Obstetric Outcomes In Women Research Articles

Obstetric outcomes in women with rheumatoid arthritis: Results from Nationwide Inpatient Sample Database 2003–2011✰

ObjectiveFertility is reduced in patients with Rheumatoid Arthritis due to unknown cause. Few studies have addressed pregnancy outcomes in RA. This study was undertaken to determine the frequency of complications occurring during pregnancy for women with RA and compare with the general obstetric population by using the largest inpatient care database. MethodsBy using the 2003–2011 Nationwide Inpatient Sample of Healthcare Cost and Utilization Project, we estimated the number of obstetric hospitalization in women with RA between the age group 18–50 years. Demographic characteristics and in-hospital obstetric complications for all pregnancy-related admissions for women with and without RA were compared. Multivariate logistic regression analysis was used to obtain adjusted odds ratio. ResultsThe total number of obstetric hospitalization was 42.32 million of which 31,439 were women with RA. The maternal age of RA population was higher (30.5 years) than that in the control group (27 years). After adjusting for potential confounders, maternal RA population had a significantly higher prevalence of hypertensive diseases, premature rupture of membranes, antepartum hemorrhage, preterm delivery, intrauterine growth retardation and cesarean delivery. The prevalence of postpartum hemorrhage and the risk of inpatient mortality were not different between two groups. ConclusionWomen with RA have a higher risk of adverse outcomes of pregnancy and thus close antenatal and post-delivery monitoring need to be performed in order to reduce complications. Further studies are needed to examine these findings in relation to severity of disease, medications used and the presence of other comorbidities.

Evaluation of risk factors\u2019 importance on adverse pregnancy and neonatal outcomes in women aged 40\u2009years or older

BackgroundWomen of advanced age (40 years or older) are generally, at risk for pregnancy and delivery related problems. In addition, there is limited knowledge on being of advanced age and having been given Assisted Reproductive Treatment (ART) and its association with negative obstetric outcomes. Therefore, data from the Swedish Medical Birth Register was used to investigate pregnancy and neonatal outcomes for women aged 40 or more who had given birth. The secondary aim was to compare the obstetric outcomes of women who had used ART and women who had not undergone ART while adjusting for marital status across the age groups.MethodWomen of advanced age who had given birth in Sweden during 2007–2012 formed the index group, n = 37,558; a reference group of women comprised 71,472 women under the age of 40. An additional subgroup of women aged 45 or older when giving birth was also formed, n = 2229. The obstetric and neonatal data for all the women was derived from national register data.ResultsWomen of advanced age were more often single, had undergone ART, and more often experienced adverse obstetric outcomes than did younger women. The neonate’s health was also more often adversely affected expressed as being born with low birth weight and Small for Gestational Age (SGA), having lower Apgar scores, and having more health problems during the first week compared to the reference group.ConclusionsWomen who are approaching the upper limit of fecundity are at greater risk for having children who are preterm and SGA. The adverse effects of being preterm and SGA may have negative long-term effects, not only on the children but also on the mothers. This needs to be addressed more frequently in a clinical setting when advising women of all ages on pregnancy and ART treatment.

DOP28 Maternal obstetric outcomes in women with IBD compared with the general population

DOP28 Maternal obstetric outcomes in women with IBD compared with the general population

Obstetric outcome of women with primary vaginismus

IntroductionDysfonction importante, le vaginisme est un problème tant individuel que du couple qui peut altérer la relation sexuelle. Il peut influencer le pronostic obstétrical. Le but de cette étude était de déterminer si les caractéristiques cliniques du vaginisme ont une incidence sur le processus de l’accouchement.MéthodesEtude rétrospective multicentrique incluant des patientes affectées par un vaginisme primaire, ayant donné naissance à terme à un premier enfant vivant, entre 2005 et 2015.RésultatsSur les 19 patientes inclues dans l’étude, nous avons constaté 9 grossesses prolongées, 14 mises en travail spontanées (dont 8 à terme atteint), 3 césariennes en dehors du travail et 2 déclenchements artificiels. Parmi les 16 femmes ayant eu un travail, nous avons dénombré 4 césariennes, 5 accouchements par voie basse avec forceps et 7 par voie basse spontanée. Parmi les 12 accouchements par voie basse, 9 épisiotomies ont été pratiquées, 7 femmes ont présenté des déchirures périnéales spontanées seules ou associées à une épisiotomie, aucune lésion périnéale de type 3 ou 4, ni de périnées intacts n’ont été recensés. Le poids moyen des nouveau-nés était de 3380g±332 (2870g-3970g, 47e percentile).ConclusionLa proportion d’accouchements dystociques et la morbidité périnéale étaient notablement élevées, ce qui parait comparable avec la plupart des données de la littérature. Il est possible que les composantes psychologiques et comportementales du vaginisme, (mécanisme de peur-évitement, anxiété) aient favorisé les grossesses prolongées, les césariennes, les dystocies mécaniques et les lésions périnéales. Des études complémentaires sont nécessaires afin de mieux cerner le vaginisme et ses implications obstétricales.

