and Methods: This is a cross-sectional study in which 5215 pre-school children aged 2-5 years old were enrolled from nine different Greek regions after applying specific inclusion and exclusion criteria. Non-adjusted and adjusted statistical analysis was performed to assess the impact of caesarean section in comparison to vaginal delivery. Results: Children delivered by caesarean section were significantly more frequently overweight or obese at the age of 2-5 years, also presenting a higher prevalence of low birth weight, length and head circumference. Caesarean section was also associated with higher incidence of asthma and diabetes type I at the age of 2-5 years. In a multivariate analysis, caesarean section increased the risk of childhood overweight/obesity and low childbirth anthropometric indices even if adjusting for several childhood and maternal confounding factors. Conclusions: Increasing trends were recorded for both caesarean section delivery and childhood overweight/obesity, which are considered serious public health concerns. Caesarean section independently increased childhood overweight/obesity in pre-school age, highlighting the emergent need to promote health policies and strategies to inform future mothers about its short and long-term risks and that this mode of delivery should preferably be performed only when there are strong medical recommendations in emergency obstetric conditions.

ASSOCIATION BETWEEN THE AGE OF PREGNANT WOMEN AND PARITY WITH THE INCIDENCE OF PLACENTA PREVIA : SYSTEMATIC REVIEW

Placenta previa is associated with an increased risk of premature birth, fetal death during intrauterine development, and asphyxia in neonates. Vaginal bleeding that is not unpleasant is one of the telltale signs of placenta previa. It is estimated that 5.2% of pregnancies would be affected by the common obstetric condition known as placenta previa. Sometimes there are no symptoms associated with placenta previa. During the second half of pregnancy, the primary symptom is vaginal bleeding that is brilliant red and completely painless. Moreover, this syndrome can cause excessive bleeding prior to or throughout the labor process. The uterus should have some scars on it as a result of a surgery or procedure that was performed in the past. a previous pregnancy in which you experienced placenta previa is considered to be a risk factor. Having a previous cesarean section (CS), having an abortion, being older than 35 years old, having more than one child, and using assisted reproductive technologies (ART) such in vitro fertilization are all variables that can increase the likelihood of developing placenta previa (IVF). It appears that the risk of placenta previa increases with both the mother's age and the number of previous pregnancies. Despite the fact that research has shown that the association is not consistent at all.

Establishing the Ethiopian Obstetric Surveillance System for Monitoring Maternal Outcomes in Eastern Ethiopia: A Pilot Study.

Although the majority of maternal deaths and complications occur in low-resource settings, almost all existing strong registration and confidential enquiry systems are found in high-resource settings. We developed and piloted the Ethiopian Obstetric Surveillance System (EthOSS), based on the successful United Kingdom Obstetric Surveillance System (UKOSS) methodology, in 3 regions in Ethiopia to improve ongoing surveillance and tracking of maternal morbidities and deaths, as well as confidential enquiry, compared to the currently used maternal death surveillance and response program in Ethiopia. We launched the EthOSS monthly case notification system in 13 hospitals in eastern Ethiopia in April 2021. Study participants included women admitted to the hospitals from April to September 2021 with major adverse obstetric conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Designated clinicians at the hospitals used a simple online system to report the number of cases and maternal deaths monthly to the EthOSS team. We present findings on the incidence and case fatality rates for adverse conditions included in the EthOSS. Over the 6-month pilot period, 904 women with at least 1 EthOSS condition were included in the study, of whom 10 died (case fatality rate, 1.1%). Almost half (46.6%, 421/904) sustained major obstetric hemorrhage, 38.7% (350/904) severe anemia, 29.5% (267/904) eclampsia, 8.8% (80/904) sepsis, and 2.2% (20/904) uterine rupture. To enable care improvement alongside surveillance, the local committee received training on confidential enquiry into maternal deaths from internal and external experts. In this facility-based project, data on severe adverse obstetric conditions were captured through voluntary reporting by clinicians. Further analysis is essential to assess the robustness of these data, and confidential enquiry into maternal deaths for specific cases is planned to investigate the appropriateness of care.

Don't sugar coat it: The independent and synergistic impacts of obesity and gestational diabetes on placental parameters.

Don't sugar coat it: The independent and synergistic impacts of obesity and gestational diabetes on placental parameters.

Postpartum Opioid-Related Mortality in Patients With Public Insurance.

To assess the incidence and risk factors for postpartum opioid overdose death and describe other causes of postpartum death in individuals with opioid use disorder (OUD). We conducted a cohort study that used health care utilization data from the Medicaid Analytic eXtract linked to the National Death Index in the United States from 2006 to 2013. All pregnant individuals with live births or stillbirths and continuous enrollment for 3 months before delivery were eligible, including 4,972,061 deliveries. A subcohort of individuals with a documented history of OUD in the 3 months before delivery was identified. We estimated the cumulative incidence of death as occurring between delivery and 1 year postpartum among all individuals and individuals with OUD. Risk factors for opioid overdose death were assessed using odds ratios (ORs) and descriptive statistics, including demographics, health care utilization, obstetric conditions, comorbidities, and medications. The incidence of postpartum opioid overdose death per 100,000 deliveries was 5.4 (95% CI 4.5-6.4) among all individuals and 118 (95% CI 84-163) among individuals with OUD. Individuals with OUD had a sixfold higher incidence of all-cause postpartum death than all individuals. Common causes of death in individuals with OUD were other drug- and alcohol-related deaths (47/100,000), suicide (26/100,000), and other injuries, including accidents and falls (33/100,000). Risk factors strongly associated with postpartum opioid overdose death included mental health and other substance use disorders. Among patients with OUD, postpartum use of medication to treat OUD was associated with 60% lower odds of opioid overdose death (OR 0.4, 95% CI 0.1-0.9). Postpartum individuals with OUD have a high incidence of postpartum opioid overdose death and other preventable deaths, including nonopioid substance-related injuries, accidents, and suicide. Use of medications for OUD is strongly associated with lower opioid-related mortality.

Successful Anesthesia Management of Complicated Case of Placenta Previa Accreta with Massive Intraoperative Bleeding and Incidentally Detected COVID-19

Placenta previa accreta is a serious obstetric condition with high risk of postoperative complications requiring the use of multiple health resource. The risk is higher in patients with previous history of caesarean section. Moreover, presence of COVID-19 infection can deteriorate the disease process. In this case report it was reported that the case of successful anesthetic management of a complicated placenta previa accreta with massive intraoperative bleeding with incidental COVID-19 diagnosis.

Care for pregnant and postpartum woman with cerebral palsy

Abstract Introduction. Disabled women are often overlooked when it comes to procreation plans and encounter social misunderstanding and lack of support. In addition, their sexual needs are often marginalized. It means that education and professional care of midwives and doctors are necessary to put flesh on problem. Aim. The aim of the work is to present knowledge and familiarize with the subject of perinatal care for a woman with a disability based on an individual case study. Method. For the purposes of this study, the qualitative research method “study case” was used, containing a description of the patient’s obstetric and clinical condition, aimed at its in-depth analysis and assessment. The patient’s informed consent to participate in the study was obtained. C-Hobic care outcome indicators were also used to describe the case. ICNP® reference terminology was used to develop care plans. Summary. Taking care of a patient with cerebral palsy, the midwife undertakes numerous interventions in the field of education of both the woman and the whole family. The overriding goal is to increase the woman’s independence, increase her confidence that she will be able to take care of a newborn and improve her competence in self-care. Due to the constant progress in maternal-fetal medicine, further research is needed on preconception and perinatal care for patients with CP.