Obstetric Outcomes In Women Research Articles

Obstetric outcomes in women with vulvodynia and vaginismus: a systematic review.

Vulvodynia and vaginismus are pain disorders associated with adverse pregnancy outcomes. The few published studies addressing this topic were limited in terms of the different outcomes studied; hence, the purpose of our study was to perform the first systematic review examining maternal, neonatal and obstetric outcomes in patients with vulvodynia and/or vaginismus (VV). We conducted a systematic review searching PubMed, EMBASE, Cochrane Library and SCOPUS until November 2023 for observational studies reporting maternal and/or neonatal outcomes of VV in pregnancy. Data on maternal characteristics and obstetric outcomes were independently extracted from the included studies by two reviewers and then summarized between those with and without VV. The search strategy yielded 1118 citations, of which 10 were included. A total of 2209 patients with a diagnosis of VV prior to pregnancy were identified over a 27-year study period. Compared with women without VV, women with VV were more likely to deliver by cesarean sect. (40.3 vs 29.8%, p < 0.001). Cesarean sections were more likely elective (41.0 vs 35.7%) and performed in response to maternal request (26.0 vs 9.5%) for women with VV. Of those who delivered vaginally, instrumental deliveries were more common among women with VV (16.7 vs 6.2%, p < 0.001), with more perineal injuries as well (43.0 vs 32.7% p < 0.001). Vaginismus/vulvodynia are high-risk conditions during pregnancy with increased rates of cesarean sections performed for elective reasons and upon maternal request. Offering support, education, and treatment for these conditions prior to pregnancy is important to reduce the rate of avoidable cesarean sections.

Obstetrical Outcomes in Women With a History of Bladder Augmentation.

To evaluate possible problems during pregnancy or delivery in women with pediatric bladder augmentation. Eleven of 59 women, who had undergone bladder augmentation in our pediatric hospital during 1990-2019, had given birth in our hospital district afterwards and their obstetrical records were evaluated. Median age at first delivery was 32 years (range 26-42). Six patients had myelomeningocele, two had bladder exstrophy and the remainder had VATER association, epispadias or traumatic paraplegia with vesicovaginal fistula. The patients had altogether 18 children (all singletons). Catheterizations were performed through continent stoma in six cases and through urethra in five cases. None of the patients needed an indwelling catheter before delivery. Antibiotic prophylaxis was initially in use during two pregnancies. Symptomatic urinary tract infections (UTIs) developed for five mothers in 11 pregnancies without prophylaxis and prophylaxis was continued after UTI in these cases. Three of the five mothers with UTI were treated with intravenous antibiotics due to pseudomonas infection (three infections) or pyelonephritis (one).Two patients with myelomeningocele delivered vaginally (one woman three times and one woman once). In the remaining 14 cases a cesarean section (CS) was performed (two urgent and one emergency CS). A urologist was present in seven CSs. Some difficulties accessing the uterus were reported in seven surgeries. There were 10-term, three late-preterm and one very preterm delivery. In four cases the information on gestational age was unavailable. Six newborns had respiratory problems, two had severe asphyxia. One newborn had myelomeningocele like her mother. Risk for UTIs during pregnancy is high in bladder augmentation patients, hence prophylactic antibiotics are justified. A multidisciplinary team should be involved in the planning of delivery. When indicated for obstetrical or urological reasons, an elective cesarean section with a urologist present may be the most rational option for many, although vaginal delivery is possible in selected patients.

Maternal and obstetric outcomes in women with pregnancy-associated haematological malignancies: an observational nationwide cohort study