Reproduction, fear of childbirth and obstetric outcomes in women treated for fear of childbirth in their first pregnancy: A historical cohort.

About 8% of the pregnant women in Sweden receive counseling for fear of childbirth (FOC) during pregnancy. Little is known about the long-term reproductive and obstetric outcomes after counseling for FOC: Therefore, the objective of this historical cohort study was to compare the long-term reproductive and obstetric outcomes in women treated for FOC in their first pregnancy to women without FOC. All nulliparas consecutively referred for treatment of severe FOC between 2001 and 2007 (n=608) were compared with all other nulliparas giving birth on the same day (n=431). Women who were not fluent in Swedish, missing a postal address, had moved out of the area, given birth at another hospital or had a late spontaneous abortion were excluded (n=555). A total of 235 women agreed to participate in the study, 63 (39%) women in the index group and 172 (53%) in the reference group. The women were contacted by letter in 2015, ie 7-14years after first childbirth, and asked to permit access to their medical charts from pregnancies and childbirths and to fill out a study specific questionnaire. Based on data from the medical charts and questionnaire, the mode of delivery, birth experience, obstetric complications, FOC, counseling for FOC and number of childbirths were compared in the two groups. Women in the index group less often gave birth more than twice compared with the reference group (8.2% vs 22.0%, P=0.012). We found no significant differences in complications during subsequent pregnancies and deliveries. Women in the index group more often gave birth by CS in their first (P=0.002) and second childbirth (P=0.001), more often had a less positive birth experience (index group NRS: median 6.0, interquartile range 6 vs reference group NRS: 7.0, interquartile range 5, P=0.004) in their first delivery and more often received counseling for FOC (58.7% vs 12.5%, P<0.001) in subsequent pregnancies. Women in the index group more often experienced FOC (18% vs 5.3%, P=0.001) 7-14years after first childbirth. FOC is not easily treated. Despite treatment and exposure to childbirth many women received treatment in their next pregnancy and still suffered from FOC 7-14years after the first childbirth.

Simple vaginal trachelectomy for early stage cervical cancer: A tertiary cancer center experience.

Less radical fertility sparing procedures have been introduced to reduce morbidity and adverse obstetric outcome in cervical cancer. Our objective was to describe oncological and obstetric outcomes of women with early-stage cervical cancer who underwent a simple vaginal trachelectomy (SVT). From 01/2013 to 05/2017, 14 women underwent SVT preceded by laparoscopic pelvic lymph node dissection. Patients' median age was 32 years and all of them were nulliparous. Histology included squamous cell carcinoma and adenocarcinoma in 12 (85.7%) and 2 (14.3%) patients, respectively. Three patients had stage 1A1 with lymphovascular space invasion, 4 1A2 and 7 1B1. After obtaining final histopathology, one patient underwent radical hysterectomy due to positive surgical margin and excluded from analysis. None of the patients had lymph node metastasis. None of the 13 patients developed a recurrence within a median follow-up of 27 (6-56) months. Seven patients have conceived: 4 were term deliveries, 2 were late preterm deliveries and 1 was spontaneous abortion. SVT in well selected early-stage cervical cancer patients seems to be a safe treatment option with excellent oncologic outcome, preserving reproductive function. Literature data will need to be confirmed in large prospective series.