Pregnancy-associated haematological malignancy is a rare event; therefore, data available to guide the treatment are scarce. We aimed to evaluate the incidence, overall survival, and maternal morbidity and mortality of women with pregnancy-associated haematological malignancies. We conducted a nationwide observational cohort study using the French National Healthcare Data System (SNDS), a health-care administrative database covering up to 99% of the French population. We included all pregnancies in France ending between Jan 1, 2012, and Dec 31, 2022. Pregnancies with terminations or miscarriages managed on an outpatient basis, and women with a history of haematological malignancies before pregnancy were excluded. A Cox proportional hazards model was used to assess overall survival, defined as the date of haematological malignancy diagnosis to either death or the end of the study follow-up, in the haematological malignancy during pregnancy group (pregnancies with a diagnosis of haematological malignancy during pregnancy) compared with the haematological malignancy post-pregnancy group (pregnancies with a diagnosis of haematological malignancy in the year following pregnancy). Severe maternal morbidity was compared in the haematological malignancy during pregnancy group versus the reference group (pregnancies without a history of haematological malignancy or a diagnosis of pregnancy-associated haematological malignancy). Births were classified as very preterm (<32 weeks of pregnancy), preterm (32-36 weeks), and term (≥37 weeks) and compared in the haematological malignancy during pregnancy group versus the reference group. Inverse probability weighting (IPW) was used for confounder adjustment, using maternal age (categorised), comorbidities, socioeconomic status, and year of delivery (as a category). Of 9 996 523 pregnancies in 5 995 235 women, 1366 pregnancy-associated haematological malignancies were identified: 413 during pregnancy (4·13 per 100 000 pregnancies) and 953 (9·53 per 100 000 pregnancies) within 12 months of the end of pregnancy (post-pregnancy). No significant differences in overall survival were observed between the haematological malignancy during and post-pregnancy groups across all types of haematological malignancy (IPW-adjusted hazard ratio 0·91 [95% CI 0·62-1·34], p=0·63), specifically for Hodgkin lymphoma (0·56 [0·07-4·53], p=0·59), aggressive B-cell non-Hodgkin lymphoma (0·52 [0·12-2·38], p=0·40), and acute leukaemia alone (0·84 [0·50-1·41], p=0·51). Severe maternal morbidity was more frequent in the haematological malignancy during pregnancy group than in the reference group (86 [26·2%] of 328 completed pregnancies vs 120 335 [1·5%] of 7 945 909 completed pregnancies; IPW-adjusted odds ratio 22·71 [95% CI 17·72-29·10], p<0·0001). We observed an increase in very preterm birth (32 [9·8%] vs 92 712 [1·2%]; IPW-adjusted odds ratio 11·90 [95% CI 7·91-17·91], p<0·0001) and preterm birth (116 [35·4%] vs 430 472 [5·4%]; 11·76 [9·34-14·81], p<0·0001) in the haematological malignancy during pregnancy group compared with the reference group. This nationwide observational study examines pregnancy-associated haematological malignancies in France, revealing no significant difference in overall survival between women diagnosed during pregnancy and post-pregnancy. Our data highlight an increased frequency of severe maternal morbidity and obstetric complications among women diagnosed during pregnancy. Notably, the study underscores the necessity for specialised care to manage these complex cases effectively. None. For the French translation of the abstract see Supplementary Materials section.

Female genital mutilation/cutting in women delivering in France: An observational national study.

International migration from source countries has meant that clinicians in high income countries, that is, receiving countries, are increasingly caring for affected women affected by female genital mutilation/cutting (FGM/C). The aim of the present study was to assess the prevalence of FGM/C among women at childbirth, and its association with pregnancy outcomes. This was an observational study using data from a cross-sectional population-based study from the French National Perinatal Survey of 2021 (ENP) conducted in all maternity units in mainland France and including all women delivering a live birth during 1 week in March 2021 (N = 10 928). We estimated the FGM/C prevalence using (i) the diagnosed cases and (ii) the indirect prevalence estimated by UNICEF in each source country. We compared population characteristics and perinatal outcomes between women diagnosed with FGM/C and two groups: (i) women originating in source countries and diagnosed as without FGM/C and (ii) all women without diagnosis of FGM/C whatever the country of birth. Diagnosed prevalence of FGM/C was 95% (95% CI: 0.78-1.14] and the indirect computed estimation prevalence was estimated at 1.53% (95% CI: 1.31-1.77) in 113 and 183 women, respectively. Labor and delivery outcomes were globally similar in women with FGM/C and the other two groups. Only episiotomy was more frequently performed in women with FGM/C than in the other two groups. In receiving countries, obstetric outcomes of women with FGM/C can be similar to those of other women, which does not preclude need of further research and training to provide the most appropriate care, including enhanced attention to diagnosis.

Preeclampsia and timing of delivery: Disease severity, maternal and perinatal outcomes

ObjectivesThis study aimed to elucidate clinical characteristics, disease severity, and obstetric outcomes in women with pregnancy complicated with preeclampsia stratified by gestational age at delivery. Study designThis retrospective study was conducted at a tertiary care facility from January 2011 to December 2020. Main outcome measuresMaternal characteristics, risk factors, clinical signs and symptoms, laboratory test results, and maternal and perinatal outcomes were compared between early (<34 weeks) versus late (≥34 weeks) and preterm (<37 weeks) versus term (≥37 weeks) preeclampsia. ResultsMore than half of the women (56 %, 612/1094) had preterm preeclampsia. Overall, 30 % (329/1094) delivered before 34 weeks of gestation. Pregnancies with early preeclampsia had the worst maternal signs and symptoms, the highest median blood pressure level, and more abnormal laboratory abnormalities compared to those with late preeclampsia. Additionally, women with co-morbid diseases (chronic hypertension, chronic kidney disease, and systemic lupus erythematosus) were more likely to develop early than late preeclampsia. Of note, although adverse maternal and perinatal events occurred more commonly in early rather than late preeclampsia, 18 % (7/39) of eclampsia and 16 % (8/50) of hemolysis, elevated liver enzymes, and low platelet count syndrome cases occurred after 37 weeks of gestation. ConclusionsEarly preeclampsia posed the highest risk to the mother and infant(s); however, adverse maternal and perinatal events were still present even in cases of preeclampsia at term. Therefore, it is crucial for healthcare practitioners to remain vigilant and manage all cases with great care to prevent adverse outcomes.

Obstetric Outcomes in Women on Lithium: A Systematic Review and Meta-Analysis.

Background/Objectives: Lithium taken during pregnancy was linked in the past with increased risk for foetal/newborn malformations, but clinicians believe that it is worse for newborn children not to treat the mothers' underlying psychiatric illness. We set to review the available evidence of adverse foetal outcomes in women who received lithium treatment for some time during their pregnancy. Methods: We searched four databases and a register to seek papers reporting neonatal outcomes of women who took lithium during their pregnancy by using the appropriate terms. We adopted the PRISMA statement and used Delphi rounds among all the authors to assess eligibility and the Cochrane Risk-of-Bias tool to evaluate the RoB of the included studies. Results: We found 28 eligible studies, 10 of which met the criteria for inclusion in the meta-analysis. The studies regarded 1402 newborn babies and 2595 women exposed to lithium. Overall, the systematic review found slightly increased adverse pregnancy outcomes for women taking lithium for both the first trimester only and any time during pregnancy, while the meta-analysis found increased odds for cardiac or other malformations, preterm birth, and a large size for gestational age with lithium at any time during pregnancy. Conclusions: Women with BD planning a pregnancy should consider discontinuing lithium when euthymic; lithium use during the first trimester and at any time during pregnancy increases the odds for some adverse pregnancy outcomes. Once the pregnancy has started, there is no reason for discontinuing lithium; close foetal monitoring and regular blood lithium levels may obviate some disadvantages of lithium administration during pregnancy.

Obstetric outcomes of women with congenital uterine anomalies in the United States

BackgroundDue to the rarity, congenital uterine anomaly type-specific evaluation of pregnant women has been relatively understudied. ObjectiveTo describe national-level obstetric outcomes in women with congenital uterine anomalies. Study DesignThis cross-sectional study queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Pregnant women with diagnosis of congenital uterine anomalies who had hospital delivery between 2016 and 2019 were examined. The World Health Organization's International Classification of Disease, 10th revision coding was used to delineate type of congenital uterine anomaly, diagnoses, and procedures performed during the index admission. Primary outcomes included pregnancy outcome, which was classified as full-term live birth, preterm live birth, abortion/stillbirth, or ectopic pregnancy. Secondary outcomes included obstetric comorbidities and severe maternal morbidity, which were compared between different subtypes of congenital uterine anomalies with multivariable logistic regression model. ResultsA total of 50,180 pregnant women with congenital uterine anomalies were identified. Bicornuate was the most common subtype (73.5%), followed by arcuate (13.5%) and unicornuate (10.0%). 70.6% of women with congenital uterine anomalies had a full-term live birth, 26.8% had a preterm live birth, 2.1% had an abortion or stillbirth, and 0.4% had an ectopic pregnancy. 61.8% of preterm births occurred between 33 and 36 weeks, 16.9% between 30 and 32 weeks, and 21.3% at <30 weeks. There were 1,440 (2.9%) periviable births. The preterm (34.5%) and periviable (6.9%) birth rates were highest in the uterine didelphys group. Overall, two-thirds (65.7%) of patients with congenital uterine anomalies were delivered via cesarean section. When compared to arcuate uterus, risk of severe maternal morbidity in septate uterus (4.8% vs 2.6%, adjusted-odds ratio [aOR] 2.60, 95% confidence interval [CI] 1.49-4.52) was increased, including hemorrhage (14.5% vs 7.7%, aOR 2.16, 95% CI 1.51-3.07). This was followed by uterine didelphys (4.2% vs 2.6%, aOR 1.75, 95% CI 1.24-2.47), unicornuate uterus (3.8% vs 2.6%, aOR 1.61, 95% CI 1.29-2.01), and bicornuate uterus (3.0% vs 2.6%, aOR 1.23, 95% CI 1.04-1.47). ConclusionWhile the majority of patients with congenital uterine anomalies result in full-term viable deliveries, each subtype of congenital uterine anomalies confers different obstetric risks. Uterine didelphys was associated with the highest risk of preterm birth, while septate uterus was associated with the highest risk of severe maternal morbidity. While this hospital delivery dataset likely overrepresents bicornuate uteri, this populational data may help inform patients with congenital anomalies considering pregnancy.El resumen está disponible en Español al final del artículo.