369. Obstetric outcomes following atrial and arterial switch procedures for transposition of the great arteries – A single, tertiary referral centre experience over 20 years

Complete transposition of the great arteries (TGA) accounts for approximately 5–7% of CHD. Almost all patients with TGA surviving until adulthood have undergone complex, reparative, cardiac surgery, which can complicate physiological adaptation to the demands of pregnancy. The atrial switch procedure (Mustard or Senning procedure) was the first operation to enable survival beyond infancy, as such, pregnancy outcomes have been well described. Cardiac risks of pregnancy include cardiac deterioration, heart failure and arrhythmias. The pregnancy risks include; pre-term delivery (31–38%) and neonates which are small for gestational age (SGA) (22–38%). The arterial switch operation (ASO) has now largely superseded the atrial switch procedures, this involves transection and ‘re-plumbing’ of the great arteries to restore near normal anatomy, it follows that adult survivors are now undertaking the challenges of pregnancy. Our unit is an adult congenital heart disease (ACHD) centre and tertiary level maternal medicine service with over twenty years’ experience in the multi-disciplinary team (MDT) management of women with surgically corrected TGA in pregnancy. Here we report and compare obstetric outcomes in women born with TGA, corrected with either an atrial switch procedure or ASO. This is the largest, cohort of pregnancies, with complete obstetric and neonatal outcomes, born to women following an ASO, reported to date and the only comparison of outcomes by procedure. There were 48 completed pregnancies in 23 women, 19 women who had undergone an atrial switch procedure delivered 38 babies and 4 who had undergone an ASO had 10 babies. We report obstetric and neonatal outcomes for all pregnancies, based upon which we make recommendations for the obstetric care of women with this condition.

Obstetric Outcomes in Women With Early Bulky Cervical Cancer Downstaged by Neoadjuvant Chemotherapy to Allow for Fertility-Sparing Surgery: A Meta-analysis and Metaregression.

It is difficult to critically outline the optimal treatment for women with early-stage cervical cancer (eCC) wishing fertility preservation. Neoadjuvant chemotherapy (NAC) to downstage "bulky" eCC could potentially lead to fertility-sparing surgery (FSS) in a wider patient population. The rationale is to provide oncological safety balanced with maximal fertility effort. We aimed to obtain the most accurate fertility outcomes for eCC women treated with NAC followed by FSS and identify potential factors favoring fertility. A systematic search of MEDLINE, EMBASE, Web of Science, and Cochrane Database was performed. Studies that reported obstetric outcomes of eCC women treated with NAC followed by FSS were located. For the meta-analysis, we calculated the proportions of women who had the outcomes per total number of women who were considered for FSS. For the meta-regression, we extracted the relative risk of the outcome variables to enable comparison of the results across the studies. Seven studies enrolling 86 patients were included in the meta-analysis. Pooling of results from seven studies rendered summary proportions of 0.49 (95% confidence interval [CI], 0.32-0.66) and 0.42 (95% CI, 0.32-0.53) for the outcomes of pregnancies and live births, respectively. The outcome of first- and second-trimester losses by pooling seven studies rendered a summary proportion of 0.16 (95% CI, 0.09-0.27). For the outcome of premature deliveries, pooling of results from five studies rendered a summary proportion of 0.06 (95% CI, 0.02-0.16). This reached 0.29 (95% CI, 0.15-0.48) in women who achieved live births. In multivariate meta-regression, the more radical surgical approach resulted in a less favorable pregnancy rate compared with the less radical surgical approach (P = 0.015). This strategy achieves live births in four of 10 eCC women who desire fertility, whereas their risk of miscarriage is low. Three of 10 live births will be premature.

Laparoscopic transabdominal cerclage: Outcomes of 121 pregnancies.

Cervical insufficiency is a significant cause of morbidity and mortality. Cervical cerclage is one option in the management of cervical insufficiency. To evaluate obstetric outcomes following insertion of a pre-pregnancy laparoscopic transabdominal cerclage in women at high risk for pre-term labour and/or mid-trimester pregnancy loss. A prospective observational study of consecutive women who underwent laparoscopic transabdominal cerclage from 2007 to 2017. Eligible women had a diagnosis of cervical insufficiency based on previous obstetric history and/or a short or absent cervix and were considered not suitable for a transvaginal cerclage. The primary outcome was neonatal survival and the secondary outcome was delivery of an infant at ≥34weeks gestation. Surgical morbidity and complications were also evaluated. During the study period, 225 women underwent laparoscopic transabdominal cerclage. We present the outcomes of 121 pregnancies resulting in 125 babies. The perinatal survival rate of viable pregnancies was 98.5% with a mean gestational age at delivery of 35.2weeks; 79.7% of babies were delivered at ≥34.0weeks gestation. Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in women with a poor obstetric history. For optimal success the procedure requires the correct surgical expertise, equipment and appropriate patient selection.