Obstetric outcomes in women with pelvic endometriosis: a prospective cohort study

ObjectiveTo determine whether obstetric outcomes differ between women with endometriosis and those without, where all women undergo first trimester screening for endometriosis DesignA prospective observational cohort study SettingThe Early Pregnancy Unit at University College London Hospital, United Kingdom SubjectsWomen with a live pregnancy progressing beyond 12 weeks’ gestation and concurrent endometriosis (n=110) or no endometriosis (n=393). ExposureAll women underwent a pelvic ultrasound examination in early pregnancy to examine for the presence of endometriosis and uterine abnormalities. Main outcome measuresThe primary outcome of interest was preterm birth, defined as delivery before 37 completed weeks’ gestation. Secondary outcomes included late miscarriage, antepartum haemorrhage, placental site disorders, gestational diabetes, hypertensive disorders of pregnancy, neonate small for gestational age, mode of delivery, intrapartum sepsis, postpartum haemorrhage and admission to the neonatal unit. ResultsWomen with a diagnosis of endometriosis did not have statistically significantly higher odds of preterm delivery (aOR 1.85 (95% CI 0.50-6.90)), but they did have higher odds of postpartum haemorrhage during Caesarean section (aOR 3.64 (95% CI 2.07-6.35);) and admission of their newborn baby to the neonatal unit (aOR 3.24 (95% CI 1.08-9.73);). Women with persistent or recurrent deep endometriosis after surgery, also had higher odds of placental site disorders (aOR 8.65 (95% CI 1.17-63.71);) and intrapartum sepsis (aOR 3.47 (95% CI 1.02-11.75);). ConclusionWe observed that women with endometriosis do not have higher odds of preterm delivery, irrespective of their disease subtype. However, they do have higher odds of postpartum haemorrhage during Caearean section and newborn admission to the neonatal unit.

Microbiome Review: Ethnicity, Diet, and Lifestyle in Bad Obstetric History

This systematic review explores the intricate relationship between the maternal microbiome and adverse obstetric outcomes in women with a history of recurrent miscarriages, preterm birth, or stillbirth, collectively known as Bad Obstetric History (BOH). The microbiome, encompassing bacteria, viruses, and fungi, within the reproductive tract is increasingly recognized as a crucial factor in pregnancy maintenance and complications. The study explores BOH's multifactorial causes—genetic, anatomical, endocrine, thrombophilic, immunological, and environmental. Despite one-third of cases being unexplained, it underscores the importance of evaluating uterine macro and microenvironments. Emerging evidence challenges prior beliefs by supporting the existence of an endometrial microbiome, hinting at its impact on pregnancy outcomes. The methodology follows a systematic approach adhering to PRISMA guidelines, incorporating electronic database searches yielding 125 relevant articles, with 47 meeting inclusion criteria. The selected studies focus on human samples from stool, oral, or vaginal swabs, including randomized clinical trials, systematic reviews, and meta-analyses. In conclusion, the review emphasizes the significance of understanding the microbial changes in pregnant females and their potential impact on obstetric outcomes. The findings propose a connection between altered microbiota and maternal complications, highlighting the potential for personalized medicine interventions. Additionally, the study delves into the nuanced relationship between ethnicity, dietary patterns, and the microbiome, underscoring the importance of personalized and culturally sensitive healthcare interventions. Overall, this comprehensive review provides valuable insights into the role of the microbiome in obstetric outcomes, paving the way for future research and targeted interventions to optimize pregnancy outcomes globally.

Obstetrical outcomes of women with new-onset isolated proteinuria diagnosed after 24weeks' gestation.

To assess a possible association between marked proteinuria and the risk of preeclampsia with severe features, as defined by the American College of Obstetricians and Gynecologists. This retrospective study included data recorded at a tertiary university-affiliated hospital between 2017 and 2022. Women at or beyond 24weeks of gestation with proteinuria (protein levels > 300mg in a 24h urine collection) and normal blood pressure during the initial 48h of admission were included. Obstetrical and neonatal outcomes were compared between women with mild proteinuria (300-1000mg/24h) and marked proteinuria (≥ 1000mg/24h). Among the women with marked proteinuria (n = 48) compared to those with mild proteinuria (n = 108), the incidences were higher of preeclampsia (50.0% vs. 22.2%, p = 0.001) and of preeclampsia with severe features (18.8% vs. 2.8%, p < 0.001). In multivariate analysis that adjusted for maternal age, primiparity, multiple pregnancy, uric acid level > 6mg/dL and aspirin treatment, marked proteinuria was a risk factor for preeclampsia with severe features (adjusted odds ratio [aOR] = 10.2, confidence interval [CI] 95% 1.9-54.0, p = 0.007) and for small-for-gestational-age infants (aOR = 2.4, 95% CI 1.02-5.6, p = 0.001). Among women with marked compared to mild proteinuria, rates were also higher of labor induction (58.3% vs. 25.9%, p < 0.001), indicated preterm delivery (41.7% vs. 25.0%, p = 0.04) and admission to the neonatal intensive care unit (44.1% vs. 25.8%, p = 0.017). Women with marked compared to mild isolated proteinuria showed higher risk of developing preeclampsia with severe features and of delivering small-for-gestational-age neonates.

Pregnancy and obstetric outcomes after fertility-sparing management of endometrial cancer and atypical hyperplasia: a multicentre cohort study.

What are the pregnancy and obstetric outcomes in women with atypical hyperplasia (AH) or early-stage endometrial cancer (EC) managed conservatively for fertility preservation? The study found a live birth rate of 62% in patients with AH or EC after conservative treatment, with higher level of labour induction, caesarean section, and post-partum haemorrhage. Fertility-sparing treatment is a viable option for women with AH or EC during childbearing years, but the outcomes of such treatments, especially regarding pregnancy and obstetrics, need further exploration. This retrospective cohort study analysed data from January 2010 to October 2022, involving 269 patients from the French national register of patients with fertility-sparing management of AH/EC. Women above 18 years of age, previously diagnosed with AH/EC, and approved for fertility preservation were included. Patients were excluded if they were registered before 2010, if their treatment began <6 months before the study, or if no medical record on the pregnancy was available. In total, 95 pregnancies in 67 women were observed. Pregnancy was achieved using ART in 63 cases (66%) and the live birth rate was 62%, with early and late pregnancy loss at 26% and 5%, respectively. In the 59 cases resulting in a live birth, a full-term delivery occurred in 90% of cases; 36% of cases required labour induction and 39% of cases required a caesarean section. The most common maternal complications included gestational diabetes (17%) and post-partum haemorrhaging (20%). The average (±SD) birthweight was 3110 ± 736 g; there were no significant foetal malformations in the sample. No significant difference was found in pregnancy or obstetric outcomes between ART-obtained and spontaneous pregnancies. However, the incidence of induction of labour, caesarean section, and post-partum haemorrhage appears higher than in the general population. The retrospective nature of the study may introduce bias, and the sample size might be insufficient for assessing rare obstetric complications. This study offers valuable insights for healthcare providers to guide patients who received fertility-sparing treatments for AH/EC. These pregnancies can be successful and with an acceptable live birth rate, but they seem to be managed with caution, leading to possible tendency for more caesarean sections and labour inductions. No increase in adverse obstetric outcomes was observed, with the exception of suspicion of a higher risk of post-partum haemorrhaging, to be confirmed. No funding was received for this study. There are no conflicts of interest to declare. N/A.