A comparison of pregnancy outcome of modified transvaginal cervicoisthmic cerclage performed prior to and during pregnancy.

To compare the pregnancy outcome of the modified transvaginal cerclage performed preconception and during pregnancy. A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China. A total of 604 women with cervical incompetence underwent the cerclage, and the time of the operation was decided by the patients or depended on when the patient presented. Main outcome measures were the gestational age and the fetal outcome. After the cerclage, the mean gestational age at delivery and the term delivery rate were significantly higher in history-indicated conception cerclage compared to preconception cerclage (36.8±3.7 vs 35.8±4.7, p<0.01; 76.1 vs 66.9%, p<0.05). The mean gestational age at delivery and the term delivery rate were significantly higher in ultrasound-indicated compared to physical examination-indicated conception cerclage (35.0±5.7 vs 31.0±5.5, p<0.01; 63.2 vs 23.3%, p<0.001). The fetal survival rate had no difference in these two comparisons, respectively. The modified transvaginal cervicoisthmic cerclage is a promising and safe technique to improve obstetric outcomes in women with cervical incompetence in different cerclage indications, and history-indicated conception cerclage appears to have better pregnancy outcome.

Association between Toxoplasma Infection and Bad Obstetric Outcomes in Women from Kirkuk

Association between Toxoplasma Infection and Bad Obstetric Outcomes in Women from Kirkuk

777: Timing of delivery in women with cardiac disease

Timing of delivery for women with cardiovascular disease (CVD) is one question for which standard guidelines do not exist. The neonatal benefit of a term delivery as compared to an early term delivery is well described. We sought to examine maternal outcomes in women with cardiac disease who delivered in the early term period (37+0 weeks through 38+6 weeks) compared with those who delivered later. This is a prospective cohort study examining cardiac and obstetric outcomes in women with CVD delivering between September 2011 and December 2016. The associations between gestational age at delivery and maternal, fetal and obstetric characteristics were evaluated. Two-hundred twenty-five women with CVD were included, 83 (37%) delivered in the early term period and 142 (63%) delivered at term. While the early term group had significantly higher rates of hypertension (18.1% vs 7%, p=0.01) and intrauterine growth restriction (22.9% vs 2.8%, p<0.001), there was no difference in high-risk cardiac or obstetric characteristics. No difference in composite cardiac morbidity was found (4.8% vs 3.5%, p=0.24). Women in the early term group were more likely to undergo cesarean delivery than women in the term group (43.4% vs 24.7%, p=0.004). There is no maternal benefit of an early term delivery in women with cardiac disease. Given the known fetal consequences of early term delivery, this study offers support to existing literature suggesting term delivery in these women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pregnancy outcomes in women with recurrent pregnancy loss and recurrent implantation failure diagnosed with chronic endometritis

To report the obstetrical outcomes in women with recurrent pregnancy loss (RPL) or recurrent implantation failure (RIF) diagnosed with chronic endometritis (CE). Prospective study from 2014-2017 in a university setting. After IRB approval, 88 patients undergoing RPL or RIF workup were enrolled. A hysteroscopy and endometrial biopsy (EMB) were performed on all patients. Diagnosis of CE was confirmed with immunochemistry stains for CD138 (>5 plasma cells per HPF1). Diagnosed patients were treated with a course of antibiotics followed by a repeat EMB to confirm response to treatment. Pregnancy rates (PR), live birth rates (LBR) and mean time to pregnancy (TTP) were observed. The overall incidence of CE was 45.5% (40/88). After a first course of antibiotics, the CE incidence was significantly reduced to 13.6% (P = 0.00000817). In the RIF and RPL groups, CE was present in 45.2% (14/31) and 46.6% (28/60) respectively. In the RIF group, PR were similar in the treated CE group compared to those with normal biopsies (85.7% (12/14) vs 64.7% (11/17); P = 0.1834). However, in the RPL group, there was a statistically significant difference in PR between patients with treated CE and normal biopsies (60.7% (17/28) vs. 84.4% (27/32); P = 0.038). There was also a trend towards higher LBR in the RPL group with normal biopsies compared to those with treated CE (46.9% (15/32) vs 25.5% (7/28), P = 0.0793). Mean TTP overall was 7.33 months in the treated CE group compared to 7.92 months for patients with a normal initial biopsy. Within the RPL group, the mean TTP was higher in women with treated CE compared to women with initial normal biopsies (8.30 vs 7.13, P=0.512). However, within the RIF group, the mean TTP was lower in women with treated CE compared to women with initial normal biopsies (6.57 vs 9.24, P=0.352). This report suggests that CE may influence pregnancy rates in patients with RPL. Furthermore, not only was CE associated with a trend towards lower LBR in RPL patients, it also seems to extend the mean TTP in patients with RPL. Further research with a higher sample size would be necessary to corroborate these findings.