Effect of type III female genital mutilation on obstetric outcomes: A systematic review and meta-analysis

BackgroundControversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta-analysis was to assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide. MethodsWe searched PubMed, Scopus, Embase, and ClinicalTrials.gov databases from inception to Jan 1, 2023. Studies were selected if they included the main outcome of postpartum haemorrhage (PPH) or secondary outcomes, which included major conditions affecting maternal-neonatal health during labour and delivery. DerSimonian-Laird random effects meta-analysis including pooled effect estimates with corresponding 95 % confidence intervals was performed. Heterogeneity was assessed using the I2 statistic. Meta regression for relevant covariates was performed when data on relevant confounders were available. The Newcastle-Ottawa scale (NOS) was used to assess quality of observational studies. The level of evidence was assessed with the GRADE method. Results14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95 % CI 1.03 to 3.24, I2 = 93 %), in pooling of data adjusted for confounders (aOR 1.76, CI 1.42 to 2.17, I2 = 0 %), and in sensitivity analysis of higher quality studies with NOS≥7 (OR 2.76, CI 1.38 to 5.51, I2 = 95 %). Meta-regression showed that nulliparity was significantly and positively associated with postpartum haemorrhage. Similarly, analysis of data adjusted for confounders showed an increased risk of episiotomy in type III FGM/C (aOR 1.56, CI 1.03 to 2.35, I2 = 52 %). Sensitivity analysis of studies with NOS≥7 revealed a significant increase for episiotomy (OR 7.53, CI 1.19 to 47.54, I2 = 96 %), perineal tears (OR 4.24, CI 1.09 to 16.46, I2 = 66 %), prolonged second stage of labour (OR 5.19, 95 % CI 1.00 to 26.85, I2 = 66 %), and Apgar score less than 7 (OR 4.19, CI 1.64 to 10.70, I2 = 0 %). No difference was found regarding obstetric anal sphincter injuries and mode of delivery in these women. Deinfibulation achieved similar obstetric and neonatal outcomes to women who never had type III FGM. The overall quality of the studies was adequate (median NOS score: 7; IQR: 6–8), the level of evidence, according to the GRADE assessment, was low. ConclusionsThese results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae. Systematic Review registration: PROSPERO CRD42023421993.

Reproductive and obstetrical outcomes after treatment of retained products of conception: hysteroscopic removal vs ultrasound-guided electric vacuum aspiration, a prospective follow-up study

BackgroundTraditionally, curettage is the most widely performed surgical intervention used to remove retained products of conception. However, hysteroscopic removal is increasingly performed as an alternative due to the potentially lower risk of intrauterine adhesions and higher rates of complete removal. Until recently, studies comparing curettage with hysteroscopic removal regarding reproductive and obstetric outcomes were limited, and data conflicting. ObjectiveTo study reproductive and obstetric outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration. Study designProspective long-term follow-up study, conducted in three teaching hospitals and one university hospital. Patients were included from April 2015 until June 2022 for follow-up; either in a randomized controlled, non-blinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive for retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial consisted of hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration, while in the cohort hysteroscopic treatment consisted of hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration. ResultsA total of 261 out of 305 patients (85.6%) were available for follow-up resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal of retained products of conception by ultrasound guided vacuum aspiration. Respectively, 92/171 (53.8%) women in the hysteroscopic removal group and 56/90 (62.2%) in the electric vacuum aspiration group wished to conceive (p=.192). Subsequent pregnancy rates were 88/91 (96.7%) after hysteroscopic removal and 52/56 (92.9%) after electric vacuum aspiration (p=.428). The live birth rate was 61/80 (76.3%) and 37/48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (p=.914), with 8/88 (9.1%) pregnancies in the hysteroscopic removal group and 4/52 (7.7%) pregnancies in the electric vacuum aspiration group still ongoing at follow-up (p=1.00). The median time to conception was 8.2 weeks (interquartile range 5.0–17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range 5.0–12.1) in the electric vacuum aspiration group (p=.262). The overall placental complication rate was 13/80 (16.3%) in the hysteroscopic removal group and 11/48 (22.9%) in the electric vacuum aspiration group (p=.350). ConclusionHysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effect on subsequent live birth rate, pregnancy rate, time to conception and pregnancy complications. Reproductive and obstetric outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications.

Poor obstetric outcomes in women with takayasu arteritis: a retrospective cohort study.

The objective of this study was to assess the pregnancy outcomes in a cohort of patients who experienced pregnancies before and/or after being diagnosed with Takayasu's arteritis (TA). The present investigation encompassed a total of 88 pregnancies seen in a cohort of 35 patients who met the criteria outlined by the American College of Rheumatology in 1990 for the classification of Takayasu arteritis (TA). Pregnancies were classified into two categories. 1. Pregnancies that occurred before the diagnosis (pre-d or pre-TA) 2. Pregnancies that happened following a diagnosis (post-d or post-TA). Fifty-nine pregnancies (67.0%) occurred in 21 TA patients before the diagnosis with and a complication rate of 15.2%, and twenty-nine pregnancies (33.0%) occurred in 14 patients concomitant with or after TA diagnosis and complication rate 100%. Although the hypertension rate was higher in the pre-d group than in the post-d group, it was not significant (32.2% vs. 10.3%, p = 0.160). However, preeclampsia (20.6% vs. 0%, p = 0.001), low birth weight (27.5% vs. 1.6%, p = 0.001), and prematurity (24.1% vs. 1.6%, p = 0.035) were observed more frequently in the post-d group compared to the pre-d group. The frequency of abortions and in-utero deaths were similar in both groups (p > 0.05). Patients with hypertension had significantly higher rates of preeclampsia (p = 0.003), preterm birth (p = 0.036), low birth weight (p = 0.250), abortion (p = 0.018), in utero death (p = 0.128), and cesarean section (p = 0.005) than those without hypertension. Renal artery involvement was detected in 15 (42.8%) patients. All patients with renal artery involvement had hypertension, and they had significantly more pregnancy complications than the other group (p = 0.001). TA negatively affects pregnancy outcomes. A good control of arterial hypertension before conception and during pregnancy is critical to improve both maternal and fetal outcomes. In addition, detecting renal artery stenosis before pregnancy is important in reducing possible negative pregnancy outcomes.

Influence of aspirin on obstetric outcomes in women with pre-gestational diabetes mellitus: a South-Western Sydney cohort study.

To investigate the effect of aspirin on obstetric outcomes in women with pre-gestational diabetes mellitus (PGDM). Retrospective audit of pregnant women with PGDM from two centres in South-Western Sydney was conducted. Women were categorised into the aspirin group (prescribed aspirin before 16 weeks, gestation) and non-aspirin group (not prescribed aspirin or prescribed aspirin at or after 16 weeks, gestation). The outcomes examined were pre-eclampsia, pre-term delivery and birthweight percentile. Of 494 women, 52 (10.5%) were in the aspirin group. Pre-eclampsia developed in 57 (12.0%) women. There was no association between aspirin use and pre-eclampsia (8 (15.4%) vs 49 (11.1%), P = 0.2). Aspirin use was not associated with difference in birthweight percentile and rate of pre-term deliveries when adjusted for maternal age, gravidity and other comorbidities. There was no difference in the rates of pre-eclampsia, pre-term delivery, or birthweight percentile between women with PGDM in aspirin group compared to women in non-aspirin group.

COVID-19 vaccination and transmission patterns among pregnant and postnatal women during the fifth wave of COVID-19 in a tertiary hospital in Hong Kong.

Vaccination is a key strategy to control the coronavirus disease 2019 (COVID-19) pandemic. Safety concerns strongly influence vaccine hesitancy. Disease transmission during pregnancy could exacerbate risks of preterm birth and perinatal mortality. This study examined patterns of vaccination and transmission among pregnant and postnatal women during the fifth wave of COVID-19 in Hong Kong. The Antenatal Record System and Clinical Management System of the Hospital Authority was used to retrieve information concerning the demographic characteristics, vaccination history, COVID-19 status, and obstetric outcomes of women who were booked for delivery at Queen Mary Hospital in Hong Kong and had attended the booking antenatal visit from 1 July 2021 to 30 June 2022. Among 2396 women in the cohort, 2006 (83.7%), 1843 (76.9%), and 831 (34.7%) had received the first, second, and third doses of COVID-19 vaccine, respectively. Among 1012 women who had received the second dose, 684 (67.6%) women were overdue for their third dose. There were 265 (11.1%) reported COVID-19 cases. Women aged 20 to 29 years had a low vaccination rate but the highest disease rate (19.1%). The disease rate was more than tenfold higher in women who had no (20.3%) or incomplete (18.8%) vaccination, compared with women who had complete vaccination (2.1%; P<0.001). Acceptance of COVID-19 vaccination was low in pregnant women. Urgent measures are needed to promote vaccination among pregnant women before the next wave of COVID-19.