Obstetric Outcomes in Women with Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases in the Western world and yet there is little research into its impact on pregnancy. A literature review was conducted in the database PubMed, with articles published between 1990 and 2017. The selected studies addressed features specifically attributed to NAFLD and associated obstetric and neonatal outcomes. Nine studies met criteria. Our aim was to consolidate the limited literature and identify trends. There was considerable heterogeneity in the diagnostic approach to NAFLD. Data are conflicting as to whether NAFLD increases the risk of gestational diabetes independent of obesity. NAFLD is associated with an elevated risk of extremes of birth weight, both small and large for gestational age. Several studies found a greater impact of NAFLD on maternal morbidity including preeclampsia in women with a body mass index <30kg/m2. NAFLD appears to be associated with increased obstetric morbidity, particularly among non-obese women. More research is needed to clarify the pathophysiology and optimize safe treatment.

Challenges in the diagnosis and management of anti-phospholipid syndrome: a case from Cameroon

BackgroundAnti-phospholipid syndrome (APLS) is a condition characterized by the presence of raised plasma levels of anti-phospholipid antibodies associated with thrombo-embolic disease and/or poor obstetrical outcomes in women. The epidemiology of APLS is unknown in most sub-Saharan African countries due to limited access to diagnosis tools.Case summaryWe report the case of APLS in a 29-year-old obese woman that was preceded by pre-eclampsia and fetal death. The diagnosis of APLS was made during a thrombo-embolic episode 4 years after the poor obstetrical outcome. Her management was challenging, as she had three thrombo-embolic events within 18-months despite treatment with anti-coagulant (acenocoumarol).ConclusionThis case highlights the need for screening for APLS after an episode of hypertensive disease in pregnancy or fetal death, and the challenges faced with the treatment, such as resistance to antivitamin K anti-coagulants and the desire for maternity.

Repeat measurements of uterine artery pulsatility index, mean arterial pressure and serum placental growth factor at 12, 22 and 32 weeks in prediction of pre‐eclampsia

To investigate the potential value of repeat measurements of uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP) and serum placental growth factor (PlGF) at 12, 22 and 32 weeks' gestation in the prediction of pre-eclampsia (PE) developing after 32 weeks. Data were derived from prospective screening for adverse obstetric outcomes in women attending their routine hospital visit at 11-13, 19-24 and/or 30-34 weeks' gestation in two maternity hospitals in England. UtA-PI, MAP and PlGF were measured. Bayes' theorem was used to combine the a-priori risk from maternal factors with UtA-PI, MAP and PlGF multiples of the median values. The performance of screening for PE developing after the 30-34-week visit by UtA-PI, MAP and PlGF measured at 11-13, 19-24 and 30-34 weeks and their combinations was examined. Screening at 30-34 weeks by UtA-PI, MAP and PlGF detected, at a 10% false-positive rate, 79%, 86% and 92% of preterm PE and 42%, 50% and 56% of term PE. The addition of biomarker values at 11-13 and/or 19-24 weeks was not associated with any improvement in the detection rate of preterm PE; in the case of term PE, there was a marginal (< 2%) improvement in detection for UtA-PI and MAP and a modest improvement of about 5% for PlGF. Measurements of UtA-PI, MAP and PlGF in the first and/or second trimester have a small or no effect on improving the prediction of PE provided by screening in the early third trimester. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: an observational cohort study.

To examine the impact of pharmacologic treatment for depression on obstetric outcomes in women treated for depression during the 2 years prior to pregnancy. Observational cohort study among 2859 women treated for depression during the 2 years prior to pregnancy. The primary exposure was any antidepressant treatment during pregnancy. Secondary analyses examined the impact of treatment by period of antidepressant exposure. Multivariable logistic regression models as well as propensity score analysis was utilized. Among 2859 women, 1648 (58%) were treated with antidepressant medication during pregnancy. Women who received antidepressants had no difference in preterm and early-term deliveries, Apgar scores, and small for gestational age (SGA); they had a lower likelihood of breastfeeding (adjusted odds ratio (AOR) 0.69, (95% confidence interval (CI): 0.51 to 0.94)). In secondary analysis, women who used antidepressants all three trimesters who delivered at term were more likely to deliver early term (AOR 1.36, (95% CI: 1.09 to 1.72)). Women who were treated with antidepressants only during the first and second trimesters had a reduced likelihood of SGA (AOR: 0.51 (95% CI: 0.32 to 0.83)). Generally similar results were observed with propensity score analysis. Antidepressant exposure during pregnancy does not confer an increased risk of preterm birth nor growth restriction in women recently treated for depression, but also does not appear to markedly improve these outcomes.

Pregnancy-specific stress, fetoplacental haemodynamics, and neonatal outcomes in women with small for gestational age pregnancies: a secondary analysis of the multicentre Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction

ObjectivesTo examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive...

Global variation in pregnancy complications in women with epilepsy: A meta-analysis

ObjectiveWomen with epilepsy are at risk of pregnancy complications. Whether these vary globally is unknown. We undertook a systematic review to assess the overall rates of obstetric outcomes in women with epilepsy, and variations in estimates across geographical region, economic status of country, and over time. Study designWe searched Medline, Embase, Cochrane, AMED and CINAHL, (January 1, 1990 and November 29, 2016), without any language restrictions for studies reporting core maternal and fetal outcomes in women with epilepsy. We pooled the results using Freeman-Tukey Transformation random effectsanalysis, and reported our findings as rates of complications per 100 pregnancies with 95% confidence intervals (CI). We assessed for differences in risk across World Health Organisation (WHO) regions, income status, and year of publication. ResultsFrom the 7420 articles screened, we included 60 studies (62 articles). In women with epilepsy (116,105 pregnancies), the commonest complications were caesarean section (29.2 per 100 pregnancies; 95% CI 25.4–33.1, I2=98.44%), and admission to the neonatal intensive care unit (12.5 per 100 pregnancies; 95% CI 9.6–15.8, I2=60.63%). There were significant differences across the WHO regions, with the highest rates of caesarean section (37%, 95% CI 32%–42%); spontaneous miscarriage (39%, 95% CI 35%–44%) and preterm birth (10%, 95% CI 8%–12%) in the Americas; postpartum haemorrhage (9%, 95% CI 7%–12%), hypertensive disorders (14%, 95% CI 8%–21%) and perinatal death (2%, 95% CI 1%–7%) in the Western Pacific; induction of labour (30%, 95% CI 19%–41%) in South East Asia and antepartum haemorrhage (10%, 95% CI 5%–17%) in the Eastern Mediterranean. The reported rates of antepartum haemorrhage, caesarean section, gestational diabetes and spontaneous miscarriage were highest in high income and high-middle income countries. Over time, there was a significant increase in caesarean section, and reduction in stillbirths, perinatal deaths and admission to the neonatal intensive care unit in women with epilepsy. ConclusionThere is significant variation in reported maternal and offspring outcomes in pregnant women with epilepsy across geographical regions, economic status of country and over time, which needs to be considered in setting priorities for clinical management and research.

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

We, the Editors and Publisher of The Journal of Maternal-Fetal and Neonatal Medicine, have retracted the following article: Mohamed Rezk, Osama Elkilani, Abdelhamid Shaheen, Awni Gamal & Hassan Badr (2018) Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study, The Journal of Maternal-Fetal & Neonatal Medicine, 31:12, 1542–1547, DOI: 10.1080/14767058.2017.1319932 Since publication, significant concerns have been raised about the integrity of the data and reported results in the article. When approached for an explanation, the authors responded, but they did not sufficiently address the concerns raised, and they have not provided their original data or sufficient supporting information to verify that the research and publication comply with the journal’s Editorial Policies. We have also contacted the author’s institution for further information, but we have not received a reply. As verifying the validity of published work is core to the integrity of the scholarly record, we are therefore retracting the article, and have informed the authors. The authors do not agree with the retraction. We have been informed in our decision-making by our policy on publishing ethics and integrity and COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.