Abstract 12902: Supraventricular Tachycardia During Pregnancy is Independently Associated With Adverse Obstetrical Outcomes

Introduction: Supraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy, however, their clinical significance is unclear. Hypothesis: We report the prevalence, describe the management and explore the association between SVT and adverse obstetric outcomes in women with structurally normal hearts. Methods: This is a case-control study of primiparous and multiparous women without history of cesarean section (CS), and no known cardiac diagnosis admitted in labor to one of 8 Northwell Health hospitals between January 2015 and August 2022. The study group consisted of women with at least one SVT episode during pregnancy and the control group was randomly selected in a 4:1 ratio. Multivariate analysis was used to examine the association between occurrence of SVT during pregnancy and incidence of cesarean section (CS), preterm labor (PTL), and length of stay (LOS). Results: Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. Of those, 76 (age 33.2±4.8 years) had at least 1 symptomatic episode during pregnancy. For the women with known SVT diagnosis prior to pregnancy, medical therapy with any antiarrhythmic agent was not associated with reduction of SVT recurrence during pregnancy (OR 1.07, 95% CI 0.41-2.80 p=0.89). On the contrary, catheter ablation prior to pregnancy was associated with significant reduction of SVT recurrence (OR 0.09, 95% CI 0.04-0.23, p&lt;0.0001). Women with SVT during pregnancy had a higher incidence of CS (39.5% vs 27.0%. p=0.03), and PLT (30.3% vs 8.6%, p&lt;0.001) compared to the control group. After adjusting for age and parity, SVT during pregnancy was independent predictor of CS, particularly elective CS (OR 2.89 95% CI 1.06-7.89) and PTL (OR 4.37 95%CI 2.30-8.31). Conclusions: SVT occurs in about 1 in every 1,000 women during pregnancy and is associated with higher rates of CS, particularly scheduled, and PLT. Any history of SVT should be sought and addressed during preconception counselling and SVT episodes during pregnancy should be approached in a multidisciplinary way to mitigate the risk of CS and associated complications.

Fertility and Obstetric Outcomes of Assisted Reproductive Technology (ART) in Women With Adenomyosis Following Gonadotropin-Releasing Hormone Agonist Therapy: A Single-Center Experience.

Adenomyosis is an ambiguous disorder causing a wide variety of implications from dysmenorrhea, heavy menstrual bleeding, and infertility to pregnancy complications. Adenomyosis is associated with altered endocrine and inflammatory milieu, resulting in impaired implantation and reduced fertility potential. It is also associated with increased incidence of obstetric complications such as miscarriage, antepartum hemorrhage, placental mal-position, hypertensive disorders, small for gestational age-intrauterine growth restriction (SGA-IUGR), cesarean section, preterm labor, preterm premature rupture of membranes (PPROM), and neonatal intensive care unit (NICU) admissions. The aim of our study was to investigate the fertility and obstetric outcomes in women with adenomyosis treated with GnRH agonists compared to controls with normal uteri undergoing in-vitro fertilization (IVF) at our center, thereby establishing the role of gonadotropin-releasing hormone (GnRH) agonists in managing sub-fertile women with adenomyosis. We carried out a retrospective cohort study at our hospital to analyze the effects of adenomyosis on IVF and pregnancy outcomes. This study (n=83) involves women with adenomyosis between the ages of 21 and 37 years who were followed up at our center between 2013 and 2022. The controls (n=83) were selected from women who underwent IVF-intracytoplasmic sperm injection (IVF-ICSI) for tubal or mild male factor infertility with normal appearing uterus within the same time frame. Women with adenomyosis were given GnRH agonist as long/ultralong agonist protocol before controlled ovarian stimulation or as down-regulated frozen embryo transfer (FET). The length of suppression was between one and six months based on the size of the uterus and response to treatment. Fertility and obstetric outcomes were analyzed. The implantation rates were found to be equivocal: 54.2% and 53% in the adenomyosis and control groups, respectively (p=0.208). The cumulative live birth rate was 50.6% and 48.2% in the study and control groups,respectively (p=0.341). The biochemical pregnancy rate and the first- and second-trimester miscarriage rates were not significantly different between the group with adenomyosis and the group with normal uterus. The incidence of preterm deliveries and antepartum hemorrhage was found to be significantly increased in the study group. Medical management in women with adenomyosis optimizes the live birth rates giving results at par with the control population.

RETRACTED ARTICLE: Predictors of poor obstetric outcome in women with systemic lupus erythematosus: a 10-year experience of a university hospital

RETRACTED ARTICLE: Predictors of poor obstetric outcome in women with systemic lupus erythematosus: a 10-year experience of a university hospital

RETRACTED ARTICLE: Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study

RETRACTED ARTICLE: Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study